Journal Club- August 2022
Introduction of a Novel Anatomic Recession Ratio in the Treatment of Gingival Recession: A Proof-of-Principle Study. Aslan S, Buduneli N, Tavelli L, Rasperini G, Cortellini P. Int J Periodontics Restorative Dent. 2022 Jul-Aug;42(4):e103-e112. doi: 10.11607/prd.5574. PMID: 35830315.
The Multilayer GBR Technique: An Alternative Approach for One-Stage Transmucosal Implant Placement in the Presence of Horizontal Defects. A Case Series. Merli M, Merli M, Pagliaro U, Fratini A, Lo Russo L, Nieri M. Int J Periodontics Restorative Dent. 2022 Jul-Aug;42(4):e113-e120. doi: 10.11607/prd.6084. PMID: 35830318.
The association between periodontitis and lung function: Results from the National Health and Nutrition Examination Survey 2009 to 2012. Chen, H, Zhang, X, Luo, J, Dong, X, Jiang, X. J Periodontol. 2022; 93: 901– 910. https://doi.org/10.1002/JPER.21-0399
Alveolar ridge preservation reduces the need for ancillary bone augmentation in the context of implant therapy. Couso-Queiruga, E, Mansouri, CJ, Alade, AA, Allareddy, TV, Galindo-Moreno, P, Avila-Ortiz, G. J Periodontol. 2022; 93: 847– 856. https://doi.org/10.1002/JPER.22-0030.
Effectiveness of surgical root coverage on dentin hypersensitivity: A systematic review and meta-analysis. Antezack, A., Ohanessian, R., Sadowski, C., Faure-Brac, M., Brincat, A., Etchecopar-Etchart, D., & Monnet-Corti, V. (2022). Journal of Clinical Periodontology, 49(8), 840–851 doi.org/10.1111/jcpe.13664.
Effects of periodontal and bisphosphonate treatment on the gingival crevicular levels of sclerostin and dickkopf-1 in postmenopausal osteoporosis with and without periodontitis. Ozden FO, Demir E, Lutfioglu M, Acarel EE, Bilgici B, Atmaca A. J Periodont Res. 2022;57:849- 858. doi: 10.1111/jre.13023.
Efficacy of combined chemical and electrochemical decontamination treatments on contaminated healing abutments and their effect on surface topography: An in vitro study. Kyaw TT, Abdou A, Nakata H, Pimkhaokham A. Clin Implant Dent Relat Res. 2022 Jul 19. doi: 10.1111/cid.13123. Epub ahead of print. PMID: 35852825.
Immediate implant placement utilizing vestibular socket therapy versus early implant placement with contour augmentation for rehabilitation of compromised extraction sockets in the esthetic zone: A randomized controlled clinical trial. ElAskary A, Elfana A, Meabed M, Abd-ElWahab Radi I, Akram M, Fawzy El-Sayed K. Clin Implant Dent Relat Res. 2022 Jul 10. doi: 10.1111/cid.13120. Epub ahead of print. PMID: 35811090.
Dental implants in patients with head and neck cancer – a systematic review and meta-analysis of the influence of radiotherapy on implant survival. Schiegnitz E, Reinicke K, Sagheb K, König J, Al-Nawas B, Grötz KA. Clin Oral Implants Res. 2022 Jul 16. doi: 10.1111/clr.13976. Epub ahead of print. PMID: 35841367.
Influence of the number of implants in the edentulous mandible on chewing efficacy and oral health-related quality of life-A within-subject design study. Passia N, Chaar MS, Krummel A, Nagy A, Freitag-Wolf S, Ali S, Kern M. Clin Oral Implants Res. 2022 Jul 22. doi: 10.1111/clr.13984. Epub ahead of print. PMID: 35869607.
Impact of radiographic field-of-view volume on alignment accuracy during virtual implant planning: A noninterventional retrospective pilot study. Pieralli S, Beyer C, Wesemann C, Vach K, Russe MF, Kernen F, Nelson K, Spies BC. Clin Oral Implants Res. 2022 Jul 21. doi: 10.1111/clr.13983. Epub ahead of print. PMID: 35861131.
Impact of abutment geometry on early implant marginal bone loss. A double-blind, randomized, 6-month clinical trial. Pérez-Sayans M, Castelo-Baz P, Penarrocha-Oltra D, Seijas-Naya F, Conde-Amboage M, Somoza-Martín JM. Clin Oral Implants Res. 2022 Jul 22. doi: 10.1111/clr.13985. Epub ahead of print. PMID: 35869615.
Accuracy of digital implant impressions in clinical studies: A systematic review. Schmidt A, Wöstmann B, Schlenz MA. Clin Oral Implants Res. 2022 Jun;33(6):573-585. doi: 10.1111/clr.13951. Epub 2022 May 18. PMID: 35527511.
Supplemental or dietary intake of omega-3 fatty acids for the treatment of periodontitis: A meta-analysis. Heo H, Bae JH, Amano A, Park T, Choi YH. J Clin Periodontol. 2022 Apr;49(4):362-377. doi: 10.1111/jcpe.13603. Epub 2022 Feb 27. PMID: 35141945.
Pocket closure and residual pockets after non-surgical periodontal therapy: A systematic review and meta-analysis. Citterio F, Gualini G, Chang M, Piccoli GM, Giraudi M, Manavella V, Baima G, Mariani GM, Romano F, Aimetti M. J Clin Periodontol. 2022 Jan;49(1):2-14. doi: 10.1111/jcpe.13547. E
Effectiveness of implant-supported fixed partial denture in patients with history of periodontitis: A systematic review and meta-analysis. Carra MC, Rangé H, Swerts PJ, Tuand K, Vandamme K, Bouchard P. J Clin Periodontol. 2022 Jun;49 Suppl 24:208-223. doi: 10.1111/jcpe.13481.
Topic: Treatment of gingival recession
Author: Aslan S, Buduneli N, Tavelli L, Rasperini G, Cortellini P.
Title: Introduction of a Novel Anatomic Recession Ratio in the Treatment of Gingival Recession: A Proof-of-Principle Study.
Source: Int J Periodontics Restorative Dent.
DOI: 10.11607/prd.5574
Type: clinical trial
Keywords: connective tissue, gingiva/ surgery, gingival recession, humans, treatment outcome
Purpose: To introduce the anatomic recession ratio (ARR), and to evaluate the clinical outcomes of using a tunneling technique with a connective tissue graft for RT1 and RT2 recession types.
Methods: Inclusion criteria for patients were systemically healthy and age ≥18 years; no signs of active periodontal disease; full-mouth plaque and bleeding score ≤20%; detectable CEJ; at least one buccal RT1 or RT2 gingival recession at anterior maxillary and mandibular sextants; no history of surgery.
Patients with extrusion, protrusion, smokers, cervical restorations, noncarious cervical lesions, tooth mobility, shallow vestibulum depth, were excluded from the study. The following clinical parameters were recorded baseline and at 12 months, probing depth (PD), clinical attachment level (CAL), recession width (RW), keratinized tissue width (KTW), gingival thickness. Esthetic outcomes assessed with root coverage esthetic score.
Surgery: modified TUN described by Sculean was used as a surgical approach. Flap extended one tooth mesial and distal from experimental tooth. Interdental papilla was elevated. 1-1.5mm CTG was harvested using the single incision technique. In case of deep GR (>4mm) the flap margins were sutured with single interrupted over the CTG in a mesio-distal direction to obtain complete or partial graft coverage.
Postsurgical instructions: Ibuprofen 600mg for 3 days; amoxicillin + clavulanic acid for 7 days; abstained from mechanical oral care for 1 month; chlorhexidine digluconate 0.12% BID.
ARR components
| Anatomic line | Curve between gingival recession contacts (GC) traced along the CEJ |
| Gingival recession line | Curve between GC traced along gingival margin |
| mP | Distance from tip of mesial papilla to the point where GR contact CEJ |
| dP | Same that mP, but from distal papilla |
ARR= mP + anatomic line + dP
mP + GR line+ dP
Results: A total of 16 patients with 33 GRs participated. Nine patients had a single recession and seven presented multiple GRs. 36% of the recessions were classified as RT1 and 64% were RT2. At 12 months there was a statistically significant decreases in RD. Mean coverage percentage (mRC) was 88.85% and complete root coverage was achieved in 58% of the sites. All clinical parameters showed SSD except for RW. A positive correlation was found between ARR and mRC. Subgroup analysis revealed that sites gaining complete root coverage had a mean preoperative ARR score of 0.84 while sites gaining partial root coverage had an ARR of 0.60. Recession depth did not reach SSD individually.
Conclusion: The study found that a higher mean coverage percentage was associated with higher ARR values. This suggests that ARR may be used as baseline parameter for CRC in TUN +CTG treatment, thus guiding the clinicians to decide on the surgical technique. The cut-off point of 0.77 for ARR was found to be critical threshold to obtain CRC. In cases when clinical evaluation reveals an ARR value <0.77, the patient may benefit more from CAF-based procedures.
Topic: Guided Bone Regeneration
Author: Merli M, Merli M, Pagliaro U, Fratini A, Lo Russo L, Nieri M.
Title: The Multilayer GBR Technique: An Alternative Approach for One-Stage Transmucosal Implant Placement in the Presence of Horizontal Defects. A Case Series.
Source: Int J Periodontics Restorative Dent.
DOI: 10.11607/prd.6084.
Type: Case Series
Keywords: bone matrix, bone regeneration, dental implants, membranes, artificial, wound healing, collagen / therapeutic use.
Purpose: to present the one-stage multilayer GBR technique (autologous bone particles, deproteinized bovine bone matrix, collagen membrane, and concentrated growth factors) to enhanced tissue regeneration in the presence of hard and soft tissue defects.
Methods: Four patients requiring implant placement were included in the study. CBCT was obtained to evaluate the 3D defect morphology. Implant placement was carried out between 6 weeks and 6 months after the extraction. Before surgery concentrated growth factor (CGF) membranes were prepared. Flap was elevated and the implant was placed. A collagen porcine membrane (Bio-Gide) was stabilized with tacks. Cortical perforations were prepared using low-speed bur in order to open access to bone marrow spaces. Autogenous bone was harvested using a scraper and the defect was filled with autogenous + DBBM (Bio-Oss). Autogenous bone was applied on the exposed implant surface and then a second layer of DBBM+ patient’s blood was positioned to complete filling the defect. Collagen membrane was folded. A layer of CGF was applied at the crestal level and later a second one on the vestibular aspect. Flap was repositioned and sutured. Implant were loaded after 8 weeks, and the final prostheses were delivered 6 months after loading. VAS scale was used to assess patient satisfaction with the esthetic results. A digital impression at baseline and 6 months after surgery were obtained to evaluate volumetric analysis.
Results: The four cases showed substantial volume augmentation with good esthetics and no complications. CGF delivers several growth factors including TGF-B1, vascular endothelial growth factor, PDGF, IGF, EGF and bone morphogenic protein, thus accelerates new bone formation. The digital analysis showed a mean increase in tissue volume of 157.4mm3.
Conclusion: Overall, the one-stage multilayer technique showed to be a suitable option resulting in substantial volume augmentation. The study also confirms the positive cumulative effect of layered materials. Furthermore, this one-stage procedure reduces the number of surgeries required, the risk of soft tissue damage, scarring, and loss of keratinized tissue, and improves patient comfort.
Topic: Periodontal disease and lung infection
Authors: Chen H, Zhang X, Luo J, Dong X, Jiang X.
Title: The association between periodontitis and lung function: Results from the National Health and Nutrition Examination Survey 2009 to 2012.
Source: J Periodontol. 2022; 93: 901– 910.
DOI: 10.1002/JPER.21-0399
Type: Epidemiological study
Keywords: periodontal-systemic disease interactions, periodontitis, public health, risk factor
Purpose: To study the relationship between periodontitis and lung function in patients with and without obstructive lung disease.
Methods: Data from the NHANES 2009-2012 surveys were collected and a total of 6313 adult patients were included. The lung function outcomes collected from NHANES data were: FEV1, FVC, and FEV1/FVC ratio. Participants with FEV1/FVC values <0.70 were considered to have airflow obstruction, whereas individuals without airflow obstruction had values >0.70. Periodontal status was based on mean PDs and CAL, using the CDC/AAP classification (none, mild, moderate, severe). Potential confounding factors, such as sex, race, tobacco use, etc., were controlled.
Results: Compared to non-periodontitis patients, individuals with moderate periodontal disease had an OR=1.38 for airflow obstruction and those with severe periodontal disease had an OR=1.38. These findings were still significant after excluding participants with respiratory disease. There was a significant association between periodontal disease and airflow obstruction in former (severe periodontitis OR=2.31) and current smokers (moderate periodontitis OR=1.84, severe periodontitis OR=1.79), but NS association found in never smokers. A non-linear dose-response relationship was observed between mean CAL and airflow obstruction, as well as PD and airflow obstruction. In both cases, the risk of airflow obstruction increased with increasing mean CAL or mean PD.
Conclusion: This study found that moderate and severe periodontitis were associated with decline in lung function. There was a negative relationship observed between mean PD/CAL and lung function in current and former smokers, but not in never smokers.
Topic: Alveolar ridge preservation
Authors: Couso-Queiruga E, Mansouri CJ, Alade AA, Allareddy TV, Galindo-Moreno P, Avila-Ortiz G.
Title: Alveolar ridge preservation reduces the need for ancillary bone augmentation in the context of implant therapy
Source: J Periodontol. 2022; 93: 847– 856
DOI: 10.1002/JPER.22-0030
Type: Retrospective cohort study
Keywords: bone grafting, dental digital radiography, dental implants, periodontal atrophy, phenotype, tooth extraction
Purpose: To investigate the efficacy of alveolar ridge preservation (ARP) following extraction of non-molar teeth compared to unassisted socket healing (USH) in reducing the need for additional bone augmentation procedure for dental implant therapy.
Methods: 140 patients who underwent single non-molar tooth extractions with or without simultaneous ARP at the University of Iowa were included in this study. CBCT imaging was taken prior to extraction and 10-36wks post-operatively, the scans were used to measure facial bone thickness and for planning implant position. All extractions were flapless and as atraumatic as possible. The materials used in the ARP group included: either allograft + dPTFE membrane or collagenated anorganic bovine bone + collagen matrix. Implant planning was performed on the CBCT software, and additional bone grafting was deemed necessary if there was <1mm of circumferential bone support around the implant.
Results: Additional bone grafting at the time of implant placement was deemed necessary in 60% (42/70 sites) of sites in the USH group. 90% of sites in the USH group that presented with a thin bone phenotype (<1mm of facial bone thickness) at baseline, required additional bone grafting at implant placement. In contrast, only 11.4% of sites in the ARP group required additional grafting at implant placement, and only 30.4% of sites in the ARP group with a thin bone phenotype required additional grafting. The odds ratio of not needing additional bone grafting at sites that received ARP was 17.8x higher than the USH group. Regardless if ARP is performed or not, for every 1mm increase in facial bone thickness, the need for additional bone augmentation was reduced 7.7x.
Conclusion: ARP significantly reduces the need for additional bone grafting at the time of implant placement compared to USH. The thicker the facial bone, the higher the chance that the site will not require additional grafting.
Topic: Dentin hypersensitivity
Author: Antezack, A., Ohanessian, R., Sadowski, C., Faure-Brac, M., Brincat, A., Etchecopar-Etchart, D., & Monnet-Corti, V.
Title: Effectiveness of surgical root coverage on dentin hypersensitivity: A systematic review and meta-analysis.
Source: Journal of Clinical Periodontology, 49(8), 840–851
DOI: 10.1111/jcpe.13664
Type: review + meta-analysis
Keywords: dentin sensitivity, gingival recession, meta-analysis, systematic review, tooth root
Purpose: To assess the effect of surgical root coverage (RC) on dentin hypersensitivity (DH) associated with gingival recession.
Methods: Various online databases were searched for articles from Jan 2000 to March 2022 for RCTs comparing two surgical root coverage techniques, or surgical techniques with or without adjuvants. A meta-analysis was then performed on the RCT data.
P: subjects > 18 years old with DH on one or more teeth with gingival recession
I: all surgical RC procedures: coronally or laterally positioned flaps with or without CTG, free gingival grafts, semilunar flaps, acellular dermal matrix grafts, periodontal regeneration procedures with enamel matrix proteins.
C: comparison before and after surgical RC procedures within the same group
O: presence or absence of DH, evaluated via air evaporation stimulus
Results: Thirteen RCTs with 701 patients and 1086 recessions were analyzed. DH suppression was shown to be 70.8% after surgical root coverage. Both recession reduction and percentage of root coverage were SS associated with reduction in DH. Coronally advanced flaps with autogenous CTG showed better results in decreasing DH than CAF + xenogenic collagen matrix (73% vs 61%).
Conclusion: Successful root coverage is statistically significantly associated with a reduction in dentinal hypersensitivity, and CAF with CTG has less hypersensitivity than CAF with xenogenic collagen matrices. However, up to one-third of patients may experience DH after surgery, which may need to be treated with other surgical or restorative options.
Topic: GCF and osteoporosis
Author: Ozden FO, Demir E, Lutfioglu M, Acarel EE, Bilgici B, Atmaca A.
Title: Effects of periodontal and bisphosphonate treatment on the gingival crevicular levels of sclerostin and dickkopf-1 in postmenopausal osteoporosis with and without periodontitis.
Source: J Periodont Res. 2022;57:849- 858
DOI: 10.1111/jre.13023
Type: clinical study
Keywords: bisphosphonates, dickkopf-1, osteoporosis, periodontal treatment/therapy, periodontitis, sclerostin
Background: As both periodontitis and osteoporosis may lead to osteoclast-related bone resorption, medications for osteoporosis may affect the progression of periodontal disease. These medications and treatments have multiple systemic interactions which should be explored to further periodontal therapy. The WNT pathway is involved in both bone formation and resorption through the RANKL/OPG cycle. The WNT/beta-catenin signals are controlled by physiological antagonists including dickkoph-1 (DKK-1) and sclerostin (SOST), both WNT inhibitors that affect bone mass. These can be measured in gingival crevicular fluid (GCF).
Purpose: To examine the effects of periodontal and bisphosphonate treatment on GCF SOST and DKK-1 in postmenopausal women, comparing those with and without osteoporosis and with and without periodontitis.
Methods: Forty-eight postmenopausal women were divided into the following four groups: OP/P both osteoporosis and periodontitis; P: systemically healthy with periodontitis; OP: periodontally healthy with osteoporosis; and H: systemic and periodontal health. Clinical parameters (GI, PI, PD, BOP, and CAL) and GCF levels of SOST and DKK-1 were measured at baseline, at 6 months, and at 12 months after beginning periodontal and/or bisphosphonate treatments. GCF samples were taken with filter paper left in the sulcus for 30 seconds. After baseline data collection, participants received periodontitis and/or BP treatment as needed. Periodontitis treatment involved scaling and root planing and maintenance visits, while periodontally healthy patients had only maintenance cleanings performed. BP treatment before perio treatment consisted of single intravenous infusion of a solution of 5 mg/100 ml zoledronic acid. All subjects returned for periodontal maintenance visits at 6 and 12 months. GCF volume was measured using electronic impedance. SOST and DKK-1 were evaluated in vitro using ELISA.
Results: All experimental groups showed clinical improvements. GCF volumes and baseline clinical measurements were significantly lower in the periodontally healthy groups compared to periodontitis groups. The group treated for both periodontal disease and with bisphosphonates had the greatest reductions in the total amounts of GCF SOST and DKK-1, though these measurements increased at 12 months post-treatment. SOST and DDK-1 total amounts were similar in the OP/P, OP, and H groups at 6 and 12 months post-treatment. The H and P groups showed significant differences in SOST and DDK-1 throughout monitoring.
Conclusion: Postmenopausal women with osteoporosis who had both periodontal and bisphosphonate treatment saw statistically significant changes in GCF SOST and DKK-1 levels. Further research may show how bisphosphonate treatments may help improve therapy for periodontal disease.
Topic: Decontamination treatment
Title: Efficacy of combined chemical and electrochemical decontamination treatments on contaminated healing abutments and their effect on surface topography: An in vitro study
Source: Clin Implant Dent Relat Res.
DOI: 10.1111/cid.13123
Type: In Vitro Study
Keywords: decontamination, healing abutment, electrolysis, sodium hypochlorite, surface topography
Background: Contaminates on the surface of healing abutments can lead to many complications such as screw loosening, preventing the close fitting of implant and spreading the contamination to the peri-implant soft tissue. Decontamination techniques include sodium hypochlorite via deproteinization which is considered the most effective technique and electrochemical cleaning using electrolysis.
Purpose: To compare the effects of different chemical and electrochemical treatments on the surface topography of contaminated healing abutments
Material and methods: This study included 80 contaminated healing abutments retrieved from patients. The healing abutments were stained with phloxine B and randomized into 4 different test groups and a control group. Group 1 was treated only with autoclaving, Group 2 was treated with 5.25% sodium hypochlorite and autoclaving, Group 3 received electrochemical treatment and autoclaving and Group 4 was treated with sodium hypochlorite, electrochemical treatment, and autoclaving. Energy-dispersive X-ray spectroscopy, optical profilometry, stereo microscopy, and scanning electron microscopy were used to analyze the surface topography of the healing abutments.
Results: Healing abutments treated with autoclaving showed no significant difference in contamination before the procedure. Although sodium hypochlorite with autoclaving can effectively remove residual contamination, electrochemical treatment with autoclaving resulted in better decontamination efficacy in the connection, body occlusal, body idle and occlusal regions. Healing abutments treated with sodium hypochlorite, electrochemical treatment and autoclaving had the best decontamination efficacy compared to the other groups. Titanium and oxygen were uniformly observed, significantly less carbon and aluminum and no calcium or phosphorus was observed compared to other groups. The study found no statistical significance in developed surface area ratio, texture- aspect ratio and surface roughness when compared all the groups to the control group.
Conclusion: In conclusion, steam autoclaving alone does not effectively decontaminate healing abutment surfaces. Sodium hypochlorite with autoclaving and electrochemical treatment with autoclaving both resulted in the incomplete removal of residual contamination. Sodium hypochlorite is limited by its potential to reach difficult areas with soft deposits and biofilm biomass hard deposits. A combination of sodium hypochlorite, electrochemical treatment and autoclaving resulted in the best decontamination potential. It can remove hard and soft tissue deposits without altering the surface topography of the healing abutments.
Topic: Immediate implants
Title: Immediate implant placement utilizing vestibular socket therapy versus early implant placement with contour augmentation for rehabilitation of compromised extraction sockets in the esthetic zone: A randomized controlled clinical trial.
Source: Clin Implant Dent Relat Res, Online ahead of print
DOI: 10.1111/cid.13120
Type: Randomized Controlled Trial
Keywords: immediate implant, bone graft, clinical trial, dental implant, contour augmentation, vestibular socket therapy
Background: Contour augmentation includes guided bone regeneration with early implant placement 4- 8 weeks after an extraction. Vestibular socket therapy included guided bone regeneration via a minimally invasive vestibular access with immediate implant placement.
Purpose: The purpose of this study is to compare vestibular socket therapy to contour augmentation techniques when treating compromised maxillary extraction sockets.
Material and methods: This study includes 40 patients that presented with nonrestorable maxillary teeth in the esthetic zone. Patients were randomized into a control group that received contour augmentation and a test group that received vestibular socket therapy. The primary outcome tested includes mid-facial soft tissue changes. The secondary outcomes tested include horizontal soft tissue changes, mesial and distal papillae dimension and labial bone plate thickness over a period of 1 year.
Results: The test group receiving vestibular socket therapy showed -0.53 +/ 1.17 mm mid facial change, -0.82 +/ 0.95 mm horizontal soft tissue change, -0.64 +/ 0.95 mm change in the mesial papilla and -0.56 mm +/ 1.17 mm change in the distal papilla. The control group showed -1.87 +/ 0.69 mm mid facial change, -1.84 +/ 0.88 mm horizontal soft tissue change, – 1.20 +/ 0.81 mm change in the mesial papilla and -1.26 +/ 0.63 mm change in the distal papilla. Evidently, patients treated with vestibular socket therapy had significantly less soft tissue changes compared to contour augmentation. Both groups presented with significant increase in labial bone thickness apically, middle and coronally with no significant difference was between the test and control group. Overall, there is a significant correlation in the reduction of mid- facial soft tissue changes and vestibular socket therapy and increased coronal bone thickness.
Conclusions: Both vestibular socket therapy and contour augmentation are good treatment options for maxillary anterior teeth required extraction and subsequent implant. However, patients that received vestibular socket therapy had significantly less soft tissue changes over a period of 12 months and is a viable treatment option when placing implants in a maxillary esthetic zone. It is a minimally invasive technique that requires one surgery and requires less treatment time compared to contour augmentation.
Topic: Implants in patients with head & neck cancer
Authors: Schiegnitz, E., Reinicke, K., Sagheb, K., König, J., Al-Nawas, B. and Grötz, K.A.
Title: Dental implants in patients with head and neck cancer – a systematic review and meta-analysis of the influence of radiotherapy on implant survival
Source: Clin Oral Implants Res. 2022 Jul 16. Epub ahead of print.
DOI: 10.1111/clr.13976
Type: Systematic review and meta-analysis
Keywords: dental implants, radiation therapy, head and neck cancer, survival rate, bone grafts
Purpose: To review current literature on dental implant in patients with head and neck cancer treated with radiation.
Methods: The focus question, “Is there a difference between implant survival in irradiated jaw and non-irradiated jaw?” was used to guide the systemic review.
The following PICO format was also utilized:
P: Patients with cancer of the head and neck region rehabilitated with dental implants
I: Radiotherapy of the head and neck (before and/or after implant placement)
C: Non-irradiated patients
O: Implant survival
To be included, studies must have at least 10 irradiated subjects, published in English or German, be either prospective or retrospective, and have at least 3 years of follow-ups.
Results: A total of 29 studies met the inclusion criteria. These were joined with the 30 studies used in previous research for a total of 59 studies. In the literature from 2013 to 2021, there were a total of 6,645 implants placed in 1,633 patients. Of these, 4,031 were placed in irradiated bone and 2,614 were placed in the non-irradiated control patients. The total, overall mean survival rate 91.2% from 2013 to 2021 and 87.8% when considering all literature 1990 to 2021. The specific implant survival rates are as follows: Irradiated native bone 89.3%, non-irradiated native bone 95.8%, irradiated grafted bone 81.4%, non-irradiated grafted bone 91.8%.
Conclusion: The results of this study support current recommendations of placing dental implants in patients who underwent radiotherapy for head and neck cancer. However, due to the negative effects of irradiation, implant therapy should be carefully considered, taking into account other risk factors such as smoking. It is preferable to place implants into native bone vs. bone graft sites.
Topic: Overdentures and chewing efficacy
Authors: Passia N, Chaar MS, Krummel A, Nagy A, Freitag-Wolf S, Ali S, Kern M
Title: Influence of the number of implants in the edentulous mandible on chewing efficacy and oral health-related quality of life-A within-subject design study.
Source: Clin Oral Implants Res. 2022 Jul 22. Epub ahead of print.
DOI: 10.1111/clr.13984
Type: Clinical
Purpose: To evaluate the chewing efficacy in patients with mandibular overdentures retained be one, two, or three implants
Methods: A total of 13 patients were included in this study. In order to evaluate chewing efficacy, participants chewed artificial test food with 40 chewing cycles. The test food was then collected and sieved with 5 differently sized sieves. Patients then underwent placement of 3 implants, one in the anterior mandible and two in the sites of the mandibular canines to establish a tripod of support. First, the central implant was uncovered and included in the overdenture design with an OT-Equator attachment. Two months later, chewing efficacy was re-evaluated. The two lateral implants were then uncovered and incorporated into overdenture design with same attachments. The central attachment was then replaced with a gingival level healing abutment so as to not retain overdenture. Chewing efficacy was then evaluated with only support from lateral implants. The central implant was reconnected to the overdenture and chewing efficacy was remeasured.
Results: The overall implant survival was 100%. Chewing efficacy was increased after implant placement compared to baseline. The within-subject results were not statistically significantly different. However, the between-subject effects of the implants was improved after loading of the central implant, and was further improved after loading of the two lateral implants. Loading all three implants together did not clearly improve mastication; efficacy decreased in 7 patients and increased in 6 patients, after loading of all three.
Conclusion: The efficacy of mastication was improved in patients after implant placement, regardless of the number of implants placed. However, the best masticatory performance was found to be in those patients with mandibular overdenture retained with two implants. Due to the limited number of patients in this study, results should be interpreted cautiously.
Topic: Implant alignment accuracy
Authors: Pieralli S, Beyer C, Wesemann C, Vach K, Russe MF, Kernen F, Nelson K, Spies BC
Title: Impact of radiographic field-of-view volume on alignment accuracy during virtual implant planning: A noninterventional retrospective pilot study.
Source Clin Oral Implants Res. 2022 Jul 21. Epub ahead of print.
DOI: 10.1111/clr.13983.
Type: Pilot Study
Keywords: Alaba, Alara, CBCT, FOV guided implantology, virtual planning
Purpose: To determine the accuracy of planned implant placement by comparing three radiographic field of view (FOV) volumes for alignment.
Background: Virtual implant planning and guided surgery has been shown to have more rehabilitation success along with a reduced number of complications. Radiographic images are recorded using a cone beam computed tomography (CBCT) and exported into digital imaging and communications in medicine format (DICOM). CBCT imaging is used to reconstruct soft tissue structures, bone, and hollow spaces in bone.
Materials and methods: The study was a noninterventional retrospective pilot study. 15 patient’s 3D radiographic imaging were collected retrospectively. Single missing tooth (ST) or multiple adjacent missing teeth (MT) in the posterior region were candidates. Patients with radiographic metal strip artifacts were placed into a separate (AR) group. The following settings were used for the imaging: FOV 170mm x 50mm, circulation time: 14.5s, tube voltage: 120kV and current intensity: 32mA. The CBCT in DICOM format was merged with STL files and a single 4.1mmx10mm bone level implant was virtually positioned. A cropping function on the planning software was developed to produce volumes with reduced FOV. For each case, two reduced volumes from the original full arch (FA) were created: limited to the quadrant (Q) and limited to the tooth/teeth area adjacent to planning site (A). An inexperienced clinician and an experienced clinician performed the merging of the STL and DICOM files. Deviations were compared at the apex and shoulder level of the implant.
Results: Mean outcomes in the ST group were significantly affected by FOV volume and transverse deviations were found. The ST group had the largest mean error with full arch FOV. Inexperienced operators showed significant vertical differences for the AR group. Larger FOV volume was favored over smaller. The highest degree of difference was seen at the implant apex level. The MT group had the highest deviation when measured with the intermediate FOV (A). The highest discrepancies were seen with the AR group. Precision was influenced by FOV volume (FA < Q < A) but not by operator expertise. For all cases the mean standard deviation was </= 0.25mm and standard deviation was not dependent upon operator experience.
Conclusion: Extended FOV does not improve accuracy for placement of single posterior missing teeth. In the presence of artifact or sites with multiple missing posterior teeth caution should be exercised when reducing the FOV.
Topic: Implant Abutment Geometry
Authors: Pérez-SayansM, Castelo-Baz P, Penarrocha-Oltra D, Seijas-Naya F, Conde-Amboage M, Somoza-Martín JM
Title: Impact of abutment geometry on early implant marginal bone loss. A double-blind, randomized, 6-month clinical trial
Source: Clin Oral Implants Res. 2022 Jul 22. Epub ahead of print
DOI: 10.1111/clr.13985.
Type: Clinical Trial
Keywords: dental implant, early marginal bone loss, prostheses abutment width, randomized clinical trial, single tooth
Purpose: To determine how early marginal bone loss is affected by abutment width, comparing conventional cylindrical abutments to concave abutments
Background: Modern implants have met the concerns needed to achieve osseointegration, strength and esthetics, but new problems have arisen, such as peri-implant diseases. Keeping implant tissue healthy post implant placement is one of the hardest challenges with implants currently. Controlling and preventing marginal bone loss (MBL) is turning out to be difficult.
Materials and methods: This study is a balanced, randomized, double-blind clinical trial and uses two parallel experimental groups and lacks a control group. Two groups: cylindrical abutment and concave abutment. The manufacturer’s instructions for placement of the 4mm implant were used. Eighty Hexagonal Internal Connection implants 4 x 10mm, were placed into bone that was already healed and matured. Then 40 concave antirotational abutments were placed and 40 cylindrical esthetic antirotational abutments. The implants were placed 4mm underneath the anticipated gingival margin. MBL was measured using digital intraoral radiology 8 weeks preloading and 6 months post loading. Stability was measured by resonance frequency (RFA) quantified by ISQ
Results: Three implants failed and were not included in the study, bringing the sample size down to 77 implants in 25 different patients. RFA average was 69.1ISQ and no significant difference was observed between the two abutment types. At 8 weeks mesial bone loss was 0.4mm on average and distal was -0.3mm on average. No significant difference seen between the two groups. Average MBL was -0.3mm, cylindrical abutment average MBL was -0.5mm and concave abutment average was -0.2mm. Significant difference was seen between the two groups.
Conclusion: This study found that at 6 months post loading, the concave abutments present significantly less early MBL compared to the classical cylindrical abutments.
Topic: digital implant impression accuracy
Authors: Schmidt A, Wostmann B, Schlenz MA
Title: Accuracy of digital implant impressions in clinical studies: A systematic review
Source: Clinical Oral Implants Research
DOI: 10.1111/clr.13951
Type: Systematic review
Keywords: clinical study, dental implants, dental impression technique, digital dentistry, dimensional measurement accuracy, intraoral scanner
Purpose: The purpose of this study was to do a systematic review to address the PICO question “Which accuracy is described for digital implant impressions in clinical studies?” There have been no literature reviews done to date on the accuracy of digital implant impressions in clinical studies.
Material and methods: A systematic and meta-analysis review was done searching for clinical studies on partially or completely edentulous patients with single-unit or multi-unit implant impressions with common IOS systems comparing the accuracy of the digital implant impression and reference model and measuring that accuracy.
Results: Based on inclusion and exclusion criteria, eight in vivo studies were selected for review. IOS manufacturers included Trios IOS, iTero IOS, and True Definition IOS with Trios being the most used. There was a lot of deviation in study design between implant systems, conventional impression material and methods used, and scan paths. The oldest study by Andriessen et al. in 2014 had the highest deviations and more recent studies show lower deviations.
Conclusions: Few studies exist that measure the accuracy of digital implant impressions. However, the accuracy is clinically acceptable with recent IOSs. More studies should be done
Topic: omega-3 fatty acids as treatment of periodontitis
Authors: Heo H, Bae JH, Amano A, Park T, Choi YH
Title: Supplemental or dietary intake of omega-3 fatty acids for the treatment of periodontitis: A meta-analysis
Source: Journal of Clinical Periodontology
DOI: 10.1111/jcpe.13603
Type: meta-analysis
Keywords: dietary intake, inflammation, omega-3 fatty acids, periodontitis
Purpose: The purpose of this study was to evaluate the effect of omega-3 fatty acids in supplemental and dietary form on periodontitis. Omega-3 fatty acids have been recommended to prevent general diseases due to their anti-inflammatory effect.
Material and methods: A meta-analysis included randomized controlled clinical trials published in English between January 2010 and December 2020. Selection criteria for included studies had adults over the age of 18 (P), presence of gingivitis and/or periodontitis, all intervention types of omega-3 fatty acids (I), comparison of placebo or omega-3 rich diet (C), and outcome effects (O) on periodontal pocket depth (PPD), clinical attachment loss (CAL), and bleeding on probing (BOP).
Results: Thirteen studies were included. Two studies looked at omega-3 fatty acid rich diets and the other 11 used supplements. Duration of studies varied in range from 8 weeks to 6 months. Age ranges varied from 30s to 50s. Periodontal severity varied from gingivitis to chronic periodontitis. Thirteen studies evaluated PPD, 11 studies evaluated CAL, and 7 studies evaluated BOP. All parameters had a statistically significant reduction in all studies at 8 weeks, 3 months, and 6 months for omega-3 interventions.
Conclusions: Supplemental or dietary intake of omega-3 fatty acids statistically reduced PPD, CAL, and BOP and can be used a supplement for treatment or periodontal maintenance. Some studies did not provide details on the omega-3 fatty acids or placebo used so caution should be taken when applying these to clinical practice.
Topic: periodontal pockets
Authors: Citterio F, Gualini G, Chang M, Piccoli GM, Giraudi M, Manavella V, Baima G, Mariani GM, Romano F, Aimetti M.
Title: Pocket closure and residual pockets after non-surgical periodontal therapy: A systematic review and meta-analysis
Source: J Clin Periodontol, 2022 Jan;49(1):2-14.
DOI: 10.1111/jcpe.13547
Type: Systematic review and meta-analysis
Keywords: non-surgical periodontal therapy, pocket closure, probing depth, residual pockets, scaling and root planing
Purpose: To analyze efficacy of non-surgical periodontal therapy (NST) with regard to pocket closure (PC) and residual pockets.
Material and methods: Electronic search up to January 2020 performed. Journal of Clinical Periodontology, Journal of Periodontology, The International Journal of Periodontics and Restorative Dentistry, and Journal of Periodontal Research were manually hand-searched. Two examiners extracted data from relevant studies. Studies included had to meet inclusion criteria. Studies were excluded if follow up was shorter than 1 year after NST or had less than 10 patients.
Results: Studies were screened and 27 were selected for analysis. The different studies provided unique numbers used to measure probing depths (PD) percentages after NST (table). The studies found that there was increased in %PD ≤3mm, ≤4mm after NST. It was also observed that PD ≥4mm exhibited a decrease in those sites after NST (lower %PD). Only one study reported PC, 39 PC out of 61 sites with PD ≥4mm.
| Pocket depth category | Studies included | Before NST (mean %) | 1-year after NST (mean %) |
| PD ≤3mm | 4 | 39.06 | 64.11 |
| PD ≤4mm | 1 | 44.20 | 87.47 |
| PD 4-6mm | 5 | 41.04 | 33.63 |
| PD ≥4mm | 2 | 52.74 | 18.15 |
| PD ≥5mm | 6 | 28.23 | 11.71 |
| PD ≥6mm | 2 | 24.60 | 7.33 |
| PD ≥7mm | 7 | 13.65 | 3.40 |
Table reports data collected of probing depth (PD) before and after non-surgical therapy (NST). Observed increase in sites with lower PD and decrease in site with higher PD.
Discussion: Evidence of NST and PC is limited and for the most part is unreported. Studies did not report or explicitly state pocket closure, the researchers indirectly calculated measurements in the different studies. It was also noted that sites with PD less than 3mm does not benefit from scaling and root planing and can even lead to clinical attachment loss if treated. Sites with PD greater than 6mm should be planned for additional treatment and shorter recall intervals.
Conclusion: It was observed that NST is effective in residual pocket reduction and may produce pocket closure, but more data is needed.
Topic: implant-supported fixed partial denture
Authors: Carra MC, Rangé H, Swerts PJ, Tuand K, Vandamme K, Bouchard P.
Title: Effectiveness of implant-supported fixed partial denture in patients with history of periodontitis: A systematic review and meta-analysis
Source: J Clin Periodontol, 2022 Jun;49 Suppl 24:208-223
DOI: 10.1111/jcpe.13481
Type: Systematic review and meta-analysis
Keywords: implant supported, fixed, partial denture, survival rate, periodontal disease, periodontitis, peri-implantitis
Purpose: To evaluate implanted supported fixed partial denture (IS-FPD) in patients with a history of periodontitis (HP) versus patients with no history of periodontitis (NHP).
Material and methods: Research question using PICO guidelines. (P), participants who were partially edentulous adults. (I), interventions, placement of IS-FPDs in partially edentulous patients to replace missing teeth. (C), comparison of IS-FPD in patients with HP versus NHP. (O), outcomes of IS-FPD, defined as survival, success rate, marginal bone level (MBL), and biological complications. (S), study design, reviewed studies (prospective and retrospective) with at least 1 year follow-up from implant loading. Literature search using electronic databases in May 2020 and updated in July 2020.
Results: 17 studies were included in this systematic review. 8 studies evaluated only IS-FPD in partially edentulous patients. 9 studies evaluated patients receiving different types of IS-restorations, with more than 70% received IS-FPD. Implant survival rate was significantly higher in the NHP group, however no significant difference was noted in studies with follow-up less than 5 years. Implant placed in HP groups had a higher failure rate over time and was also at greater risk for implant failure. Peri-implantitis was the most frequent complication in implant failure, other reasons included implant fracture/trauma, lack/loss of osseointegration, implant mobility, pain/paresthesia. These reason for failures were not differentiated between HP or NHP group. Risk of peri-implantitis was 3.3 times higher in HP patients compared to NHP patients. No significant difference in MBL between implants in HP and NHP groups.
Conclusion: IS-FPD in HP patients had a lower survival rate than NHP. HP patients were at higher risk of developing peri-implantitis, which is the most frequent cause of implant failure. No clear data on success rate was reported among the studies. Marginal bone loss was not significantly different between HP and NHP.