Implants and/or teeth: consensus statements and recommendations.

In August 23-25, 2007, the Scandinavian Society for Prosthetic Dentistry in collaboration with the Danish Society of Oral Implantology arranged a consensus conference on the topic 'Implants and/or teeth'. It was preceded by a workshop in which eight focused questions were raised and answered in eight review articles using a systematic approach. Twenty-eight academicians and clinicians discussed the eight review papers with the purpose to reach consensus on questions relevant for the topic. At the conference the consensus statements were presented as well as lectures based on the review articles. In this article the methods used at the consensus workshop are briefly described followed by the statements with comments.

Implant-supported overdentures: a longitudinal prospective study.

The aim of this study was to evaluate the clinical function and long-term prognosis of overdentures retained by a small number of implants in the maxilla and mandible using one of two different attachment systems. Included in the study were all patients referred to specialty clinics in Jönköping and Linköping, Sweden, during the treatment period who needed an overdenture and could be provided with a minimum number of two bilaterally-placed implants. Excluded were patients with bone-grafted jaws, irradiated cancer patients, heavy bruxers, and patients who had lost a fixed prosthesis because of implant losses. The patients were randomly assigned to receive one retentive system, either a round 2-mm-diameter bar with clips or ball attachments (Nobel Biocare). Eighteen overdentures were placed in maxillae and 32 in mandibles, supported by a total of 115 Brånemark implants. Of the implants placed, 86.1% were continuously osseointegrated. The cumulative implant survival rates after 7 years of loading were 75.4% in the maxillae and 100% in the mandibles. There was no difference in implant survival rate between the attachment systems. Patients with implant losses were characterized by severely resorbed maxillary ridges and inferior bone quality, together with unfavorable loading circumstances such as short implants combined with long leverages. Complications and prosthetic adjustments were mostly resolved early and easily.

Caries prevalence and distribution in 20-80-year-olds in Jönköping, Sweden, in 1973, 1983, and 1993.

In 1973, a cross-sectional study on oral health status was performed on 1000 individuals in the age groups 3-70 years in Jönköping, Sweden. In 1983 and 1993, new cross-sectional studies were carried out in the age groups 3-80 years. The aim of the present study was to analyze caries prevalence and distribution in the three investigations 1973, 1983, and 1993 in the age groups 20-80 years. In the younger age groups (20-40 years), a larger proportion of individuals with good oral health was found in 1993 than in 1973 or 1983. A steady increase in the number of teeth in the age groups 40-80 years could be found, which was also reflected in the increasing number of decayed and filled tooth surfaces (DFS) in the same age groups. A marked decrease in proximal DFS in 20-50-year-olds in 1993 compared to 1973 and 1983 was found. However, a rather large and unchanging group of individuals suffering from severe caries was also observed. This situation demands an individualized caries treatment strategy based on risk assessment.

Osseointegrated implants in the oral habilitation of a boy with ectodermal dysplasia: a case report.

The most characteristic oral feature in ectodermal dysplasia is hypodontia. Children and adolescents suffering from ectodermal dysplasia often need extensive and complicated prosthetic treatment. The development of techniques for osseointegrated implants offers new possibilities for the oral habilitation of these children. This paper describes the oral habilitation of a boy with severe ectodermal dysplasia and where Brånemark osseointegrated implants have been used as part of the treatment. The patient was seen at the dental department at the age of 1.5 years. Two conically-shaped upper incisors were at that time the only teeth that had erupted. The treatment was planned in a multidisciplinary odontological group involving paediatric dentistry, orthodontics, prosthodontics, oral surgery and maxillofacial radiology. At the age of 3 years it was verified that the boy had four primary teeth (53, 51, 61, 63) and four permanent teeth (16, 11, 21, 26). There were no teeth in the lower jaw. The alveolar ridges in the edentulous areas were low or missing. During the period 3-6 years of age the boy used an upper partial denture adapted to allow the mesial drift of the 16 and 26 teeth. At the age of 6 years, two Brånemark implants were inserted in the lower front-cuspid region. A specially designed overdenture for the lower jaw was constructed. The overdenture was retained in contact with the male attachments by two cuffs of heat-polymerized resilient silicone. Over the next 4 years the dentures were modified due to the eruption of permanent teeth and growth. However, only minor corrections were necessary concerning the retention system of the lower denture. The implants are well osseointegrated and stable and allow the boy to use a lower denture without any complications.

The effect of an airbrasive instrument on soft and hard tissues around osseointegrated implants. A case report.

A 40-year-old woman with natural teeth in the upper jaw and a complete lower denture was treated with six osseointegrated implants connected to a fixed bridge. On a recall visit 6 months posttreatment an air powder abrasive devise Prophy-Jet had been used to remove calculus and debris from the titanium abutments by the referring dentist. This resulted in an acute clinical reaction characterized by pain and submucosal emphysema. Furthermore, radiographs revealed break down of the marginal bone surrounding the fixtures. The treatment and follow-up period became long. These observations suggest that the use of air powder abrasive instruments is not the treatment of choice in the maintenance care of osseointegrated titanium implants.

A radiological inventory of possible sites for cylinder implants in edentulous regions of the jaws. An epidemiological study.

Implant treatment is nowadays requested as an alternative mode of treatment for both total and partial edentulousness. The purpose of the study was to assess the maximum number of possible implant sites in a group of adults. The study material comprised 579 persons divided into the age-groups 20, 30, 40, 50, 60 and 70 years. Based on radiological examination, the subjects were grouped according to Eichner's index. They comprised both dentate and edentulous individuals. Templates, marked with cylinder implants of different dimensions, were placed over edentulous regions. The possible number of cylinder-shaped endosseous implants that could be placed anterior to the second molar was assessed in relation to bone availability and anatomical structures. Gaps treated with fixed bridges were not registered. Altogether 1,048 presumptive fixture sites were marked, of which 78% in the age-groups 60 and 70 years. Eichner groups C 1-3, which comprised the edentulous persons, constituted 12% of the subjects and accounted for 57% of the possible number of implants. All edentulous mandibles and 70% of the edentulous maxillae were judged suitable for placement of implants. On average 5.5 and 5.8 sites were marked per edentulous maxilla and mandible, respectively. Groups B1-4 comprised 21% of the subjects and accounted for 37% of the implants. It is discussed that implant treatment in totally edentulous jaws will increase in relative terms in Sweden as in other Scandinavian countries, i.e. the percentage of edentulous jaws treated with implants will increase. In absolute terms, however, the treatment will probably decrease owing to a marked decrease in the number of edentulous individuals. The future need for implant treatment in the residual dentition will probably increase but it is difficult to predict by how much.

Possible sites for cylinder implants in Swedish individuals aged 20-70 years. A comparative radiological inventory in 1983 and 1993.

UNLABELLED: The aim of this study was to evaluate the number of possible sites for cylinder implants in an epidemiological sample of adult individuals and to compare these results with those from a similar inventory performed 10 years earlier. This study, which comprised individuals 20-70 years old, is part of two larger epidemiological dental studies of individuals from the community of Jönköping, Sweden, performed in 1983 and 1993. Random samples of 579 and 575 individuals respectively were examined and classified according to the Eichner index. The radiographic examination included an orthopantomogram and a full-mouth intra-oral examination. Only existing spaces anterior to the second molars were considered as possible implant sites. Cylinder implants with a diameter of 3.75 mm and a length between 7 and 20 mm were plotted on the radiographs. RESULT: The most striking result from this study was the reduction by almost a half of the total number of possible implant sites between 1983 and 1993. A certain proportion of existing tooth gaps had been treated with conventional fixed prostheses, usually in small tooth gaps, and this tendency had increased between 1983 and 1993. The need for implants in the anterior frontal region was small but constant (less than 1%) in 1983 and 1993. In the future, implants will be a treatment option in young individuals, most likely in cases of trauma and tooth agenesis. Further it may be assumed that implant treatment in edentulous jaws will continue to increase in relative terms, i.e. the percentage of edentulous jaws that have been treated with implants will increase. In absolute terms, however, the frequency of the treatment will decrease because fewer individuals will be edentulous. Instead, the proportion of partially dentate subjects treated with implants will increase.

Caries prevalence and distribution in individuals aged 20-80 years in Jönköping, Sweden, 1973 and 1983.

In 1973 an epidemiological study was performed in the community of Jönköping, Sweden. The study covered 1000 individuals, evenly distributed in the age groups 3, 5, 10, 15, 20, 30, 40, 50, 60 and 70 years. In 1983 a new cross-sectional study was carried out on the age-groups 3-80 years. The aim of the present study was to compare and analyse in detail caries prevalence and distribution in the age-groups 20-80 years at the examinations in 1973 and 1983. The subjects were examined clinically and radiographically regarding number of teeth, caries, restorations, etc. The mean number of teeth increased between 1973 and 1983, especially in the older age-groups. During the same period, the percentage of DFS decreased in the age-groups 20, 30 and 70 years, and was unchanged in the age-groups 40 to 60 years. There were only minor differences in DS in the respective age-group during the 10-year period. The distribution of subjects according to DFS showed that a large proportion of individuals in the age-groups 20 and 30 years had low DFS in 1983 as compared to 1973. For the age-group 40-years, the distribution was unchanged. For the 50, 60 and 70-year-olds, there was a change in distribution towards a larger proportion of individuals with high DFS values in 1983 as compared to 1973. The frequency distribution of individuals with primary and secondary carious lesions respectively was skewed, a small number of individuals having a high number of lesions in each age-group.(ABSTRACT TRUNCATED AT 250 WORDS)

Oral health of individuals aged 3-80 years in Jönköping, Sweden in 1973 and 1983. I. A review of findings on dental care habits and knowledge of oral health.

The aim of the present study was to present data from dental care habits and knowledge of oral health in two cross-sectional studies carried out in 1973 and 1983. A random sample of approximately 1000 individuals evenly distributed in the age groups 3, 5, 10, 15, 20, 30, 40, 50, 60 and 70 years was studied for each of these two years. In the 1983-year examination 80 individuals 80 years of age were also included. All subjects were inhabitants of the community of Jönköping, Sweden. A questionnaire about dental care habits and knowledge was used in combination with a clinical and radiographical examination. The participants answered 23-101 questions. The same questions were raised in 1973 and 1983. For most age groups more then 80 per cent visited a dentist yearly in 1983. This yearly attendance was higher than that for 1973. In the 20-year-old group 14 per cent of the individuals received dental care in the PDS in 1973 compared to 63 per cent in 1983. The main reason to visit a dentist in 1973 was by the patient's own initiative while in 1983 the appointments were based on the dentist's initiative. The number of subjects that felt discomfort in connection with a visit to the dentist had decreased between 1973 and 1983. Knowledge about the etiology of caries had increased between 1973 and 1983 was not the case for gingivitis and periodontitis. An increase had occurred in toothbrushing frequency and the use of toothpicks and disclosing tablets but this between 1973 and 1983. In 1983, 98 to 93 per cent of the subjects in the age groups 10-30 years had been exposed to topical fluorides. The corresponding figure for 30-year-olds in 1973 was 1 per cent. It is obvious that during the period 1973 to 1983 there has been an increase in dental attendance, knowledge of dental diseases, oral health and the use of preventive measures.

Oral health of individuals aged 3-80 years in Jönköping, Sweden, in 1973 and 1983. II. A review of clinical and radiographic findings.

The aim of this study was to present data from clinical and radiographic examinations on oral health in two cross-sectional studies carried out in 1973 and 1983. A random sample of approximately 1000 individuals, evenly distributed in the age groups 3, 5, 10, 15, 20, 30, 40, 50, 60 and 70 years was studied for each of these two years. In the 1983-year examination 80 individuals, 80 years of age, were also included. All subjects were inhabitants of the community of Jönköping, Sweden. The clinical and radiographic examination assessed edentulousness, removable dentures, number of teeth, caries, restorations and overhangs, gingival and periodontal status, oral hygiene and calculus, endodontic treatment and periapical status. A reduction in number of edentulous individuals by 25% was recorded between the two examinations. This was matched by an increase in the mean number of teeth, mainly of molars. The largest difference in mean number of teeth between the 1973 and 1983 examinations was found for the 70-year-olds. These were 8.5 and 11.8 teeth respectively. The younger age groups showed an increase in the proportion of individuals free from caries and restorations. In 1973 the caries-free proportions were 35% for 3-year-olds and 9% for 5-year-olds. In 1983 these values had improved to 70% and 29% respectively. Corresponding to this trend the number of decayed tooth surfaces was lower in 1983. Fewer filled tooth surfaces were present 1983 compared with 1973 for the age groups 10, 15, 20 and 30 years but higher for the age groups 5, 50 and 60 years and unchanged for the remaining groups. For the younger age groups the overall reduction in DFS was about 50% but this increased to 90% for buccal and lingual surfaces. Both secondary caries and overhanging restorations had decreased in the 1983 group for all ages. At least 75-86% of restorations were without overhangs in 1983 compared to 47-65% in 1973. Gingival health had improved over the 10-year period. Sites with plaque and calculus and gingival units exhibiting gingivitis had all decreased in frequency by 1983. Buccal surfaces showed the greatest improvement. The frequency of individuals with one or more periodontal pockets (greater than or equal to 4 mm) increased with age but was of the same distribution in 1983 as in 1973.(ABSTRACT TRUNCATED AT 400 WORDS)

Oral health of individuals aged 3-80 years in Jönköping, Sweden in 1973, 1983, and 1993. I. Review of findings on dental care habits and knowledge of oral health.

The aim of the present study was to compare data on dental care habits and knowledge of oral health in three cross-sectional studies carried out in 1973, 1983, and 1993. The 1973 study constituted a random sample of 1000 individuals evenly distributed in the age groups 3, 5, 10, 15, 20, 30, 40, 50, 60, and 70 years. The same age groups with addition of a group of 80-year-olds were included in the 1983 and 1993 studies which comprised 1104 and 1078 individuals, respectively. A questionnaire (23-101 questions) about dental care habits and knowledge of oral health was used in connection with a clinical and radiographic examination. The same questions were used in all the three studies. An addition to the 1993 investigation was questions concerning ethnographic background. In 1993 approximately 95% of all individuals were visiting the dentist on a regular basis every or every second year. The 30-year-olds, however, did not visit a dentist as regularly in 1993 as in 1983. The 70- and 80-year-olds visited a dentist more regularly in 1993 than in 1983. An increased number of adults in all age groups, except for the 70-year-olds, received their dental care in the Public Dental Service in 1993 compared to 1983 and 1973. Most 40-year-olds and older, however, received their dental care by private practitioners. About 80% of all adults in 1993 were enrolled in a recall system on the dentist's initiative while in 1973 most appointments were based on the patient's own initiative. The number of individuals who felt discomfort at the prospect of an appointment with the dentist was more or less the same in 1973, 1983, and 1993. The knowledge of the etiology of dental diseases has not changed much between 1973 and 1993. The frequency of toothbrushing has increased since 1973 and in 1993 more than 95% of all individuals brushed their teeth daily. The use of dental floss and toothpicks as well as disclosing tablets decreased in 1993 compared to 1983. Almost all individuals in 1993 used fluoride toothpaste. The use of topical fluorides and fluoride tablets in children had decreased considerably in 1993 compared to 1983.

Oral health of individuals aged 3-80 years in Jönköping, Sweden in 1973, 1983, and 1993. II. Review of clinical and radiographic findings.

The aim of this epidemiological study was to analyse various clinical and radiographic data on oral health and compare the results to those of two cross-sectional studies carried out in 1973 and 1983. In 1973, 1983, and 1993 a random sample of 1000, 1104, and 1078 individuals, respectively were studied. The individuals were evenly distributed in the age groups 3, 5, 10, 15, 20, 30, 40, 50, 60, and 70 years. In 1983 and 1993 80-year-olds were also included. All subjects were inhabitants of the community of Jönköping, Sweden. The clinical and radiographic examination assessed edentulousness, removable dentures, implants, number of teeth, caries, restorations and overhangs, oral hygiene, calculus, periodontal status, endodontic treatment, and periapical status. The number of edentulous individuals was reduced by half from 1973 to 1993 and is now 8% in the age groups 40-70 years. The mean number of teeth has increased and up to the age of 50 years the individuals had more or less complete dentitions. During the 20-year period there was generally decreasing number of carious lesions and restorations. In the 15- and 20-year-olds, however, there was an increasing number of decayed/filled tooth surfaces in 1993 compared to 1983. Furthermore, after the age of 50 there was an increase in number of restored tooth surfaces. As regards secondary caries there was an increase for the 10- and 15-year-olds between 1983 and 1993. For all other age groups there were only minor differences. Generally restorations exhibited a high quality and 85-90% had no proximal overhangs. In 1973 this figure was about 60%. Concerning the frequency of tooth surfaces exhibiting plaque and gingival inflammation there was a considerable decrease from 1973 to 1983, but during the period from 1983 to 1993 there seems to be no improvement. In some age groups there was even a significant increase in plaque (15-year-olds) and gingivitis (3-, 5-, 15-, 20-, and 60-year-olds). The frequency of individuals with one or more periodontal pockets (> 4 mm) increased with age. In 1993 the bone level at the age of 40 years corresponded to the bone level at the age of 20 years in 1973. The percentage of endodontically treated teeth was lower in 1993 in all age groups than in 1973 and 1983. The percentage of endodontically treated teeth with periapical or juxtaradicular destructions was unchanged in all three studies. The comparison of the three studies from 1973, 1983, and 1993 shows that there has been a great improvement in oral health over this 20-year period. In 1993, however, the increasing number of decayed/filled tooth surfaces in the 15- and 20-year-olds and an increase in plaque and gingivitis in some younger age groups calls for special attention.

Status and treatment of denture stomatitis patients: a 1-year follow-up study.

The material comprised 48 patients, 19 exhibiting atrophic and 29 hyperplastic denture stomatitis. Twenty-seven patients with healthy mucosa served as a reference group. Past history, resilience of the mucosa, denture function and scores of palatal erythema, plaque and yeasts were recorded. The therapeutic program included new dentures, surgical and nystatin treatment, hygienic instruction and nutritional advice. The result concerning past history showed significantly more smokers, more patients with recurrent urinary tract infections in combination with prolonged antibiotic therapy, and more patients wearing their dentures at night in the denture stomatitis group. Nystatin treatment did not affect the healing of palatal erythema evaluated after 1 year. The treatment program evaluated after 1 year resulted in complete healing of the mucosa in 50% of patients. The remaining 50% had persisting erythema of varying intensity. The unhealed cases showed significantly more yeasts and plaque on the denture bas compared to the healed patients and the reference group. An evaluation of factors common to failure of healing is presented.

Effect of nystatin in the treatment of denture stomatitis.

The effect of nystatin treatment on denture stomatitis subclassified as generalized simple inflammation and inflammatory papillary hyperplasia has been studied. Twenty-four patients were carefully instructed to apply a thin layer of nystatin dusting powder on the fitting surface of the maxillary denture three times a day for 14 d. Different parameters were studied on three occasions; at the beginning of experiment and after 14 and 28 d. An untreated group of 24 patients with the same types of denture stomatitis served as control. The effect of treatment was evaluated by changes in the clinical erythema, the yeast colonization obtained by mycologic sampling on the palatal mucosa and on the denture base, and changes in the histologic picture of the mucosa obtained by biopsy. Subepithelial inflammation, leukocyte penetration, edema and thickness of the epithelium were histologic parameters. After 14 d of treatment the experimental group compared with the control group showed a statistically significant decrease in palatal erythema and in the amount of yeast colonies. No significant changes were found microscopically. Twenty-eight days after start, i.e. 14 d after withdrawal of the nystatin, there still was a statistically significant improvement of the palatal erythema in the experimental group compared with the controls. However, no patient was totally cured. There were no significant changes in the number of yeast colonies and the histologic parameters.

Changes in signs and symptoms of temporomandibular disorders following treatment with implant-supported fixed prostheses: a prospective 3-year follow up.

PURPOSE: The aim was to investigate whether the replacement of lost teeth with implant-supported fixed prostheses (IFP) had any influence upon the signs and symptoms of temporomandibular disorders (TMD). MATERIALS AND METHODS: The subjects comprised 78 consecutive patients referred to a specialist clinic for treatment with IFPs. All were examined with respect to the presence of signs and symptoms of TMD before the start of treatment and after 1 and 3 years. RESULTS: Before treatment began, 21% of the patients were found to have moderate (15%) or severe (5%) clinical signs of dysfunction according to the Helkimo index. These figures decreased numerically but not statistically significantly to 10% and 1%, respectively, at the 3-year follow up. Nearly half of the patients (45%) reported one or more subjective symptoms of TMD at the first examination. The anamnestic index used had decreased statistically significantly at the 3-year follow up, when the 5 variables composing the index had improved, but the improvement was statistically significant only for the variables joint sounds and pain when opening the mouth wide. All patients were satisfied with the treatment received. CONCLUSION: The results from the present investigation show that treatment with IFPs has a good and lasting effect on the functional status of the masticatory system as well as on subjective symptoms of TMD and chewing ability in the vast majority of patients treated.

Studies of Candida serology in denture stomatitis patients.

The aim of the study was to determine the humoral antibody response to Candida by means of hemagglutinin and precipitin tests and to correlate these results to yeast colonization in the oral sites and feces and to the relapse tendency after treatment; and furthermore, to evaluate whether Candida serology can serve as a tool to predict a denture stomatitis risk group. The serologic tests were performed by means of passive hemagglutination (HA) and immunoelectroosmophoresis (counterimmunoelectrophoresis, CIE) tests in 51 denture stomatitis patients and compared with 25 individuals in the reference group. There were significantly more patients with increased hemagglutinin titers (pos. greater than or equal to 1:160) to Candida albicans polysaccharide (mannan) antigen and/or precipitin to crude C. albicans cytoplasmic antigen in serum (P less than 0.01) than in the reference group. In the denture stomatitis group there was no correlation between the presence of hemagglutinating and precipitating Candida antibody in serum and the parameters yeast colonization of the oral sites/feces, yeast score on the denture base and palatal erythema score. After local oral antimycotic treatment there was no significant change in the serum Candida hemagglutinin titers and serum precipitins. Serologic tests might be useful as a guidance in a selected group of patients for continued prosthetic treatment and as a prognostic instrument.

A combined clinical, mycological and histological study of denture stomatitis.

The clinical and histological appearance of the different types of denture stomatitis are in many respects very similar and confluent. In order to study the correlation between clinical and histological appearance and amount of yeasts, 48 patients with denture stomatitis and 24 with a healthy palatal mucosa were examined. The terms atrophic and hyperplastic denture stomatitis were introduced. The intensity of the palatal erythema and the growth of yeasts were most prominent among patients with hyperplastic lesions. Dryness and soreness of the mouth, angular cheilitis, spontaneous hemorrhage, glossitis and leukoplakias were found to a varying extent. No statistical evidence of correlation between the intensity of clinical erythema, amount of yeasts and grade of subepithelial inflammation could be found. The disease has most certainly a background other than solely increased growth of yeasts.

Evaluation of implant-supported carbon/graphite fiber-reinforced poly (methyl methacrylate) prostheses. A longitudinal multicenter study.

Carbon/graphite fiber-reinforced poly (methyl methacrylate) (CGFP) has been suggested as an alternative framework material for implant-supported fixed prostheses. The aim of this study was to evaluate CGFP prostheses clinically over time in patients treated with titanium implants of the Brånemark type and to study the handling of the material in the technical production. Twenty-five patients were fitted with 27 CGFP prostheses supported by 119 implants. Three implants, all in the upper jaw, were lost after loading. After a mean functioning time of 44 months (range 32-56), 19 prostheses (70%) were still in situ. In all, 5 prostheses fractured, of which 3 were exchanged whereas 2 could be repaired. The fractures were discovered early after loading and located close to the end abutment cylinders. During the follow-up period, the bone loss around the implants was about the same as earlier reported values for fixed prostheses with cast frameworks. It is concluded that a CGFP framework can be used to form the biocompatible superstructure of implant-supported prostheses with high precision at a low material cost and with good aesthetic results. The mechanical properties are so far not satisfactory but the method has the potential to be further developed and standardized.