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1.
Int J Oral Maxillofac Implants ; 35(5): 995-1004, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32991651

RESUMEN

PURPOSE: To describe the prevalence of alveolar bone atrophy in edentulous arches of elderly individuals in relation to insertion of dental implants and the eventual need for bone grafting procedures. MATERIALS AND METHODS: Computed tomography scan files of 228 edentulous arches of elderly patients (ages 65 to 100 years) were evaluated in relation to implant placement. Six measurements per arch were taken on cross-sectional reconstructions. Bone atrophy categories were described, in relation to implant placement, for the anterior and posterior sections of the arches. Six bone sections per arch were evaluated and allocated to the predetermined categories. Prevalence of each type of atrophy was calculated. RESULTS: In the maxilla, only 5.0% of the patients showed a bone anatomy capable of receiving implants without any augmentation both in the posterior and anterior regions; 64.4% showed the need for major reconstruction in both areas. In the mandible, 17.3% of the patients did not require any augmentation in both regions; 9.4% were in need of major reconstruction in both areas. The anterior part of the arches could eventually be treated without any bone augmentation in 10.9% of the maxillae and 72.4% of the mandibles, while minor augmentation was needed in 16.8% of maxillae and 15.8% of mandibles. CONCLUSION: Most edentulous elderly patients show some degree of alveolar bone atrophy. It is often feasible to insert implants in the anterior mandible to support a restoration. In most maxillary cases, alveolar atrophy calls for augmentation procedures in both the anterior and posterior areas. In elderly individuals, the anterior maxilla often shows bone deficiency interfering with simple implant placement procedures, thus also limiting the use of tilted implants.


Asunto(s)
Implantes Dentales/efectos adversos , Arcada Edéntula/diagnóstico por imagen , Arcada Edéntula/cirugía , Boca Edéntula/diagnóstico por imagen , Boca Edéntula/cirugía , Anciano , Anciano de 80 o más Años , Estudios Transversales , Implantación Dental Endoósea/efectos adversos , Humanos
2.
J Prosthodont ; 29(8): 707-711, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32557969

RESUMEN

PURPOSE: The image registration of optical scans to radiographic images is essential for performing computer-guided implant surgery. This study aimed to evaluate the effect of different image matching conditions on the accuracy of image registration for computer-guided implant surgery in completely edentulous jaws. MATERIALS AND METHODS: The optical scan image of a completely edentulous study model was registered to the respective cone-beam computed tomography data using three different image matching conditions: small point (SP), large point (LP), and entire surface (ES). For the SP and LP groups, gutta-percha markers (1.0 and 3.0 mm in diameter) were attached to a base template, and a radiopaque impression material was relined on the intaglio surface of template in the ES group. Image registration was performed by 20 operators in the images obtained from each group at an interval of 2 weeks (n = 20 in each group), and the registration accuracy was assessed by calculating the aligned position of the edentulous arch image. One-way analysis of variance with Tukey post hoc tests was used to compare the results among the groups (α = 0.05). RESULTS: The mean registration error was significantly larger in the SP group (0.52 ± 0.19 mm) than in the LP group (0.29 ± 0.08 mm) and ES group (0.27 ±0.06 mm) (F = 24.689, p < 0.001). No difference was found between the LP and ES groups. The image matching discrepancy was more homogeneously distributed on the arch in the ES group than in the other groups. CONCLUSION: The accuracy of image registration is affected by the size of the congruent area shown in the optical scan and radiographic images. The entire surface-based matching method is more accurate as compared to the small point-based matching method in the image registration for implant planning in full edentulous jaws.


Asunto(s)
Implantes Dentales , Arcada Edéntula , Boca Edéntula , Cirugía Asistida por Computador , Tomografía Computarizada de Haz Cónico , Humanos , Imagenología Tridimensional , Arcada Edéntula/diagnóstico por imagen
3.
BMC Oral Health ; 20(1): 96, 2020 04 06.
Artículo en Inglés | MEDLINE | ID: mdl-32252728

RESUMEN

BACKGROUND: The posterior regions of the jaws usually represent a significant risk for implant surgery. A non-valid assessment of the available bone height may lead to either perforation of the maxillary sinus floor or encroachment of the inferior alveolar nerve and consequently to implant failure. This study aimed to evaluate the reliability of surgeon's decision in appraising the appropriate implant length, in respect to vital anatomical structures, using panoramic radiographs. METHODS: Only implants that are inserted in relation to the maxillary sinus (MS) or the mandibular canal (MC) were enrolled (first premolars [1P], second premolars [2P], first molars [1M], and second molars [2M]). All preoperative panoramic radiographs were evaluated under standard conditions. The postoperative estimation (under/over) was determined depending on the available bone height (ABH) measured from the apical end of the implant to the floor of the MS and the roof of the MC using cone beam computed tomography (CBCT). Any complication or side effect that associated with overestimated implants insertion was recorded. RESULTS: The study sample included 73 patients (predominantly females) who had consecutively received 148 implants, of which 68 were inserted in the posterior maxilla and 80 in the posterior mandible. Underestimation was recorded in 93.2% of the measurements. The remaining bone height after implants insertion was < 2 mm in the majority of underestimated cases (73.9%); they were significantly (P < 0.01) more than sites with remaining bone ≥ 2 mm (26.1%). In the posterior mandible, overestimation was significantly higher than posterior maxilla. Five cases with transient paresthesia were reported in the mandibular overestimated implants. CONCLUSIONS: This study specified that surgeon's choice of implants length, based on panoramic radiographs, was reliable regarding the incapability to insert implants with further length in the majority of underestimated cases, the low percent of overestimated measurements, and the minor associated complications.


Asunto(s)
Competencia Clínica , Implantes Dentales , Arcada Edéntula/diagnóstico por imagen , Maxilar/diagnóstico por imagen , Radiografía Panorámica/métodos , Cirujanos , Adolescente , Adulto , Anciano , Proceso Alveolar/diagnóstico por imagen , Tomografía Computarizada de Haz Cónico , Implantación Dental Endoósea/métodos , Femenino , Humanos , Masculino , Nervio Mandibular/diagnóstico por imagen , Seno Maxilar/diagnóstico por imagen , Persona de Mediana Edad , Estudios Prospectivos , Reproducibilidad de los Resultados
4.
Niger J Clin Pract ; 23(2): 258-265, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32031103

RESUMEN

Background: The Cone Beam Computed Tomography (CBCT) is currently being used as the most common diagnostic method to evaluate the bone density of the maxilla and the mandible for planning dental implant. Aim: The aim of the study is to check the quantitative alveolar bone density in complete or partial edentulous and dentulous male and female patients among Riyadh sample population in Saudi Arabia. Materials and Methods: The study involved a cross-sectional analysis of 231 consecutive CBCT images of 231 different patients (115 males and 116 females). The scans were of Saudi National patients who were partially or completely edentulous without any bone infections in the maxilla and the mandible. The findings are presented as descriptive statistics and inferential statistics: student -t-test for two group means, ANOVA for three groups, Post-hoc LSD test for multiple comparisons, Levene statistics for testing the homogeneity of variances and a statistical significance at 5% level. Results: Comparison of mean alveolar bone density in maxillae of dentulous male smokers showed a statistically significant difference for bucco-cortical plate and cancellous bone among different regions. In dentulous male nonsmokers, no significant difference was observed for maxillary regions, while in mandibular areas, a statistically significant difference was seen for buccal cortex, palatal cortex, and cancellous bone among different regions. While studying the scans of female dentulous patients, a statistically significant difference was observed in alveolar bone density for all the areas. Conclusion: Evaluation of bone density is an important step in treatment planning and this study was aimed to provide insight into bone density patterns of population in Riyadh, Saudi Arabia. Further similar studies in different populations can help in planning for more efficient treatment outcomes.


Asunto(s)
Densidad Ósea/fisiología , Tomografía Computarizada de Haz Cónico/métodos , Arcada Parcialmente Edéntula/diagnóstico por imagen , Arcada Edéntula/diagnóstico por imagen , Mandíbula/diagnóstico por imagen , Maxilar/diagnóstico por imagen , Adulto , Estudios Transversales , Implantes Dentales , Femenino , Humanos , Arcada Edéntula/fisiopatología , Arcada Parcialmente Edéntula/fisiopatología , Masculino , Persona de Mediana Edad , Radiografía Panorámica/métodos , Arabia Saudita
5.
Beijing Da Xue Xue Bao Yi Xue Ban ; 53(1): 83-87, 2020 Dec 24.
Artículo en Chino | MEDLINE | ID: mdl-33550340

RESUMEN

OBJECTIVE: To compare the registration accuracy of three-dimensional (3D) facial scans for the design of full-arch implant supported restoration by five methods and to explore the suitable registration method. METHODS: According to the criteria, ten patients with maxillary edentulous jaw or end-stage dentition requiring implant supported restorations were enrolled in this study. A special rim with individual feature marks reflected appropriate occlusal relationship and esthetic characteristics was made for each patient. Both 3D facial scan data of natural laughter and with opener traction to expose the teeth or occlusal rim of each patient were acquired by facial scan and input to the digital analysis software Geomagic Qualify 2012. The dataset was superimposed by five different methods: seven facial anatomical landmark points alignment, facial immobile area alignment (forehead and nasal area), facial anatomical landmark points and immobile area combining alignment, facial feature points alignment, facial and intraoral feature points alignment with the same local coordinate system. The three-dimensional deviation of the same selected area was calculated, the smaller the deviation, the higher the registration accuracy. The 3D deviation was compared among the three registration methods of facial anatomical landmark points, facial immobile area alignment and the combination of the above two methods. Friedman test was performed to analyze the difference among the three methods (α=0.05). The effect of the aid of the facial and intraoral feature points were evaluated. Paired t test were performed to analyze the difference (P<0.05). RESULTS: The average three-dimensional deviation of the selected area after alignment with the facial anatomical landmarks was (1.501 2±0.406 1) mm, significantly larger than that of the facial immobile area best-fit alignment [(0.629 1±0.150 6) mm] and the combination of the two methods[(0.629 1±0.150 6) mm] (P < 0.001). The aid of the facial feature points could significantly reduce the deviation (t=1.001 3, P < 0.001). There was no significant statistical difference in the remaining groups. CONCLUSION: The forehead area of the 3D facial scan can be exposed as much as possible. The establishment of facial characteristic landmark points and the use of the invariant area alignment can improve the accuracy of registration. It should be clinically feasible to apply three-dimensional facial scan to the design of full-arch implant supported restoration with the registration of the immobile area on the face especially the forehead area.


Asunto(s)
Diseño Asistido por Computadora , Arcada Edéntula , Humanos , Imagenología Tridimensional , Arcada Edéntula/diagnóstico por imagen , Maxilar/diagnóstico por imagen , Cintigrafía
6.
Chin J Dent Res ; 23(4): 265-271, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33491358

RESUMEN

Objective: To evaluate the accuracy of digital models obtained from intraoral scanning of edentulous maxilla and mandible models with and without resin markers. Methods: A pair of standard edentulous models were scanned using a laboratory scanner and saved as reference models. The edentulous models were fixed onto a phantom head and scanned with an intraoral scanner (IOS) five times each. Six resin markers were attached on the maxilla model and two on the mandible model, and another five intraoral scans were taken of each model. The scanning time and number of images were recorded. The digital models obtained using the IOS were superimposed on the reference models using image processing software. The trueness and precision of the models made using the IOS were evaluated, and the scanning time and number of images were also compared. Results: The average trueness and precision of the IOS in the maxilla model with resin markers were 135.50 ± 36.28 µm and 254.55 ± 40.62 µm, respectively, while those in the mandible were 161.40 ± 55.45 µm and 368.75 ± 91.03 µm, respectively. Placing resin markers on the edentulous maxilla and mandible did not improve the trueness of the IOS, but placing resin markers on the edentulous maxilla improved the precision and scanning efficiency. However, placing resin markers on the buccal shelf of the edentulous mandible decreased the precision and increased the scanning time. Conclusion: Resin markers placed on the hard palate of edentulous maxillae could improve the precision of the IOS and improve scanning efficiency. However, they did not affect the trueness of the IOS for edentulous maxillae or mandibles.


Asunto(s)
Técnica de Impresión Dental , Arcada Edéntula , Diseño Asistido por Computadora , Modelos Dentales , Humanos , Imagenología Tridimensional , Arcada Edéntula/diagnóstico por imagen
7.
Scanning ; 2019: 4274715, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31531155

RESUMEN

Purpose: To present a digital method that combines intraoral and face scanning for the computer-assisted design/computer-assisted manufacturing (CAD/CAM) fabrication of implant-supported bars for maxillary overdentures. Methods: Over a 2-year period, all patients presenting to a private dental clinic with a removable complete denture in the maxilla, seeking rehabilitation with implants, were considered for inclusion in this study. Inclusion criteria were fully edentulous maxilla, functional problems with the preexisting denture, opposing dentition, and sufficient bone volume to insert four implants. Exclusion criteria were age < 55 years, need for bone augmentation, uncompensated diabetes mellitus, immunocompromised status, radio- and/or chemotherapy, and previous treatment with oral and/or intravenous aminobisphosphonates. All patients were rehabilitated with a maxillary overdenture supported by a CAD/CAM polyether-ether-ketone (PEEK) implant-supported bar. The outcomes of the study were the passive fit/adaptation of the bar, the 1-year implant survival, and the success rates of the implant-supported overdentures. Results: 15 patients (6 males, 9 females; mean age 68.8 ± 4.7 years) received 60 implants and were rehabilitated with a maxillary overdenture supported by a PEEK bar, designed and milled from an intraoral digital impression. The intraoral scans were integrated with face scans, in order to design each bar with all available patient data (soft tissues, prosthesis, implants, and face) in the correct spatial position. When testing the 3D-printed resin bar, 12 bars out of 15 (80%) had a perfect passive adaptation and fit; in contrast, 3 out of 15 (20%) did not have a sufficient passive fit or adaptation. No implants were lost, for a 1-year survival of 100% (60/60 surviving implants). However, some complications (two fixtures with peri-implantitis in the same patient and two repaired overdentures in two different patients) occurred. This determined a 1-year success rate of 80% for the implant-supported overdenture. Conclusions: In this study, the combination of intraoral and face scans allowed to successfully restore fully edentulous patients with maxillary overdentures supported by 4 implants and a CAD/CAM PEEK bar. Further studies are needed to confirm these outcomes.


Asunto(s)
Diseño Asistido por Computadora/instrumentación , Técnica de Impresión Dental , Prótesis Dental de Soporte Implantado/métodos , Prótesis de Recubrimiento , Arcada Edéntula/diagnóstico por imagen , Maxilar/diagnóstico por imagen , Anciano , Femenino , Humanos , Arcada Edéntula/patología , Arcada Edéntula/cirugía , Cetonas/química , Masculino , Maxilar/patología , Maxilar/cirugía , Persona de Mediana Edad , Polietilenglicoles/química , Estudios Prospectivos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
8.
Int J Oral Maxillofac Implants ; 34(6): 1493­1503, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31184639

RESUMEN

PURPOSE: The purpose of this study was the clinical and radiographic evaluation of four-implant-supported fixed prostheses and milled bar overdentures for rehabilitation of the edentulous mandible. MATERIALS AND METHODS: Thirty-six edentulous participants received four implants in the mandible (two vertical implants in the canine/lateral incisor area and two distally inclined implants anterior to the mental foramina) using flapless surgery. The implants were loaded with the mandibular dentures in the same day after necessary modifications. Three months after implant placement, participants were randomly allocated to one of two groups: (1) the overdenture group, where participants received milled bar overdentures; or (2) the fixed group, where participants received ceramo-metal fixed prostheses. Plaque and gingival indices, pocket depth, implant stability (using Osstell device), and marginal bone resorption (using standardized intraoral radiographs) were evaluated at the time of prosthesis insertion (T0), and 6 (T6) and 12 (T12) months after insertion. RESULTS: The implant survival rate was 100% for both groups. Plaque Index, Gingival Index, pocket depth, implant stability, and bone resorption significantly increased by time for anterior (P < .001) and posterior (P < .018) implants. Fixed prostheses showed significantly higher Plaque Index, Gingival Index, and pocket depth than milled bar for anterior (P < .001) and posterior (P < .037) implants. No significant differences in implant stability and bone resorption between groups were noted. For fixed prostheses, anterior implants showed significantly higher Plaque Index, Gingival Index, and pocket depth than posterior implants (P < .001) after 12 months. However, no significant differences in implant stability and bone resorption between anterior and posterior implants were noted for both groups. CONCLUSION: Both fixed prostheses and milled bar prostheses could be used successfully for immediately loaded four-implant rehabilitations of the edentulous mandible, as they were associated with favorable clinical and radiographic outcomes after 1 year. However, milled bar may be more advantageous than fixed prostheses in terms of reduced plaque/gingival indices and probing depth.


Asunto(s)
Pérdida de Hueso Alveolar , Implantes Dentales , Prótesis Dental de Soporte Implantado , Arcada Edéntula , Pérdida de Hueso Alveolar/diagnóstico por imagen , Prótesis de Recubrimiento , Estudios de Seguimiento , Humanos , Arcada Edéntula/diagnóstico por imagen , Mandíbula , Resultado del Tratamiento
9.
Surg Radiol Anat ; 41(9): 1003-1009, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31250139

RESUMEN

PURPOSE: The purpose of this study was to evaluate whether posterior alveolar bone height affects maxillary sinus septa (MSS) height in dentate and edentulous patients, as determined by cone-beam computed tomography (CBCT). MATERIALS AND METHODS: This retrospective analysis enrolled 166 patients (91 men and 75 women) with a mean age of 43.12 ± 15.26 years (range 18-74 years), who had at least one MSS on CBCT images. MSS were categorized into three regions: anterior, middle, and posterior. Patients were categorized as complete or partial posterior edentulous or fully posterior dentate. The maximum vertical diameter of the sinus septa and alveolar bone height was analyzed in sagittal CBCT sections; P < 0.05 was regarded as statistically significant. RESULTS: We found 210 MSS among the patients in this study. Of the 166 patients, 36 had bilateral septa and 4 had three septa. The septa were mainly located in the middle region in the dentate (n = 70; 33.3%) and edentulous (n = 59; 28.1%) patients. The mean septal height was significantly higher in men than in women (P = 0.024). In dentate patients, the mean MSS height was similar among the three regions. In edentulous patients, the anterior mean MSS height (4.96 ± 2.77 mm) was lower than that of the other two regions. There was no statistically significant association between septa and alveolar bone height in any anatomic region, in either group (r = 0.022; P = 0.748). CONCLUSIONS: These results suggest that MSS height is not influenced by alveolar bone height.


Asunto(s)
Proceso Alveolar/anatomía & histología , Arcada Edéntula/diagnóstico por imagen , Seno Maxilar/anatomía & histología , Adolescente , Adulto , Anciano , Proceso Alveolar/diagnóstico por imagen , Tomografía Computarizada de Haz Cónico , Femenino , Humanos , Imagenología Tridimensional , Masculino , Seno Maxilar/diagnóstico por imagen , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
10.
Int J Oral Maxillofac Implants ; 34(2): 529-534, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30883626

RESUMEN

PURPOSE: The purpose of this study was to evaluate whether fully digitally guided implant surgery may be performed with sufficient accuracy based on printing virtually designed templates after matching a surface scan with the magnetic resonance imaging (MRI) dataset mimicking edentulous cases based on cadaver maxillae of pigs. MATERIALS AND METHODS: The palatal mucosa of five young pig cadavers was scanned with an intraoral scanner. High-resolution MRI of the jaws was performed, and the images were exported as DICOM files and uploaded into software for implant planning. Six implant osteotomies were virtually planned in each jaw. The intraoral surface scans were fused with the volumetric MRI data based on the palatal soft tissue, and virtual templates for guided implant surgery were created and exported as STL files. These were printed and the templates were used to perform flapless guided osteotomy, with the templates fitting on the soft tissue of the jaws alone. Cone beam computed tomography (CBCT) of the jaws was performed after osteotomy. These data were fused with the virtually planned osteotomies, and the 3D crestal, apical, and axial deviations between the virtually planned and physically performed osteotomies were determined. RESULTS: Matching the surface scans with the mucosa was possible in three cases automatically; additional manual corrections were necessary in two cases. Thirty osteotomies were performed by applying the printed mucosa-supported templates. The mean angular deviation between the planned and realized cavities was 3.29 degrees (0.3 to 11.1 degrees; SD = 2.5 degrees), the mean 3D apical deviation was 1.3 mm (0.22 to 3.98 mm; SD = 0.94 mm), and the mean crestal deviation was 1.76 mm (0.39 to 3.79 mm; SD = 0.88 mm). CONCLUSION: MRI in combination with the presented workflow may be used in edentulous cases for guided implant surgery. Further studies are needed to prove the promising accuracy of this alternative approach in clinical trials.


Asunto(s)
Tomografía Computarizada de Haz Cónico , Implantación Dental Endoósea/métodos , Imagen por Resonancia Magnética , Impresión Tridimensional , Cirugía Asistida por Computador/métodos , Animales , Humanos , Imagenología Tridimensional/métodos , Arcada Edéntula/diagnóstico por imagen , Maxilar/diagnóstico por imagen , Boca Edéntula/cirugía , Programas Informáticos , Porcinos
11.
Comput Math Methods Med ; 2019: 8074096, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31933678

RESUMEN

Purpose: To evaluate the effects of different placements of mesial implants and different angles of distant implants in maxillary edentulous jaws on the stress on the implant and the surrounding bone tissue under dynamic loading. Materials and Methods: Cone beam computed tomography was used to acquire images of maxillary edentulous jaws. Using Mimics 17.0, Geomagic, and Unigraphics NX8.5 software, three-dimensional models were established: two mesial implants were placed vertically in the anterior region of the maxilla (bilateral central incisor, lateral incisor, and canine), and two distant implants were placed obliquely in the bilateral second premolar area at different inclined angles (15°, 30°, and 45°). The established models were designated I-IX. The models were subjected to dynamic load using Abaqus 6.12, with the working side posterior teeth loading of 150 N and simulation cycle of 0.875 s. Results: During the second to fourth phases of the mastication cycle, the stress was mainly concentrated on the neck of the distal implant. The stress of the distal implants was greater than that of mesial implants. Stress levels peaked in the third stage of the cycle. The stress of the distal cortical bone of distal implant of Model I reached the maximum of 183.437 MPa. The stress of the distal cortical bone and cancellous bone of distal implant of Model VIII represented the minima (62.989 MPa and 17.186 MPa, respectively). Conclusions: Our models showed optimal stress reductions when the mesial implants were located in the canine region and the distal implants tilted 30°.


Asunto(s)
Implantes Dentales , Análisis del Estrés Dental/métodos , Análisis de Elementos Finitos , Imagenología Tridimensional/métodos , Arcada Edéntula/diagnóstico por imagen , Anciano , Tomografía Computarizada de Haz Cónico , Humanos , Masculino , Mandíbula/diagnóstico por imagen , Masticación , Maxilar/diagnóstico por imagen , Persona de Mediana Edad , Presión , Estrés Mecánico , Diente
12.
J Craniomaxillofac Surg ; 47(1): 23-28, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30514603

RESUMEN

PURPOSE: The aim of this study was to describe the surgical technique of immediate dental implant placement in calvarial grafts for augmentation of the severely resorbed maxilla and to assess the treatment results. METHODS: In 13 patients the maxilla was augmented with calvarial bone followed by simultaneous dental implant placement (total: 68 implants). In the frontal "knife edge" region, implants were inserted in the buccal plated area. In the maxillary sinus area, implants were inserted into alveolar bone that was plated buccally or palatally through the sinus window. After 4 months, the implants were retrieved and subsequently loaded. Per-operative and post-operative variables were scored. One bone biopsy sample was taken for histological analysis. RESULTS: The surgical procedure and wound healing was uneventful. During abutment connection after 4 months, all implants were fully osseointegrated with no signs of graft resorption. Radiographically, the mean (±SD) peri-implant bone loss after 1 year of functional loading was 0.23 ± 0.44 mm. No implants were lost. Histological examination revealed vital calvarial and maxillary bone with active remodeling. CONCLUSION: Immediate dental implant placement in calvarial bone grafts to rehabilitate severely resorbed maxilla is technically feasible and seems to have a high success rate.


Asunto(s)
Trasplante Óseo/métodos , Trasplante Óseo/rehabilitación , Implantación Dental Endoósea/métodos , Implantes Dentales , Carga Inmediata del Implante Dental/métodos , Arcada Edéntula/cirugía , Maxilar/cirugía , Oseointegración , Anciano , Pérdida de Hueso Alveolar/diagnóstico por imagen , Pérdida de Hueso Alveolar/patología , Aumento de la Cresta Alveolar/métodos , Biopsia , Pilares Dentales , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Femenino , Humanos , Arcada Edéntula/diagnóstico por imagen , Arcada Edéntula/patología , Masculino , Maxilar/diagnóstico por imagen , Maxilar/patología , Seno Maxilar/diagnóstico por imagen , Seno Maxilar/cirugía , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Cicatrización de Heridas
13.
Int J Prosthodont ; 31(6): 594­600, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30339160

RESUMEN

PURPOSE: The aim of this study was to assess the frequency and location of positive radiographic findings in edentulous patients and to evaluate the oral health-related quality of life (OHRQoL) and complacency of patients with positive radiologic findings. MATERIALS AND METHODS: A total of 1,349 asymptomatic edentulous patients were retrospectively evaluated using a digital panoramic system for the presence of retained root fragments, impacted teeth, foreign bodies, radiolucencies, radiopacities, mental foramen at or near the alveolar crest, and maxillary sinus pneumatization. The patients with positive findings were called for a follow-up to take a new panoramic radiograph. The functional status and symptoms of participants were measured with the Oral Health Impact Profile (OHIP-14). RESULTS: At least one or more of the radiographic findings were observed in 35.21% of the evaluated radiographs. The most frequent finding was sinus pneumatization (20.9%). The mean total OHIP score was 9.74 ± 8.34. There was no statistically significant difference observed for gender, age, education levels, marital status, or having surgical interventions for total OHIP-14 scores (P > .05). CONCLUSION: The results of this study suggest that routine radiographic examination of edentulous patients may not be crucial before rehabilitation, and using a total percentage of positive radiographic findings may result in the exaggeration of the disease risk in edentulous patients.


Asunto(s)
Dentadura Completa , Arcada Edéntula/diagnóstico por imagen , Salud Bucal , Calidad de Vida , Radiografía Panorámica , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
14.
Int J Oral Maxillofac Implants ; 33(5): 1103-1111, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30231098

RESUMEN

PURPOSE: The aim of this study was to evaluate the clinical and radiographic peri-implant tissues of bar, Locator, and resilient telescopic attachments for two-implant stabilized overdentures in subjects with mandibular atrophied ridges. MATERIALS AND METHODS: Ninety edentulous individuals with mandibular ridge atrophy were randomly assigned into three equal groups and received two implants in the canine areas. Mandibular overdentures were constructed and attached to implants with Dolder bar attachments (BOD), resilient telescopes (TOD), and Locators (LOD). Plaque scores, gingival scores, pocket depths, implant stability, width of keratinized mucosa, vertical bone loss, and horizontal bone loss were evaluated at the time of prosthesis delivery and 6 months and 12 months after delivery. RESULTS: With the exception of pocket depth and implant stability, all parameters showed a significant increase from prosthesis delivery to 6 months. BOD recorded the highest plaque scores, gingival scores, and pocket depths followed by LOD, and TOD recorded the lowest values. No significant difference in implant stability and keratinized mucosa was observed between groups. TOD and BOD recorded the highest vertical and horizontal bone losses, respectively. LOD recorded the lowest vertical and horizontal bone losses. There was no difference in implant survival rate between groups. CONCLUSION: Bar, resilient telescopic, and Locator attachments can be used successfully for two-implant stabilized overdentures in subjects with mandibular atrophied ridges after a 1-year follow-up period. Telescopic attachments were associated with improved clinical peri-implant soft tissues compared with other attachments. However, Locator attachments may be advantageous in terms of peri-implant bone preservation.


Asunto(s)
Prótesis Dental de Soporte Implantado , Retención de Dentadura/instrumentación , Prótesis de Recubrimiento , Arcada Edéntula/rehabilitación , Anciano , Tomografía Computarizada de Haz Cónico , Diseño de Prótesis Dental , Retención de Prótesis Dentales/instrumentación , Femenino , Humanos , Arcada Edéntula/diagnóstico por imagen , Arcada Edéntula/cirugía , Masculino , Mandíbula/cirugía , Persona de Mediana Edad , Índice Periodontal
15.
Implant Dent ; 27(4): 474-479, 2018 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-30028392

RESUMEN

OBJECTIVE: To examine the nasopalatine canal (NPC) anatomical and volumetric measurements in anterior edentulous (AE) and anterior dentate (AD) individuals and to compare these findings according to sex, age, shape, and severity of resorption in the premaxilla. METHODS: Two hundred cone beam computed tomography images were divided into 2 groups: AE and AD. The diameter, the length of the NPC and the width, the length of the buccal bone anterior to the NPC were measured and recorded. Linear and volumetric measurement results were evaluated in terms of age, sex, dental status, shape, and severity of resorption. RESULTS: No significant differences were observed between the AE and AD groups in terms of the NPC volume (P = 0.289). In the AE group, the spindle shape had the highest volume, and in the same group, with aging, the volume significantly increased (P = 0.00). The mean NPC volume was found to be statistically significantly larger in males than females (P = 0.02). A statistically significant relation was observed between NPC volume and resorption status. CONCLUSION: Severe bone resorption due to sustained edentation complicated implant surgery because of the increase in incisive and nasal foramen diameters and decrease in buccal residual bone dimensions. The NPC volume was found fewer in edentulous patients, and by the resorption, the volume was decreased.


Asunto(s)
Resorción Ósea/diagnóstico por imagen , Tomografía Computarizada de Haz Cónico/métodos , Arcada Edéntula/diagnóstico por imagen , Maxilar/diagnóstico por imagen , Nariz/diagnóstico por imagen , Paladar (Hueso)/diagnóstico por imagen , Puntos Anatómicos de Referencia , Resorción Ósea/patología , Femenino , Humanos , Imagenología Tridimensional , Arcada Edéntula/patología , Masculino , Maxilar/anatomía & histología , Persona de Mediana Edad , Nariz/anatomía & histología , Paladar (Hueso)/anatomía & histología , Estudios Retrospectivos
16.
Sci Rep ; 8(1): 8975, 2018 06 12.
Artículo en Inglés | MEDLINE | ID: mdl-29895978

RESUMEN

The present study aimed to establish and evaluate a method for recording edentulous jaw relations digitally without occlusal bases, using a handheld scanner and specially designed headgear. The headgear maintained the mandibular position. Ten edentulous patients' upper (U) and lower edentulous jaw models (L) were prepared and scanned. A handheld scanner was used to capture the labial alveolar ridge mucosa relations in the upper and lower anterior arches directly (Dr). U and L were registered to Dr (test group). Complete dentures of patients in the intercuspal position were used to construct the relationship between U and L (control group). Differences in jaw relations in the test and control groups, in terms of vertical difference, displacement and rotation of the anterior and posterior, and displacement and rotation of the left and right were assessed using the Hotelling's T2 test. The differences in the mean values and the mean of the absolute values of the jaw relations between groups were not statistically significant (P = 0.331) and significant (P = 0.016), respectively. Our findings show that it is possible to make digital recording of edentulous jaw relations by using a handheld scanner and headgear.


Asunto(s)
Arcada Edéntula/diagnóstico por imagen , Mandíbula/diagnóstico por imagen , Femenino , Humanos , Registro de la Relación Maxilomandibular , Masculino , Persona de Mediana Edad , Proyectos Piloto
17.
J Oral Maxillofac Surg ; 76(10): 2151-2160, 2018 10.
Artículo en Inglés | MEDLINE | ID: mdl-29746839

RESUMEN

PURPOSE: The incidence of fractures of edentulous mandibles is relatively low. Knowledge about the management of these fractured edentulous mandibles relies heavily on case reports and observational studies. On the basis of the current literature, we compiled a treatment protocol for fractures of the edentulous mandible and hypothesized that this protocol would result in fewer complications. PATIENTS AND METHODS: We conducted a retrospective cohort study of edentulous patients with mandibular fractures. The predictor variable was the fulfillment of the treatment protocol (yes or no). The outcome variables were postoperative complications and reoperations. Patient demographic characteristics were collected from patient records. The χ2 test was used for statistical analysis between predictor and outcome variables. RESULTS: Of 61 edentulous mandibular fractures (36 patients), 53 were treated according to the protocol and 8 were not. We observed 4 complications in the first group (complication rate, 7.5% [4 of 53]) and 4 in the second group (complication rate, 50% [4 of 8]). The fracture treatments that followed the protocol had a significantly lower postoperative complication rate (P = .001; odds ratio, 0.082) and needed fewer reoperations (P = .0001; odds ratio, 0.019) compared with the treatments that did not follow the protocol. CONCLUSIONS: The results of this study show that following the compiled treatment protocol for fractures of edentulous mandibles significantly reduces postoperative complications and reoperations.


Asunto(s)
Trasplante Óseo/métodos , Protocolos Clínicos , Fijación Interna de Fracturas/métodos , Ilion/trasplante , Arcada Edéntula/cirugía , Fracturas Mandibulares/cirugía , Complicaciones Posoperatorias/prevención & control , Anciano , Anciano de 80 o más Años , Placas Óseas , Femenino , Humanos , Arcada Edéntula/diagnóstico por imagen , Masculino , Fracturas Mandibulares/diagnóstico por imagen , Persona de Mediana Edad , Radiografía Panorámica , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Resultado del Tratamiento
18.
Int J Oral Maxillofac Implants ; 33(3): 679-692, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29763504

RESUMEN

PURPOSE: New digital technologies enable real-time computer-aided (CA) three-dimensional (3D) guidance during dental implant surgery. The aim of this investigational clinical trial was to demonstrate the safety and effectiveness of a prototype optoelectronic CA-navigation device in comparison with the conventional approach for planning and effecting dental implant surgery. MATERIALS AND METHODS: Study participants with up to four missing teeth were recruited from the pool of patients referred to the University of Toronto Graduate Prosthodontics clinic. The first 10 participants were allocated to either a conventional or a prototype device study arm in a randomized trial. The next 10 participants received implants using the prototype device. All study participants were restored with fixed dental prostheses after 3 (mandible) or 6 (maxilla) months healing, and monitored over 12 months. The primary outcome was the incidence of any surgical, biologic, or prosthetic adverse events or device-related complications. Secondary outcomes were the incidence of positioning of implants not considered suitable for straightforward prosthetic restoration (yes/no); the perception of the ease of use of the prototype device by the two oral surgeons, recorded by use of a Likert-type questionnaire; and the clinical performance of the implant and superstructure after 1 year in function. Positioning of the implants was appraised on periapical radiographs and clinical photographs by four independent blinded examiners. Peri-implant bone loss was measured on periapical radiographs by a blinded examiner. RESULTS: No adverse events occurred related to placing any implants. Four device-related complications led to a switch from using the prototype device to the conventional method. All implants placed by use of the prototype device were in a position considered suitable for straightforward prosthetic restoration (n = 21). The qualitative evaluation by the surgeons was generally positive, although ergonomic challenges were identified. All study participants were present for the 1-year examination (n = 20 patients, 41 implants, 32 superstructures), and no complications or failures with any implants or superstructures were revealed. The peri-implant bone loss was less than 1 mm for all implants. CONCLUSION: Within the limitations of this trial, the prototype device provided placement of dental implants without adverse events.


Asunto(s)
Implantación Dental Endoósea/métodos , Implantes Dentales , Prótesis Dental de Soporte Implantado , Imagenología Tridimensional/instrumentación , Adulto , Anciano , Pérdida de Hueso Alveolar/diagnóstico por imagen , Fracaso de la Restauración Dental , Femenino , Estudios de Seguimiento , Humanos , Arcada Edéntula/diagnóstico por imagen , Arcada Edéntula/rehabilitación , Masculino , Mandíbula/diagnóstico por imagen , Mandíbula/cirugía , Maxilar/diagnóstico por imagen , Maxilar/cirugía , Persona de Mediana Edad
19.
Int J Oral Maxillofac Implants ; 33(3): e67-e71, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29763506

RESUMEN

Zygomatic implant site preparation could be considered a challenging procedure because of the use of a very long twist drill that could sometimes be difficult to control due to the need for drilling the malar bone on an oblique surface. Ultrasound was recently suggested to achieve better control, but the specific long tips required are not readily available, and the elongated tip also tends to reduce the efficacy. This technical note describes a proposal of a novel computer-aided technique to simplify the procedure of zygomatic implant site preparation. This method uses a standard-length ultrasonic tip to prepare the crestal bone and the zygomatic bone in two individual steps. The desired implant trajectory can be achieved during preparation using a real-time tracking navigation system. The combined use of the navigation system and the ultrasonic tips could aid the surgeon, during the first steps, in achieving optimal control of the instruments employed for the implant site preparation and keeping the planned zygomatic implant position. If the efficacy of the procedure is confirmed through clinical trials, this technique could also contribute to reducing the invasiveness of the procedure, promoting a smaller flap, and reducing the soft tissue damage.


Asunto(s)
Implantación Dental Endoósea/métodos , Prótesis Dental de Soporte Implantado , Arcada Edéntula/diagnóstico por imagen , Arcada Edéntula/cirugía , Cirugía Asistida por Computador , Ultrasonografía , Cigoma/cirugía , Anciano , Femenino , Humanos , Cigoma/diagnóstico por imagen
20.
Trials ; 19(1): 243, 2018 Apr 23.
Artículo en Inglés | MEDLINE | ID: mdl-29685161

RESUMEN

BACKGROUND: Overdentures retained by a single implant in the midline have arisen as a minimal implant treatment for edentulous mandibles. The success of this treatment depends on the performance of a single stud attachment that is susceptible to wear-related retention loss. Recently developed biomaterials used in attachments may result in better performance of the overdentures, offering minimal retention loss and greater patient satisfaction. These biomaterials include resistant polymeric matrixes and amorphous diamond-like carbon applied on metallic components. The objective of this explanatory mixed-methods study is to compare Novaloc, a novel attachment system with such characteristics, to a traditional alternative for single implants in the mandible of edentate elderly patients. METHODS/DESIGN: We will carry out a randomized cross-over clinical trial comparing Novaloc attachments to Locators for single-implant mandibular overdentures in edentate elderly individuals. Participants will be followed for three months with each attachment type; patient-based, clinical, and economic outcomes will be gathered. A sample of 26 participants is estimated to be required to detect clinically relevant differences in terms of the primary outcome (patient ratings of general satisfaction). Participants will choose which attachment they wish to keep, then be interviewed about their experiences and preferences with a single implant prosthesis and with the two attachments. Data from the quantitative and qualitative assessments will be integrated through a mixed-methods explanatory strategy. A last quantitative assessment will take place after 12 months with the preferred attachment; this latter assessment will enable measurement of the attachments' long-term wear and maintenance requirements. DISCUSSION: Our results will lead to evidence-based recommendations regarding these systems, guiding providers and patients when making decisions on which attachment systems and implant numbers will be most appropriate for individual cases. The recommendation of a specific attachment for elderly edentulous patients may combine positive outcomes from patient perspectives with low cost, good maintenance, and minimal invasiveness. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03126942 . Registered on 13 April 2017.


Asunto(s)
Cuidado Dental para Ancianos/instrumentación , Prótesis Dental de Soporte Implantado , Prótesis de Recubrimiento , Arcada Edéntula/cirugía , Mandíbula/cirugía , Factores de Edad , Anciano , Estudios Cruzados , Cuidado Dental para Ancianos/métodos , Femenino , Humanos , Arcada Edéntula/diagnóstico por imagen , Masculino , Mandíbula/diagnóstico por imagen , Satisfacción del Paciente , Diseño de Prótesis , Quebec , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Tiempo , Resultado del Tratamiento
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