Survival analysis of dental implants placed in a private practice. A multicenter prospective cohort study.

Background: This prospective cohort study aimed to assess the predictability and survival rates of dental implant treatment in edentulous patients while identifying potential factors contributing to implant failure. Material and Methods: A total of 80 outpatients, receiving 166 dental implants between September 2015 and November 2017 in two private dental clinics, were included in this study. Patient and implant characteristics, surgical procedures, primary stability, prosthetic rehabilitation, failure analysis, and survival rates were analyzed. Results: The majority of patients (53.75%) received a single implant for treating single-gap edentulism, with 6.25% requiring implants for fully edentulous jaws. Most implants (66.87%) were Avinent Ocean IC implants with specific design features. Surgical placement primarily occurred in healed pristine bone (78.31%), immediate implants in fresh extraction sockets (19.88%), and bone regeneration was simultaneous in 15.66% of cases. While 54.82% of implants achieved primary stability over 35Ncm, none exceeded 45Ncm, and only 4.82% failed to attain primary stability. Prosthetic rehabilitation revealed that 13.25% received immediate loading prostheses. During follow-up, four implants failed, resulting in a 2.41% failure rate, with bruxism (HR: 96.62; P< 0.001) and absence of primary stability (HR: 23.54; P< 0.001) significantly associated with implant failure. The cumulative survival rate at 24 months was 97.44%. Conclusions: This study demonstrates the high predictability and survival rates of dental implant treatment in edentulous patients, consistent with established standards. Factors such as bruxism and primary stability may impact early implant failure. Dental implants remain a reliable treatment option, boasting a 97.44% cumulative survival rate at 24 months. Further research is required to explore implant failure indicators and multifactorial influences. Key words:Dental implants, survival, edentulous patients.

Peri-implantitis in patients without regular supportive therapy: Prevalence and risk indicators.

OBJECTIVES: To determine the prevalence of peri-implant diseases in patients treated in a university setting without a regular peri-implant supportive therapy schedule, and to identify the risk indicators associated with peri-implantitis. MATERIAL AND METHODS: A retrospective cohort study was made of patients with dental implants with at least 12 months of functional loading who did not receive regular peri-implant supportive therapy. Patient- and implant-related variables were retrieved, and clinical and radiological examinations were performed. Descriptive and bivariate analyses and multilevel logistic regression analyses were performed to identify factors associated with peri-implantitis. RESULTS: A total of 213 implants in 88 patients were analyzed. The patient-level prevalence of peri-implantitis and peri-implant mucositis was 26.1% (95%CI: 16.7%-35.5%) and 44.3% (95%CI: 34.0%-54.6%), respectively. Peri-implant diseases were significantly more frequent when the width of the keratinized mucosa was < 2 mm (OR = 5.26; 95%CI: 1.24-22.26; p = 0.024), and when there was 12 month post-loading bone loss (OR = 2.96; 95%CI: 1.35-6.52; p = 0.007). CONCLUSIONS: Peri-implantitis is a common finding in patients without regular peri-implant supportive therapy (prevalence 16.7-35.5%). A thin peri-implant keratinized mucosa (< 2 mm) and a higher degree of bone remodeling after loading seem to be the main risk factors for peri-implantitis in this patient profile. CLINICAL RELEVANCE: Patients who do not engage in supportive peri-implant maintenance have a higher risk of peri-implantitis. A thin keratinized mucosa and bone loss during the first year of loading are predisposing factors for peri-implantitis.

Evaluation of the efficacy of hydroxyl radical (OH) release for disinfection of the air and surfaces in the dental clinic: an in vitro study / Evaluación de la eficacia de la liberación de radicales hidroxilo (OH) para la desinfección del aire y superficies en la clínica dental: un estudio in vitro

Background: Concerning about the quality of room air has increased exponentially. Specially in dental clinicswhere diary practice is characterized by the important generation of aerosols.Material and Methods: An in vitro model was used in which samples were collected from the surfaces and roomair of a dental clinic before and after the use of an OH˙ radical generator.Results: A total of 1260 samples were collected for bacteriological analysis and 14 samples for the detection ofSARS-CoV-2. Following OH˙ treatment, the tested surface samples showed a decrease in the number of colonyforming units (CFUs) of 76.9% in TSA culture medium. The circulating room air samples in turn showed adecrease in CFUs of 66.7% in Sabouraud medium and 71.4% in Mannitol agar medium. No presence of SARS-CoV-2 was observed on the surface of the face shield.Conclusions: The disinfectant technology based on the use of hydroxyl radicals (OH˙) is effective in reducing thepresence of moulds and yeasts and Staphylococcus in the air, and in reducing total aerobic bacteria on the testedsurfaces.(AU)

Role-playing para la mejora de las habilidades comunicativas en estudiantes de grado de Odontología. Un ensayo clínico no aleatorizado / Role-playing for the improvement of communication skills in Dentistry undergraduate students. A non-randomized clinical trial

Introducción: Se trata de analizar el impacto de una secuencia formativa en la autopercepción del alumnado sobre las habilidades comunicativas. Secundariamente, se pretende conocer el grado de satisfacción del alumnado en relación con las actividades propuestas. Mètodos: Es un estudio cuasi experimental realizado sobre cuatro de los subgrupos de prácticas de la asignatura obligatoria de cuarto curso Cirugía Bucal Clínica e Implantología. Dos de los subgrupos recibieron una secuencia formativa específica para la mejora de sus habilidades comunicativas (n = 40) y los otros dos actuaron como controles (n = 47). Al inicio y al final del estudio, los participantes respondieron el cuestionario validado SE-12 de autopercepción sobre comunicación odontólogo-paciente. La estrategia evaluativa fue continua y formativa. Se analizaron y compararon las puntuaciones de los distintos indicadores e instrumentos de evaluación empleados.Resultados: A excepción de un alumno del grupo de control, todos los estudiantes participaron de forma activa en el proyecto. En ambos grupos se observó una mejora estadísticamente significativa en la percepción de las habilidades comunicativas (p < 0,001). No obstante, los alumnos asignados al grupo experimental percibieron una mejora significativamente mayor (diferencia de medias = 0,96 puntos; intervalo de confianza al 95% = 0,66-1,27; p < 0,001). Los alumnos valoraron la secuencia con un 8,56 (desviación estándar = 1,14).Conclusiones: La implementación de la secuencia formativa produjo una mejora en la percepción que tienen los estudiantes sobre sus habilidades comunicativas. Es necesaria la inclusión de programas longitudinales de formación en comunicación en los planes de estudio para acreditar la consecución de las competencias comunicativas.(AU)

Introduction: To analyze the impact of a training-learning sequence on students' self-perception of communication skills. Secondarily, to know the degree of student satisfaction in relation to the proposed activities.Methods: A quasi-experimental study was carried out on four of the clinical practice subgroups of Clinical Oral Surgery and Implantology (fourth year of study). Two of the subgroups received a specific training-learning sequence to improve their communication skills (n = 40) and the other two served as controls (n = 47). At the beginning and end of the study, the participants answered the validated SE-12 self-perception questionnaire on dentist-patient communication. The evaluation strategy was continuous and formative. The scores of the different indicators and evaluation instruments used were analyzed and compared.Results: Except for one student in the control group, all students participated actively in the project. In both groups, a statistically significant improvement was observed in the perception of communication skills (p < 0.001). However, the students assigned to the experimental group perceived a significantly greater improvement (difference in means = 0.96 points; 95% confidence interval = 0.66-1.27; p < 0.001). The students valued the training-learning sequence with an 8.56 (standard deviation = 1.14).Conclusions: The implementation of the training-learning sequence produced an improvement in the perception that students have about their communication skills. It is necessary to include longitudinal training programs in communication in the curricula to prove the achievement of communication skills competences.(AU)

Tracking soluble and nanoparticulated titanium released in vivo from metal dental implant debris using (single-particle)-ICP-MS.

BACKGROUND: This work studies the presence of the Ti, Al and V metal ions and Ti nanoparticles released from the debris produced by the implantoplasty, a surgical procedure used in the clinic, in rat organs. METHODS: The sample preparation for total Ti determination was carefully optimized using microsampling inserts to minimize the dilution during the acid attack of the lyophilized tissues by a microwave-assisted acid digestion method. An enzymatic digestion method was optimized and applied to the different tissue samples in order to extract the titanium nanoparticles for the single-particle ICP-MS analysis. RESULTS: A statistically significant increase was found for Ti concentrations from control to experimental groups for several of the studied tissues, being and particularly significant in the case of brain and spleen. Al and V concentrations were detected in all tissues but they were not different when comparing control and experimental animals, except for V in brain. The possible presence of Ti-containing nanoparticles mobilized from the implantoplasty debris was tested using enzymatic digestions and SP-ICP-MS. The presence of Ti-containing nanoparticles was observed in all the analyzed tissues, however, differences on the Ti mass per particle were found between the blanks and the digested tissue and between control and experimental animals in some organs. CONCLUSION: The developed methodologies, both for ionic and nanoparticulated metal contents in rat organs, have shown the possible increase in the levels of Ti both as ions and nanoparticles in rats subjected to implantoplasty.

Effect of Implantoplasty on Roughness, Fatigue and Corrosion Behavior of Narrow Diameter Dental Implants.

Implantoplasty (IP) is used in dental implants with peri-implantitis and aims to remove threads and polish rough surfaces in order to prevent bacterial colonization. As a result of this procedure, implant strength might be compromised. We tested 20 tapered screw-shaped Ti6Al4V dental implants with a simulated bone loss of 50%. Ten implants underwent IP and 10 served as controls. Surface topography (Sa, Sz, Ssk, and Sdr) was analyzed with a confocal optical microscope. Subsequently, a minimum of four series of cyclic loads were applied with a servo-hydraulic mechanical testing machine (5 × 106 cycles at 15 Hz, between a maximal nominal value-starting at 529 N in the IP group and 735 N in the control group-and 10% of that force). We recorded the number of cycles until failure and the type of failure. Implant failure was analyzed by visual inspection and scanning electron microscopy. Open circuit potential and potenctiodynamic tests were carried out with high precision potentiostat using Hank's solution at 37 °C to evaluate the effect of the implantoplasty on the corrosion resistance. Implantoplasty significantly reduced the surface topography values (median) and interquartile range (IQR); Sa from 1.76 (IQR = 0.11) to 0.49 (IQR = 0.16), Sz from 20.98 (IQR = 8.14) to 8.19 (IQR = 4.16), Ssk from 0.01 (IQR = 0.34) to -0.74 (IQR = 0.53) and Sdr from 18.20 (IQR = 2.26) to 2.67 (IQR = 0.87). The fatigue limits of the control and implantoplasty groups were 551 N and 529 N, respectively. The scanning electron micrographs showed fatigue striations indicating fatigue failure. Besides, the fractographic analysis revealed a typical brittle intergranular fracture mechanism. The infinite life range of the dental implants evaluated was largely above the threshold of usual chewing forces. Implantoplasty seems to render a fairly smooth surface and has a limited impact on fatigue resistance. In addition, implantoplasty produces a decrease in the corrosion resistance of the implant. Corrosion current density from 0.019 µA/cm2 for as-received to 0.069 µA/cm2 in the interface smooth-roughened dental implant. These places between the machining and the rough area of the implant are the most susceptible, with the appearance of pitting.

Ion release and local effects of titanium metal particles from dental implants: An experimental study in rats.

BACKGROUND: The objective of this study was to evaluate the accumulation of ions in blood and organs caused by titanium (Ti) metal particles in a mandibular defect in rats, together with a description of the local reaction of oral tissues to this Ti alloy debris. METHODS: Twenty Sprague-Dawley rats were randomly distributed into three groups: an experimental group with a mandibular bone defect filled with metallic debris obtained by implantoplasty; a positive control group; and a negative control group. Thirty days after surgery, the rats were euthanized and perilesional tissue surrounding the mandibular defect was removed, together with the lungs, spleen, liver, and brain. Two blood samples were collected: immediately before surgery and before euthanasia. The perilesional tissue was histologically analyzed using hematoxylin-eosin staining, and Ti, aluminum, and vanadium ion concentrations in blood and organs were measured by TQ-ICP-MS. Descriptive and bivariate analyses of the data were performed. RESULTS: All rats with implanted metal debris showed metal particles and a bone fracture callus on the osseous defect. The metal particles were surrounded by a foreign body reaction characterized by the presence of histiocytes and multinucleated giant cells (MNGCs). The experimental group had a significant higher concentration of Ti ions in all studied organs except lung tissue (p < 0.05). In addition, there were more V ions in the brain in the experimental group (p = 0.008). CONCLUSIONS: Although further studies are required to confirm the clinical relevance of these results, Ti metal particles in the jaw might increase the concentration of metal ions in vital organs and induce a foreign body reaction.

Evaluation of the inflammatory and osteogenic response induced by titanium particles released during implantoplasty of dental implants.

Implantoplasty is a mechanical decontamination technique that consists of removing the threads and polishing and smoothing the dental implant surface. During implantoplasty there is a large release of titanium metal particles that might provoke a proinflammatory response and reduce the viability of osteogenic cells. We analyze the inflammatory and osteogenic response induced by Ti6Al4V particles released during implantoplasty and by as-received commercially pure Ti particles. Macrophages stimulated with metal particles obtained by implantoplasty and with as-received Ti particles showed an increased proinflammatory expression of TNF-α and a decreased expression of TGF-ß and CD206. Regarding cytokine release, there was an increase in IL-1ß, while IL-10 decreased. The osteogenic response of Ti6Al4V extracts showed a significant decrease in Runx2 and OC expression compared to the controls and commercially pure Ti extracts. There were no relevant changes in ALP activity. Thus, implantoplasty releases metal particles that seems to induce a pro-inflammatory response and reduce the expression of osteogenic markers.

Prevalence of Periodontitis among Patients Diagnosed with Marfan Syndrome: A Cross-Sectional Study Comparing Samples of Healthy Patients.

Periodontitis is an inflammatory condition caused by a bacterial plaque and characterized by progressive destruction of the tooth-supporting apparatus. Patients with Marfan syndrome (MFS) exhibit a connective tissue disorder, which can also affect oral soft and hard tissue. Thus, the aims of this cross-sectional study were to assess the association between periodontitis and MFS and secondly, to compare periodontal parameters and prevalence of disease with a control group (CG) without MFS. 152 patients (MFS = 76, CG = 76) were recruited to evaluate the following periodontal parameters: probing depth, gingival margin, clinical attachment level, plaque index, and bleeding on probing. The 2017 World Workshop guideline was followed for the diagnosis of the periodontal status. A multivariate analysis was performed using a multinomial logistic regression adjusted for age, gender, and smoking. The level of significance required was p < 0.05. Patients with MFS did not show a higher prevalence of periodontitis compared to the CG. However, patients with MFS did have higher values in probing depth, gingival recession, clinical attachment level, and plaque index compared to the CG patients (p < 0.05). In conclusion, although similar prevalence of periodontitis was found among the studied groups, MFS patients showed worse periodontal parameters.

Efficacy of the use of chondroitin sulphate and glucosamine for the treatment of temporomandibular joint dysfunction: A systematic review and meta-analysis.

OBJECTIVE: To evaluate the efficacy of chondroitin sulfate (CS) and glucosamine (GS), the most relevant drugs of "Symptomatic Slow Acting Drug for Osteoarthritis" (SYSADOA), in the functional and symptomatic improvement of temporomandibular dysfunction. Although, controversy exists regarding their benefit. METHODS: An electronic search was conducted to retrieve randomized controlled clinical trials (RCTs). The risk of bias assessment was evaluated using the Cochrane Collaboration's tool. Data were meta-analyzed with a random effect model whenever possible. RESULTS: Three RCTs were included. Qualitative results showed a decrease in pain, joint noise, and inflammatory biomarkers in synovial fluid and an improvement in maximum mouth opening without significant adverse effects. Meta-analysis showed a significant increase in maximum mouth opening with the use of CS-GS (p = 0.19). No statistically significant differences were found in pain reduction compared to tramadol. CONCLUSION: CS-GS is effective and safe in the symptomatic and functional improvement of patients with TMD.

Clinical effect of vitamin C supplementation on bone healing: A systematic review

Background: The aim of the present systematic review was to evaluate the clinical effect of vitamin C on bone healing after bone fracture or bone reconstruction procedures. Material and Methods: In October 2020, Cochrane Library, Scopus and PubMed-Medline databases were searched without restrictions to identify animal and human studies that fulfilled the eligibility criteria. Outcome measures were bone healing time, bone gain (mm), bone density and adverse events. The risk of bias assessment of the selected studies was evaluated by means of Cochrane Collaboration’s Tool for randomized clinical trials, while randomized clinical animal trials were assessed according to SYRCLE’s tool. Additionally, quality of reporting animal studies were assessed according to ARRIVE guidelines. Results: Out of the 248 articles that yielded the initial search, 11 papers about the effect of ascorbic acid on bone healing were selected. In most of the animal studies, vitamin C seemed to accelerate bone formation owing to an enhanced osteoblastic proliferation and differentiation and its antioxidant function when pro-oxidant substances were added. It was not possible to observe this phenomenon in human studies. Conclusions: Although additional well-performed animal and human studies are required, vitamin C seems to accelerate bone regeneration without adverse events. However, it is not possible to recommend a specific dose or route of administration of vitamin C to improve the bone healing process in humans as there was great heterogeneity among the included studies.(AU)

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

The main objective of this study was to compare the clinical and histological results of synthetic bone substitutes used in maxillary sinus floor augmentation. A systematic review and meta-analysis was performed by searching the PubMed/MEDLINE, Scopus, and Cochrane databases for studies of the success of endosseous dental implant, implant failure, peri-implant marginal bone loss, newly formed bone, and residual bone graft material. After the search, 10 randomized clinical trials were included, with 4 studies ranging from low to unclear risk of bias were used for meta-analysis, comparing biphasic calcium phosphate (BCP) and deproteinized bovine bone (DBB). A greater amount of residual graft material (mean difference [MD]: -4.80 mm; 95% CI: -9.35 to -0.26; P = .040) was found in the DBB group. No other statistically significant differences were found between BCP and DBB for the remaining outcomes. Our results suggested that BCP can be considered a suitable alternative to DBB in maxillary sinus floor augmentation due to its clinical and histological results.

Physicochemical and Biological Characterization of Ti6Al4V Particles Obtained by Implantoplasty: An In Vitro Study. Part I.

Implantoplasty is a mechanical decontamination technique that consists of polishing the supra-osseous component of the dental implant with peri-implantitis. This technique releases metal particles in the form of metal swarf and dust into the peri-implant environment. In the present in vitro study, the following physicochemical characterization tests were carried out: specific surface area, granulometry, contact angle, crystalline structure, morphology, and ion release. Besides, cytotoxicity was in turn evaluated by determining the fibroblastic and osteoblastic cell viability. As a result, the metal debris obtained by implantoplasty presented an equivalent diameter value of 159 µm (range 6-1850 µm) and a specific surface area of 0.3 m2/g on average. The particle had a plate-like shape of different sizes. The release of vanadium ions in Hank's solution at 37 °C showed no signs of stabilization and was greater than that of titanium and aluminum ions, which means that the alloy suffers from a degradation. The particles exhibited cytotoxic effects upon human osteoblastic and fibroblastic cells in the whole extract. In conclusion, metal debris released by implantoplasty showed different sizes, surface structures and shapes. Vanadium ion levels were higher than that those of the other metal ions, and cell viability assays showed that these particles produce a significant loss of cytocompatibility on osteoblasts and fibroblasts, which means that the main cells of the peri-implant tissues might be injured.

Mechanical Properties and Corrosion Behavior of Ti6Al4V Particles Obtained by Implantoplasty: An In Vitro Study. Part II.

In the field of implant dentistry there are several mechanisms by which metal particles can be released into the peri-implant tissues, such as implant insertion, corrosion, wear, or surface decontamination techniques. The aim of this study was to evaluate the corrosion behavior of Ti6Al4V particles released during implantoplasty of dental implants treated due to periimplantitis. A standardized protocol was used to obtain metal particles produced during polishing the surface of Ti6Al4V dental implants. Physicochemical and biological characterization of the particles were described in Part I, while the mechanical properties and corrosion behavior have been studied in this study. Mechanical properties were determined by means of nanoindentation and X-ray diffraction. Corrosion resistance was evaluated by electrochemical testing in an artificial saliva medium. Corrosion parameters such as critical current density (icr), corrosion potential (ECORR), and passive current density (iCORR) have been determined. The samples for electrochemical behavior were discs of Ti6Al4V as-received and discs with the same mechanical properties and internal stresses than the particles from implantoplasty. The discs were cold-worked at 12.5% in order to achieve the same properties (hardness, strength, plastic strain, and residual stresses). The implantoplasty particles showed a higher hardness, strength, elastic modulus, and lower strain to fracture and a compressive residual stress. Resistance to corrosion of the implantoplasty particles decreased, and surface pitting was observed. This fact is due to the increase of the residual stress on the surfaces which favor the electrochemical reactions. The values of corrosion potential can be achieved in normal conditions and produce corroded debris which could be cytotoxic and cause tattooing in the soft tissues.

A systematic review and meta-analysis on the effectiveness of xenograft to prevent periodontal defects after mandibular third molar extraction / Una revisión sistemática y un metanálisis sobre la eficacia del xenoinjerto para prevenir defectos periodontales después de la extracción del tercer molar mandibular

Background: To evaluate the use of guided bone regeneration with xenograft to prevent periodontal defect in thedistal aspect of the second molar after the surgical removal of the mandibular third molar.Material and Methods: Three electronic databases (Pubmed, Cochrane Library and Scopus) were searched inApril 2020. Randomized clinical trials in non-smokers and healthy patients, with at least six months follow-up, comparing periodontal probing depth, clinical attachment level, alveolar bone level and adverse events wereselected by two independent investigators. The risk of bias assessment of the selected studies was evaluated bymeans of the Cochrane Collaboration’s Tool. Finally, a meta-analysis of the outcomes of interest was performed.Results: Despite 795 articles were found in the initial search, only three randomized controlled clinical trials wereincluded. Pooled results favoured the use of the xenograft plus collagen membrane over the spontaneous healingin terms of periodontal probing depth gain (MD=2.36; 95% CI 0.69 to 4.03; P=0.005) and clinical attachment levelgain (MD=2.52; 95% CI 0.96 to 4.09; P=0.002). No other statistically significant differences were found.Conclusions: Within the limitations of the present review, the xenograft plus collagen membrane exhibited betterperiodontal results than spontaneous healing without increasing postoperative complications. However, future well-designed studies with larger samples are required to confirm our results.(AU)

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

INTRODUCTION: The aim of the present meta-analysis was to determine the effect of the different incision designs used in apical surgery on periodontal parameters. METHODS: An electronic search in Cochrane Library, Pubmed (MEDLINE), and Scopus was conducted on April 2020. Two independent investigators included clinical trials and prospective cohort studies comparing the influence of different incision designs used in apical surgery on gingival recession, periodontal probing depth, and clinical attachment level. A pairwise and network meta-analysis was performed in order to meta-analyze the direct and the indirect comparisons among the incision designs. RESULTS: Six articles were included for the qualitative and the quantitative syntheses, involving a total of 401 teeth (372 patients). The pairwise meta-analysis did not reveal statistically significant differences between the incision designs in any of the outcomes evaluated. However, to reduce the amount of buccal gingival recession, the papilla base incision presented the highest probabilities of being ranked the most effective incision (85.7%), followed by submarginal incision (50.0%) and intrasulcular incision (14.3%). CONCLUSION: Regardless of the incision design used, the periodontal parameters did not statistically differ after apical surgery. CLINICAL RELEVANCE: Periodontal parameters did not significantly change despite the incision used in apical surgery. However, based on the results of the present review, the papilla base incision seems to be the best option to reduce the amount of buccal gingival recession.

Accidental dental displacement into the maxillary sinus during extraction maneuvers: a case series

BACKGROUND: The aims of this study were to describe the clinical findings of patients that suffered teeth displacement into the maxillary sinus, and to report the surgical technique used to solve this complication. MATERIAL AND METHODS: A retrospective observational study was conducted involving patients that suffered a displacement of teeth into the maxillary sinus. Demographic and clinical data were recorded from the affected patients and a descriptive statistical analysis was made of the study variables. RESULTS: A total of nine patients were enrolled, six males (66.7%) and three females (33.3%), with a mean age of 36.0 years (range 22-54). In five patients (55.5%) the displaced teeth remained asymptomatic; however, dental fragments were retrieved from the maxillary sinus using Caldwell-Luc technique or endoscopic approach. CONCLUSIONS: Dental displacement into the maxillary sinus during the extraction manoeuvres is an uncommon finding. Even in asymptomatic cases, these displaced teeth should be extracted in order to avoid the development of sinus pathology

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

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

Safety and efficacy of 4% articaine in mandibular third-molar extraction: A systematic review and meta-analysis of randomized clinical trials.

BACKGROUND: The authors aimed to assess whether 4% articaine is a safe and effective local anesthetic (LA) for mandibular third-molar extractions. TYPES OF STUDIES REVIEWED: The authors searched MEDLINE (PubMed), Cochrane Library, Scopus, and Web of Science databases to identify randomized clinical trials that fulfilled the eligibility criteria. Risk of bias was evaluated using the Cochrane risk-of-bias assessment tool. The authors performed a meta-analysis of safety and efficacy variables comparing 4% articaine with different LAs. RESULTS: The authors assessed 482 articles but only 14 randomized clinical trials met the inclusion criteria for review. No statistically significant differences were found among the selected LAs regarding safety. Four percent articaine required fewer reinjections than 2% lidocaine and had a shorter onset time than 2% lidocaine, 0.5% bupivacaine, and 4% lidocaine. Four percent articaine had a longer anesthesia effect than 2% lidocaine and 2% mepivacaine, but a shorter anesthesia effect than 0.5% bupivacaine. PRACTICAL IMPLICATIONS: Use of 4% articaine for mandibular third-molar extraction is a safe choice that requires fewer reinjections and has a shorter onset time than other aminoamide-type LAs.