A meta-analysis of implants in partial edentulism

Comparative Biomechanical Evaluation of Novel Screwless Retained Dental Implant Prosthesis: A 3D Finite Element Analysis

This study aimed to comparatively evaluate the biomechanical behaviors of three types of dental implant restorations: a screw-and-cement-retained prosthetic system (SCRP); a cementless screw-retained prosthetic system (SRP); and a novel screwless hook-retained prosthetic system (HRP). Three-dimensional finite element analysis (FEA) was used to evaluate biomechanical behavior. A comparative study of three dental implant prostheses was performed under two loading conditions: a vertical load of 100 N and an oblique load of 100 N at an angle of 30°. Under both loading conditions, the maximum von Mises stress values in the dental implant using the HRP system were lower (21.33 MPa) than those of the SCRP system (32.91 MPa), and the stress distribution of the implant prosthetic components tended to be more favorable than that of the SCRP system. Thus, the results show that the performance of the HRP system was comparable to that of a conventional SRP system under the same conditions. Regarding stress distribution, the novel screwless HRP system presents a viable alternative implant prosthodontic system to the conventional SCRP system.

Retrospective Assessment of Endodontically Treated Teeth Replaced by Dental Implants

INTRODUCTION

This study investigated endodontically treated teeth that were replaced by dental implants at the University of North Carolina (UNC) at Chapel Hill School of Dentistry. The primary objective of this study was to determine the reasons leading to the extraction of endodontically treated teeth and their subsequent replacement with dental implants. The secondary objective was to evaluate the proportion of these teeth that, according to experienced endodontists, could have been preserved.

METHODS

The UNC-Chapel Hill's dental electronic health records between 2004 and 2019 were probed for implant placement that replaced root canal-treated teeth. Preextraction radiographs and clinical charts were examined to ascertain the primary reason related to the extraction and to compile a profile for each case. In cases in which endodontic failure was the primary reason for extraction, radiographs and clinical findings were evaluated by 2experienced endodontists to assess potential treatment options.

RESULTS

Between 2004 and 2019, 29.3% (1564 of 5229) of teeth replaced by dental implants at UNC School of Dentistry had undergone root canal treatment, with the mandibular first molar being the most commonly replaced tooth. The leading reasons for extraction were recurrent caries associated with defective restoration (26.6%), fracture of coronal structure (21.5%), vertical root fracture (20.9%), compromised periodontal condition (13.8%), and endodontic failure (2.4%). Two experienced endodontists evaluated extractions due to endodontic failure and concluded that 61.7% of them could have been candidates for endodontic retreatment.

CONCLUSION

Substantial loss of tooth structure was the leading cause of extraction of root canal-treated teeth, followed by vertical root fracture and periodontal disease. Although endodontic failure constituted a minor portion of the reasons for extraction, a considerable number of teeth were extracted due to vertical root fractures following root canal treatment. A significant proportion of the extracted teeth due to endodontic failure could have been considered as potential candidates for endodontic retreatment.

An In Vivo Investigation of Non-Metallic vs. Metallic Hand Scalers on Zirconia Implant-Supported Crowns: A Year-Long Analysis of Peri-Implant Maintenance

This study examined whether the degree of abutment surface modification that may occur with regular periodontal instrumentation has a clinical impact in terms of increased plaque accumulation and increased peri-implant tissue inflammation on zirconia implant abutments. Thirteen patients who had zirconia implant crowns were recruited in this randomized clinical trial. Each patient acted as their control and had either the buccal or lingual surface of their screw-retained implant restoration scaled with a metallic scaler and the other surface with a non-metallic scaler at 3, 6, 9, and 12 months. Cytokine testing of the peri-implant crevicular fluid was completed at 0, 3, and 12 months for IL-2, IL-4, IL-6, IL-8, IL-10, TNF-α, or IFNγ. Implant crowns were removed at 12 months and evaluated under an atomic force microscope for the average roughness (Ra). The implant crowns were polished and re-inserted. The results were analyzed using the Kruskal-Wallis test, and post hoc tests were conducted with a significance level of α = 0.05. Significant differences in surface roughness (Ra) were observed between the metallic and non-metallic scalers. The median Ra values were 274.0 nm for metallic scalers and 147.1 nm for non-metallic scalers. However, there were no significant differences between the type of scaler used and the amount of clinical inflammation or cytokine production. Metallic scalers produced deeper, more aggressive surface alterations to the abutment/crown zirconia surface, but there was no statistically significant difference between the degree of surface alterations, amount of BOP, and the amplitude of cytokine inflammation produced.

Comparing the Long-Term Success Rates of Tooth Preservation and Dental Implants: A Critical Review

Implant therapy is considered a predictable, safe, and reliable rehabilitation method for edentulous patients in most clinical scenarios. Thus, there is a growing trend in the indications for implants, which seems attributable not only to their clinical success but also to arguments such as a more "simplified approach" based on convenience or the belief that dental implants are as good as natural teeth. Therefore, the objective of this critical literature review of observational studies was to discuss the evidence concerning the long-term survival rates and treatment outcomes, comparing endodontically or periodontally treated teeth with dental implants. Altogether, the evidence suggests that the decision between keeping a tooth or replacing it with an implant should carefully consider the condition of the tooth (e.g., amount of remaining tooth and degree of attachment loss and mobility), systemic disorders, and patient preference. Although observational studies revealed high success rates and long-term survival of dental implants, failures and complications are common. For this reason, attempts should be made to first save maintainable teeth over the long-term, instead of immediately replacing teeth with dental implants.

Effects of TiS2 on Inhibiting Candida albicans Biofilm Formation and Its Compatibility with Human Gingival Fibroblasts in Titanium Implants

Titanium is widely used in medical devices, such as dental and orthopedic implants, due to its excellent mechanical properties, low toxicity, and biocompatibility. However, the titanium surface has the risk of microbial biofilm formation, which results in infections from species such as Candida albicans (C. albicans). This kind of biofilm prevents antifungal therapy and complicates the treatment of infectious diseases associated with implanted devices. It is critical to developing a feasible surface to decrease microbial growth while not interfering with the growth of the host cells. This study reports the influence of titanium surface modification to titanium disulfide (TiS₂) on inhibiting C. albicans biofilm formation while allowing the attachment of human gingival fibroblasts (HGFs) on their surface. The surface of titanium parts is directly converted to structured titanium and TiS₂ using direct laser processing and crystal growth methods. C. albicans adhesion and colonization are then investigated on these surfaces by the colony counting assay and reactive oxygen species (ROS) assay, using 2',7'-dichlorofluorescin diacetate (DCFH-DA) and microscopy images. Also, the viability and adhesion of HGFs on these surfaces are investigated to show their adhesion and biocompatibility. Titanium samples with the TiS₂ surface show both C. albicans biofilm inhibition and HGF attachment. This study provides insight into designing and manufacturing titanium biomedical implants.

An innovative application of pre-medicated collagen sponges with regenerative biomaterials for management of an infected extraction socket: A case report

Localized infection of the extraction socket can compromise bone quality and quantity within the socket and bone support for the adjacent dentition. These events can preclude immediate rehabilitative interventions, such as implant placement, and increase the technical sensitivity of guided bone regeneration procedures for successful tissue and bone gain. The use of local scaffolds containing effective antimicrobial agents may suppress local infection and facilitate the regenerative process related to the introduced bone graft particles and barrier collagen membrane. In this case report, pre-medicated collagen sponges containing chlorhexidine and metronidazole were used in conjunction with a bone graft and collagen membrane for guided tissue and bone regeneration, which was followed by delayed implant placement with 2 years of follow-up evaluations.

Reoperation on an Implant-Supported Restoration in the Maxillary Anterior Region to Correct a Complex Aesthetic Deficit

Introduction

In an era in which patients are becoming more and more demanding and in which there are many ways to satisfy their needs, modern implantology must consider the correct management of soft tissues during treatment planning, aiming for both functional and aesthetic rehabilitation while creating a prosthetic construction that is in harmony not only with the natural dentition of the patient but also with their face. The patient who came to our notice had a rehabilitative prosthetic implant on the left central incisor area, which did not satisfy any functional or aesthetic parameter. Furthermore, he presented an altered passive eruption in the contralateral hemiarch.

Materials and Methods

The prosthetic crown was removed, the tissues were studied, and the team decided to proceed with customizing a provisional restoration that would cause the soft tissues to descend. A surgical periodontal procedure was then performed to solve the altered passive eruption condition that was also compromising the aesthetics. In conclusion, a permanent prosthetic crown was fixed into place. Discussion. Using a periodontal approach that was both surgical and prosthetic, the patient was rehabilitated correctly regaining both functions and aesthetics. It is of fundamental importance that each step in the procedure is carefully programmed; otherwise, the risk of making mistakes increases and solving the problems becomes less simple or less immediate. In order to do this, one must bear in mind that certain clinical cases can apparently concern just one tooth, yet the mouth must be considered as a whole, both functionally and aesthetically. To perform an optimal implantology, the clinician should be an expert in periodontology so that they can plan and, should it be necessary, perform all the therapeutical options (surgical and nonsurgical) that can lead to the best possible result.

Conclusions

The resolution of this complex clinical case has been documented in order to share useful advice for the resolution of analogous cases. We strongly advise that each proposed procedure be planned meticulously and that the periodontological aspect of the case never be separated from the prosthetic or the implantological aspects since the integration of the periodontal tissues is of vital importance for both the functional and the aesthetic results.

Root Membrane Replantation as an Alternative Technique for the Socket Preservation

Background and Overview. Socket shield is a technique that allows the maintenance of tissue volumes. In the reported clinical case, the replantation of the buccal root fragment mistakenly extracted during a socket shield surgery is performed. We present a follow-up to 5 years with an unexpected healing.Case Description. An 88-year-old patient underwent an immediate loading implant placement associated with the replantation of the mistakenly extracted root fragment. The shaping of the fragment was performed extraorally, and the replantation was done so that the fragment protruded above the crest margin.Conclusions and Practical Implications. The 5-year follow-up shows an uneventful healing of the implant. At 48 months, postoperative CBCT exam reports images compatible with the regeneration of the bone over the portion of root that protruded over the margin. The outcome suggests clinical implications, as the opportunity to easily shape the fragment extraorally and replant sound portion of the root (not necessary the buccal) in buccal socket with bone defect.

In vivo efficacy of low-level laser therapy on bone regeneration

PURPOSE

In clinical use of low-level laser therapy for bone regeneration (LLLT), application protocol (dose, duration, and repetitions) has not been established. This study aimed to depict a reliable dosage of LLLT by evaluating the efficacy of different dosing of LLLT (diode) on the healing of rabbit cranial defects.

METHODS

Critical size defects were prepared in calvarias of 26 New Zealand White Rabbits in such each animal containing both test and control groups. Test groups were irradiated with 4 Joule/cm² (j/cm²), 6 j/cm², and 8 j/cm². The rabbits were subjected to six times of laser treatments in 10 days. At the end of the second week, 5 rabbits were sacrificed for histopathological and immunohistochemical analyses. At the 4th and 8th weeks, 20 rabbits (10 each) were sacrificed for micro-CT and histopathological analyses.

RESULTS

Micro-CT evaluation revealed improved new bone formation in all test groups compared to the control group. 6 j/cm² group demonstrated the highest bone formation. The highest bone morphogenic protein -2 levels were found in the 4 j/cm² group. Osteocalcin expression was significantly higher in 4 j/cm² group.

CONCLUSIONS

Our findings indicate that LLLT have a positive effect on new bone formation. The high efficacy of doses of 4 j/cm² and 6 j/cm² is promising to promote early bone healing.

Success rate of nitrous oxide-oxygen procedural sedation in dental patients: systematic review and meta-analysis

The aim of this systematic review was to determine the success rate of nitrous oxide-oxygen procedural sedation (NOIS) in dentistry. A systematic digital search was conducted for publications or reports of randomized controlled trials evaluating the clinical performance of NOIS. Abstracts of research papers were screened for suitability, and full-text articles were obtained for those who met the inclusion and exclusion criteria accordingly. The quality of the studies was assessed using the revised Cochrane risk-of-bias tool (RoB 2). A total of 19 articles (eight randomized clinical trials with parallel intervention groups and 11 crossover trials), published between May 1988 and August 2019, were finally selected for this review. The studies followed 1293 patients reporting NOIS success rates, with a cumulative mean value of 94.9% (95% CI: 88.8–98.9%). Thirteen trials were conducted on pediatric populations (1098 patients), and the remaining six were conducted on adults (195 patients), with cumulative efficacy rates of 91.9% (95% CI: 82.5–98.1%) and 99.9% (95% CI: 97.7–100.0%), respectively. The difference was statistically significant (P = 0.002). Completion of treatment and Section IV of the Houpt scale were the most used efficacy criteria. Within the limitations of this systematic review, the present study provides important information on the efficacy rate of NOIS. However, further well-designed and well-documented clinical trials are required and there is a need to develop guidelines for standardization of criteria and definition of success in procedural sedation. Currently, completion of treatment is the most used parameter in clinical practice, though many others also do exist at the same time. To maximize NOIS efficacy, clinicians should strictly consider appropriate indications for the procedure.

Immediate Implant Placement and Provisionalization in the Esthetic Zone: A 6.5-Year Follow-Up and Literature Review

The success of dental implant therapy in the esthetic zone requires not only functional osseointegration but also a satisfactory esthetic outcome. To establish harmony, balance, and continuity of gingival architecture between an implant restoration and the adjacent natural dentition is challenging. Immediate implant placement and provisionalization following tooth extraction have been documented as a predictable treatment modality, with fewer surgical interventions needed, to replace a missing tooth in the esthetic zone. This case report illustrates immediate implant placement and provisionalization to replace a failing maxillary right central incisor while maintaining optimal gingival esthetics. The maxillary right central incisor was extracted without flap elevation to minimize soft and hard tissue trauma. Immediately afterwards, the implant was installed using a surgical stent and restored with a provisional crown that had no occlusal contacts. During healing, no significant adverse effects were observed clinically or radiographically. This proposed treatment modality provided the patient with immediate esthetics, function, and comfort without any complications during a follow-up period of 6.5 years.

A deep learning approach for dental implant planning in cone-beam computed tomography images

Background

The aim of this study was to evaluate the success of the artificial intelligence (AI) system in implant planning using three-dimensional cone-beam computed tomography (CBCT) images.

Methods

Seventy-five CBCT images were included in this study. In these images, bone height and thickness in 508 regions where implants were required were measured by a human observer with manual assessment method using InvivoDental 6.0 (Anatomage Inc. San Jose, CA, USA). Also, canals/sinuses/fossae associated with alveolar bones and missing tooth regions were detected. Following, all evaluations were repeated using the deep convolutional neural network (Diagnocat, Inc., San Francisco, USA) The jaws were separated as mandible/maxilla and each jaw was grouped as anterior/premolar/molar teeth region. The data obtained from manual assessment and AI methods were compared using Bland–Altman analysis and Wilcoxon signed rank test.

Results

In the bone height measurements, there were no statistically significant differences between AI and manual measurements in the premolar region of mandible and the premolar and molar regions of the maxilla (p > 0.05). In the bone thickness measurements, there were statistically significant differences between AI and manual measurements in all regions of maxilla and mandible (p < 0.001). Also, the percentage of right detection was 72.2% for canals, 66.4% for sinuses/fossae and 95.3% for missing tooth regions.

Conclusions

Development of AI systems and their using in future for implant planning will both facilitate the work of physicians and will be a support mechanism in implantology practice to physicians.

Clinical outcomes of single implant supported crowns versus 3-unit implant-supported fixed dental prostheses in Dubai Health Authority: a retrospective study

Background

This study assessed retrospectively the clinical outcomes of single implant-supported crowns and implant-supported fixed dental prostheses (FDPs).

Methods

This case series compared biological and technical complications in single implant-supported crowns and implant-supported bridges in a time framed sample of all patients who received dental implants between 2009 and 2016 in Dubai Health Authority. Only 3-unit implant-supported prostheses (FDPs) with one intervening pontic and an implant each end were included for comparison to single crown supported implants. Cantilevered implants, implant-supported dentures and cases involving bone grafts or sinus lifts were excluded. The primary outcome measure was marginal bone loss, measured on digital radiographs taken after prosthesis placement at baseline and one year after implant loading, whilst peri-implantitis and technical complications were secondary outcomes. Mixed regression models adjusted for clustering of implants within patients was used for patient and implant factor associations.

Results

A total of 454 patients (152 males; 302 females) had 1673 implants. The mean age of males (53.7 years, SD 14.6) was significantly greater than females (49.3 years, SD 12.9, p < 0.001). Mean mesial bone loss on the FDPs was significantly greater at 1 year (1.14 mm, SD 0.63) compared with the mesial surface of single implant-supported crowns (0.30 mm, SD 0.43, p < 0.001). Mean distal bone loss was also significantly greater at 1 year on the distal surfaces of implants supporting bridgework (1.29 mm, SD 0.71) compared with distal surfaces on single implant-supported crowns (0.36 mm, SD 0.54, p < 0.001). Mean marginal bone loss mesially and distally around implants placed in the lower anterior sextant was significantly greater compared to all other sites (p < 0.001). Bone loss by gender, patient’s age and medical condition was not different between the 2 implant groups. Screw loosening was the main technical complication (11.5%) whilst peri-implantitis occurred rarely (0.5%). The 66 cement retained implants had significantly more complications compared to the 1607 screw retained implants (p < 0.001).

Conclusions

Mean marginal bone loss around the supporting implants of FDPs (3-unit fixed bridgework) was greater than on single implant-supported crowns at one year after implant loading. Position in the mouth was associated with bone loss. Biological and technical complications occurred rarely.

Long-term outcomes of adjacent and antagonistic teeth after implant restoration: a focus on patient-related factors

Purpose

To investigate factors affecting the antagonistic and adjacent teeth in patients after implant restoration and prosthetic rehabilitation.

Methods

In total, 160 patients who visited Kyungpook National University Dental Hospital for implant surgery, prosthesis placement, and supportive periodontal therapy (SPT) were included in this study. The average follow-up period was 88.06 months, and the maximum was 175 months. Patients’ history of smoking, diabetes, hypertension, and osteoporosis was investigated, and panoramic radiographs were taken after surgery and prosthetic treatment. During the follow-up period, extraction and prosthetic/endodontic treatments of the antagonistic and adjacent teeth were analyzed. The statistical analyses were performed using descriptive statistics, the chi-square test, the Fisher exact test, and multiple logistic regression analyses.

Results

Treatment was performed on 29.4% of the studied antagonistic teeth with extraction performed in 20.0% and prosthetic treatment in 10.0%. Furthermore, 19.4% of the studied adjacent teeth underwent treatment, of which extraction was performed in 12.5% and prosthetic treatment in 7.5%. The treatment rate for adjacent teeth was 25.3% in smokers, which was higher than that of non-smokers (12.3%) (P=0.039). Patients who were non-adherent to SPT showed a significantly higher rate (19.6%) of antagonistic prosthetic treatment than did those who were adherent (5.5%) (P=0.006).

Conclusions

Implant restoration can affect the adjacent and antagonistic teeth. Smoking, osteoporosis history, and absence of SPT may be risk factors for the treatment of the adjacent and antagonistic teeth.

In vitro Candida albicans biofilm formation on different titanium surface topographies

Objectives

To investigate if differences in titanium implant surface topography influence Candida albicans biofilm formation.

Materials and Methods

Titanium discs were prepared and characterized using a profilometer: Group A (R_a 0.15 µm, smooth), Group B (R_a 0.64 µm, minimally rough) and Group C (R_a 1.3 µm, moderately rough). Contact angle and surface free energy (SFE) were determined for each group. Non-preconditioned titanium discs were incubated with C. albicans for 24 h. In additional experiments, the titanium discs were initially coated with human saliva, bovine serum albumin or phosphate-buffered saline for 2 h before incubation with C. albicans for 24 h. The amount of fungal biofilm formation was quantified using a colorimetric assay.

Results

C. albicans biofilm formation was significantly lower (p < 0.05) on the minimally rough titanium surface compared to smooth and moderately rough surfaces. The titanium surface displaying the lowest SFE (Group B) was associated with significantly lower (p < 0.05) C. albicans biofilm formation than the other two groups. Salivary coating resulted in greater adherence of C. albicans with increased surface roughness.

Conclusions

The minimally rough titanium discs displayed lowest SFE compared to smooth and moderately rough surfaces and showed the least C. albicans biofilm formation. This study demonstrated that C. albicans biofilm formation increased in a SFE-dependent manner. These findings suggest that SFE might be a more explanatory factor for C. albicans biofilm formation on titanium surfaces than roughness. The presence of a pellicle coating may negate the impact of SFE on C. albicans biofilm formation on titanium surfaces.

Knowledge, Attitudes and Practice of Dental Implants among Dental Interns in Saudi Arabia – A Cross-Sectional Study

Objective:

The aim of the study is to assess knowledge, attitude and practices of dental implants among dental interns in Saudi Arabia

Materials and Methods:

A self-designed, close-ended questionnaire was distributed among 205 interns chosen by stratified random sampling technique. The questionnaire consisted of 28 items pertaining to demographic characteristics, knowledge and practices of dental implants. Responses were coded and entered into spreadsheet software (Microsoft Excel 16.0.) and analyzed using Statistical Package for Social Sciences (SPSS, IBM Version 22.0) and contingency tables and chi-square test (χ2).

Results:

The majority of the participants were males (64.4%), between 24-26 years of age (64%) and had a GPA between 4-5 (63.4%). The majority of the participants gained knowledge of dental implants through theoretical lectures (98.5%), and most of them (80%) knew, what material, an implant was made up of. Almost all participants (91.7%) knew that dental implants had surface modifications. Most (64.4%) believed that case selection is the most important criteria for the success of dental implant therapy, and this differed significantly among participants with respect to GPA (p=0.03). Many participants (60%) believed that the most important advantage of dental implants over fixed prosthesis is that reduction of adjacent tooth is not needed, and this differed significantly between males and females (p=0.026). There was a significant difference (p<0.001) between males and females when it came to confidence in independently restoring teeth using dental implants. 63% of the participants were confident to use dental implants in their future practice.

Conclusion:

Knowledge of dental implants among dental interns is satisfactory, but this study reveals that participants lack practical experience and would like to acquire more clinical skills.

Limitations:

The response rate of participants from each university was low, which made comparisons between different universities difficult because sample size from some universities was very small, which could not produce statistically accurate results.

Biomechanical Evaluation of Initial Stability of a Root Analogue Implant Design with Drilling Protocol: A 3D Finite Element Analysis

Background: The aim of this study was to biomechanically evaluate the initial stability of a patient-specific root analogue implant (RAI) design with drilling protocol by comparing it to designs without drilling protocol through a 3D finite element analysis (FEA). Methods: A 3D surface model of an RAI for the upper right incisor was constructed. To evaluate the effect of root apex drilling, four modified RAI shapes were designed with the press-fit implantation method: Non-modified, wedge added at root surface, lattice added at root surface, and apex-anchor added at root apex (AA). Each model was subjected to an oblique load of 100 N. To simulate the initial stability of implantation, contact conditions at the implant–bone interface were set to allow for the sliding phenomenon with low friction (frictional coefficient 0.1–0.5). Analysis was performed to evaluate micro-displacements of the implants and peak stress on the surrounding bones. Results: Under all low frictional coefficient conditions, the lowest von Mises stress level on the cortical bone and fewest micro-displacements of the implant were observed in the AA design. Conclusion: In view of these results, the AA design proved superior in reducing the stress concentration on the supporting cortical bone and the micro-displacement of RAI.

A cross sectional study of dental implant service provision in British and Irish dental hospitals

Introduction There are multiple ways in which treatment using dental implants is provided in a secondary care setting, not only in terms of the groups of patients treated, but also the clinicians who provide that care.Methods An online survey was circulated to speciality registrars in restorative dentistry in all UK dental hospitals and to postgraduate students in prosthodontics in the Republic of Ireland, consisting of nine questions aimed at understanding which patient groups are treated using dental implants in a hospital setting, how cases are planned, executed and to explore the underlying reasons for each unit's method of provision.Results Completed surveys were received from 67% of dental hospitals in Britain and Ireland. Treatment planning was undertaken by the restorative team alone in 64% of units in patients with hypodontia, 57% with trauma and 71% with an atrophic edentulous ridge and by a multi-disciplinary team in 50% of units for patients with cleft lip and palate (CLP) and 45% with head and neck (H&N) cancer. The restorative team place all or most of the implant fixtures in 50% of units in patients with CLP, 71% in trauma patients, 71% in hypodontia patients, 64% in edentulous patients and 43% in H&N oncology patients. Stents are produced and used by the restorative team in 64% of units for edentulous patients, 79% of patients with hypodontia, 79% of those suffering trauma, 58% of CLP patients and 50% of patients with H&N cancer. Twenty-one percent of responding units had stents made by the restorative team and used by the surgical team. The median percentage of implant-supported restorations that are screw retained is 90% (SD: 4.93, range: 25-95%) and the median percentage of zirconia abutments being used is 22.5% (SD: 5.24, range: 0-50%). Use of zygomatic implants varies hugely between responding units with 43% of them not placing any zygomatic implants.Conclusions There is a wide range of protocols and team members involved in the provision of dental implant rehabilitations throughout the British Isles reflecting the lack of any single evidence-based approach. A multi-disciplinary team approach with the restorative dentist as a key member is likely to yield the most favourable long term outcomes.

Application of cell-sheet engineering for new formation of cementum around dental implants

Periodontal disease involves the chronic inflammation of tooth supporting periodontal tissues. As the disease progresses, it manifests destruction of periodontal tissues and eventual tooth loss. The regeneration of lost periodontal tissue has been one of the most important subjects in periodontal research. Since their discovery, periodontal ligament stem cells (PDLSCs), have been transplanted into periodontal bony defects to examine their regenerative potential. Periodontal defects were successfully regenerated using PDLSC sheets, which were fabricated by cell sheet engineering in animal models, and for which clinical human trials are underway. To expand the utility of PDLSC sheet, we attempted to construct periodontal tissues around titanium implants with the goal of facilitating the prevention of peri-implantitis. In so doing, we found newly formed cementum-periodontal ligament (PDL) structures on the implant surface. In this mini review, we summarize the literature regarding cell-based periodontal regeneration using PDLSCs, as well as previous trials aimed at forming periodontal tissues around dental implants. Moreover, the recent findings in cementogenesis are reviewed from the perspective of the formation of further stable periodontal attachment structure on dental implant. This mini review aims to summarize the current status of the creation of novel periodontal tissue-bearing dental implants, and to consider its future direction.

Explore and compare the knowledge, attitude, and acceptance of dental implant as a treatment option among sub-population of Saudi Arabia

Objectives: Implant therapy has gained wide popularity in the recent years. A complete information on implant therapy should be provided to patient by the dentist. The aim of present study is to evaluate the knowledge, attitude, source of information and acceptance of dental implants among the general population in the Southern region of Saudi Arabia.Methods: A total of 712 patients were randomly selected from the OPD of dental hospitals across the southern region of Saudi Arabia. The designed questionnaire comprised of 15 open-ended questions. Only Saudi national population was selected for the survey. The questionnaire was divided into demographic data, knowledge, attitude and participant’s acceptance towards implant therapy. The collected data were statistically analyzed using the Statistical Package for Social Sciences.Results: Out of 712 participants, 675 complete the survey. 59.1% were male and 41.9% were females with an average age of 39.6 years old. All variables except for age showed statistically significant difference in the knowledge about implant among the study groups (p&lt;0.05). The knowledge score was directly related to education and professional status of the participants. Majority of the patients (66%) with a history of implant therapy were satisfied with the placed implant. 41% of the participants reported high cost as a limiting factor for selecting an implant treatment. Conclusions: Population from the southern region of Saudi Arabia has moderate knowledge about dental implant treatment. Dentists were found to be the most important source of information to the patient. The major barrier for not selecting implant treatment was the high cost of the implant therapy.

Influence of abutment material on the shade of dental implant restorations in the esthetic zone: a single case report

High esthetic demand and expectation challenges the rehabilitation of the esthetic zone with dental implants. Most implant system manufacturers offer customized and prefabricated ceramic, specifically zirconia or alumina abutments, as an alternative to titanium or gold alloy abutments, with the aid of computer-aided designing/computer aided manufacturing (CAD/CAM) technology. A 45-year-old male patient was referred to the prosthodontics clinic for the restoration of maxillary central incisors with all ceramic dental implants. After healing, both implants were restored with all-ceramic crowns but different customized abutment materials for the purpose of comparison. The all-ceramic crown was cemented on a customized zirconia abutment at the implant site # 11 and on a customized gold alloy abutment at implant site # 21. The treating dentist as well as two prosthodontists performed a meticulous clinical examination to compare the ceramic crowns side by side and agreed that the outcome was esthetically satisfactory. The patient was satisfied with the esthetics and functional outcome of the final restorations, as was the prosthodontist.

Public awareness, knowledge, attitude and acceptance of dental implants as a treatment modality among patients visiting SDM College of Dental Sciences and Hospital, Dharwad

Background:

The use of dental implants as a prosthetic treatment modality for partially edentulous or completely edentulous patients is increased more commonly ever since the concept of osseointegration has been accepted.

Objective:

The objective of this study is to assess the awareness, knowledge, attitude, and acceptance of dental implants as a treatment modality among patients visiting SDM Dental College, Dharwad.

Materials and Methods:

A cross-sectional survey was conducted among 500 patients visiting SDM College of Dental Sciences and Hospital (SDMCDSH), Dharwad, using a self-explanatory questionnaire.

Results:

A total of 500 individuals participated in the survey. The results of this survey indicate that 93.4% of the patients knew about dental implants, and for majority of them, the major source of information was through their dentist followed by relatives and friends and electronic media. About 60.4% patients disapproved the removable prosthesis as an option for the replacement of missing teeth. 77.2% patients expressed that they could not afford for the dental implant treatment. The major deterioration for this treatment was related to the cost in 80.4% patients, surgical procedure in 11.6% patients, and a long treatment time in 5.6% patients. While 60.4% patients felt that dental implants being expensive, is the treatment option only for the rich.

Conclusion:

The results of this survey showed that majority of the patients visiting SDMCDSH, Dharwad, were aware about dental implants as a treatment modality for the replacement of missing teeth. Although the attitude was positive and they did accept dental implants as a treatment option, the treatment cost mainly was the major reason to take a back step.

Transcriptomic profiling of tantalum metal implant osseointegration in osteopenic patients

OBJECTIVES

The long-term success of dental implants is established by literature. Although clinically well defined, the complex genetic pathways underlying osseointegration have not yet been fully elucidated. Furthermore, patients with osteopenia/osteoporosis are considered to present as higher risk for implant failure. Porous tantalum trabecular metal (PTTM), an open-cell porous biomaterial, is suggested to present enhanced biocompatibility and osteoconductivity. The goal of this study was to evaluate the expression patterns of a panel of genes closely associated with osteogenesis and wound healing in osteopenic patients receiving either traditional titanium (Ti) or PTTM cylinders to assess the pathway of genes activation in the early phases of osseointegration.

MATERIAL AND METHODS

Implant cylinders made of Ti and PTTM were placed in osteopenic volunteers. At 2- and 4 weeks of healing, one Ti and one PTTM cylinder were removed from each subject for RT-PCR analysis using osteogenesis PCR array.

RESULTS

Compared to Ti, PTTM-associated bone displayed upregulation of bone matrix proteins, BMP/TGF tisuperfamily, soluble ligand and integrin receptors, growth factors, and collagen genes at one or both time points. Histologically, PTTM implants displayed more robust osteogenesis deposition and maturity when compared to Ti implants from the same patient.

CONCLUSIONS

Our results indicate that PTTM properties could induce an earlier activation of genes associated with osteogenesis in osteopenic patients suggesting that PTTM implants may attenuate the relative risk of placing dental implants in this population.

Patients' Socio-Economic Status, Tobacco and Medical History Associated with Implant Failure

Objective

To examine the potential association between patients’ characteristics that experienced implant failure and those who had successful implant treatment.

Materials and methods

This retrospective case-control study is based on 186 dental records of implant failure and 186 age and gender matched successful treatments for a total of 372 patients. Age at the time of the procedure, gender, medical history, tobacco use, dental insurance status, ZIP code and type of treatment provided (implant failure/successful implant treatment) were recorded.

Results

The population consisted of 47.6% females, 48.9% individuals with dental insurance and 9.7% self-reported tobacco users. A statistically significant association (p≤0.05) was found between implant failure and successful implant treatment in regards to tobacco use, socio-economic status and medical history. Insurance status and implant location (region, arch) did not affect significantly (p>0.05) the outcome of implant therapy.

Conclusions

Within the limitation of this retrospective case-control study, individuals with high socio-economic status, no history of tobacco use and history of heart attack were more likely to have a successful implant treatment than those with a low socio-economic status, tobacco users and without history of heart attack.

Symptoms of temporomandibular disorder, self-reported bruxism, and the risk of implant failure: A retrospective analysis

OBJECTIVE

To investigate the association between symptoms of temporomandibular disorder and self-reported bruxism with the risk of implant failure.

METHODS

This retrospective study is based on 2127 records of patients who had 4519 implants placed and restored at the University of Minnesota School of Dentistry. Patient and implant level information were retrieved from each dental record: age, gender, implant location, as well as history of clicking, pain, difficulty opening, difficulty chewing, and clenching or grinding.

RESULTS

A total of 51 implant failures were identified in the sample. This corresponded to a failure rate of 1.1% at the implant level and 1.7% at the patient level. Among all the patient and implant level variables, the binary logistic regression showed that none of them were significantly associated with implant failure (p > 0.05).

DISCUSSION

The identification of risk indicators for implant loss can foster long-term implant survival, peri-implant health, and ultimately, implant prosthesis survival.

Should implants be considered for patients with periodontal disease?

Dental implants are seen as a good option for replacing missing teeth. The success and survival rates for implants are very high. Concerns are developing about the problem of peri-implantitis. The reports of its prevalence vary but it is noted that the presence of periodontal disease is a risk factor. The issue of peri-implantitis was raised in the House of Lords in 2014. Complaints relating to implants is on the rise with the General Dental Council. Placement of implants in patients with periodontal disease is not a treatment that should be done without a full periodontal assessment and stabilisation of periodontal disease first. This review considers the risk of placing implants in patients with aggressive and chronic periodontitis.

Mechanical Complications Related to the Retention Screws of Prefabricated Metal Abutments With Different Angulations: A Retrospective Study With 916 Implants

OBJECTIVES

The present retrospective study assessed the clinical performance of abutment screws from prefabricated metal abutments and compared technical complication rates between straight and angled abutments.

MATERIALS AND METHODS

Dental charts were selected for patients with dental implant rehabilitations delivered between 1998 and 2012. Abutment angulation, prosthetic screw type, and presence of complications that occurred during the selected time period were collected. Technical complications registered included abutment screw loosening and/or fractures detected during clinical and radiographic examinations. The chi-square test was used for statistical analysis.

RESULTS

Abutment angulations were divided into 2 groups: G1) prefabricated straight abutments and G2) prefabricated angled conical mini UCLA-type abutments. A total of 916 implants (799 straight and 117 angled conical mini UCLA-type abutments) were evaluated. G1 showed 91.1% had absence of failures, which were clinically defined as any screw loosening or fracture; and 8.9% reported some type of technical complication. G2 showed 92.3% and 7.7%, with and without technical complications, respectively.

CONCLUSIONS

No significant differences were observed between abutment angulation and technical complications.

The Role of Occlusion in Implant Therapy: A Comprehensive Updated Review

PURPOSE

Occlusal overload may cause implant biomechanical failures, marginal bone loss, or even complete loss of osseointegration. Thus, it is important for clinicians to understand the role of occlusion in implant long-term stability. This systematic review updates the understanding of occlusion on dental implants, the impact on the surrounding peri-implant tissues, and the effects of occlusal overload on implants. Additionally, recommendations of occlusal scheme for implant prostheses and designs were formulated.

MATERIALS AND METHODS

Two reviewers completed a literature search using the PubMed database and a manual search of relevant journals. Relevant articles from January 1950 to September 20, 2015 published in the English language were considered.

RESULTS

Recommendations for implant occlusion are lacking in the literature. Despite this, implant occlusion should be carefully addressed.

CONCLUSION

Recommendations for occlusal schemes for single implants or fixed partial denture supported by implants include a mutually protected occlusion with anterior guidance and evenly distributed contacts with wide freedom in centric relation. Suggestions to reduce occlusal overload include reducing cantilevers, increasing the number of implants, increasing contact points, monitoring for parafunctional habits, narrowing the occlusal table, decreasing cuspal inclines, and using progressive loading in patients with poor bone quality. Protecting the implant and surrounding peri-implant bone requires an understanding of how occlusion plays a role in influencing long-term implant stability.

Socket Shield Technique for immediate implant placement - clinical, radiographic and volumetric data after 5 years

OBJECTIVES

Implant placement immediately after tooth extraction is often accompanied by resorption of surrounding tissues. A clinical technique was developed where the buccal portion of the root is retained to preserve the periodontal ligament and bundle bone. This technique is based on animal studies showing the potential to preserve the facial tissues utilizing this approach. The purpose of this study was to gain more insight regarding the safety of the technique with regard to biological and implant-related long-term complications and to observe the clinical appearance of the peri-implant tissues. Another objective was to evaluate volumetric changes of the affected facial contours in long-term and the esthetic outcomes.

MATERIAL AND METHODS

This study is a retrospective case series of 10 consecutive patients with implant replacement between the maxillary first premolars. Impressions were made prior to extraction (t1) and 5 years post-implant placement (t2). 3D-surface scans of the casts were digitally superimposed for quantitative evaluation of alterations of the facial peri-implant tissue contours and soft tissue recessions. Additionally, clinical data were collected (PPD, BOP, peri-apical radiographs and photographs).

RESULTS

All implants healed without adverse events. Peri-implant probing revealed healthy conditions. The comparison of radiographic images showed physiologic bone remodeling at the implant shoulders. Mean tissue loss on the facial side in oro-facial direction was -0.21 ± 0.18 mm. Average recession at implants was -0.33 ± 0.23 mm and at neighboring teeth -0.38 ± 0.27 mm. Mean loss of the marginal bone level at the implant shoulder amounted to 0.33 ± 0.43 mm at the mesial and 0.17 ± 0.36 mm at the distal aspect of the implants. A mean pink esthetic score of 12 was recorded.

CONCLUSION

Volumetric analysis showed a low degree of contour changes from extraction and implant placement to the follow-ups. Mucosal recession at the implant restoration was comparable to that of the neighboring teeth. Within the limitations of this descriptive study, the socket shield technique offers reduced invasiveness at the time of surgery and high esthetic outcomes with effective preservation of facial tissue contours. This technique should not be used in routine clinical practice until a higher level evidence in the form of prospective clinical trials is available.

Removal techniques for failed implants

The use of dental implants is an accepted and predictable way of replacing missing or lost teeth. However, implants can and will fail and there are a variety of reasons why this occurs, which the practitioner should understand. In some instances failed implants may require removal and, therefore, practitioners should be aware of techniques that can be used to remove failed implants to potentially enable future rehabilitation of an edentulous region.

Microbiological and clinical outcomes of fixed complete-arch mandibular prostheses supported by immediate implants in individuals with history of chronic periodontitis

OBJECTIVES

The aim of this study was to assess the microbiological and clinical outcomes of immediate implants placed in chronically infected sockets for rehabilitation with fixed full-arch mandibular prostheses.

MATERIAL AND METHODS

Fourteen individuals (mean age 60.14 ± 7.69 years) were enrolled in this investigation and followed up until 8 months of function. Microbiological (microbial count and profile) and clinical (probing depth, clinical attachment level, bleeding on probing, and bone resorption) parameters were conducted before teeth extraction (T₀ - baseline) and after 4 (T₁ ) and 8 (T₂ ) months of loading. Thirty-nine microbial species including periodontopathogenic species and Candida spp. were detected and quantified by DNA checkerboard analysis.

RESULTS

Moderate to high levels of pathogenic and non-pathogenic species were found colonizing teeth and implant-related sites. No significant differences in total or individual microbial counts and microbial profile were found over time (P = 0.4929). Probing depth values from teeth (T₀ : 3.05 ± 1.45) were significantly higher when compared with implants (T₁ : 1.81 ± 0.56; T₂ : 1.66 ± 0.53; P < 0.0001). High percentages of bleeding sites were found for both teeth and implants, with the highest values recorded for teeth (P < 0.05). No significant differences were detected comparing marginal bone resorption over time.

CONCLUSIONS

Total and individual counts of target species did not differ between teeth and implants for 8 months of investigation. The mean proportions of pathogenic and non-pathogenic species remained unaltered, and no clinical complications were reported over time. Data obtained suggest that immediate loading of complete mandibular prostheses retained by implants placed immediately after extraction may be a viable treatment option for edentulous individuals with previous history of periodontal disease.

Combined implant-residual tooth supported prosthesis after tooth hemisection: A finite element analysis

Tooth hemisection preserves partial tooth structure and reduces the resorption of alveolar bone. The aim of this study was to analyze the feasibility of preserving a molar after hemisection and inserting a dental implant with different prosthetic superstructures by means of finite element analysis. First, the distance between the root of the mandibular second premolar and the distal root of the first molar were measured in 80 cone beam computed tomography (CBCT) data sets. Based on these data, the lower right posterior jaw segment was reconstructed and the geometries of the appropriate implant were imported. Four models were created: (1) Hemi-1: An implant (3.7×9mm) replaced the mesial root of the molar, and a single crown was placed on the implant and residual tooth. (2) Hemi-2: Two separate crowns were generated for the implant and the residual tooth. (3) Single: An implant (5.5×9mm) with crown replaced the whole molar. (4) FPD: A 3-unit fixed partial denture combined the distal residual part of the molar and premolar. The results indicated that stresses in the cortical bone and strains in the majority region of the spongious bone were below the physiological upper limits. There were higher stresses in implant with the Hemi-1 and Single models, which had the same maximum values of 45.0MPa. The FPD models represented the higher values of stresses in the teeth and strains in PDL compared to other models. From a biomechanical point of view, it can be concluded that a combination of an implant and residual molar after tooth hemisection is an acceptable treatment option.

Patients awareness and attitude towards dental implants

Aims:

The aim of the study was to assess the awareness of the patients regarding implant-retained prosthesis as an option for tooth replacement and the knowledge about tooth replacement as a whole including source of information and attitude towards it amongst Malaysian population.

Materials and Methods:

Information on demographic characteristics, knowledge about implant as an option for missing tooth replacement, source of information and knowledge about other options of tooth replacement were obtained from patients visiting various dental outpatient departments of hospital and private dental clinics using nationwide self-explanatory survey.

Results:

Amongst the 1013 response retrieved, 27% of respondents felt moderately well informed about the dental implant treatment. Only 9% of the respondents had dental implant treatment before and 17% felt well informed about different alternatives of replacing missing teeth. The dentists were the main source of information regarding dental implant treatment modality followed by friends and electronic media. 55.6% respondents felt implant to be as good as own teeth during function whereas high cost was the major limiting factor for implant treatment.

Conclusion:

56% of Malaysian population was aware of dental implant as an alternative for replacing missing teeth. Necessary efforts and measures should be made to raise the awareness of dental implant treatment in the country.

Esthetic Outcomes of Immediately Loaded Locking Taper Implants in the Anterior Maxilla: A Case Series Study

The purpose of this study was to evaluate the esthetic outcome of single-tooth locking taper connection implants placed in the anterior maxilla following a postextractive nonfunctional loading protocol. This preliminary clinical study involving 16 patients evaluated the results of 21 implants placed in areas with high esthetic value. For each implant the pink esthetic score, white esthetic score, cumulative survival rate, and health status of peri-implant tissues were evaluated. The cumulative survival rate was 100% 2 years after prosthetic loading, and the mean total pink esthetic score/white esthetic score was 16.9 ± 1.14 on a maximum value of 20. There was excellent plaque control in all patients, and inflammation indices were within the norm. Within the limits of this study, this immediate nonfunctional loading protocol seems to be a successful procedure esthetically and for the maintenance of peri-implant soft tissues.

The effect of implant angulation and splinting on stress distribution in implant body and supporting bone: A finite element analysis

Objective:

The aim of this study was to investigate the influence of implant crown splinting and the use of angulated abutment on stress distribution in implant body and surrounding bone by three-dimensional finite element analysis.

Materials and Methods:

For this study, three models with two implants at the site of mandibular right second premolar and first molar were designed (1): Both implants, parallel to adjacent teeth, with straight abutments (2): Anterior implant with 15 mesial angulations and posterior implant were placed parallel to adjacent tooth, (3): Both implants with 15 mesial angulations and parallel to each other with 15° angulated abutments. Restorations were modeled in two shapes (splinted and nonsplinted). Loading in tripod manner as each point 50 N and totally 300 N was applied. Stress distribution in relation to splinting or nonsplinting restorations and angulations was done with ABAQUS6.13.

Results:

Splinting the restorations in all situations, led to lower stresses in all implant bodies, cortical bone and spongy bone except for the spongy bone around angulated first molar. Angulated implant in nonsplinted restoration cause lower stresses in implant body and bone but in splinted models more stresses were seen in implant body in comparison with straight abutment (model 2). Stresses in nonsplinted and splinted restorations in cortical bone of angulated molar region were more than what was observed in straight molar implant (model 3).

Conclusion:

Implant restorations splinting lead to a better distribution of stresses in implant bodies and bone in comparison with nonsplinted restorations, especially when the load is applied off center to implant body. Angulations of implant can reduce stresses when the application of the load is in the same direction as the implant angulation.

Bisphosphonate and Implant Dentistry - Is it Safe?

Bisphosphonates are a group of drugs that are commonly used to alter bone metabolism in order to prevent bone loss in diseases such as osteoporosis and bone cancers. Unfortunately, the use of bisphosphonates has been associated with bisphosphonate-related osteonecrosis of the jaws. The debate as to whether it is wise to consider implant therapy in patients being treated with bisphosphonate therapy remains a grey area. This review will present the latest evidence and guidelines available on bisphosphonates and their possible effects on implant dentistry. The risk factors, co-morbidities, clinical presentation and findings from various imaging modalities for bisphosphonate-related osteonecrosis of the jaws are highlighted. The management of patients being treated with bisphosphonates, in whom dental implants might be considered or have already been placed, will also be discussed. Finally, the areas requiring future research are considered.

The effect of cigarette smoking habits on the outcome of dental implant treatment

The aim of this study was to analyze the influence of smoking habits and other possibly relevant factors on dental implant survival. The study population included all patients who underwent dental implants between the years 1999 and 2008 at a large military dental clinic and were examined in the periodic medical examination center.

Correlation between implant characteristics and patients’ smoking habits, as mentioned in the questionnaire answered by patients in the periodic examination, was performed.

Besides standard statistical methods, multiple linear regression models were constructed for estimation of the relative influence of some factors on implant survival rate. The long-term results of the implant treatment were good. The study refers to 7,680 implants. 7,359 (95.8%) survived and 321 (4.2%) did not survive. Concerning smoking habits, in a uni-variable analysis, factors found to have an association with implant survival were the smoking status of the patients (smoking/no smoking), the amount of smoking, passive smoking, and the time elapsed in ex-smokers from the time they ceased smoking to the time of implantation. In a multi-variable analysis, factors found to have an association with implant survival were smoking status (smoking/no smoking) and amounts of smoking as expressed in pack years.

The effects of implant angulation on the resonance frequency of a dental implant

Dental implants are ideally placed in an orientation that allows vertical transfer of occlusal forces along their long axis. Nevertheless, optimal situations for implant placement are seldom encountered resulting in implants placement in angulated positions, which may affect their long-term success. The resonance frequency (RF) is an objective tool used to monitor stability of the implant tissue integration; however, little is known of the effect of the implant orientation in bone on the RF and its potential significance. The purpose of this research was to determine the relation between the dental implant orientation and the corresponding RF of implant. Three-dimensional (3D) modelling software was used to construct a 3D model of a pig mandible from computed tomography (CT) images. The RF of the implant was analysed using finite element (FE) modal analysis in software ANSYS (v.12). In addition, a cubical model was also developed in MIMICS to investigate the parameters affecting the relationship between RF and implant orientation in a simplified environment. The orientation angle was increased from 0 to 10 degrees in 1 degree increments and the resulting RF was analysed using correlation analysis and one-way ANOVA. Our analysis illustrated that the RF fluctuation following altering implant orientation was strongly correlated (r=0.97) with the contacting cortical to cancellous bone ratio (CCBR) at the implant interface. The most extreme RF change (from 9.81kHz to 10.07kHz) occurred when the implant was moved 0.5mm in positive z-direction, which resulted in the maximum change of CCBR from 52.9 to 54.8.

Immediate placement and loading of maxillary single-tooth implants: a 3-year prospective study of marginal bone level

AIM

The purpose of this study was to evaluate marginal bone level around single-tooth implants placed in anterior maxilla and immediately restored.

MATERIALS AND METHODS

Twenty implants were placed in 20 patients (8 men and 12 women) that were selected for this study. Following atraumatic non-surgical extraction of tooth, all patients immediately received implants and the definitive prefabricated abutment was placed. Implant position was transferred to the scanning unit of the CAD/CAM system using prefabricated surgical guide. Temporary crowns were immediately fabricated and cemented. Eight weeks later final crowns were luted. Outcome assessment as implant survival and level of marginal bone radiographic evaluations were performed at 8 weeks, 1 and 3 years time period after loading.

RESULTS

All implants placed osseointegrated successfully after 3 years of functional loading. The mean marginal bone loss was 0.16 mm (SD, 0.167 mm), 0.275 mm (SD, 0.171 mm) and 0.265 mm (SD, 0.171 mm) at 8 weeks, 1 and 3 years time period respectively. Four out of the 20 implants showed no bone loss.

CONCLUSION

Immediate loading technique using the final abutment directly eliminated the need for a second stage surgery and prevented interruption of soft and hard tissue at implant neck, which resulted in better soft tissue response and reduced marginal bone loss. Clinical significance: Immediately loaded implants, in fresh extraction sockets by insertion of a provisional restoration on the titanium abutment without any later manipulation, helped to protect the initially forming blood clot and presented a template for soft tissue contouring that resulted in significant reduction of marginal bone resorption and maintenance of soft tissue architecture.

A systematic review of the survival and complication rates of implant-supported fixed dental prostheses (FDPs) after a mean observation period of at least 5 years

OBJECTIVES

The objective of this systematic review was to assess the 5- and 10-year survival of implant-supported fixed dental prostheses (FDPs) and to describe the incidence of biological and technical complications.

METHODS

An electronic Medline search complemented by manual searching was conducted to identify prospective and retrospective cohort studies and case series on FDPs with a mean follow-up time of at least 5 years. Patients had to have been examined clinically at the follow-up visit. Failure and complication rates were analyzed using standard and random-effects Poisson regression models to obtain summary estimates of 5-year and 10-year survival and complication rates.

RESULTS

The updated search provided 979 titles and 257 abstracts. Full-text analysis was performed for 90 articles resulting in a total 32 studies that met the inclusion criteria. Meta-analysis of these studies indicated an estimated survival of implants supporting FDPs of 95.6% after 5 years and 93.1% after 10 years. When machined surface implants were excluded from the analysis and only rough surface implants included, the survival rate increased to 97.2% after 5 years. The survival rate of implant-supported FDPs was 95.4% after 5 years and 80.1% after 10 years of function. When the analysis was done exclusively for metal-ceramic FDPs, hence the old gold-acrylic FDPs were excluded, the survival rate increased significantly. The survival rate of metal-ceramic implant-supported FDPs was 96.4% after 5 years and 93.9% after 10 years. Only 66.4% of the patients were free of any complications after 5 years. The most frequent complications over the 5-year observation period were fractures of the veneering material (13.5%), peri-implantitis and soft tissue complications (8.5%), loss of access hole restoration (5.4%), abutment or screw loosening (5.3%), and loss of retention of cemented FDPs (4.7%).

CONCLUSION

It may be concluded that implant-supported fixed dental prostheses (FDPs) are a safe and predictable treatment method with high survival rates. However, biological and technical complications were frequent (33.6%). To minimize the incidence of complications, dental professionals should make great effort in choosing reliable components and materials for implant-supported FDPs and the patients should be placed in well-structured maintenance system after treatment.

Influence of abutment material and luting cements color on the final color of all ceramics

PURPOSE

The purpose of this study is to evaluate the effects of different abutment materials and luting cements color on the final color of implant-supported all-ceramic restorations.

MATERIALS AND METHODS

Ten A2 shade IPS e.max Press disc shape all-ceramic specimens were prepared (11 × 1.5 mm). Three different shades (translucent, universal and white opaque) of disc shape luting cement specimens were prepared (11 × 0.2 mm). Three different (zirconium, gold-palladium and titanium) implant abutments and one composite resin disc shape background specimen were prepared at 11 mm diameter and appropriate thicknesses. All ceramic specimens colors were measured with each background and luting cement samples on a teflon mold. A digital spectrophotometer used for measurements and data recorded as CIE L*a*b* color co-ordinates. An optical fluid applied on to the samples to provide a good optical connection and measurements on the composite resin background was saved as the control group. ΔE values were calculated from the ΔL, Δa and Δb values between control and test groups and data were analyzed with one-way variance analysis (ANOVA) and mean values were compared by the Tukey HSD test (α = 0.05).

RESULTS

One-way ANOVA of ΔL, Δa, Δb and ΔE values of control and test groups revealed significant differences for backgrounds and seldom for cement color groups (p the 0.05). Only zirconium implant abutment groups and gold palladium abutment with universal shade cement group were found to be clinically acceptable (ΔE ≤ 3.0).

CONCLUSION

Using titanium or gold-palladium abutments for implant supported all ceramics will be esthetically questionable and white opaque cement will be helpful to mask the dark color of titanium abutment.