Intra- and Interexaminer Repeatability of Diagnostic Peri-Implant Clinical Measurement: A Pilot Study.

Despite the crucial role of examiner reliability on quality research and practice, there is still limited literature analyzing factors affecting examiner variability of peri-implant clinical measurements. The present study investigated clinical peri-implant parameters to quantify their repeatability and investigate factors that may affect their accuracy. Thirty-three implants were examined by 4 operators. Peri-implant probing depth (PD), recession (REC), and gingival index (GI) were measured for agreement and included in the analysis. Agreement was quantified using intraclass correlation coefficients (ICCs; 95% confidence interval); mixed linear and logistic regressions were used to assess additional variables. The overall interexaminer agreement was comparable between PD (0.80) and REC (0.78) but significantly worse for GI (0.45; P < .001). Similarly, the intraexaminer agreement was similar for PD (0.81) and REC (0.80) but significantly worse for GI (0.57; P < .05). The magnitude of PD did not influence the agreement. In contrast, increasing disagreement was noted for positive REC (odds ratio [OR]: 3.0), negative REC (OR: 4.8), and lower GI (OR: 4.4). The incidence of bleeding on probing and severity of GI increased for deeper PD (0.113-unit increase per millimeter). Negative and positive values of recession and lower GI were associated with increasing disagreement. Radiographic bone loss, restoration contour, and implant diameter did not affect PD accuracy in this study. In conclusion, within the limitations of the study, GI measurements presented higher variability than PD and REC did. The PD and GI were associated with one another and increased after multiple measurements.

Is Arthroscopic Disk Repositioning Equally Efficacious to Open Disk Repositioning? A Systematic Review.

PURPOSE: Temporomandibular joint disc repositioning surgery is 1 of the treatment modalities used for treating anterior disc displacement of the temporomandibular joint. The procedure can be arthroscopic disc repositioning or open disc repositioning. This systematic review measured and compared the efficacy of arthroscopic and open disc repositioning procedures. MATERIALS AND METHODS: The authors conducted a systematic review without meta-analysis by performing a literature search electronically and manually covering arthroscopic and open disc repositioning studies published up to July 2020 in Pubmed, Embase, and Cochrane databases. Surgical outcomes such as changes in maximal incisal opening (MIO) and pain scores, temporomandibular joint noises, diet consistency, malocclusion, and postoperative complications were extracted and analyzed. RESULTS: A total of 28 studies were included in the review and split into those assessing open disc repositioning (n = 13) and those assessing arthroscopic disc repositioning (n = 15). The average age of the study patients in the included studies was 31.5 ± 6.8 years, and women represented 83.3% of the study population. Both arthroscopic and open disc repositioning showed to be efficacious in reducing pain and increasing MIO. Due to heterogeneity in study designs and data reporting between the studies, no quantitative analysis was performed, and the groups were not directly compared. CONCLUSIONS: Both arthroscopic and open disc repositioning led to significant improvements in clinical outcomes based on pain scores and MIO. This study highlights the need for comparative studies of the 2 techniques with well-documented case selection including standardized diagnosis based on Wilkes stages and rigorous outcomes assessment including patient reported outcomes.

Influence of restorative design on the progression of peri-implant bone loss: A retrospective study.

BACKGROUND: Clinical data on the restorative designs affecting the early progression of peri-implantitis are scarce. The aim of this retrospective study was to evaluate the influence of several restorative factors (e.g., restoration emergence angle, and internal screw length/diameter) on the marginal bone loss around implants with peri-implantitis. METHODS: Implants diagnosed with peri-implantitis having 1- (T1) and 2-year (T2) follow-ups were included. In addition, within 6 months pre-diagnosis (Tb), all cases required to have full documentation in which no evidence of peri-implantitis was not indicated. Changes in marginal bone levels (MBLs) from Tb to T1 and from T1 to T2 were evaluated. The effect of several variables on MBLs changes was assessed via univariate and multivariate generalized estimating equations. RESULTS: Eighty-three bone-level implants from 65 patients were selected. The mean follow-up before peri-implantitis diagnosis was 99.47 ± 47.93 months. The radiographic mean marginal bone loss was 1.52 ± 1.33 mm (Tb to T1) and 0.58 ± 0.52 mm (T1 to T2). Restoration emergence angle and frequency of maintenance visits significantly affected MBLs from Tb to T1. Besides, 66.3% of the included implants' bone levels were in a zone within 1 mm of the apical end of the internal screw at T1 and remained in this zone during the second follow-up year. CONCLUSIONS: Significant marginal bone loss occurred in the early post-diagnosis period of peri-implantitis, which could be affected by the restoration emergence angle. Peri-implant MBLs were frequently located in a zone within 1 mm of the apical end of the internal screw.

Capnography monitoring in procedural intravenous sedation: a systematic review and meta-analysis.

OBJECTIVES: Currently, procedural sedation in the clinical setting relies heavily on the use of pulse oximetry to monitor hypoxemia. Different studies suggest that incidence of hypoxemia and incidence of arterial oxygen desaturation are reduced by early intervention via capnography monitoring. The aim of this article was to discuss the importance of implementing capnography monitoring during procedural sedations performed in a dental setting and determine whether additional capnographic monitoring reduces the incidence of arterial oxygen desaturation and the overall complications rate. MATERIALS AND METHODS: Two independent reviewers conducted electronic (PubMed and EMBASE) and manual searches up to February 2020. Randomized clinical trials (RCTs), including both patients under procedural sedation monitored by capnography and oximetry, and reporting the incidence of hypoxemia or episodes of oxygen desaturation were included. Risk ratio was used to compare the outcomes (i.e., the incidence of hypoxemia, the episodes of oxygen desaturation, the detection of apnea, the reduction of events of bradycardia, and hypotension) between patients monitored by capnography and standard approach. RESULTS: Fourteen randomized clinical trials fulfilling the inclusion criteria were selected. The analysis revealed that capnography monitoring group showed the lower incidence of hypoxemia (RR 0.76, 95%CI 0.70 to 0.83, p < 0.001) and the episodes of oxygen desaturation (RR 0.79, 95%CI 0.71 to 0.87, p < 0.001) compared with the oximetry monitoring group. Apnea was detected in capnography monitoring earlier than standard monitoring (RR 2.60, 95%CI 2.30 to 2.93, p < 0.001). No significant difference was found between capnography and standard monitoring groups in terms of reduction of events of bradycardia (RR 1.17, 95%CI 0.91 to 1.50, p = 0.225) and hypotension (RR 0.96, 95%CI 0.76 to 1.21, p = 0.746). CONCLUSION: Capnography monitoring reduced incidence of hypoxemia during procedural sedations. Within the limitations of this review, we suggest that the application of capnography during procedural sedation would decrease the frequency of oxygen desaturation events and incidence of hypoxemia. CLINICAL RELEVANCE: Training and instructing dental providers on using capnography monitoring would help in reducing adverse events during intravenous sedation.

Effect of Implant Vertical Position, Design, and Surgical Characteristics on Mucosal Vertical Dimension: A Meta-Analysis of Animal Studies.

PURPOSE: The aim of this study was to investigate the effect of implant and surgical characteristics on the mucosal vertical dimension components. Mucosal vertical dimension consists of the sulcular epithelium and the supracrestal tissue attachment, which can be clinically measured from the gingival margin to the bone-to-implant contact. Connective tissue attachment is measured from the apical border of attached epithelium to the first bone-to-implant contact, while epithelial vertical dimension is measured from the mucosal margin to the apical border of attached epithelium. MATERIALS AND METHODS: An electronic and manual search for relevant articles published from January 1980 to May 2019 was performed. Animal studies of ≥ 10 implants followed by histometric analysis were included. Quality assessment was performed using the ARRIVE guidelines, and risk of bias assessment was performed using SYRCLE guidelines. Subgroup meta-analysis was performed to analyze the influence of different surgical approaches and implant design. RESULTS: A total of 38 articles were included. The mean value and corresponding standard error of mucosal vertical dimension, supracrestal tissue attachment, connective tissue attachment, and epithelial vertical dimension were 3.39 ± 0.07 mm, 2.9 ± 0.12 mm, 1.35 ± 0.04 mm, and 2.0 ± 0.06 mm, respectively. Supracrestal and subcrestal bone-level implants had significantly higher mucosal vertical dimension than equicrestal bone-level implants. Platform-switching implants demonstrated significantly lower mucosal vertical dimension compared with non-platform-switching implants. CONCLUSION: Within its limitations, this review showed that equicrestal implants had a smaller mucosal vertical dimension than subcrestal and supracrestal implants, and platform-switching implants possessed a smaller mucosal vertical dimension.

Long-term Clinical Outcomes and Cost-Effectiveness of Full-Arch Implant-Supported Zirconia-Based and Metal-Acrylic Fixed Dental Prostheses: A Retrospective Analysis.

PURPOSE: To provide a long-term comparison of metal-acrylic and zirconia implant-supported fixed complete dental prostheses. MATERIALS AND METHODS: Patients treated with a metal-acrylic or zirconia fixed implant prosthesis with a minimum 5-year follow-up were included. All complications were registered, along with events such as peri-implantitis and implant failure. Survival and all costs associated with the prostheses were assessed to provide an overall evaluation of each type of fixed implant prosthesis protocol. RESULTS: Seventy-four rehabilitated arches (43 metal-acrylic, 31 zirconia, mean follow-up: 8.7 ± 3.37 years) were included. Delayed complications accompanied the metal-acrylic prostheses more frequently. In both groups, single tooth chipping/fracture was the most prominent minor complication, and incidence of multiple teeth and framework fracture was the most frequent major complication. Zirconia fixed implant prostheses demonstrated higher prosthetic survival rates than the metal-acrylic prostheses (93.7% ± 5.5% at 5 years vs 83.0% ± 11.1%). No difference was observed for peri-implantitis or implant failure. The initial cost for zirconia prosthesis fabrication was significantly higher than metal-acrylic hybrids (an estimated difference of $7,829 [P < .001]); however, due to reduced complication rates for the zirconia fixed implant prosthesis, maintenance and treatment for complications did not greatly differ between groups. CONCLUSION: Within the limitations, zirconia fixed implant prostheses presented higher initial costs than metal-acrylic hybrids, however, with satisfactory outcomes, reduction of overall complications, and superior survival rates.

Association between periodontitis and systemic medication intake: A case-control study.

BACKGROUND: To investigate the frequency of systemic drugs taken by elderly patients with or without periodontitis and the possible association between medication consumption and the severity of periodontitis. METHODS: A total of 1221 patients, including 608 with generalized moderate to severe periodontitis (periodontitis group) and 613 age- and gender-matched individuals with healthy periodontium (healthy group) were selected. Systemic conditions, medications and periodontal status were recorded. Medication intake frequency (%) was compared using unconditional logistic regression. RESULTS: The top three most common medications were angiotensin-converting enzyme (ACE) inhibitors (17.9%), antidepressants (17.8%), and lipid-lowering medications (16.5%). Both ACE inhibitors and antidepressants showed statistically higher intake frequency in the periodontitis group relative to healthy controls (21.5% versus 14.4%; odds ratio [OR] = 1.64), (21.1% versus 14.5%, OR = 1.57) (P < 0.01). Additionally, intake of oral hypoglycemic agents, calcium channel blockers (CCB), insulin, and diuretics were significantly higher in the periodontitis group with OR = 2.49, 2.32, 2.08 and 1.79, respectively (P < 0.05). Several medications demonstrated a disease severity-dependent association comparing generalized severe periodontitis with moderate periodontitis and healthy group: oral hypoglycemic agents (17.4% versus 16.8% versus 8.0%), CCB (14.8% versus 14.4% versus 8.0%) and anticonvulsants (13.4% versus 7.7% versus 6.4%) with OR of 2.43, 1.99, and 2.28 (severe periodontitis versus healthy group), respectively. CONCLUSION: There was a significantly higher frequency of medication intake related to cardiovascular disease and diabetes in patients with periodontitis. A disease severity-dependence with medication intake frequency was also noted. This study provides indirect evidence for the possible relationship between systemic diseases and periodontitis.

The assessment of stress, depression, and inflammation as a collective risk factor for periodontal diseases: a systematic review.

OBJECTIVES: The purpose of this review was to provide a novel perspective utilizing an assessment of biomarkers to evaluate the impact of stress-related disorders on the progression of periodontal disease and evaluate the growing body of evidence of stress as a risk indicator for periodontal disease progression. METHODS: Cross-sectional, case-control, and biomarker studies associating psychological disorders and periodontal disease were included in the literature search. Computational studies, animal studies, reviews, and studies lacking healthy controls were excluded. Electronic and manual literature searches were conducted by two independent reviewers in several databases as well as a manual search for relevant articles published up to January 2018. RESULTS: Twenty-six articles fulfilled the inclusion criteria and were included in the qualitative synthesis. Relationships between stress-related disorders and serum and salivary biomarkers such as cortisol, dehydroepiandrosterone (DHEA), chromogranin A (CgA), and pro-inflammatory cytokines were identified. CONCLUSIONS: The use of salivary pro-inflammatory cytokines alone is not sufficient for the identification of periodontal disease severity/progression with or without the presence of stress-associated diseases. Keeping in mind the limitations of this review, a positive qualitative correlation was observed in the literature among stress-related biomarkers and the severity of periodontal disease. This correlation may serve as an important reporter of patient susceptibility for periodontal breakdown in the future. CLINICAL RELEVANCE: Stress-related disorders should be included in the list of globally screened diseases because it can change the biochemistry of both the local periodontal microenvironment as well as the global systemic inflammatory burden.

Impact of Implant Length on Survival of Rough-Surface Implants in Nonaugmented Posterior Areas: A Systematic Review and Meta-Regression Analysis.

PURPOSE: Short implants have been considered as an alternative to regular implants even where native bone is potentially adequate. Hence, the aim of this study was to evaluate the impact of implant length on its survival. MATERIALS AND METHODS: A systematic literature search of randomized controlled trials and prospective studies was performed using the PubMed (MEDLINE), EMBASE, and Cochrane databases. Meta-regression analysis determined the effect of the length on the implant survival rate. RESULTS: Sixty-six studies comprising 4,525 implants were included in the meta-regression analysis. Overall, for each additional 1 mm of length, the survival rate was increased by 0.42 percentage points (P = .056). In the maxilla, an additional 1 mm in length implied 0.68 percentage points more in the rate (P < .001), while in the mandible, statistical significance was not reached. Eventually, the implant survival rate in the 3- to 5-year period was strongly affected by the length of the implants in the maxilla, since it increased by 2% for each additional 1 mm of length. CONCLUSION: In the presence of adequate native bone, placement of longer/regular-sized implants should be chosen over placement of short implants in the maxilla. However, in a posterior mandible, short implants offer a judicious alternative.

Incidence and severity of postoperative complications following oral, periodontal, and implant surgeries: A retrospective study.

BACKGROUND: Incidence and severity of postoperative complications are key elements in determining the risk-benefit relationship of any surgical procedure. The aim of this retrospective study was to assess and categorize the postoperative complications that occur following, and are associated with, oral, periodontal, and implant surgeries. METHODS: A total of 3,900 patients who underwent surgical procedures including, but not limited to, sinus floor elevation, guided tissue regeneration, crown lengthening, implant placement, soft tissue graft, open flap debridement or surgical removal of impacted teeth were included. Postoperative complications were recorded and graded based on impedance to routine daily activity and favorable surgical outcomes. Regression models were generated to evaluate correlations between complication types, as well as between patient/surgical characteristics and the incidence of complications. RESULTS: Surgical removal of impacted teeth and lateral sinus floor elevation had the highest incidence and severity of complications. Postoperative dentinal hypersensitivity (5.7%) was the most frequent complication, followed by excessive pain (4.1%), and moderate postoperative bleeding (3.5%). Based on the devised grading system described in this paper, the complications were 11.1% of Grade I, 3.3% of Grade II, 8.3% of Grade III, 0.1% of Grade IV, and no complications recorded under Grades V or VI. CONCLUSIONS: Surgical removal of impacted teeth and lateral sinus floor elevation are more prone to more severe complications compared with other procedures. Additionally, complications that do not impede favorable surgical outcomes and/or routine daily activity are the most likely to occur. Smoking and diabetes are generally associated with postoperative complications.

Effects of NSAIDs on Periodontal and Dental Implant Therapy.

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed group of drugs in dentistry for managing postoperative pain and discomfort. Little is known regarding their effects on the healing of periodontal and peri-implant tissues. METHODS: The authors conducted a review of the literature to provide an overview of knowledge about NSAIDs and their potential effects on periodontal and implant wound healing. RESULTS: A Pubmed (MEDLINE) database search was conducted to identify articles evaluating the influence of administration of NSAID drugs on outcomes following periodontal treatments (nine clinical studies) and dental implant placement (four animal studies and two human clinical studies). Conflicting results were found on the effects of NSAIDs during periodontal wound healing. NSAID administration, specifically selective COX-2 inhibitors could inhibit bone formation around orthopedic implants. CONCLUSION: Within the limitations of this review, NSAIDs negatively affected osseointegration of titanium implants. However, quality of evidence from available human clinical studies is poor and there are conflicting results from animal models. Future and better clinical studies are needed to more precisely evaluate the potential effects of NSAIDs on dental wound healing. PRACTICAL IMPLICATIONS: Dental surgeons must be aware of the potential effects of NSAID use on osseous healing following common oral surgical procedures such as periodontal and implant therapy.

Comparison of three different types of implant-supported fixed dental prostheses: A long-term retrospective study of clinical outcomes and cost-effectiveness.

OBJECTIVE: To study the performance of 2-3 posterior bone-level dental implants constructed with either three non-splinted crowns (NSC), three splinted crowns (SC), or a 3-unit implant-supported bridge over two implants (ISB). MATERIAL AND METHODS: Patients treated with three metal-ceramic NSC, SC, or an ISB were included in the present retrospective study. Implant survival and success rate as well as all biological and technical complications were collected. The cost associated with each of the treatment options was evaluated in the comparative analysis. RESULTS: One hundred and forty-five patients (40 NSC, 52 SC, and 53 in the ISB) receiving 382 bone-level implants (120 NSC, 106 ISB, and 156 SC) were included (mean follow-up of 76.2 months). Lack of success was observed in 33.8% of the total patient sample, being lower in the ISB group. Implant survival rates were 92.5% in the NSC, 100% in the ISB, and 88.5% in the SC, with significant difference noted between the ISB and SC (p = 0.01). Overall, 9.9% of the total implants were found to have peri-implantitis (PI), with 16.7% in the SC, 7.5% in the NSC, and 2.8% in the ISB. Patients presenting prosthodontic complications were significantly higher in NSC (32.5%) than ISB (13.2%) and SC (15.4%). The total cost of the ISB group was significantly lower when compared to the NSC and SC groups (p < 0.001). CONCLUSIONS: An 3-unit implant-supported bridge restoring 2 implants seems to present the most ideal long-term therapeutic solution, among the investigated approaches in this study, in rehabilitating a 3-unit edentulous area.

Long-Term Effectiveness of Extra-Short (≤ 6 mm) Dental Implants: A Systematic Review

PURPOSE: This systematic review evaluated the mean survival rate and marginal bone loss (MBL) of dental implants with ≤ 6 mm in length, across a time frame of 5 years. The overall prosthetic and biologic complications were evaluated, and their survival rates obtained. In addition, the complication rates of the splinted vs nonsplinted implants were assessed. MATERIALS AND METHODS: An electronic literature search in PubMed (MEDLINE) and EMBASE (OVID) and Cochrane were performed, in addition to a manual search through all periodontics and implantology-related journals, up to October 2017, to identify relevant articles. RESULTS: Out of 515 potentially eligible articles, 19 investigations assessing a total of 910 extra-short (≤ 6 mm) implants were included and further evaluated. After 5 years of follow-up, a mean survival rate of 94.1% (90% in the maxilla and 96% in the mandible) and a maximum bone loss of 0.53 mm were demonstrated. Additionally, a statistically significant difference in terms of bone loss was observed between tissue-level (0.12 mm) and bone-level implants (0.36 mm) at 12 months (P < .01), but not between internal and external abutment connections (P = .17). The most commonly reported prosthetic complication was screw loosening. Finally, splinted implants showed less overall prosthetic complications (RR = 3.32; 95% CI: 1.9 to 5.7), screw loosening (RR = 15.2; 95% CI: 5.92 to 39.31), and implant failure (RR = 1.96; 95% CI: 0.8 to 4.8) than nonsplinted implants. CONCLUSION: Extra-short implants are a viable treatment alternative in ridges exhibiting atrophy, demonstrating a satisfactory survival rate, as well as a low rate of prosthetic and biologic complications across a 5-year follow-up. Additionally, splinting extra-short implants is associated with fewer prosthetic complications and lower implant failure rate compared with nonsplinted implants.

Meta-analysis of randomized clinical trials comparing clinical and patient-reported outcomes between extra-short (≤6 mm) and longer (≥10 mm) implants.

AIM: To compare the clinical outcomes of ≤6 mm extra-short implants (test group) versus ≥10 mm long implants (control group), with and without bone augmentation procedures. MATERIALS AND METHODS: A systemic literature search of randomized clinical trials was performed using the PubMed (MEDLINE) and EMBASE databases. A quantitative meta-analysis was conducted to compare all the outcome variables. Meta-regression analysis determined the effect of bone augmentation procedures and the influence of other clinical covariates on the results. RESULTS: Eighteen studies comprising 1,612 implants (793 extra-short and 820 long implants) were selected for the meta-analysis. No statistically significant difference in the survival rate was observed at 1 and 3 years (p > 0.05). Extra-short implants displayed less marginal bone loss (MBL) from both implant placement time points (1 and 3 years) and prosthetic placement (1 year), as well as less biological complications, surgical time and treatment cost (p < 0.05). Contrarily, a statistically significant small number of prosthetic complications were reported with long implants (p < 0.05). CONCLUSIONS: Placement of extra-short implants (≤6 mm) presented as an equivalent option in the treatment of patients with an atrophic posterior arch up to 3-year follow-up. However, the long-term effectiveness of extra-short dental implants remains to be further studied.