Clinical Pearls: A JOMI review by AO's YCC
As an occasional feature of AO CONNECT, articles from The International Journal of Oral and Maxillofacial Implants (JOMI) — the official journal of AO— are reviewed from the viewpoint of a member of the Academy’s Young Clinicians Committee (YCC). Today’s “JOMI Clinical Pearls” by Dr. Nicole Olivares are pulled from Volume 32, Number 3, 2017.
By Nicole Olivares
Comparison of Marginal Bone Level Changes of Immediately Loaded Implants, Delayed Loaded Nonsubmerged Implants, and Delayed Loaded Submerged Implants: A Randomized Clinical Trial
(Maria Cecília Giacomel, DDS, MSc1/Paulo Camati, DDS, MSc1/ Juliana Souza, DDS, MSc, PhD2/Tatiana Deliberador, DDS, MSc, PhD3)
This study aimed to compare changes in marginal bone levels between implants that were either loaded immediately, nonsubmerged implants with delayed loading, and submerged implants with delayed loading. The implants which were loaded immediately had provisional restorations placed the day of surgery. The delayed loaded, nonsubmerged group, had healing abutments placed the day of surgery and restorations placed at 3 months. The delayed loaded, submerged implants were submerged with a coverscrew at the time of placement and a second implant exposure surgery was performed at 3 months to place the healing abutment. The definitive restoration was placed 3 months later. What is unique about the approach was that they included patients who needed three adjacent implants in the posterior mandible and placed one implant from each of the three groups. Fifteen patients fit these criteria. Implants were placed in a random order, by the same clinician, during the same procedure. The same implant type and dimension was used, 3.5 mm in width and however they varied by length, depending on anatomy. Definitive restorations (metal-ceramic) were cemented 3 months after implant placement for all groups. A customized paralleling device was utilized for standardizing radiographs which were taken at placement, three months, six months and nine months after implant placement. Biased on computer analysis of periapical radiographs, no statistically significant differences in marginal bone loss was noted between any of the implant conditions during the study timeframe. Disregarding the small sample size and short follow-up,
Satisfaction and Patient-Related Outcomes in 128 Patients with Single Implant Crowns In Situ for up to 14 Years
(Terry R. Walton, BDS, MDSc (Syd), MS (Mich), FRACDS1/Danielle M. Layton, BDSc (Hons)(Qld), MSc Oxon, MDSc (Hons)(Syd), DPhil Oxon2)
This study sought to assess patient satisfaction with single implant restorations in a private prosthodontic practice. Patients completed a questionnaire that asked them to rate their satisfaction now and to recall what it was when the implant crown was first derived. Satisfaction ratings were based on a variety of factors: appearance of crown and soft tissue, cleasibility, cost and overall satisfaction with treatment. Implants we restored between 2001 and 2014. Only patients with single implants adjacent natural teeth were included. They had a 62% response rate and the only significant difference between those that responded and those that did not, was that those that did not tended to have more than one single implant crown. Overall, satisfaction for all participants was high or “met expectations.” They found that over time, respondents were more satisfied with the appearance of the prosthesis, especially in respect to contour and soft tissue. Color satisfaction did not change. Generally respondents reported that they were moderately satisfied with the implant treatment initially, but reported higher satisfaction at the time of the questionnaire. Another interesting finding was that patients who received their implants between the ages of seventeen and forty-four were initially less satisfied than counterparts over 44 years of age. Satisfaction with appearance did not change, however satisfaction with cost, did improve. Overall patients in this practice found that single implant crowns met their expectations. It would be interesting to know if patients’ remembered satisfaction levels differ from their actual initial satisfaction. It would also be relevant to know by what means the practitioner sought to establish patient expectations and if different methods could influence initial and future satisfaction levels.
Implications of Wear at the Titanium-Zirconia Implant-Abutment Interface on the Health of Peri-implant Tissues
(Andrew Tawse-Smith, DDS, Cert Periodontology1/Sunyoung Ma, BDS, DClinDent2/Warwick J Duncan, BDS, MDS, PhD3/Andrew Gray, BA, BCom(Hons)4/Malcolm R. Reid, BSc, PhD5/Alison M. Rich, BDS, MDSc, PhD6)
Past in vitro studies have shown that zirconia abutments used in implant restorations can cause wear of the titanium and potentially the accumulation of titanium particles in the peri-implant soft tissue. This study evaluated patients who had received sintered zirconia abutments veneered with porcelain, 5 years after use. This study compared clinical findings at recall on non-mobile implants to the contralateral tooth. Parameters measured included, pocket depth, bleeding on probing and plaque at four sites (mesial, distal, buccal and palatal). Also measured was gingival recession, and on the implants was referenced at the implant abutment interface to the free gingival margin. Exfoliative cytology was performed buccal and palatal of both teeth and implants and internal at implants by collecting samples from the tissue at the implant abutment interface when the screw retained crown was removed.
Standardized radiographs were performed. Cytology smears were evaluated with light microscopy, scanning electron microscopy and energy dispersive spectroscopy, and trace elemental analysis. They found a higher number of inflammatory cells on the external swabs of the implant than the natural tooth or the internal implant collection. On the internal tissue surface they found greater number of partials of titanium and an assortment of other metals such as gold, aluminum, silver and zirconium. Source of titanium and zirconium was thought to be from wear of the implant interface. Gold was assumed to be from the gold abutment screw used. Other sources could be from maintenance of the implant over the previous 5 years. What they did not find was an increased signs of inflammation or worse health then the contralateral teeth. This study did not examine implants with titanium abutments. Another limitation is that the only implant studied was the Co-axis implant, which may have different loading than a more common, nonangulated abutment. This method of exportation could also be expanded to disease implants with inflamed tissue.
About the Author
Dr. Nicole Olivares obtained her doctorate in dentistry from the University of California, Los Angeles. She went on to complete her specialty training in periodontics at Oregon Health and Science University. Dr. Olivares is a Diplomate of the American Board of Periodontology. She is in private practice in San Francisco, California with a focus on dental implants, periodontal plastic surgery and disease treatment.