Implant based rehabilitation options for the atrophic edentulous jaw

The Evolution of Custom Subperiosteal Implants for Treatment of Partial or Complete Edentulism in Patients with Severe Alveolar Ridge Atrophy

Dental implants have always played an important role in dentistry and have been used to replace missing teeth since around 600 AD. They can be classified into three groups: endosteal, subperiosteal, and transosteal. Over time, different materials have been used to manufacture dental implants and these, in turn, can be divided into three groups: metals, ceramics, and polymers. Today, the most commonly used treatment for edentulism is the use of endosteal implants. However, such an approach cannot be used in patients with severe alveolar ridge atrophy and, in such cases, custom subperiosteal implants are an alternative. This review article focuses on historical developments and improvements that have been made over recent years in treatment options for patients suffering from edentulism and significant resorption of the alveolar ridge. These treatment options involve the utilization of custom subperiosteal implants. This paper looks at the historical evolution of these implants, the significance of diagnostic imaging, and the application of the contemporary methods of production, such as CAD-CAM and additive manufacturing. The research emphasizes the importance of accuracy and personalization provided by these emerging technologies that have rendered subperiosteal implants a more feasible and less intrusive alternative for patients suffering from significant bone loss.

The atrophic edentulous alveolus. A preliminary study on a new generation of subperiosteal implants

The aim of this cohort case series is to present a new subperiosteal implant device that uses CAD-CAM technologies together with 3D metal printing capabilities to produce direct bone-anchored dental prosthetic solutions for the management of atrophic edentulous alveolus and jaws. The clinical experience of 21 subperiosteal devices implanted over a 4-year period is presented. The results of this study showed 14 of the 21 cases were successful (66.7%), while 7 cases had complications including exposure of the metal frame (5 cases), mobility of the device (1 case) and 1 case failed for reasons unrelated to the device. Four of the 7 cases were successfully salvaged resulting in an overall success rate of 85.7% (18 /21 cases). This study supports the use of fully customized subperiosteal jaw implants as a simple and reliable alternative for dental rehabilitation of atrophic edentulous cases which would otherwise require bone grafts for conventional fixed dental implant solutions. With more research, the clinical potential for this device is significant as it not only avoids the need for complex and lengthy reconstructive jaw surgery but also allows for the placement of immediate prosthetic teeth at the time of implantation.

Short implants without bone augmentation vs. long implants with bone augmentation: systematic review and meta-analysis

PURPOSE

Anatomical limits such as the location of the lower alveolar nerve, the maxillary sinus in atrophied jaws might extend implant surgery treatment. The purpose of this systematic literature review is to review the literature and determine whether short implants can be an effective alternative to standard-length implants after bone augmentation.

MATERIALS AND METHODS

A systematic search was performed on PRISMA wizard. Searched for clinical trials 2010-2020 in the Medline database. The keywords chosen are "short versus long implants, augmented bone, clinical trial", and their various variations.

RESULTS

Meta-analyses of the studies of implant loss after 1, 3 and 5 years showed a statistically insignificant difference between groups. The number of complications after 1 year was statistically significantly higher in the control group. Meta-analyses with follow-up periods of 3 and 5 years showed a statistically insignificant difference; Meta-analyses of studies of marginal bone loss after 1, 3 and 5 years showed a statistically insignificant difference between the groups.

CONCLUSIONS

Short dental implants may be a suitable alternative to standard length dental implants after bone augmentation. The risk of their complications is possibly lower because of the lack of need for bone augmentation.

Incidence of Neurosensory Disturbance and Success Rates of Solid-Screw Implants Placed in Conjunction with Inferior Alveolar Nerve Transposition

Background:

Implant-supported prosthetic rehabilitation of a severely atrophic posterior mandibular alveolar ridge is a real challenge. Implant placement in such situations is very difficult and implies the risk of inferior alveolar nerve (IAN) damage.

Purpose:

The purpose of this study is to evaluate the incidence of neurosensory disturbance and the cumulative survival of dental implants placed after the IAN transposition (IANT) procedures followed by dental implants placement.

Materials and Methods:

Twenty International Team for Implantology implants were placed in eight patients following unilateral IANT. In two patients, nerve transposition was performed bilaterally, and hence, a total of 10 IAN transposition surgeries were performed. Neurosensory dysfunction was objectively evaluated by using light touch test (LT), pain test (PT), and 2-point discrimination test (2-DT). In addition, patients were asked to answer a short questionnaire to investigate the individual feeling of discomfort and advantages related to this surgical technique. The mean follow-up periods were 47.1 months (range 12–78 months).

Results:

Neurosensory disturbance (i.e., disturbance registered by the LT, PT, and 2-DT tests) was experienced in 2 of 10 cases. The cumulative implant survival was 100%. However, at the time of data analysis (12–79 months after surgery), all patients indicated that they would go through the surgery again.

Conclusion:

IANT can permit the placement of implants with adequate length and good initial stabilization as used in routine sites, with the same favorable prognosis. All patients felt that they had received benefits from their new prostheses in terms of improved comfort, chewing efficiency, and esthetics.

Stress Distribution on the Prosthetic Screws in the All-on-4 Concept: A Three-Dimensional Finite Element Analysis

The all-on-4 concept, which is used to rehabilitate edentulous patients, can present with mechanical complications such as screw loosening and fracture. The purpose of this study was to evaluate the stress patterns induced in the prosthetic screws by the different prosthetic screw and abutment designs in the all-on-4 concept using finite element analysis. Von Mises stress values on 6 groups of each screw type, including short and narrow screw, short abutment; short and wide screw, short abutment; long and wide screw, short abutment; short and narrow screw, long abutment; short and wide screw, long abutment; and long and wide screw, long abutment, were compared under a cantilever loading of 200 N that was applied on the farther posterior to the position of the connection between the distal implant and the metal framework. Posterior prosthetic screws showed higher stress values than anterior prosthetic screws. The stress values in posterior prosthetic screws decreased as the length and diameter increased. In conclusion, the long and wide screw design offers advantages in stress distribution when compared with the short and narrow design.

Oral Cancer

The management of oral cancer is a multidisciplinary endeavour, as each patient presents the treating clinicians with a unique set of challenges the management of which impacts on both survival and quality of life. This article focuses on the management of oral cancer. We highlight the epidemiology and risk factors for oral cancer in Australia, the various clinical presentations that occur and the staging of oral cancer. In the vast majority of cases surgery remains the mainstay of treatment. Radiation and medical oncology is usually used in an adjuvant context. Dental professionals play a critical role in many stages of management from the initial detection, to optimising pre treatment dental health and managing the short and long term sequelae of treatment. Monitouring for recurrence and the development of second primary tumours is a key role.

Implantology in oral & maxillofacial surgery. The complexity of 'simple' cases

Dental implants have been a routine part of dental practice for many years and are performed by a variety of practitioners with different backgrounds and training. This paper will outline the principles and practical surgical aspects of 'simple' implant placement against a background of our current understanding of the literature that informs our surgical procedures. Implants need to be placed in a restoratively suitable position surrounded by sufficient bone, draped in adequate keratinised soft tissue and sufficiently separated from one another and the adjacent teeth. Practically, while the above principles apply, there are nuances based on the local situation, adjacent teeth and restorative needs which will be considered in this paper. Surgery for the placement of implants needs a practitioner with adequate surgical training and experience and who understands the biological aspects and restorative needs of each clinical situation.