European Journal of Oral Implantology最新文献

Purpose: To evaluate a possible association between the inter-implant distance and the papilla deficit. Additionally, the effect of high or low contact points of the crowns on the papilla deficit was investigated.

Materials and methods: Periapical radiographs taken 1 year after loading were used to assess the distance from the shoulder of the implant to the adjacent tooth or implant. On the clinical images, the interdental papilla height, soft tissue deficit and crown length were evaluated. The papilla crown proportion and the proportion of the height of the contact point to the crown length were assessed.

Results: Eighty-one patients, with a total of 104 zirconia implants and 208 measurements were involved in this cross-sectional survey. Considering patient means, the correlation between the papilla deficit and the interproximal distance, respectively inter-implant distance, was very low (r = -0.05220; P = 0.6435, N = 81). Logistic regression at implant-level showed that there was no significant difference in the likelihood for a papilla deficit between a high and a low contact point of the crowns with P = 0.8191 (Odds ratio: 1.106 with 95%CI 0.461; 2.654).

Conclusions: Horizontal interproximal dimensions around zirconia implants showed very weak influence on the papilla height. A high or a low contact point position of the crowns did not affect the papilla deficit. Conflict of Interest and sources of funding: All authors reported no conflict of interest. There were no sources of funding for the research.

Background and aim: Compromised fit between the contact surfaces of screw-retained implant-supported fixed dentures (IFDs) is thought to create uncontrolled strains in the prosthetic components and peri-implant tissues, thus evoking biological and technical complications such as bone loss, screw loosening, component fractures and, at worst, loss of implants or prostheses. The aim of this systematic review was to evaluate the impact of marginal misfit on the clinical outcomes of IFDs, and to elucidate definition and assessment methods for passive fit.

Materials and methods: A systematic review of the literature was conducted with a PICO question: "For partially or complete edentulous subjects with screw-retained IFDs, does the marginal misfit at the implant-prosthesis interfaces have an impact on the clinical outcomes?". A literature search was performed electronically in PubMed (MEDLINE) with the help of Boolean operators to combine key words, and by hand search in relevant journals. English written in vivo studies published before August 31, 2016 that reported on both clinical outcome and related implant prosthesis misfit (gap, strains, torque) were selected using predetermined inclusion criteria.

Results: The initial search yielded 2626 records. After screening and a subsequent filtering process, five human and five animal studies were included in the descriptive analysis. The selected studies used different methods to assess misfit (linear distortion, vertical gap, strains, screw torque). While two human studies evaluated the biological response and technical complications prospectively over 6 and 12 months, the animal studies had an observation period < 12 weeks. Four human studies analysed retrospectively the 3 to 32 years' outcomes. Screw-related complications were observed, but biological sequelae could not be confirmed. Although the animal studies had different designs, bone adaptation and implant displacement was found in histological analyses. Due to the small number of studies and the heterogenic designs and misfit assessment methods, no meta-analysis of the data could be performed.

Conclusions: The current literature provides insufficient evidence as to the effect of misfit at the prosthesis-implant interface on clinical outcomes of screw-retained implant-supported fixed dentures. Marginal gaps and static strains due to screw tightening were not found to have negative effects on initial osseointegration or peri-implant bone stability over time. Based on two clinical studies, the risk for technical screw-related complications was slightly higher. While the degree of tolerable misfit remains a matter of debate, the present data do not imply that clinicians neglect good fit, but aim to achieve the least misfit possible. Conflict of interest statement: The authors declare no conflict of interest. The review was conducted as part of the 2016 Foundation

Purpose: To evaluate whether it is more effective to complete endodontic treatment in a single visit or in two visits with 1-week intracanal calcium hydroxide medication in symptomatic teeth and teeth with periapical lesions.

Materials and methods: One hundred and ninety-nine patients, with one symptomatic tooth or a tooth with a periapical lesion, were randomised, according to a parallel group design, to receive a complete endodontic treatment in a single visit (99 patients) or in two visits with 1-week intracanal calcium hydroxide medication (100 patients), at two centres. Patients were followed for up to 1 year post-treatment and the outcome measures were tooth loss, radiographic healing, any complication, post-treatment pain and amount of painkillers used.

Results: Seven patients dropped out from the single-visit and ten patients from the two-visit group (all patients from one centre only). One patient lost his tooth from the single-visit and two patients from the two-visit group (difference in proportion = -0.01; 95% CI: -0.05 to 0.03; P = 0.619). Five single-visit patients and nine two-visit patients experienced one complication each (difference in proportion = -0.05; 95% CI: -0.12 to 0.03; P = 0.278). There were no statistically significant differences in tooth loss and complications. One year after treatment, complete radiographic healing was observed in 22 patients of the single-visit group and in 19 patients of the two-visit group; improvement in 43 patients of the single-visit group and in 54 patients of the two-visit group; and no changes/worsening in 24 patients of the single-visit group and in 15 patients of the two-visit group. There were no statistically significant differences in radiographic healing between the two groups (P = 0.509). Pre-treatment pain was reported by 68 single-visit patients and by 68 two-visit patients; 1-week post-treatment pain was reported by 27 single-visit patients and by 46 two-visit patients, and 2-week post-treatment pain was reported by 2 single-visit patients and 11 two-visit patients. For the first week, an average of 0.53 ± 1.23 tablets was taken by single-visit patients and 1.44 ± 3.32 tablets by two-visit patients. For the second week, no single-visit patients needed tablets and in the two-visit group the average was 0.37 ± 1.72 tablets. Patients of the two-visits group had statistically significant more post-treatment pain at 1 (P = 0.002) and 2 weeks (P = 0.011), and took more ibuprofen tablets at 1 (difference = -0.92; 95% CI: -1.62 to -0.21; P = 0.011) and 2 weeks after treatment (difference = -0.37; 95% CI: -0.72 to -0.03; P = 0.033), than in patients treated in a single visit.

Conclusions: One year after treatment, both groups achieved similar clinical results; however, patients endodontically treated in a single visit suffered less postoperative pain and took less analgesics than patients treated in t

Purpose: To compare outcomes for immediately loaded one-piece implants (OPI), placed flapless, and conventionally loaded two-piece implants (TPI), placed after two-stage flapped surgery.

Materials and methods: Thirty-eight participants were randomised to receive either one OPI (19 participants, OPI group) or one TPI (19 participants, TPI group) inserted in the posterior mandible with a torque of at least 35 Ncm according to a parallel group design. OPI were immediately loaded with non-occluding temporary crowns. After 3 months, TPI were exposed and implants in both groups were occlusally loaded with zirconia crowns. Outcome measures were implant failure, prosthesis failure, any complication and changes of probing pocket depth (PPD), plaque index (PI), gingiva index (GI), and peri-implant marginal bone level, recorded by unblinded assessors.

Results: Three years after occlusal loading, three participants dropped out from the TPI group. There were no statistically significant differences between the groups with regard to participants with implant failure (OPI group 1/19; TPI group 0/16; difference in proportions (DIP), -5.3%; 95% confidence interval (CI) -15.3 to 4.8; P = 1.000), prosthesis failure (OPI group 3/19, TPI group 5/16; DIP, 15.5%; 95% CI -12.6 to 43.5; P = 0.424), any complication (OPI group 6/19, TPI group 5/16; DIP, -0.3%; 95% CI -31.2 to 30.5; P = 1.000), or changes of PPD (P =0.174), PI (P = 0.222), or GI (P = 0.415). Veneer chipping accounted for most prosthesis failures and complications. On average OPI and TPI lost 1.34 mm and 0.67 mm of marginal bone, respectively, the difference between groups being statistically significant (mean difference, 0.66 mm; 95% CI -0.02 to 1.34; P = 0.024) in favour of TPI implants.

Conclusions: Both implant procedures might be viable in the short term, but statistically significantly more bone loss might be indicative of future problems with OPI. Because of the high incidence of chipping, veneered zirconia crowns cannot be recommended on posterior implants. Conflict-of-interest statement: The authors are grateful to Nobel Biocare for providing the study materials free of charge. Money received from the manufacturer was used to reimburse participants for regular attendance at follow-up appointments and to finance data management. The authors declare no conflict of interest.

Purpose: To evaluate the clinical and radiographic outcomes of a one-stage crestal sinus elevation procedure using a self-tapping endosseous implant system (iRaise, Maxillent, Herzliya, Israel) developed for sinus augmentation, 1 year after loading.

Materials and methods: Patients needing restoration in the posterior maxilla with a residual alveolar crest of 3 to 8 mm in height and 5 mm in width distal to the canine as measured on CBCT scan were treated using the iRaise sinus lift system. Outcome measures were: implant and prosthetic failures, any complications, increased bone height (iBH), marginal bone loss (MBL), implant stability quotient (ISQ), radiographic tissue remodelling patterns using the sinus grafting remodelling index (SGRI), volumetric measurements of sinus graft, patient self-reported post-surgical swelling, consumption of pain medication and histological analysis.

Results: A total of 30 consecutive participants with a mean age of 54.2 ± 9.4 years underwent a transcrestal elevation of the sinus membrane, insertion of bone graft, and implant placement. A total of 50 implants were placed (30 iRaise system implants and 20 adjunctive iSure implants, Maxillent). The mean follow-up was 15.8 ± 2.1 months after implant loading. One patient dropped out at the 1-year after loading follow-up examination. No implants and no prostheses failed during the entire follow-up. One patient experienced a small membrane tear. Before implant insertion, the mean residual alveolar ridge height was 4.64 ± 0.86 mm (range: 3.4-6.4 mm; 95% CI: 4.39-5.01 mm). One year after loading, the bone height was 16.86 ± 3.13 mm (95% CI 15.83-18.07 mm). At the 1-year after loading follow-up, the mean MBL was 0.19 ± 1.05 mm (95% CI 0.02-0.78 mm). The mean ISQ at implant placement was 65.2 ± 5.4 (95% CI 63.6-67.4) and increased during the healing period reaching the mean value of 73.6 ± 3.7 (95% CI 73.1-75.9; range 62-79). The difference was statistically significant (8.4 ± 5.3; 95% CI 5.9-39.7; P = 0.0000). One year after loading, SGRI score was evaluated in 23 implants. Overall, the mean SGRI value was 2.29 ± 2.41 mm (95% CI 1.22-2.98 mm). Bone volume at implant placement was 2.41 ± 0.25 CC (95% CI 2.22-2.48 CC). During the 6-month, submerged healing period, a slight bone contraction of 11.3% were observed. (2.13 ± 0.24 CC;95% CI 2.02-2.26; difference = 0.27 ± 0.25 CC; 95% CI 0.10-0.36; P = 0.0011). At the first year post-loading period, the bone graft remained stable (2.11 ± 0.22 CC; 95% CI 2.02-2.24). The difference was not statistically significant (0.02 ± 0.07 CC; 95% CI 0.01-0.04; P = 0.2166). From the patient's point of view, the mean pain value was 0.52 ± 0.74 (range 0-3); mean swelling value was 0.27 ± 0.52 (range 0-2); and the mean consumption of analgesic was 0.87 ± 4.94 tablets (range 0-4) 3 days after surgery. Morphological and histomorphometric analyses showed that all the samples had a normal

Aim: The purpose of this systematic review was to assess the clinical performance of implant-supported monolithic all-ceramic single- and multi-unit restorations.

Materials and methods: The electronic databases of MEDLINE via PubMed, the Cochrane Library (CENTRAL) and EMBASE were searched for clinical studies on monolithic all-ceramic single and multi-unit implant-supported fixed dental prostheses. Human studies with a mean follow-up of at least 2 years and published in English or German language peer-reviewed journals up until August 2016 were included. Two independent examiners conducted the literature search and review process.

Results: The search resulted in 2510 titles and of these, 57 studies were selected for full-text evaluation. Three studies were included on the basis of the pre-determined criteria. Two articles reported on monolithic lithium disilicate implant-supported single crowns (SC) and revealed a survival rate of 97,8 and 100% after 3 years. One study investigated implant- supported monolithic zirconia SCs and fixed partial dentures (FPD) and showed a survival rate of 100% after 5 years. No studies could be identified on the clinical performance of monolithic resin matrix ceramic restorations. Clinical studies are lacking on the long-term outcome of implant-supported monolithic all-ceramic single- and multi-unit restorations.

Conclusions: Preliminary clinical data indicate high short-term survival for implant-supported monolithic lithium disilicate and zirconia single- and multi-unit restorations. Randomised clinical studies and observations with a longer duration are necessary to validate the broad application of this therapy. Conflict-of-interest statement: The authors declare no conflict of interest.

Purpose: To compare the outcome of site preparation for zygomatic oncology implants using conventional preparation with rotary drills or piezoelectric surgery with dedicated inserts for placing two zygomatic implants per zygoma according to a split-mouth design.

Materials and methods: Twenty edentulous patients with severely atrophic maxillas not having sufficient bone volume for placing dental implants and less than 4 mm of bone height subantrally had their hemi-maxillas randomised according to a split-mouth design into implant site preparation with conventional rotational drills or piezoelectric surgery. Two zygomatic oncology implants (unthreaded coronal portion) were placed in each hemi-maxilla. Implants that achieved an insertion torque superior to 40 Ncm were immediately loaded with screw-retained metal reinforced acrylic provisional prostheses. Outcome measures were: prosthesis and implant failures, any complications, time to place the implants, presence of post-operative haematoma, and patient's preference by independent assessors. All patients were followed up to 1 year after loading.

Results: In two patients drills had also to be used at the piezoelectric surgery side to enable implant sites to be prepared. One implant for the conventional drill group did not achieve an insertion torque superior to 40 Ncm since it fractured the zygoma. No patients dropped out and two distal oncology implants failed in the same patient (one per group), who was not prosthetically rehabilitated. Six complications occurred at drilled sites and three at piezoelectric surgery sites (two patients had bilateral complications), the difference being not statistically significant (P (McNemar's test) = 0.375; odds ratio = 4.00; 95% CI of odds ratio: 0.45 to 35.79). Implant placement with convention drills took on average 14.35 ± 1.76 min and with piezoelectric surgery 23.50 ± 2.26 min, implant placement time being significantly shorter with conventional drilling (difference = 9.15 ± 1.69 min; 95%CI: 8.36 to 9.94 min; P < 0.001). Post-operative haematomas were more frequent at drilled sites (P = 0.001), and 16 patients found both techniques equally acceptable, while four preferred piezoelectric surgery (P = 0.125).

Conclusions: Both drilling techniques achieved similar clinical results, but conventional drilling required 9 min less and could be used in all instances, although it was more aggressive. These results may be system-dependent, therefore they cannot be generalised to other zygomatic systems with confidence. Conflict-of-interest statement: This study was partially supported by Southern Implants (Irene, South Africa), the manufacturer of the zygomatic implants and the conventional drills evaluated in this study. However, data property belonged to the authors and by no means did the manufacturer interfere with the conduct of the trial or the publication of its results. Dr

Purpose: To evaluate the efficacy of short (5 or 6 mm long) dental implants vs 10 mm or longer implants placed in crestally lifted sinuses.

Materials and methods: Twenty partially edentulous patients with 5 to 7 mm of residual crestal height and at least 7 mm thickness below the maxillary sinuses as measured on computed tomography scans were randomised according to a parallel group design to receive either one to two 5 or 6 mm long implants (10 patients) or 10 mm long implants (10 patients) after crestal sinus lifting and grafting with anorganic bovine bone. Implants were left to heal submerged for 4 months and were loaded with reinforced acrylic provisional prostheses, replaced, after 4 months, by definitive provisionally cemented or screw-retained metal-ceramic or metal-composite prostheses. Outcome measures were: prosthesis and implant failures, any complications, radiographic peri-implant marginal bone level changes, and patient's satisfaction assessed by blinded assessors, when possible. All patients were followed up to 3 years after loading.

Results: Two patients from the augmented group dropped out after the 1-year follow-up. No implant or prosthesis failure occurred. One short implant patient was affected by two complications vs one complication in the long implant group. There was no difference for patients experiencing complications between the two groups (difference in proportions = -0.03 %; 95%CI: -0.32 to 0.27; P = 1.000). Short implants lost 0.89 ± 0.25 mm and long implants lost 1.08 ± 0.29 mm of peri-implant marginal bone 3 years after loading, the difference between the two groups being not statistically significant (difference = -0.19 mm; 95%CI: -0.46 to 0.09; P = 0.165). All patients were fully or partially satisfied with function and fully satisfied with aesthetics.

Conclusions: Both techniques achieved excellent results and no differences were observed between prostheses supported by one to two 5 or 6 mm long implants vs 10 mm long in posterior atrophic maxillae up to 3 years after loading; therefore it is up to clinicians to decide which procedure to use, although longer follow-ups with larger patient populations are needed to better understand if one of these procedures could be more effective in the long-term. Conflict of interest statement: this study was partially supported by Zimmer Biomet. However, data property belonged to the authors, and by no means did the manufacturer interfere with the conduct of the trial or the publication of its results.

Purpose: To evaluate the safety and clinical efficacy of a novel surface treatment (SurfLink, Nano Bridging Molecules, Gland, Switzerland) on titanium dental implants. SurfLink consists of a monolayer of permanently bound multiphosphonic acid molecules, which mimics the surface of naturally occurring hydroxyapatite.

Materials and methods: Twenty-three patients requiring at least two single dental implants had their sites randomised according to a split-mouth design to receive one titanium grade 4 implant treated with SurfLink and one untreated control implant. Additional SurfLink-treated implants were placed if needed. Implants were submerged for 3 months in mandibles and 6 months in maxillae, then loaded with definitive metal-ceramic crowns and followed for 3 years after loading. Outcome measures were crown/implant failures, any complication, radiographic peri-implant marginal bone level changes and marginal bleeding.

Results: Three patients dropped out but all remaining patients were followed up to 3-years post-loading. No implant failed. Complications were reported for three patients, affecting both types of implant in two patients and only SurfLink implant in one patient. No differences for complications between the two implant types was observed (McNemar test, P = 1, difference in proportions = -0.04, 95% CI: -0.22 to 0.14). No bleeding was observed when a periodontal probe was run in the peri-implant soft tissues around any of the implants, with the exception of three implants affected by peri-implantitis. There were no statistically significant differences in marginal bone level changes between the two groups (at 3 years post-loading P = 0.86, mean difference = -0.05; SD = 1.15; 95% CI: -0.56 to 0.47).

Conclusions: Medium-term data (3-years post-loading) of implants with a biomimetic monolayer of permanently bound multiphosphonic acid molecules (SurfLink surface treatment) presented no safety issues. Clinical healing in both control and SurfLink-treated implant groups was uneventful and did not differ significantly. More challenging clinical situations need to be investigated to evaluate the real effectiveness of this surface treatment. Conflict-of-interest statement: Marco Esposito and Ivan Dojcinovic declare that they have no conflict of interest, and they acted as consultants for Nano Bridging Molecules (NBM). Sabrina Buchini, Péter Péchy and Björn-Owe Aronsson are employed at NBM. NBM, the manufacturer of the SurfLink surface treatment, supported and carefully monitored this trial without interfering with the presentation of its results.