1
|
Qian X, Vánkos B, Kelemen K, Gede N, Varga G, Hegyi P, Gerber G, Hermann P, Joób-Fancsaly Á, Mikulás K. Comparison of implant placement and loading protocols for single anterior maxillary implants: A systematic review and network meta-analysis. J Prosthet Dent 2024:S0022-3913(24)00412-8. [PMID: 39054170 DOI: 10.1016/j.prosdent.2024.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 05/31/2024] [Accepted: 05/31/2024] [Indexed: 07/27/2024]
Abstract
STATEMENT OF PROBLEM With increasing esthetic needs, patients prefer missing anterior teeth to be restored as soon as possible, but how the timing of implantation and prosthetic loading influences peri-implant tissue and the esthetic results remains unclear. PURPOSE The purpose of this systematic review and network meta-analysis of randomized controlled trials was to investigate and rank the hard-tissue and soft-tissue outcomes, esthetics, and patient satisfaction of single maxillary implant placement and loading protocols. MATERIAL AND METHODS A systematic search was conducted to identify studies with at least a 1-year follow-up that compared different implant placement and loading protocols and reported on survival, marginal bone loss (MBL), soft tissue, and esthetics. A random effects model and a Bayesian approach were applied to compare protocols by using mean differences (MD) with 95% credible intervals (CrI) and surface under the cumulative ranking curve (SUCRA) values. RESULTS A total of 43 articles were included, with a follow-up of 1 to 5 years. All protocols had high survival rates and no significant differences for 1-year or 2-year MBL. Immediate placement with immediate loading ranked first in pink and white esthetic scores and satisfaction and was statistically significantly better than immediate placement with delayed loading or late placement protocols in pink esthetic scores, where its advantage over late placement with late loading was also clinically relevant [MD: -1.74, CrI: -2.34 to -1.15]. CONCLUSIONS Immediate implantation with immediate loading showed a considerable esthetic advantage over later rehabilitation, whereas only a slight difference in MBL resulted from different protocols.
Collapse
Affiliation(s)
- Xinyi Qian
- PhD Student, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; and Resident, Department of Prosthodontics, Semmelweis University, Budapest, Hungary
| | - Boldizsár Vánkos
- PhD Student, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; and Resident, Department of Prosthodontics, Semmelweis University, Budapest, Hungary
| | - Kata Kelemen
- PhD Student, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; and Assistant Lecturer, Department of Prosthodontics, Semmelweis University, Budapest, Hungary
| | - Noémi Gede
- Biostatistician, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; and Biostatistician, Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Gábor Varga
- Vice-director, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; and Professor, Department of Oral Biology, Semmelweis University, Budapest, Hungary
| | - Péter Hegyi
- Director, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Director, Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary; and Director, Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Gábor Gerber
- Supervisor, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Dean, Faculty of Dentistry, Semmelweis University, Budapest, Hungary; and Associate Professor, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
| | - Péter Hermann
- Supervisor, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Vice-rector, Semmelweis University, Budapest, Hungary; and Director, Department of Prosthodontics, Semmelweis University, Budapest, Hungary
| | - Árpád Joób-Fancsaly
- Supervisor, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; and Vice-director, Department of Oro-Maxillofacial Surgery and Stomatology, Semmelweis University, Budapest, Hungary
| | - Krisztina Mikulás
- Supervisor, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; and Associate Professor, Department of Prosthodontics, Semmelweis University, Budapest, Hungary.
| |
Collapse
|
2
|
Zhang Y, Wen G, Dong W. Clinical outcomes of narrow- and regular-diameter implants with bone augmentation in the anterior maxilla: a systematic review and meta-analysis. Clin Oral Investig 2024; 28:196. [PMID: 38443497 DOI: 10.1007/s00784-024-05588-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/25/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVES To evaluate the clinical outcomes of narrow-diameter implants (NDIs) and regular-diameter implants (RDIs) with bone augmentation in the anterior maxilla, with implant survival rate (ISR) as the primary outcome. Additionally, secondary outcomes such as peri-implant marginal bone loss (MBL), pocket probing depth (PPD), mechanical complications, and biological complications were also considered. MATERIALS AND METHODS A thorough literature search was performed to identify randomized controlled trials and cohort studies comparing outcomes of NDIs and RDIs with bone augmentation in the anterior maxilla published up to February 2024. Only studies with a minimum follow-up period of 12 months were selected for analysis. Meta-analysis was performed if at least two articles with similar characteristics were available. RESULTS Of the 288 articles initially considered, 5 were included in the analysis, involving 282 NDIs and 100 RDIs. At the 36-month follow-up, no statistically significant differences in ISR, which ranged 93.8-100% for NDIs and were 100% for RDIs, were observed between the two groups (relative risk, 0.989; 95% confidence interval, 0.839-1.165; p = 0.896). Similarly, MBL and PPD did not differ significantly between the two groups. Soft tissue dehiscence was the most common complication found in RDIs. CONCLUSION The results indicate that NDIs yield clinical outcomes similar to those of RDIs with bone augmentation in the anterior maxilla over a 36-month follow-up period. CLINICAL RELEVANCE Considering the similar clinical outcomes, the shortened treatment duration and more rapid esthetic improvement associated with NDIs may render them preferrable to RDIs with bone augmentation, particularly in this esthetic zone.
Collapse
Affiliation(s)
- Yan Zhang
- School of Stomatology, North China University of Science and Technology, Tangshan, Hebei, 063210, China
| | - Guochen Wen
- School of Stomatology, North China University of Science and Technology, Tangshan, Hebei, 063210, China
| | - Wei Dong
- School of Stomatology, North China University of Science and Technology, Tangshan, Hebei, 063210, China.
| |
Collapse
|
3
|
Luongo F, Lerner H, Gesso C, Sormani A, Kalemaj Z, Luongo G. Accuracy in static guided implant surgery: Results from a multicenter retrospective clinical study on 21 patients treated in three private practices. J Dent 2024; 140:104795. [PMID: 38016619 DOI: 10.1016/j.jdent.2023.104795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/22/2023] [Accepted: 11/26/2023] [Indexed: 11/30/2023] Open
Abstract
PURPOSE To evaluate the accuracy of a static computer-assisted implant surgery (s-CAIS) system across different private practices. METHODS This retrospective clinical study was based on data retrieved from 21 patients who received 61 implants between 2018 and 2020 in 3 private practices run by surgeons with extensive experience with s-CAIS. All patients were treated using the same s-CAIS system, planning software, template manufacturing process, and surgical guides. The standard tessellation language (STL) file of the intraoral scan of the fixture taken immediately after implant placement was matched with that of the preoperative plan for comparisons of preoperative and planned implant positions with postoperative and actual implant positions. The study outcomes were linear and angular deviations between the planned and actual implant positions. RESULTS No surgical or postsurgical complications occurred. The overlap of the two STL files resulted in a mean angular deviation of 2.94° The mean linear deviation at the implant shoulder was 0.73 mm, and that at the apex was 1.06 mm. The mean vertical deviations at the implant shoulder and the apex were 0.29 mm and 0.01 mm, respectively. CONCLUSION All cases showed satisfactory accuracy within the limits of this study (small number of patients and retrospective design). These results might be related to the use of a standardized digital workflow by experienced operators. STATEMENT OF CLINICAL RELEVANCE The study shows that careful control of each step, from data acquisition to final execution, is key for the accuracy of stent-guided systems.
Collapse
Affiliation(s)
- Fabrizia Luongo
- MS, Private Practice, DDS, Via Frattina 27, Rome 00187, Italy.
| | | | | | - Alice Sormani
- Biomedical Engineer, International Consultant Medical Imaging and Guided Surgery Applications, 3Diemme srl Cantù, Italy
| | - Zamira Kalemaj
- PhD, MsC in Epidemiology and Statistics Private Practice, DDS, Milan, Italy
| | - Giuseppe Luongo
- MD, DDS, Department of Oral and Maxillofacial Surgery, Federico II University, Naples, Italy
| |
Collapse
|
4
|
Morton D, Wismeijer D, Chen S, Hamilton A, Wittneben J, Casentini P, Gonzaga L, Lazarin R, Martin W, Molinero-Mourelle P, Obermailer B, Polido WD, Tahmaseb A, Thoma D, Zembic A. Group 5 ITI Consensus Report: Implant placement and loading protocols. Clin Oral Implants Res 2023; 34 Suppl 26:349-356. [PMID: 37750529 DOI: 10.1111/clr.14137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/06/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVES Working Group 5 was convened to discuss and find consensus on the topics of implant placement and loading protocols associated with single missing teeth in the anterior maxilla (aesthetic zone). Consensus statements, clinical recommendations, patient perspectives and future research suggestions were developed and presented to the plenary for discussion and approval. MATERIALS AND METHODS Two systematic reviews were developed and submitted prior to the conference. The group considered in detail the systematic reviews and developed statements, clinical recommendations, patient perspectives and future research suggestions based on the findings of the reviews and experience of group members. Definitive versions were developed after presentation to and discussion by the plenary. RESULTS Five consensus statements were developed and approved from each systematic review. Twelve clinical recommendations were developed by the group based on both reviews and experience. Three patient perspectives were developed, and five suggestions made for future research. CONCLUSIONS Based on the findings of the systematic reviews and experience of group members, the Type 1A protocol (immediate placement and immediate loading), when utilized in the anterior maxilla under favorable conditions, is considered predictable and is associated with high survival rates. The procedure is considered clinically viable and is associated with aesthetic outcomes, although surgical, technical, and biological complications can occur.
Collapse
Affiliation(s)
- Dean Morton
- Department of Prosthodontics, Center for Implant, Esthetic and Innovative Dentistry, Indiana University School of Dentistry, Indianapolis, Indiana, USA
| | | | - Stephen Chen
- Periodontics, Melbourne Dental School, Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Adam Hamilton
- Division of Oral Restorative and Rehabilitative Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Julia Wittneben
- Department of Reconstructive Dentistry and Gerodontology, University of Bern, Bern, Switzerland
| | | | - Luiz Gonzaga
- Department of Oral and Maxillofacial Surgery, Center for Implant Dentistry, University of Florida, College of Dentistry, Gainesville, Florida, USA
| | - Rafael Lazarin
- Discipline of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - William Martin
- Department of Oral and Maxillofacial Surgery, Center for Implant Dentistry, University of Florida, College of Dentistry, Gainesville, Florida, USA
| | - Pedro Molinero-Mourelle
- Department of Reconstructive Dentistry and Gerodontology, University of Bern, Bern, Switzerland
| | | | - Waldemar D Polido
- Department of Oral and Maxillofacial Surgery, Center for Implant, Esthetic and Innovative Dentistry, Indiana University School of Dentistry, Indianapolis, Indiana, USA
| | - Ali Tahmaseb
- Department of Oral and Maxillofacial Surgery, Erasmus University, Rotterdam, The Netherlands
| | - Daniel Thoma
- Center for Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Anja Zembic
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
| |
Collapse
|