Clinical Impact on Dental Implant Survival in Patients Taking Antiresorptive Medications: A Systematic Review and Meta-Analysis.

Dental implants are a predictable option to replace missing teeth. Patients on antiresorptive medications used to treat disorders associated with bone resorption may need dental implants to replace missing teeth. The data on implant failure in patients on antiresorptive medication requiring dental implants, is conflicting and limited. This systematic review aims to investigate if antiresorptive medications have any clinical impact on dental implant survival. Electronic databases were searched until May 2020. The focus question (PICOS): Participants: humans, Interventions: implant placement surgery in patients on antiresorptive medication, Comparisons: patients on antiresorptive medication vs control (patients not on antiresorptive medication), Outcomes: implant survival, and Study design: clinical studies. The protocol of this systematic review was registered in PROSPERO (CRD42020209083). Fourteen nonrandomized studies were selected for data extraction and risk of bias assessment using the ROBINS-1 tool. Only studies with a control were included for the meta-analysis, 8 articles were included in the meta-analysis using implant-level data, and 5 articles were included in the meta-analysis using patient-level data. There was no statistical significance between the 2 groups at the patient level based on 265 patients. However, there was a statistically significant difference at the implant level based on 2697 implants. Therefore, antiresorptive medications, mainly bisphosphonates (BPs), may significantly contribute to implant failure. Antiresorptive medications, especially BPs may reduce implant survival and impair the osseointegration of dental implants. Failed implants in patients on BPs may not lead to osteonecrosis and may be replaced with success.

COVID-19: Variants, Immunity, and Therapeutics for Non-Hospitalized Patients.

The continuing transmission of coronavirus disease 2019 (COVID-19) remains a world-wide 21st-century public health emergency of concern. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused greater than 600 million cases of COVID-19 and over 6 million deaths globally. COVID-19 continues to be a highly transmissible disease despite efforts by public health officials and healthcare providers to manage and control the disease. Variants identified in selected worldwide epicenters add to the complexity of vaccine efficacy, overage, and antibody titer maintenance and bioactivity. The identification of the SARS-CoV-2 variants is described with respect to evading protective efficacy of COVID-19 vaccines and breakthrough infections. Vaccines and other therapeutics have prevented millions of SARS-CoV-2 infections and thousands of deaths in the United States. We explore aspects of the immune response in a condensed discussion to understand B and T cell lymphocyte regulatory mechanisms and antibody effectiveness and senescence. Finally, COVID-19 therapies including Paxlovid, Remdisivir, Molnupiravir and convalescent plasma in non-hospitalized patients are presented with limitations for identification, collection, and distribution to infected patients.

Preprocedural Viral Load Effects of Oral Antiseptics on SARS-CoV-2 in Patients with COVID-19: A Systematic Review.

(1) There are limited clinical trials to support the effectiveness of mouth rinses when used as a preprocedural rinse against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This systematic review aims to evaluate the efficacy of antiseptic mouth rinses as a preprocedural rinse in reducing SARS-CoV-2 oral viral load in-vivo. (2) Methods: A literature search was conducted through November 2022 for the following databases: PubMed, Web of Science, Cochrane Library, and Google Scholar. The evaluated outcomes were quantitative changes in viral load and the statistical significance of that change after using antiseptic mouth rinses. (3) Results: 14 randomized controlled trials (RCT) were selected for risk of bias assessment and data extraction. (4) Conclusion: Within the limits of this systematic review, preprocedural mouth rinses may significantly reduce SARS-CoV-2 in the mouth, thus, reducing the viral particles available for airborne dispersion. Preprocedural mouth rinses may be an effective strategy for reducing airborne SARS-CoV-2 dispersion in the environment. Their use may be a preventive strategy to reduce the spread of COVID-19 in selected medical and healthcare facilities, including dental clinics. Potential preprocedural mouth rinses are identified for use as an integral part of safe practice for healthcare protocols. This systematic review was registered with the National Institute for Health Research, international prospective register of systematic reviews (PROSPERO): CRD42022315177.

Current SARS-CoV-2 Protective Strategies for Healthcare Professionals.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is responsible for the Coronavirus disease 2019 (COVID-19). COVID-19 was first reported in China in December 2019. SARS-CoV-2 is highly contagious and spread primarily via an airborne route. Hand hygiene, surgical masks, vaccinations and boosters, air filtration, environmental sanitization, instrument sterilization, mouth rinses, and social distancing are essential infection control measures against the transmission of SARS-CoV-2. This paper aims to provide healthcare professionals with evidence-based protective strategies.

Laser Treatment of Peri-Implantitis: A Systematic Review of Radiographic Outcomes.

(1) Background: This systematic review aimed to evaluate the effects of laser therapy on radiographic bone level (RBL) changes in peri-implantitis defects. (2) Methods: A literature search with defined inclusion criteria was performed. PubMed, Web of Science, Cochrane Library, and Google Scholar were searched through September 2020. The evaluated primary outcomes were RBL changes. In studies that reported RBL data, corresponding secondary clinical outcomes were probing depth (PD), bleeding on probing (BOP), and clinical attachment level (CAL). (3) Results: Thirteen articles were selected for data extraction and risk of bias assessment. Eight studies showed evidence of RBL gain in the laser groups compared to baseline, but did not report the statistical significance. Eight of these 13 studies reported comparisons to control. Five of the eight studies did not show RBL gain in the laser groups compared to control. In the laser groups compared to baseline, 11 of 13 reported reduced PD, and 6 of 13 reported significantly reduced BOP. Compared to the control, eight of the eight reported reduction of PD, and three of six reported significantly reduced BOP. Statistical significance was not consistently reported. (4) Conclusions: Within the limits of this systematic review, laser treatment may promote bone gain in peri-implantitis defects, may reduce BOP and PDs, and may be comparable to mechanical therapy. However, definitive conclusions can only be made with statistically significant data, which were found lacking in the currently available studies. This systematic review was registered with the National Institute for Health Research, international prospective register of systematic reviews (PROSPERO): CRD42020207972.

SARS-CoV-2: Overview and Its Impact on Oral Health.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its virulent variants causing coronavirus disease 2019 (COVID-19) COVID-19 has spread rapidly worldwide, and is highly contagious. A comprehensive search was conducted for the most current published information about SARS-CoV-2, COVID-19, and oral health. Clinical studies, case reports, in vivo studies, and any current published evidence on SARS-CoV-2 and COVID-19 were included in this review. Survival against SARS-CoV-2 infection may be partially dependent on periodontal health, good oral hygiene, and access to dental care. Optimum oral health, maintaining good systemic health, and elimination of smoking habits may be beneficial for the prevention and management of COVID-19 infections.

Tooth-to-Implant-Supported Fixed Partial Denture: A Comprehensive Overview of Systematic Reviews.

OBJECTIVES: Tooth-to-implant-connected prostheses have been described as a possible treatment option for patients with long-span edentulous situations that were not conducive for placement of an adequate number of supporting implants. In this comprehensive overview of systematic reviews, the incidence of complications and the long-term survival rates of tooth-to-implant-supported fixed partial dentures (FPDs) were evaluated to determine whether it is a viable treatment. MATERIALS AND METHODS: A systematic search of 5 electronic databases was conducted for systematic reviews and meta-analyses of tooth-to-implant-supported FPDs up to January 2017. The articles were AMSTAR rated for methodological quality, and low-quality articles were eliminated. RESULTS: The initial search yielded 369 reviews in PubMed, 248 in Web of Science, 49 in EMBASE, 63 in Cochrane Library, and 27 in Google Scholar. After removal of duplicates and after full-text analysis, 5 were selected for the overview. CONCLUSIONS: Within the limitations of this overview, it was concluded that (1) the 10-year survival rates for tooth-to-implant FPDs were lower than the 5-year survival rates, (2) the tooth-to-implant FPDs' survival was lower than the individual abutment tooth or implant supporting it, (3) the biological and technical complications were more at 10 years compared with 5 years, and (4) the intrusion of the abutment teeth was more in the nonrigid connection FPDs than the rigid connection FPDs. Therefore, tooth-to-implant FPDs are a viable option but should be considered secondary to other available options with higher long-term survival rates and lower complications.

Prevalence of Maxillary Sinus Pathology Based on Cone-Beam Computed Tomography Evaluation of Multiethnicity Dental School Population.

OBJECTIVE: The goal of the study was to evaluate prevalence of maxillary sinus pathology among populations considered for possible sinus augmentation procedures for dental implants. STUDY DESIGN: Eight hundred twenty-one cone-beam computed tomography (CBCT) scans were retrospectively evaluated for prevalence of maxillary sinus pathology. Scans were classified based on the type of sinus pathology detected. Categories of sinus findings were healthy, mucosal thickening larger than 3 mm, polypoidal mucosal thickening, partial opacification, complete opacification, and others. Age, sex, ethnicity, and dentition status were evaluated to determine associated relationships with the incidence of pathology. RESULTS: Sixty-two percent (62.79%) of scans presented with bilateral healthy sinuses and 37.21% of scans exhibited pathology. 73.38% of sinuses were classified as clinical healthy, 14.93% presented with mucosal thickening, 8.53% with polypoidal mucosal thickening, 2.13% with partial opacification, 0.66% with complete opacification, and 0.37% with a foreign body. Sex is found to be a significant factor with higher pathology incidence rates in male patients. Age is a significant factor with higher pathology incidence rates in older subjects. Dentition status and ethnicity did not have a significant association with pathology incidence rates. CONCLUSIONS: The prevalence of maxillary sinus pathologies and associations with age, sex, ethnicity, and dentition status were obtained. Thirty-seven percent of scans would require further medical consultation before proceeding with maxillary sinus augmentation surgery for dental implants.

Maxillary sinus augmentation using chairside bone marrow aspirate concentrates for implant site development: a systematic review of histomorphometric studies.

Maxillary sinus pneumatization following dental tooth extractions and maxillary alveolar bone resorption frequently leaves inadequate bone levels for implant placement. The objectives of this systematic review are to evaluate the effects of bone marrow aspirate concentrates (BMACs) used in maxillary sinus augmentation for implant site development.A systematic search was conducted using PubMed, EMBASE, Web of Science, Cochrane Library, and Google Scholar for studies which histomorphometrically evaluated the efficacy of BMACs and BMAC-enriched biomaterials in sinus floor elevation. Six studies were selected, and the risk of bias was evaluated.Reported ranges of vital mineralized tissue for the BMAC groups for the selected studies were 34.63-55.15% compared to 27.30% for control groups. For vital mineralized bone, these studies reported variable statistical significance. At 3-4 months, new bone formation for BMAC groups with controls using no BMAC was 7.4-12.6% and for the control groups was 9.45-14.3%. At 6 months, new bone formation for BMAC groups was 13.5-14.12% and for control groups was 10.41-13.9%. For new bone formation, these studies reported no significant difference between test and control and between 3 and 6 months histologic evaluation.Within the limits of this systematic review, the chairside method to harvest BMAC produced similar implant survival and new bone formation compared to the laboratory FICOLL group, without the additional cost and time of laboratory cell isolation techniques. The iliac crest or tibia origins, single or double centrifugation, for BMAC do not appear to be a factor for implant survival or bone formation. Although some favorable outcomes were reported, the increase in new bone formation using chairside-harvested BMAC compared to control is not predictably more significant across studies.Clinically, new bone formation in the maxillary sinus is not always contingent on the presence of BMAC. The novelty of this method requires more future studies.

Peri-implantitis: A Comprehensive Overview of Systematic Reviews.

The objective of this systematic review was to perform a comprehensive overview of systematic reviews and meta-analyses pertaining to peri-implantitis in humans, including the prevalence and incidence, the diagnostic findings, microbial findings, effects of systemic diseases, and treatment of peri-implantitis. Electronic databases were searched for systematic reviews and meta-analyses of peri-implantitis. In view of the limitations of the included systematic reviews, the outcome of this overview suggested that (1) occurrence of peri-implantitis was higher in patients with periodontitis, in patients who smoke, and after 5 years of implant function; (2) the microbial profile of peri-implantitis was different from periodontitis; (3) risk for peri-implantitis was higher in patients with uncontrolled diabetes and cardiovascular disease; (4) there was no strong evidence to suggest the most effective treatment intervention for peri-implantitis, although most peri-implantitis treatments can produce successful outcomes; and (5) postimplant maintenance may be crucial in patients with a high risk of peri-implantitis.

Maxillary Sinus Augmentation for Dental Implant Rehabilitation of the Edentulous Ridge: A Comprehensive Overview of Systematic Reviews.

OBJECTIVES: The objective of this systemic review was to perform a comprehensive overview of systematic reviews and meta-analyses of the maxillary sinus augmentation procedure for implant rehabilitation in humans. The following were evaluated in this overview: (1) anatomic variables affecting sinus augmentation, (2) histomorphometric analysis of the grafted sinus, (3) volumetric changes after sinus grafting, and (4) implant survival beyond 1 year. MATERIAL AND METHODS: Electronic databases were searched for systematic reviews and meta-analyses of implant-related sinus augmentation published from 1976 to September 2015. The studies selected must identify itself as a systemic review or meta-analysis in the title or abstract and must pertain to sinus augmentation. RESULTS: Thirty-three publications fulfilled the review criteria. The AMSTAR ratings for the 33 chosen reviews scored greater than 3 of 11, with 8 reviews scoring greater or equal to 8 of 11. CONCLUSION: The outcome of this overview suggested that the following will increase the success of sinus augmentation and survival of implants placed in the grafted sinus: (1) the use of barrier membranes over the lateral window when using a lateral approach to graft the sinus, (2) the use of particulate autogenous bone with or without other substitute graft materials, (3) sinus augmentation without the use of grafting materials may be considered provided that the space between the sinus membrane and floor can be maintained, (4) the use of rough-surfaced implants, (5) simultaneous implant placement with residual bone height greater than 4 mm, and (6) the cessation of smoking.

Surgical and Patient Factors Affecting Marginal Bone Levels Around Dental Implants: A Comprehensive Overview of Systematic Reviews.

OBJECTIVES: The objective of this systematic review was to perform a comprehensive overview of systematic reviews and meta-analyses of surgical and patient factors affecting marginal bone loss around osseointegrated dental implants in humans. MATERIAL AND METHODS: Electronic databases were searched for systematic reviews and meta-analyses published up to November 2015. RESULTS: Of the 41 articles selected, 11 evaluated implant factors, 10 evaluated patient factors, 19 evaluated surgical protocol-related factors, and one evaluated all three factors. The chosen studies were AMSTAR rated for quality. The following parameters have statistically significant effect on marginal bone loss: (1) marginal bone loss was significantly more in patients with periodontitis than in periodontally healthy patients; (2) significantly greater in generalized aggressive periodontitis patients compared with chronic periodontitis patients; (3) significantly less in alveolar socket preservation techniques; (4) significantly more in alveolar ridge augmentation sites; (5) significantly more in men than in women; (6) significantly more in smokers than in nonsmokers; and (7) smokers also have significantly more marginal bone loss in the maxilla than in the mandible. CONCLUSION: Knowledge of the surgical and patient factors that affect marginal bone loss can aid the clinician in making informed choices in selecting implant treatment options that will enhance the longevity and long-term success of their implant-supported cases.

Classification and Effects of Implant Surface Modification on the Bone: Human Cell-Based In Vitro Studies.

Implant surfaces are continuously being improved to achieve faster osseointegration and a stronger bone to implant interface. This review will present the various implant surfaces, the parameters for implant surface characterization, and the corresponding in vitro human cell-based studies determining the strength and quality of the bone-implant contact. These in vitro cell-based studies are the basis for animal and clinical studies and are the prelude to further reviews on how these surfaces would perform when subjected to the oral environment and functional loading.

Salvaging Implants With an Nd:YAG Laser: A Novel Approach to a Growing Problem.

As the incidence of implant placement expands, so too does the occurrence of implant-related pathological conditions such as peri-implant mucositis and peri-implantitis. This article will discuss implementation of a laser protocol that serves as a treatment modality designed specifically to help save ailing and failing implants. This multi-stage approach incorporates application of laser energy from a particular Nd:YAG laser with variable pulse width. This laser wavelength has demonstrated a variety of capabilities that may contribute to its clinical effectiveness. Representative long-term results of this treatment method are described, and a case depicting the protocol is presented.

Medication-related osteonecrosis of the jaws from once per year intravenous zoledronic acid (Reclast): report of 4 cases.

Osteonecrosis of the jaws is a commonly reported side effect with patients prescribed oral antiresorptive medications to treat osteoporosis and osteopenia. Oral antiresorptive agents are considered as the standard of care for the prevention and treatment of women with postmenopausal osteoporosis. Because of patient's noncompliance of the antiresorptive medications, which may require once-weekly or once-monthly oral ingestion, a new once a year intravenous (IV) infusion of zoledronic acid was recently introduced in the management of osteoporosis. Reports of medication-related osteonecrosis of the jaw (MRONJ) have been reported in patients with cancer treated with multiple doses of IV zoledronic acid. However, there is a paucity of reports occurring with the once-yearly infusion of zoledronic acid (Reclast) for the management of osteoporosis. In this article, we report 4 cases of patients who had a history of long-term oral antiresorptive therapy and now were taking the once-yearly IV zoledronic acid (Reclast) and soon developed MRONJ after completing surgery of the maxilla and mandible.

Low-Dose Radiation Risks of Computerized Tomography and Cone Beam Computerized Tomography: Reducing the Fear and Controversy.

Regulations for protecting humans against stochastic biological effects from ionizing radiation are based on the linear no-threshold (LNT) risk assessment model, which states that any amount of radiation exposure may lead to cancer in a population. Based on the LNT model, risk from low-dose radiation increases linearly with increasing doses of radiation. Imaging procedures in medicine and dentistry are an important source of low-dose ionizing radiation. The increased use of computerized tomography (CT) and cone beam computerized tomography (CBCT) has raised health concerns regarding exposure to low-dose ionizing radiation. In oral and maxillofacial surgery and implant dentistry, CBCT is now at the forefront of this controversy. Although caution has been expressed, there have been no direct studies linking radiation exposure from CT and CBCT used in dental imaging with cancer induction. This article describes the concerns about radiation exposure in dental imaging regarding the use of CT.

A comparison of computed tomography scans and digital periapical radiographs ridge height measurements.

To investigate the agreement between computerized tomography scans (CT) and intraoral periapical digital radiographs (PA) alveolar ridge height measurements in maxillary and mandibular posterior regions. We reviewed 100 implant patient radiographic records and identified 27 mandibular sites in 19 patients and 23 maxillary sites in 13 patients with available CT scans and matching PA radiographs. The distance from the crest of the ridge to the floor of the maxillary sinus or to the superior border of the inferior alveolar canal was measured. PAs were measured with Dexis software v. 8.0 and CTs were measured with Simplant software v. 11.02. Two examiners (RJ and MM) recorded the measurements separately; each examiner recorded two readings. The average of the 4 readings was used for data analysis. Absolute agreement: Paired t test comparing ridge-height measurements between the two imaging methods showed no differences for maxillary sites (P > 0.2) and significant differences for the mandibular sites (CT > PA, P = 0.0009). Relative agreement: Kendall rank correlation analysis of ridge-height measurements between the 2 imaging methods showed a high positive correlation for maxillary sites (Kendall's tau = 0.76, P = 0.0001) and moderate correlation for the mandibular sites (Kendall's tau = 0.46, P = 0.001). Maxillary PAs tend to approximate CT ridge-height measurements. By contrast mandibular PAs tend to underestimate the distance from the crest of the ridge to the inferior alveolar canal.

Use of an Intraoral Laser Scanner During the Prosthetic Phase of Implant Dentistry: A Pilot Study.

The accuracy of a digital impression technique to fabricate the implant restoration and abutment for a dental implant using an intraoral laser scanner was evaluated in 36 patients who were missing a single posterior tooth in either the mandible or maxilla that was restored with a single implant. The spatial position of each integrated implant, including the surrounding anatomic hard and soft tissues of adjacent structures, was captured utilizing a special scanning abutment with an intraoral laser scanner. Data from the scanning protocol was then delivered via the Internet in the form of an STL file to the manufacturing site for the production of a custom computer-aided design abutment and crown. All 36 restorations and abutments were delivered to the patients and evaluated for marginal integrity, interproximal contact points, and occlusion. Of the 36 patients, 6 required contact adjustments, 7 required occlusal adjustments, and 3 required a gingivectomy around the implant to completely seat the restoration. Chair time for adjustments did not exceed 15 minutes. The findings suggest that an intraoral laser scanner can be used with confidence to obtain consistent and accurate digital impressions to fabricate custom restorations and abutments for dental implants.