The effect of systemic antibiotics on clinical and patient-reported outcome measures of oral implant therapy with simultaneous guided bone regeneration.

OBJECTIVES: The aim of the present superiority study was to determine the effect of systemic antibiotics primarily on patient-reported outcome measures (PROMs) and post-surgical complications in patients undergoing oral implant therapy with simultaneous guided bone regeneration (GBR). MATERIALS AND METHODS: A total of 236 medically and periodontally healthy patients received oral implants with simultaneous GBR at seven centres. Pre-operative antibiotics of 2 g amoxicillin were prescribed to the test group 1 hr prior to surgery and 500 mg thrice daily on days 1-3 after surgery. The control group was given a placebo. Group allocation was performed randomly. Primary outcome variables were PROMs recorded as visual analogue scale scores assessed on days 1-7 and 14 on pain, swelling, haematoma and bleeding. Post-operative complications as secondary outcome variables were examined at 1, 2, 4 and 12 weeks from surgery. Chi-square tests and repeated measures of analysis of variance (ANOVA) were performed for statistical evaluation. RESULTS: No statistically significant differences (p > .05) between the two groups were detected for the evaluated PROMs. The same was noted with respect to post-surgical complications. Four implants were lost-three in the test group and one in the control group. CONCLUSION: In this trial, systemic antibiotics did not provide additional benefits to PROMs, nor the prevention of post-surgical complications in medically and periodontally healthy patients undergoing oral implant therapy with simultaneous GBR. However, further studies with larger sample sizes are still required to support the clinical outcomes of this study.

Antibacterial Additives in Epoxy Resin-Based Root Canal Sealers: A Focused Review.

Dental materials used in root canal treatment have undergone substantial improvements over the past decade. However, one area that still remains to be addressed is the ability of root canal fillings to effectively entomb, kill bacteria, and prevent the formation of a biofilm, all of which will prevent reinfection of the root canal system. Thus far, no published review has analysed the literature on antimicrobial additives to root canal sealers and their influence on physicochemical properties. The aim of this paper was to systematically review the current literature on antimicrobial additives in root canal sealers, their anti-fouling effects, and influence on physicochemical properties. A systematic search was performed in two databases (PubMed and Scopus) to identify studies that investigated the effect of antimicrobial additives in epoxy resin-based root canal sealers. The nature of additives, their antimicrobial effects, methods of antimicrobial testing are critically discussed. The effects on sealer properties have also been reviewed. A total of 31 research papers were reviewed in this work. A variety of antimicrobial agents have been evaluated as additives to epoxy resin-based sealers, including quaternary ammonium compounds, chlorhexidine, calcium hydroxide, iodoform, natural extracts, antibiotics, antifungal drugs, and antimicrobial agent-functionalised nanoparticles. Antimicrobial additives generally improved the antimicrobial effect of epoxy resin-based sealers mainly without deteriorating the physicochemical properties, which mostly remained in accordance with ISO and ANSI/ADA specifications.

Peri-implant marginal bone loss rate pre- and post-loading: An exploratory analysis of associated factors.

OBJECTIVES: To perform an exploratory analysis of factors influencing annual rates of peri-implant marginal bone loss (RBL) calculated over different time frames, at implants unaffected by peri-implantitis. MATERIAL AND METHODS: A total of 154 implants from 86 patients were reviewed at 1.6-6.8 years after placement. Marginal bone levels (MBL) were assessed on intraoral radiographs at three time-points: immediately post-placement, time of loading, and least 1-year post-loading. RBLs (mm/year) were computed using these three time frames and corresponding MBL changes as: RBL placement-loading, RBL loading-review, RBL placement-review. Exploratory ordination of three RBLs, corresponding time durations, and 17 background factors were used for visualization. Hierarchical linear mixed-effects models (MEM) with predictor selection were applied to RBL outcomes. The correlation of actual MBL with MBLs predicted by RBL placement-loading and RBL loading-review was tested. RESULTS: Median RBL placement-loading was 0.9 mm/year (IQR = 2.02), loading-review was 0.06 mm/year (IQR = 0.16), and overall RBL placement-review was 0.21 mm/year (IQR = 0.33). Among-patient variance was highest for RBL placement-loading (SD = 0.66). Longer time predicted lower RBL in all time frames. Shorter time of loading significantly predicted lower RBL placement-review. Augmentation predicted lower RBL placement-loading, while anterior location and older age predicted lower RBLs placement-loading placement-review. Only MBL projected using RBL placement-loading significantly correlated with actual MBL. CONCLUSIONS: Exploratory analysis indicated RBL varied with the time duration used for calculation in pre- and post-loading, and overall periods. In each period, RBL declined with increasing time. Earlier loading predicted lower overall RBL. Higher pre-loading RBL predicted worse actual bone level.

The effects of surface treatments on tensile bond strength of polyether-ketone-ketone (PEKK) to veneering resin.

OBJECTIVES: To test the different PEKK surface treatment methods on the tensile bond strength (TBS) of a resin composite to PEKK. METHODS: Two hundred and fifty polished PEKK specimens were fabricated, divided into 5 groups (n = 50) and underwent the following treatments: no pre-treatment (control group C), 110 µm Al2O3 gritblasting at 2 bar for 10 s (Group Al), 98 wt% sulfuric acid etching for 60 s (Group SA), tribochemical silica-coating through air-abrasion with Rocatec Plus 110 µm at 2 bar for 10 s (Group Trib), and sulfuric acid etching and subsequent tribochemical silica-coating (Group SATrib). Ten specimens in each group were taken out for surface characterization. On the samples of Groups Trib and SATrib, a silane coupling agent was applied. Then, for all groups, veneering resin stubs (diameter: 3 mm) were bonded on the treated surfaces. Half of the specimens (n = 20) in each group were submitted to thermo-cycling for 7000 cycles between 5 °C and 55 °C. The TBS of all groups was examined using a universal testing machine. Fracture analysis was performed. For statistical analyses, one-way ANOVA (post-hoc: Bonferroni) and t-test were used at α = 0.05. RESULTS: Although the surface treatment methods used in this study were able to increase PEKK surface roughness, none of them showed impact on TBS between PEKK and the resin composite before thermal cycling (p > 0.05). However, after thermo-cycling, significantly higher TBS was measured for Groups Trib and SATrib (p < 0.05). Furthermore, the TBS for the SATrib group was not significantly affected by thermal cycling. Groups SA, Trib and SATrib illustrated an increase of Weibull moduli after thermocycling, but decrease was observed in Groups C and Al. CONCLUSION: Despite low tensile bond strengths were found in all groups in this study, Tribochemical silica-coating through air-abrasion with Rocatec Plus on polished or sulfuric-etched PEKK surface can significantly increase the tensile bonding stability as well as durability of resin composite to PEKK.

Patient-reported outcome measures (PROMs) and maintenance events in 2-implant-supported mandibular overdenture patients: A 5-year prospective study.

OBJECTIVE: To prospectively evaluate patient-reported outcome measures (PROMs) and treatment outcomes of mandibular two-implant retained overdentures (IOD) in an edentulous geriatric cohort with history of deficient complete dentures (CD). MATERIALS AND METHODS: A total of 103 patients with deficient CD received new optimal CD. After a period of 3 months, 80 of the patients voluntarily received IOD. Outcomes collected at pre-, post-CD/post-IOD treatment annually up to 5 years, included (a) Clinical outcomes: denture-quality (Woelfel's index), complications, and maintenance events, (b) PROMs: patient complaints (maxillary, mandibular functional complaint scores, generic aesthetic complaint scores, frequency, and intensity of complaints) and patient satisfaction, and (c) Maintenance events: technical complications and adverse events. RESULTS: Five-year data were collected from 67 patients (mean age at initiation = 71.3 years, mean observation = 5.9 years) with cumulative implant survival rate = 98.72%. Multiple comparisons for 8 time points showed significant improvements in denture quality and PROMs after new CD and IOD delivery. Further significant improvements were only after IOD delivery in: mandibular denture-quality, mandibular and generic functional complaints, frequency, intensity of complaints, and overall patient satisfaction score. Thereafter, denture-quality and PROMs remained stable. Maintenance events clustered on 1st year and within a minority of patients. Technical complications and overall maintenance events significantly correlated with overall patient satisfaction score at 1st year. CONCLUSIONS: Mandibular IOD was a beneficial treatment option for seniors with history of deficient CD, improving denture-quality, patient satisfaction, and reducing patient complaints up to 5 years. Maintenance events clustered on 1st year, showing no significant impact on long-term patient satisfaction and other PROMs.

Differences in micromorphology of the implant-abutment junction for original and third-party abutments on a representative dental implant.

STATEMENT OF PROBLEM: Evidence for micromorphology and precision of fit of third-party prosthetic components compared with the original manufacturer's components is lacking. PURPOSE: The purpose of this in vitro pilot study was to evaluate the micromorphological differences among different commercial brands of zirconia, titanium, and gold abutments for dental implants in terms of tight surface contact. MATERIAL AND METHODS: The following abutments (n=3 per type) were preloaded on Straumann Bone Level implants according to the manufacturer's instructions for zirconia (Zr, Zr2, Zr3), titanium (Ti and Ti2), and gold (Gold 1, Gold 2). The micromorphology of the implant-abutment units was investigated by using scanning electron microscopy (original magnification ×10 to ×500) after microtome sectioning. After we calibrated, the length of the areas with tight contact (TC) (discrepancy ≤3 µm) was calculated at the level of conical connection (CC), lower internal connection (LIC), and screw threads (STs). The interexaminer agreement was assessed by using intraclass correlation coefficient(s) (ICC). One-way ANOVA was used for the overall comparison of the Zr groups, and the Student paired t test was used for pairwise comparisons of the abutments of the same group. After we adjusted for multiple comparisons, the significance level for the overall and pairwise comparisons of Ti and Gold groups was set at a P value of .008 and a P value of .003 for the Zr groups. RESULTS: Major differences were found among the different abutment types in terms of design and extent of surface contact. The TC showed significant differences among the abutments of Zr group, depending on the side and level of evaluation (Zr1 > Zr2 > Zr3 on the left side for CC; Zr1, Zr2 > Zr3 on the right side for CC, and, Zr2 > Zr3 on the right side for LIC; P<.003). In Ti group, no significant differences were found (P>.008). The Gold and Gold 2 groups had significantly greater contact on the left side of CC (P<.008). CONCLUSIONS: A difference in design of the abutments was apparent. The tight surface contact was significantly different among the examined abutments or abutment screws and the respective area of the inner surface of the implants.

Group 5 ITI Consensus Report: Digital technologies.

OBJECTIVES: Working Group 5 was assigned the task to review the current knowledge in the area of digital technologies. Focused questions on accuracy of linear measurements when using CBCT, digital vs. conventional implant planning, using digital vs. conventional impressions and assessing the accuracy of static computer-aided implant surgery (s-CAIS) and patient-related outcome measurements when using s-CAIS were addressed. MATERIALS AND METHODS: The literature was systematically searched, and in total, 232 articles were selected and critically reviewed following PRISMA guidelines. Four systematic reviews were produced in the four subject areas and amply discussed in the group. After emendation, they were presented to the plenary where after further modification, they were accepted. RESULTS: Static computer-aided surgery (s-CAIS), in terms of pain & discomfort, economics and intraoperative complications, is beneficial compared with conventional implant surgery. When using s-CAIS in partially edentulous cases, a higher level of accuracy can be achieved when compared to fully edentulous cases. When using an intraoral scanner in edentulous cases, the results are dependent on the protocol that has been followed. The accuracy of measurements on CBCT scans is software dependent. CONCLUSIONS: Because the precision intraoral scans and of measurements on CBCT scans and is not high enough to allow for the required accuracy, s-CAIS should be considered as an additional tool for comprehensive diagnosis, treatment planning, and surgical procedures. Flapless s-CAIS can lead to implant placement outside of the zone of keratinized mucosa and thus must be executed with utmost care.

Accuracy of linear measurements on CBCT images related to presurgical implant treatment planning: A systematic review.

OBJECTIVE: The aim of this systematic review was to identify, review, analyze, and summarize available evidence on the accuracy of linear measurements when using maxillofacial cone beam computed tomography (CBCT) specifically in the field of implant dentistry. MATERIAL AND METHODS: The search was undertaken in April 2017 in the National Library of Medicine database (Medline) through its online site (PubMed), followed by searches in the Cochrane, EMBASE, ScienceDirect, and ProQuest Dissertation and Thesis databases. The main inclusion criterion for studies was that linear CBCT measurements were performed for quantitative assessment (e.g., height, width) of the alveolar bone at edentulous sites or measuring distances from anatomical structures related to implant dentistry. The studies should compare these values to clinical data (humans) or ex vivo and/or experimental (animal) findings from a "gold standard." RESULTS: The initial search yielded 2,516 titles. In total, 22 studies were included in the final analysis. Of those, two were clinical and 20 ex vivo investigations. The major findings of the review indicate that CBCT provides cross-sectional images that demonstrate high accuracy and reliability for bony linear measurements on cross-sectional images related to implant treatment. A wide range of error has been reported when performing linear measurements on CBCT images, with both over- and underestimation of dimensions in comparison with a gold standard. A voxel size of 0.3 to 0.4 mm is adequate to provide CBCT images of acceptable diagnostic quality for implant treatment planning. CONCLUSIONS: CBCT can be considered as an appropriate diagnostic tool for 3D preoperative planning. Nevertheless, a 2 mm safety margin to adjacent anatomic structures should be considered when using CBCT. In clinical practice, the measurement accuracy and reliability of linear measurements on CBCT images are most likely reduced through factors such as patient motion, metallic artefacts, device-specific exposure parameters, the software used, and manual vs. automated procedures.