Assessment of Peri-Implant Soft Tissues Conditions around Short and Ultra-Short Implant-Supported Single Crowns: A 3-Year Retrospective Study on Periodontally Healthy Patients and Patients with a History of Periodontal Disease.

The aim of this retrospective study was to evaluate implant survival, marginal bone loss and peri-implant complications in 326 short and ultra-short implants. Implants were placed in the maxillary and mandibular posterior regions of 140 patients with (PP) and without (NPP) a history of periodontal disease. Clinical and radiographic examinations were performed at 3-year recall appointments. The 8.0, 6.0 and 5.0 mm-length implants placed in PP and NPP were respectively 43.75% and 38.46%, 35.10% and 34.19%, 21.15% and 27.35%; 325 implants (one early failure) were rehabilitated with single crowns in 139 patients. Overall implant survival after 3 years of follow-up was 97.55%, 98.08% and 96.61% for PP and NPP (p = 0.46). Crestal bone level variations were not statistically different among PP and NPP; 15.41% of implants presented signs of mucositis, 14.71% and 16.67% in PP and NPP (p = 0.64). Setting the threshold for bone loss at 2 mm after 36 months, peri-implantitis prevalence was 2.2%, 1.96% and 2.63% in PP and NPP (p = 0.7). Overall implant success was 82.39%, 83.33% and 80.7% for PP and NPP (p = 0.55). Short-term outcomes suggest that short and ultra-short locking-taper implants can successfully be restored with single crowns in the posterior jaws both in PP and NPP.

The effect of single tooth implant restorations on the survival, morbidity, pulpal, and periapical health of adjacent teeth: A chart review.

PURPOSE: To determine whether the placement and restoration of a single tooth posterior implant affects the survival, morbidity, pulpal, and periapical health of adjacent natural teeth. MATERIALS AND METHODS: A retrospective chart review identified patients who received single posterior tooth implants between August 2004 and July 2015 at the UNC SOD and met the study inclusion criteria. Preoperative and postoperative records were reviewed; survival and changes in coronal, pulpal, and periapical status of teeth adjacent to the implant and contralateral tooth were recorded. Dichotomous survival, restoration, and retreatment outcomes were analyzed using conditional logistic regression with patient as strata and implant versus control as the predictor. Exact odds ratio estimates and the 95% confidence intervals were obtained for the relationship of implant versus control side and outcomes. RESULTS: Five hundred and fifty-five sites with follow-up time averaging 5 years ± 30.8 months were reviewed. Teeth adjacent to implants had 1.75 (95% CI: 1.17, 2.64) times the odds of restorative retreatments as compared to controls (P = .005). On the implant side, 48 adjacent teeth (4.5%) were more heavily restored at follow up, while 84 (7.9%) experienced retreatment with comparable number of surfaces restored. On the contralateral side, 54 adjacent teeth (5.0%) were more heavily restored, and 56 (5.2%) experienced comparable levels of retreatment. In addition, 17 (1.7%) implant adjacent teeth required root canal treatment, compared to 12 (1.2%) on the contralateral side; 1 implant adjacent tooth required root canal retreatment. Forty-two teeth (3.8%) adjacent to implants were lost, compared to 35 (3.2%) adjacent to natural teeth. CONCLUSIONS: The incidence for restorative retreatment was significantly higher on teeth adjacent to implant restorations as compared to the contralateral controls. There were no significant differences in the survival, morbidity, pulpal, or periapical health of teeth adjacent to single tooth implants compared to those adjacent to the contralateral natural tooth.

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.

Aesthetic perception of single implants placed in the anterior zone. A cross-sectional study

BACKGROUND: Several aesthetic indexes have been described to assess implant aesthetics. The aim of this study was to compare the aesthetic assessment made by dental professionals and students of single-tooth implants placed in the upper incisors. MATERIAL AND METHODS: A cross-sectional survey study using a subjective questionnaire to assess the aesthetics in 3 implant supported single-tooth cases in the anterior maxilla was performed. The interviewed subjects were divided into 4 groups: dentists with experience in implant treatment, dentists without experience in implants and 3rd and 5th year dental students. The questionnaire consisted of 2 visual analogue scales (VAS) to evaluate aesthetics, the pink esthetic score (PES), the white esthetic score (WES) and the simplified papilla index (PI). RESULTS: One-hundred dentists and one-hundred dental students filled the aesthetic assessment questionnaire. The results showed that the subjects were more critical than reference values, specially concerning prosthetic issues. The differences between groups were more obvious in the case with the best result. On the other hand, few differences were detected in the remaining cases. Regarding soft tissue and crown features, experienced dentists in implant dentistry were the most demanding. Cronbach's Alpha showed values ≥ 0,8 in the questionnaire in every case, which indicates an adequate reliability. CONCLUSIONS: Dentists and dental students have different opinions when assessing aesthetics of single tooth implant supported cases. Experience and area of expertise seem to influence the evaluation of aesthetics in the anterior region

Oral health-related quality of life and implant therapy: A prospective multicenter study of preoperative, intermediate, and posttreatment assessment.

PURPOSE: Loss of teeth is associated with a significant reduction in quality of life. The aim of this prospective multicenter study was to assess the impact of dental implants on oral health-related quality of life (OHRQoL). MATERIAL AND METHODS: Patients with various kinds of indications for dental implants ranging from single-tooth loss to edentulous jaws were included. Quality of life related to dental implants was assessed through the Oral Health Impact Profile (OHIP-G 21), which has a score from 0 to 20 in healthy patients. RESULTS: In total, 8689 patients from 17 centers from 2009 to 2014 were enrolled in the study. The sex distribution was almost even (53.3% men, 46.7% women). The most frequent indications for the insertion of dental implants were free-end gaps (30.6%) and posterior single-tooth gaps (27%). In all, 12.4% of patients had an edentulous jaw. For all indications, patients reported significant changes in mean OHIP scores after prosthetic reconstruction. The most significant improvements in the OHIP score occurred in the groups of patients with edentulous jaws (pretreatment score: 42.3) after prosthodontic reconstruction (score: 24.8) and in the patient group with an anterior single-tooth gap (pretreatment score: 36.4) after prosthodontic reconstruction (score: 24.8). CONCLUSION: The insertion of dental implants and prosthodontic rehabilitation led to an improved OHRQoL for patients with all indications for dental implants, with the most significant improvements in patients with edentulous jaws and anterior single-tooth gaps.

Effectiveness of Implant Therapy Analyzed in a Swedish Population: Prevalence of Peri-implantitis.

Peri-implantitis is an inflammatory disease affecting soft and hard tissues surrounding dental implants. As the global number of individuals that undergo restorative therapy through dental implants increases, peri-implantitis is considered as a major and growing problem in dentistry. A randomly selected sample of 588 patients who all had received implant-supported therapy 9 y earlier was clinically and radiographically examined. Prevalence of peri-implantitis was assessed and risk indicators were identified by multilevel regression analysis. Forty-five percent of all patients presented with peri-implantitis (bleeding on probing/suppuration and bone loss >0.5 mm). Moderate/severe peri-implantitis (bleeding on probing/suppuration and bone loss >2 mm) was diagnosed in 14.5%. Patients with periodontitis and with ≥4 implants, as well as implants of certain brands and prosthetic therapy delivered by general practitioners, exhibited higher odds ratios for moderate/severe peri-implantitis. Similarly, higher odds ratios were identified for implants installed in the mandible and with crown restoration margins positioned ≤1.5 mm from the crestal bone at baseline. It is suggested that peri-implantitis is a common condition and that several patient- and implant-related factors influence the risk for moderate/severe peri-implantitis (ClinicalTrials.gov NCT01825772).

An Up-to-15-Year Comparison of the Survival and Complication Burden of Three-Unit Tooth-Supported Fixed Dental Prostheses and Implant-Supported Single Crowns.

PURPOSE: To assess and compare the outcomes and economic complication burden of three-unit tooth-supported fixed dental prostheses (TFDPs) and implant-supported single crowns (ISCs) provided to a sequential cohort in a specialist prosthodontic practice over a 15-year period. MATERIALS AND METHODS: Sequential patients requiring replacement of a single missing tooth between 1996 and 2010 with a metal-ceramic three-unit TFDP (n = 145 patients, n = 174 prostheses) or ISC (n = 174 patients, n = 220 prostheses) were included. Prostheses subjectively judged at insertion to have an unfavorable 10-year prognosis (17 TFDPs, 0 ISCs) were removed from statistical analyses. The estimated cumulative survival (ECS) was calculated with the life table actuarial method and standard errors calculated with the Greenwood formula. Differences in outcomes between all prostheses and those replacing only anterior or only posterior teeth were assessed with the log rank test. Complication incidence, severity, and economic burden, measured in time/cost accounting units (TAUs), were tallied and compared descriptively. RESULTS: The 15-year ECS did not differ for 112 TFDPs (92.75% ± 3.28%) and 81 ISCs (95.95% ± 2.92%) replacing posterior teeth. However, the 15-year ECS was significantly greater for 139 ISCs (93.33% ± 6.44%) than for 45 TFDPs (82.82% ± 6.50%) replacing anterior teeth. The economic burden of nonterminal complications for both prostheses was low (mean = 0.3 and 0.2 TAUs per prosthesis for TFDPs and ISCs, respectively). This equated to 3 TAUs/100 years in clinical service and 4 TAUs/100 years in clinical service for the TFDPs and ISCs, respectively. CONCLUSION: The survival of three-unit TFDPs and ISCs over 15 years was not statistically different when replacing posterior teeth, but ISCs survived significantly better when replacing anterior teeth. The complication rates of the TFDPs and ISCs were similar, but the economic burden for the TFDPs was greater.

Interdisciplinary index of prosthodontic/substitution orthodontic treatment need for patients with missing teeth.

The need for treatment in cases of missing teeth may result from aesthetic demands or functional impairment, although tooth loss itself does not necessarily constitute a need for prosthetic replacement. In selected cases, restorative treatment can be replaced by tooth autotransplantation or substitution orthodontic treatment. The authors have tried to make an index based not on missing particular teeth, but on the presence of spacing requiring restoration. An attempt has been made to categorize the restorative treatment need. Orthodontic treatment was considered, when it could completely eliminate the need for prosthetic treatment. The proposed classification could be used for assessing eligibility for public refund of restorative or substitution orthodontic treatment, as well as to motivate the patients to have restorations. It should be an individual approach-based decision, which treatment: orthodontic substitution tooth movement or prosthodontic is more cost-effective for the rest of the patient's life.

Survival rates and complication types for single implants provided at the Melbourne Dental School.

BACKGROUND: Single implants and implant-supported single crowns (ISSCs) have become popular treatment modalities for single tooth replacement. Studies have identified high implant survival rates, but also many complications. The aim of this five-year retrospective study was to assess the survival rates, complication types and occurrences for single implants and ISSCs at the Melbourne Dental School (MDS) in Victoria, Australia. METHODS: A search of the Royal Dental Hospital of Melbourne (RDHM) database was conducted for data on all implant treatment and reported complications during the period between 1 January 2005 and 31 December 2009. Complications were categorized into surgical, biological and restorative types. RESULTS: A total of 622 implant fixtures and 444 ISSCs were inserted into 406 patients. Seventeen implants failed during the mean follow-up time of 2.18 years, yielding a 2.7% failure rate and an estimated one- and five-year survival rate of 98.8% and 93.9%, respectively. The cumulative surgical, biological and restorative complication incidences were 11.9%, 17.6% and 14.1%, respectively. CONCLUSIONS: This study confirmed that single tooth replacement using implant therapy within a teaching environment had a high survival rate. However, complications frequently occurred. This article only provides a descriptive analysis. Correlation analysis between variables would provide greater insight into the causes of complications.

The effect of age, gender, and insertion site on marginal bone loss around endosseous implants: results from a 3-year trial with premium implant system.

OBJECTIVES: The goal of this study was to evaluate bone changes around endosseous implants in partially edentulous patients. MATERIALS AND METHODS: A total of 632 two-stage implants were placed in 252 patients. The implants had straight emergence profile, ZirTi surface, 3.3 to 5 mm diameter, and 8.5 to 13 mm length. Bone levels were assessed on orthopantomography immediately after surgery and after 36 months and marginal bone loss (MBL) was calculated from their difference. RESULTS: Cumulative survival rate was 98.73%. Overall MBL was 0.8 mm ± 0.03 (mean ± SEM). Higher MBL was observed around implants in the maxilla than in the mandible (P < 0.007). A relation between implant diameter and MBL (P < 0.0001) was observed in male and, more limitedly, female patients. Older patients had higher MBL in the maxilla, but not in the mandible (P < 0.0001). MBL progressively increased with age in male patients, but reached a peak already in the 50-60 years age group in the female subset (P < 0.001). CONCLUSIONS: The overall MBL is consistent with the available literature. Site difference and patient age and gender appear to significantly affect MBL, representing important factors to be considered during implant placement.

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.

Improvements in implant dentistry over the last decade: comparison of survival and complication rates in older and newer publications.

PURPOSE: The objective of this systematic review was to assess and compare the survival and complication rates of implant-supported prostheses reported in studies published in the year 2000 and before, to those reported in studies published after the year 2000. MATERIALS AND METHODS: Three electronic searches complemented by manual searching were conducted to identify 139 prospective and retrospective studies on implant-supported prostheses. The included studies were divided in two groups: a group of 31 older studies published in the year 2000 or before, and a group of 108 newer studies published after the year 2000. Survival and complication rates were calculated using Poisson regression models, and multivariable robust Poisson regression was used to formally compare the outcomes of older and newer studies. RESULTS: The 5-year survival rate of implant-supported prostheses was significantly increased in newer studies compared with older studies. The overall survival rate increased from 93.5% to 97.1%. The survival rate for cemented prostheses increased from 95.2% to 97.9%; for screw-retained reconstruction, from 77.6% to 96.8%; for implant-supported single crowns, from 92.6% to 97.2%; and for implant-supported fixed dental prostheses (FDPs), from 93.5% to 96.4%. The incidence of esthetic complications decreased in more recent studies compared with older ones, but the incidence of biologic complications was similar. The results for technical complications were inconsistent. There was a significant reduction in abutment or screw loosening by implant-supported FDPs. On the other hand, the total number of technical complications and the incidence of fracture of the veneering material was significantly increased in the newer studies. To explain the increased rate of complications, minor complications are probably reported in more detail in the newer publications. CONCLUSIONS: The results of the present systematic review demonstrated a positive learning curve in implant dentistry, represented in higher survival rates and lower complication rates reported in more recent clinical studies. The incidence of esthetic, biologic, and technical complications, however, is still high. Hence, it is important to identify these complications and their etiology to make implant treatment even more predictable in the future.

Assessment of short dental implants restored with single-unit nonsplinted restorations.

OBJECTIVES: To investigate the survival rate of short (≤9 mm) implants restored with single-unit, nonsplinted crowns after an average follow-up of 37 months (21-94 months). MATERIALS AND METHODS: Two hundred and twenty-one implants placed in 168 patients (74 men, 94 women, aged 34-87 years, mean = 61 years). Implant lengths were 6 (n = 16), 8 (n = 166), 8.5 (n = 2), or 9 mm (n = 34). The implant diameters ranged from 3.7 to 5.6 mm. Implants were placed in the maxillary (n = 44) and mandibular arches (n = 176). RESULTS: Survival rate was 94.1% (maxilla [88.6%] and mandible [96.0%]) and 12 early failures (first 4 months) and 1 late failure (4.5 years in the maxillary molar region) observed. Of the 12 early failures, 4 were in the maxilla (2 premolars and 2 molars) and 8 in the mandible (2 premolars and 6 molars). The early failures were 11 implants of 8 mm long and a 9-mm implant. Smoking cigarettes, diabetes mellitus, and bone augmentation procedures were not associated with implant failure significantly (P > 0.05). CONCLUSIONS: Survival rate of short implants restored with single-unit, nonsplinted restorations over an average period of 37 months was favorable and comparable with longer implants.

One-year results of a clinical and radiological prospective multicenter study on NEOSS® dental implants.

BACKGROUND: NEOSS® (Neoss Ltd., Harrogate, UK) dental implant system was introduced on the clinical arena in 2003. It is important that novel implant systems are systematically evaluated in a multicenter setting. PURPOSE: The aim of this study was to follow a large number of consecutively treated patients, with NEOSS dental implant system, both clinically and radiographically. The current report constitutes the 1-year data of a planned 5-year study. MATERIALS AND METHODS: The study included a total of 177 patients treated with 590 NEOSS implants at 13 clinics in Sweden. The material was composed of 72 males and 105 females treated for single, partial, and total edentulism. Clinical, radiographic, and subjective evaluations were performed. RESULTS: Out of 590 implants, 13 early failures have been reported, corresponding to a 1-year cumulative survival rate (CSR) of 97.8%. Evaluation of function and esthetics at the 1-year visit resulted in 100% success for function and 98% success for the esthetic outcome. The mean marginal bone loss was 0.6 mm (SD 1.1) after 1 year in clinical function. No adverse effects of the NEOSS dental implants were reported, and complications were few and similar to those reported for implant treatment in general. CONCLUSION: The CSR in the present study was 97.8%. No adverse effects of the NEOSS implants were reported, and complications during the study period were few and similar to those reported to for other well-documented implants system. Based on the present data, we conclude that NEOSS dental implant is a safe and predictable implant system. However, the high number of dropouts in the radiological evaluation must be considered when interpreting the data.

An analysis of the decision-making process for single implant treatment in general practice.

PURPOSE: To study the frequency of and factors associated with the decision to perform single implant treatment after tooth extraction by general practitioners in a private, fee-for-service setting. MATERIAL AND METHODS: One hundred practitioners with a general dental practice in Ghent were randomly selected. Clinicians were asked to fill in a study form for every single extraction they performed during an 8-week period. The form related to the treatment decision and a number of patient- and clinician-related factors. RESULTS: Ninety-four general dentists (52 men, 42 women; mean age 49; range 24-68) agreed to participate and extracted 1180 single teeth. After exclusion of third molars and cases where the reason for tooth loss would generally prohibit replacement, 900 cases were identified. In 24% of these patients, there was no treatment decision and in 18% replacement was deemed unnecessary. When replacement was necessary (n = 526), removable partial denture (RPD), fixed partial denture (FPD), single implant treatment and resin-bonded bridge were chosen in 54%, 24%, 21% and 1% of the patients, respectively. Multinomial logistic regression was used to evaluate the decision-making process for single implant treatment against RPD and FPD. In relation to RPD, single implant treatment was more likely in highly educated patients with few missing teeth and no bone loss at adjacent teeth. In relation to FPD, single implant treatment was more likely in patients with intact adjacent teeth and when the tooth was extracted by a female dentist. Experience in implant prosthetics was positively associated with single implant treatment in all analyses. CONCLUSIONS: Single implant treatment is not the most common procedure in daily practice to restore a single tooth gap. Patient's education, oral factors and clinician-related factors may affect the decision-making process, whereas medical factors may not.

Dental dilemmas: Endodontics or dental implants?

UNLABELLED: This narrative review explores treatment planning options in restorative dentistry. The growth of dental implants, as an accessible and predictable treatment option, gives practitioners a useful tool for managing the missing tooth or teeth with a hopeless prognosis. Traditionally, endodontics and fixed prosthodontics have been used to restore teeth and spaces where the outlook for such treatment appears reasonable. Practitioners may, however, question the predictability and cost effectiveness of such an approach where, at times, it might appear that replacement of a compromised tooth with a dental implant could be a more predictable option. The evidence base for these treatment options is explored and discussed, and suggestions are made for future management strategies. CLINICAL RELEVANCE: A clear knowledge and understanding of the scientific literature for implants and endodontic treatment is necessary if practitioners are to make an evidence-based approach when treatment planning these modalities for their patients. This is particularly true in cases where there may appear to be a reasonable choice between the two of these.

Success rate of immediate implants placed and restored by novice operators.

AIMS: The primary aim of this study was to evaluate the 1-year crestal bone loss and success rate of an immediately placed single-stage implant placed and restored by novice operators. A secondary aim was to determine the patient's assessment of the appearance of the final restoration. METHODS: Fifty-one patients received a tooth extraction and placement of at least 1 immediate implant by a Graduate Periodontics resident. Clinical and radiographic measurements were taken at the surgical, 4-month, and 1-year follow-up visits. After at least 3 months healing, dental students restored the implants with either a crown or an overdenture. Patient satisfaction was assessed using 5 categories: excellent, very good, good, fair, or poor. RESULTS: Sixty-two immediate implants were placed. The success rate was 100% at the 12-month visit and was subclassified as grade 3 because of the mean first year bone loss of 1.3 +/- 1.0 mm. Using the 2008 classification of Misch et al, 42 implants were classified as success optimum health, 19 as survival satisfactory health, and 1 as survival compromised health. Radiographic bone loss was stratified by implant platform position relative to the alveolar crest and changed from time 0 to time 12 by -1.0 +/- 1.2 mm for the supracrestal group (n = 25, P < 0.05), -1.5 +/- 0.9 mm for the crestal group (n = 31, P < 0.05), and -1.3 +/- 1.2 mm for the subcrestal group (n = 6, P < 0.05). The supracrestal group had significantly less bone loss than either the crestal or the subcrestal group (P < 0.05). The appearance of the final restoration at 1 year was rated excellent by 82% of patients, very good by 16%, and good by 2%. CONCLUSIONS: Immediate implant placement by novice operators using routine dental school procedures was a highly predictable procedure as indicated by the 100% success rate at 12 months. Most patients rated the restoration appearance as excellent.