Schneiderian membrane perforation via transcrestal sinus floor elevation: A randomized ex vivo study with endoscopic validation

ObjectiveTo endoscopically determine the incidence of Schneiderian membrane perforation during transcrestal maxillary sinus floor elevation (SFE), in relation to the bone preparation technique, amount of bone graft, membrane elevation height and different surgical steps.Materials and methodsSeven cadaver heads corresponding to 12 maxillary sinuses were used to perform three SFE via transcrestal approach per sinus (36 elevations). Each sinus was randomly assigned to either the Sinus Crestal Approach (SCA) drill kit technique (experimental group) or the conventional osteotome technique (control group). During all phases of the surgery, the integrity of the sinus membrane was monitored through endoscopic examination.ResultsA significant difference was found in the incidence of perforation (p = 0.007) and vertical elevation height (p < 0.001) between the study groups, favoring the experimental group. A safety elevation threshold of 5 mm without bone graft and implant placement was estimated. A significant correlation was observed between the residual ridge height and the incidence of perforation (p < 0.001; OR = 0.51).ConclusionThe SCA drill kit may demonstrate superior osteotomy preparation and membrane elevation capabilities to the osteotome technique, and significantly when a 6â mm SFE is indicated. Residual ridge height and vertical elevation height are risk determinant factors.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147768/1/clr13388_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147768/2/clr13388.pd

Comparison of three different types of implantâ supported fixed dental prostheses: A longâ term retrospective study of clinical outcomes and costâ effectiveness

ObjectiveTo study the performance of 2â 3 posterior boneâ level dental implants constructed with either three nonâ splinted crowns (NSC), three splinted crowns (SC), or a 3â unit implantâ supported bridge over two implants (ISB).Material and methodsPatients treated with three metalâ ceramic NSC, SC, or an ISB were included in the present retrospective study. Implant survival and success rate as well as all biological and technical complications were collected. The cost associated with each of the treatment options was evaluated in the comparative analysis.ResultsOne hundred and fortyâ five patients (40 NSC, 52 SC, and 53 in the ISB) receiving 382 boneâ level implants (120 NSC, 106 ISB, and 156 SC) were included (mean followâ up of 76.2 months). Lack of success was observed in 33.8% of the total patient sample, being lower in the ISB group. Implant survival rates were 92.5% in the NSC, 100% in the ISB, and 88.5% in the SC, with significant difference noted between the ISB and SC (p = 0.01). Overall, 9.9% of the total implants were found to have periâ implantitis (PI), with 16.7% in the SC, 7.5% in the NSC, and 2.8% in the ISB. Patients presenting prosthodontic complications were significantly higher in NSC (32.5%) than ISB (13.2%) and SC (15.4%). The total cost of the ISB group was significantly lower when compared to the NSC and SC groups (p < 0.001).ConclusionsAn 3â unit implantâ supported bridge restoring 2 implants seems to present the most ideal longâ term therapeutic solution, among the investigated approaches in this study, in rehabilitating a 3â unit edentulous area.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149366/1/clr13415.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149366/2/clr13415_am.pd

Ultrasonography for chairside evaluation of periodontal structures: A pilot study

BackgroundThe crestal bone level and soft tissue dimension are essential for periodontal diagnosis and phenotype determination; yet, existing measurement methods have limitations. The aim of this clinical study was to evaluate the correlation and accuracy of ultrasound in measuring periodontal dimensions, compared to direct clinical and cone- beam computed tomography (CBCT) methods.MethodsA 24- MHz ultrasound probe prototype, specifically designed for intraoral use, was employed. Periodontal soft tissue dimensions and crestal bone levels were measured at 40 teeth and 20 single missing tooth gaps from 20 patients scheduled to receive a dental implant surgery. The ultrasound images were interpreted by two calibrated examiners. Inter- rater agreement was calculated by using inter- rater correlation coefficient (ICC). Ultrasound readings were compared with direct clinical and CBCT readings by using ICC and Bland- Altman analysis.ResultsThe following six parameters were measured: 1) interdental papilla height (tooth), 2) mid- facial soft tissue height (tooth), 3) mucosal thickness (tooth), 4) soft tissue height (edentulous ridge), 5) mucosal thickness (edentulous ridge), and 6) crestal bone level (tooth). Intra- examiner calibrations were exercised to achieve an agreement of at least 0.8. ICC between the two readers ranged from 0.482 to 0.881. ICC between ultrasound and direct readings ranged from 0.667 to 0.957. The mean difference in mucosal thickness (tooth) between the ultrasound and direct readings was - 0.015 mm (95% CI: - 0.655 to 0.624 mm) without statistical significance. ICC between ultrasound and CBCT ranged from 0.654 to 0.849 among the measured parameters. The mean differences between ultrasound and CBCT range from - 0.213 to 0.455 mm, without statistical significance.ConclusionUltrasonic imaging can be valuable for accurate and real- time periodontal diagnosis without concerns about ionizing radiation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/156207/2/jper10483_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/156207/1/jper10483.pd

The 2nd Baltic Osseointegration Academy and Lithuanian University of Health Sciences Consensus Conference 2019. Summary and consensus statements: Group II - Extraction socket preservation methods and dental implant placement outcomes within grafted sockets

Introduction: The task of Group II was to review and update the existing data concerning extraction socket preservation with or without membranes and soft tissue influence on post-extraction alveolar ridge preservation; extraction socket preservation using different biomaterials as bone grafts, growth factors, and stem cells. Special interest was paid to the dental implant placement outcomes within grafted sockets.Material and Methods: The main areas evaluated by this group were as follows: quantitative and qualitative assessment of the effect of different alveolar preservation techniques performed immediately after tooth extraction, with or without membranes and/or soft tissue grafting, and the use of different bone substitutes, stem cells or growth factors in the postextraction socket. Evaluation of the treatment outcomes of dental implants placed in the grafted sockets in terms of primary and secondary outcomes were assessed. The systematic reviews and/or meta-analyses were registered in PROSPERO, an international prospective register of systematic reviews: http://www.crd.york.ac.uk/PROSPERO/. TThe literature in the corresponding areas of interest was screened and reported following the PRISMA guidelines (Preferred Reporting Item for Systematic Review and Meta-Analysis) Statement: http://www.prisma-statement.org/. Method of preparation of the systematic reviews, based on comprehensive search strategies, was discussed and standardized. The summary of the materials and methods employed by the authors in preparing the systematic reviews and/or meta-analyses is presented in the Preface chapter.Results: The results and conclusions of the review process are presented in the respective papers. Three systematic reviews and one systematic review and meta-analysis were performed. The group's general commentaries, consensus statements, clinical recommendations and implications for research are presented in this article.info:eu-repo/semantics/publishedVersio

Static computer-aided, partially guided, and free-handed implant placement: a systematic review and meta-analysis of randomized controlled trials

Objective To analyze the outcomes of static computer‐aided implant placement (sCAIP) compared to partially guided (PGIP) and free‐handed (FHIP) implant placement. Material and Methods This study was registered in PROSPERO (CRD42019131397). A comprehensive literature search was performed by two independent examiners. Only randomized controlled trials (RCTs) were selected. Treatment modalities included sCAIP, PGIP, and FHIP. Data pertaining to the outcomes of interest were extracted. Random‐effects meta‐analyses were feasible for a subset of outcomes. Results From an initial list of 2,870 records, fourteen articles for a total of ten RCTs were selected. Data from 7 of these studies allowed for the conduction of three meta‐analyses comparing accuracy of implant placement across modalities. Survival rate up to 12 months post‐loading was high (>98%) and comparable between treatments (low‐quality evidence). No tangible differences in terms of patient perception of intra‐ or postoperative discomfort were observed (low‐quality evidence). Quantitative analyses revealed significantly lower angular (MD = 4.41° , 95% CI 3.99–4.83, p < .00001), coronal (MD = 0.65 mm, 95% CI 0.50–0.79, p < .00001), and apical (MD = 1.13 mm, 95% CI 0.92–1.34, p < .00001) deviation values for sCAIP as compared to FHIP (8 studies, 383 patients, 878 implants, high‐quality evidence). A similar discrepancy, in favor of sCAIP, was observed for angular deviation only as compared to PGIP (MD = 2.11° , 95% CI 1.06–3.16, p < .00001)

Post-extraction dimensional changes: A systematic review and meta-analysis

Aim To analyse the evidence pertaining to post‐extraction dimensional changes in the alveolar ridge after unassisted socket healing. Materials and Methods The protocol of this PRISMA‐compliant systematic review (SRs) was registered in PROSPERO (CRD42020178857). A literature search to identify studies that fulfilled the eligibility criteria was conducted. Data of interest were extracted. Qualitative and random‐effects meta‐analyses were performed if at least two studies with comparable features and variables reported the same outcome of interest. Results Twenty‐eight articles were selected, of which 20 could be utilized for the conduction of quantitative analyses by method of assessment (i.e. clinical vs radiographic measurements) and location (i.e. non‐molar vs molar sites). Pooled estimates revealed that mean horizontal, vertical mid‐facial and mid‐lingual ridge reduction assessed clinically in non‐molar sites was 2.73 mm (95% CI: 2.36–3.11), 1.71 mm (95% CI: 1.30–2.12) and 1.44 mm (95% CI: 0.78–2.10), respectively. Mean horizontal, vertical mid‐facial and mid‐lingual ridge reduction assessed radiographically in non‐molar sites was 2.54 mm (95% CI: 1.97–3.11), 1.65 mm (95% CI: 0.42–2.88) and 0.87 mm (95% CI: 0.36–1.38), respectively. Mean horizontal, vertical mid‐facial and mid‐lingual ridge reduction assessed radiographically in molar sites was 3.61 mm (95% CI: 3.24–3.98), 1.46 mm (95% CI: 0.73–2.20) and 1.20 mm (95% CI: 0.56–1.83), respectively. Conclusion A variable amount of alveolar bone resorption occurs after unassisted socket healing depending on tooth type

Degree of risk of bias in randomized controlled trials: does it have an impact on root coverage outcomes?

ObjectiveImprovementovertime inmean (MRC)andcompleterootcoverage(CRC) reportedin randomized controlled trials (RCTs) has been documented. Our objective was toassess the effect that the ROB has on relevant outcomes reported in RCTsevaluating the efficacy of a commonly performed root coverage procedure.MethodsRCTs that involved the use of a bilaminar technique of coronally advancedflap withconnective tissue graft were selected. The following data were extracted: MRC,CRC, whether conflict of interest was addressed (yes/no), adequacy of randomsequence generation, allocation concealment, and blinding of outcome assess-ment. Trials were categorized into four groups as per different time periods: beforeConsolidated Standards of Reporting Trials (CONSORT) (before 1996), CONSORT(1997 to 2001), CONSORT 2001 (2002 to 2010), and CONSORT 2010 (2011 to2019). Differences between group means were assessed using statistical analyses.ResultsThe search yielded a total of 47 RCTs published between 1993 and 2019 that metthe inclusion criteria. A trend toward lower ROB over time in the selected RCTswas observed. However, differences in MRC and CRC with respect to the degreeROB of included trials were not significant.ConclusionsDegree of ROB did not influence MRC and CRC reported in the RCTs included inthis investigation. Thisfinding suggests that the observed improvement of clinicaloutcomes over time should be attributed to other factors, such as refinement ofsurgical techniques

Longâ term survival of structurally compromised tooth preserved with crown lengthening procedure and restorative treatment: A pilot retrospective analysis

AimSince there is limited study to assist in an evidencedâ based decision whether to extract or preserve a structurally compromised tooth, the aim of this retrospective study was to investigate the longâ term survival rate of tooth preservation after crown lengthening procedure (CLP) and restorative treatments.MethodsElectronic and paper chart of patients received CLP in our graduate clinic from 1990 to 2015 were reviewed. Statistical analysis was done using Cox regression analysis and Kaplanâ Meier estimator.ResultsA total of 766 coded charts were initially collected. Four hundred and fourteen cases were included in the final analysis. The Kaplanâ Meier estimate shows a cumulative survival rate of 88.3% in 5 years, 78.4% in 10 years and 68.1% in 15 years. In terms of reasons for failure, restorative problem such as recurrent decays was the main issue (35.2%), followed by fracture (29.6%), endodontic complications (23.9%) and periodontal breakdown (11.3%).ConclusionsWithin the limitation of this study, structurally compromised teeth have a reasonable longâ term survival rate close to 80% after 10 years in a teaching institute. Patients with high fracture or caries risk may pose a higher chance of failure. Objective information should be presented to the patient to arrive at an evidenceâ based decision.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149679/1/jcpe13124.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149679/2/jcpe13124_am.pd