Background: Although many studies have been published on single implants, long-term data remain scarce. Purpose: To evaluate immediately restored single implants after at least 8 years of follow-up in terms of buccal bone, soft tissue alterations, aesthetic ratings, and patient-reported outcomes. Materials and Methods: This prospective cohort study included patients who were consecutively treated with an immediately restored single implant installed in an extraction socket (IIT) or a healed ridge (CIT) in the anterior maxilla. Biomaterials were never used. CBCTs were taken at study termination, soft tissue alterations, and Pink Esthetic Score were evaluated between 1 year and study termination using standardized clinical images. Patient satisfaction was also registered. Results: About 11/16 initially treated patients in the IIT cohort (10 men, 6 women; mean age 45) and 18/23 initially treated patients in the CIT cohort (12 men, 11 women; mean age 40) could be evaluated after more than 8 years. A buccal bone wall less than 2 mm was found at all implant sites. A thin buccal bone wall less than 1 mm was found at 42% of the implant sites. In the CIT cohort, 8 patients had a missing buccal bone in the crestal area, although bone was present at the time of surgery. Alveolar process deficiency significantly deteriorated (P .046), whereas vertical soft tissue levels and PES remained stable over time in both cohorts. Patients expressed high overall satisfaction. Conclusions: Substantial dimensional changes may be expected at the buccal aspect of single implants inserted in the premaxilla. As a result, contour augmentation procedures at the time of implant placement should be considered to counteract these bone alterations, even when implants are fully embedded in bone upon insertion.

Background: Competence profiles are purposed to provide a blueprint in support to develop and/or benchmark the learning outcomes of undergraduate dental curricula. This study aims to investigate whether a competence profile as proposed by academic-and clinical experts is able to represent the real clinical reality. Methods: A questionnaire was developed including questions about gender and age, perception about required competences, and educational organisation and was distributed among Flemish dentists via email and on paper during a symposium. The data was analysed using descriptive statistics, Chi-square and non-parametric Mann-Whitney U-tests. Results: A total of 312 questionnaires were completed (= 6.5% of dentist population, with similar gender and age characteristics). All competences in the European competence profile were rated between 7.2 and 9.4 on a 10-point scale. In dentists under 50 years, females rated the importance of identifying/managing anxiety and abnormal patient behaviour; and promoting/improving oral health as significantly higher than males. In dentists of 50 years and above, females rated 8 competences significantly higher than males, including obtaining/recording a complete history; identifying/managing anxiety and abnormal patient behaviour; obtaining/interpreting radiography; identifying temporomandibular and associated disorders; identifying orthodontic needs; awareness of own limitations/when to refer; managing dental urgencies; and basic-life-support/defibrillation. Clinical practice management was most frequently reported as additional competence to address in dental education. Furthermore, the respondents suggested an undergraduate dental curriculum based on 34% theoretical education, 26% preclinical skills training, and 40% clinical education and 86% agreed with a duration of 5 years. Finally, the respondents also illustrated the dynamic nature of dentistry including a reduction of amalgam fillings, a shift from individual practice to group practices, an increased administrative load, and more assertive patients. Conclusion: Findings in the present study suggest the validation of the proposed competences for graduating European dentists within the clinical reality of dental professionals in daily practice. Nevertheless, the results have also demonstrated heterogeneity regarding gender and age within the dentist population and emphasised a continuously evolving dental profession and required competences. Hence, to maintain high quality of dental care, a strategy should be developed in which dental curricula are continuously benchmarked against an evolving clinical reality.

OBJECTIVES: The impact of single implants on oral health-related quality of life (OHRQoL) is scarcely investigated, especially when combined with immediate placement and loading in extraction sockets. The aim was to describe prospectively the changes of OHRQoL with single implants placed in the esthetic zone in healed ridges or in extraction sockets after 5 years. MATERIAL AND METHODS: Ninety-six patients, enrolled at three clinical centers, received 102 single implants placed in a healed ridge (n = 54 implants/50 patients) or in extraction sockets (n = 48 implants/46 patients). Implants were immediately provisionalized, and permanent crowns were cemented after 12 weeks. Oral health impact profile questionnaires (OHIP-14) were completed before surgery, after 1 (provisional crown), 6 (permanent crown), 12 and 60 months, respectively. The overall OHIP-14 score pertains to seven domains with two items each and was assessed on a Likert scale of 0-4 (0 = never and 4 = very often). The evolution of the total OHIP-14 score and changes within all OHIP domains over time and between groups were assessed with a linear mixed-effect model analysis. RESULTS: After 5 years, overall implant survival was 98%. The total OHIP-14 score for both groups combined decreased from 0.50 at baseline to 0.17 at 6 months (P < 0.001), indicative of improvement. For both groups, this remained stable up to 5 years (P = 0.41). However, after 5 years, the total OHIP-14 score revealed a statistically significantly higher improvement in the healed group compared with the extraction group (P = 0.027). CONCLUSION: Missing a single tooth in the maxillary esthetic zone leads to limited OHRQoL problems as reflected by a low overall OHIP score. However, OHRQoL improves less in the extraction group, reflecting that replacing a missing tooth is perceived as more beneficial than replacing a present tooth.

Purpose The study aims to identify predictors of early and late peri-implant bone loss following complete implant-supported rehabilitation using multivariate analyses. Materials and Methods Fifty patients (28 women, 22 men; mean age 58, range 35-76) in need of a complete implant-supported rehabilitation on five to eight implants were consecutively treated. Patients were reinvited for a clinical and radiographic examination after an average 9 years of function. Implant survival and peri-implant bone loss were considered the dependent variables. Multivariate analyses were adopted to identify predictors of early and late peri-implant bone loss Results In total, 39 patients were examinated. Two implants failed after 4 years of function, resulting in an overall survival rate of 99.2%. After a mean follow-up of 9 years, mean bone loss of 1.68mm (SD 2.08, range -1.05 to 10.95) was found. The abutment height was a significant predictor of early peri-implant bone loss (1 year) (p=.024), whereas smoking (p=.046) and history of periodontitis (p=.046) affected late peri-implant bone loss Conclusion Within the limits of this study, it can be concluded that initial bone remodeling was affected by soft tissue thickness as reflected by the height of the abutment, whereas smoking and history of periodontitis affected long-term peri-implant bone stability

Despite the consensus on the importance of reflection for dental professionals, a lack of understanding remains about how students and clinicians should develop their ability to reflect. The aim of this study was to investigate dental students' and mentors' perceptions of mentor groups as an instructional method to facilitate students' reflection in terms of the strategy's learning potential, role of the mentor, group dynamics, and feasibility. At Ghent University in Belgium, third-and fourth-year dental students were encouraged to reflect on their clinical experiences and personal development in three reflective mentor sessions. No preparation or reports afterwards were required; students needed only to participate in the sessions. Sessions were guided by trained mentors to establish a safe environment, frame clinical discussions, and stimulate reflection. Students' and mentors' perceptions of the experience were assessed with a 17-statement questionnaire with response options on a five-point Likert scale (1=totally disagree to 5=totally agree). A total of 50 students and eight mentors completed the questionnaire (response rates 81% and 89%, respectively). Both students and mentors had neutral to positive perceptions concerning the learning potential, role of the mentor, group dynamics, and feasibility. The mean ideal total time for sessions in a year was 99 minutes (third-year students), 111 minutes (fourth-year students), and 147 minutes (mentors). Reported reflective topics related to patient management, frustrations, and practice of dentistry. Overall mean appreciation for the experience ranged from 14.50 to 15.14 on the 20-point scale. These findings about students' and mentors' positive perceptions of the experience suggest that mentor groups may be a potentially valuable strategy to promote dental students' reflection.

ObjectiveTo determine the relationship between buccal bone and soft tissue thickness at teeth in the premaxilla by means of non-invasive registration methods. Materials and MethodsBuccal bone thickness at central incisors, lateral incisors and canines was measured at five reference points (1-5mm from the top of the alveolar crest) on CB-CT scans of 21 patients. The corresponding buccal gingival thickness was measured by the use of an ultrasonic device. Spearman's correlation coefficient was calculated to assess the correlation between buccal bone and soft tissue thickness at each tooth type ResultsMean buccal bone thickness (SD) at central incisors, lateral incisors and canines was 1.07mm (0.34mm), 1.16mm (0.54mm) and 0.98mm (0.37mm), respectively. For central incisors, 68% of all sites had a thickness <1mm and 32% had a thickness between 1.0 and 2.0mm. At lateral incisors, 44% demonstrated buccal bone thickness between 0 and 1.0mm, 48% between 1.0 and 2.0mm and 8% 2mm. For canines, 57% of the sites were <1mm thick; 41% were between 1.0 and 2.0mm thick, and 2% demonstrated 2mm thickness. Mean gingival thickness (SD) at central incisors, lateral incisors and canines was 1.37mm (0.32mm), 1.33mm (0.32mm) and 1.08mm (0.25mm), respectively. The correlation between buccal bone and soft tissue thickness was moderately positive (=0.406; P<0.001 ConclusionsA thin buccal bone wall (<1mm) may be expected in over half of the central incisors and canines. The correlation between buccal bone and soft tissue thickness was moderately positive

ObjectivesTo compare smokers to non-smokers in terms of soft tissue alterations following single implant treatment in healed bone. Material and methodsNon-smoking and smoking patients with sufficient bone volume in need of a single implant in the anterior maxilla (15-25) were consecutively recruited in three centres. Conventional single implant surgery was performed and an immediate provisional crown was installed. Eight to 12weeks later, the latter was replaced by a permanent one (baseline). Papilla regrowth and midfacial recession was registered after 2years of function. ResultsThe sample consisted of 39 non-smokers (21 females; mean age 42) and 46 smokers (22 females; mean age 45). Smokers had three early failures, whereas all implants integrated successfully in non-smokers. Statistically significant papilla regrowth was observed in non-smokers (distal 0.63mm, mesial 0.76mm), whereas smokers showed stable papillae (between cohorts: P0.025). Midfacial soft tissue level demonstrated statistically significant regrowth in non-smokers (0.53mm), whereas it remained stable in smokers (between cohorts: P=0.004). ConclusionSmokers failed to demonstrate papilla regeneration and showed more midfacial recession following single implant treatment when compared to non-smokers.

PURPOSE: The objective of this prospective clinical study was to document the overall treatment outcome of immediately loaded single Astra Tech Osseospeed™ (Astra Tech AB, Mölndal, Sweden) implants placed in extraction sockets, healed ridges, and grafted sites. MATERIALS AND METHODS: Forty-eight patients in need of a single implant in the anterior maxilla (15-25) were recruited. Patients were allocated to a conventional implant treatment (CIT) or immediate implant treatment (IIT) group on the basis of specific criteria. If the buccal bone plate was damaged or missing upon tooth removal, patients were allocated to a grafted implant treatment (GIT) group. Irrespective of the treatment concept, implants were immediately provisionalized. Hard and soft tissue alterations, aesthetic parameters (pink and white esthetic scores, [PES and WES]) and patient's opinion (Oral Health Impact Profile [OHIP-14] questionnaires) were registered at different time points. RESULTS: After 1 year of function, the overall implant survival rate was 98% with one failure following IIT. The mean bone level to the implant-abutment interface was 0.65 (SD 0.79), 0.85 (SD 0.64), and 0.56 mm (SD 0.44) for CIT, IIT, and GIT. Complete papilla loss was rare following either strategy. Mean midfacial recession amounted to 1.00 (SD 1.15), 0.12 (SD 0.78), and 0.49 mm (SD 0.82) for CIT, IIT, and GIT, respectively. The aesthetic outcome showed a mean PES of 10.30 (SD 1.89) and mean WES of 7.11 (SD 2.14), all patients considered. Patient's satisfaction showed a significant improvement after 1 year of function on all seven domains (p < .001). CONCLUSIONS: This prospective study showed that single implants clinically and aesthetically perform well under immediate non-occlusal loading conditions in the premaxilla. In this context, it is of pivotal importance to stress that patients were carefully selected for IIT and GIT.

PURPOSE: Cone beam computerized tomography (CBCT) provides three-dimensional information and could absolutely be useful for evaluating circumferential implant bone levels. However, the accuracy and precision of the technique has not been described. The aim of the study was to assess the accuracy and precision of CBCT (i-CAT(R), Imaging Sciences International(R), Hatfield, PA, USA) using periapical radiographs (PA) as a reference and to evaluate the circumferential bone level on CBCT around immediately loaded single implants placed in healed ridges (CIT, conventional implant treatment) and extraction sockets (IIT, immediate implant placement). MATERIALS AND METHODS: PA and CBCT radiographs were obtained from 26 single Astra Tech Osseospeed implants (Astra Tech AB, Molndal, Sweden) 1 year after loading in respectively healed ridges (CIT) or extraction socket (IIT). For accuracy analysis, the three mesial and three distal interproximal levels obtained by CBCT were pooled to enable a comparison with PA. Precision was analyzed by intra- and interexaminer reliability calculation from mesial and distal sites on CBCT. The circumferential bone level considered all eight positions assessed on CBCT. RESULTS: Accuracy of CBCT was low (R = 0.325/p = .019) given the fact that bone level of the total group was 0.70 mm (standard deviation [SD] 0.78, range 0.00-3.20) on PA and 0.23 mm (SD 0.27, 0.00-1.20) on CBCT (p < .001) with only 42% of the measurements showing deviation within 0.2 mm. However, intra- and interexaminer reliability were favorable (R >/= 0.611/p < .001, >/= 83%). The mean circumferential bone level on CBCT was 0.21 mm (SD 0.30) and 0.26 mm (SD 0.18) for IIT and CIT, respectively. The impact of the treatment strategy was not significant. CONCLUSION: PA should be the standard technique to assess interproximal bone level but correlates poorly with the CBCT measurements. However, the precision of CBCT was high. CBCT requires further improvements of hardware and/or software. Within the limitations of the study, there is an indication that the buccal bone 1 year after implant treatment is evenly preserved when implants are immediately loaded in extraction sockets or in healed bone.