Pain perception following epithelialized gingival graft harvesting: a randomized clinical trial.

OBJECTIVES: The aim of this study was to compare the effects of a hemostatic collagen sponge and a collagen sponge sealed with a bio-adhesive material on the palatal donor sites with the purpose of minimizing postoperative pain after epithelialized gingival graft (EGG) harvesting. MATERIAL AND METHODS: The present study consisted of 44 EGGs harvested in 44 patients. In the control group, a hemostatic collagen sponge was applied over the palatal wound, while the test group was treated with additional cyanoacrylate. Patients were observed for 14 days, evaluating the pain level by using the visual analogic scale. The consumption of analgesic during the postoperative period, the willingness for retreatment and the characteristic of the graft were also analyzed. RESULTS: Statistically significant differences in pain perception were found between test and control groups in each of the studied days (p < 0.01). Analgesic consumption was lower in the test group (p < 0.01). Graft width < 14 mm was found to be associated with lower discomfort (p < 0.01). CONCLUSIONS: Adding an additional layer of cyanoacrylate over a hemostatic collagen sponge on the palatal wound following EGG harvesting was found to be successful in minimizing the postoperative discomfort and the need for analgesics. CLINICAL RELEVANCE: Postoperative pain after palatal tissue harvesting can be successfully minimized if the donor site open wound is protected with an external layer of cyanoacrylate over a collagen sponge.

Volumetric changes and graft stability after lateral window sinus floor augmentation: A randomized clinical trial.

INTRODUCTION: The present investigation compared the stability and volumetric changes of two different grafting material used for lateral window sinus floor augmentation (LWSFA). METHODS: Sixteen patients with a total 20 maxillary sinuses in need of LWSFA were included in the present study. The sinuses were grafted with either 100% anorganic bovine bone mineral (ABBM) alone (Group 1) or a mixture (0.8:1 ratio) of ABBM and mineralized cortical allograft (MCA) (Group 2). Cone beam computer tomography (CBCT) was obtained pre-operatively, and at 2-weeks, and 6-months after LWSFA to perform linear measurements including lateral window dimensions, sinus anatomy, residual bone height/thickness (RBH/RBT), and Schneiderian membrane thickness (SMT), among others. Three-dimensional segmentation analysis was used to evaluate changes of bone graft volume/height (GV/GH). RESULTS: A total of 10 sinuses per group were included in the analysis. No statistically significant difference was found in between groups regarding mean reduction of GV (Group 1: 14.87% ± 16.60%, Group 2: 18.06% ± 9.81%, p = 0.33). Among the linear measurements, only SMT revealed a significant increase after 2-weeks more pronounce in Group 1 (8.70 mm) when compared with Group 2 (5.70 mm) with plausible effect upon LWSFA outcomes. Sinus width showed weak positive correlation with GH reduction after 6 months. CONCLUSION: This study demonstrated that both ABBM alone and ABBM + MCA represent suitable alternatives for LWSFA with adequate graft stability as they revealed similar volumetric and linear dimensional changes 6 months postoperatively.

Effect of Abutment Height on Marginal Bone Loss Around Dental Implants: A Systematic Review.

PURPOSE: To analyze the influence of abutment height (AH) on marginal bone loss (MBL). MATERIALS AND METHODS: A literature search was performed for human studies (RCTs, prospective and retrospective cohorts) reporting on AH and MBL. The data obtained-including clinical outcomes, treatment covariates, and patient characteristics-were analyzed. Meta-regression was performed on the effect size of the differences between the shorter and larger AHs on the MBL of each study. The estimation was done using the restricted maximum likelihood method. RESULTS: The initial screening and full-text analysis resulted in 7,936 and 46 articles, respectively. Finally, 14 articles were included in the systematic review, reporting a total of 1,606 implants. An overall high-to-moderate risk of bias was determined among the included investigations. Meta-regression analysis revealed that AH had a significant effect on MBL (b = -1.630, P < .003), demonstrating that longer abutments were correlated with less MBL. No effects were observed for the study type (P = .607), the number of stages (P = .510), or the elapsed time (P = .491). CONCLUSIONS: The height of the abutment has a significant impact on MBL. As such, increased AH is related to less MBL. Nevertheless, the role of confounding variables remains to be studied and determined.

Effect of Abutment Height on Marginal Bone Loss Around Dental Implants: A Systematic Review.

PURPOSE: To analyze the influence of abutment height (AH) on marginal bone loss (MBL). MATERIALS AND METHODS: A literature search was performed for human studies (randomized controlled trials, prospective and retrospective cohorts) reporting on the AH and MBL. The data obtained-including clinical outcomes, treatment covariates and patient characteristics-were analyzed. Meta-regression was performed on the effect size of the differences between the shorter and larger AHs on the MBL of each study. The estimation was done using the restricted maximum likelihood method. RESULTS: The initial screening and full-text analysis resulted in 7,936 and 46 articles, respectively. Finally, 14 articles were included in the systematic review, reporting a total of 1,606 implants. An overall high-to-moderate risk of bias was determined among the included investigations. Meta-regression analysis revealed that AH had a significant effect on MBL (b = - 1.630, P < .003), demonstrating that longer abutments were correlated with less MBL. No effects were observed for the study type (P = .607), the number of stages (P = .510), or the elapsed time (P = .491). CONCLUSION: The height of the abutment has a significant impact on MBL. As such, increased AH is related to less MBL. Nevertheless, the role of confounding variables remains to be studied and determined.

Immediate implant placement in molar extraction sockets: a systematic review and meta-analysis.

BACKGROUND: Immediate implants are frequently employed in the anterior maxillary area. However, the installation of dental implants simultaneously with tooth extraction can also provide with benefits in the posterior areas with a reduction in time prior the recovery of the masticatory function. Results previously reported in the literature show high-survival and success rates for implants placed in extraction sockets in molar areas; however, this topic has received limited systematic analysis. MATERIAL AND METHODS: Electronic and manual literature searches were performed by two independent reviewers in several data-bases, including MEDLINE, EMBASE, and Cochrane Oral Health Group Trials Register, for articles up to January 2019 reporting outcomes of immediate implants placed in molar areas. Primary outcomes included survival and success rates, as well as marginal bone loss. Secondary outcomes included the influence of implant position, type of implant connection, grafting protocol, flap or flapless approach, implant diameter, surgical phase, presence of buccal plate, and loading protocol. RESULTS: Twenty studies provided information on the survival rate, with a total sample of 1.106 implants. The weighted mean survival rate of immediate implants after 1 year of follow-up was 96.6%, and the success rate was 93.3%. On the other hand, marginal bone loss was 1.29 ± 0.24 mm. Secondary outcomes demonstrated that grafting the gap and the loading protocol have an effect on survival and success rates. Similarly, the presence or absence of the buccal bone affect crestal bone levels. Meta-analysis of 4 investigations showed a weighted mean difference of 0.31 mm ± 0.8 IC 95% (0.15-0.46) more marginal bone loss at immediate implant placement versus implants in healed sites (p < 0.001) I2 = 15.2%. CONCLUSION: In selected scenarios, immediate implant placement in molar extraction socket might be considered a predictable technique as demonstrated by a high survival and success rates, with minimal marginal bone loss.

Peri-implant Soft Tissue Management: Cairo Opinion Consensus Conference.

Peri-implant soft tissues play a role of paramount importance, not only on the esthetic appearance, but also on the maintenance and long-term stability of implants. The present report presents the conclusions from the Consensus Conference of the South European North African Middle Eastern Implantology & Modern Dentistry Association (SENAME) (4-6 November 2016, Cairo, Egypt). The conference focused on the topic of the soft tissue around dental implants, and in particular, on the influence of implant configurations on the marginal soft tissues, soft tissue alterations after immediate, early or delayed implant placement and immediate loading, the long-term outcomes of soft tissue stability around dental implants, and soft tissue augmentation around dental implants. Thirty world experts in this field were invited to take part in this two-day event; however, only 29 experts were in the final consensus voting process.

Comparison between Subepithelial Connective Tissue Graft and De-epithelialized Gingival Graft: A systematic review and a meta-analysis.

AIM: Sup-epithelial connective tissue graft (SCTG) and de-epithelialized gingival graft (DGG) approaches have been investigated with a focus on post-operative morbidity but not from a clinical outcome standpoint. The aim of this systematic review was to systematically investigate the literature for coronally advanced flaps (CAFs) combined with SCTG or DGG. MATERIALS AND METHODS: Electronic and hand searches were performed to identified randomized controlled trials (RCTs) investigating the treatment of gingival recession (GRs) using CAF, with at least a 1-year of follow-up. The primary outcome was the mean root coverage (mRC), while the secondary outcomes included recession reduction (Rec Red), keratinized tissue (KT) gain, probing depth (PD) change, and clinical attachment level (CAL) gain. RESULTS: Ten RCTs with a total of 408 gingival recessions were included. The meta-analysis demonstrated that CAF + DGG is associated with superior mRC, Rec Red, KT gain, PD reduction and CAL gain. The mRC for SCTG and DGG at 1-year was 89.3% and 94.0% respectively, while the mean difference of the other clinical parameters between the two approaches was within 1 mm in favor of the DGG group. CONCLUSIONS: Limited evidence is available when comparing the two techniques, however the usage of DGG may be considered as the preferred technique of choice for autologous CTG harvesting when incorporated with a CAF.

Surface Topographical Changes of a Failing Acid-Etched Long-Term in Function Retrieved Dental Implant.

The aim of the present study was to report the main topographical and chemical changes of a failing 18-year in function retrieved acid-etching implant in the micro- and nanoscales. A partially edentulous 45 year old rehabilitated with a dental implant at 18 years of age exhibited mobility. After careful examination, a 3.25 × 13-mm press-fit dental implant was retrieved. Scanning electron microscope (SEM) analysis was carried out to study topographical changes of the retrieved implant compared with an unused implant with similar topographical characteristics. Moreover, X-ray photoelectron spectroscopy (XPS) analysis was used to study the surface composition of the retrieved failing implant. Clear changes related to the dual dioxide layer are present as visible in ≥×500 magnification. In addition, it was found that, for the retrieved implant, the surface composition consisted mainly of Ti2p, O1s, C1s, and Al2p. Also, a meaningful decrease of N and C was noticed, whereas the peaks of Ti2p, Al2p, and O1s increased when analyzing deeper (up to ×2000s) in the sample. It was shown that the superficial surface of a retrieved press-fit dual acid-etched implant 18 years after placement is impaired. However, the causes and consequences for these changes cannot be determined.