Smoking interferes with the prognosis of dental implant treatment: a systematic review and meta-analysis

AIM: This systematic literature review was performed to investigate if smoking interferes with the prognosis of implants with and without accompanying augmentation procedures compared with non-smokers. METHODS: A systematic electronic and handsearch (articles published between 1989 and 2005; English and German language; search terms "dental or oral implants and smoking"; "dental or oral implants and tobacco") was performed to identify publications providing numbers of failed implants, related to the numbers of smokers and non-smokers for meta-analysis. Publications providing statistically examined data of implant failures or biologic complications among smokers compared with non-smokers were included for systematic review. RESULTS: Of 139 publications identified, 29 were considered for meta-analysis and 35 for systematic review. Meta-analysis revealed a significantly enhanced risk for implant failure among smokers [implant-related odds ratio (OR) 2.25, confidence interval (CI(95%)) 1.96-2.59; patient-related OR 2.64; CI(95%) 1.70-4.09] compared with non-smokers, and for smokers receiving implants with accompanying augmentation procedures (OR 3.61; CI(95%) 2.26-5.77, implant related). The systematic review indicated significantly enhanced risks of biologic complications among smokers. Five studies revealed no significant impact of smoking on prognosis of implants with particle-blasted, acid-etched or anodic oxidized surfaces. CONCLUSION: Smoking is a significant risk factor for dental implant therapy and augmentation procedures accompanying implantations.     

Postoperative infections after dental implant placement: Variables associated with increased risk of failure

1 Background

Wound infections after dental implant placement are a rare finding that might lead to early implant failure. However, the available information on this topic is scarce.

2 Methods

This retrospective cohort study was conducted to determine factors that may increase the failure rate of dental implants that presented a postoperative infection during the osseointegration period. Postoperative infections were defined as the presence of pus or fistula in the surgical area, with pain or tenderness, swelling, redness, and heat or fever, before prosthetic loading. A bivariate and multivariate analysis of the data using Cox proportional‐hazards regression was performed to detect prognostic factors for implant failure in patients that suffer infections.

3 Results

The patient‐based prevalence of postoperative infections after implant placement was 2.80% (95% confidence interval (95%CI): 2.04% to 3.83%). Thirty‐three out of 37 (89.19%) patients with infections had to be surgically retreated because of antibiotic failure and 65% of the infected implants were removed. The bivariate analysis showed a significant association between implant failure and the collar surface (HR: 3.12; 95% CI: 1.16 to 8.41; P = 0.014). Cox proportional‐hazards regression indicated that rough‐surfaced collars increased 2.35 times the likelihood of failure (95% CI: 0.87 to 6.37; P = 0.071).

4 Conclusions

The survival of implants placed in the maxilla, with smooth collar, and late‐onset of infection was higher than those placed in the mandible, with a rough collar and early onset of infection. In general, signs of infection after dental implant placement compromises the survival rate of the affected fixtures.     

Multivariate study of factors influencing primary dental implant stability

Objectives: The purpose was to determine by multivariate analysis in a large series of dental implants the variables associated with primary endosseous dental implant stability (DIS). Material and methods: A 10‐year retrospective study was conducted of 1084 Brånemark^® implants placed in 316 patients. Clinical variables (age, gender, smoking habit, and periodontal status), implant diameter, implant length, and Periotest^® values (PTVs) were analyzed in bivariate and multivariate studies in order to determine their influence on DIS, using a cut‐off PTV value of ?2. Results: The site of implant insertion showed the strongest association with primary DIS failure among the study variables. Implants in the anterior mandible had a 6.43‐fold lower risk of primary DIS risk vs. those at other sites [95% confidence interval (CI) 3.28–12.61], and implants in the maxillary had a 2.70‐fold higher risk of primary DIS failure vs. those in the mandible (95% CI 1.82–4). Among other variables, females had a 1.54‐fold higher risk of primary DIS failure vs. males (95% CI 1.88–2.22) and implants <15 mm in length had a 1.49‐fold higher risk of failure vs. longer implants (95% CI 1.09–2.04). Conclusion: According to these findings, primary DIS failure is more likely in females, at sites other than the anterior mandible, and with dental implants shorter than 15 mm, at least when non‐threaded titanium implants are used. These data may be of value in the identification of patients at a high risk of primary DIS failure with immediate implant loading.     

Occurrence of Progressive Bone Loss Around Anodized Surface Implants and Resorbable Blasting Media Implants: A Retrospective Cohort Study

Background: This study evaluates occurrence of progressive bone loss (PBL) around implants with different implant surfaces. Methods: Retrospective examination of 2,517 implants was performed in 903 patients, including 1,147 anodized‐surface implants in 454 patients and 1,370 resorbable blasting media (RBM)‐surface implants in 449 patients, which were placed from January 2006 to December 2010. Through regular check‐up radiographs and records, presence of PBL (up to >50% of fixture length) was investigated. Implant removal for any reason was regarded a failure. Results: In total, 2,186 implants (979 anodized implants and 1,207 RBM implants) in 793 patients were included in this study. PBL was more frequently observed among anodized implants (n = 36 in 21 patients; 4%) than among RBM implants (n = 19 in 14 patients; 2%), and this difference was statistically significant (P <0.001). Occurrence of PBL was significantly influenced by surface modification and implant diameter (odds ratio [OR] of anodized surface = 4.40, 95% confidence interval [CI] = 1.78 to 10.89, P = 0.001; OR of wide implants = 9.62, 95% CI = 1.13 to 81.68, P = 0.038; determined by mixed‐effects logistic regression analysis with random patient effect). However, total survival rate was significantly influenced by implant diameter and not by surface modification (P = 0.019), although effect of implant diameter was observed to be significant on anodized implants (P = 0.030). Conclusion: Implant surface modification and implant diameter are significantly associated with occurrence of PBL.     

COVID-19 as a factor associated with early dental implant failures: A retrospective analysis

Objectives

To analyze the effect of COVID-19 on early implant failures and identify potential risk factors for early implant failure, concerning patient- and implant-related factors.

Materials and Methods

This retrospective study is based on 1228 patients who received 4841 implants between March 11, 2020, and April 01, 2022, at Erciyes University Faculty of Dentistry. COVID-19, age and gender of patients, smoking, diabetes, irradiation, chemotherapy, osteoporosis, the implant system, location, and characteristics of implants were recorded. At the implant level, univariate and multivariate generalized estimating equation (GEE) logistic regression was used to examine the effect of explanatory variables on early implant failure.

Results

The early implant failure rate was 3.1% at the implant level and 10.4% at the patient level. Smokers showed a significantly higher incidence of early implant failures compared to nonsmokers. (odds ratio (OR; 95% CI): 2.140 (1.438–3.184); p < 0.001). Short implants (≤8 mm) had a higher risk of early implant failure than long implants (≥12 mm) (OR (95% CI): 2.089 (1.290–3.382); p = 0.003).

Conclusions

COVID-19 had no significant effect on early implant failure. Smoking and short implants were associated with a higher risk for early implant failures.     

Influence of Laser‐Microtextured Surface Collar on Marginal Bone Loss and Peri‐Implant Soft Tissue Response: A Systematic Review and Meta‐Analysis

Background: A laser‐microtextured surface (LMS) dental implant collar appears to promote a more tooth‐like gingival collagen fiber attachment, which may help to stabilize peri‐implant tissues. The purpose of this systematic review is to assess the clinical effect of an LMS versus non‐LMS collar on crestal bone level and peri‐implant soft tissue response. Methods: Electronic and manual literature searches were performed by two independent reviewers for articles written in English up to December 2016. Studies were included if they were human clinical trials with the purpose of evaluating the impact of an LMS collar on peri‐implant hard and soft tissues. Cumulative marginal bone loss (MBL), probing depth (PD), and survival rate (SR) with 95% confidence intervals (CIs) were calculated to show the performance of LMS implant collars. MBL, PD, and SR data were analyzed with a random effects model to compare the influence of LMS collars with non‐LMS collars (e.g., roughened surface and machined surface). Results: Fifteen human clinical studies (three randomized controlled trials, six cohort studies, and six case series) with 772 implants met the inclusion criteria. For the overall data, the weighted mean MBL was 0.72 mm (95% CI: 0.59 to 0.85 mm), PD was 1.81 mm (95% CI: 1.13 to 2.49 mm), and SR was 0.97 (95% CI: 0.95 to 0.98). MBL around an LMS collar was significantly less than around machined‐surface collars (weighted mean difference [WMD]: ?0.77; 95% CI: ?1.01 to ?0.52; I² = 95.2%; P <0.001). PD in the LMS group was significantly shallower than in the machined‐surface group (WMD: ?1.34; 95% CI: ?1.62 to ?1.05; I² = 81.4%; P <0.001). However, no statistically significant difference was detected for MBL between the LMS and roughened‐surface groups (WMD: ?0.04; 95% CI: ?0.16 to 0.08; I² = 0.0%; P = 0.75). No statistically significant difference was found for SR between the LMS and non‐LMS groups (risk ratio: 1.01; 95% CI: 0.97 to 1.04; I² = 0.0%; P = 0.91). Conclusions: Meta‐analysis showed that an LMS collar can reduce the amount of MBL and PD compared with a machined‐surface collar. Due to high heterogeneity between the included studies, results should be interpreted cautiously.     

Clinical viability of single implant-retained mandibular overdentures: a systematic review and meta-analysis

The aim of this meta-analysis was to verify the clinical viability of single implant-retained mandibular overdentures (SIMO). An electronic search of the PubMed and Cochrane databases was performed (end date July 2017); this was supplemented by a manual search of the literature. Only prospective clinical trials and randomized controlled trials (RCTs) that evaluated SIMO with a minimum follow-up of 12 months were included. The meta-analysis was based on the Mantel–Haenszel method. Dental implant and prosthetic failure were the dichotomous outcome measures; these were evaluated through the risk ratio (RR) and odds ratio (OR), with corresponding 95% confidence intervals (CI). Of 499 articles identified, nine fulfilled the inclusion criteria. A total of 205 implants were placed in patients with a mean age of 64.1 years; the cumulative survival rate was 96.6% over a mean follow-up period of 37.3 months. The procedure used (SIMO vs. two implant-retained mandibular overdenture) did not affect dental implant failure (P = 0.45) or prosthetic failure (P = 0.65): RR 1.06 (95% CI 0.91–1.23) and RR 0.88 (95% CI 0.51–1.51), respectively; OR 2.56 (95% CI 0.27–24.39; P = 0.41) and OR 0.44 (95% CI 0.15–1.26; P = 0.13), respectively. Within the limitations of this systematic review and meta-analysis, SIMO with a complete denture as the opposing arch may be considered an alternative treatment for completely edentulous patients. However, this study also confirmed the need for more RCTs on this topic.     

Immediate Placement of Dental Implants in the Esthetic Zone: A Systematic Review and Pooled Analysis

Background: Research interest on immediate placement of dental implants has shifted from implant survival toward optimal preservation of soft and hard tissues. The aim of this study is to systematically assess the condition of implant survival, peri‐implant hard and soft tissue changes, esthetic outcome, and patient satisfaction of immediately placed single‐tooth implants in the esthetic zone. Methods: MEDLINE, EMBASE, and CENTRAL databases were searched for publications up to June 2013. Studies reporting on implant survival, changes in hard and soft peri‐implant tissues, esthetic outcome, and patient satisfaction were considered. A pooled analysis was performed to identify factors associated with survival and peri‐implant tissue changes after immediate implant placement. Results: Thirty‐four studies were considered eligible. Immediate placement of single‐tooth implants in the esthetic zone was accompanied by excellent 1‐year implant survival (97.1%, 95% confidence interval [CI]: 0.958 to 0.980). Mean marginal peri‐implant bone loss was 0.81 ± 0.48 mm, mean loss of interproximal peri‐implant mucosa level was 0.38 ± 0.23 mm, and mean loss of peri‐implant midfacial mucosa level was 0.54 ± 0.39 mm. Regression analysis revealed that delayed provisionalization (odds ratio [OR] 58.03, 95% CI: 8.05 to 418.41, P <0.000), use of a flap (OR 19.87, 95% CI: 10.21 to 38.66, P <0.000), and use of a connective tissue graft (OR 4.56, 95% CI: 1.72 to 12.08, P <0.002) were associated with marginal peri‐implant bone‐level change >0.50 mm. Because of underreporting, esthetic results and patient outcome did not allow for reliable analysis. Conclusion: Immediate placement with immediate provisionalization of dental implants in the esthetic zone results in excellent short‐term treatment outcome in terms of implant survival and minimal change of peri‐implant soft and hard tissue dimensions.     

Early implant failure. Prognostic capacity of Periotest: retrospective study of a large sample

Objectives: The objectives of this study were to determine the accuracy of Periotest^® to monitor primary implant stability at first‐stage surgery, to identify by multivariate analysis the variables associated with early implant failure and to compare Periotest^® with radiographic study in the diagnosis of implant stability at second‐stage surgery (during osseointegration period). Material and methods: A 10‐year retrospective study was conducted on 1084 Brånemark^® implants placed in 316 patients. Clinical variables, implant diameter and length, Periotest^® values (PTVs) and radiological variables were analyzed in bivariate and multivariate studies in order to determine their influence on early implant failure. Results: After examination of the sensitivity and specificity values obtained for different PTV cutoff points, a cutoff PTV of ?2 was selected (84% sensitivity and 39% specificity). In the bivariate analysis, early failure was significantly related to smoking habits, implant location, bone type, implant features and PTVs (?2 and ≥?2). In the final multiple logistic model, only age (odds ratio (OR)=4.53; 95% confidence interval (CI), 1.34–15.27), smoking habits (OR=2.5; 95% CI, 1.3–4.79), bone type (OR=1.93; 95% CI, 1.01–3.7) and PTV at first surgery (OR=3.01; 95% CI, 1.5–6.02) were independently related to early failure. Conclusions: The Periotest^® (with ?2 cutoff) at first surgery offers high sensitivity in the prognosis of early implant loss and shows a greater capacity to evaluate stability during the osseointegration period compared with radiographic study.     

Outcomes of osseointegrated implants in patients with benign and malignant pathologies of the head and neck: a 10-year single-centre study

The surgical management of head and neck pathologies involving the maxilla and mandible results in significant functional and aesthetic deficits, and ultimately reduced quality of life. Composite free flaps used for reconstruction address many of these deficits and create a foundation for the use of osseointegrated implants to support prosthetic replacement of the dentition. There are few comparative studies examining outcomes of implants in native and reconstructed bone in head and neck cancer patients. The aim of this retrospective cohort study was to compare survival rates and the effects of risk factors between implants placed in native and reconstructed bone. The Kaplan–Meier method estimated cumulative 1- and 5-year implant survival rates of 99.5% and 95% for native bone and 96% and 88% for reconstructed bone. Multivariate Cox regression found an increased risk of implant failure in reconstructed bone (hazard ratio (HR) 9.9, 95% confidence interval (CI) 3.4–29.7, P < 0.001). Subgroup analysis of the cohorts found an increased risk of failure in the reconstructed group associated with radiotherapy (HR 6.4, 95% CI 1.8–22.3, P = 0.004), current smoking (HR 23.2, 95% CI 2.7–198.6, P = 0.004), and previous smoking (HR 9.0, 95% CI 1.1–71.9, P = 0.038). There was no effect in the native bone group. Implants placed into reconstructed bone had higher rates of failure, and smoking status and radiotherapy increased the risk of implant failure.     

Klinische und radiologische Ergebnisse nach Augmentationen – eine prospektive Evaluation

The clinical follow up of atrophic jaws treated with augmentation procedures and dental implants is demonstrated and evaluated over a period of five years. In total 50 patients (24 male and 26 female) from the department of maxillofacial surgery of the Friedrich Alexander University Erlangen–Nuernberg who received an augmentation procedure were prospectively evaluated. The mean age was 59.1 years on the female and 56.9 years on the male patients. All patients received prior to implant placement an augmentation with autogenous bone or a bone substitute and were reconstructed using a fixed or removable implant borne rehabilitation. Overall 293 implants from five different systems were used, 10 implants on eight patients were lost in the observation period. Three implants were lost during the healing period and seven after prosthetic rehabilitation. This leads to a cumulative survival rate of 96.6%. The success rate, according to the criterions defined by Karoussis et al. [25] was 94.04%. After twelve months in the area of augmentation an overall resorption rate of 26.4 % was found, at five years the rate mounted to 31.67%. Comparing the resorption rates in maxilla and mandible the vertical loss was 35.88%, rsp. 26,05%. Comaring the posterior and anterior augmentation areas the vertical loss was significantly (p: 0.048%) higher in the posterior with 38.72% compared to 28.26% in the anterior region. Measurement of the SFFR (sulcus fluid flow rate) demonstrated a significant (P. 0.03) correlation with bone resorption, meaning that higher SFF rates showed higher rates of vertical resorption. Additionally a high SFF rate correlated with higher pocket depths and reduced keratinized periimplant gingival rates.     

Minimal invasiveness in soft tissue augmentation at dental implants: A systematic review and meta-analysis of patient-reported outcome measures

The aim of this study was to compare patient-reported outcome measures (PROMs) of soft tissue substitutes versus autogenous grafts for soft tissue augmentation procedures at implant sites. Comprehensive and systematic literature searches were performed until December 2021. A focused question was formulated based on the Population, Intervention, Comparison and Outcome criteria (PICO): In patients with dental implants undergoing soft tissue augmentation (P), do soft tissue substitutes (I) compared to autogenous soft tissue graft (SCTG [subepithelial connective tissue graft]) (C) limit the post-operative morbidity and other patient reported-outcomes measures (O). Randomized controlled clinical trials, prospective-, retrospective- and case-series studies were included. Meta-analyses were performed whenever possible and the results were expressed as weighted mean differences (WMD). A total of 29 clinical studies were included. For mucosal thickness gain, soft tissue substitutes significantly reduced the pain perception compared to SCTG (n = 4; WMD = 14.91 Visual Analog Scale [VAS] units; 95% confidence interval [CI] 6.42-23.40; P < .0006) based on a 0-100 VAS scale. Based on a 0-10 VAS scale, a borderline significance of pain reduction was found when soft tissue substitutes were applied (n = 4; WMD = 1.62 VAS units; 95% CI 0.01-3.23; P = .05). For keratinized tissue gain, soft tissue substitutes significantly reduced the pain perception after keratinized tissue augmentation compared to SCTG based on a 0-100 VAS scale (n = 2; WMD = 21.43 VAS units; 95% CI 12.58-30.28; P < .0001). Based on the 0-10 VAS scale, soft tissue substitutes significantly reduced the pain as compared to SCTG (n = 4; WMD = 1.65 VAS units; 95% CI 0.66-2.64; P = .001). Regarding pain medication, soft tissue substitutes required less painkillers (n = 6; WMD = 1.56 tablets; 95% CI 1.22-1.91; P < .00001) after soft tissue augmentation. The surgery time was significantly reduced when soft tissue substitutes were used (n = 5; WMD = 10.9 minutes; 95% CI 4.60-17.19; P < .00001). There were no significant differences in satisfaction, aesthetics, and quality of life (OHIP-14) between soft tissue substitutes and autogenous grafts following soft tissue augmentation at implants sites. Soft tissue substitutes, compared to autogenous grafts, significantly improve PROMs following soft tissue augmentation at implant sites. Soft tissue substitutes can reduce pain perception, amounts of painkillers and surgery time while achieving similar levels of patient´s satisfaction as autogenous grafts without impairing the clinical outcomes. The current evidence indicates that they constitute a valid and reliable alternative to minimize the invasiveness in soft tissue augmentation procedures at implant sites.     

Morse taper connection implants supporting "planned" maxillary and mandibular bar-retained overdentures: a 5-year prospective multicenter study

Objectives: In contrast to the excellent long‐term outcomes described for implant‐supported mandibular overdentures, less favorable long‐term survival and success rates have been reported for maxillary implants supporting overdentures. The aim of this study was to evaluate the treatment outcome of “planned” bar‐retained maxillary and mandibular overdentures supported by Morse taper connection implants, investigating implant survival, peri‐implant tissue health, marginal bone resorption and prosthetic complications. Material and methods: Over a 2‐year period, 60 patients were enrolled in this study, in four different clinical centers. The overdentures (maxilla 38, mandible 34) were planned with support from four implants anchored on a bar. A total of 288 Morse taper connection implants (Leone Implant System^®) were inserted (152 maxilla, 136 mandible). Implants were evaluated 5 years after insertion. Success criteria included the absence of pain, suppuration or clinical mobility, the distance between implant shoulder and first crestal bone–implant contact (DIB) <2 mm and no exudate history. Results: The overall 5‐year implant survival rate was 98% (maxilla 97.4%, mandible 98.6%), with 282 implants still in function. Among these surviving implants, 278 (98.6%) were classified in the success group. At the 5‐year examination, the mean DIB was 0.7 mm (±0.53). Few prosthetic complications were reported. Conclusions: With “planned” bar‐retained maxillary and mandibular overdentures supported by Morse taper connection implants, satisfactory survival and success rate can be achieved. To cite this article:
Mangano C, Mangano F, Shibli JA, Ricci M, Sammons R, Figliuzzi M. Morse taper connection implants supporting “planned” maxillary and mandibular bar‐retained overdentures: a 5‐year prospective multicenter study.
Clin. Oral Impl. Res. 22 , 2011; 1117–1124
doi: 10.1111/j.1600‐0501.2010.02079.x     

Volumetric changes of the graft after maxillary sinus floor augmentation with Bio-Oss and autogenous bone in different ratios: a radiographic study in minipigs

Objective: The objective of the present study was to learn about the volumetric changes of the graft after maxillary sinus floor augmentation with Bio‐Oss and autogenous bone from the iliac crest or the mandible in different ratios in minipigs. Material and methods: Bilateral maxillary sinus floor augmentation was performed in 40 minipigs with: (A) 100% autogenous bone, (B) 75% autogenous bone and 25% Bio‐Oss, (C) 50% autogenous bone and 50% Bio‐Oss, (D) 25% autogenous bone and 75% Bio‐Oss, and (E) 100% Bio‐Oss. The autogenous bone graft was harvested from the iliac crest or the mandible and the graft composition was selected at random and placed concomitant with implant placement. Computed tomographies of the maxillary sinuses were obtained preoperatively, immediately postoperatively, and at euthanasia after 12 weeks. The volumetric changes of the graft were estimated using the Cavalieri principle and expressed as mean percentage with a 95% confidence interval (CI). Results: The mean volume of the graft was reduced by (A) 65% (95% CI: 60–70%), (B) 38% (95% CI: 35–41%), (C) 23% (95% CI: 21–25%), (D) 16% (95% CI: 12–21%), and (E) 6% (95% CI: 4–8%). The volumetric reduction was significantly influenced by the ratio of Bio‐Oss and autogenous bone (P<0.001), but not by the origin of the autogenous bone graft (P=0.2). Conclusions: The volume of autogenous bone grafts from the iliac crest and the mandible is reduced significantly after maxillary sinus floor augmentation in minipigs. The graft volume is better preserved after the addition of Bio‐Oss and the volumetric reduction is significantly influenced by the ratio of Bio‐Oss and autogenous bone. However, further studies are needed addressing the amount of new bone formation and bone‐to‐implant contact before the final conclusion can be made about the optimal ratio of Bio‐Oss and autogenous bone. To cite this article:
Jensen T, Schou S, Svendsen PA, Forman JL, Gundersen HJG, Terheyden H, Holmstrup P. Volumetric changes of the graft after maxillary sinus floor augmentation with Bio‐Oss and autogenous bone in different ratios: a radiographic study in minipigs.
Clin. Oral Impl. Res. 23 , 2012; 902–910
doi: 10.1111/j.1600‐0501.2011.02245.x     

Splinted and unsplinted overdenture attachment systems: A systematic review and meta‐analysis

Splinted and unsplinted overdenture attachment systems have unique advantages and disadvantages. The aim of the present systematic review was to determine the influence of splinted and unsplinted overdenture attachment systems on the marginal bone loss, prosthetic complications and implant survival rate. PubMed/MEDLINE , Scopus and Cochrane databases were searched for articles published up to October 2017, using the following search terms: “overdenture AND attachment OR overdenture AND bar OR overdenture splinted.” The PICO question “Do splinted overdenture attachment systems promote better clinical results in comparison to unsplinted systems?” was evaluated. Eligible studies included randomized controlled clinical trials, prospective studies with at least 10 participants and a minimum follow‐up of 6 months, and studies published in English that compared splinted and unsplinted attachment systems within the same study. The 95% confidence interval (CI ) was considered for all outcomes analysed. After completion of the different steps in the article selection process, nine articles were included in the qualitative and quantitative analyses. A total of 984 implants were placed in 380 patients (mean age: 62.8 years). The meta‐analysis demonstrated no statistically significant differences between splinted and unsplinted attachment systems with regard to marginal bone loss (P  = .39; MD : ?0.11; 95% CI : ?0.37 to 0.14), complications (P  = .31; RR : 1.26; CI : 0.80‐1.99) and implant survival rate (P  = .14; RR : 0.37% CI : 0.10‐1.36). In addition, splinted and unsplinted overdenture attachment systems achieved similar results with regard to marginal bone loss, prosthetic complications and implant survival rate.     

Clinical and microbiological analysis of subjects treated with Brånemark or AstraTech implants: a 7-year follow-up study

Aims: To assess the impact of different implant systems on the clinical conditions and the microbiota at implants, and whether the presence of bacteria at tooth sites was predictive of the presence at implant sites. Materials and methods: Subjects with either AstraTech or Brånemark in function for 7 years were enrolled. Sub‐gingival bacterial samples at tooth and implant sites were collected with sterile endodontic paper points, and analyzed by the checkerboard DNA–DNA hybridization method (40 species). Results: Fifty‐four subjects, 27 supplied with AstraTech (n=132 implants) and 27 with Brånemark (n=102) implants, were studied. Test tooth sites had significantly less evidence of bleeding on probing (P<0.001) and presence of plaque (P<0.001) than implant test sites. Implant sites presented with deeper probing pocket depth than tooth sites (mean difference: 1.1 mm, standard error of differences: 0.08, 95% confidence intervals (CI): 0.9–1.3, P<0.001). Tannerella forsythia (P<0.05), Capnocytophaga sputigena (P<0.05), Actinomyces israelii (P<0.05) and Lactobacillus acidophilus (P<0.05) were found at higher levels at tooth surfaces. No differences in bacterial load for any species were found between the two implant systems. The odds of being present/absent at tooth and implants sites were only significant for Staphylococcus aureus [odds ratio (OR): 5.2 : 1, 95% CI: 1.4–18.9, P<0.01]. Conclusions: After 7 years in function, implants presented with deeper probing depths than teeth. S. aureus was commonly present at both teeth and implants sites. S. aureus at tooth sites was predictive of also being present at implant sites.     

Efficacy of articaine vs lignocaine in maxillary and mandibular infiltration and block anesthesia in the dental treatments of adults: A systematic review and meta‐analysis

The aim of the present systematic review and meta‐analysis was to address the following Population, Intervention, Comparison, and Outcome question: Is the efficacy of articaine better than lignocaine in adults requiring dental treatment? Four percent articaine was compared with 2% lignocaine for maxillary and mandibular infiltrations and block anesthesia, and with the principal outcome measures of anesthetic success. Using RevMan software, the weighted anesthesia success rates and 95% confidence intervals (CIs) were estimated and compared using a random‐effects model. For combined studies, articaine was more likely to achieve successful anesthesia than lignocaine (N = 18, odds ratio [OR]: 1.92, 95% CI: 1.45‐2.56, P < 0.00001, I² = 32%). Maxillary and mandibular infiltration studies showed obvious superiority of articaine to lignocaine (N = 8, OR: 2.50, 95% CI: 1.51‐4.15, P = 0.0004, I² = 41%). Maxillary infiltration subgroup analysis showed no significant difference between articaine and lignocaine (N = 5, OR: 1.69, 95% CI: 0.88‐3.23, P = 0.11, I² = 19%). For combined mandibular anesthesia studies, articaine was superior to lignocaine (N = 14, OR: 1.99, 95% CI: 1.45‐2.72, P < 0.0001, I² = 32%), with further subgroup analysis showing significant differences in both mandibular block anesthesia (N = 11, OR: 1.55, 95% CI: 1.19‐2.03, P = 0.001), I² = 0%) and mandibular infiltration (N = 3, OR: 3.87, 95% CI: 2.62‐5.72, P < 0.00001, I² = 0%), indicating that articaine is more effective than lignocaine in providing anesthetic success in routine dental procedures.     

Overdentures in the Edentulous Mandible Supported by Implants and Retained by a Dolder Bar: A 5‐Year Prospective Study

Purpose: This prospective study was performed to evaluate the outcomes of XiVE® S plus implants (Dentsply Friadent, Mannheim, Germany) following conventional restoration with bar structures and overdentures in the edentulous mandible. Materials and Methods: A total of 39 patients were treated with four interforaminal implants (n = 156) splinted by a Dolder bar. Overdentures were attached to the bars after 3 months of healing. As primary outcome measures, clinical and radiological parameters were evaluated at the time of implant placement (baseline) and once a year (1, 2, 3, 4, 5 years) after functional loading. Secondary outcome measures included (i) primary stability and surgical complications, as well as (ii) Periotest® (Medizintechnik Gulden, Modautal, Germany) values, implant survival, and prosthetic complications at baseline and follow‐up. Results: A total of 156 implants were placed. The vast majority (n = 149) were tightened to >30 Ncm, while torques in the range of 20–30 Ncm were obtained in the remaining cases (n = 7). Mean crestal bone levels around the implants were 0.41 mm at baseline and 1.04/1.20/1.34/1.45/1.44 mm after 1/2/3/4/5 years respectively. The mean values of the plaque, calculus, bleeding, and mucosal indices remained low throughout this period. The reported follow‐up periods involved one implant loss after 3 months (survival rate: 99.4%) and one implant failure after 4 years (success rate: 98.4%). Prosthetic complications included factures of bars (n = 3) and denture teeth (n = 7). Prosthetic survival was 100%. Conclusions: Dolder bars to restore oral implants in the edentulous mandible appear to offer a high rate of implant survival, good stability of the peri‐implant tissue, and a low rate of prosthetic complications.     

The outcome of intraoral onlay block bone grafts on alveolar ridge augmentations: A systematic review

Aim: The purpose of this study was to systematically review clinical studies examining the survival and success rates of implants placed with intraoral onlay autogenous bone grafts to answer the following question: do ridge augmentations procedures with intraoral onlay block bone grafts in conjunction with or prior to implant placement influence implant outcome when compared with a control group (guided bone regeneration, alveolar distraction, native bone or short dental implants.)? Material and Method: An electronic data banks and hand searching were used to find relevant articles on vertical and lateral augmentation procedures performed with intraoral onlay block bone grafts for dental implant therapy published up to October 2013. Publications in English, on human subjects, with a controlled study design –involving at least one group with defects treated with intraoral onlay block bone grafts, more than five patients and a minimum follow-up of 12 months after prosthetic loading were included. Two reviewers extracted the data. Results: A total of 6 studies met the inclusion criteria: 4 studies on horizontal augmentation and 2 studies on vertical augmentation. Intraoperative complications were not reported. Most common postsurgical complications included mainly mucosal dehiscences (4 studies), bone graft or membrane exposures (3 studies), complete failures of block grafts (2 studies) and neurosensory alterations (4 studies). For lateral augmentation procedures, implant survival rates ranged from 96.9% to 100%, while for vertical augmentation they ranged from 89.5% to 100%. None article studied the soft tissues healing. Conclusions: Survival and success rates of implants placed in horizontally and vertically resorbed edentulous ridges reconstructed with block bone grafts are similar to those of implants placed in native bone, in distracted sites or with guided bone regeneration. More surgical challenges and morbidity arise from vertical augmentations, thus short implants may be a feasible option. Key words:Alveolar ridge augmentation, intraoral bone grafts, onlay grafts, block grafts, dental implants.     

Multicenter Randomized Clinical Trial: Early Loading of Implants in Maxillary Bone

Purpose: The aim of this study was to show prognostic equivalence between implant loading in the maxilla after 12 weeks versus 4 weeks. Materials and Methods: One hundred four patients, from four centers in this open‐labeled randomized multicenter prospective controlled clinical trial, were assigned to either 12 weeks or 4 weeks of unloaded healing. Two hundred sixty‐nine implants (sand blasted large‐grid, acid etched [SLA] surface, ≥4.1 mm diameter; ≥10 mm length) were inserted and evaluated during an individual 5‐year follow‐up. Primary outcome was implant success after 12 months; prognostic equivalence was characterized by a maximum difference of ±5% in implant failure rates. Results: Implant‐wise 1‐year failure rates were estimated 3.1% (5/163 implants) in the 4 weeks group versus 3.6% (4/112 implants) in the 12 weeks group (95% confidence interval [CI] for the difference ?3.2 –+4.2%); implant‐wise evaluation demonstrated statistically significant prognostic equivalence of 4 and 12 weeks loading. Patient‐wise 1‐year failure rates were estimated 6.7% (n = 4 patients) in the 4 weeks group versus 5.1% (n = 2 patients) in the 12 weeks group (95% CI for the difference ?9.6 –+6.5%). All implant failures occurred within the first 3 months of the individual observation period. Prior bone augmentation, underdimensioned drilling, bone quality, implant type, implant length, implant diameter, residual teeth, and fixing of the restoration did not reveal associations with the implant outcome: trial site, posterior jaw region, and splinting were associated with a higher failure rate. Resonance frequency analysis did not serve as a predictor of implant failures at the time of implant insertion. Conclusion: Loading of standard SLA implants in the maxilla 4 weeks versus 12 weeks after insertion resulted in statistically equivalent failure patterns within a 1‐year follow‐up period; nevertheless, the observed patient‐wise failure patterns of the interim analysis requires further understanding of patient‐individual aspects of the early loading concept.