Immediate implants without bone augmentation
Researchers determined in a retrospective study with 22 years of follow-up that immediate implant placement in extraction sockets exhibits excellent prognosis even without bone augmentation. The researchers published their study findings in the February issue of Journal of Prosthodontics.“The successful clinical outcome of implant therapy is crucial from a life perspective for both subjects and the dental profession,” the researchers wrote. “Consequently, studies with a follow-up period of 20 years and more are substantial in judging the success or survival rates of the implant.”
Researchers noted “a constant debate about the placement of implants using an immediate protocol versus the traditional or delayed placement protocol.”
Their retrospective study aimed to evaluate the long-term outcome of immediate implants with a smooth machined surface placed in fresh extraction sockets without bone augmentation after 22 years of follow-up.
Inclusion criteria were the availability of intraoral periapical radiographs and the clinical examination data obtained from subsequent follow-ups after prosthodontic treatment.
A total of 36 implants were placed in 35 patients at the time of treatment in fresh sockets between natural teeth. Clinicians placed implants using an immediate placement protocol to avoid additional surgical interventions and thus reducing treatment time and alveolar bone resorption.
Of the 35 patients, 29 underwent the clinical and radiographic examinations at the 22-year follow-up. The dropout rate was 14.3% throughout the study.
All patients received single immediate implants in 1997. The mean (standard deviation) age of the patients (14 men and 21 women) at the time of implant placement was 40 (5.54) years. A total of 36 implants were placed in 35 participants; 1 participant received 2 single, unsplinted implants.
A single practitioner at Alhada Hospital for Armed Forces, Taif, Saudi Arabia, placed all implants without any bone augmentation. All patients received a transmucosal abutment followed by prosthodontic treatment 4 through 6 months after implant placement. At a recall visit 1 week after the prostheses were placed, clinicians evaluated patients for occlusion, prosthesis mobility, and pain associated with implants. Radiographs were obtained if there was any evidence of inflammation determined by clinical examination.
Follow-up visits occurred at 1, 5, 10, 15, 20, and 22 years after prosthetic loading. During the follow-up visits, the patients were evaluated for oral hygiene, routine oral prophylaxis was performed, and radiographs were obtained if clinical examination deemed there was a need.
The marginal bone level measurements were calculated at various time intervals from prosthetic loading (baseline) to 22 years after loading. The calculation was performed at 1, 5, 10, 15, 20, and 22 years after loading.
At the 22-year examination, none of the patients had any pain from the implants or surrounding tissues. Panoramic radiographs of the patients did not reveal any signs of peri-implant radiolucency that could indicate signs of implant failure. The cumulative survival rate (CSR) of the implants was 97.2% at the 22-year follow-up.
“The CSR of dental implants with smooth machined surfaces in this study was 97.2%,” researchers wrote. “This survival rate obtained after a 22-year follow-up indicates an excellent prognosis for an immediate implant placed in fresh sockets without bone augmentation procedures. This outcome is consistent with the findings of previous long-term studies evaluating implants with machined surfaces.”
The mean bone loss from baseline to the 22-year follow-up appointment in this study was 1.61 millimeters, which means an annual bone loss of 0.052 mm, according to the researchers. “In defining a successful implant therapy, a mean bone loss of 1 mm during the first year after prosthetic loading, and an annual bone loss < 0.2 mm has been suggested,” they wrote. “The mean bone loss in the present study is in accordance with previous long-term studies.”
Researchers counted the following as limitations of their study: a small sample size, which could hinder applying the outcome to the general population; the lack of a comparison group; radiographs that were not standardized; and the retrospective nature of the study design.
Read the original article here or contact the ADA Library & Archives for assistance.
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Lithium disilicate laminate veneers
A 10-year retrospective analysis with experienced clinicians operating under strict clinical conditions yielded good results with lithium disilicate laminate veneers (LDLVs) placement. Researchers reported their study findings in the November 2019 issue of The International Journal of Prosthodontics.
Turkish researchers established that clinicians predominately used porcelain laminate veneer restorations fabricated out of glass-ceramic materials with survival rates of 90% and higher over 4- to 10-year follow-up periods. Similarly, researchers routinely used pressable lithium disilicate glass-ceramic porcelain but had little to report regarding their efficacy and effectiveness over 10 or more years.
“Since it may be surmised that successful outcomes with porcelain laminate veneer restorations are related to clinician experience, this report on clinical outcomes of pressable lithium disilicate glass-ceramic laminate veneer restorations (LDLVs) placed by two prosthodontists using the same ceramic material, luting agent, and preparation method offers guidance to dentists on the selection of a veneering protocol,” researchers wrote.
The controlled clinical study included 41 participants (27 women and 14 men) aged 20 through 60 years (mean age, 29.8 years) and referred to the Prosthodontics Department of Marmara University, Faculty of Dentistry, Istanbul, Turkey, from 2006 through 2007. Participants underwent the same dental hygiene protocol. All teeth to be restored had to be free of periodontal inflammation with probing depths of greater than 3 millimeters and bleeding on probing. Researchers excluded patients with severe parafunctional habits. A total of 364 LDLVs were placed in the patients with complaints of mild to moderate dental wear and discoloration.
Clinical criteria included color and esthetic match of the porcelain surface, chipping and fracture occurrence, marginal discoloration, and integrity. To assess outcomes, researchers used the US Public Health Service scoring system. The 10-year survival and success analyses of the 364 LDLVs were 97.4% and 76.3%, respectively, with complications including 6 (1.64%) mechanical failures observed in the form of debonding (1.09%) and fracture (0.55%). Researchers analyzed survival and success time with a statistical software program using Kaplan-Meier method and log-rank test to enhance the cumulative survival rates relative to observations.
“The highly successful outcomes in the present study were due to detailed exclusion criteria, and the lower number of complications seen in this study can be attributed to the fact that experienced specialists kept the preparations mostly in enamel and used a butt-joint design preparation,” researchers wrote. “Another factor contributing to the high mechanical success could be that the work was performed by an experienced dental technician using a pressable lithium disilicate glass-ceramic system.”
The researchers found no long-term studies of LDLVs placed using the same material, luting agent, and technician for consistent reports.
“Nonetheless,” they wrote, “it is tempting to speculate on the likelihood that experienced clinical operators and dental technicians, employing robust and repeatable clinical and laboratory protocols ... might have also avoided technical vulnerabilities and significantly contributed to creating increased fracture resistance of the restorations.”
Read the original article’s abstract here or contact the ADA Library & Archives for assistance.
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Sleep disorders and temporomandibular disorder
Study participants with a temporomandibular disorder (TMD) and particularly those in diagnostic groups with higher pain and disability levels had worse sleep disorders in an adult population-based cross-sectional survey in southern Brazil. Researchers published their findings in the January/February issue of The International Journal of Prosthodontics.
The researchers cited a previous systematic review that showed prevalence of 2 or more sleep disorders in TMD patients, with the occurrence being as high as 43%. That study showed insomnia occurring in TMD patients at 36% and sleep apnea at 28.4%.
Researchers noted that valid studies are needed in the dental literature on the prevalence and distribution of sleep disorders in TMD in general and in different TMD diagnostic groups, such as those with pain, disc displacements, or arthralgia/osteoarthritis/osteoarthrosis. Researchers designed their study to compare sleep disorders in a TMD population not seeking treatment with a control population without TMD. Study participants were men and women aged 18 through 65 years from Maringá, Brazil, who were registered in the Brazilian public health system.
Researchers excluded patient participants with a history of systemic disease or disorders, chronic or acute pain conditions, or chronic use of medications affecting the central nervous system.
The final sample included 1,643 people (recruitment retention, 92.56%) and most were women (65.9%), young to middle-aged adults (84.7%), married or single (90.6%), white (70.1%), with a Brazilian medium income (75.1%), and a high school education or higher (79.9%).
Researchers used the Research Diagnostic Criteria for TMD (RDC/TMD), a clinical questionnaire developed to create a set of diagnostic criteria by which to classify TMD.
“It allows a multidimensional evaluation of chronic TMD pain using a two-axis diagnostic system,” researchers wrote. The 2-axis diagnostic system includes Axis I, which measures mandibular movement, muscle or TMJ pain on palpation, and auscultation of TMJ sounds, such as clicking and crepitus, as well as socioeconomic conditions (education level, income, age, etc.) and psychosocial variables (depression and somatization with or without pain), and Axis II, which measures chronic pain disability.
Researchers also used a Sleep Assessment Questionnaire (SAQ) to evaluate the following sleep disorders: insomnia, nonrestorative sleep, sleep schedule disorders, daytime sleepiness, sleep apnea, and restlessness.
“Subjects with TMD diagnosed by the RDC/TMD in both Axes I and II had significantly worse levels and higher prevalence of sleep disorders measured by the SAQ than asymptomatic controls,” researchers wrote. “Sleep disorders were directly related to the higher pain intensity found in TMD subjects with myofascial pain and arthralgia/osteoarthritis/osteoarthrosis, as compared to subjects with lower pain intensity found in disc displacements, where no difference was found between TMD subjects and asymptomatic controls in most sleep disorders.”
Researchers declared that longitudinal studies from the general population using both axes I and II are needed to confirm their findings.
Read the original article’s abstract here or contact the ADA Library & Archives for assistance.
Short implants and removable partial dentures
For partially edentulous patients seeking a mandibular removable partial denture, the use of short posterior implants may be a viable treatment option, researchers reported in the January/February issue of The International Journal of Oral & Maxillofacial Implants.
“Partial distal edentulism very often shows a low quality of residual bone, thus making the use of conventional length implants impossible. In these cases, it becomes very necessary to resort to short implants (i.e., less than 7 [millimeters]). Although the use of short implants in fixed prosthodontics is well documented in the literature, studies on their application in RPDs are still missing.”
The aim of the study was to evaluate the survival at 1 and 4 years for short implants retaining RPDs in Kennedy Class I and II edentulism.
Researchers designed a prospective study involving all patients with RPDs at the Department of Prosthodontics of CIR Dental School, Oral and Maxillofacial rehabilitation, University of Torino, Turin, Italy, from 2004 through 2011. They included participants with presence of Kennedy Class I or II edentulism rehabilitated with an RPD in either the mandible or maxilla; absence of systemic pathologies contraindicating implant rehabilitation, such as diabetes not under medical control; absence of temporomandibular disorders; absence of smoking; presence of low-bone quantity in the posterior ridges, but enough for placing 6-mm–long implants; and a willingness to undergo surgery to improve RPD stability, retention and support, and no further costs.
A total of 20 patients met eligibility criteria and 35 implants were placed from September 2012 through April 2014. A total of 3 implants had a probing depth of 4 mm and 1 implant a probing depth of 5 mm at the 1-year follow-up. Only 2 implants were lost during follow-up, and implant survival rate was 94.3% at 4 years (95% confidence interval, 80.84 to 99.30). Mean (standard deviation) bone loss was 1.04 (1.88) mm.
The researchers summarized demographic and clinical characteristics of patients and implants using frequency and percentage for qualitative variables and median and range for continuous variables. They reported clinical assessments during the follow-up as frequency and calculated 95% confidence interval for bone loss and probing depth.
“The use of short implants applies especially to patients with low vertical bone height, when complementary surgeries are not favorable, for saving time and minimizing patient discomfort while simultaneously maximizing implant insertion in a strategic position,” researchers wrote.
Read the original article’s abstract here or contact the ADA Library & Archives for assistance.
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Knowledge of the factors that cause complications and failure in fixed prosthodontics enhances your ability to treat and help your patients. CE courses offered by the ADA will help you identify the most common difficulties associated with fixed prosthodontics, as well as methods of minimizing or preventing them. This five-part series will address various types of fixed prosthodontics and provide the most common issues associated with each.
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The consulting editor for JADA+ Specialty Scan — Prosthodontics is Donald A. Curtis, DMD, FACP, Diplomate, American Board of Prosthodontics Professor, University of California San Francisco. |
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