Overdentures on primary mandibular implants in patients with oral cancer: a follow-up study over 14 years.

We aimed to assess oral functioning, patients' satisfaction, condition of peri-implant tissues, and survival of implants up to 14 years after their insertion in patients with oral cancer who had had mandibular overdentures placed over primary implants. Endosseous dental implants were inserted prospectively in the interforaminal region of the mandible during resection of the tumour in 164/180 patients with oral cancer. All 58 patients were evaluated by questionnaires and clinical assessments during a final assessment in 2012. Implant-retained mandibular overdentures were inserted, and prosthetic rehabilitation and oral functioning were not associated with primary site or stage of the tumour, number or type of implants inserted, or the type of reconstruction. Over time the peri-implant mucosa was usually free of inflammation. More implants were lost in patients treated by radiotherapy (27/318, 8.5%) than in those not so treated (1/206, 0.5%). Patients who had been treated by irradiation reported more problems in oral functioning and less satisfaction than those who had not. Patients with an implant-retained mandibular overdenture reported fewer problems in oral functioning than patients without an overdenture. Primary insertion of an implant should be routinely incorporated in the surgical planning for patients with oral cancer, as oral functioning in those wearing mandibular overdentures improved considerably and peri-implant health was at least reasonable.

Comparison between conventional and piezoelectric surgical tools for maxillary sinus floor elevation. A randomized controlled clinical trial.

AIM: The aim of this study was to assess the performance of conventional rotative instruments and a piezoelectric device for maxillary sinus floor elevation surgery, and to assess whether application of a resorbable membrane reduces resorption of an augmented site in a randomized clinical trial. MATERIALS AND METHODS: Thirty-six consecutive patients (59.2 ± 10.7 years, range 38-76 years) needing bilateral sinus floor elevation surgery agreed to participate in this study. In a parallel split mouth design randomized clinical trial, in which the allocation of the surgical technique to be used on the determined sites was randomly assigned, one site was always treated with conventional rotative instruments (control group) and the other site with piezosurgery (test group). In addition, in a random order, the grafted sites were covered with a collagen membrane or no membrane. After a healing period of 3-4 months implants were placed. RESULTS: Comparison of clinical features of the test and control sites revealed no differences with regard to wound healing and complications (perforations of the sinus membrane) during or postsurgery (p = .458, p = 1.0, respectively). A clinically insignificant, but statistically shorter operation time was observed when using conventional rotative instruments (11.1 ± 2.4 minutes) than using piezosurgery (15.1 ± 2.9 minutes; p < .001). In both groups, application of a resorbable membrane did not result in less horizontal bone resorption (membrane: 1.43 mm, no membrane: 1.06 mm; p = .062); All 193 implants could be placed with primary stability. One year after functional loading, survival rate was 100%. CONCLUSION: It can be concluded that, for maxillary sinus floor elevation surgery, a piezoelectric device shows no advantages over rotative instruments as well as that placement of a barrier membrane did not reduce resorption of the augmented site.

Does hypoxia-reperfusion injury occur in osteoarthritis of the temporomandibular joint?

AIMS: To determine the available evidence in the literature for whether hypoxia-reperfusion injury plays a role in the pathogenesis of joint diseases in general and of osteoarthritis (OA) of the temporomandibular joint (TMJ) in particular. METHODS: The electronic databases CENTRAL, PubMed, and EMBASE were systematically searched. The search strategy combined thesaurus terms "reperfusion injury" and "joints" and excluded "tourniquet," which possibly induces iatrogenic reperfusion injury. Inclusion and exclusion criteria were applied, data were extracted, and quality was assessed. RESULTS: Four studies could be included, investigating four different aspects of the hypoxia-reperfusion mechanism in joints. All studies investigated several arthritides in the knee or shoulder joint and were observational studies, except for one section of one of the studies, which was a randomized controlled trial. These studies do not provide any evidence to support or reject the hypothesis that hypoxia reperfusion occurs in TMJ OA. Positive but weak evidence is provided to support the hypothesis that hypoxia-reperfusion injury occurs in OA of the knee joint. Furthermore, some results of the included studies suggest differences between OA and other types of arthritis in relation to the hypoxia-reperfusion mechanism. CONCLUSION: There is no evidence to support or reject the hypothesis that hypoxia reperfusion occurs in TMJ OA, and limited evidence is provided to support that hypoxia-reperfusion injury occurs in OA of the knee joint. Since the studies suggest differences between OA and other types of arthritis in relation to hypoxia-reperfusion mechanisms, further research in this field needs to distinguish OA from other types of arthritis.

Long-term oral appliance therapy in obstructive sleep apnea syndrome: a controlled study on temporomandibular side effects.

The objective of this study was to assess variations in the occurrence of temporomandibular disorders (TMDs) and the risk of developing pain and function impairment of the temporomandibular complex in obstructive sleep apnea syndrome (OSAS) patients treated with either an oral appliance (mandibular advancement device) or continuous positive airway pressure (CPAP) in a 2-year follow-up study. In addition, we assessed the relationship between the mean mandibular protrusion and the frequency of wearing the appliance during follow-up with the occurrence of pain and function impairment of the temporomandibular complex. Fifty-one patients were randomized to oral appliance therapy and 52 patients to CPAP therapy. TMDs (diagnosed according to the Axis I Research Diagnostic Criteria for TMD), pain intensity and disability and mandibular function impairment were recorded at baseline, after 2 months, 1 year and 2 years of therapy. Only in the initial period of treatment the occurrence of pain-related TMDs was considerably higher (24%) in the oral appliance group compared to CPAP (6%). Oral appliance therapy furthermore resulted in more temporomandibular pain compared to CPAP (odds ratio 2.33, 95% confidence interval (1.22-4.43)). However, there were no limitations in mandibular function in both groups during the (entire) follow-up period. Although generally not serious and of transient nature, oral appliance therapy results in more pain-related TMDs in the initial period of use compared with CPAP therapy. Oral appliance therapy is associated with increased pain in the temporomandibular complex in the initial period of use. Because of the transient nature, this pain is not a reason to contra-indicate an oral appliance in OSAS patients. Moreover, TMDs and the risk of developing pain and function impairment of the temporomandibular complex appear limited with long-term oral appliance use.

Treatment outcome of immediate, early and conventional single-tooth implants in the aesthetic zone: a systematic review to survival, bone level, soft-tissue, aesthetics and patient satisfaction.

AIM: This study evaluated, through a systematic review of the literature, the outcome of single-implant restorations in the aesthetic zone with natural adjacent teeth, thereby addressing immediate, early and conventional implant approaches. MATERIAL AND METHODS: MEDLINE (1950-2008), EMBASE (1966-2008), and CENTRAL (1800-2008) were searched to identify eligible studies. Two reviewers independently assessed the methodological quality using specific study-design-related assessment forms. RESULTS: Out of 86 primarily selected articles, 19 studies fulfilled the inclusion criteria. A meta-analysis showed an overall survival rate of 95.5% [95% confidence interval: (93.0-97.1)] after 1 year. A stratified meta-analysis revealed no differences in survival between immediate, early and conventional implant strategies. Little marginal peri-implant bone resorption was found together with low incidence of biological and technical complications. No significant differences in outcome measures were reported in clinical trials comparing immediate, early or conventional implant strategies. CONCLUSION: The included literature suggested that promising short-term results could be achieved for immediate, early and conventional single-implants in the aesthetic zone. However, important parameters as aesthetic outcome, soft-tissue aspects, and patient satisfaction were clearly underexposed. The question whether immediate and early single-implant therapies would result in better treatment outcomes remained inconclusive due to lack of well-designed controlled clinical studies.