Patient-Centered Risk Assessment in Implant Treatment Planning.

PURPOSE: To evaluate the current scientific evidence on estimating cumulative risk for biologic complications relating to dental implants and to develop a patient-centered risk assessment tool for establishing aggregate risk. MATERIALS AND METHODS: A review of the scientific literature on risk indicators relating to dental implants was completed with the goal of identifying and weighting individual risk indicators so aggregate biologic risk could be estimated. Three authors completed independent reviews of the literature, identifying 31 systematic reviews on risk indicators for biologic complications with dental implants, from which 24 potential risk indicators were considered. Due to inconclusive scientific data on risk indicators, a Delphi process was used to gather structured expert opinion to supplement findings from the literature. Eleven Delphi participants with expertise in prosthodontics or periodontics participated in two email exchanges and one face-to-face meeting to comment and debate on the initial identification and weighting of risk indicators, propose the addition or removal of risk indicators, and provide recommended clinical management for each risk indicator. RESULTS: After three rounds of debate, literature review, and additions and removals of various risk indicators, consensus (defined as 95% or more in agreement) was achieved on 20 risk indicators. The Delphi group concluded that the risk indicators of smoking, diabetes, antiresorptive agents, and cemented restorations should include subcategories to more accurately identify and represent patient-specific risk. Clinical recommendations based on individual and aggregate risk were established by consensus. CONCLUSION: The literature on risk indicators for biologic complications was conflicting and inconclusive. The Delphi method was used to identify and establish the weighting of individual risk indicators, resulting in a risk assessment tool for estimating aggregate risk.

Er:YAG laser debonding of porcelain veneers.

BACKGROUND AND OBJECTIVES: The removal of porcelain veneers using Er:YAG lasers has not been previously described in the scientific literature. This study was designed to systematically investigate the efficacy of an Er:YAG laser on veneer debonding, possibly without damage to the underlying tooth, and preservation of the veneer integrity. STUDY DESIGN/MATERIALS AND METHODS: The Fourier Transform Infrared Spectroscopy was used on 10 flat veneer samples (IPS Empress Esthetic, e.max Press HT) to assess which infrared laser wavelengths transmits through a veneer. Additionally, Fourier Transform Infrared (FTIR) spectra for a bonding cement (RelyX) were obtained. Consequently, Er:YAG laser energy transmission (wavelength 2,940 nm, 10 Hz repetition rate, pulse duration 100 µseconds at 133 mJ/pulse) through different veneer thicknesses was measured. Twenty-four veneers were bonded to freshly extracted and prepared incisors. The energy necessary for debonding was determined and then the veneers were debonded with the laser. Time needed for total debonding was measured and possible damage to the underlying tooth structure was assessed by light microscopy. RESULTS: While the veneer materials did not show any characteristic water absorption bands in the FTIR, the bonding cement showed a broad H(2) O/OH absorption band. The veneers transmitted between 11.5% and 43.7% of the incident Er:YAG energy with Emax transmitting twice the energy as EE at comparable thicknesses. Initial signs of cement ablation occurred at 1.8-4.0 J/cm(2) with the fiber tip positioned at a distance of 3-6 mm from the veneer surface and 133 mJ output energy. All 24 bonded veneers were completely removed with an average removal time of 113 ± 76 seconds. Underlying tooth structure was not damaged. The debonding mainly occurred at the cement/veneer interface. None of the Emax veneers fractured during debonding, while 36% of the EE did. CONCLUSION: Er:YAG laser irradiation effectively debonds porcelain veneers while preserving tooth structure. Maintaining veneer integrity possibly depends on the flexure strength of the veneer porcelain.

The effects of an airborne-particle abrasion and silica-coating on the bond strength between grooved titanium alloy temporary cylinders and provisional veneering materials.

STATEMENT OF PROBLEM: Even though mechanical retentive features, such as grooves, are incorporated into the surface of titanium alloy temporary cylinders, a reliable bond to veneering provisional materials is not always achievable for screw-retained provisional implant restorations. There is insufficient information about the effect of tribochemical silica coating on the bond strength between provisional materials and grooved titanium alloy temporary cylinders. PURPOSE: The purpose of this study was to evaluate, in vitro, the effect of an airborne-particle abrasion and silica-coating technique on the bond strength between grooved titanium alloy temporary cylinders and provisional veneering bisphenol-A glycidyl methacrylate and polymethyl methacrylate materials. MATERIAL AND METHODS: Forty grooved titanium alloy (Ti-6Al-4V) internal connection implant temporary cylinders were used. A disc of veneering material (7.1 × 3.4 mm) was created around the midsection of each cylinder. Forty specimens were divided into 4 groups (n=10): group NoTxPMMA, no surface treatment and polymethyl methacrylate veneering material; group NoTxBisGMA, no surface treatment and BisGMA veneering material; group AbPMMA, airborne-particle abrasion, silica-coating surface treatment (Rocatec), and polymethyl methacrylate; and group AbBisGMA, airborne-particle abrasion, silica-coating surface treatment (Rocatec), and BisGMA. Each specimen was subjected to ultimate shear load testing at the interface of the veneering material and the temporary cylinder in a universal testing machine at a constant crosshead speed of 5 mm/min. Data were analyzed with a 1-way ANOVA (α=.05) followed by post hoc Student-Newman-Keuls test. Each specimen underwent surface observation with a light microscope at ×40 magnification to compare fracture patterns. RESULTS: Airborne-particle abrasion and silica-coating surface treatment significantly lowered the shear bond strength (P<.05). The type of provisional material did not significantly affect the shear bond strength, with or without surface treatment. Group AbBisGMA demonstrated the lowest mean value (3.49 MPa) compared to the other groups. CONCLUSIONS: Airborne-particle abrasion and silica-coating treatment did not improve the bond between grooved titanium alloy temporary cylinders and provisional veneering materials. It weakened the provided mechanical retention, especially when it was used with BisGMA veneering material. Material choice, whether it was polymethyl methacrylate or BisGMA, did not make a statistically significant difference.

The use of dental implants to improve quality of life for edentulous patients.

The number of edentulous patients in the United States requiring prosthodontic care is projected to increase in the next 20 years. Awareness of the restorative options to manage edentulous patients will become increasingly important to all dental practitioners. The authors' purpose is to sensitize the reader to the functional deficit in the completely edentulous patient and how restorative approaches with implants can improve patient reports of function and quality of life.

Transitioning patients: teeth to implants.

The transition of patients from a dentate state to an implant-supported restoration requires significant planning. Traditionally, protocols have included the extraction of teeth and interim use of a removable prosthesis. Newer protocols include approaches to decrease the period of time a patient is required to use a traditional denture. The authors' purpose is to outline options and provide clinical examples when transitioning patients from natural dentition to an implant-supported prosthesis.

Using implants for the growing child.

The use of implants for the growing child is not routinely recommended. The concerns about placing implants for patients in this age group are related to jaw growth. However, not all children with missing teeth need to wait for growth to be completed prior to implant placement. In this paper, the authors will discuss the indications for implant placement in the growing child. The decision for implant placement is based not only on growth, but also the number and location of the missing teeth.