1,720,980 research outputs found
Quantitative evaluation of implemented interproximal enamel reduction during aligner therapy: a prospective observational study
No full textObjectives: To investigate the correspondence between programmed interproximal reduction (p- IPR) and implemented interproximal reduction (i-IPR) in an everyday-practice scenario. The secondary objective was to estimate factors that might influence i-IPR to make the process more efficient. Materials and Methods: Fifty patients treated with aligner therapy by six orthodontists were included in this prospective observational study. Impressions were taken at the beginning of treatment and after the first set of aligners. Data on p-IPR, i-IPR and technical aspects of IPR were gathered for 464 teeth. Statistical analyses included the Wilcoxon signed-rank test, Kruskal-Wallis, and multilevel mixed regression. Results: Mean difference between p-IPR and i-IPR was 0.15 mm (SD: 0.14 mm; P = .0001), with lower canines showing the highest discrepancy. Use of burs and measuring gauges resulted in a smaller difference (respectively: coeff.: 0.09, P=.029; coeff.:-0.06, P=.013). IPR was performed more accurately on the mesial surface of teeth than on the distal surface. Round tripping before IPR resulted in a slightly more precise i-IPR compared to the previous alignment (coeff.: -0.021, P = .041). Conclusions: Implemented IPR tends to be less than p-IPR, especially for lower canines and distal surfaces of teeth. Burs tend to provide more precise i-IPR, especially compared to manual strips; however, there is variation between the techniques. Using a measuring gauge tends to increase the precision of i-iPR. As several factors influence the implementation of IPR, particular attention must be paid during the procedure to maximize its precision
FOUR-MM-LONG VERSUS LONGER IMPLANTS IN AUGMENTED BONE IN ATROPHIC POSTERIOR JAWS: THREE-YEAR POST-LOADING RESULTS FROM A MULTICENTRE RANDOMISED CONTROLLED TRIAL
No full textPURPOSE. To evaluate whether 4-mm-long dental implants could be an alternative to bone augmentation with xenografts and placement of implants of length at least 10 in posterior atrophic jaws. MATERIALS AND METHODS. Forty patients with atrophic posterior (premolar and molar areas) mandibles having 5 to 6 mm bone height above the mandibular canal and 40 patients with atrophic maxillae having 4 to 5 mm bone height below the maxillary sinus were randomised according to a parallel-group design to receive one to three 4.0-mm-long implants or one to three implants of length at least 10 mm in augmented bone at two centres. All implants had a diameter of 4.0 or 4.5 mm. Mandibles were vertically augmented with interpositional equine bone blocks and resorbable barriers. Implants were placed 4 months after grafting. Maxillary sinuses were augmented with particulated porcine bone via a lateral window covered with resorbable barriers, and implants were placed simulta-neously. Implants were not submerged. Four months later, screw-retained reinforced acrylic restorations were fitted, and replaced after 4 months by definitive screw-retained metal-composite prostheses. Patients were followed up to 3 years post-loading. Outcome measures were: prosthesis and implant failures, any complications, and peri-implant marginal bone level changes. RESULTS. Nine patients dropped out, six from the augmentation group and three from the short implant group. In six augmented mandibles (30%) it was not possible to place implants of length at least 10.0 mm, so shorter implants had to be placed instead. In man-dibles, two implants from the augmentation group failed in two patients, versus two 4.0-mm-long implants in two patients from the short implant group. In maxillae, four short implants failed in three patients versus seven long implants in four patients (two long implants and one short implant dropped into the maxillary sinus). Three prostheses on short implants (one mandibular and two maxillary) failed or were placed at a later stage due to implant failure, versus eight prostheses (three mandibular and five maxil-lary) at augmented sites. There were no statistically significant differences in implant failures (P [Fisher’s exact test] = 0.159; difference in proportion = 0.05; CI 95%-0.11 to 0.21) or prostheses failures (P [Fisher’s exact test] = 0.919; difference in proportion = 0.02; CI 95%-0.14 to 0.18). There were more patients affected by complications in the augmentation group (18 patients affected by 30 complications versus 8 patients affected by 10 complications), but the difference was not statistically significant (P [Fisher’s exact test] = 0.587; difference in proportion =-0.72; CI 95%-0.29 to 0.14). At 3 years post-loading, average peri-implant bone loss was 0.62 mm at 4-mm-long mandibular implants, 0.71 mm at 10-mm or longer mandibular implants, 1.14 mm at short maxillary implants and 0.73 mm at long maxillary implants. The difference was not statistically significant in mandibles (mean difference-0.08 mm, 95% CI-0.37 to 0.20, P [ANCOVA] = 0.568), but was significant in maxillae, with greater bone loss at short implants (mean difference 0.41 mm, 95% CI-0.04 to 0.87, P [ANCOVA] = 0.037). CONCLUSIONS. Three years after loading, 4.0-mm-long implants yielded similar, if not bet-ter, results than longer implants in augmented jaws, but were affected by fewer compli-cations. Hence, short implants may be preferable to bone augmentation, especially in mandibles, since the treatment is less invasive, faster, cheaper, and associated with less morbidity. However, 5-to 10-year post-loading data will be necessary to make reliable recommendations
Periodontal considerations in adult orthodontic patients
Full text linkThe relationship between periodontology and orthodontics consists of a highly complex, bidirectional and close interaction that is nowadays characterized by controversial scientific opinions and clinical approaches. The relevant increasing number of adult orthodontic patients which in most cases present already-compromised periodontal tissues has markedly highlighted the potential of orthodontic treatment in enhancing or deteriorating periodontal health and also the outmost relevance of peculiar periodontal planning prior and during orthodontic treatment. Since the progress in adult orthodontics trend is rapid, there is also an increasing need for evidence-based protocols that might guide clinicians through a comprehensive, interdisciplinary and successful treatment. This chapter has been compiled with the aim of providing orthodontists, periodontists and general practitioners with sound evidence-based protocols and valid clinical approaches that have proven to be successful for numerous patients over long follow-ups. It is structured following the steps for a correct therapy management, starting from comprehensive examination and diagnosis to before and during orthodontic treatment considerations, and finally analysing the present state of new adult orthodontic technologies
Regenerative surgical treatment of furcation defects: A systematic review and Bayesian network meta-analysis of randomized clinical trials
No full textAims: To investigate the clinical performance of regenerative periodontal surgery in the treatment of furcation defects versus open flap debridement (OFD) and to compare different regenerative modalities. Material and Methods: A systematic search was conducted to identify RCTs evaluating regenerative surgical treatment of furcations with a minimum of 12-month follow-up. Three authors independently reviewed, selected and extracted data from the search conducted and assessed risk of bias. Primary outcomes were tooth loss, furcation improvement (closure/conversion) (FImp), gain of horizontal bone level (HBL) and attachment level (HCAL). Secondary outcomes were gain in vertical attachment level (VCAL), probing pocket depth (PPD) reduction, PROMs and adverse events. Data were summarized into Bayesian standard and network meta-analysis in order to estimate direct and indirect treatment effects and to establish a ranking of treatments. Results: The search identified 19 articles, reporting on 20 RCTs (19 on class II, 1 on class III furcations) with a total of 575 patients/787 defects. Tooth loss was not reported. Furcation closure ranged between 0% and 60% (10 trials), and class I conversion from 29% to 100% (six trials). Regenerative techniques were superior to OFD for FImp (OR = 20.9; 90% CrI = 5.81, 69.41), HCAL gain (1.6 mm), VCAL gain (1.3 mm) and PPD reduction (1.3 mm). Bone replacement grafts (BRG) resulted in the highest probability (Pr = 61%) of being the best treatment for HBL gain. Non-resorbable membranes + BRG ranked as the best treatment for VCAL gain (Pr = 75%) and PPD reduction (Pr = 56%). Conclusions: Regenerative surgery of class II furcations is superior to OFD. FImp (furcation closure or class I conversion) can be expected for the majority of defects. Treatment modalities involving BRG are associated with higher performance
Immediate occlusal loading of one-piece zirconia implants: five-year radiographic and clinical evaluation.
No full textCRESTAL VERSUS LATERAL SINUS LIFT: ONE-YEAR RESULTS FROM A WITHIN-PATIENT RANDOMISED CONTROLLED TRIAL
No full textPURPOSE. To compare the effectiveness of and patient preference for crestal versus lateral sinus lift. MATERIALS AND METHODS. Fifteen partially edentulous patients missing bilateral maxillary molars and/or premolars and having 2 to 6 mm of residual crestal height below the maxillary sinuses were randomised to receive one to three implants placed in sinuses crestally or laterally lifted with bone substitutes according to a split-mouth design. Implants were submerged and loaded after 6 months with definitive screw-retained me-tal-ceramic prostheses, and patients were followed-up to 1 year after loading. RESULTS. Twenty crestal implants were placed versus 23 lateral ones. One patient dropped out and one lateral implant failed (n = 14; difference = 0.07, 95% CI from-0.28 to 0.13; P = 0.99). No prosthesis failed. Three patients were affected by three complications at crestal versus three patients by four complications at lateral sites. The difference was not statistically significant (n = 14; Diff = 0.07; 95% CI-0.24 to 0.38; P-value = 0.99). Statistically significantly less time was required to place crestal implants (28.2 versus 62.2 minu-tes on average; Diff = 33.4; SD = 12.1; 95% CI-40.4 to 26.4; P = 0.001). Eight patients preferred the crestal procedure and six had no preference. Crestal implants lost 0.99 mm (SD = 0.55) of peri-implant bone height versus 1.02 mm (SD = 0.57) for lateral ones, the difference being not statistically significant (0.03 mm; 95% CI of difference-0.52 to 0.59; P = 0.89) CONCLUSIONS. Both techniques produced successful outcomes, but the crestal technique required less surgical time and was preferred by patients
EFFECTIVENESS OF COMPUTER-ASSISTED ANESTHETIC DELIVERY SYSTEM (STATM) IN DENTAL IMPLANT SURGERY: A PROSPECTIVE STUDY
Full text linkObjectives. This prospective cohort study aimed to investigate effectiveness of Computerized Local Anesthesia (CLA) on oral implantology through estimation of pain and discomfort and total quantity of injected anesthetic.
Methods. Forty-five consecutive patients whose treatment plan included immediate or late dental implants were included in this study. The main inclusion criteria comprised: previous implant intervention under conventional anesthesia (CA) during the past 3 years and no previous treatment of pain relief. All patients reported on a 0-10 scale on previous experience with CA, and new experience with CLA. The same CLA system, namely Single Tooth Anesthesia (STA) was used for all patients with half of the quantity normally used for CA. Data on quantity of anesthetic and reported ratings were collected and described. Potential associations and determinant variables were analysed through correlation analysis and regression models.
Results. Out of 45 patients, 27 received post-extractive implant surgery whereas the rest 18 implant surgery on healed sites. The reported pain from STA (mean 1.6, SD 0.7) showed important difference as compared to CA (7.9, SD 1.2; z=5.873; p<0.0001). The comfort perceived during the STA ranged from 7 to 10 (mean 9.5, SD 0.79). A second injection with half of the initial dose was necessary in three cases only.
Conclusions. STA system proved to be effective during interventions of dental implantology, by markedly reducing patients’ pain and discomfort and the total quantity of necessary anesthetic
Dimensional changes of buccal bone plate in immediate implants inserted through open flap, open flap and bone grafting and flapless techniques: A cone-beam computed tomography randomized controlled clinical trial
No full textObjectives: To assess through cone-beam computed tomography (CBCT) buccal alveolar bone alterations after immediate implant placement using the following techniques: open flap and grafting (flap-graft), open flap and no grafting (flap-nograft) and flapless and no grafting (noflap-nograft). Materials and methods: This was a three-armed parallel group randomized clinical trial with allocation ratio 1:1:1. Patients were eligible in case they needed immediate implant replacing teeth in maxillary premolar area, with sufficient buccal bone support. CBCT was performed immediately after the intervention and 6 months later. The main outcomes were CBCT measurements performed at apical (A-EA), medial (M-EM) and external and internal implant bevel level (B-EB, B-IB) and vertical defect depth (DP). Pain and discomfort, time of surgery and complications were recorded. Differences between groups were estimated through ANOVA tests and post-hoc Scheffe's analysis for pairwise comparisons. Multiple regressions were conducted to estimate influence of gingival biotype and baseline marginal gap dimension. Results: Forty-five patients were recruited and randomized to treatments with one lost to follow-up. Analysis of variance showed that the effect of treatment technique was not relevant for all horizontal and vertical outcomes. The three techniques exhibited almost complete fill of marginal gap, with a mean residual vertical gap of 0.27 mm and horizontal gap of 0.5 mm. Regression models indicated a positive effect of thick biotype on gap filling and dimensional bone reduction. The noflap-nograft technique resulted less painful. Conclusions: The option of noflap-nograft surgery in post-extraction implants allows for minimal surgical intervention with comparable buccal bone changes and gap filling after a follow-up of 6 months in sites with sufficient buccal bone support
Design techniques to optimize the scaffold performance: Freeze-dried bone custom-made allografts for maxillary alveolar horizontal ridge augmentation
Full text linkThe purpose of the current investigation was to evaluate the clinical success of horizontal ridge augmentation in severely atrophic maxilla (Cawood and Howell class IV) using freeze-dried custom made bone harvested from the tibial hemiplateau of cadaver donors, and to analyze the marginal bone level gain prior to dental implant placement at nine months subsequent to bone grafting and before prosthetic rehabilitation. A 52-year-old woman received custom made bone grafts. The patient underwent CT scans two weeks prior and nine months after surgery for graft volume and density analysis. The clinical and radiographic bone observations showed a very low rate of resorption after bone graft and implant placement. The custom-made allograft material was a highly effective modality for restoring the alveolar horizontal ridge, resulting in a reduction of the need to obtain autogenous bone from a secondary site with predictable procedure. Further studies are needed to investigate its behavior at longer time periods
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