Evaluation of Quality of Life and Satisfaction with Fixed Prostheses on Zygomatic Implants vs All-on-Four Concept: A Randomized Clinical Study.

AIM: To compare between the rehabilitation of atrophied maxilla with fixed prosthesis using two posterior zygomatic implants and two conventional anterior implants or four implants inserted according to the all-on-four concept regarding the patient quality of life and satisfaction after one year of prosthesis insertion. MATERIALS AND METHODS: Thirty-six patients with atrophic edentulous maxillae were randomized into two groups: Group I (rehabilitated with fixed prostheses supported by two zygomatic and two conventional implants in the anterior region) and group II (fixed prostheses on four implants in the anterior region following an all-on-four concept). One year after the placement of the definitive prostheses, patients completed oral health impact profile-14 and satisfaction questionnaires. RESULTS: All patients were satisfied regarding retention, stability, occlusion, comfort, cleaning, speaking, chewing, bolus quality, appearance, handling, prosthesis apart, and embarrassing, with no significant significance between two groups except satisfaction with surgical procedures and healing period. CONCLUSIONS: Using two distally tilted zygomatic implants or all-on-four concept to rehabilitate atrophied maxilla by fixed detachable prosthesis could be considered a promising functional and esthetic treatment option regarding the patient satisfaction. CLINICAL SIGNIFICANCE: Traditionally, treatment of maxillary atrophied ridges was done by bone grafting or sinus-lifting techniques; however, using all-on-four concept or zygomatic implants was a successful treatment as it has high success rates and highly satisfied by the patients. How to cite this article: Nagib MA, Ibrahim AM, Abdel-Rahman FH, et al. Evaluation of Quality of Life and Satisfaction with Fixed Prostheses on Zygomatic Implants vs All-on-Four Concept: A Randomized Clinical Study. J Contemp Dent Pract 2024;25(2):141-147.

Assessment of Stress Distribution Around Dental Implants Based on the All-on-Four Treatment Concept using Finite Element Analysis.

The present study was conducted to assess stress distribution around dental implants based on the all-on-four treatment concept. The finite element analysis (FEA) models comprised cancellous bone covered with cortical bone. Four dental implants were placed in two different designs. In model 1, the four implants were placed parallel to each other, whereas, in model 2, the all-on-four concept was followed. The vertical and lateral loads of various values were applied, and stress was evaluated. In model 2, the least stress was observed in both lateral and vertical loading in the peri-implant region. The all-on-four concept proved to be beneficial in reducing the stress around dental implants, thereby reducing the treatment cost.

Evaluation of Quality of Life and Satisfaction in Patients with Fixed Prostheses on Zygomatic Implants Compared with the All-on-Four Concept: A Prospective Randomized Clinical Study.

Purpose: No published research has compared patients' quality of life and satisfaction with fixed prostheses supported by zygomatic implants with those supported by all-on-four prostheses. The aim of this study was to evaluate patients' quality of life and satisfaction with fixed prostheses on zygomatic implants compared with the all-on-four concept. Materials and Methods: A total of 80 patients with atrophic edentulous maxillae were randomized into two groups: Group 1 (rehabilitated with fixed prostheses supported by 2-4 zygomatic and 2-4 conventional implants in the anterior region) and Group 2 (fixed prostheses on four implants in the anterior region following an all-on-four concept). One year after placement of the definitive prostheses, patients completed OHIP-14 and satisfaction questionnaires. Results: In all seven domains of the OHIP-14 and in the overall scores, a worse quality of life was found in Group 2 patients, with statistically significant differences between the two groups (p ≤ 0.05). Patients with zygomatic implants were more satisfied with their prostheses, with a statistically significant difference (p < 0.001). Conclusions: According to the results of this study, rehabilitation of patients with edentulous atrophic maxillae with prostheses supported by zygomatic implants combined with anterior implants provided better patient quality of life and satisfaction than prostheses supported by four implants.

Effects of Occlusal Scheme on All-on-Four Abutments, Screws, and Prostheses: A Three-Dimensional Finite Element Study.

An ideal occlusal scheme plays an important role in a good prognosis of All-on-Four applications, as it does for other implant therapies, because of the potential impact of occlusal loads on implant prosthetic components. The aim of the present 3D finite element analysis (FEA) study was to investigate the stresses on abutments, screws, and prostheses that are generated by occlusal loads via different occlusal schemes in the All-on-Four concept. 3D models of the maxilla, mandible, implants, implant substructures, and prostheses were designed according to the All-on-Four concept. Forces were applied from the occlusal contact points formed in maximum intercuspation and eccentric movements in canine guidance occlusion (CGO), group function occlusion (GFO), and lingualized occlusion (LO). The von Mises stress values for abutment and screws and deformation values for prostheses were obtained, and results were evaluated comparatively. It was observed that the stresses on screws and abutments were more evenly distributed in GFO. Maximum deformation values for prosthesis were observed in the CFO model for lateral movement both in the maxilla and mandible. Within the limits of the present study, GFO may be suggested to reduce stresses on screws, abutments, and prostheses in the All-on-Four concept.

Maxillary and mandibular all-on-four implant designs: A review.

OBJECTIVE: The objective of this review is to evaluate maxillary and mandibular all-on-four implant designs, their indications and contraindications, advantages and disadvantages. METHODS: By using Pubmed, Cochrane Library, and Google Scholar, data from January 2003 to February 2018 were scanned electronically and manually as the title, abstract, and full text. The keywords specified were determined to be the all-on-four concept, full-arch implant prostheses, 4-implant full-arch, and tilted implants. The inclusion criteria consisted of the all-on-four implant design, its use in completely edentulous maxillary and mandibular cases, advantages and disadvantages of the technique, and changes observed in the maxilla and mandible in completely edentulous cases. Clinical trials and laboratory studies on the subject using the full text and English language were evaluated. RESULTS: A total of 176 articles were found as a result of Google Scholar, Pubmed, and Cochrane Library. Thirty-seven articles were selected according to inclusion criteria; of these, 20 were related to the clinical trials. In addition, a total of 13 articles were found as a result of an additional hand search by screening the reference list of all included publications; of these, 11 was related to the clinical trials. CONCLUSIONS: It is necessary to carry out longer-term clinical and laboratory studies to determine long-term success criteria in all-on-four implant designs and to use new ceramic systems.

Biomechanical comparison of implant inclinations and load times with the all-on-4 treatment concept: a three-dimensional finite element analysis.

The purpose of this study was to compare the effects of implant inclinations and load times on stress distributions in the peri-implant bone based on immediate- and delayed-loading models. Four 3D FEA models with different inclination angle of the posterior implants (0°, 15°, 30°, 45°) were constructed. A static load of 150 N in the multivectoral direction was applied unilaterally to the cantilever region. The stress distributions in the peri-implant bone were evaluated before and after osseointegration. The principal tensile stress (σmax), mean principal tensile stress (σmax), principal compressive stress (σmin) and mean principal compressive stress (σmin) of the bone and micromotion at the contact interface between the bone and implants were calculated. In all the models, peak principal stresses occurred in the bone surrounding the left tilted implant. The highest σmax and σmin were all observed in the 0° model for both immediate- and delayed-loading models. And the 0° and 15° models showed higher σmax and σmin values. The 0°models showed the largest micromotion. The observed stress distribution was better in the 30° and 45° models than in the 0° and 15° models.

Finite Element Stress Analysis of Applied Forces to Implants and Supporting Tissues Using the "All-on-Four" Concept with Different Occlusal Schemes.

PURPOSE: The aim of this study was to evaluate stress distributions on implants and alveolar bone due to occlusal load produced during chewing by prostheses prepared according to the All-on-Four concept with different occlusal schemes using a finite element analysis method. MATERIALS AND METHODS: On standard jaw models, teeth were set in accordance with the basic standards of canine-guided occlusion, group function occlusion, bilateral balanced occlusion (BBO), lingualized occlusion, and monoplane occlusion schemes. Three-dimensional (3D) images of these models were obtained using a surface scanner. Implants, superstructures, the maxilla, and mandible were modeled in the All-on-Four concept with 3D modeling software. Forces were defined on contacts formed in maximum intercuspation, lateral, and protrusive movement position for all 5 occlusion types. Stress outputs were recorded as maximum and minimum principal stresses (Pmax , Pmin ) and von Mises stress values for the implants. RESULTS: The highest Pmax value for the maxilla was observed in cortical bone in the group function occlusion during lateral movement (15.56 MPa). For the mandible, the highest Pmax value was observed on the cortical bone in maximum intercuspation of lingualized occlusion (72.75 MPa). The highest Pmin value for the maxilla was observed during the lateral movement in group function and for the mandible in BBO (-29.23 and -86.31 MPa, respectively). The lowest stress values were observed with canine-guided occlusion in all related conditions and on all structures. CONCLUSIONS: With the limitations of this simulation study, considering stresses on alveolar bone and implants in All-on-Four applications, the use of canine-guided occlusion may be suggested.

Micromotion analysis of different implant configuration, bone density, and crestal cortical bone thickness in immediately loaded mandibular full-arch implant restorations: A nonlinear finite element study.

BACKGROUND: Excessive micromotion may cause failure of osseointegration between the implant and bone. PURPOSE: This study investigated the effects of implant configuration, bone density, and crestal cortical bone thickness on micromotion in immediately loaded mandibular full-arch implant restorations. MATERIALS AND METHODS: A finite element model of the edentulous mandible was constructed. Four implants were inserted in two different configurations, which were four parallel implants or tilted distal implants according to the all-on-four concept. Different cancellous bone densities and crestal cortical bone thicknesses were simulated. The framework was made of acrylic resin. A vertical load of 200 N was applied at the cantilever or on the distal implant (noncantilever loading). RESULTS: The maximum extent of micromotion was significantly influenced by the density of cancellous bone and to a lesser extent by implant configuration and the crestal cortical bone thickness. The all-on-four configuration showed less micromotion than the parallel implant configuration in some circumstances. The maximum micromotion detected with noncantilever loading was less than 1/3 of that with cantilever loading. CONCLUSIONS: Implant configuration had a limited influence on micromotion. Avoiding cantilever loading during the healing period should effectively reduce the risk of excessive micromotion in patients with low-density cancellous bone and thin crestal cortical bone.

Biomechanical analysis of immediately loaded implants according to the "All-on-Four" concept.

PURPOSE: The purpose of this study was to investigate the biomechanical behavior of immediately loaded implants in an edentulous mandible according to the "All-on-Four" concept. METHODS: A 3D-finite element model of an edentulous mandible was constructed. Four implants were placed between the bilateral mental foramen according to "All-on-Four" concept. A framework made of titanium or acrylic resin between the bilateral first molars was modeled. Immediate loading and a delayed loading protocol were simulated. A vertical load of 200N was applied at the cantilever or on the abutments region of the distal implants, simulating the absence of a cantilever. RESULTS: The peak principal compressive strains in the immediate loading models resulted in 24.0-35.8% and 26.4-39.0% increases compared with the delayed loading models under non-cantilever loading and cantilever loading, respectively. The loading position greatly affected the principal compressive and tensile strain values. The peak principal compressive strains in non-cantilever loading resulted in a 45.3-52.6% reduction compared with those in cantilever loading. The framework material did not influence the peak compressive and tensile strain. The maximum micromotion at the bone-implant interface in the immediate loading models was 7.5-14.4µm. CONCLUSIONS: Mandibular fixed full-arch prostheses without cantilevers may result in a favorable reduction of the peri-implant bone strain during the healing period, compared with cantilevers. The maximum micromotion was within the acceptable limits for uneventful implant osseointegration in the immediate loading models. Framework material did not play an important role in reducing the peri-implant bone strain and micromotion at the bone-implant interface.

Evaluation of "all-on-four" concept and alternative designs with 3D finite element analysis method.

PURPOSE: The aim of the present study was to evaluate the effect of the forces on the implant and supporting alveolar ridge in "all on four" concept and alternative designs using finite element analysis. MATERIALS AND METHODS: Different treatment alternatives with various implant designs were performed in an edentulous mandible. In Design 1, implants were placed according to "All-on-Four" concept; Design 2, two long (13 mm long, 4 mm diameter) and two short (7 mm long, 4 mm diameter) implants; Design 3, four long and two short implants; and Design 4, two long and four short implants were placed vertically. A force of 100 N for each tooth, a total of 300 N load was applied. Finite element analysis was used to evaluate and compare the different designs. RESULTS: The stress concentration within the cortical bone was significantly higher than the trabecular bone around the neck of the implants. The maximum stress values were located around the cortical bone of the distal implant for all designs. The reduction in the number of implants did not diminish the success of the design. CONCLUSIONS: In the presence of vertically resorbed posterior mandibula, although the "all on four" concept is a feasible approach clinically, short implants had decreased the amount of force transmitted to the supporting bone.