2023 Jul-Sep; Vol 14, No 3
Differences in Titanium, Titanium-Zirconium, Zirconia Implants Treatment Outcomes: a Systematic Literature Review and Meta-Analysis
J Oral Maxillofac Res 2023;14(3):e1
Objectives: The objective of this systematic review is to test the hypothesis that treatment with titanium, titanium-zirconium and zirconia dental implants has different clinical outcomes in survival rate, marginal bone loss, bleeding on probing, plaque control record, and probing depth.
Material and Methods: A systematic electronic search through the PubMed (MEDLINE) and Cochrane Library databases was performed to identify studies published between January 1, 2013 and January 1, 2023 containing a minimum of 10 patients per study comparing titanium (Ti), titanium-zirconium (Ti-Zr), and zirconia (Zr) dental implants. Ti, Ti-Zr, and Zr dental implant clinical outcomes were determined by evaluating survival rate, marginal bone level, bleeding on probing, probing depth, plaque control record. Quality and risk-of-bias assessment were evaluated by Cochrane risk of bias tool.
Results: A total of 1361 articles were screened, with 10 meeting the inclusion criteria and being utilized for this systematic review and meta-analysis. A total of 301 patients with 637 implants (304 Ti, 134 Ti-Zr, and 199 Zr) were evaluated, showing a survival rate of 97.7% for Ti, 98.6% for Ti-Zr, and 93.8% for Zr implants respectively. In a meta-analysis, no difference in marginal bone level was found between Ti, Ti-Zr, and Zr implants (P = 0.84).
Conclusions: Dental implant survival rate was lower in zirconia group. Assessment of marginal bone loss and bleeding on probing showed better results with titanium-zirconium dental implants. Plaque control result was similar in all groups. Due to limited sample size assessed it was not possible to obtain conclusion on probing depth parameter.
Keywords: dental implants; systematic review; titanium; zirconia.
Inflammatory Gene Profile and Particle Presence in Peri-Implant Mucosa: a Pilot Study on 9 Patients
J Oral Maxillofac Res 2023;14(3):e2
Objectives: The purpose of this pilot study is to compare gene expression in mucosa around dental implants with zirconia abutment to titanium and investigate presence of particles in mucosa samples and on implant heads.
Material and Methods: Ten patients with a single implant supported prosthesis connected to zirconia or titanium abutments were invited at the five-year control. A clinical examination and a survey on experience of function and appearance were conducted. A mucosa biopsy taken in close vicinity to the implant were analysed by real-time polymerase chain reaction (qPCR) and presence of particles in a scanning electron microscope/energy-dispersive X-ray spectroscope (SEM/EDX). Cytological smear samples were collected and analysed through inductively coupled plasma mass spectrometry (ICP-MS) to investigate presence of particles on implant heads.
Results: In total, 9 patients participated in the study, five with titanium abutments and four with zirconia abutments. All patients were satisfied with function and aesthetics. Titanium and iron particles were detected in mucosa biopsies. The ICP - MS analysis demonstrated presence of zirconia and titanium. Several proinflammatory genes were upregulated in the zirconia abutment group.
Conclusions: Around zirconia abutments a slight increase in proinflammatory response and amount of wear particles was seen as compared to titanium. Wear particles of titanium were present in all soft tissue samples, however zirconia particles only in the samples from implants heads/mucosa with zirconia abutments.
Keywords: ceramics; dental abutments; dental implants; gene expression; titanium.
Is There a Relationship Between Maxillary Sinus’s Inferior Pneumatisation and Sinonasal Variations? A Retrospective CBCT Study
J Oral Maxillofac Res 2023;14(3):e3
Objectives: This retrospective study aims to analyse alveolar and palatal process pneumatisation and their relationships with sinonasal variations using cone-beam computed tomography.
Material and Methods: The study included 500 patients aged 18 to 87 years, involving 1000 maxillary sinuses with cone-beam computed tomography scans. We examined the relationship between inferior maxillary pneumatisation and the following anatomic variations: Haller cell, concha bullosa, paradoxical concha, bifid concha, and septal deviation.
Results: Among the 1000 maxillary sinuses assessed, we found 223 (22.3%) with alveolar process pneumatisation (APP), 37 (3.7%) with palatal process pneumatisation (PPP), and 23 (2.3%) with the presence of both APP and PPP. Significant relationships were observed between the Haller cell (P = 0.005), nasal septum deviation (P = 0.000), and middle concha bullosa (P = 0.01) with APP. However, there were no significant relationships between the paradoxical middle concha (P = 0.07), bifid middle concha (P = 0.74), and APP. Similarly, significant relationships were observed between the Haller cell (P = 0.001), paradoxical middle concha (P = 0.009), bifid middle concha (P = 0.000), and PPP. However, there were no significant relationships between concha bullosa (P = 0.799) and PPP. Additionally, we found significant relationships between the Haller cell (P = 0.003) and the presence of both APP and PPP.
Conclusions: This study provides an anatomical basis for imaging diagnosis by investigating the frequency of inferior pneumatisation of the maxillary sinus and its relationship with certain sinonasal variations.
Keywords: anatomic variation; cone-beam computed tomography; maxillary sinus.
Evaluation of Cortical Thicknesses and Bone Density Values of Mandibular Canal Borders and Coronal Site of Alveolar Crest
J Oral Maxillofac Res 2023;14(3):e4
Objectives: The objectives of this retrospective study are to measure the amount of the alveolar crest cortication and cortication around the mandibular canal, and to evaluate bone density values of alveolar crest, cortication around mandibular canal, and possible implant placement area for edentulous sites.
Material and Methods: Six hundred forty-two cone-beam computed tomography scans from 642 subjects were evaluated in four centers. Cortical thicknesses of alveolar crest and mandibular canal cortical borders (buccal, lingual, apical, and coronal) in each mandibular posterior teeth region were measured. Bone density of alveolar crest and mandibular canal cortical borders (buccal, lingual, apical, and coronal) in each mandibular posterior teeth region were recorded. The correlations between numeric variables were investigated using Pearson’s correlation test.
Results: The largest cortical border of the canal was measured 1.1 (SD 0.71) mm at the left second molar area and in coronal side of the mandibular canal (MC). Left and right first premolar regions showed higher bone density values compared to the other sites in all bone density values evaluations. The buccal side of the canal at the right first premolar region showed the highest bone density values (832.32 [SD 350.01]) while the coronal side of the canal at the left second molar region showed the lowest (508.75 [SD 225.47]). The bone density of possible implant placement area at the both left (692.25 [SD 238.25]) and right (604.43 [SD 240.92]) edentulous first premolar showed the highest values. Positive correlations between the bone density values of alveolar crest and the coronal side of MC were found in molar and left second premolar regions (P < 0.05).
Conclusions: Results may provide information about the amount of cortication and bone densities tooth by tooth for posterior mandible to surgeons for planning the treatment precisely.
Keywords: bone density; dental implants; mandibular canal; tomography.
Spongiotic Gingival Hyperplasia in a Child with Asperger Syndrome: a Case Report
J Oral Maxillofac Res 2023;14(3):e5
Background: Asperger syndrome is a type of autism spectrum disorder that may affect oral health and dental management. Spongiotic gingival hyperplasia is a rare lesion with unique clinicopathological features and unknown pathogenesis that has not been previously reported in a patient with autism spectrum disorder. The purpose of this case report is to present the first case of spongiotic gingival hyperplasia in a child with Asperger syndrome.
Methods: A 14-year-old boy with Asperger syndrome was referred for diagnosis and management of bright red granular overgrowths of the marginal gingiva and interdental papilla of the mandibular right incisors and marginal gingiva of the mandibular left incisor. A biopsy was performed on the interdental papilla between the mandibular right incisors.
Results: Microscopic examination and cytokeratin 19 immunopositivity confirmed the diagnosis of spongiotic gingival hyperplasia. The parents of the patient declined any further intervention, and four months later the gingival lesions, including the biopsied area, did not show any significant difference from the initial examination.
Conclusions: Patients with autism spectrum diseases, such as Asperger syndrome, cannot achieve a good level of oral hygiene. Thus, it is expected that the incidence of spongiotic gingival hyperplasia should be higher in this group of patients, in case oral microbiome participates in its pathogenesis. Management of such lesions is challenging, as such patients do not comply with a proper oral hygiene program and do not cooperate with surgical excision.
Keywords: Asperger syndrome; autism spectrum disorder; gingival diseases; gingival hyperplasia.