Radiographic bone loss around dental implants: a large-cohort, long-term follow-up revealing prevalence and predictive factors.

OBJECTIVE: This retrospective study analyzed radiographic bone levels of 10,871 dental implants in a cohort of 4,247 patients over a 22-year period. The objectives of the study were to assess and explore risk factors associated with the radiographic bone level of dental implants. METHOD AND MATERIALS: A longitudinal observational cohort study based on data collected from 1995 to 2019 was conducted on implants placed by a single periodontist. Inclusion criteria included both partially and fully edentulous sites. Exclusion criteria were patients who were considered ASA 3 or greater. Information on medical and dental status prior to implant placement such as diabetes and smoking were included in the analysis. Implant factors such as the implant characteristics (length and diameter) and surgical site were recorded. The outcome assessed was the prevalence of bone loss around implants and any associative factors related to the bone loss. RESULTS: Overall, dental implants lost an average of 0.05 ± 0.38 mm of bone 2 to 3 years after placement and 0.21 ± 0.64 mm 8 years after placement. The soft tissue condition was evaluated using the Implant Mucosal Index (IMI), and bone loss around dental implants was significantly higher when bleeding on probing was multi-point and moderate, multi-point and profuse, and when infection with suppuration was recorded. The mean difference in bone level between smokers and nonsmokers was 0.26 mm (P < .01) over a 4-year period. A mean difference of 0.10 mm (P = .04) in bone loss over 4 years was found between those with an autoimmune disease compared to those without. The diameter of the implant and immediate loading of the dental implant did not influence the radiographic bone levels over time. CONCLUSIONS: This large dataset of dental implants highlights predictive risk factors for bone loss around dental implants and the impact these risk factors have on the implant bone level. Consideration of these risk factors by both the dental team and the patient prior to dental implant placement will promote success of the treatment.

Use of a Novel In Situ Hardening Biphasic Alloplastic Bone Grafting Material for Guided Bone Regeneration Around Dental Implants: A Prospective Case Series.

INTRODUCTION: The novel bioresorbable polymer poly (lactide-co-glycolic acid) (PLGA) coated biphasic calcium phosphate material (BCP) hardens into a stable and porous hard tissue scaffold when exposed to body fluids. The self-containable, stable bone graft material might be beneficial for facilitating guided bone regeneration (GBR) around dental implants, especially for a defect with an absence of bony wall(s). The aim of this prospective case series is to evaluate the post-surgical implant survival and success where the in situ hardening BCP was used for GBR around dental implants. CASE SERIES: Ten patients received 13 implants with simultaneous bone augmentation. Dehiscence and/or fenestration type of bony defect was detected in nine surgical sites, and three surgical sites exhibited a suprabony defect. In nine out of the 13 implants, a membrane was used in conjunction with the bone grafting. Patients were evaluated at the day of the surgery as well as 2 weeks, and 1, 3, 6, and 12 months postoperatively. All post-surgical wounds were uneventfully healed. Radiographic bone levels showed stability over time with an average bone loss/remodeling of 0.19 ± 0.6 mm (range, -0.5-1.5 mm) from implant placement to the last follow-up at 12 months. All implants survived after 12 months. CONCLUSIONS: Implant placement with simultaneous bone grafting using the in situ hardening BCP, was shown to be a viable and safe procedure with stable clinical and radiographic results over the follow-up period. Further long-term studies are warranted, however, the combination of the ease of handling and the favorable results are promising.

Do root coverage procedures affect the longevity of teeth? A systematic review.

OBJECTIVE: The objective of this study was to systematically review the literature regarding the effect of root coverage procedures on tooth survival and periodontal outcomes. DATA SOURCES: A systematic search of the literature was performed according to the PRISMA guidelines. A PICO-based search strategy was performed in six databases. Eligibility criteria included studies comparing tooth survival and periodontal outcomes of teeth treated with root coverage procedures versus teeth that had no treatment. The search resulted in 3,646 articles; 212 articles were downloaded for review, and six articles (three studies) were included. Only a single study reported on tooth survival and found no difference between teeth that underwent root coverage procedures versus those that did not. Although the surgeries described in each study were mostly successful in reducing recession and increasing keratinized gingiva, teeth which did not undergo surgery did not seem to have a clinically significant change in recession. The study with the longest follow-up (18 to 35 years) showed an average increase in recession of 0.5 ± 0.9 mm and a decrease in keratinized tissue of 0.3 ± 0.8 mm in the control group. CONCLUSION: This systematic review highlights the need for randomized controlled trials to assess the influence of root coverage surgeries on tooth longevity in order to better inform evidence-based practice. When compared to no surgical intervention, there is presently no evidence to suggest that root coverage surgeries increase tooth longevity. Furthermore, the amount of recession does not appear to increase a clinically significant amount over time without surgical intervention in the presence of proper maintenance and home care.

Comparison of new formulas of stannous fluoride toothpastes with other commercially available fluoridated toothpastes: A systematic review and meta-analysis of randomised controlled trials.

AIM: The aim of this study was to systematically review and analyse the difference in efficacy of stannous fluoride toothpaste formulations in comparison to other fluoridated toothpastes without stannous fluoride. MATERIALS AND METHODS: A systematic search of the literature was performed according to PRISMA guidelines. A search strategy was developed to answer the study question and was performed in PubMed-Medline databases. Inclusion criteria were randomised controlled clinical trials comparing stannous fluoride toothpaste formulations with other fluoridated toothpastes not containing stannous fluoride. RESULTS: The search in PubMed-Medline databases resulted in 384 articles; 23 articles were downloaded for review, 16 articles were included in the report and six could be used for meta-analysis. All studies were randomised controlled clinical trials that compared clinical outcomes between toothpastes with stannous fluoride combinations and toothpastes with only fluoride. The overall results of the 16 studies favoured the stannous fluoride formulations. However, in a meta-analysis of the randomised controlled clinical trials, it was demonstrated that stannous fluoride toothpaste formulations provided significantly better outcomes based on the Gingival Index (SMD -0.14, 95% CI -0.20, -0.07, P = 0.0001), but not the Modified Gingival Index (SMD -0.30, 95% CI -0.7, 0.09, P = 0.13). PRACTICAL IMPLICATIONS: The antibacterial properties of stannous seem to provide favourable results when formulated with a fluoridated toothpaste. This systematic review highlights the lack of homogenous research available to rigorously compare stannous fluoride toothpaste formulations with other fluoridated toothpastes without stannous fluoride.

Systematic review and meta-analysis of randomized controlled studies comparing oscillating-rotating and other powered toothbrushes.

BACKGROUND: The aim of this study was to systematically review and analyze the difference in efficacy of oscillating-rotating toothbrushes compared with other powered toothbrushes. METHODS: The authors performed a systematic search of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The authors used the population, intervention, comparison, and outcome format to develop a search strategy to answer the study question. The authors searched PubMed-MEDLINE databases. Inclusion criteria were randomized controlled clinical trials comparing oscillating-rotating (OR) toothbrushes with other powered toothbrushes published from January 1, 2009 through March 1, 2019. RESULTS: The authors' search resulted in 454 articles; 21 articles were downloaded for review, 15 articles were included in the report, and 12 could be used for meta-analysis. All of the studies were randomized controlled clinical trials that assessed plaque removal and gingival inflammation indexes. Results of the meta-analysis of the randomized controlled clinical trials showed that OR toothbrushes had superior, statistically significant outcomes for whole-mouth plaque reduction, assessed using the Rustogi Modified Navy Plaque Index (P < .01), and gingivitis, assessed by using number of bleeding sites (P < .001), but not for the modified gingival index (P > .05) or gingival bleeding index (P > .05). PRACTICAL IMPLICATIONS: There is some evidence to suggest that OR powered toothbrushes might remove more plaque and reduce the number of bleedings sites better than other powered toothbrushes, specifically, sonic action toothbrushes.