Changes in oral home care and smoking habits during COVID-19 pandemic: A cross-sectional study.

OBJECTIVES: The coronavirus disease-19 (COVID-19) pandemic has caused disruption in the health behavior in many aspects of life. While hand hygiene was promoted as one of the precautionary measures to mitigate and contain COVID-19, oral health and smoking might have received less attention in the media campaigns. The aim of this study was to examine health behavioral changes in terms of oral home care habits, smoking, and perception of dental care during the COVID-19 pandemic. MATERIAL AND METHODS: An online survey was designed to assess oral home care, smoking habits, and attitude toward dental services of participants aged 18 years and older. The data were collected between September and November 2021. The strength of association between changes in oral home care habits, smoking, and attitude toward invasive/long dental procedures and each variable was measured by χ2 analysis. Estimates of relative risk were also calculated for all variables. Predictors of avoiding dental procedures were estimated by a binary logistic regression. RESULTS: A total of 532 participants, based in the United Arab Emirates, took part in this online survey with a response rate of 88.7%. The age of the participants ranged between 18 and 67 with mean age of 34.9 ± 9.0 years. The majority of the participants have adopted changes in their routine oral home care habits, with 82.1% of them changing the toothbrush more frequently. Participants who changed their oral home care habits were more likely to have received sufficient information on the importance of maintaining oral health. Likewise, the changes in smoking habits were significantly associated with receiving information on the relationship between smoking and the severity of the COVID-19 (p < 0.001). CONCLUSIONS: The findings showed that positive behavior toward oral home care and smoking was noticed during the pandemic particularly when public receives sufficient and up-to-date information.

Diode Laser as an Adjunctive Treatment for Peri-implant Mucositis: A Systematic Review and Meta-analysis.

The early detection and management of peri-implant mucositis may help in reducing inflammatory parameters and arrest disease progression to peri-implantitis. The potential therapeutic benefits of different adjunctive therapies, such as the diode laser, are still not completely understood. The objective of this systematic review and meta-analyses was to assess the outcomes of using diode laser on the management of peri-implant mucositis in terms of changes in periodontal parameters. Electronic databases were searched to identify randomised controlled trials (RCTs) that compared the combined use of mechanical debridement and diode laser with mechanical debridement alone. A specific risk-of-bias tool was used to assess the risk of bias. Data were analysed using a statistical software programme. In total, 149 studies were found. A meta-analysis of 3 RCTs showed no statistically significant differences in probing pocket depths (mean difference [MD], -0.36; 95% confidence interval [CI], -0.88 to 0.16; P = .18) or bleeding on probing (MD, -0.71; 95% CI, 1.58-0.16; P = .11) between the 2 groups at 3 months. In the management of peri-implant mucositis, the combined use of diode laser and mechanical debridement did not provide any additional clinical advantage over mechanical debridement alone. Long-term, well-designed RCTs are still needed.

A Retrospective Analysis of Biological Complications of Dental Implants.

Methods: A retrospective analysis of patients aged ≥18 years and having dental implants placed at Dubai Health Authority in 2010. Relevant information related to systemic-, patient-, implant-, site-, surgical- and prosthesis-related factors were collected. The strength of association between the prevalence of peri-implant mucositis and peri-implantitis and each variable was measured by chi-square analysis. A binary logistic regression analysis was performed to identify possible risk factors. Results: A total of 162 patients with 301 implant-supported restorations were included in the study. The age of the patients ranged between 19 and 72 with a mean age of 46.4 ± 11.7 years. The prevalence of peri-implant mucositis at the patient and implant levels were 44.4% and 38.2%, respectively. For peri-implantitis, the prevalence at the patient level was 5.6%, while the prevalence at the implant level was 4.0%. The binary logistic regression identified three risk factors (smoking habits, histories of treated periodontitis and lack of peri-implant maintenance) for peri-implantitis. Conclusion: Within the limitations of this study, smoking habits, history of treated periodontitis and lack of peri-implant maintenance were significant risk factors for peri-implantitis. Early detection of these factors would ensure appropriate planning and care of patients at high risk of developing peri-implant diseases.

Outcome of supportive peri-implant therapy on the rates of peri-implant diseases and marginal bone loss: a systematic review and meta-analysis.

Objective: The aim of this systematic review and meta-analysis was to evaluate the impact of supportive peri-implant therapy (SPIT) on the rates of peri-implant diseases and peri-implant marginal bone loss. ?Data sources: The guidelines of PRISMA statement were followed in searching for randomized controlled trials, controlled clinical trials, and retrospective studies in several electronic databases and reference lists. The Cochrane Collaboration's Risk of Bias tools for nonrandomized studies were used to assess the risk of bias. Data were analyzed using statistical software. ?A total of 159 studies were identified. Five trials, with 1,570 implants in 617 patients, met the inclusion criteria. Overall meta-analysis showed significantly reduced rates of peri-implantitis with SPIT compared with non-SPIT at implant and patient levels. Peri-implant mucositis was significantly reduced with SPIT at implant level only. Peri-implant marginal bone loss was significantly reduced in patients with SPIT compared to those who did not attend SPIT.
Conclusion: SPIT can significantly reduce the rate of peri-implantitis and marginal bone loss. The evidence on the role of SPIT in reducing the rate of peri-implant mucositis, on the other hand, remains limited. Further well-designed studies on the impact of SPIT on implant treatment outcome are still needed. Clinical significance: There is a need to adopt a SPIT regimen for patients receiving implant therapy to reduce the rate of peri-implant diseases and marginal bone loss. This need should be stipulated in the patient information and consent forms prior to implant therapy. (Quintessence Int 2021;52:122-131; doi: 10.3290/j.qi.a45428)

Predicting peri-implant disease: Chi-square automatic interaction detection (CHAID) decision tree analysis of risk indicators.

BACKGROUND: Further validation of the risk indicators / predictors for peri-implant diseases is required to allow clinicians and patients to make informed decisions and optimize dental implant treatment outcomes. The aim of this study was to build prediction models, using Chi-square automatic interaction detection (CHAID) analysis, to determine which systemic-, patient-, implant-, site-, surgical- and prostheses-related risk indicators had more impact on the onset of peri-implant diseases. METHODS: A retrospective analysis of 200 patients who received implant-supported prostheses between 1998 and 2011 was conducted to evaluate the prevalences and risk indicators for peri-implant mucositis and peri-implantitis. The data were further analyzed using CHAID to produce two predictive models. RESULTS: The prevalence of peri-implant mucositis was 20.2% and 10.2% for patients and implants, respectively, while the prevalence of peri-implantitis was 10.1% at the patient level and 5.4% at the implant level. CHAID decision tree analysis identified three predictors (history of treated periodontitis, absence of regular supportive peri-implant maintenance, and use of bone graft) for peri-implant mucositis and three predictors (smoking, absence of regular supportive peri-implant maintenance, and placement of ≥2 implants) for peri-implantitis. CONCLUSIONS: Within the limitations of this study, CHAID decision tree analysis identified the most plausible risk indicators and provided two predictive models for use in a particular university setting that would allow early detection and ensure appropriate care and maintenance of patients at high risk of peri-implant diseases.

Piezoelectric versus conventional implant site preparation: A systematic review and meta-analysis.

BACKGROUND: The use of a piezoelectric device (PED) for implant site preparation (ISP) has been introduced to overcome the limitations of using conventional drills (CDs). With little and inconsistent information in the literature regarding their efficiency for preparing implant osteotomies, the objective of this systematic review was to compare the use of CDs to PEDs for ISP with regard to implant stability values, marginal bone level changes, operating time, and dental implant failure rate. METHODS: The systematic review was prepared according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The literature was searched for studies that assessed the use of CDs and PEDs for ISP. The Cochrane Collaboration risk of bias tool was used to evaluate the selected studies and meta-analyses were performed using statistical software. RESULTS: A total of 755 citations were identified. Of these, 4 studies with 178 implant osteotomies in 80 participants were included. The pooled estimates for the implant stability showed significant differences between the 2 surgical techniques in favor of PEDs at baseline, 8 and 12 weeks. A statistically significant difference in the operating time was also shown between the 2 techniques with more time required using PED. The differences in marginal bone level changes or implant failure rate were not statistically significant. CONCLUSIONS: With the limitations of this review in mind, PEDs appear to be a viable alternative to traditional drilling techniques for ISP. With the exception of prolonged operating time associated with the use of PEDs, both techniques were comparable in terms of the marginal bone level changes and the risk of implant failure. The favorable influence of the implant stability pattern related to the use of PEDs on the predictability of immediate and early loading protocols need to be confirmed in future studies.

The Octagon Model: a clinical tool for assessing marginal tissue recession.

The Octagon Model is a clinical assessment tool designed to assess marginal tissue recession (MTR) and estimate the level of difficulty in achieving root coverage. It evaluates eight patient- and siterelated factors: patient's expectations, smoking status, width of keratinized tissue, absence/presence of cervical lesion, interproximal soft tissue/bone level, depth and width of recession defect, and buccal bone thickness. The model is presented in a three-colored diagram to facilitate communication between clinicians and between clinicians and their patients, and to assist clinicians in optimizing treatment plans at both site and patient levels.

Maxillary Three-Implant Overdentures Opposing Mandibular Two-Implant Overdentures: 10-Year Surgical Outcomes of a Randomized Controlled Trial.

BACKGROUND: The surgical placement of four maxillary implants for overdentures may not be obligatory when opposing mandibular two-implant overdentures. PURPOSE: To determine 10-year surgical outcomes and implant success of three narrow diameter implants in edentulous maxillae with conventional loading. MATERIALS AND METHODS: Forty participants with mandibular two-implant overdentures were randomly allocated for surgery for maxillary overdentures. Using osteotomes, three implants of similar systems were placed with a one-stage procedure and 12-week loading with splinted and unsplinted prosthodontic designs. Marginal bone and stability measurements were done at surgery, 12 weeks, 1-, 2-, 5-, 7-, 10 years. RESULTS: One hundred seventeen implants were placed in 39 participants, with 35 being seen at 1 year; 29 at 2 years; 28 at 5 years; 26 at 7 years; and 23 (59%) at 10 years. Marginal bone loss was 1.35 mm between surgery and 12 weeks; 0.36 mm between 12 weeks and 1 year; 0.48 mm between 1 and 5 years; and 0.22 mm between 5 and 10 years. Implant stability quotients were 56.05, 57.54, 60.88, 58.80, 61.17 at surgery, 12 weeks, 1 year, 5 years, and 10 years. Four-field tables by implant showed success rates of 82% at 1 year; 69.2% at 2 years; 66.7% at 5 years; 61.5% at 7 years; 51.3% at 10 years. Data showed no differences between surgical technique, systems, or prosthodontic designs. CONCLUSIONS: Surgical placement with osteotomes of three narrow diameter implants for maxillary overdentures, opposing mandibular two-implant overdentures, is an acceptable approach, subject to strict patient selection. Implant success is independent of prosthodontic design.

Piezoelectric surgery vs rotary instruments for lateral maxillary sinus floor elevation: a systematic review and meta-analysis of intra- and postoperative complications.

PURPOSE: Lateral maxillary sinus floor elevation (LMSFE) is a predictable preprosthetic surgical procedure that is used to overcome the limitations of the atrophied alveolar ridge for the placement of oral implants. Techniques using piezoelectric devices (PEDs) and conventional rotary instruments have been described for LMSFE in the literature, with little information regarding their efficiency in terms of membrane perforation, operating time, and implant outcomes. The aim of this systematic review was to examine the intra- and postoperative events associated with the use of PEDs and conventional rotary instruments for LMSFE. MATERIALS AND METHODS: This systematic review was prepared according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The literature was searched for studies comparing the use of PEDs with conventional rotary instruments for LMSFE. The Cochrane Collaboration risk of bias tool was used to assess the studies selected, and meta-analyses were performed using statistical software. RESULTS: A total of 124 citations were identified. Of these, four studies with 178 LMSFEs in 120 participants were included. The pooled estimates for the risk of sinus membrane perforation did not show any significant difference between the two surgical techniques (risk ratio, 0.87; 95% confidence interval, 0.40-1.91; P = .73). Similarly, no significant difference in implant failure was found after 1 year of functional loading. The overall meta-analysis showed a statistically significant difference in the operating time between the two techniques with more time required for PED. CONCLUSION: The intra- and postoperative events associated with the use of PEDs and conventional rotary instruments for LMSFE are comparable.

The prognostic accuracy of resonance frequency analysis in predicting failure risk of immediately restored implants.

OBJECTIVES: It is of imperative clinical significance to define a safe threshold for planned immediate implant restoration. The aim of this report was to evaluate the prognostic accuracy of resonance frequency analysis (RFA) measurements recorded at two different times (implant placement and 8-week post-implant placement) and to determine the optimal threshold value for predicting failure risk of immediately restored/loaded implants. MATERIAL AND METHODS: Twenty-eight 8- or 9-mm-diameter implants were placed in either a fresh molar extraction socket or a healed site. An electronic RFA device was used to record the implant stability quotients (ISQs) at implant placement surgery, 8 weeks and 1 year. Receiver operating characteristic (ROC) analysis was used to identify the optimal cut-off level. Sensitivity and specificity were also determined at the selected cut-off value. RESULTS: The area under the ROC curve for RFA at 8 weeks was 0.93 with a significant P-value (P = 0.001). The optimum cut-off value for detecting implant stability was 60.5 ISQ measured at 8 weeks, with sensitivity and specificity of 95.2% and 71.4%, respectively. CONCLUSIONS: The implant stability measurements after 8 weeks showed a better accuracy in predicting implants that were at risk of failure than those taken at the time of implant placement.

Immediate single implant restorations in mandibular molar extraction sockets: a controlled clinical trial.

BACKGROUND: In the replacement of missing teeth, a paradigm shift is currently observed with immediate implant placement and/or restoration, particularly in the aesthetic zone. In molar sites, however, anatomical, occlusal and biomechanical considerations remain deterrent factors influencing the outcome of this treatment paradigm. The aim of this report was to evaluate immediate placement and immediate restoration of strongly tapered wide-diameter implant in fresh mandibular molar extraction sockets. METHODS: Twenty-four 8- or 9-mm diameter implants were placed in either a fresh molar extraction socket or a healed site. All the implants received provisional crowns within 48 h. The provisional crowns were replaced with full ceramic crowns after 8 weeks of implant placement. RESULTS: The overall implant success rate after 1 year of service for the 24 implants in two treatment groups was 75%. Success rates were 83.3% and 66.7% for the delayed and immediate placement groups respectively, with no significant difference observed between the two groups (P = 0.35). Implant stability measurements identified the immediately placed implants to be more stable immediately after surgery than delayed placed implants. In contrast, the delayed placed implants were more stable after 8 week healing time. CONCLUSIONS: The rehabilitation of single missing mandibular molars by immediately placed and restored wide-diameter implants was associated with a relatively high failure rate.

The frequency of peri-implant diseases: a systematic review and meta-analysis.

BACKGROUND: The peri-implant diseases, namely peri-implant mucositis and peri-implantitis, have been extensively studied. However, little is known about the true magnitude of the problem, owing mainly to the lack of consistent and definite diagnostic criteria used to describe the condition. The objective of the present review is to systematically estimate the overall frequency of peri-implant diseases in general and high-risk patients. METHODS: The systematic review is prepared according to the Meta-analysis of Observational Studies in Epidemiology statement. Studies were searched in four electronic databases, complemented by manual searching. The quality of the studies was assessed according to Strengthening the Reporting of Observational Studies in Epidemiology, and the data were analyzed using statistical software. RESULTS: Of 504 studies identified, nine studies with 1,497 participants and 6,283 implants were included. The summary estimates for the frequency of peri-implant mucositis were 63.4% of participants and 30.7% of implants, and those of peri-implantitis were 18.8% of participants and 9.6% of implants. A higher frequency of occurrence of peri-implant diseases was recorded for smokers, with a summary estimate of 36.3%. Supportive periodontal therapy seemed to reduce the rate of occurrence of peri-implant diseases. CONCLUSIONS: Peri-implant diseases are not uncommon following implant therapy. Long-term maintenance care for high-risk groups is essential to reduce the risk of peri-implantitis. Informed consent for patients receiving implant treatment must include the need for such maintenance therapy.

Diagnostic accuracy of panoramic radiography in determining relationship between inferior alveolar nerve and mandibular third molar.

PURPOSE: The aim of this review was to determine the diagnostic accuracy of panoramic radiographic markers in the detection of the relationship between the mandibular canal and third molar roots. MATERIALS AND METHODS: A literature search of electronic databases, Cochrane Oral Health Group's Trials Register, National Research Register, conference proceedings, and abstracts was performed to identify studies that had investigated the diagnostic accuracy of the 3 panoramic radiographic markers (ie, darkening of the root, interruption of the radiopaque borders, and diversion of the mandibular canal). RevMan, version 5.0, and Meta-DiSc software programs were used for the pooled analyses and the construction of a summary receiver operating characteristic curve. RESULTS: A total of 5 studies were included, involving 894 observations. The overall pooled sensitivity and specificity for darkening of the root was calculated as 51.2% (95% confidence interval [CI] 42% to 60%) and 89% (95% CI 87% to 90%), respectively. The interruption of radiopaque borders showed a pooled sensitivity of 53.5% (95% CI 78.1% to 81.8%) and a pooled specificity of 80% (95% CI 78.1% to 81.8%). The diversion of the canal criterion had a pooled sensitivity of 29.4% (95% CI 21.8% to 38.1%) and a pooled specificity of 94.7% (95% CI 93.6% to 95.7%). The area under the receiver operating characteristic curve was 70% to 77%. CONCLUSIONS: The results of this meta-analysis suggest a reasonable diagnostic accuracy for panoramic radiography in the preoperative evaluation of the relationship between third molars and the canal. Additional studies are needed to examine a more accurate, accessible, and cost-effective initial radiographic technique before third molar surgery.

Tooth loss among Saudi adolescents: social and behavioural risk factors.

OBJECTIVES: To examine the prevalence of tooth loss in Saudi adolescents, to investigate the reasons behind such loss and to identify any associated social and behavioural factors. METHODS: A cross-sectional study was carried out in the Eastern Province of Saudi Arabia, from March 2006 through January 2007. A total of 484 subjects, aged 14-19-years of age, were included in the study. The subjects had a clinical examination and completed a self-administered questionnaire regarding their demographic, social, oral and general health attitudes. The prevalence and mean tooth loss were calculated, and a binary regression model was used to construct a risk prediction model. RESULTS: A 90% response rate was achieved. The prevalence of tooth loss was 40.9% (n=198). Permanent first molars were the most frequently missing teeth (57.1%). The overall mean tooth loss was 0.83 +/- 1.18. Both the proportion and mean tooth loss were significantly associated with sweet consumption, smoking, tooth brushing, dental flossing, dental visiting pattern and self-rated oral health. In logistic regression analysis, five social and behavioural factors had significant independent effects. CONCLUSIONS: Several socio-behavioural characteristics have been related to the high prevalence of tooth loss among Saudi adolescents. Tooth loss should be urgently addressed through implementation of community preventive programmes in Saudi Arabia.