Search Results (42)

Background/Objectives: The maintenance of peri-implant soft tissue health is critical for the long-term success of implant therapy, particularly in edentulous patients rehabilitated with mandibular overdentures. Leukocyte- and platelet-rich fibrin (L-PRF) has been proposed as an autologous biomaterial to enhance peri-implant tissue quality. This randomized controlled clinical trial evaluated the effect of L-PRF on peri-implant mucosal thickness in edentulous patients treated with mandibular implant-retained overdentures. Methods: Edentulous patients received two interforaminal implants to retain a mandibular overdenture and were randomly assigned to a test group (L-PRF applied during surgery) or a control group (standard protocol without L-PRF). Clinical measurements of keratinized mucosal thickness and width were recorded at baseline, 12 weeks, and 24 weeks. Volumetric analyses of soft and hard tissue changes were performed using digital superimposition of STL models. The trial was conducted in accordance with the Declaration of Helsinki and approved by the Scientific Ethics Committee of the Aconcagua Health Service. All participants provided written informed consent. Results: A significant increase in keratinized mucosal thickness was observed in the L-PRF group at 12 and 24 weeks compared with baseline (p < 0.01). No significant differences were detected between the groups in soft tissue volume (p = 0.12) or bone volume (p = 0.45). Mucosal width remained stable in both groups throughout follow-up. Conclusions: The application of L-PRF at implant placement resulted in a significant gain in peri-implant mucosal thickness, suggesting a soft tissue modulating effect. Enhancing keratinized mucosal thickness during implant surgery may improve peri-implant tissue quality and support long-term stability of mandibular overdentures. Full article

Successful health management in older adults requires adequate nutrition, which is often compromised by oral health issues like edentulism. Tooth loss can reduce masticatory function, especially when rehabilitation treatments fail. The present study aims to generate initial information on the potential effects of the placement of mandibular mini-implants in patients with complete maxillary and mandibular dentures on mandibular kinetics, electromyographic activity, and quality of life. Participants with complete dentures, adequate mandibular bone height, and good general health were recruited. All underwent cone beam computed tomography for diagnosis and planning to place two mandibular mini-implants. Mandibular movements were analyzed using electromagnetic articulography and electromyography before treatment and five months after implant placement. Oral health-related quality of life (OHRQoL) was assessed using the OHIP-7sp at baseline and six months post-treatment. Five subjects were included (mean age 69.7 ± 10.8 years). All mini-implants demonstrated a 100% initial success rate. At five months, significant improvements were observed in the vertical range of maximum opening, as well as in the area, trajectory, and range of frontal and sagittal movement envelopes (p < 0.05)—along with increased movement symmetry. OHRQoL also improved, with greater esthetic satisfaction, communication, and social engagement. Mandibular mini-implants improved mandibular movements and prosthetic stability, enhancing patients’ oral health-related quality of life without altering muscle activity. Full article

Background: The long-term success of implant-supported mandibular overdentures depends largely on the type of attachment system used. This review compares the clinical performance, complication rates, maintenance requirements, and patient satisfaction between ball and Locator attachments. Methods: A literature search was conducted across PubMed, Scopus, and Web of Science. Studies evaluating clinical outcomes, prosthetic complications, patient-reported satisfaction, and frequency of maintenance in ball and Locator attachments were included. Results: Locator attachments showed higher patient satisfaction scores (mean VAS 8.1–9.0) compared to ball attachments (VAS 6.7–7.9). Complication rates, including matrix wear and attachment loosening, were lower in Locator systems (14–20%) than in ball systems (24–35%). Maintenance needs were more frequent in ball attachments, particularly for the replacement of retentive components (1.8 interventions/year vs. 0.9 in Locator). Peri-implant bone loss was comparable in both systems (<1.5 mm/year), with no statistically significant difference in survival rates over 3–5 years. Conclusions: Locator attachments demonstrate superior clinical performance in terms of patient satisfaction and lower complication rates, with reduced maintenance interventions compared to ball attachments. However, both systems remain viable options depending on anatomical and financial considerations. Full article

Purpose: The aim of this study was to evaluate the long-term clinical results of two different implant–abutment connection types (screw-retained/Morse locking taper), marginal bone loss, and complications in prosthetic restorations. Materials and Methods: In 2017–2018, 579 implants and 242 implant-supported restorations applied to 137 patients were included in the study. Patients were recalled every six months, clinical evaluations were accomplished, and complications were recorded. When examining the distribution of prosthetic restorations by type, it was determined that 38 (15.70%) were single crowns, 136 (56.19%) were fixed partial cement-retained bridge restorations, 53 (21.90%) were fixed partial screw-retained bridge restorations, and 15 (6.19%) were overdenture prostheses. Findings: Overall, complications included eighteen (21.68%) retention losses, nineteen (22.89%) instances of screw loosening, twenty-one (25.30%) veneer ceramic fractures, three (3.61%) acrylic base fractures, fourteen (16.87%) cases of peri-implantitis, and eight (9.64%) implant losses. Conclusions: Differences in complication rates were observed between implants with different implant–abutment connection designs. While no significant differences were found regarding annual mesial and distal marginal bone loss for implants with conical locking connections, a significant difference was detected in those with screw-retained connections. In both implant groups, mesial and distal marginal bone loss progressed gradually over the follow-up period. Full article

Introduction: Generally, after an oral oncological therapeutic process in which, unfortunately, surgery plays a fundamental role, a reconstructive and rehabilitative procedure should be initiated, seeking as far as possible to recover the patient’s vital functions (mastication, aesthetics, and phonetics). Case report: We present the case of a patient who successfully underwent treatment for mandibular sarcoma. After a disease-free period of one year, following oncological treatment, an intervention was performed for the insertion of dental implants into the fibula to subsequently rehabilitate the patient prosthetically. There were several challenges, including free-end edentulous space in the lower jaw with a depth of 18 mm on peri-implant tissues consisting of osteoseptocutaneous skin graft, hypotonic perioral musculature, and high aesthetic expectations of the patient. An overdenture with a titanium milled bar substructure with retentive prosthetic components was chosen for treatment. This implant-supported removable prosthesis was selected to facilitate cleaning, since the patient did not maintain oral hygiene habits. The patient was educated on using and handling the prosthesis, and the treatment objectives were achieved (to restore aesthetics and masticatory function). Conclusions: Removable prostheses are a valid alternative for oncologic patients and patients with unfavorable conditions for more complex implant-supported rehabilitation. Full article

Background and Objectives: This research describes the management of mandibular fractures in edentulous patients with atrophic mandibles and implant-retained overdentures, exploring etiologies and treatment options. Materials and Methods: A retrospective study (January 2010–December 2023) was conducted on six patients from two hospitals (Hospital Gregorio Marañón y Hospital La Paz, Madrid). The data collected included fracture etiology, treatment type, and complications. Results: All six patients were women, with a mean age of 76.33 years. The most common cause of fracture was peri-implantitis (50%). Surgical treatment (open reduction and internal fixation) was performed in five patients, with different surgical approaches and fixation methods. One patient, due to multiple comorbidities, received conservative treatment. Complications occurred in 50% of cases, including delayed healing and hypoesthesia. The average hospital stay was four days, with a mean follow-up of 34 months. Conclusions: Mandibular fractures in these patients are rare. Surgical treatment using rigid fixation plates is recommended. The rational use of bone grafting should be taken into account. Treatment depends on fracture type, patient condition, and surgeon experience. Full article

This clinical report details the prosthetic rehabilitation of a patient following maxillary ablation to remove a peripheral giant cell granuloma. After a hemimaxillectomy, the defect was reconstructed with a fasciocutaneous radial free flap. Implant placement was digitally planned using the dual scanning technique, and implants were inserted with the aid of an acrylic surgical guide. After implant osseointegration, a removable implant-supported overdenture with an electroplated secondary structure retained on a titanium bar was fabricated. At the 3-year follow-up, peri-implant tissues remained healthy, showing only mild gingival hyperplasia around the bar, while no prosthesis retention loss or significant technical complications were observed. In conclusion, the reconstruction of the moderate maxillary defect using a soft-tissue flap provided satisfactory functional and esthetic outcomes, significantly enhancing patient satisfaction. However, the limited bone availability necessitated precise implant planning to ensure adequate biomechanical support for the overdenture. Full article

Background/Objectives: Implant treatment in patients who require teeth extraction due to periodontitis presents a significant challenge. The consideration of peri-implantitis is crucial when planning the placement of dental implants. The predictability of implant treatment relies on the suitability of both hard and soft tissue quality. The aim of this article is to present a case report demonstrating a secure treatment protocol for implant procedures in patients with periodontitis requiring the extraction of all teeth, soft tissue management targeted at increasing the keratinized mucosa zone, and the provision of a reliable prosthetic solution. The secondary objective is to review the relevant literature regarding the significance of keratinized mucosa surrounding dental implants and its association with the occurrence of peri-implantitis. Case presentation: A 65-year-old female with generalized periodontitis, stage IV grade C and very poor oral hygiene came for treatment and rehabilitation of the lower jaw. CBCT revealed periodontal lesions and labio-lingual ridge dimensions in the region of teeth 34–44 from 8.0 to 10.2 mm. The first surgery included teeth extraction and periodontal lesions enucleation with simultaneous placement of four implants in the positions of teeth 32, 34, 42, 44. The second-stage surgery involved increasing the keratinized mucosa using two free gingival grafts. Conclusions: The present case report described the treatment process of the patient with periodontitis, including immediate implantation in the infected region, soft tissue augmentation using free gingival grafts and the ultimate placement of a bar-retained overdenture for final restoration. After two years of observation, despite questionable hygiene, no symptoms of gingival inflammation were detected. Furthermore, there is limited information in the literature regarding the correlation between inadequate keratinized gingiva and the occurrence of peri-implantitis. Full article

This study presents the first 10-year follow-up investigation of the implant survival and peri-implant outcomes of one-piece mini dental implants (MDIs) retaining mandibular implant overdentures (IODs), including marginal bone level alterations (ΔMBLs), clinical peri-implant parameters, and complications. Twenty participants with horizontally atrophied mandibles received complete dentures and four MDIs (diameter 1.8 mm) at baseline. The dentures were converted into IODs with O-ring attachments. The 10-year follow-up comprised a radiological assessment of ΔMBLs, peri-implant parameters, as well as biological and technical complications. Results from a 10-year follow-up of 14 participants showed a 100% implant survival rate for all 56 implants. The mean ΔMBL after 10 years was −1.12 ± 0.80 mm, with 49 implants classified as successful (ΔMBL < 2 mm) and 7 implants with satisfactory survival (ΔMBL 2–4 mm). Time after implant placement significantly influenced ΔMBL, with stable MBLs after 5 years. The prosthetic survival rate after 10 years was 93%. ΔMBLs were not influenced by implant position or gender but were significantly smaller in subjects older than 65 years. Conclusively, one-piece MDIs with O-ring attachments offer a reliable treatment option for horizontally atrophied mandibles after 10 years, with high implant and prosthetic survival rates, potentially benefiting from advanced age regarding peri-implant bone stability. Full article

Background: Patients with edentulism often have an impaired functional, phonetic, and esthetic status, resulting in poor quality of life; hence, the mandibular overdenture has been considered the standard implant treatment for such patients. Therefore, this study aimed to assess the effectiveness of mandibular overdentures retained using mini-implants on patient-reported satisfaction and their long-term survival. Methods: We searched patients’ medical records for eligible subjects, screening and inviting patients who received a mandibular overdenture anchored on mini-implants over ten years ago. We used a numerical rating scale from 0 (the worst) to 10 (the best) to assess four aspects: comfort, retention, chewing ability, and speaking ability before and after having mini-implants. We carried out Kaplan–Meier analysis to assess their survival. Results: Forty-eight elderly patients who were medically compromised and had a mandibular overdenture anchored on four permucosal mini-implants were included. All patient-reported satisfaction (comfort, retention, chewing ability, and speaking ability) was significantly improved after supporting mandibular overdentures with mini-implants (p-values < 0.05), with retention and chewing ability being the most substantially improved. The 10- and 15-year mini-implant survival rates were both 97.9%. Conclusions: Mandibular overdentures with mini-implants can be considered a valid and practical alternative to conventional implant-supported overdentures in patients with atrophic ridges, medically compromised, and the elderly. Full article

The new Ti–Zr (Roxolid^®) mini-implants have not yet been fully researched. We analyzed peri-implant and posterior edentulous area microstrains during mandibular overdenture (OD) loading at different sites with different extents of forces when one-, two-, three-, or four- mini dental implants (MDIs) as single-units supported the respective ODs. The models were designed from cone beam computed tomography (CBCT) scans of an appropriate patient with narrow ridges. The mucosal thickness was 2 mm. Strain gauges were bonded on the vestibular and oral peri-implant sites, and in the distal edentulous area under the saddles. The loads were applied posteriorly bilaterally and unilaterally with 50, 100 and 150 N forces, and anteriorly with 50 and 100 N forces. Each loading was repeated 15 times. Statistical analysis included descriptive statistics, boxplots and the MANOVA. Higher forces induced higher peri-implant microstrains, as well as unilateral loadings, especially on the loaded side, in all models except the one-MDI model where anterior loads (100 N) elicited the highest peri-implant microstrain (1719.35 ± 76.0). The highest microstrains during unilateral posterior loading (right side) with 150 N force were registered from the right MDI in the two-MDI model (1836.64 ± 63.0). High microstrains were also recorded on the left side (1444.48 ± 54.6). By increasing the number of implants, peri-implant microstrains and those in the edentulous area decreased. In the three- and four-MDI models, higher microstrains were found in the posterior than in the anterior MDIs under posterior loadings. None of the recorded microstrains exceeded bone reparatory mechanisms, although precaution and additional research should be provided when only one or two MDIs support ODs. Full article

Diabetes Mellitus (DM) is identified as an important condition that leads to implant complications, and the apico-coronal position and the prosthetic abutment seem to interfere with peri-implant tissue behavior This study aimed at assessing the effect on peri-implant parameters after implant loading of two different methodologies in type two diabetics patients (T2DM) who received implant muco-retained overdentures. Twenty-two mandibular edentulous T2DM received two implants: Test group: prosthetic abutment of a diameter smaller than the platform of the implant and a morse taper subcrestal implant level; Control group: prosthetic abutment of diameter identical to the platform and hexagonal external implant placed at crestal bone level. Clinical, inflammatory, and tomographic evaluations were performed at baseline (after prosthesis installation), and twelve and twenty-four months after implant loading. Test implants presented inferior probing depth and clinical attachment level compared to control at baseline and 12 months (p < 0.05). Test implants presented reduced levels of pro-inflammatory cytokines at 24 months compared to the control implants (p < 0.05). The control group had more changes in bone parameters from baseline to the first and second years (p < 0.05). The test group resulted in reduced bone remodeling and better clinical conditions and positively modulated peri-implant immunoinflammatory molecules. Trial identification UTN code: U1111-1239-3638. Full article

Several factors determine the retention force in removable implant-retained overdentures using prefabricated ball- or locator-type attachment systems. In this context, it was the goal of this in vitro study to examine the effect of implant angulation and female part alignment. Two model situations with two parallel or 12° tilted implants were fabricated onto which locator or ball attachments could be mounted. Simulated prostheses (n = 5) were made as antagonist parts and the assemblies were positioned in a universal testing machine for repeatedly (three times per female attachment) quantifying retention force. Statistical analysis was based on Shapiro–Wilk tests, Levene tests, ANOVAs, Tukey’s HSD tests and Welch t-tests, with the level of significance set at p < 0.05. With tilted implants, the retention force of locators was significantly diminished (p < 0.004) by at least 21%, while with ball attachments, a maximum reduction of 8% was noted, with only yellow inserts showing a significant difference (p = 0.040) compared with the parallel situation. Not aligning female retentive components on tilted implants for achieving a common path of insertion in ball anchors had only a minor effect on retentive force (6.5% increase as compared with aligned female parts), which was not statistically significant (p = 0.100). Not being able to establish a common path of insertion in locator attachments affects retention force. Ball anchors allow for aligning female retentive components, but due to the spherical structure of the male component this seems not even to be necessary. Full article

Background and Objectives: Due to a lack of long-term clinical studies that would clarify whether the insertion of three mini-implants (MDIs) can be as successful treatment as the insertion of four MDIs for the retention of mandibular overdentures (ODs), this 5-year prospective cohort study was set up. Materials and Methods: Participants (n = 83) randomly received either four or three MDIs and a mandibular OD. Clinical examinations were performed at the baseline, as well as after one, three, and five years, respectively. A total of 73 participants (38 in the four-MDI and 35 in the three-MDI groups) partook in the study. The marginal bone level change, success and survival rates, and prosthodontic maintenance were assessed. Results: Repeated measures showed that the mean peri-implant bone loss increased progressively at a small amount over five years in both groups (four-MDI group = −0.36 ± 0.74; three-MDI group = −0.33 ± 0.27 mm; p < 0.05). However, an ANCOVA revealed no significant effects of the group (no significant difference between the three- and the four-MDI groups; F = 0.085; p = 0.771), gender (F = 0.023; p = 0.88), or covariate age (F = 1.95; p = 0.167) on the dependent variable: the 5-year MBL change. The success rate (together with successful survival) was 93.8% in the four-MDI group and 91.7% in the three-MDI group. The log-rank (Mantel–Cox) test revealed no significant differences between them (X² = 0.373; p = 0.541). Conclusions: In patients with narrow ridges, the insertion of three MDIs in the mandible for overdenture retention can be equally as successful as the insertion of four MDIs. Full article

This article presents the outcomes of prosthetic oral rehabilitation using CAD/CAM telescopic bar overdentures in patients with oral cancer (n = 3), severe facial trauma (n = 2), or various syndromes (n = 1), all suffering from severe tissue deficits and requiring complex and comprehensive oral rehabilitation. The aim was to assess the durability and functionality of implant-retained prosthetic structures, ensuring easy oral hygiene and minimizing specialized follow-up needs. The data for this study were sourced from a retrospective cohort at Helsinki University Hospital. The prosthetic reconstruction encompassed the Atlantis 2in1 and the Createch removable telescopic systems. Thus, 40 implants were placed (4 to 7 per patient), with prosthetic structures in the maxilla (n = 4 patients), in the mandible (n = 1), and in both jaws (n = 1). Two patients experienced no complications, two patients had part of the acrylic resin break, and one patient experienced loosening of the bar structure. All complications associated with prosthetic structures were successfully managed, and none of the implants were lost. The follow-up time ranged from 7 to 126 months. This rehabilitation is proved to be an effective solution for patients with complex oral conditions, facilitating both functional restoration and ease of maintenance. These findings underscore the importance of individualized treatment approaches in cases of tissue deficits. Full article