Mucoadhesive delivery systems for oral candidiasis treatment: A systematic review and meta-analysis.

OBJECTIVES: This systematic review and meta-analysis aimed to evaluate the clinical and mycological effectiveness of mucoadhesives as vehicles for drugs or natural products in the treatment of oral candidiasis. MATERIALS AND METHODS: The search for articles was carried out in the Medline/PubMed, SCOPUS, EMBASE, Web of Science, Cochrane Library, and SciELO databases before August 2023. We selected the studies, extracted the data, evaluated the study quality, graded the evidence, performed the risk of bias, and carried out meta-analysis. RESULTS: A total of 389 potentially relevant articles were identified, and 11 studies (1869 participants) met the inclusion criteria of the systematic review. The overall risk of bias was considered low. The most common presentation of mucoadhesives was tablets, with miconazole being the most frequently drug used in the delivery system. Mucoadhesives demonstrated comparable efficacy with topical or systemic antifungal agents, with no significant differences between treatments in terms of clinical (RR = 0.907; 95CI = 0.3-1.297; p = 0.591; I2 = 64.648) or mycological (RR = 0.95; 95CI = 0.667-1.360; p = 0.789; I2 = 73.271) efficacy. CONCLUSIONS: Mucoadhesives may be a suitable alternative to conventional treatments, with the advantage of reducing the frequency of application by up to 5 times and the daily dosage by up to 20 times.

Influence of ceramic crown design (translucent monolithic zirconia vs. bilayered) of implant-supported single crowns after mechanical cycling.

OBJECTIVES: This study aimed to assess the influence of translucent monolithic versus bilayered crowns and whether the use of a CoCr base abutments affects the fatigue and fracture resistance of screwed implant-supported single crowns with external connections under mechanical cycling. MATERIALS AND METHODS: Fifty specimens were divided into groups: (1) metal-ceramic (MC) crown, (2) veneered zirconia crown (Zr), (3) veneered zirconia crown with a CoCr base abutment (ZrB), (4) monolithic translucent zirconia crown (MZr), and (5) monolithic translucent zirconia crown with a CoCr base abutment (MZrB). Specimens underwent mechanical cycling (5 × 106 cycles; 150 N) evaluating fatigue resistance (number of failures) and those that failed were subsequently subjected to fractographic analyses (stereomicroscope and scanning electron microscope) to evaluate failure location and area, and maximum fracture load was also measured. RESULTS: The failure-related survival rate (100%) and maximum fracture resistance of the MZrB were significantly higher than those of MC and Zr (50%; p < 0.05). There were no significant differences in the failure rate and fracture resistance when a CoCr base abutment was used or not in the translucent monolithic Zr groups (p > 0.05;MZrB vs. MZr). Failure location, with MC crowns' fractures, noted at the screw area (p = 0.043), while all-ceramic crowns were mostly in the cuspid and to failure area, the Zr group had the largest mean (15.55 ± 9.17 mm2) among the groups, significant difference only when compared with MC (1.62 ± 0.81 mm2) (p = 0.025). CONCLUSIONS: Translucent monolithic zirconia crowns exhibited significantly higher fatigue and fracture resistance compared with conventional MC and bilayered crowns. CLINICAL SIGNIFICANCE: The appropriate choice of material and manufacturing technique is crucial for predicting the higher clinical performance of single crowns. Enhanced mechanical resistance in terms of fatigue and fracture resistance can be achieved by replacing MC and bilayered restorations with computer-aided design and computer-aided manufacturing monolithic zirconia.

Comparison of Manual (2D) and Digital (3D) Methods in the Assessment of Simulated Facial Edema.

BACKGROUND: An edema assessment following dental surgeries is essential to improving the dental surgeon's technique and, consequentially, patient comfort. PURPOSE: Two-dimensional (2D) methods are limited in analyzing 3-dimensional (3D) surfaces. Currently, 3D methods are used to investigate postoperative swelling. However, there are no studies that directly compare 2D and 3D methods. The goal of this study is to directly compare 2D and 3D methods used in the assessment of postoperative edema. STUDY DESIGN AND SAMPLE: The investigators implemented a prospective, cross-sectional study with each subject serving as its own control. The sample was composed of dental student volunteers without facial deformities. PREDICTOR VARIABLE: The predictor variable is the method used to measure edema. After simulating edema, manual (2D) and digital (3D) techniques were used to measure edema. The manual method used direct facial perimeter measurements. The two digital methods were photogrammetry using a smartphone (iPhone 11, Apple Inc, Cupertino, California), and facial scanning with a smartphone application (Bellus3D FaceApp, Bellus3D Inc, Campbell, California) [3D measurements] MAIN OUTCOME VARIABLE: The coefficient of variation (CV) (CV = standard deviation /mean) was used to assess homogeneity of edema measurements. ANALYSIS: The Shapiro-Wilk and equal variance tests were applied to assess data homogeneity. Next, one-way analysis of variance was performed, followed by a correlation analysis. Finally, the data were submitted to Tukey's test. The statistical significance threshold was set at 5% (P < .05). RESULTS: The sample was composed of 20 subjects aged 18-38 years. The CV showed higher values using the manual (2D) method (47%; 4.88% ± 2.99), compared with the photogrammetry method (18%; 8.55 mm ± 1.52) and the smartphone application (21%; 8.97 mm ± 1.93). A statistically significant difference was observed between the manual method values and those of the other two groups (P < .001). There was no difference between the facial scanning and photogrammetry groups (3D methods) (P = .778) CONCLUSION AND RELEVANCE: Both digital measuring methods (3D) demonstrated greater homogeneity than the manual method in analyzing facial distortions caused by the same swelling simulation. Therefore, it can be affirmed that digital methods may be more reliable that manual methods for assessing facial edema.

Evaluation of the clinical performance of dentures manufactured by computer-aided technology and conventional techniques: A systematic review.

STATEMENT OF PROBLEM: The introduction of computer-aided design and computer-aided manufacturing (CAD-CAM) technology for complete denture fabrication may have improved clinical outcomes compared with conventional techniques. However, systematic reviews comparing these techniques are lacking. PURPOSE: The purpose of this systematic review was to identify, compare, and synthesize the outcomes of published clinical studies related to complete denture fabrication, with respect to the differences between CAD-CAM technology and conventional techniques. MATERIAL AND METHODS: A comprehensive search of studies published up to March 16, 2020, was conducted by using the PubMed/MEDLINE, Web of Science, Cochrane Library, SciELO, and Embase databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement criteria and was registered in the International Prospective Register of Systematic Reviews (PROSPERO ID 42020202614). The population, intervention, comparison, and outcome (PICO) question was: Do CAD-CAM complete dentures have a similar functional performance to those fabricated by conventional techniques? The quality of publications was appraised by using the Critical Appraisal Skills Program (CASP) checklists. RESULTS: Of the 1232 titles, 6 articles were selected. The studies reported better retention of digitally manufactured complete dentures without denture adhesives than that of conventional complete dentures with or without denture adhesives. Other studies reported that dentures manufactured with digital systems were better adapted to tissue surfaces, required less clinical time, were lower in cost, and provided better experience and satisfaction to patients. CONCLUSIONS: The assessment of CAD-CAM planning and manufacturing through clinical studies is ongoing. However, preliminary results indicate better clinical performance and lower overall costs of digital complete dentures than conventional dentures.

Are implant-supported removable partial dentures a suitable treatment for partially edentulous patients? A systematic review and meta-analysis.

STATEMENT OF PROBLEM: A consensus on the clinical performance of implant-supported removable partial dentures (ISRPDs) is lacking. PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate the clinical performance of ISRPDs in terms of the implant survival rates, marginal bone loss, and patient-reported outcome measures (PROMs). MATERIAL AND METHODS: Four electronic databases (MEDLINE/PubMed, EMBASE, Web of Science, and Cochrane Library) were independently searched by 2 reviewers for articles published up to December 2020. A single-arm meta-analysis was performed to evaluate the implant survival rates and marginal bone loss by using the R program. The Cochrane collaboration tool was used to evaluate the risk of bias of randomized controlled trials (RCTs), and the Newcastle-Ottawa scale for non-RCT studies. RESULTS: Sixteen studies were included, with a total of 334 participants and a mean age of 58 years. The participants received a total of 581 dental implants, 475 conventional and 106 mini-implants. All included studies reported implant survival rate above 90% (range: 92% to 100%). Meta-analysis indicated a high proportion of implant survival rates of 3% (95% confidence interval [CI]: 2% to 5%) and a low mean raw score of marginal bone loss 0.98 mm (CI: 0.61 to 1.36 mm). Compared with conventional RPDs, improved patient quality of life and satisfaction were reported by studies that evaluated ISRPDs. RCT studies exhibited a low risk of bias for most domains, while most non-RCT studies were classified as good quality. CONCLUSIONS: ISRPDs exhibited high implant survival rates and acceptable bone loss with improvement in the quality of life and satisfaction of patients when compared with conventional RPDs. Therefore, they can be considered suitable for the rehabilitation of partially edentulous patients.

Photodynamic therapy in the treatment of denture stomatitis: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Photodynamic therapy is widely used in dentistry, but limited evidence exists regarding its effectiveness in treating denture stomatitis. High resistance to antifungals has been reported, and photodynamic therapy could be an alternative treatment. PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate whether photodynamic therapy is effective in reducing denture stomatitis. MATERIAL AND METHODS: A systematic review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and recorded in the prospective register of systematic reviews (PROSPERO) (CRD42020205589) to answer the population, intervention, control, outcome (PICO) question: "Is photodynamic therapy effective in the treatment of denture stomatitis when compared with the use of antifungal agents?" Electronic searches were performed in databases PubMed/MEDLINE, Cochrane library, and Web of Science for articles published until February 2021 by using the following terms: (denture stomatitis OR oral candidiasis) AND (low-level light therapy OR laser therapy OR lasers OR photodynamic therapies OR photochemotherapy) AND (antifungal drugs OR antifungal agents OR antimicrobial OR treatment). Clinical trials and randomized clinical trials, studies in the English language, and studies comparing antifungal agents with photodynamic therapy were included. RESULTS: In total, 5 articles were selected for the qualitative analysis and 3 for the meta-analysis. No significant difference was detected between antifungal therapy and photodynamic therapy in the reduction of colony-forming units on the palate. In a subgroup analysis, a significant difference was found in the reduction of colony-forming units on the palate at 15 days and at the denture surface at 30 days. CONCLUSIONS: Photodynamic therapy is effective in the treatment of denture stomatitis, but after 30 days and 15 days, the antifungals demonstrated better performance.

Attachment systems for mandibular implant-supported overdentures: A systematic review and meta-analysis of randomized controlled trials.

STATEMENT OF PROBLEM: Although mandibular implant-supported overdentures have been highly recommended as a treatment option, a consensus on the type of attachment systems that can be used to increase implant and prostheses survivability is lacking. PURPOSE: The purpose of this systematic review and meta-analysis was to compare different types of attachments for retention by investigating outcome measures such as implant and prosthesis survival rates and biological and prosthesis complications in participants with a mandibular implant-supported overdenture. MATERIAL AND METHODS: The search was performed in the PubMed, Cochrane, Embase, and Scopus databases by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria and registered with the International Prospective Register of Systematic Reviews (CRD42021253566). An analysis of association was conducted between different attachment systems and implant and overdenture survival rates in randomized controlled clinical trials. RESULTS: The initial search indicated 477 studies, of which 25 randomized controlled trials (RCTs) were included for analysis. A total of 2154 implants and 737 overdentures were analyzed in the meta-analysis. The main results indicated the failure rate for dental implants to be 2.0% (95% confidence interval [CI], 1.3 to 3.2) and overdentures 4.2% (95% CI, 1.6 to 10.5), respectively. With regard to different attachment systems, a similar failure rate was identified with bar-type retention (7.7% to 95% CI, 3.0 to 18.1), magnetic retention systems (7.6% to 95% CI, 2.2 to 22.7), and ball-type retention (6.8% to 95% CI, 3.0 to 14.3). No significant difference was found in biological complications for splinted and unsplinted implant overdentures (P=.902). Regarding prosthetic complications, the most favorable groups were LOCATOR attachments followed by telescopic and Conus, bar, and ball attachments. Magnet attachments had higher prosthetic complications (7.4 times) than the other attachments. CONCLUSIONS: Implants and implant-supported mandibular overdentures showed a high survival rate irrespective of the attachment system used. Splinting implants did not significantly affect the rate of biological complications. Prosthetic complications were most common for magnet and least common for LOCATOR attachments.

Survival and prosthetic complications of monolithic ceramic implant-supported single crowns and fixed partial dentures: A systematic review with meta-analysis.

STATEMENT OF PROBLEM: Monolithic ceramic implant-supported restorations have been used to rehabilitate partially edentulous patients. However, knowledge of the survival and prosthetic complications of single crowns (SCs) and fixed partial dentures (FPDs) is limited. PURPOSE: The purpose of this systematic review with meta-analysis was to evaluate the clinical performance of monolithic ceramic implant-supported SCs and FPDs in terms of survival and prosthetic complication rates. MATERIAL AND METHODS: The systematic review was registered on the prospective register of systematic reviews (PROSPERO) (CRD42017078568). Five electronic databases were independently searched by 2 authors for articles published until May 2022. In addition, a hand search was performed in the nonpeer-reviewed literature, specific journals, and reference lists of included articles. A single-arm meta-analysis was performed by using the R program. The risk of bias and quality were assessed using the Cochrane risk of bias tools and the Newcastle-Ottawa scale. RESULTS: Twenty-eight studies were included in the quantitative synthesis. A total of 1298 monolithic ceramic implant-supported restorations (1116 SCs and 182 FPDs) were evaluated in 1193 participants, with a median observation time of 24 months (range: 12 to 72 months). Meta-analysis indicated the proportion of failures and prosthetic complication rates of 2% (95% confidence interval [CI]: 1% to 4%) for SCs. No difference was observed for monolithic zirconia and lithium disilicate SCs. In the FPDs, only monolithic zirconia was considered, with 1 failure reported totaling the proportion of failures of 0% (0% to 1%) and complication rates of 4% (0% to 12%). The most complications reported for both types of restorations were screw loosening, debonding, and minor chipping and were considered repairable. The included studies showed a low risk of bias and good quality. CONCLUSIONS: The use of monolithic ceramic implant-supported SCs, independent of ceramic material, and monolithic zirconia implant-supported FPDs should be considered an effective and safe treatment option because of favorable short-term survival and low prosthetic complications. However, additional well-conducted studies with a longer-term follow-up and direct comparison between veneered restorations are recommended to reassess clinical performance.

Computer-aided technology for fabricating removable partial denture frameworks: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: A consensus that establishes the indications and clinical performance of removable partial denture (RPD) frameworks designed and manufactured with computer-aided design and computer-aided manufacturing (CAD-CAM) systems is lacking. PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate the currently published literature investigating different CAD-CAM methods and techniques for RPD manufacturing and their clinical performance. MATERIAL AND METHODS: A comprehensive search of studies published up to September 2019 was performed in PubMed/MEDLINE, Web of Science, Cochrane Library, and SciELO databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA Statement) criteria and was registered and approved in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42020152197). The population, intervention, comparison, outcome (PICO) question was "Do the CAD-CAM frameworks have similar performances to those fabricated by conventional techniques?" The meta-analysis included clinical and in vitro studies based on the effect size and test of Null (2-Tail) with 95% confidence interval (CI). Clinical and in vitro studies were selected and analyzed separately. RESULTS: A total of 15 articles out of 358 were selected. For clinical studies, quantitative analysis with a sample of 25 participants showed a mean discrepancy between occlusal rests and rest seats of 184.91 µm (95% CI: 152.6 µm-217.15 µm) and heterogeneity (I2) of 0%. Clinical data considered that frameworks were acceptable for continuity of treatment. The predominant materials were cobalt-chromium (Co-Cr) and polyetheretherketone (PEEK), and studies using Co-Cr reported that the structure required adjustments. In addition, it has been reported that the indirect technique was time-consuming and selective laser melting (SLM) can be costly. PEEK structures have been more widely accepted because of improved esthetics. Quantitative data from the in vitro studies revealed that the additive manufacturing technique (2.006 mm: 95% CI: -2.021 mm to 6.032 mm) was not significantly different from the indirect technique (0.026 mm; P=.455; random: I2: 98.402%). CONCLUSIONS: Clinical studies and in vitro research on CAD-CAM planning and manufacturing of removable prosthesis frameworks are still sparse. However, preliminary data indicate a similar fit and esthetic improvement when compared with the conventional technique.

Toxicity potential of denture adhesives: A scoping review.

STATEMENT OF PROBLEM: Denture adhesives are widely used products, but limited evidence regarding their toxicity is available. PURPOSE: The purpose of this scoping review was to map the existing literature on the toxic potential of denture adhesives. MATERIAL AND METHODS: This scoping review was structured based on the 5-step methodology proposed by Arksey and O'Malley and The Joanna Briggs Institute Manual for Evidence Synthesis and followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. The methods were registered on the Open Science Framework (). The following research question was formulated: Are there any toxic effects related to the use of denture adhesives? The electronic literature search was performed independently by 2 authors in the following databases: PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library. The inclusion criteria were in vitro and clinical studies; studies that evaluated the cytotoxic properties of denture adhesives as local or systemic implications; and studies published in English. RESULTS: The search conducted in October 2020 provided 1099 articles. In total, 33 studies were included, 14 in vitro and 19 clinical studies. Commercially available denture adhesives have a dose-dependent cytotoxic effect on fibroblasts and keratinocytes, with poor cell recovery noted in older human fibroblasts. Patients presented different levels of neurologic or hematological alterations associated with the excessive use of denture adhesives. CONCLUSIONS: Most commercially available denture adhesives have a dose-dependent cytotoxic effect, and the use of well-adapted removable dental prostheses, proper patient follow-ups, and correct instructions for their use when indicated should be a priority.

Fixed partial dentures in adult patients with cleft lip and palate and their relationship with the quality of life: A cross-sectional clinical study.

STATEMENT OF PROBLEM: Reports on the impact of fixed partial denture treatments on the quality of life of patients with cleft lip and palate are lacking. PURPOSE: The purpose of this cross-sectional clinical study was to assess the impact of fixed partial dentures on the quality of life of adults with cleft lip and palate. MATERIAL AND METHODS: A total of 52 participants (23 women and 29 men) with cleft lip and palate, aged between 20 and 50 years old, and who required treatment with fixed partial dentures were enrolled in the study. They responded to the Oral Health Impact Profile (OHIP)-14 questionnaire before and 30 days after the fixed prosthodontic treatment. The final value from the OHIP-14 was generated by totaling the 14 answers, giving a range from 0 to 56, with higher values indicating a worse relationship between oral health and the quality of life. Nonparametric statistical analysis was performed with the Wilcoxon test (α=.05). RESULTS: Forty-six participants reported some negative experience before the fixed partial denture, and 48 indicated an improved quality of life 30 days after delivery. All domains assessed showed significant quality of life improvements between the periods compared (P≤.014). CONCLUSIONS: Oral treatment with fixed partial dentures improved the quality of life in adults with cleft lip and palate.

Does microwave disinfection affect the dimensional stability of denture base acrylic resins? A systematic review.

OBJECTIVE: To systematically evaluate the effect of microwave disinfection on the dimensional stability of denture base acrylic resins. BACKGROUND: Microwave disinfection has been considered as an alternative method for disinfecting complete dentures to help prevent and treat denture stomatitis. However, data on the impact of microwave disinfection on the dimensional stability of acrylic resins are still scarce. METHODS: The PubMed/Medline, SCOPUS and EMBASE databases were searched in order to assess articles published in English up to January 2021 (CRD42021212267). We included studies that have assessed the effect of microwave disinfection, on the dimensional stability of acrylic resins, comparing them with negative or positive controls. RESULTS: A total of seven in vitro studies were included. The qualitative synthesis demonstrated that, in general, microwave disinfection produced more distortion on the materials than do immersion in sodium hypochlorite, chloride solution, chlorhexidine, and water immersion. However, considering the dimensional stability of the specimens, microwave disinfection at 500 W for 3 minutes, and at 450 W for 5 minutes, produced similar or better outcomes than did control groups. CONCLUSION: In general, microwave disinfection promotes changes in the dimensional stability of denture base acrylic resins, and should thus be used with caution. However, microwave disinfection protocols at lower power settings (500 and 450 W) and exposure times (3 and 5 minutes) produces similar or less distortion than chemical disinfection. More studies are still required in order to evaluate the clinical and long-term implications of microwave disinfection.

Materials Sealing Preventing Biofilm Formation in Implant/Abutment Joints: Which Is the Most Effective? A Systematic Review and Meta-Analysis.

The purpose of this systematic review was to evaluate the literature available for materials exhibiting the best efficacy in preventing biofilm formation in the interior of implants. We searched PubMed/MEDLINE, Scopus, and Cochrane databases. This review is registered with the PROSPERO database and followed the suitability of the PRISMA protocol. The initial search resulted in 326 articles from the databases. After they were read, 8 articles remained, and the inclusion and exclusion criteria were applied. Six of these 8 articles were classified as in vitro and 2 were classified as in situ. The regions of the implants evaluated ranged from the interface of the pieces to the occlusal upper access of the abutment. The implant connections evaluated the Morse taper, external connection, and internal connection. Meta-analysis of the quantitative data was performed at a significance level of .05. Cotton exhibited poor control of infiltration, even in combination with other materials. Isolated gutta-percha (GP) and polytetrafluoroethylene (PTFE) tape with composite resin (CR) or GP performed better as physical barriers. The best results for chemical barriers were observed by the application of 1% chlorhexidine gluconate (CG) gel, thymol varnish, and the deposition of Ag films onto the surface. The applied meta-analysis did not show a significant difference in comparison between the different types of implant connections (P > .05). The application of CG and thymol varnish antimicrobials was effective in preventing biofilm formation and easy clinical execution; these could be used in combination with CR, GP, and PTFE.

Surgical versus non-surgical treatment of actinic cheilitis: A systematic review and meta-analysis.

OBJECTIVE: The aim of this systematic review was to compare outcomes between surgical and non-surgical treatment of actinic cheilitis (AC). MATERIALS AND METHODS: A systematic review and meta-analysis based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses guideline were performed. A search of PubMed/MEDLINE, Web of Science, and Cochrane Library databases was conducted. Articles were selected based on the inclusion criteria: randomized clinical trials, prospective/retrospective studies, and case series with at least 10 patients, with a minimum follow-up period of 6 months. A weighted remission rate (RER) and recurrence rate (RR) with a 95% confidence interval was performed. Data analysis was performed using a comprehensive meta-analysis software. RESULTS: A total of 283 ACs in 10 studies were included. About 2.5% surgically treated cases underwent malignant transformation. The weighted remission rate was higher for surgical (92.8%) compared to non-surgical treatment (65.9%). The recurrence rate was lower for surgical (8.4%) compared to non-surgical treatment (19.2%). CONCLUSION: In this systematic review, the surgical treatment was more favorable than non-surgical for AC. Meanwhile, further studies are needed that should maximize methodological standardization and have greater rigor of the data collection process.

Optimal number of implants for complete-arch implant-supported prostheses with a follow-up of at least 5 years: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Consensus is lacking regarding the optimal number of implants for supporting complete-arch prostheses with good survival rates and lower prosthetic complications and marginal bone loss. PURPOSE: The purpose of this systematic review was to evaluate the influence of the number of implants used for complete-arch prostheses with at least 5 years of follow-up. MATERIAL AND METHODS: A search was performed in the PubMed/MEDLINE, Scopus, and Cochrane Library databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria and was registered in The International Prospective Register of Systematic Reviews (CRD42016048468). The following was the population, intervention, comparison, outcome (PICO) question: Does the number of implants influence the longevity of complete-arch prostheses? RESULTS: Nineteen studies including 1006 patients with a mean age of 61.44 years were selected for evaluation. The number of implants per jaw ranged between 2 and 9 in the maxilla, mandible, or both jaws. For implant survival rate in complete-arch prostheses with fewer than 5 implants per jaw, the pooled weighted event rate was 1.4% (I2=25.26%; P=.211) and 4.2% (I2=81.35%; P<.001) for complete arches with more than 4 implants per jaw. For the prosthesis survival rate, the pooled weighted event rate for a complete-arch with fewer than 5 implants per jaw was 1.5% (I2=0%; P=.677) and 9% (I2=17.33%; P=.304) for complete arches with more than 4 implants per jaw. For prosthesis complications for complete arches with fewer than 5 implants per jaw, the pooled weighted event rate was 19.9% (I2=93.5%; P<.001) and 24.5% (I2=88.89; P<.001) for complete arches with more than 4 implants per jaw. The mean marginal bone loss for complete arches with fewer than 5 implants per jaw was 1.22 ±0.49 mm (I2=99.46; P<.001) and 1.46 ±0.46 mm (I2=99.6; P <.001) for more than 4 implants per jaw. CONCLUSIONS: The current systematic review indicated no relationship of the number of implants used to support a complete-arch prosthesis with implant survival rate, prosthesis survival rate, prosthesis complications, or marginal bone loss in studies with follow-up periods of between 5 and 15 years.

Effectiveness of Corticoid Administration in Orthognathic Surgery for Edema and Neurosensorial Disturbance: A Systematic Literature Review.

PURPOSE: The aim of this systematic review was to evaluate the effect of corticosteroid (CS) administration on edema and neural regeneration in orthognathic surgery. MATERIALS AND METHODS: A systematic literature search was conducted using the PubMed (Medline), Cochrane Library, and Scopus databases. The PICO approach was used, in which patients with skeletal dentofacial deformity composed the population; uni- or bimaxillary orthognathic surgery composed the intervention; administration versus no administration of CSs composed the comparison; and decrease in postoperative edema and neurosensory disorders composed the outcome. Thirty of 240 articles were selected and evaluated for their titles and abstracts in relation to the inclusion and exclusion criteria. After duplicate references were eliminated, 8 articles remained. RESULTS: Patients who used CSs had lower rates of edema. In fact, after 4 months, there were no remarkable edema rates. These results suggest that neurosensory disorders resolved after 3 months. In addition, in the early and late periods, administration of CSs did not influence the regression of neurosensory disorders. CONCLUSIONS: Administering CSs in orthognathic surgery improved the regression of facial edema independent of the dosage used but did not influence neurosensory disorders.

Evaluation of the effect of an offset implant configuration in the posterior maxilla with external hexagon implant platform: A 3-dimensional finite element analysis.

STATEMENT OF PROBLEM: Slight offset of the central implant in 3-unit implant-supported prostheses has been reported to improve biomechanical behavior. However, studies that assessed the effects of an offset implant configuration in the posterior maxilla are scarce. PURPOSE: The purpose of this 3-dimensional (3D) finite element analysis was to assess the effects of splinting in 3-unit implant-supported prostheses with varying implant positions (straight-line or offset configuration) in terms of the stress/strain distribution on bone tissue and the stress distribution on abutment screws. MATERIAL AND METHODS: Three 3D models were used to simulate a posterior maxilla bone block (type IV): straight-line implants supporting single crowns (model M1), straight-line implants supporting 3-unit splinted fixed dental prosthesis (model M2), and an offset implant configuration supporting 3-unit splinted fixed dental prosthesis (model M3). The applied forces were 400 N axially and 200 N obliquely. The type of implant platform simulated was an external hexagon. von Mises stress on the abutment screws was measured, and the maximum principal stress and microstrain values were used to perform cortical bone tissue analysis. Analysis of variance (ANOVA) and the Tukey honest significant differences post hoc test were used to determine the significance of the results and interactions among the main variables (α=.05). RESULTS: In all models, oblique load increased the stress on abutment screws and bone tissue and the microstrain on bone tissue. Model M3 decreased the stress concentration on the abutment screws and bone tissue. With regard to microstrain distribution, model M3 had the smallest values, and M1 and M2 had similar values. CONCLUSIONS: Splinting associated with an offset implant configuration was effective for decreasing the stress on abutment screws and bone tissue and the microstrain on bone tissue.

Evaluation of cement-retained versus screw-retained implant-supported restorations for marginal bone loss: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: No consensus has been reached on which retention system, cement- or screw-retained, is best to avoid bone loss around the implant of a fixed implant-supported restoration. PURPOSE: The purpose of this systematic review and meta-analysis was to compare cement- and screw-retained retention systems in fixed implant-supported restorations in terms of marginal bone loss, implant survival, and prosthetic complications. MATERIAL AND METHODS: A comprehensive search of studies published from January 1995 to March 2015 and listed in the PubMed/MEDLINE, Embase, Scopus and the Cochrane Library databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The meta-analysis was based on the Mantel-Haenszel and inverse variance methods. Marginal bone loss was the continuous outcome measure evaluated by mean difference (MD), and implant survival and prosthetic complications were the dichotomous outcome measures evaluated by risk ratio (RR), both with corresponding 95% confidence intervals (CI). RESULTS: The 20 studies selected for review evaluated 2139 participants, whose mean age was 47.14 years and who had received 8989 dental implants. The mean follow-up was 65.4 months (range: 12-180 months). Results of the MD for marginal bone loss showed statistically significant differences in favor of the cement-retained prosthesis (P =.04; MD: -0.19; CI: -0.37 to -0.01). The implant survival rate was higher for the cement-retained prosthesis (P =.01; RR: 0.49; CI: 0.28 to 0.85), and the prosthetic complication rate was higher for the screw-retained prosthesis (P =.04; RR: 0.52; CI: 0.28 to 0.98). Additional analysis of the mean plaque index did not show differences between retention systems (P=.58; MD: 0.13; CI: -0.32 to 0.57). CONCLUSIONS: The current meta-analysis indicated that cement-retained, fixed implant-supported restorations showed less marginal bone loss than screw-retained, fixed implant-supported restorations during the follow-up period, which ranged from 12 to 180 months. However, the small difference between the mean values may not show clinical significance. The rates of prosthetic complication and implant survival also compared favorably with cement-retained prostheses.

Three-Dimensional Finite Element Analysis of Anterior Single Implant-Supported Prostheses with Different Bone Anchorages.

The aim of this study was to evaluate the stress distribution of monocortical and bicortical implant placement of external hexagon connection in the anterior region of the maxilla by 3D finite element analysis (FEA). 3D models were simulated to represent a bone block of anterior region of the maxilla containing an implant (4.0 × 10.0 mm) and an implant-supported cemented metalloceramic crown of the central incisor. Different techniques were tested (monocortical, bicortical, and bicortical associated with nasal floor elevation). FEA was performed in FEMAP/NeiNastran software using loads of 178 N at 0°, 30°, and 60° in relation to implant long axis. The von Mises, maximum principal stress, and displacement maps were plotted for evaluation. Similar stress patterns were observed for all models. Oblique loads increased the stress concentration on fixation screws and in the cervical area of the implants and bone around them. Bicortical technique showed less movement tendency in the implant and its components. Cortical bone of apical region showed increase of stress concentration for bicortical techniques. Within the limitations of this study, oblique loading increased the stress concentrations for all techniques. Moreover, bicortical techniques showed the best biomechanical behavior compared with monocortical technique in the anterior maxillary area.

Influence of parafunctional loading and prosthetic connection on stress distribution: a 3D finite element analysis.

STATEMENT OF PROBLEM: Clinicians should consider parafunctional occlusal load when planning treatment. Prosthetic connections can reduce the stress distribution on an implant-supported prosthesis. PURPOSE: The purpose of this 3-dimensional finite element study was to assess the influence of parafunctional loading and prosthetic connections on stress distribution. MATERIAL AND METHODS: Computer-aided design software was used to construct 3 models. Each model was composed of a bone and an implant (external hexagon, internal hexagon, or Morse taper) with a crown. Finite element analysis software was used to generate the finite element mesh and establish the loading and boundary conditions. A normal force (200-N axial load and 100-N oblique load) and parafunctional force (1000-N axial and 500-N oblique load) were applied. Results were visualized as the maximum principal stress. Three-way analysis of variance and Tukey test were performed, and the percentage of contribution of each variable to the stress concentration was calculated from sum-of squares-analysis. RESULTS: Stress was concentrated around the implant at the cortical bone, and models with the external hexagonal implant showed the highest stresses (P<.001). Oblique loads produced high tensile stress concentrations on the site opposite the load direction. CONCLUSIONS: Internal connection implants presented the most favorable biomechanical situation, whereas the least favorable situation was the biomechanical behavior of external connection implants. Parafunctional loading increased the magnitude of stress by 3 to 4 times.