Objectives
The aim of this intrasubject clinical study was to measure and compare prosthodontic and patient‐reported outcome measures (PROMs) in the fabrication of implant‐supported, all‐ceramic ...single crowns with a full digital workflow and a conventional workflow.
Materials and methods
Thirty‐one patients were subjected to first a digital (test group) and then a conventional impression (control group) at the same visit. From the intraoral optical scanner (IOS), a screw‐retained, monolithic crown was delivered according to a complete digital workflow (no cast), whereas a veneered crown on a zirconia (Zi) frame was provided as a control treatment. Both crowns were assessed during the clinical stages of try‐in. Prosthodontic outcomes (contact points, occlusion, PROMs, and esthetic results using the white esthetic score WES) were assessed.
Results
Occlusion and interproximal contacts showed comparable results for the two workflows (p = 0.37 and p = 0.36, respectively), whereas the global WES was significantly higher (p < 0.0001) in the control group. Patient satisfaction scores, using visual analog scales (VAS), were significantly better for IOS than for conventional impressions (p = 0.0098). On the contrary, patients’ perception of the esthetic outcomes showed significantly higher value (p < 0.0001) in the control group.
Conclusions
Both workflows allowed the delivery of ceramic crowns within two appointments. The clinical fit was acceptable in both groups. A better esthetic outcome, in both patients’ and clinicians’ opinions, was found in the control group. PROMs showed higher satisfaction with the IOS.
Aims
The primary objective was to assess the occurrence rate of Medication‐Related OsteoNecrosis of the Jaw (MRONJ) after dental extraction in patients treated with Antiresorptive Drugs (ARD) for ...OsteoPorosis (OP) or for oncological reasons. The secondary objective was to compare the extraction techniques regarding the occurrence of MRONJ.
Materials and Methods
A systematic search in PubMed/MEDLINE, EMBASE and LILACS databases was performed. Prospective studies considering human patients treated with ARD and providing information regarding the occurrence of MRONJ after dental extraction were selected. Meta‐analysis for incidence of MRONJ at the patient level was performed. The effect of administration route and surgical technique on MRONJ was evaluated.
Results
The risk of MRONJ after dental extraction was significantly higher in patients treated with ARD for oncological reasons (3.2%) than in those treated with per os ARD for OP (0.15%) (p < 0.0001). Dental extraction performed with adjusted extraction protocols decreased significantly MRONJ development. Potential risk indicators such as concomitant medications and pre‐existing osteomyelitis were identified.
Conclusion
The risk of MRONJ after dental extraction in patients treated with ARD exists, especially in patients treated for oncologic reasons. This risk tends to decrease with adjusted extraction protocols.
Background and Aims
To review the regenerative technologies used in bone regeneration: bone grafts, barrier membranes, bioactive factors and cell therapies.
Material and Methods
Four background ...review publications served to elaborate this consensus report.
Results and Conclusions
Biomaterials used as bone grafts must meet specific requirements: biocompatibility, porosity, osteoconductivity, osteoinductivity, surface properties, biodegradability, mechanical properties, angiogenicity, handling and manufacturing processes. Currently used biomaterials have demonstrated advantages and limitations based on the fulfilment of these requirements. Similarly, membranes for guided bone regeneration (GBR) must fulfil specific properties and potential biological mechanisms to improve their clinical applicability. Pre‐clinical and clinical studies have evaluated the added effect of bone morphogenetic proteins (mainly BMP‐2) and autologous platelet concentrates (APCs) when used as bioactive agents to enhance bone regeneration. Three main approaches using cell therapies to enhance bone regeneration have been evaluated: (a) “minimally manipulated” whole tissue fractions; (b) ex vivo expanded “uncommitted” stem/progenitor cells; and (c) ex vivo expanded “committed” bone‐/periosteum‐derived cells. Based on the evidence from clinical trials, transplantation of cells, most commonly whole bone marrow aspirates (BMA) or bone marrow aspirate concentrations (BMAC), in combination with biomaterial scaffolds has demonstrated an additional effect in sinus augmentation and horizontal ridge augmentation, and comparable bone regeneration to autogenous bone in alveolar cleft repair.
Aims
Over the past decades, the placement of dental implants has become a routine procedure in the oral rehabilitation of fully and partially edentulous patients. However, the number of ...patients/implants affected by peri‐implant diseases is increasing. As there are – in contrast to periodontitis – at present no established and predictable concepts for the treatment of peri‐implantitis, primary prevention is of key importance. The management of peri‐implant mucositis is considered as a preventive measure for the onset of peri‐implantitis. Therefore, the remit of this working group was to assess the prevalence of peri‐implant diseases, as well as risks for peri‐implant mucositis and to evaluate measures for the management of peri‐implant mucositis.
Methods
Discussions were informed by four systematic reviews on the current epidemiology of peri‐implant diseases, on potential risks contributing to the development of peri‐implant mucositis, and on the effect of patient and of professionally administered measures to manage peri‐implant mucositis. This consensus report is based on the outcomes of these systematic reviews and on the expert opinion of the participants.
Results
Key findings included: (i) meta‐analysis estimated a weighted mean prevalence for peri‐implant mucositis of 43% (CI: 32–54%) and for peri‐implantitis of 22% (CI: 14–30%); (ii) bleeding on probing is considered as key clinical measure to distinguish between peri‐implant health and disease; (iii) lack of regular supportive therapy in patients with peri‐implant mucositis was associated with increased risk for onset of peri‐implantitis; (iv) whereas plaque accumulation has been established as aetiological factor, smoking was identified as modifiable patient‐related and excess cement as local risk indicator for the development of peri‐implant mucositis; (v) patient‐administered mechanical plaque control (with manual or powered toothbrushes) has been shown to be an effective preventive measure; (vi) professional intervention comprising oral hygiene instructions and mechanical debridement revealed a reduction in clinical signs of inflammation; (vii) adjunctive measures (antiseptics, local and systemic antibiotics, air‐abrasive devices) were not found to improve the efficacy of professionally administered plaque removal in reducing clinical signs of inflammation.
Conclusions
Consensus was reached on recommendations for patients with dental implants and oral health care professionals with regard to the efficacy of measures to manage peri‐implant mucositis. It was particularly emphasized that implant placement and prosthetic reconstructions need to allow proper personal cleaning, diagnosis by probing and professional plaque removal.
Dental implants’ success comprises their proper stability and adherence to different oral tissues (integration). The implant is exposed to different mechanical stresses from swallowing, mastication ...and parafunctions for a normal tooth, leading to the simultaneous mechanical movement and deformation of the whole structure. The knowledge of the mechanical properties of the bone and gingival tissues in normal and pathological conditions is very important for the successful conception of dental implants and for clinical practice to access and prevent potential failures and complications originating from incorrect mechanical factors’ combinations. The challenge is that many reported biomechanical properties of these tissues are substantially scattered. This study carries out a critical analysis of known data on mechanical properties of bone and oral soft tissues, suggests more convenient computation methods incorporating invariant parameters and non-linearity with tissues anisotropy, and applies a consistent use of these properties for in silico design and the application of dental implants. Results show the advantages of this approach in analysis and visualization of stress and strain components with potential translation to dental implantology.
Objectives
The aim of this prospective study was to evaluate the implant, prosthesis, and patient‐reported outcomes of maxillary removable prostheses retained by 4 implant‐supported study abutments ...after a follow‐up period of 1 year in patients with natural teeth or a fixed rehabilitation in the mandible.
Materials and Methods
A total of 30 patients were included, and all received 4 implants in the upper maxilla. After 12 weeks, the prostheses were connected to the implant with unsplinted attachments. The implant and prosthodontics outcomes were assessed over a follow‐up period of 1 year. Patient‐reported outcome measures (PROMs) were evaluated with the Oral Health Impact Profile (OHIP‐20) questionnaire and an adaptation of the McGill Denture Satisfaction Instrument using a visual analogue scale (VAS).
Results
A single patient dropped out. At the post‐operative 12‐week follow‐up, 79.3% (95% CI: 64.6%–94.1%) of the patients displayed peri‐implant mucosa hyperplasia and 69.0% (95% CI: 52.1%–85.8%) showed pain. After 1 year, 16 implants failed in 10 patients, leading to an implant survival rate of 86.2% (95% CI: 79.0%–92.5%), and the mean peri‐implant bone loss was 1.01 ± 0.77 mm (95% CI: 0.85–1.16 mm). The prosthesis survival rate was 96.6% (95% CI: 82.2%–99.9%). The OHIP‐20 and VAS scores both improved significantly from baseline to 1 year (p < .001).
Conclusion
The implant survival rate was lower compared to the literature for the upper maxilla. Despite the encountered problems, PROMs showed significant improvement with the implant overdenture retained by 4 unsplinted implants compared to conventional dentures.
This descriptive study reviewed the 1- to 15-year survival rates of fixed implant rehabilitations in the edentulous maxilla.
An electronic search was conducted, and cohort studies with 1- to 15-year ...follow-ups were identified by two independent reviewers. The implant and prosthodontic survival rates were reviewed at 1-, 3-, 5-, 10-, and 15-year endpoints. Descriptive analysis includes surface characteristics, bone-augmentation procedure, prosthetic design, and implant number and distribution along the edentulous maxilla.
Thirty-three studies, including 1,320 patients and 8,376 implants, were selected for analysis. The overall calculated implant survival rates ranged from 94% (1 year) to 87.7% (15 years). The implant survival rates for rough-surface implants ranged from 97% (1 year) to 98% (15 years); machined implants showed survival rates of 92% to 87.7%; respectively. Implants placed in native bone had greater survival rates than those placed in augmented bone. The prosthodontic survival rate ranged from 98.2% at 1 year to 92.1% at the 10-year endpoint, and it was only influenced by the implant number and distribution.
Implants with rough surfaces showed a statistically higher survival rate than machined implants at all intervals. Implants placed in augmented bone had a statistically lower survival rate, except for rough-surface implants, for which no statistical difference between augmented and non-augmented bone survival rates was found. Machined implants showed a stable survival rate only when placed in native bone. When machined implants were placed in augmented bone, the survival rate decreased significantly at each study endpoint. The prosthetic design, veneering material, and the number of prostheses per arch had no influence on the prosthodontic survival rate. Implant number and distribution along the edentulous maxilla seemed to influence the prosthodontic survival rate.
Objective
To explore patient-related outcomes measures (PROMs) of piezocision-assisted orthodontic treatment compared to a conventional orthodontic treatment using customized appliance.
Materials and ...methods
Twenty-four adult patients requiring orthodontic treatment for mild-to-moderate overcrowding in both jaws were randomly assigned to a test group, treated with a piezocision-assisted orthodontic treatment, or to a control group, where piezocision was not applied. The patient-related outcomes were recorded using a 0–10 visual analog scale (VAS). Daily analgesic consumption and pain level were also recorded following the placement of the orthodontic appliance in both groups and after the piezocision procedure in the test group. Moreover, levels of apprehension and satisfaction were also assessed in both groups.
Results
In the piezocision group, over the 7-day period, paracetamol consumption was comparable after the placement of the orthodontic appliance and after the piezocision surgery. Pain levels after the orthodontic and the surgical procedure decreased with time (
p
< 0.0001) but remained globally higher after piezocision (
p
= 0.0056). Significantly, more patients of the piezocision group reported that they would undergo the treatment again (
p
= 0.033) and that they greatly appreciated the duration of treatment (
p
= 0.0008). However, the level of apprehension was significantly higher in the piezocision group compared to the test group (
p
= 0.012).
Conclusions
Although, the degree of apprehension before the surgery and higher pain level in the piezocision group, PROMs emphasized similar pain killer consumption in both group and revealed high acceptance and satisfaction with piezocision approach.
Clinical relevance
The benefit of piezocision-assisted orthodontic treatment seems to be relevant from a patient perspective.
Trial registration
NCT03406130
In this study, planting density and site effects on hybrid poplar productivity and stem dimensions were evaluated on the mid-term and longer term (8 and 14 years) in southern Québec (Canada). We also ...evaluated the effects of planting density and site on biomass accumulation and carbon stocks in different plantation compartments, on biomass partitioning at the stand-level, on soil carbon stocks and on soil nutrient supply rate after 14 years. The experimental design consisted of three replicate poplar stands located along a site fertility gradient. Each stand contained six planting densities (ranging from 494 to 1975 trees/ha) and a single genotype (Populus canadensis × P. maximowiczii hybrid). Planting density had a large effect on stem dimensions, but a minor effect on stand volume, aboveground woody biomass production, and aboveground biomass carbon stocks. Site selection and tree survival were more important factors affecting these variables. At all sites, and independent of planting density, mean annual volume increments were also higher after 14 vs. 8 years. On fertile sites, strong correlations between area per tree at planting and biomass partitioning, carbon allocation belowground, soil nutrient supply rate and soil carbon stocks were observed. Aboveground, higher competition for light with increasing planting density resulted in an increase in the stem to branch ratio. Belowground, higher competition for soil resources with increasing planting density reduced soil macronutrient availability (except for potassium), which likely stimulated carbon allocation belowground and carbon accumulation in the soil. Over the longer-term, higher density plantations of poplars could provide greater benefits in terms of carbon storage belowground (soil and roots).
The mechanisms underlying the pathophysiology of medication-related osteonecrosis of the jaw (MRONJ) development have not yet been fully elucidated. MRONJ is described as a multi-factorial process in ...which bacterial infection seems to play an important role. The purpose of the present study was to investigate the influence of a primary installed infectious disease in the development of MRONJ after dental extraction.
Twenty-six rats underwent pulpal exposure of one upper and one lower first molar to induce periapical lesions. Thereafter, animals received zoledronate during a 4-week period. The day after the last injection, the four first molars from each quadrant were extracted. Eight weeks later, animals were sacrificed for macroscopic, radiological, and histological assessment.
The incidence of MRONJ was highest in mandibular infected teeth (47.4%), while the histological evaluation showed the highest incidence of osteonecrosis (88.2%) and the largest mean value for extent of the necrotic bone area (1.22 ± 0.71 mm2). Radiological findings confirmed the clinical and histological results. Statistical analysis showed that the combination of both factors, mandibular localization and periapical infection, significantly increased the incidence of MRONJ after extraction, considering clinical (p = 0.0074), radiological (p = 0.026), and histological (p = 0.0022) outcomes.
These findings support the potential implication of inflammatory/infectious dental pathology in initiating the osteonecrotic process before dental extraction. The possible partial role of the infectious process in MRONJ development emphasizes the importance of maintaining good oral health and dental care for preventing infectious pathology in the management of these patients.
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