Objectives
The purpose of this systematic review was to evaluate the impact of the abutment characteristics on peri‐implant tissue health and to identify the most suitable material and surface ...characteristics.
Methods
A protocol was developed aimed to answer the following focused question: “Which is the effect of the modification of the abutment design in regard to the maintenance of the peri‐implant soft tissue health?” Further subanalysis aimed to investigate the impact of the abutment material, macroscopic design, surface topography and surface manipulation. Randomised controlled trials (RCTs) with a follow‐up of at least 6 months after implant loading were considered as inclusion criteria. Meta‐analyses were performed whenever possible.
Results
Nineteen final publications from thirteen investigations were included. The results from the meta‐analysis indicated that zirconia abutments (Zi) experienced less increase in BOP values over time n = 3; WMD = −26.96; 95% CI (−45.00; −8.92); p = .003 and less plaque accumulation n = 1; MD = −20.00; 95% CI (−41.47; 1.47); p = .068 when compared with titanium abutments (Ti). Bone loss was influenced by the method of abutment decontamination n = 1; MD = −0.44; 95% CI (−0.65; −0.23); p < .001. The rest of the studied outcomes did not show statistically significant differences.
Conclusions
The macroscopic design, the surface topography and the manipulation of the implant abutment did not have a significant influence on peri‐implant inflammation. In contrast, the abutment material demonstrated increased BOP values over time for Ti when compared to Zi abutments.
Bone‐regenerative interventions aiming to restore deficient alveolar ridges, such as the use of block grafts or through the application of guided bone‐regeneration principles, have reported positive ...outcomes in the published scientific literature. These interventions, however, are invasive, and hence, intraoperative and/or postoperative complications may occur. The types of complications and their severity may vary from the exposure of the biomaterial (membrane or graft) to postsurgical infections, neurosensorial disturbances, occurrence of hemorrhage, and pain, etc. The aim of the present narrative review was to search the available scientific evidence concerning the incidence of these complications, their effect on treatment outcomes, their clinical management and, finally, strategies aimed at prevention. Exposure of the barrier membrane or the block graft is the most common complication associated with oral regenerative interventions. To manage these complications, depending on the extent of the exposure and the presence or absence of concomitant infections, therapeutic measures may vary, from the topical application of antiseptics to the removal of the barrier membrane or the block graft. Regardless of their treatment, the occurrence of these complications has been associated with patient selection, with compliant patients (eg, nonsmokers) having a lower reported incidence of complications. Similarly, surgical factors such as correct flap elevation and a tensionless closure are of obvious importance. Finally, to prevent the incidence of complications, it appears prudent to utilize whenever possible less invasive surgical interventions.
Objectives
The primary aim of this systematic review was to evaluate the available evidence on the effect of the abutment material on the stability and health of the peri‐implant hard tissues.
...Methods
A protocol was developed to answer the following focused question: “Which is the effect of the abutment material on stability and health of the peri‐implant hard tissues?” Randomized controlled trials (RCTs), controlled clinical trials (CCTs) or prospective case series (CS) with at least 6 months of follow‐up were included, and meta‐analyses were performed to compare abutment materials vs. titanium and to evaluate the impact of various abutment materials on bone changes (primary outcome), probing depth, plaque levels and peri‐implant mucosal inflammation.
Results
Twenty‐nine publications from 33 investigations were included. Results from the meta‐analyses demonstrated no significant differences between the different abutment materials when compared to titanium, in regard to the changes in marginal bone levels (MBLs) (n = 15; WMD = 0.034; 95% CI −0.04, 0.10; p < 0.339). The meta‐analysis reported a significantly greater increase in bleeding on probing for titanium compared to zirconia abutments (n = 3; WMD = −26.96%; 95% CI −45.00%, −8.92%; p = 0.003). When evaluating the behaviour of each material different to titanium, there was a significant bone loss over time (n = 31; WMD = 0.261; 95% CI 0.18, 0.35; p < 0.001) for all the individual materials except for titanium nitride.
Conclusions
This systematic review has shown that the abutment material had minimal impact on marginal bone levels when compared to the standard titanium.
Aim
The primary aim of this systematic review was to evaluate the effect of various techniques used for vertical ridge augmentation on clinical vertical bone gain.
Material and Methods
A protocol was ...developed to answer the following focused question: “In patients with vertical alveolar ridge deficiencies, how effective are different augmentation procedures for clinical alveolar ridge gain?” Randomized and controlled clinical trials and prospective and retrospective case series were included, and meta‐analyses were performed to evaluate vertical bone gain based on the type of procedure and to compare bone gains in controlled studies.
Results
Thirty‐six publications were included. Results demonstrated a significant vertical bone gain for all treatment approaches (n = 33; weighted mean effect = 4.16 mm; 95% CI 3.72–4.61; p < 0.001). Clinical vertical bone gain and complications rate varied among the different procedures, with a weighted mean gain of 8.04 mm and complications rate of 47.3% for distraction osteogenesis, 4.18 mm and 12.1% for guided bone regeneration (GBR), and 3.46 mm and 23.9% for bone blocks. In comparative studies, GBR achieved a significant greater bone gain when compared to bone blocks (n = 3; weighted mean difference = 1.34 mm; 95% CI 0.76–1.91; p < 0.001).
Conclusions
Vertical ridge augmentation is a feasible and effective therapy for the reconstruction of deficient alveolar ridges, although complications are common.
Background and objectives
Immediate loading has become a predictable option to restore all clinical situations. The aim of this systematic review was to assess whether immediate loading protocols ...achieve comparable clinical outcomes when compared to conventional loading protocols depending on the type of prosthetic restoration.
Methods
A protocol was developed aimed to answer the following focused question: “What are the effects of immediate implant loading protocols compared to conventional implant loading, in terms of implant failure, marginal bone levels, and biological and mechanical complications based on the type of restoration?” The next subanalysis were performed as follows: the extent, type, and material of the restoration and the type of occlusal contact in function. This systematic review only included randomized controlled trials (RCTs) with a follow‐up of at least 6 months after implant loading.
Results
Thirty‐seven final papers were included. The results from the meta‐analyses have shown that the immediately loading implants demonstrated a statistically significant higher risk of implant failure RR = 1.92; 95% CI (1.04; 3.54); P = 0.036, a statistically significant lower bone loss WMD = 0.046; 95% CI (0.043; 0.049); P = 0.000 and a smaller increase in ISQ values WMD = −1.096; 95% CI (−1.615; −0.577); P < 0.001, although both groups attained high survival rates (98.2% in the test and 99.6% in the control). Single teeth implants were greater risk of failure, when compared to immediately loaded full arch restorations (RR = 2 vs. 0.9), so as the occlusal pattern when compared to non‐occlusal (RR = 1.9 vs. 1.4).
Conclusions
Immediate loading may impose a greater risk for implant failure when compared to conventional loading, although the survival rates were high for both groups.
Objective
To review the dental literature in terms of soft tissue augmentation procedures and their influence on peri‐implant health or disease in partially and fully edentulous patients.
Methods
A ...MEDLINE search from 1966 to 2016 was performed to identify controlled clinical studies comparing soft tissue grafting versus no soft tissue grafting (maintenance) or two types of soft tissue grafting procedures at implant sites. The soft tissue grafting procedures included either an increase of keratinized tissue or an increase of the thickness of the peri‐implant mucosa. Studies reporting on the peri‐implant tissue health, as assessed by bleeding or gingival indices, were included in the review. The search was complemented by an additional hand search of all selected full‐text articles and reviews published between 2011 and 2016. The initial search yielded a total number of 2,823 studies. Eligible studies were selected based on the inclusion criteria (finally included: four studies on gain of keratinized tissue; six studies on gain of mucosal thickness) and quality assessments conducted. Meta‐analyses were applied whenever possible.
Results
Soft tissue grafting procedures for gain of keratinized tissue resulted in a significantly greater improvement of gingival index values compared to maintenance groups (with or without keratinized tissue) n = 2; WMD = 0.863; 95% CI (0.658; 1.067); p < .001. For final marginal bone levels, statistically significant differences were calculated in favor of an apically positioned flap (APF) plus autogenous grafts versus all control treatments (APF alone; APF plus a collagen matrix; maintenance without intervention with or without residual keratinized tissue) n = 4; WMD = −0.175 mm; 95% CI: (−0.313; −0.037); p = .013. Soft tissue grafting procedures for gain of mucosal thickness did not result in significant improvements in bleeding indices over time, but in significantly less marginal bone loss over time WMD = 0.110; 95% CI: 0.067; 0.154; p < .001 and a borderline significance for marginal bone levels at the study endpoints compared to sites without grafting.
Conclusions
Within the limitations of this review, it was concluded that soft tissue grafting procedures result in more favorable peri‐implant health: (i) for gain of keratinized mucosa using autogenous grafts with a greater improvement of bleeding indices and higher marginal bone levels; (ii) for gain of mucosal thickness using autogenous grafts with significantly less marginal bone loss.
Objective
To assess the added value of using a bone replacement graft in combination with immediate implants in reducing the bone dimensional changes occurring in the residual ridge.
Material and ...methods
Randomized parallel controlled clinical trial to study the efficacy of grafting with demineralized bovine bone mineral with 10% collagen (DBBM‐C) in the gap between the implant surface and the inner bone walls when the implants were immediately placed in the anterior maxilla. The changes between implant placement and 16 weeks later in the horizontal and vertical crestal bone changes in relation to the implant were evaluated through direct bone measurements using a periodontal probe. Mean changes were compared between the experimental and control sites using parametric statistics.
Results
A total of 86 implant sites in 86 subjects were included in the analysis (43 in the test group and 43 in the control group). The horizontal crest dimension underwent marked changes during healing mainly at the buccal aspect of the alveolar crest where this reduction amounted to 1.1 (29%) in the test group and 1.6 mm (38%) in the control group, being these statistically significant (P = 0.02). This outcome was even more pronounced at sites in the anterior maxilla and with thinner buccal bone plates.
Conclusions
In conclusion, the results from this clinical trial demonstrated that placing a DBBM‐C bone replacement graft significantly reduced the horizontal bone resorptive changes occurring in the buccal bone after the immediate implantation in fresh extraction sockets.
Objectives
This in vitro investigation was aimed to evaluate the cleaning ability of four mechanical devices designed for decontaminating implant surfaces.
Material and methods
Ninety‐six implants ...were coated with permanent ink and inserted into 3D‐printed resin blocks simulating three different intraosseous defect configurations (types Ib, Ic, and Ie). The four tested mechanical decontamination devices (air‐polishing with glycine powder, rotating titanium brush, polyetheretherketone PEEK‐coated ultrasonic tip, and stainless steel ultrasonic tip) were randomly applied onto the 5 mm exposed implant surface. Standardized photographs were taken from a frontal perspective and with a 30° angle coronally and apically to the implant axis. The area with remnant ink on the implant surface was calculated.
Results
Although none of the groups achieved complete ink removal, air‐polishing with glycine and titanium brushes demonstrated a higher cleaning ability when compared with ultrasonic devices either with standard or PEEK tips for all three defect configurations. For the three tested models, the best cleaning ability in all groups was shown on implant surfaces without facing an intraosseous wall. Titanium brush was the most effective when the intraosseous walls existed. Cleaning effectiveness diminished in the threads located in the apical third, especially when using air‐polishing and ultrasonic devices.
Conclusions
Titanium brushes and air‐polishing devices were more effective in removing artificial biofilm using this in vitro model, although their effectiveness was influenced by the presence of the intrabony component.
Aim
This systematic review aimed to answer the following focused questions: (a) “In patients with periodontitis, how effective are access flaps (AFs) as compared to subgingival debridement in ...attaining probing depth (PD) reduction?” and (b) “In patients with periodontitis, does the type of AF impact PD reduction?”.
Material and Methods
Randomized clinical trials were searched in three databases. Besides PD, information concerning clinical attachment level (CAL) and other relevant outcomes was also collected. Meta‐analyses were performed whenever possible and results were categorized based on the initial PD.
Results
Thirty‐six publications were included. AFs resulted in a significantly greater PD reduction in deep pockets (>6 mm or ≥6 mm), as compared to subgingival debridement, in short‐ (n = 4; weighted mean difference WMD = 0.67 mm; 95% confidence interval CI 0.37,0.97; p < .001) and long‐term studies (n = 4; WMD = 0.39 mm; 95% CI 0.09,0.70; p = .012), while in moderately deep pockets (4–6, 5–6 or 4–5 mm) only in short‐term studies (n = 4; WMD = 0.34; 95% CI 0.21,0.46; p < .001). In shallow pockets (1–3 or 1–4 mm), AFs led to greater CAL (n = 7; WMD = −0.43 mm; 95% CI −0.56, −0.28; p < .001). There was not enough evidence to answer question PICO 2.
Conclusions
AFs resulted in greater PD reduction in the treatment of deep and moderate pockets.
Open and closed sinus lifting procedures are predictable methods to augment the bone needed for appropriate implant placement in the posterior maxilla in cases where available bone is limited. ...However, these techniques may give rise to complications and associated comorbidities. In the case of open sinus lifting, perforation of the Schneiderian membrane during osteotomy is the most common complication, with an incidence rate of around 20%‐25%. Apart from those complications associated with oral surgery in general (such as swelling or hematoma), there are specific complications of open sinus lifting procedures that may arise less frequently (chronic rhinosinusitis, hemorrhage, or ostium blockage by overfilling) but which may nevertheless compromise the viability of the graft and/or the implants and cause substantial discomfort to the patient. Closed sinus lifting is a less invasive approach that allows transcrestal placement of the implants in cases where there is sufficient residual bone height. However, it may also be associated with specific complications, including membrane perforation, benign paroxysmal positional vertigo, and implant displacement to the sinus cavity. New technologies have been proposed to reduce these complications and comorbidities associated with conventional sinus lifting procedures, such as the use of piezoelectric devices and hydraulic sinus lift or reamer burs. The evidence supporting their effectiveness and safety, however, is still lacking. A detailed medical history together with a thorough radiographic and clinical examination are essential prior to any kind of bone regenerative augmentation involving the maxillary sinus. Moreover, it is recommended to employ the most appropriate surgical technique for the specific characteristics of the case and, at the same time, accommodating the experience and skills of the surgeon.
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