European Journal of Oral Implantology最新文献

Aim: Nowadays, oral implants are a leading concept in oral rehabilitation. Patient satisfaction with this treatment is high, but are the expectations of the patients met? The aim of this review was to systematically screen the literature on patients' expectations of implant-based therapy before treatment and to assess whether these expectations were being met.

Materials and methods: A search strategy was developed for manuscripts dealing with patients' expectations of implant-based therapy to support different types of prosthodontics. Patients had an indication for implants, were seeking implants or had received implants. PubMed/MEDLINE, Ovid/EMBASE and Cochrane/CENTRAL were searched to identify eligible studies. Two reviewers independently assessed the articles.

Results: In total, 16 out of 3312 studies assessing patients' expectations of patients before implant-based therapy matched the inclusion criteria. A variety of methods were used in the studies. Patients had high expectations, with function followed by aesthetics being the most important expected improvements. Women had higher expectations than men. Costs were a major factor against implant-based therapy. The expectations that implants will last a lifetime and require no special needs of oral hygiene were of concern.

Conclusion: Prior to treatment, patients have high expectations of implant therapy. In general, these expectations are met. Most studies revealed that women have higher expectations than men. The variety of applied study designs impaired comparability of results. Thus, standardised methods for measuring expectations of implant-based therapy are eagerly needed.

This review provides an overview of review and consensus articles of the past 5 years regarding surgical complications in implant dentistry. The focus in this article is on surgical complications occurring after implant insertion and on risk factors that compromise oral implant osseointegration.

Purpose: The objective of this 3-year post-loading parallel randomised controlled trial is to compare two bone substitutes and resorbable membranes in a one-stage procedure for horizontal bone augmentation: anorganic bovine bone and porcine collagen membranes (BB group) versus synthetic resorbable bone graft substitute made of pure β-tricalcium phosphate and porcine pericardium collagen membranes (CJ group).

Materials and methods: Patients in need of implant treatment having at least one site with horizontal osseous defect at a private clinic in Rimini, Italy, were included in this study. Patients were randomised to receive either BB or CJ in a one-stage procedure for horizontal bone augmentation in a submerged approach. Randomisation was computer-generated with allocation concealment by opaque sequentially numbered sealed envelopes. Patients and the outcome assessor were blinded to group assignment. The abutment connection was made after 6 months of healing. The application of the provisional prosthesis was performed after abutment connection and a definitive metal-ceramic prosthesis was placed 6 months post-loading. The patients were followed-up to 3 years post-loading. Primary outcome measures were: implant failure, complications and peri-implant margin bone level changes. Secondary outcome measures were: visual analogue scale (VAS) for functional and aesthetic satisfaction and pink aesthetic score (PES).

Results: Twenty-five patients with 32 implants were randomly allocated to the BB group and 25 patients with 29 implants to the CJ group. All 50 randomised patients received the treatment as allocated and there were 7 drop-outs in the BB group and 11 drop-outs in the CJ group up to 3 years' post-loading. There were no implant failures. There were six complications in five patients of the BB group and three complications in three patients of the CJ group (relative risk: 1.32, 95% CI from 0.37 to 4.64, P = 1.0000). Radiographic bone loss was 1.61 mm for the BB group and 1.02 mm for the CJ group (difference 0.54 mm, 95% CI from -0.53 to 1.60, P = 0.3100). The functional VAS was 9.0 for the BB group and 9.6 for the CJ group (difference 0.6, 95% CI from -0.4 to 1.5, P = 0.2393). The aesthetic VAS was 9.4 for the BB group and 9.6 for the CJ group (difference 0.2, 95% CI from -0.5 to 0.8, P = 0.6141). PES was 8.7 for the BB group and 8.5 for the CJ group (difference -0.1, 95% CI from -2.9 to 2.7, P = 0.9360).

Conclusions: No significant differences were observed in this randomised controlled trial comparing anorganic bovine bone with porcine collagen membranes versus synthetic resorbable bone made of pure β-tricalcium phosphate with pericardium collagen membranes for horizontal augmentation.

Purpose: To compare the clinical outcome of dental implants restored with definitive occluding partial fixed prostheses within 1 week after implant placement with immediate non-occluding provisional restorations to be replaced by definitive prostheses after 4 months.

Materials and methods: Forty partially edentulous patients treated with one to three dental implants, at least 8.5 mm long and 4.0 mm wide, inserted with a torque of at least 35 Ncm, were randomised in two groups of 20 patients each, to be immediately loaded with partial fixed prostheses. Patients in one group received one definitive screw-retained, metal-ceramic prosthesis in occlusion within 1 week after placement. Patients in the other group received one non-occluding provisional acrylic reinforced prosthesis within 24 h of implant placement. Provisional prostheses were replaced by definitive ones after 4 months. The follow-up for all patients was 3 years post-loading. Outcome measures were prosthesis and implant failures, any complications, peri-implant marginal bone level changes, aesthetic evaluation by a dental practitioner, patient satisfaction, chair time and number of visits at the dental office from implant placement to delivery of definitive restorations.

Results: Three patients dropped out, one from the non-occlusal group and two from the occlusal group. Two immediately occlusally loaded implants with their related definitive prostheses failed early (difference in proportions = 0.10; 95% CI = -0.03 to 0.23; P = 0.488). Five patients from the occlusally loaded group were affected by six complications vs three patients (three complications) in the non-occlusally loaded group. The difference in proportions was not statistically significant (difference in proportions = 0.08; 95% CI = -0.17 to 0.34; P = 0.697). Three years after loading, patients subjected to occlusal loading lost an average of 1.13 mm of peri-implant bone vs 1.03 mm of patients restored with non-occluding definitive partial fixed prostheses. There were no statistically significant differences for marginal bone level changes between the two groups (mean difference = 0.10 mm; 95% CI -0.62 to 0.82; P = 0.779). No significant were the differences for pink aesthetic scores (7.09 vs 6.90; P = 0.873); for aesthetics evaluated by patients (Mann-Whitney U test P = 0.799) and function satisfaction (Mann-Whitney U test P = 0.578). Significantly less chair time (mean difference -38.00; 95% CI -58.96 to -17.04; P = 0.001) and number of visits (mean difference -2.15; 95% CI -2.77 to -1.53; P < 0.001) were required for the immediate definitive prosthesis group.

Conclusions: This study did not provide a conclusive answer, but suggests that immediate occlusal loading by manufacturing immediate definitive partial fixed prostheses decreases chair time and number of visits.

Purpose: To present a rare clinical case of migration of a displaced implant fragment from the maxillary sinus to the stomach.

Materials and methods: A 66-year-old man was referred from a local dental clinic to remove a displaced implant apical fragment in the left maxillary sinus. After 15 days from the displacement, no foreign body was seen in the maxillary sinus or in any other craniofacial cavity. Thoracic and abdominal radiographs were taken, and a 3 × 3 mm radiopaque object, which corresponded to the piece of implant fragment, was detected within the patient's stomach.

Results: Follow-up radiographs were taken to monitor the progress after 1 week, and it was found that the radiopaque object had disappeared.

Conclusions: A displaced dental implant fragment in the maxillary sinus can migrate and exit from the maxillary sinus within a few days. Since it presents a potential risk for swallowing or aspiration, displaced implants or other objects in the maxillary sinus should be removed immediately. Before removal, additional radiographs are recommended to confirm the current position of the implant.

Purpose: To evaluate whether 6.6-mm long implants could be a suitable alternative to longer implants placed in vertically augmented atrophic posterior mandibles.

Materials and methods: Sixty partially edentulous patients having 7 to 8 mm of residual crestal height and at least 5.5-mm thickness measured on computed tomography scans above the mandibular canal were randomly allocated according to a parallel-group design either to receive one to three submerged 6.6-mm long implants or 9.6-mm or longer implants (30 patients per group) placed in vertically augmented bone. Bone was augmented with interpositional anorganic bovine bone blocks fixed with titanium plates and covered with resorbable barriers. Grafts were left to heal for 5 months before implant placement. Four months after implant placement, provisional acrylic prostheses were delivered, replaced, after 4 months, by definitive metal-ceramic prostheses. Outcome measures were: prosthesis and implant failures, complications, and radiographic peri-implant marginal bone level changes. Patients were followed up to 8 years after loading.

Results: Eight years after loading 12 patients dropped out, five from the short implant group and seven from the augmented group. The augmentation procedure failed in two patients and only 6.6-mm long implants could be inserted. There were no statistically significant differences for prosthesis and implant failures. Four prostheses failed in three patients of the short implant group versus three prostheses in three patients of the augmented group (Fisher exact test P = 1.000; difference in proportions = 0.01; 95% CI: -0.19 to 0.22). Five short implants failed in three patients versus three long implants in three patients (Fisher exact test P = 1.000; difference in proportions = 0.01; 95% CI: -0.19 to 0.22). There were statistically more complications in augmented patients (27 complications in 22 augmented patients versus 9 complications in 8 patients of the short implant group) (Fisher exact test P < 0.001; difference in proportions = 0.64; 95% CI: 0.38 to 0.79). Both groups gradually lost peri-implant bone in a statistically significant way. Eight years after loading, short implant group patients lost an average of 1.58 mm of peri-implant bone compared with 2.46 mm in the augmented group. Short implants experienced statistically significantly less bone loss (0.88 mm, 95% CI: 0.50 to 1.26 mm) than long implants.

Conclusions: When residual bone height over the mandibular canal is between 7 and 8 mm, 6.6-mm short implants are an interesting alternative to vertical augmentation in posterior atrophic mandibles since the treatment is faster, cheaper and associated with less morbidity.

Aim: A large variety of dental materials are available for the production of implant-supported fixed restorations. Materials with different properties are likely to behave differently during clinical function, which may result in different prevalence and types of complications. The aim of the present review was to summarise, analyse and discuss the prevalence and types of complications or failures related to dental materials in implant-supported restorations.

Materials and methods: A strategy was set up using the PICO format and the search was performed using the PubMed database, including a hand search of reference lists. Two independent reviewers selected papers based on a set of criteria. The number of events of complications was summarised.

Results: The initial search produced 2764 titles. After application of criteria, 47 publications were selected for analysis. Seventeen studies reported on 1447 single crowns and 30 studies reported on 2190 fixed dental prostheses. The most common complications were fracture or chipping of the veneer material, loss of retention and lost access hole fillings. Due to the heterogeneity of studies, and large variation in number of restorations per material group, no conclusive correlation between type of material and type of technical complication and/or failure could be established.

Conclusions: The review did not succeed in providing convincing evidence to answer the question concerning a possible relationship between restoration materials and prevalence of technical complications in implant-supported restorations.

"If terms be incorrect, then statements do not accord with facts". (Confucius) "Words form the thread on which we string our experiences". (Aldous Huxley) Semantics is a term coined by Michel Bréal (1832 to 1915) a Jewish German-French linguist referring to the Greek semantikos (= meaning) in his 1897 book, "Essai de sémantique". He was a very gifted man: for example, he was the one who suggested to Pierre de Coubertin to include the marathon in the Olympic Games and who also, with the help of a Francophile American dental practitioner, Thomas William Evans, created the "Doctorat d'Université", finally allowing American students to pursue their doctorate at a French university.

Aim: To describe general observations of immunological reactions to foreign materials and to realize that CP titanium gives rise to a foreign body reaction with subsequent bone embedment when placed as oral implants. To analyse the possibility of titanium allergy.

Materials and methods: The present paper is of a narrative review type. Hand and Medline searches were performed to evaluate marginal bone loss of oral implants and the potential of titanium allergy.

Results: Immunological reactions to foreign substances include Type I hypersensitivity reactions such as allergy, Type II hypersensitivity reactions characterised by IgM or IgG antibodies that may react with blood group antigens at transfusion, and Type III hypersensitivity caused by antigen-antibody immune complexes exemplified by acute serum sickness. There is also Type IV hypersensitivity, or delayed hypersensitivity, which is typically found in drug and foreign body reactions. It proved very difficult to find a universally acceptable definition of reasons for marginal bone loss around oral implants, which lead to most varying figures of so-called peri-implantitis being 1% to 2% in some 10-year follow-up papers to between 28% and 56% of all placed implants in other papers. It was recognised that bone resorption to oral as well as orthopaedic implants may be due to immunological reactions. Today, osseointegration is seen as an immune-modulated inflammatory process where the immune system is locally either up- or downregulated. Titanium implant allergy is a rare condition, if it exists. The authors found only two papers presenting strong evidence of allergy to CP titanium, but with the lack of universally accepted and tested patch tests, the precise diagnosis is difficult.

Conclusions: CP titanium acts as a foreign body when placed in live tissues. There may be immunological reasons behind marginal bone loss. Titanium allergy may exist in rare cases, but there is a lack of properly designed and analysed patch tests at present.

Purpose: To report the 5-year clinical and aesthetic outcomes of a novel surgical-prosthetic approach for the treatment of buccal soft tissue dehiscence around single dental implants.

Materials and methods: Twenty patients with buccal soft tissues dehiscence around single implants in the aesthetic area were treated by removing the implant-supported crown, reducing the implant abutment, coronally advanced flap in combination with connective tissue graft and final restoration. After the first year, patients were recalled three times a year until the final clinical re-evaluation performed 5 years after the final prosthetic crown. Complications, bleeding on probing (BoP), peri-implant probing depth (PPD), clinical attachment level (CAL), keratinized tissue height (KTH), soft tissue coverage and thickness (STT), patient satisfaction (VAS) and aesthetic assessment (PES/WES) were evaluated 5 years after the final restoration.

Results: Of the 20 patients enrolled in the study, 19 completed the study at 5 years. A total of 99.2% mean soft tissue dehiscence coverage, with 79% of complete dehiscence coverage, was achieved at 5 years. A statistically significant increase in buccal soft tissue thickness (0.3 mm 0.1-0.4 P < 0.001) and keratinized tissue height (0.5 mm 0.0-1.0; P < 0.001) at 5 years with respect to 1 year was demonstrated. The patient aesthetic evaluation showed high VAS scores with no statistical difference between 1 year and 5 years (8.75 ± 1.02 and 8.95 ± 0.91 respectively). A statistical significant PES/WES score improvement was observed between baseline and 5 years (9.48 ± 2.68; P < 0.001), but not between 1 and 5 years.

Conclusions: Successful aesthetic and soft tissue dehiscence coverage outcomes were well maintained at 5 years. The strict regimen of post-surgical control visits and the emphasis placed on the control of the toothbrushing technique could be critical for the successful long-term maintenance of soft tissue dehiscence coverage results.