Comparative evaluation of biological, mechanical, and patient-reported outcomes of angulated screw channel abutments versus multi-unit abutment-retained single-unit implant restorations in the anterior esthetic zone: An-in vivo study.

Aims: The study aimed to evaluate biological, mechanical, and patient reported parameters associated with ASC abutments and MU abutments for the fabrication of screw retained implant crowns in the anterior esthetic zone. Setting and Design: For the study, 20 patients were selected and implants were placed within the constraints of prosthetic envelope. Later, the screw retained crown was fabricated. Materials and Methods: Biological parameters (including implant survival rate, marginal bone levels using cone beam computed tomography, and soft tissue assessment using periodontal indices) were measured at the time of crown placement and 1 year follow up. Mechanical parameter (screw loosening) was calculated using removal torque loss (RTL) values obtained at the time of crown placement and 1 year follow up. Patient reported parameters were evaluated using a questionnaire at 1 year follow up. Statistical Analysis Used: All data were tabulated, statistically analyzed, and compared using SPSS version 23 IBM Corporation, Armonk, NY, USA. Results: Implant survival was found 100% in both the groups. The marginal bone level reduced considerably in both the groups from baseline to 1 year follow up. The MU abutment group had slightly less marginal bone loss than the ASC abutment group. Additionally, there was no statistically significant difference between the two groups' periodontal indices at baseline and 1-year follow-up values. At baseline, the RTL value was substantially lower (P <0.003) in the ASC abutment group than in the MU abutment group, however at the 1-year follow-up, there was no statistically significant difference in RTL or screw loosening between the two groups. Patient-reported data showed no statistically significant difference. Conclusion: Within the constraints of this study, it was suggested that both ASC and MU abutments provide equally promising results in terms of biological, mechanical, and patient-reported parameters in the anterior esthetic region for single screw-retained crowns.

Adjunctive systemic antimicrobials for the non-surgical treatment of periodontitis.

BACKGROUND: Systemic antimicrobials can be used as an adjunct to mechanical debridement (scaling and root planing (SRP)) as a non-surgical treatment approach to manage periodontitis. A range of antibiotics with different dosage and combinations are documented in the literature. The review follows the previous classification of periodontitis as all included studies used this classification. OBJECTIVES: To assess the effects of systemic antimicrobials as an adjunct to SRP for the non-surgical treatment of patients with periodontitis. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases to 9 March 2020: Cochrane Oral Health's Trials Register, CENTRAL, MEDLINE, and Embase. The US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. SELECTION CRITERIA: We included randomized controlled trials (RCTs) which involved individuals with clinically diagnosed untreated periodontitis. Trials compared SRP with systemic antibiotics versus SRP alone/placebo, or with other systemic antibiotics. DATA COLLECTION AND ANALYSIS: We selected trials, extracted data, and assessed risk of bias in duplicate. We estimated mean differences (MDs) for continuous data, with 95% confidence intervals (CIs). We assessed the certainty of the evidence using GRADE. MAIN RESULTS: We included 45 trials conducted worldwide involving 2664 adult participants. 14 studies were at low, 8 at high, and the remaining 23 at unclear overall risk of bias. Seven trials did not contribute data to the analysis. We assessed the certainty of the evidence for the 10 comparisons which reported long-term follow-up (≥ 1 year). None of the studies reported data on antimicrobial resistance and patient-reported quality of life changes. Amoxicillin + metronidazole + SRP versus SRP in chronic/aggressive periodontitis: the evidence for percentage of closed pockets (MD -16.20%, 95% CI -25.87 to -6.53; 1 study, 44 participants); clinical attachment level (CAL) (MD -0.47 mm, 95% CI -0.90 to -0.05; 2 studies, 389 participants); probing pocket depth (PD) (MD -0.30 mm, 95% CI -0.42 to -0.18; 2 studies, 389 participants); and percentage of bleeding on probing (BOP) (MD -8.06%, 95% CI -14.26 to -1.85; 2 studies, 389 participants) was of very low certainty. Only the results for closed pockets and BOP showed a minimally important clinical difference (MICD) favouring amoxicillin + metronidazole + SRP. Metronidazole + SRP versus SRP in chronic/aggressive periodontitis: the evidence for percentage of closed pockets (MD -12.20%, 95% CI -29.23 to 4.83; 1 study, 22 participants); CAL (MD -1.12 mm, 95% CI -2.24 to 0; 3 studies, 71 participants); PD (MD -1.11 mm, 95% CI -2.84 to 0.61; 2 studies, 47 participants); and percentage of BOP (MD -6.90%, 95% CI -22.10 to 8.30; 1 study, 22 participants) was of very low certainty. Only the results for CAL and PD showed an MICD favouring the MTZ + SRP group. Azithromycin + SRP versus SRP for chronic/aggressive periodontitis: we found no evidence of a difference in percentage of closed pockets (MD 2.50%, 95% CI -10.19 to 15.19; 1 study, 40 participants); CAL (MD -0.59 mm, 95% CI -1.27 to 0.08; 2 studies, 110 participants); PD (MD -0.77 mm, 95% CI -2.33 to 0.79; 2 studies, 110 participants); and percentage of BOP (MD -1.28%, 95% CI -4.32 to 1.76; 2 studies, 110 participants) (very low-certainty evidence for all outcomes). Amoxicillin + clavulanate + SRP versus SRP for chronic periodontitis: the evidence from 1 study, 21 participants for CAL (MD 0.10 mm, 95% CI -0.51 to 0.71); PD (MD 0.10 mm, 95% CI -0.17 to 0.37); and BOP (MD 0%, 95% CI -0.09 to 0.09) was of very low certainty and did not show a difference between the groups. Doxycycline + SRP versus SRP in aggressive periodontitis: the evidence from 1 study, 22 participants for CAL (MD -0.80 mm, 95% CI -1.49 to -0.11); and PD (MD -1.00 mm, 95% CI -1.78 to -0.22) was of very low certainty, with the doxycycline + SRP group showing an MICD in PD only. Tetracycline + SRP versus SRP for aggressive periodontitis: we found very low-certainty evidence of a difference in long-term improvement in CAL for the tetracycline group (MD -2.30 mm, 95% CI -2.50 to -2.10; 1 study, 26 participants). Clindamycin + SRP versus SRP in aggressive periodontitis: we found very low-certainty evidence from 1 study, 21 participants of a difference in long-term improvement in CAL (MD -1.70 mm, 95% CI -2.40 to -1.00); and PD (MD -1.80 mm, 95% CI -2.47 to -1.13) favouring clindamycin + SRP. Doxycycline + SRP versus metronidazole + SRP for aggressive periodontitis: there was very low-certainty evidence from 1 study, 27 participants of a difference in long-term CAL (MD 1.10 mm, 95% CI 0.36 to 1.84); and PD (MD 1.00 mm, 95% CI 0.30 to 1.70) favouring metronidazole + SRP. Clindamycin + SRP versus metronidazole + SRP for aggressive periodontitis: the evidence from 1 study, 26 participants for CAL (MD 0.20 mm, 95% CI -0.55 to 0.95); and PD (MD 0.20 mm, 95% CI -0.38 to 0.78) was of very low certainty and did not show a difference between the groups. Clindamycin + SRP versus doxycycline + SRP for aggressive periodontitis: the evidence from 1 study, 23 participants for CAL (MD -0.90 mm, 95% CI -1.62 to -0.18); and PD (MD -0.80 mm, 95% CI -1.58 to -0.02) was of very low certainty and did not show a difference between the groups. Most trials testing amoxicillin, metronidazole, and azithromycin reported adverse events such as nausea, vomiting, diarrhoea, mild gastrointestinal disturbances, and metallic taste. No serious adverse events were reported. AUTHORS' CONCLUSIONS: There is very low-certainty evidence (for long-term follow-up) to inform clinicians and patients if adjunctive systemic antimicrobials are of any help for the non-surgical treatment of periodontitis. There is insufficient evidence to decide whether some antibiotics are better than others when used alongside SRP. None of the trials reported serious adverse events but patients should be made aware of the common adverse events related to these drugs. Well-planned RCTs need to be conducted clearly defining the minimally important clinical difference for the outcomes closed pockets, CAL, PD, and BOP.

To compare the stability and crestal bone loss of implants placed using osseodensification and traditional drilling protocol: A clinicoradiographical study.

AIM: The present study was done to evaluate and compare the stability of the implant and the loss of crestal bone in the implants placed using OD drilling and traditional drilling technique. SETTING AND DESIGN: In vivo-comparative study. MATERIALS AND METHODS: A total of 20 implants were placed in the anterior maxilla, and the patients were divided into two groups. In Group I, the implants were placed using traditional drilling technique, and in Group II, implant placement was done using OD drilling technique. Primary stability was measured in both the groups at baseline (immediate postoperative), and at an interval of 6 months, while crestal bone levels were measured at baseline, 6, and 8 months. STATISTICAL ANALYSIS USED: The data obtained were subjected to unpaired t-test to make intergroup comparisons, while one-way ANOVA F-test was used to make intragroup comparisons. RESULTS: The primary stability of implant placed using OD drills was found to be slightly higher than implant placed with traditional drilling; however, there was no statistical significance (P > 0.05). When the data obtained for crestal bone levels were statistically analyzed, no significant difference between the two groups was obtained (P > 0.05). CONCLUSION: Within the limitations of this study following conclusions were drawn: there was no statistically significant difference in implant stability between the traditional drilling and OD drilling (P < 0.05). On comparison of crestal bone levels between OD and traditional drilling, no statistically significant difference was found between the two groups (P < 0.05).

Interforaminal hemorrhage during anterior mandibular implant placement: An overview.

Implant surgery in mandibular anterior region may turn from an easy minor surgery into a complicated one for the surgeon, due to inadequate knowledge of the anatomy of the surgical area and/or ignorance toward the required surgical protocol. Hence, the purpose of this article is to present an overview on the: (a) Incidence of massive bleeding and its consequences after implant placement in mandibular anterior region. (b) Its etiology, the precautionary measures to be taken to avoid such an incidence in clinical practice and management of such a hemorrhage if at all happens. An inclusion criterion for selection of article was defined, and an electronic Medline search through different database using different keywords and manual search in journals and books was executed. Relevant articles were selected based upon inclusion criteria to form the valid protocols for implant surgery in the anterior mandible. Further, from the selected articles, 21 articles describing case reports were summarized separately in a table to alert the dental surgeons about the morbidity they could come across while operating in this region. If all the required adequate measures for diagnosis and treatment planning are taken and appropriate surgical protocol is followed, mandibular anterior region is no doubt a preferable area for implant placement.

A Simple Technique to Fabricate a Facial Moulage with a Prefabricated Acrylic Stock Tray: A Clinical Innovation.

An accurate facial moulage helps in understanding the orientation and proper position of the facial prosthesis relative to other facial landmarks even in the absence of the patient. To make impression for fabricating facial moulage previously described techniques in literature made use of elastomeric impression material, alginate, and dental plaster directly over the patient's face to obtain the moulage which have their own disadvantages. Taking these into consideration a novel clinical technique is described herein to fabricate an acrylic stock tray for making accurate impression and to support the impression material while setting and pouring.