Undirbúningur fyrir máttöku : yfirlit yfir þær aðferðir sem notaðar eru í dag

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)Krónur, skeljar, innlegg og álegg (onlay) eru reglulega notuð í tannlækningum til að byggja upp skemmdar tennur og/eða til að bæta útlit. Þegar tannskurðarbrúnir eru staðsettar subgingivalt er nauðsynlegt að ýta tannholdinu tímabundið til hliðar (gingival retraction) þannig að þær verði aðgengilegar við máttöku. Áratugum saman snerust rannsóknir í munn-og tanngervalækningum aðallega um tæknilegar útfærslur og hvaða efni skyldu notuð. Það var fyrst í lok fimmta og á sjötta áratug síðustu aldar sem áhrif efna og aðferða á tannhold fékk aukið vægi í rannsóknum

Sjúklingatilfelli frá Tannlæknadeild Háskóla Íslands - Krónu- og brúargerð, tannfylling

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A systematic review of the influence of the implant-abutment connection on the clinical outcomes of ceramic and metal implant abutments supporting fixed implant reconstructions

OBJECTIVES The objective of this systematic review was to assess the influence of implant-abutment connection and abutment material on the outcome of implant-supported single crowns (SCs) and fixed dental prostheses (FDPs). METHODS An electronic Medline search complemented by manual searching was conducted to identify randomized controlled clinical trials, prospective and retrospective studies with a mean follow-up time of at least 3 years. Patients had to have been examined clinically at the follow-up visit. Failure and complication rates were analyzed using robust Poisson regression, and comparisons were made with multivariable Poisson regression models. RESULTS The search provided 1511 titles and 177 abstracts. Full-text analysis was performed for 147 articles resulting in 60 studies meeting the inclusion criteria. Meta-analysis of these studies indicated an estimated 5-year survival rate of 97.6% for SCs and 97.0% for FDPs supported by implants with internal implant-abutment connection and 95.7% for SCs and 95.8% for FDPs supported by implants with external connection. The 5-year abutment failure rate ranged from 0.7% to 2.8% for different connections with no differences between the types of connections. The total number of complications was similar between the two connections, yet, at external connections, abutment or occlusal screw loosening was more predominant. Ceramic abutments, both internally and externally connected, demonstrated a significantly higher incidence of abutment fractures compared with metal abutments. CONCLUSION For implant-supported SCs, both metal and ceramic abutments with internal and external connections exhibited high survival rates. Moreover, implant-supported FDPs with metal abutments with internal and external connections for also showed high survival rates

The effect of systemic antibiotics on clinical and patient‐reported outcome measures of oral implant therapy with simultaneous guided bone regeneration

Publisher's version (útgefin grein)Objectives: The aim of the present superiority study was to determine the effect of systemic antibiotics primarily on patient-reported outcome measures (PROMs) and post-surgical complications in patients undergoing oral implant therapy with simultaneous guided bone regeneration (GBR). Materials and Methods: A total of 236 medically and periodontally healthy patients received oral implants with simultaneous GBR at seven centres. Pre-operative antibiotics of 2 g amoxicillin were prescribed to the test group 1 hr prior to surgery and 500 mg thrice daily on days 1–3 after surgery. The control group was given a placebo. Group allocation was performed randomly. Primary outcome variables were PROMs recorded as visual analogue scale scores assessed on days 1–7 and 14 on pain, swelling, haematoma and bleeding. Post-operative complications as secondary outcome variables were examined at 1, 2, 4 and 12 weeks from surgery. Chi-square tests and repeated measures of analysis of variance (ANOVA) were performed for statistical evaluation. Results: No statistically significant differences (p >.05) between the two groups were detected for the evaluated PROMs. The same was noted with respect to post-surgical complications. Four implants were lost—three in the test group and one in the control group. Conclusion: In this trial, systemic antibiotics did not provide additional benefits to PROMs, nor the prevention of post-surgical complications in medically and periodontally healthy patients undergoing oral implant therapy with simultaneous GBR. However, further studies with larger sample sizes are still required to support the clinical outcomes of this study.This study has been supported by a research grant of the ITI Foundation (ITI Grant‐No: No. 962_2013). Further, we want to thank the Geistlich AG, Wolhusen, Switzerland, for providing bone substitutes and collagen membranes (Bio‐Oss® and Bio‐Gide®); Medochemie Limassol, Cyprus, for providing the study medication; and the Straumann AG (Basel, Switzerland) for granting a 50% discount on all the implant materials used in the presented study. The co‐operation of the staff of the centres involved in the study is highly appreciated: (1) Peking University, School of Stomatology, Beijing PR China (2) Medical University Graz, University Clinic of Dental Medicine & Oral Health, Department of Oral Surgery and Orthodontics, Graz Austria (3) Griffith University, Gold Coast, School of Dentistry and Oral Health, Queensland, Australia (4) The University of Hong Kong, Faculty of Dentistry, Hong Kong SAR PR China (5) University of Iceland, Faculty of Odontology, Reykjavik, Iceland (6) Shanghai Jiao Tong University, Shanghai Ninth People's Hospital, Department of Implant Dentistry, Shanghai PR China (7) National Dental Centre Singapore, SingaporePeer Reviewe

Are dental implants better than natural teeth?

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadAlnetið býr yfir miklum fróðleik af ýmsum toga. Þar úir og grúir af upplýsingum um tannplanta, en upplýsingar um tennur eru af skornum skammti. Í þessari grein eru bornar saman lifunarhorfur tannplanta við lifunarhorfur náttúrulegra tanna og áhrifaþættir ræddir. Til einföldunar er umræðan byggð á hefðbundinni flokkun tanna í öruggar, vafasamar og vonlausar. Öruggar tennur ættu að endast vel og lengi án mikillar meðferðarþarfar. Vafasamar tennur gætu þurft á talsverðri meðferð að halda og stöðugu eftirlit. Eina meðferð sem skynsamleg er fyrir vonlausar tennur, er úrdráttur. Margvíslegir áhættuþættir geta aukið líkur á því að vafasöm tönn lendi sem vonlaus tönn og sé fjarlægð. Rétt er að benda á að tannplantar eiga sér aldrei betri horfur en heil og heilbrigð tönn. Tannplantar og plantaborin tanngervi eru afbragðskostir til að bæta fyrir tapaðar tennur, en eiga aldrei að koma í stað heilbrigðra, náttúrulegra tanna.There is vast amount of information on dental treatment on the internet, often indicating excellent survival and success rates of different types of implant-supported fixed dental prostheses. However, there is much less information regarding survival and success rates of the natural teeth – sometimes leaving the reader a bit confused, if natural teeth are as good as dental implants. The present article emphasizes the importance of making an evidence-based treatment plan with the best possible outcome for the patient. Dental implants and implant-supported restorations are an excellent treatment modality, but it must always be kept in mind that it is associated with a risk of biological and technical complications. Implants are supposed to replace missing teeth – they are not supposed to replace teeth

A multicenter randomized, controlled clinical trial comparing the use of displacement cords, an aluminum chloride paste, and a combination of paste and cords for tissue displacement

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadTilefni rannsóknar. Tannholdsrýrnun vegna tannholdsfærslu fyrir máttöku í tanngervasmíði gæti orðið útlitslegt vandamál fyrir sjúklinga. Takmarkað er vitað um viðbrögð mjúkvefs við algengum aðferðum við tannholdsfærslu. Tilgangur. Tilgangur þessarar slembnu klínísku rannsóknar var að meta breytingar í hæð tannholdsbrúnar eftir 3 mismunandi aðferðir við tannholdsfærslu fyrir máttöku við tanngervasmíði. Auk þess voru viðbrögð sjúklinga könnuð og tannsmiðir fengnir til að meta stautaundirbúning. Efniviður og aðferðir. 67 þátttakendum var raðað í 3 hópa af handahófi. Í hópi 1 (T1), (n=22) var álklóríðkvoða notuð ein og sér. Í hópi 2 (T2), (n=23) var þræði pakkað og álklóríð kvoða einnig notuð. Í samanburðarhópnum (C), (n=22) voru 2 þræðir notaðir við tannholdsfærsluna. Klínískar mælingar voru gerðar á tannholdi fyrir meðferð sem og 30±10 dögum eftir límingu tanngervisins. Study módel voru gerð á ákveðnum stigum meðferðar og staðlaðar ljósmyndir voru teknar af þeim. Breytingar í hæð búkkal tannholdsbrúnar voru mældar af ljósmyndum í myndaforriti. Auk þess voru viðbrögð sjúklinga könnuð og mat lagt á stautaundirbúninginn með VAS-aðferðinni. Niðurstöður. Rannsóknartennur allra hópanna voru eins m.t.t. klínískra mælinga, utan þess að tennur sem höfðu fengið krónulengingu fyrir meðferð voru marktækt fleiri í T1 borið saman við hina hópana. Á tímabilinu frá máttöku að límingu varð aukning í hæð tannholdsbrúnar upp á 0.058 mm (SD 0.13) í T1 og 0.013 mm (SD 1.19) í T2. Hins vegar, fannst væg tannholdsrýrnun upp á 0.049 mm (SD 0.13) í C. Niðurstöður allra hópanna sýndi að í 21% tilfella jókst hæð tannholdsbrúnar um >0.1 mm, 58% tannanna höfðu stöðuga tannholdsbrún (0 ± 0.10 mm), 21% tilfella sýndi væga tannholdsrýrnun (0.1-0.5 mm) en ekkert tilfelli sýndi meðal-eða alvarlega rýrnun (>0.5 mm). Væg tannholdsrýrnun varð í 8% tilfella í T1, 23% í T2 og 32% í C. Munurinn í tíðnidreifingunni milli hópanna var marktækur (p=.015). 15 þátttakendur (24%) lýstu óþægindum eftir máttökuna. Munurinn milli hópanna var ómarktækur. Tannsmiðum fannst marktækt erfiðara að undirbúa stauta í T1 (VAS 79) og T2 (VAS 82), borið saman við C (VAS 93), (p=.003). Ályktanir. Væg tannholdsrýrnun (<1 mm) er líklegri þegar þræðir eru notaðir við tannholdsfærslu fyrir máttöku samanborið við álklóríðkvoðu. Hins vegar er líklegra að tannsmiðir eigi erfiðara með að greina krónubrúnir í mátum þar sem álklóríðkvoða er notuðStatement of problem. Gingival recession due to soft tissue displacement for impression-making in fixed prosthodontics may pose a problem for treatment success in the esthetic areas of the mouth. There is limited knowledge about the soft tissue reaction of common gingival displacement methods. Purpose. The purpose of this randomized controlled clinical trial (RCT) was to evaluate changes in the marginal soft tissue height to 3 different gingival tissue displacement techniques during fixed prosthodontics definitive impressions of natural teeth. Additionally, participants' perception of the intervention and technicians' evaluation of the easiness of die preparation was evaluated using Visual Analogue Scales. Material and Methods. Sixty-seven individuals were randomized into 3 groups. In test group 1 (T1), (n=22) only aluminum chloride paste was used to retract the gingiva. In Test group 2 (T2), (n=23) a cord was inserted and aluminum chloride paste was used as well. In the Control group (C), (n=22) 2 cords were used to retract the gingiva (double cord technique). Clinical measurements of the gingival position were made before treatment initiation and 30±10 days after prosthesis delivery. Study casts were fabricated at different stages of the treatment, standardized photographs of these were taken and changes in the buccal gingival position measured using a graphics editing software. In addition, participants' perception of the clinical procedure and technicians' evaluation of the die preparation were recorded. Results. Baseline clinical parameters of the study teeth were the same for all groups except for surgical crown lengthening, for which all 3 included cases were allocated to T1. In the period between impression and delivery, a minor gain in gingival height was reported of 0.058 mm (SD 0.13) for T1 and 0.013 mm (SD 1.19) for T2. However, a minor gingival recession of 0.049 mm (SD 0.13) was reported for group C. The results for all groups showed that 21% of abutment teeth gained >0.1 mm gingival height, 58% had stable gingival height (0 ± 0.10 mm), 21% showed minor gingival recessions (0.1-0.5 mm), and no abutment teeth showed moderate or severe gingival recessions (>0.5 mm). The incidence of minor gingival recession was 8% in T1, 23% in T2 and 32% in C. The difference in frequency distribution of the gingival position between the 3 groups reached statistical significance (p=.015). Fifteen participants, (24%) experienced some discomfort after the procedure. The difference between the groups was not significant. The dental technicians found the working die preparation significantly more challenging for group T1 (VAS 79) and T2 (VAS 82), as compared to group C (mean VAS 93), (p=.003). Conclusion. Minor or moderate gingival recession (< 1 mm) is more likely to occur when conventional cords are used during impression making. However, utilizing the double cord technique, the dental technicians found die preparation significantly less challenging compared with impressions made using the aluminum chloride paste

All-ceramic or metal-ceramic tooth-supported fixed dental prostheses (FDPs)? A systematic review of the survival and complication rates: Single crowns

Objective. To assess the 5-year survival of metal-ceramic and all-ceramic tooth-supported single crowns (SCs) and to describe the incidence of biological, technical and esthetic complications. Methods. Medline (PubMed), Embase, Cochrane Central Register of Controlled Trials (CEN-TRAL) searches (2006–2013) were performed for clinical studies focusing on tooth-supported fixed dental prostheses (FDPs) with a mean follow-up of at least 3 years. This was complimented by an additional hand search and the inclusion of 34 studies from a previous systematic review. Survival and complication rates were analyzed using robust Poisson’s regression models to obtain summary estimates of 5-year proportions. Results. Sixty-seven studies reporting on 4663 metal-ceramic and 9434 all-ceramic SCs fulfilled the inclusion criteria. Seventeen studies reported on metal-ceramic crowns, and 54 studies reported on all-ceramic crowns. Meta-analysis of the included studies indicated an estimated survival rate of metal-ceramic SCs of 94.7% (95% CI: 94.1–96.9%) after 5 years. This was similar to the estimated 5-year survival rate of leucite or lithium-disilicate reinforced glass ceramic SCs (96.6%; 95% CI: 94.9–96.7%), of glass infiltrated alumina SCs (94.6%; 95% CI: 92.7–96%) and densely sintered alumina and zirconia SCs (96%; 95% CI: 93.8–97.5%;92.1%; 95% CI: 82.8–95.6%). In contrast, the 5-year survival rates of feldspathic/silica-based ceramic crowns were lower (p &lt; 0.001). When the outcomes in anterior and posterior regions were compared feldspathic/silica-based ceramic and zirconia crowns exhibited significantly lower survival rates in the posterior region (p &lt; 0.0001), the other crown types performed similarly. Densely sintered zirconia SCs were more frequently lost due to veneering ceramic fractures than metal-ceramic SCs (p &lt; 0.001), and had significantly more loss of retention (p &lt; 0.001). In total higher 5 year rates of framework fracture were reported for the all-ceramic SCs than for metal-ceramic SCs. Conclusions. Survival rates of most types of all-ceramic SCs were similar to those reported for metal-ceramic SCs, both in anterior and posterior regions. Weaker feldspathic/silica-based ceramics should be limited to applications in the anterior region. Zirconia-based SCs should not be considered as primary option due to their high incidence of technical problems

All-ceramic or metal-ceramic tooth-supported fixed dental prostheses (FDPs)? A systematic review of the survival and complication rates. Part II: Multiple-unit FDPs.

OBJECTIVE To assess the 5-year survival of metal-ceramic and all-ceramic tooth-supported fixed dental prostheses (FDPs) and to describe the incidence of biological, technical and esthetic complications. METHODS Medline (PubMed), Embase and Cochrane Central Register of Controlled Trials (CENTRAL) searches (2006-2013) were performed for clinical studies focusing on tooth-supported FDPs with a mean follow-up of at least 3 years. This was complemented by an additional hand search and the inclusion of 10 studies from a previous systematic review [1]. Survival and complication rates were analyzed using robust Poisson's regression models to obtain summary estimates of 5-year proportions. RESULTS Forty studies reporting on 1796 metal-ceramic and 1110 all-ceramic FDPs fulfilled the inclusion criteria. Meta-analysis of the included studies indicated an estimated 5-year survival rate of metal-ceramic FDPs of 94.4% (95% CI: 91.2-96.5%). The estimated survival rate of reinforced glass ceramic FDPs was 89.1% (95% CI: 80.4-94.0%), the survival rate of glass-infiltrated alumina FDPs was 86.2% (95% CI: 69.3-94.2%) and the survival rate of densely sintered zirconia FDPs was 90.4% (95% CI: 84.8-94.0%) in 5 years of function. Even though the survival rate of all-ceramic FDPs was lower than for metal-ceramic FDPs, the differences did not reach statistical significance except for the glass-infiltrated alumina FDPs (p=0.05). A significantly higher incidence of caries in abutment teeth was observed for densely sintered zirconia FDPs compared to metal-ceramic FDPs. Significantly more framework fractures were reported for reinforced glass ceramic FDPs (8.0%) and glass-infiltrated alumina FDPs (12.9%) compared to metal-ceramic FDPs (0.6%) and densely sintered zirconia FDPs (1.9%) in 5 years in function. However, the incidence of ceramic fractures and loss of retention was significantly (p=0.018 and 0.028 respectively) higher for densely sintered zirconia FDPs compared to all other types of FDPs. CONCLUSIONS Survival rates of all types of all-ceramic FDPs were lower than those reported for metal-ceramic FDPs. The incidence of framework fractures was significantly higher for reinforced glass ceramic FDPs and infiltrated glass ceramic FDPs, and the incidence for ceramic fractures and loss of retention was significantly higher for densely sintered zirconia FDPs compared to metal-ceramic FDPs

All-ceramic or metal-ceramic tooth-supported fixed dental prostheses (FDPs)? A systematic review of the survival and complication rates. Part I: Single crowns (SCs).

OBJECTIVE To assess the 5-year survival of metal-ceramic and all-ceramic tooth-supported single crowns (SCs) and to describe the incidence of biological, technical and esthetic complications. METHODS Medline (PubMed), Embase, Cochrane Central Register of Controlled Trials (CENTRAL) searches (2006-2013) were performed for clinical studies focusing on tooth-supported fixed dental prostheses (FDPs) with a mean follow-up of at least 3 years. This was complimented by an additional hand search and the inclusion of 34 studies from a previous systematic review [1,2]. Survival and complication rates were analyzed using robust Poisson's regression models to obtain summary estimates of 5-year proportions. RESULTS Sixty-seven studies reporting on 4663 metal-ceramic and 9434 all-ceramic SCs fulfilled the inclusion criteria. Seventeen studies reported on metal-ceramic crowns, and 54 studies reported on all-ceramic crowns. Meta-analysis of the included studies indicated an estimated survival rate of metal-ceramic SCs of 94.7% (95% CI: 94.1-96.9%) after 5 years. This was similar to the estimated 5-year survival rate of leucit or lithium-disilicate reinforced glass ceramic SCs (96.6%; 95% CI: 94.9-96.7%), of glass infiltrated alumina SCs (94.6%; 95% CI: 92.7-96%) and densely sintered alumina and zirconia SCs (96%; 95% CI: 93.8-97.5%; 92.1%; 95% CI: 82.8-95.6%). In contrast, the 5-year survival rates of feldspathic/silica-based ceramic crowns were lower (p<0.001). When the outcomes in anterior and posterior regions were compared feldspathic/silica-based ceramic and zirconia crowns exhibited significantly lower survival rates in the posterior region (p<0.0001), the other crown types performed similarly. Densely sintered zirconia SCs were more frequently lost due to veneering ceramic fractures than metal-ceramic SCs (p<0.001), and had significantly more loss of retention (p<0.001). In total higher 5 year rates of framework fracture were reported for the all-ceramic SCs than for metal-ceramic SCs. CONCLUSIONS Survival rates of most types of all-ceramic SCs were similar to those reported for metal-ceramic SCs, both in anterior and posterior regions. Weaker feldspathic/silica-based ceramics should be limited to applications in the anterior region. Zirconia-based SCs should not be considered as primary option due to their high incidence of technical problems