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Plaque Accumulation Beneath Maxillary All-on-4™ Implant-Supported Prostheses
Abstract
Maxillary prostheses supported by four implants, following the All-on-4™ principles, have become an accepted effective treatment for totally edentulous patients. Maintaining the hygiene of such fixed implant-supported prostheses is challenging.
The purpose of this clinical study was to evaluate the distribution of plaque on the fitting surface of All-on-4 fixed prostheses in order to find new strategies for maintaining their hygiene.
Twenty All-on-4 maxillary fixed prostheses collected from 20 patients, 6 months after delivery, were stained with methylene blue to disclose plaque accumulation at the fitting surfaces of the prostheses. Digital photographs of the fitting surfaces of the prostheses were recorded and processed. The distribution of accumulated plaque was evaluated statistically.
The average percentage of area covered with plaque was 28 ± 8% of the total area of the fitting surface of the prostheses. The fitting surfaces of the prostheses had three times more plaque on the palatal area (52.5 ± 7.33%) than on the buccal area (17.3 ± 7.33%, p < .05). The interimplant proximal areas of the fitting surface covered with plaque were high when the distance between implants was short (r = -0.326, p = .014).
These findings suggest that the hygiene of the All-on-4 prostheses could be improved by maximizing the distances between the inserted implants in the jaw, minimizing the prostheses' palatal extension and guiding patients to optimize their oral hygiene practices targeting the palatal area of their prostheses.
... However, reducing this space makes it more difficult to perform hygiene procedures. 11 Controlling biofilm accumulation is essential to reduce the incidence of peri-implant disease, 12 since poor oral hygiene is a risk factor for the development of mucositis and peri-implantitis. 13,14 Access to hygiene can be planned in implant-supported prostheses 15 that have a convex shape and a smooth and polished surface. ...
... [18][19][20] In addition to the intaglio surface contour, the distance between implants also affects hygiene access; implants that are close together impede biofilm control. 12 For treatment to be successful with few complications, regular professional follow-up and self-performed hygiene procedures are essential. 2,6,21,22 Information on how the shape of the intaglio surface of complete-arch implant-supported prostheses affects treatment outcomes is scarce. ...
... This finding is consistent with other findings 13,18,26 that reported that fixed prostheses can present contours and spaces that are difficult to clean, increasing the probability of changes in peri-implant tissues. 12,13 Biofilm accumulation on the protheses has been reported to play an important role in the initiation and progression of inflammation and infection in the denture bearing area. Poor hygiene is a major factor predisposing denture surfaces to biofilm accumulation. ...
s
Statement of problem
Whether the shape of the intaglio surface of fixed implant-supported maxillary prostheses is associated with the occurrence of biological is unclear.
Purpose
The purpose of this cross-sectional study was to evaluate the shape (convex or concave) of the intaglio surface of complete-arch implant-supported maxillary fixed prostheses and to assess the association with biofilm accumulation, hyperemia, bone loss, and patient satisfaction.
Material and methods
Study participants consisted of 56 individuals with fixed complete implant-supported maxillary prosthesis attending follow-up appointments. The 56 prostheses supported by 388 implants had been in place for an average of 5.5 years (range 1-14 years). The intaglio surface was divided into areas corresponding to the cantilever regions and between implants (n=442) and was assessed for shape (concave or convex) and biofilm index (0 to 3). Tissue hyperemia (redness) was assessed as absent or present. Bone loss (mm) was measured from digital periapical radiographs by 2 calibrated evaluators (kappa=94.9%). Study participant satisfaction was investigated by using a visual analog scale. Association assessments (α=.05) between the shape of each area and all these parameters were performed with the Friedman, linear regression, and logistic regression tests.
Results
Of the analyzed areas, 58 (13.1%) were concave, and 384 (86.9%) were convex. Biofilm was absent on 3.5% of the concave and 5.5% of the convex areas. Biofilm was detectable with a probe on 12% of the concave and 22.4% of the convex areas and clinically visible in 58.6% of the concave and 57.8% of the convex areas. Abundant biofilm was seen in 25.9% of the concave and 14.3% of the convex areas and was associated with hyperemia (P=.003). A statistically significant association was found between the shape and biofilm accumulation (P=.009). Hyperemia was present in 199 (45%) areas. The association analysis between the shape of the area and the presence of hyperemia was not significant (P>.05). The mean bone loss was 0.71 mm (0.91 mm). Implants placed near concave areas underwent greater bone loss (P=.001). Study participants reported a high level of satisfaction with the esthetics, mastication, speech, and smile provided by the prosthesis, with satisfaction scores ranging between 8.46 and 8.77. However, in relation to ease of cleaning, only 19.6% were fully satisfied.
Conclusions
The shape of the intaglio surface of prostheses influenced the occurrence of biofilm accumulation and bone loss, and concave areas showed greater biofilm accumulation and bone resorption. High rates of satisfaction with treatment were identified.
... In a previous study of full-arch implant restorations, 28% of the mucosal fitting surface on the implant bridge with gingiva was reportedly covered with plaque [15], but plaque removal by patients is difficult [16]. Thus, herein we investigated whether bacterial counts can be reduced by removing the superstructure at the abutment level during professional mechanical plaque removal (PMPR). ...
... The implant interval is reduced by increasing the number of implants. Abi et al. [15] reported that the interimplant proximal areas of the fitting surface covered with plaque were high when the distance between the implants was short. Thus, the number of implants affects the quantity of plaque. ...
... In the present study, we produced the mucosal side of the superstructure using titanium or zirconia. In a previous study of plaque quantities on fitting surfaces, Abi [15] showed that minimizing palatal extensions of prostheses improves the hygiene of All-on-4 prostheses. Accordingly, we made and fixed prostheses after considering the cleaning state with their provisional restoration. ...
Purpose:
The purpose of this study was to determine whether removing the superstructure of the implant bridge in cases of full-arch implant restorations for edentulous atrophic arches at the abutment level during professional mechanical plaque removal (PMPR) affects bacterial counts.
Methods:
This crossover clinical trial included 20 patients who received screw-retained prostheses at the abutment level. Patients were randomly assigned to two groups and received PMPR with or without removal of the superstructure. After a three-month washout period, the type of treatment was reversed between the groups. Bacterial counts around the cylinder and abutment were measured and compared before and after PMPR.
Results:
Bacterial numbers around the cylinder and abutment were significantly reduced after PMPR as compared with before PMPR regardless of whether the superstructure was removed (p <0.05). However the ratio of subjects with bacteria at 1.0 × 105 colony forming unit/ml (cfu/ml) or more after PMPR was significantly higher when the superstructure was not removed (p < 0.05). Among patients with bacterial counts of less than 10 × 105 cfu/ml, bacterial loads were reduced to less than 1.0 × 105 cfu/ml even when superstructures were not removed. Among patients with bacterial load of >10 × 105 cfu/ml, bacterial numbers were not reduced to <1.0 × 105 cfu/ml when PMPR was performed without removing the superstructure.
Conclusions:
Removal of the superstructure in cases of full-arch implant restorations for edentulous atrophic arches during PMPR reduces bacterial numbers around the implant bridge at the abutment level.
... 11 Namely, the use of chemotherapeutic mouth rinses to reduce inflammation and prevent oral diseases by controlling the oral biofilm is common practice, but these are associated with a limitation in the transposition to the periodontal sulcus to less than 2 mm. 12 This restriction is further increased in fixed prosthetic rehabilitations, which are known to be challenging for the patient to clean. Consequently, high levels of bacterial plaque accumulation occur on their surfaces, 13 deeming necessary to explore alternatives and complementary methods. ...
... 56 In addition, the fact that the implants studied served as a support for an implant-supported prosthesis, which is a unique and large structure that is difficult to sanitize, may also have compromised the effectiveness of the daily oral hygiene performed by the participants. 13 The results obtained may have been influenced by some limitations present in this investigation: (i) due to the principal investigator being working alone in the field, there was no blinding of the examiner or the participants, both being aware of the study group to which they were allocated; (ii) data were interpreted based on the confidence of cooperation and compliance with the reported probiotic intake and delivery of the empty container by the TG individuals; (iii) the interpretation of numerous practical and theoretical concepts of P-im as well as the diversity of criteria and gingival indices used in the diagnosis, extent and severity of this condition in the literature, may potentially influence the diagnosis of this condition making it difficult to compare with other studies; (iv) the mean age of the participants in this study was considerably higher than other studies on this topic, as most studies addressed P-im in single or partial rehabilitations, associated with younger populations; (v) due to the vasoconstrictor action of nicotine, the inclusion of smokers, although few and well distributed among the study groups, may have contributed to reduce the severity of mBI. The strengths of this investigation include the study design (randomized controlled trial) that accounts as a benchmark for studying causal relationships between interventions and outcomes as randomization eliminates part of the bias inherent with other study designs. ...
Objectives Mechanical debridement is the traditional method for the treatment of peri-implant mucositis (P-im) and its success depends on the patient's correct oral hygiene. It is believed that probiotics may help by their ability to modulate the oral biofilm, resulting in anti-inflammatory and antibacterial plaque action. The aim of this study was to evaluate the adjuvant effect of the probiotic Limosilactobacillus reuteri (LR) in the mechanical treatment of P-im.
Materials and Methods This exploratory study included 29 subjects with implant-supported total rehabilitation and P-im, divided into test (TG) and control (CG) groups, equally subjected to professional mechanical debridement, with the administration of a daily GUM PerioBalance lozenge for 30 days added to the TG. The modified Plaque Index (mPlI) modified Sulcus Bleeding Index (mBI) and pocket depth (PD) were evaluated before the intervention (baseline) and 6 and 10 weeks later.
Statistical Analysis Parametric and nonparametric tests with 5% significance level were used in the statistical analysis, using IBM SPSS Statistics 27.0 software.
Results Both treatments resulted in reduced mPlI, mBI, and PD at 6 weeks; while from 6 to 10 weeks there was an increase in mPlI and mBI and maintenance of PD. Compared with baseline, differences were close to statistical significance in the reduction in PD at 10 weeks in the CG (p = 0.018), after Bonferroni correction, and statistically significant in the mPlI at 6 weeks in the CG (p = 0.004) and in the TG (p = 0.002) as well as at 10 weeks in the TG (p = 0.016). Comparing the groups in the postintervention assessments, no statistically significant differences were found.
Conclusion LR adjuvant mechanical treatment of P-im does not show a clear benefit compared with mechanical treatment alone, with both interventions achieving similar clinical results. Further prospective and long-term studies are needed.
... However, there are no publications comparing hygiene measures or peri-implant health in relation the degree of hygiene space or tissue contact in fixed implant supported bridges. In situations where tissue contact is necessary, a concave intaglio surface of a fixed prosthesis must be avoided, with a minimum of 3 mm distance between implants, which will help patient's ability to reduce plaque accumulation (Figure 14), 107 also described the plaque accumulations beneath fixed prosthesis to be three times more on palatal side, where access for cleaning is more challenging. 107 Therefore, should the patients' anatomical characteristics and placement of implants provide an unfavorable situation for a hygienic fixed prosthesis design, a removable solution may be a better option to maintain tissue health. ...
... In situations where tissue contact is necessary, a concave intaglio surface of a fixed prosthesis must be avoided, with a minimum of 3 mm distance between implants, which will help patient's ability to reduce plaque accumulation (Figure 14), 107 also described the plaque accumulations beneath fixed prosthesis to be three times more on palatal side, where access for cleaning is more challenging. 107 Therefore, should the patients' anatomical characteristics and placement of implants provide an unfavorable situation for a hygienic fixed prosthesis design, a removable solution may be a better option to maintain tissue health. ...
Over the past decade, emerging evidence indicates a strong relationship between prosthetic design and peri‐implant tissue health. The objective of this narrative review was to evaluate the evidence for the corresponding implant prosthodontic design factors on the risk to peri‐implant tissue health. One of the most important factors to achieve an acceptable implant restorative design is the ideal implant position. Malpositioned implants often result in a restorative emergence profile at the implant‐abutment junction that can restrict the access for patients to perform adequate oral hygiene. Inadequate cleansability and poor oral hygiene has been reported as a precipitating factors to induce the peri‐implant mucositis and peri‐implantitis and are influenced by restorative contours. The implant–abutment connection, restorative material selection and restoration design are also reported in the literature as having the potential to influence peri‐implant sort tissue health.
... An appropriate design should have prosthesis contact with the soft tissue similar to that of a modified ridge lap pontic design, specifically by designing prosthesis contact with the soft tissue toward the buccal aspect of the prosthesis yet maintaining a flat or convex intaglio design toward the palatal side that allows unimpeded plaque removal measures. 20,[30][31][32] In the present study, the prosthetic design was not always consistent with these guidelines, because different residents and dental laboratory technicians were involved in the fabrication of the IFCDPs. It is therefore likely that less than ideal prosthesis design led to an increased prevalence of periimplant mucositis. ...
... In addition, periodic maintenance and supportive periodontal therapy is important to minimize biofilm-mediated complications. [30][31][32][33][34][35] While regular hygiene and recall protocols were in place, compliance with maintenance appointments and selfperformed plaque removal in this study cohort was less than ideal. Indeed, few patients attended their maintenance visits as scheduled. ...
Statement of problem
Limited information is available on the association between prosthesis-associated risk factors and biologic complications for patients with implant fixed complete dental prostheses (IFCDPs).
Purpose
The purpose of this retrospective study was to assess the implant survival and biologic complications of IFCDPs up to 5 years of follow-up.
Material and methods
Patients who had received IFCDPs between August 1, 2009 and August 1, 2014 were identified through an electronic health record review. Those who consented to participate in the study attended a single-visit study appointment. Clinical and radiographic examinations, intraoral photographs, and peri-implant hard and soft tissues parameters were assessed. Only prostheses which could be removed during the study visit were included. Associations between biologic complications and prosthetic factors, such as time with prosthesis in place, prosthesis material, number of implants, cantilever length, and type of prosthesis retention, were assessed.
Results
A total of 37 participants (mean ±standard deviation age 62.35 ±10.39 years) with 43 IFCDPs were included. None of the implants had failed, leading to an implant survival of 100% at 5.1 ±2.21 years. Ten of the prostheses were metal-ceramic (Group MC) and 33 were metal-acrylic resin (Group MR). Minor complications were more frequent than major ones. Considering minor complications, peri-implant mucositis was found in 53% of the implant sites, more often in the maxilla (P=.001). The most common major biologic complication was peri-implantitis, which affected 4.0% of the implants, more often in the mandible (P=.025). Peri-implant soft tissue hypertrophy was present 2.79 times more often (95% CI: 1.35 – 5.76, P<.003) around implants supporting metal-acrylic resin prostheses than metal-ceramic ones, with the former type also showing significantly more plaque accumulation (P<.003).
Conclusions
Biologic complications such as soft tissue hypertrophy and plaque accumulation were more often associated with metal-acrylic resin prostheses. Peri-implant mucositis occurred more often under maxillary IFCDPs, while peri-implantitis appeared more common around mandibular implants.
... Furthermore, the immediate function concept with immediate screw-retained prosthesis provides cost effective, time-saving treatments and achieves immediate function and esthetics 14 Although All on four concept for edentulous mandible achieves high success rate, Browaeys et al 15 showed significantly lower implant success after 1 year in maxilla (56%) compared with the mandible (90%) when implants were immediately loaded with an All-on-4 full-arch screw-retained prosthetic bridge. Moreover, the oral hygiene of the hybrid All on four fixed restoration is challenging due to presence of extensive prosthetic flanges which induce more plaque accumulation 16 . Therefore, the maximum use of the residual bone anatomy should be considered to customize the proper implant number, position, and improve success of dental restoration 17 . ...
... Also, All on 4 group showed significant higher plaque and gingival scores than All on 6 group. This may be due to complicated oral hygiene of the hybrid All on four fixed restoration due to presence of extensive prosthetic flanges which induce more plaque accumulation 16 . Moreover, the presence of cantilever in All on 4 group and increased spaces between the implants enhance plaque stagnation and make cleansing more difficult. ...
... Since the prosthesis is retained by four implants, the area contacting the alveolar ridge between each implant spontaneously becomes a long-fitting surface and thus is likely to become covered with plaque. Abi Nader et al. reported the area of plaque accumulation on the fitting surface of maxillary All-on 4™ FDPs to be 28.3 ± 8.4% [23], which is comparable with our result of 35.2 ± 3.2%. These results suggest that approximately one third of the fitting surfaces of All-on 4™ FDPs are likely to be covered with plaque. ...
... d Consecutive data of the individual subjects in the good brushing group. *p < 0.05 [23]. Although we found that the SD and OralB electric toothbrushes were preferable to the manual toothbrush in the buccal area, there were no significant differences in the palatal area; the plaque removal rates in the buccal area were consistently lower than those in the palatal area for the three electric instruments. ...
Background
The aim of this study was to evaluate the plaque removal efficacies of electric toothbrushes and electric dental floss compared with conventional manual toothbrushing in cleaning the fitting surface of an All-on-4™ concept (Nobel Biocare, Zürich-Flughafen, Switzerland) implant-supported fixed dental prosthesis (FDP).
Methods
Nine patients with maxillary edentulous arches participated in the study. We investigated two electric-powered brushes (Sonicare Diamond Clean®, Koninklijke Philips N.V., Amsterdam, the Netherlands [SD group], and the Oral-B Professional Care Smart Series 5000®, Braun GmbH, Kronberg, Germany [OralB group]) and one electric dental floss unit (Air Floss®, Koninklijke Philips N.V. [AF group]). A manual toothbrush (Tuft24® MS, OralCare Inc., Tokyo, Japan) was used by the control group. The fitting surface of the FDP was stained to allow visualization of the entire accumulated plaque area. Both the buccal and palatal portions of the plaque area were assessed before and after brushing to evaluate each instrument’s plaque removal rate using a crossover study design. Two-week washout periods were employed between each evaluation.
Results
The plaque removal rates were 53.5 ± 8.5%, 70.9 ± 6.5%, 75.4 ± 6.3%, and 74.4 ± 4.2% for the control, AF, OralB, and SD groups, respectively. When participants were divided into two groups based on their plaque removal rates with a manual toothbrush (poor brushing and good brushing), the poor brushing group showed significant improvement in the plaque removal rate when using electric-powered toothbrushes. The plaque removal rates for the buccal area were significantly higher for the OralB and SD groups than for the manual brushing group (control group), with rates of 52.8 ± 7.9%, 70.1 ± 7.3%, 77.7 ± 6.5%, and 79.5 ± 3.7% for the control, AF, OralB, and SD groups, respectively. The plaque removal rates in the palatal area were consistently lower than those in the buccal area for each of the three electric instruments.
Conclusions
The results suggest that patients who are not adept at manual toothbrushing may potentially improve their removal of plaque from the fitting surfaces of FDPs by using electric toothbrushes.
... İmplantlar arasındaki mesafenin kısa olması, plak ile kaplı alan yüzdesinin daha yüksek olmasına neden olmaktadır. (19,20) Ayrıca yapılan çalışmalar, all-on-4 prosedürü ile yapılan tam ark subperiosteal implant protezlerinin, 6 veya 8 tam ark subperiosteal implant tarafından desteklenen protezlere göre temizlenmesinin daha kolay olduğunu göstermiştir. (21) Subperiosteal implantın kemik yüzeyinde bulunan komponentinin çok hacimli yapılmaması, alttaki alveolar kemiği kaplayan çerçevenin miktarının azaltılması ve abutment çıkış profili morfolojisinin yüzey alanının azaltılması, bakteriyel kolonizasyon insidansını azaltmak ve plak kontrolünü etkin bir şekilde sağlayabilmek için önerilmektedir. ...
Diabetes mellitus (DM), a chronic metabolic disorder characterized by elevated
blood glucose levels, has emerged as a global health concern with profound
implications for various physiological systems and it stands
as a widespread chronic disease, affecting a significant portion of the global population.
Current estimates indicate a prevalence of 9.3%, encompassing approximately
463 million individuals, with projections suggesting an alarming increase
to 10.2% (578 million) by the year 2030 and a further surge to 10.9% (700
million) by 2045.
Type 2 DM, a predominant form of this metabolic disorder, assumes a central
role as a leading cause of disability and premature mortality.
The primary contributors to these adverse outcomes are often traced to complications arising from vascular and renal impairments. The
impacts of Type 2 DM extends are not only its immediate metabolic implications,
but permeating various physiological systems and significantly diminishing the
quality of life for affected individuals. Therefore, it becomes imperative to both
comprehend the sheer magnitude of its global burden and also to recognize the
far-reaching consequences. The association between DM and its complications
necessitates a concerted global effort to mitigate the escalating impact and promote a healthier, more resilient population.
Beyond its impact on systemic health, DM is increasingly recognized for its
association with oral health. Individuals with DM often have distinctive oral health
manifestations, including an increased susceptibility to various oral infections,
compromised periodontal health, and altered salivary function. Conversely,
poor oral health may exacerbate glycemic control and contribute to the progression
of diabetes-related complications. Understanding the connections between
DM and oral health is imperative for healthcare professionals, researchers.
... This design, called modified ovate pontic [13][14][15] is indicated for allowing intimate contact of the prosthesis to the ridge (to prevent air leakage) and effective contact of dental floss on the entire internal surface of the prosthesis, to ensure internal cleaning, favoring better hygiene [12] and biofilm control in this region. Minimal contact with the mucosa is essential so that there is no space for air or saliva to escape RGO during speech [11,16] as well as an adequate emergence profile of the fixed prosthesis of the edentulous ridge to avoid food impaction [17,18] and correct distribution of the space between the implants for access to hygiene [19] ensuring longevity in the rehabilitation treatment. These points were confirmed in this case report, corroborating a cross-sectional study [9] on maxillary dentures that found concave internal designs in posterior areas, making cleaning difficult and causing biological complications in the peri-implant hard and soft tissues [9] The adequation of spaces through osteotomy is reported and indicated to optimize the minimum required spaces according to the type of material that is chosen for the manufacture of the prosthesis. ...
Fixed implant-supported complete maxillary dentures aim to rehabilitate aesthetic, phonetic, and functional aspects of edentulous arches. A previous prosthetic preparation without a flange in the anterior sector makes it possible to evaluate the labial support and the existing space for the future prosthesis. Thus, it allows the most appropriate choice of the type of rehabilitation and surgical technique. However, follow-up studies have shown that when proceeding this way, problems in the posterior sector are still occurring, such as the lack of vertical space for an adequate bar design and concave internal designs, which make access to hygiene difficult. Faced with the problem, the aim of this study is to report a clinical case in which the previous prosthetic preparation included the removal of the flange also from the posterior sector during the teeth try-in and the duplication of this assembly in a transparent multifunctional guide that allowed the visualization of the amount of bone removal needed. The osteotomy, performed before the installation of the implants, provided enough space for the bar, acrylic, and prefabricated denture teeth in the prosthesis that was installed, an important fact considering that this is an area with greater chewing efforts. It also allowed for correct internal design in the prosthesis, which will ensure access to correct hygiene. Based on the analysis of the rehabilitated case, it seems fair to conclude that the total removal of the buccal flange at the time of testing the wax try-in of the teeth and its duplication is a differential in the approach of cases and should always be adopted to ensure a lower margin of error and greater longevity in the proposed rehabilitative treatment.
Indexing terms
Dental Implants; Dental prosthesis design; Dental prosthesis, implant-supported
... In the study by Agliardi et al., all-on-four groups had significantly higher plaque than the all-on-six groups. This could be attributable to the hybrid of four fixed restoration's complex oral hygiene due to the presence of broad flanges of the prosthesis, which cause increased plaque formation [22]. Direct metal laser sintering, a computerized way for fabrication, has been employed in the current patient as a substitute to traditional traditional partial denture prostheses. ...
This clinical report explores the effectiveness of dental implants for rehabilitating fully edentulous arches, with a focus on the all-on-six treatment approach. Implant-supported fixed restorations, particularly using six implants, are presented as an expected and cost-effective solution for the rapid repair of the edentulous patient, avoiding the need for bone grafting. This report details the successful rehabilitation of a patient's completely edentulous arches using the all-on-six concept, highlighting the meticulous planning and execution involved. It concludes that precise diagnostic and implant planning, along with thorough attention to all the features, is crucial for successful implant-supported fixed prostheses, with the all-on-six concept offering improved clinical and radiological outcomes for atrophied maxillae.
... Bảng tính điểm này được chúng tôi thiết kế dựa trên đặc điểm chung của nền phục hình toàn hàm và theo nghiên cứu xu hướng đọng cặn bám nền hàm của Samer Abi Nader 2015. 3 bảng tính điểm có thang điểm từ 0-9 với mức độ lắng đọng cặn bám nền phục hình tăng dần * Các yếu tố: + yếu tố bệnh nhân: độ rộng niêm mạc sừng hóa. + yếu tố phục hình: vật liệu phục hình, thiết kế nền phục hình, Nhận xét: Có mối liên quan giữa vật liệu phục hình với cặn bám nền phục hình, điểm trung bình cặn bám nền phục hình của nhóm phục hình nhựa cao hơn hẳn nhóm phục hình sứ. ...
Mục tiêu: Nghiên cứu này nhằm tìm hiểu một số yếu tố liên quan đến kết quả phục hình toàn hàm bắt vít trên bệnh nhân đã cấy ghép Implant All on X. Đối tượng và phương pháp: Một nghiên cứu được tiến hành trên các bệnh nhân mất răng toàn hàm được cấy ghép Implant All on X và được phục hình theo loại FP3. Có tổng số 31 bệnh nhân tham gia nghiên cứu với 37 phục hình toàn hàm và trên 177 trụ Implant. Kết quả nghiên cứu cho thấy: phần lớn nhóm đối tượng nghiên cứu là nam giới (71,0%); nữ chỉ chiếm 29,0%. Tuổi trung bình của nhóm đối tượng nghiên cứu là 61,32±10,53 tuổi, với tuổi nhỏ nhất là 27, lớn nhất là 71. Tỉ lệ xuất hiện viêm niêm mạc quanh implant là 78,38% ở cấp độ phục hình, 31,1% ở cấp độ trụ. Kết quả cho thấy, có nhiều yếu tố liên quan tới kết quả chăm sóc phục hình toàn hàm bắt vít trên bệnh nhân cắm ghép Implant All on X như là vật liệu phục hình và thiết kế nền phục hình. Phục hình nhựa cho thấy sự tích tụ mảng bám cao hơn phục hình sứ. Nhóm thiết kế nền phục hình phẳng/lồi, nhẵn có nguy cơ bị viêm niêm mạc trên Implant thấp hơn nhóm có thiết kế nền phục hình dạng yên ngựa, gồ ghề, khi tiến hành kiểm định 1 phía. Tình trạng cặn bám nền phục hình có liên quan đến tình trạng viêm niêm mạc quanh Implant.
... This could be because the abutment height of 1.5 mm can only be found in the straight abutment, which is usually used on the anterior teeth area, and the palatal side of the maxillary and lingual of the mandibular areas on the anterior teeth are not easy to clean. 58 In addition, patients who brushed three times a day had significant lower plaque and BOP index than those who brushed twice a day. Arai and colleagues 59 found that even if the upper prosthesis was not removed, the plaque scores of the abutments and prosthesis were significantly different after the mechanical plaque removal treatment. ...
Background:
The survival rate, marginal bone loss and soft tissue health of the Ankylos implants and the balanced base abutments in all-on-four or six implant restoration of edentulous or terminal dentition patients has not been reported in the clinical research.
Purpose:
This retrospective study aimed to evaluate the Ankylos implants and the balanced base abutments in all-on-four or six implant restoration of edentulous or terminal dentition patients after 1-8 years of follow-up.
Materials and methods:
A retrospective study was conducted based on the medical records of 33 patients who received all-on-four or six treatments from April 2014 to May 2020. Four radiographic examinations [immediate postoperative (T0), definitive restorations (T1), 1-3 years after prosthetic restorations (T2), and more than 3 years after prosthetic restorations (T3)] were obtained to evaluate vertical bone height (VBH). We also calculated the survival rate and examined the condition of soft tissue with this implant system in edentulous or terminal dentition patients. Three-level linear model analyses were used to explore potential risk factors for VBH changes on the mesial and distal sides. The generalized linear model was used to analyze the influencing factors of BOP and plaque.
Results:
A total of 218 implants were included in this study. The cumulative survival rate of the implants was 97.25% before the definitive prosthesis, 96.33% within 3 years of follow-up and 95.32% after more than 3 years of follow-up. The mean ± standard deviation (SD) bone losses of the VBH were 0.27 ± 0.05 mm (T1-T3) on the mesial side and 0.49 ± 0.06 mm (T1-T3) on the distal side. During 1-8 years of follow-up, the height and angle of the abutment (p < 0.001), the mandible implant site (p < 0.001), the length of the implant (p = 0.014 < 0.05) and age (p = 0.029 < 0.05) showed statistically significant effects on vertical mesial bone height (VMBH) and vertical distal bone height (VDBH). The risk of BOP among participants who brushed three times a day was lower than those who brushed less than three times. The plaque risk of short abutment height was higher than the long abutment.
Conclusion:
The current study showed that the Ankylos implants with the balanced base abutments in all-on-four or six implants treatment is a viable and predictable option with a high survival rate and low marginal bone loss in edentulous or terminal dentition patients. VBH around the implants was strongly associated with the mandible implant site, abutment height and angle, the length of the implant and age. Moreover, teeth-brushing times and abutment height significantly affect soft tissue health.
... Moreover, the presence of a cantilever in the All-on-Four prosthesis as well as greater spacing between the implants, increases plaque stagnation and makes cleaning more difficult. 42 The retrievability of bar overdentures, on the other hand, helps the patient's oral hygiene performance. These explanations were supported by studies on patient satisfaction with fixed prostheses and bar retained overdentures. ...
... fixed prosthesis, especially for patients with advanced bone atrophy, lost lip support, long clinical crowns, or increased interarch space. 7 Furthermore, overdentures are indicated with an unfavorable jaw relationship 2 and can be removed at night to avoid implant overloading if bruxism exists. 8 Recently, the present authors 9,10 described the use of milled bar overdentures as a definitive prosthetic rehabilitation for patients restored with four implants according to the All-on-4 protocol and compared this prosthetic approach to the conventional full-arch fixed restoration. ...
Purpose:
To evaluate strain around resilient stud and bar attachments for inclined implants supporting mandibular overdentures during loading and dislodging.
Materials and methods:
A mandibular edentulous model was printed using the laser sintering technique. Two vertical implants and two 30-degree distally inclined implants were placed in canine and premolar areas, respectively. Overdentures were attached to the implants with either a resilient stud (Locator, group 1) or a bar/clip (group 2) attachment. Three strain gauges were mounted at the buccal, lingual, and proximal surfaces of each implant. Microstrains were registered during vertical loading and dislodging force applications and compared between attachments (resilient stud and bar) and implant positions (vertical and inclined).
Results:
For canine implants, bar overdentures recorded significantly higher microstrains than Locator overdentures during vertical loading. For premolar (inclined) implants, Locator overdentures recorded significantly higher microstrains than bar overdentures during vertical dislodging. For both groups (during loading) and the bar overdenture group (during dislodging), canine (vertical) implants showed significantly higher microstrains than premolar (inclined) implants.
Conclusion:
Within the limitations of this in vitro study, canine (vertical) implants may be at risk of increased stresses during loading if bar attachments are used for vertical and inclined implants supporting mandibular overdentures, and premolar (inclined) implants may be at risk of increased stresses during dislodging if Locator attachments are used. For both attachments, canine implants showed significantly higher microstrains than premolar implants during loading and dislodging.
... On the other hand, implant overdentures are indicated when significant amount of bone loss occurred to restore facial support, avoid long crowns of fixed prosthesis, overcome occlusal problems resulted from classes II and III maxillomandibular ridge relationships 9,10 . In addition, the retrievability of overdentures by the patients can overcome hygienic, cleansing and bruxism problems that are usually associated with fixated restoration 11 . Generally, both hybrid fixed prosthesis (that replaces teeth and lost tissues with pink porcelain) and implant overdentures can be used to improve appearance when significant amount of hard and soft tissue loss exists 12 . ...
Purpose: The aim of this randomized controlled study was to compare three-dimensional marginal bone loss around implants supporting fixed metal-ceramic prosthesis and implant overdentures in patients with mandibular edentulous ridges. Materials and methods: Twelve completely edentulous patients were randomly assigned into two groups; 1) Group A (fixed prosthesis); patients received 6 implants (4 in the interforaminal area, and 2 posterior to the mental foramina) and fixed full arch screw-retained porcelain fused to metal restoration, 2) Group B (overdenture prosthesis); patients received four implants in the interforaminal area and the implants were connected to overdentures with locator attachments. For each participant, Three-Dimensional bone loss was measured at mesial, distal, buccal and lingual surface of each implants using cone beam computerized tomography (CBCT) which was made at time of prosthesis insertion, one year, and 3 years after insertion Results: For all implant surfaces except lingual surface, the overdenture group showed significantly higher marginal bone loss than fixed prosthesis after one years and 3 years. For fixed prosthesis group, the highest bone resorption after one and 3 years was observed in the lingual site and the lowest marginal bone loss was observed at buccal site. For overdenture group, the highest bone loss observed at the buccal site, and the lowest one loss was observed at lingual site (after one year) and distal site (after 3 years). For both groups, bone loss after 3 years was significantly higher than after one year. Conclusion: Within the limits of this randomized controlled study, fixed prosthesis was associated with reduced Three-Dimensional marginal bone loss compared to overdentures prosthesis after one and three years of prosthesis insertion. (420)
... [6][7][8] Second, the implant positions could affect the cleaning procedure. A study by Abi Nader et al 9 revealed that the distances between the inserted implants could affect the hygiene of all-on-4 prostheses. Third, the attached mucosal width also influences home maintenance. ...
Statement of problem:
Area calculation is the primary method for quantitatively analyzing accumulated plaque on the intaglio surfaces of implant-supported fixed complete dental prostheses (IFCDPs). However, the classic calculation method for stained dental plaque is based on two-dimensional (2D) photographs, which could mislead the three-dimensional (3D) representation of an object’s actual morphology, especially when a surface is not flat.
Purpose:
This pilot in vitro study, used for methodological purposes, evaluated the repeatability and precision of a 3D area calculation method to analyze simulated accumulated biofilm on the intaglio surfaces of an IFCDP.
Material and methods:
The titanium framework of an IFCDP with a smooth intaglio surface was prepared with 8 milled sites and scanned by microcomputed tomography. Out of these, 4 sites were cubic (set sides lengths=1, 2, 3, and 4 mm), and 4 sites were hemispherical (set diameters=1, 2, 3, and 4 mm). A green-colored aerosol was sprayed onto the carved-out intaglio sites. The framework intaglio surface was 3D-scanned (n=10) and 2D-photographed (n=10) at 10 different photo angles. Two raters twice measured the 3D and 2D data from the carved-out sites’ green-colored area one week apart. Intraobserver repeatability and interobserver reliability were evaluated with an independent t test. The deviation between the measurements and the microtomography values was calculated. Pearson’s correlation coefficient (r) evaluated the repeatability of multiple measurements. A standard level of significance was set at α<0.05.
Results:
The differences between the 2D photographs and the microtomography values were statistically significant (P<.001), whereas the differences between the 3D scans and the microtomography values were not significant (P=.063). The overall differences between the microtomography values and the 3D measurements were smaller (2.15 ±2.30 mm2 vs. 18.91 ±22.78 mm2, P=.055) than the differences between the microtomography values and the 2D measurements. The percentage differences between the microtomography values and the 3D measurements were significantly smaller (10.41 ±8.33% vs. 65.66 ±19.22%, P<.001) than the microtomography differences values with the 2D measurements. The measurement differences between the microtomography value and the 3D measured hemispherical site data were significantly smaller than the measurement differences between the microtomography values and the 3D measured cubical site data (P=.026). The 2D method had “poor” repeatability among the 10 different shot angles (r=0.391, P<.001), whereas the 3D method had “good” repeatability among the 10 scans (r=0.999, P<.001).
Conclusions:
An irregular intaglio surface of an IFCDP could accurately and repeatedly be recorded and analyzed by a 3D area calculation method. This color-matching assessment of the topological environment is expected to be adopted in future studies.
Clinical Implications:
The morphology of pontics of implant-supported fixed complete dental prostheses (IFCDPs) is closely related to dental plaque accumulation. The proposed 3D method could be reliable for macroscopically quantifying biofilm buildup on the intaglio surfaces of IFCDPs.
... 4,32,37 This fact was expected since there is a close relation of cause-effect between poor hygiene and gingival inflammation. 54 Difficulties in cleaning the implant-supported fixed prostheses are common, and therefore, plaque accumulation occurs on the surfaces of these prostheses. This plaque accumulation affects the health condition of the related soft tissues, leading to peri-implant mucositis or even periimplantitis. ...
Purpose:
The aim of this systematic review with meta-analysis was to compare the survival rate of single crowns supported by extra-short implants (≤ 6 mm) to those supported by conventional implants, with or without previous maxillary sinus augmentation. The proportion of failures was described according to the type of complication and follow-up periods.
Materials and methods:
Randomized and prospective clinical trials were selected from six databases and gray literature. The risk of bias was evaluated by Joanna Briggs Institute Critical Appraisal Checklist, and the certainty of the evidence was analyzed with Grading of Recommendations Assessment, Development, and Evaluation. Meta-analyses were processed with RevMan and MedCalc Statistical Software.
Results:
Single crowns supported by extra-short implants had a similar risk of failure to those supported by conventional implants, regardless of previous maxillary sinus augmentation (P > .05). Overall failure proportion of extra-short implants was 5.19%, but it varied according to follow-up (1.18% before loading, 1.56% at 12 months, 1.20% at 24 months, 2.10% at 48 months). Biologic failure complications were 37.90% for bleeding on probing, 22.45% for peri-implantitis, and 11.29% for infection. Prosthodontics failure complications were 14.88% for abutment failures and 14.73% for prosthetic screw loosening. Considering the risk of bias, most studies were classified at moderate risk.
Conclusion:
The risk of failure of single crowns supported by extra-short implants is similar to those supported by conventional implants, regardless of previous maxillary sinus augmentation or follow-up period. The most frequent biologic and prosthetic complications were bleeding on probing and abutment failures, respectively.
... However, biological complications after the placement of implant-supported fixed complete dental prostheses (IFCDPs) occur continuously over time [2]. Previous studies have indicated that peri-implant mucositis is associated with plaque accumulation [3,4] around implants and prostheses and that the hygiene of IFCDPs could be influenced by the distance between the inserted implants in the jaw, the palatal extension of the prostheses [5], and the implant materials [6]. Investigations on the bacterial adhesion on titanium, the most commonly used materials in daily practice, have revealed that the corrosion of titanium increases plaque accumulation [7]. ...
Background
The success rate of implant-supported prostheses for edentulous patients is relatively high. However, the incidence of biological complications, especially peri-implant mucositis and peri-implantitis, increases yearly after the placement of prostheses. The accumulation of pathogenic bacteria adjacent to a prosthesis is the main cause of biological complications. Titanium, one of the classical materials for implant-supported prostheses, performs well in terms of biocompatibility and ease of maintenance, but is still susceptible to biofilm formation. Zirconia, which has emerged as an appealing substitute, not only has comparable properties, but presents different surface properties that influence the adherence of oral bacteria. However, evidence of a direct effect on oral flora is limited. Therefore, the aim of the present study was to assess the effects of material properties on biofilm formation and composition.
Methods
The proposed study is designed as a 5-year randomized controlled trial. We plan to enroll 44 edentulous (mandible) patients seeking full-arch, fixed, implant-supported prostheses. The participants will be randomly allocated to one of two groups: group 1, in which the participants will receive zirconia frameworks with ceramic veneering, or group 2, in which the participants will receive titanium frameworks with acrylic resin veneering. Ten follow-up examinations will be completed by the end of this 5-year trial. Mucosal conditions around the implants will be recorded every 6 months after restoration. Peri-implant submucosal plaque will be collected at each reexamination, and bacteria flora analysis will be performed with 16S rRNA gene sequencing technology in order to compare differences in microbial diversity between groups. One week before each visit, periodontal maintenance will be arranged. Each participant will receive an X-ray examination every 12 months as a key index to evaluate the marginal bone level around the implants.
Discussion
The current study aims to explore the oral microbiology of patients following dental restoration with zirconia ceramic frameworks or titanium frameworks. The features of the microbiota and the mucosal condition around the two different materials will be evaluated and compared to determine whether zirconia is an appropriate material for fixed implant-supported prostheses for edentulous patients.
Trial registration
International Clinical Trials Registry Platform (ICTRP) ChiCTR2000029470. Registered on 2 February 2020. http://www.chictr.org.cn/searchproj.aspx?
... Previous studies have indicated that peri-implant mucositis is associated with plaque accumulation [3][4] around implants and prostheses, and that the hygiene of IFCDPs could be in uenced by the distance between the inserted implants in the jaw, the palatal extension of the prostheses [5], and the implant materials [6]. Investigations on the bacterial adhesion on titanium, the most commonly used materials in daily practice, have revealed that the corrosion of titanium increases plaque accumulation [7]. ...
Background: The success rate of implant-supported prostheses for edentulous patients is relatively high. However, the incidence of biological complications, especially peri-implant mucositis and peri-implantitis, increases yearly after the placement of prostheses. The accumulation of pathogenic bacteria adjacent to a prosthesis is the main cause of biological complications. Titanium, one of the classical materials for implant-supported prostheses, performs well in the terms of biocompatibility and ease of maintenance, but is still susceptible to biofilm formation. Zirconia, which has emerged as an appealing substitute, not only has comparable properties, but presents different surface properties the influence the adherence of oral bacteria. However, evidence of a direct effect on oral flora is limited. Therefore, the aim of the present study was to assess the effects of material properties on biofilm formation and composition.
Methods: The proposed study is designed as a 5-year randomized controlled trial. We plan to enroll 44 edentulous (mandible) patients seeking full-arch, fixed, implant-supported prostheses. The participants will be randomly allocated to one of two groups: group 1, in which the participants will receive zirconia frameworks with ceramic veneering or group 2, in which the participants will receive titanium frameworks with acrylic resin veneering. Ten follow-up examinations will be completed by the end of this 5-year trial. Mucosal conditions around the implants will be recorded every 6 months after restoration. Peri-implant submucosal plaque will be collected at each reexamination, and bacteria flora analysis will be performed with 16S rRNA gene sequencing technology in order to compare differences in microbial diversity between groups. One week before each visit, periodontal maintenance will be arranged. Each participant will receive an X-ray examination every 12 months as a key index to evaluate the marginal bone level around the implants.
Discussion: The current study aims to explore the oral microbiology of patients following dental restoration with zirconia ceramic frameworks or titanium frameworks. The features of the microbiota and the mucosal condition around the two different materials will be evaluated and compared to determine whether zirconia is an appropriate material for fixed implant-supported prostheses for edentulous patients.
Trial registration: International Clinical Trials Registry Platform (ICTRP), ID: ChiCTR2000029470. Registered on 2 February 2020.
... The increased plaque and gingival scores for group II compared to group I may be due to decreased interimplant distance between anterior and posterior implants which complicate oral hygiene procedures. In line with observation, Abi Nader et al 27 reported that plaque accumulation was influenced by the distance between the inserted implants. Also, these results are in line with other investigations, in which the authors reported that the wider inter-implant distance, cause reduced plaque accumulation on the surfaces of these implants 16,26 . ...
... Also, in cases with increased bone resorption, the insertion of fixed prosthesis may be complicated by the prosthesis overlapping onto the alveolar ridge, which can make hygienic practice more difficult for the patients 17 . Milled bar overdentures are totally implant-borne and have the same advantages of fixed prostheses regarding retention and stability with prosthodontic merits of the removable prostheses 18 . ...
Purpose:
The purpose of this study was the clinical and radiographic evaluation of four-implant-supported fixed prostheses and milled bar overdentures for rehabilitation of the edentulous mandible.
Materials and methods:
Thirty-six edentulous participants received four implants in the mandible (two vertical implants in the canine/lateral incisor area and two distally inclined implants anterior to the mental foramina) using flapless surgery. The implants were loaded with the mandibular dentures in the same day after necessary modifications. Three months after implant placement, participants were randomly allocated to one of two groups: (1) the overdenture group, where participants received milled bar overdentures; or (2) the fixed group, where participants received ceramo-metal fixed prostheses. Plaque and gingival indices, pocket depth, implant stability (using Osstell device), and marginal bone resorption (using standardized intraoral radiographs) were evaluated at the time of prosthesis insertion (T0), and 6 (T6) and 12 (T12) months after insertion.
Results:
The implant survival rate was 100% for both groups. Plaque Index, Gingival Index, pocket depth, implant stability, and bone resorption significantly increased by time for anterior (P < .001) and posterior (P < .018) implants. Fixed prostheses showed significantly higher Plaque Index, Gingival Index, and pocket depth than milled bar for anterior (P < .001) and posterior (P < .037) implants. No significant differences in implant stability and bone resorption between groups were noted. For fixed prostheses, anterior implants showed significantly higher Plaque Index, Gingival Index, and pocket depth than posterior implants (P < .001) after 12 months. However, no significant differences in implant stability and bone resorption between anterior and posterior implants were noted for both groups.
Conclusion:
Both fixed prostheses and milled bar prostheses could be used successfully for immediately loaded four-implant rehabilitations of the edentulous mandible, as they were associated with favorable clinical and radiographic outcomes after 1 year. However, milled bar may be more advantageous than fixed prostheses in terms of reduced plaque/gingival indices and probing depth.
... Pertanto, in molti pazienti con grave discrepanza dento-scheletrica, un'overdenture supportata da barra può essere un'opzione riabilitativa praticabile per la ricostruzione di tessuti molli e duri 1, 6 . Inoltre, la manutenzione igienica della protesi fissa può essere difficile quando si estendono eccessivamente le flange protesiche per sostenere correttamente i tessuti molli periorali e per superare i problemi estetici tipici dell'invecchiamento 7,8 . L'overdenture a supporto implantare è quindi un'opzione di trattamento valida per le mandibole edentule atrofiche, permettendo inoltre di migliorare il grado di soddisfazione del paziente rispetto ad una protesi totale 9 . ...
... This can make daily hygienic maintenance of a fixed prosthesis challenging, and at times virtually impossible. 8 As plaque accumulates, these restorations are associated with a higher rate of peri-implantitis and subsequent implant loss, 9 contraindicating ISFDPs for these patients. Alternatively, at least four implants may allow for a bar-supported removable implant overdenture. ...
Inadequate restorative space can result in mechanical, biologic, and esthetic complications with full-arch fixed implant-supported prosthetics. As such, clinicians often reduce bone to create clearance. The aim of this paper was to present a protocol using stacking computer-aided design/computer-assisted manufacturing (CAD/CAM) guides to minimize and accurately obtain the desired bone reduction, immediately place prosthetically guided implants, and load a provisional that replicates predetermined tissue contour. This protocol can help clinicians minimize bone reduction and place the implants in an ideal position that allows them to emerge from the soft tissue interface with a natural, pink-free zirconia fixed dental prostheses.
... 4,12 Moreover, hygienic maintenance of the prosthesis can be challenging when extensive prosthetic flanges are needed to provide adequate lip and check support to overcome esthetic problems typical of aging. 13 The purpose of this preliminary case series study was to report one-year preliminary data on Cawood and Howell Class VI patients rehabilitated with a fixed-removable solution. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology reporting guidelines. ...
O b j e c t i v e: The objective of this study was to report one-year preliminary data on Cawood and Howell Class VI patients rehabilitated with a fixed-removable solution.
M a t e r i a l s & m e t h o d s: Completely edentulous patients, aged 18 years or older, presenting with severely atrophic mandibles (Class VI according to Cawood and Howell) were enrolled and treated using four implants, a CAD/CAM titanium bar and a low-profile attachment system to support an implant-supported overdenture. Outcome measures were success rates of the implants and prosthesis, complications, marginal bone level changes, bleeding index, plaque index and patient satisfaction (Oral Health Impact Profile)
R e s u l t s: A total of 16 Osstem TSIII implants were placed in four consecutive eden-tulous participants. All of the treated patients were female with an average age of 71.5 (range: 64–82). Patients were followed up for a mean period of 13.8 months (range: 12–16) after loading. No participants dropped out, and no deviation from the original protocol occurred. At the one-year follow-up, no implants or prosthesis had failed and no biological or technical complications had occurred. At the one-year follow-up, the mean marginal bone loss was 0.23 ± 0.07 mm. The Oral Health Impact Profile summary scores demonstrated a significant decrease throughout the study, from 66.5 ± 3.7 to 19.3 ± 2.8. At the one-year follow-up, the bleeding index was 1.6% and the plaque index was 4.7%.
C o n c l u s i o n: Within the limitations of this study, an overdenture fully supported by four implants and a CAD/CAM titanium bar with a low-profile attachment system, can be considered an effective and predictable option for patients with Cawood and Howell Class VI atrophic mandibles. Minimum marginal bone remodeling, good periodontal parameters and patient satisfaction can be expected.
... In patients with moderate to severe bone resorption, the delivery of an FDP can be contraindicated because of the excessive vertical and horizontal overlap of the prosthetic flange onto the residual ridge, which can make hygienic maintenance challenging for the patient. 13 The placement of at least 4 implants of standard length may allow the delivery of an overdenture supported by a CAD/CAM titanium bar, 14 avoiding any bearing area on the soft tissue and reducing the denture base extension. 32 In the present study, the 1-year implant and prosthetic success and survival rates were 100% in both the mandible and the maxilla, and greater patient satisfaction was reported, indicating that the 4IO is a reliable treatment option. ...
Statement of problem:
In patients with an altered skeletal maxillomandibular relationship and bone resorption, the rehabilitation of edentulous jaws by combining 4 implants, 2 straight medially and 2 tilted distally, may be preferred to avoid a bone augmentation procedure.
Purpose:
The purpose of this single cohort 1-year prospective study was to evaluate the clinical performance of a 4-implant overdenture fully supported by a computer-aided designed/computer-aided manufactured (CAD/CAM) titanium bar.
Material and methods:
This single cohort prospective study included edentulous participants rehabilitated with a 4-implant overdenture in 1 of the 2 jaws. The outcomes were implant and prosthetic survival and success rates, any biologic and technical complications, periimplant marginal bone loss, changes in the oral health impact profile (OHIP), bleeding on probing, and the plaque index.
Results:
Eighteen participants received 72 implants. One year after implant placement, no implants or prosthesis had failed, and no biologic or technical complications had been observed. At the 1-year follow-up, the mean marginal bone loss was 0.29 ±0.16 mm. The OHIP summary scores demonstrated a significant improvement in oral health-related quality of life. At the 1-year follow-up, positive bleeding was found in 2 participants (11.1%) around 3 implants (4.1%). Three participants (16.6%), accounting for 5 implants (6.9%), showed a slight amount of plaque.
Conclusions:
A 4-implant overdenture supported by a CAD/CAM titanium bar may be a reliable option for the treatment of the edentulous mandible and maxilla over a 1-year period. Oral health-related quality of life significantly improved in all treated participants.
... 8 Moreover, the hygienic maintenance of the hybrid designed Allon-4 FDPs can be challenging, particularly when extensive prosthetic flanges are needed. 36 For the aforementioned reasons, patient demand, compliance, dexterity, financial capability, skeletal maxillomandibular relationship, and residual bone anatomy have to be taken into consideration to customize the proper implant number, position, and dental prostheses. 37,38 ...
Purpose: To compare the 5-year clinical and radiological outcomes of patients rehabilitated with four or six implants placed using guided surgery and immediate function concept.
Materials and Methods: Forty patients randomly received four (All-on-4) or six (All-on-6) immediately loaded implants, placed using guided surgery, to support a cross-arch fixed dental prosthesis. Outcome measures were survival rates of implants and prostheses, complications, peri-implant marginal bone loss, and periodontal parameters.
Results: No drop-out occurred. Seven implants failed at the 5-year follow-up examination: six in the All-on-6 group (5%) and one in the All-on-4 group (1.25%), with no statistically significant differences (p = .246). No prosthetic failure occurred. Both group experienced some technical and biologic complications with no statistically significant differences between groups (p = .501). All-on-4 treatment concept demonstrated a trend of more complications during the entire follow-up period. A trend of more implant failure was experienced for the All-on-6 treatment concept.Marginal bone loss (MBL) from baseline to the 5-year follow-up was not statistically different between All-on-4 (1.71 1 0.42 mm) and All-on-6 (1.51 1 0.36 mm) groups (p = .12). For periodontal parameters, there were no differences between groups (p > .05).
Conclusion: Both approaches may represent a predictable treatment option for the rehabilitation of complete edentulous patients in the medium term. Longer randomized controlled studies are needed to confirm these results.
... 8 Moreover, the hygienic maintenance of the hybrid designed Allon-4 FDPs can be challenging, particularly when extensive prosthetic flanges are needed. 36 For the aforementioned reasons, patient demand, compliance, dexterity, financial capability, skeletal maxillomandibular relationship, and residual bone anatomy have to be taken into consideration to customize the proper implant number, position, and dental prostheses. 37,38 ...
Background: There is little evidence from randomised clinical trials (RCT) or systematic reviews on the preferred or best number of implants to be used for the support of a fixed prosthesis in the edentulous maxilla or mandible, and no consensus has been reached.
Aim/Hypothesis: To compare the clinical and radiological outcomes of edentulous patients rehabilitated according to the ‘all on four’ or the ‘all on six’ immediate function concept.
Material and methods: Twenty-eight edentulous patients and twelve patients presenting failing dentition randomly received 4 (n = 20) or 6 (n = 20) implants to support a cross arch fixed dental prosthesis. A total of 200 implants were inserted. All the implants were immediately loaded. Last follow-up were scheduled at 5 years post-loading. The primary outcome measures were the success rates of the implants and prostheses. Secondary outcome measures were the occurrence of any surgical and prosthetic complications during the entire follow-up, and vertical peri-implant marginal bone level changes.
Results: No drop-out occurred. Seven implants failed at the 5-year follow-up examination. Six implants failed in the all-on-6 group (5%), while 1 implant failed in the all-on-4 group (1.25%). No prosthesis failed. Both group experienced some technical and biologic complications with no differences between them. All-on-4 treatment concept showed a slightly risk of complications during osseointegration period (P = 0.19; RR = 1.7; 95% CI 0.7 - 4.2), while, the all-on-6 treatment concept showed a higher risk of implant failure during the entire follow-up (P = 0.30; RR = 3; 95% CI 0.3 - 24.6). The overall marginal bone level changes from baseline to the 5-year follow-up was not statistically different between the all-on-4 (1.71 � 0.42 mm) and the all-on-6 (1.51 � 0.36 mm) groups (P = 0.12). Nevertheless, the marginal bone level changes between 48 and 60 months were statistically significant different, with lower value for the all-on-6 group (0.14 � 0.06 vs. 0.09 � 0.04; P = 0.01). Conclusions and clinical implications: The results of this research suggest that both treatment concepts could be a viable and predictable treatment option for the rehabilitation of complete edentulous patients in the medium term, both with possible complications. All-on-4 treatment concept showed a trend of a slightly higher bone resorption whit time, but lower implant failure. Further long term randomized controlled study are needed to confirm this results.
Mục tiêu: Nghiên cứu này nhằm (1) Đánh giá thực trạng chăm sóc phục hình toàn hàm bắt vít trên bệnh nhân đã cấy ghép Implant All on X tại Viện đào tạo Răng - Hàm - Mặt năm 2018 - 2022. (2) Phân tích liên quan giữa kiến thức, hành vi với kết quả phục hình toàn hàm bắt vít ở nhóm bệnh nhân trên. Đối tượng và phương pháp: Một nghiên cứu được tiến hành trên các bệnh nhân mất răng toàn hàm được cấy ghép Implant All on X và được phục hình theo loại FP3. Có tổng số 31 bệnh nhân tham gia nghiên cứu với 37 phục hình toàn hàm và trên 177 trụ Implant. Kết quả nghiên cứu cho thấy: phần lớn nhóm đối tượng nghiên cứu là nam giới (71,0%); nữ chỉ chiếm 29,0%. Tuổi trung bình của nhóm đối tượng nghiên cứu là 61,32±10,53 tuổi, với tuổi nhỏ nhất là 27, lớn nhất là 71. Tỉ lệ xuất hiện viêm niêm mạc quanh implant là 87,1% ở cấp độ cá thể, 31,1% ở cấp độ trụ. Tỉ lệ chảy máu tự nhiên quanh Implant là 22,1% ở cấp độ cá thể, 5,1% ở cấp độ trụ và không bệnh nhân nào có túi lợi bệnh lý. Điểm thực hành chăm sóc phục hình tốt chỉ chiếm 9,7%, điểm thực hành chăm sóc phục hình chưa tốt chiếm tới 90,3%. Kết luận: Có mối liên quan giữa việc thực hành chăm sóc chưa tốt với tình trạng viêm niêm mạc quanh Implant (OR = 3,44 và p = 0,047). Nguy cơ viêm niêm mạc quanh Implant ở nhóm đối tượng nghiên cứu thực hành chăm sóc chưa tốt cao hơn so với nhóm thực hành chăm sóc tốt. Có sự liên quan giữa việc thực hành chăm sóc và cặn bám nền phục hình (p< 0,05), giá trị trung bình cặn bám nền phục hình của nhóm thực hành chăm sóc chưa tốt cao hơn nhóm thực hành chăm sóc tốt.
Purpose:
Patients receiving full arch implant borne maxillary prostheses require functional, esthetic, and long term success. The importance of this review is to document the difficulty with implant maintenance, the prevalence of peri-implant disease, and the improvement in biologic health when using a prosthesis that can be maintained to minimize plaque. The objective is to provide surgeons with a reference to optimize surgical procedures that can result in improved hygiene and long term maintenance, as well as acceptable functional and esthetic goals.
Methods:
Pubmed.gov was the information source. Years reviewed included 1990-2022. Inclusion criteria included only articles in journals referenced in pubmed.gov. The reports excluded were case reports, reports that only included implant survival, and articles without a statistical analysis to generate meaningful conclusions. Biological complications included bone loss, hygiene difficulty, mucositis and recession, the incidence of peri-implantitis, and how complications related to patient co-morbidities. Data collected included outcomes of the study including statistical significance.
Results:
The search identified articles for review using terms which included full arch maxillary restorations (n = 736), long term success with full arch maxillary prostheses (n = 22), ceramic full arch restorations (n = 102), and complications with full arch restorations (n = 231). From this search, 53 articles were collated that satisfied the inclusion criteria. Factors found to be significant contributors to biological complications included bone loss and peri-implant disease, difficulty with daily hygiene access, plaque and biofilm coverage, and the need for continued maintenance for long term implant health.
Conclusion:
The surgeon needs to place implants to allow a full arch maxillary prosthesis to be fabricated with full access to the implants for maintenance, which should decrease the incidence of biological complications. With excellent maintenance full arch implant restorations can have limited peri-implant disease.
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.
Patients present with the need to replace missing teeth and often have loss of bone and soft tissue secondary to the processes that resulted in partial or total edentulism. This chapter addresses the treatment planning and commonly used procedures to restore missing tissues, allowing for proper implant placement. Attention is given to evidence-based procedures that have strong evidence that the long-term results are significant for patient reconstruction.KeywordsTreatment planningBone graftingSoft tissue graftingGuided implant placement
Introduction:
This study aimed to evaluate peri-implant tissue health and patient satisfaction of vertical and inclined posterior implants for mandibular bar overdentures.
Materials and methods:
Thirty edentulous participants received four implants in the interforaminal area of the mandible. The patients were randomly assigned into two equal groups; (1) vertical group (control): all implants were inserted vertically parallel to each other. Inclined group (study): the anterior implants were placed vertically, and the posterior implants were tilted 30° distally. Hader bar attachment with two 7 mm-distal cantilevers (vertical group) and without cantilevers (inclined group) was used to connect the implants to mandibular overdentures. Peri-implant tissue health (Plaque [PL] and gingival [GI] indices, pocket depth [PD], and crestal bone loss [CBL]) were evaluated after denture insertion (T0), 6 (T6), and 12 (T12) months after insertion. Patient satisfaction was evaluated using a visual analog scale after 12 months.
Results:
At T12, the vertical group showed significantly higher PL, PD, and CBL than the inclined group for anterior (p < 0.037) and posterior (p < 0.017) implants. The vertical group showed significantly higher GI than the inclined group for anterior implants (p = 0.003), and the inclined group showed significantly higher GI than the vertical group for posterior implants (p = 0.016). The inclined group showed significantly higher scores for general satisfaction (p = 0.049), prosthesis as a part of you (p = 0.013), appearance (p < 0.001), stability (p = 0.002), ease of cleaning (p < 0.001), and comfort (p = 0.001) than the vertical group.
Conclusion:
Inclined posterior implants used to support mandibular bar overdentures are recommended than vertical implants, as it was associated with improved patient satisfaction and peri-implant tissue health.
Dental implant restorasyonları yüksek sağ kalım ve başarı oranları sebebiyle, kaybedilmiş dişlerin tedavisinde güvenilir bir tedavi seçeneğidir. Ancak dental implant restorasyonları ile tedavi edilmiş hastalar özellikle tedavinin ilk yıllarında farklı komplikasyonlar sebebiyle diş hekimine başvurmaktadır. Gün geçtikçe bu tedavinin yaygınlaşması ile birlikte gelecekte komplikasyon görülme oranlarında artışın kaçınılmaz olacağı öngörülebilir. Bu nedenle dental implant restorasyonlarında görülen komplikasyonlarının teşhisi ve yönetimi dikkat edilmesi gereken konulardandır. Komplikasyonların daha iyi yönetilebilmesi amacıyla günümüzde komplikasyonlar biyolojik ve donanımsal olarak sınıflandırılmaktadır. Bu derlemenin amacı, biyolojik ve donanımsal komplikasyonlar başlığı altında incelenen dental implant restorasyon komplikasyonlarının etiyolojisi, önlenmesi ve tedavisi hakkında güncel bilgileri aktarmaktır.
Objective:
The purpose of this study was to quantify the area covered by biofilm and identify bacteria and yeasts present in mandibular acrylic resin full-arch implant-supported fixed prostheses.
Background:
Biofilm control of implant-supported fixed prosthesis is hampered by their design, and it can cause oral and systemic problems, mainly in immunocompromised patients like the elder. Knowledge about microbiota reinforces the awareness about the need for periodic professional cleaning maintenance.
Materials and methods:
Twenty prostheses were unscrewed, washed in 0.89% sodium chloride, stained with eosin 1% and photographed. The area covered by biofilm was digitally delimited and quantified. Biofilm samples were collected, diluted up to 1:107 , seeded in chromogenic agar media and incubated for 48 hours, at 37°C, for counting of colony-forming units (CFU/mL). DNA hybridization was performed to complement the identification and quantification of microorganisms. Data were analyzed using Mann-Whitney test, Spearman correlation and Fisher's exact test (α = .05).
Results:
An average of 62% of the gingival surface of the prostheses was covered by biofilm. Enterococcus spp. (5.82 ± 1.38 log10 CFU/mL) and Staphylococcus aureus (5.75 ± 2.02 log10 CFU/mL) showed higher prevalence in cultures. Patients with five implants had less biofilm compared to those with four implants (P = .031) but had higher Escherichia coli counts (P = .039). In DNA hybridization, Streptococcus pneumoniae, Veillonella parvula and Fusobacterium nucleatum presented higher quantification and were present in all the samples; patients over 65 years old contained more Candida tropicalis (P = .049); prostheses on five implants presented lower quantification for several species.
Conclusion:
Biofilm was present on all prostheses, containing potentially pathogenic microorganisms. The number of implants may play a role in quantification of biofilm and in microorganism counts.
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.
Objectives
The aim of the present paper was to present medium‐ and long‐term data on implant survival and on the prevalence of peri‐implantitis in a cohort of patients treated with full‐arch rehabilitations.
Materials and methods
Clinical records of all patients treated with immediately loaded full‐arch rehabilitation in the Dental Clinic of the IRCCS Istituto Ortopedico Galeazzi in Milan, Italy supported by moderately rough implants were retrospectively examined to calculate survival curves for implant loss and for the occurrence of peri‐implantitis (both at implant‐ and at patient‐level). Regression methods were used to evaluate the correlation between the presence of periodontitis and smoking habits with the outcomes.
Results
A total of 384 implants placed in 77 patients (96 rehabilitations) were evaluated for a mean period of 8.0 years (range 1.0 ‐ 13.7 years) from loading. After 10 years the cumulative survival rate was 96.11% (95% CI 99.17% ‐ 93.05%) (84 implants) while the cumulative rate of implants free from peri‐implantitis was 86.92% (95% CI: 82.14%, 91.71%) (60.69% (95% CI: 44.19%, 77.19%) at patient‐level). The cumulative proportion of implants without peri‐implantitis after 10 years was significantly higher in mandible (89.76%, 95% CI: 84.49%, 95.03%) than in maxilla (81.71%, 95% CI: 71.91%, 91.51%) (P=0.028). No correlation was found between periodontal and smoking status and outcomes.
Conclusions
The study reported high 10‐year implant survival rate for full‐arch rehabilitations since implant loss was relatively rare. Peri‐implantitis was relatively frequent in the examined population although the number of subjects available for 10‐year evaluation was limited.
This article is protected by copyright. All rights reserved.
Purpose:
The All-on-4 treatment concept has been shown to be an effective clinical procedure; however, to date, no studies have analyzed the subgingival microbiota present in these restorations. The purpose of this study was to evaluate the microbial profile of the subgingival biofilm around dental implants placed in the All-on-4 protocol and compare the microbial profile around axial and tilted implants.
Materials and methods:
Fourteen subjects treated by the All-on-4 concept were evaluated clinically and microbiologically. Subgingival biofilm was collected from each patient, and the amount of 40 species of bacteria was assessed using the checkerboard DNA-DNA hybridization technique.
Results:
The results for the indices of probing depth (PD), bleeding on probing, marginal bleeding, and visible plaque were 2.32 mm, 46%, 60%, and 57%, respectively. Tilted implants presented a significantly higher mean PD and Plaque Index compared with axial implants (P < .05). Fusobacterium nucleatum ssp vincentii, Veillonella parvula, and Fusobacterium nucleatum ssp polymorphum were found in higher levels; however, no difference in the microbial composition was observed between tilted and axial implants (P > .05). Tilted implants presented statistically higher mean levels for the orange complex in relation to the axial implants (P < .05).
Conclusion:
Despite the clinical success rate of the All-on-4 protocol, the subgingival biofilm of tilted implants presented a higher proportion for the orange complex pathogens in comparison to axial implants. These data could suggest that subjects with this modality of implant-supported restoration must be aware that they need a more rigorous maintenance protocol.
The introduction of dental implants has dramatically changed the lives of many edentulous patients by providing a mechanism of anchorage that contributes to stabilizing the mandibular denture during function. This has provided a variety of new options for the treatment of complete upper and lower edentulism (Emami et al., Periodontol 66:119–31, 2014).
This chapter will present a clinical case describing the treatment of a lower edentulous patient with an implant-supported fixed prosthesis. The surgical strategies underlining the placement and the distribution of the dental implants will be highlighted and discussed, as well as the concepts that underscore the design of the final prosthetic outcome.
La rehabilitación con implantes dentales es un tratamiento ya común en estos tiempos. Este tratamiento es considerado costoso, y requiere también de inversión de tiempo de parte del paciente/odontólogo tratante. Si el paciente presenta las condiciones ideales, el tiempo requerido desde la colocación del implante hasta su rehabilitación puede variar entre 2 a 6 meses; pudiendo este tiempo prolongarse, si el paciente requiere procedimientos quirúrgicos previos o conjuntamente a la colocación del implante. A pesar de la creciente aceptación y éxito de la rehabilitación con implantes dentales, se han reportado diversas complicaciones. Entre estas, la periimplantitis es cada vez mas frecuente, y a pesar de eso, es una enfermedad para la cual aún no se ha encontrado una cura 100% efectiva, conllevando muchas veces a la pérdida del implante dental. La periimplantitis es una enfermedad con una prevalencia, según la literatura, de 10% en implantes y 20% en pacientes, y que se espera aumente su ocurrencia a la par como va aumentando la frecuencia de las rehabilitaciones con implantes dentales. No se ha encontrado aún una causa específica para esta enfermedad, por lo que se han definido según varios estudios factores e indicadores de riesgo con la finalidad de prevenirla y tratarla tempranamente. Es por eso que esta revisión de literatura busca informar sobre cuáles son los factores e indicadores de riesgo conocidos actualmente para la periimplantitis.
Introduction
Oral rehabilitation with overdenture on implants of upper jaw must be taken into consideration a variety of anatomical and biomechanical issues. It is possible to provide for rehabilitation with two or more implants, in different positions, solidarizing them with a bar.
Materials & Methods
The present study involved a patient rehabilitated with 4 Xive implants (Friadent GmbH, Mannheim, Germany) solidarized with a titanium bar crafted with CAD-CAM technology for maximal comfort, precision and structural lightness.
Results & Discussion
The follow-up was 54 months, with an implant survival of 100%. Based on our clinical evidence, bars engineered with CAD-CAM technology are promising in terms of precision and comfort despite higher costs.
Aim/Hypothesis: To evaluate the 3 year clinical and radiographic data of fixed implant-supported dental prosthesis delivered on patients taking alendronate 35–70 mg weekly for at least 3 years before implant placement.
Material and methods: Between January 2008 and December 2011, forty consecutive patients treated with oral bisphosphonates requiring implant-supported restorations were recruited in two private practices. Six months after alendronate administration stopping, under antibacterial and antibiotic treatment, implants were inserted through minimally invasive approach. After 4 months of submerged healing, implants underwent prosthetic loading. Hygiene maintenance and clinical assessments were scheduled every 4 months for 3 years. Outcomes measures were the following: implant and prosthetic success, survival rates, any observed clinical complications, marginal bone remodeling and soft tissue parameters.
Results: At the end of the study, eight patients dropped out. The final sample size resulted in thirty-two consecutive partially or fully edentulous patients (32 females; mean age 64.6 years) with 98 submerged implants. In only one patient, maxillary implant failed during healing period. No prosthesis failed during the entire follow-up and no major complications were recorded. Implant and prostheses success resulted in an overall survival rate of 98, 98% and 100% respectively. Three year mean marginal bone loss was 1.35 � 0.21 (CI 95% 1.15 – 1.47). Successful soft tissue parameters were found around all implants.
Conclusions and clinical implications: Oral bisphosphonate therapy did not appear to significantly affect implant survival and success in case of accurate treatment time selection, minimally invasive surgical approach and constant follow-up. Future studies of longer follow-up are needed to confirm these results.
The purpose of this article is to illustrate the use of physical examination findings that can be used to determine the design characteristics of a full arch restoration in the maxilla. These anatomical findings include: 1) the resting and 2) smile line exposure of the central incisor; 3) the vertical position of the edentulous ridge on smile; 4) the anterior-posterior relationship of the teeth to the edentulous ridge; 5) the presence of bone posterior to the premolar region; 6) the anterior height of the alveolar bone in relationship to the floor of the nose; and 7) the planned inclination of the maxillary teeth. Based on these physical findings the final prosthetic plan can be established prior to surgery. Determination of the final restorative plan determines the surgical procedures to be performed.
Purpose:
The study aims to evaluate the all-on-four treatment concept with regard to survival rates (SRs) of oral implants, applied fixed dental prostheses (FDPs) and temporal changes in proximal bone levels.
Materials and methods:
A systematic review of publications in English and German was performed using the electronic bibliographic database MEDLINE, the Cochrane Library, and Google. Hand searches were conducted of the bibliographies of related journals and systematic reviews. The authors performed evaluations of articles independently, as well as data extraction and quality assessment. Data were submitted the weighted least-squared analysis.
Results:
Thirteen (487 initially identified) papers met inclusion criteria. A number of 4,804 implants were initially placed, of which 74 failed, with a majority of failures (74%) within the first 12 months. A total of 1,201 prostheses were incorporated within 48 hours after the surgery. The major prosthetic complication was the fracture of the all-acrylic FDP. The mean cumulative SR/SR ± (standard deviation) (36 months) of implants and prostheses were 99.0 ± 1.0% and 99.9 ± 0.3%, respectively. The averaged bone loss was 1.3 ± 0.4 mm (36 months). No statistically significant differences were found in outcome measures, when comparing maxillary versus mandibular arches and axially versus tilted placed implants.
Conclusion:
The available data provide promising short-term results for the all-on-four treatment approach; however, current evidence is limited by the quality of available studies and the paucity of data on long-term clinical outcomes of 5 years or greater. In terms of an evidence-based dentistry, the authors recommend further studies designed as randomized controlled clinical trials and reported according to the CONSORT statement.
Background:
The current investigation focuses on new implant designs for increased predictability in clinically demanding situations. Microtextured implant surfaces create favorable conditions for enhanced osseointegration of dental implants compared to implants with a smooth surface, and the macroscopic implant design may influence implant stability.
Purpose:
The aim of the present study was to retrospectively evaluate the clinical performance of a novel implant design in the rehabilitation of completely edentulous jaws and in combination with an immediate function protocol.
Materials and methods:
Forty-six consecutive patients received 189 study implants (NobelSpeedy concept implant, Nobel Biocare AB, Göteborg, Sweden) supporting 53 full-arch all-acrylic prostheses (44 maxilla, 9 mandible). The majority (66%) of the reconstructions were supported by four implants, of which the two posterior implants were tilted. All patients were followed for a minimum of 1 year. Radiographic assessment of the marginal bone level was performed.
Results:
Two implants were lost in two patients, rendering a 1-year cumulative clinical survival rate of 98.9%. The marginal bone level was, on average, situated 1.2 +/- 0.7 mm below the implant-abutment interface after 1 year of loading. Good soft tissue health and overall esthetic outcome was reported.
Conclusions:
The results of the present pilot study indicate that fully edentulous jaws with various types of bone can be treated with high success and good esthetics using immediately loaded implants with the presented design, and that favorable marginal bone levels can be maintained.
Denture plaque (DP) is not visible with naked eye when it is not mineralized or not fully fixed. Describing and studying its qualitative and quantitative aspects in Complete Dentures (CD) require precisely-located sampling but selection criteria have not yet been well defined. In order to improve our treatment and preventive strategies for patients with CD, it is necessary to explore the various DP accumulation zones on CD fitting surfaces.
The aim of this study is to assess the DP accumulation on fitting surfaces of CD.
Distribution of DP accumulation zones was assessed by naked eye observation of the fitting surfaces on 31 maxillary and 31 mandibular CD. The prostheses were to be carried regularly since at least one year. The data were collected at the Prosthodontics department of the Annaba University Medical Center in Algeria. Prostheses were immersed for 24 hours in a plaque disclosing solution containing erythrosin 2% (Dento-Plaque Inava). The maxillary fitting surface was divided into five sectors: the post damming zone (1MaxFS), the top of the palate zone (2MaxFS), the incisor zone (3MaxFS), the maxillary tuberosity zone (4MaxFS), and the end of the canine and 1st premolar zone (5MaxFS). For mandibular fitting surfaces: trigonal and retromolar zone (1ManFS), canine and 1st premolar zone (2ManFS), and incisor zone (3ManFS).
DP distribution was found to be homogeneous on the fitting surface of mandibular CD, however it was distributed in unequal way on the maxillary fitting surfaces. We noted a highly significant difference (p < 0.001) in the staining frequencies of the targeted zones. The most colored zone was the post damming one (1MaxFS), with a rate of 96.7%, whereas the least colored zone was the top of palate one (2MaxFS), with 35.5%. On the mandibular fitting surfaces, the rate of staining was 93.5% for the trigonal and retromolar zone (1ManFS) versus 83.8% on canine, 1st premolar (2ManFS) and incisor (3ManFS) zones. There was no significant difference (p = 0.422).
The accumulation of DP was found to be homogeneous on mandibular fitting surfaces and no homogeneous on maxillary fitting surfaces. These results require further investigations in order to understand the causes of this difference. This will allow us to improve our treatment and preventive strategies for edentulous patients.
The philosophy of dental disease control has been discussed. Various devices used in the elimination of plaque have been listed and discussed. These include dentifrices, brushes, flosses, devices for holding and carrying floss, stimulating devices, disclosing solutions, and water irrigating devices. The responsibility for complete and thorough restorative therapy is shared by both dentist and patient. The treatment is not final when the restoration or prosthesis is inserted. Ongoing physiotherapy in the form of a rigid plaque-control program will influence the ultimate success or failure of any restorative treatment.
Osseointegrated dental implants are used routinely in dentistry in the confidence of predictable success. However, if the implant surfaces become colonised by pathogenic bacteria, the plaque-induced inflammation around the implants may cause peri-implant tissue destruction. Peri-implant mucositis is a reversible, plaque-induced inflammatory lesion confined to the peri-implant soft tissue unit and clinically is characterised by redness, swelling and bleeding on gentle probing. Peri-implantitis is an extension of peri-implant mucositis to involve the bone supporting the implant: it is characterised by loss of osseointegration of the coronal part of the implant, by increased probing depth and by bleeding and/or suppuration on probing. Established peri-implantitis does not respond predictably to treatment. The best management of plaque-induced peri-implant inflammatory diseases is prevention. Regular personal and professional cleaning of the implant is mandatory to minimise bacterial load. Despite our best efforts, plaque-induced peri-implant inflammatory diseases will occur frequently, and as these diseases respond best to early treatment, early detection of peri-implant mucositis by regular assessment will permit timely treatment. Peri-implant mucositis is readily treated non-surgically. Peri-implantitis is more difficult to treat largely because of the problem of decontamination of the roughened, threaded surfaces of exposed implants. As a rule, surgical treatment will be necessary, and even then success is not assured.
Immediate-function Brånemark System® implants (Nobel Biocare AB, Gothenburg, Sweden) have become an accepted alternative for fixed restorations in edentulous mandibles, based on documented high success rates. Continuous development is ongoing to find simple protocols for their use.
The purpose of this study was to develop and document a simple, safe, and effective surgical and prosthetic protocol for immediate function (within 2 hours) of four Brånemark System implants supporting fixed prostheses in completely edentulous mandibles: the “All-on-Four” concept.
This retrospective clinical study included 44 patients with 176 immediately loaded implants, placed in the anterior region, supporting fixed complete-arch mandibular prostheses in acrylic. In addition to the immediately loaded implants, 24 of the 44 patients had 62 rescue implants not incorporated in the provisional prostheses but incorporated in final prostheses later on.
Five immediately loaded implants were lost in five patients before the 6-month follow-up, giving cumulative survival rates of 96.7 and 98.2% for development and routine groups, respectively. The prostheses' survival was 100%, and the average bone resorption was low.
The high cumulative implant and prostheses survival rates indicate that the “All-on-Four” immediate-function concept with Brånemark System implants used in completely edentulous mandibles is a viable concept.
Issues related to peri-implant disease were discussed. It was observed that the most common lesions that occur, i.e. peri-implant mucositis and peri-implantitis are caused by bacteria. While the lesion of peri-implant mucositis resides in the soft tissues, peri-implantitis also affects the supporting bone. Peri-implant mucositis occurs in about 80% of subjects (50% of sites) restored with implants, and peri-implantitis in between 28% and 56% of subjects (12–40% of sites). A number of risk indicators were identified including (i) poor oral hygiene, (ii) a history of periodontitis, (iii) diabetes and (iv) smoking. It was concluded that the treatment of peri-implant disease must include anti-infective measures. With respect to peri-implant mucositis, it appeared that non-surgical mechanical therapy caused the reduction in inflammation (bleeding on probing) but also that the adjunctive use of antimicrobial mouthrinses had a positive effect. It was agreed that the outcome of non-surgical treatment of peri-implantitis was unpredictable. The primary objective of surgical treatment in peri-implantitis is to get access to the implant surface for debridement and decontamination in order to achieve resolution of the inflammatory lesion. There was limited evidence that such treatment with the adjunctive use of systemic antibiotics could resolve a number of peri-implantitis lesions. There was no evidence that so-called regenerative procedures had additional beneficial effects on treatment outcome.
Clinical data are scarce on flapless-guided surgery in the mandible using the all-on-four concept. In addition, limited documentation exists on the latter under immediate loading conditions with a pre-fabricated implant bridge. The aim was to provide detailed documentation focusing on clinical and radiographic outcome and complications.
Sixteen systemically healthy non-smoking patients (10 women, 6 men, average age 59 years) with sufficient bone volume in the mandible were operated via flapless-guided surgery using the all-on-four concept. Clinical and radiographic data and complications were registered at 3, 6 and 12 months.
The overall implant survival rate was 90% with a trend for higher failure of short implants (P = 0.098). The mean bone level after 12 months of function was 0.83 mm with a maximum of 1.07 mm. Technical complications were common (15/16 patients). These mainly related to a misfit between the pre-fabricated prosthesis and abutment(s) (13/16 patients).
If immediate loading of implants is pursued fabrication of the implant bridge should be based on actual impression of the implants at the time of surgery and not on their virtual position.
Purpose: The aim of this prospective study was to assess clinical outcomes and peri-implant bone level changes around tilted and axial implants supporting full-arch fixed immediate rehabilitations up to 60 months of loading.
Material and Methods: Forty-seven patients (22 women and 25 men) were included in the study. Each patient received a full-arch fixed bridge supported by two axial and two distal tilted implants. Loading was applied within 48 hours of surgery. Patients were scheduled for follow-up at 6, 12, 18, 24 months, and annually up to 5 years. At each follow-up, plaque level and bleeding scores were assessed and radiographic evaluation of marginal bone level change was performed. Periapical radiographs were taken using a paralleling technique, and subsequently scanned at 600 dpi. An image analysis software was used to assess bone level.
Results: A total of 33 mandibles and 16 maxillae were rehabilitated (two patients received a fixed prosthesis in both arches). One hundred ninety-six Nobel Biocare implants of 4 mm diameter were placed. The mean follow-up duration was 52.8 months (range 30–66 months) in the mandible, and 33.8 months (range 22–40 months) in the maxilla. All subjects attended the scheduled follow-up visits. No implant was lost. No significant difference in marginal bone loss was found between axial and tilted implants in both jaws, at each follow-up. No significant difference in bone loss was found between mandible and maxilla, for both axial and tilted implants at each comparable time frame, although slightly higher mean values were always found for the mandible.
Conclusion: The use of tilted implants in the immediate rehabilitation of fully edentulous jaws is safe and is not associated to a higher marginal bone loss as compared to axially placed implants.
The objective of this paper is to provide a broad overview of the predominant findings from research published on pulsating dental water jets over the last 45 years.
The author performed a computerized MEDLINE search covering the years from 1962 to 2009, with 1962 chosen since it was the year the first dental water jet was introduced. Key words included "oral irrigator" and "oral irrigation." All past and current studies were reviewed and those that reflected original research were included. The article is not intended to provide an exhaustive detailed article review, but rather a broad review of predominant findings on currently available traditional pulsating dental water jets with no novelty features. The author makes no attempt to statistically analyze any of the data. Information reported in the article comes from the original investigator analysis and interpretation.
The dental water jet is supported by a well-established body of evidence demonstrating the ability to remove plaque, reduce periodontal pathogens, gingivitis, bleeding and inflammatory mediators.
The dental water jet is a viable tool for reducing bleeding and gingivitis in a wide variety of patients. Due to the extensive body of knowledge on this product, a meta-analysis or systematic review is warranted. Additional research is recommended to confirm plaque biofilm removal, its effectiveness in comparison to flossing and efficacy on patients with special oral or systemic health needs.
To evaluate the factors associated with long-term implant survival in a large cohort of patients in regular follow-up until data collection.
The study population consisted of 475 patients who were referred to a private clinic limited to Periodontics and Implantology between November 1995 and July 2006. Data were collected from patient files with regards to smoking habits, periodontal condition, diabetes mellitus, implant survival, and time when implant failure occurred. Patients were divided into those who participated in a supportive periodontal program in the clinic and those who only attended the annual free-of-charge implant examination.
A total of 1626 implants were placed with a follow-up ranging from 1 to 114 months (average 30.82 +/- 28.26 months). Overall, 77 (4.7%) implants were lost in 58 (12.2%) patients after a mean period of 24.71 +/- 25.84 months. More than one-half of the patients (246; 51.7%) participated in a structured supportive periodontal program in the clinic, and 229 (48.3%) only attended to the annual free-of-charge implant examination. Smoking and attendance in a regular supportive periodontal program were statistically associated with implant survival. Patients with (treated) moderate-to-advanced chronic periodontal disease demonstrated higher implant failure rates but, this difference did not reach statistical significance. Diabetes mellitus was not related to implant survival in this patient cohort.
Smoking and attendance in a regular supportive periodontal program were found to be strongly related to implant survival. Special attention should be given to continuous periodontal supportive programs to implant patients.
The purpose of this study was to prospectively evaluate the clinical and radiographic outcomes of immediately loaded full-arch fixed prostheses supported by a combination of axially and non-axially positioned implants in a large cohort of patients with completely edentulous jaws, up to 5 years of function.
One hundred and seventy-three edentulous patients (80 males and 93 females) were enrolled according to specific selection criteria. Each patient received a full-arch fixed prosthesis supported by two distal tilted implants and two anterior axially placed implants. The provisional functional acrylic prosthesis was delivered the same day as surgery in all cases. All cases were finalized 4-6 months later. The patients were scheduled for follow-up at 6 and 12 months of function, and annually up to 5 years. At each follow-up plaque and bleeding score was assessed and radiographic evaluation of marginal bone level was performed.
The overall follow-up range was 4-59 months. A total of 154 immediately loaded prostheses (61 in the maxilla and 93 in the mandible) were in function for at least 1 year and were considered for the analysis. Four axially placed implants failed in the maxilla and one tilted implant in the mandible, all within 6 months of loading. No further implant failure occurred to date. Implant survival at 1 year was 98.36% and 99.73% for the maxilla and the mandible, respectively. Marginal bone loss at 1 year averaged 0.9+/-0.7 mm in the maxilla (204 implants) and 1.2+/-0.9 mm in the mandible (292 implants). No difference was found in marginal bone loss between axial and tilted implants. Plaque and bleeding scores progressively improved from 6 to 12 months. Fracture of the acrylic prosthesis occurred in 14% of total cases.
The present preliminary results from a relatively large sample size suggest that the present technique can be considered a viable treatment option for the immediate rehabilitation of both mandible and maxilla.
The aim of the present systematic review of implant-supported maxillary overdentures was to assess the survival of implants, survival of maxillary overdentures and the condition of surrounding hard and soft tissues after a mean observation period of at least 1 year.
MEDLINE (1950-August 2009), EMBASE (1966-August 2009) and CENTRAL (1800-August 2009) were searched to identify eligible studies. Two reviewers independently assessed the articles.
Out of 147 primarily selected articles, 31 studies fulfilled the inclusion criteria. A meta-analysis showed an implant survival rate (SR) of 98.2% per year in case of six implants and a bar anchorage. In case of four implants and a bar anchorage, the implant SR was 96.3% per person. In case of four implants and a ball anchorage, the implant SR was 95.2% per year.
In all three treatment options, the SR of the implants is more than 95%. The studies included reveal that a maxillary overdenture supported by six dental implants, which are connected with a bar, is the most successful treatment regarding survival of both the implants and overdenture. Second in line is the treatment option with four implants and a bar. The treatment option with four or less implants and a ball attachment system is the least successful.
The purpose of this study was to investigate the effect of the domestic use of a disclosing agent for denture hygiene.
Completely edentulous participants wearing maxillary dentures were randomly assigned to one of the three intervention groups: (1) Follow-up only (control; n = 12); (2) Oral and denture hygiene instructions (n = 10); (3) Instructions associated with the home use of a disclosing agent (1% neutral red; n = 10). Biofilm coverage area (%) over internal and external surfaces of the maxillary denture was assessed at baseline and after 14 and 90 days. Data were evaluated by generalised estimating equations based on score tests (alpha = 0.05).
The participants presented low changes for areas of biofilm coverage (14 days (%): internal: GI = 1.4 +/- 0.9; GII = 1.5 +/- 1.3; GIII = -0.4 +/- 0.9; external: GI = 1.4 +/- 1.5; GII = 1.5 +/- 1.4; GIII = -0.4 +/- 0.9; 90 days (%): internal: GI = 2.0 +/- 0.9; GII = 2.2 +/- 1.4; GIII = 0.3 +/- 1.0; external: GI = 2.1 +/- 1.4; GII = 2.2 +/- 1.5; GIII = 0.3 +/- 0.9). Changes were similar for the three groups (p = 0.293) and were not influenced by the test time (p = 0.218).
It can be concluded that the home use of a disclosing agent for denture hygiene does not improve the removal of the biofilm, particularly for patients with adequate oral hygiene habits.
Peri-implant diseases include peri-implant mucositis, describing an inflammatory lesion of the peri-implant mucosa, and peri-implantitis, which also includes loss of supporting bone.
A literature search of the Medline database (Ovid), up to 21 January 2008 was carried out using a systematic approach, in order to review the evidence for diagnosis and the risk indicators for peri-implant diseases.
Experimental and clinical studies have identified various diagnostic criteria including probing parameters, radiographic assessment and peri-implant crevicular fluid and saliva analyses. Cross-sectional analyses have investigated potential risk indicators for peri-implant disease including poor oral hygiene, smoking, history of periodontitis, diabetes, genetic traits, alcohol consumption and implant surface. There is evidence that probing using a light force (0.25 N) does not damage the peri-implant tissues and that bleeding on probing (BOP) indicates presence of inflammation in the peri-implant mucosa. The probing depth, the presence of BOP, and suppuration should be assessed regularly for the diagnosis of peri-implant diseases. Radiographs are required to evaluate supporting bone levels around implants. The review identified strong evidence that poor oral hygiene, a history of periodontitis and cigarette smoking, are risk indicators for peri-implant disease. Future prospective studies are required to confirm these factors as true risk factors.
An investigation of factors controlling healing and long term stability of intra-osseous titanium implants to restore masticatory function in dogs revealed that an integrity of the good anchorage of the implant requires: (1) Non-traumatic surgical preparation of soft and hard tissues and a mechanically and chemically clean implant. (2) Primary closure of the mucoperiosteal flap, to isolate the implant site from the oral cavity until a biological barrier has been reestablished. (3) Oral hygiene to prevent gingival inflammation. Provided these precautions are taken, it is possible to subject dental prostheses, connected to the implants, to unlimited masticatory load. With these precautions such implants were found to tolerate ordinary use in dogs for periods of more than 5 years without signs of tissue injury or other indications of rejection phenomena.
Macroscopic clinical investigation, stereomicroscopy, roentgenography and light microscopy of the implant site in situ and after removal from the body showed that the soft and hard tissues had accepted the implant and incorporated it without producing signs of tissue injury. In fact the bone appeared to grow into all the minute pits and impressions in the surface of the titanium implant, without any shielding layer of buffer tissue at all.
These findings indicate that dental prostheses can be successfully anchored intra-osseously in the dog suggesting that its possible clinical use in oral rehabilitation should be given unprejudiced consideration.
It has been postulated that the wound healing in a closed submerged location is one of the prerequisites for osseointegration of dental implants. The purpose of the present study was to evaluate the tissue integration of intentionally non-submerged titanium implants inserted by a one-stage surgical procedure. 100 ITI implants were consecutively placed in 70 partially edentulous patients. After a healing period free of masticatory loading for at least 3 months, the implants were examined. The clinical status showed for all implants neither detectable mobility nor signs of a peri-implant infection. Therefore, prosthetic abutments were inserted, and the patients were restored with fixed partial dentures. All patients were regularly recalled at 3-month intervals, and no patient dropped out of the study. Thus, all 100 implants were re-evaluated 12 months following implantation. Plaque- and sulcus bleeding indices, probing depth, clinical attachment level, width of keratinized mucosa, and periotest scores were assessed. In addition, standardized radiographs were analyzed for the presence of peri-implant radiolucencies and for the location of alveolar bone levels around the implants. Based on predefined criteria, the implants were classified as successful or failing. 98 implants were considered successful, and 1 implant failing. The remaining implant exhibited a peri-implant infection requiring local and systemic antimicrobial treatment. The results of this short-term study indicate that intentionally non-submerged ITI implants yield a high predictability for successful tissue integration.
A simple and rapid test for measuring oral hygiene was recently developed. It is based on the rate of oxygen consumption of oral expectorates of milk. This investigation modified the test to study denture hygiene. The dentures of 20 patients were immersed in 10 mL of sterile milk. After a 2-minute agitation, 3 mL of milk was added to test tubes containing methylene blue. The time required for color change at the bottom of the test tube, which is indicative of the rate of oxygen consumption, was recorded. For comparison with visual plaque accumulation, the dentures were coated with disclosing solution and the extent of plaque was scored by three examiners. A correlation was found between the plaque index scores and results of the milk test (r = -0.64; p less than 0.005). The data suggests the use of this test to monitor denture hygiene.
Forty-six patients who had shown chronic maladaptive behavior in using complete dentures were treated with osseointegrated implant-supported prostheses. Forty patients needed mandibular treatment, three patients needed treatment in the maxillae, and three required treatment in both dental arches. At the most recent data collection (4 to 9 years after surgical placement of the implants), the 49 dental arches remained successfully treated with 44 implant-supported fixed partial dentures and five implant-supported overdentures. The efficacy of the osseointegration technique in maladaptive prosthetic patients is demonstrated in this descriptive study.
Literature describing the nature of denture plaque and its role in the causation of oral disease is reviewed. Similarly, the literature pertaining to the development of denture cleansing products, their mechanism of cleansing action, and their relative efficacy is reviewed. The literature indicated that the 'perfect' denture cleansing product does not yet exist. However, by assessing strengths and weaknesses, and perhaps recommending the use of more than one product, it should be possible to adequately meet the needs of most denture wearers.
Denture stomatitis has been reported in 11-67% of complete denture wearers. It is more common on the palatal mucosa and in female patients. In Newton's type I denture stomatitis, where the inflammation remains focal, trauma seems to be responsible. In Newton's types II and III denture stomatitis, where the denture-bearing mucosa is diffusely involved, most workers assert that the aetiology is multi-factorial. Evidence is presented incriminating Candida albicans colonization of the fitting surface of the prosthesis in many cases of denture stomatitis promoted by continuous denture wearing. Allergic and primary irritant reactions to the denture base material, systemic predisposing factors including dietary deficiency and haematological disorders, also play a part. In most cases of denture stomatitis, elimination of denture faults, control of denture plaque and discontinuous denture wearing are sufficient treatment. The routine use of antiseptic or antimycotic drugs seems unnecessary.
Osseointegration implies a firm, direct and lasting connection between vital bone and screw-shaped titanium implants of defined finish and geometry-fixtures. Thus, there is no interposed tissue between fixture and bone. Osseointegration can only be achieved and maintained by a gentle surgical installation technique, a long healing time and a proper stress distribution when in function. During a 15-year period (1965-1980), 2768 fixtures were installed in 410 edentulous jaws of 371 consecutive patients. All patients were provided with facultatively removable bridges and were examined at continuous yearly controls. The surgical and prosthetic technique was developed and evaluated over a pilot period of 5 years. The results of standardized procedures applied on a consecutive clinical material with an observation time of 5-9 years were thought to properly reflect the potential of the method. In this group, 130 jaws were provided with 895 fixtures, and of these 81% of the maxillary and 91% of the mandibular fixtures remained stable, supporting bridges. In 89% of the maxillary and 100% of the mandibular cases, the bridges were continuously stable. During healing and the first year after connection of the bridge, the mean value for marginal bone loss was 1.5 mm. Thereafter only 0.1 mm was lost annually. The clinical results achieved with bridges on osseointegrated fixtures fulfill and exceed the demands set by the 1978 Harvard Conference on successful dental implantation procedures.
Prosthetic parameters for implant success have not been well defined but should include patient satisfaction and prosthesis maintenance, including adjustments and repairs. In addition, differences between fixed and removable implant-supported prostheses (ISPs) should be quantified. This study retrospectively evaluated both patient satisfaction and maintenance for 156 patients. Removable ISPs averaged almost three times as many adjustments per prosthesis (2.1 versus 0.8 per fixed ISP) and more than twice as many repairs (1.9 per removable ISP versus 0.9 per fixed ISP). The most common adjustments were to the contour of both types of prosthesis, and the most frequent repairs involved the retentive clips with removable ISPs and the gold screws with fixed ISPs. The incidence of repeat repairs was more than twice as high with removable prostheses compared with fixed prostheses. However, the repairs to opposing dentures most often needed were for conventional dentures opposing fixed ISPs. The vast majority of repairs were needed within the first year of service. Despite the high maintenance needed, patients were satisfied with both types of ISP, with the exception of limited satisfaction with cleansability, particularly with fixed restorations. The high incidence of early repairs, and the greater potential for a removable ISP requiring adjustment and repair, should be considered both when discussing options with the patient and when estimating treatment and maintenance costs before the commencement of implant therapy.
From the dental professional's standpoint, implant rehabilitation offers dramatically improved treatment alternatives to orally disabled patients. However, what a patient perceives as important to their function and satisfaction with their prostheses may be quite different from what the dentist believes are significant health-related improvements.
To resolve this problem, a series of investigations were designed to measure satisfaction and performance in groups of patients who wore various types of prostheses supported by endosseous titanium implants.
Methods are described for assessing treatment efficacy and population needs, including measures of perceived levels of disability, health-related quality of life, and functional capacity.
The findings highlight patient factors that have not been considered before and appear to contribute to the success of prosthetic rehabilitation for the edentulous patient.
Patient-centered approaches to the assessment of treatment efficacy are highly relevant to today's prosthodontists, whose goals are the improvement of function and quality of life for their patients.
This article discusses a method for the predictable fabrication of fixed detachable maxillary reconstructions that abut and precisely follow the gingival contours--regardless of implant angulation or position. The technique reorders the traditional implant protocol and delays abutment selection until the definitive tooth position has been established. In this manner, final abutment selection and framework design become a single, integrated process that results in improved aesthetics, reduced angulation difficulties, and elimination of the phonetic concerns traditionally associated with fixed maxillary prostheses.
Osseointegrated implants as anchors for various prosthetic reconstructions have become a predictable treatment alternative. It was expected that implants required submucosal placement during the healing period for successful tissue integration. However, it has been demonstrated that healing and long-term health of implants could be achieved with equal predictability in a 1-stage, non-submerged approach. This prospective 5-year study not only calculates implant success by life table analysis, but also evaluates the correlation between observed bone level changes with clinical parameters as measured by suppuration, plaque indices, bleeding indices, probing depth, attachment level and mobility. A total of 112 ITI dental implants were inserted in different areas of the jaws. Clinical and radiographic parameters were evaluated annually for 5 years, whereas a portion of the study group for which 6-year evaluations were available were included in the life-table analysis. The overall success rate after 5 years in service was 99.1%, while after 6 years it was reduced to 95.5% due to the fracture of 3 implants in 1 patient. The mean crestal bone loss experienced during the first year was 0.6 mm followed by an annual yearly loss of approximately 0.05 mm. No significant differences could be found between the amount of bone loss measured at each of the yearly follow-up visits. This suggests that statistically the followed implants did not show any radiographically measurable bone loss following the initial period of bone loss associated with implant placement and osseointegration. Low levels of correlation between the individual and cumulative clinical parameters with radiographically measured bone loss suggests that these parameters are of limited clinical value in assessing and predicting future peri-implant bone loss.
The purpose of this study was to determine oral hygiene habits, denture cleanliness, presence of yeasts and denture stomatitis in elderly people. Seventy complete denture wearers were investigated clinically and mycologically. Subjects were evaluated according to, presence of denture stomatitis, presence of yeasts, denture cleanliness, frequency of denture brushing and denture cleaning methods. Swabs were taken from the palate investigated mycologically in order to identify the yeast colonies. No statistical relationship was found between denture stomatitis and frequency of denture brushing and denture cleaning methods. However, there was a statistically significant relationship between denture stomatitis, yeasts' presence and denture cleanliness.
Immediate implant function has become an accepted treatment modality for fixed restorations in totally edentulous mandibles, whereas experience from immediate function in the edentulous maxilla is limited.
The purpose of this study was to evaluate a protocol for immediate function (within 3 hours) of four implants (All-on-4, Nobel Biocare AB, Göteborg, Sweden) supporting a fixed prosthesis in the completely edentulous maxilla.
This retrospective clinical study included 32 patients with 128 immediately loaded implants (Brånemark System TiUnite, Nobel Biocare AB) supporting fixed complete-arch maxillary all-acrylic prostheses. A specially designed surgical guide was used to facilitate implant positioning and tilting of the posterior implants to achieve good bone anchorage and large interimplant distance for good prosthetic support. Follow-up examinations were performed at 6 and 12 months. Radiographic assessment of the marginal bone level was performed after 1 year in function.
Three immediately loaded implants were lost in three patients, giving a 1-year cumulative survival rate of 97.6%. The marginal bone level was, on average, 0.9 mm (SD 1.0 mm) from the implant/abutment junction after 1 year.
The high cumulative implant survival rate indicates that the immediate function concept for completely edentulous maxillae may be a viable concept.
The use of short implants (7-8.5 mm) has historically been associated with lower survival rates than for longer implants. However, recent clinical studies indicate that short implants may support most prosthetic restorations quite adequately, but still clinical documentation is sparse.
The purpose of this study was to report on the placement of short Brånemark implants, testing the hypothesis that short implants in atrophied jaws might give similar long-term implant survival rates as longer implants used in larger bone volumes.
This retrospective clinical study included 237 consecutively treated patients with 408 short Brånemark implants supporting 151 fixed prostheses. One hundred thirty-one of the implants were 7-mm long, and 277 were 8.5-mm long. Final abutments were delivered at the time of surgery, and final prostheses were delivered 4 to 6 months later.
One hundred and twenty six of the 7-mm implants (96%) have passed the 1-year follow-up; 110 (84%), the 2-year follow-up; and 88 (67%), the 5-year follow-up. Five implants failed in four patients before the 6-month follow-up, giving a cumulative survival rate of 96.2% at 5 years. The average bone resorption was 1 mm (SD=0.6 mm) after the first year and 1.8 mm (SD=0.8 mm) after the fifth year of function. Two hundred sixty nine of the 8.5-mm implants (97%) have passed the 1-year follow-up; 220 (79%), the 2-year follow-up; and 142 (51%), the 5-year follow-up. Eight implants failed in seven patients before the 6-month follow-up, giving a cumulative survival rate of 97.1% at 5 years. The average bone resorption was 1.3 mm (SD=0.8 mm) after the first year and 2.2 mm (SD=0.9 mm) after the fifth year of function.
The cumulative survival rates of 96.2 and 97.1% at 5 years for implants of 7.0- and 8.5-mm length, respectively, indicate that one-stage short Brånemark implants used in both jaws is a viable concept.
The aims of this prospective study were to assess the treatment outcome of immediately loaded full-arch fixed bridges anchored to both tilted and axially placed implants for the rehabilitation of the mandible and to compare the outcome of axial versus tilted implants.
Sixty-two patients (34 women and 28 men) were included in the study. Each patient received a full-arch fixed bridge supported by two axial implants and two distal tilted implants (All-on-Four, Nobel Biocare AB, Göteborg, Sweden). Loading was applied within 48 hours of surgery. Patients were scheduled for follow-up at 6, 12, 18, and 24 months, and annually up to 5 years. At each follow-up, plaque level and bleeding scores were assessed; moreover, patient's satisfaction for aesthetics and function was evaluated by a questionnaire. Radiographic evaluation of marginal bone level change was performed at 1 year.
The overall follow-up range was 6 to 43 months (mean 22.4 months). Forty-four patients were followed for a minimum of 1 year. No implant failures were recorded to date, leading to a cumulative implant survival and prosthesis success rate of 100%. Plaque level and bleeding scores showed progressive decrease over time, parallel to increase of satisfaction for both aesthetics and function. No significant difference in marginal bone loss was found between tilted and axial implants at 1-year evaluation.
The present preliminary data suggest that immediate loading associated with tilted implants could be considered a viable treatment modality for the mandible.
Domestic use of a disclosing solution for denture hygiene: a randomised trial
- Regis Rr Souza Rf
- C Nascimento
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- Silva
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Souza RF, Regis RR, Nascimento C, Paranhos HFO, Silva CHL. Domestic use of a disclosing solution for denture hygiene: a randomised trial. Gerodontology 2010; 27:193– 198.