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1.
Oral Maxillofac Surg Clin North Am ; 32(4): 583-591, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33004149

RESUMO

Preprosthetic surgery remains a work horse of dentoalveolar surgery. Advances in rehabilitation of the edentulous mouth with the use of endosseous osseointegrating dental implants and dermal matrix substitutes have changed the narrative of traditional preprosthetic surgery while maintaining some fundamental principles. An outline of the basic techniques in preprosthetic dentoalveolar surgery is discussed in the setting of these technological and tissue engineering advances.


Assuntos
Implantação Dentária Endo-Óssea , Animais , Cavalos , Humanos
2.
Int J Oral Maxillofac Implants ; 35(5): 924-930, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32991642

RESUMO

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


Assuntos
Aumento do Rebordo Alveolar , Implantes Dentários , Boca Edêntula , Implantação Dentária Endo-Óssea , Humanos , Estudos Retrospectivos
3.
Braz Dent J ; 31(4): 368-373, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32901711

RESUMO

The aim of this study was to clinically and radiographically compare extra short and standards implants. Forty-two implants were installed in 10 selected patients. They received prosthetic loading only after the conventional waiting time for osseointegration and the prostheses were made ferulized. Radiographic shots were performed to evaluate vertical and horizontal bone losses at times T1 (prosthetic installation), T2 (6 months follow-up) and T3 (12 months follow-up). Biological parameters such as bone level around the implants (CBL) were evaluated, CBL alteration (CBLC), total crown length (TCL) and implant/crown ratio (ICR) were digitally calculated. All implants included in the study were submitted to the analysis of the implant stability quotient (ISQ) at the time of implant installation (T0) and at 12 months of prosthetic function (T3). Data were statistically tested. The ICR was higher in the test group than in the control group (p<0.0001). The CBL measurements at the beginning of the study were 0.21±0.19 mm and 0.32±0.38 mm and at 12 months 0.65±0.24 mm and 0.87±0.34 mm, respectively in the test and control groups. CBLCs and CBL were similar at all times (p>0.05). No correlation was found between CBLC and ICR parameters, as well as between ISQ and implant length. We may conclude that standards and extra short implants can provide similar clinical results in prosthetic rehabilitation of the atrophic jaw over 12 months of follow-up.


Assuntos
Implantação Dentária Endo-Óssea , Implantes Dentários , Coroas , Planejamento de Prótese Dentária , Humanos , Osseointegração
4.
Int J Oral Implantol (Berl) ; 13(3): 241-252, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32879929

RESUMO

PURPOSE: Implant primary stability has long been considered a prerequisite for successful osseointegration. However, achieving stability may be difficult when placing implants in wide postextractive bone defects. The purpose of this study was to conduct a clinical and radiographic investigation of bone modifications at porous-structured implants inserted with or without primary stability. MATERIALS AND METHODS: Fifty porous-structured implants were inserted in the posterior sockets of 50 consecutive patients 2 months after tooth extraction, combined with allogeneic bone and a resorbable membrane. The implants were divided into two groups according to insertion torque: spinner (spinning at 35 Ncm, n = 23) and stable (stable at 35 Ncm, n = 27). Implant stability was assessed by resonance frequency analysis from baseline to 6-month function. Follow-up took place 3 years after implant placement. RESULTS: At baseline, the implant stability quotient was undetectable in the spinner group and averaged 75.07 ± 5.84 in the stable group. At uncovering, the implant stability quotient increased to 71.33 ± 4.42 and 77.97 ± 3.30 in the spinner and stable group, respectively (P < 0.001). After 6 months of loading, no between-group difference in implant stability quotient was found (P = 0.13). Marginal bone level changes were similar between groups at all follow-ups, averaging -0.41 ± 0.77 mm and -0.15 ± 0.53 mm at 36-month follow-up in the spinner and stable group, respectively (P = 0.35). No implant failed throughout the observation period. Neither biological nor mechanical complications occurred. CONCLUSION: Implants with a moderately rough surface and a porous-structured body may osseointegrate even without primary stability.


Assuntos
Implantes Dentários para Um Único Dente , Implantes Dentários , Implantação Dentária Endo-Óssea , Estética Dentária , Humanos , Porosidade , Alvéolo Dental/cirurgia
5.
Compend Contin Educ Dent ; 41(8): e16-e20, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32870703

RESUMO

The replacement of missing teeth is more complex than simply placing a dental implant and restoring it, especially when a single implant site is involved. Implants have a round cross-section, whereas natural teeth do not but instead have crestal cross-sections that vary in shape from ovoid to triangular to rectangular depending on which tooth is being replaced. When this factor is combined with the zone between the crestal bone and adjacent proximal contacts, an emergence profile presents that will govern the esthetics of the restoration. The emergence profile will also guide and maintain the soft tissue, preventing potential food accumulation areas interproximally. This article defines an emergence profile and reviews the importance of establishing it and how to develop it based on the tooth being replaced to achieve natural-appearing restorations.


Assuntos
Implantes Dentários para Um Único Dente , Implantes Dentários , Implantação Dentária Endo-Óssea , Estética Dentária
6.
Int J Prosthodont ; 33(5): 513-522, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32956432

RESUMO

PURPOSE: To compare clinical and esthetic outcomes between immediately loaded single implants placed with and without a fully guided surgical procedure. MATERIALS AND METHODS: Patients with a missing maxillary tooth (second premolar to second premolar) were considered for inclusion in this 1-year prospective nonrandomized study. Exclusion criteria were general health contraindications for oral surgery besides the need for bone grafting or ridge augmentation. One group received digital implant planning, fully guided surgery, and immediate loading (DIL). The other group received freehand surgery and immediate loading (IL). Outcome measures were implant survival, marginal bone loss, soft tissue changes, papilla index, pink and white esthetic scores (PES and WES, respectively), and patient-reported outcome measures (PROMs). RESULTS: Two of 21 implants failed in the DIL group soon after placement, resulting in a 1-year implant survival rate of 90.5%, while no implants failed in the IL group. Significantly higher papilla index scores and lower soft tissue changes were found for the DIL group compared to the IL group. No differences were found after 1 year regarding marginal bone loss, PES, WES, or PROMs. CONCLUSION: Within the limitations of this study, immediate loading in combination with fully guided surgery might negatively affect implant survival. Immediate loading, fully guided surgery, and a digital workflow appear to have a positive effect on early soft tissue adaptation.


Assuntos
Implantes Dentários para Um Único Dente , Implantes Dentários , Carga Imediata em Implante Dentário , Implantação Dentária Endo-Óssea , Estética Dentária , Humanos , Maxila/cirurgia , Satisfação do Paciente , Estudos Prospectivos , Resultado do Tratamento
7.
Int J Prosthodont ; 33(5): 565-571, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32956438

RESUMO

This case history report describes a comprehensive digital workflow for implant treatment and occlusal reconstruction to provide a systematic protocol for implant-supported restorations in edentulous patients. In this case, a restoration-oriented surgical protocol was created using an oral implant planning and design software. The implant surgery was completed under the guidance of a fully guided surgical template. This is the first report of the combined application of computer-aided diagnosis axiograph and neuromuscular evaluation systems in implant-supported occlusal reconstruction. Digital technologies can increase the accuracy, efficiency, and comfort of implant treatment and achieve satisfactory occlusal reconstruction outcomes in edentulous patients.


Assuntos
Implantes Dentários , Arcada Edêntula/cirurgia , Cirurgia Assistida por Computador , Desenho Assistido por Computador , Implantação Dentária Endo-Óssea , Prótese Dentária Fixada por Implante , Humanos , Mandíbula , Fluxo de Trabalho
8.
Int J Prosthodont ; 33(5): 553-564, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32956437

RESUMO

PURPOSE: To systematically review the literature comparing marginal bone loss (MBL) and pink esthetic scores of implants with convergent or concave transmucosal profiles vs divergent or parallel profiles. MATERIALS AND METHODS: A PICO question was defined, and an electronic search was carried out in the MEDLINE/PubMed and Cochrane Oral Health Group databases. Studies documenting type of transmucosal profile (either tissue-level profiles or abutments) and soft and/or hard tissue outcomes of implants were considered eligible. Studies were selected on the basis of the inclusion criteria and quality assessments. A meta-analysis with subgroup analyses was performed. RESULTS: Five papers fulfilled the inclusion criteria, and four were eligible for meta-analysis. Significantly less MBL was found in concave/convergent groups, with a mean difference of 0.772 (95% confidence interval [CI]: 0.450 to 1.095; P < .001). In the subgroup analyses for platform-switching and platform-matching connections, a significant effect in favor of concave/convergent was detected, with a standardized difference in means of 1.135 (95% CI: 0.688 to 1.583, P < .001) when platform switching was considered. No significant effects were found for platform-matching connections. CONCLUSION: Within the limitations of this review, it is suggested that concave/convergent implant transmucosal profiles result in less MBL. No statistically significant results were obtained for soft tissue-related outcomes or for the platform-matching connection subgroup.


Assuntos
Perda do Osso Alveolar , Implantes Dentários , Dente Suporte , Implantação Dentária Endo-Óssea , Estética Dentária , Humanos
9.
Evid Based Dent ; 21(3): 92-93, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32978537

RESUMO

Design Non-randomised controlled trial.Case selection Patients requiring dental implants were recruited from a private dental surgery in Spain. According to the clinical diagnosis and patient preference, patients were assigned to one of the following three treatment protocols: the conventional treatment (CGCL), in which implants were inserted after flap elevation without guiding templates; the guided surgery/conventional loading group (GSCL); and the guided surgery/immediate loading group (GSIL).Data analysis An oral examination and a questionnaire-based interview were carried out at baseline and three months after the delivery of the definitive prosthetic rehabilitation. Two complementary indicators, Oral Impacts on Daily Performances (OIDP) and Oral Satisfaction Scale (OSS) were used to assess the changes in oral health-related quality of life (OHQoL). Paired t-tests were used to compare the within-subject change scores. ANOVA tests were used to compare quantitative variables between groups. Chi-square tests were used to compare the distribution of data between groups. Effect size was used to assess the relative responsiveness of different health indicators and to compare the amount of change resulting from different treatment protocols. A forward stepwise logistic regression analysis was performed to predict the risk of having impact after treatment.Results A total of 104 patients were recruited: CGCL (n = 40), GSCL (n = 35) and GSIL (n = 29). At baseline, the OHQoL was significantly greater among those assigned to CGCL (2.4 ± 1.3) than those assigned to GSCL (3.3 ± 1.3), which were both greater than those patients assigned to GSIL (4.6 ± 2.0). After implant therapy, the oral wellbeing was significantly better than at baseline, and patient satisfaction was greater when the implants were loaded immediately (8.7 ± 1.1) than if the prosthetic rehabilitation was delayed (8.3 ± 1.1). In the GSIL group, the effect size of the OIDP exceeded the threshold value of 0.8 for all of the OIDP domains and for the total OIDP score and patient satisfaction.Conclusions A global improvement in the OHQoL scores and patient satisfaction was observed after implant therapy, but the change was marked greater in the GSIL group.


Assuntos
Implantes Dentários , Qualidade de Vida , Implantação Dentária Endo-Óssea , Prótese Dentária Fixada por Implante , Humanos , Saúde Bucal , Espanha , Resultado do Tratamento
10.
Int J Oral Maxillofac Implants ; 35(5): 1037-1044, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32991656

RESUMO

PURPOSE: This study examined a new 3D volumetric analysis method for the assessment of baseline-to-12-month changes of the soft tissue volume at early and immediately placed tapered implants after loading with ceramic single crowns. MATERIALS AND METHODS: Eligible patients with one incisor, canine, or premolar to be extracted were included. The patients were divided randomly into early-placement or immediate-placement groups. Tapered implants (BLT, Institut Straumann) were placed after the extractions. In the early-placement group, the implants were placed 8 weeks after extraction. In the immediate-placement group, the implants were placed immediately after the extraction. All implants healed transmucosally, and the final crowns were inserted after healing (baseline). Impressions were made at screening, baseline, and 12 months after crown insertion (Permadyne, 3M). The casts were scanned (Imetric 4D) and aligned, and a superimposed area of interest (AOI) (labial/buccal aspects) was defined to assess the volumetric changes (GOM Inspect). Specific software (3Matic, Materialise NV) was used for volumetric analysis. The vertical mucosal recession was measured at each time point. Repeated-measures one-way analysis of variance and the Tukey method were used for statistical analysis (SPSS 22, IBM). RESULTS: Twenty tapered implants (16 regular and four narrow) were placed in 20 patients (12 men and 8 women) in the early-placement (EP; n = 10) and immediate-placement (IP; n = 10) groups, respectively. Threedimensional volumetric analysis revealed soft tissue volume loss in both groups of 10.0 ± 16.5 mm3 (EP) and 24.3 ± 21.3 mm3 (IP) between baseline and 12 months (P = .6). The analysis also revealed local differences in the changes, displaying both localized gain and loss in both groups. CONCLUSION: With this novel 3D analysis method, true volumetric soft tissue differences, ie, both localized gain and loss, were specified between the treatment groups.


Assuntos
Extração Dentária , Alvéolo Dental/diagnóstico por imagem , Alvéolo Dental/cirurgia , Coroas , Implantação Dentária Endo-Óssea , Feminino , Humanos , Masculino , Projetos Piloto
11.
Int J Oral Maxillofac Implants ; 35(5): 931-938, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32991643

RESUMO

PURPOSE: This study aimed to evaluate the effect of different surgical guide manufacturing techniques on the accuracy of the surgical guides produced prior to implant placement. MATERIALS AND METHODS: Three type of guides were compared: milled guides using a commercial milling unit (C-Mill), printed guides using a commercial 3D printer (C-Print), and printed guides using a benchtop printer (B-Print). All the guides were fabricated on a single maxillary model for anterior implant and posterior implant placement. Ten guides were produced for each group. Four accuracy variables were measured: (1) internal accuracy, (2) vertical fit, (3) guide seating distortion, and (4) drilling access horizontal and vertical deviations. All the variables were virtually measured by 3D rendering software. The Kruskal-Wallis and the Mann-Whitney U tests were conducted to evaluate the significance of the differences among the guide groups. RESULTS: The C-Mill guides were significantly more accurate than the other guide groups for all the accuracy variables (P < .05). The C-Print group tended to show greater accuracy than the B-Print group, except for guide seating distortion and horizontal deviation of drilling access. However, a significant difference between the C-Print and B-Print groups was observed only for the vertical deviation of the posterior drilling access (P < .05). The location of the implant seemed to have minimal influence on the drilling access accuracy, except for the vertical deviations of C-Mill and C-Print guides, where the anterior site was associated with significantly (P < .05) greater errors than the posterior site. CONCLUSION: Producing guides by milling was more accurate and less vulnerable to seating distortion in comparison to printing. Despite the overall similarity between the two printers, the commercial printer tended to produce guides with greater accuracy than the benchtop printer.


Assuntos
Implantes Dentários , Cirurgia Assistida por Computador , Desenho Assistido por Computador , Implantação Dentária Endo-Óssea , Maxila/diagnóstico por imagem , Maxila/cirurgia
12.
Int J Oral Maxillofac Implants ; 35(5): 955-964, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32991646

RESUMO

PURPOSE: To assess the effects of drilling protocol and bone density on the primary stability of implants with different macrogeometries currently used in clinical practice. MATERIALS AND METHODS: This in vitro study compared the designs of two implants: Biomimetic Coral, a parallel-walled design with a slightly expanded platform and a symmetric progressive thread; and tapered Biomimetic Ocean, a reverse coronal design with an asymmetric progressive thread. The drilling alternatives were grouped according to the standard sequence for each type, plus an extra drill for hard bone, using laminated blocks with different densities. The insertion torques and implant stability quotient (ISQ) values were obtained with a surgical motor and resonance frequency analysis (RFA), respectively. RESULTS: A total of 120 implants (n = 60 Ocean, n = 60 Coral) were inserted and analyzed without registering any deviation from the protocol. The Coral implants presented significantly higher insertion torque values (P < .001), consistent with optimal osseointegration, for the standard drill, the dense bone drill, and the screw tap. Insertion torque was not affected by the drilling sequence (P = .124), and the effect of interaction between the implant design and drilling sequence was not significant (P = .940). Statistically significant differences were observed in insertion torque values due to the type of implant but not due to the bone density. The ISQ values were significantly higher (P < .001) for the Coral design. In both the Ocean and Coral implants, ISQ was affected by the drilling sequence (P < .001), as the ISQ values were higher in the standard sequence with screw tap drilling than in the standard sequence with a dense bone drill. A positive correlation was found between the insertion torque and ISQ values. CONCLUSION: The macrogeometry of the implant and the drilling sequence have a significant effect on both primary stability values (ISQ and insertion torque). The values for the Coral implant were statistically higher but still within the range required to achieve proper osseointegration. These results support the drilling sequence recommended by the manufacturer for this type of implant, using larger-diameter drills and screw taps in sites with harder or cortical bone.


Assuntos
Implantação Dentária Endo-Óssea , Implantes Dentários , Densidade Óssea , Osseointegração , Análise de Frequência de Ressonância
13.
Int J Oral Maxillofac Implants ; 35(5): 974-981, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32991648

RESUMO

PURPOSE: The aim of this retrospective clinical case series report was to evaluate the outcomes of patients who underwent zygomatic implant surgery with a recent technical modification of the extrasinus surgical protocol. MATERIALS AND METHODS: The implant system presented in this study had a novel designed unthreaded body with a 12.5-mm sharp threaded apical end for obtaining maximum retention to the zygomatic bone. A total of 92 patients with severely atrophic maxillae were included in this study. All the patients were treated with a modification of the extrasinus protocol for insertion of 261 zygomatic implants. The mean follow-up of the patients was 34.5 ± 17.1 (SD) months (range: 6 to 72 months). The implant survival rate was the primary outcome. The intraoperative and postoperative complications were evaluated as additional criteria for success. RESULTS: The cumulative implant survival rate was 97.99%. Definitive or provisional prostheses were delivered on the same day of surgery, which resulted in an improvement in the quality of life of the patients. Five implants failed in four patients. No sinusitis or mucositis was seen in any of the patients. Eleven postoperative complications occurred in seven patients. CONCLUSION: The novel zygomatic surgery protocol introduced in this study can be an effective alternative to augmentation procedures and conventional implants, especially in cases of extremely atrophic posterior maxillae.


Assuntos
Implantação Dentária Endo-Óssea , Implantes Dentários , Prótese Dentária Fixada por Implante , Falha de Restauração Dentária , Seguimentos , Humanos , Qualidade de Vida , Estudos Retrospectivos
14.
Int J Oral Maxillofac Implants ; 35(5): 990-994, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32991650

RESUMO

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


Assuntos
Implantes Dentários , Boca Edêntula , Implantação Dentária Endo-Óssea , Humanos , Radiografia Panorâmica
15.
Int J Oral Maxillofac Implants ; 35(5): 995-1004, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32991651

RESUMO

PURPOSE: To describe the prevalence of alveolar bone atrophy in edentulous arches of elderly individuals in relation to insertion of dental implants and the eventual need for bone grafting procedures. MATERIALS AND METHODS: Computed tomography scan files of 228 edentulous arches of elderly patients (ages 65 to 100 years) were evaluated in relation to implant placement. Six measurements per arch were taken on cross-sectional reconstructions. Bone atrophy categories were described, in relation to implant placement, for the anterior and posterior sections of the arches. Six bone sections per arch were evaluated and allocated to the predetermined categories. Prevalence of each type of atrophy was calculated. RESULTS: In the maxilla, only 5.0% of the patients showed a bone anatomy capable of receiving implants without any augmentation both in the posterior and anterior regions; 64.4% showed the need for major reconstruction in both areas. In the mandible, 17.3% of the patients did not require any augmentation in both regions; 9.4% were in need of major reconstruction in both areas. The anterior part of the arches could eventually be treated without any bone augmentation in 10.9% of the maxillae and 72.4% of the mandibles, while minor augmentation was needed in 16.8% of maxillae and 15.8% of mandibles. CONCLUSION: Most edentulous elderly patients show some degree of alveolar bone atrophy. It is often feasible to insert implants in the anterior mandible to support a restoration. In most maxillary cases, alveolar atrophy calls for augmentation procedures in both the anterior and posterior areas. In elderly individuals, the anterior maxilla often shows bone deficiency interfering with simple implant placement procedures, thus also limiting the use of tilted implants.


Assuntos
Implantes Dentários/efeitos adversos , Arcada Edêntula/diagnóstico por imagem , Arcada Edêntula/cirurgia , Boca Edêntula/diagnóstico por imagem , Boca Edêntula/cirurgia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Implantação Dentária Endo-Óssea/efeitos adversos , Humanos
16.
Int J Oral Maxillofac Implants ; 35(5): 1022-1036, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32991655

RESUMO

PURPOSE: This 3-year study aimed to evaluate hard and soft tissue modification around a two-piece implant characterized by a transmucosal hyperbolic neck in healthy consecutive patients with a need for single-tooth replacement. MATERIALS AND METHODS: Two-piece implants (n = 66) were placed with a flapless technique in 56 patients (27 men; 29 women; mean age 55 ± 9 years): 16 immediately after root extraction (immediate group), 20 after 8 to 12 weeks (early group), and 30 after 10 or more months (delayed group). The transmucosal hyperbolic neck was exposed 1 to 1.5 mm above gingival level. Customized abutments were positioned 3 months later with the implant-abutment connection located approximately 1 to 1.5 mm above soft tissue level. Provisional cemented resin crowns were designed with the finishing line at the hyperbolic neck and then positioned to avoid excessive compression of soft tissue, to guide gingival contours. Twenty days later, a definitive metal-ceramic crown was cemented. In all patients, the gingival biotype (thin or thick) was also evaluated. The primary outcomes were as follows: 36-month implant survival rate, peri-implant marginal bone level (MBL, in mm) changes observed in single-blind on radiographs at 1, 3, 6, 12, 24, and 36 months (T1, T3, T6, T12, T24, and T36), and pink esthetic score (PES) at T6, T12, and T36 to analyze soft tissue adaptation after loading and crown application. The secondary outcomes were as follows: plaque score and bleeding on probing (BOP). Linear regression models and multilevel mixed logistic regression were used to detect any statistical difference of MBL according to operative parameters. Kruskal-Wallis one-way analysis of variance (ANOVA) on ranks was performed to assess statistical differences of PES at T6, T12, and T36. RESULTS: The survival rate was 100%. The dropout rate was 1.79%. No infections, mucositis, or peri-implantitis were reported. Implants placed in thick-biotype tissues showed a statistically different lower bone loss at 36 months with respect to the thin biotype (P < .05). At 36 months, the early group showed lower bone loss compared with the delayed group (P < .05). Multilevel mixed logistic regression revealed that gingival biotype was the parameter that was most related to MBL variations (P = .025). The PES value (mean ± SD) at T6 was 10.76 ± 1.19 (median: 11; range: 8 to 13; IQR: 10 to 12). The values statistically increased at T12 and T36, where the mean values were 11.76 ± 1.10 (median: 12; range: 9 to 13; IQR: 11 to 12) and 11.83 ± 1.03 (median: 12; range: 9 to 14; IQR: 11 to 13). CONCLUSION: MBL and soft tissue clinical parameters measured around two-piece hyperbolic-neck implants were stable during the 3-year follow-up and free from complications. The exposure of the hyperbolic neck for 1.0 to 1.5 mm allowed a flapless one-stage surgery, which supported fast adaptation of the soft tissues, evidenced by high PES values and low percentages of BOP. The results from the study imply a new simple approach in the clinical management of gingival and bone tissue.


Assuntos
Implantes Dentários para Um Único Dente , Implantação Dentária Endo-Óssea/efeitos adversos , Estética Dentária , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Método Simples-Cego
17.
Int J Oral Maxillofac Implants ; 35(5): e86-e90, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32991657

RESUMO

Guided dental implant surgery can optimize implant placement positioning, increase predictability, and decrease surgical invasiveness through flapless techniques. Static surgical guides have been used to accomplish this task, though limitations of patient opening and lack of coolant contact with the surgical site have been clinically significant weaknesses. Technologic advances have allowed robotically guided implant placement using haptic guidance. The absence of a static stereolithographic guide over the surgical area allows for optimal access and adequate cooling during osteotomies. The aim of this case series was to present the workflows of both static and robotic guidance in the same patient and measure deviations from the presurgical planning software to determine the practicability and accuracy of robotic guidance. Based on this case series, it can be concluded that using robotically assisted implant surgery can yield deviation results that are comparable to static CAD/CAM stereolithographic surgical guides. Robotic surgery can be performed predictably with minimal deviation in both simple and complex clinical situations. Further testing and analysis are needed to confirm this case study's results in a larger cohort of patients.


Assuntos
Implantes Dentários , Procedimentos Cirúrgicos Robóticos , Cirurgia Assistida por Computador , Desenho Assistido por Computador , Implantação Dentária Endo-Óssea , Humanos
18.
Artigo em Inglês | MEDLINE | ID: mdl-32925991

RESUMO

The purpose of this retrospective study was to evaluate bone level stability around 441 mandibular and 350 maxillary molar implants, placed using an immediate implant protocol, that had been in function from 2 to 17 years postrestoration (mean: 9.9 years). Independent radiographic measurements using the known distance between threads on the specific implant that was used indicated a mean bone loss of 0.27 ± 0.68 mm around maxillary implants and 0.27 ± 0.67 mm around mandibular implants. Maxillary implants showed a statistically significant (SS) difference in bone loss on the mesial (0.20 mm) compared to the distal side (0.34 mm). In the mandibular group, there was an SS difference in bone loss around implants with wide (≥ 5 mm) and regular (< 5 mm) diameters. There was also an SS difference in bone loss in patients 50 years and older (0.28 mm) compared to patients younger than 50 (0.18 mm). In both groups, there were no SS differences in bone loss between machined- and rough-surface implants, men and women, single and splinted implants, nonsmokers and light/heavy smokers, or in patients with a penicillin allergy who were prescribed azithromycin as an alternate prophylactic antibiotic. All SS differences found in variables evaluated in the study were < 1.0 mm and therefore were considered clinically insignificant.


Assuntos
Perda do Osso Alveolar , Implantes Dentários , Implantação Dentária Endo-Óssea , Planejamento de Prótese Dentária , Prótese Dentária Fixada por Implante , Feminino , Humanos , Masculino , Mandíbula/cirurgia , Dente Molar , Estudos Retrospectivos
19.
Int J Periodontics Restorative Dent ; 40(5): e189-e196, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32925993

RESUMO

Dental implants are intended to provide long-term reliable dental restorations. Limited data exist on the comparison between different implant surfaces. This study aims to clarify whether there is a difference between airborne particle- abraded and acid-etched (SLA implants) and only acid-etched surfaces (Osseotite) in healthy and periodontally compromised patients. After comprehensive evaluation of all 109 patients, including nonsurgical and surgical therapy for the treatment of periodontal disease, 109 implants were placed according to the manufacturer's guidelines. Each treatment site was examined radiographically 3 to 6 months after the final coronal restorations were placed. Patients were enrolled in the follow-up maintenance program, and radiologic evaluations were carried out at 5 and 10 years. Data recorded from 91 patients who completed the final 10-year follow-up were included in the analysis (SLA: n = 50; Osseotite: n = 41). At 10 years, the difference between bone-to-implant distances (DIBs) for SLA and Osseotite was significantly different (P = .001; 95% confidence interval: 0.55, 1.89 mm). Mean ± SD DIB for SLA implants was 2.1 ± 1.1 mm and 0.9 ± 2.1 mm for Osseotite implants. The overall survival rates of SLA and Osseotite implant surfaces were high during the observation period. History of previous periodontal disease plays an important role in the incidence of complications, regardless of the surface type.


Assuntos
Implantes Dentários , Implantação Dentária Endo-Óssea , Planejamento de Prótese Dentária , Falha de Restauração Dentária , Humanos , Osseointegração , Estudos Prospectivos , Propriedades de Superfície , Titânio
20.
Artigo em Inglês | MEDLINE | ID: mdl-32925994

RESUMO

The goal of the present study was to evaluate human histologic healing of dental implants with a unique triangular neck design that is narrower than the implant body. Four patients in need of full-mouth reconstruction were recruited and received several implants to support a full-arch prosthesis. In each patient, two additional customized reduced-diameter implants were placed, designated to be harvested after 6 months of submerged healing. The eight harvested implants were all placed in healed edentulous maxillary or mandibular ridges. These implants were Ø 3.5 × 8 mm in size, and the final osteotomy drill allowed for the creation of a gap up to 0.2 mm in size between the coronal aspect of the triangular implant neck and the surrounding bone. At the end of the healing period, the implants were retrieved with the surrounding bone. Microcomputed tomography (µCT) was performed before processing the biopsy samples for undecalcified histologic exampination. Bone-to-implant contact (BIC) was measured from the µCT data and from buccolingual/buccopalatal and mesiodistal central histologic sections. All implant gaps were filled by mature remodeled bone. The mean BICs of the BL/BP and MD sections were 64.45% ± 6.86% and 65.39% ± 10.44%, respectively, with no statistically significant difference. The mean 360-degree 3D BIC measured all over the implant surface was 68.58% ± 3.76%. The difference between the BIC measured on the µCT and on the histologic sections was not statistically significant. The positive histologic results of the study confirmed the efficacy of this uniquely designed dental implant.


Assuntos
Implantes Dentários , Osseointegração , Implantação Dentária Endo-Óssea , Planejamento de Prótese Dentária , Humanos , Mandíbula/cirurgia , Microtomografia por Raio-X
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