Rehabilitation of Atrophic Mandible with Ultrashort Implants Combined with Photobiomodulation Therapy: A Split-Mouth Design Study.

Background: Atrophic edentulous mandible is a challenging clinical condition. Studies assessing the use of ultrashort implants to support overdentures are scarce; the optimum photobiomodulation (PBM) dose for enhancing osseointegration is yet unknown. Objective: This study aimed to evaluate and compare mandibular overdentures assisted by two versus four ultrashort implants with adjunctive PBM therapy using two doses. Materials and Methods: A total of 36 implants were placed in 12 edentulous male participants and they were randomly allocated to Group I (mandibular overdentures assisted by two ultrashort implants) or Group II (by four ultrashort implants). Fully guided implant placement was performed, and then a split-mouth design was implemented. The participants received PBM by diode laser (660 nm). Dose A (3.75 J/cm2) and Dose B (7.5 J/cm2) were applied to the right and left implant (s), respectively. Implant stability, peri-implant probing depth (PIPD), and modified gingival index (MGI) were evaluated at baseline, and at 6 and 12 months after loading. Results: After 12 months, the implant stability values were significantly higher in Group II compared with Group I (P < 0.001). A significant difference was observed in between the PIPDs of both groups (Group I: 2.35 ± 0.54 mm; Group II: 1.69 ± 0.35 mm;P= 0.001). The mean MGI values were low for both groups (Group I: 0.75 ± 0.58; Group II: 0.51 ± 0.41). Conclusions: Mandibular overdentures supported by four ultrashort implants had a more favorable clinical outcome, while PBM doses A and B were comparable in all evaluated parameters. Trial Registration: ClinicalTrials.gov Identifier: NCT03540316.

Outcomes of Mandibular Overdentures Supported by Four Short Implants Combined with Photobiomodulation Therapy.

PURPOSE: The aim of this study was to clinically and radiographically evaluate mandibular overdentures supported by four short implants combined with two different doses of photobiomodulation (PBM). MATERIALS AND METHODS: A split-mouth design was applied; six completely edentulous male subjects received four short implants in the canine and second premolar area. Short implants were inserted via a digital fully guided approach with a stereolithographic surgical guide. All patients received five PBM sessions immediately after surgery and every 48 hours. Group A (n = 6) implants on the right side received a dose of 3.75 J/cm2, and group B (n = 6) implants on the left side received a dose of 7.5 J/cm2. Evaluation of peri-implant probing depth (PIPD), modified Gingival Index (MGI), and vertical bone loss was performed at the time of prosthetic loading and 6 and 12 months later. The implant stability quotient (ISQ) was also assessed 6 and 12 months after loading. RESULTS: There was no significant difference between both groups regarding PIPD values. However, a minor but significant increase from the baseline (P < .001) was observed in PIPD values in both groups after 12 months. The MGI scores at the different time intervals were very low for both groups. The mean vertical bone loss after 12 months was minimal for both groups but statistically significant from the baseline (P < .001). ISQ values for both groups after 12 months revealed a significant increase from the baseline, and group B values were significantly higher than those of group A. CONCLUSION: Within the limitations of this study, a mandibular overdenture supported by four short implants is a valid treatment modality for atrophic mandibles, and a PBM dose of 7.5 J/cm2 has a potential positive influence on implant healing and osseointegration.

Clinical Efficacy of Photobiomodulation on Dental Implant Osseointegration: A Systematic Review.

BACKGROUND: Photobiomodulation (PBM) has been shown to have a positive effect on dental implant osseointegration and stability in in vitro and animal studies; however, its usefulness in dental implant clinical practice is yet unclear. OBJECTIVE: The objective was to assess the clinical effectiveness of PBM on dental implants' osseointegration. METHODS: Two reviewers independently conducted a comprehensive electronic search of articles published from inception up to January 10, 2020, in PubMed, Cochrane Library and Embase databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomized clinical trials (RCTs) and nonrandomized clinical studies that compared the effect of PBM on dental implant stability with control groups were included. Animals and in vitro studies studies as well as studies with confounders such as application of orthodontic were excluded. Risk of bias (using Cochrane Risk of Bias tool for RCTs and Risk of Bias in Non-Randomized Studies of Interventions tool for nonrandomized studies) was assessed by both authors. Owing to substantial heterogeneity, only a narrative synthesis of the included studies is presented. RESULTS: Seven relevant clinical studies were included, and they used a variety of PBM parameters and devices. The posterior region of the jaw was found to be more frequently evaluated. For assessing the effect of PBM on implant stability, five studies used resonance frequency analysis and two used periotest; three studies additionally used biomarkers for assessment. Four studies found that PBM has a potential positive effect on the outcome of dental implant stability, whereas three studies reported that PBM has no effect on implant stability. CONCLUSION: The findings of this systematic review suggest that postoperative application of PBM may potentially have some positive effect on dental implant's osseointegration and stability. However, additional studies are required with uniformity in methods to provide a more robust assessment of this effect.