Aim: The primary aim of this systematic review was to study the clinical outcomes of one-piece fixed complete dentures (complete arch fixed implant-supported prostheses) made of zirconia for edentulous patients. The secondary aim was to compare the clinical outcomes of monolithic zirconia vs zirconia veneered with porcelain (conventional, minimal or gingival) for fixed complete dentures.
Materials and methods: Two investigators conducted an independent electronic search of the literature, using PubMed and Scopus search engines from January 1, 2000, to August 31, 2016. After application of pre-determined inclusion and exclusion criteria, the final list of articles was reviewed to meet the aims of this review.
Results: A total of 12 observational studies were identified that satisfied the inclusion criteria of this systematic review. Short-term results from a combined 223 patients with 285 one-piece zirconia fixed complete dentures showed a mean failure rate of 1.4% due to the fracture of four prostheses. Prosthetic complications occurred in 46 prostheses (16.1%). Out of these, 42 prostheses (14.7%) had minor complications exclusive to fracture of veneered porcelain.
Conclusions: Current evidence indicates that zirconia fixed complete dentures have a very low failure rate in the short term, but have a substantial rate of minor complications related to chipping of veneered porcelain. Use of monolithic zirconia with only gingival stains, or zirconia that is veneered only at the gingiva may offer promising results, but will need to be validated by future long-term studies. Conflict-of-interest statement: All authors report no conflict of interest.
Statement of problem: Zygomatic implants have been utilised for the treatment of the severely atrophic maxilla since 1998. However, few articles exist as to the success of zygomatic implants and immediate loading of its prosthesis.
Aim: To systematically review the outcome of immediate loaded zygomatic implants.
Materials and methods: An electronic PubMed search was performed to identify case reports, prospective and retrospective studies of immediately loaded zygomatic implants with a mean follow-up of 12 months. Assessment of the identified studies was performed using the Delphi method. Reviewers independently assessed the articles for inclusion, with a facilitator coordinating responses. A consensus was reached on the articles that were included.
Results: The search provided 236 titles for immediately loaded zygomatic implants and resulted in 106 abstracts for analysis. Full-text analysis was performed on 67 articles, resulting in the inclusion of 38 articles for this systematic review.
Conclusion: Based on the present systematic review, the authors report that immediately loading zygomatic implants for the restoration of the severely atrophic maxilla presents a viable alternative for treatment of the atrophic maxilla.
Aim: The use of intraoral scanners (IOS) for making digital implant impressions is increasing. However, there is a lack of evidence on the accuracy of IOS compared with conventional techniques. Therefore, the aim of this systematic review was to collect evidence on the accuracy of digital implant impression techniques, as well as to identify the main factors influencing the accuracy outcomes.
Materials and methods: Two reviewers searched electronic databases in November, 2016. Controlled vocabulary, free-text terms, and defined inclusion and exclusion criteria were used. Publications in English language evaluating the accuracy outcomes of digital implant impressions were identified. Pooled data were analysed qualitatively and pertinent data extracted.
Results: In total, 16 studies fulfilled the inclusion criteria: one in vivo and 15 in vitro studies. The clinical study concluded that angular and distance errors were too large to be acceptable clinically. Less accurate findings were reported by several in vitro studies as well. However, all in vitro studies investigating the accuracy of newer generation IOS indicated equal or even better results compared with the conventional techniques. Data related to the influence of distance and angulation between implants, depth of placement, type of scanner, scanning strategy, characteristics of scanbody and reference scanner, operator experience, etc were analysed and summarised. Linear deviations (means) of IOS used in in vitro studies ranged from 6 to 337 µm. Recent studies indicated small angle deviations (0.07-0.3°) with digital impressions. Some studies reported that digital implant impression accuracy was influenced by implant angulation, distance between the implants, implant placement depth and operator experience.
Conclusions: According to the results of this systematic review and based on mainly in vitro studies, digital implant impressions offer a valid alternative to conventional impressions for single- and multi-unit implant-supported restorations. Further in vivo studies are needed to substantiate the use of currently available IOS, identify factors potentially affecting accuracy and define clinical indications for specific type of IOS. Data on Data on accuracy OF digital records, as well as accuracy of printed or milled models for implant-supported restorations, are of high relevance and are still lacking. Conflict-of-interest and funding statement: The authors state there is no conflict of interest.
Purpose: To evaluate the clinical outcome of four to five implants immediately restored with metal-resin screw-retained cross-arch fixed prostheses in edentulous jaws 1 year after loading.
Materials and methods: In total, 104 consecutive patients received four 11 × 4.5 mm implants with a torque superior to 35 Ncm. If one implant did not reach a torque superior to 35 Ncm a fifth implant was added. If two implants did not reach a torque superior to 35 Ncm, loading was postponed after 3 months. A total of 127 metal-resin screw-retained fixed prostheses (59 mandibular and 68 maxillary) were to be delivered within 3 days. Outcome measures, evaluated by the treating clinician, were: prosthesis and implant failures, as well as complications.
Results: In total, 549 implants were placed (195 immediate post-extractive implants). Twelve maxillary prostheses were delayed loaded, whereas all others were loaded immediately. One year after loading, six patients dropped out, 12 implants failed in eight patients (two patients lost three implants each), and 87 prostheses were remade in 68 patients, one because of three implant failures and then again in the recall programme (replaced twice), one because of tree implant failures and five prosthesis fractures, 10 because of prostheses fractures and 74 in a recall programme for prosthesis replacement. All patients were wearing the planned fixed prostheses at the end of the first year in function. Ninety-eight complications occurred in 66 patients, but all were successfully solved.
Conclusions: Immediately loaded cross-arch prostheses supported by four to five implants are a viable therapeutic option, if prostheses are made with resistant frameworks.
This section presents a brief review of articles on dental implants considered of special interest for the reader, in order to encourage the development of research, the interest for data analysis and the attention to scientific publications. Your comments are welcome. Please contact Dr Michele Nieri at michelenieri@gmail.com.
Purpose: The aim of this study was to compare clinical and radiographic bone level assessments to intra-surgical bone level registration around implants with peri-implantitis and to identify the clinical variables rendering peri-implant bone level assessment accuracy.
Materials and methods: The study sample included 50 implants with peri-implantitis in 23 patients. Registration methods included probing of the vertical distance between the implant/abutment interface and the bottom of the pocket (= VPD), intraoral radiography, bone sounding without flap elevation and intra-surgically assessed interproximal bone level. The latter was considered the true bone level (gold standard). Twenty clinicians evaluated all radiographs.
Results: VPD and intraoral radiography resulted in a significant underestimation of the true bone level by 1.0 mm (95% CI: 0.495-1.585; P < 0.001) and 2.3 mm (95% CI: 1.650-2.980; P < 0.013) respectively. Bone sounding without flap elevation did not differ significantly from the true bone level (mean difference 0.2 mm; 95% CI: -0.775 - 0.335; P = 0.429). Duplicate magnification registration of 50 implants resulted in excellent intra- and inter-rater reliability (ICC intra ≤ 0.99; ICC inter = 0.964; P < 0.001). Radiographic underestimation was significantly affected by defect depth (P < 0.001). Variation among clinicians was substantial (mean underestimation range 1.1 mm to 3.8 mm); however, clinical experience had no impact on radiographic underestimation (P = 0.796).
Conclusions: Bone sounding without flap elevation was the best predictor of peri-implant bone level, whereas intraoral radiography was the most inferior. Consequently, peri-implantitis may be under-diagnosed if examination is only based on radiographs. Conflict-of-interest statement: Prof Hugo De Bruyn is associated with education and research collaboration agreements with Dentsply Sirona and Southern Implants, on behalf of Ghent University. Prof Cosyn has a collaboration agreement with Nobel Biocare. All other authors declare that they have no conflict of interest.
Purpose: To compare the outcome of dental implants placed following full-thickness flap surgery with flapless surgery in controlled type 2 diabetic patients.
Materials and methods: A total of 92 controlled type 2 diabetic patients, who needed missing mandibular first molars to be replaced by implants, were selected for a single-centre, parallel group, double-blinded randomised controlled trial. Patients were randomly allocated into two groups: flap (46 patients) vs flapless (46 patients) implant placement. Implants were loaded with metal-ceramic crowns, 4 months after placement in both groups.
Outcome measures: Implant and crown success, complications, post-operative pain and swelling, plaque index, sulcular bleeding index, pocket depth and HbA1c level. Follow up examinations were made after 24 h, and on the third and seventh days for soft tissue healing, pain and swelling evaluation; then at 6 months and 12 months (after loading) for dental plaque, sulcular bleeding, pocket depth, and HbA1c level evaluation.
Results: After 16 months of implant placement, no dropouts occurred. Five implants failed, two in the flap group and three in the flapless group (4.34% vs 6.52%, McNemar test P = 1, difference = 0.4457, 95% CI of difference = 4.554 to 47.234). Seven prosthesis failures occurred, three in the flap group and four in the flapless group (McNemar test P = 1; difference = 0.4239; 95% CI of difference = 29.95 to 3.86). Two patients in each group were affected by complications. There were statistically insignificant differences in the incidence of complications between the groups (McNemar test P = 1; difference = 0.457; 95% CI of difference = 90.75 to 5.33). After 24 h, the flapped group patients showed significantly greater pain compared with the flapless group (24 h: P = 0.017, difference = 0.37 and 95% CI = 0.673 to -0.067). After the third and seventh postoperative days, the mean pain level in both groups decreased linearly after the treatments (third day: P = 0.183, difference = 0.19 and 95% CI = -0.472 to 0.092; seventh day: P = 0.225, difference = 0.09 and 95% CI = -0.237 to 0.056). The frequency of post-operative swelling "some + a lot" at the third day was significantly higher in the full thickness flap group compared with the flapless group (P = 0.002, difference = 0.1835 and 95% CI = -0.0409 to 0.4079). Most of the cases in either of the study groups demonstrated no swelling (P =1.00, difference = 0.00 and 95% CI = -0.3034 to 0.3034) on the seventh post-operative day. The mean plaque index (6 months: 1.00 ± 0.47 vs 0.83 ± 0.79, P = 0.230, difference = 0.17 and 95% CI = -0.450 to 0.110 and 12 months: 1.30 ± 0.67 vs 1.04 ± 0.86, P = 0.123, difference = 0.26 and 95% CI = 0.593 to 0.073), mean sulcular bleeding index (6 months: 1.40 ± 0.52 vs 1.04 ± 0.83, P = 0.018, difference = 0.36 and 95% CI = 0.658 to 0.062 and 12 months: 1.90 ± 0.48 vs 1.17 ± 0.57, P
Aims: This review assessed the available evidence on the performance of CAD/CAM monolithic implant-supported restorations bonded to titanium (Ti) inserts and bases, which has become a popular concept.
Materials and methods: An electronic and manual search of PubMed databases was conducted to identify studies published in English between 2000 and 2016 on the performance of monolithic ceramic implant restorations with Ti inserts.
Results: The initial search revealed 505 titles. Full-text screening was carried out for 70 studies, yielding 25 articles that met the inclusion criteria. No clinical studies could be identified regarding the performance of monolithic ceramic restorations bonded to Ti inserts. Laboratory studies on selected aspects and studies on similar prosthetic designs indicate that Ti inserts improve the overall fracture strength of ceramic abutments and crowns, protect the implant connection from wear, and offer a better marginal fit when compared with all-ceramic abutments.
Conclusions: While laboratory studies and evaluations of similar designs indicated promising outcomes, clinical studies that evaluate the performance of CAD/CAM monolithic implant-supported restorations bonded to Ti inserts and bases are needed.
Purpose: To evaluate a possible association between the inter-implant distance and the papilla deficit. Additionally, the effect of high or low contact points of the crowns on the papilla deficit was investigated.
Materials and methods: Periapical radiographs taken 1 year after loading were used to assess the distance from the shoulder of the implant to the adjacent tooth or implant. On the clinical images, the interdental papilla height, soft tissue deficit and crown length were evaluated. The papilla crown proportion and the proportion of the height of the contact point to the crown length were assessed.
Results: Eighty-one patients, with a total of 104 zirconia implants and 208 measurements were involved in this cross-sectional survey. Considering patient means, the correlation between the papilla deficit and the interproximal distance, respectively inter-implant distance, was very low (r = -0.05220; P = 0.6435, N = 81). Logistic regression at implant-level showed that there was no significant difference in the likelihood for a papilla deficit between a high and a low contact point of the crowns with P = 0.8191 (Odds ratio: 1.106 with 95%CI 0.461; 2.654).
Conclusions: Horizontal interproximal dimensions around zirconia implants showed very weak influence on the papilla height. A high or a low contact point position of the crowns did not affect the papilla deficit. Conflict of Interest and sources of funding: All authors reported no conflict of interest. There were no sources of funding for the research.
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