Group 3 ITI Consensus Report: Materials and antiresorptive drug-associated outcomes in implant dentistry.

OBJECTIVES: The aim of Working Group 3 was to address the influence of both material- and anti-resorptive drug- related factors on clinical and biological outcomes and complications in implant dentistry. Focused questions were addressed on (a) implant materials other than titanium (alloy)s, (b) transmucosal abutment materials and (c) medications affecting bone metabolism were addressed. MATERIALS AND METHODS: Three systematic reviews formed the basis for discussion in Group 3. Consensus statements and clinical recommendations were formulated by group consensus based on the findings of the systematic reviews. Patient perspectives and recommendations for future research were also conveyed. These were then presented and accepted following further discussion and modifications as required by the plenary. RESULTS: Zirconia is a valid alternative to titanium as material for implant and transmucosal components, allowing soft and hard tissue integration with clinical outcomes-identified by implant survival, marginal bone loss and peri-implant probing depths-up to 5-years comparable to titatnium. However, most of the evidence for zirconia implants is based on 1-piece implants limiting the indication range. Furthermore, based on expert opinion, zirconia transmucosal components might be preferred in the esthetic zone. In patients receiving low-dose bisphosphonate therapy, the rate of early implant failure is not increased, while the long-term effects remain poorly studied. Although it has not been sufficiently addressed, similar outcomes can be expected with low-dose denosumab. A drug holiday is not recommended when considering implant placement in patients treated with low-dose ARD. However, the specific therapeutic window, the cumulative dose and the administration time should be considered. Access to peri-implant supportive care is mandatory to prevent peri-implantitis-related medication-related osteonecrosis of the jaw (MRONJ) or implant-related sequestra (IRS). In patients receiving low-dose anti-resorptive drugs (ARD) therapy, the risk of complications related to implant placement is high, and implant procedures in this specific population should be strictly treated in a comprehensive multidisciplinary center. Finally, healthy dental implants should not be removed before low or high-dose ARD. CONCLUSIONS: Zirconia implants can be an alternative to titanium implants in selected indications. However, the current state of evidence remains limited, especially for 2-piece implant designs. Administration of low-dose ARD did not show any negative impact on early implant outcomes, but careful follow-up and supportive care is recommended in order to prevent peri-implant MRONJ and IRS. Implant placement in high-dose patients must be strictly considered in a comprehensive multidisciplinary center.

Maxillary overdenture on three implants retained by low-profile stud attachments - A prospective cohort study.

BACKGROUND: Clinical data are needed on long-term outcomes of removable implant-supported prostheses in the fully edentulous maxilla as a function of the number of implants, effects of the attachment system and other clinical variables. OBJECTIVE: To restore individuals with an edentate maxilla with a metal-reinforced removable prosthesis without palatal coverage retained by low-profile stud attachments on three implants. METHODS: The regional ethics committee approved a prospective cohort study that included all consecutive patients treated in a private speciality clinic. Primary outcomes were patients reported, that is denture satisfaction scale and oral health-related quality of life - OHIP-20. Secondary outcomes were implant- (bone loss, implant complications and peri-implant conditions) and prosthesis-related (prosthesis complications, maintenance needs and mucosa condition). RESULTS: Thirty-two study participants were recruited between March 2007 and October 2016 and followed for a minimum of five years. According to Kruskal-Wallis tests, the OHIP-20 and Denture Satisfaction Scale questionnaire pre-treatment scores differed significantly. After an average of 6.7 years, peri-implant bone loss of more than 2 mm was observed on 17% of all implants, while no or minor bone loss was seen on 38%. The estimated success of implants was 0.95 at 168 months. The estimated success of the prosthesis, that is no adverse events or need for any repairs, was 0.55 at 156 months. CONCLUSION: The positive findings in the current clinical study strengthen the notion that for many individuals with an edentulous maxilla, a removable prosthesis retained by three implants fitted with low-profile stud-attachment is a reliable technical solution.

Fabrication, workflow and delivery of reconstruction: Summary and consensus statements of group 4. The 6th EAO Consensus Conference 2021.

OBJECTIVES: To report assessments of four systematic reviews (SRs) on (i) clinical outcomes of all-ceramic implant-supported crowns (iSCs), (ii) production time, effectiveness, and costs of computer-assisted manufacturing (CAM), (iii) computer-assisted implant planning and surgery (CAIPS) time and costs, and (iv) patient-reported outcome measures (PROMS). MATERIAL AND METHODS: An author group consisting of experienced clinicians and content experts discussed and evaluated the SRs and formulated consensus on the main findings, statements, clinical recommendations, and need for future research. RESULTS: All four SRs were conducted and reported according to PRISMA and detailed comprehensive search strategies in at least three bibliometric databases and hand searching. The search strategies were deemed reproducible. Variation was noted regarding language restrictions and inclusion of grey literature, but the search comprehensiveness appeared persuasive. The SRs included bias risk assessments of the primary studies, and their study methodology impacted the interpretations of the extracted data. CONCLUSIONS: (i) There is limited evidence (49 NRCT) showing that veneered and monolithic all-ceramic iSCs have excellent outcomes observed up to 3 years. (ii) There is no evidence evaluating production time and effectiveness comparing subtractive and additive CAM of implant models, abutments and crowns. (iii) There is limited evidence (4 RCT) that CAIPS involves more time and costs when considering the entire workflow and for diagnostics, manufacturing, and insertion of the restoration. Time seems to be the decisive factor for higher costs. (iv) Patients' comfort increases when optical compared to conventional impressions are used for fabricating iSCs and short-span FPDs (2 RCT, 5 NRCT).

Systematic review of clinical and patient-reported outcomes following oral rehabilitation on dental implants with a tapered compared to a non-tapered implant design.

BACKGROUND: Dental implants are available in different shapes. AIMS: This systematic review aims to address whether tapered compared to non-tapered implants demonstrate similar clinical and patient-reported outcomes. The review follows the preferred reporting items for systematic reviews and meta-analyses (PRISMA) format. MATERIALS & METHODS: We searched electronic databases including MEDLINE through PubMed and the Cochrane Central Register of Controlled Trials for randomized clinical trials (RCT) that compare tapered versus non-tapered implants with at least 10 treated participants and a minimum mean follow-up time of 3 years. There were no restrictions to a particular treatment indication or outcome measures. Two authors independently conducted screening, risk of bias assessment, and data extraction of eligible trials in duplicate. We applied the Cochrane risk of bias assessment tool to consider risk of bias. RESULTS: We identified 18 different RCTs, of which three reported outcomes at 3 years or greater. The three trials described the results of 245 participants with 388 implants at 3 years, from the initially 306 participants with 494 implants at baseline. The three trials compared, respectively, two, two, and three different commercially available implant brands and reported only clinically insignificant differences. We judged all three trials to be at moderate risk of bias. The low number and heterogeneity of RCTs did not allow for meta-analyses. DISCUSSION AND CONCLUSION: Appropriate professional judgment in clinical decision making must include a comprehensive diagnosis of the patient's jawbone quality and quantity and consideration of osteotomy protocol in accordance with the patient's treatment preferences, where the shape of the dental implant is only one contributory factor.

Group 1 ITI Consensus Report: The influence of implant length and design and medications on clinical and patient-reported outcomes.

OBJECTIVES: The aim of Working Group 1 was to address the influence of different local (implant length, diameter, and design) and systemic (medications) factors on clinical, radiographic, and patient-reported outcomes in implant dentistry. Focused questions on (a) short posterior dental implants (≤6 mm), (b) narrow diameter implants, (c) implant design (tapered compared to a non-tapered implant design), and (d) medication-related dental implant failures were addressed. MATERIALS AND METHODS: Four systematic reviews were prepared in advance of the Consensus Conference and were discussed among the participants of Group 1. Consensus statements, clinical recommendations, and recommendations for future research were based on structured group discussions until consensus was reached among the entire expert Group 1. The statements were then presented and accepted following further discussion and modifications as required by the plenary. RESULTS: Short implants (≤6 mm) revealed a survival rate ranging from 86.7% to 100%, whereas standard implant survival rate ranged from 95% to 100% with a follow-up from 1 to 5 years. Short implants demonstrated a higher variability and a higher Risk Ratio [RR: 1.24 (95% CI: 0.63, 2.44, p = 0.54)] for failure compared to standard implants. Narrow diameter implants (NDI) have been classified into three categories: Category 1: Implants with a diameter of <2.5 mm ("Mini-implants"); Category 2: Implants with a diameter of 2.5 mm to <3.3 mm; Category 3: Implants with a diameter of 3.3 mm to 3.5 mm. Mean survival rates were 94.7 ± 5%, 97.3 ± 5% and 97.7 ± 2.3% for category 1, 2 and 3. Tapered versus non-tapered implants demonstrated only insignificant differences regarding clinical, radiographic, and patient-reported outcomes. The intake of certain selective serotonin reuptake inhibitors and proton pump inhibitors is associated with a statistically significant increased implant failure rate. The intake of bisphosphonates related to the treatment of osteoporosis was not associated with an increased implant failure rate. CONCLUSIONS: It is concluded that short implants (≤6 mm) are a valid option in situations of reduced bone height to avoid possible morbidity associated with augmentation procedures; however, they reveal a higher variability and lower predictability in survival rates. Narrow diameter implants with diameters of 2.5 mm and more demonstrated no difference in implant survival rates compared to standard diameter implants. In contrast, it is concluded that narrow diameter implants with diameters of less than 2.5 mm exhibited lower survival rates compared to standard diameter implants. It is further concluded that there are no differences between tapered versus non-tapered dental implants. Certain medications such as selective serotonin reuptake inhibitors and proton pump inhibitors showed an association with a higher implant failure rate.

Maxillary 3-implant removable prostheses without palatal coverage on Locator abutments - a case series.

OBJECTIVES: The aim of this study was to present the clinical outcomes of patients with an edentulous maxilla treated with a removable prosthesis without palatal coverage retained by Locator abutments on three titanium implants. MATERIAL AND METHODS: All the patients in a private dental clinic consecutively treated up to 6 years earlier were invited for a follow-up examination (n = 23). Two implants were placed bilaterally and one implant anteriorly in a tripod pattern. All patients underwent a clinical and radiological examination and completed questionnaires related to their experiences and satisfaction with the reconstructions. The prosthesis and implants were examined for adverse biological or technical aspects. Patient satisfaction and quality of life outcomes were collected using a self-reported Denture Satisfaction Scale and OHIP-20. Statistical analyses were limited to descriptive statistics. RESULTS: Twenty-one of 23 invited participants consented to participate. We report in this study the outcomes of the study participants who had received their implants more than 2 years ago (n = 12). None of their 36 implants gave any indications of mobility or tenderness upon percussion. Suppuration was observed on one implant. Probing around the implants caused no (53%) or minor bleeding (47%). The incidence of adverse biological and technical events was near non-existent. The rates of replacement of male attachments varied, as did any changes of male attachment retention force. All participants described the task of insertion and removal of the prosthesis as unproblematic. The marginal bone loss ranged between 0 and 5.3 mm. The OHIP-20 and the Denture Satisfaction Questionnaire scores were high. CONCLUSIONS: The results in this clinical study are positive and promising. Admittedly, the study design is purely retrospective and observational with a small participant cohort, so the technical solution of placing three implants in the edentulous maxilla to retain a removable prosthesis should be appraised further in more controlled studies.

Perioperative use of non-steroidal anti-inflammatory drugs might impair dental implant osseointegration.

OBJECTIVE: To appraise whether adverse biological events following oral implant placement may be associated with perioperative use of non-steroidal anti-inflammatory drugs (NSAIDs). METHODS: All patients treated in a university faculty postgraduate dental clinic between 1979 and 2012 that had experienced a failing and surgically removed dental implant (292 implants in 168 patients) were contacted to solicit additional information about their present dental and medical status and frequency of current and past use of NSAIDs. Potential associations between perioperative NSAIDs use and the occurrence of adverse biological events were explored by the use of 2 × 2 tables and two-tailed Fisher's exact tests. RESULTS: One hundred and four patients with initially 468 implants had experienced 238 implant failures, of which 197 were due to failing osseointegration (42%). Sixty of the participants, initially with 273 implants, had used NSAIDs perioperatively and experienced 44% implant failures, versus 38% in the non-NSAID cohort. The NSAID cohort experienced 3.2 times more cases of radiographic bone loss greater than 30% of the vertical height of their remaining implants and 1.9 times more cases of cluster failures, defined as failure of 50% or more of the implant(s) placed. CONCLUSIONS: Notwithstanding that a retrospective study design is open to potential bias, the current data indicate that dental implant osseointegration may be affected negatively by an inhibitory effect of NSAIDs on bone healing in vulnerable patients. Future and better clinical studies than the current should be designed to appraise more precisely the potential effects of NSAIDs on implant osseointegration in study populations that are not limited by stringent medical inclusion and exclusion criteria.

Prevalence among adolescents in Bergen, Western Norway, of temporomandibular disorders according to the DC/TMD criteria and examination protocol.

OBJECTIVE: The aims of this study were to assess the prevalence of temporomandibular disorders (TMD) among adolescents and to contrast the prevalence of TMD according to the DC/TMD clinical examination protocol versus the prevalence of pain related to TMD according to two screening questions. MATERIAL AND METHODS: Two hundred and ten adolescents living in the county of Bergen, Norway, were offered an additional examination for TMD in connection with their regular dental check-up appointment. Five dental clinics were selected with differing socio-economic patient populations, as reflected by stratification of average levels of DMFT, and an equal number of girls and boys were invited to participate. The participants answered two screening questions for pain related to TMD followed by a clinical examination according to the DC/TMD protocol by five calibrated examiners. RESULTS: Acceptable calibration results were obtained. Approximately 80% of eligible participants consented to partake. According to the criteria of DC/TMD, the prevalence of TMD among the study participants was 11.9%, with a peak at 16 years of age. According to the self-reported screening questions for pain related to TMD, 7.2% responded positively. Only seven participants with a TMD diagnosis established according to the DC/TMD clinical examination protocol reported also pain related to TMD based on answering the two screening questions. CONCLUSION: The prevalence of TMD is higher for girls than for boys and the prevalence of TMD established according to the DC/TMD criteria was higher than the prevalence of pain related to TMD estimated by use of two screening questions for self-reported pain.

New 3D technologies applied to assess the long-term clinical effects of misfit of the full jaw fixed prosthesis on dental implants.

OBJECTIVES: To assess implant:suprastructure misfit in patients with an edentulous jaw restored by an implant-retained fixed dental prosthesis (FDP) and its association with biologic and mechanical adverse events over an extensive period. MATERIAL AND METHODS: Thirty patients with an edentulous mandible treated with implant-supported prosthetics before 2000 were examined clinically in 2012. Each patient had received 4 to 6 implants to retain a FDP made from acrylic and three different metal alloys, that is, Ag-Pd, Pd-Ag, and Au type IV. The implant intra-oral locations were recorded digitally by use of an intra-oral scanner, and the intaglio surface of the detached FDP was recorded using a desktop scanner. The fit was estimated by digital matching of the STL files using industrial metrological software. The average misfit was correlated with the average marginal bone loss and the prevalence of screw loosening or fractures, using the patient as the statistical unit. RESULTS: Over an average of 19 years (range 12 to 32), 5 implants had been lost in 4 participants (96.7% implant survival) and 8 eight prostheses (26.7%) had been remade. Anaverage misfit was 150 µm (SD 35, range 95-232, CI 138-163). An average marginal bone loss of 2.2 mm (SD = 0.7) had occurred (range 0.6 to 5.8 mm) for individual implants. The correlation between framework misfit and marginal bone loss was weak (R² = 0.04) (P = 0.29). The prostheses with a history of screw-related adverse events showed average misfit of 169 µm (SD = 32) vs. those with no history of screw-related adverse events, that is, 134 µm (SD = 30) (P = 0.005, Student's t-test). Fourteen of the 30 participants had experienced at least one incidence of screw loosening or fracture of prosthetic or abutment screw(s) over the period of follow-up. The occurrence among the frameworks fabricated with different metal alloys did not differ (P > 0.05, Fisher's exact test). CONCLUSIONS: Combining STL files with best-fit algorithms to appraise misfit is feasible using metrological software. The effect of misfit between the superstructures on its supporting implants up to ~230 µm on the long-term clinical outcomes appears to be minor, apart from a slightly higher risk of screw-related adverse events.

Single implant-supported crowns in the aesthetic zone: patient satisfaction with aesthetic appearance compared with appraisals by laypeople and dentists.

OBJECTIVE: To appraise the patients' satisfaction with aesthetic outcomes following an implant restoration in the anterior maxilla as compared to appraisals made by dentists and laypeople. MATERIAL AND METHODS: Randomly selected patients (n = 116) restored with an implant-retained crown in the anterior maxilla were invited to rate their satisfaction with aesthetic outcomes using a questionnaire containing seven criteria, each graded from excellent to poor. Projected images of the patient smiles were appraised by dentists (n = 8) and laypeople (n = 6) using the same assessment criteria in a room setting. In addition, the laypeople judged the same cases on printed 10 × 15 cm photographs in a separate setting. Jemt papilla scores, pink aesthetic score (PES) and white esthetic score (WES) were assigned by the dentists. Differences in the levels of satisfaction between the patient, and appraisals by the dentists and the laypeople were compared using non-parametric statistical tests. RESULTS: Patients' opinions of their aesthetic appearance following the placement of a single implant-supported crown in the aesthetic zone were in general very favourable. The laypeople were more critical than the dentists when the aesthetic outcomes were appraised on magnified images projected onto a screen. Laypeople became less critical when evaluating the aesthetic outcomes on printed photographs compared to appraisals on a screen. Patient satisfaction with their aesthetic appearance differed from dentists' and laypeople's appraisals. CONCLUSION: Factors other than the actual aesthetic outcome itself appear to influence patients' satisfaction with their end results. Laypeople's appraisal is influenced by the magnification and method used for appraising the aesthetic outcomes.

Accuracy of a novel prototype dynamic computer-assisted surgery system.

OBJECTIVES: To implement and evaluate the accuracy of a prototype dynamic computer-assisted surgery (CAS) system for implant osteotomy preparation and compare its accuracy vs. three commercial static CAS systems and the use of an acrylic stent. MATERIAL AND METHODS: Eight osteotomies were prepared in radiopaque partially edentulous mandible and maxilla typodonts. After cone-beam CT acquisition, DICOM files were imported into a prototype dynamic, and three static CAS systems (NobelClinician, Simplant, and CoDiagnostiX). Implant placements were planned to replicate the existing osteotomies and respective guides were requisitioned, along with one laboratory-made acrylic guide. The eight osteotomies per jaw were transferred to one typodont pair mounted in a manikin in a clinical setting and the process was repeated for four additional pairs. The 80 (two jaws × eight holes × five pairs) osteotomies were filled with radiopaque cement in-between the testing series. Three clinicians experienced with the use of the static CAS softwares used in this study prepared each 400 (80 holes × five modalities) osteotomies. One clinician repeated the experiment twice, resulting in a total of 2000 (five clinicians × 400) osteotomies. The lateral, vertical, total, and angular deviations of the actual vs. the original osteotomies in the master typodonts were measured using stereo optical tracking cameras. Linear regression statistics using generalized estimating equations were used for comparisons between the five modalities and omnibus chi-square tests applied to assess statistical significance of differences. RESULTS: The prototype dynamic CAS system was as accurate as other implant surgery planning and transfer modalities. The dynamic and static CAS systems provide superior accuracy vs. a laboratory-made acrylic guide, except vertically. Both dynamic and static CAS systems show on average <2 mm and 5 degrees error. Large deviations between planned and actual osteotomies were occasionally observed, which needs to be considered in clinical practice. CONCLUSIONS: The prototype dynamic CAS system was comparably accurate to static CAS systems.

Immediate function on the day of surgery compared with a delayed implant loading process in the mandible: a randomized clinical trial over 5 years.

OBJECTIVES: To appraise the feasibility of loading four implants with a pre-existing denture converted to a fixed dental prosthesis (FDP) on the day of implant surgery compared with waiting for 3- to 4-month healing. METHODS: Patients with an edentulous, fully healed mandible were recruited in a faculty clinic to partake in a blinded two-arm parallel randomized controlled trial (RCT). The participants received four parallel intraforamina mandibular implants with a moderately rough titanium surface (Brånemark System Mk III or Mk IV TiUnite; Nobel Biocare AB, Göteborg, Sweden). The implants were loaded on the same day by converting the participants' pre-existing denture in the experimental group. The implants were placed using a one-stage surgery procedure, and the participants' pre-existing denture were soft-relined in the control group. For both groups, the permanent 10- to 12-unit FDP consisting of a type-3 cast precious alloy veneered with acrylic and artificial teeth was placed 3-4 months after implant surgery. All participants have been recalled annually for 5 years for appraisal of bone loss and registration of adverse events. RESULTS: Thirty-five of the original 42 participants (83%) returned for clinical and radiological examinations at the 5-year follow-up recall. No selective dropout or specific reasons for dropout was identified in the two study arms; leaving n = 17 (Intention-to-treat group, ITT) in the experimental group, alternatively n = 13 as per protocol group (PP), and n = 18 participants in the control group (ITT = PP). At study commencement, five of the participants assigned to the experimental group did not receive their planned intervention. In the control group, one implant failed to osseointegrate and another failed due to bone loss after 5 years. The crestal bone level changes over 5 years were identical in the experimental and control groups, that is, 1.2 mm (SD = 0.7). There were no differences between the two study arms with regard to incidence of biological and technical adverse events. CONCLUSIONS: Implants in the anterior mandible loaded immediately with a converted pre-existing denture appear to yield analogous clinical outcomes compared with waiting for 3-4 months over the first 5 years following implant surgery.

Evaluation of a modular palatal lift prosthesis with a silicone velar lamina for hypernasal patients.

STATEMENT OF PROBLEM: Speech bulbs and palatal lift prostheses are used to improve oral-nasal balance in speakers with hypernasality resulting from velopharyngeal dysfunction. Fabricating such speech prostheses is often a protracted process, and the nasopharyngeal impression can be uncomfortable for the client. PURPOSE: The purpose of this study was to develop and test a modular palatal lift prosthesis with a silicone velar lamina that can be fabricated without a nasopharyngeal impression. MATERIAL AND METHODS: Six adult participants with different etiologies were treated with both a conventional palatal lift prosthesis and the new prosthesis. The outcome measures were nasalance scores, speech acceptability ratings, and participant responses on a questionnaire. Inferential statistical analyses were conducted with nonparametric Friedman tests and 2-tailed paired Wilcoxon signed ranks tests. The probability was set at P<.1. RESULTS: Among the 3 speaking conditions (no prosthesis, acrylic resin prosthesis, modular silicone palatal lift prosthesis), no differences were found in nasalance scores for the oral stimuli. For the nasal sentences, a numerically greater reduction was observed for the silicone than for the acrylic resin prosthesis. Speech acceptability was better with the modular silicone palatal lift prosthesis (z=2.032, P<.05) and the acrylic resin prosthesis (z=1.753, P<.1) than with no prosthesis. The questionnaire showed better subjective speech acceptability with the acrylic resin prosthesis (z=1.706, P<.05) and the modular silicone palatal lift prosthesis (z=1.706, P<.05) than with no prosthesis. Swallowing comfort was also numerically better for the acrylic resin prosthesis than for the modular silicone palatal lift prosthesis. CONCLUSIONS: This study demonstrates the feasibility of a new design for a flexible and modular palatal lift prosthesis. The functional outcomes were comparable to those of the traditional design. Although the overall results in this study favored the traditional prosthesis, the new design may be viable for patients who require alternative treatment solutions.

Dental implant suprastructures using cobalt-chromium alloy compared with gold alloy framework veneered with ceramic or acrylic resin: a retrospective cohort study up to 18 years.

BACKGROUND: An association between the long-term success and survival of implant-supported prostheses as a function of biomaterial combinations has not been established. The use of cast cobalt-chromium for the suprastructure framework may be an alternative to the conventional approach of using type 3 gold alloys. MATERIALS AND METHODS: A retrospective chart audit of all patients who had received implant-supported fixed dental prostheses (FDP) before 1996 was identified in a private practice clinic. Data were recorded for FDPs made from four combinations of alloy frameworks and veneering material, i.e. type 3 gold and cobalt-chromium with ceramic or prefabricated acrylic teeth. The extracted data from the charts were subjected to explorative statistical tests including Kaplan-Meier survival analyses. RESULTS: Patients (n=198) with 270 short and extensive FDPs supported entirely by 1117 implants were identified. The average follow-up observation periods varied between 4 and 220 months, with an average of 120 months. The success and survival, as well as event rates and types of biological and technical complications, were similar for implant-supported FDPs using cobalt-chromium and type 3 gold alloy frameworks veneered with ceramics or prefabricated acrylic teeth. An influence of the suprastructure biomaterial combination on the clinical performance of the individual supporting implants could not be established. CONCLUSIONS: Implant-supported FDPs made from type 3 gold or cobalt-chromium frameworks and veneered with ceramic or prefabricated acrylic teeth demonstrate comparable clinical performance. The biomaterial combinations do not appear to influence the success or survival of the individual implants.

The effectiveness of lasers to reduce dentinal hypersensitivity remains unclear.

SELECTION CRITERIA: Studies were located in a wide spectrum of bibliographic databases including Medline, Science Direct, Cochrane Clinical Trials Register, Cochrane Reviews, ISI Web of Science, LILACS, and IADR. Manual hand searches supplemented the digital search. No language restrictions applied. Independent screening was performed by 2 reviewers before coming to a forced decision of inclusion or exclusion. Kappa statistics were used for measuring agreement. Corresponding authors were contacted for verification of study details if needed. KEY STUDY FACTOR: The review was limited to randomized controlled trials (RCTs) on adult patients with hypersensitive dentin comparing laser intervention versus using a placebo with a follow-up of more than 3 months. MAIN OUTCOME MEASURE: A reference is made to a requirement of the included studies to have used an "assessment of hypersensitivity by scale" and the data reported with a mean and standard deviation. It is not entirely clear whether this should be interpreted as limited to use of VAS scales only, in contrast to categorical Likert-like scales or nominal descriptors. Regardless, the list of excluded studies in the original Table 3 does not include any studies that were excluded because of the lack of fulfilling this requirement. MAIN RESULTS: Out of several thousand titles and abstracts, 63 full-text articles were examined, and 6 of these were identified as RCTs. Three of these reported on less than 3 months, leaving only 3 articles for data extraction. No metaanalyses were done on this limited and somewhat heterogeneous data material. The methodological quality was considered, leaving the authors to conclude that the estimated risk of bias was high for all 3 studies. An exception was one of the studies where the authors were contacted and apparently had produced an inadequate article, but otherwise allegedly had conducted an exemplary trial. CONCLUSIONS: Laser treatment appears to reduce dentin hypersensitivity, but the evidence for this effectiveness is weak, and the placebo effect cannot be ruled out. No pulp damage or major adverse effects were reported in the 3 identified studies.

Comparison of two early loading protocols in full arch reconstructions in the edentulous maxilla using the Cresco prosthetic system: a three-arm parallel group randomized-controlled trial.

OBJECTIVES: Appraise the feasibility of interchanging conventional components of a fixed dental prosthesis (FDP) with those of Cresco in two different early loading protocols. MATERIAL AND METHODS: In five centers patients with an edentulous, fully healed maxilla were recruited to partake in a three-arm blinded randomized-controlled trial (RCT). Each patient received 5/6 implants using a single-stage surgery approach to support a 10/12-unit FDP. The implants used were SLA solid screw two-part implants. In test groups 1 and 2 components from Cresco were used and the implants loaded 10 days or 6-8 weeks post-implant placement. Group 3 received their FDP fabricated with conventional components 6-8 weeks post-implant placement. Patients were followed up 3 years. RESULTS: Of 36 patients, 30 remained after 3 years. The adjusted means and ranges of changes in crestal bone levels were -0.65, -0.5 and -0.4 mm in groups 1, 2 and 3, respectively. The change from baseline was statistically significant in all treatment groups. Adjusting for the difference in implant depth, there was an expected additional change in bone level of -0.29 mm by each 1 mm the implant was placed deeper. There was no significant difference between the 6-8 weeks post-implant placement loading Cresco group vs. the control group or between the two Cresco groups. CONCLUSIONS: The vertical placement has more effect on bone loss than the fabrication technique used for the suprastructure and whether the implants were loaded after 10 days vs. 6-8 weeks.

The evidence for endorsing the use of short dental implants remains inconclusive.

DATA SOURCES: Medline and Embase databases were searched between 1980 and October 2009 using free text and MeSH terms. Reference lists of retrieved publications were checked. STUDY SELECTION: Randomised-controlled trials or prospective cohort studies were eligible that included partially edentulous patients in whom at least five implants (each of length <10mm) were placed and where follow up was >1 year. Main outcomes were estimated failure rate per year and the estimated implant survival rate after two years. Failure was defined as implant removal due to loss of integration, implant mobility, symptoms as pain, neuropathies, paraesthesia, violation of the mandibular canal or psychological reason. Studies designated as 'methodologically unacceptable' were excluded. This was based on the validity assessment described below. DATA EXTRACTION AND SYNTHESIS: One reviewer extracted data from all included trials and another extracted from 25% of them. Validity of included studies was assessed using 'quality assessment of a cohort study' and 'quality assessment of a randomised clinical trial' developed by the Dutch Cochrane Centre. Authors were contacted by email when there were missing data. Sources of heterogeneity were explored using stratified analyses for the determinants surface topography, location (maxilla versus mandible), smoking and bone augmentation procedures. RESULTS: Twenty-nine studies were eligible including 2611 short implants (lengths 5, 6, 7, 8, 8.5, 9 and 9.5 mm). Twenty-eight were prospective cohort studies and one was a randomised controlled trial. The authors do not present a summary of the quality of the studies. The mean follow up was 3.7 years (range 1.6 - 8.1 years). There was mild to moderate heterogeneity between the studies depending on the length of the implants placed. The estimated survival rate after two years ranged from 93.1% (95% CI: 79.7-100%) for 5mm implants to 98.6% (95% CI: 94.6-100%) for 9.5mm implants. CONCLUSIONS: There is growing evidence that placement of short (<10mm) implants can be successful in the partially edentulous patient.

Can dental implants osseointegrate in oral cancer patients?

DATA SOURCES: Medline from 1986 to September 2010. Hand-searching of unspecified journals over an unspecified period of time. STUDY SELECTION: Clinical studies, though not confined to a particular type (e.g. randomised controlled trial), involving patients having undergone radio- and chemotherapy following oral cancer surgery. Only those articles published in English were included. DATA EXTRACTION AND SYNTHESIS: No details are given of the number of reviewers, of any quality assessment of the included papers, nor of how they proposed to synthesise the data or conduct subgroup and sensitivity analysis. RESULTS: A narrative report of findings from 21 included studies. No report is made of the types of study, nor their quality. In 16 studies that examined whether dental implants osseointegrated following radiation, between 68% and 100% did (no confidence intervals reported). Studies ranged in duration from 2 months to 13 years. CONCLUSIONS: Dental implants can osseointegrate and remain functionally stable in patients having undergone oral cancer therapy.

The effectiveness of lasers to reduce dentinal hypersensitivity remains unclear.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Effectiveness of laser in dentinal hypersensitivity treatment: a systematic review. Sgolastra F, Petrucci A, Gatto R, Monaco A. J Endod 2011;37(3):297-303. REVIEWER: Asbjorn Jokstad, DDS, PhD. PURPOSE/QUESTION: Do patients with dentinal hypersensitivity subjected to laser light application compared to placebo "light experience" reduced hypersensitivity or any adverse outcomes? SOURCE OF FUNDING: Information not available TYPE OF STUDY/DESIGN: Systematic review LEVEL OF EVIDENCE: Level 2: Limited-quality, patient-oriented evidence STRENGTH OF RECOMMENDATION GRADE: Grade B: Inconsistent or limited-quality patient-oriented evidence.