Five- and 18-Year Outcome of Two Cases with Full-Arch Rehabilitations Ad modum All-on-4 in the Presence of Challenging Conditions.

Placing implants in fresh postextraction sites is a borderline rehabilitation procedure. The purpose of this report is to describe the pre-, per-, and postoperative procedures for maintaining long-term stability of two full-arch rehabilitations through the All-on-4 protocol, performed in the presence of challenging conditions. Two patients were referred for full-arch rehabilitation with immediate function, with both patients presenting infection in the jaws: patient 1 with an implant (position #45) inserted in a cystic cavity; patient 2 with one implant (position #24) inserted transsinus after the removal of a cyst on the base of the maxillary sinus and another implant (position #15) inserted with a dehiscence. Both patients received a preoperative dental hygiene appointment, a regenerative surgical protocol, and were enrolled in a postoperative maintenance protocol. After surgery a provisional prosthesis was provided ensuring immediate function, and 6 months after surgery, the final prosthesis was delivered. During the follow-up appointments (final follow-up at 5 and 18 years), the implants were stable, and no infection was observed for both patients. The present case report describes two full-arch rehabilitations in immediate function, supported by dental implants inserted in the presence of challenging conditions that do not represent the norm, rather are highly demanding for the clinical team, warranting caution in the interpretation of the results.

Three-Year Outcome of Full-Arch Fixed Prosthetic Rehabilitation through the All-on-4® Concept Using Dynamic 3D Navigated Surgery (X-Guided™): A Retrospective Study.

Background/Objectives: The insertion of dental implants using dynamic 3D navigated surgery while applying immediate function protocols for full-arch rehabilitations warrants further research. This study aimed to evaluate the outcomes of All-on-4® rehabilitations using 3D Dynamic navigated surgery (X-Guide™). Methods: This study included 10 patients (women: 7; men: 3; average age: 59.9 years) rehabilitated with full-arch prostheses through the All-on-4® concept, with 48 dental implants inserted using navigated surgery. The primary outcome evaluation was prosthetic/implant cumulative survival (CS), estimated using life tables. Secondary outcome evaluations were marginal bone resorption (MBR), biological complications, and mechanical complications. The evaluation parameters were measured between 1 and 3 years. Results: No patients were lost to follow-up. Two implants (4.2%) were lost in one patient (10%) with smoking habits, resulting in an implant CS rate of 95.8%. The average MBR was 0.51 mm ± 0.62 mm at the 1-year follow-up. The incidence rate of mechanical complications was 40% (n = 4 patients), all occurring in provisional prosthesis. No biological complications were registered. The patients maintained their prostheses in function throughout the follow-up of the study. Conclusions: Within the limitations of this study and based on the results, it can be concluded that the insertion of dental implants assisted by dynamic navigation for full-arch rehabilitation through the All-on-4® concept may be a valid treatment alternative in the short-term follow-up. However, more studies are necessary to validate this treatment modality.

Partial Implant Rehabilitations in the Posterior Regions of the Jaws Supported by Short Dental Implants (7.0 mm): A 7-Year Clinical and 5-Year Radiographical Prospective Study.

Background: Short implants have been used in the restoration of edentulous jaws in the past several years. However, some studies have suggested that short implants are less successful than standard implants. The aim of this study is to investigate the outcome of short implants placed in the posterior maxilla or mandible following one-stage or immediate-function protocols with a follow-up of 7 years (clinically) and 5 years (radiographically). Methods: This study included 127 patients rehabilitated with 217 implants measuring 7 mm and supporting 157 fixed prostheses in the posterior segments of both jaws. Final abutments were delivered at the surgery stage and were loaded after 4 months in 116 patients (199 implants). The primary outcome measure was implant survival measured through life tables. Secondary outcome measures were marginal bone loss and the incidence of biological and mechanical complications at the patient level and implant level (evaluated through descriptive statistics). Results: Twenty-four patients (18.9%) with 45 implants (20.7%) were lost to the follow-up. In total, 32 implants failed (14.8%) in 22 patients (17.3%), resulting in a cumulative survival rate at 7 years of 81.2% for 7 mm implants in the rehabilitation of the posterior regions of the maxilla and mandible. The average (standard deviation) marginal bone loss was 1.47 mm (0.99 mm) at 5 years. The incidence rate of biological complications was 12.6% and 10.6% at the patient and implant levels, respectively. The incidence rate of mechanical complications was 21.3% for patients and 16.1% for implants. A higher failure rate was registered in smokers and in implant arrangements with a sequence of three fixtures in proximity. Conclusions: Within the limitations of this study, it can be concluded that the placement of 7 mm long implants for the partial implant-supported rehabilitation of atrophic posterior jaws is possible in the long term, judging by the survival rate and stable average marginal bone loss. Nevertheless, strict case selection should be performed, especially in smokers and with implant arrangements that provide a minimum of one unit in inter-implant distance.

The 10 Year Outcomes of Implants Inserted with Dehiscence or Fenestrations in the Rehabilitation of Completely Edentulous Jaws with the All-on-4 Concept.

BACKGROUND: There is a need for a long-term evidence of implants placed in challenging conditions. The aim of this study was to investigate the outcome of full-arch rehabilitations with the All-on-4 concept for implants inserted with dehiscence or fenestrations. METHODS: This retrospective cohort study included 123 patients (dehiscence, n = 87 patients; fenestrations, n = 28 patients; both conditions, n = 8 patients), with a total of 192 implants in immediate function presenting dehiscence (n = 150), fenestrations (n = 40), or both conditions (n = 2). Primary outcome measures were cumulative implant survival (CSurR) and success (CSucR) rates. Secondary outcome measures were prosthetic survival, marginal bone loss, and incidence of biological complications. RESULTS: CSurRs were 94.1% (overall), 95.6% (dehiscence), and 88.1% (fenestrations) at 10 years using the patient as the unit of analysis. Smoking affected implant failure significantly (p = 0.019). Implant-level CSurRs and CSucRs at 10 years were 96.2% and 93.5% (overall), 97.2% and 94.6% (dehiscence), and 90.0% and 87.6% (fenestrations), respectively. Average bone resorption at 5 and 10 years was 1.22 mm and 1.53 mm, respectively. Biological complications occurred in 18 patients (n = 18 implants). CONCLUSIONS: Implants inserted with dehiscence or fenestrations demonstrate good long-term outcomes with overall high success and survival rates and low average marginal bone resorption, despite an inferior outcome in implants with fenestrations and smoking's negative effect.

Zygomatic Implants Placed in Immediate Function through Extra-Maxillary Surgical Technique and 45 to 60 Degrees Angulated Abutments for Full-Arch Rehabilitation of Extremely Atrophic Maxillae: Short-Term Outcome of a Retrospective Cohort.

The use of new devices for the rehabilitation of the severely atrophic maxillae needs validation. We aimed to report the short-term outcome of severely atrophic jaws rehabilitated with zygomatic implants with no implant head angulation placed extramaxillary in conjunction with standard implants. Forty-four patients were consecutively included with 77 zygomatic implants (31 abutments of 45 degrees and 46 abutments of 60 degrees) and 115 standard implants. Outcome measures were prosthetic survival, implant/abutment success, complications, modified plaque index (mPLI), modified bleeding index (mBI), mucosal seal efficacy evaluation (MSEE) >4 mm, and Zygomatic implants classification level (ZICL). Two patients (4.5%) were lost to follow-up. No prosthesis was lost; one patient lost one zygomatic implant; two angulated abutments of 60 degrees needed to be replaced in one patient due to an aesthetic complaint; rendering a cumulative success rate at 2-years of 95.3% and 95.9% using patient and implant/abutment as unit of analysis, respectively. Mechanical and biological complications occurred in 13 and six patients, respectively; all resolved. The median mPLI and mBI was 1; MSEE > 4 mm occurred in 17% and 21% of patients at 1- and 2-years, respectively; ZICL1 was registered in 80% of patients. The current protocol enabled good short-term outcomes.

Imaging Microstructural Damage and Alveolar Bone Loss in Rats Systemically Exposed to Methylmercury: First Experimental Evidence.

The alveolar bone is an important mineralized structure of the periodontal support apparatus, and information about the methylmercury (MeHg) effects on the structural integrity is scarce. Therefore, this study aimed to investigate whether systemic, chronic, and low-dose exposure to MeHg can change the alveolar bone microstructure of rats. Adult Wistar rats (n = 30) were exposed to 0.04 mg/kg/day of MeHg or vehicle through intragastric gavage. The animals were euthanized after 60 days, and blood samples were collected for trolox equivalent antioxidant capacity (TEAC), glutathione (GSH), lipid peroxidation (LPO), and comet assays. The mandible of each animal was collected and separated into hemimandibles that were used to determine the total Hg level in the bone and to analyze microstructural damage and alveolar bone loss in terms of trabecular number (Tb.N), trabecular thickness (Tb.Th), bone volume fraction (BV/TV), and exposed root area of the second molars. MeHg exposure triggered oxidative stress in blood represented by lower levels of GSH and TEAC and the increase in LPO and DNA damage of the blood cells. High total Hg levels were found in the alveolar bone, and the microstructural analyses showed a reduction in Tb.N, Tb.Th, and BV/TV, which resulted in an increase in the exposed root area and a decrease in bone height. Long-term MeHg exposure promotes a systemic redox imbalance associated with microstructural changes and alveolar bone loss and may indicate a potential risk indicator for periodontal diseases.

Management and Outcome of Solitary Spinal Amyloidoma-A Systematic Literature Review.

BACKGROUND: Solitary spinal amyloidoma (SSA) is a rare and poorly characterized disease. There are few cases described, and the knowledge of this neoplasm is limited. A more accurate description of demographics, clinical findings, and outcomes may be useful for a better understanding of this pathology, as well as therapeutic intervention, adding value to the research of localized amyloidosis. METHODS: A systematic search was carried out from when registries began until February 2020. We also include a case diagnosed and treated in our department. Descriptive statistics were used to evaluate data, demographics, clinical findings, diagnostic modalities, therapeutics, and finally neurologic outcomes. The Kaplan-Meier method was used to assess overall survival and progression-free survival. RESULTS: The final cohort comprises 35 patients. The mean age at diagnosis was 61.97 years, and 68.60% of the patients were male. SSA developed more frequently in the thoracic spine (48.60%), followed by the cervical spine (17.10%). Intradural lesions were rare, and the average neoplastic score for spinal instability was 9.5 points. The most common symptoms were impaired motor function (74.29%) and axial back pain (65.70%). After surgery, neurologic recovery was reported in 82.90% of cases. Mean progression-free survival and mean overall survival were 47.26 and 156.66 months. CONCLUSIONS: SSA is a rare subgroup of localized amyloidosis, usually being diagnosed in male patients between the sixth and eighth decades. The gold standard treatment seems to be surgical resection. SSA patients have excellent long-term survival and a low rate of local recurrence.

The Workflow of a New Dynamic Navigation System for the Insertion of Dental Implants in the Rehabilitation of Edentulous Jaws: Report of Two Cases.

BACKGROUND: This case series describes the surgical workflow during maxillary full-arch rehabilitations in two patients through the All-on-4 concept (standard and hybrid) assisted by DTX Studio Implant Software planning and X-Guide Navigation. RESULTS: The X-Guide Navigation enabled the drills and implants to be positioned and oriented precisely, allowing the implants to be positioned favorably under the surgical and prosthetic points of view through the avoidance of damage to the maxillary sinus and nasal cavity. Dynamic navigation-assisted surgery provided advantages, including the possibility to modify the implants' system, length, or location perioperatively. However, it must be underlined that to achieve proficiency with this technology it is necessary to consider a necessary learning curve. CONCLUSION: The insertion of dental implants assisted by dynamic navigation for maxillary full-arch rehabilitations was considered a safe and predictable procedure. Nevertheless, it can be improved (such as with a simpler fiducial markers protocol), aiming to simplify the procedure.

Physiological changes in seeds and seedlings of pumpkins submitted to salt stress / Alterações fisiológicas em sementes e mudas de abóboras submetidas a estresse salino

Salinity is one of the most limiting environmental factors for plant growth in semi-arid regions.Excessofsalts reduces water potential, causes physiological drought and can influence germination and initial growth of plants. The objective of this work was to study physiological and metabolic changes in seeds and seedlings of pumpkin (Cucurbita pepo cultivars Caserta and Redonda and C. maxima cv. Coroa)in a saline condition of salt stress. Thus, we it was quantified germination parameters; seedlings growth; seeds and seedlings respiration; degradation of total soluble sugars, reducing sugars and total proteins in cotyledons and the activity ascorbate peroxidase (APX), glutathione-S-transferase (GST) and catalase (CAT) during germination and initial growth of the pumpkin species studied in saline conditions. The experimental design was totally randomized in a factorial scheme 6x3, with six electrical conductivities (0; 2; 4; 6; 8 e 10 dS.m-1) and three cultivars (Redonda, Caserta and Coroa). Salinity did not influence the rate of seed respiration during the germination, although seedlings respiration decreased, as well as its vigour. Total sugars were degraded, while there was accumulation of reducing sugars and proteins in cotyledons of germinating seeds in salt solutions. Increased electrical conductivity reduced APX activity in the embryo and CAT in cotyledons, but did not influence GST. Pumpkin seedlings showed low tolerance to salt stress.

A salinidade é um dos fatores limitantes para o crescimento das culturas nas regiões áridas e semiáridas. O excesso de sais provoca uma redução no potencial hídrico e causa seca fisiológica e influencia na germinação e crescimento inicial de plântulas Objetivou-se estudar possíveis alterações fisiológicas e metabólicas em sementes e plântulas de abóboras (Cucurbita pepo cultivars Caserta and Redonda and C. maxima cv. Coroa), Sendo assim, avaliou-se em sementes e plântulas os parâmetros da germinação (porcentagem e velocidade); crescimento de plântulas; respiração de sementes e plântulas; degradação de açúcar solúveis totais, açúcar redutores e proteínas totais nos cotilédones e atividade das enzimas ascorbato peroxidase (APX), glutationa-S-transferase (GST) e catalase (CAT) durante a germinação e crescimento inicial das cultivares de abóbora em soluções salinas. O delineamento experimental foi inteiramente casualizado em esquema fatorial 6x3, com seis condutividades elétricas (0; 2; 4; 6; 8 e 10 dS.m-1) e três cultivares (Redonda, Caserta e Coroa). A salinidade não influenciou a taxa de respiração das sementes durante a germinação, no entanto, a respiração das plântulas diminuiu, assim como o vigor das plântulas. Houve degradação dos açúcares totais e acúmulo de açúcares redutores e proteínas em cotilédones de sementes submetidas a soluções salinas. O aumento da condutividade elétrica induziu redução da atividade de APX no embrião e de CAT nos cotilédones, mas não influenciou GST. Cultivares de aboboras apresentaram baixa tolerância ao estresse salino.

The All-on-4 concept for full-arch rehabilitation of the edentulous maxillae: A longitudinal study with 5-13 years of follow-up.

BACKGROUND: Full-arch immediate function protocols such as the All-on-4 concept need long-term validation. PURPOSE: To report the 5-13 year outcomes of the All-on-4 treatment concept for the rehabilitation of the edentulous maxilla. MATERIALS AND METHODS: This retrospective case series study involved 1072 patients (4288 maxillary implants) rehabilitated through the All-on-4 treatment concept. Primary outcome measures were cumulative prosthetic and implant success (life table analysis). Secondary outcome measures consisted in marginal bone loss (MBL) at 5 and 10 years, biological and mechanical complications. The estimation of risk indicators was performed through multivariable analysis for the outcome variables implant failure (Cox regression to estimate hazard ratios and 95% confidence intervals [95% CI]), MBL > 2.8 mm at 5 years, MBL > 3.0 mm at 10 years, biological and mechanical complications (binary logistic regression to estimate odds ratios [OR] with 95% CI). RESULTS: Eighteen patients deceased unrelated to the implant treatment (1.7%) and 219 patients (20.4%) were lost to follow-up. The prosthetic success rate was 99.2%; Implant cumulative survival and success rate was 94.7% and 93.9%, respectively, with up to 13 years of follow-up. Male gender (HR = 1.73), smoking (HR = 1.94), and mechanical complications (HR = 0.59) were significantly associated with implant failure. Average MBL at 5 and 10 years was 1.18 mm (95% CI: 1.16, 1.21) and 1.67 mm (95% CI: 1.58, 1.77) with age (OR = 0.97), male gender (OR = 0.58), smoking (OR = 1.73), and biological complications (OR = 2.1) associated with MBL > 2.8 mm at 5 years. The incidence of biological complications was 7.8% at implant level, with age (OR = 0.98) and smoking (OR = 1.53) significantly associated. The incidence of mechanical complications was 58.8% for the provisional prostheses and 7.3% for the definitive prostheses. CONCLUSIONS: The high success rates registered for both implants and prostheses together with the low MBL confirm the All-on-4 treatment concept is predictable and safe in the long term outcome.

The All-on-4 treatment concept for the rehabilitation of the completely edentulous mandible: A longitudinal study with 10 to 18 years of follow-up.

BACKGROUND: There is a need for studies evaluating the long term outcomes of the All-on-4 treatment concept. PURPOSE: To evaluate the long term clinical and radiographic outcomes of the All-on-4 treatment concept in the mandible. MATERIALS AND METHODS: This retrospective longitudinal case series study included 471 patients (women: 286, men: 185, average age = 57.7 years) rehabilitated with 1884 implants in immediate function supporting 471 fixed full-arch mandibular prostheses and followed for 10 to 18 years. Primary outcome measures were prosthetic survival and implant success and survival (estimated using life tables). Secondary outcome measures were marginal bone loss (MBL) at 10 and 15 years, biological and mechanical complications. Multivariable analysis was used to estimate potential risk indicators for implant failure (Cox regression to estimate hazard ratios and 95% confidence intervals (95%CI)), MBL > 3 mm at 10 and 15 years, biological and mechanical complications (binary logistic regression to estimate odds ratios [ORs] with 95%CI). RESULTS: Twenty-seven patients deceased (5.7%) and 149 patients (31.6%) were lost to follow-up. The cumulative prosthetic survival rate was 98.8%; the implant cumulative survival and success rate was 93% and 91.7%, respectively up to 18 years of follow-up. Previous biological complications (HR = 4.43) were significantly associated with implant failure. Average (95% CI) MBL at 10- and 15-years were 1.72 mm (95%CI: 1.59, 1.85) and 2.32 mm (95% CI: 1.98, 2.66). Smoking (OR = 2.72), previous failure of a contiguous implant (OR = 3.89) and biological complication (OR = 8.11) were associated with MBL > 3 mm. The incidence of biological complications was 11.8% at implant level, with previous failure of a contiguous implant (OR = 5.56), smoking (OR = 1.75), and systemic condition (OR = 1.65) were significantly associated. The incidence of mechanical complications was 36.7% with male gender (OR = 1.67) and type of prosthetic material used in the restoration significantly associated (metal-acrylic OR = 0.30; metal-ceramic OR = 0.22)). CONCLUSIONS: Considering the implant, prosthetic and MBL outcomes it is concluded that the All-on-4 is a viable treatment option validated in the long term. Nevertheless, biological and mechanical complications can occur.

Retrospective cohort clinical investigation of a dental implant with a narrow diameter and short length for the partial rehabilitation of extremely atrophic jaws.

We investigated the short-term clinical outcomes of narrow-diameter short-length implants for the fixed-prosthetic partial rehabilitation of extremely resorbed jaws. Twenty-three patients requiring partial rehabilitations with narrow-platform short-length implants in any jaw were included in this study. In total, 30 implants 3.3 mm in diameter and 7 (n = 15 implants) or 8.5 (n = 15 implants) mm in length were inserted. The primary outcome measure was implant cumulative survival rate (CSR); the secondary outcome measures were marginal bone resorption at 1 and 3 years and the incidence of biologic and mechanical complications. Five patients (21.7%) with six implants (20%) were lost to follow-up. Two implants failed in two patients, yielding a CSR at 3 years of follow-up of 93.4%. The average (standard deviation) marginal bone resorption was 1.34 mm (0.95 mm) after the first year and 1.38 mm (0.78 mm) after the third year. Biologic complications occurred in three patients; mechanical complications occurred in three patients. Despite the limitations of the study, our findings show that the use of new narrow-diameter short-length implants for the rehabilitation of extremely atrophic regions is viable in the short-term, and can be considered a treatment alternative in extremely resorbed jaws.

Seven mm long dental implants in posterior jaws: 3-year report of an ongoing prospective single cohort study.

PURPOSE: To report on the outcome of 7 mm long implants in the rehabilitation of posterior areas of atrophic jaws 3 years after loading. MATERIALS AND METHODS: This prospective study included 127 patients treated with 217 implants supporting 165 fixed prostheses. Final abutments were delivered at surgery stage and in the large majority of patients (n = 116) the implants (n = 199) were loaded after 4 months. Primary outcome measures were implant success and prosthetic success calculated at patient level; secondary outcome measures were complications, and marginal bone level changes calculated at patient level. RESULTS: Thirteen patients with 21 implants dropped out of the study after 3 years. Implant losses occurred in 10 of the 127 patients and 14 of the 217 implants placed failed, giving a cumulative success rate of 93.7% at 3 years, using the patient as unit of analysis. Eight prosthetic failures occurred in six patients, rendering a prosthetic success rate 95.3% at patient level. The average (standard deviation) marginal bone resorption after 3 years of follow-up was 1.46 mm (0.78 mm). Complications occurred in 13 patients (10.2%) and 15 implants (6.9%). CONCLUSIONS: Within the limitations of this study, 7 mm long implants in posterior atrophic jaws can be a viable treatment option given the good prosthetic and implant success rates, low marginal bone loss and low incidence of complications. Nevertheless, longer follow-ups are needed to validate the long-term outcome. Conflict-of-interest statement: This study was funded by grant no. 2015-1378 from Nobel Biocare Services. Paulo Maló is currently a consultant for Nobel Biocare. The remaining authors declare no conflicts of interest.

The NobelGuide® All-on-4® Treatment Concept for Rehabilitation of Edentulous Jaws: A Retrospective Report on the 7-Years Clinical and 5-Years Radiographic Outcomes.

BACKGROUND: There is a necessity of studies documenting the long-term outcome of full-arch flapless rehabilitations. PURPOSE: To evaluate the 7 years implant and prosthesis survival rate and 5-years marginal bone loss of full-arch fixed prosthetic rehabilitations supported by implants in immediate function with the All-on-4® treatment concept using a computer guided surgical protocol (NobelGuide® , Nobel Biocare). MATERIALS AND METHODS: This retrospective clinical study included 111 edentulous patients (n = 53 bruxers; n = 21 smokers; n = 59 systemically compromised), rehabilitated between February 2005 and November 2010 with 532 implants with the All-on-4® treatment concept using NobelGuide® . Outcome measures were implant and prosthesis survival, marginal bone loss at 5-years and the incidence of mechanical and biological complications. Survival was calculated using life-table analysis. Inferential analysis was performed to compare the difference in marginal bone loss between axial and tilted implants. RESULTS: Sixteen patients were lost to follow-up. The implant cumulative survival rate was 94.5% at 7 years. Prosthetic survival was 97.8% (n = 3 prosthetic failures). The average (standard deviation) marginal bone loss at 5 years was 1.3 mm (1.06 mm) overall, 1.27 mm (1.02 mm) for tilted implants and 1.34 mm (1.1 mm) for axial implants (p < .001). Ninety-one patients experienced complications in the provisional prostheses (n = 47 patients who were bruxers; n = 25 patients with implant-supported rehabilitation as opposing dentition) ranging from prosthetic fracture (n = 66 patients) to abutment or prosthetic screw loosening (n = 74 patients). Thirty-three patients experienced complications in the definitive prostheses (all exclusive to patients who were bruxers or had implant-supported rehabilitations as opposing dentition) ranging from acrylic-resin prosthetic/crown fracture (n = 23 patients) to abutment or prosthetic screw loosening (n = 10 patients). Twenty-five patients (22%) registered peri-implant pathology. CONCLUSIONS: Within the limitations of this study, it is possible to conclude that this treatment modality for completely edentulous jaws is possible with high long-term survival outcomes. Bruxing and smoking habits had a negative impact on implant failure, mechanical, and biological complications.

Complete Edentulous Rehabilitation Using an Immediate Function Protocol and an Implant Design Featuring a Straight Body, Anodically Oxidized Surface, and Narrow Tip with Engaging Threads Extending to the Apex of the Implant: A 5-year Retrospective Clinical Study.

PURPOSE: To report the 5-year outcome of NobelSpeedy design implants in immediate function fixed prosthetic rehabilitations. MATERIALS AND METHODS: This retrospective clinical study included 46 consecutive patients (29 women and 17 men) with an average age of 55 years (range, 32 to 78 years) who were rehabilitated between 2003 and 2004 with full-arch restorations supported by dental implants in immediate function. The primary outcome measures were implant survival calculated based on implant function and using life tables. The secondary outcome measures were marginal bone levels measured at 3 and 5 years, and the incidence of mechanical and biologic complications. RESULTS: Five patients with 21 study implants dropped out (11%). One-hundred eighty-nine implants were inserted in the maxilla (n = 166) and mandible (n = 23). Five patients lost five implants, giving a cumulative survival rate of 97.3% at 5 years of follow-up. The average (SD) marginal bone levels were 1.45 mm (0.83 mm) and 1.72 mm (1.04 mm) at 5 years of follow-up. The incidence of mechanical complications in the provisional and definitive prostheses was registered in 14 and 6 patients, respectively: prosthetic screw loosening (n = 4 provisional prostheses, n = 3 definitive prostheses), abutment screw loosening (n = 5 provisional prostheses), fracture of the acrylic resin prostheses (n = 5 provisional prostheses, n = 1 definitive prosthesis), chipping of a ceramic crown (n = 1 definitive prosthesis), and fracture of a ceramic crown (n = 1 definitive prosthesis). The incidence of biologic complications (peri-implant pathology) was registered in 6 patients and 12 implants (7.1%). CONCLUSION: Within the limitations of this study, it is possible to conclude that implants of the NobelSpeedy type used in immediate function for support of fixed prosthetic full-arch rehabilitations are a valid option, with a high survival rate.

Immediate Function of Anodically Oxidized Surface Implants (TiUnite™) for Fixed Prosthetic Rehabilitation: Retrospective Study with 10 Years of Follow-Up.

Purpose. To report the long-term outcome at 10 years of fixed prosthetic rehabilitation supported by dental implants with anodically oxidized surfaces in immediate function. Materials and Methods. This retrospective cohort study included 75 consecutive patients (44 females and 31 males; 14 bruxers; 21 smokers; 14 systemic compromised), with average age of 60 years, rehabilitated with 264 implants. Outcome measures were implant cumulative survival rates (calculated through life tables) and marginal bone level at 10 years. Results. Twenty-one patients with 66 implants (25%) were lost to follow-up. Six patients lost 12 implants (MkIII implants: n = 9; MkIV implants: n = 3). The overall implant cumulative survival rate at 10 years was 95.2% (maxilla: 95.6%; mandible: 94.7%). The average (standard deviation) marginal bone level at 10 years was 1.96 mm (1.50 mm), with 1.92 mm (1.31 mm) for the maxilla and 2.00 mm (1.71 mm) for the mandible, with a significant difference between nonsmokers (average = 1.60 mm) and smokers (average = 2.95 mm). Conclusions. Within the limitations of this study, it can be concluded that fixed prosthetic rehabilitation supported by implants with anodically oxidized surface in immediate function is a viable and safe treatment option for both jaws.

Long-Term Outcome of Implant Rehabilitations in Patients with Systemic Disorders and Smoking Habits: A Retrospective Clinical Study.

BACKGROUND: There is a need for more studies investigating the outcome of implant-supported rehabilitations in patients with systemic disorders. MATERIALS AND METHODS: This retrospective clinical study included 721 patients with systemic disorders or smoking habits (422 females; 299 males), with an average age of 51 years, rehabilitated with 3,998 implants and followed for 3-17 years (average 8 years). Outcome measures were: implant survival rates calculated based on implant function through life tables and using the patient (first implant failure censored) and implant as units of analysis; marginal bone levels measured at 1, 5, and 10 years; and the incidence of biological complications (peri-implant pathology, abscess formation, fistula formation, and suppuration). RESULTS: Eighty-seven patients were lost to follow-up (12%). Forty-five patients experienced prosthetic failure rendering a 94.3% survival rate. One hundred seventy-three implants failed in 98 patients, rendering an 83.5% (patient level) and 94.6% (implant level) cumulative survival rate. The average marginal bone levels were 1.18 mm, 1.56 mm, and 1.47 mm at 1, 5, and 10 years, respectively. Biological complications occurred in 86 patients (11.9%). CONCLUSIONS: Implant rehabilitations in patients presenting systemic disorders or smoking habits are possible with good outcomes. Nevertheless, different impacts on implant rehabilitations were registered according to the type of systemic disorder.

Three-Year Outcome of Fixed Partial Rehabilitations Supported by Implants Inserted with Flap or Flapless Surgical Techniques.

PURPOSE: The aim of this prospective clinical study was to evaluate the 3-year outcome of fixed partial prostheses supported by implants with immediate provisionalization without occlusal contacts inserted in predominantly soft bone with flap and flapless protocols. MATERIALS AND METHODS: Forty-one patients partially rehabilitated with 72 NobelSpeedy implants (51 maxillary; 21 mandibular) were consecutively included and treated with a flapless surgical protocol (n = 20 patients; 32 implants) and flapped surgical protocol (n = 21 patients; 40 implants). Primary outcome measure was implant survival; secondary outcome measures were marginal bone resorption (comparing the bone levels at 1 and 3 years with baseline) and the incidence of biological, mechanical, and esthetic complications. Survival was computed through life tables; descriptive statistics were applied to the remaining variables of interest. RESULTS: Eight patients with eight implants dropped out of the study. One implant failed in one patient (flapless group) giving an overall cumulative survival rate (CSR) of 98.6%. No failures were noted with the flapped protocol (CSR 100%), while for the implants placed with the flapless surgical technique, a 96.9% CSR was registered. The overall average marginal bone resorption at 3 years was 1.37 mm (SD = 0.94 mm), with 1.14 mm (SD = 0.49 mm) and 1.60 mm (SD = 1.22 mm) for the flap and flapless groups, respectively. Mechanical complications occurred in nine patients (n = 5 patients in the flapless group; n = 4 patients in the flap group). Implant infection was registered in three implants and three patients (flapless group), who exhibited inadequate oral hygiene levels. CONCLUSIONS: Partial edentulism rehabilitation through immediate provisionalization fixed prosthesis supported by dental implants inserted through flap or flapless surgical techniques in areas of predominantly soft bone was viable at 3 years of follow-up. The limitations and risks of the "free-hand" method in flapless surgery should be considered when planning implant-supported fixed prosthetic reconstructions.

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.

Double Full-Arch Versus Single Full-Arch, Four Implant-Supported Rehabilitations: A Retrospective, 5-Year Cohort Study.

PURPOSE: To report the 5-year outcome of the All-on-4 treatment concept comparing double full-arch (G1) and single-arch (G2) groups. MATERIALS AND METHODS: This retrospective cohort study included 110 patients (68 women and 42 men, average age of 55.5 years) with 440 NobelSpeedy groovy implants. One hundred sixty-five full-arch, fixed, immediately loaded prostheses in both jaws were followed for 5 years. G1 consisted of 55 patients with double-arch rehabilitations occluded with implant-supported fixed prostheses, and G2 consisted of 55 patients with maxillary single-arch rehabilitations or mandibular single-arch rehabilitations occluded with natural teeth or removable prostheses. The groups were matched for age (±6 years) and gender. Primary outcome measures were cumulative prosthetic (both interim and definitive) and implant survival (Kaplan-Meier product limit estimator). Secondary outcome measures were marginal bone levels at 5 years (through periapical radiographs and using the patient as unit of analysis) and the incidence of mechanical and biological complications. Differences in survival curves (log-rank test), marginal bone level (Mann-Whitney U test), and complications (chi-square test) were compared inferentially between the two groups using the patient as unit of analysis with significance level set at p ≤ 0.05. RESULTS: No dropouts occurred. Prosthetic survival was 100%. Five patients lost 5 implants (G1: n = 3; G2: n = 2) before 1 year, rendering an estimated cumulative survival rate of 95.5% (G1: 94.5%; G2: 96.4%; Kaplan-Meier, p = 0.645, nonsignificant). The average (SD) marginal bone level was 1.56 mm (0.89) at 5 years [G1: 1.45 mm (0.77); G2: 1.67 mm (0.99); p = 0.414]. The incidence rate of mechanical complications (in both interim and definitive prostheses) was 0.16 and 0.13 for G1 and G2, respectively (p = 0.032). The incidence rate of biological complications was 0.06 and 0.05 for G1 and G2, respectively (p = 0.669). CONCLUSIONS: Based on the results, rehabilitating double- or single-arch edentulous patients did not yield significant differences on survival curves. The incidence of mechanical complications was significantly higher for double-arch rehabilitated patients but nevertheless, these mechanical complications did not affect the long-term survival of either the prostheses or the implants.