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Backgound: The aim of this randomized controlled trial was to assess clinical and patient‐reported outcomes of subgingival instrumentation (SI) with adjunctive use of erythritol airflowing (EAF) compared to SI alone in the treatment of periodontitis. Methods: Twenty‐six participants with Stage III/IV periodontitis requiring nonsurgical periodontal treatment were randomly allocated into two treatment groups: SI with EAF or SI alone. Clinical parameters of percentage of probing pocket depths (PPDs) of ≥5 mm, full mouth bleeding and plaque scores (FMBS and FMPS), and PPD values were recorded at baseline, and at 3 and 6 months posttreatment. A visual analogue scale was used to evaluate postoperative participants' perception of pain, swelling, bleeding, bruising, and root sensitivity. The impact of periodontal treatment on quality of life was assessed using the General Oral Health Assessment Index (GOHAI) at six months. Results: A total of 26 participants with Stage III/IV periodontitis completed the 6‐month follow‐up. SI with or without EAF resulted in a statistically significant reductions in the FMBS, FMPS, PPDs, and percentage of PPDs of ≥5 mm at the 3‐ and 6‐month follow‐up visits. There was no statistically significant difference between the two treatment groups for any time interval. Participants receiving SI/EAF exhibited a higher reduction in FMBS compared to those in SI alone group at 3 (SI/EAF: 19.4 ± 11.9, SI alone: 30.1 ± 20.5; P = 0.12) and 6 months (SI/EAF: 14.3 ± 9.6, SI alone: 24.5 ± 18.2; P = 0.09). A lower percentage of sites with deep PPDs (≥5 mm) was also noted amongst participants in the SI/EAF group compared to SI alone at 3 months (SI/EAF: 14.3 ± 14.1, SI alone: 19.2 ± 20.3; P = 0.48) and 6 months (SI/EAF: 8.3 ± 10.0, SI alone: 15.4 ± 17.4; P = 0.22). Patient‐reported outcomes showed no significant differences between the two treatment groups, except in the psychosocial domain of the GOHAI at 6 months favoring the SI/EAF group (P = 0.03). Conclusions: Within the limitations of the study, the adjunctive use of EAF in addition to SI in the treatment of Stage III/IV periodontitis did not result in a significant improvement in clinical parameters. Limited improvement in the QoL with EAF could be achieved. [ABSTRACT FROM AUTHOR]

Objective: The aim of this randomized controlled trial was to assess clinical and patient reported outcomes of subgingival instrumentation (SI) with adjunctive use of diode laser (DL) versus SI alone in the treatment of periodontitis. Methods: Participants requiring non‐surgical periodontal treatment were randomly allocated into two treatment groups: SI with DL or SI alone. Clinical parameters [full mouth bleeding and plaque scores (FMBS and FMPS), probing pocket depth and clinical attachment level] were recorded at baseline, three and 6 months post‐treatment. Visual analogue scale was used to evaluate postoperative participants' perception of pain, swelling, bleeding, bruising and root sensitivity. The impact of periodontal treatment on quality of life was assessed using the General Oral Health Assessment Index (GOHAI) at 6 months. Results: A total of 22 participants with stage III/IV periodontitis completed the 6‐month follow‐up. SI with or without DL resulted in statistically significant reduction in FMBS, FMPS, PPDs, and percentage of PPDs of ≥5 mm at 3‐ and 6‐month follow‐up visits (p = 0.001 to <0.001). The participants in SI/DL group had a greater reduction in the percentage of deep PPDs (≥5 mm) compared to those receiving SI alone, but statistically significant differences between the two groups were not observed (16.40 ± 9.57 vs. 32.50 ± 38.76 at 3 months and 7.20 ± 6.86 vs. 19.50 ± 35.06 at 6 months). The difference in the mean total GOHAI scores was not statistically significant at 6 months with total GOHAI scores of 7.25 ± 2.45 and 5.40 ± 3.06 for SI and SI/DL groups, respectively. Conclusion: Within the limitations of this study, the use of DL as an adjunct to SI in the treatment of stage III/IV periodontitis did not produce significant additional improvement in clinical parameters or patient reported outcomes in the 6‐month observation period. [ABSTRACT FROM AUTHOR]

Objectives: There is a growing evidence to suggest augmenting peri‐implant keratinized mucosa in the presence of ≤ 2 mm of keratinized mucosa. However, the most appropriate surgical technique and augmentation materials have yet to be defined. The aim of this systematic review and meta‐analyses was to evaluate the clinical and patient‐reported outcomes of augmenting keratinized mucosa around implants using free gingival graft (FGG) versus xenogeneic collagen matrix (XCM) before commencing prosthetic implant treatment. Material and Methods: Electronic databases were searched to identify observational studies comparing implant sites augmented with FGG to those augmented with XCM. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool. Results: Six studies with 174 participants were included in the present review. Of these, 87 participants had FGG, whereas the remaining participants had XCM. At 6 months, sites augmented with FGG were associated with less changes in the gained width of peri‐implant keratinized mucosa compared to those augmented with XCM (mean difference 1.06; 95% confidence interval −0.01 to 2.13; p = 0.05). The difference, however, was marginally significant. The difference between the two groups in changes in thickness of peri‐implant keratinized mucosa at 6 months was statistically significantly in favor of FGG. On the other hand, XCM had significantly shorter surgical time, lower postoperative pain score, and higher color match compared to FGG. Conclusions: Within the limitation of this review, the augmentation of keratinized mucosa using FGG before the placement of the final prosthesis may have short‐term positive effects on soft tissue thickness. XCM might be considered in aesthetically demanding implant sites and where patient comfort or shorter surgical time is a priority. The evidence support, however, is of low to moderate certainty; therefore, further studies are needed to support the findings of the present review. [ABSTRACT FROM AUTHOR]

Complications such as peri-implantitis could ultimately affect the survival of a dental implant. The prevention and treatment of peri-implant diseases require managing bacterial biofilm and controlling environmental risks, including the presence of pro-inflammatory titanium (Ti) particles in the peri-implant niche. Objectives included the evaluation of the size and quantity of Ti particles released from moderately roughened Ti surfaces during common mechanical surface decontamination methods. One hundred and forty moderately roughened Ti discs were divided into seven groups (n = 20 per group); six groups received mechanical decontamination procedures (ultrasonic scaling (US) with a metal tip and poly-ether-ketone (PEEK) under low and medium power settings, air-polishing with erythritol powder, and Ti brush), and the control group underwent air–water spray using a dental triplex. The rinsing solution was collected for Ti mass analysis using inductively coupled plasma mass spectrometry (ICPMS), as well as for Ti particle size and count analysis under scanning electron microscopy (SEM) with energy-dispersive spectroscopy (EDS). US metal tip instrumentation generated 34.00 ± 12.54 μg and 34.44 ± 6.08 μg of Ti under low and medium power settings, respectively. This amount of Ti generation was significantly higher than other instrumentation methods. The mean Ti particle size of the US groups ranged from 0.89 ± 0.27 μm to 1.25 ± 0.24 μm. No statistically significant difference was found in the particle size among US groups and Ti brush group (1.05 ± 0.11 μm), except for US with the PEEK tip, where a significantly smaller mean particle diameter was found at the low power setting (0.89 ± 0.27 μm). Mechanical instrumentation can produce Ti particulates and modify the implant surfaces. US using a metal tip generated the highest amount of Ti with smaller Ti size particles compared to all other commonly used mechanical surface instrumentations. The EDS analysis confirmed Ti in PEEK US tips. It can be suggested that deterioration from the PEEK US tip and Ti brush, as observed under SEM, is an additional source of Ti release during Ti surface decontamination. [ABSTRACT FROM AUTHOR]

Light-curing units (LCUs) are often subject to clinician-determined factors such as infection control barriers (ICBs) and different positionings of the light tip that may reduce their radiant exposure. The objective of this study was to investigate the individual and cumulative effects of ICBs and LCU positioning on light output. One LCU was used, in combination with five different ICBs and five different distances and angles. ICBs were also tested when placed correctly to manufacturers' guidelines, and with creases or seams obstructing the light tip. All variables were tested in isolation and in combination with other variables. Measurements were taken from a laboratory-grade spectrometer, giving values of radiant exposure, irradiance and spectral emission. All ICBs, angles and distances showed significant reductions in light output compared to the control (p < 0.001). With increasing angle and distance, the light output was decreased further, with the greatest reduction of 80.6% from the control seen at 40° and 8 mm with an incorrectly placed ICB. When used with an ICB, an increasing angle also showed a protective relationship on the light output. When ICBs are used or when an increase in distance/angle is unavoidable, clinicians should consider compensating for the loss in radiant exposure by increasing curing times. [ABSTRACT FROM AUTHOR]

Purpose: To retrospectively assess implant stability quotient (ISQ) values in patients who were followed up between 1998 and 2014 and to evaluate any correlations between ISQ and clinical parameters, such as change in marginal bone level (MBL).Materials and Methods: A total of 173 participants (65 men and 108 women; age range 21 to 85 years) and 383 implants were included. Implant location, MBL, and ISQ were recorded at surgery and at various recall times for statistical analysis. Mixed-model analysis was applied to evaluate the impact of clinical and demographic variables (time, implant location, patient gender) on ISQ and the correlation between ISQ and MBL. The level of significance was set at P < .05.Results: Of the 21 failed implants, 20 failed within 1 year of functional loading, resulting in a 10-year cumulative implant survival estimate of 95%. The failed implants had lower ISQs at surgery (52.3 ± 7.03) and baseline (52.5 ± 4.20) when compared to surviving implants (63.0 ± 10.74 at surgery and 62.3 ± 8.30 at baseline), and the difference was statistically significant at surgery (P < .05). The mean ISQs generally increased over time, but there were various patterns of changes between implants when grouped according to patient gender and implant location. There was no statistically significant correlation between the changes in ISQ and MBL (P = .211), despite an inverse relationship.Conclusion: Low initial ISQ values may help to identify implants at higher risk of failure. There may be various patterns of change over time in addition to an overall increase in ISQ values. Both similar and contradictory findings were found when compared to earlier literature, and a correlation between resonance frequency analysis and MBL change could not be identified. Despite limitations, the present study provides an overview of the clinical performance of RFA based on long-term clinical data. [ABSTRACT FROM AUTHOR]

Purpose: To assess any correlations between resonance frequency analysis (RFA) and other clinical measurements, namely changes in marginal bone level.Materials and Methods: A systematic review was performed to investigate the relationship between RFA and changes in marginal bone level. Clinical studies published up to May 1, 2018, were searched in electronic databases, including PubMed/MEDLINE, Embase, and Cochrane, using the following MeSH terms: resonance frequency analysis; implant stability quotient; RFA; and ISQ, in combination with marginal bone level; marginal bone loss; and marginal bone resorption.Results: A total of 62 articles were included in this review after all abstracts and full-text articles were examined according to the inclusion/exclusion criteria. The Results and Discussion sections of investigations reporting both marginal bone level changes and RFA measurements were presented. Relevant findings regarding relationships between RFA and bone quality or insertion torque were also summarized. Most articles reported an overall increase in ISQs over the observation time; however, contradictory findings were found regarding the relationships between RFA measurements, marginal bone loss, and other parameters.Conclusion: A definitive conclusion could not be made, as mixed results were found in the few articles that reported significant associations and correlations between RFA measurements and bone loss, while others concluded the opposite. Heterogeneity between the studies further complicated interpretation. Longitudinal RFA measurements may still be valuable for evaluating implant stability when applied as a supplementary tool to radiographic assessments and other clinical examinations. [ABSTRACT FROM AUTHOR]

Purpose: To assess the amount of contamination remaining on used healing abutments after autoclaving and to compare the effectiveness of two additional decontamination methods.Materials and Methods: After autoclaving, a total of 120 used healing abutments were divided equally into three groups: used healing abutments after autoclaving only (group 1); used healing abutments after autoclaving and air-flow polishing (Master Piezon, EMS) using erythritol powder (AIR-FLOW PLUS, EMS) (group 2); and used healing abutments after autoclaving and sodium hypochlorite (NaOCl; 25 g/L) treatment (group 3). Residual contaminants were stained using Phloxine B (400 g/mL), and healing abutments were photographed using a light microscope with digital capture system (Nikon SMZ800). The proportion of stained (ie, contaminated) areas on each healing abutment was then measured using imaging software (ImageJ). The healing abutments were also examined using scanning electron microscopy (SEM).Results: Mean proportion of surface area affected by residual contaminants on the body, top (screwdriver-engaging), and bottom (implant-abutment interface) surfaces for group 1 was 38.2% ± 28.34%, 30.0% ± 19.55%, and 18.7% ± 17.87%, respectively; group 2 showed 3.5% ± 4.90%, 5.3% ± 3.74%, and 5.4% ± 8.49%, respectively; and group 3 showed 0.3% ± 0.16%, 1.9% ± 2.14%, and 0.7% ± 1.02%, respectively. Autoclaving alone was insufficient for successful decontamination, while additional decontamination procedures significantly reduced remaining contaminants. NaOCl was significantly more effective than air polishing. SEM analysis showed no detectable differences in the surface appearance of titanium healing abutments.Conclusion: The results show that decontamination of used healing abutments is achievable, thus strengthening the feasibility of reusing healing abutments. [ABSTRACT FROM AUTHOR]

Background: COVID‐19 pandemic has led to major life changes including suspension of dental education programmes worldwide. The impact of this unexpected disruption in clinical teaching needs to be assessed. Aim: The aim of this study was to evaluate the impact of the COVID‐19 restriction measures on the undergraduate dental students' perception regarding their physical, mental and social well‐being as well as financial stress and anxiety for their future careers. Materials and methods: An electronic questionnaire (Qualtrics, Provo, Utah, USA) with main themes (general well‐being, academic stressors, financial implications and dental career concerns) related to the COVID‐19 lockdown was sent to the undergraduate dental students at the University Of Otago, New Zealand. Participants were asked to rank their answers according to a 5‐level Likert scale (strongly disagreed‐strongly agreed). Other questions included demographic, fee‐paying status and living situation. Results: There were 301 out of 376 students who responded to the survey. Generally, the students perceived that the COVID‐19 restrictions affected their behavioural and social well‐being (3.20 ± 0.75) and less impact on their physical (2.75 ± 0.82) and psychological (2.79 ± 0.62) well‐being. Students were significantly worried about their academic work and future careers (3.41 ± 1.20), but less concerned with their financial situation (2.74 ± 1.14). Conclusions: The study provides valuable information on the impact of COVID‐19 pandemic on undergraduate dental students, and areas that the University should consider when providing support to the affected students. It is important that the University is proactive and prepared to deal with future pandemics effectively and efficiently. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the presence of metallic particles in the peri-implant mucosa around titanium dental implants after 5 years of loading using single-implant crowns with respect to clinical signs of peri-implant inflammation. Materials and Methods: Sixteen participants from an ongoing, prospective, single-arm clinical trial who had received titanium dental implants restored with single maxillary crowns veneered to zirconia abutments were available for the study. Exfoliative cytology samples were obtained from the peri-implant tissues and contralateral tooth sites using microbrushes and were evaluated by means of light microscopy (LM), scanning electron microscopy, and energy-dispersive spectroscopy (EDS). Trace elemental analysis was also carried out on the microbrushes using inductively coupled plasma mass spectrometry. Peri-implant and periodontal parameters (plaque, bleeding, attachment level, radiographic bone levels) were recorded. Results: Titanium particles were found in both the single-implant crown and contralateral natural tooth sites. LM and EDS analyses showed significantly higher numbers of Ti particles at the implant-abutment interfaces (mean = 14.168; SD = 2.36) and in the internal aspects of peri-implant mucosa in contact with the prostheses (mean = 4.438; SD = 2.22) when compared with other test and control areas. Mean probing depths were ≤ 3 mm, and no differences were found in plaque or bleeding on probing between implant and tooth sites. Median bone levels were within the normal range for both implant (mesial: 0.5 mm; distal: 0.8 mm) and tooth (mesial: 1.5 mm; distal: 1.8 mm) sites. Conclusion: Loading of single-implant zirconia crowns can cause the release of Ti particles because of functional wear at the implant-abutment level. The presence of these metal particles in the peri-implant area did not appear to affect peri-implant health in this patient group. [ABSTRACT FROM AUTHOR]

Purpose: Lateral maxillary sinus fioor elevation (LMSFE) is a predictable preprosthetic surgical procedure that is used to overcome the limitations of the atrophied alveolar ridge for the placement of oral implants. Techniques using piezoelectric devices (PEDs) and conventional rotary instruments have been described for LMSFE in the literature, with little information regarding their efficiency in terms of membrane perforation, operating time, and implant outcomes. The aim of this systematic review was to examine the intra- and postoperative events associated with the use of PEDs and conventional rotary instruments for LMSFE. Materials and Methods: This systematic review was prepared according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The literature was searched for studies comparing the use of PEDs with conventional rotary instruments for LMSFE. The Cochrane Collaboration risk of bias tool was used to assess the studies selected, and meta-analyses were performed using statistical software. Results: A total of 124 citations were identified. Of these, four studies with 178 LMSFEs in 120 participants were included. The pooled estimates for the risk of sinus membrane perforation did not show any significant difference between the two surgical techniques (risk ratio, 0.87; 95% confidence interval, 0.40-1.91; P = .73). Similarly, no significant difference in implant failure was found after 1 year of functional loading. The overall meta-analysis showed a statistically significant difference in the operating time between the two techniques with more time required for PED. Conclusion: The intra- and postoperative events associated with the use of PEDs and conventional rotary instruments for LMSFE are comparable. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate long-term marginal bone levels for two unsplinted implants supporting mandibular overdentures using conventional and early loading protocols with different implant surfaces and attachment systems. Materials and Methods: A cohort of 106 edentulous participants (mean age: 65 years) was treated with mandibular two-implant overdentures opposing complete maxillary dentures. Participants were randomly allocated into three loading protocol groups using four implant systems; single-stage surgery was performed for all participants, followed by an unsplinted prosthesis using six different attachment systems. Standardized intraoral radiographs taken at baseline (loading) and over 10 years appraised marginal bone levels mesially and distally from reference points under magnification. Three calibrated examiners repeated measurements, diminishing intra- and interobserver variability. Progressive attrition of participants occurred as a result of deaths, dropouts, and emigration. Seventy-nine participants (74.5%, mean age: 72 years) were available at the 10-year recall. Differences in bone loss among different loading protocols, implant surfaces, and attachment systems were tested using chi-square and one-way analysis of variance tests. Results: Minimal, time-dependent, long-term marginal bone loss occurred with all loading protocols. Annual marginal bone loss progressed at low levels after the first year with episodes of bone loss and gain. There was stability in marginal bone levels over the long term, with the majority of remodeling occurring during the first year of function. Roughened implant surfaces may be beneficial during the early remodeling period. The amount of marginal bone loss in the first year of loading differed significantly by loading protocol and implant surface, whereas attachment system had a minor influence. Differences were not reflected in the success rates calculated using standard criteria. The remaining participants at 10 years were classified as successful related to the criterion of marginal bone loss, irrespective of the determining criteria for success. Conclusions: Either a 2- , 6-, or 12-week loading protocol for mandibular two-implant overdentures is possible in the long term, irrespective of the attachment system used. Minimal marginal bone loss may be attributed primarily to mandibular basal bone remaining from long-term edentulism. Revision of the current implant success criteria to offer a stricter limit is desirable. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate long-term marginal bone levels for two unsplinted implants supporting mandibular overdentures using conventional and early loading protocols with different implant surfaces and attachment systems. Materials and Methods: A cohort of 106 edentulous participants (mean age: 65 years) was treated with mandibular two-implant overdentures opposing complete maxillary dentures. Participants were randomly allocated into three loading protocol groups using four implant systems; single-stage surgery was performed for all participants, followed by an unsplinted prosthesis using six different attachment systems. Standardized intraoral radiographs taken at baseline (loading) and over 10 years appraised marginal bone levels mesially and distally from reference points under magnification. Three calibrated examiners repeated measurements, diminishing intra- and interobserver variability. Progressive attrition of participants occurred as a result of deaths, dropouts, and emigration. Seventy-nine participants (74.5%, mean age: 72 years) were available at the 10-year recall. Differences in bone loss among different loading protocols, implant surfaces, and attachment systems were tested using chi-square and one-way analysis of variance tests. Results: Minimal, time-dependent, long-term marginal bone loss occurred with all loading protocols. Annual marginal bone loss progressed at low levels after the first year with episodes of bone loss and gain. There was stability in marginal bone levels over the long term, with the majority of remodeling occurring during the first year of function. Roughened implant surfaces may be beneficial during the early remodeling period. The amount of marginal bone loss in the first year of loading differed significantly by loading protocol and implant surface, whereas attachment system had a minor influence. Differences were not reflected in the success rates calculated using standard criteria. The remaining participants at 10 years were classified as successful related to the criterion of marginal bone loss, irrespective of the determining criteria for success. Conclusions: Either a 2-, 6-, or 12-week loading protocol for mandibular two-implant overdentures is possible in the long term, irrespective of the attachment system used. Minimal marginal bone loss may be attributed primarily to mandibular basal bone remaining from long-term edentulism. Revision of the current implant success criteria to offer a stricter limit is desirable. [ABSTRACT FROM AUTHOR]

Background: The use of definitive abutments (DAs) at time of implant placement has been introduced to overcome limitations of dis/reconnection of healing/provisional abutments (PAs). With little and inconsistent information in the literature regarding the effectiveness of using DAs, the aim of this systematic review is to examine marginal bone and soft tissue level changes, technical and biologic complications, and implant failure rate associated with use of DAs and PAs.Methods: This systematic review was prepared according to guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and online trial registers were searched for studies comparing use of DAs and PAs. The Cochrane Collaboration risk of bias tool was used to assess selected studies, and meta-analyses were performed using statistical software.Results: A total of 1,124 citations were identified. Of these, seven trials with 363 dental implants in 262 participants were included in the analysis. Pooled estimates for marginal bone level changes showed significant differences between the two prosthetic techniques in favor of using DAs. No significant differences were found in soft tissue level changes, technical and biologic complications, or implant failure rate.Conclusions: Within the limitations of this review, DAs appear to be a viable alternative to PAs at time of implant placement. However, favorable changes in peri-implant marginal bone level associated with use of DAs should be viewed with caution as its clinical significance is still uncertain. [ABSTRACT FROM AUTHOR]

Abstract: Background: The use of a piezoelectric device (PED) for implant site preparation (ISP) has been introduced to overcome the limitations of using conventional drills (CDs). With little and inconsistent information in the literature regarding their efficiency for preparing implant osteotomies, the objective of this systematic review was to compare the use of CDs to PEDs for ISP with regard to implant stability values, marginal bone level changes, operating time, and dental implant failure rate. Methods: The systematic review was prepared according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA). The literature was searched for studies that assessed the use of CDs and PEDs for ISP. The Cochrane Collaboration risk of bias tool was used to evaluate the selected studies and meta‐analyses were performed using statistical software. Results: A total of 755 citations were identified. Of these, 4 studies with 178 implant osteotomies in 80 participants were included. The pooled estimates for the implant stability showed significant differences between the 2 surgical techniques in favor of PEDs at baseline, 8 and 12 weeks. A statistically significant difference in the operating time was also shown between the 2 techniques with more time required using PED. The differences in marginal bone level changes or implant failure rate were not statistically significant. Conclusions: With the limitations of this review in mind, PEDs appear to be a viable alternative to traditional drilling techniques for ISP. With the exception of prolonged operating time associated with the use of PEDs, both techniques were comparable in terms of the marginal bone level changes and the risk of implant failure. The favorable influence of the implant stability pattern related to the use of PEDs on the predictability of immediate and early loading protocols need to be confirmed in future studies. [ABSTRACT FROM AUTHOR]