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Purpose: Clinicians often do not have the benefit of adequate safety or clinical data when evaluating the merit of either newly marketed implant devices or novel clinical procedures. This has been the case for dental implants following the initial documentation of their safety and efficacy and is demonstrated in the evolution of immediate load application. Following demonstration of safety and successful application of an implant in an animal study prior to its market release, this report provides the clinical outcomes for the first 100 Ti-Unite implants provided to 24 patients in a clinical practice over 9 years. Materials and Methods: An electronic record/clinical database review of consecutive early loaded implants from a multiple surgeon/single prosthodontist practice was conducted for quality assurance. Data extraction of standard exposure and outcome variables was accomplished by a trained individual not affiliated with the clinical practice. Results: The results revealed one failure before and none following definitive restoration with a variety of prostheses. The mean length of time from immediate to definitive restorations was 5.3 ± 1.1 months for crowns, 3.9 ± 1.3 months for fixed partial dentures, and 7.8 ± 4.1 months for mandibular 'hybrid' prostheses. The most common unexpected findings during the initial three postinsertion visits were lost access restoration and cement failure. Conclusions: Pre-market animal data regarding the safety and success of a new implant used with an early loading protocol was replicated in the clinical results of the first 100 implants used in practice. Additionally, the clinical results are favorable when compared to conventional loading protocols from this same practice and provide helpful comparative metrics (delayed vs immediate loading) to use when discussing implant treatment with patients. Int J Prosthodont 2011;24:199-203. [ABSTRACT FROM AUTHOR]

In this 2-part review series, the current uses of saliva as a diagnostic fluid are reviewed, first with a focus on known measurements of systemic conditions. In Part 2, the role of saliva to measure bone turnover with a special emphasis on osteoporosis will be discussed. [ABSTRACT FROM AUTHOR]

PURPOSE: To evaluate long-term clinical performance of 1-stage dental implant prostheses at a single clinic, emphasizing clinical and demographic characteristics that affect implant survival. MATERIALS AND METHODS: Dental records of all 308 patients (674 implants) treated with 1-stage implants at Mayo Clinic from October 1993 through May 2000 were reviewed from implant placement to last visit. Exposure and outcome variables affecting performance were collected separately to control bias in the data collection process. Additional confounding factors (age and sex) were adjusted with the stratified Cox proportional hazards model. Implant survival was determined by means of a Kaplan-Meier survival estimate. The log-rank test was used to determine the role of clinical and demographic variables in implant survival. The relative risk associated with the possible effect of clinical and demographic variables on implant survival was estimated with the Cox proportional hazards model. RESULTS: The implant survival rate (n = 654 implants) was 97% (mean +/- SD follow-up, 21.0 +/- 18.8 months; range, 1 to 78 months). Performance bias was limited because nearly all patients were treated by 1 prosthodontist. Two implants failed after loading (6 and 9 months). The incidence of complications was less than 4%. Among the implant failures, use of heterogeneous bone graft was associated with 4.8 times more failures than was use of autogenous bone graft (P = .04). After augmentation, delaying implant placement for 5 to 6 months resulted in 8.6 times more failures than the rate after earlier placement (P < .001). DISCUSSION: Retrospective review of the clinical performance of a 1-stage dental implant system yielded a 97% survival rate, with no failures noted after 13 months. Prosthetic complications were low, especially for fixed implant prostheses. CONCLUSION: Clinical performance of 1-stage dental implant prostheses between 1993 and 2000 demonstrated a high level of predictability. [ABSTRACT FROM AUTHOR]

Bisphosphonates are effective in the prevention and treatment of bone disease in multiple myeloma (MM). Osteonecrosis of the jaw is Increasingly recognized as a serious complication of long-term bisphosphonate therapy. Issues such as the choice of bisphosphonate and duration of therapy have become the subject of intense debate given patient safety concerns. We reviewed available data concerning the use of bisphosphonates in MM. Guidelines for the use of bisphosphonates in MM were developed by a multidisciplinary panel consisting of hematologists, dental specialists, and nurses specializing in the treatment of MM. We conclude that intravenous pamidronate and intravenous zoledronic acid are equally effective and superior to placebo in reducing skeletal complications. Pamidronate is favored over zoledronic acid until more data are available on the risk of complications (osteonecrosis of the jaw). We recommend discontinuing bisphosphonates after 2 years of therapy for patients who achieve complete response and/or plateau phase. For patients whose disease is active, who have not achieved a response, or who have threatening bone disease beyond 2 years, therapy can be decreased to every 3 months. These guidelines were developed in the Interest of patient safety and will be reexamined as new data emerge regarding risks and benefits. [ABSTRACT FROM AUTHOR]

Background: Approximately 75% of all head and neck cancer patients are treated with radiotherapy (RT). RT to the oral cavity results in acute and late adverse events which can be severe and detrimental to a patient's quality of life and function. The purpose of this study was to explore associations between RT dose to a defined oral cavity organ-at-risk (OAR) avoidance structure, provider- and patient-reported outcomes (PROs), opioid use, and hospitalization., Methods: This was a retrospective analysis of prospectively obtained outcomes using multivariable modeling. The study included 196 patients treated with RT involving the oral cavity for a head and neck tumor. A defined oral cavity OAR avoidance structure was used in all patients for RT treatment planning. Validated PROs were collected prospectively. Opioid use and hospitalization were abstracted electronically from medical records., Results: Multivariable modeling revealed the mean dose to the oral cavity OAR was significantly associated with opioid use ( p = 0.0082) and hospitalization ( p = 0.0356) during and within 30 days of completing RT., Conclusions: The findings of this study may be valuable in RT treatment planning for patients with tumors of the head and neck region to reduce the need for opioid use and hospitalization during treatment.

The purpose of this viewpoint is to provide a framework that is used within the Mayo Clinic to align recommendations from infectious disease experts, dental specialists, and orthopedic surgeons with regards to need for antibiotic prophylaxis prior to invasive dental procedures., Competing Interests: The contact author has declared that neither they nor their co-authors have any competing interests., (Copyright: © 2021 Miao Xian Zhou et al.)

Small departments within academic medical centers have fewer numbers of clinicians, less time devoted to research, and fewer staff with senior faculty academic ranks available as mentors. This report describes the rationale behind Mayo Clinic's Department of Dental Specialties' scholarly activity program, implemented to combine mentorship with scholarship provided in a variety of formats. Program objectives focused on providing mentorship, disseminating existing scholarship, and bringing a diversity of scholarly activities into departmental mainstream., Competing Interests: Conflict of InterestThe authors declare that they have no competing interests., (© International Association of Medical Science Educators 2020.)

Statement of Problem: Which impression material, impression tray type, and implant impression technique combination produces the most accurate complete-arch impression is unclear., Purpose: The purpose of this in vitro study was to compare the implant impression accuracy of a completely edentulous arch made with addition silicone occlusal registration material and an open tray with the implant impression accuracy of other conventional impression techniques., Material and Methods: A master cast was fabricated from Type IV gypsum with four 3.8-mm diameter implants with internal hexagon located in the area of mandibular canines and first molars. Impressions (N=60) were made from the master cast using the 6 techniques investigated: group B-OC-N with occlusal registration impression material (B), open custom tray (OC), and nonsplinted impression pins (N); group B-OS-N with occlusal registration impression material (B), open plastic perforated stock tray (OS), and nonsplinted impression pins (N); group PE-OC-N with polyether medium-body impression material (PE), open custom tray (OC), and nonsplinted impression pins (N); group PE-OC-S with polyether medium-body impression material (PE), open custom tray (OC), and impression pins splinted (S) with autopolymerizing resin cut after 17 minutes and reconnected; group PE-CC-N with polyether medium-body impression material (PE), closed custom tray (CC), and nonsplinted impression pins (N); group PVS-CS-N with simultaneous double-mix polyvinyl siloxane impression material (PVS), closed stock perforated metal tray (CS), and nonsplinted impression pins (N). Type IV gypsum casts were fabricated 24 hours after making the impressions. A computerized numerical control 3D coordinate measuring machine was used to measure the absolute differences of the distances between the centroids of the 4 implants among the casts produced and the distances measured at the master cast. The Kruskal-Wallis test was used to determine differences among the experimental groups (α=.05). The Mann-Whitney U post hoc analysis was used for all group combinations., Results: No significant differences were found between the test groups B-OC-N and PE-OC-S, which were more accurate than the other groups. Group B-OS-N resulted in the least accurate impressions of all experimental groups. Group PE-OC-S resulted in more accurate impressions than the PE-OC-N group. No statistically significant differences were found between groups PE-OC-N and PE-CC-N or between groups PVS-CS-N and PE-CC-N., Conclusions: For complete edentulism, the use of silicone occlusal registration material with an open custom tray and nonsplinted impression pins resulted in impressions as accurate as those produced with PE open custom tray with splinted impression pins. These 2 techniques resulted in more accurate impressions than the other 4 techniques studied., (Copyright © 2019 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Purpose: The probability of achieving important clinical outcomes is an increasingly important factor for patients considering various treatment options for tooth loss. For oral reconstruction involving dental implants, the patient-specific risks of implant failure may be influenced by the patient's medication profile. The purpose of this study was to identify associations between dental implant failure and medication use in a consecutive series of patients seen from October 1983 through December 2014 at the Department of Dental Specialties, Mayo Clinic (Rochester, Minnesota)., Materials and Methods: In this patient-level analysis, demographic, implant-specific, and medical profile data were abstracted from a prospective clinical database and individual medical records and used to determine the time to first implant failure. Implant failure-free survival at the patient level was estimated using the Kaplan-Meier method. Associations of demographic characteristics and medication use with implant failure were evaluated by using Cox proportional hazards regression models and summarized with hazard ratios and 95% confidence intervals., Results: In the 31-year study period, 6358 patients received their first dental implant (median age, 53 years). The median follow-up duration of the 5645 patients whose implants did not fail was 5.8 years, and 713 patients had implant failure (median, 0.6 years). All associations were adjusted for age, sex, and era of implantation because these features strongly influence medication use and implant failure. After adjustment, no medication increased the risk of implant failure in the cohort; specifically, medication use at the time of implant placement or starting a medication after implant placement did not increase the risk of implant failure. Among the medications used at the time of implant placement, corticosteroids were associated with a reduced risk of implant failure (hazard ratio, 0.82; 95% CI, 0.67-0.99; p = 0.04). This association was not seen when corticosteroids were started after implant placement., Conclusion: In the population studied, medication use was not associated with an increased risk of dental implant failure., (© 2018 by the American College of Prosthodontists.)

Background: Management of individuals presenting with partial loss of teeth is a common task for dentists. Outcomes important to the management of missing teeth in the partially absent dentition should be systematically summarized. This review recognizes both the challenges associated with such a summarization and the critical nature of the information for patients., Objectives: To assess the effects of different prostheses for the treatment of partially absent dentition in terms of the following outcomes: long-term success, function, morbidity and patient satisfaction., Search Methods: We searched the Cochrane Oral Health Group's Trials Register (to 21 March 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 1), MEDLINE via OVID (1950 to March 2011) and EMBASE via OVID (1980 to March 2011). There were no restrictions regarding language or date of publication. We contacted several authors to identify non-published trials., Selection Criteria: Randomized controlled trials (RCTs) comparing different methods (including the design and materials used) of treating partial edentulism, with clinically relevant outcomes, were included in this review. Trials reporting only surrogate outcomes, such as plaque accumulation or gingival volume, were excluded from this review., Data Collection and Analysis: Two review authors independently carried out the screening of eligible studies, assessment of dimensions of quality of trials, and data extraction. Results were expressed as mean differences for continuous data, risk ratios for dichotomous outcomes, and hazard ratios with 95% confidence intervals for time-to-event data., Main Results: Twenty-one trials met the inclusion criteria for this review. Twenty-four per cent of these were assessed as being at high risk of bias and the remainder were at unclear risk of bias. The clinical heterogeneity among the included studies precluded any attempt at meta-analysis. There was insufficient evidence to determine whether one type of removable dental prosthesis (RDP) was better or worse than another. With fixed dental prostheses (FDPs), there was no evidence that high gold alloys are better or worse than other alloys, nor that gold alloys or frameworks are better or worse than titanium. There is insufficient evidence to determine whether zirconia is better or worse that other FDP materials, that ceramic abutments are better or worse than titanium, or that one cement was better or worse than another in retaining FDPs. There is insufficient evidence to determine the relative effectiveness of FDPs and RDPs in patients with shortened dental arch or to determine the relative advantages of implant supported FDPs versus tooth/implant supported FDPs., Authors' Conclusions: Based on trials meeting the inclusion criteria for this review, there is insufficient evidence to recommend a particular method of tooth replacement for partially edentulous patients.

Purpose: Systematic monitoring of important clinical outcomes is increasingly important for health-care decision making, especially in the context of continuous quality improvement. Dental implant failure within the first year (early failure) has been previously shown to be more common than subsequent failure. The purpose of this study was to identify associations between early implant failure and patient factors, surgical manipulations, and systemic conditions., Materials and Methods: The authors retrospectively identified the records of consecutive adult patients with dental implants seen between 2000 and 2014 in the Department of Dental Specialties, at the Mayo Clinic. Demographic, surgical, and medical data were extracted from the database and individual medical records to determine time to first implant failure. Cox proportional hazards regression models were used to assess associations of demographic, surgical, and systemic conditions with implant failure during the first year post-implantation, summarized as hazard ratio (HR) (95% confidence interval [CI])., Results: Among 8540 implants identified during the study period, 362 (4.2%) failed within the first year of placement at a mean (SD) of 129 (96) days after placement. On univariate analysis, most candidate predictors were not shown to influence first-year failure. Preplacement surgical manipulations associated with increased early implant failure were bone augmentation only (HR, 1.45; 95% CI, 1.02-2.05; p = 0.04), socket preservation (HR, 2.67; 95% CI, 1.33-5.38; p = 0.006), and xenogenic material (HR, 2.12; 95% CI, 1.11-4.04; p = 0.02). Alveoloplasty only at placement was associated with decreased early implant failure (HR, 0.33; 95% CI, 0.17-0.65; p = 0.001). Overall, 318 implants (3.7%) had surgical complications within the first year of placement at a mean (SD) of 110 (114) days after placement; any surgical complication was significantly associated with early implant failure (hazard ratio, 15.84; 95% CI, 11.10-22.61; p < 0.001). After adjustment for age, sex, and implant era, no single or multiple medical condition(s) and no single or multiple medication(s) increased patient risk of implant failure in the first year after placement., Conclusions: These findings support a targeted effort to reduce the incidence of surgical complications to reduce early failure of dental implants., (© 2018 by the American College of Prosthodontists.)

Purpose: To identify associations between implant failure and selective serotonin reuptake inhibitor (SSRI) medication use in a cohort of consecutive patients receiving dental implants during a 20-year period., Materials and Methods: A retrospective review was conducted of all patients who received at least 1 dental implant from January 1, 1995, through December 31, 2014, assessing their history of SSRI use, active SSRI use, and SSRI use during follow-up with implant failure. Cox proportional hazards regression models assessed associations between demographic characteristics and SSRI use with implant failure, and outcomes were summarized with hazard ratios (HRs) and 95% confidence intervals (CIs). Follow-up SSRI use was analyzed with time-dependent covariates., Results: During the study period, 5456 patients received their first implant (median age, 53 years). The median duration of follow-up was 5.3 years (interquartile range, 2.3-10.2 years) for the 4927 patients who did not have implant failure. For the 529 patients who had implant failure, it occurred at a median of 0.5 years. After adjusting for age, sex, and era of implant, history of use of the SSRI sertraline was associated with an increased risk of implant failure among all patients (hazard ratio [HR], 1.60; 95% CI, 1.15-2.23; p = 0.006) and among the subset of patients with a history of SSRI use (HR, 1.64; 95% CI, 1.07-2.52; p = 0.02)., Conclusions: In the population reviewed, a history of sertraline use was associated with a 60% greater risk of implant failure; however, active SSRI use at the time of implant placement or during follow-up was not significantly associated with an increased risk of implant failure., (© 2019 by the American College of Prosthodontists.)

Purpose: To identify associations between early implant failure and prosthodontic characteristics that could be used to guide subsequent continuous quality improvement efforts of patient care., Materials and Methods: An implant-level analysis was performed in which data were abstracted from a prospective clinical database of all adult patients treated with implants and followed up from January 2000 through December 2014 at the Department of Dental Specialties at Mayo Clinic in Rochester, Minnesota. These data were used to determine time to implant failure. Associations between prosthodontic characteristics and early implant failure were evaluated with Cox proportional hazards regression models and summarized with hazard ratios (HRs) and 95% confidence intervals (CIs)., Results: Among 8762 implants in 2787 patients, 395 (4.5%) failed within the first year of placement at a mean (SD) of 127 (97) days (range, 2-364 days). Univariable analysis showed no associations between early implant failure and use of a cover screw, prosthesis, or definitive or provisional prosthesis at implant placement. Three of 25 single crowns failed, and use of a single crown was significantly associated with early implant failure (HR, 3.94; 95% CI, 1.08-14.35; P = 0.04). This study identified no significant associations between prosthodontic characteristics identified after implant placement and early implant failure., Conclusions: Use of a prosthesis at implant placement, use of a definitive or provisional prosthesis, and early mechanical complications were not associated with increased risk of early implant failure. Quality improvement efforts should focus on aspects of decision making that aim to decrease surgical complications., (© 2018 by the American College of Prosthodontists.)

Purpose: The purpose of this retrospective study was to provide practice-based evidence to determine if the consistency of dental hygiene therapy, despite utilizing instrumentation literature that has proven to cause alterations to implant surfaces, affects peri-implant health or survival., Materials and Methods: The study sample comprised patients with implant-supported full-arch fixed dental prostheses who were distributed into two groups. The consistent hygiene group patients had dental hygiene therapy at a minimum biannually and were exposed to at least three dental hygiene instrument materials. The inconsistent hygiene group patients had dental hygiene therapy at a minimum once every 3 to 10 years and were exposed to at least three dental hygiene instrument materials. Years of survival free of soft tissue pathology and/or implant failure were estimated. Continuous features were summarized with medians, interquartile ranges (IQRs), and ranges; categorical features were summarized with frequency counts and percentages., Results: Among 48 patients in the consistent hygiene group, 11 patients experienced soft tissue pathology or implant failure at a median of 11.3 years; among 99 patients in the inconsistent hygiene group, 17 patients experienced soft tissue pathology or implant failure at a median of 4.8 years. The survival free of soft tissue pathology or implant failure rate at 5 years was 94% for the consistent hygiene group and 91% for the inconsistent hygiene group. The survival free of soft tissue pathology or implant failure rate at 20 years was 70% for the consistent hygiene group and 79% for the inconsistent hygiene group (P = .91)., Conclusion: Although no statistical differences were found between the groups, this practice-based evidence suggests more consistent dental hygiene therapy increases the median in years in which soft tissue pathology or implant failure is present.

Purpose: Outcome research has become an increasingly important form of clinical evidence for making health care decisions, including oral health considerations in the field of dentistry. In oral reconstruction involving dental implants, the risk of implant failure may be influenced by a patient’s underlying medical condition. To identify associations, implant failure and systemic conditions or diseases were studied in a consecutive series of patients who received dental implants from October 1, 1983, to December 31, 2014, in the Department of Dental Specialties at Mayo Clinic in Rochester, Minnesota., Materials and Methods: Data were abstracted from a prospective clinical database and electronic health records for patients’ demographic, implant-specific, and medical profiles to determine time to first implant failure. Survival free of implant failure at the patient level was estimated by using the Kaplan-Meier method. Associations of demographic and systemic characteristics with implant failure were evaluated by using Cox proportional hazards regression models and summarized with hazard ratios and 95% confidence intervals., Results: The patient cohort consisted of 6,358 patients with a median age of 53 years at placement of the first implant. A total of 713 patients experienced implant failure at a median of 0.6 years. Among the 5,645 patients who did not experience implant failure, the median duration of follow-up was 5.8 years. More than 20 systemic diseases or conditions were identified for assessment, of which 15 comprised more than 50 patients and five comprised more than 500 patients. All associations were adjusted for age, sex, and era of implant, given the strong influence of these features on implant failure. After adjustment, no systemic disease or condition was shown to increase the risk for implant failure in the population and setting studied., Conclusion: Patients considering oral reconstruction involving implants in the medical setting studied do not appear to risk implant loss because of systemic conditions or diseases.

Objective: To determine the adherence of dental providers to the 2007 American Heart Association (AHA) infective endocarditis prevention guidelines regarding antibiotic drug administration before invasive dental procedures., Patients and Methods: The study included all adults (≥18 years old) with a moderate-risk (MR) or high-risk (HR) cardiac condition who received dental care at participating dental offices from January 1, 2005, through June 1, 2015, in Olmsted County, Minnesota. Data collected included the date and type of dental procedure performed and receipt of antibiotic prophylaxis (AP)., Results: A total of 1351 patients underwent 8854 dental visits at participating dental offices during the study period; 1236 patients had an MR cardiac condition and 115 had an HR condition. The percentage of visits in which antibiotic drugs were used for indicated dental procedures in the MR group declined from 64.6% before to 8.6% after publication of the 2007 AHA guidelines (P<.001); for the HR group, AP declined from 96.9% before to 81.3% after publication of the guidelines (P=.02)., Conclusion: In this historical cohort in Olmsted County there was a statistically significant reduction in AP in the MR group before invasive dental procedures. In addition, there was an unanticipated significant reduction in AP in the HR group after publication of the 2007 AHA guidelines. These findings can be used to provide feedback and education to medical and dental professionals who are involved in decision making regarding the use of dental prophylaxis for their patients., (Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this project was to expand the Rochester Epidemiology Project (REP) medical records linkage infrastructure to include data from oral healthcare providers. The goal of this linkage is to facilitate research studies examining the role of oral health in overall health and quality of life., Participants: Eight dental practices joined the REP between 2011 and 2015. The REP study team has linked oral healthcare information with medical record information from local healthcare providers for 31 750 participants who have resided in Olmsted County, Minnesota. Overall, 17 718 (56%) participants are women, 14 318 (45%) are 40 years of age or older and 26 090 (82%) are white., Findings to Date: A first study using this new information was recently completed. This resource was used to determine whether the 2007 guidelines from the American Heart Association affected prescription rates of antibiotics to patients with moderate-risk cardiac conditions prior to dental procedures. The REP infrastructure was used to identify a series of patients diagnosed with moderate-risk cardiac conditions by the local healthcare providers (n=1351), and to abstract antibiotic prescriptions from dental records both pre-2007 and post-2007. Antibiotic prescriptions prior to dental procedures declined from 62% to 7% following the change in guidelines., Future Plans: Dental data from participating practitioners will be updated on an annual basis, and new dental data will be linked to patient medical records. In addition, we will continue to invite new dental practices to participate in the REP. Finally, we will continue to use this research infrastructure to investigate associations between oral and medical health, and will present findings at conferences and in the scientific literature., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Background: Since 1972, patients with large nasal perforations, who were symptomatic, and who were not candidates for surgery, had the option of custom prosthetic closure at Mayo Clinic. Although septal prostheses have helped many patients, 27% of pre-1982 patients chose not to keep the prosthesis in place. Two-dimensional computed tomography (CT) sizing resulted in more of the patients choosing to retain the prosthesis. The introduction of three-dimensional (3-D) printing to the sizing process offered the potential of further improved retention by refinement in prosthesis fit., Objective: To describe the fabrication of nasal septal prostheses by using 3-D printing for sizing and to compare the retention rate of 3-D-sized prostheses with those that used previous sizing methods., Methods: Twenty-one consecutive patients who had placement of septal prostheses sized by using 3-D printed templates were studied. CT image data were used to print 3-D templates of the exact shape of the patient's septal perforation, and medical-grade silastic prostheses were fabricated to fit. In four cases, the 3-D printed template allowed preoperative surgical simulation. Metrics collected included prosthesis retention; symptoms, including intranasal crusting and epistaxis; and previous prosthetic closure failures., Results: Twenty of the twenty-one patients had improvement in symptoms. The mean diameter of the perforations was 2.4 cm; the mean closure time by the end of the study period was 2.2 years. All but two patients chose to keep their prosthesis in place, for a retention rate of 90%. Seven patients with successful closure had failed previously with prior prosthesis sized without the current 3-D printing methodology. This 90% retention rate exceeded the previous rates before the introduction of 3-D sizing., Conclusion: Sizing done by 3-D printing for prosthetic closure of nasal septal perforations resulted in a higher retention rate in helping patients with these most-challenging nasal septal perforations.

Prosthodontics has a rich history related to the principles embedded in evidence-based health care. This paper reviews the evidence-based prosthodontics activity over the past 3 decades. It also discusses the impact of health care reform on evidence-based medicine as it relates to broader context of care outcomes. Finally, the value associated with an Evidence Stewardship emphasis in prosthodontics is presented. This emphasis suggests that combining evidence from clinical trials with evidence from clinical practice environments best equips clinicians for the management of patients in the future. Adoption of a strategic Evidence Stewardship direction is an extended commitment to change that recognizes health care reform aims and seeks to be an accountable provider group in the broader health care arena. The vision to form a representative network of prosthodontic practitioners that augments a commitment to Cochrane "clinical trial" data demonstrates a responsibility to professional transparency about who we are, adds value for patients and oral health care providers, impacts teachers and students in dental education, and provides a measure of care accountability unique in dentistry., (© 2014 by the American College of Prosthodontists.)

Internal connection implants have been attracting attention in recent years leading to their being adopted for many implant systems and an increase in market share over other connections. However, internal connection implants have only been used clinically for a short period of time resulting in few clinical studies investigating outcomes and a lack of comparative clinical evidence to support their use over external hex systems at this time. Given the fact that clinical evidence is lacking regarding implant connection performance comparisons, it is important to understand what information clinicians use to choose between systems. The purpose of this study regarding implant decision-making was to ask clinicians to provide subjective evaluations of internal connection implants, in comparison with external connection implants. The survey was constructed to cover four aspects of interest; general responder information, surgical procedures and experience, prosthodontic treatments and outcomes, and implant complications. The dentists' responses indicated that internal connection implants are as user-friendly as external hex implants with respect to implant surgery, but they are favored for prosthodontic handling because impression coping and abutment placement are felt to be easier. In addition, it was revealed that dentists strongly feel that there is a lack of biological and prosthodontic evidence to support the use of internal connection implants. The findings reveal the responding clinicians recognize that they often make decisions without compelling evidence to favor one system over another. Decisions are often based on perceived ease of use or third party (colleague or manufacturer) input. For future investigations, we will seek to better understand the relative influence and validity of all forms of information used (especially third party input), as well as what barriers exist to clinicians' use of more evidence based data.

Purpose: The goals of part 2 of the study presented here were 1) to assess whether there is a difference in failure mode of different thicknesses (2.0, 1.5, 1.0, and 0.5 mm) of anatomically standardized full contour monolithic lithium disilicate restorations for posterior teeth, and 2) to assess if there is a difference among various crown thicknesses when these restorations are subjected to dynamic load forces common for posterior teeth., Materials and Methods: Four groups (n = 10), each with a different thickness of anatomically appropriate all-ceramic crowns, were to be tested as established from the statistical analysis of the preliminary phase. Group 1: 2.0 mm; group 2: 1.5 mm; group 3: 1.0 mm; group 4: 0.5 mm. The specimens were adhesively luted to the corresponding die, and underwent dynamic cyclic loading (380 to 390 N) completely submerged in an aqueous environment until a failure was noted by graphic recording and continuous monitoring., Results: There was a statistically significant difference of the fatigue cycles to failure among four groups (p < 0.001; Kruskal-Wallis test). The mean number of cycles to fail for 2.0 mm specimens was 17 times more than the mean number of cycles to fail for 1.0 mm specimens and 1.5 times more than the mean number of cycles to fail for 1.5 mm specimens. The 0.5 mm specimens failed with one cycle of loading. A qualitative characteristic noted among the 2.0 mm specimens was wear of the area of indenter contact followed by shearing of the material and/or crack propagation., Conclusion: Based on the findings of this study, it may be reasonable to consider a crown thickness of 1.5 mm or greater for clinical applications of milled monolithic lithium disilicate crowns for posterior single teeth., (© 2014 by the American College of Prosthodontists.)

Purpose: The aim of this retrospective study was to summarize practice-based evidence associated with long-term outcomes (>20 years) in the management of edentulous patients. The patient population was managed with implant-supported prostheses, following the original osseointegration protocol, provided over the period from 1983 to 1991 in the group prosthodontics practice at the Mayo Clinic. The data are an example of practice quality assurance monitoring and are used to refine care delivery when needed and to provide information regarding expected outcomes in a shared decision-making interaction with prospective patients., Materials and Methods: Two hundred and sixty four patients with at least one edentulous jaw were identified. Of these, 255 completed their care and follow-up at the Mayo Clinic (209 mandible only, 35 maxilla only, 11 mandible and maxilla). Prosthodontic outcomes categorized as anticipated or unanticipated prosthetic and biologic events and the respective interventions required for each were recorded to assess follow-up event dynamics for this care modality., Results: The mean duration of follow-up for 190 of the 255 patients (65 died at a mean follow-up of 12.6 years) was 13.0 years (median 13.6; range 0.3 to 28). At least one prosthetic event was experienced by 148 patients (58%), and 81 (32%) experienced at least one biologic event. Overall, patients experienced 3.8 times more prosthetic events than biologic events. Twenty-four (9%) patients experienced 35 implant failures. Overall survival rates at 20 years were 86% for prostheses, 15% survived free of any event, and 92% experienced survival free of implant failure (95% confidence interval)., Conclusion: Anticipated and unanticipated prosthetic events occur throughout the life of the hybrid prosthesis. Prosthetic events significantly surpass (four times more) biologic events and occur significantly later in the follow-up. For this patient group, 8.6% (22/255) had implant-supported prostheses remade during follow-up in this patient population. These findings support the recommendation that prosthodontic care for missing teeth be thought of in a "chronic condition" context, recognizing that long-term outcome monitoring to provide realistic care expectations is important for demonstrating care value in oral health promotion., (© 2013 by the American College of Prosthodontists.)

Statement of Problem: Long-term practice-based clinical evaluations of various contemporary ceramic crown restorations from multiple practitioners are limited., Purpose: The aims of this study were to evaluate the clinical performance of ceramic single crowns and to identify factors that influence their clinical performance., Material and Methods: Ceramic single crowns that had been placed at the Mayo Clinic and in function since 2005 were identified and included in the study. The restorations were examined clinically, radiographically, and with photographs. Modified United States Public Health Services criteria were used for the clinical evaluation. The ceramic systems evaluated were bilayer and monolayer., Results: Fifty-nine patients (41 women, 18 men) with 226 single teeth and implants restored with single ceramic crowns were identified. The mean duration from insertion date to study examination date was 6.1 years. Thirteen restorations (6%) were replaced at a mean 3.3 years after insertion date (range, 0.1-6.1 years). Estimated replacement-free survival rates (95% confidence interval [CI]; number of teeth/implants still at risk) at 5 years after insertion date were 95.1% (95% CI, 92.2-98.1; 153) and at 10 years were 92.8% (95% CI, 89.1-96.8; 8). The most common reason for replacement was fracture to the core of posterior layered ceramic crowns. The most commonly used luting agent was resin-modified ionomer cement. Most restorations exhibited clinically acceptable marginal integrity, shade, no caries recurrence, and no periapical pathology., Conclusions: The clinical performance of ceramic single crowns at 5 and 10 years supports their application in all areas of the mouth. With the majority of fractures to the core occurring early in the lifetime of layered ceramic posterior crowns, consideration of other monolithic ceramic systems for posterior crowns is advised., (Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.)

The functional outcomes related to treating patients afflicted with tooth loss are an important hallmark in substantiating prosthodontic intervention. The Oral Rehabilitation Outcomes Network (ORONet) conducted two international workshops to develop a core set of outcome measures, including a functional domain. The process followed the general format used in the Outcome Measures in Rheumatology (OMERACT) workshops to develop consensus for clinical outcome measures in arthritis research, which included: developing a comprehensive list of potential outcomes in the literature; submitting them to a filter for validity, clinical discrimination, and feasibility; and ranking those measures meeting all the filter criteria for relative value. The search was conducted to include functional assessments of speech, swallowing, mastication, nutrition, sensation, and motor function as they relate to dental implant therapies. This literature review surveyed 173 papers that produced some result of these descriptors in the functional domain. Of these, 67 papers reported on functional assessments and further defined objective and subjective outcomes. Many of these results were patient-perceived improvements in function, while others were objective assessments based on established methodologies and instruments. Objective evaluations of masticatory function and speech may meet criteria for validity and discriminability for selected interventions, but are generally not feasible for routine use in clinical care settings. The current recommendation is to employ a well-validated survey instrument that covers mastication and speech, such as the Oral Health Impact Profile (OHIP-14, short form), recognizing that patient perceptions of function may differ from objective ability.

Consensus regarding outcomes of the treatment of tooth loss, especially the psychologic outcomes, is needed to guide discovery of best practices and enable a better understanding of patient management for this chronic condition. This paper presents the findings of the ORONet Psychological Working Group for prosthodontics and aims to identify psychologic outcomes with properties deemed critical to meet clinical trial and clinical practice needs for the future. References obtained using a PubMed/Medline search were reviewed for clinical outcomes measures of interest. Clinical outcomes measures were judged relative to the criteria of truth, discrimination, and feasibility. Of the psychologic outcome measures identified in this systematic review, only the OHIP-14 was thought to be suitable for use in general practice and multi-institutional outcome registries and clinical trials. Development of clinically useful psychologic outcomes for future use could benefit from developmental methods and tools outlined in the patient-related outcomes field of clinical care.

Purpose: A systematic literature review was conducted to identify the types of economic measures currently used in implant prosthodontics and determine the degree to which cost of care is considered in the context of any positive outcome of the care provided., Materials and Methods: A literature search was conducted using the following set of terms plus some additional hand searching: "dental implants" (Mesh) AND ("cost") OR "maintenance" OR "healthcare policy" OR "access to care" OR "third party" OR "economic") AND (("1995/01/01"[PDat]:'2009/12/31"[PDat]) AND (Humans[Mesh]) AND (English[lang]))., Results: After a review of the 466 titles and abstracts identified by the search, 18 articles were accepted for further consideration, as some attempt at economic outcome measures was made. An additional four articles were identified by hand searching. The 22 accepted articles were grouped into four basic categories: (1) measure of costs of treatment (direct, indirect, and maintenance costs), (2) cost-effectiveness mathematical modeling applied to simulate the lifetime paths and cost of treatment, (3) cost-effectiveness analysis/cost minimization, and (4) willingness-to-pay, willingness-to-accept. Attempts at determining the costs of treatment varied widely. When the OMERACT filters were applied to the various measures it was felt that discrimination and/or feasibility was a problem for most of the current economic outcome measures., Conclusions: Measures of cost-benefit, cost-effectiveness, and cost-utility are currently the gold standard; however, feasibility of such analyses is an issue. Collaboration with health economists to guide future research is highly recommended.

The published literature describing clinical evidence used in treatment decisionmaking for the management of tooth loss continues to be characterized by a lack of consistent outcome measures reflecting not only clinical performance but also a range of patient concerns. Recognizing this problem, an international group of clinicians, educators, and scientists with a focus on prosthodontics formed the Oral Rehabilitation Outcomes Network (ORONet) to promote strategies for improving health based on comprehensive, patient-centered evaluations of comparative effectiveness of therapies for oral rehabilitation. An initial goal of ORONet is to identify outcome measures for prosthodontic therapies that represent multiple domains with patient relevance, are amenable to utilization in both institutional and practice-based environments, and have established validity. Following a model used in rheumatology, the group assessed the prosthodontic literature, with an emphasis on implantbased therapies, for outcomes related to longevity and functional, psychologic, and economic domains. These systematic reviews highlight a need for further development of standardized outcomes that can be integrated across clinical and research environments.

The Oral Rehabilitation Outcomes Network (ORONet) Longevity Working Group undertook a search of the literature from 1995 to 2009 on randomized controlled trials related to longevity of osseointegrated implants. Outcomes measures used in these studies were identified and subjected to the OMERACT component criteria of truth, validity, and feasibility. Through this process, it was a challenge to identify clinical outcomes measures that fully met the criteria. An attenuated version of the component criteria was applied, and clinical measures were identified for implant outcomes, prosthetic outcomes, and indices. A recommendation on standardized reporting periods was also presented for future consideration. The endpoint of the evaluation process is to develop consensus on clinical outcomes measures that can be applied across broad populations for osseointegrated implant care. The present ORONet initiative represents a beginning toward continual improvement and consensus development for clinical outcomes measures for osseointegrated implants.

Purpose: The goals of this study were to: (1) establish a range of the performance of four restorative systems for posterior single-tooth crowns under single load to fracture submerged in an aqueous environment, (2) identify restorative system(s) of interest to be examined in the second study phase under sliding contact step-stress fatigue as full-contour anatomically appropriate single posterior tooth restoration(s), (3) establish a range for loading/testing for phase 2., Materials and Methods: Forty specimens (n = 10/group) of 2 mm uniform thickness were tested. Group 1: monolithic lithium disilicate IPS e.max Press; group 2: IPS e.max ZirPress, 0.8 mm zirconia core with 1.2 mm pressed veneering porcelain; group 3: IPS e.max ZirPress, 0.4 mm zirconia core with 1.6 mm pressed veneering porcelain; group 4: IPS InLine PoM. Specimens were bonded to a block of polycast acrylic resin on a 30° sloped surface with resin cement. Specimens were axially single loaded to failure while submerged under water., Results: There was a statistically significant difference (p < 0.001) in failure load among the four restorative systems. Lithium disilicate showed a mean failure load similar to mean maximum posterior bite forces (743.1 ± 114.3 N). IPS e.max Zirpress with a 0.4 mm zirconia core exhibited the lowest mean failure load (371.4 ± 123.0 N)., Conclusion: Fracture resistance of monolithic lithium disilicate in an aqueous environment is promising and requires second phase testing to evaluate the potential of various thicknesses appropriate for posterior single tooth applications. Doubling the IPS e.max Zirpress zirconia core from 0.4 mm to 0.8 mm increased the fracture resistance of this restorative system threefold., (© 2012 by the American College of Prosthodontists.)

Oral cancer is often diagnosed only at advanced stages due to a lack of reliable disease markers. The purpose of this study was to determine if the epithelial-specific human calmodulin-like protein (CALML3) could be used as marker for the various phases of oral tumor progression. Immunohistochemical analysis using an affinity-purified CALML3 antibody was performed on biopsy-confirmed oral tissue samples representing these phases. A total of 90 tissue specimens were derived from 52 patients. Each specimen was analyzed in the superficial and basal mucosal cell layers for overall staining and staining of cellular subcompartments. CALML3 was strongly expressed in benign oral mucosal cells with downregulation of expression as squamous cells progress to invasive carcinoma. Based on the Cochran-Armitage test for trend, expression in the nucleus and at the cytoplasmic membrane significantly decreased with increasing disease severity. Chi-square test showed that benign tissue specimens had significantly more expression compared to dysplasia/CIS and invasive specimens. Dysplasia/CIS tissue had significantly more expression than invasive tissue. We conclude that CALML3 is expressed in benign oral mucosal cells with a statistically significant trend in downregulation as tumorigenesis occurs. CALML3 may thus be a sensitive new marker for oral cancer screening.

Selection Criteria: The authors conducted a search of MEDLINE and EMBASE databases for the period January 1980 to October 2009. This was supplemented by searching reference lists of literature obtained. There was no language restriction applied. Two authors reviewed the search yield for relevance, disagreement was resolved by consensus discussion, and the selected articles deemed relevant for full-text review were read by one reviewer. The relevant articles selected were judged against inclusion/exclusion criteria. Included studies were restricted to randomized controlled trials (RCTs) or prospective cohort studies. Only studies with partially edentulous applications of at least 5 implants shorter than 10 mm followed for more than 1 year were included. No (alumina)-zirconium implants or mini-implants for orthodontic anchorage or short implants used for cantilevered prostheses were included. A validity assessment using methodological criteria for cohort and RCTs was accomplished by 2 reviewers., Key Study Factor: The focus of the review was to determine the prognosis of short (<10 mm) implants in the partially edentulous patient. The authors sought to identify important influences on survival rate by conducting subgroup analyses where the subgroups included individual implant lengths shorter than 10 mm, smoking, implants in the mandible versus maxilla, and bone augmentation procedures. The 2-year estimated survival rate was selected based on evidence suggesting that after 1 year the implant survival rate is considered to be constant, an important aspect for survival function estimation., Main Outcome Measure: To allow a pooled estimate of prognosis from multiple studies, the estimated failure rate per year and estimated implant survival rate after 2 years was determined for each study. The estimated failure rate per study was determined as a function of number of implant failures and total implant "exposure" time. Exposure in this context means the time an implant is in vivo and, hence, exposed to failure risk. Consequently, exposure time includes implants followed the entire study, those up to the time of failure, and those followed to a premature study end (eg, patient death, moving, refusal to continue). When study data were not provided separately for the short implants in a publication, a proportional exposure (short implants/total implants χ overall exposure time) was determined. The 2-year survival calculation made from the estimated failure rate assumed a constant rate of implant failure (considered to follow a Poisson distribution). Additional analyses sought to identify independent effects on failure based on implant surface topography (rough vs machined), maxilla versus mandible, smoking status, and augmentation., Main Results: Twenty-nine studies were identified that met both the inclusion criteria and methodological requirements of the 1353 articles identified in the literature search. Of these 29 studies, 28 were prospective cohort studies and 1 was an RCT. The mean follow-up for the studies was 3.7 years, with a range from 1.6 to 8.1 years. There were 2611 short implants in the identified studies ranging in length from 5.0 mm to 9.5 mm. Table 1 provides the outcome data by implant length, including the number of implants in each group, the estimated annual failure rate (expressed as a percentage), and the 2-year estimated failure rate (expressed as a percentage). Overall, 5-mm implants were calculated to have a 2-year survival rate of 93%, whereas 9-mm implants had a 2-year survival rate of 98%. Additional analyses revealed that for all implant lengths, both rough and machined (smooth) implants had similar failure rates (0.008 and 0.010, respectively). Implants placed in the maxilla had a significantly greater failure rate than those placed in the mandible (0.010 and 0.003, respectively). Estimated failure rates in studies that excluded smokers were twice as low as those seen in studies that included heavy smokers (0.004 and 0.080, respectively). No significant difference in estimated failure rate was seen for implants placed with simultaneous augmentation compared with no augmentation (0.007 and 0.010, respectively)., Conclusions: The findings from this systematic review are important in that collectively they support consideration of placement of short implants in partially edentulous patients. The estimated data showed a tendency for improved survival rate with increasing implant length, implant placement in the mandible compared with the maxilla, and for implants placed in nonsmokers., (Copyright © 2012. Published by Mosby, Inc. All rights reserved.)

Subjects: The subjects in this retrospective case series were derived from a review of 700 patient files within the implant practice of the Department of Periodontology, University Hospital, Catholic University of Leuven. Inclusion criteria were met by 412 patients (240 females, 172 males) receiving a total of 1514 Nobel Biocare dental implants. These patients were included based on data availability for the time period 2 years after abutment surgery (considered to represent late implant failure)., Key Exposure/study Factor: Given the concern of the authors to assess the probability of late implant failure among clinic patients with certain local and systemic factors, the potential factors were multiple. The local factors included the following: implant length and diameter, bone quality and quantity, insertion site, type of edentulism, antibiotic use perioperatively, dehiscence and/or perforation of the site during surgery, and stability at insertion (measured by Periotest values). The related health and behavioral factors included the following: medications, smoking (<10 cigarettes/day, 10-20 cigarettes/day, >20 cigarettes/day), hypertension, ischemic cardiac problems, coagulation anomalies, gastric ulcers, thyroid disorders, hypercholesterolemia, rheumatoid arthritis, asthma, diabetes (types 1 and 2), Crohn's disease, and chemotherapy., Main Outcome Measure: The primary outcome was described as "late implant failure." The current study, which follows a similar study on early implant failure,(1) aims to identify negative influences on maintenance of integration. The authors used the clinical experience related to the 412 patients with 1514 implants to identify whether the observed failure rates were influenced by local and systemic factors. Failure was defined as "late" when occurring between abutment connection surgery and 2 years after this date. Patients/implants that were not available for this interval of time were not included. However, even when records were available, not all patient records provided all data sought., Main Results: Regarding local factors, the authors reported that implant diameter and location were relevant to late implant loss, whereas implant length was not (P value = .01, = .34, respectively; univariate generalized estimating equation [GEE] logistic regression). Regarding implant diameter, significantly more loss was noted for 5.00-mm implants when compared with the 4.00-mm or 4.75-mm implants. Failure related to location revealed that the maxilla compared with the mandible, posterior jaws compared with anterior jaws, and the posterior maxilla compared with all other oral locations were associated with more late failures (Table 1). Assessment of systemic factors revealed radiotherapy to be related to more late implant loss (P = .003). Neither systemic disease nor smoking exposure was associated with late failure., Conclusions: The authors concluded that late implant failure was influenced by the local factor "implant location" and the systemic factor "radiotherapy." Neither smoking nor systemic health factors were found to adversely influence implant integration from abutment connection through 2 years' performance., (Copyright © 2012. Published by Mosby, Inc. All rights reserved.)

Background: Tobacco use has significant adverse effects on oral health. Oral health professionals in the dental office or community setting have a unique opportunity to increase tobacco abstinence rates among tobacco users., Objectives: This review assesses the effectiveness of interventions for tobacco cessation delivered by oral health professionals and offered to cigarette smokers and smokeless tobacco users in the dental office or community setting., Search Methods: We searched the Cochrane Tobacco Addiction Group Specialized Register (CENTRAL), MEDLINE (1966-November 2011), EMBASE (1988-November 2011), CINAHL (1982-November 2011), Healthstar (1975-November 2011), ERIC (1967-November 2011), PsycINFO (1984-November 2011), National Technical Information Service database (NTIS, 1964-November 2011), Dissertation Abstracts Online (1861-November 2011), Database of Abstract of Reviews of Effectiveness (DARE, 1995-November 2011), and Web of Science (1993-November 2011)., Selection Criteria: We included randomized and pseudo-randomized clinical trials assessing tobacco cessation interventions conducted by oral health professionals in the dental office or community setting with at least six months of follow-up., Data Collection and Analysis: Two authors independently reviewed abstracts for potential inclusion and abstracted data from included trials. Disagreements were resolved by consensus. The primary outcome was abstinence from smoking or all tobacco use (for users of smokeless tobacco) at the longest follow-up, using the strictest definition of abstinence reported. The effect was summarised as an odds ratio, with correction for clustering where appropriate. Heterogeneity was assessed using the I² statistic and where appropriate a pooled effect was estimated using an inverse variance fixed-effect model., Main Results: Fourteen clinical trials met the criteria for inclusion in this review. Included studies assessed the efficacy of interventions in the dental office or in a community school or college setting. Six studies evaluated the effectiveness of interventions among smokeless tobacco (ST) users, and eight studies evaluated interventions among cigarette smokers, six of which involved adult smokers in dental practice settings. All studies employed behavioral interventions and only one required pharmacotherapy as an interventional component. All studies included an oral examination component. Pooling all 14 studies suggested that interventions conducted by oral health professionals can increase tobacco abstinence rates (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.44 to 2.03) at six months or longer, but there was evidence of heterogeneity (I² = 61%). Within the subgroup of interventions for smokers, heterogeneity was smaller (I² = 51%), but was largely attributable to a large study showing no evidence of benefit. Within this subgroup there were five studies which involved adult smokers in dental practice settings. Pooling these showed clear evidence of benefit and minimal heterogeneity (OR 2.38, 95% CI 1.70 to 3.35, 5 studies, I² = 3%) but this was a posthoc subgroup analysis. Amongst the studies in smokeless tobacco users the heterogeneity was also attributable to a large study showing no sign of benefit, possibly due to intervention spillover to control colleges; the other five studies indicated that interventions for ST users were effective (OR 1.70; 95% CI 1.36 to 2.11)., Authors' Conclusions: Available evidence suggests that behavioral interventions for tobacco cessation conducted by oral health professionals incorporating an oral examination component in the dental office or community setting may increase tobacco abstinence rates among both cigarette smokers and smokeless tobacco users. Differences between the studies limit the ability to make conclusive recommendations regarding the intervention components that should be incorporated into clinical practice, however, behavioral counselling (typically brief) in conjunction with an oral examination was a consistent intervention component that was also provided in some control groups.

Background: Management of individuals presenting with partial loss of teeth is a common task for dentists. Outcomes important to the management of missing teeth in the partially absent dentition should be systematically summarized. This review recognizes both the challenges associated with such a summarization and the critical nature of the information for patients., Objectives: To assess the effects of different prostheses for the treatment of partially absent dentition in terms of the following outcomes: long-term success, function, morbidity and patient satisfaction., Search Methods: We searched the Cochrane Oral Health Group's Trials Register (to 21 March 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 1), MEDLINE via OVID (1950 to March 2011) and EMBASE via OVID (1980 to March 2011). There were no restrictions regarding language or date of publication. We contacted several authors to identify non-published trials., Selection Criteria: Randomized controlled trials (RCTs) comparing different methods (including the design and materials used) of treating partial edentulism, with clinically relevant outcomes, were included in this review. Trials reporting only surrogate outcomes, such as plaque accumulation or gingival volume, were excluded from this review., Data Collection and Analysis: Two review authors independently carried out the screening of eligible studies, assessment of dimensions of quality of trials, and data extraction. Results were expressed as mean differences for continuous data, risk ratios for dichotomous outcomes, and hazard ratios with 95% confidence intervals for time-to-event data., Main Results: Twenty-one trials met the inclusion criteria for this review. Twenty-four per cent of these were assessed as being at high risk of bias and the remainder were at unclear risk of bias. The clinical heterogeneity among the included studies precluded any attempt at meta-analysis. There was insufficient evidence to determine whether one type of removable dental prosthesis (RDP) was better or worse than another. With fixed dental prostheses (FDPs), there was no evidence that high gold alloys are better or worse than other alloys, nor that gold alloys or frameworks are better or worse than titanium. There is insufficient evidence to determine whether zirconia is better or worse that other FDP materials, that ceramic abutments are better or worse than titanium, or that one cement was better or worse than another in retaining FDPs. There is insufficient evidence to determine the relative effectiveness of FDPs and RDPs in patients with shortened dental arch or to determine the relative advantages of implant supported FDPs versus tooth/implant supported FDPs., Authors' Conclusions: Based on trials meeting the inclusion criteria for this review, there is insufficient evidence to recommend a particular method of tooth replacement for partially edentulous patients.

Subjects: The subjects in this retrospective case series were derived from a review of 700 patient files within the implant practice of the Department of Periodontology, University Hospital, Catholic University of Leuven. Inclusion criteria were met by 412 patients (240 females, 172 males) receiving a total of 1514 Nobel Biocare dental implants. These patients were included based on data availability for the time period 2 years after abutment surgery (considered to represent late implant failure)., Key Exposure/study Factor: Given the concern of the authors to assess the probability of late implant failure among clinic patients with certain local and systemic factors, the potential factors were multiple. The local factors included the following: implant length and diameter, bone quality and quantity, insertion site, type of edentulism, antibiotic use perioperatively, dehiscence and/or perforation of the site during surgery, and stability at insertion (measured by Periotest values). The related health and behavioral factors included the following: medications, smoking (<10 cigarettes/day, 10-20 cigarettes/ day, >20 cigarettes/day), hypertension, ischemic cardiac problems, coagulation anomalies, gastric ulcers, thyroid disorders, hypercholesterolemia,rheumatoid arthritis, asthma, diabetes (types 1 and 2), Crohn's disease, and chemotherapy., Main Outcome Measure: The primary outcome was described as "late implant failure." The current study, which follows a similar study on early implant failure, aims to identify negative influences on maintenance of integration. The authors used the clinical experience related to the 412 patients with 1514 implants to identify whether the observed failure rates were influenced by local and systemic factors. Failure was defined as "late" when occurring between abutment connection surgery and 2 years after this date. Patients/implants that were not available for this interval of time were not included. However, even when records were available, not all patient records provided all data sought., Main Results: Regarding local factors, the authors reported that implant diameter and location were relevant to late implant loss, whereas implant length was not (P value = .01, = .34, respectively; univariate generalized estimating equation [GEE] logistic regression). Regarding implant diameter, significantly more loss was noted for 5.00-mm implants when compared with the 4.00-mm or 4.75-mm implants. Failure related to location revealed that the maxilla compared with the mandible, posterior jaws compared with anterior jaws, and the posterior maxilla compared with all other oral locations were associated with more late failures (Table 1). Assessment of systemic factors revealed radiotherapy to be related to more late implant loss (P = .003). Neither systemic disease nor smoking exposure was associated with late failure., Conclusions: The authors concluded that late implant failure was influenced by the local factor "implant location" and the systemic factor "radiotherapy." Neither smoking nor systemic health factors were found to adversely influence implant integration from abutment connection through 2 years' performance.

This paper includes an update of a Cochrane systematic review on tobacco use cessation (TUC) in dental settings as well as narrative reviews of possible approaches to TUC and a more detailed discussion of referral for specialist TUC services. On the basis of these reviews we conclude that interventions for tobacco users in the dental setting increase the odds of quitting tobacco. However, the evidence is derived largely from patients using smokeless tobacco. Pharmacotherapy (such as nicotine replacements, bupropion and varenicline) is recommended for TUC in medical settings but has received little assessment in dental applications, although such evidence to date is promising. Whether the dental setting or referral to specialist TUC services is the most effective strategy to help people to quit tobacco use is unclear. An effective specialist service providing best available TUC care alone may not be the answer. Clearly, such services should be both accessible and convenient for tobacco users. Closer integration of specialist services with referrers would also be advantageous in order to guide and support oral health professionals make their referral and to maximise follow-up of referred tobacco users. Future research direction may consider investigating the most effective components of TUC in the dental settings and community-based trials should be a priority. Pharmacotherapy, particularly nicotine replacement therapy, should be more widely examined in dental settings. We also recommend that various models of referral to external and competent in-house TUC specialist services should be examined with both experimental and qualitative approaches. In addition to overall success of TUC, important research questions include facilitators and barriers to TUC in dental settings, preferences for specialist referral, and experiences of tobacco users attempting to quit, with dental professionals or specialist services, respectively.

Background: Barriers exist to the U.S. surgeon general's call to action toward a goal of achieving oral health for all Americans. The authors describe perceptions of oral health among the public according to the results of a statewide survey conducted in Minnesota., Methods: During a four-month period in 2005, 1,636 noninstitutionalized adults received a mixed-mode mail and telephone survey. The 40-item survey contained questions regarding the importance of oral health to respondents (overall), as well as the relative importance of oral health to overall health compared with diabetes, heart disease and arthritis., Results: The majority of respondents (76.1 percent) rated the overall importance of their oral health as "very important." Interestingly, 58.2 percent, 45.8 percent and 69.2 percent of respondents believed that oral health was "about as important" as or "more important" than diabetes, heart disease and arthritis, respectively. Only sex and educational level were associated with self-reports of overall importance of oral health., Conclusions: The findings suggest that the majority of survey respondents considered oral health to be very important and equal in importance to certain medical conditions., Clinical Implications: Among survey respondents, men with less than a college education were less likely than others to value oral health. Clinicians should recognize that this may affect behavior in this patient group, especially among those who may not visit a dentist regularly. When researchers design interventions to address oral health perceptions among the public, health care professionals and/or policymakers, they need to take this patient group into account.

Purpose: The purpose of this study was to test whether calmodulin-like protein (CLP) is expressed in normal human oral mucosal cells and if downregulation of CLP occurs in malignant transformation., Materials and Methods: Oral mucosal tissue was taken from three individuals in a double-blind manner. The samples were cut, measured, and homogenized. Total RNA was extracted and reverse transcribed. Each cDNA sample was subjected to polymerase chain reaction (PCR). PCR fragments were purified, cloned, and sequenced to verify the presence of CLP. Three oral mucosal tissue samples with biopsy-confirmed squamous cell carcinoma were obtained. These samples demonstrated regions of normal epithelial cells as well as invasive squamous cell carcinoma. One normal breast epithelial sample was also obtained for positive control. Sections were stained with an affinity-purified CLP antibody and counterstained with a diluted hematoxylin. Two observers evaluated the specimens for expression of CLP. Staining patterns and intensity were noted in normal oral mucosa, comparing them to the normal breast epithelium sample. Staining patterns and intensity were then observed in squamous tumor cells, comparing them to the patterns of benign squamous mucosa., Results: CLP coding sequences were positively identified from the normal oral mucosal tissue samples by reverse transcription and polymerase chain reaction (RT-PCR) with 100% identity to the published CLP sequence (accession #M58026). In the three oral mucosa tissue samples with known squamous cell carcinoma, expression of CLP was readily detected in areas of normal oral mucosa, while a notable downregulation of CLP expression occurred in areas of malignant transformation. The staining intensity was equivalent to the staining seen in the benign breast epithelium used as a control. In the areas of squamous cell carcinoma, a decrease in CLP immunoreactivity occurred. There was a sharp contrast in staining quality and clarity between benign and malignant tissue. In the majority of the carcinoma regions, a complete lack of immunoreactivity was noted., Conclusions: The RNA for human CLP is found in normal oral mucosa. CLP expression is seen in normal oral mucosa with a downregulation of CLP expression in malignant transformation.

Background: Time and resource constraints limit the ability of oral health care professionals to help patients quit smoking. Opportunities exist for dental providers to help patients who smoke by enrolling them in tobacco use quitlines. The authors conducted a pilot study to investigate whether such referrals were feasible and effective., Methods: The authors randomly assigned eight general dental practices to provide either brief counseling regarding smoking cessation or brief counseling along with referrals to a tobacco use quitline for patients receiving routine dental hygiene care who reported that they were currently smoking cigarettes., Results: The authors enrolled 82 patients (60 in the tobacco use quitline group, 22 in the brief counseling group). At six months, the self-reported, seven-day point prevalence tobacco use abstinence rates were 25.0 percent (15 of 60 patients) in the tobacco use quitline group and 27.3 percent (six of 22 patients) in the brief-counseling group (P approximately 1.0). Twenty-eight (47 percent) of 60 subjects in the tobacco use quitline group completed the initial tobacco use quitline consultation. Abstinence rates among subjects in the quitline group were higher if they completed more telephone consultations., Conclusions: Referral to a tobacco use quitline by dental practices is a feasible strategy for helping patients quit smoking if efficient links between the dental practice and the tobacco use quitline can be established. Research is needed to evaluate whether it is more effective than standard clinical interventions for tobacco use cessation., Clinical Implications: Dental practitioners with limited time and other resources can assist patients who smoke by referring them to a tobacco use quitline.

Purpose: A systematic review of the available literature to assess the effects of time to loading of implants on treatment outcomes., Methods: PubMed search strategies identifying clinical trials on implant prosthetics, combined with searching of a personal library and reference lists from included studies, resulted in 1,882 titles published before May 1, 2005. Two independent reviewers appraised the titles and abstracts and identified 187 papers that seemed to focus on the effects of time to loading on treatment outcomes in clinical trials. These papers were retrieved and critically appraised in full text. A set of predefined inclusion and exclusion criteria were applied. All trials (randomized and nonrandomized clinical trials, prospective and retrospective) were included in the review if both an experimental and a control group were adequately described, if the implants had been followed for at least 1 year, and if the sample contained at least 5 patients., Results: Twenty-two papers, published between 1990 and 2005 described the influence of time to loading on implant treatment success. Seven trials were randomized controlled trials, 13 were prospective with concurrent controls, and 2 were retrospective with concurrent controls. The general impression of the papers was that (1) the methodologic rigor of the trials was often not very strong, (2) the reported treatment outcomes were mostly surrogate rather than patient-centered, and (3) the follow-up times were relatively short. Statistical comparisons between subgroups were considered inappropriate because of the heterogeneity of trials. Data from 19 trials reporting different patient follow-up periods between 1 and 10 years suggest that the overall performance was not significantly different between immediate or early loaded implants versus implants using a conventional loading period., Conclusion: Within the limitations of the study populations in the papers appraised in this systematic review, although the average outcome was in favor of delayed loading, there are no indications that immediate or early loading cannot be a safe procedure.

Background: Tobacco use has significant adverse effects on oral health. Oral health professionals in the dental office or community setting have a unique opportunity to increase tobacco abstinence rates among tobacco users., Objectives: This review assesses the effectiveness of interventions for tobacco cessation offered to cigarette smokers and smokeless tobacco users in the dental office or community setting., Search Strategy: We searched the Cochrane Tobacco Addiction group Specialized Register (CENTRAL), MEDLINE (1966-2004), EMBASE (1988-2004), CINAHL (1982-2004), Healthstar (1975-2004), ERIC (1967-2004), PsycINFO (1984-2004), National Technical Information Service database (NTIS, 1964-2004), Dissertation Abstracts Online (1861-2004), Database of Abstract of Reviews of Effectiveness (DARE, 1995-2004), and Web of Science (1993-2004)., Selection Criteria: We included randomized and pseudo-randomized clinical trials assessing tobacco cessation interventions conducted by oral health professionals in the dental office or community setting with at least six months of follow up., Data Collection and Analysis: Two authors independently reviewed abstracts for potential inclusion and abstracted data from included trials. Disagreements were resolved by consensus., Main Results: Six clinical trials met the criteria for inclusion in this review. Included studies assessed the efficacy of interventions in the dental office or a school community setting. All studies assessed the efficacy of interventions for smokeless tobacco users, one of which included cigarettes smokers. All studies employed behavioural interventions and only one offered pharmacotherapy as an interventional component. All studies included an oral examination component. Pooling of the studies suggested that interventions conducted by oral health professionals increase tobacco abstinence rates (odds ratio [OR] 1.44; 95% confidence interval [CI]: 1.16 to 1.78) at 12 months or longer. Heterogeneity was evident (I(2) = 75%) and could not be adequately explained through subgroup or sensitivity analyses., Authors' Conclusions: Available evidence suggests that behavioural interventions for tobacco use conducted by oral health professionals incorporating an oral examination component in the dental office and community setting may increase tobacco abstinence rates among smokeless tobacco users. Differences between the studies limit the ability to make conclusive recommendations regarding the intervention components that should be incorporated into clinical practice.

Smokeless tobacco (ST) use is an important health issue in the United States, and chronic use leads to significant morbidity. ST users are exposed to levels of nicotine comparable with smokers and experience symptoms of nicotine withdrawal when attempting to stop. Clinical treatment of ST users requires an understanding of the unique characteristics of ST. This article reviews ST products, epidemiology, pharmacology, health risks, and treatment approaches.

Overdentures supported by osseointegrated implants overcome many of the complications observed with overdentures supported by natural teeth. Dental implants are free of biologic consequences associated with natural teeth, such as dental caries and periodontal disease. Bone undercuts adjacent to implants do not mimic those found adjacent to natural tooth roots. Implants are used to provide predictable retention, support, and stability for overdenture prostheses. When lip or facial support is required, the overdenture is the treatment of choice. Likewise the overdenture may improve phonetic deficiencies associated with alveolar bone loss.