Immediate Loading Using the Digitalized Customized Restoration of Single-tooth Implants Placed in Fresh Extraction Sockets in the Aesthetic Anterior Maxilla: A 10-Year Prospective Study of Marginal Bone Level.

AIM: The objective of this study was to assess marginal bone level around single implants inserted in fresh extraction sockets in the anterior maxillary region and instantly restored with computer-aided design/computer-aided manufacturing customized temporary crowns cemented on the final abutment. MATERIALS AND METHODS: A total of 20 patients (15 females and 5 males, with a mean age of 30 years), where 20 were placed in fresh extraction sockets. After raising a full-thickness flap, atraumatic extraction was performed the implant site was prepared and fixtures were stabilized on the palatal bone wall. The implant location was immediately transmitted to the prepared master model using the pick-up impression coping seated in the surgical guide template. Prefabricated abutments were used as the final abutment on the master model, scanned and the crown was planned using computer-aided manufacturing customized software. Later on 8th weeks, abutments were torqued as per the manufacturer's recommendation, and the final crowns were cemented. Using personalized intraoral radiographs marginal bone level was evaluated mesially and distally to the implant shoulder as a reference at implant placement, 8 weeks, 1, 3, 5, and 10 years after loading. RESULTS: Wholly implants were osteo-integrated positively after 10 years of practical loading, but only 18 were available for clinical and radiological follow-up, and 2 patients with two implants were excluded from the study due to relocation abroad without any implant failure. The average marginal bone loss (MBL) in the current report was 0.16 ± 0.167 mm at crown cementation, 0.275 ± 0.171 mm after 1 year, 0.265 ± 0.171 mm after 3 years, 0.213 ± 0.185 mm after 5 years, and 0.217 ± 0.194 mm at 10 years. CONCLUSION: The strategy of inserting and not removing the final abutment at the time of implant placement facilitates the establishment of adequate attachment of both soft and hard tissues to the abutment surface, ensuring uninterrupted organization of tissue architecture and offers advantages in helping maintain soft tissue maturation and preventing marginal bone level. CLINICAL SIGNIFICANCE: Immediately loaded implants in freshly extracted sockets lead to a significant reduction in marginal ridge resorption. The use of a temporary crown on a prefabricated abutment, exclusive of successive abutment manipulation, proved effective in preserving the primarily founding blood clot and served as a prototype for shaping the soft tissue around the previously wounded gum. How to cite this article: Berberi A, El Zoghbi A, Aad G, et al. Immediate Loading Using the Digitalized Customized Restoration of Single-tooth Implants Placed in Fresh Extraction Sockets in the Aesthetic Anterior Maxilla: A 10-Year Prospective Study of Marginal Bone Level. J Contemp Dent Pract 2024;25(3):213-220.

Effect of Simulated Mastication on the Retention of Locator Attachments for Implant-Supported Overdentures: An In Vitro Pilot Study.

PURPOSE: Limited information is currently available relative to the effect of masticatory loads on the retentive properties of Locator attachments. The aims of this in vitro study were to assess and compare the effect of simulated mastication on the retention of white, pink, and blue Locator inserts for overdentures retained by 2 implants. MATERIALS AND METHODS: Thirty specimens simulating a nonanatomic edentulous flat ridge with two implants and an overdenture were divided into 3 groups according to the color of the fitted insert: transparent clear group (n = 10), pink group (n = 10), and blue group (n = 10). Retention forces were measured in an axial direction initially and after 100,000 cycles of simulated masticatory loads. One-way ANOVA followed by Tukey's post hoc tests were used to compare retention values and percentage retention loss between the 3 groups with significance set at p = 0.05. RESULTS: The 3 groups presented significant differences in retention at baseline (9.95 ± 1.91 N, 15.43 ± 4.08 N, and 41.73 ± 9.29 N for the blue, pink, and clear groups, respectively) and after simulated mastication (6.37 ± 2.64 N, 14.00 ± 3.89 N, 38.20 ± 5.11 N for the blue, pink, and clear groups, respectively). Within the same group, cyclic loading did not significantly affect retention in the clear and pink groups, while the blue inserts showed a significant retention loss (-37%) after loading. CONCLUSIONS: The results suggest that short-term simulated mastication affects the extra-light blue inserts but not the more-retentive inserts.

In Vitro Effect of Mastication on the Retention and Wear of Locator Attachments in a Flat Mandibular Ridge Model.

PURPOSE: The effect of masticatory loads on the retention of overdenture attachments is poorly documented. The aim of this in vitro study is to assess the effect of simulated mastication on the retentive properties and dimensions of Locator inserts. MATERIALS AND METHODS: 30 specimens simulating nonanatomic edentulous flat ridges with two implant replicas each were fabricated. Overdenture units were connected to the implants with Locator attachments and 3 types of inserts: transparent (Group T; n = 10 pairs), pink (Group P; n = 10 pairs), and blue (Group B; n = 10 pairs). The overdenture units were subjected to simulated bi-axial masticatory loads of 68.6 N. Locator retention was assessed using axial dislodging forces at baseline (T0) and following 100,000 (T1) and 200,000 (T2) masticatory cycles. The inner diameter of the insert (XY) and the diameter of the central core (AB) were measured under stereomicroscope at T0 and T2. Retention changes and dimensional variations of the inserts were statistically analyzed. RESULTS: The 3 groups showed significantly different retentions with the highest values recorded for group T followed by group P, and finally group B at T0, T1, and T2. Groups T and P were not affected by loading while group B showed a significant mean retention loss from T0 to T1. XY and AB were significantly different between the 3 color-coded inserts at baseline and at T2. No correlation could be established between retention changes and dimensional variations of the 3 types of inserts. CONCLUSIONS: Within the limitations of this in vitro study, simulated mastication seems to significantly affect the extra-light blue Locator inserts but not the more-retentive ones. The transparent and pink inserts may require less frequent replacements and could therefore be recommended under clinical conditions.

Influence of surgical and prosthetic techniques on marginal bone loss around titanium implants. Part I: immediate loading in fresh extraction sockets.

PURPOSE: Delayed placement of implant abutments has been associated with peri-implant marginal bone loss; however, long-term results obtained by modifying surgical and prosthetic techniques after implant placement are still lacking. This study aimed to evaluate the marginal bone loss around titanium implants placed in fresh extraction sockets using two loading protocols after a 5-year follow-up period. MATERIAL AND METHODS: A total of 36 patients received 40 titanium implants (Astra Tech) intended for single-tooth replacement. Implants were immediately placed into fresh extraction sockets using either a one-stage (immediate loading by placing an interim prosthesis into functional occlusion) or a two-stage prosthetic loading protocol (insertion of abutments after 8 weeks of healing time). Marginal bone levels relative to the implant reference point were evaluated at four time intervals using intraoral radiographs: at time of implant placement, and 1, 3, and 5 years after implant placement. Measurements were obtained from mesial and distal surfaces of each implant (α = 0.05). RESULTS: One-stage immediate implant placement into fresh extraction sockets resulted in a significant reduction in marginal bone loss (p < 0.002) compared to the traditional two-stage technique. Whereas mesial surfaces remained stable for the 5-year observation period, significant marginal bone loss was observed on distal surfaces of implants after cementation of interim prostheses (p < 0.007) and after 12 months (p < 0.034). CONCLUSIONS: Within the limitations of this study, immediate loading of implants placed into fresh extraction sockets reduced marginal bone loss and did not compromise the success rate of the restorations.

Evaluation of Marginal and Internal Fit at Implant-Abutment Interface of Original and Compatible Nonoriginal Abutments.

Is to measure the peripheral and internal gap at the implant-abutment interface of an implant system connected to its original or compatible non-original abutments. Twenty implants were assembled with four different types of abutments having the same conical internal interface. All abutments were considered compatible with Tx Astra Tech Implant SystemTM. Four groups were created and each group of five implants was connected to a different abutment; Ti DesignTM abutments (group A), DualTM abutments (group B), Natea plusTM abutments (group C) and ImplanetTM abutments (group D). The peripheral gaps between implant and abutment were observed in three points facing the flat surface of the abutment. The implant-abutment assemblies were then embedded in resin and grinded in the mesio-distal direction of the scalloped abutment margin using a diamond disk at very low speed and under water-cooling. The inner aspect of the implant abutment interface was observed in three different points, on the coronal border of the connection, in the middle area and on the apical border of the implant-abutment interface. The mean gap width was 0.543 ± 0.09 µm for group A and, respectively, 0.708 ± 0.1232 µm, 0.726 ± 0.0891 µm and 0.818 ± 0.0851 µm for groups B, C and D. When comparing group, A to B and C, a highly significant difference in numbers was obvious while an even higher variation was observed with group D. External and internal fit of components is better when using original components.

In vitro evaluation of the "replica technique" in the measurement of the fit of Procera crowns.

AIM: The objective of this study was to compare the film thickness of a light body polyvinylsiloxane addition silicone impression material using the "replica technique" (RT) to the film thickness resulting from the cementation of Procera copings. METHODS AND MATERIALS: Twenty Procera copings were fabricated on ten casts each having one central incisor and one premolar. The thickness of the light body was first measured using the RT; then on the same casts dies were cemented with glass-ionomer cement, sawed, and the film thickness of cement was measured. These two materials were expected to behave differently under stress according to their respective physical properties. RESULTS: The thickness of silicone material did not differ significantly from that of the glass-ionomer cement used in this experiment. Also, when the two groups of central incisors and premolars were taken separately, at three different areas (occlusal, axial, and cervical), no significant difference was found. Only when each surface (buccal, palatal, mesial, and distal) was compared separately at the cervical area, some significant differences between the two techniques was detected. CONCLUSION: Within the limitations of this study, the RT is an accurate and reliable technique that can simulate crown gap space after cementation. CLINICAL SIGNIFICANCE: The RT is reliable for evaluating cement thickness at the marginal and internal gaps of Procera AllCeram crowns during try-in sessions.

Influence of ceramic color and translucency on shade match of CAD/CAM porcelain veneers.

OBJECTIVE: To investigate the influence of translucency of CAD/CAM ceramic milling blocks on the final color of porcelain veneer cemented using resin cement with two different opacities. MATERIALS AND METHODS: A standardized incisal lap preparation was made on a maxillary right central incisor that was duplicated using composite resin material (Z250, A4, 3M ESPE). The resin dies were individually laser scanned (Bluecam, Sirona) in order to build a 3D model of the porcelain veneer on the CAD software (Cerec 3D). Three types of milling blocks were used to fabricate the required restorations: multichromatic, high translucency, and low translucency milling blocks (IPS Empress CAD, A1 Vita shade tab). The milled veneers were polished, glazed, and bonded on the resin dies using high opacity and low opacity resin cements (Panavia F2.0). A digital shade guide device (Easyshade Advance, Vita) was used to measure color parameters (CIE Lab values) at the incisal, middle, and cervical third of each cemented restoration. ΔE values of the cemented veneers were calculated against the target color (A1). RESULTS: Cementation of porcelain veneers resulted in significant color change of the resin die (A4) as ΔE values ranged between 8.9 and 13.7. However, the type of milling block did not have an observable effect on final color as the measured ΔE values, against original die color, were very close for the multichromatic block (ΔE = 10.7 ± 0.1), high translucency (ΔE = 9.7 ± 0.09), and low translucency blocks (ΔE = 13.4 ± 0.11). The opacity of the used resin cement did not affect the final shade match, as the observed ΔE values using either high opacity and low opacity resin cement were less than 2 for the three used ceramic blocks. The greatest color difference was observed between the incisal third of multichromatic veneers (ΔE = 8.9) and the cervical third of low translucency veneers (ΔE = 13.7), while for the rest of the test groups this shift was not clinically observable (ΔE < 2.5). CONCLUSION: Within the limitations of this study, the shade match of CAD/CAM porcelain veneers was not influenced by the translucency of used milling block or the opacity of the resin cement.