Establishing Clinically Acceptable PES/WES Threshold for Single- Tooth Implant Restoration.

PURPOSE: Determining the esthetic success of single-tooth implant restorations (STIR) requires an objective tool such as one devised by Belser et al., 2009 - pink esthetic scores and white esthetic scores (PES/WES). This study aimed to utilized PES/WES to establish threshold scores based on (1) detectability and (2) acceptability of a STIR by lay person perception, (3) to study the difference in the ability of laypeople and dentists in detecting the presence of STIR, and (4) to study the pink and white deficiencies in relation to the detectability of the presence of STIR. MATERIALS AND METHODS: A total of 38 calibrated photographs of STIR in the anterior region were scored with PES/WES by 3 prosthodontists. Next, 100 laypeople and 60 dentists were instructed to identify the STIR among the anterior teeth and provide reasoning behind the identification (based on pink and white esthetic criteria). The acceptance of the STIR was recorded. Receiver Operating Characteristics (ROC) analysis was utilized to determine the threshold scores. RESULTS: At the PES/WES score of 17, 71% of laypeople could not correctly identify the STIR, and at the PES/WES score of 12, 80% of laypeople accepted the implant. Out of 3,800 occasions, laypeople correctly identified the STIR 1,770 (46.58%) of those occasions. Among the correctly identified STIR, 751 (42.43%) of those occasions were identified with pink deficiencies and 1019 (57.57%) of those occasions were with white deficiencies. Out of 2,280 occasions, dentists correctly identified STIR 1869 (81.98%) of those occasions. CONCLUSIONS: The PES/WES score of 12 indicates the clinically acceptable threshold, while the score of 17 indicates the detectable threshold for an exceptional esthetic outcome. Laypeople tend to accept the implant despite its detectability. For both laypeople and dentists, root convexity/soft tissue color and texture are the most focused criteria of PES/WES, followed by overall white deficiencies that remain influential. Compared to laypeople, dentists tend to have a higher ability to detect STIR.

Proposal of a Decision-Making Model for the Provisional Restoration Alternatives in Single-Tooth Implant Treatment.

Background The decision-making of the most appropriate provisional restoration option in single-tooth implant practice is complex under multi-criteria conditions. The aim of our study is to conduct a case study on the determination of the appropriate provisional treatment option to be used in a single-tooth dental implant interim period after placement with the help of an entropy-based additive ratio assessment. Methodology Eight important criteria for fulfilling this purpose have been extracted from the literature search: "esthetic potential," "patient comfort," "treatment time," "laboratory cost," "occlusal clearance," "ease of removal," "durability," and "ease of modification." Provisional treatment alternatives are "removable partial denture," "vacuum-formed appliances," "bonded extracted tooth or denture," "metal or fiber-reinforced resin-bonded fixed partial denture," "wire-retained resin-bonded fixed partial denture," "acrylic resin provisional fixed partial denture," and "implant-supported fixed provisional restoration." It has been examined which of these alternatives is most appropriate in terms of both reported specifications and artificially generated dominance scenarios. The scenarios employed are S0 (criteria are equal-weighted), S1 (the criterion is tri-fold dominant), and S2 (the criterion is two-fold dominant). Results "Patient comfort" was the most important criterion (wj = 0.19). The remaining criteria were ranked as "modifications," "treatment time," "durability," "esthetic potential," "laboratory cost," "occlusal clearance," and "ease of removal." The "implant-supported fixed provisional restoration" treatment option had the maximum degree of utility in the S0 (Ki = 0.782) and S2 (Ki = 0.80) categories. If "treatment time" or "occlusal clearance" is the dominant variable, "vacuum-formed appliances" had the highest degree of utility (Ki = 0.69) in S1. Conclusions According to the rankings and scenarios created utilizing entropy-based additive ratio assessment methods, the "implant-supported fixed provisional restoration" is the appropriate provisional option for a single-tooth implant treatment. If "treatment time" or "occlusal clearance" is an absolute criterion, the "vacuum-formed provisional appliance" will replace the appropriate option.

Cost-effectiveness analysis: nonsurgical root canal treatment versus single-tooth implant.

BACKGROUND: Economic evaluation of nonsurgical root canal treatment (NSRCT) and single-tooth implant (STI) provides useful information for medical decision. This retrospective study aimed to evaluate the cost-effectiveness of NSRCT versus single-tooth implant (STI) after 5-year treatment in a university affiliated hospital in Beijing, China. METHODS: 211 patients who underwent NSRCT and 142 patients who had STI were included and recalled after 5-year treatment. The propensity scores were used to match the cases of two treatment modalities. At recall, outcomes were determined based on clinical and radiographical examinations. For endodontically treated cases, absence or reduction of radiolucency were defined as success. Marginal bone loss (MBL) ≤ 4 mm were determined as success for implant cases. Direct and indirect costs were calculated in China Yuan (CNY). Patients' willingness to pay (WTP) for each treatment modality was evaluated by questionnaires. A cost-effectiveness analysis was performed from the societal perspective. RESULTS: 170 patients with 120 NSRCT teeth and 96 STI were available at recall. Based on propensity score matching, 76 endodontically treated teeth were matched to 76 implants. Absence of the radiolucency was observed in 58 of 76 endodontically treated teeth (76%) and reduction of the radiolucency in 9 of 76 teeth (12%) and altogether the success rate was 88%. 100% implants were detected with marginal bone loss (MBL) ≤ 4 mm. The cost advantage of NSRCT (4,751 CNY) over STI (20,298 CNY) was more pronounced. Incremental cost effectiveness ratio (ICER) was 129,563 CNY (STI-NSRCT) per success rate gained. It exceeded the patients' willingness to pay value 7,533 CNY. CONCLUSIONS: Clinical outcomes of NSRCT and STI could be predictable after 5-year treatment. NSRCT may be more cost-effective than STI for managing endodontically diseased teeth.

Enhancing the Esthetics of a Maxillary Central Implant Crown with a Hybrid-Abutment: A Case Report.

Reducing the fabrication time and costs involved in classical methods of implant crown production are goals being constantly pursued. Consequently, computer-aided design and computer-aided manufacturing technologies have evolved considerably, offering improved and predictable outcomes in terms of esthetics and function. The aim of this case report is to demonstrate how hybrid-abutments can provide optimum esthetics and biomechanical foundations. A 57-year-old woman had a non-restorable tooth #8, which was indicated for extraction and immediate implant placement. Lithium disilicate (LD) crowns were used to restore the adjacent teeth #7, 9, and 10. A zirconia abutment was used to block the gray color of the titanium base. The zirconia abutment finish line was designed to be placed 1-mm apical to the free marginal gingiva of the adjacent tooth, and an LD implant crown was cemented on the hybrid-abutment. The technique demonstrated promising results, and after more than 18 months of follow-up following the implant placement, the surrounding soft tissue was well adapted around the implant crown. The hybrid-abutment enhanced the esthetics of the definitive restoration as well as saved time and cost by elimination of the casting step.

The volume of proximal bone projection can determine the osseous contour after immediate implant placement and guided bone regeneration in severe labial bony deficiency.

Anterior immediate implant placement (IIP) has many biological and esthetic challenges, including inevitable soft and hard tissue loss after extraction. Previous literatures have discussed the facial bone architecture and defective socket classification. However, none of them discussed the depression of the cervical root area which can be seen frequently after IIP in type IIB and U-shaped defective sockets. In our limited experiences, we found that the labial interproximal bone edges of type IIB and U-shaped defect dominated the esthetic result after IIP. With more labial projection of the interproximal bone present, better esthetic result could be expected in the facial aspect. With adequate evaluation of this osseous scalloping before IIP, both patient and clinician could have a comprehensive understanding of the final esthetic result. This article also detailed the process of patient selection, diagnosis, surgical options, and executions required to achieve functional and esthetic success with IIP and provisionalization.

Personality Traits and Annual Income Determine the Willingness to Pay for a Single Tooth Implant.

The objective of this study was to evaluate the factors influencing the willingness to pay for a single tooth implant in Malaysia and to assess if an additional evidence-based patient education video increases the willingness to pay. A total of 100 subjects seeking single tooth replacement at the Oral Health Centre, International Medical University (IMU), Kuala Lumpur, Malaysia, were asked to complete questionnaires about personal demographics and personality traits. Subsequently, they were randomly allocated into two groups. Group C received a conventional patient-dentist interaction on treatment options for missing teeth, while Group EV received the same content with an additional evidence-based video on the survival rate and complications for each option from recent meta-analyses. Willingness to pay the median price and the highest price that the subjects were willing to pay were assessed by a structured bidding process. A higher annual income was significantly associated with willingness to pay the median price for a single tooth implant (χ2 = 6.91, p = 0.03). Dominant personality traits of openness (r = -0.25), conscientiousness (r = -0.30) and agreeableness (r = -0.20) were negatively correlated with the highest price that the patients were willing to pay for a single tooth implant (Pearson's correlation test, p < 0.05). No significant difference in willingness to pay was found between Group C and Group EV (χ2 = 0.05, p > 0.05). In conclusion, patient education strategies for single tooth replacements with dental implants should be customized based on a patient's personality and income to maximize effectiveness.

Aesthetics outcome of immediately restored single implants placed in extraction sockets in the anterior maxilla: A case series study.

Background. Immediate single implant placement and restoration (IIR) is recognized as a novel method and is the main request of many patients. This study was designed to evaluate the aesthetic outcomes of immediately restored single implants placed in extraction sockets in theanterior maxilla. Methods. In this case series study, 18 patients were selected from two private clinics after placing a single-tooth implant in the anterior maxilla. Immediate provisional crowns were delivered on the following day or at most 48 hours later, and guidelines were provided. The Pink Esthetic Score (PES) questionnaire was used at 6- and 12-month follow-ups to assess aesthetic outcomes. Data were analyzed with single t-test and dependent t-test. Results. In general, the results showed that the status of the mesial papilla, distal papilla, curve of the facial soft tissue line, level of the facial peri-implant mucosa and root convexity soft tissue in IIR method were optimal (P<0.05), with total PES means of 9.44±0.783 and 8.58±1.003 after 6 and 12 months, respectively. Also, the results showed a significant difference in PES between the 6-month and 12-month intervals (P<0.05). Conclusion. IIR is a viable method that resulted in optimal aesthetic outcomes based on PES in the short term. Considering its confirmation in this study and previous studies, it is recommended that dentists apply this method.

Allograft and Collagen Membrane Augmentation Procedures Preserve the Bone Level around Implants after Immediate Placement and Restoration.

Background: Immediate implant placement and restoration (IPR), is a reliable treatment modality. Purpose: This historical prospective study evaluated the medium-term outcomes of hard tissue after IPR in the anterior maxilla with simultaneous hard tissue augmentation. Methods: Seventy-three patients treated with single-implant IPR in the anterior maxilla were followed for 1-8 years. Treatment involved, atraumatic extraction, immediate implant placement and abutment adaptation, followed by simultaneous augmentation with mineralized freeze-dried bone allograft (FDBA) particles to fill the gaps and restore the ridge. The surgical site was stabilized with a resorbable collagen membrane, followed by the connection of an acrylic provisional restoration. Results: All implants osseointegrated during the follow-up period (mean, 34 ± 22 months). Radiographic evaluation of the distance between the implant shoulder (IS) and crestal bone level (CBL) was of 0.86 ± 0.86 mm and 0.8 ± 0.84 mm mesially and distally, respectively. Splitting the results into up to 3 years and 3-8 years of follow-up data, the corresponding values were 0.90 ± 0.83 and 0.68 ± 0.88 for the mesial aspect and 0.99 ± 0.87and 0.74 ± 0.83 for the distal aspect, respectively. Mean peri-implant probing depth was 3.63 mm (SD ± 1.06) and 16 implants (22%) presented at least one bleeding pocket of ≥5 mm (peri implant mucositis). Conclusions: The immediate replacement of a single maxillary tooth by implants combined with guided bone regeneration is a predictable treatment modality with favorable peri-implant bony response.

Cicatrizadores personalizados: relato de caso / Customized healing abutments: case report

Quando feita a instalação de um implante imediato pode se optar entre a instalação de uma coroa provisória clínica, um cicatrizador ou pode se optar pelo fechamento do implante para um tratamento em duas etapas cirúrgicas. O uso de cicatrizadores personalizados sela os implantes e leva a uma cicatrização individualizada, que favorece a confecção das coroas subsequentes. O presente trabalho objetiva relatar um caso clínico envolvendo um implante imediato e a instalação de um cicatrizador personalizado, demonstrando os resultados e a importância de conhecimento dessa técnica pelo cirurgião-dentista.

When installing an immediate implant, you can choose between installing a temporary clinical crown, healing abutments, or to close the implant for a two-step surgical treatment. The use of customized healing abutments seals the implants and leads to individualized healing, which favors the creation of subsequent crowns. The present study aims to report a clinical case involving an immediate implant and the installation of customized healing abutments, demonstrating the results and the importance of knowledge of this technique by the dentist.

Guided Nitinol-Retained (Smileloc) Single-Tooth Dental Restorations.

Nitinol metal alloy that changes shape according to temperature has been in clinical use at select clinics worldwide for the past 2 years and is now released for general use. The Smileloc Abutment and nitinol sleeve enable "cementless," "screwless," crown fastening that saves time and cost with the prospect of replacement of much of the present, sometimes troublesome, anthropic, soon to be anachronistic, technology.

Single-Implant Treatment.

The replacement of one tooth using one implant involves a set of unique criteria for long-term success. Successful therapy should be based on long-term function and health of the adjacent tissues. Sections of this article examine these critical criteria that when working together can result in successful long-term tooth replacement.

A Retrospective Comparison of Outcome in Patients Who Received Both Nonsurgical Root Canal Treatment and Single-tooth Implants.

INTRODUCTION: Currently, no study has compared the outcome of nonsurgical root canal treatment (NSRCT) and single-tooth implants (STIs) provided to the same patient. The purpose of this study was to determine if the survival outcome of the 2 treatment modalities is different. METHODS: The medical/dental records of 3671 patients with at least 1 STI and 1 NSRCT were reviewed. One hundred seventy patients with at least a 5-year follow-up were included. The survival outcome of NSRCT and STI and related factors were evaluated. RESULTS: Both treatments had a 95% survival rate with a mean 7.5-year follow-up. Most preoperative and postoperative factors involved in both procedures had no significant effect on the treatment outcomes. The number of adjunct and additional treatments, the number of appointments, the elapsed time before the final restoration, the number of prescribed medications, and the cost of the treatment were significantly higher for STI in comparison with NSRCT. CONCLUSIONS: Both NSRCT and STI are highly successful treatments. Compromised teeth that could otherwise be saved by NSRCTs and deemed restorable should not routinely be treatment planned for STI.

Immediate loading at single crowns and 2-unit bridges supported by implants installed in a healed alveolar bony ridge or immediately after tooth extraction. An experimental study in dogs.

To evaluate presumptive differences in osseointegration at implants installed in healed sites or extraction sockets, supporting either crowns or bridges that were functionally loaded or left unloaded. In six dogs, the mesial roots of the first mandibular molars were treated endodontically. Bilaterally, the teeth were hemisected, and the distal roots extracted. First and second mandibular premolars were extracted as well. After 3 months, the mandibular third and fourth distal roots were extracted after endodontic treatment of the mesial roots. Four implants were installed bilaterally, two in the healed sites corresponding to the second premolar and first molar regions, and two into the extraction sockets. Cobalt-chrome single crowns were prepared and installed in the two most anterior implants, and bridges at the two most posterior implants, bilaterally. A 3-unit bridge was applied to the premolars in the upper jaw only at the loaded sites. All prostheses had a flat occlusal surface and contacts in centric occlusion only at the loaded sites. Three months later, biopsies were retrieved for histological analysis. Higher levels of osseointegration and bone density were observed at the unloaded sites, both at implants installed in healed and post-extraction sites. However, only at implants installed in the post-extraction sites and supporting single crowns, the difference in bone-to-Implant contact was statistically significant. In implant installation immediately following extraction or delayed after three months, osseointegration and bone density were not affected by occlusal contact schemes.

Immediate and delayed loading of fixed dental prostheses supported by single or two splinted implants: A histomorphometric study in dogs.

To evaluate presumptive differences in osseointegration at implants supporting crowns that are physiologically loaded either immediately or 3 months after installation. All premolars and first molars were extracted bilaterally in six dogs. After 3 months of healing, three implants were installed on the premolar region and two in the molar region in one side of the mandible. Likewise, after another 3 months, five implants were installed in the contralateral side, and impressions were taken bilaterally. Within 48 hours, two single crowns were screwed bilaterally onto two implants in the premolar region, and two splinted crowns reproducing the shape of the first molar were screwed bilaterally onto the implants in the molar region. The mesial implants were used as no-loaded controls. Sacrifices were performed after 3 months, and histological analyses were performed. At the premolar sites, mineralised bone-to-implant contact (MBIC%) was 78.0 ± 4.0% and 70.9 ± 7.9% at the delayed and immediately loaded sites, respectively. This difference was statistically significant. At the control implants, MBIC% was 61.4 ± 14.7% and 63.1 ± 13.1% at the delayed and the immediately loaded sites, respectively. At the molar sites, MBIC% was 79.2 ± 10.9% and 61.1 ± 10.3% at the delayed and immediately loaded sites, respectively. Applying a delayed loading to fixed dental prostheses supported by single or two splinted implants yielded higher proportions of bone-to-implant contact (osseointegration) compared to immediately loaded implants. Moreover, both types of loading protocols yielded a higher rate of osseointegration compared to unloaded implant sites after 3 months following implant installation.

Endodontics, Endodontic Retreatment, and Apical Surgery Versus Tooth Extraction and Implant Placement: A Systematic Review.

INTRODUCTION: The aim of this systematic review was to answer the following clinical question: Which is the best treatment option for a pulpally involved tooth? METHODS: An electronic search was conducted in the Cochrane, PubMed (MEDLINE), and ScienceDirect databases between December 2015 and February 2016. A manual search was also performed. The inclusion criteria were randomized clinical trials, prospective or retrospective cohort studies, and cross-sectional studies performed on humans with at least 1 year of follow-up and published within the last 10 years. Two researchers independently screened the title and abstract of every article identified in the search in order to establish its eligibility. The selected articles were classified into different levels of evidence by means of the Strength of Recommendation Taxonomy criteria. RESULTS: Sixty articles met the inclusion criteria for this systematic review. The survival rate of single-tooth implants was greater than the success rate of the distinct conservative treatments. However, among comparative studies, no important differences between both treatments were observed until at least 8 years later. CONCLUSIONS: The endodontic treatment and the implant placement are both valid and complementary options for planning oral rehabilitation. Although a level B recommendation can be stated, these results come from retrospective comparative studies because there is a lack of randomized clinical studies comparing both types of therapeutic options.

Mechanical and biological complication rates of the modified lateral-screw-retained implant prosthesis in the posterior region: an alternative to the conventional Implant prosthetic system.

PURPOSE: The modified lateral-screw-retained implant prosthesis (LSP) is designed to combine the advantages of screw- and cement-retained implant prostheses. This retrospective study evaluated the mechanical and biological complication rates of implant-supported single crowns (ISSCs) inserted with the modified LSP in the posterior region, and determined how these complication rates are affected by clinical factors. MATERIALS AND METHODS: Mechanical complications (i.e., lateral screw loosening [LSL], abutment screw loosening, lateral screw fracture, and ceramic fracture) and biological complications (i.e., peri-implant mucositis [PM] and peri-implantitis) were identified from the patients' treatment records, clinical photographs, periapical radiographs, panoramic radiographs, and clinical indices. The correlations between complication rates and the following clinical factors were determined: gender, age, position in the jaw, placement location, functional duration, clinical crown-to-implant length ratio, crown height space, and the use of a submerged or nonsubmerged placement procedure. RESULTS: Mechanical and biological complications were present in 25 of 73 ISSCs with the modified LSP. LSL (n=11) and PM (n=11) were the most common complications. The incidence of mechanical complications was significantly related to gender (P=.018). The other clinical factors were not significantly associated with mechanical and biological complication rates. CONCLUSION: Within the limitations of this study, the incidence of mechanical and biological complications in the posterior region was similar for both modified LSP and conventional implant prosthetic systems. In addition, the modified LSP is amenable to maintenance care, which facilitates the prevention and treatment of mechanical and biological complications.

Effects of flapless versus flap implant surgery on tissues surrounding implants in esthetic zone / 中华医学美学美容杂志

Objective To evaluate the effects of flapless versus flap implant surgery on the tissues surrounding the implants in the esthetic zone.Methods A controlled study was conducted in 20 patients with a single implant in the anterior esthetic zone,as compared with the flapless and traditional flap implant placement.6 and 12 months after the implant ation,the vertical reduction of labial and lingual bone were assessed by cone beam computed tomography (CBCT);6 and 12 months after the crowns restoration,the peri-implant soft tissues were examined by probing depth (PD),modification sulcus bleeding index (mSBI),papillary index (PPI) and evaluated by pink esthetic score (PES) standard.Results The vertical reduction of the flapless labial and lingual bone was lower than that of the flap,in which the change of labial bone was statistical differences at 6 months after implant surgery between groups (P ＜ 0.05).The differences of PES between two groups were not statistically significant,although PES increased over time in both groups,which the flapless group had a significantly change in PES from crown placement to 12 months (P＜0.05).Conclusions A flapless implant surgery in sufficient bone support may provide a better short-term esthetic result,whereas the longterm effects need further studies.

Mechanical and biological complication rates of the modified lateral-screw-retained implant prosthesis in the posterior region: an alternative to the conventional Implant prosthetic system

PURPOSE: The modified lateral-screw-retained implant prosthesis (LSP) is designed to combine the advantages of screw- and cement-retained implant prostheses. This retrospective study evaluated the mechanical and biological complication rates of implant-supported single crowns (ISSCs) inserted with the modified LSP in the posterior region, and determined how these complication rates are affected by clinical factors. MATERIALS AND METHODS: Mechanical complications (i.e., lateral screw loosening [LSL], abutment screw loosening, lateral screw fracture, and ceramic fracture) and biological complications (i.e., peri-implant mucositis [PM] and peri-implantitis) were identified from the patients' treatment records, clinical photographs, periapical radiographs, panoramic radiographs, and clinical indices. The correlations between complication rates and the following clinical factors were determined: gender, age, position in the jaw, placement location, functional duration, clinical crown-to-implant length ratio, crown height space, and the use of a submerged or nonsubmerged placement procedure. RESULTS: Mechanical and biological complications were present in 25 of 73 ISSCs with the modified LSP. LSL (n=11) and PM (n=11) were the most common complications. The incidence of mechanical complications was significantly related to gender (P=.018). The other clinical factors were not significantly associated with mechanical and biological complication rates. CONCLUSION: Within the limitations of this study, the incidence of mechanical and biological complications in the posterior region was similar for both modified LSP and conventional implant prosthetic systems. In addition, the modified LSP is amenable to maintenance care, which facilitates the prevention and treatment of mechanical and biological complications.