The soft tissue esthetic outcome with and without immediate provisionalization in immediate implants: A systematic review and meta-analysis.

Aim: This systematic review and meta-analysis aimed at checking influences of immediate provisionalization on the primary esthetic outcome by Pink Esthetic Score (PES) as well as other secondary soft tissue outcomes such as bleeding on probing, probing depth, plaque index, mesial papillary recession, distal papillary recession, and midfacial mucosal recession of the peri-implant mucosa around immediately placed implants in the anterior maxilla. Setting and Design: This systematic review and meta-analysis was evaluated using the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Materials and Methods: The relevant studies were found in the databases such as MEDLINE (PubMed), the Cochrane Central Register of Controlled Trials, Science Direct, and Google Scholar. The search was restricted to studies published in English only, with no time constraints. A second hand search was conducted on individual journals and study reference lists. The Evidence Project risk-of-bias tool was used to assess the risk of bias in included studies. The level of evidence was determined using the GRADEpro GDT: GRADEpro Guideline Development Tool (software). McMaster University, 2020 (developed by Evidence Prime, Inc.,). Statistical Analysis Used: The statistical meta-analysis was conducted by using Review Manager (RevMan) (Computer Program). Version 5.4. Copenhagen: The Nordic Cochrane Centre, the Cochrane Collaboration, 2020. Results: Nine studies were finalized. Seven studies were selected out of nine in the meta-analysis for PES. The results of the current meta-analysis for primary outcome observed that immediate implant placement (IIP) followed by immediate provisionalization improves the esthetic outcome, with forest plot favoring immediate provisionalization and demonstrating a statistically significant difference (mean difference [MD] =1.54, [95% confidence interval (CI): 0.82-2.27], P < 0.0001). Statistically insignificant result was observed for secondary outcomes; bleeding on probing (MD = 4.00, [95% CI: -1.15-9.15], P = 0.13), probing depth (MD = 0.17, [95% CI: -0.13-0.48], P = 0.26), plaque index (MD = -1.00, [95% CI: -7.56-5.56], P = 0.77), mesial papillary recession (MD = -0.10, [95% CI: -0.31-0.10], P = 0.33), midfacial mucosal recession (MD = -0.47, [95% CI: -1.01-0.07], P = 0.09). However, for distal papillary recession (MD = -0.32, [95% CI: -0.50--0.13], P = 0.0007), the result was statistically significant with forest plot favoring immediate provisionalization. Conclusion: When the implant is placed in the esthetic zone, IIP with immediate provisionalization provides the best gingival (pink) esthetics.

Mandibular implant-supported overdenture: A systematic review and meta-analysis for optimum selection of attachment system.

Aim: This systematic review aimed to compare different attachment systems used in mandibular implant supported overdentures by assessing outcomes such as prosthodontic maintenance and complication, peri implant tissue changes, retention, and patient satisfaction for optimum selection of attachment system. Settings and Design: This systematic review conducted following Preferred Reporting Items for the Systematic Review and Meta Analysis (PRISMA) guidelines. Materials and Methods: A systematic electronic literature search was conducted through PubMed, The Cochrane Central Register of Controlled Trials (Central), and Science direct. A hand search was also performed for individual journals and reference lists of selected studies. Randomized controlled clinical trials and crossover clinical trials from 2010 to 2020 with follow up of more than 1 year were included. The Cochrane Collaboration's tool was used for assessing the risk of bias of included studies. Statistical Analysis Used: The statistical meta analysis was performed using Review Manager (RevMan) [computer program]. Version 5.4. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboation, 2020. Results: Six studies that met the inclusion criteria possess the low risk of bias with follow up of more than 1 year were included in this systematic review. Out of four outcomes, meta analysis was performed for prosthodontic maintenance and peri implant tissue changes. Due to the limited availability of data, retention and patient satisfaction were reviewed systematically without meta analysis. The result of meta analysis for ball versus magnet attachment showed statistically significant differences in prosthodontic complications and maintenance, and ball attachment reported fewer complications than the locator attachment (risk ratio [RR] =0.55, confidence interval [CI] =95%, P = 0.03). Peri implant tissue changes were analyzed in the included studies as probing depth and marginal bone loss. The result of meta analysis for probing depth showed no statistically significant difference between bar versus telescopic type of attachment (RR = 0.20, CI = 95%, P = 0.74). The meta analysis results for marginal bone loss showed no statistically significant difference between bar versus telescopic type of attachment (mean difference = 0.35, CI = 95%, P = 0.10). Conclusion: It can be concluded from the current review that bar attachment provided the most superior retention. The telescopic attachment system not only showed the most favorable patient's satisfaction but also reported the least peri implant mucosal changes. The ball attachment system is a favorable choice for limited inter arch space and parallel implant placement.

Clinical success between tilted and axial implants in edentulous maxilla: A systematic review and meta-analysis.

Aim: This systematic review and meta-analysis evaluated the clinical survival of axial and tilted implants in atrophic edentulous maxilla after three years of immediate loading and also the corresponding marginal bone loss. Setting and Design: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines (PRISMA). Materials and Methods: The relevant studies were retrieved from MEDLINE(PubMed), the Cochrane Central Register of Controlled Trials (CENTRAL), Science Direct, Google Scholar databases. The search was limited to studies published in the English language with no date restrictions. A further hand search was conducted on individual journals and reference lists of studies. The risk of bias in included studies was assessed by using the Evidence Project risk of bias tool. Statistical Analysis Used: Statistical meta-analysis was conducted using RevMan 5.4 software. The assessment for the level of evidence was done using GRADEpro software. Results: Eleven studies were finalised. All were included in the meta-analysis for implant survival, while only seven studies were included in the meta-analysis of marginal bone loss. After three years, the meta-analysis results for implant survival showed no statistical difference between axial and tilted implants, with the forest plot neither favouring axial nor tilted implants (RR = 1.00 (95% CI: 0.98-1.01); P-value = 0.59). After three years, the meta-analysis results for marginal bone showed no statistical difference between axial and tilted implants, with the forest plot neither favouring axial nor tilted implants (MD = -0.02; 95% CI; -0.09-0.06; P-value = 0.69). Conclusion: In the immediately loaded rehabilitation of completely edentulous atrophic maxillae, tilting of implants did not induce any significant alteration in their survival and their corresponding marginal bone loss levels compared to conventionally placed axial implants even after three years of function.

Influence of occlusal vertical dimension on lip positions at smile in completely dentulous adults.

AIM: The study was conducted to evaluate the effect of increased vertical dimension on the lip positions at smile in dentulous subjects. SETTINGS AND DESIGN: Invivo - comparative study. MATERIALS AND METHODS: Thirty individuals aged between 22 and 30 years were selected for the study. Poly-vinyl siloxane (Jet Bite, Coltene, Switzerland) interocclusal bite records of varying thickness of +1, +2, +3, and +4 mm were made using articulated stone casts for all the participants, respectively. Posed smile photographs at different increased vertical dimensions of +1, +2, +3, and +4 mm were captured with D-SLR camera (Nikon D3200 of 18 megapixels with macro lens, Japan) mounted on tripod stand keeping a uniform distance of five feet from the face. Head positioning device (Genoray CBCT Machine Papaya 3D Plus, Unicorn DenMart, India) was used to stabilize the head position of the participants. Interlabial gap height, intercommissural width, smile index (width/height ratio), incisal edge-to-upper lip distance, incisal edge-to-lower lip distance, and display zone area measurements were made in AutoCAD software (Autodesk, Inc., California, USA). STATISTICAL ANALYSIS USED: One-way repeated measures ANOVA tests (α = 0.05) and Bonferroni's post hoc tests were performed for statistical analysis. RESULTS: With increasing occlusal vertical dimension, the interlabial gap height, incisal edge-to-lower lip distance, and display zone area increased significantly (P < 0.001). The smile index decreased significantly as the occlusal vertical dimension increased (P < 0.001). No significant difference was found in intercommissural width and incisal edge-to-upper lip distance. CONCLUSION: It was found that an increase in occlusal vertical dimension led to an increase in interlabial gap height, incisal edge-to-lower lip distance, and display zone area measurements, whereas the width of smile and incisal edge-to-upper lip distance did not change with increasing occlusal vertical dimension.