Prognosis of Single Implant-Supported Prosthesis in Patients With Primary Sjögren's Syndrome: A Five-Year Prospective Clinical Study

BACKGROUND

Primary Sjögren's syndrome (pSS) is a chronic systemic autoimmune disease characterized by hyposalivation. Currently, there is limited evidence for the prognosis of dental implant treatment in Sjögren's syndrome.

AIM/HYPOTHESIS

We hypothesized comparable clinical outcomes of implant-supported restorations in pSS-patients and control subjects, and improvement in oral health-related quality of life 5 years after restoration.

MATERIAL AND METHODS

Patients with pSS and matched (age, gender, and tooth region) control group were recruited between June 2016 and March 2020. The clinical and radiological examination were performed, and patient-reported oral health impact profile (OHIP-49) questionnaire was used 2 months (baseline), 1, 3, and 5 years after prosthetic treatment.

RESULTS

We included 23 patients with pSS and 24 matched control subjects (all women, mean age: 57.1 years). The overall DMFT (decayed-missed-filled-tooth) was significantly higher (p = 0.008), symptoms of dry mouth were more severe (p = 0.001), and unstimulated and chewing-stimulated saliva flow rates were significantly lower (p < 0.001) in pSS than in control group. All implants survived with no implant mobility. At implant sites, the plaque index and probing depths did not differ (p = 0.301 and 0.446, respectively), but the gingival index was significantly higher (p = 0.003) in pSS than control group. The mean marginal bone loss, prosthetic complications, and clinician-reported aesthetic outcomes were similar in both groups after 5 years. The OHIP scores were significantly higher in the pSS than control group (p < 0.001) but reduced significantly in both groups (p = 0.026).

CONCLUSION

Replacement of missing single teeth with dental implants was successful in patients with pSS 5 years after restoration.

Clinical, radiographic, and aesthetic outcomes at two narrow-diameter implants to replace congenital missing maxillary lateral incisors: A 3-year prospective, clinical study

INTRODUCTION

To present the 3-year clinical, radiographic, and aesthetic outcomes in patients with congenitally missing lateral incisors rehabilitated with two narrow-diameter implants (NDIs).

METHODS

The original population consisted of 100 patients rehabilitated with a cement-retained bi-layered zirconia single-unit crown supported by either a Ø2.9 mm (Test) or a Ø3.3 mm (Control) NDI (n = 50). At the 1- and 3-year follow-up (T2, T3), implant survival rate, crestal bone level (CBL) changes, biological, and technical complications were recorded, while the assessment of the aesthetic outcomes was performed using the Copenhagen Index Score.

RESULTS

Seventy-four patients Ø2.9 mm (n = 39) or Ø3.3 mm (n = 35) reached T3, as 24 patients were lost to follow-up and 1 implant (Ø3.3 mm) was removed. Throughout the observation period, minimal CBL changes (i.e., <1 mm) were detected between groups. Despite the positive aesthetic scores recorded (i.e., 1-2), at T3 20% of patients rehabilitated with a Ø3.3 mm versus 2.6% of patients Ø2.9 mm displayed an alveolar process deficiency (Score 3). No additional technical and/or mechanical complications were recorded between T2 and T3. Tooth vitality was maintained in all neighboring teeth. Peri-implant probing depths and plaque scores remained low in both groups (p > 0.05).

CONCLUSION

The use of 2.9 or 3.3 diameter implants showed comparable favorable mid-term results in terms of survival rate, CBL, and aesthetic outcomes. Hence, clinicians should rely on the use of such NDIs when replacing maxillary lateral incisors.

Aesthetic assessment of maxillary lateral and canine implant-supported crowns by laypersons and orthodontists

INTRODUCTION

The objectives of this study were to evaluate how laypersons and orthodontists evaluate and rank aesthetic parameters of an implant-supported crown (ISC) on the canine position (ISC-C) and lateral position (ISC-L).

METHODS

A digital survey of 11 cases, 5 ISC-C, 5 ISC-L and 1 control case without ISC, was distributed to 207 laypersons and 296 orthodontists. All cases included one extraoral photograph and three intraoral photographs. The respondents were asked to identify the ISC and to evaluate the aesthetic parameters regarding colour of the implant (CI), shape of the implant (SI) and gingival colour around ISC (GCI). Differences within and between the groups were tested using Chi-2-test and Independent-Samples t-test.

RESULTS

All invited laypersons and 184 orthodontists (62% response rate) answered the survey. Orthodontists (89%) more correctly identified the ISC, regardless of its position, than laypersons (50%) (p < 0.001). Both laypersons (54%) and orthodontists (23%) rated higher proportions of acceptance of CI, SI and GCI in favour for the ISC-L than ISC-C (laypersons: 40%, orthodontists: 10%) (p < 0.001). Assessing each parameter separately, orthodontists rated higher for ISC-L, compared to the ISC-C (p < 0.001). In general, laypersons and orthodontist ranked tooth colour (mean, standard deviation [SD]:8.0,1.5 and 9.0, 1.0) and tooth shape (mean, SD: 8.0, 1.7 and 8.8, 1.2) as aesthetically higher than the gingival colour (mean, SD: 7.2, 2.2 and 8.0, 1.7) (p > 0.001).  Conclusion: Laypersons and orthodontists consider the ISC-L as aesthetically more preferable, compared to the ISC-C.

SURVIVAL RATE OF IMPLANT-SUPPORTED, SINGLE-TOOTH RESTORATIONS BASED ON ZIRCONIA OR METAL ABUTMENT IN PATIENTS WITH TOOTH AGENESIS: A 5-YEARS PROSPECTIVE CLINICAL STUDY

OBJECTIVES

The primary aim was to investigate survival rate of zirconia versus metal abutments, and the secondary aim was clinical outcomes of all-ceramic versus metal-ceramic crowns on single-tooth implants.

METHODS

Patients with tooth-agenesis participated to previously published prospective clinical study with 3-year follow-up were recalled after 5 years. Biological variables included survival and success rate of implants, marginal bone level, modified Plaque and Sulcus Bleeding Index and biological complications. Technical variables included restoration survival rate, marginal adaptation and technical complications. The aesthetic outcome of crowns and peri-implant mucosa in addition to patient-reported outcome were recorded. Descriptive analysis, linear mixed model for quantitative data, or generalized linear mixed model for ordinal categorical data were applied; significance was set to 0.05.

RESULTS

Fifty-three patients (mean age: 32.4 years), with 89 implants participated to the 5-years examination. The implants supported 50 zirconia abutments with 50 all-ceramic (AC) crown and 39 metal abutments with 29 metal-ceramic (MC) and 10 AC crowns. The Implant and restoration survival rate was 100% and 96%, respectively. No clinically relevant biological difference between implants supporting metal or zirconia abutments was registered. The technical complications were veneering fracture of AC-crowns (n = 3), crown loosening of MC-crowns (n = 4) and one abutment screw loosening (MC-crown on metal abutment). MC-crowns had significantly better marginal adaptation than AC-crowns (p = .01). AC-crowns had significantly better color and morphology than MC-crowns (p = .01).

CONCLUSIONS

Zirconia-based single-tooth restorations are reliable alternative materials to metal-based restorations with favorable biological and aesthetic outcome, and few technical complications.

Explaining the colour of natural healthy gingiva

To examine the differences between natural gingival colour in men and women. To determine the degree of predictability of changes in the gingival colour coordinates recorded for healthy gingiva, according to age, long-term medication, frequency of toothbrushing, and smoking habits. The CIELAB colour coordinates were recorded using a spectrophotometer for 360 Caucasian adult participants (aged 18-92 years), in three zones of the healthy attached gingiva of the maxillary central incisor. Regression models were created for each zone and each sex, taking the L*, a* and b* coordinates as dependent variables and age, frequency of toothbrushing, smoking habits (0-non-smoker; 1-smoker) and whether participants were taking long-term medication (0-no; 1-yes) as independent variables. The statistical analysis was conducted with SPSS version 26.0, using multiple regression models. Statistically significant differences between men and women were found only for colour coordinate b*, in all three zones. The only colour coordinate on which the predictor variables had a significant effect was the L* coordinate. In men, age and long-term medication had the greatest effect as predictors (maximum R2 = 0.149). In women, frequency of toothbrushing was the strongest predictor in the predictive models (maximum R2 = 0.099). The colour of gingiva in men contained a larger amount of blue, given that significantly lower values for colour coordinate b* were recorded in men than women, although this difference lacked clinical implications. For both sexes, the regression models produced had a modest predictive capacity. The L* coordinate was the dependent variable that showed the greatest predictability.

Esthetic Perception of Different Clinical Situations of Maxillary Lateral Incisor Agenesis According to Populations with Dental and Non-Dental Backgrounds: A Systematic Review and Meta-Analysis

Treatment of unilateral or bilateral maxillary lateral incisor agenesis is challenging, time-consuming, expensive, and requires careful treatment planning, predictability, and esthetics. This review aimed to identify differences in esthetic perception among orthodontists, general dentists, differentiated dentists, and laypersons, which may interfere with treatment options. EBSCO, PubMed, ScienceDirect, Cochrane Library databases, and Google Scholar were searched using keyword pairing and a Boolean expression, "(congenitally missing OR agenesis OR hypodontia) AND (maxillary lateral incisors) AND (esthetic perception OR smile) AND (laypersons OR dental professional OR general dentist OR orthodontists)." Reviews and case studies were excluded. A total of 13 studies were selected for qualitative analysis (adapted ROBINS-I) and 11 were selected for meta-analysis (p < 0.05) after being sub-grouped into "Opening vs. Closure" and "No remodeling vs. Dental remodeling vs. Dental and gingival remodeling" groups. A meta-analysis evaluated the magnitude of the difference between groups based on differences in means and effect sizes (α = 0.05; 95% CI; Z-value 1.96), revealing that the esthetic perception of maxillary lateral incisor agenesis treatment remains controversial even among professionals. Gingival remodeling was not valued compared to isolated dental remodeling. Studies lack rigorously comparable methodologies. Discussion with the patient is pertinent in doubtful situations, as the best treatment option remains unclear, and overtreatment should be avoided.

The effect of motivational interviewing based on the transtheoretical model on oral cleaning behavior of patients with periodontitis who have undergone implant restoration

BACKGROUND

Implant-restored patients with periodontitis have a higher risk of developing peri-implantitis, and helping them develop oral cleaning habits is significant.

OBJECTIVE

To evaluate the effectiveness of motivational interviewing based on the transtheoretical model on the modification of oral cleaning behaviors of implant-restored patients with periodontitis.

METHODS

Patients with periodontitis (n= 70) who would receive dental implant treatment were included. And they were randomly divided into two groups: experimental (n= 35) and control (n= 35). Control patients received routine oral hygiene education, and those in the experimental group received motivational interviewing based on the transtheoretical model. Oral cleaning behavior was compared between the two groups before and after intervention. In addition, periodontal health status was compared on the day of implant restoration and three months later.

RESULTS

Compared to the control, the experimental group demonstrated significantly better oral hygiene behavior after intervention (P< 0.05). Three months after implant restoration, significantly better results were obtained by the experimental group in terms of mPLI and mSBI (P< 0.05).

CONCLUSION

Motivational interviewing based on the transtheoretical model can effectively improve the oral cleaning behavior and periodontal health of implant-restored patients with periodontitis.

The peri-implant mucosa color: A systematic appraisal of methods for its assessment and clinical significance

BACKGROUND

Peri-implant mucosa color (PMC) seems to be one of the main parameters affecting the esthetic outcome of implant therapy. However, more emphasis should be given to its assessment and reporting.

PURPOSE

To describe the available evidence on methods to assess and report the color of the peri-implant mucosa (PMC) and the respective clinical relevance.

MATERIAL AND METHODS

A comprehensive electronic and manual search was performed to identify clinical studies reporting on PMC.

RESULTS

A total of 121 studies were included. PMC was evaluated at the time of the follow-up visit (chairside) in 45.5% studies. PMC assessment was performed qualitatively, by comparing PMC with adjacent and/or contralateral gingiva (78.6%) or quantitatively, using spectrophotometry (20.7%) or a software on clinical photographs (0.8%). The most performed method to assess PMC was through esthetic indices (76.9%), either at the time of the follow-up visit (chairside) or at later time point using photographs. Quantitative reporting of PMC included averages of points from esthetic indices or color differences to natural gingiva expressed with the CIELAB color system. PMC assessment allowed describing color discrepancies compared to natural gingiva, evaluating color changes over time, and comparing the outcomes of different treatment modalities. PMC assessment through spectrophotometry was additionally utilized to assess the role of mucosal thickness (MT) on PMC.

CONCLUSIONS

Various methods for PMC assessment and reporting were described, including visual assessment, mainly through esthetic indices, and spectrophotometry. PMC evaluation has allowed to demonstrate the factors affecting the color of the peri-implant soft tissue, such as the type of abutment/restoration, MT, and soft tissue augmentation.

Closure of maxillary lateral incisor agenesis space in unilateral cleft lip and palate: a digital model assessment

OBJECTIVE

To compare dental positional and gingival parameters of maxillary anterior teeth in unilateral cleft lip and palate (UCLP) after orthodontic treatment with canine substitution due to lateral incisor agenesis.

METHODS

This split-mouth study comprised 57 subjects with UCLP (31 male, 26 female) and agenesis of maxillary lateral incisor at the cleft side, from a single center. Canine substitution was completed after the secondary alveolar bone graft. Dental models were taken between 2 to 6 months after debonding (mean age: 20.4 years). The following variables were measured in the maxillary anterior teeth: crown height, width, proportion, and symmetry, as well as steps between incisal edges, gingival margins, tooth mesiodistal angulation and labiolingual inclination. Paired t-tests with Bonferroni post-hoc correction was used for comparisons between cleft and non-cleft sides (p<0.05).

RESULTS

At the cleft side, canines replacing missing lateral incisors had a higher crown height (0.77mm) and an increased width (0.67mm), and first premolars showed a shorter crown height (1.39mm). Asymmetries were observed in the gingival level of central and lateral incisors, with a greater clinical crown at the cleft side (0.61 and 0.81mm, respectively). Cleft side central incisors were more upright than their contralaterals (2.12º).

CONCLUSIONS

Maxillary anterior teeth demonstrated positional, size and gingival height differences between cleft and non-cleft side after space closure of maxillary lateral incisor agenesis. Slight asymmetries in tooth position and gingival margin in the maxillary anterior teeth should be expected after orthodontic treatment in UCLP patients.

Distribution of congenitally missing teeth and treatment options for the lower second premolars in patients referred to special care

OBJECTIVE

The aim was to evaluate the distribution of congenitally missing teeth and the treatment provided for congenitally missing lower second premolars in an eleven-year cohort of patients referred to a publicly funded source of specialist care.

MATERIAL AND METHODS

This was a retrospective, register-based cohort study. Search for patients referred to a publicly funded source of specialist care based on ICD10 diagnosis code K00.00 (partial anodontia) and treatment codes EBA00, EBA05, EBA10, EBA12, EBB10 and EBB20 during the period 1.1.2009-27.10.2019 yielded 232 patients (151 females, 81 males), of whom 218, born in 1941-2009, were eligible. Data collected from medical files were presented in the form of descriptive statistics and analysed using Fisher's exact test.

RESULTS

The 218 subjects possessed 876 congenitally missing teeth (males 307, females 569) (third molars excluded). The most common missing teeth were upper second premolars and lateral incisors, and lower second premolars and central incisors. No difference in laterality was found. Statistically significant associations were found between the choice of treatment and both the patient's age at referral and the patient's year of birth. Most common treatment for adult patients (age 18-56 years) was placement of an implant (67%), while autotransplantation (11%) was the preferred option for children at the mixed dentition stage (age 9-15 years).

CONCLUSIONS

The congenitally missing teeth most commonly involved in referrals of patients to publicly funded specialist care were lower second premolars. The most frequent treatment was insertion of an implant for adults and autotransplantation at the mixed dentition stage.

A five-year randomised controlled trial comparing zirconia-based versus metal-based implant-supported single-tooth restorations in the premolar region

OBJECTIVES

To compare 5-year biological, technical, aesthetic, and patient-reported outcomes of single-tooth implant-supported all-ceramic versus metal-ceramic restorations.

MATERIALS AND METHODS

Thirty patients with 63 premolar agenesis participated in the 5-year follow-up. The prosthetic treatment on single-tooth implants were randomly assigned to all-ceramic crowns on zirconia abutments (AC=31) or metal-ceramic crowns on metal abutments (MC=32). All patients were recalled to clinical examinations at baseline, 1, 3, and 5 years after prosthetic treatments. Biological, technical, and aesthetic outcomes including complications, were clinically and radiographically registered. The patient-reported outcomes were recorded using OHIP-49 questionnaire before treatment and at each follow-up examination.

RESULTS

At 5-year examination, the survival rate was 100% for implants and 100 % for AC and 97% for MC crowns and abutments. The marginal bone loss after 5-years was minor and not significantly different (p= 0.056) between AC (mean: 0.3, SD: 1.1) and MC restorations (mean: -0.1, SD: 0.4). The success rate of the implants based on marginal bone loss was 77.4% for AC- and 93.7% for MC-restorations. The marginal adaptation was significantly better for MC than for AC restorations (p=0.025). The aesthetic outcomes and patient-reported outcomes between AC and MC restorations were not significantly different.

CONCLUSIONS

The biological, aesthetic and patient-reported outcomes for implant-supported AC and MC restorations were successful and with no significant difference after 5-years. The marginal adaptation of the MC crowns cemented on titanium abutments showed significantly better fit than restorations based on zirconia crowns cemented on zirconia abutments.

Management and sequelae of dental implant removal

Inappropriate and unnecessary implant therapy driven by an erroneous belief that dental implants provide enhanced function and esthetics over diseased or failing teeth has led to a growing burden of implant complications across the globe. Specifically, esthetic and biological complications frequently lead to the unfavorable prognosis of dental implants. Often, these cannot be managed predictably to improve the condition or satisfy patients' demands. In such circumstances, implant removal needs to be considered. Currently, minimally invasive methods based on reverse torque engineering are key to preserve peri-implant soft and hard tissues. Implant replacement is now feasible, as evidenced by the high survival rates of implants placed at previously failed sites. Notwithstanding these data, clinicians should still consider carefully the expendability of an implant and whether its replacement will satisfy the prosthetic, biomechanical, and esthetic demands of the patient. In the scenario where future implant placement is desired, protocols undertaken for soft/hard tissue grafting and implant placement should be based upon defect morphology and soft and hard-tissue characteristics. Currently, however, a lack of knowledge of the biological events and dimensional changes that arise following implant removal renders decision-making complex and challenging, and recommendations remain largely based upon empirical speculation. This chapter will review the indications for implant replacement for prosthetic, biomechanical, and esthetic complications, alongside considerations in decision-making, planning, implementation, and outcomes of implant replacement.

Outcome measures and methods of assessment of soft tissue augmentation interventions in the context of dental implant therapy: A systematic review of clinical studies published in the last 10 years

AIM

To identify and report outcome measures and methods of assessment on soft tissue augmentation interventions in the context of dental implant therapy reported in clinical studies published in the last 10 years.

MATERIAL AND METHODS

The protocol of this PRISMA 2020-compliant systematic review was registered in PROSPERO (CRD42021252214). A literature search was conducted to identify articles that met the pre-established eligibility criteria. Data of interest, with an emphasis on outcome measures, were extracted. For each outcome, specific methods and timing of assessment were described in detail. Following a critical qualitative analysis of the data, outcome measures were categorized. Primary outcomes were identified and frequency of reporting in the selected articles was calculated. Additionally, risk of bias assessments were performed for individual articles and primary outcomes.

RESULTS

Ninety-two articles, of which 39 reported randomized controlled trials (RCTs), 20 reported non-RCTs, and 33 reported case series studies, were selected. Outcome measures were categorized into either investigator-evaluated outcome measures (i.e., clinical, digital imaging, esthetic, histologic, biomarker, and safety) or patient-reported outcome measures (PROMs). Clinical outcomes were the most frequently reported type of outcome. Considering all categories, the most frequently reported primary outcomes were facial mucosa thickness assessed with clinical methods (22.83%), facial keratinized mucosa width assessed with clinical methods (19.57%), facial mucosal margin position / recession assessed with clinical methods (18.48%), facial mucosa thickness assessed with digital imaging methods (11.96%), facial soft tissue volume assessed with digital imaging methods (9.78%), and supracrestal tissue height assessed with clinical methods (9.78%). No distinguishable patterns of association between specific types or quality (level of bias) of clinical studies and the choice of primary outcomes were observed.

CONCLUSION

Clinical research on peri-implant soft tissue augmentation has progressively increased in the last 10 years. Although clinical outcome measures were the most frequently reported outcomes in the selected literature, trends in the field are indicative of a shift from traditional clinical assessment methods to the use of digital technologies. PROMs were generally underreported but should be considered an integral methodological component in future clinical studies. This article is protected by copyright. All rights reserved.

Soft tissue metric parameters, methods and aesthetic indices in implant dentistry: A critical review

OBJECTIVES

The primary objective was to provide an overview of soft tissue metric parameters, methods, and aesthetic indices in implant dentistry. The secondary objective was to describe reliability and validity of aesthetic indices.

MATERIALS AND METHODS

Two independent reviewers conducted an electronic literature search in Pubmed, Web of Science, Embase, and Cochrane databases up to October 2020 to identify studies on soft tissue metric parameters, methods, and aesthetic indices. Aesthetic indices were evaluated in terms of reliability and validity. Data extraction was performed by the same reviewers.

RESULTS

Five metric parameters (papilla height, linear changes in soft tissue level, color assessment, soft tissue thickness, and profilometric soft tissue changes) registered by means of several methods (intra-oral registrations, radiographic assessments, digital analyses, and ultrasonic assessments), and 15 aesthetic indices (Papilla Index (PI), ad hoc questions scored with Visual Analogue Scales, Pink Esthetic Score (PES), Implant Crown Aesthetic Index (ICAI), Implant Aesthetic Score (IAS), Rompen Index, Subjective Esthetic Score, White Esthetic Score, Copenhagen Index, Complex Esthetic Index, Californian Dental Association Index (CDAI), Peri-Implant, and Crown Index, Functional Implant Prosthodontic Score, Implant Restoration Esthetic Index (IREI), and Mucosal Scarring Index (MSI)) could be identified. With respect to metric parameters and methods, intra-oral registrations were least accurate whereas profilometric soft tissue changes on the basis of digital surface models were most accurate. Six aesthetic indices showed good inter-rater reliability (PI, PES, ICAI, CDAI, IREI, and MSI). Good validity could only be shown for two indices (PES and CEI). Given this and on the basis of ease of use and ease of interpretation, PES qualified best for clinical research on single implants. None of the indices fulfilled the quality criteria for clinical research on multiple implants.

CONCLUSION

Many soft tissue assessment methods with varying reliability and validity have been described and used, which hampers uniform reporting in implant dentistry. Clinical investigators are advised to measure linear and profilometric soft tissue changes using digital surface models, and to use a reliable and validated aesthetic index. Currently, PES qualifies best for aesthetic evaluation of single implants. An index is to be developed to assess the aesthetic outcome of rehabilitations on multiple implants.

Hypodontia and its impact on a young person's quality of life, esthetics, and self-esteem

INTRODUCTION

The impact of hypodontia on quality of life is a relatively unexplored area. The limited research shows that the issues of importance for people with hypodontia can vary from those of patients undergoing routine orthodontic treatment. This research aimed to use generic and condition-specific scales to evaluate the impact of hypodontia on a young person's oral health-related quality of life, self-esteem, and aesthetics.

METHODS

This prospective cross-sectional hospital-based study recruited 97 participants with hypodontia, aged 11-18 years. The following questionnaires were completed before the start of any planned treatment: child perception questionnaire, Bristol condition-specific questionnaire for hypodontia, child health questionnaire, and Oral Aesthetic Subjective Impact Scale. A priori sample size calculation determined a minimum of 65 participants were required, at the 5% level of significance, and with a power of 80%. The number was inflated to allow for dropouts/loss to follow-up by 30%.

RESULTS

A total of 323 teeth were missing; 58 subjects (36 female) showed mild (2 absent teeth), and 39 subjects (25 female) showed moderate to severe (>2 absent teeth) hypodontia. Forty-one (42%) patients were missing anterior teeth, with absent maxillary lateral incisors predominating. Significant differences were found for the overall child perception questionnaire (P = 0.01), emotional (P = 0.005), and social (P = 0.003) well-being; scores were highest in the moderate to severe hypodontia group, revealing the greatest negative impact. Similarly, overall Bristol condition-specific questionnaire for hypodontia (P <0.001), treatment (P = 0.001), appearance (P = 0.013), and other people's reaction (P <0.001) domains were all significant, with the moderate to severe group reporting higher levels of negative impact. No significant differences were observed in self-esteem or esthetics.

CONCLUSIONS

Hypodontia in young people appear to have a negative psychosocial impact, both in terms of its presentation and planned care.

Implant soft tissue Dehiscence coverage Esthetic Score (IDES): A pilot within- and between-rater analysis of consistency in objective and subjective scores

OBJECTIVES

To introduce an esthetic index for assessing the outcomes of peri-implant soft tissue dehiscence/deficiency (PSTD) coverage and test its within- and between-reviewer reliability.

MATERIALS AND METHODS

Photographs of 51 single PSTDs at baseline and after treatment were provided to four periodontists from three centers. The examiners were asked to rate each case at two timepoints with the Implant soft tissue Dehiscence/deficiency coverage Esthetic Score (IDES) that involved the evaluation of the post-treatment level of the soft tissue margin, peri-implant papillae height, mucosa color, and mucosa appearance (summing up to a total score of 10). Variance components analysis was conducted using multilevel regression fit in a Bayesian framework for obtaining uncertainty intervals for fractional variance contributions and intraclass correlation values (ICC) of the IDES, and for each of its four clinical variables.

RESULTS

Regression models showed reproducible esthetic evaluation among the examiners (inter-reliability) and negligible intra-reviewer variability (assessment of the same case at different timepoints). The ICC for the variability in the assessment of the overall IDES was 0.86, and for the individual components ranged from 0.78 to 0.87. Additionally, there was a strong similarity between the raters' IDES values, and their subjective esthetic response, by the same raters.

CONCLUSION

The IDES showed persistent judgment among the 4 reviewers, and only a slight intra-reviewer variability across timepoints. Within its limitations, this study suggests that the proposed novel score can be a reliable tool for evaluating the esthetic outcomes of PSTD coverage, which can aid in standardization of esthetic assessments following the treatment of a PSTD.

Reproducibility and validity of anterior implant esthetic indices: A review

Background:

The purpose of this review was to narrate about the reproducibility and validity of different indices evaluating esthetic aspects in anterior single implant-supported restorations.

Materials and Methods:

An electronic search of Medline, Scopus, Embase, Cochrane Central, and Web of Science databases was performed using the keywords “dental implants,” “anterior esthetics,” “esthetic score,” and “esthetic index.” Besides, a manual search of dental implant journals was carried out.

Results:

The electronic search revealed 932 titles. After further review, 14 articles fulfilled the eligibility criteria and were included in this review. Because of the heterogeneity of the study designs, interventions, and parameters used for assessment of esthetics, no meta-analysis could be performed.

Conclusion:

Many indices have been proposed for the evaluation of the esthetic aspects of single implant-supported reconstructions in the anterior maxilla. All of them have some advantages and drawbacks that this review pointed out. The evidence level of studies used for the validation of these indices is poor. It is necessary to achieve a consensus on the tools for assessment of the esthetic aspect and perform evidence-based studies to validate an appropriate index.

Solutions for atypical problems in the incisors area: a transdisciplinary challenge

Introduction:

A significant increase in the number of adults in search of orthodontic treatment has raised a new challenge for orthodontists: the need to interact with other specialties to achieve excellent results, particularly when dealing with smile aesthetics and facial balance. Several factors should be considered to respond to their demand: adequate tooth leveling and alignment, individual tooth proportions between adjacent teeth and their contralateral teeth, shape and natural appearance of each tooth and gingival architecture, which should all be in agreement with facial harmony. Maxillary or mandibular incisors congenitally missing or lost due to caries or trauma and tooth-size discrepancies (Bolton) are some of the important aesthetic challenges for an integrated orthodontic treatment.

Objectives:

This study describes cases that illustrate the clinical challenges of treating the anterior area, as well as the multidisciplinary strategies required for their resolution.

Conclusion:

The increasingly frequent multidisciplinary orthodontic treatments of complex cases seem to effectively maximize aesthetic and functional results using a combination of procedures conducted by specialists in related areas, such as Surgery, Prosthetics, Implantology, Restorative Dentistry and Periodontics.

Patient-reported outcome measures focusing on aesthetics of implant- and tooth-supported fixed dental prostheses: A systematic review and meta-analysis

OBJECTIVES

The aim of this systematic review and meta-analysis was to summarize the existing evidence on patient-reported aesthetic outcome measures (PROMs) of implant-supported, relative to tooth-supported fixed dental prostheses.

MATERIAL AND METHODS

In April 2017, two reviewers independently searched the Medline (PubMed), EMBASE, and Cochrane electronic databases, focusing on studies including patient-reported aesthetic outcomes of implant- and tooth-supported fixed dental prostheses (FDPs). Human studies with a mean follow-up period of at least 1 year, a minimum of ten patients, and English, German, or French publication were included. For the comparison of subgroups, random-effects meta-regression for aggregate-level data was used.

RESULTS

The systematic search for implant-supported prostheses focusing on patient-reported outcomes identified 2,675 titles, which were screened by two independent authors. Fifty full-text articles were analyzed, and finally, 16 publications (including 19 relevant study cohorts) were included. For tooth-supported prostheses, no studies could be included. A total of 816 implant-supported reconstructions were analyzed by patients. Overall aesthetic evaluation by the patients' visual analogue scale (VAS) rating was high in implant-supported FDPs (median: 90.3; min-max: 80.0-94.0) and the surrounding mucosa (median: 84.7; min-max: 73.0-92.0). Individual restorative materials, implant neck design (i.e., tissue or bone level type implants), and the use of a fixed provisional had no effect on patients' ratings of the definitive implant-supported FDPs.

CONCLUSIONS

Aesthetics is an important patient-reported measure, which lacks in standardized methods; however, patients' satisfaction was high for implant- supported FDPs and the surrounding mucosa.

Prosthetic Rehabilitation of Edentulous Patients With Implants Based on Facial Profile Assessment: A Case Report

PURPOSE

To introduce a user-friendly protocol for implant-retained prosthetic rehabilitation of fully edentulous patients based on facial profile and the cephalometric intermaxillary relationship.

MATERIALS AND METHODS

The prosthetic rehabilitation of edentulous patients with implants based on facial profile assessment protocol commences with a clinical and cephalometric analysis, followed by a preliminary projection to obtain a harmonious interarch relationship, eventually stabilized by the preplanned prosthesis. The protocol is divided into the following 5 phases: esthetic evaluation; cephalometric-occlusal assessment; surgery; provisionalization; and definitive prosthesis. Evaluation of patient's satisfaction from the treatment provided was performed through a preoperative and postoperative visual analogue scale scores.

RESULTS

The patient was granted immediate function and superior esthetics at day 1 of the treatment. These results were re-evaluated on an interval of 18 months and continued to be stable. The overall treatment time was significantly reduced.

CONCLUSION

Our recommended protocol gives the clinician a chance to grasp results beyond the offered by traditional protocols by using a wider perspective of rehabilitation, involving the patient's facial profile, thus fulfilling the integration of both occlusal and cephalometric parameters in a unified surgical-prosthetic approach.

Effect of implant therapy on oral health-related quality of life (OHIP-49), health status (SF-36), and satisfaction of patients with several agenetic teeth: Prospective cohort study

Background

Effect of fixed prosthodontics on patients with several agenetic teeth is not well understood.

Purpose

To assess the effect of implant‐based fixed prosthodontics on oral health‐related quality of life (OHRQoL), general health status, and satisfaction regarding dental appearance, ability to chew and speech in patients with several agenetic teeth.

Materials and Methods

For this prospective cohort study, all patients (≥18 years) with several agenetic teeth who were scheduled for treatment with fixed dental implants between September 2013 and July 2015 at our department were approached. Participants received a set of questionnaires before and 1 year after implant placement to assess OHRQoL (OHIP‐NL49), general health status (SF‐36), and satisfaction regarding dental appearance, ability to chew and speech.

Results

About 25 out of 31 eligible patients (10 male, 15 female; median age: 20 [19;23] years; agenetic teeth: 7 [5;10]) were willing to participate. Pre‐ and post‐treatment OHIP‐NL49 sum‐scores were 38 [28;56] and 17 [7;29], respectively (P < .001). Scores of all OHIP‐NL49 subdomains decreased tool, representing an improved OHRQoL (P < .05) as well as that satisfaction regarding dental appearance, ability to chew and speech increased (P < .001). General health status did not change with implant treatment (P > .05).

Conclusions

Treatment with implant‐based fixed prosthodontics improves OHRQoL and satisfaction with dental appearance, ability to chew and speech, while not affecting general health status.

Identification and appraisal of outcome measures used to evaluate hypodontia care: A systematic review

INTRODUCTION

Identification and appraisal of the outcome measures that have been used to evaluate hypodontia treatment and deliver services are essential for improving care. A lack of alignment between outcomes and patient values can limit the scope for patient-centered care. Our objectives were to identify and appraise the outcomes selected to evaluate hypodontia care.

METHODS

Data sources included 10 electronic databases and grey literature, searched using terms for hypodontia and its treatment methods. Study eligibility included mixed study designs to ensure comprehensive identification of outcomes, excluding case reports and case series with fewer than 10 participants and nonsystematic reviews. Participants and interventions involved people with hypodontia receiving any dental treatment to manage their hypodontia. Simulated treatment, purely laboratory-based interventions, and future treatments still in development were excluded. Research outcomes were identified and synthesised into 4 categories: clinical indicators, and patient-reported, clinician-reported, and lay-reported outcomes. No synthesis of efficacy data was planned, and consequently no methodologic quality appraisal of the studies was undertaken.

RESULTS

The search identified 497 abstracts, from which 106 eligible articles were retrieved in full. Fifty-six studies and 8 quality-improvement reports were included. Clinical indicators were reported in 49 studies (88%) including appearance, function, dental health, treatment longevity, treatment success and service delivery. Patient-reported outcomes were given in 22 studies (39%) including oral health-related quality of life, appearance, function, symptoms of temporomandibular dysfunction, and patient experience. Clinician-reported outcomes were limited to appearance. Variability was seen in the tools used for measuring outcomes.

CONCLUSIONS

There is a lack of rationale and consistency in the selection of outcome measures used to evaluate hypodontia care. Outcomes are largely clinician and researcher-driven with little evidence of their relevance to patients. There was a paucity of outcomes measuring access to care, quality of care, and cost. Evidence from hypodontia research is clinician-focused and likely to have limited value to support patients during decision making. Attempts to synthesise the evidence base for translation into practice will be challenging. There is a need for a core outcomes set with a patient-centric approach to drive improvements in health services.

Influence of Restorative Materials on Color of Implant-Supported Single Crowns in Esthetic Zone: A Spectrophotometric Evaluation

Restorations of 98 implant-supported single crowns in anterior maxillary area were divided into 5 groups: zirconia abutment, titanium abutment, and gold/gold hue abutment with zirconia coping, respectively, and titanium abutment with metal coping as well as gold/gold hue abutment with metal coping. A reflectance spectrophotometer was used to evaluate the color difference between the implant crowns and contralateral/neighboring teeth, as well as the color difference between the peri-implant soft tissue and the natural marginal mucosa. The mucosal discoloration score was used for subjective evaluation of the esthetic outcome of soft tissue around implant-supported single crowns in the anterior zone, and the crown color match score was used for subjective evaluation of the esthetic outcome of implant-supported restoration. ANOVA analysis was used to compare the differences among groups and Spearman correlation was used to test the relationships. A gold/gold hue abutment with zirconia coping was the best choice for an esthetic crown and the all-ceramic combination was the best for peri-implant soft tissue. Significant correlation was found between the spectrophotometric color difference of peri-implant soft tissue and mucosal discoloration score, while no significant correlation was found between the total spectrophotometric color difference of implant crown and crown color match score.

[Congenitally missing maxillary lateral incisors: long-term periodontal and functional evaluation after orthodontic space closure with first premolar intrusion and canine extrusion]

INTRODUCTION

The aims of this investigation were to evaluate associations between orthodontic space closure (including first premolar intrusion and canine extrusion for esthetic reasons) and periodontal tissue deterioration over a 10-year period in subjects with one or both missing maxillary lateral incisors and to investigate the occurrence of signs or symptoms of temporomandibular disorder (TMD).

METHODS

This was a retrospective cohort study comprising patients treated by the same orthodontist. The agenesis group included 26 consecutive adolescent and young adult patients (9 male, 17 female) treated with space closure. The control group consisted of 32 orthodontic patients (12 male, 20 female) with no missing teeth and no need for extractions. In the agenesis group, full-mouth probing pocket depths and bleeding on probing were recorded at six locations for each of 657 teeth (3942 periodontal sites). In the control group, comparative data were collected for the maxillary first molars, premolars, canines, and lateral incisors, a total of 264 teeth (1584 periodontal sites). Mobility and gingival recession were also evaluated. Patients in both groups completed questionnaires concerning symptoms related to TMD.

RESULTS

The full-mouth assessments in the agenesis group generally demonstrated periodontally healthy conditions, with probing depths below 4 mm and few bleeding sites. Some slight recessions were found, mostly on molars and second premolars, and there was normal mobility of first premolars that substituted for canines. Comparisons between the agenesis and control groups showed no statistically significant differences for the maxillary teeth regarding increased pocket depth (≥ 4 mm) or increased mobility. Interproximal sites in the agenesis group showed less bleeding on probing than in the control group; this was statistically significant. Anterior teeth in the agenesis group did not show any more recession than in the controls. In addition, we observed no difference in signs or symptoms between the two groups; this might be due to the limited sample size or the drawbacks of the surveys of TMD through subjects' recall. Thus, the long-term periodontal tissue health and the incidence of dysfunction or TMD signs were similar in the space-closure agenesis group and in the control group of nonextraction orthodontic patients.

CONCLUSIONS

Orthodontic space closure including first premolar intrusion and canine extrusion in patients with missing lateral incisors does not incur risks for periodontal tissue deterioration or TMD in the long term.

Occlusal rehabilitation in patients with congenitally missing teeth-dental implants, conventional prosthetics, tooth autotransplants, and preservation of deciduous teeth-a systematic review

Background

Implant patients with congenitally missing teeth share some common charateristics and deserve special attention.

Methods

The PICO question was “In patients with congenitally missing teeth, does an early occlusal rehabilitation with dental implants in comparison to tooth autotransplants, conventional prosthetics on teeth or preservation of deciduous teeth have better general outcomes in terms of survival, success and better patient centered outcomes in terms of quality of life, self-esteem, satisfaction, chewing function?”

After electronic database search, a total of 63 relevant studies were eligible, of which 42 qualified for numerical data synthesis, 26 being retrospective studies. A data synthesis was performed by weighted means for survival/success/annual failure rates.

Results

The mean survival of implants was 95.3 % (prosthesis survival 97.8 %), autotransplants 94.4 %, deciduous teeth 89.6 %, and conventional prostheses 60.2 %. The implant survival in children, adolescents, and adults was 72.4, 93.0, and 97.4 %. Annual failure rates of implants 3.317 %, autotransplants 1.061 %, deciduous teeth 0.908 %, and conventional prostheses 5.144 % indicated better results for natural teeth and more maintenance needs for the both prosthetic treatments. The mean OHIP score was 27.8 at baseline and a mean improvement of 14.9 score points was reported after implant prosthetics. The mean satisfaction rates were 93.4 (implants), 76.6 (conventional prostheses), 72.0 (autotransplants), and 65.5 % (orthodontic space closure).

Conclusions

In synopsis of general and patient-centered outcomes, implants yielded the best results, however, not in children <13 years. Autotransplants and deciduous teeth had low annual failure rates and are appropriate treatments in children and adolescents at low costs. Conventional prosthetics had lower survival/success rates than the other options. Due to heterogeneity and low number of studies, patient-reported outcomes in this review have to be interpreted with caution.

Tooth replacements in young adults with severe hypodontia: Orthodontic space closure, dental implants, and tooth-supported fixed dental prostheses. A follow-up study

INTRODUCTION

Children with severe hypodontia have a substantial impairment of their dental health starting early in life. The purpose of this study was to describe types and locations of substitutes for missing teeth in patients with severe hypodontia and to compare the crown and soft tissue morphologies of orthodontic space closure, dental implants, and tooth-supported fixed dental prostheses for replacing teeth in the anterior region.

METHODS

Fifty patients missing 6 or more teeth and aged 18 years or older (mean age, 25.6 years) took part in a follow-up study. The patients were examined clinically with panoramic radiographs and clinical photographs. Crown and soft tissue variables (mucosal discoloration, crown morphology, color, and papilla index) were compared for orthodontic space closure, dental implant fixtures, and fixed dental prostheses.

RESULTS

Dental implants, orthodontic space closure, and retaining deciduous teeth were the most commonly prescribed treatments. Persisting deciduous teeth showed a good survival rate at the follow-up examination. Mucosal discoloration was seen only for implant fixtures and was evident for almost all fixtures in the anterior mandible and two thirds of those in the anterior maxilla. The papilla index scored poorer for both implant fixtures and fixed dental prostheses compared with orthodontic space closure.

CONCLUSIONS

Dental implants in the anterior region proved to be an inadequate treatment modality in patients with severe hypodontia because of pronounced mucosal discoloration.

Transplant vs implant in a patient with agenesis of both maxillary lateral incisors: A 9-year follow-up

INTRODUCTION

Agenesis of a maxillary lateral incisor occurs in about 2% of the population. Treatment options should adapt to natural biologic changes in a lifelong perspective.

METHODS AND RESULTS

A young woman with bilateral agenesis of the maxillary lateral incisors was treated with transplantation of a developing maxillary third molar on one side and a dental implant on the contralateral side, after orthodontic space opening. The periodontal examination, including bacterial testing of the transplant, the implant, and the control central incisor, was performed 9 years after the treatment. A radiologic assessment was also performed. The transplanted tooth did not differ from a natural incisor, except for the pulp obliteration, and the total bacteria count was higher at the implant site. The periodontal tissues around the implant showed progressive signs of recession.

CONCLUSIONS

Both tooth transplants and dental implants for replacing missing maxillary incisors can be effective in the long term. This report supports natural tooth substitution rather than implant placement for dental agenesis in the anterior maxilla.

Agenesis of Maxillary Lateral Incisors: Treatment Involves Much More Than Just Canine Guidance

Objective:

In this study, we aimed highlight some clinical features present in patients whose maxillary lateral incisors are missing, and proposed more logical, rational and predictable solutions to inform decision making in rehabilitation procedures.

Methods:

Literature review and discussion.

Conclusion:

Choosing the best possible treatment for congenital absence of maxillary lateral incisors depends on the multidisciplinary diagnosis of facial, occlusal, functional and periodontal features. It also depends on the individual long-term stability, and it does not only rely on canine-guided disocclusion.

Congenitally missing maxillary lateral incisors: Long-term periodontal and functional evaluation after orthodontic space closure with first premolar intrusion and canine extrusion

INTRODUCTION

The aims of this investigation were to evaluate associations between orthodontic space closure (including first premolar intrusion and canine extrusion for esthetic reasons) and periodontal tissue deterioration over a 10-year period in subjects with one or both missing maxillary lateral incisors and to investigate the occurrence of signs or symptoms of temporomandibular disorder (TMD).

METHODS

This was a retrospective cohort study comprising patients treated by the same orthodontist. The agenesis group included 26 consecutive adolescent and young adult patients (9 male, 17 female) treated with space closure. The control group consisted of 32 orthodontic patients (12 male, 20 female) with no missing teeth and no need for extractions. In the agenesis group, full-mouth probing pocket depths and bleeding on probing were recorded at 6 locations for each of 657 teeth (3942 periodontal sites). In the control group, comparative data were collected for the maxillary first molars, premolars, canines, and lateral incisors, a total of 264 teeth (1584 periodontal sites). Mobility and gingival recession were also evaluated. Patients in both groups completed questionnaires concerning symptoms related to TMD.

RESULTS

The full-mouth assessments in the agenesis group generally demonstrated periodontally healthy conditions, with probing depths below 4 mm and few bleeding sites. Some slight recessions were found, mostly on molars and second premolars, and there was normal mobility of first premolars that substituted for canines. Comparisons between the agenesis and control groups showed no statistically significant differences for the maxillary teeth regarding increased pocket depth (≥4 mm) or increased mobility. Interproximal sites in the agenesis group showed less bleeding on probing than in the control group; this was statistically significant. Anterior teeth in the agenesis group did not show any more recession than in the controls. In addition, we observed no difference in signs or symptoms between the 2 groups; this might be due to the limited sample size or the drawbacks of the surveys of TMD through subjects' recall. Thus, the long-term periodontal tissue health and the incidence of dysfunction or TMD signs were similar in the space-closure agenesis group and in the control group of nonextraction orthodontic patients.

CONCLUSIONS

Orthodontic space closure including first premolar intrusion and canine extrusion in patients with missing lateral incisors does not incur risks for periodontal tissue deterioration or TMD in the long term.

Prosthetic treatment outcome in patients with severe hypodontia: a systematic review

Severe hypodontia (≥6 missing teeth) is associated with aesthetic and functional problems. Its presentation is heterogenic, and a variety of treatment modalities are used resulting in different treatment outcomes. As there is currently no standard treatment approach for patients with severe hypodontia, the literature was systematically reviewed with the focus on treatment outcomes. Medline, Embase and The Cochrane Central Register of Controlled Trials were searched (last search 24 August 2015). This was completed with a manual search of the reference lists of the selected studies. To be included, studies had to describe dental treatment outcome measure(s) in patients with severe hypodontia; there were no language restrictions. The methodological quality was assessed using MINORS criteria. Twenty-one studies were eligible, but the diversity in type and quality did not allow for a meta-analysis; seventeen studies had a retrospective design; sixteen studies described the results of implant treatment. Treatment with (partial) dentures, orthodontics, fixed crowns or bridges was sparsely presented in the eligible studies. Implant survival, the most frequently reported treatment outcome, ranging from 35·7% to 98·7%, was influenced by 'location' and 'bone volume'. The results of implant treatment in severe hypodontia patients are promising, but due to its heterogenic presentation, its low prevalence and the poor quality of the studies, evidence-based decision-making in the treatment of severe hypodontia is not yet feasible, thus prompting further research.

Agenesis of maxillary lateral incisor in an Angle Class II, Division 1 malocclusion patient

The present case report describes the orthodontic treatment of a patient with agenesis of maxillary left lateral incisor and Angle Class II, Division 1 malocclusion. The patient also presented with maxillary midline deviation and inclination of the occlusal plane in the anterior region. Treatment objectives were: correction of sagittal relationship between the maxilla and the mandible; correction of midline deviation, so as to cause maxillary and mandibular midlines to coincide; correction of overbite and leveling of the occlusal plane, so as to create ideal conditions for esthetic rehabilitation of anterior teeth. This case was presented to the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO) as a requirement for the title of certified by the BBO.

Missing upper incisors: a retrospective study of orthodontic space closure versus implant

Background

The aim of this retrospective study was to compare the esthetic, periodontal, and functional outcomes of orthodontic space closure versus implant substitution in patients with missing maxillary incisors 5 years after completion of treatment.

Methods

The study group consisted of ten patients treated with orthodontic space closure (six males, four females, mean age 19 ± 2.1 years at the completion of treatment) and ten patients treated with implant insertion (five males, five females, mean age 20 ± 1.4 years at the time of implant insertion). Tooth mobility, plaque index, probing depth, infraocclusion, open gingival embrasure (black triangle), and temporomandibular joint function were recorded at the 5.6 years follow-up. Self-perceived dental esthetic appearance was also evaluated through a visual analog scale (VAS) questionnaire. T-test was used to evaluate the data.

Results

All patients were equally satisfied with the appearance of their teeth 5.6 ± 0.4 years after the completion of treatment. No statistically significant differences were found in relation to the VAS scores of the subjects (P < 0.857). No significant differences were found in tooth mobility, plaque index (P < 0.632), and the prevalence of signs and symptoms of temporomandibular disorders. However, significant infraocclusion was noticed in all implant patients (P < 0.001). Probing depth was also significantly higher in implant patients (P < 0.001).

Conclusions

Orthodontic space closure and implant of missing maxillary incisors produced similar, well-accepted esthetic results. None of the treatments impaired temporomandibular joint function. Nevertheless, infraocclusion was evident in implant patients. Space closure patients also showed better periodontal health in comparison with implant patients.

Optimal parameters for final position of teeth in space closure in case of a missing upper lateral incisor

Background

The aim of this study was to provide clinical indications for the correct management of appliances in space closure treatment of patients with agenesis of the upper lateral incisors.

Methods

Virtual setup for space closure was performed in 30 patients with upper lateral incisor agenesis. Tip, torque and in-out values were measured and compared with those of previous authors.

Results

In the upper dentition, the tip values were comparable to those described by Andrews (Am J Orthod 62(3):296-309, 1972), except for at the first premolars, which require a greater tip, and the first molars, a lesser tip. The torque values showed no differences except for at the canines, where it was greater, and the in-out values were between those reported by Andrews and those by Watanabe et al. (The Shikwa Gakuho 96:209-222, 1996) (except for U3 and U4).

Conclusions

The following prescriptions are advisable: tip 5°, torque 8° and in-out 2.5 for U1; tip 9°, torque 3° and in-out 3.25 for U3; tip 10°, torque −8° and in-out 3.75 for U4; and tip 5°, torque −8° and in-out 4 for U5. Andrews' prescription is suitable for the lower jaw, except for at L6. It is also advisable to execute selective grinding (1.33 ± 0.5 mm) and extrusion (0.68 ± 0.23 mm) on the upper canine during treatment, and the first premolar requires some intrusion (0.56 ± 0.30 mm).

Esthetic failure in implant dentistry

The definition of failure for dental implants has evolved from lack of osseointegration to increased concern for other aspects, such as esthetics. However, esthetic failure in implant dentistry has not been well defined. Although multiple esthetic indices have been validated for objectively evaluating clinical outcomes, including failure of an implant-supported crown, only one author has determined a failure threshold. On the basis of objective indices, esthetic failures in implant dentistry can be categorized as pink-tissue failures and white-tissue failures. This article discusses esthetic failures, the factors involved in these failures, and their prevention and treatment.

Maxillary rehabilitation of periodontally compromised patients with extensive one-piece fixed prostheses supported by natural teeth: a retrospective longitudinal study

Objectives

Oral health-related quality of life is a relatively new but rapidly growing concept in dentistry. It is an aspect of dental health addressing the patient’s perception of whether his/her current oral health status has an impact upon his/her actual quality of life. Dentine hypersensitivity (DHS), which is a common condition of transient tooth pain associated with a variety of exogenous stimuli, may disturb the patient during eating, drinking, toothbrushing and sometimes even breathing. The resulting restrictions on everyday activities can have an important effect on the patient’s quality of life. The aims of this paper were to consider the concept of oral health-related quality of life and to review and discuss the literature on oral health-related quality of life and DHS.

Material and methods

A PubMed literature research was conducted using the terms (“dentin sensitivity” [MeSH Terms] OR (“dentin” [All Fields] AND “sensitivity” [All Fields]) OR “dentin sensitivity” [All Fields]) AND ((“oral health” [MeSH Terms] OR (“oral” [All Fields] AND “health” [All Fields]) OR “oral health” [All Fields]) AND related [All Fields] AND (“quality of life” [MeSH Terms] OR (“quality” [All Fields] AND “life” [All Fields]) OR “quality of life” [All Fields])). Furthermore, a manual search was carried out. Any relevant work published presenting pertinent information about the described issue was considered for inclusion in the review.

Results

The combination of the search terms resulted in a list of only three titles. The few published studies convincingly demonstrated that oral health-related quality of life is negatively affected in patients suffering from DHS.

Conclusions

Patients with sensitive teeth report substantial oral health-related quality of life (OHRQoL) impairment. Nevertheless, knowledge about the influence of DHS on oral health-related quality of life is incomplete and, therefore, needs further research.

Clinical relevance

Oral diseases can lead to physical, psychological and social disability. This paper shows that DHS can have a negative impact on the patients’ OHRQoL.

Treatment for agenesis of maxillary lateral incisors: a systematic review

OBJECTIVES

To compare the efficacy and safety of three orthodontic treatment modalities for agenesis of maxillary lateral incisors: 1) closing the space with the reshaped canine substituting the lateral incisor, 2) opening the space with placement of a conventional fixed bridge, and 3) opening the space with placement of a single-unit implant and an implant-supported crown.

SETTING

Brazilian Cochrane Center and Universidade Federal de São Paulo, Brazil.

MATERIAL AND METHODS

The following databases were investigated: Cochrane Register of Controlled Trials (Edition 12, 2011), EMBASE (from 1974 to December 2011), MEDLINE (from 1965 to December 2011), LILACS (from 1966 to November 2011), and Odontology Brazilian Bibliography Database (from 1966 to November 2011). Conference abstracts, main Brazilian dissertations and theses databases, and reference lists were handsearched. This systematic review included randomized or quasi-randomized controlled trials (RCTs) including women aged 15 years or over and men aged 21 years or over who received one of the interventions stated above. Two observers independently evaluated all the studies regarding eligibility criteria and assessed the risk of bias of included studies.

RESULTS

No studies were included in the review as no RCTs were found. Most of the evidence comes from case reports and narrative reviews on case reports and from three studies with a single post-intervention evaluation and non-comparable control groups with high risk of bias.

CONCLUSIONS

There is no scientific evidence for any of the three most common types of treatment for agenesis of the maxillary lateral incisors. RCTs into this issue are still necessary.

Interim prosthodontic management of surgery-induced dental agenesis: a clinical report of 8 years of treatment

The prosthodontic management of a 7-year-old girl with induced dental agenesis is described. The mandibular posterior tooth germs had been removed during surgical excision of a melanotic neuroectodermal tumor of infancy, at the age of 2 months. The ongoing prosthodontic treatment, now in its eighth year, was implemented by regular follow-up of the operation outcome and by targeted orthodontic intervention. The treatment plan included the provision of four successive interim removable partial dentures. Care was taken to preserve the oral structures, adapt to the morphological changes, and satisfy the needs of the child. Due to the unfavorable biomechanical conditions, retention and stability problems were encountered. These were resolved by engaging the mechanism of neuromuscular adaptation through optimization of the shape of the denture base. For children and adolescents with extensive dental agenesis, prosthodontic management with interim removable dentures supports function, restores esthetics, and provides a solid basis for the definitive treatment.

Oral health-related quality-of-life in patients to be treated with fixed or removable partial dental prostheses

OBJECTIVES

The aims of this study were to measure and describe the Oral Health-Related Quality-of-Life (OHRQoL) in a population about to receive removable dental prostheses (RDP) or fixed dental prostheses (FDP).

MATERIALS AND METHODS

The Oral Health Impact Profile 49 (OHIP-49) was completed by 410 patients about to receive treatment with either RDP or FDP. Objective variables were: gender, age, number of teeth, type of replacement planned (FDP/RDP) and location (one jaw or both) and zone (aesthetic/masticatory/both) of missing teeth to be replaced.

RESULTS

Women had a worse OHRQoL than men in the RDP group. Higher age was significantly correlated with a better OHRQoL independent of treatment modality. Participants about to receive FDP in one jaw in the masticatory zone only had a better OHRQoL than RDP participants in the same group. The most frequently reported problems in all groups concerned functional limitations, discomfort and physical disabilities. Little variance in reported items was seen between the sub-groups and social handicap was not frequently reported.

CONCLUSIONS

The difference in OHRQoL between participants about to receive RDP and FDP was limited. The most frequently reported problems concerned functional limitations, discomfort and physical disabilities. Social handicap was not frequently reported.

Clinical research in implant dentistry: evaluation of implant-supported restorations, aesthetic and patient-reported outcomes

The articles discussed in working group 3 dealt with specific aspects of clinical research. In this context, the literature reporting on survival and complication rates of implant-supported or implant-tooth supported restorations in longitudinal studies of at least 5 years were discussed. The second aspect dealt with the evaluation of aesthetic outcomes in clinical studies and the related index systems available. Finally, the third aspect discussed dealt with patient-reported outcome measures (PROMs). A detailed appraisal of the available methodology was presented.