An evaluation of the Periotest system. Part I: Examiner reliability and repeatability of readings. Dental Implant Clinical Group (Planning Committee).

The clinical success of endosseous dental implants is related to the extent of osseointegration. Many of the presently used methods of evaluating osseointegration are highly subjective. The Periotest is claimed to offer a more objective means to assess osseointegration and supporting bone stability of implants by means of microcomputer-controlled percussion. Investigators involved in a clinical study on dental implants being conducted by the Dental Implant Clinical Research Group participated in a two-part in vitro evaluation of the Periotest system. The first part, with which this article is concerned, involved each of 35 investigators taking three readings for each of 16 models designed to simulate an implant in place in the oral cavity and to cover most of the effective measuring range of the instrument. The Periotest system generally demonstrated a high degree of reliability and repeatability, with higher variability associated with specific model samples. Further evaluation of the Periotest as a research instrument will be conducted within the clinical environment of the Dental Implant Clinical Research Group study.     

Comparison of implant survival following sinus floor augmentation procedures with implants placed in pristine posterior maxillary bone: a systematic review

Sinus augmentation is a commonly used procedure in implant dentistry. However, a general consensus on implant survival after this procedure is still lacking. The objective of this study was to systematically review implant survival following sinus augmentation procedures compared with conventional implant placement in the posterior maxilla. Following the production of a detailed protocol, screening and quality assessments of clinical trials were conducted in duplicate and independently. The search yielded 579 abstracts and 93 were selected for full-text screening. Six publications (five studies) fulfilled all the inclusion criteria and were relevant to the study. Heterogeneity of the selected papers prevented meta-analysis. Implant survival ranged from 73% to 100% for non-augmented sinuses and from 36% to 100% for augmented sinuses in patient-based data. From implant-based data, survival varied between 75% and 100% for both non-augmented and augmented areas. Implant survival appears to show greater variability in grafted sinuses than in the posterior maxilla. However, prospective studies with larger patient numbers and control of confounding factors are urgently needed to provide definitive data on this important procedure.     

Generic terminology for endosseous implant prosthodontics.

Implant dentistry has become an integral treatment modality in the restoration of the complete and partially edentulous patient. Most practitioners have been educated by manufacturer-sponsored courses oriented to the use of a specific implant system. The ever-increasing number of implant systems has made the names of many implant components product-unique and confusing. Fortunately, a prosthetic continuity exists between most implant systems. A generic terminology for endosseous root-form prosthodontics is presented that allows effective communication between members of the profession.     

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提要：种植义齿修复牙齿缺失、牙列缺损越来越受到广大临床医生和缺失牙患者的青睐，由于种植义齿美观、舒适、最大限度地恢复咀嚼功能，又不损伤健康邻牙的优点，已成为缺牙患者的最佳选择。目前开展种植义齿修复的医疗机构和个体诊所迅猛增加。然而，有些医疗单位缺乏开展种植的必要条件和设备，医生又没有接受过正规的培训，对种植义齿修复的适应证选择、种植体植入过程中操作原则以及上部结构修复时的操作要点等方面的知识掌握不足，在临床上经常会出现一些问题。本文通过查阅了大量的国内、外相关文献，并结合自己多年的临床工作经验，对种植义齿修复过程中各个阶段常见问题的原因进行分析，并提出自己的解决方案，为临床医生提供参考。     

Evaluation of aesthetics of implant-supported single-tooth replacements using different bone augmentation procedures: a prospective randomized clinical study

OBJECTIVES: The aim of this study was to evaluate the aesthetics of implant-supported single-tooth replacements using different augmentation procedures in a prospective study with the use of an objective rating index and with a subjective patient questionnaire, and to compare the results with each other. MATERIAL AND METHODS: Ninety-three patients with a single-tooth gap in the anterior zone of the maxilla were selected for the study. All patients had a local bone defect that needed augmentation before placement of an endosseous implant with sufficient initial stability. Aesthetics of the implant-supported crown and adjacent mucosa was rated by a prosthodontist 1 year after placement of the porcelain crown. Aesthetics was rated using the Implant Crown Aesthetic Index. A subjective appreciation of the final result was assessed with a patient questionnaire. RESULTS: The Implant Crown Aesthetic Index reveals a mean overall score of 4.8, with an acceptable result in 66% of the cases. Results of the satisfaction questionnaire reveal a mean overall score of 8.5 with an acceptable result in 100% of the cases. There is no correlation between results of the Index and the questionnaire for the overall and the crown score. The patients' opinion and the professionals' opinion about the peri-implant mucosa do show a significant correlation. CONCLUSIONS: The peri-implant mucosa is rated as less satisfactory than the implant-supported crown by both the dental professional and patients. The dental professional was less satisfied with respect to the total result and results of the crown than the patients.     

Cement Selection for Implant‐Supported Crowns Fabricated with Different Luting Space Settings

Purpose : To measure and compare the retentive strength of cements specifically formulated for luting restorations onto implant abutments and to investigate the effect of varying cement gap on retention strength of implant‐supported crowns. Materials and Methods : Standard titanium abutments were scanned by means of a 3D digital laser scanner. One hundred and sixty standard metal copings were designed by a Computer Aided Design/Computer Aided Manufacturing (CAD/CAM) system with two cement gap values (20 and 40 μm). The copings were cemented to the abutments using the following eight cements with one being the control, zinc oxide temporary cement, while the other seven were specifically formulated implant cements (n = 10): Premier Implant Cement, ImProv, Multilink Implant, EsTemp Implant, Cem‐Implant, ImplaTemp, MIS Crown Set, and TempBond NE. The specimens were placed in 100% humidity for 24 hours, and subjected to a pull‐out test using a universal testing machine at a 0.5 mm/min crosshead speed. The test results were analyzed with two‐way ANOVA, one‐way ANOVA, post hoc Tamhane’ s T2, and student's t‐tests at a significance level of 0.05. Results : Statistical analysis revealed significant differences in retention strength across the cement groups (p < 0.01). Resin‐based cements showed significantly higher decementation loads than a noneugenol zinc oxide provisional cement (TempBond NE) (p < 0.01), with the highest tensile resistance seen with Multilink Implant, followed by Cem‐Implant, MIS Crown Set, ImProv, Premier Implant Cement, EsTemp Implant, and ImplaTemp. Increasing the cement gap from 20 to 40 μm improved retention significantly for the higher strength cements: Multilink Implant, Premier Implant Cement, ImProv, Cem‐Implant, and MIS Crown Set (p < 0.01), while it had no significant effect on retention for the lower strength cements: EsTemp Implant, ImplaTemp, and TempBond NE (p > 0.05). Conclusions : Resin cements specifically formulated for implant‐supported restorations demonstrated significant differences in retention strength. The ranking of cements presented in the study is meant to be an arbitrary guide for the clinician in deciding the appropriate cement selection for CAD/CAM‐fabricated metal copings onto implant abutments with different luting space settings.     

Screening and medical evaluation of adults: contraindications for invasive dental procedures

Implant and preprosthetic surgeries aim to restore normal anatomical contours, function, comfort, esthetics, and oral health. Systemic screening of a patient prior to implant and/or biomaterial insertion is critical to patient well being and success of the surgical procedure(s). It is no longer appropriate to limit the general contraindications to the malfunction of major organs and systems and not consider the devastating long-term effects of an unhealthy lifestyle (smoking, inadequate diet, etc.). Modern standards of care should not systematically exclude patients with relative or marginal health conditions without exploring the possibilities of improving and stabilizing those conditions. Based on the classification of the American Society of Anesthesiology, a number of absolute and relative contraindications are presented. Treatments are proposed for optimizing some marginal health conditions and stabilizing unbalanced physiological function prior to surgery. A knowledge of the fundamentals of internal medicine is an important prerequisite for predictable implant and preprosthetic surgery. This paper reflects the opinion of a physician and dentist who has been actively involved in implant and preprosthetic surgery for the past quarter of a century in both private and university hospital practice.     

Miniscrew implants: IMTEC Mini Ortho Implants

Mini-implant TADs, and specifically the Ortho Implant system, are an excellent adjunct to provide stable, bone-based anchorage for the application of orthodontic biomechanical force systems. The Ortho Implant is valuable in treating a wide variety of malocclusions due in large part to the small dimensions that permit placement in most intraoral locations. The surgical placement of the Ortho Implant is a simple procedure that can be performed by the orthodontist, or referred to an oral surgeon, periodontist, or general dentist. Many different orthodontic mechanics can incorporate the stable Ortho Implant as anchorage in treating a given malocclusion. The Ortho Implant is easily removed under most circumstances without anesthesia or complications. Most complications are related to the health of the soft tissues surrounding the implant.     

Dental implant procedures in immunosuppressed organ transplant patients: a systematic review

During the last decades, the number of immunosuppressed organ transplant patients has increased consistently. Nevertheless, immunosuppression has been discussed as a contraindication for dental implant procedures for many years. Hence, the purpose of this systematic review was to assess the survival rate and outcomes of dental implants after solid organ transplantation. An electronic and manual literature search was conducted up to March 2021. Publications describing dental implants placed in patients after organ transplantation were included without any limitations regarding study design or date of publication. Ten articles met the inclusion criteria, leading to a sample of 93 patients with 249 implants. Implant survival rates were 100% over a mean follow-up of 60 months. In every case, implant surgery was performed under antibiotic coverage. No major medication-related complications were reported. Despite the limited amount of evidence in the literature, implant procedures seem to be a safe treatment option in immunosuppressed organ transplant patients. The observance of appropriate treatment protocols including a strict maintenance programme seems to be crucial for the long-term success of such treatments. However, stringent data regarding various influencing factors such as the prevalence of peri-implantitis are still missing.     

An evaluation of the Periotest system. Part II: Reliability and repeatability of instruments. Dental Implant Clinical Research Group (Planning Committee).

Investigators involved in a clinical study on dental implants being conducted by the Dental Implant Clinical Research Group participated in a two-part in vitro evaluation of the Periotest system. The first part involved each of 35 investigators taking three readings for each of 16 models designed to simulate an implant in place in the oral cavity and to cover most of the effective measuring range of the instrument. The second part, with which this article is concerned, was conducted by three study investigators to determine the level of agreement in readings for six different Periotest instruments. Readings were taken according to the manufacturer's instructions until two coincident readings were obtained. The readings were compared to evaluate inter- and intrainstrument reliability. Instrument repeatability was evaluated by examining the number of attempts required to obtain the two coincident readings. The Periotest system generally demonstrated a high degree of repeatability and reliability, with higher variability associated with specific model samples.     

Comparison of "Look-Alike" Implant Prosthetic Retaining Screws

Purpose The maximum preload torque of implant prosthetic retaining screws from four manufacturers and of two alloy types was measured to determine one index of interchangeability of intersystem components. Materials and Methods Implant prosthetic retaining screws from four manufacturers (3i Implant Innovations Inc, West Palm Beach, FL; Impla-Med Inc, Sunrise, FL; Nobelpharma USA Inc, Chicago, IL; and Implant Support Systems Inc, Irvine, CA) and of two metal types (gold and titanium) were investigated using an in vitro simulation model. Five screws of each type were tightened down against a gold cylinder using a Tohnichi BTG-6 torque gauge (Tohnichi American Corporation, Northbrook, IL) until fracture occurred. Results The 3i Implant Innovations gold and the Nobelpharma gold were not significantly different. The 3i Implant Innovations titanium and the Impla-Med gold were able to withstand less preload torque than the 3i Implant Innovations gold and the Nobelpharma gold. The Implant Support Systems titanium was able to withstand significantly more preload torque than all of the other screws. Conclusions Interchanging implant prosthetic retaining screws could introduce new and unknown variables that may affect the long-term survival of implant fixtures and/or the implant prostheses.     

第三届北京口腔种植长城论坛暨口腔种植联盟工作会议纪要

第三届北京口腔种植长城论坛暨口腔种植联盟联席工作会于2020年11月在北京召开,来自长城沿线15个省市的口腔种植领域的专家和代表120多人参加了会议。会议就当前中国口腔种植发展的热点问题进行了探讨交流,对今后发展方向形成了共识。论坛将以长城为基线,传播先进的口腔种植理念和技术,带动口腔种植行业发展。围绕"前牙骨增量后的种植修复远期效果"大会主题进行的学术研讨,收到很好的效果。会议论证了刘洪臣教授主持的《口腔种植牙的保健与维护指南》并广泛征求了意见。北京口腔医学会第四届口腔种植专业委员会第四次常务委员会也同期召开,对2020年口腔种植专委会的工作进行总结,通报了新增青年委员,通过了专委会工作制度并讨论了2021年专委会的工作规划和换届工作。     

The effect of all-ceramic and porcelain-fused-to-metal restorations on marginal peri-implant soft tissue color: a randomized controlled clinical trial

The aim of this study was to test the color-change effect of all-ceramic restorations compared with porcelain-fused-to-metal (PFM) restorations on marginal peri-implant soft tissue. Thirty patients were randomly divided into 2 groups of 15 subjects each. The all-ceramic group received all-ceramic crowns on aluminum oxide-based abutments, while the PFM group received crowns on titanium or gold abutments. A reflectance spectrophotometer was used to measure the color difference (deltaE(Implant)) between the midfacial peri-implant mucosa before and after restoration insertion. The color difference (deltaE(Tooth-implant)) between the midfacial peri-implant mucosa and the gingival margin of the corresponding neighboring tooth was tested. The mucosal thickness was measured midfacially around the implant (MT(Implant)) and neighboring tooth (MT(Tooth)). deltaE(Implant) values were similar for the all-ceramic (7.4 +/- 2.7) and PFM groups (7.6 +/- 2.8). The all-ceramic group induced significantly less visible mucosal color change (3.4 +/- 1.4) compared to the PFM group (5.2 +/- 2.3). The MT(Implant) value of the all-ceramic group was 3.4 +/- 0.8 mm, while that of the PFM group was 2.9 +/- 0.9 mm, which was not significantly different. Significant differences were found when comparing MT(Implant) (3.1 +/- 0.9) and MT(Tooth) (1.2 +/- 0.3) values for test and control groups. All-ceramic restorations revealed a better color match to the neighboring teeth than PFM restorations.     

Surgical treatment of peri‐implantitis – Consensus report of working group 4

The following consensus report is based on four background reviews (Keeve et al., Implant Dent 2019 28(2): 177–186; Ramanauskaite et al., Implant Dent 2019 28(2): 187–209; Koo et al., Implant Dent 2019 28(2): 173–176; Sculean et al., Implant Dent 2019 210–216). The surgical treatment of peri‐implantitis is indicated in the cases where the first choice of treatment, the non‐surgical one, failed with recurrence of bleeding and suppuration. The aim of this review was to systematically screen the literature for possible surface decontamination techniques and material during surgical treatment, the surgical regenerative and non‐regenerative treatments of peri‐implantitis, radiological and clinical outcomes, the importance of the presence of fixed and or keratinised peri‐implant gingiva, and to determine predictable therapeutic options for the clinical surgical management of peri‐implantitis lesions. Existent clinical, radiographic and microbiological data do not favour any decontamination approaches and fail to show the influence of a particular decontamination protocol on surgical therapy. Using implantoplasty in surgical non‐regenerative treatment leads to a significant decrease in bleeding on probing and probing depth, and may result in improvement of clinical and radiographic parameters, up to 3 years after surgery compared with mechanical debridement alone. Surgical augmentative peri‐implantitis therapy resulted in improved clinical and radiographic treatment outcomes compared with the baseline in the majority of studies with 6 months to 7–10 years of follow‐up. There is no evidence to support the superiority of a specific material, product or membrane in terms of long‐term clinical benefits. The best treatment modality to improve the width of keratinised attached mucosa and bleeding and plaque scores, and to sustain the peri‐implant marginal bone level, is the use of an apically positioned flap combined with a free gingival graft.     

Cost-effectiveness modeling of dental implant vs. bridge

Aims: We assess the cost-effectiveness of dental implant first-line strategy vs. fixed partial denture strategy in patients suffering from one single missing tooth.
Materials and methods: The model used a simulation decision framework over a 20-year period. Potential treatment switches can occur every 5 years. Transition probabilities come from literature, epidemiological reports or expert opinions. They have been programmed using specific distribution ranges to simulate the patients' and practice variability, and to take into account parameter uncertainty. Direct medical costs have been assessed according to a cost survey. Probabilistic sensitivity analyses were conducted using 5000 Monte-Carlo simulations, generating confidence intervals of model outcomes.
Results: We found that mean cost-effectiveness of the bridge strategy is higher than the implant strategy.
Conclusion: Implant as the first-line strategy appears to be the 'dominant' strategy, considering the lower overall costs and the higher success rate.     

Experience with the Astra dental implant system.

The Astra Dental Implant System appears to be a relatively successful and economical method of osseointegration. This article lists its clinical components, explains how the system is fitted and discusses the preliminary results.     

Implant-supported full-mouth reconstruction Malo Implant Bridge

This article describes the clinical techniques and laboratory procedures for fabricating a predictable Malo Implant Bridge involving application of an occlusal screw-retained implant superstructure on the basis of the All-on-4 concept. The Malo Implant Bridge features a removable occlusal screw-retained superstructure; fabrication of the framework with a computer-aided design/computer-aided manufacturing system allowing accurate adaptation; and use of the final tooth position model with guide temporary crowns allowing easy porcelain build-up and satisfying the patient's esthetic concerns.     

Osseointegrated implants in irradiated bone: a case-controlled study using adjunctive hyperbaric oxygen therapy.

PURPOSE: The current investigation was undertaken to study whether osseointegration of implants in irradiated tissues is subject to a higher failure rate than in nonirradiated tissues. It further aimed to study whether hyperbaric oxygen treatment (HBO) can be used to reduce implant failure. PATIENTS AND METHODS: Seventy-eight cancer patients who were rehabilitated using osseointegrated implants between 1981 and 1997 were investigated. Three groups of patients were compared: irradiated (A), nonirradiated (B), and irradiated and HBO-treated (C). In addition, 10 irradiated patients who had lost most of their implants received new ones after HBO treatment. These were compared as a case-control group. RESULTS: Implant failures were highest in group A (53.7%). Implant failure was 13.5% in group B and 8.1% in group C. The difference between group A and the other two groups was statistically significant (P = .001 to .0023, Mantell's test). HBO significantly improved implant survival in the case-control group from 34 of 43 implants lost to 5 of 42 lost (P = .0078). CONCLUSIONS: Implant insertion in irradiated bone is associated with a higher failure rate. Adjuvant HBO treatment can reduce the failures.     

Prosthetic management of edentulous mandible using endosseous implants and overdentures

The choice of a suitable prosthesis for a specific case is determined to a great extent by the underlying residual bone as well as the mucosa. Also of significance are the expectations and demands of the patient from the prosthesis. The following case report discusses the rehabilitation of a complete edentulous mandibular arch with an implant retained mandibular over denture. CLINICAL SIGNIFICANCE: Implant retained fixed or removable prostheses are good treatment options in patients who have a compromised edentulous foundation.     

Surface characterization of three titanium dental implants

PURPOSE: The aim of this study was to evaluate topographically and compositionally the rough surface of 3 different commercial titanium dental implants. MATERIALS: Bio Com Standard, Osseotite Implant, and Fixture MT Osseospeed were analyzed using scanning electron microscopy, atomic force microscopy, and energy dispersive spectroscopy. RESULTS: The scanning electron microscopy and atomic force microscopy analyses showed that the rough surface of Bio Com Standard presents numerous impressions superimposed by sharp pits, of Osseotite Implant many discrete sharp pits, and of Fixture MT Osseospeed a mixed feature appearance. The energy dispersive spectroscopy analysis of the rough implant surfaces revealed a small trace of Si found on the surface of Osseotite Implant. Fixture MT Osseospeed showed a nonhomogeneous distribution of the detected elements. CONCLUSION: The examined implants had a different rough surface topography, which was directly dependent on the type of treatment used. The differences concerning the surface morphology were leading in a characteristic nanotopography, which might influence the biologic activities at the implant-tissue interface. Surface oxygen concentrations also indicated differences in the oxide layer width between the examined implants, being minimal in Osseotite Implant and maximal in Fixture MT Osseospeed.