Influence of Splint Support on the Precision of Static Totally Guided Dental Implant Surgery: A Systematic Review and Network Meta-analysis.

Purpose: To assess the accuracy of totally guided implant placement with static surgical splints in relation to the different types of supporting tissues (tooth, mucosa, or bone). Materials and Methods: This review was carried out following the PRISMA guidelines. An electronic search was done of the MEDLINE (PubMed), Embase, and Cochrane Library databases, without publication year or language restrictions. Results: The literature search yielded a total of 877 articles; 18 were included in the qualitative synthesis, and 16 of these articles were included in the quantitative analysis. The included studies presented a high risk of bias, except for one randomized clinical trial. The strength of the recommendations is therefore weak. In the angular deviation treatment, statistically significant differences were observed in the accuracy of the implants with tooth vs bone support: Bone support yielded 1.31 degrees greater deviation vs tooth support (SD = 0.43; 95% CI: 0.47, 2.15, P = .002). No significant differences were observed in the linear deviations. Conclusion: Tooth support proved to be significantly more precise than bone support splints. There were no differences referring to horizontal coronal deviation, horizontal apical deviation, or vertical deviation according to the type of splint support used.

Floor of the mouth hemorrhage subsequent to dental implant placement in the anterior mandible.

Complications in dental implant surgery are possible. Bleeding complications have been described that may be serious, particularly in the floor of the mouth. We present two cases of sublingual hematomas during dental implant osteotomies that impeded but did not close the airway. The clinical courses of these patient's complications are reviewed. One patient had immediate hematoma formation while the other developed a hematoma overnight, presenting the next day. The treatment rendered was a precautionary in-hospital tracheotomy for the first patient and only compression control for the second. Bleeding complications during dental implant placement in the anterior mandible can be serious issues. There is a potential for sublingual hematoma that could compromise the airway by pressing the tongue against the soft palate into the pharynx. In-hospital treatment may be necessary to prevent an adverse outcome. It must be noted that a hematoma in the submandibular space is life threatening by direct airway compression.

Salivary myeloperoxidase and malondialdehyde are increased in patients exhibiting an asymptomatic mandibular impacted third molar

Background: To determine whether saliva is a good means of evaluating concentrations of oxidative stress bio-markers, analyzing the correlation between concentrations in saliva and in follicular tissue, and to compare bio-marker concentrations in patients with one asymptomatic mandibular impacted third molar (MITM) (before ex-traction) with a healthy control, and to determine how biomarkers are modified by extraction. Material and Methods: 80 patients with one asymptomatic MITM and 80 healthy controls were included. Saliva samples were collected from all subjects (before extraction in the study group) to evaluate Myeloperoxidase (MPO) and Malondialdehyde (MDA) concentrations. Follicular tissues were obtained during surgery to measure biomarkers. One month after extraction, saliva samples were collected to assess changes of oxidative stress. Results: Salivary MPO and MDA showed positive correlation with concentrations in follicular tissue (MPO: correlation coefficient = 0.72, p = 0.025; MDA: = 0.92, p = 0.001). Patients with asymptomatic MITMs showed higher salivary concentrations of oxidative stress biomarkers than healthy control subjects, with statistical significance for both MPO (p < 0.001) and MDA (p < 0.001). One month after extraction, salivary biomarkers decreased significantly in the study group (p < 0.001)

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A combined digital and stereophotogrammetric technique for rehabilitation with immediate loading of complete-arch, implant-supported prostheses: A randomized controlled pilot clinical trial.

STATEMENT OF PROBLEM: Traditional impressions for complete-arch restorations are complex and time-consuming, and they can be uncomfortable for the patient. New digital techniques such as stereophotogrammetry may mitigate this. PURPOSE: The purpose of this randomized controlled pilot clinical trial was to compare the patient and dentist satisfaction and work times of traditional impressions (control group) and digital impressions with stereophotogrammetry in complete-arch, implant-supported prostheses. Success rates, implant survival, marginal bone loss around the dental implants, and prosthesis survival were also analyzed. MATERIAL AND METHODS: This randomized controlled pilot clinical trial included 18 participants who received 131 dental implants. Implant impressions in the experimental group were made with stereophotogrammetry (8 participants with 66 implants), while traditional impressions were made in the control group (10 participants with 65 implants). Working times were measured in minutes starting from removal of the healing abutments to their replacement after the impression. Patient and dentist satisfaction was analyzed using a questionnaire with a visual analog scale, and implant success was assessed using the Buser success criteria. Prosthesis survival was defined as the presence of the prosthesis in the mouth, without screw loosening or fracture. RESULTS: The work times were 15.6 (experimental group) and 20.5 minutes (control group) (P<.001). The patient satisfaction scores were 8.8 in the experimental and 7.9 in the control group (P=.02). The dentist satisfaction scores were 9.1 in the experimental group and 8.5 in the control group (P=.03). The implant success rate was 100% in both groups. Marginal bone loss was 0.6 ±0.5 mm (experimental group) and 0.6 ±0.2 mm (control group) (P=.72). CONCLUSIONS: Digital impressions using stereophotogrammetry may be an alternative to traditional impressions. Patient and dentist satisfaction improved, and the work time was reduced in the experimental group. No statistically significant differences were found in terms of the implant success rate, implant survival, marginal bone loss, or prosthesis survival between the 2 groups.

Immediate prosthesis over implants retained using abutments with flexible screws: A preliminary study.

BACKGROUND: Immediate loading protocols for the rehabilitation of edentulous or partially edentulous patients have become very popular, due to the conveniences they afford in comparison with conventional loading techniques. MATERIAL AND METHODS: A preliminary study was carried out with 8 patients subjected to dental implant treatment with an immediate loading protocol involving a novel system of abutments with flexible screws. Implant survival was analyzed, together with marginal bone loss and patient and dentist satisfaction. RESULTS: A total of 35 implants were subjected to immediate loading using the abutments with flexible screws. The mean patient and dentist satisfaction score was 9.1 and 8.5, respectively. After 12 months the dental implant survival rate was 95.8%, with a mean marginal bone loss of 0.51 ± 0.12 mm. CONCLUSIONS: The novel system of abutments with flexible screws offers a good alternative to conventional immediate loading, since it allows rapid and simple manufacture of a reliable passive fit, fixed interim prosthesis after surgery. Key words:Dental implants, Flexafit®, Immediate loading, Immediate prosthesis.

A versatile snap-on, metal-to-metal connection system for direct immediate loading with screw prostheses.

This technique introduces a system of abutments with a pressure or friction fitting to retain implant-supported prostheses. The system combines the chief advantages of cement and screw-retained prostheses, which are passively fit and easily removed from the mouth, respectively. This system provides an alternative to conventional immediate loading systems, since it allows easier adjustment and modeling of the prosthesis with a snap-on connection and easier removal from the implants.

Non surgical predicting factors for patient satisfaction after third molar surgery

BACKGROUND: In the third molar surgery, it is important to focus not only on surgical skills, but also on patient satisfaction. Classically studies have been focused on surgery and surgeon's empathy, but there are non-surgical factors that may influence patient satisfaction. MATERIAL AND METHODS: A cross-sectional study was performed on 100 patients undergoing surgical extractions of impacted mandibular third molars treated from October 2013 to July 2014 in the Oral Surgery Unit of the University of Valencia. A questionnaire (20 questions) with a 10-point Likert scale was provided. The questionnaire assessed the ease to find the center, the ease to get oriented within the center, the burocratic procedures, the time from the first visit to the date of surgical intervention, waiting time in the waiting room, the comfort at the waiting room, the administrative staff (kindness and efficiency to solve formalities), medical staff (kindness, efficiency, reliability, dedication), personal data care, clarity in the information received (about the surgery, postoperative care and resolution of the doubts), available means and state of facilities. Outcome variables were overall satisfaction, and recommendation of the center. Statistical analysis was made using the multiple linear regression analysis. RESULTS: Significant correlations were found between all variables and overall satisfaction. The multiple regression model showed that the efficiency of the surgeon and the clarity of the information were statistically significant to overall satisfaction and recommendation of the center. The kindness of the administrative staff, available means, the state of facilities and the comfort at the waiting room were statistically significant to the recommendation of the center. CONCLUSIONS: Patient satisfaction directly depends on the efficiency of the surgeon and clarity of the clinical information received about the procedure. Appreciation of these predictive factors may help clinicians to provide optimal care for impacted third molar surgery patients

Non surgical predicting factors for patient satisfaction after third molar surgery.

BACKGROUND: In the third molar surgery, it is important to focus not only on surgical skills, but also on patient satisfaction. Classically studies have been focused on surgery and surgeon's empathy, but there are non-surgical factors that may influence patient satisfaction. MATERIAL AND METHODS: A cross-sectional study was performed on 100 patients undergoing surgical extractions of impacted mandibular third molars treated from October 2013 to July 2014 in the Oral Surgery Unit of the University of Valencia. A questionnaire (20 questions) with a 10-point Likert scale was provided. The questionnaire assessed the ease to find the center, the ease to get oriented within the center, the burocratic procedures, the time from the first visit to the date of surgical intervention, waiting time in the waiting room, the comfort at the waiting room, the administrative staff (kindness and efficiency to solve formalities), medical staff (kindness, efficiency, reliability, dedication), personal data care, clarity in the information received (about the surgery, postoperative care and resolution of the doubts), available means and state of facilities. Outcome variables were overall satisfaction and recommendation of the center. Statistical analysis was made using the multiple linear regression analysis. RESULTS: Significant correlations were found between all variables and overall satisfaction. The multiple regression model showed that the efficiency of the surgeon and the clarity of the information were statistically significant to overall satisfaction and recommendation of the center. The kindness of the administrative staff, available means, the state of facilities and the comfort at the waiting room were statistically significant to the recommendation of the center. CONCLUSIONS: Patient satisfaction directly depends on the efficiency of the surgeon and clarity of the clinical information received about the procedure. Appreciation of these predictive factors may help clinicians to provide optimal care for impacted third molar surgery patients.

Immediate bleeding complications in dental implants: a systematic review

OBJECTIVE: A review is made of the immediate or immediate postoperative bleeding complications in dental implants, with a view to identifying the areas of greatest bleeding risk, the causes of bleeding, the length of the implants associated with bleeding, the most frequently implicated blood vessels, and the treatments used to resolve these complications. MATERIAL AND METHODS: A Medline (PubMed) and Embase search was made of articles on immediate bleeding complications in dental implants published in English up until May 2014. Inclusion criteria: studies in humans subjects with severe bleeding immediately secondary to implant placement, which reported the time until the hemorrhage, the implant lenght, the possible cause of bleeding and the treatment. Exclusion criteria: patients receiving anticoagulation treatment. RESULTS: Fifteen articles met the inclusion criteria. The area with the largest number of bleeding complications corresponded to the mandibular canine. The cause of bleeding was lingual cortical bone perforation during implant placement, with damage to the sublingual artery. The implants associated with bleeding were those measuring 15mm in length or more. Management focused on securing the airway (with intubation or tracheostomy if necessary),with bleeding control. CONCLUSIONS: It's important to pay special attention when the implants are placed in the mandibular anterior zone, especially if long implants are used. The most frequently cause of bleeding was the perforation of the lingual plate. Treatment involves securing the airway, with bleeding control

Immediate bleeding complications in dental implants: a systematic review.

OBJECTIVE: A review is made of the immediate or immediate postoperative bleeding complications in dental implants, with a view to identifying the areas of greatest bleeding risk, the causes of bleeding, the length of the implants associated with bleeding, the most frequently implicated blood vessels, and the treatments used to resolve these complications. MATERIAL AND METHODS: A Medline (PubMed) and Embase search was made of articles on immediate bleeding complications in dental implants published in English up until May 2014. INCLUSION CRITERIA: studies in humans subjects with severe bleeding immediately secondary to implant placement, which reported the time until the hemorrhage, the implant lenght, the possible cause of bleeding and the treatment. EXCLUSION CRITERIA: patients receiving anticoagulation treatment. RESULTS: Fifteen articles met the inclusion criteria. The area with the largest number of bleeding complications corresponded to the mandibular canine. The cause of bleeding was lingual cortical bone perforation during implant placement, with damage to the sublingual artery. The implants associated with bleeding were those measuring 15 mm in length or more. Management focused on securing the airway (with intubation or tracheostomy if necessary), with bleeding control. CONCLUSIONS: It's important to pay special attention when the implants are placed in the mandibular anterior zone, especially if long implants are used. The most frequently cause of bleeding was the perforation of the lingual plate. Treatment involves securing the airway, with bleeding control.