Search Results (37)

Background/Objectives: This study aimed to assess the long-term clinical performance of full-arch fixed restorations made of fiber-reinforced composite (FRC) supported by four ultra-short implants (4.0 × 5.0 mm) in patients with edentulous, atrophic mandibles. Methods: Ten patients were treated at Sapienza University of Rome and monitored over a 10-year period. Each case involved the placement of four plateau-design implants with a pure conometric connection and a calcium phosphate-treated surface. The final prostheses were fabricated using CAD/CAM-milled Trinia^® fiber-reinforced composite frameworks. Clinical parameters included implant and prosthesis survival, marginal bone level (MBL), peri-implant probing depth (PPD), and patient-reported outcome measures (PROMs). Results: Implant and prosthesis survival reached 100% over the 10-year follow-up. MBL data showed a minor bone gain of approximately 0.11 mm per 5 years (p < 0.0001). PPD remained stable under 3 mm, with a minimal increase of 0.16 mm over the same period (p < 0.0001). PROMs reflected sustained high patient satisfaction. No technical complications, such as chipping or framework fracture, were observed. Conclusions: Rehabilitation of the edentulous mandible with ultra-short implants and metal-free FRC prostheses proved to be a minimally invasive and long-lasting treatment option. The 10-year follow-up confirmed excellent implant and prosthetic outcomes, favorable peri-implant tissue health, and strong patient satisfaction. Nonetheless, further studies with larger sample sizes are needed to confirm these encouraging results and strengthen the clinical evidence. 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 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 gold standard materials used for frameworks of full-arch implant-supported fixed prostheses (ISFPs) have traditionally been metal alloys, but recently, high-performance polymers such as polyetherketones and fibre-reinforced resins have been gaining popularity despite the lack of evidence of load-bearing capacity. The aim of the present study was to evaluate the displacements and strains of milled polymeric frameworks for full-arch ISFPs using 3D digital image correlation. Methods: Twelve frameworks were milled from four polymeric materials (three per group): polyetheretherketone (PEEK), polyetherketoneketone (PEKK), poly(methyl methacrylate) (PMMA) and fibre-reinforced composite (FRC). Each framework was fitted with titanium links and screwed to implant analogues embedded in resin and tested for static load-bearing capacity up to 200N. Displacements were captured with two high-speed photographic cameras and analysed with a video correlation system on three spatial axes, U, V, and W, along with principal tensile, compressive and von Mises strains. Results: PEEK exhibited the highest displacement, indicating greater flexibility, while FRC showed the lowest displacement, suggesting enhanced rigidity. Von Mises strain analysis revealed that PMMA and PEEK experienced higher strain, whereas PEKK and FRC demonstrated lower strain distribution. Bayesian ANOVA provided strong evidence for material differences. Conclusion: FRC exhibited superior load-bearing characteristics, reinforcing its potential as a viable clinical alternative to metal-based ISFPs. Full article

This study evaluates the biomechanical effects of different implant configurations in various mandibular arch types using finite element analysis (FEA). Stress distribution and deformation patterns were analyzed under different loading conditions in square, U-shaped, and V-shaped arches. The results indicate that increasing the number of implants generally reduces cortical bone stress, particularly in U and V arches, while implant-level stress tends to increase. Under molar loading, cortical bone stress in the square arch decreased by 16.9% (from 90.61 MPa to 75.27 MPa) with the All-on-5 system, while implant stress in the V arch dropped by 46.26% (from 142.35 MPa to 76.5 MPa). Additionally, the cantilever effect in All-on-4 configurations resulted in higher stress on the prosthesis and implants, particularly in V arches. While the All-on-5 system provided better load distribution, the study highlights the importance of optimizing implant positioning based on mandibular anatomy. Despite limitations such as the use of static forces and standardized arch types, these findings offer valuable insights into the biomechanical performance of full-arch implant rehabilitations, supporting future clinical applications and research. 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

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

Objectives: The purpose of this clinical study is to compare implant full-arch intraoral scans taken immediately after implant placement with those obtained after tissue healing in patients rehabilitated with implant-supported fixed prostheses. Methods: Between September 2023 and March 2024, a total of 19 patients with compromised residual dentition (6 women; 13 men) were rehabilitated using 4-to-6 immediately loaded post-extraction implants. These implants supported fixed full-arch screw-retained prostheses either in the lower jaw (9 patients) or upper jaw (10 patients). Intraoral scans were taken immediately after implant placement (termed “immediate scan”). After a healing period of four months, the provisional prosthesis was removed, and a second intraoral scan was performed using the same scan bodies and scan pattern as the initial scan (termed “delayed scan”). The two scans were overlaid, and the discrepancies between them were measured. Results: The average discrepancy between the immediate and delayed scans was 0.1905 mm. Our statistical analysis revealed larger discrepancies for implants placed in the posterior areas, with the implant in site 1.6 (Implant 1) showing a discrepancy of 0.2326 mm, and the implant in site 2.6 (Implant 4) showing a discrepancy of 0.2124 mm (p = 0.05). No statistically significant difference was observed when comparing patients treated in the upper and lower jaws. Conclusions: Within the limitations of the study and based on this result, clinicians should be aware that an immediate post-surgical intraoral digital scan for implant-supported full-arch rehabilitations may result in a higher risk of imprecision. Furthermore, according to the results of the study, the accuracy of the digital impression on implant full-arch rehabilitations seems to be influenced by the clinician’s skills. Further studies with larger sample sizes are required to confirm our results. Full article

Objectives: Can the type of implant rehabilitation influence peri-implant bone loss in case of full-arch mandibular prosthesis? The purpose of the study was to assess, using orthopantomograms (OPGs), the bone loss around implants in different types of implant-supported prosthetic rehabilitations and identify potential risk factors, associated with the number and location of implants, that may have an association with bone defects. Methods: A radiographic study was conducted on 22,317 OPGs from 2010 to 2024. All OPGs with implant-supported prosthetic mandibular rehabilitations were included in the study. Results: A total of 155 OPGs were evaluated, with peri-implant bone loss identified in 64 (41.3%). Distal implants (furthest from the center) across various positioning patterns were most susceptible to bone loss, with positions 3.6 and 4.6 demonstrating the most frequent occurrence (25 and 26 cases, respectively). The χ² test revealed significant associations between both the implant positioning pattern (p < 0.001) and number of implants (p < 0.001) with peri-implant bone loss. Also, by updating the sample of OPGs, increased susceptibility to bone resorption was found for implants placed distal to the mental foramen compared to mesial ones in full-arch-implant-supported fixed prostheses. Conclusions: Prospective clinical studies will therefore be useful in investigating this finding further. Full article

Implant-supported immediate loading full-arch rehabilitation has been documented in the literature. More recently, computed surgical guides have frequently been used since they facilitate planning and performing surgical treatment without the need to raise a flap, thus reducing trauma and morbidity. This case report describes an immediate full-arch, fixed rehabilitation with full loading placed on four commercially available 3D-printed implants, with a 24-month follow-up. The implants were placed with the help of a digitally planned 3D-printed surgical guide. The provisional fixed prosthesis installed immediately was replaced after 3 months. At the time, the soft and hard tissue around the implants appeared stable, without signs of inflammation. The same situation was observed at the 24-month follow-up. Three-dimensional-printed implants seem to be a promising choice in this case. However, further clinical studies with longer follow-up periods are necessary to confirm their efficacy. Full article

Background: The improvement of oral-health-related quality of life (OHRQoL) with different types of prosthesis for completely edentulous jaws in the elderly population is a critical factor in clinical decision making for these vulnerable patients. This review aims to evaluate the changes in OHRQoL after treatment with different types of full-arch prostheses in the elderly edentulous population to determine the prostheses that result in the greatest improvement in OHRQoL. Materials and Methods: Clinical studies of different types of full-arch prostheses that measured the OHRQoL in edentulous patients 60 years or older were searched for in the PubMed, Embase and Scopus electronic databases, with additional hand searching to summarize the outcomes of the selected studies. Result: Among the 302 identified studies, 10 studies were selected. A total of 504 patients wearing 133 complete dentures, 372 implant overdentures and 39 fixed prostheses were assessed among the selected studies. The overall OHIP and GOHAI scores were evaluated at baseline and in the 3rd, 6th, 12th and 18th months of treatment with the respective prostheses. The improved OHRQoL with overall OHIP scores associated with conventional dentures were 9.21–12.5% from the 3rd month to 1 year after treatment, whereas those associated with implant overdentures and full-arch fixed prosthesis were 9–25.26% at 1 year and 18.53–26.79 at the 18th-month follow-up, respectively. The increased overall GOHAI scores were 21.3–25.43% for conventional dentures, 36.82–41.32% for implant overdentures and 39.48–42.83% for full-arch fixed prosthesis from the 3rd month to the 6th-month follow-up. Conclusion: In general, the improvement in OHRQoL after rehabilitation with implant overdentures declined at one year, and that with full-arch fixed prosthesis declined at the 18th-month follow-up; meanwhile, the OHRQoL associated with conventional dentures improved stably up to one year, but the implant-supported prostheses resulted in an obviously greater improvement in the OHRQoL than that obtained with conventional dentures. However, studies with longer follow-up periods are still required to evaluate the long-term clinical effectiveness. Full article

Background/Objectives: There is a need for alternative approaches to full-arch rehabilitation of atrophic maxillae. The aim of this short case series was to describe the technique and assess the short term-outcomes of atrophic maxillae rehabilitation using transnasal implants in conjunction with zygomatic implants. Methods: Three female patients (average age: 62 years) presenting comorbidities and atrophic maxillae preventing the insertion of standard maxillary anchored implants received a full-arch fixed prosthesis supported by transnasal implants together with zygomatic implants, using the ad modum all-on-4 concept. Patients were followed during the functional osseointegration period. Primary outcome measures were prosthetic and implant survival based on function. Secondary outcome measures were complication parameters (biological and mechanical), plaque and bleeding levels, and probing pocket depths > 4 mm. Results: No implant failures were registered, and all prostheses remained in function. The only complication was a fracture of a provisional crown that was resolved. Plaque and bleeding scores were mild during the follow-up period. Conclusions: The present manuscript describes the use of extra-long transnasal implants in combination with zygomatic implants in immediate function for full-arch fixed prosthetic rehabilitation of atrophic maxillae, with the objective of promoting more research into this relatively recent technique. More studies are needed to validate the technique. Full article

(1) Background: Recent digital workflows are being developed for full-arch rehabilitations supported by implants with immediate function. The purpose of this case series is to describe a new digital workflow for the All-on-4 concept. (2) Methods: The patients were rehabilitated using the All-on-4 concept with a digital workflow including computerized tomography scanning, intra-oral scanning, and CAD-CAM production of the temporary prosthesis, with the 3D printing of stackable guides (base guide, implant guide, and prosthetic guide). The passive fit of the prostheses and the time to perform the rehabilitations were evaluated. (3) Results: The digital workflow allowed for predictable bone reduction, the insertion of implants with immediate function, and the connection of an implant-supported prosthesis with immediate loading. The time registered to perform the full-arch rehabilitations (implant insertion, abutment connection, prosthesis connection) was below 2 hours and 30 min. No passive fit issues were noted. (4) Conclusions: within the limitation of this case series, the digital workflow applied to the All-on-4 concept using stackable base-, implant-, and prosthetic guides constitutes a potential alternative with decreased time for the procedure without prejudice of the outcome. Full article

Background: Fiber-reinforced composites (FRCs) have been proposed as an alternative to traditional metal alloys for the realization of frameworks in full-arch implant-supported prostheses. The aim of the present in vitro study was to evaluate the deflection under load of seven prostheses endowed with frameworks made of different materials, including different types of fiber-reinforced composites (FRCs). Methods: A master cast with four implant analogues in correspondence with the two lateral incisors and the two first molars was used to create full-arch fixed prostheses with the same shape and different materials. Prostheses were made of the following different materials (framework+veneering material): gold alloy+resin (Au+R), titanium+resin (Ti+R), FRC with multidirectional carbon fibers+resin (ICFRC+AR), FRC with unidirectional carbon fibers+composite (UCFRC+C), FRC with glass fibers+resin (GFRC+AR), FRC with glass fibers+composite (GFRC+C), and resin (R, fully acrylic prosthesis). Flexural tests were conducted using a Zwick/Roell Z 0.5 machine, and the deflection of the lower surface of the prosthesis was measured in order to obtain load/deflection graphs. Results: Greater rigidity and less deflection were recorded for UCFRC+C and GFRC+C, followed by Ti+R and Au+R. The greatest deformations were observed for resin alone, ICFRC+R, and GFRC+R. The results were slightly different in the incisal region, probably due to the greater amount of veneering material in this area. Conclusions: When used to realize full-arch frameworks, Au and Ti allow for predictable mechanical behavior with gradual deformations with increasing load. UCFRC also demonstrated good outcomes and less deflection than ICFRCs when loaded. The GFRC full-arch framework may be a valid alternative, although it showed greater deflections. Further studies are needed in order to evaluate how different prosthesis designs and material thicknesses might affect the outcomes. Full article

Both conventional and digital impressions aim to record the spatial position of implants in the dental arches. However, there is still a lack of data to justify the use of intraoral scanning over conventional impressions for full-arch implant-supported prostheses. The objective of the in vitro study was to compare the trueness and precision of conventional and digital impressions obtained with four intra-oral scanners: Trios 4 from 3Shape^®, Primescan from Dentsply Sirona^®, CS3600 from Carestream^® and i500 from Medit^®. This study focused on the impression of an edentulous maxilla in which five implants were placed for implant-supported complete prosthesis. The digital models were superimposed on a digital reference model using dimensional control and metrology software. Angular and distance deviations from the digital reference model were calculated to assess trueness. Dispersion of the values around their mean for each impression was also calculated for precision. The mean distance deviation in absolute value and the direction of the distance deviation were smaller for conventional impressions (p-value < 0.001). The I-500 had the best results regarding angular measurements, followed by Trios 4 and CS3600 (p < 0.001). The conventional and I-500 digital impressions showed the lowest dispersion of values around the mean (p-value < 0.001). Within the limitations of our study, our results revealed that the conventional impression was more accurate than the digital impression, but further clinical studies are needed to confirm these findings. Full article