Dent. J.2016, 4(2), 15; doi:10.3390/dj4020015 - published 25 May 2016 Show/Hide Abstract
Abstract: This paper reviews the literature regarding possible complications, complication-free survival, and overall survival of fixed dental prostheses that use both implants and natural teeth as abutments. The paper also provides clinical guidelines for treatment based on this literature review. An electronic search utilizing the MEDLINE, BIOSIS Citation Index, and Web of Science™ Core Collection databases was undertaken, and a review of the 25 selected texts studying 22 different patient cohorts was carried out. From a total of 1610 implants reviewed, 40 were lost (33 due to loss of integration and 7 due to fracture), whereas, out of a total of 1301 teeth, 38 were lost, of which 16 were due to fracture. Seventy-three cases of tooth intrusion were detected. From a total of 676 frameworks reviewed (metal n = 645, Zirconia n = 31), 7 fractured, while veneer material fracture occurred in 70 out of 672 bridges. Overall, 502 out of 531 tooth-implant fixed prostheses (TIPFs) remained functional, and 336 out of 439 prostheses showed no technical or biological complications and remained functional. Rigid TIFPs permanently cemented to teeth with sufficient coronal structure and with limited use of prosthetic attachments offer a good long-term treatment option to patients with good oral hygiene following sound implant placement. This mode of treatment should be used when free-standing implant-supported options may not be possible. Larger randomized control studies and other clinical studies comparing tooth-to-implant-connected treatment with other forms of treatment are needed to better understand the place of TIFP treatment in oral rehabilitation.
Dent. J.2016, 4(2), 16; doi:10.3390/dj4020016 - published 24 May 2016 Show/Hide Abstract
Abstract: Dental implants experience rare yet problematic mechanical failures such as fracture that are caused, most often, by (time-dependent) metal fatigue. This paper surveys basic evidence about fatigue failure, its identification and the implant’s fatigue performance during service. We first discuss the concept of dental implant fatigue, starting with a review of basic concepts related to this failure mechanism. The identification of fatigue failures using scanning electron microscopy follows, to show that this stage is fairly well defined. We reiterate that fatigue failure is related to the implant design and its surface condition, together with the widely varying service conditions. The latter are shown to vary to an extent that precludes devising average or representative conditions. The statistical nature of the fatigue test results is emphasized throughout the survey to illustrate the complexity in evaluating the fatigue behavior of dental implants from a design perspective. Today’s fatigue testing of dental implants is limited to ISO 14801 standard requirements, which ensures certification but does not provide any insight for design purposes due to its limited requirements. We introduce and discuss the random spectrum loading procedure as an alternative to evaluate the implant’s performance under more realistic conditions. The concept is illustrated by random fatigue testing in 0.9% saline solution.
Dent. J.2016, 4(2), 13; doi:10.3390/dj4020013 - published 24 May 2016 Show/Hide Abstract
Abstract: This systematic review looks at thematic trends in clinical research publications on dental implants. For this purpose, MEDLINE electronic searches as well as additional hand searches of six main journals in the field were conducted. A total of 2875 clinical studies published between 2001 and 2012 met the inclusion criteria and were subjected to statistical analysis. Hot topics in dental implant literature included immediate loading (14.3%), bone substitutes (11.6%), cross-arch full bridges (8.0%), and immediate implant placement (7.5%). A significant increase in scientific interest for immediate loading (+6.3%, p = 0.001), platform switching (+2.9%, p = 0.001), guided implant surgery (+1.9%, p = 0.011), growth factors (p = 0.014, +1.4%), piezoelectric surgery (+1.3%, p = 0.015), and restorative materials (+0.7%, p = 0.011) was found. A declining scientific interest in onlay grafting (−0.3%, p = 0.042) was recorded. The findings regarding current clinical oral implants research tie in with better-informed consumers and increased patient demands. Our results demonstrate an increasing interest in techniques that avoid complicated procedures such as bone grafting and that reduce treatment duration.
Dent. J.2016, 4(2), 14; doi:10.3390/dj4020014 - published 24 May 2016 Show/Hide Abstract
Abstract: Impression techniques for implant restorations can be implant level or abutment level impressions with open tray or closed tray techniques. Conventional implant-abutment level impression techniques are predictable for maximizing esthetic outcomes. Restoration of the implant traditionally requires the use of the metal or plastic impression copings, analogs, and laboratory components. Simplifying the dental implant restoration by reducing armamentarium through incorporating conventional techniques used daily for crowns and bridges will allow more general dentists to restore implants in their practices. The demonstrated technique is useful when modifications to implant abutments are required to correct the angulation of malpositioned implants. This technique utilizes conventional crown and bridge impression techniques. As an added benefit, it reduces costs by utilizing techniques used daily for crowns and bridges. The aim of this report is to describe a simplified conventional impression technique for custom abutments and modified prefabricated solid abutments for definitive restorations.
Dent. J.2016, 4(2), 12; doi:10.3390/dj4020012 - published 10 May 2016 Show/Hide Abstract
Abstract: The aim of this study was to describe Dental Foundation year one dentists’ attitudes towards prosthodontic decision making for edentulous patients, and identify whether there are gender differences in these attitudes. All South West Deanery trainees were invited to take part in the study between May and June 2011 and a previously piloted questionnaire was administered to the trainees by their training programme directors. The questionnaire posed questions based upon a clinical scenario of discussing treatment options with patients. Seventy-two questionnaires were used in the analysis (91% overall response rate). Trainees perceived their own values to be less important than the patient’s values (p < 0.001) in decision making, but similar to the patient’s friend’s/relative’s values (p = 0.1). In addition, the trainees perceived the patient’s values to be less important than their friend’s/relatives (p < 0.001). Sixty-six per cent of trainees acknowledged an influence from their own personal values on their presentation of material to patients who are in the process of choosing among different treatment options, and 87% thought their edentulous patients were satisfied with the decision making process when choosing among different treatment options. Fifty-eight per cent of trainees supported a strategy of negotiation between patients and clinicians (shared decision making). There was no strong evidence to suggest gender had an influence on the attitudes towards decision making. The finding of a consensus towards shared decision making in the attitudes of trainees, and no gender differences is encouraging and is supportive of UK dental schools’ ability to foster ethical and professional values among dentists.
Dent. J.2016, 4(2), 11; doi:10.3390/dj4020011 - published 28 April 2016 Show/Hide Abstract
Abstract: Contemporary computer-assisted technologies can support the surgical team in the treatment of patients affected by dentofacial deformities. Based on own experiences of 350 patients that received orthognathic surgery by the same team from 2007 to 2015, this clinical review is intended to give an overview of the results and risks related to the surgical correction of dentofacial anomalies. Different clinical and technological innovations that can contribute to improve the planning and transfer of corrective dentofacial surgery are discussed as well. However, despite the presence of modern technologies, a patient-specific approach and solid craftsmanship remain the key factors in this elective surgery.