Clinician assessments and patient perspectives of single-tooth implant restorations in the esthetic zone of the maxilla: A systematic review.

STATEMENT OF PROBLEM: Esthetic outcomes associated with implant dentistry are important to both clinicians and patients. However, esthetic satisfaction may vary between the 2 groups. In order to evaluate the current publications relating to this topic, the following focused question was developed, "what are the quantitative and qualitative differences between clinician evaluations and patient perspectives in the assessment of single-tooth implant outcomes in the esthetic zone?" PURPOSE: The purpose of this systematic review was to identify differences in esthetic satisfaction between clinicians and patients when evaluating single-tooth implant-supported restorations. MATERIAL AND METHODS: An electronic search of the Medline database and Cochrane Central Register of Controlled Trials (2000 to 2014) was performed. The search was supplemented by a manual search of specific journals. A quality assessment of full-text articles was performed according to Cochrane Collaboration's tool and Newcastle-Ottawa scale for risk of bias assessment. Information regarding outcomes was collected and compared. RESULTS: The search term combinations identified 555 titles. Subsequent to further review, 11 publications, including 2 randomized controlled trials, were selected for inclusion. Because of the heterogeneity of the study designs, study interventions, and esthetic assessment methods, no meta-analysis was performed. The clinicians identified a satisfactory outcome in 51% to 100% for peri-implant soft tissue and 62% to 90% for implant restorations. Patients showed a mean range score of 43% to 93% for peri-implant soft tissue and 81% to 96% for implant restorations. The visual analog scale score of the dentists was always lower than that of the patients. The review identified correlations between subjective and objective assessments for the Pink Esthetic Score (PES), the Papilla Index (PI), the Implant Crown Aesthetic Index (ICAI), and the modified (mod-ICAI) indices. CONCLUSIONS: Clinicians are more critical of esthetic outcomes than patients. The PES and the PI correlated with the patients' responses concerning the peri-implant soft tissue. The ICAI and the mod-ICAI showed a correlation of both the peri-implant mucosa and implant-supported crown satisfaction. Thus, a comprehensive and practical index should be developed to assess the esthetic outcomes for single-tooth implant restorations in the esthetic zone.

Hardness Changes of Tissue Conditioners in Various Storage Media: An in Vitro Study.

The aim of the present study was to evaluate the effects of storage media on the longitudinal hardness changes of tissue conditioning materials. Four tissue-conditioning materials were used for fabrication of 80 disc-shaped specimens and divided in four groups, stored in four storage media. The specimens underwent artificial ageing corresponding to 30 nights of extra-oral storage. Hardness measurements were obtained at nine intervals between 8 and 240 hours after specimen fabrication. To test the effects of storage media on hardness we employed multivariate modelling (Bonferroni correction; α = 0.05). The materials exhibited varying hardness changes, most pronounced when stored in ambient air.

The ABC Protocol in the Esthetic Zone: A Comprehensive Surgical and Prosthetic Approach.

The purpose of this article is to present a surgical and restorative protocol for the replacement of missing teeth in the esthetic zone. The ABC protocol consists of digitally guided implantation, autogenous bone graft (A), followed by bovine bone xenograft (B) and connective tissue graft (C). Autogenous bone is placed in contact with the implant surface to induce osseointegration; bovine bone xenograft is then applied to augment the ridge dimension and provide long-term stability. Connective tissue is used to provide additional volume. The ABC biomaterial sequence offers favorable hard and soft tissue dimensions and immediate provisional restoration predictably leads to an esthetically pleasing definitive prosthesis.

Clinical assessment of bone quality of human extraction sockets after conversion with growth factors.

PURPOSE: The study was conducted to evaluate the effect of mineralized freeze-dried bone allograft (FDBA), alone or in combination with growth factors in extraction sockets, on subjective assessment of bone quality during implant placement. MATERIALS AND METHODS: Forty-one patients whose treatment plan involved extraction of anterior or premolar teeth were randomized into four groups: Group 1, collagen plug (control); Group 2, FDBA/ß-tricalcium phosphate (ß-TCP)/collagen plug; Group 3, FDBA/ß-TCP/platelet-rich plasma (PRP)/collagen plug; Group 4, FDBA/ß-TCP/recombinant human platelet-derived growth factor BB (rhPDGF-BB)/collagen plug. After 8 weeks of healing, implants were placed. The clinicians assessed bone quality according to the Misch classification. A benchtop calibration exercise test was conducted to evaluate agreement and accuracy of operators in recognizing different bone qualities. Differences were analyzed using one-way analysis of variance (ANOVA) or chi-square tests for continuous and categorical data. Pairwise comparisons were tested using least squares means (LS means). Spearman correlation coefficients were used to evaluate the relationship of bone growth with potential confounders. P < .05 was considered statistically significant. A simple (not weighted) kappa statistic was used to assess the agreement between raters. To assess accuracy in identifying bone quality, a chi-square test was used to compare the percent correct for each rater. RESULTS: The benchtop calibration exercise test demonstrated agreement among clinicians (0.75 and 0.92 between raters 1 and 2 and raters 1 and 3, respectively). Raters were more likely to identify the correct bone quality (P > .05). Inclusion of bone grafting is associated with a shift from D4 quality to D3 quality bone. Inclusion of PRP in bone grafting eliminates the incidence of D4 bone, establishing D3 and D2 quality bone as prevalent (56% vs. 42%, respectively). Inclusion of rhPDGF-BB and ß-TCP in combination with the bone grafting has the same effect, although D2 quality is less prevalent. When compared to sockets grafted with FDBA/ß-TCP/collagen plug alone, the sockets with growth factors demonstrated fewer residual bone graft particles. CONCLUSION: (1) Inclusion of bone grafting enhanced bone quality as assessed during implant placement. (2) Overall inclusion of PRP and rhPDGF-BB enhanced subjective bone quality, eliminating incidence of D4 quality in human extraction sockets. (3) The use of PRP or rhPDGF-BB may enhance healing within extraction sockets and decrease the healing time prior to dental implant placement.

Digital data acquisition for a CAD/CAM-fabricated titanium framework and zirconium oxide restorations for an implant-supported fixed complete dental prosthesis.

This dental technique report describes a digital workflow with digital data acquisition at the implant level, computer-aided design and computer-aided manufacturing fabricated, tissue-colored, anodized titanium framework, individually luted zirconium oxide restorations, and autopolymerizing injection-molded acrylic resin to fabricate an implant-supported, metal-ceramic-resin fixed complete dental prosthesis in an edentulous mandible. The 1-step computer-aided design and computer-aided manufacturing fabrication of titanium framework and zirconium oxide restorations can provide a cost-effective alternative to the conventional metal-resin fixed complete dental prosthesis.

Application of digital diagnostic impression, virtual planning, and computer-guided implant surgery for a CAD/CAM-fabricated, implant-supported fixed dental prosthesis: a clinical report.

This clinical report demonstrated the use of an implant-supported fixed dental prosthesis fabricated with a contemporary digital approach. The digital diagnostic data acquisition was completed with a digital diagnostic impression with an intraoral scanner and cone-beam computed tomography with a prefabricated universal radiographic template to design a virtual prosthetically driven implant surgical plan. A surgical template fabricated with computer-aided design and computer-aided manufacturing (CAD/CAM) was used to perform computer-guided implant surgery. The definitive digital data were then used to design the definitive CAD/CAM-fabricated fixed dental prosthesis.

Using growth factors in human extraction sockets: a histologic and histomorphometric evaluation of short-term healing.

PURPOSE: Ridge preservation protocols reduce crestal remodeling after tooth extraction. There is insufficient evidence on bone grafting in combination with platelet-rich plasma (PRP) or recombinant human platelet-derived growth factor (rhPDGF-BB). The aim of this study is to evaluate healing of grafted and nongrafted sockets and the effect of PRP and rhPDGF-BB on early remodeling. MATERIALS AND METHODS: Forty-one patients whose treatment plan included extraction of anterior or premolar teeth were randomized into four groups. Group 1: collagen plug (control). Group 2: mineralized freeze-dried bone allograft (FDBA)/ß-tricalcium phosphate (ß-TCP)/collagen plug. Group 3: FDBA/ß-TCP/PRP/collagen plug. Group 4: FDBA/ß-TCP/rhPDGF-BB/collagen plug. At 8 weeks, a core was harvested from the center of 41 sockets. Histomorphometric analysis took place. Differences were analyzed using one-way analysis of variance (ANOVA) or chi-square tests for continuous and categorical data. Pairwise comparisons were tested using least squares means. Spearman correlation coefficients were used to evaluate the relationship of bone growth with potential confounders. A P value < .05 was considered statistically significant. RESULTS: ANOVA did not indicate statistical significance in age, gender, smoking, ethnicity, or race distribution. Significant differences in tissue distribution were identified between groups and between different thirds of harvested core. More new bone and amorphous organic matrix was noted in the control group. In sites where bone graft was combined with growth factors, the amount of residual particles was less than in sites where bone graft was used alone. CONCLUSIONS: Inclusion of bone replacement graft suppressed new bone formation during early healing. Inclusion of PRP and rhPDGF-BB produced less residual bone graft material, indicating more rapid turnover of bone graft. All treatment modalities achieved a significant amount of new vital bone at 8 weeks postextraction.

Definitive abutment-driven stage-two surgery as a means to reduce peri-implant soft tissue changes: introduction of a new concept.

This report introduces an innovative approach for optimizing esthetics and minimizing soft tissue changes in clinical scenarios that involve extensive site preparation and submerged implants. The existing soft tissue morphology is registered at the time of implant uncovery, and an optimal peri-implant transmucosal contour is created indirectly in the lab. The customized definitive abutment is inserted during stage-two surgery and subsequently guides the peri-implant soft tissue, replicating an optimal emergence profile. The concept is demonstrated through the presentation of two clinical cases.

Treatment of hemi-mandibulectomy defect with implant-supported telescopic removable prosthesis. A clinical report.

Excision of head and neck tumors (benign or malignant) often leads to large segmental resections of the mandible. The following clinical report describes the oral rehabilitation of a 60-year-old Caucasian man after partial mandibulectomy due to primary oral leiomyosarcoma. Treatment consisted of a free fibula flap and an implant-supported telescopic removable prosthesis.

Patients' profiles and perceptions of complete dentures in a university dental clinic.

This study investigated factors associated with perceptions of complete dentures (CDs) among patients presenting at a university dental clinic. A retrospective chart review of all new edentulous patients presenting at the Athens University School of Dentistry Removable Prosthodontics Clinic between 1993 and 2002 (n = 2,526) was completed. More than half of CD-wearing patients were dissatisfied with their dentures at the initial visit. Dissatisfaction was correlated with current use of denture adhesives and less time spent edentulous and was more prevalent among females. Factors affecting patients? adaptation to and satisfaction with CDs should be considered at CD fabrication and follow-up.

Loss of natural dentition: multi-level effects among a geriatric population.

OBJECTIVE: To quantify the impact of edentulousness on residual ridge volume, denture stomatitis (DS), as well as oral health behaviours among geriatric denture-wearers. BACKGROUND: Residual ridge resorption (RRR) is the primary intraoral complication of complete edentulism, but individual variation among geriatric patients has been observed. MATERIALS AND METHODS: Data collection relied upon a 10-year retrospective chart review of all complete denture-wearing geriatric patients presenting at the Removable Prosthodontics Clinic, Dental School of Athens, between 1993 and 2002. Analyses relied on descriptive, bivariate, and multivariate methods based on ordinal logistic regression. RESULTS: A total of 873 records of geriatric patients (age mean = 72; median = 70; range = 65-95) comprised our analytical sample. Subjects' mean (SD) time since edentulation was 7.7 (10.2) years. Eleven percent were diagnosed with temporomandibular disorder (TMD). While 28% of patients reported cleaning their dentures at least daily, 6% presented with denture stomatitis (DS). Each added year of edentulism increased the odds of mandibular RRR: OR (95% CI) = 1.05 (1.03, 1.07). Nightly denture wear was the strongest risk factor for DS. Finally, independent of age and sex, each year of being edentulous increased the odds of presenting with TMD: OR (95% CI) = 1.03 (1.01, 1.05). CONCLUSION: Time since edentulation was strongly associated with mandibular but not maxillary RRR, as well as TMD development.

Custom copings for accurate impressions of multiple internal connection implants.

The technique presented facilitates a 1-step final impression and registration of multiple internal connection implants that have an unfavorable proximity. This is achieved by the use of customized impression elements that provide an accurate registration of the implant positions and the maxillomandibular relation. By means of this procedure, problematic implant positions are bypassed and chair-side time is reduced significantly.

A technique for managing and accurate registration of periimplant soft tissues.

This article describes an indirect impression technique that accurately captures the soft tissue contours around an implant-supported provisional restoration. Customized impression copings are used to transfer the soft tissue architecture created by the interim prosthesis. The definitive restoration is shaped like the provisional restoration, maintaining the emergence profile and optimizing esthetics.