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The Journal of Prosthetic Dentistry Oct 2022Although recent studies have reported the success of implant-supported monolithic restorations, consensus on the use of monolithic ceramic restorations is lacking. (Meta-Analysis)
Meta-Analysis Review
STATEMENT OF PROBLEM
Although recent studies have reported the success of implant-supported monolithic restorations, consensus on the use of monolithic ceramic restorations is lacking.
PURPOSE
The purpose of this systematic review and meta-analysis was to evaluate the survival and biological and technical complication rates of monolithic single crowns and fixed partial dentures (FPDs).
MATERIAL AND METHODS
An electronic search was conducted by 2 independent authors on the PubMed/MEDLINE, Scopus, and Cochrane Library databases. The Newcastle-Ottawa scale and Cochrane risk of bias tool were used to assess the quality and risk of bias of the included studies. Meta-analysis was performed by using the R software program.
RESULTS
The search identified 763 articles, 18 of which met the eligibility criteria. A total of 15 studies evaluated monolithic ceramic single crowns, and 4 studies evaluated FPDs. The studies included 1061 monolithic single crowns (524 lithium disilicate, 461 zirconia, and 76 polymer-infiltrated ceramic network [PICN]) and 104 FPDs (36 lithium disilicate and 68 zirconia). Meta-analysis of single-arm studies indicated the proportion of survival, biological, and technical complication rates of 1% (95% confidence interval [CI]: 0% to 3%), 1% (CI: 0% to 4%), and 2% (CI: 1% to 4%), respectively, for single crowns, independent of ceramic material, and 3% (CI: 0% to 34%), 5% (CI: 1% to 21%), and 5% (CI: 1% to 21%) for FPDs, respectively. Only 5 studies performed a direct comparison between monolithic and veneered ceramic restorations, and no significant difference was observed in terms of survival (risk ratio [RR]: 0.68; CI: 0.25-1.91; P=.96), biological (RR: 0.69; CI: 0.31-1.53; P=.35), and technical complication rates (RR: 0.87; CI: 0.40-1.88; P=.29).
CONCLUSIONS
The use of monolithic ceramic can be considered a favorable treatment for tooth-supported single crowns and FPDs, with high survival and low complication rates. However, further randomized controlled trials are needed to reassess these clinical performances, mainly by comparing them with the performance of veneered restorations.
Topics: Dental Restoration Failure; Dental Prosthesis Design; Zirconium; Dental Porcelain; Ceramics; Crowns; Dental Prosthesis, Implant-Supported
PubMed: 33745685
DOI: 10.1016/j.prosdent.2021.01.020 -
The Journal of Prosthetic Dentistry Mar 2022How axial displacement may be affected by the mechanical properties and internal discrepancy of a cement-retained implant-supported prosthesis is unclear.
STATEMENT OF PROBLEM
How axial displacement may be affected by the mechanical properties and internal discrepancy of a cement-retained implant-supported prosthesis is unclear.
PURPOSE
The purpose of this in vitro study was to assess the difference in internal discrepancy and axial displacement according to the prosthesis material in cement-retained prostheses splinting nonparallel implants.
MATERIAL AND METHODS
Computer-aided design and computer-aided manufacture (CAD-CAM) titanium abutments were fabricated for a vertically placed implant and a 15-degree tilted implant. Three types of prostheses, in zirconia, cobalt-chromium (Co-Cr) alloy, and polymethylmethacrylate resin (PMMA), were fabricated (n=10). The internal discrepancy between the CAD-CAM titanium abutment and the prosthesis was measured by using the replica technique. After luting with an interim cement, they were mounted in Type IV gypsum. The specimens were cyclic loaded, and axial displacement of the prosthesis was measured after 3, 10, 100, and 10 cycles. The internal discrepancy and cumulative axial displacement were assessed by using a 3-way analysis of variance and repeated measures analysis of variance (α=.05).
RESULTS
The internal discrepancy of the prosthesis did not differ based on the prosthesis material (P=.869); however, it was significantly different based on the measurement location, with the occlusal discrepancy (224 ±29 μm) being greater than the axial discrepancy (21 ±10 μm) (P<.05). Implants with an angled placement exhibited less axial displacement than implants with vertical placement (P<.05). The PMMA prosthesis demonstrated significantly greater axial displacement than the zirconia or Co-Cr prostheses (P<.05), which were similar (P=.623).
CONCLUSIONS
Prostheses made with high-elastic moduli materials exhibited less axial displacement than PMMA prostheses, even though the internal discrepancy was not different. Moreover, vertically placed implants presented a greater axial displacement of the prosthesis than implants with angled placement.
Topics: Chromium Alloys; Computer-Aided Design; Dental Abutments; Dental Cements; Dental Implants; Dental Materials; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Zirconium
PubMed: 33309295
DOI: 10.1016/j.prosdent.2020.08.044 -
British Dental Journal Sep 2019
Topics: Dental Implants; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported
PubMed: 31562446
DOI: 10.1038/s41415-019-0804-7 -
Clinical Oral Implants Research Jul 2022To investigate tissue features and interproximal contour of posterior implant-supported single crowns (ISSC), which correlate with food impaction. 2) To evaluate the...
PURPOSE
To investigate tissue features and interproximal contour of posterior implant-supported single crowns (ISSC), which correlate with food impaction. 2) To evaluate the influence of food impaction on the health of the adjacent peri-implant tissue and patients' oral health-related quality of life (OHRQoL).
MATERIALS AND METHODS
Patients with posterior ISSC under maintenance between July 2019 and July 2020 were recruited. OHRQoL of patients who self-reported food impaction between ISSC and teeth was evaluated by Oral Impacts on Daily Performance questionnaire and reported at patient level. Interproximal prosthesis contours and periodontal/peri-implant tissue conditions were assessed by clinical and radiographic examination. Differences between food impaction (FI) and non-food impaction (NFI) sites were analysed.
RESULTS
Totally, 178 patients (286 ISSC and 410 interproximal spaces) were included. Among 119 patients who self-reported food impaction, 84 (70.6%) reported their OHRQoL to be affected with minor-to-severe intensity. The most commonly affected daily performance was the ability to clean the teeth. Plaque accumulation at ISSC, deeper probing depth, complete interdental papilla fill, loose contact, longer contact length, lower contact point level, closer distance between ISSC and tooth, lesser embrasure surface area, tissue-level implant and cement-retained restoration were found significantly more in the FI group than the NFI group (p < .05).
CONCLUSION
Interproximal features of the implant prosthesis were associated with food impaction between the ISSC and the adjacent tooth, which might affect periodontal and/or peri-implant tissue health conditions. Patients' OHRQoL was commonly affected by food impaction, but the intensity was low.
Topics: Crowns; Dental Implants; Dental Implants, Single-Tooth; Dental Prosthesis, Implant-Supported; Humans; Quality of Life
PubMed: 35578787
DOI: 10.1111/clr.13958 -
Journal of Esthetic and Restorative... Jan 2022The purpose of this article is to discuss the considerations that need to be evaluated when considering the replacement of an existing maxillary anterior fixed dental...
OBJECTIVE
The purpose of this article is to discuss the considerations that need to be evaluated when considering the replacement of an existing maxillary anterior fixed dental prosthesis (FDP) with another FDP, or when to consider converting to implants and individual crowns on the previous abutment teeth.
OVERVIEW
The need to replace unesthetic or failing maxillary anterior FDPs is something all restorative dentists will be faced with multiple times in their careers. Given the emphasis over the past few decades on utilizing implants for tooth replacement as opposed to a tooth supported FDP, the question becomes when is converting the existing FDP to implants and single crowns an appropriate choice, as opposed to redoing a new FDP. This article will focus on the risks of choosing to convert to an implant solution, and the risks of redoing the tooth supported FDP. Multiple systematic reviews on each approach will be used to aid in the decision process. The most significant risks for both approaches will be identified, and a chart of the key parameters to assess will be presented, along with their impact.
CONCLUSIONS
The statistical outcomes at 5 and 10 years of tooth supported FDPs, and Implant based restorations are very similar if certain clinical parameters are met, namely vital healthy abutment teeth for the FDP, and adequate bone and soft tissue for the implant-based restoration. If one abutment tooth is compromised the long-term prognosis drops significantly and converting to an implant-based restoration may be more predictable. Similarly, if adequate bone and soft tissue cannot be obtained through surgical augmentation procedures, using a connective tissue graft for the ridge, and redoing the FDP may obtain a more acceptable esthetic result.
CLINICAL SIGNIFICANCE
A significant number of maxillary anterior FDPs exist that will need replacement in the future. Given the desire of many dentists to utilize implants when possible, there can be a tendency to automatically treatment plan an implant-based approach for replacement of the existing FDP. Certainly, most clinicians would favor an implant-based tooth replacement rather than preparing unrestored teeth to place an FDP, but when an existing FDP exists, the teeth have already been prepared for full coverage in most instances. In addition, for most long term existing FDPs, there is a significant change in the vertical and horizontal dimension of the bone and soft tissue that can make getting an acceptable esthetic result with an implant challenging. This article provides a systematic approach to identifying when redoing the FDP may be preferable, or when converting to an implant-based approach is a better choice.
Topics: Crowns; Dental Implants; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Denture, Partial, Fixed; Maxilla
PubMed: 34870356
DOI: 10.1111/jerd.12852 -
Journal of Dentistry Nov 2023To determine the agreement of removable dental prosthesis cleanliness as assessed by a semi-automated planimetric method between images captured by a digital single-lens...
OBJECTIVES
To determine the agreement of removable dental prosthesis cleanliness as assessed by a semi-automated planimetric method between images captured by a digital single-lens reflex camera (DSLR) and smartphone.
METHODS
A total of 97 participants with removable prostheses were recruited for the quantification of the prosthesis plaque area coverage. The colour images of stained prosthesis plaque were obtained using both a DSLR camera and a smartphone. The prosthesis plaque area coverage was analysed in two ways: (i) prosthesis cleanliness index (PCI) and (ii) percentage plaque area coverage (PPC). The PPC (continuous data) was converted to the PCI (categorical data) to provide prevalence ordinal scales and the agreements in PCI ratings were determined using weighted Kappa statistics. Agreement of PPC scores was determined through assessing directional, standardised directional, and absolute differences and correlation analyses.
RESULTS
Weighted Kappa values of agreement between PCI categories were excellent (> 0.80) for all comparisons. The mean PPC was 24.79 % as determined by DSLR and 25.37 % as determined by smartphone. There was no statistically significant difference in the means of PPC between the DSLR and smartphone (P = 0.149). The standardised directional difference was 0.15 ('small'). The mean absolute difference was 2.77. The interclass correlation coefficient was 0.98 ('excellent').
CONCLUSIONS
This method showed almost perfect agreements and allowed for threshold-based plaque segmentation on the removable prostheses. There was substantial agreement between DSLR and smartphone assessment of prosthesis plaque area coverage as determined by a semi-automated planimetric assessment.
CLINICAL SIGNIFICANCE
This semi-automated planimetric assessment method has implications for monitoring removable prosthesis hygiene initiatives by offering a valid, reliable, and quantitative method of assessment with potential use in managed care and community settings.
Topics: Humans; Dental Implants; Denture, Complete; Denture, Partial, Removable
PubMed: 37741504
DOI: 10.1016/j.jdent.2023.104721 -
BMC Oral Health Sep 2021When dealing with the replacement of one missing tooth, the patient has the option of choosing between different types of treatment interventions. Several important...
BACKGROUND
When dealing with the replacement of one missing tooth, the patient has the option of choosing between different types of treatment interventions. Several important factors play a role in his decision-making process, including his limited financial means and his efforts to solve the problem of missing teeth as effectively as possible. The main goal of the study is the economic-clinical evaluation of implant treatment, as a surgical-prosthetic method in dentistry, in case of replacement of one missing tooth of the molar area.
METHODS
Cost-utility analysis from the patient's perspective is used for evaluation. The selected comparator is a purely prosthetic solution with the help of a three-unit fixed dental prosthesis. Cost-utility analysis is modelled using Markov models, which consider a 30-year time horizon.
RESULTS
Based on the results of modelling, the intervention evaluated by the patient, i.e. treatment with the help of implant-supported single crown, brings exactly 15.31 quality-adjusted prosthesis years (QAPY) after 30 years. The value of incremental cost-utility ratio amounted to USD - 1434.
CONCLUSION
The results of the cost-utility analysis suggest that implant treatment with an implant-supported single crown is more cost-effective than treatment with the three-unit fixed dental prosthesis.
Topics: Cost-Benefit Analysis; Crowns; Dental Implants; Dental Prosthesis, Implant-Supported; Denture, Partial, Fixed; Humans; Molar
PubMed: 34488727
DOI: 10.1186/s12903-021-01790-y -
The Journal of Prosthetic Dentistry Feb 2021Implant-supported prostheses have typically been retained by cement or screws, each of which has advantages and disadvantages. Two new types of prosthesis with...
STATEMENT OF PROBLEM
Implant-supported prostheses have typically been retained by cement or screws, each of which has advantages and disadvantages. Two new types of prosthesis with complementary advantages and disadvantages have been proposed: the screw- and cement-retained prosthesis, which combines cement and screw retention, and the antiloosening inner-post screw (ALIPS) type, which uses lateral screws. Both esthetic and functional factors should be considered for anterior prostheses; however, clinical studies of the complication rates of these designs are lacking.
PURPOSE
The purpose of this retrospective clinical study was to evaluate the complications of dental implant-supported restorations with various prosthetic types in the anterior region and to analyze other factors that affect complications.
MATERIAL AND METHODS
This study included 51 patients who had 83 implants placed in the anterior region by a single clinician between August 2009 and December 2016. Surgical and prosthetic features were recorded, and implant complications were analyzed.
RESULTS
There were 45 (55.4%) cement-retained implants, 5 (6.0%) screw- and cement-retained prosthesis implants, and 32 (38.6%) ALIPS-retained implants. Peri-implant mucositis was observed most frequently in the ALIPS type (21.9%), but the biological complications did not differ significantly with the prosthetic type. The most common mechanical complication was loss of retention in the cement type of prosthesis (30.4%) and screw loosening in the ALIPS type (43.8%). Implant complications varied with position (maxilla or mandible) and implantation timing (period from tooth extraction to implant placement).
CONCLUSIONS
The complications of implants placed in the anterior region were affected by different factors but did not differ significantly with the type of the retention.
Topics: Dental Implants; Dental Prosthesis Retention; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Esthetics, Dental; Humans; Retrospective Studies
PubMed: 32336540
DOI: 10.1016/j.prosdent.2020.02.018 -
Clinical Oral Implants Research Jan 2023To evaluate the association between different vertical levels of the abutment margin and residual cement prevalence in cement-retained implant restorations with... (Observational Study)
Observational Study
OBJECTIVES
To evaluate the association between different vertical levels of the abutment margin and residual cement prevalence in cement-retained implant restorations with customized abutments.
METHODS
One hundred and nine single-unit cement-retained implant restorations with a screw-access channel were included. The crowns were intraorally cemented on the abutments, and excess cement was removed. The abutment-crown complex was unscrewed, and the abutment-crown complex and peri-implant tissue were photographed. Residual cement presence was recorded by dividing the abutment-crown complex and peri-implant tissue into four quadrants: mesial, distal, buccal, and lingual. The prevalence of residual cement was compared according to the height of the custom abutment margin of the corresponding quadrant. A multilevel model was used for statistical analysis (α = .05).
RESULTS
Cement remnants were discovered on 72.48% of the dental implants. When the restoration quadrants were compared, cement remnants were present on 51.38%, 39.45%, 20.18%, and 17.43% of the mesial, distal, buccal, and lingual surfaces, respectively (p < .01). Regarding the abutment margin level, cement residues were found in 60.22% and 61.4% of the 0.5 mm subgingival and ≥1 mm subgingival margin groups, respectively, which were significantly more than those in the supragingival (23.65%) and equigingival (26.59%) margin groups (p < .01). After adjustment for confounding factors, the adjusted odds ratio (with 95% confidence interval) for residual cement in the subgingival margin groups was 3.664 (1.71, 7.852) when compared to the supragingival and equigingival margin groups.
CONCLUSIONS
The risk of residual cement occurrence was 3.66-fold higher with a subgingival abutment margin than with supragingival and equigingival abutment margins.
Topics: Cementation; Dental Implants; Dental Abutments; Dental Prosthesis, Implant-Supported; Dental Cements; Glass Ionomer Cements; Crowns
PubMed: 36278423
DOI: 10.1111/clr.14015 -
Journal of Clinical Orthodontics : JCO Aug 2023
Topics: Humans; Dental Implants; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported
PubMed: 37778122
DOI: No ID Found