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Quispe-López N, Guadilla Y, Gómez-Polo C, López-Valverde N, Flores-Fraile J, Montero J. The influence of implant depth, abutment height and mucosal phenotype on peri‑implant bone levels: A 2-year clinical trial. J Dent 2024; 148:105264. [PMID: 39053878 DOI: 10.1016/j.jdent.2024.105264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/21/2024] [Accepted: 07/22/2024] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVES To evaluate the bone changes around equicrestal and subcrestal implants, analyzing the effect of abutment height [short abutments (SA < 2 mm) and long abutments (LA > 2 mm)] and the three components of the peri‑implant soft-tissue phenotype. METHODS Twenty-six patients received 71 implants that were placed according to supracrestal tissue height (STH) in an equicrestal (n = 17), shallow subcrestal ≈1 mm (n = 33), or deep subcrestal ≈2 mm (n = 21) position. After 3 months of healing, rehabilitation was completed using metal-ceramic crowns on multi-unit abutments of 1.5 mm, 2.5 mm, or 3.5 mm in height, depending on the prosthetic space and STH. Longitudinal clinical parameters (STH, mucosal thickness, and keratinized mucosa width) and radiographic data [bone remodelling and marginal bone loss (MBL)] were collected at 3, 6, 12, and 24 months postsurgery. RESULTS The gain in STH was significantly greater around the implants placed in a subcrestal ≈2 mm position. After 2 years, the mean change in bone remodelling in the SA group was significantly greater than in the LA group. According to the multiple linear regression, bone remodelling depends primarily on abutment height (β = -0.43), followed by crestal position (β = 0.34), and keratinized mucosa width (β = -0.22), while MBL depends on abutment height (β = -0.37), and the patient's age (β = -0.36). CONCLUSIONS Implants placed in an equicrestal or subcrestal ≈1 mm position with LA undergo less bone remodelling, while the lowest level of MBL occurs in subcrestal ≈2 mm implants with LA. Differing soft-tissue thicknesses combined with the use of either SA or LA produced significant intergroup differences in bone remodelling and MBL. CLINICAL SIGNIFICANCE Abutment height is the most powerful predictor variable affecting bone remodelling and MBL. Depending on the dimensions of the peri‑implant soft-tissue phenotype, placing the implants subcrestally may also be a viable option to decrease bone remodelling and, consequently, reduce MBL. CLINICAL TRIAL REGISTRATION identification number: NCT05670340.
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Affiliation(s)
- Norberto Quispe-López
- Department of Surgery. Faculty of Medicine, Dental clinic. University of Salamanca. Campus Miguel de Unamuno. PC: 37007. Spain.
| | - Yasmina Guadilla
- Department of Surgery. Faculty of Medicine, Dental clinic. University of Salamanca. Campus Miguel de Unamuno. PC: 37007. Spain.
| | - Cristina Gómez-Polo
- Department of Surgery. Faculty of Medicine, Dental clinic. University of Salamanca. Campus Miguel de Unamuno. PC: 37007. Spain.
| | - Nansi López-Valverde
- Department of Surgery. Faculty of Medicine, Dental clinic. University of Salamanca. Campus Miguel de Unamuno. PC: 37007. Spain.
| | - Javier Flores-Fraile
- Department of Surgery. Faculty of Medicine, Dental clinic. University of Salamanca. Campus Miguel de Unamuno. PC: 37007. Spain.
| | - Javier Montero
- Department of Surgery. Faculty of Medicine, Dental clinic. University of Salamanca. Campus Miguel de Unamuno. PC: 37007. Spain.
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Imber JC, Roccuzzo A, Irani DR, Bellón B, Bosshardt DD, Sculean A, Pippenger BE. Histological evaluation of osseointegration between conventional and novel bone-level tapered implants in healed bone-A preclinical study. J Periodontal Res 2024. [PMID: 38764144 DOI: 10.1111/jre.13285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/10/2024] [Accepted: 04/24/2024] [Indexed: 05/21/2024]
Abstract
AIMS To histologically compare osseointegration and crestal bone healing between newly introduced tapered, self-cutting bone-level test implants and tapered bone-level control implants in sites with fully healed sites. METHODS Sixty-six implants (33 test, 33 control) were placed 1 mm subcrestally in a minipig model and underwent qualitative histologic and quantitative histometric analyses after 3, 6 and 12 weeks of submerged healing. The primary and secondary outcomes were the bone-to-implant contact (BIC) and first bone-to-implant contact (fBIC). Outcomes between the test and control implants were statistically compared. RESULTS The BIC values of the test implants were comparable and non-inferior over the time points studied, except for the 12 weeks time point which showed statistically significantly higher BIC values of the test (88.07 ± 5.35%) compared to the control implants (80.88 ± 7.51%) (p = .010). Similarly comparable and non-inferior were the fBIC values, except for the 6-week outcome, which showed statistically higher values for the test (-546.5 ± 450.80 μm) compared to the control implants (-75.7 ± 100.59 μm). fBIC results for the test implants were qualitatively more stable and consistent between test time points. CONCLUSION Novel self-cutting bone-level test implants demonstrated superior osseointegration and similar bone levels compared to conventional bone-level implants after a healing period of 12 weeks in healed ridges.
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Affiliation(s)
- Jean-Claude Imber
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Delia R Irani
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Benjamin Bellón
- Department of Preclinical Research, Institut Straumann, Basel, Switzerland
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Department of Periodontology, Faculty of Dentistry, University of Zurich, Zurich, Switzerland
| | - Dieter D Bosshardt
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Benjamin E Pippenger
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Preclinical Research, Institut Straumann, Basel, Switzerland
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West N, Chapple I, Culshaw S, Donos N, Needleman I, Suvan J, Nibali L, Patel A, Preshaw PM, Kebschull M. BSP Implementation of Prevention and Treatment of Peri-implant Diseases - The EFP S3 Level Clinical Practice Guideline. J Dent 2024:104980. [PMID: 38697506 DOI: 10.1016/j.jdent.2024.104980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/28/2024] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVES to adapt the supranational European Federation of Periodontology (EFP) Prevention and Treatment of Peri-implant Diseases - The EFP S3 Level Clinical Practice Guideline for UK healthcare environment, taking into account a broad range of views from stakeholders and patients. SOURCES This UK version, based on the supranational EFP guideline [1] published in the Journal of Clinical Periodontology, was developed using S3-level methodology, combining assessment of formal evidence from 13 systematic reviews with a moderated consensus process of a representative group of stakeholders, and accounts for health equality, environmental factors and clinical effectiveness. It encompasses 55 clinical recommendations for the Prevention and Treatment of Peri-implant Diseases, based on the classification for periodontal and peri-implant diseases and conditions [2]. METHODOLOGY The UK version was developed from the source guideline using a formal process called the GRADE ADOLOPMENT framework. This framework allows for adoption (unmodified acceptance), adaptation (acceptance with modifications) and the de novo development of clinical recommendations. Using this framework, following the S3-process, the underlying evidence was updated and a representative guideline group of 111 delegates from 26 stakeholder organisations was assembled into four working groups. Following the formal S3-process, all clinical recommendations were formally assessed for their applicability to the UK and adoloped accordingly. RESULTS AND CONCLUSION Using the ADOLOPMENT protocol, a UK version of the EFP S3-level clinical practice guideline for the Prevention and Treatment of Peri-implant Diseases was developed. This guideline delivers evidence- and consensus-based clinical recommendations of direct relevance to the UK healthcare community including the public. CLINICAL SIGNIFICANCE The S3-level-guidelines combine evaluation of formal evidence, grading of recommendations and synthesis with clinical expertise of a broad range of stakeholders. The international S3-level-guideline was implemented for direct clinical applicability in the UK healthcare system, facilitating a consistent, interdisciplinary, evidence-based approach with public involvement for the prevention and treatment of peri-implant diseases.
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Affiliation(s)
- Nicola West
- Restorative Dentistry, Bristol Dental School, University of Bristol, Bristol BS1 2LY, UK; Restorative Dentistry, Bristol Dental Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Marlborough Street, Bristol, BS1 3NU, Secretary General of the European Federation of Periodontology.
| | - Iain Chapple
- Birmingham NIHR Biomedical Research Centre in Inflammation. The University of Birmingham, Birmingham, United Kingdom; Birmingham Community Healthcare NHS Foundation Trust, Birmingham, United Kingdom
| | - Shauna Culshaw
- University of Glasgow Dental School, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Nikos Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London (AMUL), Turner Street, London, E1 2AD
| | - Ian Needleman
- Unit of Periodontology, UCL Eastman Dental Institute, Bloomsbury Campus, Rockefeller Building, 21 University Street, London, WC1E 6DE
| | - Jeanie Suvan
- Unit of Periodontology, UCL Eastman Dental Institute, Bloomsbury Campus, Rockefeller Building, 21 University Street, London, WC1E 6DE
| | - Luigi Nibali
- Periodontology Unit, Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Guys Hospital, Great Maze Pond, London, SE1 9RT
| | - Amit Patel
- Birmingham Dental Specialists, Associate Professor, University of Birmingham, Birmingham, UK, President of the Association of Dental Implantology
| | - Philip M Preshaw
- School of Dentistry, University of Dundee, Dundee UK; School of Dental Sciences, University of Newcastle, Newcastle upon Tyne, UK
| | - Moritz Kebschull
- Birmingham NIHR Biomedical Research Centre in Inflammation. The University of Birmingham, Birmingham, United Kingdom; Birmingham Community Healthcare NHS Foundation Trust, Birmingham, United Kingdom; Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, NY, USA; School of Dentistry, University of Birmingham, Birmingham B5 7EG, UK, President-Elect of the European Federation of Periodontology.
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Leenaars CHC, Stafleu FR, Häger C, Nieraad H, Bleich A. A systematic review of animal and human data comparing the nasal potential difference test between cystic fibrosis and control. Sci Rep 2024; 14:9664. [PMID: 38671057 PMCID: PMC11053161 DOI: 10.1038/s41598-024-60389-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 04/23/2024] [Indexed: 04/28/2024] Open
Abstract
The nasal potential difference test (nPD) is an electrophysiological measurement which is altered in patients and animal models with cystic fibrosis (CF). Because protocols and outcomes vary substantially between laboratories, there are concerns over its validity and precision. We performed a systematic literature review (SR) of the nPD to answer the following review questions: A. Is the nasal potential difference similarly affected in CF patients and animal models?", and B. "Is the nPD in human patients and animal models of CF similarly affected by various changes in the experimental set-up?". The review protocol was preregistered on PROSPERO (CRD42021236047). We searched PubMed and Embase with comprehensive search strings. Two independent reviewers screened all references for inclusion and extracted all data. Included were studies about CF which described in vivo nPD measurements in separate CF and control groups. Risk of bias was assessed, and three meta-analyses were performed. We included 130 references describing nPD values for CF and control subjects, which confirmed substantial variation in the experimental design and nPD outcome between groups. The meta-analyses showed a clear difference in baseline nPD values between CF and control subjects, both in animals and in humans. However, baseline nPD values were, on average, lower in animal than in human studies. Reporting of experimental details was poor for both animal and human studies, and urgently needs to improve to ensure reproducibility of experiments within and between species.
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Affiliation(s)
| | - Frans R Stafleu
- Department of Animals in Science and Society-Human-Animal Relationship, Utrecht University, Utrecht, The Netherlands
| | - Christine Häger
- Institute for Laboratory Animal Science, Hannover Medical School, Hannover, Germany
| | - Hendrik Nieraad
- Institute for Laboratory Animal Science, Hannover Medical School, Hannover, Germany
| | - André Bleich
- Institute for Laboratory Animal Science, Hannover Medical School, Hannover, Germany
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Quispe-López N, Gómez-Polo C, Zubizarreta-Macho Á, Montero J. How do the dimensions of peri-implant mucosa affect marginal bone loss in equicrestal and subcrestal position of implants? A 1-year clinical trial. Clin Implant Dent Relat Res 2024; 26:442-456. [PMID: 38282266 DOI: 10.1111/cid.13306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 01/30/2024]
Abstract
INTRODUCTION There is evidence that the apico-coronal implant position and the mucosal phenotype can affect the extent of peri-implant bone loss. This clinical trial analyzes the bone remodeling and marginal bone loss that occur around conical-connection implants placed equicrestally and subcrestally, assessing the effect of the peri-implant soft-tissue phenotype. METHODS Fifty-one patients received 56 implants of distinct diameters (3.5 mm Ø n = 6; 4.3 mm Ø n = 41; 5 mm Ø n = 9) in the posterior part of the maxilla or mandible. The implants were placed equicrestally, 1 mm subcrestally and >1 mm subcrestally, depending on the initial supracrestal tissue height (STH). After 3 months of non-submerged healing, single metal-ceramic screw-retained implant-supported crowns were placed. Longitudinal measurements of STH, mucosal thickness and keratinized mucosa width (KMW) were made at the time of implant placement (T0), crown placement (T1), and after 3 (T2) and 6 months (T3) of prosthetic loading. At each of these points, a radiographic evaluation of bone remodeling and marginal bone loss was also performed. RESULTS STH was significantly greater for implants placed >1 mm subcrestally than for those placed 1 mm subcrestally. After 12 months of follow-up, a very significant (p < 0.001) loss of KMW was observed, in addition to a marginal bone loss of 0.08 ± 0.1, 0.15 ± 0.2, and 0.14 ± 0.2 mm in the groups placed equicrestally, 1 mm subcrestally and >1 mm subcrestally, respectively. After the multiple linear regression, marginal bone loss was found to depend primarily on KMW (β = -0.43), while also being affected by STH (β = 0.32) and implant diameter (β = -0.28). CONCLUSIONS Marginal bone loss may be influenced by the position with respect to the bone crest, as well as the KMW, STH, and implant diameter. However, more well-controlled studies are needed to verify these above-mentioned findings with different implant designs and connections.
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Affiliation(s)
- Norberto Quispe-López
- Department of Surgery, Faculty of Medicine, Dental Clinic, University of Salamanca, Campus Miguel de Unamuno, Salamanca, Spain
| | - Cristina Gómez-Polo
- Department of Surgery, Faculty of Medicine, Dental Clinic, University of Salamanca, Campus Miguel de Unamuno, Salamanca, Spain
| | - Álvaro Zubizarreta-Macho
- Department of Surgery, Faculty of Medicine, Dental Clinic, University of Salamanca, Campus Miguel de Unamuno, Salamanca, Spain
| | - Javier Montero
- Department of Surgery, Faculty of Medicine, Dental Clinic, University of Salamanca, Campus Miguel de Unamuno, Salamanca, Spain
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AlHelal AA, Alzaid AA, Almujel SH, Alsaloum M, Alanazi KK, Althubaitiy RO, Al-Aali KA. Clinical Peri-Implant Parameters and Marginal Bone Loss for Early Mandibular Implant Overdentures: A Follow-Up of 60 Months. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:588. [PMID: 38674234 PMCID: PMC11052130 DOI: 10.3390/medicina60040588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/25/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Despite the identified benefits of early implant loading, studies have questioned its advantages compared to delayed loading in edentulous patients. This study aimed to evaluate clinical peri-implant parameters and marginal bone loss around early placed and loaded mandibular implant overdentures with a 60-month follow-up. Materials and Methods: In this prospective cohort study, 43 patients were enrolled to receive 86 early loading sub-crestal dental implants through prosthetic guides. Implant overdentures were supported by two isolated implant locator attachments between two mental foramens. Clinical peri-implant parameters, including plaque index (PI), bleeding index (BI), peri-implant pocket depth (PIPD), and marginal bone loss (MBL) were evaluated using standardized techniques at 1, 12, 24, 36, 48, and 60 months follow-up. At 60 months, complications associated with implant overdentures (IOD's) were noted. The mean comparison of peri-implant clinical parameters was performed through ANOVA test. A p-value of ≤0.05 was taken as significant. Results: Out of the total 43 enrolled patients, 8 patients were lost during follow-up; as a result, 35 patients completed the 5 years follow-up. The mean values of PI, BI, and PIPD increased with no statistical difference (p > 0.05). For marginal bone loss, an increase in the mean values was noted at different time intervals with statistical differences (p < 0.001). The most common complications noted were loosening of the abutment, occlusal adjustment, retentive locator loosening and replacement, and relining of the denture. Conclusions: Early placement of IODs failed to prevent bone loss over time and was associated with complications, predominantly consisting of abutment loosening, occlusal adjustments, broken retentive locator components, relining, and rebasing.
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Affiliation(s)
- Abdulaziz A. AlHelal
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, P.O. Box 21069, Riyadh 11475, Saudi Arabia;
| | - Abdulaziz A. Alzaid
- Restorative and Prosthetic Dental Science Department, College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia; (A.A.A.); (M.A.)
- King Abdullah International Medical Research Center, Riyadh 11426, Saudi Arabia
| | - Saad H. Almujel
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, P.O. Box 21069, Riyadh 11475, Saudi Arabia;
| | - Mohammed Alsaloum
- Restorative and Prosthetic Dental Science Department, College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia; (A.A.A.); (M.A.)
- King Abdullah International Medical Research Center, Riyadh 11426, Saudi Arabia
| | - Khalid K. Alanazi
- Conservative Dental Science Department, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia;
| | - Ramzi O. Althubaitiy
- Department of Prosthodontics, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia;
| | - Khulud A. Al-Aali
- Department of Clinical Dental Sciences, College of Dentistry, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia;
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Wu HC, Huang HL, Fuh LJ, Tsai MT, Hsu JT. Influence of implant length and insertion depth on primary stability of short dental implants: An in vitro study of a novel mandibular artificial bone model. J Dent Sci 2024; 19:139-147. [PMID: 38303865 PMCID: PMC10829676 DOI: 10.1016/j.jds.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/16/2023] [Indexed: 02/03/2024] Open
Abstract
Background/purpose Dental implants are a mainstream solution for missing teeth. For the improvement of dental implant surface treatment and design, short dental implants have become an alternative to various complex bone augmentation procedures, especially those performed at the posterior region of both the maxilla and mandible. The objective of this study was to evaluate the effect of various insertion methods on the primary stability of short dental implants. Materials and methods Commercial dental implants were inserted into artificial mandibular bone specimens using various insertion methods (equicrestal position, subcrestal position 1.5 mm, and lateral cortical anchorage) in accordance with an implant surgical guide. Insertion torque value (ITV) curves were recorded while implant procedures were performed. Both maximum ITVs (MITVs) and final ITVs (FITVs) were evaluated. Subsequently, Periotest values (PTVs) and implant stability quotients (ISQs) were measured for all specimens. A Kruskal-Wallis test was conducted to analyze the results for four primary stability parameters, and the Dunn test was used for a post hoc pairwise comparison when a difference was identified. Results For all groups, their mean MITVs ranged from 33.6 to 59.4 N cm, whereas their mean FITVs ranged from 17.5 to 43.5 N cm. Insertion torque value, ISQ, and PTV decreased significantly when implants were inserted into subcrestal positions. When implants were inserted in the lateral bicortical position, the four aforementioned parameters yielded greater values. Conclusion When 6-mm short implants were inserted in a lateral cortical anchorage position, high primary stability was yielded.
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Affiliation(s)
- Hsiang-Chun Wu
- School of Dentistry, China Medical University, Taichung, Taiwan
| | - Heng-Li Huang
- School of Dentistry, China Medical University, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
- Department of Biomedical Engineering, China Medical University, Taichung, Taiwan
| | - Lih-Jyh Fuh
- School of Dentistry, China Medical University, Taichung, Taiwan
- Department of Dentistry, China Medical University and Hospital, Taichung, Taiwan
| | - Ming-Tzu Tsai
- Department of Biomedical Engineering, Hungkuang University, Taichung, Taiwan
| | - Jui-Ting Hsu
- School of Dentistry, China Medical University, Taichung, Taiwan
- Department of Biomedical Engineering, China Medical University, Taichung, Taiwan
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Akshaya K, Rajasekar A. Association between Gingival Biotype and Crestal Bone Loss in Implants Placed in Anterior Maxilla. J Long Term Eff Med Implants 2024; 34:71-78. [PMID: 37938208 DOI: 10.1615/jlongtermeffmedimplants.2023045450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND When bone loss occurs around an implant, it can cause esthetic compromise, which might affect the tissue level design. Thus, bone level design implants are usually preferred if a natural emergence profile is important. The gingival biotype had been identified as a significant factor in the stability of crestal bone. AIM The aim of the current study is to analyze the gingival biotype and crestal bone in implants placed in anterior maxilla. MATERIALS AND METHODS retrospective study was conducted using the case records of patients in University Hospital. Data on the gingival biotype and crestal bone loss in implants placed in anterior maxilla were collected (sample size = 96 patients) and analyzed for association with age and gender by descriptive statistics and chi-square association. RESULTS In thick gingival biotype 59.3% of the cases showed no crestal bone loss and 5.2% of the patients showed only 1 mm of bone loss, but in case of thin gingival biotype, 16.6% of patients had 1 mm of bone loss, 5.2% of them has 2 mm of bone loss, and 1% of them had bone loss of 3 mm and above, with a significant p value of 0.02 (less than 0.05) showing a strong association between gingival biotype and crestal bone loss around implants. CONCLUSION It can be concluded that there exists a significant association between gingival biotype and crestal bone loss around implants placed in anterior maxilla.
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Affiliation(s)
- K Akshaya
- Department of Periodontology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, India
| | - Arvina Rajasekar
- Department of Periodontology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, India
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Comuzzi L, Ceddia M, Di Pietro N, Inchingolo F, Inchingolo AM, Romasco T, Tumedei M, Specchiulli A, Piattelli A, Trentadue B. Crestal and Subcrestal Placement of Morse Cone Implant-Abutment Connection Implants: An In Vitro Finite Element Analysis (FEA) Study. Biomedicines 2023; 11:3077. [PMID: 38002077 PMCID: PMC10669349 DOI: 10.3390/biomedicines11113077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/12/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
The issue of dental implant placement relative to the alveolar crest, whether in supracrestal, equicrestal, or subcrestal positions, remains highly controversial, leading to conflicting data in various studies. Three-dimensional (3D) Finite Element Analysis (FEA) can offer insights into the biomechanical aspects of dental implants and the surrounding bone. A 3D model of the jaw was generated using computed tomography (CT) scans, considering a cortical thickness of 1.5 mm. Subsequently, Morse cone implant-abutment connection implants were virtually positioned at the model's center, at equicrestal (0 mm) and subcrestal levels (-1 mm and -2 mm). The findings indicated the highest stress within the cortical bone around the equicrestally placed implant, the lowest stress in the -2 mm subcrestally placed implant, and intermediate stresses in the -1 mm subcrestally placed implant. In terms of clinical relevance, this study suggested that subcrestal placement of a Morse cone implant-abutment connection (ranging between -1 and -2 mm) could be recommended to reduce peri-implant bone resorption and achieve longer-term implant success.
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Affiliation(s)
- Luca Comuzzi
- Independent Researcher, San Vendemiano-Conegliano, 31020 Treviso, Italy;
| | - Mario Ceddia
- Department of Mechanics, Mathematics and Management, Polytechnic University of Bari, 70125 Bari, Italy; (M.C.); (B.T.)
| | - Natalia Di Pietro
- Department of Medical, Oral and Biotechnological Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (T.R.); (A.S.)
- Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70121 Bari, Italy; (F.I.); (A.M.I.)
| | - Angelo Michele Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70121 Bari, Italy; (F.I.); (A.M.I.)
| | - Tea Romasco
- Department of Medical, Oral and Biotechnological Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (T.R.); (A.S.)
- Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
| | - Margherita Tumedei
- Department of Medical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy;
| | - Alessandro Specchiulli
- Department of Medical, Oral and Biotechnological Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (T.R.); (A.S.)
| | - Adriano Piattelli
- School of Dentistry, Saint Camillus International University of Health and Medical Sciences, 00131 Rome, Italy;
- Facultad de Medicina, UCAM Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain
| | - Bartolomeo Trentadue
- Department of Mechanics, Mathematics and Management, Polytechnic University of Bari, 70125 Bari, Italy; (M.C.); (B.T.)
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Kang Y, Zheng X, Zhang D, Li S, Xu S, Chen L, Zhang Z, Lin X. One-Abutment at One-Time in Posterior Edentulism: A Systematic Review and Meta-Analysis. J Craniofac Surg 2023; 34:e720-e724. [PMID: 37253247 DOI: 10.1097/scs.0000000000009428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/06/2023] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVE The objective of this systematic review and meta-analysis was to investigate the clinical significance of one-abutment at one-time protocol in healed posterior edentulism. METHODS An online search was undertaken in November 2022, which included PubMed, Cochrane Library, Wiley Online Library, and Google Scholar in addition to manual searching. The Cochrane Collaboration tool was performed to assess the quality of selected articles. Marginal bone loss (MBL) was estimated by the performance of meta-analysis. Moreover, all the pooled analyses were based on random-effect models. Subgroup analysis was applied to evaluate the effects of different variables. RESULTS In line with the inclusion criteria, 6 trials with 446 dental implants were identified. The meta-analysis showed a total of 0.22 mm less MBL within 6 months and decreased by 0.30 mm at 1-year follow-up in favor of one-abutment at one-time protocol. A significant loss MBL was found in implants placed equicrestally using one-abutment at one-time protocol [6 months: mean difference (MD): -0.22 mm; 95% CI, -0.34 to 0.10 mm, P =0.0004; 12 months: MD: -0.32 mm; 95% CI, -0.40 to -0.24 mm, P <0.00001), whereas no difference was found between 2 groups in an implant placed subscrestally (6 months: MD: 0.14 mm; 95% CI, -0.03 to 0.22 mm; P =0.11; 12 months: MD: -0.12 mm; 95% CI, -0.32 to 0.08 mm; P =0.23). CONCLUSIONS Implant platform position might greatly affect the marginal bone level. Moreover, one-abutment at one-time protocol demonstrated better bone preservation in implants placed equicrestally in healed posterior edentulism. CLINICAL RELEVANCE This study highlights the significant clinical application of one-abutment at one-time protocol in healed posterior edentulism.
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Affiliation(s)
- Yujie Kang
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, PR China
| | - Xianghuai Zheng
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, PR China
| | - Danya Zhang
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, PR China
| | - Shaobing Li
- Center of Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, PR China
| | - Shulan Xu
- Center of Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, PR China
| | - Lei Chen
- Department of Burns, Wound Repair and Reconstruction, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, P.R. China
| | - Zhaoqiang Zhang
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, PR China
| | - Xi Lin
- Center of Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, PR China
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Huang X, Chen X, Zhong X, Tian T. The CNN model aided the study of the clinical value hidden in the implant images. J Appl Clin Med Phys 2023; 24:e14141. [PMID: 37656066 PMCID: PMC10562019 DOI: 10.1002/acm2.14141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 09/02/2023] Open
Abstract
PURPOSE This article aims to construct a new method to evaluate radiographic image identification results based on artificial intelligence, which can complement the limited vision of researchers when studying the effect of various factors on clinical implantation outcomes. METHODS We constructed a convolutional neural network (CNN) model using the clinical implant radiographic images. Moreover, we used gradient-weighted class activation mapping (Grad-CAM) to obtain thermal maps to present identification differences before performing statistical analyses. Subsequently, to verify whether these differences presented by the Grad-CAM algorithm would be of value to clinical practices, we measured the bone thickness around the identified sites. Finally, we analyzed the influence of the implant type on the implantation according to the measurement results. RESULTS The thermal maps showed that the sites with significant differences between Straumann BL and Bicon implants as identified by the CNN model were mainly the thread and neck area. (2) The heights of the mesial, distal, buccal, and lingual bone of the Bicon implant post-op were greater than those of Straumann BL (P < 0.05). (3) Between the first and second stages of surgery, the amount of bone thickness variation at the buccal and lingual sides of the Bicon implant platform was greater than that of the Straumann BL implant (P < 0.05). CONCLUSION According to the results of this study, we found that the identified-neck-area of the Bicon implant was placed deeper than the Straumann BL implant, and there was more bone resorption on the buccal and lingual sides at the Bicon implant platform between the first and second stages of surgery. In summary, this study proves that using the CNN classification model can identify differences that complement our limited vision.
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Affiliation(s)
- Xinxu Huang
- State Key Laboratory of Oral DiseasesNational Clinical Research Center for Oral DiseasesWest China Hospital of StomatologySichuan UniversityChengduChina
| | - Xingyu Chen
- State Key Laboratory of Oral DiseasesNational Clinical Research Center for Oral DiseasesWest China Hospital of StomatologySichuan UniversityChengduChina
| | - Xinnan Zhong
- State Key Laboratory of Oral DiseasesNational Clinical Research Center for Oral DiseasesWest China Hospital of StomatologySichuan UniversityChengduChina
| | - Taoran Tian
- State Key Laboratory of Oral DiseasesNational Clinical Research Center for Oral DiseasesWest China Hospital of StomatologySichuan UniversityChengduChina
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12
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Urban IA, Montero E, Amerio E, Palombo D, Monje A. Techniques on vertical ridge augmentation: Indications and effectiveness. Periodontol 2000 2023; 93:153-182. [PMID: 36721380 DOI: 10.1111/prd.12471] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/21/2022] [Indexed: 02/02/2023]
Abstract
Vertical ridge augmentation techniques have been advocated to enable restoring function and esthetics by means of implant-supported rehabilitation. There are three major modalities. The first is guided bone regeneration, based on the principle of compartmentalization by means of using a barrier membrane, which has been demonstrated to be technically demanding with regard to soft tissue management. This requisite is also applicable in the case of the second modality of bone block grafts. Nonetheless, space creation and maintenance are provided by the solid nature of the graft. The third modality of distraction osteogenesis is also a valid and faster approach. Nonetheless, owing to this technique's inherent shortcomings, this method is currently deprecated. The purpose of this review is to shed light on the state-of-the-art of the different modalities described for vertical ridge augmentation, including the indications, the step-by-step approach, and the effectiveness.
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Affiliation(s)
- Istvan A Urban
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Eduardo Montero
- Department of Periodontics, Universidad Complutense de Madrid, Madrid, Spain
| | - Ettore Amerio
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - David Palombo
- Department of Periodontics, Universidad Complutense de Madrid, Madrid, Spain
| | - Alberto Monje
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
- Department of Periodontology, University of Bern, Bern, Switzerland
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13
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Patel R, Ucer C, Wright S, Khan RS. Differences in Dental Implant Survival between Immediate vs. Delayed Placement: A Systematic Review and Meta-Analysis. Dent J (Basel) 2023; 11:218. [PMID: 37754338 PMCID: PMC10528222 DOI: 10.3390/dj11090218] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/09/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023] Open
Abstract
OBJECTIVES To compare the impact of immediate and delayed implant placement upon the survival of implants and to investigate the differences in implant survival between immediate and delayed placement in adults. METHODS A search for the relevant literature was performed using the databases of CENTRAL, MEDLINE and Scopus. The studies found were limited to publications between 2014 and 2022, written in the English language, peer-reviewed, and were randomised trials or comparative studies. The quality of the evidence was assessed using the Cochrane Risk of Bias 2.0 and Risk of Bias in Non-randomised Studies-of Interventions appraisal tools and implant survival, and the primary outcome was meta-analysed using RevMan v.5.3. RESULTS A total of 10 studies were eligible for inclusion, including six randomised controlled trials and four non-randomised comparative studies. Five of the six randomised trials observed a low risk of bias, while the comparative studies had a moderate-to-serious risk of bias. The search strategy resulted in 341 implants placed immediately into fresh extraction sites (332 survived, 97.4%) and 359 implants inserted into delayed sites (350 survived, 97.5%). CONCLUSION The meta-analysis demonstrated that there was no significant difference in the implant survival rates between immediately placed implants and implants placed using a delayed timing protocol (risk ratio 0.99; 95% CI 0.96, 1.02, Z = 0.75, p = 0.45). However, the detailed analysis showed that slightly more implant failures happened in the immediate dental implant placement group, with survival rates in some studies ranging between 90 and 95%, while the delayed placement group had survival rates of more than 95%.
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Affiliation(s)
- Rishi Patel
- ICE Postgraduate Dental Institute and Hospital, University of Salford, 24 Furness Quay, Salford M50 3XZ, UK; (R.P.); (C.U.); (S.W.)
| | - Cemal Ucer
- ICE Postgraduate Dental Institute and Hospital, University of Salford, 24 Furness Quay, Salford M50 3XZ, UK; (R.P.); (C.U.); (S.W.)
| | - Simon Wright
- ICE Postgraduate Dental Institute and Hospital, University of Salford, 24 Furness Quay, Salford M50 3XZ, UK; (R.P.); (C.U.); (S.W.)
| | - Rabia S. Khan
- ICE Postgraduate Dental Institute and Hospital, University of Salford, 24 Furness Quay, Salford M50 3XZ, UK; (R.P.); (C.U.); (S.W.)
- Department of Medicine, University of Lancaster, Lancaster LA1 4YR, UK
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14
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D'Orto B, Chiavenna C, Leone R, Longoni M, Nagni M, Capparè P. Marginal Bone Loss Compared in Internal and External Implant Connections: Retrospective Clinical Study at 6-Years Follow-Up. Biomedicines 2023; 11:biomedicines11041128. [PMID: 37189746 DOI: 10.3390/biomedicines11041128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 05/17/2023] Open
Abstract
The aim of this study was to assess and compare the marginal bone loss between two different categories of implants (Winsix, Biosafin, Ancona, Italy) having the same diameter and belonging to the Torque Type® (TT®) line, in the internal hexagon version (TTi, Group A) and in the external hexagon configuration (TTx, Group B). Patients with one or more straight implants (insertion parallel to the occlusal plane) in the molar and premolar regions in association with tooth extraction at least 4 months prior to implant insertion, who have a fixture diameter of 3.8 mm, who followed up for at least 6 years, and whose radiographic records were available were enrolled in this study. Depending on implant connections (externally or internally), the sample was divided into groups A and B. For externally connected implants (66), the marginal resorption was 1.1 ± 0.17 mm. The subgroup of single and bridge implants showed no statistically significant differences with a marginal bone resorption of 1.07 ± 0.15 mm and 1.1 ± 0.17 mm, respectively. Internally connected implants (69) showed an overall marginal resorption of 0.91 ± 0.17 mm, while the subgroup of single and bridge implants showed resorption of 0.90 ± 0.19 mm and 0.90 ± 0.17 mm, respectively, with no statistically significant differences. According to the obtained results, internally connected implants showed less marginal bone resorption than externally connected implants.
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Affiliation(s)
- Bianca D'Orto
- Dental School, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Carlo Chiavenna
- Dental School, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Renato Leone
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Fixed Prosthodontics, "Federico II" University of Naples, 80100 Naples, Italy
| | - Martina Longoni
- Dental School, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Matteo Nagni
- Dental School, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Paolo Capparè
- Dental School, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy
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15
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El-Danasory MB, Khamis MM, Abdel Hakim AA, Fahmy RA. Outcomes of bio-esthetic single implant-supported restorations after peri-implant soft tissue conditioning with two prosthetic techniques: A 1-year randomized clinical trial. J Prosthet Dent 2023:S0022-3913(23)00122-1. [PMID: 36966102 DOI: 10.1016/j.prosdent.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 03/27/2023]
Abstract
STATEMENT OF PROBLEM Providing a definitive restoration with an emergence profile matching that of the contralateral or extracted tooth should result in an esthetic peri-implant soft tissue contour. Whether a custom healing abutment improves the outcome of a bio-copied definitive restoration compared with a stock abutment is unclear. PURPOSE The purpose of this 1-year randomized clinical trial was to evaluate the peri-implant soft and hard tissues related to bio-esthetic single implant-supported restorations having a contralateral tooth-matching restorative emergence profile after peri-implant soft tissue conditioning with either custom or stock healing abutment for patients indicated for immediate implant placement. MATERIAL AND METHODS Twenty-four participants indicated for immediate implant placement in the maxillary esthetic zone received bio-esthetic single implant-supported restorations after peri-implant soft tissue conditioning with either a custom healing abutment (n=12) or a stock healing abutment (n=12). The pink and white esthetic score (PES-WES) was evaluated 6 and 12 months after implant placement. Peri-implant bone changes were measured with cone beam computed tomography (CBCT) scans at the same intervals. RESULTS The PES-WES showed significant difference between the 2 groups at 6 and 12 months. The CBCT scans did not show significant difference between the 2 groups. CONCLUSIONS The use of the bio-esthetic concept for immediate single implant placement achieved successful esthetic restorations after conditioning the peri-implant tissues using either custom or stock healing abutments. However, the use of custom healing abutments was associated with higher PES-WES values in comparison with the use of stock healing abutments.
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Affiliation(s)
- Muhammed B El-Danasory
- Assistant Lecturer, Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
| | - Mohamed Moataz Khamis
- Professor and Chairman, Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Ahmed Adel Abdel Hakim
- Professor, Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Rania A Fahmy
- Associate Professor, Department of Oral medicine and periodontology, Faculty of dentistry, Alexandria University, Alexandria, Egypt
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16
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De Stefano M, Lanza A, Faia E, Ruggiero A. A distinct ultrashort dental implant design for the reduction of the bone stress/strain field: a comparative numerical investigation. BIOMEDICAL ENGINEERING ADVANCES 2023. [DOI: 10.1016/j.bea.2023.100077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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17
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Stacchi C, Lamazza L, Rapani A, Troiano G, Messina M, Antonelli A, Giudice A, Lombardi T. Marginal bone changes around platform-switched conical connection implants placed 1 or 2 mm subcrestally: A multicenter crossover randomized controlled trial. Clin Implant Dent Relat Res 2023; 25:398-408. [PMID: 36725016 DOI: 10.1111/cid.13186] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/04/2023] [Accepted: 01/16/2023] [Indexed: 02/03/2023]
Abstract
INTRODUCTION This study analyzes early marginal bone modifications occurring around platform-switched implants with conical connection placed 1 or 2 mm subcrestally. METHODS This crossover randomized controlled trial enrolled partially edentulous patients needing two implants in either the posterior maxilla or mandible. Each patient received two platform-switched implants with conical connection inserted 2 mm (Test) and 1 mm (Control) subcrestally. Definitive abutments were immediately connected and, after 4 months of unsubmerged healing, screwed metal-ceramic crowns were delivered. Radiographs were taken at implant placement (T0), prosthesis delivery (T1), and after 1 year of prosthetic loading (T2). RESULTS Fifty-one patients (25 males and 26 females; mean age 61.2 ± 12.1 years) totaling 102 implants were included in the final analysis. Mean peri-implant bone level (PBL) reduction from T0 to T2 was not significantly different around Test (0.49 ± 0.32 mm) and Control implants (0.46 ± 0.35 mm; p = 0.66). Multivariate linear regression models highlighted a significant positive correlation between history of periodontitis and PBL reduction. At T2, no Test group implant and 6 Control group implants exhibited PBL below the implant platform (11.8% of Control group implants). CONCLUSION No significant differences in peri-implant marginal bone changes were demonstrated after 1 year of prosthetic loading between platform-switched implants with conical connection inserted either 1 or 2 mm subcrestally. However, 2 mm subcrestal placement resulted in deeper implant positioning at T2, with no exposure of treated implant surface and potential preventive effect against subsequent peri-implant pathology.
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Affiliation(s)
- Claudio Stacchi
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Luca Lamazza
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Rapani
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Giuseppe Troiano
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | | | | | - Amerigo Giudice
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Teresa Lombardi
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
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18
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Hariharan AS, Sivaswamy V, Subhashini R. Implant-Abutment Connections: A Structured Review. J Long Term Eff Med Implants 2022; 33:47-56. [PMID: 36382704 DOI: 10.1615/jlongtermeffmedimplants.2022042610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The aim of the study was to carry out a structured review of studies that dealt with types of implant abutment connections, the concept of platform switching and its influence on hard and soft oral tissues. Electronic search was conducted over PubMed, Google Scholar, Medline, Embase to find articles dealing with Implant abutment connection and platform switching. We came across a total of 248 articles, which were filtered to a cumulative 19 articles after cross matching with predetermined inclusion and exclusion criteria. Most of the available literature gravitates in favor of an internal connection with the incorporation of platform switching to attain satisfactory hard and soft tissue outcomes.
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Affiliation(s)
| | - Vinay Sivaswamy
- Department of Prosthodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, India
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19
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Shahdad S, Bosshardt D, Patel M, Razaghi N, Patankar A, Roccuzzo M. Benchmark performance of anodized vs. sandblasted implant surfaces in an acute dehiscence type defect animal model. Clin Oral Implants Res 2022; 33:1135-1146. [PMID: 36120735 DOI: 10.1111/clr.13996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 07/11/2022] [Accepted: 08/18/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Crestal bone formation represents a crucial aspect of the esthetic and biological success of dental implants. This controlled preclinical study analyzed the effect of implant surface and implant geometry on de novo crestal bone formation and osseointegration. MATERIALS AND METHODS Histological and histomorphometrical analysis was performed to compare three implant groups, that is, (1) a novel, commercially available, gradient anodized implant, (2) a custom-made geometric replica of implant "1," displaying a superhydrophilic micro-rough large-grit sandblasted and acid-etched surface, and (3) a commercially available implant, having the same surface as "2" but a different implant geometry. The study applied a standardized buccal acute-type dehiscence model in minipigs with observation periods of 2 and 8 weeks of healing. RESULTS The amount of newly formed crestal bone (BATA) around control groups (2) and (3) was significantly increased when compared to the test group (1) at the 8 weeks of healing time point. Similar results were obtained for all parameters related to osseointegration and direct bone apposition, to the implant surface (dBIC, VBC, and fBIC), demonstrating superior osseointegration of the moderately rough, compared to the gradient anodized functionalization. After 2 weeks, the osseointegration (nBIC) was found to be influenced by implant geometry with group (3) outperforming groups (1) and (2) on this parameter. At 8 weeks, nBIC was significantly higher for groups (2) and (3) compared to (1). CONCLUSIONS The extent (BATA) of de novo crestal bone formation in the acute-type dehiscence defects was primarily influenced by implant surface characteristics and their ability to promote osseointegration and direct bone apposition. Osseointegration (nBIC) of the apical part was found to be influenced by a combination of surface characteristics and implant geometry. For early healing, implant geometry may have a more pronounced effect on facilitating osseointegration, relative to the specific surface characteristics.
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Affiliation(s)
- Shakeel Shahdad
- Barts Health NHS Trust, The Royal London Dental Hospital, London, UK.,Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Dieter Bosshardt
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Mital Patel
- Barts Health NHS Trust, The Royal London Dental Hospital, London, UK.,Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Nahal Razaghi
- Barts Health NHS Trust, The Royal London Dental Hospital, London, UK
| | - Anuya Patankar
- Barts Health NHS Trust, The Royal London Dental Hospital, London, UK
| | - Mario Roccuzzo
- Private practice, Torino, Italy.,Department of Maxillo-facial Surgery, University of Torino, Torino, Italy.,Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
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20
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Sargolzaie N, Zarch HH, Arab H, Koohestani T, Ramandi MF. Marginal bone loss around crestal or subcrestal dental implants: prospective clinical study. J Korean Assoc Oral Maxillofac Surg 2022; 48:159-166. [PMID: 35770357 PMCID: PMC9247445 DOI: 10.5125/jkaoms.2022.48.3.159] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/01/2022] [Accepted: 05/09/2022] [Indexed: 11/07/2022] Open
Abstract
Objectives The stability of crestal bone has been reported as a major factor in the success of dental implants. Implants can be placed in an equicrestal (crestal) or subcrestal position. The aim of this study was to evaluate the effect of implant depth placement on marginal bone loss. Materials and Methods The study was created in a split-mouth design. Immediately after implant surgery, digital parallel radiographs were prepared and levels of bone were measured where marginal bone loss and bone level changes occurred. These measurements were repeated at 3-month and 6-month follow-up periods. Results In this interventional study, 49 implants were evaluated in 18 patients. Primary bone height was not significant between the intervention and control groups in both mesial and distal aspects at 3 months and 6 months from the baseline. The mean marginal bone loss on the mesial side was 1.03 mm in the subcrestal group and 0.83 mm in the crestal group. In addition, mean marginal bone loss on the distal side was 0.88 mm and 0.81 mm in the subcrestal and crestal groups, respectively. Marginal bone loss was not significantly different between sexes, the maxilla or mandible, and in the anterior or posterior regions as well as between different lengths and diameters of implants. Conclusion Based on the results of this study, there was no significant difference in terms of marginal bone loss between crestal and subcrestal implants.
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Affiliation(s)
- Naser Sargolzaie
- Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Iran
| | - Hosein Hoseini Zarch
- Department of Oral and Maxillofacial Radiology, School of Dentistry and Dental Research Center, Mashhad University of Medical Sciences, Iran
| | - Hamidreza Arab
- Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Iran
| | | | - Mahdiye Fasihi Ramandi
- Department of Periodontics, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
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21
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Gehrke SA, Júnior JA, Treichel TLE, do Prado TD, Dedavid BA, de Aza PN. Effects of insertion torque values on the marginal bone loss of dental implants installed in sheep mandibles. Sci Rep 2022; 12:538. [PMID: 35017552 PMCID: PMC8752839 DOI: 10.1038/s41598-021-04313-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/14/2021] [Indexed: 12/15/2022] Open
Abstract
The aim of the present in vivo study was to analyze and compare the effects on the crestal bone healing of two different implant macrogeometries installed in fresh socket areas and in normal bone areas with different insertion torque values. Two implant macrogeometries were used in the present study, DuoCone implant (DC) and Maestro implant (MAE), forming four groups: group DCws, in which the implants were installed in healing bone (without a socket); group DCfs, in which the implants were installed in post-extraction areas (fresh sockets); group MAEws, in which the implants were installed in healing bone (without a socket); group MAEfs, in which the implants were installed in post-extraction areas (fresh sockets). After 30 and 90 days of implantations in the bilateral mandibles of 10 sheep, eighty implants were evaluated through digital X-ray images and histologic slices. The crestal bone position in relation to the implant platform shoulder was measured and compared. The measured insertion torque was 47.2 ± 4.69 Ncm for the DCws group, 43.4 ± 4.87 Ncm for the DCfs group, 29.3 ± 3.16 Ncm for the MAEws group, and 27.7 ± 4.41 Ncm for the MAEfs group. The radiographic mesio-distal and histological bucco-lingual analyses showed significantly greater vertical bone loss in the implants installed with high torque (DC groups) in comparison to the implants installed with a low torque (MAE groups) (p < 0.05), at both evaluation times. In general, low insertion torque values (Maestro implants) showed better results of MBL when compared to implants installed with higher torque values (Duo Cone implants). Moreover, our results showed that the implants installed in the sites without sockets showed a less MBL in comparison with the implants installed in sites of fresh sockets.
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Affiliation(s)
- Sergio Alexandre Gehrke
- Department of Biotechnology, Universidad Católica de Murcia, 30107, Murcia, Spain.
- Department of Research, Biotecnos - Technology and Science, Cuareim 1483, 11100, Montevideo, Uruguay.
| | | | | | - Tales Dias do Prado
- Department of Surgery, Faculty of Medicine Veterinary, University of Rio Verde, Rio Verde, Brazil
| | - Berenice Anina Dedavid
- Department of Materials Engineering, Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, 90619-900, Brazil
| | - Piedad N de Aza
- Department of Materials, Instituto de Bioingenieria, Universidad Miguel Hernández, Elche, Alicante, Spain
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22
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Francisco H, Finelle G, Bornert F, Sandgren R, Herber V, Warfving N, Pippenger BE. Peri-implant bone preservation of a novel, self-cutting, and fully tapered implant in the healed crestal ridge of minipigs: submerged vs. transgingival healing. Clin Oral Investig 2021; 25:6821-6832. [PMID: 33950374 PMCID: PMC8602133 DOI: 10.1007/s00784-021-03970-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 04/26/2021] [Indexed: 12/03/2022]
Abstract
OBJECTIVES The aim of this study was to assess the influence of transgingival compared with submerged healing on peri-implant bone maintenance around a novel, fully tapered implant in a healed crestal ridge in minipigs. MATERIALS AND METHODS In each of 12 minipigs, two implants (Straumann® BLX, Roxolid® SLActive®, Ø 3.75 × 8 mm) were placed. Implants were either left for submerged or for transgingival healing for 12 weeks. Measurements performed were bone-to-implant contact (BIC), first bone-to-implant contact (fBIC), bone area to total area (BATA), perpendicular bone crest to implant shoulder (pCIS), bone height change from placement, and bone overgrowth (for submerged implants). RESULTS No significant differences were found between transgingival and submerged healing in any of the measured parameters, except for BATA on the buccal aspect in which significantly more bone formation was found for the transgingival healing group. For both groups, there was a gain in crestal bone height during the 12-week healing period. CONCLUSIONS Loaded compared with unloaded implants displayed comparable levels of osseointegration and equivalent marginal bone levels. This qualifies the implant placement protocol with respect to the osteotomy dimensions and subcrestal placement protocol for immediate loading. CLINICAL RELEVANCE The here presented results related to osseointegration and crestal bone maintenance after submerged or transgingival healing have demonstrated a high level of consistency in the used in vivo translational model. The obtained results support the translation of the novel implant type in conjunction with the developed surgical workflow and placement protocol into further clinical investigation and use.
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Affiliation(s)
- Helena Francisco
- Faculdade de Medicina Dentária, Universidade da Lisboa (University of Lisbon), Lisbon, Portugal
| | | | - Fabien Bornert
- Department of Oral Surgery, University of Strasbourg, Strasbourg, France
| | | | - Valentin Herber
- Department of Dentistry and Oral Health, Division of Oral Surgery and Orthodontics, Medical University of Graz, Graz, Austria
| | | | - Benjamin E Pippenger
- Department of Preclinical & Translational Research, Institut Straumann AG, Basel, Switzerland.
- Department of Periodontology, Center for Dental Medicine, University of Bern, Bern, Switzerland.
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23
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Chan C, Mirzaians A, Le BT. Outcomes of alveolar segmental 'sandwich' osteotomy with interpositional particulate allograft for severe vertical defects in the anterior maxilla and mandible. Int J Oral Maxillofac Surg 2021; 50:1617-1627. [PMID: 34229922 DOI: 10.1016/j.ijom.2021.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 06/07/2021] [Accepted: 06/22/2021] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to report the outcomes of interpositional osteotomy with mineralized allograft in the treatment of alveolar vertical defects in preparation for implant placement. Thirteen defects (11 maxillary and two mandibular) were treated with osteotomy segments ranging in length from two to five missing teeth. The segments were positioned 5-7 mm coronally, with the gap space filled with allograft and then fixated with titanium hardware. Vertical bone augmentation was analyzed by superimposing pre- and post-surgical cone beam computed tomography images and stratified based on the length and number of missing teeth in each edentulous segment. The mean vertical bone gain was 3.7 ± 1.6 mm in the area of greatest vertical defect and the mean length of the transport segment was 20.5 ± 8.1 mm. These segments represented two-, three-, four-, or five-tooth edentulous sites; the mean vertical bone gain for these segments was 1.7 ± 0.5 mm, 3.8 ± 1.0 mm, 4.6 ± 0.9 mm, and 6.7 ± 0.0 mm, respectively. Stability of vertical height gain was found to be directly proportional to the span length of the osteotomy segment, with the largest five-tooth segment achieving the greatest gain. Vertical bone gain in two-tooth segments was minimal, indicating a moderate amount of resorption.
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Affiliation(s)
- C Chan
- Division of Oral and Maxillofacial Surgery, University of Southern California, Los Angeles, CA, USA.
| | - A Mirzaians
- Division of Oral and Maxillofacial Surgery, University of Southern California, Los Angeles, CA, USA
| | - B T Le
- Division of Oral and Maxillofacial Surgery, University of Southern California, Los Angeles, CA, USA
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24
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Wada M, Mameno T, Otsuki M, Kani M, Tsujioka Y, Ikebe K. Prevalence and risk indicators for peri-implant diseases: A literature review. JAPANESE DENTAL SCIENCE REVIEW 2021; 57:78-84. [PMID: 34158874 PMCID: PMC8203834 DOI: 10.1016/j.jdsr.2021.05.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 03/18/2021] [Accepted: 05/23/2021] [Indexed: 02/08/2023] Open
Abstract
Peri-implant diseases are known as undesirable conditions that can occur after implant therapy. Although several risk indicators are becoming clear, the causes of peri-implant diseases have not been completely investigated. The purpose of this review was to summarize the prevalence and risk indicators for peri-implant diseases by referring to current papers from various angles. Many studies have reported the varied prevalence of peri-implant mucositis (23.9%-88.0% at the patient level and 9.7%-81.0% at the implant level) and peri-implantitis (8.9%-45% at the patient level and 4.8%-23.0% at the implant level). Additionally, several studies concluded that poor oral hygiene and lack of regular maintenance were strongly correlated with the development of both peri-implant mucositis and peri-implantitis. Diabetes and a history of periodontitis were revealed as risk indicators for peri-implantitis. However, there was no definitive conclusion about the correlations between peri-implant diseases and other factors such as smoking, the shape of the implant superstructure, and the condition of the keratinized mucosa. Further studies useful for evidence-based decision-making are needed for predictable implant therapy in the long term.
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Affiliation(s)
- Masahiro Wada
- Osaka University, Graduate School of Dentistry Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Japan
| | - Tomoaki Mameno
- Osaka University, Graduate School of Dentistry Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Japan
| | - Motohiro Otsuki
- Osaka University, Graduate School of Dentistry Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Japan.,Private Dental Office, Japan
| | - Misako Kani
- Osaka University, Graduate School of Dentistry Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Japan
| | - Yoshitaka Tsujioka
- Osaka University, Graduate School of Dentistry Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Japan
| | - Kazunori Ikebe
- Osaka University, Graduate School of Dentistry Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Japan
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Muñoz M, Busoms E, Vilarrasa J, Albertini M, Ruíz-Magaz V, Nart J. Bone-level changes around implants with 1- or 3-mm-high abutments and their relation to crestal mucosal thickness: A 1-year randomized clinical trial. J Clin Periodontol 2021; 48:1302-1311. [PMID: 34101234 DOI: 10.1111/jcpe.13505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 11/30/2022]
Abstract
AIM To evaluate 1-year bone-level changes around subcrestal platform-switching implants with 1 or 3 mm definitive abutments. The influence of mucosal thickness on bone-level alterations was further analysed. MATERIALS AND METHODS Implants were placed in the posterior sextants and positioned 1.5 mm subcrestally with an abutment of 1 or 3 mm height. Final restorations were delivered after 16 weeks. Radiographic measurements of inter-proximal bone level were the primary outcome and were adjusted by vertical mucosal thickness. Peri-implant clinical conditions and resonance frequency analysis were also compared. RESULTS A total of 65 subjects with 99 implants were analysed. The overall 1-year implant survival rate between the 1- and 3-mm groups was 96.4% and 94.4%, respectively. Statistically significant lower inter-proximal marginal bone-level changes were observed in the 3-mm group (1 mm: -0.17 ± 0.02 mm at mesial and -0.21 ± 0.02 mm distal; 3 mm: -0.03 ± 0.02 mm at mesial and -0.03 ± 0.02 mm and distal; mesial: p = .001; distal: p < .001). Initial vertical mucosal thickness was not correlated with inter-proximal marginal bone loss. CONCLUSIONS Subcrestal implants with 3-mm abutment were associated with minimal inter-proximal bone loss. Independent of the abutment height, crestal mucosal thickness was not correlated with bone loss.
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Affiliation(s)
- Marta Muñoz
- Department of Periodontology, Universitat International de Catalunya, Barcelona, Spain
| | - Emma Busoms
- Department of Periodontology, Universitat International de Catalunya, Barcelona, Spain
| | - Javi Vilarrasa
- Department of Periodontology, Universitat International de Catalunya, Barcelona, Spain
| | - Matteo Albertini
- Department of Periodontology, Universitat International de Catalunya, Barcelona, Spain
| | - Vanessa Ruíz-Magaz
- Department of Periodontology, Universitat International de Catalunya, Barcelona, Spain
| | - José Nart
- Department of Periodontology, Universitat International de Catalunya, Barcelona, Spain
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Gehrke SA, Dedavid BA, Prados-Frutos JC. Effects of different switched or not-switched implant and abutment platform designs and marginal bone loss on fracture strength: An in vitro study. J Prosthet Dent 2021; 128:55-62. [PMID: 33546856 DOI: 10.1016/j.prosdent.2020.11.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 12/30/2022]
Abstract
STATEMENT OF PROBLEM The use of reduced platform sets (implants and abutments) can help to control crestal bone loss around implants, which is essential for optimizing esthetics and biomechanical behavior. However, the information available on the fracture resistance of implants with a reduced platform is sparse. PURPOSE The purpose of this in vitro study was to analyze the maximum fracture strength value of implants with different platform designs during quasistatic fatigue, followed by a simulation of different bone levels of cervical insertion. MATERIAL AND METHODS One hundred and twenty sets of dental implants and abutments with different diameters and platform designs were tested. All implants had an internal hexagon connection and conical macrogeometry. Four groups (n=30) were studied: Ø4.0-mm implants with a regular matched platform (rMatch group), Ø4.0-mm implants with a regular switched platform (PSwitch group), Ø5.0-mm implants with a wide matched platform (wMatch group), and Ø5.0-mm implants with a wide switched platform (wSwitch group). Three conditions simulating different levels of bone position around the cervical portion of the implants were proposed: insertion at the implant shoulder level=0 mm (L0), level=3 mm of insertion loss (L3), and level=5 mm of insertion loss (L5). All sets of all groups and proposed insertion level were subjected to a fracture strength test at 30 degrees in relation to the axis of the sets in a universal testing machine. RESULTS Regardless of the insertion levels tested, the switched platform implants (rSwitch and wSwitch groups) showed similar mean fracture strength values (P>.05), while the implants of matched platforms (rMatch and wMatch groups) showed different fracture strength values for all insertion levels tested (P<.001). CONCLUSIONS The fracture strength values of the switched platform implants were lower at all insertion levels tested. However, for all insertion levels tested, the implants with a switched platform presented less deformation, whereas, in the matched platform implants, there was significant deformation of the implant structure.
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Affiliation(s)
- Sergio Alexandre Gehrke
- Professor, Department of Biotechnology. Universidad Católica de Murcia (UCAM), Murcia, Spain; Professor, Department of Research, Biotecnos, Montevideo, Uruguay.
| | - Berenice Anina Dedavid
- Professor, Department of Materials Engineering, Pontificia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Juan Carlos Prados-Frutos
- Professor of Department of Medical Specialties and Public Health, IDIBO Group (High Performance Group in Research and Development of Biomaterials in Dentistry), Rey Juan Carlos University, Alcorcón, Madrid, Spain
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27
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Cruz RS, Lemos CAA, de Luna Gomes JM, Fernandes E Oliveira HF, Pellizzer EP, Verri FR. Clinical comparison between crestal and subcrestal dental implants: A systematic review and meta-analysis. J Prosthet Dent 2020; 127:408-417. [PMID: 33358610 DOI: 10.1016/j.prosdent.2020.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/01/2020] [Accepted: 11/02/2020] [Indexed: 12/27/2022]
Abstract
STATEMENT OF PROBLEM How the performance of dental implants is related to their occlusogingival placement, crestal or subcrestal, is unclear. PURPOSE The purpose of this systematic review and meta-analysis was to evaluate marginal bone loss, implant survival rate, and peri-implant soft tissue parameters between implants placed at the crestal and subcrestal bone level. MATERIAL AND METHODS Two independent reviewers searched the PubMed/MEDLINE, Embase, and Cochrane Library databases for randomized clinical trials published up to September 2020. The meta-analysis was based on the Mantel-Haenszel and the inverse variance methods (α=.05). RESULTS The search identified 928 references, and 10 studies met the eligibility criteria. A total of 393 participants received 709 implants, 351 at crestal bone levels and 358 at subcrestal bone levels. Meta-analysis indicated that crestal bone level implants showed similar marginal bone loss to that seen with subcrestal bone level implants (mm) (P=.79), independent of the subcrestal level (P=.05) and healing protocol (P=.24). The bone level implant placement did not affect the implant survival rate (P=.76), keratinized tissue (mm) (P=.91), probing depth (mm) (P=.70), or plaque index (%) (P=.92). CONCLUSIONS The evidence suggests that both approaches of implant placement are clinically acceptable in terms of peri-implant tissue parameters and implant-supported restoration survival.
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Affiliation(s)
- Ronaldo Silva Cruz
- Researcher, Department of Dental Materials and Prosthodontics, Araçatuba Dental School (UNESP), Univ Estadual Paulista, Araçatuba, Brazil.
| | - Cleidiel Aparecido Araújo Lemos
- Adjunct Professor, Department of Dentistry (Division of Prosthodontics), Federal University of Juiz de Fora, Campus Avançado Governador Valadares (UFJF/GV), Governador Valadares, Minas Gerais, Brazil
| | - Jéssica Marcela de Luna Gomes
- PhD student, Department of Dental Materials and Prosthodontics, Araçatuba Dental School (UNESP), Univ Estadual Paulista, Araçatuba, Brazil
| | - Hiskell Francine Fernandes E Oliveira
- PhD student, Department of Dental Materials and Prosthodontics, Araçatuba Dental School (UNESP), Univ Estadual Paulista, Araçatuba, Brazil; PhD candidate, Department of Dental Materials and Prosthodontics, Araçatuba Dental School (UNESP), Univ Estadual Paulista, Araçatuba, Brazil
| | - Eduardo Piza Pellizzer
- Titular Professor, Department of Dental Materials and Prosthodontics, Araçatuba Dental School (UNESP), Univ Estadual Paulista, Araçatuba, Brazil
| | - Fellippo Ramos Verri
- Adjunct Professor, Department of Dental Materials and Prosthodontics, Araçatuba Dental School (UNESP), Univ Estadual Paulista, Araçatuba, Brazil
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28
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Leenaars C, Stafleu F, de Jong D, van Berlo M, Geurts T, Coenen-de Roo T, Prins JB, Kempkes R, Elzinga J, Bleich A, de Vries R, Meijboom F, Ritskes-Hoitinga M. A Systematic Review Comparing Experimental Design of Animal and Human Methotrexate Efficacy Studies for Rheumatoid Arthritis: Lessons for the Translational Value of Animal Studies. Animals (Basel) 2020; 10:E1047. [PMID: 32560528 PMCID: PMC7341304 DOI: 10.3390/ani10061047] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 12/15/2022] Open
Abstract
Increased awareness and understanding of current practices in translational research is required for informed decision making in drug development. This paper describes a systematic review of methotrexate for rheumatoid arthritis, comparing trial design between 147 animal and 512 human studies. Animal studies generally included fewer subjects than human studies, and less frequently reported randomisation and blinding. In relation to life span, study duration was comparable for animals and humans, but included animals were younger than included humans. Animal studies often comprised males only (61%), human studies always included females (98% included both sexes). Power calculations were poorly reported in both samples. Analyses of human studies more frequently comprised Chi-square tests, those of animal studies more frequently reported analyses of variance. Administration route was more variable, and more frequently reported in animal than human studies. Erythrocyte sedimentation rate and c-reactive protein were analysed more frequently in human than in animal studies. To conclude, experimental designs for animal and human studies are not optimally aligned. However, methotrexate is effective in treating rheumatoid arthritis in animal models and humans. Further evaluation of the available evidence in other research fields is needed to increase the understanding of translational success before we can optimise translational strategies.
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Affiliation(s)
- Cathalijn Leenaars
- SYRCLE, Department for Health Evidence (Section HTA), Radboud Institute for Health Sciences, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (D.d.J.); (M.v.B.); (T.G.); (R.K.); (J.E.); (R.d.V.); (M.R.-H.)
- Department of Population Health Science, Unit Animals in Science and Society, Utrecht University, 3508 TD Utrecht, The Netherlands;
- Institute for Laboratory Animal Science, Hannover Medical School, 30625 Hannover, Germany;
| | - Frans Stafleu
- Ethics Institute, Utrecht University, 3508 TC Utrecht, The Netherlands;
| | - David de Jong
- SYRCLE, Department for Health Evidence (Section HTA), Radboud Institute for Health Sciences, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (D.d.J.); (M.v.B.); (T.G.); (R.K.); (J.E.); (R.d.V.); (M.R.-H.)
| | - Maikel van Berlo
- SYRCLE, Department for Health Evidence (Section HTA), Radboud Institute for Health Sciences, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (D.d.J.); (M.v.B.); (T.G.); (R.K.); (J.E.); (R.d.V.); (M.R.-H.)
| | - Tijmen Geurts
- SYRCLE, Department for Health Evidence (Section HTA), Radboud Institute for Health Sciences, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (D.d.J.); (M.v.B.); (T.G.); (R.K.); (J.E.); (R.d.V.); (M.R.-H.)
| | - Tineke Coenen-de Roo
- Central Animal Facility, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands;
| | - Jan-Bas Prins
- Biological Research Facility, The Francis Crick Institute, London NW1 1AT, UK;
| | - Rosalie Kempkes
- SYRCLE, Department for Health Evidence (Section HTA), Radboud Institute for Health Sciences, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (D.d.J.); (M.v.B.); (T.G.); (R.K.); (J.E.); (R.d.V.); (M.R.-H.)
| | - Janneke Elzinga
- SYRCLE, Department for Health Evidence (Section HTA), Radboud Institute for Health Sciences, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (D.d.J.); (M.v.B.); (T.G.); (R.K.); (J.E.); (R.d.V.); (M.R.-H.)
| | - André Bleich
- Institute for Laboratory Animal Science, Hannover Medical School, 30625 Hannover, Germany;
| | - Rob de Vries
- SYRCLE, Department for Health Evidence (Section HTA), Radboud Institute for Health Sciences, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (D.d.J.); (M.v.B.); (T.G.); (R.K.); (J.E.); (R.d.V.); (M.R.-H.)
| | - Franck Meijboom
- Department of Population Health Science, Unit Animals in Science and Society, Utrecht University, 3508 TD Utrecht, The Netherlands;
- Ethics Institute, Utrecht University, 3508 TC Utrecht, The Netherlands;
| | - Merel Ritskes-Hoitinga
- SYRCLE, Department for Health Evidence (Section HTA), Radboud Institute for Health Sciences, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (D.d.J.); (M.v.B.); (T.G.); (R.K.); (J.E.); (R.d.V.); (M.R.-H.)
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Uraz A, Isler SC, Cula S, Tunc S, Yalim M, Cetiner D. Platform‐switched implants vs platform‐matched implants placed in different implant‐abutment interface positions: A prospective randomized clinical and microbiological study. Clin Implant Dent Relat Res 2019; 22:59-68. [DOI: 10.1111/cid.12873] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/28/2019] [Accepted: 11/13/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Ahu Uraz
- Department of Periodontology, Faculty of Dentistry Gazi University Ankara Turkey
| | - Sila C. Isler
- Department of Periodontology, Faculty of Dentistry Gazi University Ankara Turkey
| | - Serpil Cula
- Department of Insurance and Risk Management, Faculty of Commercial Sciences Baskent University Ankara Turkey
| | - Samet Tunc
- Department of Periodontology, Faculty of Dentistry Gazi University Ankara Turkey
| | - Mehmet Yalim
- Department of Periodontology, Faculty of Dentistry Gazi University Ankara Turkey
| | - Deniz Cetiner
- Department of Periodontology, Faculty of Dentistry Gazi University Ankara Turkey
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30
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Rosa EC, Deliberador TM, Nascimento TCDLD, Kintopp CCDA, Orsi JSR, Wambier LM, Khajotia SS, Esteban Florez FL, Storrer CLM. Does the implant-abutment interface interfere on marginal bone loss? A systematic review and meta-analysis. Braz Oral Res 2019; 33:e068. [PMID: 31576952 DOI: 10.1590/1807-3107bor-2019.vol33.0068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 06/13/2019] [Indexed: 11/22/2022] Open
Abstract
The objective of this systematic review was to compare the conical internal connection (IC) with the external hexagonal connection (EH) on the occurrence of marginal bone loss (ΔMBL). Different databases were used to carry out the selection of the elected studies. The studies were judged according to the risk of bias as "high", "low" and "unclear" risk. For the meta-analysis we included only studies that could extract the data of ΔMBL, survival rate (SR) and probing depth (PD). No statistically significant differences were found for ΔMBL data at one, three- and five-year survival rates between implant connections (p <0.05), however statistically significant differences were found for PD between EH and IC implants (1-year follow-up) -0.53 [95%CI -0.82 to -0.24, p = 0.0004]. This present systematic review demonstrated that there are no significant differences between IC and EH implants for both ΔMBL and SR at 1, 3 e 5 years after functional loading, although better PD values were observed for implants pertaining to the IC connections. Considering the high heterogeneity, more well-delineated, randomized clinical trials should be conducted.
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Affiliation(s)
- Enéias Carpejani Rosa
- Universidade Positivo, School of Health Sciences, Graduate Program in Dentistry, Curitiba, PR, Brazil
| | | | | | | | - Juliana Shaia Rocha Orsi
- Universidade Positivo, School of Health Sciences, Graduate Program in Dentistry, Curitiba, PR, Brazil
| | - Letícia Maíra Wambier
- Universidade Positivo, School of Health Sciences, Graduate Program in Dentistry, Curitiba, PR, Brazil
| | - Sharukh Soli Khajotia
- The University of Oklahoma Health Sciences Center, Division of Dental Biomaterials, Department of Restorative Sciences, Oklahoma City, Oklahoma, USA
| | - Fernando Luis Esteban Florez
- The University of Oklahoma Health Sciences Center, Division of Dental Biomaterials, Department of Restorative Sciences, Oklahoma City, Oklahoma, USA
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31
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Chan HL, George F, Wang IC, Suárez López Del Amo F, Kinney J, Wang HL. A randomized controlled trial to compare aesthetic outcomes of immediately placed implants with and without immediate provisionalization. J Clin Periodontol 2019; 46:1061-1069. [PMID: 31292983 DOI: 10.1111/jcpe.13171] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 06/13/2019] [Accepted: 07/06/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION There are mixed results regarding the aesthetic advantage of immediate provisionalization of dental implants. Therefore, this study aimed to compare facial mucosal level of single immediately placed implants with and without immediate provisionalization. METHODS Single implants were immediately placed to replace a hopeless maxillary anterior or premolar tooth in 40 subjects. Each implant was randomly assigned to receive a non-occluding temporary crown or a healing abutment after implant placement. At 4 months, these implants were permanently restored and followed up for 12 months. Clinical and radiographic parameters were measured and compared. RESULTS The implant survival rate at 12 months in the test and control group was 90% and 100%, respectively. Mid-facial mucosal marginal level and papilla height changes were minimal within groups, and no significant differences were found between the two groups. The amount of marginal bone remodelling was modest, with no significant difference between the two groups. Radiographic bone changes were not statistically different between the groups, except for the vertical crestal bone resorption. CONCLUSION Immediate implant placement with or without provisionalization can achieve stable vertical soft tissue level for 12 months as compared to pre-extraction level. However, immediate provisionalization was not able to improve the aesthetic outcome further.
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Affiliation(s)
- Hsun-Liang Chan
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Furat George
- Department of Biologic and Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - I-Ching Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | | | - Janet Kinney
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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32
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The Effect of Tapered Abutments on Marginal Bone Level: A Retrospective Cohort Study. J Clin Med 2019; 8:jcm8091305. [PMID: 31450607 PMCID: PMC6780335 DOI: 10.3390/jcm8091305] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/17/2019] [Accepted: 08/20/2019] [Indexed: 01/16/2023] Open
Abstract
Background: Early peri-implant bone loss has been associated to long-term implant-prosthetic failure. Different technical, surgical, and prosthetic techniques have been introduced to enhance the clinical outcome of dental implants in terms of crestal bone preservation. The aim of the present cohort study was to observe the mean marginal bone level around two-part implants with gingivally tapered abutments one year after loading. Methods: Mean marginal bone levels and change were computed following radiological calibration and linear measurement on standardized radiographs. Results: Twenty patients who met the inclusion criterion of having at least one implant with the tapered prosthetic connection were included in the study. The cumulative implant success rate was 100%, the average bone loss was −0.18 ± 0.72 mm, with the final bone level sitting above the implant platform most of the time (+1.16 ± 0.91 mm). Conclusion: The results of this cohort study suggested that implants with tapered abutments perform successfully one year after loading and that they are associated with excellent marginal bone preservation, thus suggesting that implant-connection macro-geometry might have a crucial role in dictating peri-implant bone levels.
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Leenaars CHC, Kouwenaar C, Stafleu FR, Bleich A, Ritskes-Hoitinga M, De Vries RBM, Meijboom FLB. Animal to human translation: a systematic scoping review of reported concordance rates. J Transl Med 2019; 17:223. [PMID: 31307492 PMCID: PMC6631915 DOI: 10.1186/s12967-019-1976-2] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/08/2019] [Indexed: 12/14/2022] Open
Abstract
Background Drug development is currently hampered by high attrition rates; many developed treatments fail during clinical testing. Part of the attrition may be due to low animal-to-human translational success rates; so-called “translational failure”. As far as we know, no systematic overview of published translational success rates exists. Systematic scoping review The following research question was examined: “What is the observed range of the animal-to-human translational success (and failure) rates within the currently available empirical evidence?”. We searched PubMed and Embase on 16 October 2017. We included reviews and all other types of “umbrella”-studies of meta-data quantitatively comparing the translational results of studies including at least two species with one being human. We supplemented our database searches with additional strategies. All abstracts and full-text papers were screened by two independent reviewers. Our scoping review comprises 121 references, with various units of measurement: compound or intervention (k = 104), study/experiment (k = 10), and symptom or event (k = 7). Diagnostic statistics corresponded with binary and continuous definitions of successful translation. Binary definitions comprise percentages below twofold error, percentages accurately predicted, and predictive values. Quantitative definitions comprise correlation/regression (r2) and meta-analyses (percentage overlap of 95% confidence intervals). Translational success rates ranged from 0 to 100%. Conclusion The wide range of translational success rates observed in our study might indicate that translational success is unpredictable; i.e. it might be unclear upfront if the results of primary animal studies will contribute to translational knowledge. However, the risk of bias of the included studies was high, and much of the included evidence is old, while newer models have become available. Therefore, the reliability of the cumulative evidence from current papers on this topic is insufficient. Further in-depth “umbrella”-studies of translational success rates are still warranted. These are needed to evaluate the probabilistic evidence for predictivity of animal studies for the human situation more reliably, and to determine which factors affect this process.
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Affiliation(s)
- Cathalijn H C Leenaars
- Department of Animals in Science and Society, Faculty of Veterinary Sciences, Utrecht University, Utrecht, The Netherlands. .,Institute for Laboratory Animal Science, Hannover Medical School, Hannover, Germany. .,SYRCLE, Department for Health Evidence (section HTA), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Carien Kouwenaar
- Department of Animals in Science and Society, Faculty of Veterinary Sciences, Utrecht University, Utrecht, The Netherlands
| | - Frans R Stafleu
- Department of Animals in Science and Society, Faculty of Veterinary Sciences, Utrecht University, Utrecht, The Netherlands
| | - André Bleich
- Institute for Laboratory Animal Science, Hannover Medical School, Hannover, Germany
| | - Merel Ritskes-Hoitinga
- SYRCLE, Department for Health Evidence (section HTA), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rob B M De Vries
- SYRCLE, Department for Health Evidence (section HTA), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Franck L B Meijboom
- Department of Animals in Science and Society, Faculty of Veterinary Sciences, Utrecht University, Utrecht, The Netherlands
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Durkan R, Oyar P, DESTE G. The Impact of Platform-Switched Implants on the Marginal Bone Level and Soft Tissue Dimensions. CUMHURIYET DENTAL JOURNAL 2019. [DOI: 10.7126/cumudj.505807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Can the Macrogeometry of Dental Implants Influence Guided Bone Regeneration in Buccal Bone Defects? Histomorphometric and Biomechanical Analysis in Beagle Dogs. J Clin Med 2019; 8:jcm8050618. [PMID: 31067735 PMCID: PMC6572352 DOI: 10.3390/jcm8050618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/05/2019] [Accepted: 05/05/2019] [Indexed: 12/12/2022] Open
Abstract
The aim of this experimental animal study was to assess guided bone regeneration (GBR) and implant stability (ISQ) around two dental implants with different macrogeometries. Forty eight dental implants were placed within six Beagle dogs. The implants were divided into two groups (n = 24 per group): G1 group implants presented semi-conical macrogeometry, a low apical self-tapping portion, and an external hexagonal connection (whereby the cervical portion was bigger than the implant body). G2 group implants presented parallel walls macrogeometry, a strong apical self-tapping portion, and an external hexagonal connection (with the cervical portion parallel to the implant body). Buccal (mouth-related) defects of 2 mm (c2 condition) and 5 mm (c3 condition) were created. For the control condition with no defect (c1), implants were installed at crestal bone level. Eight implants in each group were installed under each condition. The implant stability quotient (ISQ) was measured immediately after implant placement, and on the day of sacrifice (3 months after the implant placement). Histological and histomorphometric procedures and analysis were performed to assess all samples, measuring crestal bone loss (CBL) and bone-to-implant contact (BIC). The data obtained were compared with statistical significance set at p < 0.05. The ISQ results showed a similar evolution between the groups at the two evaluation times, although higher values were found in the G1 group under all conditions. Within the limitations of this animal study, it may be concluded that implant macrogeometry is an important factor influencing guided bone regeneration in buccal defects. Group G1 showed better buccal bone regeneration (CBL) and BIC % at 3 months follow up, also parallel collar design can stimulate bone regeneration more than divergent collar design implants. The apical portion of the implant, with a stronger self-tapping feature, may provide better initial stability, even in the presence of a bone defect in the buccal area.
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Acharya A, Leung MCT, Ng KT, Fan MHM, Fokas G, Mattheos N. Peri-implant marginal bone loss rate pre- and post-loading: An exploratory analysis of associated factors. Clin Oral Implants Res 2019; 30:410-419. [PMID: 30921476 DOI: 10.1111/clr.13424] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 02/21/2019] [Accepted: 03/05/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To perform an exploratory analysis of factors influencing annual rates of peri-implant marginal bone loss (RBL) calculated over different time frames, at implants unaffected by peri-implantitis. MATERIAL AND METHODS A total of 154 implants from 86 patients were reviewed at 1.6-6.8 years after placement. Marginal bone levels (MBL) were assessed on intraoral radiographs at three time-points: immediately post-placement, time of loading, and least 1-year post-loading. RBLs (mm/year) were computed using these three time frames and corresponding MBL changes as: RBL placement-loading, RBL loading-review, RBL placement-review. Exploratory ordination of three RBLs, corresponding time durations, and 17 background factors were used for visualization. Hierarchical linear mixed-effects models (MEM) with predictor selection were applied to RBL outcomes. The correlation of actual MBL with MBLs predicted by RBL placement-loading and RBL loading-review was tested. RESULTS Median RBL placement-loading was 0.9 mm/year (IQR = 2.02), loading-review was 0.06 mm/year (IQR = 0.16), and overall RBL placement-review was 0.21 mm/year (IQR = 0.33). Among-patient variance was highest for RBL placement-loading (SD = 0.66). Longer time predicted lower RBL in all time frames. Shorter time of loading significantly predicted lower RBL placement-review. Augmentation predicted lower RBL placement-loading, while anterior location and older age predicted lower RBLs placement-loading placement-review. Only MBL projected using RBL placement-loading significantly correlated with actual MBL. CONCLUSIONS Exploratory analysis indicated RBL varied with the time duration used for calculation in pre- and post-loading, and overall periods. In each period, RBL declined with increasing time. Earlier loading predicted lower overall RBL. Higher pre-loading RBL predicted worse actual bone level.
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Affiliation(s)
- Aneesha Acharya
- Implant Dentistry, Prosthodontics, Faculty of Dentistry, University of Hong Kong, Hong Kong SAR, China.,Department of Periodontology, Dr. D.Y.Patil Dental College and Hospital, Pimpri, Pune
| | - Ming Chi Terrence Leung
- Implant Dentistry, Prosthodontics, Faculty of Dentistry, University of Hong Kong, Hong Kong SAR, China
| | - King Tung Ng
- Implant Dentistry, Prosthodontics, Faculty of Dentistry, University of Hong Kong, Hong Kong SAR, China
| | - Michael H M Fan
- Implant Dentistry, Prosthodontics, Faculty of Dentistry, University of Hong Kong, Hong Kong SAR, China
| | - George Fokas
- Implant Dentistry, Prosthodontics, Faculty of Dentistry, University of Hong Kong, Hong Kong SAR, China
| | - Nikos Mattheos
- Implant Dentistry, Prosthodontics, Faculty of Dentistry, University of Hong Kong, Hong Kong SAR, China
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