Esthetics in implant-supported prostheses: a literature review

Esthetics is important for success of implant-supported prostheses. This study aimed to review esthetics concepts for implant treatment. Research in the PubMed database included studies published from 1995 to 2010 with the keywords implant esthetics, implant-supported prostheses, and esthetics. Forty-five studies were evaluated regarding the presurgical planning, surgical phase, and temporary and final restoration phases. It was concluded that esthetics in implant-supported prostheses results from a multidisciplinary approach from planning until insertion of the final restoration.

Distal extension removable partial denture with resilient attachment connect to an anterior fixed implant-supported prosthesis: a clinical report

Background: Considering the limited qualitative and quantitative bone in the posterior arch, this modality of prosthetic treatment could provide a positive emotional factor reestablished by immovability of the anterior fixed implant-supported segment. Objective: This clinical report demonstrates the possibility of achieving positive results with a removable partial denture connected to an implant-supported fixed prosthesis associated to an extra resilient attachment. Clinical significance: In cases of posterior mandibular and maxilla atrophy added to the patients desire against the bone graft, this kind of prosthetic treatment has an important place as an alternative.

A systematic review of the survival and complication rates of implant-supported fixed dental prostheses (FDPs) after a mean observation period of at least 5 years

The objective of this systematic review was to assess the 5- and 10-year survival of implant-supported fixed dental prostheses (FDPs) and to describe the incidence of biological and technical complications.

[Rehabilitation of a periodontally compromised dentition with implant-supported zirconia bridges. Case report]

Clinical aspects of reconstruction with fix prosthesis and dental implants in a patient with a history of periodontitis is shown. A successful stabilization and rehabilitation of the periodontally involved dentition can be achieved with tooth-worn crown and bridge reconstructions. From a functional and aesthetic point of view the result may not be satisfying due to mobility and overlength of the teeth and open approximal spaces. Today, dentist and patient have often to weigh if teeth shall be maintained or replaced by dental implants. Thereby, both must be aware of the fact that in complex cases long-term success and aesthetic outcome may be difficult to predict. An intense discussion with the patient on his expectations, invasive treatment, risks with regard to biologic and prosthetic aspects is mandatory and must be based on the best scientific evidence available. The present case report shows different considerations and describes a radical solution which meets the patient's needs and is based on modern CAD-CAM technology.

Complication and failure rates with implant-supported fixed dental prostheses and single crowns: a 10-year retrospective study

PURPOSE Clinical studies related to the long-term outcomes with implant-supported reconstructions are still sparse. The aim of this 10-year retrospective study was to assess the rate of mechanical/technical complications and failures with implant supported fixed dental prostheses (FDPs) and single crowns (SCs) in a large cohort of partially edentulous patients. MATERIALS AND METHODS The comprehensive multidisciplinary examination consisted of a medical/dental history, clinical examination, and a radiographic analysis. Prosthodontic examination evaluated the implant-supported reconstructions for mechanical/technical complications and failures, occlusal analysis, presence/absence of attrition, and location, extension, and retention type. RESULTS Out of three hundred ninety seven fixed reconstructions in three hundred three patients, two hundred sixty eight were SCs and one hundred twenty seven were FDPs. Of these three hundred ninety seven implant-supported reconstructions, 18 had failed, yielding a failure rate of 4.5% and a survival rate of 95.5% after a mean observation period of 10.75 years (range: 8.4-13.5 years). The most frequent complication was ceramic chipping (20.31%) followed by occlusal screw loosening (2.57%) and loss of retention (2.06%). No occlusal screw fracture, one abutment loosening, and two abutment fractures were noted. This resulted in a total mechanical/technical complication rate of 24.7%. The prosthetic success rate over a mean follow-up time of 10.75 years was 70.8%. Generalized attrition and FDPs were associated with statistically significantly higher rates of ceramic fractures when compared with SCs. Cantilever extensions, screw retention, anterior versus posterior, and gender did not influence the chipping rate. CONCLUSIONS After a mean exposure time of 10.75 years, high survival rates for reconstructions supported by Sand-blasted Large-grit Acid-etched implants can be expected. Ceramic chipping was the most frequent complication and was increased in dentitions with attrition and in FDPs compared with SCs.

Influence of prosthesis type and retention mechanism on complications with fixed implant-supported prostheses: a systematic review applying multivariate analyses

PURPOSE To identify the influence of fixed prosthesis type on biologic and technical complication rates in the context of screw versus cement retention. Furthermore, a multivariate analysis was conducted to determine which factors, when considered together, influence the complication and failure rates of fixed implant-supported prostheses. MATERIALS AND METHODS Electronic searches of MEDLINE (PubMed), EMBASE, and the Cochrane Library were conducted. Selected inclusion and exclusion criteria were used to limit the search. Data were analyzed statistically with simple and multivariate random-effects Poisson regressions. RESULTS Seventy-three articles qualified for inclusion in the study. Screw-retained prostheses showed a tendency toward and significantly more technical complications than cemented prostheses with single crowns and fixed partial prostheses, respectively. Resin chipping and ceramic veneer chipping had high mean event rates, at 10.04 and 8.95 per 100 years, respectively, for full-arch screwed prostheses. For "all fixed prostheses" (prosthesis type not reported or not known), significantly fewer biologic and technical complications were seen with screw retention. Multivariate analysis revealed a significantly greater incidence of technical complications with cemented prostheses. Full-arch prostheses, cantilevered prostheses, and "all fixed prostheses" had significantly higher complication rates than single crowns. A significantly greater incidence of technical and biologic complications was seen with cemented prostheses. CONCLUSION Screw-retained fixed partial prostheses demonstrated a significantly higher rate of technical complications and screw-retained full-arch prostheses demonstrated a notably high rate of veneer chipping. When "all fixed prostheses" were considered, significantly higher rates of technical and biologic complications were seen for cement-retained prostheses. Multivariate Poisson regression analysis failed to show a significant difference between screw- and cement-retained prostheses with respect to the incidence of failure but demonstrated a higher rate of technical and biologic complications for cement-retained prostheses. The incidence of technical complications was more dependent upon prosthesis and retention type than prosthesis or abutment material.

Digital image correlation analysis of the load transfer by implant-supported restorations

This study compared splinted and non-splinted implant-supported prosthesis with and without a distal proximal contact using a digital image correlation method. An epoxy resin model was made with acrylic resin replicas of a mandibular first premolar and second molar and with threaded implants replacing the second premolar and first molar. Splinted and non-splinted metal-ceramic screw-retained crowns were fabricated and loaded with and without the presence of the second molar. A single-camera measuring system was used to record the in-plane deformation on the model surface at a frequency of 1.0 Hz under a load from 0 to 250 N. The images were then analyzed with specialist software to determine the direct (horizontal) and shear strains along the model. Not splinting the crowns resulted in higher stress transfer to the supporting implants when the second molar replica was absent. The presence of a second molar and an effective interproximal contact contributed to lower stress transfer to the supporting structures even for non-splinted restorations. Shear strains were higher in the region between the molars when the second molar was absent, regardless of splinting. The opposite was found for the region between the implants, which had higher shear strain values when the second molar was present. When an effective distal contact is absent, non-splinted implant-supported restorations introduce higher direct strains to the supporting structures under loading. Shear strains appear to be dependent also on the region within the model, with different regions showing different trends in strain changes in the absence of an effective distal contact. (C) 2011 Elsevier Ltd. All rights reserved.

Influence of Cusp Inclination on Stress Distribution in Implant-Supported Prostheses. A Three-Dimensional Finite Element Analysis

Purpose: The aim of this study was to assess the influence of cusp inclination on stress distribution in implant-supported prostheses by 3D finite element method.Materials and Methods: Three-dimensional models were created to simulate a mandibular bone section with an implant (3.75 mm diameter x 10 mm length) and crown by means of a 3D scanner and 3D CAD software. A screw-retained single crown was simulated using three cusp inclinations (10 degrees, 20 degrees, 30 degrees). The 3D models (model 10d, model 20d, and model 30d) were transferred to the finite element program NeiNastran 9.0 to generate a mesh and perform the stress analysis. An oblique load of 200 N was applied on the internal vestibular face of the metal ceramic crown.Results: The results were visualized by means of von Mises stress maps. Maximum stress concentration was located at the point of application. The implant showed higher stress values in model 30d (160.68 MPa). Cortical bone showed higher stress values in model 10d (28.23 MPa).Conclusion: Stresses on the implant and implant/abutment interface increased with increasing cusp inclination, and stresses on the cortical bone decreased with increasing cusp inclination.

Photoelastic Stress Analysis in Screwed and Cemented Implant-Supported Dentures With External Hexagon Implants

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

Photoelastic Analysis of Cemented or Screwed Implant-Supported Prostheses With Different Prostheses Connections

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

Effect of Passive Fit Absence in the Prosthesis/Implant/Retaining Screw System: A Two-Dimensional Finite Element Analysis

The misfit between prostheses and implants is a clinical reality, but the level that can be accepted without causing mechanical or biologic problem is not well defined. This study investigates the effect of different levels of unilateral angular misfit prostheses in the prosthesis/implant/retaining screw system and in the surrounding bone using finite element analysis. Four models of a two-dimensional finite element were constructed: group I (control), prosthesis that fit the implant; groups 2 to 4, prostheses with unilateral angular misfit of 50, 100, and 200 mu m, respectively. A load of 133 N was applied with a 30-degree angulation and off-axis at 2 mm from the long axis of the implant at the opposite direction of misfit on the models. Taking into account the increase of the angular misfit, the stress maps showed a gradual increase of prosthesis stress and uniform stress in the implant and trabecular bone. Concerning the displacement, an inclination of the system due to loading and misfit was observed. The decrease of the unilateral contact between prosthesis and implant leads to the displacement of the entire system, and distribution and magnitude alterations of the stress also occurred.

Evaluation of Stress Patterns Produced by Implant-Retained Overdentures and Implant-Retained Fixed Partial Denture

The purposes of this study were to photoelastically measure the biomechanical behavior of 4 implants retaining different cantilevered bar mandibular overdenture designs and to compare a fixed partial denture (FPD). A photoelastic model of a human edentulous mandible was fabricated, which contained 4 screw-type implants (3.75 x 10 mm) embedded in the parasymphyseal area. An FPD and 3 overdenture designs with the following attachments were evaluated: 3 plastic Hader clips, 1 Hader clip with 2 posterior resilient cap attachments, and 3 ball/O-ring attachments. Vertical occlusal forces of 100 N were applied between the central incisor and unilaterally to the right and left second premolars and second molars. Stresses that developed in the supporting structure were monitored photoelastically and recorded photographically. The results showed that the anterior loading, the overdenture with 3 plastic Hader clips, displayed the largest stress concentration at the medium implant. With premolar loading, the FPD and overdenture with 3 plastic Hader clips displayed the highest stresses to the ipsilateral terminal implant. With molar loading, the overdenture with 3 ball/O-ring attachments displayed the most uniform stress distribution in the posterior edentulous ridge, with less overloading in the terminal implant. It was concluded that vertical forces applied to the bar-clip overdenture and FPD created immediate stress patterns of greater magnitude and concentration on the ipsilateral implants, whereas the ball/O-ring attachments transferred minimal stress to the implants. The increased cantilever in the FPD caused the highest stresses to the terminal implant.

Retention Systems to Implant-Supported Craniofacial Prostheses

Osseointegrated implants in craniofacial reconstructions improve prostheses retention and stability and comfort and safety for a patient. According to biomechanical principles, the treatment success regarding osseointegration maintenance depends on an adequate surgical technique associated to a retention system that provides favorable tension distribution to implants. Furthermore, patient expectation, esthetics, function, and anatomic limitations must be evaluated during treatment planning. Therefore, the aims of this study were to present available retention systems to implant-supported craniofacial prosthesis and to highlight the advantages, indications, and limitations. A literature review was conducted through a MEDLINE search. Sixteen articles and 2 textbooks met the inclusion criteria and were included in the review. It was concluded that the success of craniofacial rehabilitation with implants depends on an adequate surgical technique and an adequate selection of a retention system.

Obturator for Rehabilitation of Cleft Palate With Implant-Supported Retention System

Objective: Surgical reconstruction and prosthetic obturation are alternatives for the treatment of cleft in the soft palate.Design: The present case reports the rehabilitation of a patient presenting cleft palate with obturator prosthesis associated with implant-supported retention system.Conclusions: The use of ball attachment system improved speech, masticatory efficiency, swallowing, and social behavior of the patient.