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1.
BMJ Open ; 9(10): e029826, 2019 10 28.
Artículo en Inglés | MEDLINE | ID: mdl-31662363

RESUMEN

OBJECTIVES: To compare the use of short implants (≤6 mm) in atrophic posterior maxilla versus longer implants (≥10 mm) with sinus floor elevation. DESIGN: A systematic review and meta-analysis based on randomised controlled trials (RCTs). DATA SOURCES: Electronic searches were conducted in PubMed, Embase and the Cochrane CENTRAL. Retrospective and prospective hand searches were also performed. ELIGIBILITY CRITERIA: RCTs comparing short implants (≤6 mm) and longer implants (≥10 mm) with sinus floor elevation were included. Outcome measures included implant survival (primary outcome), marginal bone loss (MBL), complications and patient satisfaction. DATA EXTRACTION AND SYNTHESIS: Risks of bias in and across studies were evaluated. Meta-analysis, subgroup analysis and sensitivity analysis were undertaken. Quality of evidence was assessed according to Grading of Recommendations Assessment, Development and Evaluation. RESULTS: A total of seven RCTs involving 310 participants were included. No significant difference in survival rate was found for 1-3 years follow-up (RR 1.01, 95% CI 0.97 to 1.04, p=0.74, I²=0%, moderate-quality evidence) or for 3 years or longer follow-up (RR 1.00, 95% CI 0.97 to 1.04, p=0.79, I²=0%, moderate-quality evidence). However, short implants (≤6 mm) showed significantly less MBL in 1-3 years follow-up (MD=-0.13 mm, 95% CI -0.21 to 0.05; p=0.001, I²=87%, low-quality evidence) and in 3 years or longer follow-up (MD=-0.25 mm, 95% CI -0.40 to 0.10; p=0.001, I²=0%, moderate-quality evidence). In addition, short implant (≤6 mm) resulted in fewer postsurgery reaction (RR 0.11, 95% CI 0.14 to 0.31, p<0.001, I²=40%, moderate-quality evidence) and sinus perforation or infection (RR 0.11, 95% CI 0.02 to 0.63, p=0.01, I²=0%, moderate-quality evidence). CONCLUSIONS: For atrophic posterior maxilla, short implants (≤6 mm) are a promising alternative to sinus floor elevation, with comparable survival rate, less MBL and postsurgery reactions. Additional high-quality studies are needed to evaluate the long-term effectiveness of short implants (≤6 mm). TRIAL REGISTERATION NUMBER: The protocol has been registered at PROSPERO (CRD42018103531).


Asunto(s)
Implantación Dental , Implantes Dentales , Diseño de Prótesis Dental , Arcada Parcialmente Edéntula/cirugía , Maxilar/cirugía , Elevación del Piso del Seno Maxilar/métodos , Atrofia , Humanos , Maxilar/patología
2.
Oral Maxillofac Surg Clin North Am ; 31(2): 219-249, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30947848

RESUMEN

Algorithms for predictable outcomes, or checklists in health care, have been widely supported due to their highly effective outcomes. This article shares "algorithmic roadmaps" to restore single-tooth, partially edentulous, and fully edentulous complex dental implant cases in the patient population. A review of the current literature is presented to provide systematic assessments followed by criteria in a checklist format that allows the surgeon and restorative dentist to determine whether a removable or fixed implant prosthesis is the best patient option. Several cases have been chosen to illustrate the algorithms the authors used to provide an optimized prognosis for surgical/restorative success.


Asunto(s)
Implantes Dentales , Arcada Parcialmente Edéntula/cirugía , Mandíbula/cirugía , Algoritmos , Implantación Dental Endoósea , Prótesis Dental de Soporte Implantado , Humanos , Arcada Parcialmente Edéntula/rehabilitación
3.
Implant Dent ; 28(1): 86-90, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30624393

RESUMEN

The aim of this case report was to describe the inferior alveolar nerve (IAN) lateralization technique using the piezoelectric device for the posterior rehabilitation of an atrophic mandible with implants. The patient presented the absence of elements 35 and 36 associated with a vertical defect impairing the adequate dental implant placement without IAN damage. A full-thickness mucoperiosteal flap was raised, and a bone window was made with a piezoelectric device centralized on the IAN canal position. After dissection, the IAN was moved buccally with a sterile elastic strip. Morse cone 4.0 × 1.5-mm implants were inserted while the IAN remained retracted. At the 4-month follow-up, the screw-retained prosthesis was installed guaranteeing the recovering masticatory function. In conclusion, the case report showed that the IAN lateralization performed with an adequate surgical technique can be successfully indicated for longer implant placement in edentulous atrophic posterior mandible with no permanent neural damage.


Asunto(s)
Implantación Dental Endoósea/métodos , Arcada Parcialmente Edéntula/cirugía , Mandíbula/cirugía , Nervio Mandibular/cirugía , Piezocirugía/métodos , Adulto , Tomografía Computarizada de Haz Cónico , Implantes Dentales , Diseño de Prótesis Dental , Femenino , Humanos , Mandíbula/diagnóstico por imagen , Mandíbula/inervación , Nervio Mandibular/fisiología , Colgajos Quirúrgicos
4.
J Long Term Eff Med Implants ; 29(2): 159-167, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-32464025

RESUMEN

Issues associated with missing teeth can be found in almost all age groups. For edentulous patients, osseointegration is a highly efficient treatment. However, certain biochemical challenges are presented when osseointegrated implants are taken into consideration due to the periodontal ligament. Therefore, the current study focuses on clinical concerns that can occur with the use of dental implants and examines different trends of implant restoration and treatment of partial edentulous patients. Data were collected from ten research articles and analyzed by means of a qualitative secondary approach. The findings of the current study indicate that restoration and preservation of natural teeth are significant in the development of dental practices. Moreover, the determinant of endodontic treatment is considered to be a key factor in the retention and reconstruction of tooth functioning that is influenced by necrosis of dental pulp. We conclude that the osseointegration method is significant and highly effective for treating edentulous patients.


Asunto(s)
Implantación Dental Endoósea , Arcada Parcialmente Edéntula/rehabilitación , Arcada Parcialmente Edéntula/cirugía , Implantes Dentales , Restauración Dental Permanente , Humanos , Oseointegración
5.
Int J Oral Maxillofac Surg ; 48(1): 90-96, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-29843950

RESUMEN

The use of short implants as an alternative to bone reconstruction techniques for the placement of standard-length dental implants is a debated topic. The aim of this study was to perform a systematic review and meta-analysis in order to assist in the clinical decision making about the most appropriate approach for the fixed rehabilitation of the posterior atrophic partially edentulous lower jaws. Only randomized trials with at least 1-year follow-up were included. Of the 1024 studies initially retrieved, 14 articles were selected and independently evaluated by two reviewers. Finally, four studies were included, and underwent data extraction and meta-analysis with the Bayesian approach. Both treatment approaches provide high implant survival rate after 1year of function. However, the probability of survival rate of short implants being greater than standard length implants is 84%, and the probability of complications using short implants being greater than standard-length implants is 15.7%. In spite of similar survival rates when the residual bone is sufficient for placement of short implants, the latter should be preferred to augmentation techniques and standard-length implants due to fewer complications, lower morbidity and greater comfort for patients.


Asunto(s)
Pérdida de Hueso Alveolar/cirugía , Aumento de la Cresta Alveolar/métodos , Teorema de Bayes , Implantes Dentales , Diseño de Prótesis Dental , Arcada Parcialmente Edéntula/cirugía , Mandíbula/patología , Mandíbula/cirugía , Reconstrucción Mandibular/métodos , Atrofia , Fracaso de la Restauración Dental , Humanos , Complicaciones Posoperatorias , Ensayos Clínicos Controlados Aleatorios como Asunto
6.
J Craniofac Surg ; 30(4): 1068-1072, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30394968

RESUMEN

PURPOSE: The purpose of this study was to evaluate, by radiographic examinations, the marginal bone resorption around implants in cases of 2 and 3 implant-supported fixed partial prostheses (FPPs) at the posterior mandible. METHODS: A retrospective study of 41 patients (23 males, 18 females) of an average age of 67 years (range, 53-85), with 2 and 3 implants-supported FPPs in the posterior mandible that were treated during 2006 to 2015. The mean follow-up time was 6.32 years (range, 2-10). Twenty-four patients had FPPs on 2 implants (a total of 48 implants). Seventeen patients had FPPs on 3 implants (a total of 51 implants). Clinical and radiographic follow-up examinations were performed. All radiographs were analyzed for changes in marginal bone height surrounding the implants. RESULTS: The mean marginal bone loss around the most mesial implant was slightly higher in the 2-implant group (0.833 mm) compared with the 3-implant group (0.431 mm). The correlation between the mean marginal bone loss around the most mesial implant and the number of implants was of borderline value (P = 0.055). CONCLUSIONS: Considering the limitations of this preliminary study, the authors found that the mesial implant in the 2-implant group is more susceptible to marginal bone loss.


Asunto(s)
Pérdida de Hueso Alveolar , Resorción Ósea , Implantes Dentales/efectos adversos , Prótesis Dental de Soporte Implantado , Factores de Edad , Anciano , Anciano de 80 o más Años , Pérdida de Hueso Alveolar/diagnóstico por imagen , Pérdida de Hueso Alveolar/etiología , Resorción Ósea/diagnóstico por imagen , Resorción Ósea/etiología , Diseño de Prótesis Dental , Femenino , Humanos , Arcada Parcialmente Edéntula/cirugía , Masculino , Mandíbula , Persona de Mediana Edad , Retención de la Prótesis , Radiografía Dental , Estudios Retrospectivos , Factores Sexuales , Fumar
7.
Ann Anat ; 222: 88-93, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30448466

RESUMEN

There is paucity of the studies that assess the outcomes of short dental implants with a follow-up time higher than 10years. This study aims to evaluate the long-term (15years) survival and marginal bone loss around short dental implants and assess the influence of the anatomical location (mandible or maxilla) on these outcomes. A clinical retrospective study of short dental implants (≤8.5mm) was conducted in a single private dental clinic. The predictor variable was the anatomical location (mandible or maxilla). The primary outcome was the dental implant survival rate. The secondary outcomes were the marginal bone loss, the prosthesis failures and the influence of anatomical location, the antagonist type, and the clinical/anatomical crown-to-implant ratio (CIR) on the marginal bone loss and implant success rate. Descriptive analysis was performed for patients' demographic data, implant details, and prosthetic variables. Kaplan-Meier method was used to assess the implant survival rate. Fifty patients with a mean age of 59±10years had a mean follow-up time of 15years. Seventy five implants were placed being 30 in the maxilla and 45 in the mandible. The implant position did not affect significantly the implant survival. The marginal bone loss has been significantly higher in the maxilla than the mandible. The implant survival rate was 93.3%. Short dental implants could be indicated to support fixed partial prosthesis in the mandible and the maxilla. Implant position may affect the marginal bone loss around the short dental implants.


Asunto(s)
Implantes Dentales , Arcada Parcialmente Edéntula/cirugía , Mandíbula/cirugía , Maxilar/cirugía , Anciano , Implantación Dental Endoósea , Prótesis Dental de Soporte Implantado , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del Tratamiento
8.
Eur J Oral Implantol ; 11(4): 385-395, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30515480

RESUMEN

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


Asunto(s)
Implantes Dentales , Arcada Parcialmente Edéntula , Mandíbula , Diseño de Prótesis Dental , Humanos , Arcada Parcialmente Edéntula/cirugía , Titanio , Resultado del Tratamiento
9.
Int J Oral Maxillofac Implants ; 33(6): 1390-1395, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30427972

RESUMEN

PURPOSE: The aim of this clinical study was to determinate if patients allergic to penicillin present a higher incidence of dental implant failure compared with nonallergic patients. MATERIALS AND METHODS: This cross-sectional clinical study analyzed patients rehabilitated with endosseous dental implants between September 2011 and July 2015, at the University Dental Clinic, School of Dentistry, International University of Catalonia (UIC). Prophylactic antibiotic therapy was prescribed for all patients: a single dose of 2 g of amoxicillin taken orally 1 hour before implant surgery for non-penicillin-allergic patients, and 600 mg of clindamycin taken orally 1 hour before the implant surgery for penicillin-allergic patients. Postsurgical antibiotics were prescribed to prevent early implant failures and postoperative infections: amoxicillin 750 mg three times a day for 7 days for nonallergic patients, and in patients with penicillin allergy, 300 mg clindamycin every 6 hours for 7 days. Implant failure was defined as the removal of the implant for any reason and was classified as early or late failure. RESULTS: A total of 1,210 patients' files were analyzed; 8.03% of nonallergic patients and 24.68% of penicillin-allergic patients presented at least one implant failure. In penicillin-allergic patients, 21.05% were classified as late implant failure and 78.95% as early implant failure, with a lack of osseointegration (80%) being the mean reason for an early implant failure. Penicillin-allergic patients demonstrated a higher risk of implant failure with a risk ratio of 3.84 (95% CI) compared with nonallergic patients. CONCLUSION: Penicillin-allergic patients treated with clindamycin presented almost four times the risk of suffering dental implant failure, although other variables such as implant brand, location, and the surgeon's skill might have influenced these results.


Asunto(s)
Amoxicilina/efectos adversos , Implantes Dentales , Fracaso de la Restauración Dental/estadística & datos numéricos , Hipersensibilidad a las Drogas/epidemiología , Arcada Parcialmente Edéntula/cirugía , Estudios Transversales , Falla de Equipo , Femenino , Humanos , Hipersensibilidad , Masculino , Persona de Mediana Edad , Oseointegración , Complicaciones Posoperatorias/etiología
10.
Compend Contin Educ Dent ; 39(9): 636-645, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30299113

RESUMEN

Treatment of severely resorbed partially or completely edentulous maxillae can include the utilization of the zygomatic process for immediate implant fixation and stabilization with immediate function. This approach may alleviate the need for significant grafting to enable implant placement in the posterior maxilla and allow implants to be placed into denser, more stable bone. Zygomatic implants, which have been used clinically for the past 20 years in the treatment of the severely resorbed maxilla, allow implant placement to support fixed prosthetics. Their usage can potentially shorten treatment time and reduce costs, as the need to wait for osseous graft maturation is eliminated. Guided surgical approaches are being utilized to maximize placement of the prosthetic platform of these implants.


Asunto(s)
Pérdida de Hueso Alveolar/cirugía , Implantación Dental Endoósea/métodos , Arcada Edéntula/cirugía , Cigoma/cirugía , Atrofia , Trasplante Óseo , Humanos , Arcada Edéntula/patología , Arcada Parcialmente Edéntula/cirugía , Maxilar/cirugía
11.
Clin Oral Implants Res ; 29 Suppl 16: 270-275, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30328187

RESUMEN

OBJECTIVES: The aim of Working Group 3 was to focus on three topics that were assessed using patient-reported outcome measures (PROMs). These topics included the following: (a) the aesthetics of tooth and implant-supported fixed dental prostheses focusing on partially edentulous patients, (b) a comparison of fixed and removable implant-retained prostheses for edentulous populations, and (c) immediate versus early/conventional loading of immediately placed implants in partially edentate patients. PROMs include ratings of satisfaction and oral health-related quality of life (QHRQoL), as well as other indicators, that is, pain, general health-related quality of life (e.g., SF-36). MATERIALS AND METHODS: The Consensus Conference Group 3 participants discussed the findings of the three systematic review manuscripts. Following comprehensive discussions, participants developed consensus statements and recommendations that were then discussed in larger plenary sessions. Following this, any necessary modifications were made and approved. RESULTS: Patients were very satisfied with the aesthetics of implant-supported fixed dental prostheses and the surrounding mucosa. Implant neck design, restorative material, or use of a provisional restoration did not influence patients' ratings. Edentulous patients highly rate both removable and fixed implant-supported prostheses. However, they rate their ability to maintain their oral hygiene significantly higher with the removable prosthesis. Both immediate provisionalization and conventional loading receive positive patient-reported outcomes. CONCLUSIONS: Patient-reported outcome measures should be gathered in every clinical study in which the outcomes of oral rehabilitation with dental implants are investigated. PROMs, such as patients' satisfaction and QHRQoL, should supplement other clinical parameters in our clinical definition of success.


Asunto(s)
Implantes Dentales , Prótesis Dental de Soporte Implantado , Dentadura Parcial Fija , Estética Dental , Arcada Parcialmente Edéntula/cirugía , Medición de Resultados Informados por el Paciente , Diseño de Prótesis Dental , Fracaso de la Restauración Dental , Diseño de Dentadura , Dentadura Parcial Removible , Humanos , Carga Inmediata del Implante Dental , Satisfacción del Paciente , Calidad de Vida , Resultado del Tratamiento
12.
Clin Oral Implants Res ; 29 Suppl 16: 255-269, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30328205

RESUMEN

OBJECTIVES: This systematic review aimed at answering the following PICO question: In patients receiving immediate (Type 1) implant placement, how does immediate compare to early or conventional loading in terms of Patient-Reported Outcome Measures (PROMs)? MATERIAL AND METHODS: Following search strategy development, the OVID, PubMed, EMBASE, and Cochrane Database of Systematic Reviews databases were search for the relevant literature. All levels of evidence including randomized controlled trials, prospective and retrospective cohort studies, and case series of at least five patients were considered for possible inclusion. An additional manual search was performed by screening the reference lists of relevant studies and systematic reviews published up to May 2017. The intervention considered was the placement of immediate implant. Study selection and data extraction were performed independently by two reviewers. RESULTS: The search yielded a list of 1,102 references, of which nine were included in this systematic review. The limited number of studies included and the heterogeneity of the data identified prevented the performance of a meta-analysis. Three studies, one of which was a randomized controlled trial, allowed the extraction of comparative data specific to the aim of the present systematic review. The remaining studies allowed only data extraction for one single treatment modality and were viewed as single cohort studies. Overall, irrespective of the PROMs chosen, patients' satisfaction was overall high with little difference between the two loading protocols. Moreover, studies indicated a positive impact on oral health-related quality of life following immediate implant placement and loading. CONCLUSIONS: Within the limitations of the present systematic review, immediate implant placement and loading in single tooth edentulous space seems to be a well-accepted treatment modality from the patients' perspective and is worthy of consideration in clinical practice. However, the paucity of comparative data limits any definitive conclusions as to which loading protocol; immediate or early/conventional, should be given preference based on PROMs.


Asunto(s)
Implantación Dental Endoósea , Prótesis Dental de Soporte Implantado , Carga Inmediata del Implante Dental , Arcada Parcialmente Edéntula/cirugía , Boca Edéntula , Bases de Datos Factuales , Implantación Dental Endoósea/psicología , Implantes Dentales , Implantes Dentales de Diente Único , Prótesis Dental de Soporte Implantado/psicología , Fracaso de la Restauración Dental , Dentadura Completa , Humanos , Carga Inmediata del Implante Dental/psicología , Medición de Resultados Informados por el Paciente , Satisfacción del Paciente , Calidad de Vida , Resultado del Tratamiento
13.
Clin Oral Implants Res ; 29 Suppl 18: 253-274, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30306681

RESUMEN

OBJECTIVES: To investigate in which clinical situations a cantilever fixed implant supported restorations can be a treatment alternative and which complications are reported. MATERIALS AND METHODS: Two operators screened the literature (MEDLINE, EMBASE) and performed a hand search on the main journals dealing with implantology and prosthetics until 31 December 2017. Only articles that considered cantilever implant fixed restorations with at least 10 patients and with a mean follow-up of at least 5 year were selected. The outcome variables were survival of implants and prosthesis, mechanical, technical and biological complications, marginal bone loss. The review was performed according to the PRISMA statements. Risk of bias assessment was evaluated. Failure and complication rates were analysed using random effect Poisson regression models to obtain summary estimate of 5- and 10-year survival and complication rates. RESULTS: A total of nine papers were selected for partially edentulous patients and reported high survival rate of the prosthesis. The estimated survival rate for 5-10 years was calculated to be 98.4% for the implants and 99.2% for the rehabilitations. Mechanical, technical and biological complications were reported with a cumulative 5-10 years complication rate of 28.66% and 26.57% for the patients and for the prosthesis, respectively. Two papers for single implant supporting 2-unit cantilever were not sufficient to draw conclusions. CONCLUSIONS: There is evidence that cantilever can be successful treatment in partially edentulous patients. In two adjacent edentulous sites, data are not yet sufficient.


Asunto(s)
Prótesis Dental de Soporte Implantado , Arcada Parcialmente Edéntula/cirugía , Implantación Dental Endoósea , Dentadura Parcial Fija , Humanos
14.
Clin Oral Implants Res ; 29 Suppl 18: 326-331, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30306690

RESUMEN

OBJECTIVES: The aim of the present publication was to report on the EAO Workshop group-4 discussions and consensus statements on the five reviews previously prepared. These reviews provided the scientific evidence on the effect of crown-to-implant ratio, on reconstructions with cantilevers in fully and partially edentulous patients, on biological and technical complications of tilted in comparison with straight implants, and on the effects of osseointegrated implants functioning in a residual dentition. MATERIAL AND METHODS: The group discussed, evaluated, corrected where deemed appropriate, and made recommendations to the authors regarding the following five reviews submitted: (a) Is there an effect of crown-to-implant ratio on implant treatment outcomes?; (b) Implant-supported cantilevered fixed dental rehabilitations in fully edentulous patients; (c) and in partially edentulous patients; (d) Biological and technical complications of tilted implants in comparison with straight implants supporting fixed dental prostheses; (e) What are the adverse effects of osseointegrated implants functioning among natural teeth of a residual dentition? Based on the five manuscripts and the discussion among the group as well as the plenum members, the major findings were summarized, consensus statements were formulated, clinical recommendations were proposed, and areas of future research were identified. RESULTS: Crown-to-implant ratios ranging from 0.9 to 2.2 did not influence the occurrence of biological or technical complications also in single-tooth restorations. Reconstructions with cantilevers for the rehabilitation of fully and partially edentulous jaws showed high implant and reconstruction survival rates. In contrast, the rate of complications-in particular associated with veneering material-was high during the observation period of 5-10 years. The data reported were primarily derived from studies with high risk of bias. The data for single-implant reconstructions were small. There was no evidence that distally tilted implants were associated with higher failure rates and increased amounts of marginal bone loss. The data supporting these findings, however, were at high risk of bias and frequently incompletely reported. Frequent positional changes occurred between the natural teeth and the implant-supported restorations. These changes were more pronounced in younger individuals, and even though they were reduced with age, they still occurred in adult patients. Even though these changes were frequent, potential implications for the patient are unclear. CONCLUSIONS: The use of single-tooth restorations with crown-to-implant ratio in between 0.9 and 2.2 may be considered a viable treatment option. Multiunit reconstructions with cantilevers are a viable treatment option in fully and partially edentulous patients. Clinicians and patients should be aware, however, that complications are frequent and primarily related to resin material used for veneering. There is some evidence that tilting an implant does affect stability of the implant and the surrounding bone. Treatment options to tilted implants should carefully be considered, as the effect on soft tissues and on prosthesis behavior is poorly reported for tilted implants. Positional changes in the dentition in relation to implant-supported restorations occur frequently. The patient should be informed about the possible need for a treatment related to these changes in the long term.


Asunto(s)
Coronas/normas , Implantación Dental Endoósea/normas , Prótesis Dental de Soporte Implantado/normas , Fenómenos Biomecánicos , Coronas/efectos adversos , Implantación Dental Endoósea/efectos adversos , Implantación Dental Endoósea/métodos , Prótesis Dental de Soporte Implantado/efectos adversos , Prótesis Dental de Soporte Implantado/métodos , Restauración Dental Permanente/efectos adversos , Restauración Dental Permanente/métodos , Restauración Dental Permanente/normas , Dentadura Completa/efectos adversos , Dentadura Completa/normas , Dentadura Parcial Fija/efectos adversos , Dentadura Parcial Fija/normas , Humanos , Arcada Parcialmente Edéntula/cirugía , Boca Edéntula/cirugía , Resultado del Tratamiento
15.
Clin Implant Dent Relat Res ; 20(6): 997-1002, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30307129

RESUMEN

BACKGROUND: Short implants have been proposed as an alternative for the rehabilitation of atrophic edentulous areas. PURPOSE: To evaluate the efficacy of 4-mm implants vs longer implants in the atrophic posterior mandibles. MATERIALS AND METHODS: Eleven patients with bilateral atrophic mandibles were rehabilitated with two to four 4-mm implants and 10 or 8-mm long implants in augmented bone using Guided Bone Regeneration procedure. One side of the mandibles was randomly allocated to vertical augmentation with mixed autogenous bone and allograft. Implants were placed in both sides of the mandible after 6 months, and loaded after another 2 months. Subsequently, implant and prosthesis failures, marginal bone levels changes, and any complication were evaluated after 1-year follow-up. RESULTS: In this study, one patient dropped out and no failures occurred. However, 4-mm implants loss of 0.30 ± 0.34 mm peri-implant marginal bone and long implants loss of 0.47 ± 0.54 mm marginal bone were observed after 1-year of follow-up. The difference between the two groups was not statistically significant (difference = -0.16 ± 0.68 mm; P = 0.46). Eight complications occurred in five augmented sites of the patients, and no complication was found to occur in the short implants sites. CONCLUSIONS: One-year after loading, 4-mm implants had similar outcomes as long implants in augmented bone. Therefore, short implants might be a feasible treatment in atrophic mandibles.


Asunto(s)
Aumento de la Cresta Alveolar , Implantes Dentales de Diente Único , Diseño de Prótesis Dental , Pérdida de Hueso Alveolar/diagnóstico por imagen , Pérdida de Hueso Alveolar/cirugía , Atrofia , Regeneración Ósea , Implantación Dental Endoósea , Fracaso de la Restauración Dental , Femenino , Estudios de Seguimiento , Humanos , Arcada Parcialmente Edéntula/diagnóstico por imagen , Arcada Parcialmente Edéntula/cirugía , Masculino , Mandíbula/patología , Persona de Mediana Edad , Radiografía Panorámica
16.
Bull Tokyo Dent Coll ; 59(4): 285-290, 2018 Nov 30.
Artículo en Inglés | MEDLINE | ID: mdl-30333374

RESUMEN

An abnormal maxillomandibular ridge relationship frequently hinders oral implant treatment in patients with jaw deformities. Here, we describe a patient who was experiencing difficulty using dentures due to multiple maxillary tooth loss and mandibular prognathism. Treatment comprising sagittal splitting ramus osteotomy and alveolar ridge augmentation using bone grafts harvested from the mandibular ramus followed by implant treatment yielded good outcomes. The patient was a 47-year-old woman presenting with an unstable upper partial denture. Although prior prosthetic treatment for mandibular prognathism had resulted in normal overbite, she had since lost an increasing number of teeth due to advanced periodontal disease, impairing support for the denture. She was referred to the Department of Oral Implantology at the Tokyo Dental College Chiba Hospital in October 2008. Subsequent treatment comprised implant treatment following maxillary alveolar ridge augmentation and sagittal splitting ramus osteotomy to correct the maxillary-mandibular relationship. In January 2010, sagittal splitting ramus osteotomy and alveolar bone augmentation using a bone graft from the mandibular ramus were performed under general anesthesia. In July and August 2010, a total of 7 implants were placed in the maxilla and implant superstructure preparation started after 3 months. Taking both the patient's wishes and ease of maintenance into account, retrievable superstructures made of Auro Galvano Crown were fitted in April 2011. The jaw-to-jaw alveolar ridge relationship was improved by sagittal splitting ramus osteotomy, rendering subsequent treatment, from implant placement to superstructure preparation, feasible by conventional methods. The use of surplus bone generated during sagittal splitting ramus osteotomy for bone augmentation avoided the need to harvest bone from another area.


Asunto(s)
Aumento de la Cresta Alveolar/métodos , Implantes Dentales , Arcada Parcialmente Edéntula/cirugía , Maxilar/cirugía , Osteotomía Sagital de Rama Mandibular/métodos , Prognatismo/cirugía , Prognatismo/terapia , Pérdida de Hueso Alveolar/cirugía , Tornillos Óseos , Trasplante Óseo/métodos , Pilares Dentales , Implantación Dental Endoósea , Prótesis Dental de Soporte Implantado , Dentadura Completa Superior , Femenino , Humanos , Arcada Parcialmente Edéntula/rehabilitación , Mandíbula/diagnóstico por imagen , Maxilar/diagnóstico por imagen , Traumatismos Maxilofaciales/rehabilitación , Persona de Mediana Edad , Sobremordida/cirugía , Sobremordida/terapia , Prognatismo/diagnóstico por imagen , Tokio , Resultado del Tratamiento
17.
Clin Oral Implants Res ; 29(9): 907-914, 2018 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30259582

RESUMEN

AIM: The aim of this study was to compare the influence of the abutment height and insertion timing on early marginal bone loss (MBL) in posterior mandibular partial implant-supported restorations. MATERIAL AND METHODS: The study was planned as a prospective, randomized, controlled parallel group including subjects in need of at least two implants for the restoration of an edentulous posterior mandibular area. The patients were allocated into Groups A (implants immediately connected to 2-mm height abutments), B (immediately connected 1-mm height abutments), and C (2-mm abutments were inserted in a second-stage surgery). Each subject was placed in a 1-year follow-up program, including examination assessment of various soft tissue and bone-level parameters. RESULTS: A total of thirty-three patients, including sixty-eight implants, were enrolled in this study. One implant was lost on group C after the first month of healing. A mean MBL change of 0.719 ± 0.361, 0.651 ± 0.379, and 0.754 ± 0.672 mm was computed for groups A, B, and C, respectively, with no significant differences found. The early MBL at T1 was an independent predictor variable for the marginal bone alterations that were assessed at T3 (p < 0.001). CONCLUSION: The first-month MBL variation is a predictor factor of the bone alterations that might occur after 1 year of treatment. The early connection of final prosthetic abutments with distinct heights does not seem to reduce the 1-year MBL rate when compared with traditional treatment protocols.


Asunto(s)
Pérdida de Hueso Alveolar , Pilares Dentales , Diseño de Implante Dental-Pilar , Implantación Dental Endoósea , Implantes Dentales de Diente Único , Adulto , Anciano , Interfase Hueso-Implante , Pilares Dentales/efectos adversos , Femenino , Humanos , Arcada Parcialmente Edéntula/diagnóstico por imagen , Arcada Parcialmente Edéntula/cirugía , Modelos Lineales , Masculino , Mandíbula/diagnóstico por imagen , Mandíbula/patología , Persona de Mediana Edad , Estudios Prospectivos , Radiografía Dental , Factores de Tiempo
18.
J Craniofac Surg ; 29(7): 1934-1938, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30204726

RESUMEN

Cases of severely atrophic edentulous maxilla require reconstruction techniques employing bone grafts to promote adequate bone dimension for the successful placement of dental implants for prosthetic rehabilitation that reestablishes the patient's function and aesthetics. This study aims to present a severely atrophic edentulous maxilla reconstruction with the off-label use of recombinant human bone morphogenetic protein type 2 (rhBMP-2) associated with lyophilized particulate bovine bone xenograft for the prosthetic rehabilitation with osseointegrable dental implants. The paper describes a case of severely atrophic edentulous maxilla in a 42-year-old woman referred to the dental school with complaint of failure in adaptating to the dentures. The patient reported 27 years of maxilla edentulism and consecutive treatment failures, so the proposed therapy was the reconstruction of the maxilla with an association of rhBMP-2 and lyophilized bovine bone xenograft for increasing bone volume and further prosthetic rehabilitation with osseointegrated dental implants. The present report illustrates a case of atrophic edentulous maxilla in which the off-label use of rhBMP-2 was successful and the patient's prosthetic rehabilitation could be concluded. The 8 dental implants received prosthetic functional load during 1 year of follow-up with no complications. Based on the case presented, the association between rhBMP-2 and a bovine bone xenograft could be considered a viable option for the reconstruction of atrophic edentulous maxilla. After a year of functional prosthetic load follow-up, the patient is asymptomatic and satisfactorily adaptated to the prosthesis, which restored her functional and aesthetic demands.


Asunto(s)
Proteína Morfogenética Ósea 2/uso terapéutico , Trasplante Óseo/métodos , Implantación Dental Endoósea/métodos , Arcada Parcialmente Edéntula/cirugía , Maxilar/cirugía , Factor de Crecimiento Transformador beta/uso terapéutico , Adulto , Animales , Atrofia/cirugía , Bovinos , Prótesis Dental de Soporte Implantado , Estética Dental , Femenino , Liofilización , Humanos , Maxilar/patología , Proteínas Recombinantes/uso terapéutico
19.
Int J Periodontics Restorative Dent ; 38(Suppl): s49-s57, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30118533

RESUMEN

The objectives of this study were to compare conventional and computer-assisted implant planning and placement (CAIPP) protocols regarding surgical planning predictability, intraoperative complications, and patient-centered outcomes. Partially edentulous patients (N = 73) were randomly allocated to one of three treatment groups: control (C, n = 26), with preoperative planning based on conventional radiography and freehand implant placement; and test 1 (T1, n = 24) and test 2 (T2, n = 23), with two different CAIPP protocols. The clinicians' predictions of the bony morphology, materials needed for surgery, and surgery duration were matched with intrasurgical findings using kappa tests. Complications or deviations from the surgical or prosthetic protocol were recorded. Descriptive statistics were used to study the sample sorted out by treatment group. Differences between groups were evaluated with chi-square test for qualitative variables and with nonparametric Kruskal-Wallis test for quantitative continuous variables. For post-hoc tests, the Bonferroni corrected (P < .016 = .05/3) Mann-Whitney test was used. CAIPP protocols showed better diagnostic potential than conventional protocols for the bone topography, need for simultaneous GBR procedures, membrane selection, and implant length predictions. The rate of surgical protocol deviations was similar in all groups, but their nature differed. Conventional protocols showed fewer splint-related incidences. Implant bed preparation and insertion could not be fully completed using the surgical splint in 3.8% of patients in C (1/26), 45.8% in T1 (11/24), and 47.8% in T2 (11/23). Deviation from the initial prosthetic plan was necessary in one case (T2; 4.4%). No biologic or technical complications were observed. CAIPP protocols showed a higher diagnostic potential than conventional protocols. A high incidence of intraoperative surgical protocol modifications to adjust suboptimal implant placements was reported for every group. Therefore, strict intraoperative implant position monitoring is mandatory for both treatment protocols.


Asunto(s)
Implantación Dental Endoósea/métodos , Arcada Parcialmente Edéntula/cirugía , Cirugía Asistida por Computador , Adulto , Diseño Asistido por Computadora , Implantación Dental Endoósea/efectos adversos , Implantes Dentales , Humanos , Tempo Operativo , Radiografía Dental , Cirugía Asistida por Computador/métodos , Resultado del Tratamiento
20.
Int J Comput Dent ; 21(2): 87-95, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29967901

RESUMEN

Implant placement requires precise planning and execution to avoid collision with critical anatomical structures. Technology advances may improve placement outcomes. The purpose of this study was to trial and measure in an in vitro environment the accuracy of placing a single dental implant in the planned position using a specific guided surgery technique compared with a freehand surgery technique. The dental model of a patient missing tooth 16 was printed 30 times (EnvisionTEC 3Dent). Each print was scanned (TRIOS color scanner) to create a 3D surface model, and radiographed (Gendex CB-500) to create cone beam computed tomography (CBCT) data. The surface data and CBCT data were merged (Implant Studio software), and a Straumann RC bone level Ø 4.1 × 8 mm implant placement was planned. A surgical guide was printed (Stratasys OrthoDesk) for each case (n = 30). Simulated cases were assigned to Group A (guided) or Group B (freehand, where the fabricated guide was discarded). Implants were placed, and the models rescanned (TRIOS). The new data was superimposed on the original data, and the surgical implant location compared with the planned position for each model (Convince software) by a researcher blinded to group allocation. Differences in angulation (degrees); shoulder, apex, and depth displacements (mm); and direction of displacement were assessed with Mann-Whitney U and Fisher exact tests. Data was expressed as medians bounded by interquartile ranges (IQRs). Implant angulation and apical displacement were significantly closer to the planned position in the guided group compared with the freehand group (3.91 degrees: IQR 2.45 to 5.38 degrees vs 8.82 degrees: IQR 4.84 to 9.84 degrees, P = 0.005; and 0.87 mm: IQR 0.53 to 1.11 mm vs 1.48 mm: IQR 1.14 to 1.72 mm, P < 0.001, respectively). Implant shoulder displacement, depth displacements, and direction of displacement did not differ between the groups. Within the in vitro environment, merged 3D surface scan data and 3D CBCT scan data can be used to plan and guide implant placement with greater accuracy than with the freehand technique.


Asunto(s)
Diseño Asistido por Computadora , Tomografía Computarizada de Haz Cónico , Implantación Dental Endoósea/métodos , Modelos Dentales , Impresión Tridimensional , Cirugía Asistida por Computador , Implantes Dentales , Humanos , Arcada Parcialmente Edéntula/cirugía
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