vendex and Jaw--Edentulous--Partially

Tbe bilateral distal extension removable partial denture has inherent problems of retention and stability, affecting not only the integrity of denture bearing tissues and associated structures, but also patient acceptance and compliance. This paper examines factors that contribute to and exacerbate the functional movement of free-end saddle prostheses, discusses techniques used to overcome these problems and lists alternative strategies for the management of the Kennedy class I patient.

Topics: Dental Arch; Dental Stress Analysis; Denture Design; Denture Retention; Denture, Partial, Removable; Humans; Jaw, Edentulous, Partially; Torque

Osseointegrated implant support of dental restorations continues to be a popular option for the contemporary patient with missing natural dentition. This article focuses on the two most frequently used methods for attaching final prostheses to endosseous implants. The authors offer practical solutions for minimizing implant screw loosening and describe the factors involved in maintaining stable screw joint assembly.

Topics: Biomechanical Phenomena; Bite Force; Dental Abutments; Dental Alloys; Dental Implantation, Endosseous; Dental Implants; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Humans; Jaw, Edentulous, Partially; Osseointegration; Stress, Mechanical; Surface Properties; Torque

The aim of this study was to evaluate early-loaded implants supporting a two-unit fixed dental prosthesis in the posterior maxilla and to compare the clinical and radiological outcomes of two different implant systems in terms of success rates, implant stability quotient (ISQ) values, and peri-implant parameters.. Thirty patients with the unilateral loss of two consecutive maxillary posterior teeth were randomly assigned to two different implant systems: SLActive Bone level implant (Institut Straumann AG, Basel, Switzerland) in the control group and CMI IS-II active implant (Neobiotech Co., Seoul, Korea) in the experimental group. The patients received provisional and definitive two-unit fixed prostheses at 4 weeks and 6 months after implant surgery, respectively. The peak insertion torque was recorded at surgery. The stability of each implant was evaluated during surgery and at 2, 3, and 4 weeks and 6 and 13 months after implant placement by means of ISQ values. In addition, periapical radiographs and peri-implant parameters were taken throughout the trial.. Overall, comparable results were obtained between the control and experimental groups in terms of insertion torque, ISQ values, marginal bone loss, and peri-implant soft tissue parameters. All 60 implants had 100% of success rate. The average insertion torque was 36.83 ± 6.09 (control) and 35.33 ± 3.20 (test) Ncm. The ISQ values remained steady until 4 weeks and then increased with statistical significance during 4 weeks to 13 months after surgery. Both groups exhibited no stability dip during the early phase of healing. The average marginal bone loss from the baseline of implant placement for the control and experimental groups was 0.38 and 0.45 mm after 4 weeks and 0.98 and 0.61 mm after 13 months. All of the soft tissue parameters were within normal limits.. The results of this study indicate that the concept of early loading at 4 weeks after placement in the posterior maxilla can be an effective treatment option, even in the areas of low bone density, when implants satisfy the inclusion criteria of minimum insertion torque and ISQ of 30 Ncm and 65, respectively.

Topics: Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Dental Stress Analysis; Denture, Complete, Immediate; Denture, Partial, Fixed; Female; Humans; Immediate Dental Implant Loading; Jaw, Edentulous, Partially; Male; Maxilla; Middle Aged; Torque

To compare planning and patient rehabilitation using a 3D dental planning software and dedicated surgical guides with conventional rehabilitation of partially or fully edentulous patients using flapless or mini-flap procedures and immediate loading.. Fifty-one fully or partially edentulous patients requiring at least 2 implants to be restored with a single prosthesis, having at least 7 mm of bone height and 4 mm in bone width, had their implant rehabilitation planned on three-dimensional (3D) cone beam computed tomography (CBCT) scans using a dedicated software. Afterwards they were randomised according to a parallel group study design into two arms: computer-guided implant placement aided with templates (computer-guided group) versus conventional implant placement without templates (conventional group) in three different centres. Implants were to be placed flapless and loaded immediately; if inserted with a torque over 35 Ncm with reinforced provisional prostheses, then replaced, after 4 months, by definitive prostheses. Outcome measures, assessed by masked assessors were: prosthesis and implant failures, complications, peri-implant bone level changes, number of treatment sessions, duration of treatment, post-surgical pain and swelling, consumption of pain killers, treatment time, time required to solve complications, additional treatment cost, patient satisfaction. Patients were followed up to 1 year after loading.. Twenty-six patients were randomised to the conventional treatment and 25 to computerguided rehabilitation. No patient dropped out. One provisional prosthesis failed, since one of the two supporting implants failed 11 days after implantation in the conventional group (P = 1.0). Four patients of the conventionally loaded groups experienced one complication each, versus five patients (6 complications) in the computer-guided group (P = 0.726). There were no statistically significant differences between the two groups for any of the tested outcomes with the exception of more postoperative surgical pain (P = 0.002) and swelling (P = 0.024) at conventionally treated patients.. When treatment planning was made on 3D CBTC scan using a dedicated software, no statistically significant differences were observed between computer-guided and a free-hand rehabilitations, with the exception of more postoperative pain and swelling at sites treated freehand because more frequently flaps were elevated.

Topics: Adult; Aged; Aged, 80 and over; Analgesics; Cone-Beam Computed Tomography; Dental Implantation, Endosseous; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Edema; Female; Follow-Up Studies; Humans; Imaging, Three-Dimensional; Immediate Dental Implant Loading; Jaw, Edentulous, Partially; Male; Middle Aged; Mouth, Edentulous; Operative Time; Pain, Postoperative; Patient Care Planning; Patient Satisfaction; Postoperative Complications; Surgery, Computer-Assisted; Surgical Flaps; Torque; Treatment Outcome

To compare implant failure, prosthesis failure and radiographic bone level changes of immediate non-occlusal loading versus early loading in partially edentulous patients 3 years after implant placement.. A total of 80 patients with partial edentulism were selected for a two implant-supported immediate restoration and randomised to immediate loading (test group) or early loading (control group) after 2 months, 40 patients for each group. To be included in the study, implants had to be inserted with a torque ≥ 30 Ncm. In the test group, implants were provided with non-occluding temporary restorations. In the control group, healing abutments were attached and implants were left to heal nonsubmerged. Definitive prostheses were delivered 2 months after surgery with full occlusal contacts. The outcome variables were implant failure, prosthesis failure, complications and radiographic bone level changes at implants 3 years after loading. The assessor was blinded to group assignment.. Eighty-one implants were immediately loaded and 80 were early loaded. Two immediately loaded patients and 1 early loaded patient dropped out at 3 years. No implant failed. Two complications occurred in the immediate loading group and 1 in the early loading group. There were no significant differences in bone levels changes at 36 months between the two groups (P = 0.67; difference 0.2 mm; 95% CI -0.23, 0.63). Immediately loaded implants lost 0.90 mm (95% CI 0.63, 1.17) and early loaded implants 1.10 mm (95% CI 0.81, 1.39).. If adequate primary stability was achieved, no statistically significant difference in failure rates, complications or bone level changes between implants loaded immediately or early were observed 3 years after placement in partially edentulous patients.

Topics: Adult; Aged; Alveolar Bone Loss; Dental Implantation, Endosseous; Dental Implants; Dental Prosthesis Design; Dental Restoration Failure; Female; Humans; Immediate Dental Implant Loading; Jaw, Edentulous, Partially; Longitudinal Studies; Male; Middle Aged; Radiography; Single-Blind Method; Torque

To conduct a randomised controlled trial to evaluate the short-term clinical and radiographic efficacy of the NobelActive™ system and to evaluate the relative importance of achieving primary stability at placement.. A total of 32 subjects were recruited and, using a split-mouth design, the NobelActive(TM) implant was compared with a contralaterally matched Brånemark implant. Both implants were placed in a single surgical procedure into healed sites using a one-stage protocol and reviewed at monthly intervals. NobelActive(TM) implants were functionally loaded with provisional restorations at 1 month and all implants were restored with final crowns 3 months post-implant placement. The implant was assessed using peak insertion torque values, resonance frequency analysis (RFA), clinical parameters, digital subtraction radiography, and cone beam computed tomography.. The insertion torque was significantly greater for the NobelActive(TM) implant group (P = 0.02), although no observable difference in RFA values were found. Preliminary results of 6 months follow-up suggest comparable clinical and radiographic healing responses between the test and control implants. Within the limits of the sample population, the survival rates were lower with the test implants, although this difference was not statistically significant.. The NobelActive(TM) implant system requires higher insertion torques and can also achieve greater primary stability compared with a control implant system. Short-term survival and marginal bone levels of NobelActive(TM) and control implants are comparable, although the NobelActive(TM) implant system appeared to be more technique-sensitive.

Topics: Bone Density; Cone-Beam Computed Tomography; Crowns; Dental Implants; Dental Prosthesis Design; Female; Humans; Immediate Dental Implant Loading; Jaw, Edentulous, Partially; Male; Mandible; Middle Aged; Postoperative Complications; Prospective Studies; Radiography, Dental, Digital; Torque; Treatment Outcome

The benefit in terms of higher accuracy for full guided implant surgery (template based guided cavity preparation and guided implant insertion) compared with half-guided surgery (template based guided cavity preparation and free-handed, manual implant insertion) has not been proved till now.. A total of 38 identical implants were inserted into five human cadaver jaws, after virtual implant planning with the coDiagnostiX(™) device. All cavities were drilled using templates equipped with tubes for guidance. At random, 19 implants were inserted in a free handed way (half-guided), whereas 19 implants were inserted in a guided way through the templates tubes (full guided). Postoperative cone beam computer tomographies (CBCT) were performed, and based on image fusion the total deviations between the virtual implant positions at the implants base and tip were determined and compared between both implantation modi.. The mean difference in accuracy between both implantation modalities at the implants bases was 0.72 mm (range: 0.16-1.17 mm, SD: 0.45). The mean difference in accuracy between both modalities at the implants tips was 0.46 mm (range: 0.16-1.23 mm. SD: 0.49). Although full guided implantation showed a generally higher accuracy (mean tip: 1.54 mm, range: 0.33-3.64 mm; mean base: 1.52 mm, range: 0.4-3.54 mm) than half-guided implantation (mean tip: 1.84 mm, range: 0.84-3.22 mm; mean base: 1.56 mm, range: 0.49-3.43 mm), the differences were not statistically significant.. The accuracy of half-guided implant surgery is comparable with full guided implant surgery.

Topics: Cadaver; Cone-Beam Computed Tomography; Dental Implantation, Endosseous; Dental Implants; Dental Prosthesis Retention; Equipment Design; Humans; Image Processing, Computer-Assisted; Jaw, Edentulous; Jaw, Edentulous, Partially; Mandible; Osteotomy; Patient Care Planning; Surgery, Computer-Assisted; Torque; User-Computer Interface

This study evaluated the clinical outcome and the crestal bone resorption of implants placed with high insertion torque (up to 80 N cm). 102 patients were treated with 156 tapered implants. 42 implants (control group) presented insertion torque between 30 and 45 N cm (mean=37.4 SD 8.2). 114 implants (experimental group) were placed with insertion torque between 50 and 80 N cm (mean=74.8 SD 7.9). All implants were early loaded after 2 months. Peri-implant marginal bone levels were assessed immediately after surgery, and at 6- and 12-month follow up examinations. At the 12-month follow up all implants were clinically stable. After 12 months, patients in the experimental group lost an average of 0.41 mm (CI 95% 0.522; 0.263) of crestal bone compared with 0.45 mm (CI 95% 0.561; 0.286) for those in the control group. There were no significant differences between the two groups. No direct or inverse relationship was observed between the insertion torque values and crestal bone resorption. The results show that the use of high insertion torque (up to 80 N cm) did not prevent osseointegration and did not increase bone resorption around tapered implants early loaded up to 1 year after implant placement.

Topics: Adult; Aged; Bone Resorption; Cohort Studies; Dental Implantation, Endosseous; Dental Implants; Female; Follow-Up Studies; Humans; Jaw, Edentulous, Partially; Male; Middle Aged; Pressure; Prospective Studies; Torque; Treatment Outcome; Wound Healing

Our objective was to compare survival and peri-implant bone levels of immediately nonocclusally vs early loaded implants in partially edentulous patients up to 12 months after implant placement. Eighty patients (inclusion criteria: general good health, good oral hygiene, 30-65 years old; exclusion criteria: head and neck irradiation/cancer, pregnancy, uncontrolled diabetes, substance abuse, bruxism, lack of opposing occluding dentition, smokers >10 cigarettes/day, need for bone augmentation procedures) were selected in 5 Italian study centers and randomized into 2 groups: 40 patients in the immediately loaded group (minimal insertion torque 30 Ncm) and 40 patients in the early loaded group. Immediately loaded implants were provided with nonoccluding temporary restorations. Final restorations were provided 2 months later. Early loaded implants were provided with a definitive restoration after 2 months. Peri-implant bone resorption was evaluated radiographically with software (ImageJ 1.42). No dropout occurred. Both groups gradually lost peri-implant bone. After 12 months, patients of both groups lost an average of 0.4 mm of peri-implant bone. There were no statistically significant differences (evaluated with t test) between the 2 loading strategies for peri-implant bone level changes at 2 (P = .6730), 6 (P = .6613) and 12 (P = .5957) months or for survival rates (100% in both groups). If adequate primary stability is achieved, immediate loading of dental implants can provide similar success rates, survival rates, and peri-implant bone resorption as compared with early loading, as evaluated in the present study.

Topics: Adult; Aged; Alveolar Bone Loss; Bone Density; Dental Implant-Abutment Design; Dental Materials; Dental Plaque Index; Dental Prosthesis, Implant-Supported; Denture Design; Denture, Partial; Female; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Immediate Dental Implant Loading; Jaw, Edentulous, Partially; Male; Middle Aged; Oral Hygiene; Radiography, Bitewing; Survival Analysis; Titanium; Torque; Treatment Outcome

While immediate loading in the edentulous mandible is a well-documented procedure, there are limited scientific data on immediate loading in the partially edentulous mandible. Two-year success rates of immediate loading and conventional delayed loading of dental implants in partially dentate mandibles were compared. Patients were randomized into three groups: group A (n = 40), immediate provisionalization with nonocclusal loading; group B (n = 40), immediate provisionalization with occlusal loading; and group C (n = 37), delayed loading with single-stage surgery. Baseline and 2-year measurements included implant stability quotient, insertion torque, and peri-implant bone crest radiography. Two hundred nine implants were immediately loaded in 80 patients. The 2-year success rates were 93.3% for group B and 100% for groups A and C. Immediate provisionalization provided success rates similar to those for delayed loading only when not loaded in occlusion.

Topics: Alveolar Process; Bite Force; Dental Implant-Abutment Design; Dental Implantation, Endosseous; Dental Implants; Dental Occlusion; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Denture Design; Denture Repair; Denture, Partial, Temporary; Follow-Up Studies; Humans; Immediate Dental Implant Loading; Jaw, Edentulous, Partially; Mandible; Osseointegration; Prospective Studies; Radiography; Torque; Treatment Outcome

To compare peri-implant bone and soft-tissue levels of immediately non-occlusally loaded versus non-submerged early loaded implants in partially edentulous patients 5 years after implant placement.. Fifty-two patients were randomised in five Italian private practices: 25 in the immediately loaded group and 27 in the early loaded group. To be immediately loaded, single implants had to be inserted with a torque of > 30 Ncm, and splinted implants with a torque of > 20 Ncm. Immediately loaded implants were provided with non-occluding temporary restorations within 48 hours. After 2 months, the provisional restorations were put in full occlusion. Implants were early loaded after 2 months. Final restorations were provided 8 months after implant placement. Outcome measures were prosthesis and implant failures as well as biological and prosthetic complications recorded by non-blinded assessors. Blinded assessors evaluated peri-implant bone and soft-tissue levels.. Fifty-two implants were immediately loaded and 52 early loaded. One patient of the early loaded group dropped out after the 1-year recall. One single immediately loaded implant failed 2 months after placement. Only one complication (iatrogenic peri-implantitis) occurred in one patient of the early loading group. Both groups gradually lost peri-implant bone in a highly statistically significant way at 2, 8 and 14 months and at 4 and 5 years. After 5 years, patients of both groups had lost an average of 1.2 mm of peri-implant marginal bone. There were no statistically significant differences in peri-implant bone and soft-tissue level changes between the 2 groups. At 5 years, there was a statistically significant recession (0.2 mm) of the vestibular soft tissues from baseline (delivery of the final restorations 8 months after implant placement) only for immediately loaded implants.. In well maintained patients, complications are uncommon and healthy and stable periimplant tissues can be maintained for 5 years around immediately and early loaded implants.

Topics: Adult; Aged; Alveolar Bone Loss; Bone Density; Dental Abutments; Dental Implantation, Endosseous; Dental Implants; Dental Implants, Single-Tooth; Dental Occlusion; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Dental Restoration, Temporary; Female; Follow-Up Studies; Gingival Recession; Humans; Jaw, Edentulous, Partially; Male; Middle Aged; Periodontitis; Time Factors; Torque; Treatment Outcome

To compare immediate versus early (6 weeks) non-occlusal loading of dental implants placed flapless in partially edentulous patients 1 year after loading.. Sixty patients were randomised: 30 to the immediately loaded group and 30 to the early loaded group. In order to be immediately loaded, implants were inserted with a minimum torque of > or = 40Ncm. Implants were fully occlusally loaded after 6 months. Outcome measures were prosthesis and implant failures, and biological and biomechanical complications.. Five implants in five patients randomised to the immediately loaded group did not reach the required primary implant stability. Three of these implants (two prostheses) were not immediately loaded. Two patients who were randomised to the early loaded group were immediately loaded erroneously. Implants in five patients of the early loaded group were conventionally loaded. No patient dropped out and there were no failures. Two complications occurred in the early and one in the immediately loaded group (no statistically significant difference), but were solved.. The use of a flapless technique for placing dental implants in conjunction with non-occlusal immediate or early loading in selected patients can provide excellent clinical results. No differences were observed when comparing implants that were loaded immediately or early. Therefore, when a high primary implant stability is obtained, it might be preferable to load the implants immediately rather than waiting for a few weeks.

Topics: Adult; Aged; Biomechanical Phenomena; Bone Density; Crowns; Dental Abutments; Dental Implantation, Endosseous; Dental Implants; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Dental Restoration, Temporary; Female; Follow-Up Studies; Humans; Jaw, Edentulous, Partially; Male; Middle Aged; Osseointegration; Postoperative Complications; Tooth Socket; Torque; Treatment Outcome; Young Adult

To evaluate the efficacy of 7-mm-long flapless placed single implants immediately or early loaded at 6 weeks.. Thirty patients received two single Nanotite External Hex Biomet 3i implants that were then randomised for immediate or early loading. All implants had to be inserted with a minimum torque >40Ncm. Provisional crowns were put in slight occlusal contact and replaced by definitive crowns 3 months after loading. Outcome measures were implant failures, biological and biomechanical complications, peri-implant marginal bone level changes and patient preference.. Twenty-nine implants were immediately loaded and 31 early loaded. Thirteen flaps had to be elevated in 12 patients. Eleven implants in ten patients did not reach the planned insertion torque. Eight implants in seven patients were immediately replaced by implants with a larger diameter, two were loaded anyway, and one implant that was randomised to immediate loading was early loaded instead. Nine months after loading, no drop-out occurred. One implant failed in each group. There were no statistically significant differences between groups for implant losses, complications, mean marginal bone level changes, and patient preferences.. Flapless placed 7-mm-long single implants can be successfully loaded the day of insertion. Longer follow-ups are needed to monitor the long-term prognosis of short implants.

Topics: Adolescent; Adult; Alveolar Bone Loss; Biomechanical Phenomena; Bone Density; Crowns; Dental Abutments; Dental Implantation, Endosseous; Dental Implants, Single-Tooth; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Esthetics, Dental; Female; Follow-Up Studies; Humans; Jaw, Edentulous, Partially; Male; Middle Aged; Patient Preference; Periodontitis; Postoperative Complications; Surgical Flaps; Tooth Socket; Torque; Treatment Outcome; Young Adult

Fifty patients received 151 short, porous-surfaced implants in the partially edentulous maxilla. Periotest values (PTV) were recorded at baseline and after 6 months and 1 and 2 years. For this, prostheses were removed and a standard abutment attached and tightened (20-Ncm force) to each implant. Data analysis indicated significant relationships between time in function vs PTV and implant diameter (3.5, 4.1, or 5.0 mm) vs PTV There was no relationship between PTV and implant length. PTVs were more favorable in the posterior than anterior maxilla, and better PTVs were obtained with nonsplinted as opposed to splinted implants.

Topics: Alloys; Coated Materials, Biocompatible; Crowns; Dental Abutments; Dental Alloys; Dental Implants; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Denture Retention; Denture, Partial, Fixed; Electronics; Follow-Up Studies; Humans; Jaw, Edentulous, Partially; Maxilla; Middle Aged; Multivariate Analysis; Osseointegration; Periodontics; Porosity; Prospective Studies; Stress, Mechanical; Surface Properties; Titanium; Torque

Implant stability is a clinically valuable measurement of the strength of implant anchorage in the bone during placement and in the post-osseointegration period. This study aimed to determine 1) the effect of implant diameter and length and bone quality on measurements of primary and secondary stability (insertion torque [IT] and implant stability quotient [ISQ]), 2) the correlation between IT and primary and secondary ISQ, and 3) differences in ISQ in the post-osseointegration period (secondary stability) compared with immediate post-placement (primary) stability.. In this longitudinal clinical study, titanium self-tapping implants were inserted in edentulous patients. The implants were grouped according to 3 independent variables: length (10 and 11.5 mm), diameter (3.75 and 4.25 mm), and bone quality (Lekholm and Zarb classification) to analyze primary and secondary implant stability (outcome variables). Statistical analyses were performed using the Student t test for paired data, 1-way analysis of variance, and the Tukey procedure for multiple pairwise comparisons.. Data were collected on 88 self-tapping implants inserted in 63 partially edentulous patients. IT and implant stability were affected by diameter (3.75-mm implants, 26.5-N/cm IT and 74.0 ISQ; 4.25-mm implants, 33.8-N/cm IT and 77.0 ISQ) and bone type (type 1 + 2, 34.86-N/cm IT and 77.4 ISQ; type 3, 27.09-N/cm IT and 75.6 ISQ; type 4, 20.63-N/cm IT and 70.5 ISQ; P < .01 for all comparisons). Secondary ISQ was affected by diameter only (77.41 for 3.75- vs 75.51 for 4.25-mm implants). IT correlated with primary ISQ (R = 0.56; P < .01), although no clear correlation with secondary stability was found.. IT and primary ISQ in self-tapping implants differed in patients with different bone quality and implant diameter but did not differ between the 2 implant lengths compared in this study. Secondary stability was not substantially affected by any of these factors. Although IT was closely related to primary ISQ, it was unrelated to secondary ISQ. Very high primary ISQ values tended to decrease, whereas intermediate and low values tended to increase, in the transition to secondary stability.

Topics: Alveolar Bone Loss; Dental Implantation, Endosseous; Dental Implants; Dental Prosthesis Design; Dental Prosthesis Retention; Female; Humans; Jaw, Edentulous, Partially; Longitudinal Studies; Male; Middle Aged; Osseointegration; Titanium; Torque; Treatment Outcome

Subjective radiographic classifications of alveolar bone have been proposed and correlated with implant insertion torque (IT). The present diagnostic study aims to identify quantitative bone features influencing IT and to use these findings to develop an objective radiographic classification for predicting IT.. Demographics, panoramic radiographs (taken at the beginning of dental treatment), and cone-beam computed tomographic scans (taken for implant surgical planning) of 25 patients receiving 31 implants were analyzed. Bone samples retrieved from implant sites were assessed with dual x-ray absorptiometry, microcomputed tomography, and histology. Odds ratio, sensitivity, and specificity of all variables to predict high peak IT were assessed.. A ridge cortical thickness >0.75 mm and a normal appearance of the inferior mandibular cortex were the most sensitive variables for predicting high peak IT (87.5% and 75%, respectively). A classification based on the combination of both variables presented high sensitivity (90.9%) and specificity (100%) for predicting IT.. Within the limitations of this study, the results suggest that it is possible to predict IT accurately based on radiographic findings of the patient. This could be useful in the treatment plan of immediate loading cases.

Topics: Absorptiometry, Photon; Adult; Aged; Alveolar Process; Biomechanical Phenomena; Biopsy; Bone Density; Cone-Beam Computed Tomography; Dental Implantation, Endosseous; Dental Implants; Female; Follow-Up Studies; Forecasting; Humans; Image Processing, Computer-Assisted; Jaw, Edentulous, Partially; Male; Mandible; Maxilla; Middle Aged; Radiography, Dental, Digital; Radiography, Panoramic; Sensitivity and Specificity; Torque; X-Ray Microtomography

To evaluate the clinical and radiological performance of an immediately loaded novel implant design over a 3-year period.. This prospective study includes 54 consecutive partially edentulous patients treated between December 2010 and October 2011. Outcome measures were: implant and prosthetic failures; biological and mechanical complications; marginal bone loss (MBL); sulcus bleeding index (SBI); and plaque score (PS).. A total of 118 (29 narrow platform, 70 regular platform and 19 wide platform) NobelReplace Conical Connection implants were placed in both post-extraction sockets and healed sites and immediately loaded. The mean insertion torque was 63.4 ± 7.1 Ncm. One hundred out of 118 implants (84.7%) were inserted with a torque ranging between 55 and 70 Ncm. Each patient received a single prosthesis. At the 3-year follow-up, no patient dropped out and only two post-extractive implants failed (1.7%) in two patients (3.7%). The only complication (1.9%) observed was an event of periimplantitis, consisting of a mean mesiodistal peri-implant bone loss of 3.2 mm reported in a healed site of a smoker patient at the 2-year follow-up examination. No prosthesis failures were detected. The cumulative mean MBL between implant placements at the 3-year follow-up was 0.68 mm (95% CI: 0.44, 0.92). At the 3-year follow-up session, the SBI and PS were 5.7% and 15.4%, respectively.. The NobelReplace Conical Connection implant can be considered as a valuable treatment option for immediate implant placement and loading in the partially edentulous patients over a 3-year period. Insertion torques ranging between 55 and 70 Ncm are not detrimental to osseointegration.

Topics: Adult; Aged; Aged, 80 and over; Alveolar Ridge Augmentation; Bone Substitutes; Cohort Studies; Dental Implant-Abutment Design; Dental Implants; Dental Plaque Index; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Female; Follow-Up Studies; Humans; Immediate Dental Implant Loading; Jaw, Edentulous, Partially; Male; Middle Aged; Minerals; Peri-Implantitis; Periodontal Index; Prospective Studies; Tooth Socket; Torque; Treatment Outcome; Young Adult

To evaluate the short- and mid-term effects of commercial pure (cp) titanium implant surface topography on osseointegration, bone-regenerative potential and mechanical retention in the human maxilla and mandible.. 32 micro-implants with the same geometry but with four different surface treatments were implanted in the maxilla and mandible of eight patients. Each patient received four micro-implants, one of each type. Percentage of bone-to-implant contact analysis and histological evaluation was carried 3, 6 and 12 weeks after implantation. Furthermore, reverse removal torque tests were conducted 3 and 6 weeks after implantation to analyze functional bone attachment. Implant surfaces tested were: machined, grit-blasted, acid-etched, and grit-blasted with acid-etch. One-way ANOVA was performed using the multiple comparison Fisher's test to determine significance of observed differences among test groups. The level of significance was established at 5% (P < 0.05). Mean and standard deviations of the test groups were calculated.. Surface roughness had a significant correlation with the evolution of bone regeneration. The surfaces with roughness Ra approximately 4 microim (grit-blasted and grit-blasted with acid-etch), showed rapid tissue colonization compared to machine and acid-etched surfaces. The results of reverse removal torque tests confirmed a significant correlation between surface roughness and functional bone attachment. Grit-blasted and grit-blasted with acid etched surfaces showed higher retention values compared to machine and acid-etched implants. This finding was supported by higher bone-to-implant contact observed for rougher surfaces (grit-blasted and grit-blasted with acid etching).

Topics: Acid Etching, Dental; Adult; Aluminum Oxide; Bone Regeneration; Dental Etching; Dental Implants; Dental Materials; Dental Prosthesis Design; Dental Prosthesis Retention; Female; Follow-Up Studies; Humans; Hydrofluoric Acid; Immediate Dental Implant Loading; Jaw, Edentulous, Partially; Male; Mandible; Maxilla; Microscopy, Electron, Scanning; Miniaturization; Osseointegration; Surface Properties; Titanium; Torque

To investigate in vivo the correlation between the bone microarchitecture of implant bone sites, bone tissue classification subjectively assessed in radiographs and primary implant stability.. Periapical and panoramic radiographs were obtained from 32 partially edentulous patients. Three surgeons classified bone quality at implant sites using two different methods: assessments in periapical and panoramic radiographs (PP) and according to the classification proposed by Lekholm and Zarb (L&Z). During the implant insertion, bone biopsies were taken, and three-dimensional parameters were measured by microcomputed tomography (microCT). Insertion torque value (ITV) and initial implant stability quotient (ISQ) were recorded at the moment of the implantation. ISQ was also recorded at the uncovering stage of a traditional implant protocol.. Bone types 2 and 3 were the most prevalent classifications according to PP (54.3%) and L&Z (58.7%). The mean and standard deviation values of primary stability variables were 38.7(16.7) for ITV, 75.3 (7.7) for initial ISQ and 79.3 (6.8) for uncovering ISQ. Several microCT original and factor variables were found to correlate with bone tissue classifications and primary stability variables. L&Z correlated with architecture (r = 0.31; P < 0.05), density (r = -0.43; P < 0.01) and bulk (r = -0.35; P < 0.05), whereas ITV correlated with architecture (r = -0.40; P < 0.01) and density (r = 0.51; P < 0.01). Multiple linear regression analysis revealed that density and bulk explained 32% of the variability of L&Z bone classification, while density and architecture explained 42% of the variability of ITV.. This study demonstrates the first step in validating L&Z classification. MicroCT provides objective and detailed quantitative data on bone microarchitecture. Intraosseous implant stability is mainly determined by the density of the bone. ITVs could be a good indicator of primary implant stability, whereas ISQs measurements have some limitations and should not be used alone.

Topics: Adult; Bone Density; Dental Implantation, Endosseous; Dental Implants; Dental Prosthesis Design; Female; Humans; Jaw, Edentulous, Partially; Male; Mandible; Maxilla; Radiography, Panoramic; Torque; X-Ray Microtomography

This study describes a new procedure for sinus elevation using computer-guided planning and guided surgical approach through the use of computer-aided design (CAD)/computer-aided manufacturing (CAM)-generated surgical template in combination with expander-condensing osteotomes thus providing a minimally invasive surgical technique.. Sixty-six consecutive patients were treated with 136 implants placed by transcrestal-guided sinus floor elevation technique and the patients were followed for at least 3 years in function. The drilling protocol is customized based on the bone density of each implant site to achieve an insertion torque ranging between 45 and 55 Ncm. Titanium temporary abutments were connected to the implants with prosthetic screws tightened to 35 Ncm and an acrylic resin provisional restoration was adapted and delivered immediately. Six months after initial loading, a definitive CAD/CAM-generated restoration was delivered. Outcome measurements assessed were implant and prosthesis survival rate, biological or biomechanical complications, marginal bone level changes, total alveolar ridge bone height before and after procedure, periodontal parameters measured as well as patient's perception of pain levels during recovery period.. Mean follow-up was 43.96 (range from 36 to 52) months. Cumulative implant survival rate was 98.53% at 3 years. No biological or mechanical complications were encountered and no prosthetic failures occurred during the entire follow-up period. Mean marginal bone loss (MBL) during the first year of function was 0.33 ± 0.36 mm, while at the 3-year follow-up, the mean MBL was 0.51 ± 0.29 mm. The mean residual bone height of the alveolar crest prior to grafting was of 6.7 ± 1.6 mm (range 5.1-9.2 mm), while, the mean bone height gained was 6.4 ± 1.6 mm (range 3.2-8.1 mm). All patients reported low levels of pain and found to have normal periodontal parameters.. This proof-of-concept study suggests that the use of guided surgery to perform transcrestal maxillary sinus floor elevation for alveolar ridge height augmentation is a successful minimally invasive technique for the short- to medium-term follow-up, thus avoiding the extended treatment time and morbidities associated with maxillary sinus floor augmentation.

Topics: Adult; Aged; Bone Density; Female; Humans; Immediate Dental Implant Loading; Jaw, Edentulous, Partially; Male; Maxillary Sinus; Middle Aged; Minimally Invasive Surgical Procedures; Pain Measurement; Periodontal Index; Prospective Studies; Radiography; Sinus Floor Augmentation; Surgery, Computer-Assisted; Torque; Treatment Outcome

Primary stability can be improved by using a tapered implant in a slightly underprepared implant site. This may lead to high compression forces and elevated insertion torques. It has been postulated that disturbance of the local microcirculation may occur, leading to necrosis of the osteocytes and bone resorption.. Report on the clinical outcome of 42 implants placed with an insertion torque equal or greater than 70 Ncm and evaluate bone levels around these implants.. This prospective study included 48 patients treated with 66 4.5 mm diameter Tapered Screw-Vent implants (Zimmer Dental®, Carlsbad, CA, USA). Maximum insertion torque (MIT) was recorded with an electronic torque measuring device (Tohnichi® STC200CN, Hitachi, Tokyo, Japan). Nine implants (control group) presented MIT between 30 and 50 Ncm (mean = 37.1 Ncm) and 42 implants (experimental group) MIT greater than 70 Ncm (mean = 110.6 Ncm, range: 70.8-176 Ncm). Marginal bone levels were recorded at the time of loading and 1 year later for the two groups.. After 2-3 months of non-sumerged healing, all implants were clinically stable. Mean marginal bone resorption was 1.03 mm (SD = 0.44) for the control group (low torque) and 0.72 mm (SD = 0.56) for the experimental group (high torque) at time of loading, and 1.09 (SD = 0.62) and 1.24 mm (SD = 0.75), respectively, after 1 year. There were no significant differences between the two groups for bone stability and implant success rate.. The use of high insertion torques (up to 176 Ncm) did not prevent osseointegration. Marginal bone levels in the control and experimental groups were similar both at the time of loading and 1 year later.

Topics: Adult; Aged; Aged, 80 and over; Alveolar Bone Loss; Alveolar Process; Dental Implantation, Endosseous; Dental Implants; Dental Prosthesis Design; Dental Prosthesis Retention; Female; Follow-Up Studies; Humans; Jaw, Edentulous, Partially; Male; Mandible; Maxilla; Middle Aged; Osseointegration; Prospective Studies; Torque; Treatment Outcome

Passive fit of a long-span screw-retained implant prosthesis is an important criteria for the success of the restoration. This article describes a technique for fabricating a ceramometal implant fixed dental prosthesis (FDP) for a long-span partially edentulous situation by altering the conventional screw-retained design. The possibility of a passive fit is maximized by intraoral luting of the cast frame to milled abutments, and the potential framework distortion during fabrication is compensated to a major extent. Retrievability is ensured by screw retention of the prosthesis to the implants. Compared with conventional porcelain fused to metal screw-retained FDP, this prosthesis is relatively inexpensive to fabricate.

Topics: Cementation; Composite Resins; Dental Implant-Abutment Design; Dental Implantation, Endosseous; Dental Implants; Dental Impression Technique; Dental Marginal Adaptation; Dental Porcelain; Dental Prosthesis, Implant-Supported; Denture Design; Denture Retention; Denture, Partial, Fixed; Humans; Jaw Relation Record; Jaw, Edentulous, Partially; Maxilla; Metal Ceramic Alloys; Resin Cements; Torque

Evaluation of the effect of different span length and preparation designs on the fracture load of tooth-implant-supported fixed dental prostheses (TIFDPs) manufactured from yttrium-stabilized zirconia frameworks.. Forty-eight TIFDPs were manufactured using a CAD/CAM system and veneered with a press ceramic. Rigidly mounted implants (SLA, diameter 4.1 mm, length 10 mm) in the molar region with a titanium abutment were embedded in PMMA bases pairwise with premolars. All premolars were covered with heat-shrink tubing to simulate physiological tooth mobility. Six different test groups were prepared (a) differing in the preparation design of the premolar (inlay [i]; crown [c]), (b) the material of the premolar (metal [m]; natural human [h]) and (c) the length of the TIFDPs (3-unit [3]; 4-unit [4]). All TIFDPs underwent thermomechanical loading (TCML) (10,000 × 6.5°/60°; 6 × 10(5) × 50 N). The load to fracture (N) was measured and fracture sites were evaluated macroscopically.. None of the restorations failed during TCML. The mean fracture loads (standard deviations) were 1,522 N (249) for the 3-unit, inlay-retained TIFDPs on a metal abutment tooth (3-im), 1,910 N (165) for the 3-cm group, 1,049 N (183) for group 4-im, 1,274 N (282) for group 4-cm, 1,229 N (174) for group 4-ih and 911 N (205) for group 4-ch. Initial damages within the veneering ceramic occurred before the final failure of the restoration. The corresponding loads were 24-52% lower than the fracture load values.. All restorations tested could withstand the mastication forces expected. Fracture-load values for 3- and 4-unit inlay-crown and crown-crown-retained TIFDPs should spur further clinical investigation.

Topics: Bite Force; Cementation; Computer-Aided Design; Dental Abutments; Dental Materials; Dental Porcelain; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Dental Stress Analysis; Denture, Partial, Fixed; Humans; Jaw, Edentulous, Partially; Materials Testing; Models, Dental; Statistics, Nonparametric; Titanium; Torque; Yttrium; Zirconium

To evaluate the incidence of prosthetic complications in implant-retained crowns made with UCLA castable abutments and to identify possible risk factors with a view to establishing recommendations to help predict the success of such restorations.. A cohort follow-up study was carried out in 71 partially dentate patients rehabilitated with 93 implant-retained single crowns. Data regarding socio-demographic background, anatomical features, implant-, and prosthesis-related variables were recorded. The incidence rate (%), relative risk (RR) and odds ratio (OR) were applied for predictive risk factors. ANOVA and Student t-tests were used to compare quantitative variables, the chi-square test was used to compare proportions and also a logistic regression analysis was performed. The statistical significance was set at α = 0.05.. Two implants (2.2%) were lost during the first year of function. The incidence of prosthetic complications in the observed mean period (26.2 ± 15.4 months) was 11.9%, consisting of screw loosening (10.8%) and ceramic fracture (1.1%). A higher tendency for prosthetic complications was noticed in posterior mandibular crowns restoring saddles longer than 10 mm with mesiodistal cantilevers longer than 6mm, having natural antagonists, after long-term use (>20 months), with initial torque values superior than 30 Ncm.. Screw loosening is the most frequent complication in implant-retained crowns fabricated with UCLA abutments cast in cobalt-chromium. Nevertheless, the connection usually remains stable after retightening the screws. A high survival rate was recorded, and these prostheses may be a suitable treatment option.. Based on the study findings, the risk of prosthetic complications is expected to increase when long-span posterior edentulous areas are rehabilitated with single implant-supported crowns. The antagonist occlusal plane should be restored to prevent torsional forces and overloading. Implant systems with initial torque values less than 30 Ncm should be selected.

Topics: Adult; Aged; Cementation; Chromium Alloys; Cohort Studies; Crowns; Dental Casting Technique; Dental Implant-Abutment Design; Dental Implants, Single-Tooth; Dental Porcelain; Dental Prosthesis Design; Dental Prosthesis Retention; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Female; Follow-Up Studies; Humans; Jaw, Edentulous, Partially; Male; Metal Ceramic Alloys; Middle Aged; Osseointegration; Risk Factors; Smoking; Survival Analysis; Torque; Torsion, Mechanical; Treatment Outcome

To introduce a new strain gauge approach to assess the fit of fixed implant frameworks.. A partially edentulous epoxy resin mandible model received two Straumann implants in the area of the lower left second premolar and second molar. The model was used to fabricate four zirconia and four identical cobalt-chromium alloy frameworks using a laboratory computer-aided design/computer-aided manufacturing (CAD/CAM) system. A total of four linear strain gauges were then bonded around each implant on the peri-implant structure (mesial, distal, buccal, and lingual). The experimental part was composed of two phases: qualitative and quantitative. For the qualitative assessment, the model was verified by recording the response of each strain gauge while applying a near-constant force of known directions on each implant. For the quantitative phase, the frameworks were attached on the implants and the screws were torqued to 15 N cm.. In the qualitative phase, the strain gauge response to every force direction was recorded. After attaching the frameworks, all frameworks produced measurable strains, but with different strain patterns. Upon correlating the two phases, the zirconia frameworks were found to be slightly smaller than the inter-implant distance, whereas the cobalt-chromium alloy frameworks tended to be slightly larger than the inter-implant distance.. The proposed technique is not only valid for detecting implant framework misfit but also for determining the form of inaccuracies. Model verification is an essential informative step to aid the interpretation of the pattern of framework distortion.

Topics: Chromium Alloys; Computer-Aided Design; Dental Implants; Dental Marginal Adaptation; Dental Materials; Dental Prosthesis, Implant-Supported; Dental Stress Analysis; Denture Design; Denture, Partial, Fixed; Humans; Jaw, Edentulous, Partially; Mandible; Materials Testing; Models, Anatomic; Stress, Mechanical; Surface Properties; Torque; Transducers; Zirconium

To evaluate the survival rate of implants placed in the maxillary tuberosity region using the fixed prosthesis in partially edentulous cases.. Of implant-treated patients who visited Kyung Pook National University Hospital, 7 partially edentulous patients (2 male and 5 female; mean age, 52.3 years; range, approximately 43 to 65) were selected according to the following criteria: 1) less than 3-mm thickness alveolar bone reaming at the first molar area and 2) 1 to 2 fixture premolars, with the additional implant at the maxillary tuberosity region. For the control group, patients who had nontuberosity areas were selected. After 1 to 7 years, marginal bone level, fixture mobility, and radiolucency of tuberosity fixtures of the fixed prostheses were evaluated by digital panorama (Starpacs, Infinitt, Seoul, Korea).. None of the fixtures of the tuberosity-installed implants for 1 to 7 years failed. The marginal bone level around the implants of the maxillary tuberosity 1 to 6 years (average 3.4 years) after the final prostheses was approximately 0.6 to 1.3 mm, with an average of 0.94 mm.. The fixture installation at the maxillary tuberosity using the unilateral partially edentulous implant-fixed prosthesis would be a clinically acceptable treatment module.

Topics: Adult; Aged; Alveolar Bone Loss; Anodontia; Dental Implantation, Endosseous; Dental Prosthesis Design; Dental Prosthesis Retention; Dental Prosthesis, Implant-Supported; Dental Stress Analysis; Denture, Partial, Fixed; Female; Humans; Jaw, Edentulous, Partially; Kaplan-Meier Estimate; Male; Maxilla; Middle Aged; Molar; Periodontal Splints; Radiography, Panoramic; Retrospective Studies; Torque

The objective of this retrospective study was to evaluate the overall success of immediately loaded implants in the mandible. This report focuses on immediately loaded anterior and posterior mandibular implants.. A total of 979 patients received 2,904 mandibular dental implants placed from January 2007 to December 2008. One hundred sixty-one of the implants were placed anterior to the mental foramen, and 95 were placed posterior to the mental foramen. All immediately loaded implants were torque tested to 35 N-cm. All were provisionally restored the day of insertion.. A total of 256 immediately loaded mandibular dental implants were placed in a 2-year period. Of the 256 immediately loaded implants, 252 integrated and were restored and 4 failed. Of the 4 failed implants, 3 were in the anterior mandible and the fourth was in the posterior mandible. All 4 were replaced, integrated, and have been restored. The survival rate for immediately loaded implants in the anterior mandible was 99.4%, and the survival rate in the posterior mandible was 97%.. Immediately loaded implants have predictable clinical success in the anterior and posterior mandible.

Topics: Dental Abutments; Dental Implants; Dental Occlusion; Dental Prosthesis Design; Dental Prosthesis Retention; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Follow-Up Studies; Humans; Jaw, Edentulous; Jaw, Edentulous, Partially; Mandible; Osseointegration; Retrospective Studies; Survival Analysis; Time Factors; Torque; Treatment Outcome

The purpose of this study was to observe the clinical outcome of bone spreading and standardized dilation of horizontally resorbed bone during immediate implant placement using a "screw-type" configuration of expansion and threadformers. Fifty-three patients were included in this study, and 41 edentulous areas in anterior and posterior maxillas were treated. Sixty-eight implants were placed using an insertion torque of at least 40 Ncm. Abutments were delivered 4 to 6 months after implant placement. The overall failure percentage was 4.41% (3 failures). A retrieved analysis of 1 implant removed at 3 years after placement demonstrated bone resorption down to the level of the third thread. The bone spreader technique is different from Summers' osteotome, both in clinical use and in armamentarium. The main advantage of the crest-expanding technique is that it is a less invasive procedure; the facial wall expands after the medullary bone is compressed against the cortical wall. Within the limits of this preliminary study, the cumulative survival rate for this method of implant placement is 95.58% at 3 years. This study confirms that a bone spreader used in the maxilla shows an unusually low failure rate after 3 years.

Topics: Adult; Alveolar Ridge Augmentation; Bone Resorption; Dental Abutments; Dental Implantation, Endosseous; Dental Implants; Dental Restoration Failure; Dilatation; Female; Follow-Up Studies; Humans; Jaw, Edentulous, Partially; Male; Maxilla; Middle Aged; Minimally Invasive Surgical Procedures; Surgical Flaps; Survival Analysis; Torque; Treatment Outcome; Wound Healing