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JADA Specialty Scan - Prosthodontics
Prosthodontics - A Quarterly Newsletter on Dental SpecialtiesJADA Specialty Scan

Implant failure, proton pump inhibitors association

Swedish researchers reported a possible association between patients' use of proton pump inhibitors (PPI) and dental implant failure in the September/October issue of The International Journal of Oral & Maxillofacial Implants.

PPIs inhibit acid output of the stomach and are a common treatment for acid-related disorders, such as gastroesophageal reflux disease or gastric ulcer.

In their retrospective cohort study, researchers hypothesized that intake of PPIs might be associated with increased risk of experiencing dental implant failure. They set out to describe and compare dental implant failure in a group of PPI users with a control group.

They used regression model analysis to consider 10,096 implants placed in 2,670 patients consecutively treated with implant-supported prostheses between 1980 and 2014 at the Clinic for Prosthodontics, Centre of Dental Specialist Care in Malmo, Sweden. Researchers included all complete cases of modern endosseous dental implants with cylindrical or conical design. They excluded zygomatic implants and implants detected in radiographs but not mentioned in the patients’ files.

PPI users were defined as those taking the medicament during the preoperative appointment, 1 to 2 weeks before implant placement. Verified PPIs included omeprazole, lansoprazole, dexlansoprazole, esomeprazole, pantoprazole, rabeprazole, and ilaprazole.

PPI status was the predictor variable. Implant failure was the outcome variable, with failure being an implant removed owing to precipitating signs and symptoms. Researchers considered many other variables, some of which included type of implant surface, implant location, patient’s sex and age, health factors, patient’s habits (such as smoking and bruxism), and use of medications such as antidepressants, immunosuppressives, and bisphosphonates.

Of the 10,096 implants placed in 2,670 patients, 3,559 implants placed in 999 patients were associated with information available for all study variables. A total of 67 PPI users received 250 implants and 932 nonusers received 3,309 implants. A total of 178 implants failed between both PPI users (30 of 250 [12%]) and nonusers (148 of 3,309 [4.5%]).

“The intake of PPIs was shown to have a statistically significant negative effect for implant survival rate,” the researchers wrote in their conclusion. They reported a hazard ratio of 2.811 (95% confidence interval, 1.139 to 6.937; P = .025).

Of the confounding variables, researchers identified bruxism, smoking, implant length, prophylactic antibiotic regimen, and implant location as factors that had statistically significant effect on the rate of implant survival. Confounders not significantly affecting implant survival rate included age, sex, implant diameter, implant surface, implant type, bone augmentation, former smokers, and the intake of antihypertensive, antidepressant, antithrombotic, and immunosuppressive drugs.

Researchers stated that the retrospective study model is one of the limits of their study, as this type of study is associated with flaws from gaps in information and incomplete records.

Read the original article.


Consulting Editor: Donald A. Curtis, DMD, FACP
Diplomate, American Board of Prosthodontics
Professor, University of California San Francisco

Systemic diseases and implant failure

For 31 years, researchers at Mayo Clinic in Rochester, MN, followed thousands of patients who received dental implants to determine if there were any associations between systemic conditions and dental implant failure. They published their findings in the September/October issue of The International Journal of Oral & Maxillofacial Implants.

Citing the growing significance of outcome research in health care decisions, including in dentistry, the researchers identified risk of implant failure as an important implant-related outcome to monitor and discuss. They noted that approximately one-half of all adults in the United States had 1 or more chronic health conditions, and 1 of 4 adults had 2 or more chronic health conditions in 2012.

“Given this prevalence, it is important to understand the potential impact of systemic conditions on oral reconstruction, including dental implants, to better predict individual patient risk,” the researchers wrote.

The researchers studied a series of consecutive patients who received dental implants from October 1, 1983, to December 31, 2014, in the Department of Dental Specialties at Mayo Clinic. They assessed 6,384 patients.

They extracted data from a prospective clinical database and electronic health records to obtain patients’ demographic, implant-specific, and medical profiles and to determine time to first implant failure. They used the Kaplan-Meier method to estimate survival of implants at the patient level and evaluated associations of demographic and systemic characteristics with implant failure using Cox proportional hazards regression models, summarizing with hazard ratios and 95% confidence intervals (CI).

The researchers identified more than 20 systemic diseases or conditions to assess, with 15 of these comprising more than 50 patients and 5 comprising more than 500 patients.

Their patient cohort was reduced to 6,358 patients with a median age of 53 years at the placement of first implant. Implant failure occurred in 713 patients at a median of 0.6 years. Researchers followed the remaining 5,645 patients who did not experience implant failure for a median duration of 5.8 years.

After adjusting all associations for age, sex, and era of implant, researchers concluded that none of 21 systemic diseases or conditions studied increased the risk of experiencing implant failure in the cohort.

A weakness that the researchers cited in their study was that they did not assess the level of disease management, obfuscating understanding of failure impact on disease or condition control.

Read the original article here.


Planmeca CALM
Our proprietary Planmeca CALM (Correction Algorithm for Latent Movement) addresses patient movement during a 3D scan. It’s an excellent solution for imaging patients who struggle to remain still during CBCT imaging. With Planmeca CALM, our CBCTs can analyze and compensate for slight movements during a scan to provide improved diagnostic images AND virtually eliminate retakes-less retakes equals less radiation.


Zirconia-ceramic and metal-ceramic restorations

A Swiss study published in the September/October issue of The International Journal of Prosthodontics compared survival, technological, and biological outcomes of posterior zirconia-ceramic (ZC) and metal-ceramic (MC) fixed dental prosthesis (FDP).
With MC being the “gold standard,” the researchers wrote, for FDPs, they sought to investigate the suitability of ZC as an option in light of patient demands for metal-free restorations.

In their 5-year, randomized controlled clinical trial, researchers randomly restored posterior FDP sites in 58 patients with 40 ZC and 36 MC FDPs, for a total of 76 FDPs. The researchers examined 52 of the patients with 40 ZC and 29 MC posterior FDPs, assessing the restorations at baseline (day of cementation) and annually.

Researchers later further reduced the data set. “Since some of the patients received more FDPs (> 1), 1 FDP per patient was selected at random for the statistical comparison of the treatment groups,” the researchers wrote.
Ultimately, the researchers statistically assessed a reduced data set of 52 patients with 52 FDPs (26 ZC and 26 MC). For statistical tools, they used nonparametric Mann-Whitney test for metric variables and Fisher exact test for categorical data to compare the 2 independent groups.

Following the guidelines for MC restorations, the researchers performed the same clinical treatment for both the MC and ZC FDPs. The baseline and annual examinations included “technical outcomes using modified US Public Health Service criteria, general periodontal parameters at abutment (test) and control teeth, sensitivity testing, and periapical x-rays.”

The researchers’ analysis revealed a 100% survival rate in both the ZC and MC groups at the 5-year mark. They found no significant differences between the 2 groups in their technical examination. For all of the biological parameters they analyzed, they found stable periodontal tissues with no significant differences between ZC and MC or between test and control teeth.

A main conclusion of the study is that the data it yielded indicate that ZC is an alternative to MC for posterior FDPs.

Read the original article here.


Intraoral digital scanners compared

A team of Medical University of South Carolina dental researchers evaluated 7 digital scanning systems for trueness and precision and published their findings in the July issue of The Journal of Prosthetic Dentistry.

“Deficiencies with elastomeric impression materials and techniques have been documented to support the need for new and better impression techniques,” the researchers wrote.

Intraoral digital impression has evolved so it has the ability to record complete arches from previous limits to single-tooth preparations and sextant scanning, researchers noted. They cited recent advances in chairside and laboratory digital technology, the emergence of newer and easier-to-use intraoral digital scanners, and the adoption of digital technology into dental school curriculum as elements spurring increased acceptance and wider use of digital technology in dentistry.

The 7 digital impressions systems they evaluated were CEREC Omnicam, CEREC Bluecam, Planmeca Planscan, Cadent iTero, Carestream 3500, 3Shape TRIOS 3, and 3Shape D800. Their null hypothesis was that no differences would be found between the various scanners regarding accuracy and precision in sextant and complete-arch scanning and that scanning time would not be related to the accuracy and precision of the scanners.

They evaluated the scanners—6 intraoral scanners and 1 laboratory scanner—in both sextant and complete-arch scenarios. They also evaluated time of scanning and correlated it to trueness and precision.

To conduct the study, researchers customized and fabricated a complete-arch model with refractive index similar to tooth structure. They scanned the model for posterior sextant and complete-arch scenarios using each of the 7 digital impression systems. For analysis, they measured discrepancies between the master model and experimental casts using 3-dimensional metrology software.

The researchers ranked the 7 scanner systems for trueness and precision, which they explain in detail in the study. Overall, they concluded that their null hypothesis was “partially rejected” due to significant differences in trueness and precision among some of the scanning systems, although not rejected for all relationships related to scanning time.

They acknowledged several limitations in their study, including using only investigators experienced in each scanning system (to minimize risk of operator bias and experience influencing the results). They also did not account for saliva, soft-tissue isolation, patient movement, humidity in the oral environment, or laboratory procedures after scanning. Thus, they advised interpreting their results cautiously.

Read the original article here.

The Planmeca difference

Solutions are a big part of the Planmeca ProMax 3D story. Our cone beam computed tomography units feature Planmeca Ultra-Low-Dose imaging, which achieves an average 77% radiation dose reduction without a statistical reduction in image quality. * This intelligent protocol can be used with all voxel sizes (75μm to 600μm) and in all imaging modes, from normal to endodontic.
Additionally, Planmeca Romexis open architecture software can allow clinicians to access numerous software upgrades and advances. This includes our Planmeca CALM (Correction Algorithm for Latent Movement) that addresses movement during a 3D scan. Planmeca CALM analyzes and compensates for slight movements to provide improved diagnostic images and virtually eliminate retakes.

Planmeca has a passion for innovation, integrity, and collaborative relationships. We develop solutions to help clinicians provide better, safer patient care, improve workflow and help strengthen their practices.

*According to “Dosimetry of Orthodontic Diagnostic FOVs Using Low Dose CBCT Protocol” by JB Ludlow and J Koivisto. For a copy of this study, contact Planmeca USA.

Digital Dentistry Symposium set for Feb. 20-21, 2018 in Chicago

All dental professionals are invited to attend the American College of Prosthodontists Digital Dentistry Symposium, Feb. 20-21 in Chicago. Featuring breakout sessions for novice, intermediate, and advanced users of digital technology, this symposium is designed for dental professionals who are interested in state-of-the-art digital solutions for the treatment of restorative patients. Topics include 3D diagnosis and treatment planning, clinical workflows, and design materials, with a focus on application in dental practice. Register at or call 312-573-1260.


Are your estate planning needs covered?

No matter what stage of your dental career you’re in, it’s important to be organized and prepared for the future when it comes to managing and protecting your assets. Tom Kacirek, vice president, Specialty Insurance Markets for Great-West Financial, discusses the importance of life insurance, disability insurance and effective risk management in his article, Do You Have All Your Estate Planning Needs Covered? The article is featured in the Fall 2017 issue of Dental Practice Success.

This is the third installment in ongoing series of estate planning articles prepared in cooperation with Great-West Financial, underwriter for ADA Members Insurance Plans. Other articles include Why You Need an Estate Plan and Common Mistakes with Estate Planning and Risk Management.


Low Dose, High Quality
Our exclusive Planmeca Ultra-Low Dose protocol enables 3D imaging with an even lower patient radiation dose - achieving an average of 77% reduction in radiation dose when compared with standard imaging protocols, without statistical reduction in image quality* allowing for multiple fields of view, and greater patient safety. *According to “Dosimetry of Orthodontic Diagnostic FOVs Using Low Dose CBCT Protocol” by JB Ludlow and J Koivisto. For a copy of this study visit:


JADA+ Specialty Scans and JADA+ Scans

JADA+ Specialty Scans and JADA+ Scans are quarterly newsletters updating dentists on the latest research in selected specialties and disciplines in dentistry. ADA Publishing and the consulting editors from the represented specialties and disciplines aggregate and summarize research from previously published materials, each item attributed to its publication of origin. JADA+ Scan specialties and disciplines include endodontics, oral pathology, orthodontics, pediatric dentistry, periodontics, prosthodontics, radiology, cosmetic/esthetic and osseointegration. The ADA has engaged the specialty organizations in these areas as well as its own Science Institute and Division of Legal Affairs to assist with these newsletters. View past issues here.

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