Marginal Bone Stability Around Tapered, Platform-Shifted Implants Placed with an Immediately Loaded Four-Implant-Supported Fixed Prosthetic Concept: A Cohort Study.

PURPOSE: To longitudinally evaluate marginal bone remodeling around tapered, platform-shifted implants placed for total arch rehabilitation with fixed hybrid prostheses. MATERIALS AND METHODS: A retrospective cohort study was designed that evaluated radiographic data from patients undergoing implant surgical procedures with an immediately loaded four-implant-supported fixed prosthetic concept in a single clinic setting during a 36-month period. The primary outcome variable was the change in marginal bone levels during a 12- to 36-month follow-up postloading with the definitive prosthesis. All measurements were performed on matched and calibrated periapical radiographs obtained at: (1) the time of placement of the definitive prosthesis (baseline) versus (2) 12 to 36 months following definitive loading (follow-up). Other study variables, including duration of follow-up, implant position, maximum insertion torque, implant angulation, and implant diameter, were assessed for their association with changes in marginal bone levels. RESULTS: One hundred sixty-nine patients (n = 856 implants) with a mean age of 59.5 ± 10.5 years were included in this study. Two implants failed, resulting in a 99.8% overall survival rate (mean follow-up: 15.2 ± 4.8 months, range: 12 to 36 months). The radiographic mean bone levels at baseline and follow-up were 1.16 ± 0.71 mm (n = 805) and 1.31 ± 0.93 mm (n = 805), respectively. The mean marginal bone loss from baseline to follow-up was 0.14 ± 0.59 mm (n = 805). The duration of follow-up had no effect on the extent of marginal bone loss (P = .154). CONCLUSION: Within the limitations of this large-scale retrospective cohort study, it was concluded that the use of tapered, platform-shifted implants for total arch rehabilitation with the use of the All-on-Four protocol yields very favorable radiographic outcomes, at least after a minimum of 12 months in function.

Clinical evaluation of 262 osseointegrated implants placed in sites grafted with calcium phosphosilicate putty: a retrospective study.

Along with the widespread use of dental implants, regenerative procedures have become an indispensable tool for implant surgeons in managing residual ridges and the surrounding bone. Putty bone grafts have significantly superior handling characteristics in comparison to particulates. These include ease of placement, enhanced particle containment, and a viscous consistency that has allowed for unique delivery systems to be developed. The aim of this study was to report the clinical efficacy of calcium phosphosilicate (CPS) putty in a wide variety of indications related to implant reconstruction and to report the survival rate of implants placed in these grafted sites. The CPS putty was used as the graft material of choice. Treatments were categorized into following groups: extraction graft, extraction with immediate implant placement, all-on-four concept, peri-implantitis treatment, bone augmentation before implant placement, implant replacement graft, and grafting around implant placed in resorbed ridges. Included in the analysis were 65 patients (36 men, 29 women) with a mean age of 63 ± 12 years. In total, 262 implants were placed. Four implants were diagnosed with peri-implantitis and were treated as described in category 4, for a total of 266 grafted sites. Two implants from the extraction graft category and 3 implants from the all-on-four group were lost and replaced with successfully osseointegrated implants during a mean study follow-up period of 12.24 ± 2.32 months. The implant success rate at 1 year was 98.1% (257/262). Based on results of this large-scale, retrospective study we conclude that (1) the use of putty bone grafts can simplify bone-grafting procedures and reduce intraoperative time in various grafting indications, (2) this study verified the efficacy of a CPS putty bone graft biomaterial in a large array of implant-related surgical indications, and (3) implants placed in sites grafted with CPS putty yield very high survival rates.

Patient-related and financial outcomes analysis of conventional full-arch rehabilitation versus the All-on-4 concept: a cohort study.

BACKGROUND: Patient-related variables such as cost of treatment, length of the treatment period, and comfort provided by the interim prosthesis when treatment planning for full-arch rehabilitation are often neglected in dental publications. METHODS: Two patient cohorts were followed up longitudinally in this study: the "All-on-4 treatment concept group" and the "historical group." The number of implants, total treatment time, number of surgical procedures, number of sinus grafts, necessity for immediate provisional implants, adjusted cost associated for treatment in each group, and the quality of interim prosthesis were compared. RESULTS: The total adjusted cost for patients receiving All-on-4 treatment concept averaged at $42,422 ± 3860 (&OV0556;31,392 ± 2856), whereas the mean total adjusted cost for the historical group was $57,944 ± 20,198 (&OV0556;42,879 ± 2113) (P = 0.01). The difference in cost had a mean value of $7307 (&OV0556;5407) per jaw. Factors associated with complexity of treatment and patient comfort, such as the quality of interim prosthesis, number of surgeries, and duration of treatment time, all significantly favored the All-on-4 treatment concept group in comparison with conventional treatment modalities. CONCLUSIONS: When implant rehabilitation of the total jaw is sought, the All-on-4 treatment concept should be considered the least costly and least time consuming treatment option.

A new approach to the All-on-Four treatment concept using narrow platform NobelActive implants.

Although a number of approaches to implant-supported restoration of severely atrophic maxillae and mandibles have been developed, most of these treatments are costly and protracted. An exception is the All-on-Four concept, which uses only 4 implants to support an acrylic, screw-retained provisional prosthesis delivered on the day of implant placement, followed by a definitive prosthesis approximately 4 months later. After the introduction of a new implant design in 2008, a new protocol was developed for provisionally treating patients with severely atrophic jaws using the All-on-Four concept and 3.5-mm-diameter implants. This article describes that protocol and reports on the results of 227 implants after 1 to 3 years of follow-up. The cumulative survival rate was 98.7% at the end of 3 years, with a 100% prosthetic survival rate. Combining the 3.5-mm-diameter NobelActive implants with the All-on-Four concept promises to become a new standard of care for severely compromised patients.

Posttreatment quantification of patient experiences with full-arch implant treatment using a modification of the OHIP-14 questionnaire.

Patient well-being is always the goal of rehabilitation of edentulism; however, evaluations of treatment success often overlook the patient's subjective feelings about comfort, function, speech, social image, social inhibitions, psychological discomfort, and/or disabilities. The purpose of this study was to assess these patient responses using an oral health questionnaire. To assess such feelings, a self-administered 20-question multiple-choice patient-reported Edentulous Patient Impact Questionnaire was developed, based upon the previously validated Oral Health Impact Profile patient-assessment tool. Responses were solicited from randomly selected patients treated with an implant-supported, fixed, immediately loaded full arch prosthesis. The questionnaires were completed by 250 patients. Of the respondents, 95% described themselves as being either extremely satisfied (74%) or satisfied (21%) with their new teeth, and 98% said they would definitely recommend similar treatment (88%) or consider recommending it (10%) to a friend or colleague. Based upon an oral health impact survey completed by 250 patients treated with full-arch implant-supported, immediately loaded fixed dental prostheses, it appears that patient satisfaction is high and that treated patients would generally be willing to recommend this treatment to others.

A single-center retrospective analysis of 1001 consecutively placed NobelActive implants.

This single-center retrospective study evaluated the survival rates of the NobelActive implant (Nobel Biocare AB, Gothenburg, Sweden) with a tapered body design. One thousand and one implants demonstrated a cumulative survival rate of 97.4% (97.1% in maxilla and 98% in the mandible) for up to 31 months of loading.

The all-on-four immediate function treatment concept with NobelActive implants: a retrospective study.

The All-on-Four treatment concept provides patients with an immediately loaded fixed prosthesis supported by 4 implants. This single-center retrospective study evaluated the concept while using the NobelActive implant (Nobel Biocare, Gothenburg, Sweden). Seven hundred eight implants placed in 165 subjects demonstrated a cumulative survival rate of 99.6% (99.3% in maxilla and 100% in the mandible) for up to 29 months of loading. The definitive prosthesis survival rate was 100%.

A new transitional abutment for immediate aesthetics and function.

Maintenance of the patient's self-esteem and confidence throughout the implant-treatment process is essential. Development of a provisional prosthesis that will be stable and esthetic should begin with the initial examination and should involve all members of the implant team. This article presents 3 cases that demonstrate a team-centered approach in using a poly (acrylether) ketone plastic provisional abutment (Peek). This abutment, cost-effective and easily modified, supports a transitional prosthesis that is delivered at the time of implant placement.

A new atraumatic system for tooth removal and immediate implant restoration.

Methods for extracting teeth have remained remarkably static over the decades, with trauma to the surrounding tissues continuing to be a common occurrence. This article reviews the mechanisms involved in traditionally extracting teeth,and discusses a technological breakthrough that enables nonmolar intact teeth to be extracted mechanically and atraumatically. The benefits of using this technology include preservation of the adjacent papillae and underlying host bone, along with dramatically improved patient experiences. Teeth that are extracted with an innovative system may be immediately replaced with implants.

Evolution of a dental implant practice. The Camlog implant system.

After extensive experience with a variety of implant systems dating back to the late 1960s, the author has begun placing Camlog implants, developed by Dr. Axel Kirsch. The design of this system eliminates the risk of rotation and screw-loosening, while at the same time offering extraordinary ease of use. The treatment of three patients with Camlog implants is described.

An in vitro and in vivo evaluation of autologous platelet concentrate in oral reconstruction.

A platelet concentrate, when combined with calcified thrombin, produces a platelet gel that has been used to achieve hemostasis and modulate bone growth and wound healing. The recovery of high concentrations of viable platelets and their resulting growth factor levels represents the most important factor in the clinical utility of a platelet concentrate because only functional platelets can release the growth factors that are necessary to induce tissue growth and bone regeneration. The SmartPReP system's efficiency in recovery of platelets from a sample of whole blood averaged 70.6%, almost twice that of various manual techniques using laboratory centrifuges. Platelet concentrates prepared by the SmartPReP system had a viability equal to platelet concentrates prepared for transfusion as measured by hypotonic stress, platelet aggregation, and p-selectin. A series of clinical case studies demonstrates the use of autologous platelet gel in oral surgery.

Histologic evaluation of human biopsies after dental augmentation with a demineralized bone matrix putty.

To solve some of the problems inherent in bone regeneration, various types of graft materials, matrix, putty, and gel delivery systems have been developed. These deliver demineralized bone matrix (DBM) to a graft site and maintain it in an appropriate position to achieve favorable results. This prospective study reviewed 10 cases of extraction immediate grafting with a putty-DBM delivery system. Five patients were male and 5 female. At intervals ranging from 4 to 21 months postextraction grafting, bone cores were harvested at the time of surgical insertion of Replace endosteal two-stage implants. All patients were restored with single-tooth self-standing prostheses. Bone quality and quantity in each of the bone cores were evaluated. All 10 cases were completed with favorable outcomes.