In conclusion, the benefit of rough surfaces relative to minimally rough ones in this loaded animal model was confirmed histologically. The comparison of different surface treatment modalities revealed no significant differences between the modern moderately rough surfaces. Resonance frequency analysis seems to be influenced in a major part by the transducer used, thus prohibiting the comparison of different implant systems.

ObjectiveImpaired health conditions and related lack of adequate host healing are among the most important conditions that account for dental implant failure. Today clinicians face an increasing number of immunocompromised patients requesting implant-based rehabilitation. To provide clinical evidence for prospective decision-making, the aim of this systematic review and meta-analysis was to analyse the influence of immunodeficiency on dental implant survival.MethodsThe study was conducted according to the PRISMA Statement and the principles of the Cochrane Collaboration. MEDLINE and Web of Science were searched. Results were calculated by the pooled incidence of implant loss. Reported odds ratios (OR) from fully adjusted models were preferred. Distinct risk estimates were synthesised with 95% confidence intervals.ResultsA total of 62 publications including 1751 endosseous implants placed in immunocompromised patients were included. For the follow-up of 24 months and longer, the mean survival rate of implants in patients with HIV was 93.1%, chemotherapy was 98.8%, autoimmune disease was 88.75%, after organ transplantation was 100%. Crohn’s disease showed a significant effect on early implant failure and resulted in increased, however not significant, implant loss.ConclusionNo significant effect of immunocompromised conditions on implant survival was detectable. Implant-based therapy in immunocompromised patients should not aggravate the general morbidity and must not interfere in life-saving therapies. A careful risk stratification prior implant therapy is fundamental. To further decipher the role of immunosuppression on dental implantology, more data from controlled and randomised studies are needed.

W e read with great interest the recent article "Diagnosis and Management of Osteonecrosis of the Jaw: A Systematic Review and International Consensus" by Khan and colleagues. (1) Medication-related osteonecrosis of the jaw (MRONJ) is a potentially severe adverse side effect of antiresorptive agents, and although a significant body of literature has been produced, there remains little evidence-based guidance for clinicians with respect to most aspects of this disease. Therefore, we applaud the attempt of Khan and colleagues to provide a much-needed systematic review.However,itisimportantthatanyreviewonthistopicisaddressed on the basis of the best available evidence and a balanced analysis of the literature. More importantly, systematic reviews require rigorous research methods and a clear and transparent presentation of results in order to limit bias and maximize readability. (2)(3)(4) In the work of Khan and colleagues, (1) we have identified several issues that we suggest carry a risk of affecting the validity of their results.Assessing the risk of bias is a crucial part of systematic reviews. (5,6) Khan and colleagues presented the criteria they used to assign level of evidence and grade recommendations, but unfortunately provided little information regarding qualitative assessment of reviewed studies, related risk of bias, as well as the process of article selection. Overall, it is hard to understand how and why articles were selected or excluded.The presentation of data on incidence and prevalence makes the interpretation of the results difficult. It is well established that incidence data without definition of a time period can be meaningless; (7) nevertheless, results upon incidence of MRONJ are in several instances presented without mentioning the relevant time frame. There are also inconsistencies between different sections of the article: For example, in the abstract, it is stated that "in the osteoporosis patient population MRONJ incidence is estimated at 0.001 to 0.01%," whereas different figures are reported in the results (0.15% to <0.001% personyears of exposure). Furthermore, the authors state that the prevalence of MRONJ in the oncological setting ranges from "0 to 0.186%" whereas the work of Walter and colleagues, which they cite, reports a prevalence of 18.6%. (8) Khan and colleagues report that the incidence of MRONJ in the osteoporosis population would only be "marginally higher than the incidence in the general population," which in the abstract is reported to be <0.001%. (1) This statement is quite

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