Oral rehabilitation of maxilla: technical consideration

Oral rehabilitation of edentulous maxilla is particularly difficult because of the lack of bone in correspondence of maxillary sinuses, therefore, the surgeon is forced to place implants in sites where bone is more prevalent. In addition, patients require more frequent oral immediate rehabilitation in order to reduce the discomfort related to wearing a total denture. A viable solution to provide stability and retention of the prosthesis in a short time is represented by the technique of intraoral welding supporting total denture or fixed prosthesis. This goal may be achieved thanks to the technique of welding titanium bars onto implant abutments. In fact, the procedure can be performed directly in the mouth, eliminating the possibility of errors or distortions due to prosthetic procedures. This paper describes a case report and the most recent data regarding long-term success and high predictability of intraorally-welded titanium bar in immediate loading implants.

Effect of Nd:YAG laser parameters on the penetration depth of a representative Ni-Cr dental casting alloy

The effects of voltage and laser beam (spot) diameter on the penetration depth during laser beam welding in a representative nickel-chromium (Ni-Cr) dental alloy were the subject of this study. The cast alloy specimens were butted against each other and laser welded at their interface using various voltages (160-390 V) and spot diameters (0.2-1.8 mm) and a constant pulse duration of 10 ms. After welding, the laser beam penetration depths in the alloy were measured. The results were plotted and were statistically analyzed with a two-way ANOVA, employing voltage and spot diameter as the discriminating variables and using Holm-Sidak post hoc method (a = 0.05). The maximum penetration depth was 4.7 mm. The penetration depth increased as the spot diameter decreased at a fixed voltage and increased as the voltage increased at a fixed spot diameter. Varying the parameters of voltage and laser spot diameter significantly affected the depth of penetration of the dental cast Ni-Cr alloy. The penetration depth of laser-welded Ni-Cr dental alloys can be accurately adjusted based on the aforementioned results, leading to successfully joined/repaired dental restorations, saving manufacturing time, reducing final cost, and enhancing the longevity of dental prostheses.

Retention systems for implant-retained overdentures

There have been demographic and cultural changes in the past few decades with regards to edentulism. Conventional mucosa-borne dentures can be poorly accepted by some patients. Implant overdentures have a useful role to play in the treatment of some of these patients. Some form of attachment mechanism between the implants and the prosthesis is normally required. This paper updates the reader on the different types of attachment systems and bars available.

CLINICAL RELEVANCE

It is important that dentists and technicians are able to understand the advantages and disadvantages of different attachment types for overdentures, in order to select the most appropriate technique for each patient.

The effect of axial and oblique loading on the micromovement of dental implants

PURPOSE

To quantify implant displacement upon axial and oblique force application and compare the effects of bone quality using an in vitro experimental setup.

MATERIALS AND METHODS

One hundred ninety-two implants were inserted into artificial bone block specimens using a drill guide. Ninety-six implants were placed in soft cancellous bone and loaded in 10-N increments up to 80 N in axial and oblique (30-degree angle) directions (n = 48 in each group). The other 96 implants were inserted in dense artificial bone and loaded in axial and oblique directions in the same force increments. Three-dimensional displacement data were recorded for all implants using a noncontact optical image correlation technique based on photogrammetric principles, and the absolute displacement vector was calculated.

RESULTS

There were significant differences in the absolute implant displacement in the different bone densities over all load increments. Implant displacement was significantly higher in soft cancellous bone than in dense bone. Axial and oblique loading revealed significant differences in implant displacement in the cancellous specimens, whereas oblique loading showed increased displacement (339 ± 47 Μm at 80 N) compared to axial loading (266 ± 39 Μm at 80 N). However, axial and oblique loading showed no significant differences over all load increments when implants were inserted in dense specimens (absolute displacement with an 80-N load: 147 ± 10 Μm axial and 126 ± 17 Μm oblique).

CONCLUSIONS

Bone density influenced implant displacement. The loading character (axial versus oblique) significantly influenced implant displacement in soft cancellous bone block specimens only. However, the limitation of the measured displacement values to an in vitro application that did not represent the complexity of vital bone has to be considered.

[Clinical analysis of laser welding on porcelain bonded metal surface]

PURPOSE

To evaluate the clinical effect of laser-welded crowns and bridges.

METHODS

Two hundred defective crowns and bridges were welded by using Heraplus laser welding machine, and then restored by porcelain.

RESULTS

After being welded ,those defective crowns and bridges of different materials fit well and their marginal areas were also satisfactory. During the follow up period of one year, no fractured porcelain and crack were found at welding spots.

CONCLUSIONS

The technology of laser welding has no direct effect on welding spots between metal and porcelain and could be used to deal with the usual problems of the crowns and bridges.

Are sectioning and soldering of short-span implant-supported prostheses necessary procedures?

The aim of this study was to evaluate the fit between dental abutments and the metal framework of a 3-unit fixed prosthesis screwed to two implants to determine whether sectioning and soldering of the framework are in fact necessary procedures. The study was based on a model of a metal framework of a 3-unit prosthesis screwed to two implants. A total of 18 metal frameworks were constructed and divided into 3 groups: (1) NS group - each framework was cast in one piece and not sectioned; (2) CS group - the components of each sectioned framework were joined by conventional soldering; and (3) LW group - the components of each sectioned framework were joined by laser welding. The control group consisted of six silver-palladium alloy copings that were not cast together. Two analyses were mperformed: in the first analysis, the framework was screwed only to the first abutment, and in the second analysis, the framework was screwed to both abutments. The prosthetic fit was assessed at a single point using a measuring microscope (Measurescope, Nikon, Japan) and the marginal gap was measured in micrometers. Statistical analysis was performed using analysis of variance (ANOVA), Scheffe's test, Student's t-test, and Mann-Whitney U test. The NS group had larger marginal gaps than the other groups (p<0.01), while the CS and LW groups had a similar degree of misfit with no significant difference between them. The results revealed that, in the case of short-span 3-unit fixed prostheses, the framework should be sectioned and soldered or welded to prevent or reduce marginal gaps between the metal framework and dental abutments.

[Study of physical-mechanic characteristics of prosthetic construction after their adjustment with the use of laser welding and hot metal adding]

Study of physical-mechanic characteristics of connecting joints of beam construction after laser welding and hot metal adding was performed. Increase of microhardness of joints as well as small reduction of bending strength of prosthetic constructions was established.

Strength of attachment between band and glass ionomer cement

AIM

To determine the strength of attachment between plain stainless steel band material and glass ionomer cement.

METHODS

Seventy-five extracted upper premolars, free of visible structural defects, were used. The teeth were divided randomly into three groups and embedded in acrylic resin blocks. A short length of plain, stainless steel band material with a welded stainless steel standard edgewise 0.022 inch bracket was adapted to the buccal surface of each tooth. The bracket-stainless steel pads were then cemented to the teeth with either Bandtite (Group 1), Granitec (Group 2) or Ariadent (Group 3) glass ionomer cement and stored in an incubator at 37 degrees C for 30 days. The shear bond strengths of the specimens were measured and compared.

RESULTS

The mean shear bond strengths (SBS) were significantly different: Bandtite 0.7331 +/- 0.056 Mpa; Granitec 0.3869 +/- 0.047 Mpa; Ariadent 0.2931 +/- 0.033 Mpa (ANOVA, p < 0.001). Tukey HSD post-hoc tests also showed significant differences between Bandtite and Granitec, Bandtite and Ariadent, and Granitec and Ariadent (p < 0.001). All specimens failed at the band-cement interface.

CONCLUSION

The highest and lowest SBS were related to Bandtite and Ariadent cements, respectively. All cements had bond strengths less than the range of bond strengths considered to be clinically acceptable for bonded orthodontic attachments. Mechanical factors are important for band retention.

Evaluation of shear bond strength of porcelain bonded to laser welded titanium surface and determination of mode of bond failure

The aim of this study was to evaluate the shear bond strength of porcelain to laser welded titanium surface and to determine the mode of bond failure through scanning electron microscopy (SEM) and energy dispersive spectrophotometry (EDS). Forty five cast rectangular titanium specimens with the dimension of 10 mm x 8 mm x 1 mm were tested. Thirty specimens had a perforation of 2 mm diameter in the centre. These were randomly divided into Group A and B. The perforations in the Group B specimens were repaired by laser welding using Cp Grade II titanium wire. The remaining 15 specimens were taken as control group. All the test specimens were layered with low fusing porcelain and tested for shear bond strength. The debonded specimens were subjected to SEM and EDS. Data were analysed with 1-way analysis of variance and Student's t-test for comparison among the different groups. One-way analysis of variance (ANOVA) showed no statistically significant difference in shear bond strength values at a 5% level of confidence. The mean shear bond strength values for control group, Group A and B was 8.4 +/- 0.5 Mpa, 8.1 +/- 0.4 Mpa and 8.3 +/- 0.3 Mpa respectively. SEM/EDS analysis of the specimens showed mixed and cohesive type of bond failure. Within the limitations of the study laser welding did not have any effect on the shear bond strength of porcelain bonded to titanium.

Magnet-retained implant-supported overdentures: review and 1-year clinical report

Open-field aluminum-nickle-cobalt magnets have been used in prosthodontics for many years, but success has been limited because these magnets are susceptible to corrosion by the saliva and because their retentive force is weak relative to the initial retention offered by mechanical attachments. More recently, magnets have been made from alloys of the rare earth elements samarium and neodymium, which provide stronger magnetic force per unit size. In addition, a new generation of laser-welded containers has improved protection from salivary corrosion. The current resurgence of interest in this type of attachment appears justified because, unlike mechanical attachments, magnets have potential for unlimited durability and might therefore be superior to mechanical ball or bar attachments for the retention of removable prostheses on implants. To date, no long-term prospective trials have been conducted to confirm the clinical durability of this new generation of magnets for retaining dentures on either teeth or implants. The aim of this study was to document initial clinical experiences and levels of satisfaction among edentulous patients treated with mandibular implant-supported overdentures retained using a new generation of rare-earth magnetic attachments. At the outset, all but one of the 17 patients had had several years of experience with implant-supported overdentures. During the first year, the mean overall satisfaction among these 17 patients increased from less than 70 to over 90 out of 100 (standardized visual analogue scale). No unusual difficulties were encountered in rendering the treatment or maintaining the attachments. This report offers preliminary evidence of the excellent potential of these magnets for retaining mandibular implant-supported overdentures.

Implant overdenture using Konus telescope on one-piece implant: a case report

An implant-retained Konus (tapered double crown) telescopic complete overdenture was fabricated for a mandibular edentulous patient. The Konus telescopic overdenture coping crowns and framework assembly were cast with commercially pure (CP) titanium, joined using laser welding and placed on four one-piece implants. Sufficient retention and stability were obtained using this method.

A resin acrylic and plaster solder index technique for realigning an ill-fitting fixed partial denture framework

A resin acrylic and plaster solder index technique is a simple, accurate, secure, and cost-effective way to intraorally realign an ill-fitting fixed partial denture framework. Once the fixed partial denture framework is sectioned and segments are found to fit, an intraoral index preserves the correct relationship among segments and holds castings together securely enough to avoid separating until they can be embedded in solder investment and soldered in the dental laboratory. This technique is described here, together with a literature review and a discussion of the technique's advantages relative to other indexing techniques and materials.

Laser welding of removable partial denture frameworks

PURPOSE

To identify and measure distortions inherent in the casting process of a Class III mandibular cobalt-chromium (Co-Cr) framework to illustrate the problems faced by the laboratory technician and the clinician and to measure the changes that occur during the correction of the fit discrepancy using laser welding.

MATERIALS AND METHODS

Five identical castings of a Co-Cr alloy partial denture casting were made and measured between 3 widely separated points using the x, y, and z adjustments of a Nikon Measurescope. The same measurements were made after each of the following clinical and laboratory procedures: sprue removal, sectioning of the casting into 3 parts through the posterior meshwork, fitting the segments to the master cast, picking up the segments using resin, and laser welding of the 3 segments.

RESULTS

Measurements of all 5 castings showed a cross-arch decrease after sprue removal, an increase after fitting the segments to the master cast, and a slight decrease after resin pickup and laser welding.

CONCLUSIONS

Within the limitations of this study, the findings suggest that precise tooth-frame relations can be established by resin pickup and laser welding of segments of Co-Cr removable partial denture frameworks.

A simplified method to assess precision of fit between framework and supporting implants: a preliminary study

PURPOSE

To present a simplified method for assessment of precision of fit between screw-retained frameworks and supporting implants in clinical situations.

MATERIALS AND METHODS

Torque-angle signature analysis is a method for analysis of tension within a joint. The OsseoCare device developed by Nobel Biocare was utilized for the tests. Three titanium frameworks were fabricated on the same master cast according to 3 different methods: (1) 1-piece casting, (2) the CNC (computer numeric controlled) method, and (3) the CTiP (Cresco Ti Precision) method. These frameworks were used to test the device and indirectly the application of the torque-angle signature analysis technology.

RESULTS

The frameworks fabricated according to the CNC and CTiP methods demonstrated OsseoCare tracings similar to the reference models of passively fitting joints, while the 1-piece cast framework did not.

CONCLUSION

According to this pilot study, the OsseoCare device and torque-angle signature analysis proved to be feasible for clinical assessment of fit between frameworks and supporting implants.

Micro-XRD study of beta–titanium wires and infrared soldered joints

OBJECTIVE

The purpose of this study was to investigate the metallurgical phases in beta-titanium soldered joints prepared by infrared soldering, using the Micro X-ray diffraction technique (Micro-XRD), and to characterize the Vickers hardness in the soldered beta-titanium wires.

METHODS

Beta-titanium wires with cross-section dimensions of 0.032in.x0.032in. (TMA, Ormco), and both titanium-based solder (Ti-30Ni-20Cu, Selec) and silver-based solder (Ag-22Cu-17Zn-5Sn, Tomy) were selected. Soldering was performed using infrared radiation (RS-1, Morita) under argon atmosphere. Micro-XRD analyses were performed at room temperature. Micro-XRD spectra were obtained for the boundary region of the soldered beta-titanium wires using 50microm and 10microm diameter analysis regions. Hardness was measured at 30microm intervals from boundary of the diffusion layer and beta-titanium wire. The Kruskal-Wallis test with the Bonferroni and Wilcoxson Mann-Whitney tests for nonparametric means were employed as statistical methods (P<0.05).

RESULTS

For both types of soldered beta-titanium samples, the Micro-XRD spectra contained four major peaks for body-centered cubic (bcc) beta-titanium. Additional peaks at about 41 and 45 degrees are attributed to Cu-Ti intermetallic phase(s), which may be metastable under soldering conditions. The diffusion layer had greater hardness than bulk beta-titanium for both types of soldered specimens (P<0.05).

SIGNIFICANCE

Soldering of beta-titanium orthodontic wire by infrared radiation may be acceptable for clinical use, since Micro-XRD spectra revealed that both types of soldered specimens largely retained the bcc beta-titanium structure. Further research is needed to investigate the mechanical properties and corrosion behavior of infrared-soldered beta-titanium wire.

Sagittal and vertical load-deflection and permanent deformation of transpalatal arches connected with palatal implants: an in-vitro study

INTRODUCTION

The purposes of this laboratory investigation were to (1) measure the sagittal and vertical deflection of loaded transpalatal arches (TPAs) connected to a palatal implant, (2) measure the extent of permanent deformation of the connecting TPA in the sagittal and vertical directions, (3) test various wire dimensions in terms of deflection behavior, and (4) evaluate soldering vs laser welding vs adhesive bonding of TPAs in terms of load deflection behavior.

METHODS

Stainless steel wires of 6 dimensions were tested: 0.8 x 0.8, 0.9, 1, 1.1, 1.2, and 1.2 x 1.2 mm. For each dimension, 10 specimens were soldered to the palatal implant abutment, 10 were laser welded, and 10 were adhesively bonded to the implant abutment (total, 180 specimens). The measuring device applied increments of force of 50 cN, from 0 to 500 cN. Then the specimens were unloaded. The values were statistically described and analyzed with ANOVA and Wilcoxon rank sum tests.

RESULTS AND CONCLUSIONS

Absolute orthodontic anchorage without deformation of TPAs was not observed with the wire dimensions tested. To prevent loss of anchorage greater than 370 mum (sagittal deflection of 1.2 x 1.2 mm adhesively bonded TPA at 500 cN force level), wires thicker than 1.2 x 1.2 mm or cast anchorage elements must be considered for clinical practice. However, larger cross sections might cause more patient discomfort, and laboratory procedures increase costs.

Joining characteristics of orthodontic wires with laser welding

Laser welding 0.016 x 0.022 in. beta-Ti, Ni-Ti, and Co-Cr-Ni orthodontic wires was investigated by measuring joint tensile strength, measuring laser penetration depth, determining metallurgical phases using micro X-ray diffraction (micro-XRD), and examining microstructures with an scanning electron microscope (SEM). Welding was performed from 150 to 230 V. Mean tensile strength for Ni-Ti groups was significantly lower (p < 0.05) than for most other groups of laser-welded specimens. Although mean tensile strength for beta-Ti and Co-Cr-Ni was significantly lower than for control specimens joined by silver soldering, it was sufficient for clinical use. The beta-Ti orthodontic wire showed deeper penetration depth from laser welding than the Ni-Ti and Co-Cr-Ni orthodontic wires. Micro-XRD patterns of laser-welded beta-Ti and Ni-Ti obtained 2 mm from the boundary were similar to as-received specimens, indicating that original microstructures were maintained. When output voltages of 190 V and higher were used, most peaks from joint areas disappeared or were much weaker, perhaps because of a directional solidification effect, evidenced by SEM observation of fine striations in welded beta-Ti. Laser welding beta-Ti and Co-Cr-Ni wires may be acceptable clinically, since joints had sufficient strength and metallurgical phases in the original wires were not greatly altered.

Tensile strength and corrosion resistance of brazed and laser-welded cobalt-chromium alloy joints

STATEMENT OF PROBLEM

The longevity of prosthodontic restorations is often limited due to the mechanical or corrosive failure occurring at the sites where segments of a metal framework are joined together.

PURPOSE

The purpose of this study was to determine which joining method offers the best properties to cobalt-chromium alloy frameworks. Brazed and 2 types of laser-welded joints were compared for their mechanical and corrosion characteristics.

MATERIAL AND METHODS

Sixty-eight cylindrical cobalt-chromium dental alloy specimens, 35 mm long and 2 mm in diameter, were cast. Sixteen specimens were selected for electrochemical measurements in an artificial saliva solution and divided into 4 groups (n=4). In the intact group, the specimens were left as cast. The specimens of the remaining 3 groups were sectioned at the center, perpendicular to the long-axis, and were subsequently rejoined by brazing (brazing group) or laser welding using an X- or I-shaped joint design (X laser and I laser groups, respectively). Another 16 specimens were selected for electrochemical measurements in a more acidic artificial saliva solution. These specimens were also divided into 4 groups (n=4) as described above. Electrochemical impedance spectroscopy and potentiodynamic polarization were used to assess corrosion potentials, breakdown potentials, corrosion current densities, total impedances at lowest frequency, and polarization charge-transfer resistances. The remaining 36 specimens were used for tensile testing. They were divided into 3 groups in which specimen pairs (n=6) were joined by brazing or laser welding to form 70-mm-long cylindrical rods. The tensile strength (MPa) was measured using a universal testing machine. Differences between groups were analyzed using 1-way analysis of variance (alpha=.05). The fracture surfaces and corrosion defects were examined with a scanning electron microscope.

RESULTS

The average tensile strength of brazed joints was 792 MPa and was significantly greater (P<.05) than the tensile strength of both types of laser-welded joints (404 MPa and 405 MPa). When laser welding was used, successful joining was limited to the peripheral aspects of the weld. The welding technique did not significantly affect the joint tensile strength. Electrochemical measurements indicated that the corrosion resistance of the laser-welded joints was better than of the brazed ones, primarily due to differences in passivation ability.

CONCLUSION

Laser welding provides excellent corrosion resistance to cobalt-chromium alloy joints, but strength is limited due to the shallow weld penetration. Brazed joints are less resistant to corrosion but have higher tensile strength than laser welds.

Physical and metallurgical considerations of failures of soldered bars in bar attachment systems for implant overdentures: a review of the literature

The purpose of this literature review was to identify the etiological factors of failure of soldered bars in bar attachment systems for removable implant overdentures. A search of MEDLINE using the key words "bar attachment systems" was performed of English language peer-reviewed journals published between 1975 and 2005. Clinical studies of implant overdentures with prosthodontic maintenance complications of bar attachment systems were identified to establish the perceived etiology of failure. A further search of MEDLINE using the key words "solder joint" was also performed of the fixed prosthodontic literature to identify specific factors affecting the strength, fatigue resistance, and quality of gold solder joints used for bar attachment systems. The first search on bar attachment systems produced evidence of low failure rates of interabutment bars, but higher failure rates of bars where distal cantilever extensions were used. There were no explanations or descriptions of the nature of those failures in the clinical studies reviewed. The second search on fixed prosthodontic literature identified multiple factors that could potentially relate to the failed solder joints with bar attachments. Two potential sites of failure in bar attachments with distal cantilevers were identified, and a simple estimate of the tensile stresses at the solder joints was performed. The values found are comparable to the fatigue failure stresses reported in the searched literature.

[Structural characteristics of laser-welded cast pure titanium joints by different gap distance]

OBJECTIVE

To measure the microstructure of laser-welded cast pure titanium by different gap distance.

METHODS

Forty specimens were sectioned and welded at four gaps (0.00 mm, 0.25 mm, 0.50 mm and 1.00 mm). Took microhardness test and metallographic examination of welded zone surface.

RESULTS

There were no difference in microhardness value and metallographic observation between welded specimens. The width of heat-effected zone was different. The smaller grains and needle-like alphamartensitic structure were found in the heat-affected zone.

CONCLUSION

The effects of the joint gap were not significant.

Clinical Experiences with Laser-Welded Titanium Frameworks Supported by Implants in the Edentulous Mandible: A 10-Year Follow-Up Study

BACKGROUND

Long-term follow-up studies for more than 5 years are not available on laser-welded titanium frameworks.

PURPOSE

To report and compare 10-year data on implant-supported prostheses in the edentulous mandible provided with laser-welded titanium frameworks and conventional gold alloy frameworks.

MATERIALS AND METHODS

Altogether, 155 patients were consecutively treated with prostheses at abutment level with two generations of fixed laser-welded titanium frameworks (test groups). A control group of 53 randomly selected patients with conventional gold alloy castings was used for comparison. Clinical and radiographic 10-year data were collected for the three groups.

RESULTS

All patients followed-up for 10 years (n=112) still had fixed prostheses in the mandible (cumulative success rate [CSR] 100%). The overall 10-year cumulative success rate (CSR) was 92.8 and 100.0% for titanium and gold alloy frameworks, respectively. Ten-year implant cumulative survival rate (CSR) was 99.4 and 99.6% for the test and control groups, respectively. Average 10-year bone loss was 0.56 (SD 0.45) mm for the titanium group and 0.77 (SD 0.36) mm for the control group (p < 0.05). The most common complications for titanium frameworks were resin or veneer fractures, soft tissue inflammation, and fractures (12.9%) of the metal frame. Loose and fractured implant screw components were below 3%.

CONCLUSION

Excellent overall long-term results with 100% CSR could be achieved with the present treatment modality. Fractures of the metal frames and remade prostheses were more common for the laser-welded titanium frameworks, and the first generation of titanium frameworks worked poorly when compared with gold alloy frameworks during 10 years (p < 0.05). However, on average more bone loss was observed for implants supporting gold alloy frameworks during 10 years. The reasons for this difference are not clear.

Bilateral space maintainers: a 7-year retrospective study from private practice

PURPOSE

The purpose of this study was to report survival times and problems encountered with bilateral space maintainers placed over a 7 year period.

METHODS

Charts were reviewed for all patients who had bilateral space maintainers placed between January 1, 1996 and December 31, 2003. Appliance lifetime and problems encountered were recorded and assessed on July 30, 2005, if still in use. Failures were recorded as: (1) cement loss; (2) solder breakage; (3) split band; (4) eruption interference; (5) bent wire; (6) loss; or (7) not specified. Also recorded were: (1) failed appliances; (2) transferred patients; and (3) those lost to follow-up.

RESULTS

A total of 482 space maintainers were evaluated, with 114 failures (24%) and 349 successes (72%). Of the 114 known failures: 68 (60%) were from cement loss; 12 (10%) were from solder breakage; 11 (10%) were from split bands; and 13 (11%) were from reasons not specified. No statistical differences were noted between types of failures or between genders. Mean pooled survival times were 20 months for lingual arches and 23 months for Nance appliances, with no statistical differences between arches, except in successful appliances where Nance was superior (P = .011). Of the 114 failed appliances: 44 (39%) were not recemented or remade, which was considered clinically successful; 51 (45%) were recemented; and 19 (17%) were remade. Eight appliances were lost to follow-up or transferred.

CONCLUSION

The majority of bilateral space maintainers (72%) lasted their anticipated lifetimes.