Comparison of implant placement and loading protocols for single anterior maxillary implants: A systematic review and network meta-analysis.

STATEMENT OF PROBLEM: With increasing esthetic needs, patients prefer missing anterior teeth to be restored as soon as possible, but how the timing of implantation and prosthetic loading influences peri-implant tissue and the esthetic results remains unclear. PURPOSE: The purpose of this systematic review and network meta-analysis of randomized controlled trials was to investigate and rank the hard-tissue and soft-tissue outcomes, esthetics, and patient satisfaction of single maxillary implant placement and loading protocols. MATERIAL AND METHODS: A systematic search was conducted to identify studies with at least a 1-year follow-up that compared different implant placement and loading protocols and reported on survival, marginal bone loss (MBL), soft tissue, and esthetics. A random effects model and a Bayesian approach were applied to compare protocols by using mean differences (MD) with 95% credible intervals (CrI) and surface under the cumulative ranking curve (SUCRA) values. RESULTS: A total of 43 articles were included, with a follow-up of 1 to 5 years. All protocols had high survival rates and no significant differences for 1-year or 2-year MBL. Immediate placement with immediate loading ranked first in pink and white esthetic scores and satisfaction and was statistically significantly better than immediate placement with delayed loading or late placement protocols in pink esthetic scores, where its advantage over late placement with late loading was also clinically relevant [MD: -1.74, CrI: -2.34 to -1.15]. CONCLUSIONS: Immediate implantation with immediate loading showed a considerable esthetic advantage over later rehabilitation, whereas only a slight difference in MBL resulted from different protocols.

The early loading of different surface-modified implants: a randomized clinical trial.

BACKGROUND: Various surface treatment options have been adopted with the aim to improve osseointegration, reducing the overall treatment time. Implant stability of early loaded implants with different modified surfaces was compared in the present study. METHODS: Patients were selected from the Department of Oro-Maxillofacial Surgery and Stomatology at Semmelweis University. Patients randomly received SA (alumina sandblasted and acid-etched), NH (bioabsorbable apatite nanocoating) or SLA (large-grit sandblasted and acid-etched) surface implants. Outcome measures were: implant success, implant stability, and periodontal parameters. The implant stability was measured at the time of implant placement (primary stability) and six weeks after (prothesis delivery, secondary stability). Osstell and Periotest were applied to take all the measurements. The primary and secondary stability were compared in the three study groups Finally the periimplant probing depth appearing after three months of loading was checked on 6 points around to the implant-supported prostheses. Shapiro-Wilk and Mann-Whitney tests were used for the comparison between the study groups. RESULTS: A total of 75 implants with different length and diameter were inserted into various positions. One implant failed spontaneously at the fourth week after implant placement. The survival rate was 98,7%. Comparing the primary and secondary stability values, the data were significantly improved in every groups. The difference was the highest in the NH group, however, this difference was not significant compared to the two other groups. Good periodontal parameters were experienced in all the tested implants, independently by the groups. CONCLUSIONS: With the limitation of the present study, all the implants showed improved stability six weeks after implant placement. A trend of higher result was found for the NH group. Further studies with longer follow-up are needed to confirm this preliminary results. TRIAL REGISTRATION: Current Controlled Trials ISRCTN13181677; the date of registration: 04/03/2021. Retrospectively registered.

Intraosseous Heat Generation During Osteotomy Performed Freehand and Through Template With an Integrated Metal Guide Sleeve: An In Vitro Study.

OBJECTIVE: To investigate drill wear and consequent intraosseous temperature elevation during freehand and guided bone drilling, with attention to the effect of metal-on-metal contact during guided drilling. MATERIALS AND METHODS: Osteotomies were performed on bovine ribs, with 2.0 mm diameter stainless steel drill bits of the SMART Guide System, under 3 sterilization protocols, at 800, 1200, 1500, and 2000 rpm. Sterilization was performed after every 3 drilling. Temperature was measured after every 30 drilling. RESULTS: The studied contributing factors had a cumulative effect, and each contributed significantly to temperature elevation. Whether guide use led to a near-necrotic (47°C) temperature increment depended largely on the applied sterilization protocol. CONCLUSION: The metal sleeve is a significant contributing factor to heat generation during guided osteotomy, but its effect can be offset by keeping the other studied factors under control.

[Incidence and case-control study of delayed-onset infection after lower third molar surgery]. / Az alsó bölcsességfogak mutéti eltávolítását követo késoi posztoperatív gyulladás (delayed-onset infection) vizsgálata.

INTRODUCTION AND AIM: Delayed-onset infection was defined as an infectious swelling and trismus accompained by pain or the presence of suppuration starting after the discharge of the patient, generally a week after surgery. Our aim was to describe incidence and possible risk factors of delayed-onset infection after lower wisdoom tooth removal. MATERIAL AND METHODS: Retrospective study of 851 lower third molar surgeries, performed between January 2013 and August 2017 at Semmelweis University Faculty of Dentistry, Department of Oro-Maxillofacial Surgery and Stomatology, has been done. The teeth were removed by 2 surgeons. Under age of 26, a case-control study comprising a total of 150 lower third molar surgeries were done to indentify possible risk factors. RESULTS: 10 delayed-onset wound infections were recorded after suture removal (1.17% of the patients). The mean time elapsing from surgery to delayed-onset infection was 30 days. Lower third molars with total soft tissue coverage, a bigger amount of bone coverage, a lack of distal space (Pell-Gregory class III), deeper impaction (Pell-Gregory classes B, C) or mesioangular tilt are associated with the development of this complication (p<0.05). Female sex and young age seem to be risk factors, too. CONCLUSION: Patients with risk factors should be warned that infection may still occur several weeks after surgery. The clinicians should observe these patients longer and emphasize keeping their wound clean for a prolonged period. Orv Hetil. 2018; 159(31): 1278-1283.

Effect of the Combination of Low-Speed Drilling and Cooled Irrigation Fluid on Intraosseous Heat Generation During Guided Surgical Implant Site Preparation: An In Vitro Study.

PURPOSE: Investigating the effect of the combination of low-speed drilling and cooled irrigation fluid on intraosseous temperature rise during guided and freehand implant surgery. MATERIALS AND METHODS: Bovine ribs were used as bone specimens. Grouping determinants were as follows: drill diameter (2.0, 2.5, 3.0, and 3.5 mm), irrigation fluid temperature (10°C, 15°C, and 20°C), and surgical method (guided and freehand). Drilling speed was 800 rpm. Results were compared with previous ones using 1200 rpm. Temperature measurements were conducted using K-type thermocouples. RESULTS: No mean temperature change exceeded 1.0°C if irrigation fluid cooled to 10°C was used, regardless of the drill diameter or the surgical method, with the highest elevation being 2.10°C. No significant reduction was measured when comparing groups using 15°C and 20°C irrigation fluids, regardless of both drill diameter and surgical method. CONCLUSION: The use of irrigation fluid being cooled to 10°C combined with low-speed drilling (800 rpm) seems to be a safe method for implant site preparation and drilling through a drilling guide in terms of temperature control.

[Prospective randomized study regarding the effect of the preoperative antibiotic and chlorhexidine rinse on wound healing after mandibular third molar surgery]. / A preoperatív antibiotikus és antiszeptikus kezelés hatása a mutéti úton eltávolított alsó bölcsességfogak sebgyógyulására ­ prospektív randomizált vizsgálat.

INTRODUCTION AND AIM: The study compares the antibiotic prophylaxis combined with postoperative antibiotic therapy to preoperative chlorhexidine rinse combined with postoperative antibiotic therapy in preventing complications after surgical removal of a mandibular third molar. METHOD: 71 healthy patients in four groups were enrolled in the study: I. prophylactic dose of 2000 mg of amoxicillin clavulanate, continued with amoxicillin clavulanate postoperatively; II. prophylactic dose of 600 mg of clindamycin, continued with clindamycin postoperatively; III. prophylactic chlorhexidin rinsing, continued randomized amoxicillin clavulanate or clindamycin postoperatively; IV. control, with clindamycin postoperatively. RESULTS: The pain was smaller in the prophylaxis groups. Alveolitis occurred only in the control group: 2 patients. Wound opening occurred in 22,2 % in group IV., 14,2 % in group II, 10 % in group I., 5 % in group III. CONCLUSION: We consider completing the indicated postoperative antibiotic prescription with antibiotic or antiseptic prophylaxis. Chlorhexidin prophylaxis could have the same positive effect. Orv. Hetil., 2017, 158(1), 13-19.

Impact of rheumatoid arthritis in oral surgery and implantology treatment based on literature.

Rheumatoid arthritis (RA) is an autoimmune disease that results in a chronic, systemic inflammatory disorder that principally attacks synovial joints. The pathology of the disease process often leads to the destruction of articular cartilage and the bone. Normal bone remodeling cycle requires the balance between bone resorption and bone deposition which is determined by the activities of two principle cell types, namely, osteoclasts and osteoblasts. Osteoblasts and osteoclasts, coupled together via cytokine mediated cell signaling. The dominance of pro-inflammatory cytokines in bone homeostasis leads to osteolysis. Many articles have been published about the pathobiochemical similarity between rheumatoid arthritis and periodontitis, whereas the role of the disease in bone regeneration and osseointegration is less proven. According to the international literature in rheumatoid arthritis, due to frequent periodontitis, decreased salivary secretion, medication, as well as a decrease in bone regenerative potential, rheumatoid arthritis is considered as relative contraindication in implantology. In daily practice, we face more frequently with rheumatoid arthritis which makes the topic so important in oral surgery and implantology. It can be said that adequate preoperative preparation (healthy periodontal status, antibiotic protection, consultation with the rheumatologist to modify medication) interventions can be done more safely. The risk of failure is higher in patients suffering from rheumatoid arthritis of the underlying disease which fact is important to be communicated before surgical intervention.

[Dental and oral surgical treatment of medication-induced bleeding patients: Audit of the national guideline in Hungary]. / A gyógyszer indukálta vérzékeny betegek fogorvosi, szájsebészeti ellátása: a 2015-ös hazai szakmai ajánlás alkalmazása és értékelése.

INTRODUCTION: In 2015 a new Hungarian guideline was published regarding dental treatment and management of anticoagulated patients in agreement of the Hungarian Association of Oral and Maxillofacial Surgeons and the Dental Implantology Association of Hungarian Dentists. AIM: The aim of the authors was to evaluate the efficiency and safety of local hemostatic measures recommended by the guideline in anticoagulated patients. METHOD: In these patients, postoperative bleeding episodes were examined after dental and oral surgical treatments, retrospectively. RESULTS: Overall 263 bleeding risk cases were treated; 138 patients with vitamin K antagonists, 97 patients with antiplatelet therapy and 6 patients with novel oral anticoagulants. Six patients (2.3%) had minor postoperative bleeding after the "one hour control", while one patient needed a night duty support (0.5%). In contrast, 86 patients who were treated in rural practices neglecting the guideline attended the night duty with postoperative bleeding (3 patients treated with vitamin K antagonists, 24 patients taking low molecular weight heparin, 30 patients receiving antiplatelet therapy and one patient on novel oral anticoagulant therapy. CONCLUSIONS: The Hungarian guideline can be applied safely, without increasing the risk of postoperative bleeding, however, rural dental practices are frequently unprepared for these treatments. Orv. hetil., 2016, 157(43), 1722-1728.

[Dental management of hemorrhage-prone patients]. / A vérzékeny betegek fogorvosi ellátása.

The authors present a proposal of dental treatment and management of anticoagulated patients and of patients on antiplatelet therapy, with the approval by the Hungarian Association of Oral and Maxillofacial Surgeons and by the Dental Implantology Association of Hungarian Dentists. This current guide was based on recent Hungarian and on several foreign national guidelines and considers significant publications from international literature.

[Difficulties in differential diagnosis of dentin dysplasia. Case report]. / A dentin dysplasia differenciáldiagnosztikai nehézségei. Esetismertetés.

In cases of periapical lesions of unknown origin we have to keep in mind the possibility of dentin dysplasia. From the differential diagnostic point of view of differential diagnosis it is important to recognize this disease as it significantly influences the treatment modality. It is an anomaly of unknown etiology that could affect both deciduous and permanent dentition. Dentin dysplasia presentation varies clinically and radiologically. A rare manifestation which affects 1: 100000 patients is spontaneously occurring either as periapical abscess or odontogenic cyst. The affected teeth could become mobile and eventually lost. Dentin dysplasia is a genetic disease which shows autosomal dominant inheritance and characterized by abnormal formation of dentin structure which occurs during tooth development. For this article we have reviewed available literature and PubMed database. Dentin dysplasia increases the risk of early tooth loss and associated with it esthetic and functional disturbances. As a result it can influence the psychological and social status of the patients and affect their quality of life.

[Survival and success rate of dental implants treated with high intensity laser]. / Lézerrel felületkezelt dentális implantátumok túlélési és sikerességi rátájának vizsgálata.

Clinical and radiological evaluations were conducted in patients with high energy Nd : glass laser-treated dental implants. These patients underwent dental implantation surgery between 1997 and 2006. Strict success criteria were used for the examination and analysis of implants. Based on clinical and radiological evaluation, success and survival rates of laser surface treated dental implants were similar to those of sandblasted, acid-etched surface implants frequently reported in the literature. Specific surface morphology and high degree of purity of laser surface treated dental implants ensure excellent osseointegration and a good clinical performance also on the long-term.

[Guidelines on the pharmacotherapy of the dental patient during pregnancy]. / A várandós nok gyógyszeres kezelésének irányelvei a fogorvosi gyakorlatban.

Physiological differences occuring in pregnancy modify certain steps of dental treatments. Since in our everyday practice we meet expectant patients, we have to be aware of what kind of changes does this transitional state require from the dentist, how to do a good timing in the course of dental treatment, which are those medicaments that can be used safely and those which should be avoided. The summerized data in the article are to contribute the safe choice of the possibly necessary antibiotics during the treatments. Besides, dental care should not be delayed due to our doubts about local anestetics, because it may carry serious consequences later. Relying on the most up-to-date facts, moreover, we mention the guidelines of the use of analgesics during pregnancy in dentistry. The treatment of pregnant women does not differ to a high degree from those who are non-pregnant, yet some of its viewpoints need special attention and we have to take them into consideration in order to do the appropriate medical work. Basically, in our opinion, before every dental and dental surgical intervention it is essential to consult with the patient's gynaecologist and in agreement with him/her to determine the course of the medicinal treatment.

Advancing accuracy in guided implant placement: A comprehensive meta-analysis: Meta-Analysis evaluation of the accuracy of available implant placement Methods.

OBJECTIVES: This meta-analysis aimed to determine the accuracy of currently available computer-assisted implant surgery (CAIS) modalities under in vitro conditions and investigate whether these novel techniques can achieve clinically acceptable accuracy. DATA: In vitro studies comparing the postoperative implant position with the preoperative plan were included. Risk of bias was assessed using the Quality Assessment Tool For In Vitro Studies (QUIN Tool) and a sensitivity analysis was conducted using funnel plots. SOURCES: A systematic search was performed on April 18, 2023, using the following three databases: MEDLINE (via PubMed), EMBASE, and Cochrane Central Register of Controlled Trials. No filters or restrictions were applied during the search. RESULTS: A total of 5,894 studies were included following study selection. Robotic- and static CAIS (sCAIS) had the most accurate and clinically acceptable outcomes. sCAIS was further divided according to the guidance level. Among the sCAIS groups, fully guided implant placement had the greatest accuracy. Augmented reality-based CAIS (AR-based CAIS) had clinically acceptable results for all the outcomes except for apical global deviation. Dynamic CAIS (dCAIS) demonstrated clinically safe results, except for horizontal apical deviation. Freehand implant placement was associated with the greatest number of errors. CONCLUSIONS: Fully guided sCAIS demonstrated the most predictable outcomes, whereas freehand sCAIS demonstrated the lowest accuracy. AR-based and robotic CAIS may be promising alternatives. CLINICAL SIGNIFICANCE: To our knowledge, this is the first meta-analysis to evaluate the accuracy of robotic CAIS and investigate the accuracy of various CAIS modalities.

Association between Hyperglycemia and Medication-Related Osteonecrosis of the Jaw (MRONJ).

BACKGROUND: Medication-related osteonecrosis of the jaw (MRONJ) is a type of jawbone necrosis caused by the use of drugs for some types of cancer and osteoporosis. The current study aimed to evaluate the associations between hyperglycemia and the development of medication-related osteonecrosis of the jaw. METHODS: Our research group investigated data collected between 1 January 2019 and 31 December 2020. A total of 260 patients were selected from the Inpatient Care Unit, Department of Oromaxillofacial Surgery and Stomatology, Semmelweis University. Fasting glucose data were used and included in the study. RESULTS: Approximately 40% of the necrosis group and 21% of the control group presented with hyperglycemia. There was a significant association between hyperglycemia and MRONJ (p < 0.05, p = 0.003). Vascular anomaly and immune dysfunction caused by hyperglycemia can lead to necrosis after tooth extraction. Necrosis is more common in the mandible (75.0%) and in the case of parenteral antiresorptive treatment (intravenous Zoledronate and subcutaneous Denosumab). Hyperglycemia is a more relevant risk factor than bad oral habits (26.7%). CONCLUSIONS: Ischemia is a complication of abnormal glucose levels, a possible risk factor for necrosis development. Hence, uncontrolled or poorly regulated plasma glucose levels can significantly increase the risk of jawbone necrosis after invasive dental or oral surgical interventions.

Enhancement of Hydrophilicity of Nano-Pitted TiO2 Surface Using Phosphoric Acid Etching.

Our research group developed a novel nano-pitted (NP) TiO2 surface on grade 2 titanium that showed good mechanical, osteogenic, and antibacterial properties; however, it showed weak hydrophilicity. Our objective was to develop a surface treatment method to enhance the hydrophilicity of the NP TiO2 surface without the destruction of the nano-topography. The effects of dilute and concentrated orthophosphoric (H3PO4) and nitric acids were investigated on wettability using contact angle measurement. Optical profilometry and atomic force microscopy were used for surface roughness measurement. The chemical composition of the TiO2 surface and the oxidation state of Ti was investigated using X-ray photoelectron spectroscopy. The ccH3PO4 treatment significantly increased the wettability of the NP TiO2 surfaces (30°) compared to the untreated control (88°). The quantity of the absorbed phosphorus significantly increased following ccH3PO4 treatment compared to the control and caused the oxidation state of titanium to decrease (Ti4+ → Ti3+). Owing to its simplicity and robustness the presented surface treatment method may be utilized in the industrial-scale manufacturing of titanium implants.

[Examination of periodontal status after removal of impacted lower wisdom teeth, a comparative analysis of two flap design]. / Alsó impactált bölcsességfogak eltávolítása utáni parodontális állapotok vizsgálata, két lebenytechnika összehasonlító elemzése.

AIM OF THE STUDY: Before removing impacted lower wisdom teeth, a mucoperiosteal flap is prepared. In the practice we use 2 types of flaps: with or without a releasing incision. There are few publications about how the removal of impacted wisdom teeth damage the periodontium of the second molars. In our study, we examined whether there is any difference in the healing between the two flap designs. MATERIALS AND METHODS: A total of 76 lower wisdom teeth have been removed. Two types of flaps were used. Prior surgery, at suture removal, 3 and 6 months after surgery 6 periodontal depth points were investigated around the second molars. We compared the technical events during surgery, complaints, probing depths after surgery and their correlance in function of flap design. RESULTS: After removal of lower impacted wisdom teeth, we measured greater probing depths using envelope flap than L-shaped flap. However, this difference was not significant, and after 6 months, no differences were noted.

[A clinical study of dental surgery in anticoagulated patients]. / Antikoaguláns kezelésben részesülo betegek szájsebészeti ellátásának klinikai vizsgálata.

It is a worldwide trend that oral surgeons do not stop patients' anticoagulant therapy, but they leave the INR in the therapeutic range (INR: 2.0-3.0). The reason is that stopping drugs carries a higher risk of embolism, and thrombosis. The purpose of the present study is to reproduce these international guidelines in a Hungarian setting. On the day of surgery a lab test is performed immediately before the operation. These tests include coagulation data. A control (INR < 1.89) and an experimental group (INR: 2.0-3.0) were formed. Clinical complications, especially bleeding and thromboembolic complications were monitored. Based on the data and types of surgery no significant differences were found between the two groups. In conclusion it can be stated that it would be advisable to implement international guidelines and recommendations because there is a higher risk for anticoagulated patients if their therapy is stopped as if their INR is left in the therapeutic range. Of course appropriate wound care and bleeding control are necessary.

Point-of-care HbA1c Measurements in Oral Cancer and Control Patients in Hungary.

BACKGROUND/AIM: This study aimed to investigate the link between preoperative glycated hemoglobin (HbA1c) levels and oral cancer patients and diabetes mellitus (DM). We aimed to highlight the importance of point-of-care HbA1c measurements in oral cancer patients. PATIENTS AND METHODS: A total of 214 patients were admitted to the Department of Inpatient Care at Semmelweis University's Department of Oromaxillofacial Surgery and Stomatology between 1 September 2020 and 21 May 2021; individuals, who had undergone maxillofacial surgery under general anesthesia, were included in the study. RESULTS: There was a significant difference between the oral cancer group and the control group in terms of smoking (p=0.009) and alcohol intake (p=0.003). There was no statistically significant difference regarding sex (p=0.132) and DM (p=0.147) between the two groups. The tumor group had an 8.52% greater prevalence of DM, which was not significant. In the oral cancer group, twenty individuals (17.69%) had a higher HbA1c level than the upper level of the optimal metabolic value (6.9%). Nine participants (8.91%) in the control group had an HbA1c value greater than 6.9%, which means that their metabolic level was poor. The oral cancer group did not have higher blood glucose levels than those of the control group. CONCLUSION: No direct connection between high blood glucose levels and oral cancer was found. However, point-of-care HbA1c measurement can be a diagnostic tool to detect DM in the dental office.

Relation between medication-related jaw necrosis and blood glucose levels A retrospective epidemiological study / A gyógyszer okozta állcsontnekrózis és a vércukorszint kapcsolata. Retrospektív epidemiológiai vizsgálat

Maslach and Jackson. Results: In the field of examined dimensions of burnout syndrome, the most characteristic was emotional exhaustion, which has occurred with a frequency of nearly 30% and with typically high intensity among professionals working in neonatal intensive care units (N = 278). In addition, one-fifth were characterized by a high frequency and intensity of depersonalization. At the same time, nearly a third of them experienced a decrease in personal effectiveness. Workplace and time spent in healthcare did not show a significant connection with the incidence of burnout syndrome, however, burnout syndrome occurred with a higher frequency and intensity among those working in level III. neonatal intensive care unit. Conclusion: This is the first comprehensive burnout survey among premature and new born intensive care units in

Delayed-onset infections after lower third molar surgery: a Hungarian case-control study.

OBJECTIVE: Delayed-onset infection is defined as infectious swelling and trismus accompanied by pain or the presence of suppuration starting approximately 30 days after surgery. This study aimed to describe the occurrence and potential predisposing factors of delayed-onset infection. STUDY DESIGN: A retrospective case-control study of 223 lower third molar surgeries was performed. Participants were selected from among 1102 outpatients who underwent surgery between January 2013 and June 2018 at Semmelweis University. The inclusion criterion for the case group was inflammation of the operated area after suture removal. Patients in the control group were healthy nonsmokers <26 years old who healed without complication. Statistical analysis was performed using the Shapiro-Wilk test, the Mann-Whitney U test, and Fisher's exact test. RESULTS: Complications occurred only in patients <26 years old approximately 29.5 days after surgery. A significantly higher risk was observed for younger age, total soft tissue coverage, deeper impaction, lower Nolla stage (P < .001), mesioangular direction (P = .002), and full bone coverage (P < .05). Distal space was inversely correlated with complications (P < .001). CONCLUSIONS: Lower Nolla stage, total soft tissue coverage, lack of distal space, deeper impaction, or mesioangular tilt may promote delayed-onset infection. Follow-up of at-risk patients and the maintenance of oral hygiene are recommended.