Esthetics in Implant Prosthodontics

In times of social media and selfie-hypes, patients’ expectations concerning dental treatment are increasing. Achieving a prosthetic ideal esthetic outcome using implants in esthetic sites is often challenging. Pink and white esthetics are influenced by the prosthetic workflow. This thesis aimed to investigate factors influencing the final esthetic outcome (provisional phase, abutment selection, vertical growth of the adjacent teeth) of implant supported prosthesis using objective esthetic parameters and including patient`s perception of the final treatment

Accuracy of intraoral scanning in completely and partially edentulous maxillary and mandibular jaws: an in vitro analysis

OBJECTIVES New generation intraoral scanners are promoted to be suitable for digital scans of long-span edentulous spaces and completely edentulous arches; however, the evidence is lacking. The current study evaluated the accuracy of intraoral scanning (IOS) in partially and completely edentulous arch models and analyzed the influence of operator experience on accuracy. MATERIALS AND METHODS Four different resin models (completely and partially edentulous maxilla and mandible) were scanned, using a new generation IOS device (n = 20 each). Ten scans of each model were performed by an IOS-experienced and an inexperienced operator. An industrial high-precision scanner was employed to obtain reference scans. IOS files of each model-operator combination, their respective reference scan files (n = 10 each; total = 80), as well as the IOS files from each model generated by the same operator, were superimposed (n = 45; total = 360) to calculate trueness and precision. An ANOVA for mixed models and post hoc t tests for mixed models were used to assess group-wise differences (α = 0.05). RESULTS The median overall trueness and precision were 24.2 μm (IQR 20.7-27.4 μm) and 18.3 μm (IQR 14.4-22.1 μm), respectively. The scans of the inexperienced operator had significantly higher trueness in the edentulous mandibular model (p = 0.0001) and higher precision in the edentulous maxillary model (p = 0.0004). CONCLUSION The accuracy of IOS for partially and completely edentulous arches in in vitro settings was high. Experience with IOS had small influence on the accuracy of the scans. CLINICAL RELEVANCE IOS with the tested new generation intraoral scanner may be suitable for the fabrication of removable dentures regardless of clinician's experience in IOS

The influence of age and gender on perception of orofacial esthetics among laypersons in Switzerland.

OBJECTIVE The purpose of this study was to evaluate the perception and role of orofacial esthetics by laypersons, and how attitudes may be correlated with age and gender in Switzerland. MATERIAL AND METHODS Self-administrated questionnaires (SAQ) were distributed both conventionally and digitally to Swiss residents over 16 years of age (range 16-99 years). The participants were identified in the medical practice, at an open house of the ZMK Bern, in elderly care centers, and via the internet (Facebook and Instagram). To verify that the participants were Swiss residents and laypersons, they were checked by an operator (conventional) or were provided an exact description of eligible participants at the beginning of the SAQ (digital). The SAQ included 30 questions with multiple-choice responses and visual analogue scales (0-100) divided into four sections regarding dental appearance with respect to body esthetics, partner selection, employment and career opportunities, and overall health/quality-of-life. For statistical analysis, respondents were segregated into two age groups (<25 years and ≥25 years) and into two gender groups (male and female). Descriptive analyses, the Fisher exact test, and Welch's t-test were applied (α = 0.05). RESULTS Five hundred and two laypersons completed the SAQ. The study's hypothesis-that various age groups and genders have different perceptions of dental esthetics-was supported. The willingness to correct one's own dentition was lower among older participants (OR: 0.54; p = 0.001); charisma and dental esthetics were considered equally important with a trend toward charisma in both age groups (p = 0.003). The belief that excellent dentition improves employment chances at a job interview (OR: 0.47; p = 0.0003) was significantly lower among older participants, and the belief that dental correction would improve quality-of-life was significantly higher among older participants (OR: 1.81; p = 0.001). The assumption that individuals with attractive teeth appear happier was significantly lower among older respondents (OR: 0.67; p = 0.03). Women were less satisfied with their dental appearance and, proportionally, their willingness to receive correction was significantly higher (OR: 1.79; p = 0.01 and OR: 1.77; p = 0.002 relative to men, respectively). Moreover, male participants had a lower desire to have brighter teeth and undergo bleaching treatments (OR: 0.54; p = 0.002; OR: 0.53; p = 0.002). The proportion of men believing that having beautiful teeth improves attractiveness and employment chances was significantly lower (OR: 0.33; p = 0.02 and OR: 0.66; p = 0.04; respectively). CONCLUSIONS Within the limitations of this observational study, it was concluded that age and gender of laypersons in Switzerland have a significant impact on the perception of dental esthetics. CLINICAL SIGNIFICANCE Evaluating and quantifying perceptions of dental esthetics for daily life across various age groups and genders can improve clinicians' understanding of individual needs in order to offer patient-oriented dental care

Investigating the Response of Human Neutrophils to Hydrophilic and Hydrophobic Micro-Rough Titanium Surfaces.

Various treatments have been used to change both the topography and chemistry of titanium surfaces, aiming to enhance tissue response and reduce healing times of endosseous implants. Most studies to date focused on bone healing around dental implants occurring later during the healing cascade. However, the impact of the initial inflammatory response in the surgical wound site on the success and healing time of dental implants is crucial for implant integration and success, yet it is still poorly understood. The purpose of this study was to investigate the effect of titanium surface hydrophilicity on the response of human neutrophils by monitoring oxygen radical production, which was measured as chemiluminescence activity. Materials and Methods: Neutrophils were isolated from human donors' blood buffy coats using the double sucrose gradient method. Neutrophils were exposed to both hydrophilic and hydrophobic titanium surfaces with identical topographies in the presence and absence of human serum. This resulted in six experimental groups including two different implant surfaces, with and without exposure to human serum, and two control groups including an active control with cells alone and a passive control with no cells. Two samples from each group were fixed and analyzed by SEM. Comparisons between surface treatments for differences in chemiluminescence values were performed using analysis of variance ANOVA. Results and Conclusion: In the absence of exposure to serum, there was no significant difference noted between the reaction of neutrophils to hydrophilic and hydrophobic surfaces. However, there was a significant reduction in the mean and active chemiluminescence activity of neutrophils to serum-coated hydrophilic titanium surfaces than to serum-coated hydrophobic titanium surfaces. This suggests that surface hydrophilicity promotes enhanced adsorption of serum proteins, which leads to decreased provocation of initial immune cells and reduction of local oxygen radical production during wound healing. This can help explain the faster osseointegration demonstrated by hydrophilic titanium implants

Clinical performance of immediately placed and immediately loaded single implants in the esthetic zone: A systematic review and meta-analysis.

OBJECTIVES The aim of this study was to assess the following PIO question: In adult patients treated with an indication for single tooth extraction in the maxillary esthetic zone (15-25), what is the influence of an immediate implant placement and immediate loading protocol on the clinical performance (primary aim) and esthetic outcomes (secondary aim) focusing on investigations published after 2010. MATERIAL AND METHODS An electronic search in Medline (PubMed), the Cochrane Central Register of Controlled Trials, and EMBASE databases up to April 2022 was performed to identify clinical studies investigating the outcome of single implants subjected to immediate placement with immediate restoration/loading (Type 1A). RESULTS Sixty-three studies (10 randomized controlled trials, 28 prospective and 25 retrospective cohort studies) were included with a follow-up ranging from 12 to 96 months. One thousand nine hundred sixty-one implants reported survival rates of 99.2 (98.6-99.5) % at 1 year, 97.5 (95.9-98.4) % after 3 years, and 95.8 (93.3-97.4) % after 5 years; 1064 immediately loaded restorations presented survival rates of 98.9 (97.8-99.5) % after 1 year, 96.8 (93.6-98.4) % after 2 years, and 94.8 (89.6-97.4) % after 5 years. Comparing baseline to 12-month data using the Hedges' g effect size (95% CI), papilla height presented an overall effect size of -0.71 (-1.25, -0.1) mm, midfacial recession change of -0.15 (-0.66, 0.36) mm, and a 0.82 (0.37, 1.28) gain in PES. CONCLUSIONS Immediate implant placement and immediate loading can be considered a predictable and safe treatment option for single maxillary anterior restorations with adequate survival rates and favorable esthetics outcomes for up to 5 years

Selection criteria for immediate implant placement and immediate loading for single tooth replacement in the maxillary esthetic zone: A systematic review and meta-analysis.

OBJECTIVES The aim of this study was to review available evidence for Type 1A (immediate implant placement and immediate loading) of single tooth replacement in the maxillary esthetic zone. MATERIALS AND METHODS An electronic search was conducted utilizing the databases of MEDLINE, Embase, and Cochrane to identify publications reporting on the outcomes of Type 1A for single tooth replacement in the maxillary esthetic zone. The success and survival rates of the included articles were reported, which were further categorized according to the clinical criteria reported in Type 1A. Mean survival rates were univariately compared between risk groups and additionally between studies published before and since 2012 using bias-corrected and study size-weighed bootstrap tests. A study time-correcting meta-analysis was then performed to obtain an overall effect for the study pool. RESULTS A total of 3118 publications were identified in the search, with a total of 68 articles included. A mean number of implants per study were 37.2 and mean follow-up was 2.8 years. All the included studies utilizing Type 1A report highly selective inclusion and exclusion criteria. Univariate risk group comparison determined that studies before 2012 report a significantly lower mean survival rate (difference of -1.9 percentage points [PP], 95% CI: [-0.3, -4.0], p = .02), facial gap dimension had an impact on survival rates (+3.1 PP [0.2, 5.3] for width >2 mm, p = .04), as well as presence of endodontic infection (+2.6 PP [0.9, 5.1], p = .004). CONCLUSIONS Type 1A has a high survival rate in studies reporting strict patient and site selection criteria. Further research is required to assess esthetic and functional success with Type 1A treatments

Group 5 ITI Consensus Report: Implant placement and loading protocols

ObjectivesWorking Group 5 was convened to discuss and find consensus on the topics of implant placement and loading protocols associated with single missing teeth in the anterior maxilla (aesthetic zone). Consensus statements, clinical recommendations, patient perspectives and future research suggestions were developed and presented to the plenary for discussion and approval.Materials and MethodsTwo systematic reviews were developed and submitted prior to the conference. The group considered in detail the systematic reviews and developed statements, clinical recommendations, patient perspectives and future research suggestions based on the findings of the reviews and experience of group members. Definitive versions were developed after presentation to and discussion by the plenary.ResultsFive consensus statements were developed and approved from each systematic review. Twelve clinical recommendations were developed by the group based on both reviews and experience. Three patient perspectives were developed, and five suggestions made for future research.ConclusionsBased on the findings of the systematic reviews and experience of group members, the Type 1A protocol (immediate placement and immediate loading), when utilized in the anterior maxilla under favorable conditions, is considered predictable and is associated with high survival rates. The procedure is considered clinically viable and is associated with aesthetic outcomes, although surgical, technical, and biological complications can occur

Esthetics in Implant Prosthodontics

In times of social media and selfie-hypes, patients’ expectations concerning dental treatment are increasing. Achieving a prosthetic ideal esthetic outcome using implants in esthetic sites is often challenging. Pink and white esthetics are influenced by the prosthetic workflow. This thesis aimed to investigate factors influencing the final esthetic outcome (provisional phase, abutment selection, vertical growth of the adjacent teeth) of implant supported prosthesis using objective esthetic parameters and including patient`s perception of the final treatment

Influence of prosthesis type and retention mechanism on complications with fixed implant-supported prostheses: a systematic review applying multivariate analyses

PURPOSE To identify the influence of fixed prosthesis type on biologic and technical complication rates in the context of screw versus cement retention. Furthermore, a multivariate analysis was conducted to determine which factors, when considered together, influence the complication and failure rates of fixed implant-supported prostheses. MATERIALS AND METHODS Electronic searches of MEDLINE (PubMed), EMBASE, and the Cochrane Library were conducted. Selected inclusion and exclusion criteria were used to limit the search. Data were analyzed statistically with simple and multivariate random-effects Poisson regressions. RESULTS Seventy-three articles qualified for inclusion in the study. Screw-retained prostheses showed a tendency toward and significantly more technical complications than cemented prostheses with single crowns and fixed partial prostheses, respectively. Resin chipping and ceramic veneer chipping had high mean event rates, at 10.04 and 8.95 per 100 years, respectively, for full-arch screwed prostheses. For "all fixed prostheses" (prosthesis type not reported or not known), significantly fewer biologic and technical complications were seen with screw retention. Multivariate analysis revealed a significantly greater incidence of technical complications with cemented prostheses. Full-arch prostheses, cantilevered prostheses, and "all fixed prostheses" had significantly higher complication rates than single crowns. A significantly greater incidence of technical and biologic complications was seen with cemented prostheses. CONCLUSION Screw-retained fixed partial prostheses demonstrated a significantly higher rate of technical complications and screw-retained full-arch prostheses demonstrated a notably high rate of veneer chipping. When "all fixed prostheses" were considered, significantly higher rates of technical and biologic complications were seen for cement-retained prostheses. Multivariate Poisson regression analysis failed to show a significant difference between screw- and cement-retained prostheses with respect to the incidence of failure but demonstrated a higher rate of technical and biologic complications for cement-retained prostheses. The incidence of technical complications was more dependent upon prosthesis and retention type than prosthesis or abutment material

Clinical Performance of Screw- Versus Cement-Retained Fixed Implant-Supported Reconstructions- A Systematic Review.

PURPOSE To assess the survival outcomes and reported complications of screw- and cement-retained fixed reconstructions supported on dental implants. MATERIALS AND METHODS A Medline (PubMed), Embase, and Cochrane electronic database search from 2000 to September 2012 using MeSH and free-text terms was conducted. Selected inclusion and exclusion criteria guided the search. All studies were first reviewed by abstract and subsequently by full-text reading by two examiners independently. Data were extracted by two examiners and statistically analyzed using a random effects Poisson regression. RESULTS From 4,324 abstracts, 321 full-text articles were reviewed. Seventy-three articles were found to qualify for inclusion. Five-year survival rates of 96.03% (95% confidence interval [CI]: 93.85% to 97.43%) and 95.55% (95% CI: 92.96% to 97.19%) were calculated for cemented and screw-retained reconstructions, respectively (P = .69). Comparison of cement and screw retention showed no difference when grouped as single crowns (I-SC) (P = .10) or fixed partial dentures (I-FDP) (P = .49). The 5-year survival rate for screw-retained full-arch reconstructions was 96.71% (95% CI: 93.66% to 98.31). All-ceramic reconstruction material exhibited a significantly higher failure rate than porcelain-fused-to-metal (PFM) in cemented reconstructions (P = .01) but not when comparing screw-retained reconstructions (P = .66). Technical and biologic complications demonstrating a statistically significant difference included loss of retention (P ≤ .01), abutment loosening (P ≤ .01), porcelain fracture and/or chipping (P = .02), presence of fistula/suppuration (P ≤ .001), total technical events (P = .03), and total biologic events (P = .02). CONCLUSIONS Although no statistical difference was found between cement- and screw-retained reconstructions for survival or failure rates, screw-retained reconstructions exhibited fewer technical and biologic complications overall. There were no statistically significant differences between the failure rates of the different reconstruction types (I-SCs, I-FDPs, full-arch I-FDPs) or abutment materials (titanium, gold, ceramic). The failure rate of cemented reconstructions was not influenced by the choice of a specific cement, though cement type did influence loss of retention