Sheldon Winkler

THE EFFECT OF SMOKING ON IMPLANT SURVIVAL AT SECOND-STAGE SURGERY: DICRG INTERIM REPROT NO. 5

Smoking has been reported to have a deleterious effect on the oral cavity. Research has associated smoking with oral cancer, periodontal disease, leukoplakia, stomatitis nicotina, and impaired gingival bleeding. In 1991 the Dental Implant Clinical Research Group initiated a prospective, randomized cSmoking has been reported to have a deleterious effect on the oral cavity. Research has associated smoking with oral cancer, periodontal disease, leukoplakia, stomatitis nicotina, and impaired gingival bleeding. In 1991 the Dental Implant Clinical Research Group initiated a prospective, randomized clinical study in cooperation with the Department of Veterans Affairs to investigate the influence of implant design, application, and site of placement on long-term clinical performance and crestal bone height. Over 70 dental and medical history variables and exclusion factors were analyzed to determine relationships, if any, with implant failure at the time of second-stage surgery. The variables were analyzed separately for individual implants, cases (prostheses), and patients. The cases ranged from one to five implants each, and more than one case from a single patient could be included in the investigation. At this interim analysis, 2,066 implants have been placed representing 433 cases in 310 patients. With regard to implant failure rates, possible exclusion variable (9) and medical history variables (39) were not found to be statistically significant. For the dental history variables (23), only the question related to smoking was statistically significant on an implant, case, and patient basis (P < 0.007). Results of this interim analysis suggest that smoking is detrimental to implant success.

Second – stage failures related to bone quality in patients receiving endosseous dental implants: Dicrg interim report no. 7

The quality of bone plays an important role in the long-term clinical success of dental implant treatment. An interim evaluation of the relationship between bone quality and the incidence of failure at second-stage surgery is presented. The data include 2,131 root form implants placed by the Dental Implant Clinical Research Group over the past three years. Trends to date suggest differences in the rates of osseointegration among the various bone qualities. Quality 1 bone experienced the greatest failure rate, whereas quality 2 and quality 3 bone had the lowest failure rates. (Implant Dent 1994;3:252–255)

PATIENT DEMOGRAPHICS AND IMPLANT SURVIVAL AT UNCOVERING: DENTAL IMPLANT CLINICAL RESEARCH GROUP INTERIM REPORT No. 6

Implant prognoses for healthy elderly patients have been found to be comparable with those reported for younger patients. In 1991, the Dental Implant Clinical Research Group initiated a prospective, randomized clinical study in cooperation with the Department of Veterans Affairs to investigate the influence of implant design, application, and site of placement on long-term clinical performance and crestal bone height. As a result of the large sample size and wide range of patient ages, the study provided an opportunity to determine if age correlates with implant survival. Interim analysis of 2,132 root form implants at uncovering on an implant, case, and patient basis suggests that implant survival does not appear to be influenced by age in the largely white, male sample. (Implant Dent 1994;3:247–251)

The influence of implant type material, coating, diameter, and length on periotest values at second-stage surgery: Dicrg interim report no. 4

Many of the presently used methods of evaluating osseointegration at second-stage surgery are highly subjective. The Periotest is claimed to offer a more objective means to assess osseointegration by means of microcomputer-controlled percussion. In 1991 the Dental Implant Clinical Research Group initiated a long-term clinical study in cooperation with the Department of Veterans Affairs to investigate the influence of implant design, application, and site of placement on clinical performance and crestal bone height. As part of this investigation, the Periotest values for 1,565 root form implants were determined at second-stage surgery and correlated with type, material, coating, diameter, and length. Hydroxyapatite-coated implants and increased implant diameter and length produced Periotest values that indicated a greater extent of stability as compared with noncoated implants with shorter diameters and lengths. Hydroxyapatite-coated cylinder-type implants yielded the most favorable Periotest readings. Not only does the Periotest have the potential of being a valuable instrument for assessing implant mobility at second-stage surgery, but it also appears to have the capability of determining slight differences in the implant-bone complex.

Stylohyoid syndrome. Report of a case.

A classic case of stylohyoid syndrome, in which the patient complained of vague oral pain, dysphagia, and pain when turning the head to either side, is presented. Although radiographic evidence confirmed the diagnosis, a number of practitioners failed to identify the cause of the patients discomfort, which ultimately led to her death.

DENTAL IMPLANTS AND THE GERIATRIC PATIENT

Dental care of the aging patient presents a number of problems not encountered in younger patients. Most of these problems result from tissue changes that occur during aging. Dental implants and implant-retained and/or implant-supported prostheses are viable treatment options for older patients. The majority of elderly patients in their younger retirement years are relatively healthy and not limited in activity. The clinician must be aware of the physical, metabolic, and endocrine changes associated with aging and how these changes may affect implant treatment. The elderly deserve the best care the dental profession can offer.

ASSESSMENT OF IMPLANT MOBILITY AT SECOND-STAGE SURGERY WITH THE PERIOTEST: DICRG INTERIM REPORT NO. 3

Many of the presently used methods of evaluating osseointegration at implant uncovering are highly subjective. The Periotest is claimed to offer a more objective means to assess osseointegration by means of microcomputer-controlled percussion. Investigators involved in a long-term clinical study of dental implants being conducted by the Dental Implant Clinical Research Group used the Periotest to evaluate the mobility associated with all study implants at second-stage surgery and correlate the Periotest values with various bone densities. The Periotest values for 1,838 root form implants ranged from —8 to +25. Implants that appeared to be osseointegrated at uncovering recorded a mean Periotest value of −3.37 ± 3.25, while nonosseointegrated implants had a mean Periotest value of +13.87 ± 14.27. Mean Periotest values were −3.82 ± 3.04 for quality 1 bone, −3.70 ± 3.06 for quality 2 bone, −3.31 ± 3.18 for quality 3 bone, and −1.29 ± 3.57 for quality 4 bone. The Periotest has the potential of being a valuable instrument for assessing the status of osseointegration at second-stage surgery. (Implant Dent 1994;3:153–156)

The Effect Of Soldering, Electrowelding, And Cast-to Procedures On The Accuracy Of Fit Of Cast Implant Bars

The effect of three different connecting procedures on the accuracy of fit of cast implant bars over their supporting abutments was investigated. Thirty Hader implant bars were waxed on a master cast over two abutment analogs and cast in a type IV gold alloy. The bars were sectioned and divided into three groups of ten implant bars according to the connecting procedure that was to be followed. Group 1 bars were connected by soldering, Group 2 bars were connected by electrowelding, and Group 3 bars were connected with the cast-to procedure. The accuracy of fit of each group of bars was measured at the gold cylinder-abutment interface in microns using a stereomicroscope. The use of the cast-to procedure resulted in a more accurate fit as compared with the soldering and the electrowelding techniques.

An improved split-denture technique.

A technique for the construction of split dentures with a cast framework to hold the denture segments together has been described. The advantages of this technique to the patient were noted. Patients are carefully instructed first on how to insert the sections and then on how to insert the casting after the individual segments of each arch are in place.

Improved mouth guard design for protection and comfort

Mouth guards worn during contact sports have been shown to provide considerable protection against traumatic injuries to the teeth and supporting structures. Of the 3 types available, the custom-made mouth guard is considered superior to stock and mouth-formed mouth guards. The procedure for making a special mouth guard designed for protection and comfort is described.