Crestal Sinus Augmentation with Recombinant Human Bone Morphogenetic Protein 2: Clinical and Radiographic Outcomes of 2-Year Pilot Trial.

PURPOSE: Recombinant human bone morphogenetic protein 2 (rhBMP-2) together with an absorbable collagen carrier (ACS) was approved for augmentation of the maxillary sinus prior to implant placement. The original registration trial was based on a lateral window approach. Clinical outcomes of crestal sinus augmentation with rhBMP-2 have not been reported so far. MATERIALS AND METHODS: An uncontrolled pilot trial in which seven patients with a residual maxillary height below 5 mm were enrolled to receive crestal sinus augmentation with rhBMP-2/ACS was conducted. Elevation of the sinus mucosa was performed by gel pressure. Primary endpoints were the gain in augmentation height and volume measured by computed tomography after 6 months. Evaluation of bone quality at the time of implant placement was based on histology. Secondary endpoints were the clinical and radiologic evaluation of the implants and patient satisfaction by visual analog scale (VAS) at the 2-year follow-up. RESULTS: Median gain in augmentation height was 7.2 mm (range 0.0 to 17.5 mm). Five patients gained at least 5 mm of bone height. Two patients with a perforation of the sinus mucosa failed to respond to rhBMP-2/ACS and underwent lateral window augmentation. The median gain in augmentation volume of the five patients was 781.3 mm³ (range 426.9 to 1,242.8 mm³). Biopsy specimens showed a cancellous network consisting of primary plexiform bone with little secondary lamellar bone. After 2 years, implants were in function with no signs of inflammation or peri-implant bone loss. Patients were satisfied with the esthetic outcomes and chewing function. CONCLUSION: This pilot clinical trial supports the original concept that rhBMP-2/ACS supports bone formation, also in crestal sinus augmentation, and emphasizes the relevance of the integrity of the sinus mucosa to predict the bone gain.

Patient information on treatment alternatives for missing single teeth - Systematic review.

AIM: This study systematically evaluates existing evidence-based literature covering the topic of patient information about different treatment alternatives for missing single teeth, in order to summarise current evidence. MATERIAL AND METHODS: Three scientific databases - Pubmed, OvidSP and Scopus - were searched for publications up to July 2015, relating to patient information on treatment options for missing single teeth. References of publications and the google scholar database were screened additionally leading to a total of 183 journal articles written in English. Following the selection criteria, 33 articles were included. Twenty-nine questionnaire- based publications were compared by descriptive analysis of six key parameters - awareness of treatment options, source of information, knowledge, attitude to treatment, preference of treatment option and reason for refusal. RESULTS: Included studies consisted of data from 23,702 responding participants and which were performed in 16 countries. Mean values and standard deviations revealed variations between and within countries. The level of awareness and attitude to treatment in most countries is acceptable. Insufficient knowledge as well as a high demand for knowledge was found. Clinicians are the most important source of information followed by media, family and friends. Dental Implants and FPDs were preferred and high costs would be the major reason for refusal. CONCLUSION: Clinicians play an important role in improving awareness and knowledge of patients about treatment alternatives. Non-uniform study designs could lead to variations in results. This systematic review can be considered in further studies, in order to standardise methods using key parameters and a representative study population.

Patients' perspectives on dental implant and bone graft surgery: questionnaire-based interview survey.

PURPOSE: To assess up-to-date expectations and preferences of patients seeking dental implants. MATERIAL AND METHODS: One hundred and fifty consecutive patients (66 male and 84 female interviewees) were asked to rank their concerns regarding implant therapy and answer a questionnaire on implant and bone graft surgery, cost and time considerations and second-opinion behaviour. RESULTS: Treatment predictability and avoidance of removable dentures were ranked high priority (compared with time and cost efficiency or avoidance of bone grafts). Patients' estimation of the 10-year implant success rate was 84%, and 59% of patients expected implants to last for a lifetime. Total treatment time was estimated to be 4 months on average, and only 12% would tolerate increased risk of implant failure for the sake of shortening treatment duration. 61% of interviewees accepted autologous bone grafts (the majority favouring the retromolar area), while only 23% were willing to undergo bone harvesting from the hip. 43% opted for bone substitute material to avoid donor site morbidity. 67% would accept the additional costs associated with computed tomography, software-based treatment planning and guided implant placement to avoid bone graft surgery. Motivation for second-opinion seeking was high (46-62%), especially in young and male patients. CONCLUSION: Patient expectations on implant success and predictability are high compared with their reluctance towards treatment costs and duration. Acceptance of treatment morbidity is high among patients reporting low denture satisfaction; however, minimally invasive treatment alternatives are generally preferred.

Esthetic evaluation of single-tooth implants in the anterior mandible.

OBJECTIVES: Single-tooth replacement of anterior mandibular teeth is frequently complicated by insufficient bucco-lingual bone width and limited mesio-distal space available for implant placement. The aim of the present study was to assess implant esthetics in the partially edentulous anterior mandible. MATERIAL AND METHODS: Esthetic evaluation of 43 anterior mandibular single-tooth implants in 15 women and 28 men was performed using esthetic indices (PES = Pink Esthetic Score, PI = Papilla Index, SES = Subjective Esthetic Score) as well as subjective patients' Visual Analogue Scale (VAS) ratings. Clinical and radiological parameters (implant and crown dimensions, pocket depth, bleeding on probing, plaque, keratinized mucosa, marginal bone level, and distance to adjacent teeth) were tested for influence. RESULTS: Implant esthetics were judged satisfactory (PES ≤10) in 42% of implants compared with a patient satisfaction rate of 87%. Correlation between objective indices (PES/PI: rs  = 0.62, PES/SES: rs  = -0.73, PI/SES: rs  = -0.48) was highly significant (P ≤ 0.001); however, no association to subjective patients' ratings could be observed. Type of prosthetic restoration (single crown vs. tulip-shaped double crowns), mesio-distal crown width as well as anatomic crown length significantly affected esthetic scores. Patients' judgment, by contrast, could not be associated to any prognostic factor. CONCLUSION: Subjective patient satisfaction with implant esthetics in the partially edentulous anterior mandible is high, however, remains hard to predict or objectively quantify.

Relevance of variations in the opposing dentition for the functionality of fixed and removable partial dentures: a systematic review.

The aim of this systematic review was to evaluate the functionality of fixed and removable partial dentures as test interventions in relation to variations in the opposing dentition and their prosthetic restoration. The abstracts identified in the respective databases were screened independently by two investigators. RCTs and uncontrolled studies were considered, provided the patients were included consecutively and the confounding variables were adequately monitored. Seventeen papers were included. The study and publication quality was assessed using a "biometric quality" tool showing an overall poor quality. The reported outcomes, such as survival rates, were in each case obtained from a single study. Two possible trends could be deduced for the endpoint longevity: (a) the first trend in favor of removable partial dentures, compared to fixed partial dentures, with a fully edentulous opposing arch fitted with a removable prosthesis; (b) the second trend in favor of implant-supported partial dentures, compared to conventionally fixed partial dentures, with natural opposing dentition or with a removable partial denture in the opposing arch. No evidence could be generated as to whether, and if so how, variations in the opposing dentition have a bearing on the decision to fit a partially edentulous arch with a fixed or removable partial denture.

Auricular acupuncture effectively reduces state anxiety before dental treatment--a randomised controlled trial.

OBJECTIVES: The objective of this study was to analyse whether auricular acupuncture, acupuncture at the outer ear, could reduce state anxiety before dental treatment. METHODS: This prospective, randomised patient-blinded study with 182 patients compared anxiety before dental treatment following auricular acupuncture at the relaxation-, tranquillizer- and master cerebral points (auricular acupuncture group) versus acupuncture at sham points (finger-, shoulder- and tonsil points; sham group) and a non-intervention control group. Anxiety was assessed using the Spielberger State Trait Anxiety Inventory (German version) before auricular acupuncture and 20 min thereafter, immediately before dental treatment. RESULTS: Auricular acupuncture reduced state anxiety score more effectively from 54.7 ± 10.8 to 46.9 ± 10.4 (mean ± SD) than sham acupuncture from 51.9 ± 10.2 to 48.4 ± 10.0. In contrast, state anxiety in the control group increased from 51.0 ± 11.7 to 54.0 ± 11.6 (mean increase +3.0; CI +4.7 to +1.2). The decrease in state anxiety in both intervention groups was statistically significant (p < 0.001) when compared to the non-intervention control group. After correcting for group differences in baseline state anxiety, the reduction in anxiety was -7.3 score points (CI -9.0 to -5.6) in the auricular acupuncture group and -3.7 score points (CI -5.4 to -1.9) in the sham group (p = 0.008). CONCLUSION: Auricular acupuncture, a minimally invasive method, effectively reduces state anxiety before dental treatment. CLINICAL RELEVANCE: Auricular acupuncture could be an option for patients scheduled for dental treatment, who experience an uncomfortable degree of anxiety and request an acute intervention for their anxiety.

Impact of dental implant length on early failure rates: a meta-analysis of observational studies.

AIM: To test the null hypothesis of no difference in failure rates of short (minimum length: 7 mm) and longer dental implants (≥ 10 mm), a meta-analysis was performed on prospective observational trials. MATERIALS AND METHODS: A systematic electronic and hand search was performed to identify eligible studies. Having additional data supplied by the authors, 54 publications were included (19,083 implants). RESULTS: In case of mandibular implants, the null hypothesis of no impact of reduced implant length on failure within the first year of prosthetic loading could not be rejected. A significant impact of implant length could be substantiated for short machined implants in the anterior [odds ratio (OR) 5.4] and posterior maxilla (OR 3.4), while short rough-surfaced implants demonstrated increased failure rates in the anterior maxillary sites. No influence of implant diameter and denture type on the failure rate of short implants could be revealed. CONCLUSION: In areas of reduced alveolar bone height the use of short dental implants may reduce the need for invasive bone augmentation procedures.

Progress and trends in patients' mindset on dental implants. II: implant acceptance, patient-perceived costs and patient satisfaction.

OBJECTIVES: compared with widespread investigations on dental implant survival and biologic parameters, patient-based outcomes of implant dentistry have been neglected for years and are now becoming more popular. The aim of this representative opinion poll was to assess the up-to-date patients' mindset on dental implants and draw comparisons with the results published in 2003. MATERIAL AND METHODS: one thousand adults - representative for the Austrian population - were presented with a total of 16 questionnaire items regarding acceptance and subjectively perceived costs of dental implant treatment as well as patient satisfaction with implant-supported rehabilitation. RESULTS: the implant acceptance rate was 56%, while 23% of the interviewees decidedly rejected implant treatment (same rate as in 2003), especially those over 50 years of age. Only 5% had themselves undergone implant treatment and 22% reported to know someone fitted with implants. The estimated costs of implant treatment were significantly higher than those in 2003, and three-quarters felt that the prize was too high and that the sick fund or social security agencies should bear them. Satisfaction scores were significantly higher among interviewees wearing implant-supported rehabilitations compared with those with conventional fixed or removable dentures. CONCLUSIONS: little has changed in patients' attitude toward dental implants compared with the representative opinion poll in 2003. Neither implant acceptance nor implant prevalence in the Austrian population demonstrated upward trends. Professional public relations efforts are indicated to drop resentments and increase patient acceptance of dental implants as a treatment modality.

Progress and trends in patients' mindset on dental implants. I: level of information, sources of information and need for patient information.

OBJECTIVES: Little is known about the level of information on implant dentistry in the public. A representative opinion poll on dental implants in the Austrian population was published in 2003 (Clinical Oral Implants Research 14:621-642). Seven years later, the poll was rerun to assess the up-to-date information level and evaluate recent progress and trends in patients' mindset on dental implants. MATERIAL AND METHODS: One thousand adults--representative for the Austrian population--were presented with a total of 19 questionnaire items regarding the level and the sources of information about dental implants as well as the subjective and objective need for patient information. RESULTS: Compared with the survey of 2003, the subjective level of patient information about implant dentistry has significantly increased in the Austrian population. The patients' implant awareness rate was 79%. The objective level of general knowledge about dental implants was still all but satisfactory revealing unrealistic patient expectations. Three-quarters trusted their dentists for information about dental implants, while one-quarter turned to the media. The patients' wish for high-quality implant restorations was significantly higher than in 2003, yet the majority felt that only specialists should perform implant dentistry. CONCLUSIONS: This representative survey reveals that dentists are still the main source of patient information, but throws doubt on the quality of their public relations work. Dentists must improve communication strategies to provide their patients with comprehensible, legally tenable information on dental implants and bridge information gaps in the future.

New safety margins for chin bone harvesting based on the course of the mandibular incisive canal in CT.

OBJECTIVES: Altered pulp sensitivity of anterior lower teeth is a frequent finding following chin bone harvesting. Persistent loss of tooth sensitivity has been reported in up to 20% of the patients. The aim of this study was to evaluate current recommendations for the location of the harvest zone with respect to the course of the mandibular incisive canal (MIC), the intrabony continuation of the mandibular canal mesial to the mental foramen. MATERIAL AND METHODS: On computed tomographic (CT) scans of 50 dentate mandibles, the MIC was located and its distance to the root apices, to the labial bony surface, and to the inferior margin of the mandible was assessed. The risk of nerve injury and the percentage of patients suitable for chin bone grafting were calculated. RESULTS: Respecting current recommendations for chin bone grafting, the content of the MIC was endangered in 57% of the CTs. Therefore, new safety margins are suggested: the chin bone should be harvested at least 8 mm below the tooth apices with a maximum harvest depth of 4 mm. CONCLUSIONS: Applying the new safety recommendations and proper patient selection in chin bone harvesting could reduce the risk of altered postoperative tooth sensitivity due to injury of the mandibular incisive nerve.

A 5-year prospective multicenter study on 1-stage smooth-surface Brånemark System implants with early loading in edentulous mandibles.

PURPOSE: The purpose of the current prospective multicenter study was to evaluate the 5-year implant success and peri-implant conditions of smooth-surface Brånemark System implants when using a novel technique including a 1-stage surgical procedure with early loading in edentulous mandibles. MATERIALS AND METHODS: The study protocol included 1-stage surgery as well as placement of the definitive prosthesis within 6 weeks after implant insertion (ie, early loading). Clinical evaluation, as well as evaluation of function and esthetics, was performed at each follow-up visit. Radiographs were obtained at connection of the prostheses and at the 1, 3-, and 5-year check-ups. RESULTS: A total of 40 patients with a mean age of 56 years (range, 30 to 70) were included in the study. In all, 170 implants were placed in between the mental foramina, of which 120 implants in 30 patients were associated with overdenture treatment and 50 implants in 10 patients with fixed complete dentures. Twelve implants failed in 6 patients. The cumulative implant survival rate was 92.9% after both 1 and 5 years of follow-up. Another 3 implants were recorded as mobile but still in function when individually checked at the 5-year visit, which resulted in a cumulative success rate of 91.0%. Mean bone remodeling over the study period was less than 0.1 mm/y after the first year of loading, resulting in a mean marginal bone level of 0.66 mm (SD 0.73, n = 138) apical to the implant collar reference point after 5 years. CONCLUSIONS: One-stage, early loaded smooth-surface Brånemark System implants functioned well for the majority of patients with edentulous mandibles. Stable peri-implant conditions were observed. Bone remodeling resulted in a mean bone level above the first implant thread after 5 years. The somewhat lower success rate of 91.0% compared to a 2-stage procedure may be related to generous inclusion criteria and to a learning curve involving a novel treatment procedure.

Clinical study of horizontal alveolar distraction with modified micro bone screws and subsequent implant placement.

The aim of this study was to evaluate the clinical relevance of horizontal distraction osteogenesis (DO) with bone micro screws for reconstructing knife-edge alveolar crests before implant placement. Horizontal DO was performed in upper and lower alveolar crests of seven patients with resorption class IV according to Cawood and Howell. After osteotomy and a 1-week latency period, micro bone screws were reset daily for horizontal expansions by 0.5 mm. Dental implants were placed in the distracted area following a consolidation period of 12 weeks. Computer tomography was performed before DO and implant placement. Morphometric analysis showed a mean gain of 34.01 mm(2) (95% confidence interval [CI]: 10.55-57.48) in bone area and of 3.06 mm (95% CI: 1.81-4.31) in horizontal width, i.e. the horizontal dimension of the alveolus was approximately doubled within the first 5 mm of height. All 12 implants placed into the distracted area fulfilled the success criteria of stable osseointegration after 1 year of functional loading according to Albrektsson and colleagues. Despite the limited number of patients treated, data from the clinical study of horizontal DO with bone micro screws suggest that the generation of sufficient hard tissue in previously knife-edge alveolar crests for subsequent implant placement was possible.

Bony press-fit closure of oro-antral fistulas: a technique for pre-sinus lift repair and secondary closure.

PURPOSE: To evaluate the use of intra-oral bone grafts for closing chronic oro-antral fistulas (OAFs), for providing a sound basis for subsequent conventional sinus lifting and for preserving the teeth adjacent to OAFs. PATIENTS AND METHODS: Twenty-one patients with oro-antral fistulas of variable origin were treated with monocortical bone blocks harvested from the retromolar or interforaminal regions of the mandible. The preoperative treatment, the surgical procedure for both hard and soft tissue closure, and the postoperative management are reviewed in detail. RESULTS: Press-fit closure for repair of the bony sinus floor was sufficient in 17 patients. Four of them needed additional internal fixation. In all 21 patients adequate closure of the fistulas was obtained, although 3 patients (14.3%) developed wound dehiscences at the grafted sites, which healed by secondary intention. Meanwhile, 3 patients underwent successful sinus lifting. CONCLUSION: The use of monocortical bone grafts harvested at intra-oral donor sites is a safe and easy technique for repairing defects of the maxilla, especially OAFs in need of secondary closure. It provides a sound basis for subsequent conventional sinus lifting and preserves the teeth adjacent to OAFs.

Histologic and histomorphometric analysis of three types of dental implants following 18 months of occlusal loading: a preliminary study in baboons.

The purpose of this study was to determine the percentage of 'bone area' (BA) and 'bone-to-implant contact' (BIC) of dental implants with different designs and surface modifications after functional loading. Three types of dental implants with fixed partial dentures were placed in the posterior jaws of adult baboons (commercially pure titanium (CpTi) screws, grit-blasted acid-etched (GBAE) screws, and titanium plasma-sprayed (TPS) cylinders), three of the same design per quadrant. After 18 months of functional loading, all implants investigated were successfully integrated in the jawbone and histologic and histomorphometric analyses were carried out. Statistical evaluation was performed with a mixed model with data given as least-square means and standard errors of the mean (SEM). Histologically, direct BIC without connective tissue interposed between implant surfaces and peri-implant bone was seen. Analysis of BA within 1 mm around implants showed significant differences between CpTi (50.5%) and TPS (39.7%) (+/-2.72 SEM; P<0.01) in the maxilla. To account for the different implant designs, absolute BIC was calculated. Significant differences were found between CpTi (23.9 mm) and TPS (15.1 mm) and between GBAE (27.2 mm) and TPS (15.1 mm) (+/-1.05 SEM; P<0.01) in the maxilla and between GBAE (26.5 mm) and TPS (19.6 mm) (+/-1.42 SEM; P<0.01) in the mandible. Overall, the data indicate that, in the maxilla, screw-shaped implants showed more absolute BIC than cylindrical implants, which had less maxillary than mandibular absolute BIC after 18 months of functional loading.

The effect of platelet-rich plasma upon implant stability measured by resonance frequency analysis in the lower anterior mandibles.

Using a one-stage surgical protocol, a total of 34 Brånemark Mk-III Ti-Unite implants with a length of 13 mm and a diameter of 3.75 mm were inserted in 10 edentulous mandibles. Of these, seven patients received four and three patients two interforaminal implants. All implants were followed with repeated stability measurements by means of resonance frequency analysis at different time interval: 0, 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44 days. In quadrant III platelet-rich plasma (PRP) was instilled locally before implant placement, while no PRP was added in quadrant IV to serve as control group (split-mouth design). Results showed no statistically significant difference between the two groups. Nonetheless, both groups (PRP+control) showed a highly significant reduction of the implant stability quotient (P<0.001) between days 0 and 4. However, no difference was noted between the two groups after day 4, it may be concluded that the instillation of PRP during implant placement in the lower anterior mandible did not add additional benefit.

Alveolar ridge augmentation with a prototype trilayer membrane and various bone grafts: a histomorphometric study in baboons.

Barrier membranes have become a standard treatment option in alveolar ridge augmentation prior to implant placement. However, non-resorbable membranes require secondary surgery and resorbable membranes show an unfavorable degradation profile. The purpose of this study was to evaluate the potential of a slowly biodegradable/bioresorbable prototype trilayer membrane (PTLM) for supporting bone regeneration in alveolar ridge augmentation. Clinically relevant cavities were made 3 months after the extraction of the first and second molars in each jaw of six baboons. Each animal was treated with four different regimens: (1) autogenous bone block (ABB) alone, (2) ABB+PTLM, (3) deproteinized bovine bone mineral (DBBM)+PTLM and (4) no treatment. After 9 months, the baboons were sacrificed and block sections of the augmented area were subjected to histologic and histomorphometric analyses. Newly formed bone areas were determined at a distance of 1, 3, 7 and 10 mm from crestal. The data showed a well-preserved ridge profile at the membrane-protected sites, whereas non-protected bone blocks and control sites underwent severe resorption resulting in knife-edge ridge profiles. Significant differences were found between ABB+PTLM and ABB (P=0.0137-0.0232). DBBM+PTLM also produced a larger bone area compared with ABB alone (P=0.0396-0.0439). No significant difference in bone area was detectable between ABB+PTLM and DBBM+PTLM (P>0.05). The present study supports the use of the slowly biodegradable/bioresorbable PTLM with autografts and DBBM for lateral ridge augmentation in this type of bone defects.

Radiologic follow-up of peri-implant bone loss around machine-surfaced and rough-surfaced interforaminal implants in the mandible functionally loaded for 3 to 7 years.

PURPOSE: In this retrospective study, marginal peri-implant bone height around machined and sandblasted/acid-etched interforaminal implants in the mandible was evaluated radiologically at least 3 years after functional loading. MATERIALS AND METHODS: Fifty-one patients, each with 4 interforaminal screw-type implants placed between 1994 and 1998, were included in this study. Of these, 36 patients (70.6%) with a total of 144 implants (76 machined Mk II implants and 68 sandblasted/acidetched Frios implants) were available for follow-up studies. Interforaminal marginal bone loss was evaluated by extraoral rotational panoramic radiographs. In addition, predictive factors such as patient age and sex, nicotine use, implant position, implant life, and site of measurement were recorded, as well as bone loss at surgery (ie, baseline bone loss). Analysis of covariance for repeated measurements was used for statistical analysis. Between-group differences were expressed as least square means +/- standard error. RESULTS: Sandblasted/acid-etched implants showed significantly less marginal bone loss than machine-surfaced implants (2.4 +/- 0.23 mm vs 1.64 +/- 0.27 mm). Implants placed in the anterior of the arch showed significantly more peri-implant bone loss than implants placed in the posterior (P = .0001). DISCUSSION AND CONCLUSIONS: Significantly less long-term peri-implant bone loss was observed for rough implant surfaces compared to machine-surfaced implants. However, it was also demonstrated that both types of implants, in combination with bar-supported overdentures, can produce excellent long-term results in the atrophic edentulous mandible. Mesially placed implants showed more bone resorption than distally positioned implants, independent of surface roughness.

Rotational panoramic versus intraoral rectangular radiographs for evaluation of peri-implant bone loss in the anterior atrophic mandible.

PURPOSE: In patients with atrophic mandibles, elevation of the floor of the mouth often prevents intraoral rectangular radiography for longitudinal follow-up studies, while extraoral techniques such as panoramic radiographs tend to produce distorted views of the interforaminal region. In this study, intraoral rectangular radiographs and panoramic radiographs were compared for their accuracy in evaluating peri-implant bone loss. MATERIALS AND METHODS: In a recall program, 22 patients with 88 screw-type implants (44 MKII and 44 Frios) were followed. Interforaminal marginal bone loss was evaluated by extraoral orthopantomograms and by intraoral rectangular radiographs. In addition, pocket depth, Periotest readings, and bleeding on probing were recorded. For statistical analysis, the Spearman coefficient of correlation was used. The effects on bone loss and clinical variables were computed with a mixed model and the Bland and Altman method. RESULTS: Computed as least square means, the mean difference between panoramic radiographs (2.4 +/- 0.2 mm for MKII implants and 1.6 +/- 0.2 mm for Frios implants) and intraoral radiographs (2.6 +/- 0.2 mm and 1.4 +/- 0.2 mm, respectively) was 0.2 mm (range, 0.1 to 0.8 mm). DISCUSSION: In this study, the 2 imaging techniques were comparable clinically in terms of the precision with which they could be used to measure marginal bone loss. CONCLUSION: For highly atrophic mandibles with unfavorable imaging conditions, rotational panoramic radiographs can be a useful alternative to intraoral small-format radiographs for evaluating peri-implant bone loss.

Representative marketing-oriented study on implants in the Austrian population. II. Implant acceptance, patient-perceived cost and patient satisfaction.

Oral implantology is an established subspecialty of restorative dental and oral surgery. While an extensive body of evidence on the fundamentals of osseointegration and associated factors has been published, marketing-oriented analyses based on representative public opinion polls of implant acceptance, patient-perceived cost and patient satisfaction are scarce. In this study, an attempt was made to address these points by questioning a representative sample of 1000 adults in the household setting. The interviewees were presented with 14 questions. Of those familiar with implants as one of the treatment alternatives, 61% reported they would accept implants if the need arose. Implant acceptance was highest among males and interviewees below the age of 30 years. The interest in implants increased with increasing family incomes. Four percent of those questioned already had implants. Twenty-five percent knew someone who had undergone implant treatment. All those questioned found implant-supported rehabilitation to be very expensive. Many of them blamed the dentists for the high cost. One detail was particularly evident: satisfaction among implanted patients was clearly higher than satisfaction rates perceived by them from what they were told about implants by others. First-hand experiences with implants proved to be less biased than reported second-hand information.

Representative marketing-oriented study on implants in the Austrian population. I. Level of information, sources of information and need for patient information.

The number of dental implants inserted annually worldwide has been estimated to come close to a million. But the level of information available to patients about realistic, evidence-based treatment options by implants is often enough more than fragmentary, and what is disseminated by the media and the industry does not always reflect evidence-based empirical data. This survey of 1000 adults presented with 18 questions was designed to shed light on several points. These were (1). level of subjective patient information, (2). sources of information and prejudices, (3). future demand for implant treatment and target groups for patient information campaigns, and (4). potential misinformation, information deficits, discrepancies of information and how these come about. Of those questioned, 20% said unprompted that implants were a possibility to replace missing teeth. When prompted, 72% said that they knew about dental implants. Most of those questioned felt poorly informed about the options for replacing missing teeth and many knew less about implants than about other alternatives. The dentist was said to be the desired source of information, but 77% of those questioned reported that their dentists did not practice implant dentistry. More than 79% of those questioned did not know whether their dentist worked with implants. Forty-four percent thought that implants should only be placed by specially trained doctors. Sixty-one percent were of the opinion that dentists who provide implant dentistry were better qualified than their nonimplanting colleagues. Half of those questioned attributed implant failures to allergies and incompatibilities, the other half to poor medical care. Only 29% incriminated poor oral hygiene as a cause of implant failure. Future strategies should be geared to more professional public relations and patient information. Internationally operating qualified implant institutions could contribute much to balance discrepant information.