Search

This study was carried on to assess the clinical performance of a novel restorative concept consisting in single monolithic lithium disilicate full-contour crowns bonded on computer-aided design/computer-aided manufacturing (CAD/CAM) zirconia complete-arch implant bridges, to overcome the drawbacks related to the chipping of porcelain fused to zirconia restorations. Sixteen patients received 18 implant-supported hybrid screw-cement-retained complete-arch restorations, consisting of single monolithic lithium disilicate full-contour crowns bonded on CAD/CAM zirconia frameworks. The restorations were supported by 4-8 implants. All patients were followed up for at least 3 years on function (range 36 to 60 months, mean 49.3 months). Clinical controls were scheduled every 4 months. The outcomes were implant and prosthetic survival and success rates, any complications, patient satisfaction, and soft tissue parameters. No dropouts occurred. The overall implant and prosthesis survival rates were 100%. One of 18 restorations (1 of 236 dental units) showed a chip-off fracture of the veneering ceramic that was polished intraorally without any additional treatment, scoring a cumulative prosthetic success rate of 100%, according to the California Dental Association index. All patients were functionally and esthetically highly satisfied with their restorations. Successful soft tissue parameters were found around all implants. Single monolithic lithium disilicate full-contour crowns, bonded on CAD/CAM screw-retained complete-arch zirconia frameworks, showed favorable preliminary outcomes with medium-term follow-up. However, randomized controlled studies of this technique are required for further conclusive recommendations.

Purpose: The purpose of this study is to retrospectively evaluate the implant and prosthetic survival and success rates of zirconia-based, implant-supported, screw-retained, cross-arch restorations up to 5 years after placement., Materials and Methods: Twenty-two consecutive edentulous patients (11 males and females, each; mean age 68.3 years) received 26 CAD/CAM cross-arch zirconia implant bridges (NobelProcera™ Implant Bridge Zirconia; Nobel Biocare AG, Zurich, Switzerland) supported by 4 to 10 implants each. All patients were followed for at least 3 years (range 36-60 months, mean 42.3 months). Clinical assessments were scheduled every 4 months during hygiene maintenance. Outcomes were implant and prosthetic survival rates, prosthetic success rate, any observed clinical complications, patient satisfaction, and soft tissue parameters. Fisher's exact test was used to assess associations between categorical variables., Results: No dropouts occurred. The overall implant and prostheses survival rate up to 5 years was 100%. Three out of 26 restorations (five out of three hundred forty eight dental units) showed an adhesive chip-off fracture of the veneering ceramic, scoring a cumulative prosthetic success rate of 88.5% at the prosthetic level and 98.6% at the unit level. All 22 patients were functionally and aesthetically highly satisfied with their restorations. Successful soft tissue parameters were found around all implants., Conclusions: Industrially manufactured, zirconia-based, implant-supported, screw-retained, cross-arch restorations are a viable alternative to conventionally manufactured porcelain-fused-to-metal restorations for rehabilitating the edentulous patient., (© 2013 Wiley Periodicals, Inc.)

Purpose: To compare two different impression techniques for implants in totally edentulous patients., Materials and Methods: A total of 38 patients had impressions taken both using plaster and splinted vinyl polysiloxane (splinted-VPS). Two casts per patient were generated and allocated as test (plaster) and control (splinted-VPS) cast groups according to a randomised cross-over design. One of the two casts from each patient was randomly selected as master cast according to a parallelgroup design and used to fabricate the definitive prosthesis. Outcome measures were implant and prosthetic success rates, complications, marginal bone level (MBL) changes, patient satisfaction, chair time required to take the impressions, inter-implant discrepancy between the casts, sulcus bleeding index (SBI) and plaque score (PS)., Results: In total, 76 impressions were taken in 38 patients. Two plaster impressions failed. Furthermore, 38 computer-aided design/computer-assisted manufacturing screw-retained complete-arch prostheses were fabricated onto the master cast (18 from plaster and 20 from splinted-VPS impressions) and the patients were followed up for 3 years after loading. No drop-out occurred and no implants or prostheses failed, accounting for a cumulative implant and prosthesis survival rate of 100% over the 3-year post-loading period. Plaster impressions yielded significantly greater patient satisfaction and shorter chair time. The discrepancy between the casts was 0.055 ± 0.067 mm (P = 0.931). Mixed model analysis revealed a significant main effect from both the implant number and the inter-implant distance, while no difference was found with regard to implant angulation. Five chip-off fractures of the porcelain veneer occurred in 5 of the 38 patients (3 in restorations fabricated onto the plaster cast group and 2 in the splinted-VPS cast group) with no effect from the type of impression on the prosthetic success rate (P = 0.331). However, all of the patients were functionally and aesthetically satisfied with their prostheses. Furthermore, mean MBL, SBI and PS showed no significant differences (P > 0.05) between the groups., Conclusions: The clinical outcome of plaster impressions for completely edentulous patients was found to be the same as that for splinted-VPS impressions. The intraoral pre-scan resin framework try-in can be avoided. Plaster impressions may be less time consuming and thus more comfortable for the patient, but sometimes may have to be repeated due to fractures., Conflict-Of-Interest Statement: All materials used in this study were purchased by the authors and there were no commercial or institutional interests.

PURPOSE:To introduce a proof of concept technique and new integrated workflow to optimize the functional and esthetic outcome of the implant-supported restorations by means of a 3-dimensional (3D) facially-driven, digital assisted treatment plan. METHODS:The Smiling Scan technique permits the creation of a virtual dental patient (VDP) showing a broad smile under static conditions. The patient is exposed to a cone beam computed tomography scan (CBCT), displaying a broad smile for the duration of the examination. Intraoral optical surface scanning (IOS) of the dental and soft tissue anatomy or extraoral optical surface scanning (EOS) of the study casts are achieved. The superimposition of the digital imaging and communications in medicine (DICOM) files with standard tessellation language (STL) files is performed using the virtual planning software program permitting the creation of a VDP. CONCLUSIONS:The smiling scan is an effective, easy to use, and low-cost technique to develop a more comprehensive and simplified facially driven computer-assisted treatment plan, allowing a prosthetically driven implant placement and the delivery of an immediate computer aided design (CAD) computer aided manufacturing (CAM) temporary fixed dental prostheses (CAD/CAM technology).

Statement of problemIn patients with an altered skeletal maxillomandibular relationship and bone resorption, the rehabilitation of edentulous jaws by combining 4 implants, 2 straight medially and 2 tilted distally, may be preferred to avoid a bone augmentation procedure.PurposeThe purpose of this single cohort 1-year prospective study was to evaluate the clinical performance of a 4-implant overdenture fully supported by a computer-aided designed and computer-aided manufactured (CAD-CAM) titanium bar.Material and methodsThis single cohort prospective study included edentulous participants rehabilitated with a 4-implant overdenture in 1 of the 2 jaws. The outcomes were implant and prosthetic survival and success rates, any biologic and technical complications, periimplant marginal bone loss, changes in the oral health impact profile (OHIP), bleeding on probing, and the plaque index.ResultsEighteen participants received 72 implants. One year after implant placement, no implants or prosthesis had failed, and no biologic or technical complications had been observed. At the 1-year follow-up, the mean marginal bone loss was 0.29 ±0.16 mm. The OHIP summary scores demonstrated a significant improvement in oral health-related quality of life. At the 1-year follow-up, positive bleeding was found in 2 participants (11.1%) around 3 implants (4.1%). Three participants (16.6%), accounting for 5 implants (6.9%), showed a slight amount of plaque.ConclusionsA 4-implant overdenture supported by a CAD-CAM titanium bar may be a reliable option for the treatment of the edentulous mandible and maxilla over a 1-year period. Oral health-related quality of life significantly improved in all treated participants.

Objective: Despite the wide clinical use of translucent zirconia for full‐arch implant prostheses, reduced flexural strength and fracture toughness compared with high‐strength opaque zirconia needs to be addressed. A novel proof of concept for FP1 full‐arch prosthesis featured by translucent monolithic zirconia and titanium framework was presented. Clinical Considerations: Computer‐guided implant planning and surgery were executed and digitally designed FP1 temporary prosthesis prefabricated. Implant and prosthetic placement were achieved with a set of three‐dimensional (3D)‐printed templates. Implants were immediately loaded. After 4 months intraoral optical scan was taken to record implant coordinates, soft tissue anatomy, and temporary FP1 prosthesis. A novel digital workflow was used to design and mill overlaying translucent zirconia and anatomically shaped titanium framework with a scalloped soft‐tissue interface. Final FP1 prosthesis was assembled cementing zirconia jacket on titanium counterpart. Conclusions: Translucent zirconia supported by titanium framework can address esthetic and mechanical requirements of FP1 full‐arch prosthesis, minimizing risk of fracture and providing a rigid and passive joint with supporting implants. The smooth and highly polished titanium surface with an anatomic design, tightly matching scalloped soft tissue interface, can limit food impaction, air and saliva leakage and contribute to overall biologic integration of FP1 full‐arch prosthesis. Clinical Significance: Translucent monolithic zirconia featured with anatomically shaped titanium framework with scalloped transmucosal part, combining a pleasant esthetic outcome with increased flexural strength and fracture toughness, may be indicated to increase the clinical performance of FP1 full‐arch prosthesis. [ABSTRACT FROM AUTHOR]

Objective: To assess clinical and radiological performance of novel digital workflow integrating dynamic guided surgery, to streamline execution of implant placement, soft and bone tissue sculpturing, and immediate delivery of navigation guided complete‐arch prosthesis. Materials and Methods: This proof of concept prospective single cohort study investigated 10 consecutive patients (three males, seven females; mean age 62.5 ± 8.9 years; range, 48–75) requiring at least one complete‐arch fixed dental prostheses (FDP) in both jaws, treated between January and August 2019. Primary outcomes were implant and prosthetic success rates, surgical and prosthetic complications. Secondary outcomes were marginal bone loss (MBL), implant stability quotient (ISQ), periodontal parameters (plaque and bleeding indexes). Results: Sixty implants (32 NobelParallel TiUltra and 28 NobelActive TiUltra, Nobel Biocare) were placed and 14 complete‐arch FDPs immediately loaded (mean follow‐up 16.2 ± 1.7 months, 14–18). One implant failed and was immediately replaced. No other surgical or biological complications occurred, accounting for a cumulative success rate of 98.3%. No prosthetic complication occurred, leading to 100% prosthetic success rate. Mean ISQ at implant placement was 71 ± 2.8 (65–78). The mean MBL was −0.53 ± 0.28 mm (−0.22 to −1.12 mm). Plaque and bleeding scores were 14.4 ± 8.18 and 7.15 ± 4.4, respectively. Conclusion: Within the limitations of this proof‐of‐concept dynamic navigation was effective to deliver in the planned coordinates both implants and prosthesis and guide bone and soft tissue sculpturing. Immediate loading of digitally prefabricated esthetically driven complete‐arch FDP was facilitated, resulting in high implant and prosthetic success rates. Clinical Significance: The investigated digital workflow integrating dynamic navigation may overcome the difficulties related to immediate positioning and loading of digitally prefabricated complete‐arch FDP. The navigation guided soft and bone tissues sculpturing, associated to xenogeneic collagen matrix grafting, represented a predictable technique to achieve the digitally planned interface, reestablishing the mucosal dimension required for the protection of underlying bone while maintaining tissue health. [ABSTRACT FROM AUTHOR]

Purpose: To introduce a digitally assisted technique to achieve the ideal soft and bone tissue interface for anatomic-driven pink free implant supported fixed prosthesis, and prefabricate an interim prosthesis to be used the day of the surgery as a prosthetic scaffold to condition the healing Methods: The digital assisted soft tissue sculpturing (DASS) technique allows the previsualization of the ideal soft and bone tissue interface and fabricate a computer aided design computer aided manufacturing (CAD-CAM) anatomic-driven pink free complete arch interim prosthesis for the immediate loading. Bone and soft tissue interface as well as the interim prosthesis design are performed in a segmented multiple standard tessellation language (STL) file embedding the bone anatomy, the intraoral surface anatomy (dental and soft tissue), the digital wax-up and the implant positioning. The interim prosthesis is used as a prosthetic scaffold to guide the soft and bone tissue surgical sculpturing and regeneration. Conclusions: The DASS technique is a predictable integrated digital workflow that simplifies the achievement of a scalloped tissue interface for pink free fixed implant prosthesis, reestablishing the mucosal dimension required for the protection of underlying bone while maintaining tissue health. The surgical sculpturing and maturation of the soft and bone tissue is driven and enhanced by the xenogeneic collagen matrix grafting and prosthetic scaffold effect of the digitally prefabricated interim prosthesis delivered the day of the surgery. [ABSTRACT FROM AUTHOR]

Purpose This study describes a new procedure for sinus elevation using computer-guided planning and guided surgical approach through the use of computer-aided design (CAD)/computer-aided manufacturing (CAM)-generated surgical template in combination with expander-condensing osteotomes thus providing a minimally invasive surgical technique. Materials and Methods Sixty-six consecutive patients were treated with 136 implants placed by transcrestal-guided sinus floor elevation technique and the patients were followed for at least 3 years in function. The drilling protocol is customized based on the bone density of each implant site to achieve an insertion torque ranging between 45 and 55 Ncm. Titanium temporary abutments were connected to the implants with prosthetic screws tightened to 35 Ncm and an acrylic resin provisional restoration was adapted and delivered immediately. Six months after initial loading, a definitive CAD/ CAM-generated restoration was delivered. Outcome measurements assessed were implant and prosthesis survival rate, biological or biomechanical complications, marginal bone level changes, total alveolar ridge bone height before and after procedure, periodontal parameters measured as well as patient's perception of pain levels during recovery period. Results Mean follow-up was 43.96 (range from 36 to 52) months. Cumulative implant survival rate was 98.53% at 3 years. No biological or mechanical complications were encountered and no prosthetic failures occurred during the entire follow-up period. Mean marginal bone loss ( MBL) during the first year of function was 0.33 ± 0.36 mm, while at the 3-year follow-up, the mean MBL was 0.51 ± 0.29 mm. The mean residual bone height of the alveolar crest prior to grafting was of 6.7 ± 1.6 mm (range 5.1-9.2 mm), while, the mean bone height gained was 6.4 ± 1.6 mm (range 3.2-8.1 mm). All patients reported low levels of pain and found to have normal periodontal parameters. Conclusion This proof-of-concept study suggests that the use of guided surgery to perform transcrestal maxillary sinus floor elevation for alveolar ridge height augmentation is a successful minimally invasive technique for the short- to medium-term follow-up, thus avoiding the extended treatment time and morbidities associated with maxillary sinus floor augmentation. [ABSTRACT FROM AUTHOR]