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Purpose: To assess the accuracy of totally guided implant placement with static surgical splints in relation to the different types of supporting tissues (tooth, mucosa, or bone). Materials and Methods: This review was carried out following the PRISMA guidelines. An electronic search was done of the MEDLINE (PubMed), Embase, and Cochrane Library databases, without publication year or language restrictions. Results: The literature search yielded a total of 877 articles; 18 were included in the qualitative synthesis, and 16 of these articles were included in the quantitative analysis. The included studies presented a high risk of bias, except for one randomized clinical trial. The strength of the recommendations is therefore weak. In the angular deviation treatment, statistically significant differences were observed in the accuracy of the implants with tooth vs bone support: Bone support yielded 1.31 degrees greater deviation vs tooth support (SD = 0.43; 95% CI: 0.47, 2.15, P = .002). No significant differences were observed in the linear deviations. Conclusion: Tooth support proved to be significantly more precise than bone support splints. There were no differences referring to horizontal coronal deviation, horizontal apical deviation, or vertical deviation according to the type of splint support used. [ABSTRACT FROM AUTHOR]

Objective: To compare patient satisfaction during surgery, postoperative pain and inflammation and quality of life between high‐speed drilling with irrigation and low‐speed drilling without irrigation for implant bed preparation. Materials and Methods: Sixty‐six posterior single edentulous patients were included in a randomized controlled clinical trial. Implant beds were created using high‐speed drilling with irrigation (control group) or low‐speed drilling without irrigation (test group). Patient satisfaction during surgery (in relation to drilling‐time perception, vibration, pressure, noise, comfort, and drowning sensation) and postoperative pain and inflammation were evaluated using a 100‐mm visual analogue scale (VAS)‐based questionnaire. Quality of life was analyzed with a Likert scale (in relation to mouth opening, chewing, speaking, sleeping, daily routine, and job). The follow‐up period was 7 days. Results: Patient satisfaction in relation to drilling‐time perception, vibration, pressure, and noise did not show statistically significant differences (p >.05). The highest scores of drowning sensation (p <.05) were correlated (moderate correlation (r =.57)) with lowest scores of comfort (p <.005). Both postoperative pain and inflammation means were significantly higher in the control group than in the test group. No significant differences in quality of life were observed during the postoperative period (p >.05). Conclusion: Low‐speed drilling without irrigation for single implant site preparation was more comfortable for patients than high‐speed drilling with irrigation, due to the correlation between important drowning sensation and low perceived comfort. Postoperative pain and inflammation were lower for low‐speed drilling without irrigation. Further studies are needed to validate or refute these results. [ABSTRACT FROM AUTHOR]

Purpose: A systematic review was performed of the dimensional changes in facial cortical bone following implant placement into healed ridges, with the aim of establishing a minimum bone thickness that limits such changes. The influence of such bone remodeling upon the soft tissues and implant survival was also evaluated. Materials and Methods: A search was done of two electronic databases (MEDLINE via PubMed and CENTRAL), complemented by a manual search and lists of references. The risk of bias and methodological quality were assessed using the Cochrane Collaboration tool, the Methodological Index for Non-randomized Studies (MINORS), and the Quality Appraisal Checklist for Case Series. Results: The search yielded 536 publications, of which 11 (four randomized clinical trials, two non-randomized clinical trials, and five case series) were entered in the review. All the included studies reported vertical and horizontal implant facial bone resorption. Decreased facial bone thickness was correlated with increased vertical bone resorption, which in turn was associated with slight soft tissue retraction. A meta-analysis could not be performed, due to the heterogeneity of the study designs and measurement sites. Conclusion: No minimum facial bone thickness was seen that would completely avoid peri-implant bone loss and maintain soft tissue stability. However, a thickness of approximately 2 mm was associated with diminished vertical bone resorption and less peri-implant mucosal recession. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the 5-year outcome of a previously reported case series of patients with severely atrophic maxillae treated with palatally positioned implants and fixed full-arch rehabilitations. Materials and Methods: A retrospective cross-sectional clinical study of patients treated between January 2000 and January 2004 with palatally positioned implants was carried out. The parameters evaluated at the 5-year follow-up visit were: implant success rate, peri-implant soft-tissue conditions, biological and prosthetic post-loading complications, radiographic peri-implant marginal bone loss, and patient satisfaction. Results: A total of 33 patients with 151 palatally positioned implants were included in the study; 15 patients had received cemented prostheses and 18 had received screwed full-arch prostheses. The success rate for palatally positioned implants after 5 years was 98.7%. Average peri-implant mucosa retraction was 0.39 ± 0.94 mm and the average probing depth was 2.89 ± 0.77 mm. Plaque Index was 0 in 63.1% of the implants, 1 in 18.8%, 2 in 8.7%, and 3 in 9.4%. The modified Bleeding Index was 0 in 71.1%, 1 in 14.1%, and 2 in 14.8%. Mucositis was found in 5.2% of the implants and none had peri-implantitis. Prosthetic complications occurred in 12.1% of the cases. Average peri-implant marginal bone loss was 1.03 ± 1.28 mm. General patient satisfaction averaged 8.2 ± 1.8 according to a 10-point visual analog scale, and good quality of life was reported by most patients. Conclusions: Palatally positioned implants were found to be an adequate treatment for patients with severely atrophic maxillae. A high implant success rate, good peri-implant soft tissue stability, low marginal bone loss, high patient satisfaction and few complications were registered. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the clinical, microbiologic, and host response characteristics (interleukins 1β and 6) in the peri-implant sulcus fluid (PISF) of patients with healthy dental implants and with peri-implant mucositis.Materials and Methods: Clinical parameters (modified Gingival Index [mGI], modified Plaque Index [mPI],probing pocket depth [PPD], and absence or presence of radiologic bone loss) were recorded, and PISF samples were obtained from peri-implant sites showing mucositis as well as healthy sites. The periodontopathogenic bacteria Tannerella forsythia (Tf), Treponema denticola (Td), and Porphyromonas gingivalis (Pg) were evaluated, together with the total bacterial load (TBL) and the interleukin (IL) 1βand IL-6 values. Results: The study population consisted of 34 individuals, and 77 dental implants were evaluated during the study (23 mucositis and 54 healthy peri-implant sites). The mGI, mPI, and PPD scores of the peri-implant mucositis group were significantly greater than in the healthy group. No differences in detection frequency were found for putative periodontal pathogens and TBL between the healthy peri-implant sites and mucositis sites. The mucositis group showed a significantly greater expression of IL-6 than the healthy group (P < .05). Although IL-1β was increased in the mucositis group, there was no statistically significant difference versus the healthy implant group. Conclusions: An analysis was made of the clinical, microbiologic, and host response characteristics in implants with peri-implant mucositis, establishing comparisons with healthy implants. In the patients studied, bacterial plaque induced an inflammatory response that can lead to the development of peri-implant mucositis. Adequate plaque control is therefore able to increase peri-implant health, avoiding the risk of future complications. No specific association to the studied bacterial species was established. [ABSTRACT FROM AUTHOR]

Background: Clinical evidence of the autologous platelet concentrates effects on the patient-reported outcome measures (PROMs) after endodontic surgery is still limited. Objectives: To investigate the effect of the advanced platelet-rich fibrin (A-PRF+) membrane application upon patient postoperative pain, and quality of life in endodontic surgery. Materials and methods: A two-parallel-arm randomized clinical trial was made comparing endodontic surgery with or without A-PRF+ as adjunctive treatment. Fifty individuals comprehending 50 apical lesions (second premolar to the second premolar) of upper maxilla were included. Pain perception and quality of life (functional limitations and other symptoms) were assessed 1 week after surgery using a visual analog scale and a Likert scale-based questionnaire. Descriptive analysis was done using χ2 and t test. Binary logistic regression, ANOVA-type statistic, and GEE analysis were used for inferential analysis. Results: Pain perception was mild in both groups [A-PRF+ 12.7 ± 8.5] versus [no A-PRF+ 20.7 ± 16.3]; it proved less variable during the first 4 days in test group, showing lower extreme pain values (p = 0.096). Analgesic use was similar in both groups. Controls reported significantly worse sleep and speech functions (p < 0.05). Bleeding and bad taste/breath were the most discriminative symptoms. Conclusions: Postoperative pain perception was mild in endodontic surgery of the upper anterior maxilla. Differences in pain perception were not statistically significant. The use of A-PRF+ afforded less variable pain perception than in the controls. Altered quality of life parameters were more prevalent in the control group and prove significant for speech and sleep functions. Clinical relevance: Patient-related outcomes are of utmost importance in clinical practice. The use of A-PRF+ provides an affordable and safe alternative to improve postoperative quality of life in endodontic surgery. [ABSTRACT FROM AUTHOR]

Purpose: To describe implant survival at least 1 year after the surgical treatment of early apical peri-implantitis (EAP) and explore potential risk factors of failure of such treatment. Materials and methods: An ambispective cohort study was conducted, involving all patients in whom EAP was detected and surgically treated between 1996 and 2016. Reporting followed the STROBE guidelines. The time from implant placement (IP) to EAP surgery (EAPS), the diagnostic stage and intraoperative variables (location, apical lesion in the tooth being replaced, mesial and distal tooth-implant distance measured at the apex, periapical surgery of the adjacent tooth, guided bone regeneration, implant resection, explantation) were recorded to determine their impact upon treatment outcome. Results: The initial sample consisted of 58 implants in 46 patients. The mean time from IP to EAPS was 21.7 ± 10.1 days. At the time of surgery, eight implants presented mobility and were explanted. The final sample consisted of 50 implants in 39 patients evaluated for implant survival after surgical treatment. A cumulative survival rate of 78.3% was recorded. The mean survival time of the EAP treated implants was 85.4 months (standard deviation [SD] 5.94). The diagnostic stage (P < 0.001) and the existence of a previous periapical lesion in the tooth being replaced (P = 0.022) had a significant influence upon implant survival. Conclusions: The cumulative survival rate was 78.3%, with a mean survival time of 85.4 months. The diagnostic stage of EAP and the presence of a lesion in the tooth being replaced significantly influenced the survival of implants with EAP subjected to surgical treatment. [ABSTRACT FROM AUTHOR]

Purpose: To explore risk indicators potentially associated with early apical peri-implantitis (EAP). Materials and methods: A retrospective survey was performed in 2017 with recorded information from patients receiving dental implants between 1996 and 2016. Reporting follows the STROBE (strengthening the reporting of observational studies in epidemiology) guidelines. Data were collected from the medical histories and radiographs: diagnosis of EAP (health/disease), gender, age, type of surgery (immediate/delayed placement), implants placed (position, width, length, location, mesial and distal tooth-implant distance measured at the apex, state of the adjacent tooth and tooth being replaced, and surgical complications. Once the EAP had developed, data were collected regarding days of evolution, symptoms, signs and radiological findings. Results: A total of 2548 patients (57.1% females and 42.9% males) with 8110 implants were enrolled in the study. 46 patients with 58 implants were diagnosed with EAP -- 23 in the maxilla (39.6%) and 35 in the mandible (60.4%) -- between 6 and 50 days after implant placement, with a mean period of 21.7 days (SD 10.1). The frequency of EAP was 1.81% in patients and 0.71% in implants. Immediate placement multiplied the odds of developing EAP 21-fold (95% CI 6.74 to 65.7; P < 0.001) versus delayed placement. The existence of an apical lesion in the tooth being replaced multiplied the odds of developing EAP 26.3-fold (95% CI 4.24 to 162.8; P < 0.001). Replacing a tooth endodontically treated increased the odds 3.48 times (95% CI 0.99 to 12.3; P = 0.052). The presence of an adjacent endodontically treated tooth increased the odds 0.97-fold (95% CI 0.26 to 3.60; P = 0.963). An apical mesial distance of ≤ 1.5 mm increased the odds up to 5.12-fold (95%CI 2.12 to 12.4; P < 0.001). Conclusions: The presence of endodontic periapical lesions or endodontic treatment in the tooth being replaced, immediate implant placement or mesial tooth-implant distance measured at the apex were significantly associated with increased odds of EAP. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to compare marginal bone loss and success rates 1 year after implants had been placed in maxillary molar sites, either immediately postextraction or after the extraction sites had healed (delayed). Materials and Methods: A retrospective case study was made of subjects treated with immediate or delayed dental implants in the maxillary molar region between January 2006 and December 2008. A protocol was prepared in which patient age, sex, implant length and diameter, type of prosthesis, buccal plate width, and use of bone grafting were recorded. After 12 months, data relating to the clinical and radiologic conditions of the implants and the success rate according to the criteria of Buser et al were recorded. The variables were analyzed statistically (Student t test, Pearson correlation, Games- Howell test). Results: The study included 123 implants placed in 70 patients; 35 implants were immediate and 88 were delayed. Two immediate and six delayed implants failed, resulting in success rates of 94.3% and 93.2%, respectively. Average marginal bone loss was 0.56 mm for immediate implants and 0.67 mm for delayed implants. Conclusions: The placement of immediate implants in maxillary molar sites achieved similar results to implants placed in healed sites in the same region after 12 months. No statistically significant differences were found between implant survival rates or average marginal bone loss. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the present study was to determine bone density in designated implant sites using cone beam computed tomography (CBCT) and to evaluate possible correlations between age, gender, insertion torque measurements, and resonance frequency analysis (RFA) values. Materials and Methods: Completely and partially edentulous patients were treated with implants between 2007 and 2008 and evaluated retrospectively. The preoperative examination included a panoramic radiograph, CBCT, diagnostic casts, and a clinical examination of the jaws. With the CBCT scans, bone densities were recorded in Hounsfield units (HU). Insertion torque values and implant stability measurements (via RFA) were also noted. Results: Mean bone density and insertion torque values were 623 ± 209 HU and 42.4 ± 4 Ncm, respectively, for the 82 implants placed. Mean primary stability (implant stability quotient) was 62.4 ± 8. The differences in mean bone density at implant sites in the mandible (717 ± 204 HU) and the maxilla (490 ± 128 HU) were statistically significant for all patients (P < .05). There was a statistically significant relationship between bone density values and insertion torque measurements for implant sites in the anterior mandible (r = 0.562, P < .05), as well as between bone density and RFA values for men (r = 0.412, P < .05). Conclusions: Bone density measurements using preoperative CBCT may be helpful as an objective diagnostic tool. These values, in conjunction with RFA values and insertion torque measurements, can provide the implant surgeon with an objective assessment of bone quality and may be especially useful where poor-quality bone is suspected. [ABSTRACT FROM AUTHOR]

Purpose: To assess the prevalence of radiographic signs of maxillary sinus pathology in patients undergoing dental implant treatment and to compare the efficacy of panoramic radiography, computed tomography (CT), and three-dimensional (3D) CT with Implametric software in the diagnosis of sinus pathology. Materials and Methods: Thirty patients were selected at random from those being treatment-planned to receive implant-supported restorations in the maxilla and who had a panoramic radiograph, a conventional CT scan in acetate, and a 3D CT scan in digital format. The radiographic maxillary sinus findings were categorized as: (1) no sign of pathology, (2) mucosal thickening, (3) mucous cyst, or (4) occupation of the entire sinus. Results: Seventeen women and 13 men were included, with a mean age of 50.9 years. There was a 38.3% prevalence of radiographic abnormalities (23.3% mucosal thickenings, 10% mucous cysts, and 5% occupation of the entire sinus). Of the 23 sinuses that displayed radiographic signs of pathology, only 1 (4.3%) was correctly diagnosed by the panoramic radiograph. Conclusions: The most common radiographic maxillary sinus finding was mucosal thickening, followed by mucous cysts and occupation of the whole sinus. Conventional CT can be considered a reliable method for the diagnosis of maxillary sinus pathology. [ABSTRACT FROM AUTHOR]