Single versus splinted short implants at sinus augmented sites: A systematic review and meta-analysis.

OBJECTIVE This review primarily evaluated the success, survival and failure rates of implants shorter than 10 mm restored with single-unit or splinted fixed dental prostheses in maxillary sinus augmented sites. MATERIAL AND METHODS Two reviewers independently performed the systematic search of electronic databases, including MEDLINE, EMBASE and CENTRAL, up to September 2019 with no language restriction. A supplemental hand search consisted of screening 13 journals. The inclusion criteria were: primary studies reporting implant, prosthetic and patient-reported outcome measures (PROMs) of extra-short and short implants placed in conjunction with sinus floor elevation in partially dentate patients, restored with single- and splinted-crowns for direct comparison, with a minimal 1-year follow-up. Weighted arithmetic mean (WAM) of the implant survival was performed according to the type of prosthesis. This was confirmed by using Review Manager software to perform meta-analysis. RESULTS Two observational studies reporting on 106 tapered, press-fit, sintered porous-surfaced implants with a length ranging from 5 mm to 9 mm were included in this systematic review. Of these, 20 and 86 implants were restored with single and splinted prostheses, respectively. The risk ratio (RR) was 1.16 (95% CI: .31-4.30, p = .58, I² = 0%) for individually restored implants failure when compared to splinted implants, indicating that short dental implants restored with single crowns could have a 16% higher possibility of failure if compared to implants with splinted crowns. The heterogeneity value was not statistically significative (p = .58). No statistical difference in the implant survival rate of the two types of analysed prostheses was observed after WAM (p= .923). The level of evidence for the included studies ranged from low (4) to fair (2B). CONCLUSION Similar clinical outcomes up to a 9-year follow-up were observed in single and splinted porous-surfaced implants shorter than 10 mm located in sites with sinus lift. However, the conclusion shall be interpreted with caution due to the level of evidence and limited number of included studies included in this systematic review

Medical malpractice, legal and social consequences under the lens of Sociology of Law

This doctoral thesis revolves around a central question: What is the essence of medical malpractice, as seen under the lens of Legal Sociology? The prism through which we investigate the phenomenon of medical malpractice is “Ethics”. The emphasis on medical ethics is the principal axis that runs through our entire analysis.Our thesis is divided into seven chapters. In chapter one (“Medical Malpractice and Social Solidarity”), we deal with the term of medical malpractice in general. We expound on what it is, why it happens and what it means for patients and their families, as well as for society and the public health system. An implicit aim is the attempt to show that there is a close connection between medical malpractice and social-economic policies and the gradual disestablishment of the welfare state. In chapter two of the Thesis (“Sociology of Health and Medical Culture”) we first present the theoretical approach of the phenomenon of disease by four distinguished sociologists: Émile Durkheim, Max Weber, Talcott Parsons and Karl Marx. In chapters three, four and five of the Thesis (“Medical Malpractice and Civil Liability in France, Germany and the United Kingdom”), we introduce and analyze the concept of medical malpractice and civil liability in the context of the welfare system of France, Germany and the U.K, and comparisons are presented among various legal practices, methods and institutions, always viewed through the lens of the teleological interpretation of national legislation.In chapter six of the Thesis (“Medical Malpractice and Civil Liability in Greece”), we examine more closely the concept of medical malpractice and the institution of medical liability in Greece. We use Greek case law and we juxtapose it with Greek legal theory to investigate the current Greek legislative framework on medical malpractice. We also elaborate on how the teleological interpretation of the relatively recent law entitled “Code of Medical Deontology” (enacted in 2005) holds pace with the particularities of Greek social reality and the dominant social ethics. We critically analyze and scrutinize this legislative text through the prism of Sociology of Law.Finally, the conclusive remarks drawn from the previous six chapters of the Thesis are presented and discussed in our final Chapter Seven. We close with a critical evaluation and certain thoughts and suggestions for managing the phenomenon of medical malpractice. In our view, the goal should not be only to have a safer treatment of the highest number of patients who seek medical help, but also to reach a certain point where doctors will be able to practice their profession adopting the perspective of preventive medicine, thus alleviating human pain and suffering across the globe.Έναυσμα για τη συγγραφή αυτής της διδακτορικής διατριβής αποτέλεσε η εμπειρική παρατήρηση ότι ένας αριθμός εκπροσώπων του ιατρικού επαγγέλματος στην χώρα μας υποπίπτει σε ιατρικά λάθη. Ένας πρώτος ερευνητικός άξονας που προκύπτει είναι πώς συνδέεται ο χώρος παροχής ιατρικών υπηρεσιών και η σχέση γιατρού και ασθενούς μέσα στο γενικότερο κλίμα της οικονομικής κρίσης της τελευταίας δεκαετίας. Ο δεύτερος ερευνητικός άξονας είναι η ιατρική κουλτούρα, κατά πόσο δηλαδή οι άγραφοι κανόνες, οι κυρίαρχες αξίες και τα ήθη που διαπνέουν την άσκηση του ιατρικού επαγγέλματος σχετίζονται με την συχνότητα των ιατρικών λαθών. Η παρούσα εργασία χωρίζεται σε πέντε νοηματικά μέρη και επτά κεφάλαια. Στο πρώτο μέρος (κεφάλαιο πρώτο) γίνεται λόγος για το ιατρικό λάθος γενικά. Γιατί συμβαίνει και τι σημαίνει τόσο για τον ασθενή, όσο και για την κοινωνία και το σύστημα υγειονομικής περίθαλψης εν γένει. Ιατρικό λάθος: Η «έννοια – κλειδί» της ιατρικής ευθύνης είναι το ιατρικό λάθος (Faute Médicale, Medical Malpractice, Behandlungsfehler), το οποίο ορίζεται ως εκείνη η συμπεριφορά του ιατρού που αξιολογείται ως υπολειπόμενη της επιβαλλομένης στο επάγγελμά του και η έλλειψη της επιβαλλομένης κατά την συγκεκριμένη χρονική στιγμή επιμέλειας. Στο δεύτερο μέρος (κεφάλαιο δεύτερο) εξετάζεται η ανάδυση της «Κοινωνιολογίας της Υγείας και της Ασθένειας» ως διακριτού επιστημονικού κλάδου και η θεωρητική προσέγγιση του φαινομένου της «ασθένειας», όπως αυτή έγινε αντιληπτή και αναλύθηκε από τέσσερεις κορυφαίους Κοινωνιολόγους: Émile Durkheim, Max Weber, Talcott Parsons και Karl Marx. Το τρίτο και εκτενέστερο μέρος (κεφάλαια τρίτο, τέταρτο και πέμπτο) παρουσιάζει και εξετάζει λεπτομερώς το ιατρικό λάθος και την ιατρική ευθύνη στα πλαίσια των συστημάτων περίθαλψης της Γαλλίας, της Γερμανίας και της Βρετανίας. Το ιατρικό λάθος σε κάθε χώρα εξετάζεται σχολαστικά υπό το πρίσμα της αστικής ευθύνης, με οδηγό όμως πάντοτε την τελολογική ερμηνεία της νομικής ρύθμισης του νομοθέτη κάθε χώρας. Στο τέταρτο μέρος (κεφάλαιο έκτο) παρουσιάζεται το ιατρικό λάθος και η ιατρική ευθύνη στην Ελλάδα και συγκεκριμένα πώς η ελληνική νομοθεσία αντιμετωπίζει το ιατρικό λάθος. Ποιά είναι η τελεολογική ερμηνεία των νομοθετικών διατάξεων και του νέου Κώδικα Ιατρικής Δεοντολογίας (2005) και αν σε τελική ανάλυση οι νομοθετικές διατάξεις συμβαδίζουν με τις ιδιορρυθμίες της ελληνικής κοινωνικής πραγματικότητας. Τέλος, αν θα έπρεπε να συνοψίσω τα συμπεράσματα της εργασίας μου σε ένα μόνο συμπέρασμα, αυτό θα ήταν η τεράστια σημασία της κοινωνιολογικής έρευνας, που πρέπει να προηγείται πριν από κάθε νομοθετική μεταρρύθμιση και στην περίπτωσή μας θα έπρεπε και να προηγηθεί της θέσπισης του Κ.Ι.Δ. Μια κοινωνιολογική έρευνα εθνικής εμβέλειας με επαρκές αντιπροσωπευτικό δείγμα που θα έχει συντάξει και κατασκευάσει μια ειδική ομάδα κοινωνιολόγων και κοινωνιολόγων του δικαίου, θα είναι ό,τι καλύτερο προκειμένου να προληφθούν οι αθέλητες συνέπειες του νομοθετήματος που πρόκειται να θεσπιστεί και επίσης να αυξηθεί και να ενισχυθεί η κοινωνική αποτελεσματικότητα των διατάξεων. Έτσι η κοινωνιολογία καθίσταται «Πραξεολογία»

Computer-assisted, template-guided immediate implant placement and loading in the mandible: a case report

Abstract Background Computer-assisted implant planning has become an important diagnostic and therapeutic tool in modern dentistry. This case report emphasizes the possibilities in modern implantology combining virtual implant planning, guided surgery with tooth and implant supported templates, immediate implant placement and loading. Case presentation A straight forward approach was followed for the mandible presenting with hopeless lower incisors. Diagnosis, decision making and treatment approach were based on clinical findings and detailed virtual three-dimensional implant planning. Extractions of the hopeless mandibular incisors, immediate and guided implant placement of six standard implants, and immediate loading with a provisional fixed dental prosthesis (FDP) were performed fulfilling patient’s functional and esthetic demands. The final computer assisted design / computer assisted manufacturing (CAD/CAM) FDP with a titanium framework and composite veneering was delivered after 6 months. At the 1-year recall the FDP was free of technical complications. Stable bony conditions and a healthy peri-implant mucosa could be observed. Conclusions Computer assisted implantology including three-dimensional virtual implant planning, guided surgery, and CAD/CAM fabrication of provisional and final reconstructions allowed for a concise treatment workflow with predictable esthetic and functional outcomes in this mandibular full-arch case. The combination of immediate implant placement and immediate loading was considerably more complex and required a high level of organization between implantologist, technician and patient. After the usage of a first tooth-supported surgical template with subsequent extraction of the supporting teeth, a second surgical template stabilized on the previously inserted implants helped to transfer the planned implant position in the extraction sites with a guided approach

Computer-assisted, template-guided immediate implant placement and loading in the mandible: a case report

Abstract Background Computer-assisted implant planning has become an important diagnostic and therapeutic tool in modern dentistry. This case report emphasizes the possibilities in modern implantology combining virtual implant planning, guided surgery with tooth and implant supported templates, immediate implant placement and loading. Case presentation A straight forward approach was followed for the mandible presenting with hopeless lower incisors. Diagnosis, decision making and treatment approach were based on clinical findings and detailed virtual three-dimensional implant planning. Extractions of the hopeless mandibular incisors, immediate and guided implant placement of six standard implants, and immediate loading with a provisional fixed dental prosthesis (FDP) were performed fulfilling patient’s functional and esthetic demands. The final computer assisted design / computer assisted manufacturing (CAD/CAM) FDP with a titanium framework and composite veneering was delivered after 6 months. At the 1-year recall the FDP was free of technical complications. Stable bony conditions and a healthy peri-implant mucosa could be observed. Conclusions Computer assisted implantology including three-dimensional virtual implant planning, guided surgery, and CAD/CAM fabrication of provisional and final reconstructions allowed for a concise treatment workflow with predictable esthetic and functional outcomes in this mandibular full-arch case. The combination of immediate implant placement and immediate loading was considerably more complex and required a high level of organization between implantologist, technician and patient. After the usage of a first tooth-supported surgical template with subsequent extraction of the supporting teeth, a second surgical template stabilized on the previously inserted implants helped to transfer the planned implant position in the extraction sites with a guided approach

Clinical Fitting and Adjustment Time for Implant-Supported Crowns Comparing Digital and Conventional Workflows.

PURPOSE The aim of this prospective cohort study was to investigate clinical and laboratory performance of implant-supported reconstructions comparing the digital to the conventional workflow. MATERIALS AND METHODS Twenty study participants were treated in a cross-over design for single-tooth replacement in posterior sites, each with a customized titanium abutment plus computer-assisted design and computer-assisted manufacturing (CAD/CAM)-zirconia-suprastructure (test: digital workflow; n = 20) and a standardized titanium abutment plus PFM-crown (control: conventional pathway; n = 20). Evaluation of the 40 reconstructions included: 1) feasibility of laboratory cross-mounting of each abutment-crown-connection, and 2) assessment of adaptation time for clinical adjustments of interproximal and occlusal surfaces. Statistical analyses were performed using the exact Wilcoxon rank sum tests. RESULTS Laboratory cross-mounting was feasible for three reconstruction pairings revealing a 15% vice versa transfer success rate. All implant crowns could be provided successfully within two clinical appointments, independently of the workflow used. The mean clinical adjustment time was significantly lower (p < .001) for test reconstructions from the digital workflow with 2.2 min (standard deviation [SD] ± 2.1) compared with the ones from the conventional pathway with 6.0 min (SD ± 3.9). CONCLUSIONS The digital workflow was almost threefold more efficient than the established conventional pathway for fixed implant-supported crowns. Clinical fitting could be predictably achieved with no or minor adjustments within the digital process of intraoral scanning plus CAD/CAM technology

Prosthetically driven, computer-guided implant planning for the edentulous maxilla: a model study

OBJECTIVES: To analyze computer-assisted diagnostics and virtual implant planning and to evaluate the indication for template-guided flapless surgery and immediate loading in the rehabilitation of the edentulous maxilla. MATERIALS AND METHODS: Forty patients with an edentulous maxilla were selected for this study. The three-dimensional analysis and virtual implant planning was performed with the NobelGuide software program (Nobel Biocare, Göteborg, Sweden). Prior to the computer tomography aesthetics and functional aspects were checked clinically. Either a well-fitting denture or an optimized prosthetic setup was used and then converted to a radiographic template. This allowed for a computer-guided analysis of the jaw together with the prosthesis. Accordingly, the best implant position was determined in relation to the bone structure and prospective tooth position. For all jaws, the hypothetical indication for (1) four implants with a bar overdenture and (2) six implants with a simple fixed prosthesis were planned. The planning of the optimized implant position was then analyzed as follows: the number of implants was calculated that could be placed in sufficient quantity of bone. Additional surgical procedures (guided bone regeneration, sinus floor elevation) that would be necessary due the reduced bone quality and quantity were identified. The indication of template-guided, flapless surgery or an immediate loaded protocol was evaluated. RESULTS: Model (a) - bar overdentures: for 28 patients (70%), all four implants could be placed in sufficient bone (total 112 implants). Thus, a full, flapless procedure could be suggested. For six patients (15%), sufficient bone was not available for any of their planned implants. The remaining six patients had exhibited a combination of sufficient or insufficient bone. Model (b) - simple fixed prosthesis: for 12 patients (30%), all six implants could be placed in sufficient bone (total 72 implants). Thus, a full, flapless procedure could be suggested. For seven patients (17%), sufficient bone was not available for any of their planned implants. The remaining 21 patients had exhibited a combination of sufficient or insufficient bone. DISCUSSION: In the maxilla, advanced atrophy is often observed, and implant placement becomes difficult or impossible. Thus, flapless surgery or an immediate loading protocol can be performed just in a selected number of patients. Nevertheless, the use of a computer program for prosthetically driven implant planning is highly efficient and safe. The three-dimensional view of the maxilla allows the determination of the best implant position, the optimization of the implant axis, and the definition of the best surgical and prosthetic solution for the patient. Thus, a protocol that combines a computer-guided technique with conventional surgical procedures becomes a promising option, which needs to be further evaluated and improved

Misfit of implant prostheses and its impact on clinical outcomes. Definition, assessment and a systematic review of the literature.

BACKGROUND AND AIM Compromised fit between the contact surfaces of screw-retained implant-supported fixed dentures (IFDs) is thought to create uncontrolled strains in the prosthetic components and peri-implant tissues, thus evoking biological and technical complications such as bone loss, screw loosening, component fractures and, at worst, loss of implants or prostheses. The aim of this systematic review was to evaluate the impact of marginal misfit on the clinical outcomes of IFDs, and to elucidate definition and assessment methods for passive fit. MATERIALS AND METHODS A systematic review of the literature was conducted with a PICO question: "For partially or complete edentulous subjects with screw-retained IFDs, does the marginal misfit at the implant-prosthesis interfaces have an impact on the clinical outcomes?". A literature search was performed electronically in PubMed (MEDLINE) with the help of Boolean operators to combine key words, and by hand search in relevant journals. English written in vivo studies published before August 31, 2016 that reported on both clinical outcome and related implant prosthesis misfit (gap, strains, torque) were selected using predetermined inclusion criteria. RESULTS The initial search yielded 2626 records. After screening and a subsequent filtering process, five human and five animal studies were included in the descriptive analysis. The selected studies used different methods to assess misfit (linear distortion, vertical gap, strains, screw torque). While two human studies evaluated the biological response and technical complications prospectively over 6 and 12 months, the animal studies had an observation period < 12 weeks. Four human studies analysed retrospectively the 3 to 32 years' outcomes. Screw-related complications were observed, but biological sequelae could not be confirmed. Although the animal studies had different designs, bone adaptation and implant displacement was found in histological analyses. Due to the small number of studies and the heterogenic designs and misfit assessment methods, no meta-analysis of the data could be performed. CONCLUSIONS The current literature provides insufficient evidence as to the effect of misfit at the prosthesis-implant interface on clinical outcomes of screw-retained implant-supported fixed dentures. Marginal gaps and static strains due to screw tightening were not found to have negative effects on initial osseointegration or peri-implant bone stability over time. Based on two clinical studies, the risk for technical screw-related complications was slightly higher. While the degree of tolerable misfit remains a matter of debate, the present data do not imply that clinicians neglect good fit, but aim to achieve the least misfit possible. Conflict of interest statement: The authors declare no conflict of interest. The review was conducted as part of the 2016 Foundation of Oral Rehabilitation Consensus Conference on "Prosthetic Protocols in Implant-based Oral Rehabilitation"

Maintenance of implant-supported maxillary prostheses: a 2-year controlled clinical trial

To analyze maintenance service of fixed maxillary prostheses and overdentures based on conventional gold bars or titanium bars and frameworks fabricated with computer-aided design/computer-assisted manufacture (CAD/CAM) technology

Clinical outcome of single porcelain-fused-to-zirconium dioxide crowns: a systematic review

STATEMENT OF PROBLEM The increasing demand by patients for esthetic and metal-free restorations has driven the development of ceramic restorations with good esthetic and mechanical stability. Recent clinical studies have investigated the use of zirconium dioxide as a core material for complete crowns and computer-aided-design/computer-aided-manufacturing fabricated restorations. PURPOSE The aim of this systematic review was to evaluate the clinical survival rates of porcelain-fused-to-zirconia (PFZ) single crowns on anterior and posterior teeth and to compare them with metal ceramic (MC) crowns. MATERIAL AND METHODS A systematic search was conducted with PubMed and manual research to identify literature written in English that refers to in vivo studies published from January 1, 1950 through July 1, 2011. Clinical trials that evaluated PFZ and MC single crowns on natural teeth were selected for further analysis. Titles and/or abstracts of articles identified through the electronic searches were reviewed and evaluated for appropriateness. In addition, a hand search of relevant dental journals was peformed, and reference lists of culled articles were screened to identify publications. RESULTS The search resulted in a total of 488 initial matches. Nineteen studies with a total of 3621 crowns met the inclusion criteria. The survival rates of PFZ crowns (total 300) ranged from 92.7% to 100% for a follow-up time of 24 to 39 months, whereas those of MC crowns (total 3321) ranged from 70% to 100% for a follow-up time of 12 to 298 months. Studies that reported long-term results were found only for the MC crown group. CONCLUSIONS The scientific clinical data available to compare PFZ and MC crowns are limited. The survival rates may well be influenced by the selection and appropriate use of the veneering ceramic, and, therefore, additional prospective long-term clinical trials are necessary to draw reliable conclusions