A survey of clinical members of the association of dental implantology in the United Kingdom. Part II. The use of augmentation materials in dental implant surgery.

The following were the objectives of Part II of the survey: (1) to determine which augmentation materials were used by respondents, (2) to elicit which factors influenced the choice of augmentation materials, (3) to establish the perceived levels of evidence that support augmentation materials, and (4) to ascertain the clinical applications of particulate augmentation materials (autografts, allografts, and alloplasts). Autogenous bone and demineralized freeze-dried bone are used most frequently. The majority of respondents involved in bone augmentation indicated that alloplasts and allografts should be used to correct small defects or as volume expanders in conjunction with autogenous bone. Research publications and personal clinical observation mainly determine the choice of an augmentation material. Of the clinicians who preferred to use autogenous bone, 26.3% thought that there was at least one randomized controlled trial with histological evidence supporting its use in oral implantology. In comparison, 30% of demineralized freeze-dried bone users thought that there was at least one randomized controlled trial with histological evidence supporting its use. Collected bone debris is currently used for the correction of bone dehiscences and fenestrations around endosseous dental implants in the simultaneous implant-placement augmentation technique. There is a pressing requirement for the two most commonly used augmentation materials (autogenous bone and demineralized freeze-dried bone) to be evaluated by accepted scientific protocols. Although regard for autogenous bone as an augmentation material is high, its use in the form of collected bone debris seems to be limited at present.

Survey of clinical members of the association of dental implantology in the United Kingdom: Part I. Levels of activity and experience in oral implantology.

The aims of this survey were to 1) determine recruitment rates of active oral implantologists, 2) establish the proportion of participants who carry out the surgical aspects of implantology, 3) quantify levels of surgical activity, 4) determine the type of qualifications held by this sample, and 5) identify the location of implant activity of clinical members of the Association of Dental Implantology (UK). Questionnaires were mailed to the 408 members of the ADI registered as clinical members of the ADI; data were collected between July 1998 and May 1999. A response rate of 66.9% was achieved. Active members increased markedly from 1985 to 1995. Surgical activity and clinical experience varied widely: 32.9% had placed 100 to 499 implants, 29.8% had inserted 1 to 49 implants, and 4.3% had inserted > or = 2,000 implants. The total number of implants inserted by this sample could only be estimated (between 51,000 and 90,000). The majority of this sample possessed postgraduate qualifications, although only 2.6% possessed a degree in oral implantology. The data from this sample indicated that the recruitment rate to the ADI (UK) increased markedly between 1985 to 1995, after which it seems to have slowed down. Most of the respondents were involved in the surgical aspects of implantology, although the level of surgical involvement varied widely. The low incidence of postgraduate degrees in implantology might reflect the relatively limited opportunities currently available for such training in the UK.

A survey of clinical members of the Association of Dental Implantology in the United Kingdom. Part III. The use of augmentation techniques in dental implant surgery.

The aims of the survey were to: (1) determine the use of the staged and simultaneous augmentation techniques; (2) determine trends in the use of barrier membranes; (3) establish the perceived reliability of techniques used to monitor implants that have undergone simultaneous augmentation; and (4) assess the use of biopsy techniques to confirm the histologic outcome of bone augmentation. One hundred seventy-two respondents replied to this section of the survey and indicated that the "staged" and "simultaneous" augmentation techniques were used in roughly equal numbers during 1997, and a wide range of complications was reported with the latter. The majority used barrier membranes to correct defects of between 5 and 10 mm3, and resorbable membranes were preferred. With regard to clinical techniques used to monitor augmented implants, these were mainly considered to be "adequate" or "poor." Tissue biopsy was recognized as an important tool for determining the outcome of augmentation procedures but was rarely used. The use of resorbable membranes is likely to increase. The diagnostic tools currently used to monitor augmented implants are considered to have limited reliability, and they should be evaluated by prospective, comparative studies. More widespread use of biopsy techniques might help establish an evidence base for the histologic outcome of augmentation materials and techniques.

A survey of oral implantology teaching in the university dental hospitals and schools of the United Kingdom and Eire.

AIM: To provide an overview of the currently available academic teaching and clinical training in oral implantology at the university dental schools and hospitals of the United Kingdom and Eire. METHOD: A questionnaire was sent to the dean or director of dental studies and forwarded to the respective units involved in the academic teaching and clinical training of oral implantology. The setting was the university dental hospitals, and dental schools of the UK and Eire. Information was collected between July 1997 and March 1999. The main outcome measures were course availability, duration and emphasis for undergraduate and postgraduate study in the clinical discipline of oral implantology. The units or departments responsible for training and teaching were identified and formal degree courses were distinguished from non-degree courses. RESULTS: All institutions replied to the survey. All university dental schools provide undergraduate training in oral implantology in accordance with the guidelines provided by the General Dental Council. However, the courses vary with regard to the departments involved and the level of student participation. Thirteen centres provide informal postgraduate training with the duration ranging from one to eighteen days. Just eight centres provide formal academic graduate training based on oral implantology leading to recognised degrees. CONCLUSION: All university dental schools provide undergraduate teaching in oral implantology. Most centres also provide informal postgraduate training based on oral implantology. However, opportunities for academic graduate training, leading to recognised qualifications in this subject, appear limited at present.

Physiotherapy in the treatment of temporomandibular joint disorders: a comparative study of four treatment methods.

Temporomandibular joint pain dysfunction syndrome (TMJPDS) comprises of a constellation of signs and symptoms including joint tenderness and pain on function, restricted jaw movement, clicking, jaw locking and tenderness in the muscles of mastication. Headache may also be a feature. Physiotherapy is commonly employed in the treatment of this condition but there is little published material reporting the relative efficacy of the different types of treatment currently available. Further, no attempt seems to have been made to compare the costs of physiotherapy with other forms of treatment of this disorder such as occlusal splint therapy. This paper reports a comparative evaluation of four different physiotherapy treatments and placebo in the management of TMJPDS and comments on their cost benefit aspects compared with that of splint therapy. The four methods of physiotherapy tested were short-wave diathermy, megapulse, ultrasound and soft laser. There was no statistically significant difference in success rate between any of the four tested (range 70.4-77.7%) although each individually was significantly better than placebo treatment. The time of improvement appeared to vary between the four methods.

Implants in children: a case report.

A post-crowned, root-filled tooth in a 13-year-old child which is retraumatised resulting in palatal fracture of the root often necessitates removal of the root. The future treatment plan involves appropriate space management and restorative treatment. In this instance the root was retained in order to preserve alveolar bone until the patient was old enough for an implant.

Experience with ITI osseointegrated implants at five centres in the UK.

Experience with the two-part ITI titanium implant system at five centres in the UK is reported. A total of 461 implants were inserted in 176 patients, who received 189 prostheses. Criteria for the assessment of success following implantation are listed. Results over a 3-year period showed a success rate of 94% when implants were used for mandibular overdentures and crown and bridge prosthetics. A lower success rate in the edentulous maxilla was recorded.

Treatment options for the edentulous mandible.

Prosthodontic literature is replete with articles reporting longitudinal studies of, and clinical and laboratory procedures for, dental implants. There is no doubt that implant-borne prostheses are ideal treatment options for some patients; for other, alternatives must be considered. The purpose of this article is to present an overview of the aetiology of mandibular atrophy and to review a broad range of treatment options for patients who have atrophic mandibles. Whilst techniques are listed for completeness and not necessarily out of preference, with epidemiological and demographic trends in mind, the need for preventive prosthodontics is emphasised.

Alternative management of a crown root fractured tooth in a child.

A crown root fracture of a tooth in a young person may necessitate the removal of the root and the placement of a space-maintaining partial denture followed by provision of a bridge. A case is reported of an alternative approach to treatment, in which the root fragment is retained in situ until the end of the pubertal growth spurt, in order to preserve alveolar bone, following which it is removed and replaced by an implant.

Aesthetic provisional restoration for the partially edentulous, immediate, postimplantation patient.

This article reviews the methods currently used for making provisional restorations for endosseous dental implants. With the requirements for osseointegration in mind, a simple and aesthetic alternative is suggested. The clinical and laboratory stages for the fabrication of the prosthesis are outlined.