Rehabilitation of full-arch edentulism with fixed or removable dentures retained by root-form dental implants: A systematic review of outcomes and outcome measures used in clinical research in the last 10 years.

AIM: To evaluate outcome measures, methods of assessment, and analysis in clinical studies on the rehabilitation of full-arch edentulism with implant-supported fixed or removable prostheses. MATERIALS AND METHODS: A protocol-oriented search was conducted in MEDLINE via PubMed, EMBASE, and Cochrane Library (PROSPERO registration CRD42021265179) from 1 January 2011 to 27 July 2021 to identify longitudinal studies reporting on the rehabilitation of edentulous patients with implant-supported prostheses. The primary aim of this study was the collection of all objectively reported outcomes in each study. Secondary aims included the description of the methods of assessment and analytical methods. Risk of bias was applied according to the study design (randomized controlled trial, cohort study, or descriptive pre-post study). Individual study data were extracted into an outcomes matrix. Outcomes were grouped into domains and descriptively analysed. A network diagram was generated to establish relationships between domains. The present review follows the PRISMA statement. RESULTS: The screening and selection processes resulted in the identification of 491 publications, corresponding to 421 different studies (cohorts of patients). Only 24% of the studies reported the use of EQUATOR network guidelines. Implant failure/survival was the most reported outcome (270 studies), but the criterion to determine implant failure and/or survival was frequently not described or was ambiguous. Implant success was much less frequently reported (88) and was based on several heterogenous composite definitions. Marginal bone levels (233 studies), technical complications (158), and clinical outcomes (150), including peri-implant soft tissue and implant stability assessment, were also frequently reported. Patient-reported outcome measures (PROMs) (145) and function-based outcomes (40) were predominantly reported in isolation from other outcomes and most frequently in removable restorations. While quality of life was evaluated using valid instruments, patient satisfaction was evaluated based on a common sense concept of satisfaction. Economic outcomes were under-reported (13). CONCLUSIONS: There is great heterogeneity in the criteria to define implant failure or survival and implant success, which prevents the comparison of rates across studies. Even though studies frequently report multiple outcomes, PROMs are usually reported in isolation from other outcomes. It would be valuable to have a set of core outcome variables and standardized methods of measurement for future studies.

Rehabilitation of full-arch edentulism with fixed or removable dentures retained by root-form dental implants: A systematic review of outcomes and outcome measures used in clinical research in the last 10 years.

AIM: To evaluate outcome measures, methods of assessment, and analysis in clinical studies on the rehabilitation of full-arch edentulism with implant-supported fixed or removable prostheses. MATERIALS AND METHODS: A protocol-oriented search was conducted in MEDLINE via PubMed, EMBASE, and Cochrane Library (PROSPERO registration CRD42021265179) from 1 January 2011 to 27 July 2021 to identify longitudinal studies reporting on the rehabilitation of edentulous patients with implant-supported prostheses. The primary aim of this study was the collection of all objectively reported outcomes in each study. Secondary aims included the description of the methods of assessment and analytical methods. Risk of bias was applied according to the study design (randomized controlled trial, cohort study, or descriptive pre-post study). Individual study data were extracted into an outcomes matrix. Outcomes were grouped into domains and descriptively analysed. A network diagram was generated to establish relationships between domains. The present review follows the PRISMA statement. RESULTS: The screening and selection processes resulted in the identification of 491 publications, corresponding to 421 different studies (cohorts of patients). Only 24% of the studies reported the use of EQUATOR network guidelines. Implant failure/survival was the most reported outcome (270 studies), but the criterion to determine implant failure and/or survival was frequently not described or was ambiguous. Implant success was much less frequently reported (88) and was based on several heterogenous composite definitions. Marginal bone levels (233 studies), technical complications (158), and clinical outcomes (150), including peri-implant soft tissue and implant stability assessment, were also frequently reported. Patient-reported outcome measures (PROMs) (145) and function-based outcomes (40) were predominantly reported in isolation from other outcomes and most frequently in removable restorations. While quality of life was evaluated using valid instruments, patient satisfaction was evaluated based on a common sense concept of satisfaction. Economic outcomes were under-reported (13). CONCLUSIONS: There is great heterogeneity in the criteria to define implant failure or survival and implant success, which prevents the comparison of rates across studies. Even though studies frequently report multiple outcomes, PROMs are usually reported in isolation from other outcomes. It would be valuable to have a set of core outcome variables and standardized methods of measurement for future studies.

Scientific rationale for study: Consistent data on the outcomes of treatments for full-arch edentulism are fundamental for establishing high-quality clinical practices with effective impact on patients' lives. Principal findings: Despite the increasing number of studies assessing the rehabilitation of full-arch edentulism with implant-supported prostheses, there has been little adherence to reporting guidelines (EQUATOR network), resulting in high variability regarding the type of outcomes reported. The clinical performance of these restorations has been mostly evaluated using clinician-oriented and patient-reported outcomes. Assessment methods are frequently not described and vary across studies. Practical implications: It would be valuable to have a set of core outcome variables and standardized methods of measurement for future studies.

Systematic review evaluating the influence of the prosthetic material and prosthetic design on the clinical outcomes of implant-supported multi-unit fixed dental prosthesis in the posterior area.

OBJECTIVE: The objectives of the study were to assess the survival, failure, and technical complication rates of implant-supported fixed dental prosthesis (iFDPs) with pontic or splinted crown (iSp C) designs in the posterior area and compare the influence of prosthetic materials and prosthetic design on the outcomes. METHODS: Electronic and manual searches were performed to identify randomized-, prospective-, and retrospective clinical trials with follow-up time of ≥12 months, evaluating the clinical outcomes of posterior iFDPs with pontic or iSp Cs. Survival and complication rates were analyzed using robust Poisson's regression models. RESULTS: Thirty-two studies reporting on 42 study arms were included in the present systematic review. The meta-analysis of the included studies indicated estimated 3-year survival rates of 98.3% (95%CI: 95.6-99.3%) for porcelain-fused-to-metal (PFM) iFDPs, 97.5% (95%CI: 95.5-98.7%) for veneered zirconia (Zr) iFDPs with pontic, 98.9% (95%CI: 96.8-99.6%) for monolithic or micro-veneered zirconia iFDPs with pontic, and 97.0% (95%CI: 84.8-99.9%) for lithium disilicate iFDPs with pontics. The survival rates for different material combination showed no statistically significant differences. Veneered restorations, overall, showed significantly (p < .01) higher ceramic fracture and chipping rates compared with monolithic restorations. Furthermore, there was no significant difference in survival rates (98.3% [95%CI: 95.6-99.3%] vs. 99.1% [95%CI: 97.6-99.7%]) and overall complication rates between PFM iFDPs with pontic and PFM iSp Cs. CONCLUSIONS: Based on the data identified by this systematic review, PFM, veneered Zr, and monolithic Zr iFDPs with pontic and iSp Cs showed similarly high short-term survival rates in the posterior area. Veneered restorations exhibit ceramic chipping more often than monolithic restorations, with the highest fracture rate reported for veneered Zr iFDPs.

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).

The effect of systemic antibiotics on clinical and patient-reported outcome measures of oral implant therapy with simultaneous guided bone regeneration.

OBJECTIVES: The aim of the present superiority study was to determine the effect of systemic antibiotics primarily on patient-reported outcome measures (PROMs) and post-surgical complications in patients undergoing oral implant therapy with simultaneous guided bone regeneration (GBR). MATERIALS AND METHODS: A total of 236 medically and periodontally healthy patients received oral implants with simultaneous GBR at seven centres. Pre-operative antibiotics of 2 g amoxicillin were prescribed to the test group 1 hr prior to surgery and 500 mg thrice daily on days 1-3 after surgery. The control group was given a placebo. Group allocation was performed randomly. Primary outcome variables were PROMs recorded as visual analogue scale scores assessed on days 1-7 and 14 on pain, swelling, haematoma and bleeding. Post-operative complications as secondary outcome variables were examined at 1, 2, 4 and 12 weeks from surgery. Chi-square tests and repeated measures of analysis of variance (ANOVA) were performed for statistical evaluation. RESULTS: No statistically significant differences (p > .05) between the two groups were detected for the evaluated PROMs. The same was noted with respect to post-surgical complications. Four implants were lost-three in the test group and one in the control group. CONCLUSION: In this trial, systemic antibiotics did not provide additional benefits to PROMs, nor the prevention of post-surgical complications in medically and periodontally healthy patients undergoing oral implant therapy with simultaneous GBR. However, further studies with larger sample sizes are still required to support the clinical outcomes of this study.

A systematic review of the survival and complication rates of zirconia-ceramic and metal-ceramic single crowns.

OBJECTIVES: The aim of the present systematic review was to analyze the survival and complication rates of zirconia-based and metal-ceramic implant-supported single crowns (SCs). MATERIALS AND METHODS: An electronic MEDLINE search complemented by manual searching was conducted to identify randomized controlled clinical trials, prospective cohort and retrospective case series on implant-supported SCs with a mean follow-up time of at least 3 years. Patients had to have been clinically examined at the follow-up visit. Assessment of the identified studies and data extraction was performed independently by two reviewers. Failure and complication rates were analyzed using robust Poisson's regression models to obtain summary estimates of 5-year proportions. RESULTS: The search provided 5,263 titles and 455 abstracts, full-text analysis was performed for 240 articles, resulting in 35 included studies on implant-supported crowns. Meta-analysis revealed an estimated 5-year survival rate of 98.3% (95% CI: 96.8-99.1) for metal-ceramic implant supported SCs (n = 4,363) compared to 97.6% (95% CI: 94.3-99.0) for zirconia implant supported SCs (n = 912). About 86.7% (95% CI: 80.7-91.0) of the metal-ceramic SCs (n = 1,300) experienced no biological/technical complications over the entire observation period. The corresponding rate for zirconia SCs (n = 76) was 83.8% (95% CI: 61.6-93.8). The biologic outcomes of the two types of crowns were similar; yet, zirconia SCs exhibited less aesthetic complications than metal-ceramics. The 5-year incidence of chipping of the veneering ceramic was similar between the material groups (2.9% metal-ceramic, 2.8% zirconia-ceramic). Significantly (p = 0.001), more zirconia-ceramic implant SCs failed due to material fractures (2.1% vs. 0.2% metal-ceramic implant SCs). No studies on newer types of monolithic zirconia SCs fulfilled the simple inclusion criteria of 3 years follow-up time and clinical examination of the present systematic review. CONCLUSION: Zirconia-ceramic implant-supported SCs are a valid treatment alternative to metal-ceramic SCs, with similar incidence of biological complications and less aesthetic problems. The amount of ceramic chipping was similar between the material groups; yet, significantly more zirconia crowns failed due to material fractures.

Fracture strength of zirconia implant abutments on narrow diameter implants with internal and external implant abutment connections: A study on the titanium resin base concept.

BACKGROUND: There is limited knowledge regarding the strength of zirconia abutments with internal and external implant abutment connections and zirconia abutments supported by a titanium resin base (Variobase, Straumann) for narrow diameter implants. OBJECTIVES: To compare the fracture strength of narrow diameter abutments with different types of implant abutment connections after chewing simulation. MATERIAL AND METHODS: Hundred and twenty identical customized abutments with different materials and implant abutment connections were fabricated for five groups: 1-piece zirconia abutment with internal connection (T1, Cares-abutment-Straumann BL-NC implant, Straumann Switzerland), 1-piece zirconia abutment with external hex connection (T2, Procera abutment-Branemark NP implant, Nobel Biocare, Sweden), 2-piece zirconia abutments with metallic insert for internal connection (T3, Procera abutment-Replace NP implant, Nobel Biocare), 2-piece zirconia abutment on titanium resin base (T4, LavaPlus abutment-VarioBase-Straumann BL-NC implant, 3M ESPE, Germany) and 1-piece titanium abutment with internal connection (C, Cares-abutment-Straumann BL-NC implant, Straumann, Switzerland). All implants had a narrow diameter ranging from 3.3 to 3.5 mm. Sixty un-restored abutments and 60 abutments restored with glass-ceramic crowns were tested. Mean bending moments were compared using ANOVA with p-values adjusted for multiple comparisons using Tukey's procedure. RESULTS: The mean bending moments were 521 ± 33 Ncm (T4), 404 ± 36 Ncm (C), 311 ± 106 Ncm (T1) 265 ± 22 Ncm (T3) and 225 ± 29 (T2) for un-restored abutments and 278 ± 84 Ncm (T4), 302 ± 170 Ncm (C), 190 ± 55 Ncm (T1) 80 ± 102 Ncm (T3) and 125 ± 57 (T2) for restored abutments. For un-restored abutments, C and T4 had similar mean bending moments, significantly higher than those of the three other groups (p < .05). Titanium abutments (C) had significantly higher bending moments than identical zirconia abutments (T1) (p < .05). Zirconia abutments (T1) with internal connection had higher bending moments than zirconia abutments with external connection (T2) (p < .05). For all test groups, the bending moments were significantly reduced when restored with all-ceramic crowns. CONCLUSIONS: For narrow diameter abutments, the fracture strength of 2-piece internal connected zirconia abutments fixed on titanium resin bases was similar to those obtained for 1-piece titanium abutments. Narrow diameter zirconia abutments with internal connection exhibited higher fracture strength than zirconia abutments with an external connection. Titanium abutments with an internal connection were significantly stronger than identical zirconia abutments.

Reconstructive aspects: Summary and consensus statements of group 3. The 5th EAO Consensus Conference 2018.

OBJECTIVES: The tasks of this working group were to evaluate the existing evidence on the efficiency and efficacy of the digital and conventional workflows for the fabrication of fixed implant reconstructions, to assess the performance of all-ceramic fixed implant reconstructions and, finally, to evaluate the outcomes of internally and externally connected implant abutments and reconstructions. METHODS: Four reviews were available analyzing the current literature on the respective topics. One review dealt with the efficiency and efficacy of digital and conventional fabrication workflows. Two reviews analyzed the outcomes of all-ceramic fixed implant reconstructions, one focusing on single-implant reconstructions and the other evaluating multiple-unit implant fixed dental prostheses (FDPs). The fourth review evaluated the clinical outcome on external, respectively, internal implant-abutment connections. These reviews were the basis for the discussions within the group and at the plenary sessions. RESULTS: The present consensus report gives the consensus statements, the clinical recommendations, and the implications for future research as discussed and approved by the plenum of the consensus conference. The four manuscripts by Mühlemann et al., Rabel et al., Pieralli et al., and Pjetursson et al. are published as part of the journal supplement of the present EAO consensus conference.

Dental implants - are they better than natural teeth?

Nowadays, patients find much information on dental treatment from the Internet. There is a vast amount of information on dental implants, in contrast to the limited information available on natural teeth. This review addresses research on survival of natural teeth and dental implants, and discusses factors affecting the survival rate of implants, as well as certain dogmas in implant dentistry. To simplify treatment planning, the article presents a classification system in which teeth are classified as secure, doubtful, or irrational to treat. Secure teeth should last for a long period of time without need for complex treatment. Doubtful teeth are teeth that might need complicated treatment and additional maintenance in order to be maintained. Teeth irrational to treat are teeth that cannot be saved and for which extraction is the only treatment option. Multiple risk factors might decrease the survival probability of teeth. The survival and success rates of dental implants will never succeed the survival rates of healthy, clean teeth. Dental implants and implant-supported restorations are an excellent treatment modality, but it must always be kept in mind that it is associated with a risk of biological and technical complications. Implants are supposed to replace missing teeth - they are not supposed to replace teeth.

Extending the service life of existing dental restorations with esthetic and functional limitations.

Adhesive cementation is a useful procedure not only for cementing restorations onto teeth but also for attaching new ceramic restorations to existing restorations to improve their esthetics and/or function. This clinical report presents a technique for modifying an existing nonsatisfactory implant-supported fixed dental prosthesis by means of adhesively cemented veneers and onlays bonded to the pre-existing metal-ceramic surface with resin cement. This modification may avoid the replacement of the fixed dental prosthesis, reducing both treatment costs and time while fulfilling the patient's demands.

A multicenter randomized, controlled clinical trial comparing the use of displacement cords, an aluminum chloride paste, and a combination of paste and cords for tissue displacement.

STATEMENT OF PROBLEM: Gingival recession after soft tissue displacement for impression making in fixed prosthodontics may pose a problem for treatment success in the esthetic areas of the mouth. Knowledge about the soft tissue reaction of common gingival displacement methods is limited. PURPOSE: The purpose of this clinical randomized controlled trial (RCT) was to evaluate changes in the marginal soft tissue height with 3 different gingival tissue displacement techniques for definitive impression making of natural teeth. MATERIAL AND METHODS: A total of 67 individuals were randomized to 3 groups. In test group 1 (P; n=22), only aluminum chloride paste was used to displace the gingiva. In test group 2 (CP; n=23), a cord was inserted, and aluminum chloride paste was also used. In the control group (C; n=22), 2 cords were used to displace the gingiva (double-cord technique). Clinical measurements of the gingival position were made before treatment began and at 30 ±10 days after prosthesis delivery. Study casts were fabricated at different stages of the treatment, standardized photographs were made, and changes in the buccal gingival position were measured using graphics editing software. In addition, the participants' perception of the clinical procedure and the technicians' evaluation of the die preparation were recorded. One-way ANOVA models were applied to compare the response variables among the groups: (a) the position of the gingival margin (millimeters), (b) mean probing pocket depth (millimeters), (c) gingival thickness (millimeters), (d) amount of keratinized tissue (millimeters), and (e) mean changes in gingival margin height (millimeters). Unpaired t tests were also used to compare the mean values between groups. For comparisons between different categories, chi-square tests were performed (α=.05 for all tests). RESULTS: In the period between impression and delivery, a minor gain in gingival height of 0.058 mm (±0.13 SD) for P and 0.013 mm (±1.19 SD) for CP. However, a minor gingival recession of 0.049 mm (±0.13 SD) was reported for group C. The results for all groups showed that 21% of abutment teeth gained >0.1 mm in gingival height, 58% had stable gingival height (0 ±0.10 mm), 21% showed minor gingival recession (0.1 to 0.5 mm), and no abutment teeth showed moderate or severe gingival recession (>0.5 mm). The incidence of minor gingival recession was 8% in group P, 23% in group CP, and 32% in group C (P=.015). Fifteen participants (24%) experienced some discomfort after the procedure. The differences between the groups were not significant (P>.05). The laboratory technicians found the definitive die preparation significantly more challenging for group P (visual analog scale [VAS], 79) and CP (VAS, 82) than group C (mean VAS, 93; P=.003). CONCLUSIONS: Minor or moderate gingival recession (<1 mm) is more likely to occur when conventional cords are used during impression making. However, the laboratory technicians found the die preparation significantly less challenging when the double-cord technique was used than when impressions were made using the paste displacement technique.

A systematic review of the survival and complication rates of resin-bonded fixed dental prostheses after a mean observation period of at least 5 years.

OBJECTIVES: The objective of this systematic review was to assess the 5-year and 10-year survival of resin-bonded fixed dental prostheses (RBBs) and to describe the incidence of technical and biological complications. MATERIALS AND METHODS: An electronic MEDLINE search complemented by manual searching was conducted to identify prospective and retrospective cohort studies and case series on RBBs with a mean follow-up time of at least 5 years. Patients had to have been examined clinically at the follow-up visit. Assessment of the identified studies and data extraction were performed independently by two reviewers. Failure and complication rates were analyzed using robust Poisson regression models to obtain summary estimates of 5- and 10-year proportions. RESULTS: The search provided 367 titles and 87 abstracts. Full-text analysis was performed for 22 articles resulting in seven studies that met the inclusion criteria. Five articles were found through manual search, and 17 studies were provided from (Pjetursson et al. 2008, Clinical Oral Implants Research, 19, 131), resulting in an overall number of included studies of 29. Meta-analysis of these studies reporting on 2300 RBBs indicated an estimated survival of resin-bonded bridges of 91.4% (95 percent confidence interval [95% CI]: 86.7-94.4%) after 5 years and 82.9% (95% CI: 73.2-89.3%) after 10 years. A significantly higher survival rate was reported for RBBs with zirconia framework compared with RBBs from other materials. RBBs with one retainer had a significantly higher survival rate (P < 0.0001) and a lower de-bonding rate (P = 0.001) compared with RBBs retained by two or more retainers. Moreover, the survival rate was higher for RBBs inserted in the anterior area of the oral cavity compared with posterior RBBs. The most frequent complications were de-bonding (loss of retention), which occurred in 15% (95% CI: 10.9-20.6%) and chipping of the veneering material that was reported for 4.1% (95% CI: 1.8-9.5%) of the RBBs over an observation period of 5 years. CONCLUSION: Despite the high survival rate of RBBs after 5 and 10 years, technical complications like de-bonding and minor chipping were frequent. RBBs with zirconia framework and RBBs with one retainer tooth showed the highest survival rate.

Sinus floor elevation utilizing the transalveolar approach.

A transalveolar approach for sinus floor elevation with subsequent placement of dental implants was first suggested by Tatum in 1986. In 1994, Summers described a different transalveolar approach using a set of tapered osteotomes with increasing diameters. The transalveolar approach of sinus floor elevation, also referred to as 'osteotome sinus floor elevation', the 'Summers technique' or the 'Crestal approach', may be considered as being more conservative and less invasive than the conventional lateral window approach. This is reflected by the fact that more than nine out of 10 patients who experienced the surgical procedure would be willing to undergo it again. The main indication for transalveolar sinus floor elevation is reduced residual bone height, which does not allow standard implant placement. Contraindications for transalveolar sinus floor elevation may be intra-oral, local or medical. The surgical approach utilized over the last two decades is the technique described by Summers, with or without minor modifications. The surgical care after implant placement using the osteotome technique is similar to the surgical care after standard implant placement. The patients are usually advised to take antibiotic prophylaxis and to utilize antiseptic rinses. The main complications reported after performing a transalveolar sinus floor elevation were perforation of the Schneiderian membrane in 3.8% of patients and postoperative infections in 0.8% of patients. Other complications reported were postoperative hemorrhage, nasal bleeding, blocked nose, hematomas and benign paroxysmal positional vertigo. Whether it is necessary to use grafting material to maintain space for new bone formation after elevating the sinus membrane utilizing the osteotome technique is still controversial. Positive outcomes have been reported with and without using grafting material. A prospective study, evaluating both approaches, concluded that significantly more bone gain was seen when grafting material was used (4.1 mm mean bone gain compared with 1.7 mm when no grafting material was utilized). In a systematic review, including 19 studies reporting on 4388 implants inserted using the transalveolar sinus floor elevation technique, the 3-year implant survival rate was 92.8% (95% confidence interval: 87.4-96.0%). Furthermore, a subject-based analysis of the same material revealed an annual failure rate of 3.7%. Hence, one in 10 subjects experienced implant loss over 3 years. Several of the included studies demonstrated that transalveolar sinus floor elevation was most predictable when the residual alveolar bone height was ≥ 5 mm and the sinus floor anatomy was relatively flat.

Risk factors associated with the longevity of multi-rooted teeth. Long-term outcomes after active and supportive periodontal therapy.

AIM: To investigate risk factors for the loss of multi-rooted teeth (MRT) in subjects treated for periodontitis and enrolled in supportive periodontal therapy (SPT). MATERIAL AND METHODS: A total of 172 subjects were examined before (T0) and after active periodontal therapy (APT)(T1) and following a mean of 11.5 ± 5.2 (SD) years of SPT (T2). The association of risk factors with loss of MRT was analysed with multilevel logistic regression. The tooth was the unit of analysis. RESULTS: Furcation involvement (FI) = 1 before APT was not a risk factor for tooth loss compared with FI = 0 (p = 0.37). Between T0 and T2, MRT with FI = 2 (OR: 2.92, 95% CI: 1.68, 5.06, p = 0.0001) and FI = 3 (OR: 6.85, 95% CI: 3.40, 13.83, p < 0.0001) were at a significantly higher risk to be lost compared with those with FI = 0. During SPT, smokers lost significantly more MRT compared with non-smokers (OR: 2.37, 95% CI: 1.05, 5.35, p = 0.04). Non-smoking and compliant subjects with FI = 0/1 at T1 lost significantly less MRT during SPT compared with non-compliant smokers with FI = 2 (OR: 10.11, 95% CI: 2.91, 35.11, p < 0.0001) and FI = 3 (OR: 17.18, 95% CI: 4.98, 59.28, p < 0.0001) respectively. CONCLUSIONS: FI = 1 was not a risk factor for tooth loss compared with FI = 0. FI = 2/3, smoking and lack of compliance with regular SPT represented risk factors for the loss of MRT in subjects treated for periodontitis.

Effect of systemic antibiotics on clinical and patient-reported outcomes of implant therapy - a multicenter randomized controlled clinical trial.

OBJECTIVES: To determine the effect of various systemic antibiotic prophylaxis regimes on patient-reported outcomes and postsurgical complications in patients undergoing conventional implant installation. MATERIAL AND METHODS: Three hundred and twenty-nine healthy adults in need of conventional implant installation were randomly assigned to one of four groups: (i) preoperatively 2 g of amoxycillin 1 h before surgery (positive control, PC), (ii) postoperatively 2 g of amoxycillin immediately following surgery (test 1, T1), (iii) preoperatively 2 g of amoxycillin 1 h before and 500 mg thrice daily on days 2 and 3 after surgery (test 2, T2), (iv) preoperatively 2 g of placebo 1 h before surgery (negative control, NC). Subjects were examined clinically by blinded examiners over 8 weeks after implant installation. In addition, Visual Analogue Scales (VAS) for pain, swelling, bruising and bleeding were obtained over 14 days. ANOVA was performed for the VAS. Chi-square tests were applied for postsurgical complications. RESULTS: All VAS scores were low for all groups and decreased over time (P < 0.001). There were no significant differences for the VAS scores between the various groups at any time point (P > 0.05). There was only a significant difference in flap closure at week 4, where NC had 5% of the subjects not achieving complete wound closure compared to 0% for the three other groups (P = 0.01), with no other significant differences for any postsurgical complications (P > 0.05). CONCLUSION: For standard single implant placement, prophylactic systemic antibiotics either before or after, or before and after the surgical procedure do not improve patient-reported outcomes or prevalence of postsurgical complications.

Quality of reporting of clinical studies to assess and compare performance of implant-supported restorations.

OBJECTIVES: The objective of this analysis was to assess and compare the 5- and 10-year survival of different types of tooth-supported and implant-supported fixed dental prostheses (FDPs) and single crowns (SCs), and to describe the incidence of biological and technical complications with emphasis on quality of reporting. MATERIAL AND METHODS: The analysis was based on six systematic review identifying prospective and retrospective cohort studies and case-series on FDPs and SCs with a mean follow-up time of at least 5 years. Patients had to have been examined clinically at the follow-up visit. Failure and complication rates were analysed using random-effects Poisson regression models to obtain summary estimates of 5- and 10-year survival proportions. RESULTS: Meta-analyses of the included studies indicated that the 5-year survival rates ranged from 89.2% to 95.5% for different types of restorations. Investigating the relative failure rates using implant-supported SCs as reference, conventional and cantilever tooth-supported FDPs and resin-bonded prosthesis (RBPs) showed higher failure rates. Moreover, for RBPs, this difference reached statistical significance (p = 0.018). Analysing the studies with 10 years follow-up time, the survival ranged from 65% to 89.4%. After a 10-year observation period, the lowest annual failure rates were seen for implant-supported SCs (1.12%), conventional tooth-supported FDPs (1.14%) and implant-supported FDPs (1.43%). Cantilever tooth-supported FDPs, combined tooth-implant-supported FDPs and RBPs had significantly (p < 0.001) higher annual failure rates of 2.20%, 2.51% and 4.31%, respectively. According to presently recommended standards for reporting cohort studies (STROBE Statement), it was evident that the included studies did not fulfil the present standards to a great extent. Information on study design, methods of selecting study participants, percentage and reason for participants lost to follow-up was often not reported. Furthermore, the included studies rarely discussed possible limitations and potential sources of bias. Moreover, funding sources were generally not reported. CONCLUSION: Based on the present analysis treatment planning in a mutilated dentition in need of oral reconstructions should base on the results of the systematic reviews performed. In this context, the choice of reconstructions on teeth with end abutments, of reconstructions on implants (both FDPs and SCs) should be given first priority, while combined tooth-implant-supported reconstructions, cantilever reconstructions on teeth and RBPs represent options of second priority. Future studies on performance of implant-supported restorations should be prospective in design and should follow the present recommendation for reporting cohort studies (The STROBE statement).

A systematic review of the survival and complication rates of implant-supported fixed dental prostheses (FDPs) after a mean observation period of at least 5 years.

OBJECTIVES: The objective of this systematic review was to assess the 5- and 10-year survival of implant-supported fixed dental prostheses (FDPs) and to describe the incidence of biological and technical complications. METHODS: An electronic Medline search complemented by manual searching was conducted to identify prospective and retrospective cohort studies and case series on FDPs with a mean follow-up time of at least 5 years. Patients had to have been examined clinically at the follow-up visit. Failure and complication rates were analyzed using standard and random-effects Poisson regression models to obtain summary estimates of 5-year and 10-year survival and complication rates. RESULTS: The updated search provided 979 titles and 257 abstracts. Full-text analysis was performed for 90 articles resulting in a total 32 studies that met the inclusion criteria. Meta-analysis of these studies indicated an estimated survival of implants supporting FDPs of 95.6% after 5 years and 93.1% after 10 years. When machined surface implants were excluded from the analysis and only rough surface implants included, the survival rate increased to 97.2% after 5 years. The survival rate of implant-supported FDPs was 95.4% after 5 years and 80.1% after 10 years of function. When the analysis was done exclusively for metal-ceramic FDPs, hence the old gold-acrylic FDPs were excluded, the survival rate increased significantly. The survival rate of metal-ceramic implant-supported FDPs was 96.4% after 5 years and 93.9% after 10 years. Only 66.4% of the patients were free of any complications after 5 years. The most frequent complications over the 5-year observation period were fractures of the veneering material (13.5%), peri-implantitis and soft tissue complications (8.5%), loss of access hole restoration (5.4%), abutment or screw loosening (5.3%), and loss of retention of cemented FDPs (4.7%). CONCLUSION: It may be concluded that implant-supported fixed dental prostheses (FDPs) are a safe and predictable treatment method with high survival rates. However, biological and technical complications were frequent (33.6%). To minimize the incidence of complications, dental professionals should make great effort in choosing reliable components and materials for implant-supported FDPs and the patients should be placed in well-structured maintenance system after treatment.

Systematic review of the survival rate and the incidence of biological, technical, and aesthetic complications of single crowns on implants reported in longitudinal studies with a mean follow-up of 5 years.

OBJECTIVE: To assess the 5-year survival of implant-supported single crowns (SCs) and to describe the incidence of biological, technical, and aesthetic complications. The focused question was: What is the survival rate of implants supporting single crowns and implant-supported crowns with a mean follow-up of 5 years and to which extent do biological, technical, and aesthetic complications occur? METHODS: A Medline search (2006-2011) was performed for clinical studies focusing on implant-supported SCs with a mean follow-up of at least 5 years. The search was complemented by an additional hand search and the inclusion of 24 studies from a previous systematic review (Jung et al. 2008a). Survival and complication rates were analyzed using random-effects Poisson's regression models to obtain summary estimates of 5- and 10-year proportions. RESULTS: Forty-six studies derived from an initial search count of 1083 titles and the complementary publications from the previous systematic review (Jung et al. 2008a) were selected and the data were extracted. Based on the meta-analysis, survival of implants supporting SCs at 5 years amounted to 97.2% (95% CI: 96.3-97.9%), and at 10 years amounted to 95.2% (95% CI: 91.8-97.2%). The survival of implant-supported SCs was 96.3% (95% CI: 94.2-97.6%) after 5 years and 89.4% (95% CI: 82.8-93.6%) after 10 years. For biological complications, a 5-year cumulative soft tissue complication rate of 7.1% (95% CI: 4.4-11.3%) and a cumulative complication rate for implants with bone loss >2 mm of 5.2% (95% CI: 3.1-8.6%) were calculated. Technical complications reached a cumulative incidence of 8.8% (95% CI: 5.1-15.0%) for screw-loosening, 4.1% (95% CI: 2.2-7.5%) for loss of retention, and 3.5% (95% CI: 2.4-5.2%) for fracture of the veneering material after 5 years. The cumulative 5-year aesthetic complication rate amounted to 7.1% (95% CI: 3.6-13.6%). CONCLUSIONS: The outcomes of the meta-analysis demonstrated high implant survival rates for both the single tooth implants and the respective single crowns after 5 and 10 years. However, technical, biological, and aesthetic complications were frequent.

Peri-implantitis susceptibility as it relates to periodontal therapy and supportive care.

OBJECTIVE: To assess the long-term survival of implants inserted in periodontally susceptible patients and to investigate the influence of residual pockets on the incidence of peri-implantitis and implant loss. MATERIALS AND METHODS: For 70 patients, comprehensive periodontal treatment was followed by installation of 165 Straumann Dental implants. Subsequently, 58 patients entered a University supportive periodontal therapy (SPT) program and 12 had SPT in a private practice. The follow-up time ranged from 3 to 23 years (mean 7.9 years). Bleeding on probing (BOP), clinical attachment level (CAL), and peri-implant probing depths (PPD) were evaluated at baseline (T0), completion of active treatment (T1), and at follow-up (T2). Peri-implant bone levels were assessed on radiographs at T2. Patients were categorized as having implants not affected by peri-implantitis (non-PIP), or affected by peri-implantitis (PIP). RESULTS: From 165 implants inserted, six implants were lost, translating into a cumulative survival rate of 95.8%. Solid screw implants yielded significantly higher survival rates than the hollow cylinder and hollow screw implants (99.1% vs. 89.7%). Implants lost due to peri-implant infection were included in the PIP groups. When peri-implantitis (PPD ≥ 5 mm, BOP+) was analyzed, 22.2% of the implants and 38.6% of patients had one or more implants affected by peri-implantitis. Using the peri-implantitis definition (PPD ≥ 6 mm, BOP+), the prevalence was reduced to 8.8% and 17.1%, respectively. Moreover, all these implants demonstrated significant (≥ 2 mm) bone loss at T2. At T1, the non-PIP group had significantly (P = 0.011) fewer residual pockets (≥ 5 mm) per patient than the PIP group (1.9 vs. 4.1). At T2, the PIP group displayed an increased number of residual pockets compared to T1, whereas in the non-PIP group, the number remained similar to T1. At T2, mean PPD, mean CAL and BOP were significantly higher in the PIP group compared with the non-PIP group. The prevalence of peri-implantitis was lower in the group that was in a well organized SPT at the University. CONCLUSIONS: In periodontitis susceptible patients, residual pockets (PPD ≥ 5 mm) at the end of active periodontal therapy represent a significant risk for the development of peri-implantitis and implant loss. Moreover, patients in SPT developing re-infections are at greater risk for peri-implantitis and implant loss than periodontally stable patients.

The effect of different implant neck configurations on soft and hard tissue healing: a randomized-controlled clinical trial.

OBJECTIVE: to compare the soft and hard tissue healing and remodeling around tissue-level implants with different neck configurations after at least 1 year of functional loading. MATERIAL AND METHODS: eighteen patients with multiple missing teeth in the posterior area received two implants inserted in the same sextant. One test (T) implant with a 1.8 mm turned neck and one control (C) implant with a 2.8 mm turned neck were randomly assigned. All implants were placed transmucosally to the same sink depth of approximately 1.8 mm. Peri-apical radiographs were obtained using the paralleling technique and digitized. Two investigators blinded to the implant type-evaluated soft and hard tissue conditions at baseline, 6 months and 1 year after loading. RESULTS: the mean crestal bone levels and soft tissue parameters were not significantly different between T and C implants at all time points. However, T implants displayed significantly less crestal bone loss than C implants after 1 year. Moreover, a frequency analysis revealed a higher percentage (50%) of T implants with crestal bone levels 1-2 mm below the implant shoulder compared with C implants (5.6%) 1 year after loading. CONCLUSION: implants with a reduced height turned neck of 1.8 mm may, indeed, lower the crestal bone resorption and hence, may maintain higher crestal bone levels than do implants with a 2.8 mm turned neck, when sunk to the same depth. Moreover, several factors other than the vertical positioning of the moderately rough SLA surface may influence crestal bone levels after 1 year of function.