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Item does not contain fulltext, BACKGROUND: Long-term follow-up of single implants and crowns is scarce, especially when inserted using flapless surgery. AIM: Evaluate survival, peri-implantitis incidence, and technical/biologic complications of solitary implants/crowns after 10-12 years of function. MATERIAL AND METHODS: 49 patients with 53 single implants, initially operated with a one-stage flap (F) or flapless (FL) surgery and delayed loading, were recalled. Implant survival, radiographic bone-level changes compared to baseline, peri-implant health, and soft tissue aesthetics were registered. Differences in implant level between and within groups were statistically tested using the Mann-Whitney U-Test and Wilcoxon Signed Ranks Test, respectively. RESULTS: 36 patients with 40 implants were reassessed, yielding 100% implant and 97.5% crown survival. The bone loss in F (n = 19) was 0.56 mm (SD 0.89; range -0.9-2.02) and -0.85 mm (SD 0.98; range -2.84-0.53) in FL (n = 21), indicative of bone gain in FL (p = 0.003), the latter due to a difference at baseline but bone-level was comparable (p = 0.126). Groups were comparable for probing pocket depth (PPD); (3.32 vs. 3.19 mm), Bleeding Index (BI); (0.15 vs. 0.22), and gingival recession; (0.38 vs. 0.17 mm). According to international criteria, the peri-implantitis incidence was 0%, but 32.5% of the implants/crowns experienced biological or technical complications irrespective of surgical technique. CONCLUSIONS: Solitary implants and crowns show good long-term clinical outcomes and peri-implant health. Flapless surgery is a good alternative to conventional in straightforward cases with sufficient bone volume and proper treatment planning.

Contains fulltext : 294748.pdf (Publisher’s version ) (Open Access), (1) Although the accuracy of static computer-aided implant surgery (sCAIP) is well reported, information on its long-term effect on peri-implant health and complications is scarce. (2) Twenty-six patients initially treated were recalled. Implant survival, radiographic bone level, peri-implant health, and complications were registered. A multilevel regression model was applied to study the relationship between the research variables. (3) Sixteen patients participated in this study (average age 58.5 years; range 27.8-73.8). The mean follow-up time was 9.1 years (range 7.3-11.3). Two implants failed, resulting in a survival rate of 97.1%. The mean bone level change corresponded to a loss of 0.63 mm (SD 1.90) for the whole group, 0.17 mm (SD 1.46), and 0.91 mm (SD 2.09) for tooth- and mucosa-supported guides, respectively. The mean PPD for the total group was 4.24 mm (SD 1.25), and 3.79 mm (SD 0.97) and 4.51 mm (SD 1.33) for the tooth- and mucosa-supported guides, respectively. Four implants (6.3%) were diagnosed with peri-implantitis. Coronal deviation was slightly associated with having a negative impact on bone level at follow-up, but this was not statistically significant. Seven patients (43.8%) experienced technical complications. Biological complications were seen in 3/16 patients (18.75%). (4) SCAIP may contribute to more predictable implant placement; the long-term clinical outcome is similar to conventional nonguided surgery.

Radboud University, 01 november 2023, Promotor : Bruyn, H. de Co-promotor : D'Haese, J., Item does not contain fulltext

Contains fulltext : 297153.pdf (Publisher’s version ) (Closed access), BACKGROUND: The long-term clinical outcome of mini dental implants (MDIs) to support an overdenture is underreported especially in severely atrophic maxillae and when installed flaplessly. PURPOSE: The current report is a 5-years follow-up of the previously published 2- and 3-years clinical outcome of MDIs supporting a maxillary overdenture in narrow alveolar ridges. MDI survival, marginal bone level, peri-implant health, technical complications, and oral health related quality of life (OHIP) and respective changes over time are reported. MATERIALS AND METHODS: Subjects aged 50 years or older, in need of improvement of maxillary denture retention, were included. The MDIs were 2.4 mm diameter one-piece tapered implants, Class 4 pure Titanium, and lengths 10 or 11.5 mm. Under local anesthesia, 5-6 MDIs were placed in atrophic maxillae with a free-handed flapless approach. One week postoperative the denture was adapted with a retentive soft reliner. The final prosthetic connection was established after 6 months with a metal-reinforced horse-shoe denture. Clinical outcome after 5 years was assessed with probing pocket depts (PPD), bleeding on probing (BoP), and additional cone beam computed tomography (CBCT) MDI bone level measurements were performed. Oral Health-Related Quality of Life (OHRQoL) investigated with OHIP-14 was assessed preoperative, during provisional loading, and after final prosthetic connection up to 5 years. RESULTS: Initially, 31 patients (14 females and 17 males) with mean age 62.30 underwent treatment. In the provisional loading interval, 16 patients encountered 32/185 MDIs failures, resulting in a failure of 17.3%; 170 MDIs were functionally loaded in 29 patients. Additionally, 14 implants were lost in three patients, all of whom had had already previous failures. Reimplantation of 17 MDIs were performed during the provisional loading and 2 MDI after functional loading. After 5 years, the absolute implant failure rate was 46/204 (22.5%), correspon

Radboud University, 14 april 2022, Promotores : Bruyn, H. de, Vandeweghe, S. Co-promotor : Vervaeke, S., Contains fulltext : 247704.pdf (Publisher’s version ) (Closed access)

Radboud University, 14 april 2022, Promotores : Bruyn, H. de, Lierde, K. Van Co-promotor : Bruneel, L., Contains fulltext : 247700.pdf (Publisher’s version ) (Closed access)

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Item does not contain fulltext, BACKGROUND: According to literature, peri-implant bone loss is minimized on implants with microthreaded neck design and internal type of abutment connection. However, most clinical studies may be biased due to confounding factors. PURPOSE: This nonblinded RCT assessed the effect of implant neck (microthreaded vs non-microthreaded) as well as the type of abutment connection (internal conical vs external flat-to-flat) on peri-implant bone stability and peri-implant health after at least 36 months. MATERIALS AND METHODS: Twenty-five patients were treated with a maxillary implant-supported bar-retained overdenture on four different implant types: internal connection with microthreads (I-MT), internal connection without microthreads (I-NMT), external connection with microthreads (E-MT), and external connection without microthreads (E-NMT). To control confounding factors, all other design features were similar. A linear mixed-model analysis or mixed-model logistic regression analysis was used to determine the effect of implant type on bone level, probing pocket depth, bleeding on probing, and plaque. RESULTS: Four out of 98 implants (4.1%) placed in 25 patients failed during provisionalization and were replaced. Mean overall bone loss after 6 months was 0.39 mm (SD 0.62, range 0.00-3.48) with limited additional bone loss of 0.04 mm (SD 0.54, range -1.80-1.63) after at least 3 years. Microthreads or connection type had no effect on the bone level, probing pocket depth, bleeding on probing, nor plaque. CONCLUSIONS: With 96% of implant survival, the maxillary overdenture supported with a bar on four implants yield a predictable outcome and the implant-abutment connection type (internal vs external) and implant neck design (microthreaded vs non-microthreaded) have no influence on peri-implant bone remodeling after initial bone remodeling nor up to 4 years of function. Peri-implant bone levels are within international success standards and peri-implant health is indicative of

Contains fulltext : 241063.pdf (Publisher’s version ) (Open Access)

Contains fulltext : 238898.pdf (Publisher’s version ) (Closed access), BACKGROUND: Implant-supported overdentures (IOD) are becoming a more commonly used treatment in the dental practice and it risks causing speech problems. PURPOSE: The aim of this study was investigating the changes in speech, satisfaction with speech, and overall oral health-related quality of life (OHRQoL) in edentulous patients during and after treatment with maxillary IODs. MATERIALS AND METHODS: Twenty-one patients receiving an IOD participated in speech assessment. They were examined preoperatively with their conventional denture (CD) with full palatal coverage, after connection of the implant-bar connected denture, without palatal coverage, and 3 years thereafter. The examination included assessment of articulation in speech, OHRQoL based on total OHIP-14, and satisfaction with overall oral health and speech (visual analogue scale). RESULTS: There was a reduction in mean number of articulation disorders from 1.00 at baseline to 0.55 at connection, although statistically insignificant (p = 0.059). Especially the /s/ sound is vulnerable. At 3 years follow-up, still 6/16 (37.5%) of the patients suffered from this speech problem. Overall satisfaction improved from 64.05/100 at baseline to 82.95/100 at connection (p = 0.008) and remained unchanged with 81.69/100 after 3 years follow-up. Patients' satisfaction with speech increased from 70.62/100 with CD to 82.63/100, 3 years follow-up (p = 0.009). Total OHIP-14 decreased from 21.45/56 with CD to 8.00/56 (p < 0.001) with IOD and 6.13/56 3 years after connection (p = 0.001). Significant improvement of all seven domains in OHRQoL was observed with IOD compared to CD. CONCLUSIONS: Patients treated with maxillary IODs show improved OHRQoL 3 years after connection of the IOD compared to the CD. Even though patients reported improvement of satisfaction and OHRQoL, articulation disorders were still present, suggesting that patients should be informed about possible speech issues.

Contains fulltext : 231920.pdf (Publisher’s version ) (Open Access)

Contains fulltext : 229066.pdf (publisher's version ) (Closed access), OBJECTIVES: Longitudinal evaluation of Oral Health-Related Quality of Life (OHRQoL) during treatment of flaplessly placed, one-piece mini-dental-implants (MDIs) for maxillary overdentures is rarely investigated, nor is the impact of MDI failures. MATERIAL AND METHODS: This multicenter prospective cohort study evaluated the 3-year outcome of 5-6 MDIs in the edentulous maxilla in patients above 50 years with dentate mandible. Provisional dentures were provided before final prosthetic connection was established at 6 months. Postoperative discomfort was assessed using a visual analogue score (VAS). OHRQoL was investigated using the Oral Health Impact Profile (OHIP)-14 at baseline (preoperatively), postoperatively, post-prosthetic connection and after 3 years in function. RESULTS: 164 (78.4%) of the 204 placed MDIs were still in situ after 3 years, in 29/31 patients. Two patients lost 5/6 MDIs resulting in two prosthetic failures (6.45%). With regard to pain, a score of 4.1/10 (SD 2.8) was recorded on day 1, and 1.1/10 (SD 1.7) on day 7. A decrease in total OHIP-14 scores was observed postoperatively (15.6; SD 12.8) as compared to baseline (21.3; SD 13.1), with improvement of OHRQoL. Furthermore, this was statistically significant at connection of the final prosthesis (7.3; SD 6.7) (p = .006). The OHIP-14 improved less (p = .011) when experiencing one or more implant losses (9.5; SD: 9.85), in comparison with no implant loss (20.7; SD: 13.97). A failure of one MDI did not affect OHIP-14 score (p = .658); however, multiple failures did (p = .007). CONCLUSION: Maxillary MDI overdenture treatment yields significant OHRQoL improvement when at least 5 MDIs survive, preserving functional comfort.

Item does not contain fulltext, PURPOSE: To evaluate the effect of early bone loss (EBL), on long-term bone stability and future peri-implantitis development. MATERIALS AND METHODS: Patients referred for implant placement between 2005 and 2009 were consecutively treated and followed for 10 years. After 10 years, patients were invited for a scientific diagnostic visit to evaluate implant survival and bone loss. Bone level changes were compared with baseline. Non-parametric testing was performed in cross-tabs (Pearson Chi-square and Fishers's exact test). Kaplan-Meier-estimated survival curves were plotted for different thresholds for EBL at different timepoints. Generalized linear mixed models with binomial distribution and logit link for peri-implantitis were fitted. An adjusted logistic mixed model was made to evaluate peri-implantitis, in relation with smoking status, history of periodontitis, and EBL > 0.5 mm. RESULTS: Four hundred and seven patients (mean age of 64.86 years [range 28-92, SD 10.11]), with 1482 implants, responded to the 10-year recall invitation. After an average follow-up time of 10.66 years (range 10-14, SD 0.87), implant survival was 94.74%. Mean crestal bone loss after 10 years was 0.81 mm (SD 1.58, range 0.00-17.00). One hundred and seventy five implants in 76 patients had peri-implantitis (11.8% on implant level, 18.7% on patient level). EBL of 0.5, 1, and 2 mm were significant predictors for peri-implantitis and implant loss after 10 years. Implants with EBL ≥0.5 mm during the first year of function showed a 5.43 times higher odds for future peri-implantitis development. Probability in developing peri-implantitis was 52.06% when smoking, Periodontal history and EBL of >0.5 mm was combined. CONCLUSION: The present study suggests that EBL is a predictor for long-term peri-implant pathology, with a significant higher risk for peri-implantitis when early bone loss exceeds the thresholds of 0.5 and 1 mm, especially when additional risk factors such as smoking or susceptibilit

Contains fulltext : 238870.pdf (Publisher’s version ) (Closed access), BACKGROUND: Modifications of facial and oral structures affect aesthetic appearance, orofacial functions, and have impact on quality of life. PURPOSE: This study determined alterations of articulation, oromyofunctional behavior, and Oral Health Related Quality of Life (OHRQoL) in patients replacing complete removable dentures by implant retained overdentures in the mandible. MATERIALS AND METHODS: Twenty-one fully edentulous patients received mandibular overdenture retained on a bar connecting two titanium dental implants. Patients were evaluated after receiving a new set of fully removable dentures (stage 1), after surgery during provisionalization on healing abutments (stage 2), and after final connection to the bar (stage 3). Assessments were taken by speech therapists and included evaluation of: articulation (picture naming and reading); oromyofunctional behavior; OHRQoL (OHIP-14 questionnaire), and overall satisfaction and speech (VAS). To measure changes over time, Wilcoxon matched-pairs signed-rank-test and McNemar test was used. RESULTS: There was no significant impact of the treatment on speech nor on the results of oromyofunction. In stage 1, patients had different kinds of articulation errors (mean:1.21) which evolved to 0.71 and 0.67. In stage 3, especially problems with the /s/ sound are seen in 37% (7/19) of the participants. Results of OHRQoL and satisfaction reveal that the average of satisfaction with oral health evolved from 67% to 63% and finally 78%. OHIP-14 total score was 17.4/56 in stage 1, remained unchanged in stage 2 and evolved in stage 3 to 9.8/56 (P: .010). This indicates improvement. Satisfaction with speech evolved significantly from 68% pretreatment to 82% in stage 3 (P: .013). CONCLUSION: Despite existing articulation and oromyofunctional disorders after treatment, people are very satisfied with their OHRQoL and their speech. Impact of mandibular denture wearing on OHRQoL declines once connected. It's important to inform patients tha

Contains fulltext : 230820.pdf (publisher's version ) (Open Access)

Item does not contain fulltext, BACKGROUND: Bony concavities at the buccal aspect may cause a distortion between the implant axis and ideal prosthetic axis. Angulated implants can overcome this problem, yet long-term data are lacking. In addition, papilla-sparing incisions have been proposed to reduce tissue loss, yet aesthetic outcomes have not been published. PURPOSE: To evaluate the 5 to 7-year outcome of single angulated implants installed following papilla-sparing flap elevation. MATERIALS AND METHODS: Patients who had been consecutively treated with a single angulated implant (Co-axis®, Southern Implants, Irene, South Africa) in the anterior maxilla were re-examined after 5 to 7 years. Available data at 1 year (T1) were compared to those obtained at 5 to 7 years (T2). RESULTS: Twenty out of 22 treated patients (11 females, 9 males, mean age of 52) with 22 implants attended the 5 to 7-year reassessment. All implants survived and stable clinical conditions could be reached with mean marginal bone loss of 1.28 mm at T2. Papilla-sparing flap elevation resulted in Pink Esthetic Score of 9.83 at T1 and 8.23 at T2 (p = 0.072). Mucosal Scarring Index was 4.61 at T1 and 3.50 at T2 (p = 0.165). The overall appearance of scarring significantly improved over time (p = 0.032), yet 59% of the cases still demonstrated scarring at T2.c CONCLUSIONS: Within the limitations of the study, angulated implants (Co-axis®, Southern Implants) reached stable clinical conditions. Papilla-sparing incisions may not be recommended in aesthetically demanding patients due to high risk of scarring.

Contains fulltext : 225314.pdf (Publisher’s version ) (Open Access), OBJECTIVES: This study analysed the cost-effectiveness of two different attachments for the 2-implant overdenture (2IOD) in edentulous mandibles. MATERIALS AND METHODS: When considering alternative treatments, cost-effectiveness analysis is an important factor for stakeholders (patient, clinician, social security, insurance company, etc.). A general practice population (n = 116) was treated between 2003 and 2013 with a mandibular 2IOD with 2 different ball/stud attachment systems, one spherical (Group D) and one cylindrical (Group L). Patient well-being was assessed with OHIP-14-Total (OHIP-14-T), at intake and annually up to 5 years, to calculate the health effect. Initial and maintenance costs of both treatments were inventoried. The cost-effectiveness was compared. Annual discount rates of 4% and 1.5% were applied to future costs and health outcomes, following Dutch guidelines. Prices were adjusted to the year 2003. To offset the uncertainty in relevant input parameters, a sensitivity analysis was performed using bootstrap analysis. Significance was set at p < .05. RESULTS: The health effect was 6.36 (SD 5.32) for Group D and 8.54 (SD 5.63) for Group L. The sum of the discounted costs up to 5 years was EUR 4,210.98 (SD 634.75) for the D and EUR 3,840.62 (SD 302.63) for the Group L (p = .005). The bootstrapping reports that L abutment clearly dominates the D abutment in terms of cost-effectiveness. CONCLUSIONS: The 2IOD on the L abutment is dominant compared to the 2IOD on D abutment, in a 5-year perspective.

Contains fulltext : 220567.pdf (publisher's version ) (Open Access), BACKGROUND: The purpose of this study was to compare the survival and peri-implant bone loss of implants with a fluoride-modified surface in smokers and non-smokers. MATERIAL AND METHODS: All patients referred for implant treatment between November 2004 and 2007 were scrutinized. All implants were placed by the same surgeon (B.C.). The single inclusion criterion was a follow-up time of at least 10 years. Implant survival, health, and bone loss were evaluated by an external calibrated examiner (S.W.) during recall visits. Radiographs taken at recall visits were compared with the post-surgical ones. Implant success was based on two arbitrarily chosen success criteria for bone loss (

Contains fulltext : 221710.pdf (publisher's version ) (Open Access)

Contains fulltext : 217636.pdf (Publisher’s version ) (Closed access)

Contains fulltext : 228740.pdf (publisher's version ) (Open Access)

Contains fulltext : 222118.pdf (publisher's version ) (Open Access)

Contains fulltext : 229202.pdf (Publisher’s version ) (Closed access), Immediate implant placement holds considerable value, yet primary implant stability is often a critical factor. The aim of this study was to evaluate the stability, volumetric viability, and buccal gap size of reverse tapered body shift (RTBS) implants after immediate placement. Peak insertion torque measurements of two RTBS designs (apical 40% vs. apical 50%), relative to conventionally tapered implants, were assessed in simulated extraction sockets prepared in synthetic bone blocks. Additionally, the proximity of the RTBS implants to neighbouring teeth and anatomical structures, and the buccal gap distance were evaluated in human cadavers. The mean (± standard deviation) insertion torque was 12.00±1.40N• cm for the conventionally tapered implants (n=50), 35.36±2.74N• cm (n=50) for RTBS-1, and 48.20±2.90N• cm (n=50) for RTBS-2; the difference between designs was statistically significant (P<0.01). In total, 40 RTBS implants (20 per design) were placed in six cadaveric premaxillae. Only one locus was inappropriate for both RTBS implant designs, due to the proximity of neighbouring teeth. The average buccal gap for both implant designs was 2.8mm (P=0.104). The improved primary stability and increased buccal gap size with RTBS implants may enhance the feasibility of immediate placement. The study findings should be further validated in clinical trials.

Contains fulltext : 229181.pdf (Publisher’s version ) (Open Access), BACKGROUND: The advent of computer-guided surgery removed the need for complex surgical interventions such as extensive flap elevations, second stage implant exposure, and complications usually associated with conventional protocols. PURPOSE: (a) Analyze available literature reporting on applicability, accuracy, clinical outcome of flapless surgery with or without computer guidance. (b) Evaluate quality of studies, in terms of scientific level of evidence and ethical committee approval. MATERIALS AND METHODS: A PUBMED search was performed in July 2018. A first search was based on a general search string limited to "Dental Implants" and "flapless surgery." A second search focused on accuracy of computer-guided surgery using search string "Surgery, Computer-Assisted" or "guided surgery," and "Dental implants." The following inclusion criteria were applied: (a) studies in English; (b) human studies (excluding cadaver); (c) systematic reviews; (d) systematic reviews with meta-analysis. Reviews not mentioning accuracy were excluded in search 2. RESULTS: Nine reviews included in total. Implant survival ranged between 89% and 100%. Early surgical and prosthetic complications reported in 9.1% to 36.4% of reviewed papers. Tooth-supported guides show more accuracy than bone or mucosa-supported guides. Fully guided surgery yields higher accuracy, with lower values for horizontal coronal, horizontal apical and angular deviation (1.00, 1.23, and 3.13°mm, respectively) than those placed with half guided surgery (1.44, 1.91, and 4.30 mm, respectively). Thirty-four of 71 human studies included in nine reviews, mentioned ethical committee approval or compliance with Declaration of Helsinki. CONCLUSIONS: Guided flapless surgery is comparable to free-hand surgery in terms of implant survival, marginal bone remodeling, and peri-implant variables. Clinicians advised to take care in all steps of the protocol, and include safety margins around virtually planned implants. Regarding complia

1 september 2019, Item does not contain fulltext, OBJECTIVES: This prospective study analyses the 5-year clinical outcome, patient satisfaction and the technical outcome of a 2-implant overdenture on stud abutments. In addition, the influence of mandibular resorption and implant position on these outcomes was assessed. MATERIAL AND METHODS: Patients received two implants in a one-stage delayed protocol. Final prosthesis on stud abutments was finalized after 3 months. Implant survival, bone loss, plaque and sulcus bleeding index, OHIP-14, technical outcome and costs were assessed after 5 years. The Cawood-Howell classification defined the mandibular resorption. Inter-implant distances and angles (frontal, sagittal) were digitally measured. The significance level was p < .05. RESULTS: Fifty-six patients, 23 female and 33 males (mean age = 66.3, range 41-82), completed the follow-up. No implants were lost. Radiographical crestal bone loss was on average 1.25 mm (standard deviation SD 1.06), bleeding index was 0.75 (SD 0.73), and plaque index was 1.15 (SD 0.75) and higher for low mandibles (p = .001). The OHIP-14 reduction post-connection and after 5 years was significant (p < .001). Five-year maintenance required on average 6.7 (SD 4.8, range 0-25) interventions per patient. A larger inter-implant distance was associated with fewer replacement of retention inserts (p = .034) and less interventions (p = .006). Larger frontal (p = .023) and sagittal (p = .046) inter-implant angles (non-parallelism) required more inserts. The maintenance cost negatively influences the patient satisfaction (p = .004). 83% of the stud abutments showed wear. CONCLUSION: The implant overdenture on cylindrical stud abutments is a good and stable solution, irrespective of the resorption profile of the mandible. OHIP-14 improved permanently up to 5 years but is negatively influenced by complication cost. A small inter-implant distance, more frontal, sagittal inter-implant divergence increased maintenance.

01 december 2019, Contains fulltext : 215318.pdf (publisher's version ) (Open Access), Large proportions of patients are edentulous and wear removable dentures leading to reduced functional comfort and less oral health-related quality of life. Satisfaction with the oral situation after implantation depends on the outcome in eating comfort, speech comfort and aesthetics. Modification in form and location of the teeth may affect speech. The aim of this study is to determine speech, oromyofunctional behaviour, satisfaction with the treatment and the impact on quality of life of the horse-shoe overdenture retained by mini-dental implants (MDIs) in the maxilla. This prospective multicentre cohort study included 32 patients for treatment. 5 to 6 implants were placed, traumatically piercing the mucosa. Patients were evaluated three times during treatment (pre-operatively with conventional prosthesis including full palatal coverage (CD), post-operatively with provisionally relined CD and with horse-shoe overdenture on MDI). The assessment included a phonetic evaluation, examination of oromyofunctional behaviour, evaluation of the impact on quality of life (OHIP-14) and a rating of satisfaction with the treatment and speech on a visual analogue scale. Several speech sounds are found to be disturbed before treatment. In the next two stages of the treatment, the number of speech issues decreases. In the final stage, ten people show minor speech problems, especially with the /s/ sound. In this stage, seven people still present with oromyofunctional problems, especially whistling problems. In this last stage, people are very satisfied with the treatment (83%) and with speech (84%). The impact on quality of life is low (8.23/56).

Item does not contain fulltext, This study evaluated implant outcome in patients with Down syndrome (DSPs) and provides clinical guidelines to maximize treatment outcome. A total of 57 implants were placed in eight DSPs. During follow-up, implant survival was recorded and crestal bone level was evaluated when possible. After a mean follow-up time of 5 years, six patients with 45 implants were evaluated and an implant survival rate of 84.4% was recorded. A mean crestal bone loss of 1.7 mm (SD 0.9) was measured in three patients around 20 implants. Down syndrome is not a contraindication to dental implant placement, but multiple complicating factors yield reduced implant survival.

Item does not contain fulltext, BACKGROUND: It is uncertain, which is the optimal attachment for a mandibular 2-implant overdenture (2IOD). PURPOSE: To assess 5 years clinical implant outcome, prosthetic maintenance, cost, and PROMs of two cohorts receiving 2IOD on ball or stud abutments in a comparative study. MATERIALS AND METHODS: Ninety edentulous individuals were treated with balls (n = 34) or locator (n = 56). Implant survival, bone-to-implant level, prosthetic outcome, technical maintenance, and OHIP-14 were assessed. Statistics to compare between baseline and 1/5 years and between groups were t-test or Mann-Whitney (P < .05); chi-square was adopted to analyze plaque and technical maintenance or interventions between groups. RESULTS: Five years implant survival was 98.7%, irrespective of attachment. Overall mean bone loss was 1.1 mm, probing pocket depth 1.92 mm, bleeding score 0.60, plaque score 1. Plaque accumulated more on locators (P = .023). OHIP-14 declined from 18.1 to 2.7 irrespective of attachment. Retention for balls was better (P < .005), locators required more maintenance (P < .001), caused by retention-adjustment (P < .001) or ulcers/pain (P = .014). Five years maintenance-cost was 11% of initial cost, irrespective of attachment. CONCLUSIONS: Balls and locators yield stable 5-years implant outcome and improved Oral Health Related Quality of Life (OHRQoL). Locators required more maintenance and resulted in a lower retention. Maintenance costs are minimal but may affect OHRQoL at least for stud abutments.

Contains fulltext : 215456.pdf (publisher's version ) (Open Access), In fully edentulous patients, the support of a lower dental prosthesis by two implants could improve the chewing ability, retention, and stability of the prosthesis. Despite high success rates of dental implants, complications, such as peri-implantitis, do occur. The latter is a consequence of crestal bone loss and might be related to the implant surface and peri-implant soft tissue thickness. The aim of this paper is to describe the effect of implant surface roughness and soft tissue thickness on crestal bone remodeling, peri-implant health, and patient-centered outcomes. The mandibular overdenture supported by two implants is used as a split-mouth model to scrutinize these aims. The first study compared implants placed equicrestal to implants placed biologically (i.e., dependent on site-specific soft tissue thickness). The second clinical trial compared implants with a minimally to a moderately rough implant neck. Both studies reported an improvement in oral health-related quality of life and a stable peri-implant health after three years follow-up. Only equicrestal implant placement yielded significantly higher implant surface exposure, due to the establishment of the biologic width. Within the limitations of this study, it can be concluded that an implant supported mandibular overdenture significantly improves the quality of life, with limited biologic complications and high survival rates of the implants.

Contains fulltext : 205086.pdf (publisher's version ) (Open Access)

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Item does not contain fulltext, A prospective case series was performed to examine the clinical and radiographic changes to peri-implant tissues 2 years after resective treatment of peri-implantitis, including an apically positioned flap, osteoplasty, and implantoplasty. In total, 25 patients with 40 titanium implants of multiple brands and advanced peri-implantitis were included in this study. After 2 years, all implants survived, mean probing pocket depth was reduced from 8.7 to 3.3 mm, and bone level remained stable in 92.5% of the implants. Findings suggest the approach of an apically positioned flap combined with osteoplasty and implantoplasty as an effective and reliable strategy against peri-implantitis, although increased gingival recessions may limit its application in esthetic areas.

Contains fulltext : 200156.pdf (Publisher’s version ) (Open Access)

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Item does not contain fulltext, AIM: The primary objective of this study was (1) to evaluate the 5-year clinical outcome of regenerative periodontal therapy (RPT) using minimally invasive surgery and a collagen-enriched bovine-derived xenograft and (2) to identify predictors for clinical attachment level (CAL) gain and vertical radiographic bone (RB) gain. MATERIALS AND METHODS: Ninety-five non-smoking patients with /= 6 months after initial periodontal therapy with >/= 1 isolated interdental infrabony defect were recruited. Minimally invasive surgery (MIST or M-MIST) and a collagen-enriched bovine-derived xenograft were used in all patients. Patients were surgically treated by the same clinician and evaluated up to 5 years of follow-up. Multivariate analyses were used to identify predictors for CAL gain and RB gain. RESULTS: Before surgery, mean probing depth (PD) was 7.8 mm, CAL was 10.0 mm, and defect depth amounted to 5.2 mm. Seventy-one patients (33 men, 38 women, mean age 52) could be evaluated at 5 years. Mean PD reduction was 3.3 mm (SD 2.2), CAL gain was 3.0 mm (SD 2.1), and RB gain was 57% (SD 38). Forty-five percent showed >/= 4 mm CAL gain, whereas 24% were considered failures (/= 75%). Regression analyses showed that plaque was a significant predictor for CAL gain (p = 0.001) and RB gain (p = 0.005). Patients' compliance had a significant impact on RB gain (p < 0.001). CONCLUSION: Only patients with perfect oral hygiene and excellent compliance should be considered for RPT. Especially, the latter can only be assessed after sufficient follow-up following initial periodontal therapy. CLINICAL RELEVANCE: RPT failed in 24% of the patients after 5 years. Regression analyses demonstrated a significant impact of plaque and patients' compliance on the long-term outcome. Only patients with perfect oral hygiene and excellent compliance should be considered for RPT. Patients s

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1 augustus 2018, Item does not contain fulltext, PURPOSE: The purpose of this study is to evaluate the 10-year outcome of 25 patients with immediate loading in the edentulous mandible. MATERIAL AND METHODS: Twenty-five patients were consecutively treated with 5 immediately loaded fluoride-modified implants in the edentulous mandible. Implant survival and bone loss were evaluated by an external researcher comparing digital periapical radiographs taken during recall visits with baseline (at implant insertion). Statistical descriptive analysis and nonparametric tests were performed using SPSS v23, multilevel analysis was performed by means of R version 3.1.0. to identify risk factors for bone loss. RESULTS: Twenty-one patients (8 males, 13 females, mean age 68.4, range 49-84) responded to the 10-year recall invitation. No implants were lost during follow-up, resulting in a 100% survival rate. After 10 years, bleeding on probing and plaque were present at 49.5% and 67.6% of the sites, respectively. The mean pocket probing depth was 3.77 mm (SD 0.73, range 3.0-6.83). Bone loss on implant level after 3, 12, 24, and 120 months was 0.16 mm (SD 0.33, range 0-1.75), 0.14 mm (SD 0.24, range 0-1.05), 0.17 mm (SD 0.27, range 0-1.5), and 0.49 mm (SD 1.08, range 0-7.8). Five implants were identified with or at risk for progressive bone loss. Forty-seven percent of the implants did not show any bone loss after 10 years in function and 87% lost less than 1 mm. Multilevel statistical analysis identified 2-year bone loss as a predictor for bone loss after 10 years of function. CONCLUSION: Immediate loading of 5 fluoride-modified dental implants with a fixed prosthetic rehabilitation is a predictable and reliable treatment in the edentulous mandible, based on a 100% implant survival and limited peri-implant bone loss. Implants used for immediate loading in the edentulous mandible who are showing early bone loss may be at higher risk to develop peri-implantitis.

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Item does not contain fulltext, PURPOSE: The primary objective of the present controlled study was to determine the accuracy and precision of intraoral radiography in assessing interproximal bone defect morphology in patients suffering from periodontal disease as well as in patients with peri-implantitis. A secondary objective was to evaluate the possible impact of clinical experience on accuracy and precision. MATERIALS AND METHODS: The study sample comprised a total of 99 interproximal bony defects (40 patients) needing surgical treatment. Forty-nine defects were periodontal (17 patients), while the remaining 50 were peri-implant defects (23 patients). Following reflection of a mucoperiosteal flap and removal of granulation tissue, the type of bone defect as classified by Goldman and Cohen (1958) was determined. This intrasurgical registration was considered the true bone defect morphology. An intraoral radiograph was taken for each interproximal site. Twenty clinicians determined the bone defect morphology on each intraoral radiograph twice, with a washout period of 3 months. RESULTS: Using the Goldman and Cohen (1958) classification, the overall accuracy of intraoral radiography in assessing interproximal bone defect morphology was slight for teeth/implants (kappa = 0.132; 95% CI: 0.091 to 0.173/kappa = 0.126; 95% CI: 0.091 to 0.162). Duplicate evaluation indicated fair precision (kappa = 0.369; 95% CI: 0.308 to 0.430/kappa = 0.355; 95% CI: 0.230 to 0.414). Pooling one-, two- and three-wall defects into one category had a positive impact on accuracy (kappa = 0.254; 95% CI: 0.201 to 0.307/kappa = 0.387; 95% CI: 0.340 to 0.435), as well as on precision (kappa = 0.504; 95% CI: 0.423 to 0.584/kappa = 0.560; 95% CI: 0.463 to 0.657). A significant difference between experienced clinicians and trainees was not found (P >/= 0.285). CONCLUSIONS: Intraoral radiography lacks accuracy for assessing interproximal bone defect morphology around teeth and implants. Clinical experience does not seem to influen

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Item does not contain fulltext, OBJECTIVES: The accuracy of analogue and especially digital intra-oral radiography in assessing interdental bone level needs further documentation. The aim of this study was to compare clinical and radiographic bone level assessment to intra-surgical bone level registration (1) and to identify the clinical variables rendering interdental bone level assessment inaccurate (2). MATERIALS AND METHODS: The study sample included 49 interdental sites in 17 periodontitis patients. Evaluation methods included vertical relative probing attachment level (RAL-V), analogue and digital intra-oral radiography and bone sounding without and with flap elevation. The latter was considered the true bone level. Five examiners evaluated all radiographs. RESULTS: Significant underestimation of the true bone level was observed for all evaluation methods pointing to 2.7 mm on average for analogue radiography, 2.5 mm for digital radiography, 1.8 mm for RAL-V and 0.6 mm for bone sounding without flap elevation (p < 0.001). Radiographic underestimation of the true bone level was higher in the (pre)molar region (p

1 mei 2018, Item does not contain fulltext, AIM: To evaluate the effect of soft tissue thickness on bone remodelling and to investigate whether implant surface exposure can be avoided by adapting the vertical implant position in relation to the soft tissue thickness. MATERIALS AND METHODS: Twenty-five patients received two non-splinted implants supporting an overdenture in the mandible. Soft tissue thickness was measured using bone sounding and ultrasonically. One implant was installed equicrestally (control), and the vertical position of the second implant was adapted to the site-specific soft tissue thickness (test). Crestal bone levels were determined on digital peri-apical radiographs and compared with baseline (implant placement). RESULTS: Twenty-five patients were consecutively treated. No implants failed during the follow-up. A significant correlation was observed between soft tissue thickness and bone level alterations after 6 months (ultrasound ICC = 0.610; bone sounding ICC = 0.641) with inferior bone levels for equicrestal implants when thin tissues are present. Subcrestal implants showed significantly better bone levels after 6-month (n = 24, 0.04 mm versus 0.72 mm; p < .001), 1-year (n = 24, 0.03 mm versus 0.77 mm; p < .001) and 2-year follow-up (n = 24, 0.04 mm versus 0.73 mm; p < .001). CONCLUSION: Initial bone remodelling was affected by soft tissue thickness. Anticipating biologic width re-establishment by adapting the vertical position of the implant seemed highly successful to avoid implant surface exposure.

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