Single and partial tooth replacement with fixed dental prostheses supported by dental implants: A systematic review of outcomes and outcome measures used in clinical trials in the last 10 years.

AIM: To evaluate outcome measures, methods of assessment, and analysis in clinical studies on fixed single- and multiple-unit implant restorations. MATERIALS AND METHODS: Three independent electronic database searches (MEDLINE, EMBASE, and Cochrane) were done to identify prospective and retrospective clinical studies published from January 2011 up to June 2021 with ≥20 patients and minimum 1-year follow-up period on technical and clinical outcomes of implant-supported single crowns (SCs) and partial fixed dental prostheses (P-FDPs). An entire data extraction was performed to identify primarily the most reported outcome measures and later to define the choice of assessment methods of those outcome measures. The outcomes were analysed descriptively, and the strength of association was evaluated using the Pearson chi-square test (p ≤ .05). RESULTS: In a total 531 studies, 368 on SCs (69.3%), 70 on P-FDPs (13.1%), and 93 on both restoration types (17.5%) were included; 56.3% of all studies did not clearly define a primary outcome. The most frequent primary outcome was marginal bone level (MBL) (55.2%) followed by implant survival (5.3%), professional aesthetic evaluation (3.4%), and technical complications (2.1%). Peri-implant indices were the most reported secondary outcome (55.1%), followed by implant survival (39.9%), MBL (36%), and implant success (26.4%). Prosthetic failure (seven studies [3.9%]) was one of the least reported outcome measures. CONCLUSIONS: Outcome measures and their assessment methods showed high heterogeneity among studies. Primary outcomes were not often defined clearly, and the most frequently selected primary outcome was marginal bone loss. Prosthetic outcomes, implant survival, and patient-related outcomes were only infrequently reported.

Single and partial tooth replacement with fixed dental prostheses supported by dental implants: A systematic review of outcomes and outcome measures used in clinical trials in the last 10 years.

AIM: To evaluate outcome measures, methods of assessment, and analysis in clinical studies on fixed single- and multiple-unit implant restorations. MATERIALS AND METHODS: Three independent electronic database searches (MEDLINE, EMBASE, and Cochrane) were done to identify prospective and retrospective clinical studies published from January 2011 up to June 2021 with ≥20 patients and minimum 1-year follow-up period on technical and clinical outcomes of implant-supported single crowns (SCs) and partial fixed dental prostheses (P-FDPs). An entire data extraction was performed to identify primarily the most reported outcome measures and later to define the choice of assessment methods of those outcome measures. The outcomes were analysed descriptively, and the strength of association was evaluated using the Pearson chi-square test (p ≤ .05). RESULTS: In a total 531 studies, 368 on SCs (69.3%), 70 on P-FDPs (13.1%), and 93 on both restoration types (17.5%) were included; 56.3% of all studies did not clearly define a primary outcome. The most frequent primary outcome was marginal bone level (MBL) (55.2%) followed by implant survival (5.3%), professional aesthetic evaluation (3.4%), and technical complications (2.1%). Peri-implant indices were the most reported secondary outcome (55.1%), followed by implant survival (39.9%), MBL (36%), and implant success (26.4%). Prosthetic failure (seven studies [3.9%]) was one of the least reported outcome measures. CONCLUSIONS: Outcome measures and their assessment methods showed high heterogeneity among studies. Primary outcomes were not often defined clearly, and the most frequently selected primary outcome was marginal bone loss. Prosthetic outcomes, implant survival, and patient-related outcomes were only infrequently reported.

The Influence of Prosthesis Design on the Outcomes of Tooth Implants Immediately Placed and Loaded by Means of One-Piece Titanium Machined Restoration.

Our purpose was to evaluate the occurrence of complications and the degree of bone loss in a cohort of patients treated with fixed prostheses supported by immediately loaded dental implants. The primary aim was to compare partial versus full-arch fixed dental prostheses. We then tested the effect of sinus lifting. In the present retrospective cohort study, the patients had their implants restored with fixed dental prostheses supported by dental implants positioned in the posterior maxilla and mandible. When necessary, the maxillary sinuses were grafted with particulate autogenous bone. Patients were then ranked according to the following predictors: length of prosthesis, crown-to-implant ratio, number of crowns to number of implants ratio, and presence of sinus lifting. Outcomes were evaluated for up to 2 years regarding the peri-implant marginal bone loss and implant/prosthesis survival rates. Fifty-eight subjects (209 implants) were rehabilitated with 25 fixed full-arch prostheses and 33 partial fixed dental implant bridges (16 supported by implants placed in grafted sinus). The mean marginal bone loss for implants supporting partial fixed dental prostheses amounted to 0.81 mm, whereas that for implants within the group of full-arch fixed dental prostheses was 1.21 mm; the comparison of the levels in the 2 groups showed a significant difference ( P = .0055). A statistically significant difference ( P = .0006) was found between the bone loss around maxillary implants (1.53 mm) and the bone loss around mandibular implants (1.10 mm). Two implants and 4 prostheses failed; 2-year survival rates of partial and of full-arch fixed dental prostheses, respectively, were 94.1% and 96%. Bone loss in full-arch prostheses appeared to be higher than in that of partial prosthesis. Implant-supported prostheses in the maxillae exhibited a bone loss higher than that registered in mandibles.

Clinical evaluation of small diameter straumann implants in partially edentulous patients: a 5-year retrospective study.

OBJECTIVE: The aim of the present study was to retrospectively evaluate small-diameter (3.3 mm) Straumann® dental implants placed in the maxilla or the mandible over a period of 5 years in function. MATERIALS AND METHODS: Twenty-eight partially edentulous patients received a total of 48 implants over a 5-year period. After the standard healing period (3 to 6 months), the implants were restored with single-tooth prostheses or fixed partial dentures. All patients were followed according to a strict maintenance program with regular recalls. The cumulative survival rates of implants were analyzed and prosthetic complications were assessed. RESULTS: After 5 years of function, one single 10-mm-long implant in the maxillary premolar region was lost because of recurrent peri-implant infection in a female patient. Two single 10-mm-long maxillary implants placed in the posterior region were lost due to body fracture. The cumulative 5-year survival rate of the implants was 93.75 %. The most common prosthetic complication was loosening of the occlusal screw. CONCLUSION: Within the limited observation period and the number of patients included in this study, it may be concluded that the use of small-diameter implants appears to be predictable if clinical guidelines are followed and appropriate prosthetic restorations are provided. However, it should be noted that fatigue fracture may occur.

Distribución de esfuerzos en tramos protésicos fijos de cinco unidades con pilar intermedio: análisis biomecánico utilizando un modelo de elementos finitos / Distribución de esfuerzos en tramos protésicos fijos de cinco

Introducción: el presente estudio pretendió determinar el comportamiento mecánico entre tramos protésicosrígidos y no rígidos de una prótesis fija de cinco unidades con pilar intermedio utilizando el análisis de elementos finitos (AEF) Métodos: se diseñó un modelo rígido de cinco unidades con 124,469 nodos y 76,215 elementos y un modelo no rígido con 125,130 nodos y 77,396 elementos, conformados por hueso esponjoso, hueso cortical, ligamento periodontal, pulpa, dentina,raíz, cemento resinoso, coronas metal-cerámica y ajuste tuve-lock (Sterngold®, Implamed Attleboro MA). El tramo protésico comprendió un incisivo central, un incisivo lateral, un canino, un primer premolar y un segundo premolar superior. Se aplicóuna fuerza de 200 N con dirección oblicua y vertical. Las variables incluidas en el modelado fueron módulo de elasticidad, razón de Poisson y el ajuste no rígido. Fueron calculados los esfuerzos von Misses, máximos principales y mínimos principalespara cada grupo. Resultados y conclusiones: el análisis del comportamiento mecánico indicó que en el tramo protésico rígidohubo mejor distribución de los esfuerzos en relación con el modelo no rígido. El comportamiento de cada grupo indicó que el modelo rígido transmitió menos esfuerzo a la raíz y al hueso subyacente. La influencia de poner un ajuste no se justificaría según los resultados de este estudio.

Introduction: the purpose of this study is to establish the mechanical behavior between rigid and non-rigid fixeddental prosthesis of five units with an intermediate abutment using the finite element analysis (FEA). Methods: a five unit rigid model with 124.469 nodes and 76.215 elements and a non-rigid model with 125.130 nodes and 77.396 elements were designed. It consisted of trabecular bone, cortical bone, periodontal ligament, pulp, dentine, root, resinous cement, metal ceramic crowns and tube-lock adjustment (Sterngold®, Implamed Attleboro MA). The fixed dental prosthesis included a central incisor, lateral incisor, canine, first and second upper premolars. A force of 200 N was applied with an oblique and vertical direction. The variables included in the model were modulus of elasticity, Poisson’s ratio and non-rigid adjustment. Von Misses stresses, main, maximum and minimum, were calculated for each group. Results and conclusions: the analysis of the mechanical behavior indicated that the rigid fixed dental prosthesis showed a better distribution of the stresses in comparison with the non-rigid model. The behaviorof each group indicated that the rigid model transmitted less stress to the underlying root and bone. The indication to use an adjustment would not be justified according to the results of this study.

A importância do planejamento protético em Implantodontia / The importance of prosthetic treatment planning on implant dentistry: a case report

Em reabilitações orais extensas devemos buscar uma visão multidisciplinar durante o diagnóstico, prognóstico e plano de tratamento a fim de proporcionar um resultado que tenha boa previsibilidade e atenda as expectativas estéticas e funcionais do paciente que vai se submeter ao tratamento. Para tal, o correto planejamento é de fundamental importância. Este caso clínico apresenta um paciente com 58 anos, diabético controlado, com infarto de miocárdio há mais de seis meses, apresentando-se bastante insatisfeito com o trabalho que havia sido finalizado há pouco tempo. Observamos uma severa alteração do plano oclusal, próteses sobreimplantes com falta de adaptação, ausência de intermediários protéticos, comprometimento gengival nas regiões peri-implantares, a prótese com cantiléver distal no hemiarco superior direito com invasão do espaço biológico e recidiva de cárie nos pré-molares, grande comprometimento estético e severo comprometimento psicológico. O plano de tratamento incluía moldagem, modelo de estudo, jig, chapa de prova com registro em cera, montagem em ASA, em RC, enceramento diagnóstico, raspagem e polimento coronário, instalação de componentes protéticos do tipo pilar cônico, regulares e angulados (Neodent), provisórios sobreimplante, cirurgia de levantamento de seio maxilar direito e instalação de implantes (Neodent), núcleo metálico fundido em ouro, moldagens com casquetes, moldagens de transferência, pontos de solda e restaurações finais em metalocerâmica. Foi possível concluir que em um trabalho de reabilitação oral, o planejamento é de fundamental importância para que obtenhamos um prognóstico favorável e uma condição clínica ótima para a realização do trabalho, proporcionando a satisfação do paciente.

In complex oral rehabilitation work, we must seek a multidisciplinary vision for the diagnosis, prognosis, and treatment, providing a result that has good predictability and meets the aesthetic and functional expectations of the patient. For this, a sound treatment planning is important. This case presents a 58 years-old patient, metabolically controlled for diabetes mellitus, with myocardial infarction of more than six months, being quite dissatisfied with the a recent work. We noticed severe change of the occlusal plane, lack of fit at the implant-supported prosthesis, peri-implant inflammation, and impingement of biological width at the prosthesis with distal cantilever on the upper right quadrant; biological recurrence of caries in premolars, great aesthetic and severe psychological impairment. The treatment planning included confection of study models study and wax rims for centric relation registration in a semi-adjustable articulator, scaling and polishing at the coronal level, abutment installation, surgical removal of the right maxillary sinus and implant placement, as well as traditional procedures for definitive ceramic restorations. It can be concluded that treatment planning is very important to achieve a favorable prognosis and patient satisfaction.