Impact of digital technologies on implant surgery in fully edentulous patients: A scoping review.

BACKGROUND: For over three decades, digital technologies have been used in Implant Dentistry, beginning with the introduction of planning software for Static Computer-Assisted Implant Surgery (S-CAIS). During this time, this field has witnessed the emergence of diverse methodologies and a proliferation of technological advancements. Today, S-CAIS is a widely adopted procedure for the placement of dental implants in both partially and fully edentulous patients, with Dynamic Computer-Assisted Surgery (D-CAIS) and Robotic-Assisted Implant Surgery (RAIS) rapidly gaining attention among dental professionals. The continuous advancements in this arena are not merely indicative of technological progress; they represent a steadfast dedication to refining precision, enhancing efficiency, and fostering innovation with the goal of optimizing patient outcomes in dental implantology. AIMS: The purpose of the following review is to meticulously examine the spectrum of digital technologies available and to describe their protocols, advantages, and shortcomings as well as to evaluate their accuracy in implant surgery in patients with complete edentulism. MATERIALS AND METHODS: A scoping review was performed following the Joanna Briggs Institute (JBI) protocols, leveraging the population, concept, and context (PCC) framework to construct the research question and determine the inclusion and exclusion criteria. RESULTS: Two hundred and sixty-seven records were identified for screening. After applying all the screening criteria, 41 articles were included for review and qualitative data analysis. DISCUSSION: S-CAIS, D-CAIS, and RAIS were identified as the main technologies for computer assisted implant surgery. Their applications, characteristics, protocols and levels of accuracy were compared and described. CONCLUSION: Taking into consideration the limitations of this study, S-CAIS appears to be the most applied and validated technology in implant surgery for fully edentulous patients followed by D-CAIS and RAIS being these last two promising initiatives in the field. Despite having similar levels of accuracy, the overall comparison showed a slightly higher values in RAIS followed by D-CAIS and S-CAIS.

The Use of CAD-CAM Templates in Lateral Sinus Floor Augmentation Procedure: A Systematic Review.

INTRODUCTION: Maxillary sinus floor augmentation is a procedure known for its long-term success and predictable outcomes. However, the perforation of the Schneiderian membrane remains the most common complication associated with this procedure. OBJECTIVE: This systematic review aims to determine the presence of complications during maxillary sinus floor augmentation procedures using CAD-CAM surgical templates. MATERIAL AND METHODS: An electronic search was carried out in MEDLINE (via PubMed), Web of Science, and Scopus. A descriptive analysis of the data was performed. Studies that have performed lateral sinus floor augmentation were included in the inclusion criteria. The CAD-CAM surgical template design and the intraoperative complications were registered. RESULTS: A total of 13 studies were included. Seven were case reports, four were case series, and two were randomized clinical trials. A total of 94 lateral SFA procedures were included (84 using CADCAM templates and 10 without using templates). Three of the 84 maxillary sinus floor augmentation procedures using a CAD-CAM template presented intraoperative complications. CONCLUSIONS: Maxillary sinus floor augmentation performed by using CAD-CAM surgical templates could be related to low rates of complications, however, due to the heterogeneity of the articles included, more standardized studies are needed to confirm these outcomes.

The Anatomy of the Mandibular Incisive Canal and Its Influence in Implant Therapy. A Scoping Review.

INTRODUCTION: The interforaminal region is considered more favorable for implant placement than the posterior mandible in edentulous patients, mainly because of the interference of the inferior alveolar nerve with implant placement in the severely resorbed posterior mandible. However, complications in the interforaminal region may occur due to the presence of the mandibular incisive nerve. OBJECTIVE: This scoping review aims to describe the mandibular incisive nerve anatomy related to the potential interference in implant therapy. MATERIAL AND METHODS: A comprehensive literature search was conducted in the following databases: MEDLINE (via PubMed), Web of Science, and Scopus. This scoping review was structured according to the Joanna Briggs Institute method. RESULTS: Thirteen studies were included in the review. All the studies were observational cohort anatomical studies, carried out mainly by CBCT and on cadavers. A total of 1471 patients/cadavers were studied. The mandibular incisive nerve was presented in 87-100% of the cases, with an average length of 9.97 mm and an average diameter of 1.97 mm. The mandibular incisive nerve may be damaged during drilling and implant placement, especially using implant lengths larger than 12 mm. CONCLUSIONS: Damage to the mandibular incisive nerve due to implant placement could be present, however, it is necessary to conduct more studies focusing on assessing mandibular incisive nerve damage to understand the clinical relevance of this nerve and its associated morbidities such as neurosensorial alterations. Due to the different anatomical characteristics of this nerve, CBCT analysis is recommended for implant therapy in the anterior mandible to prevent the described complications.

Considerations for predictable outcomes in static computer- aided implant surgery in the esthetic zone.

OBJECTIVE: To provide technical and clinical recommendations for implementing a digital workflow in Static Computer-Aided Implant Surgery in the anterior maxilla. CLINICAL CONSIDERATIONS: An optimal 3D implant position is crucial for achieving satisfying results in implant rehabilitation in the esthetic area. Due to its complexity, implant placement in the esthetic zone should be executed with precision and predictability. Static Computer-Aided Implant Surgery requires thorough planning and detailed attention to every step of the digital workflow protocol. CONCLUSIONS: Implant positioning in the esthetic zone using Static Computer-Aided Implant Surgery is a technique-sensitive procedure that requires precise execution of each step. This approach ensures accurate prosthetically driven 3D implant placement and prevents potential errors that could lead to inaccurate positioning. CLINICAL SIGNIFICANCE: The proper implementation of Static Computer-Aided Implant Surgery may increase the level of agreement between the planned and definitive implant 3D positions in the esthetic zone, thus enhancing the esthetic outcomes of implant rehabilitation.

Evaluating the clinical behavior of veneered zirconia in comparison with monolithic zirconia complete arch implant-supported prostheses: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Because the use of zirconia in dentistry is relatively new, the number of published studies on the subject is scarce, even though material selection is an important factor in clinical performance. Therefore, a systematic assessment of the impact of the prosthetic material, framework design, veneering material, and manufacturing process is required. PURPOSE: The purpose of this systematic review and meta-analysis was to investigate the survival and success rates of feldspathic porcelain veneered zirconia (VZir) in comparison with monolithic zirconia (MZir) complete arch implant-supported prostheses (CAISPs). A secondary objective was to assess the influence of the type of loading, the presence or absence of a cantilever, the type of zirconia used, the location, and the opposing arch on complications rates and patient satisfaction. MATERIAL AND METHODS: An electronic search of the MEDLINE database (via PubMed), Scopus, Science Direct, Cochrane Library, and OpenGrey was carried out. The criteria described in the preferred reporting items for systematic reviews and meta-analyses statement were used. The search was restricted from January 2000 to January 2022. RESULTS: The systematic search resulted in 20 articles that met the established criteria. In total, 751 patients (VZir=302; MZir=449) with 3038 CAISPs (VZir=368; MZir=2670) were analyzed. Higher prosthetic survival and success rates were found in MZir compared with VZir CAISPs (100% and 95.45%, respectively). The meta-analysis found significantly fewer complications related to MZir (9.4% [4.8%-14.1%]) compared with VZir (33.7% [17.5%-49.9%]). CONCLUSIONS: Based on the findings of this systematic review, MZir CAISPs had higher survival and success rates than VZir CAISPs, with significantly fewer prosthetic complications. The influence of factors such as the type of functional loading, the presence of a cantilever, the material used in the prosthodontic workflow, the location of the CAISP, and the type of antagonist arch on the performance of Zir CAISPs remains unclear.

Does the Prosthetic Phase of Dental Implants Justify the Prescription of Preventive Antibiotics in Healthy Patients? A Systematic Review.

Recently published surveys data show that the routine prescription of preventive antibiotics (PA) in the prosthetic phase of dental implants is more common than might be expected. The present study aimed to answer the PICO (population, intervention, comparison, and outcome) question "In healthy patients starting the implant prosthetic phase, does the prescription of PA compared with not prescribing PA decrease the incidence of infectious complications?" by a systematic literature review. A search was performed in 5 databases. The criteria employed were those described in the PRISMA Declaration. Studies included were those that provided information on the need to prescribe PA in the prosthetic phase of implants, that is, in second-stage surgeries, impression-taking, and prosthesis placement. The electronic search identified 3 studies that met the established criteria. The prescription of PA in the prosthetic phase of implants does not show a justified benefit/risk ratio. Preventive antibiotic therapy (PAT) may be indicated in the second stages or in peri-implant plastic surgery procedures lasting more than 2 hours and/or where soft tissue grafts are used extensively. In these cases, given the current lack of evidence, it is recommended to prescribe 2 g of amoxicillin 1 hour before surgery and, in allergic patients, to prescribe 500 mg of azithromycin 1 hour preoperatively.

Preoperative HbA1c and Blood Glucose Measurements in Diabetes Mellitus before Oral Surgery and Implantology Treatments.

Diabetes mellitus has become a worldwide epidemic and is frequently accompanied by a number of complications proportional to the duration of hyperglycemia. The aim of this narrative review is to assess the most up-to-date guidelines on DM provided by both diabetes and dental associations. Furthermore, to gather evidence on the uni/bidirectional relationships of elevated HbA1c levels on dental surgery, implantology, bone augmentation, and periodontology and to demonstrate the importance of measuring HbA1c levels before invasive dental treatments. HbA1c and blood glucose measurements are a minimally invasive method for preventing complications in diabetes mellitus. The authors conducted a literature review to determine which oral conditions are affected by diabetes mellitus. MEDLINE served as a source with the use of a specific search key. Regarding oral complications of diabetes, prevention is the most vital factor. With this publication, we hope to assist physicians and dentists to make prompt diagnoses and to help in recognizing various oral manifestations of diabetes and follow the existing guidelines.

The use of platelet-rich fibrin in vestibuloplasty: A 36-month follow-up technique report.

INTRODUCTION: Vestibuloplasty is a mucogingival procedure that aims to increase the vestibule and the amount of keratinized tissue (KT) around teeth and dental implants. Currently, the gold standard in this procedure is still represented by free gingival grafts (FGGs); however, they require a second surgical site, which means more morbidity for the patient and a higher risk of surgical complications, as well as surgical time and chromatic alteration of the recipient area. CASE PRESENTATION: This is a description of the vestibuloplasty technique with platelet-rich fibrin (PRF) in a 35-year-old female patient with a thin gingival phenotype and no medical history of interest. The reason for consultation was tooth sensitivity during brushing and the presence of recessions in the fifth sextant. CONCLUSIONS: The use of PRF as a graft biomaterial in vestibuloplasty is a valid and effective option as an alternative to secondary epithelialization of the surgical site, as well as to FGGs, with acceptable results in terms of KT gain and root coverage, and with minimal postoperative discomfort. KEY POINTS: Why is this case new information? The use of PRF is an interesting option as an alternative to second-intention healing, as FGGs in vestibuloplasty. What are the keys to successful management of this case? The most important part of the membranes is the part that was in close relation to the erythrocyte fraction in the blood collection tube, so this part must be oriented toward the recipient bed. A minimum of four membranes should be obtained, overlapping one on top of the other. What are the primary limitations to success in this case? The stability of the PRF.

Implants in the pterygoid region: An updated systematic review of modern roughened surface implants.

PURPOSE: To determine the survival rates of modern roughened surface dental implants in the pterygoid region. METHODS: This systematic review was an update from a previously published systematic review in 2011, which largely reported data on older machined surface dental implants. An electronic search for articles in the English language literature published from January 1, 2010 to December 8, 2021 was performed using PubMed, Scopus, and CENTRAL search engines. After applying a systematic search process in three stages, the final list of selected articles on roughened surface pterygoid implants was obtained. Data from the selected articles were collated with data from pertinent articles on roughened implant surface from the previous systematic review. The combined data were then used for calculating the interval survival rate and cumulative survival rate (CSR) of pterygoid implants. RESULTS: The initial electronic search resulted in 1263 titles. The systematic search process eventually resulted in 10 clinical studies reporting on modern roughened surface pterygoid implants. These 10 studies reported on a total of 911 pterygoid implants with 39 reported failures over a 6-year period. The majority of failures (37) were reported during the first year time interval and a majority of them (30) occurred before loading of the pterygoid implants. Only two late failures were reported after loading, during the sixth-year time interval. The majority of implants were used for rehabilitation of full-arch fixed implant-supported prosthesis. At the maximum follow-up interval of 6 years, the CSR of pterygoid implants with roughened surfaces was 95.5%, which was 5% higher than reported in the previous systematic review which combined machined and roughed surface pterygoid implants. CONCLUSIONS: The survival rate of modern roughened surface dental implants in the pterygoid region is favorable at 95.5% over a 6-year period, and comparable to the existing evidence on survival of implants in other regions of the maxilla and mandible.

Manejo integral quirúrgico y ortodóntico del autotrasplante de un canino incluido en maxilar. A propósito de un caso / Integral surgical and orthodontic treatment of an autotransplanted maxillary canine: case report

Introducción: El tratamiento de caninos incluidos maxilares, se basa prin cipalmente en la tracción ortodóntica. Cuando esta fracasa, se suele plantear como alternativa la extracción del canino y la posterior colocación de un implante dental. El autotrasplante se plantea como opción de tratamiento siempre que la extracción íntegra del canino sea viable ya que aporta muchas ventajas como la capacidad de ser movilizados con ortodon cia.Caso clínico: Se describe un caso clínico en el que se realizó un autotrasplante de un canino incluido tras haber fracasado la tracción en una paciente joven. Tras realizar una cirugía regenerativa, fue sometida a tratamiento de ortodoncia y restaurador. Después de 20 meses de seguimiento la paciente se encuentra asintomática, sin signos de movilidad ni reabsorción y con un estable estado periodontal de dicho diente.Conclusión: A pesar de las limitaciones, se puede concluir que siempre que sea viable, el autotrasplante puede constituir una alternativa válida cuando la tracción ortodóntica no funciona, principalmente en pacientes jóvenes en los que no están indicados los implantes (AU)

Introduction: The main treatment of impacted canines is orthodontics. In case of failure, extraction of the canine and the subsequent placement of a dental implant is given as an alternative. Autotransplantation is considered a treatment option as long as the full extraction of the canine is viable, because it provides many advantages as the ability of mobilization with orthodontics Case report: Description of a clinical case in which an autotransplantation of an included canine was carried out after traction failed in a young patient. After regenerative surgery was realized in its surroundings the patient underwent orthodontic and restorative treatment. 18 months of follow–up later the patient remains asymptomatic, with no mobility or resorption signs and with a healthy periodontal state in said canine. Conclusion: Autotransplantation can be a suitable alternative when orthodontic traction has failed, as long as it is viable, especially in young patient when implants are not recommended (AU)

Point-of-care HbA1c Measurements in Oral Cancer and Control Patients in Hungary.

BACKGROUND/AIM: This study aimed to investigate the link between preoperative glycated hemoglobin (HbA1c) levels and oral cancer patients and diabetes mellitus (DM). We aimed to highlight the importance of point-of-care HbA1c measurements in oral cancer patients. PATIENTS AND METHODS: A total of 214 patients were admitted to the Department of Inpatient Care at Semmelweis University's Department of Oromaxillofacial Surgery and Stomatology between 1 September 2020 and 21 May 2021; individuals, who had undergone maxillofacial surgery under general anesthesia, were included in the study. RESULTS: There was a significant difference between the oral cancer group and the control group in terms of smoking (p=0.009) and alcohol intake (p=0.003). There was no statistically significant difference regarding sex (p=0.132) and DM (p=0.147) between the two groups. The tumor group had an 8.52% greater prevalence of DM, which was not significant. In the oral cancer group, twenty individuals (17.69%) had a higher HbA1c level than the upper level of the optimal metabolic value (6.9%). Nine participants (8.91%) in the control group had an HbA1c value greater than 6.9%, which means that their metabolic level was poor. The oral cancer group did not have higher blood glucose levels than those of the control group. CONCLUSION: No direct connection between high blood glucose levels and oral cancer was found. However, point-of-care HbA1c measurement can be a diagnostic tool to detect DM in the dental office.

Efficacy of Pre-Procedural Mouthwashes against SARS-CoV-2: A Systematic Review of Randomized Controlled Trials.

The oral mucosa is one of the first sites to be affected by the SARS-CoV-2. For this reason, healthcare providers performing aerosol-generating procedures (AGPs) in the oral cavity are at high risk of infection with COVID-19. The aim of this systematic review is to verify whether there is evidence in the literature describing a decrease in the salivary viral load of SARS-CoV-2 after using different mouthwashes. An electronic search of the MEDLINE database (via PubMed), Web of Science, SCOPUS, and the Cochrane library database was carried out. The criteria used were those described by the PRISMA® Statement. Randomized controlled trial studies that have used mouthwashes as a form of intervention to reduce the viral load in saliva were included. The risk of bias was analyzed using the Joanna Briggs Institute Critical Appraisal Tool. Ultimately, eight articles were included that met the established criteria. Based on the evidence currently available in the literature, PVP-I, CHX and CPC present significant virucidal activity against SARS-CoV-2 in saliva and could be used as pre-procedural mouthwashes to reduce the risk of cross-infection.

Virucidal Activity of Different Mouthwashes against the Salivary Load of SARS-CoV-2: A Narrative Review.

The saliva of COVID-19-confirmed patients presents a high viral load of the virus. Aerosols generated during medical and dental procedures can transport the virus and are a possible causative agent of cross-infection. Since the onset of the pandemic, numerous investigations have been attempting to mitigate the risk of transmission by reducing the viral load in saliva using preprocedural mouthwashes. This study aims to review the most up-to-date in vitro and in vivo studies investigating the efficacy of different mouthwashes on reducing the salivary viral load of SARS-CoV-2, giving particular attention to the most recent randomized control trials published.

Prognosis Value of Immunoregulatory Molecules in Oral Cancer Microenvironment: An Immunohistochemical Study.

OBJECTIVES: To evaluate the relationship of the immune-checkpoint PD-1/PD-L1 with the clinical evolution of OSCC; to assess survival in OSCC based on the characteristics of TME and histologic risk score; to evaluate the clinical and histopathological relationship of OSCC with immunological TME. MATERIAL AND METHODS: A retrospective study was carried out on 65 samples from patients with OSCC on the floor of the mouth or tongue. Clinicopathological variables and the expression of the biomarkers PD-1, PD-L1, FoxP3, CD4, CD8, CSF1R, and p16 were recorded. The relationship of the clinical and histological variables with the expression of the biomarkers and survival was studied. RESULTS: The univariate and multivariate analysis indicated that positive PD-1 expression was an independent protective factor for survival (overall, disease-free, disease-specific survival) and that high PD-L1 also improved survival. Poorly differentiated histological grades and metastasis were associated with a worse prognosis. CONCLUSIONS: PD-1 is a protective survival factor that is maintained independently of PD-L1 expression. High values of PD-L1 expression also improve survival. Higher expression of PD-1 is observed in smaller tumors, and higher expression of PD-L1 is more likely in women. No relationship between the tumor microenvironment and histologic risk score was found to influence the survival patterns studied in the OSCC. There is no evidence of a relationship between the histopathological features and the studied markers, although the positive PD-1 and PD-L1 cases have a lower risk of a high WPOI score, and positive PD-1 expression was associated with a lower DOI.

Treatment of oroantral communication with Platelet-Rich Fibrin: A systematic review.

BACKGROUND: Oroantral communication (OAC) is the opening between the maxillary sinus and the oral cavity, which constitutes a gate for the mucosal infection in the maxillary sinus. On the other hand, an OAF develops when the OAC does not close spontaneously, remains manifest and is epithelialized. Several methods have been proposed to solve these situations, however, they are associated with increased postoperative morbidity and/or higher associated costs and require some experience of the surgeon to perform them. To overcome these disadvantages, the use of Platelet-Rich Fibrin (PRF) is proposed. The present study aims to perform a systematic review of the literature, collecting cases in which PRF was used in the treatment of OACs/OAFs. MATERIALS AND METHODS: An electronic search of the MEDLINE database (via PubMed) and Web of Science was performed using the following MeSH terms (Medical Subjects Headings): (oroantral communication OR oroantral fistula OR buccosinusal communication) AND (platelet-rich fibrin OR prf OR fibrin mesh). The criteria used were those described by the PRISMA® Statement. The search was not time-restricted and was updated to April 2021. RESULTS: After searching, 11 articles were included that met the established criteria. In these, PRF was used alone or in combination with bi- or trilaminar techniques achieving complete resolution in 100% of cases (n = 116). CONCLUSIONS: With the limitations of this study, it can be established that PRF can be used alone for the treatment of OACs/OAFs up to 5 mm and, in larger defects, it is advisable to combine it with bi- or trilaminar techniques. PRF is an effective therapeutic option, with minimal associated postoperative morbidity compared to other techniques and allows the position of the mucogingival junction to be preserved. Its combination with bone grafting improves the starting point before the replacement of the missing tooth with a dental implant.

Autotransplantation of teeth with incomplete root formation: systematic review and meta-analysis.

OBJECTIVES: To determine the survival of intentional autotransplantation of developing teeth. MATERIAL AND METHODS: An electronic search was carried out in the MEDLINE database, Web of Science, and Cochrane Library. The criteria used are the ones described in the PRISMA Declaration. The following MeSH terms were used: ("tooth" [MeSH Terms] OR "tooth" [All Fields]) AND ("transplantation, autologous" [MeSH Terms] OR ("transplantation" [All Fields] AND "autologous" [All Fields]) OR "autologous transplantation" [All Fields] OR "autotransplantation" [All Fields]) AND ("humans" [MeSH Terms]. Randomised clinical trials and prospective and retrospective clinical studies were included. RESULTS: The meta-analytic study of overall survival included a total of 14 studies, yielding an overall survival rate of 97.9%. In studies with 1-year follow-ups, survival was 98%. The resulting 2-year follow-up rate was 97%, while the 5- and 10-year survival rates were 95.9% and 96.9%, respectively. CONCLUSIONS: The autotransplantation technique performed in a single-phase and on teeth that have not completed their development is a predictable technique, with a described survival rate at a 2-year follow-up of more than 97%. CLINICAL RELEVANCE: The technique of dental autotransplantation is considered an important resource for the resolution and rehabilitation of tooth loss in patients, especially in those who are still in a growth period. Moreover, this technique has a low complication rate and a 10-year survival rate of 96.9%. It should therefore be considered a safe and reliable procedure.

Povidone-Iodine as a Pre-Procedural Mouthwash to Reduce the Salivary Viral Load of SARS-CoV-2: A Systematic Review of Randomized Controlled Trials.

The use of pre-procedural rinses has been investigated to reduce the number of viral particles and bacteria in aerosols, potentially decreasing the risk of cross-infection from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during medical and dental procedures. This review aims to confirm whether there is evidence in the literature describing a reduction in salivary load of SARS-CoV-2 when povidone-iodine (PVP-I) is used as a pre-intervention mouthwash. An search of the MEDLINE, Embase, SCOPUS, and the Cochrane library databases was conducted. The criteria used followed the PRISMA® Statement guidelines. Randomized controlled trials investigating the reduction of salivary load of SARS-CoV-2 using PVP-I were included. Ultimately, four articles were included that met the established criteria. According to the current evidence, PVP-I is effective against SARS-CoV-2 in saliva and could be implemented as a rinse before interventions to decrease the risk of cross-infection in healthcare settings.