Comparison of the efficacy of different techniques to seal the alveolus during alveolar ridge preservation: Meta-regression and network meta-analysis

AIM

To evaluate the efficacy of different techniques to seal the alveolus (flap advancement [FA], open healing with barrier [OHB], and open healing without barrier [OHNB]) during alveolar ridge preservation (ARP) in terms of horizontal ridge width resorption.

MATERIALS AND METHODS

Randomized trials of at least 2 months duration comparing at least two techniques to seal the alveolus against each other or against spontaneous healing (SH) were eligible. Searches were conducted in MEDLINE via PubMed, EMBASE, Scopus, and Cochrane Central. Conventional meta-analysis, meta-regression, and network meta-analysis (NMA) were conducted, with clinical and tomographic ridge width changes as outcomes. Predictive intervals (95% PI) were reported.

RESULTS

Twenty-two studies were included, accounting for 52 study arms. Meta-regression identified that the socket sealing technique and publication year explained the observed heterogeneity. NMA showed that FA and OHB led to significantly lower ridge resorption than SH, resulting in 1.18 mm (95% PI 0.21-2.13) and 1.10 mm (95% PI 0.49-1.69) wide alveolar ridges, respectively. No significant difference between OHNB and SH was found (0.46 mm, 95% PI -0.70 to 1.64). The treatment with the largest probability for ARP was FA (52.7%), followed by OHB (39.1%) and OHNB (8.2%).

CONCLUSIONS

FA and OHB are efficacious techniques to seal the alveolus during ARP.

Surgical and non-surgical debridement for the treatment of peri-implantitis: a two-center 12-month randomized trial

OBJECTIVES

To compare surgical (ST) and non-surgical (NST) debridement for the treatment of peri-implantitis in a two-center randomized trial.

MATERIALS AND METHODS

Forty-five individuals with 63 implants with probing depth (PPD) ≥5mm, bleeding on probing (BOP), and radiographic bone loss ≥2mm were included. In the NST (30 implants), submucosal debridement was performed. In the ST (33 implants), a mucoperiosteal flap was raised and surfaces were decontaminated only by debridement as performed in NST. Clinical parameters and radiographs were compared at baseline and after 12 months. Means and standard errors were reported.

RESULTS

PPD considering all implant sites reduced significantly in NST from 4.14±0.25 to 3.25±0.18mm. In ST, PPD also significantly changed (3.74±0.22 to 3.00±0.29mm). No significant differences were observed between the two groups. For deep sites (≥7mm), PPD was 7.82±0.20mm at baseline and reduced to 5.10±0.30mm in NST, while in ST group, it was 7.11±0.11mm and changed to 5.22±0.91mm (between-groups p value=0.51). BOP significantly reduced from ~60 to 35% of all sites in both groups, without significant differences between them. When sites with radiographic bone level ≥3mm at baseline were analyzed, there was a significant difference between groups in bone gain after 12 months in favor of ST (ST=0.78±0.30mm compared to NST=0.25mm±0.13; p=0.03).

CONCLUSIONS

Surgical and non-surgical debridement for the treatment of peri-implantitis present similar clinical outcomes. Bone levels were better improved in ST than NST for sites with higher initial bone loss.

CLINICAL RELEVANCE

The treatment of peri-implantitis is still a challenge in clinical practice, since less than half of affected implants achieve health after surgical or non-surgical debridement. Considering the lack of clinically relevant differences between these two treatments, non-surgical debridement should be considered the first therapeutic choice for peri-implantitis, mainly mild to moderate cases.

ANTI-PLAQUE AND ANTI-GINGIVITIS EFFICACY OF DIFFERENT BRISTLE STIFFNESS AND END-SHAPE TOOTHBRUSHES ON INTERPROXIMAL SURFACES: A SYSTEMATIC REVIEW WITH META-ANALYSIS

OBJECTIVE

This systematic review aimed to evaluate the efficacy of interproximal plaque scores and gingival inflammation reduction of different toothbrush bristle stiffness and end-shape.

METHODS

Randomized clinical trials evaluating the effect of different toothbrushes on interproximal plaque/gingivitis reduction, with a minimum follow-up of 1 week. MEDLINE-PubMed, Scopus and Embase were searched. Soft tapered-tip bristle toothbrushes were compared to soft end-rounded, medium (any end-shape), or hard (any end-shape) bristle toothbrushes. Two meta-analyses were performed for plaque and gingivitis reduction. For plaque index (PI) and gingival index (GI), a standard mean difference (SMD) and mean difference between baseline and 4 weeks were calculated, respectively. In all analyses, random effect models were used.

RESULTS

Nine studies were included. All included studies demonstrated statistically significant improvement, in at least one parameter, in favor of the tapered-tip bristle toothbrush compared to the end-rounded bristle toothbrush. When analyzing toothbrush stiffness, medium and hard toothbrushes presented significantly higher improvement when compared to soft toothbrushes in all parameters. In the meta-analyses, groups that used soft tapered-tip bristle toothbrushes demonstrated significant greater reductions in PI (SMD -2.64; 95% CI: -4.26 - -1.01) and in GI (MD -0.14; 95% CI: -0.18 - -0.10) when compared to soft end-rounded bristle toothbrushes.

CONCLUSION

It is concluded that, when considering interproximal surfaces, better results may be expected for tapered-tip bristle toothbrushes when compared to end-rounded bristles toothbrushes. Additionally, better results may be expected in medium or hard toothbrushes, regardless of the bristle end-shape, in non-interproximal cleaners.