Percorrer por autor "Madruga, David"
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- Occlusal vs non-occlusal modality of the loading protocol for oral implants in partially edentulous patients : a systematic review and meta-analysisPublication . Kourkoutis, Panagiotis; Shado, Rawand; Pereira, Ines Novo; Madruga, David; Hassan, HaidarBackground: Occlusal loading refers to a modality in which an implant-supported prosthesis is subjected to functional loading, maintaining contact with the opposing dentition from the onset of prosthetic placement. In contrast, non-occlusal loading represents a non-functional approach, wherein a provisional implant prosthesis is initially placed in infra-occlusion or fully relieved of contact with the opposing dentition, which is subsequently (at a later stage) followed by functional (occlusal) loading with the definitive prosthesis. Aim: To compare clinical outcomes in partially edentulous cases following an occlusal modality of loading versus non-occlusal modality of loading. Method: A search on Pubmed, Scopus and Embase databases was conducted to identify randomised controlled trials (RCTs) comparing occlusal versus non-occlusal modalities of implant loading in partially edentulous patients receiving implants with single crowns or fixed bridges, between January 1 (2004) to June 12 (2024), examining implant survival, complications and marginal bone loss (MBL) of implants. The inclusion criteria involved RCTs of evidence level II (Oxford Centre for Evidence-Based Medicine Levels of Evidence). For assessing bias in the included studies, the Cochrane Risk of Bias tool was used. Results: This review identified seven RCTs investigating 273 implants over 1–3 years follow-up periods. seven studies reported 1-year MBL data and three reported 3-year data. Publication bias was noted at the 1-year follow-up (p < 0.01) but not at 3 years (p > 0.05). Differences in MBL were not statistically significant at both 1 year (Hedges’ d = 0.01, p = 0.920, 95% CI: [−0.21, 0.24]) and 3 years (Hedges’ d = 0.01, p = 0.952, 95% CI: [−0.28, 0.30]). Differences in complication occurrences were not statistically significant (RR = 0.882, p = 0.759, 95% CI: [0.397, 1.964]). The nature of data on implant survival rates prevented a meaningful meta-analysis. Conclusion: For short-term periods of 1–3 years, no significant evidence supports clinical superiority in terms of complication rates and MBL between non-occlusal and occlusal modalities of implant loading. Future studies should explore functional and aesthetic aspects, as well as patient reported outcomes to determine any short-term differences or consider long-term follow-up with large sample sizes to detect significant clinical differences.
- Patient reported pain following tooth extraction with different autologous platelet concentrates : systematic reviewPublication . Hassan, Haidar; Shado, Rawand; Pereira, Ines Novo; Madruga, DavidBackground: Autologous platelet concentrates (APCs) have played a significant role in regenerative dentistry, with clinical evidence suggesting its benefits over controls. Particularly, APCs could reduce postoperative pain following tooth extractions. Aim: To compare patient reported pain after tooth extractions using different autologous platelet concentrates (APCs) such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF). Method: A search on Pubmed, Scopus, Embase and Google Scholar databases was conducted to identify human studies using APC(s) in extraction sockets between January 2014 and June 2024. This review followed the PRISMA guidelines. The inclusion criteria involved comparative human studies ranging from evidence levels II to III (Oxford Centre for Evidence-Based Medicine Levels of Evidence). For assessing bias in the included studies, the Cochrane Risk of Bias tools were used. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to determine the quality of evidence available. Results: This review identified 8 studies; with 338 extraction sites in total and 1–15 days pain follow up. Four studies showed no statistically significant difference in postoperative pain reduction between PRP and PRF. One study observed no statistically significant difference between leukocyte-rich PRF (L-PRF) and titanium-prepared PRF (T-PRF). One study indicated that advanced platelet-rich fibrin (A-PRF) is superior to PRF in reducing postoperative pain on day 2 postoperatively. In addition, two studies reported that A-PRF is more effective than L-PRF on day 2. Moderate-to-high risk of bias was identified within 75% of the selected papers. GRADE score for evidence quality assessment was ‘Low’. Conclusion: A-PRF was favoured to reduce postoperative pain on day 2 among the investigated APCs, although the GRADE criteria rate the evidence as “Low”. Future trials should directly compare A-PRF with PRF and L-PRF using high-quality randomized controlled designs.