An overview of zirconia ceramics: Basic properties and clinical applications

The purpose of this article is to identify the types of complications that have been reported in conjunction with endosseous root form implants and associated implant prostheses. A Medline and an extensive hand search were performed on English-language publications beginning in 1981. The searches focused on publications that contained clinical data regarding success/failure/complications. The complications were divided into the following 6 categories: surgical, implant loss, bone loss, peri-implant soft tissue, mechanical, and esthetic/phonetic. The raw data were combined from multiple studies and means calculated to identify trends noted in the incidences of complications. The most common implant complications (those with a greater than a 15% incidence) were loosening of the overdenture retentive mechanism (33%), implant loss in irradiated maxillae (25%), hemorrhage-related complications (24%), resin veneer fracture with fixed partial dentures (22%), implant loss with maxillary overdentures (21%), overdentures needing to be relined (19%), implant loss in type IV bone (16%), and overdenture clip/attachment fracture (16%). It was not possible to calculate an overall complications incidence for implant prostheses because there were not multiple clinical studies that simultaneously evaluated all or most of the categories of complications. Although the implant data had to be obtained from different studies, they do indicate a trend toward a greater incidence of complications with implant prostheses than single crowns, fixed partial dentures, all-ceramic crowns, resin-bonded prostheses, and posts and cores.

Clinical complications with implants and implant prostheses.

Objective: To systematically review the incidence of biological and technical complications in implant therapy reported in prospective longitudinal studies of at least 5 years.

Methods:  A MEDLINE search was conducted for prospective longitudinal studies with follow-up periods of at least 5 years. Screening and data abstraction were performed independently by multiple reviewers. The types of complications assessed were as follows: implant loss, sensory disturbance, soft tissue complications, peri-implantitis, bone loss ≥2.5 mm, implant fracture and technical complications related to implant components and suprastructures.

Results:  The search provided 1310 titles and abstracts, out of which 159 were selected for full-text analysis. Finally, 51 studies were included. Meta analysis of these studies indicated that implant loss prior to functional loading is to be expected to occur in about 2.5% of all implants placed in implant therapy including more than one implant and when routine procedures are used. Implant loss during function occurs in about 2–3% of implants supporting fixed reconstructions, while in overdenture therapy >5% of the implants can be expected to be lost during a 5-year period. Few studies (41% of those included) reported data on the incidence of persisting sensory disturbance >1 year following implant surgery. Most of the studies that provided such data reported on the absence or a low incidence (1–2%) of this complication beyond this interval. A higher incidence of soft tissue complications was reported for patients treated with implants supporting overdentures. There is limited information regarding the occurrence of peri-implantitis and implants exhibiting bone loss ≥2.5 mm. Implant fracture is a rare complication and occurs in <1% of all implants during a 5-year period. The incidence of technical complications related to implant components and suprastructures was higher in overdentures than in fixed reconstructions.

Conclusion:  Implant loss was most frequently described (reported in about 100% of studies), while biological complications were considered in only 40–60% and technical complications in only 60–80% of the studies. This observation indicates that data on the incidence of biological and technical complications may be underestimated and should be interpreted with caution.

A systematic review of the incidence of biological and technical complications in implant dentistry reported in prospective longitudinal studies of at least 5 years

Advancing dental implant surface technology--from micron- to nanotopography.

Statement of problem Developments in ceramic core materials such as lithium disilicate, aluminum oxide, and zirconium oxide have allowed more widespread application of all-ceramic restorations over the past 10 years. With a plethora of ceramic materials and systems currently available for use, an overview of the scientific literature on the efficacy of this treatment therapy is indicated. Purpose This article reviews the current literature covering all-ceramic materials and systems, with respect to survival, material properties, marginal and internal fit, cementation and bonding, and color and esthetics, and provides clinical recommendations for their use. Material and methods A comprehensive review of the literature was completed seeking evidence for the treatment of teeth with all-ceramic restorations. A search of English language peer-reviewed literature was undertaken using MEDLINE and PubMed with a focus on evidence-based research articles published between 1996 and 2006. A hand search of relevant dental journals was also completed. Randomized controlled trials, nonrandomized controlled studies, longitudinal experimental clinical studies, longitudinal prospective studies, and longitudinal retrospective studies were reviewed. The last search was conducted on June 12, 2007. Data supporting the clinical application of all-ceramic materials and systems was sought. Results The literature demonstrates that multiple all-ceramic materials and systems are currently available for clinical use, and there is not a single universal material or system for all clinical situations. The successful application is dependent upon the clinician to match the materials, manufacturing techniques, and cementation or bonding procedures, with the individual clinical situation. Conclusions Within the scope of this systematic review, there is no evidence to support the universal application of a single ceramic material and system for all clinical situations. Additional longitudinal clinical studies are required to advance the development of ceramic materials and systems.

Current ceramic materials and systems with clinical recommendations: A systematic review

A Abbe flap \ăb# e flăp\ [Robert Abbe, New York, N.Y. surgeon, 18511928]: eponym for a lip switch operation. A triangular, full thickness flap from the lower lip used to fill in a deficit in the upper lip. Specifically applied to the midportion of the upper or lower lip— called also lip switch operation Abbe, R. A new plastic operation for the relief of deformity due to double harelip. Med Rec 1898;53:477. ab duct \ăb dŭkt#\ vt (1834): to draw away from the median plane— comp ADDUCT ab er rant \ă-bĕr#ant\ adj (ca. 1798)1: a deviation from the normal or usual course, form, or location 2: straying from the normal way ab frac tion \ăb frăk#shun\ n (1991): the pathologic loss of hard tooth substance caused by biomechanical loading forces. Such loss is thought to be due to flexure and chemical fatigue degradation of enamel and/or dentin at some location distant from the actual point of loading—comp ABLATION, ABRASION, ATTRITION, and EROSION ab la tion \ă-bl a#shun\ n (15c) 1: separation or detachment; extirpation; eradication 2: removal of a part, especially by cutting—see ABFRACTION, EROSION abrade \uh-br ad#\ vt (1677): to rub away the external covering or layer of a part—comp ATTRITION, EROSION abra sion \ă-br a #shun\ n (1656) 1: the wearing away of a substance or structure (such as the skin or the teeth) through some unusual or abnormal mechanical process 2: an abnormal wearing away of the tooth substance by causes other than mastication—comp ATTRITION, EROSION abra sive \uh-br a # siv, -ziv\ n (1853): a substance used for abrading, smoothing, or polishing abra sive \uh-br a # siv, -ziv\ adj (1875) 1: tending to abrade 2: causing irritation—abra sive ly adv, abra sive ness n ab ra si vity \uh-br a#siv-ı̆-t e, -ziv-ı̆-t e\ v (1998): the property of one material to wear away another material by means of frictional contact absorbed dose \ab-sôrbd#,-zôrbd# d os\: the amount of energy from ionizing radiation absorbed per unit mass of matter, expressed in Gray units ab sorp tance \ab-sôrp#tans, -zôrp#tans\ n (ca. 1931): the ratio of the radiant energy absorbed by a body to that incident upon it ab sorp tion \ab-sôrp#shun, -zôrp#-\ n (1741) 1: the uptake of substances into or through tissues, e.g., mucosa, skin, and intestine 2: in radiology, the uptake of energy by matter with which the radiation interacts—see A. of RADIATION—comp ADSORPTION absorption of radiation \ab-sôrp#shun ŭv r a#d ea#shun\: collisionlike interactions between the individual particulate or quantum components of a beam of radiation and the subatomic parts of matter that occur at random during irradiation. Each interaction may result in partial or complete transfer of energy abut ment \a-bŭt#ment\ n (1634) 1: that part of a structure that directly receives thrust or pressure; an anchorage2: a tooth, a portion of a tooth, or that portion of a dental implant that serves to support and/or retain a prosthesis—usage see ANGULATED A., HEALING A., DENTAL IMPLANT A., INTERMEDIATE A., ONE PIECE A., PREPARATION PIECE A., STANDARD A., TWO PIECE A. DropB

The glossary of prosthodontic terms.

Statement of problem. There is no comprehensive review of the literature that identifies the complications reported in clinical dental implant studies. Purpose. This article attempted to determine the types of complications that have been reported and to provide data regarding their frequency. Methods. All available clinical studies from 1981 to 1997, published in English or with English abstract, that presented success/failure data regarding implant treatment were evaluated to determine the types of reported complications and to quantify implant loss as it relates to type of prosthesis, arch, time, implant length, and bone quality. Results. Greater implant loss occurred with overdentures than with other types of prostheses. There was greater loss in the maxilla than mandible with fixed complete dentures and overdentures, whereas little arch difference was noted with fixed partial dentures. Implant loss increased with short implants and poor bone quality. The time of implant loss (preprosthetic vs postprosthetic) varied with type of prosthesis. Surgical complications included neurosensory disturbance, hematoma, mandibular fracture, hemorrhage, and tooth devitalization. Initial and long-term marginal bone changes were identified. Peri-implant soft tissue complications included dehiscence, fistulas, and gingival inflammation/proliferation. Mechanical complications were screw loosening/fracture, implant fractures, framework, resin base and veneering material fractures, opposing prosthesis fractures, and overdenture mechanical retention problems. Some studies also presented phonetic and esthetic complications. Conclusions. Although the literature presents considerable information on implant complications, variations in study design and reporting procedures limited the available data and therefore precluded proper analysis of certain complications. (J Prosthet Dent 1999;81:537-52.)

Clinical complications of osseointegrated implants

The purpose of this article is to identify the incidence of complications and the most common complications associated with single crowns, fixed partial dentures, all-ceramic crowns, resin-bonded prostheses, and posts and cores. A Medline and an extensive hand search were performed on English-language publications covering the last 50 years. The searches focused on publications that contained clinical data regarding success/failure/complications. Within each type of prosthesis, raw data were combined from multiple studies and mean values calculated to determine what trends were noted in the studies. The lowest incidence of clinical complications was associated with all-ceramic crowns (8%). Posts and cores (10%) and conventional single crowns (11%) had comparable clinical complications incidences. Resin-bonded prostheses (26%) and conventional fixed partial dentures (27%) were found to have comparable clinical complications incidences. The 3 most common complications encountered with all-ceramic crowns were crown fracture (7%), loss of retention (2%), and need for endodontic treatment (1%). The 3 most common complications associated with posts and cores were post loosening (5%), root fracture (3%), and caries (2%). With single crowns, the 3 most common complications were need for endodontic treatment (3%), porcelain veneer fracture (3%), and loss of retention (2%). When fixed partial denture studies were reviewed, the 3 most commonly reported complications were caries (18% of abutments), need for endodontic treatment (11% of abutments), and loss of retention (7% of prostheses). The 3 most common complications associated with resin-bonded prostheses were prosthesis debonding (21%), tooth discoloration (18%), and caries (7%). (J Prosthet Dent 2003;90:31-41.) A complication has been defined 1 as “a secondary disease or condition developing in the course of a primary disease or condition.” Although complications may be an indication that clinical failure has occurred, this is not typically the case. It is also possible that complications may reflect substandard care. But once again, this is usually not true. Most of the time, complications are conditions that occur during or after appropriately performed fixed prosthodontic treatment procedures. Knowledge regarding the clinical complications that can occur in fixed prosthodontics enhances the clinician’s ability to complete a thorough diagnosis, develop the most appropriate treatment plan, communicate realistic expectations to patients, and plan the time intervalsneededforpost-treatmentcare.Althoughaplethora of articles present clinical complications data, none provide a comprehensive comparison of the complications associated with the most commonly used restorations/

Clinical complications in fixed prosthodontics

Statement of the problem. No recent literature has reviewed the current scientific knowledge on complete coverage tooth preparations. Purpose. This article traces the historic evolution of complete coverage tooth preparations and identifies guidelines for scientific tooth preparations. Material and methods. Literature covering 250 years of clinical practice was reviewed with emphasis on scientific data acquired during the last 50 years. Both a MEDLINE search and an extensive manual search were used to locate relevant articles written in English in the last 50 years. Results. Teeth should be prepared so that they exhibit the following characteristics: 10 to 20 degrees of total occlusal convergence, a minimal occlusocervical dimension of 4 mm for molars and 3 mm for other teeth, and an occlusocervical-to-faciolingual dimension ratio of 0.4 or greater. Facioproximal and linguoproximal line angles should be preserved whenever possible. When the above features are missing, the teeth should be modified with auxiliary resistance features such as axial grooves or boxes, preferably on proximal surfaces. Finish line selection should be based on the type of crown/retainer, esthetic requirements, ease of formation, and personal experience. Expectations of enhanced marginal fit with certain finish lines could not be validated by recent research. Esthetic requirements and tooth conditions determine finish line locations relative to the gingiva, with a supragingival location being more acceptable. Line angles should be rounded, and a reasonable degree of surface smoothness is desired. Conclusion. Nine scientific principles have been developed that ensure mechanical, biologic, and esthetic success for tooth preparation of complete coverage restorations. (J Prosthet Dent 2001;85:363-76.)

http://www.saudident.com/album/data/media/11/Tooth_preparations_for_complete_crowns_An_art_form_based_on_scientific_principles.pdf

Charles J. Goodacre

Papers

The glossary of prosthodontic terms.

Clinical complications with implants and implant prostheses.

Clinical complications of osseointegrated implants

Clinical complications in fixed prosthodontics

Tooth preparations for complete crowns: An art form based on scientific principles