Publications by authors named "Alan B Carr"

46 Publications

WITHDRAWN: Interventions for replacing missing teeth: partially absent dentition.

Cochrane Database Syst Rev 2019 Jul 17;7:CD003814. Epub 2019 Jul 17.

Department of Dentistry, Illinois Masonic Medical Center, 811 W Wellington, Chicago, IL, USA, 60657.

Background: Management of individuals presenting with partial loss of teeth is a common task for dentists. Outcomes important to the management of missing teeth in the partially absent dentition should be systematically summarized. This review recognizes both the challenges associated with such a summarization and the critical nature of the information for patients.

Objectives: To assess the effects of different prostheses for the treatment of partially absent dentition in terms of the following outcomes: long-term success, function, morbidity and patient satisfaction.

Search Methods: We searched the Cochrane Oral Health Group's Trials Register (to 21 March 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 1), MEDLINE via OVID (1950 to March 2011) and EMBASE via OVID (1980 to March 2011). There were no restrictions regarding language or date of publication. We contacted several authors to identify non-published trials.

Selection Criteria: Randomized controlled trials (RCTs) comparing different methods (including the design and materials used) of treating partial edentulism, with clinically relevant outcomes, were included in this review. Trials reporting only surrogate outcomes, such as plaque accumulation or gingival volume, were excluded from this review.

Data Collection And Analysis: Two review authors independently carried out the screening of eligible studies, assessment of dimensions of quality of trials, and data extraction. Results were expressed as mean differences for continuous data, risk ratios for dichotomous outcomes, and hazard ratios with 95% confidence intervals for time-to-event data.

Main Results: Twenty-one trials met the inclusion criteria for this review. Twenty-four per cent of these were assessed as being at high risk of bias and the remainder were at unclear risk of bias. The clinical heterogeneity among the included studies precluded any attempt at meta-analysis. There was insufficient evidence to determine whether one type of removable dental prosthesis (RDP) was better or worse than another. With fixed dental prostheses (FDPs), there was no evidence that high gold alloys are better or worse than other alloys, nor that gold alloys or frameworks are better or worse than titanium. There is insufficient evidence to determine whether zirconia is better or worse that other FDP materials, that ceramic abutments are better or worse than titanium, or that one cement was better or worse than another in retaining FDPs. There is insufficient evidence to determine the relative effectiveness of FDPs and RDPs in patients with shortened dental arch or to determine the relative advantages of implant supported FDPs versus tooth/implant supported FDPs.

Authors' Conclusions: Based on trials meeting the inclusion criteria for this review, there is insufficient evidence to recommend a particular method of tooth replacement for partially edentulous patients.
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http://dx.doi.org/10.1002/14651858.CD003814.pub3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6699666PMC
July 2019

Accuracy of complete-arch implant impression made with occlusal registration material.

J Prosthet Dent 2020 Jan 10;123(1):143-148. Epub 2019 May 10.

Contributing Faculty, Department of Public Health, Walden University, Minneapolis, Minn.

Statement Of Problem: Which impression material, impression tray type, and implant impression technique combination produces the most accurate complete-arch impression is unclear.

Purpose: The purpose of this in vitro study was to compare the implant impression accuracy of a completely edentulous arch made with addition silicone occlusal registration material and an open tray with the implant impression accuracy of other conventional impression techniques.

Material And Methods: A master cast was fabricated from Type IV gypsum with four 3.8-mm diameter implants with internal hexagon located in the area of mandibular canines and first molars. Impressions (N=60) were made from the master cast using the 6 techniques investigated: group B-OC-N with occlusal registration impression material (B), open custom tray (OC), and nonsplinted impression pins (N); group B-OS-N with occlusal registration impression material (B), open plastic perforated stock tray (OS), and nonsplinted impression pins (N); group PE-OC-N with polyether medium-body impression material (PE), open custom tray (OC), and nonsplinted impression pins (N); group PE-OC-S with polyether medium-body impression material (PE), open custom tray (OC), and impression pins splinted (S) with autopolymerizing resin cut after 17 minutes and reconnected; group PE-CC-N with polyether medium-body impression material (PE), closed custom tray (CC), and nonsplinted impression pins (N); group PVS-CS-N with simultaneous double-mix polyvinyl siloxane impression material (PVS), closed stock perforated metal tray (CS), and nonsplinted impression pins (N). Type IV gypsum casts were fabricated 24 hours after making the impressions. A computerized numerical control 3D coordinate measuring machine was used to measure the absolute differences of the distances between the centroids of the 4 implants among the casts produced and the distances measured at the master cast. The Kruskal-Wallis test was used to determine differences among the experimental groups (α=.05). The Mann-Whitney U post hoc analysis was used for all group combinations.

Results: No significant differences were found between the test groups B-OC-N and PE-OC-S, which were more accurate than the other groups. Group B-OS-N resulted in the least accurate impressions of all experimental groups. Group PE-OC-S resulted in more accurate impressions than the PE-OC-N group. No statistically significant differences were found between groups PE-OC-N and PE-CC-N or between groups PVS-CS-N and PE-CC-N.

Conclusions: For complete edentulism, the use of silicone occlusal registration material with an open custom tray and nonsplinted impression pins resulted in impressions as accurate as those produced with PE open custom tray with splinted impression pins. These 2 techniques resulted in more accurate impressions than the other 4 techniques studied.
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http://dx.doi.org/10.1016/j.prosdent.2018.12.011DOI Listing
January 2020

Relationship between Selective Serotonin Reuptake Inhibitors and Risk of Dental Implant Failure.

J Prosthodont 2019 Mar 28;28(3):252-257. Epub 2019 Jan 28.

Division of Biomedical Statistics and Informatics Mayo Clinic, Rochester, MN.

Purpose: To identify associations between implant failure and selective serotonin reuptake inhibitor (SSRI) medication use in a cohort of consecutive patients receiving dental implants during a 20-year period.

Materials And Methods: A retrospective review was conducted of all patients who received at least 1 dental implant from January 1, 1995, through December 31, 2014, assessing their history of SSRI use, active SSRI use, and SSRI use during follow-up with implant failure. Cox proportional hazards regression models assessed associations between demographic characteristics and SSRI use with implant failure, and outcomes were summarized with hazard ratios (HRs) and 95% confidence intervals (CIs). Follow-up SSRI use was analyzed with time-dependent covariates.

Results: During the study period, 5456 patients received their first implant (median age, 53 years). The median duration of follow-up was 5.3 years (interquartile range, 2.3-10.2 years) for the 4927 patients who did not have implant failure. For the 529 patients who had implant failure, it occurred at a median of 0.5 years. After adjusting for age, sex, and era of implant, history of use of the SSRI sertraline was associated with an increased risk of implant failure among all patients (hazard ratio [HR], 1.60; 95% CI, 1.15-2.23; p = 0.006) and among the subset of patients with a history of SSRI use (HR, 1.64; 95% CI, 1.07-2.52; p = 0.02).

Conclusions: In the population reviewed, a history of sertraline use was associated with a 60% greater risk of implant failure; however, active SSRI use at the time of implant placement or during follow-up was not significantly associated with an increased risk of implant failure.
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http://dx.doi.org/10.1111/jopr.13015DOI Listing
March 2019

Association Between Early Implant Failure and Prosthodontic Characteristics.

J Prosthodont 2019 Jan 9;28(1):30-35. Epub 2018 Dec 9.

Department of Dental Specialties, Mayo Clinic, Rochester, MN.

Purpose: To identify associations between early implant failure and prosthodontic characteristics that could be used to guide subsequent continuous quality improvement efforts of patient care.

Materials And Methods: An implant-level analysis was performed in which data were abstracted from a prospective clinical database of all adult patients treated with implants and followed up from January 2000 through December 2014 at the Department of Dental Specialties at Mayo Clinic in Rochester, Minnesota. These data were used to determine time to implant failure. Associations between prosthodontic characteristics and early implant failure were evaluated with Cox proportional hazards regression models and summarized with hazard ratios (HRs) and 95% confidence intervals (CIs).

Results: Among 8762 implants in 2787 patients, 395 (4.5%) failed within the first year of placement at a mean (SD) of 127 (97) days (range, 2-364 days). Univariable analysis showed no associations between early implant failure and use of a cover screw, prosthesis, or definitive or provisional prosthesis at implant placement. Three of 25 single crowns failed, and use of a single crown was significantly associated with early implant failure (HR, 3.94; 95% CI, 1.08-14.35; P = 0.04). This study identified no significant associations between prosthodontic characteristics identified after implant placement and early implant failure.

Conclusions: Use of a prosthesis at implant placement, use of a definitive or provisional prosthesis, and early mechanical complications were not associated with increased risk of early implant failure. Quality improvement efforts should focus on aspects of decision making that aim to decrease surgical complications.
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http://dx.doi.org/10.1111/jopr.13003DOI Listing
January 2019

Early Implant Failure Associated With Patient Factors, Surgical Manipulations, and Systemic Conditions.

J Prosthodont 2019 Jul 22;28(6):623-633. Epub 2018 Oct 22.

Department of Dental Specialties, Mayo Clinic, Rochester, MN.

Purpose: Systematic monitoring of important clinical outcomes is increasingly important for health-care decision making, especially in the context of continuous quality improvement. Dental implant failure within the first year (early failure) has been previously shown to be more common than subsequent failure. The purpose of this study was to identify associations between early implant failure and patient factors, surgical manipulations, and systemic conditions.

Materials And Methods: The authors retrospectively identified the records of consecutive adult patients with dental implants seen between 2000 and 2014 in the Department of Dental Specialties, at the Mayo Clinic. Demographic, surgical, and medical data were extracted from the database and individual medical records to determine time to first implant failure. Cox proportional hazards regression models were used to assess associations of demographic, surgical, and systemic conditions with implant failure during the first year post-implantation, summarized as hazard ratio (HR) (95% confidence interval [CI]).

Results: Among 8540 implants identified during the study period, 362 (4.2%) failed within the first year of placement at a mean (SD) of 129 (96) days after placement. On univariate analysis, most candidate predictors were not shown to influence first-year failure. Preplacement surgical manipulations associated with increased early implant failure were bone augmentation only (HR, 1.45; 95% CI, 1.02-2.05; p = 0.04), socket preservation (HR, 2.67; 95% CI, 1.33-5.38; p = 0.006), and xenogenic material (HR, 2.12; 95% CI, 1.11-4.04; p = 0.02). Alveoloplasty only at placement was associated with decreased early implant failure (HR, 0.33; 95% CI, 0.17-0.65; p = 0.001). Overall, 318 implants (3.7%) had surgical complications within the first year of placement at a mean (SD) of 110 (114) days after placement; any surgical complication was significantly associated with early implant failure (hazard ratio, 15.84; 95% CI, 11.10-22.61; p < 0.001). After adjustment for age, sex, and implant era, no single or multiple medical condition(s) and no single or multiple medication(s) increased patient risk of implant failure in the first year after placement.

Conclusions: These findings support a targeted effort to reduce the incidence of surgical complications to reduce early failure of dental implants.
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http://dx.doi.org/10.1111/jopr.12978DOI Listing
July 2019

Risk of Dental Implant Failure Associated With Medication Use.

J Prosthodont 2019 Aug 5;28(7):743-749. Epub 2018 Mar 5.

Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.

Purpose: The probability of achieving important clinical outcomes is an increasingly important factor for patients considering various treatment options for tooth loss. For oral reconstruction involving dental implants, the patient-specific risks of implant failure may be influenced by the patient's medication profile. The purpose of this study was to identify associations between dental implant failure and medication use in a consecutive series of patients seen from October 1983 through December 2014 at the Department of Dental Specialties, Mayo Clinic (Rochester, Minnesota).

Materials And Methods: In this patient-level analysis, demographic, implant-specific, and medical profile data were abstracted from a prospective clinical database and individual medical records and used to determine the time to first implant failure. Implant failure-free survival at the patient level was estimated using the Kaplan-Meier method. Associations of demographic characteristics and medication use with implant failure were evaluated by using Cox proportional hazards regression models and summarized with hazard ratios and 95% confidence intervals.

Results: In the 31-year study period, 6358 patients received their first dental implant (median age, 53 years). The median follow-up duration of the 5645 patients whose implants did not fail was 5.8 years, and 713 patients had implant failure (median, 0.6 years). All associations were adjusted for age, sex, and era of implantation because these features strongly influence medication use and implant failure. After adjustment, no medication increased the risk of implant failure in the cohort; specifically, medication use at the time of implant placement or starting a medication after implant placement did not increase the risk of implant failure. Among the medications used at the time of implant placement, corticosteroids were associated with a reduced risk of implant failure (hazard ratio, 0.82; 95% CI, 0.67-0.99; p = 0.04). This association was not seen when corticosteroids were started after implant placement.

Conclusion: In the population studied, medication use was not associated with an increased risk of dental implant failure.
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http://dx.doi.org/10.1111/jopr.12773DOI Listing
August 2019

Consistency of Dental Hygiene Therapy Utilizing Various Dental Hygiene Instrumentation and Its Effect on Peri-implant Health and Survival of Dental Implants: A Retrospective Study.

Int J Oral Maxillofac Implants 2017 Nov/Dec;32(6):1371-1376

Purpose: The purpose of this retrospective study was to provide practice-based evidence to determine if the consistency of dental hygiene therapy, despite utilizing instrumentation literature that has proven to cause alterations to implant surfaces, affects peri-implant health or survival.

Materials And Methods: The study sample comprised patients with implant-supported full-arch fixed dental prostheses who were distributed into two groups. The consistent hygiene group patients had dental hygiene therapy at a minimum biannually and were exposed to at least three dental hygiene instrument materials. The inconsistent hygiene group patients had dental hygiene therapy at a minimum once every 3 to 10 years and were exposed to at least three dental hygiene instrument materials. Years of survival free of soft tissue pathology and/or implant failure were estimated. Continuous features were summarized with medians, interquartile ranges (IQRs), and ranges; categorical features were summarized with frequency counts and percentages.

Results: Among 48 patients in the consistent hygiene group, 11 patients experienced soft tissue pathology or implant failure at a median of 11.3 years; among 99 patients in the inconsistent hygiene group, 17 patients experienced soft tissue pathology or implant failure at a median of 4.8 years. The survival free of soft tissue pathology or implant failure rate at 5 years was 94% for the consistent hygiene group and 91% for the inconsistent hygiene group. The survival free of soft tissue pathology or implant failure rate at 20 years was 70% for the consistent hygiene group and 79% for the inconsistent hygiene group (P = .91).

Conclusion: Although no statistical differences were found between the groups, this practice-based evidence suggests more consistent dental hygiene therapy increases the median in years in which soft tissue pathology or implant failure is present.
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http://dx.doi.org/10.11607/jomi.5715DOI Listing
May 2018

Association of Systemic Conditions with Dental Implant Failures in 6,384 Patients During a 31-Year Follow-up Period.

Int J Oral Maxillofac Implants 2017 Sep/Oct;32(5):1153-1161

Purpose: Outcome research has become an increasingly important form of clinical evidence for making health care decisions, including oral health considerations in the field of dentistry. In oral reconstruction involving dental implants, the risk of implant failure may be influenced by a patient’s underlying medical condition. To identify associations, implant failure and systemic conditions or diseases were studied in a consecutive series of patients who received dental implants from October 1, 1983, to December 31, 2014, in the Department of Dental Specialties at Mayo Clinic in Rochester, Minnesota.

Materials And Methods: Data were abstracted from a prospective clinical database and electronic health records for patients’ demographic, implant-specific, and medical profiles to determine time to first implant failure. Survival free of implant failure at the patient level was estimated by using the Kaplan-Meier method. Associations of demographic and systemic characteristics with implant failure were evaluated by using Cox proportional hazards regression models and summarized with hazard ratios and 95% confidence intervals.

Results: The patient cohort consisted of 6,358 patients with a median age of 53 years at placement of the first implant. A total of 713 patients experienced implant failure at a median of 0.6 years. Among the 5,645 patients who did not experience implant failure, the median duration of follow-up was 5.8 years. More than 20 systemic diseases or conditions were identified for assessment, of which 15 comprised more than 50 patients and five comprised more than 500 patients. All associations were adjusted for age, sex, and era of implant, given the strong influence of these features on implant failure. After adjustment, no systemic disease or condition was shown to increase the risk for implant failure in the population and setting studied.

Conclusion: Patients considering oral reconstruction involving implants in the medical setting studied do not appear to risk implant loss because of systemic conditions or diseases.
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http://dx.doi.org/10.11607/jomi.5888DOI Listing
April 2018

Effect of the American Heart Association 2007 Guidelines on the Practice of Dental Prophylaxis for the Prevention of Infective Endocarditis in Olmsted County, Minnesota.

Mayo Clin Proc 2017 May 10. Epub 2017 May 10.

Division of Infectious Diseases, Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.

Objective: To determine the adherence of dental providers to the 2007 American Heart Association (AHA) infective endocarditis prevention guidelines regarding antibiotic drug administration before invasive dental procedures.

Patients And Methods: The study included all adults (≥18 years old) with a moderate-risk (MR) or high-risk (HR) cardiac condition who received dental care at participating dental offices from January 1, 2005, through June 1, 2015, in Olmsted County, Minnesota. Data collected included the date and type of dental procedure performed and receipt of antibiotic prophylaxis (AP).

Results: A total of 1351 patients underwent 8854 dental visits at participating dental offices during the study period; 1236 patients had an MR cardiac condition and 115 had an HR condition. The percentage of visits in which antibiotic drugs were used for indicated dental procedures in the MR group declined from 64.6% before to 8.6% after publication of the 2007 AHA guidelines (P<.001); for the HR group, AP declined from 96.9% before to 81.3% after publication of the guidelines (P=.02).

Conclusion: In this historical cohort in Olmsted County there was a statistically significant reduction in AP in the MR group before invasive dental procedures. In addition, there was an unanticipated significant reduction in AP in the HR group after publication of the 2007 AHA guidelines. These findings can be used to provide feedback and education to medical and dental professionals who are involved in decision making regarding the use of dental prophylaxis for their patients.
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http://dx.doi.org/10.1016/j.mayocp.2017.03.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5681438PMC
May 2017

Linking medical and dental health record data: a partnership with the Rochester Epidemiology Project.

BMJ Open 2017 03 29;7(3):e012528. Epub 2017 Mar 29.

Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.

Purpose: The purpose of this project was to expand the Rochester Epidemiology Project (REP) medical records linkage infrastructure to include data from oral healthcare providers. The goal of this linkage is to facilitate research studies examining the role of oral health in overall health and quality of life.

Participants: Eight dental practices joined the REP between 2011 and 2015. The REP study team has linked oral healthcare information with medical record information from local healthcare providers for 31 750 participants who have resided in Olmsted County, Minnesota. Overall, 17 718 (56%) participants are women, 14 318 (45%) are 40 years of age or older and 26 090 (82%) are white.

Findings To Date: A first study using this new information was recently completed. This resource was used to determine whether the 2007 guidelines from the American Heart Association affected prescription rates of antibiotics to patients with moderate-risk cardiac conditions prior to dental procedures. The REP infrastructure was used to identify a series of patients diagnosed with moderate-risk cardiac conditions by the local healthcare providers (n=1351), and to abstract antibiotic prescriptions from dental records both pre-2007 and post-2007. Antibiotic prescriptions prior to dental procedures declined from 62% to 7% following the change in guidelines.

Future Plans: Dental data from participating practitioners will be updated on an annual basis, and new dental data will be linked to patient medical records. In addition, we will continue to invite new dental practices to participate in the REP. Finally, we will continue to use this research infrastructure to investigate associations between oral and medical health, and will present findings at conferences and in the scientific literature.
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http://dx.doi.org/10.1136/bmjopen-2016-012528DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372048PMC
March 2017

Three-dimensional printing of large nasal septal perforations for optimal prosthetic closure.

Am J Rhinol Allergy 2016 Jul;30(4):287-93

Department of Otorhinolaryngology, Acibadem University, Istanbul, Turkey.

Background: Since 1972, patients with large nasal perforations, who were symptomatic, and who were not candidates for surgery, had the option of custom prosthetic closure at Mayo Clinic. Although septal prostheses have helped many patients, 27% of pre-1982 patients chose not to keep the prosthesis in place. Two-dimensional computed tomography (CT) sizing resulted in more of the patients choosing to retain the prosthesis. The introduction of three-dimensional (3-D) printing to the sizing process offered the potential of further improved retention by refinement in prosthesis fit.

Objective: To describe the fabrication of nasal septal prostheses by using 3-D printing for sizing and to compare the retention rate of 3-D-sized prostheses with those that used previous sizing methods.

Methods: Twenty-one consecutive patients who had placement of septal prostheses sized by using 3-D printed templates were studied. CT image data were used to print 3-D templates of the exact shape of the patient's septal perforation, and medical-grade silastic prostheses were fabricated to fit. In four cases, the 3-D printed template allowed preoperative surgical simulation. Metrics collected included prosthesis retention; symptoms, including intranasal crusting and epistaxis; and previous prosthetic closure failures.

Results: Twenty of the twenty-one patients had improvement in symptoms. The mean diameter of the perforations was 2.4 cm; the mean closure time by the end of the study period was 2.2 years. All but two patients chose to keep their prosthesis in place, for a retention rate of 90%. Seven patients with successful closure had failed previously with prior prosthesis sized without the current 3-D printing methodology. This 90% retention rate exceeded the previous rates before the introduction of 3-D sizing.

Conclusion: Sizing done by 3-D printing for prosthetic closure of nasal septal perforations resulted in a higher retention rate in helping patients with these most-challenging nasal septal perforations.
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http://dx.doi.org/10.2500/ajra.2016.30.4324DOI Listing
July 2016

Evidence and the practice of prosthodontics: 20 years after EBD introduction.

Authors:
Alan B Carr

J Prosthodont 2015 Jan 14;24(1):12-6. Epub 2014 Oct 14.

Chair, Department of Dental Specialties, Mayo Clinic, Rochester, MN, Division Director, ACP Education & Research, Mentor to, ACP Cochrane Oral Health Group, Prosthodontic Practice Network.

Prosthodontics has a rich history related to the principles embedded in evidence-based health care. This paper reviews the evidence-based prosthodontics activity over the past 3 decades. It also discusses the impact of health care reform on evidence-based medicine as it relates to broader context of care outcomes. Finally, the value associated with an Evidence Stewardship emphasis in prosthodontics is presented. This emphasis suggests that combining evidence from clinical trials with evidence from clinical practice environments best equips clinicians for the management of patients in the future. Adoption of a strategic Evidence Stewardship direction is an extended commitment to change that recognizes health care reform aims and seeks to be an accountable provider group in the broader health care arena. The vision to form a representative network of prosthodontic practitioners that augments a commitment to Cochrane "clinical trial" data demonstrates a responsibility to professional transparency about who we are, adds value for patients and oral health care providers, impacts teachers and students in dental education, and provides a measure of care accountability unique in dentistry.
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http://dx.doi.org/10.1111/jopr.12232DOI Listing
January 2015

Evaluation of fracture resistance in aqueous environment under dynamic loading of lithium disilicate restorative systems for posterior applications. Part 2.

J Prosthodont 2014 Jul 13;23(5):353-7. Epub 2014 Jan 13.

Former Assistant Professor of Dentistry, Mayo Clinic College of Medicine, Chief Resident, Prosthodontics and Maxillofacial Prosthetics, Division of Prosthetic and Esthetic Dentistry, Department of Dental Specialties, Mayo Clinic, Rochester, MN Currently: Maxillofacial Prosthodontist, University of Pittsburgh School of Dental Medicine, Department of Prosthodontics, Pittsburgh, PA.

Purpose: The goals of part 2 of the study presented here were 1) to assess whether there is a difference in failure mode of different thicknesses (2.0, 1.5, 1.0, and 0.5 mm) of anatomically standardized full contour monolithic lithium disilicate restorations for posterior teeth, and 2) to assess if there is a difference among various crown thicknesses when these restorations are subjected to dynamic load forces common for posterior teeth.

Materials And Methods: Four groups (n = 10), each with a different thickness of anatomically appropriate all-ceramic crowns, were to be tested as established from the statistical analysis of the preliminary phase. Group 1: 2.0 mm; group 2: 1.5 mm; group 3: 1.0 mm; group 4: 0.5 mm. The specimens were adhesively luted to the corresponding die, and underwent dynamic cyclic loading (380 to 390 N) completely submerged in an aqueous environment until a failure was noted by graphic recording and continuous monitoring.

Results: There was a statistically significant difference of the fatigue cycles to failure among four groups (p < 0.001; Kruskal-Wallis test). The mean number of cycles to fail for 2.0 mm specimens was 17 times more than the mean number of cycles to fail for 1.0 mm specimens and 1.5 times more than the mean number of cycles to fail for 1.5 mm specimens. The 0.5 mm specimens failed with one cycle of loading. A qualitative characteristic noted among the 2.0 mm specimens was wear of the area of indenter contact followed by shearing of the material and/or crack propagation.

Conclusion: Based on the findings of this study, it may be reasonable to consider a crown thickness of 1.5 mm or greater for clinical applications of milled monolithic lithium disilicate crowns for posterior single teeth.
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http://dx.doi.org/10.1111/jopr.12124DOI Listing
July 2014

External versus internal abutment connection implants: a survey of opinions and decision making among experienced implant dentists in Japan.

Odontology 2015 Jan 17;103(1):75-83. Epub 2013 Dec 17.

Implant Dentistry, Nihon University School of Dentistry Dental Hospital, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8310, Japan,

Internal connection implants have been attracting attention in recent years leading to their being adopted for many implant systems and an increase in market share over other connections. However, internal connection implants have only been used clinically for a short period of time resulting in few clinical studies investigating outcomes and a lack of comparative clinical evidence to support their use over external hex systems at this time. Given the fact that clinical evidence is lacking regarding implant connection performance comparisons, it is important to understand what information clinicians use to choose between systems. The purpose of this study regarding implant decision-making was to ask clinicians to provide subjective evaluations of internal connection implants, in comparison with external connection implants. The survey was constructed to cover four aspects of interest; general responder information, surgical procedures and experience, prosthodontic treatments and outcomes, and implant complications. The dentists' responses indicated that internal connection implants are as user-friendly as external hex implants with respect to implant surgery, but they are favored for prosthodontic handling because impression coping and abutment placement are felt to be easier. In addition, it was revealed that dentists strongly feel that there is a lack of biological and prosthodontic evidence to support the use of internal connection implants. The findings reveal the responding clinicians recognize that they often make decisions without compelling evidence to favor one system over another. Decisions are often based on perceived ease of use or third party (colleague or manufacturer) input. For future investigations, we will seek to better understand the relative influence and validity of all forms of information used (especially third party input), as well as what barriers exist to clinicians' use of more evidence based data.
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http://dx.doi.org/10.1007/s10266-013-0141-2DOI Listing
January 2015

Practice-based clinical evaluation of ceramic single crowns after at least five years.

J Prosthet Dent 2014 Feb 10;111(2):124-30. Epub 2013 Dec 10.

Professor, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn; and Consultant, Division of Prosthetic and Esthetic Dentistry, Department of Dental Specialties, Mayo Clinic, Rochester, Minn.

Statement Of Problem: Long-term practice-based clinical evaluations of various contemporary ceramic crown restorations from multiple practitioners are limited.

Purpose: The aims of this study were to evaluate the clinical performance of ceramic single crowns and to identify factors that influence their clinical performance.

Material And Methods: Ceramic single crowns that had been placed at the Mayo Clinic and in function since 2005 were identified and included in the study. The restorations were examined clinically, radiographically, and with photographs. Modified United States Public Health Services criteria were used for the clinical evaluation. The ceramic systems evaluated were bilayer and monolayer.

Results: Fifty-nine patients (41 women, 18 men) with 226 single teeth and implants restored with single ceramic crowns were identified. The mean duration from insertion date to study examination date was 6.1 years. Thirteen restorations (6%) were replaced at a mean 3.3 years after insertion date (range, 0.1-6.1 years). Estimated replacement-free survival rates (95% confidence interval [CI]; number of teeth/implants still at risk) at 5 years after insertion date were 95.1% (95% CI, 92.2-98.1; 153) and at 10 years were 92.8% (95% CI, 89.1-96.8; 8). The most common reason for replacement was fracture to the core of posterior layered ceramic crowns. The most commonly used luting agent was resin-modified ionomer cement. Most restorations exhibited clinically acceptable marginal integrity, shade, no caries recurrence, and no periapical pathology.

Conclusions: The clinical performance of ceramic single crowns at 5 and 10 years supports their application in all areas of the mouth. With the majority of fractures to the core occurring early in the lifetime of layered ceramic posterior crowns, consideration of other monolithic ceramic systems for posterior crowns is advised.
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http://dx.doi.org/10.1016/j.prosdent.2013.06.015DOI Listing
February 2014

Economic outcomes in prosthodontics.

Int J Prosthodont 2013 Sep-Oct;26(5):465-9

Purpose: A systematic literature review was conducted to identify the types of economic measures currently used in implant prosthodontics and determine the degree to which cost of care is considered in the context of any positive outcome of the care provided.

Materials And Methods: A literature search was conducted using the following set of terms plus some additional hand searching: "dental implants" (Mesh) AND ("cost") OR "maintenance" OR "healthcare policy" OR "access to care" OR "third party" OR "economic") AND (("1995/01/01"[PDat]:'2009/12/31"[PDat]) AND (Humans[Mesh]) AND (English[lang])).

Results: After a review of the 466 titles and abstracts identified by the search, 18 articles were accepted for further consideration, as some attempt at economic outcome measures was made. An additional four articles were identified by hand searching. The 22 accepted articles were grouped into four basic categories: (1) measure of costs of treatment (direct, indirect, and maintenance costs), (2) cost-effectiveness mathematical modeling applied to simulate the lifetime paths and cost of treatment, (3) cost-effectiveness analysis/cost minimization, and (4) willingness-to-pay, willingness-to-accept. Attempts at determining the costs of treatment varied widely. When the OMERACT filters were applied to the various measures it was felt that discrimination and/or feasibility was a problem for most of the current economic outcome measures.

Conclusions: Measures of cost-benefit, cost-effectiveness, and cost-utility are currently the gold standard; however, feasibility of such analyses is an issue. Collaboration with health economists to guide future research is highly recommended.
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http://dx.doi.org/10.11607/ijp.3405DOI Listing
January 2014

Psychologic outcomes in implant prosthodontics.

Int J Prosthodont 2013 Sep-Oct;26(5):429-34

Consensus regarding outcomes of the treatment of tooth loss, especially the psychologic outcomes, is needed to guide discovery of best practices and enable a better understanding of patient management for this chronic condition. This paper presents the findings of the ORONet Psychological Working Group for prosthodontics and aims to identify psychologic outcomes with properties deemed critical to meet clinical trial and clinical practice needs for the future. References obtained using a PubMed/Medline search were reviewed for clinical outcomes measures of interest. Clinical outcomes measures were judged relative to the criteria of truth, discrimination, and feasibility. Of the psychologic outcome measures identified in this systematic review, only the OHIP-14 was thought to be suitable for use in general practice and multi-institutional outcome registries and clinical trials. Development of clinically useful psychologic outcomes for future use could benefit from developmental methods and tools outlined in the patient-related outcomes field of clinical care.
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http://dx.doi.org/10.11607/ijp.3403DOI Listing
January 2014

Functional outcomes for clinical evaluation of implant restorations.

Int J Prosthodont 2013 Sep-Oct;26(5):411-8

The functional outcomes related to treating patients afflicted with tooth loss are an important hallmark in substantiating prosthodontic intervention. The Oral Rehabilitation Outcomes Network (ORONet) conducted two international workshops to develop a core set of outcome measures, including a functional domain. The process followed the general format used in the Outcome Measures in Rheumatology (OMERACT) workshops to develop consensus for clinical outcome measures in arthritis research, which included: developing a comprehensive list of potential outcomes in the literature; submitting them to a filter for validity, clinical discrimination, and feasibility; and ranking those measures meeting all the filter criteria for relative value. The search was conducted to include functional assessments of speech, swallowing, mastication, nutrition, sensation, and motor function as they relate to dental implant therapies. This literature review surveyed 173 papers that produced some result of these descriptors in the functional domain. Of these, 67 papers reported on functional assessments and further defined objective and subjective outcomes. Many of these results were patient-perceived improvements in function, while others were objective assessments based on established methodologies and instruments. Objective evaluations of masticatory function and speech may meet criteria for validity and discriminability for selected interventions, but are generally not feasible for routine use in clinical care settings. The current recommendation is to employ a well-validated survey instrument that covers mastication and speech, such as the Oral Health Impact Profile (OHIP-14, short form), recognizing that patient perceptions of function may differ from objective ability.
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http://dx.doi.org/10.11607/ijp.3404DOI Listing
January 2014

Human Calmodulin-Like Protein CALML3: A Novel Marker for Normal Oral Squamous Mucosa That Is Downregulated in Malignant Transformation.

Int J Dent 2013 8;2013:592843. Epub 2013 Jul 8.

Peninsula Prosthodontics, 19365 7th Avenue NE, Suite 114, Poulsbo, WA 98370, USA.

Oral cancer is often diagnosed only at advanced stages due to a lack of reliable disease markers. The purpose of this study was to determine if the epithelial-specific human calmodulin-like protein (CALML3) could be used as marker for the various phases of oral tumor progression. Immunohistochemical analysis using an affinity-purified CALML3 antibody was performed on biopsy-confirmed oral tissue samples representing these phases. A total of 90 tissue specimens were derived from 52 patients. Each specimen was analyzed in the superficial and basal mucosal cell layers for overall staining and staining of cellular subcompartments. CALML3 was strongly expressed in benign oral mucosal cells with downregulation of expression as squamous cells progress to invasive carcinoma. Based on the Cochran-Armitage test for trend, expression in the nucleus and at the cytoplasmic membrane significantly decreased with increasing disease severity. Chi-square test showed that benign tissue specimens had significantly more expression compared to dysplasia/CIS and invasive specimens. Dysplasia/CIS tissue had significantly more expression than invasive tissue. We conclude that CALML3 is expressed in benign oral mucosal cells with a statistically significant trend in downregulation as tumorigenesis occurs. CALML3 may thus be a sensitive new marker for oral cancer screening.
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http://dx.doi.org/10.1155/2013/592843DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3723245PMC
August 2013

Practice-based evidence from 29-year outcome analysis of management of the edentulous jaw using osseointegrated dental implants.

J Prosthodont 2014 Apr 26;23(3):173-81. Epub 2013 Jul 26.

Assistant Professor, Mayo Clinic College of Medicine and Chief Resident, Prosthodontics and Maxillofacial Prosthetics, Department of Dental Specialties, Division of Prosthetic and Esthetic Dentistry, Mayo Clinic, Rochester, MN.

Purpose: The aim of this retrospective study was to summarize practice-based evidence associated with long-term outcomes (>20 years) in the management of edentulous patients. The patient population was managed with implant-supported prostheses, following the original osseointegration protocol, provided over the period from 1983 to 1991 in the group prosthodontics practice at the Mayo Clinic. The data are an example of practice quality assurance monitoring and are used to refine care delivery when needed and to provide information regarding expected outcomes in a shared decision-making interaction with prospective patients.

Materials And Methods: Two hundred and sixty four patients with at least one edentulous jaw were identified. Of these, 255 completed their care and follow-up at the Mayo Clinic (209 mandible only, 35 maxilla only, 11 mandible and maxilla). Prosthodontic outcomes categorized as anticipated or unanticipated prosthetic and biologic events and the respective interventions required for each were recorded to assess follow-up event dynamics for this care modality.

Results: The mean duration of follow-up for 190 of the 255 patients (65 died at a mean follow-up of 12.6 years) was 13.0 years (median 13.6; range 0.3 to 28). At least one prosthetic event was experienced by 148 patients (58%), and 81 (32%) experienced at least one biologic event. Overall, patients experienced 3.8 times more prosthetic events than biologic events. Twenty-four (9%) patients experienced 35 implant failures. Overall survival rates at 20 years were 86% for prostheses, 15% survived free of any event, and 92% experienced survival free of implant failure (95% confidence interval).

Conclusion: Anticipated and unanticipated prosthetic events occur throughout the life of the hybrid prosthesis. Prosthetic events significantly surpass (four times more) biologic events and occur significantly later in the follow-up. For this patient group, 8.6% (22/255) had implant-supported prostheses remade during follow-up in this patient population. These findings support the recommendation that prosthodontic care for missing teeth be thought of in a "chronic condition" context, recognizing that long-term outcome monitoring to provide realistic care expectations is important for demonstrating care value in oral health promotion.
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http://dx.doi.org/10.1111/jopr.12084DOI Listing
April 2014

Clinical outcomes measures for assessment of longevity in the dental implant literature: ORONet approach.

Int J Prosthodont 2013 Jul-Aug;26(4):323-30

Department of Biomedical Science and Human Oncology, Prosthodontic Section University of Turin, Torino, Italy.

The Oral Rehabilitation Outcomes Network (ORONet) Longevity Working Group undertook a search of the literature from 1995 to 2009 on randomized controlled trials related to longevity of osseointegrated implants. Outcomes measures used in these studies were identified and subjected to the OMERACT component criteria of truth, validity, and feasibility. Through this process, it was a challenge to identify clinical outcomes measures that fully met the criteria. An attenuated version of the component criteria was applied, and clinical measures were identified for implant outcomes, prosthetic outcomes, and indices. A recommendation on standardized reporting periods was also presented for future consideration. The endpoint of the evaluation process is to develop consensus on clinical outcomes measures that can be applied across broad populations for osseointegrated implant care. The present ORONet initiative represents a beginning toward continual improvement and consensus development for clinical outcomes measures for osseointegrated implants.
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http://dx.doi.org/10.11607/ijp.3402DOI Listing
September 2013

Oral Rehabilitation Outcomes Network-ORONet.

Int J Prosthodont 2013 Jul-Aug;26(4):319-22

Department of Biomedical Science and Human Oncology, Prosthodontic Section, University Turin, Torino, Italy.

The published literature describing clinical evidence used in treatment decisionmaking for the management of tooth loss continues to be characterized by a lack of consistent outcome measures reflecting not only clinical performance but also a range of patient concerns. Recognizing this problem, an international group of clinicians, educators, and scientists with a focus on prosthodontics formed the Oral Rehabilitation Outcomes Network (ORONet) to promote strategies for improving health based on comprehensive, patient-centered evaluations of comparative effectiveness of therapies for oral rehabilitation. An initial goal of ORONet is to identify outcome measures for prosthodontic therapies that represent multiple domains with patient relevance, are amenable to utilization in both institutional and practice-based environments, and have established validity. Following a model used in rheumatology, the group assessed the prosthodontic literature, with an emphasis on implantbased therapies, for outcomes related to longevity and functional, psychologic, and economic domains. These systematic reviews highlight a need for further development of standardized outcomes that can be integrated across clinical and research environments.
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http://dx.doi.org/10.11607/ijp.3400DOI Listing
September 2013

Evaluation of fracture resistance in aqueous environment of four restorative systems for posterior applications. Part 1.

J Prosthodont 2013 Jun 20;22(4):256-60. Epub 2012 Dec 20.

Division of Prosthetic and Esthetic Dentistry, Department of Dental Specialties, Mayo Clinic, Rochester, MN 55905, USA.

Purpose: The goals of this study were to: (1) establish a range of the performance of four restorative systems for posterior single-tooth crowns under single load to fracture submerged in an aqueous environment, (2) identify restorative system(s) of interest to be examined in the second study phase under sliding contact step-stress fatigue as full-contour anatomically appropriate single posterior tooth restoration(s), (3) establish a range for loading/testing for phase 2.

Materials And Methods: Forty specimens (n = 10/group) of 2 mm uniform thickness were tested. Group 1: monolithic lithium disilicate IPS e.max Press; group 2: IPS e.max ZirPress, 0.8 mm zirconia core with 1.2 mm pressed veneering porcelain; group 3: IPS e.max ZirPress, 0.4 mm zirconia core with 1.6 mm pressed veneering porcelain; group 4: IPS InLine PoM. Specimens were bonded to a block of polycast acrylic resin on a 30° sloped surface with resin cement. Specimens were axially single loaded to failure while submerged under water.

Results: There was a statistically significant difference (p < 0.001) in failure load among the four restorative systems. Lithium disilicate showed a mean failure load similar to mean maximum posterior bite forces (743.1 ± 114.3 N). IPS e.max Zirpress with a 0.4 mm zirconia core exhibited the lowest mean failure load (371.4 ± 123.0 N).

Conclusion: Fracture resistance of monolithic lithium disilicate in an aqueous environment is promising and requires second phase testing to evaluate the potential of various thicknesses appropriate for posterior single tooth applications. Doubling the IPS e.max Zirpress zirconia core from 0.4 mm to 0.8 mm increased the fracture resistance of this restorative system threefold.
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http://dx.doi.org/10.1111/j.1532-849X.2012.00948.xDOI Listing
June 2013

Implant location and radiotherapy are the only factors linked to 2-year implant failure.

Authors:
Alan B Carr

J Evid Based Dent Pract 2012 Sep;12(3 Suppl):217-9

Mayo Clinic College of Medicine, Department of Dental Specialties, 200 First St., SW, Rochester, MN 55905, USA.

Subjects: The subjects in this retrospective case series were derived from a review of 700 patient files within the implant practice of the Department of Periodontology, University Hospital, Catholic University of Leuven. Inclusion criteria were met by 412 patients (240 females, 172 males) receiving a total of 1514 Nobel Biocare dental implants. These patients were included based on data availability for the time period 2 years after abutment surgery (considered to represent late implant failure).

Key Exposure/study Factor: Given the concern of the authors to assess the probability of late implant failure among clinic patients with certain local and systemic factors, the potential factors were multiple. The local factors included the following: implant length and diameter, bone quality and quantity, insertion site, type of edentulism, antibiotic use perioperatively, dehiscence and/or perforation of the site during surgery, and stability at insertion (measured by Periotest values). The related health and behavioral factors included the following: medications, smoking (<10 cigarettes/day, 10-20 cigarettes/day, >20 cigarettes/day), hypertension, ischemic cardiac problems, coagulation anomalies, gastric ulcers, thyroid disorders, hypercholesterolemia, rheumatoid arthritis, asthma, diabetes (types 1 and 2), Crohn's disease, and chemotherapy.

Main Outcome Measure: The primary outcome was described as "late implant failure." The current study, which follows a similar study on early implant failure,(1) aims to identify negative influences on maintenance of integration. The authors used the clinical experience related to the 412 patients with 1514 implants to identify whether the observed failure rates were influenced by local and systemic factors. Failure was defined as "late" when occurring between abutment connection surgery and 2 years after this date. Patients/implants that were not available for this interval of time were not included. However, even when records were available, not all patient records provided all data sought.

Main Results: Regarding local factors, the authors reported that implant diameter and location were relevant to late implant loss, whereas implant length was not (P value = .01, = .34, respectively; univariate generalized estimating equation [GEE] logistic regression). Regarding implant diameter, significantly more loss was noted for 5.00-mm implants when compared with the 4.00-mm or 4.75-mm implants. Failure related to location revealed that the maxilla compared with the mandible, posterior jaws compared with anterior jaws, and the posterior maxilla compared with all other oral locations were associated with more late failures (Table 1). Assessment of systemic factors revealed radiotherapy to be related to more late implant loss (P = .003). Neither systemic disease nor smoking exposure was associated with late failure.

Conclusions: The authors concluded that late implant failure was influenced by the local factor "implant location" and the systemic factor "radiotherapy." Neither smoking nor systemic health factors were found to adversely influence implant integration from abutment connection through 2 years' performance.
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http://dx.doi.org/10.1016/S1532-3382(12)70042-8DOI Listing
September 2012

Survival of short implants is improved with greater implant length, placement in the mandible compared with the maxilla, and in nonsmokers.

Authors:
Alan B Carr

J Evid Based Dent Pract 2012 Sep;12(3 Suppl):189-91

Mayo College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.

Selection Criteria: The authors conducted a search of MEDLINE and EMBASE databases for the period January 1980 to October 2009. This was supplemented by searching reference lists of literature obtained. There was no language restriction applied. Two authors reviewed the search yield for relevance, disagreement was resolved by consensus discussion, and the selected articles deemed relevant for full-text review were read by one reviewer. The relevant articles selected were judged against inclusion/exclusion criteria. Included studies were restricted to randomized controlled trials (RCTs) or prospective cohort studies. Only studies with partially edentulous applications of at least 5 implants shorter than 10 mm followed for more than 1 year were included. No (alumina)-zirconium implants or mini-implants for orthodontic anchorage or short implants used for cantilevered prostheses were included. A validity assessment using methodological criteria for cohort and RCTs was accomplished by 2 reviewers.

Key Study Factor: The focus of the review was to determine the prognosis of short (<10 mm) implants in the partially edentulous patient. The authors sought to identify important influences on survival rate by conducting subgroup analyses where the subgroups included individual implant lengths shorter than 10 mm, smoking, implants in the mandible versus maxilla, and bone augmentation procedures. The 2-year estimated survival rate was selected based on evidence suggesting that after 1 year the implant survival rate is considered to be constant, an important aspect for survival function estimation.

Main Outcome Measure: To allow a pooled estimate of prognosis from multiple studies, the estimated failure rate per year and estimated implant survival rate after 2 years was determined for each study. The estimated failure rate per study was determined as a function of number of implant failures and total implant "exposure" time. Exposure in this context means the time an implant is in vivo and, hence, exposed to failure risk. Consequently, exposure time includes implants followed the entire study, those up to the time of failure, and those followed to a premature study end (eg, patient death, moving, refusal to continue). When study data were not provided separately for the short implants in a publication, a proportional exposure (short implants/total implants χ overall exposure time) was determined. The 2-year survival calculation made from the estimated failure rate assumed a constant rate of implant failure (considered to follow a Poisson distribution). Additional analyses sought to identify independent effects on failure based on implant surface topography (rough vs machined), maxilla versus mandible, smoking status, and augmentation.

Main Results: Twenty-nine studies were identified that met both the inclusion criteria and methodological requirements of the 1353 articles identified in the literature search. Of these 29 studies, 28 were prospective cohort studies and 1 was an RCT. The mean follow-up for the studies was 3.7 years, with a range from 1.6 to 8.1 years. There were 2611 short implants in the identified studies ranging in length from 5.0 mm to 9.5 mm. Table 1 provides the outcome data by implant length, including the number of implants in each group, the estimated annual failure rate (expressed as a percentage), and the 2-year estimated failure rate (expressed as a percentage). Overall, 5-mm implants were calculated to have a 2-year survival rate of 93%, whereas 9-mm implants had a 2-year survival rate of 98%. Additional analyses revealed that for all implant lengths, both rough and machined (smooth) implants had similar failure rates (0.008 and 0.010, respectively). Implants placed in the maxilla had a significantly greater failure rate than those placed in the mandible (0.010 and 0.003, respectively). Estimated failure rates in studies that excluded smokers were twice as low as those seen in studies that included heavy smokers (0.004 and 0.080, respectively). No significant difference in estimated failure rate was seen for implants placed with simultaneous augmentation compared with no augmentation (0.007 and 0.010, respectively).

Conclusions: The findings from this systematic review are important in that collectively they support consideration of placement of short implants in partially edentulous patients. The estimated data showed a tendency for improved survival rate with increasing implant length, implant placement in the mandible compared with the maxilla, and for implants placed in nonsmokers.
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http://dx.doi.org/10.1016/S1532-3382(12)70035-0DOI Listing
September 2012

Interventions for tobacco cessation in the dental setting.

Cochrane Database Syst Rev 2012 Jun 13(6):CD005084. Epub 2012 Jun 13.

Department of Dental Specialities, Mayo Clinic, Rochester,

Background: Tobacco use has significant adverse effects on oral health. Oral health professionals in the dental office or community setting have a unique opportunity to increase tobacco abstinence rates among tobacco users.

Objectives: This review assesses the effectiveness of interventions for tobacco cessation delivered by oral health professionals and offered to cigarette smokers and smokeless tobacco users in the dental office or community setting.

Search Methods: We searched the Cochrane Tobacco Addiction Group Specialized Register (CENTRAL), MEDLINE (1966-November 2011), EMBASE (1988-November 2011), CINAHL (1982-November 2011), Healthstar (1975-November 2011), ERIC (1967-November 2011), PsycINFO (1984-November 2011), National Technical Information Service database (NTIS, 1964-November 2011), Dissertation Abstracts Online (1861-November 2011), Database of Abstract of Reviews of Effectiveness (DARE, 1995-November 2011), and Web of Science (1993-November 2011).

Selection Criteria: We included randomized and pseudo-randomized clinical trials assessing tobacco cessation interventions conducted by oral health professionals in the dental office or community setting with at least six months of follow-up.

Data Collection And Analysis: Two authors independently reviewed abstracts for potential inclusion and abstracted data from included trials. Disagreements were resolved by consensus. The primary outcome was abstinence from smoking or all tobacco use (for users of smokeless tobacco) at the longest follow-up, using the strictest definition of abstinence reported. The effect was summarised as an odds ratio, with correction for clustering where appropriate. Heterogeneity was assessed using the I² statistic and where appropriate a pooled effect was estimated using an inverse variance fixed-effect model.

Main Results: Fourteen clinical trials met the criteria for inclusion in this review. Included studies assessed the efficacy of interventions in the dental office or in a community school or college setting. Six studies evaluated the effectiveness of interventions among smokeless tobacco (ST) users, and eight studies evaluated interventions among cigarette smokers, six of which involved adult smokers in dental practice settings. All studies employed behavioral interventions and only one required pharmacotherapy as an interventional component. All studies included an oral examination component. Pooling all 14 studies suggested that interventions conducted by oral health professionals can increase tobacco abstinence rates (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.44 to 2.03) at six months or longer, but there was evidence of heterogeneity (I² = 61%). Within the subgroup of interventions for smokers, heterogeneity was smaller (I² = 51%), but was largely attributable to a large study showing no evidence of benefit. Within this subgroup there were five studies which involved adult smokers in dental practice settings. Pooling these showed clear evidence of benefit and minimal heterogeneity (OR 2.38, 95% CI 1.70 to 3.35, 5 studies, I² = 3%) but this was a posthoc subgroup analysis. Amongst the studies in smokeless tobacco users the heterogeneity was also attributable to a large study showing no sign of benefit, possibly due to intervention spillover to control colleges; the other five studies indicated that interventions for ST users were effective (OR 1.70; 95% CI 1.36 to 2.11).

Authors' Conclusions: Available evidence suggests that behavioral interventions for tobacco cessation conducted by oral health professionals incorporating an oral examination component in the dental office or community setting may increase tobacco abstinence rates among both cigarette smokers and smokeless tobacco users. Differences between the studies limit the ability to make conclusive recommendations regarding the intervention components that should be incorporated into clinical practice, however, behavioral counselling (typically brief) in conjunction with an oral examination was a consistent intervention component that was also provided in some control groups.
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http://dx.doi.org/10.1002/14651858.CD005084.pub3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3916957PMC
June 2012

Interventions for replacing missing teeth: partially absent dentition.

Cochrane Database Syst Rev 2012 Feb 15(2):CD003814. Epub 2012 Feb 15.

Department of Dentistry, Illinois Masonic Medical Center, Chicago, IL, USA.

Background: Management of individuals presenting with partial loss of teeth is a common task for dentists. Outcomes important to the management of missing teeth in the partially absent dentition should be systematically summarized. This review recognizes both the challenges associated with such a summarization and the critical nature of the information for patients.

Objectives: To assess the effects of different prostheses for the treatment of partially absent dentition in terms of the following outcomes: long-term success, function, morbidity and patient satisfaction.

Search Methods: We searched the Cochrane Oral Health Group's Trials Register (to 21 March 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 1), MEDLINE via OVID (1950 to March 2011) and EMBASE via OVID (1980 to March 2011). There were no restrictions regarding language or date of publication. We contacted several authors to identify non-published trials.

Selection Criteria: Randomized controlled trials (RCTs) comparing different methods (including the design and materials used) of treating partial edentulism, with clinically relevant outcomes, were included in this review. Trials reporting only surrogate outcomes, such as plaque accumulation or gingival volume, were excluded from this review.

Data Collection And Analysis: Two review authors independently carried out the screening of eligible studies, assessment of dimensions of quality of trials, and data extraction. Results were expressed as mean differences for continuous data, risk ratios for dichotomous outcomes, and hazard ratios with 95% confidence intervals for time-to-event data.

Main Results: Twenty-one trials met the inclusion criteria for this review. Twenty-four per cent of these were assessed as being at high risk of bias and the remainder were at unclear risk of bias. The clinical heterogeneity among the included studies precluded any attempt at meta-analysis. There was insufficient evidence to determine whether one type of removable dental prosthesis (RDP) was better or worse than another. With fixed dental prostheses (FDPs), there was no evidence that high gold alloys are better or worse than other alloys, nor that gold alloys or frameworks are better or worse than titanium. There is insufficient evidence to determine whether zirconia is better or worse that other FDP materials, that ceramic abutments are better or worse than titanium, or that one cement was better or worse than another in retaining FDPs. There is insufficient evidence to determine the relative effectiveness of FDPs and RDPs in patients with shortened dental arch or to determine the relative advantages of implant supported FDPs versus tooth/implant supported FDPs.

Authors' Conclusions: Based on trials meeting the inclusion criteria for this review, there is insufficient evidence to recommend a particular method of tooth replacement for partially edentulous patients.
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http://dx.doi.org/10.1002/14651858.CD003814.pub2DOI Listing
February 2012

Survival of short implants is improved with greater implant length, placement in the mandible compared with the maxilla, and in nonsmokers.

Authors:
Alan B Carr

J Evid Based Dent Pract 2012 Mar;12(1):18-20

Mayo College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.

Purpose/question: What is the 2-year estimated implant survival rate of short (<10 mm) dental implants installed in partially edentulous patients?

Source Of Funding: Information not available.

Type Of Study/design: Systematic review with meta-analysis of data.

Level Of Evidence: Level 1: Good quality, patient-oriented evidence.

Strength Of Recommendation Grade: Grade B: Inconsistent or limited-quality, patient-oriented evidence.
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http://dx.doi.org/10.1016/j.jebdp.2011.12.008DOI Listing
March 2012

Oral cancer therapy may influence survival of dental implants.

Authors:
Alan B Carr

J Evid Based Dent Pract 2011 Sep;11(3):124-6

Mayo Clinic College of Medicine, Department of Dental Specialties, USA.

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http://dx.doi.org/10.1016/j.jebdp.2011.06.009DOI Listing
September 2011

Immediate restoration with ti-unite implants: practice-based evidence compared with animal study outcomes.

Int J Prosthodont 2011 May-Jun;24(3):199-203

Department of Dentistry, Faculty of Medicine, Charles University-Prague, Hradec Kralove, Czech Republic.

Purpose: Clinicians often do not have the benefit of adequate safety or clinical data when evaluating the merit of either newly marketed implant devices or novel clinical procedures. This has been the case for dental implants following the initial documentation of their safety and efficacy and is demonstrated in the evolution of immediate load application. Following demonstration of safety and successful application of an implant in an animal study prior to its market release, this report provides the clinical outcomes for the first 100 Ti-Unite implants provided to 24 patients in a clinical practice over 9 years.

Materials And Methods: An electronic record/clinical database review of consecutive early loaded implants from a multiple surgeon/single prosthodontist practice was conducted for quality assurance. Data extraction of standard exposure and outcome variables was accomplished by a trained individual not affiliated with the clinical practice.

Results: The results revealed one failure before and none following definitive restoration with a variety of prostheses. The mean length of time from immediate to definitive restorations was 5.3 ± 1.1 months for crowns, 3.9 ± 1.3 months for fixed partial dentures, and 7.8 ± 4.1 months for mandibular "hybrid" prostheses. The most common unexpected findings during the initial three postinsertion visits were lost access restoration and cement failure.

Conclusions: Pre-market animal data regarding the safety and success of a new implant used with an early loading protocol was replicated in the clinical results of the first 100 implants used in practice. Additionally, the clinical results are favorable when compared to conventional loading protocols from this same practice and provide helpful comparative metrics (delayed vs immediate loading) to use when discussing implant treatment with patients.
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September 2011