Patient-reported outcome measures and health economics in regenerative periodontal therapy: A systematic review and meta-analysis.

Understanding patient responses to periodontal regeneration is crucial. This systematic review and meta-analysis addressed two key questions: (a) the impact of periodontal regeneration on patient-reported outcome measures (PROMs) for intrabony and furcation involvement and (b) the cost-effectiveness of periodontal regeneration for treating periodontal defects. Twenty-four studies were included, with 20 randomized clinical trials (RCTs) reporting patient-reported outcomes and five (three RCTs and two economic model-based studies) reporting cost-effectiveness outcomes. Results favored regeneration therapy over conventional flap surgery for intrabony defects, showing improvements in qualitative (i.e., amount of regenerated attachment apparatus) and quantitative parameters (i.e., probing and radiographic parameters). In terms of PROMs, regenerative treatments involving barrier membranes resulted in longer chair times and higher rates of complications (such as membrane exposure or edema) compared to flap with biologic agents or access flap alone. Despite this, oral health-related quality of life improved after both regenerative and extraction procedures. Economically, regeneration remained favorable compared to extraction and replacement or open flap debridement alone for periodontal defects. Single-flap variants in open flap debridement yielded similar outcomes to regenerative treatment, offering a potentially cost-effective option. Nevertheless, further discussion on the benefits of less-invasive flap designs is needed due to the lack of histological evaluation.

Dental Pathophysiology of Odontogenic Sinusitis: Oral Surgical Complications.

The article explores the understudied pathophysiology of odontogenic sinusitis (ODS) development as a result of oral surgical complications such as oroantral communication (OAC) or fistula (OAF), maxillary sinus bone grafting, and dental implantation. A temporary OAC presents most often after dental extraction, especially with posterior maxillary teeth, though can happen with any oral surgical intervention. Maxillary sinus augmentation can also cause ODS, and while the pathophysiology is incompletely understood, it may be related to OAC/OAF formation or bone graft infection. Dental implants may also lead to ODS either via displacement into the sinus, partial protrusion into the sinus, or peri-implantitis.

Iliac crest vertical block grafts -placing outside or inside the bone contour: A cohort study.

OBJECTIVE AND AIM: Challenging defect configurations and dimensions arise from severe, localized vertical alveolar ridge defects caused by trauma or prior surgery. This study aims to analyze three-dimensional bone gain, assess marginal bone stability in such defect configurations, and evaluate the impact of grafting outside the bone contour on the overall outcome, with a focus on iliac crest block grafts as a valid treatment option. MATERIALS AND METHODS: The prospective cohort study evaluated patients who required vertical block grafting due to localized bone defects in the maxilla or mandible and who had received iliac grafts. Three-dimensional bone gain was analyzed using cone beam computed tomography (CBCT) after 3 months of bone healing for each treated site and implant position. A comparison between bone grafts inside and outside the bone contour was conducted. Marginal bone stability was measured using intraoral radiographs during routine annual follow-up visits. RESULTS: Seventy patients with 89 treated sites were evaluated. After 3 months of graft healing, the mean vertical bone gain was 11.03 ± 3.54 mm, the mean horizontal bone gain was 7.18 ± 2.00 mm, and the mean graft length was 28.19 ± 11.01 mm. A total of 217 implants were placed in the augmented regions. On implant level, a mean vertical bone gain of 10.44 ± 3.44 mm and a mean horizontal bone gain of 6.54 ± 1.86 mm were measured. Over a 43-month observation period, mesial and distal marginal bone loss averaged 0.44 ± 0.92 mm and 0.49 ± 1.05 mm, respectively. Eight implants were diagnosed with periimplantitis, resulting in the loss of four implants, while no early implant losses were reported. CONCLUSION: Within the limitations of this study, vertical bone grafts with iliac crest block grafts were found to be a dependable treatment option for dental implant placement, and placing block grafts outside the bone contour did not lead to inferior outcomes.

Root surface biomodification in periodontal therapy: Biological rationale and clinical applications.

Regenerative periodontal therapy aims to form new cementum, periodontal ligament, and alveolar bone, all sealed by gingival tissue. The root surface acts as the wound margin during this regeneration process. Root surface biomodification (root conditioning/root decontamination), therefore, seems instrumental in promoting surface decontamination and enhancing tissue attachment by removing the smear layer, exposing collagen fibrils, and facilitating blood clot formation and stabilization. This review attempted to provide an all-encompassing, evidence-based assessment of the role of root surface biomodification in regenerative periodontal therapy, particularly in intrabony defects, furcation defects, and root coverage procedures. The reviewed evidence suggested that root conditioning agents, whether used independently or in conjunction with bone graft materials, biological agents, membranes, or connective tissue grafts, do not offer any clinical advantage regarding clinical attachment gain. Thus, integrating chemical methods with the mechanical root instrumentation process does not necessarily contribute to superior clinical outcomes.

Oronasal Fistula Closure and Defect Reconstruction: Two Case Reports Using Periodontal Plastic Surgery Principles.

OBJECTIVES: Oronasal fistulas are common sequelae following cleft lip and palate surgery and can significantly impact a patient's quality of life. They result from various factors, including surgical techniques, tissue management, and patient-specific factors. This case report explores the modern approach to oronasal fistula closure using periodontal plastic surgery principles. MATERIALS AND METHODS: The report presents two cases of patients with oronasal fistulas due to previous maxillofacial surgical intervention. These patients underwent microsurgical procedures that involved partial flap thickness preparation of the fistula areas, the use of connective tissue grafts from the palate, and meticulous suturing techniques to ensure graft integrity. The procedures were performed in stages, and postoperative care was provided. RESULTS: Both cases demonstrated successful fistula closure and graft survival. The patients reported improvements in breathing, speech, aesthetics, and quality of life. The second case also included guided bone regeneration and implant placement. CONCLUSIONS: Oronasal fistulas resulting from maxillofacial surgery can be effectively treated using periodontal plastic surgery techniques, significantly improving patients' quality of life and aesthetic outcomes. This approach represents a valuable addition to the existing repertoire of oronasal fistula closure methods.

Performance of three artificial intelligence (AI)-based large language models in standardized testing; implications for AI-assisted dental education.

INTRODUCTION: The emerging rise in novel computer technologies and automated data analytics has the potential to change the course of dental education. In line with our long-term goal of harnessing the power of AI to augment didactic teaching, the objective of this study was to quantify and compare the accuracy of responses provided by ChatGPT (GPT-4 and GPT-3.5) and Google Gemini, the three primary large language models (LLMs), to human graduate students (control group) to the annual in-service examination questions posed by the American Academy of Periodontology (AAP). METHODS: Under a comparative cross-sectional study design, a corpus of 1312 questions from the annual in-service examination of AAP administered between 2020 and 2023 were presented to the LLMs. Their responses were analyzed using chi-square tests, and the performance was juxtaposed to the scores of periodontal residents from corresponding years, as the human control group. Additionally, two sub-analyses were performed: one on the performance of the LLMs on each section of the exam; and in answering the most difficult questions. RESULTS: ChatGPT-4 (total average: 79.57%) outperformed all human control groups as well as GPT-3.5 and Google Gemini in all exam years (p < .001). This chatbot showed an accuracy range between 78.80% and 80.98% across the various exam years. Gemini consistently recorded superior performance with scores of 70.65% (p = .01), 73.29% (p = .02), 75.73% (p < .01), and 72.18% (p = .0008) for the exams from 2020 to 2023 compared to ChatGPT-3.5, which achieved 62.5%, 68.24%, 69.83%, and 59.27% respectively. Google Gemini (72.86%) surpassed the average scores achieved by first- (63.48% ± 31.67) and second-year residents (66.25% ± 31.61) when all exam years combined. However, it could not surpass that of third-year residents (69.06% ± 30.45). CONCLUSIONS: Within the confines of this analysis, ChatGPT-4 exhibited a robust capability in answering AAP in-service exam questions in terms of accuracy and reliability while Gemini and ChatGPT-3.5 showed a weaker performance. These findings underscore the potential of deploying LLMs as an educational tool in periodontics and oral implantology domains. However, the current limitations of these models such as inability to effectively process image-based inquiries, the propensity for generating inconsistent responses to the same prompts, and achieving high (80% by GPT-4) but not absolute accuracy rates should be considered. An objective comparison of their capability versus their capacity is required to further develop this field of study.

Residual vertical defects: risk of disease progression, retreatment rates, and cost: a retrospective analysis.

OBJECTIVES: This study aimed to explore the relationship between Radiographic Residual Vertical Defects (RVDs) and the progression of periodontitis in patients undergoing periodontal maintenance therapy (PMT). MATERIALS AND METHODS: Teeth with RVDs were compared to the same contralateral teeth in the same patient. The study investigated the effect of smoking, diabetes, compliance, disease Stage, and Grade, baseline probing depth (PD), periodontal risk score (PRS), baseline pocket closure (PC) (≤ 4 mm), and tooth mobility on disease progression. We calculated the need for retreatment during PMT and its associated cost. Generalized estimation equations and linear and multilevel logistic regression analyses were employed for data analysis. RESULTS: Each group had 139 teeth, accounting for 80 patients. Although the group with RVDs had similar PD reduction compared to the control teeth, the prevalence of PC at the last follow-up was reduced to half in the RVDs group (odds ratio OR = 0.5; p-value = 0.028), regardless of PC status at the baseline. RVDs were also significant predictors of tooth loss due to periodontitis (TLP), with an OR of 2.28 (p = 0.043). Patients with diabetes, Stage IV, higher mobility, and higher PRS scores had a higher risk of tooth loss due to periodontitis (OR = 4.71, 3.84, 3.64, and 5.97, respectively (P < 0.01). Incidences of sites requiring retreatment were similar in both groups, but the cost of treatment was 30% higher for teeth with RVDs. Grade C had the most significant influence on receiving retreatments (OR = 18.8, p = 0.005). CONCLUSION: Teeth with RVDs represent a risk indicator for tooth loss compared to identical contralateral teeth with similar PD in the same patient. Teeth with RVD had more risk of pocket opening during follow-up. CLINICAL RELEVANCE: While teeth with RVDs can be maintained long-term, they have twice the risk of pocket opening and tooth loss due to periodontitis during follow-up. Patients with systemic and local risk factors need to be monitored closely as they are at the highest risk of losing teeth with RVDs. The increased cost of retreatment for teeth with RVDs also has implications in terms of retention versus extraction and replacement.

Impact of smoking on cost-effectiveness of 10-48 years of periodontal care.

The study aims were (1) to explore whether "periodontal treatment" consisting of surgical therapy (flap, resective, or regenerative) or scaling and root planing treatment with long-term periodontal maintenance treatment, is cost-effective in terms of preventing periodontitis-attributable tooth extraction and replacement by implant-supported crowns ("extraction/replacement"); (2) to assess the effect of cigarette smoking on this cost-effectiveness. Data for this observational retrospective study were collected from dental charts of patients who had received periodontal therapy and at least annual follow-up visits for >10 years were analyzed by linear regression generalized estimating equations and generalized linear models. Among 399 adults (199 males, 200 females), those with the least mean annual treatment cost experienced the greatest mean annual costs for extraction/replacement, indicating general cost-effectiveness. Cigarette smoking adversely impacted this cost-effectiveness, with current heavy smokers experiencing no cost-effectiveness. Former smokers with Grade C periodontitis benefitted most, whereas smoking did not influence cost-effectiveness for Grade B periodontitis. Assessed by mean annual costs of "extraction/replacement," periodontal treatment was cost-effective, which decreased in a dose-response manner by former and current smoking intensity. Cigarette smoking should be factored into treatment planning and cost-effective analyses of periodontal treatment. Smoking cessation should be encouraged.

Association between asthma and periodontitis: A case-control analysis of risk factors, related medications, and allergic responses.

AIMS: This study aimed to investigate the association between asthma, related allergies and medication use, and the presence and severity of periodontitis among individuals at the University of Michigan School of Dentistry. METHODS: Employing a case-control design, the study analyzed data from 892 patients, half with asthma and half without asthma. Data collection included demographics, asthma history, medication use, allergies, and periodontal examination outcomes, including probing pocket depth (PPD), mobility, furcation involvement, and radiographic bone loss (RBL). Logistic regression models assessed the relationship between asthma and periodontitis, adjusting for confounders. RESULTS: Asthmatic patients exhibited significantly lower odds of periodontitis (OR = 0.10, p < .001) and were less likely to present with advanced stages (OR = 0.23, p < .001) and grades of the disease (OR = 0.31, p < .001) compared to non-asthmatic patients. The study also found a higher proportion of females in the asthmatic group (67% vs. 51.8%, p < .001). Smoking was identified as a significant factor associated with periodontitis in patients with asthma, with former smokers at more than double the odds (OR = 2.28, p = .035) and current smokers at a slightly lower yet significant odds (OR = 1.87, p = .050). Additionally, asthmatic patients on adrenergic inhalers had an increased likelihood of developing periodontitis (OR = 1.76, p = .045). Allergies to codeine and latex were associated with higher odds of periodontitis, with ORs of 3.41 and 6.09, respectively. CONCLUSIONS: Asthma was found to be associated with lower odds of periodontitis. However, this association appears to be modified by smoking habits and the use of certain asthma medications, which are related to an increased likelihood of periodontitis among asthmatic patients.

Factors associated with furcation involvement and fixed prostheses: A cross-sectional study.

OBJECTIVE: The study aims to explore the relationship between horizontal and vertical furcation involvement (FI) in teeth with or without a single unit fixed prosthesis (FP). MATERIALS AND METHODS: Adult subjects presenting to the periodontics department requiring cone beam computed tomography (CBCT) analysis were recruited for this study. 79 patients, with a total of 200 teeth, were split into two groups based on the presence or absence of FP within the same patient. Our analysis considered patient-level factors like smoking, diabetes, and periodontal severity and tooth-level factors including root trunk length (RTL), probing depth (PD), periodontal supracrestal tissue height (STH), supracrestal tissue attachment (STH-PD), interproximal bone distance (IPBD) to the cementoenamel junction (CEJ) (control) or crown margin (Test), and the distance from the furcation to the CEJ (control) or crown margin (Test). Subsequently, we developed a predictive model for FI. RESULTS: The presence of a prosthesis had a significant association with FI, with an odds ratio (OR) of 12.8 (p < 0.001). Other factors significantly correlated with FI were periodontitis (OR = 10.9; p = 0.006), buccal furcation site (OR = 5.70; p < 0.001), and PD (OR = 1.90; p = 0.027). FP placement increased IPBD by 1.08 mm (p < 0.001). The predictive model built for FI demonstrated a sensitivity of 92.9% and a specificity of 66.7%. CONCLUSIONS: Fixed prosthesis significantly influenced FI only in periodontitis patients. Factors such as periodontitis Stage, probing depth, and buccal site contribute to FI. The high sensitivity of the predictive model highlights the importance of considering these correlations during treatment planning. CLINICAL RELEVANCE: Comprehending FI factors is vital for devising customised treatment plans to halt disease progression and enhance outcomes of periodontal regenerative therapies.

Tooth autotransplantation outcomes using platelet-rich fibrin: A promising approach; case study.

BACKGROUND: Autogenous tooth transplantation refers to a surgical procedure involving the relocation of a tooth within the same individual. Incorporating platelet-rich fibrin (PRF) in this procedure holds the potential to improve healing, accelerate recovery, and optimize treatment outcomes. METHODS: In this article, the authors illustrate a PRF-based approach for autogenous tooth transplantation through two case scenarios. These cases outline the surgical steps of tooth transplantation and demonstrate the potential role of PRF in enhancing soft tissue healing. Furthermore, the article provides insights from a long-term follow-up spanning over 7 years. RESULTS: Tooth transplantation in young adults is promising but depends on factors such as root development stage and donor tooth size matching. Including PRF may improve healing, at least in the short term, due to its rich concentration of growth factors and cytokines, promoting effective tissue regeneration. CONCLUSIONS: Autogenous tooth transplantation has shown to be a viable treatment option for replacing the missing dentition. Adding PRF to the autogenous tooth transplantation procedure may speed up and enhance the treatment outcome. While the favorable results of these cases might be partially attributed to the use of PRF, the contribution of PRF to the healing process of tooth transplant remains conjectural and requires validation through additional research. KEY POINTS/HIGHLIGHTS: Tooth autotransplantation can be performed in younger patients without requiring root canal treatment, while also potentially benefiting from the incorporation of platelet-rich fibrin (PRF).

25 years of Clinical Implant Dentistry and Related Research (CIDRR): A modern bibliometric and Altmetrics network analysis.

INTRODUCTION: Since its establishment in 1999, the journal of Clinical Implant Dentistry and Related Research (CIDRR) has consistently disseminated notable clinical and translational research within the domain of oral implantology. As the journal approaches its milestone 25th anniversary, this study endeavors to systematically delineate the publication trends, level of evidence, and bibliometric indices characterizing the initial quarter-century of CIDRR's scholarly activity. Notably, the investigation adopts a contemporary methodology by incorporating Altmetric analysis, thereby enriching the evaluation with an assessment of the broader societal and online impact of the published research. METHODS: A comprehensive search was performed in SCOPUS and PubMed to access the bibliographic data of all articles published in the journal from 1999 to 2024. Additionally, Altmetric database was used to obtain social media attention scores (AAS). Journal's overall performance via impact factor and quartile range was assessed. Most cited papers were identified and the most prolific authors, institutions and countries and the collaboration networks among those were assessed. The level of evidence of all articles was determined based on Oxford level of evidence scale. All articles were categorized based on their major topic in the field of implant dentistry. RESULTS: Throughout its first 25 years of activity, CIDRR published 1912 articles with an annual growth rate of 2.67% and consistently being ranked at Q1 quartile in "Dentistry (miscellaneous)" and "Oral Surgery" journal categories. When clinical studies are considered, level I and II evidence constituted 22.82% and 11.82% of all articles, respectively. Sweden, the USA, and Italy as well as Göteborgs Universitet, Sahlgrenska Akademin. and Malmö Högskola were the most prolific countries and institutions respectively. "Implant system/design/characteristics," "Bone Augmentation," and "Implant Prosthesis" were the top most investigated topics. CONCLUSIONS: The examination of the journal's initial 25 years highlighted that CIDRR has surpassed similar dental research journals in publishing a greater number of high-level evidence articles. It also showcased diverse country- and author-collaboration networks. However, the journal's social media presence is still evolving. This article, presenting a comprehensive overview of the journal's scientometric and bibliographic activities, serves as a valuable reference for researchers, clinicians, and stakeholders, offering insights into both traditional and contemporary perspectives.

Calibrated intraoral scan protocol (CISP) for full-arch implant impressions: An in vitro comparison to conventional impression, intraoral scan, and intraoral scan with scan-aid.

OBJECTIVE: To assess a newly developed intraoral scan protocol in enhancing the accuracy of complete-arch implant impressions. MATERIALS AND METHODS: Four impression approaches were applied to the same maxillary edentulous model with 6 implants: (1) intraoral scan (IOS), (2) intraoral scan with scan aid (IOS-SA), (3) calibrated intraoral scan protocol (CISP), and (4) conventional splinted open-tray impression (CONV). Each approach was repeated 10 times, and a direct scan of the model with a desktop scanner was used as a reference model. The alignment of scans and the reference model was conducted by two methods: (a) aligning all scan bodies to evaluate the overall fit, and (b) aligning the first and second scan bodies to simulate the Sheffield fit test for passive fitting of multiple implant-supported prostheses. Linear deviations from the reference model (trueness) and within each group (precision) were analyzed using Python scripts. RESULTS: When aligned by all scan bodies, the CISP group exhibited comparable mean trueness (38.33 µm) and precision (45.97 µm) to the CONV group (44.30 and 47.92 µm respectively), both of which significantly outperformed the IOS group (86.82 and 83.17 µm, respectively). Furthermore, in the virtual Sheffield fit test, the CISP group achieved the highest levels of mean trueness at the end span (121.7 µm), making a linear deviation reduction of 36.7%, 60%, and 41.4% when compared to the CONV, the IOS, and the IOS-SA groups, respectively. Moreover, the CISP group (104.3 µm) displayed a remarkable 65, 182, and 86 µm advantage in precision over the CONV, IOS, and IOS-SA groups, respectively. CONCLUSION: CISP demonstrated comparable accuracy to the gold standard, the conventional splinted open-tray impression. Furthermore, it excelled in the virtual passive fitting test.

Efficacy of autogenous platelet concentrates in immediate implant therapy: A systematic review and meta-analysis of prospective controlled clinical trials.

PURPOSE: To provide an overview of the outcomes of the use of autogenous platelet concentrates in immediate implant placement. MATERIALS AND METHODS: Based on an a priori protocol, a systematic search was performed of the National Library of Medicine (MEDLINE via PubMed), Embase and Scopus databases. Randomised and non-randomised controlled clinical trials on immediate implant placement including at least one study arm with use of platelet-rich fibrin or platelet-rich plasma as a gap filler between immediately placed implants and the alveolar bone were included. A random-effects meta-analysis model was built to assess the primary outcomes of marginal bone loss and probing pocket depths between test (platelet concentrates) and control (no graft or other graft materials) groups. A risk of bias assessment was performed and the Grading of Recommendations Assessment, Development and Evaluation approach was used to assess the certainty of evidence. RESULTS: A total of 20 trials (595 immediate implants placed in 454 individuals) were included in the meta-analytic model. Based on the data from studies with a minimum post-prosthetic loading period of 6 months after immediate implant placement, overall, the application of platelet concentrates was associated with significantly lower marginal bone loss and probing pocket depth compared to the control groups (mean difference -0.36 mm; P < 0.01 and mean difference -0.47 mm; P < 0.01, respectively). No additional benefit of application of platelet concentrates was detected regarding primary stability of immediate implants. Subgroup analysis revealed significantly lower marginal bone loss with xenogeneic bone alone compared to platelet concentrates alone as grafting material in immediate implant placement (mean difference 0.66 mm; P < 0.01). Evidence on soft tissue outcomes and aesthetic parameters was scarce. CONCLUSIONS: A low level of certainty based on the Grading of Recommendations Assessment, Development and Evaluation approach indicates superior outcomes in terms of marginal bone loss and probing pocket depth in immediate implant placement with the use of platelet concentrates versus no graft. Future research should be tailored towards a standardised protocol for preparation of platelet concentrates and inclusion of soft tissue and aesthetic outcomes as well.

Utilizing Individualized Titanium Frames for Protected Alveolar Bone Augmentation: A Feasibility Case Series.

Despite the various treatments proposed with barrier membranes, one of the main challenges for guided bone regeneration (GBR) is maintaining space for large defects and ensuring an adequate blood supply. The presented feasibility case series aims to introduce an original titanium frame (TF) design, customized for each defect, as a modification of well-known principles and materials for GBR to achieve an enhanced and more predictable horizontal and vertical bone augmentation. Three patients with significant horizontal defects were treated with pre-trimmed TFs to create needed space, and then a 50/50 mixture of autograft and bovine xenograft was placed and covered with a collagen membrane. After 8 months of healing, the sites were reopened, and the titanium screws were removed with the frame. An average of 8.0 ± 1.0 mm of horizontal and 3.0 ± 0.0 mm of vertical bone gain were achieved at the time of reentry and implant placement surgery. Bone core biopsy sample was obtained during the implant placement. Histomorphometric analysis revealed that 42.8% of the sample was new vital bone, 18.8% was residual bone graft particles, and 38.4% was bone marrow-like structures. After 3 to 4 months from implant placement, the implants were restored with provisional crowns and then finalized with zirconia screw-retained crowns. This case series suggests that GBR utilizing TFs with or without collagen membranes can be considered a suitable approach for horizontal and vertical bone augmentation. However, based on only three reported cases, the results should be carefully interpreted.

Oral Frenum Composition and Clinical Implications in Bone Regeneration: A Review.

Successful bone augmentation relies on primary wound closure. The labial frenum is a soft tissue that connects the lip to the alveolar mucosa or gingiva. However, the frenum may exert biomechanical forces to the wound edge, causing wound instability. The aim of this study is to review the frenum composition and classifications and to understand the significance of the frenum in wound stability upon bone regeneration. Together with a manual search, an electronic search was conducted through three online databases on studies published until September 2022. A total of 300 articles were identified, and 9 studies were included in this review. Two of the included studies discovered that 35% to 37.5% of the labial frenum had muscle fibers. Other studies showed that the labial frenum was mainly composed of connective tissue with elastic fibers. There are two widely used classifications for the frenum based on its morphology and attachment position. No studies specifically evaluated the impact of the frenum on bone regeneration, but the frenum location intercorrelated with the amount of keratinized tissue, which could influence wound stability. A modified frenum classification for the edentulous ridge and a decision diagram to manage the frenum is proposed for research and evidence-based practice.

Maxillary sinus opacification after surgery in asymptomatic patients: Transient swelling of the sinus mucosa or graft dispersion into the maxillary sinus. A radiographic report of three cases after a follow-up period of at least 5 years.

Maxillary sinus grafting is a predictable regenerative technique to facilitate maxillary posterior implant placement when there is insufficient vertical bone height inferior to the maxillary sinuses to allow placement of implants of adequate dimensions. It enables an increase in vertical bone height, which makes implant placement easier. Maxillary sinus mucosal membrane perforation is one of the most common intraoperative complications during maxillary sinus grafting and may result in extrusion of graft material into the sinus. When this occurs, the mucociliary function of the maxillary sinus may expel the extruded graft material through its natural ostium, though graft particles may remain in the sinus or possibly occlude the natural ostium. After grafting, transient maxillary sinus mucosal oedema may occur. A postoperative CBCT scan may reveal varying degrees of sinus opacification, namely partial, subtotal or total. Although it is always possible to identify graft material, which may enter the sinus as a result of membrane perforation that might not even be visible to the implantologist during the surgical procedure, it is challenging to assess whether sinus opacification is due to mucosal thickening or mucus accumulation. The aim of the present case series was to offer a pragmatic approach to managing asymptomatic patients whose CBCT scans demonstrated partial, subtotal or total maxillary sinus opacification with bone graft particles that seemed to have been extruded into the sinus.

Decision Tree for Reconstructive Treatment of Peri-implantitis Defects.

Peri-implantitis, a common complication among patients receiving implant-supported restorative therapy, often requires surgical intervention for effective treatment. Understanding the specific configuration of peri-implant bony defect and adjacent bone peaks is crucial for tailoring treatment strategies and improving outcomes. A decision tree for reconstructive peri-implantitis therapy has been developed based on the new classification of defect configurations (Class I to V), guiding clinicians in selecting treatment options, including biomaterials, techniques, and healing approaches. Furthermore, clinicians are encouraged to consider various factors such as local predisposing factors (such as soft tissue characteristics, prosthetic design, and implant position in three-dimensional perspective), clinical factors (surgeon skill and experience), and patient-related factors (such as local and systemic health, preferences, and cost) when evaluating reconstructive therapy options.

Influence of Ti-base Supported Implant Restoration on Peri-implant Conditions: A Systematic Review and Meta-analysis.

PURPOSE: The objective of this systematic review and meta-analysis was to examine the impact of titanium base supported single implant restorations on peri-implant conditions. MATERIALS AND METHODS: Six randomized controlled trials (RCTs), comprising a total of 274 implants that met the inclusion criteria, were chosen for data analysis. A random effects model was employed for the metaanalysis. RESULTS: Data from this study revealed that the Ti-base group exhibited a slightly but statistically significant increase in peri-implant marginal bone loss (difference in means = 0.088, 95% confidence interval = 0.003 to 0.17, p = 0.041) compared to the one-piece-abutment group. These effects were consistent in the subgroup analysis of regular-threaded implants comparing to the microthreaded subgroup. However, no significant differences were observed between the Ti-base group and the abutment group concerning probing depth (PD), bleeding on probing (BOP), and the risk of prosthetic-related complications. CONCLUSIONS: The utilization of Ti-base in single-implant supported restoration is associated with a slight increase in peri-implant marginal bone loss, while other periimplant health parameters show no significant correlation. Therefore, to determine the impact of Tibase on peri-implant condition of single implant-supported restoration is insufficient based on the findings of this meta-analysis.

Five decades of research on immediate implant therapy: A modern bibliometric network analysis via Altmetric and level of evidence mapping.

AIM: To conduct a bibliometric network analysis to explore the research landscape of immediate implant placement (IIP) and provide insights into its trends and contributors. MATERIALS AND METHODS: The Scopus database was utilized as the bibliographic source, and a search strategy was implemented to identify relevant research articles. Various bibliometric parameters were extracted, including publication year, journal, authors, citations, and funding. The analysis involved examining authorship patterns, international collaborations, level of evidence, Altmetric data, and funding analysis. RESULTS: We identified a steady annual growth rate of 6.49% in IIP research. The top three countries contributing to research output were the USA, Italy, and China. Prolific authors were identified based on publication and citation metrics. International collaborations among different countries were observed. The level of evidence analysis revealed that over 30% of the articles fell into higher levels of evidence (levels 1 and 2). Altmetric data analysis indicated no significant correlations between citation counts and Altmetric Attention Score (AAS), and conversely a significant association with Mendeley readers count. Funding and open access did not significantly impact the bibliometric indices of the papers. CONCLUSIONS: The focus of research on IIP has been evolving as indicated by an exponential growth rate in this study. Only approximately 16% of the articles fit into level 1 evidence, therefore, emphasizing on higher quality level research study shortage in this field. Modern indices can be used as new bibliometric indicators as they also cover social media and online attention scores.