Interventions For The Replacing Missing Teeth Essay
Interventions For The Replacing Missing Teeth Essay
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Introduction:
An end osseous implant is also known as a dental implant or fixture, it is a surgical component which provides support to the dental prosthesis by linking it to the jaw bone. It also can act as the orthodontic anchor in certain cases. Interventions For The Replacing Missing Teeth Essay. The process that is used in case of instillation of modern dental implant devices is the process of osseointegration. Other two techniques that are abundantly used in case of the endosseous implanting are extracoronal technique which wires the implant with the adjacent teeth. The other technique utilizes intracoronal techniques like inlay splinting and parallel or nonparallel pin splinting (1).
It has to be mentioned that loss of teeth is a very common problem which is facilitated by the lack of bone support that eventually leads to an unfavourable crown to root ratio. The endosseous implant is an abundantly utilized technique used in such cases. Although loss of teeth can occur to adults as well, the most prevalence has been reported in the elderly population. Hence the most plausible target market in this case is the elderly population, preferably the age group of 70 and above.
Design Of An Endosseous Implant:
Endosseous implants are the most common dental implant designs that are found and utilized. It has a more or less complex design when compared to the other types og dental implants. This type of implants is generally positioned inside or within the jaw bone to gain the optimal support from the bone by the process of osseointegration.Interventions For The Replacing Missing Teeth Essay/ The shape of the implants can vary however; the shape generally conforms to the natural root (2). However, the screw resembling design of the implants is also commonly utilized. The material that is used in case of the dental implants are generally the titanium or titanium alloy. Along with that, the surface of the implants are often coated in order o create a textured surface so that osseointegration can be enhanced. There are primarily three basic components of the endosseous implants, the fixture, which is primarily the implant component that enlarges the bone. The second component is the transmucossal abutment, which provides the connection between the fixture and prosthesis. And the third and the final part of the dental implant is the prosthesis.
The material for this type of implant is mainly of two types metal and ceramic and the choice depends on the need of the patients or the implant components used. However, metallic implants are more abundantly used in clinical setting and the metals generally used are titanium and gold
Background: Dental implants are available in different materials, shapes and with different surface characteristics. In particular, numerous implant surface modifications have been developed for enhancing clinical performances. Objectives: To test the null hypothesis of no difference in clinical performance between various root-formed osseointegrated dental implant types. Search strategy: We searched the Cochrane Oral Health Group’s Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Handsearching included several dental journals. We checked the bibliographies of relevant clinical trials and review articles for studies outside the handsearched journals. We wrote to authors of the identified randomised controlled trials (RCTs), to more than 55 oral implant manufacturers; we used personal contacts and we asked on an internet discussion group in an attempt to identify unpublished or ongoing RCTs. No language restriction was applied. The last electronic search was conducted on 28 June 2004. Selection criteria: All RCTs of oral implants comparing osseointegrated implants with different materials, shapes and surface properties having a follow up of at least 1 year. Data collection and analysis: Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two reviewers.Interventions For The Replacing Missing Teeth Essay. Results were expressed as random effects models using weighted mean differences for continuous outcomes and relative risk for dichotomous outcomes with 95% confidence intervals. Main results: Thirty-one different RCTs were identified. Twelve of these RCTs, reporting results from a total of 512 patients, were suitable for inclusion in the review. Twelve different implant types were compared with a follow up ranging from 1 to 5 years. All implants were made in commercially pure titanium and had different shapes and surface preparations. On a ‘per patient ‘ rather than ‘per implant’ basis no significant differences were observed between various implant types for implant failures. There were statistically significant differences for peri-implant bone level changes on intraoral radiographs in three comparisons in two trials. In one trial there was more bone loss only at 1 year for IMZ implants compared to Branemark (mean difference 0.60 mm; 95% CI 0.01 to 1.10) and to ITI implants (mean difference 0.50 mm; 95% CI 0.01 to 0.99). In the other trial Southern implants displayed more bone loss at 5 years than Steri-Oss implants (mean difference -0.35 mm; 95% CI -0.70 to -0.01). However this difference disappeared in the meta-analysis. More implants with rough surfaces were affected by perimplantitis (RR 0.80; 95% CI 0.67 to 0.96) meaning that turned implant surfaces had a 20% reduction in risk of being affected by perimplantitis over a 3-year period. Authors’ conclusions: Based on the available results of RCTs, there is limited evidence showing that implants with relatively smooth (turned) surfaces are less prone to loose bone due to chronic infection (perimplantitis) than implants with rougher surfaces. On the other hand, there is no evidence showing that any particular type of dental implant has superior long-term success. These findings are based on a few RCTs, often at high risk of bias, with few participants and relatively short follow-up periods. More RCTs should be conducted, with follow up of at least 5 years including a sufficient number of patients to detect a true difference if any exists. Such trials should be reported according to the CONSORT recommendations (http://www.consort-statement.org/) Interventions For The Replacing Missing Teeth Essay.
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Background: To minimise the risk of implant failures after their placement, dental implants are kept load-free for 3 to 8 months to establish osseointegration (conventional loading). It would be beneficial if the healing period could be shortened without jeopardising implant success. Nowadays implants are loaded early and even immediately and it would be useful to know whether there is a difference in success rates between immediately and early loaded implants compared with conventionally loaded implants.
Objectives: To evaluate the effects of (1) immediate (within 1 week), early (between 1 week and 2 months), and conventional (after 2 months) loading of osseointegrated implants; (2) immediate occlusal versus non-occlusal loading and early occlusal versus non-occlusal loading; (3) direct loading versus progressive loading immediately, early and conventionally.
Search methods: The following electronic databases were searched: the Cochrane Oral Health Group’s Trials Register (to 8 June 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2012, Issue 4), MEDLINE via OVID (1946 to 8 June 2012) and EMBASE via OVID (1980 to 8 June 2012). Authors of identified trials were contacted to find unpublished randomised controlled trials (RCTs). There were no restrictions regarding language or date of publication.
Selection criteria: All RCTs of root-form osseointegrated dental implants, having a follow-up of 4 months to 1 year, comparing the same implant type immediately, early or conventionally loaded, occlusally or non-occlusally loaded, or progressively loaded or not. Outcome measures were: prosthesis and implant failures and radiographic marginal bone level changes.
Data collection and analysis: Data were independently extracted, in duplicate, by at least two review authors. Trial authors were contacted for missing information. Risk of bias was assessed for each trial by at least two review authors, and data were extracted independently, and in duplicate. Results were combined using fixed-effect models with mean differences (MD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI). A summary of findings table of the main findings was constructed. Interventions For The Replacing Missing Teeth Essay.
Main results: Forty-five RCTs were identified and, from these, 26 trials including a total of 1217 participants and 2120 implants were included. Three trials were at low risk of bias, 12 were at high risk of bias and for the remaining 11 the risk of bias was unclear. In nine of the included studies there were no prosthetic failures within the first year, with no implant failures in 7 studies and the mean rate of implant failure in all 26 trials was a low 2.5%. From 15 RCTs comparing immediate with convential loading there was no evidence of a difference in either prosthesis failure (RR 1.87; 95% CI 0.70 to 5.01; 8 trials) or implant failure (RR 1.65; 95% CI 0.68 to 3.98; 10 trials) in the first year, but there is some evidence of a small reduction in bone loss favouring immediate loading (MD -0.10 mm; 95% CI -0.20 to -0.01; P = 0.03; 9 trials), with some heterogeneity (Tau² = 0.01; Chi² = 14.37, df = 8 (P = 0.07); I² = 44%). However, this very small difference may not be clinically important. From three RCTs which compared early loading with conventional loading, there is insufficient evidence to determine whether or not there is a clinically important difference in prosthesis failure, implant failure or bone loss. Interventions For The Replacing Missing Teeth Essay. Six RCTs compared immediate and early loading and found insufficient evidence to determine whether or not there is a clinically important difference in prosthesis failure, implant failure or bone loss. From the two trials which compared occlusal loading with non-occlusal loading there is insufficient evidence to determine whether there is a clinically important difference in the outcomes of prosthesis failure, implant failure or bone loss. We did not identify any trials which evaluated progressive loading of implants.
Authors’ conclusions: Overall there was no convincing evidence of a clinically important difference in prosthesis failure, implant failure, or bone loss associated with different loading times of implants. More well-designed RCTs are needed and should be reported according to the CONSORT guidelines (www.consort-statement.org/).
Conflict of interest statement
Marco Esposito is among the authors of six of the included, and one of the excluded studies, however, he was not involved in the quality assessment of these trials. Marco Esposito is working as independent methodological consultant for various implant related projects for some of the companies whose implants were used both in the included and excluded trials, however, in this review, implant brands were not under evaluation. Interventions For The Replacing Missing Teeth Essay.
