Search Results (17)

Background/Objectives: The satisfaction of patients following maxillary full-arch rehabilitation is crucial in assessing treatment effectiveness. This one-year study evaluated patients’ satisfaction, quality of life, and aesthetic perception after receiving the Maxilla-for-All^®/All-On-X treatments, which combine standard, pterygoid, trans-sinus, and zygomatic implants to support a fixed prosthesis and offer a graftless solution that reduces morbidity and treatment time. Methods: A prospective cohort study using convenience sampling of subjects treated for severe maxillary atrophies was conducted on patients receiving immediate implant-supported full-arch fixed prostheses. The Oral Health Impact Profile (OHIP-14) and Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ-23) were administered preoperatively and one year post-treatment. Patients were grouped based on the presence or absence of complications (surgical, technical, and mechanical) and Wilcoxon tests were used for comparison (significance level = 0.05). Results: A total of 56 patients (29 female, 27 male) participated, with no implant or prosthesis failures. Eleven patients reported unilateral sinus membrane perforation, and seven had technical or mechanical complications. Preoperatively, 69% of patients rated their oral condition as unfavorable according to the OHIP-14; this dropped significantly to 21.8% post-treatment (p-value < 0.0001). After one year, the average PIDAQ-23 score improved significantly from 44.7 ± 16.6 to 6.8 ± 5.3 (p-value < 0.0001). No significant differences were observed between patients with or without complications (p-values ranging from 0.5270 to 0.8920). Conclusions: Full-arch rehabilitation using Maxilla-for-All^®/All-On-X treatments significantly improved both aesthetic perception and chewing function in patients with severe maxillary atrophies. They reported a substantial reduction in oral health-related discomfort, as shown by a significant decrease in OHIP-14 scores one year post-treatment. Clinical or technical complications did not significantly impact patients’ quality-of-life outcomes or satisfaction, supporting the reliability of this treatment protocol. Full article

The biophysiological differences between teeth and dental implants and the issue of occlusal overload, although controversial, form the basis for the management of occlusion in implant-supported full-arch fixed dental prostheses (ISFAFDPs). Although there is currently a lack of scientific evidence on occlusal management, it is clear that the favorable prognosis of ISFAFDPs is linked to a correct understanding of the biomechanical principles involved. In the design of ISFAFDPs, the lack of proprioceptive feedback requires special attention to biomechanical factors: minimizing overloading complications and providing biomechanical stability are among the main goals of the occlusion. In ISFAFDPs, the occlusion must be decided on the basis of several factors that influence the loads on prosthesis and implants: each case must be evaluated individually and requires a personalized occlusion. The main aim of this narrative review is to provide an overview of the occlusal principles and materials that can be used in ISFAFDPs based on the data currently available in the literature. Practical clinical recommendations for the occlusion management of ISFAFDPs and a biomechanical risk score index to personalize implant-prosthetic treatment are proposed. Full article

The use of zirconia for full-arch Implant-Supported Fixed Complete Dental Prostheses (ISFCDPs) is common and reliable, with different techniques available for their design and fabrication. This retrospective study investigated prosthetic and implant survival/success rates and patients’ satisfaction for ISFCDPs produced with three different techniques: zirconia-on-titanium (milled zirconia arch glued to a titanium bar), progressive monolithic zirconia (entirely made of zirconia and directly screwed to the implants) and zirconia-on-zirconia (milled esthetic zirconia crowns glued to a milled high resistance zirconia frame). Fourteen patients (five males, nine females) aged 52–80 and treated with 14 ISFCDPs (86 implants) were included in this analysis. The mean follow-up at the time of recall was 36 months. Prosthetic and implant-related success rates were, respectively, 92.86% and 95.35%. No failures have been reported. One case of prosthetic chipping was observed; however, it was successfully repaired intraorally. Patients’ satisfaction was high: 78.57% were completely satisfied, 14.53% very satisfied and 7.14% satisfied. In conclusion, all the patients recommend treatment with ISFCDPs as full-arch prosthetic rehabilitation. The present study demonstrates positive clinical outcomes and high patients’ satisfaction. Further long-term, prospective studies with a larger cohort of patients are needed to confirm the advantages of the different prosthetic designs. Full article

Background/Objectives: The technical development of implant-supported fixed dental prostheses (iFDP) initially concentrated on the computer-aided manufacturing of prosthetic restorations (CAM). Advances in information technologies have shifted the focus for optimizing digital workflows to AI-based processes for design (CAD). This pre-clinical pilot trial investigated the feasibility of the automatic design of three-unit iFDPs using CAD software (Dental Manger 2021, 3Shape; DentalCAD 3.1 Rijeka, exocad GmbH). Methods: Two clinical scenarios based on a full dentition were created virtually. Physical models were produced and digitized using two intraoral scanners applying quadrant or full-arch scans (Trios3, 3Shape, Copenhagen, Denmark; and Primescan AC, Dentsply Sirona, Bensheim, Germany). For each scenario, iFDP designs were generated automatically using two laboratory software systems (Dental Manger 2021, 3Shape; DentalCAD 3.1 Rijeka, exocad GmbH), resulting in 80 STL datasets (2 scenarios × 2 scan strategies × 2 IOS systems × 5 scan repetitions × 2 software). The files were analyzed clinically for the contact schemes and pontic area. One of the automated designs for each scenario was manually post-processed and one iFDP design for each scenario was manually created by experienced dental technicians (control). The time required for all the design processes was recorded. Results: The automatic design of iFDPs without manual adjustment did not lead to clinically acceptable restorations. The time required for the automatically generated/manually adjusted iFDPs designs was not significantly different to that for the manually designed restorations. Conclusions: Current laboratory software can not automatically generate three-unit iFDPs with clinically acceptable results in terms of the interproximal and occlusal contacts and the pontic design. The automatic iFDP design process currently requires manual adjustment, which means there is no benefit in terms of the working time compared with manually created restorations. Full article

The geometry of implants plays a crucial role in the success of All-on-Four treatments for the lower jaw. This study builds upon prior research by evaluating the biomechanical performance of implant-supported prostheses in full-arch fixed dental restorations, specifically focusing on different implant lengths and connection types in cases of mild atrophic resorption of the mandible. Four groups were analyzed using finite element analysis (FEA): We utilized 13 or 18 mm posterior 17-degree tilting implants, each paired with two kinds of abutment connections. The external hexagon connection (EHC) group utilized 4 mm diameter implants, while the internal hexagon connection (IHC) group employed 4.3 mm diameter implants. A vertical force was applied to the cantilever region located at the distal side of the posterior implant. The maximum stress regions were observed in prosthetic screws and multi-unit abutments (MUAs) across all groups, with the lowest von Mises stress values noted in the bone. Stress peaks for implant screws and fixtures in the 13 mm group were 19.98% and 11.42% lower, respectively, compared to the IHC group. Similarly, in the 18 mm group, stress peaks were reduced by 33.16% and 39.70% for the EHC group compared to the IHC group. The stress levels on all components remained below the ultimate strength of the titanium alloy. For the same implant lengths, the stress in the prosthetic screw, MUAs, implant screw, and implant fixture positions was lower in the EHC group. When implant length was increased, a decrease in stress levels was observed in the implant screw and fixture of the EHC group and only in the implant screw of the IHC group. However, an increase in stress was noted in the prosthetic screw and MUAs for both groups. Full article

The present short-term retrospective study evaluated the implant survival rate and peri-implant bone loss around additive-manufactured titanium implants placed in sinuses grafted with Plenum Osshp (Plenum Bioengenharia, Jundia, SP, Brazil) (70HA:30β-TCP) material. A total of 39 implants were inserted after 23 sinus floor elevation procedures in 16 consecutive patients. Prosthetic rehabilitation included fixed partial prostheses (three units), single crowns (eleven units), and fixed full arches (three units). Clinical and radiographic parameters of implant-supported restorations were evaluated after at least one year of occlusal loading. The implant–crown success criteria included the absence of pain, suppuration, and clinical mobility, an average distance between the implant shoulder and the first visible bone contact (DIB) < 1.0 mm from the initial surgery, and the absence of prosthetic complications at the implant–abutment interface. The overall cumulative implant survival rate was 97.43%. No prosthetic complications at the implant–abutment interface were reported. After one year, the mean DIB was 0.23 mm ± 0.14. Within the limits of this retrospective study, it can be concluded that 70 HA:30 β-TCP allowed stable and reliable bone support to maintain healthy conditions around titanium dental implants produced by additive manufacturing. Full article

The success of implant-supported fixed complete dental prostheses (ISFCDPs) depends on multiple factors: some are related to the fixtures, such as fixture material, surface characteristics, positioning, and type of connection to prosthetic components; others are related to the prostheses, such as design and materials used. Zirconia is a material widely used in fixed prosthodontics, whether on natural teeth or on implants, with excellent results over time. Regarding the use of zirconia for ISFCDPs, the 2018 ITI Consensus Report stated that “implant-supported monolithic zirconia prostheses may be a future option with more supporting evidence”. Since CAD/CAM technology and zirconia are being continuously innovated to achieve better results and performances over time, a narrative review of the literature seems necessary to focus research efforts towards effective and durable solutions for implant-supported, full-arch rehabilitations. The objective of the present narrative review was to search the literature for studies regarding the clinical performance of zirconia-based ISFCDPs. According to the results of this review, the use of zirconia for ISFCDPs showed good clinical outcomes, with high survival rates ranging from 88% to 100% and prosthetic complications that were restorable by the clinicians in most cases. Full article

This report describes a technique integrating facial and dental scanners for treatment planning and execution of a tooth-borne full-mouth reconstruction (FMR) with zirconia fixed prostheses. A partially edentulous female adult presented generalized worn dentition in the incisal and occlusal surfaces. The patient accepted the option for treatment with a fixed FMR solution using a fully digital workflow. An intraoral scan (IoS) for both arches and facial scans collected the initial clinical situation. A digital diagnostic wax-up was generated as part of the treatment plan, and the models were printed. The intervention included crown lengthening of the maxillary teeth aided by a printed guide, installing milled provisional restorations, and delivering permanent milled zirconia partial restorations, single crowns (SCs), and fixed dental prostheses (FDPs). The functional extraoral scanner permitted designing an FMR that created a harmonious dental, gingival, and facial relationship with the patient’s esthetic consent approval. IoS captured the initial clinical situation to design (CAD) and fabricate (CAM) the PMMA provisional and zirconia final partial restorations, SCs, and FDPs. Facial and intraoral scanners are technologies that can synergistically assist oral health providers in the diagnosis, planning, and execution of fixed FMR using an entirely digital workflow. Full article

Background: The aim of the present study was to investigate the accuracy of a new digital impression system, comparing it to the plaster impression technique in the realization of full-arch implant-supported metal frameworks. Methods: We took 11 scans (8 of the upper maxilla and 3 of the lower jaw) on a sample of nine patients previously rehabilitated with fixed full-arch screw-retained prostheses following the Columbus Bridge Protocol (CBP) with four to six implants (total: 51) since at least 4 months. Two impressions were taken for each dental arch: one analogic plaster impression using pick-up copings and an open tray technique and a second one using an intra-oral scanner. Two milled metal substructures were realised. The precision and passivity of the substructures were clinically analysed through the Sheffield test and endo-oral radiographs. Laboratory scans of the plaster casts obtained from an intra-oral scanner (IOS) and of the plaster casts obtained from traditional impression were compared with the intraoral scans following Hausdorff’s method and an industrial digital method of optical detection to measure discrepancies. A Mann–Whitney test was performed in order to investigate average distances between surfaces after the superposition. Results: The Sheffield test demonstrated an excellent passivity of the frameworks obtained through both the digital and the analogic method. In 81.81% of cases (n = 9) both substructures were found to have a perfect fit with excellent passivity, while in 18.18% (n = 2) of cases the substructures were found to have a very slight discrepancy. From the radiographic examination, no gaps between the frameworks and the implant heads or multiunit abutments were observed, with 100% accuracy. By superimposing digital files of scans according to Hausdorff’s method, a statistically significant discrepancy (p = 0.006) was found between the digital scans and the digital models obtained from plaster impressions. Three-dimensional optical detection found a mean discrepancy of 0.11 mm between the analogic cast and the cast derived from the digital impression. Conclusions: The present study clinically demonstrates that milled implant-supported full-arch frameworks obtained through a digital scan and the herein described technique have an accuracy comparable to those obtained with traditional plaster impression. Full article

Implant dental therapy is a clinical procedure used for treating patients with tooth loss with known clinical success. This clinical study aimed to evaluate the long-term clinical outcomes of dental implants in partially and totally edentulous patients. A total of 544 Microdent (Microdent SU, Implant Microdent System^®, Santa Eulàlia de Ronçana Barcelona, Spain) screw implants were placed in 111 patients using a two-stage surgical technique and a conventional loading protocol (lasting 3 months). Implant and prosthetic clinical findings were evaluated during a 15-year follow-up. A total of 6 implants were lost during the healing period, and 124 prostheses were placed over the 538 implants that remained: 20 single crowns, 52 partially fixed bridges, 45 full-arch fixed restorations, and 7 overdentures. A total of 20 of these were lost during the follow-up period. The cumulative survival rate for all implants was 96.4%. The data underwent statistical analysis (significance level: p < 0.05). The mean marginal bone loss was 1.82 ± 0.54 mm, ranging from 1.2 to 3.1 mm. The most frequent complications were mechanical prosthodontic complications (16.2%). In all, 11.8% of implants showed periimplantitis as the primary biological complication. Dental implants inserted in both the maxillary and mandibular areas produce long-term favorable outcomes and stable tissue conditions when a delayed loading protocol is followed. Full article

Background: Discordant opinions have emerged among clinicians and researchers regarding a digital impression for full-arch implant-supported fixed dental prostheses (FDPs). The purpose of this study was to assess the fit of screw-retained milled frameworks on six implants realized from digital impressions through the Sheffield test. Methods: One patient received a maxillary full-arch implant-supported FDP. Six months after the surgical procedure, ten intraoral full-arch digital impressions were performed to mill ten frameworks. To clinically assess the fit, the Sheffield test was applied for all frameworks. The gaps among the frameworks and the implant analogs were measured using a microscope on the master model realized with a traditional impression. The Wilcoxon sum-rank test was used to compare the misfit value among the different implant positions. Results: The Sheffield test did not show gaps in the framework–implant interfaces when the screw was completely tightened on the more distal implant for all the milled frameworks. The mean misfit value calculated after microscope examination was 38 ± 5 μm. Differences that were statistically significant emerged when the misfit values of central positions were compared with other values. Conclusions: The use of full-arch implant digital impressions represents a viable alternative to traditional impressions for the fabrication of implant-supported FDPs. Full article

This systematic review and meta-analysis set out to assess the clinical behavior of mandibular implant-supported fixed complete dental prostheses (ISFCDP) on three dental implants by analyzing implant and prosthetic survival rates, marginal bone loss, biological/technical complications, and patient-reported outcomes. The review was conducted according to PRISMA guidelines. Electronic searches were conducted in the Medline (PubMed), Web of Science, and Cochrane databases, complimented by a manual search in specialist journals for relevant articles published up to February 2021. The Newcastle-Ottawa Quality Assessment Scale tool was used to assess the quality of evidence in the studies reviewed. The study included 13 articles with 728 patients treated with 2184 implants. A mean implant survival rate of 95.9% (95% CI: 94.6–97.3%) and a prosthetic survival rate of 97.0% (95% CI: 95.7–98.3%) were obtained over 1–6-year follow-up periods. Mandibular implant-supported fixed complete dental prostheses on three dental implants would appear to be a viable option for restoring the edentulous mandible in comparison with mandibular ISFCDP on more than three implants. Further comparative studies are needed, with adequate protocols, as well as sufficient sample sizes and follow-up periods to confirm these findings. Full article

Background: In edentulous patients, bone resorption cannot allow the installation of standard implants and it is demanded to use short implants in the residual alveolar bone or longer implants in grafted bone. Aim: To compare the survival and bone level changes of standard plus short 4-mm implants used as distal support of a maxillary full-arch fixed dental prostheses (FDPs) with standard (10-mm) implants placed in association with a bilateral sinus floor augmentation procedure. Material and Methods: Full-arch FDPs supported by six implants were randomly placed in both groups. In the control group, all implants were 10 mm long and 4.1 mm in diameter. The distal implant in both sides of the maxilla was installed after 4 months from bilaterally sinus floor elevation. In the test group (short group), the distal implant in both sides of the maxilla was 4 mm long and 4.1 mm in diameter. No sinus floor elevations were performed in the test group. Clinical assessments and X-rays were taken at prosthesis delivering and after 6, 12, 18, and 24 months. Patient-reported outcome measures (PROMs) were also evaluated before surgery and after 6, 12, and 24 months. Results: The changes over time of the bone level for the short implants were −0.01 ± 0.11 mm, −0.04 ± 0.13 mm, −0.17 ± 0.29 mm, and −0.28 ± 0.37 mm after 6, 12, 18, and 24 months from prosthesis delivering, respectively. For the standard implants, bone changes were −0.21 ± 0.33 mm (p = 0.103), −0.30 ± 0.32 mm (p = 0.023), −0.40 ± 0.37 mm (p = 0.144), and −0.54 ± 0.49 mm (p = 0.128), respectively. A statistically relevant difference was found only at 12 months after loading between the two groups. Conclusions: Similar results on implant survival rate and marginal bone loss were observed for the short and standard implants, placed in association with a bilateral sinus floor augmentation procedure, used as distal support of a maxillary full-arch FDP. A statistically relevant difference was found only at 12 months after loading between the two groups (p = 0.023). Full article

Previous studies on accuracy of three-dimensional (3D) printed model focused on full arch measurements at few points. The aim of this study was to examine the dimensional accuracy of 3D-printed models which were teeth-prepped for three-unit fixed prostheses, especially at margin and proximal contact areas. The prepped dental model was scanned with a desktop scanner. Using this reference file, test models were fabricated by digital light processing (DLP), Multi-Jet printing (MJP), and stereo-lithography apparatus (SLA) techniques. We calculated the accuracy (trueness and precision) of 3D-printed models on 3D planes, and deviations of each measured points at buccolingual and mesiodistal planes. We also analyzed the surface roughness of resin printed models. For overall 3D analysis, MJP showed significantly higher accuracy (trueness) than DLP and SLA techniques; however, there was not any statistically significant difference on precision. For deviations on margins of molar tooth and distance to proximal contact, MJP showed significantly accurate results; however, for a premolar tooth, there was no significant difference between the groups. 3D color maps of printed models showed contraction buccolingually, and surface roughness of the models fabricated by MJP technique was observed as the lowest. The accuracy of the 3D-printed resin models by DLP, MJP, and SLA techniques showed a clinically acceptable range to use as a working model for manufacturing dental prostheses Full article

We aimed to assess the biological and mechanical-technical complications and survival rate of implants of full-arch metal-ceramic prostheses, during five years of follow-up. 558 implants (of three different brands) retaining 80 full-arch metal-ceramic prostheses were placed in 65 patients, all of whom were examined annually for biological and mechanical-technical complications during the five years of follow-up. Descriptive statistics and univariate logistic regression were calculated. The cumulative survival rate of the implants was 99.8%, and 98.8% prosthesis-based. Mucositis was the most frequent of the biological complications and peri-implantitis was recorded as 13.8% at restoration-level, 16.9% at patient level and 2.0% at implant level. An implant length greater than 10 mm was shown to be a protective factor against biological complications. The mechanical-technical complications were associated with implant diameter, abutment/implant connection and retention system. Loss of screw access filling was the most frequent prosthetic complication, followed by the fracture of the porcelain. Full-arch metal-ceramic prostheses show a high prevalence of implant and prosthesis survival, with few biological and mechanical-technical complications. Full article