Despite the crucial role of examiner reliability on quality research and practice, there is still... more Despite the crucial role of examiner reliability on quality research and practice, there is still limited literature analyzing factors affecting examiner variability of peri-implant clinical measurements. The present study investigated clinical peri-implant parameters to quantify their repeatability and investigate factors that may affect their accuracy. Thirty-three implants were examined by four operators. Peri-implant probing depth (PD), recession (REC) and gingival index (GI) were measured for agreement and included for analysis. Agreement was quantified using intraclass correlation coefficients (ICC; 95% CI); mixed linear and logistic regressions were used to assess additional variables. The overall inter-examiner agreement was comparable between PD (0.80) and REC (0.78), but significantly worse for GI (0.45) (p<0.001). Similarly, the intra-examiner agreement was similar for PD (0.81) and REC (0.80), but significantly worse for GI (0.57) (p<0.05). The magnitude of PD did ...
Objectives Currently, procedural sedation in the clinical setting relies heavily on the use of pu... more Objectives Currently, procedural sedation in the clinical setting relies heavily on the use of pulse oximetry to monitor hypoxemia. Different studies suggest that incidence of hypoxemia and incidence of arterial oxygen desaturation are reduced by early intervention via capnography monitoring. The aim of this article was to discuss the importance of implementing capnography monitoring during procedural sedations performed in a dental setting and determine whether additional capnographic monitoring reduces the incidence of arterial oxygen desaturation and the overall complications rate. Materials and methods Two independent reviewers conducted electronic (PubMed and EMBASE) and manual searches up to February 2020. Randomized clinical trials (RCTs), including both patients under procedural sedation monitored by capnography and oximetry, and reporting the incidence of hypoxemia or episodes of oxygen desaturation were included. Risk ratio was used to compare the outcomes (i.e., the incidence of hypoxemia, the episodes of oxygen desaturation, the detection of apnea, the reduction of events of bradycardia, and hypotension) between patients monitored by capnography and standard approach. Results Fourteen randomized clinical trials fulfilling the inclusion criteria were selected. The analysis revealed that capnography monitoring group showed the lower incidence of hypoxemia (RR 0.76, 95%CI 0.70 to 0.83, p < 0.001) and the episodes of oxygen desaturation (RR 0.79, 95%CI 0.71 to 0.87, p < 0.001) compared with the oximetry monitoring group. Apnea was detected in capnography monitoring earlier than standard monitoring (RR 2.60, 95%CI 2.30 to 2.93, p < 0.001). No significant difference was found between capnography and standard monitoring groups in terms of reduction of events of bradycardia (RR 1.17, 95%CI 0.91 to 1.50, p = 0.225) and hypotension (RR 0.96, 95%CI 0.76 to 1.21, p = 0.746). Conclusion Capnography monitoring reduced incidence of hypoxemia during procedural sedations. Within the limitations of this review, we suggest that the application of capnography during procedural sedation would decrease the frequency of oxygen desaturation events and incidence of hypoxemia. Clinical relevance Training and instructing dental providers on using capnography monitoring would help in reducing adverse events during intravenous sedation.
The International Journal of Oral & Maxillofacial Implants, 2019
Purpose: Short implants have been considered as an alternative to regular implants even where nat... more Purpose: Short implants have been considered as an alternative to regular implants even where native bone is potentially adequate. Hence, the aim of this study was to evaluate the impact of implant length on its survival. Materials and Methods: A systematic literature search of randomized controlled trials and prospective studies was performed using the PubMed (MEDLINE), EMBASE, and Cochrane databases. Meta- regression analysis determined the effect of the length on the implant survival rate. Results: Sixty-six studies comprising 4,525 implants were included in the meta-regression analysis. Overall, for each additional 1 mm of length, the survival rate was increased by 0.42 percentage points (P = .056). In the maxilla, an additional 1 mm in length implied 0.68 percentage points more in the rate (P < .001), while in the mandible, statistical significance was not reached. Eventually, the implant survival rate in the 3- to 5-year period was strongly affected by the length of the implants in the maxilla, since it increased by 2% for each additional 1 mm of length. Conclusion: In the presence of adequate native bone, placement of longer/regular-sized implants should be chosen over placement of short implants in the maxilla. However, in a posterior mandible, short implants offer a judicious alternative.
International Journal of Oral & Maxillofacial Implants, 2020
Purpose: The aim of this study was to investigate the effect of implant and surgical characterist... more Purpose: The aim of this study was to investigate the effect of implant and surgical characteristics on the mucosal vertical dimension components. Mucosal vertical dimension consists of the sulcular epithelium and the supracrestal tissue attachment, which can be clinically measured from the gingival margin to the bone-to-implant contact. Connective tissue attachment is measured from the apical border of attached epithelium to the first bone-to-implant contact, while epithelial vertical dimension is measured from the mucosal margin to the apical border of attached epithelium. Materials and Methods: An electronic and manual search for relevant articles published from January 1980 to May 2019 was performed. Animal studies of ≥ 10 implants followed by histometric analysis were included. Quality assessment was performed using the ARRIVE guidelines, and risk of bias assessment was performed using SYRCLE guidelines. Subgroup meta-analysis was performed to analyze the influence of different surgical approaches and implant design. Results: A total of 38 articles were included. The mean value and corresponding standard error of mucosal vertical dimension, supracrestal tissue attachment, connective tissue attachment, and epithelial vertical dimension were 3.39 ± 0.07 mm, 2.9 ± 0.12 mm, 1.35 ± 0.04 mm, and 2.0 ± 0.06 mm, respectively. Supracrestal and subcrestal bone-level implants had significantly higher mucosal vertical dimension than equicrestal bone-level implants. Platform-switching implants demonstrated significantly lower mucosal vertical dimension compared with non–platform-switching implants. Conclusion: Within its limitations, this review showed that equicrestal implants had a smaller mucosal vertical dimension than subcrestal and supracrestal implants, and platform-switching implants possessed a smaller mucosal vertical dimension.
Purpose: To provide a long-term comparison of metal-acrylic and zirconia implant-supported fixed ... more Purpose: To provide a long-term comparison of metal-acrylic and zirconia implant-supported fixed complete dental prostheses. Materials and Methods: Patients treated with a metal-acrylic or zirconia fixed implant prosthesis with a minimum 5-year follow-up were included. All complications were registered, along with events such as peri-implantitis and implant failure. Survival and all costs associated with the prostheses were assessed to provide an overall evaluation of each type of fixed implant prosthesis protocol. Results: Seventy-four rehabilitated arches (43 metal-acrylic, 31 zirconia, mean follow-up: 8.7 ± 3.37 years) were included. Delayed complications accompanied the metal-acrylic prostheses more frequently. In both groups, single tooth chipping/fracture was the most prominent minor complication, and incidence of multiple teeth and framework fracture was the most frequent major complication. Zirconia fixed implant prostheses demonstrated higher prosthetic survival rates than the metal-acrylic prostheses (93.7% ± 5.5% at 5 years vs 83.0% ± 11.1%). No difference was observed for peri-implantitis or implant failure. The initial cost for zirconia prosthesis fabrication was significantly higher than metal-acrylic hybrids (an estimated difference of $7,829 [P < .001]); however, due to reduced complication rates for the zirconia fixed implant prosthesis, maintenance and treatment for complications did not greatly differ between groups. Conclusion: Within the limitations, zirconia fixed implant prostheses presented higher initial costs than metal-acrylic hybrids, however, with satisfactory outcomes, reduction of overall complications, and superior survival rates.
Background: Incidence and severity of postoperative complications are key elements in determining... more Background: Incidence and severity of postoperative complications are key elements in determining the risk-benefit relationship of any surgical procedure. The aim of this retrospective study was to assess and categorize the postoperative complications that occur following, and are associated with, oral, periodontal, and implant surgeries. Methods: A total of 3,900 patients who underwent surgical procedures including, but not limited to, sinus floor elevation, guided tissue regeneration, crown lengthening, implant placement, soft tissue graft, open flap debridement or surgical removal of impacted teeth were included. Postoperative complications were recorded and graded based on impedance to routine daily activity and favorable surgical outcomes. Regression models were generated to evaluate correlations between complication types, as well as between patient/surgical characteristics and the incidence of complications. Results: Surgical removal of impacted teeth and lateral sinus floor elevation had the highest incidence and severity of complications. Postoperative dentinal hypersensi-tivity (5.7%) was the most frequent complication, followed by excessive pain (4.1%), and moderate postoperative bleeding (3.5%). Based on the devised grading system described in this paper, the complications were 11.1% of Grade I, 3.3% of Grade II, 8.3% of Grade III, 0.1% of Grade IV, and no complications recorded under Grades V or VI. Conclusions: Surgical removal of impacted teeth and lateral sinus floor elevation are more prone to more severe complications compared with other procedures. Additionally , complications that do not impede favorable surgical outcomes and/or routine daily activity are the most likely to occur. Smoking and diabetes are generally associated with postoperative complications. K E Y W O R D S guided tissue regeneration, infection, oral surgery, pain, postoperative complications, sinus floor augmentation J Periodontol. 2019;0:1-9.
Background: To investigate the frequency of systemic drugs taken by elderly patients with or with... more Background: To investigate the frequency of systemic drugs taken by elderly patients with or without periodontitis and the possible association between medication consumption and the severity of periodontitis. Methods: A total of 1221 patients, including 608 with generalized moderate to severe periodontitis (periodontitis group) and 613 age-and gender-matched individuals with healthy periodontium (healthy group) were selected. Systemic conditions, medications and periodontal status were recorded. Medication intake frequency (%) was compared using unconditional logistic regression. Results: The top three most common medications were angiotensin-converting enzyme (ACE) inhibitors (17.9%), antidepressants (17.8%), and lipid-lowering medications (16.5%). Both ACE inhibitors and antidepressants showed statistically higher intake frequency in the periodontitis group relative to healthy controls (21.5% versus 14.4%; odds ratio [OR] = 1.64), (21.1% versus 14.5%, OR = 1.57) (P < 0.01). Additionally , intake of oral hypoglycemic agents, calcium channel blockers (CCB), insulin, and diuretics were significantly higher in the periodontitis group with OR = 2.49, 2.32, 2.08 and 1.79, respectively (P < 0.05). Several medications demonstrated a disease severity-dependent association comparing generalized severe periodontitis with moderate periodontitis and healthy group: oral hypoglycemic agents (17.4% versus 16.8% versus 8.0%), CCB (14.8% versus 14.4% versus 8.0%) and anticonvulsants (13.4% versus 7.7% versus 6.4%) with OR of 2.43, 1.99, and 2.28 (severe periodontitis versus healthy group), respectively. Conclusion: There was a significantly higher frequency of medication intake related to cardiovascular disease and diabetes in patients with periodontitis. A disease severity-dependence with medication intake frequency was also noted. This study provides indirect evidence for the possible relationship between systemic diseases and periodontitis. K E Y W O R D S cardiovascular diseases, diabetes mellitus, drug therapy, periodontitis J Periodontol. 2020;00:1-11.
International Journal of Oral and Maxillofacial Implants, 2019
Purpose: This systematic review evaluated the mean survival rate and marginal bone loss (MBL) of ... more Purpose: This systematic review evaluated the mean survival rate and marginal bone loss (MBL) of dental implants with ≤ 6 mm in length, across a time frame of 5 years. The overall prosthetic and biologic complications were evaluated, and their survival rates obtained. In addition, the complication rates of the splinted vs nonsplinted implants were assessed. Materials and Methods: An electronic literature search in PubMed (MEDLINE) and EMBASE (OVID) and Cochrane were performed, in addition to a manual search through all periodontics and implantology-related journals, up to October 2017, to identify relevant articles. Results: Out of 515 potentially eligible articles, 19 investigations assessing a total of 910 extra-short (≤ 6 mm) implants were included and further evaluated. After 5 years of follow-up, a mean survival rate of 94.1% (90% in the maxilla and 96% in the mandible) and a maximum bone loss of 0.53 mm were demonstrated. Additionally, a statistically significant difference in terms of bone loss was observed between tissue-level (0.12 mm) and bone-level implants (0.36 mm) at 12 months (P < .01), but not between internal and external abutment connections (P = .17). The most commonly reported prosthetic complication was screw loosening. Finally, splinted implants showed less overall prosthetic complications (RR = 3.32; 95% CI: 1.9 to 5.7), screw loosening (RR = 15.2; 95% CI: 5.92 to 39.31), and implant failure (RR = 1.96; 95% CI: 0.8 to 4.8) than nonsplinted implants. Conclusion: Extra-short implants are a viable treatment alternative in ridges exhibiting atrophy, demonstrating a satisfactory survival rate, as well as a low rate of prosthetic and biologic complications across a 5-year follow-up. Additionally, splinting extra-short implants is associated with fewer prosthetic complications and lower implant failure rate compared with nonsplinted implants. Int J Oral MaxIllOfac IMplants 2019;34:68-84.
Objectives The purpose of this review was to provide a novel perspective utilizing an assessment ... more Objectives The purpose of this review was to provide a novel perspective utilizing an assessment of biomarkers to evaluate the impact of stress-related disorders on the progression of periodontal disease and evaluate the growing body of evidence of stress as a risk indicator for periodontal disease progression. Methods Cross-sectional, case-control, and biomarker studies associating psychological disorders and periodontal disease were included in the literature search. Computational studies, animal studies, reviews, and studies lacking healthy controls were excluded. Electronic and manual literature searches were conducted by two independent reviewers in several databases as well as a manual search for relevant articles published up to January 2018. Results Twenty-six articles fulfilled the inclusion criteria and were included in the qualitative synthesis. Relationships between stress-related disorders and serum and salivary biomarkers such as cortisol, dehydroepiandrosterone (DHEA), chromogranin A (CgA), and pro-inflammatory cytokines were identified. Conclusions The use of salivary proinflammatory cytokines alone is not sufficient for the identification of periodontal disease severity/progression with or without the presence of stress-associated diseases. Keeping in mind the limitations of this review, a positive qualitative correlation was observed in the literature among stress-related biomarkers and the severity of periodontal disease. This correlation may serve as an important reporter of patient susceptibility for periodontal breakdown in the future. Clinical relevance Stress-related disorders should be included in the list of globally screened diseases because it can change the biochemistry of both the local periodontal microenvironment as well as the global systemic inflammatory burden.
Aim: To compare the clinical outcomes of ≤6 mm extra-short implants (test group) versus ≥10 mm lo... more Aim: To compare the clinical outcomes of ≤6 mm extra-short implants (test group) versus ≥10 mm long implants (control group), with and without bone augmentation procedures. Materials and Methods: A systemic literature search of randomized clinical trials was performed using the PubMed (MEDLINE) and EMBASE databases. A quantitative meta-analysis was conducted to compare all the outcome variables. Meta-regression analysis determined the effect of bone augmentation procedures and the influence of other clinical covariates on the results. Results: Eighteen studies comprising 1,612 implants (793 extra-short and 820 long implants) were selected for the meta-analysis. No statistically significant difference in the survival rate was observed at 1 and 3 years (p > 0.05). Extra-short implants displayed less marginal bone loss (MBL) from both implant placement time points (1 and 3 years) and prosthetic placement (1 year), as well as less biological complications, surgical time and treatment cost (p < 0.05). Contrarily, a statistically significant small number of prosthetic complications were reported with long implants (p < 0.05). Conclusions: Placement of extra-short implants (≤6 mm) presented as an equivalent option in the treatment of patients with an atrophic posterior arch up to a 3-year follow-up. However, the long-term effectiveness of extra-short dental implants remains to be further studied.
Objective: To study the performance of 2–3 posterior bone‐level dental implants constructed with ... more Objective: To study the performance of 2–3 posterior bone‐level dental implants constructed with either three non‐splinted crowns (NSC), three splinted crowns (SC), or a 3‐unit implant‐supported bridge over two implants (ISB). Material and methods: Patients treated with three metal‐ceramic NSC, SC, or an ISB were included in the present retrospective study. Implant survival and success rate, as well as all biological and technical complications, were collected. The cost associated with each of the treatment options was evaluated in the comparative analysis. Results: One hundred and forty‐five patients (40 NSC, 52 SC, and 53 in the ISB) receiving 382 bone‐level implants (120 NSC, 106 ISB, and 156 SC) were included (mean follow‐up of 76.2 months). Lack of success was observed in 33.8% of the total patient sample, being lower in the ISB group. Implant survival rates were 92.5% in the NSC, 100% in the ISB, and 88.5% in the SC, with significant difference noted between the ISB and SC (p = 0.01). Overall, 9.9% of the total implants were found to have peri‐implantitis (PI), with 16.7% in the SC, 7.5% in the NSC, and 2.8% in the ISB. Patients presenting prosthodontic complications were significantly higher in NSC (32.5%) than ISB (13.2%) and SC (15.4%). The total cost of the ISB group was significantly lower when compared to the NSC and SC groups (p < 0.001). Conclusions: A 3‐unit implant‐supported bridge restoring 2 implants seems to present the most ideal long‐term therapeutic solution, among the investigated approaches in this study, in rehabilitating a 3‐unit edentulous area.
Despite the crucial role of examiner reliability on quality research and practice, there is still... more Despite the crucial role of examiner reliability on quality research and practice, there is still limited literature analyzing factors affecting examiner variability of peri-implant clinical measurements. The present study investigated clinical peri-implant parameters to quantify their repeatability and investigate factors that may affect their accuracy. Thirty-three implants were examined by four operators. Peri-implant probing depth (PD), recession (REC) and gingival index (GI) were measured for agreement and included for analysis. Agreement was quantified using intraclass correlation coefficients (ICC; 95% CI); mixed linear and logistic regressions were used to assess additional variables. The overall inter-examiner agreement was comparable between PD (0.80) and REC (0.78), but significantly worse for GI (0.45) (p<0.001). Similarly, the intra-examiner agreement was similar for PD (0.81) and REC (0.80), but significantly worse for GI (0.57) (p<0.05). The magnitude of PD did ...
Objectives Currently, procedural sedation in the clinical setting relies heavily on the use of pu... more Objectives Currently, procedural sedation in the clinical setting relies heavily on the use of pulse oximetry to monitor hypoxemia. Different studies suggest that incidence of hypoxemia and incidence of arterial oxygen desaturation are reduced by early intervention via capnography monitoring. The aim of this article was to discuss the importance of implementing capnography monitoring during procedural sedations performed in a dental setting and determine whether additional capnographic monitoring reduces the incidence of arterial oxygen desaturation and the overall complications rate. Materials and methods Two independent reviewers conducted electronic (PubMed and EMBASE) and manual searches up to February 2020. Randomized clinical trials (RCTs), including both patients under procedural sedation monitored by capnography and oximetry, and reporting the incidence of hypoxemia or episodes of oxygen desaturation were included. Risk ratio was used to compare the outcomes (i.e., the incidence of hypoxemia, the episodes of oxygen desaturation, the detection of apnea, the reduction of events of bradycardia, and hypotension) between patients monitored by capnography and standard approach. Results Fourteen randomized clinical trials fulfilling the inclusion criteria were selected. The analysis revealed that capnography monitoring group showed the lower incidence of hypoxemia (RR 0.76, 95%CI 0.70 to 0.83, p < 0.001) and the episodes of oxygen desaturation (RR 0.79, 95%CI 0.71 to 0.87, p < 0.001) compared with the oximetry monitoring group. Apnea was detected in capnography monitoring earlier than standard monitoring (RR 2.60, 95%CI 2.30 to 2.93, p < 0.001). No significant difference was found between capnography and standard monitoring groups in terms of reduction of events of bradycardia (RR 1.17, 95%CI 0.91 to 1.50, p = 0.225) and hypotension (RR 0.96, 95%CI 0.76 to 1.21, p = 0.746). Conclusion Capnography monitoring reduced incidence of hypoxemia during procedural sedations. Within the limitations of this review, we suggest that the application of capnography during procedural sedation would decrease the frequency of oxygen desaturation events and incidence of hypoxemia. Clinical relevance Training and instructing dental providers on using capnography monitoring would help in reducing adverse events during intravenous sedation.
The International Journal of Oral & Maxillofacial Implants, 2019
Purpose: Short implants have been considered as an alternative to regular implants even where nat... more Purpose: Short implants have been considered as an alternative to regular implants even where native bone is potentially adequate. Hence, the aim of this study was to evaluate the impact of implant length on its survival. Materials and Methods: A systematic literature search of randomized controlled trials and prospective studies was performed using the PubMed (MEDLINE), EMBASE, and Cochrane databases. Meta- regression analysis determined the effect of the length on the implant survival rate. Results: Sixty-six studies comprising 4,525 implants were included in the meta-regression analysis. Overall, for each additional 1 mm of length, the survival rate was increased by 0.42 percentage points (P = .056). In the maxilla, an additional 1 mm in length implied 0.68 percentage points more in the rate (P < .001), while in the mandible, statistical significance was not reached. Eventually, the implant survival rate in the 3- to 5-year period was strongly affected by the length of the implants in the maxilla, since it increased by 2% for each additional 1 mm of length. Conclusion: In the presence of adequate native bone, placement of longer/regular-sized implants should be chosen over placement of short implants in the maxilla. However, in a posterior mandible, short implants offer a judicious alternative.
International Journal of Oral & Maxillofacial Implants, 2020
Purpose: The aim of this study was to investigate the effect of implant and surgical characterist... more Purpose: The aim of this study was to investigate the effect of implant and surgical characteristics on the mucosal vertical dimension components. Mucosal vertical dimension consists of the sulcular epithelium and the supracrestal tissue attachment, which can be clinically measured from the gingival margin to the bone-to-implant contact. Connective tissue attachment is measured from the apical border of attached epithelium to the first bone-to-implant contact, while epithelial vertical dimension is measured from the mucosal margin to the apical border of attached epithelium. Materials and Methods: An electronic and manual search for relevant articles published from January 1980 to May 2019 was performed. Animal studies of ≥ 10 implants followed by histometric analysis were included. Quality assessment was performed using the ARRIVE guidelines, and risk of bias assessment was performed using SYRCLE guidelines. Subgroup meta-analysis was performed to analyze the influence of different surgical approaches and implant design. Results: A total of 38 articles were included. The mean value and corresponding standard error of mucosal vertical dimension, supracrestal tissue attachment, connective tissue attachment, and epithelial vertical dimension were 3.39 ± 0.07 mm, 2.9 ± 0.12 mm, 1.35 ± 0.04 mm, and 2.0 ± 0.06 mm, respectively. Supracrestal and subcrestal bone-level implants had significantly higher mucosal vertical dimension than equicrestal bone-level implants. Platform-switching implants demonstrated significantly lower mucosal vertical dimension compared with non–platform-switching implants. Conclusion: Within its limitations, this review showed that equicrestal implants had a smaller mucosal vertical dimension than subcrestal and supracrestal implants, and platform-switching implants possessed a smaller mucosal vertical dimension.
Purpose: To provide a long-term comparison of metal-acrylic and zirconia implant-supported fixed ... more Purpose: To provide a long-term comparison of metal-acrylic and zirconia implant-supported fixed complete dental prostheses. Materials and Methods: Patients treated with a metal-acrylic or zirconia fixed implant prosthesis with a minimum 5-year follow-up were included. All complications were registered, along with events such as peri-implantitis and implant failure. Survival and all costs associated with the prostheses were assessed to provide an overall evaluation of each type of fixed implant prosthesis protocol. Results: Seventy-four rehabilitated arches (43 metal-acrylic, 31 zirconia, mean follow-up: 8.7 ± 3.37 years) were included. Delayed complications accompanied the metal-acrylic prostheses more frequently. In both groups, single tooth chipping/fracture was the most prominent minor complication, and incidence of multiple teeth and framework fracture was the most frequent major complication. Zirconia fixed implant prostheses demonstrated higher prosthetic survival rates than the metal-acrylic prostheses (93.7% ± 5.5% at 5 years vs 83.0% ± 11.1%). No difference was observed for peri-implantitis or implant failure. The initial cost for zirconia prosthesis fabrication was significantly higher than metal-acrylic hybrids (an estimated difference of $7,829 [P < .001]); however, due to reduced complication rates for the zirconia fixed implant prosthesis, maintenance and treatment for complications did not greatly differ between groups. Conclusion: Within the limitations, zirconia fixed implant prostheses presented higher initial costs than metal-acrylic hybrids, however, with satisfactory outcomes, reduction of overall complications, and superior survival rates.
Background: Incidence and severity of postoperative complications are key elements in determining... more Background: Incidence and severity of postoperative complications are key elements in determining the risk-benefit relationship of any surgical procedure. The aim of this retrospective study was to assess and categorize the postoperative complications that occur following, and are associated with, oral, periodontal, and implant surgeries. Methods: A total of 3,900 patients who underwent surgical procedures including, but not limited to, sinus floor elevation, guided tissue regeneration, crown lengthening, implant placement, soft tissue graft, open flap debridement or surgical removal of impacted teeth were included. Postoperative complications were recorded and graded based on impedance to routine daily activity and favorable surgical outcomes. Regression models were generated to evaluate correlations between complication types, as well as between patient/surgical characteristics and the incidence of complications. Results: Surgical removal of impacted teeth and lateral sinus floor elevation had the highest incidence and severity of complications. Postoperative dentinal hypersensi-tivity (5.7%) was the most frequent complication, followed by excessive pain (4.1%), and moderate postoperative bleeding (3.5%). Based on the devised grading system described in this paper, the complications were 11.1% of Grade I, 3.3% of Grade II, 8.3% of Grade III, 0.1% of Grade IV, and no complications recorded under Grades V or VI. Conclusions: Surgical removal of impacted teeth and lateral sinus floor elevation are more prone to more severe complications compared with other procedures. Additionally , complications that do not impede favorable surgical outcomes and/or routine daily activity are the most likely to occur. Smoking and diabetes are generally associated with postoperative complications. K E Y W O R D S guided tissue regeneration, infection, oral surgery, pain, postoperative complications, sinus floor augmentation J Periodontol. 2019;0:1-9.
Background: To investigate the frequency of systemic drugs taken by elderly patients with or with... more Background: To investigate the frequency of systemic drugs taken by elderly patients with or without periodontitis and the possible association between medication consumption and the severity of periodontitis. Methods: A total of 1221 patients, including 608 with generalized moderate to severe periodontitis (periodontitis group) and 613 age-and gender-matched individuals with healthy periodontium (healthy group) were selected. Systemic conditions, medications and periodontal status were recorded. Medication intake frequency (%) was compared using unconditional logistic regression. Results: The top three most common medications were angiotensin-converting enzyme (ACE) inhibitors (17.9%), antidepressants (17.8%), and lipid-lowering medications (16.5%). Both ACE inhibitors and antidepressants showed statistically higher intake frequency in the periodontitis group relative to healthy controls (21.5% versus 14.4%; odds ratio [OR] = 1.64), (21.1% versus 14.5%, OR = 1.57) (P < 0.01). Additionally , intake of oral hypoglycemic agents, calcium channel blockers (CCB), insulin, and diuretics were significantly higher in the periodontitis group with OR = 2.49, 2.32, 2.08 and 1.79, respectively (P < 0.05). Several medications demonstrated a disease severity-dependent association comparing generalized severe periodontitis with moderate periodontitis and healthy group: oral hypoglycemic agents (17.4% versus 16.8% versus 8.0%), CCB (14.8% versus 14.4% versus 8.0%) and anticonvulsants (13.4% versus 7.7% versus 6.4%) with OR of 2.43, 1.99, and 2.28 (severe periodontitis versus healthy group), respectively. Conclusion: There was a significantly higher frequency of medication intake related to cardiovascular disease and diabetes in patients with periodontitis. A disease severity-dependence with medication intake frequency was also noted. This study provides indirect evidence for the possible relationship between systemic diseases and periodontitis. K E Y W O R D S cardiovascular diseases, diabetes mellitus, drug therapy, periodontitis J Periodontol. 2020;00:1-11.
International Journal of Oral and Maxillofacial Implants, 2019
Purpose: This systematic review evaluated the mean survival rate and marginal bone loss (MBL) of ... more Purpose: This systematic review evaluated the mean survival rate and marginal bone loss (MBL) of dental implants with ≤ 6 mm in length, across a time frame of 5 years. The overall prosthetic and biologic complications were evaluated, and their survival rates obtained. In addition, the complication rates of the splinted vs nonsplinted implants were assessed. Materials and Methods: An electronic literature search in PubMed (MEDLINE) and EMBASE (OVID) and Cochrane were performed, in addition to a manual search through all periodontics and implantology-related journals, up to October 2017, to identify relevant articles. Results: Out of 515 potentially eligible articles, 19 investigations assessing a total of 910 extra-short (≤ 6 mm) implants were included and further evaluated. After 5 years of follow-up, a mean survival rate of 94.1% (90% in the maxilla and 96% in the mandible) and a maximum bone loss of 0.53 mm were demonstrated. Additionally, a statistically significant difference in terms of bone loss was observed between tissue-level (0.12 mm) and bone-level implants (0.36 mm) at 12 months (P < .01), but not between internal and external abutment connections (P = .17). The most commonly reported prosthetic complication was screw loosening. Finally, splinted implants showed less overall prosthetic complications (RR = 3.32; 95% CI: 1.9 to 5.7), screw loosening (RR = 15.2; 95% CI: 5.92 to 39.31), and implant failure (RR = 1.96; 95% CI: 0.8 to 4.8) than nonsplinted implants. Conclusion: Extra-short implants are a viable treatment alternative in ridges exhibiting atrophy, demonstrating a satisfactory survival rate, as well as a low rate of prosthetic and biologic complications across a 5-year follow-up. Additionally, splinting extra-short implants is associated with fewer prosthetic complications and lower implant failure rate compared with nonsplinted implants. Int J Oral MaxIllOfac IMplants 2019;34:68-84.
Objectives The purpose of this review was to provide a novel perspective utilizing an assessment ... more Objectives The purpose of this review was to provide a novel perspective utilizing an assessment of biomarkers to evaluate the impact of stress-related disorders on the progression of periodontal disease and evaluate the growing body of evidence of stress as a risk indicator for periodontal disease progression. Methods Cross-sectional, case-control, and biomarker studies associating psychological disorders and periodontal disease were included in the literature search. Computational studies, animal studies, reviews, and studies lacking healthy controls were excluded. Electronic and manual literature searches were conducted by two independent reviewers in several databases as well as a manual search for relevant articles published up to January 2018. Results Twenty-six articles fulfilled the inclusion criteria and were included in the qualitative synthesis. Relationships between stress-related disorders and serum and salivary biomarkers such as cortisol, dehydroepiandrosterone (DHEA), chromogranin A (CgA), and pro-inflammatory cytokines were identified. Conclusions The use of salivary proinflammatory cytokines alone is not sufficient for the identification of periodontal disease severity/progression with or without the presence of stress-associated diseases. Keeping in mind the limitations of this review, a positive qualitative correlation was observed in the literature among stress-related biomarkers and the severity of periodontal disease. This correlation may serve as an important reporter of patient susceptibility for periodontal breakdown in the future. Clinical relevance Stress-related disorders should be included in the list of globally screened diseases because it can change the biochemistry of both the local periodontal microenvironment as well as the global systemic inflammatory burden.
Aim: To compare the clinical outcomes of ≤6 mm extra-short implants (test group) versus ≥10 mm lo... more Aim: To compare the clinical outcomes of ≤6 mm extra-short implants (test group) versus ≥10 mm long implants (control group), with and without bone augmentation procedures. Materials and Methods: A systemic literature search of randomized clinical trials was performed using the PubMed (MEDLINE) and EMBASE databases. A quantitative meta-analysis was conducted to compare all the outcome variables. Meta-regression analysis determined the effect of bone augmentation procedures and the influence of other clinical covariates on the results. Results: Eighteen studies comprising 1,612 implants (793 extra-short and 820 long implants) were selected for the meta-analysis. No statistically significant difference in the survival rate was observed at 1 and 3 years (p > 0.05). Extra-short implants displayed less marginal bone loss (MBL) from both implant placement time points (1 and 3 years) and prosthetic placement (1 year), as well as less biological complications, surgical time and treatment cost (p < 0.05). Contrarily, a statistically significant small number of prosthetic complications were reported with long implants (p < 0.05). Conclusions: Placement of extra-short implants (≤6 mm) presented as an equivalent option in the treatment of patients with an atrophic posterior arch up to a 3-year follow-up. However, the long-term effectiveness of extra-short dental implants remains to be further studied.
Objective: To study the performance of 2–3 posterior bone‐level dental implants constructed with ... more Objective: To study the performance of 2–3 posterior bone‐level dental implants constructed with either three non‐splinted crowns (NSC), three splinted crowns (SC), or a 3‐unit implant‐supported bridge over two implants (ISB). Material and methods: Patients treated with three metal‐ceramic NSC, SC, or an ISB were included in the present retrospective study. Implant survival and success rate, as well as all biological and technical complications, were collected. The cost associated with each of the treatment options was evaluated in the comparative analysis. Results: One hundred and forty‐five patients (40 NSC, 52 SC, and 53 in the ISB) receiving 382 bone‐level implants (120 NSC, 106 ISB, and 156 SC) were included (mean follow‐up of 76.2 months). Lack of success was observed in 33.8% of the total patient sample, being lower in the ISB group. Implant survival rates were 92.5% in the NSC, 100% in the ISB, and 88.5% in the SC, with significant difference noted between the ISB and SC (p = 0.01). Overall, 9.9% of the total implants were found to have peri‐implantitis (PI), with 16.7% in the SC, 7.5% in the NSC, and 2.8% in the ISB. Patients presenting prosthodontic complications were significantly higher in NSC (32.5%) than ISB (13.2%) and SC (15.4%). The total cost of the ISB group was significantly lower when compared to the NSC and SC groups (p < 0.001). Conclusions: A 3‐unit implant‐supported bridge restoring 2 implants seems to present the most ideal long‐term therapeutic solution, among the investigated approaches in this study, in rehabilitating a 3‐unit edentulous area.
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Papers by Hussam Asker
Materials and Methods: A systemic literature search of randomized clinical trials was performed using the PubMed (MEDLINE) and EMBASE databases. A quantitative meta-analysis was conducted to compare all the outcome variables. Meta-regression analysis determined the effect of bone augmentation procedures and the influence of other clinical covariates on the results.
Results: Eighteen studies comprising 1,612 implants (793 extra-short and 820 long implants) were selected for the meta-analysis. No statistically significant difference in the survival rate was observed at 1 and 3 years (p > 0.05). Extra-short implants displayed less marginal bone loss (MBL) from both implant placement time points (1 and 3 years) and prosthetic placement (1 year), as well as less biological complications, surgical time and treatment cost (p < 0.05). Contrarily, a statistically significant small number of prosthetic complications were reported with long implants (p < 0.05). Conclusions: Placement of extra-short implants (≤6 mm) presented as an equivalent option in the treatment of patients with an atrophic posterior arch up to a 3-year follow-up. However, the long-term effectiveness of extra-short dental implants remains to be further studied.
Material and methods: Patients treated with three metal‐ceramic NSC, SC, or an ISB were included in the present retrospective study. Implant survival and success rate, as well as all biological and technical complications, were collected. The cost associated with each of the treatment options was evaluated in the comparative analysis. Results: One hundred and forty‐five patients (40 NSC, 52 SC, and 53 in the ISB) receiving 382 bone‐level implants (120 NSC, 106 ISB, and 156 SC) were included (mean follow‐up of 76.2 months). Lack of success was observed in 33.8% of the total patient sample, being lower in the ISB group. Implant survival rates were 92.5% in the NSC, 100% in the ISB, and 88.5% in the SC, with significant difference noted between the ISB and SC (p = 0.01). Overall, 9.9% of the total implants were found to have peri‐implantitis (PI), with 16.7% in the SC, 7.5% in the NSC, and 2.8% in the ISB. Patients presenting prosthodontic complications were significantly higher in NSC (32.5%) than ISB (13.2%) and SC (15.4%). The total cost of the ISB group was significantly lower when compared to the NSC and SC groups (p < 0.001).
Conclusions: A 3‐unit implant‐supported bridge restoring 2 implants seems to present the most ideal long‐term therapeutic solution, among the investigated approaches in this study, in rehabilitating a 3‐unit edentulous area.
Materials and Methods: A systemic literature search of randomized clinical trials was performed using the PubMed (MEDLINE) and EMBASE databases. A quantitative meta-analysis was conducted to compare all the outcome variables. Meta-regression analysis determined the effect of bone augmentation procedures and the influence of other clinical covariates on the results.
Results: Eighteen studies comprising 1,612 implants (793 extra-short and 820 long implants) were selected for the meta-analysis. No statistically significant difference in the survival rate was observed at 1 and 3 years (p > 0.05). Extra-short implants displayed less marginal bone loss (MBL) from both implant placement time points (1 and 3 years) and prosthetic placement (1 year), as well as less biological complications, surgical time and treatment cost (p < 0.05). Contrarily, a statistically significant small number of prosthetic complications were reported with long implants (p < 0.05). Conclusions: Placement of extra-short implants (≤6 mm) presented as an equivalent option in the treatment of patients with an atrophic posterior arch up to a 3-year follow-up. However, the long-term effectiveness of extra-short dental implants remains to be further studied.
Material and methods: Patients treated with three metal‐ceramic NSC, SC, or an ISB were included in the present retrospective study. Implant survival and success rate, as well as all biological and technical complications, were collected. The cost associated with each of the treatment options was evaluated in the comparative analysis. Results: One hundred and forty‐five patients (40 NSC, 52 SC, and 53 in the ISB) receiving 382 bone‐level implants (120 NSC, 106 ISB, and 156 SC) were included (mean follow‐up of 76.2 months). Lack of success was observed in 33.8% of the total patient sample, being lower in the ISB group. Implant survival rates were 92.5% in the NSC, 100% in the ISB, and 88.5% in the SC, with significant difference noted between the ISB and SC (p = 0.01). Overall, 9.9% of the total implants were found to have peri‐implantitis (PI), with 16.7% in the SC, 7.5% in the NSC, and 2.8% in the ISB. Patients presenting prosthodontic complications were significantly higher in NSC (32.5%) than ISB (13.2%) and SC (15.4%). The total cost of the ISB group was significantly lower when compared to the NSC and SC groups (p < 0.001).
Conclusions: A 3‐unit implant‐supported bridge restoring 2 implants seems to present the most ideal long‐term therapeutic solution, among the investigated approaches in this study, in rehabilitating a 3‐unit edentulous area.