Recently published reports(1-5) as well as a consensus statement(6) have suggested an alarming increase in inflammatory responses around dental implants that are accompanied by variable levels of marginal bone loss. These responses are popularly referred to as an escalating disease entity-so-called "peri-implantitis." This emerging mindset poses serious questions for the long-term viability of the osseointegration technique if the condition indeed exists in a primary form. However, the bulk of the existing literature related to osseointegration has not described peri-implant gingivitis with accompanying marginal bone changes in such dramatic terms. In fact, it has been well documented that failure to induce and maintain long-term osseointegration actually occurs in less than 5% of treated patients. Moreover, clinical outcome studies have not routinely described complications related to progressive soft or hard tissue deterioration. Consequently, the current emphasis on the significance of peri-implant bone loss represents either an ignored phenomenon or is an overtly pessimistic interpretation of or emphasis on a somewhat rarely occurring event. In an effort to determine which of these dichotomous occurrences more closely resembles the truth, an independent initiative sought to evaluate questions related to soft and hard tissue damage adjacent to dental implants.

Purpose: The aim of this study was to test the null hypothesis that there is no difference in implant failure rates, marginal bone loss, and postoperative infection for implants inserted in bone with different qualities and quantities according to the classification of Lekholm and Zarb. Materials and Methods: An electronic search was undertaken in January 2015 for randomized and nonrandomized human clinical studies. Results: A total of 94 publications were included. When bone sites of different qualities were considered, the results suggested the following comparative implant failure rates: 1 > 2, 1 > 3, 3 > 2, 4 > 1, 4 > 2, and 4 > 3. Sensitivity analyses suggested that when implants inserted in bone qualities 1 and 2 and 1 and 3 were compared, oxidized and sandblasted/acid-etched surfaces showed a decrease in significant difference in failures compared with turned implants. The same is not true for failure of implants inserted in bone quality 4 compared to failure of implants in all other bone qualities. When bone sites of different quantities were considered, the following comparative implant failure rates were observed: A > B, A > C, A < D, B < C, B < D, C < D, E > A, E > B, E > C, E > D. Due to insufficient information, meta-analyses for the outcomes postoperative infection and marginal bone loss were not performed. Conclusion: Sites with poorer bone quality and lack of bone volume may statistically affect implant failure rates. Implant surfaces may play a role in failure of implants in different bone qualities.

Purpose: To assess the influence of several factors on the prevalence of dental implant failure, with special consideration of the placement of implants by different dental surgeons. Materials and Methods: This retrospective study is based on 2,670 patients who received 10,096 implants at one specialist clinic. Only the data of patients and implants treated by surgeons who had inserted a minimum of 200 implants at the clinic were included. Kaplan-Meier curves were stratified with respect to the individual surgeon. A generalized estimating equation (GEE) method was used to account for the fact that repeated observations (several implants) were placed in a single patient. The factors bone quantity, bone quality, implant location, implant surface, and implant system were analyzed with descriptive statistics separately for each individual surgeon. Results: A total of 10 surgeons were eligible. The differences between the survival curves of each individual were statistically significant. The multivariate GEE model showed the following variables to be statistically significant: surgeon, bruxism, intake of antidepressants, location, implant length, and implant system. The surgeon with the highest absolute number of failures was also the one who inserted the most implants in sites of poor bone and used turned implants in most cases, whereas the surgeon with the lowest absolute number of failures used mainly modern implants. Separate survival analyses of turned and modern implants stratified for the individual surgeon showed statistically significant differences in cumulative survival. Conclusion: Different levels of failure incidence could be observed between the surgeons, occasionally reaching significant levels. Although a direct causal relationship could not be ascertained, the results of the present study suggest that the surgeons’ technique, skills, and/or judgment may negatively influence implant survival rates.

PURPOSE: The purpose of the study was to investigate whether oral health-related quality of life (OHRQOL) in an adult Swedish population could be explained by social attributes; individual attributes; dental status, with a special focus on the role of prosthodontics; and dental care attitudes. MATERIALS AND METHODS: The study was based on responses to a questionnaire sent in 1998 to a random sample of 1,974 persons aged 50 to 75 years (66% response rate). Three factors representing various aspects of OHRQOL were set as dependent variables in multiple-regression models: oral health impact on everyday activities, oral health impact on the psychologic dimension, and oral health impact on oral function. Independent variables in the models were social attributes, individual attributes, number of teeth, denture (ie, type of denture, if present), and dental care attitudes. RESULTS: General health in relation to age peers had the strongest association with all 3 dependent variables, followed by number of teeth and need care--cost barrier. When number of teeth was excluded, removable denture was found to covary with the dependent variables in each of the 3 regression models. CONCLUSION: The number of remaining teeth is more important than the type of denture in explaining OHRQOL. It is less important that a denture is fixed for those with few remaining teeth, in contrast to all others. Explanations are also found in general health and various aspects of dental care costs.

PURPOSE: This study compared the long-term effects of treatment with a stabilization appliance and treatment with a control appliance in patients with temporomandibular disorders (TMD). MATERIALS AND METHODS: In a controlled trial, 60 TMD patients with tem-poromandibular joint (TMJ) pain were evaluated after 10 weeks of treatment with either a stabilization appliance or a control appliance. At the 10-week follow-up, the 60 patients were assigned to one of three groups according to their demand for treatment. Group T, the treatment group, comprised 30 patients treated with a stabilization appliance; group C, the control group, comprised nine patients treated with a control appliance; and group M, the mixed treatment group, comprised 21 patients treated with first a control appliance and then a stabilization appliance. Signs and symptoms were evaluated in all three groups at 6- and 12-month follow-ups. RESULTS: At the 6- and 12-month follow-ups, a significant reduction in TMJ pain as measured on a visual analogue scale was found in all three groups, and a significant decrease in signs and symptoms was found in groups T and M. CONCLUSION: After 6 and 12 months of use, the stabilization appli-ance was found to still be effective in the alleviation of signs and symptoms in patients with TMD. Many patients in group C changed to a stabilization appliance at the 1 0-week follow-up, which significantly reduced the number of patients in this group. Most patients reported positive change in overall subjective symptoms in this trial. The stabilization appliance can therefore be recommended for patients with TMD.

PURPOSE: The aim of this investigation was to evaluate the clinical outcome of two different surgical protocols in the edentulous mandible: submerged and nonsubmerged. Further, the Paragon dental implant with a titanium plasma-sprayed surface was evaluated. MATERIALS AND METHODS: Twenty-nine consecutively treated patients with 168 implants supporting fixed prostheses were included. All but 3 patients were provided 6 implants, placed via nonsubmerged healing on one side and submerged healing on the other. Data were collected from patient records and radiographs. Twenty-four patients participated in the 5-year clinical follow-up examination. RESULTS: After 5 years, all patients still had their mandibular fixed prostheses in function. Cumulative survival rates were 100% for prostheses and 99.4% for implants. However, 3 implants fractured in 1 patient. One submerged implant was lost before loading but no further implants were lost during follow-up. The radiographic bone loss was small for all implants with a mean of 0.14 mm (standard deviation [SD]: 0.37) at 1 year and 0.42 mm (SD: 0.48) at 5 years for nonsubmerged implants and 0.17 mm (SD: 0.32) at 1 year and 0.51 mm (SD: 0.33) at 5 years for submerged implants. Nineteen implants (including the 3 that fractured) presented annual bone loss exceeding 0.2 mm after the first year, yielding a cumulative success rate of 86.2% after 5 years. CONCLUSION: Single-stage surgery was shown to have the same predictability as two-stage surgery in the anterior edentulous mandible. Paragon implants with a titanium plasma-sprayed surface showed a fracture rate of 2.2% and a success rate of 86.2% after 5 years.

The aim of this study was to evaluate the reliability of the impression replica technique with a four-unit zirconia fixed dental prosthesis (FOP). Marginal and internal fit were measured by repeatedly placing the FDP on an epoxy cast using light-body silicone material corresponding to cement. All measured marginal and internal fit points showed varying values. The greatest variations were seen at the most distal margin (33 mu m) and at the distal abutment of the FDP (77 mu m). The results showed that the technique gives moderate variations and is a useful method to evaluate marginal and internal fit.

Purpose: To systematically evaluate and compare the clinical performance of lithium disilicate (LDS)and zirconium dioxide (ZrO2)-based ceramic monolithic crowns in the posterior dentition. Materials and Methods: Treatment was administered by two experienced general dental practitioners in two public dental health care clinics. Forty-four patients received 60 crowns randomized to be either LDS or ZrO2 and cemented with resin cement. Evaluations were performed after 3 years using California Dental Association criteria. Results: The mean follow-up time was 40 months (range: 31 to 50). No crown fractured during the observation time, and no chip-off fractures occurred. The success rate for ZrO2 was 80%, and the survival rate was 93.3%. For LDS, the success rate was 89.7%, and the survival rate was 100%. Survival after 3 years for all crowns together was 96.6%, and success was 84.7%. There was no significant difference between the two materials. Conclusion: Crowns made of monolithic translucent ZrO2 and LDS show equal and promising clinical results from a short-term perspective. There seems to be a difference between how patients and professionals rate crowns concerning esthetics (color and shape), with patients rating the restorations more favorably.

Purpose: To assess the clinical outcomes of maxillary overdentures supported by dental implants by conducting a literature review. Materials and Methods: An electronic search was undertaken in March 2019. Eligibility criteria included publications reporting cases of implant-supported maxillary overdentures with follow-up information. Results: A total of 131 publications were included (1,478 overdentures supported by 6,681 implants). The mean number of attachments per overdenture was 3.8 ± 1.2 (range: 1 to 9), and a bar-clip system was used in about half of the cases. The prostheses were followed up for a mean of 47.9 ± 32.8 (range: 1 to 240) months. A total of 401 implants (6.0%) failed in 219 patients (14.8%), and 55 prostheses (3.7%) failed at a mean of 40.2 ± 53.2 (range: 6 to 240) months after placement. Most of the failures happened within the first year after placement for both implants (52.1%) and prostheses (41.8%). Patients with fewer implants per prosthesis presented higher prosthesis failure rates than patients with more implants per prosthesis. The cumulative survival rate for dental implants after 19 years was 70.4%, and for implant-supported maxillary overdentures was 79.8%. Presence of palatal coverage and/or metallic structure/reinforcement does not seem to have an influence on failure rate. Of the most commonly used attachment systems, the ball/O-ring and the Ceka were the ones with the highest rates of patients having at least one implant failure. Conclusion: Most of the prosthesis failures were due to loss of implants, and the first year was the most critical period for failures. The number of dental implants placed per patient seemed to have an impact on the occurrence of overdenture failure.

Purpose: To compare clinical and esthetic outcomes between immediately loaded single implants placed with and without a fully guided surgical procedure. Materials and Methods: Patients with a missing maxillary tooth (second premolar to second premolar) were considered for inclusion in this 1-year prospective nonrandomized study. Exclusion criteria were general health contraindications for oral surgery besides the need for bone grafting or ridge augmentation. One group received digital implant planning, fully guided surgery, and immediate loading (DIL). The other group received freehand surgery and immediate loading (IL). Outcome measures were implant survival, marginal bone loss, soft tissue changes, papilla index, pink and white esthetic scores (PES and WES, respectively), and patient-reported outcome measures (PROMs). Results: Two of 21 implants failed in the DIL group soon after placement, resulting in a 1-year implant survival rate of 90.5%, while no implants failed in the IL group. Significantly higher papilla index scores and lower soft tissue changes were found for the DIL group compared to the IL group. No differences were found after 1 year regarding marginal bone loss, PES, WES, or PROMs. Conclusion: Within the limitations of this study, immediate loading in combination with fully guided surgery might negatively affect implant survival. Immediate loading, fully guided surgery, and a digital workflow appear to have a positive effect on early soft tissue adaptation.

This article presents three cases of single labially tilted implants restored with screw-retained single crowns. Individualized abutments with an angled screw channel were used to avoid an unesthetic vestibular access channel. This individualized abutment allows the dentist and dental technician to use the screw-retained restorations where a cemented reconstruction would otherwise have been needed.

PURPOSE: The purpose of this study was to investigate the clinical and radiographic outcome of a prospective 5-year longitudinal multicenter test of a simplified implantology concept comprising an abut-ment-free implant system (Cresco) and a new method for fabrication of passively fitting superstructures, the Cresco Ti Precision method. MATERIALS AND METHODS: The tests were carried out at three different centers. Sixty partially or completely edentulous patients were restored by fixed implant-supported superstructures fabricated according to the Cresco Ti Precision method. In all, 215 Cresco implants were placed for the support of the superstructures. For various reasons, eight patients (13%) could not be followed through the 5 years. The radiographic measurements were recorded from radiographs exposed perpendicular to the implants. RESULTS: The initial implant failure rate (during the healing phase) was 2%, and the survival rate after loading was 98%. The mean peri-implant bone loss was 0.29 mm (SD 0.57). Of the measured sites, 71% showed a crestal bone loss of less than 0.5 mm. Very few mechanical complications were observed. This was attributed to the passively fitting superstructures. CONCLUSION: The results from the present multicenter test demonstrated that the abutment-free Cresco implantology concept is a reliable alternative method for implant-supported fixed prosthetic rehabilitation of edentulous and partially edentulous jaws.

Purpose: This study aimed to review published quantitative studies for evidence regarding the influence of oral rehabilitation following total or partial tooth loss on self-perceived oral health–related quality of life (OHRQoL). Materials and Methods: Three databases were searched using specified indexing terms. The reference lists of relevant publications were also searched manually. Quality of evidence was classified according to GRADE guidelines as high, moderate, low, or very low. Results: The search yielded 2,138 titles and abstracts, 2,102 of which were of a quantitative study design. Based on pre-established criteria, the full-text versions of 322 articles were obtained. After data extraction and interpretation, 5 publications of high or moderate study quality remained. The results of these 5 studies showed positive effects of oral rehabilitation on OHRQoL. Two studies showed substantial improvements. Conclusions: This is a relatively new field of research; there are very few quantitative studies of how patients perceive OHRQoL following tooth loss and subsequent rehabilitation. While this review indicates that treatment has positive effects on quality of life, the scientific basis is insufficient to support general conclusions about the influence of various interventions on the OHRQoL of patients who have experienced total or partial tooth loss. To achieve a more comprehensive analysis, it is recommended that future studies be based on a combination of quantitative and qualitative methods, ie, questionnaires and semi-structured interviews. The follow-up period must also be appropriate for the specific intervention studied.

Purpose: To investigate the impact of different extents of misfit between a restoration and the supporting implant on veneer fractures in screw-retained implant-supported metal-ceramic fixed dental prostheses (FDPs). Materials and Methods: A finite element analysis (FEA) model of a five-unit screw-retained metal- ceramic FDP supported by three implants was constructed, replicating a previous in vitro study. Eight different gap configurations at the single terminal implant, ranging from 0 to 150 μm, were tested. All setups were tested after clamping and with a load of 200 N applied. Maximum stress within the FDP was calculated. Results: The stress increased with each increase in misfit size above 30 μm, with the relationship between gap size and stress being linear up to 100-μm misfit. Above 100 μm, the stress increase accelerated. The stress pattern within the FDP changed with increasing gap size, confirming the findings of a previously conducted in vitro experiment for a misfit of 150 μm. Conclusion: The results of the FEA were in agreement with in vitro observations, validating the predictive value of FEA for technical complications. A misfit between an FDP and a supporting implant implies an increased risk of veneer fracture. Above a misfit of 30 μm, the stress levels are likely to be high enough to cause veneer fracture, and the risk increases disproportionately for misfit above 100 μm.

PURPOSE: The purpose of this investigation was to obtain the opinions and assess the attitudes of Swedish general dental practitioners in private practice versus a public health care setting regarding management of patients with a shortened dental arch (SDA). MATERIALS AND METHODS: A questionnaire containing different statements regarding the SDA concept was sent to a random sample of 189 clinicians. Differences between male and female practitioners and between private practitioners (PPs) and those employed by the Public Dental Health Service (PDHS) were tested for statistical significance by the Student t test. RESULTS: The response rate was 54% (102 clinicians). Among the respondents, 62% were men and 38% were women. Fifty-six percent were PPs and 44% were employed by the PDHS. The results showed small differences in attitudes between various groups of practitioners but large individual variations. In general, Swedish general practitioners had a positive attitude toward the SDA concept with respect to oral function and oral comfort. They recognized few risks with a dentition lacking molar support, although female clinicians were more risk conscious. PPs expressed fewer advantages in using the SDA concept than PDHS practitioners with respect to the reduced risk for overtreatment, better patient economy, and the ability for older patients to keep their teeth. CONCLUSION: The results from this questionnaire study indicate that, overall, Swedish general practitioners have an affirmative opinion toward the SDA concept.

PURPOSE: The aim of this study was to evaluate the clinical performance of two- to five-unit implant-supported all-ceramic restorations and to compare the results of two different all-ceramic systems, Denzir (DZ) and In-Ceram Zirconia (InZ). MATERIALS AND METHODS: Eighteen patients were treated with a total of 25 two- to five-unit implant-supported fixed dental prostheses. Nine patients were given DZ system restorations and 9 were given InZ system restorations. The restorations were cemented with zinc phosphate cement onto customized titanium abutments and were evaluated after 1, 3, and 5 years. RESULTS: At the 5-year follow-up, all restorations were in function; none had fractured. However, superficial cohesive (chip-off) fractures were observed in 9 of 18 patients (11 of 25 restorations). Sixteen units in the DZ group (9 of 13 restorations) and 3 in the InZ group (2 of 12 restorations) had chip-off fractures. The difference between the two groups regarding frequency of chip-off fractures was statistically significant (P < .05 at the FDP level and P < .001 at the unit level). CONCLUSION: The results suggest that all-ceramic implant-supported fixed dental prostheses of two to five units may be considered a treatment alternative. The DZ system, however, exhibited an unacceptable amount of veneering porcelain fractures and thus cannot be recommended for the type of treatment evaluated in this trial. Poor compatibility or problems with the bond mechanisms between the veneer and framework could not explain the chip-off fractures. Stress distribution, as well as other factors concerning the veneering porcelain, need to be evaluated further.

PURPOSE: The aim of this study was to evaluate the long-term clinical performance of and patient satisfaction with implant-supported all-ceramic fixed dental prostheses (FDPs) and to compare two different all-ceramic systems, Denzir (DZ) and In-Ceram Zirconia (InZ). MATERIALS AND METHODS: A total of 18 patients received 25 partial FDPs; 13 DZ, and 12 InZ. RESULTS: Of these patients, 17 attended the 10-year follow-up. None of the restorations had fractured. Fractures of the veneering porcelain were observed in nine patients; two from the InZ group and seven from the DZ group. All FDPs were in use, and all patients were fully satisfied with the treatment. CONCLUSION: Results from this long-term follow-up suggest that implant-supported all-ceramic FDPs are an acceptable treatment alternative.

PURPOSE: The development of high-strength oxide ceramic materials has led to increased interest in all-ceramic fixed dental prostheses (FDPs). Success rates reported in clinical studies for all-ceramic FDPs based on high-strength oxide ceramic materials reportedly approach those of porcelain-fused-to-metal FDPs. These reconstructions, however, are still of limited size and have mainly concerned FDPs supported by natural teeth. The purpose of this study was to evaluate the clinical performance of multiunit all-ceramic FDPs supported by dental implants. MATERIALS AND METHODS: Ten patients received mandibular yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) FDPs manufactured according to the Cercon technique and supported by four Astra Tech implants. Nine patients received 10-unit FDPs and one patient received a 9-unit FDP. The FDPs were cemented with Panavia F 2.0 onto individually prepared titanium abutments. The FDPs were evaluated at baseline and after 12, 24, and 36 months. RESULTS: At the 3-year follow-up, all FDPs were in use, and all patients were fully satisfied with their treatment. None of the reconstructions had fractured. Superficial chip-off fractures of the veneering porcelain were, however, observed in nine patients (34 of 99 units, 34%). CONCLUSION: Results from this 3-year study suggest that implant-supported full-arch Y-TZP FDPs manufactured according to the Cercon technique should be viewed as a treatment alternative cautiously. A better understanding of the factors resulting in chip-off fractures is needed, together with longer follow-up studies involving larger numbers of patients, before the material and technique can be recommended for general use.

Purpose: This Review aimed to evaluate the documented clinical success of zirconia-based crowns in clinical trials. Materials and Methods: Electronic databases were searched for original studies reporting on the clinical performance of tooth- or implant-supported zirconia-based crowns including PubMed, Cochrane Library and Science Direct. The electronic search was complemented by manual searches of the bibliographies of all retrieved full text articles and reviews as well as hand search of the following journals: International Journal of Prosthodontics, Journal of Oral Rehabilitation, International Journal of Oral & Maxillofacial Implants and Clinical Oral Implants Research. Results: The search yielded 3,216 titles. Based on pre-established criteria, 42 full-text articles were obtained. While 16 studies fulfilled the inclusion and exclusion criteria, only 3 randomized controlled trials were reported. Seven studies reported on tooth-supported and four on implant-supported crowns, and 5 studies reported on both types of support. Ten studies on tooth-supported and 7 on implant-supported crowns provided sufficient material for statistical analysis. Life table analysis revealed cumulative 5-year survival rates of 95,9% for tooth-supported and 97,1% for implant-supported crowns respectively. For implant-supported crowns the most common reasons for failure were technical (veneering material fractures). For tooth-supported crowns technical (veneering material fractures, loss of retention) and biological (endodontic/periodontic) reasons for failure were equally common. The most common complications for implant-supported crowns were veneering material fractures and bleeding on probing. For tooth-supported crowns the most common complications were loss of retention, endodontic treatment, veneering material fractures, and bleeding on probing. Conclusion: The results suggest that the success rate of tooth-supported and implant-supported zirconia-based crowns is adequate, similar, and comparable to that of conventional porcelain-fused-to-metal crowns. These results are, however, based on a relatively few studies, many that are not controlled clinical trials. Well-designed studies with large patient groups and long follow-up times are needed before general recommendations for the use of zirconia-based restorations can be provided.

PURPOSE: Despite the interest and need to assess orofacial esthetics in prosthodontic patients, few self-reporting instruments are available to measure this construct, and none describe how prosthodontic patients perceive the appearance of their face, mouth, teeth, and dentures. The development of the Orofacial Esthetic Scale (OES) is reported in this article, in particular its conceptual framework, how questionnaire items were generated, and the scale's measurement model. MATERIALS AND METHODS: After test conceptualization, the authors solicited esthetic concerns from 17 prosthodontic patients by asking them to evaluate their own photographs. A focus group of 8 dental professionals reduced the initial number of concerns/items and decided on an item response format. Pilot testing in 9 subjects generated the final instrument, the OES. Exploratory factor analysis was performed to investigate OES dimensionality and item analysis to investigate item difficulty and discrimination in 119 subjects. RESULTS: Prosthodontic patients generated an initial 28 esthetic concerns. These items were reduced to 8 preliminary representative items that were subsequently confirmed during pilot testing. Analysis supported 8 items assessing appearance: face, profile, mouth, tooth alignment, tooth shape, tooth color, gums, and overall impression, measured on an 11-point numeric rating scale (0 = very dissatisfied, 10 = very satisfied). Exploratory factor analysis found only 1 factor and high positive loadings for all items (.73 to .94) on the first factor, supporting the unidimensionality of the OES. CONCLUSIONS: The OES, developed especially for prosthodontic patients, is a brief questionnaire that assesses orofacial esthetic impacts.

PURPOSE: This study evaluated the reliability and validity of the Orofacial Esthetic Scale (OES)-an instrument assessing self-reported orofacial esthetics in prosthodontic patients. MATERIALS AND METHODS: The OES has seven items addressing direct esthetic impacts in the orofacial region, as well as an eighth global assessment item. The response format was a 0 to 10 numeric rating scale (very dissatisfied to very satisfied with appearance, respectively). OES summary scores ranged from 0 (worst score) to 70 (best score). Test-retest reliability (n = 27) and internal consistency (n = 119) were assessed. Content validation (asking patients about their satisfaction with the questionnaire content, n = 119) and discriminative validation (comparing OES scores between patients and healthy controls, n = 119) were performed. Convergent validity was assessed by correlating patients' own OES scores (n = 29) with ratings from a consensus expert group (n = 4) and with the Oral Health Impact Profile (OHIP) esthetic-item summary score (n = 119). RESULTS: Test-retest reliability was excellent for the OES scores (intraclass correlation coefficient = .96). Internal consistency was satisfactory for esthetically impaired patients (n = 27, Cronbach alpha = .86). Patients rated their satisfaction with the questionnaire content as 7.8 +/- 1.3 units on a 0 to 10 numeric rating scale (0 = very dissatisfied, 10 = very satisfied). OES scores discriminated esthetically impaired patients (31.4 units) from healthy controls (45.9 units, P < .001). OES scores correlated well with other measures of the same construct (r = .43 for patients' own assessment with an assessment by experts using the OES, r = -.72 for a correlation with the OHIP's three esthetic-related items). CONCLUSIONS: The OES, developed especially for prosthodontic patients, exhibited good score reliability and validity.

Purpose: To assess and compare the clinical outcomes of three different types of all-ceramic posterior monolithic tooth-supported crowns. Materials and Methods: A total of 71 patients received 90 all-ceramic crowns randomized to be either high-translucency zirconia (ZC), high-translucency zirconia with a partial buccal veneer (ZC-V), or lithium disilicate glass-ceramic (LDS). All treatments were performed by four general dentists. Choice of material was blinded. Baseline and subsequent annual evaluation were based on modified California Dental Association (CDA) criteria. A questionnaire was used to include patient-reported outcomes and to compare them to the crown quality rating performed by dentists. Results: A total of 66 patients with 84 crowns were examined after 3 years. The survival rate was 98.8%. No crowns fractured during the observation period. One ZC-V crown failed due to loss of retention, and three complications were noted: loss of retention occurred in one ZC crown, and two ZC crowns needed to be endodontically treated. There was no significant difference between the different crowns regarding marginal integrity, surface, or anatomical form. Both patients and examining dentists rated the crowns favorably regarding esthetics, patients more than dentists. Conclusion: Posterior lithium disilicate glass-ceramic crowns and translucent zirconia crowns with or without a partial buccal veneer show excellent and promising clinical outcomes from a short-term perspective. Patients and dentists rate the restorations favorably concerning esthetics and function.

Emerging evidence implies significant interrelations between the condition of the peri-implant tissues and the implant-abutment-prosthesis complex. A new paradigm for studying the peri-implant tissues in close interrelation with the implant-abutment-prosthesis complex in the presence of the oral biofilm is essential. The aims of this paper are to introduce the concept of the "implant supracrestal complex" (ISC) and to describe the critical elements that define it as a unique anatomical and functional system of human tissues, mechanical components, and oral bacteria/biofilm. This paper reviews recent evidence to identify the impact of design features on short-term clinical outcomes and long-term health of the peri-implant bone and soft tissues. Prosthetic-driven implant placement is a prerequisite for proper ISC design, which in turn can indirectly influence the structure and dimensions of the peri-implant soft tissues. Design features of the implant-prosthesis-abutment complex, such as the emergence profile, emergence angle, and cervical margin, as well as the design of the implant-abutment and abutment-prosthesis junctions and their locations in relation to the tissues of the ISC, can have a significant impact on the maintenance of stable and healthy peri-implant tissues in the long term.

PURPOSE: The purpose of the study were to evaluate the clinical performance of the Procera porcelain-fused-to-titanium crown system in general practice during a 2-year period, and to evaluate the performance of a new low-fusing porcelain as a veneering material on titanium.

MATERIALS AND METHODS: A number of consecutive complete-coverage crowns (40) in 25 patients (14 women and 11 men) with a mean age of 53.1 years (range 35 to 79 years) were made according to the Procera (Nobel Biocare) technique in a 3-month period. The titanium copings were fabricated from solid rods of pure titanium using spark erosion and copy-milling technique, whereafter they were veneered with a new type of low-fusing ceramic material. The crowns were evaluated using the CDA criteria at baseline and after 2 years.

RESULTS: The general failure rate was low and was restricted to one carious lesion, one porcelain fracture, and one loss of a crown resulting from failure of retention of a post and core. The most frequent single reason that the "excellent" color level was not recorded was a "too-high value." A slightly dull or granular porcelain surface was observed both at baseline and after 2 years. Overall, the responses of the patients were positive.

CONCLUSION: Within the limitations of the study it can be concluded that porcelain-veneered Procera titanium crowns can be used as an alternative to other porcelain-fused-to-metal systems. However, conclusions should be made with caution from the results of this study because of the limited number of patients and crowns and the short observation period.

PURPOSE: The aim of this research was to investigate possible factors behind the desire for and changes in attitude toward implant treatment in a population of middle-aged and older individuals in Sweden. MATERIALS AND METHODS: In 1989 and 1999, questionnaires were sent to 3,000 residents in Orebro County, Sweden. Response rates were 79% and 68%, respectively. Those responding to both questionnaires yielded a longitudinal study panel. Logistic regression models were done with "desire of implant treatment" and "changes in desire of implant treatment" as dependent variables. RESULTS: Older people, non-city residents, and those with one or several missing and unreplaced teeth changed their desire for implant treatment between study years. Effects of age, residence, and better dental status disappeared during the 10-year study period. Those who were edentulous and those with removable dentures (pseudo R2: 0.17) expressed lower desire for treatment than those with all teeth remaining or only one or a few teeth missing (pseudo R2: 0.24) in 1989. High income significantly increased the probability to desire implant treatment for the study panel at both study occasions (P = .016 and P = .034 for 1989 and 1999, respectively). CONCLUSIONS: Factors influencing desire for implant treatment were primarily income and dental status. The influence of young age, urban living, and dental status regarding the subgroup with one or several teeth missing in relation to those with all their teeth disappeared during the 10-year study period

PURPOSE: The aims of this research were to describe the process leading to desire for implant treatment, describe how patients missing teeth gained information about implant treatment, identify gatekeeping factors for implant treatment, and note experiences in changes in oral health-related quality of life. MATERIALS AND METHODS: The constant comparative method for a grounded theory was used in collecting and analyzing data. Ten informants participated in the study, all of whom were treated with implant-supported fixed dentures during the past year. RESULTS: The emerging core category was that participants experienced a journey from social stigma to exhilaration. This process ended in the perspective that the participants' new lives with dental implants were very good and meant an end to their social stigma, but gatekeeping factors before treatment, such as cost and dental anxiety, were noted. The dentist's opinion and suggestions were the most decisive part of the decision-making process, and trust in the dentist and dental team was crucial in the decision to undergo treatment and in the overall treatment experience. Great improvement in oral health-related quality of life was noted. CONCLUSION: This qualitative study gives as the core category and main finding the importance of patients' trust and confidence in the dentist and his/her staff in the process of transforming desire for dental implant treatment into demand and also in making it more likely for patients to be satisfied with treatment regardless of complications.

PURPOSE: To assess, at a 10-year interval, changes in attitudes toward desire for implant treatment among middle-aged and older Swedish subjects with respect to dental status. MATERIALS AND METHODS: Three thousand subjects, residents of Orebro County, Sweden, were surveyed via the same questionnaire in 1989 and again in 1999 regarding their possible need for and interest in implant-based prosthodontic treatment. RESULTS: One thousand six hundred sixty-five subjects responded to both surveys. In 1989 few respondents indicated an interest in implant treatment, whereas in 1999, 92% of those who had not indicated an interest in the earlier survey now indicated that they desired implant treatment. The cohort reporting having no teeth had a considerable lower increase in desire. Among those who reported a possible treatment need (ie, missing 1 or more teeth and had not had them replaced or those who wore complete dentures), cost was the most commonly cited reason for declining implant treatment. CONCLUSIONS: There was a dramatic increase in the interest for implant treatment over the period from 1989 to 1999. Changes in awareness of implant treatment, along with an expansion in the number of qualified providers, may have contributed to this increase.

PURPOSE: Patients' oral health needs are estimated through dialogue and professional assessment. The concepts of need and demand are vital to studies of dental care and oral health. Need does not always lead to demand for treatment or to utilization, depending on the gatekeeping processes between need and demand and between demand and utilization. Demand must be accepted with the understanding that there is no objective need and that demand depends on the patient's opinion. In accordance with this, the need for prosthodontic treatment is highly individual and is not automatically related to oral health status, making need and demand difficult to measure in that respect. Therefore, sociodental factors should be included and evaluated in studies of need and demand for utilization of prosthodontic care. MATERIALS AND METHODS: This theoretical and analytic paper focuses on the gatekeeping processes between need and demand and between demand and utilization of prosthodontic care. RESULTS: The concept of gatekeeping refers to the social and psychologic processes that transform need into demand and demand into utilization. It implies that they are complex processes that can render great differences between demand and actual utilization. CONCLUSION: It is not possible to estimate a patient's needs for prosthodontic care, since there is no objective need. Demand and utilization are factors that play an important role in the gatekeeping process. These factors are dependent on the patient's opinion, which is influenced by numerous factors.

PURPOSE: The concepts of need and demand are central in studies on dental care. In the literature, a normative definition is often used, but it pays little attention to the individual's personal comfort and quality of life. Need and demand for prosthodontic services are difficult to measure, as prosthodontic treatment is highly individual and not closely related to edentulousness. Need, however defined, does not always lead to demand for treatment, depending on a variety of factors. MATERIALS AND METHODS: The present article is part of a larger study in which the intention is to evaluate need and demand for prosthodontic treatment among the participants in a 1989 and 1999 longitudinal study of a population sample. As the first step, this article reports a conceptual analysis of the need concept from the literature. RESULTS: Need is stated as socially established in the interaction between patient and clinician. It makes demand dependent on available treatment options from the care provider and society. In the prosthetic treatment decision-making process, the emancipatory perspective with the patient-clinician dialogue is of utmost importance to achieve an optimal treatment result. CONCLUSION: The professional attitude toward need must be that there is no true objective or subjective need. Need is established only in a communicative dialogue with mutual respect between the professional and the patient.

Purpose: To investigate the risk factors related to failure of removable partial dentures (RPDs) and to compare the survival of RPDs when abutment teeth have good vs reduced bone support. Materials and Methods: In this longitudinal patient record-based cohort study with a mean follow-up of 44.9 months, Cox regression models were used to evaluate the associations between clinical covariates and abutment tooth failure, as well as prosthesis failure. Results: A total of 142 patients and 172 RPDs were included. Of the 172 prostheses, 64 (nearly 40%) failed after a mean time of about 4 years. Loss of abutment teeth was the main reason leading to RPD failure, followed closely by poor fit and adaptation. No factor was shown to be statistically significant at the prosthesis level. Women (Hazard Ratio [HR] = 0.542), endodontic treatment (HR = 3.460), presence of post and core (HR = 0.302), presence of a prosthetic crown (HR = 3.403), and abutment tooth type (in relation to incisor: canine HR = 0.196, premolar HR = 0.449) were the risk factors statistically significantly associated with the loss of abutment teeth. The pre-prosthesis amount of bone support of the teeth did not affect their prognosis as abutments for RPDs. Conclusion: RPD treatment modality presented a high failure rate after a mean follow-up of 4 years. Vital abutment teeth had a better survival rate than the ones treated endodontically (whether restored with or without a post and core); nevertheless, the amount of bone support did not affect their survival.

PURPOSE: This study aimed to evaluate the outcomes of treatment methods used to rehabilitate adult patients with maxillary and/or mandibular edentulism after at least 5 years of follow-up. The risks, adverse effects, and cost effectiveness of these methods were also evaluated. MATERIALS AND METHODS: Three databases as well as the reference lists of included publications were searched using specified indexing terms. Publications that met the inclusion criteria were read and interpreted using pre-established protocols. Quality of evidence was classified according to the GRADE system (high, moderate, low, or very low). RESULTS: The search yielded 2,130 titles and abstracts. Of these, the full-text versions of 488 publications were obtained. After data extraction and interpretation, 10 studies with moderate study quality of evidence and 1 study with low quality of evidence regarding outcomes, risks, and adverse effects remained. Three studies on the economic aspects of treatment were also included (1 with moderate quality and 2 with low quality). Low-quality evidence showed that the survival rate of implant-supported fixed prostheses is 95% after 5 years in patients with maxillary edentulism and 97% after 10 years in patients with mandibular edentulism. The survival rate of implant-supported overdentures is 93% after 5 years (low-quality evidence). In implant-supported fixed prostheses, 70 of every 1,000 implants are at risk of failing in the maxilla after 5 years and 17 of every 1,000 implants in the mandible are at risk after 10 years. Regarding economic aspects, the evidence was insufficient to provide reliable results. CONCLUSIONS: Due to the low quality of evidence found in the included studies, further research with a higher quality of evidence is recommended to better understand the outcomes of treatment for patients with maxillary and/or mandibular edentulism.

Purpose: The aim of this study was to assess the evidence of a correlation between the expertise of surgeons and the survival rate of dental implants. Materials and Methods: An electronic search in four databases (MEDLINE, EMBASE, SCOPUS, and the Cochrane Library) was performed for publications from their inception to May 2016 and was supplemented by manual searches. Prospective and retrospective cohorts were included if they met the following criteria: (1) the presence of an exposed group (inexperienced surgeons); and (2) the presence of a control group (experienced surgeons). Meta-analyses were performed to evaluate the effect of expertise on implant failure. Results: Of 609 potentially eligible articles, 8 were included in the qualitative analysis and 6 in the quantitative synthesis. Two meta-analyses were performed for different definitions of experienced surgeons. In the first meta-analysis, which included four retrospective comparative studies that defined experienced professionals as specialists, the experience of the surgeon did not significantly affect the implant failure rate (P = .54), with an odds ratio (OR) of 1.24 (95% CI, 0.62–2.48). In the second meta-analysis, which included two retrospective studies that defined experienced surgeons as professionals that had placed more than 50 implants, the expertise of the surgeon did significantly affect the implant failure rates (P = .0005), with an OR of 2.18 (95% CI, 1.40–3.39). Conclusion: The data from the included publications suggest that surgical experience did not significantly affect implant failure when considering experience based on specialty but were significantly affected when considering experience based on the number of implants placed. Further standardized prospective studies with a control of confounding factors are needed to clarify the role of surgical expertise on implant survival rates.

PURPOSE: Dentist-patient verbal communicatioo is important for patient satisfaction The aim of this study was to investigate the dentist´s role in the provider-patient relationship as to verbal communication and patient satisfaction with the treatment outcome in prosthetic dentistry. The dentist-specific properties were analyzed in random coefficient modeling MATERIALS AND METHODS: Sixty-one dentist-patient pairs were followed through 61 prosthodontic treatment periods. The treatment performed was ftxed prosthodontic restorations on teeth or implants One encounter at the end of each treatment period was tape recorded. The verbal communication on the recordings was analyzed using an interaction analysis instrument. Various measures of communication were used, summarizing the variational pattern of verbal interaction. Two differrent aspects of the patient satisfaction concept were used as dependent variables: cure (overall patient satisfaction with prosthodontic treatment), and care (patient satisfaction with a particular dental encounter during the prosthodontic treatment period). RESULTS: In the multilevel model for care, the dentist variance was mostly explained by the communication variables. In the cure model, there was no dentist variance. The communication patterns used by the dentists thus influenced patient satisfaction in a shortterm perspective but not in an intermediate perspective. CONCLUSION: Patient evaluation of the care during an encounter is dependent on the dentist´s verbal communication activity during the encounter, but this communication has no impact on the patient evaluation of overall prosthetic treatment outcome in the intermediate time perspective.

PURPOSE: The purpose of this systematic review was to identify and critically appraise published studies of treatment methods used in general practice to rehabilitate adult patients with single tooth loss or partial edentulism, with special emphasis on outcomes reported after at least 5 years of follow-up. MATERIALS AND METHODS: Three databases were searched using specified indexing terms. Publications were included if the study design, research questions, and sample size satisfied pre-established criteria. Reference lists of relevant publications and systematic reviews were also searched. The quality of evidence was classified according to the GRADE system as high, moderate, low, or very low. RESULTS: The search yielded 7,675 titles, of which 1,130 were read in full text. A final total of 15 publications were deemed eligible for inclusion: 5 of moderate quality and 10 of low quality. The five studies of moderate quality were all related to implant-based treatment. The 5-year survival rates for implant-supported single crowns and prostheses were 91% and 94.7%, respectively (implant survival rates: 98.5% and 94.9%, respectively). The underlying scientific evidence was low in quality. No relevant publications were identified regarding the economic aspects of treatment. CONCLUSION: Due to the low scientific evidence of the included studies, it was not possible to compare various treatment methods used for rehabilitation of single tooth loss or partial edentulism.

PURPOSE: The aim of this study was to evaluate and compare the outcomes of immediately loaded all-ceramic crown restorations supported by implants placed in both mature bone and immediate extraction sockets. MATERIALS AND METHODS: Forty-three tapered, external hex implants were placed immediately after extraction or in healed bone in a convenience sample of 38 patients from two clinics, with 23 implants immediately placed after tooth extraction and 20 placed in mature bone. Thirty implants were located in the maxilla and 13 in the mandible. Each surgical implant placement was followed by the fabrication of a screw-retained all-ceramic crown (zirconia-toughened alumina cylinder and layered with porcelain) that was then put into immediate function. Each patient was recalled annually for clinical and radiographic assessments. RESULTS: All implants were loaded immediately and all functioned successfully following a mean follow-up of 26 months. Significantly more bone loss was recorded around delayed implants compared with immediately placed ones. Smoking, platform switching, and jaw location did not influence peri-implant bone loss. Porcelain chipping was noted in the case of two crowns. CONCLUSION: The short-term outcome of prefabricated ceramic cylinders used to support a single screw-retained crown was regarded as successful. Immediate implant placement did not appear to increase the risk for implant failure and was accompanied by reduced peri-implant bone loss.

Purpose: The purpose of this study was to investigate whether the properties of the In-Ceram material are adequate for use in posterior three-unit fixed partial dentures (FPD) and to evaluate the clinical method regarding preparation technique, design, and choice of cement. Materials and Methods: Eighteen patients were treated with a total of 20 posterior three-unit FPDs according to the In-Ceram technique. The FPDs were constructed with bilateral support and one pontic and were all replacing one premolar or a molar (11 replacing premolars and 9 replacing molars). They were evaluated 6 months after delivery and then once yearly. Results: Eighteen of the 20 FPDs (90%) showed no defects at any of the follow-up examinations and were functioning well after 5 years. No caries or signs of gingivitis or periodontitis exceeding those found in the rest of the dentition were registered. Conclusion: The In-Ceram technique is, in a 5-year perspective and adopted for three-unit FPDs, an acceptable treatment alternative. Further studies must, however, be performed before the material can be recommended for more extensive restorations than the FPDs included in this study.

PURPOSE: This study evaluated outcome and quality of treatments with telescopic crownretained dentures. MATERIALS AND METHODS: A total of 72 subjects (27 men and 45 women; mean age 67 years) wearing 75 telescopic crown-retained dentures (18 in the man-dible and 57 in the maxilla) participated in the study. There were a total of 368 abutment teeth, 272 in the maxilla and 96 in the mandible. Each patient was clinically examined. Using the CDA evaluation sys-tem, four calibrated evaluators also examined, independently, the in-ner crowns for margin integrity and the superstructure for retention, occlusion, stability, wear, and esthetic appearance. Observer consis-tency was measured with Cohen’s kappa. RESULTS: Tbe observation period varied from 9 months to 9.3 years (mean 3.8 years) One tele-scopic crownretained denture was lost, and 24 abutment teeth (7%) were extracted during the observation period. In 49 abutment teeth (13%), technical complications had occurred, and a total of four framework fractures (5%) were observed. Based on the CDA criteria, most of the characteristics were evaluated as satisfactory. The charac-teristics “condition of denturesupporting soft tissue” and “superstructure wear” showed the highest frequencies of not acceptable ratings, 44% and 45%, respectivly. CONCLUSION: In this retrospective followup study, satisfactory outcome was found for tooth-supported telescopic crown-retained dentures over a mean observation period of 3.8 years.