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Implant Therapy (implant + therapy)
Selected AbstractsOral health and oral implant status in edentulous patients with implant-supported dental prostheses who are receiving long-term nursing careGERODONTOLOGY, Issue 4 2009Rita Isaksson Aim:, The aim of this study was to investigate oral health and oral implant status in a group of edentulous patients receiving long-term residential or nursing care (LTC), all of whom had implant-supported fixed or removable dental prostheses. Material and methods:, A dental examination was performed on a total of 3310 patients receiving LTC and from this population 35 edentulous patients in whom dental implants had been placed formed the cohort for this study. All examinations were performed by a specialist in hospital dentistry and took place in the patients' own home environment. Oral health was assessed by means of a protocol which evaluated oral hygiene status, possible oral mucosal inflammation and oral mucosal friction levels. Any problems with the implant-supported prosthesis, implant mobility or other complications were also assessed. In addition, patients were asked about any oral symptoms and their usual oral hygiene procedures. Results:, About half of the subjects (17/35) were registered as having no/mild inflammation with 18 of 35 having moderate/severe inflammation. Twelve of the 35 patients had good/acceptable oral hygiene and 23 of 35 had poor/bad oral hygiene. Twenty-one of the 35 patients depended on help from the nursing personnel for their daily oral hygiene procedures. Obvious problems with food impaction were noted in 11 patients. A total of 229 implants had been placed in 43 jaws supporting 40 full arch-fixed prostheses and three implant-borne overdentures. There was no evidence of mobility or fractures of either the implants or the prostheses. Fifteen implants showed some exposed screw threads. Pus was exuding from one implant site and general peri-implant gingival hyperplasia was noted in two patients. Twenty-four patients were completely satisfied with the function and appearance of their implant-supported prostheses. Two patients were totally dissatisfied. Conclusion:, This study indicates that oral implant therapy can be considered as a treatment of choice in elderly patients, even if oral hygiene is sub-optimal. [source] Tissue Engineering Research in Oral Implant SurgeryARTIFICIAL ORGANS, Issue 3 2001Minoru Ueda Abstract: In this article, we introduce some of the more extensively evaluated technologies using concepts of tissue engineering. We report on hard tissue engineering and soft tissue engineering and their utility for dental implant therapy. For hard tissue engineering, we evaluated human recombinant bone morphogenetic protein-2 and marrow mesenchymal stem cells using a model of sinus augmentation procedure in rabbit. We also describe distraction osteogenesis as another category for hard tissue engineering. In addition, we evaluate soft tissue management using cultured epithelial grafting for soft tissue engineering. The results of our tissue regeneration materials and methods in this study are positive. When the tissue engineering materials are used in clinics in the future, implant surgery could be the leading field. [source] Interventions for replacing missing teeth: bone augmentation techniques for dental implant treatmentAUSTRALIAN DENTAL JOURNAL, Issue 1 2009M Esposito 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. [source] Patient assessment and diagnosis in implant treatmentAUSTRALIAN DENTAL JOURNAL, Issue 2008NU Zitzmann Abstract As in any dental treatment procedure, a thorough patient assessment is a prerequisite for adequate treatment planning including dental implants. The literature was searched for references to patient assessment in implant treatment up to September 2007 in Medline via PubMed and an additional handsearch was performed. Patient assessment included the following aspects: (1) evaluation of patient's history, his/her complaints, desires and preferences; (2) extra-and intra-oral examination with periodontal and restorative status of the remaining dentition; (3) obligatory prerequisites were a panoramic radiograph and periapical radiographs (at least from the adjacent teeth) for diagnosis and treatment planning. Additional tomographs are required depending on the anatomic situation and the complexity of the planned restoration; (4) study casts are needed especially in more complex situations also requiring a diagnostic set-up, which can be tried-in and transferred into a provisional restoration as well as into a radiographic and surgical template. The current review clearly revealed the necessity for a thorough, structured patient assessment. Following an evaluation, a recommendation is given for implant therapy or, if not indicated, conventional treatment alternatives can be presented. [source] Provisional restoration options in implant dentistrAUSTRALIAN DENTAL JOURNAL, Issue 3 2007RE Santosa Abstract Unlike their use in conventional crown and bridge, provisional restorations during implant therapy have been underutilized. Provisional restorations should be used to evaluate aesthetic, phonetic and occlusal function prior to delivery of the final implant restorations, while preserving and/or enhancing the condition of the peri-implant and gingival tissues. Provisional restorations are useful as a communication tool between members of the treatment team which, in most cases, consists of the restorative clinician, implant surgeons, laboratory technicians, and the patient. This article describes and discusses the various options for provisionalization in implant dentistry. Clinicians should be aware of the different types of provisional restorations and the indications for their use when planning implant retained restorations. [source] Clinical and Microbiological Determinants of Ailing Dental ImplantsCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 1 2009Giorgio Tabanella DDS ABSTRACT Background: The failure of the host tissue to establish or maintain osseointegration around dental implants is due to either occlusal or parafunctional forces, premature loading, ill-directed stress, or microbial infection. The long-term failure rate of dental implants is generally 5,10%. Although a variety of etiologies of early peri-implant bone loss (from implant placement to 1-year post-loading) have been proposed, factors associated with late implant failures are less well understood but are probably related to both the peri-implant microbial environment and host factors. Discriminating between causes of implant failure is of importance for instituting a successful implant therapy. Purpose: The objective of this cross-sectional split-mouth study was to identify clinical, radiographic, and bacterial characteristics of peri-implant disease sites. Materials and Methods: Fifteen patients with bilateral implants (Brånemark®, Nobel Biocare AB, Göteborg, Sweden; and 3iÔ implant systems, Implant Innovations Inc., Palm Beach Gardens, FL, USA) participated in the study. Sites with peri-implantitis (radiographic bone loss beyond the third implant thread) and peri-implant healthy tissues (radiographic bone level above the first implant thread) were identified in periapical radiographs using a long-cone paralleling projection technique. Microbiological identification was carried out using established anaerobic culture techniques. A descriptive statistics based on means and standard deviations was reported. Results: Peri-implant bone loss was associated with the absence of radiographic crestal lamina dura, peri-implant pocket depth, pain on chewing, and the submucosal presence of the putative periodontopathogens Tannerella forsythia, Campylobacter species, and Peptostreptococcus micros. Pain was associated with P. micros, Fusobacterium species, and Eubacterium species. Discussion and Conclusion: The absence of radiographic crestal lamina dura and the presence of suspected major periodontal pathogens seem to be associated to peri-implantitis. [source] Implant-Supported Fixed Prostheses for the Rehabilitation of Periodontally Compromised Dentitions: A 3-Year Prospective Clinical StudyCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 3 2001Odont(hc), Seung-Won Yi DDS ABSTRACT Background: The application of a strict hygiene maintenance care protocol following rehabilitation of periodontally compromised dentitions by means of tooth-supported fixed partial dentures has demonstrated excellent long-term treatment outcome. Purpose: A clinical and radiographic study was performed to document and evaluate the short- and medium-term result of occlusal rehabilitation by means of implant-supported fixed prostheses (ISFPs) in patients treated for advanced peri-odontal disease. Materials and Methods: Forty-three consecutive patients were included. All patients were referred because of advanced periodontal disease. Before the implant therapy was initiated, periodontal treatment was performed and the outcome evaluated during at least a 6-month period. An individual maintenance care program was designed for each patient. All 125 implants were placed using a two-stage surgical approach. Following installation of the ISFPs, all patients underwent a baseline examination including evaluation of oral hygiene, periodontal or peri-implant conditions, and radiographs. These examinations were repeated annually during the 3-year observation period. Results: No single implant was lost during the 3-year follow-up period. The percentages of plaque-harboring surfaces and bleeding units on probing were found to be low (< 10%), and no soft-tissue complications were recorded. The mean marginal bone resorption during the observation period amounted to 0.21 mm. In a few patients, apposition of marginal bone was observed. Bone loss amounting to 0.5 mm or less was found around 81% of the implants (101/125 implants). The amount of bone loss around the remaining 24 implants (19%) varied between 0.5 and 2.0 mm. Conclusions: The present clinical trial demonstrates that, at least during a 3-year period, the ISFP is an acceptable and predictable treatment option for rehabilitation in patients who have lost their teeth because of periodontal disease. This observation seems to be valid in edentulous and partially dentate jaws. A prerequisite to reach such a favorable treatment outcome is possibly the combination of the strict maintenance care program and the careful design of the ISFPs. [source] Willingness to pay for implant therapy: a study of patient preferenceCLINICAL ORAL IMPLANTS RESEARCH, Issue 8 2010Katherine C. M. Leung Abstract Aims: This study determined the amount of willingness to pay (WTP) for implant treatment and identified the factors affecting WTP. Methods: Subjects attending a university dental hospital were recruited (n=59). They were presented with two hypothetical clinical scenarios: missing one anterior/posterior tooth. The clinical procedures, outcome and plausible complications of various replacement options (fixed and removable partial dentures, implants) and sequelae of no treatment were presented. They were then asked how much they were willing to pay for tooth replacement under the two situations using a bidding method, with a starting bid of Hong Kong (HK)$20,000 in HK$1000 increment/decrement if they were willing/unwilling to pay that amount (1 USD=7.8 HKD). The amount was recorded at which the subject chose the opposite option or it reached HK$0. Demographic data were also collected. WTP values were compared between anterior and posterior replacements, and among various demographic subgroups. Spearman's correlations and linear regression analysis were also conducted. Results: Ninety-four percent and 84% of the subjects chose implant treatment to replace missing anterior and posterior teeth, respectively. The mean WTP amounts for anterior/posterior tooth replacement were HK$11,000/HK$10,000 (P>0.05). Higher WTP amounts were obtained from females, subjects without missing teeth or restorative need, and had attained higher level of education (P<0.05). Gender (P<0.05), level of education (P=0.042), and the presence of missing teeth (P=0.001) were independent predictors of WTP. Conclusions: The estimated WTP value for a single tooth replacement using dental implants was HK$10,000. Gender, level of education and presence of missing teeth were independent predictors that influenced WTP. To cite this article: Leung KCM, McGrath CPJ. Willingness to pay for implant therapy: a study of patient preference. Clin Oral Impl Res. 21, 2010; 789,793. doi: 10.1111/j.1600-0501.2009.01897.x [source] What influence do anticoagulants have on oral implant therapy?CLINICAL ORAL IMPLANTS RESEARCH, Issue 2009A systematic review Abstract Objectives: This systematic review aims to assess the risks (both thromboembolic and bleeding) of an oral anticoagulation therapy (OAT) patient undergoing implant therapy and to provide a management protocol to patients under OAT undergoing implant therapy. Material and methods: Medline, Cochrane Data Base of Systematic Reviews, the Cochrane Central Register of Controlled Trials and EMBASE (from 1980 to December 2008) were searched for English-language articles published between 1966 and 2008. This search was completed by a hand research accessing the references cited in all identified publications. Results: Nineteen studies were identified reporting outcomes after oral surgery procedures (mostly dental extractions in patients on OAT following different management protocols and haemostatic therapies). Five studies were randomized-controlled trials (RCTs), 11 were controlled clinical trials (CCTs) and three were prospective case series. The OAT management strategies as well as the protocols during and after surgery were different. This heterogeneity prevented any possible data aggregation and synthesis. The results from these studies are very homogeneous, reporting minor bleeding in very few patients, without a significant difference between the OAT patients who continue with the vitamin K antagonists vs. the patients who stopped this medication before surgery. These post-operative bleeding events were controlled only with local haemostatic measures: tranexamic acid mouthwashes, gelatine sponges and cellulose gauzes's application were effective. Post-operative bleeding did not correlate with the international normalised ratio (INR) status. In none of the studies was a thromboembolic event reported. Conclusions: OAT patients (INR 2,4) who do not discontinue the AC medication do not have a significantly higher risk of post-operative bleeding than non-OAT patients and they also do not have a higher risk of post-operative bleeding than OAT patients who discontinue the medication. In patients with OAT (INR 2,4) without discontinuation, topical haemostatic agents were effective in preventing post-operative bleeding. OAT discontinuation is not recommended for minor oral surgery, such as single tooth extraction or implant placement, provided that this does not involve autogenous bone grafts, extensive flaps or osteotomy preparations extending outside the bony envelope. Evidence does not support that dental implant placement in patients on OAT is contraindicated. [source] Biomechanics/risk management (Working Group 2)CLINICAL ORAL IMPLANTS RESEARCH, Issue 2009Mariano Sanz Abstract Introduction: The remit of this workgroup was to update the existing knowledge base in biomechanical factors, navigation systems and medications that may affect the outcome of implant therapy. Material and methods: The literature was systematically searched and critically reviewed. Five manuscripts were produced in five specific topics identified as areas where innovative approaches have been developed in biomechanical factors, navigation systems and medications that may affect the outcome of implant therapy. Results: The results and conclusions of the review process are presented in the following papers, together with the group consensus statements, clinical implications and directions for future research: , To what extent do cantilevers affect survival and complications of implant supported restorations in partially dentate patients? , To what extent does the crown,implant ratio affect survival and complications of implant supported restorations? , A systematic review on the accuracy and the clinical outcome of computer-guided template based implant dentistry. , What is the impact of systemic bisphosphonates on patients undergoing oral implant therapy? , What is the impact of anticoagulants on patients undergoing oral implant therapy? [source] Maxillary sinus floor elevation using the (transalveolar) osteotome technique with or without grafting material.CLINICAL ORAL IMPLANTS RESEARCH, Issue 7 2009Part I: implant survival, patients' perception Abstract 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. [source] Clinical characteristics at implants with a history of progressive bone lossCLINICAL ORAL IMPLANTS RESEARCH, Issue 2 2008Christer Fransson Abstract Objective: The aim of the present study was to describe the clinical characteristics at implants with a history of progressive bone loss. Material and methods: Eighty-two out of 184 previously identified subjects with a history of progressive bone loss volunteered for the study. Clinical assessments of plaque, bleeding on probing (BoP), probing pocket depth (PPD), suppuration following probing (Pus), presence of calculus on implants surfaces (Calc) and ,recession' i.e. the mucosal margin in level with or apical of the fixture/abutment junction were performed at the mesial, distal, buccal and lingual aspects of each implant and without removing the bridge constructions. Results: It was demonstrated that the frequencies of BoP, Pus, ,recession' and PPD,6 mm were higher at implants with than without ,progressive' bone loss. In addition, smokers had larger numbers of affected implants than non-smokers, and the proportion of affected implants that exhibited Pus and PPD,6 mm was higher in smokers than in non-smokers. The logistic regression analysis revealed that the findings of Pus, ,recession' and PPD,6 mm at an implant in a smoking subject had a 69% accuracy in identifying the history of progressive bone loss. Conclusion: The results from this study demonstrate an association between clinical signs of pathology and bone loss at implants. It is recommended to include clinical assessments in the evaluation of implant therapy. [source] Bone density and primary stability in implant therapyCLINICAL ORAL IMPLANTS RESEARCH, Issue S2 2006Liene Molly Abstract Introduction: To improve patient comfort, deviations from the very successful standard osseointegration protocol are being developed. To keep implant failure rates as low as possible, the most perfect treatment planning and a good patient selection are extremely important. Because bone density plays an important role in implant outcome, known relations of bone density could improve treatment planning. Material and methods: A Pubmed search revealed 66 manuscripts investigating and discussing bone density of human jawbone whether or not related to implant stability or outcome. Forty-five of these will be discussed in this review. Results and discussion: Many pre-operative methods of jawbone density assessment are available. Most of those techniques correlate well with one another. Some are more elaborate to use in clinical practice. Primary stability measurements show significant correlations with different bone densities and also with implant outcome; however, not many studies investigate both at the same time. Conclusion: To investigate the outcome of adaptation methods of the surgical protocol with regard to the jawbone density, an objective pre-surgical determination of bone density is necessary. [source] Psychological impact on implant patients' oral health-related quality of lifeCLINICAL ORAL IMPLANTS RESEARCH, Issue 2 2006Abu Hantash Ra'ed Omar Abstract Objectives: The literature has shown that patients' satisfaction with dental prostheses is associated with the existence of certain personality profiles. It is important to study such relationships in dental implant patients. Material and methods: Fifty patients (28 men and 22 women), aged between 22 and 71 years (mean age 43.22 years, SD 12.24 years), who were partially edentulous and were seeking dental implant therapy were entered into this study. The patients were requested to answer two reliable and valid questionnaires , the Dental Impact on Daily Living (DIDL) and the Neuroticism Extraversion Openness Five-Factor Inventory (NEO-FFI) , before implant treatment and 2,3 months after prosthodontic rehabilitation therapy. Results: Certain personality traits were found to have a significant relationship with patients' satisfaction with dental implants both before and after implant therapy (P<0.05). Neuroticism score had valuable features in predicting patients' total satisfaction ratings (P=0), satisfaction with appearance dimension (P=0), satisfaction with oral comfort dimension (P=0.005) as well as satisfaction with general performance dimension (P=0). Conclusion: Personality traits have an impact on patients' satisfaction with dental implant therapy. In addition, personality traits provide valuable information for the prediction of patients' satisfaction with their implant-supported prostheses. Neuroticism, openness, agreeableness and consciousness are very helpful in this regard. Neuroticism was found the main predictor of the patients' oral health-related quality of life following implant treatment. [source] Microbiological and clinical outcomes and patient satisfaction for two treatment options in the edentulous lower jaw after 10 years of functionCLINICAL ORAL IMPLANTS RESEARCH, Issue 3 2005Marc Quirynen Abstract Background: Long-term data on microbiological and clinical outcome as well as on patient satisfaction after implant therapy in the edentulous mandible are limited. Especially comparisons between fixed full prostheses (FFPs) and overdentures (ODs), or between anchoring systems for the latter are scarce. Aim: This study aimed to evaluate both of these parameters at the 10-year follow-up in a group of fully edentulous patients rehabilitated via an OD or a FFP (the latter to allow inter-group comparison). Material and methods: A total of 37 fully edentulous patients (25 ODs, 12 FFPs, age at implant installation ranged from 36 to 85 years) participated in this study. All subjects received their implants (Brånemark System®, Nobel Biocare AB, Gothenburg, Sweden) 10 years previously. For the ODs different attachment systems (bar, magnets, ball) had been applied that allowed a further intra-group comparison. At the follow-up visit, 10 years after the abutment insertion, a series of periodontal parameters were recorded, long-cone radiographs were taken and subgingival plaque samples were collected for analysis using checkerboard DNA,DNA hybridization. The clinical and radiographic data were recorded at abutment connection and after 1 and 10 years. Results: After 10 years of loading, mean plaque and bleeding indices and changes in attachment or marginal bone level were not significantly different, neither between the OD and FFP group, nor within the OD group. The marginal bone loss between abutment connection and year 10 was 0.86 and 0.73 mm for OD and FFP groups, respectively. The subgingival microbiota at implant sites from all (sub)-groups was comparable, with low numbers of DNA counts (±10 × 105) but high detection frequencies of Actinobacillus actinomycetemcomitans (>90%), Porphyromonas gingivalis (>85%) and Tannerella forsythensis (30%). The composition of the subgingival microbiota was influenced by probing depth and bleeding tendency. Patient satisfaction was very high for both types of prosthetic rehabilitation. The FFP group scored only slightly better for chewing comfort and general satisfaction. Conclusion: These data indicate that from the clinical and microbiological standpoint, as well as patient satisfaction, both an OD and a FFP offer a favourable long-term outcome. Résumé Les données à long terme de la guérison clinique et microbiologique ainsi que la satisfaction du patient après un traitement par implants dans la mandibule édentée sont limitées. Essentiellement des comparaisons entre les prothèses fixées complètes et les prothèses fixées amovibles ou entre les systèmes d'ancrage pour ces derniers sont rares. Cette étude a eu pour but d'évaluer ces paramètres après dix ans dans un groupe de patients complètement édentés qui avaient été soignés par une prothèse amovible ou fixée (cette dernière pour permettre la comparaison intergroupes). Trente-sept patients édentés [25 prothèses amovibles (OD), douze prothèses fixées (FFP), l'âge au moment du placement des implants était de 36 à 85 ans] ont participéà cette étude. Tous les sujets avaient reçu des implants Brånemark® 10 ans auparavant. Pour les prothèses amovibles, différents types d'attache (balle, aimant) avaient été utilisés, ce qui permettaient une comparaison intragroupe supplémentaire. Lors de la visite du suivi, dix ans après l'insertion des implants, une série de paramètres parodontaux ont été enregistrés, des radiographies par long cône prises et des échantillons de plaque sous-gingivale prélevés pour l'analyse utilisant l'hybridisation ADN-ADN échiquier. Les données cliniques et radiographiques ont été enregistrées au moment de la connexion de l'implant et après une et dix années. Dix années après la mise en charge, les indices de plaque et de saignement et les variations dans l'attache ou les niveaux osseux marginaux n'étaient pas significativement différents ni entre les groupes OD et FFP ni à l'intérieur du groupe OD. La perte osseuse marginale entre les connexions des piliers et dix ans après étaient respectivement de 0,86 et 0,73 mm pour les groupes OD et FFP. La flore sous-gingivale au niveau des implants pour tous les groupes et sous-groupes étaient semblables avec de faibles comptages ADN (±10 × 105) mais des fréquences de détection importantes de A. actinomycetemcomitans (>90%), P. gingivalis (>85%) et T.forsythensis (30%). La composition de la flore sous-gingivale a été influencée par la profondeur de la poche et la tendance au saignement. La satisfaction du patient était très élevée pour les deux types de prothèses. Le groupe FFP n'était qu'un petit peu meilleur pour le confort à la mastication et la satisfaction générale. Ces données indiquent que d'un point de vue clinique et microbiologique autant que d'un point de vue de satisfaction du patient les prothèses amovibles et fixées sont favorables à long terme. Zusammenfassung Hintergrund: Die Langzeitresultate über den mikrobiologischen und klinischen Verlauf und über die Zufriedenheit der Patienten nach Implantatversorgung im zahnlosen Unterkiefer sind limitiert. Im Speziellen sind Vergleiche zwischen festsitzenden totalen Brücken und Hybridprothesen und den verschiedenen Befestigungssystemen für Hybridprothesen selten. Ziel: Das Ziel der Studie war, beide Parameter anlässlich der Nachuntersuchung nach 10 Jahren bei einer Gruppe von zahnlosen Patienten, welche mit einer Hybridprothese oder mit einer festsitzenden Brücke wiederhergestellt worden waren, auszuwerten (bei den Hybridprothesen sollten auch Vergleiche innerhalb der Gruppe durchgeführt werden). Material und Methoden: Insgesamt nahmen 37 zahnlose Patienten an der Studie teil (25 Hybridprothesen (OD), 12 festsitzende Prothesen (FFP), Alter zum Zeitpunkt der Implantation 36 bis 85 Jahre). Alle Subjekte hatte vor 10 Jahren ihre Implantate erhalten (Brånemark System®, Nobel Biocare, Schweden). Bei den Hybridprothesen waren verschiedene Befestigungssysteme verwendet worden (Steg, Magnet, Kugeln). Dies erlaubte Vergleiche innerhalb der Gruppe. Bei der Nachuntersuchung 10 Jahre nach Einsetzten der Prothetikteile wurden parodontale Parameter aufgenommen, Röntgenbilder mit der Langkonustechnik angefertigt und subgingivale Plaqueproben zur Analyse mittels Ceckerboard DNA,DNA Hybridisierung entnommen. Die klinischen und radiologischen Daten wurden beim Einsetzten der Prothetikteile und nach 1 und 10 Jahren aufgenommen. Resultate: Nach 10 Jahren Belastung bestanden weder zwischen der OD und FFP Gruppe, noch innerhalb der OD Gruppe statistisch signifikante Unterschiede im mittleren Plaque- und Blutungsindex und in der Attachment- und marginalen Knochenhöhe. Der Verlust an marginalem Knochen zwischen der Montage der Prothetikteile und nach 10 Jahren betrug 0.86 mm für die OD Gruppe und 0.73 mm für die FFP Gruppe. Die subgingivale Flora war bei allen Implantatstellen der (Sub-) Gruppen vergleichbar. Es bestand eine geringe Anzahl an DNA Zählungen (±10 × 105) aber eine hohe Entdeckungsfrequenz für A. actinomycetemcomitans (>90%), P. gingivalis (>85%) und T. forsythensis (30%). Die Zusammensetzung der subgingivalen Mirkoflora wurde durch die Sondierungstiefe und die Blutungstendenz beeinflusst. Die Zufriedenheit der Patienten war für beide Arten der prothetischen Wiederherstellung sehr hoch. Die FFP Gruppe erreichte nur geringfügig bessere Werte bezüglich Kaukomfort und genereller Zufriedenheit. Schlussfolgerung: Diese Daten zeigen, dass sowohl vom klinischen und mikrobiologischen Standpunkt aus als auch seitens der Patientenzufriedenheit die Hybridprothese und die festsitzende totale Brücke gute Langzeitresultate zeigen. Resumen Antecedentes: Los datos a largo plazo sobre los resultados microbiológicos y clínicos al igual que la satisfacción del paciente tras la terapia de implantes en la mandíbula edéntula son limitados. Son especialmente escasas las comparaciones entre prótesis fija completa y sobredentaduras, o entre sistemas de anclaje. Intención: Este estudio se intentó para evaluar ambos parámetros en el control de seguimiento de los 10 años en un grupo de pacientes totalmente edéntulos rehabilitados por medio de una sobredentadura o una prótesis completa fija (la última para permitir comparaciones intergrupo). Material y métodos: Un total de 37 pacientes totalmente edéntulos (25 sobredentaduras (OD), 12 prótesis completas fijas (FFP), la edad en el momento de la implantación varió entre 36 a 85 años) participaron en este estudio. Todos los sujetos recibieron sus implantes (Brånemark System®, Nobel Biocare, Suecia) 10 años antes. Para las sobredentaduras se aplicaron diferentes sistemas de anclaje (barras, imanes, bolas) lo que permitieron una ulterior comparación intragrupo. En la visita de seguimiento, 10 años tras la colocación de los pilares, se recogieron una serie de parámetros periodontales, se tomaron radiografías de cono largo y se recogieron muestras de la placa subgingival para análisis usando la cuadrícula de DNA-DNA hibridación. Los datos clínicos y radiográficos se recogieron al conectar los pilares y tras 1 y 10 años. Resultados: Tras 10 años de carga, los índices medios de placa y sangrado y los cambios en el nivel óseo marginal y de inserción no fueron significativos, ni entre los grupos OD y FFP, ni dentro del grupo OD. La pérdida de hueso marginal entre la conexión de los pilares y el año 10 fue de 0.86 y 0.73 mm para los grupos OD y FFP, respectivamente. La microflora subgingival en los lugares de implantes fue comparable entre todos los (sub)-grupos, con un bajo recuento de DNA (±10 × 105) pero una alta detección de A. actinomycetemcomitans (>90%), P. gingivalis (>85%) y T. forsythensis (30%). La composición de la microflora subgingival fue influida por la profundidad de sondaje y la tendencia al sangrado. La satisfacción de los pacientes fue muy alta para ambos grupos de rehabilitación protésica. El grupo FFP puntuó solo un poco mejor para la satisfacción masticatoria y satisfacción general. Conclusión: Estos datos indican que desde el punto de vista clínico y microbiológico al igual que la satisfacción del paciente, tanto la sobredentadura como la prótesis completa fija ofrecen unos resultados favorables a largo plazo. [source] | ||||||||||