Modern implant dentistry based on osseointegration: 50 years of progress,current trends and open questions

In the 1960s and 1970s, implant‐supported prostheses based on subperiosteal or blade implants had a poor reputation because of questionable clinical outcomes and lack of scientific documentation. The change to a scientifically sound discipline was initiated by the two scientific pioneers of modern implant dentistry, Professor P. I. Brånemark from the University of Gothenburg in Sweden and Professor André Schroeder from the University of Bern in Switzerland. Together with their teams, and independently of each other, they laid the foundation for the most significant development and paradigm shift in dental medicine. The present volume of Periodontology 2000 celebrates 50 years of osseointegration. It reviews the progress of implant therapy over the past 50 years, including the basics of implant surgery required to achieve osseointegration on a predictable basis and evolving innovations. The development of bone‐augmentation techniques, such as guided bone regeneration and sinus floor elevation, to correct local bone defects at potential implant sites has increased the indications for implant therapy. The paradigm shift to moderately rough implant surfaces resulted in faster and enhanced bone integration and led to improvements in various treatment protocols, such as immediate and early implant placement in postextraction sites, and made various loading protocols possible, including immediate and early implant loading. In the past 15 years, preoperative analysis and presurgical planning improved as a result of the introduction of three‐dimensional imaging techniques. Hereby, cone‐beam computed tomography offers better image quality with reduced radiation exposure, when compared with dental computed tomography. This opened the door for digital planning and surgical modifications. Over the last 50 years this evolution has facilitated tremendous progress in esthetic outcomes with implant‐supported prostheses and improved patient‐centered outcomes. This volume of Periodontology 2000 also discusses the current trends and open questions of implant dentistry, such as the potential of digital implant dentistry in the surgical and prosthetic field, the trend for an increasing average age of implant patients and the related adaptations of treatment protocols, and the second attempt to establish ceramic implants using, this time, zirconia as the implant material. Finally, some of the hottest controversies are discussed, such as recent suggestions on bone integration being a potential foreign‐body reaction and the evidence‐based appraisal of the peri‐implantitis debate.     

Capsaicin‐induced neurogenic inflammation in the skin in patients with symptoms induced by odorous chemicals

Background: Intradermal injection of capsaicin induces the axonal release of neuropeptides, vasodilatation and flare, e.g. neurogenic inflammation. The spatial profile of neurogenic inflammation in the skin has been studied in various experimental models. Polarization spectroscopy imaging introduced recently may be used for the quantitative assessment of the temporal profile of neurogenic inflammation expressed as erythema intensity. Purpose: In the present study, we aimed to compare capsaicin‐induced erythema intensity with the flare area in patients with symptoms induced by odorous chemicals, thereby comparing the temporal and spatial profiles of neurogenic inflammation. Methods: Sixteen patients fulfilling Cullen's criteria for multiple chemical sensitivity (MCS) and 15 eczema (EC) patients with airway symptoms elicited by odorous chemicals were compared with 29 age‐matched, healthy controls. Participants were administered two intradermal injections of capsaicin 3.3 and 33 μM. Erythema intensity was measured by polarization spectroscopy imaging and flare response was quantified by visual inspection. Results: Erythema intensity and flare area did not differ between patients and controls, and they were not correlated. Erythema intensity and flare area showed a dose‐dependent increase (P<0.05). Erythema intensity increased with age at 3.3 μM but not at 33 μM capsaicin, whereas the flare area increased with age at both concentrations (P<0.05). Conclusion: Capsaicin‐induced erythema intensity and visual flare were normal in patients with MCS and EC patients with airway symptoms from odorous chemicals. Polarized light spectroscopy was a useful method for the measurement of the rapid temporal changes in erythema of experimental reactions.     

An exploration of the perceived changes in intimacy of patients' relationships following head and neck cancer

Aims and objectives. This paper reports the experiences of former patients who have undergone a range of head and neck cancer treatments and their perceptions of the changes in intimacy experienced, as an individual and through their relationships with partners, family and friends. Background. A diagnosis of head and neck cancer, subsequent surgical treatment and radiotherapy can lead to an altered quality of life. Whilst important developments have been made to improve the quality of life for this patient group from a functional perspective, psychosocial perspectives are much less understood. Design. A qualitative study approach. Methods. Data were collected in 2007/2008 via interview using open-ended questions from a purposive sample of 16 participants who were at least one year post-treatment. A thematic analysis was employed to interpret the findings. Results. Analysis of the data produced three broad themes. These were 'personal identity', 're-establishing social networks' and 'intimate relationships' and explored the person as an individual and their perceived changes to self-esteem and image. The perception of their altered position in society, the impact this has on their willingness to re-engage with society and the degree to which treatment can alter an individual's ability to resume former intimate relationships with family and partners. Conclusion. Patients' definitions of intimacy are multifaceted and related directly to the type of relationship that existed prior to treatment. The concerns and challenges faced by patients need to be addressed and support opportunities considered as part of the rehabilitation process. Relevance to clinical practice. The paper gives insight for nurses and other healthcare professionals who are expected to provide effective emotional and therapeutic support for patients who have undergone treatment for head and neck cancer. Understanding of patient concerns and recognition of adaptive and coping strategies are essential for this practice.     

Sinus floor elevation procedures to enable implant placement and integration: techniques,biological aspects and clinical outcomes

Implant treatment in an atrophied edentulous posterior maxilla constitutes a challenge for the therapeutic team. The authors of the present study acknowledge that modern micro‐rough surface implants in lengths of about 8–10 mm or longer and of different brands are similarly successful. Consequently, the authors propose that the use of different sinus floor elevation techniques should be considered when < 8 mm of bone is available below the maxillary sinus. The type of sinus floor elevation technique selected is mainly based on residual vertical bone height, marginal bone width, local intrasinus anatomy and the number of teeth to be replaced, although other factors (such as surgical training and surgical experience) may have an impact. It is proposed that a transcrestal sinus floor elevation approach can be considered as a first‐choice method for single tooth gaps in situations with sufficient width for implant placement and a residual bone height of 5–8 mm, while lateral sinus floor elevation, with or without grafting materials, is indicated when < 5 mm of bone is available and when several teeth are to be replaced. With regard to time of implant placement, a one‐stage procedure is preferred provided that high primary stability can be ensured.