A Systematic Review of Recall Regimen and Maintenance Regimen of Patients with Dental Restorations. Part 2: Implant-Borne Restorations

Attachment systems for mandibular implant-supported overdentures: A systematic review and meta-analysis of randomized controlled trials

STATEMENT OF PROBLEM

Although mandibular implant-supported overdentures have been highly recommended as a treatment option, a consensus on the type of attachment systems that can be used to increase implant and prostheses survivability is lacking.

PURPOSE

The purpose of this systematic review and meta-analysis was to compare different types of attachments for retention by investigating outcome measures such as implant and prosthesis survival rates and biological and prosthesis complications in participants with a mandibular implant-supported overdenture.

MATERIAL AND METHODS

The search was performed in the PubMed, Cochrane, Embase, and Scopus databases by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria and registered with the International Prospective Register of Systematic Reviews (CRD42021253566). An analysis of association was conducted between different attachment systems and implant and overdenture survival rates in randomized controlled clinical trials.

RESULTS

The initial search indicated 477 studies, of which 25 randomized controlled trials (RCTs) were included for analysis. A total of 2154 implants and 737 overdentures were analyzed in the meta-analysis. The main results indicated the failure rate for dental implants to be 2.0% (95% confidence interval [CI], 1.3 to 3.2) and overdentures 4.2% (95% CI, 1.6 to 10.5), respectively. With regard to different attachment systems, a similar failure rate was identified with bar-type retention (7.7% to 95% CI, 3.0 to 18.1), magnetic retention systems (7.6% to 95% CI, 2.2 to 22.7), and ball-type retention (6.8% to 95% CI, 3.0 to 14.3). No significant difference was found in biological complications for splinted and unsplinted implant overdentures (P=.902). Regarding prosthetic complications, the most favorable groups were LOCATOR attachments followed by telescopic and Conus, bar, and ball attachments. Magnet attachments had higher prosthetic complications (7.4 times) than the other attachments.

CONCLUSIONS

Implants and implant-supported mandibular overdentures showed a high survival rate irrespective of the attachment system used. Splinting implants did not significantly affect the rate of biological complications. Prosthetic complications were most common for magnet and least common for LOCATOR attachments.

Maintenance protocols for implant-supported dental prostheses: A scoping review

STATEMENT OF THE PROBLEM

Biological complications of implant-supported prostheses remain a concern. Therefore, standardizing hygiene protocols to promote their maintenance is important.

PURPOSE

The purpose of this scoping review was to identify available hygiene guidance for home care procedures, as well as periodicity and protocols for the professional maintenance of implant-supported prostheses.

MATERIAL AND METHODS

This study was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the study protocol was made available at: https://osf.io/5jdeh/. The search was last performed in the PubMed database on March 15, 2022 and was undertaken by 2 independent researchers. Clinical studies and reviews that evaluated home care and maintenance protocols for dental implant-supported prostheses (fixed or removable), without language restriction or year of publication, were included. A descriptive analysis was performed considering study characteristics (study design, restorative assembly, maintenance strategies, eligibility criteria, number of included studies, quality/level of evidence, and main findings).

RESULTS

The initial search yielded 3138 studies, of which 18 were included for descriptive analysis (6 critical reviews, 4 clinical trials, 3 systematic reviews, 2 guideline reports, 2 retrospective studies, and 1 transversal study). The main instrument recommended for home care was the use of a conventional toothbrush associated with triclosan-containing toothpaste in addition to interproximal aids (brushes or floss) for all types of restorations. The use of irrigation instruments was also frequently considered. For professional maintenance, almost all studies reported a positive effect of regular recalls every 3 months during the first year, followed by less regular recalls according to the motivation of the patient and home care efficacy. At each recall, the professional should evaluate the patient history, oral tissues, implant, abutments, and restorations, as well as perform professional cleaning of the prostheses with appropriate instruments so that the implants and abutments may be preserved.

CONCLUSIONS

Establishing an adequate hygiene protocol is indispensable for implant-supported restorations. To do so, the professional must guide and support the patient's home care by taking into account the patient's motivation and efficacy during the hygiene procedures. Also, for professional maintenance, the periodicity of recalls should be constant and include an evaluation of the condition of the restoration and adjacent tissues, followed by professional cleaning of prostheses, implants, and abutments, in addition to new instructions to improve patient home care.

Oral Irrigation Devices: A Scoping Review

OBJECTIVES

Self-performed oral hygiene is essential for preventing dental caries, periodontal, and peri-implant diseases. Oral irrigators are adjunctive oral home care aids that may benefit oral health. However, the effects of oral irrigation on oral health, its role in oral home care, and its mechanism of action are not fully understood. A comprehensive search of the literature revealed no existing broad scoping reviews on oral irrigators. Therefore, this study aimed to provide a comprehensive systematic review of the literature on oral irrigation devices and identify evidence gaps.

METHODS

The Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines were utilized to prepare the review. Four databases and eight gray literature sources were searched for English publications across any geographical location or setting.

RESULTS

Two hundred and seventy-five sources were included, predominantly from scientific journals and academic settings. Most studies originated from North America. Research primarily involved adults, with limited studies in children and adolescents. Oral irrigation was safe and well-accepted when used appropriately. It reduced periodontal inflammation, potentially by modulating the oral microbiota, but further research needs to clarify its mechanism of action. Promising results were reported in populations with dental implants and special needs. Patient acceptance appeared high, but standardized patient-reported outcome measures were rarely used. Anti-inflammatory benefits occurred consistently across populations and irrigant solutions. Plaque reduction findings were mixed, potentially reflecting differences in study designs and devices.

CONCLUSIONS

Oral irrigators reduce periodontal inflammation, but their impact on plaque removal remains unclear. Well-designed, sufficiently powered trials of appropriate duration need to assess the clinical, microbiological, and inflammatory responses of the periodontium to oral irrigation, particularly those with periodontitis, dental implants, and special needs. Patient-reported outcome measures, costs, caries prevention, and environmental impact of oral irrigation need to be compared to other oral hygiene aids.

Assessing the quality of YouTube™ videos on fixed dental implant home-care and maintenance protocols

OBJECTIVES

The implant's supporting structure differs from that of the teeth when plaque accumulates, making it more prone to inflammation and bone loss. To ensure the implant's longevity, an effective maintenance protocol should be followed. This study aimed to evaluate the information on oral hygiene procedures at home for implant-supported fixed prosthesis.

METHODS

The keywords 'cleaning dental implant,' 'how to clean dental implant,' and 'dental implant hygiene' used to search for videos on YouTube™. Following the exclusions, two researchers independently analysed the remaining 100 videos for demographic data and content usefulness.

RESULTS

In terms of usefulness score distribution, 53.52% of the videos were considered slightly useful, 38.4% moderately useful and 8.1% very useful. The video content had the least quantity of knowledge about toothpaste choice (11.1%), but the greatest quantity of knowledge on flossing (68.7%).

CONCLUSIONS

According to the study's findings, there is presently no evidence-based information on YouTube™ on dental implant oral hygiene protocols for home care procedures hygiene education. Therefore, dental care professionals should analyse the information's quality and reliability before recommending it to patients.

Plaque accumulation on the fitting surface of full-arch implant-supported fixed prostheses with contact or noncontact pontics: A split mouth randomized controlled trial

OBJECTIVE

To explore the differences in plaque accumulation on the fitting surface of full-arch implant-supported fixed prostheses with contact or noncontact pontics.

MATERIALS AND METHODS

Nineteen patients (20 prostheses, 7 in the maxilla, and 13 in the mandible) intending to undergo full-arch implant-supported immediate function prostheses were recruited. During immediate restoration and using the midline as the boundary, one side was restored as a pontic and mucosa noncontact type (the test group), and the opposite side was restored as a pontic and mucosa contact type (the control group). In a follow-up 6 months after the surgery, the cleanliness of the fitting surface of the immediate prosthesis was evaluated by plaque staining and debris index determination. Patient satisfaction was investigated by questionnaire.

RESULTS

Twenty prostheses from 19 patients included in the randomized controlled trial were followed up. Among the 20 prostheses, the percentage of area covered with plaque was significantly lower in the test group compared with that in the control group (31.5 ± 15.8% vs. 43.7 ± 15.3%; p < 0.001). The debris index in the test group was lower than that in the control group, although the difference was not statistically significant (2.77 ± 0.73 vs. 3.15 ± 0.90; p > 0.05). In the patient satisfaction survey, most of the patients were satisfied with most aspects of the prostheses, however, nearly half of the patients were not satisfied with the cleaning.

CONCLUSIONS

The pontic and mucosa noncontact prosthetic design reduces plaque accumulation on the fitting surface, which is beneficial for maintaining oral cleanliness. However, the majority of study samples were mandible and conclusions may not be fully applicable to maxilla.

TRIAL REGISTRATION

www.chictr.org.cn (ChiCTR1900028576).

CLINICAL SIGNIFICANCE

The noncontact design in full-arch implant-supported fixed prostheses may be an effective measure of improving oral hygiene promotion. There is need for more research that can further improve oral hygiene of patients with full-arch implant-supported prostheses.

Survival rates, patient satisfaction, and prosthetic complications of implant fixed complete dental prostheses: a 12-month prospective study

PURPOSE

To determine the survival rate, incidence of prosthetic complications, and patient satisfaction of implant fixed complete dental prostheses (IFCDPs) after a mean observation period of 1.4 years.

MATERIALS AND METHODS

Twenty-eight (28) eligible participants were recruited according to specific inclusion and exclusion criteria. The definitive metal-acrylic resin IFCDPs consisted of titanium bars veneered with acrylic resin and acrylic denture teeth. Prosthodontic complications, divided into major and minor, were monitored. Parameters such as gender, jaw location, bruxism, and occlusal scheme were evaluated. Moreover, a questionnaire was administered throughout the study to assess patient satisfaction. Poisson regression as well as repeated measures ANOVA were used for statistical analysis.

RESULTS

Fourteen (14) males and 14 females were enrolled and followed-up at 3, 6, and 12 months. All IFCDPs survived (100% survival rate). The most frequent minor complication was the loss of material used to close the screw access hole (20% out of total complications). The most frequent major complication was chipping of the acrylic denture teeth (77.14% out of total complications). Gender (p = 0.008) and bruxism (p = 0.030) were significant predictors for the total major complications (major wear and major chipping) while occlusal scheme was a significant predictor for major chipping events (p = 0.030).

CONCLUSIONS

While IFCDPs demonstrated high prosthetic survival rates, they also exhibited a high number of chipping events of the acrylic veneering material, especially in males, bruxers, and individuals with canine guidance occlusion. However, the occurrence of these prosthetic complications did not negatively affect patient satisfaction.

Immediate flapless full-arch rehabilitation of edentulous jaws on 4 or 6 implants according to the prosthetic-driven planning and guided implant surgery: A retrospective study on clinical and radiographic outcomes up to 10 years of follow-up

OBJECTIVES

to retrospectively evaluate clinical and radiographic outcomes of immediate, flapless full-arch prostheses, supported by 4/6 implants according to prosthetic-driven planning and guided surgery.

MATERIALS AND METHODS

The study involved 28 edentulous patients (20 female/8 males; average age 67.75 ± 8.627 years), 32 prostheses (17 all-on-4/15 all-on-6) and 164 implants. The Implants survival, prostheses success/survival, peri-implant marginal bone loss, incidence of biological and prosthetic complications were evaluated. Multiple linear regression analysis was performed to analyze the influence of implant and patient characteristics on marginal bone loss.

RESULTS

Cumulative implant survival rate was 89.7% for all-on-four (seven failures) and 99.0% for all-on-six (one failure) after a mean follow-up of 6.46 ± 2.236 years (range 1-10 years). Cumulative prosthesis success rate was 51.5% (58.8% for all-on-four/ 43.8% for all-on-six). Prosthesis survival rate was 88.2% for all-on-four. No failure was registered in all-on-six. Mean value of marginal bone loss was 1.38 ± 0.1.28 mm at 5-year and 2.09 ± 0.56 mm at 10-year follow-up. No difference was found in the mean value of marginal bone resorption between all-on-four (1.56 ± 1.61 mm) and all-on-six (1.20 ± 0.85 mm) (p = 0.104) and between tilted (1.22 ± 1.29 mm) and axial implants (1.44 ± 1.27 mm) (p = 0.385) after 5-year follow-up. The incidence of biological complications was 1.0% in all-on-six (one mucositis) and 10.3% in all-on-four (two peri-implantitis). Prosthetic complications affected teeth of final rehabilitations with 3 detachments, 10 chippings or fractures, and 3 severe occlusal wears.

CONCLUSIONS

Based on the results and within the limitations of the present study, the implant-supported hybrid prosthesis according to prosthetic-driven planning and guided surgery showed to be an efficient, safe, and effective approach to rehabilitate edentulous jaws.

Peri-implant bone-level changes in the second decade of loading with regard to the implant-abutment connection: a retrospective study on implants under systematic aftercare

BACKGROUND

This retrospective study investigates the change in the peri-implant bone level (PBL) during the 2nd decade of intraoral function in patients complying with a 'supportive implant therapy' (SIT) program. The results were statistically analyzed with respect to the implant abutment connection used.

METHODS

In a private practice, only patients with 20-year SIT compliance were identified. Of these, all patients with 10- and 20-year radiographs available were selected. Therefore, no control group was possible and implant losses had to be excluded. Two experienced researchers assessed the peri-implant bone levels. As three different abutment connection concepts (bone-level butt-joint, bone-level conical and tissue-level conical) and two different implant surfaces (machined vs. roughened) were involved, statistical analyses were performed to detect potential differences.

RESULTS

Ninety-three implants from 36 patients with 20-year SIT compliance and available radiographs were included in the study. At study baseline (10 years intraoral), a mean bone loss of - 1.7 mm (median - 1.2; standard deviation [sd] 1.4, range: 0 to - 7.2) was recorded. After 20 years, we found a mean bone loss of - 2.5 mm (median - 2.3, sd 1.79, range: - 0.5 to + 7.4). Furthermore, we found a mean bone loss of 0.8 mm in intraoral function from year 10 to year 20 (mean: 0.08 mm per year); this change was independent of the abutment connection type.

CONCLUSIONS

During the 2nd decade of function, peri-implant bone loss in patients with SIT compliance might be small in value and should not be expected in all implants.

Treatment planning considerations in the older adult with periodontal disease

Periodontal health in the elderly is influenced by numerous factors, including systemic conditions, patient compliance, age-associated changes, and restorative procedures. The numerous comorbidities seen in the elderly necessitate individualized approaches for treatment planning. In this paper, we review how age, comorbidities, oral hygiene, and restorative dental procedures collectively influence the treatment and management of the periodontium in the elderly. The elderly population is predicted to double in 30 years, which will have an economic impact the dental profession needs to plan for. Preventative and noninvasive treatment, supportive periodontal therapy, and patient-specific maintenance plans are imperative to maintaining oral health in the older population. Multiple coexisting changes, including xerostomia, altered wound healing, altered bone physiology, altered microbiome, and diminished plaque control, can add complexity to periodontal management. Considerations of the patient's general health, the selected periodontal treatment plan, and the selected completed restorative procedures need to be considered. The influence of caries, fixed prosthodontics, partial dentures, shortened dental arch, and implant therapy can have unintended impacts on periodontal health in the elderly. Adverse periodontal outcomes in the elderly can be minimized by carefully assessing the patient's medical history, impact of medications, functional needs, properly finishing and contouring restorations to avoid plaque accumulation, and designing restorations to allow access for hygiene. Partial dentures can be a source of plaque accumulation leading to periodontal disease, caries, and recession around abutment teeth. A shortened dental arch should be considered as a functional and cost-effective alternative to partial dentures. With dental implants, the patient's tissue phenotype, keratinized tissue quantity, risk of peri-implantitis, and patient access for maintaining adequate oral hygiene are all important to consider. Implant risk-assessment tools show promise by providing a systematic approach for early diagnosis to avoid future complications.

Radiographic Evaluation of Prosthodontic Patients

This article focuses on radiographic imaging with regard to planning, treating, and maintaining partially and completely edentulous prosthodontic patients with dental implants. Cone-beam computed tomography (CBCT) is the preferred imaging method for pretreatment dental implant treatment planning. Radiographic guides containing radiopaque materials and/or fiducial markers transfer both the proposed prosthesis design and desired implant location for appropriate radiographic evaluation. The three-dimensional CBCT analysis provides information on the adjacent relevant anatomy, bone volume of the edentulous sites, and restorative space assessment.

Dentists' preferences in implant maintenance and hygiene instruction

BACKGROUND

This study investigated the preferences of dentists in Australia in providing professional implant maintenance and implant-specific oral hygiene instructions (OHI).

METHODS

General dentists were surveyed online about their preferences in peri-implant diagnostics, maintenance provision, armamentarium used, and implant OHI techniques and frequency.

RESULTS

Most of the 303 respondents (96%) provided maintenance services; 87.6% reviewed implants regularly while 10.7% only performed diagnostics after detecting clinical signs/symptoms. Supragingival prosthesis cleaning was performed by 77.9% of respondents, 35.0% performed subgingival debridement, 41.9% treated peri-implant mucositis and 18.2% treated peri-implantitis. About 15% did not treat nor refer peri-implant disease, including significantly more non-implant providers and dentists without implant training. Maintenance armamentarium commonly included floss (76.3%), prophylaxis (73.9%), plastic curettes (43.3%) and stainless-steel ultrasonics (38.0%). Brushing (86.5%), flossing (73.9%) and interdental brush use (68.3%) were most commonly recommended. Implant OHI was repeated routinely by 57.4% of dentists who provided it. Dentists with greater implant training and experience were more likely to perform reviews and complex maintenance procedures.

CONCLUSIONS

Peri-implant diagnostics performed, treatments provided and armamentarium varied among dentists. Implant providers and those with higher levels of training had more preventative approaches to implant OHI. Possible shortcomings in disease management and OHI reinforcement were identified.

Aesthetic Parameters and Patient-Perspective Assessment Tools for Maxillary Anterior Single Implants

Background

This review aimed to concisely describe the current aesthetic objective indices for a single-implant maxillary anterior crown. The secondary aim was to propose introducing a unified, standardized questionnaire for adequately collecting patient-reported outcome measures (PROMs) in implant dentistry.

Materials and Methods

A literature review was conducted using both EMBASE/Ovid and MEDLINE/PubMed databases by combining keywords and Emtree/Mesh terms related to “Esthetics,” “Self-Assessment or Surveys and Questionnaires,” and “Single-Tooth Dental Implants.”

Results

The most meaningful aesthetic objective indices for single implants in the literature are the Pink Esthetic Score (PES), the Papilla Presence Index (PPI), Peri‐Implant and Crown Index (PICI), PES/White Esthetic Score (PES/WES), the Implant Crown Aesthetic Index (ICAI), and a modified version of the ICAI (mod-ICAI) index. Clearly, PES/WES is still the most widely accepted tool. It is encouraging to observe that there is an increasing tendency in recent years to report PROMs more frequently in the implant dentistry literature. We proposed the implementation of a unified, standardized questionnaire using a self-administered visual analogue scale (VAS) scoring system, which evaluates overall satisfaction, comfort, tooth appearance, gingival appearance, function, and hygiene complexity. This tool should be validated in the oral implantology research context for its regular implementation or further development.

Conclusions

Conducting qualitative studies among dental implant patients who received few implants or single-tooth implant reconstructions in the aesthetic zone may help dental researchers understand better how to efficiently develop and validate a quantitative instrument. This standard tool would reduce heterogeneity bias by providing comparable data between studies.

Access to Dental Care-A Survey from Dentists, People with Disabilities and Caregivers

The literature highlights differences in the dental conditions of people with disabilities compared with the general population. The aim of this study was to provide an overview of the dental health of people with disabilities in order to understand if their needs are met and to identify their most critical issues as per dentists. A paper and a Google Form platform were used in conducting a survey in Central Italy (the Abruzzo region), by performing an analysis on different points of view as reported by people with disabilities and dentists. The results showed that only 69.2% of dentists treat persons with disabilities. Of these, 73.5% treat less than 10 patients with physical disabilities per year. However, 54% of dentists do not treat people with cognitive impairment and a poor ability to collaborate during treatment. More than 80% of respondent dentists report that people with disabilities do not have good oral hygiene. On the other hand, 49.1% of people with disabilities (or their caregivers in cases where the patient was unable to answer) report that they rarely or never go to the dental office. Moreover, when they do go, it is mainly for emergencies. Despite this, respondents are well aware of their dental problems. However, they have difficulties in communicating their dental problems to their dentist. The 50% of dentists who treat people with cognitive impairment do not include them in follow-up, while only 20% of these patients reported being regularly recalled. This illustrates the importance of the implementation of follow-up. In addition, training courses could help clinicians to reduce this gap and create barrier-free dental offices.

Efficacy of glycine powder air-polishing in supportive periodontal therapy: a systematic review and meta-analysis

PURPOSE

This systematic review and meta-analysis was conducted to assess the effects of glycine powder air-polishing (GPAP) in patients during supportive periodontal therapy (SPT) compared to hand instrumentation and ultrasonic scaling.

METHODS

The authors searched for randomized clinical trials in 8 electronic databases for relevant studies through November 15, 2019. The eligibility criteria were as follows: population, patients with chronic periodontitis undergoing SPT; intervention and comparison, patients treated by GPAP with a standard/nozzle type jet or mechanical instrumentation; and outcomes, bleeding on probing (BOP), patient discomfort/pain (assessed by a visual analogue scale [VAS]), probing depth (PD), gingival recession (Rec), plaque index (PI), clinical attachment level (CAL), gingival epithelium score, and subgingival bacteria count. After extracting the data and assessing the risk of bias, the authors performed the meta-analysis.

RESULTS

In total, 17 studies were included in this study. The difference of means for BOP in patients who received GPAP was lower (difference of means: -8.02%; 95% confidence interval [CI], -12.10% to -3.95%; P<0.00001; I²=10%) than that in patients treated with hand instrumentation. The results of patient discomfort/pain measured by a VAS (difference of means: -1.48, 95% CI, -1.90 to -1.06; P<0.001; I²=83%) indicated that treatment with GPAP might be less painful than ultrasonic scaling. The results of PD, Rec, PI, and CAL showed that GPAP had no advantage over hand instrumentation or ultrasonic scaling.

CONCLUSIONS

The findings of this study suggest that GPAP may alleviate gingival inflammation more effectively and be less painful than traditional methods, which makes it a promising alternative for dental clinical use. With regards to PD, Rec, PI, and CAL, there was insufficient evidence to support a difference among GPAP, hand instrumentation, and ultrasonic scaling. Higher-quality studies are still needed to assess the effects of GPAP.

Angled implant brush for hygienic maintenance of full-arch fixed-implant rehabilitations: a pilot study

PURPOSE

This pilot study was conducted to evaluate the cleaning efficacy of an angled implant brush for home oral hygiene of full-arch fixed-implant prostheses.

METHODS

Forty-one patients treated with a full-arch implant rehabilitation in the maxilla or mandible (164 implants) for at least 4 months were enrolled. The screw-retained fixed prostheses were removed and baseline (T0) parameters were recorded, including plaque index (PI), probing depth (PD), and bleeding on probing (BOP). All patients completed a 5-item questionnaire on hygiene maintenance and received an implant brush for home hygiene. After 1 month (T1) PI, PD, and BOP were recorded again and patients completed a 7-item questionnaire to evaluate their satisfaction with the implant brush. One-way repeated-measures analysis of variance was conducted to evaluate the significance of changes in PI, PD, and BOP. A P value <0.05 was considered to indicate statistical significance.

RESULTS

A statistically significant reduction of BOP (0.62±0.6 at T0 vs. 0.5±0.5 at T1; P=0.032) was found, while no statistically significant changes in PD (1.74±0.5 mm at T0 vs. 1.77±0.5 mm at T1; P=0.050) or PI (1.9±0.7 at T0 vs. 1.7±0.7 at T1; P=0.280) occurred. According to the 7-item questionnaire, patients reported no difficulty in using the angled brush (63.4%) and deemed it highly (46.3%) or very highly (4.8%) effective in improving their home oral hygiene.

CONCLUSIONS

Within the limits of the present pilot study, the patients experienced a reduction of BOP 1 month after being instructed to use the angled implant brush. The angled implant brush appeared to be a well-accepted device for home-care hygiene of full-arch fixed-implant rehabilitations.

Dental follow-up and maintenance index: the development of a novel multidisciplinary protocol

Objectives

To develop a comprehensive yet simple dental follow up and maintenance protocol based on existing guidelines and recommendations.

Methods

A multidisciplinary team reviewed available maintenance and follow up guidelines and recommendations then developed a single protocol for adult dental patients.

Results

The protocol includes ten questions that categorize dental patients into one of three risk categories. Based on the risk category, each patient is assigned a recall interval and recommendations for in office and at home dental care.

Conclusions

Development of a single multidisciplinary follow up and maintenance protocol.

Changing the Focus to the Whole Patient instead of One Oral Disease: The Concept of Individualized Prevention

Oral diseases are highly prevalent and a global burden. Accordingly, their prevention appears essential. Recently, different strategies have been developed, mainly focusing on the presence of singular oral diseases or conditions. This article aims to construct a contemporary concept of individualized preventive care in dentistry whereby the focus is switched from viewing oral health in isolation to viewing the patient as a whole. The basis for individualized prevention measures is the case-oriented profile, including the synthesis of risk- and need-oriented parameters. The risk profile comprises different risk factors within the fields of systemic diseases, medications, and lifestyle that inherently pose a potential risk of complications (e.g., infectious endocarditis) and/or oral diseases (e.g., periodontitis). The needs profile includes factors originating from the aspects of oral diseases, dental restorations/appliances, and dental results with a potential risk of pathogenesis (e.g., the de novo development of caries) and/or the potential progression of oral diseases (e.g., an existing caries lesion). Based on these parameters, the general framework and content of prevention measures, as well as the maintenance interval, should be adapted to the individual patient. The implications of this concept might increase the safety, effectiveness, and efficiency of prevention in dental care. A further area of focus is primary prevention, that is, a focus on the preservation of oral health instead of a disease-related approach. However, clinical validation is needed to prove the benefits of the model presented. Individualized prevention promotes a shift from a disease-focused model to a whole-patient-focused model and provides a potential approach for establishing a contemporary concept for preventive care in dentistry.

Impact of interdental brush shape on interpapillary cleaning efficacy - a clinical trial

This study aimed to investigate whether interdental brush shape influences cleaning efficacy, by comparing a waist-shaped interdental brush (W-IDB) with a cylindrical IDB (C-IDB); both provided with the same bristle texture. Cleaning efficacy of differently shaped IDBs was measured in proximal surfaces of teeth in a split-mouth cross-over design. Twenty-eight patients abolished oral hygiene for 4 d. Line angle plaque area was scanned with an intraoral camera after use of disclosing dye in baseline and after IDB application and analyzed planimetrically. Additionally, bacterial load in the IDBs was analyzed after usage by colony forming units (cfu). A Wilcoxon signed-rank test with continuity correction was used to compare the results of the waist-shaped and the cylindrically-shaped IDBs. The waist-shaped IDBs cleaned significantly better than their cylindrically-shaped counterparts (area cleaned: 23.1% vs. 18.3%), when applied at same interdental spaces (p < 0.001). However, no significant differences were found in comparison of bacterial load on the IDBs (median cfu counts: 2.3E9 vs. 2.7E9, p = 0.93). Irrespective of bristle texture or size, IDB shape have impact on cleaning efficacy. Waist-shaped IDBs are more effective in cleaning of the line angle area than cylindrically-shaped IDBs.

Prosthesis Survival Rates and Prosthetic Complications of Implant-Supported Fixed Dental Prostheses in Partially Edentulous Patients

PURPOSE

To determine the prevalence and distribution of prosthetic complications affecting implant-supported fixed dental prostheses (ISFDPs).

MATERIALS AND METHODS

Subjects previously treated with one or more ISFDP(s) were identified from an electronic health record search and recalled for comprehensive clinical examination. Past prosthesis failures and complications were identified from the patient records while any existing complications, not previously recorded, were assessed during examination. ISFDP survival and failure rates were calculated with Kaplan-Meier curves and life table analysis, while regression Poisson analysis was used to identify associations between outcomes and possible patient- and prosthesis-based risk factors.

RESULTS

Seventy-four subjects with 107 ISFDPs were enrolled in the study with a mean time between prosthesis delivery and exam of 3.14 years (range: 1.00-9.00 years). Four prostheses failed, resulting in a cumulative prosthesis survival rate of 96.26%. Prosthetic complications affected 48.59% of ISFDPs, the majority (94.87%) of them minor complications. Only the use of a nightguard was associated with a lower prevalence of prosthetic screw loosening (HR 0.11, 95% CI 0.02-0.59, p = 0.007) while no outcome differences were noted for other variables. Patient satisfaction was high regardless of presence or number of complications.

CONCLUSIONS

ISFDPs demonstrated a high survival rate and overall high, patient-reported satisfaction. Minor prosthetic complications were common but were only significantly associated with nightguard use.

Biofilm as a risk factor in implant treatment

This article summarizes the microbiological findings at dental implants, drawing distinctions between the peri-implant microbiome and the periodontal microbiome, and summarizes what is known regarding biofilm as a risk factor for specific stages of implant treatment. Targeted microbial analysis is reviewed as well as the latest results from open-ended sequencing of the peri-implant flora. At this time there remains a lack of consensus for a specific microbial profile that is associated with peri-implantitis, suggesting that there may be other factors which influence the microbiome such as titanium surface dissolution. Therapeutic interventions to address the biofilm are presented at the preoperative, perioperative, and postoperative stages. Evidence supports that perioperative chlorhexidine reduces biofilm-related implant complications and failure. Regular maintenance for dental implants is also shown to reduce peri-implant mucositis and implant failure. Maintenance procedures should aim to disrupt the biofilm without damaging the titanium dioxide surface layer in an effort to prevent further oxidation. Evidence supports the use of glycine powder air polishing as a valuable adjunct to conventional therapies for use at implant maintenance visits. For the treatment of peri-implantitis, nonsurgical therapy has not been shown to be effective, and while surgical intervention is not always predictable, it has been shown to be superior to nonsurgical treatment for decontamination of the implant surface that is not covered by bone.

Technical Complications and Prosthesis Survival Rates with Implant-Supported Fixed Complete Dental Prostheses: A Retrospective Study with 1- to 12-Year Follow-Up

PURPOSE

To report the rate of technical complications and prosthesis survival in a cohort of edentulous patients treated with implant-supported fixed complete dental prostheses (IFCDPs) after a mean observation period of at least 1 year.

MATERIALS AND METHODS

The single-visit examination included clinical and radiographic assessment, occlusal analysis, photographs and questionnaire assessing patient satisfaction in a cohort of 52 patients rehabilitated with 71 IFCDPs (supported by 457 implants). The IFCDPs were assessed for technical complications, number of implants and cantilever extension, retention type and prosthetic material type. Comparison was made between ceramic IFCDPs (Group 1) and metal-resin IFCDPs (Group 2). Kaplan-Meier survival curve analysis was carried out for assessment of prosthesis survival and was done for both Groups 1 and 2 separately. The Cox proportional hazard model was used for survival analysis, adjusting for a number of potential confounders, to evaluate the association between prosthesis survival and several risk factors such as type of opposing occlusion, nightguard use, and presence of bruxism. Responses to patient satisfaction questions were compared with Fisher's exact test.

RESULTS

Out of 71 edentulous arches (52 patients) restored with IFCDPs, 6 IFCDPs had failed, yielding a cumulative prosthesis survival rate of 91.6 % after a mean observation period of 5.2 years (range: 1-12 years) after definitive prosthesis insertion. Three IFCDPs were lost due to implant failures after 5.8 to 11 years of functional loading. Additionally, 3 metal-resin IFCDPs failed due to technical complications. Minor complications were the most frequent complications observed, namely wear of the prosthetic material (9.8% annual rate) being the most common, followed by decementation of cement-retained IFCDPs (2.9%), and loss of the screw access filing material of the screw-retained IFCDPs (2.7%). The most frequently observed major complication was fracture of the prosthetic material (1.9% annual rate), followed by fracture of occlusal screw (0.3%), and fracture of framework (0.3%). The annual rate of wear of prosthetic material was 7.3% for porcelain IFCDPs (n = 19/55) and 19.4% for metal-resin IFCDPs (n = 13/16), yielding a statistically significant difference between the 2 groups (p = 0.01).

CONCLUSIONS

After a mean exposure time of 5.2 years, 91.6% prosthesis survival rates were achieved (65 out of 71 IFCDPs). The most frequent minor technical complication was wear of the prosthetic material with estimated 5-year rate of 49.0%, while the most frequent major complication was fracture of the prosthetic material with estimated 5-year dental unit-based rate of 9.5%. The cumulative rates for "prosthesis free of minor complications" at 5- and 10-years were 60.5% (95% CI: 47.2-71.3%) and 8.9% (95% CI: 2.9-18.0%), respectively. The cumulative rates for "prosthesis free of major technical complications" at 5- and 10-years were 85.5% (95% CI: 73.0-92.5%) and 30.1% (95% CI: 12.0-50.6%), respectively. Presence of bruxism, and absence of a nightguard were associated with increased risk for chipping of the prosthetic material of the IFCDPs.

Complications and survival rates of 55 metal-ceramic implant-supported fixed complete-arch prostheses: A cohort study with mean 5-year follow-up

STATEMENT OF PROBLEM

Long-term outcomes with metal-ceramic (MC) implant-supported fixed complete dental prostheses (IFCDPs) are scarce.

PURPOSE

The purpose of this retrospective study was to assess the rate of biologic and technical complications in a cohort of edentulous patients treated with MC IFCDPs by residents after a mean clinical follow-up of 5 years (range: 1 to 12 years).

MATERIAL AND METHODS

Forty-one participants with 55 MC IFCDPs underwent a single-visit comprehensive examination that included a medical and dental history review and clinical and radiographic examinations. All supporting implants and prostheses were examined for biologic and technical complications. Life table analysis and Kaplan-Meier survival curves were calculated.

RESULTS

Of 359 moderately rough surface dental implants, 2 had failed in 1 patient after 11 years of functional loading, yielding a cumulative implant survival rate of 99.4%. Owing to the implant failure, 1 of 55 edentulous arches restored with IFCDPs failed, yielding a cumulative prosthesis survival rate of 98.2% after mean observation period of 5.0 years. Soft tissue recession was the most frequent minor biologic complication (annual rate 7.8% at the prosthesis level) for both cement and screw-retained IFCDPs (group C and S), and peri-implantitis (annual rate 1.6% at the implant level) the most frequent major biologic complication. Wear of porcelain (annual rate 8.0% at the prosthesis level) was the most frequent minor technical complication for both groups, and fracture of porcelain (annual rate 0.8% at the dental-unit level) was the most frequent major technical complication. Minor complications were the most frequent in both the groups (cement and screw retained).

CONCLUSIONS

High implant and prosthesis survival rates (above 98%) were achieved, yet substantial complication rates were encountered. The most frequent major biologic complication was peri-implantitis, with a 5-year implant-based rate of 8% (95% confidence interval [CI]: 5.8-11.1), whereas the most frequent major complication was fracture of porcelain with a 5-year dental unit-based rate of 4%. The estimated cumulative rates for "prosthesis free of biologic complications" were 50.4% (95% CI: 36.4% to 63.0%) at 5 years and 10.1% (95% CI: 3.5% to 20.8%) at 10 years, whereas for "prosthesis free of technical complications," they were 56.4% (95% CI: 41.7% to 68.8%) at 5 years and 9.8% (95% CI: 3.2% to 21.0%) at 10 years.

Management of Implant/Prosthodontic Complications

Dental implants continue to grow in popularity because they are a predictable treatment to replace missing teeth. They have a high success rate; however, they are still associated with some clinical complications. This article discusses a diverse range of complications related to the restorative and mechanical aspects of dental implants and the management of such complications, as well as potential factors contributing to them.

A Peri-Implant Disease Risk Score for Patients with Dental Implants: Validation and the Influence of the Interval between Maintenance Appointments

Background: There is a need for tools that provide prediction of peri-implant disease. The purpose of this study was to validate a risk score for peri-implant disease and to assess the influence of the recall regimen in disease incidence based on a five-year retrospective cohort. Methods: Three hundred and fifty-three patients with 1238 implants were observed. A risk score was calculated from eight predictors and risk groups were established. Relative risk (RR) was estimated using logistic regression, and the c-statistic was calculated. The effect/impact of the recall regimen (≤ six months; > six months) on the incidence of peri-implant disease was evaluated for a subset of cases and matched controls. The RR and the proportional attributable risk (PAR) were estimated. Results: At baseline, patients fell into the following risk profiles: low-risk (n = 102, 28.9%), moderate-risk (n = 68, 19.3%), high-risk (n = 77, 21.8%), and very high-risk (n = 106, 30%). The incidence of peri-implant disease over five years was 24.1% (n = 85 patients). The RR for the risk groups was 5.52 (c-statistic = 0.858). The RR for a longer recall regimen was 1.06, corresponding to a PAR of 5.87%. Conclusions: The risk score for estimating peri-implant disease was validated and showed very good performance. Maintenance appointments of < six months or > six months did not influence the incidence of peri-implant disease when considering the matching of cases and controls by risk profile.

Double Full-Arch Fixed Implant-Supported Prostheses: Outcomes and Complications after a Mean Follow-Up of 5 Years

PURPOSE

To retrospectively assess complications and clinical and radiographic outcomes of edentulous patients treated with double full-arch implant-supported fixed complete dental prostheses (IFCDPs) after a mean observation period of 5.1 years.

MATERIALS AND METHODS

The single-visit clinical and radiographic examination included medical and dental history review and clinical assessment of biologic and technical complications encountered with all implants and IFCDPs. Life table analysis and Kaplan-Meier survival curves were calculated. Analysis was conducted to evaluate the association between prosthesis survival and several risk factors such as type of opposing occlusion, nightguard use, and presence of bruxism.

RESULTS

Nineteen edentulous patients restored with 38 IFCDPs were included. A total of 249 implants were placed and 2 implants failed after a mean observation period of 5.1 years (range: 1-12 years), yielding an overall implant survival rate of 99.2% and prosthesis survival rate of 92.1%. Three out of 38 IFCDPs were lost, 1 after implant losses and 2 due to technical complications. The most frequent minor biologic complication was soft tissue recession with an estimated 5-year rate of 45.5% (95% CI: 39.4-57.5), while the most frequent major complication was peri-implantitis with an estimated 5-year implant-based rate of 9.5% (95% CI: 6.7-11.3). The most frequent minor technical complication was wear of the prosthetic material with an estimated 5-year rate of 49.0% (95% CI: 37.4-76.4), while the most frequent major technical complication was fracture of the prosthetic material with an estimated 5-year dental unit-based rate of 8.0% (95% CI: 6.6-10.1).

CONCLUSIONS

After a mean use time of 5.1 years, high implant and prosthesis survival rates were observed. The most frequent major biologic complication was peri-implantitis, and the most frequent major technical complication was fracture of the prosthetic material. The 5-year estimated cumulative rates for "prosthesis free of biologic complications" was 50.7% (95% CI: 33.7-65.4) and for "prosthesis free of technical complications" was 57.1% (95% CI: 39.3-71.5).

Surface properties of dental zirconia ceramics affected by ultrasonic scaling and low-temperature degradation

Zirconia (3Y-TZP) dental prostheses are widely used in clinical dentistry. However, the effect of ultrasonic scaling performed as a part of professional tooth cleaning on 3Y-TZP dental prostheses, especially in conjunction with low-temperature degradation (LTD), has not been fully investigated. The present study aimed to evaluate the influence of ultrasonic scaling and LTD on the surface properties of 3Y-TZP in relation to bacterial adhesion on the treated surface. 3Y-TZP specimens (4 × 4 × 2 mm) were polished and then subjected to autoclaving at 134°C for 100 h to induce LTD, followed by 10 rounds of ultrasonic scaling using a steel scaler tip for 1 min each. Surface roughness, crystalline structure, wettability, and hardness were analyzed by optical interferometry, X-ray diffraction analysis, contact angle measurement, and nano-indentation technique, respectively. Subsequently, bacterial adhesion onto the treated 3Y-TZP surface was evaluated using Streptococcus mitis and S. oralis. The results demonstrated that the combination of ultrasonic scaling and LTD significantly increased the Sa value (surface roughness parameter) of the polished 3Y-TZP surface from 1.6 nm to 117 nm. LTD affected the crystalline structure, causing phase transformation from the tetragonal to the monoclinic phase, and decreased both the contact angle and surface hardness. However, bacterial adhesion was not influenced by these changes in surface properties. The present study suggests that ultrasonic scaling may be acceptable for debridement of 3Y-TZP dental prostheses because it did not facilitate bacterial adhesion even in the combination with LTD, although it did cause slight roughening of the surface.

Implant survival rates and biologic complications with implant-supported fixed complete dental prostheses: A retrospective study with up to 12-year follow-up

OBJECTIVES

To assess the rate of biologic complications and implant survival in edentulous patients treated with implant-supported fixed complete dental prostheses (IFCDPs) after a mean observation period of 5.2 years (range: 1-12 years).

MATERIALS AND METHODS

A single-visit clinical and radiographic examination was performed to assess types and rates of biologic complications with ceramic IFCDPs (Group 1) and metal-resin IFCDPs (Group 2).

RESULTS

Of 457 rough surface dental implants supporting 71 IFCDPs (52 patients), six had failed, yielding an implant survival rate of 98.7% after a mean observation period of 5.2 years after definitive prosthesis insertion. The most frequent minor biologic complication was soft tissue recession (7.7% annual rate), inflammation under the IFCDP (7.4% annual rate), and peri-implant mucositis (6.3% annual rate). The most frequent major biologic complication was peri-implantitis (2.0% annual rate), in 46/457 implants (10.1%) supporting 19 IFCDPs and late implant failure (0.3% annual rate). The frequency of biologic complications was not statistically different between Group 1 and Group 2. The presence of high plaque index had significant effect on bone loss.

CONCLUSIONS

After a mean exposure time of 5.2 years postdefinitive prosthesis insertion (range: 1-12 years), implant survival rate of 98.7% was achieved. The six implant failures in three patients occurred after 5 years and affected the prosthesis survival. Soft tissue recession was the most frequent minor biologic complication, whereas peri-implantitis was the most frequent major biologic complication. A 10-year implant-based mucosal recession rate of 77% (95% CI: 68.2-87.9) and a 10-year implant-based peri-implantitis rate of 20% (95% CI: 16.9-24.9) were found.