This review, while affirming the evolution and the good results found with the actual approaches, emphasizes the negative aspects that still subsist. Thus, it shows that mandible reconstruction is not a closed issue. On the contrary, it remains as a research field where new findings could have a direct positive impact on patients' life quality. The identification of the persistent problems reveals the characteristics to be considered in a new prosthetic device. This could overcome the current difficulties and result in more comfortable solutions. Medical teams have the responsibility to keep patients informed about the predictable problems related with each elected approach, even understanding that a perfect reconstruction is a secondary goal when compared with maintenance of life.
ObjectivesTo assess the treatment outcomes of the dental implants placed in the grafted sockets.Material and MethodsA search protocol was developed to evaluate the treatment outcomes of dental implants placed in the grafted sockets in terms of implant survival rates (primary outcome), marginal-bone-level (MBL) changes, clinical parameters (i.e., bleeding on probing, probing depth), occurrence of peri-implant diseases, and aesthetic outcomes (secondary outcomes). Randomized controlled clinical trials (RCTs), controlled clinical trials, and prospective studies with at least 12 months of follow-up and a minimum of 10 patients having at least one dental implant inserted into the grafted socket were conducted. MEDLINE (PubMed) was searched for relevant articles published until 1st April 2019. A meta-analysis was performed using the random-effects model on the selected qualifying articles.ResultsThe present analysis included 7 RCTs. The survival rate of the implants inserted into the grafted sockets ranged from 95 to 100% after 1 to 4 years of follow-up. MBL loss was found to be significantly greater for the implants placed in the non-grafted healed sites than for those placed in the previously grafted sockets (weighted mean difference = -1.961 mm, P < 0.0001). In terms of MBL changes, no difference was detected between immediately inserted implants versus implants placed in previously grafted sockets. None of the included studies reported on the clinical parameters or occurrence of peri-implant diseasesConclusionsImplants inserted into the previously grafted sockets showed high survival rates and lower marginal-bone-level loss than the implants inserted into the non-grafted sites.
Owing to an increased demand for safe and esthetically pleasing dental materials, ceramics have been developed and optimized to rehabilitate anterior and posterior teeth. This evolution in ceramic materials is directly related to the development of sophisticated processing technologies and systems for use in dental medicine, particularly computer-aided design/computer-assisted manufacture (CAD/CAM) technology. This study is a systematic review outlining long-term clinical survival rates of single-tooth restorations fabricated with CAD/CAM technology with a minimum follow-up of 3 years. A bibliographic search up to September 2016 was performed using two databases: MEDLINE (PubMed) and Embase. Selected keywords and well-defined inclusion and exclusion criteria guided the search of relevant results. All articles were first reviewed by title, then by abstract, and subsequently by a full text reading. Data were assessed and extracted through a standardized form. The pooled results were statistically analyzed, and the overall failure rate was calculated by random effects model. Reported failures were analyzed by CAD/CAM system, type of restoration, restorative material, and luting agent. From a total of 2,916 single-tooth restorations with a mean exposure time of 7.0 years and 351 failures, the failure rate was 2.17% per year, estimated per 100 restoration years (95% confidence interval [CI]: 1.35% to 3.51%). The estimated total survival rate after 5 years was 89.7% (95% CI: 88.1% to 91.1%). The overall survival rate of single-tooth ceramic restorations fabricated with CAD/CAM technology was similar to those conventionally manufactured.
Background
Peri-implantitis is a biological complication that affects soft and hard tissues around dental implants. Implantoplasty (IP) polishes the exposed implant surface, to decontaminate it and make it less prone to bacterial colonization. This study investigates whether a higher clinical crown-to-implant-ratio (CIR) reduces implant fracture resistance and whether implants are more fracture-prone after IP in the presence of 50% of bone loss.
Methods
Forty-eight narrow platform (3.5 mm) 15 mm long titanium dental implants with a rough surface and hexagonal external connection were placed in standardized bone-like resin casts leaving 7.5 mm exposed. Half were selected for IP. The IP and control groups were each divided into 3 subgroups with different clinical CIRs (2:1, 2.5:1 and 3:1). The implant wall width measurements were calculated using the software ImageJ v.1.51 through the analysis of plain x-ray examination of all the samples using standardized mounts. A fracture test was performed and scanning electron microscopy was used to evaluate maximum compression force (Fmax) and implant fractures.
Results
IP significantly reduced the implant wall width (P < 0.001) in all reference points of each subgroup. Fmax was significantly higher in the 2:1 subgroup (control = 1276.16 N ± 169.75; IP = 1211.70 N ± 281.64) compared with the 2.5:1 (control = 815.22 N ± 185.58, P < 0.001; IP = 621.68 N ± 186.28, P < 0.001) and the 3:1 subgroup (control = 606.55 N ± 111.48, P < 0.001; IP = 465.95 N ± 68.57, P < 0.001). Only the 2.5:1 subgroup showed a significant reduction (P = 0.037) of the Fmax between the controls and the IP implants. Most fractures were located in the platform area. Only 5 implants with IP of the 2:1 CIR subgroup had a different fracture location (4 fractures in the implant body and 1 in the prosthetic screw).
Conclusions
IP significantly reduces the fracture resistance of implants with a 2.5:1 CIR. The results also suggest that the CIR seems to be a more relevant variable when considering the resistance to fracture of implants, since significant reductions were observed when unfavorable CIR subgroups (2.5:1 and 3:1 CIR) were compared with the 2:1 CIR samples.
Surface treatments are designed to promote modified implant surfaces with positive interactions with the surrounding living tissues. However, the inadvertent early contact of these surfaces with oral fluids during surgery may lead to undesired conditions affecting osseointegration. This study aimed to investigate the possible alterations in the physico-chemical properties of modified-surfaces caused by early saliva exposure. Titanium (Ti) surfaces were exposed to three different samples of human saliva and later analyzed for protein adhesion, physico-chemical surface alterations, and osteogenic cell-viability. The results indicated that surface roughness was the most significant factor influencing saliva protein adsorption; moreover, hydrophilic surfaces had critically lost their characteristics after contact with saliva. Decreased cell viability was observed in cultures after contact with saliva. Early contact with saliva might negatively influence modified surface properties and local cell viability. Careful surgical insertion of implants with hydrophilic surfaces is recommended, particularly in sites where saliva interaction is prone to occur.
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