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Periodontology 2000 Feb 2022Both fixed and removable implant-supported prostheses are well-established methods for replacing missing teeth in partially or fully edentulous patients. Numerous... (Review)
Review
Both fixed and removable implant-supported prostheses are well-established methods for replacing missing teeth in partially or fully edentulous patients. Numerous systematic reviews have been performed in recent years to evaluate the survival and complication rates of implant-retained fixed dental prostheses and implant-retained overdentures, displaying high 5-year survival rates ranging from 97.1% for fixed dental prostheses to 95%-100% for implant-retained overdentures. However, the survival rates only represent the prostheses remaining in use for a defined follow-up time, and do not account for the potential prosthetic complications that may have arisen and influence the general success of the implant treatment. The most common technical complications of fixed implant-retained single crowns are crown fracture, fractures of ceramic implant abutments, and esthetic problems. The predominant technical complication at multiple-unit, implant-retained fixed dental prostheses is fracture/chipping of the veneering ceramic. Reported technical complications for implant-retained overdentures are overdenture fracture or chipping of the veneer materials, whereas mechanical complications include implant fracture, attachment failure, and attachment housing or insert complications. To reduce the risk of such failures, a comprehensive pretreatment diagnostic work-up is essential, including defining the prosthetic goal with the aid of a wax-up or set-up and the associated ideal, prosthetically oriented three-dimensional implant position. Furthermore, selection of the ideal type of prosthesis, including the respective implant components and materials, is important for clinical long-term treatment success.
Topics: Crowns; Dental Implantation; Dental Implants; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Humans
PubMed: 35103329
DOI: 10.1111/prd.12416 -
Journal of Esthetic and Restorative... Jan 2021Emergence profile design is important for stable peri-implant tissues and esthetically pleasing results with dental implant restorations, influenced by factors, such as,...
OBJECTIVE
Emergence profile design is important for stable peri-implant tissues and esthetically pleasing results with dental implant restorations, influenced by factors, such as, implant position and surrounding soft tissues. Different aspects of the emergence profile have been described, but detailed explanations of the different zones and corresponding designs are missing. This article describes the esthetic biological contour concept (EBC), differentiating important areas of the emergence profile and recommending particular designs for those zones.
OVERVIEW
The EBC concept considers specific parameters for proper design of the emergence profile of implant-supported restorations. Understanding the different zones of the emergence profile and their relation to factors like implant position, implant design, and soft tissue thickness is key. The suggested guidelines are geared toward providing more stable and esthetic results when restoring dental implants in the esthetic zone.
CONCLUSIONS
Each of the zones described in the EBC concept have a specific function in the design of the emergence profile. Understanding the importance and specific design features of the EBC zones facilitates esthetic and biologically sound treatment outcomes with interim and definitive implant restorations.
CLINICAL SIGNIFICANCE
Proper emergence profile design supports esthetic outcomes and provides favorable biological response to implant-supported restorations.
Topics: Dental Abutments; Dental Implants; Dental Prosthesis, Implant-Supported; Esthetics, Dental
PubMed: 33470498
DOI: 10.1111/jerd.12714 -
Materials Science & Engineering. C,... Jan 2020New inventions and innovations in the field of dentistry have potential applications to satisfy the patient's demand. In prosthodontics, a dental prosthesis plays a... (Review)
Review
New inventions and innovations in the field of dentistry have potential applications to satisfy the patient's demand. In prosthodontics, a dental prosthesis plays a major role in improving the quality of oral health care. Currently, the trends have shifted towards the implants and implant-supported prosthesis for the replacement of missing teeth. Conventional dentures are patient's preference mainly due to financial constraints. In an attempt to find solutions to current problems, we have come across new materials zirconium, titanium and new inventions like flexible dentures, fenestrated dentures, and CAD/CAM fabricated dentures. Using the progress of past five years in the field of prosthodontics, this comprehensive review focuses on denture base materials, denture liners, removable partial dentures, fixed prosthesis such as crown and bridge materials, implant-supported a fixed denture, artificial teeth materials, impression materials, and ingenious alternatives to conventional dentures. This article also sheds some light on the current promising researches and gives insight into the problems that can be the focus of future researches.
Topics: Crowns; Dental Materials; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Denture, Partial, Removable; Humans; Zirconium
PubMed: 31753414
DOI: 10.1016/j.msec.2019.110167 -
Journal of Periodontology Oct 2019The incidence of a peri-implant soft tissue dehiscence/deficiency (PSTD) is not a rare finding. Despite multiple previous attempts aimed at correcting the PSTDs, a...
BACKGROUND
The incidence of a peri-implant soft tissue dehiscence/deficiency (PSTD) is not a rare finding. Despite multiple previous attempts aimed at correcting the PSTDs, a classification of these conditions has not yet been proposed. This lack in the literature may also lead to discrepancies in the reported treatment outcomes and thus misinform the clinician or the readers. The aim of the present article was therefore to present a classification of peri-implant PSTD at a single implant site.
METHODS
Four classes of PSTDs were discussed based on the position of the gingival margin of the implant-supported crown in relation to the homologous natural tooth. In addition, the bucco-lingual position of the implant head was also taken into consideration. Each class was further subdivided based on the height of the anatomical papillae.
RESULTS
Subsequently, for each respective category a surgical approach (including bilaminar techniques, the combined prosthetic-surgical approach or soft tissue augmentation with a submerged healing) was also suggested.
CONCLUSION
This paper provides a new classification system for describing PSTDs at single implant sites, with the appropriate recommended treatment protocol.
Topics: Crowns; Dental Implantation, Endosseous; Dental Implants, Single-Tooth; Dental Prosthesis, Implant-Supported; Esthetics, Dental; Tooth Crown; Treatment Outcome
PubMed: 31087334
DOI: 10.1002/JPER.18-0616 -
Journal of the American Dental... Aug 2019Management of the full and partially edentulous arch requires an understanding regarding the amount of vertical and horizontal restorative space that is needed for...
BACKGROUND
Management of the full and partially edentulous arch requires an understanding regarding the amount of vertical and horizontal restorative space that is needed for different types of dental implant prostheses. Failure to design a prosthetic construct without considering space issues can result in a rehabilitation with diminished stability, poor esthetics, and inadequate contours. Therefore, available restorative volume must be computed before initiating therapy to ensure proper prosthesis design.
TYPES OF STUDIES REVIEWED
The authors searched the dental literature for articles that addressed space requirements for different types of dental implant prostheses and found a few on this subject.
RESULTS
The dental literature indicates there is a 3-dimensional hierarchy of restorative space necessary for different types of implant constructs. The minimum amount of vertical space required for implant prostheses is as follows: fixed screw-retained (implant level): 4 through 5 millimeters; fixed screw-retained (abutment level): 7.5 mm; fixed cement-retained: 7 through 8 mm; unsplinted overdenture: 7mm; bar overdenture: 11 mm; and fixed screw-retained hybrid: 15mm. These dimensions represent the minimal amount of vertical rehabilitative space that can accommodate the above implant prostheses. With respect to horizontal space, computations are needed to account for the discrepancy between an implant and tooth position.
CONCLUSIONS AND PRACTICAL IMPLICATIONS
Restorative spaces for each type of prostheses are restoration specific and should be considered during treatment planning to facilitate proper case selection and enhance patient satisfaction.
Topics: Dental Implantation; Dental Implants; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Denture, Overlay; Humans
PubMed: 31352966
DOI: 10.1016/j.adaj.2019.04.015 -
Clinical Oral Implants Research Jan 2022To analyze the clinical outcomes of all-ceramic single crowns (SCs) and fixed dental prostheses (FDPs) supported by ceramic implants. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To analyze the clinical outcomes of all-ceramic single crowns (SCs) and fixed dental prostheses (FDPs) supported by ceramic implants.
MATERIALS AND METHODS
Based on a focused question and customized PICO framework, electronic (Medline/EMBASE/Cochrane) and manual searches for studies reporting the clinical outcomes of all-ceramic SCs and FDPs supported by ceramic implants ≥12 months were performed. The primary outcomes were reconstruction survival and the chipping proportion. The secondary outcomes were implant survival, technical complications, and patient-related outcome measurements. Meta-analyses were performed after 1, 2, and 5 years using random-effect meta-analyses.
RESULTS
Eight of the 1,403 initially screened titles and 55 full texts were included. Five reported on monolithic lithium disilicate (LS2) SCs, one on veneered zirconia SCs, and two on veneered zirconia SCs and FDPs, which reported all on cement-retained reconstructions (mean observation: 12.0-61.0 months). Meta-analyses estimated a 5-year survival rate of 94% (95% confidence interval [CI]: 82%-100%) for overall implant survival. Reconstruction survival proportions after 5 years were: monolithic LS2, 100% (95%CI: 95%-100%); veneered zirconia SCs, 89% (95%CI: 62%-100%); and veneered zirconia FDPs 94% (95%CI: 81%-100%). The chipping proportion after 5 years was: monolithic LS2, 2% (95%CI: 0%-11%); veneered zirconia SCs, 38% (95%CI: 24%-54%); and veneered zirconia FDPs, 57% (95%CI: 38%-76%). Further outcomes were summarized descriptively.
CONCLUSIONS
Due to the limited data available, only tendencies could be identified. All-ceramic reconstructions supported by ceramic implants demonstrated promising survival rates after mid-term observation. However, high chipping proportions of veneered zirconia SCs and, particularly, FDPs diminished the overall outcome. Monolithic LS2 demonstrated fewer clinical complications. Monolithic reconstructions could be a valid treatment option for ceramic implants.
Topics: Ceramics; Crowns; Dental Implants; Dental Porcelain; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Humans; Metal Ceramic Alloys; Zirconium
PubMed: 34665900
DOI: 10.1111/clr.13871 -
Journal of Oral Science Oct 2021The recent literature on maxillary implant overdenture (IOD) was reviewed in order to clarify its predictability and establish treatment guidelines. Electronic searches... (Review)
Review
The recent literature on maxillary implant overdenture (IOD) was reviewed in order to clarify its predictability and establish treatment guidelines. Electronic searches were performed using PubMed, and articles about maxillary IOD written after 1990 were reviewed, focusing on the following items: I. implant survival rate, II. maxillary IOD survival rate, III. number of implants, IV. attachment type, V. follow-up period, VI. implant system, and VII. opposing dentition. The review revealed an implant survival rate of 61-100% and an overdenture survival rate of 72.4-100%. The attachments used included bars, balls, locators, and telescope crowns. The minimum and maximum observation periods were 12 months and 120 months, respectively, and the number of implants used for supporting IOD ranged from 2 to 8. At present, there is no strong evidence to indicate that maxillary IOD is clearly superior for all the items examined. However, the existing data indicate that maxillary IOD has almost the same therapeutic effect as fixed implant superstructures, and is a treatment option that can be actively adopted for patients in whom fixed superstructures cannot be applied for various reasons.
Topics: Dental Implants; Dental Prosthesis, Implant-Supported; Denture Retention; Denture, Overlay; Humans; Maxilla
PubMed: 34408111
DOI: 10.2334/josnusd.21-0087 -
The International Journal of... 2020Adequate management of the implant-supported restoration has become an important task when trying to obtain optimal esthetic outcomes. The transgingival area must be...
Adequate management of the implant-supported restoration has become an important task when trying to obtain optimal esthetic outcomes. The transgingival area must be developed to maintain or influence the final appearance of the peri-implant soft tissues. Two distinct zones within the implant abutment/crown can be identified: the critical contour and the subcritical contour. Their design and subsequent alteration may impact the peri-implant soft tissue architecture, including the gingival margin level and zenith, labial alveolar profile, and gingival color. Defining these two areas helps clarify how to process soft tissue contours and may additionally improve the necessary communication with the laboratory. Since there are many protocols for placing implants, it is worthwhile to determine similarities in the contouring and macrodesign of their corresponding provisional restorations. Therefore, the purpose of this paper is to discern the general characteristics of the critical and subcritical contours for provisional restorations made for immediate and delayed implants in order to obtain guidelines for daily clinical practice.
Topics: Crowns; Dental Implants, Single-Tooth; Dental Prosthesis, Implant-Supported; Dental Restoration, Temporary; Gingiva
PubMed: 31815974
DOI: 10.11607/prd.4422 -
Journal of Clinical Periodontology Nov 2022To test whether the emergence profile (CONVEX or CONCAVE) of implant-supported crowns influences the mucosal margin stability up to 12 months after insertion of the... (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
To test whether the emergence profile (CONVEX or CONCAVE) of implant-supported crowns influences the mucosal margin stability up to 12 months after insertion of the final restoration.
MATERIALS AND METHODS
Forty-seven patients with a single implant in the anterior region were randomly allocated to one of three groups: (1) CONVEX (n = 15), implant provisional and an implant-supported crown both with a convex profile; (2) CONCAVE (n = 16), implant provisional and an implant-supported crown both with a concave profile; (3) CONTROL (n = 16), no provisional (healing abutment only) and an implant-supported crown. All patients were recalled at baseline, 6, and 12 months. The stability of mucosal margin along with clinical, aesthetic, and profilometric outcomes as well as time and costs were evaluated. To predict the presence of recession, multivariable logistic regressions were performed and linear models using generalized estimation equations were conducted for the different outcomes.
RESULTS
Forty-four patients were available at 12 months post-loading. The frequency of mucosal recession amounted to 64.3% in group CONVEX, 14.3% in group CONCAVE, and 31.4% in group CONTROL. Regression models revealed that a CONVEX profile was significantly associated with the presence of recessions (odds ratio: 12.6, 95% confidence interval: 1.82-88.48, p = .01) compared with the CONCAVE profile. Pink aesthetic scores amounted to 5.9 in group CONVEX, 6.2 in group CONCAVE, and 5.4 in group CONTROL, with no significant differences between the groups (p = .735). Groups CONVEX and CONCAVE increased the appointments and costs compared with the CONTROL group.
CONCLUSIONS
The use of implant-supported provisionals with a CONCAVE emergence profile results in a greater stability of the mucosal margin compared with a CONVEX profile up to 12 months of loading. This is accompanied, however, by increased time and costs compared with the absence of a provisional and may not necessarily enhance the aesthetic outcomes.
TRIAL REGISTRATION
German Clinical Trials Register; DRKS00009420.
Topics: Crowns; Dental Implants; Dental Implants, Single-Tooth; Dental Prosthesis, Implant-Supported; Esthetics, Dental; Humans
PubMed: 35817419
DOI: 10.1111/jcpe.13696 -
The British Journal of Oral &... Jun 2021In the last few years the dental implants market has grown both in developed and developing countries, and is associated with high aesthetic expectations and well-being.... (Review)
Review
In the last few years the dental implants market has grown both in developed and developing countries, and is associated with high aesthetic expectations and well-being. Although the success rate of commercial implants is high, some problems associated with a lack of initial stability, marginal bony resorption, and periodontal health, remain, especially with immediate placement and loading. The market offers different designs of dental implants, but cylindrical and tapered devices that are fixed to the bone via an external thread are dominant. One lesser-known but potentially useful design is the expandable dental implant (EDI). This paper presents a review of expandable dental implants that encompasses a survey of the literature, published patents, and available commercial devices. We found 15 articles: prospective human trials (n=4), human case reports (n=3), published independent discussions of other articles (n=2), three big animal trials (n=3), and in silico studies (n=3). A total of 73 published patents were found and two expandable dental implants are commercially available to date. We propose a classification system that differentiates between the expansion mechanism and the origin of the expanding action. Some expandable designs have been shown to provide good primary stability, but evidence to date is limited. We encourage future clinical and biomechanical studies to clarify and optimise the potential benefits of these implants.
Topics: Alveolar Bone Loss; Dental Implantation, Endosseous; Dental Implants; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Esthetics, Dental; Humans; Prospective Studies
PubMed: 33865645
DOI: 10.1016/j.bjoms.2020.11.018