Whole-Process Digitalization-Assisted Immediate Implant Placement and Immediate Restoration in the Aesthetic Zone: A Prospective Study.

BACKGROUND This study explored the clinical effects of whole-process digitalization (WD)-assisted immediate implant placement (IIP) and immediate restoration (IR) in the aesthetic zone and clarified the clinical procedures. MATERIAL AND METHODS Patients who received maxillary aesthetic region IIP and IR treatment were randomly distributed into WD-assisted and conventional groups. Postoperative assessment included implant accuracy, marginal bone loss, aesthetic evaluation, and patient satisfaction evaluation. The aesthetic evaluation included visual analog score (VAS), pink aesthetic score (PES), and white aesthetic score (WES). Numerical data, measurement data, and grade data were analyzed by χ² test, t test, and Mann-Whitney U test. RESULTS The WD-assisted group exhibited decreased implant accuracy, including coronal deviation, apical deviation, angular deviation, and depth deviation, compared with the conventional group (P<0.05). The marginal bone loss in both the mesiodistal direction and the buccolingual direction were significantly lower in the WD-assisted group than in the conventional group (P<0.05). The VAS, PES, and WES were all significantly higher in the WD-assisted group than in the conventional group at 3, 6, and 12 months after surgery (P<0.05). Patients in the WD-assisted group also reported a higher satisfaction level than those in the conventional group (P<0.05). CONCLUSIONS WD-assisted IIP and IR treatment in the aesthetic zone increased implant accuracy, decreased marginal bone loss, improved aesthetic effect, and increased patient satisfaction compared with conventional treatment. Therefore, WD-assisted IIP and IR treatment constitutes a promising approach in clinical oral implantology.

French Otorhinolaryngology Society (SFORL) good practice guidelines for dental implant surgery close to the maxillary sinus.

OBJECTIVES: To draw up guidelines for ENT management associated with dental implant surgery with or without sinus lift. MATERIALS AND METHODS: The methodology followed the rules of laid down by the French Health Authority (HAS): "Methodological bases for drawing up professional recommendations by formalized consensus". The chosen method was the RAND/UCLA "RAND appropriateness method" (short version). RESULTS: In the pre-implantation check-up, it is recommended to systematically screen for sinonasal pathology on medical interview and to favor 3D CT or cone-beam imaging. It is recommended that imaging include the entire maxillary sinus when the patient does not have sinonasal history or functional signs on interview. Otherwise, examination of all sinonasal cavities is recommended. This attitude enables simultaneous analysis of maxillary infrastructure for pre-implantation work-up and assessment of sinonasal cavity status. Sinus mucosal incidentalomas are very common in the healthy population and must be assessed with reference to the clinical, endoscopic and radiological context. CONCLUSION: This formalized expert consensus establishes a common base of knowledge, to clarify the issues and clinical situations and to standardize practices.

The role of hyperbaric oxygen therapy in the prevention and management of radiation-induced complications of the head and neck - a systematic review of literature.

Radiation therapy for the treatment of head and neck cancer can injure normal tissues and have devastating side effects. Hyperbaric oxygen (HBO) is known to reduce the severity of radiation-induced injury by promoting wound healing. While most of the research in literature has focused on its efficacy in osteonecrosis, HBO has other proven benefits as well. The aim of this review was to identify the various benefits of hyperbaric oxygen therapy in patients who have undergone radiation for head and neck cancer. An electronic database search was carried out to identify relevant articles and selected articles were reviewed in detail. The quality of evidence for each benefit, including preserving salivary gland function, preventing osteonecrosis, dental implant success, and overall quality of life, was evaluated. Evidence showed that HBO was effective in improving subjective symptoms of xerostomia, swallowing, speech and overall quality of life. There was no conclusive evidence to show that HBO improved implant survival, prevented osteonecrosis, or improved salivary gland function. The high costs and accessibility of HBO therapy must be weighed against the potential benefits to each patient.

Impact of Different Surgeons on Dental Implant Failure.

PURPOSE: To assess the influence of several factors on the prevalence of dental implant failure, with special consideration of the placement of implants by different dental surgeons. MATERIALS AND METHODS: This retrospective study is based on 2,670 patients who received 10,096 implants at one specialist clinic. Only the data of patients and implants treated by surgeons who had inserted a minimum of 200 implants at the clinic were included. Kaplan-Meier curves were stratified with respect to the individual surgeon. A generalized estimating equation (GEE) method was used to account for the fact that repeated observations (several implants) were placed in a single patient. The factors bone quantity, bone quality, implant location, implant surface, and implant system were analyzed with descriptive statistics separately for each individual surgeon. RESULTS: A total of 10 surgeons were eligible. The differences between the survival curves of each individual were statistically significant. The multivariate GEE model showed the following variables to be statistically significant: surgeon, bruxism, intake of antidepressants, location, implant length, and implant system. The surgeon with the highest absolute number of failures was also the one who inserted the most implants in sites of poor bone and used turned implants in most cases, whereas the surgeon with the lowest absolute number of failures used mainly modern implants. Separate survival analyses of turned and modern implants stratified for the individual surgeon showed statistically significant differences in cumulative survival. CONCLUSION: Different levels of failure incidence could be observed between the surgeons, occasionally reaching significant levels. Although a direct causal relationship could not be ascertained, the results of the present study suggest that the surgeons' technique, skills, and/or judgment may negatively influence implant survival rates.

Implant Dentistry in General Practice. Part 1: Introduction.

This paper, the first of two, provides an introduction to implant dentistry for the general dental practitioner. CPD/Clinical Relevance: Implant placement and restoration is becoming more common place in general dental practice to the point where it may already be considered a routine treatment option.

Differentiating success from survival in modern implantology--key considerations for case selection, predicting complications and obtaining consent.

The use of dental implants to restore edentulous areas has increased significantly since the 1970s and is now considered, by many, the gold standard restorative treatment. As such it has become increasingly important to understand what constitutes success for these rehabilitations. Increasing focus has been given to acknowledging the difference between success and survival: the two being potentially very different outcomes for such invasive and expensive treatment. This article aims to describe this distinction and ultimately the implications of this for both patient and clinician.

An Assessment of the Risk of Bias in Randomized Controlled Trial Reports Published in Prosthodontic and Implant Dentistry Journals.

PURPOSE: The objective of this study was to assess the risk of bias of randomized controlled trials (RCTs) published in prosthodontic and implant dentistry journals. MATERIALS AND METHODS: The last 30 issues of 9 journals in the field of prosthodontic and implant dentistry (Clinical Implant Dentistry and Related Research, Clinical Oral Implants Research, Implant Dentistry, International Journal of Oral & Maxillofacial Implants, International Journal of Periodontics and Restorative Dentistry, International Journal of Prosthodontics, Journal of Dentistry, Journal of Oral Rehabilitation, and Journal of Prosthetic Dentistry) were hand-searched for RCTs. Risk of bias was assessed using the Cochrane Collaboration's risk of bias tool and analyzed descriptively. RESULTS: From the 3,667 articles screened, a total of 147 RCTs were identified and included. The number of published RCTs increased with time. The overall distribution of a high risk of bias assessment varied across the domains of the Cochrane risk of bias tool: 8% for random sequence generation, 18% for allocation concealment, 41% for masking, 47% for blinding of outcome assessment, 7% for incomplete outcome data, 12% for selective reporting, and 41% for other biases. CONCLUSION: The distribution of high risk of bias for RCTs published in the selected prosthodontic and implant dentistry journals varied among journals and ranged from 8% to 47%, which can be considered as substantial.

Mechanical Evaluation of Two Grades of Titanium Used in Implant Dentistry.

PURPOSE: To investigate the effect of core dental implant materials supporting single crowns on the probability of survival and failure modes. MATERIALS AND METHODS: Thirty-six standard external-hex titanium implants (4.0 mm in diameter) were selected to restore single crowns and divided into two groups according to core material: commercially pure grade 2 titanium (G2) and grade 5 titanium-aluminum-vanadium alloy (Ti-6Al-4V) (G5). Abutments were screwed to the implants, and standardized maxillary central incisor metal crowns were cemented and subjected to step-stress accelerated life testing in water. Use-level probability Weibull curves and reliability for missions of 100,000 cycles at 150 N and 200 N (with 90% two-sided confidence intervals [CIs]) were calculated. Polarized light and scanning electron microscopes were used to determine the failure modes. RESULTS: Use-level probability Weibull calculations showed beta values of 0.59 (CI, 0.31 to 1.11) and 1.22 (CI 0.81 to 1.84) for G2 and G5, respectively, and significantly higher characteristic strength and Weibull modulus for G5. The calculated reliability (90% CIs) for a mission of 100,000 cycles at 150 N showed that cumulative damage would lead to survival of 45% of implant-supported crowns of G2 and 98% of G5. At 200 N the probability of survival decreased to 0.03% for G2 and 21% for G5. Abutment screw fracture was the failure mode for all groups. CONCLUSION: Reliability, characteristic strength, and Weibull modulus were significantly higher for Ti-6Al-4V dental implants than for commercially pure (grade 2) titanium implants. Failure modes were similar for both groups.

A Comparative Study of Stability After the Installation of 2 Different Surface Types of Implants in the Maxillae of Dogs.

PURPOSE: This study was performed to investigate the histologic and histomorphometric findings of 2 different types of implant. MATERIALS AND METHODS: Resorbable blasting media (RBM) and sandblasted with larger grit and acid etched (SLA) surfaced implants (24 fixtures in each group) were installed in posterior maxilla of dogs. The initial stability was measured using Periotest (Periotest value [PTV]). After 6 or 12 weeks, fixtures with surrounding bone were harvested. RESULTS: The average initial stability of the SLA group (-1.71 ± 2.9) was higher than that of the RBM group (-1.25 ± 3.21), but there was no significant difference. The mean PTV of the RBM surface was higher than the SLA surface at 12 weeks. The average bone-implant contacts were 67.6% ± 16.0% at 6 weeks and 82.7% ± 8.6% at 12 weeks in the SLA group and 69.9% ± 17.6% at 6 weeks and 78.3% ± 9.2% at 12 weeks in the RBM group. CONCLUSION: The SLA and resorbable blasting media (RBM) surface implants demonstrated good stabilities and healing processes of the surrounding bone in the posterior maxilla. Therefore, the two domestic implants could provide predictable clinical results.

Animal research as a basis for clinical trials.

Animal experiments are critical for the development of new human therapeutics because they provide mechanistic information, as well as important information on efficacy and safety. Some evidence suggests that authors of animal research in dentistry do not observe important methodological issues when planning animal experiments, for example sample-size calculation. Low-quality animal research directly interferes with development of the research process in which multiple levels of research are interconnected. For example, high-quality animal experiments generate sound information for the further planning and development of randomized controlled trials in humans. These randomized controlled trials are the main source for the development of systematic reviews and meta-analyses, which will generate the best evidence for the development of clinical guidelines. Therefore, adequate planning of animal research is a sine qua non condition for increasing efficacy and efficiency in research. Ethical concerns arise when animal research is not performed with high standards. This Focus article presents the latest information on the standards of animal research in dentistry, more precisely in the field of implant dentistry. Issues on precision and risk of bias are discussed, and strategies to reduce risk of bias in animal research are reported.

Depth and lateral deviations in guided implant surgery: an RCT comparing guided surgery with mental navigation or the use of a pilot-drill template.

AIM: To assess the accuracy of guided surgery compared with mental navigation or the use of a pilot-drill template in fully edentulous patients. MATERIAL AND METHODS: Sixty consecutive patients (72 jaws), requiring four to six implants (maxilla or mandible), were randomly assigned to one of the following treatment modalities: Materialise Universal(®) mucosa, Materialise Universal(®) bone, Facilitate(™) mucosa, Facilitate(™) bone, mental navigation, or a pilot-drill template. Accuracy was assessed by matching the planning CT with a postoperative CBCT. Deviations were registered in a vertical (depth) and horizontal (lateral) plane. The latter further subdivided into BL (bucco-lingual) and MD (mesio-distal) deviations. RESULTS: The overall mean vertical deviation for the guided surgery groups was 0.9 mm ± 0.8 (range: 0.0-3.7) and 0.9 mm ± 0.6 (range: 0.0-2.9) in a horizontal direction. For the non-guided groups, this was 1.7 mm ± 1.3 (range: 0.0-6.4) and 2.1 mm ± 1.4 (range 0.0-8.5), respectively (P < 0.05). The overall mean deviation for the guided surgery groups in MD direction was 0.6 mm ± 0.5 (range: 0.0-2.5) and 0.5 mm ± 0.5 (range: 0.0-2.9) in BL direction. For the non-guided groups, this was 1.8 mm ± 1.4 (range: 0.0-8.3) and 0.7 mm ± 0.6 (range 0.0-2.9), respectively. The deviation in MD direction was significantly higher in the non-guided groups (P = 0.0002). CONCLUSION: The most important inaccuracy with guided surgery is in vertical direction (depth). The inaccuracy in MD or BL direction is clearly less. For non-guided surgery, the inaccuracy is significantly higher.

The reporting quality of meta-analysis results of systematic review abstracts in periodontology and implant dentistry is suboptimal.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Assessment of the quality of reporting in abstracts of systematic reviews with meta-analyses in periodontology and implant dentistry. Faggion CM Jr., Liu J, Huda F, Atieh M. J Periodontal Res 2014; 49(2):137-42. REVIEWER: Argy Polychronopoulou, DDS, MS, ScM, ScD PURPOSE/QUESTION: What is the reporting quality of meta-analysis results of abstracts of systematic reviews in periodontology and implant dentistry journals? SOURCE OF FUNDING: The authors received no funding for this study TYPE OF STUDY/DESIGN: Meta-epidemiological study LEVEL OF EVIDENCE: Level 3: Other evidence STRENGTH OF RECOMMENDATION GRADE: Not applicable.

An audit of implant practice websites: content and regulatory compliance.

AIMS AND OBJECTIVES: To audit the content of dental practice websites offering dental implant services against a framework based on the GDC 2012 Guidelines for Ethical Advertising and other relevant advertising standards. METHODS: An audit framework was constructed and applied to the top fifty websites resulting from a Google UK search using the search term 'dental implant specialist'. RESULTS: Compliance with many elements of the GDC Guidance remains poor. Sixty-eight percent of websites claimed that the practitioner providing the service was a GDC registered specialist, though examples were found where this claim was unfounded. Fourteen percent of practice websites claimed that the service was being carried out by an 'implant specialist' and 16% claimed the practitioner was an 'implantologist'; the majority of sites using these terms (10%) involved practitioners that had no specialist status. The display of potentially misleading memberships and fellowships of a range of dental associations, academies, societies and foundations remains common (52%), as does the adoption of the title 'Dr' (60%). CONCLUSION: Comparison with earlier studies indicates that compliance with recent GDC standards is generally improving, though whether the pace of improvement is seen as acceptable or not is something that policymakers and regulatory authorities may need to consider further.

[Periprosthetic joint infections: a practical overview for family physicians]. / Infections de prothèse articulaire: aspects pratiques à l'attention du médecin de premier recours.

Periprosthetic joint infection is a rare but serious complication. Its management requires the collaboration between general practitioner, orthopaedic surgeon and infectious disease specialist. A delay in the diagnosis can result in complications, requiring complex surgical procedures. Identification of the causative pathogen and its susceptibility pattern is crucial, because it guides both the choice of antimicrobial treatment and the surgical strategy. Antimicrobial treatment without proper micro- biological sampling must be avoided. Swabs from open wounds are not helpful, because microorganisms belonging to the skin flora will grow. The target audience of this review article on periprosthetic joint infections is the general practitioner.

Programmatic assessment of a university-based implant training program using patient-reported outcomes.

The University of Kentucky College of Dentistry (UKCD) established an implant training program that provides training in the use of a single implant system, evidence-based diagnostic and treatment protocols (standardized work practices), and a total quality management system (Implant Quality Assurance Program). The aim of this study was to assess the programmatic effectiveness of the UKCD implant training program by reporting the success and survival of implants placed, using patient-reported outcomes and comparing them to previously established benchmarks. A total of 415 patients (963 implants) were interviewed, approximately 50 percent of all qualified patients. The implant survival rate was 97 percent, and 88 percent of the implants were considered successful (as determined by patient-centric criteria). These outcomes were consistent with the program's previously established benchmarks of 90 percent. These results suggest that work standardization (in the form of specific treatment protocols) and the use of a formal, incremental learning system can result in positive patient outcomes. Clinical outcomes should be monitored in academic dental settings as part of clinical process improvement, and these outcomes can provide a means of assessing the effectiveness of the training program.

Use of methodological tools for assessing the quality of studies in periodontology and implant dentistry: a systematic review.

OBJECTIVE: To evaluate the methodological approaches used to assess the quality of studies included in systematic reviews (SRs) in periodontology and implant dentistry. MATERIALS & METHODS: Two electronic databases (PubMed and Cochrane Database of Systematic Reviews) were searched independently to identify SRs examining interventions published through 2 September 2013. The reference lists of included SRs and records of 10 specialty dental journals were searched manually. Methodological approaches were assessed using seven criteria based on the Cochrane Handbook for Systematic Reviews of Interventions. Temporal trends in methodological quality were also explored. RESULTS: Of the 159 SRs with meta-analyses included in the analysis, 44 (28%) reported the use of domain-based tools, 15 (9%) reported the use of checklists and 7 (4%) reported the use of scales. Forty-two (26%) SRs reported use of more than one tool. Criteria were met heterogeneously; authors of 15 (9%) publications incorporated the quality of evidence of primary studies into SRs, whereas 69% of SRs reported methodological approaches in the Materials/Methods section. Reporting of four criteria was significantly better in recent (2010-2013) than in previous publications. CONCLUSION: The analysis identified several methodological limitations of approaches used to assess evidence in studies included in SRs in periodontology and implant dentistry.