The efficacy of a counter-rotational powered toothbrush in the maintenance of endosseous dental implants.

BACKGROUND: Although most patients with implants have lost their natural teeth because of poor oral hygiene, limited data exist to guide practitioners in their recommendations of home-care regimens for their patients' endosseous dental implants and maintenance of peri-implant soft-tissue health. The authors conducted a study to compare the home-care effectiveness of a counter-rotational powered tooth-brush with that of conventional home-care regimens. METHODS: Before starting the six-year study, the authors trained 85 clinical investigators at 32 dental research centers across the United States in gathering periodontal data. Data for 2,966 implants were entered into a centralized database. Outcomes were derived from 24-month observations of a subset of the implants studied. RESULTS: Repeated-measures analysis of the toothbrushing methods used on 2,966 implants showed that the counter-rotational powered toothbrush removed plaque significantly better than manual methods (P < .0001 Wald statistic) from all implant surfaces and at all recall intervals up to 24 months. Similar results were demonstrated for the gingival index. CONCLUSIONS: The counter-rotational powered brush appears to be well-suited for home-care regimens aimed at maintaining optimal peri-implant soft-tissue health in patients with dental implants. CLINICAL IMPLICATIONS: The importance of maintaining the health of the peri-implant tissues is well-recognized by the dental profession. The counter-rotational powered toothbrush is an effective tool in meeting the oral hygiene challenges associated with implant prosthesis maintenance.

Implant surface coating and bone quality-related survival outcomes through 36 months post-placement of root-form endosseous dental implants.

Survival rates from placement to 36 months were reported for the ongoing Dental Implant Clinical Research Group studies of root-form endosseous dental implants. Failure rates for all implants were similar in bone qualities 1 and 2 (6.2% and 6.7%, respectively) and slightly higher in bone qualities 3 and 4 (8.5% and 8.7%, respectively). Hydroxyapatite (HA)-coated implants had an overall failure rate of 3.9% over 36 months in all bone qualities combined, while non-coated implants had a 13.4% failure rate for the same parameters. For each bone quality, there was a significant difference in implant survival for the non-coated implants (P < 0.01). The highest failure rates for non-coated implants were in bone qualities 3 and 4 (19.1% and 25.5%, respectively). No major difference in survival was found for HA-coated implants placed in each bone quality. Possible reasons for the differences in survival are discussed.

Stability of the bone-implant complex. Results of longitudinal testing to 60 months with the Periotest device on endosseous dental implants.

BACKGROUND: Maintenance of the health and integrity of the bone-implant complex (osseointegration) has been shown to be essential for long term success of root-form, endosseous dental implants. If reliable clinical indicators of adequacy of the bone-implant complex existed, they could stimulate new and innovative early intervention research to arrest of reverse early deterioration of the bone-implant complex. In the absence of such indicators, this has been problematic. The Periotest may have the potential to provide this information by indirectly assessing the status of the bone-implant complex. However, little information is available that documents either the capability of the Periotest to reliably assess changes of the bone-implant complex or the "normal variations" in Periotest values (PTVs) for both HA-coated and non-coated implants. METHODS: The purpose of this paper was to document changes in PTVs as influenced by various implant surfaces, implant designs, and bone densities. The mean PTVs recorded for each visit, for all implant types and bone densities, were combined to provide an overall average PTV (A-PTV). The changes in stability (PTVs) were analyzed using a generalized linear model (GLM) with repeated measures (Hotelling's Trace). RESULTS: The A-PTV for all implants over all visits was -3.5. The mean PTVs ranged from -4.2 (SD = 2.4) at uncovering to -3.9 (SD = 2.9) at 60 months. All implants in bone qualities 1 and 2 (BQ-1 and BQ-2) became more stable over time, while those in bone quality 3 or 4 (BQ-3 and BQ-4) showed a slight decrease in stability. In BQ-1, the mean PTVs increased from -4.7 at uncovering to -4.9 at 60 months. A similar increase in stability occurred in BQ-2 (-4.1 at uncovering to -4.4 at 60 months). In BQ-3, the stability of the implants decreased over time (-3.6 at uncovering to -2.9 at 60 months), with similar changes recorded for BQ-4 (-2.5 at uncovering to -1.0 at 60 months). When comparing the stability of all HA-coated with all non-coated implants, the HA implants became less stable (-4.4 to -3.4) over time, while non-coated implants showed an improvement in stability (-3.5 to -4.5). The changes in stability found in BQ-1, BQ-2, and BQ-3 were similar, with HA implants becoming less stable and non-coated more stable. HA- and non-coated comparisons were not possible in BQ-4 since there were too few non-coated implants placed in this type of bone. The HA-coated screw showed a decrease in stability when compared to the non-coated screw. CONCLUSIONS: Conclusions of the study are as follows: 1) PTVs are influenced by bone quality and surface coating of the implant; 2) the PTVs at the time of uncovering provide the best estimate of a clinically acceptable PTV for that bone-implant complex; 3) while the PTVs for any bone-implant complex may fluctuate +/- 1.0 around the uncovering PTV during routine healing and loading of the implant, a consistent shift toward a positive PTV that approaches "0" should be cause for concern that the bone-implant complex may be at risk of failure; 4) HA-coated implants became slightly less stable (more positive PTVs) over time, while the non-coated implants became more stable (more negative PTVs); and 5) until a "critical PTV" can be accurately identified, it is suggested that a consistent shift in recorded PTVs that exceeds the +3.0 value on the PTV scale should be viewed with concern for possible deterioration at the bone-implant complex.

Distribution of bone quality in patients receiving endosseous dental implants.

Knowledge of the distribution of bone quality in the various jaw regions assists the clinician in dental implant treatment planning. Bone quality was assessed with radiographs and tactile sensation for 2,839 implants at the time of placement into four anatomic regions of the jaw. The Lekholm-Zarb classification system was used. Overall, bone quality types 1 and 4 were found much less frequently than types 2 and 3. Although variations in density existed in each region, quality 2 bone dominated the mandible, and quality 3 bone was more prevalent in the maxilla. For both anterior and posterior jaw regions, types 2 and 3 bone predominated. The anterior mandible had the densest bone, followed by the posterior mandible, anterior maxilla, and posterior maxilla.

Bone quality and implant design-related outcomes through stage II surgical uncovering of Spectra-System root form implants.

Failure rates at second-stage surgery were reported for the ongoing Dental Implant Clinical Research Group studies of the Spectra-System (Core-Vent Corporation, Las Vegas, NV) implants. As of May 1995, 69 implants failed out of 2,633 placed and uncovered. The overall failure rate was 2.6%, with 3.6% in bone quality 1 (BQ-1), 2.4% in BQ-2, 2.5% in BQ-3, and 3.1% in BQ-4. HA-coated cylinders had the lowest number of failures and titanium alloy baskets the highest. The basket design failed more often in the posterior jaw areas; 9 of 32 clinical centers (28%) accounted for 72% of these failures.

The influence of bone quality on Periotest values of endosseous dental implants at stage II surgery.

Periotest values (Periotest, Siemens AG, Bensheim, Germany) were recorded as a baseline variable at surgical uncovering in the ongoing multicenter, prospective clinical studies of the Dental Implant Clinical Research Group, which uses implants from the Spectra-System (Core-Vent Corporation, Las Vegas, NV). For 2,212 osseointegrated implants, the mean Periotest value (PTV) of mandibular implants was -4.14 (anterior, -4.22; posterior, -4.06) versus -3.24 for maxillary implants (anterior, -2.91; posterior, -3.91). Implants in the densest bone (quality 1) had the lowest mean PTV (-4.13), followed by quality 2 (-4.00), quality 3 (-3.58), and quality 4 (-2.64).

Treatment planning of the elderly implant patient.

The prevalence of partial and complete edentulism in the older adult patient and the predictability of specific types of dental implants obligates the dental health professional to consider the fabrication of implant-related prostheses as an alternative treatment option. Special emphasis is placed in this article on the provision of clip-bat overdentures in the treatment of the fully edentulous patient and their relative advantages compared to a fixed-hybrid prosthesis.

Second-stage failures related to bone quality in patients receiving endosseous dental implants: DICRG Interim Report No. 7. Dental Implant Clinical Research Group.

The quality of bone plays an important role in the long-term clinical success of dental implant treatment. An interim evaluation of the relationship between bone quality and the incidence of failure at second-stage surgery is presented. The data include 2,131 root form implants placed by the Dental Implant Clinical Research Group over the past three years. Trends to date suggest differences in the rates of osseointegration among the various bone qualities. Quality 1 bone experienced the greatest failure rate, whereas quality 2 and quality 3 bone had the lowest failure rates.

Assessment of implant mobility at second-stage surgery with the Periotest: DICRG Interim Report No. 3. Dental Implant Clinical Research Group.

Many of the presently used methods of evaluating osseointegration at implant uncovering are highly subjective. The Periotest is claimed to offer a more objective means to assess osseointegration by means of microcomputer-controlled percussion. Investigators involved in a long-term clinical study of dental implants being conducted by the Dental Implant Clinical Research Group used the Periotest to evaluate the mobility associated with all study implants at second-stage surgery and correlate the Periotest values with various bone densities. The Periotest values for 1,838 root form implants ranged from -8 to +25. Implants that appeared to be osseointegrated at uncovering recorded a mean Periotest value of -3.37 +/- 3.25, while nonosseointegrated implants had a mean Periotest value of +13.87 +/- 14.27. Mean Periotest values were -3.82 +/- 3.04 for quality 1 bone, -3.70 +/- 3.06 for quality 2 bone, -3.31 +/- 3.18 for quality 3 bone, and -1.29 +/- 3.57 for quality 4 bone. The Periotest has the potential of being a valuable instrument for assessing the status of osseointegration at second-stage surgery.

A review of panoramic radiography and its potential use in implant dentistry.

Radiographic follow-up of dental implants is one of the most important clinical parameters a practitioner can assess. Recent advances in the design of panoramic radiograph machines have increased their potential use in the longitudinal clinical evaluation of dental implants. Changes from the earliest designs allow for a projection geometry that more closely approximates the shape of the human jaw. The fundamentals of panoramic radiography are reviewed including common errors in patient positioning, their effect on the radiographic image, and how to correct the errors. Comparative advantages and disadvantages of intraoral periapical and bitewing films as compared with panoramic radiographs are discussed, specifically focusing on the amount of radiation exposure, ability to detect bone loss/bone defects, and inherent problems with both systems.