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Purpose: The purpose of this retrospective study was to provide practice-based evidence to determine if the consistency of dental hygiene therapy, despite utilizing instrumentation literature that has proven to cause alterations to implant surfaces, affects peri-implant health or survival. Materials and Methods: The study sample comprised patients with implant-supported full-arch fixed dental prostheses who were distributed into two groups. The consistent hygiene group patients had dental hygiene therapy at a minimum biannually and were exposed to at least three dental hygiene instrument materials. The inconsistent hygiene group patients had dental hygiene therapy at a minimum once every 3 to 10 years and were exposed to at least three dental hygiene instrument materials. Years of survival free of soft tissue pathology and/or implant failure were estimated. Continuous features were summarized with medians, interquartile ranges (IQRs), and ranges; categorical features were summarized with frequency counts and percentages. Results: Among 48 patients in the consistent hygiene group, 11 patients experienced soft tissue pathology or implant failure at a median of 11.3 years; among 99 patients in the inconsistent hygiene group, 17 patients experienced soft tissue pathology or implant failure at a median of 4.8 years. The survival free of soft tissue pathology or implant failure rate at 5 years was 94% for the consistent hygiene group and 91% for the inconsistent hygiene group. The survival free of soft tissue pathology or implant failure rate at 20 years was 70% for the consistent hygiene group and 79% for the inconsistent hygiene group (P = .91). Conclusion: Although no statistical differences were found between the groups, this practice-based evidence suggests more consistent dental hygiene therapy increases the median in years in which soft tissue pathology or implant failure is present. Keywords: dental implants, dental prophylaxis, dental prosthesis implant-supported, dental scaling

Purpose: Outcome research has become an increasingly important form of clinical evidence for making health care decisions, including oral health considerations in the field of dentistry. In oral reconstruction involving dental implants, the risk of implant failure may be influenced by a patient's underlying medical condition. To identify associations, implant failure and systemic conditions or diseases were studied in a consecutive series of patients who received dental implants from October 1, 1983, to December 31, 2014, in the Department of Dental Specialties at Mayo Clinic in Rochester, Minnesota. Materials and Methods: Data were abstracted from a prospective clinical database and electronic health records for patients' demographic, implant-specific, and medical profiles to determine time to first implant failure. Survival free of implant failure at the patient level was estimated by using the Kaplan-Meier method. Associations of demographic and systemic characteristics with implant failure were evaluated by using Cox proportional hazards regression models and summarized with hazard ratios and 95% confidence intervals. Results: The patient cohort consisted of 6,358 patients with a median age of 53 years at placement of the first implant. A total of 713 patients experienced implant failure at a median of 0.6 years. Among the 5,645 patients who did not experience implant failure, the median duration of follow-up was 5.8 years. More than 20 systemic diseases or conditions were identified for assessment, of which 15 comprised more than 50 patients and five comprised more than 500 patients. All associations were adjusted for age, sex, and era of implant, given the strong influence of these features on implant failure. After adjustment, no systemic disease or condition was shown to increase the risk for implant failure in the population and setting studied. Conclusion: Patients considering oral reconstruction involving implants in the medical setting studied do not appear to risk implant loss because of systemic conditions or diseases. Keywords: association, implant failure, patient-based, systemic condition, systemic disease

The functional outcomes related to treating patients afflicted with tooth loss are an important hallmark in substantiating prosthodontic intervention. The Oral Rehabilitation Outcomes Network (ORONet) conducted two international workshops to develop a core set of outcome measures, including a functional domain. The process followed the general format used in the Outcome Measures in Rheumatology (OMERACT) workshops to develop consensus for clinical outcome measures in arthritis research, which included: developing a comprehensive list of potential outcomes in the literature; submitting them to a filter for validity, clinical discrimination, and feasibility; and ranking those measures meeting all the filter criteria for relative value. The search was conducted to include functional assessments of speech, swallowing, mastication, nutrition, sensation, and motor function as they relate to dental implant therapies. This literature review surveyed 173 papers that produced some result of these descriptors in the functional domain. Of these, 67 papers reported on functional assessments and further defined objective and subjective outcomes. Many of these results were patient-perceived improvements in function, while others were objective assessments based on established methodologies and instruments. Objective evaluations of masticatory function and speech may meet criteria for validity and discriminability for selected interventions, but are generally not feasible for routine use in clinical care settings. The current recommendation is to employ a well-validated survey instrument that covers mastication and speech, such as the Oral Health Impact Profile (OHIP-14, short form), recognizing that patient perceptions of function may differ from objective ability.

Consensus regarding outcomes of the treatment of tooth loss, especially the psychologic outcomes, is needed to guide discovery of best practices and enable a better understanding of patient management for this chronic condition. This paper presents the findings of the ORONet Psychological Working Group for prosthodontics and aims to identify psychologic outcomes with properties deemed critical to meet clinical trial and clinical practice needs for the future. References obtained using a PubMed/Medline search were reviewed for clinical outcomes measures of interest. Clinical outcomes measures were judged relative to the criteria of truth, discrimination, and feasibility. Of the psychologic outcome measures identified in this systematic review, only the OHIP-14 was thought to be suitable for use in general practice and multi-institutional outcome registries and clinical trials. Development of clinically useful psychologic outcomes for future use could benefit from developmental methods and tools outlined in the patient-related outcomes field of clinical care.

Purpose: A systematic literature review was conducted to identify the types of economic measures currently used in implant prosthodontics and determine the degree to which cost of care is considered in the context of any positive outcome of the care provided. Materials and Methods: A literature search was conducted using the following set of terms plus some additional hand searching: "dental implants" (Mesh) AND ("cost") OR "maintenance" OR "healthcare policy" OR "access to care" OR "third party" OR "economic") AND (("1995/01/01"[PDat]:'2009/12/31"[PDat]) AND (Humans[Mesh]) AND (English[lang])). Results: After a review of the 466 titles and abstracts identified by the search, 18 articles were accepted for further consideration, as some attempt at economic outcome measures was made. An additional four articles were identified by hand searching. The 22 accepted articles were grouped into four basic categories: (1) measure of costs of treatment (direct, indirect, and maintenance costs), (2) cost-effectiveness mathematical modeling applied to simulate the lifetime paths and cost of treatment, (3) cost-effectiveness analysis/costminimization, and (4) willingness-to-pay, willingness-to-accept. Attempts at determining the costs of treatment varied widely. When the OMERACT filters were applied to the various measures it was felt that discrimination and/or feasibility was a problem for most of the current economic outcome measures. Conclusions: Measures of cost-benefit, cost-effectiveness, and cost-utility are currently the gold standard; however, feasibility of such analyses is an issue. Collaboration with health economists to guide future research is highly recommended.

The published literature describing clinical evidence used in treatment decisionmaking for the management of tooth loss continues to be characterized by a lack of consistent outcome measures reflecting not only clinical performance but also a range of patient concerns. Recognizing this problem, an international group of clinicians, educators, and scientists with a focus on prosthodontics formed the Oral Rehabilitation Outcomes Network (ORONet) to promote strategies for improving health based on comprehensive, patient-centered evaluations of comparative effectiveness of therapies for oral rehabilitation. An initial goal of ORONet is to identify outcome measures for prosthodontic therapies that represent multiple domains with patient relevance, are amenable to utilization in both institutional and practice-based environments, and have established validity. Following a model used in rheumatology, the group assessed the prosthodontic literature, with an emphasis on implantbased therapies, for outcomes related to longevity and functional, psychologic, and economic domains. These systematic reviews highlight a need for further development of standardized outcomes that can be integrated across clinical and research environments.

The Oral Rehabilitation Outcomes Network (ORONet) Longevity Working Group undertook a search of the literature from 1995 to 2009 on randomized controlled trials related to longevity of osseointegrated implants. Outcomes measures used in these studies were identified and subjected to the OMERACT component criteria of truth, validity, and feasibility. Through this process, it was a challenge to identify clinical outcomes measures that fully met the criteria. An attenuated version of the component criteria was applied, and clinical measures were identified for implant outcomes, prosthetic outcomes, and indices. A recommendation on standardized reporting periods was also presented for future consideration. The endpoint of the evaluation process is to develop consensus on clinical outcomes measures that can be applied across broad populations for osseointegrated implant care. The present ORONet initiative represents a beginning toward continual improvement and consensus development for clinical outcomes measures for osseointegrated implants.

Purpose: Clinicians often do not have the benefit of adequate safety or clinical data when evaluating the merit of either newly marketed implant devices or novel clinical procedures. This has been the case for dental implants following the initial documentation of their safety and efficacy and is demonstrated in the evolution of immediate load application. Following demonstration of safety and successful application of an implant in an animal study prior to its market release, this report provides the clinical outcomes for the first 100 Ti-Unite implants provided to 24 patients in a clinical practice over 9 years. Materials and Methods: An electronic record/clinical database review of consecutive early loaded implants from a multiple surgeon/single prosthodontist practice was conducted for quality assurance. Data extraction of standard exposure and outcome variables was accomplished by a trained individual not affiliated with the clinical practice. Results: The results revealed one failure before and none following definitive restoration with a variety of prostheses. The mean length of time from immediate to definitive restorations was 5.3 ± 1.1 months for crowns, 3.9 ± 1.3 months for fixed partial dentures, and 7.8 ± 4.1 months for mandibular "hybrid" prostheses. The most common unexpected findings during the initial three postinsertion visits were lost access restoration and cement failure. Conclusions: Pre-market animal data regarding the safety and success of a new implant used with an early loading protocol was replicated in the clinical results of the first 100 implants used in practice. Additionally, the clinical results are favorable when compared to conventional loading protocols from this same practice and provide helpful comparative metrics (delayed vs immediate loading) to use when discussing implant treatment with patients.

Purpose: A systematic review of the available literature to assess the effects of time to loading of implants on treatment outcomes. Methods: PubMed search strategies identifying clinical trials on implant prosthetics, combined with searching of a personal library and reference lists from included studies, resulted in 1,882 titles published before May 1, 2005. Two independent reviewers appraised the titles and abstracts and identified 187 papers that seemed to focus on the effects of time to loading on treatment outcomes in clinical trials. These papers were retrieved and critically appraised in full text. A set of predefined inclusion and exclusion criteria were applied. All trials (randomized and nonrandomized clinical trials, prospective and retrospective) were included in the review if both an experimental and a control group were adequately described, if the implants had been followed for at least 1 year, and if the sample contained at least 5 patients. Results: Twenty-two papers, published between 1990 and 2005 described the influence of time to loading on implant treatment success. Seven trials were randomized controlled trials, 13 were prospective with concurrent controls, and 2 were retrospective with concurrent controls. The general impression of the papers was that (1) the methodologic rigor of the trials was often not very strong, (2) the reported treatment outcomes were mostly surrogate rather than patient-centered, and (3) the follow-up times were relatively short. Statistical comparisons between subgroups were considered inappropriate because of the heterogeneity of trials. Data from 19 trials reporting different patient follow-up periods between 1 and 10 years suggest that the overall performance was not significantly different between immediate or early loaded implants versus implants using a conventional loading period. Conclusion: Within the limitations of the study populations in the papers appraised in this systematic review, although the average outcome was in favor of delayed loading, there are no indications that immediate or early loading cannot be a safe procedure. Keywords: early loading, immediate loading, oral implants, osseointegration, prosthodontics

In this 2-part review series, the current uses of saliva as a diagnostic fluid are reviewed, first with a focus on known measurements of systemic conditions. In Part 2, the role of saliva to measure bone turnover with a special emphasis on osteoporosis will be discussed.