Andreas L. Ioannou

A Systematic Review of Observational Studies Evaluating Implant Placement in the Maxillary Jaws of Medically Compromised Patients

BACKGROUND Even though the efficacy of implant treatment and the excellent success rates that modern implant surfaces yield remain unchallenged, there is limited information available on implant success rates in medically compromised patients. PURPOSE The aim of this systematic review was to evaluate the survival of implants placed in the maxillary jaws of medically compromised patients. MATERIALS AND METHODS Two reviewers using predefined selection criteria performed an electronic search complemented by a manual search, independently and in duplicate. RESULTS After the final selection, 11 studies reporting on four distinct medical conditions were included out of 405 potentially eligible titles. In detail, three studies reported on implants placed in diabetic patients, six on implants placed in patients with a history of oral cancer, one on implants in patients with a history of epilepsy, and one on implants in patients with autoimmune rheumatoid arthritis. CONCLUSIONS Placement of maxillary implants in medically compromised patients seems to yield acceptable survival rates. Implant survival in well-controlled diabetic patients, patients diagnosed with rheumatoid arthritis, and patients treated for severe epilepsy is comparable to that in healthy patients. Implants placed in the maxillae of patients treated for oral cancer may attain osseointegration less predictably than in the mandible.

Prognostic factors in periodontal therapy and their association with treatment outcomes

During the incipient steps of periodontal treatment, clinicians are usually asked to predict the prognosis of teeth with compromised periodontium. The aim of this literature review was to investigate the association between periodontal Prognosis, Tooth Loss and risk indicators, such as smoking and genetics. Results showed that the definition of good prognosis has much higher predictability than the one for questionable prognosis. Several risk indicators for periodontal prognosis and tooth loss are discussed as well as different definitions of questionable prognosis and their success in predicting tooth loss. In conclusion, the major focus of future studies should be to construct simplified prognostic models with high predictability that will increase the confidence of dentists and periodontists when assigning teeth prognosis.

Soft Tissue Surgical Procedures for Optimizing Anterior Implant Esthetics.

Implant dentistry has been established as a predictable treatment with excellent clinical success to replace missing or nonrestorable teeth. A successful esthetic implant reconstruction is predicated on two fundamental components: the reproduction of the natural tooth characteristics on the implant crown and the establishment of soft tissue housing that will simulate a healthy periodontium. In order for an implant to optimally rehabilitate esthetics, the peri-implant soft tissues must be preserved and/or augmented by means of periodontal surgical procedures. Clinicians who practice implant dentistry should strive to achieve an esthetically successful outcome beyond just osseointegration. Knowledge of a variety of available techniques and proper treatment planning enables the clinician to meet the ever-increasing esthetic demands as requested by patients. The purpose of this paper is to enhance the implant surgeons rationale and techniques beyond that of simply placing a functional restoration in an edentulous site to a level whereby an implant-supported restoration is placed in reconstructed soft tissue, so the site is indiscernible from a natural tooth.

A clinical and radiographic case series of implants placed with the simplified minimally invasive antral membrane elevation technique in the posterior maxilla

The aim of the present case series was to evaluate a simplified minimally invasive transalveolar sinus elevation technique utilizing calcium phosphosilicate (CPS) putty for hydraulic sinus membrane elevation. The simplified minimally invasive antral membrane elevation technique is based on the application of hydraulic pressure via a viscous bone graft that acts as an incompressible fluid. In this retrospective study, 21 patients (mean age: 48.5 ± 12 years) consecutively treated with the simplified minimally invasive transalveolar sinus elevation technique were evaluated. 28 tapered implants were placed in posterior maxillary sites with less than 6 mm of residual bone height as determined radiographically on cone beam volumetric tomographs. No sinus membrane perforations were noted and none of the patients complained of symptoms of sinusitis post-operatively (0%). The mean gain in bone height post-operatively was 10.31 ± 2.46 mm (p < 0.001). All implants successfully integrated (100% success rate) and were loaded with cement-retained prostheses. The proposed technique is a simple, efficacious, minimally invasive approach for sinus elevation that can be recommended for sites with at least 3 mm of residual height.

Ridge Preservation Procedures after Tooth Extractions: A Systematic Review

Background The purpose of this systematic review was to accurately assess the procedural success of ridge preservation technique through the application of strict inclusion and exclusion criteria. Data Sources A methodical search of PubMed of the US National Library of Medicine and the Cochrane Central Register of Controlled Trials was conducted for applicable articles. Only randomized controlled trials comparing ridge preservation treatment with a nongrafting control, ten-subject minimum sample size, and three or more months of follow-up were included in our study. Types of Studies Reviewed In a screening between January 1980 and September 2017, articles meeting predetermined criteria were further examined in a qualitative data analysis. A thorough search of the databases provided 1876 articles. Of these records, 174 were assessed for eligibility through the systematic employment of inclusion and exclusion criteria. Results Two records were appropriate for further data analysis. One study used a mixture of a deproteinized cancellous bovine bone and porcine collagen fibers in a block form (DBB/CF), while the other study used leukocyte-platelet-rich fibrin (L-PRF). The use of DBB/CF reduced the magnitude of vertical bone resorption, yet the study showed high risk of bias. The use of L-PRF reduced the magnitude of both the horizontal and vertical crestal bone resorption; however, the low sample size created wide standard deviations between the test and control groups. Inherent weaknesses were present in both studies. Through methodical analysis of both records, the dissimilarities prevented the conduction of a meta-analysis. Implications of Key Findings Within the limitations of this systematic review, L-PRF reduced the magnitude of vertical and horizontal bone resorption, which places L-PRF as a potential material of choice for ridge preservation procedures. Conclusions Within the limitations and weaknesses of both studies, the use of DBB/CF prevented the vertical crestal bone resorption while the L-PRF prevented both the horizontal and vertical crestal bone resorption. More randomized controlled clinical trials are needed to eliminate all the confounding factors, which bias the outcome of ridge preservation techniques.