Group 1 ITI Consensus Report: The influence of implant length and design and medications on clinical and patient-reported outcomes.

OBJECTIVES: The aim of Working Group 1 was to address the influence of different local (implant length, diameter, and design) and systemic (medications) factors on clinical, radiographic, and patient-reported outcomes in implant dentistry. Focused questions on (a) short posterior dental implants (≤6 mm), (b) narrow diameter implants, (c) implant design (tapered compared to a non-tapered implant design), and (d) medication-related dental implant failures were addressed. MATERIALS AND METHODS: Four systematic reviews were prepared in advance of the Consensus Conference and were discussed among the participants of Group 1. Consensus statements, clinical recommendations, and recommendations for future research were based on structured group discussions until consensus was reached among the entire expert Group 1. The statements were then presented and accepted following further discussion and modifications as required by the plenary. RESULTS: Short implants (≤6 mm) revealed a survival rate ranging from 86.7% to 100%, whereas standard implant survival rate ranged from 95% to 100% with a follow-up from 1 to 5 years. Short implants demonstrated a higher variability and a higher Risk Ratio [RR: 1.24 (95% CI: 0.63, 2.44, p = 0.54)] for failure compared to standard implants. Narrow diameter implants (NDI) have been classified into three categories: Category 1: Implants with a diameter of <2.5 mm ("Mini-implants"); Category 2: Implants with a diameter of 2.5 mm to <3.3 mm; Category 3: Implants with a diameter of 3.3 mm to 3.5 mm. Mean survival rates were 94.7 ± 5%, 97.3 ± 5% and 97.7 ± 2.3% for category 1, 2 and 3. Tapered versus non-tapered implants demonstrated only insignificant differences regarding clinical, radiographic, and patient-reported outcomes. The intake of certain selective serotonin reuptake inhibitors and proton pump inhibitors is associated with a statistically significant increased implant failure rate. The intake of bisphosphonates related to the treatment of osteoporosis was not associated with an increased implant failure rate. CONCLUSIONS: It is concluded that short implants (≤6 mm) are a valid option in situations of reduced bone height to avoid possible morbidity associated with augmentation procedures; however, they reveal a higher variability and lower predictability in survival rates. Narrow diameter implants with diameters of 2.5 mm and more demonstrated no difference in implant survival rates compared to standard diameter implants. In contrast, it is concluded that narrow diameter implants with diameters of less than 2.5 mm exhibited lower survival rates compared to standard diameter implants. It is further concluded that there are no differences between tapered versus non-tapered dental implants. Certain medications such as selective serotonin reuptake inhibitors and proton pump inhibitors showed an association with a higher implant failure rate.

IRAK4 gene polymorphism and odontogenic maxillary sinusitis.

OBJECTIVES: This study aimed to evaluate whether a specific interleukin-1 receptor-associated kinase-4 (IRAK4) gene polymorphism had any influence on the development of changes in maxillary sinus, particularly in the presence of etiological factors of dental origin. MATERIALS AND METHODS: The study population included 153 Portuguese Caucasians that were selected from a database of 504 retrospectively analysed computed tomography (CT) scans. A genetic test was performed, and a model was created through logistic analysis and regression coefficients. The statistical methodologies included were the independent Chi test, Fisher's exact test, binary logistic regression and the receiver operating characteristic (ROC) curve. RESULTS: The estimated prevalence of IRAK4 gene polymorphism found in a Portuguese Caucasian population was 26.8 % (CI 95%) [20.1, 34.7 %]. A model to predict the inflammatory response in the maxillary sinus in the presence etiological factors of dental origin was constructed. This model had the following as variables: previously diagnosed sinusitis, sinus pressure symptoms, cortical bone loss observed on CT, positive genetic test result and radiographic examination that revealed the roots of the teeth communication with the maxillary sinus, which are interpreted as risk factors. CONCLUSIONS: The constructed model should be considered an initial clinical tool. The area under the ROC curve found, AUC = 0.91, revealed that the model correctly predicts the outcome in 91.1% of cases. CLINICAL RELEVANCE: The clinical relevance of this study lies in trying to achieve a potential tool (a model) that may assist the clinician in the implementation of suitable dental treatment plans in complex cases, with probable involvement of the maxillary sinus.

Bond Strength of Metallic or Ceramic Orthodontic Brackets to Enamel, Acrylic, or Porcelain Surfaces.

Bonding strategies within different brackets and dental materials are still a challenge concerning adhesion and dental surface damage. This study compared the shear and tensile bond strength of orthodontic ceramic and metallic brackets to enamel, acrylic, and ceramic surfaces after thermal cycling. Dental surfaces were divided into three groups: enamel, ceramic, and acrylic. Each group received stainless-steel and ceramic brackets. After thermal cycling, specimens were randomly divided into two subgroups considering tensile (TBS) or shear bond strength (SBS) test. After the mechanical testing, scanning electron and optical microscopy were performed, and the adhesive remnant index (ARI) was determined. The two-way ANOVA full factorial design was used to compare TBS, SBS, and ARI on the surface and bracket type (α = 0.05). There were significant differences in TBS, SBS, and ARI values per surface (p < 0.001 and p = 0.009) and type of bracket (p = 0.025 and p = 0.001). The highest mean SBS values were recorded for a ceramic bracket bonded to an acrylic surface (8.4 ± 2.3 MPa). For TBS, a ceramic bracket bonded to acrylic showed the worst performance (5.2 ± 1.8 MPa) and the highest values were found on a metallic bracket bonded to enamel. The adhesion of metallic or ceramic brackets is enough for clinical practice although the damage of the enamel surface after debonding is irreversible and harmful for the aesthetic outcome of the teeth.

Survival Rate of Dental Implants in Patients with History of Periodontal Disease: A Retrospective Cohort Study.

PURPOSE: To evaluate the differences between the survival rates of implants placed in patients with no history of periodontal disease (NP) and in patients with a history of chronic periodontal disease (CP). MATERIALS AND METHODS: A retrospective cohort study was conducted in which all consenting patients treated with dental implants in a private clinic in Oporto, Portugal, from November 2, 2002 through February 11, 2011 were included. All patients were treated consecutively by the same experimental operator. This study aimed to analyze how the primary outcomes (presence of disease, time of placement, and time of loading) and the secondary outcomes (severity-generalized periodontitis, brand, implant length, prosthesis type, prosthesis metal-ceramic extension) influence the survival rate of dental implants. The survival analysis was performed through the Kaplan-Meier method, and the equality of survival distributions for all groups was tested with the log-rank test with a significance level of .05 for all comparisons. RESULTS: The sample consisted of 202 patients (47% NP and 53% CP) and 689 implants (31% NP and 69% CP). The survival rate in the NP and CP groups showed no statistically significant differences (95.8% versus 93.1%; P ≥ .05). Implants were lost before loading in 54.9% of the cases. The majority of the implants were lost in the first year and stabilized after the second year. Survival rates in the NP and CP patients showed no statistically significant differences when comparing the following factors: subclassification of the disease, implant brands, implant length (short/standard), type of prosthesis, extension of the prosthesis metal-ceramic, and time of placement and loading (P ≥ .05). CONCLUSION: This work disclosed no statistically significant differences in terms of survival rates when compared with the control group. Placing implants in patients with a history of periodontal disease appears to be viable and safe.

The Influence of Crown-to-Implant Ratio on Short Implant Marginal Bone Loss.

PURPOSE: There is a need for more studies evaluating the marginal bone loss (MBL) of rehabilitations in the posterior regions of extremely resorbed maxillae and mandibles supported by short-length dental implants with a high crown/implant ratio (C/I-R). The aim of this study was to evaluate the influence of the C/I-R in implants on MBL considering dental implants with 4 mm of width and 7 mm of length. MATERIALS AND METHODS: This retrospective cohort study included 59 patients (mean age of 52.8 years) rehabilitated with at least one implant 4 mm in width and 7 mm in length, with an anodically oxidized surface and external connection on the premolar or molar positions, supporting a fixed prosthesis, and in function for a period of 36 months. Periapical radiographs at 36 months were used to calculate the C/I-R and MBL. The Spearman correlation coefficient was used to test the correlation between C/I-R and MBL. The level of significance was set at 5%. RESULTS: One hundred eighteen implants from 59 patients were evaluated. The mean ± SD MBL was 0.67 ± 0.63 mm. The C/I-R mean ± SD was 2.53 ± 0.79 mm. Thirty implants presented a C/I-R ≤ 2, while 88 implants had a C/I-R > 2. A weak nonsignificant inverse correlation (r = -0.081; P = .383, Spearman) was registered between C/I-R and MBL. CONCLUSION: Within the limitations of this study, it is possible to conclude that implant-supported fixed prostheses with C/I-R > 2 do not correlate positively with MBL.

Retrospective multicenter study of 230 6-mm SLA-surfaced implants with 1- to 6-year follow-up.

PURPOSE: Using short implants poses a challenge in implant surgery. Implant surfaces have evolved, making it possible to improve the success of short implants substantially. However, there is still little information about the long-term predictability achieved with short, rough-surfaced implants. The objective of this study was to evaluate the long-term survival rate of 6-mm rough implants. MATERIALS AND METHODS: A retrospective multicenter analysis of the survival of short 6-mm SLA-surfaced implants was conducted. A total of 230 implants placed in 159 patients were included. The follow-up time ranged between 1 and 6 years. RESULTS: Seven of the 230 implants failed, which gives a cumulative survival rate of 96.4%. Two hundred and fourteen implants were placed in the mandible (93.1%), as opposed to 16 placed in the maxilla (6.9%). Five implants failed during the osseointegration period, and two failed after receiving the prosthetic load. No statistically significant differences were found (P < .44). Of the loaded implants, 209 were splinted to other implants, as opposed to 14 that were not. One implant failed in each group, resulting in a 99.5% for the splinted implants and 92.9% for the unsplinted implants. No statistically significant differences were found between the splinted and unsplinted groups (P < .12). CONCLUSIONS: The short implants used in this study displayed high longterm predictability when placed in the mandible and splinted. There is insufficient- information to extrapolate these results to the maxilla and non-splinted implants.

Profilaxia antibiótica na prevenção da infeção associada aos terceiros molares / Antibiotic prophylaxis on prevention of third molars infection

Existe controvérsia acerca da eficácia da profilaxia antibiótica na prevenção de complicações após a remoção dos terceiros molares. Esta revisão bibliográfica baseada em meta-análises, 5 ensaios clínicos, ensaios clínicos randomizados e artigos de revisão tem por objetivo comparar a profilaxia versus o efeito placebo. Sendo a infeção o principal variável resposta "outcome". Efetuou-se uma pesquisa eletrônica na base de dados da PubMed, utilizando as palavras-chave "Third Molar" e " Antibiotic prophylaxis". Foram incluídos trabalhos de meta-análise, ensaios clínicos, ensaios clínicos randomizados, revisões sistemáticas e artigos de revisão. Foram pré-selecionados 35 artigos, dos quais 14 foram descartados por não atenderem aos critérios de inclusão. A amostra final foi composta por uma meta-análise, quatro ensaios clínicos, 11 ensaios clínicos randomizados e cinco artigos de revisão. Observou-se evidência científica limitada acerca das vantagens e desvantagens da profilaxia antibiótica associada à remoção dos terceiros molares. Novos estudos são necessários a fim de se obter um consenso sobre a efetividade da profilaxia antibiótica.

There is controversy regarding the efficacy of antibiotic prophylaxis in preventing complications after the third molar removal. Based on meta-analysis, randomized and clinical trials and reviews the main goal of this review is to report the use of antibiotic prophylaxis when compared to the use of placebo, being "infection" as an outcome. Research on PubMed database was performed with the following key-words: "Third Molar" and "Antibiotic prophylaxis". Meta-analysis, clinical trials, randomized clinical trials and review articles were selected.Initially 35 articles were selected. After consider inclusion criteria, 14 articles were eliminated. Our final sample was composed of 21 articles (1 metaanalyses, 4 clinical trials, 11 randomized clinical trials and 5 reviews). There is limited evidence about the advantages and disadvantages using antibiotics in preventing complications after the third molar removal. Well designed and well reported randomized trials are needed in order to reach a final consensus on the efficacy of antibiotic prophylaxis.