Ibero-Panamerican Federation of Periodontology Delphi study on the trends of periodontology and periodontics by the year 2030. A Latin American consensus.

BACKGROUND AND OBJECTIVE: As elsewhere in the world, the prevalence of periodontitis in stages I-II is high in the Latin American population, this scenario emphasizes the need for identification of urgent needs for allocating adequate resources to provide diagnosis, prevention, and treatment of these diseases. The aim of this Delphi study was to predict the trends in periodontology/periodontics in the Latin American region by the year 2030. METHODS: A steering committee and an advisory group of experts in periodontology/periodontics were selected from 16 countries. An open questionnaire of 60 questions was validated and used following the Delphi methodology. RESULTS: Two hundred and twenty-five experts from Latin America answered the two rounds of the questionnaire. Moderate to strong consensus was reached on 45 questions (75%). The prediction was that the prevalence of gingivitis and periodontitis in stages I and II will be maintained, the importance of the link with systemic diseases will increase, and the impact of prevention and periodontal treatment will also increase, mainly in the private sector. There was a strong consensus that plastic and regenerative surgical procedures will increase, as well as the demand for training in the specialty of periodontology. CONCLUSIONS: The present study has provided relevant and useful information on predictions in periodontology/periodontics in Latin America, with important level of consensus among experts. It has been predicted that periodontitis will still be a highly prevalent disease, and its links with other medical conditions should demand more attention by health authorities to develop adequate prevention and management policies and strategies.

Unusual complications at the recipient site following periodontal plastic surgery procedures: a systematic review.

OBJECTIVE: To identify and describe unusual soft tissue complications of periodontal plastic surgery procedures at the recipient site after periodontal grafts. MATERIALS AND METHODS: Two independent reviewers performed a comprehensive search in MEDLINE, Cochrane, periodontics journals, reference lists, and grey literature for articles dated up to July 2021. Publications related to surgical interventions only around the teeth with an unusual complication at the recipient site were selected. No restrictions were made in the number of cases, follow-up period, or language. The Cochrane Collaboration's tool for assessing risk of bias, the Newcastle-Ottawa Scale (NOS), and two validated case report/series checklists were used to critically appraise the studies. RESULTS: A total of 1434 articles were examined, of which 28 met the inclusion criteria: one RCT, two cohort studies, and twenty-five case reports/series. The periodontal plastic surgery procedures described in these articles were conducted to treat lack of attached gingiva and gingival recessions. The following unusual complications were found: bone exostosis, epithelial inclusion, root resorption, abscess, overgrowth, "liver clot" formation, and oroantral communication. CONCLUSION: Bone exostosis and epithelial inclusions were the most prevalent unusual complications following treatment with subepithelial connective tissue graft, free gingival graft, and acellular dermal matrix allograft. Due to the nature of the reports, the clinical recommendations for diagnosis and treatment cannot be homogenized. Clinical studies reporting complications are required to develop management protocols (PROSPERO CRD42021230875). CLINICAL RELEVANCE: Clinicians need to know the main complications that can occur in mucogingival surgeries as well as their clinical management to provide a successful and predictable treatment.

Delphi Project on the trends in Implant Dentistry in the COVID-19 era: Perspectives from Latin America.

AIM: To establish trends in Implant Dentistry in Latin America in the COVID-19 pandemic. MATERIAL AND METHODS: A steering committee and an advisory group of experts in Implant Dentistry were selected among eighteen countries. An open-ended questionnaire by Delphi methodology was validated including 64 questions, divided in 7 topics, concerning the various trends in dental implantology. The survey was conducted in two rounds, which provided the participants in the second round with the results of the first. The questionnaires were completed on August 2020, and the online meeting conference was held on September 2020. The final prediction was developed through consensus by a selected group of experts. RESULTS: A total of 197 experts from Latin America answered the first and second questionnaire. In the first round, the established threshold for consensus (65%) was achieved in 30 questions (46.87%). In the second round, performed on average 45 days later, this level was achieved in 47 questions (73.43%). Consensus was completely reached on the item "Diagnostic" (100%), the field with the lowest consensus was "Demand for treatment with dental implants" (37.5%). CONCLUSIONS: The present study in Latin America has provided relevant and useful information on the predictions in the education and practice of Implant Dentistry in the COVID-19 era. The consensus points toward a great confidence of clinicians in the biosecurity protocols used to minimize the risk of SARS-CoV-2 transmission. It is foreseen as an important change in education, with introduction of virtual reality and other simulation technologies in implant training.

The risk of bias of animal experiments in implant dentistry: a methodological study.

OBJECTIVES: To evaluate the risk of bias (ROB) in reports of randomised controlled trials (RCTs) of animal experiments published in implant dentistry, and to explore the association between animal experiment characteristics and ROB. MATERIAL AND METHODS: We searched the MEDLINE (via PubMed), SCOPUS and SciELO databases from 2010 to March 2015 for reports of RCTs of animal experiments published in implant dentistry. We evaluated independently and in duplicate the ROB of these experiments by the use of a tool specifically developed to evaluate ROB in animal studies, the SYRCLE's tool. ROB was judged as low, high or unclear (when there was not enough information to judge ROB). We used univariate and multivariate logistic regression analyses to evaluate the association of specific study characteristics and extent of ROB. RESULTS: We initially selected 850 publications and 161 reports of animal experiments were included. For a total of 1449 entries (records), 486 (34%) were rated as low ROB. High ROB was attributed to 80 (6%) of entries, and 883 (60%) entries were rated as unclear ROB. The characteristics "impact factor" (IF), reporting of standard error (SE) and reporting of confidence interval (CI) were significantly associated with low ROB in some SYRCLE domains. CONCLUSIONS: A substantial number of items with unclear ROB were observed in this sample of animal experiments in implant dentistry. Furthermore, the present findings suggest that implant dentistry animal experiments published in journals with higher IF and better report of measures of precision; that is, CI and SE may have lower ROB than those not having these characteristics.

The 300 most cited articles published in periodontology.

OBJECTIVES: It is important to evaluate the characteristics of the most cited articles in any specialty. The number of citations may be a proxy for clinical and research activity. The objectives of the present methodological study were (1) to report the characteristics of the 300 most cited articles in periodontology and (2) to explore the association of these characteristics with the number of citations. METHODS: We searched in the Web of Science database for the 300 most cited articles published in periodontology on June 15, 2015. We described characteristics of the articles such as type of study, type of scientific journal, topic reported, year of publication, affiliation of the first author of the article, and impact factor. Linear regression analysis was used to investigate associations of these variables with the number of citations. RESULTS: The search retrieved approximately 155,356 publications; out of the studies that met the eligibility criteria, the 300 most cited were included for analysis. Comprising more than 50 % of the included articles, basic biology and the detection of bacteria were the most prevalent topics. Narrative reviews were the most frequent type of article (27 % of the sample). Regression analysis demonstrated that some characteristics, for example "narrative reviews," are more prone to be cited than others. CONCLUSION: We conclude that scientific evolution in periodontology has been based more on narrative reviews than on reproducible systematic reviews. CLINICAL RELEVANCE: Future research is encouraged to elucidate the extent to which scientific progress is improved through systematic compared with narrative reviews.

Is the evaluation of risk of bias in periodontology and implant dentistry comprehensive? A systematic review.

BACKGROUND/OBJECTIVE: The objective of this study was to assess how authors of systematic reviews (SRs) with meta-analyses published in periodontology and implant dentistry evaluate risk of bias (ROB) in primary studies included in these reviews. MATERIAL/METHODS: A literature search for SRs with meta-analyses was performed in PubMed and Cochrane library databases up to July 20th 2014. The reference lists of included articles were screened for further reviews. The standards of evaluating ROB in primary studies were evaluated by using a 14-item checklist based on the Cochrane approach for evaluating ROB. Standards in ROB evaluations in Cochrane and paper-based SRs were compared using the Fisher's exact test. All searches, data extraction and evaluations were performed independently and in duplicate. RESULTS: Seventy SRs were included (45 paper-based and 25 Cochrane SRs, respectively). The median percentage of items addressed was 58% (interquartile range 4-100%). Cochrane SRs more frequently included ROB assessments than paper-based reviews in terms of examiner blinding (p = 0.0026), selective outcome reporting (p = 0.0207) and other bias (p = 0.0241). CONCLUSIONS: The ROB evaluation in primary studies currently included in SRs with meta-analyses in periodontology and implant dentistry is not sufficiently comprehensive. Cochrane SRs have more comprehensive ROB evaluation than paper-based reviews.

Consistency of recommendations of clinical practice guidelines in periodontology: a systematic review.

The aim of this systematic review was to evaluate the methodological quality and the consistency of recommendations of clinical practice guidelines (CPGs) in Periodontology. An electronic search was conducted in two databases, MEDLINE and EMBASE, eight CPGs databases, and home pages of scientific societies in Periodontology up to April 2022. Three reviewers independently assessed methodological quality using the AGREE II instrument. In addition, we evaluated the consistency of the recommendations. Eleven CPGs were included, and the topics developed focused on prevention, diagnosis, risk factors, surgical and non-surgical periodontal treatment, antimicrobial therapy, root coverage, and maintenance. We found that the AGREE domains 2 (Stakeholder involvement) and 5 (Applicability) obtained the lowest scores. Domains 1 (Scope and purpose), 3 (Rigor of development) and 4 (Clarity of presentation) obtained the highest scores among the evaluated CPGs. The clinical recommendations for treatment of periodontal diseases were mostly consistent. Overall, the quality of CPGs used in periodontics was high. There was consistency of recommendations in specific fields. These findings may help researchers to promote CPGs focused on different fields of periodontics that have not yet been developed. Furthermore, the clinician will be able to make better clinical decisions.

Socket seal surgery techniques in the esthetic zone: a systematic review with meta-analysis and trial sequential analysis of randomized clinical trials.

BACKGROUND: The socket seal surgery (SSS) technique is a common alternative for the management of the post-extraction sockets that requires a primary closure of the wound to promote proper regeneration and ridge preservation. OBJECTIVE: To learn about the effect of different SSS techniques on alveolar ridge preservation MATERIAL AND METHODS: Two independent and calibrated reviewers conducted an electronic search in PubMed, Cochrane, and Web of Science for randomized clinical trials (RCT) published up to June 2020. The evaluation of the risk of bias in the included studies was carried out following the Cochrane manual for interventions of systematic reviews, version 5.1.0. A meta-analysis of ridge width changes at - 1, - 3, and - 5 mm cutoff points from bone crest was conducted using a random-effects model. The risk of types I and II errors against accrued data was appraised obtaining the required information size using a trial sequential analysis package (TSA). RESULTS: A total of 135 sockets located in the esthetic zone were evaluated with a minimum of a 3-month follow-up after tooth extraction in 6 RCTs. The evaluated SSS techniques were free gingival graft (FGG), collagen matrix (CM), collagen sponge (CS), acellular dermal matrix (ADM), and polytetrafluoroethylene membrane (PTFEm). The FGG in sockets without bone filling showed significant results in preserving both buccal and lingual bone height (- 1.42 mm in the experimental group versus - 0.01 in the control group). The comparison of CM and FGG with bone filling did not show clinical differences in terms of dimensional bone changes. No clinical differences were found in either width or gingival thickness when comparing CM and CS. The meta-analyses of RW changes comparing CM versus FGG showed no significant differences, but a trend for lessening horizontal reduction at - 1, - 3, and - 5 mm in favor of FGG. The TSA showed that accrued data did not reach the required information size, and more evidence is required for clinical significance inferences. CONCLUSIONS: There are several predictable SSS techniques to improve clinical results in ridge preservation. More clinical studies in the form of clinical trials are required to demonstrate the superiority of one technique over another.

Ibero-Panamerican Federation of Periodontics Delphi study on the trends in diagnosis and treatment of peri-implant diseases and conditions: A Latin American consensus.

BACKGROUND: The social diversity, heterogeneous culture, and inherent economic inequality factors in Latin America (LA) justify conducting a comprehensive analysis on the current status and future trends of peri-implant diseases and conditions. Thus, the aim of this Delphi study was to predict the future trends in the diagnosis and treatment of peri-implant diseases and conditions in LA countries for the year 2030. METHODS: A Latin American steering committee and group of experts in implant dentistry validated a questionnaire including 64 questions divided into eight sections. The questionnaire was run twice with an interval of 45 days, with the results from the first round made available to all the participants in the second round. The results were expressed in percentages and data was analyzed describing the consensus level reached in each question. RESULTS: A total of 221 experts were invited to participate in the study and a total 214 (96.8%) completed the two rounds. Moderate (65%-85%) to high consensus (≥ 85%) was reached in 51 questions (79.69%), except in the questions dealing with "prevalence", where no consensus was reached. High and moderate consensus was attained for all the questions in three fields (risk factors and indicators, diagnosis and treatment of peri-implant conditions and deficiencies, and prevention and maintenance). CONCLUSIONS: The present study has provided relevant and useful information on the predictions in the diagnosis and treatment of peri-implant diseases with a high level of consensus among experts. Nevertheless, there is still a lack of agreement in certain domains.

Embryo transfer, a useful technique to be applied in small community farms?

The objective of this study was to determine if the technique of embryo transfer in cattle can be commercially feasible in a region situated in the humid tropics of Mexico. Twenty-six Bos taurus and twenty-six Bos indicus cows were estrous synchronized and superovulated to obtain a total of 80 embryos of both sub-species. Embryos were classified using stereoscopic microscopy based on established criteria. Nine dual-purpose farms situated in the tropics of Mexico were chosen to provide ten recipient cows each to transfer one embryo per cow. The females were transferred using a fixed-time protocol after verifying the presence of a corpus luteum on the seventh day after the end of hormonal treatment. Pregnancy diagnosis was carried out 28 days after embryo transfer by ultrasonography. Estimation of the cost was determined by calculating the expenses for preparation of the donor and embryo recovery, which were US $633 and US $589 for B. taurus and B. indicus, respectively. The cost of each embryo was determined considering the number of transferable embryos recovered, which was 3.8 on mean. The cost of each conception was calculated taking into account the percentage of pregnant animals (27% on mean), and the cost for preparing donor and recipient cows, for transferring embryo. The overall cost per gestation was US $1,447. Considering a 50:50 ratio of male to female born, the cost for a replacement heifer calf was US $2,894, which surpassed by far the commercial cost of a crossbred ready-to-bred heifer normally used as replacement (approximately US $900).

Cryopreservation induces higher oxidative stress levels in Bos indicus embryos compared with Bos taurus.

Freezing and thawing of Bos indicus embryos affect their quality for embryo transfer. The objective of this study was to compare the levels of reactive oxygen species between Bos indicus and Bos taurus embryos produced in vivo, before and after conventional freezing, as well as to analyze damage caused by apoptosis and lipid peroxidation. Bos indicus has higher levels of reactive oxygen species than Bos taurus embryos, both fresh (14.32 ± 1.41 auf vs 8.07 ± 1.15 auf (arbitrary units of fluorescence), P < 0.05) and after freezing (20.91 ± 1.21 auf vs 14.39 ± 0.58 auf, P < 0.05). The number of apoptotic nuclei is also significantly higher in Bos indicus embryos than Bos taurus (8.28 ± 0.80 vs 1 ± 0.57, P < 0.05) but highlighting a notable increase after the freeze-thaw process in both subspecies (Bos indicus from 8.28 ± 0.80 to 10.71 ± 0.42, P < 0.05; Bos taurus from 1 ± 0.57 to 5.5 ± 1.15, P < 0.05). Finally, although lipid peroxidation is lower in Bos indicus embryos before freezing in comparison with Bos taurus (2.46 ± 0.14 vs 4.20 ± 0.51), the effect after the freeze-thaw process showed an increase of 4.34 in Bos indicus than Bos taurus embryos (51.45 ± 5.52 auf vs 11.85 ± 2.88 auf, P < 0.05). In conclusion, in comparison with Bos taurus, Bos indicus embryos undergo greater oxidative stress causing increases in the cryopreservation process, promoting major cell damage and lowering embryonic viability.

Risk of bias over time in updates of Cochrane oral health reviews.

OBJECTIVES: To assess the changes in the risk of bias (RoB) across different versions of the same Cochrane systematic review, and to identify characteristics of systematic reviews which may be associated with different RoB scores by means of regression analysis. METHODS: We examined changes in RoB ratings in domains of randomized controlled trials (RCTs) and controlled trials (CTs) included in original Cochrane systematic reviews and their updates published in oral health. First, we checked the number of domains assessed for RoB in the different versions of the systematic review. Then, we computed the percentage of different ratings of RoB (low, high and unclear) in these systematic review versions. All data selection, extraction and analysis were conducted independently and in duplicate by two assessors. Time trends were reported in the form of line graphs. We also assessed systematic review characteristics as predictors of RoB scores by means of regression analysis. RESULTS: A total of 173 reviews consisting of the original reviews and their updates were examined. The proportion of different ratings of RoB was kept stable over the different versions. However, in more recent versions, the proportion of unclear RoB slightly increased, and the proportion of high RoB decreased. Cochrane risk of bias domains were a significant RoB score predictor (Likelihood ratio test p-value < 0.001). CONCLUSIONS: Methodological improvements in RCTs and CTs included in Cochrane reviews are needed. This comprehensive information on the RoB trend may help oral health researchers improving the methodology related to specific domains. CLINICAL SIGNIFICANCE: Methodological improvements are necessary for primary studies included in Cochrane reviews in oral health. The increase of domains rated as unclear RoB is of concern and suggests that strategies should be developed to improve the level of communication between trialists and systematic reviewers.

The search and selection for primary studies in systematic reviews published in dental journals indexed in MEDLINE was not fully reproducible.

OBJECTIVES: To evaluate whether the reporting of search strategies and the primary study selection process in dental systematic reviews is reproducible. STUDY DESIGN AND SETTING: A survey of systematic reviews published in MEDLINE-indexed dental journals from June 2015 to June 2016 was conducted. Study selection was performed independently by two authors, and the reproducibility of the selection process was assessed using a tool consisting of 12 criteria. Regression analyses were implemented to evaluate any associations between degrees of reporting (measured by the number of items positively answered) and journal impact factor (IF), presence of meta-analysis, and number of citations of the systematic review in Google Scholar. RESULTS: Five hundred and thirty systematic reviews were identified. Following our 12 criteria, none of the systematic reviews had complete reporting of the search strategies and selection process. Eight (1.5%) systematic reviews reported the list of excluded articles (with reasons for exclusion) after title and abstract assessment. Systematic reviews with more positive answers to the criteria were significantly associated with higher journal IF, number of citations, and inclusion of meta-analysis. CONCLUSION: Search strategies and primary study selection process in systematic reviews published in MEDLINE-indexed dental journals may not be fully reproducible.

Consistency of recommendations of clinical practice guidelines in periodontology: a systematic review

Abstract The aim of this systematic review was to evaluate the methodological quality and the consistency of recommendations of clinical practice guidelines (CPGs) in Periodontology. An electronic search was conducted in two databases, MEDLINE and EMBASE, eight CPGs databases, and home pages of scientific societies in Periodontology up to April 2022. Three reviewers independently assessed methodological quality using the AGREE II instrument. In addition, we evaluated the consistency of the recommendations. Eleven CPGs were included, and the topics developed focused on prevention, diagnosis, risk factors, surgical and non-surgical periodontal treatment, antimicrobial therapy, root coverage, and maintenance. We found that the AGREE domains 2 (Stakeholder involvement) and 5 (Applicability) obtained the lowest scores. Domains 1 (Scope and purpose), 3 (Rigor of development) and 4 (Clarity of presentation) obtained the highest scores among the evaluated CPGs. The clinical recommendations for treatment of periodontal diseases were mostly consistent. Overall, the quality of CPGs used in periodontics was high. There was consistency of recommendations in specific fields. These findings may help researchers to promote CPGs focused on different fields of periodontics that have not yet been developed. Furthermore, the clinician will be able to make better clinical decisions.

The 300 Most-Cited Articles in Implant Dentistry.

PURPOSE: The purpose of this study was to review and evaluate the characteristics of the 300 most-cited articles that have been published in the most important implant dentistry journals. MATERIALS AND METHODS: A search and selection of the most-cited articles up to October 2014 was conducted for implant journals with the highest impact factors, according to the ISI Web of Science. The 300-most-cited articles were evaluated according to the most commonly studied topics and methodological designs used. The most-cited journals and the number of articles cited by year were calculated. Descriptive statistics were used to summarize the results. RESULTS: The most-cited topics consisted of implant success/survival and guided bone regeneration, and the most-cited methodological designs were case series and cohort studies. The most frequently referenced journal was The International Journal of Oral and Maxillofacial Implants, with 47% of the citations, and the period with the most citations was 1996 to 2000. CONCLUSION: Longitudinal studies of success and survival have had great scientific impact on the practice of implant dentistry. Awareness of the most-cited articles in implant dentistry will contribute to scientific advances, as it serves to identify the most researched areas, the most frequently used study designs, and areas that require further research.

Methodological Quality of Consensus Guidelines in Implant Dentistry.

BACKGROUND: Consensus guidelines are useful to improve clinical decision making. Therefore, the methodological evaluation of these guidelines is of paramount importance. Low quality information may guide to inadequate or harmful clinical decisions. OBJECTIVE: To evaluate the methodological quality of consensus guidelines published in implant dentistry using a validated methodological instrument. METHODS: The six implant dentistry journals with impact factors were scrutinised for consensus guidelines related to implant dentistry. Two assessors independently selected consensus guidelines, and four assessors independently evaluated their methodological quality using the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument. Disagreements in the selection and evaluation of guidelines were resolved by consensus. First, the consensus guidelines were analysed alone. Then, systematic reviews conducted to support the guidelines were included in the analysis. Non-parametric statistics for dependent variables (Wilcoxon signed rank test) was used to compare both groups. RESULTS: Of 258 initially retrieved articles, 27 consensus guidelines were selected. Median scores in four domains (applicability, rigour of development, stakeholder involvement, and editorial independence), expressed as percentages of maximum possible domain scores, were below 50% (median, 26%, 30.70%, 41.70%, and 41.70%, respectively). The consensus guidelines and consensus guidelines + systematic reviews data sets could be compared for 19 guidelines, and the results showed significant improvements in all domain scores (p < 0.05). CONCLUSIONS: Methodological improvement of consensus guidelines published in major implant dentistry journals is needed. The findings of the present study may help researchers to better develop consensus guidelines in implant dentistry, which will improve the quality and trust of information needed to make proper clinical decisions.

Use of Biologic Agents to Promote Bone Formation in Implant Dentistry: A Critical Assessment of Systematic Reviews.

PURPOSE: The use of biologic agents is emerging in bone regeneration procedures due to their ability to increase cellular events in wound healing and therefore to obtain more predictable outcomes. Hence, the aim of the present study was to critically evaluate the methodology of systematic reviews investigating biologic agents in promoting bone formation and implant site development. MATERIALS AND METHODS: A literature search for systematic reviews with and without meta-analyses was performed in Medline, Embase, and the Cochrane database, as well as in journals with high impact factors in periodontics and implant dentistry. Titles, abstracts, and full-text articles were analyzed for potential inclusion. Three guidelines--AMSTAR, R-AMSTAR, and the checklist proposed by Glenny et al--were utilized to analyze their methodologic quality. Two calibrated reviewers performed all data extraction and appraisal. Cohen's kappa coefficients were calculated to appraise the interexaminer agreement. RESULTS: A total of 12 systematic reviews, 3 with meta-analyses, were evaluated. Platelet-rich derivatives and BMP-2 were the most widely studied biologic agents and sinus augmentation was the most common procedure evaluated. The R-AMSTAR mean score was 28 (range 14-38) and none of the systematic reviews analyzed met all of the items. In the AMSTAR checklist, the mean score was 5.75 (range 2-9) and the only item met by all the systematic reviews was the a priori design. The Glenny et al checklist mean score was 8.6 (range 4-13) and two items, "focused question" and "to identify all relevant studies," were met by all systematic reviews. CONCLUSION: Systematic reviews on biologic agents demonstrate substantial methodologic variability. Therefore, caution must be exercised when interpreting their findings.

Correction: Methodological Quality of Consensus Guidelines in Implant Dentistry.

[This corrects the article DOI: 10.1371/journal.pone.0170262.].

Long-Term Survival Rates of Titanium Implants Placed in Expanded Alveolar Ridges Using Split Crest Procedures: A Systematic Review.

PURPOSE: To evaluate the survival rates of titanium dental implants placed using split crest procedures for alveolar ridge expansion. MATERIALS AND METHODS: The MEDLINE, CENTRAL, and OpenGrey databases were searched up to January 2015 for studies assessing implants that had been placed in areas submitted to split crest procedures. Two methodologic quality-assessment tools were used based on the type of study. For randomized controlled trials (RCTs), the Cochrane Collaboration tool was used to assess the risk of bias. For the observational studies, an adapted version of the Newcastle-Ottawa scale was used. RESULTS: A total of 1,178 patients received 3,033 implants with ridge expansion. On average, the success rate was 96.6% and the survival rate was 96.8%, with a mean follow-up of 58.3 months. Six of the nine included studies used a bone substitute associated or not with a membrane, and seven studies used an implant in both the maxilla and mandible. In addition, half of the observational studies were considered to be of medium quality, whereas the others were considered to be of low quality; the sole RCT included was classified as having a high risk of bias. CONCLUSION: The use of split crest techniques appears to provide predictable alveolar ridge augmentation as well as high survival rates in the short and long term for implants placed in the maxilla or mandible. Patients must be selected with caution.