RESUMO
OBJECTIVES: To determine the prevalence of peri-implant diseases in patients treated in a university setting without a regular peri-implant supportive therapy schedule, and to identify the risk indicators associated with peri-implantitis. MATERIAL AND METHODS: A retrospective cohort study was made of patients with dental implants with at least 12 months of functional loading who did not receive regular peri-implant supportive therapy. Patient- and implant-related variables were retrieved, and clinical and radiological examinations were performed. Descriptive and bivariate analyses and multilevel logistic regression analyses were performed to identify factors associated with peri-implantitis. RESULTS: A total of 213 implants in 88 patients were analyzed. The patient-level prevalence of peri-implantitis and peri-implant mucositis was 26.1% (95%CI: 16.7%-35.5%) and 44.3% (95%CI: 34.0%-54.6%), respectively. Peri-implant diseases were significantly more frequent when the width of the keratinized mucosa was < 2 mm (OR = 5.26; 95%CI: 1.24-22.26; p = 0.024), and when there was 12 month post-loading bone loss (OR = 2.96; 95%CI: 1.35-6.52; p = 0.007). CONCLUSIONS: Peri-implantitis is a common finding in patients without regular peri-implant supportive therapy (prevalence 16.7-35.5%). A thin peri-implant keratinized mucosa (< 2 mm) and a higher degree of bone remodeling after loading seem to be the main risk factors for peri-implantitis in this patient profile. CLINICAL RELEVANCE: Patients who do not engage in supportive peri-implant maintenance have a higher risk of peri-implantitis. A thin keratinized mucosa and bone loss during the first year of loading are predisposing factors for peri-implantitis.
Assuntos
Peri-Implantite , Humanos , Peri-Implantite/epidemiologia , Peri-Implantite/etiologia , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Prevalência , Idoso , Implantes Dentários/efeitos adversos , AdultoRESUMO
INTRODUCTION: An evaluation was made of the psychometric properties of a Spanish version of the Consultation and Relational Empathy Measure (CARE) to assess relational empathy in undergraduate dental students. In addition, the influence of demographic, socio-economic and consultation-related factors upon the degree of perceived empathy and overall satisfaction was studied. MATERIALS AND METHODS: A cross-sectional study was carried out in patients seen in the Oral Surgery Unit by fourth year dental students. Dentists, specialized translators and psychologists developed the translation of the questionnaire. After a pilot test, a convenience sample of patients was included. Construct validity was tested by factor analysis using principal component analysis with varimax rotation and Kaiser standardization, and internal consistency was assessed by Cronbach's α. RESULTS: Two pilot tests were carried out with a panel of experts until the final version of the questionnaire was established. In the validation stage, 191 patients participated (92 men and 99 women), with a mean age of 52.5 ± 17 years. The mean score of the CARE measure was 47.2 ± 4.4, and 57.6% of the patients (n = 110) reported the maximum score on the questionnaire. The final version showed a 1-factor solution explaining 68.6% of the total variance, with excellent final internal consistency (α = 93.4%). CONCLUSION: The Spanish version of the CARE measure affords high reliability and validity in assessing relational empathy in dental students. Perceived empathy is related to overall satisfaction. Patient demographics and the number of visits do not influence perceived empathy.
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Empatia , Estudantes de Odontologia , Masculino , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Estudos Transversais , Reprodutibilidade dos Testes , Educação em Odontologia , Psicometria , Inquéritos e Questionários , Encaminhamento e ConsultaRESUMO
OBJECTIVES: To assess dental implant placement accuracy with a dynamic computer-assisted implant surgery (dCAIS) system and a freehand approach. Secondarily, to compare the patients' perception and quality of life (QoL) with the two approaches. METHODS: A double-arm randomized clinical trial was conducted. Consecutive partially edentulous patients were randomly allocated to the dCAIS or standard freehand approach groups. Implant placement accuracy was evaluated by overlapping the preoperative and postoperative Cone Beam Computer Tomographs (CBCT) and recording linear deviations at the implant apex and platform (in mm) and angular deviations (in degrees). Questionnaires recorded self-reported satisfaction, pain and QoL during surgery and postoperatively. RESULTS: Thirty patients (22 implants) were enrolled in each group. One patient was lost to follow-up. A significant difference (p < .001) in mean angular deviation was found between the dCAIS (4.02°; 95% CI: 2.85 to 5.19) and the FH (7.97°; 95% CI: 5.36 to 10.58) groups. Linear deviations were significantly lower in the dCAIS group, except for the apex vertical deviation, where no differences were found. Although dCAIS took 14 min longer (95% CI: 6.43 to 21.24; p < .001), patients in both groups considered the surgical time acceptable. Postoperative pain and analgesic consumption during the first postoperative week were similar between groups and self-reported satisfaction was very high. CONCLUSION: dCAIS systems significantly increase the accuracy of implant placement in partially edentulous patients in comparison with the conventional freehand approach. However, they increase the surgical time significantly and do not seem to improve patient satisfaction or reduce postoperative pain.
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Implantes Dentários , Boca Edêntula , Cirurgia Assistida por Computador , Humanos , Qualidade de Vida , Implantação Dentária Endóssea , Tomografia Computadorizada de Feixe Cônico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Desenho Assistido por Computador , Imageamento TridimensionalRESUMO
STATEMENT OF PROBLEM: The implant abutment connection interface has been considered one of the major factors affecting the outcome of implant therapy. However, drawbacks of traditional meta-analyses are the inability to compare more than 2 treatments at a time, which complicates the decision-making process for dental clinicians, and the lack of a network meta-analysis. PURPOSE: The purpose of this network meta-analysis was to assess whether the implant abutment connection influences the outcome of implant-supported prostheses. MATERIAL AND METHODS: An electronic search was undertaken to identify all randomized clinical trials comparing the effect of at least 2 different implant abutment connection designs published from 2009 up to May 2020. Outcome variables were implant survival rate, peri-implant marginal bone loss, and biologic and prosthetic complication rates at 12 months after prosthetic loading. Relevant information was extracted, and quality and risk of bias assessed. Pairwise meta-analyses and network meta-analyses based on a multivariate random-effects meta-regression were performed to assess the comparisons (α=.05 for all analyses). RESULTS: For peri-implant marginal bone loss and prosthetic complications, conical interfaces were determined to be the most effective, with significant differences when compared with external hexagonal connections (P=.011 and P=.038, respectively). No significant differences were found among the implant abutment connections in terms of survival and biologic complications (P>.05 in all direct, indirect, and mixed comparisons). CONCLUSIONS: After 1 year of loading, conical connections showed lower marginal bone loss and fewer prosthetic complications than external hexagonal connections. However, the implant abutment connection design had no influence on the implant survival and biologic complication rates.
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Produtos Biológicos , Implantes Dentários , Metanálise em Rede , Projeto do Implante Dentário-Pivô , Prótese Dentária Fixada por Implante , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
AIM: To present a minimally invasive approach to expose palatally displaced canines (PDCs) using a surgical guide. MATERIALS AND METHODS: Surgical guides for palatal canine exposure are fabricated with CAD/CAM technology. With adequate software, it is possible to match the STL files of the dental arch with the DICOM images of the maxilla. On the STL 3D model file, the operator can localize and determine the exact position of the impacted canine. In turn, this allows the identification of the ideal location of the window. A software application facilitates the design of the surgical guide, which is printed using a 3D printer. RESULTS: Exposure of PDCs can be achieved satisfactorily using surgical guides. CONCLUSIONS: The use of computer-guided surgical exposure of PDCs allows both the reduction of surgical time and surgical invasiveness, minimizing patients' postoperative discomfort. Controlled clinical trials are necessary to evaluate more fully any advantages of this minimally invasive technique.
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Maxila , Software , Humanos , Maxila/cirurgia , Computadores , Dente Canino/cirurgiaRESUMO
OBJECTIVE: To determine the usefulness of Serum C-terminal telopeptide cross-link of type 1 collagen (sCTX) as a preoperative marker for predicting the risk of developing medication-related osteonecrosis of the jaws (MRONJ) after invasive oral surgery in patients on antiresorptive medication. MATERIALS AND METHODS: Two authors independently searched four electronic databases up to March 25, 2021, for case-control studies and prospective and retrospective cohort studies that assessed preoperative sCTX levels in patients taking antiresorptive medication who underwent oral surgery procedures. The main outcome was the number of MRONJ cases in patients with an sCTX value lower and higher than 150 pg/mL. Qualitative and quantitative data was extracted in tables and the risk of bias was assessed using the QUADAS-2 tool. Estimates of diagnostic accuracy were expressed as sensitivity, specificity, negative and positive likelihood ratio (LR - and LR +), and diagnostic odds ratio (DOR), with a 95% confidence interval (95%CI). The data were combined using random-effects models based on the inverse variance method. RESULTS: Seven studies were included in the meta-analysis. The results were as follows: sensitivity 57% (95%CI: 41-71%), specificity 72% (95%CI: 64-79%), LR + 2 (95%CI: 1.3-3.1), LR - 0.6 (95%CI: 0.4-0.9), and DOR 3.4 (95%CI: 1.5-7.7). CONCLUSIONS: The low overall performance of sCTX indicates that this parameter is not suitable for predicting MRONJ risk in patients on antiresorptive medication who need an oral surgery procedure. CLINICAL RELEVANCE: sCTX should not be considered a reliable preoperative marker to predict MRONJ development.
Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Conservadores da Densidade Óssea , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/diagnóstico , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/tratamento farmacológico , Conservadores da Densidade Óssea/efeitos adversos , Colágeno Tipo I , Testes Diagnósticos de Rotina , Difosfonatos/efeitos adversos , Humanos , Arcada Osseodentária , Estudos Prospectivos , Estudos Retrospectivos , Fatores de RiscoRESUMO
The main objective of this study was to compare the clinical and histological results of synthetic bone substitutes used in maxillary sinus floor augmentation. A systematic review and meta-analysis was performed by searching the PubMed/MEDLINE, Scopus, and Cochrane databases for studies of the success of endosseous dental implant, implant failure, peri-implant marginal bone loss, newly formed bone, and residual bone graft material. After the search, 10 randomized clinical trials were included, with 4 studies ranging from low to unclear risk of bias were used for meta-analysis, comparing biphasic calcium phosphate (BCP) and deproteinized bovine bone (DBB). A greater amount of residual graft material (mean difference [MD]: -4.80 mm; 95% CI: -9.35 to -0.26; P = .040) was found in the DBB group. No other statistically significant differences were found between BCP and DBB for the remaining outcomes. Our results suggested that BCP can be considered a suitable alternative to DBB in maxillary sinus floor augmentation due to its clinical and histological results.
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Substitutos Ósseos , Implantes Dentários , Levantamento do Assoalho do Seio Maxilar , Animais , Substitutos Ósseos/uso terapêutico , Bovinos , Implantação Dentária Endóssea/métodos , Seio Maxilar/cirurgia , Levantamento do Assoalho do Seio Maxilar/métodosRESUMO
OBJECTIVES: To assess the accuracy of dynamic computer-aided implant surgery (dCAIS) systems when used to place dental implants and to compare its accuracy with static computer-aided implant surgery (sCAIS) systems and freehand implant placement. MATERIALS AND METHODS: An electronic search was made to identify all relevant studies reporting on the accuracy of dCAIS systems for dental implant placement. The following PICO question was developed: "In patients or artificial models, is dental implant placement accuracy higher when dCAIS systems are used in comparison with sCAIS systems or with freehand placement? The main outcome variable was angular deviation between the central axes of the planned and final position of the implant. The data were extracted in descriptive tables, and a meta-analysis of single means was performed in order to estimate the deviations for each variable using a random-effects model. RESULTS: Out of 904 potential articles, the 24 selected assessed 9 different dynamic navigation systems. The mean angular and entry 3D global deviations for clinical studies were 3.68° (95% CI: 3.61 to 3.74; I2 = 99.4%) and 1.03 mm (95% CI: 1.01 to 1.04; I2 = 82.4%), respectively. Lower deviation values were reported in in vitro studies (mean angular deviation of 2.01° (95% CI: 1.95 to 2.07; I2 = 99.1%) and mean entry 3D global deviation of 0.46 mm (95% CI: 0.44 to 0.48 ; I2 = 98.5%). No significant differences were found between the different dCAIS systems. These systems were significantly more accurate than sCAIS systems (mean difference (MD): -0.86°; 95% CI: -1.35 to -0.36) and freehand implant placement (MD: -4.33°; 95% CI: -5.40 to -3.25). CONCLUSION: dCAIS systems allow highly accurate implant placement with a mean angular of less than 4°. However, a 2-mm safety margin should be applied, since deviations of more than 1 mm were observed. dCAIS systems increase the implant placement accuracy when compared with freehand implant placement and also seem to slightly decrease the angular deviation in comparison with sCAIS systems. CLINICAL RELEVANCE: The use of dCAIS could reduce the rate of complications since it allows a highly accurate implant placement.
Assuntos
Implantes Dentários , Cirurgia Assistida por Computador , Desenho Assistido por Computador , Computadores , Tomografia Computadorizada de Feixe Cônico , Implantação Dentária Endóssea , Humanos , Margens de ExcisãoRESUMO
INTRODUCTION: The aim of the present meta-analysis was to determine the effect of the different incision designs used in apical surgery on periodontal parameters. METHODS: An electronic search in Cochrane Library, Pubmed (MEDLINE), and Scopus was conducted on April 2020. Two independent investigators included clinical trials and prospective cohort studies comparing the influence of different incision designs used in apical surgery on gingival recession, periodontal probing depth, and clinical attachment level. A pairwise and network meta-analysis was performed in order to meta-analyze the direct and the indirect comparisons among the incision designs. RESULTS: Six articles were included for the qualitative and the quantitative syntheses, involving a total of 401 teeth (372 patients). The pairwise meta-analysis did not reveal statistically significant differences between the incision designs in any of the outcomes evaluated. However, to reduce the amount of buccal gingival recession, the papilla base incision presented the highest probabilities of being ranked the most effective incision (85.7%), followed by submarginal incision (50.0%) and intrasulcular incision (14.3%). CONCLUSION: Regardless of the incision design used, the periodontal parameters did not statistically differ after apical surgery. CLINICAL RELEVANCE: Periodontal parameters did not significantly change despite the incision used in apical surgery. However, based on the results of the present review, the papilla base incision seems to be the best option to reduce the amount of buccal gingival recession.
Assuntos
Gengiva , Retração Gengival , Apicectomia , Assistência Odontológica , Retração Gengival/cirurgia , Humanos , Estudos ProspectivosRESUMO
OBJECTIVE: To compare the efficacy and safety of inferior alveolar nerve blocks (IANB) with additional buccal infiltration (standard technique) and of buccal and lingual anaesthetic infiltration (experimental technique) for lower third molar (L3M) extractions. STUDY DESIGN: A randomised, double-blind clinical trial involving 129 L3M extractions was conducted. In the IANB group, an IANB was performed using the conventional approach, followed by a buccal injection in the extraction area. In the infiltration group (INF), an infiltration was performed in the buccal and lingual areas of the lower second molar. A 4% articaine solution was employed in all cases. The main outcome variable was anaesthetic efficacy. Other variables like intraoperative and postoperative pain, onset time and adverse events were also recorded. Descriptive and bivariate analyses of the data were made. RESULTS: 120 patients were randomised. The IANB group showed significantly higher anaesthetic efficacy than the INF group (64.4 vs. 45.8%) (odds ratio = 0.47; 95% confidence interval = 0.22-0.97; p = 0.042). No complications were observed. CONCLUSIONS: IANB with additional buccal infiltration is more suitable than the experimental technique for achieving adequate analgesia in L3M extractions. Moreover, the standard method is safe and provides a shorter onset time and lower initial postoperative pain levels.
Assuntos
Anestesia Dentária , Bloqueio Nervoso , Anestesia Local , Anestésicos Locais , Carticaína/efeitos adversos , Método Duplo-Cego , Humanos , Lidocaína , Nervo Mandibular , Dente Serotino/cirurgia , Bloqueio Nervoso/efeitos adversosRESUMO
It is well known that wound dehiscence is one of the most frequent complications in guided bone regeneration. The main cause of this complication may be a lack of tension-free and primary wound closure. The aim of this study was to evaluate and compare the effect of periosteal releasing incisions (PRI) on the extension of 3 different flap designs: envelope, triangular, and trapezoidal. Twelve pig mandibles were used to quantify extension of the flap designs. The mandibles were equally and randomly distributed into the 3 flap groups. Each mandible was divided into 2 sides: 1 was subjected to a PRI and the other not. The flap was pulled with a force of 1.08 N, and the extension was recorded. The subgroups without PRI showed an average extension of 5.14 mm with no statistically significant differences among them (P = .165). The PRI provided an average extension of 7.37 mm with statistically significant differences among the subgroups (P < .001). The releasing incisions significantly increased flap extension in each flap design. The increase in extension of the trapezoidal flap with PRI was significantly greater than in the other subgroups. In cases where primary closure is required, surgeons should consider performing trapezoidal flaps with PRI in order to reduce tension.
Assuntos
Aumento do Rebordo Alveolar , Retalhos Cirúrgicos , Animais , Cadáver , Modelos Animais de Doenças , Regeneração Tecidual Guiada Periodontal , Retalhos Cirúrgicos/cirurgia , SuínosRESUMO
PURPOSE: The purpose was to determine the effect of watching an informative video about mandibular third molar (M3M) removal on patient anxiety and hemodynamic parameters. PATIENTS AND METHODS: A randomized controlled clinical trial was carried out in healthy patients (aged between 18 and 40 years) requiring M3M extraction under local anesthesia. Patients with previous tooth extractions, psychiatric disorders, or cardiac problems or patients undergoing anxiolytic or antidepressant drug treatment were excluded. Participants were randomized into 2 groups according to whether they watched an informative video about the surgical procedure (video group) or not (control group). The primary outcome variable was the difference between groups regarding patient anxiety assessed with the State-Trait Anxiety Inventory (STAI) and the Modified Dental Anxiety Scale (MDAS). The secondary outcome variables were hemodynamic parameters recorded during different moments of the surgical procedure. Descriptive, bivariate, and multivariate analyses were performed, and a repeated-measures mixed model was generated. Statistical significance was considered for P < .05. RESULTS: Fifty patients referred for M3M extraction met the inclusion criteria. The final data analysis was based on 47 patients: 25 from the video group and 22 controls. The bivariate analysis showed the video group to have a significant decrease in anxiety as measured by the MDAS (P = .006; 95% confidence interval [CI], -4.1 to -0.7) and STAI-State (P = .003; 95% CI, -13.7 to -0.7). A significantly lower heart rate was likewise found in the video group (χ2 = 4.30, df = 1, P = .038). The linear regression analysis adjusting for the STAI-Trait also showed lower dental anxiety measured by the MDAS in the video group (P = .023; 95% CI, 0.32 to 4.14). CONCLUSIONS: Providing preoperative information through an informative video about M3M removal significantly reduces patient anxiety and heart rate during the surgical procedure.
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Dente Serotino , Dente Impactado , Adolescente , Adulto , Ansiedade/prevenção & controle , Ansiedade ao Tratamento Odontológico/prevenção & controle , Hemodinâmica , Humanos , Dente Serotino/cirurgia , Extração Dentária , Adulto JovemRESUMO
OBJECTIVES: To compare selective COX-2 inhibitors with ibuprofen in terms of analgesia, rescue medication consumption, and adverse effects after impacted third molar removal. MATERIALS AND METHODS: Electronic databases were searched. Single dose, double-blind, randomized, and controlled clinical trials comparing the analgesic effect of a selective COX-2 inhibitor versus at least one active control group using ibuprofen after impacted third molar removal were selected. RESULTS: Twelve studies were included for the qualitative synthesis and eight were included in the meta-analysis. No statistically significant differences were found between selective COX-2 inhibitors and ibuprofen in terms of pain relief after 6, 8, and 12 h. Rescue analgesia use after 24 h was significantly greater in the ibuprofen group than in the selective COX-2 inhibitor group. There were no statistically significant differences in the number of patients presenting one or more adverse events between the two groups, though ibuprofen intake was related with more nausea and vomiting. CONCLUSIONS: No statistically significant differences were found in terms of pain relief 6, 8, and 12 h post-medication between selective COX-2 inhibitors and ibuprofen following totally or partially impacted third molar removal. The patients who consumed selective COX-2 inhibitors needed less rescue analgesia after 24 h. The occurrence of one or more adverse events was similar in both groups, though patients who consumed ibuprofen had more nausea and vomiting. CLINICAL RELEVANCE: COX-2 inhibitors could be considered a suitable alternative to ibuprofen for pain relief after third molar extraction in patients at risk of developing nausea and vomiting. Also, COX-2 inhibitors seem to slightly reduce the need of rescue medication consumption.
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Analgésicos/uso terapêutico , Inibidores de Ciclo-Oxigenase 2/uso terapêutico , Dente Serotino , Manejo da Dor/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Extração Dentária , Método Duplo-Cego , Humanos , Dor Pós-OperatóriaRESUMO
BACKGROUND: Peri-implantitis is a biological complication that affects soft and hard tissues around dental implants. Implantoplasty (IP) polishes the exposed implant surface, to decontaminate it and make it less prone to bacterial colonization. This study investigates whether a higher clinical crown-to-implant-ratio (CIR) reduces implant fracture resistance and whether implants are more fracture-prone after IP in the presence of 50% of bone loss. METHODS: Forty-eight narrow platform (3.5 mm) 15 mm long titanium dental implants with a rough surface and hexagonal external connection were placed in standardized bone-like resin casts leaving 7.5 mm exposed. Half were selected for IP. The IP and control groups were each divided into 3 subgroups with different clinical CIRs (2:1, 2.5:1 and 3:1). The implant wall width measurements were calculated using the software ImageJ v.1.51 through the analysis of plain x-ray examination of all the samples using standardized mounts. A fracture test was performed and scanning electron microscopy was used to evaluate maximum compression force (Fmax) and implant fractures. RESULTS: IP significantly reduced the implant wall width (P < 0.001) in all reference points of each subgroup. Fmax was significantly higher in the 2:1 subgroup (control = 1276.16 N ± 169.75; IP = 1211.70 N ± 281.64) compared with the 2.5:1 (control = 815.22 N ± 185.58, P < 0.001; IP = 621.68 N ± 186.28, P < 0.001) and the 3:1 subgroup (control = 606.55 N ± 111.48, P < 0.001; IP = 465.95 N ± 68.57, P < 0.001). Only the 2.5:1 subgroup showed a significant reduction (P = 0.037) of the Fmax between the controls and the IP implants. Most fractures were located in the platform area. Only 5 implants with IP of the 2:1 CIR subgroup had a different fracture location (4 fractures in the implant body and 1 in the prosthetic screw). CONCLUSIONS: IP significantly reduces the fracture resistance of implants with a 2.5:1 CIR. The results also suggest that the CIR seems to be a more relevant variable when considering the resistance to fracture of implants, since significant reductions were observed when unfavorable CIR subgroups (2.5:1 and 3:1 CIR) were compared with the 2:1 CIR samples.
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Perda do Osso Alveolar , Implantes Dentários , Peri-Implantite , Perda do Osso Alveolar/diagnóstico por imagem , Perda do Osso Alveolar/etiologia , Coroas , Implantes Dentários/efeitos adversos , Planejamento de Prótese Dentária , Humanos , Peri-Implantite/etiologia , TitânioRESUMO
INTRODUCTION: To determine changes in anxiety perceived in students during their first experience injecting local anaesthetic and assess the variability in the perception in the teaching/learning experience as surgeons and patients in relation to gender. MATERIAL AND METHODS: This cross-sectional study was carried out on students enrolled in the Anaesthesia and Resuscitation course at the University of Barcelona. A descriptive and bivariate analysis was carried out using McNemar and Fisher tests. The level of significance was set at a P-value of <.05. RESULTS: Out of 85 students, a total of 71 responses were obtained. Overall, significant anxiety changes associated with the inferior alveolar nerve block were observed, specifically, before and during (P = .003), before and after (P < .001), and during and after (P < .001) the injection. The calm/relaxed category showed significant differences between before and after (P < .001) and during and after (P < .001) the procedure. Opinions and responses from male and female students differed statistically in relation to the injection on each other as preparation for real work situations (P < .023), recognition of landmarks (P < .001), determination of the insertion points (P = .032) and the need for supervision (P = .043). CONCLUSIONS: This study showed that the overall, students felt more anxious before being injecting with the anaesthetic and the students learning to give the local anaesthetic to each other is an appropriate learning method. No gender-related differences were observed in the participants.
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Anestesia Dentária , Anestesia Local , Estudos Transversais , Educação em Odontologia , Feminino , Humanos , Masculino , EstudantesRESUMO
PURPOSE: The purpose of this study was to assess which regenerative techniques are most effective for preventing periodontal defects after extraction of the third molars, as well as to compare these procedures with spontaneous healing of the socket. MATERIALS AND METHODS: Five electronic databases were searched to identify randomized clinical trials that fulfilled the eligibility criteria. Two independent reviewers conducted literature screening, article selection, and data extraction. The outcome measures were mean clinical attachment level (CAL) gain, mean probing depth (PD) reduction, mean alveolar bone level (ABL) gain, and adverse events. The influence of several variables of interest on the outcomes of periodontal regenerative therapy was explored via subgroup analyses. RESULTS: Among 1,205 potentially eligible articles, 21 randomized clinical trials were included. Eighteen trials assessed periodontal regenerative therapy as an alternative to extraction alone. Statistically significant differences were found in CAL gain (1.98 mm; 95% confidence interval [CI], 1.44 to 2.52 mm; P < .001), PD reduction (1.76 mm; 95% CI, 1.20 to 2.31 mm; P < .001), and ABL gain (1.21 mm; 95% CI, 0.21 to 2.21 mm; P = .018). The risk of complications developing at treated sites did not increase with the regenerative procedures (odds ratio, 1.49; 95% CI, 0.71 to 3.14; P = .290). There was no evidence of any regenerative procedure being better than any other. However, osseous grafting techniques were associated with a significantly higher adverse event rate. CONCLUSIONS: Regenerative periodontal therapy, in comparison with spontaneous healing of the wound, is more effective regarding initial improvement in CAL gain, PD reduction, and ABL gain, without increasing the risk of postoperative complications.
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Regeneração Tecidual Guiada Periodontal/métodos , Dente Serotino/cirurgia , Doenças Periodontais/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Extração Dentária , Dente Impactado/cirurgia , Humanos , Doenças Periodontais/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do TratamentoRESUMO
PURPOSE: To determine possible risk factors for postoperative infections after implant surgery, explain their effects on the occurrence of such infections, and assess the relation between postoperative infections and early implant failure. PATIENTS AND METHODS: A case-and-control study was performed. Postoperative infections were defined as purulent drainage or fistula in the operated region with pain or tenderness, localized swelling, redness, and heat or fever before prosthetic loading. Bivariate and multivariate analyses of the data were performed. RESULTS: Eighty-eight outpatients (22 patients in the infection group and 66 controls) were selected. Male gender and submerged healing were meaningfully associated to the development of postoperative infections (bivariate analysis). Healing type and location were the independent variables included in the final logistic regression model. Postoperative infections during the osseointegration period considerably increased the risk of early failure (odds ratio = 78.0; 95% confidence interval, 9.12 to 666.90). CONCLUSIONS: Patients undergoing dental implant placement in the mandible with submerged healing are more prone to postoperative infections. This complication is relevant because it is associated with a considerable and almost 80-fold increase in the risk of early implant failure.
Assuntos
Implantação Dentária/efeitos adversos , Infecção da Ferida Cirúrgica/etiologia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , CicatrizaçãoRESUMO
PURPOSE: To determine the prevalence and describe the clinical features and treatment of patients with early infections after implant placement. MATERIALS AND METHODS: A retrospective cohort study was performed. Postoperative infections were defined as the presence of purulent drainage and/or increasing pain and swelling in the operated area before prosthetic loading. Patient-based infection prevalences and 95% confidence intervals for implant were determined. Patients who healed, were followed up to determine implant survival and success rates. RESULTS: Three hundred thirty-seven participants (1273 implants) were included. Twenty-two postoperative infections were recorded (6.5% of the patients and 1.7% of the implants). These complications were usually diagnosed within the first month, and in 17 cases (77.3%) surgical treatment was performed because of antibiotic therapy failure. Twelve implants (54.6%) in 12 patients (54.6%) failed before prosthetic loading. The survival and success rates of the infected loaded implants were 80% and 50%, respectively, with a mean follow-up of 42.9 months (SD of 10.2 months). CONCLUSION: Four to 10% of patients receiving dental implants develop postoperative infections. This complication is important because applied treatments are usually ineffective and two-thirds of the infected implants fail, most before prosthetic loading.
Assuntos
Implantação Dentária/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Adulto , Idoso , Antibacterianos/uso terapêutico , Falha de Restauração Dentária , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/etiologiaRESUMO
OBJECTIVES: To compare miniscrew versus bone tracing registration methods on dental implant placement accuracy and time efficiency in edentulous jaws using a dynamic computer-assisted implant surgery (d-CAIS) system. METHODS: Twelve fully edentulous maxillary models were allocated into two groups: miniscrew tracing (MST) group, where registration was performed by tracing four miniscrews; and bone tracing (BT) group, where registration was conducted by tracing maxillary bone fiducial landmarks. Six implants were placed on each model using the X-Guide® d-CAIS system. Pre- and postoperative cone-beam computed tomography (CBCT) scans were superimposed to evaluate implant placement accuracy. The time required for registration and the overall surgery time were also recorded. RESULTS: Thirty-six implants were placed in each group. The MST group showed significantly lower mean angulation deviations (mean difference (MD): -3.33°; 95 % confidence interval (CI): -6.56 to -0.09); p = 0.044), 3D platform deviations (MD: -1.01 mm; 95 % CI: -1.74 to -0.29; p = 0.006), 2D platform deviations (MD: -0.97 mm; 95 % CI: -1.71 to -0.23; p = 0.010), and 3D apex deviations (MD: -1.18 mm; 95 % CI: -1.92 to -0.44; p = 0.002) versus the BT group. The overall surgery time was similar for both groups (MD: 6.10 min.; 95 % CI: -0.31 to 12.51; p = 0.06), though bone tracing required significantly more time compared with miniscrew registration (MD: 4.79 min.; 95 % CI: 2.96 to 6.62; p < 0.05). CONCLUSIONS: Registration with MST increases the accuracy of implant placement with a d-CAIS system in edentulous jaws compared with the BT method, and slightly reduces the overall surgery time. CLINICAL SIGNIFICANCE: Miniscrew tracing registration improves implant placement accuracy in comparison with bone tracing registration.
RESUMO
Background: This prospective cohort study aimed to assess the predictability and survival rates of dental implant treatment in edentulous patients while identifying potential factors contributing to implant failure. Material and Methods: A total of 80 outpatients, receiving 166 dental implants between September 2015 and November 2017 in two private dental clinics, were included in this study. Patient and implant characteristics, surgical procedures, primary stability, prosthetic rehabilitation, failure analysis, and survival rates were analyzed. Results: The majority of patients (53.75%) received a single implant for treating single-gap edentulism, with 6.25% requiring implants for fully edentulous jaws. Most implants (66.87%) were Avinent Ocean IC implants with specific design features. Surgical placement primarily occurred in healed pristine bone (78.31%), immediate implants in fresh extraction sockets (19.88%), and bone regeneration was simultaneous in 15.66% of cases. While 54.82% of implants achieved primary stability over 35Ncm, none exceeded 45Ncm, and only 4.82% failed to attain primary stability. Prosthetic rehabilitation revealed that 13.25% received immediate loading prostheses. During follow-up, four implants failed, resulting in a 2.41% failure rate, with bruxism (HR: 96.62; P< 0.001) and absence of primary stability (HR: 23.54; P< 0.001) significantly associated with implant failure. The cumulative survival rate at 24 months was 97.44%. Conclusions: This study demonstrates the high predictability and survival rates of dental implant treatment in edentulous patients, consistent with established standards. Factors such as bruxism and primary stability may impact early implant failure. Dental implants remain a reliable treatment option, boasting a 97.44% cumulative survival rate at 24 months. Further research is required to explore implant failure indicators and multifactorial influences. Key words:Dental implants, survival, edentulous patients.