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1.
Artículo en Inglés | MEDLINE | ID: mdl-33528453

RESUMEN

In everyday practice, surgeons have to deal with bone atrophy. These rehabilitations are even more complex in the posterior mandible, and it is still unclear in the literature which fixed rehabilitation option is best. The purpose of this article was to help oral surgeons to choose the proper and updated treatment for their atrophic patients. Posterior mandible bone atrophies were divided into four main groups depending on the bone height measured above the inferior alveolar nerve: (1) ≤ 4 mm; (2) > 4 mm ≤ 5 mm; (3) > 5 mm ≤ 6 mm; (4) > 6 mm < 7 mm. Different approaches were proposed for each group, considering patient expectations. If ≤ 4 mm of bone height was available, guided bone regeneration was used as the adequate approach. For bone heights > 4 mm and ≤ 6 mm, the "sandwich" technique and/or short implants were used, depending on esthetics. In cases with > 6 mm and < 7 mm above the mandibular canal, short implants might be the proper option. The authors' clinical experience and the literature were considered in order to suggest a possible correct treatment decision based on the residual bone height in the posterior mandible.


Asunto(s)
Aumento de la Cresta Alveolar , Implantes Dentales , Atrofia/patología , Implantación Dental Endoósea , Prótesis Dental de Soporte Implantado , Humanos , Mandíbula/diagnóstico por imagen , Mandíbula/patología , Mandíbula/cirugía , Resultado del Tratamiento
2.
Artículo en Inglés | MEDLINE | ID: mdl-33528460

RESUMEN

This study aimed to histologically analyze the bony tissue formed around dental implants after osseointegration. A 58-year-old patient presented with pain and discomfort caused by two dental implants in her maxilla placed 8 months earlier. At clinical and radiographic analysis, the implants appeared well osseointegrated but tilted buccally, emerging in nonkeratinized mucosa. For this reason, the discomfort began right after the prosthetic load, 4 months after implant placement, and the patient felt pain when wearing the implant-supported removable prosthesis. Both implants were made of titanium, airborne-particle abraded with zirconium oxide, and etched with mineral acids. The implants were removed, preserving the bone around the implant threads, and replaced with two new implants, inserted in a prosthetically guided, correct position. The removed implants were histologically observed. Histologic analysis showed good bone-to-implant contact, mature bone with few marrow spaces, presence of direct connecting bridges between the peri-implant bone trabeculae and the implant surface, and no inflammatory cells nor connective fibrous tissue ingrowth. This study showed that dental implants coated with a rough surface were properly osseointegrated, with no inflammatory signs nor connective fibrous tissue ingrowth, 8 months after placement.


Asunto(s)
Implantes Dentales , Oseointegración , Implantación Dental Endoósea , Implantes Dentales/efectos adversos , Diseño de Prótesis Dental , Femenino , Humanos , Maxilar/diagnóstico por imagen , Maxilar/cirugía , Persona de Mediana Edad , Propiedades de Superficie , Titanio
3.
Methods Protoc ; 3(4)2020 Nov 05.
Artículo en Inglés | MEDLINE | ID: mdl-33167345

RESUMEN

Dynamic Navigation is a computer-aided technology that allows the surgeon to track the grip instruments while preparing the implant site in real time based on radiological anatomy and accurate pre-operative planning. The support of this technology to the zygoma implant placement aims to reduce the risks and the errors associated with this complex surgical and prosthetic treatment. Various navigation systems are available to clinicians currently, distinguished by handling, reliability, and the associated economic and biological benefits and disadvantages. The present paper reports on the different protocols of dynamic navigations following a standard workflow in correlation with zygomatic implant supported rehabilitations and describes a case of maxillary atrophy successfully resolved with this technology. An innovative and minimally invasive dynamic navigation system, with the use of an intraoral anchored trust marker plate and a patient reference tool, has been adopted to support the accurate insertion of four zygomatic implants, which rapidly resolved maxillary atrophy from a 75-year-old male system. This approach provided an optimal implant placement accuracy reducing surgical invasiveness.

4.
Int J Periodontics Restorative Dent ; 40(6): e235-e240, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33151196

RESUMEN

This case report describes the rehabilitation of an extremely atrophic posterior mandible using 4-mm ultrashort implants and reports clinical and radiographic outcomes 7 years after loading. The patient refused to undergo any other treatment, from the removable prosthesis to the reconstructive surgery, and asked for a fixed, minimally invasive solution in the shortest possible time. The residual bone height above the alveolar nerve was an average of about 5 mm, so it was decided to treat the patient with four 4-mm ultrashort implants. Within the limitations of this case report, this procedure appears successful at 7 years after loading in this specific case and could reduce invasiveness, rehabilitative times, and costs. However, longer follow-ups on a large number of patients coming from randomized controlled clinical trials are necessary before making more reliable recommendations.


Asunto(s)
Pérdida de Hueso Alveolar , Aumento de la Cresta Alveolar , Implantes Dentales , Pérdida de Hueso Alveolar/cirugía , Implantación Dental Endoósea , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Estudios de Seguimiento , Humanos , Mandíbula/diagnóstico por imagen , Mandíbula/cirugía , Resultado del Tratamiento
5.
Clin Implant Dent Relat Res ; 22(5): 552-566, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32902123

RESUMEN

PURPOSE: To compare clinical and radiographic outcomes of <7 mm short (SH) implants inserted in native bone vs longer (ST) implants placed in vertically augmented partially edentulous posterior jaws. A further aim was to evaluate if the residual bone dimension plays a role in the outcomes of SH and extra-SH implants. MATERIALS AND METHODS: This review was registered with PROSPERO. An electronic literature search was performed on PubMed, Scopus and Web of Science. Randomized controlled trials (RCTs) with at least 1-year follow-up, comparing fixed prostheses supported by SH vs ST implants in augmented sites were included. Marginal bone level (MBL) changes, implant survival rate, and complications were evaluated through a meta-analysis. Subgroup analysis was performed dividing the SH implants according to length at each follow-up (1-, 3-, 5-year of function). RESULTS: Twenty-five articles fulfilled the inclusion criteria, featuring a total of 650 SH implants placed in 415 patients and 685 ST implants placed in 403 patients. There was a trend for a significantly lower MBL associated with SH implants respect to ST implants at each follow-up, whilst there was no evidence of a difference in failure rates between SH and ST implants, for any SH length considered and at any follow-up. There was evidence for a lower incidence of complications in favor of SH implants at both 1-year (P < .0001) and 3-year follow-up (P = .01), while at 5-year follow-up there was no evidence of a difference between SH and ST groups (P = .30). CONCLUSION: SH implants supporting partial fixed rehabilitations represent a valuable alternative to augmentation procedures in the medium term. While the performance of implants at least 5-mm long is well documented, more studies with at least 5-year follow-up are needed to confirm the promising outcomes observed with <5 mm-long fixtures.

6.
Artículo en Inglés | MEDLINE | ID: mdl-32925998

RESUMEN

The aim of this retrospective study was to evaluate clinical and radiographic outcomes of guided bone regeneration (GBR) procedures in the rehabilitation of partially edentulous atrophic arches. A total of 58 patients were included with a follow-up of 3 to 7 years after loading. Data seem to indicate that GBR with nonresorbable membranes can be a good clinical choice and suggest that it could be used to vertically reconstruct no more than 6 mm of bone in the posterior mandible. However, this technique remains difficult and requires expert surgeons.


Asunto(s)
Pérdida de Hueso Alveolar , Implantes Dentales , Regeneración Ósea , Implantación Dental Endoósea , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Estudios de Seguimiento , Humanos , Membranas Artificiales , Estudios Retrospectivos
7.
Artículo en Inglés | MEDLINE | ID: mdl-32559036

RESUMEN

This case report describes the minimally invasive full fixed rehabilitation of a totally edentulous severely atrophic mandible. The patient refused to undergo any other treatment, from the reconstructive surgery to the removable prosthesis, and asked for a fixed minimally invasive solution in the shortest possible time. Considering that the posterior mandibular bone was inadequate in height and that the interforaminal bone was only 4.3 to 5 mm in height, the patient received four 4-mm-ultrashort implants in the interforaminal area that were immediately loaded. Within all the limitations of this case report this procedure in this specific case appears successful through 2 years of loading.


Asunto(s)
Implantes Dentales , Arcada Edéntula/cirugía , Atrofia , Implantación Dental Endoósea , Prótesis Dental de Soporte Implantado , Prótesis de Recubrimiento , Humanos , Mandíbula/cirugía , Resultado del Tratamiento
8.
Artículo en Inglés | MEDLINE | ID: mdl-32231082

RESUMEN

Peri-implant soft tissues play a role of paramount importance, not only on the esthetic appearance, but also on the maintenance and long-term stability of implants. The present report presents the conclusions from the Consensus Conference of the South European North African Middle Eastern Implantology & Modern Dentistry Association (SENAME) (4-6 November 2016, Cairo, Egypt). The conference focused on the topic of the soft tissue around dental implants, and in particular, on the influence of implant configurations on the marginal soft tissues, soft tissue alterations after immediate, early or delayed implant placement and immediate loading, the long-term outcomes of soft tissue stability around dental implants, and soft tissue augmentation around dental implants. Thirty world experts in this field were invited to take part in this two-day event; however, only 29 experts were in the final consensus voting process.


Asunto(s)
Implantes Dentales , Mucosa Bucal , Consenso , Egipto , Humanos
9.
Int J Oral Implantol (Berl) ; 12(3): 267-280, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31535097

RESUMEN

PURPOSE: To compare the clinical outcome of fixed prostheses supported by 4- to 8-mm-long implants with prostheses supported by longer implants placed in vertically augmented atrophic mandibles after a follow-up of 5 years in function. MATERIALS AND METHODS: The Cochrane Central Register of Controlled Trials (CENTRAL) and MEDLINE were searched up to 1st September 2018 for randomised controlled trials (RCTs) with a follow-up of at least 5 years in function comparing fixed prostheses supported by 4- to 8-mm-long implants with prostheses supported by longer implants placed in vertically augmented atrophic mandibles. Outcome measures were prosthesis failure, implant failures, augmentation procedure failures, complications, and peri-implant marginal bone level changes. Screening of eligible studies, assessment of the risk of bias and data extraction were conducted in duplicate and independently by two review authors. The statistical unit of the analysis was the prosthesis. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CIs). RESULTS: Four eligible RCTs that included originally 135 patients were included. Two RCTs had a parallel-group design and two a split-mouth design. Short implants were 5.0 to 6.6 mm long and were compared with longer implants placed in posterior mandibles augmented with interpositional blocks of bone substitutes. All trials were judged at unclear risk of bias. Twelve (14%) bone augmentation procedures failed to achieve the planned bone height to allow placement of implants with the planned length. Five years after loading, 28 patients (21%) had dropped out from the four RCTs. There were no differences for patients having prosthesis (RR = 1.46; 95% CI: 0.52 to 4.09; P = 0.47; I2 = 0%) or implant (RR = 1.00; 95% CI: 0.31 to 3.21; P = 1.00; I2 = 0%) failures between the two interventions, but there were more patients experiencing complications (RR = 4.72; 95% CI: 2.43 to 9.17; P < 0.00001; I2 = 0%) and peri-implant marginal bone loss (mean difference = 0.60 mm; 95% CI: 0.36 to 0.83; P < 0.00001; I2 = 45%) at longer implants in augmented bone. CONCLUSIONS: Five years after loading, prosthetic and implant failures were similar between the two interventions, but complications and peri-implant marginal bone loss were higher and more severe at longer implants placed in vertically augmented mandibles. Larger trials and longer follow-ups up to 10 years after loading are needed to confirm or reject the present preliminary findings. However in the meantime short implants could be the preferable option.


Asunto(s)
Aumento de la Cresta Alveolar , Implantes Dentales , Implantación Dental Endoósea , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Estudios de Seguimiento , Humanos , Mandíbula , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
10.
Int J Oral Implantol (Berl) ; 12(1): 25-37, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31116186

RESUMEN

PURPOSE: To evaluate whether 5-mm short dental implants could be an alternative to augmentation with anorganic bovine bone and placement of at least 10-mm long implants in posterior atrophic jaws. MATERIALS AND METHODS: Fifteen patients with bilateral atrophic mandibles (5 to 7 mm bone height above the mandibular canal) and 15 patients with bilateral atrophic maxillae (4 to 6 mm bone height below the maxillary sinus), and bone thickness of at least 8 mm, were randomised according to a split-mouth design to receive one to three 5-mm short implants or at least 10-mm long implants in augmented bone. Mandibles were vertically augmented with interpositional bone blocks and maxillary sinuses with particulated bone via a lateral window. Implants were placed after 4 months, submerged and loaded, after another 4 months, with provisional prostheses. Four months later, definitive provisionally cemented prostheses were delivered. Outcome measures were: prosthesis and implant failures, any complication and peri-implant marginal bone level changes. RESULTS: In five augmented mandibles the planned 10-mm long implants could not be placed and shorter implants (7.0 and 8.5 mm) had to be used instead. Five years after loading, six patients, five treated in the mandible and one in the maxilla, dropped out. Three prostheses (one mandibular and two maxillary) failed in the short-implant group versus none in the long-implant group. In mandibles one long implant failed versus two short implants in one patient. In maxillae one long implant failed versus three short implants in two patients. There were no statistically significant differences in implant (n = 26; P = 1.00, difference = 3.85%, 95% CI: -12.95% to 20.64%) and prosthetic (n = 26; P = 0.250, difference = 11.54%, 95% CI: -0.74% to 23.82%) failures. Eleven patients had 16 complications at short implants (one patient accounted for six complications) and 12 patients had 14 complications at long implants. There were no statistically significant differences in complications (n = 28; P = 1.00, difference = -3.57%, 95% CI: -30.65% to 23.51%). Five years after loading, patients with mandibular implants lost on average 1.72 mm at short implants and 2.10 mm at long implants of peri-implant marginal bone. This difference was statistically significant (difference = 0.37 ± 0.43 mm; 95% CI: 0.07 to 0.68 mm; P = 0.022). In maxillae, patients lost on average 1.31 mm at short implants and 1.79 mm at long implants. This difference was statistically significant (difference = 0.48 ± 0.43 mm; 95% CI: 0.22 to 0.74 mm; P = 0.002). CONCLUSIONS: Five years after loading, 5-mm short implants achieved similar results to longer implants in augmented bone. The choice of short implants might be preferable to vertical bone augmentation, especially in mandibles, since the treatment is faster and cheaper.


Asunto(s)
Aumento de la Cresta Alveolar , Arcada Edéntula , Animales , Bovinos , Implantación Dental Endoósea , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Humanos
11.
Int J Oral Implantol (Berl) ; 12(1): 39-54, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31116187

RESUMEN

PURPOSE: To evaluate whether 5 × 5 mm dental implants with a novel nanostructured calcium-incorporated titanium surface could be an alternative to implants at least 10-mm long placed in bone augmented with bone substitutes in posterior atrophic jaws. MATERIALS AND METHODS: Forty patients with atrophic posterior (premolar and molar areas) mandibles having 5- to 7-mm bone height above the mandibular canal, and 40 patients with atrophic maxillae having 4- to 6-mm bone height below the maxillary sinus, were randomised according to a parallel-group design to receive one to three 5-mm implants or one to three at least 10-mm long implants in augmented bone at two centres. All implants had a diameter of 5 mm. Mandibles were vertically augmented with interpositional bovine bone blocks covered with resorbable barriers. Implants were placed after 4 months. Maxillary sinuses were augmented with particulated porcine bone via a lateral window covered with resorbable barriers and implants were placed simultaneously. All implants were submerged and loaded after 4 months with provisional prostheses. Four months later, definitive screw-retained or provisionally cemented metal-ceramic or zirconia prostheses were delivered. Patients were followed to 5 years post-loading and the outcome measures were: prosthesis and implant failures, any complication and peri-implant marginal bone level changes. RESULTS: Sixteen patients dropped out before the 5-year evaluation (four short mandibles, three short maxillae, six augmented mandibles and three augmented maxillae). In mandibles, two grafted patients were not prosthetically rehabilitated because of multiple complications, and three implants failed in the same patient (one was a replacement implant) versus one patient who lost his short implant and crown 2 years after loading. In maxillae one short implant failed with its provisional crown 3 months post-loading. There were no statistically significant differences in prostheses (difference in proportion = -0.003; 95% CI: -0.14 to 0.13; P = 1.000) and implant failures (difference in proportion = -0.03; 95% CI: -0.17 to 0.09; P = 0.609) up to 5 years after loading. Significantly more complications occurred at mandibular grafted sites: 17 augmented patients were affected by complications versus nine patients treated with short implants in mandibles (difference in proportion = 0.39; 95% CI: 0.10 to 0.62; P = 0.013). In the maxilla seven sinus-elevated patients versus two patients treated with short implants were affected by complications, the difference not being statistically significant (difference in proportion = 0.25; 95% CI: -0.04 to 0.49; P = 0.128). Patients with mandibular short implants lost on average 1.22 mm of peri-implant bone at 5 years and patients with 10-mm or longer mandibular implants lost 1.70 mm. Patients with maxillary short implants lost on average 1.25 mm of peri-implant bone at 5 years and patients with 10-mm or longer maxillary implants lost 1.73 mm. Longer implants showed a greater bone loss up to 5 years after loading than short implants both in maxillae (mean difference: -0.48 mm; 95% CI: -0.89 to -0.07 mm; P = 0.024) and in mandibles (mean difference: -0.48 mm; 95% CI: -0.79 to -0.18 mm; P = 0.004). CONCLUSIONS: Five years after loading, 5 × 5 mm implants achieved similar results to longer implants placed in augmented bone. Short implants might be a preferable choice to bone augmentation especially in posterior mandibles since the treatment is faster, cheaper and associated with less morbidity; however, 10-year post-loading data are necessary before making reliable recommendations.


Asunto(s)
Aumento de la Cresta Alveolar , Titanio , Animales , Bovinos , Implantación Dental Endoósea , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Humanos
12.
Int J Oral Implantol (Berl) ; 12(1): 57-72, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31116188

RESUMEN

PURPOSE: To evaluate whether 6-mm-long by 4-mm-wide dental implants could be an alternative to implants at least 10-mm long placed in bone augmented with bone substitutes in posterior atrophic jaws. MATERIALS AND METHODS: A total of 20 patients with bilateral atrophic mandibles and 20 patients with bilateral atrophic maxillae, having 5 to 7 mm of bone height below the maxillary sinus or 6 to 8 mm above the mandibular canal, had their sides of the jaws randomly allocated according to a split-mouth design. They were allocated to receive one to three 6-mm-long and 4-mm-wide implants, or implants at least 10-mm long in augmented bone by two different surgeons in different centres. Mandibles were vertically augmented with interpositional equine bone blocks and resorbable barriers, and implants were placed 3 months later. Maxillary sinuses were augmented with particulated porcine bone via a lateral window and implants were placed simultaneously. All implants were submerged and loaded, after 4 months, with provisional prostheses. Four months later, definitive prostheses were delivered. Outcome measures were prosthesis and implant failures, any complication and radiographic peri-implant marginal bone level changes. The follow-up was 5 years after loading for all patients. RESULTS: Eight patients (five treated in mandibles and three in maxillae) dropped out before the 5-year post-loading follow-up. Four short implants (two maxillary and two mandibular) affected by peri-implantitis failed together with their prostheses versus three mandibular prostheses which could not be placed on implants at least 10-mm long due to graft failures; one was associated with the loss of three implants because of infection. There were no statistically significant differences in implant (P = 1.0) and prosthesis failures (P = 1.0). In total, 19 complications occurred in 14 patients at augmented sites versus five complications in four patients with 6-mm-long implants (P = 0.118). More complications occurred at grafted sites both in mandibles (P = 0.727), and maxillae (P = 0.063), although the differences were not statistically significant. In mandibles, patients with 6-mm-long implants lost an average of 1.34 ± 0.35 mm of peri-implant bone at 5 years versus 2.11 ± 0.59 mm in patients with implants at least 10-mm long. The difference was statistically significant (mean difference = 0.77 ± 0.70 mm; 95% CI: 0.32 to 1.21 mm; P = 0.003). In maxillae, patients with 6-mm-long implants lost an average of 1.52 ± 0.47 mm of peri-implant bone at 5 years versus 1.85 ± 0.51 mm in patients with implants at least 10-mm long. The difference was statistically significant (mean difference = 0.33 ± 0.36 mm; 95% CI: 0.14 to 0.53 mm; P = 0.002). CONCLUSIONS: Results at 5 years after loading indicate that 6-mm-long implants with a conventional diameter of 4 mm achieved similar results to longer implants placed in augmented bone. Short implants might be a preferable choice to bone augmentation, especially in posterior mandibles since the treatment was faster, cheaper and associated with less morbidity. However, 10-year post-loading data are necessary before making reliable recommendations.


Asunto(s)
Aumento de la Cresta Alveolar , Implantación Dental Endoósea , Animales , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Caballos , Humanos
13.
Biomed Res Int ; 2019: 4386709, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30891457

RESUMEN

Although the number of complications and failures in bone augmentation procedures is still relatively high, these problems remain poorly documented. Moreover, the literature concerning reconstructive techniques and the treatment of their complications in the anterior areas rarely considers the final esthetic result. The aim of this paper is to propose a new classification of bone augmentation complications in the esthetic area, providing treatment guidelines useful for the management of these cases. Failures of bony regeneration procedures can be mainly divided into partial failures and complete failures. A partial failure can be solved with a corrective surgical intervention: this second surgery can have success or may not be able to provide the desired esthetic result. When the bone reconstructive procedure fails totally, a complete failure occurs and the whole procedure has to be repeated. This new intervention can have success but also this new reconstructive surgery can fail in the same way as the first, causing important damage and a compromise solution that will hardly be acceptable from an esthetic point of view. Bone augmentation techniques are not completely predictable and are not always able to guarantee the expected result, especially in the atrophic anterior maxilla. Complications and failures can often occur and this possibility must always be clearly explained to those patients with high esthetic demands and expectations.


Asunto(s)
Aumento de la Cresta Alveolar/clasificación , Estética Dental , Maxilar/patología , Maxilar/cirugía , Atrofia , Materiales Biocompatibles/química , Regeneración Ósea , Resorción Ósea/patología , Coronas , Implantes Dentales , Porcelana Dental/química , Humanos , Colgajos Quirúrgicos , Resultado del Tratamiento
14.
Eur J Oral Implantol ; 11(4): 385-395, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30515480

RESUMEN

PURPOSE: To evaluate whether 6.6-mm long implants could be a suitable alternative to longer implants placed in vertically augmented atrophic posterior mandibles. MATERIALS AND METHODS: Sixty partially edentulous patients having 7 to 8 mm of residual crestal height and at least 5.5-mm thickness measured on computed tomography scans above the mandibular canal were randomly allocated according to a parallel-group design either to receive one to three submerged 6.6-mm long implants or 9.6-mm or longer implants (30 patients per group) placed in vertically augmented bone. Bone was augmented with interpositional anorganic bovine bone blocks fixed with titanium plates and covered with resorbable barriers. Grafts were left to heal for 5 months before implant placement. Four months after implant placement, provisional acrylic prostheses were delivered, replaced, after 4 months, by definitive metal-ceramic prostheses. Outcome measures were: prosthesis and implant failures, complications, and radiographic peri-implant marginal bone level changes. Patients were followed up to 8 years after loading. RESULTS: Eight years after loading 12 patients dropped out, five from the short implant group and seven from the augmented group. The augmentation procedure failed in two patients and only 6.6-mm long implants could be inserted. There were no statistically significant differences for prosthesis and implant failures. Four prostheses failed in three patients of the short implant group versus three prostheses in three patients of the augmented group (Fisher exact test P = 1.000; difference in proportions = 0.01; 95% CI: -0.19 to 0.22). Five short implants failed in three patients versus three long implants in three patients (Fisher exact test P = 1.000; difference in proportions = 0.01; 95% CI: -0.19 to 0.22). There were statistically more complications in augmented patients (27 complications in 22 augmented patients versus 9 complications in 8 patients of the short implant group) (Fisher exact test P < 0.001; difference in proportions = 0.64; 95% CI: 0.38 to 0.79). Both groups gradually lost peri-implant bone in a statistically significant way. Eight years after loading, short implant group patients lost an average of 1.58 mm of peri-implant bone compared with 2.46 mm in the augmented group. Short implants experienced statistically significantly less bone loss (0.88 mm, 95% CI: 0.50 to 1.26 mm) than long implants. CONCLUSIONS: When residual bone height over the mandibular canal is between 7 and 8 mm, 6.6-mm short implants are an interesting alternative to vertical augmentation in posterior atrophic mandibles since the treatment is faster, cheaper and associated with less morbidity.


Asunto(s)
Implantes Dentales , Arcada Parcialmente Edéntula , Mandíbula , Diseño de Prótesis Dental , Humanos , Arcada Parcialmente Edéntula/cirugía , Titanio , Resultado del Tratamiento
15.
Eur J Oral Implantol ; 11(3): 295-306, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30246183

RESUMEN

PURPOSE: To compare the outcome of cross-arch prostheses supported either by 5 mm long or 11.5 mm long implants placed flapless and immediately restored with a metal-resin screw-retained cross-arch prostheses. MATERIALS AND METHODS: Thirty patients with edentulous or to-be- rendered edentulous mandibles, and 30 with edentulous maxillas, having sufficient bone to allow the placement of four and six implants respectively, of at least 11.5 mm long, were randomised according to a parallel group design into two equal groups and received either 5 mm or 11.5 mm long implants at one centre. Implants had a diameter of 5 mm, were to be placed flapless, and with an insertion torque of at least 50 Ncm. Mandibles received four implants between the mental foramina. Implants were to be immediately loaded with metal-resin definitive prostheses the same day as implant placement. Patients were followed to 5 years post-loading and the outcome measures were: prosthesis and implant failures, complications, and peri-implant marginal bone level changes. RESULTS: Four patients per group dropped out. Two prostheses were remade, one on short maxillary implants and one on long mandibular implants (difference in proportions = 0; 95% CI: -0.15 to 0.15; P = 1.000). Three patients lost six short implants vs three patients who lost four long implants (difference in proportions = 0; 95% CI: -0.19 to 0.19; P = 1.000). Four short implant patients were affected by complications vs five patients with long implants (difference in proportions = 0.04; 95% CI: -0.17 to 0.25; P = 1.000). There were no statistically significant differences for prostheses failures, implant failures and complications. Patients with mandibular short implants lost on average 0.22 mm of peri-implant bone at 5 years while patients with long mandibular implants lost 0.83 mm. Patients with maxillary short implants lost on average 0.30 mm of peri-implant bone at 5 years and patients with long maxillary implants lost 0.89 mm. Short implants showed less bone loss when compared with long implants and the differences up to 5 years were statistically significant both in maxillae (mean difference = 0.59 mm, 95% CI: 0.33 to 0.86 mm, P < .0001) and in mandibles (mean difference = 0.61 mm, 95% CI: 0.36 to 0.86 mm, P < 0.0001). CONCLUSIONS: Flapless-placed 5 mm long implants achieved similar results as 11.5 mm long implants when supporting immediately loaded cross-arch prostheses both in maxillae and mandibles up to 5 years after loading. These results must be confirmed by other trials, and 10 years post-loading data is necessary before making reliable recommendations.


Asunto(s)
Implantación Dental Endoósea , Diseño de Prótesis Dental , Boca Edéntula , Implantación Dental Endoósea/métodos , Prótesis Dental de Soporte Implantado , Humanos , Mandíbula , Maxilar , Boca Edéntula/cirugía
16.
Biomed Res Int ; 2018: 2908484, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30140692

RESUMEN

Novel one-piece implants with concave smooth neck have been introduced to promote the formation of a thick mucosal layer and preserve marginal bone. A retrospective study on 70 patients with 1- to 6-year follow-up was carried out. Cumulative survival rates were assessed. Variations of marginal bone level were measured on periapical radiographs as distance of the implant-abutment junction from the bone crest. Influence of different variables on treatment outcome was evaluated. Cumulative success rate after 6 years was 99.4 % at implant level and 98.6 % at patient level. Marginal bone level changed in a significant way over time. After 4 months, an increase of radiographic bone level of 0.173 ± 1.088 mm at implant level and 0.18 ± 1.019 mm at patient level was recorded. Mean marginal bone loss after 5 years was 0.573 ± 0.966 mm at implant level and 0.783 ± 1.213 mm at patient level. Age, sex, smoking habits, implant sites, implant lengths and diameters, prosthetic retentions, and timing of loading did not influence marginal bone remodeling in a statistically significant way. At 4-year follow-up partial restorations lost a mean of 0.96 mm of more marginal bone compared with single restorations. This difference was statistically significant.


Asunto(s)
Implantación Dental Endoósea , Diseño de Prótesis Dental , Adulto , Anciano , Pérdida de Hueso Alveolar , Implantes Dentales , Implantes Dentales de Diente Único , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
17.
Biomed Res Int ; 2018: 6758245, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29955608

RESUMEN

Purpose: The majority of the techniques used to assess the primary implant stability are subjective and empirical and can be used during or after the surgery. The aim of this study is to evaluate the bone density prior to surgery, in order to give recommendations to the clinician about the best surgical technique and the type of implant which is needed. Materials and Methods: A surgeon operated on 75 patients for 269 implants over the period 2010-2014. He required a CT to plan the surgery and he documented the type, the diameters, and the lengths of the implants, the insertion torque, and the ISQ values. At a later stage another clinician measured bone density and cortical thickness. We endeavoured to get the most accurate superimposition between the implants placed by the surgeon and those placed by the clinician. Results: In maxilla ISQ showed a significant positive correlation with HU values detected for coronal-buccal (r = 0.302; p = 0.020) and middle-lingual (r = 0.295; p = 0.023). Torque showed a positive correlation with cortical bone thickness at the middle of the ridge (ρ = 0.196; p = 0.032). Conclusion: It is important to take into consideration the Hounsfield Units and the cortical thickness as predictive parameters during the preoperative assessment, with regard to the choice of the implant type as well as the surgical technique.


Asunto(s)
Densidad Ósea , Implantación Dental Endoósea , Implantes Dentales , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Maxilar , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Torque , Adulto Joven
18.
Eur J Oral Implantol ; 11(2): 145-161, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29806663

RESUMEN

PURPOSE: To compare the clinical outcome of immediately loaded cross-arch maxillary prostheses supported by zygomatic implants vs conventional implants placed in augmented bone. MATERIALS AND METHODS: In total, 71 edentulous patients with severely atrophic maxillas without sufficient bone volumes for placing dental implants, or when it was possible to place only two implants in the anterior area (minimal diameter 3.5 mm and length of 8 mm) and less than 4 mm of bone height subantrally, were randomised according to a parallel group design to receive zygomatic implants (35 patients) to be loaded immediately vs grafting with a xenograft, followed after 6 months of graft consolidation by placement of six to eight conventional dental implants submerged for 4 months (36 patients). For immediate loading, zygomatic implants had to be inserted with an insertion torque superior to 40 Ncm. Screw-retained metal reinforced acrylic provisional prostheses were provided, to be replaced by definitive Procera Implant Bridge Titanium prostheses (Nobel Biocare, Göteborg, Sweden), with ceramic or acrylic veneer materials 4 months after initial loading. Outcome measures were: prosthesis, implant and augmentation failures, any complications, quality of life (OHIP-14), patients' number of days with total or partial impaired activity, time to function and number of dental visits, assessed by independent assessors. Patients were followed up to 1 year after loading. RESULTS: No augmentation procedure failed. Five patients dropped out from the augmentation group. Six prostheses could not be delivered or failed in the augmentation group vs one prosthesis in the zygomatic group, the difference being statistically significant (difference in proportions = -16.5%; P = 0.045; 95% CI: -0.34 to -0.01). Eight patients lost 35 implants in the augmentation group vs two patients who lost four zygomatic implants, the difference being statistically significant (difference in proportions = -20.1%; P = 0.037; 95% CI: -0.38 to -0.02). A total of 14 augmented patients were affected by 22 complications, vs 28 zygomatic patients (40 complications), the difference being statistically significant (difference in proportions = 34.8%; P = 0.005; 95% CI: 0.12 to 0.54). The 1-year OHIP-14 score was 3.93 ± 5.86 for augmented patients and 3.97 ± 4.32 for zygomatic patients with no statistically significant differences between groups (mean difference = 0.04; 95% CI: -2.56 to 2.65; P = 0.747). Both groups had significantly improved OHIP-14 scores from before rehabilitation (P < 0.001 for both augmented and zygomatic patients). On average, the number of days of total infirmity was 7.42 ± 3.17 for the augmented group and 7.17 ± 1.96 for the zygomatic group, the difference not being statistically significant (mean difference = -0.25; 95% CI: -1.52 to 1.02; P = 0.692). The number of days of partial infirmity were on average 14.24 ± 4.64 for the augmented group and 12.17 ± 3.82 for the zygomatic group, the difference being statistically significant (mean difference = -2.07; 95% CI: -4.12 to -0.02; P = 0.048). The mean number of days that needed to have a functional prosthesis was 444.32 ± 207.86 for augmented patients and 1.34 ± 2.27 for zygomatic patients, the difference being statistically significant (mean difference = -442.98; 95% CI: -513.10 to -372.86; P < 0.001). The average number of dental visits was 19.72 ± 12.22 for augmented patients and 15.12 ± 5.76 for zygomatic patients, the difference not being statistically significant (mean difference = -4.61; 95% CI: -9.31 to 0.92; P = 0.055). CONCLUSIONS: Preliminary 1-year post-loading data suggest that immediately loaded zygomatic implants were associated with statistically significantly fewer prosthetic failures (one vs six patients), implant failures (two vs eight patients) and time needed to functional loading (1.3 days vs 444.3 days) when compared to augmentation procedures and conventionally loaded dental implants. Even if more complications were reported for zygomatic implants, they proved to be a better rehabilitation modality for severely atrophic maxillae. Long-term data are absolutely needed to confirm or dispute these preliminary results.


Asunto(s)
Aumento de la Cresta Alveolar , Implantación Dental Endoósea , Carga Inmediata del Implante Dental , Maxilar/patología , Adulto , Anciano , Atrofia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo , Resultado del Tratamiento , Cigoma
19.
Eur J Oral Implantol ; 11(2): 175-187, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29806665

RESUMEN

PURPOSE: To evaluate whether 6 mm long × 4 mm wide dental implants could be an alternative to implants of at least 10 mm long placed in bone augmented with bone substitutes in posterior atrophic jaws. MATERIALS AND METHODS: A total of 20 patients with bilateral atrophic mandibles, and 20 patients with bilateral atrophic maxillae, having 5 mm to 7 mm of bone height below the maxillary sinus or 6 mm to 8 mm above the mandibular canal, had their side of the jaws randomly allocated according to a split-mouth design. They were allocated to receive one to three 6 mm long × 4 mm wide implants, or implants of at least 10 mm long in augmented bone by two different surgeons at different centres. Mandibles were vertically augmented with interpositional equine bone blocks and resorbable barriers, and implants were placed 3 months later. Maxillary sinuses were augmented with particulated porcine bone via a lateral window and implants were placed simultaneously. After 4 months, all implants were submerged and loaded with provisional prostheses. Four months later, definitive prostheses were delivered. Outcome measures were prosthesis and implant failures, any complication and radiographic peri-implant marginal bone level changes. RESULTS: Five patients (three treated in mandibles and two in maxillae) dropped out before the 3-year post-loading follow-up. Two short maxillary implants affected by peri-implantitis failed together with their prosthesis vs three mandibular prostheses that could not be placed on implants at least 10 mm long due to graft failures; one was associated with the loss of three implants because of infection. There were no statistically significant differences in implant (difference in proportions = 0.000; 95% CI: -0.140 to 0.140; P = 1.000) and prosthesis failures (difference in proportions = 0.057; 95% CI: -0.094 to 0.216; P = 0.625). In total, 18 complications occurred in 13 patients at augmented sites vs four complications in three patients with 6 mm long implants. Significantly more complications occurred at grafted sites in mandibles (difference in proportions = 0.353; 95% CI: 0.005 to 0.616; P = 0.031), but not in maxillae (difference in proportions = 0.222; 95% CI: -0.071 to 0.486; P = 0.219). In mandibles, patients with 6 mm long implants lost an average of 1.25 mm of peri-implant bone at 3 years vs 1.54 mm in patients with implants of at least 10 mm long. The difference was statistically significant (mean difference = 0.29 mm; 95% CI: 0.08 to 0.51 mm; P = 0.010). In maxillas, patients with 6 mm-long implants lost an average of 1.28 mm of peri-implant bone at 3 years vs 1.50 mm in patients with implants of at least 10 mm long. The difference was statistically significant (mean difference = 0.22 mm; 95% CI: 0.08 to 0.35 mm; P = 0.003). CONCLUSIONS: Results at 3 years after loading indicate that 6 mm long implants with a conventional diameter of 4 mm achieved similar, if not better, results than longer implants placed in augmented bone. Short implants might be a preferable choice to bone augmentation, especially in posterior mandibles, since the treatment is faster, cheaper and associated with less morbidity. However, data obtained 5 to 10 years after loading are necessary before making reliable recommendations.


Asunto(s)
Pérdida de Hueso Alveolar/rehabilitación , Pérdida de Hueso Alveolar/cirugía , Aumento de la Cresta Alveolar , Implantación Dental Endoósea , Prótesis Dental de Soporte Implantado , Adulto , Anciano , Anciano de 80 o más Años , Diseño de Prótesis Dental , Femenino , Humanos , Masculino , Persona de Mediana Edad
20.
Eur J Oral Implantol ; 11(2): 163-173, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29806664

RESUMEN

PURPOSE: To evaluate the long-term effectiveness of 6.6 mm long flapless-placed single implants loaded immediately or early loaded at 6 weeks. MATERIALS AND METHODS: Thirty patients each received two single Nanotite External Hex Biomet 3i implants, which were then randomly allocated to be either immediately or early loaded, according to a split-mouth design. Implants had to be inserted with a torque superior to 40 Ncm. Provisional crowns were put in slight occlusal contact and replaced by definitive crowns 3 months after loading. Patients were followed for 9 years after loading. Outcome measures were implant failures, biological and biomechanical complications, peri-implant marginal bone level changes and patient preference. RESULTS: A total of 29 implants were immediately loaded, while 31 were early loaded. Nine years after loading, three patients dropped out. One implant failed in each group within 2 months after loading. One patient asked for the immediately loaded crown to be remade for aesthetic reasons and then again to have both metal-ceramic crowns replaced by full ceramic crowns. Another patient had his immediately loaded crown remade after repeated debonding. Six patients from each group experienced complications, the difference being not statistically significant (difference of proportions = 0.00; 95% CI -0.20 to 0.20, P = 1.000). Peri-implant bone loss was 0.60 mm for patients with immediately loaded implants and 0.46 mm for early loaded ones, which was not significantly different (mean difference = 0.14 mm, 95% CI -0.13 to 0.41, P = 0.283). All but one patient had no preference for either procedure after 9 years. CONCLUSIONS: Flapless-placed 6.6 mm long single implants can be immediately loaded and remain successful up to 9 years after loading. Conflict-of-interest statement:


Asunto(s)
Implantación Dental Endoósea , Implantes Dentales de Diente Único , Carga Inmediata del Implante Dental , Diseño de Prótesis Dental , Femenino , Humanos , Masculino , Factores de Tiempo
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