Early complications and quality of life in patients with immediately loaded implant-supported maxillary partial rehabilitations: A prospective cohort study / Complicaciones tempranas y calidad de vida en pacientes con rehabilitaciones parciales maxilares implantosoportadas con carga inmediata: un estudio de cohorte prospectivo

Background: Immediate loading of dental implants is considered an excellent option to reestablish function and aesthetics in a short period of time, thereby reducing the psychological impact of edentulism. The aim of this study was to describe the incidence of complications in immediately loaded implant-supported single or partial maxillary provisional rehabilitations; to assess changes in patient quality of life (QoL); to evaluate patient overall satisfaction; and to determine whether the occurrence of complications affects these outcomes. Material and Methods: Patients requiring partial rehabilitation with implants in the maxilla were included in a prospective cohort study. In all cases, implant-based restoration with an immediate loading protocol was indicated. A provisional restoration was placed within 72 hours after implant placement. Patient QoL was measured at the first appointment and just before placing the final restoration, using two validated questionnaires. All mechanical and biological complications occurring up until placement of the final restoration were documented. A descriptive and bivariate analysis of the data was performed. Results: Thirty-five patients with 40 prostheses supported by 60 implants were analyzed. Three implant failures were observed, yielding a 95% survival rate. Five provisional prosthesis fractures and two prosthetic screw loosenings were recorded in four patients. A significant reduction in OHIP-14 score was observed. Likewise, significant differences were found in the results of the QoLFAST-10, with a mean difference in score of 7.3 between the initial and final evaluation. Conclusions: Patients receiving immediately loaded implant-supported single or partial maxillary provisional rehabilitations seem to have a low risk of developing early mechanical (13.3%) or biological complications (5%)...(AU)

Retrospective Cohort Study on the Influence of Bone Remodeling on Marginal Bone Loss and Peri-implantitis Around Immediately Loaded Implants Supporting Complete-Arch Restorations.

PURPOSE: The main objective of this study was to assess the influence of bone remodeling on late marginal bone loss in immediately loaded, implant-supported, complete-arch restorations and, secondarily, to determine its relationship to peri-implant disease occurrence using a multilevel analysis. MATERIALS AND METHODS: A retrospective cohort study of patients treated consecutively in a private clinic with immediately loaded full-arch restorations with at least 12 months of follow-up was conducted. Bone remodeling and marginal bone loss were determined through measurements made on panoramic radiographs by two calibrated examiners. Peri-implant health status was diagnosed in a visit for peri-implant maintenance. Descriptive, bivariate, and multilevel analyses were performed with Stata/IC 15.1 software (StataCorp). RESULTS: A total of 30 patients (11 men and 19 women, mean age: 63.3 ± 10.4 years), with a mean follow-up of 37.7 ± 19.6 months were included. Forty arches (20 maxillary and 20 mandibular) received 207 implants. Bone remodeling had an inversely proportional effect on marginal bone loss (P =.005) but was not related to peri-implantitis (P =.103; hazard rate [HR] = 2.1). CONCLUSION: Taking into account the limitations of this study, bone remodeling around immediately loaded dental implants supporting complete-arch restorations does not appear to increase marginal bone loss or peri-implantitis.

Peripheral giant cell granuloma associated with a dental implant: A case report.

Peripheral giant cell granuloma (PGCG) is a reactive exophytic lesion classified as a benign tumor of the oral mucosa. Although its etiology is not clear, it may be a consequence of local chronic irritation or persistent trauma. The objective of this case report was to document the main clinical and histopathological characteristics of a patient with a PGCG associated with a dental implant. A 36 years-old man presented a partly-ulcerated violet-colored sessile-based tumor in the buccal aspect of an implant placed in the fourth quadrant. Radiographically, the implant had one third of marginal bone loss. Differential diagnosis included PGCG and pyogenic granuloma. The implant and the lesion were removed and the histopathological diagnosis was PGCG. After 6 months, there was no evidence of relapse. Peripheral giant cell granulomas may appear in implants that have suffered bone loss. When facing with peri-implant soft tissue lesions, it is advisable to perform an anatomopathological study to obtain a correct diagnosis, to establish an adequate treatment plan, and to rule out malignant lesions. Key words:Peri-implant bone loss, peripheral giant cell granuloma, benign tumor.

Mechanical complications of implant-supported complete-arch restorations and impact on patient quality of life: A retrospective cohort study.

STATEMENT OF PROBLEM: Mechanical complications (for example, fractures) in implant-supported complete-arch restorations may affect the social and professional activities of the patient. However, most studies seem to overlook patient perceptions and generally do not assess the changes in the quality of life (QoL) of patients who experience these complications. PURPOSE: The purpose of this retrospective cohort study was to assess the influence of technical or mechanical complications of complete-arch implant-supported prostheses on patient perception and QoL by using the Oral Health Impact Profile (OHIP)-14. MATERIAL AND METHODS: A retrospective cohort study was formed of patients treated consecutively at a private clinic with immediately loaded complete-arch prostheses supported by a minimum of 4 implants (Replace Tapered; Nobel Biocare AB) and Multi-Unit conical abutments (Multi-Unit abutments; Nobel Biocare AB). OHIP-14 and questions regarding self-reported satisfaction were used to evaluate the influence of mechanical complications on QoL. RESULTS: Fifty-six participants (26 men and 30 women) with a mean age of 64 ±11.1 years, and 72 restored arches were included. The mean ±standard deviation follow-up time was 52 ±26 months. The prosthetic success rate was 38.8%, and the survival rate was 100% (no failure was registered). The most common complications were abutment screw loosening (43%), chipping or fracture of the veneering material (25%), and screw loosening (21%). The OHIP-14 scores were close to zero, without differences between participants with or without mechanical complications. Overall, the participants reported that the prostheses allowed good oral hygiene (94.6%) and met their expectations (89%) and that they would repeat the treatment (87.5%) and would recommend it to others (93%). CONCLUSIONS: Minor mechanical complications such as screw loosening and chipping or fracture of the veneering material were frequent events but had no impact on the satisfaction and QoL of patients with immediately loaded complete-arch implant-supported prostheses.

Torsion Resistance of the Ball Head System Screw and Screwdriver for Angled Screw Channels on Implant Prosthetics.

The primary objective of this study was to determine the torsion resistance of the Ball Head System (BHS) screw and screwdriver set at 0°, 20°, and 30° angulations. The secondary objective was to compare the BHS set with the 1.3-mm hexagonal screwdriver system (HexS) at 20° and analyze the condition of the BHS after 10 and 30 iterations with 30 N·cm torque at 30° angulation. A workbench made from type 4 plaster with 6 steel implant replicas (external hexagon, 4.1 mm) inserted at 0°, 20°, and 30° angulation was designed. An analogical torque meter was used. The deformations produced on the whole set were examined by field emission scanning electron microscopy. A descriptive analysis was performed. The maximum torque performance for BHS at 30° angulation was 54 ± 12 N·cm. Most screws could be removed despite the deformations produced. At 20° angulation, the BHS set achieved an average torque resistance of 67 ± 12 N·cm, whereas the HexS failed at 45 ± 2 N·cm. Although the iterations performed at 30 N·cm torque and 20° angulation produced some deformations on BHS sets; these could be tightened and unscrewed. The BHS allows tightening at a torque of up to 54 N·cm. Under the same conditions, BHS showed more torque resistance than HexS. Deformation of BHS sets was directly related to the number of iterations.

Inflammatory fibro-epithelial hyperplasia related to a fixed implant-supported prosthesis: A case report.

The gingival overgrowth is a common finding in the clinical practice with a diverse etiology. There are no treatment guidelines defined for this oral lesions. These can provoke discomfort to the patient and often, can alter the function of the stomatologic system. This article presents a case report of a bilateral gingival overgrowth in a 68 years old woman wearing a fixed upper-arch implant-supported prosthesis placed five years ago. The clinical exam after removing the prosthesis showed an intense accumulation of plaque around the intermediate abutments associated to a mucosal enlargement with suppuration on touching the buccal area of the implant in position 1.5 and a probing depth of 8mm. The 2.4 and 2.5 implants also showed vestibular mucosal enlargement and a probing depth of 6mm. No changes were observed in the peri-implant bone level measured in the periapical radiographs. An incisional biopsy was made on second quadrant and sent for the histopathological study. The definitive diagnosis was inflammatory fibro-epithelial hyperplasia. No recurrence has been reported after a 6 month follow-up. Key words:Fibro-epithelial hyperplasia, gingival enlargement, gingival overgrowth, full-arch implant-supported prosthesis.

Novel Ball Head Screw and Screwdriver Design for Implant-Supported Prostheses With Angled Channels: A Finite Element Analysis.

The primary objective of this study was to design the optimal geometry of a novel screwdriver, create the grooves on a ball head screw, and demonstrate its resistance to a torque of up to 40 Ncm at angulations of 0°, 15°, and 30° by using nonlinear finite element analysis. A secondary objective was to create a foolproof, easily recognizable system. The grooved ball head screw and geometry of the screwdriver, functioning from an angulation of 0° to 30°, was generated using Pro-ENGINEER Wildfire 5.0 software. Static structural analyses among bodies in contact were performed at different angles of 0°, 15°, and 30° at a torque of 20 Ncm and 40 Ncm using nonlinear finite element simulation by means of ANSYS 12.0. The maximum stress supported by the ball head screw and screwdriver was similar at 20 Ncm and 40 Ncm. Although greater deformations were found at 40 Ncm, these were small and might not affect the performance of the system. Further, the rupture torque value for the M2 connection was 55 Ncm for 0° and 30°, and 47.5 Ncm for 15°. Numerical simulation showed that the ball head system design can achieve the mechanical strength requirements expected for screws used in implant-supported restorations at an angulation of up to 30°. Finite element analysis showed this novel ball head screw and screwdriver system to be a good solution for angled screw channels in implant-supported prostheses.

Bimaxillary simultaneous immediate loading of full-arch restorations: A case series.

AIM: To describe a bimaxillary simultaneous immediate loading protocol with full-arch implant-supported fixed prostheses. MATERIAL AND METHODS: A prospective case series of 8 patients who required full-arch rehabilitation was conducted. The main inclusion criteria were patients with teeth that required extraction. At least 1 molar per arch was temporarily employed to stabilize the surgical template and the provisional prosthesis during intraoral relining. RESULTS: Two upper implants failed in 1 patient. Structural fracture was registered in 3 patients, around 3 months after loading. All of them had bruxism. Three esthetic complications were registered: midline deviation, canting of the oclusal plane and color mismatch. CONCLUSIONS: Although this protocol achieves optimal results, some mechanical complications were encountered. The fracture of the provisional prosthesis is a relatively common mechanical complication but does not seem to jeopardize the final treatment result. Key words:Implant-supported full-arch, provisional prosthesis fracture, bimaxillary simultaneous rehabilitation, conical abutments.

Immediately loaded implant-supported full-arches: Peri-implant status after 1-9years in a private practice.

OBJECTIVE: Evaluate the peri-implant status on the long-term (1-9years) of patients treated with immediately-loaded full-arch prostheses in a private practice. METHODS: A retrospective cohort study was carried out in patients consecutively treated with immediately loaded full-arch restorations supported with a minimum of 4 implants (Replace® Tapered, Nobel Biocare AB) and Multi-Unit conical abutments (MUA®, Nobel Biocare AB) with a follow-up of over 12months after placement of the final prosthesis. RESULTS: A total of 378 implants were placed in 56 patients. Forty upper and 32 lower arches were restored, and 16 patients received bimaxillary rehabilitation. The mean duration of follow-up was 50 months, and the implant and patient peri-implantitis prevalences were 14.3% and 50%, respectively. Mucositis affected 56.9% of the implants and 50% of the patients. The survival rate was 96.4% by patient, but reached 99.5% in the implant-based analysis, and the success rate was 95.5% for implants and 80.4% for patients. CONCLUSIONS: Immediately-loaded full-arch restorations have an acceptable outcome after 1-9years of follow-up. However, the incidence of peri-implant diseases is high, and further research is needed to confirm whether these may compromise the predictability of the prostheses over the long-term. CLINICAL SIGNIFICANCE: After a mean follow-up of 50months, the incidence of mucositis and peri-implantitis affected the 96.4% and 50% of patients, respectively. However, these results were reduced almost by half when the threshold of bleeding on probing and peri-implant bone loss applied was less strict.

Early Complications of Immediate Loading in Edentulous Full-Arch Restorations: A Retrospective Analysis of 88 Cases.

PURPOSE: To describe the clinical outcomes and complications related to provisional prostheses after full-arch implant-supported rehabilitation by means of an immediate loading protocol. MATERIALS AND METHODS: This retrospective cohort study included patients who were consecutively treated with full-arch implant-supported restorations with a minimum of four implants (Replace Select Tapered TiUnite, Nobel Biocare AB) per arch and conical abutments (multi-unit, Nobel Biocare AB) by means of an immediate loading protocol. The surgical procedures were performed between May 2006 and June 2014 by a single oral surgeon. Demographic, surgical, and prosthetic variables were collected, and biologic and mechanical complications were registered. RESULTS: A total of 61 maxillae (57%) and 46 mandibles (43%) were treated in 88 patients (40 men and 48 women) with a mean age of 62.4 years. A total of 558 implants were placed, 295 in postextraction sockets. A total of 331 implants (59.3%) were placed in the maxilla and 227 (40.7%) in the mandible. Within a 9-month period, 18 prostheses (16.8%) fractured (15 maxillary and 3 mandibular); in nine of these patients the opposing dentition was a full-arch, implant-supported restoration, and in the remaining nine patients, it was natural dentition. Six (1.1%) maxillary and three (0.5%) mandibular implants failed. CONCLUSIONS: A high implant survival rate is expected in the short term following this immediate loading protocol. Fracture of the provisional prosthesis is a common finding, affecting 17% of patients, and is significantly more prevalent in patients with bruxism and in maxillary prostheses.

Periodontal health and esthetic results in impacted teeth exposed by apically positioned flap technique

Objectives: This study evaluates the periodontal health status and the esthetic results of teeth subjected to orthodontictraction, after their exposure by an apically positioned flap.Study design: Fifteen patients were included in the study, ages between 11 and 28 years old. The fenestrated teethand their homologous contralateral normally erupted teeth, used as control, were evaluated. Results: Statistically significant differences were found in the position of the gingival margin (p = 0.005), with anaverage distance between cemento-enamel junction (CEJ) and gingival margin of 2.47 mm (SD 1.19) in control teeth and of 1 mm (SD 1.31) in the operated teeth, and in the depth of palatal probing (p = 0.031), with 2.1 mm (SD0.9) for the experimental teeth and 1.7 mm (SD 0.8) for the control teeth. The gingival index, the bleeding duringprobing and the probing depth did not show statistically significant differences. The patient’s subjective esthetice valuation was more favorable for the control teeth in most of the cases. Conclusions: The surgical approach for the impacted teeth by means of the apically positioned flap resulted to bea predictable technique allowing the maintenance of the periodontal health on a long-term basis (AU)

Periodontal health and esthetic results in impacted teeth exposed by apically positioned flap technique.

OBJECTIVES: This study evaluates the periodontal health status and the esthetic results of teeth subjected to orthodontic traction, after their exposure by an apically positioned flap. STUDY DESIGN: Fifteen patients were included in the study, ages between 11 and 28 years old. The fenestrated teeth and their homologous contralateral normally erupted teeth, used as control, were evaluated. RESULTS: Statistically significant differences were found in the position of the gingival margin (p = 0.005), with an average distance between cemento-enamel junction (CEJ) and gingival margin of 2.47 mm (SD 1.19) in control teeth and of 1 mm (SD 1.31) in the operated teeth, and in the depth of palatal probing (p = 0.031), with 2.1 mm (SD 0.9) for the experimental teeth and 1.7 mm (SD 0.8) for the control teeth. The gingival index, the bleeding during probing and the probing depth did not show statistically significant differences. The patient's subjective esthetic evaluation was more favorable for the control teeth in most of the cases. CONCLUSIONS: The surgical approach for the impacted teeth by means of the apically positioned flap resulted to be a predictable technique allowing the maintenance of the periodontal health on a long-term basis.

Histologic evaluation of thermal damage produced on soft tissues by CO2, Er,Cr: YSGG and diode lasers

Objective: The aim of this in vitro experimental study was to perform histological evaluation of the thermal effect produced on soft tissue irradiated with CO2, Er,Cr:YSGG or diode lasers. Study design: Porcine oral mucosa samples were irradiated with Er,Cr:YSGG laser at 1 W with and without water / air spray, at 2 W with and without water / air spray, and at 4 W with water / air spray, with CO2 laser at 1 W, 2 W, 10 W, 20 W continuous mode and 20W pulsed mode and diode laser at 2W, 5W, and 10W pulsed mode. The thermal effect was evaluated measuring the width of damaged tissue adjacent to the incision, stained positively for hyalinized tissue with Hematoxylin-Eosinand Masson Trichrome stains. Besides, histological changes in the irradiated tissue were described using subjective grading scales. Results: The evaluated lasers developed a wide range of thermal damage with significant differences between groups. The samples with lowest thermal effect were those irradiated with Er,Cr:YSGG laserusing water / air spray, followed by CO2 and diode lasers. Conclusions: Emission parameters of each laser systemmay influence the thermal damage inflicted on the soft tissue, however, the wave length of each laser determines the absorption rate characteristics of every tissue and the thermal effect (AU)

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Histologic evaluation of thermal damage produced on soft tissues by CO2, Er,Cr:YSGG and diode lasers.

OBJECTIVE: The aim of this in vitro experimental study was to perform histological evaluation of the thermal effect produced on soft tissue irradiated with CO2, Er,Cr:YSGG or diode lasers. STUDY DESIGN: Porcine oral mucosa samples were irradiated with Er,Cr:YSGG laser at 1 W with and without water / air spray, at 2 W with and without water / air spray, and at 4 W with water / air spray, with CO2 laser at 1 W, 2 W, 10 W, 20 W continuous mode and 20 W pulsed mode and diode laser at 2 W, 5 W, and 10 W pulsed mode. The thermal effect was evaluated measuring the width of damaged tissue adjacent to the incision, stained positively for hyalinized tissue with Hematoxylin-Eosin and Masson Trichrome stains. Besides, histological changes in the irradiated tissue were described using subjective grading scales. RESULTS: The evaluated lasers developed a wide range of thermal damage with significant differences between groups. The samples with lowest thermal effect were those irradiated with Er,Cr:YSGG laser using water / air spray, followed by CO2 and diode lasers. CONCLUSIONS: Emission parameters of each laser system may influence the thermal damage inflicted on the soft tissue, however, the wave length of each laser determines the absorption rate characteristics of every tissue and the thermal effect.

Locally aggressive central odontogenic fibroma associated to an inflammatory cyst: a clinical, histological and immunohistochemical study.

The case describes a 38-year-old woman presenting a multilocular radiolucency affecting the entire right half of the lower jaw, with an unerupted third molar displaced to the region of the coronoid process. The histological study showed the presence of fibroblasts, focally with pleomorphic nuclei, dense collagen and an odontogenic epithelium with dystrophic calcifications. A cyst with an important inflammatory infiltrate was, moreover, observed.