Pain after mandibular ramus block harvesting and lateral ridge augmentation with and without involvement of platelet-rich fibrin: a randomized controlled trial.

The purpose of this study was to evaluate pain after mandibular ramus block harvesting and lateral ridge augmentation. Autogenous bone block grafts were covered with platelet-rich fibrin (PRF) membranes (test group) or deproteinized bovine bone and a resorbable collagen membrane (control group). This study included 27 partially edentulous patients (test = 14, control = 13) with an indication for bone block augmentation before staged implant placement. Postoperative methylprednisolone (32 mg, day 1) and analgesics comprising ibuprofen (400 mg, four times daily) and paracetamol (1 g, four times daily) were prescribed for 1 week. Pain was recorded by the patient on a 100-mm visual analogue scale (VAS), hourly on the day of surgery and daily for the following 7 days. The average (mean ± standard deviation) maximum pain score over the whole observation period was similar in the test (13.6 ± 13.5) and control (21.0 ± 19.9) groups (P = 0.17). In conclusion, harvesting of a mandibular ramus block and lateral ridge augmentation, in conjunction with the pharmacological protocol described, is characterized by low postoperative pain. Adding PRF membranes to the surgical site generally resulted in slightly lower pain perception, although a statistically significant difference between the test and control groups was only identified on day 1 postoperative.

Short implants (≤8mm) compared to standard length implants (>8mm) in conjunction with maxillary sinus floor augmentation: a systematic review and meta-analysis.

The objective was to test the hypothesis of no difference in the treatment outcome after the installation of short implants (≤8mm) in the posterior part of the maxilla compared to standard length implants (>8mm) in conjunction with maxillary sinus floor augmentation (MSFA) using the lateral window technique, after an observation period of ≥3years. A search of the MEDLINE, Embase, and Cochrane Library databases, in combination with a hand-search of relevant journals, was conducted. The search yielded 1102 titles. Finally, three studies that fulfilled the inclusion criteria were included. All were considered to have a low risk of bias. Meta-analyses revealed no significant differences in implant survival or peri-implant marginal bone loss between the two treatment modalities. However, the use of standard length implants in conjunction with MSFA was characterized by a tendency towards more peri-implant marginal bone loss. There was no statistically significant difference between the two treatment modalities with regard to overall patient satisfaction. Short implants seem to be a suitable alternative to standard length implants in conjunction with MSFA. However, further randomized controlled trials with larger patient samples and an observation period of more than 3years are needed before one treatment modality might be considered superior to the other.

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.

Timing of implant placement relative to tooth extraction.

In recent years, immediate or early implant placement after tooth extraction has becoming more common. The present review focuses on the clinical outcome of immediate or early implant placement. Only limited knowledge exists about most of the factors with particular significance for this treatment mode. Randomized controlled clinical studies comparing the various treatment protocols are scarce. With the background in the existing literature some conclusions can be drawn with caution. Survival rates for implants placed immediately, early, delayed, or late seem to be similar in the short perspective and amounts to approximately 95%. Successful immediate implant placement may be possible in all regions of the jaws, although replacement of molars is more challenging. Chronic infection is not an absolute contraindication for immediate implant placement. It is controversial whether immediate placement of implants may preserve the alveolar bone. Small gaps between implant surface and socket wall have a potential for spontaneous healing. No consensus exists on the need for bone augmentation in these situations. With the limited information available it may be stated that a good prognosis can be obtained following immediate/early functional or non-functional loading of immediately placed implants. However, higher risk of failures seems to exist compared with a delayed, conventional approach. It is advocated that this treatment modality should be restricted to skilled well-trained teams. Data on the aesthetic outcomes following immediate/early implant placement are inconclusive, but this treatment can offer high patient satisfaction with the aesthetic and functional outcomes.

A 5-year clinical study of indirect and direct resin composite and ceramic inlays.

OBJECTIVE: The aim of this investigation was to evaluate the clinical performance of 4 types of tooth-colored inlays. METHOD AND MATERIALS: Fifteen direct ceramic inlays (Cerec Cos 2.0), 15 direct resin composite inlays (Brilliant Direct Inlay), 14 indirect ceramic inlays (Vita Dur N), and 14 indirect resin composite inlays (Estilux) were made in 37 patients, according to the manufacturers' instructions. The inlays were evaluated 1 week (baseline) and 6, 12, 36, 48, and 60 months after cementation (modified CDA Quality Evaluation System). RESULTS: Two Vita Dur N inlays fractured after 1 and 4 years in function, and one Cerec inlay fractured after 4.5 years. Two Brilliant DI inlays needed replacement because of secondary caries (after 1 and 5 years), and one inlay (Estilux) needed replacement due to persisting hypersensitivity. Three inlays (1 Estilux and 2 Brilliant DI) were repaired due to chipping or minor fractures. During the observation period, the surface texture of Brilliant DI and Vita Dur N inlays became significantly rougher. After 5 years, the Estilux inlays had significantly lower ratings for morphology compared to baseline ratings. In general, the occlusal marginal adaptation did not show further disintegration of the luting cement after 1 year. CONCLUSION: Eighty-eight percent of the inlays were in function after 5 years. No significant differences were revealed among the survival rates of the different types of inlays.

Outcome of treatment with implant-retained dental prostheses in patients with Sjögren syndrome.

The purpose of this investigation was to evaluate the outcome of treatment with implant-retained prostheses in patients suffering from Sjögren syndrome. Eight women were included in the study; all had suffered oral symptoms of Sjögren syndrome for many years. Seven patients were edentulous in both arches, and 1 patient was edentulous in the maxilla only. All patients reported poor or very poor comfort levels with their conventional dentures. It was the intention to treat each arch that showed subjective and objective denture problems with a complete fixed prosthesis after placement of 6 implants. In all, 54 Brånemark dental implants were placed in these patients. No implants were lost, but 7 implants in 4 patients were clinically not osseointegrated at the time of the abutment connection procedure. Because of nonosseointegrated implants and lack of jawbone, 3 arches were treated with an implant-retained overdenture. Fixed prostheses were made with a titanium framework of premachined components welded together (Procera) and acrylic resin teeth and flanges. Patients answered a questionnaire regarding their oral function before the onset of treatment and 1 month and 2 years after treatment. An average radiographic bone loss of 0.7 mm from the time of implant placement to 1 year after treatment was observed; additional bone loss of less than 0.6 mm was recorded 4 years after treatment. During the first year of function 2 implants lost osseointegration. No prostheses were lost or remade. Treatment with implant-retained prostheses considerably increased the prosthetic comfort and function of the patients. Two years after prosthetic treatment, only 1 patient indicated poor comfort of the prostheses, while the remaining patients reported good or very good comfort levels.

The influence of post length and crown ferrule length on the resistance to cyclic loading of bovine teeth with prefabricated titanium posts.

PURPOSE: The purpose of this in vitro study was to evaluate the influence of post and ferrule length on the resistance to cyclic (fatigue) loading of teeth with prefabricated titanium posts (ParaPost) and crowns. MATERIALS AND METHODS: Ninety bovine teeth with similar dimensions were mounted in acrylic blocks with artificial silicone periodontal ligaments. Combinations of post lengths of 5 mm, 7.5 mm, and 10 mm, and ferrule lengths (i.e., the vertical dentinal overlap of the crown) of 0 mm, 1.25 mm, and 2.5 mm made up 9 different groups consisting of 10 teeth each. The posts were cemented with zinc phosphate cement. Composite-resin cores were made and crowns were cemented. Each test specimen underwent cyclic loading of 400 N with a frequency of 1 load per second at an angulation of 45 degrees to the long axis of the tooth. RESULTS: All but 2 specimens failed with a root fracture; in the remaining 2 specimens the core lost retention. A large variation in the results between the various groups was observed. A nonparametric 2-way analysis for groups with a natural order revealed that the fracture resistance to cyclic loading increased statistically significantly with increasing ferrule length (P < 0.01), whereas increasing post length did not increase fracture resistance (P = 0.44). CONCLUSION: Ferrule length was more important than post length in increasing fracture resistance to cyclic loading of crowned teeth.

A 3-year study of inlays milled from machinable ceramic blocks representing 2 different inlay systems.

OBJECTIVE: The aim of this study was to evaluate the clinical performance of ceramic inlays made from machinable ceramic blocks. METHOD AND MATERIALS: The 2 inlay systems involved computer-aided design and computer-aided machining (Cerec Cos 2.1) or copy-milling technique (Celay). The study comprised 15 Celay inlays and 15 Cerec inlays placed in 17 patients. The inlays were evaluated clinically at baseline (1 week) as well as 1 and 3 years later (modified California Dental Association quality evaluation system). RESULTS: One Celay inlay fractured after 1 year of service, and 2 Cerec inlays were replaced, 1 after 6 months and 1 after 1 year, because of pulpal pain and persisting hypersensitivity. One Celay inlay lost retention after 2 years. At the 3-year evaluation, chipping and hairline cracks were seen in 2 Celay inlays. Progressive disintegration of the marginal luting cement was seen for both Celay and Cerec inlays. The remaining 25 inlays performed satisfactorily throughout the 3-year period. CONCLUSION: Because of their relatively high failure rate, these inlays should be reserved for esthetic indications.

Mobility assessment with the Periotest system in relation to histologic findings of oral implants.

The relationship between mobility assessment with the Periotest system and histologic findings was evaluated for oral implants. Five screw-type implants of pure titanium were placed in the mandibles of four monkeys. Two implants in each monkey were occlusally overloaded. These implants were brushed once a week. Plaque was allowed to accumulate around unloaded implants with abutments in the same monkeys. During the experiment, six of eight implants with occlusal overload showed increased manually detectable mobility. Two of these were lost. After 18 months of experimentation, the mobility was assessed using the Periotest system. Sections of the implants and surrounding tissue were cut. For the excessive occlusally loaded implants with manually detectable mobility, positive Periotest values were recorded, and for all other implants the values were negative (range = -7 to -2). All implants with plaque accumulation were histologically osseointegrated but showed marginal bone loss. Two of the implants with occlusal overload had lost osseointegration completely, and two other implants were osseointegrated in the apical part only. A statistically significant association between the Periotest values and the histologic bone level or the proportion of bone-implant contact was observed. If only clinically stable implants (i.e., without manually detectable mobility or with a negative Periotest value) were included in the analysis, no significant correlation was found. The Periotest values revealed only slightly more information concerning the osseointegration of implants than manual mobility assessments.

Clinical probing and radiographic assessment in relation to the histologic bone level at oral implants in monkeys.

Clinical probing level and radiographic bone level were compared to histologic bone level around screw type oral implants in 4 monkeys (Macaca Fascicularis). Two implants in each monkey retained a fixed partial prosthesis in supra-occlusal contact with an antagonizing splint. These implants were brushed 1 x a week and subgingival cleaning was performed 1 x a month. Unloaded implants in the same monkeys were never cleaned and, additionally, a cotton cord was placed around these to promote plaque accumulation. After 18 months, intraoral radiographs of the implants were obtained and probing levels were recorded with a metal probe using a standardized force of 0.2 N (Vivacare TPS Probe) and again using a moderate, unstandardized pressure. Immediately afterwards the animals were sacrificed. Sections, approximately 50 microns thick, of the implants and surrounding tissue were cut. The average probing levels with unstandardized pressure were 1.1 mm and 3.9 mm coronal to the histologic bone levels for implants with plaque accumulation or excessive occlusal load, respectively. With standardized probing force, the difference between the probing levels and histologic bone levels were even larger. The radiographic bone levels were on average only 0.5 mm and 0.1 mm short of the histologic bone levels for the two groups of implants. Only the radiographic bone level revealed a statistically significant correlation with the histologic assessment.

Histological evaluation of peri-implant bone at implants subjected to occlusal overload or plaque accumulation.

Breakdown of bone around oral implants following occlusal overload or plaque accumulation was evaluated in monkeys. 5 screw-type implants of pure titanium (Astra Tech) were inserted in the mandible of 4 monkeys (Macaca Fascicularis). 6 months after insertion of the implants a fixed partial prosthesis was mounted on the 2 implants in 1 of the lateral segments. The prosthesis was in supra-occlusal contact with an antagonizing splint and caused a lateral directed excessive occlusal load (overload). Implants retaining the prosthesis were brushed 1 x week and subgingival cleaning was performed 1 x month. The remaining implants were never cleaned and, additionally, a cotton cord was placed around the abutments of these implants to promote plaque accumulation. 6 out of 8 implants with occlusal overload became loose. 2 of these were lost, whereas the remaining 4 were retained in the jaws. After 18 months of occlusal load or plaque accumulation, the monkeys were sacrificed. Tissue blocks with the implants were infiltrated and embedded in acrylic resin. Approximately 50 microns thick sections of the implants and surrounding tissues were made. All implants with plaque accumulation were osseointegrated, but exhibited an average histologic marginal bone loss of 2.4 mm (range: 0.8-4.0 mm). Of the 6 implants with occlusal overload available for histologic analysis, 2 implants in 1 monkey had lost osseointegration completely and 2 other implants were osseointegrated in the apical part only, whereas the remaining 2 were still osseointegrated but exhibited a bone loss of 1.8-1.9 mm.

Tensile bond strength of resin luting cement to a porcelain-fusing noble alloy.

This study evaluated the tensile bond strength of resin composites to a noble alloy for ceramic bonding after various surface treatments. The flat end of bars cast in the alloy were used as test specimens. Eighteen clinically relevant combinations of luting agent, airborne particle abrasion, and surface treatment were applied. After surface treatment, two bars were bonded together. Resin cement, either dual-polymerizing (Twinlook) or chemically polymerizing (Panavia EX, Panavia 21, or RBBC), was used as a luting agent. The specimens were subjected to 1,000 thermal cycles between 15 degrees C and 60 degrees C before tensile bond strength testing. The highest median bond strengths were obtained using the Silicoater MD method/Twinlook (20.6 to 26.1 MPa) or with tin-plating/ Panavia EX (24.0 MPa), but more low values were recorded among the latter specimens. Tin-plating/Panavia 21 gave median tensile bond strengths (18.1 MPa) similar to tin-plating/Panavia EX. The Silicoater MD method resulted in similar bond strengths with or without the addition of a layer of Opaquer. The traditional Silicoater method (8.0 to 12.4 MPa) gave significantly lower median tensile bond strength values, and the lost sugar crystals method resulted in a tensile bond strength of 15.4 MPa.

Loss of osseointegration caused by occlusal load of oral implants. A clinical and radiographic study in monkeys.

The breakdown of bone around oral implants following excessive occlusal load or plaque accumulation was evaluated in monkeys. 5 screw type implants of pure titanium (Astra) were inserted in the mandible of 4 monkeys (Macaca Fascicularis). 2 implants were placed in each of the lateral segments and 1 in the frontal area. Each monkey was provided with 2 cemented splints covering the premolars and molars in the right and left side of the maxilla, respectively. 6 months after insertion of the fixtures, a fixed partial prosthesis was mounted on the 2 implants in one of the lateral segments. The prosthesis was in supra-occlusal contact with the antagonizing splint. Each prosthesis was replaced during the course of the experiment. The renewed prosthesis caused a lateral displacement of the mandible during occlusion, and therefore resulted in a lateral rather than axial excessive occlusal load. Implants retaining the prosthesis were brushed 1 x a week and subgingival cleaning was performed 1 x a month. The remaining implants were never cleaned and, additionally, a cotton cord was placed passively around each of these to promote plaque accumulation. 5 out of 8 implants with excessive occlusal load lost osseointegration (mobility and peri-implant radiolucency). The loss of osseointegration was observed 4.5 months to 15.5 months after the occlusal overload was commenced. None of the implants with plaque accumulation lost osseointegration, although an average loss of 1.8 mm in the radiographic bone level was assessed after 18 months.

Intermittent loading of teeth restored using prefabricated carbon fiber posts.

This in vivo study evaluated the fracture resistance of bovine teeth with prefabricated carbon fiber posts. Fourteen bovine teeth having similar lengths and dimensions were mounted in an acrylic resin block having a simulated periodontal ligament. The post space was prepared using two calibrated drills that provided an 8.5-mm post length. The prefabricated carbon fiber post was luted with a resin luting agent, and the core was made using the system's autopolymerizing resin core material. A crown was luted to each prepared tooth. Each test specimen was intermittently loaded (250 N) at an angulation of 45 degrees to the long axis of the tooth at a frequency of 2 loads per second. Four of the roots had an incomplete longitudinal fracture after loading. The results of this study were compared to a previous study by the authors that had been conducted under similar conditions with prefabricated parallel-sided posts (Para-Post) and tapered, individually cast posts. The failure rates of the two types of posts from the previous study were significantly higher (Logrank test; P<.02) than those of the carbon fiber posts.

Resin-bonded inlay retainer prostheses for posterior teeth. A 5-year clinical study.

This study evaluated posterior resin-bonded prostheses using inlays as retainers. Thirty-nine patients missing at least one premolar or first molar received 51 resin-bonded fixed partial dentures with high noble alloy inlay retainers and a metal ceramic pontic. Resin luting material bonding to the framework was secured by the Silicoating method (24 fixed partial dentures), lost sugar crystal method (13 fixed partial dentures), or tin plating (14 fixed partial dentures). Clinical examinations were performed 1 week, 1 month, 6 months, 1 year, 2 years, and 5 years after cementation. None of the fixed partial dentures with silicoating or sugar crystal impressions lost retention, whereas two of the tin-plated fixed partial dentures required replacement. Resin-bonded inlay-retained prostheses appear to be a favorable alternative to other types of fixed partial dentures.

Tensile bond strength of resin luting cement to glass infiltrated porous aluminium oxide cores (In-Ceram).

The effect of various methods of surface treatment of glass infiltrated aluminium oxide (In-Ceram) on tensile bond strength was evaluated. Test specimens were formed as bars. After surface treatment of the flat ends, two bars were bonded together with either a dual curing resin (Twinlook) or a chemical curing resin with a phosphate monomer (Panavia Ex). After cementation the specimens were stored in humid conditions for 1 week and then thermocycled 1,000 times between 15 degrees C and 60 degrees C. The highest median tensile bond strengths were obtained with the Silicoater MD-method without the Opaquer and Twinlook as luting agent (23.9 MPa) or with sandblasting with 250 micrometers Al2O3 particles and Panavia Ex as luting agent (22.0 MPa).

A clinical evaluation of porcelain inlays.

Sparse data are available concerning the survival rate of porcelain inlays or onlays to inform the dentist and address the expectations of patients. A total of 25 posterior porcelain inlays were inserted by two dentists at a private Danish clinic; the time elapsed since cementation was 20 to 57 months (average 40.4 months). Tooth preparations for MOD porcelain inlays were completed for 13 premolars and 12 molars but most did not include cuspal coverage. All inlays were constructed at the same commercial dental laboratory and according to the manufacturer's recommendations; they were etched and treated with silane before they were cemented. The cementation included etching of cavosurface enamel and treatment of the dentin with a dentinal bonding system. A thin layer of composite resin luting agent was applied to the tooth preparation before the porcelain inlays were cemented. The first 10 porcelain inlays were cemented with a light-curing composite resin cement and the remaining 11 with a dual-curing composite resin cement. Twelve of the 25 porcelain inlays failed and were replaced during the observation period. Ten failures were due to a fracture of the inlay, one was caused by secondary caries, and the final failure was attributed to a marginal gap between the inlay and proximal tooth surface. Porcelain inlays cemented with light-curing composite resin exhibited more failures (p = 0.05) than those cemented with dual-curing composite resin. In addition, more failures (p = 0.07) were recorded among inlays inserted in molars than among those in premolars.

Tensile bond strength of two ceramic and three resin composite inlay materials placed using a resin luting agent.

The tensile bond strength of inlay materials to dentin was evaluated. Five materials, two direct resin composite inlay products, one hybrid resin composite, a preformed ceramic block, and a conventional porcelain material were bonded to bovine dentin and bonded together using a dual-polymerizing resin luting agent. Specimens were tested with and without thermocycling. Some bar-to-bar bonding groups fractured through the bar. Significantly higher (P < .05) bar-to-bar bonds were recorded than the bar-dentin bonds, irrespective of the inlay materials. VitaDur N showed the lowest bar-to-bar failure values (7.6 MPa) compared to the four other inlay materials (14.4 MPa to 22.2 MPa), but had the highest dentin bond strength (4.5 MPa). Unexpectedly, thermal loading increased the bond strength to bovine dentin, although this was only statistically significant for VitaDur N. The dentin bond strength of Charisma (1.4 MPa) was inferior (P < .02) to all other materials (2.6 MPa to 4.5 MPa) when thermocycled before testing.

Comparison of marginal fit and microleakage of ceramic and composite inlays: an in vitro study.

The purpose of this in vitro study was to evaluate the marginal fit and microleakage of four types of ceramic or resin composite inlays. Sixty extracted human third molar teeth were randomly assigned into four groups. MOD cavities without bevels were prepared. The mesiogingival margin was cut in enamel, whereas the distogingival margin was placed below the amelocemental junction. The preparations and inlays were made according to the manufacturers' instructions. After acid-etching and treatment with a dentine bonding agent the inlays were cemented with dual curing CEREC resin composite luting material. After placement and polishing 10 teeth of each group were thermocycled 2500 times between 14 degrees C and 62 degrees C. Each tooth was bisectioned and from each part, one occlusal and three proximal sections of 75-100 microns thickness were cut and ground (EXAKT Cutting and Grinding system). The marginal discrepancy and the thickness of the luting cement were measured microscopically at each section and an average for each tooth was calculated. Considerable variation of marginal fit was seen, within inlays, and among different types of inlays. In general, the Vita Dur N inlays showed the best fit, e.g. the thickness of the luting cement for Vita Dur N was 114 microns occlusally and 119 microns mesiogingivally compared to 199 microns occlusally for CEREC and 219 microns mesiogingivally for Estilux. At enamel margins, a tendency of less microleakage was seen for ceramic inlays compared to composite inlays.

A one-year clinical study of indirect and direct composite and ceramic inlays.

The aim of this study was to evaluate the clinical performance of four types of tooth-colored inlays. The systems included 15 direct ceramic inlays (CEREC Vita-Blocks), 15 direct composite inlays (Brilliant D.I., Coltène), 14 indirect ceramic inlays (Vita Dur N), and 14 indirect composite inlays (Estilux) in 37 patients. The inlays were evaluated clinically 1 wk (base line) and 6 and 12 months after cementation. The clinical assessments were supported by bitewing radiographs. One Vita Dur N inlay fractured after 1 yr of service, and one Brilliant D.I. inlay had to be replaced because of secondary caries. No apparent increase in plaque accumulation or gingival inflammation could be related to treatment with inlays. At base line and throughout the observation period, the Vita Dur N inlays received the highest ratings for morphology and color match. The Brilliant D.I. inlays showed the smoothest surface texture, whereas the Estilux inlays showed the roughest texture. After 6-12 months of observation, all types of inlays showed varying degrees of disintegration of the composite luting cement. Within the observation period, all inlay systems appeared to be clinically acceptable.