Stefano Corbella

Implant Survival Rates after Osteotome‐Mediated Maxillary Sinus Augmentation: A Systematic Review

PURPOSE The aim of the present study was to systematically evaluate the implant survival rate after osteotome-mediated maxillary sinus augmentation with or without using grafting materials. MATERIALS AND METHODS MEDLINE database was searched using a combination of specific search terms. Furthermore, a hand searching of the relevant journals and of the bibliographies of reviews was performed. Prospective and retrospective clinical studies with at least 20 patients treated by osteotome-mediated sinus floor elevation were included. RESULTS Nineteen studies were selected for data analysis. A total of 1,822 patients, accounting for 3,131 implants were considered. Mean weighted cumulative implant survival at 1, 2, 3, and 5 years was estimated as 98.12%, 97.40%, 96.75%, and 95.81%, respectively. No significant difference was found in relation to the use of grafting material nor in relation to implant length. Overall implant survival was 92.7% for 331 implants placed in <5 mm ridge height and 96.9% for 2,525 implants inserted in ≥ 5 mm ridge height. The difference was significant (p = .0003). CONCLUSIONS The transalveolar sinus augmentation technique could be a viable treatment in case of localized atrophy in the posterior maxilla even in case of minimal residual bone height. The prognosis can be more favorable when the residual ridge is at least 5 mm high.

Clinical evaluation of an implant maintenance protocol for the prevention of peri‐implant diseases in patients treated with immediately loaded full‐arch rehabilitations

OBJECTIVE The aim of this prospective study was to assess the outcomes of an implant maintenance protocol for implants supporting a full-arch rehabilitation. MATERIALS AND METHODS Sixty-one patients (28 women and 33 men) treated with immediately loaded full-arch rehabilitation, both mandibular and maxillary, supported by a combination of two tilted and two axial implants, were included in the study. Patients were scheduled for follow-up visits every 6 months for +2 years, then yearly up to 4 years. Each patient received professional oral hygiene treatment and detailed oral hygiene instructions. During each visit, modified plaque index, bleeding index and probing depth were assessed. The presence of peri-implant tissue inflammation was also evaluated. RESULTS Mean observation time, considering both mandible and maxilla, was 18.3 months ranging from 6 months to 5 years. Both plaque and bleeding indexes frequency decreased over time. Probing depth was stable (2.46 ± 0.5 mm at 4 years). Only three implants were lost due to peri-implantitis (1.4% at 12 months), whereas the incidence of peri-implant mucositis was less than 10% in each considered period. CONCLUSIONS The adoption of a systematic hygienic protocol is effective in keeping low the incidence of peri-implant mucositis as well as in controlling plaque accumulation and clinical attachment loss.

Effect of periodontal treatment on glycemic control of patients with diabetes: A systematic review and meta-analysis

The aim of the present study was to investigate whether non‐surgical periodontal treatment reduces glycated hemoglobin (HbA1c) and fasting plasma glucose (FPG) levels in diabetic patients.

Bone level changes around axial and tilted implants in full-arch fixed immediate restorations. Interim results of a prospective study.

PURPOSE The aim of this prospective study was to assess clinical outcomes and peri-implant bone level changes around tilted and axial implants supporting full-arch fixed immediate rehabilitations up to 60 months of loading. MATERIAL AND METHODS Forty-seven patients (22 women and 25 men) were included in the study. Each patient received a full-arch fixed bridge supported by two axial and two distal tilted implants. Loading was applied within 48 hours of surgery. Patients were scheduled for follow-up at 6, 12, 18, 24 months, and annually up to 5 years. At each follow-up, plaque level and bleeding scores were assessed and radiographic evaluation of marginal bone level change was performed. Periapical radiographs were taken using a paralleling technique, and subsequently scanned at 600 dpi. An image analysis software was used to assess bone level. RESULTS A total of 33 mandibles and 16 maxillae were rehabilitated (two patients received a fixed prosthesis in both arches). One hundred ninety-six Nobel Biocare implants of 4 mm diameter were placed. The mean follow-up duration was 52.8 months (range 30-66 months) in the mandible, and 33.8 months (range 22-40 months) in the maxilla. All subjects attended the scheduled follow-up visits. No implant was lost. No significant difference in marginal bone loss was found between axial and tilted implants in both jaws, at each follow-up. No significant difference in bone loss was found between mandible and maxilla, for both axial and tilted implants at each comparable time frame, although slightly higher mean values were always found for the mandible. CONCLUSION The use of tilted implants in the immediate rehabilitation of fully edentulous jaws is safe and is not associated to a higher marginal bone loss as compared to axially placed implants.

Long-Term Outcomes for the Treatment of Atrophic Posterior Maxilla: A Systematic Review of Literature

PURPOSE The aim of the present systematic review was to estimate the implant survival rate in different types of techniques for the rehabilitation of posterior atrophic maxilla, after at least 3 years of follow-up. MATERIALS AND METHODS MEDLINE database was searched using a combination of specific terms. A hand searching of the relevant journals and of the reference lists of systematic reviews was also performed. All retrospective and prospective studies evaluating short implants in posterior maxilla, osteotome sinus floor elevation and lateral approach sinus floor elevation, and having a follow-up of at least 3 years, were included. RESULTS Forty-four articles were included in the review. In four studies reporting on a total of 901 short implants, the implant survival rate varied from 86.5% to 98.2% with up to 5 years follow-up. For the osteotome technique, 1,208 implants in eight studies were considered, showing a survival rate varying from 95.4% to 100% after 3-year follow-up. Twenty-nine studies, accounting for 6,940 implants placed in 2,707 sinuses augmented through lateral technique were considered. Implant survival rate varied from 75.57% to 100%. Only three comparative studies were found that showed no significant difference in clinical outcomes between lateral approach and osteotome technique. CONCLUSIONS Sinus floor elevation with the lateral approach and with the osteotome technique is an effective and well-documented therapeutic option for the rehabilitation of atrophic posterior maxilla. The use of short implants is promising but needs further investigation to be considered as effective as the other techniques in the long term. However, the indication for the three different techniques is not perfectly equivalent and the treatment choice should be based on a careful evaluation of the individual case, in particular on the available residual bone.

Periodontal disease as a risk factor for adverse pregnancy outcomes: a systematic review and meta-analysis of case-control studies.

Periodontal disease is a highly prevalent group of illnesses of microbial etiology, whose consequence is a severe breakdown of tooth-supporting structures. A link between periodontal infection and several systemic conditions, among which adverse pregnancy outcomes, has been suggested in the recent years. The aim of this review based on case–control studies was to evaluate if periodontal disease could be considered as a risk factor for preterm birth, low birth-weight and preterm low birth-weight. An electronic search (via Pubmed) was performed for case–control studies investigating the relationship between periodontal disease and adverse pregnancy outcomes. From the initially retrieved 417 articles, 17 case–control studies, accounting for a total of 10,148 patients, were included in the review and in the meta-analysis. The estimated odds ratio was 1.78 (CI 95%: 1.58, 2.01) for preterm birth, 1.82 (CI 95%: 1.51, 1.20) for low birth-weight and 3.00 (CI 95%: 1.93, 4.68) for preterm low birth-weight. Despite the results of the analysis of pooled data suggested a link between periodontal diseases and adverse pregnancy outcomes, the presence of important confounders, whose effect could not be addressed, prevents a validation of the meta-analysis outcomes. Further more accurate investigations based on individual data analysis could give a better insight into the topic of the present review.

Cone beam computed tomography for the diagnosis of vertical root fractures: a systematic review of the literature and meta-analysis

OBJECTIVE The aim of this review was to compare the efficiency of cone beam computed tomography (CBCT) and conventional intraoral radiography for the detection of vertical root fractures (VRFs). STUDY DESIGN Data from comparative and noncomparative studies investigating CBCT, conventional radiography, or both for the diagnosis of VRFs were searched. The main outcome variables were sensitivity, specificity, and accuracy of the techniques. Data were separated into 4 groups: in vivo, ex vivo/untreated teeth, ex vivo/treated teeth, and ex vivo with post. The weighted mean of each parameter was estimated. RESULTS Twelve articles were considered for the analysis. There was a large heterogeneity of the characteristics of the studies and a wide variability in outcome variables. No significant differences were found between radiographic techniques. CONCLUSIONS No superiority of CBCT compared with conventional radiography was found for VRF detection. Adequate choice of voxel size seems to be important when diagnosing VRFs.

Adverse pregnancy outcomes and periodontitis: A systematic review and meta-analysis exploring potential association.

OBJECTIVE The correlation between periodontal status and systemic conditions, among them pregnancy, is widely described in the scientific literature. The aim of the present systematic review of the literature was to evaluate periodontal diseases as an independent risk factor for adverse pregnancy outcomes. DATA Case-control studies reporting pregnancy outcomes and periodontal status of the subjects were included. Risk of bias evaluation was performed using a tool developed by the Cochrane Bias Methods Group. After risk of bias evaluation of included studies, a meta-analysis was performed computing the Risk Ratio (RR) for each pregnancy outcome. SOURCES Electronic databases (MedLine, Embase, Cochrane Central) were searched after preparation of an appropriate search string. STUDY SELECTION The search resulted in 422 entries that were screened. After application of inclusion and exclusion criteria, a total of 22 studies were included in the review accounting for a total of 17,053 subjects. The computed RR for periodontitis was 1.61 for preterm birth evaluated in 16 studies (P < .001), 1.65 for low birthweight evaluated in 10 studies (P < .001), and 3.44 for preterm low birthweight evaluated in four studies. CONCLUSION The present systematic review reported a low but existing association between periodontitis and adverse pregnancy outcomes. This assumption is the result of proper corrections of biased methodologies and of heterogeneity of studies. (.

Evaluation of Clinical Outcomes and Bone Loss around Titanium Implants with Oxidized Surface: Six-Year Follow-Up Results from a Prospective Case Series Study

PURPOSE The aim of this prospective study was to assess long-term clinical outcomes and peri-implant bone level changes around oxidized implants supporting partial fixed rehabilitations. MATERIALS AND METHODS Twenty-two partially edentulous patients were included in the study. A total of 33 fixed rehabilitations were placed, supported by 54 titanium implants with oxidized microtextured surface. Prostheses were delivered after 3 and 6 months of implant placement in the mandible and maxilla, respectively. Patients were scheduled for follow-up at 6 and 12 months and then yearly. At each follow-up, plaque level and bleeding scores were assessed and periapical radiographs were taken. The main outcomes were prosthesis success, implant survival, implant success, and marginal bone level change. RESULTS Three patients were excluded from the study because they did not attend the 1-year follow-up. Nineteen patients, accounting for 49 implants, were followed for at least 6 years after prosthesis delivery. The mean follow-up duration was 81.8 months (range 75-96 months). One mandibular single-tooth implant failed after 1 year in a smoker woman. Cumulative implant survival and success at 6 years were 98.0% and 95.9%, respectively. Prosthesis success was 96.7%. The mean peri-implant bone loss at 6 years was 0.76 ± 0.47 mm. Not significantly (p = .75) greater bone loss was found in the maxilla (0.78 ± 0.14 mm, n = 19) as compared with the mandible (0.74 ± 0.59 mm, n = 30). In the maxilla, bone loss was significantly greater around implants supporting partial prostheses as compared with single-tooth implants (p = .03). Full patient satisfaction was reported. CONCLUSION Implants with oxidized microtextured surface may achieve excellent long-term clinical outcomes in the rehabilitation of partial edentulism.

Temperature Changes in Cortical Bone after Implant Site Preparation Using a Single Bur versus Multiple Drilling Steps: An In Vitro Investigation

OBJECTIVES The study aims to test the hypothesis of no differences in temperature variation by using a single bur for implant site preparation as compared with conventional drilling sequence using multiple burs with incremental diameter. MATERIALS AND METHODS Synthetic blocks of bone (type I density) were used for drilling procedures. THREE GROUPS WERE EVALUATED Group 1 and Group 2 - drilling with three consecutive burs for a 4.1 mm cylindrical implant and for a 4.3 mm conical implant, respectively; Group 3 - drilling with a single bur for a 4.2 mm conical implant. For each group, 20 drilling procedures were performed without irrigation and 20 with external irrigation. The temperature in the cortical bone during osteotomy for implant site preparation was measured through a thermocouple. RESULTS The mean temperatures and standard deviations for the drilling without irrigation were: 25.5 ± 1.24°C for Group 1; 28.1 ± 1.76°C for Group 2; 26.5 ± 1.79°C for Group 3. Considering the drilling with irrigation, the mean values and standard deviations were: 20.4 ± 1.17°C for Group 1; 22.2 ± 1.38°C for Group 2; 20.2 ± 0.83°C for Group 3. Groups 1 and 3 yielded similar results, while Group 2 displayed significantly higher temperature increase than the other two groups. CONCLUSIONS The single bur drilling protocol did not produce greater bone heating than the conventional protocol and may be considered a safe procedure.