Evaluation of jaw function, oral health-related quality of life, and nutritional status during oral rehabilitation procedures - a pilot study.

AIMS: To evaluate limitations in jaw function, oral health-related quality of life (OHRQoL), and nutritional status during extensive oral rehabilitation procedures. MATERIAL METHODS: Fourteen participants (mean age ± SD: 70 ± 3.8) undergoing major oral rehabilitation involving the restoration of a minimum of eight teeth were recruited in the study. Jaw function limitations scores (JFLS), oral health-impact profile (OHIP), and nutritional status were measured at different time points during, six months, and one year after the rehabilitation procedures. Nutritional status was evaluated by measuring the body weight and arm and calf muscle circumference. The effect of time points on the measured variables was evaluated with Friedman's test. Trends in nutritional status were evaluated with linear regression analysis. RESULTS: The results of the analysis showed significant main effects of time points on the JLFS (p < .001) and OHIP scores (p = .005). However, there was no effect of time points on the body weight (p = .917) and calf muscle circumference (p = .424), but a significant effect on arm circumference (p = .038). Further, there was a decreasing trend for body weight (64.3%), arm (71.4%), and calf circumference (64.3%) in the majority of the patients. CONCLUSION: The results of the preliminary study suggest that people undergoing extensive oral rehabilitation procedures show improvement in jaw function and an increase in OHRQoL after the rehabilitation procedure. Despite no major changes in the nutritional indicators, most patients showed a negative trend in their body weight, arm circumference, and calf circumference, suggesting that they may be susceptible to nutritional changes.

A retrospective clinical study of fixed tooth- and implant-supported prostheses in titanium and cobalt-chromium-ceramic: 5-9-year follow-up.

OBJECTIVES: The aim of this retrospective study was to evaluate the clinical outcome of fixed tooth- and implant-supported protheses manufactured in porcelain veneered cobalt-chromium (CoCr) or titanium with a follow-up period of 5-9 years. MATERIALS AND METHODS: This study included 63 patients with a total of 86 fixed dental protheses (FDPs) (53 implant-supported and 33 tooth-supported). In total, 67 were short-span FDPs (3-5 units) and 19 were long-span FDPs (6-12 units). The FDPs were evaluated using a modified version of the California Dental Association (CDA). RESULTS: The binary regression analysis indicated that neither CoCr nor titanium had a statistically significant effect on the odds of success or survival of either tooth- or implant-supported FDPs. However, the success of FDPs was negatively affected by greater FDP length and general tooth wear. The survival of FDPs was negatively affected by increased FDP longevity. CONCLUSIONS: This study found no statistically significant effect on the odds of success and survival outcomes for any combination of tooth-supported, implant-supported, porcelain-veneered CoCr, or porcelain-veneered titanium FDPs. As the number of FDPs was limited, the results should be interpreted with caution. CLINICAL RELEVANCE: This study shows that the choice between CoCr porcelain and titanium porcelain in fixed protheses did not have a statistically significant effect on the outcome.

Bone and soft tissue outcomes, risk factors, and complications of implant-supported prostheses: 5-Years RCT with different abutment types and loading protocols.

BACKGROUND: Data on risk factors and complications after long-term implant treatment is limited. The aims were to evaluate the role of various fixation modes and to analyze complications and risks that affect long-term use of implant-supported partial fixed dental prostheses. MATERIALS AND METHODS: Fifty partially edentulous subjects received three Brånemark TiUnite™ implants. Superstructures were attached directly at implant level (IL) or via abutments: machined surface (AM) and an oxidized surface (AOX, TiUnite™). Implants were immediately loaded (test) or unloaded for 3 months (control). Examinations occurred over a 5-year period. RESULTS: Forty-four subjects were re-examined after 5 years. Cumulative survival rates in test and control groups were 93.9% and 97.0%, respectively. Marginal bone loss (MBL; Mean [SEM]) was significantly lower at superstructures connected to AM (1.61 [0.25] mm) than at sites with no abutment IL (2.14 [0.17] mm). Peri-implantitis occurred in 9.1% of subjects and in 4.0% of implants. Multiple linear regression indicated that increased probing pocket depth (PPD), periodontal disease experience, deteriorating health, and light smoking (≤10 cigarettes/day) predict greater MBL, whereas increased buccal soft tissue thickness and higher ISQ predict lower MBL. CONCLUSIONS: The results show that MBL was influenced by the connection type. A machined abutment, instead of connecting the superstructure directly at the implant level, was beneficial. The following factors influenced MBL: PPD, periodontal disease experience, deteriorating health, light smoking, buccal soft tissue thickness, and ISQ. The results on peri-implantitis underscore the need for long-term maintenance care. Further, the abutment material surface properties constitute additional target for strategies to minimize MBL.

Bone Response and Soft Tissue Changes Around Implants With/Without Abutments Supporting Fixed Partial Dentures: Results From a 3-Year, Prospective, Randomized, Controlled Study.

BACKGROUND: Diverging opinions exist regarding rough surface abutment usage, and abutment exclusion effects are unstudied. PURPOSE: The study aims to: (1) assess tissue response to oxidized or machined abutments or no abutment; and (2) evaluate immediate implant-loading effects. MATERIALS AND METHODS: In a 2005-2008 parallel-group randomized, clinical trial, 50 partially edentulous subjects received three Brånemark TiUnite™ (Nobel Biocare®, Gothenburg, Sweden) implants. Superstructures were attached via abutments (one with a TiUnite surface - AOX, and one with a machine-milled surface - AM) or directly at implant level (IL). Implants were immediately loaded (test) or unloaded for 3 months (control). Postoperative examinations were done up to 3 years. RESULTS: Forty-seven subjects were reexamined after 3 years. Four and two implants were lost in test and control groups, respectively, during the first year. Thereafter, no implant loss occurred (95.7% survival). After 1 year, mean (SEM) peri-implant marginal bone loss (MBL) was 1.33 (0.08) mm (test) and 1.25 (0.08) mm (control). Between 1 and 3 years, a nonsignificant MBL occurred: 0.36 (0.08) mm (test) and 0.33 (0.06) mm (control). Similar MBL was found at IL (1.81 [0.93] mm) and AOX (1.77 [0.14] mm) after 3 years and was significantly lower at AM (1.42 [0.17] mm) than at IL (groups merged); 42% of the implants displayed mucosal bleeding at 3 years and probing pocket depths varied between 2.13 (0.12) mm and 3.62 (0.15) mm, significantly lower buccally. Bleeding on probing (BoP) in minute amounts was found in 30-45% of the sites and abundant BoP at about 20% of the sites. Soft tissue retracted mostly during year 1 and was more pronounced buccally. Regression analyses revealed significant effects from smoking, periodontal disease, abundant BoP, and a low initial implant stability quotient on MBL. CONCLUSIONS: No further significant MBL was found between 1 and 3 years, irrespective of loading protocol. Use of machined abutments may benefit marginal bone stability over time.

Immediately loaded implants with or without abutments supporting fixed partial dentures: 1-year results from a prospective, randomized, clinical trial.

PURPOSE: To evaluate 1-year implant survival and marginal bone loss around implants that support fixed partial dentures loaded immediately or after 3 months, and effects from abutment usage. MATERIALS AND METHODS: In this 2005 to 2009 randomized, parallel-group, clinical trial, 50 partially edentulous patients each received three Brånemark TiUnite™ implants (Nobel Biocare®, Göteborg, Sweden), mostly in the posterior maxilla. Two implants were fitted with abutments: a TiUnite™ surface and a machine-milled surface; the suprastructure was attached directly at implant level for the third implant. After randomized allocation, implants were immediately loaded with a fixed temporary bridge (test group) or left unloaded for 3 months (control group). A permanent fixed suprastructure replaced the temporary bridge after 6 months (test). Hard and soft tissues were examined during pretreatment and surgery plus 2 days, 14 days, 4 weeks, 3 months, and 1 year after surgery. RESULTS: After 1 year, four implants were lost in the test and two in the control groups (1-year survival rates of 94.9% [test] and 97.2% [control], with no significant intergroup difference). Resonance frequency analysis values indicated a similar pattern in both groups, with implant stability quotient (ISQ) reduction between 2 and 4 weeks. The test group had a significantly lower ISQ than the control group at these appointments. After 1 year, marginal bone losses around the implants were, on average, 1.32 mm (test, standard error of the mean [SEM] 0.08) and 1.24 mm (control, SEM 0.08), with no significant intergroup difference. Significantly larger marginal bone loss was observed at implants without abutment compared with implants with abutment. CONCLUSIONS: For both groups, this study showed similar implant survival rates and marginal bone loss. Larger bone loss was found at implants loaded without attached abutments.

Gene expression of inflammation and bone healing in peri-implant crevicular fluid after placement and loading of dental implants. A kinetic clinical pilot study using quantitative real-time PCR.

PURPOSE: Early detection of healing complications after placement of dental implants is a pressing but elusive goal. This paper proposes a non-invasive diagnostic tool for monitoring healing- and peri-implant disease specific genes, complementary to clinical evaluations. MATERIAL AND METHODS: Eighteen partially edentulous patients were recruited to this pilot study. Three Brånemark TiUnite® implants/patient (Nobel Biocare) were placed in a one-stage procedure. Abutments with smooth or rough (TiUnite®) surface were placed. The test group (n = 9) received fixed bridges (immediate loading), whereas the control group (n = 9) implants were loaded 3 months after surgery. In addition to clinical measurements, crevicular fluid was collected using paper strips at the implant abutments 2, 14, 28, and 90 days postoperative. mRNA was extracted, purified, and converted to cDNA. Quantitative PCR assays for IL-1ß, TNF-α, Osteocalcin (OC), Alkaline Phosphatase (ALP), Cathepsin K, Tartrate Resistant Acid Phosphatase, and 18S ribosomal RNA were designed and validated. Relative gene expression levels were calculated. RESULTS: One implant was lost in the control group and three in the test group. In one test patient, one implant showed lowered stability after 2 to 4 weeks and was unloaded. Later implant stability improved which allowed for loading after 3 to 4 months. TNF-α and ALP most commonly showed correlation with clinical parameters followed by IL-1ß and OC. The strongest correlation was found for TNF-α with clinical complications at 2 and 14 days (p = .01/r = -048, and p = .0004/r = -0.56, respectively; test and control groups together). In some cases, gene expression predicted clinical complications (TNF-α, ALP, CK). CONCLUSION: This study is based on samples from few individuals; still, some genes showed correlation with clinical findings. Further studies are needed to refine and optimize the sampling process, to find the appropriate panel, and to validate gene expression for monitoring implant healing.

Oral health of individuals aged 3-80 years in Jönköping, Sweden during 30 years (1973-2003). I. Review of findings on dental care habits and knowledge of oral health.

The aim of the present study was to compare data on dental care habits and knowledge of oral health in four cross-sectional epidemiological studies carried out in 1973,1983,1993, and 2003. The 1973 study constituted a random sample of 1,000 individuals evenly distributed in the age groups 3, 5, 10, 15, 20, 30, 40, 50, 60, and 70 years. The same age groups with addition of a group of 80-year-olds were included in the 1983, 1993 and 2003 studies, which comprised 1,104, 1,078, and 987 individuals, respectively. A questionnaire about dental care habits and knowledge of oral health was used in connection with a clinical and radiographic examination. The same questions were used in all the four studies. An addition to the 1993 and 2003 investigations were questions concerning ethnic background. In 2003 approximately 90-95 per cent of all individuals were visiting the dentist on a regular basis every or every second year. The 30- and 40-yea r-olds, however, did not visit a dentist as regularly in 2003 as in 1993. In these age groups 21-24 per cent of the individuals, respectively, reported that they had not visited a dentist in the last 2 years. Almost all children 3-15 years old received their dental care within the Public Dental Service (PDS). During the period 1973-2003 an increase in percentage of individuals aged 20-50 years treated by the PDS was seen compared to private practice, while among 60-80 year-olds there were only minor changes. Most so-year-olds and older received their dental care by private practitioners. About 70-80 per cent of all adults in 2003 were enrolled in a recall system on the dentist's initiative while in 1973 most appointments were based on the patient's own initiative. The number of individuals who were frightened, 5-17 per cent, or felt discomfort at the prospect of an appointment with the dentist was more or less the same during the whole period. The knowledge of the etiology of dental diseases did not changed much between 1973 and 2003. The frequency of toothbrushing increased since 1973 and in 2003 more than 90 per cent of all individuals brushed their teeth twice or once a day. The use of dental floss and toothpicks decreased in 2003 compared to 1983 and 1993. Almost all individuals in 2003 used fluoride toothpaste. It was obvious that the dental team constituted the main source of dental health information. For the age groups 20 and 30 years information from friends and relatives was also important. In the age groups 3-20 years up to 45 per cent of the individuals were consuming soft drinks every day or several times a week.

Oral health of individuals aged 3-80 years in Jönköping, Sweden during 30 years (1973-2003). II. Review of clinical and radiographic findings.

The aim of this epidemiological study was to analyze various clinical and radiographic data on oral health and compare the results to those of three cross-sectional studies carried out in 1973 and 1983, and 1993. In 1973, 1983, 1993, and 2003 a random sample of 1,000; 1,104; 1,078; and 987 individuals, respectively, were studied. The individuals were evenly distributed in the age groups 3, 5, 10, 15, 20, 30, 40, 50, 60, 70, and 80 years. In 1973 80-year-olds were not included. All subjects were inhabitants of the City of Jönköping, Sweden. The clinical and radiographic examination assessed edentulousness, removable dentures, implants, number of teeth, caries, restorations and overhangs, oral hygiene, calculus, periodontal status, endodontic treatment, and periapical status. The number of edentulous individuals in the age groups 40-70 years was reduced from 16 per cent in 1973 to 8 per cent in 1993, and to 1 per cent in 2003. The mean number of teeth increased, and up to the age of 60 years, individuals had more or less complete dentitions. During the 30-year period,the number of carious lesions and restorations decreased in general. In the 15-year-olds the decrease in number of restored tooth surfaces was 900 per cent and the corresponding figure for 30-year-olds was 79 per cent. The age groups 60-800 years showed an increase in number of restored tooth surfaces and had as a mean 50 filled tooth surfaces. The oral health among 3-5-year-olds improved markedly between 1973 and 1993. In 2003, however, there was no further improvement in 3- and 5-year-olds compared to 1993. Generally, restorations in 2003 exhibited a high quality and 90-95 per cent had no proximal overhangs. In 1973 this figure was about 60 per cent. In the age groups 20-50 years there were continuously fewer teeth fitted with crowns or bridges during the 30-year period. In 1973 the 50-year-olds had a mean of 24.5 per cent of the teeth crowned and in 2003 6.8 percent. Compared to data from 1973 there was a reduction by half concerning occurrence of plaque and gingivitis in 2003. The frequency of individuals with one or more periodontal pockets (> or = 4 mm) increased with age. In 2003 the bone level at the age of 60 years corresponded to the bone level at the age of 40 years in 1973. The percentage of endodontically treated teeth was lower in 2003 in all age groups compared to 1973, 1983, and 1993. The percentage of endodontically treated teeth with periapical orjuxtaradicular destructions was generally lower in 2003 than in the earlier surveys, about 20 per cent in 2003 compared to 25-30 per cent in 1973,1983, and 1993. The comparison of the four studies shows that there has been a great overall improvement in oral health over this 30-year period.

Complications after treatment with implant-supported fixed prostheses: a retrospective study.

PURPOSE: The aim was to retrospectively evaluate the frequencies of different complications, as well as the number of visits to dentists because of such complications, after treatment with implant-supported fixed prostheses. MATERIALS AND METHODS: The study group comprised 75 patients who had been treated with implant-supported fixed prostheses 3 years earlier. All case records were scrutinized, and notes of complications in association with implants and superstructures were registered. RESULTS: The most common intervention made was occlusal adjustment/selective grinding of the prostheses. Complications in association with both implants and superstructures were fairly common. The most frequent complication was fractures of the acrylic resin matrix, including artificial acrylic resin teeth. Consultations because of periimplant mucosal inflammation were much more common among women compared to men, while complications that could be attributed to heavy loading tended to be more common in men. CONCLUSION: Complications with both implants and superstructures are fairly common after treatment with implant-supported fixed prostheses. Regular follow-ups to maintain optimal function in these patients are thus mandatory.