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.

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.

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.

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.

Etiology and treatment of periapical lesions around dental implants.

The widespread use of oral implants in recent years has resulted in various types of complications. One of those complications is the periapical implant lesion. Different factors have been proposed to play a role in the development and emergence of a periapical implant lesion. To date, there is no consensus on the etiology and therefore periapical lesions around dental implants are considered to have a multifactorial etiology. The diagnosis of an implant periapical lesion should be based on both clinical and radiological findings. Additionally, in order to apply the best treatment strategy the evolution of the lesion should be taken into account. The treatment of this kind of lesion, however, is still empiric. Data, primarily from case reports, seem to indicate that the removal of all granulation tissue is a first step to arrest the progression of the bone destruction. The removal of the apical part of the implant seems a valuable treatment strategy.

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.

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.

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.

Complete oral rehabilitation with implants using CAD/CAM technology, stereolithography, and conoscopic holography.

A 64-year-old totally edentulous female initially presented with ill-fitting removable prostheses. A comprehensive treatment plan with dental implants was accepted by the patient. Clinical and laboratory procedures were executed using various computer technologies including computed tomography, rapid prototyping, and optical scanning using conoscopic holography. A review of the patient's treatment and various modalities used are the focus of this patient report.

A retrospective analysis of 125 single molar crowns supported by two implants: long-term follow-up from 3 to 12 years.

PURPOSE: The purpose of this study was to analyze retrospectively the survival rate of implants used in pairs to support a single molar crown over a long-term follow-up period and to compare the efficacy of this technique to other existing methods of treatment. MATERIALS AND METHODS: The charts and radiographs of 105 patients who each received two implants to support a screw-retained single molar were examined according to the following criteria: age, gender, location of implant, time of loading (delayed versus immediate), opposing dentition, and the existence of adjacent implants. RESULTS: Patients with follow-up between 3 and 12 years were selected to illustrate the long-term outcomes of the two-implant replacement procedure. Two hundred fifty implants were placed in 125 molar sites in 105 patients. Five of the 250 implants failed, resulting in a cumulative survival rate of 98.0%. Seven of 125 restorations experienced porcelain fracture (5.6%), seven prosthetic screws loosened (5.6%), and one abutment screw loosened (< 1.0%). DISCUSSION: The placement of two implants to support a screw-retained single molar successfully reduces rotational forces that create stress on the implant. A single regular-diameter or even a wide-diameter implant is susceptible to these forces, which may lead to fatigue over the long term. CONCLUSIONS: Two implants for the replacement of a single molar represent an effective method that provides a high survival rate over a long-term follow-up period. This approach produced a cumulative survival rate higher than that usually seen in studies of single implants used for molar replacement. The two implant-supported molar crown showed fewer complications than single implant-supported molar crowns.

A protocol for immediate placement of a prefabricated screw-retained provisional prosthesis using computed tomography and guided surgery and incorporating planned alveoplasty.

Computer-aided design/computer-assisted manufacture technology is changing the way clinicians are planning treatment and delivering dental implant therapy. Although the current technology is impressive and successful clinically, there are limitations in the design that prevent all patients from benefiting immediately from this computer-designed modality. This article describes a unique prosthetically driven protocol that will allow the delivery of a prefabricated screw-retained all-acrylic prosthesis immediately after an alveoplasty with the immediate placement of dental implants.

A prospective analysis of immediate provisionalization of single implants.

PURPOSE: The purpose of this prospective study was to evaluate the viability of immediately provisionalized single-tooth implants. MATERIALS AND METHODS: One hundred forty patients (86 female, 54 male) with a mean age at implant placement of 45 years (range, 15-88 years) needing single-tooth replacement, were treated between July 1999 and December 2004. Single-tooth implants were placed and provisionalized the day of the surgery. All implants were manufactured by Nobel Biocare (Yorba Linda, CA) and had multiple diameters and configurations. The majority of the implants used in this study had oxidized titanium surfaces. The contours of the restorations were designed to mimic the original teeth and root forms. The morphology of the restorations provides support of the labial gingiva. RESULTS: Over 5.5 years, 164 implants were placed and immediately provisionalized. Sixty-four implants were placed immediately post extraction. Seven implants failed, yielding an overall survival rate of 95.73%. CONCLUSION: The application of an immediate provisionalization protocol to a single implant can be successful if the proper precautions are taken in achieving passive occlusion.

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.

Treatment of a severely atrophic maxilla using an immediately loaded, implant-supported fixed prosthesis without the use of bone grafts: a clinical report.

This report describes a clinical approach to using the zygomatic and pterygomaxillary bones to provide additional anchorage for longer implants to support an immediately functional maxillary screw-retained provisional fixed prosthesis. The purpose is to report the problems of patients who have experienced the most severe form of maxillary alveolar resorption and to demonstrate a specific protocol which provides immediately loaded implants without bone grafting.

A retrospective analysis of 110 zygomatic implants in a single-stage immediate loading protocol.

PURPOSE: This clinical study using a specific technique was carried out to determine the clinical effectiveness of zygomatic implants under an immediate loading protocol. MATERIALS AND METHODS: All patients treated between May 2000 and October 2006 who received zygomatic implants were included in this retrospective analysis. All patients were treated using the same surgical and restorative protocol. The following data were recorded: gender, age, type of implant, number of implants placed, dimensions of implants, and implant and prosthesis survival. RESULTS: Fifty-six consecutive patients (29 women, 27 men; mean age of 60.58 years [range, 38.78 to 84.01]) were treated. All were in need of oral reconstruction and had maxillary atrophy that warranted zygomatic implant placement. One hundred ten zygomatic implants were placed in these 56 patients. Four of the 110 zygomatic implants failed, resulting in a cumulative survival rate of 96.37% with follow-up data no less than 9 months and in excess of 5 years. All four failures were turned-surface zygomatic implants. There have been no failures to date with the titanium anodized-surface zygomatic implants. The prosthesis survival rate was 100.0%. CONCLUSION: In this retrospective analysis of 56 patients receiving 110 zygomatic implants, the survival rate of zygomatic implants was in excess of 96% over a period of 9 months to 5 years. This technique resulted in a stable and predictable prosthetic reconstruction.

Guided implant placement and immediate prosthesis delivery using traditional Brånemark System abutments: a pilot study of 23 patients.

PURPOSE: The aim of this study is to demonstrate the accuracy and clinical precision of a guided surgery protocol by using traditional Brånemark System abutments in conjunction with a prefabricated all-acrylic provisional prosthesis that is immediately installed after implant placement. MATERIALS: All presurgical methods in this treatment follow the standard NobelGuide protocol with the exception of the laboratory phase. Once the master cast is retroengineered from the surgical template, traditional Brånemark System abutments were secured onto the implant replicas (master cast) and an all-acrylic provisional prosthesis was constructed at the abutment level. The typical abutments used with this protocol, adjustable Guided Abutments, were not used. RESULTS: Twenty-three patients were treated in this pilot study. Via the surgical template, all implants were placed to the desired depth as planned in the virtual implant planning program. After the traditional Brånemark Abutments were installed, the provisional prosthesis was delivered and occlusion verified. The prosthesis fit was checked at abutment level clinically and radiographically. CONCLUSION: This report shows the extreme accuracy of this guided surgery protocol. If each step of this protocol is followed precisely, it is possible to deliver a prefabricated prosthesis built to traditional Brånemark System Abutments, which is extremely favorable for long-term patient and prosthesis management.

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.

A retrospective analysis of 44 implants with no rotational primary stability used for fixed prosthesis anchorage.

PURPOSE: The aim of this study was to determine the osseointegration potential of implants with apical primary stability but no resistance to rotation in variable clinical conditions. MATERIALS AND METHODS: Patient records of treatment performed between October 1993 and May 2004 were reviewed for primary implant stability. Patients who exhibited implants without rotational primary stability (RPS) were reviewed further to determine patient age, gender, implant type, implant surface, loading protocol, and prosthesis type. RESULTS: Forty-four implants without RPS were reported in 12.8% of patients treated during the period reviewed. Statistical significant differences in cumulative survival rate (CSR) were seen with implant location and surface. No significant difference in CSR was observed in relation to loading protocol, despite a higher success rate (17.4% higher) for the immediate loading population. No difference in CSR was observed with respect to gender. DISCUSSION AND CONCLUSION: In the early years of machined implants, there was a higher failure rate of implants without RPS. The results for this implant population show that there are statistically significant differences in survival rate between the maxilla and mandible, and also between titanium oxide-surfaced implants and machined implants. The sample size of this study limited the statistical significance of the difference in CSR observed between loading protocols. Implants without RPS that are not removed at the time of surgery can become osseointegrated with a survival rate of 82%. Survival rates increase when testing sample is limited to titanium oxide-surfaced implants under an immediate loading protocol. Under the appropriate level of risk, implants that have apical primary stability but no resistance to rotation can become osseointegrated when incorporated in a rigid prosthesis under immediate loading circumstances.