Traitement par la technique de Latarjet des instabilités antérieures de l'épaule au centre hospitalier de l'Ordre Malte de Dakar

Introduction : Le but de cette étude était d'évaluer les résultats cliniques et radiologiques des patients ayant une instabilité antérieure traitée par la technique de Latarjet. Patients et méthodes : Dans cette étude rétrospective 14 patients (15 épaules) ont été opérés entre janvier 2013 et décembre 2016 pour une luxation récidivante de l'épaule selon la technique de Latarjet à foyer ouvert. La fonction de l'épaule a été appréciée selon les cotations de Rowe, Duplay , et WOSI (the Western Ontario ShoulderInstability). Les résultats radiographiques ont concerné la consolidation du greffon et la position de la butée. Résultats : Le recul moyen était de 34 mois (7- 64). Douze patients étaient très satisfaits de la stabilité et de la fonction de leur épaules. il n'y avait pas de récidive. Selon la cotation de Walch et Duplay les résultats étaient bons (n=13) et moyen (n=1). Selon Rowe ils étaient bons (n=13) et mauvais ( n=1). Selon la cotation WOSI ils étaient excellents ( n=8), bons ( n=4), et moyens (n=2). Toutes les butées ont consolidées. Elles étaient sous l'équateur. Elles étaient affleurantes (n=14), médiale (n=1). Conclusion : Ce travail suggère que la technique de Latarjet réalisée à foyer ouvert offre aux patients une stabilisation de l'épaule, des mobilités quasi-normales, et la possibilité de reprendre dans de bonnes conditions des activités professionnelles et sportives

The Up-to-14-Year Survival and Complication Burden of 256 TiUnite Implants Supporting One-Piece Cast Abutment/Metal-Ceramic Implant-Supported Single Crowns.

PURPOSE: To assess the estimated cumulative survival (ECS) and explore the technical and biologic complications of 256 TiUnite implants (Nobel Biocare) supporting one-piece cast abutment/metal-ceramic implant-supported single crowns (ISCs) in situ for up to 14 years. MATERIALS AND METHODS: A prospective sequentially recruited cohort of 207 patients received 256 metal-ceramic ISCs on TiUnite implants between 2001 and 2014. All but 24 patients with 27 crowns were clinically evaluated between January 2014 and April 2015 in conjunction with or in addition to their tailored maintenance program. Radiographs were obtained, and any previously recorded treatments associated with the crowns were tabulated. The ECS and standard errors were calculated with the life table actuarial method and Greenwood's formula, respectively. The log rank test was applied to assess differences between anterior and posterior crowns. Complication incidence, severity, and economic burden, measured in time/cost accounting units (TAUs), were tallied and compared descriptively. Independent groups were compared with the Mann-Whitney U test and related groups with the Wilcoxon Signed Rank Test. RESULTS: The mean clinical service time of the crowns was 5.61 years (44 ≥ 10 years). The 14-year ECS was 95.95% ± 3.20% with no significant difference between anterior and posterior prostheses. Only seven implants lost marginal bone ≥ one thread from the time of crown insertion. There were 30 nonterminal complications (16 biologic, 14 mechanical). The associated economic burden was low (n = 35 TAUs). CONCLUSION: High gold-alloy one-piece cast abutment/metal-ceramic ISCs on TiUnite implants exhibited excellent longevity and few complications over 14 years.

Survival of teeth treated with cast post and cores: A retrospective analysis over an observation period of up to 19.5 years.

STATEMENT OF PROBLEM: Scientific data about the long-term survival of teeth treated with cast post and cores are scarce. Retrospective studies often use different target events for their analyses. A comparison is therefore complicated. For associated tooth-, jaw-, and patient-related factors little evidence exists as to their effect on survival. PURPOSE: The purpose of this study was to extend the knowledge on the survival of teeth treated with cast post and cores for observation periods of more than 10 years. A decrease or increase in survival times according to the presence or absence of associated parameters needs to be evaluated. MATERIAL AND METHODS: A retrospective evaluation was conducted of all cast post and cores inserted in 1 university clinic between January 1992 and June 2011. A Kaplan-Meier survival analysis was carried out by using extraction as the target event. The survival curves for different tooth types, the presence or absence of adjacent teeth, and the prosthetic restoration of the respective jaws were compared by using the log-rank test (α=.05). A Cox regression model was calculated for multivariate analyses. RESULTS: A total of 717 cast post and cores for 343 patients were recorded. The mean survival time was 13.5 years. A statistically significant decrease in survival times was found for canines (11.9 years) and premolars (13.4 years) versus molars (14.1 years), no adjacent teeth (10.6 years) versus at least 1 adjacent tooth (13.8 years), and the restoration with removable dental prostheses (12.5 years) versus fixed dental prostheses and single crowns (13.9 years). The largest reduction in survival time was found for teeth being used as an abutment for a double crown-retained removable partial dental prosthesis (telescopic denture) (9.8 years). Tooth type and adjacent tooth status remained as significant variables within the multivariate Cox regression model. CONCLUSIONS: Cast post and cores have an acceptable long-term survival time. Because different factors may influence survival, considering these factors in treatment planning may increase the long-term success of these restorations.

Incidence of attachment loss of canines in an overdenture population.

STATEMENT OF PROBLEM: Caries and periodontal disease are the most common cause of tooth loss in overdenture populations. Longitudinal data on attachment loss in this population have not been well reported. PURPOSE: The purpose of this longitudinal study was to measure periodontal attachment loss in overdenture abutments. MATERIAL AND METHODS: In this longitudinal overdenture study, 272 persons fulfilled all of the inclusion criteria. These persons had 662 teeth, 465 (70.2%) of which were canines. This report focused only on participants with canines who returned for 3 consecutive recalls in the 42 months of the study and included 53 persons with 116 canines. During this 42-month period, 6 teeth were extracted. Attachment loss was measured at baseline and at 6 to 18 months, 19 to 30 months, and 31 to 42 months at the mesial, distal, mid-buccal, and mid-lingual surface of each tooth, and was calculated as the combination of pocket probing depth plus height above the gingiva. Attachment loss was compared at each recall. A single examiner made all the measurements. RESULTS: At baseline, the greatest amount of loss was at the mid-buccal surface (5.43 mm), followed by the mid-lingual (4.95 mm), distal (4.41 mm), and mesial (4.35 mm) surfaces. This pattern of attachment loss did not change over the 3 time periods, except that, at the 6 to 18-month recall, the distal measurement was less than at baseline. This decrease could be due to the wear of the abutment or loss of a restoration due to caries. Attachment loss was greater on the mandibular abutments than on the maxillary abutments and could be due to the greater amount of movement of the mandibular overdenture, especially in a buccolingual direction. CONCLUSION: Attachment loss varied by arch and by site in patients who wore overdentures.

Systematic review of the survival rate and incidence of biologic, technical, and esthetic complications of single implant abutments supporting fixed prostheses.

PURPOSE: To assess the 5-year survival rate and number of technical, biologic, and esthetic complications involving implant abutments. MATERIALS AND METHODS: Electronic (Medline) and hand searches were performed to assess studies on metal and ceramic implant abutments. Relevant data from a previous review were included. Two reviewers independently extracted the data. Failure and complication rates were analyzed, and estimates of 5-year survival proportions were calculated from the relationship between event rate and survival function. Multivariable robust Poisson regression was used to compare abutment characteristics. RESULTS: The search yielded 1,558 titles and 274 abstracts. Twenty-four studies were selected for data analysis. The survival rate for ceramic abutments was 97.5% (95% confidence interval [CI]): 89.6% to 99.4%) and 97.6% (95% CI: 96.2% to 98.5%) for metal abutments. The overall 5-year rate for technical complications was 11.8% (95% CI: 8.5% to 16.3%), 8.9% (95% CI: 4.3% to 17.7%) for ceramic and 12.0% (95% CI: 8.5% to 16.8%) for metal abutments. Biologic complications occurred with an overall rate of 6.4% (95% CI: 3.3% to 12.0%), 10.4% (95% CI: 1.9% to 46.7%) for ceramic, and 6.1% (95% CI: 3.1% to 12.0%) for metal abutments. CONCLUSIONS: The present meta-analysis on single-implant prostheses presents high survival rates of single implants, abutments, and prostheses after 5 years of function. No differences were found for the survival and failure rates of ceramic and metal abutments. No significant differences were found for technical, biologic, and esthetic complications of internally and externally connected abutments.

A report on materials used by dental students for core restorations in single and multiunit crowns.

PURPOSE: This study evaluated the materials used for tooth core restorations by dental students. MATERIALS AND METHODS: The study included all patients treated with a single crown or fixed partial denture by undergraduate dental students during the years 1984 to 1986, 1994 to 1996, and 2004 to 2006. RESULTS: More direct (62%) than indirect (38%) cores were prepared during the total time period evaluated. CONCLUSION: The complication rate of indirect cores compared with direct ones appeared to be higher in single crowns, but not in fixed partial dentures.

The influence of rehabilitation characteristics in the incidence of peri-implant pathology: a case-control study.

PURPOSE: To investigate the influence of rehabilitation characteristics in the incidence of peri-implant pathology (P-iP). MATERIALS AND METHODS: A total of 1350 patients (270 with P-iP matched for age, gender, and time of follow-up with 1080 controls without P-iP) rehabilitated with dental implants were included. The effect of the independent variables [Implant length in millimeters (IL); implant diameter in millimeters; implant surface (IS); presence of cantilevers; implant:crown ratio (ICR), type of abutment (TA); abutment height; fracture of prosthetic components (FPCs); type of prosthetic reconstruction (TPR); type of material used in the prosthesis (TMUP); loosening of prosthetic components (LPCs); and passive misfit (PM) diagnosed within the previous year] was evaluated through bivariate analysis (chi-square), with level of significance of 5%. Crude odds ratios (OR) with 95% confidence intervals and the attributable fraction (AF) were calculated for the independent variables individually identified as factors associated with the incidence of peri-implant pathology. RESULTS: The following variables were identified as risk factors: machined IS (p = 0.015; OR = 1.46), 17° TA (p = 0.000; OR = 3.06), completely edentulous TPR (p = 0.000; OR = 2.49), TMUP (p = 0.000; metal-acrylic OR = 2.29; acrylic OR = 4.90; metal-ceramic OR = 8.43), 1:1 ICR (p = 0.002; OR = 1.54), FPC (p = 0.000; OR = 3.01), LPC (p = 0.000; OR = 4.15), and PM (p = 0.002; OR = 20.36). The attributable fraction rendered the following theoretical potential reductions in the cases if the exposure to the variables was removed: IS (31.5%), TA (67.3%), TMUP (5.4% to 73.3%), ICR (35%), FPC (66.8%), LPC (73.8%), and PM (95.1%). CONCLUSIONS: Within the limitations of this study, machined implant surfaces, 17° abutments, completely edentulous reconstructions, the type of metal used in the prosthesis, 1:1 implant:crown ratio, fracture of prosthetic components, loosening of prosthetic components, and passive misfit emerged as risk factors for the incidence of P-iP. Eliminating the exposure to these variables would, in theory, result in a significant reduction in the incidence of P-iP.

Multifactorial risk assessment for survival of abutments of removable partial dentures based on practice-based longitudinal study.

OBJECTIVES: Predicting the tooth survival is such a great challenge for evidence-based dentistry. To prevent further tooth loss of partially edentulous patients, estimation of individualized risk and benefit for each residual tooth is important to the clinical decision-making. While there are several reports indicating a risk of losing the abutment teeth of RPDs, there are no existing reports exploring the cause of abutment loss by multifactorial analysis. The aim of this practice-based longitudinal study was to determine the prognostic factors affecting the survival period of RPD abutments using a multifactorial risk assessment. METHODS: One hundred and forty-seven patients had been previously provided with a total of 236 new RPDs at the Osaka University Dental Hospital; the 856 abutments for these RPDs were analyzed. Survival of abutment teeth was estimated using the Kaplan-Meier method. Multivariate analysis was conducted by Cox's proportional hazard modelling. RESULTS: The 5-year survival rates were 86.6% for direct abutments and 93.1% for indirect abutments, compared with 95.8% survival in non-abutment teeth. The multivariate analysis showed that abutment survival was significantly associated with crown-root ratio (hazard ratio (HR): 3.13), root canal treatment (HR: 2.93), pocket depth (HR: 2.51), type of abutments (HR: 2.19) and occlusal support (HR: 1.90). CONCLUSION: From this practice-based longitudinal study, we concluded that RPD abutment teeth are more likely to be lost than other residual teeth. From the multifactorial risk factor assessment, several prognostic factors, such as occlusal support, crown-root ratio, root canal treatment, and pocket depth were suggested. CLINICAL SIGNIFICANCE: These results could be used to estimate the individualized risk for the residual teeth, to predict the prognosis of RPD abutments and to facilitate an evidence-based clinical decision making.

A 5-year retrospective study of cobalt-chromium-based fixed dental prostheses.

PURPOSE: The aim of this retrospective study was to evaluate the 5-year clinical outcome for ceramic veneered cobalt-chromium (Co-Cr) fixed dental prostheses (FDPs) fitted in a private clinical setting. MATERIALS AND METHODS: All patients treated consecutively with Co-Cr FDPs from January 2000 to November 2005 were included, and complications were registered. Patient records were examined for details on the restorations and abutment teeth. A total of 149 patients with 201 FDPs, 1,135 units, and 743 abutment teeth were recorded. RESULTS: Of the 149 patients, 122 (82%) were followed for 5 years. Complications occurred in 34 patients (23%) and 38 FDPs (19%). The most frequent were caries (6.7% of patients, 5% of FDPs, 2.2% of abutments) and cement failure (6.7% of patients, 5% of FDPs, 3.1% of abutments). Cohesive ceramic fractures occurred in only 7 FDPs (3.5% of FDPs, 0.7% of units). No adhesive ceramic fractures were recorded. The 5-year cumulative rates for success and survival were 83.8% and 92.8%, respectively. CONCLUSIONS: Co-Cr FDPs appear to be a promising prosthodontic treatment modality, presenting low incidence of complications and a high survival rate during the first 5 years of function. However, long-term randomized controlled studies are necessary to confirm these findings.

Survey of currently selected dental implants and restorations by prosthodontists.

PURPOSE: The purpose of this study was to survey the prosthodontists of the American College of Prosthodontists (ACP) and the American Academy of Maxillofacial Prosthetics (AAMP) to identify the most commonly used implant both during their training and currently in practice, and to evaluate overall restorative preference. Participants were asked to rank criteria that make an implant company desirable and important features when selecting an implant. MATERIALS AND METHODS: An electronic survey was emailed to 1,739 members of the ACP and AAMP. RESULTS: The majority of respondents (79%) were trained using Nobel Biocare brand implants, which was also the brand most often selected by participants for use in all regions of the oral cavity (34% to 39%, location dependent). Abutment preferences varied by area: incisors and canines (29%) and highly esthetic areas (53%) were more likely to be restored with custom milled zirconia abutments, while prefabricated titanium abutments were preferred for premolars and molar areas. Conventional loading was most often applied, ranging from 95% in medically compromised patients to 55% in esthetic areas. The majority of participants (86%) used Locator attachments for complete overdenture restorations. Also, respondents selected an implant company based on features and literature support versus cost and customer service. The implant features deemed most important were the design of the internal connection and ease of finding replacement parts; thread design and variety of abutments were deemed least important. Respondents reported that while implant planning software was used, they rarely/never order the concurrent surgical guide. CONCLUSION: Within the study's limitations, the majority of prosthodontists select implants based on training, features, and literature support.

Treatment outcomes with removable partial dentures: a retrospective analysis.

PURPOSE: This retrospective clinical study aimed to evaluate the long-term outcomes of clasp-retained, metal-framework removable partial dentures (RPDs) and their clasped teeth, the influencing factors on survival, and the type and number of repairs needed during the observation period. MATERIALS AND METHODS: The study is based on a convenience sample of 52 patients who received 65 RPDs with a total of 207 clasped teeth. The mean observation period was 3.11 ± 0.29 years (maximum: 10 years). Patient gender, prosthesis location (maxilla/mandible), number and distribution (Kennedy class) of abutment teeth, and impact of a continuous follow-up program on a favorable outcome probability were analyzed. Statistical analysis was performed using the Kaplan-Meier method (P < .05) in combination with Cox regression analysis. RESULTS: During the observation period, 9.2% of the RPDs ceased to function and 5.8% of the abutment teeth were extracted. Mean RPD survival time was 8.07 ± 0.66 years, with a positive outcome probability of 90% after 5 years. Prosthesis location was the only parameter that significantly (P < .05) impacted this probability. CONCLUSION: Overall, the high survival probability and low extraction rate of the abutment teeth reported in this study indicate that RPDs designed according to hygienic pronciples are clinically successful.

Immediate placement of tapered effect (TE) implants: 5-year results of a prospective, multicenter study.

PURPOSE: To evaluate the success and survival of immediately placed tapered implants to support fixed restorations in the maxilla and mandible. MATERIALS AND METHODS: The study was a prospective, multicenter, non-interventional study of patients requiring tooth extraction who requested an implant-supported restoration in the maxilla or mandible. Patients received at least one tapered implant (either immediately after tooth extraction or at a later time point). Abutments were placed 42 to 56 days after surgery, and prostheses were placed after a further 14 days. Treatment and implant success were the primary effectiveness criteria, and secondary parameters included radiographic bone loss, patient satisfaction, and gingival health. RESULTS: A total of 436 patients were enrolled, of whom 376 were included in the safety analysis. Single implants were placed in 77% of patients, two implants in 16%, and three or more implants in the remainder. The cumulative implant survival rates for immediately placed implants were 98.3% after 1 year and 97.7% from 2 to 5 years. Patient satisfaction was good or excellent in most patients and the majority of implants showed no or < 1-mm change in bone level for up to 5 years. CONCLUSIONS: The survival rate of immediately placed tapered implants was comparable to that found in other studies. Immediate implant placement with tapered implants can allow rapid rehabilitation with no adverse impact on implant survival.

Kennedy classification and treatment options: a study of partially edentulous patients being treated in a specialized prosthetic clinic.

PURPOSE: This study was done under the auspices of the Swedish International Development Cooperation Agency, whose aim is to improve living conditions in developing countries, including dental aid. Each year the number of medical staff from the European Union willing to help in developing countries increases, and it is thus important to highlight issues of development. From the Middle Asian region, the Republic of Kazakhstan was chosen. At present, few studies have evaluated the prevalence of various types of partial edentulism in this region, and no research has investigated the prosthetic treatment choice in the various types of partial edentulism. The purpose of this study was to determine (i) the prevalence of various types of partial edentulism in patients seeking dental care and (ii) the type of prosthetic restoration most commonly chosen to treat these patients. MATERIALS AND METHODS: One hundred twelve patient records, together with panoramic radiographs, were studied. Various types of partial edentulism were grouped into four Kennedy classes. Patient records were used to examine which treatment option was chosen for each patient. RESULTS: The most prevalent type of partial edentulism in this patient sample was Kennedy type III, in both the maxilla (50.0%) and the mandible (41.1%). Partial edentulism was most frequently managed by fixed partial dentures (FPDs) in both jaws. Kennedy IV was the least prevalent (7.1% in the maxilla, 5.6% in the mandible) and in most cases treated with removable partial dentures (RPDs) in both jaws. CONCLUSION: Our results are consistent with previous research on the prevalence of Kennedy classes in Kazakhstan. RPDs were the most common type of prosthetic management for partial edentulism.

Tooth-related risk factors for tooth loss in community-dwelling elderly people.

OBJECTIVE: To appropriately explore risk factors for tooth loss operating at the tooth-level, subject-related factors and a hierarchical data structure have to be considered. The purpose of this study was to evaluate tooth-related and subject-related risk factors affecting tooth loss. METHODS: A 10-year longitudinal survey was carried out on 286 elderly subjects. At baseline, the prosthodontic status and abutment function of the 5574 teeth were recorded. Tooth loss was defined as the main outcome variable, and a multilevel logistic regression model considering subject and tooth levels was applied. RESULTS: Tooth loss was found in 75% of subjects and most frequently in molars. A multivariable, multilevel logistic regression revealed that the following tooth-related variables were significantly related to tooth loss over 10 years: maxillary teeth, multirooted teeth, single crowns, abutment teeth for a fixed/removable partial denture (FPD/RPD), and periodontally involved teeth. Among them, single crowns, abutment teeth for an FPD, and teeth with severe periodontal disease at baseline had the highest odds of 5.1, 6.0, and 7.1, respectively. CONCLUSIONS: The findings of this study suggest that tooth loss is the result of complex interactions of tooth-related factors. Several tooth-related variables including multirooted teeth, abutments, and single crowns were found to be possible risk factors for tooth loss. Thus, these findings confirm and underline the potential benefit of minimizing prosthetic treatment of molars.

Outcome of dental implants in patients with and without a history of periodontitis: a 5-year pragmatic multicentre retrospective cohort study of 1727 patients.

AIM: To evaluate the outcome of dental implants placed in patients with a history of periodontitis. Patients with no or mild history of periodontitis served as controls. MATERIALS AND METHODS: A total of 1727 patients were consecutively treated in four private practices. Patients were divided into three groups according to their initial periodontal conditions assessed with a modified periodontal screening and recording (PSR) index: 630 patients were in the severe periodontitis (SP) group, 839 in the moderate periodontitis (MP) group, and 258 had no periodontitis (NP). Patients requiring periodontal treatment were treated prior to implantation. Various implant systems and procedures were used. In total, 3260 implants and 1707 implant-supported prostheses were placed in the SP group, 2813 implants and 1744 implant-supported prostheses in the MP group, and 647 implants and 424 implant-supported prostheses in the NP group. Mixed implant­tooth supported prostheses (98 prostheses in 89 patients) were not considered. Outcome measures were prosthesis and implant survival. RESULTS: Two-hundred and fifty patients were lost to follow-up 5 years after loading. Regarding prosthesis failures, 13 prostheses could not be placed or failed in 13 patients of the SP group (0.8%), 11 prostheses could not be placed or failed in 9 patients of the MP group (0.7%), and 3 prostheses failed in 3 patients of the NP group (0.9%). For implant failures, 130 (4.5%) implants failed in the SP group, 74 (3.1%) implants failed in the MP group, and 15 (3.0%) implants failed in the NP group. Most of the implant failures (90%) occurred before implant loading. Fitting a logistic regression for early implant failures and total implant failures, taking into account the clustering of implants in patients, there were no statistically significant differences between the three PSR groups (P > 0.05). CONCLUSIONS: Owing to the retrospective nature of this study, conclusions need to be interpreted with caution. A previous history of periodontal disease may not have a significant impact on implant failures up to 5 years after loading.

Tooth-related risk factors for periodontal disease in community-dwelling elderly people.

OBJECTIVE: While most previous epidemiological studies have focused on subject-level risk factors for periodontal destruction, tooth-related factors have not been fully explored. The purpose of this study was to evaluate both tooth-related and subject-related factors affecting periodontal disease progression using a two-level multilevel model. MATERIAL AND METHODS: A longitudinal survey over a period of 10 years was carried out on 286 community-dwelling elderly subjects aged 70 years at baseline. Clinical attachment level (CAL) was measured at six sites per tooth on all teeth present and periodontal disease progression was defined as CAL> or =3 mm. RESULTS: Periodontal disease progression was found in 79% of the subjects and most frequently in maxillary molars. Multilevel logistic regressions revealed that subjects wearing removable dentures were significantly at risk for periodontal disease progression. Abutment teeth for removable/fixed dentures were also significantly more likely to suffer periodontal breakdown. Furthermore, the following tooth-related variables were found to be possible risk factors for periodontal disease progression: maxillary and multirooted teeth. CONCLUSION: Multirooted teeth and abutments for a fixed denture were possible risk factors for periodontal disease progression.

Tooth survival following non-surgical root canal treatment: a systematic review of the literature.

AIMS: To investigate (i) the effect of study characteristics on reported tooth survival after root canal treatment (RCTx) and (ii) the effect of clinical factors on the proportion of root filled teeth surviving after RCTx. METHODOLOGY: Longitudinal human clinical studies investigating tooth survival after RCTx which were published up to the end of 2007 were identified electronically (MEDLINE and Cochrane database 1966-2007 December, week 4). In addition, four journals (Dental Traumatology, International Endodontic Journal, Journal of Endodontics, Oral Surgery Oral Medicine Oral Pathology Oral Radiology & Endodontics), bibliographies of all relevant articles and review articles were hand searched. Two reviewers (Y-LN, KG) assessed and selected the studies based on specified inclusion criteria and extracted the data onto a pre-designed proforma, independently. The criteria were as follows: (i) clinical study on RCTx; (ii) stratified analysis of primary and secondary RCTx available; (iii) sample size given and larger than 10; (iv) at least 6-month postoperative review; (v) success based on survival of tooth; and (vi) proportion of teeth surviving after treatment given or could be calculated from the raw data. Three strands of evidence or analyses were used to triangulate a consensus view. The reported findings from individual studies, including those excluded for quantitative analysis, were utilized for the intuitive synthesis, which constituted the first strand of evidence. Secondly, the pooled weighted proportion of teeth surviving and thirdly the combined effects of potential prognostic factors were estimated using the fixed and random effects meta-analyses on studies fulfilling all the inclusion criteria. RESULTS: Of the 31 articles identified, 14 studies published between 1993 and 2007 were included. The majority of studies were retrospective (n = 10) and only four prospective. The pooled percentages of reported tooth survival over 2-3, 4-5 and 8-10 years following RCTx were 86% (95% CI: 75%, 98%), 93% (95% CI: 92%, 94%) and 87% (95% CI: 82%, 92%), respectively. Substantial differences in study characteristics were found to hinder effective direct comparison of findings. Evidence for the effect of prognostic factors on tooth survival was weak. Based on the data available for meta-analyses, four conditions were found to significantly improve tooth survival. In descending order of influence, the conditions increasing observed proportion of survival were as follows: (i) a crown restoration after RCTx; (ii) tooth having both mesial and distal proximal contacts; (iii) tooth not functioning as an abutment for removable or fixed prosthesis; and (iv) tooth type or specifically non-molar teeth. Statistical heterogeneity was substantial in some cases but its source could not be investigated because of insufficient available information. CONCLUSIONS: The pooled proportion of teeth surviving over 2-10 years following RCTx ranged between 86% and 93%. Four factors (listed above) were identified as significant prognostic factors with concurrence between all three strands of evidence.

A methodology to study the effects of prosthesis misfit over time: an in vivo model.

PURPOSE: Passive fit of implant-supported superstructures cannot currently be achieved. The aim of this investigation was to create a methodology that can be used to study the effects of prosthesis misfit in humans. MATERIALS AND METHODS: An edentulous patient received two interforaminal implants and a screw-retained bar for the retention of the mandibular denture. A corresponding in vitro model with strain gauges placed mesially and distally, adjacent to the implants, was fabricated to serve as a standardizing control. Over a period of 6 months, a total of 10 measurements on both the in vitro model and in the patient's mouth were conducted with newly fixed strain gauges on the bar. RESULTS: The in vitro experiments showed that no component wear at the abutment-bar interface had occurred and that repositioning of the strain gauges on the bar caused deviations in strain measurements up to 10.55%. In vivo, a reduction in strain development, from 445 to 383 Mum/m, was observed in the initial phase up to 12 weeks after bar insertion. Subsequently, the measurement values increased, and after a period of 24 weeks, they nearly reached the initial strain level (443 microm/m). Only minor changes in strain development of the bar could be detected; these might be a result of limited dynamic loading and the cortical architecture of the surrounding bone. Deviations in measurement accuracy caused by repositioning of the bar strain gauge are a limitation of this technique and should be eliminated in future studies. CONCLUSIONS: The present methodology can be applied to study changes in static implant loading over time in humans.

Changes in patient and FDP profiles following the introduction of osseointegrated implant dentistry in a prosthodontic practice.

PURPOSE: This paper describes the effects of implant-related dentistry on patient profiles and the types of fixed dental prostheses provided in clinical practice. MATERIALS AND METHODS: All implant- and tooth-supported prostheses provided in a prosthodontic practice between 1984 and 2007 were tabulated. Incidence was analyzed in relation to gender, age at time of prostheses insertion, and prostheses type. RESULTS: Tooth-supported single crowns (TSCs) and tooth-supported fixed dental prostheses (TFDPs) were involved in 97% of treatments requiring fixed dental prostheses from 1984 to 1991. From 1991 to 2007, however, a marked increase in the number of implants restored directly corresponded with a decrease in the number of TFDPs so that by 2007, implant-supported fixed dental prostheses (IFDPs) accounted for 81% of all tooth replacements. Between 1984 and 2007 the incidence of TFDPs was 61% in females and 39% in males, whereas the incidence of IFDPs was 55% in females and 45% in males. IFDPs were also involved in 35% of restorations in patients under 31 years of age and TFDPs in 19%. In the under-21 years age group, IFDPs were more common in females (9%) than males (4%), but in the 21 to 30 years age group they were more common in males (21%) than females (13%). There was a decrease in three-unit TFDPs, in TFDPs with four or more pontics and those not satisfying Ante's Law, and in teeth used that had been subjectively assessed to have an unfavorable 10-year prognosis at the time of prosthesis insertion. CONCLUSIONS: The incorporation of osseointegrated implant dentistry into a clinical practice has resulted in changes in the patient profile and type of fixed dental prostheses provided, including a decrease in the use of TFDPs; an increase in the referral of patients under 31 years of age; a decrease in three-unit, long-span, and complex TFDPs; and a decrease in tooth abutments assessed to be structurally or biologically compromised.

Marginal bone loss at implants: a retrospective, long-term follow-up of turned Brånemark System implants.

BACKGROUND: Lately, presence of progressive bone loss around oral implants has been discussed. PURPOSE: The aim of this study was to report in a large patient group with different prosthetic restorations marginal bone level and its change as measured in radiographs obtained from prosthesis insertion up to a maximum 20 years in service. Further, it also aimed to study the impact of gender, age, jaw, prosthetic restoration, and calendar year of surgery. MATERIALS AND METHODS: Out of 1,716 patients recorded for clinical examination during 1999, 1,346 patients (78.4%) could be identified. A total of 640 patients (3,462 originally installed Brånemark System implants, Nobel Biocare, Göteborg, Sweden) with a follow-up of >or=5 years were included in the study, while patients with continuous overdentures and augmentation procedures were not. Distance between the fixture/abutment junction (FAJ) and the marginal bone level was recorded. RESULTS: The number of implants with a mean bone level of >or=3 mm below FAJ increased from 2.8% at prosthesis insertion to 5.6% at year 1, and 10.8% after 5 years. Corresponding values after 10, 15, and 20 years were 15.2, 17.2, and 23.5%, respectively. Implant-based bone loss was as a mean 0.8 mm (SD 0.8) after 5 years, followed by only minor average changes. Mean bone loss on patient level followed a similar pattern. Disregarding follow-up time, altogether 183 implants (107 patients) showed a bone loss >or=3 mm from prosthesis insertion to last examination. Significantly larger bone loss was found the older the patient was at surgery and for lower jaw implants. CONCLUSIONS: Marginal bone support at Brånemark implants was with few exceptions stable over years.