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Clinical Oral Implants Research Feb 2016The aim of this systematic review was to analyze post-loading implant loss for implant-supported prostheses in edentulous jaws, regarding a potential impact of implant... (Review)
Review
OBJECTIVES
The aim of this systematic review was to analyze post-loading implant loss for implant-supported prostheses in edentulous jaws, regarding a potential impact of implant location (maxilla vs. mandible), implant number per patient, type of prosthesis (removable vs. fixed), and type of attachment system (screw-retained, ball vs. bar vs. telescopic crown).
MATERIAL AND METHODS
A systematic literature search for randomized-controlled trials (RCTs) or prospective studies was conducted within PubMed, Cochrane Library, and Embase. Quality assessment of the included studies was carried out, and the review was structured according to PRISMA. Implant loss and corresponding 3- and 5-year survival rates were estimated by means of a Poisson regression model with total exposure time as offset.
RESULTS
After title, abstract, and full-text screening, 54 studies were included for qualitative analyses. Estimated 5-year survival rates of implants were 97.9% [95% CI 97.4; 98.4] in the maxilla and 98.9% [95% CI 98.7; 99.1] in the mandible. Corresponding implant loss rates per 100 implant years were significantly higher in the maxilla (0.42 [95% CI 0.33; 0.53] vs. 0.22 [95% CI 0.17; 0.27]; P = 0.0001). Implant loss rates for fixed restorations were significantly lower compared to removable restorations (0.23 [95% CI 0.18; 0.29] vs. 0.35 [95% CI 0.28; 0.44]; P = 0.0148). Four implants and a fixed restoration in the mandible resulted in significantly higher implant loss rates compared to five or more implants with a fixed restoration. The analysis of one implant and a mandibular overdenture also revealed higher implant loss rates than an overdenture on two implants. The same (lower implant number = higher implant loss rate) applied when comparing 2 vs. 4 implants and a mandibular overdenture. Implant loss rates for maxillary overdentures on <4 implants were significantly higher than for four implants (7.22 [95% CI 5.41; 9.64] vs. 2.31 [1.56; 3.42]; P < 0.0001).
CONCLUSIONS
Implant location, type of restoration, and implant number do have an influence on the estimated implant loss rate. Consistent reporting of clinical studies is necessary and high-quality studies are needed to confirm the present results.
Topics: Dental Implantation, Endosseous; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Denture, Overlay; Denture, Partial, Fixed; Humans; Jaw, Edentulous
PubMed: 25664612
DOI: 10.1111/clr.12531 -
International Journal of Environmental... Dec 2019To describe a technique intended to transfer of the intermaxillary and occlusal relationships in a fully digital environment from a complete denture to an...
Full Digital Workflow for the Treatment of an Edentulous Patient with Guided Surgery, Immediate Loading and 3D-Printed Hybrid Prosthesis: The BARI Technique 2.0. A Case Report.
PURPOSE
To describe a technique intended to transfer of the intermaxillary and occlusal relationships in a fully digital environment from a complete denture to an implant-supported 3D-printed hybrid prosthesis (an acrylic resin complete fixed dental prosthesis supported by implants).
METHODS
In edentulous cases, the physiological mandibular position should be determined before the immediate loading procedures. In some cases, the use of interim removable prostheses for a few weeks could be useful to test the new occlusion in centric relation and to verify the prosthetic project. When the correct intermaxillary relationships are achieved, it is difficult to transfer them from the provisional to the final prostheses, as impressions or scans of edentulous arches do not have reference points for intermaxillary records. This paper presents a complex case and the technique used to transfer information from a complete denture to an implant-supported prosthesis with a digital workflow. A prosthetic stent has been used to scan the edentulous mandibular arch and to record the intermaxillary relation.
RESULTS
The delivery of the hybrid implant-supported prostheses was carried out with no problems and minimal occlusal adjustments. The patient was extremely satisfied with the treatment and the situation remained stable at the 1-year follow up.
CONCLUSIONS
The approach described in the present article predictably maintains prosthetic information and allows the delivery of a final implant-supported restoration with the same occlusal relationship as the one tested with the provisional diagnostic dentures.
Topics: Aged; Dental Prosthesis, Implant-Supported; Female; Follow-Up Studies; Humans; Immediate Dental Implant Loading; Male; Middle Aged; Mouth, Edentulous; Printing, Three-Dimensional; Treatment Outcome; Workflow
PubMed: 31861166
DOI: 10.3390/ijerph16245160 -
Journal of Otolaryngology - Head & Neck... Jul 2023Resection of the mandible and temporomandibular joint (TMJ) without formal reconstruction is a devastating condition that negatively affects all aspects of the patient's...
INTRODUCTION
Resection of the mandible and temporomandibular joint (TMJ) without formal reconstruction is a devastating condition that negatively affects all aspects of the patient's life. We have approached the reconstruction of mandibular defects that include the condyle with simultaneous reconstruction with a vascularized free fibular flap (FFF) using Surgical Design and Simulation (SDS) and alloplastic TMJ prosthesis. The objective of this study is to report the functional and quality of life (QOL) outcomes in a cohort of patients that had undergone our reconstructive protocol.
METHODS
This was a prospective case series of adult patients that underwent mandibular reconstruction with FFF and alloplastic TMJ prosthesis at the our center. Pre-operative and post-operative maximum inter-incisal opening (MIO) measurements were collected, and patients completed a QOL questionnaire (EORTC QLQ-H&N35) during those perioperative visits.
RESULTS
Six patients were included in the study. The median patient age was 53 years. Heat map analysis of the QOL questionnaire revealed that patients reported a positive clinically significant change in the domains of pain, teeth, mouth opening, dry mouth, sticky saliva, and senses (relative change of 2.0, 3.3, 3.3, 2.0, 2.0, and 1.0 respectively). There were no negative clinically significant changes. There was a median perioperative MIO increase of 15.0 mm, and this was statistically significant (p = 0.027).
CONCLUSIONS
This study highlights the complexities involved in mandibular reconstruction with involvement of the TMJ. Based on our findings, patients can obtain an acceptable QOL and good function following simultaneous reconstruction with FFF employing SDS and an alloplastic TMJ prosthesis.
Topics: Adult; Humans; Middle Aged; Mandibular Reconstruction; Free Tissue Flaps; Quality of Life; Joint Prosthesis; Temporomandibular Joint; Treatment Outcome
PubMed: 37400904
DOI: 10.1186/s40463-023-00639-4 -
Journal of Indian Prosthodontic Society 2021Surgical resection of the lower jaw due to the presence of a benign or malignant tumor is the most frequent cause of mandibular deviation. Location and extent of the...
Surgical resection of the lower jaw due to the presence of a benign or malignant tumor is the most frequent cause of mandibular deviation. Location and extent of the tumor decide the surgical modality of mandibulectomy to be performed. The clinician must wait for an adequate span of time for completion of the healing and acceptance of the osseous graft before considering a definitive prosthesis. During the inceptive healing period, prosthodontic intervention is of utmost priority for preventing the mandibular deviation. A corrective appliance termed "guide flange prosthesis (GFP)" is indicated to limit this clinical manifestation. The basic intention of rehabilitation is to train the mandibular muscles and to re-establish an acceptable occlusal relationship so that the patient can adequately control the opening and closing movements. This case series describes early prosthodontic management of three patients who had undergone hemimandibulectomy, with different techniques of fabrication of a GFP. The three techniques described consist of two conventional methods of fabrication while the third technique is a new innovative approach.
Topics: Humans; Malocclusion; Mandible; Mandibular Osteotomy; Mandibular Prosthesis; Mandibular Prosthesis Implantation
PubMed: 33938873
DOI: 10.4103/jips.jips_12_21 -
Clinical and Experimental Dental... Aug 2021We aimed to analyse age-related anatomical changes in teeth and mandibular structures using panoramic radiographs.
OBJECTIVES
We aimed to analyse age-related anatomical changes in teeth and mandibular structures using panoramic radiographs.
MATERIALS AND METHODS
We included 471 subjects aged 13-70 years (mean, 35.12 ± 18.72 years). Panoramic radiographs were used to record intraoral condition and radiomorphometric parameters. After grouping the subjects by age decade, descriptive statistics and analysis of variance were performed to assess age-related patterns.
RESULTS
The number of missing teeth, endodontically treated teeth, full veneer crowns, and implant prosthesis increased with age (all p < .05). The prevalence of periodontitis significantly increased after the 40s and was the highest in the 60s (57.1%). The maxillary canine root was the longest in the 10s and 20s (p < .001). With age, the mandibular canal and mental foramen moved towards the alveolar bone crest, on the opposite side of the mandibular inferior border. The pulp area and pulp-to-tooth ratio of maxillary/mandibular first molars were significantly higher in the 10s and 20s than in other age groups (all p < .05).
CONCLUSIONS
We provided comprehensive information on age-related anatomical changes in teeth and mandibular structures based on panoramic radiographs. Various radiographic parameters showed specific changes with increasing age. Assessing these age-related changes can be useful in determining an individual's age, and may aid in medico-legal and forensic judgments.
Topics: Humans; Mandible; Mandibular Canal; Maxilla; Molar; Radiography, Panoramic
PubMed: 33305888
DOI: 10.1002/cre2.375 -
Cureus May 2023Aim This study's objective was to assess and analyze, using 3D Finite Element Analysis, the impact of four mandibular complete arch superstructures on the distribution...
Aim This study's objective was to assess and analyze, using 3D Finite Element Analysis, the impact of four mandibular complete arch superstructures on the distribution of stress in the crestal bone during mandibular flexure. Materials and methods Four Finite element models of the mandible with different implant-retained framework designs have been developed. Three of these models had six axial implants placed at intervals of 11.8 mm, 18.8 mm and 25.8 mm from the midline, respectively. One model had two tilted implants and four axial implants splinted with a single piece of framework at intervals of 8.4 mm, 13.4 mm and 18.4 mm from the midline. For analyzing the stress distribution, the finished product was transferred to ANSYS R 18.1 software (Sirsa, Haryana, India) for finite element simulation, the models were constructed, the ends were restrained, and bilateral vertical loads of 50N, 100N and 150N were applied to the distal part of the framework. Results Bilateral loads were applied to each of the four 3D FEM and after assessment of Von Mises Stress and Total Deformation, a finding was made that the model with six axial implants supported by a single piece of framework underwent the highest total deformation and the model with four axial implants and two implants with distal tilts displayed most significant Von Mises stress. Conclusion Within the constraints of this 3D FEA, it was determined that mandibular flexure and peri-implant bone stress were affected by the way the framework is divided and the nature of mandibular movement. The three types of frames with the least bone stress are demonstrated by the mandibular deformation that results from two-piece frameworks on axial implants. Regardless of the number of implants, the single framework splinted with six implants shows a flexure in mandible with the highest bone stress around the implant irrespective of the angulation of the implant. Clinical significance When it comes to edentulous jaws, reducing stress in implant-supported restorative systems at varying degrees of the bone and implant interfaces and superstructures of prosthetics is one of the fundamental goals of implant treatment. A framework with proper design and a low modulus of elasticity reduces mechanical risk. Additionally, a larger number of implants helps to prevent cantilevers and spacing between the implants.
PubMed: 37378222
DOI: 10.7759/cureus.39357 -
BioMed Research International 2018The purpose of this study was to evaluate and compare the effect of three mandibular full-arch superstructures on the peri-implant bone stress distribution during...
PURPOSE
The purpose of this study was to evaluate and compare the effect of three mandibular full-arch superstructures on the peri-implant bone stress distribution during mandibular flexure caused by mid-opening (27 mm) and protrusion mandibular movements.
MATERIALS AND METHODS
Three-dimensional finite element models were created simulating six osseointegrated implants in the jawbone. One model simulated a 1-piece framework and the other simulated 2-piece and 3-piece frameworks. Muscle forces with definite direction and magnitude were exerted over areas of attachment to simulate multiple force vectors of masticatory muscles during mandibular protrusion and opening.
RESULTS
During the movement of 27.5 mm jaw opening, the 1-piece and 3-piece superstructures showed the lowest values of bone stress around the mesial implants, gradually increasing towards the distal position. During the protrusion movement, bone stress increased compared to opening for any implant situation and for a divided or undivided framework. The 3-piece framework showed the highest values of peri-implant bone stress, regardless of the implant situation.
CONCLUSIONS
The undivided framework provides the best biomechanical environment during mandibular protrusion and opening. Protrusion movement increases the peri-implant bone stress. The most mesial implants have the lowest biomechanical risk.
Topics: Biomechanical Phenomena; Computer Simulation; Finite Element Analysis; Humans; Mandible; Mandibular Prosthesis; Models, Biological; Prosthesis Design; Stress, Mechanical
PubMed: 29805978
DOI: 10.1155/2018/8241313 -
Medicina (Kaunas, Lithuania) Feb 2022: Edentulism is considered to be an impediment impacting both patients' quality of life and their nutrition. Conventional complete dentures are still a preferred...
: Edentulism is considered to be an impediment impacting both patients' quality of life and their nutrition. Conventional complete dentures are still a preferred treatment. However, there is no consensus on the most important factors which could substantially reduce the risk of patient dissatisfaction. This study evaluated the following determinants concerning patient satisfaction with complete maxillary and mandibular dentures: sex, denture-related functional and aesthetic aspects, and the degree of bone resorption. : This study included 70 patients aged 34-81 years of age. All complete dentures were made by following the same technology. Visual analogue scales were used to assess patients' overall satisfaction with dentures, comfort, ability to speak and chew, denture aesthetics, stability, and ease of prosthesis cleaning. Satisfaction with upper and lower dentures was rated separately. The degree of bone resorption was classified by using the Kalk and de Baat (1989) method. : The mean (SD) age of the study participants was 67.3 (10.4) years; 65.7% ( = 46) were females and 34.3% ( = 24) were males. There were no significant sex-based differences in resorption of the maxilla or mandibula. There were significant differences between maxillary and mandibular dentures, with lower mean satisfaction scores concerning chewing and maxillary complete dentures, and in regard to stability and comfort for mandibular complete dentures. There was a non-significant overall lower satisfaction with increased age. In multivariate analysis for mandibular complete dentures, aesthetics and stability significantly predicted the patient's comfort levels, and the patient's comfort significantly predicted overall satisfaction. For maxillary complete dentures, patient comfort and aesthetics significantly predicted overall patient satisfaction. : Age, sex, and degree of resorption were not associated with patient satisfaction with complete dentures. Overall, patient satisfaction with both maxillary and mandibular complete dentures was related to their comfort level and denture aesthetics, and patient comfort itself was associated with stability of the mandibular denture.
Topics: Adult; Aged; Aged, 80 and over; Denture Retention; Denture, Complete; Female; Humans; Male; Middle Aged; Mouth, Edentulous; Patient Satisfaction; Quality of Life
PubMed: 35334520
DOI: 10.3390/medicina58030344 -
Bioengineering (Basel, Switzerland) Aug 2022Compared to conventional prostheses with homogenous structures, a stress-optimized functionally gradient prosthesis will better adapt to the host bone due to its...
Compared to conventional prostheses with homogenous structures, a stress-optimized functionally gradient prosthesis will better adapt to the host bone due to its mechanical and biological advantages. Therefore, this study aimed to investigate the damage resistance of four regular lattice scaffolds and proposed a new gradient algorithm for stabilized and lightweight mandibular prostheses. Scaffolds with four configurations (regular hexahedron, regular octahedron, rhombic dodecahedron, and body-centered cubic) having different porosities underwent finite element analysis to select an optimal unit cell. Meanwhile, a homogenization algorithm was used to control the maximum stress and increase the porosity of the scaffold by adjusting the strut diameters, thereby avoiding fatigue failure and material wastage. Additionally, the effectiveness of the algorithm was verified by compression tests. The results showed that the load transmission capacity of the scaffold was strongly correlated with both configuration and porosity. Scaffolds with regular hexahedron unit cells can withstand stronger loads at the same porosity. The optimized gradient scaffold showed higher porosity and lower maximum stress than the target stress value, and the compression tests also confirmed the simulation results. A mandibular prosthesis was established using a regular hexahedron unit cell, and the strut diameters were gradually changed according to the proposed algorithm and the simulation results. Compared with the initial homogeneous prosthesis, the optimized gradient prosthesis reduced the maximum stress by 24.48% and increased the porosity by 6.82%, providing a better solution for mandibular reconstruction.
PubMed: 36134969
DOI: 10.3390/bioengineering9090424