Which type of attachment system is most effective for connecting implants to dentures?

For adults with complete tooth loss, the modern approach is to use implant dentures with attachment systems, these connect the implant to the undersurface of the dentures. The choice of the number of implants and the design of the attachments influences the success of the dentures, the amount of wear and tear, patient satisfaction, preference and cost. Continue reading

Maintaining the jaw bone to support dental implants

shutterstock_243013531When a tooth has been taken out, the bone around the tooth socket shrinks. Artificial teeth can be used to replace missing teeth following extractions. However, loss of bone width and depth after tooth extraction can affect how successful the implant will be. This is especially the case when artificial teeth (crowns or bridges) need to be held in place by dental implants inserted into the bone of the jaw where the original teeth used to be. If the bone has shrunk too much following the loss of teeth, it makes it difficult or impossible to put dental implants into the jaw. This in turn leads to gum shrinkage. A procedure known as socket preservation (ARP) may limit the shrinkage of bone following tooth loss although there is a need for evidence of its effectiveness. Several techniques and bone substitute materials can be used to fill the socket after tooth extraction. The socket may then be covered by gums or an artificial membrane and left to heal for several months. The aim is that the bone of the old tooth socket will have kept its shape and size allowing dental implants to be inserted to support crowns or bridges so that the patient’s appearance is improved and they can eat, talk and socialise with confidence. It is also hoped that the rate of failure of dental implants will be improved. Continue reading

Anchoring braces with dental implants or other surgical methods

shutterstock_126467393Orthodontic treatment is used to correct the alignment of teeth that are crooked or sticking out by moving the affected teeth. The teeth are straightened by using a brace. Sometimes there is unwanted movement of other teeth during the treatment. This is controlled by what is known as anchorage, or methods for stabilising these teeth. Conventionally, anchorage sites are inside the mouth (intraoral) using teeth for example, or alternatively outside the mouth (extraoral), using headgear devices attached to the head or neck. As an alternative to these conventional methods, surgical techniques have been developed to put dental implants into bone in the mouth to provide a firm structure for anchorage. This research reviews the evidence on these methods to find out which is most effective for anchorage in orthodontic treatment. Continue reading

Comparing dental implants – does material, surface coating or shape make a difference?

Dental implants

Missing teeth can sometimes be replaced with crowns, bridges or dentures, which may be attached to dental implants. Many different types of implant exist; more than 1,300 are available in different materials, shapes, sizes and with different surface characteristics or coatings. This newly updated review on the Cochrane Library compares the different types of implant, in terms of how often they fail and have to be removed. Failure could be biological and caused by bone loss or infection; or mechanical, where the implant itself fractures. Continue reading

Enabling dental implants: increasing the thickness of bone at the base of the sinus cavity

Maxillary_sinus_MRI_attrib Mark Hamilton

Attribution: Mark Hamilton, under Wikimedia Commons licence

This research seeks to determine whether and when it is necessary to increase the thickness of the bone layer (bone augmentation) at the base of the natural sinus cavity when inserting dental implants. The natural sinus cavity lies above the upper jaw, and can sometimes cause the bone at the back of the jaw to be too thin. This can become a problem when loading dental implants into the jaw. Dental implants offer an alternative way of replacing teeth; they look like screws and offer a stable base for artificial teeth to be anchored into.

When the bone is too thin to support the dental implants, there are a number of techniques that are used to create a thicker layer of bone at the base of the sinus cavity which are generally known as “sinus lift” procedures. These methods involve either taking bone from the patient (autogenous bone) or use of other biomaterials, or a combination of the two. Alternatively, a blood clot can be used as a base for the body to naturally form additional bone. Another option is to use short dental implants, if possible, these are 4 to 8.5mm long and do not require the same amount of bone for anchorage. Continue reading

Latest publications from the Cochrane Oral Health Group

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c. Hakan Svensson (Xauxa)

A new review, an updated review and a new protocol from the Cochrane Oral Health Group were published in the Cochrane Library in September.

Follow the links for more!

Interventions for managing relapse of the lower front teeth after orthodontic treatment
By Yongchun Yu, Jie Sun, Wenli Lai, Taixiang Wu, Stephen Koshy, Zongdao Shi

This review considers the effectiveness of fixed braces or removable retainers for managing relapse of lower front teeth after orthodontic treatment. Maintaining lower front teeth in the corrected position after orthodontic treatment is an important problem. However, this review found that there were no clinical trials which considered this question and that there was no evidence to support using one form of treatment for managing relapse over another.

Interventions for replacing missing teeth: dental implants in zygomatic bone for the rehabilitation of the severely deficient edentulous maxilla
By Marco Esposito and Helen Worthington

An updated search was conducted for this review, which considers the beneficial and harmful effects of long tooth implants passing through the sinus and into the cheekbone, as an alternative to procedures designed to build up missing bone in the jaw (such as bone grafting). No trials were found that compare zygomatic implants with conventional bone grafting.

Xylitol-containing products for preventing dental caries in children and adolescents
By Mohammad O Sharif, Farooq Ahmed, Helen V Worthington

Dental caries affects 60-90% of children as well as the majority of adults. This is a protocol for a new review which will examine whether xylitol – a sugar substitute – can help to prevent tooth decay. In this review we are specifically interested in xylitol-containing gels, toothpastes, varnishes, mouthrinses, chewing gums and sprays.

There is also a new editorial:

Other new and highlighted reviews:

Updated systematic reviews from the Oral Health Group

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c. Malcolm Koo under the Creative Commons Share-Alike License

Issue 7, 2013 of the Cochrane Library has been published, and features two new updates from the Cochrane Oral Health Group. Follow the links to read more!

New update: Interventions for replacing missing teeth: antibiotics at dental implant placement to prevent complications
By Marco Esposito, Maria Gabriella Grusovin and Helen V Worthington

This updated review looks at whether antibiotics should be given prior to dental implants to prevent infections which can threaten implant stability. Six randomized controlled trials were included, with 1,162 participants. All six of these trials compared the use of antibiotics to prevent infection (failures and complications) with no treatment or treatment with a placebo . The antibiotic used in all the trials was amoxicillin; doses and timing of doses varied, although most used a single dose taken just before the implant was placed. One of the trials, with 100 participants, also looked at different doses of amoxicillin taken at different times. It appears that the oral administration of two grams of amoxicillin one hour before placement of dental implants is effective in reducing implant failures. More specifically, giving antibiotics to 25 people will avoid one person experiencing early implant losses. It is still unclear whether postoperative antibiotics are beneficial, or which antibiotics work best.

New update: Fluoride varnishes for preventing dental caries in children and adolescents
by Valeria CC Marinho, Helen V Worthington, Tanya Walsh and Jan E Clarkson

This is an update of a review which looks at whether fluoride varnish is effective in preventing tooth decay in children. 22 randomized controlled trials were included, with a total of 12,455 participants. 13 of the trials looked at older children who have permanent (adult) teeth, and fluoride varnish was found to reduce decayed or missing teeth by 43%. Children who still have their baby or milk teeth were covered in 10 of the trials. For this group of children, fluoride varnish reduced decayed or missing teeth by 37%. The evidence produced has been found to be of moderate quality due to issues with trial designs.

Other highlights of the Cochrane Library, Issue 7 include: