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  • 1.
    Abdel-Halim, Maha
    et al.
    Malmö University, Faculty of Odontology (OD).
    Issa, Dalia
    Malmö University, Faculty of Odontology (OD).
    Chrcanovic, Bruno
    Malmö University, Faculty of Odontology (OD).
    The Impact of Dental Implant Length on Failure Rates: A Systematic Review and Meta-Analysis2021In: Materials, ISSN 1996-1944, E-ISSN 1996-1944, Vol. 14, no 14, article id 3972Article, review/survey (Refereed)
    Abstract [en]

    The present review aimed to evaluate the impact of implant length on failure rates between short (<10 mm) and long (>= 10 mm) dental implants. An electronic search was undertaken in three databases, as well as a manual search of journals. Implant failure was the outcome evaluated. Meta-analysis was performed in addition to a meta-regression in order to verify how the risk ratio (RR) was associated with the follow-up time. The review included 353 publications. Altogether, there were 25,490 short and 159,435 long implants. Pairwise meta-analysis showed that short implants had a higher failure risk than long implants (RR 2.437, p < 0.001). There was a decrease in the probability of implant failure with longer implants when implants of different length groups were compared. A sensitivity analysis, which plotted together only studies with follow-up times of 7 years or less, resulted in an estimated increase of 0.6 in RR for every additional month of follow-up. In conclusion, short implants showed a 2.5 times higher risk of failure than long implants. Implant failure is multifactorial, and the implant length is only one of the many factors contributing to the loss of an implant. A good treatment plan and the patient's general health should be taken into account when planning for an implant treatment.

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  • 2.
    Abdul Rahim, Maha
    et al.
    Malmö University, Faculty of Odontology (OD).
    Khan, Kashmala
    Malmö University, Faculty of Odontology (OD).
    Chrcanovic, Bruno Ramos
    Malmö University, Faculty of Odontology (OD).
    Influence of Crown-Implant Ratio and Implant Inclination on Marginal Bone Loss around Dental Implants Supporting Single Crowns in the Posterior Region: A Retrospective Clinical Study.2023In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 12, no 9, article id 3219Article in journal (Refereed)
    Abstract [en]

    The aim of this present record-based retrospective study was to investigate the influence of the crown-implant ratio (CIR) and implant inclination in relation to the occlusal plane on the marginal bone loss (MBL) around dental implants supporting single crowns in the posterior region of the jaws. All the cases of implant-supported single crowns in the premolar and molar regions were initially considered for inclusion. Only implants not lost, with baseline radiographs taken within 12 months after implant placement and with a minimum of 36 months of radiological follow-up, were considered for the analysis of MBL. Univariate linear regression models were used to compare MBL over time between 12 clinical covariates, after which a linear mixed-effects model was built. After the exclusion of 49 cases, a total of 316 implant-supported single crowns in 234 patients were included. The results from the statistical models suggested that implant inclination and anatomical- and clinical CIR (the main related factors investigated in the study) were not statistically significantly related to MBL over time. Age (older people), tooth region (premolar), and bruxism (bruxers) had a statistically significant influence on MBL over time.

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  • 3.
    Al Ansari, Yasmin
    et al.
    Malmö University, Faculty of Odontology (OD).
    Shahwan, Halime
    Malmö University, Faculty of Odontology (OD).
    Chrcanovic, Bruno Ramos
    Malmö University, Faculty of Odontology (OD). Malmö University, Biofilms Research Center for Biointerfaces.
    Diabetes Mellitus and Dental Implants: A Systematic Review and Meta-Analysis2022In: Materials, ISSN 1996-1944, E-ISSN 1996-1944, Vol. 15, no 9, article id 3227Article, review/survey (Refereed)
    Abstract [en]

    The present review aimed to evaluate the impact of diabetes mellitus on dental implant failure rates and marginal bone loss (MBL). An electronic search was undertaken in three databases, plus a manual search of journals. Meta-analyses were performed as well as meta-regressions in order to verify how the odds ratio (OR) and MBL were associated with follow-up time. The review included 89 publications. Altogether, there were 5510 and 62,780 implants placed in diabetic and non-diabetic patients, respectively. Pairwise meta-analysis showed that implants in diabetic patients had a higher failure risk in comparison to non-diabetic patients (OR 1.777, p < 0.001). Implant failures were more likely to occur in type 1 diabetes patients than in type 2 (OR 4.477, p = 0.032). The difference in implant failure between the groups was statistically significant in the maxilla but not in the mandible. The MBL mean difference (MD) between the groups was 0.776 mm (p = 0.027), with an estimated increase of 0.032 mm in the MBL MD between groups for every additional month of follow-up (p < 0.001). There was an estimated decrease of 0.007 in OR for every additional month of follow-up (p = 0.048). In conclusion, implants in diabetic patients showed a 77.7% higher risk of failure than in non-diabetic patients.

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  • 4.
    Albrektsson, Tomas
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Chrcanovic, Bruno
    Malmö högskola, Faculty of Odontology (OD).
    Jacobsson, Magnus
    Malmö högskola, Faculty of Odontology (OD).
    Wennerberg, Ann
    Malmö högskola, Faculty of Odontology (OD).
    Osseointegration of Implants: A Biological and Clinical Overview2017In: JSM Dental Surgery, ISSN 2573-1548, Vol. 2, no 3Article, review/survey (Refereed)
    Abstract [en]

    Osseointegration was discovered in 1962 and coined as a term in 1977. Original definitions implied direct contact between foreign materials and bone without any interposed soft tissue layers. Today, osseointegration is regarded to be a foreign body response to separate foreign elements from bone. A new definition of the term is suggested in this paper; “Osseointegration is a foreign body reaction where interfacial bone is formed as a defense reaction to shield off the implant from the tissues”. Excellent clinical results of osseointegrated implants have been reported from dentistry and Ear Nose Throat surgery, the latter with the indications of a stable anchorage of hearing aids or facial epistheses in cases of facial trauma. In Orthopaedic surgery a randomized controlled clinical trial has been undertaken demonstrating very good clinical results supported by positive radiostereo-photogrammetical data.

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  • 5.
    Albrektsson, Tomas
    et al.
    Malmö University, Faculty of Odontology (OD). Malmö University, Biofilms Research Center for Biointerfaces.
    Chrcanovic, Bruno
    Malmö University, Faculty of Odontology (OD). Malmö University, Biofilms Research Center for Biointerfaces.
    Mölne, Johan
    Wennerberg, Ann
    Malmö University, Faculty of Odontology (OD). Malmö University, Biofilms Research Center for Biointerfaces.
    Foreign body reactions, marginal bone loss and allergies in relation to titanium implants2018In: European Journal of Oral Implantology, ISSN 1756-2406, E-ISSN 1756-2414, Vol. 11, no Suppl 1, p. S37-S46Article, review/survey (Refereed)
    Abstract [en]

    Aim: To describe general observations of immunological reactions to foreign materials and to realize that CP titanium gives rise to a foreign body reaction with subsequent bone embedment when placed as oral implants. To analyse the possibility of titanium allergy. Materials and methods: The present paper is of a narrative review type. Hand and Medline searches were performed to evaluate marginal bone loss of oral implants and the potential of titanium allergy. Results: Immunological reactions to foreign substances include Type I hypersensitivity reactions such as allergy, Type II hypersensitivity reactions characterised by IgM or IgG antibodies that may react with blood group antigens at transfusion, and Type III hypersensitivity caused by antigen-antibody immune complexes exemplified by acute serum sickness. There is also Type IV hypersensitivity, or delayed hypersensitivity, which is typically found in drug and foreign body reactions. It proved very difficult to find a universally acceptable definition of reasons for marginal bone loss around oral implants, which lead to most varying figures of so-called peri-implantitis being 1% to 2% in some 10-year follow-up papers to between 28% and 56% of all placed implants in other papers. It was recognised that bone resorption to oral as well as orthopaedic implants may be due to immunological reactions. Today, osseointegration is seen as an immune-modulated inflammatory process where the immune system is locally either up- or downregulated. Titanium implant allergy is a rare condition, if it exists. The authors found only two papers presenting strong evidence of allergy to CP titanium, but with the lack of universally accepted and tested patch tests, the precise diagnosis is difficult. Conclusions: CP titanium acts as a foreign body when placed in live tissues. There may be immunological reasons behind marginal bone loss. Titanium allergy may exist in rare cases, but there is a lack of properly designed and analysed patch tests at present.

  • 6.
    Albrektsson, Tomas
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Chrcanovic, Bruno
    Malmö högskola, Faculty of Odontology (OD).
    Östman, Per-Olov
    Sennerby, Lars
    Initial and long-term crestal bone responses to modern dental implants2017In: Periodontology 2000, ISSN 0906-6713, E-ISSN 1600-0757, Vol. 73, no 1, p. 41-50Article, review/survey (Refereed)
    Abstract [en]

    Successful osseointegration is the result of a controlled foreign body reaction to dental implants. Osseointegrated implants have demonstrated excellent long-term survivability, although they may be subject to limited marginal bone loss. Marginal bone loss during the first few years after implant placement seldom represents disease, but is instead the result of an adaptive bone response to surgical trauma and implant loading. It is not uncommon for implants with early marginal bone loss to enter a long-lasting state of bone stability. Extensive bone resorption after the first year is generally due to an exacerbation of adverse body reactions caused by non-optimal implant components, adverse surgery or prosthodontics and/or compromised patient factors. Disease in the form of peri-implantitis is a late complication that affects some implants with suppuration and rapid loss of crestal bone, and is probably caused by bacterial pathogens and immunological reactions. Unfortunately, the literature is not consistent with respect to the type or magnitude of clinical implant problems, including how they are defined and diagnosed. If the peri-implantitis diagnosis is confined to cases with infection, suppuration and significant bone loss, the frequency of the disease is relatively low, which is in sharp contrast to the frequencies reported with unrealistic definitions of peri-implantitis. We suggest that when modern implants are placed by properly trained individuals, only 1–2% of implants show true peri-implantitis during follow-up periods of 10 years or more. Peri-implantitis must be separated from the initial and self-limiting marginal bone loss.

  • 7.
    Alenezi, Ali
    et al.
    Department of Prosthodontics, College of Dentistry, Qassim University, Buraydah 52571, Saudi Arabia.
    Alsweed, Mohammad
    Private Practice, Qassim Region, Buraydah 52571, Saudi Arabia.
    Alsidrani, Saleh
    Private Practice, Qassim Region, Buraydah 52571, Saudi Arabia.
    Chrcanovic, Bruno Ramos
    Malmö University, Faculty of Odontology (OD). Malmö University, Biofilms Research Center for Biointerfaces.
    Long-Term Survival and Complication Rates of Porcelain Laminate Veneers in Clinical Studies: A Systematic Review2021In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 10, no 5, article id 1074Article in journal (Refereed)
    Abstract [en]

    The presented study aimed to assess the survival rate of porcelain laminate veneers (PLV) based on a systematic review of the literature. An electronic search was last updated in February 2021. Eligibility criteria included clinical series of patients rehabilitated with PLVs published in the last 25 years, with a minimum follow-up of 3 years. Survival analysis methods were applied. Twenty-five studies were included, with 6500 PLVs. The 10-year estimated cumulative survival rate (CSR) of PLVs was 95.5%. The 10-year CSR of PLVs when fracture, debonding, occurrence of secondary caries, and need of endodontic treatment were considered as isolated reasons for failure were 96.3%, 99.2%, 99.3%, and 99.0%, respectively. PLVs without incisal coverage had a higher failure rate than PLVs with incisal coverage. Non-feldspathic PLVs performed better than feldspathic PLVs. As a conclusion, the 10-year CSR of PLVs was 95.5%, when fracture, debonding, occurrence of secondary caries, and need of endodontic treatment were considered as reasons for restoration failure. Fracture seems to be most common complication of PLVs, followed by debonding, with both more commonly happening within the first years after PLV cementation. PLVs with incisal coverage and non-feldspathic PLVs presented lower failure rates than PLVs without incisal coverage and feldspathic PLVs.

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  • 8.
    Alenezi, Ali
    et al.
    Department of Prosthodontics, College of Dentistry, Qassim University, Saudi Arabia.
    Chrcanovic, Bruno Ramos
    Malmö University, Faculty of Odontology (OD).
    Effects of the local administration of antibiotics on bone formation on implant surface in animal models: A systematic review and meta-analysis2020In: Japanese Dental Science Review, ISSN 1882-7616, Vol. 56, no 1, p. 177-183Article, review/survey (Refereed)
    Abstract [en]

    Purpose: This review aimed to evaluate the effects of the local delivery of antibiotics incorporated in implant surfaces on some quantitative parameters of bone formation. Materials and methods: An electronic search was undertaken in three databases (PubMed, Scopus, Embase) in addition to hand searching. The search was limited to animal experiments using endosseous implants combined with localized antibiotics release. Meta-analyses were performed for the percentages of bone volume (BV) and bone-to-implant contact (BIC). Results: Nine studies met the inclusion criteria. Several methods were identified for local delivery of antibiotics at the bone-implant interface, but the most commonly used method was by coating (incorporating the implant surface with the antibiotic agents). Different antibiotic agents were used, namely bacitracin, doxycycline, enoxacin, gentamicin, minocycline, tobramycin, and vancomycin. There was no statistically significant difference in the percentage of BIC between implants with or without localized antibiotic release (P = 0.59). The meta-analysis revealed higher BV around implants coated with antibiotics compared to control groups (without antibiotics) (P < 0.01). Conclusion: It is suggested that the local administration of antibiotics around implants did not adversely affect the percentage of direct bone contact around implants, with a tendency for a slightly better bone formation around implants when combined with local administration of antibiotics. It is a matter of debate whether these in vivo results will have the same effect in the clinical setting. However, the risk of bias of these studies may, to some extent, question the validity of these results. (C) 2020 The Author. Published by Elsevier Ltd on behalf of The Japanese Association for Dental Science.

  • 9.
    Alenezi, Ali
    et al.
    Malmö University, Faculty of Odontology (OD). Malmö University, Biofilms Research Center for Biointerfaces.
    Chrcanovic, Bruno
    Malmö University, Faculty of Odontology (OD). Malmö University, Biofilms Research Center for Biointerfaces.
    Wennerberg, Ann
    Malmö University, Faculty of Odontology (OD). Malmö University, Biofilms Research Center for Biointerfaces.
    Effects of Local Drug and Chemical Compound Delivery on Bone Regeneration Around Dental Implants in Animal Models: A Systematic Review and Meta-Analysis2018In: International Journal of Oral & Maxillofacial Implants, ISSN 0882-2786, E-ISSN 1942-4434, Vol. 33, no 1, p. e1-e18Article, review/survey (Refereed)
    Abstract [en]

    Purpose: One of the suggested methods for enhancing osseointegration is the local application of drug agents around implant surfaces. The aim of this review was to evaluate the methods most commonly used for local drug and chemical compound delivery to implant sites and assess their influence on osseointegration. Materials and Methods: An electronic search was undertaken in three databases (PubMed, Scopus, Embase). The search was limited to animal experiments using endosseous implants combined with local drug delivery systems. Meta-analyses were performed for the outcome bone-to-implant contact (BIC). Results: Sixty-one studies met the inclusion criteria. Calcium phosphate (CaP), bisphosphonates (BPs), and bone morphogenetic proteins (BMPs) were the most commonly used chemical compounds. There were two main methods for local drug delivery at the bone-implant interface: (1) directly from an implant surface by coating or immobilizing techniques, and (2) the local application of drugs to the implant site, using carriers. There was a statistically significant increase in BIC for both local drug delivery methods (P = .02 and P < .0001, respectively) compared with the control methods. There was a statistically significant increase in BIC when CaP (P = .0001) and BMPs (P = .02) were either coating implants or were delivered to the implant site, in comparison to when drugs were not used. The difference was not significant for the use of BPs (P = .15). Conclusion: It is suggested that the use of local chemical compound delivery systems around implants could significantly improve implant osseointegration in animal models. It is a matter of debate whether these in vivo results might have some significant effect in the human clinical setting in the long term.

  • 10.
    Alenezi, Ali
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Naito, Yoshihito
    Malmö högskola, Faculty of Odontology (OD).
    Andersson, Martin
    Chrcanovic, Bruno
    Malmö högskola, Faculty of Odontology (OD).
    Wennerberg, Ann
    Malmö högskola, Faculty of Odontology (OD).
    Jimbo, Ryo
    Malmö högskola, Faculty of Odontology (OD).
    Characteristics of 2 Different Commercially Available Implants with or without Nanotopography2013In: International Journal of Dentistry, ISSN 1687-8728, E-ISSN 1687-8736, Vol. 2013, no 769768, article id 769768Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to assess histologically and histomorphometrically the early bone forming properties after 3 weeks for 2 commercially available implants, one supposedly possessing nanotopography and one without, in a rabbit femur model. Twenty-four implants divided equally into 2 groups were utilized in this study. The first group (P-I MICRO+NANO) was a titanium oxide (TiO2) microblasted and noble gas ion bombarded surface while the second group (Ospol) was anodic oxidized surface with calcium and phosphate incorporation. The implants were placed in the rabbit femur unicortically and were allowed to heal for 3 weeks. After euthanasia, the samples were subjected to histologic sectioning and bone-implant contact and bone area were evaluated histomorphometrically under an optical microscope. The histomorphometric evaluation presented that the P-I MICRO+NANO implants demonstrated significantly higher new bone formation as compared to the Ospol implants. Within the limitations of this study, the results suggested that nanostructures presented significantly higher bone formation after 3 weeks in vivo, and the effect of chemistry was limited, which is indicative that nanotopography is effective at early healing periods.

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  • 11.
    Ali, Amir
    et al.
    Malmö University, Faculty of Odontology (OD).
    Al Attar, Ammar
    Malmö University, Faculty of Odontology (OD).
    Chrcanovic, Bruno Ramos
    Malmö University, Faculty of Odontology (OD). Malmö University, Biofilms Research Center for Biointerfaces.
    Frequency of Smoking and Marginal Bone Loss around Dental Implants: A Retrospective Matched-Control Study2023In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 12, no 4, article id 1386Article in journal (Refereed)
    Abstract [en]

    This dental record-based retrospective study aimed to compare the marginal bone loss (MBL) around dental implants in a group of smokers in relation to a matched group of non-smokers, with a special focus on five different frequencies of daily smoking (non-smokers, and frequency of 1-5, 6-10, 11-15, and 20 cig./day). Only implants with a minimum of 36 months of radiological follow-up were considered. Univariate linear regression models were used to compare MBL over time between 12 clinical covariates, after which a linear mixed-effects model was built. After matching of the patients, the study included 340 implants in 104 smokers, and 337 implants in 100 non-smokers. The results suggested that smoking degree (greater MBL for higher degrees of smoking), bruxism (greater MBL for bruxers), jaw (greater MBL in maxilla), prosthesis fixation (greater MBL for screw-retained prosthesis), and implant diameter (greater MBL for 3.75-4.10 mm) had a significant influence on MBL over time. There appears to be a positive correlation between the degree of smoking and the degree of MBL, meaning, the higher the degree of smoking, the greater the MBL. However, the difference is not apparent for different degrees of smoking when this is high, namely above 10 cigarettes per day.

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  • 12.
    Al-Kilani, Josef
    et al.
    Malmö University, Faculty of Odontology (OD).
    Al-Kilani, Sedef
    Malmö University, Faculty of Odontology (OD).
    Chrcanovic, Bruno Ramos
    Malmö University, Faculty of Odontology (OD).
    Difference in marginal bone loss around implants between short implant-supported partial fixed prostheses with and without cantilever: a retrospective clinical study2023In: International Journal of Implant Dentistry, E-ISSN 2198-4034, Vol. 9, no 1, article id 46Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To investigate the influence of cantilever prosthetic arm on the marginal bone loss (MBL) over time around dental implants supporting short fixed partial dentures (FPDs), in a record-based retrospective study.

    METHODS: All cases of 3-unit implant-supported FPDs, supported by 2-3 implants, from the database of cases treated at one specialist clinic were considered for inclusion. Only implants with a minimum of 36 months of radiological follow-up were considered. Univariate linear regression models were used to compare MBL over time between 12 clinical covariates, after which a linear mixed-effects model was built.

    RESULTS: One-hundred-thirty-nine patients (64 men, 75 women) with 164 3-unit implant-supported FPDs (333 implants supporting non-cantilevered FPDs, 94 supporting cantilevered FPDs) were included in the study. The patients were followed up clinically and radiographically for a mean of 154.1 ± 78.0 (min-max, 37.3-364.6) and 132.9 ± 77.3 months (min-max, 36.8-329.9), respectively. The total number of marginal bone level double measurements (mesial and distal sides of each implant) was 2909. FPDs with cantilever presented an estimated greater MBL over time compared to FPDs without cantilever. Bruxism, sex (women), implant (modified) surface, and (poor) bone quality were also associated with higher MBL over time.

    CONCLUSIONS: The use of a cantilever extension is suggested to negatively affect the bone marginal level over time around implants supporting 3-unit FPDs. Due to the small difference of the estimated MBL over long periods of follow-up between the groups, it is a matter of debate if the observed negative effect may be of clinical significance.

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  • 13. Al-Moraissi, Essam
    et al.
    El-Sharkawy, Tarek
    El-Ghareeb, Tarek
    Chrcanovic, Bruno
    Malmö högskola, Faculty of Odontology (OD).
    Three-dimensional versus standard miniplate fixation in the management of mandibular angle fractures: a systematic review and meta-analysis2014In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 43, no 6, p. 708-716Article, review/survey (Refereed)
    Abstract [en]

    The aim of the present study was to test whether there is a significant difference in the clinical outcomes between standard and three-dimensional (3D) miniplate fixation in the management of mandibular angle fractures (MAFs). An electronic search without date and language restrictions was performed in October 2013. Inclusion criteria were studies in humans including randomized controlled trials, controlled clinical trials, and retrospective studies, with the aim of comparing the two techniques. Six studies were included. The meta-analyses revealed statistically significant differences for the incidence of hardware failure and postoperative trismus. There were no significant differences in the incidence of postoperative infection, malocclusion, wound dehiscence, non-union/malunion, or paresthesia. The cumulative odds ratio was 0.42, meaning that the use of 3D miniplates in the fixation of MAFs decreases the risk of the event (postoperative complication) by 58%. The results of this meta-analysis showed lower postoperative complication rates with the use of 3D miniplate fixation in comparison with the use of standard miniplate fixation in the management of MAFs.

  • 14.
    Ayele, Sarah
    et al.
    Malmö University, Faculty of Odontology (OD).
    Sharo, Nora
    Malmö University, Faculty of Odontology (OD).
    Chrcanovic, Bruno Ramos
    Malmö University, Faculty of Odontology (OD).
    Marginal bone loss around dental implants: comparison between diabetic and non-diabetic patients-a retrospective clinical study2023In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 27, no 6, p. 2833-2841Article in journal (Refereed)
    Abstract [en]

    ObjectivesThe aim of the present retrospective study was to compare the marginal bone loss (MBL) around dental implants in a group of diabetic patients in relation to a matched group of non-diabetic patients.Materials and methodsThe present dental record-based retrospective study included patients selected from individuals treated with dental implants at one specialist clinic in Malmo, Sweden. Patients were excluded if they had history of periodontitis and/or were treated for periodontal disease. The study group included 710 implants installed in 180 patients (mean age 60.3 +/- 13.0 years), 349 implants in 90 diabetic (21 T1DM and 69 T2DM patients), and 361 implants in 90 non-diabetic patients.ResultsThe results suggested that jaw (greater MBL in the maxilla), diabetes (greater MBL for diabetic patients, and worse for T1DM patients), bruxism (greater MBL for bruxers), and smoking (greater MBL for smokers and former smokers) had a statistically significant influence on MBL over time.ConclusionsPatients with diabetes have an estimated greater MBL over time compared to non-diabetic patients. The difference was greater in patients with diabetes type 1 compared to patients with diabetes type 2. Bruxism, smoking, and implant location (maxilla) were also associated with a higher loss of marginal bone around implants over time.

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  • 15.
    Botermans, Anna
    et al.
    Malmö University, Faculty of Odontology (OD).
    Lidén, Anna
    Malmö University, Faculty of Odontology (OD).
    Machado, V. C.
    Slice Diagnóstico Volumétrico por Imagem, Belo Horizonte 30140-110, Brazil.
    Chrcanovic, Bruno Ramos
    Malmö University, Faculty of Odontology (OD).
    Immediate implant placement in the maxillary aesthetic zone: A cone beam computed tomography study2021In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 10, no 24, article id 5853Article in journal (Refereed)
    Abstract [en]

    This study aimed to investigate the factors that could be associated with the risk of labial cortical bone wall perforation with immediate implant placement (IIP) in the maxillary aesthetic zone, in a cone-beam computed tomography (CBCT) virtual study. CBCT exams from 126 qualified subjects (756 teeth) were included. Implants were virtually positioned in two different positions: in the long axis of the tooth (prosthetically-driven position) and in an ideal position in relation to adjacent anatomical structures (bone-driven position). Two different implant diameters were planned for each tooth position, namely, 3.75 and 4.3 mm for central incisors and canines, and 3.0 and 3.3 mm for lateral incisors. The incidence of perforation was nearly 80% and 5% for prostheticallyand bone-driven position, respectively. Factors associated with a higher risk of cortical bone wall perforation (bone-driven position), according to logistic regression analysis, were women, wider implants, Sagittal Root Position class IV, and decrease of the labial concavity angle. Perforation of the labial cortical bone wall can be greatly minimized when the implant is placed in a bone-driven position compared to a prosthetically-driven position. It is important to preoperatively evaluate the morphological features of the implant site for risk assessment and to individualize the treatment plan. 

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  • 16.
    Bredberg, Clara
    et al.
    Malmö University, Faculty of Odontology (OD).
    Vu, Camila
    Malmö University, Faculty of Odontology (OD).
    Häggman-Henrikson, Birgitta
    Malmö University, Faculty of Odontology (OD).
    Chrcanovic, Bruno Ramos
    Malmö University, Faculty of Odontology (OD).
    Marginal bone loss around dental implants: comparison between matched groups of bruxer and non-bruxer patients2023In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 25, no 1, p. 124-132Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To compare marginal bone loss (MBL) around dental implants in a group of bruxers in relation to a matched group of non-bruxers.

    METHODS: The present record-based retrospective study included patients selected from individuals treated with dental implants at one specialist clinic in Malmö. Only implants not lost and with baseline radiographs taken within 12 months after implant placement and with a minimum of 36 months of radiological follow-up were considered for inclusion. Univariate linear regression models and a linear mixed-effects model were performed.

    RESULTS: Two hundred and four patients (104 bruxers, 100 non-bruxers), with a total of 811 implants (416 in bruxers, 395 in non-bruxers) were included in the study. The results of the linear mixed-effects model suggested that bruxism, smoking, age, region of the jaws, implant diameter, and prosthesis type had a statistically significant influence on MBL over time. Individuals who are both bruxers and smokers showed greater MBL when compared to individuals who are either a bruxer or smoker, or neither (p < 0.001).

    CONCLUSIONS: Bruxism is suggested to increase the risk of MBL over time, as well as higher age, smoking, and the combination of bruxism and smoking. Other factors that showed a correlation with increased MBL were implant diameter, region of the jaws, and prosthesis type, but it is not possible to draw robust conclusions for these factors, as the categories of these variables were very unbalanced.

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  • 17. Chaves, Roberta Rayra Martins
    et al.
    Guimarães, Letícia Martins
    Pereira, Núbia Braga
    Chrcanovic, Bruno
    Malmö University, Faculty of Odontology (OD). Malmö University, Biofilms Research Center for Biointerfaces.
    Fonseca, Felipe Paiva
    Lafuente-Ibáñez de Mendoza, Irene
    Aguirre-Urizar, José Manuel
    Cavaliéri Gomes, Carolina
    Santiago Gomez, Ricardo
    KRAS mutations in implant‐associated peripheral giant cell granuloma2020In: Oral Diseases, ISSN 1354-523X, E-ISSN 1601-0825, Vol. 26, no 2, p. 334-340Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate the molecular pathogenesis of implant‐associated peripheral giant cell granuloma (IA‐PGCG). Methods: A convenience sample of 15 IA‐PGCG cases was selected. Hotspot mutations of KRAS, FGFR1, and TRPV4 genes, previously reported in conventional giant cell lesions of the jaws, were investigated by Sanger sequencing. As these mutations could activate MAPK/ERK pathway, the expression of phospho‐ERK1/2 was also evaluated by immunohistochemistry. Results: KRAS mutations were detected in 8/15 (53.4%) samples. Similar to conventional peripheral giant cell granuloma, the KRAS mutations most frequently occurred in codon 146 (p.A146V, n = 3), followed by codon 12 (p.G12A and p.G12D, n = 1 each) and codon 14 (p.V14L, n = 1). Variants of unknown significance (VUS) were also detected in two cases, affecting codons 37 (p.E37K) and 127 (p.T127I). All samples showed wild‐type (WT) sequences for FGFR1 and TRPV4 genes. Consistent with MAPK/ERK pathway activation, all mononuclear cells of the lesion showed strong staining for phospho‐ERK1/2 protein in the immunohistochemical analysis. Conclusions: KRAS mutations and activation of the MAPK‐ERK signaling pathway occur in IA‐PGCG. This is the first study to demonstrate cancer‐associated gene mutations in a non‐neoplastic reactive condition associated with dental implants.

  • 18.
    Chrcanovic, Bruno
    Malmö högskola, Faculty of Odontology (OD).
    A History of Periodontitis Suggests a Higher Risk for Implant Loss2015In: Journal of Evidence-Based Dental Practice, ISSN 1532-3382, E-ISSN 1532-3390, Vol. 15, no 4, p. 185-186Article in journal (Refereed)
    Abstract [en]

    ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Periodontitis, implant loss and peri-implantitis. A meta-analysis. Sgolastra F, Petrucci A, Severino M, Gatto R, Monaco A.Clin Oral Implants Res 2015;26(4):e8-16. REVIEWER: Bruno Ramos Chrcanovic, DDS, MSc, PhD student PURPOSE/QUESTION: To compare the risks of implant loss, implant bone loss, and peri-implantitis between subjects with and without a history of periodontal disease. SOURCE OF FUNDING: The authors reported that no external funding sources directly supported this study TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data LEVEL OF EVIDENCE: Level 2: Limited-quality, patient-oriented evidence STRENGTH OF RECOMMENDATION GRADE: Grade B: Inconsistent or limited-quality patient-oriented evidence.

  • 19.
    Chrcanovic, Bruno
    Malmö University, Faculty of Odontology (OD). Malmö University, Biofilms Research Center for Biointerfaces.
    Dental implants in patients with ectodermal dysplasia: a systematic review2018In: Journal of Cranio-Maxillofacial Surgery, ISSN 1010-5182, E-ISSN 1878-4119, Vol. 46, no 8, p. 1211-1217Article, review/survey (Refereed)
    Abstract [en]

    Purpose. To assess the clinical outcome and survival rate of oral implants placed in individuals with ectodermal dysplasia (ED), based on previously published studies. Methods. An electronic search without time restrictions was undertaken in 5 databases (PubMed/Medline, Web of Science, ScienceDirect, J-Stage, Lilacs). Descriptive statistics, Kaplan Meier estimator and implant failure probability were calculated. Results. 90 publications included, reporting 228 ED patients that received 1472 implants (1392 conventional, 47 zygomatic, 33 mini-implants). Mean age of the patients was 20.2±6.8 years (2-56). Patients had a mean of 3.2±2.5 maxillary and 2.1±2.6 mandibular permanent teeth (min-max, 0-14). Patients received a mean of 8.2±3.8 implants (1-20). Most implants were placed in the third decade of life, 24.6% of the implants were placed in children (0-17 years of age). 1391 implants had information on follow-up (72 failures, 5.2%). The 20-year CSR was 84.6%. The probability of failure was 4.5% (95%CI 3.5%-5.6%, p<0.001). Additional treatments performed: Le Fort I (99 implants, 20 patients, 3.5% failed), grafting (497 implants, 77 patients, 5.2% failed), distraction osteogenesis (79 implants, 16 patients, 10.1% failed). Mean follow-up 42.9±41.9 months (min-max, 2-240). Conclusions. Dental implants placed in ED patients, either infants or adults, present a high survival rate (20-year CSR 84.6%).

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  • 20.
    Chrcanovic, Bruno
    Malmö högskola, Faculty of Odontology (OD).
    Fixation of mandibular angle fractures: clinical studies2014In: Oral and Maxillofacial Surgery, ISSN 1865-1550, E-ISSN 1865-1569, Vol. 18, no 2, p. 123-152Article in journal (Refereed)
    Abstract [en]

    Purpose The purpose of this study was to review the literature regarding the evolution of current thoughts on fixation of mandibular angle fractures (MAFs). Methods An electronic search in PubMed was undertaken in August 2012. The titles and abstracts from these results were read to identify studies within the selection criteria. Eligibility criteria included studies from the last 30 years (from 1983 onwards) reporting clinical studies of MAFs. Results The search strategy initially identified 767 studies. The references from 1983 onwards totaled 727 articles. Fifty-four studies were identified without repetition within the selection criteria. Two articles showing significance in the development of treatment techniques were included. Additional hand-searching yielded 13 additional papers. Thus, a total of 69 studies were included. Conclusions Prospective randomized controlled studies of MAFs repair techniques are scarce. The available data at best predict that complications are associated with all kinds of fixation techniques. The similar results of complications in studies using different methods of fixation indicate that biomechanics are only one factor to be considered when treating MAFs. A second fracture in the mandible (which was observed in the majority of the studies’ population) can confound the outcome data because the fixation requirements of a double fracture are often different from those for an isolated fracture. It can be necessary additional effort intended for increase of stability when using biodegradable plate system to fixate MAFs. The use of 1.3 mm malleable miniplates was associated with an unacceptable incidence of plate fracture, suggesting that this is not the most adequate system to treat MAFs. The use of the 3D grid plates has shown good clinical results. The efficiency of locking miniplate system is yet to be proven because there are few clinical studies with its use to fixate MAFs, although they have shown good results. When considering the use of semirigid or rigid fixation systems, the use of two miniplates outweigh the advantages of the use of one reconstruction plate, although the use of miniplates is not recommended for displaced comminuted MAFs. Although it has been shown that absolute rigid fixation is not necessary for fracture healing, any system that provides superior stability without impacting negatively on other aspects of the procedure, i.e., time, exposure, and cost, should be favored. MAFs can be treated in a highly effective way and with a relatively low rate of complications with monocortical miniplate fixation. The large number of studies on the treatment of MAF reflects the fact that a consensus has not been reached for a single, ideal treatment method.

  • 21.
    Chrcanovic, Bruno
    Malmö högskola, Faculty of Odontology (OD).
    Fixation of mandibular angle fractures: in vitro biomechanical assessments and computer-based studies2012In: Oral and Maxillofacial Surgery, ISSN 1865-1550, E-ISSN 1865-1569, Vol. 17, no 4, p. 251-268Article in journal (Refereed)
    Abstract [en]

    Purpose The purpose of this study was to review the literature regarding the evolution of current thoughts on fixation of mandibular angle fractures (MAFs), based on in vitro biomechanical assessments and computer-based studies. Methods An electronic search in PubMed was undertaken in August 2012. The titles and abstracts from these results were read to identify studies within the selection criteria. Eligibility criteria included studies from the last 30 years (from 1983 onwards). Results The search strategy initially identified 767 studies. Thirty-one studies were identified without repetition within the selection criteria. Two articles showing significance in the development of treatment techniques was included. Additional hand searching yielded five additional papers. Thus, a total of 38 studies were included. Conclusions The osteosynthesis positions as well as the plating technique play important roles in the stability of MAF repair. The only in vitro study evaluating the use of wire osteosynthesis concluded that wires placed through the lower border approach would provide greater stability than those at the upper border. Many studies indicate that the use of two miniplates avoids (or decreases) lateral displacement of the lower mandibular border and opening of the inferior fracture gap. Some studies even suggest that the use of two miniplates may be considered a more “rigid” fixation technique for MAFs than the use of a reconstruction plate. When using two miniplates, the biplanar plate orientation provides greater biomechanical stability than the monoplanar one. However, despite its greater biomechanical stability, the two-miniplate technique has some disadvantages that should also be taken into account. Studies with biodegradable plates suggest the use of at least two plates for each MAF. There are few studies with compression plates, and they have not yet reached a consensus. The solitary lag screw proved to withstand the functional loading of the mandible; however, only few biomechanical assessments were performed. In vitro studies have shown good biomechanical stability with the use of 3-D grid plates. The use of malleable miniplates alone is not sufficient to withstand the early postoperative bite force. Some studies suggest that the segment of the tension band miniplate located at the distal fragment of the MAF should be fixed with three screws. The studies also showed some limitations. None considered the stabilization of the fracture site afforded by the masseter–pterygoid muscle pouch. Most of the studies did not evaluate plating system strength in the long term and therefore did not observe the effect of resorption on the strength of the different biodegradable plating systems. Another limitation of many studies is the absence of a control group. A confounding factor that could not be tested in in vitro investigations is the additional resistance to displacement of jagged fracture margins present in the human fracture.

  • 22.
    Chrcanovic, Bruno
    Malmö University, Faculty of Odontology (OD). Malmö University, Biofilms Research Center for Biointerfaces.
    Importance of Systematic Reviews in Implant Dentistry2019In: International Journal of Prosthodontics and Restorative Dentistry, ISSN 2231-6361, Vol. 9, no 2, p. 36-37Article in journal (Other academic)
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  • 23.
    Chrcanovic, Bruno
    Malmö högskola, Faculty of Odontology (OD).
    Locking versus non-locking plate fixation in the management of mandibular fractures: a meta-analysis2014In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 43, no 10, p. 1243-1250Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to test whether there is a significant difference in the clinical outcomes between locking and non-locking plate fixation in the management of mandibular fractures. An electronic search without time or language restrictions was undertaken in December 2013. Eligible studies were clinical human studies, either randomized or not. The search strategy identified 10 publications. The I(2) statistic was used to express the percentage of the total variation across studies due to heterogeneity. The inverse variance method was used for the random-effects model in the case of heterogeneity being detected, or the fixed-effects model in the case of heterogeneity not being detected. The estimates of an intervention were expressed as the risk ratio (RR) with 95% confidence interval. Eight studies were judged to be at high risk of bias, whereas two studies were considered at moderate risk of bias. There was no statistically significant effect on the outcome of postoperative infection (P=0.17), malocclusion (P=0.15), hardware failure (P=0.77), hardware removal (P=0.95), wound dehiscence (P=0.98), or paraesthesia (P=0.20) in favour of locking plate fixation. The test for overall effect showed that the difference between the procedures did not significantly affect the incidence of postoperative complications (P=0.21), with RR 0.79 (95% CI 0.54-1.14).

  • 24.
    Chrcanovic, Bruno
    Malmö högskola, Faculty of Odontology (OD).
    On failure of oral implants2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction: Nowadays oral implant placement is an effective and predictable treatment modality for replacing missing teeth in both fully and partially edentulous patients. Despite the high implant survival and success rates, there is a general appreciation that some risk factors predispose individuals to more complications and implant failures and may result in lower implant survival and success rates. Determining the exact elements that are critical for osseointegration would be extremely useful. A better understanding of the factors associated with implant failure provide data for the planning of future studies, facilitate clinical decision-making, and may enhance implant success. Once identified, the risks can then be avoided, or an alternative intervention can be applied, implying in the least cost to produce a given level of effectiveness in oral rehabilitation. The general aim of the present thesis was to assess the impact of several factors on the failure of oral implants.Materials and Methods: The articles included in the present thesis consist of three types of studies. First, a general overview was performed in order to identify risk factors associated with the failure of oral implants (Study I). Then, a systematic review of the literature with meta-analyses was performed to analyze the influence of one risk factor (smoking) on the failure of oral implants, marginal bone loss (MBL), and postoperative infection around implants (Study II). The seven retrospective studies (Study III-IX) were based on all 2,670 patients provided with 10,096 implants, consecutively treated on a routine basis at one specialist clinic (Clinic for Prosthodontics, Centre of Dental Specialist Care, Malmö, Sweden - Folktandvården Skåne AB, Specialisttandvård Malmö) during the period from 1980 to 2014. The dental records of all patients ever treated with implants in this clinic were read in order to collect the data. The data were directly entered into a SPSS file (SPSS software, version 23, SPSS Inc., Chicago, USA) as the files were being read. Several anatomical-, patient-, health-, and implant-related factors were collected. The clinical studies included in the thesis focused on the association between implant failure and bruxism, the intake of proton pump inhibitors and of selective serotonin reuptake inhibitors and their relation to failure, the impact of different surgeons, and the number of early failures, cluster behavior of failures, and clinical and radiological outcomes of implants followed up for a minimum of 20 years.Besides descriptive statistics and tests for the comparison of 2 or of 3 or more independent and dependent groups of continuous and categorical data, survival analyses, logistic regression models, generalized estimating equation method, and multilevel mixed effects parametric survival analysis were performed, depending on the study.Results and Conclusions: After a systematic review of the literature, it may be suggested that the following situations may increase the implant failure rate: a low insertion torque of implants that are planned to be immediately or early loaded, inexperienced surgeons inserting the implants, implant insertion in the maxilla, implant insertion in the posterior region of the jaws, implants in heavy smokers, implant insertion in bone qualities type III and IV, implant insertion in places with small bone volumes, use of shorter length implants, greater number of implants placed per patient, lack of initial implant stability, use of cylindrical (non-threaded) implants and prosthetic rehabilitation with implant-supported overdentures. Moreover, it may be suggested that the following situations may be correlated with an increase in the implant failure rate but with a weaker association than the factors listed above: use of the non-submerged technique, immediate loading, implant insertion in fresh extraction sockets, smaller diameter implants. Some recently published studies suggest that modern, moderately rough implants may present with similar results irrespective if placed in maxillae, in smoking patients or using only short implants (Study I). The systematic review of the literature with meta-analyses suggested that the insertion of oral implants in smokers affects the implant failure rates, the incidence of postoperative infections, as well as the marginal bone loss (Study II). Smoking and the intake of antidepressants are suggested to be potentially influencing factors with respect to the occurrence of implant failures up to the second-stage surgery - abutment connection (Study III). Bruxism may significantly increase both the implant failure rate and the rate of mechanical and technical complications of implant-supported restorations (Study IV). The intake of proton pump inhibitors may be associated with an increased risk of oral implant failure (Study V), but not so the intake of selective serotonin reuptake inhibitors (Study VI). Different levels of failure incidence of oral implants could be observed depending on the individual surgeons, occasionally reaching significant levels. Although a direct causal relationship could not be ascertained, it is suggested that the surgeons’ technique, skills, and/or judgment may influence the oral implant survival rates (Study VII). A cluster pattern among patients with implant failure is highly probable. Shorter implants, turned implants, poor bone quality, younger patients, the intake of antidepressants and of proton pump inhibitors, smoking, and bruxism were identified as suggested potential factors exerting a statistically significant influence on the cluster behavior of dental implant failures (Study VIII). Most of the implant failures occur at the first years after implantation, regardless of a very long follow-up. Implants in different jaw locations, irradiation, and bruxism were the factors suggested to affect the survival of implants. Marginal bone loss can be insignificant in long term observations, but it may, nevertheless, be the cause of secondary failure of oral implants in some cases (Study IX).

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  • 25.
    Chrcanovic, Bruno
    Malmö högskola, Faculty of Odontology (OD).
    Surgical versus non-surgical treatment of mandibular condylar fractures: a meta-analysis2015In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 44, no 2, p. 158-179Article, review/survey (Refereed)
    Abstract [en]

    The aim of the present study was to test whether there is a significant difference in the clinical outcomes between surgical and non-surgical treatment of mandibular condylar fractures. An electronic search was undertaken in February 2014. Eligibility criteria included clinical human studies, either randomized or not. The search strategy resulted in 36 publications. The estimates of an intervention were expressed as the risk ratio (RR) and mean difference (MD) in millimetres. A statistically significant effect was observed for the outcome of post-treatment malocclusion (RR 0.46, P<0.00001), lateral deviation during maximum inter-incisal opening (RR 0.56, P=0.0001, dichotomous; MD -0.75, P=0.002, continuous), protrusion (MD 0.68, P=0.01), and laterotrusion (MD 0.53, P=0.03) favouring surgical treatment, and for infection (RR 3.43, P=0.03) favouring non-surgical treatment. There was no statistically significant effect on temporomandibular joint pain (RR 0.81, P=0.46) or noise (RR 1.44, P=0.24), or maximum inter-incisal opening (MD 2.24, P=0.14). The test for overall effect showed that the difference between the procedures significantly affected the incidence of post-treatment complications, favouring surgical treatment, when all dichotomous and continuous outcomes were analysed (RR 0.70, P=0.006 and MD 1.17, P=0.0006, respectively).

  • 26.
    Chrcanovic, Bruno
    Malmö högskola, Faculty of Odontology (OD).
    Teeth in the line of mandibular fractures2012In: Oral and Maxillofacial Surgery, ISSN 1865-1550, E-ISSN 1865-1569, Vol. 18, no 1, p. 7-24Article in journal (Refereed)
    Abstract [en]

    Purpose This study aims to review the literature regarding the evolution of current thoughts on the management of teeth in the line of mandibular fractures (MFs). Methods An electronic search in PubMed was undertaken in June 2012. The titles and abstracts from these results were read to identify studies within the selection criteria—studies reporting clinical series of MFs in which the management of teeth in the fracture line was analyzed. Results The search strategy initially yielded 731 references. Twenty-seven studies were identified without repetition within the selection criteria. Additional hand searching yielded 12 additional papers. Conclusions It is suggested that rigid fixation systems and the use of antimicrobial agents have reduced the incidence of infection in cases of teeth in the line of MFs. Tooth buds in the line of MFs should not be removed or replaced in the (alleged) proper position despite the degree of displacement, since studies showed that even tooth buds in the early stage of calcification and those involved in widely displaced fracture sites continued development and erupted. Its removal should be considered in cases of infection, which is a predictive factor of abnormality and/or impaction. Intact teeth in the fracture line should be left in situ if they show no evidence of severe loosening or inflammatory change. Permanent teeth maintained in the line of fracture should be followed up clinically and radiographically for at least 1 year to ensure that any unnecessary endodontic treatment is avoided. Teeth in the line of fracture that prevents reduction of fractures, teeth with fractured roots, a partially impacted wisdom tooth with pericoronitis, and a tooth with extensive periapical lesion should be removed. Teeth in the line of MFs should also be removed when located in sites where there is extensive periodontal damage, with broken alveolar walls, resulting in the formation of a deep pocket (making optimal healing doubtful).

  • 27.
    Chrcanovic, Bruno
    et al.
    Malmö University, Faculty of Odontology (OD). Malmö University, Biofilms Research Center for Biointerfaces.
    Abreu, Mauro Henrique Nogueira Guimarães
    Brennan, Peter
    Santiago Gomez, Ricardo
    Some methodological issues on the review of pathologic lesions and conditions2019In: Journal of Oral Pathology & Medicine, ISSN 0904-2512, E-ISSN 1600-0714, Vol. 48, no 3, p. 260-261Article in journal (Refereed)
    Abstract [en]

    There are many pathologic conditions which occur in the maxillofacial region. Some are rare with only isolated case reports in the literature. In order to get a general picture of such lesions, it is common practice to gather information described in the literature, analyze the data, and write systematic reviews. The review of pathologic lesions and conditions is of great importance because it provides information that can improve the diagnostic accuracy and could help pathologists and surgeons to make informed decisions and refine the treatment plan to optimize the clinical outcome. With systematic reviews there are, however, the issues of missing data, wrong diagnosis, lack of histopathological information, and lack of follow-up.

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  • 28.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Albrektsson, Tomas
    Malmö högskola, Faculty of Odontology (OD).
    Wennerberg, Ann
    Malmö högskola, Faculty of Odontology (OD).
    Bisphosphonates and dental implants: A meta-analysis2016In: Quintessence International, ISSN 0033-6572, Vol. 47, no 4, p. 329-342Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To test the null hypothesis of no difference in the implant failure rates, marginal bone loss, and postoperative infection for patients receiving or not receiving bisphosphonates, against the alternative hypothesis of a difference. METHOD AND MATERIALS: An electronic search was undertaken in October 2015 in PubMed/Medline, Web of Science, and Embase, plus hand-searching and databases of clinical trials. Eligibility criteria included clinical human studies, either randomized or not. RESULTS: A total of 18 publications were included in the review. Concerning implant failure, the meta-analysis found a risk ratio of 1.73 (95% confidence interval [CI] 1.21-2.48, P = .003) for patients taking bisphosphonates, when compared to patients not taking the medicament. The probability of an implant failure in patients taking bisphosphonates was estimated to be 1.5% (0.015, 95% CI 0.006- 0.023, standard error [SE] 0.004, P < .001). It cannot be suggested that bisphosphonates may affect the marginal bone loss of dental implants, due to a limited number of studies reporting this outcome. Due to a lack of sufficient information, meta-analysis for the outcome "postoperative infection" was not performed. CONCLUSION: The results of the present study cannot suggest that the insertion of dental implants in patients taking BPs affects the implant failure rates, due to a limited number of published studies, all characterized by a low level of specificity, and most of them dealing with a limited number of cases without a proper control group. Therefore, the real effect of BPs on the osseointegration and survival of dental implants is still not well established.

  • 29.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Faculty of Odontology (OD). Malmö högskola, Biofilms Research Center for Biointerfaces.
    Albrektsson, Tomas
    Malmö högskola, Faculty of Odontology (OD). Malmö högskola, Biofilms Research Center for Biointerfaces.
    Wennerberg, Ann
    Malmö högskola, Faculty of Odontology (OD). Malmö högskola, Biofilms Research Center for Biointerfaces.
    Bone Quality and Quantity and Dental Implant Failure: A Systematic Review and Meta-analysis2017In: International Journal of Prosthodontics, ISSN 0893-2174, E-ISSN 1139-9791, Vol. 30, no 3, p. 219-237Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of this study was to test the null hypothesis that there is no difference in implant failure rates, marginal bone loss, and postoperative infection for implants inserted in bone with different qualities and quantities according to the classification of Lekholm and Zarb. Materials and Methods: An electronic search was undertaken in January 2015 for randomized and nonrandomized human clinical studies. Results: A total of 94 publications were included. When bone sites of different qualities were considered, the results suggested the following comparative implant failure rates: 1 > 2, 1 > 3, 3 > 2, 4 > 1, 4 > 2, and 4 > 3. Sensitivity analyses suggested that when implants inserted in bone qualities 1 and 2 and 1 and 3 were compared, oxidized and sandblasted/acid-etched surfaces showed a decrease in significant difference in failures compared with turned implants. The same is not true for failure of implants inserted in bone quality 4 compared to failure of implants in all other bone qualities. When bone sites of different quantities were considered, the following comparative implant failure rates were observed: A > B, A > C, A < D, B < C, B < D, C < D, E > A, E > B, E > C, E > D. Due to insufficient information, meta-analyses for the outcomes postoperative infection and marginal bone loss were not performed. Conclusion: Sites with poorer bone quality and lack of bone volume may statistically affect implant failure rates. Implant surfaces may play a role in failure of implants in different bone qualities.

  • 30.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Albrektsson, Tomas
    Malmö högskola, Faculty of Odontology (OD).
    Wennerberg, Ann
    Malmö högskola, Faculty of Odontology (OD).
    Bruxism and dental implants: a meta-analysis2015In: Implant Dentistry, ISSN 1056-6163, E-ISSN 1538-2982, Vol. 24, no 5, p. 505-516Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To test the null hypothesis of no difference in the implant failure rates, postoperative infection, and marginal bone loss after the insertion of dental implants in bruxers compared with the insertion in non-bruxers against the alternative hypothesis of a difference. METHODS: An electronic search was undertaken in June 2014. Eligibility criteria included clinical studies, either randomized or not. RESULTS: Ten publications were included with a total of 760 implants inserted in bruxers (49 failures; 6.45%) and 2989 in non-bruxers (109 failures; 3.65%). Due to lack of information, meta-analyses for the outcomes "postoperative infection" and "marginal bone loss" were not possible. A risk ratio of 2.93 was found (95% confidence interval, 1.48-5.81; P = 0.002). CONCLUSIONS: These results cannot suggest that the insertion of dental implants in bruxers affects the implant failure rates due to a limited number of published studies, all characterized by a low level of specificity, and most of them deal with a limited number of cases without a control group. Therefore, the real effect of bruxing habits on the osseointegration and survival of endosteal dental implants is still not well established.

  • 31.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Albrektsson, Tomas
    Malmö högskola, Faculty of Odontology (OD).
    Wennerberg, Ann
    Malmö högskola, Faculty of Odontology (OD).
    Dental implants in irradiated versus non-irradiated patients: a meta-analysis2016In: Head and Neck, ISSN 1043-3074, E-ISSN 1097-0347, Vol. 38, no 3, p. 448-481Article, review/survey (Refereed)
    Abstract [en]

    Background/Methods. The purpose of the present meta-analysis was to test the null hypothesis of no difference in dental implant failure rates, postoperative infection, and marginal bone loss for patients being rehabilitated by dental implants and being previously irradiated in the head and neck region versus non-irradiated patients, against the alternative hypothesis of a difference. Results/Conclusion. The study suggests that irradiation negatively affects the survival of implants, as well as the difference in implant location (maxilla vs. mandible), but there is no statistically significant difference in survival when implants are inserted before or after 12 months after radiotherapy. The study failed to support the effectiveness of hyperbaric oxygen therapy in irradiated patients. It was observed a tendency to lower survival rates of implants inserted in the patients submitted to higher irradiation doses. The results should be interpreted with caution due to the presence of uncontrolled confounding factors in the included studies.

  • 32.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Albrektsson, Tomas
    Malmö högskola, Faculty of Odontology (OD).
    Wennerberg, Ann
    Malmö högskola, Faculty of Odontology (OD).
    Dental Implants in Patients Receiving Chemotherapy: A Meta-Analysis2016In: Implant Dentistry, ISSN 1056-6163, E-ISSN 1538-2982, Vol. 25, no 2, p. 261-271Article in journal (Refereed)
    Abstract [en]

    Purpose: To test the null hypothesis of no difference in the implant failure rates, postoperative infection, and marginal bone loss for patients being rehabilitated by dental implants and being versus not being submitted to chemotherapy, against the alternative hypothesis of a difference. Methods: An electronic search without time or language restrictions was undertaken in May 2014 in PubMed/MEDLINE, Web of Science, Cochrane Oral Health Group Trials Register plus hand-searching. Eligibility criteria included clinical human studies, either randomized or not. Results: Nine publications were included. The results suggested that the insertion of dental implants in patients submitted or not submitted to chemotherapy did not affect the implant failure rates (risk ratio 1.02, 95% confidence interval 0.56-1.85; P = 0.95). Because of lack of enough information, meta-analyses for the outcomes "postoperative infection" and "marginal bone loss" were not performed. Conclusion: These results cannot suggest that the insertion of dental implants in patients submitted to chemotherapy may or may not affect the implant failure rates, because of a limited number of published studies, most of them characterized by a low level of specificity and dealing with a limited number of cases without a control group. The reliability and validity of the data collected and the potential for biases and confounding factors are some of the shortcomings of the present study.

  • 33.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Albrektsson, Tomas
    Malmö högskola, Faculty of Odontology (OD).
    Wennerberg, Ann
    Malmö högskola, Faculty of Odontology (OD).
    Dental implants inserted in fresh extraction sockets versus healed sites: a systematic review and meta-analysis2015In: Journal of Dentistry, ISSN 0300-5712, E-ISSN 1879-176X, Vol. 43, no 1, p. 16-41Article, review/survey (Refereed)
    Abstract [en]

    OBJECTIVES: The purpose of the present review was to test the null hypothesis of no difference in the implant failure rates, postoperative infection and marginal bone loss for the insertion of dental implants in fresh extraction sockets compared to the insertion in healed sites, against the alternative hypothesis of a difference. METHODS: An electronic search was undertaken in July 2014. Eligibility criteria included clinical human studies, either randomized or not. RESULTS: The search strategy resulted in 73 publications, with 8241 implants inserted in sockets (330 failures, 4.00%), and 19,410 in healed sites (599 failures, 3.09%). The difference between the procedures significantly affected the failure rates (RR 1.58, 95% CI 1.27-1.95, P<0.0001). The difference was not statistically significant when studies evaluating implants inserted in maxillae or in mandibles were pooled, or when the studies using implants to rehabilitate patients with full-arch prostheses were pooled; however, it was significant for the studies that rehabilitated patients with implant-supported single crowns and for the controlled studies. There was no apparent significant effect of implants inserted in fresh extraction sockets on the occurrence of postoperative infection or on the magnitude of marginal bone loss. CONCLUSION: It is suggested that the insertion of implants in fresh extraction sockets affects the failure rates. However, it does not affect the marginal bone loss or the occurrence of postoperative infection. The results should be interpreted with caution due to the potential for biases and to the presence of uncontrolled confounding factors in the included studies, most of them not randomized. CLINICAL SIGNIFICANCE: The question whether immediate implants are more at risk for failure than implants placed in mature bone has received increasing attention in the last years. As the philosophies of treatment alter over time, a periodic review of the different concepts is necessary to refine techniques and eliminate unnecessary procedures. This would form a basis for optimum treatment.

  • 34.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Albrektsson, Tomas
    Malmö högskola, Faculty of Odontology (OD).
    Wennerberg, Ann
    Malmö högskola, Faculty of Odontology (OD).
    Dental implants inserted in male versus female patients: a systematic review and meta-analysis2015In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 42, no 9, p. 709-722Article, review/survey (Refereed)
    Abstract [en]

    The aim of this meta-analysis was to test the null hypothesis of no difference in the failure rates, marginal bone loss (MBL) and post-operative infection for implants inserted in male or female patients, against the alternative hypothesis of a difference. An electronic search without time or language restrictions was undertaken in December 2014. Eligibility criteria included clinical human studies, either randomized or not. Ninety-one publications were included, with a total of 27,203 implants inserted in men (1185 failures), and 25,154 implants inserted in women (1039 failures). The results suggest that the insertion of dental implants in male patients statistically affected the implant failure rates (RR 1.21, 95% CI 1.07-1.37, P = 0.002). Due to the limited number of studies reporting results on MBL, it is difficult to estimate the real effect of the insertion of implants in different sexes on the marginal bone level. Due to lack of satisfactory information, meta-analysis for the outcome 'post-operative infection' was not performed. The results have to be interpreted with caution due to the presence of several confounding factors in the included studies.

  • 35.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Albrektsson, Tomas
    Malmö högskola, Faculty of Odontology (OD).
    Wennerberg, Ann
    Malmö högskola, Faculty of Odontology (OD).
    Diabetes and oral implant failure: a systematic review2014In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 93, no 9, p. 859-867Article, review/survey (Refereed)
    Abstract [en]

    The aim of this systematic review and meta-analysis was to investigate whether there are any effects of diabetes mellitus on implant failure rates, postoperative infections, and marginal bone loss. An electronic search without time or language restrictions was undertaken in March 2014. The present review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligibility criteria included clinical human studies. The search strategy resulted in 14 publications. The I (2) statistic was used to express the percentage of total variation across studies due to heterogeneity. The inverse variance method was used for the random effects model when heterogeneity was detected or for the fixed effects model when heterogeneity was not detected. The estimates of an intervention for dichotomous outcomes were expressed in risk ratio and in mean difference in millimeters for continuous outcomes, both with a 95% confidence interval. There was a statistically significant difference (p = .001; mean difference = 0.20, 95% confidence interval = 0.08, 0.31) between diabetic and non-diabetic patients concerning marginal bone loss, favoring non-diabetic patients. A meta-analysis was not possible for postoperative infections. The difference between the patients (diabetic vs. non-diabetic) did not significantly affect implant failure rates (p = .65), with a risk ratio of 1.07 (95% confidence interval = 0.80, 1.44). Studies are lacking that include both patient types, with larger sample sizes, and that report the outcome data separately for each group. The results of the present meta-analysis should be interpreted with caution because of the presence of uncontrolled confounding factors in the included studies.

  • 36.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Albrektsson, Tomas
    Malmö högskola, Faculty of Odontology (OD).
    Wennerberg, Ann
    Malmö högskola, Faculty of Odontology (OD).
    Flapless versus conventional flapped dental implant surgery: a meta-analysis2014In: PLOS ONE, E-ISSN 1932-6203, Vol. 9, no 6, article id e100624Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to test the null hypothesis of no difference in the implant failure rates, postoperative infection, and marginal bone loss for patients being rehabilitated by dental implants being inserted by a flapless surgical procedure versus the open flap technique, against the alternative hypothesis of a difference. An electronic search without time or language restrictions was undertaken in March 2014. Eligibility criteria included clinical human studies, either randomized or not. The search strategy resulted in 23 publications. The I2 statistic was used to express the percentage of the total variation across studies due to heterogeneity. The inverse variance method was used for random-effects model or fixed-effects model, when indicated. The estimates of relative effect were expressed in risk ratio (RR) and mean difference (MD) in millimeters. Sixteen studies were judged to be at high risk of bias, whereas two studies were considered of moderate risk of bias, and five studies of low risk of bias. The funnel plots indicated absence of publication bias for the three outcomes analyzed. The test for overall effect showed that the difference between the procedures (flapless vs. open flap surgery) significantly affect the implant failure rates (P = 0.03), with a RR of 1.75 (95% CI 1.07-2.86). However, a sensitivity analysis revealed differences when studies of high and low risk of bias were pooled separately. Thus, the results must be interpreted carefully. No apparent significant effects of flapless technique on the occurrence of postoperative infection (P = 0.96; RR 0.96, 95% CI 0.23-4.03) or on the marginal bone loss (P = 0.16; MD -0.07 mm, 95% CI -0.16-0.03) were observed.

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  • 37.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Albrektsson, Tomas
    Malmö högskola, Faculty of Odontology (OD).
    Wennerberg, Ann
    Malmö högskola, Faculty of Odontology (OD).
    Immediate nonfunctional versus immediate functional loading and dental implant failure rates: a systematic review and meta-analysis2014In: Journal of Dentistry, ISSN 0300-5712, E-ISSN 1879-176X, Vol. 42, no 9, p. 1052-1059Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The purpose of the present review was to test the null hypothesis of no difference in the implant failure rates, postoperative infection, and marginal bone loss for patients being rehabilitated using dental implants with immediate nonfunctional loading (INFL) compared to immediate functional loading (IFL), against the alternative hypothesis of a difference. METHODS: An electronic search without time or language restrictions was undertaken in March 2014. Eligibility criteria included clinical human studies, either randomized or not. The estimates of relative effect were expressed in risk ratio (RR) and mean difference (MD) in millimeters. RESULTS: 1059 studies were identified and 11 studies were included, of which 7 were of high risk of bias, whereas four studies were of low risk of bias. The results showed that the procedure used (nonfunctional vs. functional) did not significantly affect the implant failure rates (P=0.70), with a RR of 0.87 (95% CI 0.44-1.75). The wide CI demonstrates uncertainty about the effect size. The analysis of postoperative infection was not possible due to lack of data. No apparent significant effects of non-occlusal loading on the marginal bone loss (MD 0.01mm, 95% CI -0.04-0.06; P=0.74) were observed. CONCLUSIONS: The results of this study suggest that the differences in occlusal loading between INFL and IFL might not affect the survival of these dental implants and that there is no apparent significant effect on the marginal bone loss. CLINICAL SIGNIFICANCE: There has been a controversy concerning whether dental implants should be subjected to immediate functional or nonfunctional loading. As the philosophies of treatment may alter over time, a periodic review of the different concepts is necessary to refine techniques and eliminate unnecessary procedures. This would form a basis for optimum treatment.

  • 38.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Albrektsson, Tomas
    Malmö högskola, Faculty of Odontology (OD).
    Wennerberg, Ann
    Malmö högskola, Faculty of Odontology (OD).
    Immediately loaded non-submerged versus delayed loaded submerged dental implants: a meta-analysis2015In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 44, no 4, p. 493-506Article in journal (Refereed)
    Abstract [en]

    The purpose of the present meta-analysis was to test the null hypothesis of no difference in the implant failure rate, postoperative infection, and marginal bone loss for patients being rehabilitated with immediately loaded non-submerged dental implants or delayed loaded submerged implants, against the alternative hypothesis of a difference. An electronic search without time or language restrictions was undertaken in March 2014. Eligibility criteria included clinical human studies, either randomized or not. The search strategy resulted in 28 publications. The inverse variance method was used for a random- or fixed-effects model, depending on the heterogeneity. The estimates of an intervention were expressed as the risk ratio (RR) and mean difference (MD) in millimetres. Twenty-three studies were judged to be at high risk of bias, one at moderate risk of bias, and four studies were considered at low risk of bias. The difference between procedures (submerged vs. non-submerged implants) significantly affected the implant failure rate (P = 0.02), with a RR of 1.78 (95% confidence interval (CI) 1.12-2.83). There was no apparent significant effect of non-submerged dental implants on the occurrence of postoperative infection (P = 0.29; RR 2.13, CI 0.52-8.65) or on marginal bone loss (P = 0.77; MD -0.03, 95% CI -0.23 to 0.17).

  • 39.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Albrektsson, Tomas
    Malmö högskola, Faculty of Odontology (OD).
    Wennerberg, Ann
    Malmö högskola, Faculty of Odontology (OD).
    Periodontally compromised vs. periodontally healthy patients and dental implants: a systematic review and meta-analysis2014In: Journal of Dentistry, ISSN 0300-5712, E-ISSN 1879-176X, Vol. 42, no 12, p. 1509-1527Article, review/survey (Refereed)
    Abstract [en]

    OBJECTIVES: To test the null hypothesis of no difference in the implant failure rates, postoperative infection, and marginal bone loss for the insertion of dental implants in periodontally compromised patients (PCPs) compared to the insertion in periodontally healthy patients (PHPs), against the alternative hypothesis of a difference. METHODS: An electronic search without time or language restrictions was undertaken in March 2014. Eligibility criteria included clinical human studies, either randomized or not. RESULTS: 2768 studies were identified in the search strategy and 22 studies were included. The estimates of relative effect were expressed in risk ratio (RR) and mean difference (MD) in millimetres. All studies were judged to be at high risk of bias, none were randomized. A total of 10,927 dental implants were inserted in PCPs (587 failures; 5.37%), and 5881 implants in PHPs (226 failures; 3.84%). The difference between the patients significantly affected the implant failure rates (RR 1.78, 95% CI 1.50-2.11; P<0.00001), also observed when only the controlled clinical trials were pooled (RR 1.97, 95% CI 1.38-2.80; P=0.0002). There were significant effects of dental implants inserted in PCPs on the occurrence of postoperative infections (RR 3.24, 95% CI 1.69-6.21; P=0.0004) and in marginal bone loss (MD 0.60, 95% CI 0.33-0.87; P<0.0001) when compared to PHPs. CONCLUSIONS: The present study suggests that an increased susceptibility for periodontitis may also translate to an increased susceptibility for implant loss, loss of supporting bone, and postoperative infection. The results should be interpreted with caution due to the presence of uncontrolled confounding factors in the included studies, none of them randomized. CLINICAL SIGNIFICANCE: There is some evidence that patients treated for periodontitis may experience more implant loss and complications around implants including higher bone loss and peri-implantitis than non-periodontitis patients. As the philosophies of treatment may alter over time, a periodic review of the different concepts is necessary to refine techniques and eliminate unnecessary procedures. This would form a basis for optimum treatment.

  • 40.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Albrektsson, Tomas
    Malmö högskola, Faculty of Odontology (OD).
    Wennerberg, Ann
    Malmö högskola, Faculty of Odontology (OD).
    Platform switch and dental implants: a meta-analysis2015In: Journal of Dentistry, ISSN 0300-5712, E-ISSN 1879-176X, Vol. 43, no 6, p. 629-646Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To test the null hypothesis of no difference in the implant failure rates, marginal bone loss (MBL) and postoperative infection in patients who received platform-switched implants or platform-matched implants, against the alternative hypothesis of a difference. DATA: Main search terms used in combination: dental implant, oral implant, platform switch, switched platform, platform mismatch, and dental implant-abutment design. SOURCES: An electronic search without time or language restrictions was undertaken in December/2014 in PubMed/Medline, Web of Science, Cochrane Oral Health Group Trials Register plus hand-searching. STUDY SELECTION: Eligibility criteria included clinical human studies, either randomized or not. CONCLUSIONS: Twenty-eight publications were included, with a total of 1216 platform-switched implants (16 failures; 1.32%) and 1157 platform-matched implants (13 failures; 1.12%). There was less MBL loss at implants with platform-switching than at implants with platform-matching (mean difference -0.29, 95% CI -0.38 to -0.19; P<0.00001). An increase of the mean difference of MBL between the procedures was observed with the increase in the follow-up time (P=0.001) and with the increase of the mismatch between the implant platform and the abutment (P=0.001). Due to lack of satisfactory information, meta-analyses for the outcomes 'implant failure' and 'postoperative infection' were not performed. The results of the present review should be interpreted with caution due to the presence of uncontrolled confounding factors in the included studies, most of them with short follow-up periods. CLINICAL SIGNIFICANCE: The question whether platform-matched implants are more at risk for failure and loose more marginal bone than platform-switched implants has received increasing attention in the last years. As the philosophies of treatment alter over time, a periodic review of the different concepts is necessary to refine techniques and eliminate unnecessary procedures, forming a basis for optimum treatment.

  • 41.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Albrektsson, Tomas
    Malmö högskola, Faculty of Odontology (OD).
    Wennerberg, Ann
    Malmö högskola, Faculty of Odontology (OD).
    Prophylactic antibiotic regimen and dental implant failure: a meta-analysis2014In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 41, no 12, p. 941-956Article in journal (Refereed)
    Abstract [en]

    The aim of this meta-analysis was to investigate whether there are any positive effects of prophylactic antibiotic regimen on implant failure rates and post-operative infection when performing dental implant treatment in healthy individuals. An electronic search without time or language restrictions was undertaken in March 2014. Eligibility criteria included clinical human studies, either randomised or not. The search strategy resulted in 14 publications. The I(2) statistic was used to express the percentage of the total variation across studies due to heterogeneity. The inverse variance method was used with a fixed- or random-effects model, depending on the heterogeneity. The estimates of relative effect were expressed in risk ratio (RR) with 95% confidence interval. Six studies were judged to be at high risk of bias, whereas one study was considered at moderate risk, and six studies were considered at low risk of bias. The test for overall effect showed that the difference between the procedures (use versus non-use of antibiotics) significantly affected the implant failure rates (P = 0·0002), with a RR of 0·55 (95% CI 0·41-0·75). The number needed to treat (NNT) to prevent one patient having an implant failure was 50 (95% CI 33-100). There were no apparent significant effects of prophylactic antibiotics on the occurrence of post-operative infections in healthy patients receiving implants (P = 0·520). A sensitivity analysis did not reveal difference when studies judged as having high risk of bias were not considered. The results have to be interpreted with caution due to the presence of several confounding factors in the included studies.

  • 42.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Albrektsson, Tomas
    Malmö högskola, Faculty of Odontology (OD).
    Wennerberg, Ann
    Malmö högskola, Faculty of Odontology (OD).
    Reasons for failures of oral implants2014In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 41, no 6, p. 443-476Article in journal (Refereed)
    Abstract [en]

    This study reviews the literature regarding the factors contributing to failures of dental implants. An electronic search was undertaken including papers from 2004 onwards. The titles and abstracts from these results were read to identify studies within the selection criteria. All reference lists of the selected studies were then hand-searched, this time without time restrictions. A narrative review discussed some findings from the first two parts where separate data from non-comparative studies may have indicated conclusions different from those possible to draw in the systematic analysis. It may be suggested that the following situations are correlated to increase the implant failure rate: a low insertion torque of implants that are planned to be immediately or early loaded, inexperienced surgeons inserting the implants, implant insertion in the maxilla, implant insertion in the posterior region of the jaws, implants in heavy smokers, implant insertion in bone qualities type III and IV, implant insertion in places with small bone volumes, use of shorter length implants, greater number of implants placed per patient, lack of initial implant stability, use of cylindrical (non-threaded) implants and prosthetic rehabilitation with implant-supported overdentures. Moreover, it may be suggested that the following situations may be correlated with an increase in the implant failure rate: use of the non-submerged technique, immediate loading, implant insertion in fresh extraction sockets, smaller diameter implants. Some recently published studies suggest that modern, moderately rough implants may present with similar results irrespective if placed in maxillas, in smoking patients or using only short implants.

  • 43.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Albrektsson, Tomas
    Malmö högskola, Faculty of Odontology (OD).
    Wennerberg, Ann
    Malmö högskola, Faculty of Odontology (OD).
    Smoking and dental implants: a systematic review and meta-analysis2015In: Journal of Dentistry, ISSN 0300-5712, E-ISSN 1879-176X, Vol. 43, no 5, p. 487-498Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Recent studies implicate smoking as a significant factor in the failure of dental implants. This review aims to test the null hypothesis of no difference in the implant failure rates, risk of postoperative infection, and marginal bone loss for smokers versus non-smokers, against the alternative hypothesis of a difference. DATA: Main search terms used in combination: dental implant, oral implant, smoking, tobacco, nicotine, smoker, and non-smoker. SOURCES: An electronic search was undertaken in September/2014 in PubMed/Medline, Web of Science, Cochrane Oral Health Group Trials Register plus hand-searching. STUDY SELECTION: Eligibility criteria included clinical human studies, either randomized or not. The search strategy resulted in 1432 publications, of which 107 were eligible, with 19,836 implants placed in smokers, with 1259 failures (6.35%), and 60,464 implants placed in non-smokers, with 1923 failures (3.18%). CONCLUSIONS: The insertion of implants in smokers significantly affected the failure rates, the risk of postoperative infections as well as the marginal bone loss. The results should be interpreted with caution due to the presence of uncontrolled confounding factors in the included studies. CLINICAL SIGNIFICANCE: Smoking is a factor that has the potential to negatively affect healing and the outcome of implant treatment. It is important to perform an updated periodic review to synthesize the clinical research evidence relevant to the matter.

  • 44.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Faculty of Odontology (OD). Malmö högskola, Biofilms Research Center for Biointerfaces.
    Albrektsson, Tomas
    Malmö högskola, Faculty of Odontology (OD). Malmö högskola, Biofilms Research Center for Biointerfaces.
    Wennerberg, Ann
    Malmö högskola, Faculty of Odontology (OD). Malmö högskola, Biofilms Research Center for Biointerfaces.
    Survival and complications of zygomatic implants: an updated systematic review2016In: Journal of oral and maxillofacial surgery (Print), ISSN 0278-2391, E-ISSN 1531-5053, Vol. 74, no 10, p. 1949-1964Article, review/survey (Refereed)
    Abstract [en]

    Purpose. To assess the survival rate of zygomatic implants (ZIs) and the prevalence of complications based on previously published studies. Methods. An electronic search was performed in December/2015 in three databases and was supplemented by hand-searching. Clinical series of ZIs were included. Interval survival rate (ISR) and cumulative survival rate (CSR) were calculated. The untransformed proportion of complications (sinusitis, soft tissue infection, paresthesia, oroantral fistulas) was calculated, considering the prevalence reported in the studies. Results. Sixty-eight studies were included, comprising 4556 ZIs in 2161 patients, with 103 failures. The 12-year CSR was 95.21%. Most failures were detected within the six-month postsurgical period. Studies (n=26) that exclusively evaluated immediate loading showed a statistically lower ZI failure rate than studies (n=34) evaluating delayed loading protocols (P=0.003). Studies (n=5) evaluating ZIs for the rehabilitation of patients after maxillary resections presented lower survival rates. The probability of presenting postoperative complications with ZIs was as follows: sinusitis 2.4% (95%CI 1.8-3.0), soft tissue infection 2.0% (95%CI 1.2-2.8), paresthesia 1.0% (95%CI 0.5-1.4), oroantral fistulas 0.4% (95%CI 0.1-0.6). However, these numbers may be underestimated, as many studies failed to mention the prevalence of these complications. Conclusion. ZIs present a high 12-year CSR, with most failures occurring at the early stages postoperatively. The main observed complication related to ZIs was sinusitis, which may appear several years after ZI installation surgery.

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  • 45.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Albrektsson, Tomas
    Malmö högskola, Faculty of Odontology (OD).
    Wennerberg, Ann
    Malmö högskola, Faculty of Odontology (OD).
    Tilted versus axially placed dental implants: a meta-analysis2015In: Journal of Dentistry, ISSN 0300-5712, E-ISSN 1879-176X, Vol. 43, no 2, p. 149-170Article, review/survey (Refereed)
    Abstract [en]

    OBJECTIVES: The purpose of the present review was to test the null hypothesis of no difference in the implant failure rate, marginal bone loss, and postoperative infection for patients being rehabilitated by tilted or by axially placed dental implants, against the alternative hypothesis of a difference. METHODS: An electronic search without time or language restrictions was undertaken in July 2014. Eligibility criteria included clinical human studies, either randomised or not, interventional or observational. The estimates of an intervention were expressed in risk ratio (RR) and mean difference (MD) in millimetres. RESULTS: The search strategy resulted in 44 publications. A total of 5029 dental implants were tilted (82 failures; 1.63%), and 5732 implants were axially placed (104 failures; 1.81%). The difference between the procedures did not significantly affect the implant failure rates (P=0.40), with a RR of 1.14 (95% CI 0.84-1.56). A statistically significant difference was found for implant failures when studies evaluating implants inserted in maxillae only were pooled (RR 1.70, 95% CI 1.05-2.74; P=0.03), the same not happening for the mandible (RR 0.77, 95% CI 0.39-1.52; P=0.45). There were no apparent significant effects of tilted dental implants on the occurrence of marginal bone loss (MD 0.03, 95% CI -0.03 to 0.08; P=0.32). Due to lack of satisfactory information, meta-analysis for the outcome 'postoperative infection' was not performed. CONCLUSIONS: It is suggested that the differences in angulation of dental implants might not affect the implant survival or the marginal bone loss. The reliability and validity of the data collected and the potential for biases and confounding factors are some of the shortcomings of the present study. CLINICAL SIGNIFICANCE: The question whether tilted implants are more at risk for failure than axially placed implants has received increasing attention in the last years. As the philosophies of treatment alter over time, a periodic review of the different concepts is necessary to refine techniques and eliminate unnecessary procedures. This would form a basis for optimum treatment.

  • 46.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Faculty of Odontology (OD). Malmö högskola, Biofilms Research Center for Biointerfaces.
    Albrektsson, Tomas
    Malmö högskola, Faculty of Odontology (OD). Malmö högskola, Biofilms Research Center for Biointerfaces.
    Wennerberg, Ann
    Malmö högskola, Faculty of Odontology (OD). Malmö högskola, Biofilms Research Center for Biointerfaces.
    Turned versus anodised dental implants: a meta-analysis2016In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 43, no 9, p. 716-728Article in journal (Refereed)
    Abstract [en]

    The aim of this meta-analysis was to test the null hypothesis of no difference in the implant failure rates, marginal bone loss (MBL)and post-operative infection for patients being rehabilitated by turned versus anodised-surface implants, against the alternative hypothesis of a difference. An electronic search without time or language restrictions was undertaken in November 2015. Eligibility criteria included clinical human studies, either randomised or not. Thirty-eight publications were included. The results suggest a risk ratio of 2·82 (95% CI 1·95–4·06, P < 0·00001) for failure of turned implants, when compared to anodised-surface implants. Sensitivity analyses showed similar results when only the studies inserting implants in maxillae or mandibles were pooled. There were no statistically significant effects of turned implants on the MBL (mean difference-MD 0·02, 95%CI −0·16–0·20; P = 0·82) in comparison to anodised implants. The results of a meta-regression considering the follow-up period as a covariate suggested an increase of the MD with the increase in the follow-up time (MD increase 0·012 mm year−1), however, without a statistical significance (P = 0·813). Due to lack of satisfactory information, meta-analysis for the outcome ‘post-operative infection’ was not performed. The results have to be interpreted with caution due to the presence of several confounding factors in the included studies.

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  • 47.
    Chrcanovic, Bruno
    et al.
    Malmö University, Faculty of Odontology (OD).
    Brennan, Peter
    Rahimi, Siavash
    Santiago Gomez, Ricardo
    Ameloblastic fibroma and ameloblastic fibrosarcoma: a systematic review2018In: Journal of Oral Pathology & Medicine, ISSN 0904-2512, E-ISSN 1600-0714, Vol. 47, no 4, p. 315-325Article, review/survey (Refereed)
    Abstract [en]

    Purpose. To integrate the available data published to date on ameloblastic fibromas (AF) and ameloblastic fibrosarcomas (AFS) into a comprehensive analysis of their clinical/radiologic features. Methods. An electronic search was undertaken in July/2017. Eligibility criteria included publications having enough clinical, radiological and histological information to confirm a definite diagnosis. Results. 244 publications (279 central AF tumours, 10 peripheral AF, 103 AFS) were included. AF and AFS differed significantly with regard to the occurrence of patients’ mean age, bone expansion, cortical bone perforation and lesion size. Recurrence rates were: central AF (19.2%), peripheral AF (12.5%), AFS (all lesions, 35%), primary (de novo) AFS (28.8%), secondary AFS (occurring after an AF, 50%). Larger lesions and older patients were more often treated by surgical resections for central AF. Segmental resection resulted in the lowest rate of recurrence for most of the lesion types. AFS treated by segmental resection had a 70.5% lower probability to recur (OR 0.295; p=0.049) than marginal resection. 21.3% of the AFS-patients died due to complications related to the lesion. Conclusions. Very long follow-up is recommended for AF lesions, due to the risk of recurrence and malignant change into AFS. Segmental resection is the most recommended therapy for AFS.

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  • 48.
    Chrcanovic, Bruno
    et al.
    Malmö University, Faculty of Odontology (OD). Malmö University, Biofilms Research Center for Biointerfaces.
    Cavalieri Gomes, Carolina
    Rezende dos Santos, Thiago
    Abreu, Mauro Henrique Nogueira Guimarães
    Santiago Gomez, Ricardo
    Clinical factors associated with the recurrence of central giant cell lesions.2019In: Journal of Oral Pathology & Medicine, ISSN 0904-2512, E-ISSN 1600-0714, Vol. 48, no 9, p. 799-802Article in journal (Refereed)
    Abstract [en]

    Central giant cell lesion of the jaws (CGCLJ) is a destructive condition that shows a varied and unpredictable biological behaviour. In the present study, we aimed to evaluate factors associated with the recurrence of CGCLJ. Based on the data of a previous systematic review of 2,270 CGCLJ, we used the multiple imputation to deal with the missing data. The dependent variable was the recurrence after the first treatment (yes/no). The dichotomic covariates were sex, upper or lower jaw location, size (up to or larger than 4 cm), pain, cortical bone perforation (yes/no), locularity (uni-/multilocular), tooth displacement (yes/no), treatment type (curettage or enucleation) and root resorption (yes/no). The final logistic model indicated that the tumours associated with tooth displacement, root resorption, and treated with curettage had a more significant chance of recurrence. In conclusion, our study suggests that tooth displacement, root resorption, and the type of treatment are potentially useful in the future construction of an algorithm for patient's treatment. This article is protected by copyright. All rights reserved.

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  • 49.
    Chrcanovic, Bruno
    et al.
    Malmö University, Faculty of Odontology (OD). Malmö University, Biofilms Research Center for Biointerfaces.
    Cavalieri Gomes, Carolina
    Santiago Gomez, Ricardo
    Central giant cell lesion of the jaws: an updated analysis of 2270 cases reported in the literature2018In: Journal of Oral Pathology & Medicine, ISSN 0904-2512, E-ISSN 1600-0714, Vol. 47, no 8, p. 731-739Article, review/survey (Refereed)
    Abstract [en]

    Purpose. To review all available data published on central giant cell lesion (CGCL) of the jaws into a comprehensive analysis of its clinical/radiologic features, with emphasis on the predictive factors associated with its recurrence. Methods. Electronic search undertaken in 5 databases (February/2018), looking for publications reporting cases of CGCLs. Results. 365 publications were included, comprising 2270 lesions. CGCLs were more prevalent in women and in the mandible, being usually asymptomatic. Cortical bone perforation occurred in 50% of the cases. Marginal/segmental resection were more often performed in larger lesions, and drug therapy was more frequent in small lesions. Recurrence was reported in 232/1316 cases (17.6%). The recurrence rate of the aggressive lesions (22.8%) after surgical treatment was higher than non-aggressive lesions (7.8%). Four out of five CGCLs showed partial/total regression with pharmacological treatment. Aggressive lesions showed worse response to corticosteroids than non-aggressive lesions. For the lesions submitted to surgery as the first treatment, curettage, enucleation or marginal resection in relation to segmental resection, aggressive lesions, cortical bone perforation, and tooth root resorption were associated with increased recurrence rate. Recurrence related to combination of surgical/pharmacological treatment could not be evaluated due to the variety of protocols. Conclusions. Aggressive CGCLs recur more often than the non-aggressive ones. Despite sometimes showing poor response to corticosteroid injection or surgical curettage, a combination of both treatment strategies should be considered in these aggressive cases in order to reduce morbidities associated with radical surgery. The best protocol to manage aggressive and non-aggressive lesions remains to be determined.

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  • 50.
    Chrcanovic, Bruno
    et al.
    Malmö University, Faculty of Odontology (OD).
    Cavalieri Gomes, Carolina
    Santiago Gomez, Ricardo
    Desmoplastic ameloblastoma: a systematic review of the cases reported in the literature2020In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 49, no 6, p. 709-716Article, review/survey (Refereed)
    Abstract [en]

    The purpose was to integrate the available data published on desmoplastic ameloblastoma (DA) into a comprehensive analysis of its clinical/radiographic features. As it is not clear if the hybrid ameloblastoma has a unique biological behavior, the clinical/radiographic features of conventional DA with the hybrid variant were compared. An electronic search was undertaken in May/2019. Eligibility criteria included publications having enough clinical/radiographic/histological information to confirm the diagnosis. 128 publications reporting 285 DAs were included (246 central non-hybrid, 33 central hybrid, 6 peripheral). There was a statistically significant difference between non-hybrid and hybrid cases concerning lesion location, radiographic limits and size. In contrast to non-hybrid tumors that showed similar distribution in mandible and maxilla, a highly predominant mandible location was observed in the hybrid tumors. Also, non-hybrid lesions more often showed ill-defined radiographic margins, and were larger tumors than hybrid DAs. Enucleation with an additional therapy (either curettage or peripheral osteotomy) or resection led to a lower recurrence risk in comparison to curettage or enucleation without additional therapy. Location of the lesion and type of treatment are related to tumor recurrence. There are important differences in location and radiographic limits between hybrid and non-hybrid DAs, which support their classification as distinct lesions.

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