Clinical Outcomes of Tooth- and Implant-Supported Restorations Performed in a University-based Undergraduate Program after 13-15 Years.

AIMS: To assess the clinical concept of patient treatment with fixed tooth- and implant-supported restorations in a university-based undergraduate program after 13 - 15 years. METHODS: Thirty patients (mean age 56 years) who had received multiple tooth- and implant-supported restorations were recalled after 13-15 years. The clinical assessment comprised of biological and technical parameters as well as patient satisfaction. Data were analyzed descriptively and the 13-15-year survival rates for tooth- and implant-supported single crowns and fixed dental prostheses were calculated. RESULTS: The survival rate of tooth-supported restorations amounted to 88.3% (single crowns) and 69.6% (fixed dental prostheses); in implants it reached 100% for all types of reconstructions. Overall, 92.4% of all reconstructions were free of technical complications. The most common technical complication was chipping of the veneering ceramic (tooth-supported restorations: 5.5%; implant-supported restorations: 13-15.9%) regardless of the material used. At teeth, increased probing depth ≥5mm was the most frequent biological complication (22.8%), followed by endodontic complications of root-canal treated teeth (14%) and loss of vitality at abutment teeth (8.2%). Peri-implantitis was diagnosed in 10.2% of implants. CONCLUSION: Results of this study indicate that the clinical concept implemented in the undergraduate program and performed by undergraduate students works well. The clinical outcomes are similar to those reported in the literature. In general, the majority of biological complications occurrs in reconstructed teeth, whereas implant-supported restorations are more prone to technical complications.

The oral health landscape in Singapore: A commentary on key features, challenges and future policies.

Over the last decade, Singapore has grappled with substantial healthcare challenges, chiefly a bourgeoning aging population and a mounting burden of chronic diseases. The oral health landscape has also changed, with the Ministry of Health placing a greater focus on a life-course approach supported by policies that facilitate Singaporeans to receive dental care appropriately and affordably. A pivotal oral health policy is the National Dental Strategy, a comprehensive framework governing dental services in the public sector. This strategy encompasses aspects such as financing, workforce management, and capacity considerations. To facilitate affordability and accessibility to dental services in the public sector, the government extends subsidies to reduce out-of-pocket costs. Those attending private dental clinics also benefit from the Community Health Assist Scheme, introduced in 2012, which alleviates treatment costs for enrolled Singaporeans. Furthermore, additional age-banded subsidies have been introduced for older Singaporeans born before 1960, enhancing financial support when accessing dental services in both private and public sectors. In 2019, a national adult oral health survey was commissioned to gauge the oral health status of Singaporeans aged 21 and above. The findings reported 34.8% having untreated dental caries, and 15.7% and 41.2% experiencing moderate and severe periodontitis, respectively. While over half (53.9%) of respondents visited the dentist at least annually, about 60% of eligible individuals did not utilize their government dental subsidies. In response, the Ministry of Health is committed to strengthening oral disease prevention, integrating oral health into general healthcare services, expanding dental financing schemes to enhance service utilization, improving the quality and transparency of dental care, and leveraging advancements in tele-dentistry and other modes of dental services. It is imperative to adapt Singapore's oral health policies and service delivery models to meet the evolving needs of the population and ensure a sustainable, equitable and resilient oral healthcare system.

Early implant placement in sites with ridge preservation or spontaneous healing: histologic, profilometric, and CBCT analyses of an exploratory RCT.

PURPOSE: The aim of this study was to compare changes in soft and hard tissue and the histologic composition following early implant placement in sites with alveolar ridge preservation or spontaneous healing (SH), as well as implant performance up to 1 year after crown insertion. METHODS: Thirty-five patients with either intact buccal bone plates or dehiscence of up to 50% following single-tooth extraction of incisors, canines, or premolars were included in the study. They were randomly assigned to undergo one of three procedures: deproteinized bovine bone mineral with 10% collagen (DBBM-C) covered by a collagen matrix (DBBM-C/CM), DBBM-C alone, or SH. At 8 weeks, implant placement was carried out, and cone-beam computed tomography scans and impressions were obtained for profilometric analysis. Patients were followed up after the final crown insertion and again at 1 year post-procedure. RESULTS: Within the first 8 weeks following tooth extraction, the median height of the buccal soft tissue contour changed by -2.11 mm for the DBBM-C/CM group, -1.62 mm for the DBBM-C group, and -1.93 mm for the SH group. The corresponding height of the buccal mineralized tissue changed by -0.27 mm for the DBBM-C/CM group, -2.73 mm for the DBBM-C group, and -1.48mm for the SH group. The median contour changes between crown insertion and 1 year were -0.19 mm in the DBBM-C/CM group, -0.09 mm in the DBBM-C group, and -0.29 mm in the SH group. CONCLUSIONS: Major vertical and horizontal ridge contour changes occurred, irrespective of the treatment modality, up to 8 weeks following tooth extraction. The DBBM-C/CM preserved more mineralized tissue throughout this period, despite a substantial reduction in the overall contour. All 3 protocols led to stable tissues for up to 1 year.

Resin-Bonded Fixed Dental Prostheses with Zirconia Ceramic Single Retainers Show High Survival Rates and Minimal Tissue Changes After a Mean of 10 Years of Service.

PURPOSE: To assess the clinical outcomes of single-retainer resin-bonded fixed dental prostheses (RBFDPs) and the profilometric changes of pontic sites after a mean of 10 years in function. MATERIALS AND METHODS: Ten patients (mean age 32.4 years) who had received an RBFDP replacing a single anterior tooth were recalled after 10 years. Five patients had received a subepithelial connective tissue graft (SCTG) at the pontic site. The clinical assessment comprised the following parameters: probing depth, bleeding on probing, modified plaque control record, gingival recession, measurement of the width of keratinized mucosa, and intraoral photographs and radiographs. The modified criteria of the United States Public Health Services evaluation system were applied. Additionally, patient satisfaction was recorded. Data were analyzed descriptively, and the 10-year RBFDP survival rates were calculated using Kaplan-Meier analysis. RESULTS: The RBFDP survival rate after a mean follow-up of 10.0 years (range 7.4 to 13.3 years) was 100%. Neither technical failures nor biologic complications were observed. All abutment teeth remained vital, and no secondary caries were detected. Between baseline and follow-up examinations, the profilometric changes at the pontic sites were minimal, exhibiting a loss of -0.03 ± 0.10 mm (no SCTG) and 0.00 ± 0.37 mm (SCTG). CONCLUSION: The present study exhibited high survival rates and low complication rates of the restorations, as well as excellent profilometric stability of the pontic sites over 10 years. The use of an RBFDP is a viable long-term treatment option for replacing a single anterior tooth.

Explorative randomized controlled study comparing soft tissue thickness, contour changes, and soft tissue handling of two ridge preservation techniques and spontaneous healing two months after tooth extraction.

OBJECTIVES: To compare two ridge preservation techniques and spontaneous healing in terms of soft tissue thickness, contour changes, and soft tissue handling two months after tooth extraction. METHODS: Thirty-six patients were included with buccal bone plate dehiscences of up to 50% after single-tooth extraction in the esthetic zone. They were randomly assigned to receive one of three procedures: a deproteinized bovine bone mineral with 10% collagen (DBBM-C) covered with a collagen matrix (DBBM-C/CM), DBBM-C alone, or spontaneous healing (SH). Two months later, the status of soft tissue healing was assessed, and the thickness of the mucosa was measured at the center of the site. Thereafter, implants were placed and the need for further guided bone regeneration (GBR) to cover exposed implant surfaces was assessed. RESULTS: Thirty-six patients were evaluated at the day of implant placement. An invagination of the soft tissues was recorded in 41.7% (n = 12), 53.8% (n = 13), and 90.9% (n = 11) of the sites in groups DBBM-C/CM, DBBM-C, and SH, respectively. The median thickness of the mucosa measured was 3.0 mm in group DBBM-C/CM, 2.1 mm in group DBBM-C, and 1.5 mm in group SH. Additional GBR was necessary in 66.7% (n = 12), 53.8% (n = 13), and 90.9% (n = 11) of the sites in groups DBBM-C/CM, DBBM-C, and SH, respectively. CONCLUSIONS: The present explorative study revealed slight tendencies for more favorable soft tissue conditions with less invaginations as well as increased soft tissue volume and thickness in groups having received an alveolar ridge preservation procedure compared to spontaneously healed sites at 8 weeks of healing.

Gingival profiles in a select Asian cohort: A pilot study.

AIM: The aim of the present study was to determine the facial gingival profiles of teeth with a healthy periodontium in an Asian population. METHODS: A total of 51 patients with a healthy periodontium were examined. Gingival thickness (GT) and gingival width (GW) were assessed at the maxillary and mandibular incisors to the first molars. GT was measured by transgingival probing (GT-TGP), and probe visibility through the marginal gingiva (GT-TRAN) was assessed. Results between groups (anterior and posterior, tooth types) were analyzed using one-way analysis of variance and t-test. RESULTS: The mean age was 30.3±11.4 years, with 27 females and 24 males. The mean GT-TGP was 1.39±52 mm, while the mean GW was 4.59±1.34 mm. Considerable intra-individual and interindividual variation in GT (TGP and TRAN) was noted. GT increased from the anterior to posterior, and was thinnest at the mandibular centrals to the first premolars and maxillary canines. GT-TGP and GW were influenced by tooth type, plaque, recession, and TRAN, but not age, sex, or ethnicity. GW were recorded lowest at the mandibular canines and all premolars. Thin gingiva was recorded at 63.8%-92% (GT-TGP<1.5 mm) and 75%-90% (GT-TRAN) of the anterior teeth. CONCLUSION: A high percentage of anterior teeth had thin marginal gingiva. There was poor agreement between GT-TGP and GT-TRAN.