Clinical and Radiographic Assessment of Three-Implant-Supported Fixed-Prosthesis Rehabilitation of the Edentulous Mandible: Immediate Versus Delayed Loading.

PURPOSE: To evaluate and compare the clinical and radiographic outcomes of mandibular rehabilitation with fixed prostheses on three implants with immediate versus delayed loading. MATERIALS AND METHODS: The sample comprised 21 patients who underwent treatment with immediate loading and 23 who received delayed loading. All had worn their prostheses for at least 18 months. Radiographic evaluation of bone loss was carried out in Adobe Photoshop CS5 by a single calibrated examiner using digitized panoramic radiographs. Clinical examination of the technical conditions of the prosthetic device assessed the condition of the acrylic resin base, dental occlusion, metal framework, presence of cover screws, screw fixation of the prosthesis and abutments, length of cantilever (effort) and resistance arms, presence of plaque on prosthetic abutments, and hygiene of the prosthesis. RESULTS: One implant failed in each group, resulting in a 95.23% treatment success rate with immediate loading and 95.65% with delayed loading (no statistically significant between-group difference). In the immediate-loading group, the mean bone loss was 1.96 ± 0.73 mm around central implants and 1.64 ± 0.84 mm at distal implants. In the delayed-loading group, the mean bone loss was 1.85 ± 0.67 mm around central implants and 1.70 ± 0.77 mm at distal implants. According to Student t test, there was no significant within-group difference in bone loss and no difference between the immediate-loading and delayed-loading groups. The only prosthesis-related complications that differed significantly between groups were "condition of the acrylic base," "occlusion," and "presence of right cover screw." There was no statistically significant association of lever arm ratio with peri-implant bone loss or bone loss on the mesial surfaces compared to the distal surfaces of the distal implants. CONCLUSION: The three-implant-supported fixed prosthesis protocol tested in this study proved to be a viable therapeutic strategy for mandibular edentulous patients with maxillary complete dentures, regardless of whether loading was immediate or delayed, with no difference in peri-implant bone loss.

Assessment of rehabilitation in edentulous patients treated with an immediately loaded complete fixed mandibular prosthesis supported by three implants.

PURPOSE: Conventionally, in patients with completely edentulous mandibles, fixed prostheses have been supported by four or more implants. However, an alternative protocol employing three implants and immediate loading has been developed. The objective of the present study was to assess the rehabilitation of edentulous patients treated with a complete fixed mandibular prosthesis with immediate loading and supported by three implants. MATERIALS AND METHODS: In this observational study, a total of 99 implants placed in 33 patients was evaluated after 18 months in use. Panoramic radiographs were digitized to measure bone loss at the mesial and distal surfaces of each implant. RESULTS: Mean peri-implant bone loss was 0.66 ± 0.51 mm for the left implant, 0.92 ± 0.61 mm for the central implant, and 0.82 ± 0.53 mm for the right implant. The bone loss observed around the distal implants was similar to that seen around the central implant, and there were no statistically significant differences in peri-implant bone loss between the three implant locations. There was no significant correlation between implant length and bone loss. The results were compatible with the peri-implant bone loss that has been described for prostheses of the same type supported by larger numbers of implants. CONCLUSIONS: The use of a complete fixed mandibular prosthesis with immediate loading supported by three implants proved to be an adequate option for the rehabilitation of edentulous patients. The protocol allowed simplification of treatment while maintaining similar bone loss to that reported for the same type of treatment supported by a larger number of implants.

Avaliação do nível de satisfação e da qualidade de vida relacionada à saúde oral de pacientes edêntulos reabilitados com próteses fixas sobre três implantes em mandíbula / Assessment of patient satisfaction and oral health-related quality of life of edentulous patients with three-implant-supported mandibular fixed prosthesis

A reabilitação de pacientes desdentados totais inferiores sempre foi um dos grandes desafios da Odontologia. A descoberta da Osseointegração modificou o panorama das possibilidades terapêuticas de reabilitação oral. Além da questão técnica cirúrgica e protética, a avaliação da satisfação e da qualidade de vida é fundamental quando se visa o sucesso na terapia com implantes dentários. Objetivos: verificar o nível de satisfação e qualidade de vida relacionada à saúde oral de indivíduos edêntulos totais reabilitados com prótese fixa sobre três implantes sob carga imediata. Metodologia: 67 indivíduos participaram do estudo, sendo 24 do gênero masculino e 43 do gênero feminino. Os pacientes submeteram-se a colocação de três implantes e confecção de uma prótese fixa de carga imediata na arcada inferior. O nível de satisfação foi avaliado através da escala analógica visual (EAV) e a qualidade de vida relacionada à saúde oral foi verificada através do questionário Ohip-Edent, versão validada para o português brasileiro 18 meses após concluída a reabilitação protética. Resultados: a média de satisfação na escala EAV relatada foi de 9,15 (± 1,8). A média de escore Ohip-Edent foi de 2,60 (± 2,69). Conclusão: a avaliação do nível de satisfação e qualidade de vida relacionada à saúde oral demonstrou que o protocolo adotado no presente estudo proporcionou aos pacientes desdentados totais uma alternativa de tratamento capaz de reabilitar as funções orais, sociais e psicológicas, reduzindo custos e tempo de tratamento

Rehabilitation of the totally edentulous mandible has always been one of the greatest challenges of Dentistry. The advent of osseointegration has opened up a new range of therapeutic possibilities for oral rehabilitation. In addition to surgical and prosthetic management, assessment of patient satisfaction and quality of life is essential for achieving success in dental implant therapy. Objective: To determine patient satisfaction and oral health-related quality of life of edentulous patients treated with three-implant-supported mandibular fixed prosthesis with immediate loading. Methods: The sample consisted of 67 individuals, 24 men and 43 women. After placement of three implants, each patient received an immediately loaded implant-supported fixed prosthesis in the mandible. Patient satisfaction was assessed using a visual analog scale (VAS) and oral health-related quality of life by the Ohip-Edent questionnaire, validated for the Brazilian population, 18 months after completion of prosthetic rehabilitation. Results: Mean patient VAS satisfaction score was 9.15 (±1.8). Mean Ohip-Edent score was 2.60 (± 2.69). Conclusion: The assessment results of patient satisfaction and oral health-related quality of life showed that the protocol adopted in the present study provided totally edentulous patients with a treatment option capable of rehabilitating oral, social and psychological functions, associated with reduced costs and shorter treatment time