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1.
Artículo en Inglés | MEDLINE | ID: mdl-33528448

RESUMEN

The aim of this article is to propose a simplified digital protocol for the treatment of the fully edentulous patient, using an immediate implant and immediate loading protocol to deliver a polymethyl methacrylate metal-reinforced hybrid prosthesis. Ten consecutive patients were treated with this approach. At the end of 1 year, there was an implant survival rate of 97.8% and a prosthetic success rate of 100%. Based on the responses to the quality of life questionnaire, patients had a high acceptance rate for this treatment protocol. Within the limits of this case series, the proposed simplified digital protocol could be utilized for reconstruction in the fully edentulous patient and for delivering an implant-supported prosthesis immediately after implant placement.


Asunto(s)
Implantes Dentales , Carga Inmediata del Implante Dental , Arcada Edéntula , Boca Edéntula , Implantación Dental Endoósea , Prótesis Dental de Soporte Implantado , Estudios de Seguimiento , Humanos , Arcada Edéntula/cirugía , Boca Edéntula/cirugía , Calidad de Vida , Resultado del Tratamiento
2.
Int J Prosthodont ; 34(1): 109-117, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33570526

RESUMEN

PURPOSE: To evaluate the reserved space quantity and printing accuracy of custom edentulous trays produced by two 3D printing methods (fused deposition modeling [FDM] and stereolithography apparatus [SLA]) and to compare them to traditional handmade (HM) methods. MATERIALS AND METHODS: The tissue surface data of maxillary and mandibular edentulous gypsum models were obtained through a 3D scanner to design the digital custom trays in Geomagic software. The custom trays were then printed with FDM and SLA technologies, and handmade custom trays were used as control. The scanned data of printing trays were registered with their digital data, and the printing errors were analyzed using the deviation analysis function. The distances between the tissue surface of gypsum models and the custom trays were measured in ImageWare and represented by 3D deviation. RESULTS: None of the six groups revealed a significant difference (P > .05) compared to the set value of 1.00 mm. In the SLA group, the deviation of the mandibular area was significantly closer to the set value than for the HM group (P < .05), while no significant difference was displayed between the other groups. For the printing error between the two 3D groups, the SLA method showed significantly less error and better stability (P < .001). CONCLUSION: 3D-printed custom trays can meet clinical needs in the adaptability of tissue surfaces, and SLA-printed trays revealed better precision and less error than the other two methods. Accordingly, the use of SLA technology to make a 3D-printed custom tray is expected to be promoted in clinical practice.


Asunto(s)
Boca Edéntula , Impresión Tridimensional , Humanos , Mandíbula , Maxilar , Programas Informáticos
3.
Int J Prosthodont ; 34: s8-s20, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33571323

RESUMEN

The tasks of Working Groups 1 to 6 at the 4th Consensus Meeting of the Oral Reconstruction Foundation were to elucidate clinical recommendations for implant-supported full-arch rehabilitations in edentulous patients. Six systematic/narrative reviews were prepared to address the following subtopics: (1) the influence of medical and geriatric factors on implant survival; (2) the prevalence of peri-implant diseases; (3) the influence of material selection, attachment type, interarch space, and opposing dentition; (4) different interventions for rehabilitation of the edentulous maxilla; (5) different interventions for rehabilitation of the edentulous mandible; and (6) treatment choice and decision-making in elderly patients. Consensus statements, clinical recommendations, and implications for future research were determined based on structured group discussions and plenary session approval.


Asunto(s)
Implantes Dentales , Arcada Edéntula , Boca Edéntula , Anciano , Consenso , Prótesis Dental de Soporte Implantado , Humanos , Maxilar
4.
Int J Prosthodont ; 34: s63-s84, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33571327

RESUMEN

PURPOSE: To synthesize evidence derived from systematic reviews (SRs) on different interventions for rehabilitation of the edentulous maxilla with implant-supported restorations. MATERIALS AND METHODS: A protocol-oriented search was established to address the PICO question: What is the current evidence regarding rehabilitation of the edentulous maxilla with different implant-supported prostheses in terms of implant and prosthesis survival? The primary outcomes were implant and prosthesis survival rates evaluated from SRs of clinical studies including adult patients with complete edentulism of the maxilla and comparing different implant-supported rehabilitation strategies. Methodologic quality of the SRs was assessed with the AMSTAR-2 tool. RESULTS: The final selection process led to the inclusion of 36 SRs that were grouped as: (1) addressing maxillae with sufficient bone to place implants; (2) addressing maxillae with insufficient bone to place implants; and (3) comparing different types of prosthesis, number of implants, patient-reported outcomes, and economic evaluations. The literature describes four or more implants as suitable for full-arch fixed prostheses and implant-supported overdentures; in both cases, the overall survival rate is > 95%. Mini-implants present very high short-term failure rates (> 30%). Poor description of technical complications, adjustments, and maintenance and corresponding costs precluded a cost-effectiveness analysis. CONCLUSION: No implant-supported rehabilitation of the edentulous maxilla (fixed or removable) should be supported on fewer than four implants. A one-piece full-arch fixed dental prosthesis can be supported by a minimum of two anterior axial plus two posterior distally tilted implants or by six to eight axial implants symmetrically distributed through the posterior and anterior regions of the arch. Four to six implants is the advised number to support an overdenture. The use of mini-implants in the maxilla is inadvisable.


Asunto(s)
Implantes Dentales , Arcada Edéntula , Boca Edéntula , Adulto , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Estudios de Seguimiento , Humanos , Maxilar/cirugía , Resultado del Tratamiento
5.
Int J Prosthodont ; 34: s93-s101, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33571329

RESUMEN

PURPOSE: To review and analyze the literature regarding removable vs fixed implant prosthetic treatment for complete edentulism in elderly people. MATERIALS AND METHODS: A narrative review of published articles was conducted. Electronic and manual searches were performed to identify studies comparing removable vs fixed implant modalities for edentulous patients and/or reporting on specific outcomes for fixed vs removable implant restorations in elderly patients. RESULTS: It is evident that there are differences in mechanical and biologic maintenance needs due to differences in prosthetic materials and designs for fixed vs removable implant restorations. Anatomical restrictions, age-related problems, lifestyle, cost, maintenance needs, access to dental services, and past experience (both of the provider and the patient) all play a role in prosthesis selection for these patients. Patient expectations and their financial means will define their choices. Patient-reported outcome measures are not standardized, and any assumptions made based on different studies need to be carefully evaluated. CONCLUSION: The decision-making pathway for determining what type of implant-supported prosthesis is preferable for edentulous patients is complicated by many variables that must be considered when treatment planning for maximum benefit for the patient. Detailed explanations of potential outcomes, complications, difficulties, and benefits of therapeutic options is mandatory. Proper assessment of patients' expectations and desires before treatment is critical for a successful outcome.


Asunto(s)
Implantes Dentales , Boca Edéntula , Anciano , Prótesis Dental de Soporte Implantado , Humanos , Planificación de Atención al Paciente
6.
Gen Dent ; 69(1): 31-36, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33350953

RESUMEN

The objective of this study was to compare techniques of different methods of obtaining centric relation to verify which technique generates the greatest reproducibility of the centric relation. The PubMed/MEDLINE, Cochrane Library, SciELO, Scopus, and Web of Science databases were searched for articles published up to May 15, 2018. The search terms were combinations of "dental centric relation" with each of the following terms (individually): "reproducibility of findings"; "jaw relation record"; "chin point"; "gothic arch"; "bimanual manipulation"; "swallowing"; and "jig." The inclusion criteria included clinical studies in English that had to compare at least 2 techniques representing different methods for obtaining centric relation (based on the reproducibility of the centric relation) in individuals without temporomandibular dysfunction; and studies performed in individuals with complete or nearly complete dentition or complete edentulism. Methods (techniques) included in this study were guided methods (chin point guidance and bimanual manipulation); graphic methods (intraoral and extraoral gothic arch tracing); and physiologic methods (swallowing and tongue retrusion along the palate). A total of 1638 articles were identified. After the inclusion and exclusion criteria were applied, 7 articles were included in this review. None of the reviewed studies evaluated edentulous individuals. Two articles compared physiologic methods with guided methods; one concluded that the swallowing technique generates greater variability than guided methods, and the other concluded that there was no difference between the swallowing technique and chin point guidance. Of 5 articles comparing intraoral gothic arch tracing with guided methods, 2 showed similar results between different methods, 2 showed superior results for gothic arch tracing, and 1 showed superior results for the guided methods. Based on the guided methods and swallowing technique, it is not possible to conclude which technique can generate the greatest reproducibility of the centric relation. It is possible to suggest that in most cases intraoral gothic arch tracing is superior or equivalent when compared to guided methods.


Asunto(s)
Boca Edéntula , Relación Céntrica , Humanos , Registro de la Relación Maxilomandibular , Reproducibilidad de los Resultados
7.
Rev. Asoc. Odontol. Argent ; 108(3): 97-103, dic. 2020. ilus, graf
Artículo en Español | LILACS | ID: biblio-1147414

RESUMEN

Objetivo: Evaluar el porcentaje de implantes oseointegrados colocados en pacientes edéntulos para la confección de sobredentaduras inferiores, en el marco de la formación de recursos humanos. Materiales y métodos: Se analizaron las historias clínicas de los pacientes que recibieron dos implantes dentales inferiores para la confección de sobredentaduras en el servicio de residentes de la carrera de Especialización en Cirugía y Traumatología Bucomaxilofacial de la Facultad de Odontología de la Universidad de Buenos Aires, entre agosto de 2012 y diciembre de 2018. Se consideraron para el análisis el porcentaje de implantes oseointegrados y su relación con el tipo de operador (docente o residente), la situación del reborde óseo y el hábito de fumar. Resultados: De los 176 implantes colocados en 88 pacientes (edad promedio = 67 años), a los 3-4 meses el 98% (IC95: 94-99%) se hallaba oseointegrado. No se encontró una relación estadísticamente significativa entre el tipo de operador y el fracaso (P>0,99) Conclusión: En un servicio de formación, la tasa de éxito, evaluada en la segunda cirugía, de dos implantes dentales colocados en el maxilar inferior para sobredentaduras fue de 98%. No se hallaron diferencias entre los resultados logrados por residentes y docentes del servicio (AU)


Aim: To evaluate the percentage of osseointegrated im- plants placed in edentulous patients to restore with mandib- ular overdentures, within the post graduate dental training framework. Materials and methods: Medical records of patients who received two dental implants in the mandible for the placement of overdentures in the resident clinic of the special- ization career in Oral and Maxillofacial Surgery and Trauma- tology from the Facultad de Odontología de la Universidad de Buenos Aires, between August 2012 and December 2018. The percentage of osseointegrated implants was analysed, and the association with the variables: operator (teacher or resident), mediate or immediate placement, and smoking. Results: 176 implants were placed in 88 patients with an average age of 67 years old. 98% (IC95: 94-99%) of the implants were osseointegrated at 3-4 months. No statistically significant association was detected between the type of oper- ator and implant failure (P>0.99). Conclusion: In the teaching dental training clinic, the success rate, evaluated at the second implant stage surgery, of two dental implants placed in the mandibule for overden- tures was 98%. No differences were found between the results achieved by residents and teachers (AU)


Asunto(s)
Humanos , Masculino , Femenino , Anciano , Boca Edéntula , Implantación Dental Endoósea , Prótesis de Recubrimiento , Educación de Posgrado en Odontología , Argentina , Facultades de Odontología , Análisis Estadístico , Estudios Retrospectivos , Oseointegración , Resultado del Tratamiento
8.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 55(11): 891-896, 2020 Nov 09.
Artículo en Chino | MEDLINE | ID: mdl-33171564

RESUMEN

Objective: To evaluate the clinical outcomes of digital technique-aided occlusal rehabilitation based on implant-supported fixed prostheses (ISFP), and to provide some information for clinical application of digital technique. Methods: Retrospectively reviewed the cases which had used neuromuscular system and condylar movement tracing device to reconstruct occlusion in one or double jaw fully edentulous ISFP from January, 2013 to January, 2020. A total of 6 eligible patients were enrolled in the present study with 56 implants and 8 ISFP, including 4 male patients and 2 female patients, aged from 43 to 74 years. The clinical outcomes were evaluated in four aspects, including implant survival rate, implants success rate, marginal bone loss and the occurrence of prosthesis complications. Results: The follow-up time was (4.0±2.2) years (1-7 years). The implant survival rate was 100% (56/56) and the implant success rate was 98% (55/56), with an average missal and distal marginal bone loss of (0.04±0.11) mm/year. Veneer chipping occurred at incisal edge of 2 adjacent incisors in only one prosthesis 3 years after rehabilitation. Conclusions: Combination of digital techniques of neuromuscular system and condylar movement tracing device to assist occlusal rehabilitation based on ISFP showed a high implant success rate. The complication seldom happened. Long and stable occlusion has been observed. The clinical outcomes were favorable.


Asunto(s)
Implantes Dentales , Arcada Edéntula , Boca Edéntula , Adulto , Anciano , Implantación Dental Endoósea , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Femenino , Estudios de Seguimiento , Humanos , Arcada Edéntula/cirugía , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento
9.
Artículo en Inglés | MEDLINE | ID: mdl-33151187

RESUMEN

Pterygoid implant placement has not been a common treatment modality to manage the atrophic posterior maxilla. This randomized, controlled clinical trial evaluated the accuracy of dynamic navigation using trace registration (TR) technology in pterygoid implant placement when compared to free-hand surgery. Partially edentulous patients requiring at least one pterygoid implant to rehabilitate the atrophic posterior maxilla were included. Implant accuracy (in a prosthetically directed context) and the relation of the placed implants to the greater palatine canal (GPC) were evaluated using EvaluNav to compare the preoperative CBCT plan with the postoperative CBCT implant location. Osseointegration success, mucosal thickness, implant length, time spent for surgical placement, and ease of prosthetic restorability via degree of multi-unit abutment angulation were assessed. A total of 63 pterygoid implants were placed (31 using TR, 32 using free-hand) in 39 partially edentulous patients. Mean deviations between the planned and actual position for TR-placed implants were 0.66 mm at the coronal level, 1.13 mm at the apical level, 0.67 mm in depth, and 2.64 degrees of angular deviation, compared to 1.54 mm, 2.73 mm, 1.17 mm, and 12.49 degrees, respectively, for free-hand implants. In relation to the GPC, TR implants were more accurate when compared to the presurgical plan and took less surgical time. The mean mucosal thickness measured for all implants was 5.41 mm. Most implants were 15 to 18 mm long, and most prostheses (92%) could be accommodated by a 17- or 30-degree multi-unit screw-retained abutment. TR implants had greater short-term osseointegration success rates than free-hand implants (100% vs 93.75%). Pterygoid implant surgery can be a predictable and successful modality for prosthetically directed implant rehabilitation in the atrophic posterior maxilla, is more accurate than free-hand surgery, and takes less time when using dynamic navigation via TR.


Asunto(s)
Implantes Dentales , Boca Edéntula , Cirugía Asistida por Computador , Implantación Dental Endoósea , Humanos , Maxilar/diagnóstico por imagen , Maxilar/cirugía
10.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(5): 924-930, 2020 Oct 18.
Artículo en Chino | MEDLINE | ID: mdl-33047731

RESUMEN

OBJECTIVE: To explore the applicability of integration between three-dimensional (3D) facial and dental data to evaluate the nasolabial morphology variation before and after the cross-arch fixed restoration of the maxillary implant-supported prostheses. METHODS: Twelve patients (4 women and 8 men), mean age (54.82±5.50) years (from 45 to 62 years) referred to the Department of Oral Implan-tology, Peking University School and Hospital of Stomatology, were selected and diagnosed with edentulous maxilla. For all the patients, 4 to 6 implants were inserted into the maxilla. Six months later, the final cross-arch fixed prostheses were delivered. The 3D facial images were collected before and after the final restoration. The 3D data of prostheses were also captured. All the 3D data were registered and measured in the same coordinate system. Then the displacement of all the landmarks [cheilion left (CHL), cheilion right (CHR), crista philtri left (CPHL), crista philtri right (CPHR), labrale supe-rius (LS), subnasale (SN), stomion (STO), upper incisor (UI), upper flange border of the prostheses (F-point, F)], and the variation of the distances between these landmarks (SN-LS, CPHR-CPHL, CHR-CHL, LS-STO) were analyzed and compared. RESULTS: The consistency test among three measurements of the length of F-SN indicated that the integration method of the dental prostheses and soft tissue had the good repetitiveness, ICC=0.983 (95%CI: 0.957-0.995). After wearing the final cross-arch maxillary implant-supported prostheses, all the landmarks on the soft tissue moved forward. The nasal base area changed minimally, and the shift of SN in the sagittal direction was only (0.61±0.44) mm. But the sagittal shift of LS was (3.12±1.38) mm. In the vertical direction, SN, LS, CPHL, and CPHR moved upward. But STO, CHL, and CHR moved downward a little. Except for the slight decrease of the length of philtrum (SN-LS), the length of CHL-CHR, CPHL-CPHR, and the height of upper lip were increased together (P < 0.01). In the direction of Z axis, the strong correlations were found not only between the movements of SN and F (r=0.904 3) but also between the movements of LS and UI (r=0.958 4). CONCLUSION: The integration method of 3D facial and dental data showed good repetitiveness. And the strong correlations between the landmarks of prostheses and nasolabial soft tissue in the sagittal direction were found by this new method.


Asunto(s)
Maxilar , Boca Edéntula , Femenino , Humanos , Incisivo , Labio , Masculino , Maxilar/cirugía , Persona de Mediana Edad , Prótesis e Implantes
11.
J Craniomaxillofac Surg ; 48(11): 1045-1051, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33012600

RESUMEN

PURPOSE: To evaluate the frequency of deep lingual concavities in the lower jaw, which can cause surgical complications while inserting dental implants. METHODS: Cross-sections of the mandible alveolar ridge at the edentulous sockets were obtained via cone-beam computed tomography. Measurements were carried out using the freeware 'IC Measure' and based on the basic definitions of a previous study. RESULTS: Most (767/826 = 93%) sockets had concavities of various degrees (30-90°), while 59 (7%) sockets had no concavity. However, the majority of the concavities (71%) were mild, with angles > 60°. The other 220 (26%) sockets had deeper concavities of <60°; among these, 12 (1%) had extremely deep concavities of <40°. CONCLUSIONS: Only a few cases have deep lingual concavities that pose a high risk for lingual plate perforation during dental implantation.


Asunto(s)
Implantes Dentales , Boca Edéntula , Tomografía Computarizada de Haz Cónico , Implantación Dental Endoósea/efectos adversos , Humanos , Mandíbula/diagnóstico por imagen , Mandíbula/cirugía , Lengua , Alveolo Dental
12.
Hua Xi Kou Qiang Yi Xue Za Zhi ; 38(4): 404-409, 2020 Aug 01.
Artículo en Chino | MEDLINE | ID: mdl-32865359

RESUMEN

OBJECTIVE: To observe the changes of forward displacement of maxillary complete denture during centric occlusion, three different methods were used to record the changes of vertical overlap and the comfort level of patients before and after the selective grinding of the three dentures made according to maxillo-mandibular horizontal relationship record. METHODS: Twelve edentulous patients with normal stomatognathic system were recruited in this study. Three types of complete dentures for these 12 edentulous patients were made according to their different maxilla-mandibular horizontal relationship record methods. The amount of displacement of the maxillary complete denture, the vertical overlap of the anterior teeth as well as patient comfort level were recorded before and after selective grinding. Statistical analysis was performed using the SPSS 17.0 software package. RESULTS: Before selective grinding, the amount of displacement of denture A was significantly larger than those of dentures B and C (P<0.05). After selective grinding, there was no statistical difference among the three dentures (P>0.05). During selective grinding, the vertical overlap variation of denture A was significantly greater than those of dentures B and C (P<0.05). Before selective grinding, the comfort level of the denture A was the lowest (P<0.05), and no statistical difference was found between dentures B and C (P>0.05). After selective grinding, no statistical difference was found among the three dentures (P>0.05). CONCLUSIONS: Among the complete dentures with anatomical teeth, the dentures whose horizontal relationship was recorded at 1 mm before the apex of the Gothic arch apex and with checkbite are more in line with clinical repair requirements. Complete dentures whose horizontal relationship was recorded at the apex of Gothic arch need to be adjusted with selective grinding to meet the clinical restoration requirements.


Asunto(s)
Dentadura Completa , Boca Edéntula , Oclusión Dental Céntrica , Humanos , Mandíbula , Maxilar
13.
Prim Dent J ; 9(3): 34-39, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32940586

RESUMEN

Improvements in oral health including increased retention of natural teeth have given rise to a partially dentate older population. Replacement of missing natural teeth is important to improve function, aesthetics and quality of life for this patient group. A variety of options are available to replace missing teeth in partially dentate older adults, including fixed, removable and implant retained prostheses. This article will discuss the provision of removable partial dentures including treatment planning and denture design. When planning removable partial dentures, careful attention must be paid to stabilising the patient prior to delivering any prosthesis. Partial dentures should be designed to minimise the potential for plaque accumulation with carefully designed metal based frameworks. Acrylic resin can also be utilised with attention to detail to minimise the risk of damage to delicate supporting tissues. Removable dentures have the advantage that they can be readily added to in the event of further tooth loss which may be particularly relevant for older adults. Partial dentures which optimise support, retention and stability can function very successfully and significantly improve patients' oral health related quality of life.


Asunto(s)
Dentadura Parcial Removible , Boca Edéntula , Pérdida de Diente , Anciano , Dentadura Parcial , Humanos , Calidad de Vida
14.
Prim Dent J ; 9(3): 18-22, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32940595

RESUMEN

The prevalence of caries is set to increase in the coming years as a result of a growing ageing population and a concomitant reduction in levels of edentulousness. Evidence for management of caries in older adults is scarce compared to that for the child population, however, similar principles of risk assessment, prevention and minimal intervention should be applied by dental health professionals. Early identification of high-risk older adults facilitates the implementation of risk reduction strategies, such as topical fluoride regimes. When operative intervention cannot be avoided, Atraumatic Restorative Technique (ART) may allow for conservative cavity preparation and has the advantage of being suitable for the domiciliary setting.


Asunto(s)
Tratamiento Restaurativo Atraumático Dental , Caries Dental , Boca Edéntula , Anciano , Niño , Humanos
15.
Int J Oral Maxillofac Implants ; 35(5): 924-930, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32991642

RESUMEN

PURPOSE: The purpose of this retrospective computed tomography study was to evaluate bone availability for dental implant placement, frequency of bone augmentation procedures, frequency of anatomical structures that compromise implant placement, and frequency of implant dimensions, and to determine which edentulous sites would benefit from the use of a sloped implant versus a traditional flat design. MATERIALS AND METHODS: Recorded parameters included the width of the ridge, the buccal and lingual/palatal alveolar bone height in reference to different anatomical landmarks, determination of implant placement, selection of an implant with a flat or sloped top, and need for a secondary bone augmentation procedure. RESULTS: One thousand three hundred seventy edentulous sites were evaluated in 216 patients. Implants could be placed in 60.6% of the total sites, where the coronal portion would be sloped in 59% of sites and conventionally flat in 41%; 39.4% of sites were not adequate for implant placement, where 56.5% needed additional guided bone regeneration procedures and 43.5% required sinus augmentation procedures. The inferior alveolar canal was the most frequent anatomical structure limiting size and/or placement. CONCLUSION: The study indicates that implants can be placed in slightly over half of edentulous sites without a secondary grafting procedure. The possibility of dental implant placement varied according to the volume and morphology of alveolar bone and related anatomical structures. This decreased from anterior to posterior in both arches. The sloped implant design was beneficial. In addition, the sloped implant design resulted in the placement of a longer implant.


Asunto(s)
Aumento de la Cresta Alveolar , Implantes Dentales , Boca Edéntula , Implantación Dental Endoósea , Humanos , Estudios Retrospectivos
16.
Int J Oral Maxillofac Implants ; 35(5): 990-994, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32991650

RESUMEN

PURPOSE: The SAC Assessment Tool is a clinical decision support system based on the foundations of the SAC Classification System in Implant Dentistry developed by the International Team for Implantology in 2009. It objectively classifies a patient's rehabilitation with dental implants as straightforward, advanced, or complex, from both a surgical and restorative perspective. The aim of this research was to test the agreement between observers with different qualification levels and clinical experience when using this clinical decision support system as a method that mitigates risk. MATERIALS AND METHODS: A total of 30 patients were randomly selected from clinical records, and diagnostic casts, intraoral and extraoral images, and panoramic radiographs were obtained. All data were analyzed with and without the SAC Assessment Tool by a dentist with advanced training and clinical experience in implant dentistry (control dentist) and compared with three colleagues (dentists 1, 2, and 3) with fewer qualifications and less clinical experience. All data were analyzed using statistical agreement tests (Fless kappa), interclass correlation, and agreement rate. The level of significance (α) was set at .05. RESULTS: All patients included in this research presented 104 edentulous areas, which were subjected to surgical evaluation for possible placement of dental implants. Concerning the degree of risk evaluation for dental implant treatment, the results of this study found that the agreement rate of the control dentist without SAC and control dentist with SAC was excellent (81.7%); the agreement rate of the control dentist and dentists 1, 2, and 3 with the use of SAC was satisfactory (67.3% to 76.0%); the variable that presented a lower agreement rate (34.6%) was the comparison between dentists 1, 2, and 3 without use of the SAC Assessment Tool. CONCLUSION: The SAC classification seems to be a useful tool to assist dentists with less experience in implant dentistry with defining the complexity of the treatment and hence with patient selection. It helps in the collection and homogenization of important clinical data to assess the risk of implant-based rehabilitations, thus contributing to an increase in the agreement rate.


Asunto(s)
Implantes Dentales , Boca Edéntula , Implantación Dental Endoósea , Humanos , Radiografía Panorámica
17.
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
18.
Swiss Dent J ; 130(9): 691-698, 2020 09 07.
Artículo en Alemán | MEDLINE | ID: mdl-32909726

RESUMEN

A 61-year-old healthy patient was referred for prosthetic rehabilitation in the maxilla and mandible. The primary wish of the very anxious patient was to improve the masticatory function and his aesthetic appearance with the least invasiveness and as efficiently as possible. Furthermore, he desired to receive a reliable long-term solution. The patient had no general medical restrictions and was a non-smoker. At the time of the first clinical examination, the patient presented nearly edentulous, with a few root remnants in the mandible and remaining wisdom teeth in the maxilla. The main objective of the treatment, hence, was to improve both his chewing function and the stability of the prostheses without invasive surgeries. After the removal of the root remnants and one of the two wisdom teeth (18), two new complete dentures were fabricated. Thereafter, 6 diameter reduced mini implants (SLA® one-piece self-tapping Straumann® Mini Implants made of Roxolid®, with a diameter of 2.4 mm and a length of 10 mm) were inserted in the maxilla, and 4 mini implants (SLA® one-piece self-tapping Straumann® Mini Implants made of Roxolid®, with a diameter of 2.4 mm and a length of 10 mm) were inserted in the mandible. After the implant insertion with good primary stability, the two new complete dentures were transferred into two implant-supported removable dental prostheses and retained by means of the transmucosal integrated attachment system of the mini implants (Optiloc®). At the 3-month follow-up visit, the patient was very satisfied with the outcomes, both from a functional and aesthetic point of view.


Asunto(s)
Implantes Dentales , Boca Edéntula , Prótesis Dental de Soporte Implantado , Humanos , Masculino , Mandíbula , Maxilar , Persona de Mediana Edad
19.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 55(8): 555-564, 2020 Aug 09.
Artículo en Chino | MEDLINE | ID: mdl-32842347

RESUMEN

Objective: To evaluate the outcomes of immediate rehabilitation of the edentulous and potential edentulous jaws with implant-supported full-arch prostheses and analyse the risk factors of the complications. Methods: This retrospective study included 273 patients treated with immediate rehabilitation of the edentulous and potential edentulous jaws with implant-supported full-arch prostheses from April 2008 to December 2018 in Department of Implantology, Peking University School and Hospital of Stomatology. The patients' sex, age, place of residence, jaw position, opposing dentition, number of implants, diameter and length of implants, abutment height and abutment angle were recorded. The survival rate of implants and marginal bone loss were calculated and analyzed. Cox proportional hazards ratio model was adopted to analyze the potential risk factors of prosthetic complications. Results: A total of 225 patients (288 jaws) and 1 260 implants were included, with 126 males and 99 females, aged (57.3±11.0) years, with a following time of (5.04±3.08) years. The 1-year cumulative survival rate of implants was 98.0% (1 235/1 260). Forty-eight implants were lost during the follow-up, with 39 implants in the maxillae and 9 implants in the mandible. The risk of implant failure of the maxillae ï¼»7.2% (39/541)] is significantly higher than that of the mandible ï¼»1.3% (9/719)] (P<0.01). Average marginal bone loss at 1 and 5 years was (0.7±0.2) mm and (1.1±0.3) mm. One hundred and twenty patients experienced prosthetic complications including screw/abutment loosening (44 cases), screw/abutment fracture (2 cases) and artificial tooth/denture base fracture (99 cases). The possibility of immediate prosthesis fracture within 6-8 months was high but declined over the following years with the final prosthesis delivered. Cox regression analysis showed that the use of 17° abutments in the anterior region was significantly related to the prosthetic complications (hazard ratio=1.797, P=0.002). Conclusions: Immediate rehabilitation of the edentulous jaws with implant-supported full-arch prostheses can be a predictable technique. The immediate prosthetic mechanical complication prevalence was high. The use of 17° abutments in the anterior region may increase the risk of screw/abutment loosening. It is necessary to review in time.


Asunto(s)
Implantes Dentales , Carga Inmediata del Implante Dental , Arcada Edéntula/cirugía , Boca Edéntula , Anciano , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento
20.
J Prosthodont ; 29(8): 718-724, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32648318

RESUMEN

PURPOSE: To assess the accuracy of template-guided implant surgery for edentulous arches. MATERIALS AND METHODS: The stone master casts of 25 edentulous arches treated with either 4 or 6 implants with CBCT generated template-guided surgery were included in this observational cohort study. The stone casts generated from the surgical templates (group one) prior to implant placement were digitized into Standard Tesselation (STL) files with a reference scanner. For comparison, the stone master casts derived from intraoral complete-arch impressions after implant placement (group two) were also digitized. The resultant STL files were superimposed and best-fit-alignment algorithm was used to quantify the 3D deviations present between the two groups. Descriptive statistics were computed for all categorical variables. Due to the presence of nonindependent samples between maxillary and mandibular casts, a mixed-effects model was used. RESULTS: Deviations between the implant analogs of the stone casts representing digitally planned versus actually placed implants were found. The mean root-mean-square error (RMSE) between all 25 arches was found to be 0.2 mm (SD ± 0.15). The mean RMSE between presurgical and postsurgical maxillary stone casts were 0.19 ± 0.15 mm, while between mandibular stone casts were 0.21 ± 0.16 mm and were not significant (p = 0.67). The mean RMSE between presurgical and postsurgical stone casts arches with 4 versus 6 implants were found to be significant (p = 0.01). CONCLUSIONS: According to the results of the study and based on the amount of 3D deviations between the digitally planned implant positions and the actually placed implants, template-guided surgery is a safe treatment modality for implant placement in edentulous arches.


Asunto(s)
Implantes Dentales , Boca Edéntula , Cirugía Asistida por Computador , Diseño Asistido por Computadora , Técnica de Impresión Dental , Humanos , Maxilar/cirugía , Boca Edéntula/cirugía
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