Influence of implant and conventional prostheses on satisfaction and quality of life: A literature review. Part 2: Qualitative analysis and evaluation of the studies

PURPOSE: To review the influence of prosthodontic and dental implant treatment on patient satisfaction and oral health-related quality of life (OHQOL) based on a systematic search of the literature. MATERIALS AND METHODS: A systematic literature search was carried out for articles published between 1960 and February 2003. Details of the search process and results were reported in Part 1 of the study (Int J Prosthodont2004;17:83-93). The included studies were categorized and evaluated according to their level of evidence, following the guidelines of the Agency for Health Care Policy and Research. The characteristics and content of the studies were analyzed and tabulated. RESULTS: Among the 114 included studies, there were 76 publications reaching evidence level III. The results showed that the effects of compromised oral health are not limited to traditional clinical aspects, but can considerably affect patients in various activities of daily life. Twenty-four of the 38 investigations with evidence levels I and II dealt with implant stabilization of complete mandibular prostheses, comparing implant prostheses to conventional complete dentures. Fully edentulous patients experience negative impacts on OHQOL from their condition. They benefit significantly from the use of dental implants to support mandibular prostheses. However, support by more than 2 implants does not appear to further significantly increase patient satisfaction and OHQOL. CONCLUSIONS: To date, research in the field of patient-based outcomes has concentrated on dental implant treatment for the edentulous patient. Other prosthetic treatments such as single crowns, fixed and removable partial dentures, or further treatment concepts (eg, the shortened dental arch concept) are not well represented. The use of patient-centered outcome measures can help to find an individual, patient-oriented prosthetic solution.     

Long-term stability of orthodontic treatment and patient satisfaction. A systematic review

OBJECTIVE: To evaluate morphologic stability and patient satisfaction at least 5 years after orthodontic treatment. MATERIALS AND METHODS: Published literature was searched through the PubMed and Cochrane Library electronic databases from 1966 to January 2005. The search was performed by an information specialist at the Swedish Council on Technology Assessment in Health Care. The inclusion criteria consisted of a follow-up period of at least 5 years postretention; randomized clinical trials, prospective or retrospective clinical controlled studies, and cohort studies; and orthodontic treatment including fixed or removable appliances, selective grinding, or extractions. Two reviewers extracted the data independently and also assessed the quality of the studies. RESULTS: The search strategy resulted in 1004 abstracts or full-text articles, of which 38 met the inclusion criteria. Treatment of crowding resulted in successful dental alignment. However, the mandibular arch length and width gradually decreased, and crowding of the lower anterior teeth reoccurred postretention. This condition was unpredictable at the individual level (limited evidence). Treatment of Angle Class II division 1 malocclusion with Herbst appliance normalized the occlusion. Relapse occurred but could not be predicted at the individual level (limited evidence). The scientific evidence was insufficient for conclusions on treatment of cross-bite, Angle Class III, open bite, and various other malocclusions as well as on patient satisfaction in a long-term perspective. CONCLUSIONS: This review has exposed the difficulties in drawing meaningful evidence-based conclusions often because of the inherent problems of retrospective and uncontrolled study design.     

Association between Orthopedic and Dental Findings: What Level of Evidence is Available?

OBJECTIVE: The aim of this systematic review was to provide comprehensive access to and an analysis of the specialist literature published through December 2005 describing a correlation between orthopedic (leg-length inequality, pelvis obliquity, column diseases and head posture) and dental findings (occlusion, mandibular position, temporomandibular joints, masticatory muscles). METHOD: Four medical and dental internet sources (PubMed; Medpilot.de; databases of the Deutsche Arzte-Verlag and Quintessenz-Verlag) were screened for relevant articles using carefully selected retrieval strategies and keywords. Bibliographies of relevant articles were examined for further pertinent publications. All relevant articles were tabulated according to their year of publication, the subject area discussed, and the levels of scientific evidence. RESULTS: Our electronic inquiry yielded 359 relevant articles (electronic search: 195, search in bibliographies: 164), 355 of which could be analyzed. A correlation between dental findings and spinal column diseases was described in 266 articles, head posture in 216, pelvis obliquity in 53, and leg-length inequality in 35 papers. In 131 publications, conclusions were drawn from dental to orthopedic findings, whereas they were drawn from orthopedic to dental findings in 171 articles. The number of relevant articles rose significantly, particularly since the 1980's. Classification in levels of evidence reveals three publications (0.8%) with level II (randomized controlled trials), 63 (17.7%) with level III (experimental studies with no randomization, cohort studies, or case-control studies), 178 (50.1%) with level IV (non-experimental studies, such as cross-sectional trials, case series, case reports), and 111 (31.3%) with level V (narrative review or expert opinion without explicit critical appraisal). CONCLUSIONS: 1) While there is great interest in possible correlations between orthopedic and dental findings in the specialist literature, most publications fail to provide the hard facts and solid evidence characteristic of high-quality research. 2) This literature analysis attests to the importance of searching electronic databases while making the inherent weaknesses of such searches obvious. Manual literature searches remain essential.     

Efficacy of gabapentin in the treatment of trigeminal neuralgia: A systematic review of randomized controlled trials

The aim of this systematic review was to determine the efficacy of gabapentin (GBP) in the treatment of pain of  idiopathic trigeminal neuralgia (TN). A comprehensive literature search was conducted using the Cumulative Index of Nursing and Allied Health Literature (EBSCO Industries), Emcare (Ovid), Medline (Ovid), Medline (PubMed), Scopus (Elsevier) and Web of Science (Clarivate Analytics). The inclusion criteria comprised randomized controlled trials of GBP as a monotherapy in the treatment of idiopathic TN in adult participants and publications in English. All other study methodologies were excluded. The search yielded 1472 articles, and after exclusion, 11 full‐text articles were eligible for full‐text analysis. Only two studies met the inclusion criteria. There is insufficient evidence either to support or refute the efficacy of GBP in the management of idiopathic TN. Therefore, further well‐designed placebo‐controlled trials are required to confirm the efficacy of GBP in managing TN pain as a single therapy.     

Validity of 2D lateral cephalometry in orthodontics: a systematic review

Lateral cephalometric radiography is commonly used as a standard tool in orthodontic assessment and treatment planning. The aim of this study was to evaluate the available scientific literature and existing evidence for the validation of using lateral cephalometric imaging for orthodontic treatment planning. The secondary objective was to determine the accuracy and reliability of this technique. We did not attempt to evaluate the value of this radiographic technique for other purposes. A literature search was performed using specific keywords on electronic databases: Ovid MEDLINE, Scopus and Web of Science. Two reviewers selected relevant articles, corresponding to predetermined inclusion criteria. The electronic search was followed by a hand search of the reference lists of relevant papers. Two reviewers assessed the level of evidence of relevant publications as high, moderate or low. Based on this, the evidence grade for diagnostic efficacy was rated as strong, moderately strong, limited or insufficient. The initial search revealed 784 articles listed in MEDLINE (Ovid), 1,034 in Scopus and 264 articles in the Web of Science. Only 17 articles met the inclusion criteria and were selected for qualitative synthesis. Results showed seven studies on the role of cephalometry in orthodontic treatment planning, eight concerning cephalometric measurements and landmark identification and two on cephalometric analysis. It is surprising that, notwithstanding the 968 articles published in peer-reviewed journals, scientific evidence on the usefulness of this radiographic technique in orthodontics is still lacking, with contradictory results. More rigorous research on a larger study population should be performed to achieve full evidence on this topic.     

Clinical outcomes of pterygoid implants: Systematic review and meta-analysis

The aim of this systematic literature review was to analyze clinical outcomes of pterygoid implant for the treatment of patients with atrophic posterior maxillae and to provide clinical recommendations for this dental implant technique. An extensive search of electronic databases (PubMed/Medline, Science Direct, Lilacs, Embase, and Cochrane Library) was conducted, for articles published between January 1995 and January 2018, to identify literature presenting clinical outcomes of pterygoid implants in the treatment of patients with atrophic posterior maxillae. The systematic review was performed in accordance with PRISMA/PICO statement guidelines, and the risk of bias was assessed (Australian National Health and Medical Research Council scale). The relative risk of implant failure was analyzed within a 95% confidence interval (95% CI). After screening 331 abstracts from the electronic databases, 36 full-text articles were accessed for eligibility, and a total of 6 studies were included in this systematic review (after applying the inclusion and exclusion criteria). All studies were retrospective in nature and were classified with a poor level of evidence. A total of 634 patients received 1.893 pterygoid implants, with a mean implant survival rate of 94.87%. The mean prevalence of implant failure was 0.056 with a 95% CI of 0.04–0.077. This study demonstrates that pterygoid implants can be successfully used in patients with atrophic posterior maxilla. However, the results should be interpreted with caution, given the presence of uncontrolled confounding factors in the included studies.     

The use of administrative databases to assess oral health care

OBJECTIVE: We examined the potential for research using administrative databases containing dentists' claims to identify both the type of health services research questions addressed and the strength of the evidence that is achieved in such studies. METHODS: We searched Medline (1966 to March, 2003), retrieved additional reports from personal files, reviewed the literature cited in the relevant articles and conducted electronic searches on investigators' surnames. Information from relevant articles was abstracted into tables and the strength of the evidence for each was classified. RESULTS: Thirty-eight studies met our inclusion criteria. Researchers have used administrative databases of dental records to examine provider practices, the longevity or consequences of dental interventions, the prevalence of dental conditions, and patient factors that determined care, and to establish quality assurance criteria or standards of care. The strongest designs were prospective or case-control (Level II-2). CONCLUSION: Studies analyzing administrative databases have the advantage of size and economy but are subject to several threats to their validity and are seldom population-based. The strongest designs occurred with investigation of the longevity or consequences of care. Several studies demonstrated the benefit of linking the service data to patient or provider characteristics. The study of dentists' claims data appears under exploited, especially in the area of identifying and recommending changes in dental health care policies.     

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.     

Root damage associated with intermaxillary screws: a systematic review

This systematic review examined the literature for evidence of dental root damage after contact with intermaxillary screws (IMS). Electronic databases, including the Cochrane Library, Ovid, Scirus, Scopus and Virtual Health Library, were used to search for original articles from 1980 to January 2011. Prospective and retrospective studies that assessed the association of root damage and contact with IMS were selected. Two authors independently reviewed and extracted the data from the included studies. A methodological quality scoring process was used to classify whether the articles presented low, moderate or high evidence. The search retrieved 795 citations. Nine studies fulfilled the initial selection criteria. Of these studies, 3 were excluded. Two studies did not note any iatrogenic injuries of the dental roots; the other study was a case report. Of the 6 included articles, 2 were ranked as having low and four as having moderate evidence. The moderate evidence found suggested that the roots did not exhibit clinical changes after coming into contact with the IMS, but this situation depends on the root damage level. To obtain reliable scientific evidence, studies with an adequate sample size and diagnostic methods are required to confirm the effects of IMS on the dental root.     

Osseointegration and clinical success of zirconia dental implants: a systematic review

PURPOSE: Various ceramic implant systems made of yttria-stabilized tetragonal zirconia polycrystals (Y-TZP) have become commercially available in recent years. A systematic search of the literature was performed to assess the clinical success of dental Y-TZP implants and whether the osseointegration of Y-TZP is comparable to that of titanium, the standard implant material. MATERIALS AND METHODS: The internet database MEDPILOT was searched cumulatively for the keywords zircon* and dent* and implant as well as for zircon* and osseointegration. The last search was conducted on January 31st, 2007. Subsequently, the reference lists of the relevant publications were searched. Furthermore, a letter was sent to the 5 identified manufacturers of zirconia dental implants to ask for peer-reviewed publications. RESULTS: Ninety-six articles were found by the search strategy. No controlled clinical studies in humans regarding clinical outcomes or osseointegration could be identified. Clinical data were restricted to case studies and case series. Only 7 animal studies fulfilled the inclusion criteria. Osseointegration was evaluated at 4 weeks to 24 months after placement in different animal models and sites and under different loading conditions. The mean bone-implant contact percentage was above 60% in almost all experimental groups. In studies that used titanium implants as a control, Y-TZP implants were comparable to or even better than titanium implants. Surface modifications may further improve initial bone healing and resistance to removal torque. CONCLUSIONS: Y-TZP implants may have the potential to become an alternative to titanium implants but cannot currently be recommended for routine clinical use, as no long-term clinical data are available.     

The effectiveness of computer-aided,self-instructional programs in dental education: a systematic review of the literature

Computer-aided learning (CAL), self-instructional programs provide an accessible, interactive, and flexible way of presenting curriculum material. In order to assess the effectiveness of CAL programs in dental education, a systematic review of the published literature comparing CAL with other teaching methods was performed. A systematic search of the published literature was performed. Articles formally assessed for inclusion had to meet the following criteria: randomized controlled trials comparing CAL with any other method of instruction, and the use of academically homogeneous dental students or dental professionals with objective, predefined outcome criteria measuring performance, time spent, and attitudes. The searches located a total of 1,042 articles; of these, only twenty-seven articles met the inclusion criteria. Further quality assessment identified twelve studies that were included in the final review. Five of the studies documented statistically significant differences in outcome measures (scores on multiple choice, written or oral tests, and clinical performance) favoring CAL over comparison group(s), while six revealed no statistically significant differences. One study documented a greater improvement in test scores in the seminar group over the CAL group. Participants' attitudes towards CAL in the included studies are also discussed. Our study concluded that CAL is as effective as other methods of teaching and can be used as an adjunct to traditional education or as a means of self-instruction.     

Caries prevalence in children with cleft lip and palate--a systematic review of case-control studies

AIM: To conduct a systematic review of literature in order to examine the evidence of an increased prevalence of dental caries in children with cleft lip and palate (CLP). METHODS: A search of the PubMed database was conducted through May 2006. Sex- and age-matched case-control studies with noncavitated and manifest caries lesions as endpoint were targeted (n = 6). The studies were assessed independently by two reviewers and scored A-C according to predetermined criteria for methodology and performance. RESULTS: Significantly more caries in CLP children were reported in two of the four studies in the permanent dentition and in three out of four publications dealing with primary teeth. None of the articles were, however, assessed with the highest grade 'A' and the level of evidence was therefore based on three papers graded 'B'. There was a tendency towards higher caries scores in preschool children, but as conflicting results were revealed, the evidence that children with CLP exhibit more caries than noncleft controls was inconclusive. CONCLUSION: This systematic review of literature was unable to find firm evidence for the assumption that CLP children have an increased prevalence of dental caries.     

Developments in dental plaque pH modelling

OBJECTIVES: The objectives of this review were to give a comprehensive account of the methods used to determine dental plaque pH over the last 50 years, to review how these methods have been used in dental cariology research and to give an update as to how dental plaque pH studies might be developed in the future. DATA: Published, referred papers and abstracts of conference proceedings in the literature were reviewed. SOURCES: A comprehensive search of the electronic databases PubMed and Medline, was undertaken. In addition, a hand search of the Index Denticus was done to identify relevant citations before 1966. STUDY SELECTION: Relevant published literature in peer-reviewed publications was reviewed. No additional inclusion criteria were applied. CONCLUSIONS: This comprehensive review gives an account of the background to, history of, relative merits and demerits of, applications of and future of dental plaque pH technologies.     

Is there a certain number of implants needed to retain an overdenture?

Summary  The aim of this systematic review was to determine if there are reasons to recommend a certain number of implants for retaining or supporting maxillary or mandibular overdentures. Literature search for this review covered clinical trials, randomized controlled-clinical trials, meta-analyses and review articles in English dental journals from 1990 to 2007. The search produced 1779 articles, of which the abstracts of 182 studies were reviewed and those with any exclusion criterion were removed. The remaining 39 full articles were reviewed against the inclusion criteria for finalizing the selection. Eleven research reports meeting the inclusion criteria were selected for this review; three for the maxilla and eight for the mandible. According to this data, in the maxilla and in the mandible, patient satisfaction or function of the prosthesis are not dependent on the number of implants or type of attachment. In the mandible, an overdenture with two implants and with bar attachment has the least number of complications.     

The trends of dental biomaterials research and future directions: A mapping review

ObjectiveThis literature research aimed to compare, contrast and quantify the innovations in the most commonly used dental biomaterials.MethodologyOriginal research articles based on experimental dental biomaterials published between 2007 and 2019 were retrieved and reviewed. A search of electronic databases, PubMed, Scopus, and Web of Science indexed dental/biomaterials journals, has been conducted. The inclusion criteria in this research were: synthesis of experimental dental materials, whereas commercial dental materials, review articles, and clinical trials (case reports) were excluded.ResultsIt was found that the amount of publications related to dental subgingival implants, computer-aided modeling ceramics, aesthetic restorative materials, adhesives cements, ceramics, bioceramics, endodontic materials, bioactive scaffolds, stem cells, and guided-tissue membranes had increased significantly from 2007. At the same time, the number of publications related to dental cements, silver amalgam, and dental alloys has decreased. For characterization of dental materials it was noted that mechanical properties were tested mostly for restorative materials. On the other hand, biological properties were most assessed for dental subgingival implants and endodontic materials, however, physical properties predominantly for bioceramics.ConclusionIt is concluded that to meet clinical demands there was more focus on restorative materials that provided better aesthetics, including resin composites, adhesive resin composites (luting cements), zirconia, and other ceramics. The boost in laboratory and animal research related to bioceramics was attributed to their regenerative potential. This current literature study will help growing researchers to consider and judge the direction to which research might be guided in order to plan prospective research projects.     

Indications and contraindications of dental implants in medically compromised patients: Update

The aim of this study was to review the current scientific literature in order to analyse the indications and contraindications of dental implants in medically compromised patients. A reference research was carried out on PubMed using the key words “implant” AND (oral OR dental) AND (systemic disease OR medically compromised), in articles published between 1993 and 2013. The inclusion criteria were the following: clinical studies in which, at least, 10 patients were treated, consensus articles, reviewed articles and meta-analysis performed in humans treated with dental implants, and which included the disease diagnosis. A total of 64 articles were found, from which 16 met the inclusion criteria. Cardiac systemic diseases, diabetic endocrine pathologies or controlled metabolic disorders do not seem to be a total or partial contraindication to the placement of dental implants. Tobacco addiction, and head and neck radiotherapy are correlated to a higher loss of dental implants. Patients suffering from osteoporosis undergoing biphosphonates therapy show an increased risk of developing bone necrosis after an oral surgery, especially if the drugs are administered intravenously or they are associated to certain concomitant medication. Key words:Dental implants, medically compromised patient, systemic diseases.     

Usefulness of the Aesthetic Result as a Success Criterion for Implant Therapy: A Review

Purpose: The purpose of this study was to review the reported evaluation criteria of the aesthetic result in oral implant rehabilitation. Materials and Methods: A literature search of MEDLINE, the Cochrane Collaboration, and EMBASE was performed to retrieve studies published between January 1990 and December 2008 using the following key words: “dental implants,”“clinical trial,” and “aesthetic index” (and their synonyms). A manual search of the literature published in the same period was also carried out using the following publications: Clinical Oral Implant Research, The International Journal of Oral and Maxillofacial Implants, and The International Journal of Periodontics and Restorative Dentistry. The inclusion criteria of the published studies were the following: human clinical trial, oral implant rehabilitation, at least 10 implants, at least 6 months of follow‐up from insertion of the prosthesis, and evaluation of the aesthetic result by means of an index. Results: The literature search revealed 650 relevant bibliographic references, of which 89 were selected for further analysis. A final total of 29 articles fulfilled the inclusion criteria; these included 10 retrospective case series, 11 prospective case series, 1 retrospective controlled clinical trial, 1 prospective controlled clinical trial, and 6 randomized controlled clinical trials. In general, evaluations of aesthetic results appear only in the more recent studies and refer mostly to implant rehabilitation in the maxillary anterior zone; the index used, in most cases, was the Papilla Index of Jemt. Conclusions: Although there appears to be a growing interest in aesthetics in dental implantology, there are as yet no universally accepted evaluation criteria of the aesthetic result. Therefore, further research is necessary to establish a common, complete, and reproducible index for the evaluation of aesthetic outcome that can add in the success criteria for implant therapy in the maxillary and mandibular anterior areas.     

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.     

Dental research in Iran: a bibliometric analysis of electronically available literature

Purpose : To carry out a bibliometric analysis of all electronically available dental literature in Iran from 1983 to 2006, in order to study availability and examine trends. Materials and Methods : Accessing all electronically available Iranian dental articles published in domestic journals, and comparing the results with Iranian dental articles published in Pubmed. The following data were collected from each article: name of journal, year of publication, number of authors, gender of corresponding author, academic levels of authors, main language of article, language of abstract, study environment, population studied, field of dentistry, type of article, design strategy, design of study, and analysis design. Results : In terms of publications in domestic journals, a total of 1,994 dental articles were electronically available, published in six different dental journals in Iran. Majority of articles, 84.5%, were original studies. In terms of design strategy, 49.7% of studies were cross‐sectional, 35.5% were prospective, and 14.8% were retrospective studies. The main language of 99.3% of articles was Farsi, and 0.7% was English. Majority of articles, 38.7%, were written by two authors. Gender of corresponding author in 66.7% of articles was male, and in 33.3% of articles was female. There was an increasing trend in percentage of original studies, clinical trials and female corresponding authors. In terms of publications in Pubmed, a total of 75 dental articles from Iran were electronically available. Significant differences were revealed in terms of number of authors, study types and design strategies when compared to publications in domestic journals. Conclusion : A number of encouraging trends were identified, which is a reflection of improvements in quality of domestic electronic dental literature. However, as the majority of articles are written in Farsi, availability of research evidence to the international community is limited. Overall, results of this study indicate the need for future bibliometric analyses which can be used to construct a comprehensive database that will assist in evidence‐based clinical decision making.