Immediate implant placement utilizing vestibular socket therapy versus early implant placement with contour augmentation for rehabilitation of compromised extraction sockets in the esthetic zone: A randomized controlled clinical trial.

OBJECTIVE: The present randomized controlled trial compares for the first time the vestibular socket therapy (VST) to the contour augmentation technique in the management of compromised fresh extraction sockets in the maxillary esthetic zone, regarding mid-facial soft tissue changes (primary outcome), mesial and distal papillae dimensions, horizontal soft tissue changes and labial bone plate thickness at apical, middle and coronal levels (secondary outcomes) over 1-year. MATERIALS AND METHODS: Forty participants with single nonrestorable maxillary teeth in the esthetic zone were randomized into two groups; VST (test; n = 20) utilizing vestibular access for guided bone regeneration (GBR) with immediate implant placement, or contour augmentation (control; n = 20) undergoing an initial healing period followed by implant placement with GBR through a conventional access flap. RESULTS: All implants were successfully osseo-integrated, except for one implant in the test group. VST showed significantly less mid-facial soft tissue changes of -0.53 ± 1.17 mm versus -1.87 ± 0.69 mm in the control group (p < 0.001). Similarly, changes in mesial papilla (test = -0.64 ± 0.95 mm, control = -1.20 ± 0.81 mm), distal papilla (test = -0.56 ± 1.17 mm, control = -1.26 ± 0.63 mm), horizontal soft-tissue (test = -0.82 ± 0.95 mm, control = -1.84 ± 0.88 mm; p < 0.05) were significantly less in VST. Intra-group comparisons demonstrated a significant increase in labial bone thickness, with no differences between groups. Regression analysis revealed a significant correlation between VST as well as increased coronal bone thickness with the reduction in mid-facial soft-tissue changes. CONCLUSION: The VST showed less soft-tissue changes and could represent an innovative technique for implant placement in the maxillary esthetic zone. Both techniques showed a high implant survival rate and increased bone thickness after 12 months.

MORE EVIDENCE IS NEEDED TO DETERMINE THE EFFECTIVENESS OF FULL OCCLUSION BIOFEEDBACK SPLINTS USED FOR SLEEP BRUXISM (SB) AND TEMPOROMANDIBULAR DISORDER (TMD) PAIN.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Bergmann A, Edelhoff D, Schubert O, Erdelt KJ, Pho Duc JM. Effect of treatment with a full-occlusion biofeedback splint on sleep bruxism and TMD pain: a randomized controlled clinical trial. Clin Oral Investig. 2020 Nov;24(11):4005-4018. doi:10.1007/s00784-020-03270-z. Epub 2020 May 19. PMID: 32430774; PMCID: PMC7544753. SOURCE OF FUNDING: None. TYPE OF STUDY/DESIGN: Randomized clinical trial (parallel design).

Vestibular socket therapy with immediate implant placement for managing compromised fresh extraction sockets: A prospective single-arm clinical study.

PURPOSE: To assess hard and soft tissues regenerated around immediate implants placed in compromised fresh extraction sockets using vestibular socket therapy 2 years postoperatively. MATERIALS AND METHODS: Twenty-seven compromised fresh extraction sockets were managed using vestibular socket therapy and immediate implant placement. After immediate implant placement, a cortical bone shield was stabilised through a vestibular incision. The socket defect was filled with particulate bone graft. Labial plate thickness and bone height were evaluated 1 and 2 years postoperatively using CBCT. The pink aesthetic score and probing depth were recorded after 6 months, 1 year and 2 years. A Friedman test was used to study changes in the reported outcomes over time, with the level of statistical significance set at P ≤ 0.05. RESULTS: All implants recorded a 100.0% survival rate. A statistically significant increase in bone height (0.93 mm, P = 0.004) and apical (0.12 mm, P = 0.026), midfacial (1.26 mm, P < 0.001) and crestal (0.86 mm, P < 0.001) bone thickness was observed after 2 years. The changes in pink aesthetic score and probing depth were not significant: the pink aesthetic score was 12.48 ± 1.45 and the mean PD was 2.37 ± 0.79 mm mesially, 2.11 ± 0.70 mm facially, 2.07 ± 1.04 mm distally and 1.00 ± 0.00 mm palatally after 2 years. CONCLUSION: Combining immediate implant placement with vestibular socket therapy to manage compromised fresh extraction sockets offers promising radiographic, aesthetic and periodontal results while minimising the treatment time and number of surgical procedures required.

Limited evidence suggests complete arch digital scans are less time efficient than conventional impression.

Source of funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectorsType of study/design Randomised controlled trial (RCT) with parallel design.Subjects This RCT was conducted at the Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Centre of Dental Medicine, University of Zurich, Zurich, Switzerland. Ten patients, six women and four men, with a mean age of 62 years and an age range of 49-77 years, requiring posterior tooth-supported 3-unit fixed partial dentures (FPDs) were included in this RCT. The abutment teeth were six molars and six premolars in the maxilla and five molars and three premolars in the mandible. The patients fulfilled the following inclusion criteria: they all were >18 years, with a full mouth plaque score <25% and a full mouth bleeding score <25%. They all needed a posterior tooth-supported FPD, in which the third molar was not an abutment tooth. Only abutments with no extensive pretreatment were eligible. Adjacent and opposing teeth should be healthy or adequately restored.Treatment Three intraoral digital scanning systems (Lava C.O.S.; 3M [Lava], iTero; Align Technology Inc [iTero], Cerec Bluecam; Dentsply Sirona [Cerec]) and conventional light/regular body polyether impression in a stock tray were made on each of the included participants by the same clinician. The opposing arch impression was made in alginate. The sequence of the four techniques was computer generated and concealed in opaque sealed envelopes. Three calibrated experienced clinicians were involved in the treatment. They followed the published guidelines for preparing abutments that receive CAD/CAM ceramic FPDs. After interim prosthesis removal and double retraction cord application, the digital or the conventional impression procedure was started as dictated by the random sequence. Scans were done according to the manufacturer's guidelines, whereby Lava and Cerec required powdering of the teeth by titanium oxide and iTero did not.Main outcome Time needed for obtaining a scan or an impression was calculated. For digital scans it consisted of the time required for powdering, scanning and occlusal registration, while in conventional impression it started from the beginning of impression mixing till tray removal. The number of impression or scan remakes required until results fulfilling the quality criteria were obtained was also recorded. Visual analogue scale (VAS) was used to rate the perception of both, clinicians and patients for the procedures. Patients were asked to rate their comfort with the procedure, while clinicians rated both difficulty and comfort, where 0 indicated uncomfortable and simple and 100 difficult and comfortable. Subjective assessment of the time as judged by the clinicians and the patients was also reported.Main results Generally speaking, conventional impression was better than the three complete arch digital scans, regarding time required in seconds, difficulty for clinicians, comfort and time perception of both patients and clinicians. Number of remakes were highest in iTero (7), followed by Lava, conventional impression and finally Cerec (0). The time required for each technique differed significantly Polyether = 658 (95%CI 528-782) Cerec = 1776 (95%CI 804-2386) iTero = 1107 (785 - 2091). A significant difference was found neither among the three digital impressions, nor between the conventional impression and Lava (µ = 1091, 95%CI [717-1465]). The same findings were reported regarding difficulty for the clinicians. A significant difference was reported between conventional impression (µ = 15, 95%CI [7-24]) and both Cerec (µ = 67, 95%CI [58-77]) and iTero (µ = 43, 95%CI [25-62]). No significant difference was reported among the studied techniques regarding patients' comfort and time perceptions of both clinicians and patients except for a difference in the patients' time perception of Cerec and conventional impression, where P = .035. Regarding the clinicians' comfort a significant difference was only found between conventional impression (µ = 82, 95%CI [69-94]) and Cerec (µ = 32, 95%CI [18-46]).Conclusion Within the limitations of this RCT, it can be concluded that complete arch conventional impression is objectively less time consuming and subjectively preferred by both clinicians and patients when compared to digital scanning. Digital scanning techniques, requiring powdering, are more difficult for the clinicians than powderless ones and conventional impression.

Which is the best antibiotic prophylaxis protocol to prevent early implant failures?

Selection criteria The inclusion criteria of this systematic review were patients undergoing dental implant placement. Only randomised clinical trials (RCTs) that compared placebo, no antibiotic and/or any type of antibiotics, administered pre-operatively, intra-operatively, post-operatively or combinations of these, at any dose and for any duration were considered eligible. Included RCTs were required to have a follow up period of at least three months with at least 20 patients per treatment arm. No restrictions on date of publication or language were applied.Key study factor Four electronic databases (MEDLINE, SCOPUS, CENTRAL and Web of Knowledge) in addition to six related journals (Journal of Clinical Periodontology, Clinical Oral Implants Research, Clinical Implant Dentistry and Related Research, Journal of Periodontology, European Journal of Oral Implantology, International Journal of Oral & Maxillofacial Implants) were searched in duplicate for RCTs up to July 2017. Additional relevant literature was identified through hand-searching of reference lists, and through grey literature databases. Two independent reviewers screened the titles and abstracts . Data extraction and risk of bias assessment was performed simultaneously by two reviewers independently and in duplicate using the Cochrane tool for risk of bias assessment. A Network Meta-analysis (NMA) was conducted by integrating direct and indirect comparisons and the probability that each protocol was optimal was estimated. Subgroup and sensitivity analyses were planned to test the effect of risk of bias and of different variables on the results, but were not conducted due to the limited number of included studies.Main outcome measure Outcomes analysed were adverse events and early implant failures, defined as removal of mobile or stable implants with progressive marginal bone loss or infection in the first year after placement.Main results A total of 2248 RCTs were identified after removing duplicates, nine of which were finally included. Different protocols of antibiotic prophylaxis were compared with a total number of 1,693 participants. Seven of the included trials compared the use of one or more protocols of antibiotic prophylaxis with no prophylaxis or prophylaxis with a placebo, and two trials compared the use of different protocols, without the use of a no prophylaxis/placebo group. Amoxicillin was the only type used in all studies. Doses and timing varied among studies, although most of them used a single dose taken just before the implant placement. For the investigated outcomes, two trials were considered at low risk of bias and seven at high risk of bias.All protocols were more effective in reducing implant failures compared to placebo/no antibiotic (mean OR 0.08 to 0.45). Meta-analysis of direct comparison was only possible for the four trials comparing 2 g amoxicillin one hour preoperatively (B) to no antibiotic or placebo (A), indicating B as more effective (pulled OR = 0.40; 95% CI: 0.19-0.88; heterogeneity chi-squared 1.40, P = 0.706). These results were consistent with NMA effect estimates (mean OR = 0.45; 95% CI: 0.0210.93). A single dose of 3 g of amoxicillin administered one hour pre-operatively (C) was statistically more effective in reducing implant failures if compared to no prophylaxis/placebo (OR = 0.41, 95% CI = 0.180.91) and was considered as the most effective protocol. The single dose of 2 g of amoxicillin administered one hour pre-operatively was less effective than protocol C. Adverse events could not be studied in a meta-analysis due to an insufficient number of trials reporting it.Conlusions Implant patients are likely to benefit from antibiotis being administered one hour preoperatively in a dose of 3 g orally. The use of post-operative antibiotics does not seem, however, to be justified.

Limited Evidence Suggests Guided Bone Regeneration With or Without Autogenous Bone Grafts are Equivalently Effective in Horizontal Bone Gain.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Horizontal ridge augmentation with guided bone regeneration using particulate xenogenic bone substitutes with or without autogenous block grafts: A randomized controlled trial. Mendoza-Azpur G, de la Fuente A, Chavez E, Valdivia E, Khouly I. Clin Implant Dent Relat Res 2019;1-10. https://doi.org/10.1111/cid.12740. SOURCE OF FUNDING: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. TYPE OF STUDY/DESIGN: Randomized controlled trial (RCT) (parallel).

Limited Evidence Suggests Immediate Implant Placement Could be an Alternative to Delayed Implants in Molar Regions.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Single post-extractive ultra-wide 7-mm-diameter implants versus implants placed in molar healed sites after socket preservation. Tallarico M, Xhanari E, Pisano M, De Riu G, Tullio A, Meloni SM. Eur J Oral Implantol 2016;9(3):263-75. SOURCE OF FUNDING: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. TYPE OF STUDY/DESIGN: Randomized clinical trial with parallel design.

Limited Evidence Suggests No Benefit of Temporomandibular Joint Lavage Over Conservative Treatment for Temporomandibular Joint Pain and Dysfunction.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Temporomandibular lavage versus non-surgical treatments for temporomandibular disorders: A systematic review and meta-analysis. Bouchard C, Goulet JP, El-Ouazzani M, Fournier-Turgeon A. J Oral Maxillofac Surg 2017;75:1352-62. SOURCE OF FUNDING: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors TYPE OF STUDY DESIGN: Systematic review and meta-analysis.