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Purpose: To measure the surface temperature distribution after using a CO2 laser to heat titanium dental implants via different power settings, application intervals, and irradiation times. Materials and Methods: A total of 10 tissue-level titanium implants (Screw-Line Promote Plus, Camlog; 4.3 × 11 mm) were placed (EpoFix, Struers) and irradiated with a CO2 laser (Denta 2, Lutronic) with a wavelength of 10.6 µm at power levels of 4 watts (Group 1), 6 watts (Group 2), 8 watts (Group 3), and 10 watts (Group 4). A continuous beam mode (setting I) and noncontinuous beam modes with 5-second (setting II) and 10-second (setting III) pause intervals were used. For each setting, a total irradiation time of 50 seconds was used and repeated 10 times. The temperature was measured using external thermocouple (Testo) in contact with the implant surface at the implant shoulder, middle, and apex. A linear regression model was used to analyze the data (P = .05). Results: Setting I demonstrated the most rapid increase in implant surface temperature in all three test sites as well as the greatest total temperature at 50 seconds of irradiation time. The greater the pause interval (settings II and III) during the 50 seconds of irradiation, the lower the rate of temperature increase as well as the total temperature in all three test sites and with all power levels. The average temperature difference between the apex and shoulder site was significant for setting III for all groups, but not for any groups in settings I and II. Conclusions: Heating the internal aspect of an implant with a CO2 laser produces different temperature distribution profiles depending on the laser power level and the application interval. Laser-beam irradiation leads to a temperature gradient, which is greatest at the implant apex and smallest at the implant shoulder. [ABSTRACT FROM AUTHOR]

Objectives: Aim of this study was to assess survival rates, radiographic, and pink esthetic outcomes of a bone‐level‐tapered (BLT) implant following immediate or early implant placement. Materials and Methods: Patients in need of tooth extraction and one implant in the anterior or premolar area were recruited in five centers. Patients were randomly assigned to the immediate or early placement protocol. Implants were restored with all‐ceramic crowns cemented to titanium‐base‐abutments. Radiographic bone levels, implant stability quotient (ISQ), and pink esthetic outcomes were assessed. Data were analyzed descriptively. Level of significance was set at 0.05. Differences between groups were tested using Wilcoxon‐signed‐rank and Mann–Whitney‐U test as nonparametric tests. Results: A total of 60 patients received 60 BLT implants (Institut Straumann). At 12‐months, 59 implants (98.3%) were osseointegrated. The mean distance from implant shoulder to first bone‐to‐implant contact was 0.15 ± 0.59 mm without significant differences between the groups. Median ISQ values increased from 75.5 to 78.5. A mean buccal recession of 0.1 ± 0.70 mm occurred with no difference between groups. The mean papilla height gain in both groups was 0.5 ± 1.47 mm mesially and 0.4 ± 1.36 mm distally. Conclusions: After 1 year, immediately and early placed BLT implants exhibit similar bone level changes, ISQ values, and pink esthetic outcomes. Clinical Significance: The present research contributes to the knowledge on clinical outcomes of immediately and early placed BLT implants restored with buccally microveneered ceramic single crowns out of two different ceramic materials. The research shows that similar esthetic and radiographic outcomes can be reached by means of immediate implant placement compared to the conventional early placement protocol. The improvement of esthetic soft‐tissue parameters over time was shown for both implant placement protocols. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the influence of pristine matrix and O-ring dimensions on retention force and its reproducibility in single one-piece mini dental implants (MDIs) with ball patrices under in vitro conditions. Materials and Methods: Three different matrix/O-ring combinations (MH1, MH2, and MH3) were evaluated (n = 50 measurements each) on 1.8-mm-diameter implants. The matrices were manually mounted on the implants and subsequently removed in a vertical linear manner using a metal pin with two strain gauges, which recorded the maximum force during disconnection. The O-rings were exchanged after five disconnections, and the mean retention force was calculated, resulting in a total of 50 values for each matrix/O-ring combination. Mean and SD retention forces with 95% CI were calculated. ANOVA was used to test the global difference, and post hoc pairwise comparisons were subsequently applied. The level of significance was set at P < .05. Results: ANOVA (global P < .0001) and pairwise comparisons (all P < .001) demonstrated statistically significant differences between the three different matrix/O-ring combinations with mean values of 5.18 N (MH 1), 6.73 (MH 2), and 9.08 (MH 3). Within each combination, retention force variations of > 1 N could not be demonstrated; ie, by exchanging O-rings, a similar retention force can be reestablished. Conclusion: Matrix and O-ring dimensions have a significant influence on retention forces in one-piece MDIs. Pristine O-rings demonstrated highly reproducible initial retention forces in all matrices. [ABSTRACT FROM AUTHOR]

Explantation of fully or partially osseointegrated titanium implants is a complex procedure for myriad reasons and often results in major bone loss and pronounced defects of the hard and soft tissues. This may require more elaborate surgical interventions in cases of re-implantation. In this patient case, an osseointegrated titanium implant with some visible bone loss, missing attached mucosa at the buccal aspect, and a nonideal three-dimensional (3D) position had to be explanted. For this, the implant’s inner connection was heated using a CO2 laser, which resulted in localized laser-induced thermo-necrosis at the bone-to-implant contact. One week following laser application, explantation could be performed easily with a torque slightly more than 35 Ncm. No complications occurred during the healing period. The result was a very easily performed explantation while preserving a maximum of the surrounding bony structure. Healing was uneventful, and no further visible bone loss could be observed during the healing time. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present prospective clinical study was to assess the survival rate and the radiologic crestal bone level alteration around four interforaminal immediately loaded narrow-diameter implants (NDIs) in the edentulous mandible. Method and Materials: A total of 20 participants received each 4 NDIs (MDI, 3M Espe; diameter 1.8 mm, length 13 or 15 mm) in the edentulous mandible. Immediate loading was performed if insertion torque was 35 Ncm or higher. The implants were loaded the same day by converting the existing full denture into an implant overdenture. Follow-up visits were performed five times (baseline to 52 weeks). Standardized radiographs were taken at baseline and 12, 26, and 52 weeks post-loading. Clinical parameters (Plaque Index, probing depth, bleeding on probing) were assessed. The nonparametric ANOVA test was used to assess crestal bone level changes. Results: In all 20 patients the healing of the total 80 implants was uneventful and no implant was lost. Sixty-eight (85%) implants were loaded immediately. All clinical parameters showed healthy, stable, and well-maintained peri-implant soft tissue conditions. The mean (± standard deviation) radio graphic bone loss after 1 year was 0.78 (± 0.64) mm. Conclusion: According to the 1-year results of this prospective clinical study, NDIs seem to be a reliable alternative to support prostheses in edentulous patients with a reduced horizontal mandibular bone volume. [ABSTRACT FROM AUTHOR]

Objective: Today, only scarce information is available on monolithic zirconia reconstructions. The objective of this study was to evaluate the performance of monolithic zirconia for tooth- and implant-borne reconstructions. Method and Materials: Monolithic zirconia single crowns (SCs) and fixed dental prostheses (FDPs) supported by implants or teeth were included in this study. Implant placement and prosthetic treatment were done in the same clinical setting. One technician performed all laboratory work using the same CAD/CAM workflow (DentalDesigner, Ceramill Motion 2, Amann Girrbach). The endpoints were technical outcome, color match, marginal adaptation, anatomical form, and biologic aspects. The modified United States Public Health Service (USPHS) criteria and periodontal parameters were applied for the clinical evaluation by two independent examiners. Descriptive statistics and nonparametric tests were used for statistical comparisons. Results: Forty patients (17 men, 23 women, mean age 59.1 ± 14.7 years) with 109 reconstructions (74 SCs, 35 FDPs) supported by 38 implants and 71 teeth were assessed, resulting in a total of 238 monolithic zirconia units (including 62 pontics and 18 cantilevers). Median follow-up time was 23.8 months (12 to 36 months). No technical failures were observed. The total prosthesis survival rate was 99.6% (teeth, 100%; implants, 98.4%) due to the loss of one implant. The periodontal/peri-implant parameters stand for healthy tissue, and caries was not detected. The records obtained by the USPHS revealed good clinical outcomes. Conclusion: These short-term results indicate that monolithic zirconia reconstructions for teeth and implants may be a satisfactory treatment option, particularly in the posterior region. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to analyze the removal of implant-supported crowns retained by three different cements using an air-accelerated crown remover and to evaluate the patients' response to the procedure. Materials and Methods: This controlled clinical trial was conducted with 21 patients (10 women, 11 men; mean age: 51 ± 10.2 years) who had received a total of 74 implants (all placed in the posterior zone of the mandible). Four months after implant surgery, the crowns were cemented on standard titanium abutments of different heights. Three different cements (two temporary: Harvard TEMP and Improv; and one definitive: Durelon) were used and randomly assigned to the patients. Eight months later, one blinded investigator removed all crowns. The number of activations of the instrument (CORONAflex, KaVo) required for crown removal was recorded. The patients completed a questionnaire retrospectively to determine the impact of the procedure and to gauge their subjective perception. A linear regression model and descriptive statistics were used for data analysis. Results: All crowns could be retrieved without any technical complications or damage. Both abutment height (P = .019) and cement type (P = .004) had a significant effect on the number of activations, but the type of cement was more important. An increased total number of activations had no or only a weak correlation to the patients' perception of concussion, noise, pain, and unwillingness to use the device. Conclusions: Cemented implant crowns can be removed, and the application of an air-accelerated device is a practicable method. A type of cement with appropriate retention force has to be selected. The impact on the patients' subjective perception should be taken into account. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate technical complications and failures of zirconia-based fixed prostheses supported by implants. Materials and Methods: Consecutive patients received zirconia-based single crowns (SCs) and fixed dental prostheses (FDPs) on implants in a private clinical setting between 2005 and 2010. One dentist performed all surgical and prosthetic procedures, and one master technician performed and coordinated all laboratory procedures. One-piece computer-aided design/ computer-assisted manufacture technology was used to fabricate abutments and frameworks, which were directly connected at the implant level, where possible. All patients were involved in a recall maintenance program and were finally reviewed in 2012. Data on framework fractures, chipping of veneering ceramics, and other technical complications were recorded. The primary endpoint was failure of the prostheses, ie, the need for a complete remake. A life table analysis was calculated. Results: A total of 289 implants supported 193 zirconia-based prostheses (120 SCs and 73 FDPs) in 127 patients (51 men, 76 women; average age: 62.5 ± 13.4 years) who were reviewed in 2012. Twenty-five (13%) prostheses were cemented on 44 zirconia abutments and 168 (87%) prostheses were screw-retained directly at the implant level. Fracture of 3 frameworks (1 SC, 2 FDPs) was recorded, and significant chipping resulted in the remake of 3 prostheses (1 SC, 2 FDPs). The 7-year cumulative survival rate was 96.4% ± 1.99%. Minor complications comprised 5 loose screws (these were retightened), small chips associated with 3 prostheses (these were polished), and dislodgement of 3 prostheses (these were recemented). Overall, 176 prostheses remained free of technical problems. Conclusions: Zirconia-based prostheses screwed directly to implants are clinically successful in the short and medium term. [ABSTRACT FROM AUTHOR]

Background and aim: So far there is little evidence from randomised clinical trials (RCT) or systematic reviews on the preferred or best number of implants to be used for the support of a fixed prosthesis in the edentulous maxilla or mandible, and no consensus has been reached. Therefore, we reviewed articles published in the past 30 years that reported on treatment outcomes for implant-supported fixed prostheses, including survival of implants and survival of prostheses after a minimum observation period of 1 year. Material and methods: MEDLINE and EMBASE were searched to identify eligible studies. Short and long-term clinical studies were included with prospective and retrospective study designs to see if relevant information could be obtained on the number of implants related to the prosthetic technique. Articles reporting on implant placement combined with advanced surgical techniques such as sinus floor elevation (SFE) or extensive grafting were excluded. Two reviewers extracted the data independently. Results: A primary search was broken down to 222 articles. Out of these, 29 studies comprising 26 datasets fulfilled the inclusion criteria. From all studies, the number of planned and placed implants was available. With two exceptions, no RCTs were found, and these two studies did not compare different numbers of implants per prosthesis. Eight studies were retrospective; all the others were prospective. Fourteen studies calculated cumulative survival rates for 5 and more years. From these data, the average survival rate was between 90% and 100%. The analysis of the selected articles revealed a clear tendency to plan 4 to 6 implants per prosthesis. For supporting a cross-arch fixed prosthesis in the maxilla, the variation is slightly greater. Conclusions: In spite of a dispersion of results, similar outcomes are reported with regard to survival and number of implants per jaw. Since the 1990s, it was proven that there is no need to install as many implants as possible in the available jawbone. The overwhelming majority of articles dealing with standard surgical procedures to rehabilitate edentulous jaws uses 4 to 6 implants. Conflict of interest statement: The authors declare that they have no conflict of interest. [ABSTRACT FROM AUTHOR]

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Objective This prospective study aimed to investigate the evolution of chewing efficiency, maximum voluntary bite force ( MBF) and oral health-related quality of life ( OHRQoL) in edentulous patients treated with narrow diameter implants ( NDIs) over the course of 1 year. Materials and Methods Four NDIs ( MDI®, 3M ESPE, diameter 1.8 mm) were placed interforaminally in 20 edentulous patients. They were immediately loaded by converting the existing prosthesis into an implant overdenture. Participants were examined six times pre- and postoperatively [baseline ( BL) to week 52 (w52)]. Chewing efficiency was evaluated with a colour-mixing ability test by evaluation of the standard deviation of hue ( VOH, ViewGum©). MBF was measured using a digital force gauge. OHRQoL was determined with the Oral Health Impact Profile ( OHIPG49). Nonparametric Brunner-Langer models were applied for statistical testing. Results The study failed to demonstrate an effect on chewing efficiency. MBF increased continuously during the observation period (medians: MBF[N]@ BL = 46.6 [iqr 50.1]; MBF[N]@w52 = 103.9 [iqr 76.0]; P = 0.002). OHRQoL increased steeply after implant loading and continued improving (medians: BL ∑ OHIPG49 = 31 [iqr 40.0]; w4 ∑ OHIPG49 = 11.5 [iqr 19.5]; w52 ∑ OHIPG49 = 6 [iqr 13.0], P < 0.001). Conclusions The stabilisation of a lower complete prosthesis with four NDIs is a feasible minimally invasive and economical approach to improve oral function and OHRQoL, especially in elderly patients with limited bone support. Functional benefits might be more evident if patients receive chewing instructions. Larger studies need to confirm a positive effect on chewing efficiency and develop long-term maintenance solutions if patients become frail because no easy downgrading approaches of one-piece titanium implants exist. [ABSTRACT FROM AUTHOR]

A 61-year-old healthy patient was referred for prosthetic rehabilitation in the maxilla and mandible. The primary wish of the very anxious patient was to improve the masticatory function and his aesthetic appearance with the least invasiveness and as efficiently as possible. Furthermore, he desired to receive a reliable long-term solution. The patient had no general medical restrictions and was a non-smoker. At the time of the first clinical examination, the patient presented nearly edentulous, with a few root remnants in the mandible and remaining wisdom teeth in the maxilla. The main objective of the treatment, hence, was to improve both his chewing function and the stability of the prostheses without invasive surgeries. After the removal of the root remnants and one of the two wisdom teeth (18), two new complete dentures were fabricated. Thereafter, 6 diameter reduced mini implants (SLA® one-piece self-tapping Straumann® Mini Implants made of Roxolid®, with a diameter of 2.4 mm and a length of 10 mm) were inserted in the maxilla, and 4 mini implants (SLA® one-piece self-tapping Straumann® Mini Implants made of Roxolid®, with a diameter of 2.4 mm and a length of 10 mm) were inserted in the mandible. After the implant insertion with good primary stability, the two new complete dentures were transferred into two implant-supported removable dental prostheses and retained by means of the transmucosal integrated attachment system of the mini implants (Optiloc®). At the 3-month follow-up visit, the patient was very satisfied with the outcomes, both from a functional and aesthetic point of view.

This case report illustrates a rare complex of symptoms leading to limited mouth opening in a young woman. The 28-year old suffered from a progressively limited mouth opening over several years that finally resulted in restricted alimentation and made dental treatment impossible. Clinical findings suggest a structural alteration, including a hyperplastic mandibular angle and marked hypertrophy of the masseter muscle. Further radiologic investigations reveal a thickened aponeurosis of the masticatory muscles and hyperplastic coronoid processes that are not interfering with the zygomatic bone. Primary therapeutic options for such conditions are mainly surgical, including reduction of the masseter muscles volume and aponeurorectomy as well as bony reductions, such as coronoidectomy and mandibular angle reduction. With this treatment, the outcome and prognosis are good. Long-term results depend on concomitant physical therapy. A uniform nomenclature for this condition is yet lacking and propositions such as “masticatory muscle tendon-aponeurosis hyperplasia” have been made. However, knowledge of this condition and its typical clinical signs can make the diagnosis and treatment straightforward, thus leading to an improved quality of life of affected patients.