Implant-supported prostheses in patients with special needs: A systematic literature review of protocols and outcomes

STATEMENT OF PROBLEM

Implant-supported prostheses for individuals with special needs have been considered high-risk because of the prevalence of poor oral hygiene and parafunction in this population; however, systematic evidence on protocols and outcomes is scarce.

PURPOSE

The purpose of this systematic review was to summarize implant procedures and outcomes for the special needs population.

MATERIAL AND METHODS

A systematic literature review was conducted using PubMed, Embase, and Scopus databases in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) methodological framework. Data collected included patient information, location and number of implants, surgical and prosthetic procedures, behavior support techniques, postoperative follow-up, complications, and criteria for outcome assessment. Survival rates were pooled for quantitative analysis, and a separate analysis pooling data from groups of special needs patients that present similar risks was undertaken.

RESULTS

The qualitative analysis included 79 studies involving 759 patients and 2269 implants. The quantitative analysis included 65 studies concerning 666 patients with special needs and 1886 implants. The overall weighted implant survival rate was 95.4%, with a mean follow-up duration of 40.7 ±29.5 months.

CONCLUSIONS

In individuals with special needs considered suitable for implant-supported prostheses by their clinician, implant survival rates were similar to those reported in the general population. (J Prosthet Dent xxxx;xxx:xxx-xxx).

Retrospective Case-Control Study Genes Related to Bone Metabolism That Justify the Condition of Periodontal Disease and Failure of Dental Implants in Patients with down Syndrome

Down syndrome patients show success rates in dental implants much lower than those observed in the general population. This retrospective case-control study aimed to identify possible genes that are related to the regulation of inflammatory responses and bone metabolism related to periimplantitis and implant loss, as well as genes related to bone quality. This process involved using the functional analysis of the gene expression software Transcriptome Analysis Console (TAC version 4.0 Applied Biosystems^TM, Thermo Fisher Scientific, Waltham, MA, USA) and a search for possible candidate genes involved. The focus was placed on the 93 genes related to periodontitis, periimplantitis, bone loss, implant loss, and genes related to bone quality and regulators underlying the establishment and maintenance of osseointegration. Five genes showed statistically significant results (p < 0.05) in our comparison. Four of them, IL1B (p = 0.023), IL1RN (p = 0.048), BGLAP (p = 0.0372) and PTK2 (p = 0.0075) were down-regulated in the periodontal disease and implant rejection group, and only one was overexpressed: FOXO1A (p = 0.0552). The genes with statistically significant alterations described in this article determine that the group of Down syndrome patients with periodontal disease and implant failure is a group of patients genetically susceptible to suffering from both conditions together.

Panoramic radiographs and dental patients with Down syndrome: A scoping review

INTRODUCTION

Life expectancy for people with Down syndrome (DS) has increased to 60 years, although poor oral health affects their quality of life. Panoramic radiographs (PRs) are usually well-tolerated by people with DS and can provide valuable diagnostic data for treatment planning and research. Methods A scoping review of peer-reviewed articles published between 1971and 2021 was conducted in accordance with the PRISMA extension for scoping reviews to determine the scope of use of PRs for people with DS.

RESULTS

937 papers were screened, and 52 papers were included and charted into seven categories in this review. A high prevalence of tooth agenesis (TA) and other anomalies were reported in 45% of papers. Severe periodontal disease was considered characteristic of DS in the 1970s-80s and the benefit of time-consuming treatment was questioned. Since 2000 case reports illustrate that improved oral care, orthodontic treatment, and dental implants under local or general anaesthetic can improve the quality of life for people with DS.

CONCLUSION

PRs play an important role in the diagnosis of anomalies, periodontal disease, and implant planning for patients with DS. This review highlights the gaps in research of caries, pathology, TMJ, systemic disease indicators, and guidelines for dentists. Systematic PR viewing, with a knowledge of characteristic features of DS, will assist diagnosis of pathology and improve comprehensive dental care treatment planning for children and adults with DS.

Is Down syndrome a risk factor or contraindication for dental implants? A systematic review

STATEMENT OF PROBLEM

Whether oral rehabilitation with dental implants in patients with Down syndrome leads to an increased complication rate is unclear.

PURPOSE

The purpose of this systematic review was to determine the effectiveness of dental implants placed in patients with Down syndrome and whether the condition is a risk factor or contraindication for dental implant placement.

MATERIAL AND METHODS

Searches were conducted in 6 databases, including the non-peer-reviewed literature, up to February 2021 by 2 independent reviewers according to established inclusion and exclusion criteria to answer this question: Is Down syndrome a risk factor or contraindication for oral rehabilitation with dental implants?

RESULTS

A total of 655 studies were initially found in the databases. Five were included in this systematic review, all of which were observational studies. A total of 50 patients with 186 implants were evaluated, with a reported effectiveness of 79.1%. The risk of bias assessment determined that 3 of the 5 studies had a high risk of bias.

CONCLUSIONS

Treatment with dental implants in patients with Down syndrome is a suitable option, but more complications are to be expected than with patients without this condition. Controlled studies with better methodological design and less risk of bias should be developed to improve the scientific evidence for the treatment of these patients.