Clinical outcomes of all‐ceramic single crowns and fixed dental prostheses supported by ceramic implants: A systematic review and meta‐analyses

Objective: To analyze the clinical outcomes of all-ceramic single crowns (SCs) and fixed dental prostheses (FDPs) supported by ceramic implants. Materials and methods: Based on a focused question and customized PICO framework, electronic (Medline/EMBASE/Cochrane) and manual searches for studies reporting the clinical outcomes of all-ceramic SCs and FDPs supported by ceramic implants ≥12 months were performed. The primary outcomes were reconstruction survival and the chipping proportion. The secondary outcomes were implant survival, technical complications, and patient-related outcome measurements. Meta-analyses were performed after 1, 2, and 5 years using random-effect meta-analyses. Results: Eight of the 1,403 initially screened titles and 55 full texts were included. Five reported on monolithic lithium disilicate (LS2) SCs, one on veneered zirconia SCs, and two on veneered zirconia SCs and FDPs, which reported all on cement-retained reconstructions (mean observation: 12.0-61.0 months). Meta-analyses estimated a 5-year survival rate of 94% (95% confidence interval [CI]: 82%-100%) for overall implant survival. Reconstruction survival proportions after 5 years were: monolithic LS2, 100% (95%CI: 95%-100%); veneered zirconia SCs, 89% (95%CI: 62%-100%); and veneered zirconia FDPs 94% (95%CI: 81%-100%). The chipping proportion after 5 years was: monolithic LS2, 2% (95%CI: 0%-11%); veneered zirconia SCs, 38% (95%CI: 24%-54%); and veneered zirconia FDPs, 57% (95%CI: 38%-76%). Further outcomes were summarized descriptively. Conclusions: Due to the limited data available, only tendencies could be identified. All-ceramic reconstructions supported by ceramic implants demonstrated promising survival rates after mid-term observation. However, high chipping proportions of veneered zirconia SCs and, particularly, FDPs diminished the overall outcome. Monolithic LS2 demonstrated fewer clinical complications. Monolithic reconstructions could be a valid treatment option for ceramic implants. Keywords: ceramics; dental implants; implant-supported dental prosthesis; meta-analysis; survival analysis; systematic review; treatment outcome; zirconia

Facial pain – an interdisciplinary challenge

Im Praxis- und Klinikalltag wird der Zahnarzt regelmässig mit Patienten konfrontiert, die über Schmerzen im Gesicht klagen. Neben möglichen dentalen Ursachen können Erkrankungen aus anderen Fachgebieten, über die sich der Zahnarzt bewusst sein muss, verantwortlich für Gesichtsschmerzen sein. Eine genaue Schmerzanamnese ist daher ebenso wichtig wie eine gründliche klinische Untersuchung und die Einleitung gezielter diagnostischer Massnahmen, um dem Patienten schliesslich eine erfolgversprechende Therapie anbieten zu können. In diesem Artikel wird der Gesichtsschmerz aus der Perspektive der Fachbereiche Zahnmedizin, Neurologie und Neurochirurgie differenzialdiagnostisch erörtert, und es werden die unter- schiedlichen diagnostischen und therapeutischen Herangehensweisen erarbeitet. Ziel ist es, dem Patienten zeitraubende fehlgeleitete Therapien zu ersparen und ihn möglichst zeitnah einer effizienten, zielgerichteten Schmerztherapie zuzuführen, um die Entstehung einer Schmerzchronifizierung zu vermeiden.Acute pain has a warning function and is necessary to survive. Conversely, chronic or recurrent pain is a pathological entity itself and has tremendous impact on the quality of life of the patients . Facial pain is very common and can have various causes. The trigeminal nerve innervates the face, and tumours along its intracranial way as well as peripheral injury can lead to facial pain. Also, infections and systemic diseases, like multiple sclerosis, may cause pain in the face, so can vascular compressions of the trigeminal or glossopharyngeal nerve. Detailed pain history is crucial in order to rule out other than dental reasons for facial pain before invasive dental therapy is initiated. A multidisciplinary approach and additional imaging modalities might be necessary to find the optimal treatment for the patient

Monolithic Polymer-Infiltrated Ceramic Network CAD/CAM Single Crowns: Three-Year Mid-Term Results of a Prospective Clinical Study

Purpose: To evaluate the clinical outcomes of monolithic CAD/CAM-fabricated polymer-infiltrated ceramic network (PICN) single crowns (SC) after 3 years. Materials and Methods: A total of 34 patients who received 76 single crowns were included in this cohort study. Full-coverage crown preparation with reduced thickness (1.0 to 1.5 mm) was applied. All monolithic PICN SCs (VITA Enamic) were manufactured using a CAD/CAM system and adhesively seated. Clinical follow-up evaluations were performed at 6, 12, 24, and 36 months after insertion using modified United States Public Health Service (USPHS) criteria. Kaplan-Meier survival and success methods were applied to calculate absolute and relative failures. To determine effects of time and restoration, a mixed logit model was adjusted for the modified USPHS criteria (P < .05). Results: PICN SCs revealed an estimated Kaplan-Meier survival rate of 93.9% after 3 years. Four clinically unacceptable fractures occurred, which resulted in replacement of the affected SCs. Neither secondary caries nor debonding were recorded. The 3-year Kaplan-Meier success rate was 92.7%. Significant increases in marginal discoloration (P = .0002) and surface roughness (P < .0001) were noted over time. Color match, anatomical form, and marginal adaptation remained favorable over the given observation period. Conclusion: PICN CAD/CAM crowns with reduced thickness showed acceptable survival and success rates over a service time of 36 months. However, extended clinical follow-up periods are needed to evaluate the long-term performance

Mastication after craniotomy: pilot assessment of postoperative oral health-related quality of life

Abstract Background Neurosurgical approaches to the brain often require the mobilization of the temporal muscle. Many patients complain of postoperative pain, atrophy, reduced mouth opening, and masticatory problems. Although the pterional, frontolateral-extended-pterional, and temporal craniotomies are the most frequently used approaches in neurosurgery, a systematic assessment of the postoperative oral health-related quality of life has never been performed so far. This study evaluates the oral health-related quality of life of patients after pterional, frontolateral-extended-pterional, or temporal craniotomy using a validated and standardized dental questionnaire, compares the results with the normal values of the general population, and investigates whether this questionnaire is sensitive to changes caused by surgical manipulation of the temporal muscle. Methods The “Oral Health Impact Profile” (OHIP14) is a validated questionnaire to assess the oral health-related quality of life. It asks the patients to assess their oral health situation within the past 7 days in 14 questions. Possible answers range from 0 (never) to 4 (very often). Sixty patients with benign intracranial processes operated through a lateral cranial approach were included. The questionnaire was answered before surgery (baseline) and 3 months and 15 months after surgery. Results Overall, postoperative OHIP scores increase significantly after 3 months and decrease after 15 months, but not to preoperative values. No factors can be identified which show a considerable relationship with the postoperative OHIP score. Conclusions Postoperative impairment of mouth opening and pain during mastication can be observed 3 to 15 months after surgery and sometimes cause feedback from patients and their dentists. However, in line with existing literature, these complaints decrease with time. The study shows that the OHIP questionnaire is sensitive to changes caused by surgical manipulation of the temporal muscle and can therefore be used to investigate the influence of surgical techniques on postoperative complaints. Postoperatively, patients show worse OHIP scores than the general population, demonstrating that neurosurgical cranial approaches negatively influence the patient’s oral health-related wellbeing. Larger studies using the OHIP questionnaire should evaluate if postoperative physical therapy, speech therapy, or specialized rehabilitation devices can improve the masticatory impairment after craniotomy. Trial registration Clinical trial register: DRKS00011096. </jats:sec

Mastication after craniotomy: pilot assessment of postoperative oral health-related quality of life

Background!#!Neurosurgical approaches to the brain often require the mobilization of the temporal muscle. Many patients complain of postoperative pain, atrophy, reduced mouth opening, and masticatory problems. Although the pterional, frontolateral-extended-pterional, and temporal craniotomies are the most frequently used approaches in neurosurgery, a systematic assessment of the postoperative oral health-related quality of life has never been performed so far. This study evaluates the oral health-related quality of life of patients after pterional, frontolateral-extended-pterional, or temporal craniotomy using a validated and standardized dental questionnaire, compares the results with the normal values of the general population, and investigates whether this questionnaire is sensitive to changes caused by surgical manipulation of the temporal muscle.!##!Methods!#!The 'Oral Health Impact Profile' (OHIP14) is a validated questionnaire to assess the oral health-related quality of life. It asks the patients to assess their oral health situation within the past 7 days in 14 questions. Possible answers range from 0 (never) to 4 (very often). Sixty patients with benign intracranial processes operated through a lateral cranial approach were included. The questionnaire was answered before surgery (baseline) and 3 months and 15 months after surgery.!##!Results!#!Overall, postoperative OHIP scores increase significantly after 3 months and decrease after 15 months, but not to preoperative values. No factors can be identified which show a considerable relationship with the postoperative OHIP score.!##!Conclusions!#!Postoperative impairment of mouth opening and pain during mastication can be observed 3 to 15 months after surgery and sometimes cause feedback from patients and their dentists. However, in line with existing literature, these complaints decrease with time. The study shows that the OHIP questionnaire is sensitive to changes caused by surgical manipulation of the temporal muscle and can therefore be used to investigate the influence of surgical techniques on postoperative complaints. Postoperatively, patients show worse OHIP scores than the general population, demonstrating that neurosurgical cranial approaches negatively influence the patient's oral health-related wellbeing. Larger studies using the OHIP questionnaire should evaluate if postoperative physical therapy, speech therapy, or specialized rehabilitation devices can improve the masticatory impairment after craniotomy.!##!Trial registration!#!Clinical trial register: DRKS00011096

Failure Load and Fatigue Behavior of Monolithic Translucent Zirconia, PICN and Rapid-Layer Posterior Single Crowns on Zirconia Implants

This laboratory study aimed to evaluate the thermo-mechanical fatigue behavior and failure modes of monolithic and rapid-layer posterior single-crowns (SCs) supported by zirconia implants. Methods: 120 all-ceramic crowns supported by one-piece zirconia implants (ceramic.implant; vitaclinical) were divided into five groups (n = 24 each): Group Z-HT: 3Y-TZP monolithic-zirconia (Vita-YZ-HT); Group Z-ST: 4Y-TZP monolithic-zirconia (Vita-YZ-ST); Z-XT: 5Y-TZP monolithic-zirconia (Vita-YZ-XT); Group E: monolithic-polymer-infiltrated ceramic network (PICN,Vita-Enamic); Group RL (rapid layer): PICN-“table-top” (Vita-Enamic), 3Y-TZP-framework (Vita-YZ-HT). Half of the specimens of each group (n = 12) were exposed to fatigue with cyclic mechanical loading (F = 198N, 1.2-million cycles) and simultaneous thermocycling (5–55 °C). Single-load-to-failure testing (Z010, Zwick) was performed for all specimens without/with fatigue application. Data analysis was performed using ANOVA, Tukey’s post-hoc test, two-sample t-test and Bonferroni correction (p &lt; 0.05). Results: All specimens survived fatigue exposure. Significant differences in failure loads were detected among groups (p ≤ 0.004). Materials Z-HT and Z-ST showed the highest failure loads followed by Z-XT, RL and E. The influence of fatigue was only significant for material RL. Conclusions: All types of tested materials exceeded clinically acceptable failure load values higher than 900N and can be recommended for clinical use. Z-HT and Z-ST appear to be highly reliable towards fatigue. Rapid-layer design of PICN and YZ-HT might be an interesting treatment concept for posterior implant SCs.</jats:p

Failure Load and Fatigue Behavior of Monolithic Translucent Zirconia, PICN and Rapid-Layer Posterior Single Crowns on Zirconia Implants

This laboratory study aimed to evaluate the thermo-mechanical fatigue behavior and failure modes of monolithic and rapid-layer posterior single-crowns (SCs) supported by zirconia implants. Methods: 120 all-ceramic crowns supported by one-piece zirconia implants (ceramic.implant; vitaclinical) were divided into five groups (n = 24 each): Group Z-HT: 3Y-TZP monolithic-zirconia (Vita-YZ-HT); Group Z-ST: 4Y-TZP monolithic-zirconia (Vita-YZ-ST); Z-XT: 5Y-TZP monolithic-zirconia (Vita-YZ-XT); Group E: monolithic-polymer-infiltrated ceramic network (PICN,Vita-Enamic); Group RL (rapid layer): PICN-“table-top” (Vita-Enamic), 3Y-TZP-framework (Vita-YZ-HT). Half of the specimens of each group (n = 12) were exposed to fatigue with cyclic mechanical loading (F = 198N, 1.2-million cycles) and simultaneous thermocycling (5–55 °C). Single-load-to-failure testing (Z010, Zwick) was performed for all specimens without/with fatigue application. Data analysis was performed using ANOVA, Tukey’s post-hoc test, two-sample t-test and Bonferroni correction (p < 0.05). Results: All specimens survived fatigue exposure. Significant differences in failure loads were detected among groups (p ≤ 0.004). Materials Z-HT and Z-ST showed the highest failure loads followed by Z-XT, RL and E. The influence of fatigue was only significant for material RL. Conclusions: All types of tested materials exceeded clinically acceptable failure load values higher than 900N and can be recommended for clinical use. Z-HT and Z-ST appear to be highly reliable towards fatigue. Rapid-layer design of PICN and YZ-HT might be an interesting treatment concept for posterior implant SCs.Keywords: dental implant; zirconia; ceramics; translucent zirconia; fatigue; failure load; aging; chewing simulatio