Ignacio Sanz-Sánchez

Principles in prevention of periodontal diseases Consensus report of group 1 of the 11th European Workshop on Periodontology on effective prevention of periodontal and peri-implant diseases

AIMS In spite of the remarkable success of current preventive efforts, periodontitis remains one of the most prevalent diseases of mankind. The objective of this workshop was to review critical scientific evidence and develop recommendations to improve: (i) plaque control at the individual and population level (oral hygiene), (ii) control of risk factors, and (iii) delivery of preventive professional interventions. METHODS Discussions were informed by four systematic reviews covering aspects of professional mechanical plaque control, behavioural change interventions to improve self-performed oral hygiene and to control risk factors, and assessment of the risk profile of the individual patient. Recommendations were developed and graded using a modification of the GRADE system using evidence from the systematic reviews and expert opinion. RESULTS Key messages included: (i) an appropriate periodontal diagnosis is needed before submission of individuals to professional preventive measures and determines the selection of the type of preventive care; (ii) preventive measures are not sufficient for treatment of periodontitis; (iii) repeated and individualized oral hygiene instruction and professional mechanical plaque (and calculus) removal are important components of preventive programs; (iv) behavioural interventions to improve individual oral hygiene need to set specific Goals, incorporate Planning and Self monitoring (GPS approach); (v) brief interventions for risk factor control are key components of primary and secondary periodontal prevention; (vi) the Ask, Advise, Refer (AAR) approach is the minimum standard to be used in dental settings for all subjects consuming tobacco; (vii) validated periodontal risk assessment tools stratify patients in terms of risk of disease progression and tooth loss. CONCLUSIONS Consensus was reached on specific recommendations for the public, individual dental patients and oral health care professionals with regard to best action to improve efficacy of primary and secondary preventive measures. Some have implications for public health officials, payers and educators.

Effectiveness of Lateral Bone Augmentation on the Alveolar Crest Dimension A Systematic Review and Meta-analysis

Lateral ridge augmentation procedures are aimed to reconstruct deficient alveolar ridges or to build up peri-implant dehiscence and fenestrations. The objective of this systematic review was to assess the efficacy of these interventions by analyzing data from 40 clinical studies evaluating bone augmentation through either the staged or the simultaneous approach. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guideline for systematic reviews was used. The primary outcomes were the changes at reentry, in the ridge width, and in the vertical and horizontal dimensions of the peri-implant defect, measured in millimeters, in the staged and simultaneous approaches, respectively. The results of the meta-analysis showed, for the simultaneous approach, a statistically significant defect height reduction when all treatments were analyzed together (weighted mean difference [WMD] = −4.28 mm; 95% confidence interval: [CI] –4.88, –3.69; P < 0.01). The intervention combining bone replacement grafts with barrier membranes was associated with superior outcomes The most frequently used intervention was the combination of xenograft and bioabsorbable membrane. Similarly, for the staged approach, there was a statistically significant horizontal gain when all treatment groups were combined (WMD = 3.90 mm; 95% CI: 3.52, 4.28; P < 0.001). The most frequently used intervention was the use of autogenous bone blocks. Both treatment strategies led to high survival and success rates (>95%) for the implants placed on the regenerated sites. Nonexposed sites gained significantly more in the simultaneous and staged approaches (WMD = 1.1 and 3.1 mm).

Clinical Efficacy of Subgingival Debridement With Adjunctive Erbium:Yttrium-Aluminum-Garnet Laser Treatment in Patients With Chronic Periodontitis: A Randomized Clinical Trial

BACKGROUND The efficacy of erbium:yttrium-aluminum-garnet (Er:YAG) laser application as an adjunct to subgingival debridement in the treatment of chronic periodontitis (CP) is controversial. This study assesses the efficacy of combining full-mouth subgingival debridement with Er:YAG laser application in the treatment of patients with CP. METHODS In this 12-month, single-masked, parallel-group clinical trial, 40 patients with moderate CP were selected and randomly assigned to a test group (one session of full-mouth ultrasonic subgingival debridement followed 1 week later by Er:YAG application in sites with initial probing depths [PDs] of ≥4.5 mm) and a control group (two sessions of ultrasonic debridement within 1 week). The main outcome variable was change in PD; the secondary outcomes were change in clinical attachment level and proportion of sites with bleeding on probing. Outcomes were assessed at baseline and after 3, 6, and 12 months. Data were analyzed as intention to treat using analysis of variance to assess intergroup differences. RESULTS Both treatments resulted in significant clinical improvements. The test group achieved, in comparison with the control, a significantly lower percentage of sites with PD ≥4.5 mm (17.44% versus 22.83%, respectively; P = 0.004) and a tendency for a lower percentage of sites with PD ≥4.5 mm and bleeding on probing (9.78% versus 12.69%; P = 0.052). CONCLUSION This limited added clinical effect may justify the use of a protocol combining full-mouth ultrasonic debridement with laser therapy in the treatment of initial moderate CP.

Effects of modified abutment characteristics on peri-implant soft tissue health: A systematic review and meta-analysis

Abstract Objectives The purpose of this systematic review was to evaluate the impact of the abutment characteristics on peri‐implant tissue health and to identify the most suitable material and surface characteristics. Methods A protocol was developed aimed to answer the following focused question: “Which is the effect of the modification of the abutment design in regard to the maintenance of the peri‐implant soft tissue health?” Further subanalysis aimed to investigate the impact of the abutment material, macroscopic design, surface topography and surface manipulation. Randomised controlled trials (RCTs) with a follow‐up of at least 6 months after implant loading were considered as inclusion criteria. Meta‐analyses were performed whenever possible. Results Nineteen final publications from thirteen investigations were included. The results from the meta‐analysis indicated that zirconia abutments (Zi) experienced less increase in BOP values over time [n = 3; WMD = −26.96; 95% CI (−45.00; −8.92); p = .003] and less plaque accumulation [n = 1; MD = −20.00; 95% CI (−41.47; 1.47); p = .068] when compared with titanium abutments (Ti). Bone loss was influenced by the method of abutment decontamination [n = 1; MD = −0.44; 95% CI (−0.65; −0.23); p < .001]. The rest of the studied outcomes did not show statistically significant differences. Conclusions The macroscopic design, the surface topography and the manipulation of the implant abutment did not have a significant influence on peri‐implant inflammation. In contrast, the abutment material demonstrated increased BOP values over time for Ti when compared to Zi abutments.

Translational Oral Health Research Implants and Bone Regeneration

Immediately after tooth extraction, physiological and eventually pathological changes affect the healing of the alveolar ridge. This three-dimensional shrinkage of the alveolar bone is determinant to the subsequent implant placement. Different surgical protocols have been proposed as a way to limit these dimensional changes and hence to optimize implant placement from an aesthetic, patient-friendly and long-term perspective. The evidence-based efficacy of these interventions, the indications and contraindications, and the advantages and disadvantages of the different methods are thoroughly discussed.

Randomized controlled clinical trial comparing two dental implants with different neck configurations: Sanz-Martín et al.

BACKGROUND Peri-implant bone levels can vary according to the implant neck macro-design and the implant-abutment interface. PURPOSE To compare the changes in soft and hard tissues when using a one-piece implant with a machined collar (TG) versus a two-piece implant with a progressive platform widening and a platform switching connection (SP). MATERIAL AND METHODS Partially edentulous patients willing to receive one or two implants in the posterior maxilla or mandible were randomized to the control (TG) or to the test group (SP). Final prostheses were delivered after 12 months. Radiographic measurements of interproximal bone levels (primary outcome) were assessed at implant loading and 1-year postloading. Clinical, patient related outcomes and adverse events were assessed at loading and after 6 and 12 months. RESULTS Sixty-one implants were placed in 47 patients, 37 patients (18 in the TG group and 19 in the SP group), and 47 implants (23 TG and 24 SP) completed the 24-months follow up. At the patient level, a significantly greater bone resorption from baseline to implant loading was observed in the SP group (-0.42 ± 0.45 vs -0.07 ± 0.45; P = .001*), while from loading to the final visit, the TG group had significantly greater bone loss than the SP group (-0.26 ± 0.22 vs -0.11 ± 0.2; P = .020*). At 24 months after surgery, there were no significant differences between both groups (control: 0.33 ± 0.49 vs test: 0.53 ± 0.53; P = .230). Similarly, no significant differences were observed for the secondary outcomes. CONCLUSIONS Both types of implant reported high survival rates and similar bone level changes, clinical parameters, and patient related outcomes after 12 months of loading.