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Roccuzzo A, Imber JC, Lempert J, Jensen SS. Clinical, radiographic, and aesthetic outcomes at two narrow-diameter implants to replace congenital missing maxillary lateral incisors: A 3-year prospective, clinical study. Clin Implant Dent Relat Res 2024; 26:777-786. [PMID: 38863078 DOI: 10.1111/cid.13339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/19/2024] [Accepted: 05/03/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION To present the 3-year clinical, radiographic, and aesthetic outcomes in patients with congenitally missing lateral incisors rehabilitated with two narrow-diameter implants (NDIs). METHODS The original population consisted of 100 patients rehabilitated with a cement-retained bi-layered zirconia single-unit crown supported by either a Ø2.9 mm (Test) or a Ø3.3 mm (Control) NDI (n = 50). At the 1- and 3-year follow-up (T2, T3), implant survival rate, crestal bone level (CBL) changes, biological, and technical complications were recorded, while the assessment of the aesthetic outcomes was performed using the Copenhagen Index Score. RESULTS Seventy-four patients Ø2.9 mm (n = 39) or Ø3.3 mm (n = 35) reached T3, as 24 patients were lost to follow-up and 1 implant (Ø3.3 mm) was removed. Throughout the observation period, minimal CBL changes (i.e., <1 mm) were detected between groups. Despite the positive aesthetic scores recorded (i.e., 1-2), at T3 20% of patients rehabilitated with a Ø3.3 mm versus 2.6% of patients Ø2.9 mm displayed an alveolar process deficiency (Score 3). No additional technical and/or mechanical complications were recorded between T2 and T3. Tooth vitality was maintained in all neighboring teeth. Peri-implant probing depths and plaque scores remained low in both groups (p > 0.05). CONCLUSION The use of 2.9 or 3.3 diameter implants showed comparable favorable mid-term results in terms of survival rate, CBL, and aesthetic outcomes. Hence, clinicians should rely on the use of such NDIs when replacing maxillary lateral incisors.
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Affiliation(s)
- Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jean-Claude Imber
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Jakob Lempert
- Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Simon Storgård Jensen
- Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital, Copenhagen, Denmark
- Research Area Oral Surgery, Section for Oral Biology and Immunopathology, Faculty of Health and Medical Sciences, Institute of Odontology, University of Copenhagen, Copenhagen, Denmark
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Riera C, Karasan D, Sailer I, Mojon P, Fehmer V, Pitta J. Mechanical stability of posterior implant-supported monolithic zirconia cantilever on titanium-base abutments. An in vitro study. Clin Oral Implants Res 2024; 35:1042-1053. [PMID: 38415804 DOI: 10.1111/clr.14251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Investigate survival and technical complications of two-unit posterior implant-supported cantilever made of monolithic zirconia on titanium-base abutments (Zr-TiB) vs. porcelain-fused-to-metal on castable gold abutments (PFM-GA) using two different implant connections, internal butt-joint (IBJ) and internal conical (IC). MATERIALS AND METHODS Forty-eight implants (4.3 mm diameter) were divided into four groups (n = 12) to support 2-unit mandibular premolar cantilevers with two different materials (Zr-TiB vs. PFM-GA) and two connection types (IBJ vs. IC). Tested groups were as follows: (1) IBJ/Zr-TiB; (2) IBJ/PFM-GA; (3) IC/Zr-TiB; and (4) IC/PFM-GA. Specimens were thermomechanical aged (1,200,000 cycles, 98 N, 5-55°C) with occlusal axial load on the pontic. Catastrophic and non-catastrophic events were registered, and removal torque values measured before and after aging. Specimens surviving aging were subjected to loading until failure. Survival, total complication rates, torque loss (%), and bending moments were calculated. RESULTS From 48 specimens, 38 survived aging. Survival rates significantly varied from 16.7% (IC/PFM-GA) to 100% (IBJ/Zr-TiB; IBJ/PFM-GA; IC/Zr-TiB) (p < .01). Internal conical connection revealed significantly higher torque loss (IC/ZrTiB - 67%) compared to internal butt-joint (IBJ/Zr-TiB - 44%; IBJ/PFM-GA - 46%) (p < .01). Bending moments were higher in internal butt-joint connections than in internal conical (p < .05). CONCLUSION AND CLINICAL IMPLICATIONS Two-unit posterior implant-supported cantilever FDPs replacing mandibular premolars composed of monolithic zirconia on titanium-base abutments demonstrated higher mechanical stability compared to porcelain-fused-to-metal on castable gold abutments in this in vitro study. The internal conical connection combined with porcelain-fused-to-metal on gold abutments revealed a high number of failures; therefore, their clinical use may be considered cautiously for this indication.
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Affiliation(s)
- Carme Riera
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Duygu Karasan
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Phillipe Mojon
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Vincent Fehmer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - João Pitta
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
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Wang S, Chen X, Ling Z, Xie Y, Chen C, Shen X, He F. Clinical and radiographic outcomes of implant-supported fixed prostheses with cantilever extension in anterior mandible: A retrospective study. Clin Oral Implants Res 2024. [PMID: 38860608 DOI: 10.1111/clr.14310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVES The objective of this study is to analyze the clinical and radiographic outcomes of implant-supported fixed protheses with cantilever extensions (ISFPCs) in the partially edentulous anterior mandible. MATERIALS AND METHODS Patients who received anterior mandible implant restoration between January 2016 and December 2021 were included. Patients with two, three, or four continuous missing teeth receiving adjacent implant supported single-unit crowns (ISSCs), ISFPCs, implant-supported fixed protheses without cantilever extensions (ISFPNs) were divided into groups: ISSC+ISSC, ISFPC, ISSC+ISFPC, three-unit ISFPN, ISFPC+ISFPC, or four-unit ISFPN, respectively. We recorded and evaluated survival rates, mechanical and biological complications, peri-implant marginal bone loss (MBL), esthetic outcomes, and patient perceptions. Statistical analysis was performed using linear mixed models (LMM). RESULTS The study included 87 patients and 152 implants. No implant loss occurred during an average follow-up of 3.48 ± 1.85 years (range: 1-7 years). According to LMM models, prosthetic type had a statistically significant impact on MBL during follow-up periods, in favor of the ISFPC and ISFPC+ISFPC groups (0.16 ± 0.48 mm vs. 0.51 ± 0.49 mm, p = .034; 0.22 ± 0.49 mm vs. 0.60 ± 0.62 mm, p = .043, respectively). Mechanical and biological complications were relatively low and comparable. The four-unit ISFPC group had higher subjective esthetic scores compared with the ISSC+ISSC group (98.6 vs. 83.8, p < .05), and patients in the ISFPC+ISFPC group expressed greater satisfaction with cleanability than the ISFPN group (98.8 vs. 80.6). CONCLUSION ISFPCs offer a highly predictable treatment option in the anterior mandible, characterized by high survival rates, and comparable complication rates, peri-implant bone stability and esthetics to adjacent ISSCs or ISFPNs.
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Affiliation(s)
- Siyuan Wang
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Clinical Research Center for Oral Disease of Zhejiang Province, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Cancer Center of Zhejiang University, Hangzhou, China
| | - Xiaoyu Chen
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Clinical Research Center for Oral Disease of Zhejiang Province, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Cancer Center of Zhejiang University, Hangzhou, China
| | - Zhaoting Ling
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Clinical Research Center for Oral Disease of Zhejiang Province, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Cancer Center of Zhejiang University, Hangzhou, China
| | - Yiwen Xie
- Department of Stomatology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Cong Chen
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Clinical Research Center for Oral Disease of Zhejiang Province, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Cancer Center of Zhejiang University, Hangzhou, China
| | - Xiaoting Shen
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Clinical Research Center for Oral Disease of Zhejiang Province, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Cancer Center of Zhejiang University, Hangzhou, China
| | - Fuming He
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Clinical Research Center for Oral Disease of Zhejiang Province, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Cancer Center of Zhejiang University, Hangzhou, China
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Meijer HJA, Stellingsma K, Pol CWP, Vissink A, Gareb B, Raghoebar GM. Dental implant treatment for two adjacent missing teeth in the esthetic region: A systematic review and 10-year results of a prospective comparative pilot study. Clin Exp Dent Res 2023; 9:954-968. [PMID: 37592440 PMCID: PMC10728520 DOI: 10.1002/cre2.773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/26/2023] [Accepted: 08/02/2023] [Indexed: 08/19/2023] Open
Abstract
OBJECTIVES The aim of the systematic review was to compare studies on implant-supported two-unit cantilever crowns with two adjacent implant-supported crowns in the anterior region. The second aim was to assess in a 10-year prospective comparative pilot study, hard and soft peri-implant tissue changes in patients with a missing central and adjacent lateral upper incisor, treated with either an implant-supported two-unit cantilever crown or two single implant-supported crowns. MATERIALS AND METHODS Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched (last search March 1, 2023). Inclusion criteria were studies reporting outcomes of two missing adjacent teeth in the esthetic region and treated with a single implant-supported two-unit cantilever fixed dental prosthesis, or with two solitary implant-supported crowns. Outcome measures assessed included implant survival (primary), changes in marginal bone and gingiva level, restoration survival, subjective and objective esthetic scores, papilla volume, mid-facial marginal mucosa level, probing depth, bleeding on probing, and biological and technical complications with ≥1-year follow-up. In addition, in a 10-year pilot study, the same outcome measures were assessed of five patients with a single implant-supported two-unit cantilever crown and compared with five patients with two adjacent single implant-supported crowns in the esthetic zone. RESULTS Nine articles with 11 study groups were found eligible for data extraction. Meta-analyses of implant survival rates were 96.9% (mean follow-up 3.4 ± 1.4 years) for the implant-cantilever treatment and 97.6% (mean follow-up 3.0 ± 1.8 years) for the adjacent implants treatment (p = .79). In the 10-year comparative pilot study, no clinically relevant changes in hard and soft peri-implant tissue levels occurred in both groups. Patient satisfaction was also high in both groups. CONCLUSION Single implant-supported two-unit crowns can be a viable alternative to the placement of two adjacent single implant crowns in the esthetic zone.
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Affiliation(s)
- Henny J. A. Meijer
- Department of Oral and Maxillofacial Surgery, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
- Department of Restorative Dentistry, Dental School, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Kees Stellingsma
- Department of Oral and Maxillofacial Surgery, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Christiaan W. P. Pol
- Department of Restorative Dentistry, Dental School, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Barzi Gareb
- Department of Oral and Maxillofacial Surgery, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Gerry M. Raghoebar
- Department of Oral and Maxillofacial Surgery, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
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Meijer HJA, Stellingsma K, Vissink A, Raghoebar GM. Two adjacent implant-supported restorations in the aesthetic region: A 10-year prospective case series. Clin Implant Dent Relat Res 2023; 25:1216-1224. [PMID: 37670074 DOI: 10.1111/cid.13274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/01/2023] [Accepted: 08/21/2023] [Indexed: 09/07/2023]
Abstract
INTRODUCTION The treatment outcome of two adjacent implant-supported restorations in the maxillary aesthetic region was assessed regarding peri-implant soft and hard tissues, and satisfaction during a 10-year follow-up period. METHODS Twenty patients missing two adjacent teeth in the maxillary aesthetic region and treated with two implant-supported restorations were followed prospectively. The patients' clinical and radiographic parameters, as well as their satisfaction, were scored for a 10-year follow-up period. RESULTS Seventeen patients' data were available for the 10-year follow-up. The survival rate of the implants and restorations was 100%. The 10-year mean peri-implant bone change at the side facing the adjacent tooth was +0.11 ± 0.57 mm and at the side facing the adjacent implant was -0.08 ± 0.50 mm. The peri-implant soft tissues were healthy and the patients' satisfaction was high, but the papilla-index showed compromised inter-implant papillae and low Pink Esthetic Scores. These figures were of the same magnitude at all time points. CONCLUSION While it is difficult to obtain sufficient inter-implant papillae and satisfactory Pink Esthetic Scores, the initial treatment results remained stable and the patients were satisfied with the final result throughout the 10-year follow-up period.
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Affiliation(s)
- Henny J A Meijer
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Restorative Dentistry, Dental School, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Kees Stellingsma
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerry M Raghoebar
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Avila-Ortiz G, Vegh D, Mukaddam K, Galindo-Moreno P, Pjetursson B, Payer M. Treatment alternatives for the rehabilitation of the posterior edentulous maxilla. Periodontol 2000 2023; 93:183-204. [PMID: 37486029 DOI: 10.1111/prd.12507] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 06/11/2023] [Accepted: 06/13/2023] [Indexed: 07/25/2023]
Abstract
Rehabilitation of the edentulous maxilla with implant-supported fixed dental prostheses can represent a significant clinical challenge due to limited bone availability and surgical access, among other factors. This review addresses several treatment options to replace missing teeth in posterior maxillary segments, namely the placement of standard implants in conjunction with maxillary sinus floor augmentation, short implants, tilted implants, and distal cantilever extensions. Pertinent technical information and a concise summary of relevant evidence on the reported outcomes of these different therapeutic approaches are presented, along with a set of clinical guidelines to facilitate decision-making processes and optimize the outcomes of therapy.
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Affiliation(s)
- Gustavo Avila-Ortiz
- Private Practice, Gonzalez + Solano Atelier Dental, Madrid, Spain
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, Iowa, USA
| | - Dániel Vegh
- Department of Oral Surgery and Orthodontics, University Clinic of Dental Medicine & Oral Health, Medical University Graz, Graz, Austria
- Department of Prosthodontics, Semmelweis University, Budapest, Hungary
| | - Khaled Mukaddam
- Department of Oral Surgery and Orthodontics, University Clinic of Dental Medicine & Oral Health, Medical University Graz, Graz, Austria
- University Center of Dental Medicine, Department of Oral Surgery, University of Basel, Basel, Switzerland
| | - Pablo Galindo-Moreno
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria (IBS), Granada, Spain
| | - Bjarni Pjetursson
- Department of Reconstructive Dentistry, University of Iceland, Reykjavik, Iceland
| | - Michael Payer
- Department of Oral Surgery and Orthodontics, University Clinic of Dental Medicine & Oral Health, Medical University Graz, Graz, Austria
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Roccuzzo A, Morandini M, Stähli A, Imber JC, Sculean A, Salvi GE. Clinical and radiographic outcomes of implant-supported zirconia fixed dental prostheses with cantilever extension: A proof-of-principle study with a follow-up of at least 1 year. Clin Oral Implants Res 2023; 34:1073-1082. [PMID: 37485971 DOI: 10.1111/clr.14138] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/27/2023] [Accepted: 07/13/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVES To test the reliability of full zirconia implant-supported fixed dental prostheses with cantilever extension (FDPCs) after at least 1 year of function. MATERIALS AND METHODS Thirty-five patients in need of implant-supported single unit crowns (SUC) and FDPCs in posterior areas were enrolled. After implant placement, patients were rehabilitated with screw-retained full-zirconia FDPCs. Implant survival rate, pocket probing depth (PPD), presence/absence of bleeding on probing (BoP), and presence/absence of mechanical/technical complications were recorded. Mesial and distal radiographic marginal bone levels (mBLs) from baseline (i.e., recall appointment 3-6 months after implant loading [T0]) to the follow-up examination (i.e., latest recall appointment after at least 12 months after T0 [T1]), were calculated. RESULTS Thirty patients with 34 FDPCs (31 SUCs and 3 FDPs) supported by 37 implants were available for analysis after a mean loading time of 2.6 ± 1.5 years (range: 13-87 months). No implants were lost. MBLs and mean PPD values did not change statistically significantly from T0 to T1 from 0.92 mm ± 0.42 to 0.96 mm ± 0.38 (95% CI: -0.07/0.17; p = .418) and from 2.99 mm ± 0.70 to 3.27 mm ± 0.71 (95% CI: -0.11/0.68; p = .25) respectively. Peri-implant mucositis was diagnosed in 22 cases. Screw-loosening and zirconia chipping occurred 1× in 4 patients. CONCLUSION Within the limitations of the present proof-of-principle study, the use of full-zirconia FDPCs in posterior areas seems a valid and safe short-term treatment option.
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Affiliation(s)
- Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Michele Morandini
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Alexandra Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Jean-Claude Imber
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Roccuzzo A, Imber JC, Lempert J, Hosseini M, Jensen SS. Narrow diameter implants to replace congenital missing maxillary lateral incisors: a 1-year prospective, controlled, clinical study. Clin Oral Implants Res 2022; 33:844-857. [PMID: 35763401 PMCID: PMC9544295 DOI: 10.1111/clr.13966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/29/2022] [Accepted: 06/03/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To report the clinical, radiographic, aesthetic and patient-reported outcomes after placement of a newly developed Narrow-Diameter Implant (NDI) in patients with congenitally Missing Lateral Incisors (MLIs). MATERIALS AND METHODS Patients with MLIs with a mesio-distal distance between the canine and the central incisor of 5.9-6.3mm received a dental implant with a diameter of 2.9mm (Test), while a diameter of 3.3mm (Control) was used when the distance was 6.4-7.1mm. After healing, a cement-retained bi-layered zirconia crown was fabricated. At the 1-year follow-up (T2), implant survival rate, marginal Crestal Bone Level (CBL) changes, biological and technical complications were registered. The aesthetic outcome was assessed by using the Copenhagen Index Score, and the patient-reported outcomes were recorded using the OHIP-49 questionnaire. RESULTS One-hundred patients rehabilitated with 100 dental implants Ø2.9mm (n = 50) or Ø3.3mm (n = 50) were included. One Ø3.3mm implant was lost and 7 patients dropped out of the study, yielding an implant survival rate of 99% (p = 1.000). At T2 a CBL of -0.19 ± 0.25 mm (Test) and -0.25 ± 0.31 mm (Control) was detected, with no statistically significant difference between the groups (p = 0.342). Good to excellent aesthetic scores (i.e. 1-2) were recorded in most of cases. Technical complications (i.e. loss of retention, abutment fracture, chipping of veneering ceramic) occurred once in three patients with no statistically significant difference between the groups (p > 0.05). OHIP scores did not differ significantly at follow-ups between groups (p = 0.110). CONCLUSION The use of Ø2.9mm diameter implants represents as reliable a treatment option as Ø3.3mm implants, in terms of CBL changes, biological and technical complications. Favorable aesthetics and patient-reported outcomes were recorded for both groups.
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Affiliation(s)
- Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jean-Claude Imber
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Jakob Lempert
- Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mandana Hosseini
- Research Area Oral Rehabilitation, Section for Oral Health, Society and Technology, Institute of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Simon Storgård Jensen
- Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital, Copenhagen, Denmark.,Research Area Oral Surgery, Section for Oral Biology and Immunopathology, Institute of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Stability of Cantilever Fixed Dental Prostheses on Zirconia Implants. MATERIALS 2022; 15:ma15103633. [PMID: 35629659 PMCID: PMC9144678 DOI: 10.3390/ma15103633] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 01/13/2023]
Abstract
Background: The objective was to determine the optimal connector size and position within zirconia disks for implant-supported cantilever fixed dental prostheses (ICFDP). Methods: Two-unit ICFDPs (n = 60) were designed for the premolar region with connector sizes of either 9 or 12 mm2 and positioned in the enamel or dentin layer of two different types of zirconia disks. The restorations were milled and cemented onto zirconia implants. After simulated chewing for 1.2 Mio cycles, the fracture load was measured and fractures were analyzed. Results: No fractures of ICFDPs or along the implants were detected after simulated aging. The mean fracture load values were significantly higher for a connector size of 9 mm2 (951 N) compared with 12 mm2 (638 N). For the zirconia material with a higher biaxial flexural strength, the fracture load values were increased from 751 to 838 N, but more implant fractures occurred. The position within the zirconia disk did not influence the fracture load. Conclusions: A connector size of 9 mm2 and a zirconia material with a lower strength should be considered when designing ICFDPS on zirconia implants to reduce the risk of fractures along the intraosseous implant portion.
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Antiua E, Escuer V, Alkhraisat MH. Short Narrow Dental Implants versus Long Narrow Dental Implants in Fixed Prostheses: A Prospective Clinical Study. Dent J (Basel) 2022; 10:dj10030039. [PMID: 35323241 PMCID: PMC8947067 DOI: 10.3390/dj10030039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/17/2022] [Accepted: 03/01/2022] [Indexed: 12/10/2022] Open
Abstract
There is a paucity of studies that assess short and narrow dental implants. This prospective study aimed to evaluate the performance of both short (≤8 mm) and narrow (≤3.5 mm width) dental implants supporting fixed prostheses in the atrophic maxilla or mandible. Towards that aim, patients with short implants were included in the study. The control group was those with long and narrow dental implants (length > 8 mm and diameter ≤ 3.5 mm). Clinical and demographic variables were extracted from clinical records. During the follow-up, implant survival and marginal bone loss were evaluated and statistically analysed. Forty-one implants were included (18 and 23 implants in the test and control groups, respectively). The median follow-up time was 26 months since insertion in both groups. The results revealed that there was no implant failure and no statistically significant differences in terms of marginal bone loss. Only one screw-loosening effect occurred in the short implants group. Short, narrow dental implants could be an alternative for the restoration of severely resorbed jaws.
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Affiliation(s)
- Eduardo Antiua
- Clínica Eduardo Anitua, 01007 Vitoria, Spain;
- University Institute for Regenerative Medicine and Oral Implantology—UIRMI (UPV/EHU—Fundación Eduardo Anitua), 01007 Vitoria, Spain
- BTI Biotechnology Institute, 01005 Vitoria, Spain
- Correspondence: (E.A.); (M.H.A.)
| | - Virginia Escuer
- Clínica Eduardo Anitua, 01007 Vitoria, Spain;
- University Institute for Regenerative Medicine and Oral Implantology—UIRMI (UPV/EHU—Fundación Eduardo Anitua), 01007 Vitoria, Spain
| | - Mohammad H. Alkhraisat
- University Institute for Regenerative Medicine and Oral Implantology—UIRMI (UPV/EHU—Fundación Eduardo Anitua), 01007 Vitoria, Spain
- BTI Biotechnology Institute, 01005 Vitoria, Spain
- Correspondence: (E.A.); (M.H.A.)
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Occlusal change in posterior implant-supported single crowns and its association with peri-implant bone level: a 5-year prospective study. Clin Oral Investig 2022; 26:4217-4227. [PMID: 35129663 DOI: 10.1007/s00784-022-04394-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/17/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES This study aims to analyze the 5-year occlusal change in posterior implant-supported single crowns and the association between the relative occlusal force (ROF) and peri-implant bone level. MATERIALS AND METHODS Partially edentulous patients who had received implant-supported single crowns in the posterior region were included. Occlusal examinations with a computerized occlusion analysis system were conducted at 0.5, 3, 6, 12, 24, 36, 48, and 60 months after delivery of the implant-supported single crown. The ROFs of implant-supported single crowns, mesial adjacent teeth, and control natural teeth were recorded. Intraoral periapical radiographs were taken at each follow-up time to evaluate marginal bone level (MBL). Ordinary least square regression was used to analyze the association between ROF and MBL. RESULTS Thirty-seven posterior implant-supported single crowns in 33 participants (23.9 to 70.0 years) were followed up for 0.5 to 60 months [(42.4 ± 26.0) months]. The ROF of implant-supported single crowns increased from 2 weeks to 3 months (P < 0.01) and increased continuously between all two sequential time points from 6 to 36 months, with significant differences (P < 0.05). Then ROFs of implant-supported single crowns were significantly higher than those of control teeth at 48 and 60 months (P < 0.05). Regression analysis showed that ROF was significantly associated with MBL with a coefficient of 0.008 (P < 0.05). CONCLUSION The ROFs of posterior implant-supported single crown have significant change during 5 years' follow-up. The association between ROF and MBL has limited clinical significance. TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR-ROC-17012240. CLINICAL RELEVANCE The occlusion of implant-supported single crowns should be carefully monitored during follow-up examinations, and occlusal adjustment should be considered to prevent overloading.
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12
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Nilsson S, Stenport VF, Nilsson M, Göthberg C. A retrospective clinical study of fixed tooth- and implant-supported prostheses in titanium and cobalt-chromium-ceramic: 5-9-year follow-up. Clin Oral Investig 2022; 26:6097-6103. [PMID: 35767046 PMCID: PMC9525405 DOI: 10.1007/s00784-022-04559-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 05/20/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The aim of this retrospective study was to evaluate the clinical outcome of fixed tooth- and implant-supported protheses manufactured in porcelain veneered cobalt-chromium (CoCr) or titanium with a follow-up period of 5-9 years. MATERIALS AND METHODS This study included 63 patients with a total of 86 fixed dental protheses (FDPs) (53 implant-supported and 33 tooth-supported). In total, 67 were short-span FDPs (3-5 units) and 19 were long-span FDPs (6-12 units). The FDPs were evaluated using a modified version of the California Dental Association (CDA). RESULTS The binary regression analysis indicated that neither CoCr nor titanium had a statistically significant effect on the odds of success or survival of either tooth- or implant-supported FDPs. However, the success of FDPs was negatively affected by greater FDP length and general tooth wear. The survival of FDPs was negatively affected by increased FDP longevity. CONCLUSIONS This study found no statistically significant effect on the odds of success and survival outcomes for any combination of tooth-supported, implant-supported, porcelain-veneered CoCr, or porcelain-veneered titanium FDPs. As the number of FDPs was limited, the results should be interpreted with caution. CLINICAL RELEVANCE This study shows that the choice between CoCr porcelain and titanium porcelain in fixed protheses did not have a statistically significant effect on the outcome.
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Affiliation(s)
- Sheida Nilsson
- grid.8761.80000 0000 9919 9582The Sahlgrenska Academy, Department of Prosthodontics, Institute of Odontology, University of Gothenburg, Box 450, 405 30 Göteborg, Sweden
| | - Victoria Franke Stenport
- grid.8761.80000 0000 9919 9582The Sahlgrenska Academy, Department of Prosthodontics, Institute of Odontology, University of Gothenburg, Box 450, 405 30 Göteborg, Sweden
| | - Marco Nilsson
- grid.118888.00000 0004 0414 7587School of Education and Communication, Jönköping University, Box 1026, 551 11 Jönköping, Sweden
| | - Catharina Göthberg
- The Institute for Postgraduate Dental Education in Jönköping, Box 1030, 551 11 Jönköping, Sweden
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Ciocan LT, Ghitman J, Vasilescu VG, Iovu H. Mechanical Properties of Polymer-Based Blanks for Machined Dental Restorations. MATERIALS 2021; 14:ma14237293. [PMID: 34885448 PMCID: PMC8658077 DOI: 10.3390/ma14237293] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/22/2021] [Accepted: 11/26/2021] [Indexed: 11/17/2022]
Abstract
The tremendous technological and dental material progress led to a progressive advancement of treatment technologies and materials in restorative dentistry and prosthodontics. In this approach, CAD/CAM restorations have proven to be valuable restorative dental materials in both provisional and definitive restoration, owing to multifarious design, improved and highly tunable mechanical, physical and morphological properties. Thus far, the dentistry market offers a wide range of CAD/CAM restorative dental materials with highly sophisticated design and proper characteristics for a particular clinical problem or multiple dentistry purposes. The main goal of this research study was to comparatively investigate the micro-mechanical properties of various CAD/CAM restorations, which are presented on the market and used in clinical dentistry. Among the investigated dental specimens, hybrid ceramic-based CAD/CAM presented the highest micro-mechanical properties, followed by CAD/CAM PMMA-graphene, while the lowest micro-mechanical features were registered for CAD/CAM multilayered PMMA.
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Affiliation(s)
- Lucian Toma Ciocan
- Department of Prosthetics Technology and Dental Materials, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (L.T.C.); (V.G.V.)
| | - Jana Ghitman
- Advanced Polymer Materials Group, University Politehnica of Bucharest, 011061 Bucharest, Romania;
- Correspondence:
| | - Vlad Gabriel Vasilescu
- Department of Prosthetics Technology and Dental Materials, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (L.T.C.); (V.G.V.)
| | - Horia Iovu
- Advanced Polymer Materials Group, University Politehnica of Bucharest, 011061 Bucharest, Romania;
- Academy of Romanian Scientists, 050094 Bucharest, Romania
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14
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Wang SC, Wang JCY, Chang CJ, Yuan K. Interdisciplinary treatment with implant-supported two-unit cantilever prosthesis for a patient with hypodontia: A clinical report. J Prosthet Dent 2021; 129:676-680. [PMID: 34489088 DOI: 10.1016/j.prosdent.2021.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 07/17/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
A 21-year-old woman with multiple congenitally missing maxillary anterior teeth received interdisciplinary treatment to restore function and esthetics. The treatment was initiated with orthodontic treatment, followed by implant placement, bone and soft-tissue augmentation, and prosthetic treatment including a screw-retained implant-supported 2-unit cantilever fixed dental prosthesis.
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Affiliation(s)
- Shao-Chun Wang
- Attending Physician, Division of Prosthodontics, Department of Stomatology, National Cheng Kung University Hospital, Tainan, Taiwan, ROC.
| | - Jessica Chia-Yi Wang
- Resident, Department of Stomatology, National Cheng Kung University Hospital, Tainan, Taiwan, ROC
| | - Chen-Jung Chang
- Lecturer and Attending Physician, Division of Orthodontics, Department of Stomatology, National Cheng Kung University Hospital, Tainan, Taiwan, ROC
| | - Kuo Yuan
- Attending Physician, Division of Periodontics, Department of Stomatology, National Cheng Kung University Hospital, Tainan, Taiwan, ROC
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15
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Thoma DS, Wolleb K, Schellenberg R, Strauss FJ, Hämmerle CHF, Jung RE. Two short implants versus one short implant with a cantilever: 5-Year results of a randomized clinical trial. J Clin Periodontol 2021; 48:1480-1490. [PMID: 34448219 PMCID: PMC9292666 DOI: 10.1111/jcpe.13541] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/02/2021] [Indexed: 02/05/2023]
Abstract
Aim To test whether or not the use of a short implant with a cantilever results in similar clinical and radiographic outcomes compared to two adjacent short implants with single tooth reconstructions. Materials and methods Thirty‐six patients with two adjacent missing teeth in the posterior region were randomly assigned to receive either a single 6‐mm implant with a cantilever (ONE‐C) or two 6‐mm implants (TWO). Fixed reconstructions were inserted 3–6 months after implant placement and patients were re‐examined up to 5 years (FU‐5). Results A total of 26 patients were available for re‐examination at FU‐5. The survival rate amounted to 84.2% in ONE‐C and to 80.4% in TWO (inter‐group: p = .894). Technical complication rates amounted to 64.2% (ONE‐C) and to 54.4% (TWO) (inter‐group: p = 1.000). From baseline to FU‐5, the median changes of the marginal bone levels were 0.13 mm in ONE‐C and 0.05 mm in TWO (inter‐group: p = .775). Probing depth, bleeding on probing, and plaque control record values showed no significant differences between the two treatment modalities (p > .05). Conclusions Short implants with a cantilever render similar clinical and radiographic outcomes compared to two adjacent short implants at 5 years, however, they tend to fail at earlier time points suggesting an overload of the implants. Considering the modest survival rates, the clinical indication of either treatment option needs to be carefully evaluated. ClinicalTrials.gov (NCT01649531).
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Affiliation(s)
- Daniel S Thoma
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
| | | | - Roman Schellenberg
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
| | - Franz-Josef Strauss
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
| | | | - Ronald E Jung
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
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Jensen-Louwerse C, Sikma H, Cune MS, Guljé FL, Meijer HJA. Single implant-supported two-unit cantilever fixed partial dentures in the posterior region: a retrospective case series with a mean follow-up of 6.5 years. Int J Implant Dent 2021; 7:78. [PMID: 34409508 PMCID: PMC8374011 DOI: 10.1186/s40729-021-00361-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/28/2021] [Indexed: 11/23/2022] Open
Abstract
Background The aim of this retrospective study was to evaluate the implant survival, clinical and radiographic outcomes, and patient satisfaction of single implant-supported two-unit cantilever fixed partial dentures in the posterior region. Methods Patients who received a single implant-supported fixed partial denture with a cantilever in the posterior region between January 2004 and February 2018 were included. Survival rate of the implants and the fixed partial dentures and data regarding the marginal bone level, presence of plaque, calculus, bleeding on probing, mucosa health, pocket probing depth, and patient satisfaction were collected during an evaluation visit. Complications were recorded from the medical records. Results Twenty-three patients (mean age 64 ± 13 years) with 28 implants could be included in the study. The mean follow-up period was 6.5 ± 4.8 years at the time of data collection. The survival rate of the implants and fixed partial dentures was 100%. Mean marginal bone loss for the mesial and distal side of the implants was 0.41 mm (SD 1.18 mm) and 0.63 mm (SD 0.98 mm) respectively. A high prevalence of peri-implant-mucositis (89.3%) and peri-implantitis (17.9%) was observed as well as a limited number of technical complications. Patients were quite satisfied, as reflected by a mean VAS score of 94.0 ± 7.2 points (range 0–100) and a OHIP-NL49 score of 10.8 (range 0–196). Conclusions Single implant-supported fixed partial dentures with a mesial or distal cantilever can be a predictable treatment option in the posterior region, with stable peri-implant bone levels, minor technical complications, and very content patients. However, the prevalence of peri-implant mucositis and peri-implantitis was high. Trial registration ISRCTN, ISRCTN79055740, Registered on March 14, 2021 – —Retrospectively registered.
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Affiliation(s)
- Charlotte Jensen-Louwerse
- Center for Dentistry and Oral Hygiene, Dental School, University Medical Center Groningen, University of Groningen, PO Box 196, NL-9700AD, Groningen, The Netherlands.
| | - Harjan Sikma
- Center for Dentistry and Oral Hygiene, Dental School, University Medical Center Groningen, University of Groningen, PO Box 196, NL-9700AD, Groningen, The Netherlands
| | - Marco S Cune
- Center for Dentistry and Oral Hygiene, Dental School, University Medical Center Groningen, University of Groningen, PO Box 196, NL-9700AD, Groningen, The Netherlands.,Department of Oral and Maxillofacial Surgery, Prosthodontics and Special Dental Care, St. Antonius Hospital, Nieuwegein, The Netherlands.,Department of Oral and Maxillofacial Surgery, Prosthodontics and Special Dental Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Felix L Guljé
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Center for Dental Implants De Mondhoek, Apeldoorn, The Netherlands
| | - Henny J A Meijer
- Center for Dentistry and Oral Hygiene, Dental School, University Medical Center Groningen, University of Groningen, PO Box 196, NL-9700AD, Groningen, The Netherlands.,Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Schmid E, Roccuzzo A, Morandini M, Ramseier CA, Sculean A, Salvi GE. Clinical and radiographic evaluation of implant-supported single-unit crowns with cantilever extension in posterior areas: A retrospective study with a follow-up of at least 10 years. Clin Implant Dent Relat Res 2021; 23:189-196. [PMID: 33448601 DOI: 10.1111/cid.12973] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 11/16/2020] [Accepted: 12/17/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Implant-supported restorations with cantilever extension may display high rates of biological and technical complications. PURPOSE To report the outcomes of single-unit crowns with cantilever extension (SCCs). MATERIALS AND METHODS Patients with SCCs were reevaluated after ≥10 years of loading. Radiographic marginal bone levels (mBLs) at baseline (ie, delivery of SCCs) and follow-up were calculated and compared between implant surfaces adjacent to and distant from the cantilever extension. Implant survival and success rates were calculated. RESULTS Twenty-one patients with 25 SCs supported by 25 implants were reevaluated after a mean of 13.6 ± 3.8 years (range: 10-19 years). No implants were lost. The mean overall mBLs changed from 0.99 mm ± 0.95 at baseline to 0.95 mm ± 0.99 at follow-up (p = 0.853). The mean pocket probing depths changed from 3.39 mm ± 0.62 at baseline to 3.34 mm ± 0.54 at follow-up (p = 0.635). Loss of retention occurred 3× in 2 patients (14.3%). At follow-up, peri-implant health was diagnosed in 10 (48%) and peri-implant mucositis in 11 (52%) patients, respectively. CONCLUSIONS Within the limitations of the present study, the use of implant-supported SCs with cantilever extension in posterior areas represents a reliable long-term treatment option with a 100% implant survival rate and minimal marginal bone level changes.
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Affiliation(s)
- Eric Schmid
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Michele Morandini
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Christoph A Ramseier
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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18
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Schmid E, Morandini M, Roccuzzo A, Ramseier CA, Sculean A, Salvi GE. Clinical and radiographic outcomes of implant‐supported fixed dental prostheses with cantilever extension. A retrospective cohort study with a follow‐up of at least 10 years. Clin Oral Implants Res 2020; 31:1243-1252. [DOI: 10.1111/clr.13672] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/02/2020] [Accepted: 09/13/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Eric Schmid
- Department of Periodontology School of Dental Medicine University of Bern Bern Switzerland
| | - Michele Morandini
- Department of Periodontology School of Dental Medicine University of Bern Bern Switzerland
| | - Andrea Roccuzzo
- Department of Periodontology School of Dental Medicine University of Bern Bern Switzerland
- Department of Oral and Maxillofacial Surgery Copenhagen University Hospital (Rigshospitalet) Copenhagen Denmark
| | - Christoph A. Ramseier
- Department of Periodontology School of Dental Medicine University of Bern Bern Switzerland
| | - Anton Sculean
- Department of Periodontology School of Dental Medicine University of Bern Bern Switzerland
| | - Giovanni E. Salvi
- Department of Periodontology School of Dental Medicine University of Bern Bern Switzerland
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