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Bogner MS, Chambas V, Nicolas E, Faulks D, Hennequin M. Implant-supported prostheses in patients with special needs: A systematic literature review of protocols and outcomes. J Prosthet Dent 2023:S0022-3913(23)00628-5. [PMID: 37880026 DOI: 10.1016/j.prosdent.2023.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 10/27/2023]
Abstract
STATEMENT OF PROBLEM Implant-supported prostheses for individuals with special needs have been considered high-risk because of the prevalence of poor oral hygiene and parafunction in this population; however, systematic evidence on protocols and outcomes is scarce. PURPOSE The purpose of this systematic review was to summarize implant procedures and outcomes for the special needs population. MATERIAL AND METHODS A systematic literature review was conducted using PubMed, Embase, and Scopus databases in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) methodological framework. Data collected included patient information, location and number of implants, surgical and prosthetic procedures, behavior support techniques, postoperative follow-up, complications, and criteria for outcome assessment. Survival rates were pooled for quantitative analysis, and a separate analysis pooling data from groups of special needs patients that present similar risks was undertaken. RESULTS The qualitative analysis included 79 studies involving 759 patients and 2269 implants. The quantitative analysis included 65 studies concerning 666 patients with special needs and 1886 implants. The overall weighted implant survival rate was 95.4%, with a mean follow-up duration of 40.7 ±29.5 months. CONCLUSIONS In individuals with special needs considered suitable for implant-supported prostheses by their clinician, implant survival rates were similar to those reported in the general population. (J Prosthet Dent xxxx;xxx:xxx-xxx).
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Affiliation(s)
- Marie-Sophie Bogner
- Specialist, Centre for Research in Clinical Dentistry (CROC), University of Clermont Auvergne BP 10448, Clermont-Ferrand, France.
| | - Vivien Chambas
- Specialist, Centre for Research in Clinical Dentistry (CROC), University of Clermont Auvergne BP 10448, Clermont-Ferrand, France; and Private practice, Clermont-Ferrand, France
| | - Emmanuel Nicolas
- Professor, Centre for Research in Clinical Dentistry (CROC), University of Clermont Auvergne BP 10448, Clermont-Ferrand, France; and CHU Clermont-Ferrand, Service d'Odontologie, CHU Estaing, Clermont-Ferrand, France
| | - Denise Faulks
- Specialist Consultant, Centre for Research in Clinical Dentistry (CROC), University of Clermont Auvergne BP 10448, F-63000 Clermont-Ferrand, France; and CHU Clermont-Ferrand, Service d'Odontologie, CHU Estaing, Clermont-Ferrand, France
| | - Martine Hennequin
- Professor, Centre for Research in Clinical Dentistry (CROC), University of Clermont Auvergne BP 10448, Clermont-Ferrand, France; and CHU Clermont-Ferrand, Service d'Odontologie, CHU Estaing, Clermont-Ferrand, France
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Marques NP, Pérez-de-Oliveira ME, Normando AGC, Marques NCT, Epstein JB, Migliorati CA, Martelli-Júnior H, Ribeiro ACP, Rocha AC, Brandão TB, Sánchez FGV, Gueiros LAM, Lopes MA, Santos-Silva AR. Clinical outcomes of dental implants in head and neck cancer patients: An overview. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:42-53. [PMID: 36890080 DOI: 10.1016/j.oooo.2023.01.006] [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: 09/01/2022] [Revised: 01/03/2023] [Accepted: 01/17/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical outcomes of dental implants (DIs) in patients with head and neck cancer (HNC) treated with radiotherapy (RT), isolated chemotherapy, or bone modifying agents (BMAs). STUDY DESIGN This study was registered in the Prospective Register of Systematic Reviews (CRD42018102772); conducted via the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist; and based on PubMed, Scopus, Embase, Cochrane Library, Web of Science, and gray literature searches. The selection of studies was performed in 2 phases by 2 independent reviewers. The risk of bias (RoB) was assessed by the Measurement Tool to Assess the Methodological Quality of Systematic Reviews 2. RESULTS Twenty systematic reviews were included in the qualitative analysis. The majority scored as having high RoB (n = 11). Primary DIs placement in the mandible of patients with HNC subjected to RT doses <50 Gy was associated with better survival rates. CONCLUSIONS The placements of DIs could be considered safe in patients with HNC in sites of alveolar bone that received RT (≤5000 Gy); however, no conclusions could be made in patients with cancer managed by chemotherapy or BMAs. Due to the heterogeneity of studies included, the recommendation for DIs placement in patients with cancer should be carefully considered. Future better controlled randomized clinical trials are required to provide enhanced clinical guidelines for best patient care.
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Affiliation(s)
- Nelson Pereira Marques
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil; Dental School, University Center of Lavras, Lavras, Minas Gerais, Brazil.
| | - Maria Eduarda Pérez-de-Oliveira
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Ana Gabriela Costa Normando
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Nádia Carolina Teixeira Marques
- Dental School, University Center of Lavras, Lavras, Minas Gerais, Brazil; School of Nursing and Pharmacy, University Center of Lavras, Lavras, Minas Gerais, Brazil
| | - Joel B Epstein
- Oral Medicine Services, CA City of Hope National Medical Center, Duarte, CA, USA
| | - Cesar A Migliorati
- Department of Oral & Maxillofacial Diagnostic Sciences, University of Florida, Gainesville, FL, USA
| | - Hercílio Martelli-Júnior
- School of Nursing and Pharmacy, University Center of Lavras, Lavras, Minas Gerais, Brazil; Primary Care Postgraduate Program, State University of Montes Claros Unimontes, Montes Claros, Minas Gerais, Brazil
| | | | - Andre Caroli Rocha
- Divisão de Odontologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Thaís Bianca Brandão
- Serviço de Odontologia Oncológica, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | | | - Luiz Alcino Monteiro Gueiros
- Departamento de Clínica e Odontologia Preventiva, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Marcio Ajudarte Lopes
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
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Burtscher D, Dalla Torre D. Dental implant procedures in immunosuppressed organ transplant patients: a systematic review. Int J Oral Maxillofac Surg 2021; 51:380-387. [PMID: 34274207 DOI: 10.1016/j.ijom.2021.06.008] [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: 01/22/2021] [Revised: 06/27/2021] [Accepted: 06/30/2021] [Indexed: 12/25/2022]
Abstract
During the last decades, the number of immunosuppressed organ transplant patients has increased consistently. Nevertheless, immunosuppression has been discussed as a contraindication for dental implant procedures for many years. Hence, the purpose of this systematic review was to assess the survival rate and outcomes of dental implants after solid organ transplantation. An electronic and manual literature search was conducted up to March 2021. Publications describing dental implants placed in patients after organ transplantation were included without any limitations regarding study design or date of publication. Ten articles met the inclusion criteria, leading to a sample of 93 patients with 249 implants. Implant survival rates were 100% over a mean follow-up of 60 months. In every case, implant surgery was performed under antibiotic coverage. No major medication-related complications were reported. Despite the limited amount of evidence in the literature, implant procedures seem to be a safe treatment option in immunosuppressed organ transplant patients. The observance of appropriate treatment protocols including a strict maintenance programme seems to be crucial for the long-term success of such treatments. However, stringent data regarding various influencing factors such as the prevalence of peri-implantitis are still missing.
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Affiliation(s)
- D Burtscher
- University Clinic of Prosthodontics, Medical University Innsbruck, Innsbruck, Austria.
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Halpern LR, Adams DR. Medically Complex Dental Implant Patients: Controversies About Systemic Disease and Dental Implant Success/Survival. Dent Clin North Am 2020; 65:1-19. [PMID: 33213704 DOI: 10.1016/j.cden.2020.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Advances in dental implant therapy have created choices to enhance the expectations of dental practitioners and their patients with respect to oral rehabilitation at any age after childhood and regardless of, in most cases, medical disabilities. The medical status of the patient however can significantly influence the success rate of dental implant therapy. This article applies the hierarchy of scientific evidence ranging from case reports, retrospective, prospective cohort investigations, systematic reviews, and meta-analyses criteria in order to determine whether dental implant placement in medically compromised patients yields any detrimental sequelae.
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Affiliation(s)
- Leslie R Halpern
- Oral and Maxillofacial Surgery, University of Utah School of Dentistry, 530 South Wakara Way, Salt Lake City, UT 84108, USA.
| | - David R Adams
- Oral and Maxillofacial Surgery, University of Utah School of Dentistry, 530 South Wakara Way, Salt Lake City, UT 84108, USA
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Medikeri RS, Sinha KA. Sinus Floor Augmentation in Presence of Mucocele Eroding Maxillary Sinus Wall: A Case Report With 3 Years Follow-Up. Clin Adv Periodontics 2019; 10:81-87. [PMID: 31657529 DOI: 10.1002/cap.10083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 06/09/2019] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The maxillary mucocele is a slow-growing aggressive lesion and a mucous-containing sac lined with epithelium that occurs due to ductal obstruction and self-limiting injury. Rarely, it may be associated with non-specific symptoms. It is characterized by bone resorption due to its expanding behavior. Reduced height of bone and sinus pneumatization associated with pathologic lesions located in the floor of maxillary sinus may impede sinus augmentation. Therefore, careful diagnosis and management of pathology before sinus floor elevation is important in determining its recurrence and prognosis. CASE PRESENTATION We reported a case with small mucocele on right pneumatized antrum with insufficient residual bone height for implant placement. Radiograph in the region of teeth #3 and #4 revealed a homogeneous solitary radiopaque mass. Cone-beam computed tomography revealed irregular osteolysis of the lateral wall of the sinus. It was excised through Caldwell-Luc technique and simultaneous sinus augmentation was performed. Later, delayed implant restoration was performed. No complication or recurrence was reported during 36 months of follow-up. CONCLUSIONS The excision of mucocele on sinus floor and simultaneous sinus augmentation obviates the need for the extended treatment period. The clinician must be habituated with the anatomy and pathology of the maxillary sinus to evade any non-essential complications following lateral sinus floor augmentation procedure. A diminutive mucocele should not be regarded as a contraindication for sinus augmentation; sometimes it manifests with bone erosion. The prompt diagnosis and careful evaluation are needed to avoid future complications during implant therapy.
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Affiliation(s)
- Raghavendra S Medikeri
- Department of Periodontology, Sinhgad Dental College and Hospital, Pune, Maharashtra, India
| | - Kumar Ankit Sinha
- Department of Periodontology, Sinhgad Dental College and Hospital, Pune, Maharashtra, India
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de Oliveira-Neto OB, Santos IO, Barbosa FT, de Sousa-Rodrigues CF, de Lima FJC. Quality assessment of systematic reviews regarding dental implant placement on diabetic patients: an overview of systematic reviews. Med Oral Patol Oral Cir Bucal 2019; 24:e483-e490. [PMID: 31232387 PMCID: PMC6667003 DOI: 10.4317/medoral.22955] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 02/04/2019] [Indexed: 12/19/2022] Open
Abstract
Background Since implant placement on diabetic patients still is a controversial topic and systematic reviews are at the top of scientific evidence hierarchy, a thorough assessment of the methodological quality of these reviews must be performed to inform clinicians if their conclusions and recommendations can be followed on clinical practice. An overview of systematic reviews was performed with the purpose to assess the methodological quality of systematic reviews regarding dental implant placement on diabetic patients. In addition, we presented a synthesis of clinical outcomes about the focused theme. Material and Methods An online search was performed on MEDLINE via PubMed, EMBASE, DARE-Cochrane, Scopus, Web of Science, LILACS, and SIGLE via Open Grey. Searches were conducted from database inception to May 2018. Systematic review articles with or without meta-analysis about the placement of dental implants on diabetic patients were included. Exclusion criteria were: articles whose primary outcome was not the survival/success rate of dental implants on diabetic patients; studies that do not relate the survival/success rate of dental implants with diabetes; duplicated papers. Methodological quality assessment was performed with AMSTAR. A descriptive synthesis of clinical outcomes was performed. Results We identified 1.661 initial hits and eight articles were selected for overview (kappa=0.83; strong agreement). Six studies presented moderate methodological quality and two showed high methodological quality. Implant survival rate ranged from 31.8% to 100% and data from four meta-analysis showed that diabetes does not affect implant survival rate. On the other hand, data from two meta-analysis for marginal bone loss showed that diabetes statistically affects this outcome. Conclusions Two of the eight included studies presented high methodological quality and their meta-analysis showed that implant placement on diabetic patients does not affect implant survival rate and statistically affects marginal bone loss. However, clinicians must be aware that marginal bone loss values were not clinically relevant and may not be safe to follow the conclusions and recommendations of these studies. Key words:Dental implants, diabetes, systematic review, meta-analysis, survival rate.
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Affiliation(s)
- O-B de Oliveira-Neto
- Department of Morphology, Anatomy Area, Piracicaba School of Dentistry, University of Campinas, Av. Limeira, 901-Areião, Piracicaba, São Paulo, Brazil,
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Durham M, Brindis M, Egbert N, Halpern LR. Complex Dental Implant Cases: Algorithms, Subjectivity, and Patient Cases Along the Complexity Continuum. Oral Maxillofac Surg Clin North Am 2019; 31:219-249. [PMID: 30947848 DOI: 10.1016/j.coms.2018.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Algorithms for predictable outcomes, or checklists in health care, have been widely supported due to their highly effective outcomes. This article shares "algorithmic roadmaps" to restore single-tooth, partially edentulous, and fully edentulous complex dental implant cases in the patient population. A review of the current literature is presented to provide systematic assessments followed by criteria in a checklist format that allows the surgeon and restorative dentist to determine whether a removable or fixed implant prosthesis is the best patient option. Several cases have been chosen to illustrate the algorithms the authors used to provide an optimized prognosis for surgical/restorative success.
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Affiliation(s)
- Mark Durham
- Prosthodontist, University of Utah, School of Dentistry, 530 South Wakara Way, Salt Lake City, UT 84108, USA.
| | - Marco Brindis
- Louisiana State University, School of Dentistry, 1100 Florida Avenue, New Orleans, LA 70119, USA
| | - Nicholas Egbert
- Prosthodontist, University of Utah, School of Dentistry, 530 South Wakara Way, Salt Lake City, UT 84108, USA
| | - Leslie R Halpern
- Oral and Maxillofacial Surgery, University of Utah, School of Dentistry, 530 South Wakara Way, Salt Lake City, UT 84108, USA
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Yu H, Qiu L. Histological and clinical outcomes of lateral sinus floor elevation with simultaneous removal of a maxillary sinus pseudocyst. Clin Implant Dent Relat Res 2018; 21:94-100. [PMID: 30556644 DOI: 10.1111/cid.12708] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/15/2018] [Accepted: 08/17/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Maxillary sinus pathologies are a potential risk for failure of implant and bone augmentation. Management of lateral sinus floor elevation in the presence of a pseudocyst remains controversial, and reports on histological outcomes of endo-sinus bone augmentation with maxillary cysts are scarce. PURPOSE To present a modified surgical technique for removal of maxillary pseudocyst with simultaneous sinus floor elevation, and to evaluate clinical and histological outcomes of the bone grafting. MATERIALS AND METHODS Patients with a radiographic dome-shaped opacity in the posterior maxillary sinus were included to receive lateral sinus floor elevation with simultaneous pseudocyst removal. Bone core specimens harvested from the lateral aspect of the augmentation sites were histomorphometrically analyzed. Data were recorded and evaluated in terms of survival rates and complications. RESULTS A total of 15 patients were included who underwent 17 maxillary sinus augmentation surgeries. Implant survival rate was 97.0%. Bone biopsy specimens were obtained at 6 months after surgery. Histomorphometric analysis revealed that mean percentages of mineralized bone, bone substitute, and nonmineralized tissue were 24.9% ± 18.1%, 14.4% ± 12.5%, and 60.1% ± 12.44%, respectively. No recurrence of the pseudocyst was detected on radiographic examination. CONCLUSIONS The described technique could be successfully applied in clinical practice to perform sinus augmentation in the presence of pseudocysts.
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Affiliation(s)
- Huajie Yu
- Peking University Hospital of Stomatology Fourth Division, Beijing, China
| | - Lixin Qiu
- Peking University Hospital of Stomatology Fourth Division, Beijing, China
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Ridge Preservation Procedures after Tooth Extractions: A Systematic Review. Int J Dent 2018; 2018:8546568. [PMID: 30057608 PMCID: PMC6051091 DOI: 10.1155/2018/8546568] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/11/2018] [Accepted: 05/08/2018] [Indexed: 11/18/2022] Open
Abstract
Background The purpose of this systematic review was to accurately assess the procedural success of ridge preservation technique through the application of strict inclusion and exclusion criteria. Data Sources A methodical search of PubMed of the US National Library of Medicine and the Cochrane Central Register of Controlled Trials was conducted for applicable articles. Only randomized controlled trials comparing ridge preservation treatment with a nongrafting control, ten-subject minimum sample size, and three or more months of follow-up were included in our study. Types of Studies Reviewed In a screening between January 1980 and September 2017, articles meeting predetermined criteria were further examined in a qualitative data analysis. A thorough search of the databases provided 1876 articles. Of these records, 174 were assessed for eligibility through the systematic employment of inclusion and exclusion criteria. Results Two records were appropriate for further data analysis. One study used a mixture of a deproteinized cancellous bovine bone and porcine collagen fibers in a block form (DBB/CF), while the other study used leukocyte-platelet-rich fibrin (L-PRF). The use of DBB/CF reduced the magnitude of vertical bone resorption, yet the study showed high risk of bias. The use of L-PRF reduced the magnitude of both the horizontal and vertical crestal bone resorption; however, the low sample size created wide standard deviations between the test and control groups. Inherent weaknesses were present in both studies. Through methodical analysis of both records, the dissimilarities prevented the conduction of a meta-analysis. Implications of Key Findings Within the limitations of this systematic review, L-PRF reduced the magnitude of vertical and horizontal bone resorption, which places L-PRF as a potential material of choice for ridge preservation procedures. Conclusions Within the limitations and weaknesses of both studies, the use of DBB/CF prevented the vertical crestal bone resorption while the L-PRF prevented both the horizontal and vertical crestal bone resorption. More randomized controlled clinical trials are needed to eliminate all the confounding factors, which bias the outcome of ridge preservation techniques.
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Vissink A, Spijkervet FKL, Raghoebar GM. The medically compromised patient: Are dental implants a feasible option? Oral Dis 2018; 24:253-260. [DOI: 10.1111/odi.12762] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 08/09/2017] [Accepted: 08/09/2017] [Indexed: 12/17/2022]
Affiliation(s)
- A Vissink
- Department of Oral and Maxillofacial Surgery; University of Groningen and University Medical Center Groningen; Groningen The Netherlands
| | - FKL Spijkervet
- Department of Oral and Maxillofacial Surgery; University of Groningen and University Medical Center Groningen; Groningen The Netherlands
| | - GM Raghoebar
- Department of Oral and Maxillofacial Surgery; University of Groningen and University Medical Center Groningen; Groningen The Netherlands
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