Effects of different types of intraoral scanners and scanning ranges on the precision of digital implant impressions in edentulous maxilla: An in vitro study.

OBJECTIVE: This study aimed to evaluate the precision of digital implant impressions in comparison with conventional impressions and assess the impact of the scanning range on precision. MATERIALS AND METHODS: An edentulous maxilla model with six implants was scanned with four intraoral scanners (IOSs) and a dental laboratory scanner five times each, and stereolithography (STL) data were generated. A conventional silicone impression was made, and a model was fabricated, which was scanned using the laboratory scanner. This procedure was also repeated five times. Nine different ranges of interest (ROIs) were defined, and the average discrepancies of the measurement points between each pair of STL images out of five for each ROI were calculated. The effects of "impression method" and "ROI" on precision, as evaluated by the averaged discrepancy, were tested by two-way analysis of variance (p < .05). RESULTS: The effects of "impression methods" and "ROI" and their interactions were statistically significant. The discrepancies in the scanned datasets of the dental laboratory scanner were significantly lower than those in the other impression methods. The discrepancies of the IOSs were comparable with those of the laboratory scanner when the ROI was limited, however; the discrepancies deteriorated when the ROI expanded across the arch, while those of the laboratory scanner remained stable irrespective of the ROI. CONCLUSIONS: Within the limitation of this in vitro study, digital implant impressions by IOSs may show clinically acceptable precision when the scan range is limited, such as in 3-unit superstructure supported by two implants.

Location of implant-retained fixed dentures affects oral health-related quality of life.

BACKGROUND: The effects of the locations of dental implants on treatment outcomes, as evaluated by oral health-related quality of life (OHRQoL) assessment, remain controversial. PURPOSE: To investigate the association between the locations of dental implants and changes in OHRQoL. MATERIALS AND METHODS: Sixty-eight subjects received implant treatment in the anterior or posterior region and completed the Oral Health Impact Profile (OHIP) questionnaire before and after treatment. Change in OHIP summary scores and the 4 dimension scores were calculated to evaluate the effects of implant treatment on OHRQoL. RESULTS: The mean Oro-facial Appearance score for the anterior group was significantly higher than that for the posterior group (10.4 ± 5.1 and 7.2 ± 3.8, respectively; P ＝ .005; Effect size = 0.63) at baseline. All questionnaire scores were significantly improved following implant treatment in both groups, and no significant group differences were observed at follow-up. Regression analysis revealed a significant association between the locations of most anterior implants and changes in the Oro-facial Appearance score (adjusted R2 = 0.073; P = .015). CONCLUSION: Our results suggest that the locations of dental implants influence OHRQoL impairments and improvements after treatment. This information might be useful in clinical decision-making.

Immediate loading of two freestanding implants placed by computer-guided flapless surgery supporting a mandibular overdenture with magnetic attachments.

PURPOSE: The present article describes a novel clinical procedure for mandibular overdentures supported by two freestanding implants loaded immediately after placement via computer-guided flapless surgery. METHODS: A conventional acrylic complete denture was fabricated, and CT scans obtained using the denture as a radiographic guide. Preoperative computer-assisted planning was performed using commercially available software, permitting simulation of implant placement at optimal positions. Using simulation data, a surgical guide was manufactured and used during surgery. The surgical guide was placed and local anesthesia injected for drilling of anchor pins to stabilize the surgical guide. The drilling protocol for each osteotomy site achieved an insertion torque greater than 35 Ncm. Immediately after implant placement, a keeper of the magnetic attachment was connected to each implant, and the magnetic assembly incorporated into the denture. The mucosal surface of the denture around the magnet was relieved to avoid excessive tissue pressure. The patients were instructed to wear the denture in place continually for the following 7 days. After six months of healing and follow-up, a final denture with a metal framework may be fabricated if necessary. CONCLUSION: A novel treatment protocol for immediately loaded implant-supported mandibular overdentures is described in detail. The protocol ensures secure precise and safe implant placement, successful osseointegration, and immediate improvement of oral health-related quality of life for patients with unstable complete dentures.

[Influence of intensity of occlusal contact in implant-retained single restoration on stress distributions of crown surface and supporting bone].

PURPOSE: This study investigated the influence of intensity of occlusal contact, or occlusal height of an implant-retained single restoration on the stress in the crown surface and supporting bone. METHODS: A two-dimensional finite element model of the maxillary and mandibular first molars with supporting periodontal structures was created (Model M-M). One of the molars was replaced by a restoration retained by a thread-type implant to produce Model I-M (implant in maxilla) and Model M-I (implant in mandible). The models were isotropic and linearly elastic, except for the periodontal ligament with a non-linear material property to simulate the tooth movements. The tooth-to-tooth contact under the bite force was simulated by the vertical displacement of the mandible up to 0.24 mm from the initial occlusal contact. Non-linear contact analysis was conducted to calculate the stress in both the restoration and the supporting tissues. RESULTS: To obtain a restoration that shows the same stress in the occlusal surface as that in the natural molars under the maximum bite force, the occlusal heights in Models I-M and M-I were to be reduced by 0.10 mm and 0.11 mm, respectively. The restorations were not expected to occlude with their natural molar antagonists under bite force lower than 13.0% and 15.8% of the maximum force, respectively. CONCLUSION: Reduction in the intensity of the occlusal contact, or decreased occlusal height of an implant-retained single restoration, allows the establishment of an equivalent occlusal stress with the natural molars under the maximum bite force. This adjustment, either during fabrication or try-in procedure, can suppress excessive stress that may be created in the tissues. With this procedure, however, the restoration does not contact the antagonistic tooth under a relatively low bite force.

Stress analysis in edentulous mandibular bone supporting implant-retained 1-piece or multiple superstructures.

PURPOSE: The aim of this study was to investigate the stress distribution in mandibular bone supporting a single or separate multiple implant-retained superstructures. MATERIALS AND METHODS: Three-dimensional finite element models consisting of the mandibular bone, 8 implants, and 1 or more superstructures were created. Vertical and oblique loads were directed onto the occlusal areas of the superstructures to simulate the maximum intercuspal contacts and working contacts, such as the canine-protected and group function occlusion. RESULTS: The unseparated 1-piece superstructure generated the lowest maximum equivalent stresses in the peri-implant bone, followed by the 2-piece superstructure separated at the midline. For the 3-piece superstructure, which was separated between the canine and the premolar, the maximum stress was lower when the canine on the working side was loaded than when the posterior teeth were loaded. DISCUSSION: Separating the 1-piece superstructure into 2- to 4-piece superstructures increased the mechanical stress around supporting implants. Canine load on the working side is distributed well in 1-piece and 3-piece superstructures. CONCLUSION: Based on the results of this finite element model study, canine protected occlusion is recommended for 1-piece and 3-piece superstructures. The unseparated superstructure was more effective in relieving stress concentration in the edentulous mandibular bone than the separated superstructures.

The influence of implant location and length on stress distribution for three-unit implant-supported posterior cantilever fixed partial dentures.

STATEMENT OF THE PROBLEM: The influence of implant location for an implant-supported cantilever fixed partial denture (FPD) on stress distribution in the bone has not been sufficiently assessed. PURPOSE: This study examined the influence of location and length of implants on stress distribution for 3-unit posterior FPDs in the posterior mandibular bone. MATERIAL AND METHODS: Each 3-D finite element model included an FPD, mesial and distal implants, and supporting bone. The mesial implant with a length of 10 mm or 12 mm was placed in locations where its long axis was 3 mm to 11 mm posterior to the remaining first premolar. The distal implant with a length of 10 mm was fixed at the same distance from the premolar on each model. A buccally-oriented oblique occlusal force of 100 N was placed on each occlusal surface of the FPD. RESULTS: The maximum equivalent stresses were shown at the cervical region in the cortical bone adjacent to the mesial or the distal implants. Relatively high stresses of up to 73 MPa were shown adjacent to the mesial implant located 9 mm or more posterior to the first premolar. The use of a 12-mm-long mesial implant demonstrated a relatively weak influence on stress reduction. CONCLUSION: The implant location in the cantilever FPDs was a significant factor influencing the stress created in the bone.

[The influence of medial implant location in three-unit posterior cantilever fixed partial dentures on stress distribution in surrounding mandibular bone].

This study examined the influence of medial implant location in three-unit posterior cantilever fixed partial dentures (FPDs) on stress distribution in mandibular bone surrounding two implants. A three-dimensional finite element model that included three-unit FPD and two cylindrical-type implants (4 mm in diameter and 10 mm in length) osseointegrated in the posterior mandible, was digitized. Five different models were created according to the medial implant location between the missing second premolar and the first molar location. The distal implant was fixed at the missing second molar location. Oblique bite force of 100 N at 30 degrees buccal to the vertical direction was directed on each of three artificial teeth, respectively and simultaneously, while the lower surface of the mandible was fixed. The maximum equivalent stress in the cortical and the trabecular bone generally increased as the medial implant shifted to a distal position. Under the simultaneous bite force, relatively low maximum stresses within the cortical bone: between 55 MPa and 57 MPa, were shown in the models with the medial implant placed within the range of one implant diameter from the most medial position, while higher maximum stresses: between 64 MPa and 73 MPa, were demonstrated with more distally placed medial implants. The results suggest that reasonably low mechanical stress in the surrounding bone may be assured when the medial implant is placed in the range between the missing second premolar position and one implant diameter distal from that location.