Major clinical approaches to osseointegrated implants: a concise systematic review

Introduction: Reconstructive surgery is an important component of the specialty of oral and maxillofacial surgery. The maxillofacial skeleton is subject to various types of defects secondary to trauma, craniofacial/congenital deformities, and tumor ablation. The complex anatomy and function of the maxillomandibular complex impact the choice of reconstruction for maxillofacial defects. Objective: It was to carry out a concise systematic review to present the main considerations of osseointegrated implants. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from September to November 2022 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 127 articles were found, and 57 articles were evaluated and 30 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 10 studies with a high risk of bias and 28 studies that did not meet GRADE. Most studies showed homogeneity in their results, with I2 =95.8% >50%. It was concluded that orofacial defects affect both the form and function of the most prominent and complex part of the body, the face. Several options, such as vascularized flaps, non-vascularized autogenous grafts, or allogeneic materials, are available to reconstruct maxillofacial defects. The complex anatomy and function of the maxillomandibular complex impact the choice of reconstruction for maxillofacial defects. The real effect of bisphosphonates on osseointegration and survival of dental implants is still not well established

Bone regeneration processes with the use of biomaterials and molecular and cellular constituents for dental implants

Introduction: When a dental element is lost in the posterior region of the maxilla, there is a natural reabsorption of the alveolar process and, at the same time, pneumatization of the maxillary sinus will occur. For this reason, the maxillary sinus floor elevation procedure should be performed, or short implants when possible. Often the focus is on the type of biomaterial to be used and the success and predictability of our results does not depend only on the biomaterial. It is also necessary to consider the type of defect to be treated, its morphology. The characteristics of the biomaterials to be used must be considered, as well as the characteristics of the bed and the bone defect for treatment. Objective: It was to carry out a concise systematic review of bone regeneration processes using biomaterials and the main molecular and cellular constituents for subsequent dental implantation. Methods: The present study followed by a systematic review model (PRISMA). The search strategy was performed in the PubMed, Cochrane Library, Web of Science and Scopus, and Google Scholar databases. The Cochrane Instrument was used to assess the risk of bias of the included studies. Results and Conclusion: 152 articles involving implantology and biomaterials were found. A total of 64 articles were fully evaluated and 28 were included in the present study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 5 studies with high risk of bias (studies with small sample size) and 3 studies with uncertain risk (studies with results without statistical significance). The search for a solution for large bone defects directed studies to tissue regeneration therapy or bone regeneration. These studies can promote the use of fillers and epithelial barriers that help in the treatment as an adjuvant to bone graft techniques, favoring greater predictability in alveolar and peri-implant reconstructions and with a good prognosis. The main filler biomaterials can be fibrin-rich plasma, Bio-Oss®. However, it is necessary to understand the chemical, physical and biological processes of both the biological material and the biological niche of the host. Crossing compatible information between microenvironments allows cell recognition and signaling cascades for neovascularization and regeneration and bone filling for successful posterior dental implant

Major considerations of minimally invasive surgery in bucomaxillofacial procedures: quality of life and aesthetics

Introduction: In minimally invasive or atraumatic surgery or dental procedures, there are several clinical studies with increasing expectations to establish treatment guidelines. It is estimated that in minimally invasive dental surgery in general, synthesis studies with meta-analysis and decision analysis represent almost 29% of all studies. Objective: Demonstrate, through a systematic review of the literature, the evolution and consequent importance of improving surgical techniques and/or minimally invasive treatments in dentistry. It was hypothesized that there were statistically significant results on advances in the attempt to minimize trauma, providing quality of life and better aesthetics to patients. Methods: The present study was followed by a systematic review model (PRISMA). The search strategy was performed in the PubMed, Cochrane Library, Web of Science and Scopus, and Google Scholar databases. The Cochrane Instrument was used to assess the risk of bias of the included studies. Results: The total of 92 articles involving minimally invasive surgery and dentistry were found. A total of 54 articles were fully evaluated and 23 were included in the present study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 3 studies with a high risk of bias (studies with small sample size) and 2 studies with uncertain risk (studies with results without statistical significance). Since the most primordial extraction techniques were created and developed, several attempts have been made to minimize the professional's effort, reduce surgical time and alleviate bleeding and the inflammatory processes, edema, pain, and ecchymosis that can affect patients, in trans and postoperative periods. Thus, the maximum preservation of the integrity of the soft tissues (papillae and free and inserted gingival band) adjacent to the prosthetic spaces should be sought; preservation of the alveolar bone ridge level. Based on the histological concept in which living tissues are formed by cells joined by thin elastic tissue and with nerve fibrils, capillaries, lymphatic and blood vessels. The disruption of these cells by surgical trauma provides the release of enzymes that delay healing. For this reason, surgical trauma should be minimized. Conclusion: There are many attempts to minimize the professional effort, reduce surgical time and alleviate bleeding and inflammatory processes, edema, pain, and ecchymosis that can affect patients. Thus, the maximum preservation of the integrity of the soft tissues adjacent to the prosthetic spaces and the preservation of the level of the ridge of the alveolar bone to achieve a minimization of surgical trauma must be sought

Major considerations of dental care in COVID-19: an evidence-based on clinical studies and guidelines

Introduction: The COVID-19 pandemic has presented enormous challenges for dentists and patients. The risk of nosocomial transmission is a reality that requires the development of guidelines by the dental community to reduce the chances of infection by the new coronavirus. In this sense, it was necessary to implement alternative prophylactic techniques such as the adoption of oral rinses before dental care. Objective: To present the main considerations of clinical studies on dental care at COVID-19. Methods: The research was carried out from May 2021 to June 2021 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar, following the Systematic Review-PRISMA rules. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results: One study showed that 0.2% chlorhexidine and 1% povidone-iodine oral solutions are effective pre-procedural mouthwashes against salivary SARS-CoV-2 in dental treatments. It was observed in another study that the effect of reducing the salivary load with mouthwash with CPC and PI was maintained after 6 hours. PVP-I nasal and oral antiseptic solutions are effective in inactivating SARS-CoV-2 at a range of concentrations after exposure times of 60 seconds. There is sufficient in vitro evidence to support the use of antiseptics to potentially reduce the viral load of SARS-CoV-2. The effects against the new coronavirus in vivo still need more randomized clinical trials to prove its effectiveness. Conclusion: ACE2 receptors are highly expressed in the oral cavity, therefore, this could be a potential high-risk route for SARS-CoV-2 infection. The virus can be detected in saliva even before the appearance of symptoms of COVID-19. In this regard, randomized clinical studies have shown that some pre-procedure oral mouthwashes are effective against salivary SARS-CoV-2 in dental treatments. In addition, the American Academy of Implant Dentistry (AAID) reported on how COVID-19 impacts dental care through guidelines for general dentistry

Major approaches to bone regeneration process with gut microbiota, exosomes, and microRNAs: a systematic review

Introduction: The incidence and mortality of bone diseases are still steadily increasing, creating a significant financial burden for societies across the world. To prevent the occurrence of bone diseases, slow their progression, or reverse the injuries they cause, new alternatives or complementary treatments need to be developed. The gut microbiota plays a role in bone metabolism and the pathogenesis of osteoporosis. Objective: It was to analyze through a systematic review the main considerations and clinical findings of the bone formation process through the modulation of the gut microbiota, as well as the functions of microRNAs and exosomes. Methods: The systematic review rules (PRISMA) were followed. The search was carried out from August to September 2022 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases, using scientific articles from 2001 to 2022. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 126 articles were found. A total of 34 articles were fully evaluated and 26 were included in this systematic review. Most studies showed homogeneity in their results, with I2 =98.8%>50%. The symmetrical funnel plot does not suggest a risk of bias between small sample-size studies. The gut microbiota plays an important role in the modulation of bone healing and bone health through the traffic of inflammatory TNF+ T and Th17 cells to the bone marrow, influencing the inflammatory state of the patient, determining the “brain-gut-bone” axis. It has been shown that the diversity of the gut microbiota is decreased in patients with osteoporosis, leading to a state of dysbiosis. There is a relationship between the microbiome, osteoblasts, osteoclasts, and nuclear factor ligand receptor-kappa-B (RANKL) activator. Studies have proposed several mechanisms of gut microbiome interaction with osteoclastogenesis and bone health, including microRNA, insulin-like growth factor 1, and immune system mediation. Therefore, bone regeneration requires that the basic biological principles of osteogenesis, osteoinduction, osteoconduction, and biocompatibility are followed

Zygomatic implant: major considerations in the COVID-19 pandemic

Introduction: The dissemination of COVID-19 has presented significant challenges for dentistry. In this context, dental care during the pandemic is challenging due to the high risk of infection. In this scenario of infections and the COVID-19 pandemic, there are huge concerns in dental implant procedures, especially zygomatic implants (ZI), which need to be performed for several reasons, mainly to improve the quality of life of patients. Objective: The present study performed a brief systematic review of zygomatic implantation in the context of the COVID-19 pandemic, to highlight the main challenges and guideline-based safety strategies. Methods: The research was carried out from May 2021 to June 2021 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar, following the Systematic Review-PRISMA rules. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results: European guidelines and expert opinion showed on the control and prevention of infections in dentistry during the pandemic. As the guidelines were not based on solid evidence, they were supplemented by expert opinion on the control and prevention of infections in dentistry. The type of personal protective equipment provided by the dental team must be appropriate for the procedure and the risk of infection. the American Academy of Implant Dentistry (AAID) points to the issues listed as “What constitutes a dental implant-related emergency?; How should patients be screened and screened?; What personal protective equipment is needed?; How should operators be equipped?; What equipment should be used?; What, when, and how can procedures be performed?” Conclusion: In this current context of general care with dental procedures, especially with ZI, clinical studies show how these safety measures against COVID-19 are important, as ZI involves important surgical management

Major approaches to bucomaxillofacial bone regeneration and remodeling with the use of biomaterials: a systematic review

Introduction: The number of dental implants in the world has increased, totaling more than one million procedures per year. The development of biomaterials has represented an important therapeutic tool in the correction of bone defects. The bone regeneration process is initiated by successive mitosis of mesenchymal and endothelial stem cells, as well as by activation of osteoblasts and vascular proliferation guided by platelet-derived growth factors (PDGF) and TGF-β. Objective: To present, through a systematic review, the main results involving bone formation and remodeling in the maxillofacial system using biomaterials, cells and molecules in the appropriate biological niche of human bone. Methods: The research was carried out from July 2021 to August 2021 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar, following the Systematic Review-PRISMA rules. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results: A total of 225 articles were found. After the selection process, 95 articles were recruited for analysis, 44 articles were selected and 43 articles were used in this study to compose the textual part. The selected articles had moderate quality in their clinical trials. The bias risks found do not affect the reliability of the results. As main findings, it was found that the osteoinduction process is influenced by several factors, requiring the presence of inducers, which include β-glycerolphosphate, ascorbic acid and dexamethasone. Mesenchymal cells acquire the morphology and components of osteoblastic membranes and start to express alkaline phosphatase to deposit extracellular matrix rich in calcium and certain proteins, such as osteopontin and osteocalcin. Bone morphogenetic proteins function as growth factors with a specific role in the proliferation and differentiation of mesenchymal stem cells present in the lesion's niche. Platelet-rich fibrin (PRF) stimulates bone regeneration more efficiently. Studies have reported that the addition of PRF with bone graft is associated with positive clinical results and is a good method of manipulating the bone graft during insertion into the maxillary sinuses and it stimulates bone regeneration. Conclusion: Optimized bone regeneration is a matter of great research to accelerate the osseointegration process, leading to reduced waiting time before any subsequent procedure. The balance between the biomaterial, mesenchymal stem cells, fibrin formation and platelet activation are responsible for the process and performance of bone regeneration or formation

Virtual Surgery in Implantology: A Systematic Review and State of the Art

Introduction: Dental implant procedures have increased worldwide, reaching approximately one million dental implants per year. The optimization of faster and more accurate techniques by dentists and postoperative surgeons with better results and quality of life stimulated the development of numerous software and hardware for performing computer-guided surgeries, so-called virtual surgeries (VS). Objective: to present, through a systematic review, the main considerations of virtual surgery in dentistry and their respective advantages, disadvantages, and limitations. Methods: The model used for the review was PRISMA. We used databases such as Scielo, Lilacs, Google Scholar, PubMed. Major findings: In the scenario of VS in dentistry, advances in technology have contributed to the improvement of the models, since there was only the direct molding technique to obtain patient models, with the positioning of implants not very favorable in terms aesthetics. The information that is acquired in the 3D reconstructions allows us to determine the quantity and quality of the available bone and also allows the simulation of the installation of the implants in a virtual environment. This provides predictability of techniques and difficulties that can be encountered during surgical intervention, reducing the time and the possibility of errors, allowing the overall reduction of oral rehabilitation costs. Conclusion: Preoperative virtual planning and reconstruction of the mandible guided by dental implants through preoperative designs provide high success rates for the implant and dental rehabilitation, benefiting also prosthetic restorations supported by fixed implants. Still, the concept of using personalized implants with the help of 3D virtual treatment planning, stereolithographic models, and computer-assisted design greatly improves the mandibular restoration and helps to obtain a good facial profile, aesthetic and dental rehabilitation, avoiding complications with the grafts autologous

Benefits and harmfulness of the use of bisphosphonate in the osseointegration process for dental implants in patients with osteoporosis: a concise systematic review

Introduction: In the scenario of implantology and osteoporosis, it is highlighted that the high need and use of treatments related to dental implants result from the combined effect of several factors, highlighting aging and bone fragility. In this context, osteoporosis is a global bone disease prevalent in human aging. Bisphosphonates (BPs) are commonly used as therapy because they influence hard and soft tissue calcium metabolism. Objective: It was to present the main considerations and scientific evidence of the use of bisphosphonate in the osseointegration process for dental implants in patients with osteoporosis, as well as to emphasize the harm caused by the occurrence of osteonecrosis. Methods: The rules of the Systematic Review-PRISMA Platform were followed. The research was carried out from February 2022 to May 2022 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 110 articles were found. In total, 58 articles were fully evaluated and 28 were included and evaluated in this study. Of the initial total of articles, 26 articles were excluded because they did not meet the GRADE classification, and 4 were excluded because they presented a risk of bias. It was concluded that osteoporosis is a metabolic condition that affects alveolar bone density, which may compromise the dental implant process. Therefore, the careful use of bisphosphonates is necessary for the osseointegration process, however, dental surgeons are encouraged to know the diagnosis so that they can make a careful assessment, observing the quality of the bone through routine imaging exams, to prevent osteonecrosis. In addition, alendronate sodium is used to decrease bone resorption, being an adjuvant therapeutic agent for the treatment of osteoporosis

CAD-CAM system in dental implants: a systematic review

Introduction: In the scenario of dental implant procedures, the intraoral scanner and milling unit are used to manufacture a computer-aided design and a computer-aided surgical and radiographic guide. In this sense, the use of CAD-CAM systems is highlighted in the processes of a prosthesis and dental implants, promoting the fabrication of prostheses based on a state-of-the-art three-dimensional system. Objective: Conduct a systematic review of the main considerations of the CAD-CAM system for the development of prostheses and dental implants. Methods: The present study was followed by a systematic literature review model - PRISMA rules. The quality of the studies was based on the GRADE instrument. The risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: The use of digital tools for the automated fabrication of implant parts (CAD-CAM) is an optimizing reality in Dentistry. CAD-CAM enables high-quality, standardized, accurate, and detail-perfect prosthetic restorations. The use of metallic implants in the morse cone system in association with zirconia abutments guarantees a final product with mechanical resistance, biocompatibility, and esthetics