Impact of maxillofacial growth on implants placed in adults: A narrative review.

OBJECTIVE: To determine the effect of lifetime maxillofacial changes on dental implants placed in adults, analyze the clinical implications of these changes, identify prognostic factors, and offer possible solutions. OVERVIEW: The relationship between implant placement and maxillofacial changes, occurring during not only the active growth period but also the entire span of adulthood, has not been extensively examined. Vertical differences between implants and adjacent teeth due to the ankylotic behavior of the former might be observed at any age and endanger restoration biologically, functionally, and esthetically. Regarding interproximal contacts, firm contact loss may occur within a few months after restoration, resulting in food impaction. Many prognostic factors have been reported, but most do not exhibit a statistically significant association with implant infraocclusion and interproximal contact loss. Incorporation of alternative solutions, accurate treatment planning, strict recall protocols, and retrievability of implant-supported restorations can facilitate efficient management of complications. CONCLUSION: Maxillomandibular changes throughout adulthood may lead to complications such as implant infraocclusion and interproximal contact loss. Rehabilitation of edentulism should be characterized by well-designed and flexible treatment plans to resolve long-term complications efficiently. Further long-term clinical studies are needed to identify other risk factors. CLINICAL SIGNIFICANCE: Treatment plans for implant therapy should be reconsidered for adults. Careful patient monitoring and early intervention are essential for securing treatment outcomes.

Three-year clinical performance of posterior monolithic zirconia single crowns.

STATEMENT OF PROBLEM: Monolithic zirconia has become widely used for single crowns, with the advantages of minimal tooth reduction and good esthetics. However, clinical studies evaluating the performance of and patient satisfaction with posterior monolithic zirconia crowns are sparse. PURPOSE: The purpose of this clinical study was to evaluate the clinical performance of and patient satisfaction with posterior monolithic zirconia crowns. MATERIAL AND METHODS: Within a prospective cohort study design, participants were recruited from a university dental clinic if they required 1 posterior monolithic zirconia crown. The clinical performance was evaluated at follow-up appointments 1, 2, and 3 years after insertion. Bleeding on probing and pocket probing depths for the crowned teeth were recorded. Overall patient satisfaction was measured by using a visual analog scale (VAS), and quality of life was measured by using the validated German version of the Oral Health Impact Profile 14 (OHIP-G14). Descriptive statistical methods were applied. Mean values were calculated and compared by using the paired t test (α=.05). RESULTS: Thirty participants received a monolithic zirconia crown (14 premolars, 16 molars). One biologic complication (vertical root fracture) was identified at the 1-year follow-up. Three years after insertion, 22 participants could be examined, and the crowns were still in function. The gingival and the periodontal status of the crowned teeth had not changed significantly over the 3 years. After insertion, a significant improvement in patient satisfaction was measured up to 3 years CONCLUSIONS: Posterior monolithic zirconia crowns led to enhanced patient satisfaction up to 3 years after insertion. They provided good middle-term success and offered a promising alternative to conventional metal-ceramic crowns.

Clinical Fit of Monolithic Zirconia Single Crowns.

PURPOSE: To analyze the clinical fit of monolithic zirconia single crowns (MZSCs) in a prospective cohort study. MATERIALS AND METHODS: A total of 30 posterior teeth were restored with MZSCs. Silicone replicas were made to measure the clinical fit using a stereomicroscope. Measurements were conducted at 17 points per crown at the marginal and occlusal surfaces. RESULTS: The mean clinical fit was 0.104 mm at the crown margin and 0.101 mm at the occlusal surface. Measured distances at the marginal and occlusal surfaces were comparable. CONCLUSION: MZSCs showed acceptable clinical fit.

Impact of Bruxism on Ceramic Defects in Implant-Borne Fixed Dental Prostheses: A Retrospective Study.

PURPOSE: Ceramic veneer fracture is a frequent complication in implant-borne fixed restorations. The retrospective clinical study assesses the effect of bruxism on this complication. MATERIALS AND METHODS: A sample of 507 implant-borne fixed units inserted between 1995 and 2011 in 144 patients were examined. Any detected veneer fractures were assigned to one of four groups according to extent and position. A hypothetical correlation between bruxism and ceramic veneer fractures was examined. RESULTS: Of 34 patients (23.6%) with at least one ceramic veneer fracture, 24 were bruxers (70%) and 10 were nonbruxers (30%) (P = .002). CONCLUSION: Bruxism may pose a risk for ceramic fractures.

Ceramic Defects in Metal-Ceramic Fixed Dental Prostheses Made from Co-Cr and Au-Pt Alloys: A Retrospective Study.

PURPOSE: Ceramic defects in porcelain-fused-to-metal (PFM) restorations may depend on framework alloy type. This study assessed ceramic defects on cobalt-chromium- (Co-Cr-) and gold-platinum- (Au-Pt-) based PFM restorations. MATERIALS AND METHODS: In this study, 147 Co-Cr-based and 168 Au-Pt-based PFM restorations inserted between 1998 and 2010 (139 patients) were examined for ceramic defects. Detected defects were assigned to three groups according to clinical defect relevance. RESULTS: Ceramic defect rates (Co-Cr-based: 12.9%; Au-Pt-based: 7.2%) revealed no significant difference but a strong statistical trend (U test, P = .082). Most defects were of little clinical relevance. CONCLUSIONS: Co-Cr PFM restorations may be at higher risk for ceramic defects compared to Au-Pt-based restorations.

All-ceramic prosthetic rehabilitation of a worn dentition: Use of a distal cantilever. Two-year follow-up.

The rehabilitation of heavily abraded occlusion in patients with parafunctional habits is a restorative challenge to the dentist. Use of all-ceramic systems in such cases is widely considered, but uncertainty over their resistance hinders their broad use. The authors would like to illustrate a possible approach by mixing two all-ceramic systems based on zirconium dioxide and lithium disilicate. A 48-year-old female patient attended with reduced vertical dimension in a full dentition. She suffered from craniomandibular (CMD) pain and desired an esthetic rehabilitation. Prosthodontic treatment was started in a pain-free condition, after correction of the vertical dimension with an occlusal splint, over four months. Determination of the treatment was based on the clinical findings: IPS e.max(®) ZirCAD frameworks veneered with IPS e.max(®) Ceram were used for discolored retainers or subgingival finishing lines. All the rest received IPS e.max(®) Press crowns. A zirconia-based, single-tooth-retained distal cantilever reconstruction was used to replace a missing second molar. No technical or biological complication was observed 24 months after treatment. The patient was highly satisfied and pain-free.