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Oreste Iocca Editor Evidence-Based Implant Dentistry Oreste Iocca Editor Evidence-Based Implant Dentistry 123 Evidence-Based Implant Dentistry Oreste Iocca Editor Evidence-Based Implant Dentistry Editor Oreste Iocca International Medical School Sapienza University of Rome Rome , Italy Private Practice Limited to Oral Surgery Periodontology and Implant Dentistry Rome , Italy ISBN 978-3-319-26870-5 ISBN 978-3-319-26872-9 (eBook) DOI 10.1007/978-3-319-26872-9 Library of Congress Control Number: 2016954323 © Springer International Publishing Switzerland 2016 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG Switzerland Pref ace The information provided in this book are the result of an evidence-based approach to the dental implant literature with the aim to analyze the most common dilemmas faced by the clinicians who adopt dental implants in their practice. Our work is directed to the students, the general practitioners, and the implant specialists who wish to have an update on various implantology topics. The fi rst two chapters are intended to describe the bibliographic tools used for literature searches and the most common statistical concepts necessary to fully understand the medical and dental literature. Chapter 3 analyzes the old dilemma in regard to extraction or implant placement. A schematic approach is adopted in the analysis of the various clinical scenarios. Finally, treatment algorithms are drawn in order to facili- tate the decision-making process. Chapter 4 focuses on bone response to implant surfaces, bone remodeling after dental extraction and subsequent implant placement, the processes of osseointegration, and the defi nition of implant stability and its clinical impli- cations. A review of the outcomes of implants placed in infected sites is also provided. Chapter 5 provides a description of the various placement and loading protocols in order to establish if any difference exists in terms of survival and success rates between the various protocols. Chapters 6 and 7 give an organized classifi cation of implant designs, implant length, and platform confi gurations in an attempt to establish their impacts on clinical outcomes. Chapters 8 and 9 examine the various prosthetic solutions for implant res- toration. The materials and designs of abutments and prostheses are analyzed in a way to facilitate the clinical decision-making. Chapter 10 covers the topic of pre-implant surgery. Careful review of all the possible surgical options for the edentulous patient is performed and is accompanied by a rich iconography. Chapter 11 is intended as a review of the pathogenesis, clinical aspects, and proposed treatment options for the most worrisome long-term complica- tion of the implant treatment: periimplantitis. Acknowledging that a consen- v vi Preface sus on this topic is far to be reached, an analysis of the proposed management strategies and results is attempted. I hope that our work will be useful for the colleagues in search of evidence- based answers to their questions and also as a refresh to the most frequent topics in current implantology practice. Rome, Italy Oreste Iocca , DDS Acknowle dgments The Editor is grateful to Tanja Maihoefer at Springer, to Rekha Udaiyar and Selvaraj Suganya at SPi Technologies for their attention in bringing this book to publication. The Editor also expresses his deep appreciation to Dr. José Pardiñas Arias and Dr. Carmen López Prieto for sharing some of their clinical cases, which contributed enormously to enrich the iconography of the book. vii Contents 1 Introduction to Evidence-Based Implant Dentistry . 1 Oreste Iocca 2 Basics of Biostatistics . 19 Oreste Iocca 3 Teeth or Implants? . 33 Oreste Iocca, Giuseppe Bianco, and Simón Pardiñas López 4 Bone Response to Implants . 59 Oreste Iocca 5 Implant Placement and Loading Time . 83 Oreste Iocca and Simón Pardiñas López 6 Implant Design and Implant Length . 97 Nicholas Quong Sing 7 Platform Design . 109 Giovanni Molina Rojas and David Montalvo Arias 8 Implant Abutments . 125 Oreste Iocca 9 Implant Prosthodontics . 141 Oreste Iocca , Giuseppe Bianco , and Simón Pardiñas López 10 Pre-Implant Reconstructive Surgery . 171 Simón Pardiñas López , Eduardo Anitua , and Mohammad H. Alkhraisat 11 Peri-implantitis . 229 Oreste Iocca and Giuseppe Bianco ix Contributors Mohammad H. Alkharaisat , DDS, MS, PhD Division of Clinical Dentistry, Biotechnology Institute , Victoria-Gasteiz , Spain Eduardo Anitua , MD, DDS, PhD Oral Surgery and Implantology , Clinica Eduardo Anitua , Vitoria-Gasteiz , Spain David Montalvo Arias , DDS Periodontics, Implant and Cosmetic Dentistry , Apa Aesthetic and Cosmetic Dental Centre, LLC , Dubai , United Arab Emirates Giuseppe Bianco , DDS, PhD Center Polispecialistico Fisioeuropa , Viale dell’Umanesimo , Rome , Italy Oreste Iocca , DDS International Medical School, Sapienza University of Rome , Rome , Italy Private Practice Limited to Oral Surgery, Periodontology and Implant Dentistry , Rome , Italy Simón Pardiñas López , DDS, MS Oral Surgery, Periodontology and Implantology , Clínica Pardiñas , A Coruña , Galicia , Spain Giovanni Molina Rojas , DDS Prosthodontics, Implant Dentistry, Apa Aesthetic and Cosmetic Center , Dubai , United Arab Emirates Nicholas Quong Sing , BDS, MFD, FFD OSOM, cert OSOM Dental Smiles Ltd , Carenage , Trinidad and Tobago xi Introduction to Evidence-Based Implant Dentistry 1 Oreste Iocca Abstract Evidence-based dentistry (EBD) concepts are of extraordinary importance for a good clinical practice. The clinician, the patient, and the scientifi c evidence are the three main components of EBD, whose integration involves the application of four steps: formulating of a question, getting the evidence, appraising the evidence, and applying the evidence. Evidence-based information comes from electronic databases and hand searches with the use of appropriate bibliographic techniques. Basic knowledge of the methodologies used in observational and experimental studies will allow to perform a critical appraisal of the available evidence. Finally, the application of the evidence-based information to the clinical scenario needs a quality assessment of the studies and is possible only when internal and external validity are high. 1.1 Evidence-Based Dentistry evidence available, all of this mediated by the preferences of the patient” [ 1 , 2 ]. The defi nition of evidence-based medicine Therefore, the three main components of (EBM) comes from the infl uential work of Prof. EBM are the clinician, the scientifi c evidence, David Sackett who stated that “EBM constitutes and the patient. a new approach to clinical practice in which clin- Good EBM practice articulates in four steps: ical decisions derive from the integration of the doctor’s experience with the conscientious, • Formulating a question means to translate a clin- explicit and judicious use of the best scientifi c ical doubt into a searchable question format. • Getting the evidence involves the knowledge of all the instruments available to answer the original question. O. Iocca , DDS • Appraising the evidence means to possess the International Medical School , Sapienza University instruments to critically analyze the available of Rome , Viale Regina Elena 324 , 00161 Rome , Italy scientifi c literature. Private Practice Limited to Oral Surgery , • Applying the evidence is the process by which Periodontology and Implant Dentistry , Rome , Italy the collected evidence is applied to a specifi c e-mail: [email protected] clinical scenario. © Springer International Publishing Switzerland 2016 1 O. Iocca (ed.), Evidence-Based Implant Dentistry, DOI 10.1007/978-3-319-26872-9_1 2 O. Iocca All of these factors apply to all fi elds of medi- to measure the odds of exposure among cases cine, including dentistry and its subspecialties. versus a control group. In this way, we select a Luckily, the term evidence-based dentistry (EBD) group of patients that had the implant fracture is now of common use among dental practitio- complication (rare outcome cases) and a control ners who are eager to put in practice the above- group (implant patients without implant frac- mentioned principles [ 3 ]. ture); in other words, we analyze the two groups Nevertheless, even the most scrupulous clini- retrospectively in order to understand why the cian may encounter diffi culties in staying updated rare adverse event occurred in the case group in with the overwhelming
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