Dentin Matrix Protein 1 on Titanium Surface Facilitates Osteogenic Differentiation of Stem Cells.

Dentin matrix protein 1 (DMP1) contains a large number of acidic domains, multiple phosphorylation sites, a functional arginine-glycine-aspartate (RGD) motif, and a DNA binding domain, and has been shown to play essential regulatory function in dentin and bone mineralization. DMP1 could also orchestrate bone matrix formation, but the ability of DMP1 on Ti to human mesenchymal stem cell (hMSC) conversion to osteoblasts has not been studied. There is importance to test if the DMP1 coated Ti surface would promote cell migration and attachment to the metal surface and promote the differentiation of the attached stem cells to an osteogenic lineage. This study aimed to study the human mesenchymal stem cells (hMSCs) attachment and proliferation on DMP1 coated titanium (Ti) disks compared to non-coated disks, and to assess possible osteoblastic differentiation of attached hMSCs. Sixty-eight Ti disks were divided into two groups. Group 1 disks were coated with dentin matrix protein 1 and group 2 disks served as control. Assessment with light microscopy was used to verify hMSC attachment and proliferation. Cell viability was confirmed through fluorescence microscopy and mitochondrial dehydrogenase activity. Real-time polymerase chain reaction analysis was done to study the gene expression. The proliferation assay showed significantly greater cell proliferation with DMP1 coated disks compared to the control group (p-value < 0.001). Cell vitality analysis showed a greater density of live cells on DMP1 coated disks compared to the control group. Alkaline phosphatase staining revealed higher enzyme activity on DMP1 coated disks and showed itself to be significantly higher than the control group (p-value < 0.001). von Kossa staining revealed higher positive areas for mineralized deposits on DMP1 coated disks than the control group (p-value < 0.05). Gene expression analysis confirmed upregulation of runt-related transcription factor 2, osteoprotegerin, osteocalcin, osteopontin, and alkaline phosphatase on DMP1 coated disks (p-value < 0.001). The dentin matrix protein promoted the adhesion, proliferation, facilitation differentiation of hMSC, and mineralized matrix formation.

Fracture Resistance of Various Thickness e.max CAD Lithium Disilicate Crowns Cemented on Different Supporting Substrates: An In Vitro Study.

PURPOSE: To investigate the influence of abutment material properties on the fracture resistance and failure mode of lithium disilicate (IPS e.max) CAD/CAM (computer-aided design/manufacturing) crowns on traditionally and minimally prepared simulated tooth substrates. MATERIALS AND METHODS: Thirty lithium disilicate (IPS e.max) CAD/CAM crowns were divided into three groups (n = 10): TD: traditional thickness crowns cemented on Paradigm MZ100 abutments; MD: minimal thickness crowns cemented on Paradigm MZ100 abutments; ME: minimal thickness crowns cemented on e.max abutments. The 3Shape system was used to scan, design and mill all abutments and crowns with a die space set to 40 µm. Traditional thickness crowns were designed based on manufacturer guidelines with 1.5 mm occlusal thickness and 1.0 mm margins. Minimal thickness crowns were designed with 0.7 mm occlusal thickness and 0.5 mm margins. MZ100 composite and e.max abutments were selected to simulate dentin and enamel substrates, respectively, based on their elastic-modulus. Variolink Esthetic was used to cement all samples following manufacturer's instructions. A universal testing machine was used to load all specimens to fracture with a 3 mm radius stainless steel hemispherical tip at a crosshead speed 0.5 mm/minute along the longitudinal axis of the abutment with a 1 mm thermoplastic film placed between the loading tip and crown surface. Data was analyzed using ANOVA and Bonferroni post hoc assessment. Fractographic analysis was performed with scanning electron microscopy (SEM). RESULTS: The mean fracture load (standard deviation) was 1499 (241) N for TD; 1228 (287) N for MD; and 1377 (96) N for ME. Statistically significant difference between groups did not exist (p = 0.157, F = 1.995). In groups TD and MD with low e-modulus abutments, the dispersion of a probability distribution (coefficient of variation: CV) was statistically higher than that of group ME with high e-modulus abutments. SEM illustrated larger micro-fracture dimensions in Group MD than Group ME. CONCLUSION: Minimal thickness e.max crowns did not demonstrate statistical difference in fracture resistance from traditional thickness crowns. Fracture mechanisms of minimal thickness e.max crowns may be affected by the e-modulus of the substrate. Minimal thickness e.max crowns may be a viable restorative option when supported by high e-modulus materials.

Patient-Specific, Risk-Based Prevention, Maintenance, and Supportive Care: A Need for Action and Innovation in Education.

PURPOSE: To develop a competency-based curriculum framework for prevention, supportive care, and maintenance for use in educational and patient care programs and to seek consensus on an overarching competency statement that embraces these critical learning and patient care concepts. MATERIALS AND METHODS: A preliminary survey of current preventive and maintenance practices in U.S. dental and prosthodontic programs was completed and summarized with quantitative analysis. The American College of Prosthodontists organized a one-day consensus workshop with 14 participants from various U.S. dental schools with diverse backgrounds to develop a curriculum framework. The curriculum framework was used in the development of a joint competency statement using an iterative, online consensus process of debate and feedback. RESULTS: The preliminary survey helped frame the initiative and identify potential educational needs and gaps. Consensus was achieved for a recommended competency statement: "Graduates must be competent in promoting oral health through risk assessment, diagnosis, prevention, and management of the hard tissue, soft tissue, and prostheses, and as part of professional recall and home maintenance." This competency statement complements the proposed curriculum framework designed around 3 domains-caries prevention, periodontal supportive care, and prosthesis supportive care-with a set of recommended learning objectives. CONCLUSIONS: Commission on Dental Accreditation (CODA) learning standards do not outline patient-customized, evidence-based recall and home maintenance programs that highlight prevention of dental caries, periodontal supportive care, prosthesis maintenance, and patient education. The proposed competency-based curricular framework serves as an initial step in addressing student learning and patient care within the context of a recall system and home maintenance program while offering schools the needed flexibility for implementation within their curriculum.

Making the Best Clinical Decisions for Patients: The Pros-CAT ProtocolTM.

The Pros-CAT protocol critical appraisal method uses accepted strategies to identify and summarize best evidence to support patient care through evidence-based analysis that includes assessing the patient; developing a concise clinical question; conducting a literature search to identify pertinent research; critically appraising the identified literature for validity, reliability, and applicability to the patient situation; synthesizing the literature into a meaningful conclusion using an organized method; and applying that synthesis to the patient's need. The Pros-CAT protocol is applicable for practicing clinicians, dental students, postgraduate students, and residents. The Pros-CAT index compares evidence strength for patient applicability.

Patient-Reported and Clinical Outcomes of Implant-Supported Fixed Complete Dental Prostheses: A Comparison of Metal-Acrylic, Milled Zirconia, and Retrievable Crown Prostheses.

The purpose of this retrospective study was to assess the incidence of biologic and technical complications for implant-supported fixed complete dental prostheses (IFCDPs) and their relationship to oral health-related quality of life (OHQoL) and patient-reported outcomes. Metal-acrylic (MA), retrievable crown (RC), monolithic zirconia (MZ), and porcelain veneered zirconia (PVZ) prostheses were included. Patients who received an IFCDP at least 1 year prior to recall were identified. Exclusion criteria were: (1) an opposing complete denture and (2) time in service >70 months. A total of 37 patients with 49 prostheses, including 22 MA, 14 RC, 7 MZ, and 6 PVZ prostheses were recalled. Patient-reported outcomes were assessed via OHIP-49 (Oral Health Impact Profile) and a scripted interview with open-ended questions. All designs had high complication rates (12 of 22 MA, 10 of 14 RC, 2 of 7 MZ, and 5 of 6 PVZ). The most common complications were: (1) MA: posterior tooth wear, (2) RC: chipping and fracturing of the restorations, (3) MZ: wear of opposing restorations, and (4) PVZ: chipping of opposing restorations. Average OHIP-49 scores ranged from 7 to 29, indicating high OHQoL, patient satisfaction, regardless of prosthetic design ( P = .16). The standardized interview highlighted that although most patients were extremely satisfied (73%), some continued to be bothered by material bulk (14%) and felt that maintenance of oral hygiene was excessively time-consuming (16%). In the context of this study, despite high complication rates and maintenance needs, all IFCDP designs resulted in high OHQoL and patient satisfaction.

Integration of Digital Dentistry into a Predoctoral Implant Program: Program Description, Rationale, and Utilization Trends.

A recently revised predoctoral implant curriculum at the University of Illinois at Chicago College of Dentistry integrated digital dentistry into both the preclinical dental implant course and clinical activities. Traditionally, competence in the didactic and clinical parts of predoctoral education in single tooth implant restorations has emphasized the analog impression technique and subsequent mounting of soft tissue working casts. However, computer-aided design/computer-aided manufacturing (CAD/CAM) implant restorations can play a significant role in predoctoral dental education utilizing digital technologies. The goal of the curriculum expansion is to transition from analog to partially digital and, finally, complete digital workflow. The aim of this article is to describe the specific components, implementation, and rationale for the new digitally integrated implant curriculum and present short-term clinical utilization trends.

Micro-Computed Tomography of Tooth Volume Changes Following Post Removal.

PURPOSE: To measure tooth volume change before and after post removal using micro-CT and to compare the difference among various combinations of prefabricated post and cement systems. MATERIALS AND METHODS: Forty-eight extracted maxillary anterior teeth and mandibular canines were sectioned 13 mm from the apex. Root canals were properly instrumented. Preparations were filled with gutta percha using lateral condensation. Post space was prepared with a touch and heat device, leaving 5 mm of gutta percha from the apex. Specimens were scanned with micro-CT to establish objective baseline volume and divided into two groups of post systems: stainless steel (SS) ParaPost and glass-fiber reinforced composite (FRC) post. Half the posts for each group were cemented with Ketac Cem radiopaque glass-ionomer cement, and the other half with SpeedCEM dual-curing resin cement. The posts and residual cement were removed by the same operator, using the ultrasonic vibration technique under an endodontic operating microscope. The remaining tooth root structure was scanned again using micro-CT with volume reported (mm3 ). The statistical difference between the combination of posts and cements was measured using the Kruskal-Wallis ANOVA test (α = 0.001). The independent variables were evaluated separately using post hoc Tukey examination to determine which groups resulted in a statistically significant difference. RESULTS: There was a statistical difference of tooth root volume change among the groups. Post hoc exam revealed a statistically significant difference in tooth root volume change between group 1 (SS + GI) and the other groups (α = 0.0002). CONCLUSION: Compared to other post and cement combinations, serrated parallel-sided SS posts cemented with GI cement had the most tooth root structure loss upon post removal using the ultrasonic vibration technique.

Abutment Material Effect on Peri-implant Soft Tissue Color and Perceived Esthetics.

PURPOSE: The purpose of this study was to evaluate the effect of implant abutment material on peri-implant soft tissue color using intraoral spectrophotometric analysis and to compare the clinical outcomes with patient and clinician perception and satisfaction. MATERIALS AND METHODS: Thirty patients and four prosthodontic faculty members participated. Abutments were zirconia, gold-hued titanium, and titanium. Peri-implant mucosa color of a single anterior implant restoration was compared to the patient's control tooth. Spectrophotometric analysis using SpectroShadeTM Micro data determined the color difference (ΔE, ΔL*, Δa*, Δb*) between the midfacial peri-implant soft tissue for each abutment material and the marginal gingiva of the control tooth. Color difference values of the abutment groups were compared using ANOVA (α = 0.05). Patient and clinician satisfaction surveys were also conducted using a color-correcting light source. The results of each patient and clinician survey question were compared using chi-square analysis (α = 0.05). Pearson correlation analyses identified the relationship between the total color difference (ΔE) and the patient/clinician perception and satisfaction, as well as between ΔE and tissue thickness. RESULTS: Zirconia abutments displayed significantly smaller spectrophotometric gingival color difference (ΔE) compared to titanium and gold-hued titanium abutments (respectively, 3.98 ± 0.99; 7.22 ± 3.31; 5.65 ± 2.11; p < 0.05). Among ΔL*, Δa*, and Δb*, only Δa* (red-green spectrum) showed significant difference between groups. There was no significant correlation between measured soft tissue thickness and ΔE, but thick gingival phenotype, determined by a probe test, demonstrated a smaller ΔE than thin phenotype (4.82 ± 1.49; 6.41 ± 3.27; p = 0.097). There was no statistical difference in patient or clinician satisfaction among abutment materials, and no correlation between ΔE and the patient and clinician satisfaction. Patient satisfaction was significantly higher than clinician, and patient-perceived differences were lower than clinicians' (p < 0.01). Clinicians' satisfaction was higher for gingival (pink) esthetics than crown (white) esthetics (p < 0.05). CONCLUSIONS: Peri-implant mucosa with zirconia abutments demonstrated significantly lower mean color difference compared to titanium or gold-hued titanium abutments as measured spectrophotometrically; however, no statistical difference in patient or clinician perception/satisfaction among abutment materials was demonstrated. Patients were significantly more satisfied than clinicians.

Retrospective Analysis of Implant Overdenture Treatment in the Advanced Prosthodontic Clinic at the University of Illinois at Chicago.

The aim of the present retrospective study was to evaluate the clinical outcomes of implant-supported overdenture treatment provided by prosthodontic specialty residents. Twenty-three patients with 25 implant-supported overdentures (IODs) participated in the study. Seventy-four implants were placed by periodontic, prosthodontics, or oral and maxillofacial surgery students. All prostheses were fabricated in the advanced prosthodontics clinic at University of Illinois at Chicago. The condition of the peri-implant soft tissue, implants, and prostheses were evaluated. Complications and any maintenance were documented. Patients completed an oral health impact profile-14 and semantic differential scale questionnaires. Statistical analyses were performed using SPSS statistical software. Twenty mandibular and 5 maxillary IODs were evaluated. Ninety-seven percent of the attachments were locators (Zest Anchors) and 3% ball attachments. None of the implants had lost osseointegration, but 14 implants (19%) had developed marginal bone loss in one-third of the implant length or more. Fourteen (19%) implants had developed dehiscence, which ranged from 1 to 4 mm. A variation in the width of the keratinized tissue, gingival, plaque, and calculus index was observed. There was a statistically significant relationship between the presence of plaque and the bleeding on probing on the buccal aspect of implants (P = .012). The incidence of dehiscence was significantly higher on the midfacial when the keratinized tissue was less than 2 mm (P < .0001). The majority of the complications were prosthetic in nature, such as broken denture teeth (74%) and worn or loose matrices (35%). Debris was observed in 19% of the locator abutments, and 36% of the overdentures were not stable in application of anterior force. Patients were compliant with oral hygiene protocols and their chewing ability was high (mean = 8.0). The overall experience was pleasant (mean = 7.5); the treatment provided good esthetics (mean = 8.3) and great satisfaction (mean = 8.5). From an educational and clinical perspective, IOD therapy has been documented to be a predictable and successful treatment option. Patients should be informed of the required maintenance and the possible complications related to IOD therapy.

Prosthodontic Implant Club at UIC, Program Description and Survey Analysis.

PURPOSE: This study aims to (1) describe the Predoctoral Implant Club at UIC (PIC-UIC) mentoring model while providing a rationale for the program and (2) investigate PIC members' perception about the club and prosthodontics in general via a questionnaire and focus group discussion. MATERIALS AND METHODS: A survey to investigate PIC members' perception regarding the club was distributed at a meeting. The survey consisted of questions about the members' prior exposure to prosthodontics, faculty, and residents; current exposure to and perceptions of prosthodontics; future outcomes from membership; and possible improvements to PIC-UIC. Four student members of PIC-UIC participated in a focus group discussion about their exposure to prosthodontics during each year of their training, their exposure to prosthodontics following PIC-UIC membership, including rotations in the advanced prosthodontic clinic, mentorships by prosthodontic faculty and residents, and attendance at the American College of Prosthodontists Annual Session. RESULTS: Following PIC-UIC membership, students indicated an increased exposure to prosthodontics and prosthodontic faculty. More than a third of the respondents indicated that they are "likely" to consider a prosthodontic residency after having joined PIC-UIC. Almost two-thirds of the respondents indicated that they would recommend PIC to students at other universities and believed their understanding of the prosthodontic specialty has increased. Students who participated in the focus group agreed they had little exposure to prosthodontics, prosthodontic faculty, and advanced restorative procedures in the beginning of their dental education. They felt that involvement in PIC-UIC was a valuable experience that helped them consider or reinforced their decision to pursue prosthodontics as a career. CONCLUSIONS: PIC-UIC increased predoctoral students' interest in prosthodontics. Involving prosthodontic faculty and residents in mentoring and educational activities was evaluated positively by students. PIC-UIC may serve as a pipeline program for predoctoral students at other dental schools.

Patient Perception and Satisfaction with Implant Therapy in a Predoctoral Implant Education Program: A Preliminary Study.

PURPOSE: The purpose of this study was to assess the level of satisfaction and quality of life for patients receiving mandibular implant-supported overdenture (IOD) or single-tooth implant (STI) therapy in a predoctoral dental implant program. MATERIALS AND METHODS: Patients who received IOD and STI therapy and presented for recall visits at University of Illinois-Chicago College of Dentistry Predoctoral Implant Program were recruited. IOD treatment included placement of two endosseous implants in the mandibular canine region, followed by two abutments for resilient attachments. STI treatment included placement of endosseous implants, abutments, and cement-retained crowns. A modified Oral Health Impact Profile (OHIP)-14 questionnaire was given at least 6 months following insertion of implant-supported prostheses for both groups. Patient age, gender, distribution of STI, and OHIP-14 data were gathered and analyzed. Descriptive statistics were used to assess post-treatment data; Mann-Whitney U test was used to analyze the differences between groups older and younger than mean age and gender among the IOD and STI groups. RESULTS: Fifty-one consecutive patients in the IOD (60.7% male, 39.2% female, mean age 63.7) and 50 consecutive patients in the STI group (58.0% female, 42.0% male, mean age 50.8) were included in this recall study. In the STI group, 69 implants were placed for 50 patients; the most common region was the maxillary posterior quadrant (49.3%). Scores from modified OHIP-14 ranged from 0.14 to 0.78 for the IOD group and 0.02 to 0.18 for the STI group. Both IOD and STI data showed satisfaction with the treatment outcome. There was a significant difference found between men and women among the IOD group pertaining to questions regarding pronouncing words, sense of taste, meal interruption, and feeling embarrassed from OHIP-14, but not between the age groups. Also, no significant differences were noted for gender or age group within the STI patients and OHIP-14 scores. CONCLUSION: Dental implant therapy provided in a predoctoral setting had a significant impact on the quality of life and a high level of satisfaction for patients seeking implant treatment.

Are predoctoral students able to provide single tooth implant restorations in the maxillary esthetic zone?

The objective of this study was to assess the ability of the University of Illinois at Chicago College of Dentistry (UIC-COD) predoctoral students to provide single tooth implant (STI) prostheses in the maxillary esthetic zone. The patient's esthetic satisfaction and the correlation between prosthodontists' and patients' perspectives were examined. Twenty-seven patients were recruited for recall examinations at the UIC-COD predoctoral implant program and underwent clinical and radiographic examination with clinical photographs of the implant sites. The patients completed a semantic differential scale questionnaire. The collected information was formulated into a PowerPoint presentation for two Diplomate of the American Board of Prosthodontists to use the Pink/White Esthetic Score (PES/WES) to evaluate the esthetic outcome. Descriptive analyses, Cohen kappa test, and Spearman rank correlation coefficient test were performed. The average PES/WES were above 6.0 (out of 10). The median for the patient satisfaction and esthetic outcome questionnaires were 10 and 9, respectively, on a scale with 10=highest. There was a medium and positive correlation between prosthodontists' and patients' perspectives in esthetic outcome. This study found that, with strict guidance and proper selection criteria, predoctoral students were able to provide esthetically acceptable STI prostheses in the maxillary esthetic zone and patients were satisfied with the treatment provided.

Electrochemical behavior of titanium in artificial saliva: influence of pH.

Titanium is the most common material chosen for dental implants because it is highly corrosion resistant because it constantly reforms a protective passive film layer. The formation and composition of the passive film layer is dependent on the environmental conditions. If the stable oxide layer is damaged, the titanium surface underneath can corrode. The purpose of this study was to determine if basic corrosion of commercially pure titanium (CpTi) alloy in artificial saliva was affected by pH and to understand the corrosion kinetics/mechanisms of CpTi as a function of pH. In this study, titanium alloy discs were subjected to corrosion tests. Before the tests, all samples were cleaned and polished using standard metallographic preparation methods. Artificial saliva was used as the testing medium. The following pH values were tested: 3.0, 4.5, 6.0, 6.5, 7.5, and 9.0. Different pH values were achieved by adding lactic acid (acidic) or NaOH (basic) in appropriate amounts. Potentiodynamic curves indicated behavior change at each pH. In addition, the corrosion current density value determined from the potentiodynamic curve exhibited the poorest corrosion resistance for pH 7.5. The Nyquist plot (from the electrochemical impedance spectroscopy results) indicated that pH 7.5 had the poorest resistance. Scanning electron microscopy images indicated that pH levels of 6.5, 7.5, and 9.0 had considerable surface corrosion. The results showed that the media's pH significantly influenced the corrosion behavior of CpTi. The poor corrosion behavior at the neutral pHs invites some concerns and highlights the need for further study.

Influence of corrosion on lipopolysaccharide affinity for two different titanium materials.

STATEMENT OF PROBLEM: Titanium is subject to corrosion in the oral cavity, which could contribute to periimplantitis. However, the effect of corrosion on the lipopolysaccharide affinity for titanium remains unknown. PURPOSE: This study evaluated the role of corrosion (in artificial saliva at pHs 3, 6.5, and 9) on the lipopolysaccharide (LPS) affinity for commercially pure titanium (cp-Ti) and Ti-6Al-4V alloy. MATERIAL AND METHODS: Seventy-two titanium disks were anodically polarized in a controlled environment (n=9). Control specimens were not corroded. Deionized water with different concentrations of LPS (1.5, 15, and 150 µg/mL) were used to treat the disks for 24 hours to investigate LPS adherence (n=3). Then specimens were immersed in LPS-free water to evaluate LPS elution at 24, 48, and 72 hours. Data were analyzed by the 2-way, 3-way, and 3-way repeated measures ANOVA, t tests, and the Tukey honestly significant difference (HSD) tests (α=.05). RESULTS: A greater corrosion rate of cp-Ti and Ti-6Al-4V alloy and a higher LPS adherence to titanium surfaces (P<.05) were noted at acidic pH. The LPS affinity was higher for the Ti-6Al-4V alloy than for cp-Ti (P<.05). More LPS was eluted from titanium surfaces after a 24-hour interval. CONCLUSION: Lipopolysaccharide affinity for cp-Ti and Ti-6Al-4V alloy is influenced by the corrosion process.

Retrospective analysis of dental implants placed and restored by advanced prosthodontic residents.

PURPOSE: The purposes of this retrospective clinical review were to: (1) describe the demographics of implant patients, types of implant treatment and implant-supported prostheses in an Advanced Education in Prosthodontic Program, (2) evaluate the survival rate of dental implants placed by prosthodontic residents from 2006 to 2008, and (3) analyze the relationship between resident year of training and implant survival rate. MATERIAL AND METHODS: All patients who received dental implants placed by prosthodontic residents from January 2006 to October of 2008 in the Advanced Prosthodontic Program at the University of Illinois at Chicago College of Dentistry were selected for this study. Age, gender, implant diameter, length, implant locations, surgical and restorative detail, and year of prosthodontic residency training were collected and analyzed. Life-table and Kaplan-Meier survival analyses were performed based on implants overall, locations, year of training, and use of a computer-generated surgical guide. A Logrank statistic was performed between implant survival and year of prosthodontic residency training, location, and use of computer-generated surgical guide (α= 0.05). RESULTS: Three hundred and six implants were placed, and of these, seven failed. Life-table and Kaplan-Meier analyses computed a cumulative survival rate (CSR) of 97% for overall implants and implants placed with a computer-generated surgical guide. No statistical difference was found in implant survival rates as a function of year of training (P= 0.85). CONCLUSION: Dental implants placed by prosthodontic residents had a CSR comparable to previously published studies by other specialties. The year of prosthodontic residency training and implant failure rate did not have any significant relationship.

Early survival of single-tooth implants in the esthetic zone may be predictable despite timing of implant placement or loading.

SELECTION CRITERIA: The authors used MEDLINE, EMBASE, and CENTRAL (Cochrane Central Register of Controlled Trials) databases to locate studies for this systematic review (SR). For studies to be eligible for this SR, all had to evaluate single-implant restorations with a follow-up of at least 1 year after implant loading. A total of 19 prospective studies met inclusion and exclusion criteria. Fifteen studies provided implant survival data (499 patient/509 implants), whereas 5 studies provided radiographic marginal bone height data (52 patients/52 implants). The analysis included studies with patients with single anterior or premolar, maxillary or mandibular edentulous sites bounded by anterior and posterior neighboring teeth. Meta-analyses of prospective trials (randomized-controlled trials, clinical trials, cohort studies, case series) reported loaded implant survival with one-year or more than one-year follow-up. Meta-analysis of prospective trials reporting marginal bone loss with one-year follow-up was also reported. KEY STUDY FACTOR: The key interventions were the timing of implant placement following extraction and the timing of implant loading after implant placement. Comparisons following greater than one-year follow-up were made between implants with immediate placement with immediate loading, immediate/early placement with conventional loading, conventional placement with immediate/early loading, or conventional placement with conventional loading. MAIN OUTCOME MEASURE: The main outcome was implant survival. Radiographically determined peri-implant bone level change was also reported. Meta-analyses were completed using studies that reported one-year implant survival data (15 studies) and more than one-year implant survival data (11 studies). One-year marginal bone level data were analyzed for implants treated conventionally (5 studies). For survival and marginal bone levels, weighted rates and random effects models were used to calculate overall effects of the included studies. For greater than one-year follow-up, survival data were stratified by intervention type. Results were weighted for study size and stratified based upon timing of implant placement and loading. Esthetics, and patient satisfaction, and complications were reported, but heterogeneity of study design and reported outcomes excluded the results from meta-analysis. MAIN RESULT: Approximately two-thirds of patients received implants in healed edentulous sites. Survival of single-tooth implants one year in function was 95.5% [95% CI: 93.0 -97.1]. Meta-analysis identified no difference in survival rate at one year when the results were weighted for study size and stratified based upon timing of implant placement and loading. Survival of single-tooth implants more than one year in function ranged from 92.4% [95% CI: 84.4 -96.4] for conventional placement with immediate loading to 97.5% [95% CI: 88.399.5] for immediate placement with immediate loading. The third meta-analysis identified 0.20-mm [95% CI: 0.034-0.36] marginal bone loss for implants one year in function. Qualitative interpretation of other esthetic, patient satisfaction, and complication outcomes revealed no difference in immediate, early, or conventional therapy approaches. CONCLUSIONS: The authors concluded that implant-supported single-tooth replacement in the aesthetic zone with adjacent natural teeth can lead to short-term, favorable outcomes with regard to implant survival and marginal bone level change with early/immediate or conventional surgical placement and loading strategies.

An alternative approach in fabrication of fixed complete dentures using a duplicate denture.

The traditional prosthetic steps in the fabrication of a fixed complete denture after implant osseointegration include final impression, verification of implant positioning in the working cast, mounting of the working cast, and mock denture wax trial insertion prior to the laboratory fabrication of the metal substructure; however, in patient scenarios of immediate loading of implants, the interim conversion prosthesis can be used to advance from the final impression to the milling of the underlying framework in one appointment. Consistency in the initial wax trial insertion, radiographic guide, and intraoral positioning of the conversion prosthesis can result in a well-designed definitive prosthesis in less time with the use of the existing duplicate complete denture.