Which type of soft tissue augmentation at dental implant sites is best supported by evidence?

Data sources PubMed, the Cochrane Oral Health Group Trials Register and Embase. Additionally, issues of the following journals between 2000 and April 2019 were hand-searched: Journal of Clinical Periodontology, Journal of Periodontology, International Journal of Periodontology and Restorative Dentistry, European Journal of Oral Implantology, Journal of Oral and Maxillofacial Surgery, Clinical Implant Dentistry and Related Research, and Clinical Oral Implants Research.Study selection Only randomised controlled trials (RCTs) involving soft tissue augmentation at dental implant sites were considered for inclusion. The selection was restricted to RCTs published in English language with at least ten patients per group and a minimum follow-up period of three months. A PICO method was used to organise the inclusion criteria and soft tissue augmentations were clustered into three groups; that is, before prosthetic treatment, after prosthetic treatment and at immediate implant placement.Data extraction and synthesis The screening of titles and abstracts was carried out by two reviewers and disagreements were moderated by a third reviewer. Eligibility was determined using full texts and data were extracted using purposefully designed forms. The Cochrane handbook for systematic reviews of interventions toolkit was used to assess the risk of bias. The studies were grouped according to the type of intervention and subjected to quantitative data synthesis. Continuous outcome measures were assessed using random-effects meta-analyses and pooled estimates were expressed as weighted mean differences (MDs) along with 95% confidence intervals (CIs).Results Following initial electronic and hand-searches, 2,119 studies were screened for title and abstract, and 32 studies were considered for full-text screening. Only 14 RCTs met the inclusion criteria and the remaining 18 studies were excluded from the systematic review. The included studies described soft tissue augmentation for 538 implants placed in 475 patients. Three studies (68 patients; 78 implants) reported improved soft tissue thickness with xenogenic collagen matrix (XCM) augmentation compared to no augmentation at the implant sites before prosthetic treatment (high/unclear risk of bias). One study (28 patients; 41 implants) reported improved height of keratinised tissue (KT) and marginal bone levels (MBLs) with free gingival graft (FGG) compared to no augmentation at the implant sites after prosthetic treatment (unclear risk of bias). Three RCTs (126 patients; 126 implants) focused on connective tissue grafting (CTG) and bone grafting versus no grafting in conjunction with immediate implant placement after tooth extraction (unclear risk of bias). There was no difference in MBLs in any of the studies, while one study showed superior soft tissue thickness (STT). Four RCTs (129 patients; 133 implants) compared different augmentation techniques before prosthetic treatment. Only one study showed improved STT with CTG compared to XCM (low risk of bias). Finally, three RCTs (124 patients; 160 implants) compared different augmentation techniques after prosthetic treatment (high/unclear risk of bias). FGG was observed to be superior to acellular dermal matrix (ADM) and vestibuloplasty to improve KT. Meta-analyses did not favour CTG to improve MBLs at extraction sites but CTG was superior to XCM to improve STT before prosthetic treatment.Conclusions Notwithstanding the limitations of the systematic review, soft tissue augmentation significantly enhances the amount of soft tissue at the implant site. CTG at the extraction site also improves subsequent bone level of the implants. Moreover, CTG before prosthetic treatment is superior to XCM to improve thickness of peri-implant soft tissues. However, these findings are based on short-term follow-up and future studies with improved methodology are required to establish the long-term benefits of soft tissue augmentation at the dental implant sites.

What are the long-term survival and complication rates of complete-arch fixed implant rehabilitation in edentulous patients?

Cohort selection The study cohort was selected through screening of electronic records of all patients rehabilitated with interforaminal implants and implant-supported fixed complete dental prostheses (IFCDPs) over an 11-year period at the Tufts University School of Dental Medicine. Evaluation was based on medical and dental history; clinical oral examination of hard and soft tissues; and radiographic examination during a single visit.Data analysis Survival and failure rates of implants and prostheses were recorded based on predefined criteria. Along with descriptive statistics, the observed annual incidence, and the estimated five- and ten-year biologic and technical complications were computed with 95% confidence intervals.Results The study cohort included 41 patients with an average age of 65.8 years (range = 39 to 88 years) and comprised 19 females and 22 males. A total of 359 moderately rough surface dental implants (Nobel Biocare, Straumann, Biomet 3i) were used to rehabilitate 36 cement-retained and 19 screw-retained metal-ceramic IFCDPs in maxilla (N = 32) mandible (N = 23). The mean observation times for implants and prostheses were 5 and 7.5 years, respectively. Two implant failures in a single patient were recorded 11 years post-insertion, yielding an implant survival rate of 99.4%. The cumulative prostheses survival rate was 98.2% (100% at five years and 92.9% at ten years). Biologic and/or technical complications were associated with all 55 prostheses. Among major complications, the most frequent biologic complication was peri-implantitis while porcelain fractures were the most common technical complication. The cumulative rates of 'prostheses free of biologic complications' were 50.4% (95% CI: 36.4% to 63.0%) at five years and 10.1% (95% CI: 3.5% to 20.8%) at ten years. The cumulative rates for 'prosthesis free of technical complications' were 56.4% (95% CI: 41.7% to 68.8%) at five years and 9.8% (95% CI: 3.2% to 21.0%) at ten years.Conclusions Metal-ceramic implant-supported fixed full arch dental prostheses show high survival rates at five-year follow-up, including an implant survival rate of 99.4% and prosthesis survival rate of 98.2%. However biological and technical complications were observed in 47.1% and 42%, respectively.

A qualitative exploration of promoting oral health for infants in vulnerable families.

Introduction Oral disease in very young children is far more common among children in deprived and vulnerable families than among their peer group. Such children are at the highest risk of requiring a general anaesthetic for removal of decayed primary teeth.Aim This study aimed to create new knowledge about how best to promote oral health among a target population, about who very little is established with regard to how to successfully intervene to improve long-term oral health.Method Phase one of the study developed a logic model, and phase two delivered an oral health-promoting intervention by working with the Family Nurse Partnership. The social and empirical acceptability of the intervention was explored, and the attributes needed by people delivering such an intervention were investigated in-depth.Results The thematic analysis of phase one data produced seven key themes which appeared to influence parents' ability and willingness to accept an oral health intervention aimed at their infants. These were: their personal experiences, current oral health knowledge, desire for dental care for their child, the timing of an intervention, their perception of difficulties, family norms and the level of trust developed.Conclusion It is possible to motivate the most vulnerable families to establish behaviours which are conducive to good oral health, and that intervention is feasible and appropriate if a trusting relationship is adopted by the deliverer of the intervention. Families were successful in adopting oral health behaviours and visiting dental services when such circumstances were established.

Is there an association between past dental visits and the incidence of cancers of the head and neck (HN), upper aerodigestive tract (UADT), and oral cavity?

Data sources PubMed, CINAHL, and Cochrane databases.Study selection Papers reporting a primary study with any population, one or both genders specified, participants of any age, incidence of any cancer subsite of HN, and UADT reported as the health outcome, frequency of dental visits/check-ups prior to the diagnosis of one of these cancers (assessed as the exposure), and availability of sufficient data to estimate the measure of association, ie, unadjusted odds ratio (OR) along with its corresponding 95% confidence interval (CI).Data extraction and synthesis Two reviewers independently screened the title and abstract of the identified citations. Full texts of citations judged as potentially eligible were acquired by at least one of the two reviewers. Thereafter, both the reviewers used a standardised and pilot-tested form to independently screen every full text for eligibility. Methodological quality of the studies was assessed using the quality assessment tool for quantitative studies developed by the Effective Public Health Practice Project (EPHPP)Results After initial search of 1377 studies, thirty-eight articles were included in the analysis for systemic review including 32 case-control and six other design studies not limited to cross-sectional, observational, case-series, and screening. Finally, twenty-six case-control studies were included in the meta-analysis. Subgroup analyses of studies in meta-analysis showed the overall pooled estimate risk was (OR 2.01; 95% CI 1.76 to 2.30, P <0.001). The test for heterogeneity produced Tau square of 0.00, Q = 36.33, I2 = 31.76%, test for overall effect z = 9.24, (P <0.001). No publication bias was observed in the meta analysis. Conclusions Individuals with never/irregular/not frequent dental visits are more likely to be incident cases of HNCs/UADT cancers. Targeted education to alert those at risk about OCs and other HNCs, and the warning signs, and better training coupled with opportunistic oral cavity examinations by dentists could reduce the burden of this disease.

The shortened dental arch--an assessment of patients' dental health state utility values.

OBJECTIVES: The aim of this study was to determine how patients value the potential outcomes from different treatments for the shortened dental arch (SDA). METHODS: 110 partially dentate patients were interviewed and presented with illustrative models as well as a description of the process and likely outcome of six possible treatments for the shortened dental arch. The patients were asked to indicate on a standardised visual analogue scale how they would value the health of their mouth if they had received each of the treatments described. RESULTS: With a utility value of 0.0 representing the worst possible health state for a mouth and 1.0 representing the best, the mean utility value for 'no treatment' for a SDA was 0.28 (sd=0.29). For a cobalt-chromium based removable partial denture, an acrylic-resin based removable partial denture, implant treatment, a resin-bonded cantilevered bridge and a conventional cantilevered fixed bridge the utility values were 0.42 (sd=0.3), 0.49 (sd=0.31), 0.53 (sd=0.35), 0.63 (sd=0.26) and 0.64 (sd=0.28) respectively. CONCLUSIONS: The treatment outcome from a cantilevered bridge attracted the highest mean utility value. Participants did not value implant treatment as highly as fixed bridgework, but they did rate the utility of implants more highly than the utility value of removable dentures. However, the patients placed a very low value on the outcome from 'no' treatment. Thus, the appropriateness of the shortened dental arch as an oral health goal can be questioned.