| 1. |
- Esposito, Marco, 1965, et al.
(författare)
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Endodontic retreatment versus dental implants of teeth with an uncertain endodontic prognosis: 3-year results from a randomised controlled trial.
- 2018
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Ingår i: European journal of oral implantology. - 1756-2406. ; 11:4, s. 423-438
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Tidskriftsartikel (refereegranskat)abstract
- To ascertain whether in the presence of a previously endodontically treated tooth with periapical pathology and/or symptoms and an uncertain prognosis, it is better to endodontically retreat it or to replace the tooth with a single-implant-supported crown.Twenty patients requiring the treatment of a previously endodontically treated tooth, with periapical pathology and/or symptoms of endodontic origin and an uncertain prognosis, as judged by the recruiting investigator, were randomly allocated to endodontic retreatment (Endo group, 10 patients) or tooth extraction and replacement with an implant-supported crown (Implant group, 10 patients) according to a parallel-group design at a single centre. Patients were followed to 3 years after completion of the treatment. Outcome measures were: failure of the procedure, complications, marginal bone level changes at both teeth and implants, endodontic radiographic success (teeth only), number of patients' visits and days to complete the treatment, patients' chair time, costs, aesthetics assessed using the pink aesthetic score (PES) for the soft tissues and the white aesthetic score (WES) for the tooth/crown recorded by independent assessors.No patient dropped out. One endodontically retreated tooth fractured and another had a crown loosening. There were no statistically significant differences for treatment failure or complications (difference in proportions = 0.10; 95% CI: -0.09 to 0.29; P (Fisher exact test) = 1.000). The mean marginal bone levels at endodontic retreatment/implant insertion were 2.10 ± 0.66 mm for the Endo group and 0.05 ± 0.15 mm for the Implant group. Three years after completion of the treatment, teeth lost on average 0.23 ± 0.82 mm and implants 0.62 ± 0.68 mm, the difference not being statistically significant (mean difference = -0.39 mm; 95% confidence interval [CI]: -1.12 to 0.33; P (t test) = 0.267). Three years after completion of the endodontic retreatment, of the four teeth that originally had a periapical radiolucency, one was lost, two showed complete healing, and one showed radiographic improvement. There were no statistically significant differences for the number of patients' visits (Endo = 6.67 ± 0.71; Implant = 6.10 ± 0.74; mean difference = 0.57; 95% CI: -0.14 to 1.27; P (t test) = 0.106). It took significantly more days to complete the implant rehabilitation (Endo = 61 ± 12.97; Implant = 191.40 ± 75.04; mean difference = -130.40; 95% CI: -184.45 to -76.35; P (t test) < 0.001) but less patients' chair time (Endo = 629.44 ± 43.62 min; Implant = 326 ± 196.99 min; mean difference = 303.44; 95% CI: 160.87 to 446.02; P (t test) = 0.001). Implant treatment was significantly more expensive (Endo = €1,588.89 ± 300.81; Implant = €2,095 ± 158.90; mean difference = €-506.11; 95% CI: -735.41 to -276.82; P (t test) < 0.001). Three years after treatment completion, mean PES were 11.11 ± 1.97 and 6.50 ± 2.46 and mean WES were 7.78 ± 1.30 and 6.80 ± 2.39 in the Endo group and Implant group, respectively. Soft tissues aesthetics (PES) were significantly better at endodontically retreated teeth (mean difference 4.61; 95% CI: 2.44 to 6.78; P (t test) < 0.001) whereas no significant differences were observed for tooth aesthetics (WES) (mean difference 0.98; 95% CI: -0.89 to 2.85; P (t test) = 0.281) between treatments.The present preliminary results suggest that both endodontic retreatment and replacement of previously endodontically treated teeth with persisting pathology and a dubious endodontic prognosis provided similar short-term success rates. Aesthetics of the soft tissues and time needed to complete treatment were in favour of endodontic retreatment whereas implant rehabilitation required half of the chair time than endodontic retreatment, but was significantly more expensive. Much larger patient populations and longer follow-ups are needed to fully answer this question; however, in this scenario the less invasive endodontic retreatment could be the first therapeutic option to be considered.
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| 2. |
- Esposito, Marco, 1965, et al.
(författare)
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Endodontic retreatment vs dental implants of teeth with an uncertain endodontic prognosis: 1-year results from a randomised controlled trial.
- 2017
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Ingår i: European journal of oral implantology. - 1756-2406. ; 10:3, s. 293-308
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Tidskriftsartikel (refereegranskat)abstract
- To ascertain whether in the presence of a previously endodontically treated tooth with a periapical pathology and/or symptoms and an uncertain prognosis, it is better to endodontically retreat it or to replace the tooth with a single implant-supported crown.Forty patients requiring the treatment of a previously endodontically treated tooth, with a periapical pathology and/or symptoms of endodontic origin and an uncertain prognosis, as judged by the recruiting investigators, were randomly allocated to endodontic retreatment (endo group; 20 patients) or tooth extraction and replacement with an implant-supported crown (implant group; 20 patients) according to a parallel group design at two different centres. Patients were followed to 1 year after completion of the treatment. Outcome measures were: failure of the procedure, complications, marginal bone level changes at both teeth and implants, endodontic radiographic success (teeth only), number of patients' visits and days to complete the treatment, patients' chair time, costs, aesthetics assessed using the pink esthetic score (PES) for the soft tissues and the white esthetic score (WES) for the tooth/crown recorded by independent assessors.No patient dropped out and no complications occurred during the entire follow-up; however, one endodontically retreated tooth (5%) and one implant (5%) fractured, the difference for treatment failures being not statistically significant (difference in proportions = 0; 95% CI -0.14 to 0.14; P Fisher's exact test) = 1.000). The mean marginal bone levels at endo retreatment/implant insertion were 2.34 ± 0.88 mm for the endo and 0.23 ± 0.35 mm for the implant group, which was statistically significantly different (mean difference = 2.11 mm; 95% CI: 1.68 to 2.55; P (t-test) < 0.001). One year after completion of the treatment, teeth lost on average 0.32 ± 0.53 mm and implants 0.48 ± 0.72, the difference not being statistically significant (mean difference = -0.16 mm; 95% CI: -0.58 to 0.27; P (t-test) = 0.457). One year after completion of the endodontic retreatment, of the 13 teeth that originally had a periapical radiolucency, one was lost, six showed complete healing; four a radiographic improvement; and two showed no changes/worsening. Two of the teeth originally without a lesion developed a lesion. There were no statistically significant differences for the number of patients' visits (endo = 5.2 ± 1.8; implant = 5.5 ± 1.1; mean difference = -0.03 95% CI: -1.24 to 0.64; P (t-test) = 0.522). It took significantly more days to complete the implant rehabilitation (endo = 48.9 ± 19.5; implant = 158.5 ± 67.2; mean difference = -109.60; 95% CI: -141.26 to -77.94; P (t-test) < 0.001), but less patients' chair time (endo = 405.5 ± 230.3 min; implant = 260.0 ± 154.6 min; mean difference = 45.50; 95% CI: 19.35 to 271.65; P (t-test) = 0.025). Implant treatment was significantly more expensive (endo = 1195 ± 503.7 €; implant = 1907.5 ± 232.4 €; mean difference = -712.50; 95% CI: -963.59 to -461.41; P (t-test) < 0.001). One year after treatment completion, the mean PES was 10.92 ± 1.93 and 7.07 ± 2.87 and the mean WES was 7.67 ± 1.83 and 7.60 ± 2.32 in the endo group and implant group, respectively. Soft tissues aesthetics (PES) was significantly better at endodontically retreated teeth (mean difference 3.85; 95% CI 1.94 to 5.76; P (t-test) < 0.001) whereas no significant differences were observed for tooth aesthetics (WES) (mean difference 0.07; 95% CI -1.62 to 1.76; P (t-test) = 0.936) between treatments.The preliminary results suggest that both endodontic retreatment and replacement of previously endodontically treated teeth with persisting pathology and a dubious endodontic prognosis provided similar short-term success rates. Aesthetics of the soft tissues and time needed to complete treatment were in favour of endodontic retreatment, whereas implant rehabilitation required half of the chair time than endodontic retreatment, but was significantly more expensive. Although much larger patient populations and longer follow-ups are needed to fully answer this question, in this scenario the less invasive endodontic retreatment could be the first therapeutic option to be considered.
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| 3. |
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| 4. |
- Xhanari, Erta, et al.
(författare)
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MACHINED VERSUS CAST ABUTMENTS FOR SINGLE DENTAL IMPLANTS: A 3-YEAR WITHIN-PATIENT MULTICENTRE RANDOMIZED CONTROLLED TRIAL
- 2023
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Ingår i: Clinical Trials in Dentistry. - 2784-9015 .- 2785-3039. ; 5:1, s. 5-16
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE. To compare clinical outcomes of machined titanium abutments (machined group) versus cast cobalt-chrome abutments (cast group). MATERIALS AND METHODS. Thirty-one partially edentulous subjects received two single non-adjacent implant-supported crowns each at three centres. Three and a half months after implant placement, implants were randomized at impression taking to receive one machined and one cast abutment according to a within-patient study design. Four patients dropped out and one patient lost one implant before randomization, so only 26 patients had their implants randomized. Outcome measures were: prosthesis and implant failures, any complications, and radiographic peri-implant marginal bone level changes. Patients were followed up for 3 years after loading. RESULTS. After randomization, three patients dropped out. One implant failed and two crowns on cast abutments were lost, but differences in implant and prosthesis failures were not statistically different (McNemar test P = 1.000; difference in proportions = 0.04 and P = 0.500; difference in proportions = 0.08, respectively). Two minor complications occurred in the cast group versus one in the machined group, the difference not being statistically different (McNemar test P = 1.000; difference in proportions = 0.04; 95% CI 0.18 to 22.06). Both groups presented statistically significant peri-implant marginal bone loss from implant placement to 3 years after loading, respectively-0.72 ± 0.90 mm (P = 0.001) for machined and-0.60 ± 0.61 mm (P <0.001) for cast abutments, with no statistically significant differences between the two groups (mean difference-0.12 mm; 95% CI-0.57 to 0.34; P = 0.624). Both groups gradually lost marginal peri-implant bone from loading (baseline) to 3 years after loading, but this was not statistically significant; machined lost-0.05 ± 0.12 mm while cast lost-0.14 ± 0.11 mm, a difference that was not statistically significant (mean difference 0.06 mm; 95% CI-0.24 to 0.35; P = 0.708). CONCLUSIONS. The present clinical data suggest that implant prognosis up to 3 years after loading is not affected by the choice of machined or cast abutments.
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| 7. |
- Esposito, Marco, 1965, et al.
(författare)
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MACHINED VERSUS CAST ABUTMENTS FOR DENTAL IMPLANTS: A 1-YEAR WITHIN-PATIENT MULTICENTRE RANDOMIZED CONTROLLED TRIAL ASSESSING MARGINAL SEAL CAPACITY AND OUTCOMES
- 2021
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Ingår i: Clinical Trials in Dentistry. - 2784-9015. ; 3:2, s. 19-31
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE To compare clinical outcomes of machined titanium abutments (machined group) versus cast cobalt-chrome abutments (cast group) and to evaluate in vitro their implant fit. MATERIALS AND METHODS This study comprised two parts. In the in vitro part, the im-plant–abutment fit of 5 cast abutments and 5 machined abutments screwed on with a torque of 30 Ncm was qualitatively and quantitatively evaluated using micro-computed tomography (µ-CT) and AgNO3 to reveal connection gaps. In the clinical part, 31 partially edentulous subjects received two single non-adjacent implant-supported crowns at three centres. At impression taking, three and a half months after implant placement, implants were randomized to receive a machined or cast abutment according to a wi-thin-patient study design. Unfortunately, four patients dropped out and one patient lost one implant before randomization, so only 26 patients had their implants randomized. Outcome measures were: prosthesis and implant failures, any complications, and radiographic peri-implant marginal bone level changes. Patients were followed up to 1 year after loading. RESULTS The fit of the implant–abutment connection was assessed in vitro using µ-CT scans. No gaps were revealed at any of the machined or cast abutments tested. In the clinical part, after randomization, three patients dropped out, no implant failed, but one crown on a cast abutment was replaced. The between-group difference in prosthesis failure was not statistically different (McNemar chi-square test P = 1.0; difference in proportions = 0.039). One complication occurred in each group, the difference not being statistically different (McNemar test P = 1.000; difference in proportions = 0; 95% CI 0.06 to 15.99). Both groups presented statistically significant peri-implant marginal bone loss from implant placement to 1 year after loading, respectively-0.76 ± 1.01 mm for machined and-0.69 ± 0.82 mm for cast abutments, with no statistically significant differences between the two groups (mean difference 0.07 mm; 95% CI-0.54 to 0.67; P = 0.828). Both groups gradually lost marginal peri-implant bone from loading to 1 year after loading but this was not significantly different, respectively-0.06 ± 0.56 mm for machined and-0.10 ± 0.29 mm for cast abutments, with no statistically significant differences between the two groups (P = 0.739; mean difference 0.07 mm; 95% CI-0.12 to 0.16; P = 0.739). CONCLUSIONS Our clinical data suggests that implant prognosis up to 1 year after loading is not affected by using machined or cast abutments. In support of these findings, in vitro analysis proved that both types of abutments allow a tight fit with no gaps. The-refore, for the time being dentists should feel free to choose whichever type they prefer. However, these preliminary results need to be confirmed by larger trials with at least 10 years of follow-up.
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| 8. |
- Tallarico, M., et al.
(författare)
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Computer-guided vs freehand placement of immediately loaded dental implants: 5-year postloading results of a randomised controlled trial
- 2018
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Ingår i: European Journal of Oral Implantology. - 1756-2406. ; 11:2, s. 203-213
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To compare planning and patient rehabilitation using 3D implant planning software and dedicated surgical templates with conventional freehand implant placement for the rehabilitation of partially or fully edentulous patients using flapless or mini-flap procedures and immediate loading. Materials and methods: Patients requiring at least two implants to be restored with a single prosthesis, having at least 7 mm of bone height and 4 mm in bone width were consecutively enrolled. Patients were randomised according to a parallel group study design into two groups: computerguided group or conventional freehand group. Implants were loaded immediately with a provisional prosthesis, replaced by a definitive prosthesis 4 months later. Outcome measures assessed by a blinded independent assessor were: implant and prosthesis failures, any complications, marginal bone levels, number of treatment sessions, duration of treatment, post-surgical pain and swelling, consumption of pain killers, surgical and prosthetic time, time required to solve complications, and patient satisfaction. Patients were followed up to 5 years after loading. Results: Ten patients (32 implants) were randomised to the computer-guided group and 10 patients (30 implants) were randomised to the freehand group. At the 5-year follow-up examination one patient of the computer-guided group and one of the freehand group dropped-out (both moved to another country). No prostheses failed during the entire follow-up. Two implants failed in the conventional group (6.6%) vs none in the computer-guided group (P = 0.158). Ten patients (five in each group) experienced 11 complications (six in the computer-guided group and five in the freehand group), that were successfully solved. Differences between groups for implant failures and complications were not statistically significant. Five years after loading, the mean marginal bone loss was 0.87 mm ± 0.40 (95% CI: 0.54 to 1.06 mm) in the computer-guided group and 1.29 mm ± 0.31 (95% CI: 1.09 to 1.51 mm) in the freehand group. The difference was statistically significant (difference 0.42 mm ± 0.54; 95% CI: 0.05 to 0.75; P = 0.024). Patient self-reported post-surgical pain (P = 0.037) and swelling (P = 0.007) were found to be statistically significant higher in patients in the freehand group. Number of sessions from patient's recruitment to delivery of the definitive prosthesis, number of days from the initial CBCT scan to implant placement, consumption of painkillers, averaged surgical, prosthetic, and complication times, were not statistically significant different between the groups. At the 5-year followup, all the patients were fully satisfied with the function and aesthetics of their definitive prostheses. Conclusions: Both approaches achieved successful results over the 5-year follow-up period. Statistically higher post-operative pain and swelling were experienced at sites treated freehand with flap elevation. Less marginal bone loss (0.4 mm) was observed in the computer-guided group, at 5 years follow-up. © Quintessenz.
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| 10. |
- Xhanari, E., et al.
(författare)
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CRESTAL VERSUS LATERAL SINUS LIFT: ONE-YEAR RESULTS FROM A WITHIN- PATIENT RANDOMISED CONTROLLED TRIAL OPEN
- 2019
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Ingår i: Clinical Trials in Dentistry. ; 2019:1, s. 67-78
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE. To compare the effectiveness of and patient preference for crestal versus la- teral sinus lift. MATERIALS AND METHODS. Fifteen partially edentulous patients missing bilateral maxillary molars and/or premolars and having 2 to 6 mm of residual crestal height below the maxillary sinuses were randomised to receive one to three implants placed in sinuses crestally or laterally lifted with bone substitutes according to a split-mouth design. Implants were submerged and loaded after 6 months with definitive screw-retained metal-ceramic prostheses, and patients were followed-up to 1 year after loading. RESULTS. Twenty crestal implants were placed versus 23 lateral ones. One patient drop- ped out and one lateral implant failed (n = 14; difference = 0.07, 95% CI from -0.28 to 0.13; P = 0.99). No prosthesis failed. Three patients were affected by three complications at crestal versus three patients by four complications at lateral sites. The difference was not statistically significant (n = 14; Diff = 0.07; 95% CI -0.24 to 0.38; P-value = 0.99). Statistically significantly less time was required to place crestal implants (28.2 versus 62.2 minutes on average; Diff = 33.4; SD = 12.1; 95% CI -40.4 to 26.4; P = 0.001). Eight patients preferred the crestal procedure and six had no preference. Crestal implants lost 0.99 mm (SD = 0.55) of peri-implant bone height versus 1.02 mm (SD = 0.57) for lateral ones, the difference being not statistically significant (0.03 mm; 95% CI of difference -0.52 to 0.59; P = 0.89) CONCLUSIONS. Both techniques produced successful outcomes, but the crestal technique required less surgical time and was preferred by patients.
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