ORCID Profile
0000-0002-7181-0006
Current Organisations
University of Queensland
,
Universidad de Castilla-La Mancha
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Publisher: Wiley
Date: 15-05-2018
DOI: 10.1111/JERD.12385
Abstract: The purpose of this retrospective study was to investigate the influence of implant placement timing on the esthetic outcomes for single implants in the anterior maxilla. One hundred and ten patients (48 males 62 females) who received a single-tooth implant after extraction either immediately (Type 1) after 4-8 weeks (Type 2) after 8-16 weeks (Type 3) or more than 16 weeks (Type 4) were evaluated in terms of esthetic outcomes after a mean post-placement interval of 26.3 months (range 12-116). Esthetic outcomes were measured using the Pink and White Esthetic Score (PES WES). Stepwise regression analysis was performed to analyze the effect of timing of placement, as well as patient demographics and other clinical parameters on the esthetic outcomes. No statistically significantly differences in PES were found between the various treatment modalities with Type 1 implants (n = 33) scoring 10.58 ± 1.65 (median: 11), followed by 10.36 ± 2.09 (median: 10.5), 9.68 ± 2.43 (median: 10), and 9.63 ± 2.21 (median: 10) for Type 2 (n = 14), Type 3 (n = 19), and Type 4 (n = 44), respectively. For immediate implants, a trend towards better esthetic outcomes was observed when implant placement was done flaplessly in cases with intact buccal bone (Type 1A, median PES 11) as compared to cases with partial/complete missing buccal plates where a flap was raised (Type 1B, median PES 10). Overall, the only parameter that influenced esthetic outcomes (as measured by PES) was gender, with females having significantly superior results. The median WES was 8 and 96% of the crowns were deemed esthetically acceptable, with crowns placed by specialist prosthodontists yielding higher scores than those placed by general practitioners. Single tooth implants in the anterior maxilla showed satisfactory outcomes when measured with objective esthetic criteria. Timing of implant placement did not significantly influence the esthetic outcomes, although a trend towards better outcomes was seen with immediate implant placement as observed by higher median PES values. Single tooth implant placement in the anterior maxilla is a predictable treatment modality for achieving acceptable esthetic outcomes regardless of the timing of placement.
Publisher: Wiley
Date: 11-2018
DOI: 10.1111/CLR.13378
Abstract: This prospective study evaluated the impact of timing of placement (immediate and early) on the horizontal ridge dimensional changes, clinical, and aesthetic outcomes of implants placed in single-tooth gaps in the anterior maxilla. Implants were placed in single-tooth gaps in the anterior maxilla of 30 patients, either immediately after extraction (Group A, n = 15) or after a healing period of 4-8 weeks (Group B, n = 15). In both groups, implant placement was followed by a 3- to 4-month period of non-submerged healing, after which definitive crowns were placed. Study models were obtained before extraction (T0), at implant placement (T1), at the insertion of a definitive crown (T2), and 1-year thereafter (T3). Horizontal ridge dimensional changes were measured by superimposing the optical scans of the study models from different time-points. Radiographs and photographs were used to evaluate changes in marginal bone levels and soft tissue recession. Aesthetic evaluation was carried out using the Pink and White Esthetic Score (PES and WES) indices. Patient-reported outcomes were measured using a subjective questionnaire. A 100% implant survival rate was observed in both groups after a 1-year follow-up. Analysis showed a labial horizontal tissue dimensional change of 0.61 mm and 0.72 mm from T0 to T3 in Groups A and B, respectively. Acceptable PES values were observed in both groups (Group A: 9.40 Group B: 9.27) after the 1-year follow-up period. No incidence of advanced mucosal recession was observed between definitive crown insertion and 1-year follow-up in both groups. No significant changes were observed for all other measured variables at different time-points. Immediate and early placed implants in single-tooth gaps in the anterior maxilla showed similar ridge dimensional changes as well as acceptable clinical, aesthetic, and patient-centred outcomes in the short-term (1-year follow-up).
Publisher: Wiley
Date: 16-02-2018
DOI: 10.1111/CLR.13125
Abstract: To evaluate the impact of the timing of restoration on clinical and aesthetic outcomes following immediate implant placement in the maxillary aesthetic zone. Forty patients (16 males, 24 females) with a mean age of 50.55 ± 12.79 years (range 19-74) who had a single maxillary anterior tooth replaced by an immediate implant were included in this study. Twenty patients had their implant restored immediately with a provisional restoration (Group A), while the other 20 patients had a delayed restoration placed after 3-4 months of non-submerged healing (Group B). Clinical parameters and hard-tissue changes were evaluated after a mean follow-up period of 3 years. Aesthetic evaluation was carried out using the Pink Esthetic Score (PES) and the White Esthetic Score (WES). No significant differences were observed in the bone level changes between the two groups: 0.05 ± 0.65 mm mesially and 0.06 ± 0.52 mm distally for the immediate group and 0.30 ± 0.54 mm mesially and 0.21 ± 0.60 mm distally for the delayed group, respectively. The median PES scores were 11.5 for Group A and 10 for Group B. Mean PES and WES scores did not differ significantly between Groups A and B: PES (11.1 vs. 10.3 p = .16) and WES (8.4 vs. 7.8 p = .16). In terms of in idual PES variables, the distal papillae were significantly better in Group A as compared to Group B (p = .006). Within the limits of this study, timing of restoration seemed to positively affect the aesthetic outcomes of immediately placed implants as evidenced by higher median PES values for the immediate restoration group when compared to the delayed restoration group. Restoration timing had no impact on the in idual PES variables, except for the distal papillary height which was superior in the immediate restoration group.
Publisher: Georg Thieme Verlag KG
Date: 2016
Abstract: Objective: The aim of this study was to determine any relationship, if exists, between the patient's mental attitude with age, sex, or educational qualification. Methods: A total of 200 patients who attended the outpatient department during a span of 1 year, for the fabrication of new complete dentures, were chosen for the study. After completing a routine case history and examination, a questionnaire was filled by the clinician as answered by the patient. Participants were evaluated and categorized based on the questionnaire and clinical experience during treatment according to a predefined classification of determining mental attitudes. Outcomes from the survey were correlated with participant gender, age, and educational status. Results: The male to female ratio was 83:117, out of the 200 enrolled participants. The results from the questionnaire showed that females were found to be more exacting (P = 0.007) in nature, while males, on the other hand, revealed more indifferent attitude (P = 0.02) both differences being statistically significant. Of the three age group categories: Participants in the age group of 45–54 years revealed a significant inclination toward an exacting attitude when compared with other age groups (P 0.001). In regards to educational status, an illiterate or minimally educated group significantly outnumbered the college graduates in the indifferent attitude group (P 0.001). Conclusions: Within the limitations of this study, it could be said that the mental attitudes of patients could vary according to gender, age, and educational status, which could affect patient cooperation and satisfaction with oral rehabilitation, eventually manipulating the overall success of the treatment rendered.
Publisher: Wiley
Date: 21-08-2020
DOI: 10.1002/CRE2.241
Publisher: Peter Lang D
Date: 02-02-2017
DOI: 10.3726/B10693
Publisher: Wiley
Date: 29-07-2016
DOI: 10.1111/CLR.12939
Abstract: This study evaluated the correlation between pre-operative buccal cortical bone thickness and peri-implant tissue response following immediate placement and restoration of implants in the maxillary aesthetic zone. Eighteen patients (3 males, 15 females) with an age range of 19-57 years requiring the replacement of a single maxillary anterior tooth were included in this prospective study. Patients were selected on the basis of defined criteria: intact socket walls, absence of any acute infection in the sockets, absence of any gingival marginal pathology and attainment of a high primary stability (≥30 Ncm) at implant placement. Regardless of buccal bone thickness, all participating patients underwent the same treatment strategy that involved removal of the failed tooth, flapless surgery, immediate implant placement, grafting of the implant-socket gap and connection of a screw-retained provisional restoration. Buccal bone thickness was evaluated using pre-operative CBCT scans. Intra-oral photographs were taken before implant placement (baseline) and at 1- and 2-year follow-up to assess soft tissue changes around the implants. Aesthetic evaluation was carried out using the pink esthetic score (PES). All implants remained osseointegrated during the follow-up period of 2 years with mesial papilla, distal papilla, and mid-facial gingiva showing a mean recession of 0.06 ± 0.71 mm, 0.25 ± 0.78 mm, and 0.22 ± 0.83 mm, respectively. Pink esthetic score values improved from a median value of 9 (IQR 8.75-10.25) pre-operatively to 11 (IQR 9.75-12) at the end of 2 years. No significant correlation was found between buccal bone thickness (range 0.45-1.24 mm) and soft tissue or aesthetic changes. Within the limits of this study, no significant correlation could be found between pre-operative buccal bone width and the soft tissue and aesthetic outcome following immediate implant placement and restoration in the anterior maxilla. Therefore, favourable clinical and aesthetic outcomes could be achieved by applying a strict selection criteria and treatment protocol regardless of the initial thickness of the buccal bone.
Publisher: Wiley
Date: 21-04-2017
DOI: 10.1111/CID.12487
Abstract: Immediate implant placement followed by an immediate restoration has proven to be a viable technique in the anterior maxillary region. This prospective study evaluated the mid-long term (2-5 years) tissue changes around immediately placed and restored implants in the anterior maxilla using flapless surgery and simultaneous hard tissue augmentation. Thirty AstraTech implants were immediately placed in 30 patients, followed by the delivery of an immediate provisional restoration on the same day. All participating 30 patients underwent the same treatment strategy that involved flapless removal of a failing maxillary anterior tooth, immediate implant placement, simultaneous augmentation with a deproteinized particulate xenograft, followed by the connection of a screw-retained provisional restoration. Radiographs and photographs were used to measure hard and soft tissue changes. Aesthetic evaluation was performed using the Pink Esthetic Score (PES). All implants remained osseointegrated during the follow up period of 2-5 years (mean 47 ± 15 months). Twelve of the thirty patients completed the 5 year follow up. Radiographic evaluation revealed average gains in bone levels of 0.18 and 0.34 mm mesially and distally, respectively. Soft tissue evaluation showed a mean tissue loss of 0.05 ± 0.64 mm and 0.16 ± 0.63 mm at the mesial and distal papillae, respectively, while mid-facial mucosal recession was 0.29 ± 0.74 mm. A significant improvement in the Pink Esthetic Scores was seen at the final follow-up (mean PES 11.50), as compared to the baseline (mean PES 10.27) (P = .001). In addition to a favorable implant success rate and peri-implant bony response, the soft tissue levels and overall aesthetics around single immediately placed and restored implants can also be maintained in the mid-long term.
Publisher: MDPI AG
Date: 06-05-2021
DOI: 10.3390/PROSTHESIS3020014
Abstract: The nature of immediate implant placement followed by an immediate restoration protocol makes it particularly suited to the anterior maxilla. In addition to saving treatment time and avoiding additional surgical procedures, this protocol has been reported to improve aesthetic outcomes by supporting the peri-implant tissues during the implant healing phase through the use of a provisional restoration. This case report documents the use of this protocol in a patient with a failing maxillary anterior tooth and reports on the soft and hard tissue changes over an observation period of 10 years. An implant was immediately placed after removal of a failing maxillary central incisor followed by the provision of a screw retained provisional crown on the same day. A definitive restoration was placed after a 3-month healing period. Not only did this protocol manage to maintain peri-implant bone levels over the 10-year follow-up period, excellent aesthetic outcomes and very limited soft tissue recession were observed with the use of this technique.
Publisher: Wiley
Date: 21-04-2016
DOI: 10.1111/JRE.12386
Abstract: The aim of this review was to evaluate the outcomes of preclinical trials that assessed the use of melatonin as a pro-osteogenic agent in the field of oral implantology. Melatonin is a hormone that has been shown to have beneficial antioxidant and bone-metabolic effects. A number of experimental studies have analysed its effect in promoting osseointegration around dental implants in animals. A bibliographic search in PubMed, Scopus and EBSCOhost was performed. Animal studies that quantitatively analysed the pro-osteogenic effect of melatonin were included. Quality assessment of the included studies was performed using the ARRIVE guidelines. Eight studies met the inclusion criteria. The experimental animals used were dogs, rabbits and rats. Melatonin was used in a lyophilized powdered form, an injectable form or as a dipping solution. Six of the eight studies included showed a statistically significant positive effect of melatonin on bone-implant contact and various other histomorphometric parameters. The ARRIVE criteria were generally well reported by the included studies (17.5 ± 1.60/24), although several criteria (including randomization and blinding) were poorly documented, with most of the studies showing a high/unclear risk of bias. The majority of the studies included showed a statistically significant positive effect of melatonin on bone formation around implants. However, the clinical significance of this effect was unclear given the high/unclear risk of bias in the majority of included studies. Given the limited amount of data available, further research should be conducted to evaluate the clinical potential of this pineal hormone in clinically relevant situations, such as compromised sites or patients.
Publisher: MDPI AG
Date: 20-04-2021
Abstract: Purpose: Mini-dental implants (MDIs) have been used to support and retain overdentures, providing patients with a less invasive placement procedure. Although lucrative, the use of MDIs to retain a maxillary overdenture is still not an established treatment modality. This systematic review aims to answer the question: Do mini-implant-retained maxillary overdentures provide a satisfactory treatment outcome for complete edentulism? Methods: A systematic search for relevant articles was conducted to include articles published until April 2021 in the following electronic databases: CINAHL, Cochrane, EMBASE, PubMed, and Web of Science. All empirical studies evaluating the biological, survival, or patient-reported outcomes after placing mini-implant-retained overdentures in maxilla were considered for inclusion. The risk of bias was assessed by utilizing the Joanna Briggs Institute critical appraisal checklist. Study screening and data extraction were conducted by three reviewers independently. Results: The electronic search retrieved 1276 titles after omitting duplicates. Twenty articles were considered for full-text review, of which six studies were included in this systematic review. The included studies evaluated a total of 173 participants with a mean age of 66.3 years. The overall mini-implant survival rate was 77.1% (95% CI: 64.7–89.5%) with a mean follow-up time of 1.79 years (range: 6 months to 3 years). Implant survival differed significantly when comparing complete and partial palatal coverage overdentures. Those with complete palatal coverage exhibited less bone loss overall compared to partial coverage overdentures. Participants of all studies reported an increase in the quality of life and in satisfaction after rehabilitation treatment with MDIs. Conclusions: The survival rate of mini-implants retaining an overdenture in the maxilla was observed to be lower than the values reported for traditional implants in the literature. Improvements were observed in all aspects in terms of patient satisfaction, quality of life, oromyofunction, and articulation after the treatment.
Publisher: Wiley
Date: 12-2015
Abstract: The aim of this review is to assess the outcome of single-tooth immediate implant placement and restoration (IPR) in the maxillary anterior region, with a particular emphasis on soft tissue and esthetic outcomes. An electronic search in Medline, EBSCOhost, and Ovid (PubMed) was performed to identify studies that reported on soft tissue outcomes following immediate placement and restoration of implants in the maxillary esthetic region with a mean follow-up of ≥1 year. Nineteen studies on single implants inserted immediately into fresh extraction sockets and provisionally restored in the maxillary esthetic region were included. Soft tissue changes were found to be acceptable, with most studies reporting mean gingival recession of 0.27 ± 0.38 mm and mean papillary height loss of 0.23 ± 0.27 mm after follow-up of ≥1 year. Advanced buccal recession (>1 mm) occurred in 11% of cases. Long-term follow-up studies (>2 years) reported that the interdental papillae, in particular, showed a tendency to rebound over time. The few studies that reported on patient-centered outcomes showed a high level of patient satisfaction with the outcomes of IPR treatment. The IPR protocol resulted in generally acceptable soft tissue and esthetic outcomes, with suboptimal results reported in ≈11% of low-risk cases. Factors such as preoperative tissue biotype or use of a flap or connective tissue graft did not significantly influence soft tissue and esthetic outcomes. Long-term prospective controlled clinical trials are necessary to identify factors that may influence the esthetic outcomes associated with IPR.
No related grants have been discovered for Himanshu Arora.