Interdisciplinary management of Type 3 oligodontia: A retrospective case series.

STATEMENT OF PROBLEM: Type 3 oligodontia is the most dentoalveolar deficient manifestation of congenital tooth absence. There is a need to rehabilitate these children functionally and esthetically to improve quality of life. PURPOSE: The purpose of this retrospective case series was to evaluate the short- and intermediate-term outcomes of the dental treatment provided in a children's hospital and to develop a sequential interdisciplinary treatment planning protocol from infancy to the completion of jaw development. MATERIAL AND METHODS: A total of 10 patients were included in this retrospective longitudinal case series report. Different interventions had been carried out at times related to growth and development of the jaws. Implant-supported fixed dental prostheses were provided after the lateral growth of the anterior mandible had stabilized at around 12 years of age. Definitive mandibular prostheses were provided after the cessation of growth and following maxillary treatment. Treatment for the maxilla was more complex. Bone grafted and graftless implant-supported fixed prostheses were offered as alternatives to a complete denture. Implant stability and soft tissue response were evaluated at prosthesis removal. RESULTS: Seven patients received a 4-implant and 2 a 5-implant-supported immediately loaded fixed mandibular prosthesis. One patient elected to maintain the interim complete denture. Of the 38 implants, 2 failed and were satisfactorily replaced. In the maxilla, 4 patients elected to maintain a complete denture, and 6 received a maxillary implant-supported fixed prosthesis: 1 with bilateral sinus lift bone grafting and 6 regular implants; 1 with 6 regular implants; 1 with 4 regular implants; 2 with bilateral zygoma implants plus 2 regular anterior implants; and 1 with 4 zygoma implants. No implant failures were recorded in the maxilla. Follow-up for mandibular treatment ranged from 1 to 12 years and for maxillary treatment 1 to 9 years. All implants were classified as asymptomatic and surviving. CONCLUSIONS: The use of fixed implant-supported prostheses in selected individuals with Type 3 oligodontia can improve functional and esthetic outcomes as compared with the use of removable prostheses alone. Implant-supported prostheses require an interdisciplinary approach from early childhood until growth cessation.

A Prospective Study of Immediately Loaded Single Implant-Retained Mandibular Overdentures: Long-Term Results, 15 Years Follow-up.

PURPOSE: The purpose of this prospective study was to investigate the long term predictability of simplifying mandibular overdenture treatment using single-stage surgery and immediate prosthetic loading of a single implant to provide a more affordable treatment option. MATERIAL AND METHODS: Twenty-nine patients with a mean age of 68 years with problematic mandibular dentures were treated. A single implant (Brånemark TiUnite Mk lll) was placed into the mandibular midline, achieving primary stability. A ball attachment was placed, and the retentive cap incorporated into the existing denture. The patients were recalled at 3 and 12 months and at 3, 5, 10 and 15 years. Clinical assessments, radiographs and resonance frequency analysis were recorded. All complications, failures, maintenance, and reasons for failure to follow-up were noted. Visual analogue scale questionnaires were used to record patient satisfaction (analysis of variance P<.05). RESULTS: One implant did not achieve sufficient primary stability to be immediately loaded and was, therefore treated with a two-stage delayed loading protocol. Of the 28 patients receiving immediately loaded implants, 14 patients were available for follow-up at 15 years. Implant survival remained at 100% throughout the study. Patient satisfaction was high, with a significant increase in all comfort and functional parameters (P values ranged from <.001 to .07) throughout the 15 year period. CONCLUSIONS: These 15-year results indicate that immediate loading of a single oxidized surface implant used to retain a mucosa-borne overdenture is a safe, reliable, and cost-effective treatment with high levels of patient satisfaction long term.

A Prospective Single-Cohort Multicenter Study of an Innovative Prefabricated Three-Implant-Supported Full-Arch Prosthesis for Treatment of Edentulous Mandible: 1-year Report.

PURPOSE: To clinically evaluate a recently developed, standardized, three-implant-supported full-arch treatment concept for fully edentulous mandibles. MATERIALS AND METHODS: This ongoing multinational prospective cohort study is evaluating the performance of the treatment concept over 5 years in patients who were fully edentulous or had failing dentition of the mandible. The primary outcome was the cumulative survival rate of implants (CSRI). Secondary outcomes included the cumulative survival rate of the prostheses (CSRP), marginal bone level change, soft tissue outcomes, impact on quality of life, and patient and clinician satisfaction. The 1-year report is presented here. RESULTS: In total, 110 patients (330 implants) were included. Prostheses underwent immediate loading in 76.4% of cases and early loading in 23.6% of cases. The mean surgical time was 1.60 ± 0.78 hours, and the mean laboratory time was 3.99 ± 1.74 hours. At 1 year, eight implants and three prostheses failed, yielding an implant-level CSRI of 97.5% and a CSRP of 97.3%. All prosthetic failures were due to loss of two implants in the patient. The mean marginal bone level change at 1 year was -0.62 ± 1.39 mm. Among soft tissue outcomes, the Bleeding Index improved significantly between the 6-month and 1-year follow-up, and 242 implants (75%) were surrounded by keratinized mucosa by the 6-month follow-up. Patients reported a significant improvement in quality of life between prosthesis placement and the 6-month follow-up based on the Oral Health Impact Profile for Edentulous 21 questionnaire. Both patient and clinician satisfaction with function and esthetics were high throughout treatment. CONCLUSION: This novel treatment concept using a passively fitting standardized framework with simplified surgical and prosthetic workflow demonstrated high survival and excellent outcomes at 1 year while reducing chair and fabrication time. This concept may offer patients a safe and efficient option for full-arch mandibular prostheses.

An Innovative Implant-Supported Treatment for the Edentulous Mandible: Case Report.

When surveyed, edentulous patients commonly state that they would prefer an implant-supported restoration to conventional removable dentures. However, acceptance of implant-supported restorations remains low, primarily due to the high cost of available solutions. To reduce cost and treatment time for patients with an edentulous mandible or failing mandibular dentition, an innovative treatment concept consisting of a standardized framework and time-efficient surgical and restorative protocols was developed. The prefabricated titanium framework is supported on three implants using an adaptive fixation mechanism that compensates for surgical misalignment of the implants to achieve passive fit. The definitive fixed, full-arch mandibular prosthesis can be delivered within 24 hours of implant placement. This patient presentation demonstrates the treatment of a man 82 years of age with complete edentulism. The entire treatment time from surgery to definitive placement was 3 hours over a single business day. After 2 years of function with immediate loading, the patient displayed favorable hard and soft tissue outcomes. Initial results indicate that treatment with this premanufactured device could potentially provide patients with a fixed full-arch implant-supported mandibular restoration with reduced clinical treatment time compared with other implant-supported treatments.

Long-term follow-up of implant treatment for oligodontia in an actively growing individual: a clinical report.

An 11-year-old patient with a history of oligodontia and hypohidrotic ectodermal dysplasia had implants placed in the anterior and posterior mandible as part of his prosthetic rehabilitation. The maxilla was restored by using traditional prosthodontic methods. The long-term follow-up of the treatment is presented, and the clinical implications of placing implants in an actively growing child are discussed.

The immediately loaded single implant-retained mandibular overdenture: a 36-month prospective study.

PURPOSE: The aim of this study was to ascertain whether simplifying mandibular overdenture treatment by using single-stage surgery and immediate prosthetic loading of a single implant will achieve acceptable implant success rates, functional improvement, and increased patient satisfaction. As part of this study, the Mk III Branemark implant with an oxidized surface was compared to the classic machined Mk III Branemark implant. MATERIALS AND METHODS: Thirty-five patients (mean age: 68 years) with problematic mandibular dentures were treated. The primary complaints among the patients referred to the clinic for treatment were poor retention of the mandibular denture, instability, denture sores, and phonetic problems. Initially, patients were placed randomly into the "machined surface" or "oxidized surface" groups. A single implant was placed in the mandibular midline with high initial stability. A ball attachment was placed and the retentive cap incorporated into the existing denture. Reviews took place at 3, 12, and 36 months posttreatment. Clinical assessments, radiographs made with custom film holders, and stability measurements by both manual and resonance frequency analysis methods were recorded. All complications, failures, maintenance, and reasons for dropout were noted. Visual analog scale questionnaires were used to record patient satisfaction (analysis of variance: P < .05). RESULTS: Three of eight machined-surface implants failed, representing an unacceptably high failure rate (37.5%). The machined surface was therefore discontinued for this study. One machined and two oxidized-surface implants did not achieve sufficient primary stability to be immediately loaded, so they were treated with a two-stage delayed loading protocol. The 25 immediately loaded oxidized-surface implants were all classified as surviving at the 36-month recall. Patient satisfaction was very high with a significant increase in all comfort and functional parameters. CONCLUSIONS: Within the limitations of this study and research design, it appears that over a 3-year observation period, the immediately loaded single implant-retained mandibular overdenture, using an oxidized-surface implant and the existing prosthesis in a small group of prosthetically maladaptive patients, can provide a beneficial treatment outcome with a minimal financial outlay. Int J Prosthodont 2010;23:13-21.

Periimplant tissue response following immediate provisional restoration of scalloped implants in the esthetic zone: a one-year pilot prospective multicenter study.

STATEMENT OF PROBLEM: Flat platform implants may present a limitation when irregular or scalloped bone topography is encountered, resulting in compromised periimplant bone and soft tissue contours. PURPOSE: This 1-year pilot prospective multicenter study assessed the success rates and periimplant tissue response of scalloped implants undergoing immediate provisional restoration in the maxillary esthetic zone. MATERIAL AND METHODS: Twenty-nine patients, 15 men and 14 women, mean age of 45.1 (range: 18-70) years, were included in this study. Thirty-eight scalloped implants with a 1.5-mm machined surface collar and a titanium oxide surface (TiUnite) were placed both in healed sites (15) and extracted sites (23), and provisional restorations were placed immediately. The definitive restorations were placed an average of 12.6 months later. The patients were evaluated clinically with respect to gingival papilla appearance, presence or absence of plaque and gingivitis, and radiographically for bone level measurements at 0, 3, 6, and 12 months after implant placement. Descriptive statistics were used to analyze the data. RESULTS: At 12 months, all implants remained in function. The mean (SD) marginal bone change from the time of implant placement to 12 months was 0.1 (3.3) mm. For implants placed in extracted sites the mean (SD) marginal bone change was 1.0 (3.6) mm, compared to those in healed sites, which was -1.6 (1.9) mm. The marginal bone level in 9 of the initial 22 sites (41%) was retained in the scalloped area of the implants at 12 months. In the follow-up, after 3 months of function, no significant changes with respect to mean papilla index score were observed. The patients maintained acceptable hygiene throughout the follow-up period. CONCLUSIONS: Although favorable implant success rates and periimplant tissue response can be achieved with immediate provisional restoration of scalloped implants in the esthetic zone, bone was not regularly maintained at the original levels around the scalloped area of the implants.

A prospective study of immediately loaded single implant-retained mandibular overdentures: preliminary one-year results.

STATEMENT OF PROBLEM: The cost of rehabilitation of the problematic mandibular complete denture with implant-retained overdentures or implant-supported fixed prostheses is beyond the financial scope of many compromised denture patients. Therefore, a more affordable treatment alternative is desirable. PURPOSE: The purpose of this preliminary study was to investigate the predictability of simplifying mandibular overdenture treatment using single-stage surgery and immediate prosthetic loading of a single implant. MATERIAL AND METHODS: Twenty-eight patients with a mean age of 69.8 years and problematic mandibular dentures were treated. The primary complaints among the patients referred to the clinic for treatment related to poor retention of the mandibular denture, instability, denture sores, and phonetic problems. A single implant (Branemark TiUnite Mk III) was placed into the mandibular midline, achieving primary stability. A ball attachment was placed and the retentive cap incorporated into the existing denture. The patients were recalled at 3 and 12 months. Clinical assessments, radiographs made with custom film holders, and stability measurements by both manual and resonance frequency analysis methods were recorded. All complications, failures, maintenance, and reasons for failure to follow-up were noted. Visual analogue scale questionnaires were used to record patient satisfaction. A 1-way repeated-measures ANOVA was used to determine differences between means in the following categories: general satisfaction, social life, mastication of hard food, comfort, and fit (P=.05). RESULTS: Three implants did not achieve sufficient primary stability to be immediately loaded and were, therefore, treated with a 2-stage delayed loading protocol. The 25 immediately loaded implants were all surviving at the 12-month recall. Patient satisfaction was high, with a significant increase in all comfort and functional parameters (P values ranged from <.001 to .07). CONCLUSIONS: These preliminary 1-year results indicate that immediate loading of a single oxidized surface implant used to retain a mucosa-borne overdenture is a safe, reliable, and cost-effective treatment.