Is the implant-retained overdenture a solution to improve the patient quality of life?

Design The research was a retrospective cohort study evaluating a study which performed routine control sessions to assess bone loss around the dental implant over five years and 12 and 24 months, after their prosthetic restorations.Aim The study aimed to evaluate patients' dental implant marginal bone loss after oral rehabilitation with bar and locator retainers and their possible complications.Methods A study of 114 patients who had received 283 dental implants from 2013-2018 was conducted. Two follow-up recall sessions were conducted, one at 12 months and one at 24 months, after dentures were placed. Intraoral and extraoral examinations were also conducted in addition to clinical assessments. The patients' prostheses were assessed for occlusion, tissue health and soft-tissue continuity, complaints, implant success rates and marginal bone loss, in addition to prosthetic complications, at follow-up sessions.Results In this study, 94 patients were fitted with implant-supported removable prostheses on locator attachments on both arches and 20 were fitted with removable prostheses using bar attachments. After evaluating the location of the implant, the number of days after implantation and the type of retainer in all patients, both groups showed a significant amount of marginal bone loss in the 12th and 24th months. The presence of complications was significantly associated with both prosthesis types at month 24 (p >0.05). When the relation between the position of the denture and the presence of complications at month 12 was evaluated, 36% of the complications were observed in the maxilla and 21.3% in the mandible. There was no significant difference associated between denture location and complication presence at month 24 (p >0.05).Conclusions Even though complications do not affect marginal bone loss, a patient's failure to maintain adequate oral hygiene results in marginal bone loss. Therefore, it appears that regular post-treatment prosthesis inspections are essential. If the requirements resulting from these inspections are satisfied, future complications may be prevented.

Direct custom implant impression copings for the preservation of the pontic receptor site architecture.

The direct custom implant impression coping technique is designed to record the periimplant gingiva and pontic receptor site after the tissues have been shaped with a provisional restoration. The technique prevents inaccurate recording of the gingival architecture by using a dual polymerizing composite resin placed into the sulcus and pontic receptor sites and adapted to the open tray implant impression copings. This technique may improve soft tissue accuracy between the clinical condition and the laboratory cast.

How do smoking, diabetes, and periodontitis affect outcomes of implant treatment?

PURPOSE: Implant therapy is highly predictable and successful. However, certain risk factors can predispose individuals to lower rates of success. The purpose of this systematic review was to evaluate the available literature to assess whether smoking, diabetes, and periodontitis have an adverse affect on the outcomes of implants placed in patients with these conditions. MATERIALS AND METHODS: The dental literature was searched using the MEDLINE, Cochrane Collaboration, and EMBASE databases. Using specific inclusion and exclusion criteria, 2 reviewers evaluated titles, abstracts, and full articles to identify articles relevant to this review. All searches were conducted for articles published through May 2005. Data from included articles for each of the risk factor groups, smoking, diabetes, and periodontitis, were abstracted and analyzed. RESULTS: A detailed search of the literature and evaluation of relevant articles identified 35 articles for inclusion in this systematic review. Nineteen articles were identified for smoking, 4 articles were identified for diabetes, and 13 articles were identified for periodontitis. One article met the criteria for both smoking and periodontitis. Implant survival and success rates were reported for smokers versus nonsmokers; diabetic patients versus nondiabetic patients; and patients with a history of treated periodontitis versus patients with no history of periodontitis. The findings revealed statistically significant differences in survival and success rates for smokers (better for nonsmokers), with greater differences observed when the data were analyzed according to bone quality (less for loose trabecular bone). No difference in implant survival rate was found between patients with and without diabetes. Likewise, no difference in implant survival rates was found between patients with a history of treated periodontitis compared to patients with no history of periodontitis. CONCLUSIONS: The results of this systematic review of the literature demonstrated that smoking has an adverse affect on implant survival and success. The effect of smoking on implant survival appeared to be more pronounced in areas of loose trabecular bone. Type 2 diabetes may have an adverse effect on implant survival rates, but the limited number of studies included in this review do not permit a definitive conclusion. A history of treated periodontitis does not appear to adversely affect implant survival rates but it may have a negative influence on implant success rates, particularly over longer periods.

Platelet-derived growth factor stimulates bone fill and rate of attachment level gain: results of a large multicenter randomized controlled trial.

BACKGROUND: Growth factors are generally accepted to be essential mediators of tissue repair via well-established mechanisms of action that include stimulatory effects on angiogenesis and cellular proliferation, ingrowth, differentiation, and matrix biosynthesis. The aim of this study was to evaluate in a large-scale, prospective, blinded, and randomized controlled clinical trial the safety and effectiveness of purified recombinant human platelet-derived growth factor (rhPDGF-BB) mixed with a synthetic beta-tricalcium phosphate (beta-TCP) matrix for the treatment of advanced periodontal osseous defects at 6 months of healing. METHODS: Eleven clinical centers enrolled 180 subjects, each requiring surgical treatment of a 4 mm or greater intrabony periodontal defect and meeting all inclusion and exclusion criteria. Subjects were randomized into one of three treatment groups: 1) beta-TCP + 0.3 mg/ml rhPDGF-BB in buffer; 2) beta-TCP + 1.0 mg/ml rhPDGF-BB in buffer; and 3) beta-TCP + buffer (active control). Safety data were assessed by the frequency and severity of adverse events. Effectiveness measurements included clinical attachment levels (CAL) and gingival recession (GR) measured clinically and linear bone growth (LBG) and percent bone fill (% BF) as assessed radiographically by an independent centralized radiology review center. The area under the curve (AUC), an assessment of the rate of healing, was also calculated for CAL measurements. The surgeons, clinical and radiographic evaluators, patients, and study sponsor were all masked with respect to treatment groups. RESULTS: CAL gain was significantly greater at 3 months for group 1 (rhPDGF 0.3 mg/ml) compared to group 3 (beta-TCP + buffer) (3.8 versus 3.3 mm; P = 0.032), although by 6 months, this finding was not statistically significant (P = 0.11). This early acceleration of CAL gain led to group 1 exhibiting a significantly greater rate of CAL gain between baseline and 6 months than group 3 as assessed by the AUC (68.4- versus 60.1-mm weeks; P = 0.033). rhPDGF (0.3 mg/ml)-treated sites also had significantly greater linear bone gain (2.6 versus 0.9 mm, respectively; P < 0.001) and percent defect fill (57% versus 18%, respectively; P < 0.001) than the sites receiving the bone substitute with buffer at 6 months. There was less GR at 3 months in group 1 compared to group 3 (P = 0.04); at 6 months, GR for group 1 remained unchanged, whereas there was a slight gain in gingival height for group 3 resulting in comparable GR. There were no serious adverse events attributable to any of the treatments. CONCLUSIONS: To our knowledge, this study is the largest prospective, randomized, triple-blinded, and controlled pivotal clinical trial reported to date assessing a putative periodontal regenerative and wound healing therapy. The study demonstrated that the use of rhPDGF-BB was safe and effective in the treatment of periodontal osseous defects. Treatment with rhPDGF-BB stimulated a significant increase in the rate of CAL gain, reduced gingival recession at 3 months post-surgery, and improved bone fill as compared to a beta-TCP bone substitute at 6 months.