Influence of Smoking on Periodontal and Implant Therapy: A Narrative Review.

BACKGROUND: smoking is considered the most modifiable risk factor for periodontal disease. OBJECTIVE: the aim of this narrative review is to emphasize the effect of smoking on periodontal and implant therapy. METHODS: The authors reviewed the literature reporting the clinical outcomes of smoking on periodontal surgical and nonsurgical treatment. The impact of smoking on implant therapy and sinus lifting procedures were also reviewed. RESULTS: Periodontal and implant therapy outcomes are adversely affected by smoking. Smokers respond less favorably to periodontal therapy and periodontal flap procedures as compared to nonsmokers. Clinical outcomes for smokers are 50-75% worse than for nonsmokers. Studies reveal that smokers experience a significantly lower reduction in pocket depth compared to nonsmokers as well as less bone growth after treating infra-bony defects with guided tissue regeneration. The relative risk of implant failure is significantly higher in patients who smoke 20 cigarettes or more per day compared to nonsmokers. Additionally, smoking has also been shown to increase postoperative wound dehiscence and infection rates following sinus floor elevation. Longitudinal studies on smoke cessation have shown a reduction in bone loss and probing depths for periodontitis patients after cessation compared to those who smoke. CONCLUSION: Smoking cessation can reduce probing depths and improve clinical attachment after nonsurgical periodontal therapy. There is insufficient evidence regarding the effect of smoking on peri-implantitis, as well as the loss of implants in the long-term.

Trends in implant dentistry: Implant systems, complications and barriers in Riyadh, Saudi Arabia.

BACKGROUND: Patients who are partially dentate or edentulous can receive both conventional and implantsupported fixed prostheses, which leads to improvement in function, esthetics and self-esteem. Currently, implant dentistry is one of the fastest-growing disciplines in dentistry. OBJECTIVES: The aim of the study was to assess the education and training of dentists practicing implant therapy in the Riyadh region of Saudi Arabia, including their preferred dental implant systems, the clinical complications experienced as well as the barriers to implant therapy they encounter. MATERIAL AND METHODS: A self-administered questionnaire was distributed among dentists in Riyadh performing dental implants in both the state and private sectors. The questionnaire included demographic data, such as nationality, the practitioner's affiliated specialist category and their respective qualifications. Other data included their main sources of education pertaining to implant dentistry, the most commonly used implant systems, common clinical complications, and barriers to implant therapy. A descriptive statistical analysis of the data was carried out. RESULTS: A significant majority of non-Saudi dental practitioners were employed in the private sector (p = 0.001), whereas a significant majority of Saudi dental practitioners were employed in the state sector (p = 0.001). The largest group of practitioners performing implants were general dentists (48.1%). The 3iTM implant system was the most widely utilized (35.4%). Failed osseointegration (12.6%) and peri-implantitis (12%) were the most common clinical complications. The biggest barrier to placing implants was the cost of implants to patients (59.1%). CONCLUSIONS: Fundamental to implant practice is the clinical practitioner and patient selection. The utilization of implant systems should preferably be based on the chemical properties of implant surfaces which promote early osseointegration. Comparative studies investigating the reasons for failed osseointegration and other clinical complications are needed locally and internationally. Further research, together with advanced clinical specialist training, can lead to improvement in the quality of implant therapy for the benefit of patients.

What is the Best Micro and Macro Dental Implant Topography?

Implant surface micro and macro topography plays a key role in early osseointegration. The physicochemical features of the implant surface (ie, chemical composition, hydrophobicity/hydrophilicity and roughness) influence the deposition of extracellular matrix proteins, the precipitation of bone mineral, and the stimulation of cells. Modification of the implant topography provides better primary stability and faster osseointegration, allowing for immediate placement or immediate loading. Randomized clinical trials are warranted to compare the response of osseointegration with various implant micro and macro surface topographies in people with various local or systemic risk factors.

Tooth Extraction Protocols for Patients on Bisphosphonate Therapy: An Update.

The aim of this review is to give an update on various tooth extraction protocols for patients on bisphosphonate therapy. Presently there is an increasing prevalence of patients receiving bisphosphonate therapy. This review has included the pathogenesis of bisphosphonate-related osteonecrosis of the jaws (BRONJ) associated with tooth extraction, its effect on alveolar bone, epithelium, variations in healing time, angiogenesis, and the risk factors associated with BRONJ development, as well as a revised staging of disease presentation for the stratification of patients. There is much heterogeneity and a lack of consensus concerning management protocols, as many recommendations lack supportive evidence-based approaches. Various regimens and treatment protocols have been reviewed for the management of patients on bisphosphonate therapy. It is envisaged that dental practitioners working in different parts of the world will get a better understanding of bisphosphonate therapy and the complications associated with tooth extraction, so as to enable them to render care with confidence and to improve the quality of life of their patients on bisphosphonate therapy.