Fluoride Varnish May Improve White Spot Lesions

Design A randomised, parallel-group, controlled clinical trial. Intervention The test group had fluoride varnish applied onto the tooth surfaces with WSLs using a miniature cotton swab or brush and advised not to brush for four hours. The control group had saline solution applied. Outcome measure Status of the WSLs were assessed using a DIAGNOdent pen (KaVo, Biberach, Germany). Results Of the 110 participants recruited, 14 dropped out between the debonding and the six-month recall visit. There were statistically significant differences between the mean DIAGNOdent readings of the two groups at the three-month (P Conclusions A greater decrease in DIAGNOdent pen readings was found in the test group during the first six months after debonding. This may be taken to imply an improvement in the WSLs. Thus, topical fluoride varnish application appears to be a good method to treat WSLs and should be advocated as a routine measure after orthodontic treatment

Dental Student Indebtedness: Where did It Come From and Where Will It Lead?

Today’s dental school graduates are burdened by an ever-increasing amount of student loan debt from both their undergraduate and predoctoral educations. Although considered to be multifactorial in origin, this article explores the microeconomic theory of supply and demand as a source for rising tuition costs and subsequent educational debt. The historical context for the cost of a dental education is provided, and serious questions are posed about how this indebtedness might impact the future of the profession

Short Implants Had Lower Survival Rates in Posterior Jaws Compared to Standard Implants

Data sources PubMed/Medline, Embase and Cochrane Library databases supplemented by searches of the journals; Clinical Implant Dentistry and Related Research, Clinical Oral Implants Research, International Journal of Oral and Maxillofacial Implants, International Journal of Oral and Maxillofacial Surgery, Journal of Clinical Periodontology, Journal of Dentistry, Journal of Oral and Maxillofacial Surgery, Journal of Oral Implantology, Journal of Oral Rehabilitation, Journal of Periodontology, Periodontology 2000. Study selection Randomised controlled trials (RCTs) and prospective studies with at least ten patients, published in the last ten years that compared short and standard implants and published in English were considered. Data extraction and synthesis A single author abstracted data with checking by a second reviewer. Methodological quality was assessed using the Jadad Scale and the Cochrane risk of bias tool. Risk ratios (RR) were calculated for implant survival rates, complications and prostheses failures and marginal bone loss was evaluated using mean difference (MD). Results Thirteen studies consisting of ten RCTs and three prospective studies were included. The ten RCTs were considered to be of high quality. Two thousand six hundred and thirty-one implants were placed in 1269 patients (981 short and 1650 standard implants). Thirty-eight short implants failed (3.87%) and 45 standard implants (2.72%). Random effects meta-analysis found no statistically significant difference between standard implants and short implants placed in the posterior regions; RR =1.35 (95% CI; 0.82-2.22: P=0.24). Marginal bone loss was evaluated in nine studies and no differences in marginal bone loss were observed. Complications were reported by seven studies and no significant difference was seen between standard and short implants; RR= 0.54 (95% CI; 0.27-1.09: P = 0.08). There was also no significant difference in prosthesis failures between standard and short implants; RR= 0.96 (95% CI: 0.44–2.09: P = 0.92) Conclusions Short implants showed marginal bone loss, prosthesis failures and complication rates similar to standard implants, being considered a predictable treatment for posterior jaws, especially in cases that require complementary surgical procedures. However, short implants with length less than 8 mm (4-7 mm) should be used with caution because they present greater risks for implant failures when compared to standard implants

Platform Switching of Implants May Decrease Bone Loss

Data sources: PubMed/Medline, Web of Science and the Cochrane Oral Health Group Trials Register, clinicaltrials.gov, www.centerwatch.com/clinical-trials, www.clinicalconnection.com supplemented by a manual search of dental implants-related journals. Study selection: Clinical studies, either randomised or not, comparing implant failure rates, marginal bone level (MBL) and/or postoperative infection in any group of patients receiving platform-switched implants or platform-matched implants were considered. Data extraction and synthesis: Study quality was assessed using the Newcastle-Ottawa scale (NOS).Only randomised clinical trials (RCTs) were considered for meta-analysis. Implant failure and postoperative infection were the dichotomous outcomes measures evaluated. Weighted mean differences were used for MBL. Results: Twenty-eight studies (18 RCTs, six CCTs and four retrospective analyses) were included. Twenty-six studies were considered to be of high quality. Twelve hundred and sixteen platform-switched implants were included with 16 failures (1.32%) and 1157 platform-matched implants and 13 failures (1.12%). Twenty studies had no implant failures. In a meta-analysis for the outcome MBL (18-RCTs) there was less MBL loss at implants with platform-switching than at implants with platform-matching (mean difference -0.29, 95% CI −0.38 to −0.19; P\u3c0.00001) Conclusions: The results of the present study suggest that there is a significantly less MBL loss at implants with platform-switching than on implants with platform-matching. The results of the present review should be interpreted with caution due to the presence of uncontrolled confounding factors in the included studies, most of them with short follow-up periods

Evidence Supporting Platform-Switching to Preserve Marginal Bone Levels Not Definitive

Data sources MEDLINE, EMBASE, The Cochrane Oral Health Group\u27s Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL), UK National Research Register, Australian New Zealand Clinical Trials Registry (ANZCTR), Database of Abstracts of Reviews of Effectiveness (DARE), ISI Proceedings for relevant conference abstracts. The search strategy used keywords but not subject heading terms. A number of relevant journals were hand searched (seven most recent years) and authors were contacted in the absence of complete data. Study selection Randomised controlled trials (RCT) or controlled clinical trials (CCT) reported in English only, that compared platform-switched to platform-matched implants were eligible. A minimum of 10 implants had to have been placed in the platform-switched group (it is unclear if there was a minimum for the comparison group) and they had to have been followed up for a minimum of 12 months. Primary outcome was marginal bone level changes. Secondary outcome was implant failure rate. Data extraction and synthesis Data were extracted by more than one author using a data extraction form. Quality assessment was done using the Jadad scale. Meta-analysis was conducted using fixed effects model in the absence of significant heterogeneity, and the random effects model where heterogeneity was greater. Statistical heterogeneity was assessed using the chi2 and I2 tests. Sensitivity and subgroup analyses were planned to identify any potential causes of heterogeneity. Results Ten studies including 1239 implants were included and all were published 2007-2010. Seven were RCTs, three were CCTs. Range of observation was 12-60 months. Methodological quality was assessed as ‘satisfactory’. Chi2 =126.79 (P2= 91% indicating significant statistical heterogeneity. Thus the random effects model was used to synthesise the data. Bone loss in the platform-matched implant group was greater with a mean difference of −0.37 mm (95% CI −0.55 to −0.20, P Conclusions Platform-switching may preserve vertical crestal bone levels more than platform-matching when placing implants

Are the Outcomes of Immediate and Early Single Tooth Implants Comparable to Conventionally Placed Implants?

Data Sources Medline, Embase, the Cochrane Central Register of Controlled Trials (Central) and references of relevant studies were searched. Study selection Longitudinal studies [randomised controlled trials (RCT), clinical trials, cohort-studies and case series] were considered for evaluation. Retrospective studies were excluded. Only case series that investigated at least five patients were considered for inclusion. Outcome measures considered were implant survival, radiographical assessment of marginal peri-implant bone levels, dental-professional-assessed aesthetics, peri-implant biological structures (level of marginal gingiva, papilla index, probing depth, presence of plaque, bleeding on probing), patient satisfaction, and biological and technical complications. Data extraction and synthesis Articles were screened independently by two examiners and the following parameters recorded: number of patients, implants placed, dropouts, followup time, type of intervention and details of outcomes. To assess the agreement between the two reviewers on the quality of studies, Cohen\u27s kappa statistic was calculated. A meta-analysis was performed using a statistical software package [Comprehensive Meta-analysis Version 2.2, Biostat, Englewood NJ]. To calculate the overall effects for the included studies, weighted rates together with random effects models were used. Stratification procedures were applied for followup time and type of intervention. No formal heterogeneity testing was conducted. Results Nineteen studies were included, of which five were RCT, two were clinical trials and 12 were case series. 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. Conclusions The selected studies provide promising short-term results for immediate, early and conventional single-implants in the aesthetic zone. Important parameters, such as aesthetic outcome, peri-implant structures and patient satisfaction, however, still need further evaluation. The outcome measures could not be fully evaluated when comparing immediate, early and conventional implants because of the lack of RCT

Review Found Little Difference between Sandblasted and Acid-etched (SLA) Dental Implants and Modified Surface (SLActive) Implants

Data sources Medline, Embase, the Cochrane Oral Health Group\u27s Trials Register and OpenGREY databases were searched together with the reference lists of identified articles. Study selection Randomised controlled trials (RCTs) and prospective cohort studies of at least six month duration were included. Studies/case series in which there was only one implant surface (SLA or SLActive) and one loading protocol (immediate or early) were also considered. Data extraction and synthesis Two reviewers screened, selected and abstracted data, independently. RCTs were assessed for quality using the Cochrane risk of bias approach and observational studies using the Newcastle-Ottawa scale (NOS). The primary outcomes were changes from baseline to follow-up of clinical attachment level (CAL), probing depth (PD) and radiographic changes in the peri-implant bone level and number of implants lost. Cumulative survival rates (%) of each included study were calculated. Results Twenty-three articles reporting 19 studies (seven RCTs; 12 prospective observational studies) were included. The seven RCTs included 407 patients with 853 implants (8% titanium plasma-sprayed, 41.5% SLA and 50.5% SLActive). Only one RCT was considered to be at low risk of bias, the others were considered to be at unclear risk. The 12 observational studies included 1394 SLA and 145 SLActive implants and were considered to be of medium methodological quality based on the NOS. A narrative summary of the studies was undertaken owing to marked heterogeneity of the loading periods, types of implants described and lack of occurrence of the outcome of interest. There were no significant differences reported in the studies in relation to implant loss or clinical parameters between the immediate/early loading and delayed loading protocols. Overall, 95% of SLA and 97% of SLActive implants still survive at the end of follow-up. Conclusions Despite the positive findings achieved by the included studies, few RCTs were available for analysis for SLActive implants. Study heterogeneity, scarcity of data and the lack of pooled estimates represent a limitation between studies\u27 comparisons and should be considered when interpreting the present findings