Efficacy of acellular xenogeneic dermal matrix graft in the treatment of multiple gingival recessions: systematic review and meta-analysis

OBJECTIVE

This study aimed to compare the efficacy of acellular xenogeneic dermal matrix graft (AXDM) compared to connective tissue graft (CTG) in treating multiple gingival recessions.

MATERIALS AND METHODS

A systematic search of electronic databases was conducted to identify randomized clinical trials (RCTs) that compared AXDM and CTG. The selected studies were subjected to bias risk assessment, data extraction, and meta-analyses. Parameters such as gingival recession height, width, mean percentage of root coverage, and complete root coverage were analyzed.

RESULTS

Seven RCTs involving 146 patients were included. The meta-analyses indicated that CTG was statistically superior to AXDM in reducing gingival recession height at the final follow-up (mean difference: -0.104 mm, 95% confidence interval [CI]: -0.180-0.028, p = 0.008) and width at the final follow-up (mean difference: -0.285 mm, 95% CI: -0.541-0.030, p = 0.029). CTG also demonstrated a significantly higher mean percentage of root coverage at the 6-month follow-up (difference in means: -2.761 mm, 95% CI: -4.932-0.590, p = 0.013) and a higher percentage of complete root coverage at the 6-month follow-up (odds Ratio [OR]: 0.598, 95% CI: 0.4-0.892, p = 0.012) compared to AXDM. However, there was no significant difference in the number of teeth with complete root coverage between CTG and AXDM (OR: 1.610, 95% CI: 0.983-2.636, p = 0.058) and aesthetic outcomes (mean difference: 0.148, 95% CI: -0.277-0.573, p = 0.494).

CONCLUSIONS

CTG is more effective than AXDM in treating multiple gingival recessions. This is evidenced by significant reductions in gingival recession height and width, a higher mean percentage of root coverage, and a greater percentage of complete root coverage at the 6-month follow-up.

CLINICAL RELEVANCE

In some clinical situations an alternative to CTG is required for the treatment of multiple gingival recessions. AXDM, despite presenting clinical outcomes that are not as satisfactory as CTG, can be used for this purpose.

Efficacy of photobiomodulation in the treatment of avulsed teeth: A systematic review of animal studies

The objective of this systematic review was to evaluate the effectiveness of photobiomodulation therapy (PBM) in managing avulsed teeth. This systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (i.e., "PRISMA") statement 2020 and was registered in the International Prospective Register of Systematic Reviews (i.e., PROSPERO) with number CRD42022362198. The participants, intervention, comparison, outcomes, and study design (i.e., PICOS) for the present study considered the following question: "Does the use of laser PBM in the treatment of teeth with avulsion influence tissue repair performance?" A literature search was performed in PubMed/MEDLINE, Embase, Web of Science, Cochrane Library, and ProQuest databases until January 2023. The SYRCLE's RoB tool (Systematic Review Center for Laboratory Animal Experimentation) for animal studies were used for quality assessment. A total of 7 in vivo studies published between 2011 and 2018 were included in this systematic review for qualitative analysis. All studies used Wistar rats, totaling 368 specimens that simulated tooth avulsion trauma. The effect of photodynamic therapy in the treatment of avulsed teeth was positive in 5 studies (significant increase in tissue repair) and negative in 2 studies, in which both studies with negative results kept teeth in saline solution before reimplantation and showed the longest time and power of laser application. PBM appears to be effective for tissue repair in the treatment of avulsed teeth, depending on the means of conservation of the avulsed tooth and the laser application protocol.

Steel drills versus zirconia drills on heat generation at the surgical site of dental implants: A systematic review and meta-analysis

Objective

The aim was to evaluate the difference in the heat generated between zirconia (Zr) and steel (SS) drills, during implant site preparation.

Material and methods

This systematic review followed the PRISMA methodology criteria and used the JBI Critical Assessment Guidelines for Quasi-Experimental Studies for quality assessment. The electronic search was conducted by using the PubMed/MEDLINE, Embase, and Cochrane Library databases to January 2023. The formulated population, intervention, comparison, outcome (PICO) question was "Do zirconia drills generate less heat than steel drills during implant site preparation?". The meta-analysis was based on an inverse variance (IV) method.

Results

This review included 10 studies in vitro that used zirconia drills compared to steel drills with or without coatings. The meta-analysis indicated a significant difference between Zr drills and SS drills, with a lower bone temperature variation with Zr drills.

Conclusions

Despite the limitations of this review, it was concluded that Zr drills had significantly less temperature variation than SS drills.

Color stability and surface roughness of resin-ceramics with different surface treatments: A systematic review and meta-analysis of in vitro studies

STATEMENT OF PROBLEM

Surface treatments for resin-ceramics have been developed to obtain a smooth surface and improve color stability. However, a consensus on the best treatment for these materials is lacking.

PURPOSE

The purpose of this systematic review and meta-analysis was to evaluate the color stability and roughness of glass-ceramics versus resin-ceramics with different surface treatments.

MATERIAL AND METHODS

The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed, and the study was registered in the open science framework (OSF) for in vitro studies. The population, intervention, control, and outcome (PICO) question was "Is there a difference in color stability and roughness between resin-ceramic vs vitreous ceramics in different surface treatment protocols?" A literature search was performed in PubMed/MEDLINE, Embase, Web of Science, Scopus, Cochrane Library, and ProQuest databases up to January 2023. The Joanna Briggs Institute's critical assessment guidelines for quasi-experimental studies were used for quality assessment. The meta-analysis was based on the inverse variance (IV) method (α=.05).

RESULTS

A total of 18 laboratory studies were published between 2015 and 2022, with a total of 2160 specimens, all of which were analyzed qualitatively. The meta-analysis indicated significantly less optical alteration for lithium disilicate ceramics (P<.01; MD: 2.69; 95% CI: 2.00-3.39; I²=89%, P<.01), even when compared with resin-ceramics with polish or sealants (P<.01; MD: 2.45; 95% CI: 1.59-3.30; I²=87%, P<.01) and (P<.01; MD: 3.24; 95% CI: 2.02-4.47; I²=89%, P<.01), while there was no significant difference in surface roughness (P=.08; MD: -0.71; CI 95%: -1.52 to 0.09; I²=87%, P<.01) (P=.33; MD: -0.31; CI 95%: -0.94 to 0.32; I²=87%, P<.01), respectively.

CONCLUSIONS

Resin-ceramics that have been polished or treated with sealants have lower color stability than glazed glass-ceramics; however, they are similar in terms of surface roughness.

Polyetheretherketone materials for removable partial denture frameworks: an integrative review

Polyetheretherketone (PEEK) resin is a high-performance thermoplastic polymer that has been introduced as a possible candidate to replace metallic components in dental prostheses. The objective of this integrative review was to compare, through analysis of studies in the literature, the mechanical performance of removable partial denture frameworks and clasps manufactured with PEEK with the performance of cobalt-chromium (Co-Cr) frameworks and clasps. The guiding question was, "Does the use of PEEK as a substitute for Co-Cr alloys for the construction of removable partial denture frameworks result in better mechanical properties?" The PubMed/ MEDLINE, Embase, Web of Science, Scopus, and SciELO databases were searched for articles published through October 2021. The JBI Critical Appraisal Checklist for Quasi-Experimental Studies was used to assess the methodologic quality of the selected in vitro studies. A total of 208 articles were identified. After the exclusion of duplicates and articles that did not meet the inclusion criteria, 7 studies- -4 in vitro and 3 three-dimensional finite element analyses- -published between 2012 and 2021 were included in the integrative review. The appraisal checklist revealed that the reviewed studies had a low risk of bias and high methodologic quality. The results of the review showed that PEEK alloys have adequate mechanical properties for use in clasps and removable partial denture frameworks, but Co-Cr alloys exhibit better mechanical properties and are more suitable in most circumstances.

Effect of Extrinsic Pigmentation on Dimensional Stability, Hardness, Detail Reproduction, and Color of a Silicone

OBJECTIVE

 The aim of the study is to evaluate the effect of extrinsic pigmentation on the dimensional stability, hardness, detail reproduction, and color of a silicone after thermocycling.

MATERIALS AND METHODS

 Sixty samples of MDX4-4210 silicone (Dow Corning Corporation Medical Products) with intrinsic pink pigment (H-109-P, Factor II) and intrinsic opacifier (TiO) were fabricated. Two groups were created: Group 1-only intrinsic pigmentation (H-109P, Factor II + TiO) (Control); and Group 2-intrinsic (H-109P, Factor II + TiO) and extrinsic (Tan FE - 215, Factor II) pigmentation. The following tests were performed for each group: dimensional stability, Shore A hardness, detail reproduction, and color. Readings for the tests were taken before and after thermocycling (2,000 cycles). For dimensional stability and hardness, two-way analysis of variance (ANOVA) was used. One-way ANOVA was used for the color test. In case of significant statistical difference, the Tukey test was applied (p <0.05). All samples achieved the same detail reproduction score, therefore, no statistical evaluation was performed.

RESULTS

 For the dimensional stability test, comparing the initial time with the final time, there was a significant contraction in both groups after thermocycling. For the hardness test, comparing the time points, only group 1 showed a significant reduction in hardness after thermocycling. Groups 1 and 2 scored 2 for the detail reproduction test, before and after thermocycling. Comparing group 1 with group 2, there was no significant difference for color change.

CONCLUSION

 Based on the tests performed, extrinsic pigmentation did not show a negative effect on silicone, and therefore it can be indicated. The results of the dimensional, hardness, detail reproduction and color evaluations of the MDX4-4210 silicone were clinically acceptable in all cases in the groups with and without extrinsic pigmentation.

Do dental implants placed in patients with osteoporosis have higher risks of failure and marginal bone loss compared to those in healthy patients? A systematic review with meta-analysis

PURPOSE

This systematic review and meta-analysis aimed to compare the dental implant survival rate and marginal bone loss between patients with and without osteoporosis.

MATERIALS AND METHODS

This systematic review was registered in PROSPERO (CRD42022356377). A systematic search was performed using five databases: MEDLINE/PubMed, Web of Science, Scopus, Embase, and ProQuest for articles published up to July 2022. Additional searches in ClinicalTrials.gov and the reference lists of included studies were performed. The eligibility criteria comprised observational studies with a direct comparison between patients with and without osteoporosis, with a minimum follow-up of 1 year and 10 implants placed in each group, which consider data analysis based on implant level, without restrictions on period or language of publication. The meta-analysis was performed using RevMan 5.4 program. Risk of bias analysis of the included studies was performed using the Newcastle-Ottawa scale (NOS).

RESULTS

Twelve studies met the eligibility criteria, totaling 1132 patients with a mean age range from 54 to 76.6 years. Most of the included patients were women (73.6%). A total of 3505 implants were evaluated-983 in patients with osteoporosis and 2522 in patients without osteoporosis. The meta-analysis indicated no difference in implant survival rates between patients with and without osteoporosis (OR, 1.78; 95% confidence interval [CI], 0.86-3.70; P = 0.12). However, significant bone loss was observed around dental implants placed in patients with osteoporosis (SMD, 0.71 mm; 95% CI, 0.06-0.87 mm). The NOS indicated a low risk of bias in the studies included. However, the certainty of the evidence was classified as very low and low for implant survival rates and bone loss, respectively.

CONCLUSION

According to the limitations of the present review, the data suggest that dental implants are a viable treatment option for the rehabilitation of patients with osteoporosis. However, clinical care by professionals is necessary to ensure the maintenance of peri-implant bone stability, as these patients may be susceptible to increased bone loss.

Evaluation of bond strength of glass and resin-ceramics with laser phototherapy: A systematic review and meta-analysis of in vitro studies

STATEMENT OF PROBLEM

Laser phototherapy has been studied as a surface treatment capable of increasing the adhesion of cement to the ceramic surface. However, the bond strength of glass and resin-ceramics after laser phototherapy is unclear.

PURPOSE

The objective of this systematic review and meta-analysis was to compare the bond strength of glass and resin-ceramics using laser therapy and conventional hydrofluoric acid etching.

MATERIAL AND METHODS

This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was registered in the Open Science Framework (OSF) for in vitro studies. A population, intervention, control, and outcome (PICO) question was formulated: "Does phototherapy promote better bond strength in glass and resin-ceramics than conventional hydrofluoric acid etching?" A literature search was performed in PubMed/MEDLINE, Embase, Web of Science, Scopus, Cochrane Library, and ProQuest databases up to January 2023. The Joanna Briggs Institute critical assessment guidelines for quasi-experimental studies were used for quality assessment. The meta-analysis was based on the inverse variance (IV) method (α=.05).

RESULTS

A total of 6 in vitro studies published between 2007 and 2019 with a total number of 348 specimens were included for qualitative analysis; 1 study had a positive effect. Five of the studies were included in the meta-analysis, which indicated a significant decrease for feldspathic ceramics that received laser phototherapy and lithium disilicate (P=.002; MD: -2.15; 95% CI: -3.53 to -0.77; I²=89%, P<.01) and (P<.01; MD: -2.13; 95% CI: -2.99 to -1.27; I²=82%, P<.01), respectively.

CONCLUSIONS

Laser irradiation as surface etching of glass ceramics does not produce a bond strength equal to that of conventional hydrofluoric acid etching.

Prevalence of proximal contact loss between implant-supported prostheses and adjacent natural teeth: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Proximal contact loss between implant-supported prostheses and adjacent natural teeth is a complication that has been reported in clinical practice. However, the prevalence of the condition is unclear.

PURPOSE

The purpose of this systematic review and meta-analysis was to assess the proportion of reported proximal contact loss between implant-supported prostheses and adjacent natural teeth.

MATERIAL AND METHODS

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology criteria and was registered on the international prospective register of systematic reviews (PROSPERO) platform (CRD42021225138). The electronic search was conducted by using the PubMed/MEDLINE, Embase, and Cochrane Library databases to September 2020. The formulated population, intervention, comparison, outcome (PICO) question was "Is there a correlation of the proximal contact loss between implant-supported prostheses and the adjacent natural tooth?" A single-arm meta-analysis of proportion was performed to evaluate the cumulative prevalence of survival and complication rates.

RESULTS

This review included 10 studies, half of which presented proximal contact loss rates higher than 50%. In the general analysis, the open proximal contact showed a cumulative proportion of 41% (confidence interval: 30% to 53%; heterogeneity: I²=98%; t²=0.578; P<.01). From the subanalysis, the mesial contact (47%; confidence interval: 32% to 62%; heterogeneity: I²= 96%; t²=0.657; P<.01) and the mandibular arch (41%; confidence interval: 30% to 52%; heterogeneity: I²=92%; t²=0.302; P<.01) were found to have higher prevalence.

CONCLUSIONS

The prevalence of proximal contact loss was high, occurring more frequently with the mesial contact and in the mandibular arch. Significant differences were not found in relation to sex or between the posterior and anterior regions.

Is the clinical performance of internal conical connection better than internal non-conical connection for implant-supported restorations? A systematic review with meta-analysis of randomized controlled trials

PURPOSE

To evaluate bone loss, prosthodontics and biological complications, and implant survival rates of internal conical connections (ICC) compared with internal non-conical connection (INCC) implants.

METHODS

The systematic review was registered on PROSPERO (CRD42021237170). Meta-analysis was performed using standardized mean difference (SMD) for bone loss and risk ratio (RR) for implant survival and complication rates. Risk of bias analysis was evaluated using RoB 2.0, whereas the GRADE tool was used to evaluate the certainty of evidence. A systematic search of the PubMed, Web of Science, Embase, Cochrane, and ProQuest databases was performed independently by two reviewers for articles published up to March 2022. The search criteria had no language or publication date restrictions. Handsearching analysis was performed in the reference list of potential articles.

RESULTS

Twelve randomized clinical trials, including 678 patients and 1006 implants (ICC [n = 476]; INCC [n = 530]), were included. Meta-analysis revealed that ICC demonstrated a lower risk for marginal bone loss (SMD: -0.80 mm; p = 0.004) and prosthodontics complications (RR: 0.16; p = 0.01) than INCC. However, both internal connections demonstrated no significant difference in implant survival rates (RR: 0.54; p = 0.10) and biological complications (RR: 0.90; p = 0.82). The overall risk of bias revealed some concerns and a low risk of bias for most of the included studies. However, the certainty of evidence of outcomes was considered low to moderate.

CONCLUSION

ICC may be considered a more favorable treatment option than INCC owing to greater preservation of peri-implant bone tissue and a lower probability of prosthodontics complications. However, well-conducted studies with long-term follow-up are warranted.

Root-supported overdenture in a patient with a cleft palate and extensive bone loss after traumatic injury

Maxillofacial trauma caused by automobile accidents can result in extensive loss of alveolar bone, teeth, and gingival tissues as well as a cleft palate. Patients who have undergone such trauma may experience a loss of vertical dimension of occlusion, esthetic deformity, and difficulties in speaking, chewing, and swallowing. Both prosthodontic and surgical treatment are required in these cases. This case report describes the use of palatoplasty and maxillary and mandibular complete overdentures with a ball attachment system supported by natural roots as rehabilitative treatment for a 65-year-old man who had been injured in an automobile accident 24 years previously. Palatoplasty was performed to close the cleft palate that resulted from the trauma. Other procedures, including tooth extractions, endodontic treatment, cementation of ball attachments, and fabrication of temporary removable partial dentures to reestablish the vertical dimension of occlusion, were performed before the overdentures were placed. This treatment reestablished the patient's chewing, phonetic, and esthetic functions at a lower cost than other treatment options. At the 1-year follow-up evaluation, the patient's oral health was satisfactory, with no loss of abutment teeth, and the prostheses were functioning correctly.

Influence of antimicrobial photodynamic therapy on the bond strength of endodontic sealers to intraradicular dentin: A systematic review and meta-analysis

BACKGROUND

The objective of this systematic review and meta-analysis (SRMA) was to investigate the influence of antimicrobial photodynamic therapy (aPDT) on the bond strength of endodontic sealers to intraradicular dentin.

METHODS

This SRMA followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was registered in the International Prospective Registry of Systematic Reviews (PROSPERO) (CRD42022319856). A population, intervention, control, and outcome (PICO) question was formulated: "Does antimicrobial photodynamic therapy decrease the bond strength of root canal sealers?". A literature search was performed in PubMed/MEDLINE, Embase, Web of Science, Scopus, Cochrane Library, and ProQuest databases until July 2022. Joanna Briggs Institute Critical Assessment Guidelines for Quasi-Experimental Studies were used for quality assessment. The meta-analysis was based on the inverse variance (IV) method (p<0.05).

RESULTS

Out of an initial 345 articles, 8 in vitro studies were included, published between 2013 and 2022. The studies were qualitatively analyzed; two studies showed a positive effect, two studies a negative effect, and the other studies showed no effect on bond strength of endodontic sealers to intraradicular dentin. Seven of the studies were included in the SRMA, which indicated that there was no significant difference in bond strength when using aPDT (P = 0.90; MD: -0.03; 95% CI: -0.46 to -0.41). There was a high level of evidence for each meta-analysis outcome.

CONCLUSION

It can be concluded that the use of aPDT as a method of root canal disinfection does not negatively influence the bond strength of endodontic sealers in the root canal.

Impact of tilted implants for implant-supported fixed partial dentures: A systematic review with meta-analysis

STATEMENT OF PROBLEM

The use of tilted implants has been considered a suitable option for completely edentulous patients. However, consensus on their clinical performance is lacking, specifically for partial rehabilitation.

PURPOSE

The purpose of this systematic review and meta-analysis was to evaluate the marginal bone loss and implant survival rate of tilted implants compared with those of axial implants for implant-supported fixed partial dentures (ISFPDs).

MATERIAL AND METHODS

A systematic search of the MEDLINE/PubMed, Web of Science, Embase, Cochrane, and ProQuest databases and reference lists for articles published until May 2022 was performed by 2 independent reviewers without language or publication date restrictions. A meta-analysis was performed using the RevMan version 5.4 program. Quality assessments were performed using the Newcastle-Ottawa scale.

RESULTS

Nine studies were included, totaling 258 participants and 604 implants (269 tilted implants and 335 axial implants). No significant differences were found between the tilted and axial implants for the implant survival rate (P=.81; risk ratio: 1.14). However, higher marginal bone loss values were observed for tilted implants (P=.001; mean difference: 0.12 mm). No significant heterogeneity was observed in either analysis.

CONCLUSIONS

No significant relationship was found between tilted and axial implants for ISFPD rehabilitation. However, tilted implants presented greater risks of marginal bone loss than axial implants.