Search

Objectives: To investigate in which clinical situations a cantilever fixed implant supported restorations can be a treatment alternative and which complications are reported. Materials and Methods: Two operators screened the literature (MEDLINE, EMBASE) and performed a hand search on the main journals dealing with implantology and prosthetics until 31 December 2017. Only articles that considered cantilever implant fixed restorations with at least 10 patients and with a mean follow‐up of at least 5 year were selected. The outcome variables were survival of implants and prosthesis, mechanical, technical and biological complications, marginal bone loss. The review was performed according to the PRISMA statements. Risk of bias assessment was evaluated. Failure and complication rates were analysed using random effect Poisson regression models to obtain summary estimate of 5‐ and 10‐year survival and complication rates. Results: A total of nine papers were selected for partially edentulous patients and reported high survival rate of the prosthesis. The estimated survival rate for 5–10 years was calculated to be 98.4% for the implants and 99.2% for the rehabilitations. Mechanical, technical and biological complications were reported with a cumulative 5–10 years complication rate of 28.66% and 26.57% for the patients and for the prosthesis, respectively. Two papers for single implant supporting 2‐unit cantilever were not sufficient to draw conclusions. Conclusions: There is evidence that cantilever can be successful treatment in partially edentulous patients. In two adjacent edentulous sites, data are not yet sufficient. [ABSTRACT FROM AUTHOR]

Aim: To investigate fully edentulous patients rehabilitated with cantilever‐fixed implant‐supported restorations and to analyse which complications are reported for this type of treatment. Materials and Methods: Two operators screened the literature (MEDLINE, EMBASE) and performed a hand search on the main journals dealing with implantology and prosthetics until 31 December 2017. Only articles that considered cantilever implant‐fixed restorations with at least 10 patients and with a mean follow‐up of at least 5 years were selected. The outcome variables were survival of implants and prosthesis, mechanical, technical and biological complications, marginal bone loss. The review was performed according to the PRISMA statements. The risk of bias was evaluated for each article. Failure and complication rates were analysed using random effect Poisson regression models to obtain summary estimate of 5‐ and 10‐year survival and complication rates. Results: Fourteen papers for fully edentulous patients were selected. The estimated 5 to 10 years survival rate was calculated to be 99.00% and 96.7% for the implants and the prosthesis, respectively. A total of 299 complications (technical and biological) were reported with a cumulative 5–10 years complication rate of 44.41% and 39.46% for the patients and for the prosthesis, respectively. Conclusions: There is evidence that cantilever can be successful treatment in fully edentulous patients. [ABSTRACT FROM AUTHOR]

Objectives: To investigate in which clinical situations a cantilever fixed implant supported restorations can be a treatment alternative and which complications are reported. Materials and Methods: Two operators screened the literature (MEDLINE, EMBASE) and performed a hand search on the main journals dealing with implantology and prosthetics until 31 December 2017. Only articles that considered cantilever implant fixed restorations with at least 10 patients and with a mean follow‐up of at least 5 year were selected. The outcome variables were survival of implants and prosthesis, mechanical, technical and biological complications, marginal bone loss. The review was performed according to the PRISMA statements. Risk of bias assessment was evaluated. Failure and complication rates were analysed using random effect Poisson regression models to obtain summary estimate of 5‐ and 10‐year survival and complication rates. Results: A total of nine papers were selected for partially edentulous patients and reported high survival rate of the prosthesis. The estimated survival rate for 5–10 years was calculated to be 98.4% for the implants and 99.2% for the rehabilitations. Mechanical, technical and biological complications were reported with a cumulative 5–10 years complication rate of 28.66% and 26.57% for the patients and for the prosthesis, respectively. Two papers for single implant supporting 2‐unit cantilever were not sufficient to draw conclusions. Conclusions: There is evidence that cantilever can be successful treatment in partially edentulous patients. In two adjacent edentulous sites, data are not yet sufficient. [ABSTRACT FROM AUTHOR]

Aim: To investigate fully edentulous patients rehabilitated with cantilever‐fixed implant‐supported restorations and to analyse which complications are reported for this type of treatment. Materials and Methods: Two operators screened the literature (MEDLINE, EMBASE) and performed a hand search on the main journals dealing with implantology and prosthetics until 31 December 2017. Only articles that considered cantilever implant‐fixed restorations with at least 10 patients and with a mean follow‐up of at least 5 years were selected. The outcome variables were survival of implants and prosthesis, mechanical, technical and biological complications, marginal bone loss. The review was performed according to the PRISMA statements. The risk of bias was evaluated for each article. Failure and complication rates were analysed using random effect Poisson regression models to obtain summary estimate of 5‐ and 10‐year survival and complication rates. Results: Fourteen papers for fully edentulous patients were selected. The estimated 5 to 10 years survival rate was calculated to be 99.00% and 96.7% for the implants and the prosthesis, respectively. A total of 299 complications (technical and biological) were reported with a cumulative 5–10 years complication rate of 44.41% and 39.46% for the patients and for the prosthesis, respectively. Conclusions: There is evidence that cantilever can be successful treatment in fully edentulous patients. [ABSTRACT FROM AUTHOR]

The oral rehabilitation of MRONJ patients represents a challenging situation. Conventional dental implant insertion is not indicated because of the risk of creating a new necrotic area. This case study describes the oral rehabilitation of a 78-year-old female patient, who developed an osteonecrotic lesion in the fourth year of bisphosphonate treatment. The patient underwent a series of surgeries, including resection of the necrotic tissue on the right maxillary region and removal of conventional implants. The patient had a large maxillary defect, and no other treatment modalities such as conventional prosthetic appliances and traditional dental implant insertions were applicable. The patient had a very poor quality of life and as a rehabilitation option, two zygomatic implant insertions were planned and performed as an anchorage for maxillary fixed prosthesis. Radiographic and clinical examination after three years of follow-up indicated that healing was achieved, and healthy tissues formed around zygomatic implants. The patient did not suffer from any additional necrotic tissues or other complications in the oral cavity. According to the results of this case report, zygomatic implantation after resective surgery might be considered as a promising alternative for MRONJ patients with large defects when other treatment alternatives fail or are not applicable. [ABSTRACT FROM AUTHOR]

ABSTRACT Purpose: The aim of this review was to evaluate the survival rate of upright and tilted implants supporting fixed prosthetic reconstructions for the immediate rehabilitation of partially and fully edentulous jaws, after at least 1 year of function. Materials and Methods: An electronic search of databases plus a hand search on the most relevant journals up to December 2009 was performed. The articles were selected using specific inclusion criteria, independent of the study design. Results: The literature search yielded 347 articles. A first screening based on the title and abstract identified 25 eligible studies. After full-text review of these studies, 10 articles were selected for analysis. Seven were prospective single-cohort studies and three had a retrospective design. A total of 462 patients have been rehabilitated with 470 immediately loaded prostheses (257 in the maxilla, 213 in the mandible), supported by a total of 1,992 implants (1,026 upright and 966 tilted). Twenty-five implants (1.25%) failed in 20 patients within the first year. All failures except one occurred in the maxilla. No significant difference in failure rate was found between tilted and upright implants, nor between maxillary and mandibular implants. No prosthesis failure was reported. Limited peri-implant bone loss was reported with no difference between upright and tilted implants. Full patients' satisfaction for function, phonetics, and esthetics was reported in three studies, based on questionnaires. Conclusions: The use of tilted implants to support immediately loaded fixed prostheses for the rehabilitation of edentulous jaws can be considered a predictable technique, with an excellent prognosis in the short-medium term. However, randomized long-term trials are needed to determine the efficacy of this surgical approach. [ABSTRACT FROM AUTHOR]

Background: Full‐arch IOS scan of edentulous areas rehabilitated with dental implants is nowadays still described as an unpredictable procedure. To improve the accuracy, a universal scan template (UST®) is proposed in this article. The clinician can easily assemble the template with a mechanical coupling, by matching the scan bodies with objects of known dimension characterized by specific markers. The UST® facilitates the scanning of an entire arch on scan bodies, reducing the learning curve, simplifying acquisition movements, shortening the scanning time, and drastically reducing the risk of distortions and aberrations of the scans. Materials and Methods: In a case series study on 12 patients, the improvement in the accuracy of the scans with UST® was validated by comparing the STL files derived from scans with and without the guide in place. A titanium bar was produced from each optical impression. Results: The bars obtained from the optical impressions taken without UST® were found to be nonpassive in the mouth in the majority of the cases. On the contrary with the use of UST® we obtained 12 passive prosthetic rehabilitations. Conclusions: The proposed solution may represent a valid method to improve the predictability of full arch optical impressions on implants. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this prospective study was to investigate the clinical success of a treatment protocol for the rehabilitation of edentulous posterior maxilla consisting of the positioning of short implants in combination with transcrestal sinus lifting, with the adjunct of pure (leukocyte-free) platelet-rich plasma, in order to reducing the risk of membrane perforation and other surgical complications. Materials and Methods A total of 25 patients (65 implants) were treated. Pure platelet-rich plasma was used in the sinus membrane lifting procedure. Implants of 8.5 mm length or shorter were splinted through the prosthetic rehabilitation with one or more implants longer than 10 mm. Results After a follow-up period ranging from 12 to 19 months (mean 14.4 months) after prosthetic loading, 23 patients (60 implants) were evaluated. Overall implant success and survival rates were 100% at 1 year follow-up visit. All prosthetic rehabilitations were successful and in function. After 1 year of loading, peri-implant bone loss averaged 0.34 ± 0.21 mm for 8.5 mm or shorter implants ( n = 25) and 0.36 ± 0.30 mm for longer implants ( n = 35) (overall mean 0.35 ± 0.25 mm) without significant difference between the two groups ( p = 0.23). Conclusions The proposed treatment protocol is a viable option for the rehabilitation of edentulous posterior atrophic maxilla. [ABSTRACT FROM AUTHOR]

Objectives: To present the results of guided bone regeneration (GBR) of atrophic edentulous ridges with customized CAD/CAM titanium meshes. Material and methods: Forty‐one patients, presenting with 53 atrophic sites, were enrolled between 2018 and 2019. GBR was obtained with titanium meshes filled with autogenous bone chips and bovine bone mineral (BBM). After a mean of 7 months (range: 5–12 months), meshes were removed and 106 implants placed. After a mean of 3.5 months (range: 2–5 months), implants were uncovered and prosthetic restorations started. The outcomes were vertical and horizontal bone augmentation changes, biological complications and implant survival. Results: Out of 53 sites, 11 underwent mesh exposure: eight of them were followed by uneventful integration of the graft, while three by partial bone loss. The mean vertical and horizontal bone gain after reconstruction was 4.78 ± 1.88 mm (range 1.00–8.90 mm) and 6.35 ± 2.10 mm (range 2.14–11.48 mm), respectively. At the time of implant placement, mean changes of initial bone gain were −0.39 ± 0.64 mm (range −3.1 to + 0.80 mm) and −0.49 ± 0.83 mm (range –3.7 to +0.4 mm), in the vertical and horizontal dimensions, respectively. Reduction of bone volume was significantly higher (p <.001 for both dimensions) in the exposed sites. The mean follow‐up of implants after loading was 10.6 ± 6.5 months (range: 2–26 months). The survival rate of implants was 100%. Conclusion: Customized titanium meshes can represent a reliable tool for GBR of severely atrophic sites, with simplification of the surgical phases. [ABSTRACT FROM AUTHOR]

Objectives: To report the clinical and radiographic outcomes of patients presenting with edentulous and atrophic ridges and treated with autogenous mandibular bone blocks and rehabilitated with implant‐supported prostheses. Materials and methods: From 1997 to 2015, 75 patients presenting with bone defects of the jaws were grafted with autogenous mandibular bone blocks. One‐hundred eighty‐two implants were placed 4 to 12 months later and loaded 3 to 10 months later: the mean follow‐up was 10 years (range: 3–16 years). The following outcomes were recorded: (a) complication rate of the reconstructive procedure; (b) bone graft resorption before implant placement; (c) peri‐implant bone resorption; (d) implant‐related complications; and (e) implant survival and success rates. Results: Postoperative recovery was uneventful in the majority of patients. An early dehiscence occurred in three patients, but with no significant bone loss, while 3 experienced temporary paraesthesia. The mean vertical and horizontal bone resorption before implant placement was 0.18 mm (standard deviation [SD] = 0.43) and 0.15 mm (SD = 0.42), respectively. The mean peri‐implant bone loss ± standard deviation was 1.06 ± 1.19 (range: 0.00–5.05) at patient level and 1.11 ± 1.26 (range: 0.00–5.20) at implant level. Two implants in 2 patients lost integration and were removed; 10 implants in 7 patients developed peri‐implantitis, but healed after surgical treatment. The cumulative implant survival and success rates were 98.11% and 85.16%, respectively. Conclusion: Implants placed in areas reconstructed with mandibular bone blocks presented survival rates consistent with those obtained for implants placed in native bone. [ABSTRACT FROM AUTHOR]

Background Implant site preparation usually consists of several consecutive drilling steps, performed using different burs with increasing diameter. Purpose The purpose of the present study was to report the clinical outcomes of edentulous patients that underwent implant treatment, in which a special bur that allows preparation of the implant site in a single drilling step was used. Material and Methods One hundred forty-nine patients (79 males, 70 females, mean age 51.8 ± 12.2 [SD] years, range 20-80 years) have been rehabilitated using different oral surgery procedures. A total of 350 implants were inserted (171 in the maxilla and 179 in the mandible). A barrier membrane was used for covering a total of 126 implants. Fifteen implants were placed by using the osteotome technique and 52 by using the lateral sinus lift procedure. Eighty-nine implants were placed in postextraction sockets. Thirty-six implants underwent immediate loading. Implant survival, peri-implant bone level change, and patients' satisfaction were the main variables assessed. Results No patient dropout occurred. The mean follow-up on a patient basis was 21.5 ± 3.1 months (range 12-27 months). A total of seven implant failures were recorded in six patients, leading to a mean implant survival of 98.0% (96.0% on a patient basis). The mean peri-implant bone loss after 1 year was 0.58 ± 0.44 mm ( n = 282). Apart from implant failures, no biological nor mechanical complications occurred. All patients demonstrated full satisfaction. Conclusions The use of a single bur for implant site preparation allows the reduction of the time needed for the surgical procedure, without compromising the clinical outcomes. Further, long-term comparative studies are needed to confirm the results of this study. [ABSTRACT FROM AUTHOR]

Objective To evaluate the efficacy of the topical administration of bisphosphonates in implant therapy. Materials and Methods Thirty-nine consecutive patients were selected for a split-mouth study. Inclusion criteria were: presence of a bilateral or total edentulism, ability to tolerate conventional implant procedures, older than 18 years. Ten patients were smokers. Ten patients were fully edentulous in both maxilla and mandible, 12 patients had fully edentulous maxilla or mandible, and 17 were bilaterally partially edentulous (9 in the mandible and 8 in the maxilla). A one-stage procedure was adopted in all cases. The prosthetic phase started 10 weeks after implant insertion. Each patient received implants on the control side and the test side, with insertion performed in the conventional way on the control side; on the test side, a 3% clodronate solution mixed with a surfactant (Tween-20) at a 1:3 ratio was topically administered both at the implant surface and at the implant site. Results One hundred fifty-five implants were inserted. The test and control groups included 75 and 80 implants, respectively. The implant insertion torque was no less than 30 Ncm. A total of 7 implants failed in the control group (6 before loading and one after 12 months of loading). No failure occurred on the test side. By the 5-year follow-up, no further implant failure had been recorded. Overall, implant survival rates at 5 years for the test and control groups were, respectively, 100% and 91.3%, the difference being significant ( p < .01). Mean marginal bone loss was 0.85 ± 0.71 mm in the test group and 1.12 ± 0.85 mm in the control group after 1 year of loading and stable thereafter. The difference was not significant. Conclusions The topical administration of bisphosphonates may positively affect implant survival in the preloading and postloading phases in partially and fully edentulous patients. However, a larger study population is needed to verify these promising clinical results. [ABSTRACT FROM AUTHOR]

Purpose This retrospective study deals with the issue of how to realize the transition from a failing dentition to an implant-supported prosthesis. The main aim was to assess the reliability of immediate implant and immediate loading ( IL) protocols in the edentulous jaws. A further aim was to investigate the role of patient-related, implant-related, and surgery-related secondary variables in the occurrence of implant failure. Materials and Methods Patients with at least a 4-year post-loading follow-up undergoing the transition from a failing dentition to an implant-supported prosthesis were retrospectively investigated. Primary variables of implant failure were immediate placement and IL. Secondary variables were categorized as demographic, anatomic, site, and prosthetically related. Cumulative survival rates ( CSRs) were compared using the Kaplan- Meier survival estimate method. Predictors of failure were included in a multivariate Cox regression model to evaluate the simultaneous effects of multiple covariates and control for correlated observation. Crestal bone loss was also measured at the delayed and the immediately loaded implants. Results Five hundred nineteen implants rehabilitating 91 jaws in 80 patients were followed. The Kaplan- Meier survival estimate method showed that immediate implant and IL decreased the CSR significantly in the maxilla but not in the mandible. Some secondary variables were found to affect the CSR: maxillary location, age over 70 years, prostheses supported by only immediate implants or a majority of them, temporary cementation, implant diameter, and length. Crestal bone loss was not significantly related to the outcomes. Conclusions The present data may provide clinical recommendations to the practitioner treating the transitional patient. In the mandible, the use of immediate implants and IL does not increase the failure rate. In the maxilla however, combining immediate placement and IL may significantly increase the failure rate. [ABSTRACT FROM AUTHOR]