Jaime L. Lozada

Outcomes of root canal treatment and restoration, implant-supported single crowns, fixed partial dentures, and extraction without replacement: a systematic review

STATEMENT OF PROBLEMnDentists and patients are regularly confronted by a difficult treatment question: should a tooth be saved through root canal treatment and restoration (RCT), be extracted without any tooth replacement, be replaced with a fixed partial denture (FPD) or an implant-supported single crown (ISC)?nnnPURPOSEnThe purpose of this systematic review was to compare the outcomes, benefits, and harms of endodontic care and restoration compared to extraction and placement of ISCs, FPDs, or extraction without tooth replacement.nnnMATERIAL AND METHODSnSearches performed in MEDLINE, Cochrane, and EMBASE databases were enriched by hand searches, citation mining, and expert recommendation. Evidence tables were developed following quality and inclusion criteria assessment. Pooled and weighted mean success and survival rates, with associated confidence intervals, were calculated for single implant crowns, fixed partial dentures, and initial nonsurgical root canal treatments. Data related to extraction without tooth replacement and psychosocial outcomes were evaluated by a narrative review due to literature limitations.nnnRESULTSnThe 143 selected studies varied considerably in design, success definition, assessment methods, operator type, and sample size. Direct comparison of treatment types was extremely rare. Limited psychosocial data revealed the traumatic effect of loss of visible teeth. Economic data were largely absent. Success rates for ISCs were higher than for RCTs and FPDs, respectively; however, success criteria differed greatly among treatment types, rendering direct comparison of success rates futile. Long-term survival rates for ISCs and RCTs were similar and superior to those for FPDs.nnnCONCLUSIONSnLack of comparative studies with similar outcomes criteria with comparable time intervals limited comparison of these treatments. ISC and RCT treatments resulted in superior long-term survival, compared to FPDs. Limited data suggested that extraction without replacement resulted in inferior psychosocial outcomes compared to alternatives. Long-term, prospective clinical trials with large sample sizes and clearly defined outcomes criteria are needed.

Facial Gingival Tissue Stability After Connective Tissue Graft With Single Immediate Tooth Replacement in the Esthetic Zone: Consecutive Case Report

PURPOSEnThe present consecutive case report evaluated facial gingival tissue stability after immediate tooth replacement with connective tissue grafting in the esthetic zone. The implant success rate and peri-implant tissue response were also recorded.nnnPATIENTS AND METHODSnA total of 20 consecutive patients with a mean age of 52.3 years (range 28 to 71), who had undergone 20 single immediate tooth replacement with connective tissue grafting, were evaluated clinically and radiographically at the preoperative examination, immediately after implant placement and provisionalization with connective tissue grafting, and at the latest follow-up appointment. The data were analyzed using the t test and Wilcoxon signed rank test at a significance level of alpha = .05.nnnRESULTSnAt the preoperative examination, a thick gingival biotype was observed in 8 patients and a thin gingival biotype in 12. At a mean follow-up of 2.15 years (range 1 to 4), all implants were functioning and exhibited a thick biotype. At the latest follow-up appointment, no significant differences (P > .05) were found between the initially thick and thin gingival biotypes in the mean mesial marginal bone level changes (-0.53 versus -0.55 mm), the mean distal marginal bone level changes (-0.50 versus -0.44 mm), and the mean facial gingival level changes (+0.23 mm versus +0.06 mm). The frequency distribution of the papilla index score showed that peri-implant papillae were well preserved at the latest follow-up visit.nnnCONCLUSIONSnWith proper 3-dimensional implant positioning and bone grafting into the implant-socket gap, the facial gingival level can be maintained after connective tissue grafting with single immediate tooth replacement, regardless of the initial gingival biotype, indicating that the thin gingival biotype can be converted to the thick gingival biotype morphologically and behaviorally with this procedure. Nevertheless, careful patient selection and treatment planning, as well as immaculate execution by skillful clinicians, are required to achieve a successful result.

Effects of smoking on implant success in grafted maxillary sinuses

STATEMENT OF THE PROBLEMnCigarette smoking has been identified as a significant risk factor for dental implant treatment.nnnPURPOSEnThis retrospective study evaluated the effect of smoking and the amount of cigarette consumption on the success rates of the implants placed in grafted maxillary sinuses.nnnMATERIAL AND METHODSnSixty patients (16 smokers and 44 nonsmokers) were evaluated for the effects of smoking on osseointegrated implants placed in 84 grafted maxillary sinuses that contained a total of 228 endosseous root-form implants. Seventy implants were placed in 26 maxillary sinuses in smokers, whereas 158 implants were placed in 58 sinuses in nonsmokers. The number of implant failures and the amount of cigarette consumption were recorded.nnnRESULTSnOf the 228 implants, 205 (89.9%) remained in function, after a mean follow-up period of 41.6 months (2 to 60 months). There was a significantly higher cumulative implant success rate in nonsmokers (82.7%) than in smokers (65.3%) (P =.027). Overall cumulative implant success rate was 76%. There was no correlation between implant failures and the amount of cigarette consumption (P >.99).nnnCONCLUSIONnWithin the limitations of this study, cigarette smoking appeared to be detrimental to the success of osseointegrated implants in grafted maxillary sinuses regardless of the amount of cigarette consumption.

Horizontal ridge augmentation with a collagen membrane and a combination of particulated autogenous bone and anorganic bovine bone-derived mineral: a prospective case series in 25 patients.

This prospective case series evaluated the use of a resorbable natural collagen membrane with a mixture of autogenous bone and anorganic bovine bone-derived mineral (ABBM) for lateral ridge augmentation and subsequent implant placement. A mixture (1:1) of particulated autogenous bone and ABBM was used for lateral ridge augmentation and covered with a resorbable, natural collagen bilayer membrane to treat knife-edge ridges and prepare them for implant placement. Ridge measurements were obtained pre- and postsurgery, complications recorded, and biopsy specimens examined histologically. Seventy-six implants were placed in 25 patients with 31 knife-edge ridge surgical sites. One defect had a bone graft complication (3.2%; exact 95% confidence interval: 0.1%, 16.7%). Clinical measurements revealed an average of 5.68 mm (standard deviation [SD] = 1.42 mm) of lateral ridge augmentation after a mean 8.9-month (SD = 2.1 months) graft healing period. Clinically, all treated ridges were sufficient in width for subsequent implant placement. All implants survived with an average follow-up of 20.88 months (SD = 9.49 months). Histologic analysis of nine surgical sites showed that ABBM was connected with a dense network of newly formed bone with varying degrees of maturation. Histomorphometric analysis demonstrated that autogenous bone represented a mean of 31.0% of the specimens, ABBM 25.8%, and marrow space 43.2%. The treatment of horizontally deficient alveolar ridges with the guided bone regeneration technique using autogenous bone mixed with ABBM and a natural collagen resorbable barrier membrane can be regarded as successful. Implant success and survival need to be confirmed with long-term follow-up examinations.

Immediate Loading of a Single Hydroxyapatite-Coated Threaded Root Form Implant: A Clinical Report

The successful results of endosseous root form implants in the treatment of partially and completely edentulous patients has been made possible by the application of standardized surgical and prosthetic protocols. Different techniques have been published in the literature with the purpose of reducing implant prosthetic rehabilitation times. This clinical case report describes a new surgical concept and a technique to fabricate screw-retained provisional crowns for immediate loading of free-standing single tooth implants. Further clinical and histologic studies are necessary in order to promote routine clinical application of this technique.

The use of resorbable collagen membrane in conjunction with autogenous bone graft and inorganic bovine mineral for buccal/labial alveolar ridge augmentation: A pilot study ☆

STATEMENT OF PROBLEMnNo study provides human histologic evidence regarding the use of resorbable collagen membrane for a 2-stage localized alveolar augmentation procedure.nnnPURPOSEnThe purpose of this pilot study was to evaluate the potential of use of a resorbable collagen membrane in conjunction with an autogenous bone graft and inorganic bovine mineral (IBM) for labial/buccal alveolar ridge augmentation prior to placing dental implants. Material and methods Seven consecutively treated human patients participated in the study. All patients received labial/buccal alveolar ridge augmentation. An autogenous block graft was secured at the recipient site with fixation screws and a mixture of autogenous particulate with IBM was placed at the periphery. Resorbable collagen membrane was used as a barrier. Radiographic and laboratory measurements were made to quantify ridge augmentation and resorption rate. Preoperative and postoperative stone casts were used to quantify alveolar ridge augmentation. Volumetric evaluation was measured in mL whereas linear laboratory evaluation was measured in millimeters. Measurements were made 1 and 6 months after bone grafting. Histologic and histomorphometric analysis from the grafted area evaluated new bone formation, and osteoconductivity of IBM.nnnRESULTSnFor all patients Type II to III bone quality was achieved at the augmented sites. The implant survival rate was 100% at second-stage surgery. No complication was observed at the recipient sites. Radiographic evaluation revealed 4.65 mm labial/lingual augmentation, whereas laboratory analysis revealed 4.57 mm. Volumetric laboratory analysis demonstrated 1.00 (+/- 0.29) mL alveolar ridge augmentation 6 months after bone grafting and 13.79% resorption between months 1 and 6. Histomorphometric analysis revealed that on average, the area occupied by bone was 34.28% (range 24 to 50; +/-9.05),] soft tissue 46.00% (+/-9.20%; range 30% to 55%), and IBM particles 19.71% (+/-11.74%, range 3% to 42%). The proportion of the surface of the IBM particles in contact with bone was 47.14% (range 15% to 64%; SD 17.21%).nnnCONCLUSIONSnResorbable collagen membranes may be used as barriers for labial/buccal alveolar ridge augmentation procedures.

Effects of connective tissue grafting on the facial gingival level following single immediate implant placement and provisionalization in the esthetic zone: a 1-year randomized controlled prospective study.

PURPOSEnThis 1-year randomized controlled prospective study evaluated the implant success rate and peri-implant tissue response following single immediate implant placement and provisionalization (IIPP) with and without subepithelial connective tissue graft (SCTG) in the esthetic zone.nnnMATERIALS AND METHODSnImplants were placed either IIPP with SCTG (test group) or IIPP without SCTG (control group). The implants were evaluated both clinically and radiographically before surgery, immediately after implant placement, and 3, 6, and 12 months after implant placement. Data were analyzed using Friedman, Wilcoxon signed-rank, and Mann-Whitney U tests at the significance level of α = .05.nnnRESULTSnTwenty implants (10 test, 10 control) were placed in 20 patients (7 men, 13 women) between the ages of 27 and 87 (mean age, 52.6 years). At 1 year, all implants remained osseointegrated, with overall mean marginal bone changes of -0.01 mm and -0.14 mm for the test and control groups, respectively. Mean facial gingival level change was significantly more pronounced in the control group (-0.70 mm) than in the test group (-0.25 mm). The modified Plaque Index scores showed that patients were able to maintain a good level of hygiene throughout the study. At 1 year, the Papilla Index indicated that more than 50% papilla fill was observed in 75% of the test sites and 80% of the control sites.nnnCONCLUSIONSnWithin the limitations of this study, SCTG was shown to be beneficial in maintaining facial gingival level when performed in conjunction with IIPP procedures.

Effect of teeth with periradicular lesions on adjacent dental implants

OBJECTIVESnIt is generally accepted that dental implants should not be placed in infected sites. However, the effect of periradicular infections of natural teeth on adjacent osseointegrated implants is less understood. The purpose of this study was to evaluate effects of periradicular lesions on osseointegration of existing implants. Study design Forty titanium solid root-form implants were placed close to premolars in dogs. After healing following implant placement, the adjacent premolars were treated in 1 of 4 ways: group A, no treatment of the adjacent premolar; group B, induction of a periradicular lesion followed by nonsurgical root canal therapy of the premolar; group C, induction of a periradicular lesion followed by nonsurgical root canal therapy of the premolar and surgical detoxification of the implant surface; and group D, induction of periradicular lesion and no treatment of the tooth. After 7(1/2) months, block sections were prepared and the percentage of osseointegration was analyzed histomorphometrically.nnnRESULTSnThe average integration for implants in groups A-B was 54%, 74%, 56%, and 68%, respectively. One-way analysis of variance demonstrated no difference between the 4 groups ( P =.518).nnnCONCLUSIONSnThe results of this study indicate that teeth with periradicular lesions do not adversely affect adjacent titanium solid root-form implants.

Vertical ridge augmentation with titanium-reinforced, dense-PTFE membranes and a combination of particulated autogenous bone and anorganic bovine bone-derived mineral: a prospective case series in 19 patients.

PURPOSEnThis prospective case series evaluated the use of a new titanium-reinforced nonresorbable membrane (high-density polytetrafluoroethylene), in combination with a mixture of anorganic bovine bone-derived mineral (ABBM) and autogenous particulated bone, for vertical augmentation of deficient alveolar ridges.nnnMATERIALS AND METHODSnA mixture of ABBM and autogenous particulated bone was used for vertical ridge augmentation and covered with a new titanium-reinforced nonresorbable membrane. Ridge measurements were obtained before and after the procedure, complications were recorded, and biopsy specimens were taken for histologic examination.nnnRESULTSnTwenty vertical ridge augmentation procedures were carried out in 19 patients. All treated defect sites exhibited excellent bone formation, with an average bone gain of 5.45 mm (standard deviation 1.93 mm). The healing period was uneventful, and no complications were observed. Eight specimens were examined histologically; on average, autogenous or regenerated bone represented 36.6% of the specimens, ABBM 16.6%, and marrow space 46.8%. No inflammatory responses or foreign-body reactions were noted in the specimens.nnnCONCLUSIONnThe treatment of vertically deficient alveolar ridges with guided bone regeneration using a mixture of autogenous bone and ABBM and a new titanium-reinforced nonresorbable membrane can be considered successful.

The incidence of maxillary sinus membrane perforation during endoscopically assessed crestal sinus floor elevation: a pilot study.

Transcrestal sinus membrane elevation is a surgical procedure performed to increase the bone volume in the maxillary sinus cavity. Because of visual limitations, the potential for maxillary sinus membrane perforations may be greater than with the lateral approach technique. The aim of this study was to macroscopically investigate ex vivo the occurrence of sinus membrane perforation during surgery using 3 transcrestal sinus floor elevation methods. Twenty fresh human cadaver heads, with 40 intact sinuses, were used for simultaneous sinus membrane elevation, placement of graft material, and dental implants. Real-time sinus endoscopy, periapical digital radiographs, and cone-beam computerized tomography (CBCT) images were subsequently used to evaluate the outcome of each surgical procedure. Perforation rates for each of the 3 techniques were then compared using a significance level of P < .05. No statistically significant differences in the perforation rate (P = .79) were found among the 3 surgical techniques. Although the sinus endoscope noted a higher frequency of perforations at the time of implant placement as compared with instrumentation or graft insertion, the difference was not statistically significant (P = .04). The CBCT readings were judged to be more accurate for identifying evidence of sinus perforations than the periapical radiographs when compared with the direct visualization with the endoscope. This pilot study demonstrated that a sinus membrane perforation can occur at any time during the sinus lift procedure, independent of the surgical method used.