2018 Jul-Sep; Vol 9, No 3
Mandibular Midline Distraction Osteogenesis with a Bone-borne, Tooth-borne or Hybrid Distraction Appliance: a Systematic Review
J Oral Maxillofac Res 2018;9(3):e1
Objectives: The objective of the present systematic review was to assess the transverse skeletal and dental arch expansion and relapse after mandibular midline distraction osteogenesis with a bone-borne, tooth-borne or hybrid distraction appliance.
Material and Methods: A MEDLINE (PubMed), Embase and Cochrane library search in combination with a hand-search of relevant journals was conducted. Human studies published in English until the 3rd of July, 2018 were included.
Results: Two comparative and seven non-comparative studies characterized by high risk of bias fulfilled the inclusion criteria. Transverse mandibular widening was achieved with the different types of distraction appliance displaying a horizontal V-shaped opening with larger anterior transverse expansion declining progressively towards the posterior part of the mandible. Bone-borne and hybrid appliance facilitate more skeletal expansion compared with tooth-borne appliance, whereas comparable dental arch expansion was achieved with the different types of distraction appliance. Skeletal and dental arch relapse with the different type of appliance was limited and comparable. However, frequency of complications was higher with bone-borne appliance compared with tooth-borne or hybrid appliance.
Conclusions: Mandibular midline distraction osteogenesis with bone-borne, tooth-borne or hybrid distraction appliance is an effective treatment modality to correct severe transverse mandibular discrepancies, although the skeletal and dental arch expansion pattern was dissimilar with the different types of appliance. However, dissimilar evaluation methods, different outcome measures, various methodological confounding factors posed serious restrictions reviewing the literature in a quantitative systematic manner. Hence, well-designed long-term randomized controlled trials applying three-dimensional technology, patient-related outcome measures and an economic perspective are needed before definite conclusions can be provided.
Keywords: bone lengthening; mandible; orthodontics; orthognathic surgery; review.
Dental Implant Placement in Patients on Bisphosphonate Therapy: a Systematic Review
J Oral Maxillofac Res 2018;9(3):e2
Objectives: The review aims to study dental implant placement purposefulness for patients who have been treated or are on treatment with bisphosphonate medication.
Material and Methods: Structured search strategy was applied on electronic databases: MEDLINE, PubMed, PubMed Central and ResearchGate. Scientific publications in English between 2006 and 2017 were identified in accordance with inclusion, exclusion criteria. Publication screening, data extraction, and quality assessment were performed. Outcome measures included implant failure or implant-related osteonecrosis of the jaw.
Results: In total, 32 literature sources were reviewed, and 9 of the most relevant articles that are suitable to the criteria were selected. Heterogeneity between the studies was found and no meta-analysis could be done. Five studies analysed intraoral bisphosphonate medication in relation with implant placement, three studies investigated intravenous bisphosphonate medication in relation with implant placement and one study evaluated both types of medication given in relation with implant placement. Patients with intraoral therapy appeared to have a better implant survival (5 implants failed out of 423) rate at 98.8% vs. patients treated intravenously (6 implants failed out of 68) at 91%; the control group compared with intraoral bisphosphonate group appeared with 97% success implant survival rate (27 implants failed out of 842), showing no significant difference in terms of success in implant placement.
Conclusions: Patients treated with intravenous bisphosphonates seemed to have a higher chance of developing implant-related osteonecrosis of the jaw. The intraorally treated patient group appeared to have more successful results. Implant placement in patients treated intraorally could be considered safe with precautions.
Keywords: bisphosphonate-associated osteonecrosis of the jaw; bisphosphonate osteonecrosis; dental implants; oral surgery.
Effect of Implant Location on Palateless Complete Overdenture Retention: an In Vitro Study
J Oral Maxillofac Res 2018;9(3):e3
Objectives: The purpose of this in vitro study was to evaluate effect of implant location on initial retention values of palateless complete overdentures retained by four o-rings at different inter-implant distances.
Material and Methods: Two standard acrylic models representing completely edentulous maxillary arches were used. Four single piece ball type implants were placed in each model. Models were divided into two groups according to the distance between anterior and posterior implants. Two canine implants with 32 mm inter-implant distance were placed in both models. In one model (G1), two posterior implants were placed in second premolar region away from canine implants by 14 mm on both sides, while in the other model (G2), the two posterior implants were placed in first molar region away from canine implants by 22 mm on both sides. Eighteen palateless complete overdentures were constructed for each model. Overdentures were retained by four o-rings. Initial axial (central), and para-axial (anterior, posterior, and lateral) retention values of overdentures were estimated and compared using a universal testing machine.
Results: Independent t-test revealed that implant location has a significant role in palateless complete overdenture retention with a level of significance set at P < 0.05.
Conclusions: For in vitro simulated palateless implant overdentures retained by four o-rings, increasing the inter-implant distance between anterior and posterior implants is favourable for a more retentive prosthesis.
Keywords: dental implants; dental prosthesis design; implant-supported denture; maxilla; palate; retention.
Short Dental Implants (6 mm) Versus Standard Dental Implants (10 mm) Supporting Single Crowns in the Posterior Maxilla and/or Mandible: 2-Year Results from a Prospective Cohort Comparative Trial
J Oral Maxillofac Res 2018;9(3):e4
Objectives: The purpose of present study was to compare short (6 mm) with longer implants with the same surface use in the posterior maxilla and/or mandible.
Material and Methods: A total of 110 implants of 6 or 10 mm in length were placed with an internal hex (n = 60) and with a conical connection (n = 50) but the same material, surface and design, supporting single crowns in the posterior maxilla and/or mandible. Outcomes measured were implant survival and marginal bone level changes up to 24 months after loading.
Results: Final group consisted of 105 implants: 6 mm (n = 58) and 10 mm (n = 47). Success rate after 24 months was similar between treatment groups (98.3% vs. 100%; P = 0.361). Failure rates of the short implants in mandible (1/18, 5.6%) and in maxilla (0/40, 0%) were also not significantly different (P = 0.133). Success rate after 2 years was similar between internal hex vs. conical connection implants (100% vs. 97.7%; P = 0.233). Subjects lost statistically significant marginal peri-implant bone in both groups, but without differences (6 mm group: 0.38 mm [95% CI = 0.09 to 0.67] vs. 10 mm group: 0.43 mm [95% CI = 0.15 to 0.61]; P = 0.465 at 24 months), in relation also to type of implant (internal hex vs. conical, P = 0.428 at 24 months) or operator (P = 0.875 at 24 months).
Conclusions: Short implants may be successful in the posterior areas during the first 24 months of loading, with similar outcomes to 10 mm long implants, supporting their use as a valid option in selected cases. However, larger and longer follow-ups of 5 years or more are needed.
Keywords: dental care for aged; dental implantation; oral surgery; permanent dental restoration.
Is Articaine More Potent than Mepivacaine for Use in Oral Surgery?
J Oral Maxillofac Res 2018;9(3):e5
Objectives: To investigate the potency and speed of action of 4% articaine and 2% mepivacaine for maxillary teeth extractions.
Material and Methods: Ninety-four patients, aged between 16 to 70 years old, were recruited in this study. Two regimens were randomly administered over one visit. Patients of treatment group 1 received mepivacaine 2% with 1:100,000 adrenaline, whereas treatment group 2 - articaine 4% with 1:100,000 adrenaline. The onset time of pulp anaesthesia for maxillary teeth indicated for extraction was determined by electronic pulp testing. At any point of trial (10 minutes), the anesthetized tooth becomes unresponsive for maximal pulp stimulation (64 reading), the extraction was carried out.
Results: In this study, 85 patients had successful local anaesthetic followed by extraction within the study duration time (10 min). However, 5 patients had failed dental extraction (4 in mepivacaine group and 1 in articaine group). Patients in the articaine buccal infiltration group recorded faster onset time of action regarding anaesthesia and teeth extraction than patients in mepivacaine buccal infiltration group (P = 0.03).
Conclusions: Articaine is an effective anaesthetic with a rapid onset, comparable to mepivacaine in infiltrative techniques used for maxillary teeth extraction. However, articaine has clinically achieved faster dental anaesthesia and earlier teeth extraction than mepivacaine. So, articaine can be the local anaesthetic of first choice in oral surgery.
Keywords: anesthesia; articaine; local anesthesia; mepivacaine; oral surgery; tooth extraction.