Purpose The aim of this systematic review was to determine the most effective alveolar augmentation technique for vertical bone gain. Materials and Methods A systematic search to select clinical trials and retrospective studies done on patients with reduced vertical bone height was conducted. The intervention of interest was autogenous block graft done compared to procedures such as distraction osteogenesis (DO), particulate grafting, block plus particulate grafting with titanium mesh, and tent pole technique in systematically healthy adult patients age 18 and older. The following electronic databases were explored: PubMed, CINAHL, and Dental and Oral Science. A supplementary manual search of published full‐text articles from January 2005 to December 2017 was done using Google Scholar. Grey literature was also sought using greylit.org. The review protocol was registered at the Prospero registry (CRD # 42017072432). The risk of bias of the included studies was assessed using EPOC criteria. Meta‐analysis was performed using Review Manager for studies with quantitative data on mean values of vertical bone gain and bone resorption achieved with various bone augmentation techniques. Random effect model was used. Heterogeneity among studies was evaluated using the I2 statistic. Results A total of 2322 articles were found. After excluding the irrelevant papers, only 8 papers were finally selected for the detailed evaluation. Of these 8, 5 were clinical trials, and 3 were retrospective studies. Four studies were on DO, 2 on particulate grafting, 1 on autogenous block grafting plus particulate grafting, and 1 on tent pole grafting. The control group in all studies were autogenous block graft. Meta‐analysis revealed no significant difference between DO and autogenous block grafting for vertical bone gain (mean difference 0.82 [–1.28, 2.91]). Similarly, no significant difference was observed in the 2 techniques for bone resorption (mean difference 0.38 [–0.23, 0.99]). Conclusions DO was not superior to autogenous block grafting for vertical bone augmentation. Both techniques were associated with a number of complications. There was no difference in the bone resorption observed in the 2 techniques. No conclusive results can be drawn on other techniques on account of limited data.
Immature necrotic permanent tooth presents a distinctive challenge for the endodontist. Various treatment modalities have been employed to create hard tissue barrier at the apex, which includes non-vital pulp therapy with calcium hydroxide, apexification with mineral trioxide aggregate, pulp revascularisation and regeneration. Regenerative endodontics is a novel modality which involves physiological replacement of the damaged structures of tooth like dentin, root and cells of the pulp-dentin complex. Numerous published case reports have revealed increased dentinal wall thickness, continued root development and apical closure, but there is still lack of sound scientific evidence regarding histological nature of the type of tissue. The current literature review was planned to summarise the evidence regarding the treatment of immature necrotic permanent teeth by regenerative endodontic procedures.
Background and Aim: Gingival hyperpigmentation is an esthetic problem. The aim of the present study was to identify most effective treatment modality for managing generalized physiological gingival pigmentation. Materials and Methods: A systematic review and meta-analysis were done (1919 to October 2018) using PubMed, CINHAL, Dental and Oral Science, and manual searches. Twenty-five articles were finally reviewed. Only human clinical trials were considered with physiological gingival pigmentation treated with different depigmentation methods and compared with surgical stripping. The outcome was the achievement of gingival depigmentation and its recurrence. RevMan software was used for data analysis. Results: Of 26,132 articles, 25 met the inclusion criteria. Seventeen were randomized control trials and 8 were nonrandomized control trials. Most of the studies were on laser. The control group was scalpel surgery. Majority of studies showed no difference in compared treatment modality. A meta-analysis compared laser ablation with surgical stripping revealed a nonsignificance difference regarding recurrence ( P = 0.75) and depigmentation ( P = 0.23) and a statistically significant difference regarding postoperative pain favoring laser ablation ( P ≤ 0.05). Conclusions: Surgical stripping has been the conventional treatment of choice, but our review showed that new techniques are equally effective or even better. Laser especially diode laser was the most frequently used technique and showed better esthetic outcomes, less pain, faster healing, and patients' preference and satisfaction after treatment. However, laser showed more regimentation at 6-month evaluation. More good quality randomized controlled trials with different depigmentation methods are needed to draw strong conclusions.
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