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Background: Immediate implant placement with immediate esthetics has become a more common procedure over time, though ensuring good emergence of the axis of the implant has been a challenge. A novel macroimplant design with an angled platform (Co-Axis®) has been developed to ensure exit of the head of the implant in the correct prosthetic position. A systematic literature review was carried to determine the survival rate and marginal bone loss associated with these implants. Material and Methods: An electronic and manual literature search was made in accordance with the PRISMA statement. The search strategy was limited to human studies, retrospective and prospective clinical trials, cross-sectional studies, and cohort studies reporting outcomes of a novel macrohybrid implant with a 12° angled implant connection. Results: Three articles met the inclusion criteria and were reviewed in the analysis. The estimated success rate was 95.9%. The global marginal bone loss was estimated to be -0.17 ± 0.58 mm in an environment characterized by great heterogeneity (I2 = 99%). The estimated mean implant stability was 69.6 ± 0.92 (ISQ). As only two studies provided the required information, it was not possible to determine publication bias. Lastly, mean recession was estimated to be practically zero (0.06 ± 0.23 mm), with great heterogeneity. Conclusions: Within the limitations of this systematic review, it can be affirmed that immediate implant treatment with Co-Axis® implants shows a survival rate of 95.9% at one year of follow-up, with low marginal bone loss values, near-zero soft tissue recession, and favorable papilla index values. Nevertheless, the great heterogeneity of the data requires the findings to be interpreted with caution.
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OBJECTIVE: A cohort prospective study was conducted to assess the three-dimensional positioning accuracy of the implant between pre-surgical and the final implant position using a static fully guided approach in the posterior area of the jaws. MATERIALS AND METHODS: A total of 60 implants (30 patients) were digitally analyzed after superimposing the Digital Imaging and Communications in Medicine (DICOM) files obtained from the Cone Beam Computed Tomography (CBCT) pre- and post-implant placement. The software calculations included deviations at the implant shoulder and at the implant apex, global deviation (3D offset), and angle deviation. Statistical analysis was performed with α = 0.05. RESULTS: Considering the total number of implants, mesiodistal, buccolingual, and apicocoronal mean deviations at the shoulder and implant apex were equal or below 0.21 ± 0.69 mm, and only the buccolingual mean deviation at the apex reached up to 0.67 ± 1.06 mm. The mesiodistal and apicocoronal deviations were not statistically significant at both the shoulder and apex levels of the implant. The mean total angular deviation was 5.62° ± 4.09. The main limitation of this surgical approach was the requirement for a wide mouth opening. CONCLUSIONS: Static fully guided surgery for dental implant placement exhibits minimum deviations respect to presurgical planning. The main limitation in the posterior areas is the requirement for a wide mouth opening. CLINICAL RELEVANCE: Even with minimum deviations clinically acceptable, precautions and safety margins must be respected when using static full-guided surgery to place dental implants.
Assuntos
Implantes Dentários , Arcada Edêntula , Cirurgia Assistida por Computador , Desenho Assistido por Computador , Tomografia Computadorizada de Feixe Cônico , Implantação Dentária Endóssea/métodos , Humanos , Imageamento Tridimensional , Arcada Edêntula/cirurgia , Estudos Prospectivos , Cirurgia Assistida por Computador/métodosRESUMO
RESUMEN: La reabsorción condilar como complicación postoperatoria en cirugía ortognática es una causa frecuente de recidiva de anomalías dentomaxilares, existiendo diversos factores que se relacionan con su aparición. El objetivo de este estudio fue describir mediante una revisión narrativa la reabsorción condilar como complicación postoperatoria en cirugía ortognática. Se realizó una búsqueda electrónica de la literatura en las bases de datos electrónicas PubMed, EBSCO, TripDatabase y Epistemonikos sin límite de años, en idioma inglés y español, incluyendo revisiones sistemáticas, ensayos clínicos y estudios observacionales. Se excluyeron reportes de casos, estudios en animales y aquellos que no relacionaran la complicación con cirugía ortognática. Se evaluaron los estudios según grado de recomendación y calidad de reporte. Veintiún artículos fueron seleccionados según los criterios de selección establecidos en esta revisión. La literatura reportada sugiere que la reabsorción condilar es una patología de frecuencia relativa en pacientes postoperados de cirugía ortognática (1,4-32 % de los casos) y que está asociada a factores de riesgo preoperatorios tales como género, edad, tipo de anomalía dentomaxilar y técnica quirúrgica utilizada. La reabsorción condilar es una complicación postoperatoria a cirugía ortognática que debemos considerar en la planificación del tratamiento e identificar pacientes con factores de riesgo. Luego de la intervención quirúrgica es de vital importancia realizar un seguimiento estricto a este tipo de pacientes e identificar de forma temprana cambios clínicos y radiográficos. Finalmente, es importante seguir investigando sobre esta materia para establecer criterios de prevención y diagnóstico, con mayor claridad.
ABSTRACT: Condylar resorption as a complication following orthognathic surgery is considered to cause dento-facial anomalies, relating to different pre and intra-operative factors. The aim of the research was to describe condylar resorption as a postoperative complication after orthognathic surgery. A review of the literature was made in four databases: PubMed, EBSCO, Trip database and Epistemonikos. The search was carried out without year limiting, articles in English and Spanish, including systematic reviews, observational studies and clinical trials. Exclusion criteria were applied for report cases, animal studies and articles that do not relate condylar resorption with orthognathic surgery. Quality of evidence and strength of the recommendations were assessed for the chosen studies. For this study 21 articles were selected following the inclusion criteria. The literature found reported that condylar resorption is a relatively frequent complication following orthognathic surgery (1.4-32 % of frequency) and that it can be associated with several factors such as genre, age, dento-maxillary anomaly and surgical technique. Condylar resorption is a complication that we must consider in the planning of orthognathic surgery, in order to identify risk factors and patients who are more likely to present this post-surgical complication. Following surgery, strict follow-up is a key factor to determine early clinical and radiographic changes. Finally, further research is needed to establish stronger prevention and diagnostic criteria.
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Humanos , Reabsorção Óssea/complicações , Doenças Mandibulares/fisiopatologia , Côndilo Mandibular/anormalidades , Côndilo Mandibular/fisiopatologia , Complicações Pós-Operatórias , Articulação Temporomandibular , Transtornos da Articulação Temporomandibular/cirurgia , Procedimentos Cirúrgicos Ortognáticos/métodosRESUMO
RESUMEN: Los dispositivos de administración electrónica de nicotina aparecieron con el objetivo de reemplazar el uso del tabaco y contribuir al reciente crecimiento de las políticas antitabaco. Actualmente, los efectos que producen los químicos que contiene son desconocidos. El objetivo de este trabajo consistió en describir la información encontrada en la literatura sobre los posibles daños generados por los dispositivos de administración electrónica de nicotina, en la cavidad bucal y los tejidos periodontales. Se realizó una búsqueda electrónica y manual, sin límite de idioma ni año. Se excluyeron, opiniones de expertos y artículos que estudiaran otros dispositivos de administración de nicotina. Se seleccionaron 18 artículos, 7 estudios in-vitro, 2 estudios longitudinales, 2 ensayos clínicos y 7 reportes de caso. Se encontró que existen niveles de citotoxicidad elevados, observando cambios a nivel de morfología y metabolismo celular. Sin embargo, si lo comparamos con el tabaco, se observa que los niveles de toxicidad son menores en los dispositivos de administración electrónica de nicotina. En los estudios longitudinales y ensayos clínicos se observó un aumento del sangramiento al sondaje y de la circulación sanguínea, medida con láser Doppler, al cambiar de cigarro convencional a cigarro electrónico. Los reportes de caso informan de importantes traumatismos en el territorio maxilofacial, causados por la explosión de estos dispositivos, durante su uso. Los dispositivos de administración electrónica de nicotina son tóxicos a nivel de las células periodontales, generando necrosis y daños al ADN celular. Presentan riesgos de uso, reportándose traumatismos graves a nivel oral y maxilofacial, por sobrecalentamiento de las baterías. Los ensayos clínicos y estudios longitudinales no fueron concluyentes, por lo que se debe seguir investigando en la materia.
ABSTRACT: Electronic nicotine delivery systems were introduced to replace tobacco use and contribute to the anti-smoking policies. Today, the effect the chemicals it contains produce in the human body, are unknown. The aim of this work was to describe the information found in the literature about the possible damage produced in the periodontal tissue and the oral cavity, by the electronic nicotine delivery systems. An electronic and manual search was carried by a single reviewer, without year or language limit, excluding expert's opinions and articles that studied other nicotine delivery systems. Eighteen articles were selected; 7 in vitro studies, 2 longitudinal studies, 2 clinical trials and 7 case reports. Toxicity levels were found to be high, showing changes in cellular morphology and metabolism. Comparing with conventional cigarette, toxicity levels were lower in the electronic nicotine delivery systems. Longitudinal studies and clinical trials observed an increase in bleeding on probing and in blood circulation, by using laser doppler velocimetry, when changing from conventional cigarette to electronic cigarette. Also reports about explosions while using these electronic devises were encountered in the literature, with grave consequences in the maxillofacial territory. Electronic nicotine delivery systems show toxic levels, generating necrosis and DNA damage in periodontal ligament and gingival fibroblast cells. The risk of using these devices is high, due to possible explosion following overheating of the lithium battery, causing facial and oral trauma. Clinical trials and longitudinal studies were not conclusive, so investigations should continue in this matter.
