Ten-year survival of pressed, acid-etched e.max lithium disilicate monolithic and bilayered complete-coverage restorations: Performance and outcomes as a function of tooth position and age.

STATEMENT OF PROBLEM: Long-term clinical data on the survival of pressed lithium disilicate glass-ceramic restorations and the effect that different technical and clinical variables have on survival are lacking. PURPOSE: The purpose of this clinical study was to examine the 10-year survival of pressed lithium disilicate glass-ceramic restorations and the relationship between clinical parameters on outcomes. MATERIAL AND METHODS: Five hundred and fifty-six patients, ranging in age from 17 to 97 years, from a private clinical practice were enrolled. All participants required single-tooth replacement or repair in any area of the mouth, including single crowns, 3-unit fixed partial dentures, cantilevered anterior restorations, and foundation restorations. Together, the longevity of 1960 complete-coverage restorations was studied. Participants were offered the options of gold, conventional metal-ceramic, or lithium disilicate restoration. Participants who chose glass-ceramic restorations were included in the study. The overall survival of the glass-ceramic restorations was assessed by using clinical factors determined at recall, and the effect of various clinical parameters was evaluated by using Kaplan-Meier survival curves to account for attrition bias and other reasons for failure. The statistical significance of differences between parameters was determined using the log-rank test (α=.05). RESULTS: A total of 556 patients electing lithium disilicate restorations were evaluated. The mean age of patients at the time of restoration placement was 62 years, with a range of 17 to 97 years. Men comprised 39.5% of the patients, and women, 60.5%. Many patients required more than one restoration. Seven failures (bulk fracture or large chip requiring replacement) were recorded for the 1960 complete-coverage lithium disilicate restorations, with the average time of failure being 4.2 years. The total time at risk computed for the units was 5113 years, providing an estimated failure risk of 0.14% per year. The 10-year estimated cumulative survival was 99.6% (95% confidence : 99.4-99.8).The estimated cumulative survival rate of 1410 monolithic and 550 bilayered e.max complete-coverage restorations was 96.5% and 100%, respectively, at 10.4 and 7.9 years (P<.05). Seven failures were recorded for the monolithic complete-coverage restoration units placed. The total time at risk for these monolithic units was 3380 years, providing an estimated risk of 0.2% per year. Failures were primarily in molar teeth (5 of 7) and occurred in both arches (3/2). No failures were recorded for the bilayered complete-coverage restorations. The total time at risk computed for the bilayered units was 1733 years, providing an estimated risk of 0% per year. CONCLUSIONS: Pressed lithium disilicate restorations in this study survived successfully over the 10.4-year period studied with an overall failure rate below 0.2% per year and were primarily confined to molar teeth. The risk of failure at any age was minimal for both men and women.

Clinical performance of intentionally tilted implants versus axially positioned implants: A systematic review.

OBJECTIVES: The aim of this review was to determine the clinical performance of dental implants that are intentionally tilted when compared with implants that are placed following the long axis of the residual alveolar ridge. MATERIALS AND METHODS: A systematic review of the scientific literature using a predefined research question (PICO) and search strategy was undertaken. This search included five electronic databases. Two independent reviewers examined electronic databases and performed a manual review following search strategy to accomplish the item generation and reduction. Included articles were evaluated to determine the level of evidence. Data were extracted only from level I and level II studies, based on the Oxford Centre for Evidence-based Medicine-Levels of Evidence (March 2009). If included studies were homogeneous in nature, data were to be accumulated. However, if included studies were heterogeneous in nature, only descriptive data would be reviewed and analyzed. RESULTS: A total of 811 articles were identified through the PICO question and search strategy. Detailed review of the abstracts and articles resulted in further item reduction, and 46 articles were included for full-text review. A total of 42 articles were then selected for inclusion in the systematic review. The identified articles included two level I and 20 level II studies. In addition, 15 level IV, one gray literature, and four previous systematic reviews with meta-analyses were also used in the study. The extracted data from the included studies demonstrated heterogeneity that prevented quantitative assessment, and only one level II study directly compared tilted and axially placed implants. Assessment of the descriptive data demonstrated no differences in implant survival, marginal bone loss, prosthesis survival, or patient-reported outcome measures (PROMs) whether implants are placed axially or with intentional inclination of the coronal aspect of the implant toward the distal aspect of edentulous jaws. CONCLUSIONS: Based upon the systematic review of the literature, an analysis of the descriptive data suggested no differences in clinical performance between implants that are placed in an axial position relative to the residual alveolar ridge when compared with implants that are intentionally tilted toward the distal aspect of edentulous jaws.

Group 2 ITI Consensus Report: Prosthodontics and implant dentistry.

OBJECTIVES: Working Group 2 was convened to address topics relevant to prosthodontics and dental implants. Systematic reviews were developed according to focused questions addressing (a) the number of implants required to support fixed full-arch restorations, (b) the influence of intentionally tilted implants compared to axial positioned implants when supporting fixed dental prostheses (FDPs), (c) implant placement and loading protocols, (d) zirconia dental implants, (e) zirconia and metal ceramic implant supported single crowns and (f) zirconia and metal ceramic implant supported FDPs. MATERIALS AND METHODS: Group 2 considered and discussed information gathered in six systematic reviews. Group participants discussed statements developed by the authors and developed consensus. The group developed and found consensus for clinical recommendations based on both the statements and the experience of the group. The consensus statements and clinical recommendations were presented to the plenary (gathering of all conference attendees) and discussed. Final versions were developed after consensus was reached. RESULTS: A total of 27 consensus statements were developed from the systematic reviews. Additionally, the group developed 24 clinical recommendations based on the combined expertise of the participants and the developed consensus statements. CONCLUSIONS: The literature supports the use of various implant numbers to support full-arch fixed prostheses. The use of intentionally tilted dental implants is indicated when appropriate conditions exist. Implant placement and loading protocols should be considered together when planning and treating patients. One-piece zirconia dental implants can be recommended when appropriate clinical conditions exist although two-piece zirconia implants should be used with caution as a result of insufficient data. Clinical performance of zirconia and metal ceramic single implant supported crowns is similar and each demonstrates significant, though different, complications. Zirconia ceramic FDPs are less reliable than metal ceramic. Implant supported monolithic zirconia prostheses may be a future option with more supporting evidence.

Implant-supported single crowns predictably survive to five years with limited complications.

SELECTION CRITERIA: An electronic MEDLINE search was conducted to identify cohort studies, prospective or retrospective, describing clinical performance of implant-supported single crowns. Manual searches of bibliographies from full-text articles and related reviews were conducted using numerous scientific journals. Studies were included if the mean follow-up time was at least 5 years, if articles were published in the English or German language, if patients were physically examined, and if study details were sufficient for data extraction. Of the initial 3601 studies identified, only 26 were selected. No randomized control trials were identified. KEY STUDY FACTOR: The 5-year survival and complications of implant-supported single crowns. MAIN OUTCOME MEASURES: The primary outcome measure in this study was survival of endosseous implants when used to support single crowns. In addition, the clinical performance of soft tissue (peri-implantitis) and hard tissue (bone level) was documented. Clinical complications of a biomechanical nature were recorded relative to fracture of restorative materials. Poisson's regression models were used to estimate failure and complication rates at 5 years. MAIN RESULTS: A systematic review of the scientific literature identified 26 studies from which data were extracted (1558 placed implants). Meta-analysis identified survival of implants used to support and retain single crowns at 96.8% (95% confidence interval [CI]: 95.9%-97.6% after 5 years). The survival rate of the single crown restorations documented in 13 studies was 94.5% (95% 92.5%-95.9%) with a significantly higher survival rate when metal ceramic crowns were used in comparison with all ceramic crowns (95.4% 93.6%-96.7%; 91.2% CI: 86.8%-94.2%). Soft tissue complications, including peri-implantitis, were observed in 9.7% of the single crowns, whereas bone loss exceeding 2 mm was identified on 6.3% of the implants over the 5-year study. Prosthetic or abutment screw loosening was observed in 12.7% of the restoration and screw fracture occurred in 0.35%. Although only 7 of the 26 studies reported esthetic complications, the cumulative effects of esthetic complications approached 9% at 5 years.

A systematic review of marginal bone loss around implants retaining or supporting overdentures.

PURPOSE: To evaluate, through a systematic review of the literature, the effects of implant design and attachment type on marginal bone loss in implant-retained/supported overdentures. MATERIALS AND METHODS: With the combined search terms "implant and overdenture," "implant-supported overdenture," "implant-retained overdenture," and "implant-anchored overdenture," along with specific inclusion and exclusion criteria, eligible articles between 1997 and 2008 (up to April 1) were retrieved from PubMed, EMBASE, OVID, the Cochrane Library databases, and seven journals by hand searching. Marginal bone loss values with regard to time, attachment type, and implant system used were compared by Kruskal-Wallis tests. Means and standard deviations of data were combined using fixed- and random-effect models and evaluated using meta-analysis. RESULTS: Forty-six articles were included in the analyses; data extraction and meta-analysis were able to be conducted on eight studies. Data regarding maxillary overdentures could not be analyzed statistically. Bone loss around mandibular implants did not seem to be influenced by implant system or attachment design (bar, ball, magnet, and other types) in the first year, from 1 to = or < 5 years, and even after 5 years (P > .05). Meta-analysis could not detect differences in implant systems or attachment types (P > .05). CONCLUSIONS: Based upon a systematic review and meta-analysis of the literature that identified a total of 4,200 implants from 13 manufacturers, there was no difference in marginal bone loss around implants retaining/supporting mandibular overdentures relative to implant type or attachment designs.

Systematic review of prosthetic maintenance requirements for implant-supported overdentures.

PURPOSE: To evaluate prosthetic maintenance requirements for implant-retained/supported overdentures via a review of the literature. MATERIALS AND METHODS: Using the combined search terms "implant and overdenture," "implant-supported overdenture," "implant-retained overdenture," and "implant-anchored overdenture," along with specific inclusion and exclusion criteria, eligible articles between 1997 and 2008 (up to April 1) were retrieved from PubMed, EMBASE, OVID, the Cochrane Library databases, and seven journals by hand-searching. The initial search yielded 3,120 titles, and 287 articles were assigned to full-text analysis. Upon classification of the prosthetic complications with regard to the jaws treated and the attachment systems used, within- and between-group comparative frequency analyses were undertaken with the Kruskal-Wallis test or the Mann-Whitney U test at P < .05. RESULTS: A total of 49 articles were included. Within- and between-group evaluations with regard to jaw treated as well as the attachment systems used showed that the frequency of complications did not change over time (P > .05). The differences detected were more matrix replacements after 5 years in the maxilla and mandible and more matrix replacements and patrix fractures after the first year in the mandible (P < .05). Among the attachment systems, a dislodged, worn, or loose matrix or its respective housing was more common in the ball-attachment group after the first year (P < .05). Prosthetic complications for all types of attachments were comparable (P > .05), except for the differences in peri-implant or interabutment mucosal enlargement rates after 1 year. CONCLUSIONS: Prosthetic maintenance requirements for overdentures on both jaws seem to be comparable. The impact of attachment system on the prosthetic outcome is negligible.

Implant-supported single crowns predictably survive to five years with limited complications.

SELECTION CRITERIA: An electronic MEDLINE search was conducted to identify cohort studies, prospective or retrospective, describing clinical performance of implant-supported single crowns. Manual searches of bibliographies from full-text articles and related reviews were conducted using numerous scientific journals. Studies were included if the mean follow-up time was at least 5 years, if articles were published in the English or German language, if patients were physically examined, and if study details were sufficient for data extraction. Of the initial 3601 studies identified, only 26 were selected. No randomized control trials were identified. KEY STUDY FACTOR: The 5-year survival and complications of implant-supported single crowns. MAIN OUTCOME MEASURES: The primary outcome measure in this study was survival of endosseous implants when used to support single crowns. In addition, the clinical performance of soft tissue (peri-implantitis) and hard tissue (bone level) was documented. Clinical complications of a biomechanical nature were recorded relative to fracture of restorative materials. Poisson's regression models were used to estimate failure and complication rates at 5 years. MAIN RESULTS: A systematic review of the scientific literature identified 26 studies from which data were extracted (1558 placed implants). Meta-analysis identified survival of implants used to support and retain single crowns at 96.8% (95% confidence interval [CI]: 95.9%-97.6% after 5 years). The survival rate of the single crown restorations documented in 13 studies was 94.5% (95% CI: 92.5%-95.9%) with a significantly higher survival rate when metal ceramic crowns were used in comparison with all ceramic crowns (95.4% CI: 93.6%-96.7%; 91.2% CI: 86.8%-94.2%). Soft tissue complications, including peri-implantitis, were observed in 9.7% of the single crowns, whereas bone loss exceeding 2 mm was identified on 6.3% of the implants over the 5-year study. Prosthetic or abutment screw loosening was observed in 12.7%of the restoration and screw fracture occurred in 0.35%. Although only 7 of the 26 studies reported esthetic complications, the cumulative effects of esthetic complications approached 9% at 5 years. CONCLUSIONS: From the presented data it may be concluded that 5-year survival of implant-supported single crowns is high, although biologic and mechanical complications are anticipated.

Meta-analysis of methods used to assess implant stability.

PURPOSE: To evaluate correlations between Periotest, cutting torque or insertion torque, and/or the reverse torque test with resonance frequency analysis measurements. MATERIALS AND METHODS: The combined search terms dental implant, primary stability, resonance frequency analysis, removal torque, vibration analysis, torque, Periotest, cutting torque, and insertion torque and specific inclusion and exclusion criteria were used to retrieve eligible articles published between 1998 and 2008 (up to April 1) from PubMed, EMBASE, OVID, The Cochrane Library databases, and 10 journals by hand-searching. The pooled P value was calculated with the Fisher method. The correlation coefficients (r) were combined using fixed and random effect models. Heterogeneity of the studies was tested by performing the homogeneity test. RESULTS: Fifty articles were identified, but 3 studies were excluded because of limitations in study design. Studies that fulfilled the inclusion criteria fell into a variety of categories (11 human cadaver, 16 clinical, 15 animal, and 5 in vitro studies). Assessment of P values revealed that correlation between cutting torque or insertion torque and resonance frequency analysis was significant (6 studies; P = .0022). Correlation between Periotest and cutting torque or insertion torque was significant (1 study; P = .015), and correlations between resonance frequency analysis and reverse torque test values (1 study; P = .319; r = 0.405) and Periotest and resonance frequency analysis (P = .28) were insignificant. Nine articles provided r values, and cutting torque or insertion torque and resonance frequency analysis showed a statistically significant and direct relationship of 55.4% (P = .000). One study provided an r value of -0.149. A statistically significant and direct relationship of 87.6% was found between cutting torque or insertion torque and reverse torque (2 studies; P = .000). CONCLUSION: This meta-analysis of 47 studies showed a statistically significant correlation between cutting torque or insertion torque and resonance frequency analysis.

Nonlinear finite element analysis versus ex vivo strain gauge measurements on immediately loaded implants.

PURPOSE: To evaluate the level of agreement between nonlinear finite element stress analysis (NL-FEA) and ex vivo strain gauge analysis (EV-SGA) on immediately loaded implants. MATERIALS AND METHODS: Four 4.1-mm-diameter, 12-mm-long implants were placed bilaterally into the lateral and first premolar regions of completely edentulous maxillae of four human cadavers. Two-element 90-degree rosette strain gauges were bonded to the labial cortical bone around the implants, and 100 N maximal load was applied over two miniature load cells on bar-retained overdentures while simultaneous data acquisition from load cells and strain gauges was performed at a sample rate of 10 KHz. Individualized numeric models of the cadavers were constructed, and contact analysis with normal contact detection and separation behavior was performed between the implants and bone. Upon simulation of the loading regimen, axial and lateral strains were recorded. The NL-FEA data and EV-SGA data were compared. RESULTS: There was a high level of agreement regarding the quality of strains, as determined by both techniques, although the mean values obtained with EV-SGA were higher than those found with NL-FEA. However, the strains recorded by NL-FEA did not differ significantly (P<.05) from the strains recorded by EV-SGA. CONCLUSION: Considering the complex biomechanical behavior of human hard and soft tissues, EV-SGA and NL-FEA did not suggest inconsistency in the detection of the quality of strains. Further, the methods provided comparable values for the quantification of strains on implants supporting maxillary overdentures.

Heat transfer to the implant-bone interface during preparation of a zirconia/alumina abutment.

PURPOSE: Excessive heat at the implant-bone interface may compromise osseointegration. This study examined the heat generated at the implant surface during preparation of a zirconia/alumina abutment in vitro. MATERIALS AND METHODS: Sixty zirconia/alumina abutments were randomized into 12 experimental groups. The abutments were connected to implants and embedded in an acrylic resin block in a 37 degrees C water bath. The abutments were reduced by 1 mm in height over a period of 1 minute with a high-speed handpiece and then polished for 30 seconds with a low-speed handpiece, both with and without an air/water coolant. Temperatures were recorded via thermocouples at the cervical, middle, and apical part of the implant surfaces. The Mann-Whitney rank-sum test was used to assess the statistical significance of the difference in temperature between the abutment/implant complexes altered with and without coolant. RESULTS: The 1-mm reduction with the high-speed handpiece without coolant resulted in a maximum temperature of 41.22 degrees C at the cervical portion of the implant. Three of four temperatures above 40 degrees C were observed at the cervical part of the implant following use of the high-speed handpiece without coolant. The temperature difference between "with coolant" and "without coolant" during both low-speed polishing and high-speed reduction was statistically significant at the cervical portion of the implant (P = .009). In contrast, the temperature difference between "with coolant" and "without coolant" during both low-speed polishing and high-speed reduction was not statistically significant at the middle and apical parts of the implant (P > .05). CONCLUSIONS: Preparation of a zirconia/alumina abutment caused an increase in temperature within the implant, but this temperature increase did not reach the critical levels described in the implant literature.

A retrospective study of the survival of smooth- and rough-surface dental implants.

PURPOSE: To compare the time-dependent cumulative survival rates of smooth- and rough-surface dental implants. MATERIALS AND METHODS: A retrospective chart review was conducted for two time periods: January 1, 1991, through December 31, 1996, during which smooth-surface implants were used, and January 1, 2001, through December 31, 2005, during which rough-surface implants were used. This study included all implants placed and restored in one institution during the two time frames. Data were collected relative to patient age, gender, implant diameter, implant length, and anatomic location of implants. To facilitate the comparison, implants from the first and second time periods were followed through mid-1998 and mid-2007, respectively. Associations of patient/implant characteristics with implant survival were evaluated using marginal Cox proportional hazards models (adjusted for age and gender) and summarized with hazard ratios and corresponding 95% confidence intervals. RESULTS: A total of 593 patients (322 women and 271 men; mean age, 51.3 +/- 18.5 years) received 2,182 smooth-surface implants between 1991 and 1996, while 905 patients (539 women and 366 men; mean age, 48.2 +/- 17.8 years) received 2,425 rough-surface implants between 2001 and 2005. At 5 years after implant placement, survival rates were 94.0% and 94.5%, respectively, for smooth- and rough-surface implants (difference not significant). Among the smooth implants, implant length

Contamination of handpieces during pulpotomy therapy on primary teeth.

PURPOSE: The purpose of this in vivo study was to determine the potential for internal bacteriol contamination of low-speed handpiece/ contraangle systems. METHODS: Clinical contamination was measured for 24 pulpotomies on primary first or second molar teeth from 20 subjects. The investigators used microbiologic analysis to determine the extent of bacterial contamination from the patient's saliva using enriched trypticase soy agar (ETSA) plates. Analysis for the presence of blood also occurred. RESULTS: Microbial analysis indicated aerobic and anaerobic bacterial contamination at all 3 culturing sites from all 24 handpieces (100% contamination, 95% confidence intervals [CI] = 86%-100%). Aerobic and anaerobic bacteria levels (CFU/mL) were not significantly different (P = .43 overall, P > .25 for each of the 3 evaluated sites). The sites also did not have significantly different CFU/mL levels (P = .13 overall, P = .63 for aerobic, P = .14 for anaerobic). The analysis showed no blood contamination at any of the 3 culturing sites for any of the 24 handpieces (0% contamination, 95% CI = 0%-14%). CONCLUSIONS: The in vivo data suggest that low-speed handpiece/contraangle systems can become bacterially contaminated during the performance of pulpotomies and, unless properly sterilized between patients, there is the potential for pathogenic micro-organisms to enter, adhere, and then emit during use on subsequent patients.

Retrospective 9-Year Clinical Outcome Report on Adhesive Post-endodontic Treatment of Anterior Teeth Using Prefabricated Fiber Posts.

PURPOSE: To evaluate survival rates of adhesive post-endodontic buildups made using composite resin and prefabricated quartz fiber posts. MATERIALS AND METHODS: This retrospective study included all buildups placed between January 1, 2008, and December 31, 2012, by a single skilled operator using a single-adhesive system and dual-curing cement. Final restorations included direct composites, various types of crowns, and fixed partial dentures. During recall, teeth were inspected by four different dentists, and survival analysis was performed using Kaplan-Meier test. RESULTS: A total of 301 root canal-treated incisors and canines were restored. At repeat follow-up appointments, 291 restorations were still in function after a mean time of service of 7.13 ± 2.11 years. Cumulative survival probability at 9 years was 96.0%. No parameter observed was found by log-rank test to have a statistically significant effect on survival rate. CONCLUSION: Adhesive buildup with prefabricated fiber posts in anterior teeth is a reliable method of post-endodontic treatment in this given clinical protocol.

Immediately Loaded Fixed Full-Arch Implant-Retained Prosthesis: Clinical Analysis When Using a Moderate Insertion Torque.

PURPOSE: This study uses intentionally tilted implants with a moderate insertion torque to retain an immediately loaded fixed full-arch implant-retained prosthesis using four implants. The aims of this study were to determine the likelihood that this type of implant-retained prosthesis can be predictably provided on the day of implant placement, the survival rate when providing immediate load, and the importance of insertion torque on the survival of the implants. MATERIALS AND METHODS: All implants that were placed after August 1, 2015 and before December 31, 2016 at the ClearChoice Dental Implant Center of Minneapolis were recorded. The performance of these implants was followed to determine the success rate in the category of "intention to treat" where the treatment is provided on the same day as implant placement. Insertion torque was recorded for all implants. Implants were followed to determine survival of the implants and complications observed. RESULTS: Between August 1, 2015 and December 31, 2016, a total of 1,903 implants were placed. These implants were utilized to support 441 prostheses, with 440 actually being restored with a provisional prosthesis on the day of implant placement. Mean follow-up time was 484 days with a maximum of 972 days and a median of 474 days. A total of 36 implants failed to achieve osseointegration, resulting in an overall survival rate of 98.1% with a confidence interval (CI) of 98.7% to 97.5%. Survival was 97.6% in the maxilla and 98.9% in the mandible. Insertion torque of less than 15 Ncm (n = 80, 77 survival), between 15 and 34 Ncm (n = 122, 120 survival), and greater than 35 Ncm (n = 1,701, 1,670 survival) demonstrated no difference in implant survival. CONCLUSION: Based on this study of 1,903 implants placed between August 1, 2015 and December 31, 2016, the following observations were made: (1) this surgical/prosthetic treatment approach succeeded in the "intention to treat" category with 440/441 (99.8%) prostheses inserted on the day of implant surgery; (2) overall implant survival was 98.1%; (3) insertion torque appeared to have no effect on implant survival.

The effects of smoking on the survival of smooth- and rough-surface dental implants.

PURPOSE: To compare the long-term survival rates of smooth- and rough-surface dental implants among smokers and nonsmokers. MATERIALS AND METHODS: A retrospective chart review was conducted for 2 time periods: January 1, 1991, through December 31, 1996, during which smooth-surface implants were utilized, and January 1, 2001, through December 31, 2005, during which rough-surface implants were utilized. This review included all implants placed and restored in 1 institution during the 2 timeframes. Data were specifically collected relative to patient age, gender, smoking status, implant diameter, implant length, and anatomic location of implants. Implants from the first and second time periods were followed through mid-1998 and mid-2007, respectively. Associations of patient/implant characteristics with implant survival were evaluated using marginal Cox proportional hazards models (adjusted for age and gender) and summarized with hazard ratios (HR) and corresponding 95% confidence intervals (CI). RESULTS: A total of 593 patients (322 [54.3%] female; mean [SD] age, 51.3 [18.5] years) received 2,182 smooth-surface implants between 1991 and 1996, while 905 patients (539 [59.6%)] female; mean [SD] age, 48.2 [17.8] years) received 2,425 rough-surface implants between 2001 and 2005. Among the rough-surface implants, smoking was not identified as significantly associated with implant failure (HR = 0.8; 95% CI = 0.3 to 2.1; P = .68). In contrast, smoking was associated with implant failure among the group with smooth-surface implants (HR = 3.1; 95% CI = 1.6 to 5.9; P < .001). Implant anatomic location was not associated with implant survival among patients with rough-surface implants (P = .45) and among nonsmokers with smooth-surface implants (P = .17). However, anatomic location affected the implant survival among smokers with smooth-surface implants (P = .004). In particular, implant survival was the poorest for implants placed in the maxillary posterior areas of smokers. CONCLUSIONS: Based on this retrospective study, the following observations were made: Smoking was identified as a risk factor for implant failure of smooth-surface implants only; among the smokers who received smooth-surface implants, an association was identified between implant failure and location of the implant placement; no association was identified between implant failure and location among the smokers who received rough-surface implants.

On Implant Prosthodontics: One Narrative, Twelve Voices - 3.

No abstract available.

Replacing Six Missing Adjacent Teeth in the Anterior Maxilla With Implant Prostheses: A Case Series.

Restoring multiple adjacent missing teeth in the anterior maxilla is one of the most challenging situations in clinical implant dentistry, as restorations need to be both functional and highly esthetic. The purpose of this article is to highlight the issues that arise during treatment planning for replacement of six missing maxillary anterior teeth with implant-supported fixed dental prostheses. Representative clinical reports are provided to illustrate the treatment planning and surgical and prosthodontic management. The authors describe the rationale for selecting the appropriate number and location of implants in relation to the amount of missing soft and hard tissues to achieve functional and esthetic prostheses.

In patients requiring single-tooth replacement, what are the outcomes of implant- as compared to tooth-supported restorations?

PURPOSE: The study provides a systematic review of the literature to determine the long-term survival characteristics of single implant-supported crowns and fixed partial dentures. MATERIALS AND METHODS: A search of the MEDLINE, EMBASE, and Cochrane Collaboration databases was conducted to identify articles that compared survival and success of fixed partial dentures and single implant-supported crowns. In addition to comparative cohort studies, articles that pertained specifically to single implant-supported crowns or fixed partial dentures were included in this review. Inclusion criteria for implant and fixed partial denture articles included a minimum 2-year study, primary publication in the English language, a minimum of 12 implants, implants designed to osseointegrate, and inclusion of data regarding implant and prosthetic performance. Data were analyzed using cumulative proportions of survival and success for both prosthetic types and for individual implants. Wilson score method was used to establish 95% confidence intervals for each population. The chi-square test for homogeneity was performed. RESULTS: The literature search failed to identify any articles that directly compared survival or success of single implant-supported restorations with fixed partial dentures. Following the search criteria, and independent analysis by reviewers, 51 articles were identified in the implant literature (agreement, 95.42%; kappa coefficient, 0.8976), and 41 were identified in the fixed partial denture literature (agreement, 90.97%; kappa coefficient, 0.7524). Pooled success of single-implant restorations at 60 months was 95.1% (CI: 92.2%-98.0%), while fixed partial dentures of all designs exhibited an 84.0% success rate (CI: 79.1%-88.9%). CONCLUSIONS: This systematic review of the scientific literature failed to demonstrate any direct comparative studies assessing clinical performance of single implant-supported crowns and tooth-supported fixed partial dentures. The analysis suggested differences at 60 months between survival of implant-supported single crowns and natural tooth-supported fixed prostheses when resin-bonded and conventionally retained fixed prostheses were grouped. This difference disappeared when implant-supported single crowns were compared with conventionally retained fixed partial dentures at 60 months. For other time periods, direct comparative data were unavailable.

Epidemiology of Implant Mortality Disparity Among Intraoral Positions and Prosthesis Types.

PURPOSE: To examine the disparity of single-crown implant failure with a similar loss of the splinted prosthesis in differing anatomical locations while controlling for other demographic and clinical variables that may confound the relationship between prosthesis types and implant loss. MATERIALS AND METHODS: A multicenter retrospective cohort study was designed to include patients treated with dental implants from 2003 to 2014. The variables included age, sex, systemic disease, bone graft, implant placement date, position of dental implant, length of dental implant, diameter of dental implant, loading time, type of prosthesis, type of opposing occlusion, latest check date, and survival or loss of the dental implant. The demographic and clinical variables' influence on the survival of dental implants was estimated by the Kaplan-Meier method. The position and diameter were adjusted for the accurate estimation of the relationship between the prosthesis type and survival of the dental implant with the Cox proportional hazard method. RESULTS: A total of 1,151 dental implants from 403 patients were ascertained. After adjusting for the confounding effect of position and diameter, single-crown prostheses were 38.1 (95% CI: 15.1-118) times more likely to be lost than the connected-type prostheses. For single-crown implants, the waiting time for osseointegration before loading was the highest for the maxillary molar position and the lowest for the mandibular molar position (P < .0001), while the most frequent implant loss occurred in the maxillary anterior area, and the second frequent area was the maxillary molar position; the lowest occurrence of implant loss was for the mandibular molar position. This disparity was statistically significant (P = .0271). CONCLUSION: Despite the high survival rates of endosseous implants as a whole, since the variation of implant loss was observed among the different anatomical positions for single-crown implants, special attention has to be given to the maxillary anterior and maxillary molar positions. A longer healing time assuming compensation for disadvantageous bone quality was not directly effective in increasing implant longevity in the vulnerable positions.