Implant rehabilitation of edentulous jaws with predominantly monolithic zirconia compared to metal-acrylic prostheses: a 2-year retrospective clinical study.

Limited data are available on the clinical outcomes of patients with edentulism treated with predominantly monolithic zirconia fixed complete dentures (FCDs) compared to traditional restoration materials. The purpose of this study was to analyze the differences in terms of complications and failures of definitive full-arch implant rehabilitations made in metal-acrylic versus those made in monolithic zirconia with porcelain veneering limited to non-functional areas. This retrospective clinical study included 50 patients treated between January 2015 and December 2018, with 222 implants inserted in fifty edentulous jaws. All patients were treated with immediately loaded full-arch fixed prostheses (22 maxillary; 28 mandibular) each supported by four to six implants (two/four axial, two distally tilted). All 25 zirconia prostheses were predominantly monolithic with ceramic veneering limited to non-functional areas. The primary outcome measures were prosthetic success of the definitive restoration and implant survival. The secondary outcome measures were full mouth plaque score, full mouth bleeding score, peri-implant probing depths and periimplant keratinized tissue. All implants and prostheses analyzed had a minimum of 2 years of followup. No chipping of the veneered facial porcelain or other technical complication was observed over the study period achieving a prosthesis survival and success rate of 100%. No implants were lost, achieving a 100% survival rate. Bleeding on probing was positive in 33% and 13% of probing sites for metal-acrylic prosthesis and zirconia prosthesis, respectively (p = 0.0445). Plaque index was positive in 76% and 53% of probing sites for metal-acrylic prosthesis and zirconia prosthesis, respectively (p = 0.0491). Mean probing depth was 1.74mm (SD 0.89mm) for the 106 implants supporting metal-acrylic prosthesis and 1.52mm (SD 0.63mm) for the 116 implants supporting zirconia prosthesis (p=0.0412). No other statistically significant differences were found between the two groups. The results of this retrospective evaluation showed that predominantly monolithic zirconia is a feasible alternative to the conventional metal framework acrylic for full arch implant-supported prosthesis. The restauration material did not influence the failure rate and complication risk of both prosthesis and implants.

How to consider implant-prosthetic rehabilitation in elderly patients: a narrative review.

With the beginning of the twenty-first century, population aging has emerged as a major worldwide phenomenon. The dentist must respond to this demographic change by taking into consideration the possibility of restoring oral function in the elderly patient with the use of dental implants. This article aims to provide a narrative review of the literature regarding the implant survival rate in geriatric patients and the relative importance and advantages of implant-prosthetic rehabilitation through a scientific analysis of the literature through online databases and dental journals. Tooth loss can have a significant impact on patients' oral function and significantly affects quality of life, self-esteem, and nutritional status. Although many studies in the past have reported that implant success is age-dependent, more recent studies suggest that they are safe and predictable for geriatric patients, improving quality of life, with similar results to those of younger age groups. Advanced age does not necessarily represent a contraindication for implant placement and osseointegration and success is influenced by patient and site-specific factors. Aging is a process that affects each patient differently, consequently, there should be a specific therapeutic approach for everyone, which must consider the functional and cognitive status of the patient, his medical condition, and his social situation-economic and motivational.

The association between three attitude-related indexes of oral hygiene and secondary implant failures: A retrospective longitudinal study.

OBJECTIVE: This study evaluated the strength of the association between three widely used clinical indexes considered as distal behavioural indicators of attitude-related oral status (an index of oral hygiene, the plaque index [PI] and two periodontal indexes, that is the presence of bleeding on probing [BOP] and of pockets probing depth [PPD]) and secondary implant failure due to peri-implantitis in patients rehabilitated with cemented prosthesis. MATERIALS AND METHODS: The study included patients who underwent implant-prosthetic rehabilitation and had joined the programme of maintenance of the same hospital. Implant failures, number of months between implant insertion and implant loading, and patients' surgical protocol were monitored and recorded. Further, PI, BOP and PPD-all attitude-related indicators of oral hygiene and periodontal inflammation-were recorded and related, in terms of odds ratios (ORs ) and corresponding risk factors, to secondary implant failures. RESULTS: A total of 1427 patients (2673 implants) were enrolled. The follow-up ranged from 1.5 to 9 years (mean 5.3 years±1.3). The cumulative survival rate was 98.01%. Thirty-two patients (36 implants, 1.36% of all implants) had implant failure. A statistically significant association between PI, BOP, PPD and secondary failures due to peri-implantitis was observed. CONCLUSION: Within the limitations of this study, all three attitude-related behavioural indicators-the plaque index (PI), bleeding on probing (BOP) and abnormal probing pocket depth (PPD)-proved to be significant risk indicators for secondary implant failure due to peri-implantitis, both from a clinical and from a socio-psychological attitude-related perspective.

Prosthetic management of patients with oro-maxillo-facial defects: a long-term follow-up retrospective study.

INTRODUCTION: The aim of this study is to determine the outcome of maxillofacial prosthetic rehabilitation after oncological resections, including both intra- and extra-oral prosthetic devices. METHODS: In this study were included 72 patients, who have undergone an intra or extra-oral maxillofacial prosthetic rehabilitation after an oncologic resection. Tumors on the head and neck were analyzed and the defects of these resections have been divided in two different groups: intra and extra-oral defects. RESULTS: 72 participants were treated with maxillofacial prosthesis, 3 of which with post-traumatic wounds and 69 with resections of tumors on the head and neck. Of the 69 treated for neoplastic disease, 43 received an intraoral prosthesis (palatal obturator) and 29 with an extraoral epithesis (18 with nasal prostheses, 8 with orbital implants and 3 with ear implants). The group included patients with different types of tumors. All the patients were evaluated in terms of aesthetic appearance after the construction of the prostheses and the results were satisfactory. CONCLUSION: Within the limitations of this study, after the use of maxillofacial protheses patients feel more confident and self-assured. Maxillofacial protheses are a good solution in order to improve the life's quality in patients with tumors resections: prostheses are easy to handle and provide a satisfying social interaction for the patients.

The park-bench position in cervico-facial reconstructive surgery: a technical note.

Resection and simultaneous reconstruction with free flaps of wide tumours of the scalp and posterior neck region are difficult to perform through a single surgical approach. In such cases, the park-bench position - a lateral oblique position - could allow simultaneous resection and reconstruction of tumours of the scalp and occipital region without changing the patient's position. In the case described here, this position was used to treat microcystic adnexal carcinoma in a patient who presented with three scalp lesions and a lesion of the right scapular region. This arrangement allowed both resection and reconstruction with a microvascular flap without changing the patient's position, as a result of being able to find neck vessels suitable for microanastomosis. Reconstruction was carried out using a right latissimus dorsi myogenous and subcutaneous flap, and anastomoses were created between the thoracodorsal artery and vein, and the transverse cervical artery and vein. In this position, transverse cervical vessels are well placed, with good exposure, and are in an optimal location for use in microvascular surgery. At 8 months post-reconstruction, the patient was in good condition without local recurrence or distant metastases, and the flap showed a good lining and contour. In conclusion, the park-bench position facilitates surgical excision, flap harvesting and microsurgery in the same patient position.

A preliminary study of the use of peripheral quantitative computed tomography for investigating root canal anatomy.

AIM: To evaluate the use of peripheral quantitative computed tomography (pQCT) for qualitative and quantitative analysis of root canal anatomy and for assessing the extent of canal enlargement during root canal instrumentation. SUMMARY: The volume variation achieved by S1 ProTaper instruments in the coronal third of the root canals was analysed using peripheral computed tomography. The tooth was scanned in the horizontal plane producing 36 consecutive cross-sectional images. All images were the result of 360 projections with a section thickness of 250 microm, a distance between slices of 0.5 mm and an in-plane pixel size of 70 x 70 microm. The evaluation was completed before and after S1 ProTaper instrumentation (with or without circumferential filing) of one root canal of a freshly extracted maxillary first premolar tooth. The acquired images were realigned geometrically and processed using a 3D visualization software. pQCT scanning allowed 3D reconstruction of the root canal anatomy and the assessment of the extent of canal enlargement during root canal instrumentation with lateral displacement of canal walls and hence volume change being greater than the coefficient of variation. The densitometry evaluation showed uniform density along the root canal wall. KEY LEARNING POINTS: * pQCT scanning allowed 3D reconstruction of the root canal anatomy and the assessment of the extent of canal enlargement during root canal instrumentation. * pQCT shows promise for allowing qualitative and quantitative analysis of endodontic procedures.