Efficacy of clinical methods to assess jawbone tissue prior to and during endosseous dental implant placement: a systematic literature review

PURPOSE: To evaluate the evidence for the diagnostic accuracy of clinical methods to assess bone density, quantity, or quality prior to and during dental implant placement. MATERIALS AND METHODS: A PubMed literature search with specific indexing terms and a hand search were made. From the retrieved titles and abstracts, 3 reviewers selected publications on the basis of predetermined inclusion and exclusion criteria. Data were extracted from the selected publications using a protocol. Original studies were interpreted with the aid of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. RESULTS: The literature search yielded 145 titles and abstracts, of which 71 were selected and read in full text. Seven studies were judged relevant. In 1 study, no method was presented as the test method. In 6 studies, the results of the test method were compared to those of a reference method. However, only 1 study presented the results in terms of percentage of correct diagnoses. In that study, the use of periapical radiography together with reference images yielded correct assessment of the trabecular pattern of the mandible in 3 categories in 58% of the sites. The kappa index of interobserver agreement was 0.35 and intraobserver agreement was 0.67. Corresponding kappa values for 4 classes of bone quality presented by Lekholm and Zarb were 0.33 and 0.43, respectively. No study examined the accuracy of the method originally described by Lekholm and Zarb. CONCLUSION: The evidence for the efficacy of clinical methods to assess jawbone tissue prior to and during endosseous dental implant placement is sparse. This emphasizes the need for studies that incorporate accepted methodologic criteria for diagnostic efficacy.     

A comprehensive and critical review of dental implant prognosis in periodontally compromised partially edentulous patients

OBJECTIVES: The outcome of implant treatment in periodontally compromised partially edentulous patients has not been completely clarified. Therefore, the aim of the present study was to perform, applying a systematic methodology, a comprehensive and critical review of the prospective studies published in English up to and including August 2006, regarding the short-term (<5 years) and long-term (>or=5 years) prognosis of osseointegrated implants placed in periodontally compromised partially edentulous patients. MATERIAL AND METHODS: Using The National Library Of Medicine and Cochrane Oral Health Group databases, a literature search for articles published up to and including August 2006 was performed. At the first phase of selection the titles and abstracts and at the second phase full papers were screened independently and in duplicate by the three reviewers (I. K. K., S. K., I. F.). RESULTS: The search provided 2987 potentially relevant titles and abstracts. At the first phase of evaluation, 2956 publications were rejected based on title and abstract. At the second phase, the full text of the remaining 31 publications was retrieved for more detailed evaluation. Finally, 15 prospective studies were selected, including seven short-term and eight long-term studies. Because of considerable discrepancies among these studies, meta-analysis was not performed. CONCLUSIONS: No statistically significant differences in both short-term and long-term implant survival exist between patients with a history of chronic periodontitis and periodontally healthy individuals. Patients with a history of chronic periodontitis may exhibit significantly greater long-term probing pocket depth, peri-implant marginal bone loss and incidence of peri-implantitis compared with periodontally healthy subjects. Even though the short-term implant prognosis for patients treated for aggressive periodontitis is acceptable, on a long-term basis the matter is open to question. Alterations in clinical parameters around implants and teeth in aggressive periodontitis patients may not follow the same pattern, in contrast to what has been reported for chronic periodontitis patients. However, as only three studies comprising patients treated for aggressive periodontitis were selected, more studies, specially designed, are required to evaluate implant prognosis in this subtype of periodontitis. As the selected publications exhibited considerable discrepancies, more studies, uniformly designed, preferably longitudinal, prospective and controlled, would be important.     

Therapy of peri-implantitis: a systematic review

Aim: The objective of this study was to provide a systematic review of randomized controlled and/or comparative clinical trials published in the international peer-reviewed literature in the English language, up to and including July 2007, concerning the efficacy of all treatment modalities implemented for the therapy of peri-implantitis.
Material and Methods: PubMed and The Cochrane Library databases were searched electronically and numerous journals were examined manually. In the first phase of selection, the titles and abstracts, and in the second phase, complete papers were screened independently and in duplicate by three reviewers (S. K., I. K. K. and M. T.).
Results: The search yielded 1304 possibly relevant titles and abstracts. After the first phase of selection, 13 publications were singled out for a rigorous evaluation. Following the second phase, five studies were selected.
Conclusions: The selected studies are too limited in number and exhibit small sample sizes and short follow-up periods. Therefore, there is a definite need for more well-designed, preferably longitudinal, randomized controlled clinical trials. Within the limitations of the selected studies, mechanical debridement combined with antiseptic/antibiotic therapy, the Er:YAG laser or regenerative techniques may be used for treating peri-implantitis, but the indications for each of these techniques have not been delineated clearly.     

Implant therapy in partially edentulous, periodontally compromised patients: a review

AIM: The purpose of the present study was to perform a review using a systematic approach to evaluate the long-term (>/=5 years) success of implants placed in partially edentulous patients with a history of periodontitis as evidenced by loss of supporting bone and implant loss. MATERIAL & METHODS: An electronic search of the National Library of Medicine, Washington DC (Medline-PubMed) was performed using specific search terms to identify studies assessing, in periodontitis patients, the success of implants with regard to bone level outcomes. Search was performed on abstracts registered up to October 2003. RESULTS: The searches identified 877 abstracts. Titles and abstracts were independently screened by two reviewers (G.A.W. & K.M.B.) to identify publications that met the inclusion criteria. Review of these abstracts resulted in 13 publications for detailed review. These papers were reviewed by the three authors. Finally four papers which met the criteria of eligibility were independently selected by the three reviewers. CONCLUSION: Based on the limited data, it seems justified to conclude that the outcome of implant therapy in periodontitis patients may be different compared to individuals without such a history as evidenced by loss of supporting bone and implant loss.     

Bone formation around titanium implants in the rat tibia: role of insulin

BACKGROUND AND PURPOSE: Clinical and experimental studies show, with few exceptions, that type 1 diabetes mellitus is associated with a delay in bone repair around endosseous implants. The effect of insulin in bone repair/remodeling is not completely understood. The aim of this study was to investigate the course of histological and ultrastructural changes of the osseointegration process under the influence of insulin. MATERIALS AND METHODS: Titanium implants were inserted into the tibiae of male Wistar rats. Animals were divided into three groups: 1) rats with alloxan-induced diabetes; 2) diabetic rats treated with isophane insulin (2 IU/day); and 3) matching controls. Histological and histomorphometric analysis of bone-implant sections were performed 10 and 21 days after implant placement. RESULTS: Relative to control values, rats with alloxan-induced diabetes exhibited a 50% reduction in the area of formed bone (P < 0.001) and in the surface of contact between bone and implant (P < 0.01) 21 days after implant placement. There were no significant differences between groups 10 days after surgery. Values returned to normal levels in diabetic rats after insulin treatment. Presence of chondrocyte-like cells surrounded by a cartilaginouslike matrix in diabetic rats suggests a delay in the process of bone repair. Ultrastructural characteristics of bone-implant interface in diabetic rats treated with insulin resembled those observed in controls. CONCLUSION: The data presented suggest that bone repair around endosseous implants is regulated, at least in part, by insulin. The results imply that the control of the metabolic status of the diabetic patient is essential for a successful osseointegration.     

Long‐Term Evaluation of Periodontal Parameters and Implant Outcomes in Periodontally Compromised Patients: A Systematic Review

Background : The aim of this systematic review is to evaluate the long‐term outcomes of patients with periodontitis submitted to periodontal therapy/maintenance and implant placement. Methods: Studies reporting clinical and/or long‐term implant outcomes from partially edentulous patients with periodontitis who were treated and followed periodontal maintenance for ≥5 years were considered eligible for the review. Screening of the articles, data extraction, and quality assessment were conducted independently and in duplicate. Results: Search of MEDLINE, EMBASE, and CENTRAL databases resulted in 959 papers, and of them 931 were excluded after title/abstract assessment. The full texts of 28 potentially eligible publications were screened, but only 10 studies met inclusion criteria. Most of the included studies (77.8%) presented a medium/high methodologic quality. The results demonstrated that patients with a diagnosis of periodontitis had satisfactory implant outcomes. Implant survival was high (92.1%) within studies reporting 10 years of follow‐up. Parameters related to probing depth, clinical attachment level, and bone loss around teeth increased the occurrence of peri‐implantitis and implant loss. Non‐attendance to periodontal maintenance and smoking habits were also associated with less favorable implant outcomes. Conclusions: This systematic review confirmed that implant therapy can be successfully used in patients with a diagnosis of periodontitis who underwent proper therapy and regular periodontal maintenance. Residual pockets, non‐attendance to the periodontal maintenance program, and smoking were considered to be negative factors for the long‐term implant outcomes.     

Influence of surface modified dental implant abutments on connective tissue attachment: A systematic review

ObjectiveDetermine whether surface modified prosthetic abutments for dental implants influence connective tissue attachment to the implant-abutment system.DesignA systematic review was conducted using the MEDLINE-PubMed database, with two independent reviewers filtering the titles and abstracts. Two reviewers assessed all potentially relevant articles. An assessment was carried out on the level of evidence of the research according to the guidelines of the Oxford Centre for Evidence-Based Medicine (OCEBM).ResultsAfter an initial search, 109 potentially relevant articles were found. After reading the titles and abstracts, 99 articles were excluded because the surface treatment was limited to the implant and not to the abutment, or because different materials were analysed instead of surface treatments; 28 were also duplicate articles. An additional 6 research studies were included that were of interest and were found by reading the references of the included articles. The studies included are: 7 in vitro studies, 5 experimental studies in animals, 2 clinical trials in humans and 2 clinical cases.ConclusionSurface modification for prosthetic abutments on dental implants can achieve connective tissue attachment to the abutment; however, more studies should be conducted in humans to obtain more and better evidence of these results.     

Techniques for dental implant nanosurface modifications

PURPOSE

Dental implant has gained clinical success over last decade with the major drawback related to osseointegration as properties of metal (Titanium) are different from human bone. Currently implant procedures include endosseous type of dental implants with nanoscale surface characteristics. The objective of this review article is to summarize the role of nanotopography on titanium dental implant surfaces in order to improve osseointegration and various techniques that can generate nanoscale topographic features to titanium implants.

MATERIALS AND METHODS

A systematic electronic search of English language peer reviewed dental literature was performed for articles published between December 1987 to January 2012. Search was conducted in Medline, PubMed and Google scholar supplemented by hand searching of selected journals. 101 articles were assigned to full text analysis. Articles were selected according to inclusion and exclusion criterion. All articles were screened according to inclusion standard. 39 articles were included in the analysis.

RESULTS

Out of 39 studies, seven studies demonstrated that bone implant contact increases with increase in surface roughness. Five studies showed comparative evaluation of techniques producing microtopography and nanotopography. Eight studies concluded that osteoblasts preferably adhere to nano structure as compared to smooth surface. Six studies illustrated that nanotopography modify implant surface and their properties. Thirteen studies described techniques to produce nano roughness.

CONCLUSION

Modification of dental osseous implants at nanoscale level produced by various techniques can alter biological responses that may improve osseointegration and dental implant procedures.     

The adjunctive use of platelet‐rich plasma in the therapy of periodontal intraosseous defects: a systematic review

Kotsovilis S, Markou N, Pepelassi E, Nikolidakis D. The adjunctive use of platelet‐rich plasma in the therapy of periodontal intraosseous defects: a systematic review. J Periodont Res 2010; 45: 428–443. © 2009 The Authors. Journal compilation © 2009 Blackwell Munksgaard Background and Objective: The evidence for the efficacy of the adjunctive use of platelet‐rich plasma (PRP) in periodontal intraosseous defects has not been systematically evaluated. The objective of this review was to address the focused question, ‘What is the efficacy, with respect to clinical, radiographical and patient‐centred outcomes, of combinations of PRP with other therapeutic bioactive agents/procedures, compared with the efficacy of the same agents/procedures without the adjunctive use of PRP in the therapy of periodontal intraosseous defects in patients with chronic periodontitis and without systemic diseases that could potentially influence the outcome of periodontal therapy?’ by performing a systematic review of randomized controlled clinical trials (RCTs) published in the dental literature in any language, up to and including September 2008. Material and Methods: Data sources principally included electronic databases, manually searched journals and contact with experts. In the first phase of study selection, the titles and abstracts, and in the second phase, full papers were screened independently and in duplicate by two reviewers. Results: In the first phase, 6124 potentially relevant titles and abstracts were examined. In the second phase, the full text of 20 publications was thoroughly evaluated. Eventually, 10 RCTs were selected. Conclusion: Diverse outcomes (positive and negative) have been reported for the efficacy of PRP combined with various therapeutic bioactive agents/procedures, reflecting the limited and heterogeneous data available and possibly suggesting that the specific selection of agents/procedures combined with PRP could be important. Additional research on the efficacy of each specific combination of PRP is necessary.     

Prognosis of implants and fixed restorations after lateral sinus elevation: a literature review

Aim of this review was to investigate the prognosis of implants inserted in augmented sinuses and fixed restorations supported by these implants. Special attention was given to the impact of grafting material, time of implant placement, residual bone height and type of fixed restoration. An electronic search in PubMed, the German database medpilot and the Cochrane Library was executed followed by supplementary manual search in relevant journals. The search was limited to human studies published up to November 2010. Only publications in English and German, in peer-reviewed journals, were considered. After the initial search and application of selection criteria on titles and abstracts, a full-text analysis of 67 articles was performed, out of which six prospective and three retrospective studies were finally included in the review. The heterogeneous properties of the identified articles did not allow systematic analysis of the data. Success rates of implants were between 96·3% and 100%, survival rates were between 75% and 100%, and survival rates of single crowns, splinted crowns and fixed partial dentures ranged between 96·4% and 100% after a follow-up of 12-101 months. Within the limits of this review, the prognosis of implants and fixed restorations seemed not to be influenced by the type of restorations, graft material, residual bone height and time of implant placement. However, conclusions of this review are based on studies with low level of evidence; therefore, careful interpretation is required. Multicentre randomised controlled clinical trials with sufficient statistical power concentrating on few factors are needed to reach sound conclusions.     

Placement and restoration of dental implants in a patient with Paget's disease in remission: literature review and clinical report.

Paget's disease is a disorder of bone that results in the replacement of normal bone with highly vascularized, low density bone. The diminished bone quality associated with Paget's disease is a relative contraindication to the use of dental implants, as it interferes with achievement of osseointegration. There is no current literature on the success of dental implants in patients with Paget's disease. Furthermore, there is no current literature on dental implant success in patients with remissive Paget's disease or in bone that appears to be unaffected by the disease in patients with Paget's. This case report follows the treatment of a patient with a partially edentulous maxilla and mandible (ACP PDI Classification III) who presented with remissive Paget's disease. Definitive treatment included the placement of four endosseous implants used to retain full veneer crowns. Despite the radiographic appearance of adequate bone quality, upon surgical placement it was discovered that the quality of bone was poor, yet implant survival was achieved through careful surgical management and rigid splinting of some of the endosseous implants.     

Minimal invasiveness in the alveolar ridge preservation,with or without concomitant implant placement

The aim of this systematic review was to evaluate the benefit of ridge preservation (RP) with minimally invasive (MI) approaches with or without concomitant implant placement on morbidity, esthetics, and patient-related outcomes. Three Internet sources were used to search for appropriate papers. The search strategy was designed to include any clinical study published on RP with MI approaches such as flapless surgery, socket shield and socket sealing techniques and, use of biological agents. Characteristics of the individual studies, regarding methodological aspects, quantitative and qualitative data were extracted. The potential risk of bias was estimated, and the acquired evidence was graded. Independent screening of 860 reports resulted in 26 included original articles. Nine publications evaluated MI approaches for RP without concomitant implant placement. Eleven studies evaluated interventions for RP with immediate implant placement (IIP). Six studies compared RP with IIP vs RP without IIP. This systematic review found that MI approaches in most of the studies failed to improve clinical variables regarding morbidity, esthetics, and patient-related outcomes. Based on the limited number of studies analyzed and the methodological discrepancies observed, it is not possible to confirm that MI approaches promote a significant benefit when applied to RP procedures.     

Clinical application of spiral tomography in anterior implant placement: case report

BACKGROUND: Placement of endosseous dental implants in edentulous areas of the anterior maxilla poses a unique challenge due to variations in the amount of residual alveolar bone. Implant position becomes crucial in cases demanding high esthetic results but possessing minimal ridge width or in cases requiring augmentation. Recent advances in spiral tomography have allowed for more precise planning and placement of endosseous implants in these challenging areas. METHODS: The purpose of this report is to describe a series of clinical cases in which spiral tomography was utilized in the planning and placement of endosseous dental implants. Two cases will be described utilizing initial spiral tomographic radiographs for implant planning and surgical guide fabrication, followed by post-insertion tomography to evaluate the results of implant position and inclination. RESULTS: Preimplant spiral tomograms revealed that the initial prosthetic trajectory through the proposed incisal edge of each tooth replacement would result in a final osteotomy site that would compromise the overall thickness of the facial cortical plate. After adjusting for magnification and distortion factors, new prosthetic/surgical trajectories were fabricated into the surgical guide, and this information was utilized to prepare the final implant osteotomy site. This adjustment resulted in 2 mm of residual crestal facial bone postimplant insertion, which became wider at more apical measurements. These findings were verified in the postimplant serial tomograms. CONCLUSIONS: Spiral tomography was a valuable adjunct in the treatment planning phases of endosseous dental implant placement especially in cases with minimal crestal width, high esthetic demands, or where exact implant placement is critical for successful treatment outcomes.     

Maxillary insufficiency implant and tooth-retained maxillary overdenture: a clinical case report

The following represents a clinical case report of a maxillary insufficiency implant and tooth-retained maxillary overdenture. The case required surgical and prosthetic treatment and was successfully completed over a 2-year time. A combination of dental implant techniques were utilized to achieve form, function, comfort, and aesthetics. These techniques included ridge modification with bone grafting, endosseous root and blade form implant surgical placement, and the construction of a bar-retained overdenture on a severe hypoplastic maxilla.     

Biomechanical implant treatment complications: a systematic review of clinical studies of implants with at least 1 year of functional loading

Purpose: The aim of this article is to discuss the current literature available on the etiology and management of biomechanical complications of dental implant treatment. Materials and Methods: An electronic search of the PubMed database for English-language articles published before May 31, 2011, was performed based on a focus question: "How can biomechanical implant treatment complications be managed and identified?" The key words used were "dental implant," "etiology," "management," "excessive occlusal forces," "occlusal forces," "occlusion," "parafunctional habits," "biomechanical failure," "biomechanical complications," and "occlusal overloading." Clinical trials with a minimum of 10 implants followed for at least 1 year after functional loading were included. Results: The initial electronic search identified 2,087 publications, most of which were eliminated, as they were animal studies, finite element analyses, bench-top studies, case reports, and literature reviews. After the titles, abstracts, and full text of 39 potentially eligible publications were reviewed, 15 studies were found to fulfill the inclusion criteria. Conclusion: Occlusal overloading was thought to be the primary etiologic factor in biomechanical implant treatment complications, which commonly included marginal bone loss, fracture of resin/ceramic veneers and porcelain, retention device or denture base fracture of implant-supported overdentures, loosening or fracture of abutment screws, and even implant failure. Occlusal overloading was positively associated with parafunctional habits such as bruxism. An appreciation of the intricacy of implant occlusion would allow clinicians to take a more preventive approach when performing implant treatment planning, as avoidance of implant overloading helps to ensure the long-term stability of implant-supported prostheses.     

腭部专用正畸支抗种植体Straumann Orthosystem Implant

腭部专用正畸支抗种植体Straumann Orthosystem Implant是专门设计植入腭正中区的一种骨内牙种植体,为口腔正畸移动牙齿提供临时固定支抗功能。本文详细综述了该种植体的基本结构、植入方法、实验研究、临床应用以及其优缺点,旨在为正畸医生提供参考与帮助。     

Photodynamic therapy in the treatment of aggressive periodontitis: A systematic review

Background

Aggressive periodontitis (AgP) is a severe form of periodontal diseases with rapid destruction of the supporting bone around teeth. The efficacy of PDT in suppressing periodontal pathogens may be crucial in adopting new protocols for the treatment of AgP. Thus, the aim of this systematic review was to investigate the possible role of PDT in the treatment of AgP as an adjunctive therapy or monotherapy.

Material and Methods

A systematic search of the literature was performed. Additionally, the references from all the selected full-text studies were searched for relevant articles. Two reviewers screened independently titles and abstracts or full text copies. Quality assessment of all the included studies was held.

Results

Initial screening of electronic databases yielded 418 potentially relevant publications. After screening of the titles and full-text examination, five studies were included in the systematic review. Four publications evaluated the effects of PDT adjunctive to SRP in patients with AgP: two of them compared the clinical outcomes of SRP and PDT with a control group that received therapy with SRP and antibiotics (metronidazole and amoxicillin); two publications included SRP and PDT in the test group, and SRP alone in the control group. In one study, PDT was tested as a monotherapy compared with SRP alone.

Conclusions

Within the limitations of this review, PDT may exhibit a beneficial role in the therapy of aggressive periodontitis after repeated applications. In the future, more methodologically sound, long-term randomized clinical trials are needed to be conducted. Key words:Photodynamic therapy, periodontitis, systematic review.     

Extra-oral endosseous craniofacial implants: current status and future developments

The published experience of extra-oral endosseous craniofacial implants (EOECIs) is reviewed. The definition of osseointegration, concept of success, the relative merit of one- or two-stage implant placement, EOECI design and control of peri-abutment skin infection are discussed. A plea is made for more consistent and objective reading of clinical experience of this technique.