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Researchers evaluated the survival outcomes of 1-piece complete arch fixed implant-supported prostheses (CAFIPs) fabricated by a large U.S.-based dental laboratory and determined that monolithic zirconia, the biomaterial in the investigated CAFIPs, is an excellent choice of material. They published their results online July 6 in The Journal of Prosthetic Dentistry.

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In writing about their study, researchers discussed how CAFIPs conventionally have been fabricated with a metal framework and acrylic resin for artificial teeth and gingiva or with metal-composite resin or metal-ceramic biomaterials.

They discussed zirconia as an emergent alternative biomaterial for CAFIPs and cited 2 recent systematic reviews that summarized some of the material’s promising aspects and less desirable characteristics. Advantages identified for clinicians and patients included reduced laboratory costs; good dental and gingival esthetics; superior strength, durability, wear characteristics, biocompatibility and fit; availability of a digital file for future replication; reduced plaque accumulation; and favorable soft-tissue response.

Disadvantages included inability to repair framework fractures; difficulty in adjusting and polishing; low tolerance of minor inaccuracies in the impression, resulting in fractures during insertion; and minimal long-term scientific data for clinical outcomes.

This 5-year retrospective study used practice-based evidence in the form of warranty data from the dental laboratory that fabricated all of the prostheses involved in the study. All of the prostheses were made of the same kind of zirconia. Each prosthesis was predominantly monolithic zirconia, screw-retained, and had veneered porcelain restricted to the gingival region. The researchers collected and assessed data from the dental laboratory’s database for all zirconia prostheses from January 1, 2012, to December 31, 2016. They recorded how many prostheses were returned to the laboratory to be remade or adjusted under the warranty.

In evaluating the large sample database of 2,039 prostheses from the dental laboratory during the study period, researchers determined that 319 had a minimum of 3 years of clinical service, and 69 had a minimum of 4 years of clinical service. They identified 6 reported fractures, resulting in a first-year interval survival rate of 99.8% and a 5-year cumulative survival rate of 99.3%. In addition, 6 prostheses (0.29%) were returned to the laboratory owing to technical complications caused by debonding of the titanium cylinder, and 3 (0.14%) were returned owing to fracture of the titanium cylinder (0.14%).
However, no prostheses were returned to the laboratory owing to chipping of the veneered gingival porcelain (an outcome determined at a rate of 14.7% in a previous literature analysis of 12 clinical studies on prosthetic use of monolithic zirconia). The laboratory successfully addressed all technical complications and returned the prostheses to clinicians without further returns.

In conclusion, researchers determined that the 1-piece zirconia CAFIP with veneered porcelain restricted to the gingival region has excellent short-term survival outcomes, a low rate of technical complications, and is an acceptable choice in the fixed implant rehabilitation of edentulous patients.

Read the original article here.

Consulting Editor: Donald A. Curtis, DMD, FACP
Diplomate, American Board of Prosthodontics
Professor, University of California San Francisco

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Implant failure rate and surgical experience

Brazilian and Swedish investigators questioned whether a correlation exists between surgeons’ experiences and dental implant survival. They published results of their systematic review in the July/August issue of The International Journal of Prosthodontics.

The systematic review, performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and registered in the International Prospective Register of Systematic Reviews, drew on dental literature found through MEDLINE (PubMed), Embase, Scopus, and the Cochrane Library database searches. Researchers searched publications from their inception to May 20, 2016, using keywords with Boolean operators to combine terms.

Their population, intervention, comparison, outcomes framework question was “Are the survival rates of dental implants placed by experienced surgeons similar to those placed by inexperienced surgeons?”

“Few studies have associated implant failure with individual characteristics of the surgeon, such as clinical training and expertise, and contradictory observations have been reported,” the researchers wrote.

Eight studies, gleaned from 599 studies, ultimately met researchers’ criteria for inclusion in their systematic review. One study was a prospective clinical trial, and 7 were retrospective cohorts. None was a randomized controlled clinical trial.

The referenced literature deemed experienced surgeons as those who were specialists in oral and maxillofacial surgery, periodontology, or prosthodontics with surgical training in implantology; clinicians with more than 5 years of clinical experience in implant dentistry; or clinicians who had placed more than 50 implants. Implant survival in the studies meant no implant loss, no mobility, no pain or discomfort, and the absence of detectable bone loss.

Researchers conducted 2 meta-analyses to different definitions of experienced surgeons. The first meta-analysis addressed definitions in 4 retrospective comparative studies that defined experienced surgeons as specialists in oral and maxillofacial surgery, periodontology, or prosthodontics with surgical training in the implant field. In evaluating failure in these studies, researchers found that the experience of the surgeon did not significantly affect the implant failure rate (P = .54), with an odds ratio of 1.24 (95% confidence interval [CI], 0.62 to 2.48).

The second meta-analysis compared definitions from 2 retrospective studies that defined experienced surgeons as professionals that had placed more than 50 implants. Using a fixed meta-analysis, the researchers determined that the experience of the surgeon significantly affected the implant failure rates (P = .0005), with an odds ratio of 2.18 (95% CI, 1.40 to 3.39).

The researchers concluded that when defining surgical experience by the number of implants placed as opposed to surgical experience as based on dental specialization implant failure was significantly affected. They also concluded that further standardized prospective studies with control groups of confounding factors are needed to clarify the role of surgical expertise on implant survival rates.

Read the original article here.

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