Implant-supported double-bar overdenture to reestablish lip support in an atrophic maxilla: a case report.

Prosthodontic treatment for edentulous maxillae with severe bone loss is a challenge to clinicians. Although implant-supported, fixed maxillary complete dentures are increasingly common, they are not always able to provide adequate lip support without a buccal overextension in patients with bone loss. The overextended buccal flange makes it difficult for patients to clean under the prosthesis. This case report describes rehabilitation of an atrophic maxilla through an implant-supported double-bar overdenture designed to resolve difficulties in oral hygiene maintenance that were caused by the buccal overextension of the prosthetic flange in a previous implant-supported fixed complete denture. In addition to reestablishing lip support, overdentures with a double-bar system provide retention and stability, because the prosthesis is only removed for cleaning by the patient with the help of a specific key. Implant-supported double-bar overdentures represent a viable and versatile option for rehabilitation of atrophic maxillae.

Microbiologic Analysis of Immediately Loaded Full-Arch Implant-Retained Prosthesis Protocol After 2 Years of Loading: A Retrospective Study.

PURPOSE: The All-on-4 treatment concept has been shown to be an effective clinical procedure; however, to date, no studies have analyzed the subgingival microbiota present in these restorations. The purpose of this study was to evaluate the microbial profile of the subgingival biofilm around dental implants placed in the All-on-4 protocol and compare the microbial profile around axial and tilted implants. MATERIALS AND METHODS: Fourteen subjects treated by the All-on-4 concept were evaluated clinically and microbiologically. Subgingival biofilm was collected from each patient, and the amount of 40 species of bacteria was assessed using the checkerboard DNA-DNA hybridization technique. RESULTS: The results for the indices of probing depth (PD), bleeding on probing, marginal bleeding, and visible plaque were 2.32 mm, 46%, 60%, and 57%, respectively. Tilted implants presented a significantly higher mean PD and Plaque Index compared with axial implants (P < .05). Fusobacterium nucleatum ssp vincentii, Veillonella parvula, and Fusobacterium nucleatum ssp polymorphum were found in higher levels; however, no difference in the microbial composition was observed between tilted and axial implants (P > .05). Tilted implants presented statistically higher mean levels for the orange complex in relation to the axial implants (P < .05). CONCLUSION: Despite the clinical success rate of the All-on-4 protocol, the subgingival biofilm of tilted implants presented a higher proportion for the orange complex pathogens in comparison to axial implants. These data could suggest that subjects with this modality of implant-supported restoration must be aware that they need a more rigorous maintenance protocol.

The clinical performance of all-ceramic implant-supported single crowns: A systematic review and meta-analysis.

OBJECTIVE: This review aimed at evaluating the survival and technical complication rates of all-ceramic implant-supported single crowns (SC). MATERIAL AND METHODS: Three electronic databases were searched for clinical studies conducted at ≥ 15 patients examining implant-supported all-ceramic SCs over ≥ 12 months. Survival rates of implants and restorations plus technical complication rates of SCs were calculated and tested for statistical correlation with confounding variables. Statistical analysis was performed using a negative binomial distribution model to calculate 5- and 10-year survival and complication estimates. RESULTS: Forty-one included studies reported on implant-supported SCs made of veneered and monolithic high-strength oxide ceramics, monolithic, and veneered glass-based ceramics and of a monolithic resin-nano-ceramic (RNC). Survival estimates for SCs of 93% (95% CI: 86.6%-96.4%) after 5 years and 94.4% (95% CI: 91.1%-96.5%) after 10 years were calculated, corresponding values for implant survival were 95.3% (95% CI: 90.6%-97.7%) and 96.2% (95% CI: 95.1%-97.1%). Technical complication rates after 5/10 years were as follows: chipping 9.0% (95% CI: 5.4%-14.8%)/2.7% (95% CI: 2.1%-3.5%), framework fractures 1.9% (95% CI: 0.7%-4.9%)/1.2% (95% CI: 1%-1.5%), screw loosening 3.6% (95% CI: 1.6%-8.4%)/5.2% (95% CI: 3.6%-7.5%), and decementations with 1.1% (95% CI: 0.4%-2.8%) after 5 years. Some confounding variables influenced the above-mentioned estimates significantly. CONCLUSIONS: All-ceramic implant-supported SCs showed-with the exception of a RNC material-high survival rates. However, failures and technical complications occurred which have to be considered when informing patients on the treatment with implant-supported all-ceramic SCs.

Inhibitory effect of zirconium oxide nanoparticles on Candida albicans adhesion to repaired polymethyl methacrylate denture bases and interim removable prostheses: a new approach for denture stomatitis prevention.

BACKGROUND: Despite drawbacks, cold-cured acrylic resin is still the most common material used in denture repair. Zirconia nanoparticles were among the reinforcements added to increase the strength of the resin. The effect on Candida due to the addition of zirconia nanoparticles to the resin has not been investigated. PURPOSE: The aim of this study was to evaluate the effect of zirconia nanoparticles added to cold-cured acrylic resin on Candida albicans adhesion. MATERIALS AND METHODS: A total of 120 acrylic resin specimens with dimensions measuring 22×10×2.5 mm3 were prepared and divided into two equal groups. One group (repair) comprised heat-polymerized specimens that were sectioned at the center and prepared to create a 2 mm repair area that was repaired with cold-cured resin reinforced with 0% wt, 2.5% wt, 5% wt, and 7.5% wt zirconia nanoparticles. The second group contained intact cold-cured acrylic resin specimens reinforced with 0% wt, 2.5% wt, 5% wt, and 7.5% wt zirconia nanoparticles. Specimens were incubated at 37°C in artificial saliva containing C. albicans, and the effect of zirconia nanoparticles on C. albicans was assessed using two methods: 1) a slide count method and 2) a direct culture test. Variations in the number of living Candida were observed in relation to the different concentrations of zirconia nanoparticles. Analysis of variance (ANOVA) and post hoc Tukey's tests were performed for data analysis. If the P-value was ≤0.05, then the difference was considered as statistically significant. RESULTS: It was found that C. albicans adhesion to repaired specimens was significantly decreased by the addition of zirconia nanoparticles (P<0.00001) in comparison with the control group. Intact cold-cured groups and groups repaired with cold-cured resin reinforced with 7.5% wt zirconia nanoparticles showed the lowest Candida count. Tukey's test showed a significant difference between the repaired group and the intact cold-cured group, while the later demonstrated a lower Candida count. CONCLUSION: The addition of zirconia nanoparticles to cold-cured acrylic resin is an effective method for reducing Candida adhesion to repaired polymethyl methacrylate (PMMA) denture bases and cold-cured removable prosthesis. CLINICAL SIGNIFICANCE: Based on the results of the current study, zirconia nanoparticles have an antifungal effect, which could be incorporated in the repair material for repairing denture bases and in PMMA removable prostheses as a possible approach for denture stomatitis prevention.

A method of facilitating the fabrication of access openings for implant-supported complete fixed dental prostheses.

This report describes a method for fabricating access openings for implant-supported complete fixed dental prostheses (ICFP) by using a dental milling machine and silicone putty matrix. The method can help clinicians achieve the accurate and precise fabrication of access openings for ICFPs without excessive grinding.

Microbiological and clinical outcomes of fixed complete-arch mandibular prostheses supported by immediate implants in individuals with history of chronic periodontitis.

OBJECTIVES: The aim of this study was to assess the microbiological and clinical outcomes of immediate implants placed in chronically infected sockets for rehabilitation with fixed full-arch mandibular prostheses. MATERIAL AND METHODS: Fourteen individuals (mean age 60.14 ± 7.69 years) were enrolled in this investigation and followed up until 8 months of function. Microbiological (microbial count and profile) and clinical (probing depth, clinical attachment level, bleeding on probing, and bone resorption) parameters were conducted before teeth extraction (T0 - baseline) and after 4 (T1 ) and 8 (T2 ) months of loading. Thirty-nine microbial species including periodontopathogenic species and Candida spp. were detected and quantified by DNA checkerboard analysis. RESULTS: Moderate to high levels of pathogenic and non-pathogenic species were found colonizing teeth and implant-related sites. No significant differences in total or individual microbial counts and microbial profile were found over time (P = 0.4929). Probing depth values from teeth (T0 : 3.05 ± 1.45) were significantly higher when compared with implants (T1 : 1.81 ± 0.56; T2 : 1.66 ± 0.53; P < 0.0001). High percentages of bleeding sites were found for both teeth and implants, with the highest values recorded for teeth (P < 0.05). No significant differences were detected comparing marginal bone resorption over time. CONCLUSIONS: Total and individual counts of target species did not differ between teeth and implants for 8 months of investigation. The mean proportions of pathogenic and non-pathogenic species remained unaltered, and no clinical complications were reported over time. Data obtained suggest that immediate loading of complete mandibular prostheses retained by implants placed immediately after extraction may be a viable treatment option for edentulous individuals with previous history of periodontal disease.

Removal Torque and Biofilm Accumulation at Two Dental Implant-Abutment Joints After Fatigue.

PURPOSE: The aim of this study was to evaluate the removal torque and in vitro biofilm penetration at Morse taper and hexagonal implant-abutment joints after fatigue tests. MATERIALS AND METHODS: Sixty dental implants were divided into two groups: (1) Morse taper and (2) external hexagon implant-abutment systems. Fatigue tests on the implant-abutment assemblies were performed at a normal force (FN) of 50 N at 1.2 Hz for 500,000 cycles in growth medium containing human saliva for 72 hours. Removal torque mean values (n = 10) were measured after fatigue tests. Abutments were then immersed in 1% protease solution in order to detach the biofilms for optical density and colony-forming unit (CFU/cm²) analyses. Groups of implant-abutment assemblies (n = 8) were cross-sectioned at 90 degrees relative to the plane of the implant-abutment joints for the microgap measurement by field-emission guns scanning electron microscopy. RESULTS: Mean values of removal torque on abutments were significantly lower for both Morse taper (22.1 ± 0.5 µm) and external hexagon (21.1 ± 0.7 µm) abutments after fatigue tests than those recorded without fatigue tests (respectively, 24 ± 0.5 µm and 24.8 ± 0.6 µm) in biofilm medium for 72 hours (P = .04). Mean values of microgap size for the Morse taper joints were statistically signicantly lower without fatigue tests (1.7 ± 0.4 µm) than those recorded after fatigue tests (3.2 ± 0.8 µm). Also, mean values of microgap size for external hexagon joints free of fatigue were statistically signicantly lower (1.5 ± 0.4 µm) than those recorded after fatigue tests (8.1 ± 1.7 µm) (P < .05). The optical density of biofilms and CFU mean values were lower on Morse taper abutments (Abs630nm at 0.06 and 2.9 × 104 CFU/cm²) than that on external hexagon abutments (Abs630nm at 0.08 and 4.5 × 104 CFU/cm²) (P = .01). CONCLUSION: The mean values of removal torque, microgap size, and biofilm density recorded at Morse taper joints were lower in comparison to those recorded at external hexagon implant-abutment joints after fatigue tests in a simulated oral environment for 72 hours.

Hereditary gingival fibromatosis with extreme ridge thickness and insufficient interarch distance: A clinical report of surgical and prosthetic management.

Hereditary gingival fibromatosis is a rare genetic disorder resulting in gingival overgrowth that can be found in both dental arches. As a result of the gingival overgrowth and associated dental displacement, affected patients occasionally present with increased occlusal vertical dimension and/or inadequate lip closure. Depending on the disorder's severity, these patients can be challenging to treat. This clinical report describes a comprehensive surgical and prosthetic approach to the rehabilitation of a middle-aged patient with severe manifestations of hereditary gingival fibromatosis and severe generalized chronic periodontitis.

Identificação de micro-organismos do gêneroCandida na saliva de usuários de prótese total convencional e prótese total fixa sobre implantes / Identification of Candida genus microorganisms in saliva of conventional denture and fixed dentures on implants users

Candida albicans é a espécie mais encontrada em relação às demais em pacientes usuários de próteses dentárias acrílicas. Colonização por espécies do gêneroCandida comumente associam-se à estomatite protética. O objetivo desse estudo foi isolar, quantificar e identificar espécies do gêneroCandidaem amostras de saliva em usuários de prótese total convencional e prótese total fixa sobre implantes. Foram coletados 20 ml de saliva não estimulada de indivíduos voluntários sistemicamente saudáveis. 100 µ de cada amostra de saliva foram semeados separadamente no meio Agar Sabouraud dextrose cloranfenicol (Difco) e no Chromagar. Após o período de incubação, foi feita a contagem das Unidades Formadoras de Colônias (UFC). As colônias foram transferidas para tubos contendo caldo Sabouraud Dextrose, para posterior identificação. No grupo de usuários de prótese total convencional, foram encontradas duas espécies: Candida albicans (50%) e Candida tropicalis (50%), no grupo de usuários de prótese fixa sobre implantes foram encontradas as espécies C. tropicalis (70%) e C. krusei (30%). Conclui-se que: micro-organismos do gênero Candida estão presentes na saliva de usuários de prótese total convencional e fixa sobre implantes (AU).

Candida albicans is the species most commonly found in relation to other species in patients users of acrylic denture. Colonization by species of the genus Candida are commonly associated with denture stomatitis. The aim of this study was to isolate, quantify and identify species of the genus Candida in saliva samples in conventional denture and fixed dentures on implants users. It was collected 20 ml of unstimulated saliva of systemically healthy volunteers. 100 µ of each saliva sample were seeded separately in the middle Sabouraud Agar chloramphenicol dextrose (Difco) and Chromagar. After the incubation period the counting of Colony Forming Units (CFU) was performed. The colonies were transferred to tubes containing Sabouraud Dextrose broth, for later identification. In the conventional denture user group two species were found: Candida albicans (50%) and Candida tropicalis (50%), in the fixed dentures on implants user group were found the C. tropicalis species (70%) and C. krusei (30%). In conclusion: microorganisms of Candida genus are present in the saliva of conventional and fixed denture on implants users (AU).

A 5-Year Prospective Study on Cone-Anchored Implants in the Edentulous Maxilla.

PURPOSE: To investigate dentist- as well as patient-centered outcomes of the implant-supported cone-anchored removable prosthesis in the edentulous maxilla over 5 years. MATERIALS AND METHODS: Ten patients, edentulous in the maxilla, received six Ti implants after which they were delayed loaded through a cone-anchored removable prosthesis. Clinical parameters such as plaque and bleeding indices, PTV, implant success, marginal bone loss, device and prosthesis complications, and patient satisfaction (visual analogue scale) were collected at follow-up visits scheduled 1, 3, 6, 12, 24, 36, and 60 months postprosthesis delivery. RESULTS: After at least 5 years of follow-up (mean: 63.7 months), 53/59 implants were rated successful, while two of 59 failed and one implant was kept sleeping. Mean marginal bone loss from prosthesis delivery until 1, 3, and 5 years, respectively, was; 0.15 (SD: 0.87), 0.36 (SD: 1.07), and 0.60 mm (SD: 1.12). The mean Periotest® values at baseline and 5 years did not differ significantly. After 1 year, a significant improvement in patient satisfaction was recorded compared with the old denture, and this remained stable over the 5-year period. CONCLUSIONS: Cone-anchored removable dental prostheses retained by secondary splinted implants offer a safe alternative for patients with an edentulous maxilla in need of more comfort. Dentist- as well as patient-centered outcomes compete with reports using other prosthetic anchoring devices. Larger replica studies are encouraged to further validate this concept.

Stress analysis of mandibular implant-retained overdenture with independent attachment system: effect of restoration space and attachment height.

In this in vitro study, 2 implants were embedded in the interforaminal region of an acrylic model. Two kinds of retention mechanisms were used to construct complete overdentures: ball type and direct abutment (Locator). The ball-type retention mechanism models included 3 different collar heights (1, 2, and 3 mm) with 15 mm occlusal plane height, and 3 different occlusal plane heights (9, 12, and 15 mm) with 1 mm collar height. The direct abutment models included 3 different occlusal plane heights (9, 12, and 15 mm) with 1 mm cuff height. Vertical unilateral and bilateral loads of 150 N were applied to the central fossa of the first molar. The stress of the bone around the implant was analyzed by finite element analysis. The results showed that by increasing vertical restorative space, the maximum stress values around implants were decreased in both unilateral and bilateral loading models. The results also showed that the increase in maximum stress values around implants correlated with the ball attachment collar height. The Locator attachment with a 1 mm cuff height and 9 mm occlusal plane height demonstrated 6.147 and 3.914 MPa in unilateral and bilateral loading conditions, respectively. While a reduction in the collar height of a ball-type retention mechanism and an increase in the vertical restorative space in direct abutment retention mechanisms are both biomechanically favorable, and may result in reduced stress in peri-implant bone, a ball attachment seems to be more favorable in the stress distribution around an implant than a Locator attachment.

Assessment of Candida species colonization and denture-related stomatitis in bar- and locator-retained overdentures.

The aim of this study was to assess the prevalence of denture-related stomatitis (DRS) in different attachment-retained overdenture wearers and its association with particular colonizing Candida species. Thirty-seven edentulous patients with implant-supported maxillary or mandibular overdentures were enrolled. A full clinical history was obtained, including details of patients' oral hygiene practices and the levels of erythema based on Newton's classification scale. Swabs were taken from the palate and investigated mycologically to identify the yeast colonies. Quantitative and qualitative microbiological assessments were performed, which included recording the total numbers of colonies (cfu), their color, and their morphological characteristics. Significant differences were found in cfu values between the attachment and inner surfaces of locator- and bar-retained overdentures (P < .05). Candida albicans was the most common species in both evaluations, being isolated from 81.3% of bar-retained overdentures and 38.1% of locator-retained overdentures. DRS developed in all patients using bar-retained overdentures but in only 71.4% of those using locator-retained overdentures. No statistically significant relationship was found between bar and locator attachments according to smoking habit, overnight removal, or plaque and gingival indices (P > .05).

Caries management by risk assessment care paths for prosthodontic patients: oral microbial control and management.

The development of an oral care path focuses on the identification of the early indicators of disease. Once the risks have been identified and diagnosed, the proper therapies can be selected and prescribed. The experienced practitioner must meld clinical experience and observation with evidence-based scientific dentistry and information on the treatment and prevention of continued disease for the prosthodontic patient after restorations have been completed. The incorporation of dental implants has not allowed for complications of caries and periodontal disease on teeth and implants. Osseoseparation is necessary for justification of continued maintenance.

Biofilm formation of Candida albicans on implant overdenture materials and its removal.

OBJECTIVES: The purposes of this study were to clarify the surface characteristics of various implant overdenture materials and the capabilities of Candida albicans adherence and biofilm formation on these surfaces, and to investigate the role of salivary mucin in biofilm formation. METHODS: Seven commonly used implant and restorative materials were assessed. The surface roughness averages of all materials were limited to 0.07-0.10 µm. Contact angles and salivary mucin absorption were measured. After 90-min initial adhesion and 2-day biofilm formation, the amounts of C. albicans were determined by counting colony-forming units and the morphological characteristics were observed by scanning electron microscopy (SEM). The effects of saliva coating and the influences of material surface property on initial adhesion, biofilm formation and its removability were analysed by univariate two-way analysis of variance and multiple linear regression analysis. RESULTS: Surface contact angle of materials, the index of hydrophobicity, was found to be correlated positively with initial adhesion and biofilm formation of C. albicans. A negative correlation between mucin absorption and removability of Candida biofilm indicates that mucin plays an important role in biofilm formation and its rigidity. SEM observation also revealed fewer Candida cells on saliva-coated Ti than on saliva-coated hydroxyapatite or acrylic resin. CONCLUSIONS: The materials with different hydrophobic property and compositions display diverse manners of salivary mucin absorption, initial adhesion and biofilm formation. The hydrophobic materials encourage enhanced initial adhesion, subsequently resulting in the active biofilm formation. Mucin has decisive effects on Candida immobilization and biofilm development on the materials. CLINICAL SIGNIFICANCE: Surface hydrophilic property and composition of materials and salivary proteins, especially mucin, affect the process of Candida biofilm formation and influence the amount and rigidity of formed biofilm. The present data may be applied as a reference for selecting materials in implant overdenture treatment from a microbiological point of view.

Open or submerged healing of implants with platform switching: a randomized, controlled clinical trial.

AIM: The temporal pattern of bone-level alterations in conventionally restored implants is dependent upon healing mode (open or submerged). This study examined the influence of healing on marginal bone levels at implants with a medium-rough surface including the implant collar and a clearance-fit implant-abutment connection restored according to a platform-switching concept. MATERIAL AND METHODS: Two implants were placed in the posterior mandible of 21 test subjects, randomly assigned to open (OH) or submerged (SH) healing. Standardized radiographs were obtained after implant surgery, before re-entry, after crown mounting, 1 and 2 years after implant surgery, and evaluated for implant-bone-level alterations (ΔIBL). Bacterial samples of the implants' inner cavities were analysed by cultivation. STATISTICS: Brunner-Langer Model, equivalence testings by Wilcoxon's (equivalence range ±0.4mm). RESULTS: After 2 years, ΔIBL were -0.47±0.46mm (OH) and -0.54±0.38mm (SH). At the 1-year follow-up, all implants were contaminated with bacteria. ΔIBL (p<0.001) and the amount of bacterial contamination (p<0.001) significantly depended on time, but not on healing mode. ΔIBL of OH and SH were equivalent at all time points (all p0.044). CONCLUSIONS: Platform-switched implants showed very limited peri-implant bone-level alterations. The healing-mode neither affected the total amount nor the temporal patterns of ΔIBL. Thus, the results for the tested implants with a non-rigid implant-abutment connection were similar to results reported previously for implants with a rigid implant-abutment connection.

Application of a diagnostic-therapeutic procedure using implant-supported dental prosthesis as a preventive therapy for candidiasis of upper gastrointestinal tract in complete denture users.

Our previous studies demonstrated that the use of acrylic based prosthesis in edentulous patients had a direct impact on the increased incidence of oral mycosis and further episodes of mycosis in the digestive tract. This dependency is associated with formation of a space between the surface of the prostheses and adhering mucosal membrane, where a specific micro environment is being formed, which - as stated - creates a superior breeding ground mainly for microorganisms of the genus Candida.

Avaliação da clorexidina a 2% no controle bacteriano na região interna de implantes de hexágono externo / Assessment of the chlorhexidin (2%) for the bacterial control in the internal área of extenal-hexagon oral implants

A infiltração de fluidos orgânicos e de microorganismo pode ocorrer entre o pilar protético e o implante osseointegrado, causando mau odor e possível inflamação de tecidos perimplantares. Este estudo teve como objetivo identificar oito espécies periodontopatôgenicas no espaço interno de implantes de hexágono externo e a avaliação do uso de solução de clorexidina a 2% no controle bacteriano nesse espaço. Foram selecionados quatro indivíduos portadores de duas próteses sobreimplante cada. As próteses foram removidas, limpas e desinfetadas com álcool-iodado a 0,02% anteriormente às coletas de material da interface parafuso- implante. Após a primeira coleta, foram reposicionados os pilares de prótese sendo que, num dos implantes, foi adicionada solução de digluconato de clorexidina a 2% e no outro implante (controle), nada foi adicionado. Os indivíduos foram divididos em dois grupos para novas coletas 30 e 90 dias após a primeira. As amostras foram submetidas a exames microbiológicos para identificação de periodontopatógenos, por cultivo e detecção do DNA pela reação em cadeia da polimerase (PCR). Os resultados demonstraram a presença de F nucleatum e T denticola nas amostras coletadas 30 dias após a aplicação de clorexidina e de T denticola e P intermedia nas que não receberam essa aplicação. Aos 90 dias foi detectada a presença de C.rectus nas amostras dos espaços não tratados com clorexidina e de P gingivalis e P. intermedia, indiferentemente da aplicação ou não desse antimicrobiano.

Reliability of findings around healthy implants in association with oral hygiene measures: a clinical, microbiological, and immunological follow-up in edentulous patients.

OBJECTIVES: To assess the performance of clinical, microbiological, and immunological diagnosis of peri-implant health and the influence of professional hygiene measures on them. MATERIAL AND METHODS: Twenty-one edentulous patients with oral implants supporting a lower overdenture were followed up over 3 months beginning 1 week before their annual recall visit. Hygiene scores, probing depth, bleeding on probing (BOP), implant stability, gingival crevicular fluid (GCF) volume, sulcular interleukin-1beta (IL-1beta) and prostaglandin E2 (PGE2) concentrations, and relative concentrations of five bacterial species (polymerase chain reaction) were investigated. Measurement variation was assessed as a function of (a) intra- and (b) inter-examiner reliability, (c) inter-implant variation in each patient, (d) time, and (e) effect of hygiene measures by accuracy, repeatability, reproducibility, and visualization with the Bland and Altman Plot. RESULTS: Measurement means and accuracy (in parentheses) were as follows: GCF volume 1.5 microl (1.5), Interleukin-1beta 8 ng/ml (26), PGE2 63 ng/ml (185), bacteria sum score 0.2 (0.7), plaque score 1 (1), BOP score 0 (1), Periotest value -4 (3), resonance frequency analysis ISQ 66 (11), and pocket probing depth 2.3 mm (0.7). No finding exhibited any statistically significant measurement variation as explained by accuracy, repeatability, or reproducibility. Bland and Altman Plots revealed insufficient agreement for replicated BOP assessments. A short post-treatment reduction in plaque and BOP scores was visually apparent. Still, professional oral hygiene measures exerted no sustained influence on the clinical and biochemical appearance of the peri-implant tissues. CONCLUSION: All findings except BOP showed statistically acceptable repeatability and moderate vulnerability to influences present 'chairside' in clinical practice.

A comprehensive and critical review of dental implant prognosis in periodontally compromised partially edentulous patients.

OBJECTIVES: The outcome of implant treatment in periodontally compromised partially edentulous patients has not been completely clarified. Therefore, the aim of the present study was to perform, applying a systematic methodology, a comprehensive and critical review of the prospective studies published in English up to and including August 2006, regarding the short-term (<5 years) and long-term (>or=5 years) prognosis of osseointegrated implants placed in periodontally compromised partially edentulous patients. MATERIAL AND METHODS: Using The National Library Of Medicine and Cochrane Oral Health Group databases, a literature search for articles published up to and including August 2006 was performed. At the first phase of selection the titles and abstracts and at the second phase full papers were screened independently and in duplicate by the three reviewers (I. K. K., S. K., I. F.). RESULTS: The search provided 2987 potentially relevant titles and abstracts. At the first phase of evaluation, 2956 publications were rejected based on title and abstract. At the second phase, the full text of the remaining 31 publications was retrieved for more detailed evaluation. Finally, 15 prospective studies were selected, including seven short-term and eight long-term studies. Because of considerable discrepancies among these studies, meta-analysis was not performed. CONCLUSIONS: No statistically significant differences in both short-term and long-term implant survival exist between patients with a history of chronic periodontitis and periodontally healthy individuals. Patients with a history of chronic periodontitis may exhibit significantly greater long-term probing pocket depth, peri-implant marginal bone loss and incidence of peri-implantitis compared with periodontally healthy subjects. Even though the short-term implant prognosis for patients treated for aggressive periodontitis is acceptable, on a long-term basis the matter is open to question. Alterations in clinical parameters around implants and teeth in aggressive periodontitis patients may not follow the same pattern, in contrast to what has been reported for chronic periodontitis patients. However, as only three studies comprising patients treated for aggressive periodontitis were selected, more studies, specially designed, are required to evaluate implant prognosis in this subtype of periodontitis. As the selected publications exhibited considerable discrepancies, more studies, uniformly designed, preferably longitudinal, prospective and controlled, would be important.

A comparison of implant-supported, bar- or ball-retained mandibular overdentures: a retrospective clinical, microbiologic, and immunologic study of 10 edentulous patients attending a recall visit.

PURPOSE: Clinical, microbiologic, and immunologic comparisons of the peri-implant health in edentulous volunteers wearing long-standing implant-supported ball- or Dolder bar-retained mandibular overdentures were performed. MATERIALS AND METHODS: Ten age- and gender-matched individuals (mean age, 71 years) with either ball- or bar-retained complete mandibular overdentures, scheduled for an annual implant recall examination, were investigated an average of 7 years after implant placement. Plaque and gingival crevicular fluid samples were obtained from the peri-implant sulcus. The groups were compared with regard to peri-implant probing depth; plaque and bleeding on probing scores; sulcular fluid flow rates; implant stability measurements (Periotest device); relative concentrations of Actinobacillus actinomycetemcomitans, Prevotella intermedia, Fusobacterium nucleatum, Porphyromonas gingivalis, Tannerella forsythensis, and Treponema denticola assessed by polymerase chain reaction analysis; and sulcular concentrations of interleukin-1beta and prostaglandin E2, assessed by enzyme-linked immunosorbent assay. RESULTS: No statistically significant differences were found for any of the examined parameters between both study groups. CONCLUSION: Within the limitations of this study, both ball attachments and Dolder bars can be recommended for overdenture retention, with either one showing satisfying clinical, microbiologic, and immunologic findings in the peri-implant tissues after several years of service in healthy recall patients with good oral hygiene habits.