Group 4 ITI Consensus Report: Patient benefits following implant treatment in partially and fully edentulous patients.

OBJECTIVES: The aim of Working Group 4 was to address patient benefits associated with implant dentistry. Focused questions on (a) dental patient-reported outcomes (dPROs), (b) improvement in orofacial function, and (c) preservation of orofacial tissues in partially and fully edentulous patients following provision of implant-retained/supported dental prostheses were addressed. MATERIALS AND METHODS: Three systematic reviews formed the basis for discussion. Participants developed statements and recommendations determined by group consensus based on the findings of the systematic reviews. These were then presented and accepted following further discussion and modifications as required by the plenary of the 7th ITI Consensus Conference, taking place in 2023 in Lisbon, Portugal. RESULTS: Edentulous patients wearing complete dentures (CD) experience substantial improvements in overall dPROs and orofacial function following treatment with either complete implant-supported fixed dental prostheses (CIFDP) or implant overdentures (IODs). With respect to dPROs, mandibular IODs retained by two implants are superior to IODs retained by one implant. However, increasing the number of implants beyond two, does not further improve dPROs. In fully edentulous patients, rehabilitation with CIFDP or IOD is recommended to benefit the preservation of alveolar bone and masseter muscle thickness. CONCLUSIONS: Completely edentulous patients benefit substantially when at least the mandible is restored using an CIFDP or an IOD compared to CD. In fully edentulous patients, implant prostheses are the best option for tooth replacement. The availability of this treatment modality should be actively promoted in all edentulous communities, including those with limited access and means.

Evaluation of Omega-3 piscine acellular dermal matrix membrane as a soft tissue alternative for the treatment of mucogingival defects.

BACKGROUND: The natural Omega-3 lipids in the OADM serve to reduce inflammation. Preliminary results in a human model reported no adverse events and favorable healing and esthetic outcomes. OBJECTIVE: The primary objective of this animal model study was to histologically evaluate the use of Omega-3 piscine acellular dermal matrix (OADM) as a soft tissue alternative in surgically created mucogingival defects. METHODS: Bilateral maxillary canines in 6 adult beagle dogs were randomly assigned to the test (OADM) and control sub-epithelial connective tissue graft (SCTG) groups. Dehiscence defects 4 × 6 mm were created surgically on the buccal surfaces. The OADM/SCTG were placed to completely cover the root surface to the level of the cemento-enamel junction and sutured with resorbable sling sutures. The gingival flap was repositioned to cover the grafts. At two months follow-up, the dogs were sacrificed, and block samples were retrieved, including the whole canine and periodontium. The histological outcomes were evaluated using qualitative analysis. RESULTS: The qualitative histological analysis revealed the oral, sulcular and junctional epithelium had healed with normal appearance on both test and control sites. None of the test (OADM) samples presented with any foreign body reaction. CONCLUSION: The use of this new piscine xenograft resulted in minimal complications and the attachment apparatus healed normally.

The Association Between Suppuration on Palpation and Diagnosis of Peri-implantitis: A Cross-sectional Study.

PURPOSE: The aim of this study was to evaluate suppuration on palpation, used as a diagnostic test, in the detection of peri-implantitis. MATERIALS AND METHODS: A total of 65 patients with 267 implants were examined. Clinical inspection was performed by two blinded examiners: The first measured suppuration on palpation, and the second conducted a complete clinical examination. A third examiner combined the previously collected information with radiographic data and diagnosed the patients according to the European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) classification system. Calibration was conducted previously to the fourth examiner on a set of five patients not belonging to the study sample. RESULTS: When suppuration on palpation was associated with diagnosis of peri-implantitis, the specificity and negative predictive value were high (88% and 84%, respectively), meaning that an implant that was negative to suppuration on palpation had a high chance of not being affected by peri-implantitis. Conversely, the sensitivity and positive predictive value were low (45% and 54%), demonstrating that a suppurating implant will be affected by peri-implantitis in only half of the cases. Area under the curve was calculated as 60.4 (P = .012), and accuracy was found to be 78%. CONCLUSION: Suppuration on palpation alone, as with any other clinical sign, does not allow a precise diagnosis of peri-implantitis. An implant without suppuration on palpation shows a high chance of being free of peri-implantitis, while an implant that suppurates upon palpation is not necessarily affected by peri-implantitis. Suppuration on palpation may be a valuable clinical sign, especially when evaluating implants that are difficult to examine via probing.

Fabrication, workflow and delivery of reconstruction: Summary and consensus statements of group 4. The 6th EAO Consensus Conference 2021.

OBJECTIVES: To report assessments of four systematic reviews (SRs) on (i) clinical outcomes of all-ceramic implant-supported crowns (iSCs), (ii) production time, effectiveness, and costs of computer-assisted manufacturing (CAM), (iii) computer-assisted implant planning and surgery (CAIPS) time and costs, and (iv) patient-reported outcome measures (PROMS). MATERIAL AND METHODS: An author group consisting of experienced clinicians and content experts discussed and evaluated the SRs and formulated consensus on the main findings, statements, clinical recommendations, and need for future research. RESULTS: All four SRs were conducted and reported according to PRISMA and detailed comprehensive search strategies in at least three bibliometric databases and hand searching. The search strategies were deemed reproducible. Variation was noted regarding language restrictions and inclusion of grey literature, but the search comprehensiveness appeared persuasive. The SRs included bias risk assessments of the primary studies, and their study methodology impacted the interpretations of the extracted data. CONCLUSIONS: (i) There is limited evidence (49 NRCT) showing that veneered and monolithic all-ceramic iSCs have excellent outcomes observed up to 3 years. (ii) There is no evidence evaluating production time and effectiveness comparing subtractive and additive CAM of implant models, abutments and crowns. (iii) There is limited evidence (4 RCT) that CAIPS involves more time and costs when considering the entire workflow and for diagnostics, manufacturing, and insertion of the restoration. Time seems to be the decisive factor for higher costs. (iv) Patients' comfort increases when optical compared to conventional impressions are used for fabricating iSCs and short-span FPDs (2 RCT, 5 NRCT).

Prospective study of the impact of peri-implant soft tissue properties on patient-reported and clinically assessed outcomes.

BACKGROUND: It has been proposed that the presence of a zone of keratinized mucosa (KM) around implants is associated with less discomfort during brushing and improved esthetic outcomes. Therefore, mucogingival procedures have been recommended for patients with discomfort during brushing, and to enhance esthetic results around implants without KM. However, no study has systematically assessed and compared discomfort during brushing, patient soft tissue esthetic satisfaction, and other clinical parameters between implants with and without KM. METHODS: Group 1 included patients with implants surrounded by KM, whereas patients in Group 2 had no KM around implants. Patient discomfort during brushing and esthetic satisfaction were measured with a visual analog scale and compared between the 2 groups using a mixed model. Clinical width of KM, probing depth, peri-implant recession, plaque index, and bleeding on probing were compared within and between groups 3 and 6 months following implant restoration. RESULTS: Twenty-four patients (12 in each group) were evaluated at the 3- and 6-month follow-up visits. Patients without peri-implant KM were less satisfied with the esthetics of the soft tissue around their implants (P < 0.01). However, lack of KM was not associated with discomfort during brushing. In Group 1, width of KM was significantly increased after 6 months (P < 0.01). There was greater recession around implants without KM after 3 months (P < 0.01), but not after 6 months. CONCLUSIONS: Patients reported that presence or absence of keratinized mucosa did not affect discomfort associated with brushing. Yet, esthetically, patients preferred implants with a zone of keratinized mucosa.