Implant-supported full-arch rehabilitation with immediate loading using two different digital impression techniques: a case report with 2-year follow-up.

Immediate full-arch loading is a highly complex and technique-sensitive procedure. Digital impression techniques aim to replace conventional analog systems to carry out dental treatments in a more predictive, safer, and less time-consuming way. This case report describes a patient with a guarded periodontal prognosis, who was rehabilitated with implant-supported fixed prostheses after full-mouth extractions. Immediate full-arch loading was performed by means of two digital impression systems: photogrammetric technology with PIC dental in the maxillary arch, and MedicalFit in the mandible. Immediate provisional prostheses in acrylic resin (polymethyl methacrylate) were milled and placed within 12 hours after implant placement surgeries. Both provisional structures fitted properly providing adequate esthetics and function. After the implant osseointegration period, final digital impressions were registered, and definitive zirconia full-arch implant-supported prostheses were delivered. The 24-month follow-up did not show biologic or mechanical complications.

Effect of Luting Cement and Convergence Angle of the Preparation on the Internal Fit of Zirconia Restorations.

The objective was to evaluate the effect of luting agents and the preparation design on the internal fit of zirconia restorations. Sixty dies were prepared and divided in occlusal convergence angle of 6° (OC6) and 12° (OC12). CAD/CAM zirconia copings were fabricated (Lava All-Ceramic System). A zinc phosphate cement (ZPC); a glass ionomer cement (GIC); and a resin cement (RC) were studied. Specimens were sectioned and coping/die discrepancies were evaluated through Stereoscopic Microscopy. A closer fit was observed in OC12 when compared to OC6 (p < 0.001). For OC6 no significant differences were observed in between ZPC, GIC, and RC (p > 0.05). For OC12, a significantly closer fit was recorded on the ZPC subgroup when compared to the GIC subgroup (p < 0.001). Preparations of 12 degrees demonstrated a closer internal fit when compared to 6 degrees. Preparations of 12 degrees achieved better internal fit values with ZPC (Fortex) followed by RC (RelyX Unicem), and GIC (Ketac Cem). No differences were found when comparing different luting agents over 6° degrees preparations.

Effect of Platelet Concentrates on Marginal Bone Loss of Immediate Implant Procedures: A Systematic Review and Meta-Analysis.

BACKGROUND: To evaluate marginal bone loss (MBL) in immediate implant procedures (IIP) placed in conjunction with platelet concentrates (PCs) compared to IIP without PCs. METHODS: A search was performed in four databases. Clinical trials evaluating MBL of IIP placed with and without PCs were included. The random effects model was conducted for meta-analysis. RESULTS: Eight clinical trials that evaluated MBL in millimeters were included. A total of 148 patients and 232 immediate implants were evaluated. The meta-analysis showed a statistically significant reduction on MBL of IIP placed with PCs when compared to the non-PCs group at 6 months (p < 0.00001) and 12 months (p < 0.00001) follow-ups. No statistically significant differences were observed on MBL of IIP when compared PCs + bone graft group vs. only bone grafting at 6 months (p = 0.51), and a significant higher MBL of IIP placed with PCs + bone graft when compared to only bone grafting at 12 months was found (p = 0.03). CONCLUSIONS: MBL of IIP at 6 and 12 months follow-ups is lower when PCs are applied in comparison to not placing PCs, which may lead to more predictable implant treatments in the medium term. However, MBL seems not to diminish when PCs + bone graft are applied when compared to only bone grafting.

Effect of a single-component ceramic conditioner on shear bond strength of precoated brackets to different CAD/CAM materials.

OBJECTIVES: To compare the shear bond strength (SBS) of the CAD/CAM material-bracket interface using three surface treatments: following manufacturers' instructions (MI), Monobond Etch & Prime (MEP) and 9.6% hydrofluoric acid plus silane (9.6% HF), after 24 h of water storage (24 h) and 10,000 cycles of thermocycling (TC). MATERIALS AND METHODS: A total of 126 crowns with four identical buccal surfaces were fabricated using seven different CAD/CAM materials: CEREC Blocs unglazed (CBU), CEREC Blocs glazed (CBG), IPS Empress CAD (EMP), IPS e.max CAD (EMA), VITA SUPRINITY PC (SUP), inCoris TZI (TZI) and VITA ENAMIC (ENA). A total of 504 APC Flash-Free (APC FF)-precoated brackets were bonded applying three surface treatments: (1) MI; (2) MEP and (3) 9.6% HF. SBS was performed after 24 h and TC. Results were analyzed by Kruskal-Wallis and Mann-Whitney U tests (p < 0.05). RESULTS: MEP conditioning yielded lower SBS results compared with MI and 9.6% HF for CBG (24 h and TC) and EMA (TC) materials. EMP conditioning with MEP after 24 h obtained lower SBS values compared with MI; however, after TC, SBS was similar to MI group and higher than with 9.6% HF. After TC for TZI ceramic, MI protocol (sandblasting) obtained higher SBS scores than MEP, but similar than 9.6% HF. Treatment of ENA with MI and MEP produced higher results than 9.6% HF after TC. SBS results were similar for CBU and SUP, regardless of the treatment. CONCLUSIONS: Although each CAD/CAM material requires specific surface treatment to obtain the highest SBS of APC FF brackets, the treatment with MEP is a valid orthodontic alternative for most of the materials tested. TC significantly decreased SBS for most of the materials. CLINICAL RELEVANCE: MEP can be considered a valid and promising product to condition most of the CAD/CAM ceramics evaluated for APC FF bracket bonding purposes, allowing a faster and safer procedure.

PROA concept: prosthetic restoration with orthodontic appliance.

This paper describes an alternative computer-aided design/computer-aided manufacturing (CAD/CAM) technique for the creation of a combined prosthetic restoration with orthodontic appliance (PROA). This concept allows the use of orthodontic appliances such as brackets, attachments, or any other type of appliance over different types of prosthetic restorations. The PROA concept aims to mitigate problems associated with performing restorative treatment when orthodontic treatment is necessary. This proposed concept provides the clinicians with proper control and planning of the interdisciplinary treatment that will lead to the final tooth shape, form, and proportions while performing orthodontic tooth movements.

All-on-four rehabilitation using photogrammetric impression technique.

Conventional implant impression techniques may introduce distortions in the framework that can lead to a lack of accuracy of the prostheses. Misfit between the restoration and the implants facilitates the occurrence of biomechanical failures and prostheses complications due to inadequate stress dissipation. Digital impressions present an alternative to eliminate procedural distortions by improving the fit between the restoration and the implants. Among the different types of digital impressions, photogrammetry has emerged as an alternative for multiple implant impressions. This case report describes photogrammetric technique for a full-arch rehabilitation in All-on-four of a 68-year-old patient with a fixed implant-supported restoration on the mandible. Photogrammetric technique has demonstrated to be a successful digital alternative to conventional multiple-implant impression. Esthetics and function remained stable over a follow-up period of 1 year. No biomechanical or biologic complications were observed.

Photogrammetry Impression Technique: A Case History Report.

PURPOSE: The aim of this report is to present photogrammetry as a reliable step in the fabrication of a full-arch immediate rehabilitation. MATERIALS AND METHODS: A 59-year-old man attended the department seeking dental rehabilitation for the sequelae of severe oral health neglect. The mandibular teeth suffered from advanced periodontal disease and the patient wore a maxillary complete denture. An irreversible hydrocolloid impression of the mandibular arch was made, poured in stone, and digitally scanned to create the first stereolithography (STL) file. All teeth with the exception of two retained as landmarks were extracted, and seven implants were placed under local anesthesia and their positions recorded using photogrammetry. Maxillary and mandibular dental arch alginate impressions were made, poured in laboratory stone, and scanned. A provisional restoration was placed 7 hours after surgery using the STL files to determine the best-fit line. RESULTS: Radiographic and clinical follow-up after 1 year showed a favorable evolution of the implants. No screw loosening or other mechanical or biologic complications were observed. CONCLUSION: The case history using the described system suggests certain advantages over conventional techniques. More research is needed to assess the possible benefits associated with photogrammetry when making implant-supported restorations.

Phentolamine mesylate to reverse oral soft-tissue local anesthesia: A systematic review and meta-analysis.

BACKGROUND: Knowing that patients desire reduced duration of local anesthesia, the authors performed a meta-analysis to evaluate the efficacy of phentolamine mesylate (PM) in reducing anesthesia duration and the occurrence of adverse effects. TYPES OF STUDIES REVIEWED: The authors searched studies in 4 electronic databases up to December 18, 2014. For each study, the methodological quality was assessed according to the Cochrane Collaboration's tool for assessing risk of bias. Randomized controlled trials (RCTs) that used PM met the inclusion criteria. RESULTS: Six RCTs met the inclusion criteria and were used to carry out a meta-analysis of the effectiveness of PM and a qualitative analysis of its adverse effects. The use of PM was more effective in reversing the anesthetic effect on the lower lip and tongue than was applying a placebo. Adverse effects reported in the studies were not statistically significant, the most frequent being headache, pain during injection, and postprocedure pain. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Based on limited evidence, PM is effective in reducing the persistence of anesthesia duration on the lower lip and tongue, with infrequent adverse effects of little clinical significance.

Evolución de un implante migrado al seno maxilar tras rehabilitación con carga inmediata / No disponible

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Implantes inmediatos postextracción con estética inmediata / Immediate postextraction implant with immediate aesthetic

Introducción: A día de hoy, la calidad esté- tica es algo altamente solicitado por los pacientes en todos los campos de la odontología. Los procedimientos de estética inmediata, ampliamente documentados en la literatura científica, se postulan como una alternativa prostodóncica mediante la utilización de la implantología, ya que pueden ofrecer una elevada naturalidad durante el periodo de osteointegración. Además, su utilización parece traducirse en un mayor acondicionamiento de los tejidos peri implantarios a la vez que mejoran la satisfacción y aceptación por parte del paciente. Objetivo: Presentar como alternativa terapéutica, un procedimiento de implantes inmediatos postextracción con estética inmediata antero-superior. Caso clínico: Paciente mujer de 68 años que acude al servicio de Cirugía Bucal e Implantología del hospital Virgen de La Paloma de Madrid por presentar episodios de dolor e inflamación a nivel de la premaxila. La paciente, que era portadora de prótesis fija, mostraba fractura horizontal a nivel de la cresta ósea alveolar en los dientes pilares. A nivel radiológico, se podía observar además, una lesión radiotransparente en el ápice del 13. Ante esta situación se decidió la extracción de estos dientes y rehabilitación con implantes y procedimiento de estética inmediata. Conclusiones: La utilización de los procedimientos de estética inmediata en el sector anterosuperior junto con la colocación de implantes post-extracción permiten unos resultados fiables y predecibles cuando son realizados bajo un correcto diagnóstico y una precisa técnica tanto quirúrgica como prostodóncica (AU)

Introduction: Nowadays, aesthetic quality is highly requested by patients in all areas of Dentistry. Immediate aesthetic procedures, widely documented in literature, are postulated as a prosthodontic alternative using dental implants. This method offers great naturality during the Osseo integration period. Moreover, using this method, better soft tissue conditioning can be achieved. At the same time, greater satisfaction and acceptance by the patient is accomplished. Objective: An immediate postextraction implant procedure with immediate aesthetic in the anterior region is presented as a therapeutic alternative. Case report: A 68-year-old woman attends the Oral Surgery and Implatology Service in the hospital Virgen de La Paloma de Madrid presenting pain and swelling in the premaxilla area. Clinical examination revealed fixed dental-supported prosthesis with horizontal fracture of the abutment teeth at the level of the alveolar crest. Radiological examination showed a radiolucent area at the apex of the upper right canine. In this situation, it was decided to perform the extraction of the present teeth and immediate implant and aesthetic rehabilitation. Conclusion: using immediate aesthetic procedures in the anterior superior region with post-extraction implants leads to reliable and predictable results when performed under correct diagnose and a precise surgical and prosthodontic technique (AU)