Clark M Stanford’s research while affiliated with University of Illinois Chicago and other places

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Publications (173)


Clinical Performance of Dental Implants
  • Article

April 2024

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21 Reads

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2 Citations

The International journal of oral & maxillofacial implants

Clark M Stanford

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Jan-Eirik Ellingsen

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“Can patients detect peri-implant mucosal inflammation? Results from a multicentre randomized trial”

June 2023

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37 Reads

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1 Citation

Journal of Dentistry

Purpose: The objective of this study was to compare patient reported outcomes (PROs) of peri-implant soft tissue inflammation and aesthetics around single-tooth implants in the anterior maxillary region with three different implant-abutment interface designs. Methods: Participants were randomized to one of three different types of implant-abutment interface designs [Conical (CI), flat-to-flat (FI), and Platform Switched (PS)]. Implants and provisional crowns with prefabricated titanium abutments were placed 5 months following extraction and/or ridge augmentation. Permanent ceramic crowns with zirconia abutments were placed after 12 weeks. To assess PROs, appearance and inflammation questionnaires were completed from provisional crown placement to the 3-year follow-up. Results: Tooth appearance at the 3-year follow-up revealed a difference amongst CI, FI and PS implants (p=0.049; Kruskal-Wallis test). PS was rated better than FI (p=0.047) at 1 year for appearance of soft-tissue and satisfaction with colour. There were no differences for self-consciousness, smile and pain/discomfort while eating/hard food items. Conclusions: Although participants tended to rate the health of mucosa around PS implants as slighty better than the other two implant systems, the differences were minimal and inconsisitent. Thus, patient satisfaction in terms self-perceived gingival health and esthetics was high for all 3 systems tested, suggesting that patients are unable to detect mucosal inflammation. Clinical significance: Patients find it difficult to perceive mucosal inflammation; hence, it is recommended that patients attend implant follow-up visits, even if they do not perceive inflammation. The study suggests that there is a relationship between the PROs and the clinical outcomes of tested implants.


Integrating an innovative social work practice into a pediatric dental residency program

January 2023

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6 Reads

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2 Citations

Journal of Social Work

This article describes the implementation and outcomes of a social work program in a university pediatric dental clinic serving low-income families. The goal was to decrease barriers to dental care access, decrease appointment failure, and improve interprofessional practice (IPP). Funding was obtained through a foundation to hire a social worker and two interns, and cover program costs. A survey identified barriers families faced to obtain and complete pediatric dental care. Residents, dental students, and faculty make referrals to the social workers who intervene to help families overcome challenges for their children's care. Findings The program started in January 2019 and outcomes are reported through June 2021. The largest barriers families identified were lack of a pediatric dentist near home accepting public insurance (91%), the dentist who saw their child only did exams and cleanings but not fillings (84%), and need for specialized dental care (77%). Five hundred and eleven families were referred to the social workers, most commonly for resources, information or other referrals (30.5%), dental insurance lapse (14.9%), caregiver guidance on oral health (10.6%), mental health concerns (10.4%), and poor treatment compliance (9.6%). Social workers provided 424 interventions, mostly about information regarding community resources (26.8%), transportation issues (15.9%), and telephone consults (14.2%). Appointment failure rates decreased from 17% to 13.5%, while the cancelation rate decreased from 19.2% to 14.3% from January 2019 to June 2021, respectively. Applications Social workers helped decrease barriers to pediatric dental care, improve attendance to dental appointments, and enhance IPP for pediatric dental residents, students, and faculty.


Supplement-DropletDataByChair.pdf
  • Data
  • File available

November 2021

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22 Reads

This supplemental data file shows the distances traveled and residence times (minimum/maximum/average) for droplets as a function of diameter for each chair considered in the dental clinic.

Download

Prevalence of Radiographically Identifiable Dental Anomalies in Children and Association with Health Status

November 2021

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15 Reads

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4 Citations

Purpose: The purpose of this study was to describe the prevalence of radiographically identifiable developmental dental anomalies (DDA) in a university-based pediatric dental clinic and to assess for associations between DDA and health status. Methods: Retrospective data, obtained from the electronic dental records of a three-year pediatric patient cohort, were evaluated by two trained and calibrated examiners. Strict inclusion/ exclusion criteria were applied. A validated image quality grading system was used for radiograph assessment, and the physical status classification of the American Academy of Anesthesiology was utilized. A chi-square test and bivariate logistic regression were used for statistical analysis. The inter- and intraexaminer reliability was assessed using Cohen's Kappa. Results: A total of 1,478 subjects (69 percent medically healthy) were enrolled. DDA were identified in 25 percent of the subjects, with hyperdontia, hypodontia, and microdontia being more common. A statistically significant association was found between the presence of DDA and health status (P<0.001) and between DDA and asthma (P=0.035). Patients with systemic disturbances showed 2.12 times greater odds of having DDA (P<0.001, 95 percent confidence interval equals 1.7-2.7). Conclusions: The prevalence of developmental dental anomalies was high, with one in four patients affected. DDA in number were the most common. Patients with systemic disturbances had greater odds of having DDA.


Fig. 1 The experimental schematics for the three different experimental orientations. (a) Case 1: The teeth are 0° and the point of the CUS is 90˚from90˚from the x-axis, respectively. (b, c) Case 2 and 3: The teeth are rotated to be 45˚from45˚from the x-axis. The point of the CUS is rotated so that it is 5˚in5˚in reference to the front of the teeth. (b) The configuration with a P1 data collection plane and (c) shows the P2 data collection plane. (d, e) Diagrams of the lower mandible teeth with the appropriate teeth numbers (black) and the coordinate system in reference to the scaler tip and the front of the central incisor teeth (red). The tip of the CUS rests firmly against the (d) front of tooth #24 in Case 1, and (e) tooth #25 for Cases 2 and 3. (f) An image of the scaler tip being used with the CUS for this study experiments. The water jet is located within the concave side of the CUS tip.
Fig. 5 (a) The droplet locations at one instant in time for Case 1, P1 plane with the scaler at 0ångle, with the laser sheet 20 mm from the point of the Cavitron. (b) The particle trajectories for 20% of droplets identified at the same laser sheet location. The color bars correspond to the velocity magnitude of the detected individual droplets. The locations of the droplets in a plane located 20 mm from the point of the scaler can be seen in Figure 5(a). These droplets are likely candidates for carrying viral loads. Figure 5(b) demonstrates there are multiple droplets within the P1 data collection planes that are not following the average motion of the droplets near the gumline of the teeth model. These droplets near the gumline of the teeth model show very low velocities in comparison to those droplets that are further away from the gumline. The dark blue color corresponds to droplets with very small velocity. There are droplets further away from the teeth with higher velocities which are able to move out and away from the mouth. It should be noted that Fig. 5(b) shows a limited number of droplets with high velocity trajectories since this figure represents the trajectories of only 20% of the detected droplets. This was performed to clarify the figure so individual trajectories could be easily tracked and observed. It is then safe to assume there are more high velocity droplets away from the teeth, within a plane that is 20mm from the CUS point. These droplets will eventually evaporate and seed the atmosphere with viral particles. Clearly at a further distance from the mouth the particles trajectories are dictated by ambient air flows. To further characterize the droplets' sizes and velocities and to gain knowledge of how the droplets propagate into the environment, we applied a shadowgraphy technique with the scaler/ teeth setup of the Case 1, P1 plane orientation with the CUS at 0°. We considered the flow rate reported in (Mirbod, Haffner, Bagheri and Higham 2021) (29.5 ml/min) which is close to the flow rate used in this study and for a lower flow rate of 16.2 ml/min. There were two different flow control mechanisms on the CUS, these were manipulated to achieve the different flow rates. This flow rate was closer to what is typically used in dental practice in conjunction with a CUS. The shadowgraphy procedure has been discussed in detail in our previous publication (Haffner and Mirbod 2020, Mirbod, Haffner, Bagheri and Higham 2021, Wu and Mirbod 2018). Using the shadowgraphy technique, we obtained the raw images.
Fig. 8 The far field velocity magnitudes for the P1 plane at a location (a) 15 mm and (b) 20 mm from the tip of the CUS. These maps are related to the Case 2.
Fig. A3 Case 2: setup í µí±£ (left column) and í µí±¢ (right column) components of velocity at a P1 plane (a, b) 6 mm and (c, d) 9 mm away from the tip of the CUS.
Fig. A4 Case 2: setup í µí±£ (left column) and í µí±¢ (right column) components of velocity at a P1 plane (a, b) 15 mm and (c, d) 20 mm away from the tip of the CUS.

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An experimental approach to analyze aerosol and splatter formations due to a dental procedure

October 2021

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274 Reads

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13 Citations

Experiments in Fluids

Throughout 2020 and beyond, the entire world has observed a continuous increase in the infectious spread of the novel coronavirus (SARS-CoV-2) otherwise known as COVID-19. The high transmission of this airborne virus has raised countless concerns regarding safety measures employed in the working conditions for medical professionals. Specifically, those who perform treatment procedures on patients which intrinsically create mists of fine airborne droplets, i.e., perfect vectors for this and other viruses to spread. The present study focuses on understanding the splatter produced due to a common dentistry technique to remove plaque buildup on teeth. This technique uses a high-speed dentistry instrument, e.g., a Cavitron ultrasonic scaler, to scrape along the surface of a patient’s teeth. This detailed understanding of the velocity and the trajectory of the droplets generated by the splatter will aid in the development of hygiene mechanisms to guarantee the safety of those performing these procedures and people in clinics or hospitals. Optical flow tracking velocimetry (OFTV) method was employed to obtain droplet velocity and trajectory in a two-dimensional plane. Multiple data collection planes were taken in different orientations around a model of adult mandibular teeth. This technique provided pseudo-three-dimensional velocity information for the droplets within the splatter developed from this high-speed dental instrument. These results indicated that within the three-dimensional splatter produced there were high velocities (1–2 m/s) observed directly below the intersection point between the front teeth and the scaler. The splatter formed a cone-shape structure that propagated 10–15 mm away from the location of the scaler tip. From the droplet trajectories, it was observed that high velocity isolated droplets propagate away from the bulk of the splatter. It is these droplets which are concerning for health safety to those performing the medical procedures. Using a shadowgraphy technique, we further characterize the individual droplets’ size and their individual velocity. We then compare these results to previously published distributions. The obtained data can be used as a first step to further examine flow and transport of droplets in clinics/dental offices. Graphical abstract


Testing for COVID-19 in dental offices: Mechanism of action, application, and interpretation of laboratory and point-of-care screening tests

May 2021

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35 Reads

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21 Citations

The Journal of the American Dental Association

Background The dental office potentially possesses all transmission risk factors for SARS-CoV-2 virus. Anticipating the future widespread use of COVID-19 testing in the dental offices, this article is a proactive effort to provide dental health care providers with current and necessary information surrounding the topic. Methods All relevant and recent guidelines from CDC and FDA, as well as online resources and review articles were consulted. Results Routine COVID-19 screening and triage protocols are unable to detect all infected individuals. With the advancements in diagnostic tools/techniques, COVID-19 testing at home or in the dental office may provide dentists with abilities to evaluate the disease status of their patients. At home or point-of-care tests, providing results within minutes of being administered, would allow for appropriate measures and rapid decisions about dental patients' care process. In this review, we familiarize the reader with current available laboratory and point-of-care COVID-19 screening methods, and, identify and elaborate the options available for use by dentists as well as the regulatory requirements of test administration. Conclusion Dentists need to be familiar with COVID-19 point-of-care testing options. While contributing to public health, such tests may deliver rapid, accurate and actionable results to clinical and infection control teams to enhance the safe patient flow in dental practices.


FIG. 1. (a) Dentistry clinic and (b) layout of the dentistry room. Red and blue circles locate the ventilation outlets and inlets, respectively. Labels within the patient cubicles denote the cubicle number.
FIG. 2. (a) Inlet vent mounted on the ceiling of the clinic and (b) CAD model of inlet vent.
FIG. 3. (a) Details of the numerical mesh near high-velocity inlets, (b) curvature refinement for dental unit, (c) side view of mesh refinement near the dental unit, and (d) top view of mesh refinement in the immediate vicinity of the patient chair.
FIG. 8. Comparison of experimental measurements and numerical predictions for temperature (T) and humidity (/Þ at six locations in the clinic. Upper predictions are taken 1 in. below the drop ceiling and the bottom values are taken one foot from the floor.
FIG. 9. Streamlines colored by velocity magnitude in the dentistry clinic.
Computer simulation of the SARS-CoV-2 contamination risk in a large dental clinic

March 2021

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503 Reads

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75 Citations

COVID-19, caused by the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) virus, has been rapidly spreading worldwide since December 2019, causing a public health crisis. Recent studies showed SARS-CoV-2's ability to infect humans via airborne routes. These motivated the study of aerosol and airborne droplet transmission in a variety of settings. This study performs a large-scale numerical simulation of a real-world dentistry clinic that contains aerosol-generating procedures. The simulation tracks the dispersion of evaporating droplets emitted during ultrasonic dental scaling procedures. The simulation considers 25 patient treatment cubicles in an open plan dentistry clinic. The droplets are modeled as having a volatile (evaporating) and nonvolatile fraction composed of virions, saliva, and impurities from the irrigant water supply. The simulated clinic's boundary and flow conditions are validated against experimental measurements of the real clinic. The results evaluate the behavior of large droplets and aerosols. We investigate droplet residence time and travel distance for different droplet diameters, surface contamination due to droplet settling and deposition, airborne aerosol mass concentration, and the quantity of droplets that escape through ventilation. The simulation results raise concerns due to the aerosols' long residence times (averaging up to 7.31 min) and travel distances (averaging up to 24.45 m) that exceed social distancing guidelines. Finally, the results show that contamination extends beyond the immediate patient treatment areas, requiring additional surface disinfection in the clinic. The results presented in this research may be used to establish safer dental clinic operating procedures, especially if paired with future supplementary material concerning the aerosol viral load generated by ultrasonic scaling and the viral load thresholds required to infect humans.


Characteristics of the alternative specimens/site for detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
Characteristics and Detection Rate of SARS-CoV-2 in Alternative Sites and Specimens Pertaining to Dental Practice: An Evidence Summary

March 2021

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110 Reads

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20 Citations

Knowledge about the detection potential and detection rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in various body fluids and sites is important for dentists since they, directly or indirectly, deal with many of these fluids/sites in their daily practices. In this study, we attempt to review the latest evidence and meta-analysis studies regarding the detection rate of SARS-CoV-2 in different body specimens and sites as well as the characteristics of these sample. The presence/detection of SARS-CoV-2 viral biomolecules (nucleic acid, antigens, antibody) in different clinical specimens depends greatly on the specimen type and timing of collection. These specimens/sites include nasopharynx, oropharynx, nose, saliva, sputum, bronchoalveolar lavage, stool, urine, ocular fluid, serum, plasma and whole blood. The relative detection rate of SARS-CoV-2 viral biomolecules in each of these specimens/sites is reviewed in detail within the text. The infectious potential of these specimens depends mainly on the time of specimen collection and the presence of live replicating viral particles.


A 5-Year Esthetic RCT Assessment of Anterior Maxillary Single-Tooth Implants with Different Abutment Interfaces

January 2021

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134 Reads

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9 Citations

The International journal of oral & maxillofacial implants

Purpose: This study sought to define the tissue responses at different implant-abutment interfaces by studying bone and peri-implant mucosal changes using a 5-year prospective randomized clinical trial design study. The conus interface was compared with the flat-to-flat interface and platform-switched implant-abutment systems. Materials and methods: One hundred forty-one subjects were recruited and randomized to the three treatment groups according to defined inclusion and exclusion criteria. Following implant placement and immediate provisionalization in healed alveolar ridges, clinical, photographic, and radiographic parameters were measured at 6 months and annually for 5 years. The calculated changes in marginal bone levels, peri-implant mucosal zenith location, papillae lengths, and peri-implant Plaque Index and bleeding on probing were statistically compared. Results: Forty-eight conus interface implants, 49 flat-to-flat interface implants, and 44 platform-switched implants were placed in 141 subjects. Six platform-switched interface and eight flatto- flat interface implants failed, most of them within 3 months. After 5 years, 33 conical interface, 28 flat-to-flat interface, and 27 platform-switched interface implants remained for evaluation. Calculation of marginal bone level change showed a mean marginal bone loss of -0.16 ± 0.45 (-1.55 to 0.65), -0.92 ± 0.70 (-2.90 to 0.20), and -0.81 ± 1.06 (-3.35 to 1.35) mm for conical interface, flat-to-flat interface, and platform-switched interface implants, respectively (P < .0005). The peri-implant mucosal zenith changes were minimal for all three interface designs (0.10 mm and +0.08 mm, P > .60). Only 16% to 19% of the surfaces had presence of bleeding on probing, with no significant differences (P > .81) between groups. Interproximal tissue changes were positive and similar among the implant interface designs. Conclusion: Over 5 years, the immediate provisionalization protocol resulted in stable peri-implant mucosal responses for all three interfaces. Compared with the flat-to-flat and platform-switched interfaces, the conical interface implants demonstrated significantly less early marginal bone loss. The relationship of marginal bone responses and mucosal responses requires further experimental consideration.


Citations (49)


... 15 Additionally, a recent study described the implementation and outcomes of a social work program in a pediatric dental clinic serving low-income families with the goal of decreasing barriers to accessing dental care, decreasing appointment failure, and improving interprofessional practice. 27 The results of this study demonstrated that the social workers in the program helped decrease barriers to pediatric dental care, improved attendance for dental appointments, and enhanced interprofessional practice for pediatric dental residents, social work students, and faculty. 27 More largescale studies similar to those discussed above are needed to help decrease barriers to accessing care and addressing the unmet social needs that affect access to care at the population level. ...

Reference:

Application of principles learned in a prevention-focused pediatric dental residency curriculum to professional practice
Integrating an innovative social work practice into a pediatric dental residency program
  • Citing Article
  • January 2023

Journal of Social Work

... Зубощелепні аномалії (ЗЩА) та деформації є актуальною проблемою сьогодення. За даними ВООЗ їхня частота сягає 92 % [1][2][3][4][5][6][7]. Щороку фахівці більшості країн світу спостерігають зростання поширеності зубощелепних аномалій у дітей і підлітків та пов'язують це з процесами урбанізації, погіршенням екологічної ситуації [2]. ...

Prevalence of Radiographically Identifiable Dental Anomalies in Children and Association with Health Status
  • Citing Article
  • November 2021

... The latest research utilized state-of-the-art experimental fluid mechanics tools to detect the number and the transmission speed of aerosol droplets through the advanced high-speed imaging techniques and optical flow tracking velocimetry. The initial velocity of these droplets can be quite significant, typically ranging between 1 m/s and 2.6 m/s [14,26,27]. ...

An experimental approach to analyze aerosol and splatter formations due to a dental procedure

Experiments in Fluids

... In addition to contributing to public health, such tests may deliver rapid, accurate, and actionable results to clinical and infection control teams to enhance the safe patient flow in dental practice. 13 The fear of contracting the COVID-19 disease at the dental office may cause patients' reluctance to seek dental care, and in some cases may lead to delay presentation. A study that evaluated perceived vulnerability to coronavirus infection and the impact on dental practice reported high levels of vulnerability regarding contracting COVID-19 disease, and thus avoiding dental care among the groups of subjects considered. ...

Testing for COVID-19 in dental offices: Mechanism of action, application, and interpretation of laboratory and point-of-care screening tests
  • Citing Article
  • May 2021

The Journal of the American Dental Association

... As well as general dentistry, implant surgery involves the use of instruments such as implant motors and ultrasonic bone cutting devices, there is a risk of exposure to contaminated aerosol containing blood and saliva. Aerosol and splatter diffusion has been simulated using numerical models and computational fluid dynamic model approaches [9][10][11]. Furthermore, previous studies have reported case of transmission between patients infected with COVID-19 and dental healthcare workers during dental treatment [12]. ...

Computer simulation of the SARS-CoV-2 contamination risk in a large dental clinic

... 10 Detection rate of SARS-COV-2 in alternative sites and specimens pertaining to dental practice has been extensively reviewed. 11 To control the spread of the disease, many countries, including Nigeria imposed measures such as border screening, social distancing and restriction of all movement, both intra and inter-state movement of people and vehicles, exempting only vehicles carrying food items, fuel, medical supplies and other essential services. Due to the high infective nature of the disease, in many places, dentists were restricted to only handling urgencies and emergencies. ...

Characteristics and Detection Rate of SARS-CoV-2 in Alternative Sites and Specimens Pertaining to Dental Practice: An Evidence Summary

... external hexagon [30,39,39,56,57,64,78,86,102,120,120,122,127,132,140], (4) internal hexagon [20,39,58,[63][64][65]67,68,78,122,130,133], (5) internal octagonal butt-joint [108], (6) internal polygonal buttjoint [148], and (7) internal trilobate joint [72] (Table 2). A total of 1 case-control, 5 cohort prospective studies, 4 cross-sectional studies, 58 non-randomized clinical trials (CTs), 28 randomized clinical trials, and 44 retrospective studies were included in the analysis (Table 2). ...

A 5-Year Esthetic RCT Assessment of Anterior Maxillary Single-Tooth Implants with Different Abutment Interfaces
  • Citing Article
  • January 2021

The International journal of oral & maxillofacial implants

... Dental implant success criteria have been described by Albrektsson et al. as lack of mobility of the implant, no radiographic evidence of peri-implant radiolucency, less than 0.2 mm bone alveolar bone 1-year post implant placement, and absence of persistent pain or infection (62). Many newer published dental implant success criteria do not include the annual bone loss as a criterion as newer implant designs have largely reduced or eliminated successive bone loss after loading (63,64). ...

Three-Year Prospective Randomized Comparative Assessment of Anterior Maxillary Single Implants with Different Abutment Interfaces
  • Citing Article
  • January 2019

The International journal of oral & maxillofacial implants

... Several indicators have been developed to objectively evaluate the post operative esthetic outcome such as the Pink Esthetic Score which is a widely used index that also showed good reproducibility in other studies. 24,[51][52][53] As it has been suggested that a PES >7 was clinically acceptable, in the present study PES revealed very favorable esthetic outcome in both groups, as indicated by a mean PES of greater than 9. This is consistent with other studies reporting high esthetic outcomes after soft tissue augmentation. ...

Pink Esthetic Score Outcomes Around Three Implant-Abutment Configurations: 3-Year Results

The International journal of oral & maxillofacial implants

... Short implants work exceptionally well for replacing a single tooth, especially in places where bone height is restricted. Because of their reduced size, they can be placed without requiring further augmentation, which speeds up the healing process (221)(222)(223)(224)(225)(226)(227)(228)(229)(230)(231)(232)(233)(234)(235)(236). Short implants may effectively anchor prosthetic restorations in wholly or partially edentulous patients. ...

Marginal bone level and survival of short and standard‐length implants after 3 years: An Open Multi‐Center Randomized Controlled Clinical Trial
  • Citing Article
  • July 2018

Clinical Oral Implants Research