Thesis
Key questions in implant dentistry: accuracy of placement modalities, predictive factors of early failure and cost effectiveness of surgical peri-implantitis therapy
University of Iowa
Master of Science (MS), University of Iowa
Spring 2023
DOI: 10.25820/etd.007241
Abstract
This thesis consisted of three studies. The objectives of the individual studies that constitute this project were: (1) to comprehensively analyze the clinical, digital and patient-centered outcomes of static computer aided implant placement (sCAIP) compared to other implant placement modalities; (2) to assess the association of implant placement surgery start time (SST; morning versus afternoon) with the risk for early implant failure (EIF) in an academic setting; and (3) to evaluate the cost-effectiveness of different options of surgical peri-implantitis therapy.
Study 1 is a systematic review and meta-analysis of randomized controlled trials evaluating sCAIP compared to free-handed (FHIP) and partially guided (PGIP) implant placement. A comprehensive literature search was performed by two independent examiners. Data pertaining to the outcomes of interest were extracted. Random-effects meta-analyses were feasible for a subset of outcomes. From an initial list of 2,870 records, fourteen articles for a total of ten RCTs were selected. Data from 7 of these studies allowed for the conduction of three meta-analyses comparing accuracy of implant placement across modalities. Survival rate up to 12 months post-loading was high (>98%) and comparable between treatments (low-quality evidence). No tangible differences in terms of patient perception of intra- or post-operative discomfort were observed (low-quality evidence). Quantitative analyses revealed significantly lower angular (MD = 4.41°, 95% CI 3.99– 4.83, p < .00001), coronal (MD = 0.65 mm, 95% CI 0.50–0.79, p < .00001), and apical (MD = 1.13 mm, 95% CI 0.92–1.34, p < .00001) deviation values for sCAIP as compared to FHIP (8 studies, 383 patients, 878 implants, high-quality evidence). A similar discrepancy, in favor of sCAIP, was observed for angular deviation only as compared to PGIP (MD = 2.11°, 95% CI 1.06–3.16, p < .00001). sCAIP is associated with superior accuracy compared to PGIP and FHIP.
Study 2 is retrospective case-control study evaluating the relationship between SST and EIF. Data were extracted from the electronic health records of 61 patients who had at least one EIF and 140 age- and gender-matched, randomly selected, non-EIF controls. Bivariate and multivariable analyses were performed to identify relevant associations between EIF and different variables, such as SST. Incidence of EIF was not significantly associated with SST (HR: 1.9 for afternoon implant placement, 95% CI: 0.9–3.9; p = .105). Other factors that were associated with a significantly increased risk for EIF in a multivariable model were pre-placement ridge augmentation (HR: 7.5, 95% CI: 2.2–25.1; p = .001), intra-operative complications (HR: 5.9, 95% CI: 2.2–16.3; p < .001), simultaneous soft tissue grafting (HR: 5.03, 95% CI: 1.3–19.5; p = .020), simultaneous bone grafting (HR: 3.7, 95% CI: 1.6–8.8; p = .002), and placement with sedation (HR: 3.4, 95% CI: 1.5–7.5; p = .002). While SST was not associated with the occurrence of EIF in our cohort, other variables, such as ridge augmentation prior to implant placement, simultaneous bone or soft tissue grafting, intra-operative complications, implant placement with sedation, and number of implants in the oral cavity, were associated with an increased risk for this adverse event.
Study 3 is a retrospective cohort study investigating the cost-effectiveness of surgical peri-implantitis therapy. Data were extracted from the electronic health records of 78 patients with 90 dental implants that had been diagnosed with and surgically treated for peri-implantitis. Data regarding implant placement, disease characteristics, active peri-implantitis treatment and supportive implant therapy were collected. Bivariate analyses, regression analyses and Kaplan-Meier survival plots were performed to identify cost-effectiveness as well as influencing factors of treatment outcomes. The final analysis included a comparison between reconstructive therapy (RT) and implant removal and replacement therapy (IRRT) due to limited number of cases related to other treatment options (resective therapy and access flap surgery). The overall success rate was 69.7% (73.0% in the IRRT group and 65.5% in the RT group (p = .514)). patients with no history of periodontitis demonstrated a 9.55-fold greater chance of treatment success compared to those with history of periodontitis (p = .009). IRRT showed a greater initial cost of therapy ($4085.2 ± $2076.9 versus $1551.7 ± $113.9; p < .001) and RT showed a greater cost of supportive implant therapy ($559.4 ± $821.3 versus $1317.0 ± $1166.6; p = .005). In a generalized linear model, RT was shown to be significantly more cost-effective than IRRT (p = .004). In this study sample, RT was found to be more cost-effective in the short term compared to IRRT. Patients without history of periodontitis were more likely to exhibit treatment success versus patients with history of periodontitis in this patient cohort.
Details
- Title: Subtitle
- Key questions in implant dentistry: accuracy of placement modalities, predictive factors of early failure and cost effectiveness of surgical peri-implantitis therapy
- Creators
- Mustafa Tattan
- Contributors
- Carlos Garaicoa-Pazmiño (Advisor)Muhammad H.A. Saleh (Committee Member)Gustavo Avila-Ortiz (Committee Member)Christopher Barwacz (Committee Member)Salahaldeen Abuhammoud (Committee Member)
- Resource Type
- Thesis
- Degree Awarded
- Master of Science (MS), University of Iowa
- Degree in
- Oral Science
- Date degree season
- Spring 2023
- Publisher
- University of Iowa
- DOI
- 10.25820/etd.007241
- Number of pages
- xii, 142 pages
- Copyright
- Copyright 2023 Mustafa Tattan
- Language
- English
- Date submitted
- 04/25/2023
- Date approved
- 06/30/2023
- Description illustrations
- color illustrations
- Description bibliographic
- Includes bibliographical references (pages 119-128).
- Public Abstract (ETD)
Between the year 1999 and 2016, the prevalence of dental implants has jumped from 0.7% to 5.7%. If the same trend continues, by the year 2026, this number is expected to increase to 17%. Conversely, if the trend steepens, we are looking at a prevalence of 23%. In other words, in just 3 years from now, a quarter of the population could have dental implants. With a rapid spread of a treatment which can still be considered relatively new in the field of dentistry, important questions regarding the ramifications of unwanted outcomes are continuously posed in the private practice and academic community. From among these questions, three categories in particular have become of particular interest: guided implant surgery, early implant failure and surgical peri-implantitis therapy. What is unknown remains greater than what is known, and each day our gaps in dental implant knowledge as a community become less and less regarding these topics of interest within the realm of implant dentistry.
Therefore, this project aimed to (1) comprehensively analyze the clinical, digital and patient-centered outcomes of guided implant placement compared to other implant placement methods; (2) assess the association of implant placement surgery start time (morning versus afternoon) with the risk for early implant failure in an academic setting; and (3) evaluate the cost-effectiveness of different options of surgical peri-implantitis therapy.
- Academic Unit
- Oral Pathology, Radiology and Medicine
- Record Identifier
- 9984425314702771
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