Implants and/or teeth: consensus statements and recommendations.

In August 23-25, 2007, the Scandinavian Society for Prosthetic Dentistry in collaboration with the Danish Society of Oral Implantology arranged a consensus conference on the topic 'Implants and/or teeth'. It was preceded by a workshop in which eight focused questions were raised and answered in eight review articles using a systematic approach. Twenty-eight academicians and clinicians discussed the eight review papers with the purpose to reach consensus on questions relevant for the topic. At the conference the consensus statements were presented as well as lectures based on the review articles. In this article the methods used at the consensus workshop are briefly described followed by the statements with comments.

When should we extract deciduous teeth and place implants in young individuals with tooth agenesis?

The aim was to systematically review and find evidence to determine when to extract deciduous teeth and place implants in young individuals with tooth agenesis. A search was made in MEDLINE on combinations of the terms 'tooth agenesis', 'deciduous teeth' and 'dental implants'. Publications with an abstract and written in the English language only were included. To give a background to the clinical management of young individuals with agenesis of teeth, publications on epidemiology of tooth agenesis, persistence of deciduous teeth, treatment outcomes after multi-disciplinary treatment planning and experiences of treatment with dental implants in young individuals were also reviewed. A search on the terms 'tooth agenesis', 'deciduous teeth' and 'dental implants' resulted in nine references and a search on 'dental implants' and 'tooth agenesis' gave 132 references; 46 met the inclusion criteria. Only two were prospective studies on treatment with implants in young individuals. A vast majority of publications on the clinical management of young individuals with tooth agenesis are reflections of clinical experiences and single case reports. Deciduous teeth are extracted for different reasons and at different ages in an optimal plan for a good treatment result from aesthetic and functional point of view. For ethical reasons, randomized clinical trials on when to extract deciduous teeth and place implants cannot be made in young individuals. There was only limited, low level evidence on when to extract deciduous teeth and place implants. Recommendations on treatment are based mainly on clinical experience.

The management of ectodermal dysplasia and severe hypodontia. International conference statements.

An international conference on ectodermal dysplasias and hypodontia, held in London in 2004, featured a session devoted to the management of the ectodermal dysplasias and severe hypodontia. This paper presents a set of statements prepared by an international specialist panel, including representatives of patient support groups, who presented and subsequently debated a series of papers on this subject. The following topics were explored: potential roles of patient support groups; core care standards, including the roles and composition of medical and dental multidisciplinary teams for treating these conditions; the format of a baseline data set for patients with an ED; and priorities for research in ectodermal dysplasias, with particular regard to laboratory and clinical studies, and research methodology. The statements are intended to form an international framework for developing patient care pathways, and collaborative research in this field.

Signs and symptoms from ectodermal organs in young Swedish individuals with oligodontia.

OBJECTIVES: The aim was to assess signs and symptoms from other ectodermal organs in addition to teeth in young individuals with oligodontia and to establish the prevalence of oligodontia. SAMPLE AND METHODS: Children born 1981-94 reported by dental teams in the Public Dental Service to have oligodontia were asked to participate in a clinical study. The examinations comprised a structured interview on symptoms from ectodermal organs, and testing of salivary secretion. RESULTS: One hundred and sixty-two individuals met the inclusion criteria, and 123 individuals (75.9%) participated in the clinical study. Half of the individuals had one to four signs or symptoms from ectodermal organs beside oligodontia. The most common sign was low salivary secretion. Twelve individuals (9.6%) with isolated oligodontia reported impaired function of the sweat glands, hair, or nails. The prevalence of oligodontia was 0.090%. CONCLUSIONS: An early identification of individuals with oligodontia can be made in a majority of cases by checking that all permanent incisors have erupted at the age of 8 years. The validity in asking individuals about normal and abnormal function of ectodermal organs was found to be low. This indicates that there is a strong need to establish routine clinical criteria for dysplasia of ectodermal organs.

Prosthetic habilitation of a young patient with hypohidrotic ectodermal dysplasia and oligodontia: a case report of 20 years of treatment.

PURPOSE: The aim of this article is to describe the oral habilitation, over a period of 20 years, of a young patient with hypohidrotic ectodermal dysplasia and agenesis of 15 permanent teeth. MATERIALS AND METHODS: Different clinical interventions were adapted to suit the patient's dental and psychologic stage of development. The prosthodontic treatment, which took place at different ages, comprised several treatment modalities: composite-retained onlay fixed partial dentures, a removable partial denture, tooth-supported and implant-supported fixed partial dentures, and laminate crown therapy. RESULTS: The different phases of treatment were successful, and the patient is satisfied from a functional as well as a psychosocial point of view. CONCLUSION: Extensive prosthodontic treatment in growing individuals should preferably be performed with a multidisciplinary team approach. In treatment that is planned and performed over long periods, this approach has the advantages of continuity and shared responsibility for therapy decisions.

The role of prosthodontists in habilitation and rehabilitation in rare disorders: the ectodermal dysplasia experience.

PURPOSE: The aim of this article is to highlight the strong worldwide trend of enhancing the opportunities for individuals with rare disorders to get adequate information and treatment. Hypohidrotic ectodermal dysplasia is used as an example. MATERIALS AND METHODS: The development in recent years of databases for rare disorders, the establishment of resource centers in dentistry, and the strong movement of user influence by the formation of patient organizations and exchange of information through the Internet are described. Reference is made to the recent Scandinavian consensus conference on ectodermal dysplasia. RESULTS: Motives for the centralization of treatment planning to resource centers for persons with rare disorders, the compilation of treatment outcomes in databases, and the advocation of a multidisciplinary team approach in dentistry are presented. CONCLUSION: The prosthodontic profession has a key position in the habilitation and rehabilitation of many different diagnoses of rare disorders.

Fixed prosthodontics in adults in Jönköping, Sweden in 1983 and 1993. An epidemiological study of prevalence and choice of material.

The aim of the study was to assess the prevalence of fixed prostheses, i.e. single crowns and fixed partial dentures, in adults 20-80 years old in two cross-sectional studies carried out in 1983 and 1993 and to analyse whether the choice of material for fixed prostheses had changed during this time period. The material comprised 586 and 593 individuals. A descriptive analysis of number of individuals with fixed prostheses was made concerning the number of crowns and pontics, the distribution in the jaws, and the materials used. The prevalence of individuals with fixed prostheses was shown to increase with age both in 1983 and 1993. In 1993 the number of individuals with fixed prostheses was slightly lower than in 1983 (44 and 48 percent respectively). There was no difference according to gender. The proportion of individuals with fixed prostheses was lower or almost unchanged in the 20-, 30-, 40-, 50-, 60-, and 80-year-olds in 1993 compared to 1983. In the 70-year-olds, however, the proportion of individuals with fixed prostheses was considerably higher in 1993 compared to 1983. Most individuals with fixed prostheses had a small number of crowned teeth, and about half of the individuals had not more than four crowned teeth. Likewise most individuals with pontics had a small number of pontics. The distributions of crowned teeth and pontics in the jaws were similar in 1983 and 1993. Pontics and crowns were more frequent in the upper than in the lower jaw. Crowns made of porcelain or metal ceramic had increased by 1993 in the 30-80 year age groups, and the study thus confirms general clinical experience that porcelain and metal ceramic are more often the materials of choice in fixed prosthodontics in adults today.

Laser-welded titanium frameworks for implant-supported fixed prostheses: a 5-year report.

The 5-year results from a multicenter study of implant-supported, laser-welded titanium frameworks are reported here as a complement to earlier reported 2-year results. Implant survival rates were satisfactory for patients with titanium frameworks and for a control group of patients with gold-alloy frameworks. At the 5-year review, more patients with titanium frameworks had lost implants than the patients with gold-alloy frameworks, but this difference was not statistically significant. More fractures of the titanium frameworks occurred, compared to the gold-alloy frameworks; again, this difference was not statistically significant. No significant differences in marginal bone levels were found between the 2 groups of patients. Slightly more fractures of artificial teeth occurred in patients with titanium frameworks than in patients with gold-alloy frameworks. Overall results for the titanium frameworks after 5 years in function are encouraging.

Laser-welded titanium frameworks supported by implants in the edentulous maxilla: a 2-year prospective multicenter study.

PURPOSE: The aim of this study was to evaluate the clinical and radiographic performance of patients who received implants and fixed prostheses with laser-welded titanium frameworks. MATERIALS AND METHODS: Fifty-eight consecutive patients were treated with 349 osseointegrated implants ad modum Brånemark in the edentulous maxilla at 6 implant centers. The patients were randomly arranged into 2 groups at the time of final impression. Twenty-eight patients received laser-welded titanium frameworks and 30 patients received conventional cast frameworks. Clinical and radiographic data were collected for 2 years in function. RESULTS: The 2 groups of patients showed similar results. The 2-year overall cumulative implant survival rate from the time of implant placement and prosthesis insertion was 93.7% and 96.2%, respectively. The corresponding cumulative survival rate for prostheses was 96.6%. Two patients, 1 from each group, failed completely and resumed using conventional complete dentures. The only obvious factor that could possibly be related to the 2 complete failures was a smoking habit. However, it was not possible to significantly correlate implant failures to smoking habits in this study. No fractures were observed in the frameworks or implant components, and both groups experienced the same frequency of resin veneering material fractures. The overall average marginal bone loss was 0.4 mm (SD 0.8 mm). CONCLUSION: Patients treated with implant-supported prostheses fabricated with laser-welded titanium frameworks in the edentulous maxilla presented comparable results to patients with conventional cast frameworks after 2 years in function.

A multidisciplinary approach to oral rehabilitation with osseointegrated implants in children and adolescents with multiple aplasia.

Oral rehabilitation of children with extensive aplasia includes a number of dental considerations as well as attention to psychological and physical development. The well-documented results of the use of implants in adults have raised the question of the use of implants and the timing of this procedure in children and adolescents with multiple aplasia. Eight-years' experience of a multidisciplinary approach to oral rehabilitation of children with extensive aplasia is described. Special emphasis is placed on early diagnosis, careful therapy planning, and co-ordination and timing of different parts of the therapy. The specific considerations from the point of view of paediatric dentists, orthodontists, oral surgeons, and prosthodontists are presented. A system for integrating all these aspects and knowledge will be a guarantee for high professional standards and a successful outcome. To exemplify the multidisciplinary approach, three treated cases are presented.

Laser-welded titanium frameworks for fixed prostheses supported by osseointegrated implants: a 2-year multicenter study report.

Nineteen prosthodontic clinics participated in a prospective study of fixed prostheses supported by osseointegrated implants (FPOIs) with laser-welded titanium frameworks. Ninety-three patients with 100 FPOIs were included and followed for 2 years. The results from this group were compared to another group that was examined retrospectively. In the retrospective group (control group), 91 patients received 96 FPOIs with cast frameworks, and these patients were treated shortly before the patients in the titanium-framework group (test group). The two groups were treated at the same centers. The results for both groups were good, with only 1.2% of loaded implants lost during the follow-up period (1.6% in the titanium-framework group; 0.7% in the control group). One framework in each group fractured. However, in complete maxillary cases, there were significantly more subjects in the titanium-framework group who were affected by implant losses compared to the control group. There was also a tendency towards more fractures of artificial teeth and acrylic resin in the titanium-framework group, compared to the control group. A possible explanation might be that dental technicians at the different centers were not used to the design of the titanium frameworks when the study began. Thus, the results from the first 2 years are promising, but further studies are needed to establish the long-term serviceability of laser-welded titanium frameworks.

The relative importance of tooth loss and denture wearing in Swedish adults.

Having natural teeth is a matter of varying importance according to the priorities given to dental health status, compliance with recommendations and demand for dental care. The aim of this study was to assess the relative adjustment needed when one or more teeth are lost and when dentures are provided compared with other life events. The study was conducted as a mailed questionnaire to a sample of 311 20-70 year old subjects in the community of Jönköping. Seventy-five per cent of the sample, with a mean age of 43.2 years, responded. The Social Readjustment Rating Questionnaire, comprising 46 life events, was supplemented with two events concerning tooth loss and denture-wearing. The answers were given on a graphic rating scale with end points 'not difficult at all' and 'more difficult than anything' and coded by values 0 to 20. After calculation of mean values, the questions were rank ordered; the item with the highest mean was given the highest rank. 'Losing one or more teeth' was ranked 28.5 (means = 10.7) and 'getting dentures' 33 (means = 12.0) of the 48 life events investigated. This suggests that a majority of respondents perceived losing teeth and being provided with dentures as more important in terms of adjustment than events such as 'marriage', 'retirement' and 'changing work'. No significant differences in relation to age and sex were found.

Dietary pattern and dental caries in 19-year-old adolescents subjected to preventive measures focused on oral hygiene and/or fluorides.

Dietary habits and dental caries were analysed in 95 19-year-old Swedish adolescents who had been subjected to different preventive measures during their late teens. A 24-hour recall was used and showed that the intakes of milk and milk products, meat, fish and eggs accorded with recommended norms but not those of vegetables, fruits and berries, and potatoes and root vegetables. Only 6% of the subjects had eaten the recommended three principal meals during the day tested. At the end of the trial, only weak or moderate correlations were found between snacks, including sucrose snacks, and selected clinical variables. Subjects who did not develop new carious lesions during the experimental 2 years had fewer risk factors, defined as the most negative values (quartile limit) for sucrose snack consumption, tooth cleaning score, lactobacillus count, saliva secretion rate and saliva buffer capacity, than those who developed one or more new lesions. During the experimental period, with an overall low caries incidence, no single factor tested for presumed risk was found to be the discriminating factor for occurrence of dental caries.

Composite retained onlay bridges. A follow-up study in adolescents.

A follow-up study of composite retained onlay bridges inserted to replace permanent anterior teeth in adolescents was performed. The material comprised 100 bridges and the dominating reasons for replacement of teeth were aplasia and trauma. Clinical controls were performed every six months and the mean observation time was 34 months. (Range 11-59 months). Seventyone bridges were functioning without complications during the observation period. Dislodgement occurred in 29 bridges on 54 different occasions. Dislodgement was seen more frequently in boys. The dominating reason for dislodgement was new trauma during sports activities or fights, which occurred more frequently in patients with trauma as the original reason for replacement of teeth. Owing to the tooth-preserving potential and reversibility, it is considered a valuable method of replacing missing anterior teeth in young individuals. Further investigations should concentrate on technical development aimed at achieving optimum retention and on clinical evaluation over longer periods.

Dental prophylaxis for youths in their late teens. II. Knowledge about dental health and diseases and the relation to dental health behavior.

A study of the knowledge about dental health and diseases of youths in their late teens has been conducted. A 10-class questionnaire relating to dental caries and gingivitis/periodontitis was answered by three test groups (A, B, C) totalling seventy-eight 19-year-olds who, during a 3-year period, had undergone professional prophylaxis at different intervals. Nineteen young people of the same age without organized preventive measures since their last attendance at the public dental service constituted a control group (D). The test groups were found to have a significantly better knowledge of factors relating to gingivitis/periodontitis than the control group. In questions relating to caries there were no differences among the groups. Higher points were scored in knowledge of therapy and prevention than of the causes and symptoms of the dental diseases. Several regularly repeated sessions for professional prophylaxis did not lead to better knowledge than only a few. No consistent correlation was found for any of the groups between knowledge and both quantitative tooth cleaning, i.e. type and frequency of use of oral hygiene aids, and qualitative tooth cleaning, expressed as the occurrence of plaque and gingivitis. Nor were significant differences found in these respects between individuals with and without a caries increment during the observation period regardless of grouping.