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Clinical Oral Implants Research Feb 2016The aim of this systematic review was to analyze post-loading implant loss for implant-supported prostheses in edentulous jaws, regarding a potential impact of implant... (Review)
Review
OBJECTIVES
The aim of this systematic review was to analyze post-loading implant loss for implant-supported prostheses in edentulous jaws, regarding a potential impact of implant location (maxilla vs. mandible), implant number per patient, type of prosthesis (removable vs. fixed), and type of attachment system (screw-retained, ball vs. bar vs. telescopic crown).
MATERIAL AND METHODS
A systematic literature search for randomized-controlled trials (RCTs) or prospective studies was conducted within PubMed, Cochrane Library, and Embase. Quality assessment of the included studies was carried out, and the review was structured according to PRISMA. Implant loss and corresponding 3- and 5-year survival rates were estimated by means of a Poisson regression model with total exposure time as offset.
RESULTS
After title, abstract, and full-text screening, 54 studies were included for qualitative analyses. Estimated 5-year survival rates of implants were 97.9% [95% CI 97.4; 98.4] in the maxilla and 98.9% [95% CI 98.7; 99.1] in the mandible. Corresponding implant loss rates per 100 implant years were significantly higher in the maxilla (0.42 [95% CI 0.33; 0.53] vs. 0.22 [95% CI 0.17; 0.27]; P = 0.0001). Implant loss rates for fixed restorations were significantly lower compared to removable restorations (0.23 [95% CI 0.18; 0.29] vs. 0.35 [95% CI 0.28; 0.44]; P = 0.0148). Four implants and a fixed restoration in the mandible resulted in significantly higher implant loss rates compared to five or more implants with a fixed restoration. The analysis of one implant and a mandibular overdenture also revealed higher implant loss rates than an overdenture on two implants. The same (lower implant number = higher implant loss rate) applied when comparing 2 vs. 4 implants and a mandibular overdenture. Implant loss rates for maxillary overdentures on <4 implants were significantly higher than for four implants (7.22 [95% CI 5.41; 9.64] vs. 2.31 [1.56; 3.42]; P < 0.0001).
CONCLUSIONS
Implant location, type of restoration, and implant number do have an influence on the estimated implant loss rate. Consistent reporting of clinical studies is necessary and high-quality studies are needed to confirm the present results.
Topics: Dental Implantation, Endosseous; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Denture, Overlay; Denture, Partial, Fixed; Humans; Jaw, Edentulous
PubMed: 25664612
DOI: 10.1111/clr.12531 -
Hua Xi Kou Qiang Yi Xue Za Zhi = Huaxi... Feb 2017The development of clinical implant dentistry was intensively affected by dental implant design improvement and innovation, which brought about new concept, even...
The development of clinical implant dentistry was intensively affected by dental implant design improvement and innovation, which brought about new concept, even milestone-like changes of clinical protocol. The current improvements of dental implant design and their clinical importance could be highlighted as followings: 1) The implant apical design influences the implant preliminary stability in immediate implant. The apical 3-5 mm design of implant makes implant stable in immediate implant, because this part would be screwed into alveolar bone through fresh socket, the other part of implant could not be tightly screwed in the socket because of smaller implant diameter. Implant apical form, screw design, self-taping of apical part would be essential for immediate implant. 2) The enough preliminary stability of implant makes immediate prosthesis possible. When osseointegration does not occur, the implant stability comes from a mechanical anchorage, which depends on implant form, screw thread and self-taping design. 3) Implant neck design may have influence for soft tissue recession in esthetic zone. The implant with large shoulder would not be selected for the esthetic area. The platform design may be more favorable in the area. 4) The connection design between implant and abutment is thought a very important structure in implant long-term stability. Moose taper and "tube in tube" were well documented structure design in 20-year clinical practice in Peking University. 5) In last 15 years, the plenty studies showed the platform design of implant had positive influence in implant marginal bone level. Whatever in single implant restoration or multi-implant prosthesis. 6) The digital technology makes clinical work more precise and high-tech. This would be a trend in implant dentistry. New generation of chair-side digital computer-aided design/computer-aided manufacturing makes immediate prosthesis without conventional impression possible. 7) New abutment design have changed clinical protocol greatly. The All-on-four concept and Weldone concept benefit both from the abutment innovation, which were large angulated abutment and special welding abutment materials.
Topics: Computer-Aided Design; Dental Implants; Dental Prosthesis Design; Humans; Osseointegration
PubMed: 28326723
DOI: 10.7518/hxkq.2017.01.003 -
Clinical Oral Implants Research Oct 2018The aim of the present systematic review was to analyze the survival and complication rates of zirconia-based and metal-ceramic implant-supported single crowns (SCs).
OBJECTIVES
The aim of the present systematic review was to analyze the survival and complication rates of zirconia-based and metal-ceramic implant-supported single crowns (SCs).
MATERIALS AND METHODS
An electronic MEDLINE search complemented by manual searching was conducted to identify randomized controlled clinical trials, prospective cohort and retrospective case series on implant-supported SCs with a mean follow-up time of at least 3 years. Patients had to have been clinically examined at the follow-up visit. Assessment of the identified studies and data extraction was performed independently by two reviewers. Failure and complication rates were analyzed using robust Poisson's regression models to obtain summary estimates of 5-year proportions.
RESULTS
The search provided 5,263 titles and 455 abstracts, full-text analysis was performed for 240 articles, resulting in 35 included studies on implant-supported crowns. Meta-analysis revealed an estimated 5-year survival rate of 98.3% (95% CI: 96.8-99.1) for metal-ceramic implant supported SCs (n = 4,363) compared to 97.6% (95% CI: 94.3-99.0) for zirconia implant supported SCs (n = 912). About 86.7% (95% CI: 80.7-91.0) of the metal-ceramic SCs (n = 1,300) experienced no biological/technical complications over the entire observation period. The corresponding rate for zirconia SCs (n = 76) was 83.8% (95% CI: 61.6-93.8). The biologic outcomes of the two types of crowns were similar; yet, zirconia SCs exhibited less aesthetic complications than metal-ceramics. The 5-year incidence of chipping of the veneering ceramic was similar between the material groups (2.9% metal-ceramic, 2.8% zirconia-ceramic). Significantly (p = 0.001), more zirconia-ceramic implant SCs failed due to material fractures (2.1% vs. 0.2% metal-ceramic implant SCs). No studies on newer types of monolithic zirconia SCs fulfilled the simple inclusion criteria of 3 years follow-up time and clinical examination of the present systematic review.
CONCLUSION
Zirconia-ceramic implant-supported SCs are a valid treatment alternative to metal-ceramic SCs, with similar incidence of biological complications and less aesthetic problems. The amount of ceramic chipping was similar between the material groups; yet, significantly more zirconia crowns failed due to material fractures.
Topics: Ceramics; Crowns; Databases, Factual; Dental Implants; Dental Materials; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Esthetics, Dental; Humans; Metal Ceramic Alloys; Survival Analysis; Zirconium
PubMed: 30328190
DOI: 10.1111/clr.13306 -
Clinical Oral Implants Research Oct 2021To assess the survival, failure, and complication rates of veneered and monolithic all-ceramic implant-supported single crowns (SCs). (Meta-Analysis)
Meta-Analysis Review
A systematic review and meta-analysis evaluating the survival, the failure, and the complication rates of veneered and monolithic all-ceramic implant-supported single crowns.
OBJECTIVE
To assess the survival, failure, and complication rates of veneered and monolithic all-ceramic implant-supported single crowns (SCs).
METHODS
Literature search was conducted in Medline (PubMed), Embase, and Cochrane Central Register of Controlled Trials until September 2020 for randomized, prospective, and retrospective clinical trials with follow-up time of at least 1 year, evaluating the outcome of veneered and/or monolithic all-ceramic SCs supported by titanium dental implants. Survival and complication rates were analyzed using robust Poisson's regression models.
RESULTS
Forty-nine RCTs and prospective studies reporting on 57 material cohorts were included. Meta-analysis of the included studies indicated an estimated 3-year survival rate of veneered-reinforced glass-ceramic implant-supported SCs of 97.6% (95% CI: 87.0%-99.6%). The estimated 3-year survival rates were 97.0% (95% CI: 94.0%-98.5%) for monolithic-reinforced glass-ceramic implant SCs, 96.9% (95% CI: 93.4%-98.6%) for veneered densely sintered alumina SCs, 96.3% (95% CI: 93.9%-97.7%) for veneered zirconia SCs, 96.1% (95% CI: 93.4%-97.8%) for monolithic zirconia SCs and only 36.3% (95% CI: 0.04%-87.7%) for resin-matrix-ceramic (RMC) SCs. With the exception of RMC SCs (p < 0.0001), the differences in survival rates between the materials did not reach statistical significance. Veneered SCs showed significantly (p = 0.017) higher annual ceramic chipping rates (1.65%) compared with monolithic SCs (0.39%). The location of the SCs, anterior vs. posterior, did not influence survival and chipping rates.
CONCLUSIONS
With the exception of RMC SCs, veneered and monolithic implant-supported ceramic SCs showed favorable short-term survival and complication rates. Significantly higher rates for ceramic chipping, however, were reported for veneered compared with monolithic ceramic SCs.
Topics: Ceramics; Crowns; Dental Implants; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Prospective Studies; Retrospective Studies
PubMed: 34642991
DOI: 10.1111/clr.13863 -
Journal of Esthetic and Restorative... Nov 2019The unavoidable extraction of teeth in the esthetic area can be overcome through different treatment modalities. Recently, immediate implants appeared as a minimally...
OBJECTIVE
The unavoidable extraction of teeth in the esthetic area can be overcome through different treatment modalities. Recently, immediate implants appeared as a minimally invasive approach to resolving these cases; however, immediate implant loading is not always possible or indicated. In these cases, an innovative approach through customized healing abutments could be used to preserve the soft tissue contour, eliminating the need for reopening surgery and the use of provisional restorations to condition the mucosal contour.
CLINICAL CONSIDERATIONS
The present cases describe a simplified chairside approach to use customized healing abutments for immediate implants placed after tooth extraction in the anterior and posterior areas in order to maintain the soft tissue contours while reducing the clinical steps until delivering the final restorations.
CONCLUSIONS
This technique seems to be effective to guide the soft tissue healing around dental implants allowing a natural emergence profile with implant-supported restorations, reducing the number of treatment steps.
CLINICAL SIGNIFICANCE
The use of customized healing abutments prepares soft tissue for the prosthetic stage preserving its contours and eliminating the need for reopening surgery.
Topics: Dental Abutments; Dental Implantation, Endosseous; Dental Implants; Dental Implants, Single-Tooth; Dental Prosthesis, Implant-Supported; Humans; Immediate Dental Implant Loading; Tooth Extraction
PubMed: 31268244
DOI: 10.1111/jerd.12512 -
International Journal of Implant... Nov 2021Implant-assisted removable partial dentures (IARPDs) have recently become popular, but little information is available on the treatment outcomes based on the Kennedy... (Review)
Review
BACKGROUND
Implant-assisted removable partial dentures (IARPDs) have recently become popular, but little information is available on the treatment outcomes based on the Kennedy classification and attachment types.
OBJECTIVE
The objective of this review was to evaluate the treatment outcomes of IARPD delivered for distal extension edentulous areas based on the differences in the Kennedy classification and attachment type.
MATERIALS AND METHODS
English-language clinical studies on IARPD published between January 1980 and February 2020 were collected from MEDLINE (via PubMed), the Cochrane Library (via the Cochrane Central Register of Controlled Trials), Scopus online database, and manual searching. Two reviewers selected the articles based on pre-determined inclusion and exclusion criteria, followed by data extraction and analysis.
RESULTS
Eighty-one studies were selected after evaluating the titles and abstracts of 2410 papers. Nineteen studies were finally included after the perusal of the full text. Fourteen studies focused on Class I, 4 studies investigated both Class I and II, and only 1 study was conducted on Kennedy's class II. Eight types of attachments were reported. The ball attachment was the most frequently used attachment, which was employed in 8 of the included studies. The implant survival rate ranged from 91 to 100%. The reported marginal bone loss ranged from 0.3 mm to 2.30 mm. The patient satisfaction was higher with IARPD than with conventional RPDs or that before treatment. The results of prosthetic complications were heterogeneous and inconclusive.
CONCLUSION
IARPD exhibited favorable clinical outcomes when used as a replacement for distal extension edentulous areas. The comparison between the clinical outcomes of Kennedy's class I and II was inconclusive owing to the lack of studies focusing on Kennedy Class II alone. The stud attachment was the most commonly used type in IARPDs. Overall, the different attachment systems did not influence the implant survival rate and patient satisfaction. Further high-quality studies are needed to investigate the attachment systems used in IARPD.
Topics: Dental Implants; Dental Prosthesis, Implant-Supported; Denture, Partial, Removable; Humans; Patient Satisfaction; Treatment Outcome
PubMed: 34773513
DOI: 10.1186/s40729-021-00394-z -
Journal of Clinical Periodontology Nov 2022To test whether the emergence profile (CONVEX or CONCAVE) of implant-supported crowns influences the mucosal margin stability up to 12 months after insertion of the... (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
To test whether the emergence profile (CONVEX or CONCAVE) of implant-supported crowns influences the mucosal margin stability up to 12 months after insertion of the final restoration.
MATERIALS AND METHODS
Forty-seven patients with a single implant in the anterior region were randomly allocated to one of three groups: (1) CONVEX (n = 15), implant provisional and an implant-supported crown both with a convex profile; (2) CONCAVE (n = 16), implant provisional and an implant-supported crown both with a concave profile; (3) CONTROL (n = 16), no provisional (healing abutment only) and an implant-supported crown. All patients were recalled at baseline, 6, and 12 months. The stability of mucosal margin along with clinical, aesthetic, and profilometric outcomes as well as time and costs were evaluated. To predict the presence of recession, multivariable logistic regressions were performed and linear models using generalized estimation equations were conducted for the different outcomes.
RESULTS
Forty-four patients were available at 12 months post-loading. The frequency of mucosal recession amounted to 64.3% in group CONVEX, 14.3% in group CONCAVE, and 31.4% in group CONTROL. Regression models revealed that a CONVEX profile was significantly associated with the presence of recessions (odds ratio: 12.6, 95% confidence interval: 1.82-88.48, p = .01) compared with the CONCAVE profile. Pink aesthetic scores amounted to 5.9 in group CONVEX, 6.2 in group CONCAVE, and 5.4 in group CONTROL, with no significant differences between the groups (p = .735). Groups CONVEX and CONCAVE increased the appointments and costs compared with the CONTROL group.
CONCLUSIONS
The use of implant-supported provisionals with a CONCAVE emergence profile results in a greater stability of the mucosal margin compared with a CONVEX profile up to 12 months of loading. This is accompanied, however, by increased time and costs compared with the absence of a provisional and may not necessarily enhance the aesthetic outcomes.
TRIAL REGISTRATION
German Clinical Trials Register; DRKS00009420.
Topics: Crowns; Dental Implants; Dental Implants, Single-Tooth; Dental Prosthesis, Implant-Supported; Esthetics, Dental; Humans
PubMed: 35817419
DOI: 10.1111/jcpe.13696 -
Journal of Dentistry Oct 2017This clinical study evaluated the long-term outcome and survival rate of all-ceramic cantilever resin-bonded fixed dental prostheses (RBFDPs) made of zirconia-ceramic...
OBJECTIVES
This clinical study evaluated the long-term outcome and survival rate of all-ceramic cantilever resin-bonded fixed dental prostheses (RBFDPs) made of zirconia-ceramic with a single-retainer design to replace missing incisors. In addition, whether the reason for missing incisors has an influence on the longevity of RBFDPs was analyzed.
MATERIALS AND METHODS
One hundred and eight zirconia ceramic cantilever RBFDPs were provided for 87 patients. Seventy-five RBFDPs replaced maxillary incisors and 33 mandibular incisors. The restorations were subsequently categorized into 3 groups according to the reasons for missing teeth (congenitally missing, trauma and other reasons). The patients were followed up annually, and the restorations were assessed for function and aesthetics. The mean observation time of the RBFDPs was 92.2±33months.
RESULTS
Six debondings and 1 loss of restoration were recorded. The lost restoration was removed at the patient's request after a small chip occurred on the mesial edge of the pontic. Three of the 6 observed debondings were caused by traumatic incidents. All debonded RBFDPs were rebonded successfully with no further complications. Zirconia ceramic RBFDPs yielded a 10-year survival rate of 98.2% and a success rate of 92.0%.
CONCLUSIONS
Anterior zirconia ceramic cantilever RBFDPs provided excellent clinical longevity. The reasons for missing incisors did not influence the longevity of the cantilever RBFDPs.
Topics: Adolescent; Adult; Aged; Ceramics; Dental Bonding; Dental Materials; Dental Prosthesis; Dental Restoration Failure; Denture Design; Denture, Partial, Fixed; Female; Follow-Up Studies; Germany; Humans; Incisor; Male; Middle Aged; Resin Cements; Retrospective Studies; Tooth Loss; Treatment Outcome; Young Adult; Zirconium
PubMed: 28688950
DOI: 10.1016/j.jdent.2017.07.003 -
Clinical Oral Implants Research May 2022To compare screw-retained and cemented all-ceramic implant-supported single crowns regarding biological and technical outcomes over a 5-year observation period. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To compare screw-retained and cemented all-ceramic implant-supported single crowns regarding biological and technical outcomes over a 5-year observation period.
MATERIALS AND METHODS
In 44 patients, 44 two-piece dental implants were placed in single-tooth gaps in the esthetic zone. Patients randomly received a screw-retained (SR) or cemented (CR) all-ceramic single crown and were then re-examined annually up to 5 years. Outcome measures included: clinical, biological, technical, and radiographic parameters. Data were statistically analyzed with Wilcoxon-Mann-Whitney, Wilcoxon, and Fisher's exact tests.
RESULTS
During the observation period, three patients (6.8%) were loss to follow-up. Eight restorations (18.2%, CI (8.2%, 32.7%)) were lost due to technical (6 patients, 13.6% (CI (5.2%, 27.4%)), 2 CR and 4 SR group, intergroup p = .673; implants still present) or biological complications (2 patients, 4.5% (CI (0.6%, 16.5%)), only CR group, intergroup p = .201, both implants lost). This resulted in a survival rate of 81.2% (CI (65.9%, 90.1%)) on the restorative level (18 SR; 15 CR, 3 lost to follow-up). At the 5-year follow-up, the median marginal bone levels were located slightly apical relative to the implant shoulder with 0.4 mm (0.5; 0.3) (SR) and 0.4 mm (0.8; 0.3) (CR) (intergroup p = .582). Cemented restorations demonstrated a significantly higher biological complication rate (36.8%, SR: 0.0%; intergroup p = .0022), as well as a significantly higher overall complication rate (68.4%, SR: 22.7%, intergroup p = .0049). All other outcomes did not differ significantly between the two groups (p > .05).
CONCLUSIONS
All-ceramic single-tooth restorations on two-piece dental implants resulted in a relatively low survival rate. Cemented restorations were associated with a higher biological and overall complication rate than screw-retained restorations.
Topics: Bone Screws; Crowns; Dental Abutments; Dental Implants; Dental Implants, Single-Tooth; Dental Porcelain; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Esthetics, Dental; Humans; Zirconium
PubMed: 35224774
DOI: 10.1111/clr.13913 -
Journal of Clinical Periodontology Jan 2019To compare the clinical outcomes of ≤6 mm extra-short implants (test group) versus ≥10 mm long implants (control group), with and without bone augmentation procedures. (Meta-Analysis)
Meta-Analysis
AIM
To compare the clinical outcomes of ≤6 mm extra-short implants (test group) versus ≥10 mm long implants (control group), with and without bone augmentation procedures.
MATERIALS AND METHODS
A systemic literature search of randomized clinical trials was performed using the PubMed (MEDLINE) and EMBASE databases. A quantitative meta-analysis was conducted to compare all the outcome variables. Meta-regression analysis determined the effect of bone augmentation procedures and the influence of other clinical covariates on the results.
RESULTS
Eighteen studies comprising 1,612 implants (793 extra-short and 820 long implants) were selected for the meta-analysis. No statistically significant difference in the survival rate was observed at 1 and 3 years (p > 0.05). Extra-short implants displayed less marginal bone loss (MBL) from both implant placement time points (1 and 3 years) and prosthetic placement (1 year), as well as less biological complications, surgical time and treatment cost (p < 0.05). Contrarily, a statistically significant small number of prosthetic complications were reported with long implants (p < 0.05).
CONCLUSIONS
Placement of extra-short implants (≤6 mm) presented as an equivalent option in the treatment of patients with an atrophic posterior arch up to 3-year follow-up. However, the long-term effectiveness of extra-short dental implants remains to be further studied.
Topics: Humans; Dental Implantation, Endosseous; Dental Implants; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Patient Reported Outcome Measures; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 30362137
DOI: 10.1111/jcpe.13026