Objectives: The outcome of implant treatment in periodontally compromised partially edentulous patients has not been completely clarified. Therefore, the aim of the present study was to perform, ...applying a systematic methodology, a comprehensive and critical review of the prospective studies published in English up to and including August 2006, regarding the short‐term (<5 years) and long‐term (≥5 years) prognosis of osseointegrated implants placed in periodontally compromised partially edentulous patients.
Material and methods: Using The National Library Of Medicine and Cochrane Oral Health Group databases, a literature search for articles published up to and including August 2006 was performed. At the first phase of selection the titles and s and at the second phase full papers were screened independently and in duplicate by the three reviewers (I. K. K., S. K., I. F.).
Results: The search provided 2987 potentially relevant titles and s. At the first phase of evaluation, 2956 publications were rejected based on title and . At the second phase, the full text of the remaining 31 publications was retrieved for more detailed evaluation. Finally, 15 prospective studies were selected, including seven short‐term and eight long‐term studies. Because of considerable discrepancies among these studies, meta‐analysis was not performed.
Conclusions: No statistically significant differences in both short‐term and long‐term implant survival exist between patients with a history of chronic periodontitis and periodontally healthy individuals. Patients with a history of chronic periodontitis may exhibit significantly greater long‐term probing pocket depth, peri‐implant marginal bone loss and incidence of peri‐implantitis compared with periodontally healthy subjects. Even though the short‐term implant prognosis for patients treated for aggressive periodontitis is acceptable, on a long‐term basis the matter is open to question. Alterations in clinical parameters around implants and teeth in aggressive periodontitis patients may not follow the same pattern, in contrast to what has been reported for chronic periodontitis patients. However, as only three studies comprising patients treated for aggressive periodontitis were selected, more studies, specially designed, are required to evaluate implant prognosis in this subtype of periodontitis. As the selected publications exhibited considerable discrepancies, more studies, uniformly designed, preferably longitudinal, prospective and controlled, would be important.
Aim
To evaluate the non‐inferiority of the adjunct of a xenogeneic collagen matrix (CMX) or connective tissue graft (CTG) to coronally advanced flaps (CAF) for coverage of multiple adjacent ...recessions and compare superiority in patient‐reported outcomes (PROM).
Material and methods
One hundred and eighty‐seven subjects (92 CMX) with 485 recessions in 14 centres were randomized and followed up for 6 months. Patients filled daily diaries for 15 days to monitor patient‐reported experience. The primary outcome was changed in position of the gingival margin. Multilevel analysis used centre, subject and tooth as levels and baseline parameters as covariates.
Results
Average baseline recession was 2.5 ± 1.0 mm. The surgery was 15.7 min shorter (95%CI from 11.9 to 19.6, p < .0001) and perceived lighter (11.9 VAS units, 95%CI from 4.6 to 19.1, p = .0014) in CMX subjects. Time to recovery was 1.8 days shorter in CMX. Six‐month root coverage was 1.7 ± 1.1 mm for CMX and 2.1 ± 1.0 mm for CTG (difference of 0.44 mm, 95%CI from 0.25 to 0.63 mm). The upper limit of the confidence interval was over the non‐inferiority margin of 0.25 mm. Odds of complete root coverage were significantly higher for CTG (OR = 4.0, 95% CI 1.8–8.8).
Conclusion
Replacing CTG with CMX shortens time to recovery and decreases morbidity, but the tested generation of devices is probably inferior to autologous CTG in terms of root coverage. Significant variability in PROMs was observed among centres.
Therapy of peri-implantitis: a systematic review Kotsovilis, Sotirios; Karoussis, Ioannis K.; Trianti, Maria ...
Journal of clinical periodontology,
July 2008, Volume:
35, Issue:
7
Journal Article
Peer reviewed
Aim: The objective of this study was to provide a systematic review of randomized controlled and/or comparative clinical trials published in the international peer‐reviewed literature in the English ...language, up to and including July 2007, concerning the efficacy of all treatment modalities implemented for the therapy of peri‐implantitis.
Material and Methods: PubMed and The Cochrane Library databases were searched electronically and numerous journals were examined manually. In the first phase of selection, the titles and s, and in the second phase, complete papers were screened independently and in duplicate by three reviewers (S. K., I. K. K. and M. T.).
Results: The search yielded 1304 possibly relevant titles and s. After the first phase of selection, 13 publications were singled out for a rigorous evaluation. Following the second phase, five studies were selected.
Conclusions: The selected studies are too limited in number and exhibit small sample sizes and short follow‐up periods. Therefore, there is a definite need for more well‐designed, preferably longitudinal, randomized controlled clinical trials. Within the limitations of the selected studies, mechanical debridement combined with antiseptic/antibiotic therapy, the Er:YAG laser or regenerative techniques may be used for treating peri‐implantitis, but the indications for each of these techniques have not been delineated clearly.
Objectives: A thorough and exhaustive analysis of the available studies concerning placement of endosseous dental implants in diabetic subjects has not been previously published. The aim of the ...present study was to perform a comprehensive and critical review of experimental and clinical studies published in the international peer‐reviewed literature in the English language regarding endosseous implant installation in diabetic subjects and to draw evidence‐based conclusions on the effectiveness and predictability of dental implant therapy in diabetic patients.
Material and methods: Literature search for articles published up to and including March 2005 in the English language was performed with a personal computer (PC) using The National Library Of Medicine (http://www.ncbi.nlm.nih.gov/PubMed) and Cochrane Oral Health Group databases. Search strategy included a specific series of terms and key words. The reference lists of identified publications, relevant texts and previous workshops were also scanned. Data sources also included several hand‐searched journals and contact with experts, when it was considered appropriate. Search was conducted independently by the three reviewers (S. K., I. K. K., I. F.). At the first phase of selection the titles and s and at the second phase full papers were screened independently by the three reviewers. Disagreement regarding inclusion of full papers was resolved by discussion among the reviewers.
Results: The search provided 227 potentially relevant titles and s. At the first phase of evaluation, 199 publications were rejected based on title and . At the second phase, the full text of the remaining 28 publications was retrieved for more detailed evaluation. These publications included 11 experimental studies and 16 clinical studies (one clinical study corresponded to two publications). Finally, 11 experimental and eight clinical studies were accepted. Clinical studies included four prospective and four retrospective studies. Because of the limited number of available studies and their heterogeneity, focusing on a specific predefined question to be answered by a systematic review was not feasible and therefore no meta‐analysis was planned.
Conclusion: Within the limits of the existing investigations, experimental studies seem to reveal an impaired bone healing response to implant placement in diabetic animals compared with non‐diabetic controls, both quantitatively and qualitatively. The majority of clinical studies tend to indicate that diabetes is no contraindication for implant placement, on condition that it remains under metabolic control. However, definitive guidelines with objective criteria, such as type and duration of diabetes and glucosylated hemoglobin levels, need to be established in the future.
Aim: This prospective multicenter randomized controlled clinical trial was designed to compare the clinical outcomes of papilla preservation flap surgery with or without the application of enamel ...matrix derivatives (EMD). This article reports on early healing events, post‐operative morbidity and patient perceptions of the surgical outcomes.
Material and Methods: One hundred and seventy‐two patients with advanced chronic periodontitis and at least one intrabony defect of 3 mm were recruited in 12 centres in seven countries (European Research Group on Periodontology (ERGOPERIO)). Papilla preservation flaps were used to obtain access and primary closure. After debridement, and root conditioning, EMD was applied in the test subjects, and omitted in the controls. Healing was monitored 1, 2, 3, 4, 6 and 12 weeks after surgery. During the first 12 weeks of healing, supracrestal soft‐tissue density was evaluated with a computer‐assisted densitometric image analysis system (CADIA) using underexposed radiographs taken on a subset of 34 patients. Patient perceptions were evaluated with a questionnaire immediately after the procedure, at suture removal 1 week later and at 1 year.
Results: Subjects reported little intraoperative or post‐operative pain or discomfort for both test and controls. Twenty‐four percent of controls and 30% of tests (p=0.64) reported a degree of interference with daily activities for an average of 3 and 3.5 days, respectively. Post‐surgical edema was noted in 25% of tests and 28% of controls. Wound dehiscence in the interdental portion of the flap was uncommon (14% of tests and 12% of controls at week 1) and of limited size. Root sensitivity was the most frequent post‐operative adverse event: it affected 45% of test and 35% of controls (p=0.55). Up to 6 weeks post‐operatively, soft‐tissue densities were significantly higher in subjects treated with EMD with respect to controls. One year after completion of the surgery, patients reported high levels of satisfaction with the outcomes. The most frequently reported benefits included the ability to preserve a tooth/dentition and to maintain/improve chewing ability. The cost and need for frequent follow‐ups were cited as significant drawbacks.
Conclusions: This study portrayed the early healing events, pain, discomfort and adverse events of papilla preservation flap surgery and the 1‐year patient perceptions of the benefits and disadvantages of periodontal surgery in intrabony defects. Earlier gains in soft‐tissue density were observed following application of EMD. In terms of patient‐centered outcomes, however, both procedures performed in a similar manner.
For decades, oral implants have been used successfully for the replacement of missing teeth. Nevertheless, peri‐implant diseases have become an increasingly important issue in daily practice. In this ...working group, the prevalence of peri‐implant mucositis and peri‐implantitis, as well as different general risk factors and their impact on the onset and progression of peri‐implant diseases, were discussed based on reviews reflecting the current state of evidence. The influence of smoking on the peri‐implant bone‐healing process and its association with peri‐implantitis has been explored in the current literature, demonstrating that smoking is an important risk indicator for the development of peri‐implantitis and implant loss. Compared with non‐smokers, smokers have a higher potential for pathological peri‐implant bone loss, which is also influenced by poor oral hygiene. Despite the fact that a growing number of genetic polymorphisms have been identified and related to periodontal diseases, there are still no genetic patterns that could act as adjuncts to clinical diagnostics in order to identify patients at higher risk of peri‐implant diseases. Long‐term medications, such as bisphosphonate therapy (> 3 years), may have an impact on implant loss. A higher incidence of implant failure was reported in patients using selective serotonin reuptake inhibitors in anti‐depression therapy. Alcoholism (defined as more than 5 units a day) has been associated with implant loss in retrospective and case–control studies, as well as in animal studies.
A meta-analysis on the survival of short implants compared to conventional implants has never been performed. Therefore, the aim of this study was to address the focused question "Is there a ...significant difference in survival between short (<or=8 or <10 mm) and conventional (>or=10 mm) rough-surface dental implants placed in 1) totally or 2) partially edentulous patients?" by conducting a systematic review and meta-analysis of prospective studies published in the dental literature in the English language up to and including August 2007.
PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were scanned electronically, and seven journals were searched manually. In the first phase of selection, titles and abstracts, and in the second phase, full texts, were evaluated autonomously and in duplicate by two reviewers. Extensive contact with authors was carried out in search of missing, unclear, or unpublished data.
The electronic and manual search provided, respectively, 1,056 and 14,417 titles and abstracts. In the second phase of selection, the complete text of 300 articles was examined, and 37 articles reporting on 22 patient cohorts were selected. Meta-analyses revealed no statistically significant difference in survival between short (<or=8 or <10 mm) and conventional (>or=10 mm) rough-surface implants placed in totally or partially edentulous patients.
Within the limitations of this systematic review, the placement of short rough-surface implants is not a less efficacious treatment modality compared to the placement of conventional rough-surface implants for the replacement of missing teeth in either totally or partially edentulous patients.
Several studies have shown that GTR therapy of intrabony defects results in significantly better outcomes than access flap alone. Most of the available data, however, have been produced in highly ...controlled research environments by a small group of investigators. Generalizability of results to different clinicians and different subject populations has not been evaluated so far.
This parallel group study involved 143 patients recruited in a practice-based research network of 11 offices in 7 countries. It was designed to evaluate: 1) the applicability of the documented added benefits of GTR in the treatment of intrabony defects to different populations, and 2) the generalizability of the expected results to different clinicians. GTR was compared to access flap alone. Defects, one in each patient, were accessed with a previously described papilla preservation flap in both the test and control group. In addition, GTR sites received application of a bioabsorbable poly-D,L-lactide-co-glycolide membrane. A stringent plaque control regimen was enforced in all patients during the 1-year observation period. Outcomes included gains in clinical attachment (CAL) and reductions in probing depth.
Observed gains in CAL were 2.18 +/- 1.46 mm for access flap and 3.04 +/- 1.64 mm for the GTR-treated group. The treatment-associated difference was statistically significant (P = 0.03) after correcting for both center effect and defect anatomy. Among the various centers, a 1.73 mm difference in CAL gain was observed. This is a clinically relevant amount, which underlines the significance of center variability in the outcome of periodontal surgical procedures. A frequency distribution analysis of the obtained CAL gains indicated that GTR treatment of deep intrabony defects decreased, with respect to the access flap control, the probability of obtaining only a modest attachment gain at 1 year. Conversely, CAL gains of 4 mm or more were observed in more than 40% of GTR-treated defects and in less than 20% of the controls (P < 0.0001).
These data indicate that GTR therapy of deep intrabony defects performed by different clinicians on various patient populations resulted in both greater amounts and improved predictability of CAL gains than access flap alone.
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