Objective
To assess the 5-year survival of implant-supported single crowns (SCs) and to describe the incidence of biological, technical, and aesthetic complications. The focused question was: What is the survival rate of implants supporting single crowns and implant-supported crowns with a mean follow-up of 5 years and to which extent do biological, technical, and aesthetic complications occur?

Methods
A Medline search (2006–2011) was performed for clinical studies focusing on implant-supported SCs with a mean follow-up of at least 5 years. The search was complemented by an additional hand search and the inclusion of 24 studies from a previous systematic review (Jung et al. 2008a). Survival and complication rates were analyzed using random-effects Poisson's regression models to obtain summary estimates of 5- and 10-year proportions.

Results
Forty-six studies derived from an initial search count of 1083 titles and the complementary publications from the previous systematic review (Jung et al. 2008a) were selected and the data were extracted. Based on the meta-analysis, survival of implants supporting SCs at 5 years amounted to 97.2% (95% CI: 96.3–97.9%), and at 10 years amounted to 95.2% (95% CI: 91.8–97.2%). The survival of implant-supported SCs was 96.3% (95% CI: 94.2–97.6%) after 5 years and 89.4% (95% CI: 82.8–93.6%) after 10 years. For biological complications, a 5-year cumulative soft tissue complication rate of 7.1% (95% CI: 4.4–11.3%) and a cumulative complication rate for implants with bone loss >2 mm of 5.2% (95% CI: 3.1–8.6%) were calculated. Technical complications reached a cumulative incidence of 8.8% (95% CI: 5.1–15.0%) for screw-loosening, 4.1% (95% CI: 2.2–7.5%) for loss of retention, and 3.5% (95% CI: 2.4–5.2%) for fracture of the veneering material after 5 years. The cumulative 5-year aesthetic complication rate amounted to 7.1% (95% CI: 3.6–13.6%).

Conclusions
The outcomes of the meta-analysis demonstrated high implant survival rates for both the single tooth implants and the respective single crowns after 5 and 10 years. However, technical, biological, and aesthetic complications were frequent.

Systematic review of the survival rate and the incidence of biological, technical, and aesthetic complications of single crowns on implants reported in longitudinal studies with a mean follow-up of 5 years

Orthodontic pain, the most cited negative effect arising from orthodontic force application, is a major concern for parents, patients, and clinicians. Studies have reported this reaction to be a major deterrent to orthodontic treatment and an important reason for discontinuing treatment. Surprisingly this area, which requires attention in clinical practice as well as in research, is ignored as evidenced by the scarcity of publications on the topic in comparison with other areas of orthodontic research. This review attempts to organize the existing published literature regarding pain, which appears as part of orthodontic mechanotherapy and to address questions that might arise in a clinical setting from the viewpoint of clinicians and patients/parents. It also provides an overview of current management strategies employed for alleviating orthodontic pain.

Orthodontic pain: from causes to management--a review.

Recurrent aphthous ulcers today: a review of the growing knowledge

Lateral and frontal cephalometric analysis of a mixed longitudinal survey of 257 individuals with complete unilateral cleft lip and palate from the Oslo CLP Growth Archive is described. All subjects were treated and followed up by the Oslo CLP Team according to strictly defined protocols for treatment and documentation. Craniofacial form for this sample is generally similar to that reported for Caucasian children treated for this condition elsewhere.

A study of facial growth in patients with unilateral cleft lip and palate treated by the Oslo CLP Team.

SUMMARY The aims of this study were to investigate the intensity, location and duration of patients' discomfort following insertion of orthodontic appliances, and to examine for inter­ actions between patient age, gender, appliance type and the perception of pain. After insertion of orthodontic appliances, 170 patients received eight questionnaires, one they completed and returned after 4 h, then one daily for 7 days. The respondents' ages ranged from 8-53 years (median age 13 years 7 months); 45 per cent were male and 55 per cent female. Of the patients, 65 per cent reported pain after 4 hand 95 per cent after 24 h. After 7 days, 25 per cent of the patients still reported discomfort. Patients' pain intensity scores were significantly higher for the anterior than for the posterior teeth. On day 1, 16 per cent took analgesics and 18 per cent reported being awakened the first night. Comparing a 2 x 4 appliance, a full appliance in one arch and in both arches, no statistical differences were found for reported pain frequency, general intensity of pain, pain at the teeth, discomfort when biting and chewing and analgesic consumption. The perception of general pain intensity, analgesic consumption, pain when eating and the influence of discomfort on daily life were all significantly greater in girls than in boys. Patients younger than 13 years reported pain significantly less frequently than the older patients. The highest frequency of pain was found in the group of 13-16 year olds. The pain intensity did not differ among the age groups.

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Perception of pain as a result of orthodontic treatment with fixed appliances

In the present investigation the frequency of oral ulcers and pain in 161 orthodontic patients was recorded. Of all patients, 95% had experienced pain, but 84.5% said that the pain lasted a few days only. About 11% maintained that the treatment was constantly painful. Significantly more patients coming from private clinics complained of pain than those attending treatment at the Department of Orthodontics. About 50% said that activating or changing archwire was most annoying, whereas 28.7% said ulceration and 21% said headgear was the most annoying part of the treatment. According to 75% of the patients, sleeping habits were not influenced. Only eight patients reported truancy, and seven of these had done this only once. Of all patients, 6.2% had requested interim visits. Small wounds caused by the fixed appliance were reported by 75.8% of the patients, and 2.5% had suffered badly from ulceration caused by the fixed appliances. More girls than boys reported ulceration. There was a significant sex difference as regards recurrent aphthous ulceration (RAU). Increase in the frequency of RAU was reported by 23.1% of the girls and 9.6% of the boys while they had fixed appliances.

Traumatic ulcers and pain during orthodontic treatment.

In the present investigation the frequency of oral ulcers and pain in 79 adults orthodontic patients was recorded. Only four of all patients had never had oral ulceration during treatment, but 83% of the patients characterized the trouble as minor. About 47% of the patients said that ulcers caused by the fixed appliance were the most annoying part of the treatment, and 38% said that activation of the appliance caused the most discomfort. In about 63% of the patients there was less pain when the treatment had lasted for some months, and in 24% there was no significant change in the discomfort. The pain following activation lasted for only 2-3 days (71%), but 20% had pain for more than 3 days, and five individuals felt pain constantly. The recurrence of aphthous ulceration (RAU) was not significantly affected during the orthodontic treatment, and in only one case was there an increase in the occurrence of herpes labialis.

Traumatic ulcers and pain in adults during orthodontic treatment.

PURPOSE To measure the long-term changes of clinical crown height in patients treated with single-implant crowns and compare them to those of an adult population with normal dentition. MATERIALS AND METHODS The test group comprised 23 patients, consecutively restored with a total of 48 single-implant crowns in the anterior maxilla. Mean age was 26.1+/-11.4 years at inclusion. Original master casts were stored after treatment, and patients were recalled for new study casts an average of 15.8+/-0.74 years later. The control group comprised 141 dental students with a mean age of 22.9 +/-1.20 years at inclusion. Study casts were made at inclusion and after 10 (n = 141) and 20 years (n = 60). Clinical crown height was measured for maxillary anterior teeth, and data were pooled and compared regarding clinical crown height and changes in height. RESULTS Implant clinical crowns were an average of 0.6+/-1.04 mm longer than the contralateral teeth (P or = 1.0 mm increase or decrease of clinical crown height during 20 years, respectively. Initially, shorter teeth presented a trend (P < .05 to .001) of more mucosal recession than longer teeth. CONCLUSION Mean values of clinical crown height disguise significant individual variations of changes. To perform a risk evaluation for potential future mucosal recession, it could be suggested that greater changes in clinical crown height may occur in patients provided with implant-supported crowns than in untreated control subjects, possibly more for women than men, and more for initially shorter teeth than for longer adjacent teeth.

Changes of anterior clinical crown height in patients provided with single-implant restorations after more than 15 years of follow-up.

The purpose of this study was to examine occlusal changes in the adult dentition. Study models made at average ages of 23 and 34 years of 64 females and 80 males of Norwegian descent were measured. None of the subjects underwent orthodontic treatment or surgery during the observation period. The means of the measured changes were small, with none exceeding 0.55 mm, and were larger in males than in females. The most obvious finding in both sexes was a decrease of up to 2.5 mm in the mandibular anterior perimeter, with very few subjects showing an increase. Significant changes were found in mandibular intercanine width and intermolar distance in both arches. A significant decrease in maxillary arch perimeter was seen in females, but with smaller values than in the mandibular arch. Overjet and overbite decreased significantly only in males. For each variable in each sex, some subjects showed decreases and others showed increases, indicating that individual prediction may be difficult. However, very few subjects demonstrated increased space in the anterior segments.

Changes in occlusion between 23 and 34 years.

PURPOSE To analyze the prevalence and magnitude of tooth movements adjacent to single-implant crowns in a long-term study, and to discuss these changes in relation to changes in cephalometric measurements of a reference group after 10 years. MATERIALS AND METHODS Twenty-five of an original group of 39 patients, consecutively restored with single-implant crowns in the anterior maxilla, were included. The mean age was 25.4 years (SD: 10.0) at inclusion. Clinical photographs were taken at implant crown placement and at the final examination an average of 15.9 years (SD: 0.74) later. The reference group comprised 134 dental students with a mean age of 22.9 years (SD: 1.20) at inclusion. Cephalograms and study casts were made at inclusion and after 10 years. Study casts were also made after 20 years (n = 61). Tooth movements were assessed adjacent to the implant crowns according to a clinical index. For the reference group, cephalometric measurements were performed for anterior and posterior face height and gonion and nasion-sella line/mandibular line (NSL/ML) angles. Vertical overbite measurements were collected from the study casts. RESULTS Altogether, 28 implant crowns were included in the test group. Male patients presented a clinically stable situation without any signs of vertical tooth movement adjacent to the single-implant restorations in 11 of 20 implant sites, compared to none in female patients (P < .05). With regard to horizontal tooth movements, 55% of the sites showed palatal tooth movements, which were relatively more common in females. Both males and females presented a significant average increase of anterior and posterior face height (P < .05), but only females presented a significant increase of the NSL/ML angle. Average vertical overbite was basically stable for 20 years, but individual variations were obvious. CONCLUSIONS A possible relationship between significantly higher incidence of tooth movements adjacent to implants in females in the study group and significantly greater increase of anterior face height and posterior rotation of the mandible in the female reference group was observed.

Olav Bondevik

Papers

Traumatic ulcers and pain during orthodontic treatment.

Traumatic ulcers and pain in adults during orthodontic treatment.

Changes of anterior clinical crown height in patients provided with single-implant restorations after more than 15 years of follow-up.

Changes in occlusion between 23 and 34 years.

Tooth movements adjacent to single-implant restorations after more than 15 years of follow-up.