title: Key questions in implant dentistry
title: accuracy of placement modalities, predictive factors of early failure and cost effectiveness of surgical peri-implantitis therapy
titleType: Subtitle
Creators: name: Tattan, Mustafa
Publisher: name: University of Iowa
Year: 2024
Subjects: subject: Digital dentistry
subject: Implant dentistry
subject: Implant failure
subject: Oral surgery
subject: Peri-implant disease
subject: Peri-implantitis
subject: Health sciences
subject: FOS: Health sciences
subject: public abstract

description: 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.
description: 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 (&gt;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 &lt; .00001), coronal (MD = 0.65 mm, 95% CI 0.50–0.79, p &lt; .00001), and apical (MD = 1.13 mm, 95% CI 0.92–1.34, p &lt; .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 &lt; .00001). sCAIP is associated with superior accuracy compared to PGIP and FHIP.
description: 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 &lt; .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.
description: 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 &lt; .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.