Fawad Javed

The role of primary stability for successful immediate loading of dental implants. A literature review

OBJECTIVES To assess the role of primary stability for successful immediate loading (IL) of dental implants. DATA Original articles studying the role of primary stability for successful immediate loading of dental implants were included. The reference lists of potentially relevant review articles were also sought. SOURCES The MEDLINE-PubMed databases were searched for appropriate articles addressing the objectives of the present study. Databases were searched from 1979 up to and including April 2010. The search was performed using a variety of keywords in different combinations. Articles published only in English language were included. Letters to the Editor, historical reviews and unpublished articles were not sought. CONCLUSIONS There is a significant biological response by the hard and soft tissues to IL of dental implants. Within the limitations of the present literature review, it is evident that the core issue to observe during IL is the establishment of a good implant primary stability. There is sufficient evidence to suggest that the degree of achieved primary stability during IL protocols is dependent on several factors including bone density and quality, implant shape, design and surface characteristics and surgical technique. Further research is required in situations, such as poor bone quality and quantity and multiple implants or augmentation procedures, which may challenge the attainment of primary stability during IL.

Impact of Diabetes Mellitus and Glycemic Control on the Osseointegration of Dental Implants: A Systematic Literature Review

BACKGROUND Implant treatment is an attractive substitute to traditional fixed/removable prosthetic appliances. In patients with diabetes, dental implant therapy has been considered a contraindication. Hyperglycemia augments the severity of periodontal disease, and glycemic control is an essential variable in determining the success of dental implants in subjects with diabetes. Subjects with well-controlled diabetes may not be significantly compromised and can have high dental implant success rates compared to individuals with poorly controlled diabetes. The focused questions addressed in this systematic review were as follows: Can patients with diabetes be good candidates for dental implant therapy? And how does hyperglycemia and glycemic control influence osseointegration? METHODS A systematic literature search of MEDLINE/PubMed articles published from 1982 up to and including July 2009 was independently performed by two investigators. In addition, reference lists of original and review articles were searched. The search strategy was to use the following terms in different combinations: dental implants, immediate implants, osseointegration, periodontal disease, diabetes, hyperglycemia, metabolic control, and glycemic control. The search included studies on humans and diabetes-induced animal models. The selection criteria included all levels of available evidence. Suitable variables included the implant survival rate among individuals with diabetes, effects of hyperglycemia and glycemic control on bone, and maintenance of dental implants in subjects with diabetes. Articles published only in the English language were considered, and unpublished data were not sought. RESULTS We initially identified 33 studies. Fifteen studies, which did not fulfill the selection criteria, were excluded. The included studies reported that poorly controlled diabetes negatively affects implant osseointegration; however, under optimal serum glycemic control, osseointegration can successfully occur in patients with diabetes. Animal studies have confirmed that osseointegration can be successfully achieved in insulin-controlled rats with diabetes, whereas in uncontrolled rats with diabetes, the bone-to-implant contact appears to decrease with time. The use of antiseptic mouthrinses and oral-hygiene maintenance helps in achieving a successful dental implant osseointegration in subjects with diabetes. CONCLUSION A successful dental implant osseointegration can be accomplished in subjects with diabetes with good metabolic control (serum glycemic level and hemoglobin A1c in normal range) in a similar manner as in subjects without diabetes.

Osseointegration of Dental Implants in Patients Undergoing Bisphosphonate Treatment: A Literature Review

BACKGROUND Bisphosphonates (BPs) are an important group of drugs used for the treatment of metabolic and oncologic pathologies involving the skeletal system. Osteonecrosis of the jaw (ONJ) is a complication observed in patients using oral or intravenous (IV) BPs. It was suggested that all patients undergoing BP therapy who are expected to receive dental implants should be informed of the possible risks of development of ONJ. The aim of this literature review is to assess the osseointegration of dental implants in patients undergoing BP therapy. METHODS The MEDLINE-PubMed databases of The National Library of Medicine, National Institutes of Health, Bethesda, Maryland, were searched for articles addressing the focused question: Can dental implants osseointegrate and remain functionally stable in patients undergoing oral and IV BP therapy? Databases were searched from 1995 up to and including February 2010 using the following terms in different combinations: bisphosphonate, dental implant, immediate-loading, implant survival rate, intravenous, oral, osseointegration, and osteonecrosis. RESULTS The initial search yielded 89 articles. Scrutiny of the titles and abstracts reduced the number of articles to 12 (seven case reports and five retrospective studies). In 10 studies, the patients were using oral BPs, and in two studies, patients were using IV BPs. Six case reports showed that the placement of implants in patients using BPs could yield a successful osseointegration and function. Four retrospective studies demonstrated that BPs did not have a negative influence on implant success. Two studies showed a negative impact of BPs on implant success. CONCLUSION Dental implants can osseointegrate and remain functionally stable in patients using BPs.

Role of primary stability for successful osseointegration of dental implants: Factors of influence and evaluation

A secure implant primary (mechanical) stability is positively associated with a successful implant integration and long-term successful clinical outcome. Therefore, it is essential to assess the initial stability at different time-points to ensure a successful osseointegration. The present study critically reviews the factors that may play a role in achieving a successful initial stability in dental implants. Databases were searched from 1983 up to and including October 2013 using different combinations of various keywords. Bone quality and quantity, implant geometry, and surgical technique adopted may significantly influence primary stability and overall success rate of dental implants.

Cytokine profile in the gingival crevicular fluid of periodontitis patients with and without type 2 diabetes: a literature review.

BACKGROUND Periodontitis may occur in patients with and without type 2 diabetes (T2D). It may be hypothesized that the gingival crevicular fluid (GCF) cytokine profile in patients with periodontitis with poorly controlled T2D may differ from the GCF cytokine profile in medically healthy individuals with periodontitis. The aim was to review the cytokine profiles in the GCF of patients with periodontitis with and without T2D. METHODS Databases were searched from 1988 to August 2011 using different combinations of various keywords. Titles and abstracts of articles that satisfied the eligibility criteria were screened by the authors and checked for agreement. Only articles published in English were included. RESULTS Ten studies were included. Two studies reported GCF concentrations of interleukin (IL)-6 to be higher in patients with periodontitis with T2D compared to medically healthy patients with periodontitis. Two studies showed GCF IL-6 levels to be higher in periodontitis with T2D compared to medically healthy subjects without periodontitis. In one study GCF levels of IL-17, IL-23, and interferon-γ were higher in patients with periodontitis with T2D compared to medically healthy patients with periodontitis. In one study, GCF concentrations of IL-8 were significantly higher in patients with periodontitis with T2D compared to medically healthy individuals with periodontitis. Three studies reported GCF levels of IL-1α to be significantly higher in patients with periodontitis with T2D compared to medically healthy individuals with periodontitis. CONCLUSION The GCF cytokine profile in patients with and without T2D seems to be governed by the intensity of periodontal inflammation and the role of T2D in this regard is rather secondary.

Periodontal conditions, oral Candida albicans and salivary proteins in type 2 diabetic subjects with emphasis on gender

BackgroundThe association between periodontal conditions, oral yeast colonisation and salivary proteins in subjects with type 2 diabetes (T2D) is not yet documented. The present study aimed to assess the relationship between these variables in type 2 diabetic subjects with reference to gender.MethodsFifty-eight type 2 diabetic subjects (23 males and 35 females) with random blood glucose level ≥ 11.1 mmol/L were investigated. Periodontal conditions (plaque index [PI], bleeding on probing [BOP], probing pocket depth [PD] (4 to 6 mm and ≥ 6 mm), oral yeasts, salivary immunoglobulin (Ig) A, IgG and total protein concentrations, and number of present teeth were determined.ResultsPeriodontal conditions (PI [p < 0.00001], BOP [p < 0.01] and PD of 4 to 6 mm [p < 0.001], salivary IgG (μg)/mg protein (p < 0.001) and salivary total protein concentrations (p < 0.05) were higher in type 2 diabetic females with Candida albicans (C. albicans) colonisation compared to males in the same group. Type 2 diabetic females with C. albicans colonisation had more teeth compared to males in the same group (p < 0.0001).ConclusionClinical and salivary parameters of periodontal inflammation (BOP and IgG (μg)/mg protein) were higher in type 2 diabetic females with oral C. albicans colonisation compared to males in the same group. Further studies are warranted to evaluate the association of gender with these variables in subjects with T2D.

Periodontal conditions and oral symptoms in gutka-chewers with and without type 2 diabetes

Objective. The aim of the study was to investigate the periodontal conditions and oral symptoms among gutka-chewers in subjects with and without type 2 diabetes (T2D). Material and methods. Subjects aged between 45 and 64 years were included. “Gutka-chewers” were defined as subjects who had been chewing at least one sachet of gutka daily for at least 12 months. Subjects who reported never to have used tobacco in any form were categorized as “non-chewers”. Periodontal conditions (plaque index [PI], bleeding on probing [BOP], and probing depth [PD] [4 mm<6 mm and ≥6 mm]), number of missing teeth, oral symptoms, reasons for gutka use, and random blood glucose levels were recorded. Exclusion criteria were smoking and use of antibiotics, non-steroidal anti-inflammatory drugs, and steroids. Results. Mean durations of gutka use in subjects with and without T2D were 10.5 (range 8.0–15.5 years) and 8.4 (range 6.0–20.2 years) years correspondingly. In subjects with T2D, gutka-chewers (n=29) and non-chewers (n=44) showed no difference in periodontal conditions, missing teeth, and gingival bleeding. In subjects without T2D, gutka-chewers (n=36) had increased PI (p<0.01), BOP (p<0.001), PD (4 mm<6 mm) (p<0.01), number of missing teeth, and gingival bleeding (p<0.01) compared to non-chewers (n=42). Non-chewers in subjects with T2D had poorer periodontal conditions and increased oral symptoms compared to gutka-chewers and non-chewers in subjects without T2D. Conclusion. In subjects without T2D, gutka-chewers have severe periodontal conditions and oral symptoms compared to non-chewers. In subjects with T2D, the severity of these variables is related to glycemic levels rather than gutka consumption.

Effect of Cigarette Smoking on the Clinical Outcomes of Periodontal Surgical Procedures

Introduction:Experimental studies have revealed that nicotine upregulates the expression of receptors of advanced glycation end products and retards fibroblastic cell migration in the gingiva of smokers compared with nonsmokers, thereby inducing a proinflammatory effect. The aim of this study was to review the effect of cigarette smoking on the clinical outcomes of periodontal surgical procedures. Methods:To address the focused question, “What is the effect of cigarette smoking on clinical outcomes after periodontal surgical interventions?”, databases were searched from 1968 to May 2010 using various combinations of the following key words: inflammation, mucoperiosteal flap, periodontal surgery, smoking and tobacco. The inclusion criteria included all levels of available evidence. Articles published only in the English language were evaluated, and unpublished data were not sought. Results:Twenty-four clinical studies were included. The duration of smoking habit ranged from at least 5 years to 27.8 years. Sixteen studies showed that reductions in probing depth and gains in clinical attachment levels were compromised in smokers in comparison with nonsmokers. Three studies showed residual recession after periodontal surgical interventions to be significantly higher in smokers compared with nonsmokers. Three case reports showed periodontal healing to be uneventful in smokers. Conclusion:Cigarette smoking has a negative effect on periodontal wound healing after surgical interventions.

Implant surface morphology and primary stability: is there a connection?

Purpose:The aim was to review the influence of surface morphology on the primary stability of dental implants. Methods:MEDLINE-PubMed databases were explored from 1991 up to and including April 2010 using different combinations of the following terms: “dental,” “implant surface roughness,” “immediate loading,” “initial stability,” “primary stability,” and “osseointegration.” Articles published only in English language were included and hand searching was also performed. Letters to the Editor and unpublished data were excluded. Results:Ten studies (three clinical and seven experimental) were included according to the search databases. In six studies (three experimental and three clinical), the implant stability was measured at least after 4 weeks after implant insertion; and primary implant stability was recorded in four experimental studies, using the insertion and removal torque tests and resonance frequency analysis using implant stability quotient values. Conclusion:Rough-surfaced implants have significantly higher success rates compared with dental implants with smooth surfaces; however, the question “Is there a connection between implant surface roughness (microdesign) and primary stability?” remains unanswered.

A short-term evaluation of Nd:YAG laser as an adjunct to scaling and root planing in the treatment of periodontal inflammation.

BACKGROUND This split-mouth, single-masked, randomized, controlled clinical trial compares the short-term outcomes of a combined treatment with scaling and root planing (SRP) and neodymium-doped:yttrium, aluminum, and garnet (Nd:YAG)-laser irradiation with treatment with SRP alone. METHODS Thirty patients were recruited. The mandibular left or right side was randomly assigned as the test side (SRP with laser treatment) or control side (SRP alone). The water-cooled Nd:YAG laser was used at 4 W, 80 mJ/pulse, 50 Hz, and with a pulse width of 350 micros. At baseline, gingival crevicular fluid (GCF) samples were taken from the test and control sides, and levels of matrix metalloproteinase (MMP)-8 and interleukin (IL)-1beta, -4, -6, and -8 were measured using standard techniques. The plaque index (PI), gingival index (GI), and probing depth (PD) were measured by calibrated examiners. RESULTS At the 1-week follow-up, PD (P <0.001), PI (P <0.05), and GCF volume (P <0.001) showed significant improvement on test sides compared to control sides. At the 3-month follow-up, PD (P <0.01), PI (P <0.01), GI (P <0.01), and GCF volume (P <0.05) also showed significant improvement on test sides compared to control sides. At the 1-week follow up, IL-1beta and MMP-8 levels were significantly reduced on test sides compared to control sides. The 3-month follow-up confirmed that the improvements on test sites had been sustained compared to the treatment outcomes of control sites. CONCLUSION In the short-term, SRP in combination with a single application of a water-cooled Nd:YAG laser significantly improves clinical signs associated with periodontal inflammation compared to treatment with SRP alone.