A systematic review of the survival and complication rates of resin-bonded bridges after an observation period of at least 5 years

OBJECTIVES: The objectives of this systematic review were to assess the 5-year survival of resin-bonded bridges (RBBs) and to describe the incidence of technical and biological complications. METHODS: An electronic Medline search complemented by manual searching was conducted to identify prospective and retrospective cohort studies on RBBs with a mean follow-up time of at least 5 years. Patients had to have been examined clinically at the follow-up visit. Assessment of the identified studies and data extraction were performed independently by two reviewers. Failure and complication rates were analyzed using random-effects Poissons regression models to obtain summary estimates of 5-year proportions. RESULTS: The search provided 6110 titles and 214 abstracts. Full-text analysis was performed for 93 articles, resulting in 17 studies that met the inclusion criteria. Meta-analysis of these studies indicated an estimated survival of RBBs of 87.7% (95% confidence interval (CI): 81.6-91.9%) after 5 years. The most frequent complication was debonding (loss of retention), which occurred in 19.2% (95% CI: 13.8-26.3%) of RBBs over an observation period of 5 years. The annual debonding rate for RBBs placed on posterior teeth (5.03%) tended to be higher than that for anterior-placed RBBs (3.05%). This difference, however, did not reach statistical significance (P=0.157). Biological complications, like caries on abutments and RBBs lost due to periodontitis, occurred in 1.5% of abutments and 2.1% of RBBs, respectively. CONCLUSION: Despite the high survival rate of RBBs, technical complications like debonding are frequent. This in turn means that a substantial amount of extra chair time may be needed following the incorporation of RBBs. There is thus an urgent need for studies with a follow-up time of 10 years or more, to evaluate the long-term outcomes.     

Factors influencing ridge alterations following immediate implant placement into extraction sockets

Aim: To identify factors that may influence ridge alterations occurring at the buccal aspect of the extraction site following immediate implant placement.
Material and methods: In 93 subjects, single-tooth implants were placed immediately into extraction sockets in the maxilla (tooth locations 15–25). A series of measurements describing the extraction site were made immediately after implant installation and at re-entry, 16 weeks later. The implant sites were stratified according to four factors: (i) implant location (anterior/posterior), (ii) cause of tooth extraction (periodontitis/non-periodontitis), (iii) thickness of the buccal bone walls (≤1/>1 mm) and (iv) the dimension of the horizontal buccal gap (≤1/>1 mm).
Results: (i) The location where the implant was placed (anterior/posterior) as well as (ii) the thickness of the buccal bone crest and (iii) the size of the horizontal buccal gap significantly influenced the amount of hard tissue alteration that occurred during a 4-month period of healing. At implant sites in the premolar segment, the fill of the horizontal gap was more pronounced than in the incisor–canine segment, while the vertical crest reduction was significantly smaller. Furthermore, at sites where the buccal bone wall was thick (>1 mm) and where the horizontal gap was large (>1 mm), the degree of gap fill was substantial.
Conclusions: The thickness of the buccal bone wall as well as the dimension of the horizontal gap influenced the hard tissue alterations that occur following immediate implant placement into extraction sockets.
To cite this article:
Ferrus J, Cecchinato D, Pjetursson EB, Lang NP, Sanz M, Lindhe J. Factors influencing ridge alterations following immediate implant placement into extraction sockets.
Clin. Oral Impl. Res . 21 , 2009; 22–29.     

A systematic review of the success of sinus floor elevation and survival of implants inserted in combination with sinus floor elevation Part II: Transalveolar technique

Objectives: The objectives of this systematic review were to assess the survival rate of implants placed in sites with transalveolar sinus floor elevation.
Material and Methods: An electronic search was conducted to identify prospective and retrospective cohort studies on transalveolar sinus floor elevation, with a mean follow-up time of at least 1 year after functional loading. Failure and complication rates were analyzed using random-effects Poisson regression models to obtain summary estimates/ year proportions.
Results: The search provided 849 titles. Full-text analysis was performed for 176 articles, resulting in 19 studies that met the inclusion criteria. Meta-analysis of these studies indicated an estimated annual failure rate of 2.48% (95% confidence interval (95% CI): 1.37–4.49%) translating to an estimated survival rate of 92.8% (95% CI): 87.4–96.0%) for implants placed in transalveolarly augmented sinuses, after 3 years in function. Furthermore, subject-based analysis revealed an estimated annual failure of 3.71% (95% CI: 1.21–11.38%), translating to 10.5% (95% CI: 3.6–28.9%) of the subjects experiencing implant loss over 3 years.
Conclusion: Survival rates of implants placed in transalveolar sinus floor augmentation sites are comparable to those in non-augmented sites. This technique is predictable with a low incidence of complications during and post-operatively.     

The effect of different implant neck configurations on soft and hard tissue healing: a randomized-controlled clinical trial

Objective: To compare the soft and hard tissue healing and remodeling around tissue‐level implants with different neck configurations after at least 1 year of functional loading. Material and methods: Eighteen patients with multiple missing teeth in the posterior area received two implants inserted in the same sextant. One test (T) implant with a 1.8 mm turned neck and one control (C) implant with a 2.8 mm turned neck were randomly assigned. All implants were placed transmucosally to the same sink depth of approximately 1.8 mm. Peri‐apical radiographs were obtained using the paralleling technique and digitized. Two investigators blinded to the implant type‐evaluated soft and hard tissue conditions at baseline, 6 months and 1 year after loading. Results: The mean crestal bone levels and soft tissue parameters were not significantly different between T and C implants at all time points. However, T implants displayed significantly less crestal bone loss than C implants after 1 year. Moreover, a frequency analysis revealed a higher percentage (50%) of T implants with crestal bone levels 1–2 mm below the implant shoulder compared with C implants (5.6%) 1 year after loading. Conclusion: Implants with a reduced height turned neck of 1.8 mm may, indeed, lower the crestal bone resorption and hence, may maintain higher crestal bone levels than do implants with a 2.8 mm turned neck, when sunk to the same depth. Moreover, several factors other than the vertical positioning of the moderately rough SLA surface may influence crestal bone levels after 1 year of function. To cite this article:
Tan WC, Lang NP, Schmidlin K, Zwahlen M, Pjetursson BE. The effect of different implant neck configurations on soft and hard tissue healing: a randomized‐controlled clinical trial.
Clin. Oral Impl. Res. 22 , 2011; 14–19.
doi: 10.1111/j.1600‐0501.2010.01982.x     

Evidence against PALB2 involvement in Icelandic breast cancer susceptibility

Several mutations in the PALB2 gene (partner and localizer of BRCA2) have been associated with an increased risk of breast cancer, including a founder mutation, 1592delT, reported in Finnish breast cancer families. Although most often the risk is moderate, it doesn't exclude families with high-risk mutations to exist and such observations have been reported. To see if high-risk PALB2-mutations may be present in the geographically confined population of Iceland, linkage analysis was done on 111 individuals, thereof 61 breast cancer cases, from 9 high-risk non-BRCA1/BRCA2 breast cancer families, targeting the PALB2 region. Also, screening for the 1592delT founder mutation in the 9 high-risk families and in 638 unselected breast cancer cases was performed. The results indicate no linkage in any of the high-risk families and screening for the 1592delT mutation was negative in all samples. PALB2 appears not to be a significant factor in high-risk breast cancer families in Iceland and the 1592delT mutation is not seen to be associated with breast cancer in Iceland.     

Flt3/Flk-2 ligand in combination with thrombopoietin decreases apoptosis in megakaryocyte development

The growth factors thrombopoietin (TPO) and Flt3/Flk-2-ligand (FL), either independently or in combination, modulate megakaryocyte development. Our results show that bone marrow CD34+ cells cultured with TPO and FL differentiate at a slower rate into CD41+ cells and are delayed in apoptosis at the later stages of the cultures compared to cells cultured with TPO alone. Our data also show that FL in synergy with TPO may inhibit apoptosis in megakaryocyte development by up-regulating bcl-2 and inducing conformational changes of p53, in MK progenitors. FL in combination with TPO slows down maturation and consequently delays apoptosis of MK progenitor cells.     

Maxillary sinus floor elevation using the (transalveolar) osteotome technique with or without grafting material. Part I: implant survival and patients' perception

Objectives: To analyze the survival and success rates of implants installed utilizing the (transalveolar) osteotome technique, to compare peri‐implant soft tissue parameters and marginal bone levels of osteotome‐installed implants with implants placed using standard surgical procedures, and to evaluate patient‐centered outcomes. Material and methods: During 2000 to 2005, 252 Straumann^® dental implants were inserted in 181 patients. The surgical technique was a modification of the original osteotome technique presented by Summers. In addition to the clinical examination, the patients were asked to give their perception of the surgical procedure, utilizing a visual analogue scale. Results: The cumulative survival rate of the osteotome‐installed implants after a mean follow‐up time of 3.2 years, was 97.4% (95% confidence intervals: 94.4–98.8%). From the 252 implants inserted, three were lost before loading and another three were lost in the first and second year. According to residual bone height the survival was 91.3% for implant sites with ≤4 mm residual bone height, and 90% for sites with 4 mm and 5 mm, when compared with that of 100% in sites with bone height of above 5 mm. According to implant length the survival rates were 100% for 12 mm, 98.7% for 10 mm, 98.7% for 8 mm and only 47.6% for 6 mm implants. Soft tissue parameters (pocket probing depth, probing attachment level, bleeding on probing and marginal bone levels) did not yield any differences between the osteotome‐installed and the conventionally placed implants. More than 90% of the patients were satisfied with the implant therapy and would undergo similar therapy again if necessary. The cost associated with implant therapy was considered to be justified. Conclusion: In conclusion, the osteotome technique was a reliable method for implant insertion in the posterior maxilla, especially at sites with 5 mm or more of preoperative residual bone height and a relatively flat sinus floor.