Sara A. Alfadda

A randomized controlled clinical trial of edentulous patients treated with immediately loaded implant-supported mandibular fixed prostheses.

PURPOSE A 1-year blinded two-arm parallel randomized controlled clinical trial was conducted to test the null hypothesis that immediate loading of four dental implants between the mental foramina with a fixed prosthesis has no benefits compared with the conventional loading technique in terms of implant success and clinical function. MATERIALS AND METHODS Forty-five patients, completely edentulous in the mandibles seeking implant-supported prostheses at the Faculty of Dentistry, University of Toronto, were recruited. Four TiUnite dental implants (NobelBiocare®, Göteborg, Sweden) were placed following the one-stage surgical protocol. Immediately after surgery, the patients were randomly assigned to either study arms by a third independent party. In the experimental arm (EA), existing mandibular denture was converted into an interim implant-supported fixed bridge (ISFB) on the same day of surgery. In the control arm (CA), the mandibular denture was hollowed out and relined with a soft tissue reline. The implants were loaded with the permanent ISFB at least 3 months postsurgery. Patients were assessed by a calibrated independent investigator at 2, 6, and 12 months following completion of treatment. RESULTS A total of one hundred sixty implants were placed. Due to anatomical limitations, one patient was excluded from the study. Four patients in the EA did not receive intervention as allocated and were transferred to the CA. Implant success rate was comparable between the two arms and exceeded 96%. Marginal bone loss was statistically significantly more in the immediate loading arm, -0.296 mm versus -0.037 mm (intention to treat: p = .002; per protocol: p = .021). The relatively early intervention and insertion of the final prosthesis in the immediate arm, when bone healing and remodeling process had not yet been completed, might explain the difference in the amount of bone loss. CONCLUSION Immediate loading of four dental implants with a fixed prosthesis in the edentulous mandible is a feasible treatment option and leads to a substantial improvement in perceived oral health status.Purpose A 1-year blinded two-arm parallel randomized controlled clinical trial was conducted to test the null hypothesis that immediate loading of four dental implants between the mental foramina with a fixed prosthesis has no benefits compared with the conventional loading technique in terms of implant success and clinical function. Materials and Methods Forty-five patients, completely edentulous in the mandibles seeking implant-supported prostheses at the Faculty of Dentistry, University of Toronto, were recruited. Four TiUnite dental implants (NobelBiocare®, Goteborg, Sweden) were placed following the one-stage surgical protocol. Immediately after surgery, the patients were randomly assigned to either study arms by a third independent party. In the experimental arm (EA), existing mandibular denture was converted into an interim implant-supported fixed bridge (ISFB) on the same day of surgery. In the control arm (CA), the mandibular denture was hollowed out and relined with a soft tissue reline. The implants were loaded with the permanent ISFB at least 3 months postsurgery. Patients were assessed by a calibrated independent investigator at 2, 6, and 12 months following completion of treatment. Results A total of one hundred sixty implants were placed. Due to anatomical limitations, one patient was excluded from the study. Four patients in the EA did not receive intervention as allocated and were transferred to the CA. Implant success rate was comparable between the two arms and exceeded 96%. Marginal bone loss was statistically significantly more in the immediate loading arm, −0.296 mm versus −0.037 mm (intention to treat: p = .002; per protocol: p = .021). The relatively early intervention and insertion of the final prosthesis in the immediate arm, when bone healing and remodeling process had not yet been completed, might explain the difference in the amount of bone loss. Conclusion Immediate loading of four dental implants with a fixed prosthesis in the edentulous mandible is a feasible treatment option and leads to a substantial improvement in perceived oral health status.

Vertical marginal gap evaluation of conventional cast and computer numeric controlled-milled titanium full-arch implant-supported frameworks.

PURPOSE To use a novel approach to measure the amount of vertical marginal gap in computer numeric controlled (CNC)-milled titanium frameworks and conventional cast frameworks. MATERIALS AND METHODS Ten cast frameworks were fabricated on the mandibular master casts of 10 patients. Then, 10 CNC-milled titanium frameworks were fabricated by laser scanning the cast frameworks. The vertical marginal gap was measured and analyzed using the Contura-G2 coordinate measuring machine and special computer software. RESULTS The CNC-milled titanium frameworks showed an overall reduced mean vertical gap compared with the cast frameworks in all five analogs. This difference was highly statistically significant in the distal analogs. The largest mean gap in the cast framework was recorded in the most distal analogs, and the least amount was in the middle analog. CONCLUSIONS Neither of the two types of frameworks provided a completely gap-free superstructure. The CNCmilled titanium frameworks showed a significantly smaller vertical marginal gap than the cast frameworks.

Do Ultra-Low Multidetector Computed Tomography Doses and Iterative Reconstruction Techniques Affect Subjective Classification of Bone Type at Dental Implant Sites?

PURPOSE To investigate whether ultra-low-dose multidetector computed tomography (MDCT) combined with the reconstruction techniques filtered backprojection (FBP), adaptive statistical iterative reconstruction (ASIR), or model-based iterative reconstruction (MBIR) alters the subjective classification of revised Lekholm and Zarb (LZ) bone types at prospective dental implant sites. MATERIALS AND METHODS Three cadavers underwent a reference MDCT examination using a standard dose volume (CT dose index [CTDIvol]: 29.4 mGy) and reconstructed with FBP in addition to five test protocols (LD1-LD5) using ultra-low doses (CTDIvol: 4.19, 2.64, 0.99, 0.53, and 0.29 mGy, respectively) and reconstructed with FBP, ASIR 50, ASIR 100, and MBIR. Transverse cross-sectional images of the jawbones were obtained, and three examiners subjectively classified the bone type in each image using the revised LZ classification. The bone type classifications obtained using the reference examination were compared with those obtained from the test protocols for each examiner, and kappa statistic was used to analyze the level of agreement between the reference and test protocols. The clinical significance of the differences was analyzed with Wilcoxon signed rank test. RESULTS Examiners 1 and 2 found moderate to strong agreement between the reference and test protocols, while Examiner 3 found strong to almost perfect agreement (P < .001). The Wilcoxon signed rank test did not demonstrate a clinical significance of the differences between the reference and test protocols for any of the three examiners. CONCLUSION MDCT dose reductions of up to 99% did not significantly alter the subjective classification of bone at dental implant sites.

Comparison of Clinical, Radiographic, and Immunologic Inflammatory Parameters around Crestally and Subcrestally Placed Dental Implants: 5‐Year Retrospective Results

PURPOSE To compare changes in clinical (bleeding on probing [BOP] and probing pocket depth [PPD]), radiographic (crestal bone loss [CBL]), and immunologic inflammatory (interleukin-1beta [IL-1β] and matrix metalloproteinase-9 [MMP-9]) parameters around crestally and subcrestally placed dental implants 5 years after implant placement. MATERIALS AND METHODS Fifty-two patients were divided into 2 groups: group 1 (n = 27): patients with single implants placed approximately 2 mm below the alveolar crest; group 2 (n = 25): patients with single implants placed at bone level. In both groups, peri-implant BOP, PPD, and CBL were measured, and levels of IL-1β and MMP-9 were determined in duplicates using enzyme-linked immunosorbent assay. Full-mouth debridement was performed biannually in both groups. Statistical analysis was performed using the Mann-Whitney U test (significance set at p < 0.05). RESULTS All measurements in groups 1 and 2 were performed 5.3 ± 0.2 and 5.2 ± 0.1 years after implant placement, respectively. The mean CBL was 1.2 ± 0.2 mm and 1.4 ± 0.2 mm in groups 1 and 2, respectively. There was no significant difference in mean BOP, PPD, CBL and in levels of IL-1β, and MMP-9 among implants in both groups. CONCLUSION Clinical, radiographic, and immunologic inflammatory parameters are comparable around crestally and subcrestally placed single dental implants up to 5 years after placement. The depth of implant placement appears to have no effect on clinical status and performance of single dental implants.

A clinical investigation of the relationship between the quality of conventional complete dentures and the patients' quality of life

Objective The purpose of this study was to determine whether there is a correlation between the clinical quality of conventional complete dentures and patient quality of life. Materials and methods This study included a random sample of 32 completely edentulous patients (15 males and 17 females) who were treated with conventional complete dentures. Using a validated questionnaire, three investigators evaluated the dentures independently on the basis of seven clinical parameters: esthetics (lip support and lower lip line), retention and stability of the maxillary and the mandibular dentures, and occlusion. Patients completed the validated Oral Health Impact Profile-20 (OHIP-20) questionnaire. Correlations were determined by using the point-biserial correlation coefficient. Results Clinicians rated the overall clinical quality of the dentures satisfactory in 80.3% of patients. The mean (±standard deviation) total OHIP-20 score was 56.3 ± 15.9 out of a possible 120 maximum. A statistically significant negative correlation was found between the stability of the maxillary and mandibular dentures and the total OHIP-20 score (p = 0.009 and 0.0023, respectively). A negative correlation between the total OHIP-20 score and the retention of the mandibular denture approached significance (p = 0.092). Esthetics, retention of the maxillary denture, and occlusion were not correlated with patient quality of life (p > 0.169). Conclusion Stability of the maxillary and mandibular dentures is the denture quality parameter that can most significantly affect patient quality of life.

A conservative and reversible approach for restoring worn teeth: A clinical report

A 48-year-old man presented with worn dentition due to daytime bruxism. His chief concern was compromised esthetics due to short teeth. The occlusal vertical dimension was increased by 2 to 3 mm in the premolar area, and a maxillary titanium overdenture with composite resin facings was fabricated to address his concern. The advantages of this treatment, as opposed to complete coverage restorations, include preservation of tooth structure, lower cost, and shorter treatment time. Four years after insertion, the titanium overdenture continues to function successfully and to address the patients concerns.

Comparison of Clinical, Radiographic, and Immunologic Inflammatory Parameters around Crestally and Subcrestally Placed Dental Implants: 5-Year Retrospective Results: Depth of Placement and Peri-Implant Inflammation

PURPOSE To compare changes in clinical (bleeding on probing [BOP] and probing pocket depth [PPD]), radiographic (crestal bone loss [CBL]), and immunologic inflammatory (interleukin-1beta [IL-1β] and matrix metalloproteinase-9 [MMP-9]) parameters around crestally and subcrestally placed dental implants 5 years after implant placement. MATERIALS AND METHODS Fifty-two patients were divided into 2 groups: group 1 (n = 27): patients with single implants placed approximately 2 mm below the alveolar crest; group 2 (n = 25): patients with single implants placed at bone level. In both groups, peri-implant BOP, PPD, and CBL were measured, and levels of IL-1β and MMP-9 were determined in duplicates using enzyme-linked immunosorbent assay. Full-mouth debridement was performed biannually in both groups. Statistical analysis was performed using the Mann-Whitney U test (significance set at p < 0.05). RESULTS All measurements in groups 1 and 2 were performed 5.3 ± 0.2 and 5.2 ± 0.1 years after implant placement, respectively. The mean CBL was 1.2 ± 0.2 mm and 1.4 ± 0.2 mm in groups 1 and 2, respectively. There was no significant difference in mean BOP, PPD, CBL and in levels of IL-1β, and MMP-9 among implants in both groups. CONCLUSION Clinical, radiographic, and immunologic inflammatory parameters are comparable around crestally and subcrestally placed single dental implants up to 5 years after placement. The depth of implant placement appears to have no effect on clinical status and performance of single dental implants.

Internal Adaptation of Implant-Supported, Polymer-Infused Ceramic Crowns Fabricated by Two CAD/CAM Systems: 3D fit of CAD/CAM crowns

PURPOSE The aim of this in vitro study was to compare the internal 3D adaptation of polymer-infused ceramic crowns fabricated using two CAD/CAM systems: CEREC inLab MC XL and Ceramill Motion 2 (5X). MATERIALS AND METHODS Twenty-five implant-supported metal-ceramic crowns were fabricated conventionally using the lost-wax technique, and the outer contour was scanned to serve as a guide for designing the polymer-infused ceramic CAD/CAM crowns. Twenty-five crowns were fabricated using CEREC, and 25 crowns were fabricated using Ceramill. The cement space was set to 20 μm. The Zeiss Accura Microsystem Coordinate Measuring Machine (CMM), Calypso, and Geomagic software were used to measure the 3D accuracy of fit of all crowns to their respective implant abutments. To test for the statistical significance between groups in terms of 3D total distortion, a one-way ANOVA was conducted. The Kolmogorov-Smirnov test was used to investigate the differences in the x, y, and z coordinates. A p-value of 0.05 or less was considered statistically significant at an alpha level of 0.05. RESULTS Comparing the 3D misfit of metal-ceramic crowns to those of CAD/CAM crowns fabricated using CEREC revealed no significant difference (88.20 ± 36.59 μm vs. 102.45 ± 36.58 μm, p = 0.161). Similarly, no significant difference in 3D total distortion was identified between metal-ceramic crowns and crowns fabricated using Ceramill (88.20 ± 36.59 μm vs. 78.40 ± 31.03 μm, p = 0.336); however, the 3D total distortion of polymer-infused crowns made by Ceramill was significantly reduced compared to that of crowns fabricated by CEREC (78.3 ± 31.0 μm vs. 102.4 ± 36.5 μm, p = 0.019). CONCLUSIONS Polymer-infused ceramic crowns fabricated using CEREC exhibited the least accurate 3D fit. All misfit values of the tested groups were within clinically acceptable levels.

Revised, Computed Tomography–Based Lekholm and Zarb Jawbone Quality Classification

PURPOSE To propose a revised Lekholm and Zarb classification that takes into account all possible combinations of compact and trabecular bone and to provide guidelines for increased reproducibility of the classification. MATERIALS AND METHODS Three new classes were added to the previous classification. The new classes have been designated as subclasses of bone types 2 and 3, as follows: Type 2b: Thick layer of compact bone surrounding a core of medium-density trabecular bone; Type 2c: Thick layer of compact bone surrounding a core of low-density trabecular bone; and Type 3b: Thin layer of compact bone surrounding a core of medium-density trabecular bone. Three interpretation guidelines were recommended to increase the reproducibility of the revised classification. Three experienced examiners were trained using the revised classification and provided with computed tomography (CT) sectional images of edentulous jawbones for classification. Each examiner classified the images twice with at least a 1-week interval. The intra-observer agreement was measured. RESULTS The kappa statistic for the intra-observer agreement of the examiners ranged from 0.835 to 0.919 (P < .001). CONCLUSION The high reproducibility of the proposed revised CT-based Lekholm and Zarb classification obtained in the current study suggests its efficacy in distinguishing between the various combinations of compact and trabecular bone.

Knowledge, attitude and practice of antibiotic use and misuse among adults in Riyadh, Saudi Arabia

Objectives: To assess the knowledge, attitude, and practice of antibiotics (ABs) use and misuse among adults living in Riyadh, Saudi Arabia. Methods: In this cross-sectional study, a self-administered questionnaire was distributed to participants from March 2016 to January 2017 in the outpatient department of King Khalid University Hospital and Dental Hospital, King Saud University, Riyadh, Saudi Arabia. The questionnaire was divided into 4 sections. The first and second section inquired regarding demographic details and knowledge of ABs. The third section assessed practice of ABs and the fourth section assessed attitude of participants towards ABs use. Questionnaires were hand delivered to respondents using convenience sampling. Statistical analysis using frequency distributions and knowledge responses of AB resistance for ‘yes’ and ‘no’ were associated with participant characteristics using Chi-square test. Results: A total of 1966 questionnaires were completed (response rate: 93.5%). Sixty-seven percent of the respondents were unaware of the meaning of ABs resistance. Sixty-seven percent of respondents were unaware of ABs being harmful for children’s teeth and 64.9% unaware of ABs that develop allergy and death. Twenty-four percent believed that ABs worked on viruses, 31% on cold and 21% can cure cough. Almost 51% used ABs without physician prescription while 37.5% obtained ABs directly from pharmacists without physician’s prescription. Almost 42% participants discontinued ABs on alleviation of symptoms. There was significant difference in knowledge response of AB resistance and source of AB use (p=0.026), reason of AB use (p=0.038) and discontinuation of ABs (p=0.041). Conclusion: Adults showed insufficient knowledge and understanding regarding the safe use of ABs consumption among the population.