The restoration of traumatized teeth.

The restoration of a traumatized tooth may require minimally invasive or more extensive treatment options. The majority of injuries occur in the younger population, so management should consider the long-term outcome, failure and future treatment needs over the course of, often, many decades. The aim should be to provide a tooth-restoration complex that closely mimics the functional and aesthetic qualities of an intact tooth for as long as possible. This narrative review will assess the relevant literature pertinent to restoration of traumatized teeth in order to provide guidance for the practising clinician.

Patient-related risk factors for implant therapy. A critique of pertinent literature.

BACKGROUND: Treatment planning for dental implants involves the assessment of patient-related risk factors prior to formulation of a treatment plan. The aim of this review was to assess relevant literature and provide evidence-based information on the successful surgical placement of dental implants. METHODS: An electronic search of Medline, PubMed and the Cochrane Databases of Systematic Reviews was undertaken using a combination of MeSH terms and keywords. A handsearch was also performed and cross-referenced with articles cited in papers selected. The primary study parameter was implant failure. RESULTS: Forty-three studies were selected based on specific inclusion criteria. Many studies contain confounding variables, numbers in subcategories are often too small for meaningful statistical analysis, and follow-up times vary and are often short-term. CONCLUSIONS: There are many risk factors which the clinician is required to know and understand to advise patients, and consider in planning and treatment provision. Consistent evidence exists to show an increased failure rate with smokers, a history of radiotherapy and local bone quality and quantity. Weaker evidence exists to show a higher incidence of peri-implant disease in patients with a history of periodontitis-related tooth loss. Lack of evidence precludes definitive guidelines for patients with autoimmune disorders where expert opinion recommends caution. Osteoporotic patients show acceptable survival rates; however patients on oral bisphosphonates show a small incidence but high morbidity from osteonecrosis of the jaw. Emerging evidence suggests that there is a correlation between genetic traits and disruption of osseointegration.

Immediate loading of dental implants.

The purpose of this review is to explore the concept of immediate loading as it pertains to dental implants and the indications for clinical practice. The definition of immediate loading will be considered together with a review of the relevant literature in an attempt to provide evidence-based guidelines for successful implementation into practice. A search of electronic databases including Medline, PubMed and the Cochrane Database of Systematic Reviews was undertaken using the terms "immediate loading'', "dental implants'', "immediate function'', "early loading'', "oral implants'', "immediate restoration'' and "systematic review''. This was supplemented by handsearching in peer-reviewed journals and cross-referenced with the articles accessed. Emphasis was given to systematic reviews and controlled clinical trials. A definition of immediate loading was suggested pertinent to the realities of logistics in clinical practice with respect to application and time frame. The literature was evaluated and shown to be limited with significant shortcomings. Guidelines and recommendations for clinical protocols were suggested and illustrated by examples of case types with a minimum of 1-3 years follow-up. A list of additional references for further reading was provided. Within the limitations of this review, there is evidence to suggest that immediate loading protocols have demonstrated high implant survival rates and may be cautiously recommended for certain clinical situations. However, more high level evidence studies, preferably randomized controlled trials (RCTs), over a long time frame are required to show a clear benefit over more conventional loading protocols.