Dental implants survival after nasal floor elevation: a systematic review

Purpose The aim of this work is to assess the clinical outcomes of implants placed after a nasal floor elevation procedure. Methods A systematic review was conducted using four electronic databases; Medline (Pubmed), Cochrane library, DOAJ and SCOPUS, following the PRISMA statement recommendations to answer the PICO question: “In patients undergoing dental implant placement in the maxillary anterior region (P), Do implants placed after nasal floor elevation (I) have a different survival (O) from those implants placed without grafting procedures (C)?. The study was pre-registered in PROSPERO (CRD42021229479). Included articles quality was assessed using the “NIH quality assessment tool”, “The Newcastle-Ottawa scale” and “JBI critical appraisal tools for case reports''. Results Twelve articles were finally selected, including 151 patients and 460 implants. The weighted mean follow-up was 32.2 months, and the weighted survival rate after this period was 97.64% (range 89.2-100%). No statistical differences could be inferred between the treatments performed in one-stage or two-stage, following a lateral approach or a transcrestal approach or using different grafting materials. A great heterogeneity was found in terms of study design and methodological aspects. For this reason, a quantitative analysis followed by meta-analysis was not possible. Conclusion Within the limitations of this study, implants placed after a nasal floor elevation present a good survival and a low range of complications. In absence of randomized studies, the level of evidence was low, attending the GRADE system and based on the study quality level, the strength of evidence attending the SORT taxonomy was B.

Implant placement in the aesthetic zone: More efficiency in guided surgery

The aim of this case report is to describe the combining of a surgical guide with a temporary restoration to streamline the implant process. A 54-year-old male patient presenting partial edentulism underwent computer-aided template-guided implant placement for the replacement of the missing upper second right incisor. The presented technique was used during the surgical procedures; it introduced the integration of a surgical guide into the temporary fixed partial denture. Using computer-aided design, computer-aided manufacturing technology and virtual implant planning, a temporary-implantation fixed partial denture was constructed, and a guidance sleeve was implemented into it. The implant bed preparation was then performed using the bridge as a surgical guide. After osteotomy, the guidance sleeve within the bridge was sealed, and the bridge was temporarily incorporated for submerged healing of the implant. The usage of a temporary restoration as a surgical guide seems to make the digital workflow of guided implant placement more efficient, by achieving a representative clinical outcome.

The Effect of Different Implant-Abutment Mis-Matches on Stress Distribution: A 3-Dimensional Finite Element Study

Platform-switching reduces peri-implant marginal bone loss (MBL), and the aim of this study was to compare the effect of platform-switching on stress within crestal bone using different implant-abutment mis-matches (0.65 and 1mm) under two different vertical loads (30 N vs 200 N) for implants placed in posterior jaw sites. 3-D modeling software was used for an implant of 4.5mm diameter and 13mm length. Molars were modeled using CT images of bone density in human maxilla (D3 bone) and mandible (D2 bone). Collected data were analyzed using CATIA software. In posterior mandible, stress of 30 N force with platform mis-matches of 0.65 or 1mm were 2.920 and 2.440 MPa respectively. Using 200 N force, values increased to 19.44 and 16.30 MPa. In posterior maxilla and 30 N force, stresses with mis-matches of 0.65 and 1mm were 3.77 and 3.18 MPa respectively increasing to 25.14 & 20.17 with 200 N force. The effect can be predicted to be greatest as the mis-match increases with implants placed into lower quality bone (posterior maxilla with D3 quality).

Esthetic And Functional Integration Of Soft Tissue Around Dental Implants: Thickness, Width, Stability.

The long-term Functional success of the implant treatment depends on the stability of the crestal bone tissue around the implant platform. The Esthetic result is achieved by an adequate soft tissue in the peri-implant zone. Furthermore, the soft tissue creates the buffer area that ensures the mechanical and biological protection of the underlying bone. Therefore, it is necessary to maintain for a long term, not only the implant osseointegration but also the integration of the soft tissue around the Sub and Supra-structure of the restoration. In order to create the protective soft tissue area, it is necessary to ensure three criteria. This treatment approach will be defined as the TWS – Soft Tissue Management : T for Thickness , W for Width, and S for Stability . The purpose of this article is to present with clinical cases, the detailed description of each criteria. There are many ways to achieve the two first criteria and they are well described in the literature. Achieving the third criteria of the Stability become possible only in the last years since the development of the digital technology and its implementation into the dental practice. A one time abutment and the creation of peri- implant mucosal thickness with an optimal amount of the attached keratinized gingiva above and around the implant platform, for muco-gingival integration of the system, are therefore a prerequisite for functional and esthetic result. The article presents the possibility for the clinicians to use in their daily practice this new clinical approach of TWS - Soft Tissue Management.

Comparative efficacy of different flapless ridge preservation techniques: A systematic review and meta-analysis

Although the efficacy of ridge preservation is well-documented, there is a lack of robust evidence regarding the influence of different surgical techniques. Flapless approaches are thought to be better at preserving soft tissue architecture and have been suggested for mild to moderate defects. This review investigates the efficacy of different flapless techniques for ridge preservation in mild to moderate defects with <50% buccal bone loss. PubMed, EMBASE, and Cochrane Library databases were searched to obtain relevant articles published in English from 1974 to December 2019. The primary outcome was horizontal and vertical hard tissue dimensional changes. Soft tissue changes were evaluated as a secondary outcome. The Bio-Col technique, subperiosteal tunnel technique, and hard tissue with autogenous soft tissue graft/collagen matrix technique were identified. Eight studies were included, and quantitative analyses were performed for four studies for the primary outcome variables. The meta-analysis revealed significant reductions for horizontal changes (WMD = 2.56 mm, 95% CI [2.18, 2.95]), vertical mid-buccal (WMD = 1.47 mm, 95% CI [1.04, 1.90]), and vertical mid-lingual (WMD = 1.28 mm, 95% CI [0.68, 1.87]), in favor of flapless ridge preservation techniques. Subgroup analysis based on technique suggest minimal hard tissue differences. The efficacy of flapless ridge preservation techniques on soft tissue changes was inconclusive. In conclusion, flapless ridge preservation techniques are effective for mild to moderate defects. The technique or material used to close the extraction socket does not seem to significantly affect hard tissue changes, while the effect on soft tissue changes warrants further investigation.

Efficacy of Various Implant Abutment Screw Access Channel Sealing Materials in Preventing Microleakage: A Systematic Review

The aim of this systematic review is to evaluate the effectiveness of different materials used for sealing dental implant abutment screw access channel (ASAC), in preventing microleakage. As per the searched indexed English literature, this study is the first review of its kind. Indexed English literature published up to 20 th February 2021 was systematically searched on relevant electronic data bases. The recommendations specified by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were applied for constructing framework, and reporting the current review. The focused PICO question was: “Which material (C) is more effective in sealing (I) implant ASAC (P) in terms of causing minimal microbial leakage (O)”. Quality of articles was assessed with modified CONSORT scale for in vitro studies. Five in vitro studies were selected for qualitative analysis after final stage screening. Modified CONSORT scale suggested that out of the five selected studies, one each was of low and high quality, whereas three studies were of moderate quality. Included studies had contrasting results related to the efficacy these materials as sealants in ASAC. Sealing capacity against microleakage should be considered as one of the important criteria while selecting the material to fill implant ASAC. Definitive conclusions asserting superiority of a single material over others are difficult to draw, due to non-homogeneity in study design of the included papers. More studies should be conducted in the near future to investigate the efficacy of various combination of materials in preventing micro leakage.

Management of a complication with Partial Extraction Therapy: A Clinical Case Letter and Clinical Recommendations

no abstract required

Reconstruction after hemimandibulectomy by a titanium mesh and particulate cancellous bone and marrow harvested from posterior ilia: a case report

A particulate cancellous bone and marrow (PCBM) graft combined with titanium (Ti-) mesh tray has become one of the most popular mandibular reconstruction methods. The technique has been applied to the mandibular discontinuity defects after segmental mandibulectomy. To the best of our knowledge, there are no reports on using the technique after hemimandibulectomy, during which a wide mandibular resection, including the condyle, is performed. Here we report firstly a case of mandibular reconstruction after hemimandibulectomy, using a plate and soft-tissue free flap, followed by a Ti-mesh and PCBM harvested from the bilateral posterior ilia, which was successful. This case report first revealed how bone resorption occurred clinically in mandibular reconstruction using PCBM and Ti-mesh tray after hemimandibulectomy. We also revealed the high predictability of the mandibular reconstruction using PCBM and Ti-mesh tray after hemimandibulectomy. Our report also provides a guiding principle to overcome the limitation of mandibular reconstruction using PCBM and Ti-mesh tray after hemimandibulectomy. However, our manuscript has limited evidence being a case report.

The Influence of Storage in Saline or Irradiation by Ultraviolet on Implant Hydrophilicity and Osseointegration: An Experimental Study in Rabbits

Storage in aqueous solution or ultraviolet (UV) irradiation can re t ain or regain the hydrophilicity of titanium implant surface. In this study, t hree types of commercial titanium implants were used : ZBL (ZDI Bone L evel ® ), CEL (C-tech Esthetic Line ® ) , and modSLA (Straumann SLActive ® ). ZBL and CEL implants were treated with UV irradiation for 4 h. Surface characterization of the four groups (ZBL, ZBL-UV, CEL-UV, modSLA) was evaluated by scanning electron microscopy and contact angle measurements. The in vivo bone response was evaluated by removal torque (RTQ) tests and histomorphometric analysis at 3, 6 , and 12 weeks post-implantation. A total of 144 implants and 36 rabbits were used for experiments according to a previously established randomization sequence. The ZBL-UV, CEL-UV , andmodSLA groups were hydrophilic, and nanostructures were observed on the modSLA implant surface.ModSLA achieved better RTQ value than ZBL at 12 weeks ( p <0.05). For histomorphometric analysis, ZBL-UV and CEL-UV implants showed higher bone area values in the cancellous bone zone at 6 weeks than did modSLA and ZBL implants ( p <0.05).In the cortical bone zone, all groups showed comparable bone-to-implant contact at all healing time points ( p >0.05).Both storage in saline and UV irradiation could retain or provoke hydr o philic surfaces and improve osseointegration. Compared to storage in saline, UV irradiation displayed slight advantages in promoting new bone formation in cancellous bone zone at an early stage.

Comparison of the accuracy of pilot-drill-guided and fully guided implant surgery with dynamic navigation. In vitro model study

The aims of the present study are to measure and compare dental implant deviations with fully guided and pilot-drill-guided protocols using dynamic navigation systems in polyurethane models. The pilot-drill-guided group was determined to be the study group and included 12 implant applications. In this group, the pilot hole was drilled with navigation guidance, and the procedure was completed freehandedly. In the control group, all the drilling and implant placement steps were performed using the navigation system, and a total of 12 implants were placed. The pre- and postoperative images were compared to calculate the magnitude of implant deviation. The quantitative data of the two groups were compared using the independent-samples t-test and Mann-Whitney U-test. The analyses revealed that the length of the procedure significantly differed between the two groups (p < 0.001). The procedure duration was significantly shorter in the study group. The entry deviation values of the two groups were not significantly different (p = 0.079). The analysis revealed the apex deviation to be higher in the study group than in the control group (p = 0.003). However, the two-dimensional vertical apex deviation values of the implants were not significantly different between groups (p = 0.068). Angular deviation was determined to be significantly higher in the study group (p < 0.001). In the present study, all implants were successfully placed in the models using a dynamic navigation system. The results of this study may be useful for future clinical studies.