Scientific highlights of the month (November 2021)

Scientific Highlights

Scientific Highlights

Issue 6/21

SHORT OVERVIEWS ON RECENTLY PUBLISHED SCIENTIFIC EVIDENCE.

Issue 6/2021

Edited by Dr Pooja Nair Page | 1

Scientific Highlights

Issue 6/21

IN THIS ISSUE EDITOR’S CHOICE 1.

Clinical performance of hydrophilic, titanium-zirconium dental implants in patients with wellcontrolled and poorly-controlled type 2 diabetes: One-Year results of a dual-center prospective cohort study

HIGHLIGHTS

2. Impact of design elements of the implant supracrestal complex (ISC) on the risk of peri-implant mucositis and peri-implantitis: A critical review

3. Immediate implant placement combining socket seal abutment and peri-implant socket filling: A prospective case series

4. Microtomographic reconstruction of mandibular defects treated with xenografts and collagen-based membranes: A pre-clinical minipig model

5. Does the timing of implant placement and loading influence biological outcomes of implantsupported multiple-unit fixed dental prosthesis-A systematic review with meta-analyses

6. Immediate Loading of Straumann® TLX Implant in Grafted Maxillary First Molar Site 7. Is the timing of implant placement and loading influencing esthetic outcomes in single-tooth implants?-A systematic review

8. Long-term outcomes of maxillary single-tooth implants in relation to timing protocols of implant placement and loading: Systematic review and meta-analysis

9. Principles of Combined Surgical Therapy for the Management of Peri-implantitis 10. Patient-reported outcome measures following soft-tissue grafting at implant sites: A systematic review

REFERENCES

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Scientific Highlights

Issue 6/21

In this issue

in this issue EDITOR’S CHOICE Clinical performance of hydrophilic, titanium-zirconium dental implants in patients with well-controlled and poorly-controlled type 2 diabetes: One-Year results of a dual-center prospective cohort study (J M Latimer et al. 2021)

and Immediate implant placement combining socket seal abutment and peri-implant socket filling: A prospective case series (R Lilet et al. 2021)

Microtomographic reconstruction of mandibular defects treated with xenografts and collagen-based membranes: A pre-clinical minipig model (J Gomez et al. 2021)

Does the timing of implant placement and loading influence biological outcomes of implant-supported multiple-unit fixed dental prosthesis-A systematic review with meta-analyses (L L Aiquel et al. 2021)

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Scientific Highlights

Issue 6/21

Editor’s choice J Periodontol. 2021 Nov 5. doi: 10.1002/JPER.21-0015.

Clinical performance of hydrophilic, titanium-zirconium dental implants in patients with well-controlled and poorly-controlled type 2 diabetes: One-Year results of a dual-center prospective cohort study J M Latimer, K L Roll, D M Daubert, H Zhang, T Shalev, ABCD study collaborators, L F Wolff, G A Kotsakis

Study objectives and methods This study assessed the clinical performance of hydrophilic dental implants in a patient cohort with type 2 diabetes mellitus (T2DM).

Subjects with T2DM of ≥ 2-years duration were allocated to either the well-controlled (WC; HbA1c ≤ 7.0%,) or poorly-controlled

(PC; 7.5 < HbA1c < 10%) groups in a dual-center, prospective cohort study. Each subject received a single, titanium-zirconium (Ti-Zr) dental implant with a chemically-modified, hydrophilic (modSLA) surface in a posterior mandibular site. Postoperatively,

subjects were followed at 1, 2, 4, 8 and 12-week intervals. Post-loading, subjects were followed at 3, 6 and 12-months. Clinical and radiographic parameters of implant success, and dental patient-reported outcomes were collected.

Results •

Twenty-one dental patients (NWC = 11; NPC = 10; mean age: 66.8 ± 7.5 years) were enrolled and the 1-year implant

success rate was 100%.

•

Peri-implant bone levels were stable with 0.15 ± 0.06 mm mean marginal loss at one year without significant inter-

•

Postoperative pain was minimal at 1-week, and OHIP-5 scores decreased significantly over time as compared with

group differences (p = 0.79).

preoperative levels (p < 0.001) suggesting significant improvement in patient-perceived oral health following implant therapy.

Conclusions Elevated HbA1c levels> 7.5% did not compromise 1-year success rates, or oral health-related quality of life in PC patients receiving modSLA, Ti-Zr implants.

Adapted from J M Latimer et al., J Periodontol. 2021 Nov 5, for more info about this publication click HERE

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Scientific Highlights

Issue 6/21

Highlights Clin Oral Implants Res. 2021 Sep 22.doi: 10.1111/clr.13852.

Immediate implant placement combining socket seal abutment and peri-implant socket filling: A prospective case series R Lilet, M Desiron, G Finelle, G Lecloux, L Seidel, F Lambert

Study objectives and methods The aim of this prospective case series was to assess the implant outcomes as well as hard and soft tissue dimensional changes

of immediate implant placement in posterior sites using a custom-made sealing socket abutment (SSA) combined to peri-

implant socket filling (PISF).

Twenty patients were considered for single extraction and immediate implant in upper or lower posterior regions. The

remaining peri-implant sockets were filled with Deproteinized Bovine Bone Mineral. Based on intra-oral scans (IOS), custommade SSAs were placed the same day. Implant survival rate, peri-implant bone changes, peri-implant health and pink esthetic score (PES) were recorded up to 1 year post-implant placement. Moreover, CBCT and IOS were performed to monitor hard and soft tissue dimensional changes.

Results • • • •

One implant failed to osseointegrate leading to an implant survival rate of 95% after 1 year.

Peri-implant bone changes yielded 0.19 ± 0.31 mm and 84.2% of the implants displayed no or mild bleeding on probing. Horizontal bone remodeling was not significant from baseline to 1 year at any levels.

Finally, soft tissue profile was stable in the most cervical area while minor changes occurred during the first 6 months below the gingival margin.

The absence of mid-buccal recession (0.07 mm) and good PES were found after 1 year.

Conclusions Despite its limitations, this study showed that immediate implants in the posterior region using the SSA + PISF protocol resulted in promising implant outcomes with limited hard and soft tissue dimensional changes while decreasing the overall treatment time.

Adapted from R Lilet, et al., Clin Oral Implants Res. 2021 Sep 22, for more info about this publication click HERE

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Scientific Highlights

Issue 6/21

Med Oral Patol Oral Cir Bucal. 2021 Nov 1;26(6):e825-e833. doi: 10.4317/medoral.24811

Microtomographic reconstruction of mandibular defects treated with xenografts and collagen-based membranes: A pre-clinical minipig model J Gomez, E-T Bergamo, N Tovar, H-S Talib, B-E Pippenger, V Herdia, M Cox, P-G Coelho, L Witek

Study objectives and methods The goal of this study was to evaluate hard tissue response following guided bone regeneration using commercially available

bovine bone grafts and collagen membranes; bilayer collagen membrane and porcine pericardium-based membrane, by

means of a non-destructive three-dimensional (3D) computerized volumetric analysis following microtomography reconstruction.

Bone regenerative properties of various bovine bone graft materials were evaluated in the Göttingen minipig model. Two standardized intraosseous defects (15mm x 8mm x 8mm) were created bilaterally of the mandible of eighteen animals (n=72

defects). Groups were nested within the same subject and randomly distributed among the sites: (i) negative control (no graft

and membrane), (ii) bovine bone graft/bilayer collagen membrane (BOB) (iii) Bio-Oss® bone graft/porcine pericardium-based membrane (BOJ) and (iv) cerabone® bone graft/porcine pericardium-based membrane (CJ). Samples were harvested at 4, 8,

and 12-week time points (n=6 animal/time point). Segments were scanned using computerized microtomography (μCT) and

three dimensionally reconstructed utilizing volumetric reconstruction software. Statistical analyses were performed using IBM SPSS with a significance level of 5%.

Results •

From a temporal perspective, tridimensional evaluation revealed gradual bone ingrowth with the presence of particulate bone grafts bridging the defect walls, and mandibular architecture preservation over time.

•

Volumetric analysis demonstrated no significant difference between all groups at 4 weeks (p>0.127). At 8 and 12

weeks there was a higher percentage of new bone formation for control and CJ groups when compared to BOB and BOJ groups (p<0.039).

•

The natural bovine bone graft group showed more potential for graft resorption over time relative to bovine bone graft, significantly different between 4 and 8 weeks (p<0.003).

Conclusions Volumetric analysis yielded a favorable mandible shape with respect to time through the beneficial balance between graft resorption/bone regenerative capacity for the natural bovine bone graft.

Adapted from J Gomez.et al., Med Oral Patol Oral Cir Bucal. 2021 Nov 1;26(6):e825-e833, for more info about this publication click HERE

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Scientific Highlights

Issue 6/21

Clin Oral Implants Res. 2021 Jun 15. doi: 10.1111/clr.13796.

Does the timing of implant placement and loading influence biological outcomes of implant-supported multiple-unit fixed dental prosthesisA systematic review with meta-analyses L L Aiquel, J Pitta, G N Antonoglou, I Mischak, I Sailer, M Payer

Study objectives and methods To investigate the impact of timing of implant placement and loading on implant survival and biological outcomes of multipleunit implant-supported fixed dental prosthesis (FDPs).

A literature search was performed by three independent reviewers for studies reporting on ≥10 patients with FPDs supported

by ≥two implants over ≥3 years of follow-up. Data were analyzed on implant survival and biological complications as primary outcomes and biological events, including changes in peri-implant marginal bone level (MBL), probing depth, soft-tissue level, and health condition as secondary outcomes.

Results • •

A 7002 titles were identified, 360 full-texts were screened, and 14 studies were included.

These comprised 6 randomized controlled studies (RCTs), 5 cohort studies, and 3 case series with identifiable implant placement and loading protocols in five of 09 possible combinations.

• •

All groups but one (IPIL) showed implant survival rates >90%.

A meta-analysis based on 3 RCTs found no differences in survival rate between DPIL and DPDL (p = .227).

Conclusions High survival rates for all studied implant placement and loading combinations were shown for FPDs over ≥3 years of follow-up. When a delayed implant placement protocol is applied, immediate or delayed loading demonstrated similar survival rates. The heterogeneity of the data did not allow to draw any further conclusions on the occurrence of biological complications related to timing of implant placement/loading.

Adapted from L L Aiquel et al., Clin Oral Implants Res. 2021 Jun 15., for more info about this publication click HERE

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Scientific Highlights

Issue 6/21

Compend Contin Educ Dent. 2021 Oct;42(9):e1-e4

Immediate Loading of Straumann® TLX Implant in Grafted Maxillary First Molar Site D Morton, A Orgev, W D Polido

Abstract The patient treatment described in this case report demonstrates management of a failing maxillary first molar utilizing an immediate loading approach. Following extraction, the site was successfully managed with socket grafting (ridge preservation)

and allowed to heal prior to implant placement. A Straumann® TLX implant was placed using a guided approach and restored using CAD/CAM.

Adapted from D Morton et al., Compend Contin Educ Dent. 2021 Oct;42(9):e1-e4, for more info about this publication click HERE

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Scientific Highlights

Issue 6/21

Clin Oral Implants Res. 2021 Oct;32 Suppl 21:181-202.

Impact of design elements of the implant supracrestal complex (ISC) on the risk of peri-implant mucositis and peri-implantitis: A critical review N Mattheos, M Janda, A Acharya, S Pekarski, C Larsson

Study objectives and methods The aim of this review was to investigate the evidence correlating the emergence profile (EP) and emergence angle (EA), peri-

implant tissue height, implant neck design, abutment and/or prosthesis material, retention and connection types with risk of peri-implant mucositis and peri-implantitis.

Seven focus questions were identified, and seven electronic search queries were conducted in PubMed. Human studies

reporting on bleeding on probing, probing depth or case definitions of peri-implant mucositis and peri-implantitis were included.

Results •

Emerging evidence with bone-level implants suggests a link between EA combined with convex EP and periimplantitis.

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Depth of the peri-implant sulcus of ≥3 mm is shown to be reducing the effectiveness of treatment of established peri-implant mucositis.

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Modification of the prosthesis contour is shown to be an effective supplement of the anti-infective treatment of periimplant mucositis.

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Limited evidence points to no difference with regard to the risk for peri-implant mucositis between tissue- and bonelevel implants, as well as the material of the abutment or the prosthesis.

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Limited evidence suggests the use or not of prosthetic abutments in external connections and does not change the risk for peri-implantitis.

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Literature with regard to prosthesis retention type and risk for peri-implantitis is inconclusive.

Conclusions Limited evidence indicates the involvement of EA, EP, sulcus depth and restricted accessibility to oral hygiene in the

manifestation and/or management of peri-implant mucositis/peri-implantitis. Conclusions are limited by the lack of consensus

definitions and validated outcomes measures, as well as diverse methodological approaches. Purpose-designed studies are

required to clarify current observations.

Adapted from N Mattheos et al., Clin Oral Implants Res. 2021 Oct;32 Suppl 21:181-202, for more info about this publication click HERE

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Scientific Highlights

Issue 6/21

Clin Oral Implants Res. 2021 Oct;32 Suppl 21:28-55. doi: 10.1111/clr.13811.

Is the timing of implant placement and loading influencing esthetic outcomes in single-tooth implants?-A systematic review H Francisco, D Marques, C Pinto, L Aiquel, J Caramês

Study objectives and methods To address the following question: "Is the timing of implant placement and/or loading influencing the esthetic outcomes of implant-supported single crowns?".

A literature screening was performed in four electronic databases until June 2020. Randomized controlled clinical trials with a

minimum of 10 patients and 1 year of follow-up and reporting on dimensional changes of the peri-implant mucosa (midfacial

recession, papilla level) and esthetic indexes were included. Cochrane Risk of Bias Tool was used, and comparable trials were subjected to meta-analyses.

Results • • • • • •

Out of 8549 articles, 72 full-text articles were assessed for eligibility and 18 were included.

Nine trials evaluated the timing of implant placement, and nine trials evaluated the timing of loading.

The included trials comparing immediate implant placement to delayed implant placement evaluating the midfacial recession reported heterogeneous findings.

No differences were found at 1 and 2-years, when comparing midfacial recession and papilla level between immediate and early implant placement.

In immediate and delayed implant placement, when comparing conventional and immediate loading, the midfacial mucosal margin change was not statistically significant at the 1-year follow-up.

When evaluating the timing of implant placement and/or loading the included trials found no differences in the Pink Esthetic score, White Esthetic score, and Papilla Index between groups.

Conclusions Both immediate and early implant placement protocols presented stable treatment results in terms of esthetic outcomes at the 1-, 2-, and 10-years follow-up. Loading protocols did not seem to influence esthetic outcomes in short- and medium-term follow-ups.

Adapted from H Francisco et al.,Clin Oral Implants Res. 2021 Oct;32 Suppl 21:28-55, for more info about this publication click HERE

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Scientific Highlights

Issue 6/21

Clin Oral Implants Res. 2021 Oct;32 Suppl 21:56-66. doi: 10.1111/clr.13838.

Long-term outcomes of maxillary single-tooth implants in relation to timing protocols of implant placement and loading: Systematic review and meta-analysis B Pommer, M Danzinger, L L Aiquel, J Pitta, R Haas

Study objectives and methods The aim of the present systematic literature review was to determine whether long-term treatment results with single-tooth

implants may differ depending on the timing of implant placement in relation to tooth extraction (immediate IP/early EP/delayed DP) and the timing of prosthetic loading (immediate IL/early EL/delayed DL).

Electronic and manual searches were performed to identify studies reporting on long-term results (survival rate and/or marginal bone resorption after ≥3 years) of maxillary single-tooth implants in the aesthetic zone using defined placement and

loading protocols. Comparative trials were subjected to meta-analyses whilst data from single-arm studies were pooled to evaluate differences between timing protocols.

Results •

A total of 7 controlled trials were considered for meta-analyses: immediate loading was compared to delayed loading

in 3 studies on immediate placement (IPIL vs. IPDL, p = .306) and in 2 studies on delayed placement (DPIL vs. DPDL, p = 1.000) whilst 2 studies compared early versus delayed placement with delayed loading (EPDL vs. DPDL, p = .600), however, without significant differences.

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Pooled data analysis of 29 studies (965 implants) did not show differences between timing of placement or loading as well as marginal bone remodelling.

•

No impact of the one abutment - one time concept, flap design and simultaneous bone or soft tissue augmentation

could be established..

Conclusions Insufficient data are available for meta-analytic comparison of all combinations of implant placement and loading protocols.

Adapted from B Pommer et al., Clin Oral Implants Res. 2021 Oct;32 Suppl 21:56-66., for more info about this publication click HERE

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Scientific Highlights

Issue 6/21

Clin Adv Periodontics. 2021 Sep 27.doi: 10.1002/cap.10186.

Principles of Combined Surgical Therapy for the Management of Periimplantitis A Monje, F Schwarz

Abstract

The purpose of this technical note is to present the principles for combined therapy as well as to illustrate the step-by-step

approach of this procedure to efficiently manage peri-implantitis.

Peri-implantitis is the primary threat that compromises the longevity of dental implants. This entity is regarded as a biofilm-

mediated inflammatory condition. As such, the arrestment of disease is conditioned by the elimination of the etiological factor

and the clinical resolution of inflammation by eliminating pathogenic pockets. It was suggested that the therapy of peri-

implantitis relies upon defect configuration. In this sense, defect configuration is, in part, conditioned by the dimensions of the

alveolar bone and implant position. In the clinical basis, it is frequent to identify combined defects exhibiting area(s) where

reconstructive therapy is inefficient due to uncontained defect morphology. These situations represent clinical indications for combined therapy.

Conclusions This therapeutic modality is based on the combination of reconstructive therapy in the infra-osseous defect component and surface modification for the area of the implant within the supra-crestal component or outside the reparative potential.

Adapted from A Monje et al., Clin Adv Periodontics. 2021 Sep 27, for more info about this publication click HERE

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Scientific Highlights

Issue 6/21

Clin Oral Implants Res. 2021 Oct;32 Suppl 21:157-173. doi: 10.1111/clr.13767

Patient-reported outcome measures following soft-tissue grafting at implant sites: A systematic review M Stefanini, L Tavelli, S Barootchi, M Sangiorgi, G Zucchelli

Study objectives and methods To review the available literature on patient-reported outcome measures (PROMs) following soft tissue augmentation at implant sites.

A comprehensive electronic and manual search was performed to identify clinical studies that involved soft tissue augmentation

around dental implants and reported PROMs, including post-operative morbidity, painkillers intake, quality of life, aesthetics and satisfactions.

Results •

Nineteen articles were included in the qualitative analysis. Autogenous grafts (free gingival graft and connective tissue

graft), acellular dermal matrix and xenogeneic collagen matrix were utilized, either with a bilaminar- or an apically

positioned flap approach.

•

PROMs reported in the literature included perceived hardship of the procedure and pain during the surgery, post-

operative morbidity, painkillers intake, number of days with discomfort, satisfaction, aesthetic evaluation, quality of life and willingness to undergo the treatment again.

•

Most of the included studies showed similar PROMs between autogenous grafts and substitutes, in terms of post-

operative morbidity, painkillers intake, quality of life, aesthetic assessment and satisfaction. Nevertheless, a trend towards lower post-operative discomfort was observed for graft substitutes.

•

High scores for patient satisfaction and aesthetic evaluation were observed in all the interventions compared to non-

grafted sites.

Conclusions PROMs represent a crucial endpoint of clinical studies evaluating the outcomes of soft tissue grafts at implant sites. Most of the studies did not find significant differences in terms of patient morbidity and painkillers between autogenous grafts

and substitutes. Soft tissue grafting can enhance patient satisfaction and aesthetic evaluation compared to non-grafted sites.

Adapted from M Stefanini et al.,Clin Oral Implants Res. 2021 Oct;32 Suppl 21:157-173, for more info about this publication click HERE

J M Latimer et al., J Periodontol. 2021 Nov 5| | R Lilet, et al., Clin Oral Implants Res. 2021 Sep 22| J Gomez.et al., Med Oral Patol Oral Cir Bucal. 2021 Nov 1;26(6):e825-e833| L L Aiquel et al., Clin Oral Implants Res. 2021 Jun 15 | D Morton et al., Compend Contin Educ Dent. 2021 Oct;42(9):e1e4| N Mattheos et al., Clin Oral Implants Res. 2021 Oct;32 Suppl 21:181-202| H Francisco et al., Clin Oral Implants Res. 2021 Oct;32 Suppl 21:28-55| B Pommer et al., Clin Oral Implants Res. 2021 Oct;32 Suppl 21:56-66| A Monje et al., Clin Adv Periodontics. 2021 Sep 27| M Stefanini et al., Clin Oral Implants Res. 2021 Oct;32 Suppl 21:157-173 | source: www.pubmed.gov | Dr Nair holds a position of Global Scientific Communications Manager at Institute Straumann in Basel, Switzerland.

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References