V. Moraschini

Evaluation of survival and success rates of dental implants reported in longitudinal studies with a follow-up period of at least 10 years: a systematic review

The aim of this systematic review was to evaluate the survival and success rates of osseointegrated implants determined in longitudinal studies that conducted a follow-up of at least 10 years. A broad electronic search was conducted in MEDLINE/PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL) for relevant publications in indexed journals, evaluating the clinical performance of dental implants. Using inclusion and exclusion criteria, two reviewers analyzed titles, abstracts, and complete articles, prioritizing studies of the randomized clinical trial type. A total of 23 articles were included in this review. Ten prospective studies, nine retrospective studies, and four randomized clinical trials, which evaluated 7711 implants, were selected. The mean follow-up time of the studies included was 13.4 years. All of the studies reported survival rates and mean marginal bone resorption values, with cumulative mean values of 94.6% and 1.3mm, respectively. Fourteen studies related success rates. Taking into consideration the disparate outcome measures employed to assess dental implant performance and within the limitations of this systematic review, we may affirm that osseointegrated implants are safe and present high survival rates and minimal marginal bone resorption in the long term.

Amalgam and resin composite longevity of posterior restorations: A systematic review and meta-analysis

OBJECTIVES The aim of the present review was to evaluate by means of a systematic review and meta-analysis the hypothesis of no difference in failure rates between amalgam and composite resin posterior restorations. DATA Randomized controlled trials, controlled clinical trials and prospective and retrospective cohort studies were included in this review. The eligibility criteria included clinical trials in humans with at least 12 months of follow-up comparing the failures rates between occlusal and occlusoproximal amalgam and composite resin restorations. Clinical questions were formulated and organized according to the PICOS strategy. SOURCE An electronic search without restriction on the dates or languages was performed in PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, and Web of Science up until March 2015. STUDY SELECTION The initial search resulted in 938 articles from PubMed/MEDLINE, 89 titles from the Cochrane Central Register of Controlled Trials, and 172 from the Web of Science. After an initial assessment and careful reading, 8 studies published between 1992 and 2013 were included in this review. According to the risk of bias evaluation, all studies were classified as high quality. CONCLUSIONS The results of this review suggest that composite resin restorations in posterior teeth still have less longevity and a higher number of secondary caries when compared to amalgam restorations. In relation to fractures, there was no statistically significant difference between the two restorative materials regarding the time of follow-up. CLINICAL SIGNIFICANCE There is currently a worldwide trend towards replacing amalgam restorations with mercury-free materials, which are adhesive and promote aesthetics. It is important to perform an updated periodic review to synthesize the clinical performance of restorations in the long-term.

Implant survival rates, marginal bone level changes, and complications in full-mouth rehabilitation with flapless computer-guided surgery: a systematic review and meta-analysis

This systematic review evaluated the implant survival rate, changes in marginal bone level, and complications associated with guided surgery for the treatment of fully edentulous patients followed up for longer than 1 year. A comprehensive literature search was conducted in MEDLINE/PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL) to retrieve studies published up until July 2014 that met predefined eligibility criteria. Thirteen studies were included. In studies on the guided surgery technique, a survival rate of 97.2% and a mean marginal bone loss of 1.45 mm were found during 1-4 years of follow-up. However, associated complications, such as implant loss, prosthesis or surgical guide fractures, and low primary stability, were often found, and there is a learning curve to achieve treatment success. Further longitudinal comparative studies should improve the technique and its success rate.

Immediate versus conventional loaded single implants in the posterior mandible: a meta-analysis of randomized controlled trials

The purpose of this meta-analysis was to compare implant survival, marginal bone loss, and complications between immediate and conventional loading of single implants installed in the posterior mandible. An extensive electronic search was performed of PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials to identify relevant articles published up to January 2015. After the selection process, five studies met the eligibility criteria and were included. The results of the meta-analysis were expressed in terms of the odds ratio (OR) or standardized mean difference (SMD), with a confidence interval (CI) of 95%. Results were pooled according to heterogeneity using the fixed- or random-effects model. There was no statistically significant difference between the two techniques (immediate loading vs. conventional loading) with regard to implant survival (OR 1.71, 95% CI 0.40 to 7.36; P=0.47). There was no statistically significant difference in marginal bone loss (SMD -0.58, 95% CI -1.55 to 0.38; P=0.24). The reported mechanical and biological complications were common to both types of intervention, with the exception of probing depth, which was greater following the immediate loading technique (SMD 0.13, 95% CI -0.19 to 0.44), although this was not statistically significant (P=0.43).

Success of dental implants in smokers and non-smokers: a systematic review and meta-analysis

The purpose of this review was to test the null hypothesis of no difference in marginal bone loss and implant failure rates between smokers and non-smokers with respect to the follow-up period. An extensive electronic search was performed in PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials to identify relevant articles published up to February 2015. The eligibility criteria included randomized and non-randomized clinical studies. After an exhaustive selection process, 15 articles were included. The meta-analysis was expressed in terms of the odds ratio (OR) or standardized mean difference (SMD) with a confidence interval (CI) of 95%. There was a statistically significant difference in marginal bone loss favouring the non-smoking group (SMD 0.49, 95% CI 0.07-0.90; P=0.02). An independent analysis revealed an increase in marginal bone loss in the maxilla of smokers, compared to the mandible (SMD 0.40, 95% CI 0.24-0.55; P<0.00001). A statistically significant difference in implant failure in favour of the non-smoking group was also observed (OR 1.96, 95% CI 1.68-2.30; P<0.00001). However, the subgroup analysis for follow-up time revealed no significant increase in implant failure proportional to the increase in follow-up time (P=0.26).

Use of Platelet‐Rich Fibrin Membrane in the Treatment of Gingival Recession: A Systematic Review and Meta‐Analysis

BACKGROUND The aim of this systematic review is to evaluate the effects of platelet-rich fibrin (PRF) membranes on the outcomes of clinical treatments in patients with gingival recession. METHODS Articles that were published before June 2015 were searched electronically in four databases without any date or language restrictions and searched manually in regular journals and unpublished studies. The eligibility criteria comprised randomized controlled trials (RCTs) and prospective controlled trials with follow-up periods of ≥ 6 months that compared the performance of PRF to other biomaterials in the treatment of Miller Class I or II gingival recessions. For the meta-analysis, the inverse variance method was used in fixed- or random-effect models, which were chosen according to heterogeneity. The estimates of the intervention effects were expressed as the mean differences in percentages or millimeters. RESULTS Six RCTs and one prospective clinical trial are included in this review. Root coverage (RC) and clinical attachment level (CAL) did not differ significantly between the analyzed subgroups (P = 0.57 and P = 0.50, respectively). The keratinized mucosa width (KMW) gain was significantly greater (P = 0.04) in the subgroup that was treated with connective tissue grafts. CONCLUSION The results of the meta-analysis suggest that the use of PRF membranes did not improve the RC, KMW, or CAL of Miller Class I and II gingival recessions compared with the other treatment modalities.

Effect of autologous platelet concentrates for alveolar socket preservation: a systematic review

The current literature was reviewed to evaluate the effect of autologous plasma concentrates on the preservation of extraction sockets. A comprehensive literature search was performed from October 2013 to February 2014 in the MEDLINE/PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Four studies, published between the years 2010 and 2013, met the eligibility criteria and were included in the review. There were 102 extractions (55 tests, 47 controls) in 82 patients. There was considerable heterogeneity between studies with regard to the design, follow-up time, surgical techniques, and method of preparation of plasma concentrates, and therefore the data could not be analyzed quantitatively. The use of plasma concentrates seems to accelerate healing and soft tissue epithelialization in extraction sockets and reduce postoperative pain and discomfort. However, there is no evidence to date to confirm that plasma concentrates improve hard tissue regeneration.

Effect of submucosal injection of dexamethasone after third molar surgery: a meta-analysis of randomized controlled trials

The aim of this meta-analysis was to analyse the effectiveness of submucosal injection of dexamethasone to control the postoperative signs and symptoms resulting from impacted third molar surgery. An electronic search was conducted, without restriction on date or language, in the PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, and Web of Science databases until June 2015 . The eligibility criteria included non-randomized or randomized clinical trials in humans. After the search and selection process, eight articles were included. The fixed-effects or random-effects model, depending on heterogeneity, was built on the inverse-variance method used. The estimations of intervention were expressed as the mean difference (MD) in millimetres. The results of this meta-analysis suggest that the submucosal injection of dexamethasone presents a reduction in the postoperative signs and symptoms resulting from impacted third molar surgery, especially those associated with oedema and pain. In relation to trismus, the meta-analysis showed no statistically significant difference between dexamethasone and the placebo solution.

Quality assessment of systematic reviews on alveolar socket preservation

The aim of this overview was to evaluate and compare the quality of systematic reviews, with or without meta-analysis, that have evaluated studies on techniques or biomaterials used for the preservation of alveolar sockets post tooth extraction in humans. An electronic search was conducted without date restrictions using the Medline/PubMed, Cochrane Library, and Web of Science databases up to April 2015. Eligibility criteria included systematic reviews, with or without meta-analysis, focused on the preservation of post-extraction alveolar sockets in humans. Two independent authors assessed the quality of the included reviews using AMSTAR and the checklist proposed by Glenny et al. in 2003. After the selection process, 12 systematic reviews were included. None of these reviews obtained the maximum score using the quality assessment tools implemented, and the results of the analyses were highly variable. A significant statistical correlation was observed between the scores of the two checklists. A wide structural and methodological variability was observed between the systematic reviews published on the preservation of alveolar sockets post tooth extraction. None of the reviews evaluated obtained the maximum score using the two quality assessment tools implemented.

The impact of diabetes on dental implant failure: a systematic review and meta-analysis.

The aim of this study was to investigate the hypothesis that there is no difference in implant failure rate or marginal bone loss between type 1 or 2 diabetes subjects and non-diabetic subjects. An electronic search was conducted, without restrictions on date or language, in the PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, and EMBASE databases, and in the grey literature, through August 2015. The eligibility criteria included prospective and retrospective cohort studies and randomized controlled trials. The initial search resulted in 1093 titles from PubMed/MEDLINE, 164 from the Cochrane Central Register of Controlled Trials, 134 from Web of Science, 228 from EMBASE, and four from the grey literature. Following the search and selection process, 14 studies published between 2000 and 2015 were included in this systematic review. According to the risk of bias analysis, all studies were classified as high quality. The results of this systematic review suggest that the number of implant failures does not differ between diabetic and non-diabetic subjects. Additionally, the results of the comparison between type 1 and 2 diabetes subjects showed no difference in the number of failures. With regard to marginal bone loss, there was a statistically significant difference favouring non-diabetic subjects.