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PubMed2002

Effects of different types of temporary cements on the tensile strength and marginal adaptation of crowns on implants.

PURPOSE: The aim of this study was to evaluate the influence of four different types of temporary cements, Tempbond (Kerr), Tempbond NE (Kerr), Improv (Sterioss), and Dycal (Dentsply/Caulk), on the marginal adaptation and tensile strength of prosthetic specimens cemented on replicas of CeraOne abutments. MATERIALS AND METHODS: Four test groups were formed: Group 1 (G-1), Tempbond (Kerr); Group 2 (G-2), Tempbond NE (Kerr); Group 3 (G-3), Improv (Sterioss); Group 4 (G-4), Dycal (Dentsply/Caulk). For the specimens, gold cylinders (DCB 160, Nobel Biocare) adapted to stainless steel replicas of CeraOne abutments (Nobel Biocare) were utilized. The replicas on a stainless steel base were made in a special machine for implant components. The cement thicknesses for each luting agent were measured using a Measurement Comparative Microscope (Mitutoyo). The readings obtained before cementation were used as the controls (G-0). Following each group's cementation, the specimens were submitted to tensile strength tests with a Universal Testing Machine (Kratus). RESULTS: The results of the marginal adaptation test as reflected by cement thicknesses were: G-0 = 11.7 microm, G-1 = 35.7 microm (+/- 8.8), G-2 = 41.7 microm (+/- 9.0), G-3 = 32.6 microm (+/- 9.7) and G-4 = 38.2 microm (+/- 6.7). The tensile strength tests yielded the following values: G-1 = 58.5 N (+/- 14.8), G-2 = 51 N (+/- 8.2), G-3 = 61.8 N (+/- 17.1) and G-4 = 71.8 N (+/- 9.3). CONCLUSION: The four temporary cements tested all provided similar marginal adaptation. G-4 (Dycal) showed a higher tensile strength than G-2 (Tempbond NE).

Analysis of Variance↗
PubMedDate not supplied

Dental implants and onlay bone grafts in the anterior maxilla: analysis of clinical outcome.

PURPOSE: Loss of alveolar bone in the anterior maxilla may preclude implant placement or compromise positioning and thus diminish the final esthetic result of the restoration. Bone augmentation can overcome such difficulties but may affect osseointegration. The aim of this study was to report the outcome of buccal onlay bone grafting in the anterior maxilla in routine dental implant practice. MATERIALS AND METHODS: Seventeen consecutive patients (12 men and 5 women, mean age 31.4 years) received autogenous bone grafts from the mandibular symphysis to the anterior maxilla. A total of 35 Brånemark System MK II implants were placed in grafted bone. RESULTS: Fifteen patients had a mean period of graft consolidation of 19.7 weeks (range 13 to 32 weeks). Two patients had simultaneous graft and implant placement; 1 implant failed to Integrate in this group. This represents a survival rate of 97.1% of implants in functional loading after a mean follow-up period of 153.6 weeks from occlusal loading (range 74 to 283 weeks). DISCUSSION AND CONCLUSION: Mandibular block onlay grafts appear to be a predictable method for augmenting the width of the anterior maxilla prior to implant placement.

Adolescent↗
PubMedDate not supplied

Immediate functional loading of Brånemark system implants in edentulous mandibles: clinical report of the results of developmental and simplified protocols.

PURPOSE: This report evaluates the 5-year results of 9 of 10 patients in a clinical investigation of immediate functional loading of Brånemark System implants in edentulous mandibles, and of 24 patients treated with a simplified protocol for the same indication. The purpose of the paper is to suggest a simple, reliable, and documented method for immediate implant loading of complete-arch mandibular prostheses. MATERIALS AND METHODS: Ten healthy patients in need of full-arch mandibular implant reconstruction (development group) were treated between December 1993 and December 1994 with 130 Brånemark System standard Implants, placed in fresh extraction and healed sites. Four implants per patient were immediately loaded with acrylic resin fixed prostheses. The prostheses were replaced by metal-framework conversion prostheses approximately 6 weeks later, and definitive metal-reinforced prostheses incorporating all implants were placed after second-stage surgery. An additional 24 patients were treated with a simplified protocol using a total of 144 implants placed between March 1997 and October 2000. In these patients, the acrylic resin prostheses were not disturbed for 3 months, and fewer implants were used with an increasing ratio of implants loaded. Eventually, all Implants were loaded immediately for the last patients treated. RESULTS: The prosthesis survival rate was 100% for the total material. In the developmental group, the implant cumulative survival rate was 80% for the immediately loaded implants after 5 years, while the 2-stage implants reached 96%. Bone level measurements showed no differences between immediate and 2-stage protocols for this group. The implant cumulative survival rate was 97% for the simplified treatment group. DISCUSSION AND CONCLUSION: A predictable and simple concept for loading of immediate implant prostheses in edentulous mandibles was demonstrated. Results from the development of this technique suggest that it may be essential to maintain the initial implant splinting over a healing period of about 3 months and that implant placement between the mental foramina provides optimal support.

Aged↗
PubMedDate not supplied

A clinical study of the efficacy of gold-tite square abutment screws in cement-retained implant restorations.

PURPOSE: The purpose of this study was to record the effectiveness of Gold-Tite square abutment screws, tightened to 35 Ncm with a torque indicator, in maintaining a clinically stable implant/abutment connection. MATERIALS AND METHODS: The study consisted of 73 patients who were treated with 110 Osseotite implants. All patients were restored with either pre-machined titanium or customized UCLA hexed abutments. All abutments were fabricated per the Gold Standard ZR abutment design of Implant Innovations. All of the abutment screws were Gold-Tite square abutment screws. They were torqued to 35 Ncm with a torque indicator at the time of abutment connection. All crown restorations were cemented to the abutments. Patients were followed for at least 1 year post-occlusal loading. RESULTS: Four patients with 6 implants were lost between the 6- and 12-month recall appointments. Clinical assessments of implant/restoration mobility were made by the author. One abutment screw was found to be loose at the 12-month recall appointment, representing a 99% survival rate. DISCUSSION: These results add to the growing evidence that abutment screws with enhanced surfaces may provide increased screw/implant contact, higher rotational values, and calculated preload values. CONCLUSION: The use of the Gold-Tite square abutment screws, torqued to 35 Ncm, maintained a stable implant/abutment connection that was successful in clinical practice for this minimal evaluation period.

Adolescent↗
PubMed2003

[Success rates of implant supported prostheses in partially edentulous patients--Part II].

The use of dental implants is an established procedure for the treatment of partially edentulous patients. However, there is only little knowledge about the prosthetic outcome of implant-supported restorations. The purpose of this prospective long-term study was to evaluate success rates of implant-supported restorations in partially edentulous patients three years after loading. The study group consisted of 76 patients (47 females, 29 males) with 214 3i-implants (machined surface). 64 implants were used to support single crowns, 81 implants for 81 splinted crowns (36 units), 17 implants for seven bridges and 61 implants for 23 cantilevered bridges. For prosthesis construction, UCLA-Abutments were used. Screw connection was achieved by gold-alloy-coated square head screws and titanium hexagon head screws. Clinical follow-up visits were performed at the time of prosthesis insertion, three months, six months, one year, two years and three years after insertion of the prosthesis. The evaluation of the superstructures was performed according to the success criteria defined by Walton (1998). The success rate for the prosthetic reconstructions was estimated at 84.9% 36 months after loading. The success rate was 88.6% for fixed partial dentures, 86.4% for single crowns and 76% for cantilevered bridges. Technical problems included screw loosening, screw fractures, framework fractures, veneering material failures and failures because of implant loss and following remake or modification of the superstructures. Since mainly technical complications such as screw loosening and screw fractures were causing problems, the connection between implant and superstructure should be improved.

Crowns↗
PubMed2003

Single-tooth implants in the maxillary incisor region with immediate provisionalization: 2-year prospective study.

Osseointegrated implants have been increasingly used for aesthetic, predictable restorative treatment. This study presents the 2-year postoperative results of patients treated with immediate, single, tapered implants in the maxillary incisor region and the simultaneous placement of provisional implant-supported crowns. Of the total of 92 implants placed, 6 were lost. Eighty-six implants were reevaluated and judged to have no signs of mobility, peri-implant inflammation, or adverse reactions. When used in selected cases, this technique facilitated maintenance of the gingival architecture adjacent to immediate transalveolar implants.

Crowns↗
PubMed2002

Achieving and maintaining predictable implant esthetics through the maintenance of bone around dental implants.

The position of gingival soft tissues depends on the position and health of the underlying alveolar bone. Implant designs are evolving to maintain bone at predictable positions on the implant body through the development of stable and simplified prosthetic choices in abutment designs. The positioning of the restorative abutment deep inside the implant allows the abutment-implant joint to remain stable for a prolonged service life. With this stability, the titanium abutment allows the connective tissue and junctional epithelial seal ("biological width") to form and remain on the side of the abutment, rather than the side of the implant. Abutment joint stability plus well-defined implant surface topographies allow predictable implant rehabilitation in challenging situations. With the use of a mechanically and biologically stable joint interface, the prosthetic flexibility of a two-piece modular-style implant system allows the greatest flexibility for application in routine surgical and restorative implant dentistry.

Adult↗
PubMed2002

A system for definitive restoration of single-stage implants in one day.

While the Novum system does not offer a solution for immediate loading and restoration of mandibular implants in all patients, it is a valuable treatment option for many individuals. Although the surgery is precise and labor intensive, the fact that no additional (stage 2) surgery is necessary, and that a definitive restorative outcome is possible in a single working day, makes this an appealing treatment option. Current results with this technique in the United States are favorable but short term. Experience in Europe, however, appears to validate this technique, with results that are comparable with the well-documented 2-stage approach.

Dental Implantation, Endosseous↗
PubMed2003

[Resonance frequency analysis in immediate loading of dental implants].

Immediate loading of dental implants aims to shorten treatment time. Stability at implant insertion is critical to success. The aim of this prospective study is to compare primary implant stability, measured by insertion torque (IT) with resonance frequency analysis (RFA) expressed as ISQ. Patients requiring implant therapy were treated by teeth extractions, placement of 1-9 MIS implants, bone augmentation as needed and fixed provisional restorations. We measured IT and ISQ for non-submerged loaded (NSL), non-submerged non loaded (NSNL) and submerged (S) implants. 14 patients, aged 34-79 years, were recruited. 53 implants were inserted (38 maxillary & 15 mandibular). 30 implants, 18 in fresh extraction sites, were immediately loaded. ISQ was 63.3 +/- 2.8 (S.E.), 67.2 +/- 3.5 (S.E.) and 58.8 +/- 2.7 for the NSL, NSNL and S groups, respectively (p = 0.0459). IT was 40.4 +/- 1.8 Ncm, 46 +/- 4.0 and 35.3 +/- 2.1 (p = 0.0646). ISQ and IT were not statistically different between extraction vs. non-extraction and augmented vs. non-augmented sites. We found a significant difference in IT between maxillary & mandibular sites, and a significant correlation between ISQ & IT and between ISQ & implant diameter. These data suggest that ISQ is correlated to IT and is influenced mainly by implant diameter and not by implant length, location or bone level. Finally, a case including immediate implants, bone augmentation and immediate provisional restoration is presented.

Adult↗
PubMed2003

The evolution of external and internal implant/abutment connections.

The indications for implant dentistry continue to increase, enabling the restoration of partially and totally edentulous patients with greater success and predictability. Recent goals for implant dentistry include simplifying the involved procedures, reducing the duration of therapy for the patient and clinician, and enabling the use of conventional prosthodontic techniques for implant-supported restorations. This article reviews key developments in implantology and highlights the various design characteristics of internal abutment connection implants, demonstrating their clinical application in a detailed case presentation.

Dental Abutments↗
PubMed2003

A predictable precision cast for multi-unit screw-retained implant prosthesis: rationale and technique.

The aim of this article is to describe a technique derived from the premachined cylinder luting technique with the goal to predictably fabricate a highly precise master cast. An impression can be taken directly at implant level or, with some technique modification, at the abutment level. Concurrently, multiple techniques can be employed to fabricate the final framework with the assurance that a framework that fits the cast will fit in the mouth. This predictability improves the workflow of the restoring dentist and laboratory technician since multiple framework try-ins and adjustments are eliminated.

Dental Implantation, Endosseous↗
PubMed2003

When is an implant ready for a tooth?

The capability of placing an osseointegrated implant at the time of tooth extraction and immediately placing a restoration on the implant depends upon a number of factors. This paper describes the traditional Brånemark protocol, the evolution of single-stage surgery, the guidelines for immediate placement, the measurement of implant stability, and the considerations critical to immediately loading.

Dental Implantation, Endosseous↗
PubMed2003

Immediate-loading dental endosteal implants and the elderly patient.

The concept of immediately loading dental implants has the potential of being a viable addition to treatment modalities. The major decision-making challenge in managing depleted dentitions and complete edentulism in an aging society lies in differentiating the treatment outcomes, especially patient-mediated assessments (including economic analyses) of the various prosthodontic options available for older adults. The ability to chew properly is of great importance to maintain a healthy nutrition and improve oral comfort and quality of life, particularly in the elderly years.

Aged↗
PubMed2003

The partially edentulous patient: fixed prosthodontics or implant treatment options.

The replacement of missing teeth by conventional fixed partial dentures or by implant supported prostheses occupies a major portion of the average restorative and prosthodontic practice. New materials, techniques, and technologies are constantly being added to our armamentarium. The demand for fixed prosthodontic patient services will continue to grow. It is the ultimate duty of the provider of these services to utilize an evidence-based rationale when determining the best possible treatment for the partially edentulous patient.

Dental Implants, Single-Tooth↗
PubMedDate not supplied

Prototype provisional restorations for implant-supported, full-mouth, metal-ceramic reconstructions: the hybrid technique.

The restoration of fully edentulous patients using fixed, metal-ceramic prostheses is one of the most challenging tasks in aesthetic dentistry. Provisional restorations provide the treatment team with a valuable means of addressing criteria that are required throughout the surgical, prosthetic, and technical stages. They also enable the clinician to place and evaluate a prototype of the definitive restoration in the patient's intraoral environment. This presentation describes a technique for the fabrication of provisional restorations for patients receiving fixed implant prostheses.

Cementation↗
PubMed2003

Implant prosthodontics: what next?

Treatment concepts that are "ideal" from a medical perspective, representing an excellent simulation of missing tissues (alveolar ridge, teeth), are not automatically tantamount to high treatment cost and difficult clinical procedures. An analysis of different treatment concepts has shown that relatively simple implant-borne solutions are made possible by preserving and integrating elements of the residual dentition; by not including complicated and technically elaborate constructions (such as screw fixation, attachments, splints); and by using prefabricated components (abutments shaped extraorally; conical crowns). In this context, there cannot be a single clear-cut answer to the question, "Implant prosthodontics: What next?"; it can be answered only in terms of probabilities. There is one certainty: implant prosthodontics is here to stay, whatever its path and whatever its destination, and it will become established as an essential--a constituent part of current-day dental practice. As so often happens with medical progress, what once was a very specialized treatment modality is becoming a standard procedure. The concomitant cost reduction will allow us to apply treatment concepts that include implant procedures in a much larger number of cases than today.

Alveolar Ridge Augmentation↗
PubMedDate not supplied

Cement- and screw-retained implant-supported prostheses: up to 10 years of follow-up of a new design.

PURPOSE: This retrospective study investigated treatment outcomes over 10 years of a new prosthesis design in implant prosthodontics that uses a combined cement- and screw-retained principle. MATERIALS AND METHODS: The clinical data of 78 implant-supported prostheses were examined. Each prosthesis incorporated at least 1 screw-retained element and 1 or more cement-retained telescopic units. One hundred twenty-four screw-retained and 161 cement-retained abutments were employed. RESULTS: Of the 286 implants placed, 5 were lost prior to prosthetic loading and 4 (1.4%) were lost approximately 14 months after loading. Eight (2.8%) abutment screws were retightened and 1 gold prosthetic screw was replaced after 1,372 days following fracture. No accidental dislodgment of any prosthesis occurred. DISCUSSION: The introduction of a screw retainer into a series of cement retainers permitted the use of weak cement on the telescopic abutments. This facilitated removal when required while preventing accidental dislodgment. Improved equipment and the learning curve decreased the incidence of abutment screw loosening with time. CONCLUSION: The ease of retrievability, allied with the security of seating and excellent appearance, makes the combined screw- and cement-retained prosthesis valuable in implant prosthodontics.

Cementation↗