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Background: Cross-sectional studies have shown that elderly with a natural dentition have better general health than edentulous elderly, but this has not been confirmed in studies with longitudinal design., Methods: This prospective longitudinal study with a follow-up of 8 years aimed to assess differences in general health, healthcare costs and dental care use between elderly with a natural dentition and edentulous elderly wearing implant-retained or conventional dentures. Based on data of all national insurance claims for dental and medical care from Dutch elderly (aged ≥75 years) general health outcomes (chronic conditions, medication use), healthcare costs and dental care use could be assessed of three groups of elderly, viz. elderly with a natural dentition, elderly with conventional dentures and elderly with implant-retained overdentures., Results: At baseline (2009), a total of 168,122 elderly could be included (143,199 natural dentition, 18,420 conventional dentures, 6503 implant-retained overdentures). Here we showed that after 8 years follow-up elderly with a natural dentition had more favorable general health outcomes (fewer chronic conditions, less medication use), lower healthcare costs and lower dental costs - but higher dental care use - than edentulous elderly. At baseline the general health of elderly with an implant-retained overdentures resembled the profile of elderly with a natural dentition, but over time their general health problems became comparable to elderly with conventional dentures., Conclusions: It was concluded that elderly with a natural dentition had significant better health and lower healthcare costs compared to edentulous elderly (with or without dental implants)., (© 2021. The Author(s).)

The aim of this study was to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the outcomes of short dental implants (≤7mm) versus vertical bone augmentation followed by regular dental implants (>7mm) in the deficient posterior mandible. In total, eight RCTs (six using interpositional sandwich grafting and two using a guided bone regeneration technique) were reported in 17 articles at different time points. In the meta-analysis of the sandwich group, the relative risk (RR) for implant loss at 1year was in favour of short implants (RR 0.41, P=0.02), while no significant difference was found at 3 years (RR 0.65, P=0.43), 5 years (RR 1.08, P=0.86), or 8 years (RR 1.53, P=0.52). The risk of complications was in favour of short implants (RR 0.34, P=0.0002), as was the mean difference in marginal bone resorption after 1 year (-0.09mm, P=0.17), 3 years (-0.32mm, P<0.00001), 5 years (-0.65mm, P<0.00001), and 8 years (-0.88, P<0.00001). The mean residual osseointegration length of the implants was between 2.94mm and 4.44mm in the short implants group and between 7.97mm and 8.62mm in the regular implants group after 5 years. In conclusion, in the deficient atrophic posterior mandible, short implants and regular implants demonstrate comparable outcomes within the first 5 years. Patients who are fit for surgery should be informed about the risks and benefits of both options., (Copyright © 2021 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Evaluation of dental implant treatment is mostly based on studies with well-controlled study groups treated within a university-based setting. There are no long-term observational practice-based studies known on implant-supported overdentures. The present retrospective study deals with implant survival, peri-implant hard and soft tissue health, surgical and prosthetic aftercare, and satisfaction of patients treated with an implant-supported mandibular overdenture in a daily dental practice., Materials and Methods: Within the years 2006 till 2015, 295 patients were treated with two, three, or four implants for mandibular overdenture treatment in a daily dental practice in Zaandam, The Netherlands. Outcome parameters were scored at a routine yearly inspection including implant loss, plaque index, gingival index, bleeding index, presence of calculus, probing depth, and satisfaction with implant-supported overdenture. Radiographic analysis was performed to assess peri-implant bone changes. Surgical and prosthetic aftercare was obtained from the medical record., Results: A total of 133 patients were seen for an evaluation visit (mean follow-up 51.2 months). Cumulative implant survival rate in the 2-implant group, 3-implant group, and 4-implant group was 100%, 99.1%, and 97.8% respectively, with a mean peri-implant bone loss of 0.53 mm, 0.61 mm, and 0.40 mm. Patients' satisfaction was high in all groups., Conclusion: It was demonstrated, within the limitations of this study, that patients, who were treated with an implant-supported mandibular overdenture in a daily dental practice, experienced a high cumulative implant survival rate and a good peri-implant health, and were very satisfied., Trial Registration: Netherlands Trial Register, NL8867 . Registered 15 September 2020-retrospectively registered.

Objectives: To compare erythritol air polishing with piezoelectric ultrasonic scaling in the non-surgical treatment of peri-implantitis., Material and Methods: Eighty patients (n = 139 implants) with peri-implantitis (probing pocket depth (PPD) ≥5 mm, marginal bone loss (MBL) ≥2 mm as compared to bone level at implant placement, bleeding, and/or suppuration on probing (BoP/SoP)) were randomly allocated to air polishing or ultrasonic treatment. The primary outcome was mean BoP (%) at 3 months after therapy (T3). Secondary outcomes were mean SoP (%), plaque score (Plq) (%), PPD (mm), MBL (mm), full mouth periodontal scores (FMPS) (%), levels of 8 classical periodontal pathogens, and treatment pain/discomfort (Visual Analog Scale, VAS). Patients who were considered successful at T3 were additionally assessed at 6, 9, and 12 months. Differences between both groups were analyzed using multilevel statistics., Results: Three months after therapy, no significant difference in mean BoP (%) between the air polishing and ultrasonic therapy was found (crude analysis β (95% CI) -0.037 (-0.147; 0.073), p = .380). Neither secondary outcomes SoP (%), Plq (%), PPD (mm), MBL (mm), FMPS (%), and periodontal pathogens showed significant differences. Treatment pain/discomfort was low in both groups (VAS score airpolishing group 2.1 (±1.9), ultrasonic 2.6 (±1.9); p = .222). All successfully treated patients at T3 (18.4%) were still considered successful at 12-month follow-up., Conclusions: Erythritol air polishing seems as effective as piezoelectric ultrasonic scaling in the non-surgical treatment of peri-implantitis, in terms of clinical, radiographical, and microbiological parameters. However, neither of the proposed therapies effectively resolved peri-implantitis. Hence, the majority of patients required further surgical treatment., (© 2021 The Authors. Clinical Oral Implants Research published by John Wiley & Sons Ltd.)

Background: The aim of this study was to introduce a complete 3D workflow for immediate implant retained prosthetic rehabilitation following maxillectomy in cancer surgery. The workflow consists of a 3D virtual surgical planning for tumor resection, zygomatic implant placement, and for an implant-retained prosthetic-obturator to fit the planned outcome situation for immediate loading., Materials and Methods: In this study, 3D virtual surgical planning and resection of the maxilla, followed by guided placement of 10 zygomatic implants, using custom cutting and drill/placement-guides, was performed on 5 fresh frozen human cadavers. A preoperatively digitally designed and printed obturator prosthesis was placed and connected to the zygomatic implants. The accuracy of the implant positioning was obtained using 3D deviation analysis by merging the pre- and post-operative CT scan datasets., Results: The preoperatively designed and manufactured obturator prostheses matched accurately the per-operative implant positions. All five obturators could be placed and fixated for immediate loading. The mean prosthetic point deviation on the cadavers was 1.03 ± 0.85 mm; the mean entry point deviation was 1.20 ± 0.62 mm; and the 3D angle deviation was 2.97 ± 1.44°., Conclusions: It is possible to 3D plan and accurately execute the ablative surgery, placement of zygomatic implants, and immediate placement of an implant-retained obturator prosthesis with 3D virtual surgical planning.The next step is to apply the workflow in the operating room in patients planned for maxillectomy.

Objectives: To assess the Efficacy of Frenotomy with regard to Breastfeeding and Reflux Improvement (BRIEF) in infants with breastfeeding problems., Materials and Methods: A cohort of 175 consecutive breastfeeding women with breastfeeding and reflux problems related to a tongue-tie or lip-tie fulfilling the inclusion criteria was longitudinally followed for 6 months. The effect of frenotomy on these problems was studied by a standardized oral assessment and completing the validated Breastfeeding Self-Efficacy Short Form (BSES-SF), nipple pain score (Visual Analogue Scale, VAS), and Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R) questionnaires pre-frenotomy and at 1 week, 1 month, and 6 months' post frenotomy., Results: All 175 women completed the 1-month follow-up and 146 women the 6 months' follow-up. Frenotomy resulted in a significant improvement of BSES-SF, nipple pain score, and I-GERQ-R after 1 week, which improvement maintained to be significant after 1 month for BSES-SF and I-GERQ-R, and after 6 months for I-GERQ-R. The improvements were irrespective of the type lip-tie or tongue-tie underlying the breast feeding and reflux problems. No post-operative complications were observed. About 60.7% of infants still was breastfed 6 months after treatment., Conclusions: Frenotomy is a safe procedure with no post-operative complications and resulting in significant improvement of breastfeeding self-efficacy, nipple pain, and gastro-oesophageal reflux problems., Clinical Relevance: Frenotomy of a tongue-tie and or lip-tie can lead to improvement of breastfeeding and reflux problems irrespective of the type of tongue-tie or lip-tie and should be considered by clinicians as a proper tool to resolve these problems if non-interventional support did not help., International Trial Register: ISRCTN64428423.

Background: Autologous bone grafts have been applied successfully to severely atrophied maxilla via a preimplant procedure. Differences in graft incorporation at the microscopic level can be the decisive factor in the choice between anterior iliac crest and calvarial bone., Purpose: To compare conversion of anterior iliac crest bone and calvarial bone 4 months after grafting of the edentulous maxilla., Materials and Methods: Twenty consecutive patients were randomly assigned to either anterior iliac crest (n = 10) or calvarial (n = 10) bone harvesting to reconstruct their atrophied maxillae. Biopsies were taken from both fresh bone grafts and reconstructed maxillae after 4 months healing, at time of implant placement. Micro-CT, histomorphometric and histological analyses were performed., Results: Micro-CT analysis revealed that both the anterior iliac crest and calvarial bone grafts retained their volume and bone mass after being incorporated in the maxilla, but with a favor for calvarial bone grafts: calvarial bone grafts had a higher mineral density before and after incorporation. Both bone grafts types were well incorporated after 4 months of healing with preservation of bone volume and mineral density. Although the fresh bone biopsies were similar histomorphometrically, after 4 months of graft incorporation, the osteoid percentage and osteocyte count remained higher in the anterior iliac crest bone whereas the percentage of bone was higher in the calvarial bone grafts compared to the anterior iliac crest bone grafts., Conclusions: Both donor sites, that is, anterior iliac crest and calvarial bone, are well suited to provide a reliable and stable basis for implant placement 4 months after grafting with mineral density, porosity, and resorption rate in favor of calvarial bone grafts., (© 2021 The Authors. Clinical Implant Dentistry and Related Research Published by Wiley Periodicals LLC.)

Aim: To compare biomarker levels in peri-implant crevicular fluid (PICF) of healthy implants with levels in PICF of implants with peri-implantitis (before and after non-surgical treatment)., Materials and Methods: Samples were taken from 20 healthy implants (n = 17 patients) and from 20 implants with peri-implantitis (n = 19 patients) before and 3 months after non-surgical treatment using the Airflow Master Piezon ® (EMS). A Luminex™ assay was used to evaluate pro-inflammatory and anti-inflammatory cytokines IL-1β, TNF-α, IL-6 and G-CSF, collagen degradation enzyme MMP-8, chemokines MCP-1 & MIP-1α/CCL3, bone markers OPG and sRANKL and interferon-γ. Clinical and radiographical characteristics were assessed. A Mann-Whitney U and Wilcoxon signed-rank test analysed between- and within-group differences., Results: IL-1β and MMP-8 levels were found significantly elevated in implants with peri-implantitis (p = .007; p = <.001, respectively). No difference in levels of TNF-α, IL-6, MCP-1 and MIP-1α/CCL3, OPG and G-CSF between healthy and diseased implants was found. Levels of sRANKL and INF-γ were under the level of detection. None of the biomarker levels improved after non-surgical therapy, and levels of IL-1β and MMP-8 remained high., Conclusion: Implants diagnosed with peri-implantitis have higher levels of IL-1β and MMP-8 in PICF compared to healthy implants. Non-surgical therapy did not influence the inflammatory immune response., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Connective tissue grafting has a beneficial effect on the peri-implant mucosa, but the effect of grafting the buccal mucosa on buccal bone thickness (BBT) has not been investigated, although BBT is proposed to be a key factor for the soft-tissue contour. The aim of this trial was to assess the outcome of a connective tissue graft (CTG) in the esthetic zone of single immediate implants on the change of BBT according to cone beam computed tomography (CBCT) scan analysis., Methods: In a 1-year randomized controlled trial, 60 patients received an immediately placed implant and provisionalization, either combined with CTG (test group) or without CTG (control group). CBCTs were taken preoperatively (T pre ) and 1 year after definitive restoration (T 2 ). Any change in BBT was assessed at different implant levels. Additionally, the change in mid-buccal mucosal level (MBML) and approximal marginal bone level were assessed., Results: Fifty-five patients were available for statistical analysis (test group, n = 28; control group, n = 27). At T 2 , the average change in BBT was significantly larger in the test group (-0.84 ± 0.61 mm) than in the control group (-0.46 ± 0.54 mm, P = 0.02). A MBML gain of 0.07 ± 0.85 mm in the test and a MBML loss -0.52 ± 1.16 mm in the control group was observed at T 2 . Average loss of marginal bone was 0.05 ± 0.33 mm and 0.01 ± 0.38 mm, respectively., Conclusions: The application of CTG in the esthetic zone of immediately placed and provisionalized implants is accompanied with more loss of BBT, but at the same time better maintains the mid-buccal mucosal level., (© 2020 The Authors. Journal of Periodontology published by Wiley Periodicals, Inc. on behalf of American Academy of Periodontology.)

Background: Very little information is available on the general health of elderly who are provided with an implant-retained overdenture (IOD)., Purpose: The general health status of three groups of elderly (≥75 years) were compared: those with a natural dentition (ND), those treated with an implant-retained overdenture (IOD), and those wearing a conventional denture (CD)., Materials and Methods: Data on healthcare costs were obtained from records of Dutch health insurers that are collected by Vektis. Data on general health (chronic diseases, medication use, and polypharmacy) were acquired for elderly patients with a ND, an IOD, and a CD in 2009 and 2017. Data on the general health of elderly who received an IOD were also acquired from 2010 through 2016., Results: On average, the general health of elderly who received an IOD was comparable to general health of elderly with a ND and was better than the general health of elderly with a CD (lower prevalence of diabetes, cardiac disease, and hypertension). The general health profile of elderly receiving an IOD was consistent during all years., Conclusions: The general health of elderly with a ND or IODs is better than those with CDs., (© 2021 The Authors. Clinical Implant Dentistry and Related Research Published by Wiley Periodicals LLC.)

Background: Clinical studies of single-tooth replacement in compromised bone using bone level tapered implants in the aesthetic zone are scarce., Aim: To assess clinically, radiographically and aesthetically over 1 year the performance of a bone level tapered implant in the maxillary aesthetic zone in sites after alveolar ridge preservation., Material and Methods: Thirty patients (16 male, 14 female) with a failing tooth and large bone defect after removal received alveolar ridge preservation. After 3 months, implants were placed with immediate provisionalization. Definitive restorations were placed after 3 months. The treatment was evaluated 1 year following the definitive restoration., Results: All the patients attended the 1-year follow-up. One implant was lost (96.7% implant survival rate). The mean implant stability quotient value was 68.9 ± 8.74 at implant placement. The mean marginal bone level change was minor (- 0.07 ± 0.12 mm). The mean mid-buccal mucosa changed with + 0.01 ± 0.45 mm. The median Pink Esthetic Score and White Esthetic Score after 1 year were 6 [4; 7] and 8 [7; 9], respectively. The patients' mean overall satisfaction (0-100 VAS scale) was 86.6 ± 10.3., Conclusion: Bone level tapered implants with immediate provisionalization perform well after alveolar ridge preservation in the maxillary aesthetic zone, according to implant stability, clinical, radiographic, aesthetic and patient-centred outcomes., Trial Registration: NTR, NL8755 . Registered on 1 January 2016.

Aim: To compare marginal bone level changes around immediately placed and immediately provisionalized implants with immediately placed and delayed provisionalized implants in the aesthetic region after five years of function., Materials and Methods: Forty patients with a failing tooth in the maxillary anterior region were randomly assigned immediate implant placement with immediate (Group A: n = 20) or delayed (Group B: n = 20) provisionalization. Definitive crown placement occurred three months after provisionalization. The primary outcomes were changes in marginal bone level. In addition, survival rates, buccal bone thickness, soft peri-implant tissues, aesthetics and patient-reported outcomes were assessed., Results: After 5 years, the mean mesial and distal marginal bone level changes were 0.71 ± 0.68 mm and 0.71 ± 0.71 mm, respectively, in group A and 0.49 ± 0.52 mm and 0.54 ± 0.64 mm, respectively, in group B; the difference between the groups was not significant (p = .305 and p = .477, respectively). Implant and restoration survivals were 100%. No clinically relevant differences in buccal bone thickness or in mid-facial peri-implant mucosal level, aesthetic and patient outcomes were observed., Conclusions: The mean marginal bone level changes following immediate implant placement and provisionalization were comparable with immediate implant placement and delayed provisionalization. (www.isrctn.com: ISRCTN57251089 and www.trialregister.nl: NL8255)., (© 2020 The Authors. Journal of Clinical Periodontology published by John Wiley & Sons Ltd.)

Background: Oral cancer patients can benefit from dental implant placement. Traditionally, implants are placed after completing oncologic treatment (secondary implant placement). Implant placement during ablative surgery (primary placement) in oral cancer patients seems beneficial in terms of early start of oral rehabilitation and limiting additional surgical interventions. Guidelines on the ideal timing of implant placement in oral cancer patients are missing., Objective: To perform a scoping literature review on studies examining the timing of dental implant placement in oral cancer patients and propose a clinical practice recommendations guideline., Methods: A literature search for studies dealing with primary and/or secondary implant placement in MEDLINE was conducted (last search December 27, 2019). The primary outcome was 5-year implant survival., Results: Sixteen out of 808 studies were considered eligible. Both primary and secondary implant placement showed acceptable overall implant survival ratios with a higher pooled 5-year implant survival rate for primary implant placement 92.8% (95% CI: 87.1%-98.5%) than secondary placed implants (86.4%, 95% CI: 77.0%-95.8%). Primary implant placement is accompanied by earlier prosthetic rehabilitation after tumor surgery., Conclusion: Patients with oral cancer greatly benefit from, preferably primary placed, dental implants in their prosthetic rehabilitation. The combination of tumor surgery with implant placement in native mandibular bone should be provided as standard care., (© 2020 The Authors. Oral Diseases published by John Wiley & Sons Ltd.)

Head and neck cancer treatment can severely alter oral function and aesthetics, and reduce quality of life. The role of maxillofacial prosthodontists in multidisciplinary treatment of head and neck cancer patients is essential when it comes to oral rehabilitation and its planning. This role should preferably start on the day of first intake. Maxillofacial prosthodontists should be involved in the care pathway to shape and outline the prosthetic and dental rehabilitation in line with the reconstructive surgical options. With the progress of three-dimensional technology, the pretreatment insight in overall prognosis and possibilities of surgical and/or prosthetic rehabilitation has tremendously increased. This increased insight has helped to improve quality of cancer care. This expert review addresses the involvement of maxillofacial prosthodontists in treatment planning, highlighting prosthodontic rehabilitation of head and neck cancer patients from start to finish., (© 2020 The Authors. Oral Diseases published by John Wiley & Sons Ltd.)

Background: Little is known about immediate implant placement in head and neck cancer patients. We studied implant survival and functional outcomes of overdentures fabricated on implants placed immediately after removal of the lower dentition during ablative surgery or preceding primary radiotherapy (RT)., Methods: Inclusion criteria were primary head and neck cancer, dentate lower jaw, and indication for removal of remaining teeth. Two implants to support a mandibular overdenture were placed immediately after extraction of the dentition during ablative surgery, or prior to starting primary radiotherapy. Standardized questionnaires and clinical assessments were conducted (median follow-up 18.5 months, IQR 13.3)., Results: Fifty-eight implants were placed in 29 patients. Four implants were lost (implant survival rate 93.1%). In 9 patients, no functional overdenture could be made. All patients were satisfied with their dentures., Conclusions: Combining dental implant placement with removal of remaining teeth preceding head neck oncology treatment results in a favorable treatment outcome.

The aim of this study was to assess implant retreatment in a group of patients whose maxillary implants were all failing after full arch rehabilitation. Treatment involved implant removal, augmentation, and placement of an overdenture supported by four to six implants. All consecutive patients referred between 2008 and 2018, following multiple late implant failures in the rehabilitated maxilla, were included in the study. Seventy implants in 15 patients were evaluated at 3.3 ± 2.5 years (range 1.1-8.6 years) after loading. Implant survival, complications, clinical parameters, marginal bone loss, and patient-related outcome measures were recorded at the time of evaluation. Overall implant survival was 95.7%. Three implant failures occurred within the first year of function. Marginal bone loss was 0.32 ± 0.46 mm; pocket probing depth was 4.55 ± 1.59 mm. Plaque, calculus, inflammation, and bleeding were hardly seen (median index score 0). Patients scored their satisfaction with their overdentures as high (mean overall score 8.7 ± 1.2, maximum 10). Chewing soft and tough food was scored as 'good' and hard food as 'moderate'. The mean Oral Health Impact Profile score was 29.5 ± 33.3. It can be concluded that the replacement of multiple failing implants in an edentulous maxilla after bone augmentation is a safe and predictable treatment procedure when applied as an implant-supported overdenture., (Copyright © 2020 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Purpose: To test the applicability of coded healing abutments, intraoral scanners, and monolithic zirconia for the fabrication of three-unit fixed dental prostheses (FDPs) on two dental implants., Materials and Methods: Patients with three missing teeth in the posterior region of either the maxilla or mandible received two dental implants. After healing, coded healing abutments were placed. Full-arch intraoral scans were made to produce individual titanium abutments and a three-unit FDP. Peri-implant tissues were assessed 2 weeks after placement of the FDP and again after 1 year. Patient-reported outcome measures were registered prior to treatment and after 1 year. The quality of the FDPs was assessed using modified United States Public Health Service criteria after 1 year of service., Results: A total of 54 patients were treated with 60 restorations, and 51 patients with 56 restorations were available at the 1-year follow-up. Implant survival was 99.1%, and prosthesis survival was 100%. The peri-implant tissues remained healthy, and patient satisfaction was high. However, the USPHS evaluation showed that some prostheses exhibited fit or color issues that needed to be addressed, although most were rated as successful (80.4%)., Conclusion: The use of coded healing abutments and intraoral scanners to produce full-zirconia three-unit FDPs on two dental implants proved to be a feasible technique, with promising objective and subjective results. However, technical challenges still impacted the treatment results, resulting in a number of restorations having clinical or radiographic marginal gaps or reduced color match.

Aim: The aim of this prospective cohort study was to assess the effect of a pocket irrigator/evacuator device (IED) in the non-surgical treatment of peri-implantitis., Material and Methods: In total 24 patients having 38 implants diagnosed with peri-implantitis were included in this study. Peri-implant pockets were irrigated six times in three consecutive weeks. The primary outcome was bleeding on probing (BoP). Secondary outcome parameters included plaque index (Pl), suppuration on probing (SoP), probing pocket depth (PPD), marginal bone loss (MBL), presence and numbers of periodontal pathogens. Parameters were assessed at baseline and 3 months after the last treatment. Treatment pain perception was scored using the visual analog scale (VAS) after the first and last treatment., Results: At 3 months, IED treatment revealed significant reduction of peri-implant BoP (71% [±20] vs 57% [±28] [P = .014]) and peri-implant plaque scores (10 [±14] to 5 [±9] [P = .039] [T0 vs T3 respectively]). Significant reduction in mean peri-implant PPD from 4.92 mm (SD ± 1.28) to 4.66 mm (SD ± 1.35) (P = .041) was observed. In addition, a reduction in VAS pain score between the first and the last (6th) treatment was found (P = .039). No reduction in SoP (P = .088) was found. No changes in mean periodontal full mouth plaque, BOP, SOP and PPD levels, MBL and microbiological outcomes were found., Conclusion: Beneficial clinical effects in terms of BoP, PPD and PI were found at 3 months after IED treatment. However, the IED does not seem to effectively treat peri-implantitis in terms of disease resolution., (© 2020 The Authors. International Journal of Dental Hygiene published by John Wiley & Sons Ltd.)

Background: Calvarial bone grafts are successful in the reconstruction of the severely atrophied maxilla as a pre-implant procedure. However, not much is known about graft incorporation at the microscopic level., Purpose: This study aimed to assess calvarial bone conversion 4 months after being grafted in the edentulous maxillary bone., Materials and Methods: In 13 patients (age:65.3 ± 8.7 years) the atrophic maxilla was reconstructed with autologous calvarial bone. Biopsies were taken from fresh calvarial bone grafts and from the reconstructed maxillae after 4 months of healing. Micro-CT, histomorphometric, and histological analysis were performed. From three patients biopsies were obtained after 9, 11, or 45 months., Results: The micro-CT analysis revealed that in the maxilla the calvarial bone was well preserved even after 45 months. Histology showed progressive incorporation of grafted bone within a maxillary bone. Osteoid and osteocytes were present in all biopsies indicating new bone formation and vital bone. Histomorphometrically, the percentage of grafted bone volume over total volume decreased from 79.8% (IQR78.7-83.3) in fresh calvarial grafts to 59.3% (IQR44.8-64.6) in healed grafts. The biopsies were taken after 9, 11, and 45 months showed similar values., Conclusions: Calvarial bone grafts result in stable and viable bone, good incorporation into native maxillary bone, and a minor decrease in bone volume after healing. Consequently, they provide a solid base for implant placement in severely atrophied edentulous maxillary bone., (© 2020 The Authors. Clinical Implant Dentistry and Related Research Published by Wiley Periodicals LLC.)

Background: Calvarial bone grafts as a pre-implant augmentation procedure are mostly used to reconstruct the edentulous maxilla, although calvarial grafts could also be used in the partially dentate patients needing extensive bone grafting., Methods: In 7 consecutive partially dentate patients needing bone grafting because of a large bony defect as a result of trauma (n = 1), oligodontia (n = 1), failed previous bone augmentation (n = 1), or atrophy (n = 4), the alveolar process was reconstructed with calvarial bone as a pre-implant procedure., Results: A total of 30 implants was placed either immediate at the time of bone grafting (13 implants) or after a healing time of 4 months when immediate placement was not possible (17 implants). One wound dehiscence occurred that needed secondary intervention. During follow-up (40 ± 14 months), one implant was lost due to peri-implantitis with an infected osteosynthesis screw. Marginal peri-implant bone loss was 0.65 ± 0.47 mm during this period., Conclusion: Calvarial bone is a sound extra-oral donor site when aiming for reconstruction of a large bony defect of the alveolar process of partially dentate patients.

Statement of Problem: Implant-retained auricular prostheses, on a bar-clip or with a magnetic retention system, are considered successful treatment for missing ears. However, which of these 2 retention systems is preferred by patients is unknown., Purpose: The purpose of this clinical study was to assess which retention system is mostly preferred by patients wearing implant-retained auricular prostheses: bar-clip retention or magnetic retention., Material and Methods: All consecutive patients visiting the clinic between March 2014 and November 2014 for a routine follow-up of their implant-retained auricular prostheses on a bar-clip retention system were asked to enroll in this descriptive study comparing patient preference for the retention system: bar-clip versus magnets. Participants were asked to complete a questionnaire to obtain patient satisfaction scores regarding their auricular prosthesis before and 3 months after changing to a magnetic-retained auricular prosthesis. After 3 months, participants were asked to state their preference for either their previous bar-clip system or the new magnetic system. If they did not prefer the magnetic system, participants were able to return to their previous bar-clip system. The study follow-ups were performed at 6, 12, 24, and 36 months. Again, patient satisfaction was scored with the aid of the same questionnaire, and prosthetic care and aftercare were also assessed., Results: Of 20 eligible patients, 17 participants (12 men, 5 women) enrolled in the study. The mean score for patient satisfaction for the bar-clip system at the start of the study was high (8 ±1.62). After 3 months, 2 participants wanted to return to their previous bar-clip system, followed by 1 more at the 6-month evaluation and 2 more at the 1-year evaluation. After 3 years, 9 of 16 participants (57%) preferred the magnetic-retained auricular prosthesis. During the 3 years of follow-up, aftercare was considered minor for both the bar-clip and the magnetic system. No participants developed peri-implantitis. All participants indicated that cleaning and placing the magnetic-retained auricular prosthesis was easier than the bar-clip system., Conclusions: The majority of the participants (59%) in this study, especially the elderly participants, preferred the magnetic retention system. When compared with the bar-clip system, no additional aftercare was needed., (Copyright © 2019 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the influence of the cervical crown contour on marginal bone loss and soft tissue health around platform-switched, posteriorly placed, two-piece implants., Materials and Methods: A dataset from two previously conducted studies was used. Patients with single two-piece, platform-switched implants in between two natural teeth or adjacent to one natural tooth were included. Clinical parameters and standardized periapical radiographs from 1 month and 5 years after final crown placement were assessed. A new measurement method was developed to analyze geometric values of the cervical crown contour. Inter- and intraexaminer reliability were assessed. Emergence angles were measured at 1, 2, and 3 mm above the implant shoulder. Linear correlations between variables were determined by calculating Pearson correlation coefficients., Results: A total of 64 patients with 67 posterior implants met the inclusion criteria. At 1, 2, and 3 mm above the implant shoulder, mean emergence angles at the mesial implant sites were 0.5 ± 2.8, 12.8 ± 12.8, and 18.0 ± 11.3 degrees, respectively. At the distal sites, the corresponding values were 2.8 ± 8.3, 16.2 ±16.6, and 18.7 ± 13.8 degrees, respectively. Mean marginal bone loss between 1 month and the 5-year evaluations was 0.14 ± 0.34 mm at the mesial aspect and 0.26 ± 0.47 at the distal aspect of implants. No correlation with peri-implant bone loss or soft tissue health could be found. No implants showed signs of peri-implantitis., Conclusion: The cervical crown contour at platform-switched, posteriorly placed, two-piece implants showed no correlation with peri-implant marginal bone loss or soft tissue health up to 5 years after implant placement.

The aim of this retrospective study was to assess the clinical and aesthetic outcomes, and patient satisfaction, following dental implant therapy in cleft patients. Implant survival, changes in marginal bone level, pocket probing depths, plaque and bleeding indices, aesthetics, and patient satisfaction were assessed in 17 alveolar cleft patients and 17 matched controls. At follow-up (mean 72.4±46.4 months), one implant had been lost in the cleft group. Mean marginal bone loss at follow-up was -0.4±0.4mm in cleft patients and -0.2±0.4mm in controls. Aesthetics of the peri-implant soft tissues (pink aesthetic score) were less favourable (P=0.025) in cleft patients (5.0±1.9) than in controls (6.5±1.7), while peri-implant parameters were comparable in the two groups. Overall patient satisfaction was 8.6±0.9 in cleft patients and 8.9±1.1 in controls (P=0.331). In cleft patients, no difference in aesthetics was observed between patients who received additional bone augmentation at 3 months prior to implant placement and those who did not (P=0.092). Dental implant therapy in cleft patients is associated with high implant survival, minor marginal bone loss, healthy peri-implant soft tissues, and high patient satisfaction. Only the aesthetics of the soft tissues was worse in cleft patients compared to augmented non-cleft patients., (Copyright © 2020 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Templates aim to facilitate implant placement in the prosthetically preferred position. Mucosa-supported and bone-supported templates are commonly used in the edentulous maxilla. In the atrophic maxilla (Cawood V and VI), however, these templates can be easily displaced due to a lack of supportive tissues, even in cases where anterior sites offer sufficient bone for implant placement. To assist in positioning and stabilisation, we designed a template that utilises the nasal aperture as a fulcrum to create a forced and exclusive fit. The aim of this study was to assess the clinical usability of the developed template and the corresponding implant placement accuracy in patients with edentulous atrophic maxillae. Deviations between planned and placed implant positions were measured by aligning pre- and post-operative cone beam computed tomography scans., Results: Twenty-four implants were placed in 11 patients. One template did not fit properly due to a slight undercut. All implants could be placed with good primary stability. The implants had high accuracy at the implant shoulder (global deviation 1.1 ± 0.5 mm, lateral deviation 0.8 ± 0.5 mm) and a mean angular deviation of 7.2 ± 3.4°., Conclusions: The developed surgical template offers stabilised and secure template placement in the edentulous atrophic maxilla, resulting in satisfying implant placement accuracy when using a semi-guided approach., Trial Registration: Netherlands Trial Register, NL6561, registered 26 September 2017.

Background: Prospective aesthetic outcomes on a high number of patients after immediate implant placement and provisionalization (IIPP) are lacking., Purpose: To analyze the aesthetic outcome after IIPP., Materials and Methods: One hundred consecutive patients with a failing maxillary incisor were provided with an immediately placed and provisionalized nonloaded implant using a flapless procedure and palatal implant positioning. The remaining gap buccally was filled with a bone substitute. Preoperatively (T0), 2 weeks postoperatively (T1), direct after placement of the permanent crown (T2), and 1 year after IIPP (T3), standardized light photographs were made. Change in aesthetic score was the primary outcome measure. Both the white aesthetic score (WES) and pink aesthetic score (PES) were used., Results: In the first year postsurgery, the mean total-WES and total-PES scores raised from 4.5 to 8.2, and from 9.9 to 12.1, respectively. The mean PES scores for mesial and distal papilla, soft tissue marginal level, contour, color, and texture, raised significantly (P < .05), while the alveolar process contour, on average, remained stable from T0 to T3., Conclusions: Within the limitations of this 1-year research, it may be concluded that, following this minimal invasive IIPP procedure, a high aesthetic outcome was achieved., (© 2020 Wiley Periodicals, Inc.)

Background: There is a growing tendency to place single tooth implants immediately after extracting a failing tooth in the posterior region. The aim of this prospective case series pilot study was to evaluate immediate implant placement in molar post-extraction sites during a 1-year follow-up period., Materials and Methods: Fifteen consecutive patients with a single failing molar in the maxilla or mandible, and presenting enough bone to expect primary implant stability and an implant site free of infection, were included. The implants, with a large thread depth and sharp thread edges, were placed in each patient according to a two-staged surgical procedure. Three months later, a full contour screw-retained zirconia restoration with an angulated screw channel abutment was provided. Clinical and radiographic examinations were performed 1 month and 12 months after placing the restoration. In addition, the patients' satisfaction with the restoration was scored after 12 months., Results: Four out of 15 of the mobile implants had to be removed before the 1-year evaluation. The implant and restoration survival rates were 73.3% at the 1-year evaluation (n = 15). The mean marginal bone loss, from loading to the 12-month follow-up, was 0.17 mm (n = 11). The mean plaque, calculus, peri-implant mucosa, bleeding, and pocket probing depth scores were low, depicting healthy peri-implant conditions. The patients were very satisfied., Conclusion: It was demonstrated, within the limitations of this study, that immediate placement of regular diameter implants in molar post-extraction sites in the maxilla and mandible resulted in a high implant failure rate during a 1-year follow-up period., Trial Registration: Netherlands Trial Register, NL8117. Registered 24 October 2019 - Retrospectively registered, https://www.trialregister.nl/trial/8117.

Background: Implant-supported restorations in the posterior region are subjected to various complications that could be prevented by changing either the design or the material., Purpose: The aim of this prospective case series study was to evaluate full-zirconia implant-supported restorations with angulated screw channel abutments in the molar region of the maxilla and mandible and their effect on hard and soft peri-implant tissues, during a 1-year follow-up period., Materials and Methods: Thirty consecutive patients with a single missing molar, sufficient bone height, and implant site free of infection were included. Each patient was to receive a parallel-walled implant with conical connection according to a two-staged surgical protocol. After 3 months, a full-contour screw-retained zirconia restoration with angulated screw channel abutment was provided. Clinical and radiographic examinations were performed 1 and 12 months after placement of the restoration. Patients' satisfaction was scored prior to treatment and after 12 months with the restoration in function. Primary outcome measure was success of the restoration., Results: All patients could be evaluated after 12 months. Success of the restorations was 100%. From loading to the 12-month follow-up, the mean marginal bone loss was 0.16 mm (SD: 0.26). Mean scores for plaque, calculus, peri-implant mucosa, bleeding, and pocket probing depth were low, depicting healthy peri-implant conditions. Patients' satisfaction was high and had improved after treatment., Conclusion: Full-contour zirconia implant-supported restorations with angulated screw channel abutments in the molar region have an excellent clinical performance after 1 year of function., (© 2019 The Authors. Clinical Implant Dentistry and Related Research Published by Wiley Periodicals, Inc.)

Objectives: To assess clinical, radiographic and aesthetic outcomes, and satisfaction of patients treated with single implant restorations in the maxillary aesthetic region 5 years after final restoration., Material and Methods: Sixty patients (29 male/31 female, mean age 37 years) with a missing anterior tooth in the maxilla (39 central incisors/10 lateral incisors/5 cuspids/6 first premolars) received a bone-level implant with conical connection. In 29 patients, a bone augmentation procedure was necessary before implant placement (autogenous bone grafts mixed with spongiosa granules). All implants (12 with 3.3 mm diameter/ 48 with 4.1 mm diameter) were loaded after 3 months of submerged healing. The restoration consisted of an individually designed full-zirconia abutment veneered with porcelain. Follow-up with clinical and radiographic assessment was conducted until 60 months after the final restoration. Aesthetic outcome of the restoration was determined with the Pink Esthetic Score-White Esthetic Score (PES-WES). Patient satisfaction was assessed with a VAS scale and satisfaction questionnaire., Results: Fifty patients completed the 5-year follow-up. Implant survival was 100%, restoration survival 98%. Mean bone-level change was -0.13 ± 0.66 mm with a median (IQR) pocket probing depth of 2.75 [2.25; 3.25]. The mean PES and WES scores were 6.6 ± 1.7 and 7.8 ± 1.5, respectively. Patient satisfaction was high (92.1 ± 7.8 on 100 mm VAS scale). There were no differences between patients with or without a bone augmentation procedure., Conclusion: Bone-level implants with a conical connection are a reliable treatment option in single-tooth replacements in the maxillary aesthetic zone., (© 2019 The Authors. Clinical Oral Implants Research published by John Wiley & Sons Ltd.)

Purpose: Comparison of outcomes of maxillary implant overdentures retained by use of either locator attachments or bars in a 1-year randomized controlled trial., Methods: Fifty edentulous participants received four maxillary implants. They were allocated to two groups (n = 25) differing in type of prosthetic attachment used to retain the maxillary prosthesis: either locator attachments or bars were applied. After one year, implant and overdenture survival was assessed. Peri-implant hygiene (Plaque-index, presence of calculus), soft tissue conditions (Gingiva-index, Sulcus Bleeding-index and pocket probing depth) and patient satisfaction (oral health impact profile (OHIP-49), denture complaints questionnaire and general satisfaction score (GSS)) were compared. The peri-implant bone level was estimated using intra-oral radiographs (student T-test)., Results: Implant survival was 96.7% in the locator group and 97.9% in the bar group. No overdentures had to be remade. Patient satisfaction was significantly greater in the bar group when rated by OHIP-49 sum score and by GSS. When comparing the denture complaints questionnaire and the separate OHIP-49 item scores, no significant difference was found. There was not a significant difference in hygiene and soft tissue conditions. Marginal bone loss was estimated 0.58 ± 0.71 mm for locators and 0.31 ± 0.47 mm for bars., Conclusions: Maxillary overdentures on four implants retained by bars or locators were compared. Bone loss was within an acceptable range for both groups after 1 year. However, less bone was lost in the bar group. Even though both treatment options improved patient satisfaction, bars seem to be particularly beneficial with regard to OHIP-49 sum score., (Copyright © 2019 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.)

Purpose: To evaluate the effect of placement of single implants in the esthetic zone of the maxilla in preserved alveolar ridges, compared with nonpreserved alveolar ridges, on the change in midlabial mucosal level, esthetics, marginal bone level, and patient satisfaction., Materials and Methods: Patients with a failing single tooth, and demonstrating a large vertical defect (≥ 5 mm) of the labial wall of the extraction socket, were pre-augmented with a mixture of autologous bone and anorganic bovine bone. A mucosal graft sealed the pocket. After 4 months, a single implant was placed in the preserved alveolar ridge (test group; n = 20). The results were compared with those from patients who had one missing tooth and were treated with placement of an implant in a nonpreserved alveolar ridge, whereby the connective tissue graft was combined with the placement of the implant (control group; n = 20). Changes in midlabial mucosal level were scored on intraoral images. Intraoral radiographs were made to assess marginal bone level changes after definitive crown placement (1 month [T 1 ], 12 [T 12 ] months). The pink esthetic score/white esthetic score at T 12 was used to determine esthetics. Patient satisfaction was assessed before treatment (T pre ), and at T 1 and T 12 ., Results: The mean midlabial mucosal level changes were 0.07 ± 0.29 mm and -0.15 ± 0.23 mm at T 1 and T 12 for the control and test groups, respectively (P = .01). No significant changes were observed for the other outcome variables., Conclusion: Single implant treatment in a preserved alveolar ridge and nonpreserved alveolar ridge is accompanied by clinically nonrelevant changes in the midlabial mucosal level. Changes in marginal bone level, esthetics, and patient satisfaction were comparable between the groups.

Purpose: To assess clinical performance of single restorations supported by 6-mm long implants in the posterior mandible after 5 years in function., Materials and Methods: Twenty-one consecutive patients with the absence of premolars or molars in the posterior mandible and an estimated bone volume of at least 6 mm in width and an estimated height of 8 mm between the top of the ridge and alveolar nerve were included. Each patient received one or more 6-mm implants. Custom-made titanium abutments with cemented zirconia-based porcelain crowns were placed after a 3-month osseointegration period. Data of clinical examinations and radiographs were assessed at placement of the restoration and 12 and 60 months thereafter. The patients answered a questionnaire to score the satisfaction before treatment and after 12 and 60 months with the restoration in function., Results: Implant survival was 100%. Five-years' mean marginal bone loss was 0.14 mm (SD: 0.4). Indices scores for plaque, calculus, gingiva, and bleeding were low as well as mean pocket-probing depth. Patients' satisfaction was high., Conclusion: Five-year follow-up data of this limited case series study revealed that 6-mm dental implants inserted in the resorbed posterior mandible provide a solid basis for single tooth restoration., (© 2019 The Authors. Clinical Implant Dentistry and Related Research Published by Wiley Periodicals, Inc.)

Background: Little is known about the impact of bone graft harvesting for pre-implant augmentation of the maxilla from a patient's perspective. To assess patient-reported outcome measures (PROMs) related to augmentation of the extremely resorbed edentulous maxilla with calvarial or anterior iliac crest bone., Materials and Methods: For this randomised controlled trial, 20 consecutive edentulous patients needing extensive pre-implant surgery of the maxilla were randomly assigned to either calvarial (n = 10) or anterior iliac crest (n = 10) bone harvesting. Patient reports on procedure-related satisfaction, questionnaires on oral functionality (denture satisfaction, chewing ability) and oral health-related quality of life (OHIP-49NL) and subjective donor site-related outcomes (e.g. of post-operative pain, scar formation, physical mobility) were assessed., Results: Irrespective of the harvesting site, patients were generally satisfied (median VAS score 93 (86-99) mm, p = 0.400) with the procedure and its final results. Post-operative pain was mild (median 40 (20-40) mm) and decreased to no pain (4 (0-16) mm) within 14 days. Early post-operative pain was significantly higher following anterior iliac crest harvesting (p < 0.00). Impact on physical mobility, daily functioning and satisfaction with the scar formation were similar in both groups., Conclusions: The assessed PROMs confirmed that bone graft harvesting from the calvarium or anterior iliac crest is an appropriate procedure, reflected by high levels of satisfaction, minor long-term sequela and improvement of perceived oral health. For clinical decision-making, decisions can be based on individual features and preferences., Trial Registration: NTR, NTR3968 , registered 1 July 2013.

Purpose: To prospectively assess long-term (20 year) clinical, radiographic, and patient-reported outcomes of an elderly population provided with mandibular implant-supported overdentures., Materials and Methods: A total of 53 elderly (aged ≥60 years at the time of treatment) were provided with two endosseous implants supporting a mandibular overdenture and a conventional maxillary denture. Outcome parameters-including implant loss, plaque index, gingival index, bleeding index, presence of calculus, probing depth, and satisfaction with implant-supported overdenture-were scored 1, 5, 10, and 20 years after prosthetic treatment. Radiographic analysis was performed to assess peri-implant bone changes. At the 20-year evaluation, frailty (Groningen Frailty Index) and quality of life (EuroQol 5D) were additionally assessed., Results: A total of 15 patients completed the 20-year follow-up. The 20-year implant survival rate was 92.5%. Plaque index, bleeding index, and probing depth increased slightly over time, while gingival index and presence of calculus remained unchanged. Radiographic analysis revealed minor marginal bone loss during the first 10 years and no further loss thereafter. Participants were very satisfied with their prosthesis and reported a good quality of life. At the 20-year evaluation, 64.3% of the patients were classified as frail., Conclusions: The long-term survival of implants supporting a mandibular overdenture is high. Although most elderly in the study became frail over time, peri-implant health and marginal bone level remained at a satisfactory level., (© 2019 The Authors. Clinical Implant Dentistry and Related Research Published by Wiley Periodicals, Inc.)

Implant treatment for two central incisors in the maxillary aesthetic region is complex due to concerns regarding inter-implant hard and soft tissue stability. A treatment protocol was therefore developed and implemented in a 1-year prospective case series study involving 16 patients with two failing or missing central incisors in the maxillary aesthetic region. The protocol consists of five options depending on whether teeth are still present (options 1-3) or not (options 4 and 5) and on the amount of bone available at the start of treatment: (1) extraction followed by immediate implant placement and provisionalization, (2) extraction followed by immediate implant placement and delayed provisionalization, (3) extraction followed by ridge preservation, delayed implant placement and immediate provisionalization, (4) delayed implant placement and guided bone regeneration with delayed provisionalization, (5) guided bone regeneration (extensive bone augmentation of the alveolar ridge), delayed implant placement, and delayed provisionalization. The patients were assessed regarding peri-implant hard and soft tissue parameters, aesthetic index score, and patient satisfaction. All treatment options showed good clinical and radiographic results and high patient satisfaction., (Copyright © 2019 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

There is need to get insight into condition-specific oral health-related quality of life in Dutch children with oligodontia. Between October 2014 and March 2017, 11-17-year-old oligodontia patients were approached to join a study assessing the impact of oligodontia on condition-specific oral health-related quality of life (OHrQoL). The patients received a condition-specific OHrQoL questionnaire prior to the start of orthodontic treatment. Non-oligodontia children in the same age group, but also requiring orthodontic treatment, were approached to serve as a control. The Fisher's Exact Test was used for comparison purposes with the control group because of the small group sizes. Furthermore, subgroup analyses were performed for gender, age, number of congenitally missing teeth, tooth agenesis in the aesthetic region, orthodontic classification and microdontia via independent t -tests. p -values of <0.05 were considered statistically significant. Twenty-eight oligodontia patients and 23 controls agreed to participate. The oligodontia patients' scores were comparable to the controls except for the items about dental appearance and treatment complexity. The impact of oligodontia on OHrQoL in youngsters is limited and mainly concerns dental appearance and the complexity of the treatment.

Aim: To assess the long-term effectiveness (≥5 years) of maxillary sinus floor augmentation (MSFA) procedures applying the lateral window technique and to determine possible differences in outcome between simultaneous and delayed implant placement, partially and fully edentulous patients and grafting procedures., Materials and Methods: MEDLINE (1950-May 2018), EMBASE (1966-May 2018) and Cochrane Central Register of Controlled Trials (1800-May 2018) were searched. Inclusion criteria were prospective studies with follow-up ≥5 years and a residual bone height ≤6 mm. Outcome measures included implant loss, peri-implant bone level change, suprastructure survival, patient-reported outcome measures and overall complications. Data were pooled and analysed using a random effects model., Results: Out of 2,873 selected articles, 11 studies fulfilled all inclusion criteria. Meta-analysis revealed a weighted annual implant loss of 0.43% (95% CI: 0.37%-0.49%). Meta-regression analysis did not reveal significant differences in implant loss neither between edentulous and dentate patients nor implants placed simultaneously with or delayed after MSFA, nor implants placed in MSFA using solely autologous bone or bone substitutes. The results of the other outcome measures were favourable, and overall complications were low., Conclusion: MSFA is a reliable procedure in the partially and fully edentulous maxilla for support of dental implants., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background and Aims: Bone augmentation procedures to enable dental implant placement are frequently performed. The remit of this working group was to evaluate the current evidence on the efficacy of regenerative measures for the reconstruction of alveolar ridge defects., Material and Methods: The discussions were based on four systematic reviews focusing on lateral bone augmentation with implant placement at a later stage, vertical bone augmentation, reconstructive treatment of peri-implantitis associated defects, and long-term results of lateral window sinus augmentation procedures., Results: A substantial body of evidence supports lateral bone augmentation prior to implant placement as a predictable procedure in order to gain sufficient ridge width for implant placement. Also, vertical ridge augmentation procedures were in many studies shown to be effective in treating deficient alveolar ridges to allow for dental implant placement. However, for both procedures the rate of associated complications was high. The adjunctive benefit of reconstructive measures for the treatment of peri-implantitis-related bone defects has only been assessed in a few RCTs. Meta-analyses demonstrated a benefit with regard to radiographic bone gain but not for clinical outcomes. Lateral window sinus floor augmentation was shown to be a reliable procedure in the long term for the partially and fully edentulous maxilla., Conclusions: The evaluated bone augmentation procedures were proven to be effective for the reconstruction of alveolar ridge defects. However, some procedures are demanding and bear a higher risk for post-operative complications., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The effect of maxillary implant overdentures on masticatory ability in edentulous patients with complaints regarding their conventional maxillary dentures is unknown., Purpose: To assess the change in objective masticatory ability (mixing ability index, MAI), patient reported masticatory ability (questionnaire), and patient satisfaction (GSS) after maxillary implant overdenture treatment with either solitary attachments or bars., Materials and Methods: Two groups randomly received four-implant maxillary overdentures on either solitary attachments (group I, n = 25) or bars (group II, n = 25). The MAI, questionnaire, and GSS were scored before (T0) and 12 months (T12) after treatment., Results: After treatment, both groups had significantly better MAI outcomes, better questionnaire scores and better GSS. Post-treatment questionnaire scores and GSS were significantly better for group II. Before treatment a strong, positive correlation between the MAI and the questionnaire was found for all participants who had had full conventional dentures combined (group I, n = 17; group II, n = 3)., Conclusion: Mixing ability was the same for all the participants treated with maxillary implant overdentures on either solitary attachments or bars. Patient reported masticatory ability and satisfaction was better for participants treated with maxillary implant overdentures on bars. There was a correlation between MAI and patient reported masticatory ability in participants with full conventional dentures., (© 2019 The Authors. Clinical Implant Dentistry and Related Research Published by Wiley Periodicals, Inc.)

Objective: To compare clinical and patient-reported outcomes when providing maxillary overdentures on four bar- and six bar-connected implants placed in the posterior region during a 5-year follow-up period., Materials and Methods: Sixty-six fully edentulous patients with functional maxillary denture complaints and insufficient bone volume to allow implant placement were scheduled for a maxillary sinus floor elevation procedure with bone from the anterior iliac crest and randomized to receive either four or six implants in the posterior maxilla and four implants in the mandible. After 3 months of osseointegration, a bar-supported overdenture was constructed. Maxillary implant survival, overdenture survival, clinical scores, peri-implant bone height changes and patient satisfaction were assessed., Results: Sixty patients completed the 5-year follow-up. Implant survival was 100% in the four-implant group and 99.5% in the six-implant group. No new overdentures had to be made in the four-implant group, and three new overdentures were made in the six-implant group due to excessive wear of the denture base and teeth (90.9% overdenture survival). Clinical parameters did not differ significantly between groups. Mean marginal bone loss compared to baseline was 0.58 ± 0.51 mm in the four-implant group and 0.60 ± 0.58 mm in the six-implant group, respectively. Overall, patient satisfaction improved significantly, but did not differ between groups., Conclusion: Following a bilateral maxillary sinus floor elevation procedure, a bar-supported overdenture on four implants in the posterior maxillary region is not inferior to an overdenture supported by six implants after a 5-year evaluation period in patients with functional maxillary denture complaints and marked posterior resorption (Clinical trial registration number: NTR2969)., (© 2019 The Authors. Clinical Oral Implants Research Published by John Wiley & Sons Ltd.)

Background: There is lack of studies regarding preservation and possible changes in BBT at dental implants., Purpose: To assess, on cone beam computer tomograms, the presence of bone at the time of tooth extraction in the maxillary esthetic region and the mean buccal bone thickness 1 month and 1 year after final restoration placement in patients with large bony defects., Material and Methods: In a cohort study, patients were selected presenting a failing tooth with a large bony defect (test group [n = 20]: large bony defect, immediate placed implant and delayed provisionalization). Results were compared with a group in which patients presented a failing tooth without or with a small bony defect: (control group [n = 20]: without or small bony defect, immediate placed implant and delayed provisionalization). Cone beam computer tomograms were made preoperatively, and 1 month and 1 year after placement of the restoration, and buccal bone thickness was analyzed., Results: In both groups approximately 1 mm of buccal bone thickness was present after 1 month and 1 year, without a significant difference between the groups., Conclusion: In patients with large bony defects at a failing tooth it was possible to create a bone layer buccally of the implant and this bone layer remained stable during a 1-year follow-up; there were no significant differences between thickness of buccal bone at 1 month and 1 year in patients with large buccal bony defects and patients without or with small bony defects., (© 2018 The Authors. Clinical Implant Dentistry and Related Research Published by Wiley Periodicals, Inc.)

Purpose: To assess the clinical performance of single crowns in the posterior maxilla supported by either 11-mm-long implants combined with maxillary sinus floor elevation surgery or 6-mm-long implants during a 5-year follow-up period., Materials and Methods: A total of 38 consecutive patients, missing a premolar or a molar in the posterior maxilla and residual bone height underneath the maxillary sinus between 6 to 8 mm, were included. Subjects were randomly allocated to receive one 11-mm-long implant in combination with maxillary sinus floor augmentation or to receive one 6-mm-long implant without any grafting. A total of 41 implants (21 implants in 20 patients in the 6-mm group, and 20 implants in 18 patients in the 11-mm group) were placed and subsequently restored after 3 months with custom-made titanium abutments and cemented zirconia-based porcelain crowns. Both groups were followed by clinical (implant survival, restoration survival, complications, pocket probing depth and presence of plaque, calculus, bleeding and peri-implant inflammation) and radiographic examinations up to 5 years. The patient satisfaction was scored before treatment, and 12 and 60 months after functional implant restoration., Results: One patient (11-mm group) died before the 12-month evaluation and one patient (6-mm group) moved away. In addition, one patient in the 6-mm group lost one implant and no implants were lost in the 11-mm group. Two patients lost three restorations in the 6-mm group and no restorations were lost in the 11-mm group. From loading until the 60-month assessment, the mean marginal bone loss in the 6-mm group and the 11-mm group was 0.12 ± 0.36 mm and 0.14 ± 0.63 mm, respectively, without a significant difference (mean difference 0.02 mm; 95% CI -0.32 to 0.37; P = 0.884). Implant loss, restoration loss, screw loosening and porcelain chipping were defined as complications. Four patients in the 6-mm group and one patient in the 11-mm group had one or more complications, without a significant difference between the groups (95% CI 0.019 to 0.244; P = 0.198). The patient satisfaction was high in both groups (mean overall satisfaction in the 6-mm and the 11-mm groups was 9.4 ± 0.8 and 9.2 ± 0.8, respectively; mean difference 0.2; 95% CI -0.33 to 0.76; P = 0.434)., Conclusions: Reconstructions performed using an 11-mm implant combined with maxillary sinus floor augmentation or a 6-mm implant in the resorbed posterior maxilla are equally successful in supporting a single restoration over 5 years., Competing Interests: Conflict of interest statement: This two-centre study has been partially sponsored by Dentsply Implants. None of the authors has an economic interest in the products related to this study or in the company.

Purpose: The aim of this study was to describe the surgical technique of immediate dental implant placement in calvarial grafts for augmentation of the severely resorbed maxilla and to assess the treatment results., Methods: In 13 patients the maxilla was augmented with calvarial bone followed by simultaneous dental implant placement (total: 68 implants). In the frontal "knife edge" region, implants were inserted in the buccal plated area. In the maxillary sinus area, implants were inserted into alveolar bone that was plated buccally or palatally through the sinus window. After 4 months, the implants were retrieved and subsequently loaded. Per-operative and post-operative variables were scored. One bone biopsy sample was taken for histological analysis., Results: The surgical procedure and wound healing was uneventful. During abutment connection after 4 months, all implants were fully osseointegrated with no signs of graft resorption. Radiographically, the mean (±SD) peri-implant bone loss after 1 year of functional loading was 0.23 ± 0.44 mm. No implants were lost. Histological examination revealed vital calvarial and maxillary bone with active remodeling., Conclusion: Immediate dental implant placement in calvarial bone grafts to rehabilitate severely resorbed maxilla is technically feasible and seems to have a high success rate., (Copyright © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

A 74-year-old woman needed a subtotal bilateral maxillectomy due to squamous cell carcinoma of the palate. Immediate and secondary reconstruction of the defect was not feasible, so the defect was closed with an obturator prosthesis wired to the zygoma complex. To improve the patient's severely impaired speech and swallowing, a patient-specific sub-periosteal implant (psSPI) was designed that matched the remnants of the zygoma complex. First, the patient's post-surgical anatomy was visualized through segmentation of the pre- and post-maxillectomy computed tomography data. Next, based on the data, a customized zygoma-supported framework was designed to support the obturator prosthesis. Surgical guides for intraoperative navigation were designed and three-dimensionally printed, along with an obturator prosthesis to fit the planned outcome situation. The preoperatively manufactured psSPI and obturator prosthesis matched the intraoperative conditions. The postoperative results were favourable; within a week after surgery the patient could speak and swallow normally without nasal leakage. No problems occurred during follow-up. These results indicate that a psSPI-retained prosthesis can be considered for the restoration of speech and oral functioning in cases with a largely compromised maxillary bone anatomy, accompanied by impaired oral functioning and no feasible conventional reconstruction options., (Copyright © 2018 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Autogenous bone graft harvesting is still commonly considered the gold standard for the reconstruction of a severely resorbed maxillary alveolar ridge; however, the preferred donor site remains a subject of debate. This study compared the morbidity of calvarial and iliac crest donor sites after harvesting. Twenty edentulous patients with an insufficient volume of maxillary bone for reliable implant placement were assigned randomly to either calvarial (n=10) or anterior iliac crest (n=10) bone harvesting groups. All patients underwent a maxillary sinus floor elevation procedure combined with widening of the alveolar process using buccal bone blocks. Donor site morbidity was assessed before, during, and at 1year after the surgery through patient questionnaires, physical examination, and medical records. No perioperative complications occurred. The anterior iliac crest group reported minor postoperative pain after harvesting. The scars after calvaria harvesting were significantly longer (P=0.003), but this was not bothersome for the group of patients. Long-term pain was negligible and satisfaction was high in both groups. Both the calvaria and anterior iliac crest are associated with low long-term donor site morbidity and high patient satisfaction. Thus, patient-centred decision-making is appropriate when selecting the preferred harvesting method for that patient., (Copyright © 2018 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Statement of Problem: Long-term assessments of implant survival and treatment outcome in patients with oligodontia are lacking., Purpose: The purpose of this retrospective clinical study was to assess which factors determine a long-term implant survival and treatment outcome of up to 25 years in a cohort of patients with oligodontia., Material and Methods: The medical records of all patients with oligodontia treated with fixed implant prosthodontics between January 1991 and December 2015 in the Department of Oral and Maxillofacial Surgery at the University Medical Center Groningen, the Netherlands, were assessed. Specifically, this involved the retrieval of records on the need for and mode of bone augmentation, implant survival, and survival of and adverse events associated with the prosthodontics. The Kaplan-Meier estimator was used to analyze implant and superstructure survival. Log-rank tests were used to compare the survival of subgroups., Results: A total of 126 patients with oligodontia were treated with dental implants. Of the 777 implants in total, 56 were lost, resulting in a 5-year cumulative survival of 95.7% (95% confidence interval [CI], 94.2% to 97.2%) and a 10-year cumulative survival of 89.2% (95% CI, 86.2% to 92.2%). The survival of implants placed in regions where bone augmentation surgery had been performed was significantly lower. The 5-year cumulative superstructure survival was 90.5% (95% CI, 87.6% to 93.5%), and the 10-year cumulative superstructure survival was 80.3% (95% CI, 75.3% to 85.3%). The performance of the screw-retained and cemented superstructures was comparable, but the survival of single crowns was significantly higher than the survival of fixed partial dentures (P<.001)., Conclusions: Implant treatment is a predictable treatment option for patients with oligodontia with a favorable long-term outcome. Survival of implants in augmented areas is lower., (Copyright © 2018 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Translucent acrylic templates have been used to indicate implant positions for implant-retained extraoral prostheses; however, this procedure can be challenging, as the acrylic templates have to be positioned onto reflected skin flaps. The fabrication of an acrylic-based colorless template or duplicating an existing prosthesis can facilitate the location of extraoral implants. Spots can be created on templates to indicate the optimal position of the implants. Afterward, punching the skin to the bone with a very thick sharp needle or a small sharp bur will mark the desired implant position on the bone before reflecting the skin., (© 2016 by the American College of Prosthodontists.)

Objectives: High crown-to-implant ratios may lead to complications due to unfavorable occlusal forces, including nonaxial forces, on the bone surrounding the neck of the implant and within the connection of the crown and implant itself. The aim of this study was to perform a systematic review on the influence of crown-to-implant ratio of single-tooth, nonsplinted, implants on biological and technical complications., Materials and Methods: MEDLINE (1950-January 2018), EMBASE (1966-January 2018), and Cochrane Central Register of Controlled Trials database (1800-January 2018) were searched to identify eligible studies. Inclusion criteria were as follows: crown-to-implant ratio of single-tooth, nonsplinted, implant-supported restorations in the posterior maxilla or mandible and follow-up of at least 1 year. Main outcome measures were as follows: implant survival rate, marginal bone level changes, biological complications, and technical complications. Two reviewers independently assessed the articles. A meta-analysis was carried out for implant survival rate and peri-implant bone changes., Results: Of 154 primarily selected articles, eight studies fulfilled the inclusion criteria. Study groups presented a mean crown-to-implant ratio varying from 0.86 (with 10-mm implants) to 2.14 (with 6-mm implants). The meta-analysis showed an implant survival of more than 99% per year and mean peri-implant bone changes of <0.1 mm per year. Limited biological and technical complications were reported., Conclusion: Data reviewed in the current manuscript on crown-to-implant ratio, ranging from 0.86 to 2.14, of single-tooth, nonsplinted, implants did not demonstrate a high occurrence of biological or technical complications., (© 2018 The Authors. Clinical Oral Implants Research Published by John Wiley & Sons Ltd.)