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AIMS: To conduct a traditional meta-analysis and a Bayesian Network meta-analysis to synthesize the information coming from randomized controlled trials on different socket grafting materials and combine the resulting indirect evidence in order to make inferences on treatments that have not been compared directly. MATERIALS AND METHODS: RCTs were identified for inclusion in the systematic review and subsequent statistical analysis. Bone height and width remodelling were selected as the chosen summary measures for comparison. First, a series of pairwise meta-analyses were performed and overall mean difference (MD) in mm with 95% CI was calculated between grafted versus non-grafted sockets. Then, a Bayesian Network meta-analysis was performed to draw indirect conclusions on which grafting materials can be considered most likely the best compared to the others. RESULTS: From the six included studies, seven comparisons were obtained. Traditional meta-analysis showed statistically significant results in favour of grafting the socket compared to no-graft both for height (MD 1.02, 95% CI 0.44-1.59, p value < 0.001) than for width (MD 1.52 95% CI 1.18-1.86, p value <0.000001) remodelling. Bayesian Network meta-analysis allowed to obtain a rank of intervention efficacy. CONCLUSIONS: On the basis of the results of the present analysis, socket grafting seems to be more favourable than unassisted socket healing. Moreover, Bayesian Network meta-analysis indicates that freeze-dried bone graft plus membrane is the most likely effective in the reduction of bone height remodelling. Autologous bone marrow resulted the most likely effective when width remodelling was considered. Studies with larger samples and less risk of bias should be conducted in the future in order to further strengthen the results of this analysis.
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Perda do Osso Alveolar/prevenção & controle , Substitutos Ósseos/uso terapêutico , Extração Dentária , Teorema de Bayes , Humanos , Metanálise em RedeRESUMO
Three-dimensional printing (3DP) technology has revolutionized the field of the use of bioceramics for maxillofacial and periodontal applications, offering unprecedented control over the shape, size, and structure of bioceramic implants. In addition, bioceramics have become attractive materials for these applications due to their biocompatibility, biostability, and favorable mechanical properties. However, despite their advantages, bioceramic implants are still associated with inferior biological performance issues after implantation, such as slow osseointegration, inadequate tissue response, and an increased risk of implant failure. To address these challenges, researchers have been developing strategies to improve the biological performance of 3D-printed bioceramic implants. The purpose of this review is to provide an overview of 3DP techniques and strategies for bioceramic materials designed for bone regeneration. The review also addresses the use and incorporation of active biomolecules in 3D-printed bioceramic constructs to stimulate bone regeneration. By controlling the surface roughness and chemical composition of the implant, the construct can be tailored to promote osseointegration and reduce the risk of adverse tissue reactions. Additionally, growth factors, such as bone morphogenic proteins (rhBMP-2) and pharmacologic agent (dipyridamole), can be incorporated to promote the growth of new bone tissue. Incorporating porosity into bioceramic constructs can improve bone tissue formation and the overall biological response of the implant. As such, employing surface modification, combining with other materials, and incorporating the 3DP workflow can lead to better patient healing outcomes.
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Dental implant failure cannot always be explained by clinical risk factors. Recent literature suggests that immune cells are pivotal players in the integration of biomaterials and have a co-relationship within a set of osteal macrophages known as "OsteoMacs." These cells have been known to polarize quickly between a M1 pro-inflammatory and a M2 wound healing state during implant osseointegration. OsteoMacs play a critical immune surveillance role in the osseointegration of dental implant healing and bone homeostasis. This review is intended to provide an overview of the current understanding of OsteoMacs and their role in early implant failure and osseointegration.
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Implantes Dentários , Osseointegração , Macrófagos , Materiais Biocompatíveis , Cicatrização , Implantação Dentária EndósseaRESUMO
Introduction: Patients suffering temporomandibular joint internal disc derangement (IDD) ignore appointments after the first examination or after the first or second sessions of initial treatment. The dropout rate for these patients varies from 36% to 78% as per literature. Unfortunately, very few studies have investigated the dropout rate of these patients. Hence, the present study was undertaken to find out the dropout rate among these kinds of patients. Material and Methods: A retrospective study was done from June 2008 to December 2017 by collecting the records of the patients who were diagnosed to have IDD. Outcome variables included were age, sex, distance traveled, occupation, and education. Results: Out of 1021 patients 766 patients were included in the study after fulfilling the inclusion and exclusion criteria. The data were analyzed using Chi-square test. The level of significance was set at <0.05. In this study, there is slight male predominance (52.8%) and 63.1% (21-40 years) were among young adults and the patients in the age group of 21-30 years had shown good compliance, Postgraduate has shown the highest follow-up rate when compared with graduates and school level and the difference was found to be statistically significant. People in the job had shown good compliance when compared with business class and retired people and the patients within 50 km had shown the maximum follow-up with a statistically significant difference (P < 0.01). Conclusion: This study has shown that the dropout rate of treatment in temporomandibular joint disorder is affected by age, sex, distance traveled, occupation, and education.
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To achieve restorative success for esthetic cases a process is needed that can be reproduced repeatedly. As with any process there are critical steps that must be followed to ensure accurate and precise results. This article outlines a verification process of provisional restorations in order to obtain appropriate esthetics, phonetics, and function. Additionally, the article discusses how newly created contours can be transferred intraorally to the laboratory benchtop and then to the final restorations. Through the process of verification, the clinician can establish restorative predictability to enhance the restorative success of any esthetic case.
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Cannabis , Sistemas Eletrônicos de Liberação de Nicotina , Estética DentáriaRESUMO
With the incidence of failed and ailing dental implants increasing, the authors conducted research to evaluate and characterize all known criteria used in the assessment of implant health in the clinical setting. A review of articles found in electronic databases was performed. Once all parameters for implant assessment as supported by current literature were selected, implant assessment documents were created: a data acquisition form and a quantitative comprehensive evaluation. These documents provide the clinician an algorithm that yields a prognosis of survival for each implant. Diagnostic criteria were organized to offer a comprehensive assessment of risk factors related to implant health. Data acquisition prior to establishing the prognosis is necessary in accordance with the staging system developed. Parameters for diagnosis and staging include a thorough medical/social history of the patient, implant history, and clinical evaluation. The authors concluded that the establishment of parameters for comprehensive implant evaluation in the clinical setting is feasible. This assessment process enables an effective clinical approach to evaluate and treat ailing implants while facilitating a clinical diagnostic algorithm.
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Implantes Dentários , Falha de Restauração Dentária , Humanos , PrognósticoRESUMO
Background: The goal of this study was to evaluate hard tissue response following guided bone regeneration us-ing commercially available bovine bone grafts and collagen membranes; bilayer collagen membrane and porcinepericardium-based membrane, by means of a non-destructive three-dimensional (3D) computerized volumetricanalysis following microtomography reconstruction.Material and Methods: Bone regenerative properties of various bovine bone graft materials were evaluated in theGöttingen minipig model. Two standardized intraosseous defects (15mm x 8mm x 8mm) were created bilaterallyof the mandible of eighteen animals (n=72 defects). Groups were nested within the same subject and randomlydistributed among the sites: (i) negative control (no graft and membrane), (ii) bovine bone graft/bilayer collagenmembrane (BOB) (iii) Bio-Oss® bone graft/porcine pericardium-based membrane (BOJ) and (iv) cerabone® bonegraft/porcine pericardium-based membrane (CJ). Samples were harvested at 4, 8, and 12-week time points (n=6animal/time point). Segments were scanned using computerized microtomography (μCT) and three dimensionallyreconstructed utilizing volumetric reconstruction software. Statistical analyses were performed using IBM SPSSwith a significance level of 5% Results: From a temporal perspective, tridimensional evaluation revealed gradual bone ingrowth with the presenceof particulate bone grafts bridging the defect walls, and mandibular architecture preservation over time. Volumetricanalysis demonstrated no significant difference between all groups at 4 weeks (p>0.127). At 8 and 12 weeks therewas a higher percentage of new bone formation for control and CJ groups when compared to BOB and BOJ groups(p<0.039). The natural bovine bone graft group showed more potential for graft resorption over time relative to bo-vine bone graft, significantly different between 4 and 8 weeks (p<0.003)...(AU)