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CLINICAL CASE OF TREATMENT OF A PATIENT WITHFIXED DENTURES SUPPORTED BYUNFAVOURABLY POSITIONNED DENTAL IMPLANTS
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Objective
To assess the survival and technical complication rate of partial and full‐arch all‐ceramic implant‐supported fixed dental prostheses (P‐FDP/FA‐FDP) and supporting implants.
Materials and methods
An electronic search through three databases (MEDLINE/Pubmed, Cochrane Library, Embase) was conducted to identify relevant clinical studies with an observation period of at least 12 months, including ≥15 patients. Reconstruction and implant survival rates, technical complications and confounding variables such as processed/installed materials, retention mode and location in the mouth were obtained. Failure and complication rates were analyzed using standard Poisson regression models to calculate 5‐year survival and complication estimates.
Results
A total of five studies for the P‐FDP group and seven studies for the FA‐FDP group were included, throughout evaluating veneered zirconia reconstructions. In the P‐FDP group, reconstructions were located in posterior regions. Meta‐analysis indicated survival estimates on the reconstruction level of 98.3% and 97.7% for P‐ and FA‐FDPs after 5 years. However, chipping of the veneering ceramic was frequent, resulting in estimated 5‐year complication rates of 22.8% (P‐FDPs) and 34.8% (FA‐FDPs). Five‐year survival estimates of implants supporting P‐FDPs and FA‐FDPs of 98.5% and 99.4% were calculated, respectively. Including a total of 540 FDPs, one screw‐loosening and 11 de‐cementations were reported. Confounding variables were not found to have a significant influence on survival and complication rates.
Conclusions
All‐ceramic implant‐supported P‐ and FA‐FDPs comprising veneered zirconia frameworks showed high survival but clinically inacceptable fracture rates of the veneering ceramic. Their suitability with regard to this indication and a successful long‐term outcome needs to be further evaluated.
Key Clinical Message
Treatment of atrophic edentulous jaws with implant‐supported fixed prostheses is one of the most complicated challenges in dentistry. This clinical report describes the prosthesis which consists of screw retained frameworks with individual cement retained crowns which combines the advantages of the screw retained restoration with the advantage of cement retained.
After tooth loss, an individual may seek tooth replacement so that his/her function and esthetics could be restored. Clinical prosthodontics, during the past decade, has significantly improved and developed according to the advancements in the science and patient's demands and needs. Conventional options in prosthodontics for substituting a missing single tooth include the removable partial denture, partial and full coverage bridgework, and resin-bonded bridgework. Dental implants have gained increasing popularity over the years as they are capable of restoring the function to near normal in both partial and completely edentulous arches. With substantial evidence available, fixed implant-supported prosthesis are fully acknowledged as a reliable treatment option for the replacement of single or multiple missing teeth nowadays. While dental implants are increasingly becoming the choice of replacement for missing teeth, the impediments associated with them are progressively emerging too.
Background and aims. All-on-four technique involves the use of tilted implants to allow for shorter cantilevers. This finite element analysis aimed at investigating the amount and distribution of stress in maxillary bone surrounding the implants with all-on-four vs. frequently used method with six implants technique using different numbers and inclination angles.
Materials and methods. A 3D edentulous maxillary model was created and implants were virtually placed anterior to the maxillary sinus and splinted with a superstructure. In total, five models were designed. In the first to the fourth models, four implants were placed with distal implants inclined 0, 15, 30, and 45 degrees, respectively. In the fifth model, six vertical implants were placed. 100 N loading was placed in the left most distal region of the superstructure. Maximum von Mises stress values were evaluated in cancellous and cortical bone.
Results. The maximum stress values recorded in cancellous and cortical bone were 7.15 MPa and 51.69 MPa, respectively (model I). The reduction in stress values in models II to V 6%, 18%, 54%, and 24% in cancellous bone and 12%, 36%,62%, and 62% in cortical bone, respectively.
Conclusion. Increasing the inclination in posterior implants resulted in reduction of cantilever length and maximum stress decline in both cancellous and cortical bone. The effect of cantilever length seems to be a dominant factor which can diminish stress even with less number of implants.
Purpose:
The aim of this study was to evaluate the effect of implant inclination and cantilever length on the stress distribution in mandibular cortical bone, implant, abutment, prosthetic framework, and prosthetic screw via three-dimensional (3D) finite element analysis (FEA).
Materials and methods:
Four different finite element models (0-0, 17-17, 30-30, 45-30) were designed according to the tilting angle (0, 17, 30, and 45 degrees) of the posterior implant and angle of multiunit abutments (0, 17, and 30 degrees). Screw-retained fixed prostheses with different cantilever lengths in accordance with implant inclination were modeled. A foodstuff was used for the 100-N load application. Maximum principal (Pmax) and minimum principal (Pmin) stresses were calculated for cortical bone, and von Mises stress values were calculated for the implant, abutment, metal framework, and prosthetic screw.
Results:
The highest stress values were observed in the anterior implant, surrounding bone, and prosthetic components of the 0-0 configuration. Pmin stress values in bone were gradually decreased with the increasing inclination of both anterior and posterior implants. Peak Pmax stress values were detected in the 0-0 group. For the cortical bone around the posterior implant, the 30-30 group showed the lowest Pmax value. The highest von Mises stress on implants was found at the posterior implant of the 30-30 group. The stress values on abutments gradually decreased with the increase of the angulation of the posterior implants. For prosthetic screws, the 30-30 and 45-30 groups exhibited lower stress values, and for the metal framework, the 30-30 group exhibited lower stress values.
Conclusion:
Biomechanical comparison via 3D FEA revealed that decreasing the cantilever length by tilting the posterior implants resulted in a reduction in stress values in the peri-implant bone, abutment, prosthetic screw, and metal framework. The groups with 30- and 45-degree tilted posterior implants and shorter cantilever lengths showed better stress distributions in comparison to the straight and 17-degree tilted groups.
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