This page brings together the scientific literature on which we base our approach to treatment at Apolonija Dental Clinic: guidelines and consensus statements of professional societies, systematic reviews, meta-analyses and long-term clinical studies. The literature is organised by service, and each paper comes with a short summary and a link to the source.
Fillings and tooth repair
Guidelines, consensus reports and official positions of professional societies
Dhar V et al. (2023). Evidence-based clinical practice guideline on restorative treatments for caries lesions: a report from the American Dental Association. J Am Dent Assoc. An American Dental Association guideline with 16 recommendations for the treatment of moderate and advanced carious lesions in vital, non-endodontically treated teeth. https://www.ada.org/resources/research/science/evidence-based-dental-research/caries-management-clinical-practice-guidelines/evidence-based-clinical-practice-guideline-on-restorative-treatments-for-caries-lesions/
Schwendicke F et al. (2016). Managing carious lesions: consensus recommendations on carious tissue removal. Adv Dent Res. Consensus of the International Caries Consensus Collaboration. Entry into the restorative cycle should be delayed as long as possible, and when a filling is indicated, the priorities are preserving healthy and remineralisable tissue, achieving a seal, maintaining pulp health and ensuring the longevity of the restoration. https://doi.org/10.1177/0022034516639271
Systematic reviews and meta-analyses
Fernández E et al. (2026). Clinical longevity of direct dental restorations: an umbrella review of systematic reviews. J Esthet Restor Dent. Sixteen systematic reviews and meta-analyses published between 2012 and 2025, covering more than 15,000 restorations with follow-up of 6 to 120 months. Conventional composites showed survival above 90% after 5 years, especially with multi-step adhesive systems. Bulk-fill composites give comparable short- and medium-term results, with failure rates below 7%, but there are not yet enough long-term data. https://doi.org/10.1111/jerd.70052
Opdam NJM et al. (2014). Longevity of posterior composite restorations: a systematic review and meta-analysis. J Dent Res. An analysis of 2,816 restorations from 12 longitudinal studies with at least 5 years of follow-up. The main reasons for failure were secondary caries and fracture, and patients at high caries risk and restorations involving several tooth surfaces had a significantly higher risk of failure. A reference paper explaining why the longevity of a filling depends on the patient as well, not only on the material. https://pubmed.ncbi.nlm.nih.gov/25048250/
Lewis SR et al. (2025). Restorative materials for the direct coronal restoration of permanent posterior dentition: an overview of systematic reviews. Cochrane Oral Health. A Cochrane review of the evidence on the effectiveness and longevity of materials for direct fillings in permanent posterior teeth, prepared in the context of the phase-down of amalgam. The abstract was published in 2025, and the full review is being published in the Cochrane Library. https://oralhealth.cochrane.org/news/mercury-free-restoration-materials-summary-evidence
Santos MJMC et al. (2025). Clinical longevity of complex direct posterior resin composite and amalgam restorations: a systematic review and meta-analysis. Oper Dent. For large multi-surface fillings, no statistically significant difference in failure rates was found between composite and amalgam. The most common reasons for failure of composite fillings were secondary caries and fracture of the filling or the tooth. https://pubmed.ncbi.nlm.nih.gov/40458903/
Tennert C et al. (2024). Longevity of posterior direct versus indirect composite restorations: a systematic review and meta-analysis. Dent Mater. Five randomised trials and 627 restorations. The annual failure rate was 0% to 5.4% for direct and 0% to 15.5% for indirect composite restorations, with a statistically significantly lower failure rate for direct fillings. The level of evidence is very low. https://pubmed.ncbi.nlm.nih.gov/39122602/
Huang X et al. (2025). The clinical performance of high-viscosity glass ionomer-based and bulk-fill resin-based restorations in permanent teeth with occlusal or proximal cavities: a systematic review and meta-analysis. Clin Oral Investig. A comparison of high-viscosity glass ionomer and bulk-fill composite fillings in occlusal and proximal cavities of permanent teeth. https://doi.org/10.1007/s00784-024-05371-3
Factors affecting the longevity of fillings
Santos MJMC et al. (2024). Multifactorial contributors to the longevity of dental restorations: an integrated review of related factors. Dent J 12(9):291. A review of tooth-, patient- and dentist-related factors that affect the lifespan of direct restorations. It notes that roughly half of all fillings placed in general practice are in fact replacements of existing, failed fillings. https://doi.org/10.3390/dj12090291
Professional teeth cleaning and prevention
Guidelines, consensus reports and official positions of professional societies
Sanz M et al. (2020). Treatment of stage I–III periodontitis — the EFP S3 level clinical practice guideline. J Clin Periodontol. The highest-level (S3) guideline of the European Federation of Periodontology, based on 15 systematic reviews. The first step of therapy includes motivating the patient to successfully remove supragingival biofilm, controlling risk factors, and professional mechanical removal of plaque and calculus. Removal of supragingival biofilm and calculus is considered a key component of primary and secondary prevention of periodontitis, as well as the basis of gum disease treatment. https://onlinelibrary.wiley.com/doi/10.1111/jcpe.13290
Herrera D et al. (2023). Prevention and treatment of peri-implant diseases — the EFP S3 level clinical practice guideline. J Clin Periodontol. The corresponding guideline for patients with implants. Prevention begins at the implant planning stage, and regular professional maintenance is the foundation for preventing peri-implant mucositis and peri-implantitis. https://onlinelibrary.wiley.com/doi/10.1111/jcpe.13823
Weyant RJ et al. (2013). Topical fluoride for caries prevention: executive summary of the updated clinical recommendations and supporting systematic review. J Am Dent Assoc. An American Dental Association guideline based on 71 clinical trials. For people at elevated caries risk, professional application of 2.26% fluoride varnish or 1.23% fluoride gel every three to six months is recommended, together with home use of fluoride gel or mouthrinse for those over 6 years of age. For children under 6, only fluoride varnish is recommended. Recommendations and patient materials are also available on the association’s website. https://jada.ada.org/article/S0002-8177(14)60659-0/fulltext
https://www.ada.org/resources/research/science/evidence-based-dental-research/topical-fluoride-clinical-practice-guideline
Regular cleaning visits and long-term effect
Axelsson P et al. (2004). The long-term effect of a plaque control program on tooth mortality, caries and periodontal disease in adults. Results after 30 years of maintenance. J Clin Periodontol. The most important study on the long-term value of regular professional maintenance. More than 550 adults were followed for 30 years in a plaque control programme tailored to each patient’s needs. Over three decades, only 0.4 to 1.8 teeth per person were lost, and the main reason for tooth loss was root fracture — only 21 teeth were lost due to progression of periodontitis or caries. The mean number of new carious lesions was 1.2 to 2.1, and most sites showed no loss of attachment. https://pubmed.ncbi.nlm.nih.gov/15312097/
Lee CT et al. (2015). Impact of patient compliance on tooth loss during supportive periodontal therapy. J Dent Res. A systematic review and meta-analysis of the relationship between regular attendance at maintenance therapy and tooth loss. Patients who regularly attended check-ups and professional cleaning lost significantly fewer teeth than those who attended irregularly, which is why adherence to a maintenance programme is considered one of the most important factors for long-term success. https://journals.sagepub.com/doi/abs/10.1177/0022034515578910
Fee PA et al. (2020). Recall intervals for oral health in primary care patients. Cochrane Database Syst Rev. A Cochrane review on the optimal interval between check-ups in general practice. No clinically important differences in gum bleeding or caries were found between six-month and risk-based recall intervals in adults, which supports scheduling appointments individually according to the patient’s risk. Open access. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004346.pub5/full
Lamont T et al. (2018). Routine scale and polish for periodontal health in adults. Cochrane Database Syst Rev. Two studies with a total of 1,711 adult patients in general dental practice. In adults without severe periodontitis who attend check-ups regularly, routine scaling and polishing over two to three years made little or no difference to gingivitis or probing depths. Patients nevertheless consistently reported that their teeth felt cleaner. Together with the previous papers, it confirms that cleaning frequency should be determined according to risk. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004625.pub5/full
Air-polishing and biofilm removal
Abdulbaqi HR et al. (2022). Efficacy of erythritol powder air-polishing in active and supportive periodontal therapy: a systematic review and meta-analysis. Int J Dent Hyg. Eight randomised trials. Air-polishing with erythritol powder gave results comparable to hand and ultrasonic instruments in reducing probing depth and bleeding, with a significant additional gain in clinical attachment when used as an adjunct to active therapy. Microbiological findings were the same, but patients found air-polishing considerably less painful and tolerated it better. https://pubmed.ncbi.nlm.nih.gov/34318577/
Yuan ZL et al. (2025). Clinical effects of erythritol, glycine and trehalose as subgingival air-polishing powders on non-surgical periodontal treatment: a systematic review with meta-analysis of randomized controlled trials. Front Physiol. Nine randomised trials and 462 patients. In a direct comparison of erythritol, glycine and trehalose, no statistically significant difference in probing depth reduction was found, although erythritol was ranked slightly better. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336208/
Divnic-Resnik T et al. (2022). The efficacy of the adjunct use of subgingival air-polishing therapy with erythritol powder compared to conventional debridement alone during initial non-surgical periodontal therapy. J Clin Periodontol. A randomised clinical trial on the added value of subgingival air-polishing with erythritol powder alongside conventional cleaning in initial non-surgical therapy. https://pubmed.ncbi.nlm.nih.gov/35373340/
Fluoridation and other preventive procedures
Marinho VCC et al. (2013). Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. Twenty-two randomised trials. Application of fluoride varnish two to four times a year, in both primary and permanent teeth, was associated with a substantial reduction in caries increment. The effect was present in populations with different caries risk and different exposure to other sources of fluoride. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD002279.pub2/full
Walsh T et al. (2019). Fluoride toothpastes of different concentrations for preventing dental caries. Cochrane Database Syst Rev. A review of the effect of different fluoride concentrations in toothpastes. Standard family toothpastes contain about 1,000 to 1,500 ppm fluoride, and the choice of concentration should be matched to the other fluoride sources the patient uses and, in young children, to the risk of fluorosis. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007868.pub3/full
Correct toothbrushing
Rajwani AR et al. (2020). Effectiveness of manual toothbrushing techniques on plaque and gingivitis: a systematic review. Oral Health Prev Dent. Thirteen studies on the effectiveness of individual brushing techniques — Bass, modified Bass, Charters, Fones, circular, roll and others. No technique proved consistently better than the others at removing plaque and reducing gingivitis. The authors conclude that there is not yet enough evidence to recommend a single “best” technique, so it matters more that patients brush thoroughly and for long enough than which exact technique they use. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11654539/
Yaacob M et al. (2014). Powered versus manual toothbrushing for oral health. Cochrane Database Syst Rev. Powered toothbrushes reduce plaque and gingivitis more than manual ones, both in the short and the long term, with the strongest evidence for oscillating-rotating brushes. The clinical significance of this difference remains unclear, and the side effects recorded were localised and transient. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD002281.pub3/full
Dağdeviren F et al. (2025). The effectiveness of power versus manual toothbrushes on plaque removal and gingival health in children — a systematic review and meta-analysis. Int J Dent Hyg. A more recent meta-analysis focusing on children who brush their own teeth, since only a small proportion of studies in the earlier Cochrane review included children and adolescents. There is moderate evidence that powered toothbrushes give children a small advantage in plaque removal over manual toothbrushes. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12516003/
Endodontic treatment of tooth roots
Fractures of endodontically treated teeth
Yoshino K et al. (2015). Prevalence of vertical root fracture as the reason for tooth extraction in dental clinics. Clin Oral Investig. In 24 dental practices over six months, 736 teeth were extracted in 626 patients. Vertical root fracture was the reason for extraction of 233 teeth (31.7%), and 93.6% of these teeth had been endodontically treated. Among the extracted non-vital teeth, 82.1% had a cast or screw post. In men, the proportion of extractions due to fracture increased with age. https://pubmed.ncbi.nlm.nih.gov/25398363/
Fuss Z, Lustig J, Tamse A (1999). Prevalence of vertical root fractures in extracted endodontically treated teeth. Int Endod J. A classic study of teeth referred for extraction. The main reasons were restorative (43.5%) and endodontic (21.1%), and vertical root fractures accounted for 10.9% of extractions. The authors note that the true proportion is probably higher, because a fracture is difficult to diagnose before extraction. https://pubmed.ncbi.nlm.nih.gov/10551119/
Patel S, Bhuva B, Bose R (2022). Present status and future directions: vertical root fractures in root filled teeth. Int Endod J. A review paper on vertical root fractures in treated teeth. Fracture is a common reason for extraction, diagnosis is demanding because clinical signs are often absent, and a conventional X-ray is often not enough. It stresses the importance of recognising predisposing factors: loss of hard tissue, posts and excessive canal enlargement. https://onlinelibrary.wiley.com/doi/10.1111/iej.13737
Haupt F, Wiegand A, Kanzow P (2023). Risk factors for and clinical presentations indicative of vertical root fracture in endodontically treated teeth: a systematic review and meta-analysis. J Endod. A systematic review and meta-analysis of the risk factors and clinical signs indicating a vertical root fracture in endodontically treated teeth. A reference paper for early clinical suspicion. https://pubmed.ncbi.nlm.nih.gov/37086847/
Prevalence of vertical root fractures in root filled teeth and their clinical and radiographic risk factors: a modern case-control analysis based on surgical diagnosis (2025). J Endod. An analysis of 411 treated teeth referred for endodontic surgery, with 130 fracture cases and 260 controls. The proportion of fractures in this group was 31.6%. Significant risk factors were age, a probing depth of 5 mm or more and an isolated perilateral radiolucency. https://www.jendodon.com/article/S0099-2399(25)00447-9/fulltext
Protecting the treated tooth with a crown or a cusp-covering restoration
Sequeira-Byron P et al. (2015). Single crowns versus conventional fillings for the restoration of root-filled teeth. Cochrane Database Syst Rev. The Cochrane review found only one randomised trial and therefore concludes that there is insufficient evidence from randomised trials to claim that a crown is better than a filling for every treated tooth. Until new evidence is available, the decision should be based on the condition of the individual tooth and clinical judgement. This paper supports the statement that a crown is not automatic after every root canal treatment. https://www.cochrane.org/CD009109/ORAL_single-crowns-or-routine-fillings-restoration-root-filled-teeth
Remaining tooth structure and prognosis of restored endodontically treated teeth: a systematic review (2025). A comparison of the survival of treated teeth restored with direct composite without cusp coverage and those restored with partial or full crowns, taking into account the amount of remaining tissue and the presence of a ferrule. In the short term both groups had very high survival, often 100% up to 36 months, while in the long term cusp coverage shows an advantage in structurally weakened teeth. The authors warn of the limited level of evidence. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12604680/
Stavropoulou AF, Koidis PT (2007). A systematic review of single crowns on endodontically treated teeth. J Dent. A systematic review reporting a ten-year survival of treated teeth with a crown of approximately 81%, compared with approximately 63% for teeth without crown coverage. https://pubmed.ncbi.nlm.nih.gov/17512103/
Survival and success rates of endodontically treated teeth restored with full veneer crowns or full cuspal coverage onlays: a systematic review (2023). Eleven studies. Overlay survival ranged from 95 to 100% after two years and from 90.7 to 100% after three years, and full crown survival from 84 to 97.7% over a period of five to ten years. It supports the practice of choosing a more conservative ceramic overlay instead of a crown for some teeth. https://pubmed.ncbi.nlm.nih.gov/37549135/
Reinforcement with glass-fibre composite
Fernández et al. (2026). Efficacy of short fiber-reinforced composite resins in MOD and endodontically treated posterior teeth: a systematic review. J Esthet Restor Dent. Laboratory studies consistently show higher fracture resistance and a higher proportion of repairable fractures with short-fibre composites compared with conventional composites, especially in large MOD cavities and endodontically treated teeth. Clinical studies with follow-up of up to four years show good survival and marginal adaptation, but no clear superiority over conventional composite. The authors conclude that the level of evidence is low for now. This paper also justifies the caveat in our text. https://onlinelibrary.wiley.com/doi/10.1111/jerd.70046
In vitro assessment of fracture resistance of endodontically treated teeth restored with short fiber reinforced resin based composite and ceramic overlays (2025). BMC Oral Health. Fifty premolars with MOD cavities after endodontic treatment. Teeth restored with a ceramic overlay and those restored with a composite containing fibres with a high length-to-thickness ratio showed the highest fracture resistance, with no significant difference between them. The authors conclude that short-fibre composite can be a conservative alternative to indirect restorations. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807320/
Bijelic-Donova J et al. (2022). Direct short-fiber reinforced composite resin restorations and glass-ceramic endocrowns in endodontically treated molars: a 4-year clinical study. Eur J Prosthodont Restor Dent. Four-year clinical follow-up of molars restored with direct short-fibre restorations and glass-ceramic endocrowns. https://pubmed.ncbi.nlm.nih.gov/35726526/
Tekçe N et al. (2020). Clinical performance of direct posterior composite restorations with and without short glass-fiber-reinforced composite in endodontically treated teeth: 3-year results. J Adhes Dent. A three-year clinical comparison of direct composite restorations with and without a short glass-fibre reinforced layer in endodontically treated teeth. https://pubmed.ncbi.nlm.nih.gov/32236402/
Number of visits and intracanal medication
Mergoni G et al. (2022). Single versus multiple visits for endodontic treatment of permanent teeth. Cochrane Database Syst Rev. The latest version of the Cochrane review on single-visit versus multiple-visit treatment. There is no evidence of a difference in healing between one and several visits; differences appear mainly in post-operative pain and analgesic use. https://pubmed.ncbi.nlm.nih.gov/36512807/
Sathorn C, Parashos P, Messer HH (2005). Effectiveness of single- versus multiple-visit endodontic treatment of teeth with apical periodontitis: a systematic review and meta-analysis. Int Endod J. A comparison of single-visit treatment without intracanal medication with multiple-visit treatment using calcium hydroxide for a week or longer, in teeth with apical periodontitis. No difference in healing rates was found. https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2591.2005.00955.x
Sathorn C, Parashos P, Messer H (2007). Antibacterial efficacy of calcium hydroxide intracanal dressing: a systematic review and meta-analysis. Int Endod J. A review of clinical studies on the extent to which calcium hydroxide in the canal actually eliminates bacteria. The effect is limited: in a considerable proportion of canals, bacteria can still be cultured after the medication has been used. https://pubmed.ncbi.nlm.nih.gov/17209826/
Evans M et al. (2002). Mechanisms involved in the resistance of Enterococcus faecalis to calcium hydroxide. Int Endod J. Explains the mechanism by which E. faecalis survives the alkaline environment of calcium hydroxide — a proton pump that maintains its intracellular pH balance. The basis for the claim that intracanal medication does not deal with precisely those bacteria that are most common in treatment failures. https://pubmed.ncbi.nlm.nih.gov/11985665/
Dental implants
Guidelines, consensus reports and official positions of professional societies
Schwarz F et al. (2026). First global consensus for clinical guidelines: structured recommendations (S2k-level guideline framework) for the rehabilitation of the edentulous maxilla based on core outcome sets. Clin Oral Implants Res. The first global consensus guideline, developed jointly by the European Association for Osseointegration (EAO), the ITI and the Osteology Foundation. The recommendations cover the entire course of treatment, from patient selection to long-term maintenance, with an emphasis on individualised oral hygiene instruction and regular check-ups for early detection of complications. https://onlinelibrary.wiley.com/doi/10.1111/clr.70084
Morton D et al. (2023). Group 5 ITI Consensus Report: implant placement and loading protocols. Clin Oral Implants Res. Report of the 7th Consensus Conference of the International Team for Implantology on implant placement and loading protocols and on patient selection criteria for immediate and early loading. It highlights primary stability as a key prerequisite for predictable osseointegration. https://onlinelibrary.wiley.com/doi/10.1111/clr.14137
Herrera D et al. (2023). Prevention and treatment of peri-implant diseases — the EFP S3 level clinical practice guideline. J Clin Periodontol. The highest-level guideline of the European Federation of Periodontology. Prevention of peri-implant diseases begins at the planning stage: it includes treating periodontitis before placement, an implant position that allows cleaning, a restoration shape accessible to oral hygiene, and a lifelong programme of professional maintenance. https://onlinelibrary.wiley.com/doi/10.1111/jcpe.13823
Implant survival and long-term outcomes
Howe MS et al. (2019). Long-term (10-year) dental implant survival: a systematic review and sensitivity meta-analysis. J Dent. Eighteen prospective studies with contemporary rough-surface implant systems. The pooled estimate of 10-year implant-level survival was 96.4%, with a prediction interval of 91.5% to 99.4%. A reference figure for discussing expected implant longevity with patients. https://pubmed.ncbi.nlm.nih.gov/30904559/
Derks J et al. (2015). Effectiveness of implant therapy analyzed in a Swedish population: early and late implant loss. J Dent Res. An analysis of 11,311 implants in 2,765 randomly selected patients from more than 800 practices — real-world data rather than selected samples from specialist centres. A significant difference in late implant loss was found between implant manufacturers. https://journals.sagepub.com/doi/10.1177/0022034514563077
Implant characteristics — what sets better solutions apart from weaker ones
Atieh MA et al. (2025). Peri-implantitis and survival outcomes of tissue level versus bone level dental implants: a systematic review and meta-analysis. Clin Exp Dent Res. Five randomised trials with 501 implants in 241 patients. Tissue-level implants showed lower rates of peri-implantitis and failure and smaller changes in probing depth than bone-level implants, but the differences were not statistically significant. Over one to five years of follow-up, both types showed comparable survival. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12529224/
Reis I et al. (2025). The prevalence of peri-implant mucositis and peri-implantitis based on the World Workshop criteria: a systematic review and meta-analysis. J Dent. The first reliable global estimates based on the standardised 2017 criteria. Roughly two in three adults with implants have peri-implant mucositis, and one in four has peri-implantitis. The strongest argument for a mandatory programme of regular check-ups after placement. https://pubmed.ncbi.nlm.nih.gov/40523497/
Transmucosal abutments and transmucosal height
Galindo-Moreno P et al. (2014). Prosthetic abutment height is a key factor in peri-implant marginal bone loss. J Dent Res. 131 patients and 315 implants with an internal conical connection. Abutment height was the main factor in marginal bone loss at 6 and 18 months after loading, with additional influence of the bone bed (native or augmented), periodontitis and smoking. Bone loss was not linear — it was greatest in the first six months. https://journals.sagepub.com/doi/abs/10.1177/0022034513519800
Chen Z et al. (2019). Influence of abutment height on peri-implant marginal bone loss: a systematic review and meta-analysis. J Prosthet Dent. Fourteen studies, eight of which were included in the meta-analysis. For bone-level implants, a long abutment significantly reduces early marginal bone loss compared with a short one. The evidence is insufficient to assess the effect on late bone loss or on tissue-level implants. https://www.sciencedirect.com/science/article/abs/pii/S0022391318309193
Muñoz et al. (2023). Influence of the abutment height on marginal bone level changes around two-piece dental implants: meta-analysis and trial sequential analysis of randomized clinical trials. Clin Oral Implants Res. A meta-analysis of randomised trials with additional trial sequential analysis. The advantage of tall abutments (at least 2 mm) over short ones is most pronounced early and evens out over time, yet it is precisely early bone loss that predisposes to further breakdown. The sequential analysis shows that there are not yet enough patients for a long-term conclusion. https://onlinelibrary.wiley.com/doi/10.1111/clr.14025
Linkevicius T et al. (2015). Influence of vertical soft tissue thickness on crestal bone changes around implants with platform switching: a comparative clinical study. Clin Implant Dent Relat Res. Vertical soft tissue thickness at the implant site affects marginal bone changes. With thin mucosa, bone loss was greater even with platform switching, which underpins the recommendation to augment thin mucosa or to choose a greater transmucosal height. https://pubmed.ncbi.nlm.nih.gov/24673875/
Distance of the crown margin from the bone and emergence profile
Derks J et al. (2016). Effectiveness of implant therapy analyzed in a Swedish population: prevalence of peri-implantitis. J Dent Res. 588 randomly selected patients examined nine years after therapy. Peri-implantitis was found in 45%, and moderate to severe peri-implantitis in 14.5%. A significantly higher risk was found for implants with the crown margin placed 1.5 mm or less from the bone crest, implants in the lower jaw, patients with periodontitis and with four or more implants, implants from certain manufacturers, and cases in which the prosthetics were made by a general dentist. The source of the 1.5 mm threshold used in risk assessment today. https://pubmed.ncbi.nlm.nih.gov/26701919/
Katafuchi M et al. (2018). Restoration contour is a risk indicator for peri-implantitis: a cross-sectional radiographic analysis. J Clin Periodontol. 83 patients and 168 implants with a mean follow-up of 10.9 years. A restoration emergence angle greater than 30 degrees is a significant risk indicator for peri-implantitis in bone-level implants, and a convex profile further increases the risk. No such association was found for tissue-level implants. The recommendation is a smaller emergence angle with a straight or concave profile in the proximal areas. https://onlinelibrary.wiley.com/doi/10.1111/jcpe.12829
Yi Y et al. (2020). Association of prosthetic features and peri-implantitis: a cross-sectional study. J Clin Periodontol. Independent confirmation of the association between prosthetic features — emergence angle and profile, accessibility for hygiene and type of retention — and the occurrence of peri-implantitis. https://pubmed.ncbi.nlm.nih.gov/31912511/
Chan D et al. (2019). The depth of the implant mucosal tunnel modifies the development and resolution of experimental peri-implant mucositis: a case-control study. J Clin Periodontol. The depth of the mucosal tunnel around the implant affects the development and resolution of experimentally induced peri-implant mucositis. A deeper tunnel makes recovery more difficult, linking prosthetic design to biological outcome. https://pubmed.ncbi.nlm.nih.gov/30638273/
The need for bone augmentation
ITI (International Team for Implantology) — consensus statements: Bone augmentation procedures in localized alveolar ridge defects. Survival rates of implants placed in regenerated bone after treatment of localised ridge defects are comparable to those of implants in native bone. It was not possible to demonstrate the superiority of one augmentation technique over another based on implant survival. https://academy.iti.org/academy/consensus-database/consensus-statement/-/consensus/bone-augmentation-procedures-in-localized-alveolar-ridge-defects/1210
ITI (International Team for Implantology) — consensus statements: Bone augmentation procedures in extended alveolar ridge defects. In extended ridge defects, implant survival rates are somewhat lower than in native bone. Lateral sinus floor elevation is predictable for augmentation in the posterior maxilla, and various materials — autogenous, allogeneic, xenogeneic and synthetic — can be used safely, alone or in combination. The quantity and quality of residual bone affect survival regardless of the type of augmentation. https://academy.iti.org/academy/consensus-database/consensus-statement/-/consensus/bone-augmentation-procedures-in-extended-alveolar-ridge-defects/1211
Uehara PN et al. (2018). Short dental implants (≤7 mm) versus longer implants in augmented bone area: a meta-analysis of randomized controlled trials. Open Dent J. Seven randomised trials. Short implants in an atrophic ridge showed survival comparable to longer implants in augmented bone, and marginal bone loss was statistically significantly lower in the short-implant group. A key paper for discussing with patients when augmentation can be avoided. Open access. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5958294/
Lee SA et al. (2014). Systematic review and meta-analysis of randomized controlled trials for the management of limited vertical height in the posterior region: short implants (5 to 8 mm) vs longer implants (>8 mm) in vertically augmented sites. Int J Oral Maxillofac Implants. Short implants can be a predictable alternative to longer implants with vertical augmentation, with fewer surgical complications and less burden for the patient. The conclusion should be taken with caution, as it is based on four studies with a risk of bias. https://pubmed.ncbi.nlm.nih.gov/25216134/
PRF (platelet-rich fibrin)
Strauss FJ et al. (2018). The use of platelet-rich fibrin to enhance the outcomes of implant therapy: a systematic review. Clin Oral Implants Res. A systematic review prepared for the European Association for Osseointegration (EAO) consensus conference. It concludes that PRF shows promising results in implant dentistry, but that the level of evidence is limited due to the wide variety of preparation protocols, small samples and short follow-up. https://pubmed.ncbi.nlm.nih.gov/30306698/
Miron RJ et al. (2025). Periodontal regeneration using platelet-rich fibrin. Furcation defects: a systematic review with meta-analysis. Periodontol 2000. The corresponding review for furcation defects, comparing PRF alone and in combination with bone substitutes and statins, with an analysis of vertical and horizontal gains in attachment and bone. https://onlinelibrary.wiley.com/doi/full/10.1111/prd.12583
Miron RJ et al. (2020). Use of platelet-rich fibrin for the treatment of gingival recessions: a systematic review and meta-analysis. Clin Oral Investig. A meta-analysis of PRF use in gingival recession coverage, compared with the connective tissue graft as the gold standard. Important for patient expectations: PRF shortens the procedure and avoids a second surgical site, but does not necessarily achieve the same root coverage. https://doi.org/10.1007/s00784-020-03400-7
Castro AB et al. (2017). Regenerative potential of leucocyte- and platelet-rich fibrin. Part B: sinus floor elevation, alveolar ridge preservation and implant therapy. A systematic review. J Clin Periodontol. Fourteen papers divided into three groups. In sinus floor elevation, with both lateral and transalveolar approaches, adding L-PRF to xenogeneic substitutes histologically accelerated bone healing. L-PRF alone better preserved ridge width and reduced buccal resorption compared with spontaneous healing. In implant therapy, better implant stability over time and less marginal bone loss were observed. https://onlinelibrary.wiley.com/doi/10.1111/jcpe.12658
Pan J et al. (2019). Effect of platelet-rich fibrin on alveolar ridge preservation: a systematic review. J Am Dent Assoc. A systematic review of PRF use in alveolar ridge preservation after tooth extraction, with data on preserved ridge width and height and fewer postoperative complaints. https://pubmed.ncbi.nlm.nih.gov/31439204/
Estrin NE et al. (2025). Analgesic effects of platelet-rich fibrin (PRF): a systematic review. Periodontol 2000. A review of the analgesic effect of PRF across various procedures, including third molar extraction. It pools data on pain intensity, analgesic use, swelling and trismus, and links them to the anti-inflammatory properties of the fibrin network. https://onlinelibrary.wiley.com/doi/10.1111/prd.70014
Vitamin D and osseointegration
Miron RJ et al. (2025). Relationship between vitamin D deficiency and early implant failure and osseointegration. Periodontol 2000. The most recent and most comprehensive review — 43 studies, 16 in animals and 27 in humans. Evidence from both groups strongly suggests that vitamin D deficiency impairs new bone formation and bone-to-implant contact. Supplementation, especially in patients with systemic diseases, may improve osseointegration, so the authors recommend preoperative testing and correction of vitamin D levels. https://pubmed.ncbi.nlm.nih.gov/41163589/
Mangano F et al. (2016). Is low serum vitamin D associated with early dental implant failure? A retrospective evaluation on 1625 implants placed in 822 patients. Mediators Inflamm. The largest single study on this topic — 1,625 implants in 822 patients, analysing the association between low serum vitamin D and early implant loss. https://doi.org/10.1155/2016/5319718
Alsulaimani L et al. (2022). The relationship between low serum vitamin D level and early dental implant failure: a systematic review. Cureus. A systematic review of the available clinical data on vitamin D levels and early implant loss. Reference values used: deficiency below 20 ng/mL, insufficiency 20 to 30 ng/mL, sufficient level above 30 ng/mL. https://doi.org/10.7759/cureus.21264
Other risk factors
Mustapha AD et al. (2021). Smoking and dental implants: a systematic review and meta-analysis. Medicina. Smoking is associated with a substantially higher risk of implant loss compared with non-smokers, which justifies advising patients to stop smoking before the procedure. Open access. https://pubmed.ncbi.nlm.nih.gov/35056347/
Häggman-Henrikson B et al. (2024). Bruxism and dental implants: a systematic review and meta-analysis. J Oral Rehabil. Implants placed in patients with bruxism have a higher risk of failure than in those without bruxism, which justifies a protective night guard and more careful occlusal planning. https://onlinelibrary.wiley.com/doi/10.1111/joor.13567
Dental crowns and bridges
Systematic reviews and meta-analyses — crowns
Sailer I et al. (2015). All-ceramic or metal-ceramic tooth-supported fixed dental prostheses (FDPs)? A systematic review of the survival and complication rates. Part I: single crowns. Dent Mater. Seventy-one studies. The five-year survival was 94.7% for metal-ceramic crowns, 96.6% for lithium disilicate glass-ceramic crowns and 92.1% for densely sintered zirconia crowns. Feldspathic ceramic crowns had significantly lower survival, especially in the posterior region, so they are recommended for anterior teeth only. https://pubmed.ncbi.nlm.nih.gov/25842099/
Pjetursson BE et al. (2018). A systematic review of the survival and complication rates of zirconia-ceramic and metal-ceramic single crowns. Clin Oral Implants Res. A review prepared for the 2018 ITI Consensus Conference, comparing zirconia-ceramic and metal-ceramic single crowns and analysing technical complications such as veneering ceramic chipping. https://onlinelibrary.wiley.com/doi/10.1111/clr.13306
Jung RE et al. (2012). Systematic review of the survival rate and the incidence of biological, technical, and aesthetic complications of single crowns on implants reported in longitudinal studies with a mean follow-up of 5 years. Clin Oral Implants Res. The reference review for single crowns on implants, with data on biological, technical and aesthetic complications over five years. https://pubmed.ncbi.nlm.nih.gov/23062124/
Systematic reviews and meta-analyses — bridges
Sailer I et al. (2007). A systematic review of the survival and complication rates of all-ceramic and metal-ceramic reconstructions after an observation period of at least 3 years. Part II: fixed dental prostheses. Clin Oral Implants Res. The five-year survival of metal-ceramic bridges was 94.4%, significantly higher than 88.6% for all-ceramic bridges. Framework and veneer fractures were considerably more frequent with all-ceramic bridges (6.5% and 13.6%) than with metal-ceramic ones (1.6% and 2.9%). https://pubmed.ncbi.nlm.nih.gov/17594373/
Pjetursson BE et al. (2007). Comparison of survival and complication rates of tooth-supported fixed dental prostheses (FDPs) and implant-supported FDPs and single crowns (SCs). Clin Oral Implants Res. A direct comparison of the five- and ten-year survival of bridges on natural teeth with bridges and crowns on implants, including biological and technical complications. Useful for explaining to patients when a tooth-supported bridge is a better choice than an implant. https://pubmed.ncbi.nlm.nih.gov/17594374/
Dental veneers
Systematic reviews and meta-analyses
Klein P et al. (2025). Survival and complication rates of feldspathic, leucite-reinforced, lithium disilicate and zirconia ceramic laminate veneers: a systematic review and meta-analysis. J Esthet Restor Dent. Twenty-nine studies and the most recent pooled data. After a mean of 10.4 years, survival was 96.13% for feldspathic ceramic, 93.70% for leucite-reinforced glass-ceramic and 96.81% for lithium disilicate, with no difference between materials. Lithium disilicate had the lowest complication rates (6.1% technical), while feldspathic veneers had the highest (41.48%). https://pubmed.ncbi.nlm.nih.gov/39523553/
Morimoto S et al. (2016). Main clinical outcomes of feldspathic porcelain and glass-ceramic laminate veneers: a systematic review and meta-analysis of survival and complication rates. Int J Prosthodont. The most frequently cited systematic review of ceramic veneer outcomes, with pooled data on survival and types of complications. https://pubmed.ncbi.nlm.nih.gov/26757327/
Alqutaibi AY et al. (2025). Clinical survival and complication rate of ceramic veneers bonded to different substrates: a systematic review and meta-analysis. J Prosthet Dent. Veneers bonded to enamel showed higher survival and success rates and fewer complications and failures than those bonded to dentin or to teeth with existing composite fillings. The best evidence for minimally invasive, enamel-preserving preparation. https://pubmed.ncbi.nlm.nih.gov/38604905/
Alenezi A et al. (2021). Long-term survival and complication rates of porcelain laminate veneers in clinical studies: a systematic review. J Clin Med. A review of long-term clinical studies on the survival and complications of porcelain veneers. https://pubmed.ncbi.nlm.nih.gov/33807504/
Layton DM et al. (2013). A systematic review and meta-analysis of the survival of non-feldspathic porcelain veneers over 5 and 10 years. Int J Prosthodont. A meta-analysis of the five- and ten-year survival of veneers not made of feldspathic ceramic. https://pubmed.ncbi.nlm.nih.gov/23476903/
All-on-4 fixed dentures
Guidelines, consensus reports and official positions of professional societies
ITI (International Team for Implantology) consensus statements: Loading Protocols for Fixed Prostheses in Edentulous Jaws. Immediate, early and conventional loading with a one-piece fixed provisional prosthesis show high implant and prosthesis success rates and can be recommended for both the upper and the lower jaw. The number, size and distribution of implants for a full-arch fixed prosthesis must be determined by the prosthetic plan, arch shape and bone volume, regardless of the loading protocol. Primary implant stability is key to predictable osseointegration. https://www.iti.org/academy/consensus-database/consensus-statement/-/consensus/loading-protocols-for-fixed-prostheses-in-edentulous-jaws/1313
Schwarz F et al. (2026). First Global Consensus for Clinical Guidelines: Structured Recommendations (S2k-Level Guideline Framework) for the Rehabilitation of the Edentulous Maxilla Based on Core Outcome Sets. Clin Oral Implants Res. The first global consensus guideline for the rehabilitation of the edentulous upper jaw, developed jointly by the European Association for Osseointegration (EAO), the ITI and the Osteology Foundation. The recommendations cover the entire course of treatment, from patient selection to long-term maintenance, with an emphasis on individualised oral hygiene instruction and regular check-ups for early detection of prosthesis wear and prevention of mechanical complications. https://onlinelibrary.wiley.com/doi/10.1111/clr.70084
Schwarz F et al. (2021). Recommendations for implant-supported full-arch rehabilitations in edentulous patients: The Oral Reconstruction Foundation Consensus Report. Int J Prosthodont. Consensus recommendations of six Oral Reconstruction Foundation working groups, with a decision tree for choosing the type of restoration and medical, geriatric and anatomical criteria for planning. https://pubmed.ncbi.nlm.nih.gov/33571323/
Morton D et al. (2023). Group 5 ITI Consensus Report: Implant placement and loading protocols. Clin Oral Implants Res 34(Suppl 26). Report of the 7th ITI Consensus Conference in Lisbon on implant placement and loading protocols, bringing together patient selection criteria for accelerated protocols. https://onlinelibrary.wiley.com/doi/10.1111/clr.14137
Herrera D et al. (2023). Prevention and treatment of peri-implant diseases — The EFP S3 level clinical practice guideline. J Clin Periodontol. The highest-level (S3) guideline of the European Federation of Periodontology on the prevention and treatment of peri-implant mucositis and peri-implantitis; the basis for the maintenance and check-up protocol after All-on-4 treatment. https://onlinelibrary.wiley.com/doi/10.1111/jcpe.13823
Systematic reviews and meta-analyses
Shao WH et al. (2026). All-on-4 and All-on-6 implant-supported fixed prostheses for the edentulous jaw: a systematic review and meta-analysis. Int J Oral Maxillofac Surg. Fifty-five studies. The pooled survival rate after 1 year was 99.20% for All-on-4 and 100% for All-on-6, and after 5 or more years 98.14% for All-on-4 and 97.50% for All-on-6. Marginal bone loss after 5 years was 1.28 mm and 0.94 mm, respectively. Mechanical complications were recorded in 5.91% (All-on-4) and 6.64% (All-on-6), and biological complications in 6.54% and 7.41%, respectively. Both techniques give comparable results. https://www.sciencedirect.com/science/article/pii/S0901502726001402
Del Fabbro M et al. (2022). Outcomes of fixed full-arch rehabilitations supported by tilted and axially placed implants: a systematic review and meta-analysis. Int J Oral Maxillofac Implants. A systematic review of the outcomes of fixed full-arch rehabilitations supported by a combination of tilted and axial implants. https://pubmed.ncbi.nlm.nih.gov/36170316/
Gaonkar S et al. (2021). Survival rates of axial and tilted implants in the rehabilitation of edentulous jaws using the All-on-four concept: a systematic review. J Indian Prosthodont Soc. The cumulative implant survival rate over 6 to 11 years was 94% to 98%, and prosthesis survival after 12 months was 99% to 100%. Mean bone loss was 1.3 ± 0.4 mm. No significant difference in survival was found between axial and tilted implants or between the upper and lower jaw. https://pubmed.ncbi.nlm.nih.gov/33835063/
Malak AA et al. (2024). Implant failure and marginal bone loss between axial and tilted implants: an umbrella review with meta-analysis. Int J Oral Maxillofac Implants. An umbrella review of systematic reviews. In the long term, a statistically significant difference in marginal bone loss was found between axial and tilted implants, but it amounts to only 0.18 mm, which is considered clinically negligible and does not affect implant survival. https://doi.org/10.11607/jomi.10885
Häggman-Henrikson B et al. (2024). Bruxism and dental implants: a systematic review and meta-analysis. J Oral Rehabil. Implants placed in patients with bruxism have a higher risk of failure than in those without bruxism. Relevant because bruxism is common in patients presenting for All-on-4 treatment, and it justifies a mandatory night guard. https://onlinelibrary.wiley.com/doi/10.1111/joor.13567
Mustapha AD et al. (2021). Smoking and dental implants: a systematic review and meta-analysis. Medicina 58:39. Smoking is associated with a substantially higher risk of implant loss compared with non-smokers, which justifies advising patients to stop smoking before the procedure. https://pubmed.ncbi.nlm.nih.gov/35056347/
Long-term clinical studies
Maló P et al. (2019). The All-on-4 treatment concept for the rehabilitation of the completely edentulous mandible: a longitudinal study with 10 to 18 years of follow-up. Clin Implant Dent Relat Res. The longest published follow-up of the All-on-4 concept in the lower jaw, with an implant survival rate of about 93% after 18 years. https://pubmed.ncbi.nlm.nih.gov/30924309/
Maló P et al. (2019). The All-on-4 concept for full-arch rehabilitation of the edentulous maxillae: a longitudinal study with 5–13 years of follow-up. Clin Implant Dent Relat Res. The corresponding follow-up in the upper jaw, with an implant survival rate of 94.7% over 13 years. https://doi.org/10.1111/cid.12771
Uesugi T et al. (2023). The All-on-four concept for fixed full-arch rehabilitation of the edentulous maxilla and mandible: a longitudinal study in Japanese patients with 3–17-year follow-up and analysis of risk factors for survival rate. Int J Implant Dent. Long-term follow-up with an analysis of risk factors for implant survival with immediate loading in both jaws. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10632321/
La Monaca G et al. (2022). Immediate flapless full-arch rehabilitation of edentulous jaws on 4 or 6 implants according to the prosthetic-driven planning and guided implant surgery: a retrospective study on clinical and radiographic outcomes up to 10 years of follow-up. Clin Implant Dent Relat Res 24:831–844. A direct comparison of rehabilitations on four and on six implants with guided surgery, with a cumulative survival rate of 89.7% for implants and 88.2% for prostheses in the All-on-4 group after 10 years. https://doi.org/10.1111/cid.13134
Prosthetic complications and materials
Papaspyridakos P et al. (2025). Zirconia full-arch implant prostheses: survival, complications, and prosthetic space dimensions with 115 edentulous jaws. J Prosthodont. One hundred and fifteen monolithic zirconia full-arch fixed prostheses followed for up to 6 years, with a prosthesis survival rate of 98.6%. The most common minor complications were loss of the screw access channel filling and ceramic chipping. https://onlinelibrary.wiley.com/doi/10.1111/jopr.13922
Papaspyridakos P et al. (2020). Technical complications and prosthesis survival rates with implant-supported fixed complete dental prostheses: a retrospective study with 1- to 12-year follow-up. J Prosthodont. A review of technical complications of full-arch fixed prostheses over a period of up to 12 years; useful as a realistic picture of the maintenance to be expected. https://pubmed.ncbi.nlm.nih.gov/31650669/
Function and patient-reported outcomes
Gonçalves GSY et al. (2022). Oral health-related quality of life and satisfaction in edentulous patients rehabilitated with implant-supported full dentures all-on-four concept: a systematic review. Clin Oral Investig. A systematic review of oral health-related quality of life and patient satisfaction after rehabilitation with the All-on-4 concept. https://doi.org/10.1007/s00784-021-04213-y
Sulaiman MA, Kriauciunas A (2025). Analysis of masseter muscle activity following treatment of fully edentulous patients with mono-arch and bi-arch All-on-4 prostheses: a systematic literature review. All included studies consistently show increased masseter muscle activity after rehabilitation with an All-on-4 prosthesis compared with other types of restoration, confirming improved chewing function. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12539608/
Removable dentures
Guidelines, consensus reports and official positions of professional societies
Thomason JM et al. (2009). Mandibular two implant-supported overdentures as the first choice standard of care for edentulous patients — the York Consensus Statement. Br Dent J. A consensus of the British Society for the Study of Prosthetic Dentistry, prepared as a follow-up to the 2002 McGill statement. There is a large body of evidence supporting the position that a two-implant overdenture in the lower jaw should be the minimum offered to edentulous patients as the first choice of treatment, instead of a conventional complete denture. https://www.nature.com/articles/sj.bdj.2009.728
Thomason JM et al. (2012). Two implant retained overdentures — a review of the literature supporting the McGill and York consensus statements. J Dent. A review of the evidence underpinning the McGill and York consensus statements, with data on patient satisfaction, quality of life, chewing function and costs. https://www.sciencedirect.com/science/article/pii/S0300571211002132
Schwarz F et al. (2021). Recommendations for implant-supported full-arch rehabilitations in edentulous patients: the Oral Reconstruction Foundation Consensus Report. Int J Prosthodont. Consensus recommendations from six working groups, with a decision diagram for choosing between removable and fixed restorations and medical, geriatric and anatomical criteria for planning. https://pubmed.ncbi.nlm.nih.gov/33571323/
Schwarz F et al. (2026). First global consensus for clinical guidelines: structured recommendations for the rehabilitation of the edentulous maxilla based on core outcome sets. Clin Oral Implants Res. A joint guideline of the EAO, the ITI and the Osteology Foundation covering both removable and fixed restorative options in the edentulous upper jaw. https://onlinelibrary.wiley.com/doi/10.1111/clr.70084
Treatment of jaw joint disorders and facial pain
Scientific research and clinical evidence
Lobbezoo F et al. (2018). International consensus on the assessment of bruxism: report of a work in progress. J Oral Rehabil. A consensus that separates the definitions of sleep bruxism and awake bruxism. It concludes that in otherwise healthy people bruxism is not a disease but a behaviour that can be a risk factor for certain conditions. It also proposes a grading system for the reliability of different methods of assessing bruxism. https://onlinelibrary.wiley.com/doi/10.1111/joor.12663
Del Sorbo D et al. (2026). Occlusal splint therapy in the management of temporomandibular disorders — evidence from systematic reviews. J Oral Rehabil. An umbrella review of 21 systematic reviews. Occlusal splints mostly show small favourable or neutral effects on pain and mouth opening. Twelve reviews compared splints with other conservative procedures: four found an effective reduction in pain, three did not, and five concluded that there is not enough evidence for or against splints compared with other active procedures. The methodological quality of the reviews varied widely. https://pubmed.ncbi.nlm.nih.gov/42059781/
Macedo CR et al. (2007). Occlusal splints for treating sleep bruxism (tooth grinding). Cochrane Database Syst Rev. A Cochrane review of splints for sleep bruxism. There is not enough evidence that a splint reduces bruxism activity itself, but it is considered justified for protecting the teeth from wear. A splint protects the teeth; it does not remove the cause of grinding. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005514.pub2/full
Villar-Aragón-Berzosa V et al. (2024). Manual therapy techniques versus occlusal splint therapy for temporomandibular disorders: a systematic review with meta-analysis. Dent J. Nine randomised trials and 426 patients directly comparing manual therapy with occlusal splint therapy, with outcomes for pain, maximum mouth opening, disability and health-related quality of life. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11593169/
Al-Moraissi EA et al. (2020). The hierarchy of different treatments for arthrogenous temporomandibular disorders: a network meta-analysis of randomized clinical trials. J Craniomaxillofac Surg. A network meta-analysis that sets out a hierarchy of treatments for TMD of joint origin, from conservative to minimally invasive and surgical. A reference paper for deciding when to move on to arthrocentesis or arthroscopy. https://pubmed.ncbi.nlm.nih.gov/31870713/
Derwich M et al. (2021). Mechanisms of action and efficacy of hyaluronic acid, corticosteroids and platelet-rich plasma in the treatment of temporomandibular joint osteoarthritis — a systematic review. Int J Mol Sci. Sixteen studies. Arthrocentesis alone effectively reduces pain and improves jaw function in joint osteoarthritis, while additional injections of hyaluronic acid or corticosteroids at the end of arthrocentesis do not improve the final clinical results. Corticosteroids also have several adverse effects on the articular cartilage. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8308010/
Haddad C et al. (2023). Platelet-rich plasma injections for the treatment of temporomandibular joint disorders: a systematic review. J Oral Rehabil. A review of the evidence on platelet-rich plasma injections into the joint, with data on pain and jaw mobility and on the methodological limitations of studies to date. https://pubmed.ncbi.nlm.nih.gov/37341166/
Shalish et al. (2024). The association between orthodontic treatment and temporomandibular disorders diagnosis and disease characteristics. J Oral Rehabil. Participants who had undergone orthodontic treatment had lower levels of TMD pain, less chewing muscle tenderness, fewer tender muscles and lower verbal pain scores than those who had not. The smaller number of tender muscles remained statistically significant after multivariate analysis. Diagnosis was based on a questionnaire and clinical examination according to the RDC/TMD criteria. https://onlinelibrary.wiley.com/doi/full/10.1111/joor.13630
Almalki SA et al. (2024). Impact of clear aligner therapy on masticatory musculature and stomatognathic system: a systematic review conducted according to PRISMA guidelines and the Cochrane handbook for systematic reviews of interventions. BMC Oral Health. Clear aligner therapy shows a variable effect on the chewing muscles, with a possible initial worsening of symptoms followed by improvement. Pain increased markedly at first, and a significant reduction in bite force was also recorded. The authors link the transient increase in muscle activity to the occlusal changes introduced by the aligners. https://pubmed.ncbi.nlm.nih.gov/38504207/
Jamali Z et al. (2022). Effect of the posterior stop on temporomandibular disorders: a systematic review. J Dent Res Dent Clin Dent Prospects. A systematic review of the effect of lost posterior occlusal support on temporomandibular disorders, with data on chewing muscle pain, limitation and deviation of movement, and headaches. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9871174/
Tabatabaei S et al. (2024). The effect of tooth loss on the temporomandibular joint space: a CBCT study. Clin Exp Dent Res. One hundred and eleven patients divided into three groups according to the Eichner index. In the group with the greatest loss of support zones, the condyles were positioned lower and further back than in the groups with preserved support. The authors conclude that greater loss of support zones is associated with posterior and inferior displacement of the condyles and explicitly stress the importance of replacing missing teeth to restore occlusal support and halt the progression of temporomandibular disorders. https://pubmed.ncbi.nlm.nih.gov/38345478/
Chantler J et al. (2024). Importance of an evaluation phase when increasing the occlusal vertical dimension: a systematic review. J Esthet Restor Dent. One randomised trial and 103 non-comparative papers on increasing the occlusal vertical dimension as part of extensive rehabilitation. Of the 103 papers, 80 included a trial period of adaptation to the new vertical dimension and 23 did not. Relevant to the decision on a trial phase before definitive rehabilitation in patients with muscle symptoms. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076109/
Treatment of periodontitis
Guidelines, consensus reports and official positions of professional societies
Sanz M et al. (2020). Treatment of stage I–III periodontitis — the EFP S3 level clinical practice guideline. J Clin Periodontol. The fundamental European guideline, based on 15 specially commissioned systematic reviews and the GRADE methodology. It introduces stepwise treatment: the first step covers motivation, oral hygiene and professional removal of deposits, the second subgingival instrumentation, the third re-evaluation and surgical procedures, and the fourth lifelong supportive periodontal therapy. Open access. https://onlinelibrary.wiley.com/doi/10.1111/jcpe.13290
Tonetti MS et al. (2018). Staging and grading of periodontitis: framework and proposal of a new classification and case definition. J Periodontol. The classification from the 2017 World Workshop, which divides periodontitis into stages I to IV by severity and complexity and into grades A to C by rate of progression. The basis for explaining to patients how advanced the disease is and what the risk is. https://doi.org/10.1002/JPER.18-0006
Non-surgical treatment
Suvan J et al. (2020). Subgingival instrumentation for treatment of periodontitis. A systematic review. J Clin Periodontol. A systematic review commissioned for the EFP guideline. It confirms the effectiveness of non-surgical subgingival instrumentation as the foundation of treatment and finds that hand, sonic and ultrasonic instruments give comparable clinical results. https://onlinelibrary.wiley.com/doi/10.1111/jcpe.13245
Teughels W et al. (2020). Adjunctive effect of systemic antimicrobials in periodontitis therapy: a systematic review and meta-analysis. J Clin Periodontol. An analysis of the added value of systemic antibiotics alongside subgingival cleaning in randomised trials with at least six months of follow-up. Important for explaining why antibiotics are not routinely given to every patient. https://pubmed.ncbi.nlm.nih.gov/31994207/
Supportive therapy and long-term outcomes
Axelsson P et al. (2004). The long-term effect of a plaque control program on tooth mortality, caries and periodontal disease in adults. Results after 30 years of maintenance. J Clin Periodontol. More than 550 adults were followed for 30 years in a plaque control programme tailored to each patient’s needs. Over three decades, only 0.4 to 1.8 teeth were lost per person, and just 21 teeth due to progression of periodontitis or caries. https://pubmed.ncbi.nlm.nih.gov/15312097/
Lee CT et al. (2015). Impact of patient compliance on tooth loss during supportive periodontal therapy. J Dent Res. A systematic review and meta-analysis. Patients who attended supportive therapy regularly lost significantly fewer teeth than those who attended irregularly, which is why adherence to the maintenance programme is considered one of the most important factors in long-term success. https://journals.sagepub.com/doi/abs/10.1177/0022034515578910
Teeth whitening
Systematic reviews and meta-analyses
Eachempati P et al. (2018). Home-based chemically-induced whitening (bleaching) of teeth in adults. Cochrane Database Syst Rev. Seventy-one trials with 3,780 adults. All the products tested — carbamide peroxide and hydrogen peroxide gels in trays, strips, paint-on gels, chewing gums and mouthwashes — whitened teeth compared with placebo over periods of 2 weeks to 6 months, but the certainty of the evidence is low to very low. There is not enough evidence that any concentration, method of application or duration is better than another. Open access. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006202.pub2/full
de Oliveira MN et al. (2024). Assessment of color changes and adverse effects of over-the-counter bleaching protocols: a systematic review and network meta-analysis. Clin Oral Investig. A network meta-analysis of colour change and side effects of over-the-counter whitening products. Useful for comparison with dentist-supervised whitening. https://pubmed.ncbi.nlm.nih.gov/38430338/
Cabral AEA et al. (2024). Effectiveness of desensitizing toothpastes in reducing tooth sensitivity after tooth bleaching: a systematic review. Clin Oral Investig. A review of how effective desensitising toothpastes are at reducing sensitivity after whitening — the most common side effect of the procedure, which is temporary but very important to patients. https://pubmed.ncbi.nlm.nih.gov/39078468/
