9-Year Follow-Up on Maxillofacial Implant-Supported Framework Designed to Accommodate Childhood Growth.

This clinical report focuses on the challenges and solutions for a child subjected to craniofacial trauma from a wild hyena biting off his nose and anterior maxilla. Unique considerations in prosthodontics and biomedical engineering were required based on future craniofacial growth and development of the child. The physical requirement of a maximum retentive prosthesis for an active, athletic child required unique engineering designs and executions. The sequence of treatment and prosthesis fabrication are detailed. The patient has been followed for 9 years without physiologic complications and only minor prosthodontic complications.

Incidental Findings in Cone Beam Computed Tomography for Dental Implants in 1002 Patients.

PURPOSE: The purpose of this study is to analyze the frequency and elevate the awareness of the prevalence of nondental pathology in cone beam computed tomography (CBCT) scans taken for implant placement treatment planning and postplacement evaluation. The data from the CBCT should be read by an oral and maxillofacial radiologist for proper diagnosis of dental and nondental pathology and referred to the medical specialist for proper management when necessary. MATERIALS AND METHODS: This retrospective study analyzed 1002 consecutive CBCT scans taken at a single private practice noting the prevalence of nondental pathology in CBCT images for all dental implant procedures. All scans were taken from November 2007 to March 2020. One board certified oral and maxillofacial radiologist systemically read all scans and reported all findings in the maxilla and mandible, condyles and TMJ, paranasal sinuses, nasal fossa, pharyngeal airway, skull base and temporal bone, neck soft tissues, and cervical spine. The incidental findings, variation of normal anatomy, or pathology reported in these structures were categorized based on anatomic location and significance and the incidence was investigated. RESULTS: Pathologies ranged from innocuous sinusitis, to more serious atherosclerotic calcification of the carotid arteries, narrowed airways, and neoplastic lesions. Fifty-one different findings were noted, of which 36 were pathologies that required referral or follow-up. CONCLUSIONS: Incidental findings can be detected in CBCT scans for dental implants. The clinician must be familiar with the radiographic diagnosis of head and neck pathology, and/or must refer these images to an appropriate specialist for the radiographic interpretation of the full volume.

Relationship between Radiographic Misfit and Clinical Outcomes in Immediately Loaded Complete-Arch Fixed Implant-Supported Prostheses in Edentulous Patients.

PURPOSE: To examine if an uncorrected radiographically detected immediate postoperative misfit (implant level or abutment level) in immediately loaded conversion prosthesis plays a significant role in early implant or prosthesis failure. In addition, clinical characteristics related to type of arch, implant position, type of implant, implant orientation, type of connection, and type of surgery were analyzed relative to their relationship to early implant or prosthesis failure. MATERIALS AND METHODS: Immediate postoperative and subsequent follow-up panoramic radiographs of 425 arches with immediately loaded complete-arch fixed implant-supported prostheses were screened in a retrospective analysis. Implants with misfit and nonmisfit within a given arch were summarized separately with respect to each clinical characteristic and the difference between misfit and nonmisfit groups was tested using a mixed-effects logistic regression model with a patient-specific random intercept. A p-value <0.05 was determined to be statistically significant. RESULTS: A total of 2025 implants from 311 patients were identified in the 425 arches that were screened for radiographic misfit. A total of 48 implants with misfit were found within 33 arches (23 patients) for a 2.4% prevalence rate. Among the misfit implants, two failures were documented during the healing phase for an early implant survival rate of 95.8%. Five conversion prostheses with misfit fractured during the healing phase for early prosthesis survival rate of 84.8%. None of the clinical variables analyzed were significantly associated with the misfit status (p < 0.05). CONCLUSIONS: The results from this retrospective study showed that misfit in immediately loaded complete-arch fixed implant-supported prostheses may not play a detrimental role in the implant survival but may affect survival of the conversion prostheses.

A 30-Year Follow-Up of a Patient with Mandibular Complete-Arch Fixed Implant-Supported Prosthesis on 4 Implants: A Clinical Report.

Mandibular complete-arch fixed implant-supported prostheses are recognized as one of the earliest and most popular prostheses in implant dentistry. This prosthesis was the main focus in the early era of osseointegration. Despite its widespread popularity, few clinical reports have described long-term follow-up greater than 10 years for this type of prosthesis. This report describes a 30-year follow-up of a patient who underwent treatment for a mandibular complete-arch fixed implant-supported prosthesis with 4 machined surfaced implants, opposing a maxillary complete denture. This report documents a variety of photographs and radiographs taken over a period of 30 years to compare bone levels at various stages of care and maintenance, including de novo bone formation underneath the distal cantilevers due to functional loading. The biologic and biomechanical response to this treatment protocol and long-term clinical observations and prosthodontic outcome and maintenance needs are also addressed.

Thirty-Two-Year Success of Dental Implants in Periodontally Compromised Dentition.

Osseointegrated dental implants have become an integral factor in the replacement of missing teeth. These implants have demonstrated long-term success for periodontally compromised patients, who require a high level of success to maintain a sense of optimism. This case report offers 32-year results of implant treatment in the maxilla and 25-year results in the mandible. Some maxillary implants suffered a few threads of bone loss, but all seven mandibular implants met Albrektsson's definition of success after 25 years. The purpose of this case report is to provide evidence that further supports the findings of osseointegrated implant treatment's longevity and success, as reported in other studies.

The Retread: A Definition and Retrospective Analysis of 205 Implant-Supported Fixed Prostheses.

PURPOSE: Acrylic resin teeth on fixed implant prostheses are subject to time-dependent wear. The purpose of this retrospective analysis is to evaluate and describe the management of such wear in the context of selected variables--patient gender and age, dental arch location, and opposing dentition. The clinical and dental laboratory process to replace the worn teeth is defined as a retread. MATERIALS AND METHODS: A retrospective database review from a single private prosthodontic practice was carried out on all patients who had undergone a retread procedure. The patient pool included 205 arches in 194 patients (70 in men, 135 in women) with a mean age of 57.4 years (range: 19.9 to 80.5 years). The retread procedure is described. RESULTS: The mean time between final prosthesis delivery and retread was 7.8 years (range: 1.1 to 22.9 years). Statistical analysis was significant according to dental arch and opposing dentition. A statistical difference was also noted in patients undergoing multiple retread procedures, with a reduction in time between the subsequent procedures. CONCLUSION: Acrylic resin components of implant-supported hybrid prostheses wear over time and are influenced by a combination of the nature of the opposing dentition and patient habits. The dental laboratory process to retread the implant-supported framework is important for long-term patient care and maintenance of an appropriate vertical dimension of occlusion.

Positioning handle and occlusal locks for the Teeth-in-a-Day protocol.

Positioning handles and occlusal locks have evolved as improvements to the Teeth-in-a-Day protocol. These improvements have enabled a more accurate alignment of the removable dental prosthesis during the conversion prosthesis technique. These improvements can be easily incorporated through computer-aided design and computer-aided manufacturing digital denture fabrication process.

A long-term retrospective analysis of survival rates of implants in the mandible.

PURPOSE: To retrospectively analyze the survival rate of endosseous dental implants placed in the edentulous or partially edentulous mandible over a long-term follow-up period of 10 years or more. MATERIALS AND METHODS: The charts of patients who underwent mandibular implant placement at a private prosthodontics practice and received follow-up care for 10 years or more were included in this study. Implants were examined according to the following study variables: patient sex, patient age, degree of edentulism (fully vs partially edentulous), implant location, time of loading (delayed vs immediate), implant size and type, bone quality, prosthesis type, and the presence of other implants during placement. RESULTS: The study sample was composed of 2,394 implants placed in 470 patients with 10 to 27 years of follow-up. Of these 2,394 implants, 176 failed, resulting in an overall cumulative survival rate (CSR) of 92.6%. A total of 1,482 implants were placed in edentulous mandibles, and 912 implants were placed in partially edentulous mandibles, with CSRs of 92.6% and 92.7%, respectively. Comparisons of the study variables with respect to CSR were largely nonsignificant. However, there were significant differences in CSRs between anterior vs posterior locations and rough- vs smooth-surfaced implants in addition to some prosthesis types, ages, and bone qualities. The overall CSR of 92.6% in the present study is high and comparable to survival rates observed in previous long-term analyses of mandibular implants. The significant differences observed between implant locations, patient age groups, bone qualities, and prostheses were not suggestive of any remarkable trends. CONCLUSION: Patient sex, age, degree of edentulism, implant location, time of loading, implant size and type, bone quality, prosthesis type, and the presence of multiple implants did not result in any significant effect on long-term implant survival. The CSR observed after 10 to 27 years of follow-up in a single private prosthodontic center was high (92.6%) and supports the use of endosseous dental implants as a long-term treatment option for the rehabilitation of the edentulous and partially edentulous mandible.

Fabricating an Accurate Implant Master Cast: A Technique Report.

The technique for fabricating an accurate implant master cast following the 12-week healing period after Teeth in a Day® dental implant surgery is detailed. The clinical, functional, and esthetic details captured during the final master impression are vital to creating an accurate master cast. This technique uses the properties of the all-acrylic resin interim prosthesis to capture these details. This impression captures the relationship between the remodeled soft tissue and the interim prosthesis. This provides the laboratory technician with an accurate orientation of the implant replicas in the master cast with which a passive fitting restoration can be fabricated.

Oral rehabilitation and psychosocial evaluation of a patient with bulimia nervosa following Teeth in a Day® immediate loading protocol.

PURPOSE: The purpose of this patient report is to accurately portray the clinical experience of treating an active bulimic patient by employing an immediately loaded dental implant protocol to provide the patient with an expedited esthetic and functional result. Implementation of a psychometric component statistically quantifies the psychological effects of the oral rehabilitation. MATERIALS AND METHODS: A 34-year-old woman presented with severe dental perimolysis (erosion) resulting from a 28-year history of bulimic behaviors. Clinical and radiographic evaluation of the existing dentition indicated advanced dental erosion and previous restoration attempts in a state of failure. The patient's existing teeth were extracted and treated with full maxillary and mandibular implant-supported prostheses, following the Teeth in a Day® (TIAD) immediate functional loading protocol. Psychometric assessment was conducted through administration of a 20-item questionnaire, as seen in previous literature. RESULTS: Radiographic and clinical analysis suggested all implant fixtures to be viable and accompanied by normal levels of alveolar bone 7 months into treatment. Questionnaire results at the new-patient presentation (T1) resulted in a composite score of 4.0 (SD = 2.9; P = 0.004), indicating severe body-image dysphoria. At 3 months postoperative (T2), the questionnaire score was 0.4 (SD = -1.7; P = 0.09). The final psychometric questionnaire at 7 months (T3) resulted in a score of 0.5 (SD = -1.5; P = 0.12). The patient was followed for a total of 7 years following implant placement. CONCLUSION: In this patient report, oral rehabilitation using the TIAD protocol provided an expedited and predictable alternative method for restoring functional abilities, esthetics, and self-esteem to a severely depressed bulimic patient. Psychometrically, at the postoperative (T2) and final testing period (T3), the patient's body image profile was no longer considered to be significantly different from established normative values.

Management of soft tissue irritation around exposed zygomatic implant in a hemimaxillectomy patient: a technical report.

Patients missing portions or all of the maxillary alveolar bone who are restored with zygomatic implants frequently have threads exposed that can be a mucosal irritant. If such irritation is reported, covering the threads with a highly polished titanium sleeve is recommended. The technique of placing said custom sleeve is described. This adjunctive treatment method has eliminated mucosal irritation.

Zygomatic implants as a rehabilitation approach for a severely deficient maxilla.

A gunshot injury is one of the main trauma injuries that affect the head and neck region. Severe esthetic, functional, and psychologic deficiencies are consequences of gunshot injuries. The use of implants anchored in the zygomatic bone has been advocated as an approach to the prosthetic rehabilitation of a severely deficient maxilla. This approach provides the patient with an immediate, high-quality, esthetic, and functional complete fixed prosthesis and eliminates the need for bone grafting. In this case report, a patient with a severely deficient maxilla caused by a gunshot injury was rehabilitated by placement of four zygomatic and two pterygomaxillary implants, which were immediately loaded with a complete fixed all-acrylic resin interim prosthesis. The definitive CM Prosthesis (CM Prosthetics) was constructed using computer-aided design/computer-assisted manufacture (CAD/CAM) technology.

Ectodermal dysplasia: an 11-year follow-up of siblings with 2 implant treatment approaches.

PURPOSE: To describe 2 different treatment approaches for a 20-year-old Caucasian man and his 22-year-old sister who were affected by ectodermal dysplasia (ED) and compromised maxillary bone. MATERIALS AND METHODS: The sister had a history of an iliac crest transplant with 6 implants placed in the maxillary and mandibular arches, 6 years before complications. It was necessary to debride the right sinus, remove the failing infected bone graft and 2 implants. Her brother presented with missing teeth, few remaining deciduous teeth, and wearing all-acrylic resin temporary partials in both the maxillary and mandibular arches. RESULTS: Zygomatic and pterygomaxillary implants were used to rehabilitate the brother with a screw-retained fixed prostheses. His sister had 6 new maxillary implants. Both siblings' mandibular arches were restored with screw-retained implant-supported prostheses. CONCLUSION: Although these siblings affected with ED had different treatment approaches, they both eventually obtained successful outcomes. The brother's treatment was expedited. Both siblings have been followed for a period of 11 years, and all postoperative evaluations have been uneventful.

A retrospective analysis of 800 Brånemark System implants following the All-on-Four™ protocol.

PURPOSE: The purpose of this study was to retrospectively evaluate implant survival rates in patients treated with the All-on-Four™ protocol according to edentulous jaws, gender, and implant orientation (tilted vs. axial). MATERIALS AND METHODS: All Brånemark System implants placed in patients following the All-on-Four™ protocol in a single private practice were separated into multiple classifications (maxilla vs. mandible; male vs. female; tilted vs. axial) by retrospective patient chart review. Inclusion criteria consisted of any Brånemark System implant placed with the All-on-Four™ protocol from the clinical inception (May 2005) until December 2011. Life tables were constructed to determine cumulative implant survival rates (CSR). The arches, genders, and implant orientations were statistically compared with ANOVA. RESULTS: One hundred fifty-two patients, comprising 200 arches (800 implants) from May 2005 until December 2011, were included in the study. Overall implant CSR was 97.3% (778 of 800). Two hundred eighty-nine of 300 maxillary implants and 489 of 500 mandibular implants survived, for CSRs of 96.3% and 97.8%, respectively. In male patients, 251 of 256 implants (98.1%) remain in function while 527 of 544 implants (96.9%) in female patients survived. Regarding implant orientation, 389 of 400 tilted implants and 389 of 400 axial implants osseointegrated, for identical CSRs of 97.3%. All comparisons were found to be statistically insignificant. The prosthesis survival rate was 99.0%. CONCLUSIONS: The results from this study suggest that edentulous jaws, gender, and implant orientation are not significant parameters when formulating an All-on-Four™ treatment plan. The high CSRs for each variable analyzed demonstrate the All-on-Four™ treatment as a viable alternative to more extensive protocols for rehabilitating the edentulous maxilla or mandible.

Prosthodontic revision treatment: total oral rehabilitation of a patient with intense parafunction and advanced bone loss in the posterior maxilla

Rehabilitation of a compromised dentition in individuals with parafunction and excessive masticatory forces is difficult to manage long term. This patient example illustrates an expedited treatment approach to replace and restore the missing and deteriorated dentition. A plan was developed to cope with this clinical status and future requirements. The maxilla was treated with 10 endosseous implants, which included 2 in the pterygomaxillary region and 2 in the zygoma. The mandibular arch was treated with 7 endosseus implants. The definitive screw-retained prostheses consisted of maxillary porcelain-fused-to-metal and mandibular acrylic resin veneer of a cast metal framework. The patient has been followed for seven years. Prosthodontic complications have been limited to acrylic resin veneer fractures on the mandibular implant-supported prosthesis.

Brånemark system implant lengths in the pterygomaxillary region: a retrospective comparison.

PURPOSE: Implants that engage the cortical bone of the pterygomaxillary region help restore dentition to the posterior maxilla. However, proper implant length is required. The purpose of this study was to determine if there is a statistically significant difference in the survival rates between different sized implants placed in the pterygomaxillary region. MATERIALS AND METHODS: All Brånemark System 4.0-mm-diameter implants delivered into the pterygomaxillary region in a single private practice were separated into 7- to 13-mm and 15- to 18-mm groups by retrospective patient chart review. Cumulative survival rates (CSR) were calculated. RESULTS: Of all implants delivered, 930 of the 992 osseointegrated for a CSR of 93.75%. Fifty-nine of the 67 implants in the 7- to 13-mm grouping and 871 of the 925 implants in the 15- to 18-mm grouping osseointegrated for CSRs of 88.06% and 94.16%, respectively. The results were statistically significant (P < 0.05). CONCLUSIONS: The results suggest that increased implant length in the pterygomaxillary region may result in higher osseointegration rates. The implant apex better engages the cortical bone between the medial and lateral pterygoid plates and therefore increases primary and secondary stability.

A retrospective comparison of implants in the pterygomaxillary region: implant placement with two-stage, single-stage, and guided surgery protocols.

PURPOSE: Implants placed into the pterygomaxillary region allow for increased posterior support and a full complement of teeth without the need for distal cantilevers. With advancements in research and technology, implant delivery has evolved from the traditional two-stage procedure to immediate loading freehand and guided surgical template protocols. The purpose of this retrospective study is to determine if there is a significant difference in implant survival rates between these protocols. MATERIALS AND METHODS: All pterygomaxillary implants placed in a single private practice from September 1985 to July 2011 were categorized into three separate classifications (two-stage freehand, single-stage freehand, or single-stage guided) by retrospective chart review. Life tables were constructed to determine the cumulative survival rates (CSR), and ANOVA was used to identify statistical significance. RESULTS: A total of 981 patients comprising 371 males and 610 females were included in the study. Of all pterygomaxillary implants, 1,460 of 1,608 implants osseointegrated for a CSR of 90.80%. Seven hundred nine of the 825 two-stage, 624 of the 647 single-stage, and 127 of the 136 guided surgery implants osseointegrated for CSRs of 85.94%, 96.45%, and 93.38%, respectively. The comparison between two-stage and single-stage protocols was statistically significant, (P < .05) while the difference between single-stage guided versus freehand protocols was found to be statistically insignificant (P > .05). CONCLUSION: The results from this retrospective study reinforce that immediate loading of pterygomaxillary implants with a provisional prosthesis is beneficial to both doctor and patient. The lower CSR for the guided surgery protocol compared with the single-stage freehand procedure is statistically insignificant, suggesting guided surgery is still a viable and recommended option for qualified patients.

Zygomatic bone-to-implant contact in 77 patients with partially or completely edentulous maxillas.

PURPOSE: Specifically with zygomatic implants, the bone-to-implant contact (BIC) at the zygomatic bone correlates with the survival of the implant because there is little anchorage at the alveolus. The purpose of this retrospective study was to view and measure the BIC of zygomatic implants in the zygomatic bone. MATERIALS AND METHODS: The patients in this study received zygomatic implants at a single private dental implant center. All patients were treated with the same immediate-loading protocol followed by postoperative cone beam computed tomography. The scans were exported to a computer-aided design system, where the BICs could be measured digitally. The BIC was analyzed by gender, and any statistical difference was determined by analysis of variance. RESULTS: The study sample was composed of 77 patients (62.3% women) receiving 173 zygomatic implants. The mean age of the sample was 59 ± 8.7 years. The mean BIC was 15.3 ± 5.6 mm (range, 4.9 to 32.9 mm) in the zygomatic bone. On average, 35.9% ± 11.7% (range, 12.2% to 67.3%) of the implant came into contact with the zygomatic bone. The average BIC in men was 16.5 ± 6.0 mm, and the average BIC in women was 14.7 ± 5.4 mm, a statistically significant difference by analysis of variance (P < .05). CONCLUSIONS: Evidence from this report indicates the zygomatic BIC varies greatly from patient to patient. These data show that the typical male patient has a greater zygomatic BIC than the typical female patient; however, these data do not support the hypothesis that the zygomatic BIC influences the zygomatic implant survival rate.

Treatment of a patient with cleidocranial dysplasia using a single-stage implant protocol.

This patient report describes the treatment of a 45-year-old Caucasian woman with cleidocranial dysplasia who had significant dental problems that greatly affected her quality of life. The patient had orthodontic treatment in her earlier years along with surgical removal of supernumerary teeth. Using implants, the maxillary and mandibular arches were restored with fixed screw-retained prostheses. Eight implants and six implants were placed in the maxilla and mandible, respectively. Both arches were immediately loaded following the Teeth in a Day™ protocol using an all-acrylic resin provisional prosthesis. Five months later, definitive maxillary and mandibular prostheses were fabricated. The patient has been followed for a period of 5 years, and all postoperative evaluations have been uneventful.