Evidence-based dentistry最新文献

Objective: The goal of this systematic review was to verify whether the gingival phenotype (thick or thin) could impact the dental implant survival rate by affecting the marginal bone.

Methods: The search was carried out on PubMed/MedLine, PubMed Central, and B-On databases. The research question was: "Does gingival phenotype positively or negatively influence marginal bone loss around dental implants?" The inclusion criteria were: any clinical trial/study, comparative study, prospective or retrospective articles, systematic review that addressed at least a 1-year follow-up with an assessment of the marginal bone loss (MBL) around dental implants, articles that reported the gingival phenotype (thin or thick) and were published in the last 13 years. The exclusion criteria were narrative or other reviews, letters to the editor, and commentaries. Data extraction included the author's name, year of publication, type of study, sample size, number of implants, method used, and outcomes presented. The extracted data was summarized and presented in the results section. Critical Appraisal tool in JBI Systematic Reviews was used to determine the possibility of bias.

Results: A total of 62 articles were found, but eight articles were relevant to compose this study. After deep evaluation, it was possible to observe the implant success rate for both gingival phenotypes, thin and thick, was greater than 91% within a follow-up of up to 5 years. Therefore, it is unclear whether the thickness of the gingival tissue surrounding the implant can directly influence the marginal bone level. The gingival phenotype may be indirectly involved in the survival rate of dental implants, as it can be a risk factor for peri-implantitis, leading to marginal bone loss beyond what is expected.

Discussion: The thin gingival phenotype is one of the main risk factors for additional bone loss. It is crucial to know how to preserve the healthy condition.

Conclusion: Within the results found, the gingival phenotype is indirectly related to implant survival rate and clinical parameters, which were respectively high and non-conclusive. Therefore, a higher risk of peri-implantitis is suggested when a thin phenotype is present.

Aim: It has been proven that implants are predictable substitutes for replacing teeth. However, the effectiveness and survival of implants placed in sites previously affected by failure, as well as the optimal treatment strategies, remain poorly defined. This systematic review aimed to evaluate implant survival and peri-implant health in such cases, focusing on comparing immediate versus delayed implant placement and the role of augmentation. Four electronic databases were systematically searched, and meta-analyses were conducted with subgroup analyses (PROSPERO CRD42024548610). Of 1,798 records identified, 24 studies met the inclusion criteria.

Results: The 1-year survival rate for implants placed as replacements was 96.7% (95% CI: 92.8-99.3%). No significant differences were found between immediate and delayed placement (P = 0.31), or between immediate and delayed augmentation (P = 0.85). Although implants with immediate augmentation showed a higher survival rate (97.6%, 95% CI: 93.4-99.9%) compared to those with delayed augmentation (91.7%, 95% CI: 83.4-97.5%), this difference was not statistically significant (P = 0.26). Peri-implant health outcomes, including marginal bone loss, were consistent across subgroups.

Conclusion: Replacing failed implants is often an attractive treatment option. While implants placed as replacements generally have lower survival rates compared to primary implants, immediate implant placement remains a viable option when adequate bone volume is present. The review supports the effectiveness of implant re-placement, with generally favourable.

Clinical relevance: Dental implants are widely used for replacing missing teeth, but implant failure is a known complication. Understanding the outcomes of implants placed in sites where implants have failed is important as this situation can present challenges, such as insufficient bone or altered soft tissue conditions. This article provides data on the survival and health outcomes of implants placed in these failed sites, which may provide benefit to clinicians in these scenarios.

Objective: To verify the effectiveness of school-based interventions (SBI) aimed at reducing sugar-sweetened beverage (SSB) consumption among children to create or enhance public health initiatives.

Background: An important source of sugar consumption is SSBs, which are defined as any consumable non-alcoholic water-based beverage containing considerable amounts of free sugars. A growing number of people are using SSBs as their main source of sugar. Obesity and overweight in children and adolescents is a serious public health concern. The frequent consumption of excess amounts of SSBs is a risk factor for obesity, type 2 diabetes, cardiovascular disease and dental caries. The majority of earlier studies have concentrated on the association between SSB intake and obesity, regulatory and policy initiatives on SSB purchase and consumption. Numerous behavioural interventions have been reported to target the reduction of sugary drink consumption among children; however, there is a lack of conclusive evidence regarding their effectiveness. We aimed to evaluate the effectiveness of SBI on the factors that influence the reduction of sugary beverage consumption in a school setting.

Material and methods: Systematic review of school-based interventions involving children.

Setting: The following databases were investigated: MEDLINE/PubMed, PsycINFO, CINAHL and EMBASE.

Results: A total of forty-seven studies were included in the review. Most of the studies were found to be of moderate quality. All of the interventions, irrespective of whether they targeted individuals, their environment or both, were effective in decreasing SSB consumption.

Conclusions: School-based interventions have demonstrated encouraging outcomes in decreasing sugary soft drink intake among teenagers. Several recommendations are made to improve future studies. The included trials demonstrated a moderate quality of evidence, suggesting that educational and behavioural interventions yielded only a modest effect in reducing sugar-sweetened beverage (SSB) consumption.

Data sources: This prospective study involved 35 edentulous adults aged 50 years and older, treated at a dental clinic. Data were collected across four time points: baseline (T0), 3 months post-application of conventional complete dentures (CD; T1), and 3 and 6 months after the transition to implant-supported overdentures (IOD; T2 and T3). Patient outcomes were assessed using: Mini Nutritional Assessment (MNA): To evaluate nutritional status, Oral Health Impact Profile (OHIP-14): To measure oral health-related quality of life (OHRQoL) and Chewing Ability Questionnaire: To document functional improvements.

Results: Mini Nutritional Assessment (MNA) scores declined initially after transitioning to CDs (T0-T1) but stabilized following implant overdenture placement. Significant improvements were reported, with chewing difficulty decreasing from 91.4% at baseline to 51.4% at T3. Marked enhancements in OHIP-14 scores at T2 and T3, indicating better oral health perception.

Conclusion: While implant overdentures significantly improved chewing ability and quality of life, they did not lead to measurable improvements in nutritional status. The findings highlight the functional and psychosocial benefits of implant overdentures for older adults, suggesting that oral rehabilitation enhances overall well-being even without direct nutritional effects. This study provides a moderate level of evidence based on its prospective design, validated outcome measures, and clear findings related to chewing ability and oral health-related quality of life. However, the small sample size, lack of long-term follow-up, and absence of significant improvements in nutritional status suggest the need for further research to validate and strengthen these findings. Future studies with larger populations and extended observation perimplant overdentures are essential to enhance the robustness and generalizability of the evidence.

Design: Non-randomised prospective single-arm controlled clinical trial. The main inclusion criteria for both guided and freehand access groups was pulp canal obliteration (PCO). All teeth underwent cone-beam CT (CBCT) scan prior to access. Null hypothesis was that there is no difference in technical failure between guided and unguided access. The primary outcome was canal location success as a discrete measure (found, not found, perforated). The secondary outcome was conservativeness of drill pathway using discrete measures (optimal precision, acceptable precision, technical failure (included canal not found and perforation)). Patients underwent one subsequent annual follow-up.

Case selection: Patients attended for consultation at one centre (University Hospital Leuven, Belgium). PCO extent was assigned using periapical radiograph followed by CBCT. Cases graded as 'high difficulty' (via qualitative assessment) by briefed endodontists within the centre were selected for the study. Control group was taken from historical records as assigning an active patient to the freehand over the guided group was considered unethical.

Data analysis: Sample size calculation to achieve conventional 80% power and statistical significance of 0.05% was undertaken, mandating 60 teeth per group. An analysis including all data, without matching, was performed by a generalized linear model for binary data using a logit link function with the primary outcome (canal found or not found/perforation) as response variable and the technique (guided or freehanded) as explanatory variable. p  ≤  0.05 was considered statistically significant. Blinding of operators was not possible. Teeth were matched (paired) per group to achieve group homogeneity.

Results: Guided access yielded a 98.3% (n = 59/60) success rate with only one case unsuccessful (canal not found). In comparison, freehand access yielded 81% (n = 59/73) success rate, with 9.5% (n = 7/73) of teeth with canals unfound, and 9.5% (n = 7/73) of teeth perforated. Null hypothesis rejected given statistical significance of results (p = 0.011).

Conclusions: Cases presenting with PCO that undergo guided access show optimal outcomes both from an endodontic and from a conservational perspective, with significant increased chances of canal location in a conservative manner. Freehand correction in guided access cases can be used to inform changes to initial guided access if the canal is not found.

Data sources: A comprehensive literature search was carried out via PubMed, Cochrane, Embase and Virtual health libraries till April 2024. Articles with full text were selected in English, Spanish, French, and Portuguese language. Only observational studies were included.

Study selection: All selected studies were observational in nature and published in full text in English, Spanish, French, or Portuguese language. Gestational diabetes mellitus was diagnosed based on the American Diabetes Association's guidelines, and periodontal disease was diagnosed using international criteria by expert personnel.

Data extraction and synthesis: Two examiners did data extraction and synthesis. To identify the relationship between periodontal disease and gestational diabetes mellitus, an Odds ratio with 95% confidence interval was used. The inverse of the variance fixed effects model was applied. The Der Simonian and Laird random effects model was used if the homogeneity test using the Q statistic and the I2 revealed heterogeneity (p < 0.1). Eggers's test was used for bias assessment, and a funnel plot was also used to determine publication bias. Newcastle -Ottawa criteria were used to evaluate the quality of the included studies. Stata 17 was used in the entire data extraction process. Later on, a meta-analysis was done with seven articles with an adjusted Odds ratio.

Results: A total of 187 studies were found after a literature search, later on, duplicates were removed, leaving behind 176 studies. After screening the articles based on inclusion and exclusion criteria, 11 articles were finally included in the systematic review. Out of 11 included studies, 3 studies were cohort studies, and 8 were case-control. A total of 2032 patients were evaluated, out of which 572 developed gestational diabetes mellitus. 10 studies were considered to be of high quality, and one study was of intermediate quality. Six of the eleven studies reported a link between periodontal disease and gestational diabetes mellitus, whereas five did not yield any meaningful findings. The results showed a statistically significant p-value of less than 0.0017 and an odds ratio (OR) of 1.83 with a 95% confidence interval (CI) of 1.25 to 2.69.

Conclusion: This systematic review and meta-analysis suggest that periodontal disease is related to gestational diabetes mellitus. Several studies support the hypothesis that the presence of periodontal disease increases the risk of the development of gestational diabetes mellitus, more strong evidence is required before the same is established inconclusively.

Design: A retrospective cohort study assessing the mid-to-long-term outcomes and risk factors affecting the prosthetic success and survival of implant-supported cross-arch fixed dental prostheses (IFCDPs) with monolithic zirconia frameworks.

Cohort selection: Forty-seven patients received a total of 51 cross-arch prostheses (27 maxillary and 24 mandibular prostheses), supported by 302 implants. Comprehensive clinical and radiographic records were available over a follow-up period ranging from 5 to 13 years. A strict inclusion criteria ensured the use of screw-retained implants and monolithic zirconia frameworks fabricated using standardised CAD/CAM protocols, without cemented titanium bases. Exclusion criteria included systemic conditions affecting healing, bruxism, uncontrolled periodontitis, smoking, and significant health changes during the follow-up period.

Data analysis: Descriptive statistics summarised implant and prosthesis outcomes, while complications were evaluated for peri-implantitis at an implant level and framework fractures at a prosthesis level. Peri-implantitis was identified through clinical signs, including bleeding on probing, suppuration, and radiographic evidence of bone loss. Prosthetic outcomes were classified using the modified USPHS criteria. Mixed-effects Cox regression models were applied to analyse risk factors. Hazard ratios were calculated for peri-implantitis and framework fractures, with statistical significance set at p < 0.05.

Results: The implant survival rate was 97.64%, with peri-implantitis observed in 27 implants, predominantly in the mandible, resulting in an overall implant success rate of 91.06%. Prosthesis survival was 82.35%, with nine framework fractures reported, eight of which occurred in mandibular prostheses. The mandible was identified as a significant risk factor for both framework fractures (HR = 11.64, p = 0.024) and peri-implantitis (HR = 10.88, p = 0.003).

Conclusion: IFCDPs with monolithic zirconia-based frameworks exhibited favourable clinical outcomes over a 5-13-year period. However, mandibular prostheses were more prone to framework fractures and peri-implantitis, highlighting the need to consider mandibular flexure in prosthetic design to enhance long-term success and durability.