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Park JY, Kwon YH, Song YW, Cha JK, Jung UW, Jung RE, Thoma DS. Flapless early implant placement into the uncalcified provisional matrix-Does it lead to osseointegration of the implant? A preclinical study. J Clin Periodontol 2024; 51:766-773. [PMID: 38356227 DOI: 10.1111/jcpe.13963] [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: 09/05/2023] [Revised: 01/08/2024] [Accepted: 02/01/2024] [Indexed: 02/16/2024]
Abstract
AIM To test whether early implant placement into the extraction socket containing an uncalcified provisional matrix leads to successful osseointegration and stable marginal bone levels. MATERIALS AND METHODS In six mongrel dogs, the mandibular molars were extracted. Three weeks later, early implant placement was performed according to three experimental protocols: (i) flapless implant placement with preservation of the provisional matrix; (ii) flap elevation, socket debridement and implant placement; and (iii) flap elevation, socket debridement, implant placement and guided bone regeneration (GBR). One untreated extraction socket served as a control group. Data analyses were based on histologic slides 3 months after implant placement. RESULTS There were no differences in bone-to-implant contact between the three experimental groups (66.97%, 58.89% and 60.89%, respectively) (inter-group comparison p = .42). Marginal bone levels, first bone-to-implant contact as well as the thickness of the connective tissue did not reveal any significant differences between the groups (p = .85, .60 and .65, respectively). CONCLUSIONS Flapless early implant placement into posterior extraction sockets was as effective as an open flap approach in conjunction with GBR. Mineralization of the socket seems to occur irrespective of the presence of dental implants or biomaterials.
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Affiliation(s)
- Jin-Young Park
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, South Korea
- Innovation Research and Support Center for Dental Science, Yonsei University Dental Hospital, Seoul, South Korea
| | - Yoon-Hee Kwon
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, South Korea
| | - Young Woo Song
- Department of Periodontology, Dental Hospital, Veterans Health Service Medical Center, Seoul, South Korea
| | - Jae-Kook Cha
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, South Korea
- Innovation Research and Support Center for Dental Science, Yonsei University Dental Hospital, Seoul, South Korea
| | - Ui-Won Jung
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, South Korea
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
| | - Daniel S Thoma
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, South Korea
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
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2
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Ren C, Chen W, Chen J, Mao C, Liao C, Liu J. The fusion of keratinized epithelium, an indication of early implant placement in the aesthetic area: an animal study. BMC Oral Health 2023; 23:1016. [PMID: 38115040 PMCID: PMC10729501 DOI: 10.1186/s12903-023-03755-9] [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: 10/20/2023] [Accepted: 12/10/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND In the period of the early implant placement, the socket is mainly occupied by provisional matrix (PM). Keratinized epithelium (KE) is critical for primary wound closure. Although both KE and PM are important, the detailed relationship among migrating KE, PM formation and indication of the early implant placement is still unclear. OBJECTIVE This research aimed to locate a healing stage of KE with highest osteogenic PM formation after tooth extraction, which could be treated as the optimal time point for early implant placement. MATERIAL AND METHODS Mice were sacrificed on days 1, 2, 3, 4 and 6 after incisor extraction. Clinical, histological, and immunohistochemical evaluations of the extraction sockets were performed, and statistical analyses were conducted. We then inserted implants into the PM with the greatest bioactivity and observed its osseointegration pattern for 3, 10, 17 and 30 days. RESULT When KE fusion was reached, sockets were dominated by PM with the greatest expression of osteocalcin (OC, P < 0.05) and high levels of CD34 and Runx2. OC and Runx2 expression were positively correlated with KE coverage (P < 0.05). When the implant was inserted at 4 days' healing, the PM maintained its osteogenic ability, and osseointegration proceeded perfectly. CONCLUSION The migration of KE was correlated with the formation of highly osteogenic and angiogenic PM. And the fusion of KE could be treated as an indication for early implant placement.
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Affiliation(s)
- Chengyan Ren
- Department of Oral and Maxillofacial Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Oral Diseases & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Weihui Chen
- Department of Oral and Maxillofacial Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
| | - Jiangping Chen
- Department of Oral and Cranio-maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chuanqing Mao
- Department of Oral and Maxillofacial Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Oral Diseases & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Caiyu Liao
- Department of Oral and Maxillofacial Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Oral Diseases & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Jianan Liu
- Department of Oral and Maxillofacial Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Oral Diseases & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
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3
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Na L, Hai B, Quan Y, Qiang Z. Application of orthodontics combined with porcelain laminate veneers in the aesthetic restoration and flora regulation of anterior teeth. Medicine (Baltimore) 2023; 102:e34340. [PMID: 37478279 PMCID: PMC10662840 DOI: 10.1097/md.0000000000034340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/23/2023] [Indexed: 07/23/2023] Open
Abstract
To evaluate the effectiveness of orthodontics in combination with porcelain laminate veneers (PLV) in the aesthetic restoration and flora regulation of anterior teeth. A retrospective analysis of 336 patients who underwent aesthetic restoration of anterior teeth in our hospital from April 2019 to September 2022 was performed and divided into a control group (n = 168) and an observation group (n = 168) according to the restorative modality. The restorative modality in the control group was conventional restorative remediation, while the restorative modality in the observation group was orthodontic combined with PLV treatment. To evaluate the excellent rate of aesthetic restoration of anterior teeth in the 2 groups, and compare the color, shape, degree of translucency, edge aesthetic score, complications and satisfaction rate of restoration of anterior teeth in the 2 groups before and after restoration. The observation group had a significantly higher rate of excellent aesthetic restorations (95.23%) compared to the control group (80.95%) (P < .001). The scores of anterior tooth color, morphology, degree of translucency and marginal aesthetics were improved in both groups after restoration compared to before restoration, and the scores were significantly higher in the observation group (P < .05). After restoration, the subgingival Digestive streptococcus, Campylobacter and Propionibacterium increased in both groups, but the number of bacterial strains was significantly less in the observation group (P < .05). Compared with the total complication rate in the control group (16.66%), the total complication rate in the observation group (2.38%) was significantly lower (P < .001). Compared with the control group (85.71%), the observation group had a significantly higher restoration satisfaction rate of 97.61%, with a statistically significant difference (P < .001). The application of orthodontics combined with PLV in the aesthetic restoration of anterior teeth has a significant clinical effect, which is conducive to improving the aesthetic restoration and satisfaction rate of anterior teeth, reducing the subgingival microbial imbalance and decreasing the incidence of complications.
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Affiliation(s)
- Lu Na
- Department of Stomatology, North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei, China
| | - Bai Hai
- Department of Stomatology, North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei, China
| | - Yuan Quan
- Department of Stomatology, North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei, China
| | - Zhang Qiang
- Department of Stomatology, North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei, China
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4
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Barootchi S, Tavelli L, Majzoub J, Stefanini M, Wang HL, Avila-Ortiz G. Alveolar ridge preservation: Complications and cost-effectiveness. Periodontol 2000 2023; 92:235-262. [PMID: 36580417 DOI: 10.1111/prd.12469] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 12/30/2022]
Abstract
Alveolar ridge preservation is routinely indicated in clinical practice with the purpose of attenuating postextraction ridge atrophy. Over the past two decades numerous clinical studies and reviews on this topic have populated the literature. In recent years the focus has primarily been on analyzing efficacy outcomes pertaining to postextraction dimensional changes, whereas other relevant facets of alveolar ridge preservation therapy have remained unexplored. With this premise, we carried out a comprehensive evidence-based assessment of the complications associated with different modalities of alveolar ridge preservation and modeled the cost-effectiveness of different therapeutic modalities as a function of changes in ridge width and height. We conclude that, among allogeneic and xenogeneic bone graft materials, increased expenditure does not translate into increased effectiveness of alveolar ridge preservation therapy. On the other hand, a significant association between expenditure on a barrier membrane and reduced horizontal and vertical ridge resorption was observed, though only to a certain degree, beyond which the return on investment was significantly diminished.
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Affiliation(s)
- Shayan Barootchi
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Ann Arbor, Michigan, USA
- Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Boston, Massachusetts, USA
| | - Lorenzo Tavelli
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Ann Arbor, Michigan, USA
- Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Boston, Massachusetts, USA
- Division of Periodontology, Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Jad Majzoub
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Martina Stefanini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Gustavo Avila-Ortiz
- Department of Periodontics, University of Iowa, College of Dentistry and Dental Clinics, Iowa City, Iowa, USA
- Private Practice, Atelier Dental Madrid, Madrid, Spain
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
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5
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Wu XY, Acharya A, Shi JY, Qian SJ, Lai HC, Tonetti MS. Surgical interventions for implant placement in the anterior maxilla: A systematic scoping review with evidence mapping. Clin Oral Implants Res 2023; 34:1-12. [PMID: 36245267 DOI: 10.1111/clr.14013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/26/2022] [Accepted: 09/18/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Simplification and standardization of interventions are critical challenges to improving performance in implant dentistry. This study aimed to systematically identify and schematically present the evidence base of the implant dentistry surgical interventions for the anterior maxilla as a basis for further development and standardization. METHODS Electronic searches were conducted in PubMed, Embase and Cochrane CENTRAL. Primary clinical studies reporting surgical interventions in the anterior maxilla, with a sample size of at least ten patients, were included. Bibliometric information and study details were extracted. Descriptive analysis and a mind map approach were used to describe the documentation of different surgical interventions. RESULTS Two hundred and seventy-two studies reporting on 9001 patients were included. Within the past two decades, the number of literatures on implant placement in the anterior maxilla has increased dramatically (7 studies before 2005, 151 studies after 2016). Overall, the evidence map identified six primary operations and 33 variations. For hopeless tooth extraction, immediate implant placement was the most frequently reported (141 studies, 4670 patients); flapless implant placement with hard tissue augmentation and immediate provisionalization was the most commonly reported variation (33 studies, 987 patients). Type 3/4 implant placement (62 studies, 1902 patients) and implant site augmentation (33 studies, 788 patients) were frequently reported for missing teeth. Geographical differences were observed, with type 2 placement studies almost exclusively from Europe. CONCLUSIONS Research on immediate implant placement was the most reported surgical intervention in the anterior maxilla. Hard tissue augmentation was frequently reported simultaneously with or before implant placement. Immediate provisionalization was mainly used for type 1 implant placement. The finding that six primary operations with 33 variations have been reported indicates the need for additional research to simplify and consolidate the surgical approach.
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Affiliation(s)
- Xin-Yu Wu
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Aneesha Acharya
- Department of Periodontology, Dr D Y Patil Dental College & Hospital, Pimpri, India.,Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Jun-Yu Shi
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Shu-Jiao Qian
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Hong-Chang Lai
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Maurizio S Tonetti
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China.,European Research Group on Periodontology, Genoa, Italy
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6
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ElAskary A, Elfana A, Meabed M, Abd-ElWahab Radi I, Akram M, Fawzy El-Sayed K. Immediate implant placement utilizing vestibular socket therapy versus early implant placement with contour augmentation for rehabilitation of compromised extraction sockets in the esthetic zone: A randomized controlled clinical trial. Clin Implant Dent Relat Res 2022; 24:559-568. [PMID: 35811090 DOI: 10.1111/cid.13120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The present randomized controlled trial compares for the first time the vestibular socket therapy (VST) to the contour augmentation technique in the management of compromised fresh extraction sockets in the maxillary esthetic zone, regarding mid-facial soft tissue changes (primary outcome), mesial and distal papillae dimensions, horizontal soft tissue changes and labial bone plate thickness at apical, middle and coronal levels (secondary outcomes) over 1-year. MATERIALS AND METHODS Forty participants with single nonrestorable maxillary teeth in the esthetic zone were randomized into two groups; VST (test; n = 20) utilizing vestibular access for guided bone regeneration (GBR) with immediate implant placement, or contour augmentation (control; n = 20) undergoing an initial healing period followed by implant placement with GBR through a conventional access flap. RESULTS All implants were successfully osseo-integrated, except for one implant in the test group. VST showed significantly less mid-facial soft tissue changes of -0.53 ± 1.17 mm versus -1.87 ± 0.69 mm in the control group (p < 0.001). Similarly, changes in mesial papilla (test = -0.64 ± 0.95 mm, control = -1.20 ± 0.81 mm), distal papilla (test = -0.56 ± 1.17 mm, control = -1.26 ± 0.63 mm), horizontal soft-tissue (test = -0.82 ± 0.95 mm, control = -1.84 ± 0.88 mm; p < 0.05) were significantly less in VST. Intra-group comparisons demonstrated a significant increase in labial bone thickness, with no differences between groups. Regression analysis revealed a significant correlation between VST as well as increased coronal bone thickness with the reduction in mid-facial soft-tissue changes. CONCLUSION The VST showed less soft-tissue changes and could represent an innovative technique for implant placement in the maxillary esthetic zone. Both techniques showed a high implant survival rate and increased bone thickness after 12 months.
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Affiliation(s)
- Abdelsalam ElAskary
- Elaskary and Associates Educational Center and Institute for Dental Implants, Alexandria, Egypt.,College of Dentistry, University of New York, New York, USA
| | - Ahmed Elfana
- Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | | | | | - Mahmoud Akram
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Karim Fawzy El-Sayed
- Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University, Cairo, Egypt.,Clinic for Conservative Dentistry and Periodontology, School of Dental Medicine, Christian Albrechts University, Kiel, Germany
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7
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Prognosis of Implants with Implant-Supported Fixed Dental Prostheses in the Elderly Population: A Retrospective Study with a 5- to 10-Year Follow-Up. Healthcare (Basel) 2022; 10:healthcare10071250. [PMID: 35885775 PMCID: PMC9317632 DOI: 10.3390/healthcare10071250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/11/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022] Open
Abstract
This retrospective study aimed to investigate the survival rate of implants from 5 to 10 years after the placement of implant-supported fixed dental prostheses (ISFDPs) and the management of implant loss in the elderly population. Elderly patients (≥65 years old) who had been treated with ISFDPs and followed up with for at least 5 years between October 2009 and March 2020 were enrolled. Patient profiles and implant-related data were extracted. The survival rate of implants up to 5 years as well as the 10-year cumulative survival rate were evaluated. The management of implant loss and prosthetic interventions were also investigated. In total, 195 patients (mean age: 70.1 ± 4.5 years old) and 687 implants (287 ISFDPs) were assessed. The 5-year survival rate was 99.0% and the 10-year cumulative survival rate was 98.1%. Seven of the eleven implants lost were lost due to peri-implantitis. Only three implants in two patients were placed after the loss of the implants; most were restored using non-invasive procedures. Two patients underwent a conversion from ISFDPs to removable prostheses. This study showed that high survival rates were observed in an elderly population with ISFDPs and that non-invasive procedures were often applied after the loss of an implant.
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8
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Abstract
Inappropriate and unnecessary implant therapy driven by an erroneous belief that dental implants provide enhanced function and esthetics over diseased or failing teeth has led to a growing burden of implant complications across the globe. Specifically, esthetic and biological complications frequently lead to the unfavorable prognosis of dental implants. Often, these cannot be managed predictably to improve the condition or satisfy patients' demands. In such circumstances, implant removal needs to be considered. Currently, minimally invasive methods based on reverse torque engineering are key to preserve peri-implant soft and hard tissues. Implant replacement is now feasible, as evidenced by the high survival rates of implants placed at previously failed sites. Notwithstanding these data, clinicians should still consider carefully the expendability of an implant and whether its replacement will satisfy the prosthetic, biomechanical, and esthetic demands of the patient. In the scenario where future implant placement is desired, protocols undertaken for soft/hard tissue grafting and implant placement should be based upon defect morphology and soft and hard-tissue characteristics. Currently, however, a lack of knowledge of the biological events and dimensional changes that arise following implant removal renders decision-making complex and challenging, and recommendations remain largely based upon empirical speculation. This chapter will review the indications for implant replacement for prosthetic, biomechanical, and esthetic complications, alongside considerations in decision-making, planning, implementation, and outcomes of implant replacement.
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Affiliation(s)
- Alberto Monje
- Department of Periodontics and Oral Medicine, School of Dental Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Periodontology, Universidad Internacional de Catalunya, Barcelona, Spain
| | - José Nart
- Department of Periodontology, Universidad Internacional de Catalunya, Barcelona, Spain
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9
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Gennai S, Izzetti R, Pioli MC, Music L, Graziani F. Impact of rehabilitation versus edentulism on systemic health and quality of life in patients affected by periodontitis: A systematic review and meta-analysis. J Clin Periodontol 2021; 49 Suppl 24:328-358. [PMID: 34761419 DOI: 10.1111/jcpe.13526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/27/2021] [Accepted: 06/21/2021] [Indexed: 12/18/2022]
Abstract
AIM To investigate the effect of rehabilitation in fully/partially edentulous patients with stage IV periodontitis on oral-health-related quality of life (OHRQoL) and systemic health. MATERIALS AND METHODS A systematic electronic and manual search was conducted. Three authors independently reviewed, selected, and extracted the data. Outcomes were OHRQoL (Oral Health Impact Profile 14 [OHIP-14] and OHIP-49, General Oral Health Assessment Index [GOHAI], visual analogue scale, symptoms registration) and systemic health-related outcomes (incidence and prevalence of systemic diseases, values of systemic disease indicators). Qualitative data were synthesized for OHRQoL and systemic health-related outcomes. Meta-analysis was conducted on available quantitative data. RESULTS The search identified 59 articles (6724 subjects in total). OHRQoL improved across all the studies, irrespective of the number of missing teeth, their location, or treatment modality. Meta-analysis showed significant improvement of OHIP-49 (36.86, p < .01) in manuscripts including subjects affected by periodontitis, consistently with the remaining literature (reduction of score points post rehabilitation: OHIP-14 = 10.52, OHIP-49 = 56.02, GOHAI = 5.40, p < .01 for all). Non-rehabilitated subjects exhibited inferior cognitive status, higher medication intake, and frailty. However, our data are limited and should be interpreted with caution. CONCLUSIONS Oral rehabilitation improves OHRQoL and, potentially, systemic health in edentulous patients. It is unclear whether these findings may be extrapolated to patients with stage IV periodontitis.
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Affiliation(s)
- Stefano Gennai
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Rossana Izzetti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Maria C Pioli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Larisa Music
- Department of Periodontology, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Filippo Graziani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
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10
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Shi JY, Zhang X, Qian SJ, Wei SM, Yan KX, Xu M, Lai HC, Tonetti MS. Evidence and risk indicators of non-random sampling in clinical trials in implant dentistry: A systematic appraisal. J Clin Periodontol 2021; 49:144-152. [PMID: 34747036 PMCID: PMC9299163 DOI: 10.1111/jcpe.13571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/25/2021] [Accepted: 10/29/2021] [Indexed: 11/30/2022]
Abstract
Aim Analysis of distribution of p‐values of continuous differences between test and controls after randomization provides evidence of unintentional error, non‐random sampling, or data fabrication in randomized controlled trials (RCTs). We assessed evidence of highly unusual distributions of baseline characteristics of subjects enrolled in clinical trials in implant dentistry. Materials and methods RCTs published between 2005 and 2020 were systematically searched in Pubmed, Embase, and Cochrane databases. Baseline patient data were extracted from full text articles by two independent assessors. The hypothesis of non‐random sampling was tested by comparing the expected and the observed distribution of the p‐values of differences between test and controls after randomization. Results One‐thousand five‐hundred and thirty‐eight unique RCTs were identified, of which 409 (26.6%) did not report baseline characteristics of the population, and 671 (43.6%) reported data in forms other than mean and standard deviation and could not be used to assess their random sampling. Four‐hundred and fifty‐eight trials with 1449 baseline variables in the form of mean and standard deviation were assessed. The study observed an over‐representation of very small p‐values [<.001, 1.38%, 95% confidence interval (CI) 0.85–2.12 compared to the expected 0.10%, 95% CI 0.00–0.26]. No evidence of over‐representation of larger p‐values was observed. Unusual distributions were present in 2.38% of RCTs and more frequent in non‐registered trials, in studies supported by non‐industry funding, and in multi‐centre RCTs. Conclusions The inability to assess random sampling due to insufficient reporting in 26.6% of trials requires attention. In trials reporting suitable baseline data, unusual distributions were uncommon, and no evidence of data fabrication was detected, but there was evidence of non‐random sampling. Continued efforts are necessary to ensure high integrity and trust in the evidence base of the field.
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Affiliation(s)
- Jun-Yu Shi
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Xiao Zhang
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Shu-Jiao Qian
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Shi-Min Wei
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Kai-Xiao Yan
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Min Xu
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Hong-Chang Lai
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Maurizio S Tonetti
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China.,European Research Group on Periodontology, Genoa, Italy
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11
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Jonker BP, Strauss FJ, Naenni N, Jung RE, Wolvius EB, Pijpe J. Early implant placement with or without alveolar ridge preservation in single tooth gaps renders similar esthetic, clinical and patient-reported outcome measures: One-year results of a randomized clinical trial. Clin Oral Implants Res 2021; 32:1041-1051. [PMID: 34129708 PMCID: PMC8457170 DOI: 10.1111/clr.13796] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/23/2021] [Accepted: 06/07/2021] [Indexed: 12/24/2022]
Abstract
Objectives To test whether early implant placement with alveolar ridge preservation (ARP) results in different esthetic, clinical and patient‐reported outcome measures (PROMs) compared with early implant placement without ARP. Material and methods Seventy‐five patients requiring single tooth extraction in the anterior maxilla were recruited. Following tooth extraction, the patients were randomly allocated to three groups: (a) ARP using demineralized bovine bone mineral containing 10% collagen (DBBM‐C) covered by a collagen matrix (CM) (n = 25), (b) ARP using DBBM‐C covered with a palatal graft (PG) (n = 25) and (c) spontaneous healing (control) (n = 25). Eight weeks after tooth extraction, a CBCT was taken and early implant placement was performed in all patients. Esthetic, clinical and PROMs were evaluated one year post‐loading. Results A total of 70 patients were available for re‐examination at one year post‐loading. The median mid‐facial mucosal margin change amounted to −0.02 mm (IQR −0.27–0.46) in the CM group, −0.13 mm (IQR −0.44–0.25) in the PG group and −0.14 mm (IQR −0.29–0.07) in the control group, with no significant differences between the groups. Mean PES scores amounted to 7.0 ± 1.4 in the CM group, 7.1 ± 1.5 in the PG group and 7.3 ± 1.7 in the control group without significant differences between the groups. Plaque, bleeding on probing and probing depth did not differ between treatment groups. PROMs in general revealed no significant differences between the groups. Conclusion Early implant placement with ARP using either a collagen matrix or a palatal graft rendered similar esthetic, clinical and PROMs to early implant placement without ARP. When a failing tooth can be replaced with an implant within 2 months after tooth extraction, the added value of ARP might be clinically negligible.
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Affiliation(s)
- Brend P Jonker
- Department of Oral & Maxillofacial Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Franz J Strauss
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.,Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Nadja Naenni
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Eppo B Wolvius
- Department of Oral & Maxillofacial Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Justin Pijpe
- Department of Oral & Maxillofacial Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Oral & Maxillofacial Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
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12
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Noh K, Thoma DS, Park JC, Lee DW, Shin SY, Lim HC. A case series of profilometric changes in two implant placement protocols at periodontally compromised non-molar sites. Sci Rep 2021; 11:1714. [PMID: 33462323 PMCID: PMC7813861 DOI: 10.1038/s41598-021-81402-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 01/06/2021] [Indexed: 01/13/2023] Open
Abstract
Information regarding profilometric changes at a soft tissue level following implant placement with different protocols is insufficient. Therefore, this study aimed to comparatively investigate the profilometric tissue changes with respect to late implant placement following alveolar ridge preservation (LP/ARP) and early implantation (EP) in periodontally compromised non-molar extraction sites. Sixteen patients were randomly assigned to the following groups: implant placement 4 months post-ARP (group LP/ARP) and tooth extraction and implant placement 4–8 weeks post-extraction (group EP). Dental impressions were obtained immediately after final prosthesis insertion and at 3, 6, and 12 months. At the time of implant placement, bone augmentation was performed in the majority of the patients. Profilometric changes of the tissue contour were minimal between the final prosthesis insertion and 12 months in the mid-facial area (0.04–0.35 mm in group LP/ARP, 0.04–0.19 mm in group EP). The overall tissue volume increased in both groups (1.70 mm3 in group LP/ARP, 0.96 mm3 in group EP). In conclusion, LP/ARP and EP led to similar stability of the peri-implant tissue contour between the final prosthesis insertion and at 12 months. Moreover, the change of peri-implant tissue on the soft tissue level was minimal in both modalities.
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Affiliation(s)
- Kwantae Noh
- Department of Prosthodontics, School of Dentistry, Kyung Hee University, Seoul, Republic of Korea
| | - Daniel S Thoma
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
| | - Jung-Chul Park
- Department of Periodontology, College of Dentistry, Dankook University, Cheonan-si, Republic of Korea
| | - Dong-Woon Lee
- Department of Periodontology, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Seung-Yun Shin
- Department of Periodontology, Periodontal-Implant Clinical Research Institute, School of Dentistry, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Hyun-Chang Lim
- Department of Periodontology, Periodontal-Implant Clinical Research Institute, School of Dentistry, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea.
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13
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Wessels R, Vervaeke S, Seyssens L, Eghbali A, Cosyn J. A 5‐year cohort study on early implant placement with guided bone regeneration or alveolar ridge preservation with connective tissue graft. Clin Implant Dent Relat Res 2020; 22:697-705. [DOI: 10.1111/cid.12948] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/24/2020] [Accepted: 08/24/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Retief Wessels
- Oral Health Sciences, Department of Periodontology and Oral Implantology, Faculty of Medicine and Health Sciences Ghent University Ghent Belgium
| | - Stijn Vervaeke
- Oral Health Sciences, Department of Periodontology and Oral Implantology, Faculty of Medicine and Health Sciences Ghent University Ghent Belgium
| | - Lorenz Seyssens
- Oral Health Sciences, Department of Periodontology and Oral Implantology, Faculty of Medicine and Health Sciences Ghent University Ghent Belgium
| | - Aryan Eghbali
- Oral Health Sciences, Department of Periodontology and Oral Implantology, Faculty of Medicine and Health Sciences Ghent University Ghent Belgium
- Oral Health Research Group (ORHE), Faculty of Medicine and Pharmacy Vrije Universiteit Brussel (VUB) Brussels Belgium
| | - Jan Cosyn
- Oral Health Sciences, Department of Periodontology and Oral Implantology, Faculty of Medicine and Health Sciences Ghent University Ghent Belgium
- Oral Health Research Group (ORHE), Faculty of Medicine and Pharmacy Vrije Universiteit Brussel (VUB) Brussels Belgium
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14
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Botilde G, Colin P, González‐Martín O, Lecloux G, Rompen E, Lambert F. Hard and soft tissue analysis of alveolar ridge preservation in esthetic zone using deproteinized bovine bone mineral and a saddle connective tissue graft: A long‐term prospective case series. Clin Implant Dent Relat Res 2020; 22:387-396. [DOI: 10.1111/cid.12899] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/14/2020] [Accepted: 03/10/2020] [Indexed: 01/29/2023]
Affiliation(s)
- Gaëlle Botilde
- Department of Periodontology and Oral Surgery, Faculty of Medicine University of Liege Liège Belgium
- Dental Biomaterials Research Unit University of Liège Liège Belgium
| | - Paul‐Emile Colin
- Department of Radiodiagnostic, Faculty of Medicine University of Liege Liège Belgium
| | - Oscar González‐Martín
- Department of Periodontology University Complutense of Madrid Madrid Spain
- Department of Periodontology University of Iowa Iowa Iowa USA
- Private Practice Gonzalez + Solano Atelier Dental Madrid Spain
| | - Geoffrey Lecloux
- Department of Periodontology and Oral Surgery, Faculty of Medicine University of Liege Liège Belgium
- Dental Biomaterials Research Unit University of Liège Liège Belgium
| | - Eric Rompen
- Department of Periodontology and Oral Surgery, Faculty of Medicine University of Liege Liège Belgium
- Dental Biomaterials Research Unit University of Liège Liège Belgium
| | - France Lambert
- Department of Periodontology and Oral Surgery, Faculty of Medicine University of Liege Liège Belgium
- Dental Biomaterials Research Unit University of Liège Liège Belgium
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15
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Park S, Song YW, Sanz‐Martín I, Cha J, Lee J, Jung U. Clinical benefits of ridge preservation for implant placement compared to natural healing in maxillary teeth: A retrospective study. J Clin Periodontol 2020; 47:382-391. [DOI: 10.1111/jcpe.13231] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 11/26/2019] [Accepted: 12/06/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Su‐Hyun Park
- Department of Periodontology Research Institute for Periodontal Regeneration Yonsei University College of Dentistry Seoul South Korea
| | - Young Woo Song
- Department of Periodontology Research Institute for Periodontal Regeneration Yonsei University College of Dentistry Seoul South Korea
| | - Ignacio Sanz‐Martín
- Department of Periodontology Research Institute for Periodontal Regeneration Yonsei University College of Dentistry Seoul South Korea
- Section of graduate Periodontology Faculty of Odontology Complutense University of Madrid Madrid Spain
| | - Jae‐Kook Cha
- Department of Periodontology Research Institute for Periodontal Regeneration Yonsei University College of Dentistry Seoul South Korea
| | - Jung‐Seok Lee
- Department of Periodontology Research Institute for Periodontal Regeneration Yonsei University College of Dentistry Seoul South Korea
| | - Ui‐Won Jung
- Department of Periodontology Research Institute for Periodontal Regeneration Yonsei University College of Dentistry Seoul South Korea
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16
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Lim H, Seo S, Thoma DS, Park J, Hong J, Shin S. Late implant placement following ridge preservation versus early implant placement: A pilot randomized clinical trial for periodontally compromised non‐molar extraction sites. J Clin Periodontol 2019; 47:247-256. [DOI: 10.1111/jcpe.13223] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/18/2019] [Accepted: 11/15/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Hyun‐Chang Lim
- Department of Periodontology Periodontal‐Implant Clinical Research Institute School of Dentistry Kyung Hee University Seoul Republic of Korea
| | - Seongwoo Seo
- Department of Periodontology Periodontal‐Implant Clinical Research Institute School of Dentistry Kyung Hee University Seoul Republic of Korea
| | - Daniel S. Thoma
- Clinic of Reconstructive Dentistry University of Zurich Zurich Switzerland
| | - Jung‐Chul Park
- Department of Periodontology College of Dentistry Dankook University Cheonansi Republic of Korea
| | - Ji‐Youn Hong
- Department of Periodontology Periodontal‐Implant Clinical Research Institute School of Dentistry Kyung Hee University Seoul Republic of Korea
| | - Seung‐Yun Shin
- Department of Periodontology Periodontal‐Implant Clinical Research Institute School of Dentistry Kyung Hee University Seoul Republic of Korea
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17
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Tonetti MS, Jung RE, Avila-Ortiz G, Blanco J, Cosyn J, Fickl S, Figuero E, Goldstein M, Graziani F, Madianos P, Molina A, Nart J, Salvi GE, Sanz-Martin I, Thoma D, Van Assche N, Vignoletti F. Management of the extraction socket and timing of implant placement: Consensus report and clinical recommendations of group 3 of the XV European Workshop in Periodontology. J Clin Periodontol 2019; 46 Suppl 21:183-194. [PMID: 31215112 DOI: 10.1111/jcpe.13131] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 05/03/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND The transition from a tooth requiring extraction to its replacement (with a dental implant) requires a series of clinical decisions related to timing, approach, materials, cost-effectiveness and the assessment of potential harm and patient preference. This workshop focused on the formulation of evidence-based consensus statements and clinical recommendations. METHODS Four systematic reviews covering the areas of alveolar ridge preservation/bone grafting, immediate early and delayed implant placement and alveolar bone augmentation at the time of implant placement in a healed ridge formed the basis of the deliberations. The level of evidence supporting each consensus statement and its strength was described using a modification of the GRADE tool. RESULTS The evidence base for each of the relevant topics was assessed and summarized in 23 consensus statements and 12 specific clinical recommendations. The group emphasized that the evidence base mostly relates to single tooth extraction/replacement; hence, external validity/applicability to multiple extractions requires careful consideration. The group identified six considerations that should assist clinicians in clinical decision-making: presence of infection, inability to achieve primary stability in the restoratively driven position, presence of a damaged alveolus, periodontal phenotype, aesthetic demands and systemic conditions. CONCLUSIONS A substantial and expanding evidence base is available to assist clinicians with clinical decision-making related to the transition from a tooth requiring extraction to its replacement with a dental implant. More high-quality research is needed for the development of evidence-based clinical guidelines.
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Affiliation(s)
- Maurizio S Tonetti
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, University of Hong Kong, Hong Kong, China.,European Research Group on Periodontology, Genova, Italy
| | - Ronald E Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland
| | | | - Juan Blanco
- Department of Surgery and Medical-Surgical Specialties (Dentistry area), Unit of Periodontology, University of Santiago de Compostela, Santiago, Spain
| | - Jan Cosyn
- Department of Dentistry, University of Ghent, Ghent, Belgium
| | - Stefan Fickl
- Division of Periodontology, University of Würzburg, Würzburg, Germany
| | - Elena Figuero
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, Department of Dental Clinic Specialties, Faculty of Dentistry, University Complutense, Madrid, Spain
| | - Moshe Goldstein
- Department of Periodontology, Hebrew University, Jerusalem, Israel
| | - Filippo Graziani
- Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Phoebus Madianos
- Department of Periodontology, Kapodistrian University, Athens, Greece
| | - Ana Molina
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, Department of Dental Clinic Specialties, Faculty of Dentistry, University Complutense, Madrid, Spain
| | - Jose Nart
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Ignacio Sanz-Martin
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, Department of Dental Clinic Specialties, Faculty of Dentistry, University Complutense, Madrid, Spain
| | - Daniel Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland
| | - Nele Van Assche
- Private Practice of Periodontology and Implantology, Geel, Belgium
| | - Fabio Vignoletti
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, Department of Dental Clinic Specialties, Faculty of Dentistry, University Complutense, Madrid, Spain
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