What are the gaps/future plans for filling these gaps/what areas need looking at IMPLANTS/PROSTHETICS MARCO ESPOSITO Senior Lecturer in Oral and Maxillofacial Surgery, School of Dentistry, and Editor of the Cochrane Oral Health Group, The University of Manchester, UK; Assoc Prof in Biomaterials, Göteborg University, Sweden Evidence for up-to-date clinical dental practice – a review of 10 years of the Cochrane Oral Health Group 30th-31st May 2006, Manchester
AN OVERVIEW From 11 Cochrane reviews on osseointegrated dental implants and 1 review on prosthetics Updated to March 2006 http:// www.cochrane.org http://www.cochrane-oral.man.ac.uk
We shall discuss specifically the gaps of the topics covered in the Cochrane reviews, since we know what has been done in these fields. It can difficult to discuss the gaps not knowing what has been done (importance of the systematic reviews). However, additional gaps can be addressed by the participants.
It unclear whether augmentation procedures are needed in postextractive sockets and which is the most effective augmentation procedure. In sites treated with Bio-Oss + barriers, the gingival margins may be positioned 1.2 mm higher than in sites treated with barriers alone.
GBR allows bone augmentation at fenestrated implant, but it is unclear whether it is needed, and which is the most effective technique.
Complications with GBR procedures are common. There might be an association between bone retrieved with “bone filters” also using a dedicated suction device and infective complications.
2 Various implant characteristics/systems Is a surface modification, an implant shape, a material or an implant system more effective than the others? Last literature search: February 2005. 12 RCTs with 512 participants and 12 different implant systems (19 RCTs excluded). 4 RCTs with a 5-year follow-up. Minor statistically significant differences in marginal bone loss and in the occurrence of perimplantitis (20% risk reduction to have perimplantitis at 3 years around implants with a machined surface). No statistically significant difference in failure rates. We do not know whether any implant system is superior to the others. It does not mean that they are all the same!
3 Immediate, early or conventional loading Is there any difference if implants are immediately or early loaded? Last literature search: February 2004. 5 RCTs with 124 participants (2 RCTs excluded). For “good quality mandibles” we do not know whether a difference does exist. It does not mean that the techniques provide the same results!
4 Maintenance Which is the most effective maintenance technique or regimen? Last literature search: June 2004. 5 RCTs with 127 participants (9 RCTs were excluded); electric (1 RCT) and sonic (1 RCT) vs manual toothbrush; phosphoric acid gel vs debridement (1 RCT); subgingival vs chlorhexidine mouthrinses (1 RCT); adjunctive Listerine mouthrinse vs placebo (1 RCT). Follow-up: 6 weeks-5 months. Adjunctive Listerine mouthrinse reduces dental plaque and marginal bleeding.
5 Surgical techniques Is there any surgical technique associated to higher success rates? Last literature search: September 2002. 4 RCTs (5 RCTs excluded). 2 RCTs compared 2 versus 4 implants with mandibular overdentures (170 participants); 2 RCTs compared a crestal surgical incision with a vestibular incision (20 participants). We do not know whether a surgical technique is superior, however, 2 mandibular implants are sufficient to hold an overdenture. It does not mean that all techniques are the same!
6 Immediate, immediate-delayed and delayed implants in extraction sockets How long time we need to wait to insert an implant in postextractive sockets? Last literature search: March 2006. 1 RCT with 46 participants: immediate delayed (ca 10 days) vs delayed (ca 3 months) implants. Follow-up (loading) 1 year and half. Patients treated with immediate-delayed implants were more satisfied, and the peri-implant tissues position was judged to be more appropriate in relation to the neighbouring teeth by and independent and masked assessor.
7 Treatment of perimplantitis No difference between more complex procedures and conventional debridement in light forms of perimplantitis. The adjunctive use of local antibiotics (doxycycline) to debridement showed an improvement of about 0.6 mm for PAL and PPD, after 4 months in patients affected by severe forms of perimplantitis (bone loss > 50%).
8 Preprosthetic surgery vs implants Which intervention is more effective: preprosthetic surgery and denture vs an implant supported prosthesis? Last literature search: October 2005. 1 RCT with 60 participants. Patients treated with preprosthetic surgery and dentures are less satisfied than patients who received a mandibular overdenture on implants.
12 Denture chewing surface designs Which denture chewing surface design should be used? Last literature search: April 2004. 1 cross-over RCT with 30 participants (1 RCT excluded): lingualised (maxillary anatomic and mandibular non-anatomic) vs zero-degree teeth. Patients preferred dentures with lingualised teeth.