Glenn Reside

Immediate Provisionalization of Dental Implants Placed in Healed Alveolar Ridges and Extraction Sockets: : A 5-year Prospective Evaluation

PURPOSE This 5-year prospective multicenter study compared implant survival and success, peri-implant health and soft tissue responses, crestal bone level stability, and complication rates following immediate loading of single OsseoSpeed implants placed in anterior maxillary healed ridges or extraction sockets. MATERIALS AND METHODS Individuals requiring anterior tooth replacement with single implants were treated and immediately provisionalized. Definitive all-ceramic crowns were placed at 12 weeks. Implant survival, bone levels, soft tissue levels, and peri-implant health were monitored for 5 years. RESULTS One hundred thirteen patients received implants in fresh sockets (55) and healed ridges (58). After 5 years, 45 and 49 patients remained for evaluation, respectively. During the first year, three implants failed in the extraction socket group (94.6% survival) and one implant failed in the healed ridge group (98.3% survival); this difference was not significant. No further implant failures were recorded. After 5 years, the interproximal crestal bone levels were located a mean of 0.43 ± 0.63 mm and 0.38 ± 0.62 mm from the reference points of implants in sockets and healed ridges (not a significant difference). In both groups, papillae increased over time and peri-implant mucosal zenith positions were stable from the time of definitive crown placement in sockets and healed ridges. Compared to flap surgery for implants in healed ridges, flapless surgery resulted in increased peri-implant mucosal tissue dimension (average, 0.78 ± 1.34 mm vs 0.19 ± 0.79 mm). CONCLUSION After 5 years, the bone and soft tissue parameters that characterize implant success and contribute to dental implant esthetics were similar following the immediate provisionalization of implants in sockets and healed ridges. The overall tissue responses and reported implant survival support the immediate provisionalization of dental implants in situations involving healed ridges and, under ideal circumstances, extraction sockets.

Development and Applications of Porous Tantalum Trabecular Metal-Enhanced Titanium Dental Implants

BACKGROUND Porous tantalum trabecular metal has recently been incorporated in titanium dental implants as a new form of implant surface enhancement. However, there is little information on the applications of this material in implant dentistry. PURPOSE The purpose of this article is to summarize the contemporary concept on the applications of porous tantalum trabecular metal in implant dentistry. MATERIALS AND METHODS We therefore review the current literature on the basic science and clinical uses of this material. RESULTS Porous tantalum metal is used to improve the contact between osseous structure and dental implants and therefore presumably facilitate osseointegration. Success of porous tantalum metal in orthopedic implants led to the incorporation of porous tantalum metal in the design of root-form endosseous titanium implants. The porous tantalum three-dimensional enhancement of titanium dental implant surface allows for combining bone ongrowth together with bone ingrowth, or osseoincorporation. While little is known about the biological aspect of the porous tantalum in the oral cavity, there seems to be several possible advantages of this implant design. This article reviews the biological aspects of porous tantalum-enhanced titanium dental implants, in particular the effects of anatomical consideration and oral environment to implant designs. CONCLUSIONS We propose here possible clinical situations and applications for this type of dental implant. Advantages and disadvantages of the implants as well as needed future clinical studies are discussed.

The effect of implant‐supported removable partial dentures on oral health quality of life

PURPOSE Removable partial dentures (RPDs) represent standard treatment for partial edentulism despite major shortcomings. To alleviate these shortcomings, endosseous implants provide support and stability as well as contribute to maintenance of alveolar bone. This prospective, within subject, time series study evaluated patient-based outcomes of RPDs compared to implant-supported removable partial dentures (ISRPDs). The study hypothesis was that the ISRPD would substantially improve oral health quality of life for patients. MATERIALS AND METHODS Seventeen patients requesting new mandibular Kennedy I or II RPDs received one 6-mm dental implant in one or both of the posterior edentulous areas. After healing, conventional RPDs were fabricated and delivered. Twelve weeks later, second-stage surgery was performed, and ball abutments with Clix attachments were inserted, thereby converting the prostheses to ISRPDs. Oral health quality of life was evaluated using the 49-item Oral Health Impact Profile (OHIP-49) questionnaire. The OHIP-49 was administered prior to treatment (baseline), at 6 and 12 weeks following RPD delivery and at 6 and 12 weeks following ISRPD conversion. Radiographic evaluation was performed at 6 and 12 weeks following ISRPD conversion. In statistical analysis, a fixed-slope random intercept variance components model took account of the multiple observations per person over time. RESULTS In 17 subjects, 29 of 30 implants survived. The failed implant was replaced without complications. Abutment complications were limited to one abutment loosening and one attachment replacement. Minor prosthodontic complications were recorded. The OHIP-49 score reduced by 11.8 points, on average, at 12 weeks following ISRPD conversion (P = 0.011). CONCLUSIONS Patients reported improved oral health following conversion to an ISRPD from RPD. The ISRPD involving short implants is one treatment option that should be considered when treatment planning Kennedy Class I and II patients.

Complications and Patient-Centered Outcomes with an Implant-Supported Monolithic Zirconia Fixed Dental Prosthesis: 1 Year Results

PURPOSE To characterize the number and type of complications that occur with a monolithic zirconia fixed dental prosthesis (MZ-FDP) supported by four endosseous implants in the edentulous mandible over time and to quantify the impact of treatment on oral health quality of life (OHQoL). METHODS Seventeen edentulous participants were enrolled. New conventional dentures were fabricated for each participant. Four Astra Tech Osseospeed TX implants (Dentsply) were then placed in the parasymphyseal mandible, and after a period of healing, a full-arch monolithic zirconia prosthesis (Zirkonzahn) was inserted. Complication data were recorded and OHQoL was evaluated using the Oral Health Impact Profile (OHIP-49), administered on four occasions: enrollment; implant surgery; and 6- and 12-month recalls. RESULTS Sixty-eight implants were placed in 17 edentulous individuals aged 30 to 78 (mean 57.9 years). Implant survival was 94% from the subject perspective and 99% from the implant perspective. Prosthesis survival was 88%. Twelve complications occurred in ten participants, whereas seven participants remained complication free. Both OHIP-49 severity and extent scores decreased significantly between enrollment and 12-month recall (p < 0.001). The mean OHIP-49 severity score at baseline was 94.8 (95% confidence interval [CI]: 73.9, 115.8) and declined an average of 76.8 (95% CI: -91.3, -62.3) units per participant. The mean OHIP-49 extent score at baseline was 17.2 (95% CI: 10.8, 23.6) and declined 16.3 (95% CI: -20.2, -12.4) units per participant on average. CONCLUSIONS Implant survival was high, and few complications related to the MZ-FDP were observed. The most common prosthetic complication was tooth chipping in the opposing maxillary denture, which accounted for 50% of all complication events. Substantial and clinically important improvements in OHQoL were achieved with both conventional dentures and the implant-supported MZ-FDP. The data of this short-term study indicate that the implant-supported MZ-FDP is a therapeutic option with particular advantages in the edentulous mandible that warrants further long-term study.

Immediate provisionalization of dental implants in grafted alveolar ridges in the esthetic zone: a 5-year evaluation.

This clinical study assessed at 5 years both implant survival and peri-implant tissue architecture of immediately provisionalized implants placed 4 to 6 months following augmentation with demineralized bovine bone allograft and collagen membrane. Of 23 implants in 19 patients, one implant failed prior to loading (95.6% survival). Implant tissue relationships were stable following implant placement; marginal bone level changes from implant placement to 5 years (mean ± SD: -0.18 ± 0.79 mm, range: -1.6 to 1.4 mm, P = .51), the mesial and distal papilla length changes (mesial mean ± SD: 1.14 ± 0.92 mm, P < .001; distal mean ± SD: 0.74 ± 1.46 mm, P = .04), and the unchanged mucosal zenith location (mean ± SD: 0.24 ± 0.93 mm, P = .15) were recorded. There were no major surgical complications during the 5-year period. When augmentation is required, subsequent dental implant placement in the anterior maxilla may be achieved using immediate placement and provisionalization protocol to attain osseointegration success and stable peri-implant tissue responses.

Dual jaw treatment of edentulism using implant-supported monolithic zirconia fixed prostheses.

UNLABELLED This case report describes restoration of the edentulous maxilla and mandible with implant supported fixed prostheses using monolithic zirconia, where the incisal edges and occluding surfaces were made of monolithic zirconia. Edentulism is a debilitating condition that can be treated with either a removable or fixed dental prosthesis. The most common type of implant-supported fixed prosthesis is the metal acrylic (hybrid), with ceramo-metal prostheses being used less commonly in complete edentulism. However, both of these prostheses designs are associated with reported complications of screw loosening or fracture and chipping of acrylic resin and porcelain. Monolithic zirconia implant-supported fixed prostheses have the potential for reduction of such complications. In this case, the CAD/CAM concept was utilized in fabrication of maxillary and mandibular screw-retained implant-supported fixed prostheses using monolithic zirconia. Proper treatment planning and execution coupled with utilizing advanced technologies contributes to highly esthetic results. However, long-term studies are required to guarantee a satisfactory long-term outcome of this modality of treatment. CLINICAL SIGNIFICANCE This case report describes the clinical and technical procedures involved in fabrication of maxillary and mandibular implant-supported fixed prostheses using monolithic zirconia as a treatment of edentulism, and proposes the possible advantages associated with using monolithic zirconia in eliminating dissimilar interfaces in such prostheses that are accountable for the most commonly occurring technical complication for these prostheses being chipping and fracture of the veneering material.

A multicenter randomized comparative trial of implants with different abutment interfaces to replace anterior maxillary single teeth.

PURPOSE The implant-abutment interface may affect peri-implant mucosal architecture, and influence health and esthetics. The goal of this 1-year follow-up report of a 5-year clinical investigation was to examine the peri-implant mucosal tissue responses to different implant-abutment interface designs. MATERIALS AND METHODS Subjects requiring an anterior maxillary implant were recruited. Tooth extractions, with or without preservation or ridge augmentation procedures, were performed as required. After 5 months of healing, one of three different implant-abutment combinations (conical interface [CI] n = 48); flat-to-flat interface [FI] n = 49); or platform switch interface [PS] n = 44) was placed and provisionalized. Twelve weeks later, permanent crowns were placed and data gathered throughout the first year. Peri-implant mucosal architecture and bone levels were evaluated clinically, photographically, and radiographically. RESULTS At 1 year, seven FI and six PS implants failed and two FI and two PS implant participants were lost to follow-up, resulting in survival rates of 100% (CI), 85.7% (FI), and 86.4% (PS) (90.8% overall). Marginal bone level changes were -0.22 mm (CI, P < .05), -1.2 mm (FI, P < .05), and -1.32 mm (PS, P < .05) after 1 year. Marginal bone level stability (≤ 0.5-mm bone loss or gain) was recorded for 87% (CI), 8% (FI), and 27% (PS) of implants. Measurement of midbuccal mucosal zenith and papilla positions revealed no change in the mucosal positions and 0.2 to 0.3 mm of gain in papilla dimensions in all groups. CONCLUSION Significant differences in marginal bone loss were observed among the three implant-abutment interfaces. At 1 year follow-up, changes in the buccal mucosal zenith position or papilla dimensions were not discernable. A continued longitudinal evaluation of peri-implant bone and mucosal changes around these different interfaces is ongoing.

Full-mouth rehabilitation of a patient with gastroesophageal reflux disease: a clinical report.

Gastroesophageal reflux disease (GERD) is a chronic condition caused by stomach acid regurgitating into the esophagus or oral cavity, often causing heartburn. Tooth erosion and wear are common oral manifestations of GERD. This clinical report describes the full-mouth rehabilitation of a patient with over 30 years of GERD, causing wear of maxillary and mandibular anterior teeth, along with complications associated with past restorations. Full-mouth rehabilitation of natural teeth in conjunction with dental implants was selected as the treatment option. Ideal occlusal design and optimal esthetics, along with reinforcement of oral hygiene, ensure a favorable prognosis.

A multimodal analgesic protocol may reduce opioid use after third molar surgery: A pilot study

OBJECTIVE This study was designed to assess the number of opioid doses available to patients from filled prescriptions after adoption, in 2017, of a multimodal analgesic protocol that included opioid prescribing to manage postoperative pain. STUDY DESIGN Data were retrieved from records of the first 24 patients having third molar surgery in 2017 identified from appointment schedules. Inclusion criteria were American Society of Anesthesiologists risk classification I or II, age 18 to 35 years, and at least 2 lower third molars removed. The exclusion criterion was being treated for opioid addiction/abuse. The primary outcome variable was the number of opioid doses filled by prescriptions at each patients discretion. The primary predictor variable was the multimodal analgesic protocol. RESULTS Data from records of 24 consecutive patients were analyzed; 83% were females. Median age was 25 years (interquartile range [IQR] 12-29 years). Median surgery time was 35 minutes (IQR 27-32 minutes). The median number of opioid doses filled in 2017 was 4 (IQR 0-4). CONCLUSIONS The outcomes from this pilot study suggest that implementation of a multimodal analgesic protocol to manage postoperative pain, while limiting the number of opioid doses available to the patient, may be an effective strategy for a wider range of patients and procedures.