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1.
Niger J Clin Pract ; 23(4): 456-463, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32246650

RESUMEN

Aims: The purpose of this study was to observe the stresses of all-on-four implant designs in an edentulous mandible in the implant, surrounding bone, and monolithic ceramics. Materials and Methods: In mandibular all-on-four implant models, anterior implants were placed vertically, and posterior implants were differently inclined. On the full-arch fixed prosthetic restoration monolithic zirconia framework, monolithic lithium disilicate was prepared as the superstructure. Model 1M (1M-15.5); posterior implants angled at 15° to the occlusion plane and a cantilever length of 5 mm, Model 2M; (2M-15.9), Model 3M; (3M-30.5), and Model 4M; (4M-30.9) were prepared. A total of 300 N bilateral force was applied at an angle of 30° and oblique to the occlusion plane. Stress values on dental implants, abutments, the surrounding bone, and prosthetic restorations were calculated. Results: The highest stress concentration was observed in the 2nd connector region between the canine and the 1st premolar tooth in the monolithic zirconia frameworks (457.21 MPa). Stress concentration in the cortical bone was 60.93 MPa in posterior implants. Stress was higher in posterior angled implants than straight implants. Stress at posterior angulation increased by 21 MPa in implants angled at 15°. Conclusion: In bilateral loading, the force applied to anterior implants does not have a significant effect on the bone structure. Stress concentration increases in posterior angled implants and surrounding bone. Moreover, stress concentration increases as the length of the cantilever, the weakest part in all-on-four implants, increases. As posterior implant angulation increases, stress concentration level and localization are affected.


Asunto(s)
Cerámica/química , Implantes Dentales , Prótesis Dental de Soporte Implantado/métodos , Imagenología Tridimensional/métodos , Titanio/química , Circonio/química , Diente Premolar , Arco Dental/fisiología , Modelos Dentales , Diseño de Prótesis Dental , Análisis del Estrés Dental , Análisis de Elementos Finitos , Humanos , Mandíbula/fisiología , Estrés Mecánico
2.
Braz Oral Res ; 33: e110, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31778474

RESUMEN

The objective of this systematic review and meta-analysis was to evaluate the effect of welding techniques on implant-supported prostheses and determine whether they contribute to a better adaptation compared with a one-piece cast. A search was conducted using the PubMed/MEDLINE, Embase, and Cochrane Library databases, and articles published until November 2017 were obtained from these databases. This review followed the PRISMA criteria and is registered on the PROSPERO platform (CRD42017081865). The PICO question was "Do welding procedures in one-piece cast implant-supported frameworks influence implant/abutment-framework marginal misfits?" Eleven studies were selected for a qualitative analysis, and seven studies were selected for a quantitative analysis. A total of 189 specimens were fabricated using different materials (cp-Ti, Ni-Cr, Cr-Co, and noble alloys), and welding techniques such as laser welding, conventional welding, tungsten inert gas, and brazing were applied. A vertical marginal misfit was measured using an optical microscope, a stereomicroscope, and/or a scanning electron microscopy. The qualitative analysis in the studies demonstrated a positive effect of the welding techniques on the adaptation of the infrastructures. The meta-analysis confirmed the results (p < 0.00001; MD: -36.14; 95%CI: -48.69 to -23.59). Within the limitations of this study and regarding the heterogeneity of the samples, we conclude that the soldering point technique is effective for obtaining relatively low values of marginal misfit, with laser welding as the most effective technique. However, additional studies were recommended due to the heterogeneity of different variables (alloys, connection, and misfit evaluation) in the included studies.


Asunto(s)
Prótesis Dental de Soporte Implantado/métodos , Soldadura Dental/métodos , Soldadura/métodos , Técnica de Colado Dental , Adaptación Marginal Dental , Diseño de Prótesis Dental , Humanos , Ajuste de Prótesis
3.
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
4.
Rev Saude Publica ; 532019 Aug 19.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31432931

RESUMEN

OBJECTIVE: To conduct a cost-effectiveness analysis of alternatives for rehabilitation treatment of mandibular edentulism in the context of the Brazilian Unified Health System (implant-supported total dental prosthesis versus conventional total dental prosthesis). METHODS: A Markov model was developed to capture long-term clinical and economic outcomes. The model's population was comprised of a hypothetical cohort of 1,000,000 patients, aged 55 years, with total mandibular edentulism and without medical contraindications for performing surgical procedures. The adopted analysis perspective was that of the Brazilian Unified Health System. Based on the proposed model, we calculated cost - in BRL, and effectiveness - measured by quality-adjusted prosthesis year (QAPY). The time horizon of the analysis was 20 years. RESULTS: Considering a 5% discount in costs and effects, the incremental cost-effectiveness ratio of implant-supported total dental prostheses compared to conventional total dental prosthesis (BRL 464.22/QAPY) was lower than the willingness to pay threshold adopted in the model (BRL 3,050.00/QAPY). CONCLUSIONS: The results of this economic analysis showed that the rehabilitation of mandibular edentulous patients by implant-supported total prosthesis is very cost-effective when compared to conventional complete prosthesis, considering the cost-effectiveness limits employed.


Asunto(s)
Prótesis Dental de Soporte Implantado/economía , Dentadura Parcial Fija/economía , Boca Edéntula/economía , Brasil , Análisis Costo-Beneficio , Implantes Dentales/economía , Prótesis Dental de Soporte Implantado/métodos , Humanos , Persona de Mediana Edad , Boca Edéntula/rehabilitación , Programas Nacionales de Salud
5.
J Appl Oral Sci ; 27: e20180600, 2019 Aug 12.
Artículo en Inglés | MEDLINE | ID: mdl-31411262

RESUMEN

OBJECTIVE: The immediate loading of implant-assisted fixed prostheses in edentulous maxillae may achieve favorable success rates with reduced treatment time. An evidence summary of clinical trials is key to recommend loading protocols in these cases. OBJECTIVES: To compare immediately loaded, fully implant-supported complete dentures to early and conventional/delayed loading in the edentulous maxillae of adult patients by a systematic review of controlled clinical trials (CCT). METHODOLOGY: CCTs reports were identified up to January 17, 2019 from Cochrane Oral Health Group's Trial register, Cochrane Central Register of controlled trials (CENTRAL), MEDLINE (Ovid), BIOSIS, EMBASE, CINAHL, Web of Science, and DARE. Two independent reviewers screened titles/abstracts and confirmed inclusion using full texts. Data were extracted and quality assessed (Cochrane Risk of Bias tool) independently and in duplicate. Study heterogeneity prevented pooling by meta-analysis. RESULTS: Out of 1,052 candidate studies, four CCTs were included. Two trials had patient satisfaction as an outcome: (1) A randomized trial compared immediately and early loaded fixed dentures and found more satisfaction with the first after 12 months; (2) A non-randomized study found better satisfaction with immediate fixed dentures compared to conventional loading after 3 months (no more at 12 months). Regarding implant success and prosthetic complications, three trials did not report significant differences comparing immediate loading to other protocols. CONCLUSIONS: This review found weak evidence of differences between immediate load and other loading regimens, regarding patient satisfaction and maintenance events/adversities. The potential of immediate loading for favorable results in edentulous maxillae reinforces the need for well-designed RCTs, for solid clinical guidelines. Registration number CRD42018071316 (PROSPERO database).


Asunto(s)
Prótesis Dental de Soporte Implantado/métodos , Dentadura Completa , Carga Inmediata del Implante Dental/métodos , Ensayos Clínicos Controlados como Asunto , Humanos , Sesgo de Publicación , Factores de Riesgo , Resultado del Tratamiento
6.
Rom J Morphol Embryol ; 60(1): 233-241, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31263850

RESUMEN

The aim of this paper is to eliminate suspicions of a titanium (Ti) allergy in a rare case of "flowered" implant in a 43-year-old female patient with metal allergies and no history of bruxism, using a histological and immunohistochemical (IHC) analysis to determine the phenotype of cells that participated in the immune response; also, to assess the prognosis of a future implant treatment and to highlight the psychological impact of osseointegrated implant failure caused by fracture, and the influence that the necessity to use extensive surgical procedures for reimplantation can have on the treatment solution chosen by the patient. The results of our IHC analysis did not indicate a clear response for a potential Ti allergy; still, due to psychological reasons, the patient rejected the replantation and considered the use of other restorative option, a three-unit bridge, as being the most appropriate for her. Considering her opinion and attitude, the fixed prosthetic denture assured the therapeutic success.


Asunto(s)
Prótesis Dental de Soporte Implantado/métodos , Hipersensibilidad/complicaciones , Titanio/efectos adversos , Adulto , Femenino , Humanos
7.
Oral Maxillofac Surg Clin North Am ; 31(3): 399-426, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31253346

RESUMEN

The treatment of completely edentulous or soon-to-be completely edentulous dental arches with complete-arch fixed denture restorations, supported by dental implants, are some of the more complicated patient cases in oral and maxillofacial surgery and prosthodontics. This article discusses the use of digital technologies, computerized tomographic (CT) guided planning software applications, and surgical guides in treating these complex dental implant patient cases. A discussion of the nuances and workflows of different types of treatments are provided. The importance of experience and a multi-disciplinary team approach is emphasized.


Asunto(s)
Implantación Dental Endoósea/métodos , Implantes Dentales , Prótesis Dental de Soporte Implantado/métodos , Arcada Edéntula , Cirugía Asistida por Computador/normas , Diseño Asistido por Computadora , Diseño de Prótesis Dental/métodos , Dentición , Humanos
8.
J Appl Oral Sci ; 27: e20180434, 2019 Jun 13.
Artículo en Inglés | MEDLINE | ID: mdl-31215598

RESUMEN

This study aimed to compare the linear dimensions of the dental arches of adult patients with complete unilateral cleft lip and palate (UCLP) after orthodontic and prosthetic treatment with fixed partial dentures (FPD) to patients without clefts, using 3D technology. This retrospective longitudinal study sample consisted of 35 subjects divided into two groups. Included in this sample were 15 complete UCLP individuals who had received orthodontic treatment before rehabilitation with a fixed partial denture (FG), as well as 20 patients without cleft as control group (CG). All patients were aged between 18 and 30 years. Digital dental casts were obtained in two stages: (T1) end of orthodontic treatment and (T2) one year after prosthetic rehabilitation (FG); and (T1) end of orthodontic treatment and (T2) one year after removal of the orthodontic appliance (CG). Intercanine, interfirst premolar and intermolar distances, and incisor-molar length were obtained. A precalibrated and trained examiner performed the assessments. Intergroup differences between T2 and T1 were compared between the groups using the t test or Mann-Whitney test with a significance level of 5% (p<0.05). The intercanine distance variation (T2-T1) showed statistical difference (p=0.005) increasing in the FG group and decreasing in the CG group. In the interfirst premolar distance variation, FG decreased, while CG increased with statistically significant difference (p=0.008). The intercanine distance of individuals with cleft showed stability, while that of the CG had no stability. The CG showed stability in the interfirst premolar distance, while FG had no stability. These findings showed that the FPD is capable of restricting orthodontic results, leading to a stabilization of the dental arches.


Asunto(s)
Labio Leporino/rehabilitación , Fisura del Paladar/rehabilitación , Arco Dental/patología , Prótesis Dental de Soporte Implantado/métodos , Imagenología Tridimensional/métodos , Ortodoncia Correctiva/métodos , Adolescente , Adulto , Puntos Anatómicos de Referencia , Labio Leporino/patología , Fisura del Paladar/patología , Femenino , Humanos , Masculino , Maxilar/patología , Aparatos Ortodóncicos , Valores de Referencia , Estudios Retrospectivos , Estadísticas no Paramétricas , Resultado del Tratamiento , Adulto Joven
9.
Artículo en Inglés | MEDLINE | ID: mdl-30866465

RESUMEN

Background: The objective of this study was to compare conventional versus digital impressions for Full-Arch maxillary rehabilitations. Methods: Patients selected for this study were treated with full-arch screw-retained rehabilitations supported by six immediately loaded dental implants. Patients have been scheduled randomly into control (conventional impression group, CIG) and test (digital impression group, DIG) groups respectively for a fully conventional workflow and a fully digital workflow. In both groups, within 24 h, temporary prostheses were delivered. Four months after the implant positioning, the two groups dealt with the fabrication of definitive restorations: conventional pick-up was performed in the control group, and definitive digital impressions were carried out in the test group. The time involved following these two procedures was recorded. Patients underwent intraoral digital radiographs to evaluate the accuracy of the framework-implant connection, check for the presence of voids at the bar-implant connection and measure bone level. Criteria used to assess success at the prosthetic level were the occurrence of prosthetic maintenance, the absence of fractures of the acrylic resin superstructure and voids. Results: A total of 50 patients received immediately loaded prostheses supported by six implants (total 300 implants). A fixture and prosthetic survival rate of 100% was observed. All digital X-ray examinations revealed a bar-implant connection accuracy and no voids. Differences that were not statistically significant (p > 0.05) in marginal bone loss were found between control and test groups. Significantly less time was spent to perform digital impression procedure (p < 0.05). Conclusions: Clinical and radiological results of the test group advocate a satisfactory accuracy and predictability of the intraoral scanner (IOS) to be a reliable alternative in clinical practice for implant full-arch rehabilitations and suggest fabrication of definitive restorations with a successful marginal fit precision.


Asunto(s)
Técnica de Impresión Dental/instrumentación , Prótesis Dental de Soporte Implantado/métodos , Anciano , Tornillos Óseos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo , Resultado del Tratamiento
10.
Int J Prosthodont ; 32(32): 214-216, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30856651

RESUMEN

Patients presenting both severe maxillary atrophy and dental malposition require a multidisciplinary treatment approach to achieve optimal esthetic and functional results. This case history report demonstrates how digital treatment planning and teeth set-up can serve as a reference for surgical, orthodontic, and prosthodontic procedures, leading to an all-ceramic full-arch implant-supported fixed prosthesis.


Asunto(s)
Periodontitis Crónica/complicaciones , Periodontitis Crónica/terapia , Prótesis Dental de Soporte Implantado/métodos , Planificación de Atención al Paciente , Grupo de Atención al Paciente , Impresión Tridimensional , Adulto , Estética Dental , Femenino , Humanos , Maloclusión/complicaciones , Atrofia Periodontal/etiología , Pérdida de Diente/etiología , Pérdida de Diente/terapia
11.
Int J Oral Maxillofac Implants ; 34(2): 451-460, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30883621

RESUMEN

PURPOSE: The goal of this study was to compute the estimated cumulative survival and success rates of alumina-toughened zirconia (ATZ) abutments used for external connection-type implant-supported fixed dental prostheses (FDPs) after a mean follow-up of 6.9 years (82.3 months). MATERIALS AND METHODS: From May 1998 to July 2016, patients who provided informed consent and received implant-supported restorations with ATZ abutments were recruited. Clinical performance of zirconia abutments was evaluated using survival analysis. Failure was defined as the removal of the restoration due to zirconia abutment fracture, and complications included both failure and abutment screw problems. Survival and success were the counterparts of failure and complications, respectively. The effects of restoration-related factors (restored area, type of prosthesis, and implant system) on the survival and success of the abutments were estimated. RESULTS: A total of 231 patients were included in this study. One hundred twenty-six implant-supported single-unit and 204 multiple-unit FDPs were evaluated. All the placed implants had the external hex connection. The estimated cumulative 5-year, 7-year, and 10-year survival rates (95% confidence interval [CI]) of zirconia abutment-supported FDPs were 97.3% (95.5% to 99.1%), 96.8% (94.8% to 98.8%), and 94.1% (90.4% to 97.8%), respectively. The estimated cumulative 5-year, 7-year, and 10-year success rates (95% CI) were 94.1% (91.4% to 96.8%), 90.8% (87.3% to 94.3%), and 80.1% (73.6% to 86.6%), respectively. The type of prosthesis (P = .001) and implant system (P < .001) were the significant factors in the success of zirconia abutment-supported FDPs. CONCLUSION: Prefabricated ATZ abutments have a high predictability of survival at 10 years when used in implant-supported FDPs that replace both anterior and posterior teeth. However, the success of zirconia abutments was significantly influenced by the type of prosthesis and implant system.


Asunto(s)
Óxido de Aluminio/química , Pilares Dentales , Materiales Dentales/química , Prótesis Dental de Soporte Implantado/métodos , Circonio/química , Adulto , Anciano , Anciano de 80 o más Años , Fracaso de la Restauración Dental , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Análisis de Supervivencia , Adulto Joven
12.
Int J Oral Maxillofac Implants ; 34(2): e17-e19, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30883628

RESUMEN

Subgingival presence of remaining excess cement may lead to implant complications and failures. This is a technical report and advice on how to cement implant-supported restorations using a simple and universal method applying liquid petroleum jelly to the peri-implant sulcus after cementation. This simple and user-friendly method eliminates excess cement and should be used in the daily practice.


Asunto(s)
Cementación/métodos , Cementos Dentales , Retención de Prótesis Dentales/métodos , Prótesis Dental de Soporte Implantado/métodos , Cementos para Huesos , Humanos , Irrigación Terapéutica
13.
Artículo en Inglés | MEDLINE | ID: mdl-30794256

RESUMEN

Implant-supported prosthetics are a suitable option for improving partially and totally edentulous patients' oral life quality, especially those patients with a history of periodontitis who experience early tooth loss and therefore require implant therapy. However, long-term clinical studies on dental implants have indicated that patients with periodontitis show more biologic complications and lower survival and success rates compared to periodontally healthy patients. The two clinical reports presented show that patients with aggressive periodontal diseases treated with a supportive periodontal therapy can be successfully rehabilitated with implant-supported double-crown restorations for a follow-up period of over 20 years.


Asunto(s)
Periodontitis Agresiva/cirugía , Coronas , Prótesis Dental de Soporte Implantado/métodos , Restauración Dental Permanente/métodos , Adolescente , Adulto , Estudios de Seguimiento , Humanos , Masculino
14.
Int J Oral Maxillofac Implants ; 34(3): 719­725, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30779822

RESUMEN

PURPOSE: To evaluate the clinical and radiographic outcomes of full-arch mandibular rehabilitation with fixed prostheses supported by three immediately loaded implants after at least 5 years of follow-up. MATERIALS AND METHODS: The sample comprised 58 patients who underwent treatment with immediate loading. Radiographic evaluation of bone loss was carried out in Adobe Photoshop CS5 by a single calibrated examiner using digitized panoramic radiographs. Clinical examination of the technical conditions of the prosthetic device assessed the condition of the acrylic resin base, dental occlusion, metal framework, presence of cover screws, screw fixation of the prosthesis and abutments, and length of cantilever and resistance arms. RESULTS: Five implants in four patients failed, for an overall success rate of 97.13%. Mean bone loss was 2.65 ± 1.06 mm around central implants and 2.11 ± 0.84 mm around distal implants. The most common complication was loss of abutment torque. Half of all patients in the sample experienced some prosthetic complication. There was no evidence of a statistically significant relationship of cantilever length with bone loss or prosthetic complications. CONCLUSION: The immediately loaded three-implant-supported fixed prosthesis protocol tested in this study proved to be a viable therapeutic strategy for mandibular rehabilitation in edentulous patients, with favorable outcomes after 5 years of clinical and radiographic follow-up.


Asunto(s)
Implantación Dental Endoósea/métodos , Implantes Dentales , Prótesis Dental de Soporte Implantado/métodos , Carga Inmediata del Implante Dental , Arcada Edéntula/rehabilitación , Mandíbula/cirugía , Anciano , Anciano de 80 o más Años , Tornillos Óseos , Femenino , Estudios de Seguimiento , Humanos , Arcada Edéntula/cirugía , Masculino , Persona de Mediana Edad , Radiografía Panorámica , Estudios Retrospectivos , Torque
15.
J Prosthet Dent ; 121(1): 52-58, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30006223

RESUMEN

STATEMENT OF PROBLEM: Cement-retained implant-supported prostheses eliminate screw loosening and enhance esthetics. However, retrievability and the possibility of removing extruded excess cement (EEC) have been problematic. PURPOSE: The purpose of this systematic review was to analyze the effects of modifying the screw access channel (SAC) on the amount of EEC and the retention of cement-retained implant-supported prostheses. MATERIAL AND METHODS: PubMed, Web of Science, Scopus, and Google Scholar databases were searched with appropriate key words. Related titles and abstracts published up to June 2017 were screened and selected on the basis of defined inclusion criteria. Full texts of all studies were read and subjected to quality assessments. After the initial search, 1521 articles were included in the study. Of these, 11 studies were subjected to critical appraisal, and 10 of them were reliable enough in methodology to be systemically reviewed. RESULTS: All the studies were in vitro and described a total of 260 specimens. According to the interpreted results, closed SACs caused lower retention with a higher amount of EEC, whereas open SACs caused the reverse. Also, as the abutment height decreased, retention decreased. CONCLUSIONS: Extending the crown's margin into the SAC, leaving the SAC open, and using internal vents in the SAC space are possible methods of modifying the SAC to gain higher retentive values. Also, the use of internal vents in the SAC system and open or partially filled SAC space reduce the amount of EEC.


Asunto(s)
Tornillos Óseos , Cementos Dentales/efectos adversos , Implantes Dentales , Retención de Prótesis Dentales/métodos , Prótesis Dental de Soporte Implantado/métodos , Coronas , Bases de Datos Factuales , Pilares Dentales , Fracaso de la Restauración Dental , Restauración Dental Permanente/métodos , Restauración Dental Provisional/métodos , Estética Dental , Humanos
16.
J Prosthet Dent ; 121(1): 26-31, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-29961624

RESUMEN

The conversion of a denture into an interim implant-supported, screw-retained restoration has become the standard method for immediate interim restoration in patients with complete edentulism. The most critical steps of the denture conversion process are the creation of appropriate denture access holes to prevent displacement of the denture by the interim cylinders and removal of the denture flanges to facilitate both good esthetics and accessibility for oral hygiene after the denture is connected to the interim cylinders. This article presents a digital technique for designing and fabricating an interim implant-supported, fixed prosthesis for edentulous patients. The interim prosthesis has cylinder access holes that are digitally prefabricated and a denture flange part that is designed to be easily sectioned. This technique facilitates more straightforward and efficient immediate restoration for edentulous patients after implant placement.


Asunto(s)
Implantes Dentales , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado/métodos , Dentadura Completa Inmediata , Carga Inmediata del Implante Dental , Arcada Edéntula/cirugía , Resinas Acrílicas , Diseño Asistido por Computadora , Modelos Dentales , Bases para Dentadura , Diseño de Dentadura/métodos , Dentadura Completa Inferior , Humanos , Mandíbula/patología , Mandíbula/cirugía , Boca Edéntula/cirugía , Impresión Tridimensional
17.
J Prosthet Dent ; 121(1): 129-134, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-29961625

RESUMEN

STATEMENT OF PROBLEM: The gradual loss of retention and the need for periodic replacement of attachment-system components are the most frequent complications in implant-supported overdentures. PURPOSE: The purpose of this in vitro study was to develop a new attachment system for overdentures with polymeric materials and compare its retention and deformation with a conventional O-ring attachment system. MATERIAL AND METHODS: A matrix with 2 mini-implants with ball abutments was used to simulate the mandibular border during a fatigue resistance test. A total of 60 polyacetal (n=20), polytetrafluoroethylene (n=20), and conventional O-ring (n=20) attachments were captured in pairs with acrylic resin and subjected to 3625 insertion and removal cycles, simulating 30 months of overdenture use. The internal and external deformations of the attachments were assessed using an optical stereomicroscope. One-way ANOVA and the Tukey honestly significant difference tests were used for statistical evaluation (α=.05). RESULTS: The polyacetal attachment system showed the highest retention (P<.001), followed by the O-ring and polytetrafluoroethylene attachments. The O-ring attachments exhibited the lowest deformation (P<.001), and the polyacetal attachments had the highest internal deformation (P<.001). CONCLUSIONS: The newly developed polyacetal attachment model increased the retention of mini-implant-retained overdentures, and despite the deformation experienced, the retention period appears to be better than that of conventional systems.


Asunto(s)
Implantes Dentales , Prótesis Dental de Soporte Implantado/instrumentación , Ajuste de Precisión de Prótesis , Retención de Dentadura , Prótesis de Recubrimiento , Acetales/química , Pilares Dentales , Prótesis Dental de Soporte Implantado/métodos , Análisis del Estrés Dental , Humanos , Técnicas In Vitro , Mandíbula , Ensayo de Materiales , Polímeros/química , Politetrafluoroetileno/química
18.
J Prosthet Dent ; 121(1): 41-51, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-29961632

RESUMEN

STATEMENT OF PROBLEM: The decision to splint or to restore independently generally occurs during the planning stage, when the advantages and disadvantages of each clinical situation are considered based on the proposed treatment. However, clinical evidence to help clinicians make this decision is lacking. PURPOSE: The purpose of this systematic review and meta-analysis was to assess the marginal bone loss, implant survival rate, and prosthetic complications of splinted and nonsplinted implant restorations. MATERIAL AND METHODS: This study was designed according to the Cochrane criteria for elaborating a systematic review and meta-analysis and adopted the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Also, this review was registered at the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42017080162). An electronic search in the PubMed/MEDLINE, Cochrane Library, and Scopus databases was conducted up to November 2017. A specific clinical question was structured according to the population, intervention, comparison, outcome (PICO) approach. The addressed focused question was "Should the restoration of adjacent implants be splinted or nonsplinted?" The meta-analysis was based on the Mantel-Haenszel and inverse variance methods to assess the marginal bone loss, implant survival, and prosthetic complications of splinted and nonsplinted implant restorations. RESULTS: Nineteen studies were selected for qualitative and quantitative analyses. A total of 4215 implants were placed in 2185 patients (splinted, 2768; nonsplinted, 1447); the mean follow-up was 87.8 months (range=12-264 months). Quantitative analysis found no significant differences between splinted and nonsplinted restorations for marginal bone loss. The assessed studies reported that 75 implants failed (3.4%), of which 24 were splinted (99.1% of survival rate) and 51 were nonsplinted (96.5% of survival rate). Quantitative analysis of all studies showed statistically significant higher survival rates for splinted restorations than for nonsplinted restorations. Ceramic chipping, screw loosening, abutment screw breakage, and soft tissue inflammation were reported in the selected studies. The quantitative analysis found no statistically significant difference in the prosthetic complications of splinted and nonsplinted restorations. CONCLUSIONS: Within the limitations of this systematic review and meta-analysis, it was concluded that there was no difference in the marginal bone loss and prosthetic complications of splinted and nonsplinted implant restorations; this is especially true for restorations in the posterior region. However, splinted restorations were associated with decreased implant failure.


Asunto(s)
Implantación Dental Endoósea/métodos , Implantes Dentales , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado/métodos , Férulas (Fijadores) , Pérdida de Hueso Alveolar/etiología , Bases de Datos Factuales , Retención de Prótesis Dentales , Fracaso de la Restauración Dental , Humanos , Falla de Prótesis , Férulas (Fijadores)/efectos adversos
19.
J Prosthodont ; 28(2): e682-e687, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-29286181

RESUMEN

PURPOSE: To evaluate implant impression accuracy with a new tray design concept in comparison to nonsplinted and splinted impression techniques for a 2-implant situation. MATERIALS AND METHODS: A reference bar titanium framework was fabricated to fit on 2 parallel implants. The framework was used to generate a resin master model with 2 implants that fit precisely against the framework. Three impression techniques were evaluated: (1) nonsplinted, (2) splinted, and (3) nonsplinted with modified tray impressions. All the trays were fabricated from light-cured acrylic resin material with openings that corresponded to the implant impression copings. Ten impressions were taken for each technique using poly(vinyl siloxane) impression material. The impressions were poured with type IV dental stone to generate the test casts. A rosette strain gauge was bonded to the middle of the framework. As the framework retaining screws were tightened on each test cast, the developed strains were recorded until the completion of the tightening to 35 Ncm. The generated strains of the rosette strain gauge were used to calculate the maximum principal strain. RESULTS: A statistically significant difference was observed among the different impression techniques. The modified tray design impression technique was associated with the least framework strains, which indicates greater accuracy compared with the other techniques. There was no significant difference between the splinted and the nonsplinted impression techniques. CONCLUSIONS: The new tray design concept appeared to produce more accurate implant impressions than the other techniques. Despite the statistical difference among the impression techniques, the clinical significance of this difference is yet to be determined.


Asunto(s)
Implantes Dentales , Técnica de Impresión Dental/instrumentación , Diseño de Prótesis Dental/instrumentación , Materiales de Impresión Dental , Diseño de Prótesis Dental/métodos , Prótesis Dental de Soporte Implantado/instrumentación , Prótesis Dental de Soporte Implantado/métodos , Humanos , Reproducibilidad de los Resultados
20.
J Prosthet Dent ; 121(1): 17-21, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30093118

RESUMEN

This article describes a workflow based on a top-down approach to provide a fixed-type immediate interim restoration after placing a single implant using a digitally driven surgical guide and a matrix-positioning device. A characteristic of the technique is that both the surgical guide and the matrix-positioning device are fabricated from a single diagnostic virtual trial restoration designed on computer-aided design (CAD) software. This workflow may shorten the time required for chairside placement of an interim restoration and enhance esthetics when rehabilitating anterior teeth.


Asunto(s)
Diseño Asistido por Computadora , Implantes Dentales de Diente Único , Carga Inmediata del Implante Dental/métodos , Cirugía Asistida por Computador/métodos , Flujo de Trabajo , Coronas , Implantes Dentales , Modelos Dentales , Diseño de Prótesis Dental/métodos , Prótesis Dental de Soporte Implantado/métodos , Restauración Dental Provisional , Estética Dental , Humanos
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