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Aim: To systematically identify, synthesize and critically summarize the available scientific evidence from randomized controlled trials (RCTs) regarding whether short (≤6 mm) perform as well as long (≥10 mm) implants regarding implant survival, marginal bone loss, and biologic and prosthetic complications in different clinical scenarios. Materials and Methods: Cochrane Collaboration's risk of bias tool and the GRADE approach were applied. Results were synthesized using random‐effects meta‐analyses assessed by trial sequential analyses. Results: Forty reports on 19 RCTs comprising 2214 (1097 short; 1117 long) implants were included. Moderate/high certainty/quality evidence demonstrated similar 5‐year survival rates for ≤6‐mm and ≥10‐mm implants in non‐augmented bone and full‐mouth rehabilitation in either jaw, and for 6‐mm implants in the maxilla instead of sinus lift. Nevertheless, the evidence for 5‐year survival rates remains inconclusive or insufficient for the remaining combinations of implant lengths and clinical scenarios. They include 4‐mm and 5‐mm implants as alternatives to sinus lift as well as placing all implant lengths ≤6 mm instead of vertical ridge augmentation with long implants. Marginal bone level and short‐ and long‐term biologic or prosthetic complications were similar. Conclusions: Based on moderate/high certainty/quality evidence from 5‐year RCTs, implants ≤6 mm may be viable alternatives to ≥10‐mm implants in either jaw in native bone and full‐arch rehabilitation, and 6‐mm implants may be used as an alternative to sinus lift. Trial registration: PROSPERO ID: CRD42021254365. [ABSTRACT FROM AUTHOR]

Aim: To test whether soft‐type block bone substitute used for guided bone regeneration (GBR) of peri‐implant defects leads to a different dimension of the augmented hard tissue than particulate bone substitute. Materials and Methods: In 40 patients, 40 two‐piece dental implants were placed >2 months after tooth extraction. Following random allocation, 20 peri‐implant bone dehiscences were grafted with a soft‐type block made of synthetic biphasic calcium phosphate (BCP) + collagen and 20 bone dehiscences with particulate BCP. All the sites were covered with a collagen membrane stabilized with titanium pins. Immediately after wound closure and after 6 months, the horizontal dimension (HD) of the augmented hard tissue was measured at the level of implant shoulder using cone beam computed tomography. During re‐entry at 6 months, the defect fill was clinically assessed. Results: At 6 months, the median HD measured 1.15 mm (mean: 1.31 mm) in the soft‐block group and 0.93 mm (mean: 1.05 mm) in the particulate group (p =.6). At 6 months, 7.1% of contained defects and 61.9% of non‐contained defects showed an incomplete vertical defect fill. Conclusions: Soft‐type block of BCP + collagen used for GBR of peri‐implant defects did not differ from particulate BCP regarding the dimension of the augmented hard tissue after 6 months of healing. [ABSTRACT FROM AUTHOR]

Objective: This study sought to investigate whether the immediate systemic inflammatory response following full‐mouth debridement differs following use of hand compared with ultrasonic instruments. Methods: Thirty‐nine periodontitis patients were randomized to treatment with full‐mouth debridement using either hand or ultrasonic instrumentation completed within 24 hr. Serum and periodontal clinical parameters were collected at baseline, day 1, day 7 and day 90 post‐treatment. Differences in systemic inflammatory markers were assessed using general linear models at each timepoint, corrected for age, gender, smoking status, body mass index and baseline levels of each marker. Results: Across all patients, serum C‐reactive protein increased at day 1, with no differences between hand and ultrasonic groups (p(adjusted) =.22). There was no difference between groups in interleukin‐6 (p(adjusted) =.29) or tumour necrosis factor α (p(adjusted) =.53) at day 1. Inflammatory markers returned to baseline levels by day 7. Treatment resulted in equal and marked improvements in clinical parameters in both groups; however, total treatment time was on average shorter for ultrasonic instruments (p(adjusted) =.002). Conclusions: Ultrasonic instrumentation resulted in shorter treatment time with comparable clinical outcomes. Levels of serum C‐reactive protein at day 1 were similar following debridement with hand or ultrasonic instruments. [ABSTRACT FROM AUTHOR]

Aim: The aim of this randomized clinical trial was to compare clinical and volumetric outcomes of tunnel technique (TUN) with subepithelial connective tissue graft (CTG) versus coronally advanced flap (CAF) with enamel matrix derivate (EMD) 2 years after gingival recession (GR) treatment. Materials and methods: Twenty‐three patients contributed 45 Miller class I or II GR. At baseline and follow‐up examinations, study models were collected. Their three‐dimensional scans allowed precise computer‐assisted measurement of recession depth (REC), complete root coverage (CRC), percentage of root coverage (RC), pointwise (pTHK) and mean areal (aTHK) marginal soft tissue thickness. Clinical examination delivered probing depths (PPD) and height of keratinized tissue. Results: 24 months after surgery, digitally evaluated CRC was present in 60.0% of the TUN + CTG and 0.0% of the CAF + EMD‐treated sites (p <.0001), meaning a certain relapse of the gingival margin ragarding both approaches. RC amounted to 94.0% (TUN + CTG) and 57.3% (CAF + EMD), respectively (p <.0001). REC reduction (RECred) was significantly higher for TUN + CTG (1.81 ± 0.56 mm) than for CAF + EMD (0.90 ± 0.45 mm) (p <.0001). pTHK and aTHK values were significantly greater in the TUN + CTG group (1.41 ± 0.35 mm and 1.11 ± 0.26 mm) than in the CAF + EMD group (0.78 ± 0.32 mm and 0.60 ± 0.26 mm) (p <.0001). Statistical analysis detected positive correlations between THK and both RC and RECred (p <.001). Conclusions: Two years post‐operatively, CTG showed better clinical and volumetric outcomes than EMD. Increased THK values were associated with improved outcomes regarding RC and RECred. [ABSTRACT FROM AUTHOR]

Aim: To assess the reporting and handling of incomplete outcome data in randomized clinical trials (RCTs) published in implant dentistry. Materials and methods: We included RCTs on interventions related to the treatment with dental implants and presented any form of missing data. PubMed, SCOPUS and Cochrane databases were searched for studies published between May 2015 and May 2018. Reporting and handling of missing data at the study level were evaluated using a series of relevant questions. Descriptive data were reported, and univariable analyses were performed to evaluate the association of study variables with quality of reporting and data handling. Results: One‐hundred and thirty‐seven RCT reports were included from the 7,116 initially retrieved publications. The reporting of incomplete outcome data varied greatly among the trials and for the different questions. The range of adequately reported questions was between 3.64% (question: comparison of baseline characteristics of all randomised participants) and 100% (question: explicit reporting of missing data). The complete case analysis was the most used (45.3%) approach for incomplete outcome data handling. Conclusions: Randomized studies in implant dentistry have room for improvement in both the reporting and the handling of incomplete outcome data. [ABSTRACT FROM AUTHOR]

Aim To compare immediate surgery to scaling and root planing ( SRP) in the treatment of advanced periodontitis focusing on the prevalence of residual pockets after treatment and cost-effectiveness (1); to elucidate the adjunctive effects of azithromycin in a second-treatment phase (2) up to 36 months. Materials and Methods Thirty-nine patients (18 males, 21 females; mean age: 54.6) received oral hygiene instructions and were randomly allocated to surgery ( n = 19) or SRP ( n = 20). Patients with residual pockets (≥6 mm) at 6 months received re-debridement of these sites and systemic azithromycin. Clinical measurements were performed at 12, 24 and 36 months whereby residual pockets underwent re-debridement. Patients were evaluated in terms of clinical response parameters and cost-effectiveness. Chair-time was used to assess the financial impact of treatment. Results Only six patients in the surgery group required additional treatment at 6 months, whereas 14 patients in the SRP underwent this therapy. Both treatment arms were equally effective in terms of clinical outcome demonstrating <2% residual pockets at 36 months. Surgery imposed an extra 746 Euro on the patient up to 6 months compared to SRP. At 36 months, 69 Euro of this amount could be offset due to the lower need for re-treatment during maintenance phase. Conclusions Surgery was ultimately associated with a significantly lower need for re-treatment during supportive care, however, at significantly higher costs over the 3 years. [ABSTRACT FROM AUTHOR]

Aim To assess whether outcome of immediate implant placement and immediate provisionalization after 1 year was non-inferior to immediate implant placement and delayed provisionalization regarding Marginal Bone Level (MBL). Materials and Methods Forty patients with a failing tooth in the aesthetic zone were randomly assigned for immediate implant placement with immediate ( n = 20) or delayed ( n = 20) provisionalization. Follow-up was at 1 month and after 1 year. The study was powered to detect a difference in MBL of <0.9 mm. Apart from MBL, soft tissue peri-implant parameters, aesthetic indexes and patient satisfaction were assessed. Results After 1 year, MBL changes were −0.75 ± 0.69 mesially and −0.68 ± 0.65 distally mm for the immediate group and −0.70 ± 0.64 and −0.68 ± 0.64 mm for the delayed group respectively ( NS). Regarding differences in means, non-inferiority was observed after 1 year (mesially: Group A versus B: difference in mean 0.08 mm (95% CI −0.38 to 0.53, p = 0.71 distally: Group A versus B: difference in mean 0.09 mm (95% CI −0.37 to 0.56 mm, p = 0.66).No significant differences in the other outcome variables were observed. Conclusions This study showed that immediate placement and immediate provisionalization was non-inferior to immediate placement with delayed provisionalization. In addition, although not powered for these outcome variables, no clinically relevant differences in other outcomes were observed (: ISRCTN57251089). [ABSTRACT FROM AUTHOR]

Aim To evaluate the potential of antimicrobial photodynamic therapy ( aPDT) as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis. Material and Methods In a single-centred randomized and controlled clinical trial, 90 patients (51 females and 39 males) with untreated chronic periodontitis were randomly assigned to receive SRP with aPDT (test group) or SRP alone (control group). Clinical parameters and halitosis were recorded for 6 months after treatment by a periodontist who was blinded to the procedure. Results Inter-group and intra-group statistical analyses were performed. Significant difference between the two groups with respect to each variable was assessed using non-parametric Rank Order ancova. Probing pocket depth and clinical attachment levels showed statistically significant reduction in the test group on evaluation at 3 months and 6 months as compared to the control group ( p < 0.05). A statistically significant improvement in gingival index and gingival bleeding index was seen for the test group after 2 weeks and 1 month of aPDT ( p < 0.01), whereas the improvement in gingival index and gingival bleeding index at 3 months and in plaque index at 2 weeks after aPDT was less ( p < 0.05). Also, a significant difference was detected for the test group at 1 month in terms of halitosis ( p < 0.05), which did not persist for long. Conclusions Antimicrobial photodynamic therapy acts as a beneficial adjunct to SRP in non-surgical treatment and management of chronic periodontitis in short-term. Further studies are required to assess the long-term effectiveness of aPDT. [ABSTRACT FROM AUTHOR]

Aim To evaluate the direct effects of periodontal therapy in Chronic Obstructive Pulmonary Disease ( COPD) patients with chronic periodontitis ( CP). Materials and Methods In a pilot randomized controlled trial, 60 COPD patients with CP were randomly assigned to receive scaling and root planing ( SRP) treatment, supragingival scaling treatment, or oral hygiene instructions only with no periodontal treatment. We evaluated their periodontal indexes, respiratory function, and COPD exacerbations at baseline, 6 months, 1, and 2 years. Results Compared with the control group, measurements of periodontal indexes were significantly improved in patients in two treatment groups at 6-month, 1-year, and 2-year follow-up (all p < 0.05). Overall, the means of forced expiratory volume in the first second/forced vital capacity ( FEV1/ FVC) and FEV1 were significantly higher in the two therapy groups compared with the control group during the follow-up ( p < 0.05). In addition, the frequencies of COPD exacerbation were significantly lower in the two therapy groups than in the control group at 2-year follow-up ( p < 0.05). Conclusions Our preliminary results from this pilot trial suggest that periodontal therapy in COPD patients with CP may improve lung function and decrease the frequency of COPD exacerbation. [ABSTRACT FROM AUTHOR]

Aim To compare immediate surgery to scaling and root planing (SRP) in the treatment of advanced periodontal disease focusing on the prevalence of residual sites and cost-effectiveness (1); to evaluate the adjunctive effects of azithromycin in a second treatment phase (2). Materials and Methods Thirty-nine patients (18 males, 21 females; mean age: 54.6) received oral hygiene instructions and were randomly allocated to surgery ( n = 19) or SRP ( n = 20). Patients with residual pockets (≥6 mm) at 6 months received re-debridement of these sites and systemic azithromycin. Treatment groups were followed up to 12 months and evaluated in terms of clinical response parameters and cost-effectiveness. Chair-time was used to assess the financial impact of treatment. Results Both treatment arms were equally effective in terms of clinical outcome demonstrating less than 1% residual pockets at 12 months. Surgery imposed an extra 746 Euro on the patient up to 6 months when compared to SRP. At 12 months, 46 Euro of this amount could be offset as a result of a reduced need for supportive care. Only 6 patients in the surgery group needed systemic antibiotics, whereas 14 patients in the SRP needed such additional treatment. Conclusions Although 700 Euro could be saved on average by performing SRP instead of surgery, the latter significantly reduced the need for supportive care and systemic antibiotics. [ABSTRACT FROM AUTHOR]

Background Simplified periodontal therapy might be a pragmatic strategy for public health programmes targeting Indigenous Australian adults. The objective of this randomized controlled trial was to evaluate oral health effects of single-visit, non-surgical periodontal therapy compared to no treatment. Methods This parallel-group, randomized, open label clinical trial enrolled 273 Indigenous Australians aged ≥18 years with periodontitis. Intervention participants received full-mouth periodontal scaling and root planing during a single visit while the control group received no treatment. Endpoints were summary variables derived from clinical assessments of probing depth, clinical attachment loss, plaque, calculus and gingival bleeding before treatment and 3 months later. Results Endpoints could be calculated for 169 participants with follow-up data. Compared to the control group, there were statistically significant reductions in extent of shallow pockets: PD ≥4 mm (mean difference −2.86, [95% CI −5.01 to −0.71], p = 0.009) and gingival bleeding (mean difference −0.25, [95% CI −0.43 to −0.08], p = 0.005) but not deeper pockets PD ≥5 mm (mean difference −0.48, [95% CI −1.78 to 0.82], p = 0.468) or plaque scores. Conclusions Periodontal therapy produced improvements in shallow periodontal pockets and measures of gingival bleeding in these Indigenous Australians. [ABSTRACT FROM AUTHOR]

Aim To test whether titanium-zirconium (TiZr) 3.3 mm diameter implants perform differently from titanium (Ti) 4.1 mm diameter implants with respect to marginal bone level (MBL) and clinical parameters. Material and Methods Forty subjects in need of a single implant-supported crown in the anterior or premolar regions were recruited in two centres. After random allocation, either a Ti or a TiZr implant was placed. Definitive crowns were inserted 6 months after implant placement. Implant survival, change in MBL, clinical parameters and occurrence of adverse events were assessed at the 1-year examination. Results At 1 year, 38 of the 40 included patients were examined (18 Ti and 20 TiZr implants). All the implants were in place and stable. From the implant placement to the 1-year examination, the change of MBL amounted to −0.40 mm in the Ti group and −0.41 mm in the TiZr group. There were no significant differences between the groups regarding the change in MBL, the clinical parameters and the occurrence of adverse events. Conclusions The use of TiZr implants with narrow diameter for the support of single crowns in the anterior and premolar regions leads to successful tissue integration and clinical performance over a 1-year period. [ABSTRACT FROM AUTHOR]

Aim This split-mouth double-masked randomized controlled clinical study evaluated the effectiveness of photoactivated disinfection ( PAD) using light-emitting diode ( LED) as an adjunct in the management of patients affected by moderate to severe chronic periodontitis. Materials and Methods Sixteen patients affected by moderate to severe chronic periodontitis were enrolled. After scaling and root planing (SRP), each quadrant was assigned to one of the following groups: LED group (625-635 nm, maximum power density: 2000 mW/cm2), photosensitizer group (tolouidine blue O, 0.1 mg/ml), PAD group (photosensitizer and LED) and control group (no adjunctive treatment). The adjunctive treatments were repeated after 7 and 14 days. The clinical parameters of bleeding on probing, probing pocket depth and clinical attachment level were measured at baseline and 1 and 3 months after SRP. Results At 1 and 3 months, all groups showed significant improvements with regard to all clinical parameters compared to baseline (all p: <0.001). There were no significant differences among groups in terms of changes of clinical parameters in any time interval (all p > 0.05). Conclusion The application of PAD using LED with the current setting did not have additional effects on clinical parameters in patients diagnosed with moderate to severe chronic periodontitis compared with SRP alone. [ABSTRACT FROM AUTHOR]

Aim Periodontal disease elevates systemic inflammatory markers strongly associated with coronary heart disease (CHD) risk. The aim of this randomized controlled trial was to investigate the effect of non-surgical periodontal therapy on systemic C-reactive protein ( CRP), fibrinogen and white blood cells in CHD patients. Materials and Methods Angiographically proven CHD patients with periodontitis ( n = 317) were randomized to intervention ( n = 212) or control group ( n = 105). Primary outcome was reduction in serum CRP levels; secondary outcomes were reductions in fibrinogen and white blood cells. Periodontal treatment included scaling, root planing and oral hygiene instructions. Periodontal and systemic parameters were assessed at baseline and at 2-month follow-up. Intent-to-treat ( ITT) analysis was performed. Results Study was completed by 246 subjects (intervention group = 161; control group = 85). Significant improvements in periodontal and systemic parameters were observed in intervention group. The number of subjects with CRP > 3mg/L in intervention group decreased by 38% and in control group increased by 4%. ITT analysis gave a significant ( χ2=4.381, p = 0.036) absolute risk reduction of 12.5%. Conclusion In CHD patients with periodontitis, non-surgical mechanical periodontal therapy significantly reduced systemic levels of C-reactive protein, fibrinogen and white blood cells. [ABSTRACT FROM AUTHOR]

Background The aim of this randomized clinical trial ( RCT) was to evaluate the adjunctive benefit of Connective Tissue Graft ( CTG) to Coronally Advanced Flap ( CAF) for the treatment of gingival recession associated with inter-dental clinical attachment loss equal or smaller to the buccal attachment loss ( RT2). Material and Methods A total of 29 patients with one recession were enrolled; 15 patients were randomly assigned to CAF+ CTG while 14 to CAF alone. Measurements were performed by a blind and calibrated examiner. Outcome measures included complete root coverage ( CRC), recession reduction (RecRed), Root coverage Esthetic Score ( RES), intra-operative and post-operative morbidity, and root sensitivity. Results After 6 months, CAF+ CTG resulted in better outcomes in terms of CRC (adjusted OR = 15.51, p = 0.0325) than CAF alone. CRC was observed in >80% of the cases treated with CAF+ CTG when the baseline amount of inter-dental CAL was ≤3 mm. No difference was detected in term of RecRed. CAF+ CTG was associated with longer surgical-time ( p < 0.0001), higher number of days with post-operative morbidity ( p = 0.0222) and the need for a greater number of analgesics ( p = 0.0178) than CAF alone. No difference for final RES score was detected ( p = 0.1612). Conclusion Both treatments can provide CRC in single gingival recession with inter-dental CAL loss. The application of CTG under CAF resulted in predictable CRC when inter-dental CAL was ≤3 mm. [ABSTRACT FROM AUTHOR]

Objective To compare the treatment outcome of scaling and root planing ( SRP) in combination with systemic antibiotics, local antibiotic therapy and/or periodontal surgery. Material and Methods One hundred and eighty-seven patients were assigned to eight groups treated by SRP plus none, one, two or three adjunctive treatments and monitored for 24 months in a randomized controlled clinical trial using a 2 × 2 × 2 factorial design. Systemic amoxicillin + metronidazole ( SMA), local tetracycline delivery ( LTC) and periodontal surgery (SURG) were evaluated as adjuncts. Changes in clinical attachment level ( CAL) and probing pocket depth ( PPD) were statistically evaluated by ancova of main effects. Results Effects of adjunctive therapy to SRP were minimal at 3 months. Between 3 and 6 months PPD reduction occurred particularly in patients receiving periodontal surgery. After 6 months, both CAL gain and PPD reduction reached a plateau that was maintained at 24 months in all groups. The 24-month CAL gain was improved by SMA (0.50 mm) while PPD was reduced by SMA (0.51 mm) and SURG (0.36 mm). Smoking reduced CAL gain and PPD reduction. Conclusion Patients receiving adjunctive therapies generally exhibited improved CAL gain and/or PPD reduction when compared with the outcome of SRP alone. Only additive, not synergistic effects of the various adjunctive therapies were observed. [ABSTRACT FROM AUTHOR]