Anita Visser

Mandibular overdentures supported by two or four endosseous implants: a 10-year clinical trial

OBJECTIVE The aim of this 10-year clinical trial was to evaluate the treatment outcome (condition of hard and soft peri-implant tissues, patient satisfaction, surgical and prosthetic aftercare) of mandibular overdentures supported by two or four implants. MATERIALS AND METHODS Sixty edentulous patients with a mandibular height between 12 and 18 mm participated. Thirty patients were treated with an overdenture supported by two IMZ implants (group A) and 30 patients were treated with an overdenture supported by four IMZ implants (group B). Standardised clinical and radiographic parameters were evaluated 6 weeks after completion of the prosthetic treatment and after 1, 5 and 10 years of functional loading. Prosthetic and surgical aftercare was scored during the evaluation period, as well as patient satisfaction. RESULTS There were no statistically significant differences with regard to any of the studied clinical or radiographic parameters of the peri-implant tissues between the groups. In addition, no differences in satisfaction and aftercare were observed between the groups. CONCLUSION There is no difference in the clinical and radiographical state of patients treated with an overdenture on two or four implants during a 10-year evaluation period. Patients of both groups were evenly satisfied with their overdentures and received the same amount of aftercare. For reasons of cost-effectiveness, a two-implant overdenture is advised for patients with a Cawood classes IV-VI resorption of the mandible and complaints concerning retention and stability of the lower denture.

The extremely resorbed mandible, 10-year results of a randomized controlled trial on 3 treatment strategies.

OBJECTIVES To prospectively compare the clinical and radiographic results of three modes of implant treatment for implant-retained mandibular overdentures in patients with extremely resorbed mandibles. The three treatment strategies used were (1) a transmandibular implant, (2) augmentation of the mandible with an autologous bone graft followed by placement of four endosseous implants, and (3) placement of four short endosseous implants. MATERIALS AND METHODS Sixty edentulous patients met the inclusion criteria and were assigned according to a balanced allocation method to 1 of the 3 treatment strategies. Implant survival, surgical retreatment rates, and peri-implant bone loss were assessed according to a standardized protocol during a 10-year evaluation period. RESULTS During the evaluation period, significantly more implants were lost in the transmandibular implant (cumulative 10-year implant survival rate, 76.3%) and the augmentation groups (88%) compared to the group provided with short endosseous implants (98.8%). The 10-year retreatment rate was significantly more favorable in the endosseous implants only (0%) and augmentation groups (5%) compared to the transmandibular group (30%). In all three groups, there was minor peri-implant bone loss. DISCUSSION Although implant loss is a frequently used outcome measure for success, the necessity of surgical retreatment seems to be of more relevance for both the patient and the clinician. CONCLUSION Considering the favorable clinical and radiographic parameters and the fact that patients can be treated in outdoor clinic setting, the use of short endosseous implants in combination with an overdenture is the first choice of treatment in patients with extremely resorbed mandibles.

Reliability and validity of measurements of facial swelling with a stereophotogrammetry optical three-dimensional scanner

Volume changes in facial morphology can be assessed using the 3dMD DSP400 stereo-optical 3-dimensional scanner, which uses visible light and has a short scanning time. Its reliability and validity have not to our knowledge been investigated for the assessment of facial swelling. Our aim therefore was to assess them for measuring changes in facial contour, in vivo and in vitro. Twenty-four healthy volunteers with and without an artificial swelling of the cheek were scanned, twice in the morning and twice in the afternoon (in vivo measurements). A mannequin head was scanned 4 times with and without various externally applied artificial swellings (in vitro measurements). The changes in facial contour caused by the artificial swelling were measured as the change in volume of the cheek (with and without artificial swelling in place) using 3dMD Vultus software. In vivo and in vitro reliability expressed in intraclass correlations were 0.89 and 0.99, respectively. In vivo and in vitro repeatability coefficients were 5.9 and 1.3 ml, respectively. The scanner underestimated the volume by 1.2 ml (95% CI -0.9 to 3.4) in vivo and 0.2 ml (95% CI 0.02 to 0.4) in vitro. The 3dMD stereophotogrammetry scanner is a valid and reliable tool to measure volumetric changes in facial contour of more than 5.9 ml and for the assessment of facial swelling.

Digital planning of cranial implants

Computer-aided techniques can be used in the reconstruction of defects in the skull, although there are limitations for large defects. We describe a technique for the digital design of an implant for cranioplasty using one, easy-to-use, piece of generic industrial software that shows a curvature-based, hole-filling algorithm. This approach is suitable for all kinds of defects, including those that extend across the midline of the skull. The workflow gives the user full control over the design, production, and material used for the implant.

Influence of Age on Clinical Performance of Mandibular Two-Implant Overdentures: A 10-Year Prospective Comparative Study.

PURPOSE The aim of this prospective comparative study was to assess whether age has influence on peri-implant health in patients treated with mandibular two-implant overdentures during a 10-year evaluation period. MATERIALS AND METHODS A prospective study was carried out with two groups of edentulous patients, viz a younger (n = 52; mean age 45 years, 35-50 years) and an older (n = 53; mean age 68 years, 60-80 years) group. In all patients, two dental implants were placed in the interforaminal region of the mandible and after a 3-month healing period overdentures were fabricated. Clinical and radiographic parameters were evaluated immediately after completion of the prosthetic treatment, and after 1, 5 and 10 years. Implant loss, plaque index, gingival index, bleeding index, and probing depth were assessed as clinical parameters. Peri-implant bone loss was assessed on dental radiographs made with a standardized long-cone technique with a direction device. RESULTS Implant survival after 10 years was 97.1% and 93.4% in the younger and older group, respectively. Ten-year scores of plaque, gingiva, and bleeding were between 0 and 1 for both groups (possible scores 0-3), and mean probing depth was 3 mm in both groups. Mean peri-implant bone loss after 10 years was 1.2 and 1.4 mm in the younger and older patients, respectively. No significant differences were observed between the groups. CONCLUSION Clinical performance of mandibular two-implant overdentures is equally successful in younger and older patients.

Implant-Retained Overdentures for Young Children With Severe Oligodontia : A Series of Four Cases

PURPOSE The treatment need is high in children with severe oligodontia and anodontia, because they often have functional and esthetic problems owing to missing teeth. Because the intraforaminal region barely grows after eruption of the permanent mandibular incisors, dental implant treatment should be considered a treatment option for these children. The purpose of our study was to assess the treatment outcomes regarding satisfaction and the care and aftercare of implant-retained mandibular overdentures in a series of 4 young children without erupted mandibular teeth from either severe oligodontia (n = 3) or anodontia (n = 1). PATIENTS AND METHODS Four children without erupted mandibular teeth, aged 6 to 13 years, were provided with an implant-retained overdenture on 2 implants. The surgical and prosthetic care and aftercare were scored by the clinicians. Also, the patients and their parents were queried about how satisfied they were with the overdenture. RESULTS The median follow-up of the patients was 5.2 years (range 3.2 to 8.4). No implants were lost, no cases of peri-implantitis occurred, and the need for treatment and aftercare was low. Patient and parent satisfaction with this treatment was high. CONCLUSIONS A 2-implant, retained overdenture in children with no erupted mandibular teeth is a safe treatment modality when appropriate treatment and aftercare can be provided.

Recommendations for implant‐retained nasal prostheses after ablative tumor surgery: Minimal surgical aftercare, high implant survival, and satisfied patients

Nasal defects resulting from tumor resection are preferably rehabilitated with implant‐retained nasal prostheses. Aftercare, clinical outcome of the implants, and patients’ satisfaction with implant‐retained nasal prostheses were assessed.

Dexmedetomidine versus Midazolam in Procedural Sedation: A Systematic Review of Efficacy and Safety

Objectives To systematically review the literature comparing the efficacy and safety of dexmedetomidine and midazolam when used for procedural sedation. Materials and Methods We searched MEDLINE, EMBASE and COCHRANE for clinical trials comparing dexmedetomidine and midazolam for procedural sedation up to June 20, 2016. Inclusion criteria: clinical trial, human subjects, adult subjects (≥18 years), article written in English, German, French or Dutch, use of study medication for conscious sedation and at least one group receiving dexmedetomidine and one group receiving midazolam. Exclusion criteria: patients in intensive care, pediatric subjects and per protocol use of additional sedative medication other than rescue medication. Outcome measures for efficacy comparison were patient and clinician satisfaction scores and pain scores; outcome measures for safety comparison were hypotension, hypoxia, and circulatory and respiratory complications. Results We identified 89 papers, of which 12 satisfied the inclusion and exclusion criteria; 883 patients were included in these studies. Dexmedetomidine was associated with higher patient and operator satisfaction than midazolam. Patients receiving dexmedetomidine experienced less pain and had lower analgesic requirements. Respiratory and hemodynamic safety were similar. Conclusions Dexmedetomidine is a promising alternative to midazolam for use in procedural sedation. Dexmedetomidine provides more comfort during the procedure for the patient and clinician. If carefully titrated, the safety profiles are similar.

Patients With Transmandibular Implants Are at Risk for Severe Complications When Becoming Frail

Early in the implant era, transmandibular implant systems were used for retention of implant-retained mandibular overdentures in the severely resorbed mandible. These transmandibular systems require very thorough aftercare, especially when patients become frail and dependent on care. As a result, oral care often receives less attention in frail elderly patients or the patient cannot maintain the needed level of oral care. Care providers often are unfamiliar with the level of oral care needed to preserve transmandibular implants in good condition. This case series describes the risk for severe complications, including chronic pain and fracture of the mandible, in frail elderly patients who were unable to maintain oral care at the desired level and whose caregivers did not provide the needed level of oral care.

A 15-Year Comparative Prospective Study of Surgical and Prosthetic Care and Aftercare of Overdenture Treatment in the Atrophied Mandible: Augmentation Versus Nonaugmentation

BACKGROUND Different treatment strategies for the atrophied mandible are described in literature. The need for long term care and aftercare for these strategies is sparsely described, however. PURPOSE To prospectively assess the need for prosthetic and surgical care and aftercare of two implant treatment strategies for the atrophied mandible. MATERIALS AND METHODS Forty edentulous elderly patients were randomly assigned according to a balanced allocation method to a treatment strategy: dental implants in combination with an augmentation procedure versus a nonaugmentation procedure. All surgical and prosthetic care and aftercare were scored from the first visit until 15 years after implant placement. RESULTS Twenty elderly patients completed the 15-year follow-up. As expected, the augmentation group needed significantly more surgical time than the nonaugmentation group (338 vs 145 minutes), but the need for prosthetic care and surgical/prosthetic aftercare was comparable. Implant survival was lower in augmented mandibles (88.7% vs 98.7%, p < .05). Aftercare mainly consisted of routine inspections; the need for prosthetic adjustments was minor. Surgical aftercare was hardly needed. CONCLUSION The only difference in the need for surgical and prosthetic (after) care was the extra time needed for performing augmentation surgery and the higher risk on implant loss in augmented mandibles. Otherwise, the need for care and aftercare was of the same magnitude. Thus, when applicable, nonaugmentation surgery is preferred as no general anesthesia is needed and the morbidity is low.