Eik Schiegnitz

Purpose: To identify the current status and development of zirconia barriers in bone augmentation procedures in the maxillofacial area of adult human patients.Materials and Methods: Two independent reviewers conducted an electronic literature search in PubMed/MEDLINE, Web of Science, Scopus, EBSCO, the Cochrane Library, and LILACS databases, as well as a manual search to identify eligible clinical studies up to April 15, 2024. The protocol was designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews guidelines.Results: The initial electronic search resulted in 240 studies. The systematic application of inclusion and exclusion criteria resulted in 6 articles that met the purpose of the study. The included articles were 5 clinical case series and 1 case report, published between 2016 and 2023. Only 4 articles reported histological studies. A total of 40 sites regenerated with zirconium barriers were reported in 30 patients. Results were obtained with variability in bone gain values, between 0.9–8.0 mm horizontally and 1.4–12.0 mm vertically, in addition to a 30% complication rate.Conclusions: Although the results obtained in the studies included in this scoping review are favorable with respect to the amount of bone formation and the reduced surgical time required, the number of complications is considered high. Moreover, due to a limited number of patients included in the case series and the short duration of follow‐up, additional studies including a control group are required.

Objectives: This experimental study compared the accuracy of implant insertion using the free‐hand (FH) technique, static computer‐aided surgery (S‐CAIS), or dynamic computer‐assisted surgery (D‐CAIS) and to evaluate the correlation of learning curves between surgeons' experience and surgical time.Materials and Methods: Thirty‐six models were randomly assigned to three groups (FH, n = 12; S‐CAIS, n = 12; D‐CAIS, n = 12). Each model was planned to receive four implants in the maxillary anterior and posterior regions. Twelve participants, six experienced surgeons, and six dental students were included in this study. The primary outcome was the deviation between the planned and final implant placement from each group. Secondary outcomes were each technique's learning curve regarding surgical time.Results: The average deviation at implant platform, apex and gradual deviation with FH technique were 1.31 ± 0.88 mm, 1.75 ± 0.9 mm and 6.67° ± 3.70°, respectively. The average deviation of implant platform, apex and angular in S‐CAIS were 0.67 ± 0.32 mm, 1.00 ± 0.39 and 2.66° ± 1.77°, respectively. The average deviation of implant platform, apex and angular in D‐CAIS were 1.14 ± 0.70 mm, 1.23 ± 0.58 and 3.20° ± 2.16°, respectively. Significant discrepancies at the implant platform, implant apex, and angular deviation were found between all surgical methods (p < 0.016). Learning curves were evident after multiple implant insertions using both freehand and S‐CAIS.Conclusion: The findings indicate that computer‐assisted implant insertion leads to a more precise implant alignment than implants inserted freehand in an experimental set‐up.

Objectives: This research is purposed to synthesize the existing evidence on implant survival rates in patients with oral potentially malignant disorders (OPMD) and assess potential risk factors associated with peri-implant disease. Material and Methods: A comprehensive search was performed across PubMed MEDLINE, Cochrane Library, and Web of Science. This review was conducted according to the PRISMA guidelines, including studies published between 2012 and 2023. Results: The review of studies related to oral lichen planus (OLP) revealed an implant survival rate of 99.3% (50% to 100%) with a mean follow-up of 40.1 months. One retrospective study focused on patients with leukoplakia and erythroplakia, but did not provide data on implant survival; however, it reported the presence of oral squamous cell carcinomas (OSCC) in the vicinity of dental implants. Data from a patient with proliferative verrucous leukoplakia (PVL) indicated a 100% implant survival rate, while patients with systemic lupus erythematosus (SLE) showed an implant survival rate of 97.67%. For all other entities of OPMD no articles could be found. Conclusions: With the exception of OLP, there is a limited number of studies or none on all other entities of OPMD. The available literature indicates no impact of OLP on implant survival rates and does not support OLP as a risk factor for peri-implant disease. For the other entities of OPMD, no conclusion regarding implant survival or peri-implant disease risk factors can be drawn due to a lack of studies. To validate the results and evaluate OPMD on peri-implant tissue, large-scale prospective studies for all types of OPMD, especially for leukoplakia and erythroplakia, are needed.

Differences in cell count and growth factor expression between first- and second-generation autologous platelet concentrates (APCs) have been well described. The debate over which formula best supports wound healing in various surgical procedures is still ongoing. This study aims to assess the whole proteome assembly, cell content, immunological potential and pro-angiogenic potential of second-generation APC, Platelet-Rich Fibrin (PRF) vs. first-generation APC, Platelet-Rich Plasma (PRP). The global proteome of the APCs was analyzed using nano-liquid chromatography mass spectrometry. Blood cell concentrations were determined by an automated cell counter. The effect of APCs on macrophage polarization was analyzed by flow cytometry. A yolk sac membrane (YSM) assay was used to monitor the neo-vessel formation and capillary branching in vivo. Cell count analysis revealed a higher number/concentration of leukocytes in PRF vs. PRP. Incubation of macrophages with PRP or platelet-free plasma (PFP) did not induce a significant pro-inflammatory state but led to a shift to the M0/M2 phenotype as seen in wound healing for all tested formulas. Label-free proteomics analysis identified a total of 387 proteins from three biological replicates of the respective designated groups. PRF induced increased formation of neo-vessels and branching points in vivo in comparison to PRP and PFP (each p < 0.001), indicating the enhanced pro-angiogenic potential of PRF. Overall, PRF seems superior to PRP, an important representative of first-generation formulas. Inclusion of leucocytes in PRF compared to PRP suggested rather an anti-inflammatory effect on macrophages. These results are important to support the versatile clinical applications in regenerative medicine for second-generation autologous platelet concentrates to optimize wound healing.

Objective: This meta-analysis aims to investigate the long-term survival rates of dental implants over a 20-year period, providing a practical guide for clinicians while identifying potential areas for future research. Materials and methods: Data were sourced from recent publications, focusing exclusively on screw-shaped titanium implants with a rough surface. Both retrospective and prospective studies were included to ensure an adequate sample size. A systematic electronic literature search was conducted in the databases: MEDLINE (PubMed), Cochrane, and Web of Science. The risk of bias for all studies was analyzed using a tool by Hoy et al. Results: Three prospective studies (n = 237 implants) revealed a mean implant survival rate of 92% (95% CI: 82% to 97%), decreasing to 78% (95% CI: 74%-82%) after imputation (n = 422 implants). A total of five retrospective studies (n = 1440 implants) showed a survival rate of 88% (95% CI: 78%-94%). Implant failure causes were multifactorial. Conclusion: This review consolidates 20-year dental implant survival data, reflecting a remarkable 4 out of 5 implants success rate. It emphasizes the need for long-term follow-up care, addressing multifactorial implant failure. Prioritizing quality standards is crucial to prevent overestimating treatment effectiveness due to potential statistical errors. While dental implantology boasts reliable therapies, there is still room for improvement, and additional high-quality studies are needed, particularly to evaluate implant success. Clinical relevance: Never before have the implant survival over 20 years been systematically analyzed in a meta-analysis. Although a long-term survival can be expected, follow-up is essential and shouldn't end after insertion or even after 10 years.

Objectives: To compare the clinical and radiological outcomes of novel fully tapered tissue‐level implants in immediate implant placement (type 1) versus late implant placement (type 4) for the first time.Materials and Methods: For this clinical study, 318 fully tapered tissue‐level implants in 65 patients were inserted immediately (n = 68 implants) or late (n = 250 implants) in two different centers. Implant survival and success rates and marginal bone levels were analyzed.Results: After a mean follow‐up of 12.0 ± 5 months, implant survival rates were 97.8% for all implants. No statistically significant difference in implant survival rates between type 1 and type 4 could be detected (98.5% vs 97.6%, HR 0.70, 95%‐CI 0.084–5.81). Neither for implant length (HR 0.53, 95%‐CI 0.055–5.08) nor for implant width (HR 0.27, CI 0.028–2.55), a significant influence on implant survival could be detected. Type of used biomaterial for filling the gap and immediate loading showed no effect on implant survival. Mean marginal bone loss was 0.02 ± 0.05 mm for type 1 and 0.04 ± 0.1 for type 4.Conclusions: Within the limitations of this retrospective study and the short follow‐up, the results demonstrated comparable high survival and success rates and stable marginal bone levels for type 1 and type 4 placement of this novel tissue‐level implant (no clinical trial registration as retrospective study design).

Objectives: This scoping review explores the risk and management of traumatic injuries to the inferior alveolar and lingual nerves during mandibular dental procedures. Emphasizing the significance of diagnostic tools, the review amalgamates existing knowledge to offer a comprehensive overview. Materials and methods: A literature search across PubMed, Embase, and Cochrane Library informed the analysis. Results: Traumatic injuries often lead to hypo-/anesthesia and neuropathic pain, impacting individuals psychologically and socially. Diagnosis involves thorough anamnesis, clinical-neurological evaluations, and radiographic imaging. Severity varies, allowing for conservative or surgical interventions. Immediate action is recommended for reversible causes, while surgical therapies like decompression, readaptation, or reconstruction yield favorable outcomes. Conservative management, utilizing topical anesthesia, capsaicin, and systemic medications (tricyclic antidepressants, antipsychotics, and serotonin-norepinephrine-reuptake-inhibitors), proves effective for neuropathic pain. Conclusions: Traumatic nerve injuries, though common in dental surgery, often go unrecorded. Despite lacking a definitive diagnostic gold standard, a meticulous examination of the injury and subsequent impairments is crucial. Clinical relevance: Tailoring treatment to each case's characteristics is essential, recognizing the absence of a universal solution. This approach aims to optimize outcomes, restore functionality, and improve the quality of life for affected individuals. Graphical

Objectives: The study aims to overview German dentists’ development of antibiotic and analgesic prescriptions from 2012 to 2021. Materials and methods: A longitudinal database analysis was performed based on the annual reports of the “Research Institute for Local Health Care Systems” (WIdO, Berlin). Results: From 2012 until 2021, dental antibiotic prescriptions fell by 17.9%. In contrast, the dental proportion of antibiotic prescriptions compared to all antibiotic prescriptions in Germany increased from 9.1 to 13.6%. Aminopenicillins enhanced their share from 35.6 to 49.4%, while clindamycin prescriptions declined from 37.8 to 23.4%. The proportion of ibuprofen prescriptions significantly increased from 60.4% in 2012 to 79.0% in 2021. Conclusions: Since 2013, the most frequently prescribed antibiotic by German dentists has been amoxicillin reaching nearly half of all dental antibiotic prescriptions in 2021. Simultaneously, the proportion of clindamycin has steadily decreased, but the level is still high compared to international data. During the past decade, ibuprofen as a first-line analgesic in German dentistry was continuously gaining in importance. Clinical relevance: Aminopenicillins have the best risk–benefit balance in dentistry, but the use of antibiotics generally must be limited only to cases of severe infections or compromised patients. Pre-existing diseases or permanent medications should always be considered when choosing an analgesic.

Objectives: The aim of Working Group 3 was to address the influence of both material‐ and anti‐resorptive drug‐ related factors on clinical and biological outcomes and complications in implant dentistry. Focused questions were addressed on (a) implant materials other than titanium (alloy)s, (b) transmucosal abutment materials and (c) medications affecting bone metabolism were addressed.Materials and Methods: Three systematic reviews formed the basis for discussion in Group 3. Consensus statements and clinical recommendations were formulated by group consensus based on the findings of the systematic reviews. Patient perspectives and recommendations for future research were also conveyed. These were then presented and accepted following further discussion and modifications as required by the plenary.Results: Zirconia is a valid alternative to titanium as material for implant and transmucosal components, allowing soft and hard tissue integration with clinical outcomes—identified by implant survival, marginal bone loss and peri‐implant probing depths—up to 5‐years comparable to titatnium. However, most of the evidence for zirconia implants is based on 1‐piece implants limiting the indication range. Furthermore, based on expert opinion, zirconia transmucosal components might be preferred in the esthetic zone. In patients receiving low‐dose bisphosphonate therapy, the rate of early implant failure is not increased, while the long‐term effects remain poorly studied. Although it has not been sufficiently addressed, similar outcomes can be expected with low‐dose denosumab. A drug holiday is not recommended when considering implant placement in patients treated with low‐dose ARD. However, the specific therapeutic window, the cumulative dose and the administration time should be considered. Access to peri‐implant supportive care is mandatory to prevent peri‐implantitis‐related medication‐related osteonecrosis of the jaw (MRONJ) or implant‐related sequestra (IRS). In patients receiving low‐dose anti‐resorptive drugs (ARD) therapy, the risk of complications related to implant placement is high, and implant procedures in this specific population should be strictly treated in a comprehensive multidisciplinary center. Finally, healthy dental implants should not be removed before low or high‐dose ARD.Conclusions: Zirconia implants can be an alternative to titanium implants in selected indications. However, the current state of evidence remains limited, especially for 2‐piece implant designs. Administration of low‐dose ARD did not show any negative impact on early implant outcomes, but careful follow‐up and supportive care is recommended in order to prevent peri‐implant MRONJ and IRS. Implant placement in high‐dose patients must be strictly considered in a comprehensive multidisciplinary center.

Purpose: To assess the body of evidence of short versus regular implants after bone augmentation (BA) in the atrophic posterior mandible in the context of implant treatment success outcomes.Methods: Seven databases, two registries, and reference lists were searched for systematic reviews and meta-analysis (SR/MA), randomized controlled trials (RCTs) and longitudinal studies published in English, Spanish or German since 2012. Confidence in the SR/MA methodology was evaluated using AMSTAR-2 and the risk of bias of primary studies using Cochrane’s RoB 2.0 and ROBINS-I. A random-effects meta-analysis and a meta-regression were performed for continuous and dichotomous outcomes. GRADE approach was used to assess the certainty of the evidence.Results: Eighteen SRs/MAs, most of them “critically low” and “low” confidence with substantial overlap, included 14 relevant RCTs with a high risk of bias. A cohort study with moderate risk of bias was added. Quantitative synthesis of 595 implants and 281 hemiarches/patients indicates that the use of short implants (< 10 mm) compared to regular implants and BA may reduce implant failure at 1-year follow-up, and marginal bone loss (MBL) at 3-, 5-, and 8-year follow-up; is likely to reduce the risk of biological complications at 1-, 3-, 5-, and 8-year follow-up; and may be the patient's preferred alternative. There is a correlation between bone height, MBL and biological complications.Conclusions: The available evidence partially suggests that the use of short implants could decrease implant failure, MBL, and biological complications, and increase patient satisfaction. However, given the need for further RCTs and real-world evidence to fully evaluate short- and long-term outcomes, it would be prudent for clinicians to carefully consider the individual needs and circumstances of the patients before deciding whether to use short implants.Trial registrationPROSPERO CRD42022333526Graphical