Nikos Mattheos

OBJECTIVES: The aim of this retrospective study was to compare the clinical outcomes of implant treatment in periodontally compromised and periodontally healthy patients (PHP), with a minimum follow-up period of 5 years. METHODS: Thirty treated periodontally compromised patients (PCP) and 30 PHP, with a total of 117 Straumann implants (PCP = 56, PHP = 61) were matched for age, gender, smoking and implant characteristics. The PCP group was further stratified with patients having at least one periodontal pocket ≥6 mm at follow-up examination allocated to a "residual periodontitis" (RP) group, while the remaining patients were assigned to a "no residual periodontitis" (NRP) group. These groups were compared with respect to probing pocket depth (PPD), bleeding on probing (BOP) and marginal bone loss. RESULTS: The mean follow-up period in the PCP and PHP groups was 7.99 years (range 5.04-14.40) and 8.20 years (range 5.00-13.46) respectively. There was no difference in mean PPD between the PCP and PHP groups, but the prevalence of implants with PPD ≥5 mm + BOP was greater in the PCP group than in the PHP group, at both implant- (27% vs. 13%) and patient- (37% vs. 17%) level analyses. Mean implant PPD was significantly greater in the RP group (3.18 mm) than in both the NRP (2.67 mm) and PHP (2.81 mm) groups. Mean bone loss was also significantly greater in the RP group (0.68 mm) than in the NRP (0.23 mm) and PHP groups (0.26 mm). The prevalence of bone loss and PPD ≥5 mm + BOP at the implant level was significantly greater for the RP group compared with both the NRP and PHP groups. CONCLUSIONS: Implants in PCP with residual pocketing at follow-up had increased PPD and bone loss compared with implants placed in PHP and PCP without residual pocketing. Hence, it is the maintenance of periodontal health rather than a previous history of periodontitis that is the critical determinant of increased risk of peri-implantitis, highlighting the importance of effective periodontal therapy and maintenance in patients with a history of periodontitis.

AIM: This randomized controlled clinical trial (RCT) aimed to compare the accuracy of implant positions between static computer-assisted implant surgery (CAIS) and freehand implant surgery in a single edentulous space. MATERIALS AND METHODS: Sites with single edentulous spaces and neighbouring natural teeth were randomized into static CAIS or freehand implant surgery groups. In both groups, digital implant planning was performed using data from cone beam computed tomography (CBCT) and surface scans. In the static CAIS group, a surgical guide was produced and used for fully guided implant surgery, while in the freehand group, the implants were placed in a freehand manner. Postoperative CBCT was used for nine measurements representing the deviations in angles, implant shoulders and apexes between planned and actual implant positions. RESULTS: Fifty-two patients received 60 single implants. The median (IQR) deviations in angles, shoulders and apexes were 2.8 (2.6)°, 0.9 (0.8) mm and 1.2 (0.9) mm, respectively, in the static CAIS group, and 7.0 (7.0)°, 1.3 (0.7) mm and 2.2 (1.2) mm, respectively, in the freehand group. Statistically significant differences were found in 6 out of nine measured parameters using Mann-Whitney U test (p < 0.05). CONCLUSION: Static CAIS provided more accuracy in implant positions than freehand placement in a single edentulous space.

OBJECTIVES: The aim of this RCT was to compare the accuracy of implant placement between static and dynamic computer-assisted implant surgery (CAIS) systems in single tooth space. MATERIALS AND METHODS: A total of 60 patients in need of a single implant were randomly assigned to two CAIS groups (Static n = 30, Dynamic n = 30) and implants were placed by one surgeon. Preoperative CBCT was transferred to implant planning software to plan the optimal implant position. Implants were placed using either stereolithographic guide template (Static CAIS) or implant navigation system (Dynamic CAIS). Postoperative CBCT was imported to implant planning software, and deviation analysis with the planned position was performed. Primary outcomes were the deviation measurements at implant platform, apex, and angle of placement. Secondary outcome was the distribution of the implant deviation into each 3D direction. RESULTS: The mean deviation at implant platform and implant apex in the static CAIS group was 0.97 ± 0.44 mm and 1.28 ± 0.46 mm, while that in the dynamic CAIS group was 1.05 ± 0.44 mm and 1.29 ± 0.50 mm, respectively. The angular deviation in static and dynamic CAIS group was 2.84 ± 1.71 degrees and 3.06 ± 1.37 degrees. None of the above differences between the two groups reached statistical significance. The deviation of implants toward the mesial direction in dynamic CAIS group was significantly higher than that of the static CAIS (p = 0.032). CONCLUSIONS: Implant placement accuracy in single tooth space using dynamic CAIS appear to be the same to that of static CAIS. (Thai Clinical Trials Registry TCTR20180826001).

Since 1980 the amount of medical information has doubled approximately every second year. This implies that oral health students as well as professionals need to manage the flow of information rationally, in order to learn how to undertake evidence-based decision-making for diagnosis and treatment in a given patient situation. Current research indicates that computer connected databases and computer assisted learning (CAL) may enhance learning and provide the clinician with information for decision-making when treating patients. Multimedia for CAL, which combines audio and visual data in an interactive form, has proved to be an effective tool in education. CAL may supplement and reinforce more traditional learning and create opportunities to illustrate clinical situations in an interactive way. CAL has the potential to help students develop skills and knowledge. Students, staff and professionals consider CAL stimulating and motivating. Students easily adapt to CAL although their current computer literacy is still low. New authoring tools make it easier for faculties to develop their own CAL software. In the future we will see more sophisticated software with virtual patients who can communicate and interact with the student in a very realistic way. The software will even "step out" from the screen and help the student with clinical procedures. However, at present CAL should not replace traditional education, but rather be used more as a supplement and for self-directed studies.

The use of information technology (IT) in dentistry is far ranging. In order to produce a working document for the dental educator, this paper focuses on those methods where IT can assist in the education and competence development of dental students and dentists (e.g. e-learning, distance learning, simulations and computer-based assessment). Web pages and other information-gathering devices have become an essential part of our daily life, as they provide extensive information on all aspects of our society. This is mirrored in dental education where there are many different tools available, as listed in this report. IT offers added value to traditional teaching methods and examples are provided. In spite of the continuing debate on the learning effectiveness of e-learning applications, students request such approaches as an adjunct to the traditional delivery of learning materials. Faculty require support to enable them to effectively use the technology to the benefit of their students. This support should be provided by the institution and it is suggested that, where possible, institutions should appoint an e-learning champion with good interpersonal skills to support and encourage faculty change. From a global prospective, all students and faculty should have access to e-learning tools. This report encourages open access to e-learning material, platforms and programs. The quality of such learning materials must have well defined learning objectives and involve peer review to ensure content validity, accuracy, currency, the use of evidence-based data and the use of best practices. To ensure that the developers' intellectual rights are protected, the original content needs to be secure from unauthorized changes. Strategies and recommendations on how to improve the quality of e-learning are outlined. In the area of assessment, traditional examination schemes can be enriched by IT, whilst the Internet can provide many innovative approaches. Future trends in IT will evolve around improved uptake and access facilitated by the technology (hardware and software). The use of Web 2.0 shows considerable promise and this may have implications on a global level. For example, the one-laptop-per-child project is the best example of what Web 2.0 can do: minimal use of hardware to maximize use of the Internet structure. In essence, simple technology can overcome many of the barriers to learning. IT will always remain exciting, as it is always changing and the users, whether dental students, educators or patients are like chameleons adapting to the ever-changing landscape.