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1.
  • Cosyn, Jan, et al. (författare)
  • An Exploratory Case-Control Study on the Impact of IL-1 Gene Polymorphisms on Early Implant Failure
  • 2016
  • Ingår i: Clinical Implant Dentistry and Related Research. - : John Wiley & Sons. - 1523-0899 .- 1708-8208. ; 18:2, s. 234-240
  • Tidskriftsartikel (refereegranskat)abstract
    • Background The association between IL-1 gene polymorphisms and peri-implantitis has been well documented. However, data on the association with early implant failure are scarce. Purpose The objective of this case-control study was to explore the impact of IL-1A (-889), IL-1B (-511), and IL-1B (+3,954) gene polymorphisms on early implant failure in Caucasians Materials and Methods Between September 2004 and August 2007, 461 patients were treated with dental implants at the University Hospital in Ghent, Belgium. Fourteen subjects of this patient group who had experienced one or more early implant failures (within 6 months from implant installation) were recruited as cases. Fourteen controls, matched in terms of age, gender, and smoking habits, with only surviving implants, were selected from the same patient group. Allele and genotype analysis was performed on the basis of a blood sample by Sanger sequencing of polymerase chain reaction products containing the IL-1A (-889), IL-1B (-511), and IL-1B (+3,954) gene polymorphisms Results A significant impact of the IL-1A (-889) T allele (p=.039) and the IL-1B (+3,954) T allele (p=.003) on early implant failure was demonstrated (odds ratios=3.9 and 15.0, respectively). In addition, the genotypic distribution differed significantly between cases and controls for IL-1B (+3,954) (p=.015 ConclusionsThe IL-1B (+3,954) gene polymorphism seems to affect osseointegration. Additional case-control studies in larger patient groups are needed to confirm this observation.
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2.
  • Browaeys, Hilde, et al. (författare)
  • A Retrospective Analysis of Early and Immediately Loaded Osseotite Implants in Cross-Arch Rehabilitations in Edentulous Maxillas and Mandibles Up to 7 Years
  • 2013
  • Ingår i: Clinical Implant Dentistry and Related Research. - : John Wiley & Sons. - 1523-0899 .- 1708-8208. ; 15:3, s. 380-389
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Immediate loading of full-arch restorations yields good results in selected cases, but long-term follow-up and the outcome in compromised bone are scarcely evaluated. Purpose: To evaluate immediately loaded Osseotite implants (Biomet 3i, Palm Beach, FL, USA) installed in healed or grafted bone, with regard to implant survival and peri-implant bone loss up to 7 years in function. Materials and Methods: Information was retrospectively retrieved from 83 patients' records with 749 Osseotite implants supporting immediately loaded semipermanent full-arch acrylic restorations. Five hundred sixty-eight (75.8%) implants were placed in healed bone and 181 (24.2%) in augmented bone, regenerated with sinus lifting and/or onlay/inlay grafts with/without biomaterials and membranes. Implant survival and success based on radiological peri-implant bone loss were registered. Wilcoxon rank sum tests evaluated peri-implant bone loss in compromised versus healed bone or between jaws or time intervals with p < .05 as statistically significant. Results: Sixteen of 749 implants failed (2.1%), 11/343 in maxilla (3.2%) and 5/406 (1.2%) in mandible. After 7 years, the cumulative failure rate was 9%. Mean peri-implant bone loss increased to 1.2 mm (SD 1.0) during the first 2 years but remained unchanged thereafter. Around implants in grafted bone, on average, 0.3 mm more bone loss was found. Conclusion: The Osseotite implants offer a predictable long-term outcome in terms of implant survival and stable peri-implant bone under immediate loading even in grafted bone. However, the high incidence of technical repair because of fractures of the semipermanent provisionals requires attention because it may be negative from a cost-benefit perspective. Implants in grafted bone show a tendency to a more pronounced initial bone remodeling without clinical consequence in the long term.
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3.
  • Cosyn, Jan, et al. (författare)
  • An analysis of the decision-making process for single implant treatment in general practice
  • 2012
  • Ingår i: Journal of Clinical Periodontology. - : John Wiley & Sons. - 0303-6979 .- 1600-051X. ; 39:2, s. 166-172
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose To study the frequency of and factors associated with the decision to perform single implant treatment after tooth extraction by general practitioners in a private, fee-for-service setting. Material and methods One hundred practitioners with a general dental practice in Ghent were randomly selected. Clinicians were asked to fill in a study form for every single extraction they performed during an 8-week period. The form related to the treatment decision and a number of patient- and clinician-related factors. Results Ninety-four general dentists (52 men, 42 women; mean age 49; range 24–68) agreed to participate and extracted 1180 single teeth. After exclusion of third molars and cases where the reason for tooth loss would generally prohibit replacement, 900 cases were identified. In 24% of these patients, there was no treatment decision and in 18% replacement was deemed unnecessary. When replacement was necessary (n = 526), removable partial denture (RPD), fixed partial denture (FPD), single implant treatment and resin-bonded bridge were chosen in 54%, 24%, 21% and 1% of the patients, respectively. Multinomial logistic regression was used to evaluate the decision-making process for single implant treatment against RPD and FPD. In relation to RPD, single implant treatment was more likely in highly educated patients with few missing teeth and no bone loss at adjacent teeth. In relation to FPD, single implant treatment was more likely in patients with intact adjacent teeth and when the tooth was extracted by a female dentist. Experience in implant prosthetics was positively associated with single implant treatment in all analyses. Conclusions Single implant treatment is not the most common procedure in daily practice to restore a single tooth gap. Patient's education, oral factors and clinician-related factors may affect the decision-making process, whereas medical factors may not.
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4.
  • De Bruyn, Hugo, et al. (författare)
  • Long-term clinical, microbiological, and radiographic outcomes of Brånemark™ implants installed in augmented maxillary bone for fixed full-arch rehabilitation.
  • 2013
  • Ingår i: Clinical Implant Dentistry and Related Research. - 1523-0899 .- 1708-8208. ; 15:1, s. 73-82
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: The purpose of this study was to document the long-term outcome of Brånemark implants installed in augmented maxillary bone and to identify parameters that are associated with peri-implant bone level.MATERIAL AND METHODS: Patients of a periodontal practice who had been referred to a maxillofacial surgeon for iliac crest bone grafting in the atrophic maxilla were retrospectively recruited. Five months following grafting, they received 7-8 turned Brånemark implants. Following submerged healing of another 5 months, implants were uncovered and restorative procedures for fixed rehabilitation were initiated 2-3 months thereafter. The primary outcome variable was bone level defined as the distance from the implant-abutment interface to the first visible bone-to-implant contact. Secondary outcome variables included plaque index, bleeding index, probing depth, and levels of 40 species in subgingival plaque samples as identified by means of checkerboard DNA-DNA hybridization.RESULTS: Nine out of 16 patients (eight females, one male; mean age 59) with 71 implants agreed to come in for evaluation after on average 9 years (SD 4; range 3-13) of function. One implant was deemed mobile at the time of inspection. Clinical conditions were acceptable with 11% of the implants showing pockets ≥ 5 mm. Periodontopathogens were encountered frequently and in high numbers. Clinical parameters and bacterial levels were highly patient dependent. The mean bone level was 2.30 mm (SD 1.53; range 0.00-6.95), with 23% of the implants demonstrating advanced resorption (bone level > 3 mm). Regression analysis showed a significant association of the patient (p < .001) and plaque index (p = .007) with bone level.CONCLUSIONS: The long-term outcome of Brånemark implants installed in iliac crest-augmented maxillary bone is acceptable; however, advanced peri-implant bone loss is rather common and indicative of graft resorption. This phenomenon is patient dependent and seems also associated with oral hygiene.
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5.
  • De Wilde, Elisabeth A. W. J., et al. (författare)
  • The soft tissue immunologic response to hydroxyapatite-coated transmucosal implant surfaces : a study in humans
  • 2015
  • Ingår i: Clinical Implant Dentistry and Related Research. - : John Wiley & Sons. - 1523-0899 .- 1708-8208. ; 17:S1, s. e65-e74
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectiveTo evaluate the soft tissue response in humans immunologically and histologically after placement of mini-implants coated with or without nano-size hydroxyapatite coatings. Material and MethodsCommercially pure (cp) titanium mini-implants (n=13) or nano-hydroxyapatite-coated ones (n=12) were randomly placed into partially edentulous jaws. Crevicular fluid was sampled 1week after placement and subjected to quantitative polymerase chain reaction analysis to explore the inflammatory markers. After 8weeks, implants and surrounding soft and hard tissue were trephined, and undecalcified ground sections were prepared. Inflammatory cell accumulation within a defined region of interest in the soft tissue was quantified histomorphometrically. ResultsNo statistically significant differences in immunological response to the different implant surfaces were found for IL-6 (p=.438), TGF-2 (p=.467), MMP-8 (p=.758), CCL-3 (p=.758), IL-8 (p=.771), and IL-1 (0.771). Histomorphometric evaluation presented no statistically significant difference between the two mini-implant surfaces with regards to number of inflammatory cells (p=.669). ConclusionNano-hydroxyapatite-coated surfaces in the transmucosal region yielded similar inflammatory response and is suggested to be as biocompatible as commercially pure titanium surfaces.
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6.
  • Dierens, Melissa, et al. (författare)
  • Alterations in soft tissue levels and aesthetics over a 16–22 year period following single implant treatment in periodontally-healthy patients : a retrospective case series
  • 2013
  • Ingår i: Journal of Clinical Periodontology. - : John Wiley & Sons. - 0303-6979 .- 1600-051X. ; 40:3, s. 311-318
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose Long term studies on single implants are scarce and merely focus on clinical response parameters, complications and bone remodelling. The objective of this retrospective case series was to assess alterations in soft tissue levels and aesthetics over a 16–22 year period in periodontally-healthy patients. Material and methods Patients who had received a single turned implant in the anterior maxilla/mandible at the Dental Specialist Clinic in Malmö between 1987 and 1993 were invited for a re-examination on the basis of a number of inclusion criteria. Both neighbouring teeth had to be present at re-examination and baseline clinical photographs (within the first year of function) had to be available for soft tissue evaluation. These photographs were superimposed onto final clinical photographs to assess longitudinal soft tissue alterations. Results Twenty-one patients (nine females; mean age 23, range 16–41) treated with 24 single implants met the criteria for soft tissue evaluation. Peri-implant soft tissue levels (papillae, midfacial level) remained stable over a 16–22 year observation period (p ≥ 0.372). However, neighbouring teeth demonstrated midfacial recession and eruption pointing to a major distortion with the implant crown (> 1 mm) in 5/24 (21%) and 10/24 (42%) of the cases, respectively. Baseline aesthetics was considered poor (mean Pink Esthetic Score 7.42, mean White Esthetic Score 5.43), yet a significant time effect could not be demonstrated (p ≥ 0.552). Implant and tooth bone loss was low (mean 0.6 mm and 0.4 mm, respectively) over a 16–22 year period. Conclusions This limited case series demonstrated stable peri-implant soft tissue levels and aesthetics in the long term following single implant treatment in periodontally-healthy patients. However, midfacial recession and eruption may be expected at neighbouring teeth.
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7.
  • Koole, S, et al. (författare)
  • Using Online Periodontal Case-Based Discussions to Synchronize Theoretical and Clinical Undergraduate Dental Education
  • 2012
  • Ingår i: European journal of dental education. - : Wiley-Blackwell. - 1396-5883 .- 1600-0579. ; 16:1, s. 52-58
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Clinical experience is important in undergraduate dental education, but (suitable) patients to learn from are often lacking. Online case-based discussions were introduced to overcome patient dependency and to synchronize theoretical with clinical education. Materials and methods: Undergraduate dental students in groups of 5-7 discussed online clinical case reports presenting either minor (2nd year) or complex periodontal pathology (3rd year). Each case consisted of a brief patient history, extra-and intraoral clinical pictures, periodontal chart, peri-apical and/ or orthopantomographic radiographs. Students had to discuss diagnosis and treatment planning. Questionnaires assessed students' and supervisors' general appreciation (score on 20), time investment and opinions about organisation, relation case/course content, future planning, learning effect and online environment (5-point Likert scale). A crossover design with three tests (pre-test, test in between and post-test) was used to investigate whether the frequency of case introduction (one case per week vs. one case element per week) had an effect on learning. Data was analysed with descriptive statistics (questionnaires) and repeated measures ANOVA (crossover design). Results: Students (n = 119) and supervisors (n = 9) highly appreciated the exercise. Students reported spending on average 74 min per week to read a case, prepare and post messages. Supervisors' total time investment was 342 min per semester to create a case, provide online feedback and to prepare a live-discussion. No significant differences in test-scores were found between the two modalities of case introduction. Conclusion: Online case-based discussions, in conjunction with a theoretical course, are valuable additions to the dental curriculum, especially to reinforce the transition from theory to clinical practice.
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8.
  • Miremadi, S R, et al. (författare)
  • A pilot assessment tool of the need for oral health care and cost prediction in institutionalized elderly people
  • 2017
  • Ingår i: International Journal of Dental Hygiene. - : Blackwell Munksgaard. - 1601-5029 .- 1601-5037. ; 15:4, s. 306-312
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To assess the dental treatment backlog and associated costs among institutionalized elderly people using a novel composite index, called the oral health index. BACKGROUND: Despite numerous reports about oral health of old individuals, there is still lack of a systematic and practical method to estimate their treatment need covering all relevant aspects of oral health. In addition, little has been published on associated treatment costs and prediction of such costs. MATERIALS AND METHODS: An observational study was performed on 143 dentate institutionalized elderly people, whereby several clinical parameters were registered. The collected data were included in the oral health index representing the need for oral health care. This covered the number of caries lesions, number of residual roots, periodontal health condition, plaque score and denture condition with a final score of 0-9. To investigate the validity of the index, the treatment costs were estimated using the measured clinical parameters and later compared with the actual expenditure of the patients for the following 2 years. RESULTS: The average score of the index was 4.6 (SD 1.4) with 65.1% of the individuals having a score between 3 and 6 and 27.3% having a score of 6 and more, exhibiting medium and high need for oral health care, respectively. Only 30% of the patients underwent all the indicated treatments. The major reason of non-completion of the treatment was patient's refusal. From the fully treated group, 61.5% of the subjects actually spent within the predicted range while 38.5% of them spent more than estimated. The underestimation was related to yearly calculus removals leading to repeated calculation of the same costs and newly emerging dental problems (33% developed new caries and 20% was confronted with tooth fracture within the 2-year period). CONCLUSION: The novel index can be helpful to determine oral treatment needs and associated costs. Further research is needed to extend the clinical applicability of the index.
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9.
  • Miremadi, S. R., et al. (författare)
  • Effects of root surface debridement using Er:YAG Laser versus ultrasonic scaling : a SEM study
  • 2014
  • Ingår i: International Journal of Dental Hygiene. - : John Wiley & Sons. - 1601-5029 .- 1601-5037. ; 12:4, s. 273-284
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Despite promising results of Er:YAG laser in periodontal debridement, to date there is no consensus about the ideal settings for clinical use. This experimental clinical trial aimed to determine the effects of debridement using Er:YAG laser and to compare with ultrasonic treatment. Materials and methods: Sixty-four teeth were divided into two in vivo and in vitro subgroups. Each tooth received ultrasonic treatment on one side and Er:YAG laser debridement at either 60, 100, 160 or 250mJpulse(-1) and at 10Hz on the other side on a random basis. All samples were morphologically analyzed afterwards under scanning electron microscope for surface changes and dentinal tubules exposure. Treatment duration (d) was also recorded. Results: Laser debridement produced an irregular, rough and flaky surface free of carbonization or meltdown while ultrasound produced a relatively smoother surface. The number of exposed dentinal tubules (n) followed an energy-dependent trend. The number of exposed tubules among the in vivo laser groups was n60mJ=n100mJd100mJ>dUltrasound=d160mJ>d250mJ (P0.046), while for the in vitro groups it was d60mJ>d100mJ=dUltrasound=d160mJ>d250mJ (P0.046). Conclusions: Due to excessive treatment duration and surface damage, Er:YAG laser debridement at 60 and 250mJpulse(-1), respectively, is not appropriate for clinical use. Although laser debridement at 100 and 160mJpulse(-1) seems more suitable for clinical application, compared to ultrasound the former is more time-consuming and the latter is more aggressive. Using a feedback device or lower pulse energies are recommended when using laser in closed field.
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10.
  • Van de Velde, Tommie, et al. (författare)
  • Effect of implant design on preservation of marginal bone in the mandible.
  • 2010
  • Ingår i: Clinical implant dentistry and related research. - : Wiley. - 1708-8208 .- 1523-0899. ; 12:2, s. 134-41
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Implant design and surface may have an influence on the marginal bone response during immediate functional loading. AIM: The purpose of this study was to radiographically study the effect of implant design on marginal bone preservation at immediately loaded implants used for prosthetic rehabilitation of the completely edentulous mandible. MATERIALS AND METHODS: A total of 39 patients, previously treated with five implants for support of a full-arch fixed bridge in the mandible, were included in the study. Either machined Brånemark implants (Ma) (Nobel Biocare AB, Gothenburg, Sweden) or surface modified Astra Tech implants with (Mi) or without a microthreaded neck (Ti) (TiOblast, AstraTech AB, Mölndal, Sweden) were used. All fixtures were loaded with a provisional glass fiber or metal-reinforced screw-retained restoration within 24 hours. The provisional restorations were replaced by a 12-unit screw-retained metal-ceramic or metal-resin cantilever bridge after 3 months. Bone loss from baseline to 1 year of loading was measured by means of intraoral radiographs. Only patients with baseline and 1-year radiographs of all implants were selected for comparison. Statistical analysis was carried out on both patient and implant levels. RESULTS: The survival rates after 1 year in function were 98.6, 100, and 100% for the Ma, Ti, and Mi implants, respectively. The overall mean bone loss after 1 year was 1.03 mm (SD 0.87; range -0.77 to 2.5). The mean bone loss was calculated to 1.52 (SD 0.66) for the Ma group, 0.79 (SD 0.79) for the Ti group, and 0.70 (SD 1.01) for the Mi group. There was a significant difference between Ma and Ti (p = .023) and between Ma and Mi (p = .046) groups but not within Ti and Mi implants (p = .70). These conclusions were also valid when the statistical analysis was performed on implant level. CONCLUSIONS: There is no impact of design and surface on implant survival in the completely edentulous mandible. Bone preservation in immediately loaded implants in the mandible is influenced by implant design and significantly better on surface-modified AstraTech implants compared with machined Brånemark implants. In the mandible, a microthread design of the implant collar does not seem to improve bone preservation.
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11.
  • Van de Velde, T, et al. (författare)
  • The clinical and radiographic outcome of implants placed in the posterior maxilla with a guided flapless approach and immediately restored with a provisional rehabilitation: a randomized clinical trial.
  • 2010
  • Ingår i: Clinical oral implants research. - : Wiley. - 1600-0501 .- 0905-7161. ; 21:11, s. 1223-1233
  • Tidskriftsartikel (refereegranskat)abstract
    • Abstract Objectives: To evaluate and compare the outcome of dental implants placed using a flapless protocol and immediate loading with a conventional protocol and loading after 6 weeks. Materials and methods: Fourteen patients with bilateral maxillary edentulous areas were treated using Straumann SLA-implants. Using a randomized split-mouth design, implants were placed in one side of the maxilla using a stereolithographic surgical guide for flapless surgery and immediately loaded on temporary abutments with a bridge (test). Implants in the other side were placed using the conventional protocol and loaded after 6 weeks of healing (control). Clinical and radiographic evaluation of peri-implant tissues was performed at time of implant surgery, and after 1 week, 6 weeks, 3, 6, 12 and 18 months. Results: A total of 70 implants were placed (36 test and 34 control). One implant (test) was lost after 3 months, resulting in a survival rate of 97.3% for the test implants and 100% for the control implants. Marginal bone levels were not statistically significantly different between the test and control implants but at baseline the marginal bone level was significantly lower compared to the other evaluation periods (P < 0.05). The mean bone level for test and control implants was 1.95 mm +/- 0.70 and 1.93 mm +/-0.42 after 18 months, respectively. There was a significant change in height of the attached mucosa at implants placed with a conventional flap between post-operative and 1 week and between 1 week and 6 weeks. Statistically significant differences were found between the test side and the control side for opinion about speech, function, aesthetics, self-confidence and overall appreciation the first 6 weeks. Conclusion: Implants can successfully integrate in the posterior maxilla using a flapless approach with immediate loading similar to a conventional protocol. The mucosal tissues around implants placed with a conventional flap changed significantly compared with flapless placed implants. To cite this article: Van de Velde T, Sennerby L, De Bruyn H. The clinical and radiographic outcome of implants placed in the posterior maxilla with a guided flapless approach and immediately restored with a provisional rehabilitation: a randomized clinical trial. Clin. Oral Impl. Res. xx, 2010; 000-000. doi: 10.1111/j.1600-0501.2009.01924.x.
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12.
  • Van de Velde, Tommie, et al. (författare)
  • Two-Year Outcome with Nobel Direct® Implants : A Retrospective Radiographic and Microbiologic Study in 10 Patients
  • 2009
  • Ingår i: Clinical Implant Dentistry and Related Research. - Hamilton, Ont. : Wiley. - 1523-0899 .- 1708-8208. ; 11:3, s. 183-193
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: The Nobel Direct® implant (Nobel Biocare AB, Göteborg, Sweden) was developed to minimize marginal bone resorption and to result in "soft tissue integration" for an optimized aesthetic outcome. However, conflicting results have been presented in the literature. The aim of this present study was to evaluate the clinical and microbiologic outcomes of Nobel Direct implants.Materials and Methods: Ten partially edentulous subjects without evidence of active periodontitis (mean age 55 years) received 12 Nobel Direct implants. Implants were loaded with single crowns after a healing period of 3 to 6 months. Treatment outcomes were assessed at month 24. Routine clinical assessments, intraoral radiographs, and microbiologic samplings were made. Histologic analysis of one failing implant and chemical spectroscopy around three unused implants was performed. Paired Wilcoxon signed-rank test was used for the evaluation of bone loss; otherwise, descriptive analysis was performed.Results: Implants were functionally loaded after 3 to 6 months. At 2 years, the mean bone loss of remaining implants was 2.0 mm (SD ± 1.1 mm; range: 0.0–3.4 mm). Three out of 12 implants with an early mean bone loss >3 mm were lost. The surviving implants showed increasing bone loss between 6 and 24 months (p = .028). Only 3 out of the 12 implants were considered successful and showed bone loss of <1.7 mm after 2 years. High rates of pathogens, including Aggregatibacter actinomycetemcomitans, Fusobacterium spp., Porphyromonas gingivalis, Pseudomonas aeruginosa, and Tanerella forsythia, were found. Chemical spectroscopy revealed, despite the normal signals from Ti, O, and C, also peaks of P, F, S, N, and Ca. A normal histologic image of osseointegration was observed in the apical part of the retrieved implant.Conclusion: Radiographic evidence and 25% implant failures are indications of a low success rate. High counts and prevalence of significant pathogens were found at surviving implants. Although extensive bone loss had occurred in the coronal part, the apical portion of the implant showed some bone to implant integration.
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13.
  • Vandeweghe, Stefan, et al. (författare)
  • Dental implants placed by undergraduate students : clinical outcomes and patients'/students' perceptions
  • 2014
  • Ingår i: European journal of dental education. - : John Wiley & Sons. - 1396-5883 .- 1600-0579. ; 18:S1, s. 60-69
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Implant dentistry in undergraduate education is predominantly theoretical or prosthetics oriented. Clinical experience with implant surgery could provide students a better understanding of alternatives for tooth replacements. This study describes an implant dentistry programme for undergraduate students, which included surgical placement of implants. The study presents the clinical outcomes of the programme, patients' satisfaction and students' attitudes/perceptions. It reflects on barriers and problems encountered during implementation and provides suggestions for other institutions. Materials and methods: Thirty-six students placed one implant each for a single tooth replacement after careful radiographic assessment and pre-surgical planning. One-stage surgery was performed under one-to-one supervision. Crowns were cemented on individual abutments 3-6 months later. Crestal bone loss was assessed radiographically immediately after surgery, at crown placement and after 1 year of loading. Questionnaires were used to investigate patients' perspectives and students' opinions towards the programme, as well as their perceived level of competence. Results: Thirty-six implants were placed in 27 patients; two (5.6%) failed prior to loading; mean bone loss from time of surgery to crown placement was 1.41 mm and remained unchanged thereafter, reflecting implant success. Overall, patients were satisfied and the majority would repeat the treatment by a student. The students thought it was a valuable experience, although they realised that additional education is necessary to perform implant surgery without supervision. Conclusion: Implant placement by undergraduate students resulted in acceptable clinical outcome parameters, patient satisfaction and positive student perceptions. These findings support the further development of clinical implant education in undergraduate dental curricula.
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14.
  • Windael, Simon, et al. (författare)
  • Early peri-implant bone loss as a predictor for peri-implantitis : A 10-year prospective cohort study
  • 2021
  • Ingår i: Clinical Implant Dentistry and Related Research. - : John Wiley & Sons. - 1523-0899 .- 1708-8208. ; 23:3, s. 298-308
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: To evaluate the effect of early bone loss (EBL), on long-term bone stability and future peri-implantitis development. Materials and methods: Patients referred for implant placement between 2005 and 2009 were consecutively treated and followed for 10 years. After 10 years, patients were invited for a scientific diagnostic visit to evaluate implant survival and bone loss. Bone level changes were compared with baseline. Non-parametric testing was performed in cross-tabs (Pearson Chi-square and Fishers's exact test). Kaplan-Meier-estimated survival curves were plotted for different thresholds for EBL at different timepoints. Generalized linear mixed models with binomial distribution and logit link for peri-implantitis were fitted. An adjusted logistic mixed model was made to evaluate peri-implantitis, in relation with smoking status, history of periodontitis, and EBL > 0.5 mm. Results: Four hundred and seven patients (mean age of 64.86 years [range 28-92, SD 10.11]), with 1482 implants, responded to the 10-year recall invitation. After an average follow-up time of 10.66 years (range 10-14, SD 0.87), implant survival was 94.74%. Mean crestal bone loss after 10 years was 0.81 mm (SD 1.58, range 0.00-17.00). One hundred and seventy five implants in 76 patients had peri-implantitis (11.8% on implant level, 18.7% on patient level). EBL of 0.5, 1, and 2 mm were significant predictors for peri-implantitis and implant loss after 10 years. Implants with EBL >= 0.5 mm during the first year of function showed a 5.43 times higher odds for future peri-implantitis development. Probability in developing peri-implantitis was 52.06% when smoking, Periodontal history and EBL of >0.5 mm was combined. Conclusion: The present study suggests that EBL is a predictor for long-term peri-implant pathology, with a significant higher risk for peri-implantitis when early bone loss exceeds the thresholds of 0.5 and 1 mm, especially when additional risk factors such as smoking or susceptibility for periodontal disease prior to implant treatment are present.
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15.
  • Younes, Faris, et al. (författare)
  • Relationship between buccal bone and gingival thickness revisited using non-invasive registration methods
  • 2016
  • Ingår i: Clinical Oral Implants Research. - : Blackwell Munksgaard. - 0905-7161 .- 1600-0501. ; 27:5, s. 523-528
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectiveTo determine the relationship between buccal bone and soft tissue thickness at teeth in the premaxilla by means of non-invasive registration methods. Materials and MethodsBuccal bone thickness at central incisors, lateral incisors and canines was measured at five reference points (1-5mm from the top of the alveolar crest) on CB-CT scans of 21 patients. The corresponding buccal gingival thickness was measured by the use of an ultrasonic device. Spearman's correlation coefficient was calculated to assess the correlation between buccal bone and soft tissue thickness at each tooth type ResultsMean buccal bone thickness (SD) at central incisors, lateral incisors and canines was 1.07mm (0.34mm), 1.16mm (0.54mm) and 0.98mm (0.37mm), respectively. For central incisors, 68% of all sites had a thickness <1mm and 32% had a thickness between 1.0 and 2.0mm. At lateral incisors, 44% demonstrated buccal bone thickness between 0 and 1.0mm, 48% between 1.0 and 2.0mm and 8% 2mm. For canines, 57% of the sites were <1mm thick; 41% were between 1.0 and 2.0mm thick, and 2% demonstrated 2mm thickness. Mean gingival thickness (SD) at central incisors, lateral incisors and canines was 1.37mm (0.32mm), 1.33mm (0.32mm) and 1.08mm (0.25mm), respectively. The correlation between buccal bone and soft tissue thickness was moderately positive (=0.406; P<0.001 ConclusionsA thin buccal bone wall (<1mm) may be expected in over half of the central incisors and canines. The correlation between buccal bone and soft tissue thickness was moderately positive
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16.
  • Braian, Michael, et al. (författare)
  • Tolerance Measurements on Internal- and External-Hexagon Implants
  • 2014
  • Ingår i: International Journal of Oral & Maxillofacial Implants. - : Quintessence. - 0882-2786 .- 1942-4434. ; 29:4, s. 846-852
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: To measure the horizontal machining tolerances of the interface between internal-and external-hexagon implants and analogs with corresponding components after delivery from the manufacturer. These values may be a valuable tool for evaluating increasing misfit caused by fabrication, processing, and wear. Materials and Methods: Seven implants and seven analogs with external-and internal-hexagon connections (Biomet 3i) with corresponding prefabricated gold cylinders and gold screws, prefabricated cylindric plastic cylinders, and laboratory screws were studied. One set of components from the external and internal groups was measured manually and digitally. Measurements from the test subjects were compared with identical measurements from the virtual model to obtain threshold values. The virtual model was then used to obtain optimally oriented cuts. Results: The horizontal machining tolerances for castable plastic abutments on external implants were 12 +/- 89 mu m, and for internal implants they were 86 +/- 47 mu m. Tolerance measurements on prefabricated gold abutments for external implants were 44 +/- 9 mu m, and for internal implants they were 58 +/- 28 mu m. Conclusion: The groups with metallic components showed the smallest tolerance at < 50 mu m for the external group and < 90 mu m for the internal group. The prefabricated plastic cylinder groups ranged from < 100 mu m for external and < 130 mu m for internal connection.
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17.
  • Browaeys, Hilde, et al. (författare)
  • Ongoing Crestal Bone Loss around ImplantsSubjected to Computer-Guided FlaplessSurgery and Immediate Loading Usingthe All-on-4® Concept
  • 2015
  • Ingår i: Clinical Implant Dentistry and Related Research. - : John Wiley & Sons. - 1523-0899 .- 1708-8208. ; 17:5, s. 831-843
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The All-on-4® concept is widely applied for full-arch rehabilitations, using two tilted and two axially loadedimplants in order to overcome anatomical constraints.Purpose: The aim of this study was to assess the survival and individual success of implants immediately loaded with anAll-on-4 full-arch screw-retained prosthetic bridge i n fully edentulous mandibles or maxillae over up to 3 years.Materials and Methods: In total, 20 patients with atrophic jaws (9 maxillae, 11 mandibles) were treated with computer-guided flapless surgery and immediately provided with a provisional bridge. The final prosthesis was delivered after6 months. In total, 80 TiUnite™ Brånemark implants were placed. Radiographs were taken after surgery and 1 and 3 yearslater.Results: A 3-year survival rate of 100% was seen for all implants, both in lower and in upper jaw. None of the temporaryor definite prostheses were lost over the follow-up period of 3 years. After 1 year, the mean bone loss was 1.13 mm (SD 0.94;range −0.1 to 3.8), and after 3 years, it was 1.61 mm (SD 1.40; range 0 to 5). The mean bone loss between the 1-year and3-year follow-ups was 0.48 mm (SD 0.66; range −1.2 to 3.6). This difference was statistically significant (p < .001), indicativeof ongoing bone loss. Twenty-six percent of the implants had bone loss above 1.5 mm after 1 year, but after 3 years, 30%of the implants had already lost more than 1.9 mm.Conclusion: The implant and prosthetic survival was 100%, and patients benefited from the All-on-4 treatment. However,unacceptable ongoing bone loss was seen in 49.2% of the patients; this may be a warning sign for future problems and needsclinical attention. Overloading and surgery-related aspects need to be investigated as potential explanations.
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18.
  • Browaeys, Hilde, et al. (författare)
  • The histological evaluation of osseointegration of surface enhanced microimplants immediately loaded in conjunction with sinuslifting in humans.
  • 2013
  • Ingår i: Clinical oral implants research. - : Wiley. - 1600-0501 .- 0905-7161. ; 24:1, s. 36-44
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: The aim was to investigate histomorphometrically whether or not implant surface nanotopography improves the bone response under immediate loading simultaneous to sinus grafting. MATERIALS AND METHODS: Dual acid-etched titanium microimplants with/without crystalline surface deposition of calcium phosphate particles were placed in bilateral sinuslift areas grafted with a mixture of iliac crest bone and BioOss. Surface topography of microimplants was characterized using interferometry. Loaded microimplants (MsL) were immobilized in a provisional bridge supported by four normal size implants. Some patients had unloaded microimplants as controls (MsU). Biopsies were trephined after 2 or 4months and histomorphometric analysis of bone area (BA) and bone-to-implant contact (BC) was performed. Nonparametric methods for dependent data were used to compare effect of surface modification, and healing time (2 vs. 4months). RESULTS: A total of 53 biopsies were available from 13 patients. A total of 4/28 and 1/11 MsL failed after resp. 2 and 4months vs. 0/6 and 1/5 MsU. Many loaded biopsies were damaged at the apical portion and showed no bone adhesion. MsL decreased in BA from coronal to apical from 2 to 4months; Coronal>Middle (P=0.047), Coronal>Apical (P<0.001) and Middle>Apical (P<0.001). This gradual decrease was not observed for BC; CoronalApical (P<0.001). Only the middle part showed significant bone contact after 2months. For MsL there was no statistically significant difference between surface or time indicating that improvement of osseointegration over time due to maturation of the graft was poor. The MsU did not show any difference between Osseotite and Nanotite for BIC and BA (P>0.05) but doubled both their BA and BIC (P<0.05) between 2 and 4months. CONCLUSIONS: Osseointegration in sinus-grafted bone mixed with BioOss was poor irrespective of healing time or nanotopographical surface modification. The apex of MsL showed minimal bone contact suggesting that the graft does not add to the loading capacity. Surface enhancement was not beneficial despite the enlarged surface area. Overloading, most critical coronally of an implant, increases risks for implant failure and jeopardizes bone healing especially under immediate loading conditions with high load.
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19.
  • Buser, Daniel, et al. (författare)
  • Modern implant dentistry based on osseointegration: 50 years of progress, current trends and open questions
  • 2017
  • Ingår i: Periodontology 2000. - : Wiley. - 0906-6713. ; 73:1, s. 7-21
  • Forskningsöversikt (refereegranskat)abstract
    • In the 1960s and 1970s, implant-supported prostheses based on subperiosteal or blade implants had a poor reputation because of questionable clinical outcomes and lack of scientific documentation. The change to a scientifically sound discipline was initiated by the two scientific pioneers of modern implant dentistry, Professor P. I. Brånemark from the University of Gothenburg in Sweden and Professor André Schroeder from the University of Bern in Switzerland. Together with their teams, and independently of each other, they laid the foundation for the most significant development and paradigm shift in dental medicine. The present volume of Periodontology 2000 celebrates 50 years of osseointegration. It reviews the progress of implant therapy over the past 50 years, including the basics of implant surgery required to achieve osseointegration on a predictable basis and evolving innovations. The development of bone-augmentation techniques, such as guided bone regeneration and sinus floor elevation, to correct local bone defects at potential implant sites has increased the indications for implant therapy. The paradigm shift to moderately rough implant surfaces resulted in faster and enhanced bone integration and led to improvements in various treatment protocols, such as immediate and early implant placement in postextraction sites, and made various loading protocols possible, including immediate and early implant loading. In the past 15 years, preoperative analysis and presurgical planning improved as a result of the introduction of three-dimensional imaging techniques. Hereby, cone-beam computed tomography offers better image quality with reduced radiation exposure, when compared with dental computed tomography. This opened the door for digital planning and surgical modifications. Over the last 50 years this evolution has facilitated tremendous progress in esthetic outcomes with implant-supported prostheses and improved patient-centered outcomes. This volume of Periodontology 2000 also discusses the current trends and open questions of implant dentistry, such as the potential of digital implant dentistry in the surgical and prosthetic field, the trend for an increasing average age of implant patients and the related adaptations of treatment protocols, and the second attempt to establish ceramic implants using, this time, zirconia as the implant material. Finally, some of the hottest controversies are discussed, such as recent suggestions on bone integration being a potential foreign-body reaction and the evidence-based appraisal of the peri-implantitis debate.
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20.
  • Christiaens, Veronique, et al. (författare)
  • Intraoral radiography lacks accuracy for the assessment of peri-implant bone level : a controlled clinical study
  • 2017
  • Ingår i: European Journal of Oral Implantology. - : Quintessence. - 1756-2406 .- 1756-2414. ; 10:4, s. 435-441
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: The aim of this study was to compare clinical and radiographic bone level assessments to intra-surgical bone level registration around implants with peri-implantitis and to identify the clinical variables rendering peri-implant bone level assessment accuracy. Materials and methods: The study sample included 50 implants with peri-implantitis in 23 patients. Registration methods included probing of the vertical distance between the implant/abutment interface and the bottom of the pocket (= VPD), intraoral radiography, bone sounding without flap elevation and intra-surgically assessed interproximal bone level. The latter was considered the true bone level (gold standard). Twenty clinicians evaluated all radiographs. Results: VPD and intraoral radiography resulted in a significant underestimation of the true bone level by 1.0 mm (95% CI: 0.495-1.585; P < 0.001) and 2.3 mm (95% CI: 1.650-2.980; P < 0.013) respectively. Bone sounding without flap elevation did not differ significantly from the true bone level (mean difference 0.2 mm; 95% CI: -0.775 - 0.335; P = 0.429). Duplicate magnification registration of 50 implants resulted in excellent intra- and inter-rater reliability (ICC intra <= 0.99; ICC inter = 0.964; P < 0.001). Radiographic underestimation was significantly affected by defect depth (P < 0.001). Variation among clinicians was substantial (mean underestimation range 1.1 mm to 3.8 mm); however, clinical experience had no impact on radiographic underestimation (P = 0.796). Conclusions: Bone sounding without flap elevation was the best predictor of peri-implant bone level, whereas intraoral radiography was the most inferior. Consequently, peri-implantitis may be under-diagnosed if examination is only based on radiographs.
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21.
  • Coli, Pier-Luigi, et al. (författare)
  • Reliability of periodontal diagnostic tools for monitoring peri-implant health and disease
  • 2017
  • Ingår i: Periodontology 2000. - : Wiley. - 0906-6713. ; 73:1, s. 203-217
  • Forskningsöversikt (refereegranskat)abstract
    • The prevalence, causes and consequences of crestal bone loss at dental implants are a matter of debate. In recent years, a high prevalence of peri-implant soft-tissue inflammation, associated with peri-implant bone loss, has been reported and the need for treatments similar to those offered for natural teeth affected by periodontitis has been proposed. This suggestion is based on the assumption that periodontal indices, such as probing pocket depth and bleeding on probing, are reliable indicators of the peri-implant tissue conditions and good predictors of future bone loss. However, based on a critical review of the literature in the present paper, it is concluded that periodontal indices are not reliable either for identifying peri-implant disease or for predicting future risk for peri-implant crestal bone loss and implant failure. The long-term experiences with dental implants, presented in the literature, indicate that the presence of bleeding on probing, probing pocket depths much larger than 4 mm and some bone loss seem to reflect, in most instances, normal conditions of well-functioning dental implants, bearing in mind that healing of dental implants is the result of a foreign body reaction with the formation of scar tissue. Therefore, the use of probing pocket depth and bleeding on probing assessments may lead to over-diagnosis and possibly to over-treatment of assumed biofilm-mediated peri-implantitis lesions. It is the opinion of the authors of this review that a treatment should only be initiated when a clinical problem is present based on patient's symptoms (discomfort, pain), the presence of swelling, redness and pus, and significant crestal bone loss over time (as verified with radiographs). The treatment should aim at resolving the infection, which could include removal of the implant.
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22.
  • Cooper, Lyndon F., et al. (författare)
  • Immediate Provisionalization of Dental Implants Placed in Healed Alveolar Ridges and Extraction Sockets : A 5-year Prospective Evaluation
  • 2014
  • Ingår i: International Journal of Oral & Maxillofacial Implants. - : Quintessence. - 0882-2786 .- 1942-4434. ; 29:3, s. 709-717
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: This 5-year prospective multicenter study compared implant survival and success, peri-implant health and soft tissue responses, crestal bone level stability, and complication rates following immediate loading of single OsseoSpeed implants placed in anterior maxillary healed ridges or extraction sockets. Materials and Methods: Individuals requiring anterior tooth replacement with single implants were treated and immediately provisionalized. Definitive all-ceramic crowns were placed at 12 weeks. Implant survival, bone levels, soft tissue levels, and peri-implant health were monitored for 5 years. Results: One hundred thirteen patients received implants in fresh sockets (55) and healed ridges (58). After 5 years, 45 and 49 patients remained for evaluation, respectively. During the first year, three implants failed in the extraction socket group (94.6% survival) and one implant failed in the healed ridge group (98.3% survival); this difference was not significant. No further implant failures were recorded. After 5 years, the interproximal crestal bone levels were located a mean of 0.43 +/- 0.63 mm and 0.38 +/- 0.62 mm from the reference points of implants in sockets and healed ridges (not a significant difference). In both groups, papillae increased over time and peri-implant mucosal zenith positions were stable from the time of definitive crown placement in sockets and healed ridges. Compared to flap surgery for implants in healed ridges, flapless surgery resulted in increased peri-implant mucosal tissue dimension (average, 0.78 +/- 1.34 mm vs 0.19 +/- 0.79 mm). Conclusion: After 5 years, the bone and soft tissue parameters that characterize implant success and contribute to dental implant esthetics were similar following the immediate provisionalization of implants in sockets and healed ridges. The overall tissue responses and reported implant survival support the immediate provisionalization of dental implants in situations involving healed ridges and, under ideal circumstances, extraction sockets.
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23.
  • Cosyn, Jan, et al. (författare)
  • A 5-year prospective study on single immediate implants in the aesthetic zone
  • 2016
  • Ingår i: Journal of Clinical Periodontology. - : Wiley-Blackwell. - 0303-6979 .- 1600-051X. ; 43:8, s. 702-709
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim There is a paucity of long-term data on soft tissue aesthetics of single immediate implants. The objective of this study was to evaluate the 5-year clinical and aesthetic outcome of this treatment concept. Materials and methods Twenty-two periodontally healthy patients (12 men, 10 women; mean age 50) with low risk for aesthetic complications (thick gingival biotype, intact buccal bone wall, both neighbouring teeth present) were consecutively treated with a single immediate implant in the aesthetic zone (15-25). Flapless surgery was performed and the gap between the implant and buccal bone wall was systematically filled with bovine bone particles. Implants were immediately non-functionally loaded with a screw-retained provisional crown. Cases demonstrating major alveolar process changes and/or advanced mid-facial recession (>1mm) at 3months were additionally treated with a connective tissue graft (CTG). Permanent crowns were installed at 6months. The clinical and aesthetic results at 5years were compared to those obtained at 1 year Results Seventeen patients attended the 5-year re-assessment, of whom five had been treated with a CTG for early aesthetic complications. There was one early implant failure and one complication after 1 year (porcelain chipping). Mean marginal bone loss was 0.12mm at 1 year and 0.19mm at 5years (p=0.595) with the moment of implant installation as baseline. Papilla height increased between 1 and 5years (p0.007), whereas mid-facial contour (p=0.005) and alveolar process deficiency (p=0.008) deteriorated. Mean mid-facial recession was on average 0.28mm (SD 0.48) at 1 year and 0.53mm (SD 0.53) at 5years (p=0.072) with the preoperative status as baseline. Three implants demonstrated advanced mid-facial recession (>1mm) at 5years. All three were in a central incisor position and none had been treated with a CTG. Thus, 8/17 implants showed aesthetic complications (five early and three late aesthetic complications). Implants in a lateral incisor position showed stable soft tissue levels. The pink aesthetic score was on average 12.15 at 1 year and 11.18 at 5years (p=0.030 Conclusion Single immediate implants showed high implant survival and limited marginal bone loss in the long term. However, mid-facial recession, mid-facial contour and alveolar process deficiency deteriorated after 1year. With an aesthetic complication rate of 8/17 in well-selected patients who had been treated by experienced clinicians, type I placement may not be recommended for daily practice
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24.
  • Cosyn, Jan, et al. (författare)
  • A double-blind randomized placebo-controlled study on the clinical and microbial effects of an essential oil mouth rinse used by patients in supportive periodontal care
  • 2013
  • Ingår i: International Journal of Dental Hygiene. - : John Wiley & Sons. - 1601-5029 .- 1601-5037. ; 11:1, s. 53-61
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim This 3-month double-blind randomized placebo-controlled study evaluated the clinical and microbial effects of an essential oil mouth rinse used as an adjunct to mechanical plaque control by patients in supportive periodontal care. Material and methods Fifty patients were randomly allocated to an essential oil group (Listerine® Coolmint; Johnson & Johnson, New Brunswick, NJ, USA) or placebo group to rinse twice per day as an adjunct to mechanical plaque control. At baseline and after 3 months, plaque index (PI), gingivitis index (GI), probing pocket depth, bleeding on probing (BoP) and clinical attachment level were registered. Subgingival plaque samples were collected for the detection and quantification of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Micromonas micros, Prevotella intermedia, Fusobacterium genus and Streptococcus mutans by means of real-time PCR (qPCR). Patient's compliance, satisfaction and side effects were registered. Results Twenty-three patients in the essential oil group (mean age: 57) and 21 in the placebo group (mean age: 55) with acceptable oral hygiene at intake (mean PI <1.5 on a scale of 5) adhered to the study protocol. Gingivitis index, PI and BoP significantly reduced over time (P ≤ 0.029); however, between group analyses revealed no significant differences. There was no significant change over time neither in detection frequency nor load for any of the microbiota. Daily rinsing with an essential oil rinse was found safe and perceived beneficial by the patients. Conclusion Patients in supportive periodontal care who are fairly compliant with oral hygiene may not benefit from additional mouth rinsing using an essential oil solution.
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25.
  • Cosyn, Jan, et al. (författare)
  • Disparity in embrasure fill and papilla height between tooth- and implant-borne fixed restorations in the anterior maxilla : a cross-sectional study
  • 2013
  • Ingår i: Journal of Clinical Periodontology. - : John Wiley & Sons. - 0303-6979 .- 1600-051X. ; 40:7, s. 728-733
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose The objective of the present study was to compare inter-proximal fill and papilla height between different embrasures. Material & Methods One hundred and fifty non-smoking consecutive patients (mean age 54, range 32–73; 63 males and 87 females) without periodontal disease were selected in a multidisciplinary practice during regular supportive care. All had been treated for multiple tooth loss in the anterior maxilla at least 1 year earlier by means of a fixed restoration on teeth (n = 50) or implants (n = 100) using straightforward procedures (without hard and/or soft tissue augmentation). Embrasure fill was assessed by means of Jemt's papilla index and papilla height was registered following local anaesthesia by means of bone sounding by one clinician. Results Tooth-pontic and tooth-implant embrasures demonstrated comparable inter-proximal fill and papilla height (≥58% Jemt's score 3; mean papilla height ≥4.1 mm). Between missing teeth, embrasure fill and papilla height were lower regardless of the embrasure type. The implant-implant and implant-pontic embrasure demonstrated comparable outcome (≤42% Jemt's score 3; mean papilla height ≤ 3.3 mm; p ≥ 0.416), which was significantly poorer when compared to the pontic-pontic embrasure (82% Jemt's score 3; mean papilla height 3.7 mm; p ≤ 0.019). Overall, papilla index and papilla height demonstrated a weak correlation (Spearman's correlation coefficient: 0.198; p = 0.002). Conclusions The re-establishment of a papilla is difficult when there is no tooth involved. In that scenario a short papilla should be expected and implant-borne restorations demonstrate the poorest outcome. Moreover, an implant with a pontic may not perform better than adjacent implants.
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26.
  • Cosyn, Jan, et al. (författare)
  • Minimally Invasive Single Implant Treatment (MISIT) based on ridge preservation and contour augmentation in patients with a high aesthetic risk profile : one-year results
  • 2015
  • Ingår i: Journal of Clinical Periodontology. - : John Wiley & Sons. - 0303-6979 .- 1600-051X. ; 42:4, s. 398-405
  • Tidskriftsartikel (refereegranskat)abstract
    • AimTo evaluate the 1-year outcome of Minimally Invasive Single Implant Treatment (M.I.S.I.T.) based on ridge preservation and contour augmentation in patients with a high aesthetic risk profile. Materials and MethodsPeriodontally healthy non-smoking patients with a failing tooth in the anterior maxilla (15-25) were selected. All were in need of a single implant and demonstrated high risk for aesthetic complications given mid-facial recession at the failing tooth and/or a buccal bone dehiscence and/or a thin-scalloped gingival biotype. Patients without mid-facial recession (NRG) received flapless tooth extraction and ridge preservation using a collagen-enriched bovine-derived xenograft, flapless installation of a bone condensing implant with variable-thread design (4-6months later), a provisional screw-retained crown and connective tissue graft (CTG) inserted in the buccal mucosa (3months later) and a permanent crown (3months later). Patients with mid-facial recession (RG) were treated similarly, yet they received a CTG at the time of ridge preservation. All patients were treated by an experienced periodontist using a microsurgical approach. Primary outcome variables included papillary and mid-facial recession. Clinical parameters, pink (PES) and white aesthetic score (WES) were considered secondary outcome variables. ResultsFifty patients (25 females, 25 males; mean age 39, range 19-81; 42 in NRG and 8 in RG) met the selection criteria and consented to the treatment. Forty-seven could be examined at 12months and all implants survived. Mean bone loss amounted to 0.48mm (range 0.00-1.80) at 12months. Papillary recession was minimal in both groups at 12months (mean0.3mm), as was mid-facial recession in the NRG (mean 0.1mm). Twelve patients in the NRG even demonstrated coronal migration of the mucosal margin following CTG and needed adaptation of the provisional crown to induce soft tissue retraction. Due to CTG at the time of ridge preservation in the RG, mid-facial soft tissue gain amounted to 0.9mm at 12months, hereby eliminating 2/3rd of the initial recession. PES and WES were favourable pointing to 10.9/14 and 8.2/10 respectively. ConclusionThis short-term prospective study offers a proof of principle of M.I.S.I.T. in patients with a high aesthetic risk profile.
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27.
  • Cosyn, Jan, et al. (författare)
  • Predictors of Alveolar Process Remodeling Following Ridge Preservation in High-Risk Patients
  • 2016
  • Ingår i: Clinical Implant Dentistry and Related Research. - : Wiley-Blackwell. - 1523-0899 .- 1708-8208. ; 18:2, s. 226-233
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose(1) To clinically evaluate horizontal remodeling of the alveolar process (hard and soft tissues) following ridge preservation in high-risk patients and (2) to identify predictors of such remodeling. Materials and MethodsPeriodontally healthy nonsmoking patients with a failing tooth in the anterior maxilla (15-25) were selected for a prospective case series. All were in need of a single implant and demonstrated high risk for aesthetic complications given an incomplete buccal bone wall and/or thin-scalloped gingival biotype. Following flapless tooth extraction, ridge preservation was performed using one or more collagen-enriched, bovine-derived block grafts (Geistlich Bio-Oss (R) Collagen (R) 100mg, Geistlich Pharma AG, Wolhusen, Switzerland) without the additional use of membranes or soft tissue grafts. The change in buccopalatal dimension of the alveolar process between baseline (prior to tooth extraction) and 4 months was assessed on the basis of superimposed occlusal slides. Regression analysis was performed to identify predictors of alveolar process remodeling ResultsForty-two patients (21 females, 21 males; mean age 38) met the selection criteria and consented to the treatment. Mean alveolar process remodeling was 14% (SD 7, range 4-30) with minimal remodeling (10%) in 16 patients (38%) and advanced remodeling (>20%) in 10 patients (24%). A single implant could be installed in all subjects without additional guided bone regeneration. Connective tissue grafting was performed later on in the treatment for aesthetic purposes, hereby compensating for tissue loss at the buccal aspect. Predictors of alveolar process remodeling were tooth location (central incisors and cuspids>laterals incisors and premolars), tooth abscess (p=.025), and buccal bone loss (p=.035 ConclusionAlveolar process remodeling seems inevitable yet acceptable following ridge preservation in high-risk patients. Proper case selection may reduce the incidence of advanced remodeling
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28.
  • Cosyn, Jan, et al. (författare)
  • Predictors of inter-proximal and midfacial recession following single implant treatment in the anterior maxilla : a multivariate analysis
  • 2012
  • Ingår i: Journal of Clinical Periodontology. - : John Wiley & Sons. - 0303-6979 .- 1600-051X. ; 39:9, s. 895-903
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose A number of factors have been associated with soft tissue recession following single implant treatment. However, given the cross-sectional design of most of these studies and crude associations based on univariate analyses, such factors may only be considered risk indicators. The objective of the present retrospective cohort study using multivariate analyses was to identify predictors of recession. Material and Methods Patients who had been treated by two periodontists and two prosthodontists in 2006 and 2007 for a single implant in the anterior maxilla were re-examined in 2009 and their records were scrutinized. Subjects treated via flap surgery with and without ridge re-contouring were considered. Outcome variables were inter-proximal and midfacial recession. Explanatory variables included demographic data, the surgical approach and a number of local factors that were evaluated on radiographs taken pre-operatively or at permanent crown installation (baseline). Results Data pertaining to 97/115 (60 females, 37 males; mean age 51, SD 13, range 23–80) patients were available for evaluation. Significant bone loss was observed between baseline and re-examination at the implant surface (0.2–0.3 mm, p < 0.001) and tooth surface (0.3–0.5 mm, p < 0.001). Surgery with ridge re-contouring demonstrated 0.2 mm additional bone loss at the distal tooth surface when compared to surgery without ridge re-contouring (p = 0.034). This could be explained by a disparity in possible papilla-opening procedures (three versus one or two). As a result, regression analyses identified surgery with ridge re-contouring as a predictor of inter-proximal recession (OR ≥ 3.4). Pre-operative bone level at the tooth surface was another predictor of inter-proximal recession (OR ≥ 2.1). Recession of the distal papilla was also affected by a missing contact point (OR = 221.9), the implant-to-tooth distance (OR = 0.3) and the distance of the bone peak to the contact point (OR = 2.9). Midfacial recession was only associated with a buccal shoulder position (OR = 17.2). Conclusions To optimize soft tissue levels around single implants, clinicians should limit papilla-opening procedures and pay utmost attention to a correct implant and contact point positioning.
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29.
  • Cosyn, Jan, et al. (författare)
  • Regenerative periodontal therapy of infrabony defects using minimally invasive surgery and a collagen-enriched bovine-derived xenograft : a 1-year prospective study on clinical and aesthetic outcome
  • 2012
  • Ingår i: Journal of Clinical Periodontology. - : Wiley-Blackwell. - 0303-6979 .- 1600-051X. ; 39:10, s. 979-986
  • Tidskriftsartikel (refereegranskat)abstract
    • AIM: To evaluate the clinical and aesthetic outcome of regenerative periodontal therapy (RPT) using minimally invasive surgery and a collagen-enriched bovine-derived xenograft (1); to identify risk factors for failure (clinical attachment level (CAL) gain ≤ 1 mm) and advanced gingival recession (REC) increase (>1 mm) (2). MATERIAL AND METHODS: Ninety-five non-smoking patients, with ≤ 25% full-mouth plaque and bleeding presenting ≥ 6 months after initial periodontal therapy with ≥ 1 isolated inter-dental infrabony defect were recruited. Patients were consecutively treated by the same clinician using minimally invasive surgery and a collagen-enriched bovine-derived xenograft. Clinical, radiographic and aesthetic data were collected before surgery and up to 1 year. Multivariate analyses were used to identify risk factors for failure and advanced REC increase. RESULTS: Eighty-four patients (39 men, 45 women; mean age 53) complied and demonstrated mean probing depth (PD) of 7.8 mm, CAL of 10.0 mm and defect depth of 5.2 mm before surgery. At 1 year, postsurgery mean PD reduction was 3.5 mm (range 0.0-8.0), CAL gain was 3.1 mm (range 0.0-7.0) and radiographic defect fill was 53% (range 0-100). Forty-nine percentage showed ≥ 4 mm CAL gain, whereas 15% were considered failures. Mean inter-dental and midfacial REC increase was 0.3 mm (range-2.0-2.0) and 0.5 mm (range-1.5-2.0) respectively. Midfacial REC increase and contour deterioration contributed most to a small, yet significant reduction in the Pink Esthetic Score from 10.06 to 9.42 (p = 0.002). Risk factors for failure included defects with a non-supportive anatomy (OR: ≥ 10.4), plaque (OR: 14.7) and complication(s) (OR: 12.0). Risk factors for advanced midfacial REC increase included defects with a non-supportive anatomy (OR: 58.8) and a thin-scalloped gingival biotype (OR: 76.9). CONCLUSIONS: RPT using minimally invasive surgery and a collagen-enriched bovine-derived xenograft demonstrated favourable clinical outcome after 1 year, even though soft tissue aesthetics could not be fully preserved. Defects with a non-supporting anatomy may be at risk for failure and advanced midfacial recession.
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30.
  • Cosyn, Jan, et al. (författare)
  • The peri-implant sulcus compared with internal implant and suprastructure components : a microbiological analysis.
  • 2011
  • Ingår i: Clinical Implant Dentistry and Related Research. - 1523-0899 .- 1708-8208. ; 13:4, s. 286-295
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: A recent in vivo study has shown considerable contamination of internal implant and suprastructure components with great biodiversity, indicating bacterial leakage along the implant-abutment interface, abutment-prosthesis interface, and restorative margins. The goal of the present study was to compare microbiologically the peri-implant sulcus to these internal components on implants with no clinical signs of peri-implantitis and in function for many years. Checkerboard DNA-DNA hybridization was used to identify and quantify 40 species.MATERIAL AND METHODS: Fifty-eight turned titanium Brånemark implants in eight systemically healthy patients (seven women, one man) under regular supportive care were examined. All implants had been placed in the maxilla and loaded with a screw-retained full-arch bridge for an average of 9.6 years. Gingival fluid samples were collected from the deepest sulcus per implant for microbiological analysis. As all fixed restorations were removed, the cotton pellet enclosed in the intra-coronal compartment and the abutment screw were retrieved and microbiologically evaluated.RESULTS: The pellet enclosed in the suprastructure was very similar to the peri-implant sulcus in terms of bacterial detection frequencies and levels for practically all the species included in the panel. Yet, there was virtually no microbial link between these compartments. When comparing the abutment screw to the peri-implant sulcus, the majority of the species were less frequently found, and in lower numbers at the former. However, a relevant link in counts for a lot of bacteria was described between these compartments. Even though all implants in the present study showed no clinical signs of peri-implantitis, the high prevalence of numerous species associated with pathology was striking.CONCLUSIONS: Intra-coronal compartments of screw-retained fixed restorations were heavily contaminated. The restorative margin may have been the principal pathway for bacterial leakage. Contamination of abutment screws most likely occurred from the peri-implant sulcus via the implant-abutment interface and abutment-prosthesis interface.
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31.
  • De Bruyn, Hugo, et al. (författare)
  • Implant surface roughness and patient factors on long-term peri-implant bone loss
  • 2017
  • Ingår i: Periodontology 2000. - : John Wiley & Sons. - 0906-6713 .- 1600-0757. ; 73:1, s. 218-227
  • Forskningsöversikt (refereegranskat)abstract
    • Dental implant placement is a common treatment procedure in current dental practice. High implant survival rates as well as limited peri-implant bone loss has been achieved over the past decades due to continuous modifications of implant design and surface topography. Since the turn of the millennium, implant surface modifications have focused on stronger and faster bone healing. This has not only yielded higher implant survival rates but also allowed modifications in surgical as well as prosthetic treatment protocols such as immediate implant placement and immediate loading. Stable crestal bone levels have been considered a key factor in implant success because it is paramount for long-term survival, aesthetics as well as peri-implant health. Especially during the past decade, clinicians and researchers have paid much attention to peri-implant health and more specifically to the incidence of bone loss. This could furthermore increase the risk for peri-implantitis, the latter often diagnosed as ongoing bone loss and pocket formation beyond the normal biological range in the presence of purulence or bleeding on probing. Information on the effect of surface topography on bone loss or peri-implantitis, a disease process that is to be evaluated in the long-term, is also scarce. Therefore, the current narrative review discusses whether long-term peri-implant bone loss beyond physiological bone adaptation is affected by the surface roughness of dental implants. Based on comparative studies, evaluating implants with comparable design but different surface roughness, it can be concluded that average peri-implant bone loss around the moderately rough and minimally rough surfaces is less than around rough surfaces. However, due to the multifactorial cause for bone loss the clinical impact of surface roughness alone on bone loss and peri-implantitis risk seems rather limited and of minimal clinical importance. Furthermore, there is growing evidence that certain patient factors, such as a history of periodontal disease and smoking, lead to more peri-implant bone loss.
  •  
32.
  • De Bruyn, Hugo, et al. (författare)
  • Radiographic evaluation of modern oral implants with emphasis on crestal bone level and relevance to peri-implant health.
  • 2013
  • Ingår i: Periodontology 2000. - : Wiley. - 1600-0757 .- 0906-6713. ; 62:1, s. 256-70
  • Tidskriftsartikel (refereegranskat)abstract
    • Implant stability and maintenance of stable crestal bone level are prerequisites for the successful long-term function of oral implants, and continuous crestal bone loss constitutes a threat to the longevity of implant-supported prosthetic constructions. The prevalence/incidence and reasons for crestal bone loss are under debate. Some authors regard infection (i.e. peri-implantitis) as the cause for virtually all bone loss, while others see crestal bone loss as an unavoidable phenomenon following surgery and implant loading. Irrespective of the cause of continuous crestal bone loss, correct usage and scientifically sound interpretation of radiographs are of utmost importance for evaluation of oral implants. The periapical radiographic technique is currently the preferred method for evaluating implant health based on bone loss, and digital radiographs allow easy standardization of the image contrast. It is suggested that baseline radiographs should be taken at the time the transmucosal part pierces the mucosal tissues and annually thereafter. The number of unreadable radiographs should be presented in scientific publications to give insights into the quality of the radiographic examination. It is suggested that not only mean values, but also the range of bone levels, should be presented to describe the proportion of implants that show continuous crestal bone loss. In the absence of other clinical symptoms, bleeding on probing around implants seems to be a weak indicator of ongoing or future loss of crestal bone. According to recent longitudinal studies on modern implant surfaces peri-implantitis defined as 'infection with suppuration associated with clinically significant progressing crestal bone loss' occurs with a prevalence of less than 5 % in implants with 10 years in function.
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33.
  • De Bruyn, Hugo, et al. (författare)
  • The current use of patient-centered/reported outcomes in implant dentistry : a systematic review
  • 2015
  • Ingår i: Clinical Oral Implants Research. - : John Wiley & Sons. - 0905-7161 .- 1600-0501. ; 26:S11, s. 45-56
  • Forskningsöversikt (refereegranskat)abstract
    • Aim: To provide an update on the use of Patient-Reported Outcome Measures (PROMs) in the field of implant dentistry (1); to compare PROMs for prostheses supported by one or more implants to alternative treatment options or a healthy dentition (2). Materials and methods: The dental literature was searched on PubMed until December 31, 2014, using a general search algorithm. An overall quantitative analysis was performed, and a qualitative appraisal was made on the output of the last 6 years. Per type of edentulism and prosthetic treatment, the general search algorithm was refined in order to select controlled studies comparing PROMs for prostheses supported by one or more implants to alternative treatment options or a healthy dentition. Results: With nearly half of the output (300 of 635) published in the last 6 years, there is a growing interest in PROMs by the scientific community. When scrutinizing the 300 most recent publications, only 84 controlled studies could be identified among which 38 RCTs and 31 cohort studies. An "ad hoc" approach is commonly employed using non-standardized questions and different scoring methods, which may compromise validity and reliability. Overall, 39 eligible papers related to fully edentulous patients treated with an implant overdenture (IOD) and 9 to fully edentulous patients treated with a fixed implant prosthesis (FIP). There is plenty of evidence from well-controlled studies showing that fully edentulous patients in the mandible experience higher satisfaction with an IOD when compared to a conventional denture (CD). This may not hold true for fully edentulous patients in the maxilla. In general, fully edentulous patients seem to opt for a fixed or removable rehabilitation on implants for specific reasons. Data pertaining to partially edentulous patients were limited (FIP: n = 6; single implants: n = 16). In these patients, the timing of implant placement does not seem to affect patient satisfaction. Patients seem to prefer straightforward implant surgery over complex surgery that includes bone grafting. Conclusion: There is an urgent need for standardized reporting of PROMs in the field of implant dentistry. Fully edentulous patients in the mandible experience higher satisfaction with an IOD when compared to a CD. All other types of prostheses have been underexposed to research.
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34.
  • De Bruyn, Hugo, et al. (författare)
  • Three-years clinical outcome of immediate provisionalization of single Osseospeed™ implants in extraction sockets and healed ridges
  • 2013
  • Ingår i: Clinical Oral Implants Research. - : John Wiley & Sons. - 0905-7161 .- 1600-0501. ; 24:2, s. 217-223
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim The purpose of this prospective multicenter clinical study was to compare 3 years implant survival, bone and soft tissue changes following immediate loading using single Osseospeed™ implants (Astra Tech AB, Mölndal, Sweden) installed in healed ridges or extraction sockets. Material and methods Implants were provisionally restored the day of surgery using cemented acrylic crowns out of full occlusion. The provisional crowns were replaced after 12 weeks by full-ceramic crowns. Implant survival, bone levels, soft tissue levels and peri-implant health were monitored up to 3 years. Results 55 patients (22 men, 33 women; mean age 45) had the implant installed in extraction sockets and 58 patients (25 men, 33 women; mean age 42) received conventional implant treatment in healed ridges. Three implants failed in the extraction group and one implant failed in the healed group, all failures occurred before the final crown placement. No further losses occurred during 3 years, giving a statistically comparable survival rate of 94.6% and 98.3%, respectively. The total bone loss after 3 years, compared to implant placement was 0.4 mm (SD 1.5) in healed sites, whilst the immediate sites showed a bone gain of 1.6 mm (SD 2.4) due to bone fill in the alveolus. Papillae retracted with 0.3 and 0.0 mm in the period of provisionalization, but grew back after final crown was placed with 0.3 and 0.5 mm in extraction and healed sites respectively after 3 years. Plaque and inflammation scores were very low throughout the study time, irrespective of treatment modality. Conclusions Immediate implants restored at the day of surgery show comparable risk for implant failure, bone loss and midfacial soft tissue recession compared to conventionally installed implants. The 3-years results suggest both hard and soft tissue stability.
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35.
  • Dierens, M., et al. (författare)
  • Cost estimation of single-implant treatment in the periodontally healthy patient after 16-22 years of follow-up
  • 2015
  • Ingår i: Clinical Oral Implants Research. - : John Wiley & Sons. - 0905-7161 .- 1600-0501. ; 26:11, s. 1288-1296
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Costs for single-implant treatment are mostly described for the initial treatment. Information on the additional cost related to aftercare is scarce. Objective: To make an estimation of complication costs of single implants in periodontally healthy patients after 16-22years and to compare costs for various prosthetic designs. Materials and methods: Patients with a single implant were recalled for a clinical examination and file investigation. Prosthetic designs included single-tooth (ST) and CeraOne (CO) abutments supporting a porcelain-fused-to-metal (PFM), all-ceramic (CER), or gold-acrylic (ACR) crown. Costs related to failures or technical, biologic, and aesthetic complications were retrieved from patient's records. Total and yearly additional complication costs were calculated as a percentage relative to the initial cost. Chair time needed to solve the complication was recorded and prosthetic designs were compared by Kruskal-Wallis tests. Results: Fifty patients with 59 surviving implants were clinically investigated. Additional complication costs after a mean follow-up of 18.5years amounted to 23% (range 0-110%) of the initial treatment cost. In total, 39% of implants presented with no costs, whereas 22% and 8% encountered additional costs over 50% and 75%, respectively. In 2%, the complication costs exceeded the initial cost. The mean yearly additional cost was 1.2% (range 0-6%) and mean complication time per implant was 67min (range 0-345min). Differences between prosthetic designs (CO, ST-PFM, ST-ACR) were statistically significant for total cost (P=0.011), yearly cost (P=0.023), and time (P=0.023). Pairwise comparison revealed significant lower costs for CO compared with ST-ACR reconstructions. Conclusion: Patients should be informed about additional costs related to complications with single implants. The mean additional cost spent on complications was almost one-quarter of the initial treatment price. A majority of implants presented with lower additional costs, whereas the highest complication costs were related to a smaller group with 22% of the implants needing more than half of the initial cost for complication management. Expenses were significantly different for various prosthetic designs.
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36.
  • Dierens, Melissa, et al. (författare)
  • Long-Term Follow-Up of Turned Single Implants Placed in Periodontally Healthy Patients After 16 to 22 Years : Microbiologic Outcome
  • 2013
  • Ingår i: Journal of Periodontology. - : Amer Acad Periodontology. - 0022-3492 .- 1943-3670. ; 84:7, s. 880-894
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Survival rates in implant dentistry today are high, although late failures do occur for many reasons, including peri-implant infections. The primary objective of this study is to investigate microbiota around single turned implants after 16 to 22 years. Secondary objectives are to compare teeth and implants and to correlate microbiologic, radiographic, and clinical parameters. Methods: A total of 46 patients with single implants were invited for a clinical examination. Clinical datawere collected from implants and contralateral natural teeth. Radiographic bone level was measured around implants. Microbiologic samples were taken from implants, contralateral teeth, and the deepest pocket per quadrant. Samples were analyzed with DNA-DNA hybridization including 40 species. Statistical analysis was performed using Wilcoxon signed-rank tests, McNemar tests, and Spearman correlation coefficients with a 0.05 significance level. Results: Mean follow-up was 18.5 years (range 16 to 22 years). Tannerella forsythia (1.5 x 10(5)) and Veillonella parvula (1.02 x 10(5)) showed the highest concentrations around implants and teeth, respectively. Porphyromonas gingivalis, Prevotella intermedia, and T. forsythia were significantly more present around implants than teeth. Mean counts were significantly higher around implants than teeth for Parvimonas micra, P. gingivalis, P. intermedia, T. forsythia, and Treponema denticola. Total DNA count was correlated to interproximal bleeding index (r = 0.409) and interproximal probing depth (r = 0.307). No correlations were present with plaque index or radiographic bone level. Conclusions: In the present study, bacterial counts around single implants in periodontally healthy patients are rather low. Although pathogenic bacteria are present, some in higher numbers around implants than teeth (five of 40), the majority of implants present with healthy peri-implant tissues without progressive bone loss.
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37.
  • Dierens, M., et al. (författare)
  • Long-term follow-up of turned single implants placed in periodontally healthy patients after 16–22 years : radiographic and peri-implant outcome
  • 2012
  • Ingår i: Clinical Oral Implants Research. - : John Wiley & Sons. - 0905-7161 .- 1600-0501. ; 23:2, s. 197-204
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: Retrospectively evaluate the survival, radiographic and peri-implant outcome of single turned Brånemark™ implants after at least 16 years. Materials and methods: From 134 patients (C-group), 101 could be contacted concerning implant survival and 50 (59 remaining implants) were clinically examined (I-group). Marginal bone level was radiographically measured from the implant–abutment junction at baseline (=within 6 months after abutment connection) and 1–4, 5–8 and 16–22 years post-operatively. Probing depth, gingival and plaque index were measured. Marginal bone-level changes were analyzed using Friedman's and Wilcoxon's signed ranks tests. Spearman's correlations between radiographic and clinical parameters were calculated. Results: In the C-group, 13 out of 166 implants in 11 out of 134 patients failed (CSR=91.5%). In the I-group (28 males–22 females; mean age 23.9 years at baseline; range 14–57), the mean follow-up was 18.4 years (range 16–22). The mean bone level was 1.7±0.88 mm (range −0.8 to 5) after 16–22 years. Changes in the mean marginal bone level were statistically significant between baseline and the second measuring interval (1–4 years). Thereafter, no significant differences could be demonstrated. The mean interproximal probing depth, gingival and plaque indices were 3.9±1.27 mm, 1.2±0.81 and 0.2±0.48, respectively. Probing depth was moderately correlated with gingival inflammation (r=0.6; P<0.001) but not with bone level (P>0.05). 81.4% of the implants had a bone level ≤2nd thread and 91.5% had a probing depth ≤5 mm. 76.3% had both bone level ≤2nd thread and probing depth ≤5 mm. Conclusions and clinical implications: The single turned Brånemark™ implant is a predictable solution with high clinical survival and success rates. In general, a steady-state bone level can be expected over decades, with minimal signs of peri-implant disease. A minority (5%), however, presents with progressive bone loss.
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38.
  • Dierens, Melissa, et al. (författare)
  • Prosthetic Survival and Complication Rate of Single Implant Treatment in the Periodontally Healthy Patient after 16 to 22 Years of Follow-Up
  • 2016
  • Ingår i: Clinical Implant Dentistry and Related Research. - : John Wiley & Sons. - 1523-0899 .- 1708-8208. ; 18:1, s. 117-128
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Single implants were introduced in the 1980s, but long-term follow-up is scarce. Purpose The study aims to retrospectively investigate the prosthetic survival and complication rates of single implants in periodontally healthy patients after 16-22 years, and to evaluate the influence of different prosthetic procedures Materials and Methods Patients with a single implant were recalled for clinical examination. Prosthetic procedures included single-tooth (ST) and CeraOne (CO) abutments supporting a porcelain-fused-to-metal (PFM), all-ceramic (CER), or gold-acrylic (ACR) crown. Prosthetic survival, success, and occurrence of biological, technical, and aesthetic complications were obtained. Procedures were compared by log-rank tests Results Fifty patients attended the examination. All implants were functional; however, 15% of abutments and 27% of crowns had been renewed. Replacements (1/4) were related to technical issues whereas the main cause was aesthetics. The abutment cumulative survival rate (CSR) differed significantly between ST-PFM (74%), ST-ACR (0%), and CO reconstructions (97%). The crown CSR was significantly lower for ST-ACR crowns (0%) compared with ST-PFM (68%) and CO (81%). Thirty-nine percent of implants remained complication free throughout the mean 18.5 years. Complications (1/3) required component replacement, and 53% occurred within 5 years after surgery Conclusion Prosthetic survival rates of single implants are encouraging after 16 to 22 years. However, 66% of the patients encountered at least one complication during follow-up.
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39.
  • Doornewaard, Ron, et al. (författare)
  • Long-Term Effect of Surface Roughness and Patients' Factors on Crestal Bone Loss at Dental Implants : A Systematic Review and Meta-Analysis
  • 2017
  • Ingår i: Clinical Implant Dentistry and Related Research. - : John Wiley & Sons. - 1523-0899 .- 1708-8208. ; 19:2, s. 372-399
  • Forskningsöversikt (refereegranskat)abstract
    • Publications from 2011 to 2015 were selected to evaluate effect of implant surface roughness on long-term bone loss as surrogate for peri-implantitis risk. 87 out of 2,566 papers reported the mean bone loss after at least 5 years of function. Estimation of the proportion of implants with bone loss above 1, 2, and 3 mm as well as analysis the effect of implant surface roughness, smoking, and history of periodontitis was performed. By means of the provided statistical information of bone loss (mean and standard deviation) the prevalence of implants with bone loss ranging from 1 to 3 mm was estimated. The bone loss was used as a surrogate parameter for peri-implantitis given the fact that peri-implantitis prevalence was not reported in most studies or when reported, the diagnostic criteria were unclear or of dubious quality. The outcome of this review suggests that peri-implant bone loss around minimally rough implant systems was statistically significant less in comparison to the moderately rough and rough implant systems. No statistically significant difference was observed between moderately rough and rough implant systems. The studies that compared implants with comparable design and different surface roughness, showed less average peri-implant bone loss around the less rough surfaces in the meta-analysis. However, due to the heterogeneity of the papers and the multifactorial cause for bone loss, the impact of surface roughness alone seems rather limited and of minimal clinical importance. Irrespective of surface topography or implant brand, the average weighted implant survival rate was 97.3% after 5 years or more of loading. If considering 3 mm bone loss after at least 5 years to represent the presence of peri-implantitis, less than 5% of the implants were affected. The meta-analysis indicated that periodontal history and smoking habits yielded more bone loss.
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40.
  • Glibert, Maarten, et al. (författare)
  • Clinical and Radiographic Comparison between Platform-Shifted and Nonplatform-Shifted Implant : A One-Year Prospective Study
  • 2016
  • Ingår i: Clinical Implant Dentistry and Related Research. - : John Wiley & Sons. - 1523-0899 .- 1708-8208. ; 18:1, s. 129-137
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Developments in implant hardware and biologic understanding improved treatment predictability in terms of implant survival. Current research focuses on accelerated loading protocols and crestal bone preservation. Purpose This prospective, monocenter study analyzed the clinical and radiographic outcome of a novel parallel-walled implant, with and without platform shift Materials and Methods Forty-eight consecutively treated patients (30 women, 18 men) with crowns/bridges supported by 115 implants were included. Eighty-three percent of implants were nonocclusal, immediately loaded, and 17% were subjected to one-stage surgery and delayed loading after 10 weeks; 39.1% were of diameter 5.0mm, enabling platform shifting with a 4.0mm-wide prosthetic component; 60.9% were of diameter 4.0mm with a 4.0mm component. Radiographic crestal bone levels were assessed at baseline and 1 year. A multivariate statistical analysis was performed to determine factors affecting crestal bone loss after 1 year Results All implants survived and mean marginal bone loss was 0.73mm (SD: 0.13; range: -0.60 to 5.0mm). There was a statistically significant difference between platform-shifted (0.63mm; SD: 0.18) and nonplatform-shifted (1.02mm; SD: 0.14) implants. Implants in abundant bone volume lost significant less crestal bone (0.45mm; SD: 0.14) compared with implants in small volume (1.20mm; SD: 0.21). Implant diameter, loading time, anatomical position, smoking, and bone quality did not affect crestal bone loss Conclusion After 1 year of loading, both implant-prosthetic features yield a high survival and limited crestal bone loss. Crestal bone loss is minimized using platform-shifted implants placed in sufficiently voluminous bone. To limit the crestal bone loss, an adopted implant diameter with platform shifting should be considered.
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41.
  •  
42.
  • Glibert, Maarten, et al. (författare)
  • The Influence of Initial Hard and Soft Tissue Dimensions on Initial Crestal Bone Loss of Immediately Loaded Dental Implants
  • 2018
  • Ingår i: The international journal of periodontics & restorative dentistry. - : Quintessence Publishing Co. Inc.. - 0198-7569 .- 1945-3388. ; 38:6, s. 873-878
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this case-control study was to evaluate the influence of soft tissue thickness at implant placement (thin [< 3 mm] vs thick [>= 3 mm]) and bone volume (abundant vs limited) on initial crestal bone remodeling of immediate postextraction and delayed (healed site) implants in immediate loading situations. A total of 67 patients with 133 implants could be evaluated, of which 77 were placed immediately after extraction and 56 in healed ridges. If sufficient bone volume is present and primary stability is achieved, immediate loading of the implant yields good clinical and radiographic outcomes, yet implants placed in healed ridges with thin soft tissues are more prone to initial crestal bone loss.
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43.
  • Jansson, Henrik, et al. (författare)
  • Clinical consequences of IL-1 genotype on early implant failures in patients under periodontal maintenance
  • 2005
  • Ingår i: Clinical Implant Dentistry and Related Research. - : BC Decker Inc. - 1523-0899 .- 1708-8208. ; 7:1, s. 51-59
  • Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
    • BACKGROUND: Implant failure and biologic complications such as periimplantitis are not completely avoidable. Are there any genetic and microbiologic parameters that could be used to identify patients at risk for implant failure, preferably prior to treatment? This would result in improvement of the diagnostics, treatment decision, and risk assessment. PURPOSE: The aims of this retrospective study were to describe (1) the absolute failure rate of Branemark System implants (Nobel Biocare AB, Goteborg, Sweden) consecutively installed over a 10-year period in partially edentulous patients treated for periodontal disease prior to implant treatment and under regular professional maintenance, (2) the rate of interleukin-1 (IL-1) polymorphism in those patients who experienced at least one implant failure during the first year of function, and (3) the prevalence of periodontal pathogens in dental and periimplant sites with and without signs of inflammation. MATERIAL AND METHODS: Of 766 patients, 81 encountered at least one implant failure; 22 patients were clinically examined and were tested genetically for IL-1 genotypes. The presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella ni-grescens was analyzed. RESULTS: The absolute implant survival rate for the whole population was 95.32%; 10.57% of the patients encountered an implant loss. Implant loss in the examined group (n = 22) was 32 of 106 (30.1%); 10 (45%) of the 22 patients were smokers, and 6 (27%) of the 22 patients were IL-1 genotype positive. Patients positive for IL-1 genotype were not more prone to implant loss; however, a significant synergistic effect with smoking was demon-strated. Between patients who were IL-1 genotype positive and those who were IL-1 genotype negative, the differences in regard to bleeding on probing or periodontal pathogens did not reach statistical significance. CONCLUSION: The overall implant failure rate in a population treated and maintained for periodontal disease is similar to that of healthy subjects. A synergistic effect found between smoking and a positive IL-1 genotype resulted in a significantly higher implant loss. This indicates that further research with a larger patient group should focus on multifactorial analysis for adequate risk assessment.
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44.
  • Klinge, Björn, et al. (författare)
  • The patient undergoing implant therapy : summary and consensus statements: the 4th EAO Consensus Conference 2015
  • 2015
  • Ingår i: Clinical Oral Implants Research. - : John Wiley & Sons. - 0905-7161 .- 1600-0501. ; 26 Suppl 11, s. 64-7
  • Tidskriftsartikel (refereegranskat)abstract
    • INTRODUCTION: The assignment for this working group was to update the existing knowledge regarding factors considered being of special relevance for the patient undergoing implant therapy. This included areas where conflicting opinions exists since long or recently has been expressed, like the role of antibiotic prophylaxis in dental implant surgery and peri-implantitis. Also areas with growing interest and concern such as patient-reported outcome measures (PROMs) and health-economy was included in this review.MATERIALS AND METHODS: The literature in the respective areas of interest (antibiotic prophylaxis, peri-implantitis, patient-reported outcome measurements and health-economic aspects) was searched using different strategies for the different papers. Search strategies ranged from a complex systematic review to systematic- and narrative reviews, depending on subject and available literature. All collected material was critically reviewed. Four manuscripts were subsequently presented for group analysis and discussion and plenum discussions and concensus approval. The selected areas were considered to be of key importance and relevance for the patient undergoing implant therapy.RESULTS: The results and conclusions of the review process are presented in the respective papers. The group's conclusions, identified knowledge gaps, directions for future research and concensus statements are presented in this article. The following reviews were available for group discussions and the foundation for subsequent plenary sessions: Lund B, Hultin M, Tranaeus S, Naimi-Akbar A, Klinge B. (2015) Perioperative antibiotics in conjunction with dental implant placement. A complex systematic review. Renvert S & Quirynen M. (2015) Risk indicators for peri-implantitis. A narrative review. De Bruyn H, Raes S, Matthys C, Cosyn J. (2015) The current use of patient centered/reported outcomes in implant dentistry. A systematic review. Beikler T & Flemmig T.F. (2015) Economic evaluation of implant-supported prostheses. A narrative review.
  •  
45.
  • Klinge, Björn, et al. (författare)
  • The patient undergoing implant therapy : Summary and consensus statements: The 4th EAO Consensus Conference 2015
  • 2015
  • Ingår i: Clinical Oral Implants Research. - : John Wiley & Sons. - 0905-7161 .- 1600-0501. ; 26:S11, s. 64-67
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: The assignment for this working group was to update the existing knowledge regarding factors considered being of special relevance for the patient undergoing implant therapy. This included areas where conflicting opinions exists since long or recently has been expressed, like the role of antibiotic prophylaxis in dental implant surgery and peri-implantitis. Also areas with growing interest and concern such as patient-reported outcome measures (PROMs) and health-economy was included in this review. Materials and methods: The literature in the respective areas of interest (antibiotic prophylaxis, peri-implantitis, patient-reported outcome measurements and health-economic aspects) was searched using different strategies for the different papers. Search strategies ranged from a complex systematic review to systematic-and narrative reviews, depending on subject and available literature. All collected material was critically reviewed. Four manuscripts were subsequently presented for group analysis and discussion and plenum discussions and concensus approval. The selected areas were considered to be of key importance and relevance for the patient undergoing implant therapy. Results: The results and conclusions of the review process are presented in the respective papers. The group's conclusions, identified knowledge gaps, directions for future research and concensus statements are presented in this article. The following reviews were available for group discussions and the foundation for subsequent plenary sessions: Lund B, Hultin M, Tranaeus S, Naimi-Akbar A, Klinge B. (2015) Perioperative antibiotics in conjunction with dental implant placement. A complex systematic review. Renvert S & Quirynen M. (2015) Risk indicators for peri-implantitis. A narrative review. De Bruyn H, Raes S, Matthys C, Cosyn J. (2015) The current use of patient centered/reported outcomes in implant dentistry. A systematic review. Beikler T & Flemmig T. F. (2015) Economic evaluation of implant-supported prostheses. A narrative review.
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46.
  • Koole, Sebastiaan, et al. (författare)
  • Competence profiles in undergraduate dental education : a comparison between theory and reality
  • 2017
  • Ingår i: BMC Oral Health. - : BioMed Central. - 1472-6831. ; 17
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Competence profiles are purposed to provide a blueprint in support to develop and/or benchmark the learning outcomes of undergraduate dental curricula. This study aims to investigate whether a competence profile as proposed by academic-and clinical experts is able to represent the real clinical reality. Methods: A questionnaire was developed including questions about gender and age, perception about required competences, and educational organisation and was distributed among Flemish dentists via email and on paper during a symposium. The data was analysed using descriptive statistics, Chi-square and non-parametric Mann-Whitney U-tests. Results: A total of 312 questionnaires were completed (= 6.5% of dentist population, with similar gender and age characteristics). All competences in the European competence profile were rated between 7.2 and 9.4 on a 10-point scale. In dentists under 50 years, females rated the importance of identifying/managing anxiety and abnormal patient behaviour; and promoting/improving oral health as significantly higher than males. In dentists of 50 years and above, females rated 8 competences significantly higher than males, including obtaining/recording a complete history; identifying/managing anxiety and abnormal patient behaviour; obtaining/interpreting radiography; identifying temporomandibular and associated disorders; identifying orthodontic needs; awareness of own limitations/when to refer; managing dental urgencies; and basic-life-support/defibrillation. Clinical practice management was most frequently reported as additional competence to address in dental education. Furthermore, the respondents suggested an undergraduate dental curriculum based on 34% theoretical education, 26% preclinical skills training, and 40% clinical education and 86% agreed with a duration of 5 years. Finally, the respondents also illustrated the dynamic nature of dentistry including a reduction of amalgam fillings, a shift from individual practice to group practices, an increased administrative load, and more assertive patients. Conclusion: Findings in the present study suggest the validation of the proposed competences for graduating European dentists within the clinical reality of dental professionals in daily practice. Nevertheless, the results have also demonstrated heterogeneity regarding gender and age within the dentist population and emphasised a continuously evolving dental profession and required competences. Hence, to maintain high quality of dental care, a strategy should be developed in which dental curricula are continuously benchmarked against an evolving clinical reality.
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47.
  • Koole, S., et al. (författare)
  • Contemporary undergraduate implant dentistry education : a systematic review
  • 2014
  • Ingår i: European journal of dental education. - : John Wiley & Sons. - 1396-5883 .- 1600-0579. ; 18:S1, s. 12-23
  • Forskningsöversikt (refereegranskat)abstract
    • Introduction: Consensus reports recommend that students upon graduation should possess a significant level of knowledge and competence in implant dentistry, including basic competences in diagnostics, treatment planning, restorative, straightforward surgical and maintenance procedures. In response, undergraduate curricula need to integrate implant dentistry. This narrative review explores educational programmes in terms of competences, related research and barriers or reflections, regarding implementation in undergraduate curricula. Materials and methods: Publications (2008-2013) were searched systematically in WoS, PubMed and ERIC and screened independently by two authors in four stages: removal of duplicates, title screening, abstract screening and full-text reading. Inclusion criteria encompassed implant dentistry in undergraduate education. Results: Finally, 37 of 420 papers were included. Detailed information regarding programme content, number of participants, staff input, logistics/funding issues is scattered. Theoretical education is predominant, and pre-clinical/clinical training is offered minimally, often carried out in elective programmes. However, selected straightforward cases treated by undergraduates yield positive outcomes with low failure rates, few complications, high patient satisfaction and student appreciation. Barriers to implementing implant dentistry in the undergraduate curriculum include funding issues, limitations in time or staff availability/competence and lack of suitable patients. Overcoming these barriers is worthwhile as experience-based implant education affects future practice as well-informed students propose more restorative alternatives to their patients. Conclusion: Although implant dentistry is increasingly integrated in undergraduate curricula, challenges remain in developing strategies to implement existing competence profiles and the extent of experience-based education. To support further advancement, universities should report comprehensively on their implant programmes to allow comparison and reproduction in other environments.
  •  
48.
  • Koole, Sebastiaan, et al. (författare)
  • Exploring the relation between online case-based discussions and learning outcomes in dental education
  • 2014
  • Ingår i: Journal of Dental Education. - : John Wiley & Sons. - 0022-0337 .- 1930-7837. ; 78:11, s. 1552-7
  • Tidskriftsartikel (refereegranskat)abstract
    • Online case-based discussions, parallel to theoretical dental education, have been highly valued by students and supervisors. This study investigated the relation between variables of online group discussions and learning outcomes. At Ghent University in Belgium, undergraduate dental students (years two and three) are required to participate in online case-based discussion groups (five students/group) in conjunction with two theoretical courses on basic periodontics and related therapy. Each week, a patient case is discussed under supervision of a periodontist, who authored the case and performed the treatment. Each case includes treatment history and demand, intra- and extraoral images, and full diagnostic information with periodontal and radiographic status. For this retrospective study, data were obtained for all 252 students in forty-three discussion groups between 2009 and 2012. Spearman's rank correlations were calculated to investigate the relation among group dynamics (number of group posts and views), individual student contributions (number of individual posts, newly introduced elements, questions, and reactions to other posts), supervisors' interventions (number of posts and posed questions), and learning outcomes (examination result). The results showed that learning outcomes were significantly related to the number of student posts (Spearman's rho (ρ)=0.19), newly introduced elements (ρ=0.21), reactions to other posts (ρ=0.14), number of supervisors' interventions (ρ=0.12), and supervisors' questions (ρ=0.20). These results suggest that individual student contributions during online case-based discussions and the provided supervision were related to learning outcomes.
  •  
49.
  • Koole, Sebastiaan, et al. (författare)
  • Facilitating Dental Student Reflections : Using Mentor Groups to Discuss Clinical Experiences and Personal Development
  • 2016
  • Ingår i: Journal of Dental Education. - : American Dental Education Association. - 0022-0337 .- 1930-7837. ; 80:10, s. 1212-1218
  • Tidskriftsartikel (refereegranskat)abstract
    • Despite the consensus on the importance of reflection for dental professionals, a lack of understanding remains about how students and clinicians should develop their ability to reflect. The aim of this study was to investigate dental students' and mentors' perceptions of mentor groups as an instructional method to facilitate students' reflection in terms of the strategy's learning potential, role of the mentor, group dynamics, and feasibility. At Ghent University in Belgium, third-and fourth-year dental students were encouraged to reflect on their clinical experiences and personal development in three reflective mentor sessions. No preparation or reports afterwards were required; students needed only to participate in the sessions. Sessions were guided by trained mentors to establish a safe environment, frame clinical discussions, and stimulate reflection. Students' and mentors' perceptions of the experience were assessed with a 17-statement questionnaire with response options on a five-point Likert scale (1=totally disagree to 5=totally agree). A total of 50 students and eight mentors completed the questionnaire (response rates 81% and 89%, respectively). Both students and mentors had neutral to positive perceptions concerning the learning potential, role of the mentor, group dynamics, and feasibility. The mean ideal total time for sessions in a year was 99 minutes (third-year students), 111 minutes (fourth-year students), and 147 minutes (mentors). Reported reflective topics related to patient management, frustrations, and practice of dentistry. Overall mean appreciation for the experience ranged from 14.50 to 15.14 on the 20-point scale. These findings about students' and mentors' positive perceptions of the experience suggest that mentor groups may be a potentially valuable strategy to promote dental students' reflection.
  •  
50.
  • Koole, S., et al. (författare)
  • Implant dentistry education in Europe : 5 years after the Association for Dental Education in Europe consensus report
  • 2014
  • Ingår i: European journal of dental education. - : John Wiley & Sons. - 1396-5883 .- 1600-0579. ; 18:S1, s. 43-51
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: To promote consensus on implant dentistry university education in Europe, a workshop amongst university teachers and opinion leaders was organised in 2008. As a result, guidelines on both under-and postgraduate education were issued. This study aims to investigate the current status of university teaching of implant dentistry and the impact of the recommendations for teaching and assessment, 5 years after the first consensus. Finally, this report attempts to identify future directions in education within the discipline. Materials and methods: An online survey was distributed amongst 105 academic leaders in implant education in Europe, and 52 questionnaires were returned (response rate 50%). Results: The average amount of implant dentistry in undergraduate curricula has increased to 74 h, compared to 36 h in 2008, and the inclusion of pre-clinical and clinical education has increased. No change occurred with regard to the aimed competence levels. It was suggested that certain implant procedures including surgery should be provided by dentists after attending additional courses, whilst complex treatments will still require specialist training. The 2008 workshop guidelines have been implemented to a varying extent (25-100%) in under-and postgraduate education. Main reported implementation barriers included limited time availability in the curriculum and limited financial/material resources. Future discussions about implant dentistry in Europe should be focused towards integration in current dental curricula, approaches to overcome barriers and the relations with and role of industrial partners. Conclusion: Implant dentistry is increasingly integrating in undergraduate dental education. Development of the consensus guidelines in 2008 may have facilitated this process. Nevertheless, further progress is needed on all educational levels to align training of professionals to the growing treatment needs of the population.
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