Short (≤6 mm) compared with ≥10-mm dental implants in different clinical scenarios: A systematic review of randomized clinical trials with meta-analysis, trial sequential analysis and quality of evidence grading.

AIM: To systematically identify, synthesize and critically summarize the available scientific evidence from randomized controlled trials (RCTs) regarding whether short (≤6 mm) perform as well as long (≥10 mm) implants regarding implant survival, marginal bone loss, and biologic and prosthetic complications in different clinical scenarios. MATERIALS AND METHODS: Cochrane Collaboration's risk of bias tool and the GRADE approach were applied. Results were synthesized using random-effects meta-analyses assessed by trial sequential analyses. RESULTS: Forty reports on 19 RCTs comprising 2214 (1097 short; 1117 long) implants were included. Moderate/high certainty/quality evidence demonstrated similar 5-year survival rates for ≤6-mm and ≥10-mm implants in non-augmented bone and full-mouth rehabilitation in either jaw, and for 6-mm implants in the maxilla instead of sinus lift. Nevertheless, the evidence for 5-year survival rates remains inconclusive or insufficient for the remaining combinations of implant lengths and clinical scenarios. They include 4-mm and 5-mm implants as alternatives to sinus lift as well as placing all implant lengths ≤6 mm instead of vertical ridge augmentation with long implants. Marginal bone level and short- and long-term biologic or prosthetic complications were similar. CONCLUSIONS: Based on moderate/high certainty/quality evidence from 5-year RCTs, implants ≤6 mm may be viable alternatives to ≥10-mm implants in either jaw in native bone and full-arch rehabilitation, and 6-mm implants may be used as an alternative to sinus lift. TRIAL REGISTRATION: PROSPERO ID: CRD42021254365.

Radiographic evaluation of a novel bone adhesive for maintenance of crestal bone around implants in canine oversized osteotomies.

BACKGROUND: A novel bone adhesive (tetracalcium phosphate and O-phospho-L-serine) has been developed as an osteoconductive, biodegradable bone-adherent material. The purpose of this study was to evaluate the maintenance of crestal bone/material level by standardized radiographs. METHODS: This was a randomized, controlled, three arm, prospective study. Twenty-six mixed breed hound dogs were included in this study. Three implants were placed on either side of the mandible with either bone adhesive (BA), bovine bone mineral (BBM), or no biomaterial (negative control [NC]). Standardized periapical radiographs were taken immediately after implant placement and at every month up to 1 year. The vertical distance between the implant platform to the first radiopaque material on both the mesial and distal surfaces were measured and crestal bone/material level changes were analyzed. RESULTS: The crestal bone/material level adjacent to BA was stable and maintained throughout the study. There were statistically significant differences found between BA and NC in terms of maintenance of crestal bone levels at any given timepoint. CONCLUSION: This study demonstrated that BA maintained crestal bone levels and had a similar ability to maintain that level over 1 year compared with BBM.

Research progress of superhydrophilic implants / 中国基层医药

In the past few decades, some studies reported that changing the specific surface properties of titanium implants, such as surface morphology, surface chemistry, surface charge and wettability, improved the bone bonding ability of titanium implants. Based on the existing evidence, this review paper analyzes the methods and characteristics of surface chemical modification of the superhydrophilic implants (Thommen INICELL?) that were listed in China in recent years, and clarifies the process of early osseointegration from the viewpoint of histomorphology, and evaluates its clinical application effects.

One-year retrospective radiographic assessment of marginal bone loss around basal implants and impact of multiple risk factors using multivariate analysis / Evaluación radiográfica retrospectiva de un año de la pérdida ósea marginal alrededor de los implantes basales y el impacto de múltiples factores de riesgo mediante análisis multivariado

Background: Factors like medical and periodontal conditions, implant location and smoking can affect marginal bone loss (MBL) of basal implants. Objectives: The purpose of this study is to explore the association of MBL with multiple variables including gender, age, smoking status, diabetes, implant placement protocol, location of implant, and type of prosthesis. Material and Methods: A total of 156 single-piece basal implants (Dr. Ihde Dental AG in Gommiswald, Switzerland) were placed in 44 patients. Dental panoramic tomographs were obtained postoperatively and following a one-year of service to determine MBL on mesial and distal sides. The association of MBL with the multiple variables was analysed using the multivariate and the random forest analysis. Results: The mean mesial and distal MBL was 0.64 millimetres. None of the implants presented MBL exceeding 1 millimetre. All implants were retained without complications during the firstyear of service. The MBL was remarkably associated with the smoking status, diabetes, location of implant and implant placement protocol. Diabetes mellitus is the most vital parameter in predicting MBL. Conclusion: The mean MBL of all implants did not exceed the threshold of 1 millimetre during the first year of service. When placing implants in patients who smoke and have diabetes, care should be taken.

Antecedentes: Factores como las condiciones médicas y perio-dontales, la ubicación del implante y el tabaquismo pueden afectar la pérdida marginal de hueso (PMH) de los implantes basales. Objetivo: La finalidad de este estudio es explorar la asociación de PMH con múltiples variables, incluido el sexo, la edad, el tabaquismo, la diabetes, el protocolo de colocación del implante, la ubicación del implante y el tipo de prótesis. Material y Métodos: Se colocaron 156 implantes basales de una sola pieza (Dr.Ihde Dental AG, Gommiswald, Suiza) en 44 pacientes. Se obtuvieron tomografías panorámicas dentales después de la operación y después de un año de servicio para deter-minar la MBL en los lados mesial y distal. La asociación de la PMH con las múltiples variables se analizó mediante el análisis multivariado y de bosque aleatorio. Resultados: La PMH media mesial y distal fue de 0,64 milímetros. Ninguno de los implantes presentó PMH superior a 1 milímetro. Todos los implantes se mantuvieron sin complicaciones durante el primer año de servicio. La PMH se asoció nota-blemente con el tabaquismo, la diabetes, la ubicación del implante y el protocolo de colocación del implante. La diabetes mellitus es el paráme-tro más importante para predecir la MBL. Conclusion: La PMH media de todos los implantes no superó el umbral de 1 milímetro durante el primer año de servicio. Se debe tener especial cuidado al colocar implantes en pacientes que fuman y tienen diabetes.

A 5-Year Retrospective Analysis of Biologic and Prosthetic Complications Associated With Single-Tooth Endosseous Dental Implants: Practical Applications.

FOCUSED CLINICAL QUESTION: What are the key considerations of the incidence and timing for single-tooth implant complications, including early failure, biological complications, and prosthetic complications? SUMMARY: Single-tooth dental implants have been shown to have a high overall survival rate, but implant complications affect patient satisfaction and may lead to costly and/or time-consuming repair and revision. Assessing the incidence and types of biologic and prosthetic complications and the timing of such complications is helpful so that the underlying causes can be addressed during the treatment planning process. Furthermore, identification of patient demographics, patient-, implant-, and site-specific factors associated with such complications may allow for more comprehensive risk assessment during treatment planning. CONCLUSIONS: Overall, dental implants have a high survival rate. Identification of the incidence of both biologic and prosthetic complications and minimizing their impact in patients with dental implants is critical to overall implant success. Utilization of careful treatment planning and dental implant fixtures, surgical protocols, and prosthetic designs that reduce complication rates can improve patient acceptance and outcomes. Further research is necessary to fully assess complication rates and risk factors.

Clinical Decision Making for Primary Peri-Implantitis Prevention: Practical Applications.

FOCUSED CLINICAL QUESTION: When planning dental implant therapy, what risk-reduction strategies allow practitioners to select patients, sites, and restorative plans that decrease the incidence of peri-implant disease? SUMMARY: With a marked increase in the number of patients receiving dental implants to treat partial or complete edentulism, it follows that the prevalence of peri-implant mucositis and peri-implantitis have increased. Risks associated with implant therapies may vary based upon underlying local, environmental, surgical, patient, prosthetic, and fixture-related factors. Furthermore, an emphasis on preventative measures and maintenance should be undertaken to avoid development and progression of peri-implant diseases. Thorough risk assessment, proper treatment planning, and early diagnosis and intervention are critical in the absence of definitive data of long-term success of treatments for peri-implant condition. Given the difficulty in intervention once peri-implantitis is established, identification of risk factors and development of treatment plans to address those factors before dental implant therapy is critical to the long-term health and success of dental implants. CONCLUSIONS: A patient-centered, evidence based approach to dental implant treatment planning to reduce the risk for peri-implantitis should be undertaken. Systematic diagnosis of disease state(s) and evaluation of the etiologic and modifying risk factors for peri-implant diseases can yield more optimal outcomes to reduce peri-implantitis rates.

Regenerative Treatment of Peri-Implantitis: A Systematic Revie.

Objectives: The aim of this systematic review was to assess the clinical efficacy of bone regeneration for treatment of peri-implantitis. Materials and Methods: Electronic search of the literature was performed to identify randomized clinical trials (RCTs) and case series on treatment of peri-implantitis using bone regeneration procedures with at least 6 months of follow-up. The guidelines of the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) were applied. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool. Results: Two RCTs and 16 case series with a total of 520 treated patients (2002 implants) were included. Bone regenerative procedures showed controversial results regarding bone fill. Two studies reported statistically significant bone gain while four studies reported insignificant bone gain. Other studies reported bone gain with no P value. Pocket depth (PD) reduction varied among the studies since four studies reported a significant reduction in PD while four others reported insignificant reduction in PD. Other studies reported a reduction in PD with no P value. Bone regeneration procedures seemed to decrease bleeding on probing (BOP) but they did not seem conducive to increase the width of keratinized gingiva. Increased keratinized gingiva was noted in cases with subepithelial grafts. Conclusion: Evaluation of the effectiveness of bone regeneration techniques in this systematic review presented limitations related to heterogeneity in patient selection (age, history of periodontitis, smoking status and implant system), means of disinfection and decontamination, and variability of the materials used for treatment.

Bacterial Colonization and Dental Implants: A Microbiological Study

Abstract Objective: To compare colony forming unit (CFU) of oral bacterial from buccal mucosa and lingual buccal tongue among patients with a dental implant and normal oral hygiene individuals without a dental implant. Material and Methods: Twenty-six individuals with a dental implant and twenty-six individuals without dental implants were included in this study. The samples were sent to the laboratory to culture with Brain Heart Infusion Broth (BHI), prepared serial dilution and then spread to the blood agar. CFU was counted when a single layer of bacteria is formed on the blood agar at any dilution level. An independent-T test was used to compare the means different of CFU oral bacterial between control and test groups from buccal mucosa and lingual buccal mucosa, respectively. Results: Buccal mucosa control group (186.19 ± 5.61) and test group (186.65 ± 6.24) (p>0.05). The result from the lingual buccal tongue control group (198.38 ± 6.12) and test group (197.96 ± 6.50) (p>0.05). There was no significant difference between the control group and test group CFU bacterial load. Conclusion: The presence of implants in the oral cavity do not interfere or worsen the oral condition; nevertheless, the effect of implants surrounding oral flora is similar to natural teeth.

Histometry Analysis of Osteoclasts, Osteoblasts and Fibroblasts in Immediate Placement Implants with Addition of Aloe Vera Extract

Objective: To analyze the effect of immediate placement of implants with extract from the new bone formation histometically. Material and Methods: In this true-experimental design with randomized post test control group, 9 mongrel dogs weighing 10 to 12 kg were used, which were divided into 3 groups, based on observation time of 14 days, 28 days and 56 days. On the installation of implants (∅3.5x10 mm) sequentially, the former socket extraction of the lower jaw's right second premolar tooth in the study sample injected 10% Aloe vera gel extract and left second left premolar tooth without injection of 10% Aloe vera extract. To compare independent groups use the Mann-Whitney test. All analysis were carried out using SPSS version 20. Results: There was an increase in the number of osteoblast cells in both treatment and control groups, but the value of the treatment group was greater. There were significant differences in the number of osteoblast cells between the treatment and control groups 14 days (p=0.019), 28 days: (p=0.018), and 56 days (p=0.009). There were no significant differences in the number of fibroblast cells between the treatment and control groups (p>0.05). But at observations 28 and 56 days, it was showed a significant difference in the number of fibroblast cells between the treatment and control groups (p=0.353 and p=0.024, respectively). Conclusion: Immediate placement of implants with 10% Aloe vera extract gel on extracted socket increases the number of osteoblasts and suppresses the number of osteoclasts and fibroblasts.

[Clinical evaluation of two transalveolar methods for sinus augmentation with placing 1 204 implants immediately].

Objective: To compare the clinical outcomes of posterior maxillary implant surgery when using the regular transalveolar approach or with the crestal approach-sinus (CAS-KIT), a device for maxillary sinus membrane elevation by the crestal approach using a special drilling system and hydraulic pressure. Methods: In this retrospective study 887 patients during Jan 2012 to July 2015 in Hangzhou Dental Hospital with underwent either regular transalveolar approach or CAS-KIT approach for maxillary augmentation; whereas 11 patients dropped out for the reason of serious membrane perforations. Totally, 876 patients with 1 204 plants, placed immediately after transalveolar maxillary augmentation, were included in this study. The data analysis was performed by radiological measures to assess the changes in height of maxillary sinus floor after the transalveolar augmentation at different time points. In addition, the complications after surgery, failure rates, osseointegration condition and the performance of rehabilitation were evaluated as well. Results: Five hundred and three patients were experienced with regular transalveolar approach, and 7 patients were drop out for the serious membrane perforations. Thus, 496 patients received 653 implants in this group; the average lifted range in maxillary sinus floor height changes was (4.08±3.45) mm. The complications were minor membrane perforations during procedure in 64 patients, postoperative maxillary sinus infection happening in 2 patients and 13 patients experienced rehabilitation failure. Three hundred and eighty-four patients had CAS-KIT approach with 4 patients dropped out. Three hundred and eighty patients get 551 implants with the mean lifted range of (8.36±4.07) mm in maxillary sinus floor height changes. Minor membrane perforations during procedure occurred in 31 people and 2 got postoperative maxillary sinus infection. The 4 year overall survival rate of 1 204 implants was 97.26%, with four implants fell off after 3 months of rehabilitation and one implant occurred after one year of rehabilitation. Conclusions: The regular transalveolar sinus lift technique is easier and time saving, but the compromised lifting range in maxillary sinus floor height and the comparatively high occurrence of intraoperative membrane perforations should be concerned. Using CAS-KIT could be an alternative method to perform maxillary sinus augmentation with a reduced incidence of complications. There was no statistically difference in implant failure rates and incidence of postoperative maxillary sinus infection between two groups.

Radiographic analysis of dental implant extensions using bone grafts on dogs.

BACKGROUND: Despite the wide use of dental implants they can bring inconveniences, as the moment one reaches osseointegration, these can no longer be extended. Therefore, if a problem occurs regarding its positioning, the options open are substitution or burial of the implant. With implant substitution, there exists the risk of local bone loss and/or future loss of the new implant. PURPOSE: This study proposes a new device (implant extender) for extending the dental implant. The feasibility of this technique is verified through installing dental implant extensions onto the humerus bone of dogs with autogenous bone grafts. MATERIALS AND METHODS: Implants of 3.3 mm in diameter by 6 mm in length and implant extensions with a 3.3 mm diameter and 2.2 mm length were installed onto humerus of 4 healthy dogs, using an autogenous bone graft in a block made from ilium. The biomechanical percussion tests were performed on the implant extensions and then the implant-extension sets were removed for radiographic analysis. RESULTS: In the biomechanical percussion, none of the extensions present clinical mobility. As for the x-rays, these were analyzed by 20 professionals, who concluded that there was a 100% success rate with bone formation around the implants, 74.1% for bone neoformation of the implant extensions, and 80.1% referring to the adaptation of the implant extension. DISCUSSION AND CONCLUSION: Bone formation occurred in every installed dental implant. In most cases, there occurred bone neoformation of the extensions and adaptation of the extension/implant set, according to the x-ray analysis performed by the evaluators. An absence of clinical mobility in the extensions was also observed. Although the results were promising, these techniques still need to be researched in humans, as an alternative for reducing elongated prosthetic crowns or poorly installed implants, as well as the modification of the type of implants among other applications.

Evaluation of Frontal Teeth Stabilization after Root Apex Resection among the Ukrainian Young People

Objective: To develop a protocol of improved stabilization of teeth after root apex resection among young people using endodonto-endoossal implants and assessing its effectiveness. Material and Methods: Thirty-six patients were previously selected and divided into Group 1 (without additional stabilization) and Group 2 (with additional stabilization). The efficacy of treatment in both clinical groups was estimated at 90, 180 and 360 days, respectively. The results were evaluated on the Miller scale in the Flesrar modification. Density of bone tissue was expressed in Hounsfield units. Results: The average mobility indices over 90 days indicate a significant lower mobility of teeth in patients in Group 2, where as an advanced method, the RTR with an additional filling of the bone marrow defect with an osteoplastic material was chosen as the method of treatment (+ 18.0 ± 0.21 U.M. 10.0 ± 0.8 µm, p<0.05). In Group 1, 90 and 180 days after surgery, the density of bone tissue in the defect area was 756.3 ± 2.45 HU and 880.1 ± 4.34 HU. In Group 2, these indices were insignificantly higher and amounted to 834.3 ± 4.35 HU and 880.4 ± 2.56 HU. After 360 days after treatment in the first clinical group the bone density index was 957.4 ± 2.45 HU, while in the second group - 1003.3 ± 4.38 HU. Conclusion: The mobility of teeth among patients on 90-th day corresponded to level 1, and on 360-th day corresponded to level 0, indicating the effectiveness of the proposed method. The biomechanical stabilization of the teeth was confirmed by the results of densitometry among patients of both groups, in particular, the recovery of bone density in the affected site was observed after 360 days.

Clinical evaluation of two transalveolar methods for sinus augmentation with placing 1 204 implants immediately / 中华口腔医学杂志

Objective@#To compare the clinical outcomes of posterior maxillary implant surgery when using the regular transalveolar approach or with the crestal approach-sinus (CAS-KIT), a device for maxillary sinus membrane elevation by the crestal approach using a special drilling system and hydraulic pressure.@*Methods@#In this retrospective study 887 patients during Jan 2012 to July 2015 in Hangzhou Dental Hospital with underwent either regular transalveolar approach or CAS-KIT approach for maxillary augmentation; whereas 11 patients dropped out for the reason of serious membrane perforations. Totally, 876 patients with 1 204 plants, placed immediately after transalveolar maxillary augmentation, were included in this study. The data analysis was performed by radiological measures to assess the changes in height of maxillary sinus floor after the transalveolar augmentation at different time points. In addition, the complications after surgery, failure rates, osseointegration condition and the performance of rehabilitation were evaluated as well.@*Results@#Five hundred and three patients were experienced with regular transalveolar approach, and 7 patients were drop out for the serious membrane perforations. Thus, 496 patients received 653 implants in this group; the average lifted range in maxillary sinus floor height changes was (4.08±3.45) mm. The complications were minor membrane perforations during procedure in 64 patients, postoperative maxillary sinus infection happening in 2 patients and 13 patients experienced rehabilitation failure. Three hundred and eighty-four patients had CAS-KIT approach with 4 patients dropped out. Three hundred and eighty patients get 551 implants with the mean lifted range of (8.36±4.07) mm in maxillary sinus floor height changes. Minor membrane perforations during procedure occurred in 31 people and 2 got postoperative maxillary sinus infection. The 4 year overall survival rate of 1 204 implants was 97.26%, with four implants fell off after 3 months of rehabilitation and one implant occurred after one year of rehabilitation.@*Conclusions@#The regular transalveolar sinus lift technique is easier and time saving, but the compromised lifting range in maxillary sinus floor height and the comparatively high occurrence of intraoperative membrane perforations should be concerned. Using CAS-KIT could be an alternative method to perform maxillary sinus augmentation with a reduced incidence of complications. There was no statistically difference in implant failure rates and incidence of postoperative maxillary sinus infection between two groups.

Clinical study of custom abutment and digital provisional crown in implant denture gingival formation / 中国基层医药

Objective To analyze the effect of custom abutment and computer aided design and computer aided manufacturing(CAD/CAM) provisional crown on gingival shaping around the implant,and to research the main effect of the custom abutment in the formation of gingival.Methods According to the wishes of patients,fifteen patients were divided into two groups.Gingival molding used CAD/CAM in the observation group(n=7) to design and make custom abutment and provisional crown.The control group(n=8) used the prefabricated abutment and the hand-made self-curing resin temporary crown.Immediately after inserting of final insertion and three months later,pink esthetic score(PES) was calculated in both two groups.Results The labial gingiva curve of the observation group was (1.93±0.27)points,which was higher than (1.56±0.51)points of the control group,there was significant difference between the two groups(t=2.496,P0.05).The PES score of the observation group was (8.50±1.09)points,which was higher than (7.75±1.13)points of the control group,but the difference was not statistically significant(P>0.05).Conclusion The effect of the custom abutment on curvature of facial mucosa is significant.The combination of custom abutment and digital provisional crown can achieve better soft tissue stability and ideal aesthetic effect in a short time.

Immediate Single-Tooth Implant Placement in Bony Defects in the Esthetic Zone: A 1-Year Randomized Controlled Trial.

BACKGROUND: This study aims to assess, with regard to marginal bone level (MBL), whether the outcome of immediate implant placement in bony defects in the esthetic zone was non-inferior to delayed implant placement after 1 year. METHODS: Forty patients with a failing tooth in the esthetic zone and a labial bony defect of ≥5 mm after removal of a tooth were randomly assigned for immediate (n = 20) or delayed (n = 20) implant placement. Second-stage surgery and provisionalization occurred after 3 months of healing. Follow-up was at 1 month and 1 year after definitive crown placement. The study was powered to detect a difference in MBL of >0.9 mm. Buccal bone thickness, soft tissue peri-implant parameters, esthetic indices, and patient satisfaction were also assessed. RESULTS: One year after definitive crown placement, MBL loss was 0.56 ± 0.39 mm mesially and 0.74 ± 0.51 mm distally for the immediate placement group and 0.51 ± 0.43 mesially and 0.54 ± 0.45 distally mm for the delayed placement group, respectively (not significant). Regarding differences in means, non-inferiority was observed after 1 year (difference in mean for immediate versus delayed: mesially 0.04 mm [95% confidence interval (CI) = -0.22 to 0.30 mm, P = 0.40]; distally 0.21 mm [95% CI = -0.10 to 0.51 mm, P = 0.58]). No significant differences in the other outcome variables were observed. CONCLUSIONS: Immediate implant placement with delayed provisionalization was non-inferior to delayed implant placement with delayed provisionalization in labial bony defects of ≥5 mm regarding change in MBL. Although not powered for other outcome variables, no clinically relevant differences were observed in these variables.

Comportamiento del proceso de osteointegración en implantes transalveolares inmediatos / Osseointegration of Immediate Transalveolar Implants

Fundamento: la osteointegración es un requisito primordial para comenzar la rehabilitación protésica sobre implantes. Objetivo: describir el comportamiento del proceso de osteointegración en implantes transalveolares inmediatos. Métodos: estudio prospectivo, de serie de casos, en el periodo de enero 2012 a diciembre del 2013. Se trabajó con la totalidad de los pacientes (75 pacientes con 79 implantes) que acudieron a la consulta de Prótesis Dental. La edad, sexo, osteointegración, causa de la pérdida dentaria, región implantada, diente específico, nivel óseo alrededor del implante y encía queratinizada alrededor del implante, fueron las variables estudiadas. Para el análisis de los datos, se utilizaron medidas de distribución de frecuencia, y análisis estadísticos. Resultados: predominó el sexo femenino, así como los pacientes con edades de 31 a 45 años; la osteointegración se observó en el 97,4 % de los implantes. Las zonas que más implantes recibieron fueron premaxila y maxilar posterior, específicamente en las primeras bicúspides. En la mayoría de los pacientes, la osteointegración con formación de hueso tuvo lugar a nivel del cuello del implante y en presencia de encía totalmente queratinizada, con asociación estadísticamente significativa entre ambas variables. Conclusión: el tratamiento rehabilitador con este tipo de implante, posibilita una exitosa osteointegración en la mayoría de los casos estudiados.

Background: osseointegration is critical to start prosthetic rehabilitation. Objective: to describe osseointegration of immediate transalveolar implants. Methods: a prospective case series study was conducted from January 2012 to December 2013. It included all patients (75 patients with 79 implants) who attended the Prosthodontics service. Age, sex, osseointegration, cause of tooth loss, region of the implant, specific tooth, bone level and keratinized gingiva around the implant, were the variables studied. Frequency distribution and statistical analysis were used for data analysis. Results: females and patients aged 31 to 45 years predominated. Osseointegration was observed in 97.4% of the implants. Nearly all implants were placed in the premaxilla and posterior maxilla, specifically in the first bicuspids. In most patients, osseointegration with bone formation occurred at the implant collar and in the presence of completely keratinized tissue, with a statistically significant association between the two variables. Conclusion: rehabilitation treatment with this type of implant led to successful osseointegration in most cases studied.

Screw- vs. Cement-retained Implant-supported Prosthesis in Partially Edentulous Patients: An Oral Health Technology Assessment Report.

Understanding the morbidity events, incidence, and cost associated with each type of retention system used for implant supported prosthesis will help the clinician in better decision making. This study assessed the clinical and cost-effectiveness of the screw- and cement-retained implant-supported single crown and fixed partial denture for the replacement of teeth in partially edentulous jaws, from a health services perspective. A systematic literature search conducted in 10 databases, complemented by 4 journal databases and International Association for Dental Research abstracts, identified 92 studies on the single crown and 40 studies on the fixed partial denture. Minor and major technical complication events, as well as failure events, were extracted from strong- and medium-quality studies. Studies based on similar designs were pooled with a random-effects Poisson regression model. A decision tree was developed to estimate the cost-effectiveness over a 15-y period posttreatment. The initial and maintenance costs to treat technical complication events were based on an American Dental Association survey of 2011 to 2012. Probabilistic sensitivity analysis was used to examine the uncertainty in the data input parameters. Clinical evidence generated from the meta-analysis suggested no statistical difference between the 2 retention systems. The cost-effectiveness is presented as an incremental cost-effectiveness ratio. The evidence from this report suggests that cement retention is the more cost-effective strategy as compared with screw retention prosthesis. Knowledge Transfer Statement: Evidence generated by this study will help clinicians make an appropriate cost-effective treatment decision in choosing the retention system for partially edentulous patients.

Effects of health management of stomatology on the marginal bone resorption of minimally invasive implant in the elderly / 中华健康管理学杂志

Objective To evaluate the effects of health management of stomatology on the marginal bone resorption of minimally invasive implant in the elderly.Method Tottally 54 implants were placed in 37 elderly patients of missing teeth in maxillary molar areas and the patients were randomly divided into health management group and control group.Patients in the group of health management were guided to master the proper techniques of oral hygiene practices before and after the implantation and periodontal maintenance were carried out carefully until 1 year after loading of restoration.In the control group, oral hygiene was applied. X-ray and CBCT examinations were made and implant marginal alveolar bone loss (MBL) was measured 3, 6, 9, 12 months after loading with Planmeca PROMAX3D software. Besides, 3, 6, 9, 12 months after loading, improved plaque index (iPLI), modified bleeding index (mBI) and probing depth (PD) were also recorded. SPSS 15.0 was applied to analyze the data. Result Differences in diastolic and systolic blood pressure and changes in heart rate in patients during the intraoperative period were (8.86 ± 0.31) mmHg(1 mmHg=0.133 kPa), (19.18 ± 0.22) mmHg, (20.19 ± 1.84) times/min, which were significantly lower than those of the control group values [(16.55±1.08) mmHg, (28.31±2.30) mmHg, (20.19±1.84) times/min] (P<0.05 or 0.01);at 12 months after the load around the implant in oral health management group, the values of MBL and mSBI were 2.6 (2, 4), 2.1 (2, 4), which were significantly better than control group [4.3(3, 7), 4.3(3, 7)] (P<0.01);simultaneously, there was significant difference in the values of MBL and PD between experimental group (1.42 ± 0.03, 0.77 ± 0.24) and control group (1.59 ± 0.04, 0.54 ± 0.17) (P<0.01). Conclusion Well-performed health management of peri-implant could reduce the MBL and keep healthy soft tissue environment around implants.

Dental implants installed in irradiated jaws: a systematic review.

The aim of this study was to assess the survival rate of titanium implants placed in irradiated jaws. MEDLINE, EMBASE, and CENTRAL were searched for studies assessing implants that had been placed in nongrafted sites of irradiated patients. Random effects meta-analyses assessed implant loss in irradiated versus nonirradiated patients and in irradiated patients treated with hyperbaric oxygen (HBO) therapy. Of 1,051 potentially eligible publications, 15 were included. A total of 10,150 implants were assessed in the included studies, and of these, 1,689 (14.3%) had been placed in irradiated jaws. The mean survival rate in the studies ranged from 46.3% to 98.0%. The pooled estimates indicated a significant increase in the risk of implant failure in irradiated patients (risk ratio: 2.74; 95% confidence interval: 1.86, 4.05; p < .00001) and in maxillary sites (risk ratio: 5.96; 95% confidence interval: 2.71, 13.12; p < .00001). Conversely, HBO therapy did not reduce the risk of implant failure (risk ratio: 1.28; 95% confidence interval: 0.19, 8.82; p = .80). Radiotherapy was linked to higher implant failure in the maxilla, and HBO therapy did not improve implant survival. Most included publications reported data on machined implants, and only 3 studies on HBO therapy were included. Overall, implant therapy appears to be a viable treatment option for reestablishing adequate occlusion and masticatory conditions in irradiated patients.

O uso de implantes, enxerto ósseo e condicionamento do tecido gengival perimplantar na reabilitação estética de área anterior de maxila / The use of dental implants, bone graft and peri-implant gingival tissue modeling in the esthetic rehabilitation of the maxillary anterior area

A reabilitação protética implanto-suportada de espaços edêntulos na região anterior da maxila é um desafio para o cirurgião-dentista. Um adequado posicionamento dos implantes e sua relação harmoniosa com os tecidos duros e moles são fundamentais para uma alta demanda estética. Esse caso relata a correção de um severo defeito estético no qual foi necessário associar vários procedimentos, como a realização de enxerto ósseo prévio, a instalação de implantes osseointegráveis, a manipulação dos tecidos peri-implantares e a escolha de componentes protéticos estéticos, para se alcançar um resultado estético satisfatório.

Implant-supported prosthetic rehabilitation of anterior edentulous spaces is a challenge to the dentist performing the implant surgery. Proper positioning of the implant and its harmonious relationship with the hard and soft tissues are fundamental for a high aesthetic demand. This case report a correction of a serious esthetic defect in that was necessary associate some procedures, like a previous bone graft, installation of osseointegrated implants, soft tissue manipulation and the use of esthetic prosthetic components to reach a satisfactory result.