Accuracy of computer-assisted template-based implant placement using conventional impression and scan model or intraoral digital impression: A randomised controlled trial with 1 year of follow-up.

PURPOSE: To compare accuracy and complications of computer-assisted template-based implant placement using conventional impression and scan of a physical stone cast or intraoral scanning to rehabilitate partially edentulous patients. MATERIALS AND METHODS: Any partially edentulous patients with at least five residual teeth, requiring at least one implant to be planned on three-dimensional (3D) cone beam computed tomography (CBCT) scan according to a computer-assisted template-based protocol were enrolled. Patients were randomised according to a parallel-group design into two arms: intraoral digital impression (fully digital group) or conventional impression and scan model (conventional group). Implants were placed flapless or with a minimally invasive flap, and conventionally loaded after 5 months. Outcome measures were implant and prosthetic success, complications, accuracy and peri-implant marginal bone loss. Three deviation parameters (angular, horizontal and vertical) were defined to evaluate the discrepancy between the planned and placed implant positions. Results were compared using a mixed-model repeated-measures analysis of variance (α = 0.05). RESULTS: Twenty patients (11 females and 9 males; mean age 44.6 years old) were randomised to the fully digital group (10 patients with 28 implants) or conventional group (10 patients with 29 implants). No patients dropped out. No implant or prosthesis failed up to 1 year after loading. One implant in the fully digital group was placed freehand due to limited inter-arch space. No biological or mechanical complications were experienced during follow-up. Difference between groups were not statistically significant (P = 0.999). The mean error in angle was 2.25 ± 1.41 degrees (range 0.30 to 5.00 degrees; 95% CI: 1.38 to 3.12 degrees) in the fully digital group and 2.10 ± 1.18 degrees (range 0.30 to 5.80 degrees; 95% CI: 1.37 to 2.83 degrees) in the conventional group. The difference was not statistically significant (-0.15 ± 1.63 degrees; range -3.20 to 2.90 degrees; 95% CI: -0.87 to 0.57 degrees; P = 0.668); in the horizontal plane (mesio-distal), the mean error was 0.52 ± 0.30 mm (range 0.10 to 1.10 mm; 95% CI: 0.33 to 0.70 mm) in the fully digital group and 0.44 ± 0.26 mm (range 0.10 to 0.90 mm; 95% CI: 0.27 to 0.60 mm) in the conventional group. The difference was not statistically significant (-0.08 ± 0.38 degrees; range -1.0 to 0.60 degrees; 95% CI: -0.32 to 0.16 degrees; P = 0.279); in the vertical plane (apico-coronal), the mean error was 0.58 ± 0.44 mm (range 0.00 to 1.60 mm; 95% CI: 0.31 to 0.85) in the fully digital group and 0.46 ± 0.34 mm (range 0.00 to 1.20 mm; 95% CI: 0.25 to 0.67) in the conventional group. The difference was not statistically significant (-0.12 ± 0.59 degrees; range -1.20 to 1.00 degrees; 95% CI: -0.49 to 0.24 degrees; P = 0.250). One year after loading, the mean marginal bone loss was 0.14 ± 0.12 mm (range -0.10 to 0.40 mm; 95% CI: 0.07 to 0.21 mm) in the fully digital group and 0.18 ± 0.13 mm (range -0.10 to 0.60 mm; 95% CI: 0.09 to 0.26 mm). The difference was not statistically significant (-0.04 ± 0.19 mm; range -0.50 to 0.30 mm; 95% CI: -0.16 to 0.08 mm; P = 0.294). CONCLUSIONS: With the limitations of the present trial, implant rehabilitations planned using intraoral digital impressions showed similar results compared to conventional impression and scan model. Digital impression may be a viable option for the rehabilitation of partial edentulous patients when computer-guided template-assisted implant placement is used.

Accuracy of Computer-Assisted Template-Based Implant Placement Using Two Different Surgical Templates Designed with or without Metallic Sleeves: A Randomized Controlled Trial.

Purpose: To compare virtual planning accuracy of novel computer-assisted, template-based implant placement techniques, which make use of CAD/CAM stereolithographic surgical templates with or without metallic sleeves. Furthermore, to compare open versus closed sleeves for templates without metallic sleeves. Materials and methods: Any partially edentulous patients requiring at least one implant to be placed according to a computer-assisted template-based protocol were enrolled. Patients were randomized according to a parallel group design into two arms: Surgical template with or without metallic sleeves. Three deviation parameters (angular, horizontal, vertical) were defined to evaluate the discrepancy between the planned and placed implant positions. Results: No implants failed, and no complications were experienced. Forty-one implants were placed using surgical templates with metallic sleeves while 49 implants were placed with a surgical template without metallic sleeves. Of these, 16 implants were placed through open sleeves and 33 through closed sleeves. There was a statistically significant difference in angle (p = 0.0212) and in the vertical plan (p = 0.0073) with lower values for implants placed with a surgical template without metallic sleeves. In the test group, close sleeves were more accurate compared with open sleeves in angle (p = 0.0268) and in horizontal plan (p = 0.0477). Conclusion: With the limitations of the present study, surgical templates without metallic sleeves were more accurate in the vertical plan and angle compared to the conventional template with metallic sleeves. Open sleeves should be used with caution in the molar region only in case of reduced interarch space. Further research is needed to confirm these preliminary results.

Treatment of patients with tiolox-dentaurum dental implants at the polyclinic shoshi.

INTRODUCTION: The importance of the dental implantology has influenced the development of many treatment methods in this field. The aim of our study is to evaluate the advantages and disadvantages of the treatment with TIOLOX-DENTAURUM dental implants in cases of partial and total lack of teeth, compared to classic dentures. To conduct our research we have used the prospective method. MATERIAL AND METHODS: The analyzed cases have undergone surgical treatment at the "Policlinic Shoshi" in Prishtina during 2010-2011. This study included 29 patients, 23 in the research group and 6 in the control group. The patients involved in the study were 30-59 years old. 52,2% of our patients were 30-39 years old, while 17,4% were 50-59 years old. RESULTS: In the research group, the average time of placing the dental bridges in the lower jaw was 2 months and 4.2 months in the control group. In the upper jaw, the average time was 3 months for the experimental group and 5,4 months for the control group. CONCLUSION: The period after the placement of implants until the placement of dentures, can be shortened from 4-6 months to 3 months for the upper jaw and from 3 to 2 months for the lower jaw.

Evaluation of the clinical efficacy of Biotène Oral Balance in patients with secondary Sjögren's syndrome: a pilot study.

The objective of the present study was to evaluate the efficacy of Oral Balance saliva substitute in alleviating dry mouth symptoms in a sample of patients with secondary Sjögren's syndrome. Twenty-one consecutive secondary Sjögren's syndrome patients with dry mouth complaints and hyposalivation were included in this study. Patients used a lactoperoxidase-system-containing gel (Biotène Oral Balance) for 4 weeks. The effects on subjective oral symptoms were recorded by means of a 7-items questionnaire which contained questions regarding dry mouth sensation and its effect on chewing, swallowing, taste, speech, burning sensation and denture retention. The severity of symptoms was assessed using a visual analogical scale. Oral symptom scores and unstimulated whole salivary flow were recorded at baseline and after 4 weeks' use of the product. Two patients withdrew from the study, because of nausea and unpleasant taste caused by the product. Nineteen patients (all women, mean age 52.7 years) participated throughout the entire study. Wilcoxon signed-ranked tests indicated significant improvements in visual analogical scale scores posttreatment for 5 of the 7 items on the oral dryness questionnaire, although no increase in salivary flow was found. However, the improvement in certain variables did not take a positive course in all cases. Patients with lower salivary flow at baseline tended to have greater improvement in oral symptoms. The study suggests that the use of Oral Balance gel is effective in alleviating the dry mouth symptoms in secondary Sjögren's syndrome patients, but a randomized controlled trial is needed to assess the placebo effect.

Oral mucosa involvement in rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis.

OBJECTIVES: To estimate the frequency and character of oral mucosal lesions in patients with rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis. Furthermore, the relation between oral mucosal involvement and hyposalivation was investigated. DESIGN: Case-control study. SETTING: Rheumatology Clinic, University Hospital "Mother Theresa" in Tirana, Albania. PARTICIPANTS: 124 consecutive hospitalised patients (88 with rheumatoid arthritis, 22 with systemic lupus erythematosus and 14 with systemic sclerosis) and 124 age- and gender- matched healthy controls. METHODS: Oral lesions were clinically examined and classified according to their morphologic aspects and localisation. Examination included also measurement of unstimulated whole salivary flow. MAIN OUTCOME MEASURES: Frequency of oral mucosal lesions and hyposalivation. RESULTS: Oral mucosal lesions were observed in 58.9% of patients, but in only 33.1% of control subjects. Clinical aspects of lesions varied, and palate, buccal and labial mucosa, and tongue were the most affected sites. No significant associations were found between presence of oral lesions and hyposalivation, except oral candidosis which was associated with hyposalivation in controls. CONCLUSIONS: Patients with rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis have a higher burden of oral mucosa disease than a healthy population. Collaboration of rheumatology and oral medicine units should allow appropriate management of these patients.

Sicca symptoms, and lacrimal and salivary flow in Albanian patients with rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis affects primarily the synovial joints, but is often accompanied by extra-articular manifestations, including lacrimal and salivary gland involvement. The aim of the present study was to estimate the prevalence of ocular and oral sicca symptoms and reduced lacrimal and salivary flow in rheumatoid arthritis and the relation between sicca symptoms and objective measures of lacrimal and salivary flow. METHODS: We examined 88 consecutive hospitalized patients with rheumatoid arthritis and 88 age- and gender-matched healthy controls. The examination included the standardized questionnaire for keratoconjunctivitis sicca and xerostomia which forms part of the European criteria for Sjögren's syndrome, the Schirmer's I test and measurement of unstimulated whole salivary flow rate. RESULTS: A significantly higher proportion of patients (40.9%) reported ocular sicca symptoms than healthy matched controls (8.0%). Further, a significantly higher proportion of patients (44.3%) reported oral sicca symptoms compared to controls (13.6%). 48.9% of the patients had low Schirmer I score, compared to 20.5% of controls. Reduced salivary flow was found in 27.3% of patients, compared to 9.1% of controls. The differences in lacrimal and salivary flow between patient and control group were statistically significant. The minimum prevalence of secondary Sjögren's syndrome was 14.8%. Weak association was observed between sicca symptoms and the objective measures of lacrimal and salivary flow in patients, and no association was detected in control subjects. CONCLUSIONS: Sicca symptoms and reduced lacrimal and salivary flow were common manifestations in rheumatoid arthritis and should be given adequate consideration during management of patients with rheumatoid arthritis.