Does non-surgical periodontal treatment influence on rheumatoid arthritis? A systematic review and meta-analysis.

OBJECTIVE: The objective of this systematic review was to evaluate the efficacy of non-surgical periodontal therapy on rheumatoid arthritis activity. MATERIAL AND METHODS: Articles published until April 2019 were electronically searched and screened using PubMed / MEDLINE, Scopus, and Cochrane databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). This study was recorded in the international PROSPERO database (CRD42019132205). The PICO question (population, intervention, comparison, results) was: in adult patients with rheumatoid arthritis and periodontitis (P), does non-surgical periodontal treatment (I), as compared to no treatment (C), provides better outcomes in rheumatoid arthritis activity (O). RESULTS: After searching the databases, seven articles were selected for qualitative and five for quantitative analysis. The total number of participants included was 292, with an average age of 50.5 years. All patients had rheumatoid arthritis and periodontal disease. Non-surgical periodontal treatment significantly reduced Disease Activity Score 28 (P = 0.004; I2 = 92%) and erythrocyte sedimentation rate (P = 0.01; I2 = 78%), but with no significant effect on C-reactive protein (P = 0.34; I2 = 92%). CONCLUSIONS: It can be concluded that non-surgical periodontal treatment can benefit patients with rheumatoid arthritis.

The influence of crown-to-implant ratio in single crowns on clinical outcomes: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: A consensus about the effect of crown-to-implant (C/I) ratio in single crowns regarding the implant survival rate and marginal bone loss (MBL) is lacking. PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate the influence of C/I ratio in implant-supported single crowns on clinical outcomes. MATERIAL AND METHODS: The search was made in the PubMed/MEDLINE, Scopus, and the Cochrane Library databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria and registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42018095711). The focused question was "Does the crown-to-implant ratio influence clinical outcomes for implant-supported single crowns?" RESULTS: Five direct comparative studies were included (C/I ratio ≤1 or >1, or ≤2 or >2), including a total of 262 participants with a mean age of 54.5 years. The meta-analysis comparing C/I ratio between ≤1 or >1 revealed no significant differences (P=.18; risk difference:-0.05; 95% confidence interval: -0.11 to 0.02) in terms of implant survival rate; the same was true for C/I ratio between <2 or ≥2 (P=.05; risk difference:-0.06; 95% confidence interval: -0.12 to -0.00), both analysis were made with a mean follow-up period was 36 months. The mean MBL was calculated based in the qualitative data for each C/I ratio: ≤1 (0.15 mm [-0.34 to 0.34]); >1 (0.07 mm [-0.29 to 0.22]); <2 (1.32 mm [0.38-0.9]); and ≥2 (1.37 mm [-0.02 to 0.91]). The qualitative data reported that the most common mechanical complication was screw loosening, and the most common biological complication was peri-implantitis. CONCLUSIONS: The meta-analysis revealed no relationship between categories of C/I ratio for implant survival rate. The qualitative data also suggested that MBL increased as the C/I ratio increased.

A clinical comparison of 1-piece versus 2-piece implants: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: One-step dental implant surgery with a 1-piece implant has been introduced with the aim of simplifying and increasing the effectiveness of treatment and providing greater comfort for the patient. Whether these goals have been met compared with conventional 2-piece implants remains unclear. PURPOSE: The purpose of this systematic review and meta-analysis was to compare the use of 1-piece versus 2-piece implants in terms of marginal bone loss and implant survival rate. MATERIAL AND METHODS: This systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was recorded in the International prospective register of systematic reviews (PROSPERO) database (CRD 42018095721). A literature search was conducted in the PubMed/MEDLINE, Web of Science, and Cochrane Library databases for articles published up to May 2018. The population, intervention, comparison, outcome (PICO) question was, "Do patients who received 1-piece implants show similar marginal bone loss, survival rates, and complications as those who receive 2-piece implants?" RESULTS: The meta-analysis was based on the Mantel-Haenszel and inverse variance methods. Implant survival rate was analyzed by using a dichotomous outcome, measured according to risk ratio (RR) and marginal bone loss by continuously evaluating the outcomes according to the mean difference (MD), both with a corresponding 95% confidence interval (CI). Five studies, including 270 participants with a mean age of 54.70 years and receiving 434 dental implants, were included. The mean follow-up period was 4 years. Meta-analysis did not reveal a significant difference in relation to implant survival rate (P=.85; RR: -0.89; CI: -0.27 to 2.98), as well as to marginal bone loss (P=.85; MD: -0.43; CI: -0.43 to -0.52). CONCLUSIONS: One- and 2-piece implants demonstrated effectiveness in the rehabilitation of patients requiring dental implants.

Avaliação do comportamento biomecânico de próteses unitárias implantossuportadas diante de diferentes situações clínicas: estudo pelo método de elementos finitos tridimensionais / Biomechanical evaluation of single implant-supported protheses on different clinical situations: study by the methods of finite three-dimensional elements

O objetivo do presente trabalho foi avaliar a distribuição de tensões em próteses unitárias sobre implantes de conexão interna e externa variando a proporção coroa implante mediante a utilização de coroas com alturas de 10 mm e 15 mm, o tipo ósseo (tipo III e IV) e a perda óssea marginal (sem perda óssea, com perda de 1,5 mm, 3,0 mm e 4,5 mm) através da metodologia de elementos finitos tridimensionais. Esse trabalho foi elaborado em dois capítulos, o capitulo I foi composto por 16 modelos tridimensionais simulando um bloco ósseo do tipo IV com diferentes níveis de perda óssea marginal (0 mm, 1.5mm, 3.0mm e 4.5mm) onde foi inserido um implante de cone Morse ou hexágono externo com 10 mm de comprimento e 4 mm de diâmetro suportando uma coroa metalocerâmica parafusada com altura de 10 mm ou 15 mm. O capítulo II foi composto por 8 modelos com um bloco ósseo do tipo III ou IV com um implante de hexágono externo ou cone Morse e uma coroa metalocerâmica parafusada com altura de 10 mm ou 15 mm. Os modelos foram simulados com auxílio dos programas Invesalius 3.0 (CTI, São Paulo, Brasil), Rhinoceros 3D 4.0 (NURBS Modeling for Windows, EUA) e SolidWorks 2011 (SolidWorks Corp, Massachusetts, EUA). Os resultados foram obtidos através do software ANSYS 19.2, incluindo a caracterização dos materiais, contatos, elaboração das malhas, condições de contorno e carregamento (200N axial e 100N oblíqua em 45º nas vertentes internas de cada cúspide da coroa). As tensões geradas sobre os implantes e componentes foram visualizadas por meio de mapas de tensão von Mises enquanto que as tensões no tecido ósseo foram visualizadas através de tensão máxima principal em cada modelo simulado. Os resultados do capítulo I demonstraram que o aumento da proporção coroa/implante assim como a perda óssea marginal apresentaram influência direta na maior concentração de tensões nos implantes e componentes protéticos e que a utilização da conexão interna permitiu melhor distribuição das tensões no longo eixo do implante o que aliviou o tecido ósseo peri-implantar das tensões geradas. Quanto ao capítulo II, os resultados mostraram que a qualidade do tecido ósseo não apresentou impacto na distribuição de tensões nos implantes e componentes protéticos, em contrapartida, as coroas de 15 mm apresentaram maior magnitude das tensões geradas, além disso, os implantes de cone Morse garantiram uma distribuição mais homogênea das tensões o que diminuiu a concentração de tensões no tecido ósseo(AU)

The aim of the present study was to evaluate the stress distribution on single implantsupported prostheses based on three variables: the type of connection (internal connection and external connection), crown height of 10mm and 15mm, type bone ( type III and IV) and marginal bone loss (0 mm, 1,5 mm, 3,0 mm and 4,5 mm) using the finite element method. The present study was divided into two chapters. The first one was composed of 16 threedimensional models simulating a bone type IV with different levels of marginal bone loss (0mm, 1,5mm, 3,0mm and 4,5mm). All models containing one a dental implant with 4 mm in diameter and 10 mm in length with two different connection (external hexagon or Morse taper), restored with crowns metaloceramic with a height of 10mm or 15mm. The Chapter II consisted of 8 models simulating a bone type III or IV, with external hexagon or Morse taper implant and metaloceramic crown with a height of 10 mm or 15 mm. All models were simulated using Invesalius 3.0 (CTI, São Paulo, Brazil), Rhinoceros 3D 4.0 (NURBS Modeling for Windows, USA) and SolidWorks 2011 (SolidWorks Corp, Massachusetts, USA) and ANSYS 19.2 (Southpointe, PA, USA), including the characterization of the models, materials, contacts, contouring conditions and loading (200N axial and 100N oblique at 45º). An analysis of the results was performed using the software ANSYS 19.2 and were demonstrated through von Mises stress maps (implants and components) and maximum principal stress (bone tissue). The results of the chapter I show that increasing crown / implant ratio due to progressive marginal bone loss associated with a crown height of 15 mm has a direct influence on the higher stress concentration in implants and prosthetic components and the use of the internal connection guaranteed the best distribution on the long axis of the implant or relief of periimplant bone tissue from the generated stresses. As for Chapter II, the results presented show that bone tissue quality does not affect stress distribution in implants and prosthetic components, however, crown height of 15 mm has a direct influence on the higher stress concentration. Morse taper implants ensure a more stable distribution, homogeneous stress and decreased stress concentration in bone tissue(AU)

Influence of vomer flap on craniofacial growth in patients with cleft lip and palate: A systematic review.

The aim of this review was to evaluate the impact of the vomer flap on craniofacial growth in patients with cleft lip and palate. The review was conducted according to the PRISMA checklist and is registered in the International Prospective Register of Systematic Reviews (PROSPERO - CRD42018095714). Two investigators performed the research using the PubMed/MEDLINE, Embase, and Web of Science databases for studies published until November 2018. The focused question was 'Does the vomer flap have a lesser impact on craniofacial growth in patients with cleft lip and palate?'. A total of 13 articles was selected for this review, comparing the vomer flap technique with other flap surgery techniques. The outcomes analyzed were: facial development (primary outcome); and the growth of the maxilla and mandible, occlusion, occurrence of fistula, and speech development (secondary outcomes). It was concluded that there is no difference in impact between vomer flap and the other flap surgery techniques on craniofacial development.

Effect of different types of prosthetic platforms on stress-distribution in dental implant-supported prostheses.

A biomechanical analysis of different types of implant connections is relevant to clinical practice because it may impact the longevity of the rehabilitation treatment. Therefore, the objective of this study is to evaluate the Morse taper connections and the stress distribution of structures associated with the platform switching (PSW) concept. It will do this by obtaining data on the biomechanical behavior of the main structure in relation to the dental implant using the 3-dimensional finite element methodology. Four models were simulated (with each containing a single prosthesis over the implant) in the molar region, with the following specifications: M1 and M2 is an external hexagonal implant on a regular platform; M3 is an external hexagonal implant using PSW concept; and M4 is a Morse taper implant. The modeling process involved the use of images from InVesalius CT (computed tomography) processing software, which were refined using Rhinoceros 4.0 and SolidWorks 2011 CAD software. The models were then exported into the finite element program (FEMAP 11.0) to configure the meshes. The models were processed using NeiNastram software. The main results are that M1 (regular diameter 4mm) had the highest stress concentration area and highest microstrain concentration for bone tissue, dental implants, and the retaining screw (P<0.05). Using the PSW concept increases the area of the stress concentrations in the retaining screw (P<0.05) more than in the regular platform implant. It was concluded that the increase in diameter is beneficial for stress distribution and that the PSW concept had higher stress concentrations in the retaining screw and the crown compared to the regular platform implant.