The International Journal of Prosthodontics, 01/2017

Purpose: The aim of this study was to outline how search strategies can be systematic, to examine how the searches in recent systematic reviews in prosthodontic and implant-related journals were structured, and to determine whether the search strategies used in those articles were systematic. Materials and Methods: A total of 103 articles published as systematic reviews and indexed in Medline between January 2013 and May 2016 were identified from eight prosthodontic and implant journals and reviewed. The search strategies were considered systematic when they met the following criteria: (1) more than one electronic database was searched, (2) more than one searcher was clearly involved, (3) both text words and indexing terms were clearly included in the search strategy, (4) a hand search of selected journals or reference lists was undertaken, (5) gray research was specifically sought, and (6) the articles were published in English and at least one other language. The data were tallied and qualitatively assessed. Results: The majority of articles reported on implants (54%), followed by toothsupported fixed prosthodontics (13%). A total of 23 different electronic resources were consulted, including Medline (by 100% of articles), the Cochrane Library (52%), and Embase (37%). The majority consulted more than one electronic resource (71%), clearly included more than one searcher (73%), and employed a hand search of either selected journals or reference lists (86%). Less than half used both text words and indexing terms to identify articles (42%), while 15% actively sought gray research. Articles published in languages other than English were considered in 63 reviews, but only 14 had no language restrictions. Of the 103 articles, 5 completed search strategies that met all 6 criteria, and a further 12 met 5 criteria. Two articles did not fulfill any of the criteria. Conclusion: More than 95% of recent prosthodontic and implant review articles published in the selected journals failed to use search strategies that were systematic, and this undermines the conclusions. Many resources are available to help investigators design search strategies for systematic reviews that minimize the risk of omitting important data, including the simple criteria presented in this paper.

Enamel renal syndrome (ERS) is a rare, commonly misdiagnosed condition that results in amelogenesis imperfecta and nephrocalcinosis and can lead to renal impairment in adulthood. This case history report describes a multidisciplinary dental management approach in a young adult patient with ERS.

This study aimed to compare the fracture resistance of composite core materials reinforced with varying fiber orientations. Composite cores of endodontically treated roots were prepared by reinforcing with woven fiber discs, fiber strips, or fiber chips, and their fracture resistance was compared to those with no reinforcement using a universal test machine (Instron, Lloyd Instruments). Reinforcement with fiber chips showed the highest fracture resistance and 50% retrievability, while no reinforcement showed the lowest fracture resistance with 62.5% retrievability. It can be concluded that the use of fiber chips may be an effective and practical method for reinforcement of the core material.

Purpose: This study aimed to analyze a possible gain in accuracy in intraoral scanning systems by manufacturer calibration. Materials and Methods: A master model was scanned tenfold with a Lava Chairside Oral Scanner (3m ESPE) and a CEREC Bluecam suspected to be decalibrated. Thereafter the scanners were calibrated and the model was scanned again. An iTero system served as comparison. All scans were compared to the master scan, and the mean deviation (entire arch, single tooth) was calculated. Results: After calibration, there was a significant gain in accuracy for both systems. Conclusions: Intraoral digital scanners may be sensitive to hardware decalibration invisible to the user and therefore need maintenance.

Purpose: This study investigated the stability of titanium screws in implant-abutment connections by measuring the force necessary to induce unscrewing. Materials and Methods: A total of 60 implant-abutment couplings were assigned to two groups (n = 30 each). The sequence 10-20-32 Ncm was tested in Group 1; the sequence 10-20-32-32-32 Ncm was tested in Group 2. The force necessary to unscrew each abutment-implant sample was recorded and statistically analyzed. The significance level was set at P < .05. Results: Significant differences were found between the two sequences. Group 2 required higher forces than Group 1 to unscrew. Conclusion: The stability of the implant-abutment joint may be improved by tightening with the sequence 10-20-32-32-32 Ncm.

Purpose: The aim of this study was to analyze the clinical fit of metal-frame partial removable dental prostheses (PRDPs) based on custom trays used with alginate or polyvinyl siloxane impression material. Materials and Methods: Fifth-year students of the Nijmegen Dental School made 25 correct impressions for 23 PRDPs for 21 patients using alginate, and 31 correct impressions for 30 PRDPs for 28 patients using polyvinyl siloxane. Clinical fit of the framework as a whole and of each retainer separately were evaluated by calibrated supervisors during framework try-in before (first evaluation) and after (second evaluation) possible adjustments (score 0 = poor fit, up to score 3 = good fit). Framework fit and fit of the denture base were evaluated at delivery (third evaluation). Finally, postinsertion sessions were evaluated and total number of sessions needed, sore spots, adjustments to the denture base, and reported food-impaction were recorded. Results: No significant differences in clinical fit (of the framework as a whole, for the retainers, or for the denture base) were found between the groups in the three evaluation sessions. Differences were not found for postinsertion sessions with one exception: in the alginate group, four subjects reported food impaction, versus none in the polyvinyl siloxane group. Conclusion: Clinical fit of metal-frame PRDPs based on impressions with custom trays combined with alginate or polyvinyl siloxane was similar.

Purpose: The aim of this study was to investigate the effect of Teethmate Desensitizer (TD), an aqueous slurry of calcium phosphates, on the pre- and postcementation sensitivity of contralateral premolars prepared for full-coverage restorations. Materials and Methods: In this clinical study, using a split-mouth design, 20 patients were allocated and two contralateral vital premolars per patient were randomly assigned to treatment with TD and placebo (PLA; distilled water). One day after preparation and temporization, sensitivity (PRE) upon air blast (AB) and probe scratch (PS) was determined using a 10-cm-long visual analog scale (VAS). The trial was double-blinded; neither the patient nor the investigator knew the treatment performed. Sensitivity was assessed immediately after treatment, before seating the final crowns after 1 week, and 1 month after cementation. Statistical data analysis was performed with one-way analysis of variance followed by Tukey post hoc test and two-sided paired t test. Statistical significance was determined at α < .05. Results: VAS scores upon stimulation with AB and PS were significantly lower at POST and 1 week, and with AB after 1 month. TD-treated teeth showed significantly less sensitivity than PLA. At the postcementation recall, TD and PLA were not significantly different and the average pain scores were almost 0. Conclusion: Treatment of teeth prepared for full crown restorations with TD can significantly reduce preand postcementation sensitivity.

Purpose: The aim of this multicenter single mandibular implant study was to compare the clinical outcome of an immediately loaded implant placed in the midline of an edentulous mandible with the clinical outcome when closed healing and delayed loading is chosen. Here, the patient recruitment period and the main reasons for exclusion were analyzed. Materials and Methods: Patient recruitment was performed at nine German universities. Rather conservative inclusion and exclusion criteria, including denture satisfaction, denture status, a psychologic symptom checklist, and a defined bone height in the posterior mandible, had to be fulfilled. It was initially calculated that 230 persons would have to be screened within 13 months to include 180 persons in the trial. Results: Within 13 months (December 2012 to December 2013), 201 patients were screened for possible inclusion in the trial and 148 met the inclusion criteria. Finally, after the recruitment period was extended by 2.5 months, 224 patients were screened and 169 were included. Of those screened, 55 (24.6%) did not meet the inclusion criteria and were excluded. Another 4 patients (1.8%) were excluded based on their psychologic symptom checklist score, while 5 others (2.8%) showed signs of noncompliance. A further 8 patients (4.4%) decided not to participate and withdrew their informed consent, and another 3 (1.3%) were no longer available after screening. Another 2 patients were excluded due to medical contraindications and 1 due to an insufficient mandibular denture. In 34 cases (15.2%), the residual bone height did not comply with McGarry type II or III. Conclusion: Within the limitations of this patient recruitment period, it can be concluded that residual bone height is the most important factor when considering elderly edentulous patients for implant therapy. The psychologic symptom checklist score was less important.

Purpose: The aim of the present study was to compare sociodemographic, behavioral, and educational characteristics, together with personality traits, on perceptions of individuals' own oral health and orofacial esthetics. Materials and Methods: The participants had different educational backgrounds: dentistry students and students not following health care-related courses (university groups), and volunteers with no university studies (nonstudent group). The age range was 18 to 30 years. Sociodemographic and behavioral data and data on facial and dental attractiveness were gathered via personalized interviews. Personality traits were measured using the Big Five Inventory (BFI) (extroversion, agreeableness, conscientiousness, neuroticism, openness), and the Life Orientation Test was used to measure optimism and pessimism. Results: No statistically significant differences were observed among the three educational groups regarding the mean scores on the five personality variables. The nonstudent group accorded significantly greater importance to tooth color, whereas the university groups considered tooth alignment more important (P = .016). The logistic regression model used to predict perceptions about orofacial health and esthetics revealed that underlying behavioral (pattern of visits to dentist and brushing habits), psychologic (pessimism and agreeableness), and educational (training in dentistry) factors affected the participants' perceptions of orofacial attractiveness, oral satisfaction, and self-rated oral health. Conclusions: The results of this study show that there are behavioral, psychologic, and educational factors that significantly modulate people's perceptions of orofacial esthetics, oral satisfaction, and self-rated oral health.

Purpose: This study evaluated the impact of angled abutments on strain in implants supporting a distal extension removable partial denture. Materials and Methods: An in vitro model of an implant supporting a distal extension removable partial denture was developed. The implant was positioned with a 17- or 30-degree mesial inclination, with either a healing abutment or a corrective multiunit abutment. Levels of strain under load were compared, and the results were compared using t test (P = .05). Results: Correcting angulation with a multiunit angled abutment significantly decreased strain (P < .05) when compared with a healing abutment. Conclusion: An angled abutment decreased the strain on an inclined implant significantly more than a healing abutment when loaded under a distal extension removable partial denture.

Hemifacial microsomia is the second most frequently encountered congenital facial anomaly after cleft lip and palate. This case history report describes a two-implant-supported auricular prosthetic reconstruction in a young patient with an absent auricle and malpositioned lobule. The selected treatment protocol was chosen because of its superior retention when compared with alternative retention systems. Moreover, a clip-bar attachment system is more reliable and easier to use when availability of anatomical landmarks is limited, and especially in active adolescents.

Purpose: Success rates for maxillary implant treatment are lower than for mandibular treatment because of the presence of poorer bone quality or quantity in the maxilla. The purpose of this study was to determine favorable implant positions in the maxilla using implant simulation software and clinical anatomical morphology together with bone quality data obtained by computed tomography (CT). Materials and Methods: A convenience research sample of 10 edentulous subjects was recruited, and research information from right and left edentulous sites was obtained from each subject. The height, width, angulation, and Hounsfield unit value of the maxillary alveolar bone were measured using CT data obtained from the subjects. Results: Bone height in the incisor area was significantly greater than in the molar area, and bone width in the incisor area was significantly narrower than in the molar area. The average bone quality in the maxillary molar area was significantly higher when compared with the premolar and incisor areas. The angle between the occlusal plane and the bisector of the alveolar bone in the incisor area was reduced when compared with the molar area. Conclusion: The premolar region appears to be the most favorable area in the maxillary arch for implant placement with regard to bone height, width, angulation, and quality.

Purpose: Lithium disilicate (LDS) glass-ceramic restorations are routinely used, but results over a period longer than 10 years are rare. The objective of this study was to obtain long-term clinical data on monolithic LDS posterior crowns provided by a single restorative dentist. Materials and Methods: Eligible patients who received a circumferential LDS crown in the posterior region between 1997 and 2010 were invited to participate in a clinical examination in 2015. This consisted of intraoral inspection and radiographs, performed by one observer and according to standardized criteria. Probability of survival was estimated using Kaplan-Meier survival analysis. Results: A total of 13 patients (n = 87 restorations) fulfilled the inclusion criteria. Of these, 12 patients were available for clinical evaluation (n = 74 restorations). After 5, 10, and 15 years, the cumulative chance of survival of the restoration was 92%, 85.5%, and 81.9%, respectively, with a median observation period of 12.8 years. Of the 74 restorations, 13 failed: 4 because of secondary caries, 2 because of debonding, and 7 because of fracture of the restoration. Conclusion: Lithium disilicate can be regarded as a strong and fracture-load-resistant restorative material providing reliable long-term clinical performance.

Many clinical studies and literature reviews have suggested that bar and ball attachments in maxillary and mandibular implant-supported overdentures (ISOs) should be indicated only when there is sufficient interocclusal space (IOS; minimum = 30 mm). The aim of this clinical report was to present the prosthetic rehabilitation of a patient with adenoid cystic carcinoma associated with microstomia due to radiotherapy (IOS = 23 mm). ISOs offer superior retention and greater stability than conventional obturators, so that base extensions were kept to the minimum. Placing the balls parallel to the prosthesis path of insertion is much easier with this treatment modality.

This study aimed to evaluate the effect of the configuration of implants supporting a four-unit fixed partial denture on load distribution. An epoxy resin model missing teeth from the first premolar to the second molar was used. Three-dimensional piezoelectric force transducers were set on implants placed in the missing teeth area with a four-unit experimental superstructure. Three-dimensional loads on the implants were measured with four different implant configurations when a static load of 100 N was applied. The loads on the implants changed significantly depending on the implant number and position and the applied loading points.

Purpose: The aim of this study was to compare the 5-year outcomes of glass fiber composite with cast posts and cores for the restoration of endodontically treated teeth. Materials and Methods: A total of 143 patients in need of 203 full ceramic restorations on endodontically treated teeth were included. After primary stratification based on the need for post or no post, teeth were randomly allotted to test group 1 (prefabricated glass fiber posts), 2 (custom-made glass fiber posts), or 3 (composite cores without posts). The control group was treated with gold alloy-based wrought posts and cast cores. Success (original present) and survival (present after intervention) probability lifetime curves, corrected for clustering, were drawn over the entire data set. Results: The mean follow-up time was 5.8 years (range: 0.5 to 7.2 years). At 5 years, the success and survival probabilities were 85.2% and 91.5%, respectively. Lifetime curves did not show any significant differences between the test and control groups for success (P = .85) or survival (P = .57). Moreover, no significant differences for success or survival could be found among the four groups (the three test groups and the control group). Conclusion: After 5 years of follow-up, cast gold and composite post-and-core systems on teeth with ceramic full restorations provided with a ferrule performed equally well.

Inflammatory papillary hyperplasia (IPH) is a benign lesion of the palatal mucosa. It is usually found in denture wearers but has also been reported in dentate patients with no history of wearing maxillary prostheses. This case history report describes an example of the latter and highlights the importance of professional awareness to diagnose IPH among non-denture-wearing patients.

The purpose of this study was to investigate the use and selection of materials for indirect restorations by dentists in Saudi Arabia. A structured 18-item questionnaire was designed and sent via email to all dentists with active memberships in the Saudi Dental Society. A total of 373 dentists (20.2%) out of the 1,846 contacted answered the questionnaire. The majority of the responding dentists (81.5%) prefer to use porcelain-fused-to-metal crowns for posterior teeth, while 77.5% use all-ceramic crowns for anterior teeth. Only 29.8% reported using computeraided design/computer-assisted manufacture in their practice. There was inconsistency among dentists in material selection, and this was affected by the dentist's gender, years of experience, specialty, and service sector.