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      Does the Implant Surgical Technique Affect the Primary and/or Secondary Stability of Dental Implants? A Systematic Review

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          Abstract

          Background. A number of surgical techniques for implant site preparation have been advocated to enhance the implant of primary and secondary stability. However, there is insufficient scientific evidence to support the association between the surgical technique and implant stability. Purpose. This review aimed to investigate the influence of different surgical techniques including the undersized drilling, the osteotome, the piezosurgery, the flapless procedure, and the bone stimulation by low-level laser therapy on the primary and/or secondary stability of dental implants. Materials and methods. A search of PubMed, Cochrane Library, and grey literature was performed. The inclusion criteria comprised observational clinical studies and randomized controlled trials (RCTs) conducted in patients who received dental implants for rehabilitation, studies that evaluated the association between the surgical technique and the implant primary and/or secondary stability. The articles selected were carefully read and classified as low, moderate, and high methodological quality and data of interest were tabulated. Results. Eight clinical studies were included then they were classified as moderate or high methodological quality and control of bias. Conclusions. There is a weak evidence suggesting that any of previously mentioned surgical techniques could influence the primary and/or secondary implant stability.

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          Most cited references76

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          A new concept in maxillary implant surgery: the osteotome technique.

          This article reviews the limitations of drilling into soft bone to place endosseous implants. Differences among bone types and the anatomy of the maxilla are described. The osteotome technique, which is a new method of placing implants into maxillary bone without drilling, and the rationale for two other procedures, the osteotome sinus floor elevation and the ridge expansion osteotomy, are detailed. How osteotomes conserve osseous tissue and may improve bone density around the implant is also discussed. A pilot study that shows excellent results with several types of press-fit implants using the osteotome technique is provided. The author concludes that the osteotome technique is superior to drilling for many applications in soft maxillary bone. Furthermore, the osteotome technique allows more implants to be inserted in a greater variety of sites during a routine office procedure.
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            Oral implant surfaces: Part 1--review focusing on topographic and chemical properties of different surfaces and in vivo responses to them.

            This article reviews the topographic and chemical properties of different oral implant surfaces and in vivo responses to them. The article considers detailed mechanical, topographic, and physical characteristics of implant surfaces. Anchorage mechanisms such as biomechanical and biochemical bonding are examined. Osteoattraction and doped surfaces are discussed. Surface quality of an oral implant may be subdivided into mechanical, topographic, and physicochemical properties. Topographic properties are evaluated at the micrometer level of resolution. Moderately rough surfaces (Sa between 1.0 and 2.0 microm) show stronger bone responses than smoother or rougher surfaces. The majority of currently marketed implants are moderately rough. Oral implants permit bone ingrowth into minor surface irregularities-biomechanical bonding or osseointegration. Additional biochemical bonding seems possible with certain surfaces. Osteoattraction is a commercial term without precise biologic correspondence. Surfaces doped with biochemical agents such as bone growth factors have been developed. Moderately roughened surfaces seem to have some clinical advantages over smoother or rougher surfaces, but the differences are small and often not statistically significant. Bioactive implants may offer some promise.
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              The unpredictability paradox: review of empirical comparisons of randomised and non-randomised clinical trials.

              To summarise comparisons of randomised clinical trials and non-randomised clinical trials, trials with adequately concealed random allocation versus inadequately concealed random allocation, and high quality trials versus low quality trials where the effect of randomisation could not be separated from the effects of other methodological manoeuvres. Systematic review. Cohorts or meta-analyses of clinical trials that included an empirical assessment of the relation between randomisation and estimates of effect. Cochrane Review Methodology Database, Medline, SciSearch, bibliographies, hand searching of journals, personal communication with methodologists, and the reference lists of relevant articles. Relation between randomisation and estimates of effect. Eleven studies that compared randomised controlled trials with non-randomised controlled trials (eight for evaluations of the same intervention and three across different interventions), two studies that compared trials with adequately concealed random allocation and inadequately concealed random allocation, and five studies that assessed the relation between quality scores and estimates of treatment effects, were identified. Failure to use random allocation and concealment of allocation were associated with relative increases in estimates of effects of 150% or more, relative decreases of up to 90%, inversion of the estimated effect and, in some cases, no difference. On average, failure to use randomisation or adequate concealment of allocation resulted in larger estimates of effect due to a poorer prognosis in non-randomly selected control groups compared with randomly selected control groups. Failure to use adequately concealed random allocation can distort the apparent effects of care in either direction, causing the effects to seem either larger or smaller than they really are. The size of these distortions can be as large as or larger than the size of the effects that are to be detected.
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                Author and article information

                Journal
                Int J Dent
                Int J Dent
                IJD
                International Journal of Dentistry
                Hindawi Publishing Corporation
                1687-8728
                1687-8736
                2014
                7 July 2014
                : 2014
                : 204838
                Affiliations
                1Department of Prosthodontics, Faculty of Dentistry, Arab American University, Jenin, Palestine
                2Department of Oral Surgery, Faculty of Dentistry, Al-Sharjah University, Al-Sharjah, UAE
                Author notes
                *Rola Muhammed Shadid: rola_shadeed@ 123456yahoo.com

                Academic Editor: Martin Lorenzoni

                Article
                10.1155/2014/204838
                4121016
                76d0c545-f1bf-4209-90f3-d05385e268f3
                Copyright © 2014 Rola Muhammed Shadid et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 17 March 2014
                : 8 May 2014
                : 26 May 2014
                Categories
                Review Article

                Dentistry
                Dentistry

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