The provision of oral hygiene instructions and patient motivation in a dental care system without dental hygienists.

INTRODUCTION: Oral hygiene instructions (OHI) and patient motivation (PM), often provided by dental hygienists, are essential attributes to establishing good oral health in patients. The purpose of this study was to investigate the provision of OHI and PM by dental professionals in a dental care system without dental hygienists. METHODS AND MATERIALS: A questionnaire, including 22 items (demographics, OHI and PM), was presented to 1037 dental professionals (=21.6% Flemish population). Descriptive statistics were used to analyse the provision of OHI and PM. Additionally, the Fisher-Freeman-Halton exact test was used to investigate the influence of qualification (general practitioner/specialist), work experience (< or ≥ 25 years), workload (< or ≥ 30 h), location of practice (rural/urban) and chair-side assistance (with/without). RESULTS: Response rate was 75%. Participants reported a single strategy for preventive care and felt their efforts were not in harmony with the results. Lack of time, remuneration and patient interest were reported as complicating factors and participants agreed on allowing assistants to provide preventive care. Significant variance was found based on qualification (12/17 items), work experience (7/17 items), workload (1/17 items), location of practice (2/17 items) and chair-side assistance (15/17 items). CONCLUSION: In a context without dental hygienists, OHI and PM appeared non-compliant with current international guidelines. Although dental professionals were concerned with preventive dentistry, they reported barriers including lack of time, remuneration and patient compliance. Almost all participants expressed the need for delegation of in-mouth OHI, suggesting a need for dental hygienists.

A pilot assessment tool of the need for oral health care and cost prediction in institutionalized elderly people.

OBJECTIVE: To assess the dental treatment backlog and associated costs among institutionalized elderly people using a novel composite index, called the oral health index. BACKGROUND: Despite numerous reports about oral health of old individuals, there is still lack of a systematic and practical method to estimate their treatment need covering all relevant aspects of oral health. In addition, little has been published on associated treatment costs and prediction of such costs. MATERIALS AND METHODS: An observational study was performed on 143 dentate institutionalized elderly people, whereby several clinical parameters were registered. The collected data were included in the oral health index representing the need for oral health care. This covered the number of caries lesions, number of residual roots, periodontal health condition, plaque score and denture condition with a final score of 0-9. To investigate the validity of the index, the treatment costs were estimated using the measured clinical parameters and later compared with the actual expenditure of the patients for the following 2 years. RESULTS: The average score of the index was 4.6 (SD 1.4) with 65.1% of the individuals having a score between 3 and 6 and 27.3% having a score of 6 and more, exhibiting medium and high need for oral health care, respectively. Only 30% of the patients underwent all the indicated treatments. The major reason of non-completion of the treatment was patient's refusal. From the fully treated group, 61.5% of the subjects actually spent within the predicted range while 38.5% of them spent more than estimated. The underestimation was related to yearly calculus removals leading to repeated calculation of the same costs and newly emerging dental problems (33% developed new caries and 20% was confronted with tooth fracture within the 2-year period). CONCLUSION: The novel index can be helpful to determine oral treatment needs and associated costs. Further research is needed to extend the clinical applicability of the index.

Using discussion groups as a strategy for postgraduate implant dentistry students to reflect.

INTRODUCTION: More than undergraduates, postgraduate students have the day-to-day clinical experience to reflect upon. Nevertheless, reflection in postgraduate dental education is less well studied. Hence, the purpose was to investigate the attitude towards reflection and the content of reflections in postgraduate implant dentistry education in the UK and Belgium. MATERIALS AND METHODS: To investigate the attitude towards reflection, a questionnaire was administered to the 10 postgraduates at UCL Eastman Dental Institute (EDI) and 6 postgraduates at Ghent University (UGent). Additionally, students were invited to attend two reflective sessions (60-90 minutes). The sessions' audio recordings were transcribed and analysed using a thematic approach. RESULTS: In total, 16 postgraduate implant dentistry students participated. Although the majority reported prior experience with reflection, there was variation in the provided definitions of reflection. EDI students agreed with reflection being beneficial for professional development/clinical reasoning and were positive about discussing clinical experiences in groups, but were divided about individual/group reflections. Their UGent counterparts were more indecisive (=neutral), but were positive about discussing clinical experiences. Thematic analysis identified recurring themes as individual learning process, learning and clinical experiences, attitude towards implant dentistry and course programme. EDI postgraduates' reflections focussed on specific clinical situations, while UGent postgraduates' reflections described general considerations. CONCLUSION: Although students/professionals often report to reflect, it is not clear whether/how they actually reflect, due to the all-purpose word reflection has become. A strategy, using group discussions along with supervision/guidance in how to reflect, demonstrated to expand clinical reasoning into reflections about postgraduate students' clinical actions and professional growth.

Cost estimation of single-implant treatment in the periodontally healthy patient after 16-22 years of follow-up.

BACKGROUND: Costs for single-implant treatment are mostly described for the initial treatment. Information on the additional cost related to aftercare is scarce. OBJECTIVE: To make an estimation of complication costs of single implants in periodontally healthy patients after 16-22 years and to compare costs for various prosthetic designs. MATERIALS AND METHODS: Patients with a single implant were recalled for a clinical examination and file investigation. Prosthetic designs included single-tooth (ST) and CeraOne (CO) abutments supporting a porcelain-fused-to-metal (PFM), all-ceramic (CER), or gold-acrylic (ACR) crown. Costs related to failures or technical, biologic, and aesthetic complications were retrieved from patient's records. Total and yearly additional complication costs were calculated as a percentage relative to the initial cost. Chair time needed to solve the complication was recorded and prosthetic designs were compared by Kruskal-Wallis tests. RESULTS: Fifty patients with 59 surviving implants were clinically investigated. Additional complication costs after a mean follow-up of 18.5 years amounted to 23% (range 0-110%) of the initial treatment cost. In total, 39% of implants presented with no costs, whereas 22% and 8% encountered additional costs over 50% and 75%, respectively. In 2%, the complication costs exceeded the initial cost. The mean yearly additional cost was 1.2% (range 0-6%) and mean complication time per implant was 67 min (range 0-345 min). Differences between prosthetic designs (CO, ST-PFM, ST-ACR) were statistically significant for total cost (P = 0.011), yearly cost (P = 0.023), and time (P = 0.023). Pairwise comparison revealed significant lower costs for CO compared with ST-ACR reconstructions. CONCLUSION: Patients should be informed about additional costs related to complications with single implants. The mean additional cost spent on complications was almost one-quarter of the initial treatment price. A majority of implants presented with lower additional costs, whereas the highest complication costs were related to a smaller group with 22% of the implants needing more than half of the initial cost for complication management. Expenses were significantly different for various prosthetic designs.

Contemporary undergraduate implant dentistry education: a systematic review.

INTRODUCTION: Consensus reports recommend that students upon graduation should possess a significant level of knowledge and competence in implant dentistry, including basic competences in diagnostics, treatment planning, restorative, straightforward surgical and maintenance procedures. In response, undergraduate curricula need to integrate implant dentistry. This narrative review explores educational programmes in terms of competences, related research and barriers or reflections, regarding implementation in undergraduate curricula. MATERIALS AND METHODS: Publications (2008-2013) were searched systematically in WoS, PubMed and ERIC and screened independently by two authors in four stages: removal of duplicates, title screening, abstract screening and full-text reading. Inclusion criteria encompassed implant dentistry in undergraduate education. RESULTS: Finally, 37 of 420 papers were included. Detailed information regarding programme content, number of participants, staff input, logistics/funding issues is scattered. Theoretical education is predominant, and pre-clinical/clinical training is offered minimally, often carried out in elective programmes. However, selected straightforward cases treated by undergraduates yield positive outcomes with low failure rates, few complications, high patient satisfaction and student appreciation. Barriers to implementing implant dentistry in the undergraduate curriculum include funding issues, limitations in time or staff availability/competence and lack of suitable patients. Overcoming these barriers is worthwhile as experience-based implant education affects future practice as well-informed students propose more restorative alternatives to their patients. CONCLUSION: Although implant dentistry is increasingly integrated in undergraduate curricula, challenges remain in developing strategies to implement existing competence profiles and the extent of experience-based education. To support further advancement, universities should report comprehensively on their implant programmes to allow comparison and reproduction in other environments.

Implant dentistry education in Europe: 5 years after the Association for Dental Education in Europe consensus report.

INTRODUCTION: To promote consensus on implant dentistry university education in Europe, a workshop amongst university teachers and opinion leaders was organised in 2008. As a result, guidelines on both under- and postgraduate education were issued. This study aims to investigate the current status of university teaching of implant dentistry and the impact of the recommendations for teaching and assessment, 5 years after the first consensus. Finally, this report attempts to identify future directions in education within the discipline. MATERIALS AND METHODS: An online survey was distributed amongst 105 academic leaders in implant education in Europe, and 52 questionnaires were returned (response rate 50%). RESULTS: The average amount of implant dentistry in undergraduate curricula has increased to 74 h, compared to 36 h in 2008, and the inclusion of pre-clinical and clinical education has increased. No change occurred with regard to the aimed competence levels. It was suggested that certain implant procedures including surgery should be provided by dentists after attending additional courses, whilst complex treatments will still require specialist training. The 2008 workshop guidelines have been implemented to a varying extent (25-100%) in under- and postgraduate education. Main reported implementation barriers included limited time availability in the curriculum and limited financial/material resources. Future discussions about implant dentistry in Europe should be focused towards integration in current dental curricula, approaches to overcome barriers and the relations with and role of industrial partners. CONCLUSION: Implant dentistry is increasingly integrating in undergraduate dental education. Development of the consensus guidelines in 2008 may have facilitated this process. Nevertheless, further progress is needed on all educational levels to align training of professionals to the growing treatment needs of the population.

Dental implants placed by undergraduate students: clinical outcomes and patients'/students' perceptions.

INTRODUCTION: Implant dentistry in undergraduate education is predominantly theoretical or prosthetics oriented. Clinical experience with implant surgery could provide students a better understanding of alternatives for tooth replacements. This study describes an implant dentistry programme for undergraduate students, which included surgical placement of implants. The study presents the clinical outcomes of the programme, patients' satisfaction and students' attitudes/perceptions. It reflects on barriers and problems encountered during implementation and provides suggestions for other institutions. MATERIALS AND METHODS: Thirty-six students placed one implant each for a single tooth replacement after careful radiographic assessment and pre-surgical planning. One-stage surgery was performed under one-to-one supervision. Crowns were cemented on individual abutments 3-6 months later. Crestal bone loss was assessed radiographically immediately after surgery, at crown placement and after 1 year of loading. Questionnaires were used to investigate patients' perspectives and students' opinions towards the programme, as well as their perceived level of competence. RESULTS: Thirty-six implants were placed in 27 patients; two (5.6%) failed prior to loading; mean bone loss from time of surgery to crown placement was 1.41 mm and remained unchanged thereafter, reflecting implant success. Overall, patients were satisfied and the majority would repeat the treatment by a student. The students thought it was a valuable experience, although they realised that additional education is necessary to perform implant surgery without supervision. CONCLUSION: Implant placement by undergraduate students resulted in acceptable clinical outcome parameters, patient satisfaction and positive student perceptions. These findings support the further development of clinical implant education in undergraduate dental curricula.

Developing implant dentistry education in Europe: the continuum from undergraduate to postgraduate education and continuing professional development.

INTRODUCTION: Implant dentistry is a treatment modality which has mainstream clinical practice of comprehensive care, which however is not adequately represented in the undergraduate dental curricula. A consensus workshop organised by ADEE in 2008, set the benchmarks for the knowledge and competences a modern dental practitioner must possess with regard to implant dentistry, as well as defined undergraduate and postgraduate pathways for the acquisition of these competences. Today, 5 years later, there exist several challenges for the implementation of these benchmarks in both undergraduate curricula but also post-graduation educational pathways. METHODS: A consensus workshop was organised by ADEE, bringing together 48 opinion leaders, including academic teachers of all disciplines related to implant dentistry, specialists, representatives of relevant scientific and professional associations, as well as industry delegates. The objectives of the workshop were to evaluate the existing scientific literature, reported experience and best practices in order to identify potential and limitations for the implementation of implant dentistry in the undergraduate curriculum, as well produce recommendations for the optimal educational structures for postgraduate programmes and continuing professional development. RESULTS: The scientific committee conducted two European-wide questionnaire surveys to better document the current state of education in implant dentistry. Upon completion of the surveys, reviewers were appointed to produce three scientific review papers, identifying current achievements and future challenges. Finally, during the 3 days of the workshop, all the evidence was reviewed and the main conclusions and recommendations that were adopted by all participants are reported in the present Consensus Paper. CONCLUSIONS: Implementation of implant dentistry in the undergraduate curriculum has improved significantly, but still lags behind the benchmarks set in 2008 and the diversity between institutions remains big. At the post-graduation level, there is currently a wide diversity of courses and pathways towards competences related to implant dentistry and there is at present a great need for quality assurance, as well as standardisation and transparency of the learning outcomes.

Effects of root surface debridement using Er:YAG laser versus ultrasonic scaling - a SEM study.

OBJECTIVE: Despite promising results of Er:YAG laser in periodontal debridement, to date there is no consensus about the ideal settings for clinical use. This experimental clinical trial aimed to determine the effects of debridement using Er:YAG laser and to compare with ultrasonic treatment. MATERIALS AND METHODS: Sixty-four teeth were divided into two in vivo and in vitro subgroups. Each tooth received ultrasonic treatment on one side and Er:YAG laser debridement at either 60, 100, 160 or 250 mJ pulse(-1) and at 10 Hz on the other side on a random basis. All samples were morphologically analyzed afterwards under scanning electron microscope for surface changes and dentinal tubules exposure. Treatment duration (d) was also recorded. RESULTS: Laser debridement produced an irregular, rough and flaky surface free of carbonization or meltdown while ultrasound produced a relatively smoother surface. The number of exposed dentinal tubules (n) followed an energy-dependent trend. The number of exposed tubules among the in vivo laser groups was n 60 mJ = n 100 mJ < n 160 mJ < n 250 mJ (P < 0.001). Also 160 and 250 mJ lasers led to significantly more dentinal exposure than ultrasound under in vivo condition. Within the in vitro laser groups, dentinal tubules exposure was n 60 mJ < n 100 mJ < n 160 mJ < n 250 mJ (P ≤ 0.0015). Furthermore, in vitro laser treatments at 100, 160 and 250 mJ led to significantly more dentinal denudation than ultrasound. Treatment duration (d) for the in vivo groups was d 60 mJ > d 100 mJ > d Ultrasound = d 160 mJ > d 250 mJ (P ≤ 0.046), while for the in vitro groups it was d 60 mJ > d 100 mJ = d Ultrasound = d 160 mJ >d 250 mJ (P ≤ 0.046). CONCLUSIONS: Due to excessive treatment duration and surface damage, Er:YAG laser debridement at 60 and 250 mJ pulse(-1), respectively, is not appropriate for clinical use. Although laser debridement at 100 and 160 mJ pulse(-1) seems more suitable for clinical application, compared to ultrasound the former is more time-consuming and the latter is more aggressive. Using a feedback device or lower pulse energies are recommended when using laser in closed field.

A prospective study on implants installed with flapless-guided surgery using the all-on-four concept in the mandible.

AIM: Clinical data are scarce on flapless-guided surgery in the mandible using the all-on-four concept. In addition, limited documentation exists on the latter under immediate loading conditions with a pre-fabricated implant bridge. The aim was to provide detailed documentation focusing on clinical and radiographic outcome and complications. MATERIAL AND METHODS: Sixteen systemically healthy non-smoking patients (10 women, 6 men, average age 59 years) with sufficient bone volume in the mandible were operated via flapless-guided surgery using the all-on-four concept. Clinical and radiographic data and complications were registered at 3, 6 and 12 months. RESULTS: The overall implant survival rate was 90% with a trend for higher failure of short implants (P = 0.098). The mean bone level after 12 months of function was 0.83 mm with a maximum of 1.07 mm. Technical complications were common (15/16 patients). These mainly related to a misfit between the pre-fabricated prosthesis and abutment(s) (13/16 patients). CONCLUSION: If immediate loading of implants is pursued fabrication of the implant bridge should be based on actual impression of the implants at the time of surgery and not on their virtual position.

Clinical effects of an essential oil solution used as a coolant during ultrasonic root debridement.

AIM: The use of chlorhexidine and povidone iodine solutions applied as a coolant during ultrasonic root debridement for the treatment of chronic periodontitis has been described. Hitherto, this application has not yet been extensively investigated for essential oil solutions. The goal was to clinically explore this and to compare to water irrigation. MATERIALS AND METHODS: Thirty-five chronic periodontitis patients participated in a single-blind randomized controlled clinical study. Patients were randomly allocated to the control group (n=18) or test group (n=17) receiving oral hygiene instructions and ultrasonic root debridement using water as a coolant, respectively, a pure essential oil solution. Oral hygiene was reinforced if necessary at each occasion, and clinical parameters were collected at baseline and after 1 and 3 months. RESULTS: Significant pocket reduction (control, 1.02 mm; test, 0.89 mm) and clinical attachment gain (control and test, 0.48 mm) were shown in both groups. However, there were no significant differences between the groups at any point in time for any of the parameters. CONCLUSION: Essential oil solutions do not offer a clinical benefit over water when used as a coolant during ultrasonic root debridement for the treatment of chronic periodontitis.

A double-blind randomized placebo-controlled study on the clinical and microbial effects of an essential oil mouth rinse used by patients in supportive periodontal care.

AIM: This 3-month double-blind randomized placebo-controlled study evaluated the clinical and microbial effects of an essential oil mouth rinse used as an adjunct to mechanical plaque control by patients in supportive periodontal care. MATERIAL AND METHODS: Fifty patients were randomly allocated to an essential oil group (Listerine(®) Coolmint; Johnson & Johnson, New Brunswick, NJ, USA) or placebo group to rinse twice per day as an adjunct to mechanical plaque control. At baseline and after 3 months, plaque index (PI), gingivitis index (GI), probing pocket depth, bleeding on probing (BoP) and clinical attachment level were registered. Subgingival plaque samples were collected for the detection and quantification of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Micromonas micros, Prevotella intermedia, Fusobacterium genus and Streptococcus mutans by means of real-time PCR (qPCR). Patient's compliance, satisfaction and side effects were registered. RESULTS: Twenty-three patients in the essential oil group (mean age: 57) and 21 in the placebo group (mean age: 55) with acceptable oral hygiene at intake (mean PI <1.5 on a scale of 5) adhered to the study protocol. Gingivitis index, PI and BoP significantly reduced over time (P ≤ 0.029); however, between group analyses revealed no significant differences. There was no significant change over time neither in detection frequency nor load for any of the microbiota. Daily rinsing with an essential oil rinse was found safe and perceived beneficial by the patients. CONCLUSION: Patients in supportive periodontal care who are fairly compliant with oral hygiene may not benefit from additional mouth rinsing using an essential oil solution.

Long-term follow-up of turned single implants placed in periodontally healthy patients after 16-22 years: radiographic and peri-implant outcome.

OBJECTIVES: Retrospectively evaluate the survival, radiographic and peri-implant outcome of single turned Brånemark™ implants after at least 16 years. MATERIALS AND METHODS: From 134 patients (C-group), 101 could be contacted concerning implant survival and 50 (59 remaining implants) were clinically examined (I-group). Marginal bone level was radiographically measured from the implant-abutment junction at baseline (=within 6 months after abutment connection) and 1-4, 5-8 and 16-22 years post-operatively. Probing depth, gingival and plaque index were measured. Marginal bone-level changes were analyzed using Friedman's and Wilcoxon's signed ranks tests. Spearman's correlations between radiographic and clinical parameters were calculated. RESULTS: In the C-group, 13 out of 166 implants in 11 out of 134 patients failed (CSR=91.5%). In the I-group (28 males-22 females; mean age 23.9 years at baseline; range 14-57), the mean follow-up was 18.4 years (range 16-22). The mean bone level was 1.7±0.88 mm (range -0.8 to 5) after 16-22 years. Changes in the mean marginal bone level were statistically significant between baseline and the second measuring interval (1-4 years). Thereafter, no significant differences could be demonstrated. The mean interproximal probing depth, gingival and plaque indices were 3.9±1.27 mm, 1.2±0.81 and 0.2±0.48, respectively. Probing depth was moderately correlated with gingival inflammation (r=0.6; P<0.001) but not with bone level (P>0.05). 81.4% of the implants had a bone level ≤2nd thread and 91.5% had a probing depth ≤5 mm. 76.3% had both bone level ≤2nd thread and probing depth ≤5 mm. CONCLUSIONS AND CLINICAL IMPLICATIONS: The single turned Brånemark™ implant is a predictable solution with high clinical survival and success rates. In general, a steady-state bone level can be expected over decades, with minimal signs of peri-implant disease. A minority (5%), however, presents with progressive bone loss.

Comparison of speech intelligibility, articulation and oromyofunctional behaviour in subjects with single-tooth implants, fixed implant prosthetics or conventional removable prostheses.

The purpose of this controlled study was to determine the impact of a single-tooth implant, fixed implant prosthesis and completely removable dental prosthesis on intelligibility, articulation and oromyofunctional behaviour. Additionally, the self-perceived overall satisfaction of the dental replacements and the effect on speech was questioned. Objective (acoustic analysis) as well as subjective assessment techniques (perceptual evaluation) were used. The satisfaction of single-tooth implant group was very high (100%) followed by a satisfaction of 87% for the fixed implant prosthesis group and 68% for the removable prosthesis group. The results of the phonetic analyses revealed a normal intelligibility and oromyofunctional behaviour in the three groups of dental replacements. Only one type of articulation disorders was observed in the single-tooth implant group, followed by three types of disorders in the removable prosthesis group and six types of disorders in the fixed implant prosthesis group. In this last group, not only 87% of the subjects showed distortions of one or more consonants but also most consonants of the Dutch language were disturbed in comparison with the single-tooth implant and removable prosthesis users. Special attention must be paid to the fricative /s/ because in more than 50% of all groups, this sound is disturbed.

Using online periodontal case-based discussions to synchronize theoretical and clinical undergraduate dental education.

BACKGROUND: Clinical experience is important in undergraduate dental education, but (suitable) patients to learn from are often lacking. Online case-based discussions were introduced to overcome patient dependency and to synchronize theoretical with clinical education. MATERIALS AND METHODS: Undergraduate dental students in groups of 5-7 discussed online clinical case reports presenting either minor (2nd year) or complex periodontal pathology (3rd year). Each case consisted of a brief patient history, extra- and intra-oral clinical pictures, periodontal chart, peri-apical and/or orthopantomographic radiographs. Students had to discuss diagnosis and treatment planning. Questionnaires assessed students' and supervisors' general appreciation (score on 20), time investment and opinions about organisation, relation case/course content, future planning, learning effect and online environment (5-point Likert scale). A crossover design with three tests (pre-test, test in between and post-test) was used to investigate whether the frequency of case introduction (one case per week vs. one case element per week) had an effect on learning. Data was analysed with descriptive statistics (questionnaires) and repeated measures ANOVA (crossover design). RESULTS: Students (n=119) and supervisors (n=9) highly appreciated the exercise. Students reported spending on average 74 min per week to read a case, prepare and post messages. Supervisors' total time investment was 342 min per semester to create a case, provide online feedback and to prepare a live-discussion. No significant differences in test-scores were found between the two modalities of case introduction. CONCLUSION: Online case-based discussions, in conjunction with a theoretical course, are valuable additions to the dental curriculum, especially to reinforce the transition from theory to clinical practice.

Impact of anterior single-tooth implants on quality of life, articulation and oromyofunctional behaviour: a pilot study.

The main purpose of this study is to determine the impact (one and a half year after implantation) of a single-tooth implant on articulation and oromyofunctional behaviour. This information is important for dentists, orthodontists or stomatologists who treat professional speakers. Objective (acoustic analysis) as well as subjective (questionnaire, phonetic inventory, phonetic analysis, oromyofunctional assessment of lip and tongue function, blowing, sucking and swallowing) assessment techniques were used to determine the quality of life, articulation and oromyofunctional behaviour. Fourteen subjects who received a single-tooth implant and a control group of nine subjects participated in this study. The mean overall satisfaction of single-implant users was 95%. The subjects who received a single-tooth implant were capable of producing all Dutch vowels and consonants. The phonetic analysis revealed a sigmatism in 57% of the cases. Sigmatisms (stridens sigmatism followed by simplex sigmatism) were the most frequently observed phonetic disorders. There was interobserver agreement about normal lip and tongue functions. Moreover, blowing, sucking and swallowing patterns were normal (concordance value 96%). Detailed analyses 1 or 2 years after implantation of an anterior single-tooth implant revealed normal speech intelligibility and oromyofunctional behaviour. Articulation was characterised by the presence of a persistent phonetic disorder. Further research involving more subjects with an anterior single-tooth implant is needed.

The clinical and radiographic outcome of implants placed in the posterior maxilla with a guided flapless approach and immediately restored with a provisional rehabilitation: a randomized clinical trial.

OBJECTIVES: To evaluate and compare the outcome of dental implants placed using a flapless protocol and immediate loading with a conventional protocol and loading after 6 weeks. MATERIALS AND METHODS: Fourteen patients with bilateral maxillary edentulous areas were treated using Straumann SLA-implants. Using a randomized split-mouth design, implants were placed in one side of the maxilla using a stereolithographic surgical guide for flapless surgery and immediately loaded on temporary abutments with a bridge (test). Implants in the other side were placed using the conventional protocol and loaded after 6 weeks of healing (control). Clinical and radiographic evaluation of peri-implant tissues was performed at time of implant surgery, and after 1 week, 6 weeks, 3, 6, 12 and 18 months. RESULTS: A total of 70 implants were placed (36 test and 34 control). One implant (test) was lost after 3 months, resulting in a survival rate of 97.3% for the test implants and 100% for the control implants. Marginal bone levels were not statistically significantly different between the test and control implants but at baseline the marginal bone level was significantly lower compared to the other evaluation periods (P < 0.05). The mean bone level for test and control implants was 1.95 mm ± 0.70 and 1.93 mm ± 0.42 after 18 months, respectively. There was a significant change in height of the attached mucosa at implants placed with a conventional flap between post-operative and 1 week and between 1 week and 6 weeks. Statistically significant differences were found between the test side and the control side for opinion about speech, function, aesthetics, self-confidence and overall appreciation the first 6 weeks. CONCLUSION: Implants can successfully integrate in the posterior maxilla using a flapless approach with immediate loading similar to a conventional protocol. The mucosal tissues around implants placed with a conventional flap changed significantly compared with flapless placed implants.

Rationale for a reverse tapered body shift implant for immediate placement.

Immediate implant placement holds considerable value, yet primary implant stability is often a critical factor. The aim of this study was to evaluate the stability, volumetric viability, and buccal gap size of reverse tapered body shift (RTBS) implants after immediate placement. Peak insertion torque measurements of two RTBS designs (apical 40% vs. apical 50%), relative to conventionally tapered implants, were assessed in simulated extraction sockets prepared in synthetic bone blocks. Additionally, the proximity of the RTBS implants to neighbouring teeth and anatomical structures, and the buccal gap distance were evaluated in human cadavers. The mean (± standard deviation) insertion torque was 12.00±1.40N•cm for the conventionally tapered implants (n=50), 35.36±2.74N•cm (n=50) for RTBS-1, and 48.20±2.90N•cm (n=50) for RTBS-2; the difference between designs was statistically significant (P<0.01). In total, 40 RTBS implants (20 per design) were placed in six cadaveric premaxillae. Only one locus was inappropriate for both RTBS implant designs, due to the proximity of neighbouring teeth. The average buccal gap for both implant designs was 2.8mm (P=0.104). The improved primary stability and increased buccal gap size with RTBS implants may enhance the feasibility of immediate placement. The study findings should be further validated in clinical trials.

Flaplessly placed 2.4-mm mini-implants for maxillary overdentures: a prospective multicentre clinical cohort study.

Studies on flaplessly placed, one-piece mini dental implants (MDIs) supporting overdentures in the maxilla are scarce. This prospective multicenter cohort study evaluated the outcomes (over 2 years) of five to six MDIs placed in the maxilla for overdentures. Study patients were ≥50 years old, with an edentulous maxilla and dentate/fixed prosthesis in the mandible. Dentures were provisionalized with the final connection at 6 months. Implant/prosthetic survival was evaluated, and postoperative discomfort and patient satisfaction were assessed (rating scale). Of 185 MDIs placed in 31 patients, 32 failed in 16 patients (17.3%); 22/83 in female patients and 10/102 in male patients. Kaplan-Meier analysis showed survival percentages of 86.3% (6 months), 84.0% (1year), and 82.3% (2 years). Two patients lost five or six MDIs resulting in two prosthetic failures (6.5%). Implant loss was significantly affected by sex, but not by smoking or location. The worst treatment combination was a torque value >25N·cm with an antagonist implant overdenture. The mean pain score was 4.1±2.8 on day 1 and 1.1±1.7 on day 7. The mean final satisfaction score was 8.6±1.7. The majority (96%) of the patients would recommend this treatment. Despite higher MDI failure in the maxilla compared to the mandible, prosthetic survival was acceptable and patient satisfaction was high, suggesting this to be a valuable treatment alternative.

The rationale for the introduction of implant dentistry into the dental curriculum.

This paper provides arguments for the introduction of implant dentistry into the undergraduate curriculum. The survival of teeth is very high when disease is diagnosed and treated properly and maintenance is taken care of. Nevertheless, tooth replacements by fixed and removable prostheses are highly prevalent. It is expected that dentists will face a dramatically increased need to care for elderly patients and partially edentulous patients. Hence, the demand for implant reconstructions will be substantial and more appropriately trained and competent health professionals will be needed. Increasing demands of the patient regarding aesthetics and function will influence the demands for implant therapy. The improvement of oral function and subjective chewing comfort, the preservation of tooth structures or existing reconstructions and the replacement of missing, strategically important teeth are major indications for implant placement. From both a biological and an economical point of view, the single tooth replacement with an implant is the first choice in situations with no or minimally restored neighbouring teeth compared with conventional bridgework. Stability of full dentures represent a major problem especially for the mandible. It is well documented that placement of two implants supporting an overdenture substantially improve chewing capacity, increase quality of life and is a simple and cost-effective treatment thus rendering such treatment a 'standard of care' procedure. There is no doubt that dental students should learn to incorporate the indication of oral implants in their overall treatment planning. Therefore, they will have to understand the basic aspects of healing and tissue integration, basic biomechanical and material science principles as well as surgical and prosthetic techniques. They will have to be able to monitor continuously the peri-implant tissues, render appropriate supportive therapy and cope with biological and technical complications. While it is evident that the surgical procedure per se may require additional competence, the remainder of the aspects mentioned should be taught in the dental curriculum. This should include the attribution of responsibility for maintenance of implants and handling of biological and technical complications. Moreover, it is desirable to include the surgical technique for implant placement for 'straightforward' cases into the dental curriculum. The levels and limitations to which the various aspects of implant dentistry and related skills are to be taught are determined by the academic community. Obviously, ethical and legal aspects of implant dentistry should not be forgotten.