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Purpose: The aim of this pilot exploratory cohort study was to assess the value of buccal augmentation in immediate implant placement and immediate restoration of anterior teeth in maxillae with missing buccal lamellar bone with regard to esthetic parameters, as well as soft and hard tissue level changes. Materials and Methods: This study compared three groups of 10 patients each with immediate implant placement and immediate restoration in the anterior maxilla: (1) patients with partially to totally missing buccal bone with simultaneous augmentation with bovine collagen (test group augmented [TGA]); (2) patients with partially to totally missing buccal bone without augmentation (test group nonaugmented [TNA]); and (3) patients with intact buccal lamellar bone (control group [CG]). The pink esthetic score (PES) and the course of the peri-implant bone level after 1, 3, and 12 months were used as assessment criteria. Results: Af ter 12 months, the PES in the TGA was assessed as being better than it was preoperatively (mean ± SD: 8 ± 3.09 vs 9.25 ± 3.01, respectively, P = .8243), while it remained almost identical in the other two groups (TNA = 8.75 ± 2.7 vs 8.6 ± 3.3, P = .4098; CG = 10.6 ± 2.41 vs 10.6 ± 2.22, P = .7085). A significant difference among the PES values of the three groups was not observed at any point in time (preoperative: P = .118, 12 months: P = .383). In total, the TNA and CG showed an improvement in 3 out of 7 parameters of the PES after 12 months, while this was the case in 5 out of 7 parameters in the TGA. No significant difference among the three groups could be seen at any time point regarding peri-implant bone level. In the CG and TGA patients, a nonsignificant improvement in peri-implant bone level was seen after 12 months (respectively: 1.6 mm to 0.99 mm; P = .08068; 1.89 mm to 1.73 mm; P = .5866). In contrast, TNA patients showed a nonsignificant deterioration vs the postoperative situation (1.16 mm to 1.45 mm; P = .08208). Conclusion: Within the limitations of this pilot study, it can be concluded that a missing buccal lamellar bone appears to be no contraindication for immediate implant placement and immediate restoration, provided the baseline esthetic situation is accepted. As compared to the nonaugmented defect group or the group with intact lamellar bone, neither the esthetic nor the radiologic results could be improved significantly by augmentation with bovine collagen. [ABSTRACT FROM AUTHOR]

Purpose: Poor alveolar bone quality and quantity may cause low insertion torque during implant placement; therefore, a delicate occlusal design is important for the immediate loading procedure. This retrospective clinical study aimed to investigate (1) the proportion of implants with a low insertion torque between the maxilla and mandible, (2) factors affecting implants with a low insertion torque, and (3) survival rates of implants with a low insertion torque value (< 35 Ncm) using different occlusal designs with full-arch fixed prostheses supported by immediately loaded implants. Materials and Methods: Between 2013 and 2017, patients who received full-arch reconstructions were treated with immediately loaded one-piece fixed prostheses supported by four to six implants. Full-arch fixed prostheses with at least one immediately loaded regular implant with a low insertion torque value were included in this study. The fixed provisional acrylic prosthesis with a rigid framework was delivered within 3 to 5 days after surgery. According to the distribution of implants with low insertion torque, provisional prostheses were divided into three groups with different occlusal schemes. Definitive prostheses were fabricated after 3 months of loading. Results: A total of 144 patients were treated; 608 and 304 regular implants were inserted in 118 maxillae and 76 mandibles, respectively. Moreover, 42 patients (11 men and 31 women) with 39 maxillae and 4 mandibles were included in this study. The proportion of implants with low insertion torque values in the maxilla was significantly greater than that in the mandible (10.5% vs 1.6%, respectively, P < .001). Implant length and low insertion torque value had no significant correlation (P = .948). Implants with a 3.3-mm diameter (narrow platform) had a greater proportion of low insertion torque values than 4-mm-wide implants (P = .002). Implants placed in a fresh socket had a greater proportion of insertion torque values ≥ 35 Ncm (P = .023). The overall cumulative implant survival rate was 98.6%. Groups 1, 2, and 3 had 14, 23, and 6 provisional prostheses, respectively. The survival rates for implants with insertion torque values < 35 Ncm and ≥ 35 Ncm were 98.4% and 98.7%, respectively, and were not significantly different (P = .866). All prostheses were still functioning during the mean follow-up of 3.7 ± 1.2 years. Conclusion: The high cumulative implant survival rate indicated that implants with a low insertion torque in immediately loaded full-arch provisional prostheses did not jeopardize the outcomes after a corresponding occlusal scheme was used. [ABSTRACT FROM AUTHOR]

Purpose: Comprehensive rehabilitation in patients with severe periodontal destruction may require the use of dental implants. The primary aim of this study was to evaluate bone volume changes in periodontally compromised patients over a 12-month follow-up period after immediate full-arch implant reconstruction of the mandible. The secondary aim was to evaluate the repeatability of 3D bone volume change measurement methods around dental implants. The null hypothesis was that bone volume would decrease in the first year after delivery of the definitive prosthetic reconstruction. Materials and Methods: This retrospective study analyzed CBCT scans of 16 patients before and after computer-guided immediate full-arch implant reconstruction of the mandible. The bone volume change in the mandibular body and around the implants and the peri-implant bone area in coronal and axial cross sections were calculated. Results: The average bone gain for the mandibular body was 3.3% ± 1.8%. The average bone volume increase in the peri-implant area was 23.2% ± 16.7%. The interobserver and intraobserver ICC values for 3D measurements were high (> 0.85). Conclusion: The null hypothesis was rejected. Both mandibular body and peri-implant surroundings undergo bone remodeling in the form of bone gain over 12 months after immediate implantation. [ABSTRACT FROM AUTHOR]

Background: Short implants have been used in the restoration of edentulous jaws in the past several years. However, some studies have suggested that short implants are less successful than standard implants. The aim of this study is to investigate the outcome of short implants placed in the posterior maxilla or mandible following one-stage or immediate-function protocols with a follow-up of 7 years (clinically) and 5 years (radiographically). Methods: This study included 127 patients rehabilitated with 217 implants measuring 7 mm and supporting 157 fixed prostheses in the posterior segments of both jaws. Final abutments were delivered at the surgery stage and were loaded after 4 months in 116 patients (199 implants). The primary outcome measure was implant survival measured through life tables. Secondary outcome measures were marginal bone loss and the incidence of biological and mechanical complications at the patient level and implant level (evaluated through descriptive statistics). Results: Twenty-four patients (18.9%) with 45 implants (20.7%) were lost to the follow-up. In total, 32 implants failed (14.8%) in 22 patients (17.3%), resulting in a cumulative survival rate at 7 years of 81.2% for 7 mm implants in the rehabilitation of the posterior regions of the maxilla and mandible. The average (standard deviation) marginal bone loss was 1.47 mm (0.99 mm) at 5 years. The incidence rate of biological complications was 12.6% and 10.6% at the patient and implant levels, respectively. The incidence rate of mechanical complications was 21.3% for patients and 16.1% for implants. A higher failure rate was registered in smokers and in implant arrangements with a sequence of three fixtures in proximity. Conclusions: Within the limitations of this study, it can be concluded that the placement of 7 mm long implants for the partial implant-supported rehabilitation of atrophic posterior jaws is possible in the long term, judging by the survival rate and stable average marginal bone loss. Nevertheless, strict case selection should be performed, especially in smokers and with implant arrangements that provide a minimum of one unit in inter-implant distance. [ABSTRACT FROM AUTHOR]

Narrow-diameter implants (NDI) serve as a solution for treating limited bone volume in the anterior mandible. This study aimed to evaluate the one-year clinical outcomes of various NDIs in the mandibular incisor area after immediate loading in partially edentulous patients. This single-center, prospective, single-blinded, randomized controlled trial study included 21 patients, with 7 patients in each of the following groups: control (BLT NC SLActive®; Straumann), experimental group 1 (CMI IS-III Active® S-Narrow; Neobiotech), and experimental group 2 (CMI IS-III Active® Narrow; Neobiotech). Using full digital flow, two fixtures were placed in each patient and immediately provisionalized on the day of surgery. Evaluations encompassed periapical radiographs, implant stability quotient (ISQ), implant stability test (IST) readings, per-implant soft tissue health, patient satisfaction surveys, and esthetic score assessments. Definitive prostheses were delivered twelve weeks post-surgery (CRiS, number: KCT0007300). Following exclusions due to low stability values (n = 2), fixture failure (n = 5), and voluntary withdrawal (n = 1), the implant success rate for patients completing all clinical protocols stood at 100%. The resulting patient failure rates in the control, experimental group 1, and experimental group 2 were 50.0%, 42.9%, and 14.3%, respectively. There were no significant differences between the groups in terms of marginal bone loss, soft tissue health, patient satisfaction, and esthetic scores. Narrow implants showed superior clinical outcomes, followed by S-Narrow and Straumann implants. Calculated one-year survival rates at the implant level were 66.7% for the control group, 85.7% for experimental group 1, and 100% for experimental group 2. All three types of NDIs showed acceptable clinical and radiographic results during the year-long observation period. [ABSTRACT FROM AUTHOR]

Early implant failure occurring within 1 year after implantation has been attributed to various factors. Particularly, early failure can lead to challenges in maintaining a full-arch prosthetic device, necessitating prompt intervention, including reoperation. This study aimed to retrospectively examine implant- and patient-related factors and the effects of photofunctionalisation associated with early failure in patients who underwent treatment using the all-on-four concept in both the maxilla and mandible. We conducted this retrospective study comprising 561 patients with 2364 implants who underwent implant-supported immediate loading with fixed full-arch rehabilitation using the all-on-four concept. We aimed to assess the survival rate within 1 year after implantation and determine the risk factors influencing early failure. The 1-year survival rates after implantation were 97.1% (patient level) and 98.9% (implant level) for the maxilla and 98.5% (patient level) and 99.6% (implant level) for the mandible. There was a significant difference in the implant-level survival rates between the maxilla and mandible, with a lower rate in the maxilla (p = 0.043). The risk factors associated with early implant failure according to the all-on-four concept included the maxilla (implant level) and smoking (patient level). We could not find a significant effect of photofunctionalisation on early failure (p = 0.25) following this treatment protocol. [ABSTRACT FROM AUTHOR]

Objective: Evaluate the long‐term outcomes of full‐arch rehabilitation using immediate dental implant placement and continuous functional loading with full‐fixed dental prostheses (FFDPs). Materials and Methods: Fifty‐six patients received temporary implants (n = 327) at maxillary augmentation with calvarial bone. A provisional acrylic FFDP was immediately loaded onto these implants. After 6 months, the temporary implants were replaced with definitive implants (n = 326) and immediately loaded with a second provisional FFDP (N = 55). Subsequently, a baseline radiograph was taken following a 6‐month healing period. The second bridge was then substituted with a definitive FFDP. Primary outcomes included peri‐implant marginal bone level (MBL) and definitive implant survival. Secondary outcomes evaluated provisional implant and prostheses survival, complications, and patient satisfaction. Results: The provisional implants had a survival rate of 97.9%. One patient was excluded from further analysis due to loss of temporary implants and first FFDP. The definitive implant survival rate after 10 years was 92.2%, with a moderate but significant decrease in MBL between baseline radiography and 10 years later (−0.08 ± 0.18 vs. −0.24 ± 0.44). However, large individual variations were observed, with 65.8% of implants showing no bone loss and 9.2% showing loss ≥0.5 mm. Sinusitis was experienced by 14.3% of patients upon surgery. Patient satisfaction was high or reported no issues after protocol completion (80%). One patient lost all six definitive implants and definitive FFDP 8.2 years after implant placement. Conclusions: The described protocol can be regarded as a long‐term, highly successful method for full‐arch rehabilitation of atrophied maxillae while enabling continuous masticatory and speaking functionality. [ABSTRACT FROM AUTHOR]

The digital transformation has revolutionized various sectors, including dentistry. Dentistry has emerged as a pioneer in embracing digital technologies, leading to advancements in surgical and prosthetic oral healthcare. Immediate loading for full-arch edentulous dental implants, once debated, is now widely accepted. This case report describes a 74-year-old patient with dental mobility and significant bone loss who was rehabilitated using a Toronto Bridge protocol on four dental implants with immediate loading. Digital planning, surgical guides, 3D printing, and precision techniques were employed. The surgery involved implant placement and prosthetic procedures. The patient reported minimal post-operative discomfort, and after four months, the definitive prosthesis was successfully placed. This case demonstrates the efficacy of immediate loading in complex dental scenarios with digital innovation, resulting in improved patient outcomes. The full digital workflow, including 3D printing and the use of modern materials, enhances the efficiency and predictability of oral rehabilitation, marking a transformative era in dental care. The integration of digital technology in all phases of treatment, from diagnosis to finalization, makes this approach safer, reliable, and efficient, thereby benefiting both patients and clinicians. [ABSTRACT FROM AUTHOR]

Resin coating in implants rehabilitation cannot always be aesthetic, durable and comfortable for the patient mainly due to the limited dimensions of the final structure. Intraoral welding technique and computer-aided designed prosthetic shells may be a solution. This in vitro study evaluates the capacity of load and the weakest point of implant-supported provisional prosthesis using welded titanium framework. Twelve samples were produced to simulate an implant supported fixed prosthetic bridge. Two implants (Ankylos; Dentsply Sirona Implants; Germany) were inserted inside blocks of nanoceramic material produced with a stereolithographic 3D printer. A polymethylmethacrylate (PMMA) resin shell was performed with CAD/CAM and relined on welded framework. Six samples were produced with the same procedure reducing resin thickness. The samples were subjected to fatigue test (6,500,000 cycles) using ElectroForce 3310 fatigue machine (t 1); subsequently a mechanical compression test using a universal Shimadzu AGS-X 10 machine (t 2). The samples were analyzed with a photographic and radiographic documentation at t 0, t 1 and t 2. The samples survived mechanical fatigue test without evidence of failure. The radiographic and photographic evaluation revealed the fracture of resin coating after the mechanical compression test. The samples with minimal resin thickness fractured first. Adequate assessment of the resin thickness is mandatory to improve the longevity of these rehabilitations. CAD-CAM digital prosthetic design allows us to optimize the thicknesses and the prosthetic shapes, allowing us to obtain good degrees of resistance even in the presence of reduced prosthetic spaces. [ABSTRACT FROM AUTHOR]

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The aim of the current study was to present the clinical and radiological outcomes of monolithic zirconia superstructures compared to the metal–ceramic ones in the All-on-4 concept for the prosthetic rehabilitation of the maxillae. A total of 30 patients were subdivided into groups according to their superstructure type (metal–ceramic (n = 15) or monolithic zirconia (n = 15)). All implants were functionally loaded within 24 h after insertion with provisional acrylic superstructures. Prosthetic complications, marginal bone loss, plaque accumulation, probing pocket depth, bleeding on probing, and bite force were documented over a period of 5 years. Marginal bone loss around the implants of the ceramic group remained well over the five years (1.21 ± 0.23 mm). However, marginal bone loss was significantly lower around the implants in the monolithic zirconia group (0.22 ± 0.14 mm) (p < 0.001). Bleeding on probing, plaque accumulation, and probing pocket depth values were correlated with marginal bone loss. Among all evaluated parameters, no differences could be detected in terms of the angulation of the implants. Detachment or chipping was observed in seven cases in the metal–ceramic superstructure group. In all cases, dentures were removed and repaired in the laboratory. In the monolithic zirconia group, chipping was detected after one year in two cases, after two years in four cases, and after five years in one case and could be managed by polishing in situ. Monolithic zirconia superstructures presented superior results regarding the parameters evaluated. [ABSTRACT FROM AUTHOR]

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]

Objectives: The principal objective of this study was to compare the failure load between the conventional heat polymerized PMMA and the CAD/CAM milled PMMA interim full arch implant prostheses. The secondary aim was to evaluate the success of the distal extension of the temporary PMMA prosthesis. Methods: A metallic edentulous upper arch model with 4 Straumann screw-retained abutment digital analogs was used to create 15 specimens for each of the 2 groups: Conventional and milled. Failure load was measured on 5 different regions on the left and right side of each specimen with the YLE universal testing machine: Anterior, premolar, and molar. Results: The maximum force supported before breaking was noted for each region (N). The medians of failure load were statistically analyzed. Significant differences were observed between the 2 groups and among each region in the 2 groups. The posterior cantilever was the weakest sector in both groups followed by the anterior then the premolar regions. Conclusions: The interim milled PMMA prosthesis are a better choice due to their improved mechanical stability. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the survival and success rate of and the incidence of complications affecting implants inserted and immediately loaded in sites where an impacted tooth was present in the maxilla. Materials and methods: A total of 10 patients were treated and 14 implants were inserted, 4 in healed sites and 10 in extraction sites. The implant site preparation started in the crestal bone and continued in the enamel and dentine of the impacted tooth. The radiographic depth of implant penetration into the impacted tooth, peri-implant soft tissue and hard tissue condition at the 1-year follow-up and the last follow-up appointment, marginal bone loss at the 1-year follow-up and the last follow-up appointment, and the final aesthetic result were evaluated. Results: The implants healed uneventfully with an adequate hard and soft tissue response and no adverse clinical or radiographic signs or symptoms. They were in function for a minimum of 3 and a maximum of 11 years (mean 7.2 years). Conclusion: Although further studies with a larger sample size are required to validate this unconventional approach, it can be considered a valuable clinical option to replace teeth in an area of impaction. [ABSTRACT FROM AUTHOR]

This article discusses a study that examines the effectiveness of two primary stability measurement tools for dental implants: insertion torque value and resonance frequency analysis with the ISQ scale. The study focuses on immediate loading of dental implants in the golden quadrilateral of the maxillary bone. The results show that both measurement tools are useful for ensuring adequate primary stability and long-term survival of dental implants. The study also emphasizes the importance of anchoring implants in areas of maximum resistance, such as the golden quadrilateral, for optimal results. [Extracted from the article]

Background: This randomized controlled trial aimed to compare the aesthetic outcome and patient perception of immediate versus DL of implant-supported single crowns. Methods: A total of 60 patients with a single missing tooth were enrolled and randomly assigned to two groups: immediate loading (IL) and delayed loading (DL). Each group consisted of 30 patients with a total of 30 implants. In the IL group, crowns were loaded onto implants immediately after placement, while in the DL group, a healing period of 3 months was observed before crown placement. Aesthetic outcome was assessed using the Pink Esthetic Score (PES) for soft tissue and the White Esthetic Score (WES) for the crown. Patient perception was evaluated through a visual analog scale (VAS) for satisfaction, comfort, and overall experience. Results: The IL group demonstrated comparable aesthetic outcomes to the DL group, with mean PES and WES scores of 10.2 ± 1.5 and 8.7 ± 1.2, respectively, in the IL group, and 10.5 ± 1.3 and 8.5 ± 1.4 in the DL group. Patient perception in terms of satisfaction, comfort, and overall experience was similarly high in both groups, with VAS scores above 8 for each parameter. Conclusion: This randomized controlled trial suggests that both IL and DL of implant-supported single crowns result in favorable aesthetic outcomes and high levels of patient satisfaction.

Abstract Purpose Implant-supported immediately loaded fixed full-arch rehabilitation via All-on-four treatment yields good long-term results for both the maxilla and the mandible. However, the risk factors affecting long-term implant survival are unknown, and the long-term prognosis of All-on-four concept procedures in Japanese individuals has not been elucidated. We aimed to determine the cumulative implant survival rate after 3–17-year follow-up and identify the associated risk factors. Methods We analysed 561 cases (307 maxillae, 254 mandibles) with 2364 implants (1324 maxillae, 1040 mandibles) that received All-on-four treatment. We investigated the cumulative implant- and patient-level survival rates and various risk factors for implant failure. Statistical analysis was performed using the log-rank test for differences in Kaplan–Meier curves, univariate analysis using the Chi-square test, and multivariate analysis for risk factors affecting the survival rate. Results The cumulative survival rate was 94.4% by patient level and 97.4% by implant level for the maxilla, and 96.7% by patient level and 98.9% by implant for the mandible, with up to 17 years of follow-up. The maxillary survival rate at the implant level was significantly lower (p

The objective of the present retrospective multi-center study was to analyze the outcomes of bone-level (BL) implants and tissue-level (TL) implants in immediate-loading full-arch rehabilitations. Patients who were previously rehabilitated with full-arch immediate-loading rehabilitations with either BL or TL implants were considered. Data regarding implant survival rate, marginal bone loss (MBL), peri-implant probing depth (PPD), plaque index (PI), and bleeding on probing (BOP) were recorded, and the 1-year follow-up data were statistically analyzed between the two groups. In total, 38 patients were evaluated for a total implant number of 156 (n = 80 TL implants and n = 76 BL implants). An implant survival rate of 97.37% was recoded for the BL group while an implant survival rate of 100% was noted for the TL group. A total MBL of 1.324 ± 0.64 mm was recorded for BL implants, while a total MBL of 1.194 ± 0.30 mm was recorded for TL implants. A statistically significant difference was highlighted regarding MBL at the mesial aspect (p = 0.01552) of the implants, with BL implants presenting with higher MBL. Within the range of acceptable healthy values, a statistically significant difference was also highlighted regarding BOP (p < 0.00001), with TL implants presenting higher values. No statistically significant difference (p > 0.05) was recorded for any of the other variables analyzed. Within the limitations of the present retrospective study, both TL and BL implants seem to provide good clinical outcomes after a 12-month observational period when employed in immediate-loading full-arch rehabilitation.

Purpose: The aim of this study was to analyze retrospectively the clinical reliability of complete-arch rehabilitations with screw-retained fixed prostheses supported by four dental implants inserted with a fully guided surgical protocol. Materials and Methods: All the implants were placed between December 1, 2015, and April 30, 2019. Digital implant surgical planning was performed for all the complete-arch rehabilitations, and then, fully guided surgery was performed. The fixed provisional prostheses were delivered the day of the surgery and replaced by definitive prostheses after the healing period. Patients were followed up to determine survival of the implants and success of the overall treatment. Results: A total of 160 implants were positioned in 37 patients, with three patients receiving rehabilitations in both arches. A total of 40 complete-arch rehabilitations were performed, 26 in the maxilla and 14 in the mandible. Only five implants failed, resulting in an overall implant survival rate of 96.9%. No definitive prostheses failed, resulting in a 100% prosthetic success rate. The failed implants were successfully replaced before definitive prostheses were made, resulting in an overall treatment success of 100%. Conclusion: Within the limitations of this study, digital planning and guided surgery to perform complete-arch rehabilitations on four dental implants seems to be a valid treatment option. However, several prospective studies with longer follow-up are needed to achieve more predictable results. [ABSTRACT FROM AUTHOR]

The aim of the present in vitro comparative study is to validate a novel composite polymer, named “ONLY”, developed to overcome the mechanical drawbacks of conventional, metal-reinforced poly(methyl methacrylate) (PMMA) interim restoration. Ten interim restorations were designed and fabricated (five in the composite “ONLY” group, and five in the metal-reinforced PMMA group). All the samples were screwed into the prototype models, simulating a complete edentulous mandible rehabilitated with six straight implants. Outcome measures were break point (load, N) and displacement (mm) through a static compression test, and material behavior through a dynamic cyclic test method (fatigue test). A total of 20 samples were tested (10 for static and 10 for dynamic). In each group, five samples (test and control) were used. All the specimens completed the mechanical tests, as planned. There was no statistically significant difference between groups for any test. In the test group, the break point was 1953.19 ± 543.73 N, while it was 2031.10 ± 716.68 N in the control group (p = 0.775). The displacement was 1.89 ± 0.34 mm in the test group and 1.98 ± 0.75 mm in the control group (p = 0.763). Using the dynamic cyclic test method, in the control group the mean load was 2504.60 ± 972.15 N, while in the test group the mean load was 3382.00 ± 578.50 N. The difference between groups was 877.40 ± 579.30 N (p value = 0.121). Within the limitations of this in vitro study, the novel composite polymer can be used to immediately load dental implants. Further clinical research is needed to confirm these preliminary results.

Purpose: To evaluate retrospectively at 10 years the marginal bone levels around implants located in healed ridges or in extraction sockets and loaded immediately with provisional crowns fixed in prefabricated abutments. Materials and Methods: Forty-two implants were placed in 36 patients needing single tooth replacement. Implants were inserted either in healed ridges (group 1) or in extraction sockets (group 2) and loaded immediately with prefabricated abutments. Two implants were lost during the healing period from group 2. The bone level around the implant shoulder was calculated mesially and distally on each implant using intraoral radiographs after crown cementation and 1, 3, 5, and 10 years following loading. Results: On the 10-year follow-up report, 36 implants were available for the clinical and radiologic evaluation. Besides the two implants lost during the osseointegration period, no implant loss was documented over the 5- to 10-year observation period. The average bone loss after implant and crown cementation was 0.266 ± 0.176 mm for 1 year, 0.194 ± 0.172 mm for 5 years, and 0.198 ± 0.165 mm for 10 years in healed ridges and 0.267 ± 0.161 mm for 1 year, 0.213 ± 0.185 mm for 5 years, and 0.287 ± 0.194 mm for 10 years in extraction sockets. Three crowns (in group 1) and one crown (in group 2) were replaced for esthetic reasons. Conclusion: The outcome of this study revealed that in both groups, the responses of marginal bone were similar. Immediate placement of the definitive prefabricated abutment in an immediate loading protocol appears to conserve marginal bone around the implant neck. [ABSTRACT FROM AUTHOR]

Objectives. The purpose of the present study was to evaluate by scanning electron microscope (SEM) and energy dispersive spectrophotometry (EDS), the degree of bone mineralization of the tissues on the surface of failure dental implants with immediate or late loading. Materials and method. In the study, 8 dental explants from 8 clinically healthy, non-smoking patients were taken. All implants were inserted by the same dental surgeon, 4 of them were immediate loaded and 4 were late prosthetically loaded by the same dentist. The ablation of the implants was performed as atraumatic as possible and they were collected in sterile containers and sent to the BIOMAT Research Center, where they were subjected to SEM and EDS analyses. The ratios between the chemical elements calcium and nitrogen (Ca/N), phosphorus and nitrogen (P/N), respectively calcium and phosphorus (Ca/P) were calculated for each of the 8 samples and were statistically analyzed. Results. If we compare the degree of coverage of the implants with bone tissue in different phases of mineralization, we find that the bone structures occupy a larger surface area of the implants in the cases with immediate loading compared to the cases with late loading. Thus, out of 4 immediately loaded implants, 2 were completely covered, one showed very little exposed areas, and the fourth showed alternating covered and uncovered areas. Regarding the late loaded implants, three showed alternation between covered and uncovered areas and only one was completely covered with bone. Conclusions. The degree of coverage of the explants with bone tissue was better represented for the immediate loading cases. The degree of mineralization of the bone tissue covering the explants was higher for cases with immediate loading. To confirm the obtained results, it is necessary to expand the study on larger batches of samples.

Abstract Background Dental implants emerge as a dependable and efficacious alternative for patients experiencing partial or complete tooth loss. The stability of these implants is influenced by surface topography and macro-level design. In cases where the height of the maxillary posterior region is diminished, employing short implants can prove advantageous. With the aim of examining the distribution of von Mises stress, strain, and micromovement in D4 bone quality surrounding platform-switched short implants, measuring 6 mm in length and featuring diameters ranging from 4 to 6 mm, as well as different thread designs, an in-depth finite element analysis was conducted under immediate loading conditions. Methodology A 3D finite element model was constructed to simulate maxillary molar crowns, incorporating an implant with a length of 6 mm and varying diameters and thread designs. The diameters utilized were 4/3.6 mm, 5/4 mm, and 6/4.8 mm, while the thread designs included buttress, square, and triangle patterns. Each model underwent analysis with a 100 N force applied in two directions: vertical and oblique, relative to the long axis of the implant. Stress, strain, and micromovement in the peri-implant region were recorded, employing the Ansys Workbench R v.18.1 software for modelling and analysis. Results When comparing all three diameters, the wide diameter (6 mm threads) exhibited the lowest values of peri-implant von Mises stresses (3.3 MPa and 35.1 MPa), strains (194 Ɛ and 484 Ɛ), and micromovements (0.7 μm and 1.3 Ɛ) subjected to axial and non-axial loading of a 100 N force. Notably, square microthreads yielded the most favorable stress parameters among the different thread shapes, manifesting the minimum values of stress, strains, and micromovements in their vicinity. Conclusion For the treatment of atrophic ridges or in scenarios necessitating extensive surgical preparation of the implant site, a combination of short implants, wide diameters, and platform switching can be employed. In situations with reduced bone height and the requirement for an implant-supported prosthesis to replace a missing permanent maxillary molar, the utilization of wide-diameter platform-switched short implants measuring 6 mm in length, featuring a square thread design, should be taken into consideration.

The aim of this retrospective study was to evaluate the treatment outcome of All-on-6 and All-on-4 Fast @Fixed from Bredent implants (Brdent GmbH, Senden,Germany) immediately loaded with fixed full-arch prosthesis. Delivering a full arch implant restoration, which transits a patient from the frustartions of edentulism to the stability and function of a fixed prosthesis, is one of the most rewarding experience in dentistry. With the advancement in digital technology and with modified implant design and advance prosthetic options, what started as a two stage delayed loading procedure in the seventies, evolved to immediate implant palcement in extraction sockets and even immediate loading of these implants in a browing number of indications. Within the limits of this small group (n=11 patients/114 implants), the failure rate of the analyzed implant system (n=3 respectiv 2,63% implant loss) seems to be comparable with other immediate-loading protocols. Following this study, we can conclude that the body of the bridge in point contact with the alveolar ridge allows a better sanitation of the prostehtic bridge and thus avoids the occurrence of peri-implantitis. In the case of the bridge bodies that completely cover the vestibular and oral alveolar ridge, we observed an accentuated resorption of the alveolar ridge over time.

Background: Complex implant reconstructions in patients with residual dentition due to periodontitis is a challenging task in many aspects. Methods: This study shows a full digital workflow combining 3D printing, guided implant placement, intraoral scanning and welding with immediate loading and digital smile design. An analog impression was taken to validate the passive fit of final restorations. The whole treatment plan was divided into three stages. The first stage included an intraoral scan of baseline dentition, and then the extraction of all teeth was performed, implanting four temporary implants and providing the patient with removable temporary prosthesis. The second stage was to scan the removable temporaries, implanting 10 implants and multi-unit abutments (MUA), and create a rigid construction via the intraoral welding of titanium bar and by fixing it to the 3D-printed temporary reconstructions (designed with DSD) as a form of immediate loading. The third stage included the scanning of screw-retained temporary reconstructions, then scanning from the MUA level and creating final reconstruction. Results: The presented workflow enabled the delivery of some sort of restoration to the patient at every moment of the treatment and to sustain the required esthetic effect with decent comfort of use even in the early stages. Conclusions: A full digital workflow is a reliable treatment method even in complex cases. [ABSTRACT FROM AUTHOR]

Objective: To report a novel digital workflow to replace an anterior maxillary tooth lost due to trauma with an implant multilayer restoration by using the patient's extracted tooth as a final crown restoration using computer‐aided design/computer‐aided manufacturing (CAD/CAM) technology. Clinical Considerations: Instead of using the patient's natural tooth as an immediate provisional restoration to achieve predictable results in terms of esthetics and soft tissue structure, a novel digital strategy was performed to obtain a natural final crown restoration by using the patient's tooth associated with a lithium disilicate customized implant abutment. Conclusions: The perspective of using this strategic approach for implant restorative dental treatments in patients with traumatic root fractures in the anterior region has great potential as it helps to maintain the emergence profile of the natural dentition and esthetics. Clinical Significance: Optimal esthetic outcomes are challenging in implant dentistry regarding soft tissue structure and morphology factors. Using natural teeth from surgery to deliver the final restoration might be beneficial when an anterior tooth is lost due to trauma. [ABSTRACT FROM AUTHOR]

The immediate loading protocol has become increasingly popular due to the progressive growth in demand for a reduction in treatment times. The possibility of applying this protocol would depend on certain important factors. The application of the digital workflow mentioned in the protocol guarantees rapidity, precision, and esthetics. This report aims to describe a fully digital workflow using a dual scan impression technique to fabricate immediate fixed complete dentures (FCDs) for zygomatic and standard implants. A 58-year-old female patient requested treatment for her severely atrophic maxilla, and four unrehabilitated implants in the mandible. After proper diagnosis and planification, four zygomatic implants and two standard implants were placed. During the surgery, transmucosal abutments were placed on all implants. After suturing, the positions of the implants were recorded using a stereophotogrammetric technique, creating a standard tessellation (STL) file. In the lower arch, the second phase of the surgery was carried out: the transmucosal abutments were placed, and then the implant positions were recorded in the same way. The soft tissues were rescanned after suturing with an intraoral scanner (IOS), and all STL files were aligned to obtain the virtual final models. The pre-design after virtual modifications was aligned with the definitive models. The provisional prostheses were milled and placed after six hours after the surgery, and the definitive prostheses were placed six months after the surgery. The dual scan technique used obtained a precise fit for both the provisional and definitive FCDs. This technique might be an effective and reliable alternative for the fabrication of immediate and definitive screw-retained FCDs in a completely digital workflow. The time taken for scanning and fabrication was reduced, and the clinician's and patient's satisfaction were improved. [ABSTRACT FROM AUTHOR]

With the increasing life expectancy and improved quality of life, the conventional prosthodontic removable treatment modalities are being replaced with implant retained fixed prostheses. A full-arch conventional rehabilitation of edentulous ridges requires six to ten dental implants. However, some patients demand fixed implant-supported prostheses inspite of medical conditions and economic concerns. Also in completely edentulous cases, the insufficient bone morphology directs the treatment plan towards alternatives such as cantilever prostheses, short implants or ridge augmentation procedures. These clinical conditions have brought in a quantum shift in treatment planning towards the 'all on 4 protocol' providing immediately loaded fixed prosthesis supported by 4 implants thereby providing optimum and immediate restoration of function and esthetics. [ABSTRACT FROM AUTHOR]

The objective of the present retrospective multi-center study was to analyze the outcomes of bone-level (BL) implants and tissue-level (TL) implants in immediate-loading full-arch rehabilitations. Patients who were previously rehabilitated with full-arch immediate-loading rehabilitations with either BL or TL implants were considered. Data regarding implant survival rate, marginal bone loss (MBL), peri-implant probing depth (PPD), plaque index (PI), and bleeding on probing (BOP) were recorded, and the 1-year follow-up data were statistically analyzed between the two groups. In total, 38 patients were evaluated for a total implant number of 156 (n = 80 TL implants and n = 76 BL implants). An implant survival rate of 97.37% was recoded for the BL group while an implant survival rate of 100% was noted for the TL group. A total MBL of 1.324 ± 0.64 mm was recorded for BL implants, while a total MBL of 1.194 ± 0.30 mm was recorded for TL implants. A statistically significant difference was highlighted regarding MBL at the mesial aspect (p = 0.01552) of the implants, with BL implants presenting with higher MBL. Within the range of acceptable healthy values, a statistically significant difference was also highlighted regarding BOP (p < 0.00001), with TL implants presenting higher values. No statistically significant difference (p > 0.05) was recorded for any of the other variables analyzed. Within the limitations of the present retrospective study, both TL and BL implants seem to provide good clinical outcomes after a 12-month observational period when employed in immediate-loading full-arch rehabilitation. [ABSTRACT FROM AUTHOR]

Purpose: This in vivo study aims to assess the pink esthetic score in the anterior maxilla after computer-guided immediate implant installation and fully digital immediate temporalization with and without grafting the jumping gap with a mixture of 1:1 autogenous and xenograft particulates. Materials and methods: Twenty-four patients with non-restorable upper anterior teeth in the aesthetic zone have undergone a traumatic extraction for the non-restorable tooth followed by immediate implant placement using a 3D-printed surgical guide according to prosthetically driven implant placement. The patients were divided into two groups. The study group received the dental implant after grafting the jumping gap with 1:1 autogenous and xenograft particulates, while the control group received the dental implant without grafting the jumping gap. Each patient received a digitally fabricated, immediate, nonfunctional temporary prosthesis. The esthetic outcome was compared between the two groups using the pink esthetic score at implant insertion and after 6 months of follow-up. Statistical comparisons were carried out between the studied groups using the Mann-Whitney U test. Results: Immediately postoperatively, there was no statistically significant difference between the median PES in the two groups (P-value = 0.746). After six months, the study group showed a statistically significantly higher median PES than the control group (P-value = 0.048). Conclusions: Grafting the jumping distance in the immediate implant protocol helps achieve a better esthetic outcome. Clinical relevance: The use of immediate guided implant placement along with grafting the jumping gap followed by immediate digital temporalization guarantees a better esthetic outcome while preserving time, cost, and the number of clinical visits. Trial registration: The study was registered on clinicaltrials.gov with registration number NCT04096209. (19/9/2019) [ABSTRACT FROM AUTHOR]

Purpose: Implant-supported immediately loaded fixed full-arch rehabilitation via All-on-four treatment yields good long-term results for both the maxilla and the mandible. However, the risk factors affecting long-term implant survival are unknown, and the long-term prognosis of All-on-four concept procedures in Japanese individuals has not been elucidated. We aimed to determine the cumulative implant survival rate after 3–17-year follow-up and identify the associated risk factors. Methods: We analysed 561 cases (307 maxillae, 254 mandibles) with 2364 implants (1324 maxillae, 1040 mandibles) that received All-on-four treatment. We investigated the cumulative implant- and patient-level survival rates and various risk factors for implant failure. Statistical analysis was performed using the log-rank test for differences in Kaplan–Meier curves, univariate analysis using the Chi-square test, and multivariate analysis for risk factors affecting the survival rate. Results: The cumulative survival rate was 94.4% by patient level and 97.4% by implant level for the maxilla, and 96.7% by patient level and 98.9% by implant for the mandible, with up to 17 years of follow-up. The maxillary survival rate at the implant level was significantly lower (p < 0.05). Furthermore, the maxillary survival rate within 24 months was significantly lower at the implant level (p < 0.01). Multivariate analysis revealed that the maxilla was the most significant risk factor (p < 0.01). Conclusions: All-on-four treatment yielded high long-term survival rates in Japanese patients. However, the maxilla showed a significantly lower cumulative survival rate than the mandible, while early failure was significantly higher. Furthermore, the maxilla was a significant risk factor influencing the survival rate. [ABSTRACT FROM AUTHOR]

Featured Application: Mandibular two-implant overdentures with magnetic attachment, utilizing an immediate loading protocol, could be deemed as a favorable treatment approach for edentulous patients. The immediate loading of implants yields comparable effects on the patient-reported outcomes compared to conventional loading. Comprehensive, long-term studies on patient-reported outcomes for two-implant overdentures with magnetic attachments using immediate or conventional loading methods are lacking. This study aimed to provide 5-year follow-up data comparing patient-reported outcomes for mandibular overdentures supported by two implants with magnetic attachments under immediate or conventional loading. Nineteen edentulous mandible patients were randomly assigned to immediate (IG) or conventional loading groups (CG). Two implants were placed with prostheses, loaded on the same day (immediate) or three months later (conventional). Participants completed questionnaires (oral health-related quality of life (OHRQoL), patient general satisfaction, and patient's denture assessment (PDA)) at baseline and yearly intervals for 5 years. Results showed no significant differences between IG and CG throughout the study. However, the within-group analysis revealed significant improvements in OHRQoL, patient satisfaction, and all PDA domains from the baseline to years 1–5. Regarding patient satisfaction, significant differences were observed between T1, T2, and T3 when compared with T0 of IG and T1-T0 of CG. Regarding PDA results of T4-T5, IG exhibited several significant differences compared to CG. In conclusion, this study suggests that two-implant overdentures with magnetic attachments, whether immediately or conventionally loaded, improve patient-reported outcomes. Immediate loading may have prolonged effects on the improvement of patient-reported outcomes. [ABSTRACT FROM AUTHOR]

Aim: The aim of this two dimensional (2D) finite element analysis study was to evaluate the influence of implant design (step and tapered) and length on stress distribution at bone implant interface, when placed in maxillary posterior bone under immediate loading protocol. Materials and Methods: 2D finite element models were developed to simulate the two types of implant designs, i.e., Tapered and step implants of 3.75-mm – Diameter and 6 and 10 mm lengths, respectively. Maxillary posterior bone quality (D4 bone) was simulated with a very thin cortical bone (0.5 mm) for the placement of implants. The respective material properties were assigned. The implant designs incorporated microthreads at the crestal part and rest of the implant body incorporated Acme threads. Forces of 100 Newtons were applied vertically and in oblique direction (at an angle of 45°) to long axis of the implants. Total deformation (micromovements), stresses and strains were evaluated at the bone implant interface. Results: The results of micromovements, stresses and strains were found to be lower for long implants as compared to short implants. Also, all the values were found to be higher for oblique loads as compared to vertical loads. The von mises stress values were highest for 6 mm step implants and lowest for 10 mm step implants. Conclusion: In the presence of low bone density with optimal bone height, standard diameter long step implants can be used. Incorporation of microthreads at the crestal portion and acme threads for body portion of the implant presents a good option to be used under immediate loading protocol. [ABSTRACT FROM AUTHOR]

Background: This study aimed to report the outcomes of the immediate loading of implants with fixed rehabilitations in edentulous geriatric patients. Methods: Edentulous geriatric patients were diagnosed with an oral examination, radiographic evaluation, and intermaxillary relations and treated with fixed rehabilitation over several implants. After immediate surgery, the implants were immediately loaded with a fully fixed prosthesis. Results: Twenty-four patients (20 females and 4 males) were treated using a total 210 implants. All patients (100%) had a previous history of periodontitis. Eleven patients (45.8%) were smokers. Eleven patients (45.8%) suffered from chronic medical diseases (i.e., diabetes, cardiovascular diseases). The study's clinical follow-up period extended for three years, during which thirty-three fixed prostheses were installed over the implants in 24 patients. The average marginal bone loss measured was 1.33 ± 0.17 mm. The success rate of the implants and prosthodontics being placed in this study yielded 98.5% and 97%, respectively. One patient (4.2%) showed some kind of technical complications. Eleven patients (45.8%) showed mucositis, and 25 implants (11.9%) in 10 patients (41.7%) were associated with peri-implantitis. Conclusions: This study shows that the treatment of edentulous geriatric patients by immediate loading of implants with fixed rehabilitations is a clinically successful protocol but with a high prevalence of peri-implant diseases. [ABSTRACT FROM AUTHOR]

The aim of this clinical study was to investigate and compare implant survival rates, marginal bone loss, and surgical and prosthetic complications of healthy patients and subjects affected by hypertension receiving full-arch implant-prosthetic rehabilitation. From January 2016 to November 2016, patients affected by total edentulism of one or both arches or severe impairment of residual teeth who needed full-arch implant-prosthetic rehabilitation and who had the absence of any systemic diseases or the presence of hypertension as a single pathology were randomly selected. According to the inclusion criteria, 39 patients were enrolled for this study. The sample was divided into two groups: A total of 18 patients were included in Group A (healthy patients), and 21 patients were included in Group B (patients affected by hypertension). No statistically significant difference in implant survival rates, marginal bone loss, and prosthetic complications were observed between Group A and Group B. Except for variable bleeding, the results of the Pearson's chi-square test and z-test at a 99% confidence level suggest that there is no statistically significant difference in clinical complications between the groups. Within the limitations of this study, full-arch implant-prosthetic rehabilitation could be a feasible option for treating patients with hypertension, provided that hypertension is compensated and controlled. [ABSTRACT FROM AUTHOR]

Objectives: There is a scarcity of randomized clinical trials (RCT) that report medium- and long-term results and a lack of consensus in the literature on the predictability of immediately loaded unsplinted narrow diameter implants supporting mandibular overdentures. This RCT compared the performance of conventional (CL) and immediate loading (IL) of mandibular overdentures retained by two narrow-diameter implants for 3 years. Materials and methods: Patients from an RCT treated with CL or IL were invited to attend to 2- and 3-year follow-ups. Clinical, radiographic, functional, and oral health-related quality of life parameters were evaluated. Prosthetic maintenance events, biological complications, and success and survival rates were also recorded. The data were tested by multilevel mixed-effects linear regression analysis and chi-squared tests. Results: The 1-year survival rates of 90% in the CL group and 85% in the IL group were maintained as no implants were lost between 1 and 3 years. The marginal bone loss (MBL) in the IL group was significantly lower after year 3 (-0.04; p < 0.01). Significant changes were found only for the intra-group comparisons in the third year of function: (i) CL and IL presented similar progression of implant stability, MBL, and posterior bone area resorption; (ii) while CL started deteriorating of masticatory function, IL still exhibited functional evolution and (iii) oral comfort domain in the CL and pain domain in the IL were improved. Conclusion: Although IL experienced the lowest MBL after 3 years, the outcomes showed that both loading protocols result in predictable medium-term rehabilitation when monitored annually. Clinical relevance: It can be expected that in the third year of function, patients with immediate loading may present more complaints related to general performance even with acceptable masticatory function and self-reported improvements in oral comfort. [ABSTRACT FROM AUTHOR]

Stable posterior occlusal support is crucial for adequate masticatory function and facial aesthetics. In elderly patients over the age of 65, masticatory ability has a significant impact on nutritional intake and overall health. This case report presents a prosthetic treatment of an elderly patient with edentulous maxilla and bilateral posterior edentulous mandible. The upper jaw was restored with a complete denture to establish an ideal occlusal plane, and the three-dimensional positions of the mandibular implants were determined accordingly. The implants were placed through computer-guided implant surgery and were immediately loaded with fixed provisional restorations. The implant-fixed zirconia final restorations were inserted in the lower posterior region, and the occlusal surface of posterior artificial teeth in the upper denture was substituted with cobalt-chrome alloy to resist occlusal wear. The patient’s posterior occlusal support and masticatory function were promptly restored through this treatment process, and long-term stability against wear was also obtained. [ABSTRACT FROM AUTHOR]

Zygomatic implant-supported rehabilitation has grown in popularity for use in clinical practice. Although many studies have been carried out into the surgical procedure, the prosthetic workflow is not clearly defined and standard techniques are not readily applied; thus, a digital approach may ultimately streamline the procedure. In the present study, the authors examined a digital workflow for immediately loaded prostheses supported by zygomatic implants. The novel technique proposed by the present authors, involving use of an impression reference, achieved promising results in terms of accuracy and procedural simplification. [ABSTRACT FROM AUTHOR]

Background: Bicortical engagement is the engagement of nasal cortical plate and basal cortical plate in maxillary and mandibular esthetic zone, respectively. These are longer implants which offer osseointegration along with high osseofixation. Increased length of implant provides increased bone-implant contact offering primary stability which permits immediate loading. Aim: The aim of the study was to clinicoradiographically evaluate immediate loading in bicortically engaged long implants in maxillary and mandibular esthetic region. Materials and Methods: Thirty patients with missing teeth in esthetic region were selected for the study. Implants were placed in both arches engaging nasal cortex and basal bone wherever required. One-time definitive abutment was placed and immediate loading was done. Results: No failure was observed in the study period of 9 months. The mean insertion and reverse torque was 66.67 ± 6.794 and 41.67 ± 3.101, respectively, indicating high primary stability. No pain, discomfort, infection, or implant mobility was observed. The mean crestal bone loss changes were statistically insignificant. Conclusion: Hundred percent implant survival was observed. [ABSTRACT FROM AUTHOR]

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To review the evidence from the clinical outcomes of immediately loaded implants with fixed prostheses in edentulous maxillae. Materials and Methods: An electronic search was performed in PubMed/MEDLINE, Embase, and Cochrane to identify studies investigating the outcome of implants subjected to immediate loading with fixed dental prostheses in edentulous maxillae. Only clinical studies with more than 10 patients and a mean follow-up time of more than 12 months were included. Meta-analysis was utilized to compare the clinical outcomes between immediately loaded implants and conventionally loaded implants. For immediately loaded implants, a cumulative implant survival rate (ISR) was weighted by the duration of follow-up and number of implants. The weighted marginal bone loss (MBL) was also assessed. Results: A total of 33 studies (16 retrospective studies and 17 prospective studies) were included, which involved 2,635 patients and 12,480 implants. Meta-analysis did not reveal a significant difference of ISR or MBL between the two loading groups. For immediately loaded implants, the weighted cumulative ISR was 95.53% (median: 97.50%) with a mean follow-up of 46.07 months (SD: 30.92). Fourteen studies reported on the MBL of implants, and the mean MBL was 1.19 mm (SD: 0.88) with a mean period of 57.70 months (SD: 32.56). The results should be interpreted with caution due to the lack of randomized controlled trials (RCTs) and the heterogeneity of the data. Conclusion: Despite the lack of RCTs, immediate implant loading with a fixed prosthesis in the edentulous maxilla seems to be a reliable treatment alternative with a high ISR, when appropriate inclusion/exclusion criteria are followed. [ABSTRACT FROM AUTHOR]

Objective: To evaluate implant and patient characteristics 4 to 8 years after implant installation in a study involving immediate fixed restoration of dental implants. Method and materials: The study was a follow-up of treated generalized chronic periodontitis patients who received immediate restorations on dental implants as part of a previous study. The patients were examined clinically and radiographically at implant placement, 6 months, 1 year, and 4 to 8 years later. Supportive periodontal therapy (SPT), teeth and implant probing pocket depth (TPPD and IPPD), bleeding on probing (BOP [teeth, TBOP; implant, IBOP]), and bone level (BL) measurements around implants were documented. Cases were divided into three groups according to annual SPT rate: 0.00 to 0.99/year (SPT0), 1.00 to 1.99/year (SPT1), 2.00 or more/year (SPT2). Results: Twelve patients, with 26 implants and 242 teeth, were included. The mean ± standard deviation follow-up period was 6.08 ± 1.25 years (range 4.04 to 7.94 years). All implants in the follow-up group were osseointegrated and survived during the follow-up period. The mean number of SPT appointments was 6.17 ± 5.65. A weak negative correlation was found between SPT rate and ΔTPPD (-0.24, P = .0005), whereas a strong negative correlation was found between SPT rate and ΔIPPD (-0.76, P = .0005). Negative correlations were found between SPT rate and ΔTBOP (-0.20, P = .003), and between SPT rate and ΔIBOP (-0.5, P = .009). A moderate correlation was found between SPT rate and ΔBL (0.46, P = .02). Conclusion: SPT has a significant positive effect on PPD, BOP, and on implant BLs in longterm follow-up and should be an essential part of implant therapy. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to examine clinical and patient-centered outcomes of resilient stud and stress-free bar attachments used for immediately loaded implants supporting mandibular overdentures. Materials and Methods: Thirty edentulous patients with sufficient bone mesial and distal to the mental foramen received new dentures. The patients were randomly assigned into two groups. After 3 months of adaptation, four implants were placed in the canine and second premolar areas of the mandible using computer-guided surgery and the flapless surgical approach. Overdentures were connected immediately to the implants using either resilient stud (Locator) or stress-free implant bar (SFI-Bar) attachments. Marginal resorption of bone, plaque and gingival indices, pocket depth, and implant stability were evaluated for both groups at baseline (prosthesis delivery) and 6 and 12 months thereafter. Implant survival and patient satisfaction were calculated after 12 months. Results: For both groups, marginal bone loss (P < .043), plaque scores (P < .001), and probing depth (P < .002) increased significantly with time. SFI-Bar recorded lower marginal bone loss (P = .048) and higher plaque scores (P = .021) and probing depth (P = .001) than Locator after 12 months of denture insertion. The implant survival was 96.6% and 98.3% for Locator and SFI-Bar, respectively. No significant difference was found in the survival rate between groups (P = .56). Locator showed significantly higher general satisfaction, satisfaction with retention, comfort, and cleaning of overdentures compared with SFI-Bar (P < .001). Conclusion: Within the limits of this investigation, both resilient stud and stress-free bar attachments can be used successfully with mandibular four-implant overdentures subjected to an immediate loading protocol. However, studs may be preferred regarding peri-implant soft tissue health, patient satisfaction with retention, cleaning, and comfort, and stress-free bar attachments could be more effective in terms of marginal bone preservation. [ABSTRACT FROM AUTHOR]

This case report demonstrates the use of dynamic navigation guidance for bone reduction. Information about smile line position incorporated in a virtual plan and accurate transfer to the surgical field enhances the predictability of the treatment. A virtual wax-up was made, and implant positions along with bone reduction were planned accordingly. Residual teeth in the maxilla were extracted, and bone reduction and zygomatic implant placement were assisted by surgical navigation, while conventional implants were placed using the surgical template, followed by immediate loading. When surgical navigation is used for implant placement, navigated bone reduction can easily be incorporated in the workflow. The accuracy of bone reduction was evaluated together with the accuracy of two zygomatic implants assisted by a navigation system and four conventional implants assisted by a static template. The mean deviation between planned and performed bone reduction was 1.3 ± 0.39 mm (range: 0.8 to 1.7 mm). The accuracy of this procedure corresponds to the accuracy of guided implant placement and can be considered reliable after confirmation through clinical trials. [ABSTRACT FROM AUTHOR]