Immediate loading on two adjacent single dental implants with definitive nonsplinted restorations: A proof of concept in the posterior zone.

OBJECTIVES: To evaluate clinical, clinician- and patient-reported outcomes (PROs) of two adjacent single posterior implants immediately loaded with definitive single crowns up to 1 year. Ten patients in need of two adjacent posterior single implants were included. All implants were placed applying a fully digital workflow. Definitive screw-retained single zirconia crowns were delivered within 72 h after implant placement. Clinical parameters, patient- and clinician-reported outcomes were assessed up to 1 year of follow-up. CLINICAL CONSIDERATIONS: Clinical outcomes remained stable, with no implant failures or technical and biological complications throughout the observation period. Patient satisfaction was very high at baseline (crown delivery) and remained consistently high at 6 and 12 months of follow-up. Crown insertion 3 days after implant placement was rated as an easy procedure by clinicians. CONCLUSIONS: Two adjacent single implants with immediate definitive restorations (<72 h) in the posterior region appear to be a viable and easy treatment option to shorten the overall treatment time and potentially enhancing patient satisfaction. However, randomized controlled trials are needed to confirm the advantages of this treatment protocol over a delayed loading approach. CLINICAL SIGNIFICANCE: In selected cases, immediate implant loading with definitive restorations in the posterior region appears a valuable and straightforward option to shorten the overall treatment time.

Aesthetic Outcome and Patient Perception of Immediate vs. Delayed Loading of Implant-Supported Single Crowns: A Randomized Controlled Trial.

Background: This randomized controlled trial aimed to compare the aesthetic outcome and patient perception of immediate versus DL of implant-supported single crowns. Methods: A total of 60 patients with a single missing tooth were enrolled and randomly assigned to two groups: immediate loading (IL) and delayed loading (DL). Each group consisted of 30 patients with a total of 30 implants. In the IL group, crowns were loaded onto implants immediately after placement, while in the DL group, a healing period of 3 months was observed before crown placement. Aesthetic outcome was assessed using the Pink Esthetic Score (PES) for soft tissue and the White Esthetic Score (WES) for the crown. Patient perception was evaluated through a visual analog scale (VAS) for satisfaction, comfort, and overall experience. Results: The IL group demonstrated comparable aesthetic outcomes to the DL group, with mean PES and WES scores of 10.2 ± 1.5 and 8.7 ± 1.2, respectively, in the IL group, and 10.5 ± 1.3 and 8.5 ± 1.4 in the DL group. Patient perception in terms of satisfaction, comfort, and overall experience was similarly high in both groups, with VAS scores above 8 for each parameter. Conclusion: This randomized controlled trial suggests that both IL and DL of implant-supported single crowns result in favorable aesthetic outcomes and high levels of patient satisfaction.

Immediate versus Non-immediate Loading Protocols for Reduced-diameter Implants Supporting Overdentures: A Systematic Review and Meta-analysis.

OBJECTIVE: This systematic review aimed to compare the influence of immediate and non-immediate loading protocols on overdentures retained by reduced-diameter implants(≦3.5mm). METHODS: Electronic databases, including MEDLINE (via PubMed), Embase and the Cochrane Central Register of Controlled Trials were searched for randomized controlled trials (RCTs) comparing clinical outcomes of immediately and nonimmediately loaded reduced-diameter implants supported overdentures. The risk of bias within and across the studies and the certainty of evidence were assessed by RoB 2.0 and GRADE, respectively. Sensitivity analysis was performed by eliminating studies at high risk of bias, and repeating the data synthesis employing the randomeffect model. Subgroup analyses were conducted based on the implant diameter and the length of follow-up. RESULTS: Six RCTs with 255 patients were included in this systematic review. The meta-analyses found similar implant survival rates between immediate and nonimmediate loaded implants in mini implant (RR=0.98; 95% CI=0.95, 1.01; p=0.12) and narrow implant subgroups (RR=0.99, 95% CI=0.94, 1.03, p =0.56), as well as in short-term (RR=0.98, 95% CI=0.97, 1.00, p =0.11) and long-term (RR=0.97, 95% CI=0.93, 1.01, p =0.09) follow-up subgroups. Additionally, marginal bone loss (MBL) showed no statistically significant difference between the loading protocols in the subgroup of long-term follow-up (MD=0.03; 95%CI=-0.16, 0.23; p=0.74). Three RCTs investigating peri-implant parameters found relatively higher modified plaque index and probing depth in reduced-diameter implant under immediate loading. CONCLUSION: Compared with non-immediate loading, the immediately loading protocol can achieve comparable survival rates and MBL in reduced-diameter implant retained overdentures.

Immediate loading of implants inserted through impacted teeth in the aesthetic area: A retrospective study with a mean follow-up period of 7 years.

PURPOSE: To evaluate the survival and success rate of and the incidence of complications affecting implants inserted and immediately loaded in sites where an impacted tooth was present in the maxilla. MATERIALS AND METHODS: A total of 10 patients were treated and 14 implants were inserted, 4 in healed sites and 10 in extraction sites. The implant site preparation started in the crestal bone and continued in the enamel and dentine of the impacted tooth. The radiographic depth of implant penetration into the impacted tooth, peri-implant soft tissue and hard tissue condition at the 1-year follow-up and the last follow-up appointment, marginal bone loss at the 1-year follow-up and the last follow-up appointment, and the final aesthetic result were evaluated. RESULTS: The implants healed uneventfully with an adequate hard and soft tissue response and no adverse clinical or radiographic signs or symptoms. They were in function for a minimum of 3 and a maximum of 11 years (mean 7.2 years). CONCLUSION: Although further studies with a larger sample size are required to validate this unconventional approach, it can be considered a valuable clinical option to replace teeth in an area of impaction.

Partial Implant Rehabilitations in the Posterior Regions of the Jaws Supported by Short Dental Implants (7.0 mm): A 7-Year Clinical and 5-Year Radiographical Prospective Study.

Background: Short implants have been used in the restoration of edentulous jaws in the past several years. However, some studies have suggested that short implants are less successful than standard implants. The aim of this study is to investigate the outcome of short implants placed in the posterior maxilla or mandible following one-stage or immediate-function protocols with a follow-up of 7 years (clinically) and 5 years (radiographically). Methods: This study included 127 patients rehabilitated with 217 implants measuring 7 mm and supporting 157 fixed prostheses in the posterior segments of both jaws. Final abutments were delivered at the surgery stage and were loaded after 4 months in 116 patients (199 implants). The primary outcome measure was implant survival measured through life tables. Secondary outcome measures were marginal bone loss and the incidence of biological and mechanical complications at the patient level and implant level (evaluated through descriptive statistics). Results: Twenty-four patients (18.9%) with 45 implants (20.7%) were lost to the follow-up. In total, 32 implants failed (14.8%) in 22 patients (17.3%), resulting in a cumulative survival rate at 7 years of 81.2% for 7 mm implants in the rehabilitation of the posterior regions of the maxilla and mandible. The average (standard deviation) marginal bone loss was 1.47 mm (0.99 mm) at 5 years. The incidence rate of biological complications was 12.6% and 10.6% at the patient and implant levels, respectively. The incidence rate of mechanical complications was 21.3% for patients and 16.1% for implants. A higher failure rate was registered in smokers and in implant arrangements with a sequence of three fixtures in proximity. Conclusions: Within the limitations of this study, it can be concluded that the placement of 7 mm long implants for the partial implant-supported rehabilitation of atrophic posterior jaws is possible in the long term, judging by the survival rate and stable average marginal bone loss. Nevertheless, strict case selection should be performed, especially in smokers and with implant arrangements that provide a minimum of one unit in inter-implant distance.

Effects of immediate loading directionality on the mechanical sensing protein PIEZO1 expression and early-stage healing process of peri-implant bone.

BACKGROUND: The reduced treatment time of dental implants with immediate loading protocol is an appealing solution for dentists and patients. However, there remains a significant risk of early peri-implant bone response following the placement of immediately loaded implants, and limited information is available regarding loading directions and the associated in vivo characteristics of peri-implant bone during the early stages. This study aimed to investigate the effects of immediate loading directionality on the expression of mechanical sensing protein PIEZO1 and the healing process of peri-implant bone in the early stage. METHODS: Thirty-two implants were inserted into the goat iliac crest models with 10 N static lateral immediate loading applied, followed by histological, histomorphological, immunohistochemical, X-ray microscopy and energy dispersive X-ray spectroscopy evaluations conducted after 10 days. RESULTS: From evaluations at the cellular, tissue, and organ levels, it was observed that the expression of mechanical sensing protein PIEZO1 in peri-implant bone was significantly higher in the compressive side compared to the tensile side. This finding coincided with trends observed in interfacial bone extracellular matrix (ECM) contact percentage, bone mass, and new bone formation. CONCLUSIONS: This study provides a novel insight into the immediate loading directionality as a potential influence factor for dental implant treatments by demonstrating differential effects on the mechanical sensing protein PIEZO1 expression and related early-stage healing processes of peri-implant bone. Immediate loading directions serve as potential therapeutic influence factors for peri-implant bone during its early healing stage.

Early complications and quality of life in patients with immediately loaded implant-supported maxillary partial rehabilitations: A prospective cohort study / Complicaciones tempranas y calidad de vida en pacientes con rehabilitaciones parciales maxilares implantosoportadas con carga inmediata: un estudio de cohorte prospectivo

Background: Immediate loading of dental implants is considered an excellent option to reestablish function and aesthetics in a short period of time, thereby reducing the psychological impact of edentulism. The aim of this study was to describe the incidence of complications in immediately loaded implant-supported single or partial maxillary provisional rehabilitations; to assess changes in patient quality of life (QoL); to evaluate patient overall satisfaction; and to determine whether the occurrence of complications affects these outcomes. Material and Methods: Patients requiring partial rehabilitation with implants in the maxilla were included in a prospective cohort study. In all cases, implant-based restoration with an immediate loading protocol was indicated. A provisional restoration was placed within 72 hours after implant placement. Patient QoL was measured at the first appointment and just before placing the final restoration, using two validated questionnaires. All mechanical and biological complications occurring up until placement of the final restoration were documented. A descriptive and bivariate analysis of the data was performed. Results: Thirty-five patients with 40 prostheses supported by 60 implants were analyzed. Three implant failures were observed, yielding a 95% survival rate. Five provisional prosthesis fractures and two prosthetic screw loosenings were recorded in four patients. A significant reduction in OHIP-14 score was observed. Likewise, significant differences were found in the results of the QoLFAST-10, with a mean difference in score of 7.3 between the initial and final evaluation. Conclusions: Patients receiving immediately loaded implant-supported single or partial maxillary provisional rehabilitations seem to have a low risk of developing early mechanical (13.3%) or biological complications (5%)...(AU)

A Study of the Associated Risk Factors for Early Failure and the Effect of Photofunctionalisation in Full-Arch Immediate Loading Treatment Based on the All-on-Four Concept.

Early implant failure occurring within 1 year after implantation has been attributed to various factors. Particularly, early failure can lead to challenges in maintaining a full-arch prosthetic device, necessitating prompt intervention, including reoperation. This study aimed to retrospectively examine implant- and patient-related factors and the effects of photofunctionalisation associated with early failure in patients who underwent treatment using the all-on-four concept in both the maxilla and mandible. We conducted this retrospective study comprising 561 patients with 2364 implants who underwent implant-supported immediate loading with fixed full-arch rehabilitation using the all-on-four concept. We aimed to assess the survival rate within 1 year after implantation and determine the risk factors influencing early failure. The 1-year survival rates after implantation were 97.1% (patient level) and 98.9% (implant level) for the maxilla and 98.5% (patient level) and 99.6% (implant level) for the mandible. There was a significant difference in the implant-level survival rates between the maxilla and mandible, with a lower rate in the maxilla (p = 0.043). The risk factors associated with early implant failure according to the all-on-four concept included the maxilla (implant level) and smoking (patient level). We could not find a significant effect of photofunctionalisation on early failure (p = 0.25) following this treatment protocol.

A One-Year Randomized Controlled Clinical Trial of Three Types of Narrow-Diameter Implants for Fixed Partial Implant-Supported Prosthesis in the Mandibular Incisor Area.

Narrow-diameter implants (NDI) serve as a solution for treating limited bone volume in the anterior mandible. This study aimed to evaluate the one-year clinical outcomes of various NDIs in the mandibular incisor area after immediate loading in partially edentulous patients. This single-center, prospective, single-blinded, randomized controlled trial study included 21 patients, with 7 patients in each of the following groups: control (BLT NC SLActive®; Straumann), experimental group 1 (CMI IS-III Active® S-Narrow; Neobiotech), and experimental group 2 (CMI IS-III Active® Narrow; Neobiotech). Using full digital flow, two fixtures were placed in each patient and immediately provisionalized on the day of surgery. Evaluations encompassed periapical radiographs, implant stability quotient (ISQ), implant stability test (IST) readings, per-implant soft tissue health, patient satisfaction surveys, and esthetic score assessments. Definitive prostheses were delivered twelve weeks post-surgery (CRiS, number: KCT0007300). Following exclusions due to low stability values (n = 2), fixture failure (n = 5), and voluntary withdrawal (n = 1), the implant success rate for patients completing all clinical protocols stood at 100%. The resulting patient failure rates in the control, experimental group 1, and experimental group 2 were 50.0%, 42.9%, and 14.3%, respectively. There were no significant differences between the groups in terms of marginal bone loss, soft tissue health, patient satisfaction, and esthetic scores. Narrow implants showed superior clinical outcomes, followed by S-Narrow and Straumann implants. Calculated one-year survival rates at the implant level were 66.7% for the control group, 85.7% for experimental group 1, and 100% for experimental group 2. All three types of NDIs showed acceptable clinical and radiographic results during the year-long observation period.

Lower Jaw Full-Arch Restoration: A Completely Digital Approach to Immediate Load.

The digital transformation has revolutionized various sectors, including dentistry. Dentistry has emerged as a pioneer in embracing digital technologies, leading to advancements in surgical and prosthetic oral healthcare. Immediate loading for full-arch edentulous dental implants, once debated, is now widely accepted. This case report describes a 74-year-old patient with dental mobility and significant bone loss who was rehabilitated using a Toronto Bridge protocol on four dental implants with immediate loading. Digital planning, surgical guides, 3D printing, and precision techniques were employed. The surgery involved implant placement and prosthetic procedures. The patient reported minimal post-operative discomfort, and after four months, the definitive prosthesis was successfully placed. This case demonstrates the efficacy of immediate loading in complex dental scenarios with digital innovation, resulting in improved patient outcomes. The full digital workflow, including 3D printing and the use of modern materials, enhances the efficiency and predictability of oral rehabilitation, marking a transformative era in dental care. The integration of digital technology in all phases of treatment, from diagnosis to finalization, makes this approach safer, reliable, and efficient, thereby benefiting both patients and clinicians.

Mechanical and fatigue resistance of restorations supported by welded-framework and realized using computer-aided designed prosthetic shells: In vitro pilot study.

Resin coating in implants rehabilitation cannot always be aesthetic, durable and comfortable for the patient mainly due to the limited dimensions of the final structure. Intraoral welding technique and computer-aided designed prosthetic shells may be a solution. This in vitro study evaluates the capacity of load and the weakest point of implant-supported provisional prosthesis using welded titanium framework. Twelve samples were produced to simulate an implant supported fixed prosthetic bridge. Two implants (Ankylos; Dentsply Sirona Implants; Germany) were inserted inside blocks of nanoceramic material produced with a stereolithographic 3D printer. A polymethylmethacrylate (PMMA) resin shell was performed with CAD/CAM and relined on welded framework. Six samples were produced with the same procedure reducing resin thickness. The samples were subjected to fatigue test (6,500,000 cycles) using ElectroForce 3310 fatigue machine (t1); subsequently a mechanical compression test using a universal Shimadzu AGS-X 10 machine (t2). The samples were analyzed with a photographic and radiographic documentation at t0, t1 and t2. The samples survived mechanical fatigue test without evidence of failure. The radiographic and photographic evaluation revealed the fracture of resin coating after the mechanical compression test. The samples with minimal resin thickness fractured first. Adequate assessment of the resin thickness is mandatory to improve the longevity of these rehabilitations. CAD-CAM digital prosthetic design allows us to optimize the thicknesses and the prosthetic shapes, allowing us to obtain good degrees of resistance even in the presence of reduced prosthetic spaces.

A Retrospective Evaluation of 5 Years of Clinical Results of Metal-Ceramic vs. Monolithic Zirconia Superstructures in Maxillary All-on-4TM Concept.

The aim of the current study was to present the clinical and radiological outcomes of monolithic zirconia superstructures compared to the metal-ceramic ones in the All-on-4 concept for the prosthetic rehabilitation of the maxillae. A total of 30 patients were subdivided into groups according to their superstructure type (metal-ceramic (n = 15) or monolithic zirconia (n = 15)). All implants were functionally loaded within 24 h after insertion with provisional acrylic superstructures. Prosthetic complications, marginal bone loss, plaque accumulation, probing pocket depth, bleeding on probing, and bite force were documented over a period of 5 years. Marginal bone loss around the implants of the ceramic group remained well over the five years (1.21 ± 0.23 mm). However, marginal bone loss was significantly lower around the implants in the monolithic zirconia group (0.22 ± 0.14 mm) (p < 0.001). Bleeding on probing, plaque accumulation, and probing pocket depth values were correlated with marginal bone loss. Among all evaluated parameters, no differences could be detected in terms of the angulation of the implants. Detachment or chipping was observed in seven cases in the metal-ceramic superstructure group. In all cases, dentures were removed and repaired in the laboratory. In the monolithic zirconia group, chipping was detected after one year in two cases, after two years in four cases, and after five years in one case and could be managed by polishing in situ. Monolithic zirconia superstructures presented superior results regarding the parameters evaluated.

Maxillary bone augmentation with calvarial bone graft for immediate full-arch rehabilitation: Insights from a 10-year proof-of-concept retrospective analysis.

OBJECTIVE: Evaluate the long-term outcomes of full-arch rehabilitation using immediate dental implant placement and continuous functional loading with full-fixed dental prostheses (FFDPs). MATERIALS AND METHODS: Fifty-six patients received temporary implants (n = 327) at maxillary augmentation with calvarial bone. A provisional acrylic FFDP was immediately loaded onto these implants. After 6 months, the temporary implants were replaced with definitive implants (n = 326) and immediately loaded with a second provisional FFDP (N = 55). Subsequently, a baseline radiograph was taken following a 6-month healing period. The second bridge was then substituted with a definitive FFDP. Primary outcomes included peri-implant marginal bone level (MBL) and definitive implant survival. Secondary outcomes evaluated provisional implant and prostheses survival, complications, and patient satisfaction. RESULTS: The provisional implants had a survival rate of 97.9%. One patient was excluded from further analysis due to loss of temporary implants and first FFDP. The definitive implant survival rate after 10 years was 92.2%, with a moderate but significant decrease in MBL between baseline radiography and 10 years later (-0.08 ± 0.18 vs. -0.24 ± 0.44). However, large individual variations were observed, with 65.8% of implants showing no bone loss and 9.2% showing loss ≥0.5 mm. Sinusitis was experienced by 14.3% of patients upon surgery. Patient satisfaction was high or reported no issues after protocol completion (80%). One patient lost all six definitive implants and definitive FFDP 8.2 years after implant placement. CONCLUSIONS: The described protocol can be regarded as a long-term, highly successful method for full-arch rehabilitation of atrophied maxillae while enabling continuous masticatory and speaking functionality.

Translucent monolithic zirconia titanium-supported FP1 full-arch prosthesis: A novel proof of concept to address esthetic, functional, and biologic challenges.

OBJECTIVE: Despite the wide clinical use of translucent zirconia for full-arch implant prostheses, reduced flexural strength and fracture toughness compared with high-strength opaque zirconia needs to be addressed. A novel proof of concept for FP1 full-arch prosthesis featured by translucent monolithic zirconia and titanium framework was presented. CLINICAL CONSIDERATIONS: Computer-guided implant planning and surgery were executed and digitally designed FP1 temporary prosthesis prefabricated. Implant and prosthetic placement were achieved with a set of three-dimensional (3D)-printed templates. Implants were immediately loaded. After 4 months intraoral optical scan was taken to record implant coordinates, soft tissue anatomy, and temporary FP1 prosthesis. A novel digital workflow was used to design and mill overlaying translucent zirconia and anatomically shaped titanium framework with a scalloped soft-tissue interface. Final FP1 prosthesis was assembled cementing zirconia jacket on titanium counterpart. CONCLUSIONS: Translucent zirconia supported by titanium framework can address esthetic and mechanical requirements of FP1 full-arch prosthesis, minimizing risk of fracture and providing a rigid and passive joint with supporting implants. The smooth and highly polished titanium surface with an anatomic design, tightly matching scalloped soft tissue interface, can limit food impaction, air and saliva leakage and contribute to overall biologic integration of FP1 full-arch prosthesis. CLINICAL SIGNIFICANCE: Translucent monolithic zirconia featured with anatomically shaped titanium framework with scalloped transmucosal part, combining a pleasant esthetic outcome with increased flexural strength and fracture toughness, may be indicated to increase the clinical performance of FP1 full-arch prosthesis.

Immediate Loading of Zygomatic Implants Using a Dual Scan Technique.

The immediate loading protocol has become increasingly popular due to the progressive growth in demand for a reduction in treatment times. The possibility of applying this protocol would depend on certain important factors. The application of the digital workflow mentioned in the protocol guarantees rapidity, precision, and esthetics. This report aims to describe a fully digital workflow using a dual scan impression technique to fabricate immediate fixed complete dentures (FCDs) for zygomatic and standard implants. A 58-year-old female patient requested treatment for her severely atrophic maxilla, and four unrehabilitated implants in the mandible. After proper diagnosis and planification, four zygomatic implants and two standard implants were placed. During the surgery, transmucosal abutments were placed on all implants. After suturing, the positions of the implants were recorded using a stereophotogrammetric technique, creating a standard tessellation (STL) file. In the lower arch, the second phase of the surgery was carried out: the transmucosal abutments were placed, and then the implant positions were recorded in the same way. The soft tissues were rescanned after suturing with an intraoral scanner (IOS), and all STL files were aligned to obtain the virtual final models. The pre-design after virtual modifications was aligned with the definitive models. The provisional prostheses were milled and placed after six hours after the surgery, and the definitive prostheses were placed six months after the surgery. The dual scan technique used obtained a precise fit for both the provisional and definitive FCDs. This technique might be an effective and reliable alternative for the fabrication of immediate and definitive screw-retained FCDs in a completely digital workflow. The time taken for scanning and fabrication was reduced, and the clinician's and patient's satisfaction were improved.

Functional and aesthetic rehabilitation using 'all on 4' treatment protocol with intraoral welding.

With the increasing life expectancy and improved quality of life, the conventional prosthodontic removable treatment modalities are being replaced with implant retained fixed prostheses. A full-arch conventional rehabilitation of edentulous ridges requires six to ten dental implants. However, some patients demand fixed implant-supported prostheses inspite of medical conditions and economic concerns. Also in completely edentulous cases, the insufficient bone morphology directs the treatment plan towards alternatives such as cantilever prostheses, short implants or ridge augmentation procedures. These clinical conditions have brought in a quantum shift in treatment planning towards the 'all on 4 protocol' providing immediately loaded fixed prosthesis supported by 4 implants thereby providing optimum and immediate restoration of function and esthetics.

Effect of Different Occlusal Tooth Forms of Mandibular Overdenture Retained by an Immediate Loaded Single Implant on the Masticatory Efficiency and Oral Health-Related Quality of Life.

Aim: To study the masticatory efficacy and oral health-related quality of life (OHRQoL) of participants wearing a mandibular overdenture retained by an immediate loading single implant with different occlusal tooth forms. Materials and Methods: For this nonrandomized controlled trial study, 27 edentulous participants were selected and randomly divided into three groups (n = 9) based on occlusal tooth forms of the mandibular implant overdenture (MIOD). Group I: participants received an MIOD with an anatomical tooth form; Group II: participants received an MIOD with a semianatomical tooth form; and Group III: participants received an MIOD with a nonanatomical tooth form. For each participant, a single implant (screw root form) was inserted into the midline of the mandibular ridge to support the MIOD. For each group, the masticatory efficiency was evaluated after 3 months, and the OHRQoL of the participants was evaluated after 3 and 6 months. One-way ANOVA and post hoc Tukey's test were used for data analysis (P < 0.05). Results: The masticatory efficiency of the anatomic and semianatomic tooth forms was higher than that of the nonanatomic (P < 0.05). Moreover, the improvement in the participants' OHRQoL in the anatomic group was more significant than that of other groups (P < 0.05). Conclusion: There was a greater improvement in masticatory efficiency and participants' OHRQoL when fitted with an anatomic tooth form mandibular overdenture retained by an immediate loading single implant than with a semianatomic or nonanatomic tooth form.

Guided immediate implant with and without using a mixture of autogenous and xeno bone grafts in the dental esthetic zone. A randomized clinical trial.

PURPOSE: This in vivo study aims to assess the pink esthetic score in the anterior maxilla after computer-guided immediate implant installation and fully digital immediate temporalization with and without grafting the jumping gap with a mixture of 1:1 autogenous and xenograft particulates. MATERIALS AND METHODS: Twenty-four patients with non-restorable upper anterior teeth in the aesthetic zone have undergone a traumatic extraction for the non-restorable tooth followed by immediate implant placement using a 3D-printed surgical guide according to prosthetically driven implant placement. The patients were divided into two groups. The study group received the dental implant after grafting the jumping gap with 1:1 autogenous and xenograft particulates, while the control group received the dental implant without grafting the jumping gap. Each patient received a digitally fabricated, immediate, nonfunctional temporary prosthesis. The esthetic outcome was compared between the two groups using the pink esthetic score at implant insertion and after 6 months of follow-up. Statistical comparisons were carried out between the studied groups using the Mann-Whitney U test. RESULTS: Immediately postoperatively, there was no statistically significant difference between the median PES in the two groups (P-value = 0.746). After six months, the study group showed a statistically significantly higher median PES than the control group (P-value = 0.048). CONCLUSIONS: Grafting the jumping distance in the immediate implant protocol helps achieve a better esthetic outcome. CLINICAL RELEVANCE: The use of immediate guided implant placement along with grafting the jumping gap followed by immediate digital temporalization guarantees a better esthetic outcome while preserving time, cost, and the number of clinical visits. TRIAL REGISTRATION: The study was registered on clinicaltrials.gov with registration number NCT04096209. (19/9/2019).

[A prospective single-cohort study of implant-supported full-arch metal-ceramic prosthesis with gold-platinum alloy framework for treatment edentulous mandible in elderly patients: 15-year report]. / Implantatsionnoe protezirovanie protyazhennymi metallokeramicheskimi konstruktsiyami s karkasom iz zolotoplatinovogo splava u pozhilykh patsientov: rezul'taty 15-letnego perspektivnogo odnogruppovogo kogortnogo issledovaniya.

OBJECTIVE: To study the effectiveness of implant-supported full-arch metal-ceramic prosthesis with gold-platinum alloy framework in elderly patients. MATERIALS AND METHODS: The study included patients with complete and/or partial loss of teeth and terminal dentition. In 2007-2008, 354 implants were inserted in 27 patients. The age of the patients was 61.31±5.08 years. Mombelli index criteria (mBI [modified Sulcus Bleeding Index]) were used. The plaque index was determined using a modified Löe & Silness method. The state of the peri-implant bone (ΔMBL) was determined by a series of OPG. The Geriatric Oral Health Index (GOHAI) was used to assess oral health in the elderly. RESULTS: Metal-ceramic full-arch implant prostheses with a gold-platinum alloy framework, based on a sufficient and optimal number of implants (6-8), showed high survival rate (100%) after 15 years. Marginal bone loss (ΔMBL) after 15 years was -1.44±1.27 mm. The survival rate of implants was 99.4%. Scores on the GOHAI scale were higher in patients after orthopedic rehabilitation (from 52.7±7.1 to 54.1±8.4, p<0.001). CONCLUSION: After 15 years, all prostheses had mechanical defects, which at the same time allowed them to be used without restrictions. Screw fixation of full-arch implant prostheses, although it was associated with mechanical complications, nevertheless made it possible to perform surgical interventions in a timely manner and stop the development of inflammatory complications. Thus, we do not see any grounds for removing metal-ceramic prostheses and replacing them with new implant prostheses even after a 15-year period of operation. At the same time, it is necessary to take into account the reduction in the possibility of individual oral hygiene in elderly patients, as well as possible restrictions on self-visiting a dentist or dental hygienist.

Computer Aided Full Arch Restoration by Means of One-Piece Implants and Stackable Guide: A Technical Note.

This technical note aims to present a recently developed computer-guided protocol characterized by titanium-reinforced stackable surgical guides during post-extractive implant placement and subsequent immediate loading. A full maxillary edentulism was rehabilitated with one-piece implants, starting from a pre-existing removable denture. 3D digital scans of the removable denture and upper and lower arches were performed. On this basis, a prototype with ideal esthetic and functional outcomes was realized and replicated into a custom-made radiological stent with markers. The superimposition of STL and DICOM files allowed virtual planning of one-piece implants in the ideal prosthetically driven position. The stackable guides, composed of a fixed base template and additional removable components, were then realized. The fixed template, initially secured with anchor pins to the bone, was no longer removed. The removable components, which were screwed to the base template, were used to perform implant surgery and immediate prosthetic loading. No surgical complications occurred, the implants achieved a minimum insertion torque of 35 Ncm, and immediate prosthetic loading was performed. The base template allowed for the maintenance of a fixed reference during the entire workflow, improving the transition between the digital project, the surgical procedure, and the prosthetic rehabilitation.