Three-dimensional finite element analysis of the influence of implant site and axial direction on the immediate weight bearing stress of central incisors in different alveolar fossa shapes / 口腔医学

Objective@#To analyze and investigate the effects of implant location and axial direction on the stress distribution of implants, abutments, central screws, and crowns during immediate loading of maxillary mesial incisors with different alveolar fossa morphology based on three-dimensional finite element method.@*Methods@#Referring to the oral CBCT images of a healthy adult, a three-dimensional finite element model was established for immediate implant loading of maxillary central incisors with three alveolar fossa morphs: labial, intermediate, and palatal; different implant sites(apical site, palatal/labial site) and axes(tooth long axis, alveolar bone long axis) were simulated; the established model was loaded with a force of 100 N. ANSYS software was applied to analyze the stress values of the implants, abutments, central screwss, and crownss. @*Results@#The 3D finite element models of 12 maxillary central incisors with different alveolar sockets were successfully established;the implants and their superstructures were least stressed when the maxillary central incisors with partial labial and partial palatal shape were placed along the long axis of the alveolar bone in the palatal/labial position for immediate implant loading;the implants and their superstructures were least stressed when the maxillary central incisors with central shape were placed along the long axis of the tooth in the palatal position for immediate implant loading. The implant and its superstructure were subjected to the least stress when the implant was placed along the long axis of the tooth in the immediate loading position. @*Conclusion@#The bio-mechanical characteristics of the implant and its superstructure are influenced by the different socket morphology, implantation sites and axes. Therefore, in clinical practice, different implantation axes and implantation sites should be developed for different socket morphs.

Carga inmediata de implantes extra cortos en sectores posteriores. Estudios retrospective con tres modelos de carga: 24, 48 hs y 7 días / Immediate loading of extra short implants in posterior sectors. Retrospective study with three loading models: 24 hs, 48 hs and 7 days

Los implantes extra-cortos son cada vez más utili-zados en la práctica clínica diaria. La utilización de estos implantes con carga inmediata supone un reto añadido. Clásicamente se ha postulado que la carga inmediata debe realizarse después de 24 horas de la cirugía. En la siguiente serie de casos analizamos diferentes tiempos a la hora de realizar la carga in-mediata y su posible repercusión. Fueron recolec-tados de forma retrospectiva datos sobre casos de implantes extra-cortos (5,5 y 6,5 mm) en los que fue realizada una carga inmediata en sectores poste-riores. El implante fue la unidad de análisis para la estadística descriptiva en cuanto a la localización, dimensiones del implante, y mediciones radiográ-ficas. El paciente fue la unidad de medida para el análisis de la edad, sexo y la historia clínica. La prin-cipal variable estudiada fue la supervivencia de los implantes extra-cortos con carga inmediata en tres períodos de tiempo determinados: 24 hs, 48 hs y 7 días y como variables secundarias se han estudiado, la estabilidad del hueso crestal en general y en los tres períodos de carga anteriormente mencionados, las complicaciones protésicas y la supervivencia de las prótesis. Fueron reclutados 74 pacientes en los que se insertaron 146 implantes que cumplieron con los criterios de inclusión. Todos los implantes fueron cargados mediante carga inmediata en tres perío-dos determinados de tiempo: 24 hs (40 implantes), 48 hs (42 implantes) y 7 días (42 implantes). Todos los implantes fueron ferulizados a otros implantes ge-nerándose puentes de dos o más unidades, con di-ferente longitud. En el grupo de implantes con carga inmediata en 24 hs la media de la pérdida ósea distal de todos los implantes fue de 0,21 mm (+/-0,84) y la media de la pérdida ósea mesial en este grupo fue de 0,33 mm (+/- 0,53). En el grupo de carga inmediata en 48 hs, la media de la pérdida ósea distal de todos los implantes fue de 0,20 mm (+/- 0,82) y la media de la pérdida ósea mesial fue de 0,22 mm (+/- 0,81). En el grupo de carga de 7 días, la pérdida ósea me-sial del grupo fue de 0,28 mm (+/- 0,51) y la media de la pérdida ósea distal fue de 0,17 mm (+/- 0,81). Cuando comparamos las medias de pérdida ósea me-sial y distal entre los tres grupos, no se observaron diferencias estadísticamente significativas (mesial p=0,062, distal p=0,067). En conclusión, no se obser-varon diferencias significativas en la pérdida ósea crestal ni en la supervivencia de los implantes cortos entre los 3 tiempos estudiados de aplicación de car-ga inmediata. Por ello, utilizar cualquiera de los tres protocolos puede ser adecuado, mientras se realice un correcto análisis de la situación clínica de cada paciente (AU)

Extra-short implants are increasingly used in daily clinical practice. The use of these implants with immediate loading poses an added challenge. Classically it has been postulated that immediate loading should be performed 24 hrs after surgery. In the following case series, we analyze different times of immediate loading and their possible repercussions. We retrospectively collected data on cases of extra-short implants (5.5 and 6.5 mm) in which immediate loading was performed in posterior sectors. The implant was the unit of analysis for descriptive statistics in terms of location, implant dimensions, and radiographic measurements. The patient was the unit of measurement for the analysis of age, sex and medical history. The main variable studied was the survival of immediately loaded extra-short implants in three specific time periods: 24 hrs, 48 hrs and 7 days. Secondary variables studied were crestal bone stability in general and in the three loading periods mentioned above, prosthetic complications and prosthesis survival. Seventy-four patients were recruited and 146 implants that met the inclusion criteria were inserted. All implants were loaded by immediate loading in three specific time periods: 24 hrs (40 implants), 48 hrs (42 implants) and 7 days (42 implants). All implants were splinted to other implants generating bridges of two or more units, with different lengths. In the 24-hr immediate loading group the mean distal bone loss of all implants was 0.21 mm (+/- 0.84) and the mean mesial bone loss in this group was 0.33 mm (+/- 0.53). In the 48-hr immediate loading group, the mean distal bone loss for all implants was 0.20 mm (+/- 0.82) and the mean mesial bone loss was 0,22 mm (+/- 0,81). In the 7-day loading group, the mesial bone loss of the group was 0.28 mm (+/- 0.51) and the mean distal bone loss was 0.17 mm (+/- 0.81). When we compared the mean mesial and distal bone loss between the three groups there were no statistically significant differences (mesial p=0.062, distal p=0.067). In conclusion, no significant differences were observed in crestal bone loss or in the survival of short implants between the 3 immediate load application times studied. Therefore, using any of the three protocols can be appropriate, as long as a correct analysis of the clinical situation of each patient is performed (AU)

Plasma rico en fibrina e injerto conectivo en la instalación de un implante dental / Fibrin-rich plasma and connective tissue graft in dental implant installation

Introducción: Combinar tratamientos regenerativos con injertos de tejido blando impide que el tejido periimplantario se atrofie y altere la estética. Los resultados de esta combinación son discutidos en la literatura actual cuando se trata de implantes inmediatos. Objetivo: Describir el tratamiento regenerativo combinando plasma rico en fibrina e injerto conectivo en la instalación de un implante dental en el sector anterosuperior. Presentación del caso: El paciente fue un varón de 40 años de edad sin antecedentes de enfermedades sistémicas, con trauma facial. Al examen clínico se observó una corona de porcelana fracturada a nivel cervical vestibular, secreción purulenta en proceso de cicatrización y contorno gingival alterado. En el examen radiográfico se evidenció una lesión periapical con aparente reabsorción radicular. Se extrajo el diente, se colocó plasma rico en fibrina para mejorar la cicatrización, se esperaron 6 semanas y se colocó un implante. Al cabo de 4 meses se realizó la segunda fase con un injerto de tejido conectivo y colocación del cicatrizal, se esperaron dos semanas y se colocó una corona de porcelana. Conclusiones: En el presente caso, la combinación de plasma rico en fibrina e injerto conectivo favoreció el aspecto estético periimplantario sin evidenciarse complicaciones durante el posoperatorio(AU)

Introduction: Combining regenerative treatments with soft tissue grafts prevents atrophy of the peri-implant tissue and alterations in esthetics. The results of this combination are discussed in the current literature. Objective: To describe the regenerative treatment, combining Fibrin-rich plasma and connective tissue graft in the installation of a dental implant in the upper anterior sector. Case presentation: Forty-year-old male patient with facial trauma. He has no history of systemic diseases. On clinical examination, a fractured porcelain crown was found at the vestibular cervical level. There was purulent discharge in the healing process and altered gingival contour. Radiographic examination revealed a periapical lesion with apparent root resorption. The tooth was extracted; fibrin-rich plasma was placed to improve healing. Six weeks after, an implant was placed. After the first four months, the second phase was performed with a connective tissue graft and placement of the scar tissue; two weeks after, a porcelain crown was placed. Conclusions: In the present case, the combination of Fibrin-rich plasma and connective tissue graft favored the peri-implant esthetic appearance without evidence of complications during the postoperative period(AU)

Digital workflow coupling conic retention for the immediate restoration of adjacent posterior implants / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the digital workflow coupling conic retention for the immediate restoration of adjacent posterior implants.@*METHODS@#The patients with adjacent teeth missing in the posterior jaw seeking for implant restoration in the Department of Implantology, Peking University School and Hospital of Stomatology from March, 2017 to February, 2018 were recruited. After implant placement and commercial conic retention coping delivery, the patient had an intraoral scan for digital impression, and the computer-assisted design/computer-assisted manufacturing (CAD/CAM) technology was used for the fabrication of the immediate splinted prosthesis, which was made of polymethyl methacrylate (PMMA) and loaded immediately after delivery. Six months later, all the temporary prostheses were replaced by the permanent ones made of monolithic zirconia with CAD/CAM technology as well. The parallel periapical films were taken for the temporary and permanent prostheses post-delivery. The clinical effect of this workflow was evaluated by indices including the survival rates of implants and prostheses, the change of marginal bone level, and the implant-related and prosthesis-related complications; before the final restoration, the Visual Analogue Score (VAS) was used to evaluate the satisfaction of the patients.@*RESULTS@#Ten patients (4 males and 6 females, 55.5 years old for average) were recruited. Totally 34 implants were placed; 14 prostheses were fabricated, temporary and permanent, respectively. After an observation period from 4 to 14 months, the survival rate for implants and prostheses were both 100%; the marginal bone level of the implants were (1.06±0.97) mm and (0.96±0.82) mm, immediate post-operation and 6 months later, respectively. The difference was not statistically significant (P>0.05). Neither implant- nor prostheses- related complications were observed. And the VAS of the patients' satisfaction was 87.2.@*CONCLUSION@#For the adjacent posterior implants, the immediate prostheses manufactured by digital workflow, coupling conic retention, were clinically feasible and patient-satisfactory.

Manejo de tejidos blandos en implantes con carga inmediata del sector anterosuperior: reporte de caso clínico / Handling of soft tissues of an immediate loading implant on the upper anterior sector: report of a clinical case

Los implantes dentales se han colocado en sitios de extracción cicatrizados mediante un procedimiento quirúrgico en dos etapas para un periodo de tres a seis meses sin carga. Sin embargo, los pacientes esperan ser rehabilitados lo antes posible, especialmente los pacientes sometidos a restauraciones estéticas en el maxilar anterior. Después de la colocación del implante, la fabricación de la restauración temporal y la carga del implante dentro de las 48 horas se denominan carga inmediata. Esto acorta el tiempo del tratamiento, ya que requiere menos intervenciones quirúrgicas, reduce la pérdida ósea crestal periimplantaria, conduce a la preservación de la morfología de los tejidos blandos y mejora la estética. En este artículo se hablará del caso clínico de un paciente femenino de 44 años de edad que presentaba pérdida del órgano dentario 21. Se realizó valoración periodontal, radiográfica y tomográfica de este órgano dentario, se colocó implante con la utilización de guía quirúrgica y protésica acrílica termocurable, se realizó carga inmediata, el provisional fue conformado con contorno subgingival cóncavo y se toman en cuenta criterios de contorno crítico y subcrítico para el desarrollo ideal del perfil de emergencia. En las citas de valoración se encontraron los tejidos periimplantales estables y la paciente no refirió sintomatología (AU)

Dental implants have been placed in scarred extraction sites by a twostage surgical procedure for a period of three to six months without load. However, patients expect to be rehabilitated as soon as possible, especially patients undergoing esthetic restorations in the anterior maxilla. After implant placement, the fabrication of the temporary restoration and implant loading within 48 hours are called immediate loading. This shortens the time of treatment, beacause it requires fewer surgical interventions, reduces peri-implant crestal bone loss, leads to the preservation of soft tissue morphology and improves aesthetics. In this article we will discuss the clinical case of a 44-year-old female patient who had lost the dental organ 21. Periodontal, radiographic and tomographic assessment of this dental organ was performed, an implant was placed with the use of surgical guide and acrylic prosthesis thermocurable, immediate loading was performed, the provisional was formed with a concave subgingival contour and critical and subcritical contour criteria were taken into account for the ideal development of the emergence profile. In the assessment appointments stable periimplant tissues were found and the patient did not report symptoms (AU)

Finite Element Analysis on Porous Scaffold with Different Materials to Repair Defects of Rabbit Femur under Immediate Loading / 医用生物力学

Objective To investigate the biomechanical behavior of porous scaffold with different materials (Ti, Ta, PEEK, HA) for repairing rabbit femur defects under immediate loading by three-dimensional finite element analysis (FEA), so as to explore the best porous scaffold material from the perspective of biomechanics. Methods The CBCT combined with software such as Mimics, SolidWorks, Geomagic Studio, ANSYS were used to establish an immediate loading model for the repair of rabbit femur defects with porous scaffolds at different stages of bone healing. The stress and strain distributions on the scaffolds and the surrounding tissues were calculated. Results The maximum equivalent stress of porous scaffold decreased along with the bone healing. In the granulation tissue and fibrous tissue model, the ratio of the maximum equivalent stress to the yield strength of porous scaffold was: HA＞Ta＞PEEK＞Ti. The maximum equivalent stress of the HA porous scaffold was greater than its yield strength. The number of suitable strain elements in tissues around the porous scaffolds was: PEEK＞Ta＞Ti＞HA. The number of potential fracture strain elements in tissues around the porous scaffolds was: HA＞Ta＞PEEK＞Ti. Conclusions The HA porous scaffold could not bear the immediate load and guide bone healing well under immediate loading. The elastic modulus of PEEK porous scaffold was similar to that of bone tissues, which could preferably guide bone healing. PEEK was an ideal porous scaffold material under immediate loading. The research findings provide

Biomechanical development and evaluation of a new framework for all-on-four rehabilitation / Desenvolvimento e avaliação biomecânica de uma nova infraestrutura para reabilitações "all-on-four"

Abstract Introduction For complete rehabilitation of fully edentulous mandibles, the option for immediate loading determines the use of temporary prostheses that splint the installed implants. Although temporary prostheses with reinforcement provide rehabilitations with biomechanical benefits, the non-adoption of this recommendation coexists in different studies on immediate restorations. Objective This study evaluates a type of prosthesis to restore jaws by the all-on-four concept. Material and method: The mechanical behavior of prostheses with the modified framework was evaluated in vitro, under a cantilever mechanical unilateral bending test. Two representative groups were included in the all-on-four concept, with a G1 test group (n = 10) containing modified frameworks and a G2 control group (n = 10) that included full acrylic prostheses. The samples were submitted to thermal cycling with 500 cycles (5° ± 2 °C for 30 s, and 55° ± 2° for 30 s) and to the mechanical bending test on the cantilever. Result The Mann-Whitney test revealed a significant difference between G1 and G2 (p <0.001). In the descriptive evaluation, G1 averaged 830.50 N until the initial resin fracture, while the control group presented a mean of 403.58N. The maximum resistance until complete fracture was recorded in G1, with a mean of 903.03N, while in G2, a mean of 435.20N was recorded. The linear vertical component of the flexion was 0.68 mm and 0.39 mm until the initial fracture of the bar, respectively for G1 and G2. Conclusion The modified framework for the all-on-four protocol determined better mechanical performance when compared to the same full acrylic prosthesis model.

Resumo Introdução Para reabilitação de mandíbulas totalmente edêntulas, a opção por carga imediata determina a utilização de próteses provisórias que esplintem os implantes instalados. Apesar de provisórias com reforço proverem as reabilitações com benefícios biomecânicos, a não adoção desta indicação coexiste em diferentes estudos sobre restaurações imediatas. Objetivo Este estudo avaliou um tipo de prótese para reabilitar mandíbulas pelo conceito "all-on-four". Material e método: Foi avaliado, in-vitro, o comportamento mecânico de próteses com a infraestrutura modificada, sob ensaio mecânico de flexão unilateral em cantilever. Foram avaliados dois grupos representativos para o conceito "all-on-four", sendo um grupo teste G1 (n = 10) contendo próteses com infraestrutura modificada e outro controle G2 (n = 10) que incluiu próteses totalmente acrílicas. As amostras foram submetidas à ciclagem térmica com 500 ciclos (5° ± 2 °C por 30 segundos e 55° ± 2 °C pelo mesmo tempo) e submetidas ao ensaio mecânico à flexão sobre o cantilever. Resultado O teste de Mann-Whitney revelou diferença significativa entre G1 e G2 (p<0,001). Na avaliação descritiva, G1 mostrou média de 830,50 N até a fratura inicial em resina e o grupo controle apresentou média de 403,58N. A resistência máxima até a fratura completa foi de 903,03 N para G1 e para G2 de 435,20 N. O componente vertical linear de flexão foi 0,68 mm e 0,39 mm até a fratura inicial da barra, respectivamente para G1 e G2. Conclusão A infraestrutura modificada para o protocolo "all-on-four" proporcionou melhor desempenho mecânico quando comparado ao mesmo modelo de prótese totalmente acrílico.

Protocolo Clínico para Control de Prótesis Fija Total con Carga Inmediata / Clinical Protocol for Control of an Immediately Loaded Implant-Supported Prosthesis

RESUMEN: Los protocolos odontológicos de controles son guías que tienen por objetivo optimizar la calidad de atención y estandarizar ciertos procedimientos para poder establecer mejores pronósticos. Varias complicaciones se pueden presentar posterior a la instalación de una prótesis fija total con carga inmediata (PFTC), desde el daño de la estructura protésica provisoria hasta la pérdida de la oseointegración de los implantes dentales. La escasa evidencia sobre el comportamiento clínico que se debe tener posterior a este tipo de tratamiento indica la necesidad de confección de un protocolo para poder mejorar las tasas de éxito. Para confeccionar el protocolo clínico se realizó una revisión sistemática de la literatura en la base de datos PubMed. Los filtros de búsqueda fueron ajustados de la siguiente manera. Se utilizaron los términos de búsqueda "immediate loading" AND "full arch" AND "Resonance frequency analysis". Los que fueron sometidos a los criterios de inclusión y exclusión, dando como resultado un total de 15 estudios. Todos los estudios seleccionados son ensayos clínicos controlados donde se encontraron complicaciones como fracturas, desalojos y desgaste de la estructura protésica, entre otros. En los resultados encontrados no existe evidencia sobre el número y rango de sesiones necesarias para el control clínico de una PFTCI. El momento más indicado para la extracción de la prótesis provisoria e instalación de la prótesis definitiva es durante el 3° y 4° mes posterior a la carga inmediata. Existe escasa evidencia sobre el número, momento y tipo de examen imageneológico a solicitar. Por lo que este protocolo clínico será una guía para los controles que se realicen posterior a una instalación de una PFTCI.

ABSTRACT: Dental protocols are guidelines used to optimize service quality and to standardize procedures to establish a better prognosis. There are many complications that can occur after installation of a an immediately loaded implant-supported prosthesis for rehabilitation. These may generate damage to the provisional structure and even loss of osseointegration from the dental implants. Limited evidence on the clinical approach required to monitor these procedures, makes it necessary to establish clinical protocols for treatment control, and increases the success rate. In order to develop such protocols a systematic research was carried out in the Pubmed database. The filters used were "immediate loading", "full arch" and "Resonance frequency analysis". The results were subject to the inclusion and exclusion criteria. A total of 15 studies were selected. All of the studies were randomized clinical trials. An important number of complications were recorded, such as fractures, dislodgment and wear of the prosthesis structure. There is no evidence about the number and range of sessions needed to assess the clinical control of an immediate loading fixed rehabilitation. The best time to remove the provisional prosthesis and install the restorative rehabilitation is during the third and fourth month following immediate loading. Limited evidence was found regarding the number, time and type of radiological images requested for clinical support. Therefore, the clinical protocol developed by the authors will be a guide for future controls related to an immediately loaded implant-supported prosthesis.

Control Clínico en Pacientes Rehabilitados Mediante Prótesis Fija Total con carga Inmediata. Revisión de la Literatura / Clinical Control of Patients Treated with an Immediately Loaded Implant-Supported Prosthesis. A Systematic Review

RESUMEN: Son varias las complicaciones que se pueden presentar posterior a la instalación de una prótesis fija total con carga inmediata (PFTCI), estas pudiesen generar desde el daño de la estructura protésica provisoria hasta la pérdida de la oseointegración de los implantes dentales. La escasa evidencia sobre el comportamiento clínico que se debe tener posterior a este tipo de tratamiento indica la necesidad de controlar mejor estas complicaciones. En esta revisión narrativa, el 3 de marzo de 2016 se realizó una búsqueda electrónica en la base de datos PubMed. Para poder efectuar una investigación acabada los filtros de búsqueda fueron ajustados de la siguiente manera. Se utilizaron los términos de búsqueda "immediate loading" AND "full arch" AND "Resonance frequency analysis". Los que fueron sometidos a los criterios de inclusión y exclusión, dando como resultado un total de 15 estudios. Todos los estudios eran ensayos clínicos controlados, donde se encontraron complicaciones como fracturas, desalojos y desgaste de la estructura protésica, entre otros. Se pudo observar que desde el día de la carga hasta un mes después el valor ISQ (cociente de estabilidad del implante) disminuye, para luego aumentar paulatina y progresivamente. En conclusión, no existe evidencia sobre el número y rango de sesiones necesarias para el control clínico de una PFTCI. El momento más indicado para la extracción de la prótesis provisoria e instalación de la prótesis definitiva es durante el 3° y 4° mes posterior a la carga inmediata. Existe escasa evidencia sobre el número, momento y tipo de examen imageneológico a solicitar. La presencia de complicaciones protésicas posterior a una PFTCI hace necesaria la confección de un protocolo de control clínico para este tipo de tratamiento.

ABSTRACT: There are many complications that can occur following placement with an immediately loaded implant-supported prosthesis in rehabilitation, these may generate damage to the provisional structure and even loss of the osseointegration from the dental implants. Limited evidence about clinical behavior post-installation, creates the need to better assess possible future complications that may arise. In this review, a systematic research was made in the PubMed database. The filters used were "immediate loading", "full arch" and "Resonance frequency analysis". The results were subject to the inclusion and exclusion criteria. A total of 15 studies were selected. All of the studies were randomized clinical trials, many complications were recorded, such as fractures, dislodgement and wear of the prosthesis structure. It was observed that from the first day of immediate loading until the first month, Implant Stability Quotient value decreases, subsequently, progressively increasing. There is no evidence about the number and range of sessions needed to assess the clinical control of a immediate loading fixed rehabilitation. The ideal time for removal of the provisional prosthesis and installation of the restorative rehabilitation, is during the third and fourth month after the immediate loading. Limited evidence was found regarding the number, the time and type of radiological images for clinical support. The possibility of several complications after an installation of a immediately loaded implant-supported prosthesis are very real, therefore is necessary to establish a clinical protocol for controls regarding this treatment.

Influência da extração na instalação imediata e estabilidade primária de implantes osseointegrados para reabilitação total: estudo clínico retrospectivo com 40 pacientes e 162 implantes / The influence of tooth extraction on the immediate implant placement and stability for complete mandibular rehabilitation: a clinical retrospective study with 40 patients and 162 dental implants

Objetivo: verificar a influência das exodontias realizadas no mesmo momento da instalação dos implantes osteointegráveis (IO) na frequência de complicações pós-operatórias e a estabilidade primária desses implantes. Material e métodos: mediante análise dos prontuários dos pacientes tratados na APCD (Bauru-SP), foram selecionados e comparados dois grupos de pacientes que necessitavam de reabilitação oral total de mandíbula. Grupo I: pacientes submetidos à exodontia prévia à instalação de IO (N:13). Grupo II: pacientes submetidos à exodontia e instalação de implantes no mesmo momento (N:27). No grupo I, dos 13 pacientes tratados, 12 (91,67%) foram submetidos à carga imediata (52 implantes). No grupo II, 24 (88,89%) dos 27 pacientes (110 implantes) alcançaram os parâmetros necessários de estabilidade inicial. Resultados: a comparação entre os grupos apontou maior frequência de complicações no grupo II, no qual foram perdidos dois implantes osteointegráveis (1,82%). Conclusão: as extrações realizadas no mesmo momento da instalação dos IO podem contribuir para maior incidência de perda das fixações. Assim, deve-se esclarecer aos pacientes as limitações, vantagens e desvantagens do tratamento com carga imediata.

Objectives: to verify the influence of tooth extraction and immediate implant placement on the frequency of postoperative complications and primary implant stability. Material and methods: upon reviewing of the dental charts of patients treated at APCD (Bauru- SP), two groups were selected based on their need of mandibular implant restorations. Group I: those submitted to tooth extraction and later receiving dental implant placement (N=13); Group II: patients submitted to extraction and implant placement in the same time (N=27). In Group I, 13 patients (91.67%) were submitted to immediate loading (52 implants). In Group II, 24 patients (110 implants, 88,89%) achieved the pre-requisites of initial stability. Results: the frequency of complications was higher in Group II, with two implants lost (1.82%). Conclusion: tooth extraction and dental implant placement in the same day can contribute to more implant failures. Thus, patients need to educated regarding the limitations, advantages, and disadvantages of the immediate loading protocol as a treatment option.

Influence of crown-to-implant ratio of short vs long implants on implant stability and marginal bone loss in the mandibular single molar implant

PURPOSE: The purpose of this randomized clinical trial is to determine whether implant length and the crown-to-implant (C/I) ratio influence implant stability and peri-implant marginal bone loss (MBL). MATERIALS AND METHODS: 46 patients with single tooth missing in the posterior molar region of the mandible were included in this study. 19 implants (CMI IS-III active® long implant) of 5.0 mm diameter and 10 mm length were installed for the control group, while 27 implants (CMI IS-III active® short implant) of 5.5 mm diameter and 6.6, 7.3 or 8.5 mm length were placed for the experimental group. Each implant was inserted and immediately loaded using the digitally pre-fabricated surgical template and provisional restoration. The CAD-CAM monolithic zirconia crown was fabricated at 3 months after the surgery as a definitive restoration. The ISQ value and the MBL was measured at 48 weeks after the surgery. The correlation between the C/I ratio, MBL, and secondary implant stability was analyzed. RESULTS: Successful results in terms of ISQ and MBL were achieved with both groups. There was no significant difference between the groups in terms of ISQ values and MBL at 48 weeks after the surgery (P > 0.05). No significant correlation was found between the C/I ratio and secondary stability as well as the C/I ratio and the MBL (P > 0.05). CONCLUSION: The influence of C/I ratio in both groups was not shown on the stability nor the marginal bone loss in implants supporting single crown of the mandible. Short implant could be a preferable alternative option in the reduced bone height mandible under the limited condition despite its higher C/I ratio.

Risk factors for dental implant failure with the anterior teeth / 口腔疾病防治

Objective @#To compare the 2-year survival rate of anterior implants with delayed or immediate loading and to explore the risk factors associated with immediate loading implantation@*Methods @# A total of 126 patients were assessed from July 2012 to July 2015, including 210 implants. The patients were followed for more than 2 years. Univariate and multivariate survival analyses were performed using logrank tests and Cox regression analysis to identify risk factors for dental implant failure with the immediate loading or conventional loading of anterior teeth. @*Results @#The 2-year survival rates of anterior implants with delayed and immediate loading were 96.3% and 89.0%, respectively. The difference between the two groups was statistically significant(P < 0.05). The 2-year survival rate with delayed loading of implants was higher than that of the immediate loading of implants. Survival analysis indicated that the risk factors for implant failure were smoking and maxillary implantation in both the immediate loading and conventional loading groups@*Conclusion@#There is high risk associated with the immediate loading of anterior implants. The immediate loading of maxillary anterior implants and smoking in association with implantation may cause implant failure.

Clinical outcome of immediately and early loaded implants with laser treated surface: a 3-year retrospective study

PURPOSE: The marginal bone loss of implants with laser treated surface was investigated after six weeks of loading after implant installation to the mandible molar area. MATERIALS AND METHODS: A total of 23 implants were placed in the edentulous molar area of the mandible: 13 implants were immediately loaded and 10 implants were early loaded. The implants used were made of titanium grade 23, screw shaped, 4.2 mm in diameter, and 10 mm in length. Patients were evaluated with resonance frequency analysis at implant fixture installation and 1, 2 (final prosthesis installation), 3, 5, 8, and 14 months later. X-rays were taken at 2 months after fixture installation and 1, 2, 3 years after to measure the marginal bone loss. RESULTS: The mean ISQ value measured at the implant installation was over 70 at all-time points. The average of marginal bone loss was average 0.33 mm. CONCLUSION: Immediate implant loading for laser treated implants would be possible.

Full mouth rehabilitation with Implant-Guided Surgery and Fixed prosthesis / 대한치과보철학회지

The development of cone beam computerized tomography (CBCT) allows three-dimensional analysis of the patient's anatomy. The surgical guide is a combination of CBCT, computer-aided design/computer-aided manufacturing (CAD/CAM) and implant diagnostics software, which allows well planned prostheses design and ideal implant placement. Guided surgery minimizes possible anatomical damage and allows for more reproducible treatment planning. In this case, the operation time was shortened by using a surgical guide for multiple implants placement in a fully edentulous patient. Immediate loading were performed more easily using preliminary preparation of provisional prosthesis. The patient was satisfied with improved esthetics and chewing function.

Carga imediata provisória em maxila atrófica, uma alternativa de tratamento: relato de caso / Provisional immediate loading in atrophic maxilla, a treatment alternative: report case

Introdução: os implantes osseointegrados tem se mostrado eficazes no restabelecimento da função e estética. Para reabilitação oral com implantes, o principal pré-requisito é quantidade de tecido ósseo. Entretanto, alguns pacientes apresentam como limitação a reabsorção óssea, que conduz o profissional a planejar alternativas de tratamento, muitas vezes fugindo do protocolo convencional. Objetivo: descrever um caso de reabilitação oral por meio da instalação de implantes distais inclinados e do approach palatino associado á carga imediata provisória. Métodos, Resultados e Discussão: paciente do sexo feminino, 65 anos, leucoderma, procurou atendimento relatando estar insatisfeita com a condição de retenção de sua prótese total superior e com dificuldade para se alimentar e falar. Ao exame imaginológico, notou-se a presença de uma reabsorção óssea, apresentando na região posterior pneumatização do seio maxilar. Após avaliação e planejamento definido, foi instalado seis implantes Alvim Cone Morse 3,5 x 13 mm (Neodent®), sendo os distais inclinados. Com a obtenção da estabilidade primária, realizou-se a captura dos componentes protéticos e provisionalização da prótese total, melhorando a qualidade de vida da paciente. Conclusão: a técnica empregada foi efetiva na resolução funcional e estética, permitindo grandes vantagens que favoreceram a redução da morbidade, tempo e custo à paciente.

Introduction: the osseointegrated implants have showed themselves effective at function reestablishment and aesthetics. For oral rehabilitation with implants, the main prerequisite is the bone tissue quantity. However, some patients present as a limiting factor the bone reabsorption, which leads the professional to plan treatment alternatives, often fleeing from the conventional protocol. Objective: thus, this paper aims to describe an oral rehabilitation through the use of provisionally immediate loading in atrophic maxilla, for the installation of distal implants and palatal approach associated to the provisional immediate loading. Methods, Results and Discussion: patient, 65-year-old female, leukoderma, came for treatment reporting that she was dissatisfied with the condition of retention of her total upper prosthesis and had difficulty feeding and talking. Imaging exams showed bone loss and pneumatization of sinus lift. After evaluation and treatment plane, six implants Alvim Cone Morse 3.5 x 13 mm (Neodent®) were installed and the distal are inclined. With the obtainment of primary stability in dental implant in bone, the prosthetic components were captured and provision of the total prosthesis was performed, improving the quality of life of the patient. Conclusion: the technique employed was effective in functional and aesthetic resolution, allowing great advantages that favored the reduction of morbidity, time and cost to the patient.

Implante imediato com provisionalização imediata através de cicatrizador multifuncional de PEEK / Immediate implant placement and provisionalization using a multifunctional PEEK healing abutment

Este artigo teve por objetivo apresentar um caso clínico cuja prótese provisória utilizou um componente protético multifuncional de PEEK. Este é um polímero biocompatível personalizável e de boa aderência às resinas. O caso descrito é um implante imediato com carga imediata na região do 21. Foi realizado um approach palatino do implante, preenchimento do gap vestibular com um enxerto aloplástico (Nanosynt), um provisório imediato utilizando um componente provisório multifuncional de PEEK e um dente de estoque. O caso foi acompanhado até a fase de confecção da prótese defi nitiva, na qual foi verifi cada a arquitetura dos tecidos peri-implantares quanto à saúde e manutenção. Na Implantodontia contemporânea, o PEEK é a opção biológico-funcional com melhor custo-benefício nos casos de implantes colocados e carregados imediatamente.

The aim of this article was to present a clinical case where the provisional restoration was fabricated over a multifunctional PEEK healing abutment. This biocompatible polymer can be customized and has excellent bond strength to resin composites. A dental implant was loaded at the region of tooth 21. After a palatal approach for implant placement, the buccal gap was fi lled with an alloplastic graft (Nanosynt). Then, the immediate restoration was fabricated with the multifunctional PEEK and an acrylic tooth form. At the delivery of the defi nitive restoration, the peri-implant soft tissue health and architecture were preserved. In the contemporary implant dentistry, PEEK abutments provide the best biological and functional option with a signifi cant cost-benefi t ratio for cases of immediate implant loading

Rehabilitation using immediate loading in patients with partial resection of the jaw

ABSTRACT: Ameloblastoma is a rare tumor that affects the maxillomandibular region. Surgical resection is often indicated, and oral rehabilitation becomes a challenge. This study aims to report on the mandibular rehabilitation with implant supported prosthesis using immediate loading with subsequent resection. A patient with a confirmed diagnosis of multicystic ameloblastoma in the left jaw underwent a partial resection of the mandible and a reconstruction with a titanium plate. After 2 years of follow-up with clinical examinations and imaging testing and with no signs of recurrence, the patient underwent the technique of immediate load implants, rehabilitating the mandible with an implant supported fixed prosthesis and the maxilla with a conventional complete denture. During the seven years of follow-up with the patient, there was no sign of recurrence of ameloblastoma. The rehabilitation with oral implants under immediate loading demonstrated to be successful, and the cemented cylinder technique used in this study coupled with passivity showed a favorable prognosis for the longevity of implants.

Implante dentário e carga imediata após a extração do incisivo lateral superior decíduo: quatro anos de acompanhamento / Immediate dental implant and loading after extraction of a maxillary lateral incisor deciduous tooth: 4 years of follow-up

Quando bem indicado, o implante imediato com carga é uma opção segura e eficiente para substituição de elementos dentais unitários condenados, com previsibilidade e altas taxas de sucesso quando se buscam fatores como conforto, estética, função e fonética. Uma técnica atraumática, aliada à habilidade do operador, e um bom remanescente ósseo são fatores determinantes no sucesso do tratamento. O objetivo desse trabalho foi apresentar um caso clínico de instalação de implante imediato em região anterossuperior com carga imediata, provisionamento com dente decíduo e prótese definitiva livre de metal, com acompanhamento de quatro anos.

When properly indicated, the immediate dental implant with loading is a safe and efficient option with predictability and high success rates for patients in need of comfort, esthetics, function, and phonetics. An atraumatic technique allied to the operator's skill and a good bone site are mandatory to the treatment success. This case reports the 4-year follow-up on the use of an immediate implant/loading procedure after extracting a maxillary deciduous lateral incisor and delivery of a metal-free restoration.

Immediate loading of mandibular single implant by using surgical guide and modeless digital prosthesis: a case report

In this case report, immediate loading of an implant-supported single-tooth prosthesis through complete digital workflow. A patient presented for restoration of missing a single tooth in the mandibular first molar. The digital impression was made with intraoral scanner and implant was placed using surgical guide pre-fabricated with pre-operative computed tomography (CT) and scan data. After 1 week later, prefabricated customized abutment and provisional restoration were connected for immediate loading. After 8 weeks later, abutment level impression was taken by intraoral scanner. At 3 months later from implant installation, monolithic zirconia crown were fabricated. This clinical report presents satisfying result in accuracy and patient satisfaction. A completely modeless digital procedure met expectations regarding precision, esthetics, and functionality.

Technical characteristics and clinical feasibility of 2 implant supported immediate loading mandibular implant complete denture by linear occlusion / 中国生化药物杂志

Objective To investigate the technical characteristics and clinical feasibility of 2 implant supported immediate loading mandibular implant complete denture by linear occlusion.Methods40 cases of edentulous patients in the fifth people's hospital of yuhang district hangzhou from January 2011 to January 2017 were selected, these patients were divided into 2 implants supported immediate loading implant supported mandibular complete overdenture group (immediate loading implant group, n=20) and conventional complete denture repair group (n=20) two groups according to the treatment methods, the planting denture satisfactions, body marginal bone resorption, complications of the two groups were statistically analyzed.ResultsThe planting retention function, masticatory function, language function, comfort scores of the immediate loading implant group were significantly higher,there was significant difference between two groups(P<0.05), the bone resorption was significantly lower,there was significant difference between two groups(P<0.05), the incidence of complications 10% (2/20) was significantly lower than the conventional complete denture repair group 40% (8/20).there was significant difference between two groups(P<0.05).ConclusionThe clinical feasibility of 2 implant supported immediate loading mandibular implant complete denture by linear occlusion is higher than conventional complete denture repair.