Systematic review on diabetes mellitus and dental implants: an update

Purpose Dental implant surgery was developed to be the most suitable and comfortable instrument for dental and oral rehabilitation in the past decades, but with increasing numbers of inserted implants, complications are becoming more common. Diabetes mellitus as well as prediabetic conditions represent a common and increasing health problem (International Diabetes Federation in IDF Diabetes Atlas, International Diabetes Federation, Brussels, 2019) with extensive harmful effects on the entire organism [(Abiko and Selimovic in Bosnian J Basic Med Sci 10:186–191, 2010), (Khader et al., in J Diabetes Complicat 20:59–68, 2006, 10.1016/j.jdiacomp.2005.05.006)]. Hence, this study aimed to give an update on current literature on effects of prediabetes and diabetes mellitus on dental implant success. Methods A systematic literature research based on the PRISMA statement was conducted to answer the PICO question “Do diabetic patients with dental implants have a higher complication rate in comparison to healthy controls?”. We included 40 clinical studies and 16 publications of aggregated literature in this systematic review. Results We conclude that patients with poorly controlled diabetes mellitus suffer more often from peri-implantitis, especially in the post-implantation time. Moreover, these patients show higher implant loss rates than healthy individuals in long term. Whereas, under controlled conditions success rates are similar. Perioperative anti-infective therapy, such as the supportive administration of antibiotics and chlorhexidine, is the standard nowadays as it seems to improve implant success. Only few studies regarding dental implants in patients with prediabetic conditions are available, indicating a possible negative effect on developing peri-implant diseases but no influence on implant survival. Conclusion Dental implant procedures represent a safe way of oral rehabilitation in patients with prediabetes or diabetes mellitus, as long as appropriate precautions can be adhered to. Accordingly, under controlled conditions there is still no contraindication for dental implant surgery in patients with diabetes mellitus or prediabetic conditions.

Total Oral Rehabilitation with Dental Implants in an Elderly Patient with Concomitant Diseases: a Case Report

We report a case of restoration of the masticatory and phonetic functions of a senior patient with comorbidities who receives systemic medication and lacks sufficient bone volume for implant placement in the accurate position. X-ray shows severe asymmetric atrophy of the mandible, especially on the right sight, which affects the location of the mandibular canal. This greatly limits and complicates the restoration of the masticatory and phonetic functions with conventional prostheses. Adequate management of medication and long-term disease control of the patient allow safe surgery for tooth extraction and placement of intraosseous implants in the jaw bones.

Advantages and disadvantages of cantilever bridges

Utilizing cantilever bridges to perform fixed partial prostheses has been reported in the literature based on the increasing demands in this field to improve the outcomes and relieve extensive therapeutic approaches associated with complete oral rehabilitation. The current evidence indicates that cantilever bridges can effectively replace missing teeth with more favorable outcomes than removable partial dentures. However, evidence also shows that decreasing the number and size of cantilevered pontics and increasing abutment teeth are necessary to enhance the outcomes. Furthermore, if the occlusion is harmonious and stable, it has been demonstrated that cantilever bridges can be applied with the minimal periodontal ligament, which adds to its favorable outcomes. However, it should be noted that cantilever bridges are not applicable for all patients as it needs proper oral health status to be installed. Besides, it might also be associated with complications that may lead to failure. Therefore, further studies are still needed.

Digital dentistry and guided treatments: a concise systematic review

Introduction: In the landscape of new digital technologies, many dental treatments have benefited from this digital advance. The development of computed tomography (CT) dental scanners has enabled powerful imaging capabilities and software applications. The prosthetic plane and implanted drill guides with the placement of trajectories based on a drill according to the position of the CT 3-D Space markers. Objective: To present, through a systematic review, the main considerations of guided surgery in implant dentistry and its respective advantages, disadvantages, and limitations. Methods: Clinical studies with qualitative and/or quantitative analysis were included, following the rules of the systematic review-PRISMA. Results: Out of a total of 102 articles found, 82 articles were evaluated and 57 were rejected for not meeting the GRADE classification, and only 25 articles were used in this study to compose the textual part. Advances in technology have contributed to the improvement of implant models. 3D reconstructions make it possible to determine the quantity and quality of available bone and also enable the simulation of implant installation in a virtual environment, reducing time and the possibility of errors, allowing for an overall reduction in the costs of oral rehabilitation. Conclusion: Guided preoperative planning or project-guided dental surgery provides high implant and dental rehabilitation success rates, also benefiting prosthetic restorations supported by fixed implants. Furthermore, the concept of using personalized implants with the help of 3D virtual treatment planning improves mandibular restoration with a good facial profile, esthetics, and dental rehabilitation.

A Hybrid Oral Rehabilitation of Hypohidrotic Ectodermal Dysplasia: A Conservative Approach with Three-Year Follow-Up

This case report presents a 19-year-old male patient with hypohidrotic ectodermal dysplasia, having a chief complaint of multiple missing teeth. Atraumatic extraction of the teeth with hopeless prognosis was done, and teeth with grade 2 mobility were submerged using cast dowel and coping. Following this, incremental increase in the vertical dimension was made using removable flexible splint of two-millimeter thickness. After facebow transfer and making appropriate eccentric bite records to program the semiadjustable articulator, wax-up was done at the desired vertical dimension (VD). The upper arch was finally restored using a long-span fixed partial denture and lower arch using bilateral attachment (Rhein 83) retained cast removable partial denture as a definitive prosthesis. Therefore, in conditions like hypodontia or oligodontia caused due to ectodermal dysplasia, attachment retained removable partial denture may prove beneficial by effectively distributing the occlusal forces. In clinical scenarios where implant is not feasible or not opted by the patient, this combination treatment may be a viable option.

Economic impact of biomaterials for bone regeneration in Brazil during the pandemic

Implantable devices are therapeutic options for oral rehabilitation, with several presentations available in the dental consumption market. The consumption power of health products is a little explored in the literature, particularly in the face of financial crises. The aim of this study was to evaluate the economic impact of biomaterials for bone regeneration in Brazil during the pandemic. A quantitative study was carried out through online document analysis, with publicly accessible secondary data extracted from IBGE and websites for the sale of dental products. Data collection in the second quarter of 2020 and 2021 of absolute values ​​of products, official GDP data and population estimates allowed the generation of a biomaterial/income coefficient. The categories obtained from grafts and membranes were stratified by composition, origin and industry. Statistical analysis used the Shapiro-Wilk test to assess normality, the non-parametric Kruskall-Wallis test to compare the means of variables and the Wilcoxon test for paired samples of medians according to the two periods, considering significant differences if p <0.05. Of 97 products analyzed, a higher frequency of bone grafts than barrier membranes was observed, with an average growth of 18.5% in the price of biomaterials, below 28.7% of GDP in the same period. The highest prevalence of biomaterials was the ceramic composition for bone grafts and resorbable polymeric for membranes, from the xenogenous source and Brazilian industry. There was a chronological decrease in the biomaterial/income coefficient in most categories, with a drop in the general average from 4.67±4.40% to 4.30±3.96%, accompanied by an increase in the median, demonstrating a trend towards homogeneity of this coefficient in the comparison between years. The drop in the coefficient indicates a greater purchasing power of biomaterials by the potential consumer. Market knowledge can contribute for the decision making in clinical planning involving bone regeneration.

Case Report: Reconstruction of a Large Maxillary Defect With an Engineered, Vascularized, Prefabricated Bone Graft

The reconstruction of complex midface defects is a challenging clinical scenario considering the high anatomical, functional, and aesthetic requirements. In this study, we proposed a surgical treatment to achieve improved oral rehabilitation and anatomical and functional reconstruction of a complex defect of the maxilla with a vascularized, engineered composite graft. The patient was a 39-year-old female, postoperative after left hemimaxillectomy for ameloblastic carcinoma in 2010 and tumor-free at the 5-year oncological follow-up. The left hemimaxillary defect was restored in a two-step approach. First, a composite graft was ectopically engineered using autologous stromal vascular fraction (SVF) cells seeded on an allogenic devitalized bone matrix. The resulting construct was further loaded with bone morphogenic protein-2 (BMP-2), wrapped within the latissimus dorsi muscle, and pedicled with an arteriovenous (AV) bundle. Subsequently, the prefabricated graft was orthotopically transferred into the defect site and revascularized through microvascular surgical techniques. The prefabricated graft contained vascularized bone tissue embedded within muscular tissue. Despite unexpected resorption, its orthotopic transfer enabled restoration of the orbital floor, separation of the oral and nasal cavities, and midface symmetry and allowed the patient to return to normal diet as well as to restore normal speech and swallowing function. These results remained stable for the entire follow-up period of 2 years. This clinical case demonstrates the safety and the feasibility of composite graft engineering for the treatment of complex maxillary defects. As compared to the current gold standard of autologous tissue transfer, this patient’s benefits included decreased donor site morbidity and improved oral rehabilitation. Bone resorption of the construct at the ectopic prefabrication site still needs to be further addressed to preserve the designed graft size and shape.