Search Results (93)

Background. Extensive partial edentulism alters the biological and functional balance of the stomatognathic system, requiring targeted pre-prosthetic procedures to optimize treatment outcomes. Objectives. The aim of this study was to assess the extent of improvement in the clinical–biological scores of the prosthetic field in patients with extensive edentulism, following pre-prosthetic interventions. Materials and Method. This prospective, cross-sectional study investigated 194 subjects with extensive partial edentulism. Clinical–biological scores, initially and following the pre-prosthetic phase, were recorded using a scoring system that evaluated dental and periodontal status, bone and mucosal support, occlusion, and mandibulo-cranial relationships. Statistical comparisons of clinical–biological scores were related to the type of prosthetic therapy. Statistical significance was considered at a p-value < 0.05. Results. There was an overall significant improvement in the clinical–biological scores initially (mean value 20.2) and after pre-prosthetic procedures (mean value 23.22) (p < 0.001). When treatment groups were divided, the implant-assisted prosthesis group showed the best improvement in all domains, followed by the conventional fixed-prostheses group (p < 0.01). Dental support improved significantly in those with semi-rigid composite prostheses (p = 0.014), while periodontal support was improved in both fixed- and hybrid-implant groups. Mucosal and bone support improved mostly in the fixed-implant groups (p = 0.014). Conclusions. Pre-prosthetic procedures significantly enhance the biological and functional readiness of the prosthetic field, with the degree of improvement influenced by the complexity and type of planned prosthetic rehabilitation. The findings underscore the value of individualized pre-prosthetic protocols as an essential component of prosthetic treatment planning. Full article

Background. Digital dentistry continues to evolve, offering improved accuracy, efficiency, and patient experience across various prosthodontic procedures. Many previous reviews have focused on digital applications in prosthodontics. But the use of a fully digital workflow for full-arch implant-supported prostheses in edentulous patients remains an emerging and underexplored area in the literature. Objective. This article presents a comprehensive methodological review of the digital workflow in full-arch implant-supported rehabilitation. It follows a structured literature exploration and synthesizes relevant technological processes from patient assessment to prosthetic delivery. Methods. The relevant literature was retrieved from the PubMed database on 20 June 2024, to identify the most recent and relevant studies. A total of 22 articles met the eligibility criteria and were included in the review. The majority included case and technical reports. Results. The review illustrates the integration and application of digital tools in implant dentistry, including cone-beam computed tomography (CBCT) exposure, intraoral scanning, digital smile design, virtual patients, guided surgery, and digital scanning. The key findings demonstrate multiple advantages of a fully digital workflow, such as reduced treatment time and cost, increased patient satisfaction, and improved interdisciplinary communication. Conclusions. Despite these benefits, limitations persist due to the low level of evidence, technological challenges, and the lack of standardized protocols. Further randomized controlled trials and long-term clinical evaluations are essential to validate the effectiveness and feasibility of a fully digital workflow for full-arch implant-supported rehabilitation. Full article

Background/Objectives: the precise application of torque during prosthetic screw tightening is essential to the long-term success and mechanical stability of implant-supported restorations. This study aimed to evaluate the influence of practitioner experience, glove material, screwdriver length, and hand moisture on the maximum torque value (MTV) generated during manual tightening. Methods: thirty participants, comprising 10 experienced professors and 20 senior dental students, performed tightening tasks under six hand conditions (nitrile gloves, latex gloves, and bare hands, each in dry and wet environments) using two screwdriver lengths (21 mm and 27 mm). The torque values were measured using a calibrated digital torque meter, and the results were analyzed using a linear mixed model. Results: professors applied significantly higher torque than students (16.92 Ncm vs. 15.03 Ncm; p = 0.008). Nitrile gloves yielded the highest torque (17.11 Ncm), surpassing bare hands significantly (p = 0.003). No statistically significant differences were found for screwdriver length (p = 0.12) or hand moisture (p = 0.11). Conclusions: these findings underscore the importance of clinical proficiency and glove material in torque delivery, providing evidence-based insights to enhance procedural reliability and training standards in implant prosthodontics. Full article

Background: The potential impact of the number of implants (four vs. six) on the implant survival of implant-supported fixed complete dentures (IFCDs) remains inconclusive and subject to ongoing debate. This study compared the implant survival of immediately loaded four vs. six IFCDs, delivered using a patient-centered systematic treatment plan, in a large patient cohort assessed with consistent diagnostic methodology and comprehensive longitudinal follow-up. Methods: This retrospective study included records of 943 patients receiving 5989 implants with an average follow-up of 5.0 ± 3.2 (range 0–17) years delivered using a systematic clinical decision support system (CDSS) based on a defined alveolar atrophy classification (CC). Implant survival was analyzed considering predictor variables comprising treatment and anatomic and systemic health-related factors at the overall, maxillary, and mandibular levels using Kaplan–Meier analysis, log-rank tests, and single-predictor and multilevel Cox proportional hazard analysis derived from causal direct acyclic graph methodologies. Results: The 2- and 5-year cumulative survival rates (CSRs) of four and six IFCDs were comparable (2-year: 98.6% vs. 98.4%, p = 0.362; 5-year: 98.8%, 98.7% p = 0.346). The differences between four and six IFCDs were more pronounced at the maxillary levels, specifically after 2 years (97.7% vs. 98.6% p = 0.084), and at the mandibular level after 5 years (98.6% vs. 99.4%, p = 0.136.). Multilevel Cox proportional hazard models at overall and jaw levels adjusted for confounding factors indicated that implant loss was correlated to jaw type and age at overall and age alone at the mandibular level. Alveolar atrophy (CC) defined within the adopted CDSS was not robustly associated with implant loss. Conclusions: Under the guidance of a systematically applied patient-centered CDSS, four and six IFCDs demonstrated high and comparable mid-to-long-term implant survival rates irrespective of the level of analysis or statistical model used to adjust for confounding factors. Prosthetic and technical complications were not evaluated and were, therefore, beyond the scope of this study. Full article

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

Background: Modern dentistry strives to achieve increasingly less invasive procedures as the ultimate therapeutic goal. The careful selection of suitable candidates for immediate dental implants can offer an opportunity to reduce treatment time, lower the relative costs and improve overall patient satisfaction. Methods: A systematic search was conducted in March 2025, without any time restrictions, in Medline, Pubmed and Web of Science databases. To identify other related references, further research was performed. Articles related to current knowledge about the immediate loading of dental implants supporting fixed partial prosthesis in the posterior region were included. Articles not available in abstract form and articles not published in the English language were excluded. Results: A total of ten studies were eligible for inclusion in the current study. The search strategy resulted in a survival rate ranging from 86% to 100%, and a failure rate of less than 21.6%, with a mean follow-up of 55.6 months. Statistical analysis revealed no significant differences in survival rates between implants placed in the maxilla and mandible (χ² = 0.42, p = 0.81, df = 2). Follow-up varied from one to ten years, reflecting variability both in study design and duration. Conclusions: The selected studies highlight the heterogeneity in immediate loading protocols for implant-supported fixed partial prosthesis in the posterior regions, emphasizing the variability in prosthetic materials and implant types, suggesting that immediate loading is a reliable, patient-centered therapeutic option with favorable long-term outcomes. Full article

Background: Autogenous bone grafting has long been the standard for augmenting bone prior to implant placement in atrophic ridges. However, innovative techniques are continually sought to enhance outcomes. This study introduces the honeycomb technique for horizontal bone augmentation in edentulous posterior mandibular ridges, presenting the methodology and long-term follow-up results of this novel approach. Methods: This study includes healthy patients with moderate to severe horizontal atrophy in posterior mandibular regions who underwent bone augmentation using the honeycomb technique and were followed up for a period of 10 to 14 years. The patients had orthoradiographs immediately post-surgery and underwent regular clinical and radiographic evaluations. Computed tomography at four months assessed the bone gain, followed by reentry for implant insertion and evaluation of the bone volume and quality. Fixed prosthesis-supported dental implants were placed four months post-insertion. The survival and success of the dental implants were evaluated based on the acceptable clinical and radiographic criteria. Results: A cohort of 23 patients (17 women, 6 men, mean age 47 years) underwent bone augmentation at 39 sites, with follow-up ranging from 10 to 14 years. The procedure demonstrated a 95–100% success rate with minimal morbidity and horizontal bone gain averaging 3–8 mm. Partial graft exposure occurred in two cases but was successfully managed without compromising augmentation. A total of 103 implants were placed in the augmented sites in 37 sites. The long-term survival of the dental implants was confirmed based on clinical and radiographic evaluation, with minimal marginal bone loss observed during the extended follow-up period. Conclusions: The honeycomb technique proves effective in horizontal bone augmentation of atrophic ridges in posterior mandibular defects. The satisfactory long-term outcomes validate its potential as a valuable addition to bone augmentation strategies preceding implant placement. 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

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

Background/Objectives: Internal implant–abutment connection has been proposed to increase interface stability and reduce biological and prosthetic issues. The aim of the present investigation was to evaluate the influence of the implant abutment conical angle on marginal bone loss and mechanical complications. Methods: The literature screening was performed by considering Pubmed/MEDLINE, EMBASE, and Google Scholar sources. The eligibility process was conducted in order to perform a descriptive synthesis, determine the risk of bias, and carry out network meta-analyses. The following categories were considered for pairwise comparisons: external hexagon (EI), internal hexagon (HI), cone morse (CM) (<8° contact angle), and conometric joint (>8° contact angle). For the descriptive data synthesis, the following parameters were considered: sample size, implant manufacturer, prosthetic joint type, prosthetic complications, marginal bone loss, and study outcomes. Results: A total of 4457 articles were screened, reducing the output to the 133 studies included in the descriptive synthesis, while 12 articles were included in the statistical analysis. No significant differences in marginal bone loss were reported when comparing a cone angle of <8° and a cone angle of >8; Conclusions: Within the limits of the present investigation, the cone interface seems to produce lower marginal bone loss compared to external and internal hexagon connection. No differences were found when comparing a cone angle of <8° and a cone angle of >8°. Full article

Objectives: To evaluate the clinical performance of BioHPP^® (Biocompatible High-Performance Polymer) superstructures in full-arch implant-prosthetic rehabilitations following the Toronto-Branemark protocol, focusing on biomechanical and biological outcomes. Methods: A 70-year-old edentulous male patient underwent full-arch implant-prosthetic rehabilitation using BioHPP^® superstructures fabricated through a CAD-CAM workflow. Radiological and clinical evaluations were conducted to plan implant placement and assess outcomes after one-year of follow-up. The primary endpoints included prosthetic stability, peri-implant bone resorption, and patient-reported satisfaction. Results: The BioHPP^® superstructure demonstrated effective stress distribution, leading to minimal peri-implant bone resorption and improved implant stability. Clinical evaluations showed excellent prosthetic fit and functionality, with no complications during the observation period. Radiological analyses confirmed the absence of prosthetic misfits, while patient-reported outcomes indicated high levels of comfort and aesthetic satisfaction. Conclusions: BioHPP^® superstructures offer a promising alternative to traditional materials for full-arch implant-prosthetic rehabilitations, providing significant biomechanical and aesthetic advantages. These findings suggest that BioHPP^® may enhance clinical outcomes, though further research with larger cohorts and longer follow-up periods is required to validate its long-term reliability. Full article

Background/Objectives: Defects in maxillary and mandibular continuity are common in maxillofacial practice. They can occur after trauma, osteonecrosis, congenital jaw deformities, or surgical resection of benign or malignant tumours. Reconstruction with microvascular bone flaps and subsequent prosthetic rehabilitation is considered the contemporary first line treatment. This study assessed the extent to which the underlying disease influences the treatment course of microvascular segmental jaw reconstruction. Methods: A retrospective review of prospectively collected data from all patients who underwent microvascular segmental jaw reconstruction from January 2011 to December 2020 was completed. The course of treatment as well as the process of dental rehabilitation was assessed. Results: Two hundred patients were included in the study. A total of 15.5% of patients were fitted with a conventional removable prosthesis, and implant-supported prosthetic restoration could be realized in 53.5% of patients. However, dental rehabilitation was not possible in 31.0% of patients. The outcomes of prosthetic restoration showed a statistically significant difference between the different underlying diseases (p < 0.0001). About 50% of patients with malignant diseases and osteonecrosis remained without dental rehabilitation. In contrast, more than 90% of patients with jaw continuity defects, due to benign diseases or malformations, were able to receive an implant-supported prosthesis. Among the diagnostic groups, there was a significant difference regarding the number of implants placed (p < 0.0001). There was a significant correlation between increased incidence of complications and the size of the bone flaps. Conclusions: The underlying disease influenced significantly the treatment course and the outcome of dental rehabilitation after microvascular jaw reconstruction. Full article

Objectives: The aim of this study was to systematically revise the state of art of the accuracy of digital and conventional impressions in clinical full-arch scenarios. Methods: Electronic and manual searches were conducted up to December 2024. Only trials comparing the accuracy of digital versus conventional impressions were selected by two independent reviewers. Accuracy was evaluated by analysing the fit of the prostheses obtained through conventional workflows and those obtained from digital workflows using intraoral scanners. Alternatively, accuracy was assessed by comparing the standard tessellation language data acquired from intraoral scanning with those obtained from scanning the physical model. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. Meta-analysis was conducted to pool the mean differences from the included studies, with heterogeneity tested by Cochran’s Q test and quantified by the I² index. Results: We included 9 relevant studies from a total of 2535 identified studies. The risk of bias was evaluated as low, and the main results of all the included articles reported similar accuracy between digital and conventional impressions. Random effects meta-analysis resulted in a pooled mean difference of 152.46 (95% C.I. = 76.46–228.46, p-value < 0.001, I² = 93.48%). Conclusions: In conclusion, the results of the present systematic review reveal contradictory findings regarding the accuracy of digital impressions. However, most studies analysing the clinical performance of prostheses obtained through digital impressions suggest that their accuracy falls within clinically acceptable thresholds. Future research should report comparable outcomes and focus attention on linear deviations, comparing differences between conventional and digital impressions not in absolute terms, but relative to the distance measured. Full article

Background/Objectives: In the last decades, dental implant surfaces have been evolving to increase success and implant survival rates. More studies evaluating outcomes with implants with ultra-hydrophilic multi-zone anodized surfaces are necessary. The aim of this study is to evaluate the short-term outcome of implants of conical connection with anodized ultra-hydrophilic surfaces for support of single teeth and partial rehabilitations. Methods: In this retrospective study, patients received parallel-walled implants with a gradually anodized surface. The primary outcome measure was implant survival. Secondary outcome measures were marginal bone loss and mechanical and biological complications. This study included 253 conical connection implants with anodized ultra-hydrophilic surfaces, placed in 145 patients (71 males and 74 females; average age: 55.8 years). Sixty patients presented comorbidities, and 19 patients presented smoking habits. Results: Ten patients (15 implants) were lost to follow-up. Two implants failed in two patients, resulting in a cumulative survival rate of 99.2%, with 98.5% and 100% for males and females, respectively, and 99.1% and 100% for single teeth and partial rehabilitations, respectively. The average marginal bone loss was 0.52 mm at 1 year, with 0.60 mm and 0.42 mm for males and females, respectively, and 0.52 mm and 0.50 mm for single teeth and partial rehabilitations, respectively. The rate of mechanical complications was 4.8% and 3.2% at patient and implant levels, respectively. Biological complications occurred in one patient (0.7%) at one implant (0.4%). Conclusions: These results indicate that the use of implants with ultra-hydrophilic multi-zone anodized surfaces for single teeth and partial rehabilitations is viable in the short term. Full article

This narrative review aimed to evaluate the effectiveness of computer-aided design (CAD), computer-aided manufacturing (CAM) milled, and direct metal laser sintering (DMLS) titanium frameworks in hybrid denture prostheses. A structured PICO analysis and a review of ten publications were used to compare titanium frameworks for hybrid dentures made through milling, DMLS, and CAD-CAM milling. Prosthesis success, bone loss, patient satisfaction, framework fit, and biofilm adhesion were among the outcome indicators. The inclusion criteria included comparisons between DMLS and milled titanium frameworks, investigations of hybrid dentures with metal frameworks, and various study designs. The exclusion criteria included reviews, case reports, non-comparative research, and studies unrelated to hybrid dentures. A comprehensive search was performed up to December 2023 across PubMed, PubMed Central, Cochrane Library, Scopus, and Google Scholar, using terms such as CAD-CAM, dental implantation, dental prosthesis, bone loss, damaged maxilla/mandible, implant framework, and bone volume. Ten studies were available for the final analysis. These studies shed light on milled titanium framework’s relative effectiveness and characteristics versus DMLS for implant-supported hybrid dentures. This narrative analysis clarifies the critical roles of the CAD-CAM and DMLS frameworks in implant-supported hybrid dentures. Despite the significant benefits of both of these technologies, it is evident that more investigation is required to identify the optimal framework option for specific clinical scenarios, highlighting the importance of continuing research in this field. Full article