Hilde Browaeys

Patient‐centered outcome of immediately loaded implants in the rehabilitation of fully edentulous jaws

INTRODUCTION Edentulism often involves functional, esthetic, phonetic and psychological problems. OBJECTIVES To evaluate patient-centered outcomes of full-arch screw-retained rehabilitation on immediately loaded implants. MATERIAL AND METHODS Fifty patients treated with Astra Tech(TM) implants answered self-administered questionnaires on a visual analogue scale (VAS) 100 mm scale or with multiple-choice or open questions: at baseline, 1 week, 3 or 6 months and 1 year. Changes of VAS in time were analyzed using mixed models for repeated measures, adjusting for gender, age and jaw; comparison of cross-sectional parameters between jaws was performed with the Mann-Whitney U- or chi(2)-test, all at the 0.05 significance level. RESULTS The median calculated general satisfaction score increased from 40.25 (mean=40.9; SD=23.82; range=0-95) at baseline to 98.25 (mean=95.3; SD=6.68; range=74-100) after 1 year. Overall comfort, eating comfort, speaking comfort and perceived esthetics improved significantly within 1 week after surgery and immediate provisionalization. This did not change significantly until the final bridge was installed after 3 months (mandible) or 6 months (maxilla), when a further significant improvement was demonstrated. The most common postoperative complication was swelling, especially in the maxilla. The importance of one-stage surgery and immediate loading was rated very high by patients before treatment, especially in the mandible. The main reason for choosing fixed prosthetics was eating comfort. Phonetics and esthetics were more important in the maxilla than in the mandible. CONCLUSION Immediate full-arch rehabilitation yeilds an instant significant improvement in general patient satisfaction and self-perceived factors related to comfort, function and esthetics. Eating comfort is the main concern for the patient and shows the highest improvement. Postoperative complications are limited and patients considered immediate loading important.

Healing of Extraction Sockets Filled with BoneCeramic® Prior to Implant Placement: Preliminary Histological Findings

BACKGROUND Various grafting materials have been designed to minimize edentulous ridge volume loss following tooth extraction by encouraging new bone formation in healing sockets. BoneCeramic® is a composite of hydroxyapatite and bèta-tricalcium phosphate with pores of 100-500 microns. PURPOSES The aim of this study was to evaluate bone regeneration in healing sockets substituted with BoneCeramic® prior to implant procedures. MATERIALS AND METHODS Fifteen extraction sockets were substituted with BoneCeramic® and 14 sockets were left to heal naturally in 10 patients (mean age 59.6 years). Biopsies were collected only from the implant recipient sites during surgery after healing periods ranging from 6-74 weeks (mean 22). In total, 24 biopsies were available; 10 from substituted and 14 from naturally healed sites. In one site, the implant was not placed intentionally and, in four substituted sites, implant placement had to be postponed due to inappropriate healing, hence from five sites biopsies were not available. Histological sections were examined by transmitted light microscope. RESULTS At the time of implant surgery, bone at substituted sites was softer than in controls, compromising initial implant stability. New bone formation at substituted sites was consistently poorer than in controls, presenting predominantly loose connective tissue and less woven bone. CONCLUSION The use of BoneCeramic® as a grafting material in fresh extraction sockets appears to interfere with normal healing processes of the alveolar bone. On the basis of the present preliminary findings, its indication as a material for bone augmentation, when implant placement is considered within 6-38 weeks after extraction, should be revised.

Ongoing Crestal Bone Loss around Implants Subjected to Computer-Guided Flapless Surgery and Immediate Loading Using the All-on-4® Concept.

BACKGROUND The All-on-4(®) concept is widely applied for full-arch rehabilitations, using two tilted and two axially loaded implants in order to overcome anatomical constraints. PURPOSE The aim of this study was to assess the survival and individual success of implants immediately loaded with an All-on-4 full-arch screw-retained prosthetic bridge in fully edentulous mandibles or maxillae over up to 3 years. MATERIALS AND METHODS In total, 20 patients with atrophic jaws (9 maxillae, 11 mandibles) were treated with computer-guided flapless surgery and immediately provided with a provisional bridge. The final prosthesis was delivered after 6 months. In total, 80 TiUnite(™) Brånemark implants were placed. Radiographs were taken after surgery and 1 and 3 years later. RESULTS A 3-year survival rate of 100% was seen for all implants, both in lower and in upper jaw. None of the temporary or definite prostheses were lost over the follow-up period of 3 years. After 1 year, the mean bone loss was 1.13 mm (SD 0.94; range -0.1 to 3.8), and after 3 years, it was 1.61 mm (SD 1.40; range 0 to 5). The mean bone loss between the 1-year and 3-year follow-ups was 0.48 mm (SD 0.66; range -1.2 to 3.6). This difference was statistically significant (p < .001), indicative of ongoing bone loss. Twenty-six percent of the implants had bone loss above 1.5 mm after 1 year, but after 3 years, 30% of the implants had already lost more than 1.9 mm. CONCLUSION The implant and prosthetic survival was 100%, and patients benefited from the All-on-4 treatment. However, unacceptable ongoing bone loss was seen in 49.2% of the patients; this may be a warning sign for future problems and needs clinical attention. Overloading and surgery-related aspects need to be investigated as potential explanations.

Factors Associated with Failure of Surface-Modified Implants up to Four Years of Function

OBJECTIVES The relative impact of innovative treatment concepts on the failure of surface-modified implants is not well understood. This retrospective study aimed to explore this using data obtained in a university postgraduate training center. MATERIAL AND METHODS Patients treated with implants for a variety of indications over a 3-year period were included. All implants had been at least 1 year in function. Clinical records were evaluated for implant failure and in reference to implant length/diameter/location, time from tooth loss to implant placement, bone condition (native/grafted), surgical protocol (two-/one-stage), loading protocol (delayed/early/immediate), type of prosthesis (removable/fixed), surgeons experience level (resident/trainee) and specialty (periodontist/oral surgeon). The impact of each covariate on failure was tested using the Fishers exact test. Kaplan-Meier survival functions were constructed and Mantel-Cox log-rank tests were used to compare survival functions. To correct for possible interaction, Cox proportional Hazards regression was adopted. RESULTS Forty-one of 1,180 (3.5%) implants were lost in 34/461 (7.4%) patients (245 ♀, 216 ♂; mean age 51, range 18-90). Factors showing significant impact on failure on the basis of univariate analyses were implant location (p = .015), surgical protocol (p = .002), loading protocol (p = .002), surgeons experience level (p = .035) and specialty (p = .001). When controlling for other covariates, only the loading protocol had a significant influence (p = .049) with early loading more prone to failure (p = .014) when compared with delayed loading. Immediate loading and delayed loading showed comparable implant survival (p = .311). CONCLUSIONS Implant therapy may be highly successful in a training center where inexperienced clinicians are strictly monitored and personally guided. Implant specific variables do not affect implant survival but early loading is a risk indicator for implant failure, whereas immediate loading is not.

Comparison of speech intelligibility, articulation and oromyofunctional behaviour in subjects with single‐tooth implants, fixed implant prosthetics or conventional removable prostheses

The purpose of this controlled study was to determine the impact of a single-tooth implant, fixed implant prosthesis and completely removable dental prosthesis on intelligibility, articulation and oromyofunctional behaviour. Additionally, the self-perceived overall satisfaction of the dental replacements and the effect on speech was questioned. Objective (acoustic analysis) as well as subjective assessment techniques (perceptual evaluation) were used. The satisfaction of single-tooth implant group was very high (100%) followed by a satisfaction of 87% for the fixed implant prosthesis group and 68% for the removable prosthesis group. The results of the phonetic analyses revealed a normal intelligibility and oromyofunctional behaviour in the three groups of dental replacements. Only one type of articulation disorders was observed in the single-tooth implant group, followed by three types of disorders in the removable prosthesis group and six types of disorders in the fixed implant prosthesis group. In this last group, not only 87% of the subjects showed distortions of one or more consonants but also most consonants of the Dutch language were disturbed in comparison with the single-tooth implant and removable prosthesis users. Special attention must be paid to the fricative /s/ because in more than 50% of all groups, this sound is disturbed.

Impact of fixed implant prosthetics using the 'all-on- four' treatment concept on speech intelligibility, articulation and oromyofunctional behaviour

The purpose of this case control study is to determine the impact of screw-retained fixed cross-arch prostheses, supported by four osseointegrated implants, on articulation and oromyofunctional behaviour. Objective (acoustic analysis) and subjective assessment techniques were used to determine the overall intelligibility, phonetic characteristics and oromyofunctional behaviour at an average period of 7.3 months after placement of the fixed implant prosthesis in 15 patients and 9 age-matched controls with intact dentition and without prosthetic appliances. Overall satisfaction with the prosthesis was 87%, but 53% of the subjects mentioned an impact on speech. 87% of the subjects presented with one or more distortions of the consonants. The most common distortions were distortions of the sound /s/ (sigmatismus simplex, 40% and sigmatismus stridens, 33%), simplex /z/ (27%), insufficient frication of /f/ (20%), /[symbol in text]/ (20%), addental production of /d/ (20%), /t/ (20%) or /s/ sound (13%) and devoiced /d/ (7%). In the control group, no articulation disorders were noted. Oromyofunctional behaviour in both groups was normal. To what extent motor-oriented speech therapy (with focus on tongue function) immediately after periodontal treatment (after wound healing) would decrease the persistent phonetic distortions is a subject for further research.

Peri-implant outcome of immediately loaded implants with a full-arch implant fixed denture: a 5-year prospective case series.

This prospective study evaluated clinical results of immediately loaded Biomet 3i implants with different surface topographies. Thirty-three periodontally compromised patients received 163 implants (130 in the maxilla and 33 in the mandible; 132 NanoTite and 31 Osseotite). After a mean loading period of 57 months, the survival rate was 96.3%. Mean crestal bone loss was 1.6 mm. No difference in bone loss was detected between the two surfaces. Only 6% of the implants had peri-implantitis based on total bone loss above 2 mm from the day of surgery in conjunction with probing depths of > 4 mm.

Impact of anterior single-tooth implants on quality of life, articulation and oromyofunctional behaviour: a pilot study

The main purpose of this study is to determine the impact (one and a half year after implantation) of a single-tooth implant on articulation and oromyofunctional behaviour. This information is important for dentists, orthodontists or stomatologists who treat professional speakers. Objective (acoustic analysis) as well as subjective (questionnaire, phonetic inventory, phonetic analysis, oromyofunctional assessment of lip and tongue function, blowing, sucking and swallowing) assessment techniques were used to determine the quality of life, articulation and oromyofunctional behaviour. Fourteen subjects who received a single-tooth implant and a control group of nine subjects participated in this study. The mean overall satisfaction of single-implant users was 95%. The subjects who received a single-tooth implant were capable of producing all Dutch vowels and consonants. The phonetic analysis revealed a sigmatism in 57% of the cases. Sigmatisms (stridens sigmatism followed by simplex sigmatism) were the most frequently observed phonetic disorders. There was interobserver agreement about normal lip and tongue functions. Moreover, blowing, sucking and swallowing patterns were normal (concordance value 96%). Detailed analyses 1 or 2 years after implantation of an anterior single-tooth implant revealed normal speech intelligibility and oromyofunctional behaviour. Articulation was characterised by the presence of a persistent phonetic disorder. Further research involving more subjects with an anterior single-tooth implant is needed.

Ventral Onlay Graft Urethroplasty Using Genital Skin or Buccal Mucosa in the Treatment of Bulbar Strictures: A Retrospective Analysis of 41 Cases

Background: The aim of this study was to evaluate the success of ventral onlay urethroplasty in the treatment of bulbar urethral strictures. Patients and Methods: The files of patients with bulbar stricture-disease treated with ventral onlay urethroplasty between January 2000 and July 2004 were retrospectively analysed. Forty-one patients with a mean age of 44.7 years (range 14–76 years) were included. Genital skin was used as a graft in 33 patients and buccal mucosa in 8 patients. The median follow-up was 3 years (range 1–5 years). If recurrence was suspected (clinical and/or on uroflowmetry), urethrography was performed. Need for any further instrumentation or re-operation was considered as a failure. Results: The mean stricture length was 5.2 cm (range 3–8 cm). Two complications (4.9%) were noted: 1 patient developed orchiepididymitis and another suffered from neuralgic pain in the region of the ischial nerve. Three patients (2 genital skins, 1 buccal mucosa) developed a recurrence of the stricture-disease. The final success rate was 92.7%. Conclusion: Ventral onlay urethroplasty remains a good technique in the treatment of bulbar urethral strictures that can not be treated with end-to-end anastomosis.