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After tooth loss in the posterior area of the maxilla, sinus floor elevation is often required to compensate the vertical bone loss due to sinus pneumatization. This narrative review reports on the potential benefits of autologous platelet concentrates (APCs) during this procedure. As for transcrestal approach, APCs have been used as "sole" substitute/graft. However, because of the low number of clinical trials available with PRGF, and even none for PRP, no definitive conclusions can be made regarding their efficacy. The number of studies on the use of L-PRF were outnumbered indicating good feasibility for vertical bone gain, with a high implant survival rate and a low degree of complications. PRP and PRGF have not been studied as a "single/sole" substitute for a one-stage lateral window approach, probably because of the weak physical characteristics of the membranes. L-PRF alone appears to be a predictable grafting material for lateral maxillary sinus grafting and a reduced RBH should not be considered as a risk factor. Compared to a "standard" bone substitute L-PRF shows slightly less vertical bone gain (consider enough membrane application and use of bony window as new sinus floor roof over the implant apices), enhanced early resorption (first 6 months after application), but a similar stable bone gain afterward. For a two-stage lateral window approach, APCs "alone" cannot be recommended, due to their weak withstand to the sinus pneumatization forces. APCs combined with bone substitutes seem to accelerate bone formation, without any additional benefits on the long-term new bone gain. The use of L-PRF membranes for the treatment of perforations appears to be an effective treatment option, but further clinical studies are needed to confirm this. Even though the abovementioned statements are based on large numbers of studies, additional RCTs comparing APCs with different types of grafting procedures for sinus elevation are needed.
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AIM: To update the competences and learning outcomes and their evaluation, educational methods and education quality assurance for the training of contemporary specialists in periodontology, including the impact of the 2018 Classification of Periodontal and Peri-implant Diseases and Conditions (2018 Classification hereafter) and the European Federation of Periodontology (EFP) Clinical Practice Guidelines (CPGs). METHODS: Evidence was gathered through scientific databases and by searching for European policies on higher education. In addition, two surveys were designed and sent to program directors and graduates. RESULTS: Program directors reported that curricula were periodically adapted to incorporate advances in diagnosis, classification, treatment guidelines and clinical techniques, including the 2018 Classification and the EFP CPGs. Graduates evaluated their overall training positively, although satisfaction was limited for training in mucogingival and surgical procedures related to dental implants. Traditional educational methods, such as didactic lectures, are still commonly employed, but they are now often associated with more interactive methods such as case-based seminars and problem-based and simulation-based learning. The evaluation of competences/learning outcomes should employ multiple methods of assessment. CONCLUSION: An update of competences and learning outcomes of specialist training in periodontology is proposed, including knowledge and practical application of the 2018 Classification and CPGs. Harmonizing specialist training in periodontology is a critical issue at the European level.
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Periodontal diseases, including gingivitis and periodontitis, are among the most prevalent diseases in humans. Gingivitis is the mildest form of periodontal disease, characterized by inflammation of the gingiva caused by the accumulation of dental plaque. Salivary diagnostics are becoming increasingly popular due to the variation in saliva composition in response to pathological processes. We used a metabolomics approach to investigate whether a specific saliva metabolic composition could indicate preclinical stage of gingivitis. 1H-NMR spectroscopy was used to obtain the salivary metabolite profiles of 20 healthy subjects. Univariate/multivariate statistical analysis evaluated the whole saliva metabolite composition, and the Full-Mouth Bleeding Score (FMBS) was employed as a classification parameter. Identifying a signature of specific salivary metabolites could distinguish the subjects with high FMBS scores but still within the normal range. This set of metabolites may be due to the enzymatic activities of oral bacteria and be associated with the early stages of gingival inflammation. Although this analysis is to be considered exploratory, it seems feasible to establish an FMBS threshold that distinguishes between the absence and presence of early inflammatory alterations at the salivary level.
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Gingivitis , Voluntarios Sanos , Saliva , Humanos , Saliva/metabolismo , Femenino , Masculino , Proyectos Piloto , Adulto , Gingivitis/metabolismo , Gingivitis/diagnóstico , Metabolómica/métodos , Hemorragia Gingival/metabolismo , Metaboloma , Adulto Joven , Persona de Mediana Edad , Biomarcadores/metabolismoRESUMEN
Bone regeneration is often required concomitant with implant placement to treat a bone fenestration, a dehiscence, and for contouring. This systematic review assessed the impact of different biomaterials employed for guided bone regeneration (GBR) simultaneous to implant placement on the stability of radiographic peri-implant bone levels at ≥12 months of follow-up (focused question 1), as well as on bone defect dimension (width/height) changes at re-assessment after ≥4 months (focused question 2). Only randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that compared different biomaterials for GBR were considered. A Bayesian network meta-analysis (NMA) was performed using a random-effects model. A ranking probability between treatments was obtained, as well as an estimation of the surface under the cumulative ranking value (SUCRA). Overall, whenever the biological principle of GBR was followed, regeneration occurred in a predictable way, irrespective of the type of biomaterial used. A lower efficacy of GBR treatments was suggested for initially large defects, despite the trend did not reach statistical significance. Regardless of the biomaterial employed, a certain resorption of the augmented bone was observed overtime. While GBR was shown to be a safe and predictable treatment, several complications (including exposure, infection, and soft tissue dehiscence) were reported, which tend to be higher when using cross-linked collagen membranes.
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Aumento de la Cresta Alveolar , Materiales Biocompatibles , Regeneración Ósea , Implantes Dentales , Humanos , Aumento de la Cresta Alveolar/métodos , Materiales Biocompatibles/farmacología , Regeneración Ósea/efectos de los fármacos , Implantación Dental Endoósea/métodos , Regeneración Tisular Guiada Periodontal/métodos , Metaanálisis en RedRESUMEN
The key factors that are needed for bone regeneration to take place include cells (osteoprogenitor and immune-inflammatory cells), a scaffold (blood clot) that facilitates the deposition of the bone matrix, signaling molecules, blood supply, and mechanical stability. However, even when these principles are met, the overall amount of regenerated bone, its stability over time and the incidence of complications may significantly vary. This manuscript provides a critical review on the main local and systemic factors that may have an impact on bone regeneration, trying to focus, whenever possible, on bone regeneration simultaneous to implant placement to treat bone dehiscence/fenestration defects or for bone contouring. In the future, it is likely that bone tissue engineering will change our approach to bone regeneration in implant dentistry by replacing the current biomaterials with osteoinductive scaffolds combined with cells and mechanical/soluble factors and by employing immunomodulatory materials that can both modulate the immune response and control other bone regeneration processes such as osteogenesis, osteoclastogenesis, or inflammation. However, there are currently important knowledge gaps on the biology of osseous formation and on the factors that can influence it that require further investigation. It is recommended that future studies should combine traditional clinical and radiographic assessments with non-invasive imaging and with patient-reported outcome measures. We also envisage that the integration of multi-omics approaches will help uncover the mechanisms responsible for the variability in regenerative outcomes observed in clinical practice.
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Regeneración Ósea , Osteogénesis , Humanos , Regeneración Ósea/fisiología , Materiales Biocompatibles/uso terapéutico , Ingeniería de Tejidos/métodos , OdontologíaRESUMEN
AIM: To evaluate the efficacy of bone reconstructive procedures for the reduction of probing pocket depth (PPD), bleeding on probing (BOP), and suppuration in peri-implantitis-related bone defects at ≥12-month follow-up. MATERIALS AND METHODS: Three databases were searched for randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that compared bone reconstructive therapies to access flap surgery (AFS) (Focused Question-FQ 1), and RCTs, CCTs, and prospective case series that assessed the efficacy of reconstructive therapies (FQ 2). Meta-analysis was performed for FQ1 when more than three studies were identified, while for FQ2 a network was drawn based on RCTs with common treatment arms. RESULTS: Seven RCTs were identified for FQ1 while five RCTs and six prospective case series for FQ2. There was no significant difference in PPD change between AFS and reconstructive surgery (-0.387; p = .325) at 12 months. Furthermore, no clear differences in terms of PPD and BOP changes resulted from the different reconstructive therapies included in the network. Only a small percentage of treated cases with any modality achieved peri-implantitis resolution, as defined by different composite outcomes. CONCLUSIONS: Reconstructive surgery does not offer significant improvements in peri-implant clinical parameters as compared to AFS at 12 months. It was not possible to establish a hierarchy of efficacy among the different biomaterials employed for reconstructive surgery.
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Implantes Dentales , Periimplantitis , Procedimientos de Cirugía Plástica , Humanos , Periimplantitis/cirugía , Implantes Dentales/efectos adversos , Materiales Biocompatibles , Resultado del TratamientoRESUMEN
OBJECTIVE: This systematic review aims to assess the available literature on the clinical efficacy of hand versus power-driven instruments for subgingival instrumentation during surgical periodontal therapy (ST). MATERIALS AND METHODS: A search of the literature was carried out on MEDLINE via Ovid, Embase, Web of Science, the Cochrane Database, LILACS, and Scopus. RCTs comparing the use of powered instruments (test) to hand scalers (control) for subgingival instrumentation in terms of changes in probing pocket depth (PPD) after surgical periodontal treatment were included and screened in duplicate. Descriptive synthesis of the data and risk of bias assessment were undertaken. RESULTS: Four RCTs met the inclusion criteria and were included in this systematic review. ST in all studies was performed by means of open flap debridement. Gracey curettes were the most commonly used hand instruments, while sonic and ultrasonic devices were used in the test group. Sites with initial PPD ≥ 6 mm had pocket reduction ranging from 2.93 to 4.89 mm in the control group and from 2.77 to 3.86 mm in the test group. All studies found no significant difference between the different types of instruments/devices in terms of PPD reduction. CONCLUSIONS: Despite the limited number of studies, both manual and power-driven instruments appear to be effective in reducing PPD after surgical treatment of periodontitis. CLINICAL RELEVANCE: Based on the findings of this systematic review, the clinician may make a decision whether to use manual or powered instruments during ST on a case-by-case basis and considering other factors, such as the risk of creating high concentrations of aerosols.
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Periodontitis , Terapia por Ultrasonido , Humanos , Raspado Dental , Periodontitis/terapia , Resultado del Tratamiento , Ultrasonido , Aplanamiento de la RaízRESUMEN
OBJECTIVES: Periodontal disease and diabetes have an extensively investigated bidirectional correlation. Non-surgical periodontal treatment (NSPT) was proven to contribute to glycemic control. Moreover, it may benefit from the association of adjunctive therapies. The aim of the present systematic review is to assess the clinical efficacy of NSPT in association with laser (LT) or photodynamic therapy (PDT) in controlled or uncontrolled diabetic patients, and to grade the level of evidence. MATERIALS AND METHODS: Randomized controlled clinical trials with at least 3-month follow-up were searched in MEDLINE via OVID, EMBASE, and Cochrane Central, screened for inclusion, and grouped based on the performed treatments, follow-up time, type of diabetes, and level of glycemic control. RESULTS: Eleven RCTs with 504 total subjects were included. The adjunct of PDT showed a statistically significant 6-month difference in PD changes (with low certainty of evidence), but not in CAL changes, while a significant difference in 3-month PD and CAL changes was found with the adjunct of LT (low certainty of evidence). Patients treated with PDT registered a higher decrease in HbA1c levels at 3 months, but no significant difference was noted at 6 months; LT also led to better HbA1c changes at 3 months with a moderate certainty of evidence. CONCLUSION: Despite the promising short-term HbA1c decrease, the results should be interpreted with caution due to the small effect sizes and the statistical heterogeneity, and further evidence from well-designed RCTs is needed to support the routine use of PDT or LT in adjunct to NSPT.
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Periodontitis Crónica , Diabetes Mellitus Tipo 2 , Enfermedades Periodontales , Periodontitis , Fotoquimioterapia , Humanos , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/terapia , Hemoglobina Glucada , Periodontitis/tratamiento farmacológico , Enfermedades Periodontales/tratamiento farmacológico , Fotoquimioterapia/métodos , Periodontitis Crónica/terapia , Raspado Dental/métodosRESUMEN
OBJECTIVE: The present retrospective study aimed to investigate the influence of malposition on the occurrence of peri-implantitis. MATERIALS AND METHODS: The study included clinical records of systemically healthy patients with single and partial implant-supported rehabilitations and at least 1-year post-loading follow-up. The parameters collected included implant-related factors, patient-related factors, site-related factors, and prosthesis-related factors. The radiographic measurements were taken by using a dedicated software and the diagnosis of peri-implantitis was made based on all the available clinical and radiographic data. Descriptive statistics were provided for all variables. Following an exploratory approach, an implant-level analysis of factors influencing the occurrence of peri-implantitis was done through a multilevel multivariate logistic regression (mixed). RESULTS: A total of 180 implants belonging to 90 subjects were randomly selected. Malposition showed no statistically significant association with the occurrence of peri-implantitis. According to the multi-level analysis, the parameters that were significantly associated with peri-implantitis included presence / history of periodontitis (OR = 5.945, 95% CI: 1.093 - 32.334, P = 0.039) and presence of an emergence profile angle ≥ 45° (OR = 9.094, 95% CI: 2.017 - 40.995, P = 0.005). CONCLUSIONS: Implant malposition, as defined following Buser's criteria (2004), did not influence the occurrence of peri-implantitis in the selected cohort. Conversely, history of periodontitis and presence of a prosthetic emergence profile with an angle ≥ 45° were correlated to an increased risk of peri-implantitis.
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Implantes Dentales , Periimplantitis , Periodontitis , Humanos , Periimplantitis/diagnóstico por imagen , Periimplantitis/epidemiología , Periimplantitis/etiología , Estudios Retrospectivos , Implantes Dentales/efectos adversos , Periodontitis/complicaciones , RadiografíaRESUMEN
OBJECTIVE: This systematic review assessed the available evidence on the survival and success rate of zirconia and titanium implants. As secondary outcomes, aesthetic, radiographic and clinical parameters, as well as biological and mechanical complications, were considered. MATERIALS AND METHODS: A systematic search was performed up to March 2022 to identify CCTs/RCTs comparing zirconia and titanium implants with a minimum of 12 months of follow-up. Meta-analysis was performed when ≥ 2 articles with similar characteristics were retrieved. RESULTS: Four published articles with two RCTs (2 different patient populations) with 100 zirconia and 99 titanium implants that were followed up over 12-80 months were selected out of the 6040 articles. A non-statistically significant difference between zirconia and titanium implant survival at 12 months was suggested (P = 0.0938). The success rates were 57.5-93.3% and 57.1-100% for zirconia and titanium implants, respectively. The pink aesthetic score (PES) was higher for zirconia (10.33 ± 2.06 to 11.38 ± 0.92) compared to titanium implants (8.14 ± 3.58 to 11.56 ± 1.0). CONCLUSION: Based on the 2 RCTs retrieved in the literature, similar survival rates were reported for zirconia and titanium implants in the short term (12 months of follow-up). Future RCTs are warranted to evaluate the long-term outcomes of zirconia implants. CLINICAL RELEVANCE: Zirconia implants may be the procedure of choice, particularly in the aesthetic zone, since they show a similar survival and success rate as titanium implants on a short-term follow-up. TRIAL REGISTRATION: Systematic review registration number-CRD42021288704 (PROSPERO).
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Implantes Dentales , Humanos , Titanio , Fracaso de la Restauración Dental , Estética Dental , Circonio , Diseño de Prótesis DentalRESUMEN
While it is well-established that patients that develop signs of relapsing periodontitis in supportive periodontal care (SPC) will need to repeat subgingival instrumentation of the residual pockets, less certainty is available in terms of which protocol should be followed and whether the use of adjunctive therapies or physical agents might provide additional benefits to repeated instrumentation alone. The aim of this systematic review was therefore to assess whether repeating subgingival instrumentation in combination with adjunctive therapies (other than antimicrobials) might provide a significant benefit in terms of pocket closure, probing pocket depth (PPD) reduction or clinical attachment level (CAL) gain in patients during SPC with residual/relapsing pockets. Four databases were searched to identify randomized controlled trials (RCTs) and controlled clinical trials (CCTs) with a minimum follow-up of 3 months that investigated the use of adjunctive therapies (other than antimicrobials) in case of residual/relapsing pockets in patients in SPC since at least 3 months. Data extraction and risk of bias assessment were performed in the studies meeting the inclusion criteria and meta-analysis was performed when ≥3 studies assessing the same adjunctive therapy were identified. 12 studies (2 CCTs and 10 RCTs) were included for qualitative analysis. Meta-analysis was performed only for 3 studies on the adjunctive use of photodynamic therapy (PDT) and it indicated a nonsignificant benefit compared to the placebo in terms of PPD reduction and CAL gain at 3 months (weighted mean difference 0.07 and -0.03, respectively) and at 6 months of follow-up (weighted mean difference -0.09 and -0.18, respectively). While antiseptics did not provide significant benefits, one study on probiotics and one on the use of vitamin D and calcium supplementation showed significant improvements in periodontal parameters. There is currently insufficient/poor evidence to determine the efficacy of adjunctive strategies (other than antimicrobials) to improve the outcomes of SPC in case of residual/relapsing pockets.
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Antiinfecciosos Locales , Antiinfecciosos , Periodontitis Crónica , Fotoquimioterapia , Antiinfecciosos/uso terapéutico , Antiinfecciosos Locales/uso terapéutico , Periodontitis Crónica/terapia , Raspado Dental/métodos , Humanos , Fotoquimioterapia/métodosRESUMEN
AIMS: To compare tooth- (TSRP) and implant-supported (ISRP) removable prostheses in terms of abutment and prosthesis survival (PICO 1) and estimated cumulative survival of teeth/implants and prostheses (PICO 2) at ≥12-month post-prosthesis delivery in patients with stage IV periodontitis. MATERIALS AND METHODS: Five databases were searched to identify RCTs, CCTs, single arms, prospective cohort studies, case series and retrospective studies. Duplicate screening was performed, and ranges for abutment and prosthesis survival were calculated. RESULTS: Twenty-six studies were included in the qualitative assessment. Only one study with critical risk of bias comparing the two treatment modalities reported similar survival rates at 2 years. Overall, prospective studies on ISRPs indicated an implant survival rate ranging from 96.4% to 100% and a prosthesis survival rate of 100% with a follow-up from 12 to 54 months. Prospective studies on TSRPs indicated a tooth survival ranging from 85.71% to 100% at 1- to 10-years follow-up. CONCLUSIONS: The available evidence is of poor quality, and it does not allow to make robust conclusions on the efficacy of these rehabilitations in stage IV periodontitis patients. Particularly for TSRPs, careful patient selection is crucial and a certain number of biological and prosthetic complications should be expected.
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Implantes Dentales , Periodontitis , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Dentición , Estudios de Seguimiento , Humanos , Periodontitis/terapia , Estudios Prospectivos , Falla de Prótesis , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: To compare a behavioural management program (test) to a standard communication approach (control) to reduce plaque, improve clinical outcomes and patient's compliance with oral self-care. BACKGROUND: Since psychological factors affect oral health-related behaviours, approaches directed at changing behaviours and improving compliance might improve the effect of oral health education. MATERIALS AND METHODS: This was a randomized, single-blind, parallel-design trial involving 71 patients with mild to moderate periodontitis. During a run-in period, all participants began using a power toothbrush. Two sessions of non-surgical periodontal therapy were performed post-baseline, along with one of the two oral healthcare communication approaches. Plaque and bleeding scores, probing pocket depth (PPD) and clinical attachment level (CAL) were recorded at the screening visit, baseline visit and at 8 and 14 weeks post-baseline. Patients were asked to fill in oral self-care diaries. Experience questionnaires were administered to both clinicians and patients to assess subjective experience of the clinician-patient interactions during the visits. RESULTS: In both groups, a significant reduction in plaque and bleeding scores was observed from baseline to 8 weeks after baseline, which then remained stable at week 14, but no differences between the groups were noted. An improvement in CAL and PPD was recorded at week 8 post-baseline in the test compared to the control group. No inter-group differences in the clinician's and subject's experience questionnaires were observed. CONCLUSION: Both approaches significantly promoted periodontal health. However, changing lifestyle requires repeated communication/engagement over time and a behavioural management program based upon two visits did not provide additional benefit compared to a standard approach.
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Placa Dental , Periodontitis , Adulto , Placa Dental/prevención & control , Humanos , Método Simple Ciego , Cepillado DentalRESUMEN
BACKGROUND: Considering the role of the inflammatory host response in the pathogenesis of periodontitis, different host modulators have been proposed to enhance the outcomes of non-surgical periodontal therapy (NSPT), but their efficacy has not been fully clarified. OBJECTIVES: This systematic review investigated the efficacy of host modulators combined with NSPT in reducing probing pocket depth (PPD) in periodontitis patients. MATERIALS AND METHODS: Placebo-controlled RCTs with ≥6 months follow-up were searched. Meta-analysis was conducted when ≥5 studies using the same host modulator were identified. RESULTS: Fifty eight studies met the inclusion criteria. After 6 months, local administration of 1.2% statin gels as adjuncts to NSPT significantly improved PPD reduction (1.83 mm) in infrabony defects and systemic administration of sub-antimicrobial dose doxycycline (SDD) in addition to NSPT improved PPD reduction of deep pockets. Administration of probiotics conferred limited clinical benefits. Local bisphosphonate and metformin gels showed potential for clinical use in infrabony defects, which needs to be confirmed. CONCLUSIONS: Local delivery of statins in infrabony defects and systemic SDD for deep pockets may confer additional clinical benefits to NSPT. Their long-term effectiveness and safety need to be confirmed in independent multi-centred studies. Further studies are needed to confirm the benefit of other host modulators.
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Antiinfecciosos , Periodontitis , Antibacterianos/uso terapéutico , Atención Odontológica , Raspado Dental , Doxiciclina , Humanos , Periodontitis/tratamiento farmacológico , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
AIM: This review critically appraises the available knowledge on the pre-clinical and clinical use of bioactive factors for bone regeneration in the cranial and maxillofacial area. MATERIALS AND METHODS: The use of growth factors, amelogenins and autologous platelet concentrates (APCs) for bone regeneration was reviewed in a systematic manner. More specifically, pre-clinical and clinical studies on ridge preservation, alveolar ridge augmentation, regeneration of peri-implant defects and sinus augmentation models were considered. RESULTS: Amongst different bioactive factors, the highest pre-clinical and clinical evidence of a positive effect on bone formation is associated with rhBMP-2 and the lowest with amelogenins. While APCs seem to accelerate clinical healing and reduce postoperative discomfort, there is insufficient and contrasting evidence of a significant effect on hard tissue regeneration for the different clinical applications. CONCLUSIONS: Although there is increasing evidence that bioactive factors might enhance the bone regeneration process, the great heterogeneity of the available studies and the limited number of RCTs do not allow to draw robust conclusions. Issues that still need to be investigated include the optimal carriers for bioactive agents (direct vs. indirect), the dosage, the timing of administration, as well as the possibility of combining different agents to promote synergistic effects.
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Aumento de la Cresta Alveolar , Implantes Dentales , Regeneración Ósea , Implantación Dental Endoósea , OsteogénesisRESUMEN
BACKGROUND AND AIMS: To review the regenerative technologies used in bone regeneration: bone grafts, barrier membranes, bioactive factors and cell therapies. MATERIAL AND METHODS: Four background review publications served to elaborate this consensus report. RESULTS AND CONCLUSIONS: Biomaterials used as bone grafts must meet specific requirements: biocompatibility, porosity, osteoconductivity, osteoinductivity, surface properties, biodegradability, mechanical properties, angiogenicity, handling and manufacturing processes. Currently used biomaterials have demonstrated advantages and limitations based on the fulfilment of these requirements. Similarly, membranes for guided bone regeneration (GBR) must fulfil specific properties and potential biological mechanisms to improve their clinical applicability. Pre-clinical and clinical studies have evaluated the added effect of bone morphogenetic proteins (mainly BMP-2) and autologous platelet concentrates (APCs) when used as bioactive agents to enhance bone regeneration. Three main approaches using cell therapies to enhance bone regeneration have been evaluated: (a) "minimally manipulated" whole tissue fractions; (b) ex vivo expanded "uncommitted" stem/progenitor cells; and (c) ex vivo expanded "committed" bone-/periosteum-derived cells. Based on the evidence from clinical trials, transplantation of cells, most commonly whole bone marrow aspirates (BMA) or bone marrow aspirate concentrations (BMAC), in combination with biomaterial scaffolds has demonstrated an additional effect in sinus augmentation and horizontal ridge augmentation, and comparable bone regeneration to autogenous bone in alveolar cleft repair.
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Aumento de la Cresta Alveolar , Materiales Biocompatibles , Regeneración Ósea , Trasplante Óseo , Consenso , Regeneración Tisular Guiada PeriodontalRESUMEN
OBJECTIVES: To follow-up the radiographic bone level changes and the clinical outcomes of immediately provisionalized and conventionally restored implants with a hydrophilic surface following 5 years of function. MATERIALS AND METHODS: This was a 5-year follow-up of a prospective, randomized, single-blind controlled study involving 16 of the 24 originally recruited patients in need of a single-tooth replacement in the esthetic area. Implants were either immediately provisionalized with a non-occluding temporary crown (test group, n = 7), or left without a crown (control group, n = 9). In both groups, the definitive restoration was placed 16 weeks after implant placement. Radiographic and clinical parameters were evaluated at 36, 48, and 60 months post-implant placement, together with implant survival and success rates. The esthetic outcomes were measured with the Papilla Fill Index (PFI) and the Pink Esthetic Score (PES). RESULTS: At 60 months, similar peri-implant bone loss was observed in the test (-0.42 mm ±0.17 mm) and in the control (-0.37 mm ±0.35 mm) groups. A tendency for an improved esthetic outcome from implant loading to the subsequent follow-ups was noticed in both groups. Both groups presented with high levels of long-term implant survival and success. CONCLUSIONS: This study supports non-functional immediate provisionalization as a viable long-term option for the management of single-tooth implants in the esthetic area. However, the small sample size does not allow statistical inference at 60 months of follow-up and future adequately powered studies are warranted.
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Implantes Dentales , Estética Dental , Estudios de Seguimiento , Humanos , Interacciones Hidrofóbicas e Hidrofílicas , Estudios ProspectivosRESUMEN
OBJECTIVES: To compare the radiographic bone changes, clinical parameters and aesthetic outcomes of immediately provisionalised and conventionally restored implants at 12- and 24-months post-implant placement. MATERIAL AND METHODS: In 24 patients, 24 bone level implants with a hydrophilic (SLActive) surface were placed in healed sites and they were either immediately provisionalised with a non-occluding temporary crown (test group) or left without a crown (control group). In both groups, the definitive restoration was placed 16 weeks after implant placement. Clinical and radiographic parameters were calculated at 12- and 24-months post-implant placement, together with implant success/survival rates according to three different sets of criteria. The aesthetic outcome was evaluated through the Papilla Fill Index and the Pink Aesthetic Score. RESULTS: The mean marginal bone loss at 1 year was -0.73 mm (SD 0.83 mm) in the test group and -0.22 mm (SD 0.46 mm) in the control group (p > .05). Whilst 100% survival rate and positive aesthetic outcomes were recorded in both groups, three patients of the test group did not fulfil all success criteria. CONCLUSIONS: Immediate provisionalisation may represent a viable option for the replacement of single missing teeth, with radiographic, clinical and aesthetic results comparable to those of conventionally loaded implants at 2 years of follow-up.
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Implantación Dental Endoósea/métodos , Implantes Dentales de Diente Único , Carga Inmediata del Implante Dental , Adulto , Anciano , Pérdida de Hueso Alveolar/diagnóstico por imagen , Análisis de Varianza , Coronas , Estética Dental , Femenino , Humanos , Interacciones Hidrofóbicas e Hidrofílicas , Carga Inmediata del Implante Dental/métodos , Masculino , Persona de Mediana Edad , Radiografía Dental , Método Simple CiegoRESUMEN
OBJECTIVES: The aim of this systematic review was to assess whether the systemic skeletal reduction of bone mineral density (BMD) that characterizes osteoporotic subjects is also associated with a reduction of BMD in the jawbones. MATERIAL AND METHODS: Two reviewers searched independently and in duplicate three databases up to May 2014 and assessed the risk of bias using a tailored version of the Newcastle-Ottawa scale (NOS). Only papers reporting either Pearson's correlation coefficient or Spearman's rank correlation coefficient between skeletal and jawbone mineral density in more than five osteoporotic subjects were selected. RESULTS: From 1763 citations, 64 full-text papers were screened and five papers that met the inclusion criteria were included in the final analysis. None of the included studies complied with all NOS criteria, and as only two studies were eligible for meta-analysis, this was not performed. CONCLUSIONS: Only limited conclusions can be drawn from this systematic review, due to the small number of studies included, their heterogeneity, and their high risk of bias. Future studies that take into consideration both upper and lower jaws, that use the same technique to measure skeletal and jaw BMD (ideally dual-energy X-ray absorptiometry, DXA), and that account for confounding variables (such as medications/diseases affecting bone metabolism and demographics) are needed to provide more robust conclusions.
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Densidad Ósea , Mandíbula/fisiología , Osteoporosis/fisiopatología , Absorciometría de Fotón , HumanosRESUMEN
STATEMENT OF PROBLEM: The position of dental implants placed with software-guided systems should be highly accurate in order to ensure safety and a passive fit of the immediate prosthesis. PURPOSE: The purpose of this study was to measure the discrepancy between the clinical and software-planned position of dental implants by applying a photogrammetric method. MATERIAL AND METHODS: Two casts were obtained, 1 from the surgical template and 1 from the actual position of the implants on the alveolar ridge of a patient. Photogrammetry was then applied to precisely locate the position of each implant on the casts. Because this mathematical technique required the identification of image points and of the relative spatial coordinates, 4 marks were drilled on the implant screw. The position of the implants was then identified as the geometric center of the 4 marks, while the orientation of the implant axis was represented by a vector normal to the plane fitting the points. A series of 16 convergent images all around the object was made using a high-resolution digital camera. A mathematical method called "rototranslation" was used to superimpose the cast images for the comparison. RESULTS: The tests performed on the casts resulted in an average precision level of 4 µm for the locations and less than 1 degree for the axis of the implants. A series of empirical and numerical tests were performed to assess the performance of the procedure and of the measurement protocol. CONCLUSIONS: The photogrammetric method is reproducible and can be used to measure the discrepancy between the software-planned and the real position of dental implants. Considering that the average precision level required for an implant-based prosthesis is approximately 50 µm, the error associated with this method can be considered as negligible.