Implant-supported single all-ceramic crowns made from prefabricated (stock) or individualized CAD/CAM zirconia abutments: A 5 year randomized clinical trial.

AIM: The aim of this randomized, prospective, and clinical multicenter study was to compare the overall clinical performance of two restorative options over a 5-year period: individualized CAD/CAM abutments veneered with a hand-layered ceramic, and prefabricated zirconium dioxide abutments veneered with press ceramic and inserted into a single edentulous gap in the anterior maxilla. MATERIALS AND METHODS: Forty subjects were recruited from two universities: 20 from the University of XX and 20 from the University of XY. Each subject received an implant to restore a single edentulous gap in the maxillary anterior region (14-24 FDI). 20 patients were randomized into each Group. Group A received a one-piece single crown produced from a prefabricated zirconia abutment with pressed ceramic and Group B received an individualized CAD/CAM zirconia abutment with a hand-layered technique. After 5 years, the aesthetic and radiographic parameters were assessed. RESULTS: Group A had four dropouts and one failure, resulting in a 95% survival rate and 95% success rate. Group B had two dropouts and two failures which resulted in a 90% survival rate and 90% success rate. No crestal bone level changes were observed, with a mean DIB of 0.06 mm in Group A and 0.09 mm in Group B. No statistically significant differences were present at baseline, 6 months, 1 year, 3 years, or 5 years for DIB values between time points and groups. Pink aesthetic score/white aesthetic score, Peri-Implant and Crown Index, and Implant Crown Aesthetic Index values were stable over time at all five points for both groups. CONCLUSION: Both implant-supported restorative options represent a valuable treatment option for the restoration of implant crowns in the anterior maxilla. CLINICAL SIGNIFICANCE: In general, the use of ceramic abutments in the anterior zone represents a valuable treatment procedure with both standardized and CAD/CAM individualized abutments and following the recommendations from the respective manufacturer(s).

Load bearing capacity of 3-unit screw-retained implant-supported fixed dental prostheses with a mesial and distal cantilever on a single implant: A comparative in vitro study.

OBJECTIVES: To assess the mechanical durability of monolithic zirconia implant-supported fixed dental prostheses (iFDP) design on one implant, with a distal and a mesial extension cantilever bonded to a titanium base compared to established designs on two implants. MATERIALS AND METHODS: Roxolid Tissue level (TL), and tissue level x (TLX) implants were used to manufacture screw-retained 3-unit iFDPs (n = 60, n = 10 per group), with following configurations (X: Cantilever; I: Implant, T: Test group, C: Control group): T1: X-I-X (TL); T2: X-I-X (TLX); T3: I-I-X (TL); T4: I-I-X (TLX); C1: I-X-I (TL); C2: I-X-I (TLX). The iFDPs were thermomechanically aged and subsequently loaded until fracture using a universal testing machine. The failure load at first crack (Finitial) and at catastrophic fracture (Fmax) were measured and statistical evaluation was performed using two-way ANOVA and Tukey's post-hoc tests. RESULTS: The mean values ranged between 190 ± 73 and 510 ± 459 N for Finitial groups, and between 468 ± 76 and 1579 ± 249 N for Fmax, respectively. Regarding Finitial, neither the implant type, nor the iFDP configuration significantly influenced measured failure loads (all p > 0.05). The choice of implant type did not show any significant effect (p > 0.05), while reconstruction design significantly affected Fmax data (I-I-Xa < X-I-Xb < I-X-Ic) (p < 0.05). The mesial and distal extension groups (X-I-X) showed fractures only at the cantilever extension site, while the distal extension group (I-I-X) showed one abutment and one connector fracture at the implant/reconstruction interface. CONCLUSION: Results suggest that iFDPs with I-X-I design can be recommended regardless of tested implant type followed by the mesial and distal extension design on one implant abutment (X-I-X).

Effect of Abutment Cooling on Reverse Torque Values of Abutment Screws: An In Vitro Study.

Purpose: To evaluate the effect of cooling on the reverse torque values of different abutments in bone-level and tissue-level implants. The null hypothesis was that there would be no difference in reverse torque values of abutment screws when cooled and uncooled implant abutments were compared. Materials and Methods: Bone-level and tissue-level implants (Straumann, each n = 36) were placed in synthetic bone blocks and subdivided into three groups (each n = 12) based on the abutment type (titanium base, cementable abutment, abutment for screw-retained restorations). All abutment screws were tightened to 35 Ncm torque. In half of the implants, a dry ice rod was applied on the abutments close to the implant-abutment connection for 60 seconds before untightening the abutment screw. The remaining implant-abutment pairs were not cooled. The maximum reverse torque values were recorded using a digital torque meter. The tightening and untightening procedure was repeated three times for each implant including cooling for the test groups, resulting in 18 reverse torque values per group. Two-way analysis of variance (ANOVA) was used to analyze the effect of cooling and abutment type on the measurements. Post hoc t tests were used to make group comparisons (α = .05). The P values of post hoc tests were corrected for multiple testing using the Bonferroni-Holm method. Results: The null hypothesis was rejected. Cooling and abutment type significantly affected the reverse torque values in bone-level implants (P = .004) but not in tissue-level implants (P = .051). The reverse torque values of bone-level implants significantly decreased after cooling (20.31 ± 2.55 Ncm vs 17.61 ± 2.49 Ncm). Overall mean reverse torque values were significantly higher in bone-level implants compared to tissue-level implants (18.96 ± 2.84 Ncm vs 16.13 ± 3.17 Ncm; P < .001). Conclusion: Cooling of the implant abutment led to a significant decrease in reverse torque values in bone-level implants and may therefore be recommended as a pretreatment before the application of procedures to remove a stuck implant part.

Patient-reported outcome measures focusing on the esthetics of implant-compared to tooth-supported single crowns-A systematic review and meta-analysis.

OBJECTIVES: To report a summary of published patient-reported esthetic outcome measures (PROMs) of implant-supported single crowns (SCs) compared with those of tooth-supported SCs. MATERIALS AND METHODS: Cochrane, Medline (PubMed), and EMBASE database search was performed by three reviewers on reports with patient-reported esthetic outcomes of tooth- and implant-supported SCs. Clinical studies with at least 12 months of mean follow-up period and a minimum of 10 patients, and English, French, or German reports were included. To compare the subgroups, for aggregate-level data, random-effects meta-regression was used. RESULTS: Two thousand fifteen titles were identified (initial search) and screened independently concluding 53 full-text articles to include in data extraction. Twenty-two studies with 29 study cohorts were included. Patients were satisfied with the esthetics of implant- and tooth- supported crowns Mean visual analogue scale (VAS) value from the PROMs data of 1270 implant-supported SCs evaluated by 1051 patients was 89.6% (80.0%-94.1%). The mean VAS value of patients (n = 201), who evaluated the esthetic outcome of 486 tooth-supported SCs was 94.4% (92.3%-96.0%). VAS scores of patients regarding their perception of esthetics did not show any difference among different crown materials or type of implant used. The patients' perception of esthetics focusing on SC had a tendency to be higher when the crowns were supported by teeth, however, no statistical difference was found when compared with implant-supported crowns (p = 0.067). CONCLUSIONS: Patient perception of esthetics in SCs was not affected by the type of support, crown material, implant, and presence of provisional crown for both implant- and tooth-supported SCs. CLINICAL SIGNIFICANCE: Despite that patient's expectations are increasing overall Patients are satisfied with with esthetic outcome of implant- and tooth-supported crowns.

Patient-reported outcome measures compared to professional dental assessments of monolithic ZrO2 implant fixed dental prostheses in complete digital workflows: A double-blind crossover randomized controlled trial.

PURPOSE: This double-blind randomized controlled trial analyzed patient-reported outcome measures in terms of subjective patient satisfaction compared to objective dental evaluation of prosthetic treatment with 3-unit monolithic zirconium dioxide implant fixed dental prostheses (iFDPs) in 3 digital workflows. MATERIAL AND METHODS: Twenty patients were restored with 3 iFDPs each on Straumann TL-implants with 2 completely digital workflows using different intraoral optical scanning systems with model-free fabrication of the restoration (Trios 3/3Shape [Test-1]; Virtuo Vivo/Straumann [Test-2]), and mixed analog-digital workflow with conventional impressions and digitized gypsum casts (Impregum/3M Espe [Control]). The order of impression-taking and the prosthetic try-in were randomly allocated. Sixty iFDPs were compared for patient satisfaction and dental evaluation using ANOVA. RESULTS: For iFDP evaluation, patients generally provided more favorable ratings than dental experts, regardless of the workflow. ANOVA revealed no significant difference for overall satisfaction when comparing Test-1, Test-2, or Control, either for patients (f-ratio: 0.13; p = 0.876) or dentist (f-ratio: 1.55: p = 0.221). Secondary, patients clearly favored the digital impression workflows over the conventional approach (f-ratio: 14.57; p < 0.001). Overall, the 3Shape workflow (Test-1) received the highest scores for all analyses. CONCLUSIONS: The different digital workflows demonstrated minor influence on the subjective and objective evaluation of the monolithic zirconium dioxide iFDPs in nonesthetic regions; however, the dentist may significantly increase patient satisfaction by choosing intraoral scanning instead of conventional impressions. The dentist has to consider individual patients' needs to fulfill their expectations for a personalized solution.

Indirect repair of saliva-contaminated materials using veneering ceramics.

PURPOSE: To analyze the in vitro efficacy of a surface conditioning liquid facilitating ceramic repairs of saliva-contaminated metal-ceramic and all-ceramic restorations. MATERIALS AND METHODS: Specimens constructed from nonprecious alloy (NPA), precious alloy (PA), lithium-disilicate (LD), zirconia (ZI), veneering ceramics for zirconia (VZI), veneering ceramics for lithium-disilicate (VLD), and veneering ceramics for metal alloys (VM) were manufactured (total: n = 168; each material n = 24). Veneering ceramic cylinders (thickness: 2 mm) were hand-layered on top of the specimens. Shear bond strength (SBS) tests were performed, measuring the maximum bond strength (MBS) of the cylinders on the specimens. Following this, the specimens were artificially aged and stored in artificial saliva for 30 days at 37°C. After physical cleaning using aluminum oxide air abrasion, a new surface conditioning liquid was applied (test, n = 84) or not (control, n = 84). New ceramic cylinders were hand-layered followed by a second SBS test. Descriptive statistics, linear regression analyses, and a one-sample t-test (α = 0.05) were used to ascertain the differences within (prerepair vs. postrepair) and between the groups. RESULTS: All specimens in the test group could be repaired, whereas 18 repairs in the control group failed. After the repairs, an MBS decrease was observed for the NPA specimens of the control group (-15.5 MPa, p = 0.004) but not among any of the test groups. Comparing the change in MBS between the test and control groups, the reduction was significantly higher in the repaired NPA specimens of the control group (mean difference 11.8 MPa, p = 0.017). CONCLUSIONS: Using the analyzed surface conditioning liquid, metal-ceramic and all-ceramic materials can be repaired, while some repairs failed without the liquid. The initial bond strengths between core and veneering materials could be restored in all specimens when the new surface conditioning liquid was applied.

[Swiss dental studies in comparison. A data collection of the Swiss graduating classes from the years 2015-2018 compared to the EU]. / Schweizer Zahnmedizinstudium im Vergleich. Eine Datenerhebung der Schweizer Abschlussjahrgänge aus den Jahren 2015-2018 im Vergleich zur EU.

The aim of this publication is to draw a comparison between dental studies in the EU and in Switzerland. For this purpose, Swiss students from the graduation years 2015-2018 were surveyed about their practical training. These results could be compared with figures from the EU. Of the 34 treatments compared, 26 were performed more often by Swiss students. In addition to the comparison with the EU area, it was also possible to determine that over two-thirds of the students felt well-prepared for the world of work. However, the students wished for more in-depth training in the areas of fixed prosthetics as well as surgery.

The influence of age and gender on perception of orofacial esthetics among laypersons in Switzerland.

OBJECTIVE: The purpose of this study was to evaluate the perception and role of orofacial esthetics by laypersons, and how attitudes may be correlated with age and gender in Switzerland. MATERIAL AND METHODS: Self-administrated questionnaires (SAQ) were distributed both conventionally and digitally to Swiss residents over 16 years of age (range 16-99 years). The participants were identified in the medical practice, at an open house of the ZMK Bern, in elderly care centers, and via the internet (Facebook and Instagram). To verify that the participants were Swiss residents and laypersons, they were checked by an operator (conventional) or were provided an exact description of eligible participants at the beginning of the SAQ (digital). The SAQ included 30 questions with multiple-choice responses and visual analogue scales (0-100) divided into four sections regarding dental appearance with respect to body esthetics, partner selection, employment and career opportunities, and overall health/quality-of-life. For statistical analysis, respondents were segregated into two age groups (<25 years and ≥25 years) and into two gender groups (male and female). Descriptive analyses, the Fisher exact test, and Welch's t-test were applied (α = 0.05). RESULTS: Five hundred and two laypersons completed the SAQ. The study's hypothesis-that various age groups and genders have different perceptions of dental esthetics-was supported. The willingness to correct one's own dentition was lower among older participants (OR: 0.54; p = 0.001); charisma and dental esthetics were considered equally important with a trend toward charisma in both age groups (p = 0.003). The belief that excellent dentition improves employment chances at a job interview (OR: 0.47; p = 0.0003) was significantly lower among older participants, and the belief that dental correction would improve quality-of-life was significantly higher among older participants (OR: 1.81; p = 0.001). The assumption that individuals with attractive teeth appear happier was significantly lower among older respondents (OR: 0.67; p = 0.03). Women were less satisfied with their dental appearance and, proportionally, their willingness to receive correction was significantly higher (OR: 1.79; p = 0.01 and OR: 1.77; p = 0.002 relative to men, respectively). Moreover, male participants had a lower desire to have brighter teeth and undergo bleaching treatments (OR: 0.54; p = 0.002; OR: 0.53; p = 0.002). The proportion of men believing that having beautiful teeth improves attractiveness and employment chances was significantly lower (OR: 0.33; p = 0.02 and OR: 0.66; p = 0.04; respectively). CONCLUSIONS: Within the limitations of this observational study, it was concluded that age and gender of laypersons in Switzerland have a significant impact on the perception of dental esthetics. CLINICAL SIGNIFICANCE: Evaluating and quantifying perceptions of dental esthetics for daily life across various age groups and genders can improve clinicians' understanding of individual needs in order to offer patient-oriented dental care.

Mechanical stability of dental CAD-CAM restoration materials made of monolithic zirconia, lithium disilicate, and lithium disilicate-strengthened aluminosilicate glass-ceramic with and without fatigue conditions.

STATEMENT OF PROBLEM: Studies investigating the mechanical stability of lithium disilicate-strengthened aluminosilicate glass-ceramic that do not require sintering after milling compared with other computer-aided design and computer-aided manufacturing (CAD-CAM) materials are lacking. PURPOSE: The purpose of this in vitro study was to investigate the flexural strength of CAD-CAM zirconia, lithium disilicate, and lithium disilicate-strengthened aluminosilicate glass-ceramics with and without fatigue conditions. MATERIAL AND METHODS: Specimens (N=90, n=15) (12×4×3 mm) from the following CAD-CAM materials were prepared and polished: lithium disilicate glass-ceramic (IPS e.max CAD); lithium disilicate-strengthened aluminosilicate glass-ceramic (N!ce); and zirconium dioxide ceramic (IPS e.max ZirCAD). All specimens were divided into 2 subgroups: immediate testing without aging and simulation of aging by using a mastication simulator for 1 200 000 cycles (5 °C-55 °C). Thereafter, flexural strength testing was performed by using a universal testing machine (1 mm/min) on nonaged and aged specimens. The data were evaluated by using nonparametric 2-way ANOVA and Wilcoxon rank post hoc tests (α=.05). RESULTS: Both the material type and aging significantly affected the results (P<.001). The interaction was not significant (P>.05). Under nonaged conditions, zirconium dioxide ceramic (1136 ±162 MPa) showed significantly higher mean ±standard deviation flexural strength (P<.001) than lithium disilicate (304 ±34 MPa) and lithium disilicate-strengthened aluminosilicate glass-ceramic (202 ±17 MPa). The glass-ceramic groups were also significantly different from each other (P<.001). After aging, zirconium dioxide (1087.9 ±185.3 MPa) also presented significantly higher mean ±standard deviation flexural strength (P<.001) than lithium disilicate (259 ±62 MPa) and lithium disilicate-strengthened aluminosilicate glass-ceramic (172 ±11 MPa) (P<.001). Aging significantly decreased the flexural strength of lithium disilicate (14.6%) (P=.03) and lithium disilicate-strengthened aluminosilicate glass-ceramic (14.5%) (P=.01) but had minimal effect on the zirconium dioxide ceramic (4.3%) (P=.29). CONCLUSIONS: Among the tested CAD-CAM materials, the mechanical performance of lithium disilicate-strengthened aluminosilicate glass-ceramic was comparable with that of lithium disilicate and considerably lower than that of zirconia. Aging decreased the flexural strength of both lithium disilicate and lithium disilicate-strengthened aluminosilicate glass-ceramic.

Vertical eruption of anterior maxillary teeth adjacent to single-implant-supported crowns: An assessment after a 3-year follow-up period.

STATEMENT OF PROBLEM: Vertical eruption of teeth adjacent to an implant has been reported clinically and might affect the esthetic outcome over time. The prevalence of the problem is unclear. PURPOSE: The purpose of this prospective clinical trial was to evaluate the vertical eruption of anterior maxillary teeth adjacent to single-implant crowns after a 3-year follow-up period. MATERIAL AND METHODS: Thirty single dental implants were inserted in maxillary anterior sites including the first premolar. The mean age of the participants at implant-supported crown insertion was 48.4 years (range 23 to 79 years). Each implant was restored with a 1-piece screw-retained ceramic single crown. The vertical changes of 60 adjacent anterior maxillary teeth were evaluated from periapical radiographs and casts at baseline, 6, 12, and 36 months. RESULTS: A global ANOVA test showed statistically significant differences for the outcomes of the distance-implant platform and cement-enamel junction (DPC) (P<.001), crown length distal (P=.021) and mesial (P=.035), implant crown length (P=.022), and incisal edge to edge (P<.001). CONCLUSIONS: Continuous vertical tooth eruption next to a single dental implant was observed in adult participants.

Relative amount of tooth structure removal in different partial- and full-crown preparation designs.

PURPOSE: To assess the effect of tooth morphology on the amount of tooth structure removal and the effect of different assessment methods on the detected amount of removed tooth structure. MATERIALS AND METHODS: Eight test groups (n = 10) of standardized artificial teeth were prepared for partial and full crowns. All teeth were prepared by the same operator following predefined preparation parameters. Tooth structure removal was measured using three different assessment methods: digital volumetric analysis (DVA), weight analysis (WA), and combined computer-aided manufacture and weight analysis (CAMWA). Nonparametric repeated-measures analysis of variance and post hoc analyses were used to determine the influence of tooth morphology and assessment method on the detected amount of tooth structure removal. RESULTS: For partial crown preparations, only the tooth morphology had a significant impact on the detected amount of tooth structure removal (P < .0001), not the different assessment methods used (P = .08). Tooth structure removal was not significantly different between the canine and incisor groups, but was for the other groupwise comparisons. For full crown preparations, the tooth morphology (P = .047) and different assessment methods (P = .01) had an impact on the detected tooth structure removal. However, only a few groupwise comparisons reached the significance level. CONCLUSION: The amount of tooth structure removal depended on the tooth morphology and the type of assessment method, which should be taken into account when comparing results across studies. The detected amount of tooth structure removal was below the values described in the literature, independent of the assessment method used.

Time-efficiency and cost-analysis comparing three digital workflows for treatment with monolithic zirconia implant fixed dental prostheses: A double-blinded RCT.

OBJECTIVES: This double-blinded randomized controlled trial investigated economic performance indicators (EPI) in terms of time-efficiency and production costs of 3-unit monolithic zirconium-dioxide (ZrO2) implant fixed dental prostheses (iFDP) in three different workflows. METHODS: Twenty patients with two Straumann Tissue-Level-Implants received three iFDPs; two were fabricated in proprietary complete digital workflows with intraoral optical scanning and model-free fabrication with company-related CAD/CAM lab-software while one iFDP was manufactured on digitized casts from conventional impressions. The sequence of impression-taking for the three workflows (TRIOS 3/3Shape [Test-1]; Virtuo Vivo/Dental Wings [Test-2]; Impregum/3M Espe [Control]) was randomly allocated. Sixty iFDPs bonded to ti-base abutments were analyzed. Clinical and technical worksteps for Test-1/Test-2/Control were recorded and evaluated for time-efficiency including cost-analysis (CHF=Swiss Francs) using ANOVA-Tests (significance level α=0.05). RESULTS: Mean total work time, as the sum of clinical plus technical steps, was 97.5 min (SD ± 23.6) for Test-1, 193.1 min (SD ± 25.2) for Test-2, and 172.6 min (SD ± 27.4) for Control. Times were significantly different between Test-1/Test-2 (p < 0.00001), Test-1/Control (p < 0.00001), and Test-2/Control (p < 0.03610). Technical costs were 566 CHF (SD ± 49.3) for Test-1, 711 CHF (SD ± 78.8) for Test-2, 812 CHF (SD ± 89.6) for Control, and were also significantly different for all comparisons (p < 0.00001). CONCLUSIONS: Test-1 demonstrated the best performance for time-efficiency, Test-2 revealed the worst result. This indicates that digital workflows are not the same and not necessarily superior to analog workflows of monolithic ZrO2 iFDPs. Complexity decreases by reducing the number of steps following complete digital workflows, resulting in lower production costs compared to the mixed analog-digital workflow with conventional impressions. CLINICAL SIGNIFICANCE: Complete digital workflows comprising intraoral optical scanning without physical models for treatment with monolithic ZrO2 iFDPs is an efficient alternative to mixed analog-digital workflows with conventional impressions and labside digitization of dental casts.

Trueness and marginal fit of implant-supported complete-arch fixed prosthesis frameworks made of high-performance polymers and titanium: An explorative in-vitro study.

PURPOSE: To investigate the trueness and marginal fit of computer-aided design-computer-aided manufactured (CAD-CAM) complete-arch implant-supported screw-retained fixed prosthesis (CAISFP) made of polyetheretherketone (PEEK), polyetherketoneketone (PEKK) and titanium (Ti) MATERIAL AND METHODS: A typodont model with four implants, their multiunit abutments (MUAs), and MUA scanbodies were digitized by using a laboratory scanner. The generated CAD was used to mill CAISFP frameworks in Ti, PEEK, or PEKK (each n = 10). The frameworks were digitized with an industrial light scanner to superimpose resulting standard tessellation language (STL) file with the CAD file. Deviations at five points at the abutment-framework interface of each of the four abutment sites (1:left first molar, 2:left canine, 3:right canine, 4:right first molar sites) were calculated (trueness). Marginal gaps were measured using the triple scan technique. A nonparametric repeated measures ANOVA by Brunner and Puri with factors being abutment location and material was performed to assess the mean deviations for trueness and mean marginal gaps, followed by Mann-Whitney or exact Wilcoxon Signed-Rank tests (alpha=.05). RESULTS: Material type significantly affected the trueness (p<0.0001). PEEK had the lowest deviations (0.039 +/-0.01mm) followed by PEKK (0,049 +/-0.009mm), and Ti (0.074 +/-0.011mm). For marginal gaps, only abutment location's effect was significant (p = 0.003). Within PEKK, gaps at abutment 4 were significantly larger, compared with abutments 2 (p = 0.04) and 3 (p = 0.02). CONCLUSIONS: The trueness of PEEK, PEKK, and Ti frameworks was different after milled. PEEK had the highest trueness. However, the marginal fit of the frameworks was similar and smaller than 90 µm in average. CLINICAL RELEVANCE: PEEK, PEKK, and Ti complete-arch frameworks had clinically acceptable gaps and may therefore be recommended when their fit is considered. Higher trueness after milling did not result in better marginal fit.

A Double-Blind Crossover RCT Analyzing Technical and Clinical Performance of Monolithic ZrO2 Implant Fixed Dental Prostheses (iFDP) in Three Different Digital Workflows.

This double-blind randomized controlled trial with a crossover design analyzed the technical and clinical performance of three-unit monolithic ZrO2 implant-fixed dental prostheses (iFDPs), prepared using two complete digital workflows (Test-1, Test-2) and one mixed analog-digital workflow (Control). Each of the 20 study patients received three iFDPs, resulting in 60 restorations for analysis. The quality of the restorations was assessed by analyzing laboratory cross-mounting and calculating the chairside adjustment time required during fitting. All iFDPs could be produced successfully with all three workflows. The highest cross-mounting success rate was observed for the original pairing iFDP/model of the Control group. Overall, 60% of iFDPs prepared with Test-1 workflow did not require chairside adjustment compared with 50% for Test-2 and 30% for Controls. The mean total chairside adjustment time, as the sum of interproximal, pontic, and occlusal corrections was 2.59 ± 2.51 min (Control), 2.88 ± 2.86 min (Test-1), and 3.87 ± 3.02 min (Test-2). All tested workflows were feasible for treatment with iFDPs in posterior sites on a soft tissue level type implant system. For clinical routine, it has to be considered that chairside adjustments may be necessary, at least in every second patient, independent on the workflow used.

Clinical performance of implant crowns with customized zirconia abutments: A prospective cohort study with a 4.5- to 8.8-year follow-up.

OBJECTIVE: To assess the clinical and esthetic outcomes and patient satisfaction of screw-retained one-piece implant crowns fabricated with zirconia abutments after a 4.5- to 8.8-year follow-up. MATERIAL AND METHODS: Thirty-two patients (12 women and 20 men), who received 40 implant single crowns in anterior and premolar sites, were included in this prospective study. All restorations were based on ceramic hand-veneered customized CAD/CAM zirconia abutments. The follow-up consisted of clinical and radiological examinations. The pink esthetic score-white esthetic score (PES-WES) was used to evaluate the esthetic outcome. Patients' satisfaction was assessed via visual analog scale (VAS). RESULTS: Implant and prosthetic survival rates were 100% and 97.5%, respectively. Mean marginal bone loss was -0.17 mm (SD 1.16 mm). Probing depth was ≤4 mm in 98.7% and 5 mm in 1.3% of the sites; 8.3% of them were bleeding on probing positive. No technical or biological complications were observed except for one abutment fracture. The mean PES-WES scores were 7.0 and 7.1, respectively. VAS scores (10-point) of 9.41 for function and 9.26 for esthetics showed high patient satisfaction. CONCLUSION: After a mean observation period of 6 years and 7 months, screw-retained implant crowns based on veneered customized CAD/CAM zirconia abutments with conical connection showed very good clinical performance and may be recommended for the replacement of missing anterior and premolar teeth. (ClinicalTrials.gov # NCT04370314).

Digital workflow for implant-supported fixed complete dentures based on backwards planning in an edentulous patient.

AIM: This case report describes a digital workflow for prosthetically driven surgical planning, implant placement, and the fabrication of two screw-retained, complete-arch, implant-supported dentures in an edentulous patient. The purpose of this case report is to present and discuss the digital steps in the workflow, especially the scanning technique to obtain the centric relation, through a clinical case. The limitations of the workflow are also discussed. MATERIALS AND METHODS: Static computer-aided implant surgery (s-CAIS) was planned three-dimensionally, based on cone beam computed tomography, intraoral optical scanning, and digital bite registration. Using s-CAIS, four and six implants were placed in the edentulous mandible and maxilla, respectively. The final screw-retained complete-arch monolithic zirconia restorations were manufactured based on a digital workflow, using the pre-existing modified radiologic guide for the digital maxillomandibular record. CONCLUSIONS: The evolution of digital processing methods allows for design, processing, and fabrication of implant-supported fixed complete dentures using a surgical, prosthetic, and technical workflow based on 3D restorative backward planning. A digital prosthetic setup and CAD/CAM can be used for the fabrication of intraoral try-ins that serve as a model for the final monolithic zirconia superstructure.

Mandibular implant-supported fixed complete dental prostheses on implants with ultrashort and standard length: A pilot treatment.

Edentulous patients may be restored with complete-arch implant-supported fixed complete dental prostheses (IFCDPs) on angled distal implants or on parallel implants distributed equally across the mandible to increase the area of support. A treatment is presented to introduce the clinical concept of providing edentulous patients with an implant-supported fixed complete dental prosthesison parallel tissue-level implants in the mandible with standard length implants interforaminally and ultrashort implants distally. A structured prosthetic approach was used for the tooth arrangement with a modified workflow as per the Biofunctional Prosthetic System adapted for static computer-aided implant surgery (s-CAIS) and computer-aided design and computer-aided manufacturing (CAD-CAM) of the screw-retained implant-supported fixed complete dental prosthesis. The concept offered advantages in challenging anatomic, surgical, and prosthetic conditions; providing distal nonangled abutments and implant platforms, which were straightforward to clean. If necessary, the prosthesis could have been easily converted into a removable overdenture using the existing digital prosthetic arrangement. Should implant removal be required, the extrashort implants can be removed with minimal surgical risk or morbidity.

Early Loading of Titanium Dental Implants with an Intraoperatively Conditioned Hydrophilic Implant Surface: 3-Year Results of a Prospective Case Series Study.

PURPOSE: The hydrophilic implant surface (INICELL) is a chemical alteration of a sandblasted and thermally acid-etched surface that should lead to long-term osseointegration. This study investigated 3-year results after early loading of implants with a hydrophilic, moderately rough surface in occlusal contact. MATERIALS AND METHODS: This prospective case series study was conducted in subjects with partially edentulous mandibles. Implants were placed on day 21 and loaded with a provisional reconstruction after at least 21 days of healing (baseline, day 0) if their implant stability quotient (ISQ) was ≥ 70 (mean of three measurements) and were replaced by definitive porcelain-fused-to-metal prostheses at the 6-month follow-up visit. Follow-up examinations were planned 1, 3, 6, 12, and 36 months after baseline. RESULTS: A total of 20 implants were placed in 15 patients (mean age: 51 years, range: 32 to 67 years). After 36 months, all implants were osseointegrated, and no suppuration was recorded. Small changes of bone level were observed between 3 months and 36 months. At 36 months, the median values of the 20 implants were 0.25 (range: 0 to 0.5, SD: 0.17), 0.25 (range: 0 to 1, SD: 0.27), and 4 (range: 2 to 7.25, SD: 1.17) for the mean modified Plaque Index (mPI), mean modified Sulcus Bleeding Index (mSBI), and mean probing pocket depth, respectively. The pairwise analysis between 3 and 36 months showed an improvement in the mean mPI (P = .0126) and mean mSBI (P = .0059). After 36 months, all patients (n = 15) were fully satisfied with a mean of 9.43 (range: 8 to 10, SD: 0.678) at the visual analog scale. CONCLUSION: Early functional loading of implants with a hydrophilic, moderately rough outer surface in occlusal contact 21 days after healing appears to be a safe and feasible treatment option when placed in the posterior mandible of partially edentulous patients.

Cost-effectiveness of three different concepts for the rehabilitation of edentulous mandibles: Overdentures with 1 or 2 implant attachments and hybrid prosthesis on four implants.

BACKGROUND: There are scarce data regarding the combined assessment of the costs and effects of implant treatments for edentulous patients when multiple options are available. AIM: This randomised clinical trial aimed to assess the cost-effectiveness of three different concepts for treatment: mandibular overdenture retained by a single (Group I; n = 11) or two implants (Group II; n = 13) and fixed hybrid prosthesis on four implants (Group III; n = 13). METHODS: Treatment effectiveness was measured as the 1-year before-after changes in patient satisfaction with the mandibular prosthesis. Costs were prospectively quantified from the perspective of the health provider, including all direct cost items attributed to the delivery of treatments and up to the 1-year follow-up, using a "bottom-up" costing estimation method. RESULTS: Patient satisfaction after treatment improved significantly for the three groups. The overall costs were R$ 2370.66, R$ 3185.21 and R$ 5739.52 for Groups I, II and III, respectively (P < .001). Analysis of incremental cost-effectiveness ratios suggested that the overdentures retained by one or two implants were more cost-effective than the fixed implant treatment, considering the mean cost and effectiveness values and the ±20% one-way sensitivity analysis. CONCLUSION: This study suggests that the incremental costs for the fixed hybrid prosthesis, compared to the overdenture treatments, is not proportional to the respective gain in effectiveness. Therefore, although all treatment options had satisfactory outcomes, the use of implants to retain a mandibular overdenture, irrespective of the use of one or two implants, is more cost-effective than the fixed implant treatment for the edentulous mandible.

A parallel 3-group randomised clinical trial comparing different implant treatment options for the edentulous mandible: 1-year effects on dental patient-reported outcomes and chewing function.

OBJECTIVE: This parallel three-group randomised clinical trial compared the 1-year changes in dental patient-reported outcomes and chewing function associated with three treatment strategies for the edentulous mandible: single-implant (G-I; n = 11) or two-implant overdentures (G-II; n = 13), and fixed 4-implant complete denture (G-III; n = 13). METHODS: Complete denture (CD) treatment was provided to all participants and after an adaptation period, they were randomly assigned to one of the three study groups. Implants (Neodent TI Cortical, Brazil) were inserted using single-stage surgery and conventional loading. The mandibular dentures were incorporated into implants using specific retention systems and procedures according to the treatment group: O'ring/ball attachments for G-I and GII, and mini-conical abutments for G-III. Patients were assessed at baseline (CD stage) and up to 1-year after implant-retained prosthodontic treatment. Treatment outcomes included oral health-related quality of life (OHIP-Edent), satisfaction with the dentures and chewing function using a mixing ability test. Data analyses included pairwise comparison tests, estimates of effect sizes and regression analysis using Generalized Estimating Equations. RESULTS: Results showed improvement in patient-reported outcomes (lower OHIP-Edent scores and higher satisfaction) and chewing function, compared to baseline. No significant between-group differences were found, although effect sizes were lower for G-III. CONCLUSIONS: All treatments improved the assessed outcomes after transition from the baseline condition. Findings suggest that simplified implant treatments for edentulous patients result in favourable outcomes and may be considered as suitable alternatives to more complex interventions.