Implant survival/success and peri-implant outcomes of titanium-zirconium mini implants for mandibular overdentures: Results from a 1-year randomized clinical trial.

OBJECTIVE: To report the 1-year implant survival/success and peri-implant outcomes of mandibular overdentures retained by four titanium-zirconium mini implants (Straumann® Mini Implant System), and to assess how surgery and loading protocols influence these outcomes. MATERIALS AND METHODS: A 2 × 2 factorial randomized clinical trial (RCT) tested the combined effects of two loading protocols (immediate or delayed) and two surgical approaches (flapless or flapped) on the success/survival of the mini implants, and peri-implant parameters (plaque, bleeding, sulcus depth, gingival position, and marginal bone loss). Outcomes were assessed up to 1-year after loading, and generalized estimating equations (GEEs) were used to analyze longitudinal and within-patient clustered data. RESULTS: Two hundred and ninety-six implants were placed in 74 patients. The implant survival/success rates after 1 year were 100%, and no major biological complications were observed. After 1-year, descriptive data suggest no noticeable changes in plaque scores, whilst a reduction in bleeding scores at the 6-month and 1-year follow-ups compared to baseline. Good longitudinal stability was observed for the probing depth and gingival margin height measures. Overall mean marginal bone loss was 0.68 (±0.68) mm after 3 months and 0.89 (±0.75) mm after 1-year. The flapless protocol showed better results on soft tissue stability and health but a slightly higher risk for marginal bone loss. CONCLUSION: The results of this RCT suggest that mandibular overdentures retained by this novel mini implant system represent a safe and predictable treatment option as confirmed by implant survival/success and peri-implant outcomes, even when flapless surgery and immediate loading protocols are adopted.

Dental status and its correlation with polypharmacy and multimorbidity in a Swiss nursing home population: a cross-sectional study.

OBJECTIVE: To assess the correlation between oral health status in terms of present teeth, implants, removable prostheses, and polypharmacy and/or multimorbidity in three Swiss nursing homes with affiliated or integrated dental care. METHODS: A cross-sectional study was conducted in three Swiss geriatric nursing homes with integrated dental care. Dental information consisted of the number of teeth, root remnants, implants, and presence of removable dental prostheses. Furthermore, the medical history was assessed in terms of diagnosed medical conditions and prescribed medication. Age, dental status, polypharmacy, and multimorbidity were compared and correlated using t-tests and Pearson correlation coefficients. RESULTS: One hundred eighty patients with a mean age of 85.5 ± 7.4 years were included of which a portion of 62% presented with multimorbidity and 92% with polypharmacy. The mean number of remaining teeth and remnant roots were 14.1 ± 9.9 and 1.0 ± 3.1, respectively. Edentulous individuals comprised 14%, and over 75% of the population did not have implants. Over 50% of the included patients wore removable dental prostheses. A negative correlation with statistical significance (p = 0.001) between age and tooth loss (r = - 0.27) was observed. Finally, there was a non-statistically correlation between a higher number of remnant roots and specific medications linked to salivary dysfunction; specifically antihypertensive medication and central nervous system stimulants. CONCLUSION: The presence of a poor oral health status was associated with polypharmacy and multimorbidity among the study population. CLINICAL RELEVANCE: Identifying elderly patients in need of oral healthcare in nursing homes is a challenge. In Switzerland, the collaboration of dentists and nursing staff is still improvable, but is urgently needed due to the demographic changes and raising treatment demand of the oldest portion of the population.

Willingness to accept or refuse mandibular implant overdenture treatment: A prospective study on edentulous enrolled in a clinical trial.

BACKGROUND: Several complete denture wearers have major complaints and may be benefitted from implant treatment. However, the factors that shape the demand for and utilization of implants need further investigation. OBJECTIVE: The aim was to evaluate edentulous patient's willingness to accept or refuse the offer and provision of implant-retained treatment. METHODS: As part of a clinical trial, edentulous subjects were offered a mandibular overdenture retained by four mini-implants opposing a conventional maxillary denture. Treatment was offered without any financial costs for the patients. Patients' level of interest in receiving treatment was assessed using a 5-point Likert scale, and they were asked to respond to a list of reasons that led to their decision to accept or refuse implants. Those who refused implants received conventional prosthodontic interventions as required, and those who accepted implant treatment underwent surgical planning and implant placement. RESULTS: Of 175 eligible subjects, 147 accepted the offer of treatment and were invited to take part in the study (69.4% women, mean age 67.4 ± 10.0 years). Overall, 111 patients (75.5%) expressed a positive intention to undergo implant treatment at the initial contact. Implant treatment was performed for 56.3% (9/16) of those who answered 'probably yes' about their level of interest in implant treatment on the Likert scale, and 69.6% (64/92) of 'certainly yes' (p < .001). Older subjects were less likely to receive implants (OR = 0.93; p = .036), whilst those with a positive intention towards implants (OR = 3.15; p = .001), those previously treated by the dental team (OR = 7.89; p < .001), and who actively demanded implants (OR = 18.1; p < .001) were more likely to accept treatment. Improved chewing was the most common reason for accepting implants, whilst fear of surgery was the most reported reason for refusal. CONCLUSION: Refusal of implants was high among edentate patients even when financial costs were removed. Patients' initial attitude towards acceptance is a key factor in the demand for and uptake of implant therapy.

Mandibular bone characteristics, drilling protocols, and final insertion torque for titanium-zirconium mini-implants for overdentures: A cross-sectional analysis.

OBJECTIVE: The aim of this study was to assess the final insertion torque values achieved using site-specific drilling protocols for a novel mini implant system for removable complete overdentures. Anatomical and technical factors influencing final insertion torque were recorded and analyzed. MATERIAL AND METHODS: Participants were randomized to two surgical protocol groups (flapped or flapless) and all received four mini implants (Straumann® mini implant system; Straumann AG) in the anterior mandible, using a 1.6 mm needle drill and a 2.2 mm pilot drill for the implant bed site preparation. The final insertion torque was recorded as the main outcome variable during surgery. Bone type, radiographical bone density, ridge form, implant length, and the drilling protocol were considered as independent variables. Descriptive statistics, generalized estimating equations (GEE) regression, and heatmap charts were used for data analyses. RESULTS: A total of 296 mini implants were placed in 74 patients (mean age = 64.1 ± 8.0; 64.9% female) using flapless (n = 37) or flapped (n = 37) surgeries. Mean final insertion torque was 55.8 ± 18.4 Ncm (10.5% > 35 Ncm, 48.9% between 35 and 65 Ncm, and 40.6% > 65 Ncm). The needle drill was used in only 43.9% of the implant bed sites. Higher final torque values were observed for higher bone densities (bone type I > II > III, and D1-D2 > D3-D4), highly resorbed ridge forms (5-6 > 3-4), flapped surgeries, and male patients. However, regression models showed that the likelihood of achieving optimal insertion torque (≥35 and ≤65 Ncm) was higher for females (OR = 2.14; 95%CI = 1.14-4.01; p = 0.018), ridge forms 3-4 (OR = 2.87; 95%CI = 1.05-7.85; p = 0.040), and flapless surgeries (OR = 1.96; 95%CI = 1.09-3.51; p = 0.024). CONCLUSIONS: Sufficient primary stability for immediate loading was achieved for the majority of the mini implants placed. Surgical implant bed preparation should be site-specific to achieve optimal primary stability for immediate loading while avoiding excessive insertion torque.

Flapped versus flapless surgery and delayed versus immediate loading for a four mini implant mandibular overdenture: A RCT on post-surgical symptoms and short-term clinical outcomes.

OBJECTIVE: This factorial randomized clinical trial (RCT) tested the effects of the surgical approach (flapped-FPS vs. flapless-FLS surgery) and loading protocol (delayed-DL vs. immediate-IL) for treatment with a four mini implant mandibular overdenture. MATERIAL AND METHODS: A total of 296 one-piece titanium-zirconium mini-implants were inserted in 74 patients (IL/FLS = 17; IL/FPS = 18; DL/FLS = 20; and DL/FPS = 19). Outcomes included patient's perceived surgical burdens, clinical time, implant survival, and post-surgical symptoms and complications, assessed immediately after surgery, in the 7-day and 6-week follow-ups. RESULTS: Perceived surgical burdens were relatively low, higher for females, and no difference was found between FPS and FLS surgery. Surgical time was lower for FLS surgery. Overall symptoms were mild after 24 h, and higher for females. Less symptoms were recorded for the FLS surgery compared to the FPS for the delayed loading patients, and FLS surgery was associated with a lower risk of bleeding. No early implant failure was observed until the 6-week follow-up. Delayed was associated with discontinuous use of the prosthesis and poor function. Lower complaint rates were observed for immediate loading regardless of the surgery protocol. CONCLUSIONS: Mini implants for mandibular overdenture are a feasible option regardless of surgical access and loading protocol, with high safety and predictable survival rates, and low incidence of post-insertion complications. FLS surgery requires less clinical time and results in easier intraoral prosthetic incorporation of attachments compared to FPS surgeries. Immediate loading did not increase the risk of early implant failure when satisfactory primary stability was achieved.

A model for a geriatric teaching programme and its impact on self-rated and tested competencies of undergraduate dental students.

INTRODUCTION: In the light of the growing ageing population, it is important that future dentists be taught geriatric competencies to assure good dental care and treatment addressing the special needs of older patients. MATERIALS AND METHODS: We developed and evaluated a geriatric teaching programme amongst final year undergraduate dental students (n = 30) at the University of Bern, Switzerland. The geriatric teaching programme was based on the European undergraduate curriculum in geriatric medicine for medical students covering the following eight geriatric domains that were considered relevant to dental care: Analgesics, cognitive impairment, decision-making capacity, gait and balance disorder, hearing impairment, malnutrition, polypharmacy and vision impairment. Using a pre/post-design, we administered a structured questionnaire including standardised questions on self-rated and tested competencies. Both assessments scores were standardised to a maximum score of 100 points. Data were evaluated by comparison of pre-test and post-test mean scores. RESULTS: The geriatric teaching programme proved to be feasible covering eight geriatric domains based on a case-based didactic approach in totally eight 45-minute lessons. Both self-rated and tested competencies of dental students increased in all eight domains in the course of the geriatric teaching programme. After the geriatric teaching programme, both mean self-rated competency scores (67.9 vs. 49.6, p < .001) and mean tested competency scores (78.7 vs. 56.7 points, p < .001) significantly improved compared to baseline. CONCLUSIONS: Integrating a consolidated refined geriatric teaching programme is a potentially feasible and effective method for dental undergraduate students and is expected to have an impact on better dental care of older patients.

Digital workflow for implant-supported fixed complete dentures based on backwards planning in an edentulous patient.

AIM: This case report describes a digital workflow for prosthetically driven surgical planning, implant placement, and the fabrication of two screw-retained, complete-arch, implant-supported dentures in an edentulous patient. The purpose of this case report is to present and discuss the digital steps in the workflow, especially the scanning technique to obtain the centric relation, through a clinical case. The limitations of the workflow are also discussed. MATERIALS AND METHODS: Static computer-aided implant surgery (s-CAIS) was planned three-dimensionally, based on cone beam computed tomography, intraoral optical scanning, and digital bite registration. Using s-CAIS, four and six implants were placed in the edentulous mandible and maxilla, respectively. The final screw-retained complete-arch monolithic zirconia restorations were manufactured based on a digital workflow, using the pre-existing modified radiologic guide for the digital maxillomandibular record. CONCLUSIONS: The evolution of digital processing methods allows for design, processing, and fabrication of implant-supported fixed complete dentures using a surgical, prosthetic, and technical workflow based on 3D restorative backward planning. A digital prosthetic setup and CAD/CAM can be used for the fabrication of intraoral try-ins that serve as a model for the final monolithic zirconia superstructure.

Oral factors and adherence to Mediterranean diet in an older Greek population.

PURPOSE: The aim of this study was to investigate the effect of oral factors on adherence to the Mediterranean diet in an older population METHODS: 130 persons over 60 years visiting Open Care Community Centers for Older People participated in this study. Oral interviews recorded demographic and sociomedical information, subjective oral complaints, and dental habits. Adherence to Mediterranean diet was assessed using the MDI_BNC4H index (range: 0-14). An oral examination was performed, and evaluation of the masticatory performance was carried out using a two-color chewing gum that was digitally analysed. RESULTS: The mean age of the study participants was 73.9 ± 8.5 years. The score of adherence to the Mediterranean diet ranged from 3 to 9 (5.6 ± 1.4). 58 participants used removable prostheses, while 20 used a pair of complete dentures. Univariate analyses revealed that the parameters that negatively significantly, or marginally significantly, affected the level of adherence to the Mediterranean diet were lower masticatory performance (p = 0.050), larger number of drugs per day (p = 0.056), higher BMI (p = 0.043) and smoking (p = 0.053). The multivariable analysis revealed that lower adherence to the Mediterranean diet was significantly associated with higher BMI (p = 0.047) and lower masticatory performance (p = 0.050). CONCLUSIONS: Increased masticatory performance was an independent predictor of better adherence to the Mediterranean diet in an older population.

Effect of Age on Bleeding on Probing (BOP) as an Indicator of Periodontal Inflammation in Patients Enrolled in Supportive Periodontal Therapy.

PURPOSE: To assess the effect of age on the mean percentage of bleeding on probing (BOP) during supportive periodontal therapy (SPT) in patients enrolled in SPT for at least 5 years. Materials and Methods: This study was performed as a retrospective analysis of data collected from SPT patients initially diagnosed with gingivitis or mild to severe periodontitis. Two groups of patients were selected: in group A, younger adults (age ≤ 35 years) were included while group B consisted of older SPT patients (age ≥ 65 years). BOP in the two groups was compared according to both disease severity and % compliance with SPT visits. Results: BOP in all patients (n = 236) was 19.2% (±â€¯12.4). Group A (n = 110) presented mean BOP levels of 19.7% (±â€¯11.8), while lower BOP levels of 18.7% (±â€¯13.0) were found in group B (n = 126; p = 0.5272). Older patients demonstrating high % compliance had lower mean BOP levels (14.2% ±â€¯9.5) than younger patients (18.0% ±â€¯ 11.7; p = 0.0841). Similarly, BOP was lower in older patients with moderate (group B: 18.4% ±â€¯12.1, group A: 19.3% ±â€¯14.6, p = 0.0541) or severe periodontitis (group B: 22.4% ±â€¯11.4, group A: 23.2% ±â€¯ 14.0; p = 0.3440). In patients with moderate or severe periodontitis and higher % compliance with SPT, the mean BOP was statistically significantly lower in older patients than in younger patients (moderate: 14.4% ±â€¯11.9 vs 19.4% ±â€¯15.1, p < 0.0001; severe: 13.2% ±â€¯11.1 vs 18.3% ±â€¯17.5, p = 0.0170). Conclusion: Older patients enrolled in SPT may present lower levels of BOP. This finding should be considered when determining SPT intervals with elderly patients.

Mandibular implant-supported fixed complete dental prostheses on implants with ultrashort and standard length: A pilot treatment.

Edentulous patients may be restored with complete-arch implant-supported fixed complete dental prostheses (IFCDPs) on angled distal implants or on parallel implants distributed equally across the mandible to increase the area of support. A treatment is presented to introduce the clinical concept of providing edentulous patients with an implant-supported fixed complete dental prosthesison parallel tissue-level implants in the mandible with standard length implants interforaminally and ultrashort implants distally. A structured prosthetic approach was used for the tooth arrangement with a modified workflow as per the Biofunctional Prosthetic System adapted for static computer-aided implant surgery (s-CAIS) and computer-aided design and computer-aided manufacturing (CAD-CAM) of the screw-retained implant-supported fixed complete dental prosthesis. The concept offered advantages in challenging anatomic, surgical, and prosthetic conditions; providing distal nonangled abutments and implant platforms, which were straightforward to clean. If necessary, the prosthesis could have been easily converted into a removable overdenture using the existing digital prosthetic arrangement. Should implant removal be required, the extrashort implants can be removed with minimal surgical risk or morbidity.

A parallel 3-group randomised clinical trial comparing different implant treatment options for the edentulous mandible: 1-year effects on dental patient-reported outcomes and chewing function.

OBJECTIVE: This parallel three-group randomised clinical trial compared the 1-year changes in dental patient-reported outcomes and chewing function associated with three treatment strategies for the edentulous mandible: single-implant (G-I; n = 11) or two-implant overdentures (G-II; n = 13), and fixed 4-implant complete denture (G-III; n = 13). METHODS: Complete denture (CD) treatment was provided to all participants and after an adaptation period, they were randomly assigned to one of the three study groups. Implants (Neodent TI Cortical, Brazil) were inserted using single-stage surgery and conventional loading. The mandibular dentures were incorporated into implants using specific retention systems and procedures according to the treatment group: O'ring/ball attachments for G-I and GII, and mini-conical abutments for G-III. Patients were assessed at baseline (CD stage) and up to 1-year after implant-retained prosthodontic treatment. Treatment outcomes included oral health-related quality of life (OHIP-Edent), satisfaction with the dentures and chewing function using a mixing ability test. Data analyses included pairwise comparison tests, estimates of effect sizes and regression analysis using Generalized Estimating Equations. RESULTS: Results showed improvement in patient-reported outcomes (lower OHIP-Edent scores and higher satisfaction) and chewing function, compared to baseline. No significant between-group differences were found, although effect sizes were lower for G-III. CONCLUSIONS: All treatments improved the assessed outcomes after transition from the baseline condition. Findings suggest that simplified implant treatments for edentulous patients result in favourable outcomes and may be considered as suitable alternatives to more complex interventions.

Anti-inflammatory potential of an essential oil-containing mouthwash in elderly subjects enrolled in supportive periodontal therapy: a 6-week randomised controlled clinical trial.

OBJECTIVES: Essential oils and other plant extracts have evoked interest as sources of natural medicinal products. They have been proven to exert antibacterial, antifungal, antiviral and antioxidant properties, but the mechanism of action has not been fully elucidated. AIM: This study aims to evaluate the potential of a sage-containing mouthwash to alleviate inflammatory signs of intra-oral mucosa and gingiva in comparison with a water/alcohol-based placebo. MATERIAL AND METHODS: This study was conducted as a randomised, placebo-controlled, double-blind, parallel design clinical study. Forty-eight dentate subjects were randomly assigned to a test (sage-containing mouthwash) or a placebo group (water/alcohol-based solution). Subjects rinsed once daily for 30 s over a period of 6 weeks. Sulcus Bleeding Index (SBI), Plaque Index (PLI), tooth staining, xerostomia and degree of stomatitis were assessed at baseline and after 6 weeks. RESULTS: Subjects' mean age was 77.5 ± 7.3 years. SBI was reduced from 1.3 ± 0.9 to 0.8 ± 0.7 (test, p = 0.0029) and 1.4 ± 0.9 to 1.1 ± 0.7 (placebo, p = 0.0105). Similarly, PLI was reduced from 1.2 ± 0.5 to 1.0 ± 0.3 (test, p = 0.0080) and 1.3 ± 0.4 to 1.1 ± 0.6 (placebo, p = 0.0087); no between-group differences were found (p > 0.05). Stomatitis, xerostomia and tooth staining revealed no change after 6 weeks. CONCLUSION: The irrigation with a sage-containing mouthwash did not result in a superior beneficial effect on inflammatory parameters and plaque indices compared with the placebo. The expected contribution of the plant extracts to their potential impact on oral health may need further investigation. CLINICAL RELEVANCE: The proposed mouthwash might be suitable for patients with inflammatory signs of the gingiva who prefer natural remedies.

Stabilizing Removable Partial Dentures by Immediate or Delayed Loading of Mini-implants: Chewing Efficiency in a Randomized Controlled Clinical Trial.

PURPOSE: The aim of this investigation was to compare the chewing efficiency after immediate and delayed loading of mini-implants that served as supplementary support for removable partial dentures (RPDs). MATERIALS AND METHODS: In this four-center randomized trial, patients who had RPDs in arches with unfavorable tooth distributions, ie, no canine and at most two posterior teeth in one or both quadrants, received strategic mini-implants with ball abutments. The mini-implants in group A were loaded immediately either by housings with O-rings (insertion torque ≥ 35 Ncm) or by soft relining material (insertion torque < 35 Ncm). In group B, the RPDs were only hollowed over the balls. After 4 months, the soft relined RPDs and all RPDs of group B received the housings. Masticatory efficiency was evaluated with a validated mixing ability test of two-colored chewing gum before surgery and 14 days, 4 months (before housing pickup), 4.5 months, and 12 months after surgery. The circular variance of hue was the measure of mixing. RESULTS: From 76 participants with 79 RPDs, 38 each were randomly allocated to group A or B. In group A, the housings in six participants were picked up immediately, and the remaining RPDs were primarily soft relined. There was a significant group difference only after 4 months. The mixing ability was better after immediate loading than after delayed loading (P < .0001). In group B, the chewing efficiency was notably deteriorated after the RPDs were hollowed over the ball abutments. However, immediately after all housings were picked up, the chewing efficiency in both groups was substantially improved, and the variance of hue values after 1 year were very similar in the groups. CONCLUSION: The chewing performance can be improved by inserting supplementary mini-implants under existing RPDs with unfavorable tooth support. This improvement occurred faster by immediate loading than by delayed loading.

Analysis of trends in implant therapy at a surgical specialty clinic: Patient pool, indications, surgical procedures, and rate of early failures-A 15-year retrospective analysis.

OBJECTIVES: To evaluate the patient population over a 3-year period and to compare it to observations of the population at the same clinic over a period of 15 years. MATERIAL AND METHODS: Records of patients receiving dental implants in the Department of Oral Surgery and Stomatology, University of Bern, between January 2014 and December 2016 were analyzed and then compared with data from patients treated between 2002 and 2004 and between 2008 and 2010. Patients were analyzed for demographics and for indications for therapy, as well as for presence or absence and type of complications. Inserted implants were analyzed for type, length, and diameter, as well as for the number and type of associated tissue regeneration procedures. RESULTS: Analysis revealed a continuous linear increase in the average age of patients seeking implant treatment. The most common indication for implant therapy was a single-tooth gap (STG) (50.5%), followed by distal extension situations (22.3%) and extended edentulous gaps (20.5%). A total of 60.8% of implants placed needed some type of bone augmentation, and 83.5% of implants placed in the anterior maxilla required simultaneous augmentation. Staged guided bone regeneration (GBR) was only necessary in 7% of the cases. Implant failure rates remained low at 0.6%, with postoperative hematomas being the most common postoperative complication (13.4%). CONCLUSIONS: The rising demand for dental implants continues as the patient population ages. Single-tooth gaps remained consistently the most common indication for implant therapy in recent years. Proper case selection and evidence-based surgical protocols are essential for high success rates.

Performance of a repair service set for the retrieval of fractured abutment screws: a pilot in vitro study.

PURPOSE: To report the success of a repair service set for the retrieval of fractured screws and to compare three clinical assessments to an in vitro assessment to verify the completeness of removal of the fractured screws. MATERIALS AND METHODS: Twelve clinicians were asked to remove fractured implant abutment screws from prepared specimens by means of a repair service set. The completeness of the removal of any abutment screw material was measured by the fit of an impression post, a dental surgery microscope, and the use of an elastomeric impression material. RESULTS: After the participants attempted to remove the fractured screw with the repair service set, 100%, 83.3%, 66.7%, and 75% of the fractured screws were considered successful in the impression post, dental surgery microscope, silicone replica, and stereomicroscope assessments, respectively. CONCLUSION: The retrieval of fractured screws succeeded in 75% of the cases. The silicone replica technique and the dental surgery microscope had similar diagnostic values to the stereoscopic microscope assessment.

The influence of guided sleeve height, drilling distance, and drilling key length on the accuracy of static Computer-Assisted Implant Surgery.

OBJECTIVE: The aim of this study was to evaluate the effect of guided sleeve height, drilling distance, and guided key height on accuracy of static Computer-Assisted Implant Surgery (sCAIS). MATERIALS AND METHODS: Pre and post-operative positions of implants placed in duplicate dental models were compared and recorded after placement of implants according to a standardized treatment planning and execution sCAIS protocol. Guided sleeve heights: 2 mm, 4 mm, 6 mm and guided key heights: 1 mm and 3 mm were equally randomized in six test groups with varying implant lengths (10-16 mm) and surgical drilling protocols. The mean crestal and apical three-dimensional (3D) deviation, as well as the angular deviation were calculated for each group. Data was analyzed using multivariate analysis anova. P values less than .05 were considered statistically significant. All P values of post-hoc tests were corrected for multiple testing using Bonferroni-Holm's adjustment method. RESULTS: 3D implant positioning accuracy was not significantly affected by the difference in sleeve height alone or by the implant length alone (P > .05). However, 3D and angular deviation values became significantly higher as the total drilling distance below the guided sleeve increased and significantly became lower as the guided key height above the sleeve increased. 18 mm drilling distance resulted in a significantly higher deviation, when compared to 14 mm or 16 mm drilling distances, irrespective of sleeve height or implant length (P < .01). 3 mm key height resulted in significantly less 3D deviation than 1 mm key height (P < .01). CONCLUSION: Decreasing the drilling distance below the guided sleeve, by using shorter sleeve heights or shorter implants can significantly increase the accuracy of sCAIS.

Practical Guidelines for Physicians in Promoting Oral Health in Frail Older Adults.

Good oral health in old age is particularly important for maintaining adequate oral function, preventing pain and discomfort, controlling localized or systemic inflammation, sustaining social interaction, and preserving quality of life. Given that oral health is an integral part of general health and well-being, and that major chronic systemic and oral diseases share common risk factors, oral health prevention and promotion should be embedded within routine medical assessment and care provision. The role of medical physicians, particularly primary care physicians, geriatricians, and elderly care physicians, in community and long-term care facilities in assessing and promoting oral health in frail older adults is critical and has been emphasized in recent European recommendations. All physicians should appreciate the importance of oral health and incorporate an initial oral health screening into routine medical assessment and care. A short interview with patients and carers on current oral health practices may help to assess the risk for rapid oral health deterioration. The interview should be followed by an oral health assessment, using validated tools, for nondental health care providers. Based on these findings, the physician should decide on necessary follow-up procedures, which may include oral health counseling and/or dental referral. Oral health counseling should include advice on daily oral, mucosal, and denture hygiene; denture maintenance; dietary advice; smoking cessation; limitation of harmful alcohol consumption; management of xerostomia; and frequent dental review. To enable physicians to perform the tasks recommended in this publication, appropriate teaching at both undergraduate and postgraduate levels must be delivered in addition to provision of appropriate continuing education courses.

Group 4 ITI Consensus Report: Risks and biologic complications associated with implant dentistry.

OBJECTIVES: The aim of Working Group 4 was to address topics related to biologic risks and complications associated with implant dentistry. Focused questions on (a) diagnosis of peri-implantitis, (b) complications associated with implants in augmented sites, (c) outcomes following treatment of peri-implantitis, and (d) implant therapy in geriatric patients and/or patients with systemic diseases were addressed. MATERIALS AND METHODS: Four systematic reviews formed the basis for discussion in Group 4. Participants developed statements and recommendations determined by group consensus based on the findings of the systematic reviews. These were then presented and accepted following further discussion and modifications as required by the plenary. RESULTS: Bleeding on probing (BOP) alone is insufficient for the diagnosis of peri-implantitis. The positive predictive value of BOP alone for the diagnosis of peri-implantitis varies and is dependent on the prevalence of peri-implantitis within the population. For patients with implants in augmented sites, the prevalence of peri-implantitis and implant loss is low over the medium to long term. Peri-implantitis treatment protocols which include individualized supportive care result in high survival of implants after 5 years with about three-quarters of implants still present. Advanced age alone is not a contraindication for implant therapy. Implant placement in patients with cancer receiving high-dose antiresorptive therapy is contraindicated due to the associated high risk for complications. CONCLUSIONS: Diagnosis of peri-implantitis requires the presence of BOP as well as progressive bone loss. Prevalence of peri-implantitis for implants in augmented sites is low. Peri-implantitis treatment should be followed by individualized supportive care. Implant therapy for geriatric patients is not contraindicated; however, comorbidities and autonomy should be considered.

Effect of advanced age and/or systemic medical conditions on dental implant survival: A systematic review and meta-analysis.

OBJECTIVES: his review evaluated implant survival in geriatric patients (≥75 years) and/or the impact of systemic medical conditions. MATERIALS AND METHODS: Systematic literature searches were performed to identify studies reporting on geriatric subjects with dental implants and on implant patients who had any of the seven most common systematic conditions among geriatric patients. Meta-analyses were performed on the postloading implant survival rates. The impact of systemic medical conditions and their respective treatment was qualitatively analyzed. RESULTS: A total of 6,893 studies were identified; of those, 60 studies were included. The fixed-effects model revealed an overall implant survival of 97.3% (95% CI: 94.3, 98.7; studies = 7) and 96.1% (95% CI: 87.3, 98.9; studies = 3), for 1 and 5 years, respectively. In patients with cardiovascular disease, implant survival may be similar or higher compared to healthy patients. High implant survival rates were reported for patients with Parkinson's disease or diabetes mellitus type II. In patients with cancer, implant survival is negatively affected, namely by radiotherapy. Patients with bone metastases receiving high-dose antiresorptive therapy (ART) carry a high risk for complications after implant surgery. Implant survival was reported to be high in patients receiving low-dose ART for treatment of osteoporosis. No evidence was found on implant survival in patients with dementia, respiratory diseases, liver cirrhosis, or osteoarthritis. CONCLUSIONS: Implant prostheses in geriatric subjects are a predictable treatment option with a very high rate of implant survival. The functional and psychosocial benefits of such intervention should outweigh the associated risks to common medical conditions.

An Expert Opinion from the European College of Gerodontology and the European Geriatric Medicine Society: European Policy Recommendations on Oral Health in Older Adults.

This is an expert opinion paper on oral health policy recommendations for older adults in Europe, with particular focus on frail and care-dependent persons, that the European College of Gerodontology (ECG) and the European Geriatric Medicine Society (EUGMS) Task and Finish Group on Gerodontology has developed. Oral health in older adults is often poor. Common oral diseases such as caries, periodontal disease, denture-related conditions, hyposalivation, and oral pre- and cancerous conditions may lead to tooth loss, pain, local and systemic infection, impaired oral function, and poor quality of life. Although the majority of oral diseases can be prevented or treated, oral problems in older adults remain prevalent and largely underdiagnosed, because frail persons often do not receive routine dental care, due to a number of barriers and misconceptions. These hindrances include person-related issues, lack of professional support, and lack of effective oral health policies. Three major areas for action are identified: education for healthcare providers, health policy action plans, and citizen empowerment and involvement. A list of defined competencies in geriatric oral health for non-dental healthcare providers is suggested, as well as an oral health promotion and disease prevention protocol for residents in institutional settings. Oral health assessment should be incorporated into general health assessments, oral health care should be integrated into public healthcare coverage, and access to dental care should be ensured.