Immediate functional loading of implant-supported mandibular prostheses with customized UCLA'S attachments with distal extension: A case report.

Implant-supported complete dentures are a common procedure for patients with mandibular edentulism problems. This article documents the protocol for immediate functional loading of fixed transient mandibular prostheses with fully moldable attachments and distal extensions to prevent fractures. A 56-year-old female patient was referred to the Oral Rehabilitation and Implantology Service due to periodontal problems, difficulty in chewing capacity and aesthetic compromise. The patient was treated in a single surgical procedure with dental extractions, guided regularization of the alveolar process and guided placement of five interforaminal implants and placement of functional fixed mandibular prostheses with immediate loading with personalized UCLA'S, distal extensions and short arc occlusal scheme. At 3 months postoperatively, the definitive placement of fixed mandibular metal acrylic prostheses and conventional upper prostheses was performed. The functional and aesthetic integrity of the fixed mandibular prosthesis implant preserved with UCLA'S documents that implant placement in the interforaminal zone with an immediate loading protocol is a viable treatment option for prosthetic rehabilitation of the fully edentulous mandibular arch and that design with distal extensions in the posterior sector of the mandibular arch is an effective option to avoid fracture of the prostheses, presenting a survival of the five mandibular implants of 100% at 1 year postoperatively.

Immediate versus conventional loading of mandibular implant-retained overdentures: a 3-year follow-up of a randomized controlled trial.

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

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)

Oral health-related quality of life and satisfaction in edentulous patients rehabilitated with implant-supported full dentures all-on-four concept: a systematic review.

OBJECTIVE: Address oral health-related quality of life (OHRQoL) and patient satisfaction rehabilitated by the all-on-four concept as the primary outcome. MATERIAL AND METHODS: A search was performed in the PubMed/MEDLINE, Web of Science, and Cochrane databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis criteria (PRISMA). The PICO question was used to address the following specific question: "What is the level of oral health-related quality of life and satisfaction in edentulous patients and with atrophic jaws who received dental implants for full-arch implant-supported restorations following the all-on-four in the mandible or maxilla?" RESULTS: Eleven studies including 693 patients aged 55 to 71 years were selected. The shortest follow-up period was 3 months and the longest, 7 years. Regarding the OHRQoL assessment method and patient satisfaction, the oral health impact profile (OHIP) and the visual analog scale (VAS) were the most used. CONCLUSION: OHRQoL and satisfaction in patients whose rehabilitation was based on the all-on-four concept were high. However, the current evidence is still limited by the quality of the available studies, making long-term randomized studies necessary to establish the real effectiveness of this surgical-prosthetic approach. CLINICAL RELEVANCE: Carefully analyze the aspects related to satisfaction and oral health-related quality of life of rehabilitated patients with implant-supported total prostheses made according to the all-on-four concept, aiming to achieve success through procedures with greater predictability and less complexity, as these are directly associated with recovery oral health of edentulous individuals with less morbidity and minimized costs.

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)

Immediate vs conventional loading of Facility-Equator system in mandibular overdenture wearers: 1-year RCT with clinical, biological, and functional evaluation.

BACKGROUND: The use of immediate loading (IML) is still poorly explored in elderly patients and implant-retained mandibular overdenture (IMO) wearers. For this reason, more comparisons to conventional loading (CL) are required. PURPOSE: To evaluate the clinical, biological, functional, and oral health-related quality of life (OHRQOL) influence of CL and IML loading on elders wearing IMO retained by the Facility-Equator system up to 1 year after implant installation. MATERIAL AND METHODS: Twenty edentulous patients received two narrow diameter implants in the mandible; the loading type (CL or IML) was randomized. The clinical parameters were monitored along with prosthetic events, marginal bone loss (MBL) and bone level change (BLC), implant stability quotients (ISQ), masticatory performance outcomes, and Interleukin 1 beta (IL-1ß) and tumor necrosis factor alpha (TNF-α) levels in the peri-implant crevicular fluid during the first year of loading. The OHRQoL was assessed via the Oral Health Impact Profile-EDENT questionnaire. Data were analyzed by the Mann-Whitney, χ2 , Wilcoxon paired, and McNemar tests. RESULTS: After 1 year, MBL, BLC and ISQ were statistically identical (P > .05) in the CL and IML groups. The probing depth at 12 months in the CL group (2.19 mm) was higher than in the IML group (1.29 mm; P ≤ .0001). TNF-α was 33.6% higher in the CL group at 6 months (P = .043), while IL-1ß was significantly higher in the IML group up to 6 months. The survival rate was 90% in the CL group and 85% in the IML group; 33 prosthetic events occurred in CL group and 23 in IML group. CONCLUSIONS: After 12 months, both loading protocols are viable and result in similar clinical, biological, functional, and OHRQOL outcomes. However, IML generates better adaptation of the peri-implant tissues, faster improvement in OHRQoL and fewer prosthetic intercurrences than CL.

Immediate Oral Rehabilitation Using Dental Implants After Marginal Mandibulectomy: A Case Report.

Mandibular reconstruction techniques are always a challenge to oral and maxillofacial (OMF) surgeons. Techniques and treatment plans that offer the patient OMF rehabilitation should always be available. Technological innovations have enabled more rapid, safer, and more secure treatment than in the past. This article describes a case using a different approach. The patient was treated with marginal mandibulectomy and immediate rehabilitation with osseointegrated implants; a hybrid prosthesis was fabricated a short time thereafter. This treatment plan demonstrated its utility and efficiency in this case. An approach with fewer surgeries and OMF rehabilitation needs be considered in all cases.

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)

Use of extracted anterior teeth as provisional restorations and surgical guide for immediate multiple implant placement: A clinical case report.

OBJECTIVE: The aim of this article is to describe the use of natural anterior teeth as a surgical guide to implant placement and provisional restoration for a young patient with root resorption of upper central incisors and left-lateral incisor. CLINICAL CONSIDERATIONS: Achieving soft tissue esthetics is quite a challenge in implant dentistry. Here, a case of immediate implant placement using the natural teeth of the patient as an immediate provisional restoration, which achieves satisfactory results in terms of soft tissue architecture. CONCLUSIONS: Post-extraction implant placement in combination with immediate loading of dental implants has been evolving into an appropriate procedure for the treatment of partially edentulous anterior maxilla. Different techniques that include use of the own teeth as provisional implant supported restoration helps to maintain architecture of gingival contour, specially papilla. CLINICAL SIGNIFICANCE: Natural architecture of anterior soft tissue is a big challenge in implant dentistry. Use of natural teeth as a surgical guide and provisional restorations might be helpful to obtain an optimal outcome.

Computer-guided implant surgery and full-arch immediate loading with prefabricated-metal framework-provisional prosthesis created from a 3D printed model.

OBJECTIVE: In this article, we describe the planning phase and clinical procedure where a CAD CAM 3D printed master model was utilized to create a prefabricated-titanium reinforced-fixed provisional prosthesis for a full-arch immediate loading after computer-guided implant placement. CLINICAL CONSIDERATIONS: The clinical procedure should be performed based on digital planning through an advanced surgical planning software and following the guidelines of full-arch immediate loading protocol. The fact that the master model is fabricated under a computer-assisted design and computer-assisted manufacturing approach before implant placement makes the whole process considerably easier, faster, more precise and cheaper. CONCLUSIONS: The use of a prefabricated-metal framework-provisional prosthesis for full-arch immediate loading created from a 3D printed master model seems to be a predictable treatment option when computer-guided implant surgery is performed. CLINICAL SIGNIFICANCE: The presented article described an interesting and innovative technique to optimize implant treatment based on digital technologies and 3D printing. The presented technique will help to diminish treatment costs and times especially for immediate loading procedures in fully edentulous patients because it allows to fabricate a prosthetic structure prior implant placement based on a 3D printing process.

Healing differences in narrow diameter implants submitted to immediate and conventional loading in mandibular overdentures: A randomized clinical trial.

BACKGROUND: Biological responses to different loading protocols during the bone healing phase in subjects with long time since edentulism, rehabilitated with narrow diameter implants (NDIs) to retain mandibular overdentures (MOs), are still unavailable. OBJECTIVE: This randomized clinical trial compared the peri-implant health, implant stability, and concentrations of pro- and anti-inflammatory cytokines in the peri-implant crevicular fluid (PICF) in mandibular edentulous patients under conventional (CL) and immediate loading (IML) during healing. METHODOLOGY: Twenty totally edentulous patients received two NDIs (2.9 × 10 mm, Facility NeoPoros) placed in mandible anterior region and were randomly assigned to two loading protocols: CL (n = 10) and IML (n = 10). The following clinical outcomes were evaluated 1, 2, 4, 8, and 12 weeks after surgery: (a) peri-implant tissue health (gingival index-GI, plaque index-PI, calculus-presence CP, probing depth-PD, and bleeding on probing-BOP); (b) implant stability quotient (ISQ); and (c) IL-1ß, IL-6, IL-10, and TNF-α levels in the PICF analyzed by ELISA. RESULTS: The CL group showed significantly higher CP scores at weeks 8 and 12. The IML group showed significantly higher GI from the first week onwards. The IML group presented significantly lower PD at all follow-up times, and higher BOP rates than CL at week 12. The ISQ values of the CL group were higher than those of the IML group, except at week 4. The IML group released significantly more TNF-α between weeks 1 and 4 and more IL-1ß during week 4-12, while releasing less IL-6 until week 8, mainly at week 2 (-47.6%). The release of IL-10 was similar for both groups and increased progressively over time. At week 12, the IML group released 45.74% more IL-10 than the CL group. The survival rates were 95% and 90% for CL and IML, respectively. CONCLUSION: The IML group presented more favorable PD at all evaluation times; the differences between the other clinical parameters were less systematic. The implant stability and the inflammatory marker concentrations were more stable in the CL group.

Reabilitação superior e inferior com implantes submetidos à carga imediata em paciente com doença periodontal / Upper and lower rehabilitation with implants submitted to immediate loading in patients with periodontal disease

A Odontologia multidisciplinar atual exige cada vez mais do cirurgião dentista a necessidade de conhecer e indicar vários tratamentos aos pacientes. Atualmente, os implantes dentais são evidências nos tratamentos reabilitadores de pacientes edêntulos e pacientes com doenças periodontais avançadas. A instalação de implantes em pacientes periodontais não está contraindicada, desde que a doença esteja controlada e um esquema terapêutico corretamente adotado. Esses implantes são instalados imediatamente após as extrações e seguidos de carga imediata, devolvendo de forma rápida a estética e função ao paciente. O artigo a seguir descreve um relato de caso clínico de uma reabilitação total de maxila e mandíbula de um paciente portador de doença periodontal crônica. Foram extraídos 20 elementos dentais, seguidos de instalação de 6 implantes na maxila e 4 implantes na mandíbula, os mesmos foram carregados imediatamente com duas próteses fixas provisórias em resinas e, após o período de osseointegração de 4 meses, confecção de um protocolo superior em zircônia e protocolo inferior em resina de forma definitiva. O tratamento com implantes com carga imediata, além de devolver a estética e a segurança ao paciente, ainda melhora consideravelmente o pós-operatório, visto que o mesmo não necessita da utilização de uma prótese removível e, consequentemente, a redução de um passo cirúrgico, pois não exige nova cirurgia para a instalação de intermediários protéticos. Isso torna a cirurgia com carga imediata em pacientes periodontais totalmente viável, desde que um protocolo cirúrgico e terapêutico seja seguido (AU).

Currently, multidisciplinary Dentistry increasingly demands from the dental surgeon the need to know and indicate different treatments to patients. Dental implants are in evidence in the rehabilitation treatments of edentulous patients and patients with advanced periodontal diseases. The installation of implants in periodontal patients is not contraindicated, as long as the disease is controlled and a therapeutic regimen correctly adopted. These implants are installed immediately after extractions and followed by immediate loading, returning quickly aesthetics and function to the patient. The following paper describes a clinical case report of a total maxilla and mandible rehabilitation of patient with chronic periodontal disease. Twenty dental elements were extracted, followed by the installation of 6 implants in the maxilla and 4 implants in the mandible, they were immediately loaded with 2 temporary fixed resin prostheses and after the period of osseointegration of 4 months, and superior protocol in zirconia and inferior protocol in resin were performed definitively. Treatment with implants with immediate loading besides returning the aesthetics and bringing back security to the patient, still considerably improves the postoperative, since it does not need the use of a removable prosthesis and, consequently, there is reduction of a surgical step, because it does not require a new surgery to prosthetic intermediates installation. This makes immediate loading surgery on periodontal patients fully viable, as long as surgical and therapeutic protocol is followed (AU).

Implantes imediatos na área estética em sítios com comprimento mésio-distal restrito ­ relato de caso / Immediate implants in the aesthetic area in sites with restricted mesio-distal length ­ case report

Apesar da vasta literatura científica e das novas tecnologias, substituir elementos na região maxilar anterior continua sendo um grande desafio estético quando utilizamos a terapia com implantes osseointegrados. Este artigo relata um caso clínico em que um paciente do sexo masculino, 27 anos, que apresentava agenesia dos dois incisivos laterais superiores, após tratamento ortodôntico, teve os elementos substituídos por implantes osseointegrados. Regeneração tecidual guiada (RTG) utilizando osso bovino desproteinizado em conjunto com uma membrana de colágéno natural foi necessária para compensar defeitos ósseos vestibulares bilaterais. Imediatamente após o ato cirúrgico, duas coroas definitivas de cerâmica foram cimentadas. A proservação aos 18 meses demonstra boa estabilidade dos tecidos (AU).

Despite the vast scientific literature and new technologies, to replace elements in the anterior maxillary region remains a great aesthetic challenge when using osseointegrated implant therapy. This paper reports a clinical case of a male patient, 27 years old, who presented agenesis of two upper lateral incisors, and that had the elements replaced by osseointegrated implants after orthodontic treatment. Guided tissue regeneration (GTR) using deproteinized bovine bone in conjunction with a natural collagen membrane was required to compensate bilateral vestibular bone defects. Immediately after surgical procedure, two ceramic crowns were cemented. After 18-months follow-up, the case showed good tissue stability (AU).

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.

Aumento ósseo horizontal com biomaterial para colocação de implantes osseointegráveis em mandíbula atrófica ­ três anos de acompanhamento / Horizontal bone augmentation with biomaterial for placement of osseointegrated implants in the atrophic mandible ­ 3 years of follow-up

O objetivo deste relato de caso foi apresentar um tratamento no qual foi realizado aumento ósseo horizontal em uma mandíbula atrófica, com a utilização de biomaterial xenógeno (Bio-Oss Geistlich) e membrana reabsorvível (Bio-Gide Geistlich). Após 12 meses de cicatrização da regeneração óssea, foram realizadas as exodontias dos elementos dentais presentes na mandíbula e a instalação de cinco implantes cone-morse (Implacil De Bortoli), com a confecção de uma prótese do tipo protocolo provisória em resina acrílica. Através da análise histológica de biopsias de fragmento ósseo no sentido horizontal, realizadas com brocas trefinas de 2 mm no momento da colocação dos implantes, observou-se um osso cortical bem estruturado com a presença de pequenas partículas de biomaterial enxertado e de osteócitos na margem do osso em contato com o biomaterial, demonstrando a neoformação óssea habitual de um osso cortical. Concluiu-se que o aumento ósseo horizontal em mandíbula atrófica, através da utilização de biomateriais e a instalação dos implantes osseointegráveis com carga imediata, foi eficaz no tratamento deste caso clínico, realizando a reposição estética e funcional na reabilitação oral. (AU)

The aim of this case report was to present horizontal bone augmentation in the atrophic mandible using xenogeneic material (Bio-Oss, Geistlich) along with a resorbable membrane. After 12 months of bone regenerations, tooth extraction was performed and 5 Morse dental implants (Implacil De Bortoli) were placed and followed by a resin acrylic immediate prosthesis. Also, horizontal biopsies were made with 2 mm trephine bur at the same time of implant placement, revealing a well-structured cortical bone with osteocytes at the native bonebiomaterial interface characteristic of a newly-formed cortical bone. It can be concluded that this treatment proposal by means of horizontal bone augmentation in the atrophic mandible, using biomaterials and implant placement with immediate loading, was effective in terms of esthetic and functional aspects for oral rehabilitation. (AU)

A 2-year prospective study of single-implant mandibular overdentures: Patient-reported outcomes and prosthodontic events.

OBJECTIVE: This prospective clinical trial aimed to assess clinical and patient-reported outcomes of the single-implant mandibular overdenture treatment (SIMO) after a 2-year follow-up period. MATERIALS AND METHODS: An external hexagon implant was inserted in the mandibular midline of 45 complete denture wearers. Participants had a mean age of 63.4 (SD = 8.3), and 75.6% were female. Based on the primary stability of the implant, immediate loading was performed in 38 patients (84.4%). O'ring/ball attachments were used for retention. Outcome assessment included the participants' satisfaction with the dentures and oral health-related quality of life (OHRQoL) impacts at the 3-, 6-, 12-, and 24-month follow-up visits after implant loading. Moreover, all prosthodontic events were recorded during this period. RESULTS: The post-loading implant survival rate was 95.3%. There was a significant increase in satisfaction with the mandibular overdenture (p < .001) and a decrease in the overall OHRQoL impacts (p < .001) in the 3-month follow-up. No significant changes were observed between the 3- and 24-month follow-ups. The incidence of prosthodontic events was relatively high, including the need for matrix replacement and repair of the overdenture fracture. Most prosthodontic complications were minor and properly managed in periodic recall visits. CONCLUSIONS: Single-implant mandibular overdenture is a feasible alternative for subjects poorly adapted to the mandibular denture and resulted in significant improvement in patient satisfaction and quality of life measures. A careful selection of patients based on their demanding needs and expectations is essential to indicate this alternative. The incidence of maintenance events in the long term reinforces the need for periodical clinical monitoring.

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.

Multifunctional Guide for Implant Placement, Impressions, and an Occlusal Index for Fixed Complete Dentures.

This article proposes an approach to simplify the steps and reduce fabrication time for fixed implant-supported complete dentures. A multifunctional guide can function as a surgical template during implant placement and provides a framework for the definitive impression and occlusal registration. It therefore enables immediate or early loading of dental implants in full-arch rehabilitations.