Clinical performance of minimally invasive periodontal surgery in the treatment of infrabony defects: Systematic review and meta-analysis.

AIM: To assess the effectiveness, in terms of clinical performance and patient perception, of minimally invasive periodontal surgeries (MIPSs), and to compare MIPSs to traditional surgery in the treatment of periodontal infrabony defects. MATERIALS AND METHODS: An electronic search and a manual search were carried out to identify studies investigating clinical (CAL, PPD, REC), radiographic (bone fill) and patient's centred (VAS) outcomes at least 6 months after MIPSs. A linear mixed-effect model was used for meta-analysis. Subgroup analyses were performed according to the study quality (RCT or case series). A meta-analysis assessing differences in clinical parameters between MIPSs and traditional flaps was also performed. RESULTS: Meta-analysis from the 18 included studies revealed a PPD reduction of 4.24 mm (95% CI = 3.79-4.69 mm), a CAL gain of 3.89 mm (95% CI = 3.42-4.35 mm), a REC increase of 0.44 mm (95% CI = 0.11-0.77 mm), a radiographic bone fill gain of 58.25% (95% CI = 42.30%-74.21%) and a VAS value of 1.16 (95% CI = 0.78-1.54). Based on 2 RCTs, MIPSs are more effective than traditional surgery for PPD reduction (0.93 mm, 95% CI = 1.71-0.15) and CAL gain (1 mm, 95% CI = 1.75-.24). CONCLUSION: Minimally invasive periodontal surgeries may be considered for the treatment of periodontal infrabony defects. However, the real effect cannot be systematically evaluated due to the paucity of studies comparing MIPSs to traditional flap for periodontal reconstructive surgery.

Dimensional changes after immediate implant placement with or without simultaneous regenerative procedures: a systematic review and meta-analysis.

OBJECTIVE: To analyse alveolar ridge volume changes after immediate implant placement, with or without a regenerative technique. METHODS: Studies investigating the effect of immediate implant placement on ridge dimensional changes were identified through an electronic search conducted using MEDLINE (PubMed) and EMBASE. Weighted mean changes (WMC) between baseline and follow-up time were calculated and subgroup analysis was performed according to study design, evaluation method and regenerative strategies. RESULTS: After immediate implant placement alone WMC of RCTs showed a loss in width and height of 1.1 mm. After flapless immediate implant placement with immediate provisionalization and a graft WMC showed a loss in width and height of 1.02 mm and 0.79 mm, while after flapped immediate implant placement and a graft WMC showed a gain of 1.79 mm. After immediate implant placement plus a non-resorbable membrane WMC showed a loss in height of 0.07 mm. After immediate implant placement plus a resorbable membrane and a graft WMC showed a gain in height of 1.09 mm. CONCLUSIONS: Immediate implant placement does not seem to counteract alveolar ridge modelling after tooth extraction. Furthermore, the currently available evidence does not allow for any conclusive statements regarding the efficacy of a concomitant regenerative technique in preventing the amount of alveolar reduction.

Alveolar ridge preservation techniques: a systematic review and meta-analysis of histological and histomorphometrical data.

AIM: The aim of this article was to systematically review histological and histomorphometrical data from literature that provide information regarding the effect of alveolar ridge preservation procedures on healing after tooth extraction in humans. MATERIALS AND METHODS: The MEDLINE-PubMed and the Cochrane CENTRAL databases were searched up to September 2012; 38 papers were selected from 646 founded. A meta-analysis was performed regarding the variations in the mean percentage of Bone, Connective Tissue and Residual Graft Material between three different types of Procedures. RESULTS: The highest value regarding bone percentages is produced at 3 months by Procedures with Allografts (54.4%), while the lowest is obtained, at 5 months, by those using Xenografts (23.6%). Referring to connective tissue, the highest and lowest values are shown at 7 months, with Allografts (67%) and Alloplasts (27.1%), respectively. Regarding residual graft material, the lowest rates are displayed by Procedures with Allografts (12.4-21.11%), while those using Xenografts and Alloplasts showed the best results at 7 months (37.14 and 37.23%). No statistical difference was found. CONCLUSIONS: With the limitations due to the features of the selected papers, no major histological and histomorphometrical differences arose among different procedures or when compared to spontaneous healing. Thus, it might be argued that in preserved sites it is unnecessary to wait over 3 to 4 months prior to implant insertion.

Longitudinal implant stability measurements based on resonance frequency analysis after placement in healed or regenerated bone.

Primary stability is an indicator of subsequent osseointegration of dental implants. However, few studies have compared the implant stability among anatomical regions and bone types; thus, not enough data exist regarding the stability of implants placed in regenerated bone (RB). The present study evaluated primary and long-term stability of implants placed in RB and non-regenerated healed bone (HB). A total of 216 screw cylinder implants were placed in 216 patients (98 in HB and 118 in RB, 6 [RB6, N = 68] or 12 [RB12, N = 50] months after tooth extraction). Implant stability was evaluated using resonance frequency analysis (RFA) measured at the time of implant placement (E1), at the time of loading (4 months after placement, E2), and 4 months after loading (E3). Various clinically relevant measurements were obtained, such as implant diameter, length, and location, as well as bone quality. At E1, implant location, bone quality, and experimental group significantly affected implant stability (all at P < .05). At E2, implant location, diameter, length, and experimental group significantly affected implant stability (all at P < .05). At E3, bone quality, implant diameter, length, and experimental group significantly affected implant stability (all at P < .01). Stability for the RB12 group was significantly higher than all other corresponding values; further, the values did not change significantly over time. For the HB and RB6 groups, stability was significantly higher at E2 than at E1 (P < .001) and was no different between E2 and E3. Implant location, length, and experimental group were associated with these differences (all at P < .05). Compared with HB and RB6, higher implant stability may be achieved in regenerated bone 12 months post-extraction (RB12). This stability was achieved at E1 and maintained for at least 8 months. Variables such as implant length, diameter, and bone quality affected the stability differently over time. Implant stability varied in different anatomic regions and with regard to different healing processes in the bone.

Surgical techniques for alveolar socket preservation: a systematic review.

PURPOSE: To evaluate, through a systematic review of the literature, the efficacy of different surgical techniques in maintaining residual bone in the alveolar process following tooth extractions. MATERIALS AND METHODS: MEDLINE/PubMed was searched through January 2010 and papers were selected according to the CONSORT statement and an independent three-stage screening process. The selected outcome variables were clinical width and height changes of the socket, and means and standard deviations were calculated from the included studies. For those studies that were randomized controlled trials, six meta-analyses were performed by dividing studies into three groups with regard to the use of barriers and grafting (barriers alone, graft alone, or both). RESULTS: Thirteen papers met the eligibility criteria and were included in the analyses. Statistically significant ridge preservation was found for studies that used barriers alone; the pooled weighted mean was 0.909 mm (95% confidence interval, 0.497554 to 1.320732 mm) for bone height, while the mean for bone width was 2.966 mm (95% confidence interval, 2.334770 to 3.598300 mm). CONCLUSIONS: Socket preservation procedures are effective in limiting horizontal and vertical ridge alterations in postextraction sites. The meta-analysis indicates that the use of barrier membranes alone might improve normal wound healing in extraction sites.