Prosthodontics — December 7, 2018

What's in this issue?

Implant survival, treated arch and implant surface >>

Interproximal contact loss prevalence, solutions >>

Help your patients see what’s missing >>

Product Spotlight: Planmeca ProMax family offers flexibility and customization >>

News You Can Use: American College of Prosthodontists events and resources highlighted >>

News You Can Use: Need some extra CE before the end of the year? >>


Early implant failure, long-term data, and quality improvement

Targeted efforts to prevent surgical complications that could lead to early implant failure are warranted, a study concluded and its researchers reported online October 22 in Journal of Prosthodontics.

Researchers at Mayo Clinic in Rochester, Minnesota, based their retrospective study on analysis of data related to consecutive adult patients with dental implants seen from January 1, 2000, through December 31, 2014, in the clinic’s Department of Dental Specialties.

A main purpose for their study was evaluating long-term data for quality improvement, which they said measures value as care quality, service, and safety as a function of cost over time.

In a previous study using long-term data, the authors determined that a patient’s risk of implant failure was approximately 7 times higher in the first year after implant placement than in any of the subsequent 25 years. “Recognizing this finding as an improvement opportunity, the authors now aim to investigate candidate predictors of early implant failure, defined as failure in the first year after placement, in terms of patient, systemic, and surgical risk factors,” the authors wrote.

During the study period, researchers identified 8,540 implants from among 2,798 distinct patients for analysis. Of those implants, 362 (4.2%) failed at a mean (standard deviation [SD]) of 129 (96) days after placement. Within the first year of placement, 318 implants of the 8,540 (3.7%) had surgical complications at a mean (SD) of 110 (114) days after placement.

Most candidate predictors did not influence first-year failure in univariate analysis, researchers wrote. However, preplacement surgical manipulations were significantly associated with early implant failure.

Surgical manipulations associated with higher early implant failure included preplacement of bone augmentation only (hazard ratio [HR], 1.45; 95% confidence interval [CI], 1.02 to 2.05; P = .04), socket preservation (HR, 2.67; 95% CI, 1.33 to 5.38; P = .006), and xenogenic material (HR, 2.12; 95% CI, 1.11 to 4.04; P = .02). Researchers also found significant association between any surgical complications and early implant failure (HR, 15.84; 95% CI, 11.10 to 22.61; P <  .001).

Conversely, alveoloplasty only at placement was associated with decreased incidence of early implant failure (HR, 0.33; 95% CI, 0.17 to 0.65; P = .001).

“Because of the significant failure risk associated with surgical complications, it was important to investigate whether any patient factors might be associated with development of surgical complications independent of implant failures,” the authors wrote. “A history of periodontal disease was found to be significantly associated with surgical complications, a finding consistent with a previous report.”

Researchers found that periodontal disease was associated with surgical complications, though not independently as a risk factor for implant failure.

The Mayo Clinic researchers determined that their findings support targeted effort to decrease incidence of surgical complications and declared that a quality improvement project would be initiated to guide the clinic’s surgical-prosthodontic team.

Read the original article here or contact the ADA Library & Archives for assistance.

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Full upper set of implants

Implant survival, treated arch and implant surface

A Swedish retro-prospective study on implant survival in the edentulous jaw found that using moderately rough surface implants decreased the risk of experiencing implant failure in the maxillary arch. Researchers reported their findings in the November/December issue of The International Journal of Prosthodontics.

“Early follow-up studies on the treatment of edentulous jaws have consistently reported higher risk for failure in maxillary compared to mandibular arches,” researchers wrote. “This pattern is still the most common observation in more recent studies.”

In their study, designed as a retro-prospective multivariate regression analysis, the researchers aimed to report and analyze implant failures in a large number of edentulous patients with a specific focus on the arch treated and implant surface roughness.

The study covered all patients that had been consecutively treated with dental implants in an edentulous arch from January 1986 through December 2015 at Brånemark Clinic, Public Dental Care, Region of Västra Götaland, Sweden.

Treatment at the clinic was divided into 2 periods. In the first period (1986-2002), patients received only implants with a turned surface using a 2-stage surgical protocol. In the second period (2003-2015), patients predominantly received implants with a moderately rough surface using a 2-stage surgical protocol in the maxilla and either a 1- or 2-stage protocol in the mandible. Most of the patients received a fixed, screw-retained prosthesis supported by 3 through 8 implants, but some received removable overdentures supported by 2 through 6 implants.

Researchers applied statistical analyses on first event of an implant failure in a treated edentulous arch. They presented statistical results as numbers, frequencies, percentages, means, and standard deviations, and they calculated cumulative survival rates (CSRs) for treated arches without any failures according to basic principles, as described by Kaplan and Meijer. Other forms of statistical analyses applied include univariate Poisson regression analysis, multivariate logistic regression analysis, hazard ratio values with 95% confidence intervals, and P values.

Researchers consecutively treated 3,493 edentulous arches using implants with turned surfaces during the 1986 though 2002 time frame and 1,092 edentulous arches with moderately-rough implant surfaces during the 2003 through 2015 time frame at the clinic. They consecutively identified all implant failures during routine follow-up and performed a multivariate logistic regression analysis to analyze implant failure related to arch and implant surface.

“Overall cumulative survival rates (CSR) for arches treated with turned surface implants were 75.7% and 94.6% for the maxilla and mandible, respectively,” the researchers wrote. “The corresponding 10-year CSRs for arches treated with implants with a moderately rough surface were 91.9% and 96.1%, respectively. The strongest significant association (P < .05) with risk for implant failure was the maxilla, and this was more pronounced for implants with a turned surface.”

The benefit of a moderately rough surface in the maxilla was found at both early and late time periods.

Researchers identified age at surgery, implant surgeon, calendar year of surgery, and time of follow-up as having significant associations with risk of experiencing implant failure (< .05). They also noticed that choice of cutoff point between early and late period follow-up had an impact on the results.

Implant surface did not as obviously impact treatment in the mandible as in the maxilla, researchers found.

Read the original article here or contact the ADA Library & Archives for assistance.


Woman showing her teeth

Interproximal contact loss prevalence, solutions

Researchers determined that interproximal contact loss (ICL) between implants and natural teeth is common based on a review of dental literature and offered possible solutions for prevention and treatment in a study published online October 22 in Journal of Prosthodontics.

“ICL between fixed implant prostheses and adjacent teeth is the absence of interproximal contact between the implant prosthesis and adjacent teeth, where interproximal contacts were previously established by the clinician,” researchers wrote.

In prefacing their study, researchers described complications associated with ICL, including possible food impaction that may lead to periodontal defects, recurrent caries and peri-implant complications. They noted another study in the dental literature that reported finding proximal contact tightness between fixed implant prostheses and adjacent teeth significantly decreased in mesial and distal sites over time, particularly in the mesial.

The aim of the study was to present the prevalence and possible contributing factors of ICL between implant restorations and adjacent teeth, researchers said. They also sought to provide possible prevention and treatment recommendations.

Their literature search revealed 7 studies showing high prevalence of ICL between implant prostheses and adjacent natural teeth. All but 1 of the articles they reviewed were retrospective studies. The other was a prospective study that measured the tightness of the interproximal contact without reference to ICL.

The authors excluded articles that did not provide clinical cases of ICL or that were in languages other than English. The studies included in the article indicate that ICL is greater in the mesial aspect than in the distal aspect.

In tabular materials, the researchers highlighted and compared the 7 studies’ ICL findings, providing their percentages of ICL, mesial versus distal surfaces, maxilla versus mandible, posterior versus anterior, type of study conducted, number of participants, age range of participants, and analysis period of ICL for each study.

Through their literature review, the researchers identified possible causative factors of ICL, including constitutional factors affecting the maxillary and mandible growth, anterior component of force, oral musculature, and lack of force resistance during disturbances of the proximal contact points of teeth.

Additional causative factors addressed in the study for the appearance of ICL include tooth migration, crown-related causes, and bone formation/growth-related causes.

“As the cause of the ICL seems to be multifactorial, it may be impossible to prevent it,” researchers wrote. “Changes of the alveolar-dental complex could provoke a domino effect resulting in ICL.”

However, the researchers provide recommendations for possible prevention and management of ICL between implant restorations and adjacent teeth. Their suggestions include an occlusal retainer as a preventive measure against ICL and periodic evaluations of interproximal contacts between implant restorations and the adjacent teeth.

“Teeth do not make contact with adjacent teeth at rest but do so during function and parafunction, which influences interproximal contacts, justifying recommending patients wear occlusal devices to protect the teeth and the masticatory complex,” researchers wrote.

The authors also suggested screw-retained restorations owing to ease of removal or a cement-retained prosthesis with provisional cements and a Whitehead box.

As their article primarily explores potential causes of proximal contact loss on mesial drift, the researchers suggest further exploration and studies to investigate possible reasons for distal migration.

Read the original article here or contact the ADA Library & Archives for assistance.

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News You Can Use

American College of Prosthodontists events and resources highlighted

American College of Prosthodontists logoThe next American College of Prosthodontics Digital Dentistry Symposium is Feb. 19-20 in Chicago. Choose from among 4 all-new hands-on workshops and breakout sessions for novice and experienced users, and learn how to increase predictability and efficiency in your practice with the latest in advanced dental technology. All dental professionals are welcome. Register at Prosthodontics.org.

New from the ACP, Transforming Lives: What a Prosthodontist Can Do for You is a hardcover and e-book with 24 compelling stories that describe prosthodontic treatments in patient-friendly language. Perfect for your practice waiting room, patient counseling, and referral network, this book shows patients what to expect during treatment — and why it matters to choose a prosthodontist. Check out sample chapters and more at Prosthodontics.org.

Need some extra CE before the end of the year?

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What's in this issue?

Early implant failure, long-term data, and quality improvement >>

Implant survival, treated arch and implant surface >>

Interproximal contact loss prevalence, solutions >>

Help your patients see what’s missing >>

Product Spotlight: Planmeca ProMax family offers flexibility and customization >>

News You Can Use:

American College of Prosthodontists events and resources highlighted >>

News You Can Use: Need some extra CE before the end of the year? >>


Dr. Curtis

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.


JADA+ Specialty Scans and JADA+ Scans
JADA+ Specialty Scans and JADA+ Scans are quarterly newsletters updating dentists on the latest research in selected specialties and disciplines in dentistry. ADA Publishing and the consulting editors from the represented specialties and disciplines aggregate and summarize research from previously published materials, each item attributed to its publication of origin. JADA+ Scan specialties and disciplines include endodontics, healthy aging, oral pathology, orthodontics, pediatric dentistry, periodontics, prosthodontics, radiology, cosmetic/esthetic and osseointegration. View past issues here.

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Any statements of opinion or fact are those of the authors and do not necessarily reflect the views of the American Dental Association. Neither the ADA nor any of its subsidiaries have any financial interest in any products mentioned in this publication. Any reference to a product or service, whether in advertisements or otherwise, is not intended as an endorsement or as approval by the ADA or any of its affiliated organizations unless accompanied by an authorized statement that such approval or endorsement has been granted.

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