Survival and complications of implant-supported cantilever fixed dental prostheses with zirconia and metal frameworks: A retrospective cohort study.

BACKGROUND: Current evidence about long-term survival of all-ceramic implant-supported cantilever fixed dental prostheses (cFDP) is limited. PURPOSE: To evaluate the survival and complication rates of all-ceramic and metal-ceramic implant-supported cFDPs located in anterior and posterior sites, under consideration of risk factors. METHODS OF STUDY: The retrospective analysis compared an experimental group (75 implant-supported cFDPs among 48 patients [mean age 60.47 ± 9.25 years; 21 men]; mean observation period 3.56 years) with a control group (300 implant-supported non-cantilever FDPs [ncFDP] among 241 patients [mean age 62.85 ± 10.72 years; 109 men]; mean observation period 7.25 years). Kaplan-Meier estimates were used to describe the long-term survival and success of both groups. Log-rank tests were used for group comparisons. Mixed-effects Cox proportional hazards regression models were used to examine the effects of restoration- and site-specific risk factors. A random intercept was included in the models to take multiple FDPs per patient into account. RESULTS: Five-year cumulative survival until loss of restoration was 97.1% (95% confidence interval [CI] 0.93-1.00) for cFDPs and 97.0% (95% CI 0.95-0.99) for ncFDPs. Ten-year survival was 93.7% (95% CI 0.86-1.00) for cFDPs and 92.8% (95% CI 0.87-0.98) for ncFDPs, no difference between the survival curves of these groups was observed. Success differed between cFDPs and ncFDPs (pLog  = 0.002), zirconia and metal frameworks (pLog < 0.001), and provisional and definitive cements (pLog  = 0.025). The effects of the variables "framework material" and "attachment method" were confirmed in a mixed-effects Cox regression model. Loss of retention was the predominant complication for both cFDPs and ncFDPs and usually affected provisionally cemented FDPs. CONCLUSIONS: cFDPs do not differ from ncFDPs with regard to long-term failure, whereas additional complications were higher for cFDPs. Fewer complications were observed for zirconia frameworks without occlusal veneers and definitive cemented FDPs. CLINICAL TRIAL REGISTRATION: the trial has no registration number because it commenced before January 31, 2017.

Three-unit fixed dental prostheses supported by either two abutment implants or two abutment teeth: A comparative retrospective cohort study.

OBJECTIVES: In general, similar restorative constructions are made on natural teeth and on dental implants. The assumption is made that implants and their restoration perform the same as natural roots and their prosthetic restoration. Evaluating cohorts of three-unit bridges on teeth and on implants, this retrospective clinical study aimed to compare implants and teeth as supporting units, including the reconstructions, in terms of survival, success, clinical, radiographic, and patient-reported outcomes. MATERIAL AND METHODS: From an 8-year period, all patients treated with a posterior three-unit fixed reconstruction on either implants or teeth, with a follow-up of at least 2 years, were identified. For each implant-supported reconstruction, a comparable tooth-supported reconstruction was selected, based on the length of follow-up, the material of the reconstruction, and the location in either the maxilla or mandible. RESULTS: For the Implant-group, 24 patients could be matched with 24 best matching patients with tooth-supported fixed dental prostheses (FPDs). Supporting implants and implant-supported reconstructions were all in function with a mean follow-up of 52 ± 23 months. Two tooth-supported reconstructions had been replaced (91.7% survival) (mean follow-up: 52 ± 19 months). Radiographic bone levels and soft tissue conditions were favorable in both groups with minor differences. There was no significant difference in overall patient satisfaction. The modified USPHS-score revealed an 87.5% overall success in the Implant-group and 91.7% in the Tooth-group. CONCLUSIONS: Implant-supported three-unit FDPs are a reliable treatment option with survival and success rates not significantly different from the results of tooth-supported three-unit FDPs.

Efficacy and risks of tooth-supported prostheses in the treatment of partially edentulous patients with stage IV periodontitis. A systematic review and meta-analysis.

AIM: The aim was to evaluate the efficacy and effectiveness of tooth-supported fixed prostheses in partially edentulous patients with stage IV periodontitis. MATERIAL AND METHODS: Randomized and controlled clinical trials (RCTs and CCTs) and prospective/retrospective cohort studies or case series were searched in three databases. Survival rate of abutment teeth was considered the primary outcome. Meta-analyses were performed whenever possible. RESULTS: Twenty-four publications were included. No RCTs or CCTs compared the efficacy of tooth-supported fixed prostheses between patients with severe periodontitis or non-periodontitis patients. Most of the data retrieved were derived from case series. The incidence of abutment-tooth loss after a follow-up period from 2 to 35.4 years was low (n = 17 studies; weighted mean incidence (WMI) = 4.8%; confidence interval (CI) [3.2, 6.5]). The corresponding figure for prostheses failure was WMI = 6.9% (n = 18; 95% CI [4.1, 9.7]). Technical complications seemed to be more frequent than biological complications (caries, endodontic failure, root fracture, etc.). Periodontal outcomes tended to remain stable over time. CONCLUSION: Tooth-supported fixed prostheses seemed to be a valid treatment approach to restore masticatory function in patients with stage IV periodontitis once periodontal therapy has been accomplished. However, the comparative efficacy of this treatment among periodontitis and non-periodontitis patients is unclear due to the absence of clinical trials.

A retrospective comparison of the survival of vital teeth adjacent to single, bounded edentulous spaces rehabilitated using implant-supported, resin-bonded, and conventional fixed dental prostheses.

OBJECTIVES: In this study, we aimed to compare the long-term survival of vital teeth adjacent to bounded edentulous spaces rehabilitated using an implant-supported prosthesis (ISP), a resin-bonded fixed partial denture (RBFPD), or a conventional fixed partial denture (CFPD). The risk factors for complications in teeth adjacent to the edentulous space (TAES) were also investigated. METHODS: We followed-up a consecutive series of 514 patients who underwent rehabilitation of a single bounded edentulous space with vital TAES (ISP: 103; RBFPD: 216; and CFPD: 195) from 2008 to 2017. Cumulative survival rates of prosthesis and TAES, and complication-free rates of TAES, were evaluated using the Kaplan-Meier analysis and log-rank test. Risk factors were evaluated using a Cox proportional hazards model. RESULTS: Cumulative complication-free rates of TAES showed no significant differences among the three groups. The cumulative survival rate of TAES in CFPD was significantly lower than that of ISP (p = 0.037); no significant differences were observed between ISP and RBFPD (p = 0.513), and RBFPD and CFPD (p = 0.076). Older age (p = 0.027) was the only independent significant risk factor for complications in TAES. Installation of CFPD (p = 0.019), ceramic prosthesis in edentulous space (p = 0.026), and deeper periodontal probing depth (p = 0.018) of TAES were significant risk factors for non-surviving TAES. CONCLUSIONS: Rehabilitating a single bounded edentulous space with CFPD could increase the risk for TAES loss compared with ISP. Risk of TAES loss remained similar between ISP and RBFPD, which can minimize the loss of coronal tooth structure during tooth preparation. CLINICAL SIGNIFICANCE: Teeth adjacent to edentulous space show equivalent longevity when rehabilitating a single bounded edentulous space with resin-bonded fixed partial dentures or single standing implant-supported prosthesis, at least 10 years post-installation.

Effectiveness of implant-supported fixed partial denture in patients with history of periodontitis: A systematic review and meta-analysis.

AIM: This systematic review investigates the effectiveness of implant-supported fixed partial denture (IS-FPD) in patients with history of periodontitis (HP) vs. patients with no history of periodontitis (NHP). METHODS: A literature search was performed on different databases on May 2020. Prospective and retrospective studies assessing survival (primary outcome), success and biological/mechanical complications of IS-FPDs in HP vs. NHP patients at ≥1 year after implant loading were evaluated. Meta-analyses were conducted by estimating hazard ratio (HR), risk ratio (RR) and standardized mean differences (SMD) with 95% confidence intervals (CI) using random effect models. RESULTS: Of the initially identified 4096 articles, 349 underwent a full-text evaluation. Finally, 17 were included. Pooled data analyses showed that overall implant survival was significantly higher in the NHP than the HP group (HR = 2.06; 95% CI = 1.37-3.09; I2  = 0%). This difference was noted when follow-up ≥5 years. The risk of peri-implantitis was higher in HP than NHP patients (RR = 3.3; 95% CI = 1.31-8.3; I2  = 0%), whereas the mean marginal bone level change over time was not different between the groups (SMD = -0.16 mm; 95% CI = -1.04-0.73; I2  = 98%). CONCLUSIONS: In partially edentulous patients receiving IS-FPDs, a history of periodontitis is associated with poorer survival rate and higher risk of peri-implantitis during a 5-10 years period after implant loading.

Tasa de supervivencia de prótesis fija unitaria de cerámica feldespática y feldespática reforzada / Survival rate of feldspathic and reinforced feldspathic ceramic single-unit fixed prostheses

Introducción: Gracias a su eficiencia y al uso exclusivo de cerámicas libres de metal, en rehabilitación oral se ha logrado alcanzar los estándares estéticos y mecánicos, manteniendo o, incluso, superando, la calidad de los tratamientos en comparación con las restauraciones metal cerámicas tradicionales. Actualmente los mecanismos de confeccion de cerámica libre están evolucionando cada vez mas hacia las tecnologías maquinadas CAD-CAM y disminuyendo su producción mediante la técnica de Inyeccion PRESS. Objetivo: Comparar la tasa de supervivencia de prótesis fija unitaria realizadas con cerámicas feldespáticas convencionales y reforzadas con disilicato de litio, confeccionadas con sistema CAD/CAM de CEREC® chair-side, en comparación con el método de inyección de laboratorio PRESS convencional de prensión. Métodos: Revisión sistemática realizada a través de búsqueda de evidencia científica en PubMed, PubMed Clinical Queries, Epistemónikos, Tripdatabase, Cochrane Library, recursos electrónicos de la Universidad de los Andes y bibliografía retrógrada, de artículos publicados hasta el año 2019. Se incluyeron todos aquellos estudios referentes a prótesis fija unitaria de cerámicas feldespática convencional y feldespática reforzada con disilicato de litio, confeccionadas mediante CAD/CAM y/o método convencional. Resultados: Un total de 28 artículos cumplieron los criterios de inclusión: 21 estudios observacionales de cohorte, 4 ensayos clínicos aleatorizados y 3 no aleatorizados. A corto y mediano plazo, CAD/CAM de CEREC® registró tasas de supervivencia de 98 por ciento y 91,9 por ciento, respectivamente. El sistema convencional registró tasas de supervivencia de 97,5 por ciento a corto plazo y 93 por ciento a mediano. Conclusiones: A corto plazo se describe en la literatura que CAD/CAM de CEREC® tuvo una tasa de supervivencia ligeramente superior al sistema convencional. Por otro lado, a mediano plazo CAD/CAM de CEREC® presentó una leve disminución respecto al sistema convencional. Aún no hay estudios disponibles para determinar la supervivencia clínica de los tratamientos a largo plazo(AU)

Introduction: Thanks to its efficiency and the exclusive use of metal-free ceramics, in oral rehabilitation it has been possible to achieve aesthetic and mechanical standards, maintaining or even exceeding the quality of the treatments compared to traditional metal-ceramic restorations. Currently, free ceramic manufacturing mechanisms are increasingly evolving towards CAD-CAM machined technologies and decreasing their conventional production through the PRESS Injection technique. Objective: Compare the survival rate of single-unit fixed prostheses made with conventional feldspathic ceramics and reinforced with lithium disilicate by the CEREC® CAD/CAM chairside system, with the conventional PRESS laboratory injection method. Methods: A systematic review was conducted of scientific evidence included in papers published until the year 2019 in PubMed, PubMed Clinical Queries, Epistemonikos, Tripdatabase, Cochrane Library, electronic resources of Los Andes Peruvian University, and retrograde bibliography. The papers selected dealt with conventional and lithium-disilicate reinforced feldspathic ceramic single-unit prostheses made by CAD/CAM and/or the conventional method. Results: A total 28 papers met the inclusion criteria. Of these, 21 were observational cohort studies, four were randomized clinical assays and three were non-randomized assays. Short- and mid-term, CEREC® CAD/CAM achieved survival rates of 98 percent and 91.9 percent, respectively. The conventional system achieved survival rates of 97.5 percent short-term and 93 percent mid-term. Conclusions: As described in the literature, CEREC® CAD/CAM had a slightly higher survival rate than the conventional system in the short term. In the medium term, however, CEREC® CAD/CAM displayed a slight reduction in comparison with the conventional system. No studies are available to determine the clinical survival of the treatments in the long term(AU)

Salud bucal en una escuela de formación profesional policial peruana / Oral health at a Peruvian police academy

RESUMEN Introducción: La salud bucal en el adulto joven es un derecho humano básico, y su contribución es fundamental para el goce de buena calidad de vida. Objetivo: Determinar la salud bucal en una escuela de formación profesional policial peruana en el período de julio a agosto del 2017. Métodos: Estudio observacional descriptivo de corte transversal. La muestra estuvo conformada por 276 adultos jóvenes seleccionados aleatoriamente, cumpliendo criterios de inclusión y exclusión, según las normas éticas en investigación científica. Se evaluó la salud bucal mediante una ficha epidemiológica con los indicadores: índice CPOD, índice de significancia de caries dental (SIC), índice de higiene oral simplificado (IHO-S) y el índice de necesidad y situación de prótesis dental de la OMS. La evaluación se realizó con luz natural por un observador calibrado. Los datos se analizaron en el programa STATA v 14 mediante tablas de distribución de frecuencias y figuras. Resultados: La prevalencia de caries dental fue de 63,76 por ciento (CPOD= 3,86; SIC= 9,64), IHO-S: 2,02 (DS= 0,41). La prótesis parcial fija fue la que más se usó y se necesitó en ambos maxilares. Conclusiones: La experiencia de caries dental fue moderada, la condición de higiene oral fue regular, y la prótesis parcial fija fue la que más se necesitó y se uso en ambos maxilares. Aunque los indicadores son alentadores, aún urge la necesidad de implementar políticas sanitarias en salud bucal en la comunidad policial(AU)

ABSTRACT Introduction: The oral health of young adults is a basic human right, and its contribution is fundamental for the enjoyment of a good quality of life. Objective: Determine oral health at a Peruvian police academy from July to August 2017. Methods: An observational descriptive cross-sectional study was conducted. The sample was 276 young adults randomly selected according to inclusion and exclusion criteria and in compliance with the ethical standards of scientific research. Oral health was evaluated with the aid of an epidemiological card containing the following indicators: CPOD index, dental caries significance (DCS) index, simplified oral hygiene index (OHI-S), and WHO dental prosthesis need and situation. The evaluation was conducted by a qualified observer under natural light. Data were processed with the software STATA v 14, using frequency distribution tables and figures. Results: Dental caries prevalence was 63.76 percent (CPOD= 3.86; DCS= 9.64), OHI-S: 2.02 (SD= 0.41). Fixed partial dentures were the most commonly used, and they were required in both jaws. Conclusions: Dental caries experience was moderate, oral hygiene status was fair, and fixed partial dentures were the most commonly required for both jaws. Although the indicators are heartening, there is still an urgent need to implement oral health policies in the police community(AU)

Prevalencia e intensidad de sensibilidad posoperatoria durante el tratamiento de prótesis fija / Prevalence and intensity of postoperative hypersensitivity during fixed prosthodontic treatment

RESUMEN Introducción: Durante la realización de prótesis fijas, el paciente puede presentar sensibilidad posoperatoria. Se ha descrito en la literatura diferentes prevalencias de esta sensibilidad, las cuales varían ampliamente, entre 3 por ciento y 34 por ciento. Objetivo: Determinar la prevalencia e intensidad de sensibilidad posoperatoria en el tratamiento de prótesis fija sobre diente vital. Métodos: se realizó un estudio clínico piloto descriptivo. La muestra fue de 35 dientes tratados de 20 pacientes. Esta fue conformada por pacientes atendidos por alumnos del Centro Odontológico de la Universidad de Los Andes, a los cuales se les realizó un tratamiento en base a prótesis fija sobre diente vital, desde el mes de abril hasta octubre del año 2015. Se registró la sensibilidad durante el tratamiento por medio la escala visual análoga a través de un diario completado por el paciente y por la escala verbal numérica aplicada por el investigador en distintas etapas clínicas. Resultados: Se observó una prevalencia del 31,4 por ciento con una intensidad de 0,62 ± 0,49 según la escala visual análoga y de 0 según la escala verbal numérica. Conclusiones: la prevalencia de la sensibilidad posoperatoria se aproximó al rango más alto descrito en la literatura. La intensidad de la sensibilidad observada fue leve a imperceptible clínicamente(AU)

ABSTRACT Introduction: During fixed prosthodontic treatment, patients may present postoperative hypersensitivity. The prevalence rates contained in the literature on the topic range from a mere 3 percent to 34 percent. Objective: Determine the prevalence and intensity of postoperative hypersensitivity during fixed prosthodontic treatment of vital teeth. Methods: A pilot descriptive clinical study was conducted. The sample was 35 treated teeth from 20 patients. These patients had been treated by students from the Dental Center at the University of Los Andes, and had undergone fixed prosthodontic treatment on vital teeth from April to October 2015. Hypersensitivity during the treatment was recorded with the visual analog scale based on a diary kept by patients and on the verbal numerical rating scale as applied by the researcher at the various clinical stages. Results: Prevalence was 31.4 percent with an intensity of 0.62 ± 0.49 by the visual analog scale and of 0 by the verbal numerical rating scale. Conclusions: The prevalence of postoperative hypersensitivity approached the highest range described in the literature, whereas the intensity of hypersensitivity ranged from mild to clinically imperceptible(AU)

Biomechanical aspects: Summary and consensus statements of group 4. The 5th EAO Consensus Conference 2018.

OBJECTIVES: The aim of the present publication was to report on the EAO Workshop group-4 discussions and consensus statements on the five reviews previously prepared. These reviews provided the scientific evidence on the effect of crown-to-implant ratio, on reconstructions with cantilevers in fully and partially edentulous patients, on biological and technical complications of tilted in comparison with straight implants, and on the effects of osseointegrated implants functioning in a residual dentition. MATERIAL AND METHODS: The group discussed, evaluated, corrected where deemed appropriate, and made recommendations to the authors regarding the following five reviews submitted: (a) Is there an effect of crown-to-implant ratio on implant treatment outcomes?; (b) Implant-supported cantilevered fixed dental rehabilitations in fully edentulous patients; (c) and in partially edentulous patients; (d) Biological and technical complications of tilted implants in comparison with straight implants supporting fixed dental prostheses; (e) What are the adverse effects of osseointegrated implants functioning among natural teeth of a residual dentition? Based on the five manuscripts and the discussion among the group as well as the plenum members, the major findings were summarized, consensus statements were formulated, clinical recommendations were proposed, and areas of future research were identified. RESULTS: Crown-to-implant ratios ranging from 0.9 to 2.2 did not influence the occurrence of biological or technical complications also in single-tooth restorations. Reconstructions with cantilevers for the rehabilitation of fully and partially edentulous jaws showed high implant and reconstruction survival rates. In contrast, the rate of complications-in particular associated with veneering material-was high during the observation period of 5-10 years. The data reported were primarily derived from studies with high risk of bias. The data for single-implant reconstructions were small. There was no evidence that distally tilted implants were associated with higher failure rates and increased amounts of marginal bone loss. The data supporting these findings, however, were at high risk of bias and frequently incompletely reported. Frequent positional changes occurred between the natural teeth and the implant-supported restorations. These changes were more pronounced in younger individuals, and even though they were reduced with age, they still occurred in adult patients. Even though these changes were frequent, potential implications for the patient are unclear. CONCLUSIONS: The use of single-tooth restorations with crown-to-implant ratio in between 0.9 and 2.2 may be considered a viable treatment option. Multiunit reconstructions with cantilevers are a viable treatment option in fully and partially edentulous patients. Clinicians and patients should be aware, however, that complications are frequent and primarily related to resin material used for veneering. There is some evidence that tilting an implant does affect stability of the implant and the surrounding bone. Treatment options to tilted implants should carefully be considered, as the effect on soft tissues and on prosthesis behavior is poorly reported for tilted implants. Positional changes in the dentition in relation to implant-supported restorations occur frequently. The patient should be informed about the possible need for a treatment related to these changes in the long term.

Clinical outcomes of partial and full-arch all-ceramic implant-supported fixed dental prostheses. A systematic review and meta-analysis.

OBJECTIVE: To assess the survival and technical complication rate of partial and full-arch all-ceramic implant-supported fixed dental prostheses (P-FDP/FA-FDP) and supporting implants. MATERIALS AND METHODS: An electronic search through three databases (MEDLINE/Pubmed, Cochrane Library, Embase) was conducted to identify relevant clinical studies with an observation period of at least 12 months, including ≥15 patients. Reconstruction and implant survival rates, technical complications and confounding variables such as processed/installed materials, retention mode and location in the mouth were obtained. Failure and complication rates were analyzed using standard Poisson regression models to calculate 5-year survival and complication estimates. RESULTS: A total of five studies for the P-FDP group and seven studies for the FA-FDP group were included, throughout evaluating veneered zirconia reconstructions. In the P-FDP group, reconstructions were located in posterior regions. Meta-analysis indicated survival estimates on the reconstruction level of 98.3% and 97.7% for P- and FA-FDPs after 5 years. However, chipping of the veneering ceramic was frequent, resulting in estimated 5-year complication rates of 22.8% (P-FDPs) and 34.8% (FA-FDPs). Five-year survival estimates of implants supporting P-FDPs and FA-FDPs of 98.5% and 99.4% were calculated, respectively. Including a total of 540 FDPs, one screw-loosening and 11 de-cementations were reported. Confounding variables were not found to have a significant influence on survival and complication rates. CONCLUSIONS: All-ceramic implant-supported P- and FA-FDPs comprising veneered zirconia frameworks showed high survival but clinically inacceptable fracture rates of the veneering ceramic. Their suitability with regard to this indication and a successful long-term outcome needs to be further evaluated.

Changes in Ridge Dimension with Pontics Immediately Placed at Extraction Sites: A Pilot Study.

The aim of this prospective clinical study was to evaluate dimensional changes following immediate placement of a fixed ovate pontic provisional restoration into an intact extraction socket without grafting. The mean buccolingual dimensional change at 1 month was 0.51 ± 0.48 mm and 0.93 ± 0.55 mm at 3 months. The mean incisoapical dimensional change at 1 month was 0.68 mm ± 0.19 mm, and at 3 months, 1.64 ± 1.35 mm. The dental literature reports dimensional change of 3 to 5 mm in width and 1 to 4 mm in height for ridges with no treatment following extraction. This study provides validation for the use of ovate pontics in the preservation of tissue contour. Further research is needed to determine whether placing a graft into the socket with placement of an ovate pontic will decrease dimensional changes after extraction.

[The obstructive sleep apnoea syndrome is not only bad for the heart!] / Le syndrome d'apnées obstructives du sommeil n'est pas mauvais que pour le cœur !

Obstructive sleep apnoea (OSA) is common in the general population, particularly in the elderly. This syndrome is frequently responsible for severe cardiovascular complications. However, the indications for its treatment in the elderly remain controversial. We report the case of a 79-year-old man with severe, undiagnosed OSA who inhaled his fixed dental bridge during sleep. The inhaled foreign body came to rest in the lumen of the left main stem bronchus. The association of obesity with a body mass index of 30kg/m2, snoring with breathing pauses reported by his partner, nocturia, morning headache and an Epworth score of 11 led to polysomnography which confirmed OSA with an apnoea/hypopnoea index of 53 per hour. This case report emphasises that OSA may constitute a risk fact for foreign body inhalation in elderly subjects due to arousal-induced hyperventilation following the apnoeic event.

Bone and soft tissue outcomes, risk factors, and complications of implant-supported prostheses: 5-Years RCT with different abutment types and loading protocols.

BACKGROUND: Data on risk factors and complications after long-term implant treatment is limited. The aims were to evaluate the role of various fixation modes and to analyze complications and risks that affect long-term use of implant-supported partial fixed dental prostheses. MATERIALS AND METHODS: Fifty partially edentulous subjects received three Brånemark TiUnite™ implants. Superstructures were attached directly at implant level (IL) or via abutments: machined surface (AM) and an oxidized surface (AOX, TiUnite™). Implants were immediately loaded (test) or unloaded for 3 months (control). Examinations occurred over a 5-year period. RESULTS: Forty-four subjects were re-examined after 5 years. Cumulative survival rates in test and control groups were 93.9% and 97.0%, respectively. Marginal bone loss (MBL; Mean [SEM]) was significantly lower at superstructures connected to AM (1.61 [0.25] mm) than at sites with no abutment IL (2.14 [0.17] mm). Peri-implantitis occurred in 9.1% of subjects and in 4.0% of implants. Multiple linear regression indicated that increased probing pocket depth (PPD), periodontal disease experience, deteriorating health, and light smoking (≤10 cigarettes/day) predict greater MBL, whereas increased buccal soft tissue thickness and higher ISQ predict lower MBL. CONCLUSIONS: The results show that MBL was influenced by the connection type. A machined abutment, instead of connecting the superstructure directly at the implant level, was beneficial. The following factors influenced MBL: PPD, periodontal disease experience, deteriorating health, light smoking, buccal soft tissue thickness, and ISQ. The results on peri-implantitis underscore the need for long-term maintenance care. Further, the abutment material surface properties constitute additional target for strategies to minimize MBL.

Is History of Periodontitis a Risk Factor for Peri-implant Disease? A Pilot Study.

PURPOSE: The aim of this pilot study was to evaluate clinical outcomes of implant treatment in periodontally compromised patients. MATERIALS AND METHODS: Partially edentulous patients who were diagnosed and treated for chronic periodontitis and later rehabilitated with implant-supported single crowns or fixed partial dentures were enrolled in this study. At the final follow-up, data on probing pocket depth and bleeding on probing were collected, and changes in peri-implant bone levels were assessed on periapical radiographs. Accordingly, patients were categorized into peri-implant disease-free (PID-free), peri-implant mucositis (PIM), or peri-implantitis (PI) groups. Additionally, information on the history of systemic diseases was obtained and correlated with the findings. RESULTS: Seven females and six males with a mean age of 55.2 (standard deviation [SD] ± 8.38) years were included in this study. Fifty-five implants were placed in 13 partially edentulous patients with a history of chronic periodontitis. The mean follow-up in the study was 35.1 (SD ± 2.40) months. No implants were lost in the 13 patients, for a cumulative survival of 100%. PI was confirmed in 3 patients and PIM in 8 patients, while 2 patients were found to be PID-free. Diabetes and hypertension were found to be the predominant systemic factors among patients affected by peri-implant diseases. CONCLUSION: Patients with a history of periodontitis are at considerable risk of being affected by peri-implant mucositis, if not by peri-implantitis.

Clinical Results and Technical Complications of Posterior Implant-Supported Modified Monolithic Zirconia Single Crowns and Short-Span Fixed Dental Prostheses: A 2-Year Pilot Study.

PURPOSE: The purpose of this clinical trial was to investigate the clinical outcomes of implant-supported modified monolithic zirconia single crowns (SCs) and short-span fixed dental prostheses (FDPs) after a follow-up of 2 years. MATERIALS AND METHODS: Twenty-seven patients in need of implant-supported SCs or 3-unit FDPs in the posterior maxilla or mandible were consecutively selected for this study. A total of 56 modified monolithic zirconia prostheses including 44 SCs (8 screw-retained, 36 cement-retained) and twelve 3-unit FDPs (5 screw-retained, 7 cement-retained) were included in this study. All patients were followed at 6 months, 12 months, 18 months, and 2 years after placement of the modified monolithic zirconia prostheses. During the follow-up period, all prostheses were evaluated with clinical and radiographic examinations. The following technical parameters were assessed: framework fracture, fracture of veneering porcelain, screw loosening, loss of retention because of prosthesis de-cementation and opposing tooth fracture. RESULTS: No implant was lost during the follow-up period, yielding a 2-year implant survival of 100%. One FDP failed because of framework fracture. The overall prosthesis survival rate was 98.2% after 2 years of clinical service. During the study, 5 complication events were observed in 3 SCs and one FDP, including one fracture of veneering porcelain and 2 screw loosenings in 3 SCs, and loss of retention and opposing tooth fracture in the same FDP. Therefore, the complication-free rate of prostheses was 91.1%. CONCLUSION: According to the results of this study, the modified monolithic zirconia design used in this study resulted in a favorable short-term outcome for posterior implant-supported SCs and 3-unit FDPs.

A Case of External Dental Fistula Related to a Fixed Cantilever Bridge.

An external dental fistula is a skin manifestation caused by an underlying dental problem. We report a rare case of external dental fistula associated with a fixed cantilever denture. A 77-year-old Japanese woman presented with an enlarging reddish granulomatous lesion on her right cheek that was diagnosed as an external dental fistula. A fixed cantilever denture had initially been attached to her upper jaw with her seven bona fide teeth. However, six teeth were completely lost and the denture was attached to only one tooth, which showed apical periodontitis. Subsequently, the external dental fistula developed. We should keep in mind that a patient with a fixed cantilever denture can suffer from apical periodontitis and a subsequent external dental fistula due to a failure to maintain appropriate oral hygiene.

Zirconia-based versus metal-based single crowns veneered with overpressing ceramic for restoration of posterior endodontically treated teeth: 5-year results of a randomized controlled clinical study.

OBJECTIVES: The aim of this 5-year randomized controlled trial was to compare the longevity and clinical behavior of single posterior crowns made with pressable ceramic on zirconia and on metal frameworks, and if failures occur, to delineate the contributing factors. METHODS: 72 patients, who needed the covering of at least a molar and/or premolar, were included in the study. All teeth were endodontically treated, with absence of periapical lesion or active periodontitis. Ninety single crowns were made with zirconia or metal framework and covered with pressable veneering ceramics. Two independent examiners assessed the survival of restorations at 6 months, 1-4 and 5 years after restoration placement including periapical radiographs, intraoral photographs, and USPHS modified criteria. The statistical analyses were performed with the Kaplan-Meier method. RESULTS: One core fracture occurred in Zircad/Zirpress crowns and one metal ceramic crown was lost for root fracture. Chipping fracture of the veneering ceramic was detected in 2 metal-ceramic crowns and in 3 zirconia-based crowns. The Estimate Cumulative Survival (ECS) and the Estimate Cumulative Success (ECSs) with standard deviation (SE) were respectively 97,73±2,19 and 92,64±4,14 for zirconia-based crowns whereas 97,44±2,39 and 91,11±4,27 for porcelain fused to metal crowns. CONCLUSIONS: The present randomized controlled trial shows that the survival of zirconia-based and metal-based single crowns is similar over a follow-up period of 5 years. No significant differences in esthetic, functional and biological outcomes were demonstrated between the two groups. The main failure mode was the chipping fracture of the veneering ceramic in both materials. Study number on ClinicalTrial.gov NCT02758457. CLINICAL SIGNIFICANCE: According to the results of this clinical study, zirconia-based rehabilitations with overpressing veneering technique represent a valid alternative to metal-based for posterior single crown restorations.

Oral Candida in Patients with Fixed Orthodontic Appliance: In Vitro Combination Therapy.

BACKGROUND: Fixed orthodontic appliance (FOA) increases the cariogenic microorganisms of mouth including candida. The aim was to evaluate the pharmacodynamic effects of some antibacterial drugs in combination with most applicable antifungal agents on candida isolated from patients with FOA. METHODS: Three antifungal agents (amphotericin B (AMB), ketoconazole (KET), and itraconazole (ITZ)) and three antibacterial drugs (ciprofloxacin (CIP), doxycycline (DOX), and metronidazole (MET)) with serial concentrations have been used and microdilution broth method has been done for single and combination therapy, then fungal growth was assessed spectrophotometrically, and the combinations were evaluated by bliss independent analysis. RESULTS: According to bliss independent interaction, the synergistic interactions depended on ΔE values that showed the best for CIP was with AMB (ΔE = 55.14) followed with KET (ΔE = 41.23) and lastly ITR (ΔE = 39.67) at CIP = 150 mg/L. DOX was optimal with KET (ΔE = 42.11) followed with AMB (ΔE = 40.77) and the lowest with ITR (ΔE = 9.12) at DOX = 75 mg/L. MET is the best with AMB (ΔE = 40.95) and then with ITR (ΔE = 35.45) and finally KET (ΔE = 15.15) at MET 200 mg/L. Moreover, usage of higher concentrations of antibacterial agents revealed inhibitory effects. CONCLUSION: This study uncovers the optimum antibiotic combination therapy against cariogenic candida with FOA by usage of low therapeutic concentrations.

Hardware complications and failure of three-unit zirconia-based and porcelain-fused-metal implant-supported fixed dental prostheses: a retrospective cohort study with up to 8 years.

OBJECTIVE: The aim of the present study was to assess the hardware complications and survival of three-unit implant-supported zirconia-based fixed dental prostheses (IZ) and implant-supported porcelain-fused-metal fixed dental prostheses (IP). MATERIAL AND METHODS: The study is a retrospective cohort study with up to 8 years (mean 4.8 years) follow-up. Patients with conventional three-unit implant-supported fixed dental prostheses (without cantilever) in posterior area were reviewed. Hardware complications and survival rate were evaluated. Chi-Square test was used to test the difference between IZ and IP groups. RESULTS: Two hundred and thirty-seven patents (IZ : 112, IP : 125) with 279 three-unit restorations (IZ : 127, IP : 152) participated in the study. The overall survival rate was 95.3% in IZ group and 94.7% in IP group at implant-level and 94.6% in IZ group and 94.4% in IP group at subject-level. Veneer chipping was the most frequently seen complication (20.1%). Significant higher minor veneer chipping rate (Grade 1) was found in IZ group (P = 0.04). No significant difference of veneer chipping rate (Grade 2 and Grade 3) was found between the two groups. The overall hardware complication rates of IZ were significantly higher than IP (33.07% and 18.42%, P = 0.01). CONCLUSION: High survival rate of zirconia-base and Porcelain-fused-to-metal (PFM) restorations can be achieved with up to 8 years follow-up. The zirconia-based restorations need more polishing procedures, maintenance, and professional care than PFM restorations. The number of implants supporting a fixed dental prosthesis did not influence the implant survival and hardware complications. Well-designed studies with high evidence level are still needed to further explore the hardware complications and clinical survival of IZ and IP.

A 5-Year Retrospective Assay of Implant Treatments and Complications in Private Practice: The Restorative Complications of Single and Short-Span Implant-Supported Fixed Prostheses.

PURPOSE: This report aims to describe the restorative outcome of 5,491 implant-supported single crowns, fixed partial dentures, and splinted restorations that were prescribed or had implants placed during the study period. Timing of the complications and the relationship between the complications and different factors (practitioner, patient, and restoration) are examined. MATERIALS AND METHODS: Dental clinicians qualified in or before December 2004, registered in Victoria, and placing and/or restoring implants in private practice were invited to participate in the study. Data extraction was conducted by two trained and calibrated research assistants with specific training in implant terminology and previous research experience extracting data from dental records. Prostheses average time observed/in function was calculated using the difference between the definitive restoration date and the patient record examination date or the date of implant/restoration lost. Both descriptive statistics and generalized linear mixed modeling were used to describe the restorative complications. RESULTS: Over the study period a total of 499 mechanical complications were recorded. Single-implant crowns had the largest sample size (n = 4,760) and a recorded complication rate of 2.56 per 100 prostheses per year. The majority of screw loosenings recorded in this study were inadequately described. In single-implant crowns, abutment screw loosening occurred at a rate of 0.07 per 100 per year while unspecified screw loosening occurred at a rate of 0.53. Lateral screw loosening was more common in lateral screw-retained implant crowns (1.06) than decementation was in cement-retained implant crowns (0.57). Esthetics (0.25), veneer chipping or fracture (0.41), and food packing/contact point issues (0.53) also represent significant portions of the restorative complications. Each type of complication presented with a slightly different timing profile. Clustering within the first year was common. The ratio of screw loosening between the group who prescribed between 1 and 100 during the study period and those who prescribed more than 501 implant restorations was 1:0.15 (P = .005). Patients with operator-reported attrition had double the rate of veneer fracture (P = .005). Contact point issues were approximately three times more common in the posterior segment (P = .001). CONCLUSION: During the period of January 2005 to December 2009, screw loosening, lateral screw loosening, decementation, esthetic complication, veneer chipping or fracture, and food packing/contact point issues were recorded at different rates for different types of prostheses in the private practices included in this study. Clusters of several complications within the first year were observed. For single-implant crowns, screw-loosening complications were less frequent in the more experienced group. Operator-reported attrition was related to higher rate of veneering material fracture. More contact point complications were found in the posterior regions of the oral cavity.