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Zaninovich M, Petrucci C, Drago C. Classification system for maxillary fixed dental prostheses. J Prosthodont 2024. [PMID: 39023038 DOI: 10.1111/jopr.13905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/06/2024] [Indexed: 07/20/2024] Open
Abstract
PURPOSE To present an addendum to existing fixed dental prostheses (FDPs) classification system for maxillary prostheses. The new classification identifies the relationships between FP-1 (fixed prostheses) designs and newly developed clinical interdental gingival contours. MATERIALS AND METHODS Clinical and laboratory descriptions of the various types of full-arch fixed prostheses are described with photographic illustrations. Benefits and limitations of the various prosthetic designs are explained. Surgical differences in the amount of alveolectomy are illustrated. One clinical case is demonstrated. RESULTS A new classification system for maxillary implant fixed complete dentures is presented. The new system will serve as an improved communication aid for clinicians, patients, and laboratory technicians. Treatment of patients with edentulous maxillae and/or terminal dentitions and implant fixed complete dentures include several options relative to design and materials. Restorative space can have a major impact on prosthesis design and longevity. Early on in dental implant therapy, prostheses were generally made with cast metal frameworks, denture bases and denture teeth. Prosthetic complications were widely reported. With increased clinical experience and improved materials, computer-aided design and computer-aided manufacturing (CAD-CAM) protocols were developed that allowed stronger prostheses to be constructed in reduced or small restorative volumes. FP-1 ceramic implant-supported fixed prostheses (CISFPs) are designed to replace only the dental hard tissues and to promote preservation and rehabilitation of gingival soft tissues. The physical properties and minimum thickness requirements in full arch prostheses are influenced by several factors including distances between implants and rigid connector sizes. CONCLUSION FP-1 CISFPs may be the closest prostheses the profession can offer edentulous patients that mimic the look, feel, and function of missing dentitions. Aesthetic outcomes of FP-1 CISFPs are variable and depend on a multitude of factors. This article presented a classification system that builds on existing classification by identifying the level of papilla heights achieved with FP-1 CISFPs.
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Affiliation(s)
- Michael Zaninovich
- Aria Dental Specialist Implant Centre, Perth, Western Australia, Australia
| | | | - Carl Drago
- Greenbrook Dental Group, Brookfield, Wisconsin, US
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De Angelis N, Pesce P, De Lorenzi M, Menini M. Evaluation of Prosthetic Marginal Fit and Implant Survival Rates for Conventional and Digital Workflows in Full-Arch Immediate Loading Rehabilitations: A Retrospective Clinical Study. J Clin Med 2023; 12:jcm12103452. [PMID: 37240558 DOI: 10.3390/jcm12103452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/01/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Digital impression provides several advantages in implant prosthodontics; however, its use in full-arch rehabilitations, especially immediately after surgery, has yet to be validated. The aim of this study was to retrospectively analyse the fit of immediate full-arch prostheses, fabricated using conventional or digital impressions. Patients requiring a full-arch immediate loading rehabilitation were divided into three groups: T1 (digital impression taken immediately after surgery), T2 (Preoperative digital impression, guided surgery-prefabricated temporary bridge) and C (conventional impression taken immediately after surgery). Immediate temporary prostheses were delivered within 24 h after surgery. X-rays were obtained at the time of prosthesis delivery and at the 2-year follow-up. Primary outcomes were cumulative survival rate (CSR) and prosthesis fit. Secondary outcomes were marginal bone level (MBL) and patient satisfaction. One hundred and fifty patients were treated from 2018 to 2020, with 50 in each group. Seven implants failed during the observation period. The CSR was 99% for T1, 98% for T2 and 99.5% for C. A statistically significant difference in prosthesis fit was found among T1 and T2 vs. C. A statistically significant difference was found in the MBL between T1 and C. The outcomes of the present study suggest that digital impression is a viable alternative to conventional protocols for the realisation of full-arch immediate loading prostheses.
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Affiliation(s)
- Nicola De Angelis
- Department of Surgical Sciences (DISC), Unit of Endo and Restorative Dentistry, University of Genova, Largo R. Benzi 10, 16132 Genova, Italy
- Dental Department, University Technology MARA, Sungai Buloh 40450, Malaysia
- Dental Department, University Trisakti, Jakarta 11440, Indonesia
| | - Paolo Pesce
- Department of Surgical Sciences (DISC), Unit of Prosthodontics and Implant Prosthodontics, University of Genova, Largo R. Benzi 10, 16132 Genova, Italy
| | | | - Maria Menini
- Department of Surgical Sciences (DISC), Unit of Prosthodontics and Implant Prosthodontics, University of Genova, Largo R. Benzi 10, 16132 Genova, Italy
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Pera F, Pesce P, Bagnasco F, Pancini N, Carossa M, Baldelli L, Annunziata M, Migliorati M, Baldi D, Menini M. Comparison of Milled Full-Arch Implant-Supported Frameworks Realised with a Full Digital Workflow or from Conventional Impression: A Clinical Study. MATERIALS (BASEL, SWITZERLAND) 2023; 16:ma16020833. [PMID: 36676569 PMCID: PMC9861382 DOI: 10.3390/ma16020833] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND The aim of the present study was to investigate the accuracy of a new digital impression system, comparing it to the plaster impression technique in the realization of full-arch implant-supported metal frameworks. METHODS We took 11 scans (8 of the upper maxilla and 3 of the lower jaw) on a sample of nine patients previously rehabilitated with fixed full-arch screw-retained prostheses following the Columbus Bridge Protocol (CBP) with four to six implants (total: 51) since at least 4 months. Two impressions were taken for each dental arch: one analogic plaster impression using pick-up copings and an open tray technique and a second one using an intra-oral scanner. Two milled metal substructures were realised. The precision and passivity of the substructures were clinically analysed through the Sheffield test and endo-oral radiographs. Laboratory scans of the plaster casts obtained from an intra-oral scanner (IOS) and of the plaster casts obtained from traditional impression were compared with the intraoral scans following Hausdorff's method and an industrial digital method of optical detection to measure discrepancies. A Mann-Whitney test was performed in order to investigate average distances between surfaces after the superposition. RESULTS The Sheffield test demonstrated an excellent passivity of the frameworks obtained through both the digital and the analogic method. In 81.81% of cases (n = 9) both substructures were found to have a perfect fit with excellent passivity, while in 18.18% (n = 2) of cases the substructures were found to have a very slight discrepancy. From the radiographic examination, no gaps between the frameworks and the implant heads or multiunit abutments were observed, with 100% accuracy. By superimposing digital files of scans according to Hausdorff's method, a statistically significant discrepancy (p = 0.006) was found between the digital scans and the digital models obtained from plaster impressions. Three-dimensional optical detection found a mean discrepancy of 0.11 mm between the analogic cast and the cast derived from the digital impression. CONCLUSIONS The present study clinically demonstrates that milled implant-supported full-arch frameworks obtained through a digital scan and the herein described technique have an accuracy comparable to those obtained with traditional plaster impression.
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Affiliation(s)
- Francesco Pera
- C.I.R. Dental School, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
| | - Paolo Pesce
- Department of Surgical Sciences (DISC), University of Genoa, 16132 Genoa, Italy
| | - Francesco Bagnasco
- Department of Surgical Sciences (DISC), University of Genoa, 16132 Genoa, Italy
| | - Nicolò Pancini
- Department of Surgical Sciences (DISC), University of Genoa, 16132 Genoa, Italy
| | - Massimo Carossa
- C.I.R. Dental School, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
| | - Lorenzo Baldelli
- Department of Surgical Sciences (DISC), University of Genoa, 16132 Genoa, Italy
| | - Marco Annunziata
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
| | - Marco Migliorati
- Department of Surgical Sciences (DISC), University of Genoa, 16132 Genoa, Italy
| | - Domenico Baldi
- Department of Surgical Sciences (DISC), University of Genoa, 16132 Genoa, Italy
| | - Maria Menini
- Department of Surgical Sciences (DISC), University of Genoa, 16132 Genoa, Italy
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Tomasi C, Albouy JP, Schaller D, Navarro RC, Derks J. Efficacy of rehabilitation of stage IV periodontitis patients with full-arch fixed prostheses: Tooth-supported versus Implant-supported-A systematic review. J Clin Periodontol 2021; 49 Suppl 24:248-271. [PMID: 34761430 DOI: 10.1111/jcpe.13511] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/29/2021] [Accepted: 05/25/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To evaluate the efficacy of implant-supported in comparison to tooth-supported full-arch prostheses in patients with stage IV periodontitis. MATERIALS AND METHODS Systematic electronic search (CENTRAL/MEDLINE/SCOPUS) up to March 2020 was conducted to identify randomized controlled trials and cohort-like studies comparing/evaluating fixed full-arch rehabilitation on teeth or implants in patients with stage IV periodontitis. The primary outcome measure was loss of teeth/implants and restorations. Data extraction was performed to create evidence tables, and meta-analyses were carried out as appropriate. RESULTS A total of 26 studies (31 publications) were identified but none addressed the scientific question in a controlled and randomized design. The risk of bias throughout the included studies was judged to be high, and meta-analyses demonstrated a high degree of heterogeneity. Mean-weighted observation periods in studies on tooth-supported restorations were significantly longer than in studies on implant-supported restorations. The predicted loss of teeth and tooth-supported full-arch restorations over 10 years was 1% and 5%, respectively. The 15-year estimates were 10% and 13%. Corresponding predictions for implants and implant-supported restorations for 10 years amounted to 4% and 6%, respectively. Technical complications were the most commonly reported and affected 8% of tooth-supported restorations (during 7.2 years) and 42% of implant-supported structures (during 2.6 years). Peri-implantitis- or peri-implantitis-like symptoms were observed at an estimated 9% of implants (after 3.1 years). CONCLUSIONS Based on observational studies on full-arch rehabilitation of stage IV periodontitis patients, 10-year estimates of tooth loss were lower than the corresponding estimates for implants. Estimated loss of tooth- and implant-supported restorations at 10 years was similar. Technical complications were more prevalent at implant-supported when compared to tooth-supported restorations.
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Affiliation(s)
- Cristiano Tomasi
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jean-Pierre Albouy
- Division of Comprehensive Oral Health, Department of Prosthodontics, Adams School of Dentistry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Dennis Schaller
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Renata Camino Navarro
- Division of Comprehensive Oral Health, Department of Prosthodontics, Adams School of Dentistry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Pera F, Menini M, Bagnasco F, Mussano F, Ambrogio G, Pesce P. Evaluation of internal and external hexagon connections in immediately loaded full-arch rehabilitations: A within-person randomized split-mouth controlled trial with a 3-year follow-up. Clin Implant Dent Relat Res 2021; 23:562-567. [PMID: 34219356 PMCID: PMC8457096 DOI: 10.1111/cid.13029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/30/2021] [Accepted: 06/02/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Although full-arch immediately loaded rehabilitations are widely used nowadays, little information is available on which implant/abutment connection is the most suitable in this type of treatment. PURPOSE The aim of the present multicentric split-mouth clinical trial was to compare the clinical outcomes of two different implant-abutment connections applied in full-arch immediate loading rehabilitations: external hexagon connection (EHC) versus internal hexagon connection (IHC). MATERIALS AND METHODS Twenty patients were rehabilitated with immediately loaded fixed full-arch rehabilitations. All the implants presented the same macro- and micro-topography but different implant/abutment connection. IHC were used in one randomly selected side of the jaw and EHC in the other side. Outcome measures were implant survival rate, peri-implant marginal bone loss (MBL), plaque index (PI), probing depth (PD), and bleeding on probing (BoP) evaluated at 3, 6, 12, and 36-month post-loading. Any technical and biological complication was recorded. Kaplan-Meier procedure and linear mixed model were used to perform statistical analysis. RESULTS Forty-three EHC and 40 IHC implants were inserted. No patients dropped out and two implants failed in the first 6 months. The CSR was 97.7% for EHC and 97.5% for IHC implants. No statistically significant differences were found among the two groups for any of the parameters at any time point. At the 36-month follow-up visit a slight difference was found in MBL with a mean value of 1.7 mm in the EHC and of 1.9 mm in the IHC group (p = 0.355). No biologic complications were identified. Seven loosed abutment screws were identified in the entire follow-up period, two in the EHC, and five in the IHC group without a statistically significant difference (p = 0.394). CONCLUSIONS After 36 months in function, both internal and external hexagon connections provided good clinical outcomes and were not associated with any significant difference.
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Affiliation(s)
- Francesco Pera
- CIR Dental School Department of Surgical Sciences, University of Turin, Torino, Italy
| | - Maria Menini
- Department of Surgical Sciences (DISC), Division of Prosthodontics and Implant Prosthodontics, University of Genoa, Genova, Italy
| | - Francesco Bagnasco
- Department of Surgical Sciences (DISC), Division of Prosthodontics and Implant Prosthodontics, University of Genoa, Genova, Italy
| | - Federico Mussano
- CIR Dental School Department of Surgical Sciences, University of Turin, Torino, Italy
| | - Giulia Ambrogio
- CIR Dental School Department of Surgical Sciences, University of Turin, Torino, Italy
| | - Paolo Pesce
- Department of Surgical Sciences (DISC), Division of Prosthodontics and Implant Prosthodontics, University of Genoa, Genova, Italy
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Thomé G, Caldas W, Bernardes SR, Cartelli CA, Gracher AHP, Trojan LC. Implant and prosthesis survival rates of full-arch immediate prostheses supported by implants with and without bicortical anchorage: Up to 2 years of follow-up retrospective study. Clin Oral Implants Res 2020; 32:37-43. [PMID: 33211323 DOI: 10.1111/clr.13678] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 10/28/2020] [Accepted: 10/28/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To compare implant and prosthesis survival rates between full-arch immediate prostheses supported by 4 hydrophilic implants with bicortical anchorage and by 5 or 6 hydrophilic implants placed without bicortical anchorage. MATERIAL AND METHODS The sample was retrospectively selected and comprised completely edentulous patients treated with full-arch immediate prostheses supported by Morse Taper hydrophilic implants. The selected patients were divided into four groups, according to the region of implant placement and type of anchorage. Differences in implant and prosthesis survival rates between groups, as well as the influence of bicortical anchorage on implant primary stability, were verified using Fisher's exact tests (significant at p < .05). RESULTS The sample comprised 392 implants, 72 were placed in the maxilla with bicortical anchorage, and 85 were placed without. In the mandible, 140 implants were placed with and 95 were placed without bicortical anchorage. The follow-up period was up to 24 months. A 98.8% implant survival rate was observed for the group of implants placed without bicortical anchorage in the maxilla, and of 100% for the other groups. The overall implant survival rate was 99.7% (391 of 392 implants). Prosthesis survival rate was 100% for all groups. No differences were observed between groups with respect to implant and prosthesis survival rates. Significantly higher primary stability was observed for implants placed with bicortical anchorage in both jaws. CONCLUSION Predictable results and high survival rates were achieved within the period evaluated by the present retrospective study, with immediate full-arch prostheses when only four hydrophilic implants are placed bicortically.
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Oyar P, Durkan R, Deste G. The effect of the design of a mandibular implant-supported zirconia prosthesis on stress distribution. J Prosthet Dent 2020; 125:502.e1-502.e11. [PMID: 32893017 DOI: 10.1016/j.prosdent.2020.05.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 11/24/2022]
Abstract
STATEMENT OF PROBLEM Prosthetic complications have been frequently reported in implant-supported complete-arch prosthesis. Prosthetic restorations designed with an all-on-four treatment concept and fabricated from zirconia ceramic may be used to overcome these problems. PURPOSE The purpose of this biomechanical study was to evaluate the effects of cantilever length and inclination of implant on the stress distribution in bone tissue, implant, and a monolithic zirconia ceramic-lithium disilicate glass-ceramic superstructure for all-on-four prosthesis. MATERIAL AND METHODS All-on-four mandibular prosthesis fabricated from a zirconia and lithium disilicate glass-ceramic (LDGC) superstructure was designed with cantilever lengths of either 5 mm or 9 mm and posterior implants with a distal tilt of either 15 or 30 degrees. Stresses were evaluated with a simulated application of a static load of 600 N. RESULTS Increasing implant inclination from 15 to 30 degrees led to a decrease in maximum principal stress (MaxPS) values of approximately 4 to 7 MPa in cortical bone around all implants except the right anterior implant in the designs with short cantilevers and an increase in MaxPS values (approximately 3 to 19 MPa) in the same places in the designs with the long cantilevers. Increasing cantilever length from 5 to 9 mm resulted in an increase in minimum principal stress (MinPS) values of approximately 3 to 13 MPa in the cortical bone surrounding all posterior implants. In the designs with the long cantilever, MaxPS values increased approximately 3 to 4 MPa in spongy bone adjacent to the right posterior implant. An increase in cantilever length also led to higher vMS values at the first and second implant grooves in the right posterior implant in the design with the 15-degree implant tilt. An increase in implant inclination in the design with the short cantilever resulted in lower vMS values at the apex and all grooves of the left posterior implant, whereas in the design with the long cantilever, an increase in implant inclination resulted in lower stress values in the first and second grooves of the same implant. An increase in implant inclination led to in an increase in vMS values in the core structure. CONCLUSIONS In zirconia ceramic restorations by using an all-on-four design with an LDGC superstructure, short cantilevers may be preferable because they result in a more favorable distribution of stress than long cantilevers. An increase in implant angulation from 15 to 30 degrees decreased MaxPS values in cortical bone.
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Affiliation(s)
- Perihan Oyar
- Associate Professor, Dental Prosthetics Technology, Health Services Vocational School, Hacettepe University, Ankara, Turkey.
| | - Rukiye Durkan
- Associate Professor, Department of Prosthodontics, Faculty of Dentistry, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Gonca Deste
- Assistant Professor, Department of Prosthodontics, Faculty of Dentistry, Bursa Uludağ University, Bursa, Turkey
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Alfarsi MA, Shaik S. Implant-supported fixed hybrid acrylic complete dentures opposing fully restored mandibular metal ceramic restorations. BMJ Case Rep 2020; 13:13/2/e233913. [PMID: 32107260 DOI: 10.1136/bcr-2019-233913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This report presents a full-mouth rehabilitation case. A patient came with a failing dentition in maxilla, and after the treatment, the patient had a shortened full-arch, implant-supported, screw-retained hybrid acrylic complete denture in the maxilla and full-arch metal ceramic restorations in the mandible. The report describes the steps involved in the prosthodontic rehabilitation; a cost-effective treatment plan, the restoration of vertical dimension, an immediate denture, an implant-level impression, a verified-master cast, the fabrication of definitive prosthesis, the occlusal scheme and multiple follow-ups in 6 months. We discussed the merits/demerits of screw-retained prosthesis, impression techniques and various types of fixed complete dentures. We learnt the difficulty in hygiene measures and dissatisfaction of the patient with the hygienic gaps under the acrylic fixed dentures.
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Affiliation(s)
- Mohammed A Alfarsi
- Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Sharaz Shaik
- Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Saudi Arabia
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Beretta M, Poli PP, Tansella S, Aguzzi M, Meoli A, Maiorana C. Cast-free digital workflow for implant-supported rehabilitation in a completely edentulous patient: A clinical report. J Prosthet Dent 2020; 125:197-203. [PMID: 32087844 DOI: 10.1016/j.prosdent.2019.12.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 12/10/2019] [Accepted: 12/10/2019] [Indexed: 11/29/2022]
Abstract
Digitalization of edentulous areas restored with dental implants is still considered a demanding procedure, mainly because of the lack of fixed reference landmarks, together with an increased interimplant distance. To overcome such limitations, an auxiliary device is introduced with the 3-fold purpose of stretching the soft tissues with a fixed object connected to the scan bodies, creating areas with nonhomogeneous architectures between the implants, and shortening the interimplant distance with the interposition of solid geometric figures. The rationale was to increase the accuracy of digital scans in a cast-free digital implant workflow.
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Affiliation(s)
- Mario Beretta
- Clinical Assistant Professor, Implant Center for Edentulism and Jawbone Atrophies, Maxillofacial Surgery and Odontostomatology Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Pier Paolo Poli
- Research Assistant, Implant Center for Edentulism and Jawbone Atrophies, Maxillofacial Surgery and Odontostomatology Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
| | - Sebastian Tansella
- Postgraduate student, Implant Center for Edentulism and Jawbone Atrophies, Maxillofacial Surgery and Odontostomatology Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Marco Aguzzi
- Dental Technician, Private practitioner, Fossano, Cuneo, Italy
| | - Antonio Meoli
- Dental Technician, Private practitioner, Juneau, Alaska
| | - Carlo Maiorana
- Full Professor, Implant Center for Edentulism and Jawbone Atrophies, Maxillofacial Surgery and Odontostomatology Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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Lin WS, Eckert SE. Clinical performance of intentionally tilted implants versus axially positioned implants: A systematic review. Clin Oral Implants Res 2019; 29 Suppl 16:78-105. [PMID: 30328193 DOI: 10.1111/clr.13294] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 03/18/2018] [Accepted: 03/19/2018] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The aim of this review was to determine the clinical performance of dental implants that are intentionally tilted when compared with implants that are placed following the long axis of the residual alveolar ridge. MATERIALS AND METHODS A systematic review of the scientific literature using a predefined research question (PICO) and search strategy was undertaken. This search included five electronic databases. Two independent reviewers examined electronic databases and performed a manual review following search strategy to accomplish the item generation and reduction. Included articles were evaluated to determine the level of evidence. Data were extracted only from level I and level II studies, based on the Oxford Centre for Evidence-based Medicine-Levels of Evidence (March 2009). If included studies were homogeneous in nature, data were to be accumulated. However, if included studies were heterogeneous in nature, only descriptive data would be reviewed and analyzed. RESULTS A total of 811 articles were identified through the PICO question and search strategy. Detailed review of the abstracts and articles resulted in further item reduction, and 46 articles were included for full-text review. A total of 42 articles were then selected for inclusion in the systematic review. The identified articles included two level I and 20 level II studies. In addition, 15 level IV, one gray literature, and four previous systematic reviews with meta-analyses were also used in the study. The extracted data from the included studies demonstrated heterogeneity that prevented quantitative assessment, and only one level II study directly compared tilted and axially placed implants. Assessment of the descriptive data demonstrated no differences in implant survival, marginal bone loss, prosthesis survival, or patient-reported outcome measures (PROMs) whether implants are placed axially or with intentional inclination of the coronal aspect of the implant toward the distal aspect of edentulous jaws. CONCLUSIONS Based upon the systematic review of the literature, an analysis of the descriptive data suggested no differences in clinical performance between implants that are placed in an axial position relative to the residual alveolar ridge when compared with implants that are intentionally tilted toward the distal aspect of edentulous jaws.
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Affiliation(s)
- Wei-Shao Lin
- Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, Indiana
| | - Steven E Eckert
- Mayo Clinic School of Medicine, Rochester, Minnesota.,Director of Research and Clinical Development, ClearChoice Management Services, Greenwood Village, Colorado
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Rosa EC, Do Nascimento TCDL, Sebastiani AM, Scariot R, Deliberador TM, Zielak JC, Florez FLE, Storrer CLM. All-On-Four Protocol With Immediate Load on Short Implants in an Atrophic Mandible: A Case Report with a 4-Year Follow-Up. Open Dent J 2018. [DOI: 10.2174/1874210601812011004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Purpose:
Edentulism has been demonstrated to have negative social and psychological effects on individuals that include adverse impacts on facial and oral esthetics, masticatory function and speech abilities, that when combined, are translated into significant reductions in patients’ quality of lives. It is well-known that immediate placement of implants is a challenging surgical procedure that requires proper treatment planning and surgical techniques. Therefore, the present study describes a 4-year follow-up case report where short implants were placed in an atrophic mandibule and were loaded with the utilization of an all-on-four prosthetic protocol.
Case report:
A 54 year-old woman dissatisfied with her oral and facial esthetics, masticatory function and speech ability came to the implantology clinic of the Positivo University seeking for oral rehabilitation treatment. After detailed physical and clinical examination, a Computer Tomography scan (CT-scan) was performed to determine the patient’s bone ridge density, dimensions and eligibility for the placement of dental implants. The CT-scan results have indicated the presence of an extremely atrophic mandibular bone ridge. The CT-scan was also used as an aid during the final restoration treatment planning in terms of vertical dimension of occlusion, masticatory function, and stabilization of the lower denture. An all-on-four protocol supported by short implants was then treatment-planned to reduce time, costs and morbidity, and also to achieve superior immediate esthetic results and masticatory function. To reconstruct the patient’s atrophic edentulous mandibule, 4 short implants, including 2 distally tilted, were placed with a final torque of 45 Ncm.
Results:
Following the development and implementation of a complex treatment plan, the patient displayed stable soft and hard tissues at 4-year postoperative follow-up assessment, demonstrating the effectiveness of the all-on-four technique supported by short implants.
Conclusion:
Within the limits of this study, the present case report demonstrated that the all-on-four prosthetic protocol with immediate loading on short implant was effective in an atrophic mandible over a 4-year follow-up.
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Mehl C, Kern M, Neumann F, Bähr T, Wiltfang J, Gassling V. Effect of ultraviolet photofunctionalization of dental titanium implants on osseointegration. J Zhejiang Univ Sci B 2018; 19:525-534. [PMID: 29971991 DOI: 10.1631/jzus.b1600505] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of the current study was to evaluate the effect of ultraviolet (UV) photofunctionalization of dental titanium implants with exposure to the oral cavity on osseointegration in an animal model. METHODS Forty-eight titanium implants (Camlog® Conelog® 4.3 mmx9.0 mm) were placed epicrestally into the edentulous jaws of three minipigs and implant stability was assessed by measuring the implant stability quotient (ISQ). Prior to implantation half of the implants were photofunctionalized with intense UV-light. After three months, the implants were exposed and ISQ was measured again. After six months of implant exposure, the minipigs were sacrificed and the harvested specimens were analyzed using histomorphometric, light, and fluorescence microscopy. MAIN RESULTS Forty-two of 48 implants osseointegrated. The overall mean bone-implant contact area (BIC) was (64±22)%. No significant differences were found in BIC or ISQ value (multivariate analysis of variance (MANOVA), P>0.05) between implants with and without exposure to UV photofunctionalization. CONCLUSIONS No significant effects were observed on osseointegration of dental titanium implants nine months after exposure of UV photofunctionalization.
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Affiliation(s)
- Christian Mehl
- Department of Prosthodontics, Propaedeutics and Dental Materials, Christian-Albrechts University at Kiel, Arnold-Heller-Straße 16, 24105, Kiel, Germany
| | - Matthias Kern
- Department of Prosthodontics, Propaedeutics and Dental Materials, Christian-Albrechts University at Kiel, Arnold-Heller-Straße 16, 24105, Kiel, Germany
| | - Friederike Neumann
- Department of Prosthodontics, Propaedeutics and Dental Materials, Christian-Albrechts University at Kiel, Arnold-Heller-Straße 16, 24105, Kiel, Germany
| | - Telse Bähr
- Private Practice, Lassabeker Weg 3, 24211, Lehmkuhlen, Germany
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, Christian-Albrechts University at Kiel, Arnold-Heller-Straße 16, 24105, Kiel, Germany
| | - Volker Gassling
- Department of Oral and Maxillofacial Surgery, Christian-Albrechts University at Kiel, Arnold-Heller-Straße 16, 24105, Kiel, Germany
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13
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Malchiodi L, Moro T, Cattina DP, Cucchi A, Ghensi P, Nocini PF. Implant rehabilitation of the edentulous jaws: Does tilting of posterior implants at an angle greater than 45° affect bone resorption and implant success?: A retrospective study. Clin Implant Dent Relat Res 2018; 20:867-874. [PMID: 30048036 DOI: 10.1111/cid.12655] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 05/15/2018] [Accepted: 06/09/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aimed to (1) investigate the success of posterior implants tilted >45° when 4 immediately loaded implants were used to support full-arch prostheses, eliminating any distal cantilever and (2) examine the effect on marginal bone loss (MBL) of different combinations of anterior multi-unit abutment (MUA) angles and posterior implant tilting angles. MATERIALS AND METHODS Records of patients rehabilitated according to the Columbus Bridge Protocol were analyzed. Peri-implant bone levels (PBLs) and MBL were measured for each implant. The influence of posterior implant tilting angle on PBL, MBL, and implant and prosthetic success rate was investigated. The impact on the same endpoints of different anterior MUA angles, and different combinations of anterior MUA and tilted posterior implant angles was also examined. RESULTS Records of 41 patients were analyzed, for a total of 46 complete rehabilitations, and 142 implants (52 anterior, 63 posterior tilted ≤45° [group 1], and 27 posterior tilted >45° [group 2]). No implants were lost during the follow-up (25.9 months), and no prosthetic complications were reported. Success rate for posterior implants was 100% in group 1 and 96.3% in group 2. Mean MBL differed significantly between the 2 groups (0.45 mm in group 1, 0.66 in group 2 [P = .04]), but not when the analysis was limited to implants in the same jaw. Implant tilting angle did not correlate with MBL and the MUA angle had no effect on bone resorption around posterior implants, neither in the sample as a whole nor in individual patients. CONCLUSIONS Posterior implants tilted >45° to eliminate distal cantilever may be as safe as those tilted less in severely atrophic jaws rehabilitated with immediately loaded, full-arch prostheses supported on 4 implants. Further prospective studies on larger samples of patients and implants and with longer follow-up are needed to confirm these findings.
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Affiliation(s)
- Luciano Malchiodi
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Tommaso Moro
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Diego P Cattina
- Private Practice, Piazza Almici Monsignor Giuseppe 7, 25124 Brescia (BS), Italy
| | - Alessandro Cucchi
- Department of Biomedical and Neuromotor Science, University of Bologna, Bologna, Italy
| | - Paolo Ghensi
- CIBIO (Centre for Integrative Biology), University of Trento, Trento, Italy
| | - Pier F Nocini
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
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14
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Wentaschek S, Hartmann S, Walter C, Wagner W. Six-implant-supported immediate fixed rehabilitation of atrophic edentulous maxillae with tilted distal implants. Int J Implant Dent 2017; 3:35. [PMID: 28744757 PMCID: PMC5526826 DOI: 10.1186/s40729-017-0096-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 07/13/2017] [Indexed: 11/29/2022] Open
Abstract
Background The aim of this retrospective study was to evaluate the treatment outcome of six Bredent blueSky™ implants (Bredent GmbH, Senden, Germany) immediately loaded with a fixed full-arch prosthesis (two tilted posterior and four axial frontal and premolar implants). Methods All 10 patients with atrophic edentulous maxillae being treated with a standardized procedure from 09/2009 to 01/2013, who had a follow-up of at least 3 years, were included. Sixty implants were placed to support 10 screwed prostheses. Twenty-one of them were inserted in fresh extraction sockets. Lab-side-prepared provisional fixed prostheses were placed at the day of implantation. Periotest (PT) values and implant stability quotient (ISQ) were measured after implant surgery and after 3 months of healing in all patients. Results The analyzed implants were in function in mean 64 ± 13 months (range 42 to 84 months). One axial and two tilted implants failed in three patients. The mean PT values decreased, and ISQ increased significantly after the first 3 months at the osseointegrated tilted and axial implants. With an area under the curve of 0.503 and 0.506 in the receiver operating characteristic, the PT values and the ISQ were unspecific parameters and unsuitable as a predictor for the risk of non-osseointegration. Conclusions Within the limits of this small group (n = 10 patients/60 implants), the failure rate of the analyzed implant system (n = 3 respective 5% implant loss) seems to be comparable with other immediate-loading protocols. The failure rate of tilted implants in the atrophic upper jaw was quite high, but the aimed treatment concept could be achieved in every patient. The rehabilitation of the posterior region in edentulous maxilla remains a challenge.
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Affiliation(s)
- S Wentaschek
- Department of Prosthetic Dentistry, University Medical Center of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131, Mainz, Germany.
| | - S Hartmann
- Department of Prosthetic Dentistry, University Medical Center of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - C Walter
- Department of Oral and Maxillofacial Surgery - Plastic Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - W Wagner
- Department of Oral and Maxillofacial Surgery - Plastic Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131, Mainz, Germany
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Pera F, Pesce P, Solimano F, Tealdo T, Pera P, Menini M. Carbon fibre versus metal framework in full-arch immediate loading rehabilitations of the maxilla - a cohort clinical study. J Oral Rehabil 2017; 44:392-397. [PMID: 28196278 DOI: 10.1111/joor.12493] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2017] [Indexed: 11/30/2022]
Abstract
Frameworks made of carbon fibre-reinforced composites (CFRC) seem to be a viable alternative to traditional metal frameworks in implant prosthodontics. CFRC provide stiffness, rigidity and optimal biocompatibility. The aim of the present prospective study was to compare carbon fibre frameworks versus metal frameworks used to rigidly splint implants in full-arch immediate loading rehabilitations. Forty-two patients (test group) were rehabilitated with full-arch immediate loading rehabilitations of the upper jaw (total: 170 implants) following the Columbus Bridge Protocol with four to six implants with distal tilted implants. All patients were treated with resin screw-retained full-arch prostheses endowed with carbon fibre frameworks. The mean follow-up was 22 months (range: 18-24). Differences in the absolute change of bone resorption over time between the two implant sides (mesial and distal) were assessed performing a Mann-Whitney U-test. The outcomes were statistically compared with those of patients rehabilitated following the same protocol but using metal frameworks (control group: 34 patients with 163 implants - data reported in Tealdo, Menini, Bevilacqua, Pera, Pesce, Signori, Pera, Int J Prosthodont, 27, 2014, 207). Ten implants failed in the control group (6·1%); none failed in the test group (P = 0·002). A statistically significant difference in the absolute change of bone resorption around the implants was found between the two groups (P = 0·004), with greater mean peri-implant bone resorption in the control group (1 mm) compared to the test group (0·8 mm). Carbon fibre frameworks may be considered as a viable alternative to the metal ones and showed less marginal bone loss around implants and a greater implant survival rate during the observation period.
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Affiliation(s)
- F Pera
- Implant and Prosthetic Dentistry Unit, Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - P Pesce
- Implant and Prosthetic Dentistry Unit, Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - F Solimano
- Implant and Prosthetic Dentistry Unit, Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - T Tealdo
- Implant and Prosthetic Dentistry Unit, Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - P Pera
- Implant and Prosthetic Dentistry Unit, Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - M Menini
- Implant and Prosthetic Dentistry Unit, Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
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16
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Amorfini L, Migliorati M, Drago S, Silvestrini-Biavati A. Immediately Loaded Implants in Rehabilitation of the Maxilla: A Two-Year Randomized Clinical Trial of Guided Surgery versus Standard Procedure. Clin Implant Dent Relat Res 2016; 19:280-295. [DOI: 10.1111/cid.12459] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 09/09/2016] [Accepted: 09/23/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Leonardo Amorfini
- Researcher, Department of Surgical Sciences and Integrated Diagnostic; University of Genova; Genova Italy
| | - Marco Migliorati
- Adjunct Assistant Professor, Department of Orthodontics; University of Genova; Genova Italy
| | - Sara Drago
- Researcher, Department of Orthodontics; University of Genova; Genova Italy
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Horita S, Sugiura T, Yamamoto K, Murakami K, Imai Y, Kirita T. Biomechanical analysis of immediately loaded implants according to the "All-on-Four" concept. J Prosthodont Res 2016; 61:123-132. [PMID: 27615425 DOI: 10.1016/j.jpor.2016.08.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 07/06/2016] [Accepted: 08/08/2016] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study was to investigate the biomechanical behavior of immediately loaded implants in an edentulous mandible according to the "All-on-Four" concept. METHODS A 3D-finite element model of an edentulous mandible was constructed. Four implants were placed between the bilateral mental foramen according to "All-on-Four" concept. A framework made of titanium or acrylic resin between the bilateral first molars was modeled. Immediate loading and a delayed loading protocol were simulated. A vertical load of 200N was applied at the cantilever or on the abutments region of the distal implants, simulating the absence of a cantilever. RESULTS The peak principal compressive strains in the immediate loading models resulted in 24.0-35.8% and 26.4-39.0% increases compared with the delayed loading models under non-cantilever loading and cantilever loading, respectively. The loading position greatly affected the principal compressive and tensile strain values. The peak principal compressive strains in non-cantilever loading resulted in a 45.3-52.6% reduction compared with those in cantilever loading. The framework material did not influence the peak compressive and tensile strain. The maximum micromotion at the bone-implant interface in the immediate loading models was 7.5-14.4μm. CONCLUSIONS Mandibular fixed full-arch prostheses without cantilevers may result in a favorable reduction of the peri-implant bone strain during the healing period, compared with cantilevers. The maximum micromotion was within the acceptable limits for uneventful implant osseointegration in the immediate loading models. Framework material did not play an important role in reducing the peri-implant bone strain and micromotion at the bone-implant interface.
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Affiliation(s)
- Satoshi Horita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Nara, Japan.
| | - Tsutomu Sugiura
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Nara, Japan
| | - Kazuhiko Yamamoto
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Nara, Japan
| | - Kazuhiro Murakami
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Nara, Japan
| | - Yuichiro Imai
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Nara, Japan
| | - Tadaaki Kirita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Nara, Japan
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Shigehara S, Ohba S, Nakashima K, Takanashi Y, Asahina I. Immediate Loading of Dental Implants Inserted in Edentulous Maxillas and Mandibles: 5-Year Results of a Clinical Study. J ORAL IMPLANTOL 2015; 41:701-5. [DOI: 10.1563/aaid-joi-d-14-00018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aim of the present study was to evaluate the long-term outcome of immediately loaded full-arch, fixed, one-piece prostheses supported by dental implants inserted in completely edentulous maxillae and mandibles. Twenty-eight completely edentulous jaws in 27 patients were treated with screw-fixed provisional prostheses on the same day as implant insertion. A total of 189 implants were inserted into the jaws of the patients. All provisional prostheses were the one-piece bridge type and were made with acrylic resin. Final restoration was performed more than 2 months after surgery. Implant survival rate, prosthesis success rate, and complications during the follow-up period were evaluated. Implant size (diameter and length) and bone quality (Hounsfield units) of the region of the implant were also analyzed. Mean follow-up time was 77.9 months. The cumulative survival rate of the implants was 100%, and the success rate of the prostheses was also 100% during the observation time. Although 3 types of minor complications occurred in 10 jaws (10/28; 35.7%), no major complications were found. Immediate loading of dental implants produces an equivalent outcome as that reported in previous studies using conventional loading. We believe this study not only adds to the immediate loading data but also confirms that the immediate loading technique may be most advantageous strategy for edentulous patients.
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Affiliation(s)
| | - Seigo Ohba
- Department of Regenerative Oral Surgery, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan; previously with Division of Dentistry and Oral Surgery, Department of Sensory and Locomotor Medicine, Faculty of Medicine, University of Fukui, Fukui, Japan
| | - Ken Nakashima
- Takanashi Dental Clinic, Chuou-ku, Nihon-bashi, Japan
| | - Yoshiaki Takanashi
- Shonan Dental Care Implant Clinic, city, Japan, and Takanashi Dental Clinic, city, Japan
| | - Izumi Asahina
- Department of Regenerative Oral Surgery, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
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Mo A, Hjortsjö C, Olsen-Bergem H, Jokstad A. Maxillary 3-implant removable prostheses without palatal coverage on Locator abutments - a case series. Clin Oral Implants Res 2015; 27:1193-1199. [DOI: 10.1111/clr.12724] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Arild Mo
- Department of Clinical Dentistry; Faculty of Health Sciences; UiT The Arctic University of Norway; Tromsø Norway
| | - Carl Hjortsjö
- Department of Prosthetic Dentistry and Oral Function; Institute of Clinical Dentistry; University of Oslo; Oslo Norway
| | - Heming Olsen-Bergem
- Department of Oral and Maxillofacial Surgery; Institute of Clinical Dentistry; University of Oslo; Oslo Norway
| | - Asbjørn Jokstad
- Department of Clinical Dentistry; Faculty of Health Sciences; UiT The Arctic University of Norway; Tromsø Norway
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20
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Yilmaz B, Ozcelik TB, McGlumphy E. Using the “final-on-four” concept to deliver an immediate metal-resin implant-fixed complete dental prosthesis. J Prosthet Dent 2015; 114:161-6. [DOI: 10.1016/j.prosdent.2014.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 11/05/2014] [Accepted: 11/05/2014] [Indexed: 11/24/2022]
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Menini M, Dellepiane E, Pera P, Bevilacqua M, Pesce P, Pera F, Tealdo T. A Luting Technique for Passive Fit of Implant-Supported Fixed Dentures. J Prosthodont 2015; 25:77-82. [PMID: 25898912 DOI: 10.1111/jopr.12281] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2014] [Indexed: 11/27/2022] Open
Abstract
Several factors contribute to distortion of implant prostheses during fabrication and could prevent passive, accurate adaptation between implants and implant frameworks. The misfit between implants and restorative components may be significant and possibly lead to biologic or mechanical complications. The aim of this article is to describe a laboratory luting technique used to lute implant cylinders to metal frameworks in implant prostheses. This technique provides accurate, passive fits. According to this technique, titanium implant cylinders provided with corresponding external castable cylinders are used. Implant cylinders are screwed into the analogs in the master cast while the castable cylinders on top are splinted together using castable resin to realize a castable resin pattern. After casting, the framework is adjusted and cemented to the titanium cylinders on the master cast. Due to its ease and quickness of use and clinical efficiencies, this technique is deemed particularly useful in immediate loading rehabilitations.
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Affiliation(s)
- Maria Menini
- Department of Implant and Prosthetic Dentistry (DISC), University of Genoa, Genoa, Italy
| | - Elena Dellepiane
- Department of Implant and Prosthetic Dentistry (DISC), University of Genoa, Genoa, Italy
| | - Paolo Pera
- Department of Implant and Prosthetic Dentistry (DISC), University of Genoa, Genoa, Italy
| | - Marco Bevilacqua
- Department of Implant and Prosthetic Dentistry (DISC), University of Genoa, Genoa, Italy
| | - Paolo Pesce
- Department of Implant and Prosthetic Dentistry (DISC), University of Genoa, Genoa, Italy
| | - Francesco Pera
- Department of Implant and Prosthetic Dentistry (DISC), University of Genoa, Genoa, Italy
| | - Tiziano Tealdo
- Department of Implant and Prosthetic Dentistry (DISC), University of Genoa, Genoa, Italy
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Chrcanovic BR, Albrektsson T, Wennerberg A. Tilted versus axially placed dental implants: a meta-analysis. J Dent 2014; 43:149-70. [PMID: 25239770 DOI: 10.1016/j.jdent.2014.09.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 08/30/2014] [Accepted: 09/03/2014] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The purpose of the present review was to test the null hypothesis of no difference in the implant failure rate, marginal bone loss, and postoperative infection for patients being rehabilitated by tilted or by axially placed dental implants, against the alternative hypothesis of a difference. METHODS An electronic search without time or language restrictions was undertaken in July 2014. Eligibility criteria included clinical human studies, either randomised or not, interventional or observational. The estimates of an intervention were expressed in risk ratio (RR) and mean difference (MD) in millimetres. RESULTS The search strategy resulted in 44 publications. A total of 5029 dental implants were tilted (82 failures; 1.63%), and 5732 implants were axially placed (104 failures; 1.81%). The difference between the procedures did not significantly affect the implant failure rates (P=0.40), with a RR of 1.14 (95% CI 0.84-1.56). A statistically significant difference was found for implant failures when studies evaluating implants inserted in maxillae only were pooled (RR 1.70, 95% CI 1.05-2.74; P=0.03), the same not happening for the mandible (RR 0.77, 95% CI 0.39-1.52; P=0.45). There were no apparent significant effects of tilted dental implants on the occurrence of marginal bone loss (MD 0.03, 95% CI -0.03 to 0.08; P=0.32). Due to lack of satisfactory information, meta-analysis for the outcome 'postoperative infection' was not performed. CONCLUSIONS It is suggested that the differences in angulation of dental implants might not affect the implant survival or the marginal bone loss. The reliability and validity of the data collected and the potential for biases and confounding factors are some of the shortcomings of the present study. CLINICAL SIGNIFICANCE The question whether tilted implants are more at risk for failure than axially placed implants has received increasing attention in the last years. As the philosophies of treatment alter over time, a periodic review of the different concepts is necessary to refine techniques and eliminate unnecessary procedures. This would form a basis for optimum treatment.
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Affiliation(s)
| | - Tomas Albrektsson
- Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden; Department of Biomaterials, Göteborg University, Göteborg, Sweden
| | - Ann Wennerberg
- Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
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De Bruyn H, Raes S, Östman PO, Cosyn J. Immediate loading in partially and completely edentulous jaws: a review of the literature with clinical guidelines. Periodontol 2000 2014; 66:153-87. [DOI: 10.1111/prd.12040] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 11/29/2022]
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Engelhardt S, Papacosta P, Rathe F, Özen J, Jansen JA, Junker R. Annual failure rates and marginal bone-level changes of immediate compared to conventional loading of dental implants. A systematic review of the literature and meta-analysis. Clin Oral Implants Res 2014; 26:671-87. [DOI: 10.1111/clr.12363] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2014] [Indexed: 11/29/2022]
Affiliation(s)
| | - Petros Papacosta
- Department of Implantology and Periodontology; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - Florian Rathe
- Department of Prosthodontics and Biomaterials; Danube Private University; Krems Austria
- Private Practice; Forchheim Germany
| | - Jülide Özen
- Department of Prosthetic Dentistry; Private Dental Clinic; Aachen Germany
| | - John A. Jansen
- Department of Biomaterials; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - Rüdiger Junker
- Department of Prosthodontics and Biomaterials; Danube Private University; Krems Austria
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Complications, risk factors, and failures of immediate functional loading of implants placed in the completely edentulous maxillae: a report of 3 consecutive cases. IMPLANT DENT 2014; 23:125-31. [PMID: 24614875 DOI: 10.1097/id.0000000000000027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this article was to document the failure of immediate functional loading of implants placed in 3 consecutive completely edentulous maxillae to analyze the possible causes, risk factors, and how to avoid the complications that occur due to this procedure. MATERIALS AND METHODS Six implants with standardized length and diameter were placed in 3 consecutive patients with completely edentulous maxillae in the canine, premolar, and molar region bilaterally and flaplessly using computer-guided surgical guides. Screw-retained conversion maxillary prostheses were delivered immediately after the surgery. RESULTS Patients complained from severe to moderate pain. For the first and second patients (P1 and P2), 4 implants per patient were lost during the second week after implant surgery, whereas 5 implants were lost during the third week after implant surgery for the third patient (P3). CONCLUSION This high failure rate presented in this report may be explained by 1 or more of the following reasons: poor maxillary bone quality, nonaxial loading of the implants, nonrigid splinting material, high forces delivered from the opposing dentition, and/or patients with para-functional habits.
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26
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Gatti C, Serioli L, Gatti F. Impianti nelle edentulie complete: durata, gradimento e costi delle varie soluzioni implantoprotesiche. DENTAL CADMOS 2013. [DOI: 10.1016/s0011-8524(13)70087-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Almeida EO, Rocha EP, Freitas Júnior AC, Anchieta RB, Poveda R, Gupta N, Coelho PG. Tilted and short implants supporting fixed prosthesis in an atrophic maxilla: a 3D-FEA biomechanical evaluation. Clin Implant Dent Relat Res 2013; 17 Suppl 1:e332-42. [PMID: 23910435 DOI: 10.1111/cid.12129] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE This study compared the biomechanical behavior of tilted long implant and vertical short implants to support fixed prosthesis in an atrophic maxilla. MATERIALS AND METHODS The maxilla model was built based on a tomographic image of the patient. Implant models were based on micro-computer tomography imaging of implants. The different configurations considered were M4S, four vertical anterior implants; M4T, two mesial vertical implants and two distal tilted (45°) implants in the anterior region of the maxilla; and M6S, four vertical anterior implants and two vertical posterior implants. Numerical simulation was carried out under bilateral 150 N loads applied in the cantilever region in axial (L1) and oblique (45°) (L2) direction. Bone was analyzed using the maximum and minimum principal stress (σmax and σmin ), and von Mises stress (σvM ) assessments. Implants were analyzed using the σvM . RESULTS The higher σmax was observed at: M4T, followed by M6S/L1, M6S/L2, M4S/L2, and M4S/L1 and the higher σvM : M4T/L1, M4T/L2 and M4S/L2, M6S/L2, M4S/L1, and M6S/L1. CONCLUSIONS The presence of distal tilted (all-on-four) and distal short implants (all-on-six) resulted in higher stresses in both situations in the maxillary bone in comparison to the presence of vertical implants (all-on-four).
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Affiliation(s)
- Erika O Almeida
- Department of Dentistry, Federal University of Rio Grande do Norte, Natal, RN, Brazil
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Del Fabbro M, Ceresoli V, Taschieri S, Ceci C, Testori T. Immediate Loading of Postextraction Implants in the Esthetic Area: Systematic Review of the Literature. Clin Implant Dent Relat Res 2013; 17:52-70. [DOI: 10.1111/cid.12074] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences; CRSO (Centro di Ricerca per la Salute Orale); IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Galeazzi Orthopedic Institute; University of Milan; Milan Italy
| | - Valentina Ceresoli
- Department of Biomedical, Surgical and Dental Sciences; CRSO (Centro di Ricerca per la Salute Orale); IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Galeazzi Orthopedic Institute; University of Milan; Milan Italy
| | - Silvio Taschieri
- Department of Biomedical, Surgical and Dental Sciences; CRSO (Centro di Ricerca per la Salute Orale); IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Galeazzi Orthopedic Institute; University of Milan; Milan Italy
| | - Caterina Ceci
- Department of Biomedical, Surgical and Dental Sciences; CRSO (Centro di Ricerca per la Salute Orale); IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Galeazzi Orthopedic Institute; University of Milan; Milan Italy
| | - Tiziano Testori
- Department of Biomedical, Surgical and Dental Sciences; CRSO (Centro di Ricerca per la Salute Orale); IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Galeazzi Orthopedic Institute; University of Milan; Milan Italy
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Abstract
The aim of this work was to study the biomechanical behavior of an All-on-4 implant-supported prosthesis through a finite element analysis comparing 3 different tilt degrees of the distal implants. Three-dimensional finite element models of an edentulous maxilla restored with a prosthesis supported by 4 implants were reconstructed to carry out the analysis. Three distinct configurations, corresponding to 3 tilt degrees of the distal implants (15°, 30°, and 45°) were subjected to 4 loading simulations. The von Mises stresses generated around the implants were localized and quantified for comparison. Negligible differences in von Mises stress values were found in the comparison of the 15° and 30° models. From a stress-level viewpoint, the 45° model was revealed to be the most critical for peri-implant bone. In all the loading simulations, the maximum stress values were always found at the neck of the distal implants. The stress in the distal implants increased in the apical direction as the tilt degree increased. The stress location and distribution patterns were very similar among the evaluated models. The increase in the tilt degree of the distal implants was proportional to the increase in stress concentration. The 45° model induced higher stress values at the bone-implant interface, especially in the distal aspect, than the other 2 models analyzed.
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Affiliation(s)
- Gianpaolo Sannino
- Department of Clinical Sciences and Translational Medicine, University of Rome, Tor Vergata, School of Dentistry, Rome, Italy
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30
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Sailer I, Mühlemann S, Zwahlen M, Hämmerle CHF, Schneider D. Cemented and screw-retained implant reconstructions: a systematic review of the survival and complication rates. Clin Oral Implants Res 2012; 23 Suppl 6:163-201. [DOI: 10.1111/j.1600-0501.2012.02538.x] [Citation(s) in RCA: 192] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Irena Sailer
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Switzerland
| | - Sven Mühlemann
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Switzerland
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine; University of Bern; Bern; Switzerland
| | - Christoph H. F. Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Switzerland
| | - David Schneider
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Switzerland
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Menini M, Signori A, Tealdo T, Bevilacqua M, Pera F, Ravera G, Pera P. Tilted implants in the immediate loading rehabilitation of the maxilla: a systematic review. J Dent Res 2012; 91:821-7. [PMID: 22851285 DOI: 10.1177/0022034512455802] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Tilted implants have been proposed as an alternative to traditional protocols in the rehabilitation of edentulous maxillae. The aim of this meta-analysis was to evaluate the outcomes of upright and tilted implants supporting full-arch fixed dentures for the immediate rehabilitation of edentulous maxillae, after at least 1 year of function. An electronic search of databases and a hand search of relevant journals in oral implantology were performed according to PRISMA guidelines through August, 2011. The literature search yielded 1,069 articles. Eleven articles were available for analysis. A total of 1,623 implants (778 tilted, 845 upright) were inserted into the maxillae of 324 patients. Seventeen tilted (2.19%) and 16 upright implants (1.89%) failed during the first year. No significant difference in failure rate was found between tilted and upright implants (p value = 0.52). Marginal bone level results were obtained from 6 studies. A non-significant mean difference between tilted and upright implants was found with regard to bone loss. Tilted implants demonstrated a favorable short-term prognosis in full-arch immediate loading rehabilitations of the maxillae. Randomized long-term trials are needed to better elucidate long-term success of tilted vs. upright-positioned implants.
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Affiliation(s)
- M Menini
- University of Genoa, L. Rosanna Benzi 10, Genova, 16132, Italy.
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32
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STRUB JR, JURDZIK BA, TUNA T. Prognosis of immediately loaded implants and their restorations: a systematic literature review. J Oral Rehabil 2012; 39:704-17. [DOI: 10.1111/j.1365-2842.2012.02315.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rojas-Vizcaya F. Rehabilitation of the maxillary arch with implant-supported fixed restorations guided by the most apical buccal bone level in the esthetic zone: a clinical report. J Prosthet Dent 2012; 107:213-20. [PMID: 22475463 DOI: 10.1016/s0022-3913(12)00041-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This article describes a prosthetically-driven protocol for the rehabilitation of the completely edentulous maxillary arch using immediate implant placement and loading techniques. After the incisal edges of the planned maxillary central incisors are determined, the most apical buccal bone level in the esthetic zone serves to guide complete arch rehabilitation.
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Affiliation(s)
- Fernando Rojas-Vizcaya
- Department of Prosthodontics, University of North Carolina School of Dentistry; Private practice, Castellon, Spain.
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34
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Ghoul WE, Chidiac JJ. Prosthetic Requirements for Immediate Implant Loading: A Review. J Prosthodont 2012; 21:141-54. [DOI: 10.1111/j.1532-849x.2011.00819.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Raes F, Cosyn J, De Bruyn H. Clinical, aesthetic, and patient-related outcome of immediately loaded single implants in the anterior maxilla: a prospective study in extraction sockets, healed ridges, and grafted sites. Clin Implant Dent Relat Res 2012; 15:819-35. [PMID: 22251879 DOI: 10.1111/j.1708-8208.2011.00438.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The objective of this prospective clinical study was to document the overall treatment outcome of immediately loaded single Astra Tech Osseospeed™ (Astra Tech AB, Mölndal, Sweden) implants placed in extraction sockets, healed ridges, and grafted sites. MATERIALS AND METHODS Forty-eight patients in need of a single implant in the anterior maxilla (15-25) were recruited. Patients were allocated to a conventional implant treatment (CIT) or immediate implant treatment (IIT) group on the basis of specific criteria. If the buccal bone plate was damaged or missing upon tooth removal, patients were allocated to a grafted implant treatment (GIT) group. Irrespective of the treatment concept, implants were immediately provisionalized. Hard and soft tissue alterations, aesthetic parameters (pink and white esthetic scores, [PES and WES]) and patient's opinion (Oral Health Impact Profile [OHIP-14] questionnaires) were registered at different time points. RESULTS After 1 year of function, the overall implant survival rate was 98% with one failure following IIT. The mean bone level to the implant-abutment interface was 0.65 (SD 0.79), 0.85 (SD 0.64), and 0.56 mm (SD 0.44) for CIT, IIT, and GIT. Complete papilla loss was rare following either strategy. Mean midfacial recession amounted to 1.00 (SD 1.15), 0.12 (SD 0.78), and 0.49 mm (SD 0.82) for CIT, IIT, and GIT, respectively. The aesthetic outcome showed a mean PES of 10.30 (SD 1.89) and mean WES of 7.11 (SD 2.14), all patients considered. Patient's satisfaction showed a significant improvement after 1 year of function on all seven domains (p < .001). CONCLUSIONS This prospective study showed that single implants clinically and aesthetically perform well under immediate non-occlusal loading conditions in the premaxilla. In this context, it is of pivotal importance to stress that patients were carefully selected for IIT and GIT.
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Affiliation(s)
- Filiep Raes
- Periodontist, associate professor, clinical assistant, Dental School, Department of Periodontology and Oral Implantology, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium; periodontist, assistant professor, Dental School, Department of Periodontology and Oral Implantology, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium, and visiting professor, Dental Medicine, Faculty of Medicine and Pharmacy, Free University of Brussels (VUB), Brussels, Belgium; chairman and professor, Periodontology and Oral Implantology, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium and visiting professor, Department of Prosthodontics, University of Malmö, Malmö, Sweden
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36
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Lang NP, Pun L, Lau KY, Li KY, Wong MCM. A systematic review on survival and success rates of implants placed immediately into fresh extraction sockets after at least 1 year. Clin Oral Implants Res 2011; 23 Suppl 5:39-66. [PMID: 22211305 DOI: 10.1111/j.1600-0501.2011.02372.x] [Citation(s) in RCA: 238] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Niklaus P. Lang
- The University of Hong Kong; Faculty of Dentistry; Prince Philip Dental Hospital; Hong Kong; SAR; China
| | - Lui Pun
- The University of Hong Kong; Faculty of Dentistry; Prince Philip Dental Hospital; Hong Kong; SAR; China
| | - Ka Yee Lau
- The University of Hong Kong; Faculty of Dentistry; Prince Philip Dental Hospital; Hong Kong; SAR; China
| | - Ka Yan Li
- The University of Hong Kong; Faculty of Dentistry; Prince Philip Dental Hospital; Hong Kong; SAR; China
| | - May CM Wong
- The University of Hong Kong; Faculty of Dentistry; Prince Philip Dental Hospital; Hong Kong; SAR; China
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Maló P, de Araújo Nobre M, Lopes A, Francischone C, Rigolizzo M. “All-on-4” Immediate-Function Concept for Completely Edentulous Maxillae: A Clinical Report on the Medium (3 Years) and Long-Term (5 Years) Outcomes. Clin Implant Dent Relat Res 2011; 14 Suppl 1:e139-50. [PMID: 22008153 DOI: 10.1111/j.1708-8208.2011.00395.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Paulo Maló
- Oral Surgery, Malo Clinic, Lisboa, Portugal
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38
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Chung S, McCullagh A, Irinakis T. Immediate Loading in the Maxillary Arch: Evidence-Based Guidelines to Improve Success Rates: A Review. J ORAL IMPLANTOL 2011; 37:610-21. [DOI: 10.1563/aaid-d-joi-10-00058.1] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The reliability of immediately loaded dental implants in the mandible has prompted many to investigate their application in the maxilla. Although the body of literature is growing, the long-term survivability of immediate loading in the maxilla is still pending. This review of literature investigates the status of immediate loading of dental implants in the maxilla to determine its predictability as a treatment option for partial and complete maxillary edentulism. Current terminology in the field is summarized first. Subsequently, the rationale and advantages of immediate loading in the maxilla are reviewed, and the relationships between immediate loading and osseointegration, primary stability, implant design, micromotion, immediate implant placement, and bone character are explored. The importance of a prosthodontically driven implant treatment plan emphasizing the role of splinting a high-precision and passively fitting implant restoration with reduced micromotion under function is summarized. The reliability and predictability of immediately loaded implants as a treatment option are proposed, and recommended guidelines for the successful delivery of immediately loaded implants in the maxilla are presented.
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Affiliation(s)
- Sean Chung
- General Practice Residency, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia
| | - Anthony McCullagh
- Division of Prosthodontics and Dental Geriatrics, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia
| | - Tassos Irinakis
- Graduate Periodontics, Division of Periodontics and Implant Surgery, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia
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39
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The influence of cantilever length and implant inclination on stress distribution in maxillary implant-supported fixed dentures. J Prosthet Dent 2011; 105:5-13. [PMID: 21194582 DOI: 10.1016/s0022-3913(10)60182-5] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
STATEMENT OF PROBLEM The benefits and limitations of jaw treatments with tilted versus vertical implants, as well as prosthesis design with and without posterior cantilevers, have been extensively discussed. However, biomechanical advantages associated with cantilevers in fixed dentures (FDs) and tilted implants in the maxillae are less well documented. PURPOSE The purpose of this study was to compare and analyze, via 3-dimensional (3-D) finite element analysis, stresses transmitted to tilted versus vertical implants and the surrounding periimplant bone in the maxillae. MATERIAL AND METHODS A 3-D edentulous maxillary model was created using customized computer software (FEMAP 8.3). Four implants were virtually placed in the premaxilla and splinted with an FD. Keeping the prosthesis length constant, 4 different configurations were evaluated with the distal implants inclined 0, 15, 30, and 45 degrees; cantilever extensions were 13, 9, 5, and 0 mm, respectively. A vertical load (150 N) was applied to the distal portion of the posterior cantilevers. Von Mises' stress values transmitted to periimplant bone and at the metal framework of FDs on implants were evaluated in cancellous and cortical bone. RESULTS The maximum stresses recorded in periimplant bone for the vertical implants were 75.0 MPa (distal implants), 35.0 MPa (mesial implants), and 95.0 MPa for the metal frameworks. Tilted distal implants, with consequent reduction of the posterior cantilevers, resulted in decreased stress values for all of the variables: -12.9%, -18.3%, and -11.5% for the 15-degree configuration; -47.5%, -52.6%, and -31.3% for the 30-degree configuration; and -73.5%, -77.7%, and -85.6% for the 45-degree configuration CONCLUSIONS Finite element analysis data regarding rehabilitation of atrophic maxillae revealed that tilted distal implants, rigidly splinted with an FD, decrease stress in the periimplant bone and frameworks. This treatment modality seems to be a valid therapeutic alternative to conventional maxillary fixed complete prostheses supported by vertical dental implants with posterior cantilevers.
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40
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Clinical Outcome of Immediately Loaded Maxillary Implants: A 2-Year Retrospective Study. J Oral Maxillofac Surg 2011; 69:1335-43. [DOI: 10.1016/j.joms.2010.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 09/09/2010] [Accepted: 11/02/2010] [Indexed: 11/19/2022]
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41
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Drago C, del Castillo R, Peterson T. Immediate Occlusal Loading in Edentulous Jaws, CT-Guided Surgery and Fixed Provisional Prosthesis: A Maxillary Arch Clinical Report. J Prosthodont 2010; 20:209-17. [DOI: 10.1111/j.1532-849x.2010.00661.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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42
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Mangano F, Mangano C, Macchi A, Perrotti V, Iezzi G, Piattelli A. La topografia della superficie implantare nella moderna implantologia. Parte I: superfici lisce e microrugose. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.ios.2010.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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43
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Malchiodi L, Corrocher G, Cucchi A, Ghensi P, Bissolotti G, Nocini PF. Long-Term Results of Immediately Loaded Fast Bone Regeneration–Coated Implants Placed in Fresh Extraction Sites in the Upper Jaw. J ORAL IMPLANTOL 2010; 36:251-61. [DOI: 10.1563/aaid-joi-d-09-00016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract
Recently, many authors have investigated the results of immediately loaded implants in fresh extraction sites, reporting favorable success rates, but only a few studies have included a long-term follow-up in the maxilla with analysis of clinical and radiographic data. The aim of this study was to evaluate the predictability of the immediate loading protocol with fast bone regeneration (FBR)-coated implants placed in postextractive sites in the maxilla, considering the success rate after at least 5 years of follow-up. Moreover, the clinical and radiographic results are evaluated in terms of soft tissue conditions and crestal bone loss values. One hundred fifty-eight implants were inserted following dental extraction in 70 consecutively operated patients. Each implant was immediately prosthesized. The data were collected before surgical planning, at the time of insertion, and after 3 and 5 years of occlusal loading. Specific success criteria were used to assess the success rate of immediately loaded postextraction implants. Clinical and radiographic examinations were used to determine long-term results. After a 5-year follow-up, 2 implants were lost, with a cumulative success rate of 98.7%. The radiographic and clinical data revealed well-maintained hard and soft tissues, with acceptable long-term results. The use of immediately loaded FBR-coated implants in fresh extraction sockets is shown to be a predictable technique if implants are inserted in selected cases and positioned with great care, following thorough preoperative analysis.
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Affiliation(s)
- Luciano Malchiodi
- Faculty of Medicine, Dentistry and Maxillofacial Surgery Clinic, University of Verona, Verona, Italy
| | - Giovanni Corrocher
- Faculty of Medicine, Dentistry and Maxillofacial Surgery Clinic, University of Verona, Verona, Italy
| | - Alessandro Cucchi
- Faculty of Medicine, Dentistry and Maxillofacial Surgery Clinic, University of Verona, Verona, Italy
| | - Paolo Ghensi
- Faculty of Medicine, Dentistry and Maxillofacial Surgery Clinic, University of Verona, Verona, Italy
| | - Guido Bissolotti
- Faculty of Medicine, Dentistry and Maxillofacial Surgery Clinic, University of Verona, Verona, Italy
| | - Pier Francesco Nocini
- Faculty of Medicine, Dentistry and Maxillofacial Surgery Clinic, University of Verona, Verona, Italy
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Van de Velde T, Sennerby L, De Bruyn H. The clinical and radiographic outcome of implants placed in the posterior maxilla with a guided flapless approach and immediately restored with a provisional rehabilitation: a randomized clinical trial. Clin Oral Implants Res 2010; 21:1223-33. [DOI: 10.1111/j.1600-0501.2010.01924.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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45
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Baig MR, Rajan G. Full-arch metal-resin cement- and screw-retained provisional restoration for immediately loaded implants. J ORAL IMPLANTOL 2010; 36:219-23. [PMID: 20553176 DOI: 10.1563/aaid-joi-d-09-00048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract This article describes the clinical and laboratory procedures involved in the fabrication of laboratory-processed, provisional, screw-retained, implant-supported maxillary and mandibular fixed complete dentures incorporating a cast metal reinforcement for immediate loading of implants. Precise fit is achieved by intraoral luting of the cast frame to milled abutments. Effective splinting of all implants is attained by the metal substructure and retrievability is provided by the screw-retention of the prosthesis.
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Affiliation(s)
- Mirza Rustum Baig
- Department of Prosthetic Dentistry, University of Malaya, Kuala Lumpur, Malaysia.
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46
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Del Fabbro M, Bellini CM, Romeo D, Francetti L. Tilted Implants for the Rehabilitation of Edentulous Jaws: A Systematic Review. Clin Implant Dent Relat Res 2010; 14:612-21. [DOI: 10.1111/j.1708-8208.2010.00288.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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47
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Ferreira EJ, Kuabara MR, Gulinelli JL. “All-on-four” concept and immediate loading for simultaneous rehabilitation of the atrophic maxilla and mandible with conventional and zygomatic implants. Br J Oral Maxillofac Surg 2010; 48:218-20. [DOI: 10.1016/j.bjoms.2009.08.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2009] [Accepted: 08/07/2009] [Indexed: 11/25/2022]
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48
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Att W, Bernhart J, Strub JR. Fixed rehabilitation of the edentulous maxilla: possibilities and clinical outcome. J Oral Maxillofac Surg 2009; 67:60-73. [PMID: 19835751 DOI: 10.1016/j.joms.2009.07.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Accepted: 07/23/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of the present report was to describe the different treatment approaches available for fixed rehabilitation of the edentulous maxilla in the presence of varying hard and soft tissue conditions and to review the clinical outcome of each treatment approach. MATERIALS AND METHODS A review of the published data published from 1980 through 2009 was conducted using electronic databases and manual searching to identify the treatment possibilities for the fixed rehabilitation of the edentulous maxilla and report their clinical outcomes. The search terms used, in simple or multiple conjunctions, were "fixed rehabilitation," "implants," "edentulous," "fixed dental prosthesis," "implant-supported," and "maxilla." RESULTS Several treatment modalities were identified for the fixed rehabilitation of the edentulous maxilla, with and without bone augmentation procedures. Regular, tilted, and zygoma implants were identified for treatment modalities that do not require bone augmentation. Sinus floor elevation with the lateral window technique or Le Fort I osteotomy with interpositional bone grafts was identified as a treatment possibility that required bone augmentation procedures. The database initially yielded 230 titles. Of the 230 studies, 42 were finally selected. Although all studies reported the survival rates of the implants, only 20 provided information about the prosthetic outcome. Because of the limited number of studies, at least for the specific treatment modalities, and the heterogeneity in the design of the different studies identified, it was not possible to perform a statistical analysis of the data. Except for regular implants placed in native bone, no sufficient long-term clinical studies were found for the other procedures. CONCLUSIONS Except for regular implants placed in nonaugmented native bone, the published data provide insufficient evidence about the outcome of other procedures. Until long-term data are available, such procedures should not be considered reliable treatment modalities.
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Affiliation(s)
- Wael Att
- Department of Prosthodontics, Albert-Ludwigs University School of Dentistry, Freiburg, Germany.
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49
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Pieri F, Aldini NN, Fini M, Marchetti C, Corinaldesi G. Immediate Functional Loading of Dental Implants Supporting a Bar-Retained Maxillary Overdenture: Preliminary 12-Month Results. J Periodontol 2009; 80:1883-93. [DOI: 10.1902/jop.2009.090227] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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