Gene expression, micro-CT and histomorphometrical analysis of sinus floor augmentation with biphasic calcium phosphate and deproteinized bovine bone mineral: A randomized controlled clinical trial.

AIMS: The aim of this randomized controlled clinical trial was to compare the gene expression, micro-CT, histomorphometrical analysis between biphasic calcium phosphate (BCP) of 70/30 ratio and deproteinized bovine bone mineral (DBBM) in sinus augmentation. MATERIALS AND METHODS: Twenty-four patients in need for sinus floor augmentation through lateral approach were randomized into BCP 70/30 ratio or DBBM. After at least 6 months of healing, a total of 24 bone specimens were collected from the entire height of the augmented bone at the area of implant placement and underwent micro-CT, histomorphometric and gene expression analysis. The 12 bone specimens of BCP 70/30 ratio were equally allocated to micro-CT and histologic analysis (test group, n = 6) and gene expression analysis (test group, n = 6). Similarly, the 12 bone specimens of DBBM were also allocated to micro-CT and histologic analysis (control group, n = 6) and gene expression analysis (control group, n = 6). The newly formed bone, remaining graft materials and relative change in gene expression of four target genes were assessed. RESULTS: The micro-CT results showed no statistically significant difference in the ratio of bone volume to total volume (BV/TV ratio) for the two groups (BCP 41.51% vs. DBBM 40.97%) and the same was true for residual graft material to total volume (GV/TV ratio, BCP 9.97% vs. DBBM 14.41%). Similarly, no significant difference was shown in the histological analysis in terms of bone formation, (BCP 31.43% vs. DBBM was 30.09%) and residual graft area (DBBM 40.76% vs. BCP 45.06%). With regards to gene expression, the level of ALP was lower in both groups of bone grafted specimens compared with the native bone. On the contrary, the level of OSX, IL-1B and TRAP was higher in augmented bone of both groups compared with the native bone. However, the relative difference in all gene expressions between BCP and DBBM group was not significant. CONCLUSIONS: The BCP, HA/ß-TCP ratio of 70/30 presented similar histological and micro-CT outcomes in terms of new bone formation and residual graft particles with DBBM. The gene expression analysis revealed different gene expression patterns between augmented and native bone, but showed no significant difference between the two biomaterials.

A Mapping Review of the Pathogenesis of Peri-Implantitis: The Biofilm-Mediated Inflammation and Bone Dysregulation (BIND) Hypothesis.

This mapping review highlights the need for a new paradigm in the understanding of peri-implantitis pathogenesis. The biofilm-mediated inflammation and bone dysregulation (BIND) hypothesis is proposed, focusing on the relationship between biofilm, inflammation, and bone biology. The close interactions between immune and bone cells are discussed, with multiple stable states likely existing between clinically observable definitions of peri-implant health and peri-implantitis. The framework presented aims to explain the transition from health to disease as a staged and incremental process, where multiple factors contribute to distinct steps towards a tipping point where disease is manifested clinically. These steps might be reached in different ways in different patients and may constitute highly individualised paths. Notably, factors affecting the underlying biology are identified in the pathogenesis of peri-implantitis, highlighting that disruptions to the host-microbe homeostasis at the implant-mucosa interface may not be the sole factor. An improved understanding of disease pathogenesis will allow for intervention on multiple levels and a personalised treatment approach. Further research areas are identified, such as the use of novel biomarkers to detect changes in macrophage polarisation and activation status, and bone turnover.

Cyanoacrylate tissue adhesive versus silk sutures for mandibular third molar surgery: a systematic review and meta-analysis.

OBJECTIVE: Cyanoacrylate tissue adhesive has been presented as an alternative to sutures and several studies have compared them. The objective of this meta-analysis was to evaluate the effect of cyanoacrylate tissue adhesive on postoperative pain and swelling, following mandibular third molar surgery. MATERIALS AND METHODS: Database search was conducted in MEDLINE/PubMed and Scopus, along with extensive search in the grey literature, including randomized and non-randomized clinical trials that applied cyanoacrylate adhesive for closing mandibular third molar surgical sites and compared it with silk sutures, assessing postoperative pain and swelling. The search ended on September 22, 2023. RESULTS: Of 886 identified articles, six were included and meta-analyzed. Applying cyanoacrylate demonstrated a reduction in the overall postoperative pain (SMD = -0.57, 95% CI -1.00 to -0.15, p = 0.009). A similar outcome was noted when pain was evaluated on the first and last postoperative days, based on controlled clinical trials (SMD = -0.47, 95% CI -0.92 to -0.03, p = 0.04), and randomized trials (SMD = -0.97, 95% CI -1.31 to -0.62, p < 0.00001). Patients/sides received cyanoacrylate showed a decrease in postoperative swelling (SMD = -0.26, 95% CI -0.51 to -0.01, p = 0.04). Following the GRADE rating system, the quality of evidence on pain and swelling was judged as moderate and low, respectively. CONCLUSIONS: The use of cyanoacrylate adhesive may offer benefit in reducing postoperative pain and swelling following mandibular third molar surgery. Nevertheless, this should be further investigated, considering the low number of included reports. CLINICAL RELEVANCE: The current results could help clinicians who perform this procedure to manage postoperative pain and swelling more effectively.

Oral Fluid Biomarkers for Peri-Implantitis: A Scoping Review.

Peri-implantitis, a prevalent complication in dental implant therapy, poses a significant threat to long-term implant success. The identification of reliable biomarkers for the early detection and monitoring of peri-implantitis is crucial for timely intervention and improved treatment outcomes. Salivary and peri-implant sulcular fluid (PISF) biomarkers have become promising diagnostic tools in the field of implant dentistry. This scoping review aims to explore current studies in the literature on salivary and PISF biomarkers for peri-implantitis. A systematic search was conducted on 2 databases (PubMed and Scopus) to identify relevant studies published up to January 2023. A total of 86 articles were included, which underwent data extraction and analysis. Several biomarkers have been investigated in salivary and PISF samples for association with peri-implantitis. Investigations included a wide range of biomarkers, including inflammatory markers, matrix metalloproteinases and bone loss markers. The findings suggested that certain salivary and PISF biomarkers demonstrated potential in distinguishing healthy peri-implant conditions from peri-implantitis. Elevated levels of proinflammatory cytokines, such as interleukin-1ß (IL-1ß) and interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-α), and matrix metalloproteinases, have been consistently associated with peri-implantitis. Additionally, alterations in bone loss markers have shown potential as indicators of disease progression and treatment response. In conclusion, this scoping review provides an overview of current knowledge on salivary and PISF biomarkers for peri-implantitis. The identified biomarkers are promising as noninvasive diagnostic tools for early detection, monitoring, and personalised management of peri-implantitis. Future studies should focus on establishing standardised protocols and conducting well-designed clinical trials to validate the diagnostic accuracy and clinical relevance of these biomarkers.

Evaluation of dental education during the pandemic of COVID-19-Results from an online survey among dental students.

INTRODUCTION: The aim of this study was to assess the students' experience with education during the COVID-19 pandemic, as well as to investigate their views moving forward after resumption of face-to-face education. MATERIALS AND METHODS: A questionnaire was administered to dental students in clinical dental education at seven dental schools. The questionnaire included 33 items organized in three sections: (a) Demographics, (b) Perceptions/activity during lockdown, and (c) Perceptions/activity upon resumption of face-to-face teaching. RESULTS: A total of 286 students from seven universities in Europe and Asia participated. Students' satisfaction with education during the pandemic varied among universities and ranged between 36%-80%, but students engaged in delivering emergency care had a significantly higher opinion (p = .001). Students who felt that their workload decreased, were commonly 24 years old or older (p = .015), male (p = .05) reported lower concentration and motivation, experienced a more severe disruption and valued lower the efforts of their universities to ensure the continuity of education (p = .009). The majority of the students (80.3%) felt confident to resume clinical training after the lockdown. In general, female students experienced a higher disruption of their education during the pandemic (p = .043) and expressed lower confidence to continue clinical training in comparison to their male colleagues (p = .001). CONCLUSION: Students' perception of their workload during the COVID-19 lockdown was very diverse, with those experiencing a reduction in workload being more likely to express lower satisfaction as well. Female students experienced a higher level of disruption. Engaging students in the delivery of emergency care had a positive effect on their appreciation of the education.

Computer-assisted and robotic implant surgery: Assessing the outcome measures of accuracy and educational implications.

OBJECTIVE: This scoping review aimed to (1) critically evaluate the outcomes measures used to assess the accuracy of implant placement with Computer Assisted Implant Surgery (CAIS) and (2) review the evidence supporting the efficient implementation of CAIS in training and education of clinicians. METHODS: A scoping literature review was conducted aiming to identify (a) clinical trials assessing accuracy of implant placement with CAIS, and (b) clinical trials or simulation/cadaver studies where CAIS was utilised and assessed for the training/education of clinicians. Studies since 1995 were assessed for suitability and data related to the outcomes measures of accuracy and educational efficacy were extracted and synthesised. RESULTS: Accuracy of CAIS has been mainly assessed through surrogate measures. Individual clinical trials have not shown any difference between static and dynamic CAIS, but recent meta-analyses suggest an advantage of dynamic CAIS in reducing angular deviation. The combination of static and dynamic CAIS might offer higher accuracy than each of the two used alone. Dynamic CAIS is suitable for novice surgeons and might even have added value as an education tool for implant surgery, although mastering the technique requires longer training than static. CONCLUSION: Meta-analyses of large samples, new and diverse outcomes measures, as well as benchmarking of levels of accuracy with specific clinical outcomes will help to better understand the potential and limitations of CAIS. Dynamic CAIS is suitable for novice operators, but educational interventions distributed over longer periods of time will be required for mastery of the process.

The accuracy of implant placement using a combination of static and dynamic computer-assisted implant surgery in fully edentulous arches: A prospective controlled clinical study.

OBJECTIVE: To compare the accuracy of implant position, using a combination of static and dynamic computer-assisted implant surgery (CAIS), with either static, dynamic, or freehand implant placement, in fully edentulous arches. MATERIALS AND METHODS: Twenty-one patients with a total of 88 fixtures were included. Implants were divided equally into four groups: a combination of static and dynamic CAIS (SD group), static CAIS (S group), dynamic CAIS (D group), and freehand placement (FH group). Angular deviation, as well as the 3D platform and apex deviations, were measured for all groups. Furthermore, the direction of implant deviation was recorded and compared. RESULTS: The FH group showed significantly more deviation compared to all groups, considering all the aspects, and at both the implant platform and apex. A significant difference in angular deviation between the SD and S groups (p < .001), and between the SD and D groups (p < .001) was noted, favoring the SD group. When evaluating implant distribution, the FH group showed a tendency towards the buccal, apical, and distal directions at platform and apex, while in the D group, implants shifted more to the buccal. In contrast, the SD group did not show a trend toward any specific direction. The S and SD groups did not show a statistical significance considering any direction. CONCLUSIONS: The combination of static and dynamic CAIS increases the accuracy of implant placement in fully edentulous arches when compared with either static or dynamic CAIS alone, as well as freehand placement.

Group 4 ITI Consensus Report: Patient benefits following implant treatment in partially and fully edentulous patients.

OBJECTIVES: The aim of Working Group 4 was to address patient benefits associated with implant dentistry. Focused questions on (a) dental patient-reported outcomes (dPROs), (b) improvement in orofacial function, and (c) preservation of orofacial tissues in partially and fully edentulous patients following provision of implant-retained/supported dental prostheses were addressed. MATERIALS AND METHODS: Three systematic reviews formed the basis for discussion. Participants developed statements and recommendations determined by group consensus based on the findings of the systematic reviews. These were then presented and accepted following further discussion and modifications as required by the plenary of the 7th ITI Consensus Conference, taking place in 2023 in Lisbon, Portugal. RESULTS: Edentulous patients wearing complete dentures (CD) experience substantial improvements in overall dPROs and orofacial function following treatment with either complete implant-supported fixed dental prostheses (CIFDP) or implant overdentures (IODs). With respect to dPROs, mandibular IODs retained by two implants are superior to IODs retained by one implant. However, increasing the number of implants beyond two, does not further improve dPROs. In fully edentulous patients, rehabilitation with CIFDP or IOD is recommended to benefit the preservation of alveolar bone and masseter muscle thickness. CONCLUSIONS: Completely edentulous patients benefit substantially when at least the mandible is restored using an CIFDP or an IOD compared to CD. In fully edentulous patients, implant prostheses are the best option for tooth replacement. The availability of this treatment modality should be actively promoted in all edentulous communities, including those with limited access and means.

Preplanned Computer-Assisted Advanced Implant Placement for Orthodontic Patients: Presentation of a Novel Multidisciplinary Treatment Approach and a Case Report.

This case report describes a novel approach combining orthodontic and implant digital treatment planning workflows to enable prosthetically driven implant placement before orthodontic treatment is performed or completed. The computer-assisted implant placement is performed using a static surgical guide based on the future positions of the teeth after completion of orthodontic treatment. This innovative approach allows for select partially edentulous patients to undergo fixed prosthetic rehabilitation before orthodontic treatment is completed.

The clinical efficacy of autogenous dentin blocks prepared chairside for alveolar ridge augmentation: A systematic review and meta-analysis.

OBJECTIVES: This systematic review aimed to evaluate the current evidence on the effectiveness of autogenous dentin block graft prepared chairside for alveolar ridge augmentation and compare its clinical outcomes to the main available grafting materials and techniques. MATERIALS AND METHODS: Three databases were screened, including prospective clinical studies, utilizing autogenous dentin blocks for ridge augmentation, with at least 3 months of postoperative follow-up. RESULTS: Eight articles were included, and four of them were meta-analyzed. Dentin blocks demonstrated similar vertical bone gain and significantly higher width gain, compared to bone blocks (WMD = 0.03, 95% CI -0.51 to 0.57, p = .92 and WMD = 1.34, 95% CI 0.57 to 2.12, p = .0007, respectively). Vertical and horizontal resorption were similar between the two groups (WMD = -0.36, 95% CI -0.91 to 0.18, p = .19, and WMD = -0.47, 95% CI -1.05 to 0.11, p = .11, respectively). Dentin blocks showed more incidences of postoperative complications, however, with no statistical significance (RR = 4.30, 95% CI 0.97 to 18.96, p = .054). The need for additional augmentation upon implant placement was also similar between both grafts (RR = 0.95, 95% CI 0.39 to 2.28, p = .90). Recorded incidences of graft exposure were low (2.27%), and no study stated surgical site infection. CONCLUSION: Within its limitations, this study indicates that the autogenous dentin blocks prepared chairside could be a possible alternative to the other established bone augmentation techniques for staged ridge augmentation. Nevertheless, future studies are needed to confirm its efficacy and implant success/survival in sites grafted with this material.

The role of hemostatic agents after tooth extractions: A systematic review and meta-analysis.

BACKGROUND: Hemostatic agents are used to control bleeding after tooth extraction and have been compared with conventional measures (that is, sutures or gauze pressure) in several studies. The objective of this systematic review was to evaluate the benefits of topical hemostatic agents for controlling bleeding after tooth extractions, especially in patients receiving antithrombotic therapy. TYPES OF STUDIES REVIEWED: The authors conducted a literature search in MEDLINE (PubMed), Scopus, and the Cochrane Central Register of Controlled Trials, including prospective human randomized clinical trials in which researchers compared hemostatic agents with conventional methods and reported the time to achieve hemostasis and postoperative bleeding events. RESULTS: Seventeen articles were eligible for inclusion. Hemostatic agents resulted in a significantly shorter time to achieve hemostasis in both healthy patients and patients taking antithrombotic drugs (standardized mean difference, -1.02; 95% CI, -1.70 to -0.35; P = .003 and standardized mean difference, -2.30; 95% CI, -3.20 to -1.39; P < .00001, respectively). Significantly fewer bleeding events were noted when hemostatic agents were used (risk ratio, 0.62; 95% CI, 0.44 to 0.88; P = .007). All forms of hemostatic agents (that is, mouthrinse, gel, hemostatic plug, and gauze soaked with the agent) had better efficacy in reducing the number of postoperative bleeding events than conventional hemostasis measures, except for hemostatic sponges. However, this was based on a small number of studies in each subgroup. CONCLUSIONS: The use of hemostatic agents seemed to offer better bleeding control after tooth extractions in patients on antithrombotic drugs than conventional measures. PRACTICAL IMPLICATIONS: Findings of this systematic review may help clinicians attain more efficient hemostasis in patients requiring tooth extraction. This systematic review is registered in the PROSPERO database. The registration number is CRD42021256145.

The clinical efficacy of the allogenic demineralized dentin matrix graft for implant placement: a systematic review.

PURPOSE: The Allogenic Demineralized Dentin Matrix (Allo-DDM) has been introduced as a new grafting material, and several investigations were conducted, showing its efficacy in bone augmentation. The objective of this systematic review was to evaluate the available literature on the Allo-DDM, revealing its clinical performance when used for implant placement procedures. METHODS: This study is registered in the PROSPERO database (number: CRD42021264885, date: 30/7/2021). Four databases, as well as the grey literature, were searched, selecting human studies where the Allo-DDM was applied to augment implant-recipient sites. RESULTS: Six articles were included. The total number of implants placed in Allo-DDM-grafted sites was 149. Mean implant stability quotient values (ISQ) were 60.4 and 68.67 for the primary and secondary ISQ, respectively (data from one study). Buccal marginal bone loss around implants was approximately 1.46 mm after 24 months of prosthetic loading (data from one study). Two studies documented a total of 6 cases of dehiscence of the grated area, however, not affecting early implant success. Histological findings from all studies showed new bone formation around the graft particles. CONCLUSION: A low number of publications are available, presenting only preliminary results, thus the long-term success/survival of implants still needs to be further explored. Moreover, the possibility of bony dehiscence with the use of this material should be investigated. Within these limitations, the Allo-DDM could be a possible alternative to other grafting materials used for bone augmentation and implant placement. Nevertheless, considering this limited evidence, future studies are necessary to confirm this conclusion.

Stability of guided bone regeneration with two ratios of biphasic calcium phosphate at implant sites in the esthetic zone: A randomized controlled clinical trial.

AIMS: The aim of this randomized, double-blind, clinical trial was to compare the stability of the horizontal dimensions (facial bone thickness) of augmented bone using biphasic calcium phosphate (BCP) with hydroxyapatite/ß-tricalcium phosphate ratio of either 60/40 or 70/30. MATERIALS AND METHODS: Sixty dental implants placed with contour augmentation in the esthetic zone were randomized to 60/40 BCP (n = 30) or 70/30 BCP (n = 30). Cone-beam computed tomographic was used to assess facial bone thickness post-implantation and 6 months later at implant platform and 2, 4, and 6 mm apical to it. RESULTS: The percentage of horizontal dimension reduction was 23.64%, 12.83%, 9.62%, and 8.21% in 70/30 BCP group, while 44.26%, 31.91%, 25.88%, and 21.49% in 60/40 BCP group at the level of the implant platform and 2, 4, and 6 mm apical, respectively. Statistically significant difference was found at 6 months at all levels of measurement (p-value < .05). CONCLUSIONS: BCP bone grafts with HA/ß-TCP ratio of 60/40 and 70/30 showed comparable outcomes for contour augmentation simultaneously with implant placement. Interestingly, the 70/30 ratio was significantly superior in maintaining facial thickness and showed more stable horizontal dimensions of the augmented site.

Periosteum-derived Micrografts for bone regeneration.

Bone regeneration is currently one of the most widely researched topics in regenerative medicine. Several bone-grafting materials have been introduced and compared. However, the limitations of the currently available grafts have led researchers to investigate new materials to be used. In contrast, the periosteum performs endogenous bone regeneration as seen in physiological bone fracture repair, and transplanted periosteum has been used to induce bone regeneration in animal models. Although many of the introduced bone grafting materials have not been clinically evaluated, the use of the periosteum for bone regeneration has been documented in several clinical situations. Recently, the Micrograft concept, which was initially used to treat burn patients, where the tissue sample is cut into smaller pieces to expand the area that they can cover, has been applied to oral periosteal tissue for inclusion in scaffolds for bone defect healing, and was evaluated in various clinical bone augmentation procedures. This article first presents a brief overview of some of the commonly used bone grafts and their limitations. Next, it provides background information on the periosteum, including its histology and the cell biology and signaling involved in its osteogenic effect, periosteum-derived Micrografts, their osteogenic potential, and their recent clinical applications for bone augmentation.

Association of prosthetic angles of the Implant Supracrestal Complex with peri-implant tissue mucositis.

OBJECTIVES: The aim of this study was to investigate the association of the Mucosal Emergence Angle (MEA) with peri-implant tissue mucositis. MATERIAL AND METHODS: Forty-seven patients with 103 posterior bone level implants underwent clinical and radiographic examination. Three-dimensional data from Cone Bean Computer Tomography and Optica Scan were transposed. Three angles were defined: MEA, Deep Angle (DA) and Total Angle (TA) and measured at six sites for each implant. RESULTS: There was a significant correlation between MEA and Bleeding on Probing for all sites with an overall odds ratio of odd ratio 1.07 (95% confidence interval [CI] 1.05-1.09, p < 0.001). Sites with MEA ≥ 30°, 40°, 50°, 60°, and 70° had a higher risk for bleeding with an odds ratio of 3.1, 5, 7.5, 11.4 and 33.55, respectively. When all 6 sites of an implant prostheses had MEA ≥ 40°, the risk of having bleeding at all 6 sites was 9.5 times higher (95% CI 1.70-52.97, p = 0.010). CONCLUSIONS: Maintaining MEA no wider than 30°-40° is advisable, while the aim should be to keep this angle as narrow as clinically feasible. Registered in Thai Clinical Trials Registry: http://www.thaiclinicaltrials.org/show/TCTR20220204002.

Contour angle and peri-implant tissue height: Two interrelated features of the implant supracrestal complex.

OBJECTIVES: Recent research has suggested the contour of the prosthesis and the vertical height of the peri-implant mucosa as important parameters that can influence the long term health and stability of the peri-implant tissue. In particular, overcontouring of the prosthesis has been correlated with an increased risk for peri-implantitis, while reduced soft tissue height has been associated with marginal bone loss, recession, and other soft tissue complications. Although these two parameters have been investigated as independent in the current literature, clinical experience points toward a close interrelation between transmucosal tissue height and prosthesis contour angle. It is often found that a reduced vertical height of the implant supracrestal complex is the main reason for overcontouring of the prosthesis. At the same time, achieving a favorable contour of 30o or less is not possible unless the clinician has ensured an adequate vertical height of the soft tissue. The purpose of this short communication is to establish the relation between tissue vertical height and prosthesis contour by utilizing a theoretical geometry equation based on the Pythagorean theorem. In doing so, one can use the dimensions of the implant as well as those of the prosthesis at the mucosal margin to calculate the essential vertical height for achieving a favorable prosthesis contour. CONCLUSIONS: As the treatment plan of the implant supracrestal complex is "top-down," in case of deficient vertical height, subcrestal placement of the implant should be considered to achieve a proper prosthesis contour.

Training of novice surgeons using dynamic computer assisted dental implant surgery: An exploratory randomized trial.

BACKGROUND: Dynamic Computer Assisted Implant Surgery (CAIS) systems have been shown to improve accuracy of implant placement, thus training in the use of such systems is becoming increasingly important. There is a scarcity of research on how to implement dynamic CAIS training in the settings of postgraduate university education. PURPOSE: To determine the effectiveness of two modes of CAIS training programs on motor skill acquisition of novice surgeons. MATERIALS AND METHODS: Thirty-six postgraduate students without experience in dynamic CAIS systems were randomly assigned to a distributed training program (3 training sessions over 3 days) or a massed training (3 training sessions over the same day). A post-test involving the placement of one implant was conducted for both groups, 7 days after completion of the training. Surgical time and implant accuracy were recorded and analyzed, using independent t-tests, with 0.05 significant level. RESULTS: Both groups reached the accuracy benchmarks expected by current standards in the use of CAIS. No significant differences with regards to accuracy were found between the groups, but a trend was documented favoring performance of distributed (mean difference-0.4, 95% confidence interval-0.7-0.1) in the accuracy at platform level. Distributed training students performed faster than massed for the third trial (mean difference-95.0, 95% confidence interval-178.8 to -11.2). CONCLUSIONS: Novice students reached the accuracy benchmarks with the use of CAIS through both a massed and a distributed training program, while there was a strong but marginally not significant trend for higher accuracy in the distributed group. Students who received the training in the distributed format over the process of different days, performed faster. Trial registered in Thai Clinical Trials Registry: https://www.thaiclinicaltrials.org/show/TCTR20230109002. This clinical trial was not registered prior to participant recruitment and randomization.

The lack of keratinized mucosa as a risk factor for peri-implantitis: a systematic review and meta-analysis.

This study aimed to investigate the effect of the lack of keratinized mucosa on the risk of peri-implantitis, while also accounting for possible confounding factors. A literature search was conducted in PubMed and Scopus, including human studies that assessed the presence and width of keratinized mucosa in relation to the occurrence of peri-implantitis. Twenty-two articles were included, and 16 cross-sectional studies we meta-analyzed. The prevalence of peri-implantitis was 6.68-62.3% on patient-level and 4.5-58.1% on implant-level. The overall analysis indicated that the lack of keratinized mucosa was associated with a higher prevalence of peri-implantitis (OR = 2.78, 95% CI 2.07-3.74, p < 0.00001). Similar results were shown when subgroup analyses were performed, including studies with a similar case definition of peri-implantitis (Marginal Bone Loss, MBL ≥ 2 mm) (OR = 1.96, 95% CI 1.41-2.73, p < 0.0001), fixed prostheses only (OR = 2.82, 95% CI 1.85-4.28, p < 0.00001), patients under regular implant maintenance (OR = 2.08, 95% CI 1.41-3.08, p = 0.0002), and studies adjusting for other variables (OR = 3.68, 95% CI 2.32-5.82, p = 0.007). Thus, the lack of keratinized mucosa is a risk factor that increases the prevalence of peri-implantitis and should be accounted for when placing dental implants.

Accuracy of implant placement with a combined use of static and dynamic computer-assisted implant surgery in single tooth space: A randomized controlled trial.

OBJECTIVE: To compare implant accuracy of combined static and dynamic (SD) computer-assisted implant surgery (CAIS) with static (S), dynamic (D) CAIS, and freehand surgery (FH) for single implant placement. MATERIALS AND METHODS: One hundred and twenty patients were randomized into four groups. Implants were placed using both stereolithographic surgical guide and dynamic navigation in the SD group, stereolithographic surgical guide in S group, dynamic navigation in D group, and conventional freehand in FH group. Analysis of deviation between planned and final implant position, as well as K means analysis was conducted for implant deviation at platform, apex, and angle (primary outcomes) and directional distribution at platform and apex (secondary outcome). RESULTS: Significant differences were found among the four groups (p < .001): The 3D deviation at the platform (mm) of SD, S, D, and FH groups was 0.62 ± 0.50, 1.06 ± 0.67, 1.02 ± 0.45, and 1.48 ± 0.68, respectively, at apex (mm) was 0.75 ± 0.57, 1.40 ± 0.71, 1.28 ± 0.50, and 2.18 ± 0.95, respectively, and angle (degrees) was 1.24 ± 1.41, 3.18 ± 2.04, 3.28 ± 1.57, and 7.50 ± 4.06, respectively. Deviation at the platform of FH group was significantly more toward mesial (p = .026) and coronal (p = .014) direction, while at the apex, toward distal (p = .004) and lingual (p = .002) than SD group. CONCLUSION: The use of combined static and dynamic CAIS provided significantly higher accuracy than the two alone and freehand surgery for single implant placement.