Cierre de diastema con resinas compuestas híbridas / Diastema closure with hybrid composite resins

El tratamiento para el cierre de diastemas fundamentalmente está enfocado a otorgar estética y salud periodontal. Los diastemas pueden ser resueltos con prótesis y ortodoncia, sin embargo, estas opciones generalmente requieren de preparaciones del tejido sano, incluyen procedimientos de laboratorio y aumentan el tiempo clínico. La utilización de resinas compuestas constituye una opción estética y funcional para estos casos en los que se requiere de mínima intervención sobre el tejido sano o de ninguna. El propósito de esta presentación es describir un caso de cierre de diastema central anterosuperior utilizando resinas compuestas híbridas. Una paciente femenina de 21 años de edad acude a consulta para tratarse un diastema central superior. Se le propuso realizarle un cierre con resina compuesta híbrida. Se aplicó consentimiento informado y se obtuvo aprobación. Se realizó resolución del diastema con técnica incremental con resina híbrida hasta lograr el punto de contacto cuidando la salud periodontal. Se planificó el tratamiento, se pulieron las superficies a incrementar, se aplicaron sistemas adhesivos y se aplicaron capas de resina hasta lograr el resultado deseado. Mejoró la estética y se logró la total satisfacción de la paciente. En este caso, los pasos de la técnica de restauración directa con incremento d4e resina compuesta híbrida fueron seguidos adecuadamente. Se logró el cierre del diastema y el restablecimiento del punto de contacto sin forzar la papila interdental(AU)

Treatment for diastema closure is mainly aimed at providing periodontal health and an appropriate esthetic appearance. Diastemata may be treated with prosthesis and orthodontics, but these options generally require preparation of the healthy tissue, including laboratory procedures which increase clinical time. The use of composite resins is an esthetic, functional option for cases in which little or no intervention is required upon healthy tissue. The paper is aimed at describing a case of central anterior superior diastema closure using hybrid composite resins. A 21-year-old female patient presents at consultation requesting treatment for a central superior diastema. Closure with hybrid composite resin was suggested. After obtaining informed consent, resolution of the diastema was performed using an incremental technique with hybrid resin until the contact point was reached, taking care of periodontal health. Treatment was planned, the surfaces to be increased were polished, adhesive systems were applied and resin layers were placed until the desired result was achieved. Esthetic appearance was improved, with total patient satisfaction. In this case the steps of direct restoration technique with hybrid composite resin increase were adequately followed. Diastema closure and contact point restoration were achieved without forcing the interdental papilla(AU)

Incidence of peri-implant mucositis and peri-implantitis in edentulous patients with an implant-retained mandibular overdenture during a 10-year follow-up period.

OBJECTIVES: The aim of this sub-analysis of two prospective studies was to assess the incidence of peri-implant mucositis and peri-implantitis in fully edentulous patients with an implant-retained mandibular overdenture during a 10-year follow-up period. MATERIAL AND METHODS: One hundred and fifty edentulous patients with two endosseous implants to support a mandibular overdenture were available from two prospective studies. Clinical and radiographic parameters were assessed at 5 and 10 years of functional loading. Incidence of peri-implant mucositis and peri-implantitis were calculated at implant level and patient level following the Consensus of the Seventh European Workshop on Periodontology on peri-implant diseases. RESULTS: Incidence of peri-implant mucositis at patient level was 51.9% after 5 years of evaluation and 57.0% after 10 years. Incidence of peri-implantitis at patient level was 16.9% after 5 years of evaluation and 29.7% after 10 years. CONCLUSION: Peri-implant mucositis and peri-implantitis do occur in totally edentulous patients and incidence numbers are high.

Prevalence and risk factors for peri-implant disease in Belgian adults.

OBJECTIVES: This study aimed to evaluate in a Belgian population the frequence of mucositis and peri-implantitis in patients with implants of at least 5 years of function. Another outcome was to access implants/patients characteristics as possible risk indicators for peri-implantitis. MATERIAL AND METHODS: One hundred and three patients (38 males/65 females) with a total of 266 implants were examined. Implants had been inserted in university hospitals as well as in private clinics and the mean time of implants in function was 8.5 years (±3.2). The average patients' age within the population was 62 years (±13.4). General health informations were recorded as well as habits regarding smoking, maintenance visits and oral hygiene. Full mouth clinical parameters (PlI, BoP, PPD) were assessed and radiographs taken to determine the periodontal status and implants diagnosis. RESULTS: Prevalences of mucositis and peri-implantitis at the patient's level were respectively 31% and 37%. They were 38% and 23% at the implant's level. Subjects older than 65 years (OR = 1.39) and those with active periodontitis (OR = 1.98) were prone to peri-implantitis. The association was stronger for hepatitis (OR = 2.92) and totally edentulous patients (OR = 5.56). Finally, at the implant's level, a significant correlation was found in the multi-level analyses between rough surfaces, overdentures and peri-implantitis. CONCLUSION: After 8.5 years an important proportion (±60%) of implants presented biological complications. Furthermore, a positive correlation was showed between age, periodontitis, absence of teeth, rough surfaces and peri-implantitis. Consequently, patients with such characteristics should be informed before implant placement and frequently re-called after for maintenance visits.

An inventory of mandibular fractures associated with implants in atrophic edentulous mandibles: a survey of Dutch oral and maxillofacial surgeons.

PURPOSE: The present study provides an inventory of the number of fractures that occurred in conjunction with implant placement in edentulous patients in the Dutch population from 1980 to 2007 and estimates the incidence with which this might occur. The study also sought to define the factors that increase the risk of fracture. MATERIALS AND METHODS: Questionnaires were sent to all 198 oral and maxillofacial surgeons working in 56 hospitals in the Netherlands. Questions were asked regarding the causes of fractures, the height of the edentulous mandible, and the methods of fracture treatment. RESULTS: Responses were received from 53 of the 56 departments. During the study period, 157 edentulous mandibles fractured in conjunction with implant treatment. All fractures occurred in mandibles with less than 10 mm of height, as measured in the symphysis. An incidence of less than 0.05% was estimated based on an estimated number of 475,000 patients treated with at least two implants during this time to support an overdenture. Reasons for early implant failures were insufficient bone volume, iatrogenic causes, nonintegration, and a narrow arch. Peri-implantitis, trauma, and explantation were associated with fractures occurring 1 year or more after implant placement. Several methods were employed to treat the fractured mandibles, including closed reduction, rigid fixation using osteosynthesis plates, and bone grafts with fixation. In 52% of patients, fracture healing was uneventful; however, in 48% of patients, complications were encountered, including osteomyelitis, nonunion, plate fracture, screw loosening, and dehiscences with subsequent infections. CONCLUSIONS: Mandibles with a height of 10 mm or less, as measured at the symphysis, are at risk of fractures and associated complications. The provision of proper informed consent regarding the advantages and disadvantages of placing implants in thin mandibles is essential.

Tooth-related risk factors for periodontal disease in community-dwelling elderly people.

OBJECTIVE: While most previous epidemiological studies have focused on subject-level risk factors for periodontal destruction, tooth-related factors have not been fully explored. The purpose of this study was to evaluate both tooth-related and subject-related factors affecting periodontal disease progression using a two-level multilevel model. MATERIAL AND METHODS: A longitudinal survey over a period of 10 years was carried out on 286 community-dwelling elderly subjects aged 70 years at baseline. Clinical attachment level (CAL) was measured at six sites per tooth on all teeth present and periodontal disease progression was defined as CAL> or =3 mm. RESULTS: Periodontal disease progression was found in 79% of the subjects and most frequently in maxillary molars. Multilevel logistic regressions revealed that subjects wearing removable dentures were significantly at risk for periodontal disease progression. Abutment teeth for removable/fixed dentures were also significantly more likely to suffer periodontal breakdown. Furthermore, the following tooth-related variables were found to be possible risk factors for periodontal disease progression: maxillary and multirooted teeth. CONCLUSION: Multirooted teeth and abutments for a fixed denture were possible risk factors for periodontal disease progression.

Demographics of implant placement and complications of a patient subgroup in a dental hospital population.

STATEMENT OF PROBLEM: Little has been reported about the demographics of implant placement in the Irish population and the complications that occur. This is important in terms of service planning and providing patient information. PURPOSE: The purpose of this study was to construct a database of patients who had implants placed in the Dublin Dental School et Hospital from 2000 to 2006. Also, we wanted to compare the complications that occurred in patients who had overdentures to those with a fixed prosthesis. METHODS: Hospital records were searched for all patients who had implants placed over a seven-year period and we recorded demographic information, as well as details of the implant site, implant type and restoration. Patients who had four or more implants placed for an implant-supported overdenture or fixed prosthesis were invited to attend for a clinical examination. RESULTS: A total of 1,111 implants were placed in 452 patients over the study period--half of the implants supported single crowns, while the other half supported mainly overdentures and full arch fixed prostheses, with few fixed partial dentures. The 40- to 60-year-olds had the greatest number of implants placed of any age group and most implants were placed in the anterior region. Patients with implant-supported overdentures recorded more complications (52%) compared to those with fixed prostheses (32%). The most common complications associated with both treatments were gingival inflammation and peri-implant mucositis. Overdentures additionally had a significant number of retentive clip fractures. CONCLUSIONS: Implant-supported overdentures and fixed prostheses were both clinically successful. However, patients and clinicians should be aware that soft tissue and mechanical complications are common.

Five-year clinical evaluation of short dental implants placed in posterior areas: a retrospective study.

BACKGROUND: The aims of this study were to evaluate the long-term survival rates of short dental implants in posterior areas and to analyze the influence of different factors on implant survival. METHODS: A retrospective cohort study design was used. A total of 293 subjects received 532 short implants between 2001 and 2004. All implants were placed by two experienced surgeons, and rehabilitations were done by three prosthodontists. Each implant failure was analyzed carefully. The potential influence of demographic factors, clinical factors, surgery-dependent factors, and prosthetic variables on implant survival was studied. Implant survival was analyzed using a life-table analysis (Wilcoxon [Gehan] test). RESULTS: The overall survival rates of short implants were 99.2% and 98.7% for the implant- and subject-based analyses, respectively. The mean follow-up period was 31 +/- 12.3 months. Two of 532 implants were lost during the observation period. None of the variables studied were statistically associated with implant failure. CONCLUSION: Treatment with short implants can be considered safe and predictable if used under strict clinical protocols.

A long-term study of implants supporting overdentures as a model for implant success.

BACKGROUND: Implant-supported overdentures have been a common treatment for edentulous patients for the past 20 years, achieving good clinical results. The purpose of this study was to examine survival and success rates of implants supporting overdentures in the maxilla and mandible and to examine the influence of factors related to patients, implant procedure, implant data, and follow-up period on implant success. METHODS: During a 10-year period (1990 to 2000), 285 implants were placed in 62 patients to support 69 overdentures (seven patients had overdentures in both jaws). Patients ranged in age from 45 to 85 years (mean 64.5 years). The files of 61 patients, including 277 implants supporting 68 overdentures (14 maxillary and 54 mandibular), had measurable radiographic post-exposure follow-up (range 6.63 to 110.93 months, mean 37.93 months) for cervical bone loss (CBL) measurements. Bone loss was measured by radiographic examination in which the mean number of exposed threads in mesial and distal sides of the implant was considered. Implants were rehabilitated by overdentures with bar (N = 52) or ball (N = 16) attachments. RESULTS: Implant survival rate was 96.1% (11/285 did not survive) and total 10-year cumulative survival rate was 95.4% (maxilla, 83.5%, mandible, 99.5%). The success rate was 70.4% (maxilla, 41.9%; mandible, 80.8%) when using Albrektsson et al. success criteria. A logistic regression analysis showed that the maxilla (P <0.0001) and a short follow-up period (up to 5 years) (P = 0.017) were the most influencing factors enhancing CBL. CONCLUSIONS: 1) Survival of implants supporting overdentures was very high; 2) implants supporting overdentures in the maxilla had greater CBL than in the mandible; and 3) new criteria of implant success should be considered.

A survey of U.K. centres on implant failures.

This study investigated the experience of endossoseus implants in the U.K. - how success rates compare with other countries; the common causes of failure; early detection, definition and treatment of the failing implant. Information was gathered by means of a questionnaire sent to 120 centres in the U.K. Thirty-nine centres responded to the survey, reporting on a total of 5328 implants which had been placed over an average time period of 6.5 years. A mean failure rate of 4.3% was reported in the mandible with 16% in the maxilla. The survey showed that 11 different implant systems were in use and that implants were used to support an overdenture in 56% of cases, and bridgework in 26%. The definition of the failing implant and the causes of failure were unclear, with a wide range of opinions given. A combination of methods were used to treat the failing implant including surgical techniques and chemotherapeutic agents, but the long-term success of these treatments was uncertain. Failure rates especially in the maxilla at some of the centres appear higher than have been previously suggested in the U.K. or abroad. Universal agreement on the criteria for 'success' and 'failure' of fixtures is needed along with agreed treatment protocols for the failing implant.

Implant placement in prosthodontics practice: a five-year retrospective study.

UNLABELLED: Dental implants have revolutionized dentistry in every aspect of treatment including surgery, restorative dentistry, and orthodontic treatment planning. PURPOSE: This retrospective study analyzes the treatment of completely and partially edentulous patients in a prosthodontics practice and the Edmonton Implant Seminar. MATERIAL AND METHODS: All implant surgery was performed by the prosthodontist. The majority of implants (336) were restored by the prosthodontist (71%). A total of 135 restorations were provided by 12 different general practitioners (29%) in a study group environment. RESULTS: Of 471 implants that were placed, 453 (96.2%) integrated successfully. Treatment groups were divided into single implant restoration (19.3%), fixed partial dentures (51%), overdentures (12.3%), and mandibular fixed partial denture cantilever (17.6%). Retention of final prosthesis was 99.4%. Of 18 failures, four occurred between Stage I and II surgeries, 11 occurred between Stage II surgery and final impressions, and three occurred after placement of final restorations. All three restorative failures were single implants. CONCLUSION: The results indicated that implant placement by a prosthodontist is comparable to the success of previous studies.

Characteristics of 5410 edentulous implant candidates and the treatment they receive.

Since 1989 implant dentistry in the Netherlands is a National Dental Insurance (NDI) benefit, thus reducing out-of-pocket expenditures for implant candidates considerably. A nationwide investigation was set up in order to evaluate quantitative, qualitative and financial effects of this new provision. The patient and treatment characteristics of 5410 edentulous implant candidates are discussed. Intensive monitoring of the usage of these new regulations facilitates health care policy making, including future planning. Over a 3 1/2 yr period, two out of every thousand totally edentulous NDI patients were treated in combination with dental implants. This number is being considered small, bearing in mind the number of edentulous patients in the Netherlands and the proportion of dissatisfied denture wearers. Demographic data, prosthetic and pre-prosthetic surgical history reveal that these patients, mostly female and middle-aged, experience severe denture-related problems. In the majority of cases the implants are placed by an oral surgeon and the suprastructure is made by a general dentist or at a centre for special dental care. The treatment itself mostly consists of an implant retained overdenture on two or four permucosal implants and a bar-construction.

Osseointegration and the edentulous predicament. The 10-year-old Toronto study.

This prospective study at the University of Toronto reports the 5-10-year results of treatment of edentulous patients with osseointegrated implant supported bridges. It comprised 46 consecutively treated patients, chosen because optimisation of traditional prostheses was not successful and because they were in sufficiently good health to allow minor out-patient surgery. Two hundred and seventy-four implants were surgically placed in 49 arches (three patients were treated in both arches) between October 1979 and March 1984. At the end of the 5-10-year observation period, 242 (88.32%) of the implants remained osseointegrated and 233 or 85.04% of these implants were used to support 43 fixed bridges and five overdentures. Nine implants, though osseointegrated, were not exposed and were not used to support the prostheses. Forty-eight of the 49 arches continue to be successfully restored with implant retained prostheses.

[Long-term experiences with large bridge-work after partial resection of the lower jaw]. / Langzeiterfahrungen beim Einsatz von grossen Uberbrückungsplatten nach Unterkiefer-Teilresektion.

In a period of 12 years 121 bridging plates were implanted for the reconstruction of madibular defects following radical tumour surgery. 60 (49.6%) of these implants had to be removed prematurely due to: 1. postoperative perforation of the plate through either skin or oral mucosa, 2. implant fracture, 3. infection of the graft bed, 4. postoperative dehiscence and remaining fistula. Inadequate soft tissue coverage of the bridging plate is discussed as the main reason for the above mentioned complications.