The International Journal of Prosthodontics, 06/2015

Purpose: Little is known about the relationship between implant patient mortality compared to reference populations. The aim of this study was to report the mortality pattern in patients treated with dental implants up to a 15-year period, and to compare this to mortality in reference populations with regard to age at surgery, sex, and degree of tooth loss. Materials and Methods: Patient cumulative survival rate (CSR) was calculated for a total of 4,231 treated implant patients from a single clinic. Information was based on surgical registers in the clinic and the National Population Register in Sweden. Patients were arranged into age groups of 10 years, and CSR was compared to that of the reference population of comparable age and reported in relation to age at surgery, sex, and type of jaw/dentition. Results: A similar, consistent, general relationship between CSR of different age groups of implant patients and reference populations could be observed for all parameters studied. Completely edentulous patients presented higher mortality than partially edentulous patients (P .05). Furthermore, implant patients in younger age groups showed mortality similar to or higher than reference populations, while older patient age groups showed increasingly lower mortality than comparable reference populations for edentulous and partially edentulous patients (P .05). Conclusion: A consistent pattern of mortality in different age groups of patients compared to reference populations was observed, indicating higher patient mortality in younger age groups and lower in older groups. The reported pattern is not assumed to be related to implant treatment per se, but is assumed to reflect the variation in general health of a selected subgroup of treated implant patients compared to the reference population in different age groups.

Purpose: This retrospective clinical study evaluated the long-term outcomes of cantilever fixed partial dentures (CFPDs) and the factors influencing their survival probability. Materials and Methods: The study is based on a convenience sample of 57 patients who received 71 CFPDs on a total of 176 vital abutment teeth. The mean survival time of the CFPDs was calculated using a Kaplan-Meier estimate. The following variables were analyzed as covariates of the survival function (logrank test, P .05): sex, denture location, number and distribution (Kennedy Class) of the abutment teeth, dentition in the opposing arch (removable dentures, fixed partial dentures, or natural dentition), position of the cantilever unit (mesial or distal), and participation in follow-up visits. Results: The mean observation period was 3.2 ± 2.8 years (maximum 10.7 years). During the observation period, 22.5% (n = 16) of the CFPDs ceased functioning. The calculated outcome probability was 93.0% after 5 years and 84.5% after 8 years. The number of abutment teeth was the only parameter that significantly (P .05) impacted this probability. Conclusion: The survival rate of CFPDs on vital abutment teeth is comparable to that of conventional fixed partial dentures. Thus, CFPDs on vital abutments are an acceptable alternative to removable dentures.

The aim of this study was to clarify the impact of wearing removable partial dentures (RPDs) replacing a small number of teeth on dietary intake. Participants had at least 20 teeth and were classified as Eichner B1 or B2. The participants underwent dental and oral examinations, and their dietary intake was assessed. Analysis of covariance showed that RPD wearers consumed more vegetables, n-3 fatty acids, calcium, vitamin A, and dietary fiber than nonwearers after adjusting for possible confounding factors. It is concluded that RPDs are effective for improving dietary intake even in participants who have lost a small number of teeth.

Purpose: The objective of this study was to assess the risk of bias of randomized controlled trials (RCTs) published in prosthodontic and implant dentistry journals. Materials and Methods: The last 30 issues of 9 journals in the field of prosthodontic and implant dentistry (Clinical Implant Dentistry and Related Research, Clinical Oral Implants Research, Implant Dentistry, International Journal of Oral & Maxillofacial Implants, International Journal of Periodontics and Restorative Dentistry, International Journal of Prosthodontics, Journal of Dentistry, Journal of Oral Rehabilitation, and Journal of Prosthetic Dentistry) were hand-searched for RCTs. Risk of bias was assessed using the Cochrane Collaboration's risk of bias tool and analyzed descriptively. Results: From the 3,667 articles screened, a total of 147 RCTs were identified and included. The number of published RCTs increased with time. The overall distribution of a high risk of bias assessment varied across the domains of the Cochrane risk of bias tool: 8% for random sequence generation, 18% for allocation concealment, 41% for masking, 47% for blinding of outcome assessment, 7% for incomplete outcome data, 12% for selective reporting, and 41% for other biases. Conclusion: The distribution of high risk of bias for RCTs published in the selected prosthodontic and implant dentistry journals varied among journals and ranged from 8% to 47%, which can be considered as substantial.

Bruxism is defined as a repetitive jaw muscle activity characterized by clenching or grinding of the teeth and/or bracing or thrusting of the mandible. There are two distinct circadian phenotypes for bruxism: sleep bruxism (SB) and awake bruxism, which are considered separate entities due to the putative difference in their etiology and phenotypic variance. The detailed etiology of bruxism so far remains unknown. Recent theories suggest the central regulation of certain pathophysiological or psychological pathways. Current proposed causes of bruxism appear to be a combination of genetic and environmental (G×E) factors, with epigenetics providing a robust framework for investigating G×E interactions, and their involvement in bruxism makes it a suitable candidate for epigenetic research. Both types of bruxism are associated with certain epigenetically determined disorders, such as Rett syndrome (RTT), Prader-Willi syndrome (PWS), and Angelman syndrome (AS), and these associations suggest a mechanistic link between epigenetic deregulation and bruxism. The present article reviews the possible role of epigenetic mechanisms in the etiology of both types of bruxism based on the epigenetic pathways involved in the pathophysiology of RTT, PWS, and AS, and on other epigenetic disruptions associated with risk factors for bruxism, including sleep disorders, altered stress response, and psychopathology.

Purpose: The primary objective of this study was to assess the prevalence of temporomandibular disorders (TMDs) and comorbid factors (sleep bruxism and headaches). This study was a cross-sectional population survey in the city of Maringá, state of Paraná, Brazil. Materials and Methods: Axes I and II of the Research Diagnostic Criteria for TMD (RDC/TMD) were used for assessment of TMD signs and symptoms. The population was users of the Brazilian public health system (SUS), of both sexes, between the ages of 20 and 65 years, and not seeking treatment for TMD. Results: The selected population (N = 1,643) was composed mostly of (a) women (65.9%), (b) married or single individuals (90.6%), (c) Caucasians (70.1%), (d) individuals aged 32.7 ± 10.3 years, (e) individuals earning a medium income (75.1%), and (f) those who had completed a high school education or higher (79.9%). According to the chronic pain grade classification (CPG) in the RDC/TMD Axis II, 36.2% of the population had some degree of TMD pain (CPG I to IV); however, only 5.1% had severe limitation due to pain (CPG III or IV). In the RDC/TMD Axis I diagnoses, 29.5% presented with muscle disorders (group I), 7.9% with disk displacements (group II), and 39.1% with other joint disorders (group III). Headaches were present in 67.9% and awake and sleep bruxism in 30% and 33.4% of the population, respectively. Conclusion: The prevalence of signs and symptoms of TMD was high in this population, but with low disability; however, the proportion of patients in need of treatment was much lower.

Purpose: This study aimed to evaluate the use of orthodontic mini-implants for the intrusion of supraerupted maxillary molars. Materials and Methods: Nine patients were treated using buttons bonded on dental surfaces and mini-implants inserted on the buccal and palatal sides. The intrusion was evaluated by comparing radiographs obtained at the start of treatment and at the end of intrusion. The t test was used to compare the teeth positions. Results: There was statistically significant intrusion using this method (mean: 2.4 mm; minimum: 1.2 mm; and maximum: 4.5 mm; P = .00). Conclusion: The direct use of orthodontic mini-implants was effective for the intrusion of maxillary molars.

The degree of misfit between a prosthesis and its supporting implants is a major concern in screw-retained prostheses because it can lead to screw loosening or mechanical failure of implant components. On the other hand, the difficulty of removing subgingival excess cement and the irretrievability of the superstructure are major drawbacks to cement-retained prostheses. A newly designed screw- and cement-retained prosthesis (SCRP) may solve these problems with its passivity, retrievability, and ease in the complete removal of excess cement, giving it the advantages of both screw-retained and cement-retained prostheses. This prosthetic system is mainly composed of a cement-retained framework with screw holes on the occlusal surface and specially designed cementable abutments for multiunit prostheses. The principle and structure of the SCRP system is described in this article.

Tissue transglutaminase 2 (TG2) is ubiquitously expressed in normal tissues and plays an important role in the pathophysiology of wound healing. An increase in periodontal tissues has been previously reported in cyclosporine-induced gingival overgrowth. Purpose: The aim of this study was to explore associations between TG2 expression and the vascularization and maturation processes of peri-implant soft tissues over time. Materials and Methods: Edentulous patients proposed for mandibular implant-retained overdentures were included in the study. Biopsies of the peri-implant mucosa were performed at the first surgical stage and at 4, 8, and 12 months after prosthetic load. A follow-up program was directed to record plaque indexes, bleeding on probing data, and pocket probing depth around implants. An evaluation of the vessels' density was carried out by digital virtual microscopy and using an immunohistochemistry approach (antibodies anti-CD31, anti-TG2). A robust multivariable regression model was implemented. Results: According to model results, blood vessel count and probing (as a marker of gingival overgrowth in absence of plaque) significantly decrease over time and are associated with TG2, particularly for values above the median. Conclusion: The association of an increased TG2 expression in the extracellular matrix might have a significant impact in the development of gingival overgrowth around a loaded implant.

This study evaluated the influence of implant-abutment connections on stress distribution through 3D finite element analysis. Three-dimensional models of an implant-supported fixed prosthesis in the jaw retained by four implants with different connection systems (external hex and Morse taper) were analyzed. External hex connection promoted higher microstrain values, which were concentrated on the cervical region of the distal implants extending into the trabecular bone, while Morse taper connection provided a more even distribution of the microstrain on all implants. Implant-supported fixed prostheses with external hex connections tend to concentrate strain in the distal implants, while Morse taper connection promoted a better situation. On the other hand, there was greater demand on the prosthetic screws and abutments of Morse taper connections than on external hex connections.

This case history report describes two different devices, maxillary ramp prostheses (MRP) and mandibular guide flange prostheses (MGFP), prescribed for managing a hemimandibulectomy patient's deviated mandible. The patient was given muscle reprogramming exercises with coordinated use of both guidance prostheses for 2 months, leading to improvements in both postsurgical mandibular deviation and occlusal equilibration. A successful intercuspal position was eventually accomplished through the use of the combination therapy. MRP and MGFP can be a useful approach to avoid mandibular deviation and compromised function following a partial mandibular resection.

Purpose: The aim of this study was to analyze through a three-dimensional finite element analysis (3D-FEA) stress distribution on four implants supporting a fullarch implant-supported fixed prosthesis (FFP) using different prosthesis designs. Materials and Methods: A 3D edentulous maxillary model was created and four implants were virtually placed into the maxilla and splinted, simulating an FFP without framework, with a cast metal framework, and with a carbon fiber framework. An occlusal load of 150 N was applied, stresses were transmitted into peri-implant bone, and prosthodontic components were recorded. Results: 3D-FEA revealed higher stresses on the implants (up to +55.16%), on peri-implant bone (up to +56.93%), and in the prosthesis (up to +70.71%) when the full-acrylic prosthesis was simulated. The prosthesis with a carbon fiber framework showed an intermediate behavior between that of the other two configurations. Conclusion: This study suggests that the presence of a rigid framework in full-arch fixed prostheses provides a better load distribution that decreases the maximum values of stress at the levels of implants, prosthesis, and maxillary bone.

Dental implants are one of the most widely used treatments for the rehabilitation of partially or completely edentulous areas. Achieving proper passive adjustment of the implant-supported prosthesis improves its long-term prognosis. This article discusses a new technique for digitally printing prostheses supported by multiple implants with optimum passive fit. The technique is based on a stereophotogrammetry system that captures the exact location of prosthetic implant platforms. This photogrammetry device takes 10 pictures per second with an error margin of less than 10 μm between two scanbodies and identifies the spatial position of each implant without physical contact. Three-dimensional data for each implant are registered in vector format, together with interrelated implant angles and distances. The information is then stored in an STL file.

Purpose: To evaluate the outcome of maxillary implant overdenture treatment in a selected patient sample. Materials and Methods: Eighteen out of a total of 26 patients who were prescribed overdentures supported by two to six implants each attended a follow-up clinical assessment. Evaluative criteria included oral health- related quality of life records using the OHIP-14 questionnaire. Results: Good stability and retention were observed, and mechanical failure items were recorded in eight patients. No significant differences in OHIP-14 scores were found between patients treated with two to three implants and patients treated with five to six implants, or between groups treated with a denture with palatal or horseshoe design coverage. Conclusion: Maxillary implant overdenture treatment was assessed as a viable treatment option for the selected patient sample, even when only two supporting implants were prescribed.