Análise da estética peri-implantar na instalação e provisionalização imediata de implantes unitários na região anterior da maxila: dados preliminares / Analysis of peri-implant esthetic of immediate single-tooth implant with immediate provisional restoration in anterior maxilla: preliminary data

Os objetivos desta pesquisa clínica prospectiva foram avaliar a estética peri-implantar de implantes unitários imediatos com provisionalização imediata na região anterior da maxila e a previsibilidade de obtenção de estabilidade primária com o planejamento virtual utilizando o software Dental Slice© (Bioparts Prototipagem Biomédica, Brasília, Distrito Federal, Brasil). Onze pacientes, sete homens e quatro mulheres, com idade média de 50,8 (± 11,8) anos e todos com fenótipo gengival classificado como espesso, receberam 14 implantes, modelo Helix Grand Morse™ (Neodent®, Curitiba, Paraná, Brasil), imediatamente após a exodontia. O espaço existente entre o implante e a tábua óssea vestibular foi preenchido pelo biomaterial Extra-Graft®, (Silvestre Labs®, Rio de Janeiro, Rio de Janeiro, Brasil), e a provisória foi confeccionada sobre munhão universal com diâmetro de 3,3 mm. O posicionamento, comprimento e diâmetro dos implantes foram planejados virtualmente e a sequência de perfuração baseou-se no valor obtido na ferramenta Unidade de Hounsfield do software. O resultado estético dos tecidos moles foi avaliado pelo "Pink Esthetic Score", por dois avaliadores previamente calibrados e especialistas em prótese, no pré-cirúrgico e pós-cirúrgico de 15 dias e 2 meses. O Kappa ponderado intraexaminador foi 0,84 (p<0,000) e o Kappa ponderado entre examinadores foi 0,75 (p<0,001). Os valores de PES não diferiram entre o pré-operatório, 15 dias e 2 meses de pós-operatório, com mediana de 10,5, 11,0 e 12,0 respectivamente. Todos os implantes foram submetidos a provisionalização imediata e o torque médio de instalação foi de 37,86 (±11,9) Ncm. A concordância entre o implante planejado e o implante instalado foi de 85,7%, com p<0,009. A instalação de implantes imediatos com provisionalização em áreas de fenótipo gengival espesso manteve as características originais dos tecidos moles peri-implantares, com previsibilidade do planejamento virtual para obtenção de estabilidade primária com esse modelo de implante(AU)

The objectives of this prospective clinical research was to evaluate the peri-implant esthetics of immediate single-tooth implants with immediate provisional restoration in the anterior maxilla and the predictability of obtaining primary stability with virtual planning using the Dental Slice© (Bioparts Prototipagem Biomédica, Brasília, Distrito Federal, Brazil) software. Eleven patients, seven men and four women, with a mean age of 50.8 (± 11.8) years and all with gingival phenotype classified as thick, received 14 implants, model Helix Grand Morse™ (Neodent®, Curitiba, Paraná, Brazil), immediately after extraction. The gap between the implant and the dental socket was filled with Extra-Graft® (Silvestre Labs®, Rio de Janeiro, Rio de Janeiro, Brasil), and the provisional was made on a universal abutment with a diameter of 3.3 mm. The positioning, length and diameter of the implants were planned virtually, and the drilling sequence was based on the value obtained in the Hounsfield Unit tool of the software. The esthetic result of soft tissue was evaluated by the Pink Esthetic Score, by two previously calibrated evaluators and prosthetic specialists, in the pre-surgical and post-surgical period of 15 days and 2 months. The weighted Kappa intra-examiner was 0.84 (p <0.000) and the weighted Kappa between examiners was 0.75 (p <0.001). The PES values did not differ between the preoperative period, 15 days and 2 months postoperatively, with a median of 10.5, 11.0 and 12.0 respectively. All implants were subjected to immediate provisionalization and the average installation torque was 37.86 (+ 11.9) Ncm. The predictability between the virtual planning of the implant and its installation was 85.7%, with p <0.009. The installation of immediate implants with immediate provisional restoration in areas of thick gingival phenotype maintained the original characteristics of peri-implant soft tissues, with predictability for obtaining primary stability with this implant model

Evaluation of Pink and White Esthetic Scores for Immediately Placed and Provisionally Restored Implants in the Anterior Maxilla.

PURPOSE: To evaluate the esthetic result of immediately placed implants with immediate provisional restorations in the anterior maxilla using the pink esthetic score (PES) and white esthetic score (WES). MATERIALS AND METHODS: The records of patients were evaluated retrospectively. The evaluation was carried out by two examiners using 12 evaluation criteria. RESULTS: The average PES value from the evaluation of 53 images obtained from the 53 selected patients (22 men and 31 women) was 8.63 ± 2.4 (range, 1-14), whereas the average WES value was 6.92 ± 1.67 (range, 2-10). The mesial papilla had the highest average PES (1.39 ± 0.4) and the distal papilla had the lowest PES (0.87 ± 0.54). Texture had the highest average WES (1.54 ± 0.34) and tooth shape had the lowest average WES (1.25 ± 0.43). CONCLUSION: Treatment with immediate implants providing immediate provisional restoration in the anterior maxilla yields good clinical esthetic outcomes, as assessed by PES/WES values. The PES and WES values showed strong intraexaminer agreement, but weak interexaminer agreement.

Sobredentaduras mandibulares sobre dos implantes en pacientes edéntulos totales. Un estudio a tres años / Mandibular overdentures over two implants in totally edentulous patients. A 3-year study

INTRODUCCIÓN: En la actualidad, la implantología oral constituye una modalidad terapéutica en el tratamiento prostodóncico de los pacientes mayores edéntulos totales. El estudio muestra la evaluación del tratamiento con sobredentaduras mandibulares mediante la carga precoz de implantes dentales. MÉTODOS: Treinta pacientes edéntulos totales fueron tratados con 60 implantes con superficie arenada y grabada Galimplant(R) en la mandíbula para su rehabilitación prostodóncica con sobredentaduras. Dos implantes fueron insertados en cada paciente. Los implantes fueron cargados funcionalmente tras un periodo de tiempo de 6 semanas con retenedores de fricción. Los hallazgos clínicos (implantológicos y prostodóncicos) se han seguido durante al menos 24 meses. RESULTADOS: Los resultados indican una supervivencia y éxito de los implantes del 98,3%. Durante el periodo de cicatrización libre de carga funcional, se perdió un implante por movilidad. La pérdida de hueso marginal media fue de 0,4 mm (0-1,1 mm). El 100% de los pacientes fueron tratados mediante una sobredentadura implantorretenida con anclajes de fricción. En cuatro pacientes se realizaron cambios en los componentes plásticos de los ataches. El seguimiento clínico medio fue de 40,8 meses (24-60 meses). CONCLUSIONES: Los resultados del presente estudio indican que la rehabilitación prostodóncica mediante la carga precoz con sobredentaduras con implantes de los pacientes edéntulos mandibulares representa una terapéutica implantológica con éxito

INTRODUCTION: Today, oral implantology constitute a therapeutic modality in the prosthodontic treatment of totally edentulous patients. This study reports the evaluation of treatment with overdentures in the mandible by early loading of dental implants. METHODS: 30 edentulous patients were treated with 60 Galimplant(R) sand-blasted and acid-etched surface implants for prosthodontic rehabilitation with overdentures in the mandible. Two implants were inserted in each patient. Implants were loaded after a healing free-loading period between 6 weeks with locator attaches. Clinical findings (implant and prosthodontics) were followed during at least 24 months. RESULTS: Clinical results indicate a survival and success rate of implants of 98,3%. One implant was lost during the healing period. Media marginal bone loss was 0.4 mm (0-1.1 mm). 100% of patients were treated with overdentures retained with 2 implants with locator attaches. Changes in plastic components of attaches were reported in 4 patients. The media follow-up was of 40.8 months (24-60 months). CONCLUSIONS: Clinical results of this study indicate that prosthodontic rehabilitation in the mandible of edentulous patients with early loading of overdentures supported by implants is a successful implant treatment

Axial Implants in Immediate Function for Partial Rehabilitation in the Maxilla and Mandible: A Retrospective Clinical Study Evaluating the Long-Term Outcome (Up to 10 Years).

BACKGROUND: There is a need of long-term studies evaluating the outcome of fixed partial rehabilitations (FPR) supported by implants in an immediate function protocol. The aim of this retrospective cohort study was to investigate the long-term outcome of FPR supported by implants placed in immediate function. METHODS: One hundred ninety-nine patients were consecutively included, between 1998 and 2010, with 481 implants supporting 213 FPR (maxilla: 87 and mandible: 126). Primary outcome measures were implant and FPR survival rates; secondary outcome measures were marginal bone levels at 5 and 10 years and incidence of mechanical and biological complications. RESULTS: The cumulative implant survival rate was 98.5% and 99.0% after 5 years and 92.7% and 96.7% after 10 years, using the patient and implant as unit of analysis, respectively. No prostheses were lost. Average (SD) marginal bone levels were 1.79 (0.93) and 1.89 mm (0.81 mm) at 5 and 10 years of follow-up. Mechanical complications occurred in 43 patients (21.6%), biological complications occurred in 12 patients (6%), and 16 implants (3.3%) up to the 10 years follow-up. CONCLUSIONS: FPR supported by immediate function implants in both jaws is a viable and safe treatment alternative.

Survival of immediately versus delayed loaded short implants: a prospective case series study

BACKGROUND: To assess and compare survival rates of immediately and delayed loaded short implants (7 mm) in free ends of a partially edentulous jaw with moderate-severe alveolar bone resorption. MATERIAL AND METHODS: 24 patients with atrophic edentulous free-ends were included in this prospective study. Four study groups were monitored monthly and their behavior was evaluated: bridges supported only by short implants and mixed short and long implant bridge groups, both with immediate and delayed loading. Failures, bone loss, probing depth and bleeding on probing were evaluated. RESULTS: 54 Mk III Shorty TiU and 15 Brånemark System(R)MK III TiU implants with a length longer than 7mm were included in the study. Twenty-eight implants were inserted following the immediate loading protocol and 26 according a two-stage procedure, depending on the torque value. The cumulative survival rate of short implants was 87% (n=54) after a mean time of 47.72 months (range 33-62 months), showing statistically significant differences related to loading protocol (p = 0.047). Short implants immediately loaded had a higher long-term survival rate (96.4%) compared to the other study group (76.9%). Besides, short implants splinted to longer immediately loaded implants presented the highest survival rate (100%). Twenty-five (53.19%) short implants showed a bone loss of less than one millimeter after the follow-up period. Statistically significant differences were found between bleeding on probing, presence of plaque or suppuration and a higher bone loss in both loading protocols (p= 0.0 01). CONCLUSIONS: Immediate loading of short implants placed on free ends can be considered an option in the treatment protocol of patients with severe bone resorption especially if implants are splinted to others of greater length

Long-Term Retrospective Clinical and Radiographic Follow-up of 205 Brånemark System Mk III TiUnite Implants Submitted to Either Immediate or Delayed Loading.

BACKGROUND: Studies are needed to evaluate long-term performance of immediately loaded implants with moderately rough surface. This retrospective study evaluated long-term survival and periimplant soft and hard tissue conditions in patients treated with TiUnite implants. MATERIALS AND METHODS: Forty-one consecutive patients (mean age, 52.6 years) received 205 Brånemark System Mk III TiUnite implants (145 maxillary, 60 mandibular). The indication was single tooth (n = 7 implants), partial (n = 94), or full arches (n = 104). One hundred thirteen implants were immediately loaded. Cumulative survival rate (CSR) of implants was assessed. Long-term marginal bone remodeling, probing pocket depth (PPD), and periimplant mucosa conditions were assessed. RESULTS: Follow-up averaged 8.8 years (range, 6.6-10.6 years). Eight implants in 5 patients failed. CSR was 96.1% (implant basis) and 87.8% (patient basis) up to 10 years. At the longest follow-up, bone loss averaged 0.43 ± 1.15 mm (n = 173), PPD averaged 3.64 ± 0.74 mm, and periimplant mucosa was healthy in 74.6% of cases. Furthermore, 50.3% and 35.5% of implants scored negative for plaque and bleeding, respectively. No significant difference in CSR and hard and soft tissue conditions was found in the long term between immediately and delayed loaded implants. CONCLUSION: Implants with TiUnite surface demonstrated excellent long-term survival, marginal bone response, and soft tissue conditions, despite a nonoptimal level of oral hygiene.

Sensitivity and Specificity of Stability Criteria for Immediately Loaded Splinted Maxillary Implants.

BACKGROUND: To assess the suitability of dental implants for immediate loading, primary stability is usually evaluated intraoperatively. PURPOSE: This retrospective study aimed to assess the suitability of three stability parameters - namely, insertion torque (IT), implant stability quotient (ISQ; measured by resonance frequency analysis), and Periotest (PT) values - as potential predictors for the risk of nonosseointegration of immediately loaded splinted implants. The stability parameters were routinely collected under immediate loading. MATERIALS AND METHODS: Nineteen patients with 11 edentulous and 8 partially edentulous maxillae were treated with 105 dental implants, which were immediately loaded using temporary fixed dentures. The IT results, PT values, and ISQ results were recorded. Receiver operating characteristic analysis was performed to assess the quality of each parameter as a diagnostic test. RESULTS: After a 3-month observation period, 11 implants in four patients were not osseointegrated. The IT and ISQ (IT 25.0 ± 12.5 Ncm and 8.4 ± 2.3 Ncm; PT -1.5 ± 3.0 and +2.7 ± 3.0; and ISQ 62.6 ± 6.7 and 54.7 ± 6.2) differed significantly between the osseointegrated and failed implants (p < .005). The IT showed the greatest specificity at a sensitivity of 1 and the greatest area under the curve (AUC; 0.929), followed by the PT value (AUC = 0.836) and ISQ (AUC = 0.811). CONCLUSIONS: Among the intraoperative parameters analyzed, IT showed the highest specificity at a high sensitivity of 1. Therefore, the IT can be considered the most valid prognostic factor for osseointegration of immediately loaded splinted dental implants.

Digital protocol for reference-based guided surgery and immediate loading: a prospective clinical study.

PURPOSE: To evaluate the performance of a computer-aided three-dimensional planning protocol in combination with previously inserted reference mini-implants and CAD/CAM technology to restore completely edentulous patients. The study evaluated implant and superstructure survival in a prospective clinical trial. MATERIALS AND METHODS: The plan protocol called for treatment of 35 patients who were edentulous in either arch. Mini implants were used to establish a platform for computed tomography and fixation of the surgical template. The planning software based on three-dimensional simulation was used to plan ideal implant placement, digitally integrating the future prosthetic and anatomical situations to design the definitive superstructure. RESULTS: A total of 35 patients, 20 with edentulous maxillae, 10 with edentulous mandibles, and 5 patients with edentulism in both arches were treated. All patients received definitive prostheses on the day of surgery. The majority of patients treated in maxilla underwent a sinus graft procedure to achieve sufficient bone to place implants. A total of 40 superstructures were inserted and immediately loaded. Of the 240 inserted implants, 229 (95.4%) survived, with 146 (93.6%) and 83 (98.8%) implants in the maxillary and mandibular arches, respectively. Of the 10 implants that failed in the maxilla, 9 occurred in patients with an augmented sinus. All definitive restorations demonstrated clinically acceptable fit. CONCLUSIONS: When evaluating implant and superstructure survival, reference-based guided surgery seems to be a reliable treatment option for edentulous patients. The CAD/CAM superstructure, inserted and loaded immediately after guided implant insertion, demonstrated acceptable fit to the underlying implants.

A prospective study on the accuracy of mucosally supported stereolithographic surgical guides in fully edentulous maxillae.

BACKGROUND: Flapless implant placement using guided surgery is widespread, although clinical publications on the precision are lacking. PURPOSE: The purpose of this study was to evaluate the accuracy of mucosal-supported stereolithographic guides in the edentulous maxillae. MATERIALS AND METHODS: Seventy-eight OsseoSpeed™ implants (Astra Tech AB, Mölndal, Sweden) of 3.5 to 5 mm width and 8 to 15 mm length were installed consecutively in 13 patients. Implants were functionally loaded on the day of surgery, and implant location was assessed with a computed tomography scan. Mimics 9.0 software (Materialise N.V., Leuven, Belgium) was used to fuse the images of the virtually planned and actually placed implants, and the locations, axes, and interimplant distances were compared. RESULTS: One implant was lost shortly after insertion because of abscess formation caused by remnants of impression material. Seventy-seven implant locations were analyzed. The deviation at the entrance point ranged between 0.29 mm and 2.45 mm (SD: 0.44 mm), with a mean of 0.91 mm. Average angle deviation was 2.60° (range 0.16-8.86°; SD: 1.61°). At the apical point, the deviation ranged between 0.32 mm and 3.01 mm, with a mean of 1.13 mm (SD: 0.52 mm). The mean deviation of the coronal and apical interimplant distance was respectively 0.18 mm (range 0.07-0.32 mm; SD: 0.15) and 0.33 mm (range 0.12-0.69 mm; SD: 0.28). These deviations are lower than the global coronal and apical deviations. CONCLUSION: The present study is the first to investigate the accuracy of stereolithographic, full, mucosally supported surgical guides in the treatment of fully edentulous maxillae. Clinicians should be warned that angular and linear deviations are to be expected. Short implants show significantly lower apical deviations compared with longer ones. Reasons for implant deviations are multifactorial; however, it is unlikely that the production process of the guide has a major impact on the total accuracy of a mucosal-supported stereolithographic guide.