Comparison of Guided Bone Regeneration with Periosteal Pocket Flap Technique Versus Autogenous Bone Block Graft for Horizontal Bone Augmentation: A Clinical Trial Study

The aim of this study was to assess changes in the horizontal dimension of the alveolar ridge when the autogenous bone block (ABB) or periosteal pocket flap (PPF) techniques were performed prior to implant placement. This randomized trial study was conducted on 25 patients in need of horizontal bone augmentation, who were randomly divided into two groups as follows: 13 patients underwent ridge augmentation using ABB, allograft, and a collagen membrane, while the remaining 12 underwent horizontal bone augmentation via the PPF technique. For all patients, radiographic examinations via CBCT were performed both before and 26 weeks after the operation. Following the surgery, dimensional changes in the ridge width were measured both within and between the two groups in the three regions of 0, 3, and 5 mm from the top of the alveolar crest. A total of 11 patients in the ABB group and 12 patients in the PPF group successfully completed the study. Statistical analysis showed that the increase in alveolar ridge width in each group was significant, but not significantly different between the two groups at any of the measured spots (0 mm from the crest, P = .25; 3 mm, P = .38; and 5 mm, P = .73). However, more postoperative complications were observed with the ABB technique. According to the results of the present study, there was no statistically significant difference between the PPF and ABB techniques in terms of horizontal bone gain.

Effect of Air Polishing on the Treatment of Peri-Implant Diseases: A Systematic Review and Meta-Analysis.

Peri-implant diseases have become one of the notable biological complications of postrehabilitation with implant-supported restorations. Effective modalities for decontamination of biofilm deposits around implant surfaces are critical for resolution of the inflammation. Air polishing is one of the recommended clinical methods for treating peri-implant diseases. This systematic review assessed clinical evidence on efficacy of using air polishing technology for the management of peri-implant diseases, including peri-implant mucositis and peri-implantitis. Four electronic databases from January 1990 to December 2022 were searched to identify the relative human randomized clinical trials that applied air polishing for nonsurgical and surgical treatment of peri-implant mucositis and peri-implantitis. Twelve articles were selected. For treating peri-implant mucositis, air polishing showed a comparable effect to ultrasonic scaling in the reduction of bleeding on probing (BOP) and probing pocket depth (PPD). The nonsurgical approach of air polishing in treating peri-implantitis varied in the reduction of BOP, PPD, and clinical attachment level (CAL) in evaluated studies. Air polishing in the surgical treatment of peri-implantitis was comparable to mechanical cleaning, implantoplasty, and the use of Ti-brush, in regards to the significant reduction of BOP, PPD, and CAL, as well as the improvement of the bone level between baseline and follow-ups. The standardized mean difference with a 95% confidence interval of the studied parameters was estimated using the random effect model; however, statistical differences were not detected between air polishing and comparative modalities in the treatment of peri-implantitis. Within the limitations of this review, the application of air polishing did not result in more favorable outcomes in the treatment of peri-implant diseases compared to other modalities.

Clinical and radiographic evaluation of jumping distance management using a collagen matrix in flapless immediate implant placement.

BACKGROUND: Improvement in implant design has made implant dentistry a challenging treatment modality worldwide. OBJECTIVES: This study aimed to investigate the efficacy of a xenogeneic collagen matrix in managing 3-4-millimeter gaps in flapless immediate implant placement. MATERIAL AND METHODS: Twenty-two patients received 39 immediate implants via the flapless approach. Patients with intact bony walls, buccal bone thickness ≥2 mm and a jumping distance of 3-4 mm were included in this study. The gap between the implant and the socket walls was filled with a xenogeneic collagen matrix (Collacone®). The final clinical and radiographic evaluations were performed at least 24 months following functional loading. RESULTS: There was no early or late failure, and the implants showed a 100% survival rate. The mean mesial (0.28 ±0.39 mm) and distal (0.28 ±0.39 mm) marginal bone loss (MBL) at the site of incisors was not significantly different from the values at the site of premolars and molars (0.30 ±0.42 mm and 0.34 ±0.48 mm, respectively). The evaluation of the implant success index (ISI) score revealed no difference between the mandible and the maxilla (p = 0.700), or incisors compared with premolars and molars (p = 0.420). The only significant difference was in terms of distal MBL, which was higher in the maxilla (0.39 ±0.49 mm) than in the mandible (0.12 ±0.23 mm) (p = 0.040). CONCLUSIONS: Within the limitations of this study, it seems that the application of a xenogeneic collagen matrix to manage 3-4-millimeter gaps in carefully selected cases may bring promising outcomes.

Comparison of peri-implant clinical outcomes of digitally customized and prefabricated abutments: A systematic review and meta-analysis.

BACKGROUND: Digitally customized abutments are increasingly used in contemporary implant prosthodontics. PURPOSE: This systematic review and meta-analysis aimed at comparing the peri-implant clinical outcomes of digitally customized and prefabricated abutments. MATERIALS AND METHODS: The search strategies included electronic databases (PubMed, Embase, Scopus, and Cochrane clinical trials database) and related journals up to September, 2020. A qualitative and quantitative synthesis was performed on data extracted from the included studies. RESULTS: Three RCTs (number of patients = 120; number of dental implants = 120) and two prospective cohort studies (number of patients = 144; number of dental implants = 144) with one to three-year follow-up periods were included. The quantitative analyses did not demonstrate a significant difference between digitally customized and prefabricated abutments for peri-implant pocket depth (P = 0.62), plaque index (P = 0.67), bleeding on probing (P = 0.43), keratinized mucosa width (P = 0.75), and pink aesthetic score (P = 0.30) at one-year follow-up visit. The qualitative analyses for marginal bone level change, calculus accumulation, implant survival rate, implant success rate, white aesthetic score, and patient-reported outcomes did not demonstrate a significant difference between two groups during 1 to 3-year follow-up visits. CONCLUSION: The current data do not provide evidence of significant differences between two abutment fabrication methods in terms of peri-implant clinical outcomes within short-term period (CRD42020170807).

Reopening of dental clinics during SARS-CoV-2 pandemic: an evidence-based review of literature for clinical interventions.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes serious acute respiratory diseases including pneumonia and bronchitis with approximately 2.3% fatality occurrence. MAIN BODY: This study argues the main concepts that need to be considered for the gradual reopening of dental offices include treatment planning approaches, fundamental elements needed to prevent transmission of SARS-CoV-2 virus in dental healthcare settings, personal protection equipment (PPE) for dental health care providers, environmental measures, adjunctive measures, and rapid point of care tests in dental offices. CONCLUSION: This article seeks to provide an overview of existing scientific evidence to suggest a guideline for reopening dental offices.

Outcomes of Alveolar Ridge Preservation With Recombinant Human Bone Morphogenetic Protein-2: A Systematic Review.

PURPOSE: The main focused question of this systematic review was as follows: Does the application of recombinant human bone morphogenetic protein-2 (rhBMP-2) placed in extraction sockets reduce the alveolar ridge changes? METHODS: A systematic literature search was performed up to February 2017. Clinical studies published in English were included. Outcome variables of interest were as follows: changes in alveolar ridge width and height, the quality of new bone, patient's safety, adverse events, and postoperative complications. RESULTS: Seven articles were included. Because of the vast heterogeneity and high risk of bias among the studies, performing a meta-analysis deemed not feasible. Application of rhBMP-2 in the extraction socket was more effective in the reduction of ridge width compared with that of ridge height. The superiority of 1.5 mg/mL rhBMP-2/absorbable collagen sponge over the carrier alone on alveolar ridge width/height remodeling was more significant when it was applied in the sockets with ≥50% buccal bone dehiscence. The limited available data showed that rhBMP-2 did not improve the quality of new bone. Antibodies against rhBMP-2 were detected in the serum in 1 trial. CONCLUSIONS: Within the limits of this review, 1.5 mg/mL rhBMP-2 might be beneficial for preserving the alveolar ridge width within extraction sockets given as to whether the cost-effectiveness is justifiable. Studies with lower risk of bias should be performed to confirm the above findings.

Guided Bone Regeneration for the Reconstruction of Alveolar Bone Defects.

BACKGROUND: Guided bone regeneration (GBR) is the most common technique for localized bone augmentation. PURPOSE: The purpose of this review was to categorize and assess various GBR approaches for the reconstruction of human alveolar bone defects. MATERIALS AND METHODS: Electronic search of four databases including PubMed/Medline, EMBASE, Web of Science, and Cochrane and hand searching were performed to identify human trials attempting GBR for the reconstruction of alveolar bony defects for at least 10 patients from January 2000 to August 2015. To meet the inclusion criteria, studies had to report preoperative defect dimensions in addition to outcomes of bone formation and/or resorption. RESULTS: Twenty-five human clinical trials were included of which 17 used conventional technique that is the use of space maintaining membrane with bone grafting particles (GBR I). Application of block bone graft with overlying membrane and particulate fillers was reported in seven studies (GBR II), and utilizing cortical bone block tented over a defect preserving particulate fillers was reported by one study (GBR III). A wide range of initial defects' sizes and treatment results were reported. CONCLUSIONS: This review introduces a therapeutically oriented classification system of GBR for treating alveolar bone defects. High heterogeneity among studies hindered drawing definite conclusions in regard to superiority of one to the other GBR technique.

Long-term Radiographic and Clinical Outcomes of Regenerative Approach for Treating Peri-implantitis: A Systematic Review and Meta-analysis.

PURPOSE: The purpose of this systematic review was to evaluate long-term outcomes of regenerative procedures for treating peri-implantitis. MATERIALS AND METHODS: Electronic searches of five databases and hand searches of journals were performed to identify human trials that had treated more than 10 periimplantitis lesions using a regenerative approach with a follow-up period of at least 36 months. To meet the inclusion criteria, studies had to report at least one of the following parameters: radiographic bone fill (RBF), probing depth (PD) reduction, clinical attachment level gain, bleeding on probing reduction, and mucosal level gain. The pooled weighted mean and the 95% confidence interval (CI) of each variable were estimated. RESULTS: The searches yielded 1,412 records, and after evaluating titles, abstracts, and full texts, 5 case series and 1 controlled trial were included for quantitative data synthesis. Meta-analysis of the studies for the amount of RBF revealed a weighted mean of 2.41 mm (range, 1.46 to 3.30 mm) with 95% CI. For PD reduction, the weighted mean was 3.06 mm (range, 1.24 to 5.21 mm). CONCLUSION: There is limited evidence in the literature reporting long-term results of the regenerative approach for treating peri-implantitis. Within the limits of this meta-analysis, regenerative treatment of peri-implantitis resulted in a mean radiographic defect fill of 2.41 mm after a minimum healing time of 36 months. However, this finding must be interpreted with caution, since it is difficult to discern between grafting material and newly formed bone.

Platelet-rich plasma for periodontal regeneration in the treatment of intrabony defects: a meta-analysis on prospective clinical trials.

OBJECTIVE: The aim of this systematic review and meta-analysis was to assess the influence of platelet-rich plasma (PRP) on the regeneration of periodontal intrabony defects by means of evaluating clinical and radiographic outcomes in prospective human clinical trials. BACKGROUND: PRP is a high concentration of platelets suspended in a small volume of plasma and has been used for periodontal tissue regeneration. However, although it has been broadly studied, there is much controversy on its efficacy when used to treat infrabony periodontal defects. METHODS: An electronic literature search was conducted by two reviewers (AR and AM) in several databases up to February 2014. The PICO question was: Does PRP have a higher or similar efficacy of regenerating periodontal intrabony defects compared with other conventional periodontal regeneration treatments (e.g., bone grafts, barrier membranes)? Articles were included in this systematic review if they were prospective clinical trials with 10 or more human patients, reporting the radiographic and/or clinical outcomes PRP for regeneration intrabony periodontal defects. Random effects meta-analyses of the selected studies were applied to avoid any bias being caused by methodologic differences among studies. RESULTS: Twenty-two papers were obtained and reviewed. Of these, 21 articles fulfilled the inclusion criteria and subsequently were qualitatively analyzed. Eighteen of these could be meta-analyzed. Fourteen articles were included for evaluating of probing pocket depth (PPD). The weighted mean difference (WMD) was 0.55 mm, with a 95% CI=-0.09 to 1.20 mm (P=.09). For bone level (BL), 2 articles measured BL in millimeters, and the other two articles measured BL in percentage. The WMD was 0.76 mm (95% CI=0.21-1.31 mm; P=.007) and 47.41% (95% CI=32.48%-62.33%; P<.0001), respectively. For attachment level (AL) changes, 12 articles were included. The WMD was 0.58 mm, with a 95% CI=0.24 to 0.91 mm (P=.0008). Sixteen articles were included for evaluation of marginal gingival level (MGL). The WMD -0.10 mm, with a 95% CI=-0.19 to -0.01 (P=.03). CONCLUSIONS: High heterogeneity among studies made it difficult to draw clear conclusions. Nonetheless, within the limitations of this review, PRP might offer some beneficial effects on clinical and radiographic outcomes for regeneration of periodontal intrabony defects.

The Effect of Vertical Implant Position in Relation to Adjacent Teeth on Marginal Bone Loss in Posterior Arches: A Retrospective Study.

PURPOSE: The aim of this retrospective study was to investigate the possible association between peri-implant marginal bone loss and the apicocoronal (vertical) positioning of dental implants placed adjacent to a tooth. MATERIALS AND METHODS: Dental records at the University of Michigan, School of Dentistry, were screened. To be included in the study, the patient had to have at least one implant in the premolar or molar region, unilaterally or bilaterally, in either arch, with an immediately mesial adjacent tooth. The implant had to have been functionally loaded for at least 3 years after crown insertion, and clear, nondistorted periapical films had to be available. Several landmarks were identified: the cementoenamel junction (CEJ) and crestal bone (CB) of the tooth adjacent to the implant, the implant platform (PL), and the first radiographic implant-bone contact (BL). The following parameters were measured: CEJ-PL, CEJ-CB, CB-PL, horizontal distance between the adjacent tooth and PL (HD), and vertical distance between BL and the first implant thread at the mesial (BL-m) and distal (BL-d) implant surfaces. RESULTS: A total of 139 patients with a mean age of 62.1 ± 9.3 years were included. The mean follow-up period was 4.42 ± 2.5 years. When the implant was placed more than 3 mm apical to the CEJ of the adjacent tooth, significantly greater peri-implant bone loss occurred at the mesial (difference of means = 0.57 mm) and distal (difference of means = 0.83 mm) implant surfaces. CONCLUSION: In this study population, implants placed in the posterior area with a vertical distance greater than 3 mm from the CEJ of the adjacent tooth displayed more peri-implant bone loss. Further investigation is required to determine whether this increased peri-implant bone loss predisposes a site to peri-implantitis.

Long-Term Effect of Four Surgical Periodontal Therapies and One Non-Surgical Therapy: A Systematic Review and Meta-Analysis.

BACKGROUND: The aim of this systematic review is to evaluate the long term (≥ 2 years) effect of four surgical and non-surgical therapies in treating periodontal disease. METHODS: An electronic search of four databases and a hand search of peer-reviewed journals for relevant articles were conducted. Prospective human controlled clinical trials were included that compared surgical therapy to non-surgical therapy in ≥ 10 patients diagnosed with chronic periodontitis with a follow-up period of ≥ 2 years and that reported change in probing depth (PD) and clinical attachment level (CAL) after the therapy. Random effect meta-analysis was performed to compare the outcome of surgical and non-surgical therapy in shallow, moderate, and deep PD. RESULTS: Eight human prospective clinical trials were included. In 1- to 3-mm PD, scaling and root planing (SRP), modified Widman flap (MWF), and osseous surgery (OS) resulted in 23.2%, 39.4%, and 61.39% CAL loss, respectively; SRP, MWF, and OS resulted in increased mean PD of 2.5%, 3.3%, and 6.3%, respectively. In 4- to 6-mm PD, SRP, MWF, and OS resulted in 8.4%, 6.5%, and 5.22% CAL gain, respectively; SRP, MWF, and OS resulted in 18.7%, 25.4%, and 30.8% PD reduction, respectively. In PD ≥ 7 mm, SRP, MWF, and OS resulted in 9.8%, 14.2%, and 9.38% CAL gain, respectively; SRP, MWF, and OS resulted in mean PD reduction of 21.6%, 33.1%, and 42.8%, respectively. CONCLUSIONS: Surgical therapy had significantly more CAL loss than non-surgical therapy in shallow PD. In moderate PD, MWF had significantly more PD reduction than SRP, and there was significantly less CAL gain with surgical therapy. In deep PD, OS had significantly higher PD reduction than SRP.

Effect of barrier membranes on the outcomes of maxillary sinus floor augmentation: a meta-analysis of histomorphometric outcomes.

PURPOSE: Sinus floor elevation via the lateral window approach represents a reliable technique for augmenting bone volume in the atrophic posterior maxilla. However, controversy remains regarding the effect of placement of a barrier membrane over the lateral window. This histomorphometric meta-analysis sought to clarify the effect of barrier membranes in lateral window sinus augmentation. MATERIALS AND METHODS: An electronic search of three databases and a hand search in implant-related journals for studies published through January 2013 in the English language was conducted. Randomized controlled trials, prospective human clinical studies, retrospective investigations, and case series reporting histomorphometric results after sinus elevation using the lateral window approach with at least six patients and a minimum follow-up period of 6 months were included. RESULTS: The initial search yielded 1,040 articles, of which 94 were further evaluated for eligibility. Finally, 37 studies were chosen and separated into membrane (group 1) and no-membrane (group 2) groups. Similar vital bone formation was found in both groups: 32.36% for group 1 and 33.07% for group 2. CONCLUSION: Based does not influence the amount of vital bone formation after sinus augmentation. Additionally, the type of grafting material used and healing time did not influence the histomorphometric outcome.

Outcomes of regenerative treatment with rhPDGF-BB and rhFGF-2 for periodontal intra-bony defects: a systematic review and meta-analysis.

BACKGROUND: The aim was to evaluate the effects of recombinant human platelet-derived growth factor-BB (rhPDGF-BB) and recombinant human fibroblast growth factor-2 (rhFGF-2) on treating periodontal intra-bony defects, compared to the control (carrier alone). METHODS: Electronic and hand searches were performed to identify eligible studies. The weighed mean differences of linear defect fill (LDF), probing depth (PD) reduction, clinical attachment level (CAL) gain and gingival recession (GR) were calculated using random effect meta-analysis. RESULTS: The searches yielded 1018 articles, of which seven studies were included. Only one included study was considered at low risk of bias. The outcomes that reached statistical significance in comparison to carriers alone included: LDF (0.95 mm, 95% CI: 0.62-1.28 mm or 20.17%, 95% CI: 11.81-28.54%) and CAL gain (0.34 mm, 95% CI: 0.03-0.65 mm) for PDGF, and LDF (21.22%, 95% CI: 5.82-36.61%) for FGF-2. CONCLUSIONS: Within the limits of this review, rhPDGF-BB demonstrated significantly more LDF and CAL gain; rhFGF-2 resulted in significantly higher percentage of LDF.