Long-term clinical performance of short 6-mm implants supporting single crowns in the posterior region: A 10-year cohort study.

INTRODUCTION: Long-term clinical success of non-splinted, posterior, and short implants still is unclear. This prospective cohort study reports the 10-year follow-up of 6-mm implants supporting single crowns in the posterior region, and patient-reported outcomes. METHODS: Baseline sample comprised 20 patients treated with 46 screw-retained crowns supported by 6-mm implants with moderately rough implant surface. Participants were recalled for a 10-year clinical follow-up to assess survival rates, biologic and mechanic conditions, quality of life (OHIP-14), and treatment satisfaction. Data were collected with clinical-radiographic exams and analyzed using descriptive and inferential statistics. RESULTS: Fourteen patients with 35 implant-crown units were examined after 127.6 ± 11.8 months. For the entire cohort period, 7/46 implants were lost (survival estimate: 77.7% at 133 months), and mechanic complications occurred in 14/46 units (survival estimate: 66.4% at 116 months). In the Cox models, "maximum occlusal force" had a significant effect for implant loss (p = 0.038) and for prosthetic screw loosening (p = 0.038); "arch" and "bruxism" were not significant. Peri-implant bone loss was 0.4 ± 0.6 mm at 10 years. For peri-implant bone level, "crown-to-implant ratio" (p < 0.001) and "time" (p = 0.001) were significant. Bone levels differed from baseline to 12, 48, and 120 months. Satisfaction VAS was 94.0 ± 7.9 mm and OHIP-14 was 2.3 ± 2.2. CONCLUSION: Single screw-retained crowns supported by 6-mm implants have an acceptable long-term clinical performance, with stable peri-implant bone levels after 10 years of function.

Biomechanical variables affect peri-implant bone loss in implant-supported fixed complete dentures: A methodological and prospective study.

PURPOSE: Implant-supported fixed complete dentures (IFCD) experience failures and complications related to biological and technical risk factors. This study investigated the effect of biomechanical variables of IFCD on 1-year peri-implant bone loss at the buccal, palatal/lingual, mesial, and distal implant sides. A new method was used to measure the geometric biomechanical variables of IFCD using cone beam computed tomography (CBCT). METHODS: The study sample consisted of 246 external hexagon implants supporting 48 hybrid IFCD in 44 patients. CBCT images obtained immediately (T0) and 1 year (T1) after prosthesis installation were used to measure the support polygon area, clinical crown/implant (C/I) ratio (vertical lever), anteroposterior power and resistance arms, anterior and posterior cantilevers (horizontal levers), and peri-implant bone remodeling (T1-T0). Data were analyzed using multilevel multivariable models. RESULTS: The average total bone loss in the mandible and maxilla were 0.88 mm, with a loss of 0.62 mm in the mandible and 1.08 mm in the maxilla. The C/I ratio had a significant effect on bone loss on the mesial, distal, and palatal/lingual sides (P <.05). The anterior cantilever had a protective effect on the lingual side of the anterior implant. No effect on bone loss was found for the support polygon area, posterior cantilever, resistance arm, or power arm (P >.05). CONCLUSIONS: The results suggest that the C/I ratio and anterior cantilever in IFCD affect peri-implant bone loss according to the implant side and position in the arch.

Impacto Biopsicosocial de la Rehabilitación Oral Soportada por Implantes: Revisión Analítica de Instrumentos de Investigación

Este trabajo ha realizado una revisión narrativa de la literatura para analizar los instrumentos usados en la investigación clínica para los resultados centrados en el paciente en rehabilitación oral soportada por implantes. La búsqueda ha sido realizada en bases indexadoras de periódicos nacionales e internacionales, sin restricción temporal, en los idiomas portugués e inglés, utilizando las palabras-clave: implantes dentales, investigación clínica, resultados reportados por pacientes, cualidad de vida. Actualmente, los estudios clínicos deben incluir resultados obtenidos por relatos autorales de percepció n de los beneficios del tratamiento cuanto a los aspectos funcionales, sicológicos y sociales. La mayoría de los estudios utiliza instrumentos que añaden diferentes dimensiones de cualidad de vida, tales como GOHAI (Geriatric Oral Health Assessment Index), DIDL (Dental Impacton Daily Living), OHIP (Oral Health Impact Profile), OHQoL-UK (W), OIDP (Oral Impactson Daily Performances). En general, los ítems de estos cuestionarios han sido formulados de manera negativa, con el enfoque en los problemas, siendo el OHIP-14 lo más utilizado por ser sencillo, validado para varios idiomas y consolidado para las diferentes situaciones clínicas. Otros instrumentos de sicología positiva, como los cuestionarios de Rosenberg y McCullough, han sugestionado evaluar la percepción de la autoestima y de la gratitud, con el enfoque en el bienestar y en la satisfacción del pacien te a largo plazo. Estudios cualitativos o con métodos mistos pueden fornecer también más comprensión de los resultados centrados en los pacientes en rehabilitación soportada por implantes. Con base en la literatura observada se concluye que el estudio de resultados centrados en los pacientes puede ser enriquecido con el uso de diversos métodos para capturar la percepción del paciente de los beneficios de la rehabilitación soportada por implantes. Se sugestiona el uso del OHIP-14, aunque, su uso presente limitaciones que en parte pueden ser reprimidas por la aplicación de los cuestionarios relacionados a la sicología positiva como lo de la gratitud y lo de la autoestima, los cuales presentan dominios positivos.

This study aimed to conduct a narrative review of the literatura to analyze the instruments used in clinical research for patient-reported outcomes measures in implant-supported oral rehabilitation. The search was conducted in index data bases of national and international journals without time restriction, in Portuguese and English, using the key words: dental implants, clinical research, patient-reported outcomes measures, quality of life. Currently, clinical studies should include results obtained through self- reporting of the perceived benefits of treatment in functional, psychological and social aspects. Most studies use instruments that add different dimensions of quality of life, such as GOHAI (Geriatric Oral Health Assessment Index), DIDL (Dental Impacton Daily Living), OHIP (Oral Health Impact Profile), OHQoL-UK (W), OIDP (Oral impacts in daily presentations). In general, the itens in these questionnaires were formulated in a negative way, with a focuson problens, with OHIP-14 being the most used because it is simple, validated for several languages and consolidated for different clinical situations. Other positive psychology tools, such as the Rosenberg and McCullough questionnaires, have been suggested to assess the perception of self-esteen and gratitude, with a focus on long-term well-being and patient satisfaction. Qualitative or mixed method studies can also provide a better understanding of the results centered on patients undergoing rehabilitation with implants. Based on the observed literature, it is concluded that the study of patient-centered results can be enriched with the use of various methods to capture the patient's perception of the benefits of implant-supported rehabilitation. It is suggested the use of the OHIP-14, however, their use has limitations that can be partially met by the application of questionnaires related to positive psychology, as gratitude and self-esteen, which have positive fields.

Risk factor model of mechanical complications in implant-supported fixed complete dentures: A prospective cohort study.

OBJECTIVES: This prospective cohort study estimated the effect of technical and clinical factors on mechanical complications in implant-supported fixed complete dentures (IFCDs). The patient's perception of the impact of oral rehabilitation on quality of life was assessed. MATERIAL AND METHODS: A non-probabilistic sample consisted of 88 consecutive patients treated with 94 screw-retained, metal-acrylic IFCDs. Data collection included sociodemographic variables, presence and intensity of bruxism, maximal occlusal force, opposing arch, design of the metallic framework, distribution of occlusal contacts, and quality of life (OHIP-14). IFCD-level data were analyzed using Kaplan-Meier survival analysis and Cox regression model. Quality of life data were analyzed by paired Student t test. RESULTS: During a mean follow-up of 35.1 ± 18.3 months, 16/94 IFCDs (17%) had repairable mechanical complications because of loosening/fracture of artificial teeth (n = 15) and screw loosening (n = 1). Framework design (retention pins <4 mm) was a significant risk factor for complications (HR = 11.038; p = 0.027) when adjusted for sex. Mechanical complications were not associated with sex, body mass index, thickness of the acrylic resin veneering, type of opposing arch, distribution of occlusal contacts and force, protrusion interference, presence/intensity of bruxism or maximal occlusal force. OHIP-14 total scores decreased after IFCD treatment for both patients with or without complications. CONCLUSIONS: Within the limitations of this study, the results suggest that clinical success is associated to framework design with retention pins equal or longer than 4 mm. Quality of life improved with IFCD treatment, even in patients with mechanical complications.