Plaque Accumulation Beneath Maxillary All-on-4™ Implant-Supported Prostheses

Limosilactobacillus reuteri as an Adjuvant in the Treatment of Peri-implant Mucositis in Total Rehabilitation: An Exploratory Study

OBJECTIVES

 Mechanical debridement is the traditional method for the treatment of peri-implant mucositis (P-im) and its success depends on the patient's correct oral hygiene. It is believed that probiotics may help by their ability to modulate the oral biofilm, resulting in anti-inflammatory and antibacterial plaque action. The aim of this study was to evaluate the adjuvant effect of the probiotic Limosilactobacillus reuteri (LR) in the mechanical treatment of P-im.

MATERIALS AND METHODS

 This exploratory study included 29 subjects with implant-supported total rehabilitation and P-im, divided into test (TG) and control (CG) groups, equally subjected to professional mechanical debridement, with the administration of a daily GUM PerioBalance lozenge for 30 days added to the TG. The modified Plaque Index (mPlI) modified Sulcus Bleeding Index (mBI) and pocket depth (PD) were evaluated before the intervention (baseline) and 6 and 10 weeks later.

STATISTICAL ANALYSIS

 Parametric and nonparametric tests with 5% significance level were used in the statistical analysis, using IBM SPSS Statistics 27.0 software.

RESULTS

 Both treatments resulted in reduced mPlI, mBI, and PD at 6 weeks; while from 6 to 10 weeks there was an increase in mPlI and mBI and maintenance of PD. Compared with baseline, differences were close to statistical significance in the reduction in PD at 10 weeks in the CG (p = 0.018), after Bonferroni correction, and statistically significant in the mPlI at 6 weeks in the CG (p = 0.004) and in the TG (p = 0.002) as well as at 10 weeks in the TG (p = 0.016). Comparing the groups in the postintervention assessments, no statistically significant differences were found.

CONCLUSION

 LR adjuvant mechanical treatment of P-im does not show a clear benefit compared with mechanical treatment alone, with both interventions achieving similar clinical results. Further prospective and long-term studies are needed.

Biofilm accumulation on complete arch subperiosteal implant-supported prostheses: Effect of pontic type

STATEMENT OF PROBLEM

Complete arch subperiosteal implant-supported prostheses present challenges in terms of effective cleaning, leading to the accumulation of biofilm on their intaglio surfaces. The association between different intaglio surface morphologies and biofilm accumulation on complete arch subperiosteal implant-supported prostheses is unclear.

PURPOSE

The purpose of this in vitro study was to investigate the correlation between the intaglio surface of complete arch subperiosteal implant-supported prostheses and biofilm accumulation.

MATERIAL AND METHODS

Sixty-eight complete arch subperiosteal implant-supported prostheses were fabricated with varying interimplant distances and pontic morphologies. Four different types of pontic morphologies were included: saddle, flat, scalloped, and ovate. To simulate biofilm accumulation, a green aerosol was sprayed onto the intaglio surface. Dental floss was used to clean the colored spray from the intaglio surface. The intaglio surfaces of prostheses were then scanned with an intraoral scanner. The biofilm areas were identified and calculated by using a 3-dimensional macroscopical quantification method. The distances between adjacent implants and transmucosal height were measured. The correlation between interimplant distances and biofilm areas, and the correlation between the biofilm areas and transmucosal height, were analyzed using the Spearman test. Furthermore, a generalized estimating equation (GEE) was employed to examine the relationship between pontic morphology and biofilm area, adjusting for location, cantilever, implant distance, and transmucosal height (α=.05).

RESULTS

A significant correlation was found between the biofilm area and transmucosal height (correlation coefficient=0.208, P<.001). A significant increase in biofilm accumulation was observed in the saddle group compared with the 3 groups in GEE Models I and II.

CONCLUSIONS

Flat pontics and ovate pontics have significantly lower biofilm retention. Moreover, transmucosal height plays a significant role in biofilm accumulation in the pontic area.

Prosthetic Rehabilitation of All-on-Six Implant-Supported Prosthesis: A Case Report

This clinical report explores the effectiveness of dental implants for rehabilitating fully edentulous arches, with a focus on the all-on-six treatment approach. Implant-supported fixed restorations, particularly using six implants, are presented as an expected and cost-effective solution for the rapid repair of the edentulous patient, avoiding the need for bone grafting. This report details the successful rehabilitation of a patient's completely edentulous arches using the all-on-six concept, highlighting the meticulous planning and execution involved. It concludes that precise diagnostic and implant planning, along with thorough attention to all the features, is crucial for successful implant-supported fixed prostheses, with the all-on-six concept offering improved clinical and radiological outcomes for atrophied maxillae.

Plaque accumulation on the fitting surface of full-arch implant-supported fixed prostheses with contact or noncontact pontics: A split mouth randomized controlled trial

OBJECTIVE

To explore the differences in plaque accumulation on the fitting surface of full-arch implant-supported fixed prostheses with contact or noncontact pontics.

MATERIALS AND METHODS

Nineteen patients (20 prostheses, 7 in the maxilla, and 13 in the mandible) intending to undergo full-arch implant-supported immediate function prostheses were recruited. During immediate restoration and using the midline as the boundary, one side was restored as a pontic and mucosa noncontact type (the test group), and the opposite side was restored as a pontic and mucosa contact type (the control group). In a follow-up 6 months after the surgery, the cleanliness of the fitting surface of the immediate prosthesis was evaluated by plaque staining and debris index determination. Patient satisfaction was investigated by questionnaire.

RESULTS

Twenty prostheses from 19 patients included in the randomized controlled trial were followed up. Among the 20 prostheses, the percentage of area covered with plaque was significantly lower in the test group compared with that in the control group (31.5 ± 15.8% vs. 43.7 ± 15.3%; p < 0.001). The debris index in the test group was lower than that in the control group, although the difference was not statistically significant (2.77 ± 0.73 vs. 3.15 ± 0.90; p > 0.05). In the patient satisfaction survey, most of the patients were satisfied with most aspects of the prostheses, however, nearly half of the patients were not satisfied with the cleaning.

CONCLUSIONS

The pontic and mucosa noncontact prosthetic design reduces plaque accumulation on the fitting surface, which is beneficial for maintaining oral cleanliness. However, the majority of study samples were mandible and conclusions may not be fully applicable to maxilla.

TRIAL REGISTRATION

www.chictr.org.cn (ChiCTR1900028576).

CLINICAL SIGNIFICANCE

The noncontact design in full-arch implant-supported fixed prostheses may be an effective measure of improving oral hygiene promotion. There is need for more research that can further improve oral hygiene of patients with full-arch implant-supported prostheses.

Evaluation of a platform-switched Morse taper connection for all-on-four or six treatment in edentulous or terminal dentition treatment: A retrospective study with 1-8 years of follow-up

BACKGROUND

The survival rate, marginal bone loss and soft tissue health of the Ankylos implants and the balanced base abutments in all-on-four or six implant restoration of edentulous or terminal dentition patients has not been reported in the clinical research.

PURPOSE

This retrospective study aimed to evaluate the Ankylos implants and the balanced base abutments in all-on-four or six implant restoration of edentulous or terminal dentition patients after 1-8 years of follow-up.

MATERIALS AND METHODS

A retrospective study was conducted based on the medical records of 33 patients who received all-on-four or six treatments from April 2014 to May 2020. Four radiographic examinations [immediate postoperative (T0), definitive restorations (T1), 1-3 years after prosthetic restorations (T2), and more than 3 years after prosthetic restorations (T3)] were obtained to evaluate vertical bone height (VBH). We also calculated the survival rate and examined the condition of soft tissue with this implant system in edentulous or terminal dentition patients. Three-level linear model analyses were used to explore potential risk factors for VBH changes on the mesial and distal sides. The generalized linear model was used to analyze the influencing factors of BOP and plaque.

RESULTS

A total of 218 implants were included in this study. The cumulative survival rate of the implants was 97.25% before the definitive prosthesis, 96.33% within 3 years of follow-up and 95.32% after more than 3 years of follow-up. The mean ± standard deviation (SD) bone losses of the VBH were 0.27 ± 0.05 mm (T1-T3) on the mesial side and 0.49 ± 0.06 mm (T1-T3) on the distal side. During 1-8 years of follow-up, the height and angle of the abutment (p < 0.001), the mandible implant site (p < 0.001), the length of the implant (p = 0.014 < 0.05) and age (p = 0.029 < 0.05) showed statistically significant effects on vertical mesial bone height (VMBH) and vertical distal bone height (VDBH). The risk of BOP among participants who brushed three times a day was lower than those who brushed less than three times. The plaque risk of short abutment height was higher than the long abutment.

CONCLUSION

The current study showed that the Ankylos implants with the balanced base abutments in all-on-four or six implants treatment is a viable and predictable option with a high survival rate and low marginal bone loss in edentulous or terminal dentition patients. VBH around the implants was strongly associated with the mandible implant site, abutment height and angle, the length of the implant and age. Moreover, teeth-brushing times and abutment height significantly affect soft tissue health.

Maxillary Full Arch Restorations - Biological Complications: A Narrative Review Outlining Criteria for Long Term Success

PURPOSE

Patients receiving full arch implant borne maxillary prostheses require functional, esthetic, and long term success. The importance of this review is to document the difficulty with implant maintenance, the prevalence of peri-implant disease, and the improvement in biologic health when using a prosthesis that can be maintained to minimize plaque. The objective is to provide surgeons with a reference to optimize surgical procedures that can result in improved hygiene and long term maintenance, as well as acceptable functional and esthetic goals.

METHODS

Pubmed.gov was the information source. Years reviewed included 1990-2022. Inclusion criteria included only articles in journals referenced in pubmed.gov. The reports excluded were case reports, reports that only included implant survival, and articles without a statistical analysis to generate meaningful conclusions. Biological complications included bone loss, hygiene difficulty, mucositis and recession, the incidence of peri-implantitis, and how complications related to patient co-morbidities. Data collected included outcomes of the study including statistical significance.

RESULTS

The search identified articles for review using terms which included full arch maxillary restorations (n = 736), long term success with full arch maxillary prostheses (n = 22), ceramic full arch restorations (n = 102), and complications with full arch restorations (n = 231). From this search, 53 articles were collated that satisfied the inclusion criteria. Factors found to be significant contributors to biological complications included bone loss and peri-implant disease, difficulty with daily hygiene access, plaque and biofilm coverage, and the need for continued maintenance for long term implant health.

CONCLUSION

The surgeon needs to place implants to allow a full arch maxillary prosthesis to be fabricated with full access to the implants for maintenance, which should decrease the incidence of biological complications. With excellent maintenance full arch implant restorations can have limited peri-implant disease.

Implant prosthodontic design as a predisposing or precipitating factor for peri-implant disease: A review

Over the past decade, emerging evidence indicates a strong relationship between prosthetic design and peri-implant tissue health. The objective of this narrative review was to evaluate the evidence for the corresponding implant prosthodontic design factors on the risk to peri-implant tissue health. One of the most important factors to achieve an acceptable implant restorative design is the ideal implant position. Malpositioned implants often result in a restorative emergence profile at the implant-abutment junction that can restrict the access for patients to perform adequate oral hygiene. Inadequate cleansability and poor oral hygiene has been reported as a precipitating factors to induce the peri-implant mucositis and peri-implantitis and are influenced by restorative contours. The implant-abutment connection, restorative material selection and restoration design are also reported in the literature as having the potential to influence peri-implant sort tissue health.

Peri-implant tissue health and patient satisfaction of vertical versus inclined posterior implants used to support overdentures with bar attachments. A one-year randomized trial

INTRODUCTION

This study aimed to evaluate peri-implant tissue health and patient satisfaction of vertical and inclined posterior implants for mandibular bar overdentures.

MATERIALS AND METHODS

Thirty edentulous participants received four implants in the interforaminal area of the mandible. The patients were randomly assigned into two equal groups; (1) vertical group (control): all implants were inserted vertically parallel to each other. Inclined group (study): the anterior implants were placed vertically, and the posterior implants were tilted 30° distally. Hader bar attachment with two 7 mm-distal cantilevers (vertical group) and without cantilevers (inclined group) was used to connect the implants to mandibular overdentures. Peri-implant tissue health (Plaque [PL] and gingival [GI] indices, pocket depth [PD], and crestal bone loss [CBL]) were evaluated after denture insertion (T0), 6 (T6), and 12 (T12) months after insertion. Patient satisfaction was evaluated using a visual analog scale after 12 months.

RESULTS

At T12, the vertical group showed significantly higher PL, PD, and CBL than the inclined group for anterior (p < 0.037) and posterior (p < 0.017) implants. The vertical group showed significantly higher GI than the inclined group for anterior implants (p = 0.003), and the inclined group showed significantly higher GI than the vertical group for posterior implants (p = 0.016). The inclined group showed significantly higher scores for general satisfaction (p = 0.049), prosthesis as a part of you (p = 0.013), appearance (p < 0.001), stability (p = 0.002), ease of cleaning (p < 0.001), and comfort (p = 0.001) than the vertical group.

CONCLUSION

Inclined posterior implants used to support mandibular bar overdentures are recommended than vertical implants, as it was associated with improved patient satisfaction and peri-implant tissue health.

Clinical study of the biofilm of implant-supported complete dentures in healthy patients

OBJECTIVE

The purpose of this study was to quantify the area covered by biofilm and identify bacteria and yeasts present in mandibular acrylic resin full-arch implant-supported fixed prostheses.

BACKGROUND

Biofilm control of implant-supported fixed prosthesis is hampered by their design, and it can cause oral and systemic problems, mainly in immunocompromised patients like the elder. Knowledge about microbiota reinforces the awareness about the need for periodic professional cleaning maintenance.

MATERIALS AND METHODS

Twenty prostheses were unscrewed, washed in 0.89% sodium chloride, stained with eosin 1% and photographed. The area covered by biofilm was digitally delimited and quantified. Biofilm samples were collected, diluted up to 1:10⁷ , seeded in chromogenic agar media and incubated for 48 hours, at 37°C, for counting of colony-forming units (CFU/mL). DNA hybridization was performed to complement the identification and quantification of microorganisms. Data were analyzed using Mann-Whitney test, Spearman correlation and Fisher's exact test (α = .05).

RESULTS

An average of 62% of the gingival surface of the prostheses was covered by biofilm. Enterococcus spp. (5.82 ± 1.38 log₁₀ CFU/mL) and Staphylococcus aureus (5.75 ± 2.02 log₁₀ CFU/mL) showed higher prevalence in cultures. Patients with five implants had less biofilm compared to those with four implants (P = .031) but had higher Escherichia coli counts (P = .039). In DNA hybridization, Streptococcus pneumoniae, Veillonella parvula and Fusobacterium nucleatum presented higher quantification and were present in all the samples; patients over 65 years old contained more Candida tropicalis (P = .049); prostheses on five implants presented lower quantification for several species.

CONCLUSION

Biofilm was present on all prostheses, containing potentially pathogenic microorganisms. The number of implants may play a role in quantification of biofilm and in microorganism counts.

Implant survival and biologic complications of implant fixed complete dental prostheses: An up to 5-year retrospective study

STATEMENT OF PROBLEM

Limited information is available on the association between prosthesis-associated risk factors and biologic complications for patients with implant fixed complete dental prostheses (IFCDPs).

PURPOSE

The purpose of this retrospective study was to assess the implant survival and biologic complications of IFCDPs up to 5 years of follow-up.

MATERIAL AND METHODS

Patients who had received IFCDPs between August 1, 2009 and August 1, 2014 were identified through an electronic health record review. Those who consented to participate in the study attended a single-visit study appointment. Clinical and radiographic examinations, intraoral photographs, and peri-implant hard and soft tissues parameters were assessed. Only prostheses which could be removed during the study visit were included. Associations between biologic complications and prosthetic factors, such as time with prosthesis in place, prosthesis material, number of implants, cantilever length, and type of prosthesis retention, were assessed.

RESULTS

A total of 37 participants (mean ±standard deviation age 62.35 ±10.39 years) with 43 IFCDPs were included. None of the implants had failed, leading to an implant survival of 100% at 5.1 ±2.21 years. Ten of the prostheses were metal-ceramic (Group MC) and 33 were metal-acrylic resin (Group MR). Minor complications were more frequent than major ones. Considering minor complications, peri-implant mucositis was found in 53% of the implant sites, more often in the maxilla (P=.001). The most common major biologic complication was peri-implantitis, which affected 4.0% of the implants, more often in the mandible (P=.025). Peri-implant soft tissue hypertrophy was present 2.79 times more often (95% CI: 1.35 - 5.76, P<.003) around implants supporting metal-acrylic resin prostheses than metal-ceramic ones, with the former type also showing significantly more plaque accumulation (P<.003).

CONCLUSIONS

Biologic complications such as soft tissue hypertrophy and plaque accumulation were more often associated with metal-acrylic resin prostheses. Peri-implant mucositis occurred more often under maxillary IFCDPs, while peri-implantitis appeared more common around mandibular implants.

Evaluation of the intaglio surface shape of implant-supported complete-arch maxillary prostheses and its association with biological complications: An analytical cross-sectional study

STATEMENT OF PROBLEM

Whether the shape of the intaglio surface of fixed implant-supported maxillary prostheses is associated with the occurrence of biological is unclear.

PURPOSE

The purpose of this cross-sectional study was to evaluate the shape (convex or concave) of the intaglio surface of complete-arch implant-supported maxillary fixed prostheses and to assess the association with biofilm accumulation, hyperemia, bone loss, and patient satisfaction.

MATERIAL AND METHODS

Study participants consisted of 56 individuals with fixed complete implant-supported maxillary prosthesis attending follow-up appointments. The 56 prostheses supported by 388 implants had been in place for an average of 5.5 years (range 1-14 years). The intaglio surface was divided into areas corresponding to the cantilever regions and between implants (n=442) and was assessed for shape (concave or convex) and biofilm index (0 to 3). Tissue hyperemia (redness) was assessed as absent or present. Bone loss (mm) was measured from digital periapical radiographs by 2 calibrated evaluators (kappa=94.9%). Study participant satisfaction was investigated by using a visual analog scale. Association assessments (α=.05) between the shape of each area and all these parameters were performed with the Friedman, linear regression, and logistic regression tests.

RESULTS

Of the analyzed areas, 58 (13.1%) were concave, and 384 (86.9%) were convex. Biofilm was absent on 3.5% of the concave and 5.5% of the convex areas. Biofilm was detectable with a probe on 12% of the concave and 22.4% of the convex areas and clinically visible in 58.6% of the concave and 57.8% of the convex areas. Abundant biofilm was seen in 25.9% of the concave and 14.3% of the convex areas and was associated with hyperemia (P=.003). A statistically significant association was found between the shape and biofilm accumulation (P=.009). Hyperemia was present in 199 (45%) areas. The association analysis between the shape of the area and the presence of hyperemia was not significant (P>.05). The mean bone loss was 0.71 mm (0.91 mm). Implants placed near concave areas underwent greater bone loss (P=.001). Study participants reported a high level of satisfaction with the esthetics, mastication, speech, and smile provided by the prosthesis, with satisfaction scores ranging between 8.46 and 8.77. However, in relation to ease of cleaning, only 19.6% were fully satisfied.

CONCLUSIONS

The shape of the intaglio surface of prostheses influenced the occurrence of biofilm accumulation and bone loss, and concave areas showed greater biofilm accumulation and bone resorption. High rates of satisfaction with treatment were identified.

Implant and prosthesis survival rates of full-arch immediate prostheses supported by implants with and without bicortical anchorage: Up to 2 years of follow-up retrospective study

OBJECTIVES

To compare implant and prosthesis survival rates between full-arch immediate prostheses supported by 4 hydrophilic implants with bicortical anchorage and by 5 or 6 hydrophilic implants placed without bicortical anchorage.

MATERIAL AND METHODS

The sample was retrospectively selected and comprised completely edentulous patients treated with full-arch immediate prostheses supported by Morse Taper hydrophilic implants. The selected patients were divided into four groups, according to the region of implant placement and type of anchorage. Differences in implant and prosthesis survival rates between groups, as well as the influence of bicortical anchorage on implant primary stability, were verified using Fisher's exact tests (significant at p < .05).

RESULTS

The sample comprised 392 implants, 72 were placed in the maxilla with bicortical anchorage, and 85 were placed without. In the mandible, 140 implants were placed with and 95 were placed without bicortical anchorage. The follow-up period was up to 24 months. A 98.8% implant survival rate was observed for the group of implants placed without bicortical anchorage in the maxilla, and of 100% for the other groups. The overall implant survival rate was 99.7% (391 of 392 implants). Prosthesis survival rate was 100% for all groups. No differences were observed between groups with respect to implant and prosthesis survival rates. Significantly higher primary stability was observed for implants placed with bicortical anchorage in both jaws.

CONCLUSION

Predictable results and high survival rates were achieved within the period evaluated by the present retrospective study, with immediate full-arch prostheses when only four hydrophilic implants are placed bicortically.

Comparison of peri-implant submucosal microbiota in arches with zirconia or titanium implant-supported fixed complete dental prostheses: a study protocol for a randomized controlled trial

Background

The success rate of implant-supported prostheses for edentulous patients is relatively high. However, the incidence of biological complications, especially peri-implant mucositis and peri-implantitis, increases yearly after the placement of prostheses. The accumulation of pathogenic bacteria adjacent to a prosthesis is the main cause of biological complications. Titanium, one of the classical materials for implant-supported prostheses, performs well in terms of biocompatibility and ease of maintenance, but is still susceptible to biofilm formation. Zirconia, which has emerged as an appealing substitute, not only has comparable properties, but presents different surface properties that influence the adherence of oral bacteria. However, evidence of a direct effect on oral flora is limited. Therefore, the aim of the present study was to assess the effects of material properties on biofilm formation and composition.

Methods

The proposed study is designed as a 5-year randomized controlled trial. We plan to enroll 44 edentulous (mandible) patients seeking full-arch, fixed, implant-supported prostheses. The participants will be randomly allocated to one of two groups: group 1, in which the participants will receive zirconia frameworks with ceramic veneering, or group 2, in which the participants will receive titanium frameworks with acrylic resin veneering. Ten follow-up examinations will be completed by the end of this 5-year trial. Mucosal conditions around the implants will be recorded every 6 months after restoration. Peri-implant submucosal plaque will be collected at each reexamination, and bacteria flora analysis will be performed with 16S rRNA gene sequencing technology in order to compare differences in microbial diversity between groups. One week before each visit, periodontal maintenance will be arranged. Each participant will receive an X-ray examination every 12 months as a key index to evaluate the marginal bone level around the implants.

Discussion

The current study aims to explore the oral microbiology of patients following dental restoration with zirconia ceramic frameworks or titanium frameworks. The features of the microbiota and the mucosal condition around the two different materials will be evaluated and compared to determine whether zirconia is an appropriate material for fixed implant-supported prostheses for edentulous patients.

Trial registration

International Clinical Trials Registry Platform (ICTRP) ChiCTR2000029470. Registered on 2 February 2020. http://www.chictr.org.cn/searchproj.aspx?

Reducing bacterial counts around the abutment following professional mechanical plaque removal at the implant bridge: A randomized crossover comparison of removing or not removing the superstructure

PURPOSE

The purpose of this study was to determine whether removing the superstructure of the implant bridge in cases of full-arch implant restorations for edentulous atrophic arches at the abutment level during professional mechanical plaque removal (PMPR) affects bacterial counts.

METHODS

This crossover clinical trial included 20 patients who received screw-retained prostheses at the abutment level. Patients were randomly assigned to two groups and received PMPR with or without removal of the superstructure. After a three-month washout period, the type of treatment was reversed between the groups. Bacterial counts around the cylinder and abutment were measured and compared before and after PMPR.

RESULTS

Bacterial numbers around the cylinder and abutment were significantly reduced after PMPR as compared with before PMPR regardless of whether the superstructure was removed (p <0.05). However the ratio of subjects with bacteria at 1.0 × 105 colony forming unit/ml (cfu/ml) or more after PMPR was significantly higher when the superstructure was not removed (p < 0.05). Among patients with bacterial counts of less than 10 × 105 cfu/ml, bacterial loads were reduced to less than 1.0 × 105 cfu/ml even when superstructures were not removed. Among patients with bacterial load of >10 × 105 cfu/ml, bacterial numbers were not reduced to <1.0 × 105 cfu/ml when PMPR was performed without removing the superstructure.

CONCLUSIONS

Removal of the superstructure in cases of full-arch implant restorations for edentulous atrophic arches during PMPR reduces bacterial numbers around the implant bridge at the abutment level.

Efficacy of electric-powered cleaning instruments in edentulous patients with implant-supported full-arch fixed prostheses: a crossover design

Background

The aim of this study was to evaluate the plaque removal efficacies of electric toothbrushes and electric dental floss compared with conventional manual toothbrushing in cleaning the fitting surface of an All-on-4™ concept (Nobel Biocare, Zürich-Flughafen, Switzerland) implant-supported fixed dental prosthesis (FDP).

Methods

Nine patients with maxillary edentulous arches participated in the study. We investigated two electric-powered brushes (Sonicare Diamond Clean®, Koninklijke Philips N.V., Amsterdam, the Netherlands [SD group], and the Oral-B Professional Care Smart Series 5000®, Braun GmbH, Kronberg, Germany [OralB group]) and one electric dental floss unit (Air Floss®, Koninklijke Philips N.V. [AF group]). A manual toothbrush (Tuft24® MS, OralCare Inc., Tokyo, Japan) was used by the control group. The fitting surface of the FDP was stained to allow visualization of the entire accumulated plaque area. Both the buccal and palatal portions of the plaque area were assessed before and after brushing to evaluate each instrument’s plaque removal rate using a crossover study design. Two-week washout periods were employed between each evaluation.

Results

The plaque removal rates were 53.5 ± 8.5%, 70.9 ± 6.5%, 75.4 ± 6.3%, and 74.4 ± 4.2% for the control, AF, OralB, and SD groups, respectively. When participants were divided into two groups based on their plaque removal rates with a manual toothbrush (poor brushing and good brushing), the poor brushing group showed significant improvement in the plaque removal rate when using electric-powered toothbrushes. The plaque removal rates for the buccal area were significantly higher for the OralB and SD groups than for the manual brushing group (control group), with rates of 52.8 ± 7.9%, 70.1 ± 7.3%, 77.7 ± 6.5%, and 79.5 ± 3.7% for the control, AF, OralB, and SD groups, respectively. The plaque removal rates in the palatal area were consistently lower than those in the buccal area for each of the three electric instruments.

Conclusions

The results suggest that patients who are not adept at manual toothbrushing may potentially improve their removal of plaque from the fitting surfaces of FDPs by using electric toothbrushes.

Maxillary Overdenture Retained with an Implant Support CAD-CAM Bar: A 4 Years Follow Up Case

Introduction:

Oral rehabilitation with overdenture on implants of upper jaw must be taken into consideration a variety of anatomical and biomechanical issues. It is possible to provide for rehabilitation with two or more implants, in different positions, solidarizing them with a bar.

Materials & Methods:

The present study involved a patient rehabilitated with 4 Xive implants (Friadent GmbH, Mannheim, Germany) solidarized with a titanium bar crafted with CAD-CAM technology for maximal comfort, precision and structural lightness.

Results & Discussion:

The follow-up was 54 months, with an implant survival of 100%. Based on our clinical evidence, bars engineered with CAD-CAM technology are promising in terms of precision and comfort despite higher costs.

Four-implant overdenture fully supported by a CAD-CAM titanium bar: A single-cohort prospective 1-year preliminary study

STATEMENT OF PROBLEM

In patients with an altered skeletal maxillomandibular relationship and bone resorption, the rehabilitation of edentulous jaws by combining 4 implants, 2 straight medially and 2 tilted distally, may be preferred to avoid a bone augmentation procedure.

PURPOSE

The purpose of this single cohort 1-year prospective study was to evaluate the clinical performance of a 4-implant overdenture fully supported by a computer-aided designed and computer-aided manufactured (CAD-CAM) titanium bar.

MATERIAL AND METHODS

This single cohort prospective study included edentulous participants rehabilitated with a 4-implant overdenture in 1 of the 2 jaws. The outcomes were implant and prosthetic survival and success rates, any biologic and technical complications, periimplant marginal bone loss, changes in the oral health impact profile (OHIP), bleeding on probing, and the plaque index.

RESULTS

Eighteen participants received 72 implants. One year after implant placement, no implants or prosthesis had failed, and no biologic or technical complications had been observed. At the 1-year follow-up, the mean marginal bone loss was 0.29 ±0.16 mm. The OHIP summary scores demonstrated a significant improvement in oral health-related quality of life. At the 1-year follow-up, positive bleeding was found in 2 participants (11.1%) around 3 implants (4.1%). Three participants (16.6%), accounting for 5 implants (6.9%), showed a slight amount of plaque.

CONCLUSIONS

A 4-implant overdenture supported by a CAD-CAM titanium bar may be a reliable option for the treatment of the edentulous mandible and maxilla over a 1-year period. Oral health-related quality of life significantly improved in all treated participants.

Five-Year Results of a Randomized Controlled Trial Comparing Patients Rehabilitated with Immediately Loaded Maxillary Cross-Arch Fixed Dental Prosthesis Supported by Four or Six Implants Placed Using Guided Surgery

PURPOSE

To compare the 5-year clinical and radiological outcomes of patients rehabilitated with four or six implants placed using guided surgery and immediate function concept.

MATERIALS AND METHODS

Forty patients randomly received four (All-on-4) or six (All-on-6) immediately loaded implants, placed using guided surgery, to support a cross-arch fixed dental prosthesis. Outcome measures were survival rates of implants and prostheses, complications, peri-implant marginal bone loss, and periodontal parameters.

RESULTS

No drop-out occurred. Seven implants failed at the 5-year follow-up examination: six in the All-on-6 group (5%) and one in the All-on-4 group (1.25%), with no statistically significant differences (p = .246). No prosthetic failure occurred. Both group experienced some technical and biologic complications with no statistically significant differences between groups (p = .501). All-on-4 treatment concept demonstrated a trend of more complications during the entire follow-up period. A trend of more implant failure was experienced for the All-on-6 treatment concept. Marginal bone loss (MBL) from baseline to the 5-year follow-up was not statistically different between All-on-4 (1.71 ± 0.42 mm) and All-on-6 (1.51 ± 0.36 mm) groups (p = .12). For periodontal parameters, there were no differences between groups (p > .05).

CONCLUSION

Both approaches may represent a predictable treatment option for the rehabilitation of complete edentulous patients in the medium term. Longer randomized controlled studies are needed to confirm these results.