Effectiveness of mechanical and chemical decontamination methods for the treatment of dental implant surfaces affected by peri-implantitis: A systematic review and meta-analysis.

OBJECTIVE: To assess which decontamination method(s) used for the debridement of titanium surfaces (disks and dental implants) contaminated with bacterial, most efficiently eliminate bacterial biofilms. MATERIAL AND METHODS: A systematic search was conducted in four electronic databases between January 1, 2010 and October 31, 2022. The search strategy followed the PICOS format and included only in vitro studies completed on either dental implant or titanium disk samples. The assessed outcome variable consisted of the most effective method(s)-chemical or mechanical- removing bacterial biofilm from titanium surfaces. A meta-analysis was conducted, and data was summarized through single- and multi-level random effects model (p < .05). RESULTS: The initial search resulted in 5260 articles after the removal of duplicates. After assessment by title, abstract, and full-text review, a total of 13 articles met the inclusion criteria for this review. Different decontamination methods were assessed, including both mechanical and chemical, with the most common method across studies being chlorhexidine (CHX). Significant heterogeneity was noted across the included studies. The meta-analyses only identified a significant difference in biofilm reduction when CHX treatment was compared against PBS. The remaining comparisons did not identify significant differences between the various decontamination methods. CONCLUSIONS: The present results do not demonstrate that one method of decontamination is superior in eliminating bacterial biofilm from titanium disk and implant surfaces.

Effect of implant angulation and patrice on the retention of overdenture attachment systems: An in vitro study.

PURPOSE: To test the retention of two different overdenture attachment matrices and straight abutments when implants are placed at 0-, 15-, and 30-degree diverging angulations as well as the retention of 15-degree-angled abutments to correct the overall angulation to 0-degrees. MATERIALS AND METHODS: Matching aluminum blocks were machined to incorporate two dental implants at 0-degree, 15-degree, and 30-degree relative angulations and overdenture attachments to simulate a two-implant overdenture. At 0-degree, 15-degree, and 30-degree implant angulation, straight abutments were studied. At 30-degree implant angulation, an additional group was compared utilizing 15-degree angulated abutments that corrected the overall implant angulation to 0-degrees. A custom-designed testing apparatus that allowed automated insertion and removal of the simulated overdenture was designed, with three independent testing stations, each consisting of one simulated arch and one simulated overdenture base. The baseline and residual retention forces after 30,000 dislodging cycles of the simulated overdenture were measured. One-way ANOVA was used to compare retention differences among different color patrices within the 0-, 15-, and 30-degree implant angulation groups followed by Tukey's multiple comparison test. Two sample t-tests were used to compare 0-degree versus 15-degree implant groups with straight abutments and 30-degree implant groups with straight abutments versus 30-degree implant groups with angulated abutments. RESULTS: Regardless of implant angulation or abutment correction, the change in retention exhibited by the Novaloc system after testing was not statistically significant for all patrice types (p > 0.05); however, the change in retention exhibited by the Locator system was statistically significant for the tested group (p = 0.0272). In both the Novaloc and Locator systems, the baseline and final retention values provided by the different patrices were significantly different except for the white and green Novaloc patrices in the 15-degree divergent implant group which did not meet the specified level of significance (p = 0.0776). CONCLUSION: Within the limitations of this study, implant angulations upto 15 degrees do not affect differential change in retention of Novaloc patrices. There is no difference between Novaloc white inserts (light retention value) and green inserts (strong retention values) when implants diverge upto 15 degrees. When Novaloc straight abutments were placed on implants diverging by 30 degrees, blue extra-strong retention inserts outperformed yellow medium retention inserts by maintaining a higher retention value after 30,000 cycles. When utilizing Novaloc 15-degree angulated abutments that correct the overall implant angulation to zero degrees, the red light retentive patrice provides steady retention. Finally, the Locator-green patrice system provides greater retention than the comparable Novaloc-blue patrice combination; however, it also loses more retention after 30,000 cycles.

Association of selective serotonin reuptake inhibitor use with marginal bone level changes around osseointegrated dental implants: A retrospective study.

BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) are used for the management of anxiety and depression. Existing evidence shows their negative impact on implant osseointegration, survival rates, and peri-implant health. Currently, there are limited data on their effect on peri-implant marginal bone levels. The primary goal of this retrospective study is to evaluate the association between SSRIs use and marginal bone level (MBL) changes around osseointegrated dental implants over time. METHODS: Records from patients who received at least one dental implant between 2010 and 2021 were reviewed. Information related to medical history, SSRI use, and the implant site was obtained from patients' electronic charts. Mesial and distal MBLs were measured relative to the implant platform on digital intraoral radiographs, taken at the time of prosthesis installation and at the most recent follow-up visit. MBL changes were calculated. RESULTS: A total of 152 dental implants from 105 patients were included. The mean follow-up period was 46.97 ± 21.87 months. The mean MBL change was significantly greater for SSRI users (0.41 ± 0.76 mm) compared to non-users (0.04 ± 0.65 mm) [MD = 0.37 mm, p = 0.00, 95% CI: (-0.61)-(-0.15 mm)]. Mesial MBL change of 0.42 ± 0.84 mm and 0.02 ± 0.71 mm was noted for SSRI users and non-users, respectively. The distal MBL change was 0.4 ± 0.93 mm and 0.07 ± 0.73 mm, respectively. Smoking, sex, and implant location did not seem to influence the MBL differences between groups. CONCLUSIONS: Use of SSRIs is associated with greater marginal bone loss around osseointegrated dental implants in function for a mean period of 3.8 years.

Root coverage surgery for dentin hypersensitivity reduction: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: To evaluate the effectiveness of root coverage surgery in reducing dentin hypersensitivity (DH) through a systematic review and meta-analysis. DATA SOURCES: Unrestricted search of four indexed databases up to September 2022 was performed to identify randomized controlled trials (RCTs) evaluating the effect of root coverage surgery on DH frequency and/or intensity presurgically (baseline) and at least 3 months postsurgically. Two authors independently conducted study screening and data extraction. Subgroup meta-analyses were performed separately for stimulated and unstimulated DH frequency and intensity at different timepoints. The risk of bias and quality of the available evidence were assessed. RESULTS: Nineteen RCTs presenting data from 7 days to 30 months after root coverage surgery with various treatment modalities were included from the 662 identified studies. A total of 486 patients contributed 784 recession defects. Results from the subgroup meta-analyses showed that, overall, root coverage surgery reduced the risk for DH by 67% (RR, 0.33; 95% CI, 0.21 to 0.53) and 53% (RR, 0.47; 95% CI, 0.38 to 0.58) upon unstimulated and stimulated DH assessment, respectively. The DH intensity was also significantly reduced (mean visual analog score difference, 2.37; 95% CI, 2.02 to 2.71) upon stimulated DH assessment. No significant changes in DH intensity were observed upon unstimulated DH assessment. The included studies did not have high risk of bias and the quality of evidence was low to high. CONCLUSION: Existing evidence suggests that root coverage surgery may effectively reduce the DH frequency and intensity.

Survival rates, patient satisfaction, and prosthetic complications of implant fixed complete dental prostheses: a 12-month prospective study.

PURPOSE: To determine the survival rate, incidence of prosthetic complications, and patient satisfaction of implant fixed complete dental prostheses (IFCDPs) after a mean observation period of 1.4 years. MATERIALS AND METHODS: Twenty-eight (28) eligible participants were recruited according to specific inclusion and exclusion criteria. The definitive metal-acrylic resin IFCDPs consisted of titanium bars veneered with acrylic resin and acrylic denture teeth. Prosthodontic complications, divided into major and minor, were monitored. Parameters such as gender, jaw location, bruxism, and occlusal scheme were evaluated. Moreover, a questionnaire was administered throughout the study to assess patient satisfaction. Poisson regression as well as repeated measures ANOVA were used for statistical analysis. RESULTS: Fourteen (14) males and 14 females were enrolled and followed-up at 3, 6, and 12 months. All IFCDPs survived (100% survival rate). The most frequent minor complication was the loss of material used to close the screw access hole (20% out of total complications). The most frequent major complication was chipping of the acrylic denture teeth (77.14% out of total complications). Gender (p = 0.008) and bruxism (p = 0.030) were significant predictors for the total major complications (major wear and major chipping) while occlusal scheme was a significant predictor for major chipping events (p = 0.030). CONCLUSIONS: While IFCDPs demonstrated high prosthetic survival rates, they also exhibited a high number of chipping events of the acrylic veneering material, especially in males, bruxers, and individuals with canine guidance occlusion. However, the occurrence of these prosthetic complications did not negatively affect patient satisfaction.

The effect of Er:YAG laser treatment on biofilm formation on titanium and zirconia disc surfaces.

BACKGROUND: Lasers represent a promising method for implant decontamination, but evidence on implant surface changes and subsequent biofilm formation is limited. This study aimed to assess the effect of erbium-doped yttrium aluminum garnet (Er:YAG) laser treatment on zirconia and titanium discs, and the differences in biofilm formation as a result of surface alterations. METHODS: A two-stage (in vitro and in vivo) experiment utilizing Er:YAG laser on titanium and zirconia discs was performed. In vitro, surface alterations, roughness, and elemental-material weight differences following laser treatment were assessed using scanning electron microscopy and atomic force microscopy. In vivo, four participants wore custom-made intra-oral stents, embedded with laser-treated and untreated titanium and zirconia discs overnight. Biofilm-coated discs were stained using nucleic acid fluorescence dye and visualized using multiphoton confocal laser scanning microscopy. Biofilm 3D structure, biomass, thickness, and live-to-dead bacteria ratio were assessed. RESULTS: Both titanium and zirconia discs treated with Er:YAG laser resulted in visual surface alterations, but showed no significant change in average surface roughness (titanium P = 0.53, zirconia P = 0.34) or elemental-material-weight (titanium, P = 0.98), (zirconia, P = 0.96). No significant differences in biofilm biomass, average thickness, and live-to-dead bacteria ratio of laser-treated titanium and zirconia discs were identified compared to untreated groups (titanium P > 0.05, zirconia P > 0.05). Generally, zirconia discs presented with a lower live-to-dead bacteria ratio compared to titanium discs, regardless of laser treatment. CONCLUSION: Er:YAG laser treatment of titanium and zirconia implant surfaces does not significantly affect surface roughness, elemental material weight, or early biofilm formation in the oral cavity.

The effect of electronic cigarette use on peri-implant conditions in men: a systematic review and meta-analysis.

OBJECTIVE: To systematically review the effect of electronic cigarette (e-cigarette) use on clinical, radiographic, and immunologic peri-implant parameters in males. STUDY DESIGN: A comprehensive search of indexed databases was conducted to identify studies reporting data on both e-cigarette users and nonsmokers with implant-supported prosthesis with ≥1-year in function, up to May 2022. Marginal bone loss (MBL), probing depth (PD), plaque index (PI), and bleeding on probing (BOP) were recorded. Peri-implant sulcular fluid volume (PISF), tumor necrosis factor alpha (TNF-α) and interleukin 1ß (IL-ß) levels were also assessed. A meta-analysis was performed using random-effect models to determine the effect of e-cigarette use in primary and secondary outcomes. RESULTS: Four cross-sectional studies were included with a total of 327 participants (165 e-cigarette users and 162 nonsmokers). All studies showed greater MBL, PI, PD, and lower BOP in e-cigarette users compared with never smokers. The meta-analysis indicated significant heterogeneity for all outcomes except MBL for distal implant surfaces, with the mean difference between e-cigarette users and nonsmokers of 0.89 mm (95% CI: 0.67-1.11, P < .01). The PISF volume, TNF-α, and IL-1ß levels were increased in e-cigarette users (P < .01) with no heterogeneity present between studies. CONCLUSIONS: E-cigarette use shows a negative effect on clinical, radiographic, and immunologic parameters of dental implants.

Comparison of maxillary tuberosity and palatal donor sites for soft tissue augmentation at implant placement: A pilot controlled clinical study.

PURPOSE: To compare the outcomes of soft tissue augmentation during one-stage implant placement using grafts harvested from the hard palate or the maxillary tuberosity. MATERIALS AND METHODS: In this pilot controlled clinical study, non-smoking adults with a single missing tooth in the anterior or premolar region and adequate ridge dimensions for implant placement were enrolled. Each received a single implant and connective tissue graft harvested either from the hard palate (n = 10) or the maxillary tuberosity (n = 10). Digital impressions were taken prior to treatment (T0) and then 2 and 12 months postoperatively (T1 and T2, respectively). The primary study outcome was changes in horizontal ridge dimension. Secondary outcomes included marginal bone level changes over time, pain levels in the first 2 postoperative weeks (W1 and W2) and pink aesthetic score and patient-reported outcome measures at T2. Data analysis included repeated measures analysis of variance for intergroup comparisons. RESULTS: The horizontal ridge dimension increased significantly in both groups (P ≤ 0.002) at all apico-coronal levels examined, with no significant intergroup differences. There was also no significant intergroup difference in marginal bone level changes (P = 0.376). The hard palate group experienced higher pain levels in the donor site compared to the tuberosity group at W1 (P = 0.023). The pink aesthetic score and patient-reported outcome measures were similar between groups at T2. CONCLUSIONS: Soft tissue augmentation during one-stage implant placement results in significant increases in the horizontal ridge dimension.

Comparison of Coronally Advanced Flap and Connective Tissue Graft With or Without Enamel Matrix Derivative for Gingival Recession Treatment: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

The aim of this systematic review and meta-analysis was to assess whether the addition of enamel matrix derivative (EMD) to a coronally advanced flap (CAF) combined with a connective tissue graft (CTG) resulted in a greater amount of root coverage in patients treated for gingival recessions, as compared to CAF+CTG alone. The search for clinical trials on root coverage procedures comparing CAF+CTG+EDM vs CAF+CTG was completed on online databases and gray literature, and it included studies published up to January 2022. The risk of bias was assessed using the Cochrane bias assessment tool, and the quantitative analysis was performed using a random effects model. A total of 1,917 articles were identified, and 12 underwent full-text review. Three studies were excluded, and 9 were selected for full analysis. The meta-analysis showed that there is a statistically significant difference (P = .04) in favor of CAF+CTG+EMD compared to CAF+CTG alone for the amount of root coverage (mean difference: 0.30 mm; 95% CI: 0.01, 0.58 mm). According to the results of this systematic review and meta-analysis, the addition of EMD to CAF+CTG results in a greater amount of root coverage in teeth treated for gingival recessions.

Clinical Evaluation of Pink Esthetic Score of Immediately Impressed Posterior Dental Implants.

PURPOSE: While comparative outcome results for peri-implant crestal bone levels, mucosal margin position, and peri-implant indices have been reported, no studies are available that evaluate and compare the esthetic result of impressions performed immediately at implant placement with that of impressions performed on healed implants. The purpose of this cross-sectional study was to evaluate the pink esthetic score of posterior implants restored with an immediate impression workflow compared to implants restored with a delayed impression workflow. MATERIAL AND METHODS: Twenty-eight eligible participants who had received a single implant crown either in the premolar or molar regions at least 4 months before the study, were identified by an electronic health record review and scheduled for a single-visit study appointment. Esthetic outcomes were measured using the pink esthetic score. Several local- and prosthesis-related factors were recorded and their association with the selected outcome was assessed. Two-sample t-test was used for comparisons between the groups. RESULTS: Pink esthetic score ranged between 4 and 12 (mean: 8). No significant difference between immediate (8.36 ±1.12) and delayed (7.76 ±2.14) impression workflow groups were seen for the total PES (p = 0.25). In addition, individual comparisons between immediately and delayed impressed implants for mesial papilla (1.27 ±0.47; 0.88 ±0.78), distal papilla (0.73 ±0.65; 0.76 ±0.83), tissue margin (1.73 ±0.47; 1.47 ±0.51), tissue contour (1.27 ±0.65; 0.82 ±0.64), alveolar process (0.82 ±0.60; 1.00 ±0.87), color (1.27 ±0.65; 1.29 ±0.69), and texture (1.36 ±0.50; 1.53 ±0.62) did not show significant differences. CONCLUSIONS: The current study suggests that the pink esthetic score is not significantly different between single posterior implants impressed with immediate and delayed implant workflows.

Association between oral clefts and periodontal clinical measures: A meta-analysis.

AIM: To conduct a systematic review and to evaluate the clinical parameters for periodontal diseases in individuals with cleft lip and/or palate (CL/P). DESIGN: The authors searched six indexed databases without any linguistic limitation through July 2021. The eligibility criteria were observational studies that compared the periodontal clinical measures of individuals with CL/P to those without CL/P. A meta-analysis was conducted using random-effects models with inverse variance weighting. RESULTS: The literature search generated 1277 records, and 40 full-text articles were reviewed. Twenty-three studies comprising 3235 individuals from four continents fulfilled our selection criteria. The meta-analysis revealed a significant difference in mean plaque index scores (MD = 0.31, 95% CI = 0.22, 0.41), gingival index scores (MD = 0.50, 95% CI = 0.24, 0.77), and periodontal pocket depth (MD = 0.64, 95% CI = 0.12, 1.16) between individuals with and without CL/P. A slight increase in clinical attachment loss was detected among individuals with CL/P; however, such an increase may have little clinical significance. CONCLUSIONS: As age is positively related to periodontal disease progression, and individuals with CL/P are more likely to present with more plaque accumulation and gingival inflammation, clinicians should reinforce preventive dental care from an early age.

Implant survival and biologic complications of implant fixed complete dental prostheses: An up to 5-year retrospective study.

STATEMENT OF PROBLEM: Limited information is available on the association between prosthesis-associated risk factors and biologic complications for patients with implant fixed complete dental prostheses (IFCDPs). PURPOSE: The purpose of this retrospective study was to assess the implant survival and biologic complications of IFCDPs up to 5 years of follow-up. MATERIAL AND METHODS: Patients who had received IFCDPs between August 1, 2009 and August 1, 2014 were identified through an electronic health record review. Those who consented to participate in the study attended a single-visit study appointment. Clinical and radiographic examinations, intraoral photographs, and peri-implant hard and soft tissues parameters were assessed. Only prostheses which could be removed during the study visit were included. Associations between biologic complications and prosthetic factors, such as time with prosthesis in place, prosthesis material, number of implants, cantilever length, and type of prosthesis retention, were assessed. RESULTS: A total of 37 participants (mean ±standard deviation age 62.35 ±10.39 years) with 43 IFCDPs were included. None of the implants had failed, leading to an implant survival of 100% at 5.1 ±2.21 years. Ten of the prostheses were metal-ceramic (Group MC) and 33 were metal-acrylic resin (Group MR). Minor complications were more frequent than major ones. Considering minor complications, peri-implant mucositis was found in 53% of the implant sites, more often in the maxilla (P=.001). The most common major biologic complication was peri-implantitis, which affected 4.0% of the implants, more often in the mandible (P=.025). Peri-implant soft tissue hypertrophy was present 2.79 times more often (95% CI: 1.35 - 5.76, P<.003) around implants supporting metal-acrylic resin prostheses than metal-ceramic ones, with the former type also showing significantly more plaque accumulation (P<.003). CONCLUSIONS: Biologic complications such as soft tissue hypertrophy and plaque accumulation were more often associated with metal-acrylic resin prostheses. Peri-implant mucositis occurred more often under maxillary IFCDPs, while peri-implantitis appeared more common around mandibular implants.

Clinical Evaluation of Crestal Bone Levels, Peri-Implant Indices, and Mucosal Margin Position of Immediately Impressed Posterior Dental Implants: A Cross-Sectional Study.

PURPOSE: This is a cross-sectional clinical study to evaluate crestal bone levels, mucosal margin position, probing depths, bleeding on probing, and plaque and bleeding indices of implants restored with an immediate impression workflow compared to implants restored with a delayed impression workflow. MATERIALS AND METHODS: Patients who had received a posterior single implant crown in the premolar and molar regions were identified and scheduled for a single-visit study appointment. Outcome measurements included soft tissues peri-implant indices, peri-implant mucosal margin position, and crestal bone levels. Several systemic-, local-, and prosthesis-related factors were recorded. Bitewing radiographs were used to assess crestal bone levels. Wilcoxon rank sum test was used to compare the medians of continuous measurements and Pearson chi-square test (or Fisher's exact test) was used to compare the distributions of categorical variables between the two groups. RESULTS: Twenty eight patients were included. Crestal bone levels, peri-implant mucosal margin position and peri-implant soft tissue parameters for the immediately impressed group were not statistically different from the delayed impressed group, except for probing depth for the immediately impressed buccal site, which was less than that of the delayed group. Mesial bone level for cement-retained crowns was significantly more coronal than for screw-retained ones. CONCLUSIONS: While an isolated statistical difference was found in probing depth, the current study suggests that there is no clinically significant difference between implants impressed with immediate and delayed implant workflows when considering crestal bone levels, peri-implant mucosal margin position, and most peri-implant indices.

Recommendations for Implant-Supported Full-Arch Rehabilitations in Edentulous Patients: The Oral Reconstruction Foundation Consensus Report.

The tasks of Working Groups 1 to 6 at the 4th Consensus Meeting of the Oral Reconstruction Foundation were to elucidate clinical recommendations for implant-supported full-arch rehabilitations in edentulous patients. Six systematic/narrative reviews were prepared to address the following subtopics: (1) the influence of medical and geriatric factors on implant survival; (2) the prevalence of peri-implant diseases; (3) the influence of material selection, attachment type, interarch space, and opposing dentition; (4) different interventions for rehabilitation of the edentulous maxilla; (5) different interventions for rehabilitation of the edentulous mandible; and (6) treatment choice and decision-making in elderly patients. Consensus statements, clinical recommendations, and implications for future research were determined based on structured group discussions and plenary session approval.

A Comparison Between Fixed and Removable Mandibular Implant-Supported Full-Arch Prostheses: An Overview of Systematic Reviews.

PURPOSE: To evaluate the current literature and provide clinical recommendations related to the number of implants, implant characteristics, loading protocols, survival rates, biologic and mechanical complications, patient satisfaction, and financial considerations for mandibular implant-supported full-arch prostheses. MATERIALS AND METHODS: A PubMed/MEDLINE search for literature published between January 1, 1980 and February 8, 2019, was performed for systematic reviews on this topic. The PICO question was: In mandibular fully edentulous patients treated with implant full-arch prostheses, is there any difference between fixed and removable implant prostheses in terms of implant and prosthesis survival rates? Only systematic reviews with or without meta-analyses were included. The findings varied based on the type of implant full-arch prosthesis. RESULTS: High survival rates for implants and prostheses have been reported for fixed and removable implant full-arch prostheses in the mandible. Immediate loading procedures present with high survival rates for both fixed and removable prostheses. There are differences in the number of implants, implant characteristics, complications, and financial implications between these two types of prostheses, which clinicians need to account for as part of the treatment planning process. CONCLUSION: Implant-supported overdentures and implant-supported fixed complete dentures represent clinically successful treatment approaches. In cases where both treatment options are indicated, patient expectations and cost should be the determining factors for selecting a treatment modality.

The Relationships Between Tooth-Supported Fixed Dental Prostheses and Restorations and the Periodontium.

PURPOSE: To search the literature and to critically evaluate the findings on the periodontal outcomes of restorations and tooth-supported fixed prostheses. MATERIALS AND METHODS: PubMed was searched according to a systematic methodology, previously reported, but updated to include a larger database. Filters applied were: Case reports, clinical trial, review, guideline, randomized controlled trial, meta-analysis, systematic reviews, and English. A narrative review was then synthesized to discuss periodontal outcomes related to restorations and tooth-supported fixed prostheses. Relevant data was organized into four sections: Direct restorations, indirect restorations, biologic width or supracrestal tissue attachment and tooth preparation/finish line design. RESULTS: While increased gingival index, bleeding on probing, probing depth and clinical attachment loss have been associated with subgingival restorations, intracrevicular margins do not cause periodontal diseases. Inflammation and bone loss occur, for both direct and indirect restorations, only with large overhangs. Different restorative materials are associated with different clinical responses when placed in the gingival sulcus or within the epithelial and connective tissue attachments. When the connective tissue attachment is removed, histological changes occur causing its apical shift and subsequent re-establishment. Gingival displacement during impression procedures can cause gingival recession. Emergence profile can have a range of values, not associated with periodontal diseases. Periodontal response appears to be clinically not different when compared among different finish line designs. CONCLUSIONS: Contemporary procedures and materials used for the placement and fabrication of tooth-supported restorations and fixed prostheses are compatible with periodontal health when adequate patient education and motivation in self-performed oral hygiene are present. Periodontal diagnostic criteria should be thoroughly reviewed before fixed restorative treatments are planned and executed.

Buccal bone thickness of maxillary anterior teeth: A systematic review and meta-analysis.

AIM: To systematically review buccal bone thickness (BBT) in the anterior maxilla in different teeth, age groups and genders. MATERIALS AND METHODS: PubMed, EMBASE and Cochrane databases were searched up to April 2020. Clinical and radiographic studies reporting on BBT of maxillary anterior teeth, with at least 10 patients, were included. A meta-analysis was performed using random effect models to report differences of BBT. RESULTS: 50 studies were included. Using bone crest (BC) as a reference point, no significant differences were found in BBT between different tooth types, except for 0.16 mm (95%-CI: 0.02-0.30) increased mid-root thickness of premolars compared to canines. Using the CEJ as a reference point, canines presented with a significantly increased thickness of 0.32 mm (95%-CI: 0.11-0.54) coronally compared to laterals. When BC was used as reference, males demonstrated a significantly increased thickness of 0.21 mm (95%-CI: 0.15-0.27) apically, while middle-aged adults showed a 0.06 mm (95%-CI: -0.12, -0.01) statistically significant increase in the coronal level compared to older adults. CONCLUSIONS: Few maxillary anterior teeth have BBT greater than 1 mm. Buccal bone tends to get thicker from a coronal to apical position along the root surface and from an anterior to posterior position in the arch.

Prosthesis Survival Rates and Prosthetic Complications of Implant-Supported Fixed Dental Prostheses in Partially Edentulous Patients.

PURPOSE: To determine the prevalence and distribution of prosthetic complications affecting implant-supported fixed dental prostheses (ISFDPs). MATERIALS AND METHODS: Subjects previously treated with one or more ISFDP(s) were identified from an electronic health record search and recalled for comprehensive clinical examination. Past prosthesis failures and complications were identified from the patient records while any existing complications, not previously recorded, were assessed during examination. ISFDP survival and failure rates were calculated with Kaplan-Meier curves and life table analysis, while regression Poisson analysis was used to identify associations between outcomes and possible patient- and prosthesis-based risk factors. RESULTS: Seventy-four subjects with 107 ISFDPs were enrolled in the study with a mean time between prosthesis delivery and exam of 3.14 years (range: 1.00-9.00 years). Four prostheses failed, resulting in a cumulative prosthesis survival rate of 96.26%. Prosthetic complications affected 48.59% of ISFDPs, the majority (94.87%) of them minor complications. Only the use of a nightguard was associated with a lower prevalence of prosthetic screw loosening (HR 0.11, 95% CI 0.02-0.59, p = 0.007) while no outcome differences were noted for other variables. Patient satisfaction was high regardless of presence or number of complications. CONCLUSIONS: ISFDPs demonstrated a high survival rate and overall high, patient-reported satisfaction. Minor prosthetic complications were common but were only significantly associated with nightguard use.

Peri-Implant Diseases and Biologic Complications at Implant-Supported Fixed Dental Prostheses in Partially Edentulous Patients.

PURPOSE: This is a single center, retrospective study to assess the prevalence of peri-implant disease and biologic complications in a cohort of partially edentulous subjects in relation to selected prosthetic factors. MATERIALS AND METHODS: Subjects previously treated with one or more implant-supported fixed dental prosthesis (ISFDPs) were recalled for a comprehensive examination. Clinical and radiographic records were taken and questionnaires were administered. The prevalence of implant failure, peri-implant disease and other biologic complications were correlated with selected prosthetic, clinical and patient-related factors using chi-square and multiple regression analyses. RESULTS: A convenience sample of 71 subjects with 100 prostheses supported by 222 dental implants were enrolled in the study. The mean follow-up time after prosthesis delivery was 3.3 ± 1.5 years (range of 1-9 years). The cumulative implant survival rate was 99.1%. Peri-implantitis was the most frequent major biologic complication (5% of implants), while the most frequent minor biologic complication was peri-implant mucositis (84.10% of implants). A diagnosis of peri-implant mucositis was more likely associated with cement-retained prostheses compared to screw-retained prostheses (OR 6.8, 95% CI 1.1-78.6, p = 0.045) and for short-span prostheses (≤3 prosthetic units) (OR 2.3, 95% CI 1.1-5.0, p = 0.034). Subject-reported quality of life measures were high regardless of the existence of major and/or minor complications, but decreased with increasing number of minor and total biologic complications. CONCLUSIONS: Peri-implant mucositis and other minor biologic complications were highly prevalent. The distribution of the observed complications differed based on the method of prosthesis retention and the number of prosthetic units replaced.

Digital Versus Conventional Full-Arch Implant Impressions: A Prospective Study on 16 Edentulous Maxillae.

PURPOSE: A prospective clinical study to compare for the first time the accuracy of digital and conventional maxillary implant impressions for completely edentulous patients. MATERIALS AND METHODS: Sixteen patients received maxillary implant supported fixed complete dentures. After the verification of the conventional final casts, the casts were scanned with a desktop (extraoral) scanner. Intraoral full-arch digital scans were also obtained with scan bodies and STL files. Extraoral and intraoral scans were superimposed and analyzed with reverse engineering software. The primary outcome measure was the assessment of accuracy between scans of the verified conventional casts and digital full-arch impressions. The secondary outcome was the effect of the implant number on the 3D accuracy of impressions with Spearman's rank correlation coefficient. RESULTS: The 3D deviations between virtual casts from intraoral full-arch digital scans and digitized final stone casts generated from conventional implant impressions were found to be 162 ± 77 µm. In the 4-implant group, 5-implant group, and 6-implant group the 3D deviations were found to be 139 ± 56 µm, 146 ± 90 µm, and 185 ± 81 µm, respectively. There was a positive correlation between increased implant number and 3D-deviations, but there was no statistically significant difference (p = 0.191). CONCLUSIONS: The 3D accuracy of full-arch digital implant scans lies within previously reported clinically acceptable threshold. Full-arch digital scans and a complete digital workflow in the fabrication of maxillary fixed complete dentures may be clinically feasible.