Low energy intake and nutritional maladaptation in terminal stage IV periodontitis.

AIM: Impairment of masticatory function in elderly patients with terminal dentition due to stage IV periodontitis (TDS4P) may lead to lower nutritional intake. The study aimed to report the dietary intake and nutrition status of elderly patients with TDS4P and compare them with those of the elderly Chinese population and the Chinese Dietary Reference Intakes (DRIs). MATERIALS AND METHODS: Fifty-one consecutive subjects (≥55 years old) with TDS4P were enrolled. Average dietary intake was evaluated based on a 3-day 24-h dietary recall (24HR) and food frequency questionnaire (FFQ). The daily intake of fresh vegetables and fruits, dietary energy as well as macro and micronutrients were calculated and compared with matched national data and the Chinese DRIs. Nutritional status was assessed by Short-Form Mini-Nutritional assessment. RESULTS: Of the subjects, 19.6% (95% CI: 7.2%-28.1%) were at risk of malnutrition. The mean daily energy intake was 1517.4 kcal (95% CI: 1400.5-1634.3) for males and 1110.7 kcal (95% CI: 1001.5-1219.9) for females, which were very low compared with both the national data and the DRIs. Females derived a higher percentage of energy from fat. The mean daily intake of vegetables was 151.4 g (95% CI: 128.1-174.8) by FFQ and 130.9 g (95% CI: 104.6-157.3) by 24HR. Both results were significantly lower than the national reports (95% CI: 310.3-340.1) and the DRIs (300-450 g). Insufficient micronutrient intake, especially vitamins A, C and E, was also found. CONCLUSIONS: Elderly subjects with TDS4P had a lower daily energy intake, vegetable and fruit consumption and essential macro and micronutrient intake. More studies are needed to clarify the impact of periodontitis and tooth loss/replacement on nutrition and healthy ageing.

Diagnostic accuracy of salivary active matrix metalloproteinase (aMMP)-8 point-of-care test for detecting periodontitis in adults: A systematic review and meta-analysis.

OBJECTIVE: To determine the accuracy of salivary active matrix metalloproteinase (aMMP)-8 point-of-care test (POCT) for detecting periodontitis in adults, through meta-analysis. MATERIALS AND METHODS: Diagnostic studies evaluating the accuracy of salivary/oral rinse aMMP-8 POCT for detecting periodontitis in adults, when compared with clinical examination, were considered eligible. A comprehensive search was performed up to 31 August 2023 through five databases. Quality Assessment of Diagnostic Accuracy Studies 2 was utilized to evaluate the methodological quality of the included articles. Meta-analysis was performed using Bayesian bivariate hierarchical model and subgroup analysis. RESULTS: From 368 screened studies, 6 studies (4 cross-sectional and 2 longitudinal studies) were included in the meta-analysis. Overall, the pooled sensitivity and specificity of salivary aMMP-8-POCT for detecting periodontitis were 0.63 (95% CI: 0.41-0.82) and 0.84 (95% CI: 0.65-0.95), respectively. Subgroup analyses revealed that the 95% CI for oral fluid types, predefined diagnostic thresholds and the POCT systems largely overlapped, indicating that the differences between them may not be significant. CONCLUSION: Salivary aMMP-8 POCT shows fair accuracy for detecting periodontitis. The diagnostic accuracy cannot be significantly influenced by the types of oral fluids, predefined diagnostic thresholds or the specific POCT systems used. More research is needed to confirm the clinical utility and implementation of aMMP-8 POCT in the diagnosis of periodontitis.

Improved positional accuracy of dental implant placement using a haptic and machine-vision-controlled collaborative surgery robot: A pilot randomized controlled trial.

AIM: To compare the implant accuracy, safety and morbidity between robot-assisted and freehand dental implant placement. MATERIALS AND METHODS: Subjects requiring single-site dental implant placement were recruited. Patients were randomly allocated to freehand implant placement and robot-assisted implant placement. Differences in positional accuracy of the implant, surgical morbidity and complications were assessed. The significance of intergroup differences was tested with an intention-to-treat analysis and a per-protocol (PP) analysis (excluding one patient due to calibration error). RESULTS: Twenty patients (with a median age of 37, 13 female) were included. One subject assigned to the robotic arm was excluded from the PP analysis because of a large calibration error due to the dislodgement of the index. For robot-assisted and freehand implant placement, with the PP analysis, the median (25th-75th percentile) platform global deviation, apex global deviation and angular deviation were 1.23 (0.9-1.4) mm/1.9 (1.2-2.3) mm (p = .03, the Mann-Whitney U-test), 1.40 (1.1-1.6) mm/2.1 (1.7-3.9) mm (p < .01) and 3.0 (0.9-6.0)°/6.7 (2.2-13.9)° (p = .08), respectively. Both methods showed limited damage to the alveolar ridge and had similar peri- and post-operative morbidity and safety. CONCLUSIONS: Robot-assisted implant placement enabled greater positional accuracy of the implant compared to freehand placement in this pilot trial. The robotic system should be further developed to simplify surgical procedures and improve accuracy and be validated in properly sized trials assessing the full spectrum of relevant outcomes.

The potential causal path between periodontitis stage diagnosis and vegetable consumption is mediated by loss of posterior functional tooth units and masticatory function.

AIM: Emerging evidence points to a two-way relationship between periodontitis and dietary choices and, thus, nutrition. This study aimed to assess the potential cause-effect relationship between the periodontitis stage, loss of functional tooth units (FTUs), masticatory function, and intake of different food groups using path analysis. MATERIALS AND METHODS: A single calibrated examiner determined the periodontitis stage of a consecutive sample of 241 Chinese subjects reporting for tooth replacement. Their masticatory function was quantified by the mixing ability of a two-colour chewing gum. Validated food frequency questionnaires were used to calculate the intake of 33 food group items by an experienced calibrated rater. After verification of assumptions, visual structural equation modeling was performed with Amos 23. The consistency of results and the potential modifying effect of age were assessed in 9043 subjects from the NHANES database. RESULTS: Highly significant models were constructed using periodontitis stage and age as exogenous factors. Periodontitis stage diagnosis significantly affected the number of posterior FTUs and oral health-related quality of life (OHRQoL, path coefficient [PC] = -0.55 and -0.20, p < .05, respectively). In the model, FTUs also had an independent effect on OHRQoL (PC = 0.23, p < .05). FTUs determined the level of masticatory function (PC = -0.38, p < .05), which in turn affected vegetable intake but not fruit or meat intake (PC = -0.18, p < .0.5, PC = 0.06, NS and PC = 0.11, NS, respectively). The effect of age was significant for vegetable and meat intake and was also correlated with periodontitis stage diagnosis. Analysis of the NHANES database confirmed the negative impact of periodontitis on the number of occluding pairs and vegetable consumption for the 18-44, 45-60 and >60 age groups. CONCLUSIONS: Periodontitis showed a potential cause-effect pathway affecting vegetable intake across cultures and age groups. The size of the effect is potentially of clinical and public health significance. Additional studies, including intervention trials, are required to test this potential mechanism linking oral health to nutrition.

Consensus report of the second European Consensus Workshop on Education in Periodontology.

BACKGROUND: The second European Consensus Workshop on Education in Periodontology was commissioned, as a result of the changes in the discipline and the advances in educational methods/technology, to update the 2009 Consensus report of the first European Federation of Periodontology (EFP) Workshop on the same topic that was jointly authored by the Association for Dental Education in Europe. AIM: To identify and propose changes necessary in periodontal education at three levels, namely undergraduate, specialist and continuing professional development (CPD), with respect to learning outcomes, competencies and methods of learning/training and evaluation. METHODS: Four working groups (WGs) considered education in periodontology at the undergraduate, specialist and CPD levels, and education methods. Four commissioned position papers, one per WG, summarized the relevant information. Workshop participants gathered at an in-person consensus meeting to discuss the individual reviews, and this consensus report summarizes the conclusions. RESULTS: The learning outcomes for undergraduate and specialist education in periodontology have been updated, and a proposal for learning outcomes for CPD programmes was made. Learning/teaching/training and evaluation methods were proposed for each level of education, which included face-to-face, virtual and blended learning methods. CONCLUSION: Developments in oral/dental medicine and in contemporary educational technologies have been translated into updated learning outcomes and learning/teaching/ training/evaluation methods relevant to education in periodontology.

Enhanced control of periodontitis by an artificial intelligence-enabled multimodal-sensing toothbrush and targeted mHealth micromessages: A randomized trial.

AIM: Treatment of periodontitis, a chronic inflammatory disease driven by biofilm dysbiosis, remains challenging due to patients' poor performance and adherence to the necessary oral hygiene procedures. Novel, artificial intelligence-enabled multimodal-sensing toothbrushes (AI-MST) can guide patients' oral hygiene practices in real-time and transmit valuable data to clinicians, thus enabling effective remote monitoring and guidance. The aim of this trial was to assess the effect of such a system as an adjunct to clinical practice guideline-conform treatment. MATERIALS AND METHODS: This was a single-centre, double-blind, standard-of-care controlled, randomized, parallel-group, superiority trial. Male and female adults with generalized Stage II/III periodontitis were recruited at the Shanghai Ninth People's Hospital, China. Subjects received a standard-of-care oral hygiene regimen or a technology-enabled, theory-based digital intervention consisting of an AI-MST and targeted doctor's guidance by remote micromessaging. Additionally, both groups received guideline-conform periodontal treatment. The primary outcome was the resolution of inflamed periodontal pockets (≥4 mm with bleeding on probing) at 6 months. The intention-to-treat (ITT) analysis included all subjects who received the allocated treatment and at least one follow-up. RESULTS: One hundred patients were randomized and treated (50 tests/controls) between 1 February and 30 November 2022. Forty-eight tests (19 females) and 47 controls (16 females) were analysed in the ITT population. At 6 months, the proportion of inflamed periodontal pockets decreased from 80.7% (95% confidence interval [CI] 76.5-84.8) to 52.3% (47.7-57.0) in the control group, and from 81.4% (77.1-85.6) to 44.4% (39.9-48.9) in the test group. The inter-group difference was 7.9% (1.6-14.6, p < .05). Test subjects achieved better levels of oral hygiene (p < .001). No significant adverse events were observed. CONCLUSIONS: The tested digital health intervention significantly improved the outcome of periodontal therapy by enhancing the adherence and performance of self-performed oral hygiene. The model breaks the traditional model of oral health care and has the potential to improve efficiency and reduce costs (NCT05137392).

ACES: A new framework for the application of the 2018 periodontal status classification scheme to epidemiological survey data.

AIM: To propose a framework for consistently applying the 2018 periodontal status classification scheme to epidemiological surveys (Application of the 2018 periodontal status Classification to Epidemiological Survey data, ACES). PROPOSED FRAMEWORK: We specified data requirements and workflows for either completed or planned epidemiological surveys, utilizing commonly collected measures of periodontal status (clinical attachment levels [CAL], probing depths, bleeding on probing), as well as additional necessary variables for the implementation of the 2018 periodontal status classification (tooth loss due to periodontitis and complexity factors). Following detailed instructions and flowcharts, survey participants are classified as having periodontal health, gingivitis or periodontitis. Rates of edentulism must also be reported. In cases of periodontitis, instructions on how to compute the stage and extent are provided. Assessment of grade can be derived from CAL measurements (or from radiographic alveolar bone loss data) in relation to root length and the participant's age. CONCLUSIONS: ACES is a framework to be used in epidemiological studies of periodontal status that (i) have been completed, and in which stage and grade according to the 2018 classification are inferred retroactively, or (ii) are being planned. Consistent use of the proposed comprehensive approach will facilitate the comparability of periodontitis prevalence estimates across studies.

Accuracy of robotic surgery for dental implant placement: A systematic review and meta-analysis.

OBJECTIVES: To systematically analyze the accuracy of robotic surgery for dental implant placement. MATERIALS AND METHODS: PubMed, Embase, and Cochrane CENTRAL were searched on October 25, 2023. Model studies or clinical studies reporting the accuracy of robotic surgery for dental implant placement among patients with missing or hopeless teeth were included. Risks of bias in clinical studies were assessed. Meta-analyses were undertaken. RESULTS: Data from 8 clinical studies reporting on 109 patients and 242 implants and 13 preclinical studies were included. Positional accuracy was measured by comparing the implant plan in presurgery CBCT and the actual implant position in postsurgery CBCT. For clinical studies, the pooled (95% confidence interval) platform deviation, apex deviation, and angular deviation were 0.68 (0.57, 0.79) mm, 0.67 (0.58, 0.75) mm, and 1.69 (1.25, 2.12)°, respectively. There was no statistically significant difference between the accuracy of implants placed in partially or fully edentulous patients. For model studies, the pooled platform deviation, apex deviation, and angular deviation were 0.72 (0.58, 0.86) mm, 0.90 (0.74, 1.06) mm, and 1.46 (1.22, 1.70)°, respectively. No adverse event was reported. CONCLUSION: Within the limitation of the present systematic review, robotic surgery for dental implant placement showed suitable implant positional accuracy and had no reported obvious harm. Both robotic systems and clinical studies on robotic surgery for dental implant placement should be further developed.

Development of a machine learning multiclass screening tool for periodontal health status based on non-clinical parameters and salivary biomarkers.

AIM: To develop a multiclass non-clinical screening tool for periodontal disease and assess its accuracy for differentiating periodontal health, gingivitis and different stages of periodontitis. MATERIALS AND METHODS: A cross-sectional diagnostic study on a convenience sample of 408 consecutive subjects was conducted by applying three non-clinical index tests estimating different features of the periodontal health-disease spectrum: a self-administered questionnaire, an oral rinse activated matrix metalloproteinase-8 (aMMP-8) point-of-care test (POCT) and determination of gingival bleeding on brushing (GBoB). Full-mouth periodontal examination was the reference standard. The periodontal diagnosis was made on the basis of the 2017 classification of periodontal diseases and conditions. Logistic regression and random forest (RF) analyses were performed to predict various periodontal diagnoses, and the accuracy measures were assessed. RESULTS: Four-hundred and eight subjects were enrolled in this study, including those with periodontal health (16.2%), gingivitis (15.2%) and stage I (15.9%), stage II (15.9%), stage III (29.7%) and stage IV (7.1%) periodontitis. Nine predictors, namely 'gum disease' (Q1), 'a rating of gum/teeth health' (Q2), 'tooth cleaning' (Q3a), the symptom of 'loose teeth' (Q4), 'use of floss' (Q7), aMMP-8 POCT, self-reported GBoB, haemoglobin and age, resulted in high levels of accuracy in the RF classifier. High accuracy (area under the ROC curve > 0.94) was observed for the discrimination of three (health, gingivitis and periodontitis) and six classes (health, gingivitis, stages I, II, III and IV periodontitis). Confusion matrices showed that the misclassification of a periodontitis case as health or gingivitis was less than 1%-2%. CONCLUSIONS: Machine learning-based classifiers, such as RF analyses, are promising tools for multiclass assessment of periodontal health and disease in a non-clinical setting. Results need to be externally validated in appropriately sized independent samples (ClinicalTrials.gov NCT03928080).

Multi-stakeholder contribution to the identification of a core outcome set and measurements in implant dentistry (ID-COSM initiative) using the Delphi methodology.

AIM: To obtain input from multiple stakeholders and generate agreement on essential outcomes in implant dentistry using the Delphi methodology and incorporate them into an international consensus defining a core outcome set. MATERIALS AND METHODS: Candidate outcomes in implant dentistry were generated from scientific evidence through five commissioned systematic reviews and from people with lived experience in dental implants (PWLE) through four international focus groups. A steering committee identified stakeholders among representatives from dental professionals, industry-related experts and PWLE. Participants underwent a three-round Delphi survey using a multi-stakeholder approach; they assessed candidate outcomes and additional outcomes identified in the first Delphi round. The process followed the COMET methodology. RESULTS: From the 665 potential outcomes identified in the systematic reviews and 89 in the PWLE focus group, the steering committee selected 100 and organized them into 13 categories, to be included in the first-round questionnaire as candidate outcomes. A total of 99 dental experts, 7 dental-industry-related experts and 17 PWLE participated in the first round, and 11 additional outcomes were added to the second round. There was no attrition between the first and second rounds, where 61 (54.9%) outcomes exceeded the pre-established threshold of agreement. PWLE and experts participated in the third round that applied "a priori" standard filters to distil a list of candidate essential outcomes. CONCLUSION: This Delphi study utilized a standardized, transparent and inclusive methodology and preliminarily validated 13 essential outcomes organized into four core areas. These results informed the final stage of the ID-COSM consensus.

Buccal bone thickness and mid-facial soft tissue recession after various surgical approaches for immediate implant placement: A systematic review and network meta-analysis of controlled trials.

AIM: To evaluate the relative efficacy and confidence in the precision of the results of different surgical interventions for immediate implant placement in the anterior area. MATERIALS AND METHODS: Electronic searches were performed in PubMed, Embase, and Cochrane CENTRAL. Randomized controlled trials comparing different surgical techniques in anterior jaws for type 1 implant placement were included. Outcome measures included implant survival (primary outcome), buccal bone thickness (BBT) reduction, and mid-facial soft tissue recession (MSTR). Risks of bias assessment, network meta-analysis (NMA), sensitivity analysis, and quality-of-evidence assessment were performed. RESULTS: Twenty-two studies reporting on 948 subjects and 5 surgical interventions were included. Fourteen early failures were reported. Compared with open-flap surgery without tissue augmentation (F-N) and looking at BBT preservation, NMA showed that there was moderate confidence that flapless surgery with hard tissue augmentation (FL-HTA) was better than flapless surgery without tissue augmentation (FL-N) or open-flap surgery with hard tissue augmentation (F-HTA) (mean difference -0.8 mm, 95% confidence interval: -1.1 to -0.5 mm; -0.6 mm, -0.9 to -0.4 mm; and -0.5 mm, -0.7 to -0.3 mm, respectively). There was moderate confidence that flapless surgery with hard and soft tissue augmentation (FL-HTA&STA) could significantly prevent MSTR compared with FL-HTA (-0.5 mm, -0.7 to -0.3 mm) and FL-N (-0.6 mm, -1.2 to -0.04 mm). However, there was no significant additional benefit in BBT with the FL-HTA&STA approach compared to the FL-HTA approach (-0.30 mm, -0.81 to 0.21 mm). CONCLUSIONS: For immediate implant placement in the anterior areas, the FL-HTA approach better preserves BBT (moderate confidence); adding STA improves the stability of the mid-facial soft tissue level (moderate confidence) but at the expense of BBT (low confidence).

Long-term comparison of root coverage procedures at single RT2 maxillary gingival recessions: Ten-year extension results from a randomized, controlled clinical trial.

AIM: The purpose of the present study was to assess root coverage outcomes 10 years after connective tissue graft plus coronally advanced flap (CTG + CAF) or CAF alone, at single RT2 maxillary gingival recession. MATERIALS AND METHODS: Twenty-one of the original 29 patients (11 treated with CAF + CTG and 10 with CAF alone) were available for the 10-year follow-up. A blinded and calibrated examiner performed all the measurements. Outcome measures included complete root coverage (CRC), recession reduction (RecRed), root coverage aesthetic score (RES), and keratinized tissue (KT) gain. A visual analogue scale was used to evaluate patient satisfaction. RESULTS: CRC was maintained in 63% of the test group and 20% of the control group after 10 years, with a significant difference favouring CAF + CTG (p = .030). Furthermore, the addition of CTG was associated with greater KT gain (p = .0002) and greater papilla tip recession (p = .023) than with CAF at the last follow-up. No difference was detected regarding RecRed, RES, and patient satisfaction. CONCLUSIONS: Adding CTG under CAF improved the probability of maintaining complete root coverage 10 years after single maxillary RT2 recession treatment.

Prevention and treatment of peri-implant diseases-The EFP S3 level clinical practice guideline.

BACKGROUND: The recently published Clinical Practice Guidelines (CPGs) for the treatment of stages I-IV periodontitis provided evidence-based recommendations for treating periodontitis patients, defined according to the 2018 classification. Peri-implant diseases were also re-defined in the 2018 classification. It is well established that both peri-implant mucositis and peri-implantitis are highly prevalent. In addition, peri-implantitis is particularly challenging to manage and is accompanied by significant morbidity. AIM: To develop an S3 level CPG for the prevention and treatment of peri-implant diseases, focusing on the implementation of interdisciplinary approaches required to prevent the development of peri-implant diseases or their recurrence, and to treat/rehabilitate patients with dental implants following the development of peri-implant diseases. MATERIALS AND METHODS: This S3 level CPG was developed by the European Federation of Periodontology, following methodological guidance from the Association of Scientific Medical Societies in Germany and the Grading of Recommendations Assessment, Development and Evaluation process. A rigorous and transparent process included synthesis of relevant research in 13 specifically commissioned systematic reviews, evaluation of the quality and strength of evidence, formulation of specific recommendations, and a structured consensus process involving leading experts and a broad base of stakeholders. RESULTS: The S3 level CPG for the prevention and treatment of peri-implant diseases culminated in the recommendation for implementation of various different interventions before, during and after implant placement/loading. Prevention of peri-implant diseases should commence when dental implants are planned, surgically placed and prosthetically loaded. Once the implants are loaded and in function, a supportive peri-implant care programme should be structured, including periodical assessment of peri-implant tissue health. If peri-implant mucositis or peri-implantitis are detected, appropriate treatments for their management must be rendered. CONCLUSION: The present S3 level CPG informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective modalities to maintain healthy peri-implant tissues, and to manage peri-implant diseases, according to the available evidence at the time of publication.

Relevant domains, core outcome sets and measurements for implant dentistry clinical trials: The Implant Dentistry Core Outcome Set and Measurement (ID-COSM) international consensus report.

AIM: Lack of consistently reported outcomes limits progress in evidence-based implant dentistry and quality of care. The objective of this initiative was to develop a core outcome set (COS) and measurements for implant dentistry clinical trials (ID-COSM). MATERIALS AND METHODS: This Core Outcome Measures in Effectiveness Trials (COMET)-registered international initiative comprised six steps over 24 months: (i) systematic reviews of outcomes reported in the last 10 years; (ii) international patient focus groups; (iii) a Delphi project with a broad range of stakeholders (care providers, clinical researchers, methodologists, patients and industry representatives); (iv) expert group discussions organizing the outcomes in domains using a theoretical framework and identifying the COSs; (v) identification of valid measurement systems to capture the different domains and (vi) final consensus and formal approval involving experts and patients. The methods were modified from the best practice approach following the Outcome Measures in Rheumatoid Arthritis Clinical Trial and COMET manuals. RESULTS: The systematic reviews and patient focus groups identified 754 (665 + 89, respectively) relevant outcome measures. After elimination of redundancies and duplicates, 111 were formally assessed in the Delphi project. By applying pre-specified filters, the Delphi process identified 22 essential outcomes. These were reduced to 13 after aggregating alternative assessments of the same features. The expert committee organized them into four core outcome areas: (i) pathophysiology, (ii) implant/prosthesis lifespan, (iii) life impact and (iv) access to care. In each area, core outcomes were identified to capture both the benefits and harms of therapy. Mandatory outcome domains included assessment of surgical morbidity and complications, peri-implant tissue health status, intervention-related adverse events, complication-free survival and overall patient satisfaction and comfort. Outcomes deemed mandatory in specific circumstances comprised function (mastication, speech, aesthetics and denture retention), quality of life, effort for treatment and maintenance and cost effectiveness. Specialized COSs were identified for bone and soft-tissue augmentation procedures. The validity of measurement instruments ranged from international consensus (peri-implant tissue health status) to early identification of important outcomes (patient-reported outcomes identified by the focus groups). CONCLUSIONS: The ID-COSM initiative reached a consensus on a core set of mandatory outcomes for clinical trials in implant dentistry and/or soft tissue/bone augmentation. Adoption in future protocols and reporting on the respective domain areas by currently ongoing trials will contribute to improving evidence-informed implant dentistry and quality of care.

Multi-stakeholder contribution to the identification of a core outcome set and measurements in implant dentistry (ID-COSM initiative) using the Delphi methodology.

AIM: To obtain input from multiple stakeholders and generate agreement on essential outcomes in implant dentistry using the Delphi methodology and incorporate them into an international consensus defining a core outcome set. MATERIALS AND METHODS: Candidate outcomes in implant dentistry were generated from scientific evidence through five commissioned systematic reviews and from people with lived experience in dental implants (PWLE) through four international focus groups. A steering committee identified stakeholders among representatives from dental professionals, industry-related experts and PWLE. Participants underwent a three-round Delphi survey using a multi-stakeholder approach; they assessed candidate outcomes and additional outcomes identified in the first Delphi round. The process followed the COMET methodology. RESULTS: From the 665 potential outcomes identified in the systematic reviews and 89 in the PWLE focus group, the steering committee selected 100 and organized them into 13 categories, to be included in the first-round questionnaire as candidate outcomes. A total of 99 dental experts, 7 dental-industry-related experts and 17 PWLE participated in the first round, and 11 additional outcomes were added to the second round. There was no attrition between the first and second rounds, where 61 (54.9%) outcomes exceeded the pre-established threshold of agreement. PWLE and experts participated in the third round that applied "a priori" standard filters to distil a list of candidate essential outcomes. CONCLUSION: This Delphi study utilized a standardized, transparent and inclusive methodology and preliminarily validated 13 essential outcomes organized into four core areas. These results informed the final stage of the ID-COSM consensus.

Association of crown emergence angle and profile with dental plaque and inflammation at dental implants.

BACKGROUND: The shape of implant restorations is critical for function and aesthetics. It may also be important in peri-implant tissue health preservation. This study aimed to associate the restorative contour of a single crown with marginal dental plaque accumulation, tissue inflammation and probing depths. METHODS: Subjects with a single screw-retained implant restoration were clinically examined. The presence of dental biofilm, tissue inflammation and probing pocket depths were the dependent variables. The emergence angle, profile and depth of the mucosal tunnel were measured on superimposed digital scans of the crown soft-tissue complex, the removed crown mounted on an analogue and the soft tissue. RESULTS: One hundred twenty two subjects (46.7% female, 68.9% never smokers, 77% with treated periodontitis and 52.5% participating in regular supportive peri-implant care) were examined. The emergence angles at the mucosal margin were 15.3 ± 9.4°, 12.7 ± 8.5°, 31.3 ± 11.8° and 19.2 ± 9.8° for the mesial, distal, vestibular and oral aspects of the crowns. The largest emergence profile angles were observed on the vestibular aspect (74.6% of cases), reaching a maximum of 61.7°, and profiles were convex in 59% of cases. Generalized estimating equations indicated that the site-specific platform-level emergence angle and profile and depth of the mucosal tunnel were significantly associated with the presence of detectable plaque accumulation (p < .01) and bleeding on probing (p < .02). CONCLUSIONS: Subtle variations in the shape of the restorative crown are associated with biofilm accumulation and mucosal inflammation. These findings are important for 3D implant planning/positioning and preservation of peri-implant tissue health.

Surgical interventions for implant placement in the anterior maxilla: A systematic scoping review with evidence mapping.

OBJECTIVES: Simplification and standardization of interventions are critical challenges to improving performance in implant dentistry. This study aimed to systematically identify and schematically present the evidence base of the implant dentistry surgical interventions for the anterior maxilla as a basis for further development and standardization. METHODS: Electronic searches were conducted in PubMed, Embase and Cochrane CENTRAL. Primary clinical studies reporting surgical interventions in the anterior maxilla, with a sample size of at least ten patients, were included. Bibliometric information and study details were extracted. Descriptive analysis and a mind map approach were used to describe the documentation of different surgical interventions. RESULTS: Two hundred and seventy-two studies reporting on 9001 patients were included. Within the past two decades, the number of literatures on implant placement in the anterior maxilla has increased dramatically (7 studies before 2005, 151 studies after 2016). Overall, the evidence map identified six primary operations and 33 variations. For hopeless tooth extraction, immediate implant placement was the most frequently reported (141 studies, 4670 patients); flapless implant placement with hard tissue augmentation and immediate provisionalization was the most commonly reported variation (33 studies, 987 patients). Type 3/4 implant placement (62 studies, 1902 patients) and implant site augmentation (33 studies, 788 patients) were frequently reported for missing teeth. Geographical differences were observed, with type 2 placement studies almost exclusively from Europe. CONCLUSIONS: Research on immediate implant placement was the most reported surgical intervention in the anterior maxilla. Hard tissue augmentation was frequently reported simultaneously with or before implant placement. Immediate provisionalization was mainly used for type 1 implant placement. The finding that six primary operations with 33 variations have been reported indicates the need for additional research to simplify and consolidate the surgical approach.

Accuracy and safety of a haptic operated and machine vision controlled collaborative robot for dental implant placement: A translational study.

OBJECTIVES: Multiple generations of medical robots have revolutionized surgery. Their application to dental implants is still in its infancy. Co-operating robots (cobots) have great potential to improve the accuracy of implant placement, overcoming the limitations of static and dynamic navigation. This study reports the accuracy of robot-assisted dental implant placement in a preclinical model and further applies the robotic system in a clinical case series. MATERIALS AND METHODS: In model analyses, the use of a lock-on structure at robot arm-handpiece was tested in resin arch models. In a clinical case series, patients with single missing teeth or edentulous arch were included. Robot-assisted implant placement was performed. Surgery time was recorded. Implant platform deviation, apex deviation, and angular deviation were measured. Factors influencing implant accuracy were analyzed. RESULTS: The in vitro results showed that with a lock-on structure, the mean (SD) of platform deviation, apex deviation, and angular deviation were 0.37 (0.14) mm, 0.44 (0.17) mm, and 0.75 (0.29)°, respectively. Twenty-one patients (28 implants) were included in the clinical case series, 2 with arches and 19 with single missing teeth. The median surgery time for single missing teeth was 23 (IQ range 20-25) min. The surgery time for the two edentulous arches was 47 and 70 min. The mean (SD) of platform deviation, apex deviation, and angular deviation was 0.54 (0.17) mm, 0.54 (0.11) mm, and 0.79 (0.22)° for single missing teeth and for 0.53 (0.17) mm, 0.58 (0.17) mm, and 0.77 (0.26)° for an edentulous arch. Implants placed in the mandible had significantly larger apex deviation than those in the maxilla. CONCLUSION: Cobot-assisted dental implant placement showed excellent positional accuracy and safety in both the in vitro study and the clinical case series. More technological development and clinical research are needed to support the introduction of robotic surgery in oral implantology. Trial registered in ChiCTR2100050885.

Accuracy of intraoral scan with prefabricated aids and stereophotogrammetry compared with open tray impressions for complete-arch implant-supported prosthesis: A clinical study.

OBJECTIVES: The aim of this clinical study was to compare the accuracy of intraoral scan system (IOS) with prefabricated aids and stereophotogrammetry (SPG) compared with open tray implant impression (OI) for complete-arch implant-supported fixed dental prostheses (CIFDP). MATERIALS AND METHODS: Patients needing CIFDP were enrolled in this study. OI, reference standard, IOS with prefabricated aids, and SPG were performed for each patient. Distance and angle deviations between all pairs of abutment analogs, root mean square (RMS) errors between the aligned test and reference model, and chairside time were measured. The effect of inter-abutment distance, jaw (maxilla or mandible), number of implants, and arch length on deviations was analyzed. The mixed effect model was applied to analyze deviations and RMS errors. RESULTS: Fifteen consecutive individuals (6 females and 9 males, 47-77 years old) with 22 arches (9 upper and 13 lower jaws) and 115 implants were included. There was no significant difference in distance deviation comparing SPG and IOS with OI (p > .05). IOS showed a significantly greater angle deviation and RMS errors than SPG (median 0.40° vs. 0.31°, 69 µm vs. 45 µm, p < .01). The inter-abutment distance was negatively correlated with the accuracy of SPG and IOS (p < .05). The chairside time for IOS, SPG, and OI was 10.49 ± 3.50, 14.71 ± 2.86, and 20.20 ± 3.01 min, respectively (p < .01). CONCLUSIONS: The accuracy of SPG and IOS with prefabricated aids was comparable. IOS was the most efficient workflow.

Relevant domains, core outcome sets and measurements for implant dentistry clinical trials: The Implant Dentistry Core Outcome Set and Measurement (ID-COSM) international consensus report.

AIM: Lack of consistently reported outcomes limits progress in evidence-based implant dentistry and quality of care. The objective of this initiative was to develop a core outcome set (COS) and measurements for implant dentistry clinical trials (ID-COSM). MATERIALS AND METHODS: This Core Outcome Measures in Effectiveness Trials (COMET)-registered international initiative comprised six steps over 24 months: (i) systematic reviews of outcomes reported in the last 10 years; (ii) international patient focus groups; (iii) a Delphi project with a broad range of stakeholders (care providers, clinical researchers, methodologists, patients and industry representatives); (iv) expert group discussions organizing the outcomes in domains using a theoretical framework and identifying the COSs; (v) identification of valid measurement systems to capture the different domains and (vi) final consensus and formal approval involving experts and patients. The methods were modified from the best practice approach following the Outcome Measures in Rheumatoid Arthritis Clinical Trial and COMET manuals. RESULTS: The systematic reviews and patient focus groups identified 754 (665 + 89, respectively) relevant outcome measures. After elimination of redundancies and duplicates, 111 were formally assessed in the Delphi project. By applying pre-specified filters, the Delphi process identified 22 essential outcomes. These were reduced to 13 after aggregating alternative assessments of the same features. The expert committee organized them into four core outcome areas: (i) pathophysiology, (ii) implant/prosthesis lifespan, (iii) life impact and (iv) access to care. In each area, core outcomes were identified to capture both the benefits and harms of therapy. Mandatory outcome domains included assessment of surgical morbidity and complications, peri-implant tissue health status, intervention-related adverse events, complication-free survival and overall patient satisfaction and comfort. Outcomes deemed mandatory in specific circumstances comprised function (mastication, speech, aesthetics and denture retention), quality of life, effort for treatment and maintenance and cost effectiveness. Specialized COSs were identified for bone and soft-tissue augmentation procedures. The validity of measurement instruments ranged from international consensus (peri-implant tissue health status) to early identification of important outcomes (patient-reported outcomes identified by the focus groups). CONCLUSIONS: The ID-COSM initiative reached a consensus on a core set of mandatory outcomes for clinical trials in implant dentistry and/or soft tissue/bone augmentation. Adoption in future protocols and reporting on the respective domain areas by currently ongoing trials will contribute to improving evidence-informed implant dentistry and quality of care.