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Bischof FM, Mathey AA, Stähli A, Salvi GE, Brägger U. Survival and complication rates of tooth- and implant-supported restorations after an observation period up to 36 years. Clin Oral Implants Res 2024. [PMID: 39177417 DOI: 10.1111/clr.14351] [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: 04/19/2023] [Revised: 07/02/2024] [Accepted: 07/29/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Tooth- and implant-supported fixed dental prostheses are well-documented and aesthetic treatment alternatives, and after a comprehensive periodontal treatment, a protocol with a good long-term prognosis if the maintenance program is strictly followed. AIM To reexamine a pre-existing patient cohort in order to obtain estimated long-term survival and complication outcomes of fixed dental prostheses. MATERIALS AND METHODS For this study, patients treated with fixed dental prostheses between 1978 and 2002 were reexamined between 2019 and 2020. The restorations were divided in single crowns and fixed dental prostheses supported by teeth (TSC, FPTDP) and implants (ISC, FPIDP). Survival and complication rates were obtained. Kaplan-Meier functions were used to model complication probabilities, and average hazard ratios of different strata were compared using weighted Cox regression. RESULTS The mean observation time of 40 patients and 223 reconstructions was 20.3 (±9.7, 1.2-36.2) years. The estimated survival rates were 84% (CI: 77%-92%) for TSC, 63% (CI: 51%-79%) for FPTDP, 87% (CI: 71%-100%) for ISC, and 64% (CI: 34%-100%) for FPIDP after 25 years. Biological complications included carious lesions (10.6%), periodontitis (7.9%), and peri-implantitis (6.8%). Technical complications included chipping (20.2%) and loss of retention (10.8%). CONCLUSION Biological complications lead to abutment loss in more than two-thirds of cases, regardless of the type of abutment (tooth or implant). Technical complications are less associated with abutment loss than biological complications.
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Affiliation(s)
- Frank M Bischof
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Ayse A Mathey
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Alexandra Stähli
- 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
| | - Urs Brägger
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Palma-Carrió C, Macconi A, Rubert-Aparici A, Vidal-Peiró P, Menéndez-Nieto I, Blaya-Tárraga JA. Prosthetic Complications of Single Screw-Retained Implant-Supported Metal-Ceramic Fixed Prostheses: A Retrospective Observational Study. Int J Dent 2024; 2024:9242928. [PMID: 39165325 PMCID: PMC11335423 DOI: 10.1155/2024/9242928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 06/05/2024] [Accepted: 07/04/2024] [Indexed: 08/22/2024] Open
Abstract
Purpose To analyze prosthetic complications of single screw-retained implant-supported metal-ceramic fixed prostheses (SSIMCFPs). Materials and Methods A total of 457 medical records of patients treated with implants at the University Dental Clinic of the European University of Valencia from 2016 to 2022 were reviewed. Of the 335 SSIMCFPs evaluated, 222 were included. The following data were collected from medical records: age, sex, prosthesis location, implant diameter, type of antagonist, date of prosthesis placement, type of prosthetic complications, and the date of the occurrence of complications. Statistical analysis was estimated at the patient level with a simple binary logistic regression and at the prosthesis level, a simple logistic regression with generalized estimating equation models (p < 0.05). Results A total of 222 SSIMCFPs were placed in 159 patients. The prevalence of complications was 23.3% at the patient level, equivalent to 21.6% of SSIMCFPs. A total of 48 complications were collected; screw loosening was the most frequent complication (16.2%), followed by ceramic fracture (3.1%), screw fracture (1.8%), and implant fracture (0.5%). There were no cases of abutment fracture. The mean time of the loosening of the screw was 10.5 months and ceramic fractures at 6.9 months. The factors that most influenced the occurrence of prosthetic complications were posterior position (p < 0.001), implant diameter from 3.5 to 4.8 mm (p < 0.01), and lower arch position (p < 0.05). Conclusions The most frequent complication of SSIMCFP was loosening of the screw followed by ceramic fracture. The appearance of these complications usually occurred during the first year after SSIMCFP placement. Factors related to the occurrence of complications were mandibular posterior location and implant diameter from 3.5 to 4.8 mm.
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Affiliation(s)
| | | | | | - Paula Vidal-Peiró
- Faculty of DentistryEuropean University of Valencia, Valencia, Spain
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Nogueira Barbosa Marchon R, Mourão CF, Rutkowski JL, Ghanaati S, Mello-Machado RC, Mendes Senna P. Comparative Analysis of Internal Tapered Implant-Abutment Connections: Evaluating the Morse Effect. J ORAL IMPLANTOL 2024; 50:431-434. [PMID: 38826061 DOI: 10.1563/aaid-joi-d-24-00039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
The purpose of the present study was to evaluate the Morse effect of different internal tapered implant-abutment connections (ITCs) using a pullout test. Implants with different ITCs were selected: Short (Bicon, USA), G1; Novo Colosso (Medens, Brazil), G2; Epkut (SIN, Brazil), G3; Strong SW (SIN, Brazil), G4; Flash (Conexão, Brazil), G5 and Bone Level (Straumann, Switzerland), G6. The respective computer-aided design (CAD) files were loaded into the analysis software to measure each ITC's taper angle and implant-abutment contact area. Six implants from each group were embedded in acrylic resin blocks, and the respective universal abutments were fixed using a mallet (G1) or by applying 20 Ncm of torque (G2 to G6). After 10 minutes, each abutment's retention screw was removed, and the force necessary for abutment rupture was recorded using a universal testing machine at a crosshead speed of 0.5 mm/min. The groups were compared using a one-way analysis of variance and Tukey's test. Spearman's correlation was used to check the correlation of the taper angle and contacting area with the pullout strength. G1, a no-screw abutment with a 3° taper, and G2, a 10° tapered abutment tightened by 20 Ncm, presented the highest pullout strength (P < .05). The increased taper angle of G4, compared to G3, reduced the Morse effect despite their similar implant-abutment contacting areas (P < .05). The G5 and G6 abutments loosened after screw removal and did not exhibit pullout resistance. The closer the tapered angle (r = -.958) and the higher the implant-abutment contact area (r = .880), the higher the pullout strength (P < .001). Within the limits of this study, the Morse effect is different among tapered implant-abutment connections. The closer the tapered angle and the higher the interface area, the higher the Morse effect between the abutment and the implant.
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Affiliation(s)
| | - Carlos Fernando Mourão
- Department of Periodontology, Tufts University School of Dental Medicine, Boston, Massachusetts
| | - James L Rutkowski
- Department of Restorative Dentistry, School of Dental Medicine, State University of New York, Buffalo
| | - Shahram Ghanaati
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, FORM (Frankfurt Orofacial Regenerative Medicine) Lab, University Hospital Frankfurt, Goethe University, Germany
| | | | - Plinio Mendes Senna
- Department of Prosthodontics, Rio de Janeiro State University, Rio de Janeiro, Brazil
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Peixoto RF, Tonin BSH, Pinto-Fiamengui LMS, Freitas-Pontes KM, Regis RR, Mattos MDGCD. Analysis of implant-supported cantilever fixed partial denture: An in vitro comparative study on vertical misfit, stress distribution, and cantilever fracture strength. J Prosthodont 2024; 33:584-592. [PMID: 37470305 DOI: 10.1111/jopr.13739] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 06/23/2023] [Accepted: 07/14/2023] [Indexed: 07/21/2023] Open
Abstract
PURPOSE To evaluate the vertical misfit, stress distribution around dental implants, and cantilever fracture strength of 3-unit implant-supported cantilever fixed partial dentures (FPDs) using frameworks made from different materials and manufacturing techniques. MATERIALS AND METHODS Forty FPDs were fabricated and divided into 5 groups (n = 8) based on the framework material used: LAS Co-Cr (Conventional casting-laser welding); TIG Co-Cr (Conventional casting -TIG welding); OP Co-Cr (Conventional casting-one-piece); CAD Co-Cr (CAD-CAM); and CAD Zr (CAD-CAM ZrO2). The vertical misfit was evaluated before porcelain application (T1) and before (T2), and after thermomechanical cycling (T3) by stereomicroscopy. Cantilever fracture strength was tested with a 50 kN (5000 kgf) load cell at a crosshead speed of 0.5 mm/min. Qualitative and quantitative photoelastic analysis was performed to evaluate stress distribution at seven specific points in five FPDs (n = 1/group) subjected to occlusal loading. RESULTS Only the molar showed interaction among the three factors (G × S × T; F(20.932) = 1.630; p = 0.044). Thermomechanical cycling (T2 vs. T3) had a significant effect on intra-group vertical misfit in molar, especially in LAS Co-Cr (Δ = 5.87; p = 0.018) and OP Co-Cr (Δ = 5.39; p = 0.007), with no significant effect in premolar (p > 0.05). Ceramic application combined with thermomechanical cycling (T1 vs. T3) caused a significant intra-group increase in vertical misfit in all groups, both in the molar and premolar (p < 0.05). OP Co-Cr was associated with greater vertical misfit and stress concentration. Frameworks manufactured by the CAD-CAM system exhibited lower vertical misfit and better stress distribution. FPDs with metal frameworks (>410.83 ± 72.26 N) showed significantly higher fracture strength (p < 0.05) than zirconia (277.47 ± 39.10 N), and the first signs of ceramic veneering fracture were observed around 900 N. CONCLUSIONS FPDs with frameworks manufactured using a CAD-CAM system appear to be associated with lower vertical misfit and better stress distribution, although the section of the frameworks followed by welding may be a viable alternative. In addition, metal frameworks exhibit high fracture strength.
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Affiliation(s)
- Raniel Fernandes Peixoto
- Department of Restorative Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará (FFOE/UFC), Fortaleza, Ceará, Brazil
| | - Bruna Santos Honório Tonin
- Department of Dental Materials and Prosthodontics, Ribeirão Preto School of Dentistry, University of São Paulo (FORP/USP), Ribeirão Preto, São Paulo, Brazil
| | - Lívia Maria Sales Pinto-Fiamengui
- Department of Restorative Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará (FFOE/UFC), Fortaleza, Ceará, Brazil
| | - Karina Mattes Freitas-Pontes
- Department of Restorative Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará (FFOE/UFC), Fortaleza, Ceará, Brazil
| | - Rômulo Rocha Regis
- Department of Restorative Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará (FFOE/UFC), Fortaleza, Ceará, Brazil
| | - Maria da Glória Chiarello de Mattos
- Department of Dental Materials and Prosthodontics, Ribeirão Preto School of Dentistry, University of São Paulo (FORP/USP), Ribeirão Preto, São Paulo, Brazil
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Vilela N, Gurgel BCV, Bruzos CD, Duarte WR, da Silva HDP, Pannuti CM, Duarte PM. Preloading peri-implant crestal bone loss: A retrospective study of incidence and related factors. J Periodontol 2024. [PMID: 38923568 DOI: 10.1002/jper.24-0028] [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: 01/15/2024] [Revised: 03/06/2024] [Accepted: 04/17/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The aim of this study was to evaluate the incidence of preloading crestal bone loss (PLCBL) and to identify the patient-related and implant-related factors associated with PLCBL. METHODS This retrospective cohort examined the dental records of patients who received at least one dental implant. PLCBL was defined as a reduction ⩾0.5 mm and severe PLCBL (primary variable) as a reduction ⩾1.5 mm in mesial and/or distal bone level, measured from the day of implant placement to uncovering or abutment installation/crown delivery. The incidence of PLCBL and patient and implant variables were recorded. Bivariate analysis and binary logistic regression identified factors associated with PLCBL ⩾0.5 mm and ⩾1.5 mm. RESULTS A total of 746 dental implants placed in 361 patients from January 2011 to July 2021 was included in the analyses. Of the implants assessed, 24.4% (n = 182) exhibited PLCBL ⩾ 0.5 mm and 10.5% (n = 78) presented severe PLCBL (i.e., ⩾1.5 mm). Males (odds ratio [OR] = 1.85, 95% confidence interval [CI] = 1.11-3.07), patients with diabetes (OR = 3.33, 95% CI = 1.73-6.42), and those allergic to penicillin (OR = 3.13, 95% CI = 1.57-6.22) were more likely to experience severe PLCBL (p < 0.05). Implants placed in the anterior area (OR = 2.08, 95% CI = 1.16-3.73), with bone-level platform-abutment connection (OR = 4.73, 95% CI = 1.94-11.49) and inserted supracrestally (OR = 3.77, 95% CI = 1.84-7.72), presented a greater risk of developing severe PLCBL (p < 0.05). Implants placed in a previously grafted area presented a lower likelihood of developing severe PLCBL (OR = 0.489, 95% CI = 0.28-0.84). CONCLUSION The incidence of PLCBL ⩾ 0.5 mm and ⩾1.5 mm was 24.4% and 10.5%, respectively. Male sex, diabetes, allergy to penicillin, anterior location, bone-level platform-abutment connection, and supracrestal implant placement are potential risk factors for severe PLCBL. A previously grafted area is a potential protective factor.
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Affiliation(s)
- Nathalia Vilela
- Department of Stomatology, Division of Periodontology, School of Dentistry, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Bruno C V Gurgel
- Department of Dentistry, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Carlos De Bruzos
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Wagner R Duarte
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Hélio D P da Silva
- Department of Dentistry, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - Claudio M Pannuti
- Department of Stomatology, Division of Periodontology, School of Dentistry, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Poliana Mendes Duarte
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, Florida, USA
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6
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Steyer E, Theisen K, Hulla H, Ubaidha Maheen C, Sokolowski A, Lorenzoni M. Eleven- to fifteen-year outcome for two-piece implants with an internal tube-in-tube connection: a cross-sectional analysis of 245 implants. Oral Maxillofac Surg 2024; 28:859-867. [PMID: 38315402 DOI: 10.1007/s10006-024-01215-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/19/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE The aim of this retrospective study was to evaluate the outcomes of a two-piece implant system with a tube-in-tube internal connection after up to 15 years of clinical use. MATERIAL AND METHODS A retrospective follow-up examination of patients treated with internal tube-in-tube implants between 2003 and 2006 was conducted. The implant survival rates, peri-implant conditions (marginal bone loss, bleeding on probing, plaque index, probing depth), and technical complications were determined. RESULTS In total, 312 dental implants were placed in 152 patients. Of the original 152 patients enrolled, 245 implants in 112 patients were available for a follow-up evaluation after 11 to 15 years (mean observation time, 12.9 ± 1.1 years). The overall implant survival rate was 93.9%. Outcomes for MBL (1.49 ± 1.23 mm), PI (24.3 ± 22.2%), BOP (18.3 ± 28.7%), and PD (2.74 ± 1.21 mm) were observed. Selected parameters (time after implant surgery, smoking habits, bone augmentation (GBR)) showed an influence on MBL and PD. CONCLUSIONS The internal tube-in-tube implant system showed favorable long-term results. The correlation of MBL and PD with the patient-specific factor smoking habit is in accordance with other studies. CLINICAL RELEVANCE Camlog Root-Line implants with a tube-in-tube implant-abutment connection and a 1.6-mm polished neck configuration have demonstrated favorable long-term outcomes in daily clinical practice. However, it is important to note that these implants are no longer available on the market.
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Affiliation(s)
- Elisabeth Steyer
- Division of Operative Dentistry, Periodontology and Prosthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, Billrothgasse 4, 8010, Graz, Austria
| | - Kerstin Theisen
- Division of Operative Dentistry, Periodontology and Prosthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, Billrothgasse 4, 8010, Graz, Austria.
| | - Helfried Hulla
- Division of Operative Dentistry, Periodontology and Prosthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, Billrothgasse 4, 8010, Graz, Austria
- Private Practice Straß, Graz, Austria
| | - Ceeneena Ubaidha Maheen
- Division of Operative Dentistry, Periodontology and Prosthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, Billrothgasse 4, 8010, Graz, Austria
| | - Alwin Sokolowski
- Division of Operative Dentistry, Periodontology and Prosthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, Billrothgasse 4, 8010, Graz, Austria
| | - Martin Lorenzoni
- Division of Operative Dentistry, Periodontology and Prosthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, Billrothgasse 4, 8010, Graz, Austria
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7
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Back LS, Silva J, Morsch CS, Tumedei M, Magini RDS, Piatelli A, Benfatti CAM. Clinical Performance of 170 Frictional Morse Taper Implants: 2 Years Follow-Up. J ORAL IMPLANTOL 2024; 50:127-135. [PMID: 38530824 DOI: 10.1563/aaid-joi-d-23-00054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
This study evaluated the clinical survival rates of 170 Morse taper implants through clinical and mechanical parameters in different therapeutic approaches such as single crowns, fixed partial prostheses, and fixed full-arch prostheses. Patients referred to the Center on Education and Research on Dental Implants from May 2017 to July 2018 with the indication for dental implant therapy, aged >18 years, without periodontal disease, recent evidence of inflammatory activity or other oral disorders, current pregnancy, uncontrolled diabetes mellitus or heavy smoking habit were included in this study. After 12 weeks of healing since the implants were placed in the mandible and after 16 weeks following implants placed in the maxilla, patients returned to the Center for prosthetic rehabilitation. After implant therapy, all patients underwent periodical, clinical, and prosthetic examinations every 6 months. Prosthetic restorations involved 109 fixed reconstructions in function. Few prosthetic complications were reported (6.55%). Twenty implants were rehabilitated with cemented prostheses; from those, 1 crown suffered a loss in retention/decementation. Of the 148 implants rehabilitated with screwed-retained prostheses, 6.76% suffered prosthetic screw loosening. The cumulative implant survival rate was 98.2%. When peri-implant tissue health was evaluated, the keratinized mucosa band appeared related to peri-implant tissue stability. Thus, Morse taper implants represented a successful procedure for implant rehabilitation, with a high cumulative implant survival rate, low prevalence of biological and prosthetic complications, and good stability of peri-implant tissues over the assessed period.
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Affiliation(s)
- Lara Steiner Back
- Department of Dentistry, Center for Education and Research on Dental Implants (CEPID), Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Joseane Silva
- Department of Dentistry, Center for Education and Research on Dental Implants (CEPID), Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Carolina Schäffer Morsch
- Department of Dentistry, Center for Education and Research on Dental Implants (CEPID), Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Margherita Tumedei
- Department of Biomedical, Surgical and Dental Sciences, State University of Milano, Milano, Italy and IRCCS, Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, Milano, Italy
| | - Ricardo de Souza Magini
- Department of Dentistry, Center for Education and Research on Dental Implants (CEPID), Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Adriano Piatelli
- School of Dentistry, Saint Camillus International University for Health Sciences (Unicamillus), Rome, Italy and Facultad de Medicina, Universidad Catolica San Antonio de Murcia, Murcia Spain
| | - Cesar Augusto Magalhães Benfatti
- Department of Dentistry, Center for Education and Research on Dental Implants (CEPID), Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
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Stilwell C. Occlusal considerations in maintaining health of implants and their restorations. Br Dent J 2024; 236:773-779. [PMID: 38789754 PMCID: PMC11126375 DOI: 10.1038/s41415-024-7407-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/23/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024]
Abstract
Dental implants are a regular feature in daily clinical practice and there is a need to undertake routine assessment and maintenance of implants and their restorations on par with that provided for natural teeth. Occlusal checks form an important part of the maintenance regime for preserving the integrity of implants, their restorations, and health of the peri-implant tissues. Implant restorations are subjected to the full characteristics and magnitude of occlusal forces, including those associated with parafunction. Compared with the periodontal ligament around teeth, the biophysical response to occlusal forces of osseointegration is different through the more rigid link of implant to bone and reduced proprioception. Risks attributable to occlusal forces primarily affect implant restorations and they are elevated in the presence of bruxism. The occlusal guidelines recommended by the literature are aimed at reducing these risks and regular assessment and maintenance of the occlusion is essential. A four-step sequence is presented to ensure that the annual occlusal checks include the patient's input and evaluation of restoration integrity, occlusal scheme, additional protection, and spatial changes.
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Affiliation(s)
- Charlotte Stilwell
- Specialist in Prosthodontic Dentistry, Specialist Dental Services, Harley Street, London, W1G 7HX, UK; Division of Gerodontics and Removable Prosthodontics, University of Geneva, Geneva, Switzerland.
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9
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Fan X, Chen L, Chen Q, Wang F, Wu Y, Sun Y. Influence of a mesial cantilever on stress, strain, and axial force in fixed partial dentures with a distally tilted implant in the atrophic posterior maxilla. J Prosthodont Res 2024:JPR_D_23_00218. [PMID: 38616127 DOI: 10.2186/jpr.jpr_d_23_00218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
PURPOSE This study aimed to investigate whether the presence of a mesial cantilever influences the biomechanical behavior and screw loosening in fixed partial dentures (FPDs) with a distally tilted implant in the atrophic posterior maxilla and where to best place the distal implant. METHODS Two configurations of implant-supported four-unit FPDs were modelled using finite element analysis. Five interabutment distances were considered. The stress and strain distributions in the implants, abutments, and prosthetic screws were verified under occlusal loading. The development of the axial force on the abutments and screws was also examined. Two-sample t-tests were used to identify differences (P < 0.05). RESULTS The von Mises stress distributions of the components in the two configurations were similar, as were the maximum plastic strains of the distal prosthetic screws, distal implants, and 30° abutments. The difference in the maximum plastic strains of the straight abutments was statistically significant. The preload of the 30° abutment screws was significantly reduced after the initial loading. In the absence of a mesial cantilever, the axial force on the straight abutments increased. However, when a mesial cantilever was used, the preload of the straight abutments was maintained, and the axial force on the prosthetic screws fluctuated less. The axial force fluctuation of the abutments gradually decreased as the interabutment distance increased. CONCLUSIONS Mesial cantilever usage had minimal effect on stress or strain distribution in FPD implants, abutments, or prostheses. However, it helped resist screw loosening. The distal screw access hole was preferably positioned close to the prosthetic end.
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Affiliation(s)
- Xiaohui Fan
- Shanghai Key Laboratory of Advanced High Temperature Materials and Precision Forming, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Li Chen
- Yangtze Delta Advanced Material Research Institute, Suzhou, China
| | - Qiuren Chen
- Yangtze Delta Advanced Material Research Institute, Suzhou, China
| | - Feng Wang
- Department of Second Dental Center, Shanghai Ninth People's Hospital, School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Yiqun Wu
- Department of Second Dental Center, Shanghai Ninth People's Hospital, School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Yuanyuan Sun
- Department of Second Dental Center, Shanghai Ninth People's Hospital, School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai, China
- Department of Oral Cell Biology, Academic Center for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam and University of Amsterdam, Amsterdam, Netherlands
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10
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Aliberti SM, Funk RHW, De Stefano M, Hoffmann T, Capunzo M. An epidemiological qualitative/quantitative SWOT-AHP analysis in order to highlight the positive or critical aspects of dental implants: A pilot study. Clin Exp Dent Res 2024; 10:e2836. [PMID: 38450945 PMCID: PMC10918715 DOI: 10.1002/cre2.836] [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: 08/24/2023] [Revised: 12/15/2023] [Accepted: 12/22/2023] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVES In recent years, dental implants are increasing in popularity due to their high success rate, demonstrated functionality, and aesthetic treatment results. Scientific research is very active in proposing improvements in the quality and survival of implants, taking into consideration various aspects. The objective of this study was to provide a holistic epidemiologic view of the state of dental implants, using a systematic approach based on a multimethod SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis and AHP (analytical hierarchical process) qualitative-quantitative analysis to identify the characteristics that can determine their success or failure. MATERIALS AND METHODS The study used the hybrid method of SWOT-AHP. RESULTS Analysis of the results showed that among strengths, the skill of the dentist was considered the most important factor, followed by the success of dental implants in the old people; among weaknesses, bruxism and chronic diseases were highlighted; for opportunities, biomechanical behavior, in terms of good mechanical strength and good tribological resistance to chemical and physical agents in the oral cavity, were considered the most important factors; finally, among threats, medical liability and biomechanical problems had equal weight. CONCLUSIONS This study applied a multimethod SWOT-AHP approach to bring out favorable or critical evidence on the topic of dental implants. In accordance with the result of the strategic vector identified in the Twisting zone Adjustment type section, showed that implant surgery is a widespread technique but always needs improvement to increase the likelihood of success and reduce the complications that can lead to implant failure.
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Affiliation(s)
- Silvana Mirella Aliberti
- Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”University of SalernoSalernoItaly
| | - Richard H. W. Funk
- Institute of AnatomyTechnische Universität (TU) DresdenDresdenGermany
- Division of Preventive MedicineDresden International University (DIU)DresdenGermany
| | - Marco De Stefano
- Department of Industrial EngineeringUniversity of SalernoSalernoItaly
| | - Thomas Hoffmann
- Division of Preventive MedicineDresden International University (DIU)DresdenGermany
| | - Mario Capunzo
- Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”University of SalernoSalernoItaly
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11
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Smith RB, Bryce GE, Ng Y, Gulabivala K, Dermont MA. Eight-year retrospective study investigating tooth survival after primary non-surgical root canal treatment in a UK military cohort. BMJ Mil Health 2024; 170:107-111. [PMID: 35788109 DOI: 10.1136/bmjmilitary-2021-002042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/19/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Root canal treatment (RCT) plays an important role in preserving the dentition by deferring other invasive treatments. Data on tooth survival and predictive factors for tooth loss after RCT in the military cohort are lacking. This investigation aimed to determine the proportion of teeth surviving in an 8-year period after RCT and identify potential predictive factors for tooth loss in a UK military cohort. METHODOLOGY A retrospective review of an integrated electronic health record for military patients who had received RCT was performed in a random sample of 205 patients (n=219 root-filled teeth) who had received RCT between 1 January 2011 and 1 January 2012. Tooth survival was defined as tooth presence, regardless of signs or symptoms, and measured from the point of root filling until either the end of the designated study period or time of extraction. Survival was evaluated using Kaplan-Meier estimates and association with tooth loss using the χ2 test. Potentially significant predictive factors were investigated using univariate Cox regression. RESULTS Tooth survival following RCT was 98% after 24 months; 88% after 48 months; 83% after 72 months; and 78% after 96 months. Four predictive factors were found to affect tooth loss as follows: preoperative pain (HR=3.2; p<0.001), teeth with less than two proximal contacts (HR=3.0; p=0.01), teeth with cores involving more than two surfaces (HR=2.0; p=0.03) and postoperative unscheduled dental attendances (UDA) (HR=2.7; p=0.01). CONCLUSIONS Within the limitations of this study, the presence of preoperative pain; teeth with less than two proximal contacts or with cores involving more than two tooth surfaces; and occurrence of postoperative UDA were found to significantly increase the hazard of tooth loss.
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Affiliation(s)
| | - G E Bryce
- DCRD, Aldershot Garrison, Aldershot, UK
| | - Y Ng
- Endodontology, University College London, London, UK
- Restorative Dentistry and Endodontology, UCL Eastman Dental Institute, London, UK
| | - K Gulabivala
- Restorative Dentistry and Endodontology, UCL Eastman Dental Institute, London, UK
| | - M A Dermont
- Defence Public Health Unit, Defence Medical Services, Lichfield, UK
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12
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Zhang Y, Luo J, Di P, Chen B, Li J, Yu Z, Lin Y. Screw-retained ceramic-veneered/monolithic zirconia partial implant-supported fixed dental prostheses: A 5 to 10-year retrospective study on survival and complications. J Prosthodont 2024; 33:221-230. [PMID: 37302066 DOI: 10.1111/jopr.13723] [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: 01/08/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSE To assess the clinical performance of screw-retained, ceramic-veneered, monolithic zirconia partial implant-supported fixed dental prostheses (ISFDP) over 5-10 years and to evaluate implant- and prosthesis-related factors influencing treatment failure and complications. MATERIALS AND METHODS Partially edentulous patients treated with screw-retained all-ceramic ISFDPs with 2-4 prosthetic units with a documented follow-up of ≥5 years after implant loading were included in this retrospective study. The outcomes analyzed included implant/prosthesis failure and biological/technical complications. Possible risk factors were identified using the mixed effects Cox regression analysis. RESULTS A screened sample of 171 participants with 208 prostheses (95% of the restorations were splinted crowns without a pontic) supported by 451 dental implants were enrolled in this study. The mean follow-up duration after prosthesis delivery was 82.4 ±17.2 months. By the end of the follow-up period, 431 (95.57%) of the 451 implants remained functional at the implant level. At the prosthesis level, 185 (88.94%) of the 208 partial ISFDPs remained functional. Biological complications were observed in 67 implants (14.86%), and technical complications were observed in 62 ISFDPs (29.81%). Analysis revealed only emergence profiles (over-contoured) as a significant risk factor for implant failure (P<0.001) and biological complications (P<0.001). Full-coverage ceramic-veneered zirconia prostheses had a significantly greater chance of chipping (P<0.001) compared with buccal-ceramic-veneered or monolithic zirconia prostheses. CONCLUSIONS Screw-retained ceramic-veneered, monolithic partial ISFDPs have a favorable long-term survival rate. Over-contoured emergence profile is a significant risk factor associated with implant failure and biological complications. Buccal-ceramic-veneered and monolithic zirconia partial ISFDPs lower the initial prevalence of chipping compared with a full-coverage veneered design.
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Affiliation(s)
- Yifan Zhang
- Department of Oral Implantology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, PR China
| | - Jia Luo
- Department of Oral Implantology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, PR China
| | - Ping Di
- Department of Oral Implantology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, PR China
| | - Bo Chen
- Department of Oral Implantology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, PR China
| | - Jianhui Li
- Department of Oral Implantology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, PR China
| | - Ziyang Yu
- Department of Oral Implantology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, PR China
| | - Ye Lin
- Department of Oral Implantology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, PR China
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13
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Tajti P, Solyom E, Váncsa S, Mátrai P, Hegyi P, Varga G, Hermann P, Borbély J, Sculean A, Mikulás K. Less marginal bone loss around bone-level implants restored with long abutments: A systematic review and meta-analysis. Periodontol 2000 2024; 94:627-638. [PMID: 37766634 DOI: 10.1111/prd.12534] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023]
Abstract
The aim of this study was to investigate the biological outcomes of bone-level implants restored with long vs. short abutments, with regard to the 'one abutment at one time' protocol. The systematic search was performed in five databases: MEDLINE (PubMed), EMBASE, Web of Science, Scopus, and CENTRAL for randomized controlled trials up to January 14, 2023. Data were collected for marginal bone loss, bleeding on probing, and probing pocket depth by two reviewers. As effect size measure, mean difference (MD), and risk ratio (RR) were used for continuous and categorical outcomes, R-statistics software was used for conducting statistical analyses. For quality and certainty assessment, Risk of Bias Tool 2, ROBINS-I, and GRADE approach were used. The search resulted in 4055 records without any duplicates. After title, abstract, and full-text analysis, eight articles were found eligible for inclusion. Bone-level and platform-switched implants presented less marginal bone loss after 6 months and 1 year as well, when long abutments were used (MD 0.63, 95% CI: [-0.16; 1.42]) and (MD 0.26, 95% CI: [-0.02; 0.53]). However, subgroup analysis revealed no difference in marginal bone loss when applying 'one abutment at one time' protocol (p = 0.973). Bleeding on probing and probing pocket depth presented similarly good results in both groups without almost any differences (RR 0.97, 95% CI: [0.76; 1.23]) and (MD -0.05, 95% CI: [-1.11; 1.01]). Longer abutments on bone-level implants seem to be a favorable choice for decreasing early marginal bone loss, irrespective of connection timing.
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Affiliation(s)
- Péter Tajti
- Department of Prosthodontics, Semmelweis University, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Eleonora Solyom
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Periodontology, Semmelweis University, Budapest, Hungary
| | - Szilárd Váncsa
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Mátrai
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Gábor Varga
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Oral Biology, Semmelweis University, Budapest, Hungary
| | - Péter Hermann
- Department of Prosthodontics, Semmelweis University, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Judit Borbély
- Department of Prosthodontics, Semmelweis University, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Krisztina Mikulás
- Department of Prosthodontics, Semmelweis University, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
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14
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Wittneben JG, Abou-Ayash S, Gashi A, Buser D, Belser U, Brägger U, Sailer I, Gavric J. Implant-supported single all-ceramic crowns made from prefabricated (stock) or individualized CAD/CAM zirconia abutments: A 5 year randomized clinical trial. J ESTHET RESTOR DENT 2024; 36:164-173. [PMID: 38173277 DOI: 10.1111/jerd.13188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
AIM The aim of this randomized, prospective, and clinical multicenter study was to compare the overall clinical performance of two restorative options over a 5-year period: individualized CAD/CAM abutments veneered with a hand-layered ceramic, and prefabricated zirconium dioxide abutments veneered with press ceramic and inserted into a single edentulous gap in the anterior maxilla. MATERIALS AND METHODS Forty subjects were recruited from two universities: 20 from the University of XX and 20 from the University of XY. Each subject received an implant to restore a single edentulous gap in the maxillary anterior region (14-24 FDI). 20 patients were randomized into each Group. Group A received a one-piece single crown produced from a prefabricated zirconia abutment with pressed ceramic and Group B received an individualized CAD/CAM zirconia abutment with a hand-layered technique. After 5 years, the aesthetic and radiographic parameters were assessed. RESULTS Group A had four dropouts and one failure, resulting in a 95% survival rate and 95% success rate. Group B had two dropouts and two failures which resulted in a 90% survival rate and 90% success rate. No crestal bone level changes were observed, with a mean DIB of 0.06 mm in Group A and 0.09 mm in Group B. No statistically significant differences were present at baseline, 6 months, 1 year, 3 years, or 5 years for DIB values between time points and groups. Pink aesthetic score/white aesthetic score, Peri-Implant and Crown Index, and Implant Crown Aesthetic Index values were stable over time at all five points for both groups. CONCLUSION Both implant-supported restorative options represent a valuable treatment option for the restoration of implant crowns in the anterior maxilla. CLINICAL SIGNIFICANCE In general, the use of ceramic abutments in the anterior zone represents a valuable treatment procedure with both standardized and CAD/CAM individualized abutments and following the recommendations from the respective manufacturer(s).
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Affiliation(s)
- Julia-Gabriela Wittneben
- Private Practice, Zürich, Switzerland
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Samir Abou-Ayash
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | | | - Daniel Buser
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Urs Belser
- Department of Reconstructive Dentistry, School of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Urs Brägger
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Irena Sailer
- Department of Reconstructive Dentistry, School of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Jelena Gavric
- Department of Reconstructive Dentistry, School of Dental Medicine, University of Geneva, Geneva, Switzerland
- Private Practice, Geneva, Switzerland
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15
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Jongsiri S, Arksornnukit M, Homsiang W, Kamonkhantikul K. Effect of Restoration Design on the Removal Torque Loss of Implant-supported Crowns after Cyclic Loading. J Contemp Dent Pract 2023; 24:951-956. [PMID: 38317392 DOI: 10.5005/jp-journals-10024-3604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
AIM To compare the removal torque loss (RTL) percentage of screw-retained, cement-retained, and combined screw- and cement-retained implant-supported crowns after cyclic loading and measure the impact of cyclic loading on removal torque. MATERIALS AND METHODS Thirty-two dental implants (4.0 × 10 mm) in resin blocks and abutments were divided into four groups (n = 8) based on restoration design: combined screw- and cement-retained group (SC), two cement-retained groups: cemented with adhesive resin cement (AR) (Panavia V5) or provisional cement (PR) (RelyX Temp NE), and screw-retained one-piece titanium group (TI). Removal torques were measured in Newton-centimeter (Ncm) before and after 500,000-cycle cyclic loading with forces ranging from 20 to 200 N at 15 Hz. The RTL percentage in each group was calculated. The paired t-test was used to detect the difference between pre-loading (RT1) and post-loading removal torque (RT2) in each group and 1-way ANOVA was used to detect the difference of RTL percentage between groups. RESULTS The post-loading removal torques in all groups were significantly lower than their pre-loading removal torques (p < 0.001). The 1-way ANOVA test found no significant difference in the RTL% between the study groups. The PR group exhibited the lower RTL% (30.74 ± 7.3%), followed by the TI (30.78 ± 5.6%), AR (32.12 ± 2.5%), and SC (35.71 ± 5.1%) groups. CONCLUSION Combined screw- and cement-retained restorations exhibited similar RTL compared with other restoration designs, and cyclic loading significantly affected the removal torque. CLINICAL SIGNIFICANCE Combined screw- and cement-retained restorations can be utilized in single-tooth situations, offering a comparable impact on screw joint stability while providing benefit of retrievability. Cyclic loading significantly influences joint stability, periodic checkup for screw loosening is recommended. How to cite this article: Jongsiri S, Arksornnukit M, Homsiang W, et al. Effect of Restoration Design on the Removal Torque Loss of Implant-supported Crowns after Cyclic Loading. J Contemp Dent Pract 2023;24(12):951-956.
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Affiliation(s)
- Suppanut Jongsiri
- Esthetic Restorative and Implant Dentistry Program, Department of Prosthodontics, Faculty of Dentistry, Chulalongkorn University, Pathumwan, Bangkok, Thailand, Orcid: https://orcid.org/0009-0005-8918-601X
| | - Mansuang Arksornnukit
- Department of Prosthodontics, Faculty of Dentistry, Chulalongkorn University, Pathumwan, Bangkok, Thailand, Orcid: https://orcid.org/0000-0001-5356-4086
| | - Woraporn Homsiang
- Department of Family and Community Dentistry, Faculty of Dentistry, Chiang Mai University, Suthep, Chiang Mai, Thailand, Orcid: https://orcid.org/0000-0003-2908-292X
| | - Krid Kamonkhantikul
- Department of Prosthodontics, Faculty of Dentistry, Chulalongkorn University, Pathumwan, Bangkok, Thailand, Phone: +66945599524, e-mail: , Orcid: https://orcid.org/0000-0002-0660-162X
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16
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Klein M, Tuminelli FJ, Sallustio A, Giglio GD, Lerner H, Berg RW, Waltuch A. Full-arch restoration with the NEXUS IOS® system: A retrospective clinical evaluation of 37 restorations after a one year of follow-up. J Dent 2023; 139:104741. [PMID: 37832627 DOI: 10.1016/j.jdent.2023.104741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/08/2023] [Accepted: 10/10/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVES Report the results with a novel workflow of digital restoration for completely edentulous patients with implant supported full arch fixed dental prostheses (ISFDP). METHODS This multicenter retrospective clinical study was based on the evaluation from a cohort of 29 patients restored with 37 ISFDP designed and manufactured from the data captured by a direct intraoral scan, using a novel full digital system (NEXUS IOS®, Osteon Medical, a Keystone Dental Group company, Melbourne, Australia). Data was collected over a 3-year period, in six different dental centers. This study reported on the clinical parameters including: precision of marginal fit, functional and aesthetic integration of Nexus ISFDP. All patients were followed for a period of one year post delivery. Implant survival, biologic and prosthetic complications were assessed, at one year. A statistical analysis was conducted. RESULTS All 37 ISFDP were deemed clinically acceptable on insertion. Implant survival at one year was 100 %. The biologic and prosthetic complications were minimal during the follow-up period. CONCLUSIONS ISFDP, designed and manufactured using the NEXUS IOS® system, are clinically acceptable, with a low incidence of complications at one year. Long-term clinical studies are needed. STATEMENT OF CLINICAL RELEVANCE Within the limitations of this study (retrospective design, small patient sample, limited follow-up) the NEXUS IOS® system seems to represent a viable solution for the restoration of completely edentulous patients with ISFDP, in a full digital workflow.
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Affiliation(s)
| | - Frank J Tuminelli
- Diplomate & Director, American Board of Prosthodontics, Director, Graduate Prosthodontics VA NY Harbor Healthcare System, Adjunct Clinical Instructor, NYU Dental School, Clinical Assistant Professor, Hofstra Northwell School of Medicine, New York, NJ, USA
| | - Anthony Sallustio
- Chief of Maxillofacial Prosthetics, The Regional Craniofacial Center, St. Joseph's Hospital, Paterson, NJ, USA
| | | | - Henriette Lerner
- Academic Teaching and Research Institution of Johann Wolfgang Goethe-University, Frankfurt am Main, Private Practice, Baden, Germany
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17
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Zhang WT, Ding YD, Wang LH, Yang F. Retrieval of a fractured implant abutment using a modified cover screw removal instrument: A clinical report. J Prosthet Dent 2023:S0022-3913(23)00543-7. [PMID: 37718179 DOI: 10.1016/j.prosdent.2023.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 09/19/2023]
Abstract
Implant abutment fractures are an uncommon mechanical complication, and the removal of the abutment fragment and replacement with a new prosthesis is the best solution. However, successful retrieval of the fractured abutment fragment from the implant is challenging, and effective rescue kits are lacking. This clinical report describes the retrieval of a fractured implant abutment in a conical connection implant using a modified manufacturer-specific instrument.
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Affiliation(s)
- Wen-Tao Zhang
- Attending Doctor, Center for Plastic & Reconstructive Surgery, Department of Stomatology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, PR China
| | - Yu-de Ding
- Attending Doctor, Center for Plastic & Reconstructive Surgery, Department of Stomatology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, PR China
| | - Lin-Hong Wang
- Associate Chief Physician, Center for Plastic & Reconstructive Surgery, Department of Stomatology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, PR China
| | - Fan Yang
- Professor, Center for Plastic & Reconstructive Surgery, Department of Stomatology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, PR China..
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18
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Wittneben JG, Molinero-Mourelle P, Hamilton A, Alnasser M, Obermaier B, Morton D, Gallucci GO, Wismeijer D. Clinical performance of immediately placed and immediately loaded single implants in the esthetic zone: A systematic review and meta-analysis. Clin Oral Implants Res 2023; 34 Suppl 26:266-303. [PMID: 37750531 DOI: 10.1111/clr.14172] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 08/07/2023] [Accepted: 08/13/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVES The aim of this study was to assess the following PIO question: In adult patients treated with an indication for single tooth extraction in the maxillary esthetic zone (15-25), what is the influence of an immediate implant placement and immediate loading protocol on the clinical performance (primary aim) and esthetic outcomes (secondary aim) focusing on investigations published after 2010. MATERIAL AND METHODS An electronic search in Medline (PubMed), the Cochrane Central Register of Controlled Trials, and EMBASE databases up to April 2022 was performed to identify clinical studies investigating the outcome of single implants subjected to immediate placement with immediate restoration/loading (Type 1A). RESULTS Sixty-three studies (10 randomized controlled trials, 28 prospective and 25 retrospective cohort studies) were included with a follow-up ranging from 12 to 96 months. One thousand nine hundred sixty-one implants reported survival rates of 99.2 (98.6-99.5) % at 1 year, 97.5 (95.9-98.4) % after 3 years, and 95.8 (93.3-97.4) % after 5 years; 1064 immediately loaded restorations presented survival rates of 98.9 (97.8-99.5) % after 1 year, 96.8 (93.6-98.4) % after 2 years, and 94.8 (89.6-97.4) % after 5 years. Comparing baseline to 12-month data using the Hedges' g effect size (95% CI), papilla height presented an overall effect size of -0.71 (-1.25, -0.1) mm, midfacial recession change of -0.15 (-0.66, 0.36) mm, and a 0.82 (0.37, 1.28) gain in PES. CONCLUSIONS Immediate implant placement and immediate loading can be considered a predictable and safe treatment option for single maxillary anterior restorations with adequate survival rates and favorable esthetics outcomes for up to 5 years.
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Affiliation(s)
- Julia-Gabriela Wittneben
- Department of Reconstructive Dentistry & Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Pedro Molinero-Mourelle
- Department of Reconstructive Dentistry & Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Conservative Dentistry and Orofacial Prosthetics, Faculty of Dentistry, Complutense University of Madrid, Madrid, Spain
| | - Adam Hamilton
- Division of Oral Restorative and Rehabilitative Sciences, University of Western Australia, Perth, Western Australia, Australia
- Division of Regenerative and Implant Sciences, Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | | | | | - Dean Morton
- Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, Indiana, USA
| | - German O Gallucci
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Massachusetts, USA
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19
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Ju C, Lee Y, Hong SJ, Song SJ, Choi Y, Cho E, Paek J. Risk factors associated with screw loosening in CAD-CAM custom abutments: A 6-year retrospective study. J Prosthet Dent 2023:S0022-3913(23)00369-4. [PMID: 37507308 DOI: 10.1016/j.prosdent.2023.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/28/2023] [Accepted: 05/31/2023] [Indexed: 07/30/2023]
Abstract
STATEMENT OF PROBLEM Custom abutments made by using computer-aided design and computer-aided manufacturing (CAD-CAM) are often used for implant-supported prostheses. However, studies on screw loosening of implant prostheses using custom abutments are lacking. PURPOSE The purpose of this retrospective study was to investigate the risk factors of screw loosening in implant-supported prostheses using custom abutments made with CAD-CAM. MATERIAL AND METHODS Clinical charts, radiographic images, and CAD custom abutment design file data were collected and analyzed retrospectively. The study included 255 patients with 401 dental implants, and the follow-up duration was 6 years. Age, sex (male/female), type of unit (single-unit or multiunit), location of the implant (maxilla or mandible and anterior, premolar, or molar tooth), type of antagonist, and experience of the prosthodontist were reviewed, and implant angulation (mesiodistal and buccolingual), location of the screw access hole (mesiodistal and buccolingual distances from center), and attrition status (none, localized, or generalized) were measured by using a CAD file. The frequencies and percentages of risk factors were evaluated with the Fisher exact test, and the Bonferroni correction was used as a post hoc test. Multiple logistic regression with the Firth method was performed to calculate the odds ratios and their confidence intervals (α=.05). RESULTS Screw loosening showed a correlation with the severity of attrition (P<.001). Single-unit prostheses had a higher risk of screw loosening than multiunit prostheses (P<.001). Experience of the prosthodontist (P<.001). Buccolingual angulation of the implant and abutment significantly influenced the incidence of screw loosening (P<.05). Age, sex, location of the implant, type of antagonist, mesiodistal implant angulation, and buccolingual and mesiodistal location of the screw access hole did not significantly influence the incidence of screw loosening (P>.05). CONCLUSIONS The degree of attrition, buccolingual angulation of the implant and abutment, type of unit, and experience of the prosthodontist (>3 years or <3 years) were risk factors in the incidence of screw loosening.
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Affiliation(s)
- Changmin Ju
- Graduate student, Department of Prosthodontics, Graduate School, School of Dentistry, Kyung Hee University, Seoul, Republic of Korea
| | - Younghoo Lee
- Clinical Assistant Professor, Department of Prosthodontics, Kyung Hee University Dental Hospital, Seoul, Republic of Korea
| | - Seoung-Jin Hong
- Assistant Professor, College of Dentistry, Kyung Hee University, Seoul, Republic of Korea
| | - Seung Jun Song
- Assistant Professor, College of Dental Medicine, Columbia University, New York, NY
| | - Youngkyun Choi
- Graduate student, Department of Prosthodontics, Graduate School, School of Dentistry, Kyung Hee University, Seoul, Republic of Korea
| | - Eunhan Cho
- Graduate student, Department of Prosthodontics, Graduate School, School of Dentistry, Kyung Hee University, Seoul, Republic of Korea
| | - Janghyun Paek
- Associate Professor, Department of Prosthodontics, College of Dentistry, Kyung Hee University, Seoul, Republic of Korea.
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Vieira SNV, Lourenço MF, Pereira RC, França EC, Vilaça ÊL, Silveira RR, Silva GC. Conventional and Digital Impressions for Fabrication of Complete Implant-Supported Bars: A Comparative In Vitro Study. MATERIALS (BASEL, SWITZERLAND) 2023; 16:ma16114176. [PMID: 37297310 DOI: 10.3390/ma16114176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023]
Abstract
Obtaining accurate models and well-fitting prostheses during the fabrication of complete implant-supported prostheses has been a significant challenge. Conventional impression methods involve multiple clinical and laboratory steps that can lead to distortions, potentially resulting in inaccurate prostheses. In contrast, digital impressions may eliminate some of these steps, leading to better-fitting prostheses. Therefore, it is important to compare conventional and digital impressions for producing implant-supported prostheses. This study aimed to compare the quality of digital intraoral and conventional impressions by measuring the vertical misfit of implant-supported complete bars obtained using both types of techniques. Five digital impressions using an intraoral scanner and five impressions using elastomer were made in a four-implant master model. The plaster models produced with conventional impressions were scanned in a laboratory scanner to obtain virtual models. Screw-retained bars (n = five) were designed on the models and milled in zirconia. The bars fabricated using digital (DI) and conventional (CI) impressions were screwed to the master model, initially with one screw (DI1 and CI1) and later with four screws (DI4 and CI4), and were analyzed under a SEM to measure the misfit. ANOVA was used to compare the results (p < 0.05). There were no statistically significant differences in the misfit between the bars fabricated using digital and conventional impressions when screwed with one (DI1 = 94.45 µm vs. CI1 = 101.90 µm: F = 0.096; p = 0.761) or four screws (DI4 = 59.43 µm vs. CI4 = 75.62 µm: F = 2.655; p = 0.139). Further, there were no differences when the bars were compared within the same group screwed with one or four screws (DI1 = 94.45 µm vs. DI4 = 59.43 µm: F = 2.926; p = 0.123; CI1 = 101.90 µm vs. CI4 = 75.62 µm: F = 0.013; p = 0.907). It was concluded that both impression techniques produced bars with a satisfactory fit, regardless of whether they were screwed with one or four screws.
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Affiliation(s)
- Samanta N V Vieira
- Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | | | | | - Esdras C França
- Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Ênio L Vilaça
- Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Rodrigo R Silveira
- Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Guilherme C Silva
- Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
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Couto BADA, Fernandes JCH, Saavedra-Silva M, Roca H, Castilho RM, Fernandes GVDO. Antisclerostin Effect on Osseointegration and Bone Remodeling. J Clin Med 2023; 12:jcm12041294. [PMID: 36835830 PMCID: PMC9964545 DOI: 10.3390/jcm12041294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/17/2023] [Accepted: 01/26/2023] [Indexed: 02/10/2023] Open
Abstract
Objective: This study reviewed the literature on local or systemic administration of antisclerostin, presenting results associated with osseointegration of dental/orthopedic implants and stimulation of bone remodeling. Materials and Methods: An extensive electronic search was conducted through MED-LINE/PubMed, PubMed Central, Web of Science databases and specific peer-reviewed journals to identify case reports, case series, randomized controlled trials, clinical trials and animal studies comparing either the systemic or local administration of antisclerostin and its effect in osseointegration and bone remodeling. Articles in English and with no restriction on period were included. Results: Twenty articles were selected for a full-text, and one was excluded. Finally, 19 articles were included in the study (16 animal studies and 3 randomized control trials). These studies were divided into two groups, which evaluated (i) osseointegration and (ii) bone remodeling potential. Initially 4560 humans and 1191 animals were identified. At least 1017 were excluded from the studies (981 humans and 36 animals), totaling 4724 subjects who completed (3579 humans and 1145 animals). (a) Osseointegration: 7 studies described this phenomenon; 4 reported bone-implant contact, which increased in all included studies. Similar results were found for bone mineral density, bone area/volume and bone thickness. (b) Bone remodeling: 13 studies were used for description. The studies reported an increase in BMD with sclerostin antibody treatment. A similar effect was found for bone mineral density/area/volume, trabecular bone and bone formation. Three biomarkers of bone formation were identified: bone-specific alkaline phosphatase (BSAP), osteocalcin and procollagen type 1 N-terminal Pro-peptide (P1NP); and markers for bone resorption were: serum C-telopeptide (sCTX), C-terminal telopeptides of type I collagen (CTX-1), β-isomer of C-terminal telopeptides of type I collagen (β-CTX) and tartrate-resistant acid phosphatase 5b (TRACP-5b). There were limitations: low number of human studies identified; high divergence in the model used (animal or human); the variance in the type of Scl-Ab and doses of administration; and the lack of reference quantitative values in the parameters analyzed by authors' studies (many articles only reported qualitative information). Conclusion: Within the limitations of this review and carefully observing all data, due to the number of articles included and the heterogeneity existing, more studies must be carried out to better evaluate the action of the antisclerostin on the osseointegration of dental implants. Otherwise, these findings can accelerate and stimulate bone remodeling and neoformation.
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Affiliation(s)
| | | | - Mariana Saavedra-Silva
- Departamento de Cirurgía (Área de Estomatología), Facultad de Medicina, Universidad de Salamanca, 37007 Salamanca, Spain
| | - Hernan Roca
- McCauley-Roca Lab’s, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA
| | - Rogério Moraes Castilho
- Periodontics and Oral Medicine Department, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA
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22
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Zhang R, Hao X, Zhang K. Evaluation of two different occlusal patterns on single posterior implant-supported crowns: A 12-month prospective study of occlusal analysis. J Prosthet Dent 2023:S0022-3913(22)00759-4. [PMID: 36610845 DOI: 10.1016/j.prosdent.2022.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 01/07/2023]
Abstract
STATEMENT OF PROBLEM According to the concept of implant-protected occlusion, light occlusion and late contact could prevent implants from occlusal overload. However, clinical data demonstrating how light occlusion differs from normal occlusion are lacking. PURPOSE The purpose of this prospective clinical study was to characterize the occlusal variation of single posterior implant-supported crowns with or without light occlusion. MATERIAL AND METHODS Participants with a single missing posterior maxillary or mandibular molar who were to receive implant-supported zirconia ceramic crowns were enrolled. The participants were divided into a light occlusion group, in which a 12-μm articulating film could be removed from the implant-supported crown and opposing natural teeth under the intercuspal position, and a normal occlusion group, in which the articulating film could not be removed. All participants underwent occlusal examinations using the T-scan III system, answered a satisfaction questionnaire using a visual analog scale (VAS), and received regular follow-ups. The participants were evaluated at 0.5, 3, 6, and 12 months after implant-supported crown delivery. The relative occlusal force of the implant-supported crowns, mesial teeth, control teeth (corresponding natural tooth on the dentition contralateral to each implant), and the occlusal contact time of implant-supported crowns were recorded. Moreover, the asymmetry index of the occlusal force and the VAS score were calculated. Two independent-sample tests were used to compare the 2 groups. The Wilcoxon rank sum and Mann‒Whitney tests were used to compare nonnormally distributed data (α=.001). RESULTS Fifty study participants with a mean ±standard deviation age of 36.97 ±7.34 years (23 men and 27 women aged 20 to 50 years) were followed for 0.5 to 12 months. No obvious complications of overloading were observed in either group. The mean ±standard deviation of the relative occlusal force of implant-supported crowns in the light occlusion group (from 4.91 ±3.52% to 10.34 ±4.35%) was always lower than that in the normal occlusion group (from 10.45 ±4.32% to 18.15 ±4.80%), while the mean ±standard deviation of the occlusal contact time in the light occlusion group (from 0.38 ±0.26 seconds to 0.10 ±0.07 seconds) was significantly later than that in the normal occlusion group (from 0.12 ±0.08 seconds to 0.04 ±0.02 seconds) (P<.001). The value of the asymmetry index of occlusal force remained within the normal range (10%). The VAS score in the normal occlusion group was significantly higher than that in the light occlusion group (P<.001). CONCLUSIONS Providing light occlusion to reduce occlusal force and delay the contact time was not stable over time. The relative occlusal force and occlusal contact time showed a similar development trend in both groups, and no obvious signs of occlusal overloading were observed in this study. Long-term follow-up is necessary for implant-supported prostheses because of the continuous increase in occlusal force.
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Affiliation(s)
- Ru Zhang
- Attending, Department of Prosthodontics, Capital Medical University School of Stomatology, Beijing Stomatological Hospital, Beijing, PR China
| | - Xiaoyu Hao
- Graduate Student, Department of Prosthodontics, Capital Medical University School of Stomatology, Beijing Stomatological Hospital, Beijing, PR China
| | - Kaiyu Zhang
- Associate Chief, Department of Oral and Maxillofacial Surgery, Capital Medical University School of Stomatology, Beijing Stomatological Hospital, Beijing, PR China.
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Crauste E, Struillou X, Lanoiselee E, Cloitre A. GUIDED PERI-IMPLANT AUTOGENOUS SOFT TISSUE GRAFTING: CASE REPORT. J ORAL IMPLANTOL 2022; 48:489035. [PMID: 36473180 DOI: 10.1563/aaid-joi-d-21-00201] [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: 07/01/2021] [Revised: 06/22/2022] [Accepted: 07/12/2022] [Indexed: 02/17/2024]
Abstract
This case report showed the proof-of-concept of a guided free gingival graft around a dental implant. A 65-year-old male presented to replace his 30 and 31. Once the osseointegration of the 2 implants placed by guided surgery has been achieved, a free gingival graft was indicated. The surgical planning of this graft was performed using the Cone Beam Computed Tomography and archs digital scanning already used for implant placement. The greater palatine foramen and gutter were radiologically located to protect their arterial content. Two surgical guides were designed, one for the palatal donor site and one for the recipient site. The first one will serve both as an incision guide and as a post-operative protective plate. The procedure was free of adverse events. At the 1-year recall, the average gain in keratinized tissue width amounted 2.5 mm. This guided surgery could be used in a patient with insufficient amount of keratinized tissue around a posterior implant. For the first time, it makes it possible to anticipate, accelerate and secure the intervention, to improve the practitioner's comfort and potentially the outcomes of free gingival grafts. Further research and clinical are needed to validate this protocol and to assess its long-term impact on peri-implant health.
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Affiliation(s)
- Eleonore Crauste
- Nantes University: Universite de Nantes Faculté d'odontologie 1, place Alexis Ricordeau FRANCE NANTES Loire Atlantique 44000
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Hicklin SP, Bindl A, Schmidlin PR. Radiographic results of osteotome-driven maxillary sinus floor elevation without grafting materials after 17.5 years radiographic evaluation of minimally-invasive sinus grafting. J Dent 2022; 126:104318. [PMID: 36202279 DOI: 10.1016/j.jdent.2022.104318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/30/2022] [Accepted: 10/02/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND There is growing evidence that minimally invasive sinus augmentation works without the use of filler materials. This study assessed the bone integration and sinus projection of single-unit implants in the maxilla, which were placed approximately 18 years ago using a modified filler-free osteotome technique. METHODS Sixteen of the 24 treated patients of a former publication (treatment was performed between 2001 and 2004) were reassessed after a mean implant loading period of 17.5 years. The treated posterior areas were evaluated using cone-beam computed tomography (CBCT), and as a primary outcome parameter, sinus projection was determined in sectional views at the mesial, distal, buccal, and oral sites. Additionally, the percentage of alveolar bone contact was determined with respect to the implant length. Conventional radiographs were used to determine marginal bone levels. Additionally, plaque, bleeding on probing, and probing pocket depth were measured. The reconstructions were checked for chipping and other technical complications such as loss of retention, screw loosening, and screw fracture. RESULTS The mean age of the included patients was 72.8 ± 8.5 years. Two implants were lost. Therefore, fourteen implants were available for CBCT evaluation. The highest sinus projection of 2.1 ± 1.7 mm was observed in the distal aspect, while it was 1.1 ± 1.5, 0.9 ± 1.2, and 0.9 ± 1.1 mm at the mesial, buccal, and oral sites, respectively. The maximal sinus projection in one case was 6.7 mm. The percentage calculation of osseous implant integration (in mm ± standard deviations) with respect to the selected implant length at the mesial, distal, buccal, and oral sites showed values ranging from, 87.9 ± 16.0, 78.4 ± 20.3, 91.0 ± 12.5, and 90.5 ± 11.1%, respectively. Five implants displayed probing pocket depths of more than 4 mm with bleeding; all implants had less than 1 mm of bone loss in the observation period, that is, implants had mucositis. Six of 14 crowns showed small chippings within the ceramic veneering. One case of screw loosening was reported in medical history. DISCUSSION This study showed that implant placement in non-augmented sinuses resulted in good clinical results. The sinus projection, even if persistent and present, leads to no functional impairments. Given adequate maintenance, marginal bone levels remain constant and peri‑implant health can be observed. Moreover, these results represent only a small cohort; and therefore, should be interpreted with caution. However, in view of the existing literature, these highly promising results are in line with other findings. CLINICAL SIGNIFICANCE To the best of our knowledge, this dataset is the report with the longest follow-up. Overall, implants placed in the sinus without fillers represent a valuable alternative for tooth replacement in a minimally interventional manner.
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Affiliation(s)
- Stefan P Hicklin
- Clinic of Conservative and Preventive Dentistry, Division of Periodontology and Peri-implant Diseases, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Andreas Bindl
- Clinic of Conservative and Preventive Dentistry, Division of Periodontology and Peri-implant Diseases, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Patrick R Schmidlin
- Clinic of Conservative and Preventive Dentistry, Division of Periodontology and Peri-implant Diseases, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.
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25
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Dental implant failure and factors associated with treatment outcome: A retrospective study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 124:101314. [PMID: 36280552 DOI: 10.1016/j.jormas.2022.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/26/2022] [Accepted: 10/16/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of the present study was to retrospectively 1) investigate the association between implant-, patient- and bone-related parameters with the risk of implant failure; 2) analyze the survival rates of dental implants placed in a university clinical setting. METHODS Data were retrieved from patient charts from the University of Minnesota School of Dentistry to identify patients older than 18 years of age who received dental implant treatment by faculty, residents or students in the university dental clinics. Implant-, patient- and bone-related parameters such as implant system, length, diameter, jaw, region, installation protocol, gender, smoking, medical history, history of periodontal disease, self-reported oral parafunctions, type of bone, and operator were manually retrieved and analyzed. RESULTS Five hundred and fifty-three implants were randomly selected from a total of 4,424. Of these 553 implants, 440 (79.6%) were associated with a >10 mm length, 371 (67.1%) with a >4 mm diameter and 431 (77.9%) had replaced a single tooth. Submerged healing mode was followed in 363 (65.6%) of the implants with the mean healing time being 3.2 months. History of periodontal disease was identified in 294 (53.2%) of these cases. A total of 17 implants failed after a mean time of 6.29 ± 6.75 months, resulting in an overall survival rate of 96.9%. Based on a univariate analysis, implant system, operator, time between extraction and implant surgery, time between bone grafting and implant placement, tobacco use as well as clenching and grinding were considered potential implant failure predictors and were further included in the multivariate logistic regression analysis. Tobacco use (p < 0.001) was significantly associated with implant failure. CONCLUSION Within the limitations of this retrospective randomly selected university-treated sample tobacco use increased the risk for implant failure. Failure occurred in 17 implants representing a 3.1% failure rate.
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Sass JO, Burmeister U, Ganz C, Mitrovic A, Lang H, Bader R, Vogel D. Fracture strength of monolithic and glass-soldered ceramic sub-components of 5-unit fixed dental prosthesis. J Prosthodont 2022; 32:e71-e80. [PMID: 35924927 DOI: 10.1111/jopr.13586] [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: 01/20/2022] [Accepted: 07/27/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Zirconium dioxide ceramic has been successfully introduced as a framework material for fixed dental prostheses. To reduce manufacturing constraints, joining of sub-components could be a promising approach to increase the mechanical performance of long-span fixed dental prostheses. In this experimental study, the biomechanical behavior of monolithic and soldered framework specimens for fixed dental prostheses made of Y-TZP was investigated. MATERIALS AND METHODS Framework specimens (n = 80) of 5-unit fixed dental prostheses made of Y-TZP were prepared and divided into 10 equal groups. The specimens were monolithic or composed of sub-components, which were joined using a silicate-based glass solder. Thereby, three joint geometries (diagonal, vertical with an occlusal cap, and dental attachment-based) were investigated. Moreover, the groups differed based on the mechanical test (static vs. dynamic) and further processing (veneered vs. unveneered). The framework specimens were cemented on alumina-based jaw models, where the canine and second molar were acting as abutments, before a point-load was applied. In addition, μCT scans and microscopic fractography was used to evaluate the quality of soldered joints and to determine the causes of fracture. RESULTS The determined fracture loads of the different unveneered framework specimens in static testing did not vary significantly (p = 1). Adding a veneering layer significantly increased the mechanical strength for monolithic framework specimens from 1,196.29 ±203.79 N to 1,606.85 ±128.49 N (p = 0.008). In case of soldered specimens with a dental attachment-based geometry the mechanical strength increased from 1,159.42 ±85.65 N to 1,249.53 ±191.55 N (p = 1). Within the dynamic testing, no differences were observed between monolithic and soldered framework specimens. μCT scans and fractography proved that the dental attachment-based joining geometry offers the highest quality. CONCLUSION Using glass soldering technology, sub-components of 5-unit framework specimens made of Y-TZP could be joined with mechanical properties comparable to those of monolithic frameworks. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jan-Oliver Sass
- Department of Orthopedics, Rostock University Medical Center, Rostock, Germany.,Department of Operative Dentistry and Periodontology, Rostock University Medical Center, Rostock, Germany
| | - Ulrike Burmeister
- Department of Operative Dentistry and Periodontology, Rostock University Medical Center, Rostock, Germany
| | | | | | - Hermann Lang
- Department of Operative Dentistry and Periodontology, Rostock University Medical Center, Rostock, Germany
| | - Rainer Bader
- Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - Danny Vogel
- Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
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Full-Arch Rehabilitation Using Trans-Mucosal Tissue-Level Implants with and without Implant-Abutment Units: A Case Report. Dent J (Basel) 2022; 10:dj10070116. [PMID: 35877390 PMCID: PMC9320847 DOI: 10.3390/dj10070116] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/13/2022] [Accepted: 06/22/2022] [Indexed: 01/27/2023] Open
Abstract
Recently, tissue-level implants with a convergent collar have been introduced. While different studies have investigated the outcomes of this implant design in the rehabilitation of single teeth, its use in full-arch rehabilitation has yet to be investigated. The present case report describes the clinical outcomes of a full-arch immediate loading rehabilitation using tissue-level implants, with and without using implant-abutment units, with 2 years of follow-up. A female patient with mandibular terminal dentition and a high level of bone resorption (distal areas with a few millimeters of residual bone in the vertical dimension and both distal and anterior areas with narrow crestal bone in the horizontal dimension) was seen at the C.I.R Dental School, Turin, Italy. The patient was seeking to be rehabilitated with fixed prosthodontics, and she was found eligible for an immediate loading implant full-arch rehabilitation. Four implants were inserted in the same appointment. The two anterior implants were inserted straight and connected directly to the prosthesis (no abutments); the two distal implants were tilted in order to avoid the alveolar nerve and connected to two 30° angulated abutments. Two years post-implant placement, all of the implants were successfully integrated, resulting in an implant survival rate of 100%. The peri-implant soft tissues were stable at all the implant sites. No differences were highlighted between those implants with and without abutments. Within the limitations of the present clinical report, implant full-arch rehabilitations with tissue-level implants both with and without implant-abutment units showed optimal outcomes after two years of follow-up. Further research is encouraged to confirm whether this implant design may be a valid alternative to traditional implants in this type of rehabilitation, with or without implant-abutment units.
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Juodzbalys G. Dental Implant Placement in Focal Osteoporotic Bone Marrow Defect: a Case Report and Treatment Recommendations. J Oral Maxillofac Res 2022; 13:e5. [PMID: 36382015 PMCID: PMC9617253 DOI: 10.5037/jomr.2022.13305] [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: 09/12/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Focal osteoporotic bone marrow defect is asymptomatic radiolucent area usually discovered incidentally during radiographic examination of the jaws. This bone condition can lead to clinical complications during dental implant placement or during osseointegration process. METHODS A 54-year-old woman was referred to private dental implant centre for a dental implant rehabilitation treatment in May 17, 2016. Oral examination revealed a healthy mucosa with no visible pathology. Adentia of tooth #46 and moderate atrophy of the edentulous alveolar process were found. Panoramic radiography of the jaws showed 2 cm x 2 cm radiolucency with irregular borders located in tooth #46 region. The margins of the bone defect were uneven, single trabeculae were visible, and the cortical layer was not deformed. In the absence of signs of pathology, it was decided to perform a dental implant surgery in the edentulous jaw segment #46. RESULTS The osteoporotic focus was filled with natural bovine bone substitute Cerabone®. The granules were gently condensed to the sides - to the buccal and lingual walls until they filled the entire cavity. A 10 mm long, 4.1 mm diameter Straumann® Tissue Level implant was surgically placed with the shoulder of the implant resting on the margins of the osteotomy. It was proposed six steps protocol for surgical dental implant installation in focal osteoporotic bone marrow defect in mandible. CONCLUSIONS A six-step protocol for surgical placement of dental implants in focal osteoporotic bone marrow defects may be a useful tool for clinicians in implant dentistry.
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Affiliation(s)
- Gintaras Juodzbalys
- Department of Maxillofacial Surgery, Faculty of Odontology, Medical Academy Lithuanian University of Health Sciences, KaunasLithuania.
- Dental implant centre 'Stilus Optimus', KaunasLithuania.
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Cecchinato D, Marino M, Håkansson J, Lindhe J, Derks J. Occurrence of complications in patients restored with implants. Clin Oral Implants Res 2022; 33:913-920. [PMID: 35774013 DOI: 10.1111/clr.13970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/23/2022] [Accepted: 06/26/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the occurrence and clustering of complications in subjects restored with fixed implant-supported prostheses. METHODS 241 subjects treated at one clinical center and provided with 729 implants were included in the present retrospective case series. A clinical and radiographic examination was performed after a mean follow-up period of 4.8 ±2.0 years. Additional information on occurrence of technical (chipping, loss of retention, fracture of components) and biological complications (marginal bone loss, implant loss) during follow-up was extracted from patient records. For each type of complication and complications overall, regression analyses were performed to identify potential risk factors. Cox-regression analyses were used to evaluate time-to-event for implant loss and technical complications. RESULTS In all, 30% of the 241 patients presented with at least one complication of technical and/or biological character during the follow-up period. Technical complications affected 19.5% of subjects, while 14.1% presented with marginal bone loss >2 mm. Implant loss occurred in 4.6% of subjects. While technical complications were noted already early during the maintenance period (<1,200 days), implant loss typically occurred during a later phase. A small subgroup of subjects (7.9%) experienced more than one type of complication. CONCLUSIONS Complications occurred frequently and the most common type of complication was of technical character. Technical and biological complications occurred independently of each other.
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Affiliation(s)
| | | | - Jan Håkansson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jan Lindhe
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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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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Gasser TJW, Papageorgiou SN, Eliades T, Hämmerle CHF, Thoma DS. Interproximal contact loss at implant sites: a retrospective clinical study with a 10-year follow-up. Clin Oral Implants Res 2022; 33:482-491. [PMID: 35194854 PMCID: PMC9311812 DOI: 10.1111/clr.13908] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 11/10/2021] [Accepted: 02/02/2022] [Indexed: 11/30/2022]
Abstract
AIM To assess the frequency and quantity of interproximal contact loss (ICL) between implant restorations and adjacent teeth after at least 10 years of follow-up (FU). METHODS Thirty-nine patients (median age 57.3 years) with 80 implants were re-examined at least 10 years after insertion of final restorations (single-crowns or fixed dental prostheses (FDPs)). Baseline (insertion of the restorations) and FU examinations encompassed: stone casts were scanned and superimposed for metric assessment of tooth movements, radiographs and clinical measurements. Outcome measures at implant sites were: the extent of tooth movement and the frequency of interproximal contact loss [ICL], peri-implant marginal bone levels [MBLs], and clinical measurements (plaque control record [PCR], bleeding on probing [BOP] and probing depth [PD]). Data were analyzed statistically with generalized regression modelling with robust standard errors to account for within-patient clustering at 5%. RESULTS ICL for at least one contact point after 10 years was observed in 50% of all implants (with open interproximal spaces up to 1.64 mm). Mesial contact points were significantly more prone to ICL than distal ones (relative risk [RR]=1.79; 95% confidence interval [CI]=1.07-2.99; p=0.03). The type of restoration had a significant effect on ICL, with FDPs of 2 implants being significantly more prone to mesial ICL than single crowns (RR=1.52; 95% CI=1.02-2.25; p=0.04). ICL was also associated with a significant increase in PD (+0.46 mm (95% CI=0.04-0.88 mm; P=0.03)) compared to implant sites without ICL. BOP, MBLs and PCR were not significantly influenced by ICL. CONCLUSION ICL was a common finding in 50% of the implant sites and was significantly associated with an increase in PD.
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Affiliation(s)
- Thomas J W Gasser
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Switzerland
| | - Spyridon N Papageorgiou
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Switzerland
| | - Theodore Eliades
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Switzerland
| | - Christoph H F Hämmerle
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Switzerland
| | - Daniel S Thoma
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Switzerland.,Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, Korea
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Sailer I, Karasan D, Todorovic A, Ligoutsikou M, Pjetursson BE. Prosthetic failures in dental implant therapy. Periodontol 2000 2022; 88:130-144. [PMID: 35103329 PMCID: PMC9305548 DOI: 10.1111/prd.12416] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Both fixed and removable implant‐supported prostheses are well‐established methods for replacing missing teeth in partially or fully edentulous patients. Numerous systematic reviews have been performed in recent years to evaluate the survival and complication rates of implant‐retained fixed dental prostheses and implant‐retained overdentures, displaying high 5‐year survival rates ranging from 97.1% for fixed dental prostheses to 95%‐100% for implant‐retained overdentures. However, the survival rates only represent the prostheses remaining in use for a defined follow‐up time, and do not account for the potential prosthetic complications that may have arisen and influence the general success of the implant treatment. The most common technical complications of fixed implant‐retained single crowns are crown fracture, fractures of ceramic implant abutments, and esthetic problems. The predominant technical complication at multiple‐unit, implant‐retained fixed dental prostheses is fracture/chipping of the veneering ceramic. Reported technical complications for implant‐retained overdentures are overdenture fracture or chipping of the veneer materials, whereas mechanical complications include implant fracture, attachment failure, and attachment housing or insert complications. To reduce the risk of such failures, a comprehensive pretreatment diagnostic work‐up is essential, including defining the prosthetic goal with the aid of a wax‐up or set‐up and the associated ideal, prosthetically oriented three‐dimensional implant position. Furthermore, selection of the ideal type of prosthesis, including the respective implant components and materials, is important for clinical long‐term treatment success.
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Affiliation(s)
- Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Duygu Karasan
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Ana Todorovic
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland.,Division of Prosthodontics, Faculty of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Maria Ligoutsikou
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Bjarni Elvar Pjetursson
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland.,Department of Reconstructive Dentistry, Faculty of Odontology, University of Iceland, Reykjavik, Iceland
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Prosthetic Materials Used for Implant-Supported Restorations and Their Biochemical Oral Interactions: A Narrative Review. MATERIALS 2022; 15:ma15031016. [PMID: 35160962 PMCID: PMC8839238 DOI: 10.3390/ma15031016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 12/11/2022]
Abstract
The purpose of this study is to outline relevant elements regarding the biochemical interactions between prosthetic materials used for obtaining implant-supported restorations and the oral environment. Implant-supported prostheses have seen unprecedented development in recent years, benefiting from the emergence of both new prosthetic materials (with increased biocompatibility and very good mechanical behavior), and computerized manufacturing technologies, which offer predictability, accuracy, and reproducibility. On the other hand, the quality of conventional materials for obtaining implant-supported prostheses is acknowledged, as they have already proven their clinical performance. The properties of PMMA (poly (methyl methacrylate))-which is a representative interim material frequently used in prosthodontics-and of PEEK (polyether ether ketone)-a biomaterial which is placed on the border between interim and final prosthetic use-are highlighted in order to illustrate the complex way these materials interact with the oral environment. In regard to definitive prosthetic materials used for obtaining implant-supported prostheses, emphasis is placed on zirconia-based ceramics. Zirconia exhibits several distinctive advantages (excellent aesthetics, good mechanical behavior, biocompatibility), through which its clinical applicability has become increasingly wide. Zirconia's interaction with the oral environment (fibroblasts, osteoblasts, dental pulp cells, macrophages) is presented in a relevant synthesis, thus revealing its good biocompatibility.
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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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Alonso-Pérez R, F Bartolomé J, Pradíes G. Original vs compatible stock abutment- implant connection. An in vitro analysis of the internal accuracy and mechanical fatigue behaviour. J Prosthodont Res 2021; 66:476-483. [PMID: 34866067 DOI: 10.2186/jpr.jpr_d_20_00066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE To assess the internal accuracy and mechanical behaviour under cyclic loading after artificial aging of implantsupported crowns restored with original stock abutments and two compatible non-original stock abutments. METHODS Forty-eight original internal hexagon connection implants were connected to different stock abutments. The samples were divided into three groups depending on the manufacturer of the abutment components (one original, two non-originals).Firstly, samples were cross-sectioned and observed by using Scanning Electron Microscope (SEM) to evaluate the internal accuracy in three different implant-abutment interface locations (platform, internal and screw). Further, cyclic fatigue loading was carried out according to the ISO Norm 14801 using dynamic testing machine under sinusoidal loads for 2,000,000 cycles at test frequencies of 2 Hz in air after thermocycling with 10,000 cycles at 5 °C and 55 °C in artificial saliva for aging simulation. RESULTS Original abutment components presented the highest percentage of surface with tight contact with the implant in the three implant-abutment interfaces studied. Additionally, original configuration showed highest fatigue limit value and fatigue strength exponent (280 N and -0.054) than non-original 1 (225 N and -0.109) and non-original 2 (200 N and -0.101). CONCLUSION Original abutment components provide better fit and mechanical results under cyclic loading than nonoriginal configurations. The results obtained in this study seem to suggest that the use of the original stock abutments to implants leads to a more homogeneous load distribution between the components that can influence the long-term success of the restorations.
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Affiliation(s)
- Raquel Alonso-Pérez
- Department of Buccofacial Prosthesis, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain
| | - José F Bartolomé
- Instituto de Ciencia de Materiales de Madrid (ICMM), Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain
| | - Guillermo Pradíes
- Department of Buccofacial Prosthesis, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain
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Fardin VP, Bergamo ETP, Bordin D, Hirata R, Bonfante EA, Bonfante G, Coelho PG. Effect of different tightening protocols on the probability of survival of screw-retained implant-supported crowns. J Mech Behav Biomed Mater 2021; 126:105019. [PMID: 34875501 DOI: 10.1016/j.jmbbm.2021.105019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/24/2021] [Accepted: 11/28/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE This study evaluated the effect of different tightening protocols on the probability of survival of screw-retained implant-supported anterior crowns. MATERIALS AND METHODS Seventy-two implants with internal conical connections (4.0 × 10mm, Ti-6Al-4V, Colosso, Emfils) were divided into four groups (n = 18 each): 1) Manufacturer's recommendations torque (25 N.cm for abutment's screw and 30 N.cm for crown's screw) (MaT); 2) Retightening after 10 min (ReT); 3) Torque 16% below recommended to simulate an uncalibrated wrench (AgT), and; 4) Temporary crown simulation (TeT), where crowns were torqued to 13 N.cm to simulate manual tightening, subjected to 11,200 cycles to simulate temporary crown treatment time (190 N), and then retightened to manufacturer torque (TeT). All specimens were subjected to cyclic fatigue in distilled water with a load of 190 N until 250,000 cycles or failure. The probability of survival (reliability) to complete a mission of 50,000 cycles was calculated and plotted using the Weibull 2-Parameter analysis. Weibull modulus and number of cycles at which 62.3% of the specimens would fail were also calculated and plotted. The failure mode was characterized in stereo and scanning electron microscopes (SEM). RESULTS The probability of survival was 69.3% for MaT, 70% for ReT, 54.8% for AgT, and 40.3% for TeT, all with no statistically significant difference. Weibull modulus was approximately 1.0 for all groups. The characteristic number of cycles for failure was 105,000 cycles for MaT, 123,000 for ReT, 82,000 cycles for AgT, and 54,900 cycles for TeT, with no significant difference between groups. The chief failure mode for MaT, ReT, AgT groups was crown screw fracture, whereas abutment screw fracture was the chief failure mode for the TeT group. CONCLUSION Tightening protocol did not influence the probability of survival of the screw-retained anterior crowns supported by internal conical implants (Ti-6Al-4V, Colosso, Emfils).
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Affiliation(s)
- Vinicius P Fardin
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru College of Dentistry, Bauru, SP, Brazil
| | - Edmara T P Bergamo
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru College of Dentistry, Bauru, SP, Brazil.
| | - Dimorvan Bordin
- Department of Restorative Dentistry, University Universus Veritas UNG, Guarulhos, SP, Brazil
| | - Ronaldo Hirata
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, USA
| | - Estevam A Bonfante
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru College of Dentistry, Bauru, SP, Brazil
| | - Gerson Bonfante
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru College of Dentistry, Bauru, SP, Brazil
| | - Paulo G Coelho
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, USA; Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, NY, USA; Mechanical and Aerospace Engineering, NYU Tandon School of Engineering, New York University, New York, NY, USA
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Hatakeyama W, Takafuji K, Kihara H, Sugawara S, Fukazawa S, Nojiri T, Oyamada Y, Tanabe N, Kondo H. A review of the recent literature on maxillary overdenture with dental implants. J Oral Sci 2021; 63:301-305. [PMID: 34408111 DOI: 10.2334/josnusd.21-0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The recent literature on maxillary implant overdenture (IOD) was reviewed in order to clarify its predictability and establish treatment guidelines. Electronic searches were performed using PubMed, and articles about maxillary IOD written after 1990 were reviewed, focusing on the following items: I. implant survival rate, II. maxillary IOD survival rate, III. number of implants, IV. attachment type, V. follow-up period, VI. implant system, and VII. opposing dentition. The review revealed an implant survival rate of 61-100% and an overdenture survival rate of 72.4-100%. The attachments used included bars, balls, locators, and telescope crowns. The minimum and maximum observation periods were 12 months and 120 months, respectively, and the number of implants used for supporting IOD ranged from 2 to 8. At present, there is no strong evidence to indicate that maxillary IOD is clearly superior for all the items examined. However, the existing data indicate that maxillary IOD has almost the same therapeutic effect as fixed implant superstructures, and is a treatment option that can be actively adopted for patients in whom fixed superstructures cannot be applied for various reasons.
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Affiliation(s)
- Wataru Hatakeyama
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University
| | - Kyoko Takafuji
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University
| | - Hidemichi Kihara
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University
| | - Shiho Sugawara
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University
| | - Shota Fukazawa
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University
| | - Toshiki Nojiri
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University
| | - Yutaro Oyamada
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University
| | - Norimasa Tanabe
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University
| | - Hisatomo Kondo
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University
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Gao WM, Geng W, Luo CC. Prosthetic complications of fixed dental prostheses supported by locking-taper implants: a retrospective study with a mean follow-up of 5 years. BMC Oral Health 2021; 21:476. [PMID: 34579694 PMCID: PMC8474706 DOI: 10.1186/s12903-021-01843-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 09/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Restoration with locking-taper implants is a widely used methodology. However, conical connection systems such as locking-taper implant systems have rarely been examined. This study provides a retrospective investigation of locking-taper fixed restorations, mainly focusing on prosthetic complications. METHODS Patients undergo treatment with conical connected implants from 2008 to 2010 were examined. Preparation of the implant sites was performed according to the standard procedures for the Bicon system. Bone healing took over 6 months, and the prosthetic procedure was initiated thereafter. Integrated abutment crowns or gold porcelain crowns were used, and the prosthesis type was a single crown or a fixed dental prosthesis. Once the crown was in place, its occlusion was thoroughly checked and adjusted, and then the crown was glazed or finely polished. The Kaplan-Meier method was used to calculate the cumulative complication-free rates for 5 and 10 years. Additionally, a Cox regression model was used to identify the factors that independently influenced the results. Implant survival and marginal bone loss were also investigated. RESULTS A total of 392 patients who underwent 541 implants and 434 locking taper implant-based restorations from 2008 to 2010 were examined. The overall 5-year cumulative complication-free rate was 83.34%. The most common prosthetic complication was veneer chipping, with a frequency of 67.53%. According to the Cox regression model, the complication-free rate of integrated abutment crowns was significantly higher than that of gold porcelain crowns, that of molar regions was significantly higher than that of premolar regions, and that of females was significantly higher than that of males. Only three implant failures happened, and the mean marginal bone loss values at 1- year, 5-years and 10- years were 0.25 mm (95% CI ± 0.12), 0.40 mm (95% CI ± 0.03) and 0.51 mm (95% CI ± 0.05), respectively. CONCLUSION Veneer chipping was the most common complication with locking-taper implant-supported fixed restorations. The incidence of complications for IACs is significantly higher than that for GPCs. Age, location, and prosthesis type are not determinants of prosthetic complications. Besides, the long-term clinical effect of locking-taper implant can meet the clinical needs. The bone tissue level around the implant can maintain long-term stability.
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Affiliation(s)
- Wen Mo Gao
- Department of Dental Implant Center, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, No. 4 Tian Tan Xi Li, Dongcheng District, Beijing, 100050, People's Republic of China
| | - Wei Geng
- Department of Dental Implant Center, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, No. 4 Tian Tan Xi Li, Dongcheng District, Beijing, 100050, People's Republic of China.
| | - Chen Chen Luo
- Department of Dental Implant Center, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, No. 4 Tian Tan Xi Li, Dongcheng District, Beijing, 100050, People's Republic of China
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Jung RE, Brügger LV, Bienz SP, Hüsler J, Hämmerle CHF, Zitzmann NU. Clinical and radiographical performance of implants placed with simultaneous guided bone regeneration using resorbable and nonresorbable membranes after 22-24 years, a prospective, controlled clinical trial. Clin Oral Implants Res 2021; 32:1455-1465. [PMID: 34543460 PMCID: PMC9293322 DOI: 10.1111/clr.13845] [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: 04/07/2021] [Revised: 08/02/2021] [Accepted: 08/05/2021] [Indexed: 02/03/2023]
Abstract
Aim The aim was to evaluate the performance of implants placed with simultaneous guided bone regeneration (GBR) using resorbable or nonresorbable membranes compared to implants placed in pristine bone without bone regeneration after an observation period of 22–24 years. Material and Methods The patient cohort of this clinical trial was treated from 1994 to 1996. Dehiscence defects were treated with GBR by either using resorbable collagen membranes (BG) or nonresorbable ePTFE membranes (GT). Implants placed in pristine bone served as a control (CT). Clinical parameters, marginal bone levels, and technical outcomes were evaluated following restoration placement and at the present follow‐up. A 3D radiographic analysis was conducted in order to assess buccal and oral bone dimensions. Implant survival was assessed with Kaplan–Meier analysis and a frailty model (level of significance 5%). Results Out of the originally 72 patients (mean age 75.4 ± 15.70 years) with 265 implants, 39 patients with 147 implants were included in the study after a median period of 23.5 years. Implant survival was 89.3% in group BG (n = 100), 90.2% in group GT (n = 37), and 93.8% in group CT (n = 105), without significant differences (Frailty proportional hazard model p = .79). Smoking had a negative effect on survival (p = .0122). Mean vertical marginal bone levels were −2.3 ± 1.4 mm (BG, n = 59), −3.0 ± 1.5 mm (GT, n = 21), and −2.3 ± 1.6 mm (CT, n = 52). The vertical buccal bone levels were −3.0 ± 1.9 mm (BG, n = 57), −3.5 ± 2.2 mm (GT, n = 21), and −2.6 ± 1.8 mm (CT, n = 49), without significant differences. Conclusion Implant placement with GBR procedures provides treatment outcomes with favorable implant survival rates (89.3%–93.8%) after 23.5 years. Smoking, however, affected implant survival negatively.
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Affiliation(s)
- Ronald E Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zürich, Switzerland
| | - Lily V Brügger
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zürich, Switzerland
| | - Stefan P Bienz
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zürich, Switzerland
| | - Jürg Hüsler
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zürich, Switzerland
| | - Christoph H F Hämmerle
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zürich, Switzerland
| | - Nicola U Zitzmann
- Department of Reconstructive Dentistry, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
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van Erp AL, van der Winden E, Molenaar MC, Royakkers EJ, van Daelen ACL, de Kok P, Gresnigt MMM. Bilayered ceramic anterior restorations with reinforcement of the incisal edge by using lithium disilicate: A multicenter retrospective survival analysis with a maximum of 6-year follow-up. J Prosthet Dent 2021; 129:718-724. [PMID: 34404504 DOI: 10.1016/j.prosdent.2021.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 11/25/2022]
Abstract
STATEMENT OF PROBLEM The esthetics of anterior lithium disilicate restorations can be enhanced if the buccal aspect is layered with a feldspathic ceramic. However, whether fractures and chipping of this layer are a prevalent complication is unclear. PURPOSE The purpose of this retrospective study was to evaluate the incidence of incisal fracture of a specially designed lithium disilicate reinforcement of the incisal edge for indirect anterior bilayered restorations on both teeth and implants. MATERIAL AND METHODS A total of 924 anterior bilayered pressed lithium disilicate restorations in 324 patients and made in one dental laboratory were delivered by 4 restorative dentists. The restorations had the palatal side of the incisal edge in monolithic lithium disilicate and the facial side in feldspathic porcelain. The restorations were evaluated for survival and the occurrence of fracture or chipping. Survival analyses were performed by using the Kaplan-Meier and log rank (Mantel-Cox) tests (α=.05). RESULTS Of the 924 restorations, 798 (236 complete crowns, 562 partial restorations) were placed on teeth and 126 on implants. The mean observation time was 38 months (3 to 72 months). The survival rate was 96.5%, with 14 failures occurring. The failures were fracture after dental trauma (n=5), ceramic fracture (n=1), debonding (n=6), poor shade match (n=1), and tooth loss (n=2). Restorations in patients with parafunctional habits and endodontically treated teeth showed a significant decrease in survival rate (P=.018). No significant differences were found between the survival of restorations on teeth and implants and between complete crowns and partial restorations (P=.021). No chipping was observed on any restorations in the study. CONCLUSIONS Modified anterior bilayered ceramic restorations showed good survival rates, and no chipping was observed up to 6 years of follow-up. Parafunctional habits and endodontic treatment had a negative effect on the survival rate of restorations. The support of tooth or implant and the restoration type had no effect on the survival.
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Affiliation(s)
- Audrey L van Erp
- Private practice, Department of Restorative Dentistry and Biomaterials, University Medical Center Groningen, The University of Groningen, Groningen, the Netherlands
| | - Eric van der Winden
- Master Dental Technician, Dental Laboratory Oral Design Center Holland, Excent Group, Blaricum, the Netherlands
| | | | - Eric-Jan Royakkers
- Private practice, Dental Practice Royakkers, Maastricht, the Netherlands
| | - Alwin C L van Daelen
- Private practice, Dental Practice Tendens Tandartsen, Amsterdam, the Netherlands
| | - Paul de Kok
- Private practice, Clinic for Periodontology Amsterdam, Amsterdam, the Netherlands
| | - Marco M M Gresnigt
- Assistant Professor, Department of Restorative Dentistry and Biomaterials, University Medical Center Groningen, The University of Groningen, Groningen, the Netherlands.
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Fonseca M, Molinero-Mourelle P, Forrer FA, Schnider N, Hicklin SP, Schimmel M, Brägger U. Clinical performance of implant crowns with customized zirconia abutments: A prospective cohort study with a 4.5- to 8.8-year follow-up. Clin Oral Implants Res 2021; 32:853-862. [PMID: 33949004 DOI: 10.1111/clr.13761] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 04/14/2021] [Accepted: 04/22/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the clinical and esthetic outcomes and patient satisfaction of screw-retained one-piece implant crowns fabricated with zirconia abutments after a 4.5- to 8.8-year follow-up. MATERIAL AND METHODS Thirty-two patients (12 women and 20 men), who received 40 implant single crowns in anterior and premolar sites, were included in this prospective study. All restorations were based on ceramic hand-veneered customized CAD/CAM zirconia abutments. The follow-up consisted of clinical and radiological examinations. The pink esthetic score-white esthetic score (PES-WES) was used to evaluate the esthetic outcome. Patients' satisfaction was assessed via visual analog scale (VAS). RESULTS Implant and prosthetic survival rates were 100% and 97.5%, respectively. Mean marginal bone loss was -0.17 mm (SD 1.16 mm). Probing depth was ≤4 mm in 98.7% and 5 mm in 1.3% of the sites; 8.3% of them were bleeding on probing positive. No technical or biological complications were observed except for one abutment fracture. The mean PES-WES scores were 7.0 and 7.1, respectively. VAS scores (10-point) of 9.41 for function and 9.26 for esthetics showed high patient satisfaction. CONCLUSION After a mean observation period of 6 years and 7 months, screw-retained implant crowns based on veneered customized CAD/CAM zirconia abutments with conical connection showed very good clinical performance and may be recommended for the replacement of missing anterior and premolar teeth. (ClinicalTrials.gov # NCT04370314).
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Affiliation(s)
- Manrique Fonseca
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Pedro Molinero-Mourelle
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Fiona Alena Forrer
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Nicole Schnider
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Stefan Paul Hicklin
- Clinic of Preventive Dentistry, Periodontology and Cariology, and Clinic of General, Special Care and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Martin Schimmel
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Privat-docent extra muros, Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Urs Brägger
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Genetti L, Ercoli C, Kotsailidi EA, Feng C, Tsigarida A, Chochlidakis K. Clinical Evaluation of Crestal Bone Levels, Peri-Implant Indices, and Mucosal Margin Position of Immediately Impressed Posterior Dental Implants: A Cross-Sectional Study. J Prosthodont 2021; 30:763-768. [PMID: 33834572 DOI: 10.1111/jopr.13362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This is a cross-sectional clinical study to evaluate crestal bone levels, mucosal margin position, probing depths, bleeding on probing, and plaque and bleeding indices of implants restored with an immediate impression workflow compared to implants restored with a delayed impression workflow. MATERIALS AND METHODS Patients who had received a posterior single implant crown in the premolar and molar regions were identified and scheduled for a single-visit study appointment. Outcome measurements included soft tissues peri-implant indices, peri-implant mucosal margin position, and crestal bone levels. Several systemic-, local-, and prosthesis-related factors were recorded. Bitewing radiographs were used to assess crestal bone levels. Wilcoxon rank sum test was used to compare the medians of continuous measurements and Pearson chi-square test (or Fisher's exact test) was used to compare the distributions of categorical variables between the two groups. RESULTS Twenty eight patients were included. Crestal bone levels, peri-implant mucosal margin position and peri-implant soft tissue parameters for the immediately impressed group were not statistically different from the delayed impressed group, except for probing depth for the immediately impressed buccal site, which was less than that of the delayed group. Mesial bone level for cement-retained crowns was significantly more coronal than for screw-retained ones. CONCLUSIONS While an isolated statistical difference was found in probing depth, the current study suggests that there is no clinically significant difference between implants impressed with immediate and delayed implant workflows when considering crestal bone levels, peri-implant mucosal margin position, and most peri-implant indices.
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Affiliation(s)
- Loren Genetti
- Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Carlo Ercoli
- Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY.,Department of Periodontology, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Elli Anna Kotsailidi
- Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY.,Department of Periodontology, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Changyong Feng
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY
| | - Alexandra Tsigarida
- Department of Periodontology, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Konstantinos Chochlidakis
- Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
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Alhammadi SH, Burnside G, Milosevic A. Clinical outcomes of single implant supported crowns versus 3-unit implant-supported fixed dental prostheses in Dubai Health Authority: a retrospective study. BMC Oral Health 2021; 21:171. [PMID: 33794841 PMCID: PMC8017629 DOI: 10.1186/s12903-021-01530-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 03/22/2021] [Indexed: 01/16/2023] Open
Abstract
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.
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Affiliation(s)
- Sara Hussain Alhammadi
- Hamdan Bin Mohamed College of Dental Medicine, Mohamed Bin Rashid University of Medicine and Health Sciences (MBRU), Dubai, UAE
| | - Girvan Burnside
- Department of Health Data Science, University of Liverpool, Waterhouse Building Block F, 1-5 Brownlow Street, Liverpool, L69 3GL, UK
| | - Alexander Milosevic
- Hamdan Bin Mohamed College of Dental Medicine, Mohamed Bin Rashid University of Medicine and Health Sciences (MBRU), Dubai, UAE.
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Padilla-Avalos CA, Marroquín-Soto C. [Prosthetic intermediaries in oral implantology: Literature review]. REVISTA CIENTÍFICA ODONTOLÓGICA 2021; 9:e064. [PMID: 38465276 PMCID: PMC10919799 DOI: 10.21142/2523-2754-0902-2021-064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/03/2021] [Indexed: 03/12/2024] Open
Abstract
Prosthetic intermediaries in oral implantology are attachments that allow connection between the implant and the prosthesis itself. Although this rehabilitation has a high success rate; the selection of the prosthetic abutment represents is important in implant treatment. Currently, there is a great variety of intermediate abutments, corresponding to various techniques and materials. Prosthetic intermediaries can be classified according to the type of connection, their retention to the prosthesis, their axial relationship with the implant body, the manufacturing material and type of manufacture, or whether rehabilitation is single or multiple. This scenario can lead to doubts as to the selection of the ideal implant attachment in each case in order to achieve satisfactory rehabilitation, as well as functional and aesthetic requirements and the preservation of biological principles. Indeed, oral implantology has revolutionized dentistry and will continue to expand the range of possibilities; therefore, it is important to classify the prosthetic options available. The present literature review aims to demonstrate the different alternatives and options available for the intermediate abutments most used in implant prostheses.
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Affiliation(s)
- César-Augusto Padilla-Avalos
- Facultad de Odontología, Universidad de San Martín de Porres. Lima, Perú. , Universidad de San Martín de Porres Facultad de Odontología Universidad de San Martín de Porres Lima Peru
| | - Consuelo Marroquín-Soto
- Facultad de Odontología, Universidad de San Martín de Porres. Lima, Perú. , Universidad de San Martín de Porres Facultad de Odontología Universidad de San Martín de Porres Lima Peru
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45
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Wittneben JG, Igarashi K, Brägger U, Daniel B, Schimmel M, Wismeijer D. Vertical eruption of anterior maxillary teeth adjacent to single-implant-supported crowns: An assessment after a 3-year follow-up period. J Prosthet Dent 2021; 128:605-610. [PMID: 33678439 DOI: 10.1016/j.prosdent.2020.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 11/30/2022]
Abstract
STATEMENT OF PROBLEM Vertical eruption of teeth adjacent to an implant has been reported clinically and might affect the esthetic outcome over time. The prevalence of the problem is unclear. PURPOSE The purpose of this prospective clinical trial was to evaluate the vertical eruption of anterior maxillary teeth adjacent to single-implant crowns after a 3-year follow-up period. MATERIAL AND METHODS Thirty single dental implants were inserted in maxillary anterior sites including the first premolar. The mean age of the participants at implant-supported crown insertion was 48.4 years (range 23 to 79 years). Each implant was restored with a 1-piece screw-retained ceramic single crown. The vertical changes of 60 adjacent anterior maxillary teeth were evaluated from periapical radiographs and casts at baseline, 6, 12, and 36 months. RESULTS A global ANOVA test showed statistically significant differences for the outcomes of the distance-implant platform and cement-enamel junction (DPC) (P<.001), crown length distal (P=.021) and mesial (P=.035), implant crown length (P=.022), and incisal edge to edge (P<.001). CONCLUSIONS Continuous vertical tooth eruption next to a single dental implant was observed in adult participants.
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Affiliation(s)
- Julia G Wittneben
- Research Associate and Senior Lecturer, Department of Reconstructive Dentistry & Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland; Lecturer, Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Mass.
| | - Kensuke Igarashi
- Assistant Professor, Department of Life Science Dentistry, The Nippon Dental University, Niigata, Japan
| | - Urs Brägger
- Full Professor and Chair, Department of Reconstructive Dentistry & Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Buser Daniel
- Professor Emeritus, Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Martin Schimmel
- Full Professor and Head of the Department Gerodontology, Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Daniel Wismeijer
- Full Professor, Department of Oral Implantology and Prosthetic Dentistry, ACTA, University of Amsterdam and VU University, Amsterdam, the Netherlands
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Roccuzzo A, Imber JC, Jensen SS. Need for lateral bone augmentation at two narrow-diameter implants: A prospective, controlled, clinical study. Clin Oral Implants Res 2021; 32:511-520. [PMID: 33548077 DOI: 10.1111/clr.13721] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/20/2021] [Accepted: 01/27/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To detect the potential influence of implant diameter and anatomic factors on the need for bone augmentation procedures (BAPs) when replacing congenitally missing lateral incisors (MLIs). MATERIALS AND METHODS Patients with congenitally missing MLIs with a mesio-distal distance between the canine and the central incisor of 5.9-6.3 mm received a Ø2.9 mm implant while Ø3.3 mm implants were placed when the distance was 6.4-7.1 mm. The following linear measurements were recorded using a calliper: width of the alveolar process (WAP), width of the bony alveolar ridge (WAR) and thickness of the facial bone after implant osteotomy (TFB). Guided bone regeneration was performed in case of fenestration- or dehiscence-type defects or a thin TFB (<1.7 mm). RESULTS Fifty Ø2.9 mm and 50 Ø3.3 mm were included in 100 patients. WAP and WAR did not differ between the groups (p > .05). TFB was statistically significant larger in the Ø2.9 group (1.75 ± 0.59 mm) compared to the Ø3.3 group (1.5 ± 0.63 mm) (p = .041). Fenestration-type defects (p = .005) and a thin facial bone wall (p = .045) was observed more frequently in the Ø3.3 compared to the Ø2.9 group. Correspondingly, BAP was indicated more frequently in the Ø3.3 compared to the Ø2.9 group (p = .017). WAP, MD and WAR were statistically significant correlated to the need for BAP (p < .001). As independent variable, only WAR influenced the probability of BAP (p < .001). CONCLUSION The use of 2.9 diameter implants was correlated to a reduced frequency of BAP compared to 3.3 mm implants, without reaching a statistically significant difference. Measurement of the WAP provides the clinician useful information to predict BAP.
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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 (Rigshospitalet), Copenhagen, Denmark
| | - Jean-Claude Imber
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Department of Periodontology and Operative Dentistry, University Medical Center, University of Mainz, Mainz, Germany
| | - Simon Storgård Jensen
- Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.,Department of Oral and Maxillofacial Surgery, School of Dentistry, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Lee HY, Yang SW, Kang YJ, Oh KC, Kim JH. Influence of shoulder coverage difference of abutment on stress distribution and screw stability in tissue-level internal connection implants: A finite element analysis and in vitro study. J Prosthet Dent 2021; 125:682.e1-682.e10. [PMID: 33551133 DOI: 10.1016/j.prosdent.2020.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 11/26/2022]
Abstract
STATEMENT OF PROBLEM Tissue-level internal connection implants are widely used, but the difference in abutment screw stability because of the shoulder coverage formed by the contact between the shoulder of the implant collar and the abutment remains unclear. PURPOSE The purpose of this finite element analysis (FEA) and in vitro study was to investigate stress distribution and abutment screw stability as per the difference in shoulder coverage of the abutment in tissue-level internal connection implants. MATERIAL AND METHODS Abutments were designed in 3 groups as per the shoulder coverage of the implant collar, yielding complete coverage (complete group), half coverage (half group), no coverage (no group) groups. In the FEA, a tightening torque of 30.0 Ncm was applied to the abutment screw, a force of 250 N was applied to the crown at a 30-degree angle, and the von Mises stresses and the stress distribution patterns were evaluated. In the in vitro study, the groups were tested (n=12). A total of 200 000 cyclic loads were applied at 250 N, 14 Hz, and at a 30-degree angle. Removal torque values and scanning electron microscopy (SEM) images were assessed. Removal torque values were analyzed by ANOVA and paired t tests. RESULTS The maximum von Mises stress of the abutment screw was the lowest in the complete group, slightly higher in the half group, and highest in the no group. High stresses were concentrated in 1 location in the implant abutment connection area of the no group. The removal torque values after loading were significantly lower in the no group than in the complete group (P=.047). The SEM images revealed concentrated structural loss and wear in 1 location of the no group. CONCLUSIONS FEA and in vitro studies confirmed that the shoulder coverage of the abutment in the tissue-level internal connection implant helped improve screw stability. Cyclic loading reduced the removal torque of the abutment screw.
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Affiliation(s)
- Hag-Young Lee
- Graduate student, Department of Prosthodontics, Oral Research Science Center, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Seung-Won Yang
- Former Graduate student, Department of Prosthodontics, Oral Research Science Center, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - You-Jung Kang
- Graduate student, Department of Prosthodontics, Oral Research Science Center, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Kyung Chul Oh
- Clinical Assistant Professor, Department of Prosthodontics, Oral Research Science Center, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Jee-Hwan Kim
- Associate Professor, Department of Prosthodontics, Oral Research Science Center, College of Dentistry, Yonsei University, Seoul, Republic of Korea.
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Fagbamigbe AF, Karlsson K, Derks J, Petzold M. Performance evaluation of survival regression models in analysing Swedish dental implant complication data with frailty. PLoS One 2021; 16:e0245111. [PMID: 33411801 PMCID: PMC7790411 DOI: 10.1371/journal.pone.0245111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/22/2020] [Indexed: 12/23/2022] Open
Abstract
The use of inappropriate methods for estimating the effects of covariates in survival data with frailty leads to erroneous conclusions in medical research. This study evaluated the performance of 13 survival regression models in assessing the factors associated with the timing of complications in implant-supported dental restorations in a Swedish cohort. Data were obtained from randomly selected cohort (n = 596) of Swedish patients provided with dental restorations supported in 2003. Patients were evaluated over 9 years of implant loss, peri-implantitis or technical complications. Best Model was identified using goodness, AIC and BIC. The loglikelihood, the AIC and BIC were consistently lower in flexible parametric model with frailty (df = 2) than other models. Adjusted hazard of implant complications was 45% (adjusted Hazard Ratio (aHR) = 1.449; 95% Confidence Interval (CI): 1.153-1.821, p = 0.001) higher among patients with periodontitis. While controlling for other variables, the hazard of implant complications was about 5 times (aHR = 4.641; 95% CI: 2.911-7.401, p<0.001) and 2 times (aHR = 2.338; 95% CI: 1.553-3.519, p<0.001) higher among patients with full- and partial-jaw restorations than those with single crowns. Flexible parametric survival model with frailty are the most suitable for modelling implant complications among the studied patients.
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Affiliation(s)
- Adeniyi Francis Fagbamigbe
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Division of Health Sciences, Populations, Evidence and Technologies Group, University of Warwick, Coventry, United Kingdom
- Division of Population and Behavioural Studies, School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | - Karolina Karlsson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Gao J, Min J, Chen X, Yu P, Tan X, Zhang Q, Yu H. Effects of two fretting damage modes on the dental implant–abutment interface and the generation of metal wear debris: An in vitro study. FATIGUE & FRACTURE OF ENGINEERING MATERIALS & STRUCTURES 2020. [DOI: 10.1111/ffe.13399] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Jing Gao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology Sichuan University Chengdu 610041 China
| | - Jie Min
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology Sichuan University Chengdu 610041 China
| | - Xin Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Dental Technology, West China Hospital of Stomatology Sichuan University Chengdu 610041 China
| | - Ping Yu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology Sichuan University Chengdu 610041 China
| | - Xin Tan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology Sichuan University Chengdu 610041 China
| | - Qianqian Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Dental Technology, West China Hospital of Stomatology Sichuan University Chengdu 610041 China
| | - Haiyang Yu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology Sichuan University Chengdu 610041 China
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50
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DuVall NB, DeReis SP, Vandewalle KS. Fracture strength of various titanium-based, CAD-CAM and PFM implant crowns. J ESTHET RESTOR DENT 2020; 33:522-530. [PMID: 33174333 DOI: 10.1111/jerd.12672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/28/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE CAD-CAM has dramatically advanced dental restorative procedures to include implant-supported crowns. The purpose of this study was to compare the fracture resistance following mechanical loading and thermocycling of various screw-retained and cement-retained ceramic and polymethylmethacrylate material combinations using the TiBase abutment compared to PFM implant-supported crowns. OVERVIEW Twelve implant restorations were fabricated for each of eight groups. Three groups were screw-retained and five groups were cement-retained implant restorations. The ceramic and polymethylmethacrylate restorations were fabricated on the TiBase abutment while the PFM restorations were fabricated on an UCLA abutment. Data were analyzed with a one way Analysis of Variance and Tukey's post-hoc test to evaluate the effect of abutment and crown type on fracture load (alpha = 0.05). A significant difference was found in the maximum fracture load between groups (P < 0.001). CONCLUSIONS The screw-retained implant restorations demonstrated higher fracture loads than their cement-retained counterparts. The TiBase abutment compared favorably to the UCLA abutment. CLINICAL SIGNIFICANCE The TiBase abutment is a titanium insert which combines the esthetics of a ceramic abutment with the mechanical properties of a titanium abutment and should be considered a viable clinical alternative to the conventional implant-supported PFM crown based on theses in vitro results and in context of in vivo studies. The lithium disilicate hybrid abutment/crown implant-supported restoration utilizing the TiBase abutment may be an ideal clinical choice due to simplicity, single appointment CAD-CAM, and esthetics.
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Affiliation(s)
- Nicholas B DuVall
- Program Director, AEGD Residency, 96th Dental Squadron, Eglin AFB, Florida, USA.,US Air Force Postgraduate Dental College, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Stephen P DeReis
- Certified Dental Technician, 81st Dental Squadron, Keesler AFB, Mississippi, USA
| | - Kraig S Vandewalle
- US Air Force Postgraduate Dental College, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Director of Dental Research, AEGD Residency, 59th Dental Training Squadron, Joint Base San Antonio-Lackland, Texas, USA
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