An In Vitro Investigation of the Role of Implant Abutment Materials on the Fracture Resistance and Failure Mode of Implant-Supported Restorations.

BACKGROUND: Implant-supported restorations have gained popularity in modern dentistry, and the choice of abutment material is crucial for their long-term success. This in vitro study aimed to evaluate the fracture resistance and failure mode of implant-supported restorations using different abutment materials. METHODS: Ninety standardized implant-supported restorations were included in the study. Abutments made of titanium, zirconia, and a hybrid material (titanium base with a zirconia veneer) were evaluated. Standardized abutments were fabricated, and screw-retained restorations were fabricated using a resin-based composite material. Cyclic loading was applied using a universal testing machine to simulate masticatory forces. Fracture resistance was measured in terms of the number of cycles to failure (NCF), and failure modes were analyzed. RESULTS: The findings indicate that zirconia abutments exhibited higher fracture resistance compared to titanium and hybrid abutments. Longer implants demonstrated higher fracture resistance, suggesting improved stability and resistance to mechanical forces. Increased loading angles resulted in decreased fracture resistance of implant-supported restorations, emphasizing the need for proper occlusal adjustment. Central loading showed higher fracture resistance than lateral and posterior loading locations. The distribution of failure modes varied among the abutment materials, with bulk prosthesis fracture being the most common in the titanium group, while abutment fracture was predominant in the zirconia and hybrid groups. CONCLUSION: This in vitro study demonstrated that the choice of abutment material significantly influenced the fracture resistance and failure mode of implant-supported restorations. Zirconia abutments exhibited the highest fracture resistance, followed by hybrid and titanium abutments. The failure mode analysis revealed different patterns of failure for each abutment material.

Survival and mechanical complications of single- and multiple-unit cement-retained posterior implant-supported restorations with custom CAD/CAM Atlantis titanium abutments: An up to 10-year retrospective analysis.

PURPOSE: To evaluate the survival of and incidence of mechanical complications with single- and multiple-unit cement-retained posterior implant-supported restorations with custom CAD/CAM Atlantis titanium abutments (Dentsply Sirona, Charlotte, NC, USA). MATERIALS AND METHODS: This retrospective clinical study analysed 196 Astra Tech OsseoSpeed TX Internal Hexagon implants (Dentsply Sirona) placed in 85 patients between January 2011 and January 2021. Customised Atlantis titanium abutments and cement-retained metal-ceramic crowns were employed. The clinical outcomes recorded were implant and abutment survival rates, and mechanical complications. The results were analysed according to implant length and diameter, arch, implant position and single- or multiple-unit restoration. RESULTS: Over the observation period (up to 10 years), implant and abutment survival rates were 98.5% and 100.0%, respectively. The mean observation period for the single- and multiple-unit implant-supported restorations was 106.00 ± 20.84 months, with a minimum of 41 months and a maximum of 120 months. For the 67 single-unit and 129 multiple-unit posterior implant-supported restorations, four mechanical complications were recorded: two cases of screw loosening, one case of chipping or fracture of veneering materials, and one case of crown decementation. No screw or abutment fractures were observed. CONCLUSIONS: According to the results of this retrospective clinical study, cement-retained posterior implant-supported restorations with custom CAD/CAM Atlantis titanium abutments showed high survival rates over a follow-up period of up to 10 years. No statistically significant differences were recorded when comparing implant position, implant diameter, implant length, single- versus multiple-unit restoration and arch.

Wear resistance of CAD/CAM one-piece screw-retained hybrid-abutmentcCrowns made from different restorative materials.

INTRODUCTION: The aim of this study was to measure the wear progress of three high performance polymers (HPP) materials as well as that of zirconia after artificial aging (simulated 2.5- and 5-year of clinical service with thermo-mechanical loading) and compare it with the well-documented wear of lithium disilicate. METHODS: Forty implants were used to restore a maxillary first premolar, where the abutment and the crown were manufactured as hybrid-abutment-crown and connected to the implant using a titanium insert. The implants were randomly divided, according to the restorative materials used, into five groups: 3Y-TZP zirconia (Z), lithium disilicate (L), ceramic-reinforced polyetheretherketon (P), nano-hybrid composite resin (C) and polymer-infiltrated ceramic-network (E). All hybrid-abutment-crowns were produced using CAD/CAM technology. A design of a maxillary first premolar was created with an angle of 120° between the buccal and palatal cusps, which were designed as planes. The restorations were adhesively luted onto the titanium inserts, according to the manufacturers' recommendations for each material individually, by means of dual-curing luting resin with the exception of group P, where the blocks were pre-fitted (heat-pressed) with an integrated titanium insert. The suprastructures were assembled onto the implants through titanium screws. The screw channels were sealed with Teflon tape and composite resin filling material that was polished to high-gloss. All specimens underwent 1 200 000 thermo-dynamic loading cycles with 49 N in a dual-axis chewing simulator. Elastomeric impressions were made for all specimens after 600 000 and after 1 200 000 cycles. The corresponding impressions were imaged using a laser scanning microscope and then 3D-analyzed using the software (Geomagic Wrap) to measure the volume loss of the wear area for all specimens. Statistical analysis was performed using Wilcoxon-Test regarding the two different time measurements for each material. For the analysis of the material variable, Kruskal-Wallis test was conducted followed by Mann-Whitney test. RESULTS: Group Z showed statistically the lowest volume loss compared to the other test materials, both after 600 000 and 1 200 000 cycles of artificial aging, with a median value of 0.002 mm3 volume loss after 1 200 000 cycles. In contrast, group E showed the highest volume loss with median values of 0.18 and 0.3 mm3 after 600 000 and 1 200 000 cycles, respectively. Artificial aging had significantly negative effect on the volume loss for all test materials. In addition, the choice of material had statistical influence on the outcome. CONCLUSION: Monolithic zirconia ceramic demonstrated lower wear than that reported for enamel after simulated 5-year of clinical service, whereas all other test materials showed higher volume loss after artificial aging.

PROXIMAL CONTACT LOSS MAY BE A FREQUENT COMPLICATION IN IMPLANT-SUPPORTED RESTORATIONS.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Manicone PF, De Angelis P, Rella E, Papetti L, D'Addona A. Proximal Contact Loss in Implant-Supported Restorations: A Systematic Review and Meta-Analysis of Prevalence. J Prosthodont. 2022 Mar;31(3):201-209. doi:10.1111/jopr.13407. Epub 2021 Aug 5. PMID: 34263959 SOURCE OF FUNDING: Not reported. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.

Peri-Implant Bone Loss and Overload: A Systematic Review Focusing on Occlusal Analysis through Digital and Analogic Methods.

The present review aimed to assess the possible relationship between occlusal overload and peri-implant bone loss. In accordance with the PRISMA guidelines, the MEDLINE, Scopus, and Cochrane databases were searched from January 1985 up to and including December 2021. The search strategy applied was: (dental OR oral) AND implants AND (overload OR excessive load OR occlusal wear) AND (bone loss OR peri-implantitis OR failure). Clinical studies that reported quantitative analysis of occlusal loads through digital contacts and/or occlusal wear were included. The studies were screened for eligibility by two independent reviewers. The quality of the included studies was assessed using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool. In total, 492 studies were identified in the search during the initial screening. Of those, 84 were subjected to full-text evaluation, and 7 fulfilled the inclusion criteria (4 cohort studies, 2 cross-sectional, and 1 case-control). Only one study used a digital device to assess excessive occlusal forces. Four out of seven studies reported a positive correlation between the overload and the crestal bone loss. All of the included studies had moderate to serious overall risk of bias, according to the ROBINS-I tool. In conclusion, the reported data relating the occlusal analysis to the peri-implant bone level seem to reveal an association, which must be further investigated using new digital tools that can help to standardize the methodology.

Accuracy of Fixed Implant-Supported Dental Prostheses Additively Manufactured by Metal, Ceramic, or Polymer: A Systematic Review.

PURPOSE: Additive manufacturing (AM) in prosthodontics is used as an alternative to casting or milling. Various techniques and materials are available for the additive manufacturing of the fixed and removable tooth-supported restorations, but there is a lack of evidence on the accuracy of AM fixed implant-supported prostheses. Recent studies investigated the accuracy of ceramic AM prostheses. Therefore, the aim of this systematic review was to evaluate the accuracy of additively manufactured metal, ceramic or polymers, and screw- or cement-retained fixed implant-supported prostheses. MATERIALS AND METHODS: Two calibrated investigators performed an electronic search of relevant publications in the English language following selected PICOS criteria and using a well-defined search strategy (latest search date-1st of June, 2021). Based on the exclusion criteria (no control group, less than five samples per group, 3D printing of the implant abutment part, only subjective evaluation of accuracy, etc.) studies were not included in the review. Quantitative data of accuracy evaluation such as marginal gap, strain analysis, and linear measurements was extracted and interpreted. QUADAS-2 tool was used to assess the risk of methodological bias of all included studies. RESULTS: Sixteen in vitro studies were selected for the final analysis. Six of the selected studies evaluated screw-retained restorations and 10 cement-retained implant-supported restorations. Only 4 publications concluded that AM restorations were more accurate than conventionally made (cast or milled) ones. The most common finding was that AM restorations were more accurate than cast and demonstrated less or similar accuracy compared to milled ones (n = 10 studies). Detected marginal discrepancies mean values of the AM prosthesis varied from 23 to more than 200 µm, but most of them were categorized as clinically acceptable. CONCLUSIONS: AM implant-supported fixed prostheses demonstrate similar accuracy compared to conventional and computer-aided design and computer-aided manufacturing techniques in vitro. Detected inaccuracies of AM restorations do not exceed clinically acceptable limits. Clinical studies with longer follow-up periods are needed to show the reliability of AM prostheses.

Fracture load of different veneered and implant-supported 4-UNIT cantilever PEEK fixed dental prostheses.

OBJECTIVES: To determine the fracture load before and after artificial aging of implant-supported 4-unit cantilever fixed dental prostheses (FDP) with frameworks made of two differently filled polyetheretherketone (PEEK) compounds and veneered using three different techniques. METHODS: A total of 120 duplicate 4-unit FDP frameworks were produced (n = 60 milled from PEEK, 20% TiO2 filled and n = 60 pressed from PEEK, 30% TiO2 filled) and veneered using three different techniques: (i) digital veneerings, (ii) conventional resin composite veneerings and (iii) prefabricated veneers (n = 20 per subgroup). The FDPs were adhesively bonded to titanium abutments and the fracture load was measured in a universal testing machine (1 mm/min) before and after artificial aging in a mastication simulator (1,200,000 cycles, 50 N, TC: 5/55 °C, 6000 cycles). The fracture patterns were analyzed using digital microscopy. Data were analyzed using the Kolmogorov-Smirnov test, two-way ANOVA, post hoc Scheffé, Chi2-test (p < 0.05), and Weibull modulus m, as well as fracture patterns using the Ciba-Geigy table. RESULTS: Veneering technique and filler content significantly affected the fracture load (p < 0.001). Prefabricated veneers showed higher fracture load (p ≤ 0.001) whereas digital and conventional veneerings were similar (p = 0.451). PEEK with 30% filler content presented higher fracture load (p < 0.001) compared with PEEK with 20%. Aging showed no effect on fracture load (p = 0.176). Regarding fracture types, no significant differences were found among the groups (p = 0.055). CONCLUSIONS: Filler content of PEEK compound as well as veneering technique influenced fracture load while aging had no effect on fracture load. FDPs made of PEEK with 30% of filler content veneered using prefabricated veneers had the highest fracture resistance.

Prosthetic Materials Used for Implant-Supported Restorations and Their Biochemical Oral Interactions: A Narrative Review.

The purpose of this study is to outline relevant elements regarding the biochemical interactions between prosthetic materials used for obtaining implant-supported restorations and the oral environment. Implant-supported prostheses have seen unprecedented development in recent years, benefiting from the emergence of both new prosthetic materials (with increased biocompatibility and very good mechanical behavior), and computerized manufacturing technologies, which offer predictability, accuracy, and reproducibility. On the other hand, the quality of conventional materials for obtaining implant-supported prostheses is acknowledged, as they have already proven their clinical performance. The properties of PMMA (poly (methyl methacrylate))-which is a representative interim material frequently used in prosthodontics-and of PEEK (polyether ether ketone)-a biomaterial which is placed on the border between interim and final prosthetic use-are highlighted in order to illustrate the complex way these materials interact with the oral environment. In regard to definitive prosthetic materials used for obtaining implant-supported prostheses, emphasis is placed on zirconia-based ceramics. Zirconia exhibits several distinctive advantages (excellent aesthetics, good mechanical behavior, biocompatibility), through which its clinical applicability has become increasingly wide. Zirconia's interaction with the oral environment (fibroblasts, osteoblasts, dental pulp cells, macrophages) is presented in a relevant synthesis, thus revealing its good biocompatibility.

Longitudinal Study of Dental Implants in HIV-Positive Patients.

PURPOSE: This study compared the clinical outcome of dental implants and their implant-supported restorations over a 3-year period involving patients both positive and negative for the human immunodeficiency virus. MATERIALS AND METHODS: Twenty patients testing positive for the human immunodeficiency virus were recruited for this study. Twenty-one negative control patients were also selected, for a total of forty one patients. Diagnostic impressions were collected and cone beam computed tomography images were obtained. Implant size and positioning were planned using cone beam computed tomography software. Two stage or single surgery was performed as determined by the surgeon (periodontist). After a 6-month healing period, definitive impressions were fabricated using polyvinyl siloxane impression material. Implant stability quotient values were obtained at the time of surgery and placement of the restoration. Screw-retained custom titanium abutments were designed, milled, and placed with 25 N·cm torque using a calibrated torque controller. Porcelain fused-to-metal complete coverage restorations were then cemented with elastomeric resin implant cement. Implants and restorations were assessed at 6-month intervals over a period of 3 years for stability, peri-implant health, and patient satisfaction. RESULTS: Over the 3-year period, 25 of 42 implants placed in the negative control group were assessed, and 17 of 27 implants placed in the positive control group were evaluated. The overall patient retention rate was 77%. At the 3-year follow up, restorations examined were fully functional and causing no pain. Overall implant retention within the positive group was 96%. Implant retention within the negative control group was 100%. No differences were noted between groups for bone loss based on statistical tests. CONCLUSION: Within the limitations of this clinical investigation, the presence of human immunodeficiency virus per se was not a contraindication to dental treatment with implant-supported restorations.

Clinical Performance of CAD/CAM Monolithic Lithium Disilicate Implant-Supported Single Crowns Using Solid or Predrilled Blocks in a Fully Digital Workflow: A Retrospective Cohort Study With Up To 33 Months of Follow Up.

PURPOSE: To assess the clinical performance of CAD/CAM monolithic implant-supported restorations manufactured using a fully digital workflow and two different types of ceramic blocks. MATERIALS AND METHODS: One hundred and one patients received single-unit implant-supported restorations at a University predoctoral clinic. All restorations were designed and fabricated using either a predrilled LS2 block (group P, n = 59) or a conventional solid LS2 block with an occlusal opening drilled manually prior to crystallization (group M, n = 42). The mean follow-up time after restoration delivery was 18.4 ± 4.8 months (range 12 to 33 months). Patients with less than a 12-month follow-up were excluded. Electronic health records were reviewed to identify number and type of complications during the follow-up time. Clinical outcomes were classified as success, survival, and failure of the restoration. Chi-square tests were used to identify differences in success and survival rates between the groups. Nonparametric Mann-Whitney U tests were used to identify differences in the number of major and minor complications as well as the total number of complications that were observed among groups. RESULTS: Overall success and survival rates were 80.2% and 97%, respectively. Seventy one restorations (70.3%) were complication-free. There were no significant differences between the groups with regards to the number of complications or success and survival rates. CONCLUSIONS: Single-unit CAD/CAM monolithic implant-supported restorations that are fabricated in a fully digital workflow present relatively high complication rates and moderate short-term clinical outcomes. Clinical studies with longer follow-up times are needed to evaluate long-term outcomes of these restorations.

Proximal Contact Loss in Implant-Supported Restorations: A Systematic Review and Meta-Analysis of Prevalence.

PURPOSE: This is a systematic review and meta-analysis to estimate the overall prevalence of proximal contact loss (PCL) and determine the distribution and clinical features of PCL. METHODS: This systematic review was conducted following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. As this was a systematic review of prevalence, the condition, context, and population framework was followed. The focus question was: What is the prevalence and distribution of PCL in implant-supported restorations? Two investigators independently examined the literature in four databases (Medline, Scopus, Web of Science, and Cochrane) for suitable articles published before November 11, 2020, with no start-date restriction; an additional search was conducted by hand. A standardized data extraction chart was utilized to extract the relevant information from the selected studies. RESULTS: Fifteen studies met the inclusion criteria. A total of 11,699 restorations were evaluated in the final sample. The overall prevalence was 20% at the implant restoration level (among 4984 implants) and 26.6% at the contact point level (among 2603 contact points). The frequency of PCL was higher on the mesial side, both at the implant restoration level (13.8%) and at the contact point level (21.9%), than on the distal side, where the prevalence was 3.3% and 11.0%, respectively. The event rate in the maxilla and in the mandible at the contact level was 21.4% and 21.9%, respectively. CONCLUSIONS: PCL is a frequent complication. Approximately 29% of contact points develop this condition, which may cause food impaction and damage to the interproximal tissues.

Clinical performance of tooth- or implant-supported veneered zirconia single crowns: 42-month results.

OBJECTIVES: The objective of this clinical study was to compare and assess the clinical performance of tooth-supported and implant-supported zirconia single crowns with sintered veneering caps. METHODS: In this prospective study, 118 patients with a total of 220 single crowns placed on 106 teeth (69 vital teeth, 37 endodontically treated teeth) and 114 implants in molar and premolar regions were examined during a mean observation period of 42 months. The restorations were evaluated for technical failures such as veneering porcelain fractures (chipping), surface quality, marginal fit, and the interface quality of the coping and sintered veneering. The soft tissue status was assessed using the modified Silness and Löe's plaque and gingival index (mPI) and the modified Muhlemann sulcus bleeding index (mSBI). Tooth-supported crowns were checked for secondary caries and hypersensitivity during the follow-up period. Recalls were performed every 6 months. RESULTS: The 3-year Kaplan-Meier success probability was 98.2% and 100% for implant- and tooth-supported crowns, respectively. A significant difference could be detected between the implant-supported and tooth-supported zirconia single crowns, in terms of their chipping rate (p = 0.039). Veneering material fractures were recorded on two implant-supported restorations (1.8%). No veneering fractures occurred on tooth-supported single crowns. The plaque and gingival index and sulcus bleeding index showed stable and healthy soft peri-implant and periodontal tissues. Neither loss of vitality nor secondary caries occurred on tooth-supported crowns. CONCLUSIONS: Zirconia-based single crowns with a sintered veneering cap showed promising clinical results on both tooth and implant abutments; however, the dental implants were more prone to complications. In terms of clinical significance, high-strength ceramic with a sintered veneering cap can be recommended for prosthetic treatment of both tooth- and implant-supported single crowns in molar regions. CLINICAL RELEVANCE: This study provides valuable information for further application of all-ceramic restorations.

Effects of abutment diameter, luting agent type, and re-cementation on the retention of implant-supported CAD/CAM metal copings over short abutments.

PURPOSE: The aim of this study was to evaluate the effects of abutment diameter, cement type, and re-cementation on the retention of implant-supported CAD/CAM metal copings over short abutments. MATERIALS AND METHODS: Sixty abutments with two different diameters, the height of which was reduced to 3 mm, were vertically mounted in acrylic resin blocks with matching implant analogues. The specimens were divided into 2 diameter groups: 4.5 mm and 5.5 mm (n=30). For each abutment a CAD/CAM metal coping was manufactured, with an occlusal loop. Each group was sub-divided into 3 sub-groups (n=10). In each subgroup, a different cement type was used: resin-modified glass-ionomer, resin cement and zinc-oxide-eugenol. After incubation and thermocycling, the removal force was measured using a universal testing machine at a cross-head speed of 0.5 mm/min. In zinc-oxide-eugenol group, after removal of the coping, the cement remnants were completely cleaned and the copings were re-cemented with resin cement and re-tested. Two-way ANOVA, post hoc Tukey tests, and paired t-test were used to analyze data (α=.05). RESULTS: The highest pulling force was registered in the resin cement group (414.8 N), followed by the re-cementation group (380.5 N). Increasing the diameter improved the retention significantly (P=.006). The difference in retention between the cemented and recemented copings was not statistically significant (P=.40). CONCLUSION: Resin cement provided retention almost twice as strong as that of the RMGI. Increasing the abutment diameter improved retention significantly. Re-cementation with resin cement did not exhibit any difference from the initial cementation with resin cement.

Effects of abutment diameter, luting agent type, and re-cementation on the retention of implant-supported CAD/CAM metal copings over short abutments

PURPOSE: The aim of this study was to evaluate the effects of abutment diameter, cement type, and re-cementation on the retention of implant-supported CAD/CAM metal copings over short abutments. MATERIALS AND METHODS: Sixty abutments with two different diameters, the height of which was reduced to 3 mm, were vertically mounted in acrylic resin blocks with matching implant analogues. The specimens were divided into 2 diameter groups: 4.5 mm and 5.5 mm (n=30). For each abutment a CAD/CAM metal coping was manufactured, with an occlusal loop. Each group was sub-divided into 3 sub-groups (n=10). In each subgroup, a different cement type was used: resin-modified glass-ionomer, resin cement and zinc-oxide-eugenol. After incubation and thermocycling, the removal force was measured using a universal testing machine at a cross-head speed of 0.5 mm/min. In zinc-oxide-eugenol group, after removal of the coping, the cement remnants were completely cleaned and the copings were re-cemented with resin cement and re-tested. Two-way ANOVA, post hoc Tukey tests, and paired t-test were used to analyze data (α=.05). RESULTS: The highest pulling force was registered in the resin cement group (414.8 N), followed by the re-cementation group (380.5 N). Increasing the diameter improved the retention significantly (P=.006). The difference in retention between the cemented and recemented copings was not statistically significant (P=.40). CONCLUSION: Resin cement provided retention almost twice as strong as that of the RMGI. Increasing the abutment diameter improved retention significantly. Re-cementation with resin cement did not exhibit any difference from the initial cementation with resin cement.

Implant Supported Fixed Restorations versus Implant Supported Removable Overdentures: A Systematic Review.

AIM: The aim of this study is to systematically evaluate and compare implant retained fixed restoration versus implant retained over denture. MATERIAL AND METHODS: Search was made in 2 databases including PubMed and PubMed Central. Title and abstract were screened to select studies comparing implant retained fixed restorations versus implant retained removable overdentures. Articles which did not follow the inclusion criteria were excluded. Included papers were then read carefully for a second stage filter, this was followed by manual searching of bibliography of selected articles. RESULTS: The search resulted in 5 included papers. One study evaluated the masticatory function, while the other 4 evaluated the patient satisfaction. Two of them used Visual Analogue Scale (VAS) as a measurement tool, while the other two used VAS and Categorical Scales (CAT). Stability, ability to chew, ability to clean, ability to speak and esthetics were the main outcomes of the 4 included papers. CONCLUSION: Conflicting results was observed between the fixed and removable restorations.

Complicaciones protésicas de las restauraciones implantosoportadas: revisión de la literatura / Prosthetic complications in implant-supported restorations

Las restauraciones implantosoportadas son un tratamiento exitoso para el reemplazo de los dientes perdidos por diversas causas. No obstante, este tipo de tratamiento puede presentar complicaciones. Las complicaciones protésicas pueden poner en riesgo nuestro tratamiento restaurador, por lo tanto, el odontólogo debe estar en la capacidad de diagnosticar las diferentes complicaciones protésicas e indicar el tratamiento adecuado. También, se debe prevenir la ocurrencia de las complicaciones con una adecuada selección y planificación del caso y educar al paciente para que acuda a las citas de mantenimiento de su tratamiento con este tipo de restauraciones

Implant-supported restorations are successful treatment for replacing missing teeth, due to many reasons. However, this treatment can have some complications. These prosthetic complications can jeopardize the restorative's treatment. Therefore, dentists must be able to diagnose different prosthetic complications and indicate an appropriate treatment. Although, dentists should prevent the appearance of complications with a proper selection of the case and pertinent case planning. The patient's education in order to assist to maintenance's appointment is important for success of the treatment

Complicaciones biológicas de las restauraciones implantosoportadas / Biological complications in implant-supported restorations

Las restauraciones con implantes dentales oseointegrados cada vez se utilizan con mayor frecuencia. Este tipo de restauraciones han mostrado un alto porcentaje de éxito. Sin embargo, las mismas pueden presentar complicaciones. Las complicaciones biológicas pueden poner en riesgo nuestro tratamiento restaurador, por tanto debemos estar en capacidad de diagnosticar las diferentes condiciones periimplantares y referir al especialista en el área cuando sea necesario. También, debemos prevenir la ocurrencia de las complicaciones y educar al paciente para que realice un mantenimiento correcto de las restauraciones implantosoportadas

Osseintegrated dental implants restorations are being used more frequently over the years. These restorations have shown high success rate. However, they may have biological complications, which could jeopardize the restorative's treatment. Therefore, dentists must be able to diagnose different periimplantals conditions and refer it to specialists in the area, when is required. Although, dentist must prevent the appearance of complications and educating their patients on the correct maintenance of implant-supported restorations