Hyperbaric oxygen therapy as an adjunct treatment of periodontitis, MRONJ, and ONJ: a systematic literature review.

OBJECTIVE: To review the available prospective literature on hyperbaric oxygen (HBO) therapy for periodontal conditions. MATERIALS AND METHODS: A comprehensive electronic and manual search was performed to identify clinical studies on adult patients who underwent hyperbaric oxygen therapy for periodontal treatments. A systematic literature search was conducted in PubMed, Cochrane, and Dentistry Oral Sciences Source databases. RESULTS: Fourteen articles were included in the final literature review, of which five were RCTs and 11 were prospective clinical studies. Four studies discussed HBO as an adjunct to nonsurgical treatment of periodontitis, eight reported on HBO and osteoradionecrosis, and one examined HBO in bisphosphonate-related necrosis of the jaws. CONCLUSIONS: HBO has shown superior efficacy compared to antibiotics as a prophylactic measure in preventing osteoradionecrosis (ORN) in patients with a history of high mandibular irradiation. Clinicians should consider referring such patients for HBO therapy before and after tooth extractions. However, for the surgical excision of existing ORN lesions, HBO therapy does not yield significant benefits but does not negatively impact outcomes either. Regarding the treatment of periodontitis patients, the variability among studies prevents definitive conclusions. HBO therapy as an adjunct to SRP in periodontitis treatment produces mixed results. CLINICAL RELEVANCE: This study's clinical relevance lies in its exploration of the potential benefits of HBO for periodontal conditions. Also, it provides clinicians with insights into when and how to integrate HBO therapy into their treatment approaches, particularly for patients with a history of irradiation and those undergoing complex dental procedures.

Single-rooted extraction socket classification: A systematic review and proposal of a new classification system based on morphologic and patient-related factors.

Taxonomy and classification of a disease contributes to facilitating the diagnosis and treatment planning process and simplifies communication between clinicians. The aim of this study was to provide a critical appraisal based on a systematic review of the single-rooted extraction socket (ES) classifications and subsequently, introduce a new classification system combining the cornerstones of the previously proposed systems and based on the latest consensus in implant dentistry. Following the systematic search process in PubMed, EMBASE, and SCOPUS databases 13 ES classifications were detected. The most repeated hard and soft tissue factors in the previous classifications were buccal bone dehiscence, interproximal bone, gingival recession, and soft tissue phenotype. However, there was minimal attention to patient-related factors such as systemic conditions and smoking. Therefore, a new classification system based on the combination of patient-related factors, clinical and radiographical parameters was proposed. This divides an ES into three types. Class I and II sockets are candidates for receiving immediate implant placement and conversely, a class III socket includes a compromised condition that requires multiple-stage reconstruction mostly suitable for standard delayed implant placement with alveolar ridge preservation. Within the limitations of this study, the new classification system not only provides comprehensive inclusion of various crucial parameters in implant placement (such as prediction of future implant position and osteotomy difficulty, etc.) but also, in contrast to the previously introduced systems, is able to classify the ES prior to extraction and also, takes into the account the patient-related factors as the class modifiers following the extraction.

Bone augmentation using titanium mesh: A systematic review and meta-analysis.

PURPOSE: To review and compare the available literature on bone regeneration using titanium mesh and map the current evidence on bone gain outcomes and complications while comparing this scaffold with collagen membranes. MATERIALS AND METHODS: A comprehensive electronic and manual search was performed to identify randomised and non-randomised prospective controlled clinical trials that involved the use of titanium mesh in at least one arm, with outcomes including complications and vertical and/or horizontal bone gain. The focused questions were defined as follows: What are the outcomes of using titanium mesh in ridge augmentation compared to other types of barrier membrane, and what is the complication rate (membrane exposure and infection) when titanium mesh is used in these procedures? RESULTS: A total of 22 articles were included in the qualitative analysis. Overall, the studies that measured bone gain resulted in 3.36 mm vertical (196 subjects; 95% confidence interval 2.44 to 4.64 mm, range 1.4 to 5.7 mm) and 3.26 mm horizontal augmentation (81 subjects; 95% confidence interval 2.93 to 3.63 mm, range 2.6 to 3.7 mm), with variability among studies. The most commonly noted complication was mesh exposure, regardless of the type of mesh used, and the second most common was graft failure. The overall pooled complications rate reported in clinical trials was 10.8%. The meta-analysis comparing titanium mesh and collagen membranes, controlling for the type of bone regeneration (staged or simultaneous with implant placement), failed to show a significant difference in horizontal bone gain between the two techniques. CONCLUSIONS: Within the limitations of the present study and acknowledging the heterogeneity among the articles included, titanium mesh can serve as a feasible protective scaffold for bone regeneration with a relatively acceptable complication rate and in defects requiring around 4 mm 3D reconstruction. Data on patient-reported outcomes were scarce. CONFLICT-OF-INTEREST STATEMENT: None of the authors have any financial interests, either directly or indirectly, in the products or information mentioned in the present article.

Accidental ingestion of a dental object during a periodontal surgical procedure on an IV sedated patient: Case management.

INTRODUCTION: Foreign-body aspiration (FBA) and ingestion (FBI) are rare but serious events that occur in dental offices throughout the world every year. Such events can have significant medical, legal, and financial consequences for both the dental clinician and the patient. By presenting this case study, we aim to highlight the proper management and possible sequelae of such an event. METHODS AND RESULTS: A 72-year-old woman underwent a dental procedure with intravenous sedation. In the process of dental treatment, a dental bur was accidentally ingested. The patient was promptly referred to an urgent care clinic, where serial abdominal radiographs were taken over several days to track the course of the bur through the digestive system. The bur was successfully removed without complication. CONCLUSION: Prompt management and referral of dental FBA and FBI cases, followed by successful object retrieval, lead to uncomplicated resolution of the event. KEY POINTS: Why is this case new information? This case presents the proper management of the FBA and FBI, particularly for IV sedated patients who require immediate action to mitigate and prevent serious complications. What are the keys to the successful management of this case and how can the risk of FBA and FBI be mitigated? The use of throat packs or rubber dams helps prevent foreign body aspiration and ingestion. Attaching floss to appliances and objects when appliances are used intraorally. (Specifically, to implant guide pins and implant screwdrivers.) Thorough isolation of the oropharynx from the mouth using a barrier, such as a gauze pad or rubber dam, during bracket placement, orthodontic appliance adjustment, and screwing or cementing of implant crowns Short and extra short implants should be connected by ligature to the implant handpiece. What are the primary limitations to success in this case? Lack of a throat pack Failure to confirm connection of bur to handpiece Patient's anatomy (redundant colon) preventing natural expulsion of the bur.

Implant Esthetic Complications: Anatomical, Prosthetic, and Patient-Centered Considerations for Treatment.

Implant esthetic complications can negatively affect a patient's perception of implant therapy and their quality of life. This article discusses the etiology, prevalence, and strategies for the treatment of peri-implant soft tissue dehiscences/deficiencies (PSTDs). Three common scenarios of implant esthetic complications were identified and described, in which PSTDs could be managed without removing the crown (scenario I), with the surgical-prosthetic approach (crown removal; scenario II), and/or with the horizontal and vertical soft tissue augmentation and submerged healing (scenario III).

Reliability assessment of the classification for facial peri-implant soft tissue dehiscence/deficiencies (PSTDs): A multi-center inter-rater agreement study of different skill-level practitioners.

BACKGROUND: Along with the popularity of dental implants, implant esthetic complications are also on the rise. Recently a classification was proposed to comprehensively evaluate these conditions, with the definition of peri-implant soft tissue dehiscence/deficiencies (PSTDs). The aim of this article was therefore to test the inter-examiner agreement when utilizing the established rubrics among 25 standardized cases and 34 clinicians of different skill levels. METHODS: Twelve periodontal residents, 12 general dentists, and 10 periodontists participated in this study. All examiners were provided with photographs of 25 single PSTDs and asked to rate all cases based on the proposed classification at a single timepoint. Variance components analysis was conducted with multilevel regression fit in a Bayesian framework to obtain uncertainty intervals for fractional variance contributions and interclass correlation values (ICC) to assess the agreement in the rating of all cases, among all examiners, different skill-level practitioners, and to compare their responses relative to the judgment of a gold standard examiner. RESULTS: Overall, the results showed reproducible and consistent responses among the 34 examiners, and in each subgroup of skill-level, comparable to that of the gold examiner. Nevertheless, periodontists and residents were more likely to agree with the response of the gold standard examiner in their assessments of class and subclass of the PSTDs. CONCLUSIONS: The proposed PSTD classification showed reproducible assessments among all examiners, and between examiners of the same skill-level. The response of the gold standard examiner was more in line with the assessment of the periodontists and periodontal residents.