To compare the accuracy of implant placement using the conventional freehand method and a dynamic navigation system; to assess the role of the surgeon's experience in implant placement using these two methods. A randomized in-vitro study was conducted. Six resin mandible models and 36 implants were used. Two researchers with differing clinical experience (novice and experienced) placed implants using either the Navident dynamic navigation system (navigation group) or the conventional freehand method (freehand group). Accuracy was measured by overlaying the real position in the postoperative CBCT on the virtual presurgical placement of the implant in a CBCT image. Descriptive and bivariate analyses of the data were performed. The navigation group showed significantly higher accuracy for all the variables studied except 3D entry and depth deviation. This system significantly enhanced the accuracy of the novice professional in several outcome variables in comparison with the freehand implant placement method. However, when the implants were placed by the experienced clinician the dynamic navigation system only improved angulation deviation. Significant differences were found between the 2 professionals when the freehand method was employed. Similar deviations were observed for the implants placed with the navigation system. Dynamic computer assisted surgery systems allow more accurate implant placement in comparison with the conventional freehand method, regardless of the surgeon's experience. However, this system seems to offer more advantages to novice professionals, since it allows them to reduce their deviations significantly and achieve similar results to those of experienced clinicians.

Purpose: To determine the prevalence and describe the clinical features and treatment of patients with early infections after implant placement. Materials and Methods: A retrospective cohort study was performed. Postoperative infections were defined as the presence of purulent drainage and/or increasing pain and swelling in the operated area before prosthetic loading. Patient-based infection prevalences and 95% confidence intervals for implant were determined. Patients who healed, were followed up to determine implant survival and success rates. Results: Three hundred thirty-seven participants (1273 implants) were included. Twenty-two postoperative infections were recorded (6.5% of the patients and 1.7% of the implants). These complications were usually diagnosed within the first month, and in 17 cases (77.3%) surgical treatment was performed because of antibiotic therapy failure. Twelve implants (54.6%) in 12 patients (54.6%) failed before prosthetic loading. The survival and success rates of the infected loaded implants were 80% and 50%, respectively, with a mean follow-up of 42.9 months (SD of 10.2 months). Conclusion: Four to 10% of patients receiving dental implants develop postoperative infections. This complication is important because applied treatments are usually ineffective and two-thirds of the infected implants fail, most before prosthetic loading.

The implant abutment connection interface has been considered one of the major factors affecting the outcome of implant therapy. However, drawbacks of traditional meta-analyses are the inability to compare more than 2 treatments at a time, which complicates the decision-making process for dental clinicians, and the lack of a network meta-analysis. The purpose of this network meta-analysis was to assess whether the implant abutment connection influences the outcome of implant-supported prostheses. An electronic search was undertaken to identify all randomized clinical trials comparing the effect of at least 2 different implant abutment connection designs published from 2009 up to May 2020. Outcome variables were implant survival rate, peri-implant marginal bone loss, and biologic and prosthetic complication rates at 12 months after prosthetic loading. Relevant information was extracted, and quality and risk of bias assessed. Pairwise meta-analyses and network meta-analyses based on a multivariate random-effects meta-regression were performed to assess the comparisons (α=.05 for all analyses). For peri-implant marginal bone loss and prosthetic complications, conical interfaces were determined to be the most effective, with significant differences when compared with external hexagonal connections (P=.011 and P=.038, respectively). No significant differences were found among the implant abutment connections in terms of survival and biologic complications (P>.05 in all direct, indirect, and mixed comparisons). After 1 year of loading, conical connections showed lower marginal bone loss and fewer prosthetic complications than external hexagonal connections. However, the implant abutment connection design had no influence on the implant survival and biologic complication rates.

Clinicians frequently prescribe systemic antibiotics after lower third molar extractions to prevent complications such as surgical site infections and dry socket. A systematic review of randomised clinical trials was conducted to compare the risk of dry socket and surgical site infection after the removal of lower third molars with different prophylactic antibiotics. The occurrence of any antibiotic-related adverse event was also analysed. A pairwise and network meta-analysis was performed to establish direct and indirect comparisons of each outcome variable. Sixteen articles involving 2158 patients (2428 lower third molars) were included, and the following antibiotics were analysed: amoxicillin (with and without clavulanic acid), metronidazole, azithromycin, and clindamycin. Pooled results favoured the use of antibiotics to reduce dry socket and surgical site infection after the removal of a lower third molar, with a number needed to treat of 25 and 18, respectively. Although antibiotic prophylaxis was found to significantly reduce the risk of dry socket and surgical site infection in patients undergoing lower third molar extraction, the number of patients needed to treat was high. Thus, clinicians should evaluate the need to prescribe antibiotics taking into consideration the patient's systemic status and the individual risk of developing a postoperative infection.

Background: Wound infections after dental implant placement are a rare finding that might lead to early implant failure. However, the available information on this topic is scarce.Methods: This retrospective cohort study was conducted to determine factors that may increase the failure rate of dental implants that presented a postoperative infection during the osseointegration period. Postoperative infections were defined as the presence of pus or fistula in the surgical area, with pain or tenderness, swelling, redness, and heat or fever, before prosthetic loading. A bivariate and multivariate analysis of the data using Cox proportional‐hazards regression was performed to detect prognostic factors for implant failure in patients that suffer infections.Results: The patient‐based prevalence of postoperative infections after implant placement was 2.80% (95% confidence interval (95%CI): 2.04% to 3.83%). Thirty‐three out of 37 (89.19%) patients with infections had to be surgically retreated because of antibiotic failure and 65% of the infected implants were removed. The bivariate analysis showed a significant association between implant failure and the collar surface (HR: 3.12; 95% CI: 1.16 to 8.41; P = 0.014). Cox proportional‐hazards regression indicated that rough‐surfaced collars increased 2.35 times the likelihood of failure (95% CI: 0.87 to 6.37; P = 0.071).Conclusions: The survival of implants placed in the maxilla, with smooth collar, and late‐onset of infection was higher than those placed in the mandible, with a rough collar and early onset of infection. In general, signs of infection after dental implant placement compromises the survival rate of the affected fixtures.