Interventions for replacing missing teeth: treatment of perimplantitis

Background : One of the key factors for the long‐term success of oral implants is the maintenance of healthy tissues around them. Bacterial plaque accumulation induces inflammatory changes in the soft tissues surrounding oral implants and it may lead to their progressive destruction (perimplantitis) and ultimately to implant failure. Different treatment strategies for perimplantitis have been suggested, however it is unclear which are the most effective. Objectives : To identify the most effective interventions for treating perimplantitis around osseointegrated dental implants. Search strategy : We searched the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Handsearching included several dental journals. We checked the bibliographies of the identified randomized controlled trials (RCTs) and relevant review articles for studies outside the handsearched journals. We wrote to authors of all identified RCTs, to more than 55 oral implant manufacturers and an Internet discussion group to find unpublished or ongoing RCTs. No language restrictions were applied. The last electronic search was conducted on 15 March 2006. Selection criteria : All RCTs of oral implants comparing agents or interventions for treating perimplantitis around dental implants. Data collection and analysis : Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. We contacted the authors for missing information. Results were expressed as random‐effects models using weighted mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals (CI). Heterogeneity was to be investigated including both clinical and methodological factors. Main results : Seven eligible trials were identified, but two were excluded. The following procedures were tested: (1) use of local antibiotics versus ultrasonic debridement; (2) benefits of adjunctive local antibiotics to debridement; (3) different techniques of subgingival debridement; (4) laser versus manual debridement and chlorhexidine irrigation/gel; (5) systemic antibiotics plus resective surgery plus two different local antibiotics with and without implant surface smoothening. Follow up ranged from 3 months to 2 years. No meta‐analysis was conducted due to different interventions tested and outcomes used. No side effects occurred in any of the trials. The only significant statistically differences were observed in a 4‐month follow‐up RCT evaluating the use of adjunctive local antibiotics to manual debridement in patients having lost at least 50% of the supporting bone around the implants. There were improved probing attachment levels (PAL) mean differences of 0.61mm (95% CI 0.40 to 0.82), and reduced probing pockets depths (PPD) mean differences of 0.59mm (95% CI 0.39 to 0.79) in those patients receiving adjunctive local antibiotics. This trial was judged to be at high risk of bias. Authors' conclusions : There is no reliable evidence suggesting which could be the most effective interventions for treating perimplantitis. This is not to say that currently used interventions are not effective. However, the use of local antibiotics in addition to manual subgingival debridement was associated with a 0.6mm additional improvement for PAL and PPD over a 4‐month period in patients associated with severe forms of perimplantitis. In three trials, the control therapy which basically consisted of a simple subgingival mechanical debridement seemed to be sufficient to achieve results similar to the more complex and expensive therapies. Smoothening of rough implant surfaces was not associated with statistically significant improvements of the clinical outcomes. However, sample sizes were small, therefore these conclusions have to be considered with great caution. More well‐designed RCTs are needed. Plain language summary : As with natural teeth, dental implants can be lost due to gum disease (perimplantitis). This review looked at which are the most effective treatments to arrest perimplantitis Five studies were included in the review and evaluated five different treatment modalities. In one small study of short duration (4 months) it was shown that the use of locally applied antibiotics in addition to the deep manual cleaning of the diseased implants decreased the depth of the pockets around the implants of an additional 0.6mm in patients affected by severe forms of perimplantitis. In conclusion, at present, there is no reliable evidence to determine which is the most effective way to treat perimplantitis. This is not to say that currently used interventions are not effective. The majority of trials testing more complex and expensive therapies did not show any statistically or clinically significant advantages over the deep mechanical cleaning around the affected implants.     

Burning mouth in a Finnish adult population

Abstract – Burning mouth syndrome is an oral pain disorder with a prevalence of 5–18% in patient materials. The aim of this study was to determine the prevalence of Burning mouth syndrome in a representative sample of the general adult population. Altogether 431 subjects (237 females, 194 males) participated in the study. Subjects were questioned about the experience of prolonged burning sensation; the site, severity, pattern, duration and possible associations of the onset of the burning sensation, and a thorough clinical examination was performed. In all, 15% of the subjects had experienced prolonged oral burning but a half of them had some clinically observable oral mucosal lesion or oral candidosis. The prevalence of the complaint was significantly higher in females than in males.     

Interventions for replacing missing teeth: bone augmentation techniques for dental implant treatment

Background: Dental implants require sufficient bone to be adequately stabilized. For some patients implant treatment would not be an option without bone augmentation. A variety of materials and surgical techniques are available for bone augmentation. Objectives: General objectives: To test the null hypothesis of no difference in the success, function, morbidity and patient satisfaction between different bone augmentation techniques for dental implant treatment. Specific objectives: (A) to test whether and when augmentation procedures are necessary; (B) to test which is the most effective augmentation technique for specific clinical indications. Trials were divided into three broad categories according to different indications for the bone augmentation techniques: (1) major vertical or horizontal bone augmentation or both; (2) implants placed in extraction sockets; (3) fenestrated implants. Search strategy: The Cochrane Oral Health Group’s Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched. Several dental journals were handsearched. The bibliographies of review articles were checked, and personal references were searched. More than 55 implant manufacturing companies were also contacted. Last electronic search was conducted on 9 January 2008. Selection criteria: Randomized controlled trials (RCTs) of different techniques and materials for augmenting bone for implant treatment reporting the outcome of implant therapy at least to abutment connection. Data collection and analysis: Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted independently and in duplicate. Authors were contacted for any missing information. Results were expressed as random‐effects models using mean differences for continuous outcomes and odd ratios for dichotomous outcomes with 95% confidence intervals. The statistical unit of the analysis was the patient. Main results: Seventeen RCTs out of 40 potentially eligible trials reporting the outcome of 455 patients were suitable for inclusion. Since different techniques were evaluated in different trials, no meta‐analysis could be performed. Ten trials evaluated different techniques for vertical or horizontal bone augmentation or both. Four trials evaluated different techniques of bone grafting for implants placed in extraction sockets and three trials evaluated different techniques to treat bone dehiscence or fenestrations around implants. Authors’ conclusions: Major bone grafting procedures of resorbed mandibles may not be justified. Bone substitutes (Bio‐Oss or Cerasorb) may replace autogenous bone for sinus lift procedures of atrophic maxillary sinuses. Various techniques can augment bone horizontally and vertically, but it is unclear which is the most efficient. It is unclear whether augmentation procedures at immediate single implants placed in fresh extraction sockets are needed, and which is the most effective augmentation procedure, however, sites treated with barrier plus Bio‐Oss showed a higher position of the gingival margin when compared to sites treated with barriers alone. Non‐resorbable barriers at fenestrated implants regenerated more bone than no barriers, however it remains unclear whether such bone is of benefit to the patient. It is unclear which is the most effective technique for augmenting bone around fenestrated implants. Bone morphogenetic proteins may enhance bone formation around implants grafted with Bio‐Oss. Titanium may be preferable to resorbable screws to fixate onlay bone grafts. The use of particulate autogenous bone from intraoral locations, also taken with dedicated aspirators, might be associated with an increased risk of infective complications. These findings are based on few trials including few patients, sometimes having short follow up, and often being judged to be at high risk of bias.     

Patterns of missing teeth in a population of oligodontia patients

PURPOSE: The purpose of this study was to characterize a population of oligodontia patients and identify patterns of tooth agenesis. MATERIALS AND METHODS: A total of 116 patients with nonsyndromic oligodontia were studied, and the Tooth Agenesis Code (TAC) per quadrant was calculated. Oligodontia was defined as the congenital absence of 6 or more permanent teeth, excluding the third molars. The TAC is a unique number, consistent with a specific pattern of tooth agenesis. The authors suggest the use of an overall TAC with which the dentition throughout the mouth can be presented by a single number. Frequency analysis was used to study the prevalence of various patterns. RESULTS: There was a great diversity of TACs. In the maxilla, agenesis of both premolars and the lateral incisor or the presence of only the central incisor and first molar were the most common patterns. In the mandible, agenesis of the second premolar or both premolars occurred most frequently. CONCLUSIONS: No single pattern of agenesis occurred more than twice when the full mouth was viewed. Hence, the presentation of the dentition in oligodontia is very heterogeneous. Evaluation of treatment strategies in oligodontia patients is a methodologic challenge because homogenous, comparable subgroups of patients are not available.     

Intervention for replacing missing teeth: Partially absent dentition-Evidence summary of Cochrane review

Cochrane reviews are systematic reviews with meta analysis published by the Cochrane collaboration, in the Cochrane Database of Systematic Reviews (CDSR). These reviews provide the clinicians with the highest level of evidence as they use a highly structured and transparent systematic review model to address a specific research question.The management of partially absent dentition is routinely under taken by general dentist and Prosthodontist but clinical practice guidelines based on evidence to this common problem is yet to be summarized. This Cochrane systematic review aims to address the effect of different prosthesis for the treatment of partially absent dentition in the terms of, Long-term success, function, morbidity, and patient satisfaction. All randomized controlled trials were searched till March 18, 2011, based on the inclusion and exclusion criteria, 21 trials were included and 32 trials were excluded and, it was critically appraised using the Cochrane methodology for interventions. The summary of evidence from the study concludes that there is insufficient evidence to state the effectiveness of removable and fixed prosthesis in partially edentulous subjects in the following four outcomes. There were insufficient trials to perform a meta-analysis and sensitivity analysis.This evidence-based summary emphasizes and reinforces the need to reassess the quality of research currently pursued in our profession, to address the need to provide higher level of evidence for common conditions like partial edentulousness. The included studies are basically not from our population too, hence the urgency to address this critical issue.     

Esthetic re-creation of soft tissue architecture in replacing missing maxillary anterior teeth

Replacing missing maxillary anterior teeth while providing an adequate esthetic can present a considerable challenge. A substantial effort is directed toward achieving a better tooth-to-soft tissue relationship, regardless of whether the restorative modalities are implants, naturally supported fixed bridges, or removable partial dentures. The interdental papilla is critical to the esthetically pleasant architecture and contributes to successful harmonious restoration, especially in patients with a high smile. There are several techniques for restoring the indental papilla. The best result comes from careful planning and good communication with the patient.     

Treatment planning for replacing missing teeth in UK general dental practice: current trends

Summary The aim of this study was to examine the confidence, barriers and attitudes towards the replacement of missing teeth by general dental practitioners (GDPs). The perceived impact of the recently introduced National Health Service (NHS) contract on the provision of prosthodontic treatments was also considered. Pre‐piloted postal questionnaires were mailed to 500 GDPs in Wales. Open‐ and closed‐ended questions were utilised to establish confidence, adequacy of training and attitudes towards treatments for replacing missing teeth. Two hundred and seventeen completed questionnaires were received (response rate = 43·4%). Many respondents described themselves as ‘confident’ or ‘very confident’ in the provision of removable partial dentures (RPDs) (acrylic = 100%, metal based = 99·5%), cantilever resin‐bonded bridges (94·4%) and conventional bridgework (98·6%). GDPs were ‘not confident’ providing fixed‐fixed resin‐bonded bridges (21·1%) or implants (81·4%). Financial barriers were identified to the provision of prosthodontic treatments, including comments such as “the new [National Health Service] contract does limit the treatments available”. Privately funded patients were more likely to be offered a fixed bridge or implant replacement of a missing upper first molar, whereas non‐privately funded patients were more likely to be offered no treatment (P < 0·01). Most respondents reported confidence at providing more routine forms of prosthodontic care such as RPDs and bridges. It appears that funding arrangements may have an impact on treatments offered to replace missing teeth, particularly under the current NHS contract.     

All-ceramic inlay-retained fixed dental prostheses for replacing posterior missing teeth: A systematic review

Purpose

To evaluate the current status of all-ceramic inlay-retained fixed dental prostheses (CIR-FDPs) for the replacement of posterior teeth.

Congenitally missing teeth in the Israeli cleft population.

OBJECTIVE: The purpose of the study was to determine the prevalence of congenitally missing teeth in a group of Israeli children with various types of clefts. DESIGN: Prevalence of congenitally missing teeth was determined for 179 children with cleft lip, cleft lip and alveolar ridge, cleft lip and palate, and cleft palate. Subgroupings were assessed according to patient sex, origin, cleft type, tooth type, and the side of hypodontia. The diagnosis of congenitally missing teeth (CMT) was based on initial and follow-up panoramic roentgenograms. In case of doubt, occlusal or periapical roentgenograms as well as clinical dental photographs were also used. SETTING: Data collection was conducted at the Rambam Medical Center, Orthodontic and Craniofacial Unit, Haifa, Israel. RESULTS: In the total cleft group, 67.6% of the patients presented with hypodontia, totaling 246 missing teeth. A statistically significant difference was found in the distribution of patients with CMT of Jewish and minority origin according to sex. Cleft lip and palate was the most frequently affected group in which 195 teeth were missing. The most frequently missing tooth among the cleft population was the maxillary incisor. The order of frequency of the other missing teeth was the same as in the normal population. Hypodontia and malformations of permanent teeth were most common on the cleft side. CONCLUSION: The frequency of CMT in the Israeli cleft population studied was higher than in the intact population. This confirms findings in other populations worldwide.     

Prevalence of malocclusion traits and orthodontic treatment in a Finnish adult population

Objective The aim of the study was to examine the prevalence of malocclusion traits and the extent of orthodontic treatment in a Finnish adult population. Materials and methods The study population comprised subjects (n?=?1964) from the Northern Finland Birth Cohort 1966 living in the city of Oulu and within 100?km of it. A clinical oral and dental examination with registration of occlusion was carried out in 2012 in connection with a 46-year follow-up survey. Data on previous orthodontic treatment were collected based on a questionnaire. Results In the clinical examination, 39.5% of the subjects had at least one malocclusion trait. The most common malocclusion traits were lateral crossbite (17.9%), overbite?≥?6?mm (11.7%) and overjet?≥?6?mm (9.7%). Crossbite on the left premolars, negative overjet and increased overbite were found more frequently in men. The prevalence of malocclusion traits was at the same level in treated and untreated groups. Overall, 18.6% of the subjects had undergone orthodontic treatment. Women showed a significantly higher prevalence of orthodontic treatment. Conclusions The most common malocclusion trait in the present study was lateral crossbite. Significant male dominance in the prevalence of malocclusion was observed, which has not been reported earlier in Finland. Orthodontic treatment of malocclusion traits was more common among females in Northern Finland. This study indicates that orthodontic treatment provided in childhood was, on average, adequate in reducing malocclusion traits to the level observed in the general population.     

Bilaterally impacted maxillary canines and multiple missing teeth: a challenging adult case

AUTHORS: Mesotten K, Naert I, van Steenberghe D, Willems G. OBJECTIVES: Orthodontic correction of bilateral maxillary canine impaction with agenesis of the lower second premolars and extraction of the lower first molars in an adult patient. METHODS: After surgical exposure, the canines were relocated in the arch by means of immediate orthodontic traction. Endosseous Branemark system implants were inserted in the lower jaw with a double purpose: stabilization of orthodontic anchorage and prosthetic tooth replacement. RESULTS: Closure of the edentulous space in the lower arch was accomplished by a multidisciplinary approach while orthodontic correction of the initial malocclusion was achieved. CONCLUSION: Implants provided anchorage control for tooth movement and created the possibility of prosthetic rehabilitation through a multidisciplinary treatment approach.     

Dental visits, teeth remaining, and prosthetic appliances in a Norwegian urban population

Abstract Of a random sample (177 persons) of 35-year-old Oslo citizens, 117 subjects (66.1 %) attended a dental examination. Questionnaires were returned by mail from 28 of the non-respondents. The most common reason for not attending was “difficulty in finding time for an appointment.” About 89% of the respondents had visited a dentist regularly. Regular dental care seemed to be more common among people with a high level of education than among those with a low level of education. The most common treatment performed at the last dental visit was filling of cavities. The mean number of remaining teeth was 25.7. Females in the lower educational group had significantly less teeth than those in the higher educational group. No subjects were totally edentulous, but five persons had one edentulous jaw. Nine full or partial dentures were found. Twelve percent of the subjects had one or more fixed bridges, and 29.9% of the persons had one or more crown restorations. There seemed to be no differences between the sexes or educational levels in this respect.     

Intervention for replacing missing teeth: Different types of implants - evidence summary of updated Cochrane review

Around 1300 different types of dental implants are available worldwide and the implant manufacturers are resorting to aggressive marketing strategies; claiming their implants to provide a superior outcome. The clinician is left with a constant dilemma on which implant to choose for better clinical outcome and welfare of the patient. Moreover, in India, economical consideration is a concern too. The dentist has to select an implant that provides a good result and is economical. Cochrane systematic reviews provide the gold standard evidence for intervention, diagnosis, etc., and follow a strict quality control. A Cochrane systematic review was done to shed light on whether the different implant surface modifications, shapes or materials significantly influence clinical outcomes. All randomized controlled trials (RCTs) till January 17, 2014 were searched and out of the 81 trials, only 27 met the inclusion criteria. This evidence summary from the review concludes that based on the available literature; there is no evidence of any one type of implant being superior to another. There is weak evidence showing roughened dental implants are more prone to bone loss due to periimplantitis. This review indicated that there is a need for well-designed RCTs, with long-term follow-up and low bias. Moreover, none of the included studies was from India, which also points out the need for improving the quality of RCTs conducted in India.Key Words: Cochrane database of systematic review, level of evidence, meta-analysis, prosthodontics, randomized controlled trial, systematic review