Browsing by Author "Atieh, Momen"

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Airflow for initial nonsurgical treatment of peri-implantitis: A systematic review and meta-analysis
(2021) Atieh, Momen; Almatrooshi, Aisha; Shah, Maanas S.; Hannawi, Haifa
Background: Nonsurgical treatment of peri-implantitis may help in reducing microbial load and inflammatory parameters. The potential clinical benefits of using different treatment approaches, in the initial nonsurgical treatment phase, particularly the airflow, are still not clear. The aim of this systematic review and meta-analyses was to evaluate the outcomes of nonsurgical treatment of peri-implantitis using airflow method in terms of changes in periodontal parameters, peri-implant marginal bone level, postoperative pain/discomfort, and patient satisfaction. Methods: Electronic databases were searched to identify randomized controlled trials (RCTs) that compared airflow with mechanical debridement using ultrasonic/curettes. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool. Data were analyzed using a statistical software program. Results: A total of 316 studies were identified, of which, five RCTs with 288 dental implants in 174 participants were included. Overall meta-analysis showed more reduction in probing pocket depths at 1–3 months (mean difference [MD] 0.23; 95% confidence interval [CI] -0.50–0.05; p = 0.10) and 6 months (MD -0.04; 95% CI -0.34 to 0.27; p = 0.80) in favor of airflow, but the difference was not statistically significant. The use of airflow was associated with significant reduction in bleeding on probing and increase in peri-implant mucosal recession. The differences in plaque score, peri-implant marginal bone level changes, and patient reported outcomes between airflow and mechanical debridement were not statistically significant. Conclusions: The short-term clinical and radiographic outcomes following nonsurgical treatment of peri-implantitis using airflow or mechanical debridement were comparable. The airflow has short-term positive effects on reducing bleeding on probing. Further evidence from RCTs are still required to substantiate the current findings.
Alveolar ridge preservation in extraction sockets of periodontally compromised teeth: A systematic review and meta-analysis.
(2022-07) Atieh, Momen; Alnaqbi, Maitha; Abdunabi, Farida
Objectives: Alveolar ridge preservation (ARP) procedures can limit bone changes following tooth extraction. However, the role of ARP in periodontally compromised socket lacks strong scientific evidence. The aim of this systematic review and meta analysis was to evaluate the outcomes of ARP following extraction of periodontally compromised teeth in comparison with extraction alone in terms of hard tissue changes, need for additional augmentation at the time of implant placement, and patient-reported outcomes. Material and Methods: Electronic databases were searched to identify randomized controlled trials (RCTs) that compared ARP in periodontally compromised sockets with spontaneous socket healing. The risk of bias was assessed using the Cochrane Collaboration's risk of bias tool. Results: Five studies with 134 extraction sockets in 126 participants were included. Of these, ARP was performed in 77 sites, while the remaining sites were intentionally left to heal without any ARP treatment. The follow-up time varied between 6 and 12 months. Overall meta-analysis showed significant differences in changes in ridge height (mean difference (MD) −0.95; 95% confidence interval (CI) −1.43 to −0.47; p = .0001) and bone volume (MD −38.70; 95% CI −52.17 to −25.24; P<.0001) in favor of ARP. The use of ARP following extraction of periodontally compromised tooth was also associated with significantly less need for additional bone grafting at the time of implant placement. Conclusions: Within the limitation of this review, ARP following extraction of periodontally compromised teeth may have short-term positive effects on alveolar ridge height and bone volume and minimize the need for additional augmentation procedures. However, the evidence is of very low to low certainty.
Awareness of Periodontal Health among Pregnant Females in Government Setting in United Arab Emirates
(2023) Khamis, Amar Hassan; Tawfik, Abdel Rahman; Bain, Crawford; Jamal, Mohamed; Atieh, Momen; Shah, Maanas
Objective: Periodontal disease is one of the most common infectious diseases. Several factors are associated with increased susceptibility of periodontal disease such as hormonal changes during pregnancy. Although pregnancy does not directly cause gingivitis, it can aggravate preexisting periodontal disease. This study aimed to evaluate knowledge of the association between periodontal disease and pregnancy in pregnant females. Materials and Methods: A convenience sample of pregnant females attending two United Arab Emirates government hospitals was recruited for this study. A 23-item questionnaire was developed with four sections, covering sociodemographic details, oral hygiene, oral symptoms during pregnancy, and knowledge of periodontal health during pregnancy. The study was conducted between April and October 2017. All participants consented to the survey. Results: A total of 100 participants with a mean age of 31 years (± 5.9) completed the survey. Most respondents brushed their teeth 2 to 3 times a day (65%), used a manual toothbrush (93%) but only visited the dentist when in pain (62%). Few respondents self-reported any gingival signs and symptoms during pregnancy; 38% had bleeding gums, 27% had no gum swelling, and 34% had bad odor/taste/smell. Only 21% of pregnant females lost a tooth/teeth during pregnancy, 15% believed that pregnancy increased the likelihood of gum disease, and 66% of gynecologists did not advise a visit to the dentist. Housewives were significantly less knowledgeable about periodontal health than students/employed respondents (p = 0.01). Quality of knowledge was not associated with educational attainment (< 0.06). Respondents > 30 years of age were more likely to believe in “a tooth for a baby” than younger participants aged < 30 years (p < 0.05). A logistic regression model showed that educational attainment was not a predictor for the belief in “a tooth for a baby” but age was a significant predictor (odds ratio = 2.0).
The diagnostic accuracy of saliva testing for SARS-CoV-2: A systematic review and meta-analysis
(2021) Atieh, Momen; Guirguis, Marina
Introduction: Early detection of coronavirus disease 2019 (COVID-19) is paramount for controlling the progression and spread of the disease. Currently, nasopharyngeal swabbing (NPS) is the standard method for collecting specimens. Saliva was recently proposed as an easy and safe option with many authorities adopting the methodology despite the limited evidence of efficacy. Objectives: The aim of this review was to systematically evaluate the current literature on the use of saliva test for detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and carry out a meta-analysis to determine its diagnostic accuracy. Materials and methods: Prospective studies were searched for in electronic databases, complemented by hand-searching relevant journals. The risk of bias and applicability were assessed using the revised Quality Assessment of Studies of Diagnostic Accuracy Studies (QUADAS-2) tool. Meta-analyses and meta-regression modeling were performed to calculate the diagnostic accuracy and examine sources of heterogeneity. Results: A total of 16 studies were included with 2928 paired samples. The overall meta-analysis showed a high sensitivity and specificity for saliva test at 0.88 (95% CI 0.82–0.92) and 0.92 (95% CI 0.75–0.98), respectively. The diagnostic odds ratio was calculated at 87 (95% CI 19–395) and area under the curve was calculated as 0.92 (95% CI 0.90–0.94) suggesting very good performance of the saliva tests in detecting SARS-CoV-2. Conclusion: Saliva testing has a very good discriminative and diagnostic ability to detect of SARS-CoV-2. Additional large and well-designed prospective studies are needed to further validate the diagnostic accuracy and determine a safe sample collection method prior to its recommendation for mass application.
Diode Laser as an Adjunctive Treatment for Peri-implant Mucositis: A Systematic Review and Meta-analysis
(2022-08) Atieh, Momen; Shah, Maanas; Hannawi, Haifa; Fadhul, Israa
Abstract: The early detection and management of peri-implant mucositis may help in reducing inflammatory parameters and arrest disease progression to peri-implantitis. The potential therapeutic benefits of different adjunctive therapies, such as the diode laser, are still not completely understood. The objective of this systematic review and meta-analyses was to assess the outcomes of using diode laser on the management of peri-implant mucositis in terms of changes in periodontal parameters. Electronic databases were searched to identify randomised controlled trials (RCTs) that compared the combined use of mechanical debridement and diode laser with mechanical debridement alone. A specific risk-of-bias tool was used to assess the risk of bias. Data were analysed using a statistical software programme. In total, 149 studies were found. A meta-analysis of 3 RCTs showed no statistically significant differences in probing pocket depths (mean difference [MD], 0.36; 95% confidence interval [CI], 0.88 to 0.16; P = .18) or bleeding on probing (MD, 0.71; 95% CI, 1.58−0.16; P = .11) between the 2 groups at 3 months. In the management of peri-implant mucositis, the combined use of diode laser and mechanical debridement did not provide any additional clinical advantage over mechanical debridement alone. Long-term, well designed RCTs are still needed.
Etiology of Peri-Implantitis
(2020) Atieh, Momen; Shah, Maanas
Purpose of Review: Peri-implant diseases represent the biological complications associated with implant therapy. They are defined as inflammatory responses of the peri-implant soft tissues with or without progressive loss of marginal bone. The term peri-implantitis is used when the bone loss extends beyond initial bone remodeling after loading. Knowledge of the etiology and case definitions of peri-implant diseases are used to evaluate the impact of peri-implant diseases on the long-term survival and maintenance of dental implants. The present review summarizes the current knowledge about case definitions and contemporary understanding of the etiopathogenesis of peri-implant diseases. Recent Findings: Recent studies have evaluated the instigation of peri-implant mucositis and its natural deterioration to periimplantitis. Animal models, similar to the ones used for showcasing biofilm-induced periodontal disease, have been utilized to understand the inflammatory response of supporting soft and hard tissue around dental implants. In addition, similarities have been drawn regarding the microbial composition around diseased natural teeth and implants. Summary: A better insight of the pattern of disease progression and understanding of the host response to the increased inflammatory overload provides a foundation on which future research studies can focus on host-microbial interactions and therapies that could lead to more favorable outcomes in prevention and treatment of peri-implant diseases.
Flapped versus flapless alveolar ridge preservation: a systematic review and meta-analysis
(2021) Atieh, Momen; Alfardan, Layal
Abstract: Alveolar ridge preservation (ARP) procedures can limit bone changes following tooth extraction. Flapped and flapless surgical approaches have been used for ARP; however, there is a lack of strong scientific evidence regarding their specific influences on the clinical outcomes of ARP. The aim of this systematic review and meta-analysis was to evaluate the effects of flapped and flapless surgical approaches on the dimensional changes of hard and soft tissues and patient-reported outcomes following ARP. Electronic databases were searched to identify randomized controlled trials (RCTs) that compared flapped ARP by means of a coronally advanced flap to flapless ARP where barrier membranes were left exposed. The risk of bias was assessed using the Cochrane Collaboration Risk of Bias tool. Data were analysed using a statistical software program. A total of 754 studies were identified, of which five studies with 149 extraction sockets in 128 participants were included. Overall, meta-analysis did not show any significant differences in the changes in ridge width or height between flapped and flapless ARP. The use of flapless ARP was associated with significantly less postoperative pain, thicker labial soft tissues, and marginally more favourable changes in width of the keratinized tissues compared to the flapped approach. The short-term hard tissue changes following ARP with a flapped or flapless approach are comparable. Postoperative pain and labial soft tissue changes are more favourable following ARP using a flapless approach. Further evidence from long-term RCTs is still required to substantiate the current findings.
Influence of implant restorative emergence angle and contour on peri-implant marginal bone loss: A systematic review and meta-analysis
(2023) Atieh, Momen; Shah, Maanas; Ameen, Mohammed
Background: Implant restorative emergence angle and profile may have a negative impact on peri-implant marginal bone level and may increase the risk of developing peri-implantitis. However, the role of these prosthetic features on peri-implant health is still unclear. The aim of this systematic review and meta-analyses was to evaluate the long-term outcomes of implant restorations with an emergence angle of >30º in comparison to those with ≤30º in terms of changes in peri-implant marginal bone level, periodontal parameters, and prevalence rate of peri-implantitis. Methods: Electronic databases were searched to identify observational studies that compared implant restorations with an emergence angle of >30º to those with ≤30º. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool. Results: Four studies with 912 dental implants in 397 participants were included in the present review. Of these, 455 implants had restorations with an emergence angle of >30º, while the remaining implants had restorative emergence angle of ≤30º. The follow-up time varied between 3.8 and 10.9 years. Implant restorations with an emergence angle of ≤30º were associated with less changes in peri-implant marginal bone level compared to those with emergence angle of >30º. The difference, however, was not statistically significant (mean difference 0.80; 95% confidence interval (CI) 0.13 to 1.72; p = 0.09). In platform-matched implants, the difference between the two groups was statistically significant in favor of implant restorations with emergence angle of ≤30º. In terms of emergence profile, implant restorations with convex profile had significantly higher rate of peri-implantitis (57.8%) compared to implant restorations with concave or straight profile (21.3%) (risk ratio 2.32; 95% CI 1.12– 4.82; p = 0.02). Conclusions: Within the limitation of this review, implant restorations with an emergence angles of >30º or ≤30º seem to have no significant influence on peri-implant marginal bone level. Platform-matched implants with an emergence angle of ≤30º may have positive effects on the peri-implant marginal bone level changes, but the evidence support is of low to moderate certainty.
The influence of insertion torque values on the failure and complication rates of dental implants: A systematic review and meta-analysis
(2021) Atieh, Momen; Baqain, Zaid; Almoselli, Mohamed
Background: The influence of using different insertion torque values on clinical and radiographic outcomes of implant therapy is unclear in the current literature. The aim of this systematic review and meta-analysis was to evaluate the implant outcomes and complications rates using high insertion torque values compared with those using regular insertion torque value levels. Methods: Randomized controlled trials (RCTs), nonrandomized controlled clinical trials (NRCCTs), prospective and retrospective cohorts were searched for in electronic databases and complemented by hand searching relevant dental journals. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool for randomized and nonrandomized studies. Data were analyzed using a statistical software. Results: A total of 718 studies were identified, of which, nine studies were included with 1229 dental implants in 684 participants. The meta-analysis of RCTs showed that the overall implant failure rate was not notably in favor of any insertion torque value and the difference between the two groups was not statistically significant (risk ratio 0.85; 95% confidence interval 0.07–10.52; P = 0.90). None of the RCTs was registered. The secondary analyses of non-RCTs did not either show any statistically significant difference. Overall meta-analysis did not show any significant differences in peri-implant marginal bone loss or biological/technical complications between high (≥50 Ncm) and regular insertion torque (<50 Ncm). Conclusions: There is insufficient evidence to support the use of high or regular insertion torque even with immediate implant restoration/loading. The short-term implant failure rates, changes in marginal bone level and complication rates were comparable when high or regular insertion torques were used for implant placement. The wide confidence interval indicated that results cannot be interpreted with clinically meaningful benefit for using either high or regular insertion torque.
Knowledge of Physicians about the Interrelationship between Diabetes Mellitus and Periodontitis in the United Arab Emirates
(2022-07) Tawfik, Abdel R; Hassan Khamis, Amar; Bain, Crawford; Atieh, Momen; Shah, Maanas
Objective: Diabetes mellitus is a major cause of morbidity in the United Arab Emirates (UAE), highlighting a significant social and economic burden impacting the development of the country. Studies have shown a bidirectional relationship between diabetes and periodontal disease. The awareness of this relationship is imperative not only for dentists but also for the physicians who contribute toward enhancing a diabetic patient’s health and lifestyle. There is a general need to highlight the importance of maintaining periodontal health and its positive effect on controlling diabetic health status. The purpose of this study is to investigate the knowledge of the physicians regarding diabetes and periodontal health. Materials and Methods: A cross-sectional study involving a questionnaire was distributed to the physicians who were attending the Arab Health Conference in Dubai in 2019. Statistical Analyses: A cross-tabulation analysis compared attitude, knowledge, and awareness across sector, gender, and country of graduation. A logistic regression model was used to explain the “knowledge” regarding possible confounding factors. Results: A total of 344 physicians with an average age of 38.11 (9.31) years, comprising of 186 (53.8%) males, participated in the survey. Of those participants, 285 (82.8%) were working in the government sector health care centers versus the private health care organizations. Also, 108 (31.4%) of the participants graduated within the universities based in the UAE, while the remaining 263 (68.6%) participants graduated from medical schools from other countries. At least 265 (77%) of the participants had positive outlook toward referring patients with diabetes to their dental colleagues, while 283 (82.3%) of the physicians acknowledge that diabetes affects periodontal health. While a majority of participants 261 (76%) treat diabetic patients in their clinical practice, only 50 (19%) of the participants admit to referring these patients for a dental consultation. In addition, the survey also revealed that 225 (65.5%) physicians comprehend the bidirectional relationship of periodontal disease and diabetes. Conclusion: An appropriate dental referral protocol is recommended for all diabetic patients who visit physicians. This survey demonstrated that although the physicians present with good knowledge, they rarely refer diabetic patients to receive proper periodontal care.
Outcome of supportive peri-implant therapy on the rates of peri-implant diseases and marginal bone loss: a systematic review and meta-analysis
(2021) Atieh, Momen; AlAli, Fawaghi
Objective: The aim of this systematic review and meta-analysis was to evaluate the impact of supportive peri-implant therapy (SPIT) on the rates of peri-implant diseases and peri-implant marginal bone loss. Data sources: The guidelines of PRISMA statement were followed in searching for randomized controlled trials, controlled clinical trials, and retrospective studies in several electronic databases and reference lists. The Cochrane Collaboration’s Risk of Bias tools for nonrandomized studies were used to assess the risk of bias. Data were analyzed using statistical software. A total of 159 studies were identified. Five trials, with 1,570 implants in 617 patients, met the inclusion criteria. Overall meta-analysis showed significantly reduced rates of peri-implantitis with SPIT compared with non-SPIT at implant and patient levels. Peri-implant mucositis was significantly reduced with SPIT at implant level only. Peri-implant marginal bone loss was significantly reduced in patients with SPIT compared to those who did not attend SPIT. Conclusion: SPIT can significantly reduce the rate of peri-implantitis and marginal bone loss. The evidence on the role of SPIT in reducing the rate of peri-implant mucositis, on the other hand, remains limited. Further well-designed studies on the impact of SPIT on implant treatment outcome are still needed. Clinical significance: There is a need to adopt a SPIT regimen for patients receiving implant therapy to reduce the rate of peri-implant diseases and marginal bone loss. This need should be stipulated in the patient information and consent forms prior to implant therapy.
Outcomes and Complication Rates of the Tooth-Implant–Supported Fixed Prosthesis: A Systematic Review and Meta-Analysis
(2020) Atieh, Momen
Purpose: To evaluate the implant and prosthetic outcomes and biologic and technical complications of tooth-implant– supported fixed dental prostheses (TISFDPs) in comparison with implant-supported fixed dental prostheses (ISFDPs). Materials and Methods: A comprehensive electronic search was performed by two independent reviewers up to February 2019. A hand search in relevant dental journals was also performed. The search identified a total of 175 citations, and 160 were excluded. Of the remaining 15 articles, seven were included in the review. Results: The implant failure rate was between 0% and 9% for the TISFDPs and between 0% and 13% for the ISFDPs, and the prosthesis failure rate was between 0% and 13% for the TISFDPs and between 0% and 17% for the ISFDPs; no significant differences were observed within 24 to 120 months of follow-up. Less peri-implant marginal bone loss was observed in the TISFDPs (MD: –0.29; 95% CI: –0.58, 0.00; P = .05), but the difference was marginally significant. Abutment tooth intrusion rate was 3%, while abutment tooth fracture rate was between 0% and 4%. No significant differences in the technical complications were observed, although the TISFDPs had higher failure rates in framework fracture and abutment/prosthesis screw loosening, while ISFDPs had a higher failure rate in porcelain fracture. Conclusion: The TISFDPs could be an alternative treatment option to ISFDPs for the partially edentulous patient with both treatments achieving comparable implant, prosthetic, biologic, and technical outcomes.
Peri implantitis through the looking glass
(2024) Atieh, Momen
Introduction: The states of health and disease are inseparable, as the existence of one relies on the presence of the other. The definitions of health and disease in medicine and dentistry have evolved over the years from ones that are patient-centered to a complex set of terminology that has resulted in communication ambiguity. An example of such are “peri-implant diseases, “a lingering topic in the current literature.
Periodontal tissue changes after crown lengthening surgery: A systematic review and meta-analysis
(2023) Atieh, Momen
Introduction: Crown lengthening is one of the most common periodontal surgical procedures carried out to increase the amount of supragingival tooth structure. There is a lot of literature on crown lengthening surgeries, but very few systematic reviews comparing treated and adjacent sites over a six-month period. The purpose of this systematic review and meta-analysis was to evaluate the outcomes of crown lengthening surgery in terms of changes in periodontal clinical parameters and periodontal tissue stability between treated and adjacent sites. Methods: Electronic databases were searched up to 28 February 2022 with no restriction on publication status. A manual search of journals was also performed. Predefined inclusion and exclusion criteria were used to select the relevant articles that assessed dimensional changes in periodontal tissues after crown lengthening surgery. The risk of bias was assessed using the JBI critical appraisal checklist. Data meta-analysis was performed using a statistical software program. Results: A total of 78 studies were identified, of which, four clinical controlled trials containing 182 crown lengthening surgical procedures across 111 participants were included. Meta-analysis showed no statistically significant changes after three or six months in terms of supracrestal tissue attachment levels, bone level and probing pocket depth between treated and adjacent sites. However, clinical attachment level changes were statistically significant, favouring adjacent teeth at six months.
A Retrospective Analysis of Biological Complications of Dental Implants
(2022-08) Atieh, Momen; Amir-Rad, Fatemeh; Almutairi, Zainab
Background and Objective: Several risk factors have been implicated in onset and development of peri-implant diseases. e impact of these factors, however, remains controversial across the di¬erent clinical settings and populations. The aim of this retrospective study was to evaluate the risk factors for peri-implant diseases among an Emirati population. Methods: A retrospective analysis of patients aged ≥18 years and having dental implants placed at Dubai Health Authority in 2010. Relevant information related to systemic-, patient-, implant-, site-, surgical- and prosthesis-related factors were collected. e strength of association between the prevalence of peri-implant mucositis and peri-implantitis and each variable was measured by chi-square analysis. A binary logistic regression analysis was performed to identify possible risk factors. Results: A total of 162 patients with 301 implant-supported restorations were included in the study. the age of the patients ranged between 19 and 72 with a mean age of 46.4 ± 11.7 years. The prevalence of peri-implant mucositis at the patient and implant levels were 44.4% and 38.2%, respectively. For peri-implantitis, the prevalence at the patient level was 5.6%, while the prevalence at the implant level was 4.0%. the binary logistic regression identified three risk factors (smoking habits, histories of treated periodontitis and lack of peri-implant maintenance) for peri-implantitis. Conclusion: Within the limitations of this study, smoking habits, history of treated periodontitis and lack of peri-implant maintenance were significant risk factors for peri-implantitis. Early detection of these factors would ensure appropriate planning and care of patients at high risk of developing peri-implant diseases.
The socket shield technique for immediate implant placement: A systematic review and meta-analysis
(2021) Shah, Maanas S.; Alabdulkareem, Mohammad N.; Atieh, Momen
Background: Immediate implant placement with socket shield technique (SST) may maintain the buccal bone plate and soft tissue levels, however, the potential clinical benefits of SST lack strong scientific evidence. The aim of this systematic review and meta-analysis was to evaluate the effects of SST on dimensional changes of hard tissues, esthetic outcomes, implant stability, complication, and implant failure rates. Methods: Electronic databases were searched to identify randomized controlled trials (RCTs) that compared immediate implant placement with and without SST. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool. Data were analyzed using a statistical software program. Results: A total of 982 studies were identified, of which, seven RCTs with 206 immediately placed dental implants in 191 participants were included. Overall meta-analysis showed significant differences in the changes in buccal bone plate width (mean difference (MD) -0.22; 95% confidence interval (CI) -0.30 to -0.15; p < 0.0001) and height (MD -0.52; 95% CI -0.85 to -0.18; p = 0.002) in favor of SST. The use of SST was also associated with significantly less changes in peri-implant marginal bone levels and better pink esthetic score than immediately placing implants without SST. The differences in implant stability, complication and implant failure rates were not statistically significant between immediate implant placement with or without SST. Conclusions: The short-term complication and implant failure rates following immediate implant placement with or without SST were comparable. The SST has short-term positive effects on the changes in width and height of buccal bone plate, peri-implant marginal bone levels and esthetic outcomes. Further evidence from long-term RCTs are still required to substantiate the current findings. Clinical significance: SST can reduce changes in buccal plate width and height and improve the soft tissue profile following immediate implant placement in esthetic zone.
Soft tissue changes after connective tissue grafts around immediately placed and restored dental implants in the esthetic zone: A systematic review and meta-analysis
(2019) Atieh, Momen
Objective: The aim of this systematic review and meta-analysis was to evaluate the soft tissue outcomes of connective tissue graft (CTG) combined with immediate implant placement and restoration (IIPR) in the esthetic zone. Materials and methods: Following the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, randomized controlled trials (RCTs) were searched for in electronic databases and complemented by hand searching. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool and data were analyzed using statistical software. Results: A total of 180 studies were identified, of which, four trials were included with 144 implant sites in 144 participants. Overall meta-analysis showed that CTG in conjunction with IIPR had a significantly greater gingival thickness than IIPR alone. The IIPR with CTG had less recession and higher esthetic pink score compared to IIPR group, but the difference was not statistically significant. No significant differences in implant failure rate were found between IIPR with and without CTG. Conclusions: The use of CTG in conjunction with IIPR in the esthetic zone significantly improved the thickness of the gingival tissues compared to IIPR without CTG. No significant differences were observed in the level of soft tissues around immediately placed implants with or without CTG. Clinical significance: The use of connective tissue graft with IIPR can be considered to improve the soft tissue profile and minimize mucosal recession in esthetic zone.
Systemic azithromycin versus amoxicillin/metronidazole as an adjunct in the treatment of periodontitis: a systematic review and meta-analysis
(2024) Atieh, Momen; Shah, Maanas; Hakam, Abeer; Alghafri, Meera
Background: The use of systemic azithromycin (AZT) and amoxicillin/metronidazole (AMX/MTZ) as adjuncts provided additional clinical and microbiological benefits over subgingival instrumentation alone. However, the superiority of one antibiotic regimen over another has not been proven. Therefore, the aim of this systematic review and meta-analyses was to evaluate the clinical efficacy and safety of subgingival instrumentation (SI) in conjunction with the systemic use ofAZT or AMX/MTZ for the treatment of periodontitis from current published literature. Methods: Electronic databases were searched to identify randomized controlled trials (RCTs), controlled clinical trials, prospective and retrospective human studies that compared the adjunctive use of systemic AZT to AMX/MTZ with SI in the treatment of periodontitis. The eligibility criteria were defined based on the participant (who had periodontitis), intervention (SI with adjunctive use of systemic AZT), comparison (SI with adjunctive use of systemic AMX/MTZ), out-comes (primary outcome: changes in probing pocket). The risk of bias was assessed using the Cochrane Collaboration’s Risk of Bias tool. Data were analyzed using a statistical software program. Results: Five studies with 151 participants with periodontitis were included in the present review. Of these, 74 participants received adjunctive AZT, while the remaining participants received AMX/MTZ as an adjunct to SI. The adjunctive use of AZT and AMX/MTZ had comparable changes in probing pocket depths at 1–3 months with no statistically significant difference (mean difference (MD) 0.01; 95% CI–0.20 to 0.22;P=0.94). The adjunctive use of AZT had significantly fewer number of residual sites with probing pocket depths of≥5mmat1–3 months compared to the adjunctive use of AMX/MTZ (MD–3.41; 95% CI–4.73 to–2.10;P<0.0001). The prevalence rates of adverse events among participants who received AZT and AMX/MTZ were 9.80% and 14.8%, respectively. The meta-analysis showed that the difference between the two groups was not statistically significant (risk ratio 0.69; 95% CI 0.28 to 1.72;P=0.43). Conclusions: Within the limitation of this review, there was no superiority between AZT and AMX/MTZ in terms of mean changes in probing pocket depths, clinical attachment level, bleeding on probing at 1–3 months. AZT seem to be associated with less sites with residual probing pocket depths of≥5mmat1–3 months and fewer adverse events com-pared with AMX/MTZ.©2023 Australian Dental Association.
Titanium particles: An emerging risk factor for peri-implant bone loss
(2019) Atieh, Momen
Objective: To investigate the presence of titanium particles in peri-implant tissues in cases diagnosed with peri-implantitis, and to identify immunological reactions that these particles may elicit. Methods: Ten peri-implant tissue biopsies of patients diagnosed clinically and radiographically with peri-implantitis were obtained from the archives of Oral Pathology Centre, University of Otago. The inclusion criteria involves: bleeding on probing, _6 mm probing depth and _3 mm radiographic bone loss around the dental implant. Peri-implant tissue samples were evaluated using scanning electron microscopy-energy dispersive x-ray spectroscopy (SEM-EDS) to identify of sites with/without titanium particles. Antibodies against human transforming growth factor beta 1 (TGF-b1), receptor activator of nuclear factor kappa-B ligand (RANKL), interleukin 33 (IL-33) and cluster of differentiation 68 (CD68) were used to stain the specimens. ImageJ software was used to standardise the sampling area, compare and characterise the inflammatory infiltrate in tissues with/without titanium particles. Inflammatory cytokines positivity was assessed using the immunoreactive scores (IRSs). Results: Light microscopy and SEM-EDS analysis identified titanium wear particles in 90% of the tissue samples, associated with a mixed chronic inflammatory infiltrate. Quantification analysis of RANKL revealed significantly higher IRS and intensity scores (p< 0.05) in areas containing.
Tomographic Evaluation of Alveolar Ridge Preservation Using Bone Substitutes and Collagen Membranes—A Retrospective Pilot Study
(2023) Atieh, Momen
Abstract: Alveolar ridge preservation (ARP) reduces dimensional changes following tooth extraction. We evaluated the changes in alveolar ridge dimensions after ARP using bone substitutes and collagen membranes. Objectives included the tomographic evaluation of sites prior to extraction and six months after ARP and the assessment of the extent ARP preserved the ridge and reduced the need for additional augmentation at the time of implant placement. A total of 12 participants who underwent ARP in the Postgraduate Periodontics Clinic (Faculty of Dentistry) were included. Cone beam computed tomography images were used to retrospectively assess 17 sites prior to and six months after dental extraction. Alveolar ridge changes were recorded and analysed using reproducible reference points. The alveolar ridge height was measured at buccal and palatal/lingual aspects, whilst width was measured at crestal level, 2 mm, 4 mm and 6 mm below the crest. Statistically significant changes were found in alveolar ridge width at all four heights, with mean reduction differences ranging from 1.16 mm to 2.84 mm. Likewise, significant changes in the palatal/lingual alveolar ridge height (1.28 mm) were observed. However, changes of 0.79 mm in buccal alveolar ridge height were not significant (p = 0.077). Although ARP reduced dimensional changes following a tooth extraction, some degree of alveolar ridge collapse could not be avoided. The amount of resorption on the buccal aspect of the ridge was less compared to the palatal/lingual after ARP. This indicated that the use of bone substitutes and collagen membranes was effective in reducing changes in the buccal alveolar ridge height.