James J.R. Huddleston Slater

Treatment outcome of immediate, early and conventional single-tooth implants in the aesthetic zone: a systematic review to survival, bone level, soft-tissue, aesthetics and patient satisfaction

AIM This study evaluated, through a systematic review of the literature, the outcome of single-implant restorations in the aesthetic zone with natural adjacent teeth, thereby addressing immediate, early and conventional implant approaches. MATERIAL AND METHODS MEDLINE (1950-2008), EMBASE (1966-2008), and CENTRAL (1800-2008) were searched to identify eligible studies. Two reviewers independently assessed the methodological quality using specific study-design-related assessment forms. RESULTS Out of 86 primarily selected articles, 19 studies fulfilled the inclusion criteria. A meta-analysis showed an overall survival rate of 95.5% [95% confidence interval: (93.0-97.1)] after 1 year. A stratified meta-analysis revealed no differences in survival between immediate, early and conventional implant strategies. Little marginal peri-implant bone resorption was found together with low incidence of biological and technical complications. No significant differences in outcome measures were reported in clinical trials comparing immediate, early or conventional implant strategies. CONCLUSION The included literature suggested that promising short-term results could be achieved for immediate, early and conventional single-implants in the aesthetic zone. However, important parameters as aesthetic outcome, soft-tissue aspects, and patient satisfaction were clearly underexposed. The question whether immediate and early single-implant therapies would result in better treatment outcomes remained inconclusive due to lack of well-designed controlled clinical studies.

Health-related quality of life, employment and disability in patients with Sjögren's syndrome

OBJECTIVE To compare health-related quality of life (HR-QOL), employment and disability of primary and secondary SS (pSS and sSS, respectively) patients with the general Dutch population. METHODS HR-QOL, employment and disability were assessed in SS patients regularly attending the University Medical Center Groningen (n = 235). HR-QOL, employment and disability were evaluated with the Short Form-36 questionnaire (SF-36) and an employment and disability questionnaire. Results were compared with Dutch population data (matched for sex and age). Demographical and clinical data associated with HR-QOL, employment and disability were assessed. RESULTS Response rate was 83%. SS patients scored lower on HR-QOL than the general Dutch population. sSS patients scored lower on physical functioning, bodily pain and general health than pSS patients. Predictors for reduced HR-QOL were fatigue, tendomyalgia, articular involvement, use of artificial saliva, use of anti-depressants, comorbidity, male sex and eligibility for disability compensation (DC). Employment was lower and DC rates were higher in SS patients compared with the Dutch population. CONCLUSION SS has a large impact on HR-QOL, employment and disability.

A systematic review of the prognosis of short (<10 mm) dental implants placed in the partially edentulous patient

AIM This study evaluated, through a systematic review of the literature, the estimated implant survival rate of short (<10 mm) dental implants installed in partially edentulous patients. MATERIALS AND METHODS A systematic search was conducted in the electronic databases of MEDLINE (1980-October 2009) and EMBASE (1980-October 2009) to identify eligible studies. Two reviewers independently assessed the methodological quality of the articles using specific study design-related quality assessment forms. RESULTS Twenty-nine methodologically acceptable studies were selected. A total of 2611 short implants (lengths 5-9.5 mm) were analysed. An increase in implant length was associated with an increase in implant survival (from 93.1% to 98.6%). Heterogeneity between studies was explored by subgroup analyses. The cumulative estimated failure rate of studies performed in the maxilla was 0.010 implants/year, compared with 0.003 found in the studies in the mandible. For studies that also included smokers, the failure rate was 0.008 compared with 0.004 found in studies that excluded smokers. Surface topography and augmentation procedure were not sources of heterogeneity. CONCLUSION There is fair evidence that short (<10 mm) implants can be placed successfully in the partially edentulous patient, although with a tendency towards an increasing survival rate per implant length, and the prognosis may be better in the mandible of non smoking patients.

Accuracy of linear measurements from cone-beam computed tomography-derived surface models of different voxel sizes.

INTRODUCTION The aims of this study were to determine the linear accuracy of 3-dimensional surface models derived from a commercially available cone-beam computed tomography (CBCT) dental imaging system and volumetric rendering software and to investigate the influence of voxel resolution on the linear accuracy of CBCT surface models. METHODS Glass sphere markers were fixed on 10 dry mandibles. The mandibles were scanned with 0.40 and 0.25 voxel size resolutions in 3 sessions. Anatomic truth was established with 6 direct digital caliper measurements. The surface models were rendered by a volumetric rendering program, and the CBCT measurements were established as the mean of the 3 measurements. RESULTS The intraclass correlation coefficients between the physical measurements and the measurements of the CBCT images of 0.40 and 0.25 voxels were all more than 0.99. All CBCT measurements were accurate. There was no difference between the accuracy of the measurements between the 0.40 and 0.25 voxel size groups. The smallest detectable differences of the CBCT measurements were minimal, confirming the accuracy of the CBCT measurement procedure. CONCLUSIONS The measurements on 3-dimensional surface models of 0.25 and 0.40 voxel size data sets made with the 3D eXam CBCT scanner (KaVo Dental GmbH, Bismarckring, Germany) and SimPlant Ortho Pro software (version 2.00, Materialise Dental, Leuven, Belgium) are accurate compared with direct caliper measurements. An increased voxel resolution did not result in greater accuracy of the surface model measurments.

A systematic review of implant-supported maxillary overdentures after a mean observation period of at least 1 year

AIM The aim of the present systematic review of implant-supported maxillary overdentures was to assess the survival of implants, survival of maxillary overdentures and the condition of surrounding hard and soft tissues after a mean observation period of at least 1 year. MATERIAL AND METHODS MEDLINE (1950-August 2009), EMBASE (1966-August 2009) and CENTRAL (1800-August 2009) were searched to identify eligible studies. Two reviewers independently assessed the articles. RESULTS Out of 147 primarily selected articles, 31 studies fulfilled the inclusion criteria. A meta-analysis showed an implant survival rate (SR) of 98.2% per year in case of six implants and a bar anchorage. In case of four implants and a bar anchorage, the implant SR was 96.3% per person. In case of four implants and a ball anchorage, the implant SR was 95.2% per year. CONCLUSION In all three treatment options, the SR of the implants is more than 95%. The studies included reveal that a maxillary overdenture supported by six dental implants, which are connected with a bar, is the most successful treatment regarding survival of both the implants and overdenture. Second in line is the treatment option with four implants and a bar. The treatment option with four or less implants and a ball attachment system is the least successful.

Oral Appliance Versus Continuous Positive Airway Pressure in Obstructive Sleep Apnea Syndrome: A 2-Year Follow-up

STUDY OBJECTIVES Oral appliance therapy has emerged as an important alternative to continuous positive airway pressure (CPAP) in treating patients with obstructive sleep apnea syndrome (OSAS). In this study we report about the subjective and objective treatment outcome of oral appliance therapy and CPAP in patients with OSAS. DESIGN Cohort study of a previously conducted randomized clinical trial. SETTING University Medical Center, Groningen, The Netherlands. PATIENTS OR PARTICIPANTS One hundred three patients with OSAS. INTERVENTIONS CPAP and oral appliance therapy (Thornton Adjustable Positioner type-1, Airway Management, Inc., Dallas, TX, USA). MEASUREMENTS AND RESULTS Objective (polysomnography) and subjective (Epworth Sleepiness Scale, Functional Outcomes of Sleep Questionnaire, Medical Outcomes Study 36-item Short Form Health Survey [SF-36]) parameters were assessed after 1 and 2 years of treatment. Treatment was considered successful when the apnea-hypopnea index (AHI) was < 5 or showed substantial reduction, defined as reduction in the index of at least 50% from the baseline value to a value of < 20 in a patient without OSAS symptoms while undergoing therapy. Regarding the proportions of successful treatments, no significant difference was found between oral appliance therapy and CPAP in treating mild to severe OSAS in a 2-year follow-up. More patients (not significant) dropped out under oral appliance therapy (47%) compared with CPAP (33%). Both therapies showed substantial improvements in polysomnographic and neurobehavioral outcomes. However, CPAP was more effective in lowering the AHI and showed higher oxyhemoglobin saturation levels compared to oral appliance therapy (P < 0.05). CONCLUSIONS Oral appliance therapy should be considered as a viable treatment alternative to continuous positive airway pressure (CPAP) in patients with mild to moderate obstructive sleep apnea syndrome (OSAS). In patients with severe OSAS, CPAP remains the treatment of first choice. CLINICAL TRIAL INFORMATION The original randomized clinical trial, of which this study is a 2-year follow-up, is registered at ISRCTN.org; identifier: ISRCTN18174167; trial name: Management of the obstructive sleep apnea-hypopnea syndrome: oral appliance versus continuous positive airway pressure therapy; URL: http://www.controlled-trials.com/ISRCTN18174167.

Single-tooth implants with different neck designs: a randomized clinical trial evaluating the aesthetic outcome

AIM To evaluate the aesthetic outcome of single-tooth implants in the aesthetic zone with different neck designs from a professionals and patients perception. MATERIALS AND METHODS Ninety-three patients with a missing anterior tooth in the maxilla were randomly assigned to be treated with an implant with a smooth neck, a rough neck with grooves or a scalloped rough neck with grooves. Implants were installed in healed sites. One year after definitive crown placement (18 months post-implant placement), photographs were taken and the aesthetic outcome was assessed according to two objective aesthetic indexes: pink esthetic score/white esthetic score (PES/WES) and implant crown aesthetic index (ICAI). A questionnaire was used to assess the aesthetic outcome and general satisfaction from a patients perception. standardized radiographs were taken to measure marginal bone level changes. RESULTS One implant was lost. Although there was a significant difference in marginal bone loss between the different implant neck designs (smooth neck 1.19±0.82mm, rough neck 0.90±0.57mm, scalloped neck 2.01±0.77mm), there were no differences in aesthetic outcome. According to the professionals assessments using PES/WES and ICAI, 79.3% and 62% of the cases showed acceptable crown aesthetics, and 59.8% and 56.5% of the cases showed acceptable mucosa aesthetics. Overall, patients were satisfied about the aesthetics of the mucosa (81.5%) and crown (93.3%), and general patient satisfaction was high (9.0±1.0 out of a maximum of 10). According to the professionals assessment, a pre-implant augmentation procedure was associated with less favorable aesthetics of the mucosa. CONCLUSION This study shows that the aesthetics of single-tooth implants in the maxillary aesthetic zone appears to be independent of the implant neck designs applied but dependent on the need for pre-implant surgery.

Reliability and the smallest detectable differences of lateral cephalometric measurements

INTRODUCTION The aim of this study was to determine the reliability and the measuring error (by means of the smallest detectable error) of 11 angular and 4 linear measurements commonly used for cephalometric analysis. METHODS Twenty-five digital lateral cephalograms were randomly selected and traced with Viewbox software (version 3.1.1.13, dHAL Software, Kifissia, Greece). This was repeated 3 times by 2 observers during 3 sessions. There was at least 1 week between each session. Differences were analyzed with a repeated measurement analysis of variance (ANOVA). Intraobserver and interobserver reliabilities were calculated with intraclass correlation coefficients (ICC) based on absolute agreement. Measurement error was determined by means of the smallest detectable difference. RESULTS The intraobserver agreement of the measurements was good (ICC >0.82). SNA, SNB, ANB, and ANS-Me had the smallest intraobserver errors for both observers (>1.86 mm or degrees). Except for SN-FH (ICC = 0.76), interobserver agreement was good (ICC >0.87). CONCLUSIONS Determining the appropriate measuring error of cephalometric measurements by means of the smallest detectable difference is necessary to find the true difference between the start and the end of active treatment. Depending on the magnitude of clinical significance, the measuring error was possibly clinically significant for all variables tested and, therefore, questions the use of these variables to detect the true treatment effect.

Comparison between conventional and piezoelectric surgical tools for maxillary sinus floor elevation: a randomized controlled clinical trial

AIM The aim of this study was to assess the performance of conventional rotative instruments and a piezoelectric device for maxillary sinus floor elevation surgery, and to assess whether application of a resorbable membrane reduces resorption of an augmented site in a randomized clinical trial. MATERIALS AND METHODS Thirty-six consecutive patients (59.2 ± 10.7 years, range 38-76 years) needing bilateral sinus floor elevation surgery agreed to participate in this study. In a parallel split mouth design randomized clinical trial, in which the allocation of the surgical technique to be used on the determined sites was randomly assigned, one site was always treated with conventional rotative instruments (control group) and the other site with piezosurgery (test group). In addition, in a random order, the grafted sites were covered with a collagen membrane or no membrane. After a healing period of 3-4 months implants were placed. RESULTS Comparison of clinical features of the test and control sites revealed no differences with regard to wound healing and complications (perforations of the sinus membrane) during or postsurgery (p = .458, p = 1.0, respectively). A clinically insignificant, but statistically shorter operation time was observed when using conventional rotative instruments (11.1 ± 2.4 minutes) than using piezosurgery (15.1 ± 2.9 minutes; p < .001). In both groups, application of a resorbable membrane did not result in less horizontal bone resorption (membrane: 1.43 mm, no membrane: 1.06 mm; p = .062); All 193 implants could be placed with primary stability. One year after functional loading, survival rate was 100%. CONCLUSION It can be concluded that, for maxillary sinus floor elevation surgery, a piezoelectric device shows no advantages over rotative instruments as well as that placement of a barrier membrane did not reduce resorption of the augmented site.

Lavage Therapy Versus Nonsurgical Therapy for the Treatment of Arthralgia of the Temporomandibular Joint : A Systematic Review of Randomized Controlled Trials

AIMS To carry out a systematic review of randomized controlled trials (RCTs) to investigate in patients with arthralgia of the temporomandibular joint (TMJ) the effectiveness of TMJ lavage compared to nonsurgical treatment with regard to pain intensity and mandibular range of motion. METHODS The electronic databases Cochrane Controlled Trials Register (1960-2012), PubMed÷Medline (1966-2012), and Embase (1966-2012) were systematically searched for relevant RCTs. References of relevant articles were searched for additional studies, as well as citing reports. Two authors independently performed data extraction by using predefined quality indicators. Relevant outcome data included reduction in pain, as assessed by a visual analog scale (VAS) or a pain score, and maximal mouth opening (MMO) before and 6 months after treatment. Included trials were combined using fixed and random effects meta-analysis. RESULTS Three RCTs (222 patients) were included for meta-analysis. The statistically significant overall standardized mean difference (SMD) (P < .001) with regard to pain intensity was -1.07 (95% CI = -1.38, - 0.76) in favor of TMJ lavage. The MMO did not change significantly (P > .05, SMD = .05 [95% CI = -0.33, 0.23]). CONCLUSIONS The results suggest that lavage of the TMJ may be slightly more effective than nonsurgical treatment for pain reduction. However, this difference is not likely to be clinically relevant.