Objectives/Hypothesis:
In the treatment of burning mouth syndrome (BMS), various approaches have been tried with equivocal results. The aim of the present randomized clinical trial was to determine ...the efficacy of clonazepam, a GABA agonist designed as an antiepileptic drug that exerts the typical effects of benzodiazepines.
Study Design:
Randomized clinical trial.
Methods:
Twenty patients with idiopathic BMS were carefully selected. Clonazepam (0.5 mg/day, n = 10) or placebo (lactose, n = 10) were randomly assigned to the patients.
Results:
Patients on clonazepam significantly improved in pain ratings (P < .001). These changes were less pronounced in the placebo group (P < .11). No significant changes were observed in a mood scale (P = .56) or for depression scores (P = .56). Taste test and salivary flow increased over sessions, but were not different between groups (P = .83 and P = .06, respectively).
Conclusions:
Clonazepam appears to have a positive effect on pain in BMS patients. Laryngoscope, 2012
The esthetic outcome of dental implants can be compromised when some degree of bone loss occurs around the implant. This may particularly affect the tissue-level (TL) design. Therefore, bone-level ...(BL) design implants may be preferable if a natural emergence profile is important. Notwithstanding the implant design, the gingival biotype has been identified as a crucial factor in the stability of crestal bone. The objective of this study was to investigate bone loss in patients with different gingival biotypes at TL and BL implant sites in the esthetic zone.
In 41 patients, 20 TL and 22 BL implant procedures were carried out. Intraoral radiographs of all of the 42 sites were taken immediately after implant insertion as well as during the follow-up examination. The analysis of bone height was conducted using a computerized technique. The TRAN method was used to determine the gingival biotype.
After a mean in situ period of 4.9 years in the TL group, 12 implants with a thick biotype had a mean bone loss of 0.21 mm (SD: 0.43 mm). The eight implants with a thin biotype had a loss of 0.05 mm (SD: 0.47 mm; P = .31). After a mean in situ period of 1.9 years, the 14 BL sites with a thick biotype showed a mean bone change of -0.03 mm (SD: 0.38 mm). In the eight implants with a thin biotype, a change of +0.09 mm (SD: 0.32 mm; P = .84) was noted.
Analysis of the obtained results did not reveal a dependency of bone height on implant design or on gingival biotype. However, prior to choosing an implant design, it may nevertheless be beneficial to screen for transparent soft tissues, where the BL design offers a more natural emergence profile. For this purpose, the TRAN method is clearly the fastest and easiest.
The aim of this study was to assess and compare the esthetic outcome of tissue-level (TL) and bone-level (BL) implants that had been placed as single implants in the anterior maxilla.
Between 2001 ...and 2008, patients were treated using TL implants (Straumann). From 2008 until 2012, patients received the newly developed BL implant (Straumann). All patients with a single anterior maxillary implant who came to check-ups regularly were contacted and invited to take part in the study. Standardized photographs were taken to conduct the evaluation. Five observers analyzed the esthetic outcome using the pink esthetic score (PES). For the purpose of statistical analysis, the Wilcoxon rank sum test was applied. Interobserver reliability was evaluated with Krippendorff's alpha.
Forty-six patients agreed to take part in the study. The study comprised 10 immediate (TL = 6, BL = 4), 21 early (TL = 6, BL = 15), and 15 delayed implantations (TL = 11, BL = 4). All implant sites were simultaneously augmented. The prosthetic restorations were delivered 6 to 24 weeks after implant placement in the TL group and 10 to 14 weeks after implant placement in the BL group. Esthetic evaluation was performed after a mean period of 9.5 years for TL implants (range: 5.5 to 12.0) and 3.7 years for BL implants (range: 2.6 to 7.1). The overall PES was 8.49 (SD: 2.35) for TL implants and 9.29 (SD: 1.90) for BL implants (P = .37). Comparison of single parameters was between P = .24 and P = .83, indicating no statistically significant difference between the two implant types.
Within the limits of this study, it can be stated that both implant designs showed comparably satisfying esthetic results.
Aim
The objective of this randomized clinical trial was to investigate the influence of the time of implant placement (immediate vs. early) and the time of restoration (immediate vs. early) on ...esthetic outcome in maxillary anterior single implants.
Material and methods
Forty‐eight patients with a single failing incisor in the maxilla and a natural contralateral site were randomly distributed into four groups. Treatment variations affected the time of implant placement (immediate or early) as well as the time of restoration (immediate or early) – in detail, group 1a with immediate implant placement and immediate temporary restoration, group 1b with immediate implant placement and early restoration, group 2a with early implant placement and immediate temporary restoration, and group 2b with early implant placement and early restoration. All patients received the final prosthetic restoration 10–12 weeks after implant placement. Standardized photographs were taken eight months after tooth extraction. Five competent observers analyzed the esthetic outcome according to the PES after Fürhauser. For statistical analysis, the Kruskal–Wallis test and Dunn's post hoc test were applied. Interobserver reliability was evaluated by Krippendorff's alpha.
Results
The overall scores of the four treatment groups revealed PES values of 8.47 (SD 2.08, group 1a), 7.93 (SD 3.21, group 1b), 6.62 (SD 3.24, group 2a), and 8.10 (SD 3.25, group 2b). The differences between groups 2a and 1a and between groups 2a and 2b were statistically significant (P = 0.015 and P = 0.047). The single parameter analysis displayed a certain range of fluctuation and heterogeneity.
Conclusions
Immediate implant placement and restoration appear to be a viable alternative to early implant placement if an experienced surgeon is entrusted with the implantation procedure.
Abstract Statement of problem Accurate virtual implant models are a necessity for the fabrication of precisely fitting superstructures. Purpose The purpose of this in vitro study was to evaluate ...different methods with which to build an accurate virtual model of a 3-dimensional implant in the oral cavity; this model would then be used for iterative computer-aided design and computer-aided manufacturing (CAD-CAM) procedures. Material and methods A titanium master model with 3 rigidly connected implants was manufactured and digitized with a noncontact industrial scanner to obtain a virtual master model. Impressions of the master model with the implant position locators (IPL) were made using vinyl siloxanether material. The impressions were scanned (Impression scanning technique group). For the transfer technique and pick-up technique groups (each group n=20), implant analogs were inserted into the impression copings, impressions were made using polyether, and casts were poured in Type 4 gypsum. The IPLs were screwed into the analogs and scanned. To compare the virtual master model with each virtual test model, a CAD interactive software, ATOS professional, was applied. The Kruskal-Wallis test was subsequently used to determine the overall difference between groups, with the Mann-Whitney U test used for pairwise comparisons. Through Bonferroni correction, the α-level was set to .017. Results The outcome revealed a significant difference among the 3 groups ( P <.01) in terms of accuracy. With regard to total deviation, for all axes, the transfer technique generated the greatest divergence, 0.078 mm (±0.022), compared with the master model. Deviation with the pick-up technique was 0.041 mm (±0.009), with impression scanning generating the most accurate models with a deviation of 0.022 mm (±0.007). Conclusions The impression scanning method improved the precision of CAD-CAM-fabricated superstructures.
When failing front teeth are replaced by implants, vestibular bone deficiencies frequently require augmentation, even though the amount of missing alveolar volume may vary. The objective of this ...study was to analyze the horizontal alveolar ridge dimension after implant placement and simultaneous augmentation, and to compare it to the condition at the contralateral natural site.
Forty-eight patients with a failing maxillary incisor received an immediate or early implant (Straumann Bone Level), according to a randomized study protocol. The vestibular wall of the implant site was reconstructed and moderately overcontoured with bovine hydroxyapatite and a collagen membrane (BioOss, BioGide, Geistlich). Provisional restoration followed either immediately, or after a 6-week healing period. To investigate the vestibular volume 6 months after surgery, a plaster model of the maxilla was scanned with cone beam computed tomography (CBCT; Morita 3D) and evaluated using coDiagnostiX software (Dental Wings). Statistical analysis comprised one- and two-sample t tests.
The ridge volume was not significantly influenced by the treatment schedule. The vestibular segments had a mean ± SD volume of 207.9 ± 102.5 mm³ for the implant sites, and 202.1 ± 101.5 mm³ for the corresponding natural sites (P = .28). The difference in vestibular volume between implant sites and natural tooth sites was 10.4 ± 36.2 mm³ for immediate implantation, and 0.00 ± 31.1 mm³ for early implantation (P = .32). Comparing immediate and early restoration, a difference of 0.4 mm³ and 12.5 mm³ between the implant and contralateral site was found (P = .23).
Six months after treatment, no significant differences between the alveolar volumes at augmented implant sites and natural sites were found. Moderate buccal overcontouring may have been beneficial to achieve a symmetrical contour. Long-term follow-up investigation will document if the restored volume remains stable over time.
Statement of problem In implant prosthodontics, restorations can either be cement- or screw-retained. Aside from passivity of fit, esthetics, and retrievability, the occlusal opening of the ...screw-access hole (SAH) is a major difference between the 2 types of restorations. In veneered fixed partial dentures (FPDs), the SAH forms a discontinuity of the ceramic layer and may be an origin for chipping fractures. Purpose The objective of this study was to investigate whether more chipping fractures occur during dynamic loading on the occlusal surface of screw-retained ceramic-veneered implant FPDs than in cement-retained restorations. Material and methods Ten cement-retained and 10 screw-retained ceramic veneered 5-unit FPDs were manufactured for a 3-implant situation. A masticatory simulator was used for loading the occlusal surface of the FPDs to the implant positions for 20,000 cycles with a force of 100 N applied for 1 second followed by 1 second of no loading. For analysis, 3 clinicians evaluated the FPDs using a light microscope and a dental probe. The numbers of chipping fractures found were analyzed by means of a generalized linear model with Poisson response (α=.05). Results The investigators found significantly more chipping fractures in the group of screw-retained FPDs, the rate ratio of screw-retained FPDs versus cement-retained FPDs being greater than 1 with a P value of .0023. Conclusion The SAH of screw-retained implant FPDs forms a weak point of the ceramic layer.
Mandibular two-implant telescopic overdentures Heckmann, Siegfried M.; Schrott, Alexander; Graef, Friedrich ...
Clinical oral implants research,
October 2004, Volume:
15, Issue:
5
Journal Article
Peer reviewed
: To stabilize mandibular overdentures in edentulous patients, various connector types which can be attached to between two and four implants placed in the anterior mandible are possible. Treatment ...using non‐rigid telescopic connectors on two interforaminal implants for overdenture stabilization began in 1989. The objective of this study is to investigate soft‐ and hard‐tissue conditions as well as prosthesis function after a period of 10 years. This also involved an evaluation of correlations between radiographic and clinical parameters. Twenty‐three subjects with 46 interforaminal implants (ITI solid screw implants, 12 mm in length, 4.1 mm in diameter; 10.4 years in situ, range, 8–12.8 years) were investigated. Modified plaque index (mPI), sulcus fluid flow rate (SFFR), modified sulcus bleeding index (mBI), probing depth (PD), distance from implant crown margin to the coronal border of the peri‐implant mucosa (DIM), attachment level (AL), width of keratinized mucosa (KM), Periotest® values (PTVs) and prosthesis function were evaluated. In the radiographic evaluation, the distance between implant shoulder and first crestal bone–implant contact (DIB) in mm and the horizontal bone loss (HBL) in mm were measured. The relatively high mPI scores (mean, 0.82; score, 0 in 44.4%; SD, 0.83) did not result in increased SFFR scores (mean, 12; min, 3, max, 38; SD, 7.43) or higher mBI scores (mean, 0.35; score, 0 in 70.8%; SD, 0.59), which was commensurate with healthy peri‐implant mucosa. A mean PD value of 2.15 mm (min, 1 mm; max, 5 mm; SD, 0.96) and a mean DIM value of 0.28 mm (min, 0 mm; max, 2 mm; SD, 0.52) were measured. The implants were stable, showing a mean Periotest® value of −1.91 (max, 02, min, −6; SD, 1.76). A mean DIB of 3.19±0.95 mm (range, 1.3–5.16 mm) and a mean HBL of 1.6±1.52 mm (range, 0.28–8.33 mm) were calculated. A correlation was found between DIB and the parameters SFFR (P=0.060), DIM (P=0.042), AL (P=0.050) and especially PTV (P<0.01), leading to the assumption that these clinical parameters may be useful indicators of peri‐implant bone loss. The results of the 10‐year follow‐up examination show that non‐rigid telescopic connectors with two interforaminal implants for overdenture stabilization appear to be an efficient and effective long‐term treatment modality in severely resorbed edentulous mandibles. Particularly in geriatric patient treatment this concept may provide advantages in terms of handling, cleaning and long‐term satisfaction.
Résumé
Pour stabiliser les prothèses amovibles mandibulaires chez les patients édentés, différents types de connexion pouvant être attachés entre deux ou quatre implants placés dans la région antérieure sont possibles. Le traitement utilisant des connexions téléscopiques non‐rigides sur deux implants situés entre les trous mentonniers pour la stabilisation de la prothèse a démarré en 1989. Le but de cette investigation a été d'étudier les conditions des tissus mous et durs ainsi que la fonction de la prothèse sur une période de dix années. Cela comprenait également une évaluation des relations entre les paramètres cliniques et radiographiques. Vingt‐trois patients avec 46 implants situés entre les trous mentonniers (implants vis solides ITI, 12 mm de longueur, 4,1 mm de diamètre; 10,4 années in situ, de 8 à 13 années) ont été suivis. L'indice de plaque modifiée (mPI), le taux de fluide créviculaire (SFFR), l'indice modifié de saignement sulculaire (mBI), la profondeur au sondage (PD), la distance de la partie coronaire de l'implant jusqu'au rebord coronaire de la muqueuse paroïmplantaire (DIM), le niveau d'attache (AL), la largeur de la muqueuse kératinisée (KM), les mesures Periotest® (PTV) et le fonctionnement de la prothèse ont étéévalués. Dans l'évaluation radiographique, la distance entre l'épaule implantaire et le premier contact implant‐os crestal (DIB) en mm et la perte osseuse horizontale (HBL) en mm ont également été mesurés. Les scores relativement élevés de MPI (moyenne de 0,82; score 0 dans 44,4% des cas; SD 0,83) ne s'accompagnaient pas de scores plus importants de SFFR (moyenne 12; min 3, max 38; SD 7,43) ou de scores plus élevés de MBI (moyenne 0,35; score 0 dans 71% des cas; SD 0,59), ce qui était en accord avec une muqueuse paroïmplantaire saine. Une valeur PD moyenne de 2,15 mm (min.1 mm, max 5 mm; SD 0,96) et une valeur moyenne DIM de 0,28 mm (min 0 mm, max 2 mm; SD 0,52) ont été mesurées. Les implants étaient stables, montrant une valeur Periotest moyenne de ‐1,91 (max 0,2, min, ‐6, SD 1,76). Une DIB moyenne de 3,19 ±0,95 mm (de 1,30 à 5,16 mm) et un HBL moyen de 1,60±1,52 mm (de 0,28 à 8,33 mm) ont été calculés. Une relation a été constatée entre DIB et les paramètres SFFR (P=0,060), DIM (P=0,0042), AL (P0=0,050) et surtout PTV (P<0,01), portant à croire que ces paramètres cliniques pourraient être des indicateurs utiles de la perte osseuse paroïmplantaire. Les résultats de cet examen de suivi de dix années montrent que les connexions téléscopiques non‐rigides avec deux implants situés entre les trous mentonniers pour la stabilisation des prothèses semblent une modalité de traitement à long terme efficace chez les patients sévèrement édentés. Principalement chez les patients gériatriques ce concept pourrait apporter des avantages en terme de satisfaction à long terme, de nettoyage et de maintien.
Zusammenfassung
Um den zahnlosen Unterkiefer mit Implantaten und Hybridprothesen zu versorgen, stehen verschiedene Verbindungselemente zur Verfügung. Man greift dabei auf eine Anzahl von zwei bis vier Implantaten zurück. Seit 1989 wird ein Konzept verfolgt, bei dem Resilienzteleskope auf zwei interforaminalen Implantaten zur Prothesenstabilisierung herangezogen werden. Gegenstand dieser Studie ist es, die Weich‐ und Hartgewebesituation sowie die Prothesenfunktion nach einem Zeitraum von 10 Jahren zu untersuchen. Weiterhin wurden statistische Korrelationen zwischen klinischen und röntgenologischen Parametern berechnet. 23 Patienten mit 46 interforaminalen Implantaten (ITI‐Vollschraubenimplantate, 12 mm Länge, 4,1 mm Durchmesser; 10,4 Jahre in situ, min. 8,0 Jahre, max. 12,8 Jahre) wurden untersucht. Die klinische Untersuchung umfasste den modifizierten Plaque‐Index (mPI), die Sulkusfluid‐Fließrate (SFFR), den modifizierten Blutungsindex (mBI), die Sondierungstiefe (PD), den Abstand zwischen Implantatschulter und koronaler peri‐implantärer Mukosa (DIM), das klinische Attachment‐Level (AL), die Breite der keratinisierten Mukosa (KM), Periotest®‐Messungen (PTV) und die Beurteilung der Prothesenfunktion. Zur röntgenologischen Auswertung wurden der Abstand zwischen Implantatschulter und erstem krestalem Implantat‐Knochen‐Kontakt (DIB) und der horizontale Knochenabbau (HBL) gemessen. Trotz relativ hoher mPI‐Werte (Mittelwert 0,82; Wert 0 in 44,4%; SD 0,83) blieben die SFFR‐Werte (Mittelwert 12; min. 3, max. 38; SD 7,43) und die mBI‐Werte (Mittelwert 0,35; Wert 0 in 70,8%; SD 0,59) relativ gering, was dem klinischen Bild gesunder peri‐implantärer Weichgewebe entsprach. Es wurden ein mittlerer PD‐Wert von 2,15 mm (min. 1 mm, max. 5 mm; SD 0,96) und ein mittlerer DIM‐Wert von 0,28 mm (min. 0 mm, max. 2 mm; SD 0,52) gemessen. Bei einem durchschnittlichen Periotest®‐Wert von ‐1,91 (max. 02, min. −6; SD 1,76) waren die Implantate als stabil anzusehen. Die röntgenologische Auswertung ergab einen mittleren DIB‐Wert von 3,19±0,95 mm (Bereich 1,30–5,16 mm) und einen mittleren HBL‐Wert von 1,60±1,52 (Bereich 0,28–8,33 mm). Statistisch konnte eine Korrelation zwischen DIB und den Parametern SFFR (p=0,060), DIM (p=0,042), AL (p=0,050) und besonders PTV (p < 0,01) gefunden werden, weshalb diese Parameter eventuell als wertvolle klinische Indikatoren für einen stattfindenden peri‐implantären Knochenabbau herangezogen werden können. Die 10‐Jahres‐Ergebnisse dieser Studie zeigen, dass zwei mit Resilienzteleskopen versorgte Implantate zur Stabilisierung einer Hybridprothese eine langfristig erfolgversprechende Therapiemöglichkeit im stark atrophierten zahnlosen Unterkiefer darstellen. Besonders der Behandlung älterer Patienten kommt dieses Konzept aufgrund einfacher Prothesenhandhabung, guter Hygienefähigkeit und langfristiger Patientenzufriedenheit zugute.
Resumen
Para estabilizar las sobredentaduras mandibulares en pacientes edéntulos, es posible conectar varios tipos de conectores a entre dos y cuatro implantes en la mandíbula anterior. El tratamiento utilizando conectores telescópicos no rígidos en dos implantes interforaminales para la estabilización de la sobredentadura comenzó en 1989. El objetivo de este estudio fue investigar las condiciones de los tejidos duros y blandos además de la función de la prótesis tras un periodo de 10 años. Esto también involucró una evaluación de correlaciones entre parámetros clínicos y radiográficos.
Se investigaron veintitrés sujetos con 46 implantes interforaminales (implantes roscados macizos ITI, 12 mm de longitud, 4.1 mm de diámetro; 10.4 años in situ, rango 8 a 12.8 años). Se evaluaron el índice de placa modificado (mPI), la proporción de flujo de fluido del surco (SFFR), el índice de sangrado del surco modificado (mBI), la profundidad de sondaje (PD), la distancia del margen de la corona al borde coronal de la mucosa periimplantaria (DIM), el nivel de inserción (AL), la anchura de la mucosa queratinizada (KM), las medidas del Periotest® (PTV) y la función protésica. En la evaluación radiográfica, se midió la distancia entre el hombro del implante y el primer contacto implante‐hueso crestal (DIB) en mm y la perdida horizontal de hueso (HBL) en mm. Los valores relativamente altos de mPI (media 0.82; valor 0 en 44.4%; SD 0.83) no resultaron en unos valores aumentados de SFFR (media 12; min. 3, max. 38; SD 7.43) o mayores valores de mBI (media 0.35; valor 0 en 70.8%; SD 0.59), los cuales fueron equivalentes a los de una mucosa periimplantaria sana. Se midieron unos valores medios de PD de 2.15 mm (min. 1 mm, max. 5 mm; SD 0.96)
Insertion energy has been advocated as a novel measure for primary implant stability, but the effect of implant length, diameter, or surgical protocol remains unclear. Twenty implants from one ...specific bone level implant system were placed in layered polyurethane foam measuring maximum insertion torque, torque–time curves, and primary stability using resonance frequency analysis (RFA). Insertion energy was calculated as area under torque–time curve applying the trapezoidal formula. Statistical analysis was based on analysis of variance, Tukey honest differences tests and Pearson’s product moment correlation tests (α = 0.05). Implant stability (p = 0.01) and insertion energy (p < 0.01) differed significantly among groups, while maximum insertion torque did not (p = 0.17). Short implants showed a significant decrease in implant stability (p = 0.01), while reducing implant diameter did not cause any significant effect. Applying the drilling protocol for dense bone resulted in significantly increased insertion energy (p = 0.02) but a significant decrease in implant stability (p = 0.04). Insertion energy was not found to be a more reliable parameter for evaluating primary implant stability when compared to maximum insertion torque and resonance frequency analysis.
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