Immediate implant and rehabilitation based on All-on-4 concept in patients with generalized aggressive periodontitis: A medium-term prospective study

The Significance of Keratinized Mucosa in Implant Therapy: Narrative Literature Review and Case Report Presentation

Background/Objectives: Implant treatment in patients who require teeth extraction due to periodontitis presents a significant challenge. The consideration of peri-implantitis is crucial when planning the placement of dental implants. The predictability of implant treatment relies on the suitability of both hard and soft tissue quality. The aim of this article is to present a case report demonstrating a secure treatment protocol for implant procedures in patients with periodontitis requiring the extraction of all teeth, soft tissue management targeted at increasing the keratinized mucosa zone, and the provision of a reliable prosthetic solution. The secondary objective is to review the relevant literature regarding the significance of keratinized mucosa surrounding dental implants and its association with the occurrence of peri-implantitis. Case presentation: A 65-year-old female with generalized periodontitis, stage IV grade C and very poor oral hygiene came for treatment and rehabilitation of the lower jaw. CBCT revealed periodontal lesions and labio-lingual ridge dimensions in the region of teeth 34-44 from 8.0 to 10.2 mm. The first surgery included teeth extraction and periodontal lesions enucleation with simultaneous placement of four implants in the positions of teeth 32, 34, 42, 44. The second-stage surgery involved increasing the keratinized mucosa using two free gingival grafts. Conclusions: The present case report described the treatment process of the patient with periodontitis, including immediate implantation in the infected region, soft tissue augmentation using free gingival grafts and the ultimate placement of a bar-retained overdenture for final restoration. After two years of observation, despite questionable hygiene, no symptoms of gingival inflammation were detected. Furthermore, there is limited information in the literature regarding the correlation between inadequate keratinized gingiva and the occurrence of peri-implantitis.

Immediate loading in partially edentulous patients with fixed implant-supported restorations cases report

Objectives

This article reports on four rare cases involving multiple trauma-induced adjacent missing anterior teeth in the maxillary or mandibular region. These cases were successfully treated using a 4-axial implant-based alternative insert and an immediate loading protocol.

Material and methods

This series of cases was summarized by retrospective study that 4 patients who received a total of 20 immediately loaded implants. These patients had suffered from trauma-induced loss of 8-9 adjacent anterior teeth. The 4-axial-implants were inserted with the assistance of digital pioneer drill guides. The surgical procedure involved alveolar bone trimming or ultrasonic osteotomy, eliminating the need for traditional large-area bone augmentation. Pre- and post-operative CBCT was matched using DTX Studio Implant software, the deviation of implant between actual position and preoperative design was measured and compared using SPSS software package.

Results

The average follow-up duration 48 months after implant prostheses, the cumulative retention rate of the implants was 100%, the marginal bone loss averaged 0.53 mm (SD 0.15 mm), and buccal plate bone loss averaged 0.62 mm (SD 0.41 mm).

Conclusions

This retrospective clinical report demonstrates the successful treatment of several patients with multiple adjacent maxillary or mandibular anterior teeth using four implant-supported screws to fix the frame and employing immediate loading. The approach resulted in long-term stable clinical outcomes. Moreover, the method not only shortens the period of edentulism but also facilitates easy disassembly, maintenance, and cleaning. Consequently, it emerges as a highly favorable clinical option for patients suffering from extensive tooth loss.

Critical evaluation of YouTube videos regarding the all-on-4 dental implant treatment concept: A content-quality analysis

STATEMENT OF PROBLEM

Rehabilitation of complete edentulous arches by using the all-on-4 dental implant treatment concept is a well-established procedure. Considering the popularity of YouTube as a source for health-related information, a thorough investigation of the content-quality and reliability of videos regarding the all-on-4 concept is lacking.

PURPOSE

The purpose of this cross-sectional analysis was to critically appraise the content-quality and reliability of YouTube videos regarding the all-on-4 dental implant treatment concept as a source of information for patients, students, and dentists.

MATERIAL AND METHODS

A comprehensive search was performed on the YouTube website using the specific keyword "All-on-4," which was identified as the most appropriate search term by the Google Trends website. Only English language videos regarding the all-on-4 dental implant treatment concept were included for systematic analyses. Following the eligibility criteria, the included videos were assessed for their demographic characteristics and quality-content. Based on the content score, the videos were categorized as low content (LC) and moderate + high content (MHC) groups. Further, qualitative analyses were performed by using the DISCERN tool and a global quality (GQ) scale. Statistical analyses were conducted by using the Mann-Whitney U test and the Spearman correlation analysis (α=.05).

RESULTS

Of 250 screened videos, only 73 were eligible for final analyses. The included videos presented an average 123 846 (range, 4 to 3 182 404) views with a mean duration of 528 (range, 12 to 1699) seconds. In addition, the average number of likes was 1122 (range, 0 to 3300), but, remarkably, none of the included videos received any dislikes. Overall, the mean content-quality score was 6.2 ±3.8, thus indicating low-quality content. The average DISCERN and GQ scores were 47.73 ±9.94 and 3.41 ±0.95, with the Spearman rank correlation test showing a strong positive correlation (r=.732; P<.001) among the total obtained scores. Moreover, statistically significant differences were reported between the LC and MHC groups for both DISCERN and GQ scores (P<.001).

CONCLUSIONS

The reliability of YouTube videos regarding the all-on-4 dental implant treatment concept is questionable, as they exhibit poor content-quality, thus making them an unreliable source for patients, students, and dentists seeking accurate information.

Implant survival rate and marginal bone loss with the all-on-4 immediate-loading strategy: A clinical retrospective study with 1 to 4 years of follow-up

STATEMENT OF PROBLEM

Assessing peri-implant marginal bone loss (MBL) and its risk factors with cone beam computed tomography (CBCT) may clarify the risk factors for the all-on-4 (5 or 6) strategy and further improve its survival rate.

PURPOSE

The purpose of this retrospective clinical study was to evaluate the implant survival rate, MBL, and associated risk factors of all-on-4 (5 or 6) prostheses after 1 to 4 years of follow-up with CBCT.

MATERIAL AND METHODS

A total of 56 participants rehabilitated with 325 implants by using the all-on-4 (5 or 6) concept between October 2015 and December 2019 were included. Outcome measures were cumulative implant survival (life-table analysis) and MBL. Four CBCT scans, a scan immediately after surgery (T0), a scan 1 year after surgery (T1), a scan 2 years after surgery (T2), and a scan 3 to 4 years after treatment (T3), were obtained to evaluate the MBL. The Pearson correlation coefficient analysis and linear mixed models were performed to assess the potential risk factors for MBL (α=.05).

RESULTS

The implant survival rate was 99.38%, and the prosthesis survival rate was 100%. The reductions in the vertical buccal bone height (△VBBH) were 0.74 ±0.10 mm (T0-T1), 0.37 ±0.12 mm (T1-T2), and 0.15 ±0.14 mm (T2-T3). Except for T2-T3, the △VBBH showed a significant difference at T0-T1 and T1-T2 (P≤.05). The alterations in vertical mesial bone height (VMBH), vertical distal bone height (VDBH), and vertical lingual bone height (VLBH) were similar to the trend observed in VBBH. The △VBBH (T0-T3) was negatively correlated with the horizontal buccal bone thickness (HBBT) (T0) (r=-.394, P<.001). Linear mixed models revealed that factors such as smoking (P=.001), mandible implant site (P<.001), immediate implant (P=.026), tilted implant (P<.001), female sex (P=.003), systemic disease (P=.025), and bruxism (P=.022) negatively affected MBL. The cantilever length (CL) also had a negative effect on MBL around the implants at the distal extension (P<.001).

CONCLUSIONS

The high implant and prosthesis survival rates and low MBL confirmed the predictability of the all-on-4 (5 or 6) concept. Smoking, mandible implant site, systemic disease, bruxism, female sex, immediate implant, tilted implant, and CL were identified as potential risk factors for MBL.

Plaque accumulation on the fitting surface of full-arch implant-supported fixed prostheses with contact or noncontact pontics: A split mouth randomized controlled trial

OBJECTIVE

To explore the differences in plaque accumulation on the fitting surface of full-arch implant-supported fixed prostheses with contact or noncontact pontics.

MATERIALS AND METHODS

Nineteen patients (20 prostheses, 7 in the maxilla, and 13 in the mandible) intending to undergo full-arch implant-supported immediate function prostheses were recruited. During immediate restoration and using the midline as the boundary, one side was restored as a pontic and mucosa noncontact type (the test group), and the opposite side was restored as a pontic and mucosa contact type (the control group). In a follow-up 6 months after the surgery, the cleanliness of the fitting surface of the immediate prosthesis was evaluated by plaque staining and debris index determination. Patient satisfaction was investigated by questionnaire.

RESULTS

Twenty prostheses from 19 patients included in the randomized controlled trial were followed up. Among the 20 prostheses, the percentage of area covered with plaque was significantly lower in the test group compared with that in the control group (31.5 ± 15.8% vs. 43.7 ± 15.3%; p < 0.001). The debris index in the test group was lower than that in the control group, although the difference was not statistically significant (2.77 ± 0.73 vs. 3.15 ± 0.90; p > 0.05). In the patient satisfaction survey, most of the patients were satisfied with most aspects of the prostheses, however, nearly half of the patients were not satisfied with the cleaning.

CONCLUSIONS

The pontic and mucosa noncontact prosthetic design reduces plaque accumulation on the fitting surface, which is beneficial for maintaining oral cleanliness. However, the majority of study samples were mandible and conclusions may not be fully applicable to maxilla.

TRIAL REGISTRATION

www.chictr.org.cn (ChiCTR1900028576).

CLINICAL SIGNIFICANCE

The noncontact design in full-arch implant-supported fixed prostheses may be an effective measure of improving oral hygiene promotion. There is need for more research that can further improve oral hygiene of patients with full-arch implant-supported prostheses.

Clinical outcomes of full-arch immediate fixed prostheses supported by two axial and two tilted implants: A retrospective cohort study with 12-15 years of follow-up

PURPOSE

To retrospectively assess clinical and radiographic outcomes of immediately loaded full-arch fixed prostheses supported by axial and tilted implants up to 15 years of function.

MATERIALS AND METHODS

Patients with one completely edentulous arch received an immediate full-arch fixed prosthesis supported by two anterior axial and two posterior tilted implants. Definitive prosthesis consisting of a CAD-CAM titanium framework and acrylic teeth was delivered 6 months later. Patients were regularly followed to assess clinical parameters and marginal bone level (MBL) change. Multilevel regression analysis was performed to investigate factors affecting implant failure and MBL.

RESULTS

Six hundred ninety-two implants were placed in 72 maxillae and 101 mandibles. Seven maxillary implants (5 axial and 2 tilted) in 6 patients and 12 mandibular implants (6 axial and 6 tilted) in 5 patients failed. 15-year cumulative implant survival was 97.51% and 96.91% in maxilla and mandible, respectively (p = .64). After 10 years, the difference in MBL between axial and tilted implants was not significant in the maxilla (p = .47, 65 patients), while it was in the mandible (p < .001, 80 patients). Significant higher bone loss was reported in the mandible at both 5- and 10-year follow-up (p < .001 and p = .004, respectively). Mixed-effect multilevel linear regression evidenced a correlation between arch and bone loss at 5- and 10-year follow-up, while no correlation was found with age, gender, smoking, diabetes, and history of periodontal disease.

CONCLUSION

This long-term study suggests that the present technique can be considered a viable treatment modality for the immediate rehabilitation of both maxilla and mandible.

Comparison of 4‐ or 6‐implant supported immediate full‐arch fixed prostheses: A retrospective cohort study of 217 patients followed up for 3–13 years

PURPOSE

Choosing four or six implants to support immediate full-arch fixed prostheses (FAFPs) is still controversial worldwide. This study aims to analyze and compare the long-term results of All-on-4 and All-on-6.

MATERIALS AND METHODS

This retrospective cohort study enrolled 217 patients rehabilitated with 1222 implants supporting 271 FAFPs, including 202 prostheses supported by 4 implants (All-on-4 group) and 69 prostheses supported by 6 implants (All-on-6 group), and followed up for 3-13 years. Implant survival, prosthesis survival, complications, and implant marginal bone loss (MBL) were evaluated and compared between two groups. Patient characteristics including age, gender, jaw, opposite dentition condition, smoking habit, bruxism, bone quantity and quality, cantilever length (CL), prosthesis material, and oral hygiene were analyzed to assess their influence on the clinical results of the two groups. Six surgeons and three prosthodontists who performed FAFPs more than 5 years were invited for questionnaires, to assess patient- and clinician-related influences on implant number.

RESULT

In general, All-on-4 group indicated no significant difference with All-on-6 group in the implant survival (implant-level: hazard ratio [HR] = 1.0 [95% confidence interval (CI): 0.8-1.2], P = 0.96; prosthesis-level: HR = 0.8 [95% CI: 0.3-1.8], P = 0.54), prosthesis survival (odds ratio [OR] = 0.8 [95% CI: 0.3-2.8], P = 0.56), biological complications (OR = 0.9 [95% CI: 0.5-1.8], P = 0.78), technical complications of provisional prosthesis (OR = 1.3 [95% CI: 0.7-2.3], P = 0.42), technical complications of definitive prosthesis (OR = 1.1 [95% CI: 0.6-2.2], P = 0.33) and the 1st, 5th, and 10th year MBL (P = 0.65, P = 0.28, P = 0.14). However, for specific covariates, including elderly patients, opposing natural/fixed dentition, smoking, bruxism, long CL, low bone density, and all acrylic provisional prostheses, All-on-6 was more predictable in some clinical measurements than All-on-4. The implant prosthodontists and the medium-experienced clinicians showed significant preference for All-on-6 (P < 0.05).

CONCLUSION

Based on this study, the long-term clinical results showed no significant difference between All-on-4 and All-on-6 groups in general. However, for some specific characteristics, All-on-6 seemed to be more predictable in some clinical measurements than All-on-4. For the clinicians' decision-making, medium-experienced clinicians and the implant prosthodontists showed significant preference for All-on-6.

Immediate Functional Loading with Full-Arch Fixed Implant-Retained Rehabilitation in Periodontal Patients: Clinical Study

(1) Background. The immediate functional loading of implants is a clinical procedure used for treating periodontal edentulous patients. This clinical study aimed to evaluate the clinical outcomes of the immediate functional loading of implants with fully fixed rehabilitations in compromised periodontal patients. (2) Methods. Three hundred and five implants IPX screw implants were placed in 27 periodontal patients using an immediate functional loading protocol with fixed rehabilitations. All patients had a previous history of periodontitis, four patients (14.8%) were smokers and seven patients (25.9%) suffered from chronic medical conditions. (3) Results. Implant and prosthetic clinical findings were evaluated during a mean period of 41.3 ± 19.6 months. No implants were lost during the clinical follow-up. The cumulative survival rate for all implants was 100%. Regarding the prostheses designed, a total of 54 fixed prostheses were placed in the 27 patients immediately after the surgery. Forty-four hybrid fixed prostheses (81.5%) and 10 fixed rehabilitations (18.5%) were placed in the patients. The mean marginal bone loss was 1.51 ± 1.16 mm, ranging from 0 to 3.5 mm during the follow-up evaluation. Thirty-one implants (10.2%) in 10 patients (37%) were associated with peri-implantitis. Five patients (18.5%) showed some kind of technical complications (loss/fracture of the prosthetic screw, acrylic resin fracture, ceramic chipping). (4) Conclusions. The clinical outcomes of this study demonstrate that fixed rehabilitation by immediate functional loading of implants is considered a predictable procedure.

Digitally prefabricated versus conventionally fabricated implant-supported full-arch provisional prosthesis: a retrospective cohort study

Background

To evaluate and compare the clinical outcomes of digitally prefabricated and conventionally fabricated implant-supported full-arch provisional prostheses.

Methods

In this retrospective study, a total of 39 patients (22 males and 17 females) who underwent implant-supported full-arch rehabilitation using the All-on-4 concept with an immediate loading protocol were included: 20 patients treated with digitally prefabricated provisional prostheses were assigned into Group A, and 19 patients treated with conventionally fabricated provisional prostheses were assigned into Group B. Implant/provisional prosthesis survival rates and complications were reviewed. Marginal bone loss (MBL) was investigated by CBCT. Surgical time, restorative time, and total operative time were analyzed. Postoperative pain and swelling were evaluated with the visual analog scale (VAS). The oral health impact profile (OHIP) questionnaire was administered before and after surgery.

Results

The implant/provisional prosthesis survival rate was 100%, and complications appeared with low frequency in both groups, while the mean MBL was 0.30 ± 0.29 mm in Group A and 0.31 ± 0.41 mm in Group B after 3~ 6 months (P > 0.05). The average restorative time in Group A (116.16 ± 16.61 min) was significantly shorter than that in Group B (242.11 ± 30.14 min) (P < 0.05). Patients in Group A showed lower pain/swelling VAS scores after surgery than Group B (P < 0.05). Low OHIP scores with high satisfaction with the overall effects were shown in both groups.

Conclusion

Prefabricated prostheses reduced the prosthetic time and postoperative discomfort in patients whose immediate rehabilitation was based on the All-on-4 concept. This prefabrication technology may be a predictable alternative to improve the short-term clinical outcome of implant-supported full-arch provisional rehabilitation.

The Effect of Photodynamic Therapy on the Early Outcome of Implants Placed on Patients with Periodontitis

Background: Immediate implant is a subtype of implant that is placed following tooth extraction within the socket without further delay. These implants are known to preserve the alveolar bone and minimize the total number of surgical interventions in a patient. 4 Photodynamic therapy (PDT) augments nonsurgical periodontal therapy using antibacterial mechanisms. PTD can be more effective in conjunction with scaling and root planing (SRP). The aim of this study is to assess the effects of PDT on the early outcomes of implants placed on patients with periodontitis with and without SRP at 9 months of follow-up. Materials and methods: A total of 23 implants were placed in 14 patients, with 11 in the test group and 12 in the control group. SRP was carried out prior to immediate implant placement in control sites, and PDT adjunctive to SRP (SRP + PDT) was performed in test sites before immediate implant placement. Plaque index, gingival index, probing pocket depth, clinical attachment level, and radiovisiographs were procured at baseline, 3 months, 6 months, and 9 months. Primary stability was examined at the time of implant placement, and the healing index was recorded a week later. Results: At the end of the 9 months of the study period, (SRP + PDT) group had a mean marginal bone loss of 0.95 mm, and the control group had 1.08 mm. Clinical parameters such as plaque index, gingival index, clinical attachment level, and probing depth showed definitive improvement after 9 months, compared with the baseline, but when the test and control groups were compared, the difference was statistically significant for plaque index and probing depth. The implants in both groups were followed up for a period of 9 months. There was an improvement in marginal bone loss but was not statistically significant. The survival of immediate implants in the PDT group was not different from those in the scaling and root planing group. Conclusion: The effect of PTD can be beneficially used as an adjunct to SRP. However, the effects were not significant. Photodynamic therapy can be effectively used as an adjunct to SRP owing to the better outcomes using PDT.

Immediate Maxillary Full-Arch Rehabilitation of Periodontal Patients with Terminal Dentition Using Tilted Implants and Bone Augmentation: A 5-Year Retrospective Cohort Study

Background: All-on-four protocols with tilted implants in the maxilla are used to rehabilitate the terminal dentition of the severe generalized periodontitis patients. Data on long-term biological complications are scarce. Methods: Eighty-four axial and forty-six tilted immediate implants have been placed in the extraction sockets of 23 patients according to a four–six implants protocol combined with ridge augmentation. Within 72 h, a provisional prosthesis was cemented to the implants; after 6 months, a cemented ceramic–metallic prosthesis was delivered. The patients were followed for up to 5 years. Results: The 5-year survival rate of the straight and tilted implants was 100% and 97.8, and the prosthetic one was 100%. Marginal bone loss (MBL) of the straight implants was 0.42 ± 0.67 and 0.59 ±1.01 mm on the mesial and distal sides; for the tilted, it was 0.37 ± 0.68 and 0.34 ±0.62 mm, and the differences were not statistically significant. Implant position, smoking, keratinized mucosal width, and cantilever did not affect MBL. Peri-implant mucositis involved 29.4% and 22.2% of the straight and tilted implants, respectively; peri-implantitis involved 5.8% and 4.4% of the straight and tilted implants, respectively, without statistical significance. Conclusions: This immediate loading protocol’s 5-year survival and success rates were high. No difference between the straight and tilted implants was found regarding survival, success rates, and MBL.

Efficacy of rehabilitation of stage IV periodontitis patients with full-arch fixed prostheses: Tooth-supported versus Implant-supported-A systematic review

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.

Efficacy of rehabilitation with different approaches of implant-supported full-arch prosthetic designs: A systematic review

AIM

To evaluate the efficacy of different types of rehabilitation with fixed or removable full-arch implant-supported prosthesis designs in terms of implant loss and success in patients with at least one edentulous jaw, with tooth loss mainly due to periodontitis.

MATERIALS AND METHODS

Clinical studies with at least 12 months reporting on implant loss and implant success were searched. Meta-analysis was conducted to estimate cumulative implant loss considering different prostheses designs.

RESULTS

A total of 11 studies with unclear to low risk of bias were included in the analysis. Estimated cumulative implant loss for fixed prostheses within 1 year and 5 years was 0.64% (95% confidence interval [CI]: 0.31%-1.31%) and 1.85% (95% CI: 0.85%-3.95%), respectively. The corresponding values for removable prostheses amounted to 0.71% (95% CI: 0.22%-2.28%) and 4.45% (95% CI: 2.48%-7.85%). Peri-implantitis affected 10%-50% of the patients restored with implant-supported fixed prostheses.

CONCLUSIONS

Based on the limited low-quality data, the present analysis points to a low and similar cumulative implant loss within 1 year for patients with tooth loss mainly due to stage IV periodontitis restored with either removable or fixed implant-supported full-arch prosthesis. At 5 years of functioning, there was a tendency for better outcomes using fixed designs.

Clinical Effect and Aesthetic Observation of All-on-4 Immediate Loading Implant Denture in Severe Periodontitis

Objective

To explore the clinical effect and aesthetics of All-on-4 immediate loading implant denture in severe periodontitis.

Methods

Totally, 60 patients with dentition loss caused by severe periodontitis who were admitted to our hospital from February 2017 to February 2019 were selected. The patients were randomly divided into the observation group (n = 30) and the control group (n = 30) according to different restoration methods. The control group was used in traditional implant restoration treatment, and the observation group was used in All-on-4 immediate loading implant denture restoration. The clinical effect, periodontal index, aesthetic effect, and complications of the two groups were compared, and the levels of serum leptin (LEP), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and interleukin-6 (IL-6) were measured.

Results

The total effective rate of the observation group (83.33%) was higher than that of the control group (60.00%) (P < 0.05). After treatment, the plaque index, gingival sulcus bleeding index, and depth of exploration of the two groups were lower than those before treatment (P < 0.05), and there was no significant difference between the two groups (P > 0.05). After treatment, the serum LEP, TNF-α, CRP, and IL-6 in both groups were lower than before treatment, and the serum LEP, TNF-α, CRP, and IL-6 in the observation group were lower than that in the control group (P < 0.05). The aesthetic rate of teeth in the observation group (90.00%) was higher than that in the control group (66.67%) (P < 0.05). There was no significant difference in the total incidence of complications between the two groups (P > 0.05).

Conclusion

All-on-4 immediate loading implant denture has a good effect in the treatment of severe periodontitis, which is conducive to maintaining periodontal health, reducing the level of inflammation, improving aesthetics, and has high safety.

Using a Preoperative Scan Digital Impression and a Digital Index to Build Immediate Interim Full-Arch Implant-Supported Prosthesis. A Case Report and Proof of Concept

The transfer of information such esthetics and occlusion from the preoperative to the postoperative digital impression could reduce the time needed to build an immediately loaded full-arch not-guided rehabilitation and improve the quality of the immediate interim restoration. Based on the digital technology advances of the last years, the purpose of the present clinical report is to describe a novel digital workflow based on computer-aided design and computer-aided manufacturing aimed at fabricating an interim fixed full-arch restoration. The protocol entails recording preoperative information such as esthetics, the occlusal plane and the intermaxillary relationship in implant-supported complete rehabilitations before the surgical insertion of the fixtures. Then, the information is transferred to the postoperative impression using a digital index in the lower jaw and the palatal rugae in the upper jaw. Within the inherent limitations of a case report, the workflow was accurate, predictable, without errors from conventional protocols and was apparently characterized by low biological costs.

All-on-4 Concept Update

Over the past 17 years, the All-on-4 treatment concept has been a reliable and predictable modality to rehabilitate edentulous jaws with immediate function as full-arch prostheses. This article highlights clinically relevant data compiled by numerous All-on-4 investigators including complications and their remedies, occlusion and cantilever trends, implant size utilization, and controversial topics. We provide insights for navigating the complexities of medically diverse populations, faced by our daily practice, with a focus on patient avoidance, risk factors for implant and prosthetic failures, in hopes to minimize complications so clinicians would choose this treatment with confidence.

Treating severe periodontitis with staged load applied implant restoration: A case report

BACKGROUND

Because immediate implant surgery is not recommended for patients who have been diagnosed with periodontitis, researchers have treated these patients with a variety of methods, including combining orthodontic and periodontal surgeries as well as implantation. However, these treatments cost time and money for the patient. Although it has been reported that temporary implants released a severe gag reflex in 1 case, only a few studies have documented using temporary implants to treat patients diagnosed with severe periodontitis.

CASE SUMMARY

The patient was a 49-year-old female who was missing the majority of her teeth and had gingival atrophy and severe alveolar bone atrophy. After being diagnosed with severe periodontitis, the patient underwent staged load applied implant restoration therapy. The first load-bearing stage was carried out immediately by inserting temporary Osstem mini implants. Maxillary teeth were extracted by using the guided bone regeneration technique, and lateral maxillary sinus lifting was conducted on both sides. During the second load-bearing stage, temporary implants were removed, and permanent implants were placed. The resin bridge was segmented during the third load-bearing stage. During the fourth load-bearing stage, the permanent prosthesis was positioned in the patient’s mouth.

CONCLUSION

By conducting the load-bearing treatment in stages, the patient’s mouth contained restorations throughout the procedure, thus guaranteeing basic function and appearance.

CAD-CAM-fabricated interim fixed complete-arch implant-supported restorations based on the existing dentition

An interim restoration is often used to assess the patient's functional and esthetic needs for implant-supported complete-arch fixed prostheses. A digital protocol for accurately transferring information from the existing dentition to the interim restoration is required. The purpose of this clinical report was to describe a digital workflow to fabricate an interim fixed restoration by using the vertical dimension of occlusion and occlusal relationship from the original dentition to provide an accurate, efficient, and predictable computer-aided design and computer-aided manufacturing (CAD-CAM) interim complete-arch implant-supported restoration.

Clinical performance of intentionally tilted implants versus axially positioned implants: A systematic review

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.

Immediately Loaded Bicortical Implants Inserted in Fresh Extraction and Healed Sites in Patients with and Without a History of Periodontal Disease

Background

Bicortical screw implants may be used in both healed bone and fresh extraction sockets and loaded immediately. To date, there have not been too many studies reporting clinical results of such screws used in periodontally involved sites. This study aimed to assess many aspects of bicortical screw implants used to retain full-arch and segmental cemented prostheses in the rehabilitation of the mandible and maxilla in patients with or without a history of periodontal disease.

Materials and Methods

This retrospective review involved 87 patients, of whom 77 had a history of periodontitis diagnosed before implant placement and 10 did not. They were treated following the same surgical procedure and received a total of 1019 implants which were immediately loaded with fixed prosthetic works.

Results

A total of 1019 polished surface, one-piece, bicortical screw implants were used in 87 patients who underwent the same surgical treatment, i.e., tooth extraction and immediate implant placement were investigated, of which 526 were placed in the healed bone and 493 in fresh extraction sockets with the mean follow-up time of 22.2 ± 7.3 months. Results were analyzed using log-rank test, the Kaplan-Meier method, Chi-square test, and t-test. Cumulative survival at 12, 24, and 35 months after placement was 99.3%, 98.6%, and 97.0%, respectively.

Conclusion

Bicortical smooth surface implant concept with immediate loading protocol provided predictable outcomes and survival rate of 99% in patients with and without a history of periodontitis. More studies are needed to further support the clinical advantages of bicortical anchoraged smooth surface implants.