zarb 1998 the journal of prosthetic dentistry 1

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The following report describes the proceedings of the Toronto Symposium, April 24 and 25, 1998, held at the University of Toronto, Ontario, Canada. This report seeks to articulate those clear and repro- ducible determinants which identify successful treat- ment outcome measures for implants supporting func- tioning dental prostheses. In an attempt to reach this objective, each of the four groups was provided with printed material to use as a starting point or scaffolding for focused debate. The material comprised the origi- nally proposed Albrektsson et al. (1986) and Smith and Zarb (1989) Success Criteria, plus the Guckes et al. (1996) Classification of Treatment Outcomes in Implant Therapy. The participants were given instruc- tions to massage, edit, replace, etc., any or all of the “original” criteria; to consider merits of a set of patient- mediated criteria from dentist-mediated ones (although it was clear that responsible professional behavior had recognized the twin concerns); and finally to address the question of the need to identify specific and rele- vant soft-tissue criteria. Group A was co-chaired by Drs. Franks and Lloyd and ably assisted by Dr. Anderson. They concluded that all future implant research must include patient-based outcomes that reflect degrees of satisfaction with treat- ment, quality of life, oral health status, selected mor- bidities, and economic impact. They also proposed that criteria derived from patient-based outcome measures should be recorded in terms relative to expectations and hopes, so as to permit an estimate of anticipated benefit and judgment of success. While it was self-evi- dent that the outcome criteria employed to date did not preclude patient-mediated concerns, it was empha- sized that the latter required more rigorous compila- tion of quantifiable data to ensure informed clinical decisions. Groups B, C and D were chaired by Drs. Laskin and Laney, Drs. McGivney and Fritz, and Drs. Becker and Weber, respectively. Their approach emphasized the other side of the coin of therapeutic outcomes, namely dentist-mediated concerns. This was achieved by build- ing upon a critical assessment of criteria available to date. It was also recognized that individual implant suc- cess should not be assessed separately from an answer to the most compelling question of all: did the implant prescription yield a successful prosthodontic result? The following conditions for criteria application for successful outcomes with implant-supported prostheses are proposed: (1) Implant therapy is prescribed to resolve prostho- dontic problems by permitting diverse prosthodontic treatments, which in turn impact upon the economics of the service. Such prostheses should allow for routine maintenance and should permit planned or unplanned revisions of the existing design. Treatment outcome success criteria for implant-supported prostheses should also be assessed in the context of time depen- dent considerations for any required retreatment. (2) Criteria for implant success apply to individual endosseous implants, and (a) At the time of testing, the implants have been under functional loading; (b) All implants under investigation must be accounted for; (c) Since a gold standard for mobility assess- ment is currently unavailable, the method used must be specifically described in operative terms; (d) Radiographs to measure bone loss should be standard periapical films with specified refer- ence points and angulations. The success criteria comprise the following determi- nants: (1) The resultant implant support does not preclude the placement of a planned functional and esthetic prosthesis that is satisfactory to both patient and den- tist. (2) There is no pain, discomfort, altered sensation or infection attributable to the implants. (3) Individual unattached implants are immobile when tested clinically. (4) The mean vertical bone loss is <0.2 mm annual- ly following the first year of function. Consensus report: Towards optimized treatment outcomes for dental implants Edited by George A. Zarb and Tomas Albrektsson Copyright by the International Journal of Prosthodontics, Septem- ber/October 1998;11:385-6, 389. 10/1/94525 DECEMBER 1998 THE JOURNAL OF PROSTHETIC DENTISTRY 641

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  • The following report describes the proceedings of theToronto Symposium, April 24 and 25, 1998, held at theUniversity of Toronto, Ontario, Canada.

    This report seeks to articulate those clear and repro-ducible determinants which identify successful treat-ment outcome measures for implants supporting func-tioning dental prostheses. In an attempt to reach thisobjective, each of the four groups was provided withprinted material to use as a starting point or scaffoldingfor focused debate. The material comprised the origi-nally proposed Albrektsson et al. (1986) and Smith andZarb (1989) Success Criteria, plus the Guckes et al.(1996) Classification of Treatment Outcomes inImplant Therapy. The participants were given instruc-tions to massage, edit, replace, etc., any or all of theoriginal criteria; to consider merits of a set of patient-mediated criteria from dentist-mediated ones (althoughit was clear that responsible professional behavior hadrecognized the twin concerns); and finally to addressthe question of the need to identify specific and rele-vant soft-tissue criteria.

    Group A was co-chaired by Drs. Franks and Lloydand ably assisted by Dr. Anderson. They concluded thatall future implant research must include patient-basedoutcomes that reflect degrees of satisfaction with treat-ment, quality of life, oral health status, selected mor-bidities, and economic impact. They also proposed thatcriteria derived from patient-based outcome measuresshould be recorded in terms relative to expectationsand hopes, so as to permit an estimate of anticipatedbenefit and judgment of success. While it was self-evi-dent that the outcome criteria employed to date didnot preclude patient-mediated concerns, it was empha-sized that the latter required more rigorous compila-tion of quantifiable data to ensure informed clinicaldecisions.

    Groups B, C and D were chaired by Drs. Laskin andLaney, Drs. McGivney and Fritz, and Drs. Becker andWeber, respectively. Their approach emphasized theother side of the coin of therapeutic outcomes, namelydentist-mediated concerns. This was achieved by build-

    ing upon a critical assessment of criteria available todate. It was also recognized that individual implant suc-cess should not be assessed separately from an answerto the most compelling question of all: did the implantprescription yield a successful prosthodontic result?The following conditions for criteria application forsuccessful outcomes with implant-supported prosthesesare proposed:

    (1) Implant therapy is prescribed to resolve prostho-dontic problems by permitting diverse prosthodontictreatments, which in turn impact upon the economicsof the service. Such prostheses should allow for routinemaintenance and should permit planned or unplannedrevisions of the existing design. Treatment outcomesuccess criteria for implant-supported prosthesesshould also be assessed in the context of time depen-dent considerations for any required retreatment.

    (2) Criteria for implant success apply to individualendosseous implants, and

    (a) At the time of testing, the implants havebeen under functional loading;

    (b) All implants under investigation must beaccounted for;

    (c) Since a gold standard for mobility assess-ment is currently unavailable, the method usedmust be specifically described in operative terms;

    (d) Radiographs to measure bone loss shouldbe standard periapical films with specified refer-ence points and angulations.

    The success criteria comprise the following determi-nants:

    (1) The resultant implant support does not precludethe placement of a planned functional and estheticprosthesis that is satisfactory to both patient and den-tist.

    (2) There is no pain, discomfort, altered sensation orinfection attributable to the implants.

    (3) Individual unattached implants are immobilewhen tested clinically.

    (4) The mean vertical bone loss is