Transferring emergence profile and position of interim restorative implant fixture. A novel digital technique.

The present technical article describes a protocol to digitally reproduce the emergence profile of an interim implant prosthesis (IP) and to transfer its macrogeometry into the definitive restoration. The purpose of this protocol was to minimize alterations in the gingival architecture developed during the interim restorative phase of a single implant that could potentially jeopardize its esthetic outcome. The process included obtaining an intraoral scan with the interim IP in situ, a duplicate of this intraoral scan that was used to capture the exact position of the implant, and an extraoral scan of the prosthesis. These data could then be imported into IOS software to create a model where the patients' soft tissue was incorporated with precision, allowing for the fabrication of a definitive crown with an optimal soft tissue adaptation. As there are few articles in the scientific literature that have reported a consistent method to replicate the emergence profile of an interim IP, the present technical article aims to highlight the potential of utilizing the emergence profile of an interim IP created by IOS software.

Assessment of a novel electrochemically deposited smart bioactive trabecular coating (SBTC®): a randomized controlled clinical trial.

OBJECTIVES: A randomized controlled clinical trial of dental implants was conducted to compare the clinical properties of a novel electrochemically deposited calcium phosphate coating to those of a common marketed surface treatment. MATERIAL AND METHODS: Forty implants of the same brand and type were placed in 20 fully edentulous participants requiring mandibular implantation. The two study groups were defined by the surface treatment of the implants. 20 implants in the control group were coated via a commercial electrochemical surface treatment that forms a mixture of brushite and hydroxyapatite, while the remaining 20 in the test group were coated with a novel electrochemical Smart Bioactive Trabecular Coating (SBTC®). A split-mouth design was employed, with each participants receiving one control implant in one mandibular side and a test implant in the other. To mitigate potential operator-handedness bias, control and test implants were randomly assigned to mandibular sides. All cases underwent digital planning, implant placement with a static surgical guide, and participants received locator-anchored full-arch dentures. The primary outcome was implant stability (measured using Osstell ISQ) assessed at insertion, loading, and then 3 months, 9 months, and 2 years post-insertion. The secondary outcome was bone level change (in millimeters) over the 2-year observation period. Oral health-related quality of life (OHRQL) was monitored using the OHIP-14 questionnaire. Complications and adverse events were recorded. RESULTS: Successful osseointegration and implant stability were achieved in all cases, allowing loading. ISQ values steadily increased throughout the observation period. While no significant differences were observed between the SBTC® and control coatings, the test group exhibited a higher ISQ gain. Bone resorption was somewhat lower in the SBTC® but not significantly so. Patients' OHRQL significantly improved after denture delivery and remained stable throughout the follow-up. No complications or adverse events were observed. CONCLUSIONS: Based on the study results, we conclude that the new surface treatment is a safe alternative to the widely used control surface, demonstrating similar osseointegrative properties and time-dependent bone level changes. Further research may explore the broader implications of these findings. TRIAL REGISTRATION: The study is registered on clinicaltrials.gov under the identifier ID: NCT06034171.

Effect of different fabrication workflows on the passive fit of screw-retained bar splinting two interforaminal implants: a parallel blinded randomised clinical trial.

BACKGROUND: To clinically compare the effect of the conventional and the digital workflows on the passive fit of a screw retained bar splinting two inter-foraminal implants. METHODS: The current study was designed to be a parallel triple blinded randomised clinical trial. Thirty six completely edentulous patients were selected and simply randomized into two groups; conventional group (CG) and digital group (DG). The participants, investigator and outcome assessor were blinded. In the group (CG), the bar was constructed following a conventional workflow in which an open top splinted impression and a lost wax casting technology were used. However, in group (DG), a digital workflow including a digital impression and a digital bar milling technology was adopted. Passive fit of each bar was then evaluated clinically by applying the screw resistance test using the "flag" technique in the passive and non passive situations. The screw resistance test parameter was also calculated. Unpaired t-test was used for intergroup comparison. P-value < 0.05 was the statistical significance level. The study protocol was reviewed by the Research Ethics Committee in the author's university (Rec IM051811). Registration of the clinical trial was made on clinical trials.gov ID NCT05770011. An informed consent was obtained from all participants. RESULTS: Non statistically significant difference was denoted between both groups in all situations. In the passive situation, the mean ± standard deviation values were 1789.8° ± 20.7 and1786.1° ± 30.7 for the groups (CG) and (DG) respectively. In the non passive situation, they were 1572.8° ± 54.2 and 1609.2° ± 96.9. Regarding the screw resistance test parameter, they were 217° ± 55.3 and 176° ± 98.8. CONCLUSION: Conventional and digital fabrication workflows had clinically comparable effect on the passive fit of screw retained bar attachments supported by two dental implants.

Clinical Peri-Implant Parameters and Marginal Bone Loss for Early Mandibular Implant Overdentures: A Follow-Up of 60 Months.

Background and Objectives: Despite the identified benefits of early implant loading, studies have questioned its advantages compared to delayed loading in edentulous patients. This study aimed to evaluate clinical peri-implant parameters and marginal bone loss around early placed and loaded mandibular implant overdentures with a 60-month follow-up. Materials and Methods: In this prospective cohort study, 43 patients were enrolled to receive 86 early loading sub-crestal dental implants through prosthetic guides. Implant overdentures were supported by two isolated implant locator attachments between two mental foramens. Clinical peri-implant parameters, including plaque index (PI), bleeding index (BI), peri-implant pocket depth (PIPD), and marginal bone loss (MBL) were evaluated using standardized techniques at 1, 12, 24, 36, 48, and 60 months follow-up. At 60 months, complications associated with implant overdentures (IOD's) were noted. The mean comparison of peri-implant clinical parameters was performed through ANOVA test. A p-value of ≤0.05 was taken as significant. Results: Out of the total 43 enrolled patients, 8 patients were lost during follow-up; as a result, 35 patients completed the 5 years follow-up. The mean values of PI, BI, and PIPD increased with no statistical difference (p > 0.05). For marginal bone loss, an increase in the mean values was noted at different time intervals with statistical differences (p < 0.001). The most common complications noted were loosening of the abutment, occlusal adjustment, retentive locator loosening and replacement, and relining of the denture. Conclusions: Early placement of IODs failed to prevent bone loss over time and was associated with complications, predominantly consisting of abutment loosening, occlusal adjustments, broken retentive locator components, relining, and rebasing.

Orientações de manutenção e higienização de prótese fixa total implantossuportada: revisão de literatura / Guidelines for maintenance and cleaning of implantssupported total fixed prosthesis: literature review

A evolução dos tratamentos em implantodontia possibilitou uma mudança nos tratamentos reabilitadores para pacientes edêntulos, tornando possível a colocação de próteses fixas, que proporcionam maior qualidade de vida para estes pacientes. Para que estas próteses tenham bom desempenho e longevidade satisfatórios é essencial que se mantenha um padrão adequado de higienização bucal e manutenção profissional. Assim, o objetivo deste trabalho foi realizar uma revisão de literatura a respeito dos principais recursos disponíveis para higienização e manutenção das próteses totais fixas sobre implante (protocolo de Branemark), tanto nos cuidados domiciliares dos pacientes quanto no atendimento profissional do cirurgião dentista. Foi realizada uma busca eletrônica, não sistemática, nas bases de dados Lilacs, Pubmed/Medline, Scielo e ScienceDirect, cruzando-se os seguintes descritores: "Higiene Oral"; "Implantes Dentários"; "Implantação Dentária"; "Manutenção"; "Prótese Dentária Fixada por Implante" e "Prótese Dentária". Foram consultados artigos de revisão de literatura, revisão sistemática, meta-análise, estudos clínicos randomizados, além de livros pertinentes ao assunto, publicados no período de 1995 a 2022.Verificou-se na literatura disponível que os principais instrumentos indicados para uso domiciliar são escova dental, fio dental, escova interdental, irrigador oral, dentifrício e enxaguatório. No atendimento profissional em consultório odontológico deve ser dispendida atenção especial às instruções passadas ao paciente e também fazer o possível para motivar e encorajar o seu engajamento na rotina de higienização, além do acompanhamento periodontal, possíveis substituições de parafusos e instalação de placa oclusal estabilizadora, quando necessário. Manter uma higiene oral adequada é essencial para o sucesso das próteses fixas sobre implantes e o cirurgião dentista desempenha um papel crucial não apenas ao realizar o acompanhamento periódico do paciente, mas também ao sugerir os instrumentos mais apropriados, instruir sobre a higiene oral adequada e motivar o paciente a manter a saúde bucal satisfatória(AU)

The evolution of treatments in implantology has enable a change in rehabilitation treatments for edentulous patients, making it possible to place fixed prostheses that provide a better quality of life for these patients. In order to ensure good performance and satisfactory longevity, it is essential to maintain an appropriate standard of oral hygiene and professional maintenance. Thus, the objective of this work was to conduct a literature review on the main resources available for cleaning and maintenance of complete fixed prostheses on implants (Branemark protocol), both in the patients' home care and in the professional care provided by the dentist. A nonsystematic electronic search was carried out in the Lilacs, Pubmed/Medline, Scielo, and ScienceDirect databases, crossing the following descriptors: "Oral Hygiene"; "Dental Implants"; "Dental Implantation"; "Maintenance"; "Dental Prosthesis, ImplantSupported"; and "Prosthodontics". Literature review articles, systematic reviews, meta-analyses, randomized clinical studies, and relevant books on the subject published from 1995 to 2022 were consulted. The literature available indicates that the main instruments recommended for home care are toothbrush, dental floss, interdental brush, oral irrigator, toothpaste, and mouthwash. In the professional dental office, special attention should be given to the instructions given to the patient, as well as to motivate and encourage their engagement in the hygiene routine, in addition to periodontal monitoring, possible screw replacements, and installation of an occlusal splint when necessary. Maintaining adequate oral hygiene is essential for the success of fixed prostheses on implants, and the dentist plays a crucial role, not only in providing periodic patient follow-up, but also in suggesting the most appropriate instruments, instructing on adequate oral hygiene, and motivating the patient to maintain satisfactory oral health(AU)

CAD/CAM full-mouth rehabilitation of an elderly patient: One-piece digital complete denture meets multilayered zirconia with gradient technology.

OBJECTIVE: This article highlights a CAD/CAM complete-mouth rehabilitation in an 82-year-old patient by means of a complete maxillary prosthesis and mandibular implant- and tooth-supported fixed restorations made from multilayered zirconia. CLINICAL CONSIDERATIONS: Comprehensive complete-mouth rehabilitations in elderly patients with adaptation of the occlusal vertical dimension (OVD) often present particular challenges. This applies especially when exacting functional and esthetic requirements are to be met and the treatment should not cause the patient too much effort, still ensuring the highest level of quality and efficiency and a low intervention rate. CONCLUSION: The digital approach used for the present patient allowed for an efficient treatment procedure, facilitated virtual evaluations using a face-scan, and enhanced the predictability of the prosthodontic outcome. The approach enabled some steps required in the conventional protocol to be omitted, resulting in a straightforward clinical treatment with minimal strain on the patient. CLINICAL SIGNIFICANCE: Because of the comprehensive recording of extraoral and intraoral data, for example with a facial scanner, it was possible to transfer a digital replica of the patient to the dental laboratory technician. With this protocol, many steps can be performed in the absence of the real patient.

Digital workflow for proximal adjustment of teeth adjacent to implant-supported fixed restorations using a predesigned computer-aided grinding guide.

Clinically, the proximal surfaces of teeth adjacent to an implant restoration usually need to be adjusted to build a preferable adjacency relationship. However, it is difficult for freehand preparation to get a favorable proximal contour in some cases. In the workflow presented here, virtual grinding can be made to adjacent teeth, under the consideration of functional reconstruction and biological requirements, and then the grinding can be implemented using digital templates and a specialized bur. This allows for more precise and accurate adjustments to be made during the clinical procedure, reducing the risk of over- or under-preparation of the proximal surfaces. In addition, the use of specialized diamond burs and grinding guides can make the procedure more efficient and streamlined, reducing the time required for proximal adjustment and minimizing patient discomfort. The resulting implant-supported prosthesis is more likely to function properly and last longer, as the precise proximal contacts can help distribute occlusal forces more evenly across the dentition. Overall, the use of digital technology for precise adjustment of proximal contacts during implant restorations represents an important advancement in modern dentistry, enabling dentists to provide their patients with more accurate, efficient, and effective dental care.

Implant-assisted removable partial dentures: Part II. a systematic review of the effects of implant position on the biomechanical behavior.

PURPOSE: This systematic review aimed to evaluate the effects of implant placement sites on the biomechanical behavior of implant-assisted removable partial dentures (IARPDs) using finite element analysis (FEA). STUDY SELECTION: Two reviewers independently conducted manual searches of the PubMed, Scopus, and ProQuest databases for articles investigating implant location in IARPDs using FEA, according to the 2020 Systematic Reviews and Meta-analyses statement. Studies published in English up to August 1, 2022, were included in the analysis based on the critical question. RESULTS: Seven articles meeting the inclusion criteria were systematically reviewed. Six studies investigated mandibular Kennedy Class I and one study investigated mandibular Kennedy Class II. Implant placement reduced the displacement and stress distribution of the IARPD components, including dental implants and abutment teeth, regardless of the Kennedy Class type and dental implant placement site. Most of the included studies showed that, based on the biomechanical behavior, the molar region, rather than the premolar region, is the preferred implant placement site. None of the selected studies investigated the maxillary Kennedy Class I and II. CONCLUSIONS: Based on the FEA regarding mandibular IARPDs, we concluded that implant placement in both the premolar and molar regions improves the biomechanical behaviors of IARPD components, regardless of the Kennedy Class. Implant placement in the molar region results in more suitable biomechanical behaviors compared with implant placement in the premolar region in Kennedy Class I. No conclusion was reached for Kennedy Class II due to the lack of relevant studies.

Splinting or non-splinting of fixed prostheses on adjacent implants: A critical review.

PURPOSE: The present study aimed to identify, through a critical review of the literature, the success factors associated with the splinting of fixed prostheses on adjacent implants of the posterior sectors in partially edentulous patients compared with those not splinted. STUDY SELECTION: A MEDLINE strategy was implemented based on a research question to systematically search and extract information from databases (PubMed and Scopus) using MeSH terms/keywords identified for each domain. Systematic reviews, clinical and in vitro studies were selected and classified according to eligibility criteria based on the research question and level of evidence using the PRISMA flowchart. RESULTS: A total of 32 studies were selected for data extraction and analysis according to study design (three systematic reviews, 14 clinical studies, and 15 in vitro studies). Overall, the studies found no significant difference in the association between the survival rate and prosthesis type. In clinical studies, there have been no differences in marginal bone loss between splinted and non-splinted prostheses, and the influence of peri-implant status and restorative materials has been poorly evaluated. The distribution of stress and loads determined in the in vitro studies showed results that could favor splinted prostheses; however, are generally associated with implant design. CONCLUSIONS: The need for splinted or non-splinted adjacent implant-supported prostheses remains controversial. The reviewed evidence indicates that factors such as implant size and its relationship with coronal height could be important in decision-making.

The Impacted Maxillary Canine in the Adult: A Narrative Review and Implant Treatment Options.

PURPOSE: The purpose of this article is to provide clinicians with options to restore the adult patient with an impacted maxillary canine using dental implants. Literature was reviewed to provide evidence for the methods suggested. METHODS: The search strategy utilized pubmed.gov to identify articles pertinent to identified treatment options. The search used terms which included dental implants and impacted tooth, tilted implants and fixed partial prostheses, 6 mm dental implants, and 4 mm dental implants. Articles were included if they reported dental implant procedures associated with impacted canines in adults, or if they reported on the use of tilted implants, immediate implant placement at time of canine removal, or the use of short implants. Articles with less than 12 months follow up were excluded. RESULTS: The search identified articles which included dental implants and impacted tooth (n = 142), tilted implants and fixed partial (n = 36), 6 mm dental implants (n = 182), and 4 mm dental implants (n = 162). From this search, 28 articles were collated that satisfied the inclusion criteria. The use of tilted implants had success rates ranging from 93% to 99%. Short implants had success rates ranging from 87 to 90% in the posterior maxilla. Immediate implant placement after removal of the impacted canine lacked long term reports. Two cases are included to demonstrate treatment planning using navigation to guide implant placement in an adult patient with an impacted maxillary canine. CONCLUSIONS: The evidence-based literature concerning implant placement associated with adult maxillary canines is limited. There is evidence to support tilting implants to avoid the impacted canine, or the use of short implants splinted together to avoid the impacted tooth. Other options had insufficient data to offer support.

Altered reverse impression method involving extraoral digitalization of a verification jig for the fabrication of implant-supported prosthesis by using a complete-digital workflow.

The reverse impression method involves the extraoral digitalization of the interim implant-supported prostheses and intraoral digitalization of antagonist arch and maxillomandibular relationship. This technique allows the fabrication of implant-supported prostheses by using a complete-digital workflow. The scan analogs make the reverse impression method feasible. However, this method may not be recommended if the interim polymethyl methacrylate prosthesis does not have passive fit. The present manuscript describes an altered reverse impression technique that involves the extraoral digitalization of a conventional verification jig, which has attached scan analogs. With this technique modification, the implant positions captured using the verification jig are used to obtain the virtual definitive implant cast and fabricate the definitive implant-supported prosthesis.

Recommendations for successful virtual patient-assisted esthetic implant rehabilitation: A guide for optimal function and clinical efficiency.

OBJECTIVE: Complete arch implant rehabilitation necessitates meticulous treatment planning and high-level collaboration between surgical and prosthetic dental teams. Emerging virtual technologies hold considerable promise in streamlining this process. The aim of this article is to extend recommendations to clinicians venturing into the virtual patient-assisted esthetic implant rehabilitation workflow. OVERVIEW: This article summarizes recommendations for virtual patient-assisted esthetic implant rehabilitation in the following five aspects: three-dimensional data handling and superimposition, occlusion and virtual articulator integration in creating virtual patients, streamlined face- and prosthetic-driven surgical planning, reuse of presurgical data ("Copy & Paste"), and final impression for passive fitting of final restoration. To illustrate these principles, a case with complete-mouth implant rehabilitation completed within six visits using this virtual patient workflow is presented. CONCLUSION: The virtual patient workflow serves as an invaluable tool to perform treatment planning, enhance efficiency, and ensure predictable outcomes in esthetic complete arch implant rehabilitation. CLINICAL SIGNIFICANCE: Virtual workflows are increasingly prevalent in esthetic implant rehabilitation. Nevertheless, these workflows necessitate a distinct set of knowledge and tools divergent from conventional dentistry practices. This article offers guidelines and recommendations for dental clinicians who are new to this field.

Facially Driven Digital Workflow for Maxillary and Mandibular Milled Implant- Retained Overdentures Using Two Different Unsplinted Attachment Systems: Case Report.

Unsplinted attachment systems for implant overdentures offer various benefits for edentulous patients, including cost-effectiveness, enhanced cleansability, and less need for manual dexterity. This article describes a facially driven digital workflow for fabricating a maxillary implant overdenture retained by conometric-style attachments (Atlantis® Conus) with a palateless design opposing an implant overdenture retained by standard attachments (LOCATOR®). This procedure provides a predictable and accurate technique to digitally scan the master casts with wax rims for articulation and to guide the digital teeth design set-up for a predictable esthetic outcome. The removable prosthesis workflow involves virtual teeth set-up, a 3D-printed trial denture, a milled definitive prosthesis, and intraoral pick-up for both unsplinted attachment systems. The clinical and laboratory steps are described.

Technique-Related Survival Rate and Complications of Zygomatic Implant Placement: A Systematic Review and Meta-Analysis.

PURPOSE: To assess the survival rate (SR) and probability of postoperative complications at both the implant and patient level for each of the four surgical techniques for zygomatic implant (ZI) placement: Brånemark, sinus slot, extrasinus, and extramaxillary. MATERIALS AND METHODS: A systematic literature review and meta-analysis of clinical studies that reported the survival rate and postoperative ZI complications for the rehabilitation of atrophic edentulous maxillae was conducted based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations. Two independent reviewers consulted four databases during the literature search: MEDLINE (PubMed), Google Scholar, Clinicaltrials.gov, and LILACS. Duplicate articles were eliminated. RESULTS: A total of 35 studies were included in the meta-analysis. Subgroup analysis showed that study design (prospective vs retrospective) had no significant impact (P = .10) on the outcomes. The SR was highest for the Brånemark and extrasinus techniques (100%) and lowest for the sinus slot technique (94%; 95% CI = 86% to 102%). The extramaxillary (38%; 95% CI = 1% to 3%) and the Brånemark (29%; 95% CI = 15% to 44%) techniques resulted in the highest occurrence of patient-level complications. Moreover, the extramaxillary technique showed the highest percentage of prothesis-related complications (44%; 95% CI = 27% to 62%). CONCLUSIONS: ZI placement was demonstrated to be a reliable technique for the rehabilitation of severely atrophic maxillae, irrespective of the surgical technique evaluated. Accurate case and surgical protocol selection is of paramount importance to reduce technique-related postoperative complications.

Extra-Short 4-mm Implants Splinted to 10-mm Implants in the Posterior Maxilla: 3-year Results.

PURPOSE: To evaluate the 3-year success and survival rates of fixed prostheses supported by 4-mm extra-short implants splinted to 10-mm implants in patients with shortened maxillary arches and low maxillary sinus floors. METHODS: A total of 11 patients with reduced alveolar bone heights due to low maxillary sinus floors received two or three titanium-zirconium tissue-level implants: one or two extra-short (4 mm) implants, and one implant 10 mm in length. After 6 months, prosthetic rehabilitation with splinted crowns connecting the 4- and 10-mm implants was performed. Follow-up visits and maintenance protocols were implemented every 4 to 6 months. RESULTS: The 11 patients were treated with 11 10-mm implants and 17 4-mm implants. One extra-short implant failed and was removed before loading, and its planned design was modified from three splinted crowns to a bridge between the 10- and 4-mm implants. After 36 months, all (11/11) prosthetic rehabilitations connecting the 10-mm (11/11) and 4-mm (16/16) implants were functional. At the 10-mm implant sites, the median (interquartile range [IQR]) probing depth and marginal bone loss measured 2.9 mm (2.3 to 3.2) and 1.3 mm (1.0 to 1.5), respectively. At the 4-mm implant sites, the median (IQR) probing depth and marginal bone loss measured 2.9 mm (2.4 to 3.1) and 0.3 mm (0.1 to 0.5), respectively. CONCLUSION: Prosthetic rehabilitation with splinted crowns connecting 4-mm and 10-mm implants showed promising outcomes in shortened maxillary dental arches after 3 years. Additional studies are needed to further validate these findings.

Reverse scan body: The scan pattern affects the fit of complete-arch prototype prostheses.

PURPOSE: To assess the effect of different scan patterns on the fit of implant-supported complete-arch prototype prostheses fabricated via a complete digital extraoral protocol with a reverse scan body. MATERIALS AND METHODS: A mandibular cast with four multi-unit abutment (MUA) implant analogs with adequate antero-posterior spread served as the reference cast, simulating a common clinical patient situation, and a polymethylmethacrylate interim screw-retained prosthesis was fabricated on it. Novel reverse scan bodies were connected to the interim prosthesis on the intaglio of the MUA abutments and extraoral scanning was performed with a white light intraoral scanner (TRIOS 4; 3 shape) and three different scan patterns: starting from the occlusal surface of the interim prosthesis (O-group), starting from the intaglio (I-group), and helix pattern (H-group).  The resulting STL files from the three groups were then imported to computer-aided design (CAD) software and after the digital design, the STL files were exported to a computer-aided manufacturing (CAM) milling machine which generated a total of 15 CAD-CAM milled prototype prostheses per group. Two clinicians assessed the fit of each digitally fabricated prototype prosthesis on the reference cast, utilizing the screw-resistance test and radiographic evaluation. Fisher's exact test was used to test the difference between the three groups, and Cohen's k-score was used to assess the inter-examiner agreement. RESULTS: Out of the three different groups, the O-group scan pattern led to 100% prosthesis fit, while the prototype prostheses generated from I- and H-groups had 80% and 53% fit, respectively. The results were statistically significant (p = 0.008). CONCLUSIONS: Occlusal scan pattern leads to fitting milled prototype prostheses after extraoral scanning with reverse scan bodies without intraoral implant data acquisition.

The Reverse Scan Body Protocol: Completing the Digital Workflow.

Recently developed extraoral techniques have allowed for an alternative approach for the digital acquisition of implant positions in fully edentulous patients. The "reverse scan body protocol" digitally simulates the traditional back-pouring technique long utilized in analog workflows. This article presents two cases in which an extraoral scanning technique was used to capture implant positions, design a prototype, and fabricate the definitive monolithic zirconia full-arch prosthesis.

Maxillary Full Arch Restorations - Biological Complications: A Narrative Review Outlining Criteria for Long Term Success.

PURPOSE: Patients receiving full arch implant borne maxillary prostheses require functional, esthetic, and long term success. The importance of this review is to document the difficulty with implant maintenance, the prevalence of peri-implant disease, and the improvement in biologic health when using a prosthesis that can be maintained to minimize plaque. The objective is to provide surgeons with a reference to optimize surgical procedures that can result in improved hygiene and long term maintenance, as well as acceptable functional and esthetic goals. METHODS: Pubmed.gov was the information source. Years reviewed included 1990-2022. Inclusion criteria included only articles in journals referenced in pubmed.gov. The reports excluded were case reports, reports that only included implant survival, and articles without a statistical analysis to generate meaningful conclusions. Biological complications included bone loss, hygiene difficulty, mucositis and recession, the incidence of peri-implantitis, and how complications related to patient co-morbidities. Data collected included outcomes of the study including statistical significance. RESULTS: The search identified articles for review using terms which included full arch maxillary restorations (n = 736), long term success with full arch maxillary prostheses (n = 22), ceramic full arch restorations (n = 102), and complications with full arch restorations (n = 231). From this search, 53 articles were collated that satisfied the inclusion criteria. Factors found to be significant contributors to biological complications included bone loss and peri-implant disease, difficulty with daily hygiene access, plaque and biofilm coverage, and the need for continued maintenance for long term implant health. CONCLUSION: The surgeon needs to place implants to allow a full arch maxillary prosthesis to be fabricated with full access to the implants for maintenance, which should decrease the incidence of biological complications. With excellent maintenance full arch implant restorations can have limited peri-implant disease.

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

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

How can excess residual cement be reduced in implant-supported restorations?: An in vitro study.

OBJECTIVE: The aim of this study was to investigate the effect of different cements and cementation techniques used in implant-supported restorations and the application of various vent modifications and extraoral replica techniques on the amount of overflowing cement in cemented systems. MATERIALS AND METHODS: In this study, three different abutment designs were used as fully closed, occlusal vented, and occlusal + proximal vented. An extraoral replica was produced by milling the CAD/CAM ceramic block. The number of groups with and without replicas was determined as six (n = 10). For the cementation procedures, three different cements were tested: dual-cure resin, eugenol-free zinc oxide, and polycarboxylate cements. Cobalt-chromium superstructures to be cemented to the implant analog-abutment complex were produced by direct metal laser sintering method. Twenty-four hours after the cementation process, residual cement were measered with Micro-CT. In comparisons between groups, ANOVA test was used for normally distributed variables and Kruskall-Wallis H test was used for non-normally distributed variables at a significance level of p < 0.05. RESULTS: The difference in residual cement volumes between the groups in terms of both cementation techniques (whether or not to use an extraoral replica and different vent desings) and cement types was found to be statistically significant (p < 0.05). There was significantly less residual cement in all groups that used extraoral replicas than those that did not. As for the cement types, the most residual cement occurred in the resin cement. CONCLUSION: The use of extraoral replicas and vent designs on the abutment significantly reduces the amount of residual cement. Regardless of the cementation technique, the type of cement used affects the amount of excess cement. CLINICAL RELEVANCE: To reduce residual cement, both the type of cement and the cementation technique used must be considered.