Konstantinos Chochlidakis

A Systematic Review of Dowel (Post) and Core Materials and Systems

PURPOSE The aim of this systematic review was to determine which dowel (post) and core system is the most successful when used in vivo to restore endodontically treated teeth. MATERIALS AND METHODS A MEDLINE, a Cochrane, and an EMBASE search (three specified searches) were conducted to identify randomized (RCT) and nonrandomized controlled clinical trials (CCT), cohort (CS), and case control studies (CCS) until January 2008, conducted on humans, and published in English, German, and French, relating to dowel and core systems for restoring endodontically treated teeth. Also, a hand search was conducted, along with contact with the authors when needed. RESULTS The MEDLINE, Cochrane, and EMBASE searches identified 997, 141, and 25 published articles, respectively. Ten articles from the MEDLINE and seven articles from the Cochrane search (that were also identified in the MEDLINE search) met the inclusion and validity assessment criteria. Six out of the ten studies were RCTs, two were CCTs, and two CSs. The RCT studies suggest that carbon fiber in resin matrix dowels are significantly better than precious alloy cast dowels (number needed to treat, NNT = 8.30). Tapered gold alloy cast dowels are better than ParaPost gold alloy cast dowels (NNT = 13.15). ParaPost prefabricated dowels are slightly better than ParaPost cast dowels (NNT = 175.4). Glass fiber dowels are significantly better than metal screw dowels (NNT = 5.46), but worse than titanium (NNT =-21.73) (moderately). Carbon fiber dowels are worse than gold alloy cast dowels (significantly) (NNT =-5.81) and than amalgam dowels (NNT =-125) (slightly). The CCT studies suggest that metal dowels are better (NNT = 21.73) but also worse than cast dowels (NNT =-33.33) depending on the remaining amount of coronal hard tissue. Quartz fiber dowels show success rates similar to and worse than glass fiber-reinforced dowels (NNT =-37.03). The results from the CS studies suggest that carbon fiber in resin matrix dowels are better (moderately) than carbon fiber + quartz and quartz fiber dowels. Titanium dowels with a composite build-up are better (moderately) than gold alloy cast dowels. CONCLUSIONS According to the studies of the highest levels of evidence, carbon fiber in resin matrix dowels are significantly better than precious alloy cast dowels (RCT). Glass fiber dowels are significantly better than metal screw dowels (RCT) and moderately better than quartz fiber dowels (CCT). Carbon fiber dowels are significantly worse than metal dowels (of precious alloy) (RCT). Prefabricated metal dowels are slightly better than cast dowels (RCT), but moderately worse when no collar of the dentin above the gingiva could be achieved (CCT).

Influence of Apico-Coronal Implant Placement on Post-Surgical Crestal Bone Loss in Humans

BACKGROUND Contradictory results exist regarding influence of apico-coronal implant placement on crestal bone levels. METHODS Complete charts of patients ≥18 years old with one or more dental implants were included. Demographic, medical, surgical, and prosthetic information was recorded. Implant bone levels were evaluated at initial placement, implant uncovery, prosthetic delivery, and 3 to 6, 7 to 11, and 12 to 18 months post-implant placement. RESULTS Charts of 55 patients and 134 implants were included. At baseline, 19.5%, 67.3%, and 13.3% of implants were recorded as equicrestal, subcrestal, and supracrestal, respectively, on their mesial aspect, and 32.1%, 50.0%, and 17.9% on their distal aspect, respectively. At time of prosthetic delivery, mesial aspect implant position was equicrestal in 35.4%, subcrestal in 17.7%, and supracrestal in 46.9% of cases, whereas on their distal aspects, the same categorical positions were found in 28.4%, 21.1%, and 50.5% of implants. For the mesial aspect of the implant, 3- to 6-, 7- to 11-, and 12- to 18-month intervals, and for the distal aspect of the implant, 7- to 11- and 12- to 18-month intervals, along with diabetes (for both mesial and distal), were associated with a statistically more apical position of the bone compared with baseline. Although the odds ratio of a subcrestal implant position at follow-up times was statistically greater for implants located subcrestally at surgery, linear measures of differential crestal bone loss (CBL) as a function of the categorical initial placement of the implant (supracrestal, equicrestal, subcrestal) at 3- to 6-, 7- to 11-, and 12- to 18-month time points generally showed no significant differences among groups. CONCLUSION A subcrestal position of the implant at time of surgery leads to reduced odds of having implant threads exposed; however, it is associated with similar linear CBL compared with an equicrestal or supracrestal surgical position.

Surgical and prosthetic management of ridge deficiency for an implant-supported restoration in the esthetic zone

This clinical report presents the surgical and prosthetic management of a patient with complex needs involving anterior implants. After extraction and ridge augmentation, unexpected ridge resorption occurred. Two implants were placed in conjunction with an allograft skin material. Upon healing, 2 additional soft tissue augmentation procedures were performed with autologous pedicle connective tissue grafts to correct the residual ridge deficiency. At the second stage surgery, a modified flap approach was used to further enhance the soft tissue volume and contour. Definitive implant-supported splinted crowns with minimal interproximal pink ceramic material were provided.

Challenges in implant-supported dental treatment in patients with Sjogren's syndrome: A case report and literature review.

Sjogrens syndrome (SS) is a systemic autoimmune disease that has several oral manifestations, with reduced salivary flow being the most prevalent. As a result of the dry mouth and irritated oral tissues, dental treatment may be challenging. In particular, a patients satisfaction with removable prosthesis may be limited. This case report and the literature review discuss the feasibility of implant-supported dental prostheses. The clinical and functional advantages provided by implant prostheses might outweigh the slightly lower overall implant success rate in SS patients. The impacts of SS on dental treatment are summarized in this review.

Buccal bone thickness around single dental implants in the maxillary esthetic zone.

OBJECTIVE To compare the thickness of buccal bone around single dental implants placed in the anterior maxilla (premolar to premolar) inserted with different placement protocols. DATA SOURCES An electronic search was conducted using MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE, from January 1980 to July 2015. Mean buccal bone thickness around single dental implants was measured and correlation with implant placement protocols, loading protocols, and augmentation method was assessed. A Q-test was used to access the homogeneity of levels of effect. A univariate meta-regression analysis was used for further investigation of the between-study heterogeneity. Two randomized clinical trials and 12 cohort studies were included for statistical analysis. The difference in buccal bone thickness for implants placed with different implant placement protocols (early vs immediate vs delayed) was not statistically significant (P > .05). Loading protocols (immediate vs delayed) also did not significantly influence the thickness of buccal bone. Descriptive analysis showed different buccal bone thickness for dental implants that received different bone grafting materials at the time of placement. CONCLUSION Different implant placement and loading protocols may not significantly affect the thickness of the buccal bone around single dental implants in the anterior maxilla. Different bone graft materials at the time of implant placement may have an effect on buccal bone thickness.

An alternative impression technique for mobile teeth.

The impression technique described combines elastomeric impression materials and irreversible hydrocolloid to make an accurate preliminary impression of extremely mobile and misaligned teeth. Upon setting, the materials are removed from the mouth in 3 different directions and reassembled extraorally. This technique provides an alternative, easy, accurate, and safe way to make a preliminary impression of mobile, periodontally involved teeth.