Comparison of external, internal flat-to-flat, and conical implant abutment connections for implant-supported prostheses: A systematic review and network meta-analysis of randomized clinical trials.

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.

Clinical and Histological Outcomes of Maxillary Sinus Floor Augmentation With Synthetic Bone Substitutes for Dental Implant Treatment: A Meta-Analysis.

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.

Evaluation of different mandibular blocks for the removal of lower third molars: a meta-analysis of randomised clinical trials.

OBJECTIVES: To describe the efficacy and number of side effects for the Gow-Gates mandibular block (GGMB) and Vazirani-Akinosi mandibular block (VAMB) compared to inferior alveolar nerve block (IANB) in patients requiring lower third molar (L3M) extraction. MATERIALS AND METHODS: A systematic search was performed in three electronic databases and complemented with a manual search. The inclusion criteria were randomised clinical trials in healthy patients who underwent at least one L3M extraction. Screening and article selection were carried out by two independent reviewers. After data extraction, a meta-analysis was performed for the success rate, number of positive aspirations, and onset time outcomes. RESULTS: Six randomised clinical trials were included out of the 367 potentially eligible papers. No significant differences were found in terms of success rate using GGMB (risk ratio [RR] 1.04; 95% confidence interval [CI] 0.92 to 1.18; P = 0.48) nor VAMB (RR 0.96; 95% CI 0.86 to 1.06; P = 0.41). The VAMB group exhibited a lower number of positive aspirations than the IANB group (RR 0.08; 95% CI 0.01 to 0.55; P = 0.01), but there was no statistically significant difference between the GGMB and IANB groups (RR 1.06; 95% CI 0.13 to 8.78; P = 0.96). The delayed onset was even longer in GGMB (mean difference [MD] 3.32 min; 95% CI 1.98 to 4.66; P < 0.001) and VAMB (MD 0.90 min; 95% CI 0.37 to 1.43; P = 0.0001) than IANB. CONCLUSIONS: GGMB and VAMB seem to be effective and safe anaesthetic techniques for the removal of L3M, but these blocks exhibited a more delayed onset time than IANB. CLINICAL RELEVANCE: GGMB and VAMB are safe and effective anaesthetic techniques for the removal of L3M. However, IANB can still be considered the first option since GGMB and VAMB exhibited more delayed onset times and variable buccal nerve anaesthesia.

Influence of incision on periodontal parameters after apical surgery: a meta-analysis.

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.

Is it possible to extract lower third molars with infiltration anaesthesia techniques using articaine? A double-blind randomized clinical trial.

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.

Mechanical complications of implant-supported complete-arch restorations and impact on patient quality of life: A retrospective cohort study.

STATEMENT OF PROBLEM: Mechanical complications (for example, fractures) in implant-supported complete-arch restorations may affect the social and professional activities of the patient. However, most studies seem to overlook patient perceptions and generally do not assess the changes in the quality of life (QoL) of patients who experience these complications. PURPOSE: The purpose of this retrospective cohort study was to assess the influence of technical or mechanical complications of complete-arch implant-supported prostheses on patient perception and QoL by using the Oral Health Impact Profile (OHIP)-14. MATERIAL AND METHODS: A retrospective cohort study was formed of patients treated consecutively at a private clinic with immediately loaded complete-arch prostheses supported by a minimum of 4 implants (Replace Tapered; Nobel Biocare AB) and Multi-Unit conical abutments (Multi-Unit abutments; Nobel Biocare AB). OHIP-14 and questions regarding self-reported satisfaction were used to evaluate the influence of mechanical complications on QoL. RESULTS: Fifty-six participants (26 men and 30 women) with a mean age of 64 ±11.1 years, and 72 restored arches were included. The mean ±standard deviation follow-up time was 52 ±26 months. The prosthetic success rate was 38.8%, and the survival rate was 100% (no failure was registered). The most common complications were abutment screw loosening (43%), chipping or fracture of the veneering material (25%), and screw loosening (21%). The OHIP-14 scores were close to zero, without differences between participants with or without mechanical complications. Overall, the participants reported that the prostheses allowed good oral hygiene (94.6%) and met their expectations (89%) and that they would repeat the treatment (87.5%) and would recommend it to others (93%). CONCLUSIONS: Minor mechanical complications such as screw loosening and chipping or fracture of the veneering material were frequent events but had no impact on the satisfaction and QoL of patients with immediately loaded complete-arch implant-supported prostheses.

Effect of an Informative Video on Anxiety and Hemodynamic Parameters in Patients Requiring Mandibular Third Molar Extraction: A Randomized Clinical Trial.

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.

Efficacy and safety of selective COX-2 inhibitors for pain management after third molar removal: a meta-analysis of randomized clinical trials.

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.

Evaluation of student-to-student local anaesthesia administration at the University of Barcelona: A cross-sectional study.

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.

Does Mandibular Gonial Angle Predict Difficulty of Mandibular Third Molar Removal?

PURPOSE: Predicting the difficulty of impacted mandibular third molar (IM3M) removal remains a controversial issue because many variables have been associated with increased operation time. Thus, the main objective of this study was to assess the influence of the gonial angle on the surgical difficulty of IM3M extraction. PATIENTS AND METHODS: A prospective cohort study of patients requiring IM3M removal was conducted. The gonial angle measured with a goniometer was considered the primary predictor variable. The primary outcome variable was operation time. Difficulty also was recorded by surgeons using a 100-mm visual analog scale (VAS). Postoperative complications (pain, swelling, and trismus at 48 hours and 7 days) were registered as secondary outcome variables. A descriptive bivariate statistical analysis, Pearson correlations and scatter plots, and an explanatory multiple linear regression model were performed. Significance was set at P < .05. RESULTS: The sample comprised 60 participants (17 men and 43 women) with a mean age of 25.2 years (standard deviation, 7.1 years). No significant correlations were found between the gonial angle and operation time, VAS difficulty score, and postoperative complications. Regression analysis confirmed this lack of effect of the gonial angle. The operation time was significantly affected by surgical experience (P = .016) and patient age (P = .009), whereas the 100-mm VAS difficulty score was only related to surgical experience (P = .001). CONCLUSIONS: The gonial angle is not related to the surgical difficulty of IM3M removal. Moreover, this variable is not associated with the occurrence of postoperative complications. According to the findings in this cohort, surgical experience and patient age are the only variables significantly related to increased operation time.

Guided bone regeneration using beta-tricalcium phosphate with and without fibronectin-An experimental study in rats.

OBJECTIVE: This histomorphometric study compared bone regeneration potential of beta-tricalcium phosphate with fibronectin (ß-TCP-Fn) in critical-sized calvarial defects (CSDs) in rats to assess whether fibronectin (Fn) improved new bone formation. MATERIAL AND METHODS: Critical-sized calvarial defects were created in 30 adult male Sprague Dawley rats, which were divided into four groups according to the time of euthanasia (6 or 8 weeks of healing) and type of filling (ß-TCP-Fn/6 weeks, ß-TCP/6 weeks, ß-TCP-Fn/8 weeks and ß-TCP/8 weeks). The primary variables related to new bone formation were augmented area (AA) and gained tissue (GT; sum of mineralized bone matrix [MBM] and bone substitute [BS]). Secondary variables were the diameter of the defect, MBM, non-mineralized tissue (NMT) and BS. RESULTS: A total of 29 rats and 58 histological samples were evaluated, 28 (48.3%) samples obtained at 6 weeks and 30 (51.7%) at 8 weeks, homogeneously distributed between right and left sides. Thirteen (22.4%) were treated with ß-TCP-Fn, 16 (27.6%) with ß-TCP and 29 (50%) were controls. At 8 weeks, histomorphometric analysis showed significant differences in AA using ß-TCP and ß-TCP-Fn versus controls (p = 0.001 and p = 0.005, respectively). Bone turnover expressed as % within the target area was slightly higher but not statistically significant in the ß-TCP-Fn than in ß-TCP (MBM) at 6 weeks versus 8 weeks (p = 0.067 and p = 0.335, respectively). Finally, the total GT area in mm2 was higher using ß-TCP-Fn as compared to ß-TCP (p = 0.044). CONCLUSIONS: ß-TCP-Fn was slightly but non-significantly more effective than ß-TCP without Fn for improving the volume of regenerated bone in CSDs of rats, possibly allowing a more efficient bone remodelling process. This effect however should continue being investigated.

Periodontal Regenerative Therapy for Preventing Bone Defects Distal to Mandibular Second Molars After Surgical Removal of Impacted Third Molars: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

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.

Prevalence of neuropathic pain and sensory alterations after dental implant placement in a university-based oral surgery department: A retrospective cohort study.

OBJECTIVE: To determine the prevalence and the clinical features of patients with neuropathic pain and sensory alterations after dental implant placement. BACKGROUND: Literature is very scarce concerning the prevalence of neuropathic pain after dental implant placement. PATIENTS AND METHODS: A retrospective cohort study was made in patients submitted to dental implant placement in the Dental Hospital of the University of Barcelona. A descriptive analysis of the data was made, and the 95% confidence intervals (95% CI) were calculated for the prevalences. RESULTS: The study sample was composed of 1156 subjects of whom, 1012 patients (3743 dental implants) met the study inclusion criteria. Four hundred and seventeen patients (41.2%) were male and 595 (58.8%) were female, with a mean age of 60.7 years (range 16-90 years). Three patients were diagnosed as having painful post-traumatic trigeminal neuropathy (PPTN), which corresponds to a prevalence of 0.3% (95% CI: 0%-0.6%). Additionally, 5 patients (0.5%; 95% CI: 0%-1.07%) presented trigeminal neuropathy without pain (TNWP). The combined prevalence of both disorders was 0.8% (95% CI: 0.02%-1.3%). All patients with PPTN and TNWP were 60 years old or older, with a total combined prevalence of 1.48% (95% CI: 0.46%-2.5%) in this age group. Additionally, the prevalence in this age group for women was 1.85% (95%CI: 0.38%-3.31%). CONCLUSIONS: Neuropathic pain after dental implant placement is very infrequent (0.3%) in a University Oral Surgery department. However, the presence of trigeminal neuropathies can be slightly higher and can affect up to 0.5% of patients. Older female patients seem to be more prone to this rare and disabling complication.

Primary Apical Stability of Tapered Implants Through Reduction of Final Drilling Dimensions in Different Bone Density Models: A Biomechanical Study.

PURPOSE: A biomechanical study of the primary apical stability obtained in tapered implants through the reduction of final drilling dimensions in different bone density models. MATERIAL AND METHODS: An in vitro study of maximum insertion torque and primary stability based on the resonance frequency analysis (RFA) of 24 conical implants measuring 13 mm in length and 3.75 and 4.20 mm in diameter, randomly inserted in 10-mm sockets prepared in 4 polyurethane blocks with a density of 15, 20, 30, and 40 pounds per cu ft, respectively, reducing the diameter of the final drill at constant speed (400 rpm) to obtain exclusive 4 mm anchoring of the apical third of each implant. RESULTS: The decrease in drilling diameter resulted in an increase in the insertion torque and implant stability quotient (ISQ) values in all implants, although without reaching statistical significance. In turn, a significant direct correlation was found between increasing bone analog block density and the insertion torque and ISQ values. CONCLUSIONS: Under the conditions of this study, the primary apical stability obtained may be more dependent on bone density than on reduction of the final drilling diameter.

Antibacterial suture vs silk for the surgical removal of impacted lower third molars. A randomized clinical study.

BACKGROUND: The aim of this study was to evaluate the clinical and microbiological impact of an antibacterial suture (Monocryl® Plus) in the surgical removal of I3M. MATERIAL AND METHODS: A "split-mouth", prospective pilot clinical study was designed involving 20 patients programmed for the surgical removal of I3M. Each side was randomly sutured with Monocryl® Plus or silk suture and removed for microbiological study 72 hours and 7 days after surgery. Presence of SSI, wound bleeding and the degree of discomfort associated with each type of suture material (scored by means of a visual analog scale) were evaluated. The level of contamination of each material was observed under the scanning electron microscope. RESULTS: Wound bleeding upon suture removing was slightly greater after 72 hours and 7 days with black silk suture, though the differences were not statistically significant (p=0.752 and p=0.113, respectively). Patient discomfort was very similar with both types of suture material (p=0.861). Only one case of SSI was recorded with black silk suture after 72 hours. Microbiologically, the antibacterial suture showed a lesser presence of microorganisms (p<0.001, at 72h and p=0.033 at 7th day, respectively). The most common bacterial species included grampositive cocci (Streptococcus viridans group, Neisseria spp., Coagulasenegative Staphylococcus and Peptostreptococcus), gramnegative cocci (Veillonella), grampositive Bacilli (Lactobacillus), and gramnegative Bacilli (Prevotella). CONCLUSIONS: The greatest antibacterial effect of Monocryl Plus suture was observed after 72 hours. According to most authors, there is no doubt that this antibacterial suture can provide little safety in the control of SSI.

Risk Factors for Postoperative Infections After Dental Implant Placement: A Case-Control Study.

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.

Effects of Collagen Resorbable Membrane Placement After the Surgical Extraction of Impacted Lower Third Molars.

PURPOSE: The use of resorbable collagen membranes (RMs) in the treatment of intraosseous defects and deep periodontal pockets on the distal side of a lower second molar (L2M) after surgical extraction of an impacted lower third molar (L3M) has shown contradictory results. This study evaluated the effects of RM placement on the healing of a bone defect distal to an L2M after surgical extraction of a horizontal or mesioangular impacted L3M. PATIENTS AND METHODS: A parallel-group randomized controlled trial with 2 independent groups of 30 patients requiring surgical extraction of an L3M was carried out. After extraction, patients received an RM (Bio-Gide, Geistlich Pharma AG, Wolhusen, Switzerland) or only suture. At the initial checkup and during postoperative monitoring at 1, 3, and 6 months, the distal vestibular, distal, and distolingual probing depths and distal vestibular attachment level of the L2M were measured. RESULTS: Age (control group, 33.8 ± 6.9 yr; guided tissue regeneration group, 35.6 ± 6.3 yr; P = .322) and the number of women (control group, 15 of 29; guided tissue regeneration group, 14 of 27; P = .992) were similar in the 2 groups. The distal vestibular, distal, and distolingual probing depths of the L2M, distal vestibular attachment level, distance from the cementoenamel junction, and distance from the alveolar crest to the base of the defect showed greater improvement 6 months after surgical extraction in the RM group (P < .05). CONCLUSIONS: The use of RMs after surgical extraction of mesioangular or horizontally impacted L3Ms stimulates bone regeneration, improving the attachment level and bone fill distal to the L2M. Likewise, it decreases the distal probing depth and results in faster recovery. RM placement after surgical extraction of an impacted L3M is recommended because it prevents periodontal defects after L3M surgery.

Postoperative Infections After Dental Implant Placement: Prevalence, Clinical Features, and Treatment.

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.

Compliance of postoperative instructions following the surgical extraction of impacted lower third molars: a randomized clinical trial.

OBJECTIVES: The understanding and adherence to postoperative care instructions are factors that influence the recuperation process after any surgical procedure. The aim of this study was to determine the percentage of patients who strictly follow the postoperative instructions after the extraction of an impacted lower third molar in relation to sociocultural level, preoperative anxiety scores and how postoperative information is provided to the patient. STUDY DESIGN: Patients were randomly assigned to one of three different test groups according to how the postoperative instructions were presented: verbal, written and a group that received additional information. Before surgery, patients were required to complete the Corah Dental Anxiety Scale and personal information (age, gender and educational level) was also collected. P <0.05 was considered significant. Patients were surveyed a week after surgery regarding their adherence to postoperative instructions. RESULTS: 84 patients (45 women and 39 men with an average of 28.23 ± 7.41 years) completed the study. There were no statistically significant differences regarding adherence of postoperative care instructions depending on the manner of instruction presentation, preoperative anxiety level and sociocultural level (p> 0.05). Quitting smoking or drinking of alcoholic/carbonated beverages were the main influential factors for the lack of adherence to postoperative care instructions during the week after surgery. CONCLUSIONS: Presentation of postoperative instructions, preoperative anxiety scores and sociocultural level do not appear to be key factors that promote the adherence to postoperative instructions.

Techniques for early diagnosis of oral squamous cell carcinoma: Systematic review.

BACKGROUND AND OBJECTIVES: The diagnosis of early oral potentially malignant disorders (OPMD) and oral squamous cell carcinoma (OSCC) is of paramount clinical importance given the mortality rate of late stage disease. The aim of this study is to review the literature to assess the current situation and progress in this area. MATERIAL AND METHODS: A search in Cochrane and PubMed (January 2006 to December 2013) has been used with the key words "squamous cell carcinoma", "early diagnosis" "oral cavity", "Potentially Malignant Disorders" y "premalignant lesions". The inclusion criteria were the use of techniques for early diagnosis of OSCC and OPMD, 7 years aged articles and publications written in English, French or Spanish. The exclusion criteria were case reports and studies in other languages. RESULTS: Out of the 89 studies obtained initially from the search 60 articles were selected to be included in the systematic review: 1 metaanalysis, 17 systematic reviews, 35 prospective studies, 5 retrospective studies, 1 consensus and 1 semi-structured interviews. CONCLUSIONS: The best diagnostic technique is that which we have sufficient experience and training. Definitely tissue biopsy and histopathological examination should remain the gold standard for oral cancer diagnose. In this systematic review it has not been found sufficient scientific evidence on the majority of proposed techniques for early diagnosis of OSCC, therefore more extensive and exhaustive studies are needed.