Age as compromising factor for implant insertion.
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Adolescent↗
Biomedical subjects
Marc Quirynen
Publications and source records attributed to Marc Quirynen.
Clinical assessment and surgical implications of anatomic challenges in the anterior mandible.
BACKGROUND: The anterior mandible is generally considered a rather safe surgical area, involving few risks of damage to vital anatomic structures. Nevertheless, both neurosensory disturbances and hemorrhages have been reported after implant surgery in that particular area. PURPOSE: With the increasing demand for oral implant placement, the anatomy of the anterior mandible should receive more attention. This review will focus on the anatomic peculiarities of the anterior mandible and the related clinical implications. METHODS: The scientific evidence on the anatomic, histologic, physiologic, and clinical aspects of the neurovascularization of the anterior mandible will be reviewed. RESULTS: Surgical complications may be attributed to the existence of a mandibular incisive canal with a true neurovascular supply. Potential risks may also be related to the presence of the lingual foramen and anatomic variations, such as an anterior looping of the mental nerve. CONCLUSIONS: Preoperative radiographic planning for oral implant placement in the anterior mandible should therefore not only consider all esthetic and functional demands but should also pay particular attention to the anatomic peculiarities of this region to avoid any neurovascular complications.
Arteries↗
Can toothpaste or a toothbrush with antibacterial tufts prevent toothbrush contamination?
BACKGROUND: Periopathogens and cariogenic species survive more than 48 hours on toothbrushes even under dry storage. This study examined a decontamination of toothbrushes by means of the bactericidal effect of different toothpastes or a special coating of the tufts. METHODS: Eight untreated periodontitis patients were professionally brushed, using a new toothbrush per quadrant and 3 different toothpastes containing either amine/stannous fluoride (AmF/SnF2), amine fluoride (AmF), or a mild surfactant as major antibacterial component (excipient), or no paste (C). The brushes were rinsed and stored dry at room temperature. At different time intervals, 4 tufts per toothbrush were processed for selective and non-selective culturing procedures. The protocol was repeated comparing AmF/SnF2 and C with 2 toothbrushes with coated tufts (coat1 and coat2). RESULTS: At baseline, C brushes (n = 16) harbored 10(7), 10(8), and 10(6) colony forming units (CFU) of aerobic, anaerobic, and black pigmented species, respectively. After 24 hours 10(6) CFU of aerobic and anaerobic species could still be cultured from 14 of the 16 brushes. Black-pigmented species remained detectable up to 4 hours; detection frequencies for Fusobacterium nucleatum and Streptococcus mutans at 24 hours were 5/16. With AmF/SnF2 and AmF toothpaste the number of adhering bacteria was already 2 log lower at baseline (P<0.05), but not for the excipient (0.5 log, P = 0.7). With AmF/SnF2 no vital species could be detected after 8 hours. AmF reduced the bacterial survival rate significantly more than the excipient, but less than AmF/SnF2 (P<0.05). The bactericidal effect of coat1 and coat2 was negligible when compared to C (P>0.20), and clearly inferior to the AmF/SnF2 paste (P<0.0001). After 24 hours these brushes still harbored >10(5) CFU. CONCLUSIONS: Toothpastes can significantly reduce contamination of toothbrushes, but their bactericidal activity is dependent on their composition. Coated tufts failed to limit the bacterial contamination.
Adult↗
Adhesion of Porphyromonas gingivalis serotypes to pocket epithelium.
BACKGROUND: Porphyromonas gingivalis, a key pathogen in periodontitis, is able to adhere to and invade the pocket epithelium. Different capsular antigens of P. gingivalis have been identified (K-serotyping). These P. gingivalis capsular types show differences in adhesion capacity to human cell lines or to cells cultured on a feeder layer or stromal equivalent. METHODS: The adhesion capacity of different P. gingivalis serotypes (6 capsular types and non-encapsulated strains) was compared on in vitro cultured epithelial monolayers from periodontal pockets of patients with periodontitis. The degree of adherence of P. gingivalis was evaluated by both culture and fluorescence microscopy. RESULTS: Non-encapsulated strains adhered significantly more than their capsulated variants. Capsule type 4 (K-4) adhered slightly better than the remaining K-types. CONCLUSION: This study indicates that the presence and type of capsule have a significant influence on the initial adhesion of P. gingivalis to human periodontal pocket epithelial cells.
Adolescent↗
A salivary incubation test for evaluation of oral malodor: a pilot study.
BACKGROUND: Breath odor is scored by different techniques, each with its own shortcomings. Organoleptic ratings are uncomfortable for the patient, subjective, influenced by external parameters including food and cosmetics, and especially lack international calibration. Portable sulphide monitors are relatively expensive and neglect several major malodorous molecules (e.g., butyric and propionic acids, putrescine, and cadaverine). Gas chromatography necessitates expensive devices and experienced technicians. This pilot study explored the applicability of a new technique (saliva incubation) by comparing its discrimination power, in a morning bad breath inhibition study of antiseptics, to those of hydrogen sulphide (H2S) measurement devices and organoleptic ratings. METHODS: After a professional cleaning, 8 periodontally healthy students abstained from all means of mechanical plaque control for 5 experimental periods of 7 days, with intervening washout periods of at least 2 weeks. During each experimental period, the students rinsed only twice daily with different antiseptics. At day 7, morning breath was scored clinically (volatile sulphide compound [VSC] level and organoleptic ratings), and 1.5 ml of saliva was collected and divided between 3 glass tubes that were sealed and incubated (37 degrees C, anaerobic chamber). Immediately after collection and after 3 and 6 hours of incubation, the headspace air in one of the tubes was examined for VSC production and organoleptic measurements. RESULTS: The investigations of the incubated saliva correlated well with the 7-day intraoral VSC recordings and organoleptic ratings (P < or = 0.005). Moreover, evaluations showed a similar interproduct ranking for their efficacy in malodor control. The power analyses indicated a higher discrimination power for the saliva incubation test than for the intraoral registrations. CONCLUSIONS: The strong correlation between odor production of incubated saliva and clinical assessments suggests that the saliva incubation test may be used as an indirect method to measure oral malodor and can be employed to investigate the antimalodor effectiveness of oral hygiene products.
Adult↗
Review of the treatment strategies for oral malodour.
Breath malodour, a significant social and/or psychological handicap, may be caused by several intra- and extraoral factors. Malodour of intraoral origin is the result of microbial putrefaction, during which volatile sulphur compounds (VSC) and other volatile compounds are produced. The treatment of oral malodour can therefore be focused on the reduction of the intraoral bacterial load and/or the conversion of VSC to nonvolatile substrates. This article outlines the efficacy and mechanisms of different antimalodour approaches. Most approaches were found to be inefficient and/or short lasting. The most successful treatment involves mechanical debridement (including toothbrushing, flossing, and tongue cleaning), possibly combined with the use of an antimicrobial mouthrinse.
Anti-Infective Agents, Local↗
Infectious risks for oral implants: a review of the literature.
The use of oral implants in the rehabilitation of partially and fully edentulous patients is widely accepted even though failures do occur. The chance for implants to integrate can for example be jeopardised by the intra-oral presence of bacteria and concomitant inflammatory reactions. The longevity of osseointegrated implants can be compromised by occlusal overload and/or plaque-induced peri-implantitis, depending on the implant geometry and surface characteristics. Animal studies, cross-sectional and longitudinal observations in man, as well as association studies indicate that peri-implantitis is characterised by a microbiota comparable to that of periodontitis (high proportion of anaerobic Gram-negative rods, motile organisms and spirochetes), but this does not necessarily prove a causal relationship. However, in order to prevent such a bacterial shift, the following measures can be considered: periodontal health in the remaining dentition (to prevent bacterial translocation), the avoidance of deepened peri-implant pockets, and the use of a relatively smooth abutment and implant surface. Finally, periodontitis enhancing factors such as smoking and poor oral hygiene also increase the risk for peri-implantitis. Whether the susceptibility for periodontitis is related to that for peri-implantitis may vary according to the implant type and especially its surface topography.
Animals↗
Biologic outcome of implant-supported restorations in the treatment of partial edentulism. part I: a longitudinal clinical evaluation.
The purpose of this study was to predict the outcome of implant restorations in the treatment of partial edentulism, taking into account implant interdependency and the effect of several confounding variables. Between December 1982 and June 1998, 1956 Brånemark system implants (1212 and 744 in the maxilla and mandible, respectively, 846 distal to first premolars) were installed in 660 patients (248 males) at the Department of Periodontology of the University Hospitals of the Catholic University of Leuven. Of the 810 restorations installed at the Department of Prosthetic Dentistry of the same hospital, 235 were single crowns, 166 were supported by implants and teeth and 409 were free-standing fixed partial prostheses. An additional 87 restorations was placed in private dental offices and were not included. The patients were followed from implant installation until June 1999. The estimated cumulative survival rates were 91.4% for all implants and 95.8% for all restorations over a period of 16 years. Estimated cumulative survival rates from loading for implant-tooth connected and free-standing implants were, respectively, 93.6% and 97.2%. Neither jaw site nor implant position (anterior-posterior) had any significant effect on the outcome. Short implant length, high number of implants per patient, low number of implants per prosthesis, implants loaded by acrylic-veneered restorations and implants combined with bone grafting present a higher risk hazard for implant failure. The idea of not splinting the implants in a fixed partial prosthesis is promising but needs replication before accepting it.
Acrylic Resins↗
Biologic outcome of implant-supported restorations in the treatment of partial edentulism. Part 2: a longitudinal radiographic study.
The purpose of this study was to evaluate over time the marginal bone level changes around implants installed to treat partial edentulism and to investigate the possible effect of several confounding variables. Consecutive intraoral radiographs taken with the paralleling technique were used. In all, 660 partially edentulous patients ever treated in the departments (248 males; 15-83 years of age) with 1655 implants, which were successfully integrated at abutment connection, were loaded by means of fixed partial prostheses. The observation period starting at abutment connection reached 16 years (mean 5.1). Implants were divided into three groups: 235 implants supported single-tooth crowns, 398 supported implant-tooth connected and 1022 free-standing fixed partial prostheses. Implants were placed in maxilla and mandible, both anteriorly and posteriorly. No significant difference in bone level evolution was predicted between the three groups of implants, either for posterior or for anterior sites. The estimated marginal bone loss for the first 6 months is 0.31 mm/year and after that 0.015 mm/year higher in the maxilla than in the mandible. More bone loss was predicted for the first 6 months when dehiscences existed, when a membrane or a bone graft were used, or when metal/ceramic prosthesis material was applied. Age and gender did not affect the change in bone level. The use of subsequently situated single-implant crowns to restore an edentulous space did not lead to more marginal bone loss than around splinted implants. Based on marginal bone height maintenance, the excellent prognosis of the presently used implants to support restorations in the treatment of partial edentulism was confirmed.
Adolescent↗
The relative impact of local and endogenous patient-related factors on implant failure up to the abutment stage.
The aim of the present study was to assess the influence of endogenous and local factors on the occurrence of implant failure up to the abutment stage. The study comprised a group of 399 consecutive patients, which represented the total of patients who had been treated from 1995 to 1997 (with a total of 1263 Brånemark Brån-system implants) at the Department of Periodontology of the University Hospital, Catholic University Leuven. For each patient, the medical history was carefully examined. Data collection and analysis were mainly focused on endogenous factors such as hypertension, osteoporosis, hypo- or hyperthyroid function, chemotherapy, diabetes type I or II, Crohn's disease, some local factors (e.g. bone quality, reason for tooth loss) and breach of sterility during surgery. The reason for tooth loss, smoking habits, radiotherapy and other local bone factors (bone quality and quantity) were also recorded. Implant failures were recorded up to the abutment connection. The present study indicated a success rate until this stage of 97.8%. General factors such as heavy smoking, chemotherapy plus poor bone quality increased implant failure rate. Radiotherapy, limited bone volume and claustrophobia, which led to breaching the strict preoperative rules of asepsis, appeared to be the most relevant local factors for early implant failures.
Adolescent↗
The efficacy of amine fluoride/stannous fluoride in the suppression of morning breath odour.
BACKGROUND: Breath odour is a complaint encountered worldwide, often linked to microbial overload in the oral cavity. This double blind, crossover, randomised study assessed the efficacy of several antiseptic mouthrinses or slurry vs. a control solution in the prevention of morning bad breath during an experimental period of 7 days without mechanical plaque control. METHODS: Sixteen dental students with a healthy periodontium abolished, after a thorough professional cleaning, all means of mechanical plaque control during five experimental periods of 7 days, interleaved by washout periods of at least 3 weeks. During each experimental period, as the only oral hygiene measure, the students rinsed twice a day with one of the following formulations (in a randomised order): a 0.2% chlorhexidine-alcohol mouthrinse (CHX-Alc), a 0.05% CHX + 0.05% cetylpyridinium chloride + 0.14% zinc lactate mouthrinse (CHX-CPC-Zn), an amine fluoride/stannous fluoride (125 ppm F-/125 ppm F-) containing mouthrinse (AmF/SnF2Mr), a slurry of a tooth paste (AmF/SnF2Sl) containing amine fluoride (350 ppm F-) and stannous fluoride (1050 ppm F-) and a placebo solution (placebo). At days 0, 3 and 7, morning breath was scored via VSC level measurements of the mouth air, and organoleptic ratings of the mouth air and tongue coating. At the same visits both the degree of gingival inflammation and the de novo plaque formation were rated. At the end of each period a questionnaire for subjective ratings was completed and microbiological samples were taken from the tongue dorsum, the saliva and the supragingival plaque for anaerobic and aerobic culturing. RESULTS: Although oral hygiene during the experimental periods was limited to rinsing, bad breath parameters systematically improved (P < 0.001) with the three mouthrinses (CHX-Alc, CHX-CPC-Zn, AmF/SnF2Mr), with a superiority of the CHX-CPC-Zn solution when only VSC values were considered (P < 0.003). The AmF/SnF2 slurry and the placebo solution showed only minor changes with time. The three mouthrinses reduced significantly (P < 0.001) the bacterial load (aerobic & anaerobic) in the saliva (>or= 0.5 log reduction with a superiority (P < 0.005) for the CHX-Alc when compared to the two others). Changes in the bacterial load on the tongue dorsum could only be detected for the CHX-Alc solution (0.5 log). The antibacterial effect of the placebo solution and the slurry were negligible. The composition of microflora on the other hand did not reveal significant changes. The de novo supragingival plaque formation was significantly (P < 0.05) inhibited by the three mouthrinses with a slight superiority for the CHX-Alc solution. The degree of gingival inflammation at day 7 remained low (< 0.16) for all products. The CHX-Alc solution scored significantly worse for the subjective evaluation (questionnaires) concerning taste and sensitivity of tongue). CONCLUSIONS: The results of this study demonstrate that morning breath odour can be successfully reduced by the sole twice daily use of CHX-Alc, CHX-CPC-Zn or AmF/SnF2Mr mouthrinses, which all significantly reduced the bacterial load in the saliva and retarded the de novo plaque formation.
Adult↗
Rating of statements in an internal course evaluation: comparison between different groups of assessors.
The increased concern for accountability and quality improvement is inducing universities throughout Europe to evaluate and control performance. The establishment of criteria for educational quality, a requirement for a successful evaluation, was studied as part of an evaluation of the dental education programme at the Catholic University of Leuven. Criteria suggested by different groups (members of the internal evaluation commission including graduate and postgraduate students; members of the academic staff of the School of Dentistry, Oral Pathology and Maxillo-facial Surgery, and other members of the academic staff, not directly belonging to the school), were analysed by means of ANOVA with Scheffé posthoc tests to identify intergroup differences. It was hypothesized that a closer connection to the dental curriculum or a higher responsibility in the evaluation process would result in stricter criteria. For 108 different questions (in the form of statements with a six point Likert-type scale), members of the three groups had to indicate the score below which the quality would be considered suboptimal. Except for one question, no significant differences were found between ratings given by the members of the internal evaluation commission and other members of the School. Significant differences were found between non-school members and school- and/or commission-members. This study indicates that agreement on educational quality may be presupposed within an academic faculty and between members of the internal evaluation commission. However, the study also indicated that some caution should be exercised when 'external' teachers are included in the evaluation process.
Analysis of Variance↗
Topical antiseptics and antibiotics in the initial therapy of chronic adult periodontitis: microbiological aspects.
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Adult↗
Imaging technique selection for the preoperative planning of oral implants: a review of the literature.
BACKGROUND: As the use of oral implants for the treatment of partially as well as fully edentulous patients has increased the past two decades, more specialized radiographic techniques have become available for the preoperative planning of oral implant placement. PURPOSE: The goal of this article was to enable clinicians to select the appropriate imaging techniques when planning for oral implants. MATERIALS AND METHODS: This artide reviews the available literature about various imaging techniques and their indication for the preoperative planning of oral implants. The advantages and drawbacks of each technique are described. A dosimetric overview is given relative to different radiologic techniques used in various clinical situations. RESULTS: For preoperative planning of implant placement, advantages and drawbacks of the available imaging techniques have been considered, which allows guidelines for image technique selection to be formulated based on the clinical situation provided, considering the diagnostic yield of each technique and the radiation doses involved. CONCLUSIONS: From the available literature, it can be stated that many clinical situations demand the use of cross-sectional imaging techniques for optimal preoperative planning of implant placement. Nevertheless, such techniques are not required in cases in which the clinical examination reveals sufficient bone width and where standard radiographic examinations, such as intraoral and panoramic radiography, reveal adequate bone height and space for implant placement.
Dental Implantation, Endosseous↗
Prosthetic aspects and patient satisfaction with two-implant-retained mandibular overdentures: a 10-year randomized clinical study.
PURPOSE: This study aimed to compare the prosthetic aspects and patient satisfaction with prosthetic care in two-implant-retained mandibular overdentures, whether implants were splinted with a bar or left with magnets or ball attachments. MATERIALS AND METHODS: Thirty-six completely edentulous patients had two Brånemark implants placed in the mandibular canine area. A randomized procedure allocated patients into three groups of equal size, each with a different attachment system: bars, magnets, or balls. Prosthesis retention and mechanical as well as soft tissue complications were recorded in addition to patient satisfaction. A linear mixed model was fitted with attachment type and time as classification variables and adjusted by Turkey's multiple range test. RESULTS: Ball-retained overdentures showed at year 10 the greatest vertical retention force (1,327 g), followed by bars (1,067 g) and magnets (219 g). In the ball group, need for tightening of abutment screws was the most common mechanical complication; in the magnet and bar groups, respectively, the most common complications were wear and corrosion, and the need for clip activation. Prosthesis stability and chewing comfort for the overdenture were rated significantly lower for the magnet group compared to the ball and bar groups. Prosthesis stability of the maxillary denture was rated significantly lower in the bar group compared to ball and magnet groups. CONCLUSION: The ball group scored best in relation to retention of the overdenture, soft tissue complications, and patient satisfaction at year 10. The bar group scored lower for comfort and stability of the maxillary denture. Magnets offered patients the least comfort.
Adult↗
A 10-year randomized clinical trial on the influence of splinted and unsplinted oral implants retaining mandibular overdentures: peri-implant outcome.
PURPOSE: This randomized controlled clinical trial aimed to evaluate the efficacy of splinted implants versus unsplinted implants in overdenture therapy over a 10-year period. MATERIALS AND METHODS: The study sample comprised 36 completely edentulous patients, 17 men and 19 women (mean age 63.7 years). In each patient, 2 implants (Brånemark System, Nobel Biocare, Göteborg, Sweden) were placed in the interforaminal area. Three to 5 months after placement, they were connected to standard abutments. The patients were then rehabilitated with ball-retained overdentures, magnet-retained overdentures, or bar-retained overdentures (the control group). Patients were followed for 4, 12, 60, and 120 months post-abutment connection. Group means as well as linear regression models were fitted with attachment type and time as classification variables and corrected for simultaneous testing (Tukey). RESULTS: After 10 years, 9 patients had died and 1 was severely ill. Over 10 years, no implants failed. Mean Plaque Index, Bleeding Index, change in attachment level, Periotest values, and marginal bone level at the end of the follow-up period were not significantly different among the groups. DISCUSSION: The annual marginal bone loss, excluding the first months of remodeling, was comparable with that found around healthy natural teeth. CONCLUSION: The fact that no implants failed and that overall marginal bone loss after the first year of bone remodeling was limited suggested that implants in a 2-implant mandibular overdenture concept have an excellent prognosis in this patient population, irrespective of the attachment system used.
Adult↗
The importance of implant surface characteristics in the replacement of failed implants.
PURPOSE: The purpose of the study was to compare the failure rates of implants with either a machined surface or a TiUnite surface used to replace failing implants. MATERIALS AND METHODS: The files of 578 patients, ie, of all patients who were treated at the Department of Periodontology of the University Hospital in Leuven by means of oral implants during 3 recent consecutive years, were analyzed. The implants included in the study had an observation time ranging from 9 to 49 months. All patients had been provided with Brånemark System implants. Only 2 types of implant surfaces were used: machined and TiUnite. Data collection and analysis focused on the replacement implants, ie, implants placed at sites where the original implants had failed. Data were statistically analyzed by means of Statistica for Windows Software version 5.1; a Fisher exact P test was used. The level of significance was set at P = .05. RESULTS: A total of 41 patients experienced the nonintegration of 58 implants. Of those, 29 implants with a machined surface were replaced by implants with the same surface. Six of the replacement implants failed. Nineteen machined-surface implants were replaced by TiUnite surface implants; 1 failed. Ten TiUnite-surface implants were replaced by implants with the same surface; none failed. The difference in failure rate between machined-surface replacement implants and TiUnite replacement implants was statistically significant (P = .05). DISCUSSION: In addition to the usual patient-related compromising factors, replacement of a failing implant involves the challenge of achieving osseointegration in a nonpristine bone site. In the present study, implants with TiUnite surfaces were associated with fewer failures than machined-surface implants under the same conditions. CONCLUSION: An improved implant surface such as TiUnite may offer a better prognosis when a failed implant has to be replaced at the same site.
Adult↗
Facial development, continuous tooth eruption, and mesial drift as compromising factors for implant placement.
The replacement of teeth lost by children because of trauma can be an important indication for early implant therapy. Osseointegrated dental implants, like ankylosed teeth, alter position as growth-related changes occur within the jawbones (displacement, remodeling, mesial drift). Facial growth of the child and even of the adolescent, as well as the continuous eruption of the adjacent anterior teeth, create significant risk of a less favorable esthetic and/or functional outcome. For patients with a normal facial profile, the placement of an implant should be postponed until growth is complete. For patients with a short or long face type, further growth, especially the continuous eruption of adjacent teeth, creates a serious risk even after the age of 20 years, as illustrated by some recent clinical studies. This review aims to explain these phenomena and provides some recommendations for implant placement.
Adolescent↗