Periodontal outcomes of anterior fixed partial dentures on teeth treated with the biologically oriented preparation technique: A 6-year prospective clinical trial.

STATEMENT OF PROBLEM: One of the most frequent complications in participants with fixed partial dentures (FPDs) is the apical migration of the gingival margin, which may be associated with factors such as fit, gingival margin location, or tooth preparation type. The prevalence of the complication in participants restored with FPDs prepared by using the biologically oriented preparation technique (BOPT) is unclear. PURPOSE: The purpose of this prospective clinical trial was to evaluate the clinical and biologic outcomes of FPDs on teeth prepared by using the BOPT, over a 6-year follow-up period. MATERIAL AND METHODS: Tooth-supported zirconia FPDs in the anterior region prepared by using the BOPT were evaluated. Each participant was monitored annually for 6 years by evaluating plaque index, probing depth, vestibular gingival thickness, and gingival margin stability. Biologic and/or mechanical complications were also recorded. Patient satisfaction was measured by using a visual analog scale (VAS). RESULTS: A total of 25 FPDs supported by 70 teeth in 24 participants were analyzed. Low plaque index values and stable probing depths were observed, whereas the gingival index was 0 for most of the teeth. Teeth treated by using the BOPT presented significant increase in gingival thickness, and the gingival margin was found to be stable in 100% of the treatments. FPD survival was 100%. CONCLUSION: Tooth supporting FPDs prepared by using the BOPT presented good periodontal health and gingival margin stability, without recession and with a 100% survival rate during a 6-year follow-up.

Periodontal Behavior and Patient Satisfaction of Anterior Teeth Restored with Single Zirconia Crowns Using a Biologically Oriented Preparation Technique: A 6-Year Prospective Clinical Study.

OBJECTIVES: The aim of this study was to analyze the behavior of the periodontal tissues around teeth in the anterior region when restored with zirconia single crowns, using a biologically oriented preparation technique (BOPT), over a 6-year follow-up. METHODS: The study investigated tooth-supported single crowns in the anterior region that were fabricated with a zirconia core and feldspathic ceramic covering, in 34 patients. Follow-up analysis took place annually for 6 years, assessing periodontal responses by evaluating the following variables: plaque index (PI); probing depth (PD); gingival index (GI); gingival thickness adjacent to the restoration; and stability of the gingival margin (MS). Any (biological and mechanical) complications were also recorded, as well as the patients' satisfaction with the treatment. RESULTS: After 6 years' follow-up, a low mean plaque index was obtained, probing depth was stable, and gingival thickness and margin stability had increased. Complications (biological and mechanical) did not present a statistically significant incidence and a crown survival rate of 97.2% was achieved. Patients' satisfaction obtained a mean VAS score of 9.04 under 10. CONCLUSION: Teeth that are prepared with BOPT in the anterior region present good periodontal behavior around the restored teeth, particularly in terms of the stability of the gingival margin and increased gingival thickness. Single crowns prepared with BOPT obtain an excellent clinical survival rate, as well as a high score in patients' satisfaction after 6 years.

Clinical behavior of posterior fixed partial dentures with a biologically oriented preparation technique: A 5-year randomized controlled clinical trial.

STATEMENT OF PROBLEM: Evidence of the behavior of the periodontal tissues around anterior teeth restored with the biologically oriented preparation technique (BOPT) is available. However, outcomes of this technique in posterior teeth restored with fixed partial dentures (FPDs) are lacking. PURPOSE: The purpose of this randomized controlled clinical trial was to evaluate the clinical, mechanical, and biological behavior of posterior 3-unit FPDs placed on teeth prepared with BOPT. MATERIAL AND METHODS: Forty participants received a 3-unit zirconia FPD in the posterior region of the mandible or maxilla. Twenty FPDs were placed on teeth prepared with BOPT (study group) and 20 on teeth with a horizontal chamfer finishing line (control group). Follow-up examinations were performed 1, 3, and 5 years after treatment to evaluate periodontal responses around the prepared teeth by means of the following parameters: plaque index, gingival index, probing depth, and marginal stability (MS). Mechanical behavior was also assessed, as were any complications. RESULTS: After the 5-year follow-up, 57.9% of the control group and 35% of the BOPT group presented a plaque index of 1. The gingival index was 1 in 68.4% of the control group and 30% of the BOPT group after the follow-up period. In the analysis of probing depth, 26.3% of teeth in the control group had pockets of more than 3 mm in depth, whereas the BOPT group had only 10%. Marginal stability appeared in 100% of the BOPT group, whereas only 10.5% of the control group exhibited gingival stability. Complications during the follow-up period were similar, 20% in the control group and 15% in the BOPT group. CONCLUSIONS: Posterior FPDs prepared by using BOPT had a good clinical response over a 5-year follow-up, with a low gingival index, a small increase in pocket depth, and a 100% marginal stability of the surrounding tissues. High survival rates after 5 years indicated that the technique produced predictable outcomes.

Periapical Microsurgery with an Endoscope and Microscope of Two Upper Central Incisors Already Subjected to Periapical Surgery 25 Years Ago.

INTRODUCTION: The present clinical case describes periapical microsurgery with an endoscope and microscope in a patient already treated 25 years ago due to persistent periapical disease of the two central upper incisors, restored with poorly adapted crowns. Clinical Case. The first periapical surgery had been performed with silver amalgam as a retrograde filler material, causing grayish staining of the buccal mucosa. Periapical surgery was performed raising a submarginal flap with ostectomy and apicoectomy, retrograde cavity preparation with ultrasound tips, and filling with mineral trioxide aggregate (MTA). After soft tissue healing and complete bone regeneration of the lesion, retreatment of the incisors with a fixed prosthesis was carried out, adopting the biologically oriented preparation technique (BOPT). CONCLUSIONS: The described periapical microsurgery approach with magnification and illumination of the surgical field was found to be effective, avoiding the need to extract the two central upper incisors.

Oral rehabilitation with dental implants in patients with recessive dystrophic epidermolysis bullosa: A retrospective study with 2-15 years of follow-up

BACKGROUND: Epidermolysis bullosa (EB) comprises a group of hereditary disorders characterized by mechanical fragility of the skin and mucous membranes, with the development of blisters and vesicles in response to minimum tissue friction. Recessive dystrophic epidermolysis bullosa (RDEB) with generalized involvement is the most common subtype in the oral cavity. The present study was carried out to investigate dental implant survival, peri-implant tissue condition, patient satisfaction, and the impact of treatment upon the quality of life of patients with RDEB rehabilitated with implants and full-arch implant-supported prostheses. MATERIAL AND METHODS: Thirteen patients with RDEB underwent dental implant treatment between September 2005 and December 2016. A retrospective study was made to analyze implant survival, peri-implant tissue health and patient satisfaction. RESULTS: A total of 80 implants were placed (42 in the maxilla and 38 in the mandible) in 13 patients between 20-52 years of age and diagnosed with RDEB. All the implants were rehabilitated on a deferred basis with 20 full-arch prostheses. Fifteen fixed prostheses and 5 implant-supported overdentures were placed. The implant survival rate was 97.5% after a mean follow-up of 7.5 years after prosthetic loading. Fifty percent of the implants showed mucositis at the time of evaluation. Probing depth was maintained at 1-3 mm in 96.2% of the implants, and bleeding upon probing was observed in 67.5% of the implants. There was a high prevalence of bacterial plaque (85%). CONCLUSIONS: The treatment of edentulous patients with RDEB by means of implants and implant-supported prostheses is predictable as evidenced by the high success rate, and improves patient self-esteem and quality of life

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Fracture resistance and the mode of failure produced in metal-free crowns cemented onto zirconia abutments in dental implants.

The purpose of the investigation was to analyze fracture resistance and mode of failure of zirconium oxide (zirconia) abutments placed on dental implants bearing crowns of different esthetic materials: zirconia, lithium disilicate (LDS), and nano-ceramic resin, for replacing single teeth in the anterior sector. Eighty implant-abutment-crown units were divided into four groups: Group T-MC (control): 20 metal-ceramic crowns cemented onto titanium abutments; Group Z-Z: 20 zirconia crowns on zirconia abutments; Group Z-LD: 20 lithium disilicate crowns on zirconia abutments; and Group Z-NCR: 20 nano-ceramic resin crowns on zirconia abutments. Specimens underwent a fatiguing process (dynamic loading and thermocycling), followed by static loading to evaluate mechanical fracture resistance, and the mode of failure produced. Mean fracture resistance values were: Control Group T-MC, 575.85±120.01 N; Group Z-Z 459.64±66.52 N; Group Z-LD, 531.77±34.10 N; and Group Z-NCR, 587.05±59.27 N. In Group T-MC, fracture occurred in the prosthetic fixing screw in 100% of specimens. In Group Z-Z, 80% of fractures occurred in the fixing screw, 15% in the abutment, and 5% in the abutment and crown. In Group Z-LD, 60% of fractures were produced in the fixing screw and 40% in the abutment. In Group Z-NCR, 70% of fractures were produced in the fixing screw and 30% in the abutment. All the abutments and crowns analyzed have the potential to withstand the physiological occlusal forces to which they would be subject in the anterior region. Lithium disilicate and nano-ceramic resin crowns cemented onto zirconia abutments are a good restoration alternative for single implants in the anterior sector.

Digital scanning for implant-supported fixed complete-arch dental prostheses for patients with epidermolysis bullosa: A case series evaluation.

STATEMENT OF PROBLEM: The treatment of patients with recessive dystrophic epidermolysis bullosa has been compromised in the past by the lack of oral therapeutic information and the use of conventional complete dentures. PURPOSE: The purpose of this clinical case series study was to describe a digital rehabilitation protocol involving computer-aided design and computer-aided manufacturing (CAD-CAM) techniques for the treatment of patients with recessive dystrophic epidermolysis bullosa and to follow up for 4 years the patients who underwent this treatment. MATERIAL AND METHODS: A case series analyzing implant survival, peri-implant tissue health, and patient satisfaction with the treatment received was made of 4 patients with recessive dystrophic epidermolysis bullosa. Bimaxillary fixed implant-supported complete-arch rehabilitation was carried out by using a digital protocol with CAD-CAM techniques. RESULTS: The implant survival rate was 100%, with a bleeding rate of 74.2% and an inflammation rate of 58.0%. Gingival stability was achieved in 77.4% of the patients, with gingival displacement in 22.6% of the implants. However, the probing depth was maintained between 1 and 3 mm in 96.7% of the implants placed. CONCLUSIONS: Fixed complete-arch implant-supported rehabilitation is a successful treatment for patients with epidermolysis. Digital intraoral scanning facilitates the treatment of patients with this condition and reduces the clinical complications associated with conventional impression techniques (ulceration, blistering, angular cheilitis, and so forth).

Periodontal and prosthetic outcomes on teeth prepared with biologically oriented preparation technique: a 4-year follow-up prospective clinical study.

PURPOSE: To evaluate the clinicaland biological behavior of full coverage restorations on teeth prepared without finish line during a 4-year follow-up. METHODS: This prospective study included 149 teeth treated using biologically oriented preparation technique (BOPT). The sample (149 teeth) was divided into two groups: Seventy four teeth restored with crowns, and 75 teeth supporting fixed partial dentures (FPD). Restorations were fabricated with zirconium oxide cores and ceramic coverings. Patients attended regular annual check-ups when probe depth, presence of inflammation with bleeding on probing, presence of plaque, gingival thickness, marginal stability, biological or mechanical complications, and the patient's level of satisfaction were registered over a 4-year follow-up. RESULTS: After the 4-year follow-up, 2.1% of teeth underwent increases in probing depth; 12% of the sample presented inflammation and bleeding on probing; 20% of the restored teeth presented plaque; gingival thickening increased a 32.5%; 98.6% of teeth presented marginal stability; the restoration survival rate was 96.6%, with 2% of biological complications and 1.4% of mechanical complications. General satisfaction score was 80.73. CONCLUSIONS: Restorations placed on teeth prepared using BOPT present good periodontal behavior, increase of gingival thickening, and marginal stability over a 4-year follow-up. High survival rates after 4 years show that the technique produces predictable outcomes. CLINICAL SIGNIFICANCE: The BOPT technique is a good treatment option in cases where replacement of an old restoration is required; presenting good periodontal behavior, gingival thickening, and marginal stability.

Maxillary Implant Prosthodontic Treatment Using Digital Laboratory Protocol for a Patient with Epidermolysis Bullosa: A Case History Report.

Epidermolysis bullosa belongs to a group of genetic diseases that present with skin disorders and is characterized by generalized blister formation in response to mechanical trauma. This article reports on the management of a recessive dystrophic epidermolytic patient with four remaining periodontally compromised maxillary teeth. Treatment involved placement of four maxillary implants and use of computer-aided design/computer-assisted manufacture techniques to fabricate a fixed full-arch implant-supported prosthesis. The prescribed dental treatment protocol led to a successful short-term prosthodontic outcome.

Immediate prosthesis over implants retained using abutments with flexible screws: A preliminary study.

BACKGROUND: Immediate loading protocols for the rehabilitation of edentulous or partially edentulous patients have become very popular, due to the conveniences they afford in comparison with conventional loading techniques. MATERIAL AND METHODS: A preliminary study was carried out with 8 patients subjected to dental implant treatment with an immediate loading protocol involving a novel system of abutments with flexible screws. Implant survival was analyzed, together with marginal bone loss and patient and dentist satisfaction. RESULTS: A total of 35 implants were subjected to immediate loading using the abutments with flexible screws. The mean patient and dentist satisfaction score was 9.1 and 8.5, respectively. After 12 months the dental implant survival rate was 95.8%, with a mean marginal bone loss of 0.51 ± 0.12 mm. CONCLUSIONS: The novel system of abutments with flexible screws offers a good alternative to conventional immediate loading, since it allows rapid and simple manufacture of a reliable passive fit, fixed interim prosthesis after surgery. Key words:Dental implants, Flexafit®, Immediate loading, Immediate prosthesis.

Treatment and restoration of adult dentoalveolar trauma: A clinical case report.

Adult dentoalveolar trauma most often occurs in the context of sports activities and traffic accidents. Coronal fractures are the most common type of lesion, followed by tooth luxation. We present the case of a 25-year-old woman who suffered alveolar bone damage and coronal fractures of the upper incisors, with extrusive luxation of the right central incisor, as the result of a fall. On the first visit, manual reduction of the buccal plate was carried out under local anesthesia, with repositioning of the right central incisor and splinting to the neighboring teeth. Composites were used to restore the coronal fractures. After one month, both upper central incisors and the right lateral incisor were subjected to endodontic treatment. Internal bleaching of the right lateral incisor was also carried out, due to pigmentation secondary to pulp necrosis. At follow-up 5 months later, the alveolar bone fracture was seen to have healed. Definitive anterior restorative treatment with porcelain veneers was therefore carried out. After two years the patient remains asymptomatic and in good dental condition. Key words:Dental trauma, extrusive luxation, dento-alveolar fracture, esthetic restoration.

Immediate placement of single implant simultaneously with immediate loading in a fresh socket associated to periapical infection: A clinical case report.

Early restoration of the masticatory function, phonatory and aesthetics is some of the current goals of the therapy based on endosseous implants. Facing the classic protocols of implant insertion, which recommend a period of several months between extraction and implant placement, alternatives have been developed that demonstrate that immediate implant placement after tooth extraction permits adequate osseointegration, even in those cases where there is a periapical disease. The immediate restoration of implants after placement is a possibility where aesthetic requirements are high. This article presents a case with immediate implant placement and immediate loading of a first upper premolar with prior periapical pathology due to a vertical fracture. The immediate prosthetic was performed using the extracted crown, which is adapted to be attached to a titanium temporary abutment using a resin cement. After a 4 month healing period work began on the final prosthetic crown. The screw crown was made of zirconium oxide with a covering feldspathic ceramic. At the 12-month follow-up, there were no mechanical or biological complications. The patient gave high satisfaction marks for the overall treatment, giving visual analogue scale score of nine. Immediate post-extraction implants have arisen as an alternative to traditional implants on completely healed bone. Their main aim is to reduce treatment time and number of surgical procedures, along with other objectives such as reduced bone re-absorption and improved aesthetics. Key words:Post-extraction implants, immediate loading prosthetic, implant-retained prosthesis, periapical disease, vertical fracture.

Mechanical behavior of provisional implant prosthetic abutments

INTRODUCTION: Implant-supported prostheses have to overcome a major difficulty presented by the morphology and esthetics of peri-implant tissues in the anterior sector. Diverse therapeutic techniques are used for managing the mucosa adjacent to the implant and the most noteworthy is immediate/deferred fixed provisionalization. OBJECTIVES: In vitro testing of strength and deformation of implant prosthetic abutments made from different materials(Titanium/PEEK/methacrylate).MATERIAL AND METHODS: Forty Sweden & Martina(R) implant prosthetic abutments (n=40) were divided into five groups: Group MP: methacrylate provisional abutments with machined titanium base; Group PP: Polyether etherketone (PEEK) provisional abutments; Group TP: titanium provisional abutments; Group TAD: titanium antirotational definitive abutments; Group TRD: titanium rotational definitive abutments. Their mechanical behavior under static loading was analyzed. Samples were examined under a microscope to determine the type of fractureproduced. Results and CONCLUSIONS: Definitive anti-rotational titanium abutments and definitive rotational titanium abutments achieved the best mean compression strength, while PEEK resin provisional abutments obtained the lowest. The group that showed the greatest elastic deformation was the group of titanium provisional abutments

Mechanical behavior of provisional implant prosthetic abutments.

INTRODUCTION: Implant-supported prostheses have to overcome a major difficulty presented by the morphology and esthetics of peri-implant tissues in the anterior sector. Diverse therapeutic techniques are used for managing the mucosa adjacent to the implant and the most noteworthy is immediate/deferred fixed provisionalization. OBJECTIVES: In vitro testing of strength and deformation of implant prosthetic abutments made from different materials (Titanium/PEEK/methacrylate). MATERIAL AND METHODS: Forty Sweden & Martina® implant prosthetic abutments (n=40) were divided into five groups: Group MP: methacrylate provisional abutments with machined titanium base; Group PP: Polyether ether ketone (PEEK) provisional abutments; Group TP: titanium provisional abutments; Group TAD: titanium anti-rotational definitive abutments; Group TRD: titanium rotational definitive abutments. Their mechanical behavior under static loading was analyzed. Samples were examined under a microscope to determine the type of fracture produced. RESULTS AND CONCLUSIONS: Definitive anti-rotational titanium abutments and definitive rotational titanium abutments achieved the best mean compression strength, while PEEK resin provisional abutments obtained the lowest. The group that showed the greatest elastic deformation was the group of titanium provisional abutments.