Overall there was no convincing evidence of a clinically important difference in prosthesis failure, implant failure, or bone loss associated with different loading times of implants. More well-designed RCTs are needed and should be reported according to the CONSORT guidelines (www.consort-statement.org/).
Flapless implant placement is feasible and has been shown to reduce patient postoperative discomfort in adequately selected patients. There is insufficient reliable evidence to provide recommendations on which are the best incision/suture techniques/materials, or whether techniques to correct/augment perimplant soft tissues or to increase the width of keratinized/attached mucosa are beneficial to patients or not. Properly designed and conducted RCTs are needed to provide reliable answers to these questions.
Stem cells are undifferentiated cells, capable of renewing themselves, with the capacity to produce different cell types to regenerate missing tissues and treat diseases. Oral facial tissues have been identified as a source and therapeutic target for stem cells with clinical interest in dentistry. This narrative review report targets on the several extraoral- and intraoral-derived stem cells that can be applied in dentistry. In addition, stem cell origins are suggested in what concerns their ability to differentiate as well as their particular distinguishing quality of convenience and immunomodulatory for regenerative dentistry. The development of bioengineered teeth to replace the patient's missing teeth was also possible because of stem cell technologies. This review will also focus our attention on the clinical application of stem cells in dentistry. In recent years, a variety of articles reported the advantages of stem cell-based procedures in regenerative treatments. The regeneration of lost oral tissue is the target of stem cell research. Owing to the fact that bone imperfections that ensue after tooth loss can result in further bone loss which limit the success of dental implants and prosthodontic therapies, the rehabilitation of alveolar ridge height is prosthodontists' principal interest. The development of bioengineered teeth to replace the patient's missing teeth was also possible because of stem cell technologies. In addition, a “dental stem cell banking” is available for regenerative treatments in the future. The main features of stem cells in the future of dentistry should be understood by clinicians.
Materials and Methods: One-hundred-twenty patients with any type of edentulism (single tooth, partial and total edentulism) requiring one implant-supported prosthesis were randomly allocated in two equal groups to receive either implants with external connection EC) or implants of the same type but with internal connection (IC) (EZ Plus, MegaGen Implant, Gyeongbuk, South Korea) at four centres. Due to slight differences in implant design/components IC implants were platform switched while EC were not. Patients were followed for 10 years after initial loading. Outcome measures were: prosthesis/implant failures, any complication, marginal bone level changes assessed by blinded outcome assessors, when possible.Results: Sixty patients received 96 EC implants and 60 patients 107 IC implants. Eight patients dropped-out from the EC group and nine from the IC group, but all remaining patients were followed up to 10-year post-loading. Two EC patients experienced implant and prosthetic failures versus three IC patients (P = 0.631, diff = 0.02, 95% CI: -0.07 to 0.11).Fifteen complications occurred in 13 EC patients versus 13 complications in 11 IC patients (P = 0.720, diff. = -0.03, 95% CI: -0.19 to 0.13). There were no statistically significant differences for prosthesis and implant failures and complications between the different connection types. Ten years after loading, there were no statistically significant differences in marginal bone level estimates between the two groups (diff. = 0.07 mm, 95% CI: -0.41 to 0.54 mm, P (ancova) = 0.782) and both groups lost bone from implant placement in a statistical significant way: 1.01 mm for the EC implants and 1.27 mm for the IC implants.Conclusions: Within the limitations given by the difference in neck design and platform switching between EC and IC implants, 10-year postloading data did not show any statistically significant differences between the two connection types, therefore clinicians could choose whatever they prefer.
Conflict of interest statement:This trial was partially funded by MegaGen Implant, Gyeongbuk, South Korea, the manufacturer of the implants evaluated in this investigation, however data belonged to the authors and by no means did the manufacturer interfere with the conduct of the trial or the publication of the results.
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