The purpose of this study was to examine the most frequently used criteria to define treatment success in implant dentistry. An electronic MEDLINE/PubMED search was conducted to identify randomized controlled trials and prospective studies reporting on outcomes of implant dentistry. Only studies conducted with roughened surface implants and at least five-year follow-up were included. Data were analyzed for success at the implant level, peri-implant soft tissue, prosthetics, and patient satisfaction. Most frequently reported criteria for success at the implant level were mobility, pain, radiolucency, and peri-implant bone loss (> 1.5 mm), and for success at the peri-implant soft-tissue level, suppuration, and bleeding. The criteria for success at the prosthetic level were the occurrence of technical complications/prosthetic maintenance, adequate function, and esthetics during the five-year period. The criteria at patient satisfaction level were discomfort and paresthesia, satisfaction with appearance, and ability to chew/taste. Success in implant dentistry should ideally evaluate a long-term primary outcome of an implant-prosthetic complex as a whole.

The all-light-atom X-ray crystal-structure analysis of cyclosporin A (l), a cyclic undecapeptide containing seven N-methylated amino acids, reveals a conformation very similar to that of the previously analysed iodo derivative which is characterised by a twisted P-pleated sheet involving the residues Me-Val-1 1, MeBmt-1, Abu-2, Sar-3, MeLeu-4, Val-5, MeLeu-6, and Ala-7. The@-bend at Sar-MeLeu-4 is of type II', and the loop of the residual amino acids involves a cis-peptide bond between MeLeu-9 and MeLeu-10. The NH proton of D-Ala-8 closes a $-bend with a H-bond to the MeLeu-6 CO group. The crystal was grown from acetone. A closely similar backbone conformation in apolar solvents such as CDCl, or C6D6 has been derived from the interpretation of the NMR spectral parameters (homo-and heteronuclear NOE effects, coupling constants, chemical-shift values of the C-, H-, and N-atoms). A minor variation in the backbone conformation between crystal and solution is observed in the region of o-Ala-8, where in solution a 3-center H-bond is established between the NH of D-Ala-8 und the carbonyl 0-atoms of both MeLeu-6 ($-turn) and o-Ala-8 (C5-bend). A recently proposed technique to identify intramolecular H-bond via heteronuclear NOE from NH proton to carbonyl C-atoms is critically analysed. The main difference between crystal and solution conformations lies in the orientation of the side chains of the unusual amino acid MeBmt kl = f60" in solution, -168" in the crystal) and of MeLeu-10 k1 = -60" in solution, +60' in the crystal). The differences in crystal and solution are caused by the break ofthe intermolecular H-bond of the OH group of MeBmt on dissolution of the crystal. The bifurcated H-bond ofo-Ala-8 twists the backbone in this region. Molecular modeling demonstrates that this is the origin of the change in the side chain conformation of MeLeu-10. The intramolecular flexibility in the crystal indicated by the thermal parameters obtained from the X-ray refinement, and in solution by an analysis of spin-lattice relaxation times in the NMR experiments, indicate a fairly rigid backbone and fixed conformations for all the side chains except for that of Abu-2 and the distal atoms of MeBmt.

Background The question of the importance of keratinized mucosa around dental implants for the prevention of peri-implant disease could not be answered in the relevant literature so far. Objective To investigate the influence of peri-implant keratinized mucosa on long-term peri-implant soft-tissue health and stability over a period of 5 years. Material and methods A total of 386 mandibular dental implants were placed in 73 completely edentulous patients, and subsequently restored with fixed full-arch prostheses. At prosthesis delivery (baseline) and after 3, 6, 12, 18, 24, 36, 48 and 60 months, modified plaque index (mPlI), modified sulcus bleeding index (mBI), distance between implant shoulder and mucosal margin (DIM) and width of peri-implant keratinized mucosa (KM) were recorded. Statistical analysis included multivariate logistic regression, multivariate ordinal logistic regression, generalized estimating equations and Bonferroni’s correction. Results Fifty-eight patients with 307 implants completed the 5-year study. Statistically significantly higher plaque accumulation on lingual sites (mean mPlI 0.67, SD 0.85), bleeding tendencies on lingual sites (mean mBI 0.22, SD 0.53) and larger soft-tissue recession on buccal sites (mean DIM − 0.69 mm, SD 1.11 mm) were found when the width of KM was <2 mm, compared to sites with ≥2 mm of KM (mean mPlI 0.40, SD 0.68, P = 0.001; mean mBI 0.13, SD 0.41, P < 0.01; mean DIM − 0.08 mm, SD 0.86 mm, P < 0.001). The width of keratinized mucosa had no effect on bleeding tendency or plaque accumulation on buccal sites (P > 0.05). Conclusion In patients exercising good oral hygiene and receiving regular implant maintenance therapy, implants with a reduced width of < 2 mm of peri-implant keratinized mucosa were more prone to lingual plaque accumulation and bleeding as well as buccal soft-tissue recession over a period of 5 years.

This assignment applies to all translations of the Work as well as to preliminary display/posting of the abstract of the accepted article in electronic form before publication. If any changes in authorship (order, deletions, or additions) occur after the manuscript is submitted, agreement by all authors for such changes must be on file with the Publisher. An author's name may be removed only at his/her written request. (Note: Material prepared by employees of the US government in the course of their official duties cannot be copyrighted.