Effect of Membrane Exposure on Guided Bone Regeneration: A Systematic Review and Meta‐Analysis

Aims: This review aimed at investigating the effect of membrane exposure on guided bone regeneration (GBR) outcomes at peri-implant sites and edentulous ridges. Material and Methods: Electronic and manual literature searches were conducted by two independent reviewers using four databases, including MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials, for articles up to February 2017. Articles were included if they were human clinical trials or case series reporting outcomes of GBR procedures with and without membrane exposure. A random-effects meta-analysis was conducted, and the weighted mean difference (WMD) between the two groups and 95% confidence interval (CI) were reported. Results: Overall, eight articles were included in the quantitative analysis. The WMD of the horizontal bone gain at edentulous ridges was −76.24% (95% CI = −137.52% to −14.97%, p = .01) between sites with membrane exposure and without exposure. In addition, the WMD of the dehiscence reduction at peri- implant sites was −27.27% (95% CI of −45.87% to −8.68%, p = .004). Both analyses showed significantly favorable outcomes at the sites without membrane exposure. Conclusion: Based on the findings of this study, membrane exposure after GBR procedures has a significant detrimental influence on the outcome of bone augmentation. For the edentulous ridges, the sites without membrane exposure achieved 74% more horizontal bone gain than the sites with exposure. For peri-implant dehiscence defects, the sites without membrane exposure had 27% more defect reduction than the sites with exposure

Implant Treatment in the Predoctoral Clinic: A Retrospective Database Study of 1091 Patients

Purpose: This retrospective study was conducted at the Marquette University School of Dentistry to (1) characterize the implant patient population in a predoctoral clinic, (2) describe the implants inserted, and (3) provide information on implant failures. Materials and Methods: The study cohort included 1091 patients who received 1918 dental implants between 2004 and 2012, and had their implants restored by a crown or a fixed dental prosthesis. Data were collected from patient records, entered in a database, and summarized in tables and figures. Contingency tables were prepared and analyzed by a chi-squared test. The cumulative survival probability of implants was described using a Kaplan-Meier survival curve. Univariate and multivariate frailty Cox regression models for clustered observations were computed to identify factors associated with implant failure. Results: Mean patient age (±1 SD) at implantation was 59.7 ± 15.3 years; 53.9% of patients were females, 73.5% were Caucasians. Noble Biocare was the most frequently used implant brand (65.0%). Most implants had a regular-size diameter (59.3%). More implants were inserted in posterior (79.0%) than in anterior jaw regions. Mandibular posterior was the most frequently restored site (43%); 87.8% of implants were restored using single implant crowns. The overall implant-based cumulative survival rate was 96.4%. The patient-based implant survival rate was 94.6%. Implant failure risk was greater among patients than within patients (p \u3c 0.05). Age (\u3e65 years; hazard ratio [HR] = 3.2, p = 0.02), implant staging (two-stage; HR = 4.0, p \u3c 0.001), and implant diameter (wide; HR = 0.4, p = 0.04) were statistically associated with implant failure. Conclusions: Treatment with dental implants in a supervised predoctoral clinic environment resulted in survival rates similar to published results obtained in private practice or research clinics. Older age and implant staging increased failure risk, while the selection of a wide implant diameter was associated with a lower failure risk

Immediately restored dental implants for partial-arch applications : a literature update

This article carries out a literature update on immediately restored dental implants in partially edentulous patients. A search was made in Medline of all articles published between the year 2000 and February 2007, including all articles published in both English and Spanish, in which immediate restoration of implants was made of partially edentulous areas with a minimum of 12 implants and six months follow-up. Certain decisive factors exist for the success of this technique in partially edentulous patients, such as primary stability, a roughened implant surface, and the absence of parafunctional habits in patients acceptable for this type of treatment. Following the analysis of these studies of immediate restoration of teeth in partially edentulous areas, a weighted mean survival of 95.39% was observed. In spite of the high success rate, major controversy still exists on this subject resulting in few studies and short follow-up periods, making the routine use of this technique questionable

A review on the prevention of inflammatory periimplant diseases

Background: An impressive number of dental implants are inserted worldwide. Evolution in dental implants and simplification of surgical techniques allowed a significant increase in the number of dentists involved in implant surgery. Most of them are general dentists, are not always sufficiently formed and experienced, frequently use low-quality implants, do not adopt the proper patient selective criteria, do not adequately monitor and maintain the inserted implants, and do not report their own statistics to the dental community. Consequently, the incidence of inflammatory periimplant diseases (IPDs) has progressively increased to values significantly higher than those previously indicated by the scientific literature. Materials and Methods: Two main literature searches were undertaken in October 2018 in the PubMed Website database. Only articles written in English and published from 2008 onward were considered; 'Clinical Trial,' 'Meta analysis,' 'Observational study,' 'Review,' and 'Validation study' were selected as article type filters. The following keywords were used in the searches: 'Peri implantitis prevention' and 'Dental implant failure prevention.'Results: Preventive measures are analyzed according to the different factors that can favor the occurrence of an infection. The factors are divided into (i) implant dependent, (ii) patient dependent, and (iii) surgeon dependent. Conclusions: Scientific and clinical data confirm that when materials are selected with care, patients are carefully evaluated for factors of risk and attitude to adhere to the necessary maintenance program, and operative protocols and maintenance programs are respected dental implants can be attractive and effective tools for oral rehabilitation. Nevertheless, dentists and patients should have greater awareness that in many cases the decision to utilize dental implants cannot be taken lightly

Accuracy and precision of an intraoral scanner in complex prosthetic rehabilitations: an in vitro study

The main purpose of this study is to measure the accuracy and the precision of the intraoral optical scanner CS3500® (Carestream Dental LLC, Atlanta, USA) in complex clinical situations as full arch rehabilitations on impl ants. 50 scans of the acrylic resin model were performed by using CS3500® (Carestream Dental LLC, Atlanta, USA) scanner. Each scan was compared with the virtual model derived from scanning with the laboratory scanner Dscan3® (Enhanced Geometry Soluti on, Bologna, Italy) to measure a possible misalignment. The alignment error was found to be 79,6 ( ± 12,87)  m. The measurement was taken at the level of 2 distal scan - abutments. The scanner's precision ranges from 24 to 52  m , depending on the dist ance between scan - abutment. CS3500® (Carestream Dental LLC, Atlanta, USA) intraoral scanner has detected a valid device in the execution of complex rehabilitations on implants. His accuracy and precision values fall within the range established in li terature to define acceptable the prosthetic fitting on full arch implant rehabilitation

The effect of smoking on survival and bone loss of implants with a fluoride-modified surface: a 2-year retrospective analysis of 1106 implants placed in daily practice

Aim: To compare survival and peri-implant bone loss of implants with a fluoride-modified surface in smokers and nonsmokers. Materials and Methods: Patient files of all patients referred for implant treatment from November 2004 to 2007 were scrutinized. All implants were placed by the same experienced surgeon (BC). The only inclusion criterion was a follow-up time of at least 2 years. Implant survival and bone loss were assessed by an external calibrated examiner (SV) comparing digital peri-apical radiographs taken during recall visits with the post-operative ones. Implant success was determined according to the international success criteria (Albrektsson et al. 1986). Survival of implants installed in smokers and nonsmokers were compared using the log-rank test. Both non-parametric tests and fixed model analysis were adopted to evaluate bone loss in smokers and nonsmokers. Results: 1106 implants in 300 patients (186 females; 114 males) with a mean follow-up of 31 months (SD 7.15; range 24-58) were included. 19 implants in 17 patients failed, resulting in an overall survival rate of 98.3% on implant level and 94.6% on patient level. After a follow-up period of 2 years, the CSR was 96.7% and 99.1% with the patient and implant as statistical unit respectively. Implant survival was significantly higher for nonsmokers compared to smokers (implant level p = 0.025; patient level p = 0.017). The overall mean bone loss was 0.34 mm (n = 1076; SD 0.65; range 0.00-7.10). Smokers lost significantly more bone compared to nonsmokers in the maxilla (0.74 mm; SD 1.07 vs 0.33 mm; SD 0.65; p < 0.001), but not in the mandible (0.25mm; SD 0.65 vs 0.22mm; SD 0.50; p = 0.298). Conclusion: The present study is the first to compare peri-implant bone loss in smokers and nonsmokers from the time of implant insertion (baseline) to at least 2 years of follow-up. Implants with a fluoride-modified surface demonstrated a high survival rate and limited bone loss. However, smokers are at higher risk to experience implant failure and more prone to show peri-implant bone loss in the maxilla. Whether this bone loss is predicting future biological complications remains to be evaluated

Consequences of Tooth Loss on Oral Function and need for Replacement of Missing Teeth Among Patients Attending Muhimbili Dental Clinic

Tanzanian oral health services constitute mainly of tooth extractions. Consequently, individuals susceptible to dental caries and periodontal diseases will have a substantial number of missing teeth, which can affect oral function. The main objective of this study was to determine the consequences of tooth loss on the oral function and need for replacement of lost teeth among patients seeking treatment at the School of Dentistry MUHAS. During a period of three months, patients seeking dental treatment at the School of Dentistry were recruited for the study. Criteria included age of 20 years and above with one or more missing teeth except for third molars. Participants were interviewed for demographic information, chewing ability, symptoms of temporomandibular disorder and perceived need for replacement of missing teeth. Afterwards the subjects were examined to asses: caries status, tooth mobility, occlusal tooth wear, over eruption of unopposed teeth, and signs of temporomandibular disorders. Data was analyzed using Statistical Package for Social Sciences SPSS 16. For comparison of proportions, chi-square analysis and t test were used. A linear regression analysis was performed, with the chewing ability score as the dependent variable and number of POP as the independent variable A total of 361 subjects with mean age of 40.2 years (s.d. = 14.2, range = 20-93 years) were recruited into the study. About half 175 (48.5%) of the subjects reported some difficulty with chewing. Generally the fewer the occluding pairs present the greater the difficulty in chewing observed. Subjects with more than 6 posterior occlusal pairs appeared to have little problem in chewing across the whole range of foods. The frequency of signs and symptoms of TMD and excessive tooth wear increased with decreasing number of posterior occluding pairs, being more evident in subjects with less than 3 posterior occlusal pairs remaining. Over a third of the participants had one or more teeth with severe overeruption but none reported impairment of oral function. More than half of the subjects needed replacement for missing teeth. From this study, it is concluded that tooth loss leading to a dentition of 5 to 6 occlusal pairs impairs chewing of hard foods but not soft foods. Extensive loss of teeth leading to less than 3 POP is associated with increased symptoms of TMD and excessive vii tooth wear of occluding teeth. Need for replacement of missing teeth is high for both anterior and posterior regions with the cost of dentures being the main barrier to replacement of missing teeth. Dental personnel should make an effort to identify individuals with risk of tooth loss in order to retain at least 6 well-distributed posterior occlusal pairs. Dental laboratory services need improvement in order to be able to provide quality replacement of missing teeth at affordable costs. Further long-term multicenter studies to evaluate the consequence of tooth loss and assist in giving a more accurate projection needs for dentures nationwide are required

REFORMING THE DELIVERY OF PUBLIC DENTAL SERVICES IN IRELAND: POTENTIAL COST IMPLICATIONS. ESRI RESEARCH SERIES NUMBER 80 APRIL 2019

This report details the results of an analysis of the potential cost implications of proposed changes to aspects of the model of delivery of publicly-financed dental services in Ireland, as set out in the new National Oral Health Policy (Department of Health, 2018b). Currently, dental services in Ireland are financed and delivered in a mixed public-private system, with most individuals paying out-of-pocket fees to independent dental practitioners. The public system currently finances the delivery of dental healthcare services to adult medical cardholders via the Dental Treatment Services Scheme (DTSS); to non-medical cardholder eligible adults via the Treatment Benefit Scheme (TBS); and to children and adults requiring special and complex care via the Public Dental Service (PDS). This report deals with proposed changes to the delivery of preventive dental healthcare services under the DTSS and PDS

Oral health-related quality of life in partially edentulous patients before and after implant therapy: a 2-year longitudinal study

The aim of this study was to measure the Oral Health-Related Quality of Life (OHRQoL) before and after a prosthodontic implant therapy so to determine the physical and psychological impact of implant-supported fixed partial dentures (IFPD) rehabilitation among edentulous patients. Methods. 50 partially edentulous patients aged 40-70 years, treated with IFPD, completed the OHRQoL questionnaire before the implant surgery (Time 0) and 2 years after their whole implant-prosthetic rehabilitation (Time 1). The questionnaire was proposed in a short version of Oral Health Impact Profile (OHIP-14, range 0-56) and analyzed through the ‘additive method’. We evaluated statistical mean, standard deviation, median, variance and mode of all OHIP-14 domains and the statistical significance about oral changes at Time 0 and Time 1 using the Chi-square test (p-values 0.05). Patients with I and IV Kennedy’s class edentulism showed better improvement (p < 0.05). Preoperative and post-treatment assessments of OHRQoL exhibited significant differences. The IFPD treatment had a positive effect on the OHRQoL, which improved better in patients with I and IV Kennedy’s edentulous class