CLINICAL

RESEARCH
Clinical Performance of Anterior Full Veneer
Restorations Made of Lithium Disilicate with a
Mean Observation Time of 8 Years
Anja Liebermann, PD Dr Med Dent, MSc
Kurt Erdelt, Dr Rer Biol Hum Dipl Ing
Department of Prosthetic Dentistry, University Hospital, LMU Munich, Munich, Germany.

Oliver Brix, CDT

Innovative Dental Design, Oliver Brix, Bad Homburg, Germany.

Daniel Edelhoff, Prof Dr Med Dent

Department of Prosthetic Dentistry, University Hospital, LMU Munich, Munich, Germany.

Purpose: To evaluate the survival and complication rates of full veneer restorations after up to 11 years of
clinical service. Materials and Methods: Six patients (four men, two women, median age 42.3 ± 4.7 years)
were restored with a total of 40 adhesively luted anterior full veneers (maxilla: 36; mandible: 6; mostly canine
to canine) made of lithium disilicate ceramic. Patients were treated between July 2007 and January 2014. All
restorations were examined during annual recall visits using the modified United States Public Health Service
criteria for color match, marginal discoloration, secondary caries, marginal integrity, surface texture, and
restoration fracture, rated as Alpha, Bravo, or Charlie. Data were statistically analyzed using Kaplan-Meier
estimation with log-rank test. Results: Time of clinical service was 68 to 139 months (median: 8.1 ± 2.0 years)
without any dropouts. Full veneer restorations in the anterior dentition presented a survival rate of 100% and
a complication rate of 12.5% due to reparable minor chippings (technical complication/restoration fracture
rated Bravo) of four restorations (one after 11 months, one after 20 months, and two after 66 months) and
a crack in one restoration (after 38 months) due to trauma. No further technical (debonding or discoloration)
or biologic (secondary caries) complications occurred. Conclusion: Based on the present results, minimally
invasive anterior full veneer restorations might be considered as a reliable treatment option, but further
clinical data are essential. Int J Prosthodont 2020;33:14–21. doi: 10.11607/ijp.6465

Correspondence to:
PD Dr Anja Liebermann
Department of Prosthetic Dentistry
– University Hospital
LMU Munich, Goethestrasse 70,
80336 Munich, Germany
Fax: +49-89-440059502
Email: Anja.Liebermann@
med.uni-muenchen.de
Submitted April 15, 2019;
accepted July 19, 2019.
©2020 by Quintessence
Publishing Co Inc.
G
iven their satisfying long-term clinical success rates, outstanding esthetics, and
low invasiveness, adhesively luted ceramic veneers have become an interesting
alternative to conventional single crowns for several indications.1–4
Silicate ceramic materials are considered as the material of choice for replacing lost
enamel due to their similar optical and mechanical properties.5,6 However, minimally
invasive veneer preparations, as well as adhesive luting, set higher demands on the
dentist than classic full crown preparations combined with traditional cementation.
The preservation of enamel was identified as a decisive factor for the success of ve-
neer restorations.1,7,8 Specific guidelines apply to veneer preparations, which can be
individual in design depending on the clinical situation.5,6,9,10 Substance removal is
usually between 0.3 mm (“thin” layer) and 0.6 mm (“thick” layer).11 In certain indica-
tions, the transition to a full crown preparation can be fluent, depending on the se-
lection of the type of glass-ceramic. On the other hand, monolithic zirconia ceramics
offer new less invasive guidelines in full crown preparations.12
A circular extension of the veneer preparation to a 360-degree design (full wrap or
full veneer design) is considered to be advantageous, especially in complex rehabili-
tations with a need for vertical dimension increase (VDI) in order to cover the worn
tooth structure generated mostly as a consequence of a traumatic anterior occlusion
and to close the space created palatally by the VDI on the maxillary anterior teeth.13,14
As an alternative approach, the three-step technique described by Vailati and Belser

14 The International Journal of Prosthodontics

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offers the opportunity to build up the palatal space with
composite prior to the restoration of the labial surfaces
with adhesively bonded ceramic veneers (“sandwich”
technique).15–17
In principle, a diagnostic template derived from the
wax-up or a silicone index is indispensable for orientation
during the preparation, as this enables an economization
of tooth structure removal based on the already defined
outer contour of the subsequent veneer.6,8,18 In the case
of pronounced discoloration, the preparation depths
should be slightly extended in order to provide the den-
tal technician with an adequate masking option.11,19
Esthetic and functional analyses of the patient, also
based on articulated plaster casts and photo docu-
mentation, provide decisive information for adequate
planning of the expansion of veneer restorations. The
esthetic demands of the patient should be further taken
into account. The planned results of the wax-up base
can be tried in and adjusted together with the patient
using the intraoral mock-up. Further points that must
be included in the design and expansion of veneers
(medium wrap, long wrap, or full wrap for full veneer)
are: occlusal contact position with analysis of the ante-
rior canine guidance; abrasion of the tooth substance;
expansion of fillings and root canal treatments; tooth
proportions; position of the midline; Angle class and in-
clination of the anterior teeth; lip profile; and extension
and relationship of overjet and overbite.11
Today, silica-based ceramic veneers represent a suc-
cessful type of anterior restoration. In a retrospective clin-
ical study of up to 20 years where 50.0% of the patients
were diagnosed with bruxism, this veneer type showed
clinical survival rates of 93.5% at 10 years and 82.9% at
20 years.4 In a literature review for glass-ceramic veneers
with preparation predominantly in dentin, the survival
rate was rarely 100%. Therefore, the author concludes
that the ideal preparation for porcelain veneers remains
within enamel.7 The first interim clinical results for glass-
ceramic full-wrap veneers are promising.20 However, the
data available are still insufficient to the best of the au-
thors’ knowledge. The present prospective clinical study
therefore investigated the survival and complication
rates of full veneers made of lithium disilicate ceramic
after clinical service of up to 11 years.
MATERIALS AND METHODS
Within the present nonrandomized prospective clinical
study, six patients (four men, two women, median age
42.3 ± 4.7 years) were restored with a total of 40 adhe-
sively luted anterior full veneer restorations fabricated
out of lithium disilicate ceramic. Requirements of the
Declaration of Helsinki were respected, and all patients
gave their informed consent. The study design was ap-
proved by the ethical committee (no. 012-12).
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Liebermann et al
Inclusion and exclusion criteria were defined for all
patients as follows:
• Older than 18 years and under 70 years of age
• Optimal oral hygiene
• Preparation guidelines for minimally invasive
restorations can be fulfilled
• No periodontal disease
• Not lactating or breastfeeding
Prosthetic Treatment
All full veneer restorations were part of full-mouth reha-
bilitations increasing the vertical dimension of occlusion,
restoring the posterior teeth with monolithic lithium di-
silicate occlusal onlays. A full-mouth rehabilitation was
required due to moderate to severe tooth structure loss
with significant loss of the vertical dimension, esthetic/
functional impairments, and hypersensitivities through
combined erosion and mechanical stress. The present
clinical study separated the investigation of survival and
complication rates of anterior and posterior restorations
due to diverse prosthetic restoration types being not di-
rectly comparable.
Patients receiving minimally invasive full-mouth re-
habilitations of their worn and eroded dentitions were
consecutively included in the present investigation to
evaluate the outcomes of the anterior veneer recon-
structions. Therefore, the treatment started with an
esthetic and functional diagnostic wax-up in centric re-
lation, with a direct intraoral esthetic evaluation using a
direct mock-up (with the thermoforming sheet Duran
transparent 0.5 mm, Scheu Dental). The amount of VDI
was determined according to parameters such as the
incisal edge position of the maxillary central incisors,
the width-to-length ratio of the incisors, the phonetic
distance, the freeway space, and the facial profile. After
functional evaluation for at least 3 months using a re-
positioning splint, the posterior and especially anterior
transfer into lithium disilicate ceramic was performed as
described below. To preserve a sound tooth structure
as much as possible, the preparation was guided by the
directly placed intraoral mock-up using selected depth
cutters.
Minimally invasive preparation guidelines were per-
formed with a tooth structure removal of a minimum of
0.3 mm cervical and 0.8 mm incisal (Figs 1 and 2), but
an individual amount was determined for each of the
six patients depending on tooth structure loss. The fol-
lowing preparation burs were additionally used:
• Diamond burs for depth marking (8801.314.018,
8801.314.023, and 8878.314.012, Komet Dental),
labial preparation, slight chamfer preparations (8856
314 014, Komet Dental), and palatal concavity
preparation (8379 314 023, Komet Dental)
Volume 33, Number 1, 2020 15
 Clinical Research
Fig 1   Minimally invasive full veneer preparations for the maxillary
right canine, right central incisor, and left lateral incisor. Try-in of the
full veneers with try-in paste (Glycerin Gel, Variolinik II, Try-in) on the
right lateral incisor, left central incisor, and left canine.
• Oscillating instruments (SF8878KM and SF8878KD
half-torpedo sonic tips, Komet Dental) for
interproximal chamfer preparations
• Sof-Lex disc light brown (Soflex XT pop-on discs,
medium grain, 2,382 M; 3M) and white stone burs
(modified 649.314.420, Komet Dental) for edge
breaking, rounding, and finishing
• Ceramic polisher (for example, 9545F.204.110,
Komet Dental) for polishing of adjusted ceramic
surfaces
After final preparations, polyether impressions were
taken (Impregum Penta with Permadyne Garant 2:1,
3M) and transferred into plaster casts. Full veneers con-
sisting of IPS e.max Press frameworks with vestibular
layering by IPS e.max Ceram (Ivoclar Vivadent) were fab-
ricated according to the same manufacturer’s instruc-
tions already published partially in previous publications
(Fig 3).19–21
The prepared abutment teeth were covered with
temporary restorations (Telio CS C & B, Ivoclar Vivadent)
temporarily placed by a bonding material (Heliobond,
Ivoclar Vivadent) while the definitive restorations were
fabricated in a dental laboratory. After delivery, the
full veneer restorations were tried in intraorally, check-
ing the fit with high-precision A-silicone (Fit Test C &
B, Voco). For necessary small corrections (< 1 mm2),
the surface was repolished chairside to high gloss with
ceramic polishers prior to definite adhesive luting. For
larger corrections (> 1 mm2), the restoration was sent
back to the dental laboratory for a second-glaze firing.
The full veneers were adhesively bonded (Syntac Total
16 The International Journal of Prosthodontics
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Fig 2   Minimally invasive full veneer preparations for the mandibu-
lar right canine, right central incisor, and left lateral incisor. Try-in of
the full veneers with try-in paste (Glycerin Gel, Variolinik II, Try-in) on
the right lateral incisor, left central incisor, and left canine.
Fig 3 (left)  Final vestibular veneered lithium disilicate full veneer
restorations for the anterior maxilla before adhesive luting.
etch & rinse technique, Variolink II Professional Set, low
viscosity, light curing; Ivoclar Vivadent) (Figs 4 to 6).
Technical, esthetic, and biologic outcomes (includ-
ing marginal discoloration, secondary caries, marginal
integrity, restoration fracture, and surface texture) were
assessed at annual recall visits using the modified United
States Public Health Service (USPHS) criteria, specified in
Table 1.24,25 The parameters measured were rated Alpha
(no problem), Bravo (minor complications), or Charlie
(major complications with renewal of the restoration).
Moreover, clinical variables, such as periodontal param-
eters (including the Plaque Index [PI], Gingival Index [GI],
oral and vestibular probing depth [PD], and bleeding on
probing [BOP]), were assessed.26,27 The annual recalls
were conducted by a single experienced examiner who
did not perform the prosthetic rehabilitation.
Statistical Analyses
Data were analyzed using SPSS v. 25. The survival and
complication rates were calculated using Kaplan-Meier
survival analysis. A major complication was recorded
when the restoration had to be replaced.
RESULTS
Six patients were assessed in recall appointments with-
out any dropouts. The clinical use ranged between 68
and 139 months (median: 97.5 ± 24.5 months). Detailed
patient information, including survival and complication
rates, is listed in Table 2. Figures 7 and 8 show six maxil-
lary full veneers after 40 months of clinical use without
any major complications occurring.
 Liebermann et al

Fig 4   Vestibular view of adhesively luted maxillary anterior full Fig 5   Vestibular view of adhesively luted mandibular anterior full
veneer restorations 2 weeks after insertion (baseline appointment). veneer restorations 2 weeks after insertion (baseline appointment).

Fig 6 (right)  Palatal view of adhesively luted anterior full veneer

restorations 2 weeks after insertion (baseline appointment).

Table 1   Modified USPHS Ryge Criteria22,23

USPHS criteria Alpha
Marginal No visual evidence of
discoloration marginal discoloration
Secondary caries The restoration is a
continuation of existing
anatomical form adjacent
to the restoration
Marginal integrity No probe catch
Surface texture Surface texture similar to
polished enamel
Restoration Restoration is intact and
fracture fully retained, no fracture
Bravo
Visual evidence of marginal discoloration
at the junction of the tooth structure and
the restoration, but the discoloration
has not penetrated along the restoration
in a pulpal direction
Visual evidence of dark discoloration
adjacent to the restoration
Slight catch on probing, no gap
Surface texture gritty, similar to a
surface subjected to a white stone,
or similar to a composite containing
supramicron–sized particles
Restoration is partially retained,
polishing or repair is possible
Charlie
Visual evidence of marginal discoloration
at the junction of the tooth structure
and the restoration that has penetrated
along the restoration in a pulpal direction,
renewal necessary
Renewal necessary
Highly over- or undercontoured,
renewal necessary
Surface pitting is sufficiently coarse to
inhibit the continuous movement of an
explorer across the surface,
renewal necessary
Restoration is completely missing or
huge fracture, renewal necessary

Table 2   Survival and Complication Rates of Lithium Disilicate Full Veneers Analyzed with USPHS Criteria
Time in situ No. of Survival Complication rat- Complication
Patient Age (y) Gender (mo) restorations rate (%) FDI position ing (USPHS rate) rate (mo)
1 49 M 139 5 100 23 Minor chipping (B) 11
22 Minor chipping (B) 66
21 Minor chipping (B) 66
2 39 M 128 5 100
3 38 M 87 6 100 21 Minor chipping (B) 20
4 41 F 80 12 100 11 Incisal crack (B) 38
5 39 M 83 6 100
6 48 F 68 6 100
USPHS criteria: A = Alpha; B = Bravo; C = Charlie.

Volume 33, Number 1, 2020 17

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 Clinical Research

Fig 7   Vestibular view of full veneer restorations after 40 months Fig 8   Palatal view of full veneer restorations in the maxilla after 40
of clinical service. A minor chipping occurred on the restoration of months of clinical service.
the right maxillary canine, and a wear-facette was generated on the
restoration of the left maxillary canine.

1.0

0.8

Survival rate (%)

0.6

0.4

0.2 Crack
Minor chipping
0.0
0 20 40 60 80 100
Months

Fig 9   Incisal crack of full veneer restoration of maxillary right cen- Fig 10   Kaplan-Meier survival rate of the restorations, showing the
tral incisor after trauma after 36 months of clinical service. The crack complications rated Bravo (reparable chipping and ceramic crack)
was located only in the ceramic veneer, not in the framework. that occurred.

Table 3   Detailed Surface and Periodontal A survival rate of 100% was seen for the adhesively
Parameters26,27 luted and veneered lithium disilicate full veneer restora-
Parameter tested Rating No. Percentage tions, with a total technical complication rate of 12.5%
PI 0 31 77.5 due to reparable minor chippings (restoration fracture
1 9 22.5 rated Bravo) in four restorations (one after 11, one after
2 0 0
3 0 0 20, and two after 66 months) and a crack after trauma
GI 0 12 30.0 in one restoration 36 months after placement (Figs 9
1 23 57.5 and 10). In cases of reparable chipping (rated Bravo), the
2 5 12.5 specific glass-ceramic surface was silica-coated (CoJet,
3 0 0
3M), silanized for 60 seconds (part of Monobond Plus,
Vestibular PD 1 12 30.0
2 28 70.0 Ivoclar Vivadent), and repaired with Heliobond and
3 0 0 Tetric EvoFlow shade T (both Ivoclar Vivadent). All com-
Oral PD 1 9 22.5 posite repairs were performed once, and no second
2 29 72.5 chipping of the performed repair was observed.
3 2 5.0
No further technical (debonding), esthetic (discolor-
BOP 0 38 95.0
1 2 5.0 ation), or biologic (secondary caries) complications oc-
2 0 0 curred. All detailed surface and periodontal parameters,
3 0 0 including the PI, GI, oral and vestibular PD, BOP, and
4 0 0
marginal/surface quality of the abutment teeth, are
Marginal quality 1 21 52.5
2 19 47.5 summarized in Table 3.
3 0 0
Surface quality 1 40 100 DISCUSSION
2 0 0
3 0 0
The present clinical study investigated the clinical long-
PI = Plaque Index; GI = Gingival Index; PD = probing depth; BOP = bleeding
on probing. Marginal quality rating: 1 = perfect; 2 = irregular; 3 = surplus; time performance of 40 anterior minimally invasive full
Surface quality rating: 1 = smooth; 2 = slightly rough; 3 = rough. veneers made of IPS e.max Press with a superior survival

18 The International Journal of Prosthodontics

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rate of 100% after 8 years. Only technical failures with
minor chippings or a crack formation (in total 12.5%)
occurred, leading to the conclusion that these restora-
tion types might be a reliable treatment alternative.
Minimally invasive preparations, such as those for full
veneers, place higher demands on dentists than more
invasive full-crown preparations.1,28
With regard to the enamel preservation, some authors
advise that veneer restorations should be refined within
the enamel shell.7,8,29–35 This procedure seems to make
sense because the enamel-dentin interface is biome-
chanically a very resilient connection that stabilizes the
tooth crown and cannot be permanently replaced in its
quality by adhesive luting to dentin. In addition, the rela-
tive flexibility of the tooth crown increases significantly
with the complete removal of the enamel compared to
a partial exposure of dentin.34 A higher elasticity of the
supporting tooth structure may involve a fracture risk
due to the higher stiffness of the ceramic.31,35
In clinical practice, however, preparations located in
the enamel are not always possible due to anatomical
conditions and the degree of tooth structure destruc-
tion; eg, reduced enamel by erosive tooth substance
loss and/or carious lesions. In the patients of the pres-
ent clinical investigation, the maximum preservation of
the enamel was of primary interest, but minor dentin
spots could not be complied within all preparation sites.
The amount of dentin exposure was not quantified in
this study.
In addition to the aforementioned necessary enamel
structure, there are other major risk factors that must
be considered when planning the exact extent and type
of restoration, such as bruxism and existing root canal
treatments.1,4,7,8 In the patients of the present prospec-
tive clinical study, most of the risk factors could be ex-
cluded; one limitation, however, was that patients with
bruxism were not directly excluded, as no specific inves-
tigation of bruxism parameters was performed.
Since the veneer restorations were all part of full-
mouth rehabilitations, the minimally invasive full veneer
preparation design was also chosen because of the need
of a VDI to fill the generated space between the palatal
aspect of the incisors of the maxilla and the incisal edges
and facial aspect of the mandibular anterior dentition.
Adequate anterior canine guidance should be ensured in
the anterior full veneer design, including the “freedom
in centric posterior concept,” in order to avoid shear
load on the posterior all-ceramic restorations.36–38
There are numerous clinical studies, some with very
long observation periods combined with a high number
of restorations, investigating silicate ceramic veneers.1,39
In a systematic review and meta-analysis, the 5-year cu-
mulative estimated survival rate for etchable nonfeld-
spathic porcelain veneers was identfied as over 90%.40
No significant differences in strength were detected
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Liebermann et al
between different incisal preparation options with or
without incisal coverage.41
Fractures and chippings of all-ceramic veneers or of
ceramic veneers on frameworks are still among the most
frequent causes of complications and do not necessarily
lead to a renewal of the restorations.4,42 This has been
confirmed in the present investigation with veneered
frameworks on the facial side. Despite the regular func-
tional checks, a technical complication rate of 12.5%
due to minor chippings and one crack as a consequence
of an anterior trauma was observed. However, the small
chippings of the ceramic veneer could be repaired with
silicoating, silane coupling agent, and application of a
flowable composite, as described in Results.42 All com-
posite repairs were performed just once and checked
in at annual check-ups. In addition, the crack after the
incisal trauma was not repaired, but continues to be
anually checked.
It has to be considered that most of the chippings
occurred in one patient, although prosthetic treatment
and the occlusal concept were performed identically. A
possible explanation for this phenomenon is the reduced
compliance of this specific patient, especially in wearing
the splint during nighttime, when occlusal stress might
be at its maximum. Bruxism could not be excluded, as
technical measurements were not performed.
All full veneers are still in situ. The survival rate was
therefore 100%, since no restoration had to be replaced.
This is consistent with the results from another clinical
trial in which full veneers demonstrated a survival rate of
100%.20 The question arises as to whether the compli-
cation rate would have been lower with unveneered (ie,
monolithic lithium disilicate) full veneers. Further clini-
cal investigations that analyze the comparison between
veneered and unveneered veneers, as well as different
lithium (di)silicate ceramic materials, are necessary.
There are also other ceramic materials that could have
been used as restoration materials, such as the newer
highly translucent zirconia or feldspathic ceramics. So
far, there are no scientific long-term data available on
the novel translucent zirconia materials, especially for
veneers. Additionally, this material was not available at
the time of the beginning of the present study. In regard
to veneers made of feldspathic ceramic, it was stated
in a meta-analysis the survival rate of 87.0% was sig-
nificantly lower than for veneers made of glass-ceramic
(94.0%).43 This underlines the higher survival rates for
ceramics with increased mechanical properties.28
In another retrospective study including 318 veneers
made of feldspar ceramics, leucite-reinforced glass-ce-
ramics and lithium disilicate ceramics yielded calculated
clinical survival rates of 93.5% after 10 years and 82.8%
after 20 years.4 Marginal discoloration was analyzed as
a minor complication; this occurred in 21.9% of cas-
es, predominantly in smokers. In the present study, no
Volume 33, Number 1, 2020 19
 Clinical Research
discoloration of the restoration margins was detected
and the survival rate was higher. However, the men-
tioned clinical studies cannot be directly compared due
to the different restoration geometry.
In the case of extensive restorations, the three-step
technique described by Vailati and Belser could be an
alternative to full veneer restorations.17 This technique
first calls for closing the palatal space behind the maxil-
lary anterior teeth that results from increasing the verti-
cal dimension of occlusion with composite. In a second
step, the labial surfaces receive adhesively luted ceramic
veneers (the so-called “sandwich” technique).17 Even
though no major complications have occurred after an
observation period of up to 6 years, clinical long-term
results of multi-center studies must be obtained in or-
der to make a final assessment of this technique.44
A comparison of survival and complication rates of
full veneer preparations in contrast to conventional me-
dium- or full-wrap veneers would also be interesting for
the practitioner. Nevertheless, further clinical studies
are necessary to substantiate the available results and
to further analyze ceramic materials, as no further long-
term results on full veneers are available in the scientific
literature. Comparisons to the present prospective clini-
cal study were therefore not possible.
One of the main limitations of the present clini-
cal study is the small patient cohort of six patients.
Therefore, the validity of the statistical analysis was re-
duced, and a bias caused by a single patient is high.
Further clinical studies with larger populations and a
higher amount of full veneer restorations are necessary
to support these preliminary findings.
CONCLUSIONS
Based on these analyzed data, minimally invasive adhe-
sively luted glass-ceramic full veneer restorations made
of lithium disilicate ceramic might be a reliable treat-
ment alternative to single full crown restorations on an-
terior teeth, but further clinical studies are essential to
assess the long-term clinical outcomes.
ACKNOWLEDGMENTS
This clinical study was supported by Ivoclar Vivadent. The authors
state no conflicts of interest.
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Literature Abstracts

Association Between Periodontitis and Cognitive Impairment: Analysis of National Health and Nutrition Examination Survey
(NHANES) III
Periodontitis has been hypothesized to be one of the most common potential risk factors for the development of dementia and cognitive
impairment. In order to investigate the relationship between periodontitis and cognition impairment, the National Health and Nutrition
Examination Survey (NHANES) database was analyzed after adjusting for potential confounding factors, including age and other systemic
comorbidities. In total, 4,663 participants aged 20 to 59 years who had received full-mouth periodontal examination and undergone the
cognitive functional test were enrolled. The grade of periodontal disease was categorized as severe, moderate, or mild. Cognitive function
examinations—including the simple reaction time test (SRTT), symbol digit substitution test (SDST), and serial digit learning test (SDLT)—
were adopted for the evaluation of cognitive impairment. The subjects with mild periodontitis and moderate to severe periodontitis had
higher SDLT and SDST scores (indicating decreased cognitive function) compared to the healthy group. After adjusting for demographic
factors, education, smoking, cardiovascular diseases, and laboratory data, periodontitis was significantly correlated with elevated SDST and
SDLT scores (P values for trends = .014 and .038, respectively) according to generalized linear regression models. This study highlights that
periodontal status is associated with cognitive impairment in a nationally representative sample of US adults.
Sung CE, Huang RY, Cheng WC, Kao TW, Chen WL. J Clin Periodontol 2019;46:790–798. References: 49. Reprints: Wei-Liang Chen,
weiliang0508@gmail.com —Carlo Marinello

Immediate Versus Delayed Loading of Mandibular Implant-Retained Overdentures: A 60-Month Follow-up of a Randomized
Clinical Trial
The purpose of this observational, posttrial follow-up study was to evaluate 60-month outcomes of a randomized controlled clinical trial
that compared immediate and delayed loading of two unsplinted implants supporting a Locator-retained mandibular overdenture. Patients
from the trial treated with either immediate or delayed loading of two implants supporting a Locator-retained mandibular overdenture
were recalled for a 60-month evaluation. Patients underwent clinical and radiographic examinations to evaluate the peri-implant soft tissue
parameters and bone. Prosthetic maintenance needs and complications were also recorded. Of the 30 patients, 23 were available for recall.
The mean radiographic bone level change from baseline to 60 months measured using standardized periapical radiographs was 0.89 mm
(± 0.74) and 0.18 mm (± 0.41) for the delayed loading and immediate loading groups, respectively. A statistically significant difference was
observed at 60 months, showing a smaller radiographic bone level change in the immediate loading group. No implants were lost between
12 and 60 months. At 60 months, the per-protocol implant survival rate was 100% for both groups. No difference was found in the peri-
implant soft tissue parameters and prosthetic needs between the groups. Both immediate- and delayed-loading implants supporting a
Locator-retained mandibular overdenture showed similar clinical outcomes.
Salman A, Thacker S, Rubin S, Dhingra A, Ioannidou E, Schincaglia GP. J Clin Periodontol 2019;46:863–871. References: 42.
Reprints: Gian Pietro Schincaglia, gps0002@hsc.wvu —Carlo Marinello, Switzerland

Volume 33, Number 1, 2020 21

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