Evaluation of Torque Maintenance of Abutment and Cylinder Screws With Morse Taper Implants

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Planning for Immediate Loading of Implant-Supported Prostheses: Literature Review

The aim of this study was to present the factors that influence planning for immediate loading of implants through a literature review for treatment success. Research was conducted in the PubMed database including the key words immediate implant loading, implant-supported prostheses, and implant planning for studies published from 2000 to 2011. Forty-eight articles were used in this review to describe the indications and counterindications, presurgical planning, and technologies available for planning of this treatment alternative.

Prosthetic Platforms in Implant Dentistry

The use of implant-supported prosthesis to replace missing teeth became a predictable treatment. Although high success rate has been reported, implant treatment is suitable to complications, failures, and limitations such as peri-implant bone loss after implant loading. Stress evaluation on the bone-abutment-implant interface has been carried out to develop new designs of prosthetic platform and to understand the stress distribution in this interface. Several types of prosthetic platforms are available such as external and internal hexagon, Morse cone connection, and the concept of platform switching. Therefore, this study aimed to critically describe the different options of prosthetic platforms in implant dentistry, by discussing their biomechanical concepts, clinical use, and advantages and disadvantages. It was observed that all types of prosthetic platforms provided high success rate of the implant treatment by following a strict criteria of indication and limitation. In conclusion, a reverse planning of implant treatment is strongly indicated to reduce implant overload, and the use of advanced surgical-prosthetic techniques is required to obtain a long-term success of oral rehabilitations.

Clinical Viability for Immediate Loading of Dental Implants: Part II-Treatment Alternatives

The treatment with implants aims to obtain a direct interface between bone and implant. The implant is kept load-free during 4 to 6 months in the 2-stage procedure, which is considered a requisite for osseointegration. However, this period is based on empirical principles and uncomfortable for patient. So, the immediate loading protocol was Suggested to submit implants to occlusal function after placement. This protocol has been applied for several conditions of edentulism. The aim of this study was to evaluate the treatment alternatives for immediate loading of complete and partial edentulous patients. In general, the studies have demonstrated high previsibility for rehabilitation of complete edentulous arches with full-arch, implant-supported prosthesis. The rehabilitation with immediate loading for maxillary overdenture is questionable because there is no longitudinal study in literature. The studies with partial edentulous arches have demonstrated high success rates for implants placed in the mandibular and maxillary anterior region. Additional care is recommended for posterior region mainly in the maxillary arch, and further studies are suggested to corroborate this treatment.

Clinical Viability of Immediate Loading of Dental Implants: Part I-Factors for Success

Two-stage procedure for dental implants presents corroborated clinical success over 40 years. The evolution of surgical techniques, development of diagnostic methods, knowledge about tissue biology, and quality of implants regarding design and surface supported studies with I surgical stage followed by immediate prosthesis placement. However, several factors influence the treatment success with immediate loading. SO, this Study aimed to evaluate some factors regarding the success and characteristics of implants and patients.

Digital Radiographic Evaluation of the Level of Alveolar Bone Crest in External Hexagon Implants Submitted to 2 Types of Implant Abutments Under Immediate Loading

Purpose: The aim of this study was to evaluate by means of digital radiography the behavior of the alveolar bone crest in external hexagon implants following the use of 2 different types of abutments, one for conventional cemented prosthesis and one for modified cemented prosthesis.Methods: Ten external hexagon implants (platform 4.1) were placed in 5 patients. Initial instrumentation was carried out to obtain primary stability of the temporary prostheses under immediate loading. Each patient received both abutments for conventional and modified cemented prosthesis. Standardized digital periapical radiographies were performed at times T0 (immediately after implant placement) and T1 (4 months after implant placement). A straight line was initially established from the implant platform to the distal and mesial periimplantar marginal bone tissue (immediately in contact with the implant) and measured by digital radiography, using Sidexis version 2.3 (Sirona Dental Systems GmbH, Bensheim, Germany) software. The data were submitted to paired-samples t-test analysis.Results: There was no significant difference between the conventional and modified cemented prosthesis. In both cases, t-test results were within the null hypothesis level.Conclusion: The abutment for the modified cemented prosthesis resulted in no significant radiographic difference of alveolar bone crest height, when compared with the conventional cemented prostheses.

Treatment of root surface in delayed tooth replantation: a review of literature

The time elapsed between a trauma and tooth replantation usually ranges from 1 to 4 h. The chances of root surface damage are higher when tooth replantation is not performed immediately or if the avulsed tooth is not stored in an adequate medium. This invariably leads to necrosis of pulp tissue, periodontal ligament cells and cementum, thus increasing the possibility of root resorption, which is the main cause of loss of replanted teeth. This paper presents a comprehensive review of literature on root surface treatments performed in cases of delayed tooth replantation with necrotic cemental periodontal ligament. Journal articles retrieved from PubMed/MedLine, Bireme and Scielo databases were reviewed. It was observed that, when there are no periodontal ligament remnants and contamination is under control, replacement resorption and ankylosis are the best results and that, although these events will end up leading to tooth loss, this will happen slowly with no loss of the alveolar ridge height, which is important for future prosthesis planning.

Anterior Tooth Rehabilitation With Frozen Homogenous Bone Graft and Immediately Loaded Titanium Implant Using Computer-Guided Surgery

Computed tomographic scanning is a precise, noinvasive surveying technique that enables the professionals to improve the precision of implant placement by building a prototype that allows the confection of surgical guides. The authors present a clinical case of anterior tooth rehabilitation with frozen homogenous bone graft and immediately loaded titanium implant using computer-guided surgery. A multislice computed tomography was realized, and a prototype was built. All the procedures were previously realized in the prototype before started in the patient. This technique allows a better surgical planning, makes the procedures more accurate, and reduces surgery time.

Evaluation of Satisfaction of Patients Rehabilitated With Zygomatic Fixtures

Purpose: The aim of this study was to evaluate the satisfaction of patients rehabilitated with zygomatic fixtures and prosthesis with immediate loading.Materials and Methods: The study selected patients who were rehabilitated with zygomatic implants at the clinic of the Latin American Institute for Dental Research and Education (ILAPEO. Curitiba-PR. Brasil) between 2005 and 2009. The patients were asked to answer a control-questionnaire during their follow-up visits. Data were collected regarding the level of patient satisfaction, reason for dissatisfaction, number of post-operative clinical sessions, and the type of complication. Sixteen patients were selected: 10 females and 6 males.Results: Half of the patients were completely satisfied while the other half were satisfied with some complaints. The complaints were related to hygiene, esthetics, phonetics, and discomfort during chewing. Regarding the post-operative evaluation, 50% of the patients were attended due to the prosthesis (62.5%) and the implant (37.5%).Conclusions: The treatment with zygomatic fixtures is predictable and reliable. The patients were satisfied both with implants and prosthesis. (C) 2012 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 70: 314-319, 2012

Photoelastic Analysis of the Influence of Platform Switching on Stress Distribution in Implants

The aim of this study was to evaluate the stress distribution of platform switching implants using a photoelastic method. Three models were constructed of the photoelastic resin PL-2, with a single implant and a screw-retained implant-supported prosthesis. These models were Model A, platform 5.0 mm/abutment 4.1 mm; Model B, platform 4.1 mm/abutment 4.1 mm; and Model C, platform 5.00 mm/abutment 5.00 mm. Axial and oblique (45 degrees) loads of 100 N were applied using a Universal Testing Machine (EMIC DL 3000). Images were photographed with a digital camera and visualized with software (AdobePhotoshop) to facilitate the qualitative analysis. The highest stress concentrations were observed at the apical third of the 3 models. With the oblique load, the highest stress concentrations were located at the implant apex, opposite the load application. Stress concentrations decreased in the cervical region of Model A (platform switching), and Models A (platform switching) and C (conventional/wide-diameter) displayed similar stress magnitudes. Finally, Model B (conventional/regular diameter) displayed the highest stress concentrations of the models tested.

Flabby Ridge Correction Using an Auxiliary Technique With Connective Tissue Graft

A common finding in patients with edentulous maxilla and partially dentate mandible is mainly the presence of flabbiness in the anterior edentulous alveolar ridge that can compromise the retention and stability of a denture. Thus, this case report presents the correction of a flabby ridge, using an auxiliary technique combining surgical excision and autogenous connective tissue grafting. The technique improved the quality of the osteomucosal support of the alveolar ridge and increased the vestibule deepness, whose result increased the success rate of the new conventional total prosthesis.

Periodontal and Prosthetic Biologic Considerations to Restore Biological Width in Posterior Teeth

\ The biologic width is an essential dental space that always needs to be maintained to ensure periodontal health in any dental prosthetic restorations. An iatrogenic partial fixed prosthesis constructed in lower posterior teeth predisposed the development of subgingival caries, which induced violation of the biologic width in involved teeth, resulting in an uncontrolled inflammatory process and periodontal tissue destruction. This clinical report describes a periodontal surgical technique to recover a violated biologic width in lower posterior teeth, by crown lengthening procedure associated with free gingival graft procedure, to ensure the possibility to place a modified partial fixed prosthesis in treated area. The procedure applied to recover the biologic width was crown lengthening with some modifications, associated with modified partial fixed prosthesis to achieve health in treated area. The modified techniques in both surgical and prosthetic procedures were applied to compensate the contraindications to recover biologic width by osteotomy in lower posterior teeth. The result, after 4 years under periodic control, seems to achieve the projected goal. Treating a dental diseased area is necessary to diagnose, eliminate, or control all etiologic factors involved in the process. When the traditional methods are not effective to recover destructed tissues, an alternative, compensatory, and adaptive procedure may be applied to restore the sequelae of the disease, applying a restorative method that respects the biology of involved tissues.

Passivity Versus Unilateral Angular Misfit: Evaluation of Stress Distribution on Implant-Supported Single Crowns: Three-Dimensional Finite Element Analysis

The aim of this study was to evaluate the effect of unilateral angular misfit of 100 Km on stress distribution of implant-supported single crowns with ceramic veneering and gold framework by three-dimensional finite element analysis. Two three-dimensional models representing a maxillary section of premolar region were constructed: group 1 (control)-crown completely adapted to the implant and group 2-crown with unilateral angular misfit of 100 Km. A vertical force of 100 N was applied on 2 centric points of the crown. The von Mises stress was used as an analysis criterion. The stress values and distribution in the main maps (204.4 MPa for group 1 and 205.0 MPa for group 2) and in the other structures (aesthetic veneering, framework, retention screw, implant, and bone tissue) were similar for both groups. The highest stress values were observed between the first and second threads of the retention screw. Considering the bone tissue, the highest stress values were exhibited in the peri-implant cortical bone. The unilateral angular misfit of 100 Km did not influence the stress distribution on the implant-supported prosthesis under static loading.

Platform Switching: Biomechanical Evaluation Using Three-Dimensional Finite Element Analysis

Purpose: The objective of this study was to evaluate, using three-dimensional finite element analysis (3D FEA), the stress distribution in peri-implant bone tissue, implants, and prosthetic components of implant-supported single crowns with the use of the platform-switching concept. Materials and Methods: Three 3D finite element models were created to replicate an external-hexagonal implant system with peri-implant bone tissue in which three different implant-abutment configurations were represented. In the regular platform (RP) group, a regular 4.1-mm-diameter abutment (UCLA) was connected to regular 4.1-mm-diameter implant. The platform-switching (PS) group was simulated by the connection of a wide implant (5.0 mm diameter) to a regular 4.1-mm-diameter UCLA abutment. In the wide-platform (WP) group, a 5.0-mm-diameter UCLA abutment was connected to a 5.0-mm-diameter implant. An occlusal load of 100 N was applied either axially or obliquely on the models using ANSYS software. Results: Both the increase in implant diameter and the use of platform switching played roles in stress reduction. The PS group presented lower stress values than the RP and WP groups for bone and implant. In the peri-implant area, cortical bone exhibited a higher stress concentration than the trabecular bone in all models and both loading situations. Under oblique loading, higher intensity and greater distribution of stress were observed than under axial loading. Platform switching reduced von Mises (17.5% and 9.3% for axial and oblique loads, respectively), minimum (compressive) (19.4% for axial load and 21.9% for oblique load), and maximum (tensile) principal stress values (46.6% for axial load and 26.7% for oblique load) in the peri-implant bone tissue. Conclusion: Platform switching led to improved biomechanical stress distribution in peri-implant bone tissue. Oblique loads resulted in higher stress concentrations than axial loads for all models. Wide-diameter implants had a large influence in reducing stress values in the implant system. INT J ORAL MAXILLOFAC IMPLANTS 2011;26:482-491

Orbital Implants Insertion to Improve Ocular Prostheses Motility

The objectives of this study were, through a literature review, to point the differences between orbital implants and their advantages and disadvantages, to evaluate prosthesis motility after orbital implants are inserted, and to point the implant wrapping current risks. Sixty-seven articles were reviewed. Enucleation implants can be autoplastics or alloplastics and porous (including natural and synthetic hydroxyapatite [HA]) or nonporous (silicone). Hydroxyapatite is the most related in the literature, but it has disadvantages, too, that is, all orbital implants must be wrapped. Exposure of the porous orbital implant can be repaired using different materials, which include homologous tissue, as well as autogenous graft, xenograft, and synthetic material mesh. The most used materials are HA and porous polyethylene orbital implant. The HA implant is expensive and possibly subject corals to damage, different from porous polyethylene orbital implants. Porous implants show the best prosthesis motility and a minimum rate of implants extrusion. Implant wraps can facilitate smoother entry of the implant into the orbit and allow reattachment of extraocular muscles. They also serve as a barrier between the overlying soft tissue and the rough surface of the implant, protecting implants from exposure or erosion.