Scientific highlights of the month (September 2021)

Scientific Highlights

Scientific Highlights

Issue 5/21

SHORT OVERVIEWS ON RECENTLY PUBLISHED SCIENTIFIC EVIDENCE.

Issue 5/2021

Edited by Dr Pooja Nair Page | 1

Scientific Highlights

Issue 5/21

IN THIS ISSUE EDITOR’S CHOICE

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HIGHLIGHTS

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1.

Tilted versus axial implant distribution in the posterior edentulous maxilla: A CBCT analysis

2. Long-term clinical outcomes of periodontal regeneration with enamel matrix derivative: A retrospective cohort study with a mean follow-up of 10 years

3. Prevalence of peri-implantitis and peri-implant mucositis within 15 years of implant placement.

4. Identification of the Pathway and Appropriate Use of Four Zygomatic Implants in the Atrophic Maxilla: A Cross-Sectional Study

5. Comparative assessment of the primary stability of Straumann® BLX implant design using an invitro sinus lift-simultaneous implant insertion model

6. Retrospective Analysis of the Bone Density in the Maxillary Anterior Region among Patients with Dental Implants

7. Using a Digital Dentistry Integrated Planning and Manufacturing Service in Completely Edentulous Treatment

8. The Zygoma Anatomy-Guided Approach for Placement of Zygomatic Implants 9. Immediate placement and immediate loading of full edentulous arches in 20 periodontally compromised patients – in-line clinical case series with 3 years follow-up

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10. Clinical long-term and patient-reported outcomes of dental implants in oral cancer patients

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11. Pain Experience after Dental Implant Placement Compared to Tooth Extraction

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12. Mucormycosis in head and neck area - the emerging health problem in COVID-19 pandemic. The perspective of a dental practitioner

REFERENCES

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Scientific Highlights

Issue 5/21

In this issue

in this issue EDITOR’S CHOICE Tilted versus axial implant distribution in the posterior edentulous maxilla: A CBCT analysis (A Hamilton et al. 2021)

and Long-term clinical outcomes of periodontal regeneration with enamel matrix derivative: A retrospective cohort study with a mean follow-up of 10 years (S P De Ry et al. 2021)

Prevalence of peri-implantitis and peri-implant mucositis within 15 years of implant placement.

(T T Zahng et al. 2021)

Identification of the Pathway and Appropriate Use of Four Zygomatic Implants in the Atrophic Maxilla: A Cross-Sectional Study (C Aparicio et al. 2021)

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Scientific Highlights

Issue 5/21

Editor’s choice Clin Oral Implants Res. 2021 Aug 23. doi: 10.1111/clr.13836.

Tilted versus axial implant distribution in the posterior edentulous maxilla: A CBCT analysis A Hamilton, F Z Jamjo, M Alnasser, J R Starr, B Friedland, G O Gallucci

Study objectives and methods This study aimed to determine whether distally angulating an implant is a successful strategy to avoid the maxillary sinus and the need for bone augmentation, while increasing the anterior-posterior (A-P) implant distribution in the edentulous maxilla

In 115 patients with edentulous maxillae, virtual implant planning was performed utilizing cone-beam computer tomographs.

Axial (8 mm length) and tilted (12 mm length) dental implants with 30-degree and 45-degree angulation were virtually

positioned to avoid entering the maxillary sinus, while maximizing A-P distribution. Measurements were made between the tilted and axial implants to assess the change in A-P distribution of implants at the implant and abutment levels.

Results •

Forty-seven sites (20.4%) were not able to have either treatment modality with insufficient bone for implant placement.

•

Axial implants were placed more distally than 45-degree and 30-degree tilted implants in 24% and 42% of sites, respectively.

•

The average change in A-P spread measured at the implant level, for 30- and 45-degree tilted implants was -0.25 mm (95% CI -0.76, 0.26) and 1.9 mm (95% CI 1.4, 2.3), respectively.

•

When measured from the center of each multi-unit abutment the average increase in A-P distances for tilted implants

appears larger in the 30-degree and 45-degree groups by 0.97 mm and 1.74 mm, respectively compared to

measurements at the implant level

Conclusions Angulating 12 mm implants provides a limited increase in A-P distribution of implants in edentulous rehabilitation in most situations. In certain patients, the use of 8mm axial implants may provide a greater A-P spread.

Adapted from A Hamilton et al., Clin Oral Implants Res. 2021 Aug 23, for more info about this publication click HERE

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Scientific Highlights

Issue 5/21

Highlights J Periodontol. 2021 Jul 14. doi: 10.1002/JPER.21-0347.

Long-term clinical outcomes of periodontal regeneration with enamel matrix derivative: A retrospective cohort study with a mean follow-up of 10 years S P De Ry, A Roccuzzo, N P Lang, A Sculean, G E Salvi

Study objectives and methods Despite the large body of evidence on the efficacy of enamel matrix derivative (EMD) in the treatment of periodontal intrabony defects, few studies reported long-term data (≥10-year).

Periodontal patients treated with regenerative surgery with EMD between 1999 and 2012 were invited to participate in a clinical

examination. The following clinical parameters were recorded and compared at baseline (T0), 6 months after surgery (T1) and

after at least 8 years of follow-up (T2): probing depth (PD), gingival recession (GR), clinical attachment level (CAL), plaque and bleeding scores. The primary outcome variable was CAL change.

Results • • • •

Forty-one patients with 75 treated teeth were available for analysis. Out of these, 68 (tooth survival rate: 90.7%) reached the latest follow-up with a mean observation period of 10.3 years (range: 8.0 to 21.3).

The most frequent reason for tooth loss was recurrence of periodontal disease.

Tooth survival curves showed a statistically significant difference between smokers and non-smokers (P = 0.028).

Mean CAL changed from 8.43 ± 1.86 (T0) to 6.47 ± 1.70 (T1) (P < 0.001) and to 5.91 ± 1.83 (T2) (P < 0.001).

At T1, a CAL gain of ≥3 mm was measured in 35% of the defects whereas at T2 it was detected in 51% of cases.

Conclusions Within their limitations, the present results have shown that in intrabony defects, the clinical improvements obtained following regenerative surgery with EMD can be maintained on a mean period of 10 years. Smoking status and maxillary molars were correlated with an increased risk for tooth and CAL loss, respectively.

Adapted from S P De Ry, et al., J Periodontol. 2021 Jul 14, for more info about this publication click HERE

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Scientific Highlights

Issue 5/21

Shanghai Kou Qiang Yi Xue. 2021 Jun;30(3):292-296

Prevalence of peri-implantitis and peri-implant mucositis within 15 years of implant placement.

[Article in Chinese]

T T Zahng, X J Hu, L Lin

Study objectives and methods

To explore the incidence of peri-implantitis (PI) and peri-implant mucositis (PM) during 15 years of implant placement.

A retrospective analysis of 507 patients (1 162 implants in total) who underwent oral implant restoration in the Affiliated Stomatological Hospital of Nanchang University from January 2001 to December 2005 were performed and followed up for 12-15 years. The clinical data of the patients were collected, and the individual and implant-level PI, PM incidence and influencing factors were analyzed. SPSS 22.0 software package was used for statistical analysis.

Results •

After an average of 13.37 years of follow-up, the overall incidence of PM and PI in 507 implant restoration patients was 45.0% and 9.7%, respectively. The incidence of PM and PI in 1 162 implants was 44.1% and 10.9%, respectively.

•

Among 127 implants with PI, there were 8 implants (6.3%) failed. PI had a low incidence within 0.5 to 1 year after

implantation and restoration, with a significant increase in incidence within 1 to 5 years, a decrease in incidence within 5 to 10 years, and a continuous decrease in incidence over 10 years.

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The incidence of PM was relatively high within 0.5-1 year of implantation and restoration, gradually decreased in 1-5

years, and remained basically unchanged for 5-10 years and more than 10 years.

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The incidence of PI and PM using Straumann system was the lowest, and the incidence of Osstem system was the

•

The incidence of PI and PM in the upper anterior tooth area was significantly higher than that of other teeth(P<0.05).

highest (P<0.05).

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The probability of PI and PM was the highest in patients with non-closed crown edges, followed by loose abutment screws, loose crown-retained screws, and broken abutment screws(P<0.05).

•

Multivariate logistic regression analysis showed that implantation time, implant system, implant position, and restorative factors were high-risk factors affecting the incidence of PM and PI (P<0.05).

Conclusions

The incidence of PM is widespread within 15 years of implant placement. The incidence of PI does not increase with the

increase of restoration time, but is related to implantation time, implant system, implant position and later restoration factors.

Adapted from T T Zahng et al., Shanghai Kou Qiang Yi Xue. 2021 Jun;30(3):292-296, for more info about this publication click HERE

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Scientific Highlights

Issue 5/21

Int J Oral Maxillofac Implants. Jul-Aug 2021;36(4):807-817.doi: 10.11607/jomi.8603

Identification of the Pathway and Appropriate Use of Four Zygomatic Implants in the Atrophic Maxilla: A Cross-Sectional Study C Aparicio, W D Polido, J Chow, L David, R Davo, E J De Moraes, A Fibishenko, M Ando, G Mclellan, C Nicolopoulos, M A Pikos, H Zarrinkelk, T J Balshi, M Peñarrocha

Study objectives and methods This cross-sectional study aimed to identify and characterize the pathway for appropriate placement of four zygomatic implants

in the severely atrophic maxilla and to group the anatomical variations of the osteotomy trajectory for anterior zygomatic implants.

CBCT images of patients presenting indications for the use of four zygomatic implants to withstand a maxillary rehabilitation

were reviewed. Cross-sectional planes corresponding to the implant trajectories, designed according to a zygoma anatomyguided approach for implants placed in the anterior and posterior maxilla, were assessed separately. The relationship of the

implant osteotomy trajectory with the correlated residual alveolar bone, nasal and sinus cavities, maxillary wall, and zygomatic bone anatomies was established.

Results •

The study population included 122 globally recruited patients, with 488 zygomatic implants, 244 of which had their starting point on the anterior incisor-canine area and 244 on the posterior premolar-molar area.

•

The anatomy of the osteotomy path designed for the anterior implants ("A") was named and grouped into five

assemblies from zygomatic anatomy-guided ZAGA A-0 to A-4, representing 2.9%, 4.5%, 19.7%, 55.7%, and 17.2% of

the studied sites.

•

Percentages for posterior implant ("P") trajectories of the osteotomy were grouped and named as ZAGA P-0 to P-4,

representing 5.7%, 10.2%, 8.2%, 18.4%, and 57.4% of the sites, respectively.

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Approximately 70% of the population presented anatomical intra-individual differences.

Conclusions The trajectory of the zygomatic implant followed different anatomical pathways depending on its coronal point being anteriorly

or posteriorly located, which justifies a new zygoma anatomy-guided approach classification for anteriorly placed zygomatic implants. Topographic characteristics of the anatomical structures that are cut by an anterior oblique plane joining the lateral incisor-canine area to the zygomatic bone, representing the planned anterior osteotomy path in a quadruple-zygoma

indication, have not been previously reported. Adaptation of surgical procedures and implant sections/designs to individual patients' anatomical characteristics is essential to reduce early and long-term complications.

Adapted from C Aparicio et al., Int J Oral Maxillofac Implants. Jul-Aug 2021;36(4):807-817, for more info about this publication click HERE

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Scientific Highlights

Issue 5/21

J Oral Implantol. 2021 Sep 7. doi: 10.1563/aaid-joi-D-20-00411.

Comparative assessment of the primary stability of Straumann® BLX implant design using an in-vitro sinus lift-simultaneous implant insertion model M Emmert, J Spille, E Behrens, M Ayna, F Karayurek, J Wiltfang, Y Acil, A Gülses

Study objectives and methods Straumann ® BLX is a novel implant system, which has been proclaimed to provide an ideal primary stability in all types of bone. In the current study, the primary stability of Straumann ® BLX implant systems with Straumann ® tapered effect (TE)

implants have been comparatively assessed in bovine ribs by using a simultaneous sinus elevation and implant insertion model.

In the study group, BLX (4.0 x 12 mm), TE (4.1 x 12 mm), BLX (4,5 x 12 mm) and TE (4.8 x 12 mm) were placed in each bony

window, which resembles sinus maxillaris. As a control, BLX and TE implants with same sizes were inserted into the proximal diaphysis of the bovine ribs. A total of 40 implant insertions were performed. The stability was measured with resonance frequence analysis.

Results •

In the study group, TE implants of 4.8 mm showed significantly higher values compared to 4.5 mm BLX implants (p=0.116). However, BLX implants of 4.0 mm in the control group showed higher stability compared to TE with 4.0

mm diameter. (p=0.014).

•

The primary stability of BLX implants in the control group was significantly higher compared to the experimental group in both widths (p=0.018 for BLX 4.0 and p=0.002 for BLX 4.5 respectively).

Conclusions The use of TE design with wide diameter in simultaneous implant placement with sinus lift could present higher ISQ values and

might be more appropriate option for implant recipient sites with poor bone volume and quality. However, the advantage of BLX design in standard implant insertion protocols could be precious.

Adapted from M Emmert et al., J Oral Implantol. 2021 Sep 7, for more info about this publication click HERE

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Scientific Highlights

Issue 5/21

J Long Term Eff Med Implants. 2021;31(3):51-56. doi: 10.1615/JLongTermEffMedImplants.2021038608

Retrospective Analysis of the Bone Density in the Maxillary Anterior Region among Patients with Dental Implants A A Ahamed, R Subhashree, V Rakshagan, V Ashok

Abstract Implant systems today have come a long way to provide comfort and long-term success rate in patients requiring implant

supported prosthesis as part of their oral rehabilitation. It is currently overtaking the other prosthetic treatment especially in the case of replacing anterior teeth.

The aim of this study was to evaluate the association of age, gender, bone density and implant brands with respect to implants placed in the maxillary anterior region in a private hospital setup. It is a retrospective university setting study performed by evaluating the case histories of patients placed with implants in the anterior region.

The data was extracted and subjected to statistical analyses using SPSS software. I

n this study, D2 bone was most commonly seen in the anterior region followed by D3 and D1.

D1 and D3 bone were prevalent in patients in the age group of 41 to 60 years and D2 bone was prevalent in the group of 2640 years.

Males showed greater bone density than females.

Implant brand Straumann Roxolid SLActive was mostly used in the anterior region and most of the implants are placed equicrestal in position.

As a practitioner, one should have clear knowledge on implant brand, bone densities, crestal relation and age association in order to exert a successful treatment response in the future.

Adapted from A A Ahamed et al., J Long Term Eff Med Implants.2021;31(3):51-56 for more info about this publication click HERE

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Scientific Highlights

Issue 5/21

Compend Contin Educ Dent. Jul-Aug 2021;42(7):f1-f4.

Using a Digital Dentistry Integrated Planning and Manufacturing Service in Completely Edentulous Treatment H AlQallaf, W S Lin, C C Yang

Abstract The use of an integrated digital planning and manufacturing modular service and a time-tested dental implant system to treat a completely edentulous patient, as shown in this case report, offers numerous clinical benefits. Computer-guided surgery and

digital dentistry have gained in popularity and demonstrated great clinical success; however, clinicians and dental laboratory technicians can further maximize the benefit gained from these technologies through additional training and resource

investment. By using the streamlining solution (Smile in a Box®, Straumann) described in a clinical step-by-step manner in this

case report, dental professionals can provide effective digital solutions for improved patient treatment acceptance, experience, and satisfaction.

Adapted from H AlQallaf et al., Compend Contin Educ Dent. Jul-Aug 2021;42(7):f1-f4., for more info about this publication click HERE

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Scientific Highlights

Issue 5/21

Atlas Oral Maxillofac Surg Clin North Am. 2021 Sep;29(2):203-231.doi: 10.1016/j.cxom.2021.05.004

The Zygoma Anatomy-Guided Approach for Placement of Zygomatic Implants C Aparicio, W D Polido, H M Zarrinkelk

Abstract The essence of the ZAGA Concept is to provide the patient with a zygomatic anchored rehabilitation according to their specific anatomy.

ZAGA Concept includes the choice of the adequate implant design able to adapt to the performed osteotomy.

The ZAGA concept recommends aiming for a tunnel osteotomy, whenever possible, regardless of the maxillary wall curvature.

A channel osteotomy is a groove made on the coronal-alveolar bone and sometimes also in the lateral maxillary wall and zygomatic buttress.

It is critical to preserve the sinus membrane integrity and as much bone thickness as possible at the zygomatic implant critical zone crest level.

Adapted from C Aparicio et al., Atlas Oral Maxillofac Surg Clin North Am. 2021 Sep;29(2):203-231, for more info about this publication click HERE

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Scientific Highlights

Issue 5/21

J Dent Imp Res 2021; 40(3): 59-65

Immediate placement and immediate loading of full edentulous arches in 20 periodontally compromised patients – in-line clinical case series with 3 years follow-up L Tran-Hung , M Dard

Study objectives and methods These in-line clinical case series aim to assess the cumulative implant and definitive prosthesis survival rate of full edentulous

arches in periodontally compromised patients using 4 to 6 Bone Level Tapered (BLT) implants (Straumann, Basel, Switzerland) for up to 3 years of loading.

Ninety-four implants were placed in 20 patients under the full controlled principle of in-line clinical case series (14 successive

days of surgery). Each subject received an immediate loaded and complete-arch provisional prosthesis during 24 hours after

implant surgery. The definitive prostheses were delivered within 6 to 8 weeks after implant insertion. A life table method was used to determine implant cumulative survival rate.

Results • •

Up to 3 years of loading, our results demonstrated a cumulative implant survival rate of 98.94%.

The definitive prosthesis survival rate was 100%.

Conclusions These results support the use of BLT implants according to the ProArch concept for immediate placement and immediate

loading of full edentulous arches in periodontally compromised patients. These in-line case series need to be followed by long-

term clinical evaluations.

Adapted from L Tran-Hung et al., J Dent Imp Res 2021; 40(3): 59-65, for more info about this publication click HERE

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Scientific Highlights

Issue 5/21

Int J Implant Dent. 2021 Jul 13;7(1):93.doi: 10.1186/s40729-021-00373-4.

Clinical long-term and patient-reported outcomes of dental implants in oral cancer patients E Schiegnitz, L K Müller, K Sagheb, L Theis, V Cagiran, P W Kämmerer, J Wegener, W Wagner, B Al-Nawas

Study objectives and methods The aim of this clinical study was to investigate the clinical long-term and patient-reported outcome of dental implants in patients with oral cancer. In addition, analysis of the influence of radiation therapy, timing of implant insertion, and augmentation procedures on implant survival was performed.

This retrospective study investigated the clinical outcome of 711 dental implants in 164 oral cancer patients, inserted by

experienced surgeons of the Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Germany. Oral health-related quality of life (OHRQoL) was evaluated.

Results • •

Cumulative 5-year and 10-year implant survival rates for all included implants were 87.3% and 80.0%.

Implants placed straight after ablative surgery (primary implant placement) and implants placed after completing the

oncologic treatment (secondary implant placement) showed a comparable implant survival (92.5% vs. 89.5%; p =

0.635).

•

Irradiation therapy had no significant influence on implant survival of secondary placed implants (p = 0.929). However,

regarding implant site (native bone vs. augmented bone) and radiation therapy (non-irradiated bone vs. irradiated bone), implants inserted in irradiated bone that received augmentation procedures showed a statistically significant lower implant survival (p < 0.001). Patients reported a distinct improvement in OHRQoL.

Conclusions Promising long-term survival rates of dental implants in patients after treatment of oral cancer were seen. In addition, patients benefit in form of an improved OHRQoL. However, bone augmentation procedures in irradiated bone may result in an impaired implants' prognosis.

Adapted from E Schiegnitz et al., Int J Implant Dent. 2021 Jul 13;7(1):93, for more info about this publication click HERE

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Scientific Highlights

Issue 5/21

Int J Dent. 2021 Aug 31;2021:4134932. doi: 10.1155/2021/4134932

Pain Experience after Dental Implant Placement Compared to Tooth Extraction A W AlQutub

Abstract A patients' main concern when visiting the dentist is the pain experience during the procedure and postoperatively. Patients who are undergoing dental surgical procedures in particular may experience more concerns and higher level of anxiety and

stress that can affect their psychology and decision-making ability. A thorough discussion with the patients about the planned

surgical procedure and the expected postsurgical pain and discomfort level is crucial to reduce their fear and stress. Despite

increasing popularity of dental implants, limited data are available on pain experience related to surgical implant placement.

This review is to discuss and compare postoperative pain and discomfort level after dental implant placement procedure and tooth extraction. The review has a clinical significance as it can be used as a reference when explaining to the patients about the anticipated pain and discomfort level after implant placement.

Conclusions Informing patients about implant placement surgical procedure and the anticipated postsurgical pain can reduce their anxiety level and affect postsurgical pain and discomfort. Implant placement surgical procedure is less unpleasant than tooth extraction, with less postsurgical pain and limitation of daily activities.

Adapted from A W AlQutub, Int J Dent. 2021 Aug 31;2021:4134932, for more info about this publication click HERE

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Scientific Highlights

Issue 5/21

Folia Med Cracov. 2021;61(2):117-127.

Mucormycosis in head and neck area - the emerging health problem in COVID-19 pandemic. The perspective of a dental practitioner M Pasternak, R Olszanecki

Abstract Mucormycosis is an invasive fungal disease caused by saprophytic molds and is characterized by a fulminant course and high

mortality. Reported increase of disease cases and more frequent mucormycosis superinfections in COVID-19 patients are of a

serious concern. Head and neck area is the most typical location of mucormycosis and often the first symptoms are eminent in oral cavity, therefore a dentist may be the first healthcare practitioner to recognize signs of this dangerous and potentially

fatal disease. Urgent diagnosis and implementation of appropriate treatment are essential for the patient's survival. The

dentist's participation in postoperative care is necessary and due to the destructive nature of radical surgical treatment, prosthetic rehabilitation is required to improve the patient's function and quality of life. Furthermore the vigilance of dentists will also allow early recognition of frequent recurrences of this insidious infection.

Adapted from M Pasternak et al, Folia Med Cracov. 2021;61(2):117-127, for more info about this publication click HERE

A Hamilton et al., Clin Oral Implants Res. 2021 Aug 23| S P De Ry, et al., J Periodontol. 2021 Jul 14| T T Zahng et al., Shanghai Kou Qiang Yi Xue. 2021 Jun;30(3):292-296| C Aparicio et al., Int J Oral Maxillofac Implants. Jul-Aug 2021;36(4):807-817| M Emmert et al., J Oral Implantol. 2021 Sep 7| A A Ahamed et al., J Long Term Eff Med Implants.2021;31(3):51-56 | H AlQallaf et al., Compend Contin Educ Dent. Jul-Aug 2021;42(7):f1-f4| C Aparicio et al., Atlas Oral Maxillofac Surg Clin North Am. 2021 Sep;29(2):203-231| L Tran-Hung et al., J Dent Imp Res 2021; 40(3): 59-65| E Schiegnitz et al., Int J Implant Dent. 2021 Jul 13;7(1):93| A W AlQutub, Int J Dent. 2021 Aug 31;2021:4134932| M Pasternak et al, Folia Med Cracov.

2021;61(2):117-127| source: www.pubmed.gov| and Google Scholar Dr Nair holds a position of Global Scientific Communications Manager at Institute Straumann in Basel, Switzerland.

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References