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.

Kaizen: The key to Japan‚s competitive success

Evidence from cross-sectional and case-control studies in various populations demonstrates that adult smokers are approximately three times as likely as non-smokers to have periodontitis. The association between smoking and attachment loss is even stronger when the definition of periodontitis is restricted to the most severely affected subjects. Smokers have a diminished response to periodontal therapy and show approximately half as much improvement in probing depths and clinical attachment levels following non-surgical and various surgical modalities of therapy. Implant failures in smokers are twice those of non-smokers, with a higher failure rate in the maxillary arch accounting for the majority of the difference. Tobacco-induced alterations in microbial and host factors contribute to these deleterious effects of smoking on the periodontium. In longitudinal studies, the rate of periodontal disease progression is increased in smokers, but decreases to that of a non-smoker following tobacco cessation. Likewise, recent non-smokers respond to periodontal therapy in a manner similar to patients who have never smoked. Data regarding the impact of smoking on periodontal status included in this review will be helpful to dental health professionals as they counsel their patients regarding tobacco use. The role of dental health professionals in tobacco cessation is discussed, including the use of the five A's: ask--identify tobacco users; advise--advise them to quit; assess--evaluate the patient's readiness to quit; assist--offer assistance in cessation; and arrange--follow up on the patient's cessation efforts. The addition of pharmacotherapy to behavioral therapy, including nicotine replacement therapy and bupropion, can increase cessation rates. The most popular form of nicotine replacement therapy is the patch, and its use has been shown to double cessation rates compared to behavioral therapy alone. Use of bupropion in combination with nicotine replacement therapy may be particularly helpful for heavy smokers or smokers who have experienced multiple failed attempts at cessation. The American Academy of Periodontology Parameters of Care include tobacco cessation as a part of periodontal therapy, and the 2000 Surgeon General's Report on Oral Health in America encourages dental professionals to become more active in tobacco cessation counseling. Doing so will have far-reaching positive effects on our patients' oral and general health.

Cigarette smoking and the periodontal patient.

The impact of cigarette smoking on periodontal disease and treatment

This study reviews the literature regarding the factors contributing to failures of dental implants. An electronic search was undertaken including papers from 2004 onwards. The titles and abstracts from these results were read to identify studies within the selection criteria. All reference lists of the selected studies were then hand-searched, this time without time restrictions. A narrative review discussed some findings from the first two parts where separate data from non-comparative studies may have indicated conclusions different from those possible to draw in the systematic analysis. It may be suggested that the following situations are correlated to increase the implant failure rate: a low insertion torque of implants that are planned to be immediately or early loaded, inexperienced surgeons inserting the implants, implant insertion in the maxilla, implant insertion in the posterior region of the jaws, implants in heavy smokers, implant insertion in bone qualities type III and IV, implant insertion in places with small bone volumes, use of shorter length implants, greater number of implants placed per patient, lack of initial implant stability, use of cylindrical (non-threaded) implants and prosthetic rehabilitation with implant-supported overdentures. Moreover, it may be suggested that the following situations may be correlated with an increase in the implant failure rate: use of the non-submerged technique, immediate loading, implant insertion in fresh extraction sockets, smaller diameter implants. Some recently published studies suggest that modern, moderately rough implants may present with similar results irrespective if placed in maxillas, in smoking patients or using only short implants.

Reasons for failures of oral implants

Background: The purpose of this study was to compare the incidence of the complications and survival rate related to dental implants among smokers and non-smokers, and to evaluate the influence of smoking by analyzing data of 959 implants placed in 261 patients during the years 1995 to 1998. Methods: Patients were divided into 3 groups: non-smokers, mild smokers (up to 10 cigarettes per day) and heavy smokers (more than 10 cigarettes per day); smokers were divided into 2 subgroups according to duration of smoking (less or more than 10 years). Complications included minor (spontaneous implant exposure), major (spontaneous implant exposure requiring surgical intervention), and implant failure. The influence of smoking was analyzed for the type of implant cover screw and immediate versus late implantation. Results: The overall failure rate was 2% for non-smokers and 4% for all smokers. Minor and major complications were found in higher percentages (46%) in the smoking groups than in the non-smoking group (31%). A significantly higher incidence of complications was found among smokers who received dental implants with high cover screws (63%) compared to those who received dental implants with flat cover screws (27%). Conclusions: This study establishes a relationship between implant complications and smoking, implant type (external or internal hex), and time of implantation as significant factors. A higher incidence of complications was found in the smoking group, especially in implants that had a high cover screw. Most complications will not lead to failures. Immediate implants failed less frequently than non-immediate implants. Limiting or reducing smoking habits will decrease complications of endosseous dental implants.

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Smoking and complications of endosseous dental implants.

Recurrent aphthous stomatitis (RAS) is a common, painful, and ulcerative disorder of the oral cavity of unknown etiology. No cure exists and medications aim to reduce pain associated with ulcers through topical applications or reduce outbreak frequency with systemic medications, many having serious side effects. The purpose of this pilot study was to evaluate the potential of a product to reduce the number of outbreaks of RAS ulcers. Propolis is a bee product used in some cultures as treatment for mouth ulcers. In this randomized, double-blind, placebo-controlled study, patients were assigned to take 500 mg of propolis or a placebo capsule daily. Subjects reported a baseline ulcer frequency and were contacted biweekly to record recurrences. Data were analyzed to determine if subjects had a decrease of 50% in outbreak frequency. The data indicated a statistically significant reduction of outbreaks in the propolis group (Fisher's exact test, one sided, p = 0.04). Patients in the propolis group also self-reported a significant improvement in their quality of life (p = 0.03). This study has shown propolis to be effective in decreasing the number of recurrences and improve the quality of life in patients who suffer from RAS. Propolis should be evaluated further in a larger sample clinical trial.

The effect of bee propolis on recurrent aphthous stomatitis: a pilot study

Statement of problem Providing the dental laboratory with an accurate replication of the hard and soft tissue of a patient is important. Therefore, it is essential to examine whether clinicians critically evaluate impressions routinely before sending them to the laboratory. Purpose This study evaluated the quality of impressions sent to commercial laboratories for the fabrication of fixed partial dentures (FPD) by describing the frequency of clinically detectable errors and by analyzing correlations between the various factors involved. Material and methods A total of 193 FPD impressions were evaluated, immediately after arrival at 11 dental laboratories, by 3 calibrated examiners. The impression technique and material used, tray type, and number of prepared units were recorded for each impression. Data relating to errors and faults, including defects in material polymerization, retention to tray, tissue contact by tray, crucial areas beyond tray borders, heavy-bodied material exposure through the wash material (for double-step impressions), inadequate union of materials, retraction cords embedded in impressions, and air bubbles, voids, or tears along the margin were also documented. The data were analyzed with the Pearson chi-square test (α=.05). Results Of the impressions, 89.1% had 1 or more observable errors. Significant correlations were found between material type and voids or tears at the finish line (Rv=0.17, P P Conclusions Within the limitations of this study, impressions made with polyethers had the most detectable errors, followed by condensation-type silicones. The high frequency of detectable errors found in impressions sent for FPD fabrication is of concern.

A clinical evaluation of fixed partial denture impressions

As experience with osseointegrated implants has grown, greater use has been made of placement in the posterior jaw. The aim of this study is to present the survival rate of 78 osseointegrated single implants, inserted in the molar area and to evaluate the prosthetic rehabilitation on these teeth. This retrospective study presents findings of 55 consecutive patients with 78 restored single osseointegrated implants in the molar area. The patients went through a clinical and radiological evaluation. The same maxillofacial surgeon inserted all implants. Three of the implants were inserted into the maxilla and 75 into the mandible; 4 of the 78 implants were immediate implants. The cumulative survival rate after one year was 93.6%. Follow-up was up to 80 months, with an average of 27 months. Out of all the implants, 6 failed (7.7%): 5 failed in the surgical stage, and 1 after prosthetic loading. The main implant failures were among the titanium screw implants. Prosthetic complications occurred in 11 cases (14%)...

Single Tooth Replacement of Missing Molars: A Retrospective Study of 78 Implants

The ‘ferrule effect’ is a long standing, accepted concept in dentistry that is a foundation principle for the restoration of teeth that have suffered advanced structure loss. A review of the literature based on a search in PubMed was performed looking at the various components of the ferrule effect, with particular attention to some of the less explored dimensions that infl uence the effectiveness of the ferrule when restoring severely broken down teeth. These include the width of the ferrule, the effect of a partial ferrule, the infl uence of both, the type of the restored tooth and the lateral loads present as well as the well established 2 mm ferrule height rule. The literature was collaborated and a classifi cation based on risk assessment was derived from the available evidence. The system categorises teeth according to the effectiveness of ferrule effect that can be achieved based on the remaining amount of sound tooth structure. Furthermore, risk assessment for failure can be performed so that the practitioner and patient can better understand the prognosis of restoring a particular tooth. Clinical recommendations were extrapolated and presented as guidelines so as to improve the predictability and outcome of treatment when restoring structurally compromised teeth. The evidence relating to restoring the endodontic treated tooth with extensive destruction is defi cient. This article aims to rethink ferrule by looking at other aspects of this accepted concept, and proposes a paradigm shift in the way it is thought of and utilised.

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Nachum Samet

Papers

Smoking and complications of endosseous dental implants.

The effect of bee propolis on recurrent aphthous stomatitis: a pilot study

A clinical evaluation of fixed partial denture impressions

Single Tooth Replacement of Missing Molars: A Retrospective Study of 78 Implants

Rethinking ferrule – a new approach to an old dilemma