Errores y complicaciones en la práctica clínica periodontal por sesgo metodológico y mala interpretación de la evidencia

Durante y después de la realización de procedimientos periodontales o relacionados con implantes pueden surgir diferentes tipos de errores y complicaciones. Algunos de los agentes causales de errores y complicaciones más relevantes, aunque también controvertidos y menos comentados, son los sesgos metodológicos y la mala interpretación de la evidencia. La correcta evaluación de la literatura requiere de un sólido conocimiento clínico combinado con un enfoque sistemático basado en el reconocimiento de los sesgos metodológicos comunes y la evitación de errores interpretativos para recuperar críticamente, diseccionar y aplicar juiciosamente la información disponible para la promoción de la salud periodontal y periimplantaria. Esta revisión aborda tipos comunes de sesgos metodológicos y errores interpretativos que pueden alterar las percepciones del lector sobre el efecto real y las ramificaciones potenciales de los resultados comunicados de un determinado enfoque terapéutico debido a una mala interpretación de las pruebas disponibles: (1) tipos de sesgos metodológicos; (2) sesgo de giro e interpretativo; (3) trampas de interpretación al evaluar las pruebas (4) elección de criterios de valoración relevantes para responder a la(s) pregunta(s) de interés; y (5) equilibrio entre significación estadística y relevancia clínica.Different types of errors and complications may arise during and after the execution of periodontal or implant-related procedures. Some of the most relevant, although also controversial, and less commented, causative agents of errors and complications are methodological biases and bad interpretation of the evidence. Proper assessment of the literature requires of solid clinical knowledge combined with a systematic approach built on the recognition of common methodological biases and the avoidance of interpretive errors to critically retrieve, dissect, and judiciously apply available information for the promotion of periodontal and peri-implant health. This review addresses common types of methodological bias and interpretive errors that can alter the reader's perceptions on the real effect and potential ramifications of the reported outcomes of a given therapeutic approach due to bad interpretation of the available evidence: (1) types of methodological biases; (2) spin and interpretive bias; (3) interpretation pitfalls when assessing the evidence (4) choice of relevant endpoints to answer the question(s) of interest; and (5) balance between statistical significance and clinical relevance

The peri-implant phenotype

This commentary proposes a definition for the term - peri- implant phenotype- and provides a comprehensive description of all its components.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154670/1/jper10524.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154670/2/jper10524_am.pd

Outcome measures and methods of assessment of soft-tissue augmentation interventions in the context of dental implant therapy: A systematic review of clinical studies published in the last 10 years.

AIM The aim of the study was to identify and report outcome measures and methods of assessment on soft-tissue augmentation interventions in the context of dental implant therapy reported in clinical studies published in the last 10 years. MATERIAL AND METHODS The protocol of this PRISMA 2020-compliant systematic review was registered in PROSPERO (CRD42021252214). A literature search was conducted to identify articles that met the pre-established eligibility criteria. Data of interest, with an emphasis on outcome measures, were extracted. For each outcome, specific methods and timing of assessment were described in detail. Following a critical qualitative analysis of the data, outcome measures were categorized. Primary outcomes were identified and the frequency of reporting in the selected articles was calculated. Additionally, risk of bias assessments were performed for individual articles and primary outcomes. RESULTS Ninety-two articles, of which 39 reported randomized controlled trials (RCTs), 20 reported non-RCTs, and 33 reported case series studies, were selected. Outcome measures were categorized into either investigator-evaluated outcome measures (i.e., clinical, digital imaging, esthetic, histologic, biomarker, and safety) or patient-reported outcome measures (PROMs). Clinical outcomes were the most frequently reported type of outcome. Considering all categories, the most frequently reported primary outcomes were facial mucosa thickness assessed with clinical methods (22.83%), facial keratinized mucosa width assessed with clinical methods (19.57%), facial mucosal margin position/recession assessed with clinical methods (18.48%), facial mucosa thickness assessed with digital imaging methods (11.96%), facial soft-tissue volume assessed with digital imaging methods (9.78%), and supracrestal tissue height assessed with clinical methods (9.78%). No distinguishable patterns of association between specific types or quality (level of bias) of clinical studies and the choice of primary outcomes were observed. CONCLUSION Clinical research on peri-implant soft-tissue augmentation has progressively increased in the last 10 years. Although clinical outcome measures were the most frequently reported outcomes in the selected literature, trends in the field are indicative of a shift from traditional clinical assessment methods to the use of digital technologies. PROMs were generally underreported but should be considered an integral methodological component in future clinical studies

Outcome measures and methods of assessment of soft tissue augmentation interventions in the context of dental implant therapy: A systematic review of clinical studies published in the last 10 years.

AIM To identify and report outcome measures and methods of assessment on soft tissue augmentation interventions in the context of dental implant therapy reported in clinical studies published in the last 10 years. MATERIALS AND METHODS The protocol of this Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) 2020-compliant systematic review was registered in PROSPERO (CRD42021252214). A literature search was conducted to identify articles that met the pre-established eligibility criteria. Data of interest, with an emphasis on outcome measures, were extracted. For each outcome, specific methods and timing of assessment were described in detail. Following a critical qualitative analysis of the data, outcome measures were categorized. Primary outcomes were identified, and the frequency of reporting in the selected articles was calculated. Additionally, risk-of-bias assessments were performed for individual articles and primary outcomes. RESULTS Ninety-two articles, of which 39 reported randomized controlled trials (RCTs), 20 non-RCTs, and 33 case series studies, were selected. Outcome measures were categorized into either investigator-evaluated outcome measures (i.e., clinical, digital imaging, aesthetic, histological, biomarker, and safety) or patient-reported outcome measures (PROMs). Clinical outcomes were the most frequently reported type of outcome. Considering all categories, the most frequently reported primary outcomes were facial mucosa thickness assessed with clinical methods (22.83%), facial keratinized mucosa width assessed with clinical methods (19.57%), facial mucosal margin position/recession assessed with clinical methods (18.48%), facial mucosa thickness assessed with digital imaging methods (11.96%), facial soft tissue volume assessed with digital imaging methods (9.78%), and supracrestal tissue height assessed with clinical methods (9.78%). No distinguishable patterns of association between specific types or quality (level of bias) of clinical studies and the choice of primary outcomes were observed. CONCLUSIONS Clinical research on peri-implant soft tissue augmentation has progressively increased in the last 10 years. Although clinical outcome measures were the most frequently reported outcomes in the selected literature, trends in the field are indicative of a shift from traditional clinical assessment methods to the use of digital technologies. PROMs were generally under-reported but should be considered an integral methodological component in future clinical studies

Inferior alveolar nerve trajectory, mental foramen location and incidence of mental nerve anterior loop

Background: Injury of the inferior alveolar nerve (IAN) is a serious intraoperative complication that may occur during routine surgical procedures, such as dental implant placement or extraction of impacted teeth. Thus, the purpose of this study was to analyze the trajectory of the mandibular canal (MC), the location of the mental foramen (MF) and the presence and extension of an anterior loop of the mental nerve (AL). Study Design: In this cross-sectional study, a total of 348 CBCTs were analyzed. Distances from MC to the surface of the basal, medial and lateral cortical of the mandible were measured at the level of the second molar, first molar and second premolar. Location of the MF relative to the apices of the premolars, as well as incidence and anterior extent of the AL were also determined. Results: Significant and clinically relevant correlations were found between the position of the MC in women, which was located more caudal (r=-0.219, p=0.007; r=-0.276, p<0.001; right and left, respectively) and lateral (r=-0.274, p=0.001; r=-0.285, p<0.001; right and left, respectively), particularly at the level of the premolars. Additionally, the presence (r=-0.181, p=0.001; r=-0.163, p=0.002; right and left, respectively) and anterior extension (r=-0.180, p=0.009; r=-0.285, p=0.05; right and left, respectively) of the AL was found to be inversely correlated with the age of the patient. Conclusions: This analysis of a Caucasian population has found that the older the patient, the lower the incidence of the loop and the shorter its anterior extension. Key words:Cone-beam computed tomography, mandibular nerve, mental foramen

Alveolar ridge preservation reduces the need for ancillary bone augmentation in the context of implant therapy.

BACKGROUND There is limited information on the need for bone augmentation in the context of delayed implant placement whether alveolar ridge preservation (ARP) is previously performed or not. The primary aim of this retrospective cohort study was to evaluate the efficacy of ARP therapy after tooth extraction compared with unassisted socket healing (USH) in reducing the need for ancillary bone augmentation before or at the time of implant placement. METHODS Adult subjects that underwent non-molar single tooth extraction with or without simultaneous ARP therapy were included in this study. Cone beam computed tomography scans obtained before tooth extraction and after a variable healing period were used to record the baseline facial bone thickness and to virtually plan implant placement according to a standard method. A logistic regression model was used to evaluate the effect of facial alveolar bone thickness upon tooth extraction and baseline therapy (USH or ARP) on the need for additional bone augmentation, adjusting for several covariates (i.e., age, sex, baseline KMW, and tooth type). RESULTS One hundred and forty subjects that were equally distributed between both baseline therapy groups constituted the study population. Implant placement was deemed virtually feasible in all study sites. Simultaneous bone augmentation was considered necessary in 60% and 11.4% of the sites in the USH and ARP group, respectively. Most of these sites (64.2% in the USH group and 87.5% in the ARP group) exhibited a thin facial bone phenotype (<1 mm) at baseline. Logistic regression revealed that the odds of not needing ancillary bone augmentation were 17.8 times higher in sites that received ARP therapy. Furthermore, the need for additional bone augmentation was reduced 7.7 times for every 1 mm increase in facial bone thickness, regardless of baseline therapy. CONCLUSIONS Based on a digital analysis, ARP therapy, compared with USH, and thick facial alveolar bone largely reduce the need for ancillary bone augmentation at the time of implant placement in non-molar sites

Non-invasive assessment of peri-implant mucosal thickness: A cross-sectional study.

BACKGROUND This study aimed to evaluate the reliability and reproducibility of different non-invasive methods for the assessment of peri-implant mucosal thickness. METHODS Subjects with two adjacent dental implants in the central maxillary region were included in this study. Three different methods to assess facial mucosal thickness (FMT) were compared: digital file superimposition using Digital Imaging and Communication in Medicine (DICOM) and stereolithography (STL) files of the arch of interest (DICOM-STL), DICOM files alone, and non-ionizing ultrasound (US). Inter-rater reliability agreements between different assessment methods were analyzed using inter-class correlation coefficients (ICCs). RESULTS A total of 50 subjects with 100 bone-level implants constituted the study population. Assessment of FMT using STL and DICOM files demonstrated excellent inter-rater reliability agreement. Mean ICC values of 0.97 and 0.95 were observed in the DICOM-STL and DICOM groups, respectively. Comparison between the DICOM-STL and US revealed good agreement, with an ICC of 0.82 (95% CI: 0.74 to 0.88) and a mean difference of -0.13 ± 0.50 mm (-1.13 to 0.86). Comparison between DICOM files alone versus US showed good agreement, with an ICC of 0.81 (95% CI: 0.73 to 0.89) and a mean difference of -0.23 ± 0.46 mm (-1.12 to 0.67). Comparison between DICOM-STL and DICOM files revealed excellent agreement, with an ICC of 0.94 (95% CI: 0.91 to 0.96) and a mean difference of 0.1 ± 0.29 mm (LOA -0.47 to 0.46). CONCLUSIONS Quantification of peri-implant mucosal thickness via analysis of DICOM-STL files, DICOM files, or US assessment are comparably reliable and reproducible methods

The significance of surgically modifying soft tissue phenotype around fixed dental prostheses: An American Academy of Periodontology best evidence review

BackgroundThis systematic review endeavored to investigate the effect of soft tissue phenotype modification therapy (PhMT- s) at sites with a tooth or an implant supported fixed dental prosthesis.MethodsA comprehensive literature search was conducted by two independent examiners to identify relevant studies reporting differences in clinical, esthetic, or radiographic outcomes of interest between sites underwent PhMT- s and sites that remained untreated. Risk of bias assessment was calculated for all included studies. Meta- analyses involving endpoints of interest were performed when feasible.ResultsNo controlled studies pertaining to tooth sites were identified. A total of six articles reporting on the outcomes of buccal soft tissue phenotype modification around implants were selected, of which, five were included in the meta- analyses. Quantitative analyses showed a weighted mean difference (WMD) of 0.98 mm (95% CI = 0.25 to 1.72 mm, P = 0.009) for change of tissue thickness; a WMD of - 4.87% (95% CI = - 34.27 to 24.53%, P = 0.75) for bleeding on probing (BOP); a WMD of 0.36 mm (95% CI = 0.12 to 0.59 mm, P = 0.003) for mucosal recession (MR); a WMD of 0.13 mm (95% CI = - 0.11 to 0.36 mm, P = 0.30 for probing depth (PD); a WMD of 1.08 (95% CI = - 0.39 to 2.55, P = 0.15) for pink esthetic score (PES), and a WMD of 0.40 mm (95% CI = - 0.34 to 1.14 mm, P = 0.28) for marginal bone loss (MBL).ConclusionsSurgical modification of peri- implant soft tissue phenotype via PhMT- s may decrease the amount of MR. Future clinical trials are needed to warrant the clinical benefits of modifying soft tissue phenotype around tooth- supported restorations.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154660/1/jper10458-sup-0006-figureS1F.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154660/2/jper10458_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154660/3/jper10458-sup-0001-figureS1A.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154660/4/jper10458-sup-0005-figureS1E.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154660/5/jper10458-sup-0004-figureS1D.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154660/6/jper10458-sup-0003-figureS1C.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154660/7/jper10458-sup-0002-figureS1B.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154660/8/jper10458.pd

Histological assessment and gene expression analysis of intra-oral soft tissue graft donor sites

Aim To determine the structural and gene expression features of different intra-oral soft tissue donor sites (i.e., anterior palate, posterior palate, maxillary tuberosity and retromolar pad). Materials and Methods Standardized mucosal tissue punch biopsies were collected from at least one donor site per subject. Histological processing was performed to determine tissue morphometry and quantify collagen composition. Site-specific gene distribution was mapped using targeted gene expression analysis and validated using real time polymerase chain reaction (qPCR). Results A total of 50 samples from 37 subjects were harvested. Epithelial thickness did not differ between sites. However, lamina propria was thicker in the maxillary tuberosity (2.55 ± 0.92 mm) and retromolar pad (1.98 ± 0.71 mm) than in the lateral palate. Type I collagen was the predominant structural protein in the lamina propria (75.06%–80.21%). Genes involving collagen maturation and extracellular matrix regulation were highly expressed in the maxillary tuberosity and retromolar pad, while lipogenesis-associated genes were markedly expressed in the lateral palate. The retromolar pad showed the most distinct gene expression profile, and the anterior and posterior palate displayed similar transcription profiles. Conclusions Tissue samples harvested from the anterior and posterior palate differed morphologically from those from the maxillary tuberosity and retromolar pad. Each intra-oral site showed a unique gene expression profile, which might impact their biological behaviour and outcomes of soft tissue augmentation procedures