ArticleLiterature Review

Tooth preservation or implant placement: A systematic Review of long-term tooth and implant survival rates

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Abstract

For the past few decades, dental implants have served as reliable replacements for missing teeth. However, there is an increasing trend toward replacing diseased teeth with dental implants. The authors conducted a systematic review of long-term survival rates of teeth and implants. They searched the MEDLINE database for relevant publications up to March 2013. They considered studies in which investigators assessed the long-term effectiveness of dental implants or that of tooth preservation. They included only studies that had follow-up periods of 15 years or longer. The authors selected 19 articles for inclusion. Investigators in nine studies assessed the tooth survival rate, whereas investigators in 10 studies assessed the implant survival rate. When comparing the overall long-term (that is, 15 years or more) tooth loss rate with that of implants, the authors observed rates ranging between 3.6 and 13.4 percent and 0 and 33 percent for teeth and implants, respectively. They could not perform a meta-analysis because of the substantial differences between the studies. Practical Implications. The results of this systematic review show that implant survival rates do not exceed those of compromised but adequately treated and maintained teeth, supporting the notion that the decision to extract a tooth and place a dental implant should be made cautiously. Even when a tooth seems to be compromised and requires treatment to be maintained, implant treatment also might require additional surgical procedures that might pose some risks as well. Furthermore, a tooth can be extracted and replaced at any time; however, extraction is a definitive and irreversible treatment.

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... A further confounder is that the decision to extract a tooth may not be based on a clear diagnosis of untreatability, but based on other factors. Reports have indicated that teeth may more easily be extracted than before the millennium shift, with a view to replacing teeth with implants, despite the evidence that periodontally involved but well-maintained teeth, out survive-and are cheaper-than implants (Levin & Halperin-Sternfeld, 2013;Schwendicke, Graetz, Stolpe, & Dorfer, 2014). Clearly, there are unidentified variables causing data heterogeneity and affecting the risk of tooth loss, for example different treatment traditions over the last 60 years, geographical variation, dental care reimbursement systems, the popularity of implant therapy and number of remaining natural teeth. ...
... Nevertheless, tooth loss as an endpoint of periodontal therapy could be questioned today. Tooth loss reflects tooth extractions resulting from a clinician's subjective decision (Levin & Halperin-Sternfeld, 2013) and could be favoured due to the current popularity of implant therapy; however, the tooth extraction is not always indicative of the lack of a tooth to survive in the long term. ...
... Today we realize with the arrival of an alternative for a tooth, that is a dental implant, that tooth extractions are indicated much more often by the dental profession. The perceived solution by both the dentist and the patients for loss of a tooth has sparked a worldwide increase in tooth extractions (Levin & Halperin-Sternfeld, 2013). ...
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Aim: Position paper on endpoints of active periodontal therapy for designing treatment guidelines. The question was: How are, for an individual patient, commonly applied periodontal probing measures - recorded after active periodontal therapy - related to (1) stability of clinical attachment level, (2) tooth survival, (3) need for retreatment, or (4) oral health-related quality of life. Methods: A literature search was conducted in Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily <1946 to June 07, 2019>. Results: A total of 94 papers were retrieved. From the literature search, it was found that periodontitis patients with a low proportion of deep residual pockets after active periodontal therapy are more likely to have stability of clinical attachment level over a follow-up time of ≥1 year. Other supporting literature confirms this finding and additionally reports, at the patient level, that probing pocket depths ≥6 mm and bleeding on probing scores ≥30% are risks for tooth loss. There is lack of evidence that periodontal probing measures after completion of active periodontal treatment, are tangible to the patient. Conclusions: Based on literature and biological plausibility, it is reasonable to state that periodontitis patients with a low proportion of residual periodontal pockets and little inflammation are more likely to have stability of clinical attachment levels and less tooth loss over time. Guidelines for periodontal therapy should take into consideration (i) long term tangible patient outcomes, (ii) that shallow pockets (≤4 mm) without bleeding on probing in patients with <30% bleeding sites, are the best guarantee for the patient for stability of his/her periodontal attachment, (iii) patient heterogeneity and patient changes in immune response over time, (iv) that treatment strategies include lifestyle changes of the patient. Long-term large population-based and practice-based studies on the efficacy of periodontal therapies including both clinical and patient-reported outcomes (PROs) need to be initiated, which include the understanding that periodontitis is a complex disease with variation of inflammatory responses due to environment, (epi)genetics, lifestyle, and aging. Involving people living with periodontitis as co-researchers in the design of these studies would also help to improve their relevance.
... The decision whether to extract a tooth and to replace it by a dental implant should be made cautiously, as Bextraction is a definitive and irreversible treatment^ [22,28]. According to Ramfjord (1977) and Rosling et al. (2001), periodontal stability can be maintained over long periods in well-controlled patients, despite the presence of residual pockets and restricted oral hygiene. ...
... In a previous investigation on 68 patients over an observation time of 16 years, each patient lost on average 0.15 teeth/year after primarily conservative periodontal therapy during the individualized SPT [22]. A recent published systematic review confirmed these findings and emphasized the underestimated risk for tooth loss ranging between 3.6 and 13.4% during longterm SPT of more than 15 years [28]. The authors further concluded that implant survival rates do not exceed those of compromised, but adequately treated, teeth. ...
... During the last 30 years, reported implant loss rates varied considerably between studies on patients with history of periodontitis [28], making the long-term survival of implants in these patients ambiguous, as well as of great interest for the clinical decision-making. In comparison to 0.12 teeth lost/patient/year, 0.025 implants/patients/year in patients without periodontitis and correspondingly 0.032 implants/patients/ year in patients with treated periodontitis were lost in the present study. ...
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Objectives The aim of this retrospective study was to evaluate the long-term implant survival in patients with a history of chronic periodontitis, during supportive periodontal therapy (SPT), compared to periodontally healthy patients. Materials and methodsTwenty-nine periodontitis patients (test) with SPT for ≥9 years and implant-supported restorations (≥5 years follow-up) were recruited and pair-matched with 29 periodontally healthy patients (control). Subjects in both groups were examined following active periodontal therapy and/or implantation (T1) (test 69 implants, control 76 implants) and at end of SPT or supportive postimplant therapy (T2). Differences between the groups in implant survival (primary outcome), mean marginal bone loss (MBL) and pocket probing depths (PPDs) (secondary outcomes) were evaluated. ResultsImplant survival over 5 years was 97.1% in test compared to 97.4% in control group (p = 0.562). MBL was significantly different (test 18.7 ± 18.2%; control 12.5 ± 21.3%) (p < 0.05). PPDs increased at T2 in both groups (test: T1 3.4 ± 1.0 mm; T2 4.2 ± 1.6 mm; control: T1 1.0 ± 1.2 mm; T2 2.9 ± 0.8 mm; p < 0.05 between groups). Prognostic factors for implant loss appeared to be the presence of residual periodontal pockets of ≥4 mm (OR 1.90), bone height (OR 1.81) and age (OR 1.16) at T1. Conclusion In terms of implant survival, no differences were observed between periodontitis and periodontally healthy patients. However, patients with history of periodontitis showed higher MBL and PPDs compared to periodontally healthy patients. Clinical relevanceThe presence of a good periodontal maintenance program with preceding successful active periodontal treatment seems to be indispensable components of successful implant treatment in patients with history of chronic periodontitis.
... This often resulted in the extraction of teeth that may be salvageable. Faced with the option of retaining a compromised tooth or placing a dental implant, the clinician should make an evidence-based decision, rather than based on treatment convenience (Levin and Halperin-Sternfeld 2013). Because an implant can serve as a replacement for an extracted tooth at any point, regardless of the length of time, the tooth had been maintained. ...
... A recent critical review provides a valuable insight in this issue (Levin and Halperin-Sternfeld 2013). This report assessed the long-term survival rates and treatment outcomes for retained compromised teeth in comparison with the longterm survival rates for dental implants. ...
... Their analysis also disclosed that even the tooth loss rates were low in those included studies (Levin and Halperin-Sternfeld 2013); tooth extraction was often caused by a clinician's subjective opinion, which was not always indicative of the tooth's inability to survive in the long term. Interestingly, most studies included in this investigation, which assessed tooth survival, were conducted in periodontally compromised patients. ...
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The purpose of the present study was to evaluate the longitudinal survival rate of the treatment of teeth affected with periodontally hopeless prognosis and secondary occlusal traumatism (SOT) using intentional replantation (IR) and periodontal prosthesis. We collected data from 17 individuals who received IR and participated in the study during 1995 to 2014. Of the 17 teeth affected by periodontally extreme conditions with deep angular bone defects, severe alveolar bone loss extending to or beyond the apex, and SOT, was recognized as having hopeless prognosis. Those teeth were treated sequentially using procedures that included basic periodontal therapy, therapeutic provisional prosthesis, IR, fixed dental prosthesis, crown and sleeve-coping telescopic dentures (CSCTDs), or fixed prosthesis and CSCTD combined. Longitudinal assessments of clinical parameters and radiographic bone change before and after IR were evaluated. Clinical results showed that the overall cumulative survival rate of assayed teeth after IR therapy (5–12 years) was 88.2%. The mean (±SD) estimated radiographic alveolar bone loss was 12.7 ± 2.1 mm (88.5% ± 13.3%) of the root length, initially, and estimated radiographic alveolar bone gain was 4.0 ± 2.2 mm ultimately, in 17 replanted teeth with SOT. Only one tooth (5.9%) exhibited root resorption. Ankylosis was not observed during the study. Periapical radiographs demonstrated that satisfactory periodontal healing of lamina dura and bone fills occurred in all replanted teeth with SOT. Generally, tooth mobility and SOT were significantly improved after therapy. Most treated teeth functioned well and remained stable clinically throughout the periods of study. The present study documented a promising outcome for autogenous IR and periprosthetic therapy of 17 periodontally hopeless teeth for 5–12 years. The present study revealed good bone gain and elimination of SOT and prominent occlusal function. We concluded that the application of IR, minocycline-HCL and periodontal prosthetic procedures later elevated the prognosis of these otherwise hopeless teeth with SOT, which are valuable options for retaining teeth with periodontally extreme situations.
... whereas the rate of dental implant loss ranged from 0%-33%. 31 Another review compared the survival of dental implants with endodontically treated teeth. The survival rates of dental Significance Dental implants are a popular treatment option for patients who are missing teeth. ...
... However, when it comes to establishing prognosis for periodontally compromised teeth, there is a lack of an ideal tool available to do this accurately. 29,31,40 Therefore, focusing on saving the compromised teeth is a treatment option worth merit. ...
... 26 Thus, instead of extracting teeth because it seems to be a less complicated treatment option, using periodontal treatment followed by proper supportive periodontal therapy to retain periodontally compromised teeth should be prioritized. 31 In the event that this therapy is not successful and the tooth needs to be extracted, there is still the option of a dental implant because a backup will have 10-year survival rates of 82%-94%. 30 ...
Article
Teeth are vital sensory organs that contribute to our daily activities of living. Unfortunately, teeth can be lost for several reasons including trauma, caries, and periodontal disease. While dental trauma injuries and caries are more frequently encountered in a younger population, tooth loss due to peridontal disease occurs in the older population. In the dental implant era, the trend sometimes seems to be to extract compromised teeth and replace them with dental implants. However, the long‐term prognosis of teeth might not be comparable to the prognosis of dental implants. Complications, failures and diseases such as peri‐implantitis are not uncommon, and despite popular belief, implants are not 99% successful. Other treatment options that aim to save compromised or diseased teeth such as endodontic treatment, peridontal treatment, intentional replantation, and autotransplantation should be considered on an individual basis. These treatments have competing success rates to dental implants but more importantly, retain the natural tooth in the dentition for a longer period of time. These options are important to discuss in detail during treatment planning with patients in order to clarify any misconceptions about teeth and dental implants. In the event a tooth does have to be extracted, procedures such as decoronation and orthodontic extrusion might be useful to preserve hard and soft tissues for future dental implant placement. Regardless of the treatment modality, it is critical that strict maintenance and follow up protocols are implemented and that treatment planning is ethically responsible, and evidence‐based. This article is protected by copyright. All rights reserved.
... In the latter technique, teeth with poor bone support are splinted and thus, tooth mobility is minimized. [6][7][8] Different techniques are available for splinting of mobile teeth to their adjacent teeth; 9 these techniques are divided into two groups of extracoronal and intra-coronal techniques. 10 Intra-coronal splints are not often recommended since they require tooth preparation and removal of tooth structure. ...
... 10,11 The most commonly used method of splinting of teeth with periodontal mobility is the use of extra-coronal splints by use of composite resin along with adhesives, fiber-reinforced composite (FRC) or orthodontic wires along with composite resin. 9,11 However, previous studies indicated that none of the three aforementioned techniques had any superiority to the others. 8,9,[11][12][13] Studies in this field have been limited. ...
... 9,11 However, previous studies indicated that none of the three aforementioned techniques had any superiority to the others. 8,9,[11][12][13] Studies in this field have been limited. Thus, this study aimed to biomechanically assess two common treatment plans (with and without splinting) for teeth with compromised periodontium. ...
Article
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Background: Splinting of teeth is performed for effective distribution of loads in mobile teeth and to lower the stress applied to compromised teeth. Biomechanics cannot adequately explain load distribution around natural teeth. This study aimed to compare the distribution pattern and magnitude of stress and strain around splinted and non-splinted teeth with compromised periodontium using three-dimensional (3D) finite element analysis (FEA). Methods: Six mandibular anterior teeth were scanned and data were registered in CATIA® and then SolidWorks® software programs. The jawbone was also designed. In the second model, the teeth were splinted with fiber-reinforced composite (FRC). The models were then transferred to ANSYS® software program and after meshing and fixing, 100- and 200-N loads were applied at zero and 30° angles. The magnitude and distribution of stress and strain in the periodontal ligament (PDL) and the surrounding cortical bone were determined. Results: A significant reduction in stress was noted in cortical bone around central and lateral incisors while an increase in stress was noted around the canine tooth after splinting. All these changes were more significant under 100-N load compared to 200-N load and greater differences were noted in response to the application of oblique loads compared to vertical loads. Conclusion: Splinting decreased the magnitude of stress and strain in teeth close to the center of splint and increased the stress and strain in teeth far from the center of splint. Adequate bone support of canine teeth must be ensured prior to selection of splinting as the treatment plan for the anterior mandible since it increases the longevity of all the teeth.
... Various meta-analyses have since documented favorable prognostic data for both nonsurgical (16) as well as surgical retreatment using modern techniques (17)(18)(19), whereas in regard to dental implants less encouraging data have become available. The long-term outcome exceeding 15 years of follow-up of implants versus teeth clarified that the expected prognoses of teeth, even if periodontally compromised or endodontically treated, generally outlasted dental implant restorations (20). Other studies emphasized the high prevalence of peri-implantitis and peri-implant mucositis (21,22). ...
... For the first decade of the new millennium, the replacement of natural teeth by dental implants was described as being regarded as a panacea (11). However, in the past decade, studies were published that provided new, previously missing evidence on the general outcomes of nonsurgical retreatment (16) and endodontic microsurgery (17,19), the long-term survival of dental implants versus natural teeth (20), and the incidence and nature of implant-related complications (21,29), resulting in calls to reconsider extraction and replacement strategies in favor of keeping natural teeth (23,24). Overall, ENDOs remained most consistent compared with GPs, who in turn stayed more consistent than SPECs. ...
Article
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Introduction: The aim of this study was to investigate changes in treatment planning decisions among different practitioner groups over 7 years for teeth with apical periodontitis and a history of endodontic treatment. Methods: A Web-based survey was sent to dentists in Pennsylvania in 2009 consisting of 14 cases with nonhealing periapical lesions and intact restorations without evidence of recurrent caries. Participants selected among 5 treatment options: wait and observe, nonsurgical retreatment (NSRTX), surgical retreatment (SRTX), extraction and fixed partial denture, or extraction and implant (EXIMP). In 2016, the identical survey was resent to the original 2009 participants. Results: In 2009, 262 dentists participated in the survey. Two hundred one participants were general practitioners (GPs: 76.7%), 26 endodontists (ENDOs: 9.9%), and 35 other specialists (prosthodontics, periodontics, and oral surgery [SPECs]: 13.4%) (n = 262). EXIMP, NSRTX, and SRTX were fairly equally selected but with great variation between practitioner groups (χ2 = 173.49, P < .05). A subset group of 104 participants (SUB) (39.7% of the original participants) retook the survey in 2016 (69 GPs [66.3%], 15 ENDOs [14.0%], and 20 SPECs [19.7%]). Comparisons among practitioner groups were significantly different in SUB (n = 104) for 2009 (χ2 = 95.536, P < .05) and 2016 (χ2 = 109.8889, P < .05). Intragroup reliability between 2009 and 2016 revealed no significant differences between the overall treatment planning choices for all practitioners (GPs, ENDOs, or SPECs). Intrapractitioner reliability showed many treatment planning decision changes on an individual level. Chances that individuals changed their original decision were 47.8% (95% confidence interval, 45.2%-50.4%) and were significantly different among the 3 practitioner groups (GPs > SPECs > ENDOs [χ2 = 11.2792, P < .05]). No significant changes were observed in the decision for tooth saving versus replacement treatment options (P = .520). Conclusions: No significant differences were noted between current and past treatment planning decisions in regard to tooth preservation by endodontic retreatment versus tooth extraction and replacement. However, individual practitioners lacked consistency in their decision making over time.
... While achieving a ferrule effect, the risk of "verticle fracture" must be kept in mind. [9][10][11][12][13][14][15][16] assessIng the RelIabIlIty of comPRomIsed tooth ...
... [3] The dental implants failure rate was systematically reviewed to range from 0% to 33% over the long-term (i.e., 15 years or more); in contrast, the long-term failure rate of damaged teeth, which were adequately treated and maintained, was determined to range from 3.6% to 13.4%. [9] In addition, Setzer and Kim compared dental implant survival (73%-95.5%) to endodontically treated teeth (89.7%-98.1%). [10] Although in the existence of the aggressive periodontal disease, Graetz et al. have shown that teeth with a questionable (or even poor) prognosis can be retained as long as 15 years. ...
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The proportion of the remaining tooth structure is crucial for the deliberation of whether or not to preserve a damaged tooth among adults. It has been stated in previous studies that in order to assure long-term care, restoration of a badly damaged tooth with a full crown will more frequently than not be needed. There are numerous methods for maintaining compromised permanent teeth. Apical surgery, root resection, crown resection, autotransplantation, orthodontic extrusion and intentional replantation are the methods that have remarkably high success and survival rates when cases are carefully planned and managed appropriately. These methods have greater importance in adolescence compared to adults, as implants should be preferably delayed until the completion of alveolar bone growth. The present review is aimed to discuss case selection and the techniques involved in the different methods used for maintaining compromised teeth, as well as their success rates. Based on the studies covered in this literature review, a survival rate of at least 80% can be expected for compromised teeth that have undergone treatment with these methods.
... Recent studies have demonstrated how positive is the prognosis of teeth maintained and treated. In a recent systematic literature review (19), the survival rate of periodontally affected teeth was compared to the survival rate of dental implants. The authors se opravdavale odluke o vađenju. ...
... Nedavno istraživanje pokazalo je koliko je povoljna prognoza za očuvane i tretirane zube. U aktualnom sistematiziranom pregledu literature (19), stopa preživljavanja parodontno kompromitiranih zuba uspoređena je sa stopom preživljavanja dentalnih implantata. Autori su pokazali Comparison between the level of education and training, time of experience in practice and type of undergraduation program and the decision for extractions or not in case #3 Tablica 5. Usporedba između razine edukacije, iskustva u praksi i vrsti dodiplomskog studija na odluku o vađenju za slučaj 3 *Statistically significant outcome with a significance level of 5%. ...
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Objectives: To investigate the professional aspects and clinical and radiographic evidence that influences the decision for the extraction of teeth among periodontologists and general dentists. Material and methods: The sample consisted of 150 (n=106 females and 44 males) dentists (n=103 general dentists and 47 periodontologists) that responded to a questionnaire designed to retrieve cross-sectional information related mainly to their level of training and time of experience in practice, as well as their personal decision for managing four patients with periodontal disease. Bivariate analyses were performed to test the association between the clinical decisions and the professional information collected from the dentists. Results: In specific cases, periodontologists decided to maintain more teeth than general dentists (p<0.05). In other cases, dentists with more years of experience in practice decided to opt for more extractions (p<0.05). The level of periodontal disease (50-92%), poor oral hygiene (42.6-67.3%) and lack of alveolar bone structure (43.2-79.3%) were the most prevalent reasons behind the decision for extractions. Conclusions: An advanced level of training in Dentistry, especially Periodontology, and more years of experience in practice may lead to more well-founded decisions on whether extracting teeth or not in case-specific scenarios.
... Tooth prognosis is arguably one of the most important evaluations in dentistry. Tooth prognosis uses assessments to predict the longevity of a tooth [1,2]. The purpose of this evaluation is to guide treatment planning such as extractions, restorations, and periodontal therapy. ...
... Treating periodontal disease is not impossible and periodontally involved teeth can function and be maintained for years [1,21]. Dental practitioners must understand that treating and maintaining teeth is a viable option but more importantly, communicate this to the patient. ...
Article
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Introduction: Tooth prognosis evaluation involves continual assessments to guide patient-centered treatment plans. This means that the tooth prognosis may dictate whether a tooth is restored, extracted, or maintained. Aim of study: The aim of this work was to evaluate current trends in tooth prognosis evaluation based on radiographic bone loss amongst dental practitioners. Material and Methods: A survey including demographic questions and ten radiographs (vertical bitewings or peri-apical) showing bone loss around teeth and implants were distributed to dental practitioners. Practitioners were asked to determine the prognosis of the tooth or implant and suggest a percentage describing the likelihood of the tooth or implant surviving for ten years. Results: One of the ten radiographs provided for assessment was given good to fair prognosis by 100% of the participants. Only three out of the ten radiographs presented had strong suggestions for tooth retention. Recommendation for extraction by dental practitioners varied from 1-66% across the radiographs. Furthermore, practitioners predicted a 0% chance of ten-year survival for many of the teeth. Conclusions: Assessing prognosis based on radiographs only, is insufficient and clinical data provides invaluable information to establishing tooth prognosis. Dental professionals should understand that compromised teeth can outlive dental implants and our role as dental professionals is to prevent and treat oral diseases to preserve the dentition as long as possible.
... Nonetheless, FDPs, whether they are tooth-or implant-supported, cannot fully replace all the inherent functions and properties of natural teeth (Giannobile andLang, 2016, Levin andHalperin-Sternfeld, 2013) and are not exempt of complications and diseases (Berglundh et al., 2018, Pjetursson et al., 2015, Sailer et al., 2015, some of which represent a major challenge, such as recurrent caries and periodontitis of abutment teeth (Tan et al., 2004, Tan et al., 2006, and peri-implantitis (Schwarz et al., 2018). To minimize the occurrence of biologic and mechanical implant complications, proper treatment planning and technical execution are fundamental. ...
Article
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Purpose The aim of this systematic review was to critically analyze the available evidence on the effect of different modalities of alveolar ridge preservation (ARP) as compared to tooth extraction alone in function of relevant clinical, radiographic and patient‐centered outcomes. Material and Methods A comprehensive search aimed at identifying pertinent literature for the purpose of this review was conducted by two independent examiners. Only randomized clinical trials (RCTs) that met the eligibility criteria were selected. Relevant data from these RCTs were collated into evidence tables. Endpoints of interest included clinical, radiographic, and patient‐reported outcome measures (PROMs). Interventions reported in the selected studies were clustered into ARP treatment modalities. All these different ARP modalities were compared to the control therapy (i.e. spontaneous socket healing) in each individual study after a 3‐ to 6‐month healing period. Random effects meta‐analyses were conducted if at least two studies within the same ARP treatment modality reported on the same outcome of interest. Results A combined database, grey literature and hand search identified 3,003 records of which 1,789 were screened after removal of duplicates. Following the application of the eligibility criteria, 25 articles for a total of 22 RCTs were included in the final selection, from which 9 different ARP treatment modalities were identified: 1. Bovine bone particles (BBP) + Socket sealing (SS), 2. Construct made of 90% bovine bone granules and 10% porcine collagen (BBG/PC) + SS, 3. Cortico‐cancellous porcine bone particles (CPBP) + SS, 4. Allograft particles (AG) + SS, 5. Alloplastic material (AP) with or without SS, 6. Autologous blood‐derived products (ABDP), 7. Cell therapy (CTh), 8. Recombinant morphogenic protein‐2 (rh‐BMP2), and 9. SS alone. Quantitative analyses for different ARP modalities, all of which involved socket grafting with a bone substitute, were feasible for a subset of clinical and radiographic outcomes. The results of a pooled quantitative analysis revealed that ARP via socket grafting (ARP‐SG), as compared to tooth extraction alone, prevents horizontal (Mean = 1.99 mm; 95% CI 1.54 to 2.44; P < 0.00001), vertical mid‐buccal (Mean = 1.72 mm; 95% CI 0.96 to 2.48; P < 0.00001) and vertical mid‐lingual (Mean = 1.16 mm; 95% CI 0.81 to 1.52; P < 0.00001) bone resorption. Whether there is a superior ARP or SS approach could not be determined on the basis of the selected evidence. However, the application of particulate xenogenic or allogenic materials covered with an absorbable collagen membrane or a rapidly‐absorbable collagen sponge was associated with the most favorable outcomes in terms of horizontal ridge preservation. A specific quantitative analysis showed that sites presenting a buccal bone thickness > 1.0 mm exhibited more favorable ridge preservation outcomes (difference between ARP [AG+SS] and control = 3.2 mm), as compared to sites with a thinner buccal wall (difference between ARP [AG+SS] and control = 1.29 mm). The effect of other local and systemic factors could not be assessed as part of the quantitative analyses. PROMs were comparable between the experimental and the control group in two studies involving the use of ABDP. The effect of other ARP modalities on PROMs could not be investigated, as these outcomes were not reported in any other clinical trial included in this study. Conclusion ARP is an effective therapy to attenuate the dimensional reduction of the alveolar ridge that normally takes place after tooth extraction. This article is protected by copyright. All rights reserved.
... Although it is possible to restore lost dental hard tissue with prosthodontic treatment, restored teeth require continuous monitoring and retreatment. Therefore, prosthodontic treatment is not a treatment option to completely replace natural teeth in terms of time and cost [9,10]. Therefore, to ensure long-term preservation of natural teeth, it is essential to detect early stages of pathological wear and provide preventive interventions to inhibit or postpone its progress, primarily by continually monitoring and managing the associated risk factors [5,10,11]. ...
Article
Background: Various techniques have been suggested to quantitatively assess tooth wear; most have limited clinical application. The first aim of this in vitro study was to estimate the residual enamel thickness of teeth with various degrees of occlusal wear using quantitative light-induced fluorescence (QLF). The second aim was to identify relationships between the fluorescence parameters of QLF and the conventional tooth wear index (TWI) system. Methods: Sixty-nine extracted permanent premolars and molars with initial stages of tooth wear (TWI score 1a-2: enamel wear to dentin exposure) were used. Two blinded and trained examiners participated in evaluation procedures. Occlusal QLF-digital (QLF-D) images were acquired for selecting area of interest (AOI) and calculating fluorescence for occlusal tooth wear (ΔFwear) of the AOI by the first examiner. Each specimen was crosssectioned in the buccal-lingual direction. Enamel thickness from images obtained by stereomicroscopy and TWI of each sample was determined by the second examiner. Spearman correlation was used to determine the relationship of ΔFwear with enamel thickness and TWI. ΔFwear values were compared between histological scores with the Mann-Whitney U test. Results: Seventy-six AOIs were analyzed. As enamel thickness decreased, ΔFwear values significantly increased and strongly correlated with enamel thickness (Spearman rho = -0.825, P < 0.001). There were significant differences in ΔFwear values among TWI scores (P < 0.001); ΔFwear strongly correlated with TWI (Spearman rho=0.753, P < 0.001). Conclusions: ΔFwear values, which denote fluorescence difference by using QLF, showed a strong correlation with residual enamel thickness and tooth wear severity.
... Thankfully, these educational objectives are permissible when international treatment standards and guidelines are being followed in a well-designed dental curriculum. The Commission of Dental Accreditation (CODA), the Association of Dental Education in Europe (ADEE), and the European Society of Endodontology (ESE) recommended competency-based education in a comprehensive clinical care environment [15,22,23]. Furthermore, an endodontic difficulty assessment form or tool has been developed to help guide students and general dentists in case selection [24][25][26]. ...
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Background Identify the objectives and the instructional design of undergraduate endodontics in dental schools in Saudi Arabia. Methods The online questionnaire was developed from an original survey conducted in the United Kingdom. The questionnaire was modified for purpose of the study and the region of interest. Then it was directed and emailed to the undergraduate endodontic program directors in twenty-six dental schools in Saudi Arabia. The results were analyzed using descriptive statistics and the Chi-square and Fisher’s exact tests. Results The response rate was 96.15%. The number of credit hours for preclinical endodontic courses was up to four credit hours (84%). Students were clinically trained to do vital pulp therapies (92%), root canal treatment (100%), and root canal retreatment (68%). The majority of dental schools define the minimum clinical requirements (92%). Practical and clinical competency exams were used to evaluate students' performance (92% and 84% respectively). The students were trained to treat cases of minimal (52%) to moderate complexity (48%). Endodontic treatment consent and difficulty assessment form were used by 32% and 60% of dental schools respectively. There was no significant difference in the instructional design between public and private dental schools (P > 0.05). Conclusion The endodontic undergraduate objectives were to graduate competent clinicians who acquired basic science of endodontics and who know their limitations as it is necessary for a safe general dental practice. The use of endodontic treatment consent and case difficulty assessment should be wisely considered in clinical training.
... The results in this study may indicate that occlusal force adjustments are generally performed in an unconscious feedforward manner regardless of the presence or absence of peripheral sensory information. This finding has also been implicated by the clinical use of dental implants, which are useful without connection to sensory tissue such as the periodontal ligament 39,40 . Conversely, PFC processing of periodontal tactile stimuli from the teeth may play a role in the prevention of cognitive impairment, as shown by recent clinical research in which dementia and cognitive impairment were associated with tooth loss [41][42][43] . ...
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The prefrontal cortex (PFC) plays a role in complex cognitive behavioural planning, decision-making, and social behaviours. However, the effects of sensory integration during motor tasks on PFC activation have not been studied to date. Therefore, we investigated the effect of peripheral sensory information and external information on PFC activation using functional near-infrared spectroscopy (fNIRS). Cerebral blood flow (CBF) was increased around bilateral Brodmann areas 46 and 10 during visual and auditory information integration during an occlusal force (biting) task. After local anesthesia, CBF values were significantly decreased, but occlusal force was similar. In conclusion, the effects of peripheral sensory information from the periodontal ligament and external information have minimal impacts on occlusal force maintenance but are important for PFC activation.
... However, results of eight of 10 studies included in the systematic review demonstrated preservation rates greater than 90 percent. 9 Results of other studies indicated that extended retention of dental implants (10 to 16 years) was associated with increased biological and technical problems. 10 In this regard, researchers often did not differentiate between survival and success rates of dental implants when reporting short-and long-term data. ...
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Background. Over time, the percentage of dental implants that fail increases because of biological and technical issues. Inevitably, clinicians will dedicate more time to dealing with ailing and failing dental implants. Methods. The authors searched the literature for articles that addressed diagnostic manifestations of failed implants and reasons for their demise, as well as survival rates of dental implant reimplantations. Results. The authors found that there is no precise cut point (besides 100 percent) with regard to the amount of bone loss in the absence of mobility that indicates an implant has failed. The decision to treat or explant an ailing implant is a judgment call by the treating clinician. Survival rates found in the literature after first and second reimplantations ranged from 71 percent to 100 percent and 50 percent to 100 percent, respectively. The 100 percent findings were based on small groups of implants, and there were scant data addressing implant survival after second reimplantations. Conclusions. The decision to remove an implant needs to be based on clinical assessments, radiographic evaluations or both. If the implant is deemed hopeless, there are devices that facilitate their removal. Furthermore, reimplantations can be performed successfully, but their survival rate appears to be lower than that of implants placed at sites from which they were not lost formerly. Practical Implications. Ailing dental implants should not be condemned prematurely, because patients often respond to treatment of peri-implantitis. Many patients desire reimplantations in sites in which implants have failed. This procedure is valuable, especially if it makes possible the fabrication of an implant-supported fixed or removable prosthesis.
... The conclusion that the long-term outcome of microsurgical endodontics was significantly lower than the short-term outcome after 1 year or that of single-implant restoration may have largely resulted from an outcome bias related to the lower outcome rates of RES. It has also become evident by long-term data >15 years that natural teeth, even if periodontally, endodontically, or restoratively compromised, demonstrate higher survival rates than dental implants (93). Based on this and other information, a new consensus exists that natural teeth, if restorable, should preferably be used as abutment units rather than replaced by dental implants. ...
Article
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Introduction: The aim of the present study was to investigate the influence of root-end preparation and filling material on endodontic surgery outcome. A systematic review and meta-analysis was conducted to determine the outcome of resin-based endodontic surgery (RES, the use of high-magnification preparation of a shallow and concave root-end cavity and bonded resin-based root-end filling material) versus endodontic microsurgery (EMS, the use of high-magnification ultrasonic root-end preparation and root-end filling with SuperEBA [Keystone Industries, Gibbstown, NJ], IRM [Dentsply Sirona, York, PA], mineral trioxide aggregate [MTA], or other calcium silicate cements). Methods: An exhaustive literature search was conducted to identify prognostic studies on the outcome of root-end surgery. Human studies conducted from 1966 to the end of December 2016 in 5 different languages (ie, English, French, German, Italian, and Spanish) were searched in 4 electronic databases (ie, Medline, Embase, PubMed, and Cochrane Library). Relevant review articles on the subject were scrutinized for cross-references. In addition, 5 dental and medical journals (Journal of Endodontics; International Endodontic Journal; Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics; Journal of Oral and Maxillofacial Surgery; and International Journal of Oral and Maxillofacial Surgery) were hand checked dating back to 1975. All abstracts were screened by 3 independent reviewers (H.B., M.K., and F.S.). Strict inclusion-exclusion criteria were defined to identify relevant articles. Raw data were extracted from the full-text review of these selected articles independently by each of the 3 reviewers. In case of disagreement, an agreement was reached by discussion, and qualifying articles were assigned to group RES. For EMS, the same search strategy was performed for the time frame October 2009 to December 2016, whereas up to October 2009 the data were obtained from a previous systematic review with identical criteria and search strategy. Weighted pooled success rates and a relative risk assessment between RES and EMS were calculated. To make a comparison between groups, a random effects model was used. Results: Sixty-eight articles were eligible for full-text review. Of these, per strict inclusion exclusion criteria, 14 studies qualified, 3 for RES (n = 862) and 11 for EMS (n = 915). Weighted pooled success rates for RES were 82.20% (95% confidence interval [CI], 0.7965-0.8476) and 94.42% for EMS (95% CI, 0.9295-0.9590). This difference was statistically significant (P < .0005). Conclusions: The probability for success for EMS proved to be significantly greater than the probability for success for RES, providing best available evidence on the influence of cavity preparation with ultrasonic tips and/or SuperEBA (Keystone Industries, Gibbstown, NJ), IRM (Dentsply Sirona, York, PA), MTA, or silicate cements as root-end filling material instead of a shallow cavity preparation and placement of a resin-based material. Additional large-scale randomized clinical trials are needed to assess other predictors of outcome.
... Many topic-oriented and systematic reviews published in 2013 cannot possibly be covered here, given space and time limitations. For interested readers, articles addressing the following topics, specifically relevant to prosthodontics, may be of interest: prosthodontic materials, 214 prosthetic occlusion, 215-219 dental esthetics, 220,221 prosthodontic maintenance, 222 preprosthetic surgical considerations, 223-225 3-dimensional anatomy of the tongue, 226 immediate loading of dental implants, 227 restorative outcomes of 1-piece implants, 228,229 implant abutments, 230 implant treatment considerations, [231][232][233][234][235][236][237][238][239][240] burning mouth syndrome, 241 xerostomia, 242,243 dental wear, [244][245][246] diagnostics, 247 and TMJ considerations. [248][249][250] As the profession's drive toward evidence-based practice intensifies, clinicians are tasked to develop a clear understanding of fundamental concepts related to gathering, evaluating, reporting, and clinically applying sound evidence. ...
... There is now a growing body of evidence to suggest that maintaining periodontally involved teeth can provide better survival outcomes and can also be more cost-effective than placing implant-retained crowns. 21,22 Thus there is a gradual move towards retaining periodontally involved teeth for as long as possible, before replacement with implants, as a general principle. ...
... Furthermore, in the dental field, an alternative dental implant without periodontal sensation can be applied for missing teeth where patients are similarly asked to maintain a target occlusal force [11][12][13]. Therefore, we employed the same experimental protocol among elderly patients with dental implants lacking periodontal tactile, elderly individuals with natural teeth, and young individuals with natural teeth to examine whether periodontal tactile input could increase cerebral blood flow (CBF) in the PFC. ...
Article
Full-text available
We previously studied the effect of peripheral sensory information from sensory periodontal ligament receptors on prefrontal cortex (PFC) activity. In the dental field, an alternative dental implant without periodontal sensation can be applied for missing teeth. In this study, we examine whether periodontal tactile input could increase cerebral blood flow (CBF) in the PFC against elderly patients with dental implants lacking periodontal tactile (implant group), elderly individuals with natural teeth (elderly group), and young individuals with natural teeth (young group). The experimental task of maintaining occlusal force as closed-loop stimulation was performed. Compared with the young group, the elderly group showed significantly lower CBF. Contrastingly, compared with the young group, the implant group showed significantly lower CBF. There were no significant differences between the elderly and implant groups. Regarding the mean occlusal force value, compared with the young group and the elderly group, the implant group had a numerically, but not significantly, larger occlusal force exceeding the directed range. In conclusion, the periodontal tactile input does not uniquely increase PFC activity. However, increased CBF in the PFC due to the periodontal tactile input in the posterior region requires existing attention behavior function in the PFC.
... Highly aesthetic results, comfort in wear and the preservation of neighboring teeth describe only a few of the advantages that come with the use of implant-supported prostheses [3,4]. Unlike early implant systems, today's modern implants achieve long-term survival rates and may last for decades, making them a reliable restorative option [5,6]. Moreover, sophisticated screening tools [7,8] help to identify patients suitable for implant treatment [9,10]. ...
Article
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Adequate soft-tissue dimensions have been shown to be crucial for the long-term success of dental implants. To date, there is evidence that placement of dental implants should only be conducted in an area covered with attached gingiva. Modern implant planning software does not visualize soft-tissue dimensions. This study aims to calculate the course of the mucogingival borderline (MG-BL) using statistical shape models (SSM). Visualization of the MG-BL allows the practitioner to consider the soft tissue supply during implant planning. To deploy an SSM of the MG-BL, healthy individuals were examined and the intra-oral anatomy was captured using an intra-oral scanner (IOS). The empirical anatomical data was superimposed and analyzed by principal component analysis. Using a Leave-One-Out Cross Validation (LOOCV), the prediction of the SSM was compared with the original anatomy extracted from IOS. The median error for MG-BL reconstruction was 1.06 mm (0.49–2.15 mm) and 0.81 mm (0.38–1.54 mm) for the maxilla and mandible, respectively. While this method forgoes any technical work or additional patient examination, it represents an effective and digital method for the depiction of soft-tissue dimensions. To achieve clinical applicability, a higher number of datasets has to be implemented in the SSM.
... In a systematic review of longterm tooth and implant survival, it was calculated that one in five implants would be associated with peri-implant disease and higher failure rates would be expected in periodontally compromised patients. 18 Whilst the evidence of implant survival in patients with Parkinson's disease is limited, in patients with diabetes mellitus (a group of medically compromised patients who also experience higher rates of dental disease) it was reported that implant survival was only 69% over 21 years. 19 While there are a number of factors that would prevent direct comparison between these groups, as diabetes is associated with factors that may contribute to higher levels of oral disease (eg, impairment at the cellular level). ...
Article
Full-text available
Individuals with Parkinson's disease present a challenge to dental clinicians as this degenerative disease leads to problems accessing care and maintaining an adequate level of oral health. This article provides an overview of the implications of Parkinson's disease on oral health and explores the role of dental implants in the management of such patients.
... 7 There is a lack of evidence on the long-term survival of implants compared to natural teeth. 8 Implants have been known to present with their own complications, such as failures and peri-implantitis. 9,10 Research has shown that the number of teeth a person has is correlated to their perception of quality of life. ...
Article
Aim: This report highlights the use of a seldom-used treatment modality to save a diseased multirooted tooth, as an alternative to extraction and implant. Background: Root-resection therapy is a simple surgical procedure performed by an endodontist or periodontist to save a multirooted tooth with furcation involvement and/or defective root. Case description: A 64-year-old female patient reported a strip perforation in the distobuccal (DB) root of the maxillary left first molar. The tooth had previously undergone endodontic treatment and had a well-fitted crown. After presenting the patient with treatment options and prognosis, a treatment plan of root amputation to save the tooth was formulated. A full mucoperiosteal flap was reflected. The DB root was amputated and GIC was placed to cover the root. Sutures were placed and the patient was given postoperative instructions. A follow-up was carried out with clinical examination, and periapical radiographs were taken at 10 months, 2 years, and 5 years after the procedure. The tooth was intact and functioning; no signs or symptoms were reported. Conclusion: Root resection has a deserved place in the modern clinical management of endodontic lesions or injuries. Conventional conservative treatment plans can succeed with proper treatment planning, diagnosis, case selection, maintenance of oral hygiene, and meticulous follow-up. Clinical significance: This case emphasizes a viable treatment procedure to manage teeth with compromised radicular or restorative presentations. Root resection is a venerable treatment option that is often ignored in the era of implants even though it shows favorable prognosis and success rates.
... In combination with financial considerations, this may favor patients' and clinicians' decision for implants instead of endodontic treatment. However, implant survival rates definitively do not exceed those of compromised but adequately root canal-treated teeth [37]. It is well established that root canal treatment is a successful and reliable therapy that can remain teeth functional and healthy for even more than 20 years [38,39]. ...
Article
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The aim of this study was to compare the alveolar bone crest (ABC) level of root canal filled (RCF) teeth without apical periodontitis with corresponding non-filled teeth in the same individual using three-dimensionally cone-beam computed tomography (CBCT) data. Two hundred and thirty-five matching pairs of RCF teeth and corresponding teeth without RCF were selected from a pool of 580 random CBCT-images (voxel size 160-200 µm). Teeth with apical periodontitis, perio-endodontic lesions or surgical endodontic treatment were excluded. The distance between the cemento-enamel-junction (CEJ) and the ABC was assessed centrally mesial, distal, palatal/lingual and buccal at each tooth (∑1880 measuring points) in a standardized manner. Topographic, gender, and age-related relationships were also noted. Data were analyzed using the Kruskal-Wallis-test. The ABC-level between RCF teeth (2.64 ± 1.25 mm) and teeth without RCF (2.61 ± 1.16 mm) did not differ significantly (p > 0.05). No differences concerning localization (maxilla/mandible, tooth type) and gender (p > 0.05) occurred. Overall, ABC-level in the maxilla (2.74 ± 1.48 mm) was significantly lower (p < 0.001) compared to mandibular teeth (2.50 ± 1.41 mm). Patients >41 years had significantly lower ABC-levels than younger patients (p < 0.05). Men showed a reduced bone level compared to women (p < 0.05). In conclusion, RCF teeth are identical to their non-RCF counterparts, at least in terms of crestal bone level, regardless of the location or type of tooth and the gender of the patient. Thus, root canal treatment is an essential pillar for long-term tooth preservation.
... There is now a growing body of evidence to suggest that maintaining periodontally involved teeth can provide better survival outcomes and can also be more cost-effective than placing implant-retained crowns. 21,22 Thus there is a gradual move towards retaining periodontally involved teeth for as long as possible, before replacement with implants, as a general principle. ...
Article
This is the second in a two-part series that aims to summarise answers to common questions facing dentists in general practice. The first part of this series is entitled 'Periodontal care in general practice: 20 important FAQs − Part one' (Br Dent J 2019;226: 850-854) and contains the first set of ten FAQs.
... Implicit in the decision to retain such teeth would be the joint understanding that compliance to a structured maintenance program is necessary. Indeed, the long-term longevity of implants does not exceed healthy teeth or even teeth that are compromised but adequately treated and maintained [146][147][148]. Implants are not supposed to replace teeth; they are only meant to replace missing teeth [149]. ...
Article
Full-text available
Severe periodontitis is a highly prevalent dental disease. With the advent of implant dentistry, teeth are often extracted and replaced. Periodontal surgery, where indicated, could also result in increased trauma to the patient. This literature review discusses different treatment modalities for periodontitis and proposes a treatment approach emphasizing maximum preservation of teeth while minimizing morbidity to the patient. Scientific articles were retrieved from the MEDLINE/PubMed database up to January 2021 to identify appropriate articles that addressed the objectives of this review. This was supplemented with hand searching using reference lists from relevant articles. As tooth prognostication does not have a high predictive value, a more conservative approach in extracting teeth should be abided by. This may involve repeated rounds of nonsurgical periodontal therapy, and adjuncts such as locally delivered statin gels and subantimicrobial-dose doxycycline appear to be effective. Periodontal surgery should not be carried out at an early phase in therapy as improvements in nonsurgical therapy may be observed up to 12 months from initial treatment. Periodontal surgery, where indicated, should also be minimally invasive, with periodontal regeneration being shown to be effective over 20 years of follow-up. Biomarkers provide an opportunity for early detection of disease activity and personalised treatment. Quality of life is proposed as an alternative end point to the traditional biomedical paradigm focused on the disease state and clinical outcomes. In summary, minimally invasive therapy aims to preserve health and function of the natural dentition, thus improving the quality of life for patients with periodontitis.
... The use of dental implants as a replacement for missing teeth has been increasing steadily, probably owing to the high predictability and survival rates, as reported in numerous studies. 4,16 Given the increasing popularity of dental implants, it is highly important to have a long-term "real-life" evaluation and analysis of this treatment performance. ...
Article
Full-text available
Background The present retrospective study was aimed to assess the long‐term clinical performance of dental implants in a cohort study of 4247 patients. Methods A longitudinal observational cohort study was done on all implants performed by a single periodontist from July 1995 to April 2019. The main outcome variables of this study were implant failure and marginal bone level around implants. Results The study participants received a total of 10 871 implants with a mean of 2.56 implants per patient. The cohort was followed‐up to 22.2 years (mean = 4.5 ± 4.2). Among the 4247 patients of the current study, 140 patients (3.3%) experienced a combined total of 178 implant failures. According to life table analysis, at the implant level the cumulative survival rate at 3, 5, 10, and 15 years was 98.9%, 98.5%, 96.8%, and 94.0%, respectively while at patient level was 97.4%, 96.7%, 92.5%, and 86% at 3, 5, 10, and 15 years. Patients with multiple units were at a greater risk for having an implant failure. Baseline bone level was 0.09 ± 0.28 mm while at 8–10 years the mean bone level was 0.49 ± 0.74 mm. The incidence of peri‐implant mucositis at the implant level was 9.4% at 2–3 years, 9.3% at 4–5 years, 12.1% at 6–7 years, and 11.9% at 8–10 years. The incidence of peri‐implantitis was 2%, 2.6%, 3.2%, and 7.1% at 2–3, 4–5, 6–7, and 8–10 years, respectively. Cigarette smoking and diabetes mellitus were positively correlated with implant failure. Conclusions Though the results are promising and encouraging in terms of survival and bone level over time, it is important to emphasize the potential risk factors and consider them prior to dental implant placement.
... The concept of the hopeless tooth (HT) [1][2][3][4][5][6][7] has garnered more interest as clinicians have experienced an increasing number of problems with implant failure, peri-implantitis, and prosthetic problems associated with implant restorations. [8][9][10][11] Periodontists have begun to see a paradigm shift toward saving teeth, in lieu of extracting teeth and replacing them with implants. 12 The thoughtful clinician should always consider "What's next when this treatment fails? ...
Article
Objective This case will demonstrate a thoughtful approach to the management of avulsed/replanted teeth in the adult dentition and their long‐term maintenance. Often times these teeth are either not replanted, or extracted soon after replantation when resorptive lesions appear and the teeth are deemed “hopeless”. The term “hopeless tooth” (HT) has become more popular since the advent of implants. Implants allowed for a simple solution to the HT by extraction and immediate replacement with a fixture and a restoration. However, now that we are realizing that implants do not last forever and also have attendant problems, saving the HT takes on a new light. Clinical considerations Prolonging the life of the HT can preserve bone and give the patient a functional, esthetic tooth for many years. With each additional year, clinicians garner new skills, and technology improves our future treatment outcomes. This will allow clinicians to improve and extend the life of future replacements. Conclusions If there is minimal risk to adjacent structures, retaining the HT has many advantages for the patient and clinician. Clinicians should adopt a policy of thinking ahead and asking “What's Next”? when their prospective treatment fails or needs to be replaced. By prolonging the life of the HT, the “best ultimate treatment” has a greater chance to outlive the patient. Clinical significance With the advent of single tooth implants, the term “hopeless tooth” has become more popular. It is easier to justify extraction of a tooth when it is deemed “hopeless”. Many of these teeth could be saved. The advantages of this philosophy will be elucidated.
... The reported survival rates of implants range between 69.6% and 100%. 37 Some studies with longterm follow-ups in adults have reported incompatibility between the level of the gingival margin and the incisal edge of transplanted and adjacent teeth. 38,39 In those studies, periodontal problems with marginal bone loss around the adjacent teeth and bone loss around the buccal aspect of the implants were found. ...
Article
Introduction: Autotransplantation has become a major therapeutic option for replacing missing teeth in adult orthodontic patients. However, little systematic information is available about the long-term stability of autotransplanted teeth with complete root formation after the application of an orthodontic force. The objective of this study was to investigate the outcomes of autotransplanted teeth with complete root formation that underwent orthodontic treatment. Methods: One hundred teeth, autotransplanted in 89 patients, were examined over a mean observation period of 5.8 years. Orthodontic force was applied with nickel-titanium wires 4 to 8 weeks after autotransplantation. Root resorption, ankylosis, mobility, pocket depth, and inflammation at the recipient site were investigated clinically and with radiographs. Results: The survival rate of the autotransplanted teeth was 93.0%. Abnormal findings were found in 29 teeth, including 7 lost teeth, for a success rate of 71.0%. Donor tooth type and occlusal condition of the donor tooth before transplantation were associated with abnormal findings. Conclusions: The early application of orthodontic force may increase the success rate of autotransplanted teeth, and the type and presurgical occlusal condition of donor teeth affect the success rate.
Chapter
Decision-making about a treatment plan whether to preserve a compromised tooth with endodontic therapy and a protective, functional restoration or to extract and replace it with an implant requires evidence-based diagnosis and recommendations based on patient factors, tooth and periodontium-based factors, and treatment-based factors. The first consideration should be the preservation of the natural dentition as long as possible, since the extraction and implant placement can be done at anytime and the implant treatment is not without risk. This component of the chapter outlines the evidence to recommend and plan the most appropriate treatment when faced with restoring the compromised tooth.
Article
Introduction: A 2009 American Association of Endodontists survey of dentists in general practice (GPs) to assess their perceptions and understand the factors associated with referrals to endodontists was the first of its kind. The American Association of Endodontists repeated the survey in 2012 to update our understanding of the referral behavior of GPs by reexamining the effects of endodontist characteristics and professional behavior and the role of GP demographics and perceptions in determining referrals to endodontists. Methods: Researchers conducted a cross-sectional study that included a quantitative online survey of 786 GPs in the United States (14% of 5737 initially opened invitations) from November 1-13, 2012. Results: Ninety-four percent of the GPs had positive perceptions of endodontists, but they referred only 43% of patients who required root canal treatment to endodontists. The perception that endodontists are partners in patient care and endodontic services are worth the cost was strongly related to the likelihood of referring (P < .05). GPs rated referring patients back for restorative treatment (95%, n = 734), timely follow-up of reports and images (94%, n = 726), and patient scheduling accommodation (91%, n = 707) as effective ways to build partnerships. Gender and years in practice moderated the relationships between several predictors (eg, communication, value of treatment, and expertise) and the likelihood of referring. Conclusions: There are concrete actions that endodontists can take and segments of the GP population that can be targeted to successfully address the issue of increasing referrals. However, examining the role of endodontist actions and GP perceptions and demographics is just the beginning in addressing the relationships involved in referral behavior.
Chapter
This chapter describes evolving experimental approaches that are geared toward periodontal/bone regeneration. Currently, the pinnacle of regenerative periodontal treatment is the use of bone substitutes combined with barrier membranes, which already demonstrates how far we have progressed from the old resective approaches that dominated the field. Thus, the focus of the clinical repertoire shifted from a purely surgical to biologically oriented treatment of the detrimental effects of periodontal disease and bone defects that may prevent future implant placement. The continuous presence of bacteria at the tooth-epithelium or implant-epithelium junction results in a progressive inflammatory process, which leads to the destruction of the gingival connective tissue and subsequently of the alveolar bone, periodontal ligament (PDL), and cementum on the root surface. This process, when left undisturbed, will lead eventually to the loss of the involved tooth or implant. Not only is this loss of periodontal support detrimental to the stability and function of the tooth or implant, it also hampers the restoration of the diseased area with implants following the removal of the ailing tooth/implant. Therefore, the clinical art of periodontology has been paying a tremendous amount of attention to periodontal regeneration.
Article
Background: Aggressive periodontitis renders a great challenge to the conventional implant due to the risks of infection and ongoing marginal bone loss (MBL). A study about full-arch immediate implant and restoration in patients with advanced generalized aggressive periodontitis (GAP) was not read, even though the All-on-4 concept has been proven to be predictable for edentulous patients. Purpose: This prospective study aimed to evaluate the feasibility and medium-term outcomes of immediate implant and rehabilitation based on the All-on-4 concept in patients with advanced GAP via clinical and radiographic analyses. Materials and methods: Seventeen patients (mean age 39.4 years) with advanced GAP received immediate postextraction implant and rehabilitation based on the All-on-4 concept between January 2009 and January 2014. Eighty implants were inserted into 20 arches (7 maxillae and 13 mandibles). The average follow-up duration was 5 years (range 2-7). Complications, probing depth, and plaque, bleeding, and gingiva indices were evaluated. MBL was measured based on the panoramic radiographs taken immediately after surgery and annually thereafter. Results: The cumulative survival rate (CSR) of the implants was 98.75% (79/80) after an average of 5 years. One tilted implant failed due to peri-implantitis. The average peri-implant MBL was 0.8???0.4 and 1.2???0.3 mm after 1 and 7 years, respectively. The CSR was 100% (20/20) for definite prostheses, while 85% (17/20) for provisional prostheses. The average probing depth, and plaque, bleeding, and gingiva indices at the last recall visit were 3.0???0.5, 1.2???0.4, 0.5???0.5, and 0.4???0.4 mm, respectively. Patient showed high satisfaction to the overall effects. Conclusions: Based on this study, the All-on-4 concept provided predictable outcomes in patients with GAP in 2- to 7-year follow-ups, and averted the severe bone defect area of aggressive periodontitis.
Chapter
Modern dental implants have added greatly to the restorative options available to the dental practitioner. In this context, endodontically treated teeth had been labeled as inferior to implants in regard to long-term stability and retention, and especially teeth requiring endodontic surgery were considered to be better suited for replacement than for therapy. Implant success and survival should be differentiated. This distinction is important, since, historically, implants were often reported as "successful", although mostly the mere presence of the implant in the mouth was recorded, which is in fact "survival". The long-term outcome of endodontically treated teeth should only be compared to implants on the basis of survival. If a treatment plan is made correctly and the treatment is executed well, both implant therapy as well as restored teeth with a history of root end surgery have great outcomes and can serve the patient for many years.
Chapter
Both dental implants and endodontically treated teeth have demonstrated favorable outcome rates. However, there is still controversy regarding when to extract in favor of an implant and when to keep a natural tooth. Much of this controversy stems from the way the outcome of dental implants is defined. A majority of implant studies have used the measure of “survival” instead of “success.” Survival rates up to 95.5 % after 1 year of follow-up have been reported. By contrast, most endodontic studies have applied strict success criteria, in particular requiring the resolution of apical periodontitis and the absence of symptoms. This renders a direct comparison to implant survival studies obsolete. If survival studies are compared, there is no significant difference in outcome between restored single-unit implants (95 %) and endodontically treated teeth (94 %) over 6 years.
Article
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Background: The degree of biodegradation and the inflammatory response of membranes employed for guided bone regeneration directly impact the outcome of this technique. This study aimed to evaluate four different experimental versions of Poly (L-lactate-co-Trimethylene Carbonate) (PTMC) + Poly (L-lactate-co-glycolate) (PLGA) membranes, implanted in mouse subcutaneous tissue, compared to a commercially available membrane and a Sham group. Methods: Sixty Balb-C mice were randomly divided into six experimental groups and subdivided into 1, 3, 6 and 12 weeks (n = 5 groups/period). The membranes (1 cm2) were implanted in the subcutaneous back tissue of the animals. The samples were obtained for descriptive and semiquantitative histological evaluation (ISO 10993-6). Results: G1 and G4 allowed tissue adhesion and the permeation of inflammatory cells over time and showed greater phagocytic activity and permeability. G2 and G3 detached from the tissue in one and three weeks; however, in the more extended periods, they presented a rectilinear and homogeneous aspect and were not absorbed. G2 had a major inflammatory reaction. G5 was almost completely absorbed after 12 weeks. Conclusions: The membranes are considered biocompatible. G5 showed a higher degree of biosorption, followed by G1 and G4. G2 and G3 are considered non-absorbable in the studied periods.
Article
It has long been assumed that clinicians are able to predict the course of periodontal disease and advise patients about the longevity of individual teeth; the evidence challenges this concept and suggests that clinicians are unable to do this with any certainty. Periodontal therapy can be highly effective in the long term and questionable teeth can be retained for long periods. These facts have important implications when deciding whether or not to remove a tooth and consider some form of tooth replacement. The advent of dental implants has further complicated this decision-making process. In addition, the fate of dental implants in periodontally susceptible patients is not as predictable as it is in the periodontally healthy. CPD/Clinical Relevance: This paper highlights the difficulties clinicians face when determining the prognosis of periodontally involved teeth in terms of whether to extract or retain such teeth. It also examines the survival of implants in periodontally susceptible patients. ‘Let's see what happens' is actually very sensible….time is a powerful diagnostic tool, though many patients are unimpressed by it’ (Raymond Tallis, Hippocratic Oaths 2004).
Article
Introduction A systematic review and meta-analysis were conducted to report combined and individual weighted pooled outcome rates for crown resection (CR) and root resection (RR) procedures. Methods Three electronic databases (PubMed [MEDLINE], Scopus, and the Cochrane Library) were searched to identify human studies in 12 languages on CR (hemisection, trisection, and premolarization) and RR (amputations and RRs without removal of crown portions). Five peer-reviewed journals, references of relevant publications, and reviews were hand searched. Assessment by 3 independent reviewers was based on the following predefined Population, Intervention, Comparison, Outcome, Study Design question: “For teeth in patients undergoing surgical therapy by CR versus RR, what is the expected probability of survival according to longitudinal studies with strictly defined outcome measurements and inclusion/exclusion criteria?” Clinical investigations with at least 12 months of follow-up were included. Studies and level of evidence were appraised using the Newcastle-Ottawa Scale and Grading of Recommendations, Assessment, Development and Evaluations. Results Thirty-four articles were obtained for final analysis. Data could be extracted from 19 studies (CR and RR OVERALL: N = 2667 [19 studies], CR: n = 111 [3 studies], and RR: n = 1127 [9 studies]). A random effects model showed weighted mean survival rates of 85.6% (95% confidence interval [CI], 76.7–91.5) for CR and RR procedures OVERALL. Individual data showed weighted mean survival rates of 81.9% (95% CI, 72.0–88.8) for CR and 87.2% (95% CI, 71.7–94.8) for RR. There was no statistically significant difference between CR and RR (P = .89, odds ratio calculation) or between maxillary and mandibular molars (P = .81, Fisher exact test). Conclusions Overall, CR and RR procedures showed good outcome rates. Large-scale randomized controlled trials should be conducted to strengthen the evidence.
Conference Paper
Full-text available
Role of PRF as a regenerative material in Periodontal defects.
Article
Background and overview: Teeth with coronal one-third root fractures are considered to have a poor prognosis. Historically, such teeth were likely to be extracted. Observations have indicated that at least some teeth with such fractures can survive for a significant amount of time. Case descriptions: The authors report on 2 cases of coronal one-third root fractures that have survived for 10 and 35 years and suggest that the long-term splinting of these teeth aided in their survival. Conclusion and practical implication: Stabilizing teeth with coronal one-third root fractures may allow such teeth to survive for long periods, which can be of great benefit, especially for young patients.
Chapter
The periodontium and the dental pulp are closely associated, sharing embryonic, functional, and anatomical interrelationships. Consequently, the relationship of endodontic and periodontal lesions has stirred confusion and debate as dental practitioners have become gradually further aware of the possible associations between the periodontium and the dental pulp.
Chapter
Periodontal-endodontic lesions are the combination of pulp involvement and periodontal disease in the same tooth. Diagnosis may become difficult; however, a differential etiological consideration is indispensable for appropriate treatment.
Chapter
A common dilemma encountered by dental practitioners is the decision whether to extract a compromised natural tooth and replace it with a dental implant, or to attempt preservation of the natural tooth by endodontic periodontal and restorative treatments. This intriguing dilemma has been extensively debated over the years, shifting back and forth. Nevertheless, recent publications revealed that compared to natural teeth, dental implants are more susceptible to complications, and may require additional treatments to maintain them following their placement. This complex decision requires both periodontal endodontic and restorative considerations. This chapter reviews the capabilities offered by modern dentistry to retain the natural dentition considering especially dental implants biological complications and their subsequent effects on clinical decision-making.
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Following extraction of tooth/teeth with advanced loss of periodontal support, as those with periodontal-endodontic lesions, the remaining bone architecture should be carefully evaluated, especially where implant-supported restoration is planned. Marked resorption of the residual alveolar bone is usually appreciated 3 months after tooth extraction. This process may impair implant-supported restoration outcome, especially in the upper jaw, where esthetics is a key factor. Different treatment alternatives are available at the time of tooth extraction, namely immediate implant placement, primary soft tissue closure of the extraction site that may be followed by early implant placement, ridge preservation, and ridge augmentation. For each clinical case, treatment possibilities should be considered and evaluated according to tooth location, esthetics, soft tissue characteristics, infection, number of implants simultaneously placed, available bone volume, bony defects, and treatment convenience.
Book
This book presents a multidisciplinary evidence-based approach to the management of teeth with lesions of endodontic-periodontal origin. The book opens by addressing the etiology and classification of endodontic-periodontal lesions, and demonstrates its relevance to the daily practice. Specific endodontic, prosthetic, and periodontal considerations that should be incorporated into clinical decision making and treatment planning are then discussed in detail. Subsequent chapters describe modern clinical procedures in periodontal regenerative treatment, describe vertical root fractures as an endodontic-periodontal lesion, examine treatment alternatives following the extraction of teeth with endodontic-periodontal lesions, and discuss possible biological complications in implant supported oral rehabilitation. Finally, a summary chapter considers the integration of clinical factors and patient values into clinical decision making. The text is accompanied by many figures presenting informative clinical examples. The authors are internationally renowned scientists and clinicians from the specialties of Endodontology, Periodontology, and Oral Rehabilitation. Owing to its multidisciplinary and comprehensive nature, the book will be relevant and interesting to the entire dental community.
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Dental implantology is a discipline that merges knowledge regarding treatment planning, surgical procedures, and prosthetic endeavors. To attain optimal results many numbers pertaining to different facets of therapy are integrated into treating patients. This article outlines a wide range of digits that may assist clinicians in enhancing the performance of implant dentistry. Important integers are presented in three segments related to the sequence of therapy: pre-procedural assessments, surgical therapy, and postsurgical patient management.
Article
Teeth are vital sensory organs that contribute to our daily activities of living. Unfortunately, teeth can be lost for several reasons including trauma, caries, and periodontal disease. Although dental trauma injuries and caries are more frequently encountered in a younger population, tooth loss because of periodontal disease occurs in the older population. In the dental implant era, the trend sometimes seems to be to extract compromised teeth and replace them with dental implants. However, the long-term prognosis of teeth might not be comparable with the prognosis of dental implants. Complications, failures, and diseases such as peri-implantitis are not uncommon, and, despite popular belief, implants are not 99% successful. Other treatment options that aim to save compromised or diseased teeth such as endodontic treatment, periodontal treatment, intentional replantation, and autotransplantation should be considered on an individual basis. These treatments have competing success rates to dental implants but, more importantly, retain the natural tooth in the dentition for a longer period of time. These options are important to discuss in detail during treatment planning with patients in order to clarify any misconceptions about teeth and dental implants. In the event a tooth does have to be extracted, procedures such as decoronation and orthodontic extrusion might be useful to preserve hard and soft tissues for future dental implant placement. Regardless of the treatment modality, it is critical that strict maintenance and follow-up protocols are implemented and that treatment planning is ethically responsible and evidence based.
Article
Statement of problem There is a long-held assumption that teeth are superior to implants because the periodontal ligament (PDL) confers a preeminent defense against biologic and mechanical challenges. However, adequate analysis of the literature is lacking. As a result, differential treatment planning of tooth- and implant-supported restorations has been compromised. Purpose Given an abundance and diversity of research, the purpose of this mapping review was to identify basic scientific gaps in the knowledge of how teeth and implants respond to biologic and mechanical loads. The findings will offer enhanced evidence-based clinical decision-making when considering replacement of periodontally compromised teeth and the design of implant prostheses. Material and methods The online databases PubMed, Science Direct, and Web of Science were searched. Published work from 1965 to 2020 was collected and independently analyzed by both authors for inclusion in this review. Results A total of 108 articles met the inclusion criteria of clinical, in vivo, and in vitro studies in the English language on the periradicular and peri-implant bone response to biologic and mechanical loads. The qualitative analysis found that the PDL's enhanced vascularity, stem cell ability, and resident cells that respond to inflammation allow for a more robust defense against biologic threats compared with implants. While the suspensory PDL acts to mediate moderate loads to the bone, higher compressive stress and strain within the PDL itself can initiate a biologic sequence of osteoclastic activity that can affect changes in the adjacent bone. Conversely, the peri-implant bone is more resistant to similar loads and the threshold for overload is higher because of the absence of a stress or strain sensitivity inherent in the PDL. Conclusions Based on this mapping review, teeth are superior to implants in their ability to resist biologic challenges, but implants are superior to teeth in managing higher compressive loads without prompting bone resorption.
Article
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Healthcare providers are constantly helping patients choose the best treatment option, based on the available evidence and clinician’s professional judgment. The traditional logic model used for evidence-based decision-making has four elements: (1) input of available evidence; (2) activities, including analyzing the best evidence available; (3) output, leading to the best clinical decision; and (4) impact of the treatment provided.1 Recently, this concept has evolved, as more patients become involved in the decision-making process. In medicine, some difficult decisions include chemo versus radiation therapies for cancer, or when to choose a hip replacement. In dentistry, complex situations also arise, such as deciding if a compromised tooth should be extracted — and, if so, when to opt for a dental implant.
Article
Informed consent is often perceived as a regulatory obligation without recognizing its educational potential in the dynamic provider/patient relationship. This article discusses the complex interaction of ethics, society, and law through a historical and practical perspective. The purpose is to provide the general dentists and specialists with a comprehensive understanding of the complexity and practical dimensions of informed consent. This article is protected by copyright. All rights reserved.
Chapter
The advance of the endodontic disease involves inflammatory reaction of the peri-radicular tissues while the periodontal involves marginal periodontium and results in the progressive loss of the supportive tissues. There are multiple routes of communication between the root canal space and marginal periodontium. By these communications the bacteria from the root canal space may contaminate and infect the marginal periodontium and vice versa. While in most cases the manifestation of the periodontal and endodontic diseases is clearly distinct, there are certain clinical scenarios when the signs and symptoms may be confusing, making the final diagnosis complicated and subsequently result in the wrong treatment choice.
Article
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Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users.Since the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement--a reporting guideline published in 1999--there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions.The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this Explanation and Elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA Statement, this document, and the associated Web site (http://www.prisma-statement.org/) should be helpful resources to improve reporting of systematic reviews and meta-analyses.
Article
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Purpose: To evaluate the retention of bone around implants placed immediately following tooth extraction and used to support dental prostheses. Materials and methods: Patients from a previous study of implants placed immediately following tooth extraction were recalled to the original practice to obtain dental radiographs, which were then used to compare bone levels after 1 to 22 years of clinical function supporting dental prostheses. All radiographs were evaluated by measuring the bone within the implant threads. Implant bone maintenance was correlated with smoking history, type of implant surface, antibiotics used in conjunction with surgery, bisphosphonate use, presence of splinted restorations, anatomical location (mandible or maxilla and anterior or posterior), sex, and past periodontal disease status. Statistical analysis was performed using the Mann-Whitney test for statistical significance of differences in mean bone loss. Results: A total of 1,187 implants were identified, with mean bone loss of 0.52 ± 0.79 mm. Overall bone loss was less than 1.5 mm in 90% of the implants studied. Bone loss was greater in women (0.61 ± 0.91 mm vs 0.44 ± 0.69 mm in men; P = .002). There was a correlation between bone loss and patient age at the time of tooth loss, with patients below the age of 50 experiencing significantly more loss (mean loss, 0.76 ± 1.07 mm at age < 50 and 0.46 ± 0.71 mm at age > 50; P = .008). Other significant differences were seen with implant surface (machined surface, 0.57 ± 0.77 mm; roughened surface, 0.44 ± 0.84 mm; P = .0049), maxilla vs mandible in molar areas (maxilla, 0.68 ± 0.83 mm; mandible, 0.43 ± 0.80 mm; P = .0001), and platform width (regular, 0.46 ± 0.77; wide, 0.83 ± 0.94 mm; P ≤ .0001). None of the other factors demonstrated significant differences. Conclusions: Bone loss of 1.5 mm or less was observed in 90% of the patients followed. Bone loss was correlated with age, sex, implant surface, anatomical location, and platform width. There was no statistical correlation between bone loss and any other factors evaluated.
Article
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The platform switching concept involves the reduction of the restoration abutment diameter with respect to the diameter of dental implant. Long-term follow up around these wide-platforms showed higher levels of bone preservation. The aim of this article is to carry out a literature review of studies which deal with the influence of platform-switched implants in hard and soft oral tissues. All papers involving "platform switching" that are indexed in MedLine and published between 2005 and 2011 were used. Clinical cases, experimental and non-experimental studies were included, as well as literature reviews. In our search, we analized 18 clinical cases and 3 reviews. The results indicate that peri-implant bone resorption is reduced with platform switching system. All papers written by different researchers show an improvement in peri-implant bone preservation and satisfactory aesthetic results. Further long-term studies are necessary to confirm these results.
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This review evaluated (1) the success of different surgical techniques for the reconstruction of edentulous deficient alveolar ridges and (2) the survival/success rates of implants placed in the augmented areas. Clinical investigations published in English involving more than 10 consecutively treated patients and mean follow-up of at least 12 months after commencement of prosthetic loading were included. The following procedures were considered: onlay bone grafts, sinus floor elevation via a lateral approach, Le Fort I osteotomy with interpositional grafts, split ridge/ridge expansion techniques, and alveolar distraction osteogenesis. Full-text articles were identified using computerized and hand searches by key words. Success and related morbidity of augmentation procedures and survival/success rates of implants placed in the augmented sites were analyzed. A wide range of surgical procedures were identified. However, it was difficult to demonstrate that one surgical procedure offered better outcomes than another. Moreover, it is not yet known if some surgical procedures, eg, reconstruction of atrophic edentulous mandibles with onlay autogenous bone grafts or maxillary sinus grafting procedures in case of limited/moderate sinus pneumatization, improve long-term implant survival. Every surgical procedure presents advantages and disadvantages. Priority should be given to those procedures which are simpler and less invasive, involve less risk of complications, and reach their goals within the shortest time frame. The main limit encountered in this literature review was the overall poor methodological quality of the published articles. Larger well-designed long-term trials are needed.
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The aim of this review was to offer a critical evaluation of the literature and to provide the clinician with scientifically-based diagnostic criteria for monitoring the implant condition. The review presents the current opinions on definitions of osseointegration and implant failure. Further, distinctions between failed and failing implants are discussed together with the presently used parameters to assess the implant status. Radiographic examinations together with implant mobility tests seem to be the most reliable parameters in the assessment of the prognosis for osseointegrated implants. On the basis of 73 published articles, the rates of early and late failures of Brånemark implants, used in various anatomical locations and clinical situations, were analyzed using a metanalytic approach. Biologically related implant failures calculated on a sample of 2,812 implants were relatively rare: 7.7% over a 5-year period (bone graft excluded). The predictability of implant treatment was remarkable, particularly for partially edentulous patients, who showed failure rates about half those of totally edentulous subjects. Our analysis also confirmed (for both early and late failures) the general trend of maxillas, having almost 3 times more implant losses than mandibles, with the exception of the partially edentulous situation which displayed similar failure rates both in upper and lower jaws. Surgical trauma together with anatomical conditions are believed to be the most important etiological factors for early implant losses (3.60% of 16,935 implants). The low prevalence of failures attributable to peri-implantitis found in the literature together with the fact that, in general, partially edentulous patients have less resorbed jaws, speak in favour of jaw volume, bone quality, and overload as the three major determinants for late implant failures in the Brånemark system. Conversely, the ITI system seemed to be characterized by a higher prevalence of losses due to peri-implantitis. These differences may be attributed to the different implant designs and surface characteristics. On the basis of the published literature, there appears to be a number of scientific issues which are yet not fully understood. Therefore, it is concluded that further clinical follow-up and retrieval studies are required in order to achieve a better understanding of the mechanisms for failure of osseointegrated implants.
Article
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The aim of this study was to compare the long-term outcomes of implants placed in patients treated for periodontitis periodontally compromised patients (PCP) and in periodontally healthy patients (PHP) in relation to adhesion to supportive periodontal therapy (SPT). One hundred and twelve partially edentulous patients were consecutively enrolled in private specialist practice and divided into three groups according to their initial periodontal condition: PHP, moderate PCP and severe PCP. Perio and implant treatment was carried out as needed. Solid screws (S), hollow screws (HS) and hollow cylinders (HC) were installed to support fixed prostheses, after successful completion of initial periodontal therapy (full-mouth plaque score <25% and full-mouth bleeding score <25%). At the end of treatment, patients were asked to follow an individualized SPT program. At 10 years, clinical measures and radiographic bone changes were recorded by two calibrated operators, blinded to the initial patient classification. Eleven patients were lost to follow-up. During the period of observation, 18 implants were removed because of biological complications. The implant survival rate was 96.6%, 92.8% and 90% for all implants and 98%, 94.2% and 90% for S-implants only, respectively, for PHP, moderate PCP and severe PCP. The mean bone loss was 0.75 (+/- 0.88) mm in PHP, 1.14 (+/- 1.11) mm in moderate PCP and 0.98 (+/- 1.22) mm in severe PCP, without any statistically significant difference. The percentage of sites, with bone loss > or =3 mm, was, respectively, 4.7% for PHP, 11.2% for moderate PCP and 15.1% for severe PCP, with a statistically significant difference between PHP and severe PCP (P<0.05). Lack of adhesion to SPT was correlated with a higher incidence of bone loss and implant loss. Patients with a history of periodontitis presented a lower survival rate and a statistically significantly higher number of sites with peri-implant bone loss. Furthermore, PCP, who did not completely adhere to the SPT, were found to present a higher implant failure rate. This underlines the value of the SPT in enhancing the long-term outcomes of implant therapy, particularly in subjects affected by periodontitis, in order to control reinfection and limit biological complications.
Article
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Following a complete evaluation of the patient, treatment planning requires the analysis of individual teeth, accurate diagnosis, and prognosis evaluation. Currently, there is no accepted comprehensive, standardized, and meaningful classification system for the evaluation of individual teeth that offers a common language for dental professionals. A search was conducted reviewing existing literature relating to classification and prognostication of individual teeth. The dimensions determined to be of importance to gain an overall perspective of the individual relative tooth prognosis were the periodontal, restorative, endodontic, and occlusal plane perspectives. The authors present a comprehensive classification system by conjugating the literature and currently accepted concepts in dentistry. This easy-to-use system assesses the condition of individual teeth and enables a relative prognostic value to be attached to those teeth based on tooth condition and patient-level factors.
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Implant-supported restorations have become the most popular therapeutic option for professionals and patients for the treatment of total and partial edentulism. When implants are placed in an ideal position, with adequate prosthetic loading and proper maintenance, they can have success rates >90% over 15 years of function. Implants may be considered a better therapeutic alternative than performing more extensive conservative procedures in an attempt to save or maintain a compromised tooth. Inadequate indication for tooth extraction has resulted in the sacrifice of many sound savable teeth. This article presents a chart that can assist clinicians in making the right decision when they are deciding which route to take. Articles published in peer-reviewed English journals were selected using several scientific databases and subsequently reviewed. Book sources were also searched. Individual tooth- and patient-related features were thoroughly analyzed, particularly when determining if a tooth should be indicated for extraction. A color-based decision-making chart with six different levels, including several factors, was developed based upon available scientific literature. The rationale for including these factors is provided, and its interpretation is justified with literature support. The decision-making chart provided may serve as a reference guide for dentists when making the decision to save or extract a compromised tooth.
Article
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Criteria for the evaluation of dental implant success are proposed. These criteria are applied in an assessment of the long-term efficacy of currently used dental implants including the subperiosteal implant, the vitreous carbon implant, the blade-vent implant, the single-crystal sapphire implant, the Tübingen implant, the TCP-implant, the TPS-screw, the ITI hollow-cylinder implant, the IMZ dental implant, the Core-Vent titanium alloy implant, the transosteal mandibular staple bone plate, and the Brånemark osseointegrated titanium implant. An attempt has been made to standardize the basis for comments on each type of implant.
Article
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This study presents our findings on 44 patients who were treated for periodontal disease and for varying reasons elected not to participate in the maintenance aspect of periodontal care. All patients were initially given intensive instructions in personal oral hygiene, along with initial scaling and root planing. Each patient had two or more quadrants of pocket reduction therapy. Tooth mortality revealed a mean annual adjusted tooth loss rate of 0.22 (4.7%). Between examinations, breakdown in the health status of furcations was noted. Mean probing depth scores at the second examination showed no significant differences from the first examination scores. Measurements of bone levels revealed a worsening of bone scores between examinations. The results of this study show that periodontal therapy without maintenance is of little value in terms of restoring periodontal health.
Article
Periodontal treatment is based on tooth prognosis evaluation. Different approaches for determining tooth prognosis have been described in the literature. The vast majority are based on clinical and radiographic findings, as well as patient-related factors. The availability of various systems for assigning tooth prognosis complicates both the assignment process and the communication between clinicians regarding patient status and treatment plan. In addition, performance evaluation of several systems reveals that the accuracy of prediction differs between teeth of various conditions in most methods, as well as the factors providing significant predictive power. As a standardized prognostic classification system is still lacking, an overall evaluation based on a uniform dataset could provide an objective comparison of all methods, and help progress towards developing novel approaches. The main features of such approaches should include the selection of predictive factors, their assigned weights in accordance with different tooth conditions, and the estimated period of time applicable for reevaluation of prognosis. In this paper, we propose a different approach for prognosis evaluation, suggesting reevaluating tooth prognosis at several time points during the treatment plan, and taking into consideration some of the most important issues of patient compliance, oral hygiene, and plaque control. The suggested approach attempts to address prognosis from a different perspective, viewing the process as a dynamic and recurring evaluation embedded within each step of the treatment plan. Due to the fact that accurate tooth prognosis evaluation is still (and might forever be) unavailable, a more humble and less aggressive approach should be adopted, trying to preserve more and extract less.
Article
Two systematic reviews have evaluated the quality of research and reporting of observational studies investigating the prevalence of, the incidence of and the risk factors for peri-implant diseases and of experimental clinical studies evaluating the efficacy of preventive and therapeutic interventions. For the improvement of the quality of reporting for both observational and experimental studies, the STROBE and the Modified CONSORT recommendations were encouraged. To improve the quality of research in peri-implant diseases, the following were recommended: the use of unequivocal case definitions; the expression of outcomes at the subject rather than the implant level; the implementation of study validation tools; the reporting of potential sources of bias; and the use of appropriate statistical methods. In observational studies, case definitions for peri-implantitis were agreed. For risk factor determination, the progressive use of cross-sectional and case-control studies (univariate analyses), to prospective cohorts (multilevel modelling for confounding), and ultimately to intervention studies were recommended. For preventive and interventional studies of peri-implant disease management, parallel arm RCTs of at least 6-months were encouraged. For studies of non-surgical and surgical management of peri-implantitis, the use of a composite therapeutic end point was advocated. The development of standard control therapies was deemed essential.
Article
Background: Implant-supported prostheses are today often used in rehabilitation of partially or totally edentulous patients. Both patients and the dental profession often regard implant treatment as successful in a life perspective. Therefore, studies with a long-term follow-up are important. Purpose: The aim was to investigate the outcome of implant treatment with fixed prostheses in edentulous jaws after 20 years, with special reference to survival rate of implants and prostheses and frequency of peri-implantitis. Materials and Methods: The patient material was a group of patients treated in the early 1980s. The original patient group comprised the first 48 consecutive patients treated with implant-supported prostheses at Umeå University. All patients were edentulous in one or two jaws. The patients had a mean age at the implant insertion of 54.3 years (range 40–74). At the planning of this study 20 years after treatment, 19 of the 48 patients were found to be deceased. Of the 29 patients still alive, 21 patients with altogether 23 implant-supported prostheses could be examined clinically and radiographically. All patients were treated ad modum Brånemark® (Nobel Biocare AB, Göteborg, Sweden) with a two-stage surgical procedure. The implants had a turned surface. Abutment connections were performed 3 to 4 months after fixture insertion in the mandible, and after a minimum of 6 months in the maxilla. The prostheses were fabricated with a framework of gold alloy and acrylic artificial teeth. Results: The 21 patients (with 23 implant prostheses) examined had at the time of treatment got 123 implants (27 in the upper jaw and 96 in the lower jaw) inserted. Only one of these implants had been lost (about 2 years after loading) giving a survival rate of 99.2%. Very small changes occurred in the marginal bone level. Between the 1 and 20-year examinations, the mean bone loss was 0.53 mm and the mean bone level at the final examination was 2.33 mm below the reference point. Conclusions: This follow-up over two decades of implant-supported prostheses demonstrates a very good prognosis for the treatment performed. The frequencies of peri-implantitis, implant failures, or other complications were very small, and the original treatment concept with a two-stage surgery and a turned surface of the implants will obviously give very good results.
Article
Background: Knowledge on long-term clinical performance of more than 5 years on the single-implant CeraOne™ (Nobel Biocare AB, Gothenburg, Sweden) concept is limited. Purpose: The aim of this study is to report the long-term clinical performance of the first CeraOne single-implant restorations, installed 17 to 19 years ago. Materials and Methods: The group comprised 57 patients provided with 65 CeraOne single-tooth restorations. Sixty-two all-ceramic and three metal-ceramic crowns were cemented between 1989 and 1991. Patients were followed up clinically and with intraoral radiographs at placement, after 1, 5, and between 17 and 19 years after placement. Results: Data were available for altogether 48 patients, followed up on an average time of 18 years. Excluding deceased patients (n = 2) and failed implant patients (n = 2), only five patients were lost to follow-up (8.8%). Two implants failed, resulting in an 18-year implant cumulative success rate (CSR) of 96.8%, and altogether eight original single-crown restorations were replaced (CSR 83.8%). The most common reason for crown replacement was infra-position of the implant crown (n = 3). Many of the remaining original crowns showed various signs of implant crown infraposition at the termination of the study. In general, the soft tissue at the restorations was assessed to be healthy and comparable with the gingiva at the adjacent natural teeth. Bone levels were on an average stable with only few patients exhibiting bone loss of more than 2 mm during 18 years in function. Conclusion: This long-term follow-up study of single-implant restorations shows encouraging results with few implant failures and minimal bone loss over an 18-year period. Original single-crown restorations were replaced more frequently, because of, for example, implant crown infraposition and veneer fractures. The CeraOne concept proved to be a highly predictable and safe prosthodontic treatment.
Article
Background: Comparative long-term knowledge of different framework materials in the edentulous implant patient is not available for 15 years of follow-up. Purpose: To report and compare a 15-year retrospective data on implant-supported prostheses in the edentulous mandible provided with laser-welded titanium frameworks (test) and gold alloy frameworks (control). Materials and Methods: Altogether, 155 patients were consecutively treated with abutment-level prostheses with two early generations of fixed laser-welded titanium frameworks (titanium group). Fifty-three selected patients with gold alloy castings formed the control group. Clinical and radiographic 15-year data were collected and compared for the groups. Results: All patients who were followed up for 15 years (n = 72) still had a fixed prosthesis in the mandible at the termination of the study. The 15-year original prosthesis cumulative survival rate (CSR) was 89.2 and 100% for titanium and control frameworks (p = .057), respectively (overall CSR 91.7%). The overall 15-year implant CSR was 98.7%. The average 15-year bone loss was 0.59 mm (SD 0.56) and 0.98 mm (SD 0.64) for the test and control groups (p = .027), respectively. Few (1.3%) implants had >3.1-mm accumulated bone loss after 15 years. The most common complications for titanium frameworks were resin or veneer fractures and soft tissue inflammation. Fractures of the titanium metal frame were observed in 15.5% of the patients. More patients had framework fractures in the earliest titanium group (Ti-1 group) compared to the gold alloy group (p = .034). Loose and fractured implant screw components were few (2.4%). Conclusion: Predictable overall long-term results could be maintained with the present treatment modality. Fractures of the metal frames and remade prostheses were more common in the test group, and the gold alloy frameworks had a tendency to work better when compared with welded titanium frameworks during 15 years. However, on the average, more bone loss was observed for implants supporting gold alloy frameworks.
Article
This study assessed the success rate of implants placed in horizontal and vertical guided bone regenerated areas. A systematic review was carried out of all prospective and retrospective studies, involving at least five consecutively treated patients, that analysed the success rate of implants placed simultaneously or as second surgery following ridge augmentation by means of a guided bone regeneration (GBR) technique. Studies reporting only the survival rate of implants and studies with a post-loading follow up less than 6 months were excluded. From 323 potentially relevant studies, 32 full text publications were screened and 8 were identified as fulfilling the inclusion criteria. The success rate of implants placed in GBR augmented ridges ranged from 61.5% to 100%; all studies, apart from three, reported a success rate higher than 90% (range 90-100%). The data obtained demonstrated that GBR is a predictable technique that allows the placement of implants in atrophic areas. Despite that, studies with well-defined implant success criteria after a longer follow-up are required.
Article
No abstract available. (Quintessence Int 2012;43:351).
Article
To assess the long-term survival of implants inserted in periodontally susceptible patients and to investigate the influence of residual pockets on the incidence of peri-implantitis and implant loss. For 70 patients, comprehensive periodontal treatment was followed by installation of 165 Straumann Dental implants. Subsequently, 58 patients entered a University supportive periodontal therapy (SPT) program and 12 had SPT in a private practice. The follow-up time ranged from 3 to 23 years (mean 7.9 years). Bleeding on probing (BOP), clinical attachment level (CAL), and peri-implant probing depths (PPD) were evaluated at baseline (T0), completion of active treatment (T1), and at follow-up (T2). Peri-implant bone levels were assessed on radiographs at T2. Patients were categorized as having implants not affected by peri-implantitis (non-PIP), or affected by peri-implantitis (PIP). From 165 implants inserted, six implants were lost, translating into a cumulative survival rate of 95.8%. Solid screw implants yielded significantly higher survival rates than the hollow cylinder and hollow screw implants (99.1% vs. 89.7%). Implants lost due to peri-implant infection were included in the PIP groups. When peri-implantitis (PPD ≥ 5 mm, BOP+) was analyzed, 22.2% of the implants and 38.6% of patients had one or more implants affected by peri-implantitis. Using the peri-implantitis definition (PPD ≥ 6 mm, BOP+), the prevalence was reduced to 8.8% and 17.1%, respectively. Moreover, all these implants demonstrated significant (≥ 2 mm) bone loss at T2. At T1, the non-PIP group had significantly (P = 0.011) fewer residual pockets (≥ 5 mm) per patient than the PIP group (1.9 vs. 4.1). At T2, the PIP group displayed an increased number of residual pockets compared to T1, whereas in the non-PIP group, the number remained similar to T1. At T2, mean PPD, mean CAL and BOP were significantly higher in the PIP group compared with the non-PIP group. The prevalence of peri-implantitis was lower in the group that was in a well organized SPT at the University. In periodontitis susceptible patients, residual pockets (PPD ≥ 5 mm) at the end of active periodontal therapy represent a significant risk for the development of peri-implantitis and implant loss. Moreover, patients in SPT developing re-infections are at greater risk for peri-implantitis and implant loss than periodontally stable patients.
Article
Background: The aim of this prospective study is to evaluate the prevalence of mucositis, peri-implantitis, implant success, and survival in partially edentulous patients treated for generalized aggressive periodontitis (GAgP) and in periodontally healthy individuals. Methods: Thirty-five patients treated for GAgP and 18 periodontally healthy patients orally rehabilitated with osseointegrated implants participated in the study. They were first examined 2 to 4 weeks before extraction of the non-retainable teeth (baseline) and 3 weeks after insertion of the final abutments. Additional examinations were performed during a 3-month recall schedule over a 5- to 16-year period (mean, 8.25 years). At every session, clinical parameters were recorded. At 1, 3, 5, 10, and 15 years after insertion of the superstructure, a microbiological and radiographic examination was performed. Results: The results show implant survival rates of 100% in periodontally healthy individuals versus 96% in GAgP patients. The implant success rate was 33% in GAgP patients and 50% in periodontally healthy individuals. In GAgP patients, mucositis was present in 56% and peri-implantitis in 26% of the implants. In periodontally healthy individuals, 40% of the implants showed mucositis and 10% peri-implantitis. GAgP patients had a five times greater risk of implant failure, a three times greater risk of mucositis, and a 14 times greater risk of peri-implantitis. Conclusion: These results suggest that patients with treated GAgP are more susceptible to mucositis and peri-implantitis, with lower implant survival and success rates.
Article
Treatment planning for dental implants involves the assessment of patient-related risk factors prior to formulation of a treatment plan. The aim of this review was to assess relevant literature and provide evidence-based information on the successful surgical placement of dental implants. An electronic search of Medline, PubMed and the Cochrane Databases of Systematic Reviews was undertaken using a combination of MeSH terms and keywords. A handsearch was also performed and cross-referenced with articles cited in papers selected. The primary study parameter was implant failure. Forty-three studies were selected based on specific inclusion criteria. Many studies contain confounding variables, numbers in subcategories are often too small for meaningful statistical analysis, and follow-up times vary and are often short-term. There are many risk factors which the clinician is required to know and understand to advise patients, and consider in planning and treatment provision. Consistent evidence exists to show an increased failure rate with smokers, a history of radiotherapy and local bone quality and quantity. Weaker evidence exists to show a higher incidence of peri-implant disease in patients with a history of periodontitis-related tooth loss. Lack of evidence precludes definitive guidelines for patients with autoimmune disorders where expert opinion recommends caution. Osteoporotic patients show acceptable survival rates; however patients on oral bisphosphonates show a small incidence but high morbidity from osteonecrosis of the jaw. Emerging evidence suggests that there is a correlation between genetic traits and disruption of osseointegration.
Article
To evaluate the survival and success rate of Straumann Bone Level implants placed in vertically atrophied edentulous jaws previously reconstructed with autogenous onlay bone grafts taken from the calvarium or the mandibular ramus. From 2007 to 2009, 18 patients presenting with vertical deficits of the edentulous ridges were treated with autogenous cortical bone grafts harvested from the mandibular ramus or the calvarium. Four to seven months afterward, 60 Straumann Bone Level implants were placed in the reconstructed areas. After a further waiting period of 2-3 months, patients were rehabilitated with implant-supported fixed prostheses. Follow-up ranged from 12 to 36 months (mean: 19 months) after the start of prosthetic loading. Graft resorption before implant placement, as well as survival and success rates of implants, were recorded. The mean bone resorption prior to implant placement was 0.18 mm for calvarial grafts and 0.42 mm for ramus grafts. Survival rate was 100% either for implants placed in calvarial grafts or implants placed in ramus grafts, while success rate was 90.3% for implants placed in calvarial grafts, and 93.1% for implants placed in ramus grafts. Results from this study seem to demonstrate that implants with a platform-switching design may predictably integrate in edentulous areas reconstructed with autogenous bone grafts, with survival rates consistent with those reported in recent literature reviews on the same topic, and also with implants placed in native bone. Conversely, this study was not able to demonstrate that implants with platform-switching design may reduce bone resorption around implants placed in reconstructed areas.
Article
The aim of the present study was to systematically evaluate the implant survival rate after osteotome-mediated maxillary sinus augmentation with or without using grafting materials. MEDLINE database was searched using a combination of specific search terms. Furthermore, a hand searching of the relevant journals and of the bibliographies of reviews was performed. Prospective and retrospective clinical studies with at least 20 patients treated by osteotome-mediated sinus floor elevation were included. Nineteen studies were selected for data analysis. A total of 1,822 patients, accounting for 3,131 implants were considered. Mean weighted cumulative implant survival at 1, 2, 3, and 5 years was estimated as 98.12%, 97.40%, 96.75%, and 95.81%, respectively. No significant difference was found in relation to the use of grafting material nor in relation to implant length. Overall implant survival was 92.7% for 331 implants placed in <5 mm ridge height and 96.9% for 2,525 implants inserted in ≥ 5 mm ridge height. The difference was significant (p = .0003). The transalveolar sinus augmentation technique could be a viable treatment in case of localized atrophy in the posterior maxilla even in case of minimal residual bone height. The prognosis can be more favorable when the residual ridge is at least 5 mm high.
Article
Retrospectively evaluate the survival, radiographic and peri-implant outcome of single turned Brånemark™ implants after at least 16 years. From 134 patients (C-group), 101 could be contacted concerning implant survival and 50 (59 remaining implants) were clinically examined (I-group). Marginal bone level was radiographically measured from the implant-abutment junction at baseline (=within 6 months after abutment connection) and 1-4, 5-8 and 16-22 years post-operatively. Probing depth, gingival and plaque index were measured. Marginal bone-level changes were analyzed using Friedman's and Wilcoxon's signed ranks tests. Spearman's correlations between radiographic and clinical parameters were calculated. In the C-group, 13 out of 166 implants in 11 out of 134 patients failed (CSR=91.5%). In the I-group (28 males-22 females; mean age 23.9 years at baseline; range 14-57), the mean follow-up was 18.4 years (range 16-22). The mean bone level was 1.7±0.88 mm (range -0.8 to 5) after 16-22 years. Changes in the mean marginal bone level were statistically significant between baseline and the second measuring interval (1-4 years). Thereafter, no significant differences could be demonstrated. The mean interproximal probing depth, gingival and plaque indices were 3.9±1.27 mm, 1.2±0.81 and 0.2±0.48, respectively. Probing depth was moderately correlated with gingival inflammation (r=0.6; P<0.001) but not with bone level (P>0.05). 81.4% of the implants had a bone level ≤2nd thread and 91.5% had a probing depth ≤5 mm. 76.3% had both bone level ≤2nd thread and probing depth ≤5 mm. The single turned Brånemark™ implant is a predictable solution with high clinical survival and success rates. In general, a steady-state bone level can be expected over decades, with minimal signs of peri-implant disease. A minority (5%), however, presents with progressive bone loss.
Article
The aim of this review was to evaluate a history of treated periodontitis and smoking, both alone and combined, as risk factors for adverse dental implant outcomes. A literature search of MEDLINE (Ovid) and EMBASE from January 1, 1966, to June 30, 2008, was performed, and the outcome variables implant survival, implant success, occurrence of peri-implantitis and marginal bone loss were evaluated. Considerable heterogeneity in study design was found, and few studies accounted for confounding variables. For patients with a history of treated periodontitis, the majority of studies reported implant survival rates > 90%. Three cohort studies showed a higher risk of peri-implantitis in patients with a history of treated periodontitis compared with those without a history of periodontitis (reported odds ratios from 3.1 to 4.7). In three of four systematic reviews, smoking was found to be a significant risk for adverse implant outcome. While the majority of studies reported implant survival rates ranging from 80% to 96% in smokers, most studies found statistically significantly lower survival rates than for nonsmokers. There is an increased risk of peri-implantitis in smokers compared with nonsmokers (reported odds ratios from 3.6 to 4.6). The combination of a history of treated periodontitis and smoking increases the risk of implant failure and peri-implant bone loss.
Article
To evaluate the long-term survival rates of dental implants according to the patient's periodontal status, as well as to estimate if the effect of periodontal status regarding implant failure is constant throughout the long-term follow-up. This was a historical prospective cohort study design of all consecutive patients operated from 1996 to 2006 at a periodontal clinic. The cohort consisted of 736 patients, with a total of 2336 dental implants. An extended Cox proportional hazards model, which includes interaction terms between survival time and variables of interest, was used. Patients' mean (SD) age was 51.13 (12.35). The follow-up time was up to 144 months, with a mean (SD) of 54.4 (35.6) months. The overall implant raw survival rate was 95.9%. The Kaplan-Meier estimates for the cumulative survival rate (CSR) at 108 months were 0.96 and 0.95 for implants inserted into healthy and moderate chronic periodontal patients, respectively. The CSR declined to 0.88 at 108 months for the severe periodontitis group. The extended Cox model revealed that severe chronic status turned out to be a significant risk factor for implant failure after 50 months of follow-up [hazard ratio (HR)=8.06; p<0.01]. The extended Cox model for smoking indicates a near-significant effect after 50 months (HR=2.76; p=0.061). Periodontal status and smoking are significant risk factors for late implant failures. The HR for periodontal and smoking status are not constant throughout the follow-up period.
Article
The aim of this study was to determine the survival rates of questionable and hopeless teeth in patients with aggressive periodontitis (AgP) and chronic periodontitis (CP) during 15 years of supportive periodontal therapy (SPT). Thirty-four AgP and 34 CP patients (SPT≥10 years) with bone loss of ≥50% at ≥2 teeth were consecutively recruited. Bone loss was measured on digitized radiographs and teeth were categorized as "questionable" (≥50 to <70% bone loss) or as "hopeless" (≥70%). Progression in pocket probing depths (PPD) during SPT, tooth loss and reasons for extraction were analysed. In AgP patients, 262 teeth were considered as questionable and 63 as hopeless (CP: 149/51). During active periodontal therapy, 25 questionable and 26 hopeless teeth were extracted (CP: 12/16). During 15.3 ± 4.1 years of SPT of AgP 28 questionable and 15 hopeless teeth were removed (CP: 28/12). The mean tooth loss per patient during SPT in total was 0.14 (AgP) and 0.16 (CP) teeth/year. There were no significant differences in tooth loss or longitudinal progression of PPD between AgP and CP patients. In patients with AgP, 88.2% (209 of 237) of questionable and 59.5% (22 of 37) of hopeless teeth survived 15 years during regular SPT in a dental school department.
Article
a lower survival rate for re-implantation in previously failed sites was reported. A third implant attempt in sites where previous implants have failed twice is rare; however, it may be necessary where other treatment alternatives are unacceptable. The aim of the present report is to explore the survival of implants placed three times at the same site. patients in whom a third attempt of implant placement at sites where two implants failed previously were evaluated. Medical history and smoking were recorded. The implant dimension, characteristics and survival were documented. The same implant and surgeon were involved in all three attempts. fifteen third attempt implants in 12 patients were evaluated. The average age of the patients at first implantation was 48.8 ± 14.1 years. Six of the 15 second re-do implants have failed (60.0% survival rate). Smoking was reported by two patients. The implants that survived were followed for 44.1 ± 35 months (range 4-86). The mean implant length and diameter did not vary between attempts: the mean implant width/lengths were 3.6 ± 0.3/12.2 ± 1.4, 3.7 ± 0.3/12.6 ± 1.5 and 3.80 ± 0.3/12.4 ± 1.6 mm for the first, second and third attempts, respectively (p>0.05). a third attempt to place implants in sites where two implants had failed previously results in significantly lower survival rates compared with similar procedures in pristine sites.
Article
The aim of the present study was to evaluate the long-term results of dental implants using implant survival and implant success as outcome variables. Of the 76 patients who received 162 implants of the Straumann Dental Implant System during the years 1990-1997, 55 patients with 131 implants were recalled 10-16 years after implant placement for a complete clinical and radiographic examination, followed by a questionnaire that examined the degree of satisfaction. The incidence of biological and technical complications has been carefully analysed for each implant. Success was defined as being free of all these complications over the entire observation period. Associated factors related to peri-implant lesions were analysed for each implant. The long-term implant cumulative survival rate up to 16 years was 82.94%. The prevalence of biological complications was 16.94% and the prevalence of technical complications was 31.09%. The cumulative complication rate after an observation period of 10-16 years was 48.03%, which meant that substantial amounts of chair time were necessary following implant placement. The majority of implant losses and biological complications were concentrated in a relatively small number of patients. Despite a relatively high long-term survival rate, biological and technical complications were frequent. Patients with a history of periodontitis may have lower implant survival rates than patients without a history of periodontitis and were more prone to biological complications such as peri-implant mucositis and peri-implantitis.
Article
To systematically assess the factors influencing tooth loss during long-term periodontal maintenance (PM). CENTRAL, MEDLINE and EMBASE were searched up to and including September 2009. Studies limited to patients with periodontitis who underwent periodontal therapy and followed a maintenance care programme for the at least 5 years were eligible for inclusion in this review. Studies were considered for inclusion if they reported data on tooth loss during PM. The search strategy identified 527 potentially eligible articles, of which 13 retrospective case series were included in this review. The risk of bias assessment evaluated by the Newcastle-Ottawa scale showed that eight studies were considered of medium methodological quality and five of low methodological quality. Of 41,404 teeth present after active periodontal treatment, 3919 were lost during PM. The percentages of tooth loss due to periodontal reasons and of patients who did not experience tooth loss varied from 1.5% to 9.8% and 36.0% to 88.5%. Studies' individual outcomes showed that different patient-related factors (i.e. age and smoking) and tooth-related factors (tooth type and location, and the initial tooth prognosis) were associated with tooth loss during PM. The considerable heterogeneity found among studies did not allow definitive conclusions. Age, smoking and initial tooth prognosis were found to be associated with tooth loss during PM. Overall, patients must be instructed to follow periodic PM and quit smoking (smokers). Prospective cohort studies are required to confirm the possible predictors of tooth loss due to periodontal reasons. The allocation of patients into subgroups according to the type of periodontitis and smoking frequency will allow more accurate evaluations.
Article
In part 2 of this long-term, retrospective study on the two-implant-supported overdenture in the mandible, the annual marginal bone loss was evaluated in detail and parameters, with a significant effect on the annual bone loss, were verified. For all 495 patients with an overdenture in the mandible at least 5 years in function, data up to their last follow-up visit had been collected, including long-cone radiographs (taken at the abutment connection and after years 1, 3, 5, 8, 12 and 16 of loading) and probing data at their last evaluation. General information (medical history, implant data, report on surgery) was retrieved from the patient's file. Two hundred and forty-eight patients had been clinically examined recently. For the others, information on bone level and probing depths were retrieved from the patient's files, as all patients had been enrolled in our annual follow-up schedule. The mean annual bone loss on a site level (without considering the first year of bone remodelling) after 3 years of loading was 0.08 mm/year (SD=0.22, n=1105), after 5 years of loading 0.07 mm/year (SD=0.14, n=892), after 8 years of loading 0.06 mm/year (SD=0.12, n=598), after 12 years 0.04 mm/year (SD=0.07, n=370) and 0.05 mm/year (SD=0.05, n=154) after 16 years of loading. Ongoing bone loss was seen in a number of implants (n=26) with the annual bone loss exceeding 0.2 mm. Some factors clearly showed a significant impact on bone loss: smoking (> or =10 cigarettes/day), GBR, the presence of dehiscence and bone quantity(the latter only during the first year). The probing data showed a favourable condition, with <1.2% of the approximal pockets being > or =6 mm, and 4.1%=5 mm. The mean annual bone loss over the study period was <0.1 mm/year after the first year of loading. However, a small number (2.5%) of the implants showed continuing bone loss.
Article
To evaluate the factors associated with long-term implant survival in a large cohort of patients in regular follow-up until data collection. The study population consisted of 475 patients who were referred to a private clinic limited to Periodontics and Implantology between November 1995 and July 2006. Data were collected from patient files with regards to smoking habits, periodontal condition, diabetes mellitus, implant survival, and time when implant failure occurred. Patients were divided into those who participated in a supportive periodontal program in the clinic and those who only attended the annual free-of-charge implant examination. A total of 1626 implants were placed with a follow-up ranging from 1 to 114 months (average 30.82 +/- 28.26 months). Overall, 77 (4.7%) implants were lost in 58 (12.2%) patients after a mean period of 24.71 +/- 25.84 months. More than one-half of the patients (246; 51.7%) participated in a structured supportive periodontal program in the clinic, and 229 (48.3%) only attended to the annual free-of-charge implant examination. Smoking and attendance in a regular supportive periodontal program were statistically associated with implant survival. Patients with (treated) moderate-to-advanced chronic periodontal disease demonstrated higher implant failure rates but, this difference did not reach statistical significance. Diabetes mellitus was not related to implant survival in this patient cohort. Smoking and attendance in a regular supportive periodontal program were found to be strongly related to implant survival. Special attention should be given to continuous periodontal supportive programs to implant patients.
Article
To review the literature regarding the possible association between a previous history of periodontitis and peri-implantitis. A search of MEDLINE as well as a manual search of articles were conducted. Publications and articles accepted for publication up to January 2008 were included. Out of 951 papers retrieved, a total of three papers were selected for the review. Thus, the available evidence for an association between periodontitis and peri-implantitis is scarce. Based on three studies with a limited number of patients and considerable variations in study design, different definitions of periodontitis, and confounding variables like smoking that not been accounted for, this systematic review indicates that subjects with a history of periodontitis may be at greater risk for peri-implant infections. It should, however, be stressed that the data to support this conclusion are not very robust.
Article
Implant therapy in the atrophic posterior maxilla becomes challenging in the presence of reduced maxillary bone height. Sinus augmentation can be performed for resolving this condition prior to implant placement. The aim of this article was therefore to evaluate implant survival rates in the grafted sinus taking into account the influence of the implant surface, graft material, and implant placement timing. A systematic review of the literature was performed. Articles retrieved from electronic databases were screened using specific inclusion criteria, and data extracted were divided according to: graft material (autogenous, non-autogenous, composite graft), implant surface (machined or textured), and implant placement (simultaneous with grafting or delayed). Fifty-nine articles were included. Survival rates for implants placed in grafts made of bone substitutes alone and grafts of composite material were slightly better than the survival rates for implants placed in 100% autogenous grafts. Over 90% of implants associated with non-autogenous grafts had a textured surface. Textured surfaces achieved better outcomes compared with machined surfaces, and this was independent of the graft material. Simultaneous and delayed proc