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.

Evaluation and comparison of retention and patient satisfaction with milled polyetheretherketone versus metal maxillary obturators.

STATEMENT OF PROBLEM: Metal and polyetheretherketone (PEEK) have been used to rehabilitate maxillary defects with obturators, each having advantages and disadvantages. However, patient satisfaction with the obturator retention of each material is unclear. PURPOSE: The purpose of this crossover clinical study was to compare retention and patient satisfaction between a milled cobalt chromium and a milled PEEK framework, each with a hollow bulb extension in polymethyl methacrylate (PMMA). MATERIAL AND METHODS: Twenty patients who had received unilateral total maxillectomy and were treated in the prosthodontic department's maxillofacial clinic were enrolled in this crossover study. Each participant wore 2 different types of obturators for 6 months after insertion. Type CoCr received a milled cobalt chromium framework with a hollow bulb extension in PMMA first, and type Pk received a milled modified PEEK (BioHPP) framework with a hollow bulb extension in PMMA first. Patient satisfaction and retention force were measured immediately, at 3 months, and at 6 months after obturator insertions. The Fischer exact, chi-squared, and Monte Carlo tests were used to compare qualitative data. One-way ANOVA with the post hoc Tukey test was used for pair-wise comparison, and repeated measures ANOVA was used to compare before and after treatment at 3 and 6 months. RESULTS: No significant difference was found between types in obturator insertion (P>.999), appearance of the upper lip (P>.999), mouth feeling (P=.301), pronunciation of words (P=.217), and talking in public (P=.589). A significant difference between types was found in speech after 6 months of obturator insertion (P=.016), swallowing liquids and food (P=.04), masticating foods (P=.007), appearance of clasps on anterior teeth (P=.002), satisfaction with appearance (P=.005), or avoidance of family events (P=.014) after 6 months of insertion. Types of obturators showed a statistically significant decrease in retention force with time (P<.001). CONCLUSIONS: Although the retention force was less with PEEK than with Co-Cr clasps engaging the same undercuts, this retention force was adequate for retaining removable partial dentures. Co-Cr clasps can be considered better than PEEK clasps because they engage the same undercuts regarding loss of retention with time. Quality of life in patients after maxillary resection could be improved by using maxillary obturators. Type Pk was better than type CoCr in terms of esthetics, but the retention of the PEEK obturator after 6 months decreased because of wear, leading to difficulty swallowing food or liquids, mastication, and speech.

Polyetheretherketone computer-aided design and computer-aided manufacturing framework for All-on-Four mandibular full-arch prosthesis: 3 Years' retrospective study of peri-implant soft tissue changes and ridge base relationship.

PURPOSE: This study was conducted to evaluate the clinical peri-implant soft tissue changes during the first year after occlusal loading and the ridge base relation after 3 years for mandibular computer-aided design and computer-aided manufacturing (CAD-CAM) screw-retained implant-supported hybrid prosthesis of polyetheretherketone (PEEK) framework utilized with All-on-Four treatment concept. MATERIALS AND METHODS: Sixteen completely edentulous patients were rehabilitated by four implants following the All-on-Four protocol. After 3 months, the definitive prosthesis was constructed to be a screw-retained CAD-CAM milled framework from the modified PEEK (BioHPP), bonded to polymethylmethacrylate teeth and a pink shaded indirect light-polymerized nanofilled composite resin imitating the soft tissues. Peri-implant soft tissue changes regarding plaque, bleeding, gingival scores, and probing depth were evaluated at prosthesis insertion (T0), 6 months (T1), and 12 months (T2) after insertion. Also, monitoring of the ridge base relation was performed using cone beam computed tomography at time of insertion (T0), and 1 year (T1), 2 years (T2), and 3 years (T3) after mandibular fixed detachable All-on-Four framework insertion. Using Shapiro-Wilk tests using SPSS® software version 22 (SPSS Inc., Chicago, IL), all clinical data were nonparametric, while the ridge base relation data were parametric. RESULTS: There were statistically significant differences regarding a plaque, gingival, and bleeding scores for all implants with the advancement of time. However, there was a statistically insignificant difference regarding probing depth in the posterior implants (p = 0.581). Regarding ridge base relation, there was a significant difference between observation times only in the anterior ridge area in between the two anterior implants (p = 0.011). CONCLUSIONS: Within the limitations of the study, the full-arch PEEK framework of fixed-detachable, hybrid prosthesis used with the All-on-Four concept for rehabilitation of mandibular edentulous arches is an acceptable treatment approach. Based on the stable ridge base relation posteriorly found in this study, less stress is distributed to the underlining bone due to the shock-absorbing ability of PEEK. Special considerations for frequent soft tissue follow-up and regular maintenance of oral hygiene measures are recommended.

Effect of Ridge Splitting of Mandibular Knife Edge Ridges with Two-implant Retained Overdenture with Locator Attachments on Peri-implant Bone Level and Posterior Ridge Resorption: A One-year Preliminary Study.

AIM: This study was conducted to evaluate peri-implant bone height changes and posterior ridge resorption by using two-implant retained polyetheretherketone (PEEK) overdentures with locator attachments following expansion of mandibular knife edge ridges by ridge splitting. MATERIALS AND METHODS: Eighteen patients were selected for ridge splitting followed by expansion, implant placement, and bone graft application. Six months later, the fabrication of PEEK overdentures retained by locator attachments was accomplished. Friedman test, Wilcoxon signed-rank test, and Spearman correlation were used to evaluate the changes over time. RESULTS: Peri-implant bone height loss increased significantly with the advance of time between 6 and 12 months following denture insertion. Posterior area index changes were significant over time when measured at the time of denture insertion and twelve months following denture insertion. CONCLUSION: The effect of using PEEK as overdenture base material retained with two locator attachments allowed sharing the load between the peri-implant bone anteriorly and residual ridge posteriorly in cases with ridge splitting technique. CLINICAL SIGNIFICANCE: Using PEEK as an overdenture base material is a successful means of bone preservation. How to cite this article: Helmy MA, El-Shaheed NH, El Waseef FA, et al. Effect of Ridge Splitting of Mandibular Knife Edge Ridges with Two-implant Retained Overdenture with Locator Attachments on Peri-implant Bone Level and Posterior Ridge Resorption: A One-year Preliminary Study. J Contemp Dent Pract 2023;24(11):834-839.

Polyetheretherketone subperiosteal implant retaining a maxillary fixed prosthesis: A case series.

STATEMENT OF PROBLEM: Patients needing dental rehabilitation of a complete atrophic maxilla would benefit from simplified treatment plans. PURPOSE: The purpose of this case series was to demonstrate the prosthetic management of 4 edentulous patients with severe maxillary ridge resorption who declined multiple stage surgery and sought a fixed prosthesis in single-stage surgery. MATERIAL AND METHODS: The patients were provided with completely digital computer-aided designed and computer-aided manufactured (CAD-CAM) polyetheretherketone (PEEK) maxillary subperiosteal frameworks, which were surgically placed in a 1-step procedure. The patients were followed up for 12 months and evaluated for signs of implant rejection, infection, prosthetic fracture or mobility, or implant exposure. RESULTS: At the 12-month follow-up, all the implants were functionally stable with healthy soft tissue and showed no sign of prosthetic fracture, infection, or pus discharge. CONCLUSIONS: PEEK subperiosteal implants for maxillary atrophied ridges can be considered a promising treatment option within the limitations of this clinical study with low patient numbers and a short observational time.

Impact of implants number and attachment type on the peri-implant stresses and retention of palateless implant-retained overdenture.

OBJECTIVES: To evaluate the impact of implants number and attachments type on the peri-implant stresses and retention of maxillary palateless implant-supported overdenture. MATERIALS AND METHODS: Four edentulous maxillary educational acrylic resin models were used. According to the implants number and type of attachment used, four groups were compared: Group I, 2-locator attachments in the canine area; Group II, 2- OT equator attachments in the canine area; Group III, 4-locator attachments in the canine, second premolar area and Group IV, 4-OT equator attachments in the canine, second premolar area. Implants retained palateless overdenture was constructed on each model. Four self-protected linear strain gauges were cemented on each implant. A digital loading device was used to apply compressive loads to measure the resulting peri-implant stresses. Forcemeter and Universal testing machines were used to test the retention of palateless overdenture. RESULTS: A significant difference between the same implant number and distribution with different attachments was found (P = 0.003, P = 0.020), respectively. Least stresses amount was found around the 4-implant locator palateless overdenture, while the highest was found around the 2-implant OT equator palateless overdenture. Nevertheless; the result was that 2-implant locator palateless overdenture recorded insignificant higher retentive forces than the 4-implant OT equator one. CONCLUSIONS: It can be concluded that the implant-retained palateless overdenture with four locator attachments is considered a promising treatment option regarding stress distribution. Using locator attachments, for implant-retained palateless overdenture with either two or four implants considering their superior retentive properties, is advantageous when compared to OT equator attachments.

CAD/CAM Constructed Poly(etheretherketone) (PEEK) Framework of Kennedy Class I Removable Partial Denture: A Clinical Report.

The prevalence of partially edentulous adults that could be treated by removable partial dentures (RPDs) is estimated to be greater than 20% in some regions of the United States. Problems related to traditional materials for RPD construction have been documented. Advances in polymer-based materials and digital fabrication strategies would allow increased biocompatibility, durability, and elasticity, as well as more esthetically pleasing and cost-effective benefits. This article reports on poly(etheretherketone) RPD framework produced by digital and milling technology.

Chewing efficiency and electromyographic activity of masseter muscle with three designs of implant-supported mandibular overdentures. A cross-over study.

PURPOSE: The aim of this study was to compare the effect of three designs for implant-supported mandibular overdenture on the chewing efficiency and electromyographic (EMG) activity of masseter muscles. MATERIAL AND METHODS: Eighteen edentulous patients received new maxillary and mandibular dentures (control, CD) before implant placement. After using the dentures for 3 months, patients were randomly divided into six blocks (three patients/block) and received four implants in canine and first molar areas of the mandible. Following osseointegration period, new duplicate mandibular overdentures were successively connected to the implants with: (i) ball attachment on two implants (2BOD), (ii) bar attachment on two implants (2ROD), and (iii) bar attachments on four implants (4ROD) in a random order. Chewing efficiency was measured using chewing gum, and EMG was recorded during clenching (with or without food). Evaluations were made 3 months after using each of the following prostheses: CD, 2BOD, 2ROD, and 4ROD. RESULTS: All implant-supported overdentures showed a significant increase in chewing efficiency and EMG values when compared to CD. These values increased significantly with 4ROD when compared to 2BOD or 2ROD prostheses. There was no significant difference in chewing efficiency and EMG between 2BOD and 2ROD prostheses. CONCLUSION: Four-implant-supported overdentures seem to present a functional advantage vs. two-implant-supported overdentures, independent of the chosen attachment system.

Stresses induced by mesially and distally placed implants to retain a mandibular distal-extension removable partial overdenture: a comparative study.

PURPOSE: The present in vitro study compared the stresses transmitted to canine abutments and implants placed in either the first premolar or second molar areas for retaining removable partial overdentures in models of mandibular bilateral distal-extension with the six anterior teeth remaining. The study also compared horizontal to vertical reciprocation of bracing arms when the implants were placed mesially. MATERIALS AND METHODS: Three overdenture models were used to represent two groups. In group 1, implants were placed bilaterally in the first premolar area (claspless denture); subgroup A dentures had horizontal reciprocal arms and subgroup B dentures had vertical reciprocal arms. In group 2, the implants were placed bilaterally in the second molar areas. Ball attachments were used to retain the partial overdenture. Eight strain gauges were cemented to the facial and lingual sides of each abutment (two canines and two implants). Static unilateral (right and left) and centric loads of 70 N were applied and the stresses were measured. All measurements were repeated five times for each loading impact, and means were calculated. RESULTS: Group 1A showed the highest stresses around the abutments, followed by group 1B, and the lowest stresses were found in group 2. Group 1 showed statistically significant increases in the stresses induced around the implants and the abutment teeth. For group 1, although there was no statistically significant difference between subgroups, subgroup B showed lower stresses around the abutments than subgroup A in both central and unilateral loading. CONCLUSION: A distally placed implant can be considered a more satisfactory solution than a mesially placed implant for retention of a mandibular distal-extension removable partial overdenture.