International Journal of Oral Implantology, 02/2009

Objectives: To evaluate if a one-stage implant placement procedure is as effective as a two-stage procedure. Data sources: The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE, were searched and several journals were hand-searched with no language restriction up to January 2009. Review methods: All randomised controlled trials (RCTs) of osseointegrated dental implants comparing the same dental implants placed according to one- versus two-stage procedures with a minimum follow up of 6 months after loading were eligible. Screening of studies, quality assessment and data extraction were conducted in duplicate. Outcome measures were: prosthesis failure, implant failures, radiographic marginal bone level changes, patient preference including aesthetics, aesthetics evaluated by clinicians and complications. Results: Five RCTs were identified and included reporting data on 239 patients in total. On a patient basis, rather than a per implant basis, the meta-analyses showed no statistically significant differences for prosthesis and implant failures, though trends, especially in fully edentulous patients, favoured twostage (submerged) implants. Conclusions: The number of patients included in the trials was too small to draw definitive conclusions. The one-stage approach might be preferable in partially edentulous patients since it avoids one surgical intervention and shortens treatment times, while a two-stage submerged approach could be indicated when an implant has not obtained an optimal primary stability, when barriers are used for guided tissue regeneration or when it is expected that removable temporary prostheses could transmit excessive forces on the penetrating abutments, especially in fully edentulous patients.

Purpose: The aim of the present prospective cohort study was to report on an approach for maxillary reconstruction with autogenous bone grafts allowing implant placement for immediate function with fixed bridges after 6 months. Materials and methods: A total of 35 bilateral bone grafting procedures were performed on 35 consecutive patients (mean age 54.5 years). The iliac crest was used as donor site for all patients. The method for retaining the immediate prosthesis after bone graft ranged from mucosa retention (6 patients), implant retention (10 patients with immediate-function implants placed in non-grafted bone at the same surgical step as the bone graft procedure), teeth retention (6 patients) or palatal implant retention (13 patients). The graft was considered to be successful when it allowed the placement of the planned implants for immediate function rehabilitation with a fixed bridge. Results: All bone-grafting procedures were successful, allowing all patients to be rehabilitated after 6 months with a fixed bridge supported by immediate-function implants. The cumulative survival rate of the palatal implants was 94% after 2 months. A total of 219 immediate-function implants were placed in grafted bone and loaded occlusally. Two patients dropped out of the study 2 and 4 months after the bone graft procedure, while one patient with four implants dropped out of the study 13 months after the rehabilitation with implants. The cumulative survival rate of the implants was 97.3% at 1-year and 96.7% at 5-years (up to 129 months; minimum of 29 months; median of 52.5 months). Seven implants failed to integrate in the grafted bone. The marginal bone resorption for the implants placed in grafted areas at 1-year and 5-year follow-up was 2.0 mm (SD = 1.2mm) and 2.0mm (SD = 1.1mm), respectively. Conclusions: Maxilla reconstruction with autogenous grafted bone is a viable process, allowing, in some cases, the use of a removable or fixed prosthetic rehabilitation immediately after grafting. Maxillary rehabilitation with immediate-function implants in grafted bone is possible, with the implant success rate achieved at 5 years comparable to other rehabilitations with implants placed in grafted bone, but lower than the results obtained with implants placed in residual bone.

Aim: The zygomatic implant represents a non-grafting alternative for the oral rehabilitation of patients with extreme resorption of the maxilla. Nevertheless, there are few studies concerning their long-term prognosis. The purpose of this retrospective study was to evaluate the prosthetic rehabilitation success rate and the survival rates of machined surface zygomatic implants and conventional implants placed using a 2-stage protocol in 21 consecutively treated patients with atrophic maxillae after a 5-year followup period. Materials and methods: A total of 24 consecutively treated patients (8 men, 16 women), with a mean age of 51.4 years (range 36 to 72 years) were included in this study. Rehabilitations were accomplished in 22 edentulous arches, and two partially edentulous arches. In total, 45 zygomatic and 109 conventional implants were inserted. A total of 21 patients had a screw-retained fixed implant-supported prosthesis within 6 months of implant placement and three patients had an implant-supported overdenture. Outcome measures were survival rates of the prosthetic rehabilitations, of the zygomatic and conventional implants, as well as complications. Results: Three patients dropped out, two after 1 year and one after 3 years. Continuous stability of the prostheses was achieved in 20 out of the 21 patients throughout the study. Therefore, the success rate for the prosthetic rehabilitation after 5 years was 95.8%. One overdenture supported on two zygomatic implants was removed after 1 year of function. The patient is currently waiting for the installation of two more zygomatic implants or a grafting procedure. One zygomatic implant was lost giving a survival rate 97.4% after the 5-year follow-up period. A total of 11 conventional implants were lost, resulting in a survival rate of 89.9% after 5 years of follow-up. Sinusitis was observed in five patients throughout the study, which was solved with antibiotics, meatotomy, or Caldwell-Luc antrostomy with no further consequences. Conclusions: Zygomatic implants together with conventional implants in the atrophic maxillae appear to have an acceptable 5-year clinical outcome.

Aim: The aim of the present explorative cross-sectional study was to evaluate the potential role of some periodontal variables in predicting sub-clinical atherosclerosis and systemic inflammation in young adults (=40 years) with severe periodontitis compared with healthy individuals without periodontitis. Materials and methods: A total of 90 systemically healthy subjects, 45 (mean age 36.35±3.65 years) affected by severe periodontitis (test group) and 45 individuals (mean age 33.78±3.28 years) without a history of periodontal disease (control group) were enrolled in the present study. Test and control groups were paired for age, gender, body mass index (BMI) and smoking habits. Carotid intima-media thickness (carotid IMT) was bilaterally assessed by ultrasonography at the level of the common carotid artery to evaluate sub-clinical atherosclerosis. Blood samples to assess inflammatory markers (leucocytes, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total serum cholesterol, high sensitivity C-reactive protein, glucose and haemoglobin A1c% were taken. Results: In periodontal patients, mean probing depth (PD) was a predictor of mean carotid IMT (P=0.0005), BMI (P=0.0002), systolic blood pressure (P=0.0300) and diastolic blood pressure (P= 0.0199). Full-mouth bleeding score (FMBS) was a predictor of C-reactive protein levels (P=0.0218). In controls, full-mouth plaque score was a predictor of glucose levels (P=0.0074) and higher FMBS of lower triglycerides levels (P=0.0312). Conclusion: Mean PD and FMBS may predict sub-clinical atherosclerosis and systemic inflammation in young adults with severe periodontitis.

Purpose: To appraise the reported processes involved in the development of published dental guidelines. Materials and methods: Electronic databases were searched to identify guidelines making recommendations for any health professional within dentistry. All included guidelines were appraised using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument. Results: A total of 105 guidelines met the inclusion criteria. The appraised guidelines showed lack of rigour in their development (median score 14.3%; range 0% to 100%). Only 10 (9.5%) were coded as 'strongly recommend' by at least two assessors. Conclusion: If recommendations within clinical guidelines are to be relied upon, the methods used in their development must be explicit and free from bias. When using the AGREE checklist to make decisions on whether or not to implement individual sets of guidelines, the findings of the present assessment reinforce the need for more than two assessors to be included in the appraisal of each set of guidelines.

This section presents concise educational articles for practicising dentists. The series aims to educate practitioners regarding statistics and methods of conducting and interpreting research.