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Gama LT, Bezerra AP, Schimmel M, Rodrigues Garcia RCM, de Luca Canto G, Gonçalves TMSV. Clinical performance of polymer frameworks in dental prostheses: A systematic review. J Prosthet Dent 2024; 131:579-590. [PMID: 35422333 DOI: 10.1016/j.prosdent.2022.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 03/07/2022] [Accepted: 03/07/2022] [Indexed: 12/11/2022]
Abstract
STATEMENT OF PROBLEM High-performance polymers including polyetheretherketone (PEEK) and polyetherketoneketone (PEKK) have been used as substitutes for metal frameworks in dental prostheses. However, the clinical performance of polymer-based frameworks is still uncertain. PURPOSE The purpose of this systematic review was to compare the clinical performance of PEEK and PEKK with that of metal frameworks for different dental prostheses. MATERIAL AND METHODS This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six databases and non-peer-reviewed literature (without language or follow-up restrictions) were searched for studies conducted before February 2022. Only clinical studies, either randomized clinical trials (RCTs) or nonrandomized clinical trials (N-RCTs), comparing the clinical performance of polymer and metal frameworks were included. The risk of bias and certainty of the evidence were assessed with the RoB 2.0, ROBINS-I, and GRADE. Biologic (plaque and gingival indices, probing depth, bleeding scores, implant stability quotient, marginal bone loss) and mechanical outcomes (ridge base relation, prosthetic marginal gap, and fracture) were assessed. RESULTS Only 9 studies (7 RCTs and 2 N-RCTs) were included, all with moderate to serious risk of bias and low to very low certainty of evidence. No meta-analysis was possible, but qualitative analysis revealed lower plaque and gingival indices, probing depth, and marginal bone loss, with higher survival rates for implant-supported fixed prostheses and overdentures fabricated with PEEK than for metal frameworks. No significant differences were found between groups for removable partial dentures. The marginal fit of PEEK frameworks was also better for single crowns. Three fractures were reported in the 3 PEKK fixed dental prostheses with cantilevers. CONCLUSIONS PEEK and PEKK seem to be promising materials for dental prostheses, with acceptable response from the periodontal tissue. However, further well-designed studies are necessary to better understand their clinical and long-term limitations.
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Affiliation(s)
- Lorena Tavares Gama
- PhD student, Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Adriana Pinto Bezerra
- PhD student, Department of Dentistry, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Martin Schimmel
- Full Professor, Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern (UNIBE), Bern, Switzerland; Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva (UNIGE), Geneva, Switzerland
| | - Renata Cunha Matheus Rodrigues Garcia
- Full Professor, Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Graziela de Luca Canto
- Full Professor, Department of Dentistry, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
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Minase DA, Sathe S, Borle A, Pathak A, Jaiswal T. Less Is More: A Case Report on All-on-4 Prosthesis. Cureus 2024; 16:e54873. [PMID: 38533146 PMCID: PMC10964220 DOI: 10.7759/cureus.54873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/25/2024] [Indexed: 03/28/2024] Open
Abstract
Severe alveolar ridge atrophy following tooth removal poses a common and worsening issue in edentulous jaws, affecting patient comfort and quality of life. The All-on-4 approach involves axially positioning two anterior implants and distally orienting two posterior implants, reducing cantilever length and enabling prostheses with 12 teeth. This less invasive option, utilizing distal tilting of implants at 30°, offers biomechanical advantages and has shown short-term success, though long-term research is limited. Immediate-loading treatments are gaining popularity for their high survival rates. Understanding the biomechanics of implant-supported prostheses is crucial for long-term success, emphasizing the importance of optimal occlusal schemes. Challenges such as bone defects and surgical complexity have led to the exploration of achieving full-arch fixed restorations with fewer implants, building upon Brånemark's early work with four implants. The All-on-4 concept, originating in 1999, proves to be a viable treatment option, providing excellent long-term results and improved load distribution in challenging clinical circumstances. This case report explores the successful rehabilitation of a jaw using the All-on-4 implant prosthesis concept, a technique strategically placing four implants in completely edentulous jaws to support a fixed, immediately loaded prosthesis.
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Affiliation(s)
- Dhanashree A Minase
- Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Seema Sathe
- Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anjali Borle
- Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ankita Pathak
- Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tanvi Jaiswal
- Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Martakoush-Saleh S, Salgado-Peralvo AO, Peña-Cardelles JF, Kewalramani N, Gallucci GO. Evaluating the clinical behavior of veneered zirconia in comparison with monolithic zirconia complete arch implant-supported prostheses: A systematic review and meta-analysis. J Prosthet Dent 2023:S0022-3913(23)00497-3. [PMID: 37696747 DOI: 10.1016/j.prosdent.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 09/13/2023]
Abstract
STATEMENT OF PROBLEM Because the use of zirconia in dentistry is relatively new, the number of published studies on the subject is scarce, even though material selection is an important factor in clinical performance. Therefore, a systematic assessment of the impact of the prosthetic material, framework design, veneering material, and manufacturing process is required. PURPOSE The purpose of this systematic review and meta-analysis was to investigate the survival and success rates of feldspathic porcelain veneered zirconia (VZir) in comparison with monolithic zirconia (MZir) complete arch implant-supported prostheses (CAISPs). A secondary objective was to assess the influence of the type of loading, the presence or absence of a cantilever, the type of zirconia used, the location, and the opposing arch on complications rates and patient satisfaction. MATERIAL AND METHODS An electronic search of the MEDLINE database (via PubMed), Scopus, Science Direct, Cochrane Library, and OpenGrey was carried out. The criteria described in the preferred reporting items for systematic reviews and meta-analyses statement were used. The search was restricted from January 2000 to January 2022. RESULTS The systematic search resulted in 20 articles that met the established criteria. In total, 751 patients (VZir=302; MZir=449) with 3038 CAISPs (VZir=368; MZir=2670) were analyzed. Higher prosthetic survival and success rates were found in MZir compared with VZir CAISPs (100% and 95.45%, respectively). The meta-analysis found significantly fewer complications related to MZir (9.4% [4.8%-14.1%]) compared with VZir (33.7% [17.5%-49.9%]). CONCLUSIONS Based on the findings of this systematic review, MZir CAISPs had higher survival and success rates than VZir CAISPs, with significantly fewer prosthetic complications. The influence of factors such as the type of functional loading, the presence of a cantilever, the material used in the prosthodontic workflow, the location of the CAISP, and the type of antagonist arch on the performance of Zir CAISPs remains unclear.
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Affiliation(s)
- Sara Martakoush-Saleh
- Postgraduate student, Department of Dental Clinical Specialties, Complutense University of Madrid, Spain
| | - Angel-Orión Salgado-Peralvo
- Professor, Department of Dental Clinical Specialties, Faculty of Odontology, Complutense University of Madrid, Spain.
| | - Juan-Francisco Peña-Cardelles
- Professor, Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Mass
| | - Naresh Kewalramani
- Professor, Department of Nursery and Stomatology, Faculty of Dentistry, Rey Juan Carlos University, Madrid, Spain
| | - German O Gallucci
- Professor and Department Chair, Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Mass
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Zhang Y, Li S, Di P, Zhang Y, Wu A, Lin Y. 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. Clin Implant Dent Relat Res 2022; 25:381-397. [PMID: 36522852 DOI: 10.1111/cid.13170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
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.
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Affiliation(s)
- Yan Zhang
- Department of Oral Implantology Peking University School and Hospital of Stomatology Beijing People's Republic of China
| | - Sha Li
- Department of Oral Implantology Peking University School and Hospital of Stomatology Beijing People's Republic of China
| | - Ping Di
- Department of Oral Implantology Peking University School and Hospital of Stomatology Beijing People's Republic of China
| | - Yu Zhang
- Department of Oral Implantology Peking University School and Hospital of Stomatology Beijing People's Republic of China
| | - Aozhou Wu
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Ye Lin
- Department of Oral Implantology Peking University School and Hospital of Stomatology Beijing People's Republic of China
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Topcu Ersöz MB, Mumcu E. Biomechanical investigation of maxillary implant-supported full-arch prostheses produced with different framework materials: a finite elements study. J Adv Prosthodont 2022; 14:346-359. [PMID: 36685790 PMCID: PMC9832146 DOI: 10.4047/jap.2022.14.6.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Four and six implant-supported fixed full-arch prostheses with various framework materials were assessed under different loading conditions. MATERIALS AND METHODS In the edentulous maxilla, the implants were positioned in a configuration of four to six implant modalities. CoCr, Ti, ZrO2, and PEEK materials were used to produce the prosthetic structure. Using finite element stress analysis, the first molar was subjected to a 200 N axial and 45° oblique force. Stresses were measured on the bone, implants, abutment screw, abutment, and prosthetic screw. The Von Mises, maximum, and minimum principal stress values were calculated and compared. RESULTS The maximum and minimum principal stresses in bone were determined as CoCr < ZrO2 < Ti < PEEK. The Von Mises stresses on the implant, implant screw, abutment, and prosthetic screws were determined as CoCr < ZrO2 < Ti < PEEK. The highest Von Mises stress was 9584.4 Mpa in PEEK material on the prosthetic screw under 4 implant-oblique loading. The highest maximum principal stress value in bone was found to be 120.89 Mpa, for PEEK in 4 implant-oblique loading. CONCLUSION For four and six implant-supported structures, and depending on the loading condition, the system accumulated different stresses. The distribution of stress was reduced in materials with a high elastic modulus. When choosing materials for implant-supported fixed prostheses, it is essential to consider both the number of implants and the mechanical and physical attributes of the framework material.
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Affiliation(s)
- Mirac Berke Topcu Ersöz
- Department of Prosthodontics, Faculty of Dentistry, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Emre Mumcu
- Department of Prosthodontics, Faculty of Dentistry, Eskisehir Osmangazi University, Eskisehir, Turkey.,Advanced Material Technologies Application and Research Center, Eskisehir Osmangazi University, Eskisehir, Turkey.,Translational Medicine Research and Clinical Center, Eskisehir Osmangazi University, Eskisehir, Turkey
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Influence of Framework Material and Posterior Implant Angulation in Full-Arch All-on-4 Implant-Supported Prosthesis Stress Concentration. Dent J (Basel) 2022; 10:dj10010012. [PMID: 35049610 PMCID: PMC8774799 DOI: 10.3390/dj10010012] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/27/2021] [Accepted: 01/12/2022] [Indexed: 12/10/2022] Open
Abstract
This study evaluated the influence of distal implants angulation and framework material in the stress concentration of an All-on-4 full-arch prosthesis. A full-arch implant-supported prosthesis 3D model was created with different distal implant angulations and cantilever arms (30° with 10-mm cantilever; 45° with 10-mm cantilever and 45° with 6-mm cantilever) and framework materials (Cobalt–chrome [CoCr alloy], Yttria-stabilized tetragonal zirconia polycrystal [Y-TZP] and polyetheretherketone [PEEK]). Each solid was imported to computer-aided engineering software, and tetrahedral elements formed the mesh. Material properties were assigned to each solid with isotropic and homogeneous behavior. The contacts were considered bonded. A vertical load of 200 N was applied in the distal region of the cantilever arm, and stress was evaluated in Von Misses (σVM) for prosthesis components and the Maximum (σMAX) and Minimum (σMIN) Principal Stresses for the bone. Distal implants angled in 45° with a 10-mm cantilever arm showed the highest stress concentration for all structures with higher stress magnitudes when the PEEK framework was considered. However, distal implants angled in 45° with a 6-mm cantilever arm showed promising mechanical responses with the lowest stress peaks. For the All-on-4 concept, a 45° distal implants angulation is only beneficial if it is possible to reduce the cantilever’s length; otherwise, the use of 30° should be considered. Comparing with PEEK, the YTZP and CoCr concentrated stress in the framework structure, reducing the stress in the prosthetic screw.
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Rozov RA, Trezubov VN, Gvetadze RS, Smerdov AA, Chikunov SO. [Experimental design of the lower jaw functional loading for implant-supported restoration in unfavorable clinical conditions]. STOMATOLOGIIA 2022; 101:28-34. [PMID: 36562364 DOI: 10.17116/stomat202210106128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
THE AIM OF THE STUDY Was to create a finite element design to evaluate the masticatory stress distribution on the full fixed prosthesis with three supporting implants and the mandibular bone in the conditions most closely resembling the real ones. MATERIALS AND METHODS The geometric design was created with the results of a CBCT of a real patient. The transfer of the DICOM into STL format was carried out in the Mimics Medical 21 program, in which the author's splinting device for the implant was designed. The actual thicknesses of the patient's compact and cancellous bone layers were measured with Romexis ver. 4.5.1. Scanning of the artificial dentition was performed with the iTero Element 2 Version 1.7 which created an object in STL format. Design was performed in the package for finite element analysis Ansys 19.3. Tetrahedral elements of the second order were used for calculation. The structural elements were connected in the model by a rigid «Bonded» contact. RESULTS A finite element model has been created for the experimental load design on the lower jaw for immediate implant restoration with few supports in combination with a device for stabilizing the implant in unfavorable clinical conditions. It is shown that the designed finite element model takes into account the biomechanics of the prosthesis with few supports. When calculating, the entire model was fixed to the mandibular process at its base, and was loaded with a force of 500 N, distributed over the teeth. The values of the maximum stresses obtained in the elements were 51.8 MPa for the compact layer and 245 MPa for titanium elements. CONCLUSION Thus, we created personalized geometric and finite element models for calculating the distribution of functional load on a long full fixed implant-supported prosthesis with few artificial supports, which makes the experimental results more accurate and correct.
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Affiliation(s)
- R A Rozov
- I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia.,City Dental Clinic No. 33, St. Petersburg, Russia
| | - V N Trezubov
- I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia
| | - R Sh Gvetadze
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - A A Smerdov
- N.E. Bauman Moscow State Technical University, Moscow, Russia
| | - S O Chikunov
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
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