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Fernandes G, Aras M, Chitre V, Coutinho I, Mascarenhas K. Rehabilitation of Edentulous Arch Using All-on-Four Treatment Protocol: A Case Report. Cureus 2024; 16:e58919. [PMID: 38800271 PMCID: PMC11121617 DOI: 10.7759/cureus.58919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 05/29/2024] Open
Abstract
In edentulous arches, alveolar ridge atrophy after tooth extraction is a common problem that affects patient comfort and quality of life. Implant-supported fixed restorations are a well-proven treatment option for edentulism. The concepts of implant dentistry have developed over time to produce better aesthetics and functional results. To reduce cantilever length and enable prostheses with 12 teeth, the all-on-four technique entails inserting two anterior implants axially and distally orienting two posterior implants. Compared to conventional loading, immediate loading offers various benefits without compromising quality. An instantaneous fixed provisional allows patients immediate function and preserves their quality of life while also promoting a high degree of patient satisfaction in terms of aesthetics, phonetics, mastication, and psychological comfort.
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Affiliation(s)
- Grazina Fernandes
- Department of Prosthodontics and Crown and Bridge, Goa Dental College and Hospital, Panaji, IND
| | - Meena Aras
- Department of Prosthodontics and Crown and Bridge, Goa Dental College and Hospital, Panaji, IND
| | - Vidya Chitre
- Department of Prosthodontics and Crown and Bridge, Goa Dental College and Hospital, Panaji, IND
| | - Ivy Coutinho
- Department of Prosthodontics and Crown and Bridge, Goa Dental College and Hospital, Panaji, IND
| | - Kennedy Mascarenhas
- Department of Prosthodontics and Crown and Bridge, Goa Dental College and Hospital, Panaji, IND
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Minase DA, Sathe S, Borle A, Pathak A, Jaiswal T. Less Is More: A Case Report on All-on-4 Prosthesis. Cureus 2024; 16:e54873. [PMID: 38533146 PMCID: PMC10964220 DOI: 10.7759/cureus.54873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/25/2024] [Indexed: 03/28/2024] Open
Abstract
Severe alveolar ridge atrophy following tooth removal poses a common and worsening issue in edentulous jaws, affecting patient comfort and quality of life. The All-on-4 approach involves axially positioning two anterior implants and distally orienting two posterior implants, reducing cantilever length and enabling prostheses with 12 teeth. This less invasive option, utilizing distal tilting of implants at 30°, offers biomechanical advantages and has shown short-term success, though long-term research is limited. Immediate-loading treatments are gaining popularity for their high survival rates. Understanding the biomechanics of implant-supported prostheses is crucial for long-term success, emphasizing the importance of optimal occlusal schemes. Challenges such as bone defects and surgical complexity have led to the exploration of achieving full-arch fixed restorations with fewer implants, building upon Brånemark's early work with four implants. The All-on-4 concept, originating in 1999, proves to be a viable treatment option, providing excellent long-term results and improved load distribution in challenging clinical circumstances. This case report explores the successful rehabilitation of a jaw using the All-on-4 implant prosthesis concept, a technique strategically placing four implants in completely edentulous jaws to support a fixed, immediately loaded prosthesis.
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Affiliation(s)
- Dhanashree A Minase
- Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Seema Sathe
- Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anjali Borle
- Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ankita Pathak
- Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tanvi Jaiswal
- Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Gaikwad A, Rachh P, Raut K. Critical evaluation of YouTube videos regarding the all-on-4 dental implant treatment concept: A content-quality analysis. J Prosthet Dent 2024:S0022-3913(23)00821-1. [PMID: 38216377 DOI: 10.1016/j.prosdent.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/02/2023] [Accepted: 12/05/2023] [Indexed: 01/14/2024]
Abstract
STATEMENT OF PROBLEM Rehabilitation of complete edentulous arches by using the all-on-4 dental implant treatment concept is a well-established procedure. Considering the popularity of YouTube as a source for health-related information, a thorough investigation of the content-quality and reliability of videos regarding the all-on-4 concept is lacking. PURPOSE The purpose of this cross-sectional analysis was to critically appraise the content-quality and reliability of YouTube videos regarding the all-on-4 dental implant treatment concept as a source of information for patients, students, and dentists. MATERIAL AND METHODS A comprehensive search was performed on the YouTube website using the specific keyword "All-on-4," which was identified as the most appropriate search term by the Google Trends website. Only English language videos regarding the all-on-4 dental implant treatment concept were included for systematic analyses. Following the eligibility criteria, the included videos were assessed for their demographic characteristics and quality-content. Based on the content score, the videos were categorized as low content (LC) and moderate + high content (MHC) groups. Further, qualitative analyses were performed by using the DISCERN tool and a global quality (GQ) scale. Statistical analyses were conducted by using the Mann-Whitney U test and the Spearman correlation analysis (α=.05). RESULTS Of 250 screened videos, only 73 were eligible for final analyses. The included videos presented an average 123 846 (range, 4 to 3 182 404) views with a mean duration of 528 (range, 12 to 1699) seconds. In addition, the average number of likes was 1122 (range, 0 to 3300), but, remarkably, none of the included videos received any dislikes. Overall, the mean content-quality score was 6.2 ±3.8, thus indicating low-quality content. The average DISCERN and GQ scores were 47.73 ±9.94 and 3.41 ±0.95, with the Spearman rank correlation test showing a strong positive correlation (r=.732; P<.001) among the total obtained scores. Moreover, statistically significant differences were reported between the LC and MHC groups for both DISCERN and GQ scores (P<.001). CONCLUSIONS The reliability of YouTube videos regarding the all-on-4 dental implant treatment concept is questionable, as they exhibit poor content-quality, thus making them an unreliable source for patients, students, and dentists seeking accurate information.
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Affiliation(s)
- Amit Gaikwad
- Associate Professor, Department of Prosthodontics and Crown & Bridge, MGM Dental College and Hospital, Navi-Mumbai, Maharashtra, India; Doctoral Researcher, Lower Saxony Centre for Biomedical Engineering, Implant Research and Development (NIFE), Hannover Medical School, Hanover, Germany; and Department of Prosthetic Dentistry and Biomedical Materials Science, Hannover Medical School, Hanover, Germany.
| | - Pranidhipurnima Rachh
- Graduate student, Department of Prosthodontics and Crown & Bridge, MGM Dental College and Hospital, Navi-Mumbai, Maharashtra, India
| | - Kaustubh Raut
- Graduate student, Department of Prosthodontics and Crown & Bridge, MGM Dental College and Hospital, Kamothe, Navi-Mumbai, Maharashtra, India
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Wang PS, Tsai MH, Wu YL, Chen HS, Lei YN, Wu AYJ. Biomechanical Analysis of Titanium Dental Implants in the All-on-4 Treatment with Different Implant-Abutment Connections: A Three-Dimensional Finite Element Study. J Funct Biomater 2023; 14:515. [PMID: 37888180 PMCID: PMC10606984 DOI: 10.3390/jfb14100515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/08/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023] Open
Abstract
The type of implant-abutment connection is one of the factors influencing the distribution of occlusal forces. This study aims to investigate the biomechanical performance of the mandibular all-on-4 treatment with different implant-abutment connections. Two connection types with 30° abutments and 18-mm implant fixtures were chosen for the posterior implants of the all-on-4 assembly. For the external hexagon connection (EHC) group, the implants with 4 mm in diameter were used. For the internal hexagon connection (IHC) group, we selected implants with 4.3 mm in diameter. A vertical force of 190 N was applied to the cantilever region. The FEA results indicated that the most stressed region in the two groups was prosthetic screws, followed by multi-unit abutments (MUAs). The lowest values of von Mises stress were both observed on the bone. The peak stress value of the implant screw and implant fixture in the EHC group were 37.75% and 33.03% lower than the IHC group, respectively. For stress distribution patterns, the load force tended to be concentrated at locations where components were interconnected. The EHC and IHC are clinically durable under the tested loading conditions, but the prosthetic screws and MUAs can be the weak point on the posterior implant within the mandibular all-on-four assembly. The peak stress values of implant screw and implant fixture in the EHC groups were lower than the IHC group.
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Affiliation(s)
- Pei-Shuang Wang
- Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Ming-Hsu Tsai
- Department of Mechanical Engineering, Cheng Shiu University, Kaohsiung 833, Taiwan
| | - Yu-Ling Wu
- Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Hung-Shyong Chen
- Department of Mechanical Engineering, Cheng Shiu University, Kaohsiung 833, Taiwan
- Center for Environmental Toxin and Emerging-Contaminant Research, Cheng Shiu University, Kaohsiung 833, Taiwan
| | - Yao-Ning Lei
- Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Aaron Yu-Jen Wu
- Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
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Corrêa-Silva M, de Vicq Normande Neto H, de Oliveira-Neto OB, Ostetto S, Sales PHDH, de Lima FJC. Effectiveness of palatally positioned implants in severely atrophic edentulous maxillae: a systematic review. Oral Maxillofac Surg 2023; 27:1-8. [PMID: 35301604 DOI: 10.1007/s10006-022-01055-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/06/2022] [Indexed: 11/24/2022]
Abstract
The purpose of this systematic review was to define the effectiveness of palatally positioned dental implants placed in atrophic maxillae. Searches were performed in five databases including the gray literature, up to August 2021, by 2 independent reviewers, in order to answer the following research question: Is the palatal approach technique effective in the rehabilitation of atrophic maxillae? In the initial search, 1948 articles were found and after applying the inclusion and exclusion criteria, five studies were selected, none of which was a randomized clinical trial. A total of 681 implants were placed, 549 of them with a palatal approach and 132 at the alveolar crest, with an effectiveness of 98.38% and 99.5%, respectively, with no statistically significant difference between the groups. In assessing the risk of bias, only one of the studies had a low risk of bias. Implants installed with the palatal approach technique showed high effectiveness for rehabilitation of atrophic maxilla; however, few studies in the literature report this technique, requiring more controlled studies, and with less risk of bias, to confirm the results obtained in this systematic review.
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Affiliation(s)
- Matheus Corrêa-Silva
- Hospital das Clínicas of University of São Paulo Medical School, São Paulo, Brazil
| | | | | | | | - Pedro Henrique da Hora Sales
- Department of Prothesis and Oral and Maxillofacial Surgery, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, Pernambuco, 50670-901, Brazil.
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Zhang Y, Li S, Di P, Zhang Y, Wu A, Lin Y. Comparison of 4‐ or 6‐implant supported immediate full‐arch fixed prostheses: A retrospective cohort study of 217 patients followed up for 3–13 years. Clin Implant Dent Relat Res 2022; 25:381-397. [PMID: 36522852 DOI: 10.1111/cid.13170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Choosing four or six implants to support immediate full-arch fixed prostheses (FAFPs) is still controversial worldwide. This study aims to analyze and compare the long-term results of All-on-4 and All-on-6. MATERIALS AND METHODS This retrospective cohort study enrolled 217 patients rehabilitated with 1222 implants supporting 271 FAFPs, including 202 prostheses supported by 4 implants (All-on-4 group) and 69 prostheses supported by 6 implants (All-on-6 group), and followed up for 3-13 years. Implant survival, prosthesis survival, complications, and implant marginal bone loss (MBL) were evaluated and compared between two groups. Patient characteristics including age, gender, jaw, opposite dentition condition, smoking habit, bruxism, bone quantity and quality, cantilever length (CL), prosthesis material, and oral hygiene were analyzed to assess their influence on the clinical results of the two groups. Six surgeons and three prosthodontists who performed FAFPs more than 5 years were invited for questionnaires, to assess patient- and clinician-related influences on implant number. RESULT In general, All-on-4 group indicated no significant difference with All-on-6 group in the implant survival (implant-level: hazard ratio [HR] = 1.0 [95% confidence interval (CI): 0.8-1.2], P = 0.96; prosthesis-level: HR = 0.8 [95% CI: 0.3-1.8], P = 0.54), prosthesis survival (odds ratio [OR] = 0.8 [95% CI: 0.3-2.8], P = 0.56), biological complications (OR = 0.9 [95% CI: 0.5-1.8], P = 0.78), technical complications of provisional prosthesis (OR = 1.3 [95% CI: 0.7-2.3], P = 0.42), technical complications of definitive prosthesis (OR = 1.1 [95% CI: 0.6-2.2], P = 0.33) and the 1st, 5th, and 10th year MBL (P = 0.65, P = 0.28, P = 0.14). However, for specific covariates, including elderly patients, opposing natural/fixed dentition, smoking, bruxism, long CL, low bone density, and all acrylic provisional prostheses, All-on-6 was more predictable in some clinical measurements than All-on-4. The implant prosthodontists and the medium-experienced clinicians showed significant preference for All-on-6 (P < 0.05). CONCLUSION Based on this study, the long-term clinical results showed no significant difference between All-on-4 and All-on-6 groups in general. However, for some specific characteristics, All-on-6 seemed to be more predictable in some clinical measurements than All-on-4. For the clinicians' decision-making, medium-experienced clinicians and the implant prosthodontists showed significant preference for All-on-6.
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Affiliation(s)
- Yan Zhang
- Department of Oral Implantology Peking University School and Hospital of Stomatology Beijing People's Republic of China
| | - Sha Li
- Department of Oral Implantology Peking University School and Hospital of Stomatology Beijing People's Republic of China
| | - Ping Di
- Department of Oral Implantology Peking University School and Hospital of Stomatology Beijing People's Republic of China
| | - Yu Zhang
- Department of Oral Implantology Peking University School and Hospital of Stomatology Beijing People's Republic of China
| | - Aozhou Wu
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Ye Lin
- Department of Oral Implantology Peking University School and Hospital of Stomatology Beijing People's Republic of China
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Rico ÁMS, Fernández ABM, Martínez EB, López AJE, Valadés RF, Plaza AM. Prosthetic restoration with virtual planned subperiosteal implant in adult patient with cleft lip and palate with severe sequelae. ANNALS OF 3D PRINTED MEDICINE 2022. [DOI: 10.1016/j.stlm.2022.100095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Biomechanical Effects of Bone Atrophy, Implant Design, and Vertical or Tilted of Posterior Implant on All-on-Four Concept Implantation: Finite Element Analysis. J Med Biol Eng 2022. [DOI: 10.1007/s40846-022-00725-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Ebeid K, Nouh I, Ashraf Y, Cesar PF. Accuracy of different laboratory scanners for scanning of implant-supported full arch fixed prosthesis. J ESTHET RESTOR DENT 2022; 34:843-848. [PMID: 35441805 DOI: 10.1111/jerd.12918] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/04/2022] [Accepted: 04/09/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study evaluated the accuracy of different laboratory scanners (LS) for scanning of implant-supported full arch fixed prosthesis with different implant angulations. MATERIALS AND METHODS Two maxillary models that are designed to receive an all-on-four implant retained prosthesis were fabricated then scanned using five different LS. The models were divided into two groups according to the angulation of the posterior implant (Group 1; 30° and group 2; 45°). Each group was then subdivided into five subgroups according to the type of LS, subgroup T; Medit T710, subgroup I; IneosX5, subgroup E; 3ShapeE4, subgroup A; Autoscan DS-Mix, and subgroup M; Ceramill Map600. An industrial 3D scanner was used as reference scanner, then each model was scanned with 5 LS 10 times. Trueness and precision were analyzed using Geomagic 3D analysis software. RESULTS Both scanner type and implant angle had a significant effect on the trueness (p < 0.001). Significant interaction was found between the scanner type and implant angle (p < 0.001). For scanner type tukeys post hoc test revealed highest trueness with the 3Shape E4 (21.3 ± 2.1) and the medit T710 (22.6 ± 2.1) and least trueness with the shining 3D autoscan ds-mix (33.8 ± 3.0). Significantly better trueness was observed with the 30° than the 45° angle. Regarding precision, two-way ANOVA revealed significant effect of the scanner type only (p < 0.001). There were no significant differences between the 3Shape E4, medit T710, Ineos X5, and the Ceramill map600. However, all showed significantly higher precision values when compared to shining 3D autoscan ds-mix. CONCLUSIONS All tested scanners showed results within the clinically acceptable range with 3ShapeE4 and Medit T710 showing the highest accuracy. CLINICAL SIGNIFICANCE Tested scanners can be used for scanning of All-on-four implant supported prosthesis.
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Affiliation(s)
- Kamal Ebeid
- Department of Fixed Prosthodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Ingy Nouh
- Department of Fixed Prosthodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Yasmine Ashraf
- Department of Fixed Prosthodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Paulo F Cesar
- Department of Biomaterials and Oral Biology, Faculty of Dentistry, University of São Paulo, São Paulo, Brazil
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Krennmair S, Malek M, Forstner T, Krennmair G, Stimmelmayr M, Hunger S. Immediately loaded implants simultaneously placed in fresh extraction and healed sites supporting four-implant-supported fixed mandibular prostheses using the all-on-4 concept: A 5-year prospective study. Clin Oral Implants Res 2021; 33:158-171. [PMID: 34800325 DOI: 10.1111/clr.13879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 10/18/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the peri-implant marginal bone level for immediately loaded implants placed simultaneously in both fresh extraction sites (FES) and healed sites (HS) supporting a 4-implant supported mandibular fixed prosthesis (4-ISFMP) using the all-on-4 concept. MATERIAL AND METHODS A 5-year prospective study was conducted in 24 patients (96 implants) treated with 4-ISFMP including 55 implants inserted in FES and 41 implants in HS. At implant placement (baseline) and at the 1st -, 3rd - and 5th -year follow-up examinations, peri-implant marginal bone level was evaluated radiographically and compared between placement in FES and HS. Marginal bone loss was calculated as the difference in the marginal bone level evaluated at the follow-up periods. Additionally, implant and prosthesis survival rates as well as the presence of peri-implant mucositis (bleeding on probing+[BOP]) and peri-implantitis (BOP+ >2 mm MBL) were evaluated. RESULTS 22/24 patients with 88/96 implants (dropout rate: 8.3%) were continually followed for 5 years (survival rate: 100%). Radiographically measured marginal bone level differed significantly between FES and HS at implant placement (1.46 ± 0.80 mm vs. 0.60 ± 0.70 mm; p < .001), at the 1-year (-0.04 ± 0.14 mm vs. -0.18 ± 0.20 mm; p = .002) and 3-year (-0.26 ± 0.49 mm vs. -0.58 ± 0.48 mm, p = .049), but not at the 5-year evaluation (-0.90 ± 0.66 mm vs. -1.00 ± 0.59 mm, p = .361). The marginal bone loss differed significantly (p < .001) between FES and HS between implant placement and the 1-year evaluation but not for the 1- to 3-year (p > .99) and the 3- to 5-year period (p = .082). At the 5-year follow-up evaluation, no implant/prosthesis failed (100% survival) and peri-implant mucositis and peri-implantitis were noted in 41.2% and 11.7% at patient level and in 17.6% and 4.5% at implant level respectively. CONCLUSION Implants placed in FES showed a prolonged peri-implant remodelling process but provided for similar peri-implant marginal bone levels as implants placed in HS at the 5-year evaluation for immediately loaded 4-ISFMP.
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Affiliation(s)
- Stefan Krennmair
- Department of Oral & Maxillofacial Surgery, Johannes Kepler University Linz, Linz, Austria
| | - Michael Malek
- Department of Oral & Maxillofacial Surgery, Johannes Kepler University Linz, Linz, Austria
| | - Thomas Forstner
- Department of Oral & Maxillofacial Surgery, Johannes Kepler University Linz, Linz, Austria.,Department of Applied Systems Research Statistics, Johannes Kepler University Linz, Linz, Austria
| | - Gerald Krennmair
- Dental School, Sigmund Freud Private Medical University Vienna, Austria
| | | | - Stefan Hunger
- Department of Oral & Maxillofacial Surgery, Johannes Kepler University Linz, Linz, Austria
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Clinical Effect and Aesthetic Observation of All-on-4 Immediate Loading Implant Denture in Severe Periodontitis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:3120260. [PMID: 34462640 PMCID: PMC8403045 DOI: 10.1155/2021/3120260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/12/2021] [Indexed: 12/17/2022]
Abstract
Objective To explore the clinical effect and aesthetics of All-on-4 immediate loading implant denture in severe periodontitis. Methods Totally, 60 patients with dentition loss caused by severe periodontitis who were admitted to our hospital from February 2017 to February 2019 were selected. The patients were randomly divided into the observation group (n = 30) and the control group (n = 30) according to different restoration methods. The control group was used in traditional implant restoration treatment, and the observation group was used in All-on-4 immediate loading implant denture restoration. The clinical effect, periodontal index, aesthetic effect, and complications of the two groups were compared, and the levels of serum leptin (LEP), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and interleukin-6 (IL-6) were measured. Results The total effective rate of the observation group (83.33%) was higher than that of the control group (60.00%) (P < 0.05). After treatment, the plaque index, gingival sulcus bleeding index, and depth of exploration of the two groups were lower than those before treatment (P < 0.05), and there was no significant difference between the two groups (P > 0.05). After treatment, the serum LEP, TNF-α, CRP, and IL-6 in both groups were lower than before treatment, and the serum LEP, TNF-α, CRP, and IL-6 in the observation group were lower than that in the control group (P < 0.05). The aesthetic rate of teeth in the observation group (90.00%) was higher than that in the control group (66.67%) (P < 0.05). There was no significant difference in the total incidence of complications between the two groups (P > 0.05). Conclusion All-on-4 immediate loading implant denture has a good effect in the treatment of severe periodontitis, which is conducive to maintaining periodontal health, reducing the level of inflammation, improving aesthetics, and has high safety.
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Development of a lead foil crown delineation technique for implant rehabilitations to generate patient specific finite element model of occlusal loading points. MethodsX 2021; 8:101373. [PMID: 34430269 PMCID: PMC8374443 DOI: 10.1016/j.mex.2021.101373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/26/2021] [Indexed: 11/23/2022] Open
Abstract
Understanding the clinical biomechanical basis of dental implant supported functional rehabilitation of edentulous jaws improves precision, longevity and overall success of a planned treatment. Stress distribution pattern around dental implants is an important determinant for rate of bone resorption around them. During planning the treatment for most prosthetic rehabilitations, the surgeon uses a software to virtually plan the dimension, position and angulation of the implants considering only the quantity of available bone in the area of interest but does not usually consider the strain generated around the implants after prosthetically loading them. We hence hypothesise that dental implants not be subjected to abnormal strain they should be positioned and angulated not only based on volume of bone available but also based on the vector of occlusal load. The virtual FEA model to analyse the stress distribution would hence require alveolar bone with future tooth/ teeth in centric relation to be modelled. This paper proposes a simple innovative technique to develop a 3D FE model of occlusal loading surface by using a radio-opaque malleable lead foil to generate a patient specific FE model. This would greatly minimise modelling errors and also help determine the best position of the dental implant based on both the volume of bone in the CT scan and the results of FE analyses.Functional rehabilitation using dental implant supported prosthesis needs to be biomechanically analysed to know and understand the stress distribution pattern around the implant. When teeth (Loading points) are missing, patient specific virtual model of occlusal loading points cannot be generated. ‘Lead foil crown delineation technique’ helps to generate patient specific 3D model of occlusal surface for load application.
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Korsch M, Walther W, Hannig M, Bartols A. Evaluation of the surgical and prosthetic success of All-on-4 restorations: a retrospective cohort study of provisional vs. definitive immediate restorations. Int J Implant Dent 2021; 7:48. [PMID: 34056669 PMCID: PMC8165050 DOI: 10.1186/s40729-021-00330-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/19/2021] [Indexed: 01/10/2023] Open
Abstract
Background All-on-4 concept allows an immediate restoration, which is frequently a provisional restoration (PR), and will be replaced by a definitive restoration (DR) a few months later. However, this approach involves much higher treatment efforts and costs, compared to a DR immediately after implantation. PRs were mostly incorporated in the introductory phase of the All-on-4 concept in our respective clinics. Today, PRs are only used for referred patients and bimaxillary restorations. The aim of the study was to investigate whether PRs and DRs have comparable success rates. Methods A total of 126 patients with 136 All-on-4 restorations supported by 544 implants were included in this retrospective cohort study. The observation period was 1 year. In 42 cases, a PR was placed initially and replaced by a DR 3 months later. In 94 cases, a DR was placed immediately. Biological, technical, and severe (loss of an implant or PR/DR) complications associated with PRs and DRs were compared. The absence of a serious complication was considered a success. Results A total of 27 patients were affected by 33 complications, 19 biological (2 PR and 17 DR) and 14 technical (6 in PR and 8 in DR) in the first 3 months. Eight patients had ten severe complications (1 PR and 9 DR). Severe complications were all implant losses. Implant survival rate was 98.2% (99.4% PR and 97.6 DR), and restoration survival rate was 94.4% (97.6% PR and 92.6% DR). Six out of the ten implant losses occurred in the posterior maxillae of male patients. After 3 months, ten complications occurred in six patients within 1 year. One of these complications was an implant loss in the posterior maxillae of a male patient. Conclusion PRs and DRs showed comparable complication rates during the observation period. Only in male patients did implant losses occur more frequently in the posterior maxilla. Supplementary Information The online version contains supplementary material available at 10.1186/s40729-021-00330-1.
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Affiliation(s)
- Michael Korsch
- Dental Academy for Continuing Professional Development, Lorenzstrasse 7, 76135, Karlsruhe, Germany. .,Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital, Saarland University, Building 73, 66421, Homburg, Germany. .,Center for Implantology and Oral Surgery, 69120, Heidelberg, Germany.
| | - Winfried Walther
- Dental Academy for Continuing Professional Development, Lorenzstrasse 7, 76135, Karlsruhe, Germany
| | - Matthias Hannig
- Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital, Saarland University, Building 73, 66421, Homburg, Germany
| | - Andreas Bartols
- Dental Academy for Continuing Professional Development, Lorenzstrasse 7, 76135, Karlsruhe, Germany.,Clinic for Conservative Dentistry and Periodontology, School for Dental Medicine, Christian-Albrechts-University, Kiel, Germany
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De Moor E, Huys SEF, van Lenthe GH, Mommaerts MY, Vander Sloten J. Mechanical evaluation of a patient-specific additively manufactured subperiosteal jaw implant (AMSJI) using finite-element analysis. Int J Oral Maxillofac Surg 2021; 51:405-411. [PMID: 34059405 DOI: 10.1016/j.ijom.2021.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/13/2021] [Indexed: 11/18/2022]
Abstract
Edentulism with associated severe bone loss is a widespread condition that hinders the use of common dental implants. An additively manufactured subperiosteal jaw implant (AMSJI) was designed as an alternative solution for edentulous patients with Cawood and Howell class V-VIII bone atrophy. A biomechanical evaluation of this AMSJI for the maxilla in a Cawood and Howell class V patient was performed via finite-element analysis. Occlusal and bruxism forces were incorporated to assess the loading conditions in the mouth during daily activities. The results revealed a safe performance of the implant structure during the foreseen implantation period of 15 years when exerting average occlusion forces of 200 N. For the deteriorated state of class VIII bone atrophy, increased stresses on the AMSJI were evaluated, which predicted implant fatigue. In addition, excessive bruxism and maximal occlusion forces might induce implant failure due to fatigue. The models predicted bone ingrowth at the implant scaffolds, resulting in extra stability and secondary fixation. For all considered loading conditions, the maximal stresses were located at the AMSJI arms. This area is most sensitive to bending forces and, hence, allows for further design optimization. Finally, the implant is considered safe for normal daily occlusion activities.
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Affiliation(s)
- E De Moor
- Department of Mechanical Engineering, Biomechanics section, KU Leuven, Leuven, Belgium.
| | - S E F Huys
- Department of Mechanical Engineering, Biomechanics section, KU Leuven, Leuven, Belgium.
| | - G H van Lenthe
- Department of Mechanical Engineering, Biomechanics section, KU Leuven, Leuven, Belgium.
| | - M Y Mommaerts
- European Face Centre, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium.
| | - J Vander Sloten
- Department of Mechanical Engineering, Biomechanics section, KU Leuven, Leuven, Belgium.
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15
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Bozyel D, Taşar Faruk S. Biomechanical Behavior of All-on-4 and M-4 Configurations in an Atrophic Maxilla: A 3D Finite Element Method. Med Sci Monit 2021; 27:e929908. [PMID: 33774647 PMCID: PMC8015646 DOI: 10.12659/msm.929908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In edentulous patients, the concept of 4 implants with early loading has been widely used in clinical settings. In the case of bone atrophy in the anterior maxilla, using short implants or an angulated implant may be a good choice for treatment. The occlusal scheme remains a key aspect of All-on-4. The aim of this study was to use the 3-dimensional (3D) finite element method (FEM) to evaluate how different All-on-4 designs for canine-guided and group function occlusion affected the distribution of stress in the atrophic premaxilla. MATERIAL AND METHODS A 3D edentulous maxilla model was created and in 3D FEM, 3 different configurations - M4, All-on-4, and short implant - were modeled by changing the anterior implants and using 2 different occlusal schemes. For each model, the occlusal load was applied to simulate lateral movements. For cortical bone, the maximum and minimum principal stress values were generated, and for ductile materials, von Mises stress values were obtained. RESULTS No significant differences were detected among the models; generally, however, the highest stress values were observed in the M-4 model and the models with short implants. Slightly higher stress values were observed in the group function occlusion group than in the canine-guided occlusion group. CONCLUSIONS To promote better primary stabilization, M-4 or short implant configurations with canine-guided occlusion appear to be preferable for patients who have severe atrophy in the anterior maxilla.
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Affiliation(s)
- Delal Bozyel
- Department of Prosthodontics, Near East University, Nicosia, Cyprus
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16
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Abstract
Over the past 17 years, the All-on-4 treatment concept has been a reliable and predictable modality to rehabilitate edentulous jaws with immediate function as full-arch prostheses. This article highlights clinically relevant data compiled by numerous All-on-4 investigators including complications and their remedies, occlusion and cantilever trends, implant size utilization, and controversial topics. We provide insights for navigating the complexities of medically diverse populations, faced by our daily practice, with a focus on patient avoidance, risk factors for implant and prosthetic failures, in hopes to minimize complications so clinicians would choose this treatment with confidence.
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Affiliation(s)
- Michael H Chan
- Oral & Maxillofacial Surgery, Department of Veterans Affairs, New York Harbor Healthcare System (Brooklyn Campus), 800 Poly Place (Bk-160), Brooklyn, NY 11209, USA; Oral & Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, The Brooklyn Hospital Center, 121 DeKalb Avenue (Box-187), Brooklyn, NY 11201, USA.
| | - Yoav A Nudell
- Oral & Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, The Brooklyn Hospital Center, 121 DeKalb Avenue (Box-187), Brooklyn, NY 11201, USA. https://twitter.com/YoavNudell
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17
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Bulat S, Butsan S, Salikhov K, Abramian S, Arsenidze A. Free fibula flap for reconstruction of the severely atrophic mandible: a retrospective study. Int J Oral Maxillofac Surg 2020; 50:546-554. [PMID: 32893080 DOI: 10.1016/j.ijom.2020.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/06/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022]
Abstract
The purpose of this retrospective study was to assess the feasibility of using a free fibula flap (FFF) for reconstruction of the alveolar region of the severely atrophic mandible, by determining bone stability after dental implant insertion and prosthetic rehabilitation in a series of eight female patients aged 36-65 years. Dental implant insertion was performed 3-4 months after reconstruction. Prosthetic loading was performed 3-4 months after implant insertion. The height of the reconstructed mandible after surgery was 21.20±1.87mm, with an increase of 8.80±1.71mm from the preoperative height. The height of the FFF immediately after reconstruction was 11.24±1.10mm; this showed a vertical loss of 0.99±0.52mm (8.79%) and maintenance of 91.21% of the initial height at a mean 14 months post-reconstruction. Applying the Wical and Swoope formula to estimate the original mandibular body height, it was found that the difference between this calculated height (21.17±3.76mm) and the reconstructed height (21.20±1.87mm) was only 0.03±3.17mm (0.14%). An overall insignificant decrease of 0.46±1.14 cm3 in FFF volume had occurred at 3-4 months after dental implant functional loading, while in two cases an increase in volume was found (1.22cm3 and 1.71cm3). The good and stable results obtained show that the FFF may be used to reconstruct the whole mandibular alveolar region, with the best possible outcomes.
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Affiliation(s)
- S Bulat
- Department of Maxillofacial Surgery, Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia.
| | - S Butsan
- Department of Maxillofacial Surgery, Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - K Salikhov
- Department of Maxillofacial Surgery, Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - S Abramian
- Department of Prosthetic Dentistry and Implantology, Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - A Arsenidze
- Department of Prosthetic Dentistry and Implantology, Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
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Kucukkurt S, Tukel HC. Comparison of Four Implant-Supported Fixed Rehabilitation Options of the Edentulous Mandible: A 3D Finite Element Analysis. JOURNAL OF ADVANCED ORAL RESEARCH 2020. [DOI: 10.1177/2320206820911775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: This study aims to compare four implant-supported rehabilitation concepts of an edentulous mandible and determines the most biomechanically advantageous technique. Materials and Methods: Five models with four implants in different configurations were formed: four axial interforaminal implants, All-on-4 concept (two anterior axial and two posterior distally tilted implants), All-on-4v4 concept (four distally tilted interforaminal implants), All-on-4W (two anterior mesially tilted and two posterior distally tilted implants), and two axial interforaminal implants and two posterior extra-short implants. Straumann bone-level (4.1 × 12 mm) and tissue-level (4.1 × 4 mm) extra-short implants were used for this study. Spherical loadings from canine and molar regions were applied to evaluate tension, compression, and von Mises stresses by implementing 3D finite element analysis. Results: Among the alternative concepts, the classic All-on-4 and the All-on-4v4 techniques were the most successful treatment option in biomechanical terms. On the other hand, the use of extra-short implants in the posterior region was found to be the last method of choice. This was because of the high stresses on bones in most conditions, even though it balances the forces from the molar region on the implants. Conclusion: The results of the present study indicate that the classic All-on-4 and the All-on-4v4 techniques were the most successful treatment options in biomechanical terms for the rehabilitation of an edentulous mandible with four implant-supported fixed full-arch prostheses.
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Affiliation(s)
- Sercan Kucukkurt
- Department of Oral and Maxillofacial Surgery, Istanbul Aydın University, Istanbul, Turkey
| | - Huseyin Can Tukel
- Department of Oral and Maxillofacial Surgery, Çukurova University, Adana, Turkey
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19
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Oh JH, Kim YS, Lim JY, Choi BH. Stress Distribution on the Prosthetic Screws in the All-on-4 Concept: A Three-Dimensional Finite Element Analysis. J ORAL IMPLANTOL 2020; 46:3-12. [PMID: 31647687 DOI: 10.1563/aaid-joi-d-19-00090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The all-on-4 concept, which is used to rehabilitate edentulous patients, can present with mechanical complications such as screw loosening and fracture. The purpose of this study was to evaluate the stress patterns induced in the prosthetic screws by the different prosthetic screw and abutment designs in the all-on-4 concept using finite element analysis. Von Mises stress values on 6 groups of each screw type, including short and narrow screw, short abutment; short and wide screw, short abutment; long and wide screw, short abutment; short and narrow screw, long abutment; short and wide screw, long abutment; and long and wide screw, long abutment, were compared under a cantilever loading of 200 N that was applied on the farther posterior to the position of the connection between the distal implant and the metal framework. Posterior prosthetic screws showed higher stress values than anterior prosthetic screws. The stress values in posterior prosthetic screws decreased as the length and diameter increased. In conclusion, the long and wide screw design offers advantages in stress distribution when compared with the short and narrow design.
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Affiliation(s)
- Ji-Hyeon Oh
- Department of Dentistry, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Young-Seong Kim
- Department of Mechanical, Robotics and Energy Engineering, Dongguk University, Seoul, South Korea
| | - Joong Yeon Lim
- Department of Mechanical, Robotics and Energy Engineering, Dongguk University, Seoul, South Korea
| | - Byung-Ho Choi
- Department of Dentistry, Yonsei University Wonju College of Medicine, Wonju, South Korea
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Costa CM, Mendonça S. Knowledge-intensive consumer services. Understanding KICS in the innovative global health-care sector. RESEARCH POLICY 2019. [DOI: 10.1016/j.respol.2018.10.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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21
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Spencer KR. Implant based rehabilitation options for the atrophic edentulous jaw. Aust Dent J 2018; 63 Suppl 1:S100-S107. [DOI: 10.1111/adj.12595] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- KR Spencer
- Melbourne Oral & Maxillofacial Surgeon; Melbourne Victoria Australia
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22
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Busato A, Vismara V, Grecchi F, Grecchi E, Lauritano D. Surgiplanner: a new method for one step oral rehabilitation of severe atrophic maxilla. ORAL & IMPLANTOLOGY 2017; 10:325-334. [PMID: 29285336 DOI: 10.11138/orl/2017.10.3.325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The implant-prosthetic rehabilitation of edentulous upper jaws has always been complex for surgeons and dentists. The lack of bone in both vertical and horizontal dimension does not allow the correct insertion of dental implants. In addition, patients with edentulous upper and lower arch have a loss of vertical dimension of the face and an aged expression. Many surgical techniques have been proposed to increase the bone volume, height and thickness, such as the Le Fort I osteotomy, the bone grafts and the placement of dental implants. Planning these surgical procedures is difficult, because it is not possible to reproduce the movements of osteotomized bone segments in three planes of space. This article describes the treatment of severe atrophy maxilla with a new approach using a new instrument named "Surgiplanner". Surgiplanner is a method that, only using a computerized axial tomography (CAT), allows to obtain a totally predetermined therapeutic result from both an aesthetic and functional point of view, with surgery of severe resorbed jaws. Surgiplanner allows repositioning of segment of the skeleton of the patient's face in a predetermined and controlled way for the best implant-supported oral rehabilitation.
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Affiliation(s)
| | | | - F Grecchi
- Department of Maxillo-Facial Surgery, Istituto Ortopedico Galeazzi, Milan, Italy
| | - E Grecchi
- Department of Oral Surgery, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - D Lauritano
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
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Accuracy of a CAD/CAM-guided template for locating abutment screws for cement-retained implant-supported restorations. J Prosthet Dent 2016; 116:67-73. [DOI: 10.1016/j.prosdent.2015.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/26/2015] [Accepted: 12/04/2015] [Indexed: 11/19/2022]
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