Evolution of loading protocols in implant dentistry for partially dentate arches

Complete-arch implant rehabilitation and adjunctive orthognathic surgery of a patient with hypohidrotic ectodermal dysplasia utilizing a digital workflow: A clinical report

Hypohidrotic ectodermal dysplasia (HED) is a rare genetic disorder characterized by congenital anomalies in ectodermal tissues, with dental manifestations commonly including hypodontia or oligodontia. Addressing the significant aesthetic, functional, and psychosocial challenges associated with HED requires early surgical and prosthodontic intervention following skeletal maturation. This clinical report details a digital workflow for complete-arch implant rehabilitation of the maxilla and mandible, combined with orthognathic surgery, in an adolescent patient with HED. Integrating digital technologies enhanced treatment planning, surgical precision, and prosthetic outcomes, improving aesthetics, functionality, and overall patient quality of life.

Exploring Non-conventional Dental Implants Beyond Traditional Paradigms Part I: Bridging the Gap in Bone Deficiency Cases

Dental implants have revolutionized tooth replacement, offering a functional and aesthetically pleasing alternative to traditional dentures and bridges. While conventional implants, typically titanium screws placed into the jawbone, have become the gold standard, many studies explore non-conventional implant designs and materials to address specific challenges and patient needs. This series of literature reviews aimed to delve into non-conventional dental implants, examining their unique features and applications and the current state of evidence supporting their use. The short and mini dental implants represent a cutting-edge area of research within the field of implant dentistry. Its potential application in the management of cases with limited bone availability has emerged as a viable alternative to the use of bone augmentation procedures. To date, significant progress has been made in the field of dental implants, particularly with the introduction of short and mini dental implants in the management of cases with significant bone deficiency. However, it remains a remarkable challenge that continues to be actively researched.

Single immediate implant placement in the maxillary aesthetic zone with and without connective tissue grafting: Results of a 5-year randomized controlled trial

AIM

To assess the 5-year effects of grafting connective tissue while undertaking single immediate implant placement and provisionalization at the mid-buccal mucosa level (MBML). Secondary outcomes were buccal bone wall thickness (BBT), marginal bone level (MBL) and patient satisfaction.

MATERIALS AND METHODS

Sixty patients with a single failing tooth in the maxillary anterior region were provided with an immediately placed and provisionalized implant. At implant placement, the patients randomly received either a connective tissue graft from the maxillary tuberosity (n = 30, test group) or no graft (n = 30, control group). The alveolar socket classification was mainly Type 2A. Data were collected before removing the failing tooth (T0 ), and at 1 (T1 ), 12 (T12 ) and 60 (T60 ) months after final crown placement. The primary outcome was the change in MBML compared with the pre-operative situation. Additionally, the change in BBT, MBL, aesthetics (using the Pink Aesthetic Score-White Aesthetic Score), soft-tissue peri-implant parameters and patient satisfaction were assessed.

RESULTS

At the 5-year follow-up, 27 patients could be analysed from each group. In each group, one implant was lost during the osseointegration period, within 3 months of placement, resulting in an implant survival rate of 96.7% in both groups. MBML change at T60 was -0.6 (-1.1 to -0.1) mm in the control group and 0.1 (-0.4 to 0.5) mm in the test group (p = .008). BBT and MBL, aesthetics, soft-tissue peri-implant parameters and patient satisfaction showed stable results and satisfied patients, without clinically relevant differences between the groups.

CONCLUSIONS

This 5-year follow-up study shows that grafting connective tissue when replacing a single failing tooth with immediately placed and provisionalized implant results in favourable peri-implant tissues and fewer MBML changes.

Immediate loading of fixed partial prostheses reconstructed using either tapered or straight implants in the posterior area: A randomized clinical trial

BACKGROUND

In immediately loaded implants within 72 h after the implant placement in the unilaterally and partially edentulous ridge, primary stability is considered critical, which can be influenced by the design of the implant fixture.

PURPOSE

To determine the outcomes at 1 year after the immediate loading of multiunit fixed partial prostheses over either tapered implants (TIs) or straight implants (SIs) in the posterior region.

MATERIALS AND METHODS

Forty-eight patients (24 patients, 52 implants in TI group; 24 patients, 50 implants in SI group) were included for the study. Except for the one SI group patient whose two implants showed the insertion torque less than 30 Ncm, provisional prostheses designed and fabricated from intraoral scan data obtained immediately after implant surgery were delivered to rest of the 47 subjects at 3-7 days. After a year, the survival rate was estimated by intention-to-treat (ITT) and per-protocol (PP) analyses, and marginal bone loss (MBL) and implant stability were also analyzed statistically (p < 0.05).

RESULTS

Survival rate at implant level in TI group was 96.2%, and that of SI group in the ITT analysis was 86.0%. Intergroup difference, however, was not statistically significant (p > 0.05). Insertion torque was significantly higher in TI group than SI group (47.12 ± 6.37 Ncm vs. 41.60 ± 9.77 Ncm; p < 0.05). MBLs of both groups were less than 0.1 mm at 1-year follow-up and was similar between two groups (p > 0.05).

CONCLUSIONS

Immediate loading of fixed partial prostheses after TI and SI placement showed reliable outcomes in the partially edentulous posterior ridge. In terms of the initial mechanical stability, the performance was superior for TIs than for SIs.

Zirconium dioxide implants as an alternative to titanium: A systematic review

Background

This systematic review evaluates the available scientific literature to demonstrate the aesthetic and clinical benefits and to determine the survival and the success of zirconium dioxide implants concerning titanium implants.

Material and Methods

The electronic databases were searched until January 2020. Outcome measures were pink aesthetic score (PAS), white aesthetic score (WAS), bleeding on probing (BOP) and probing depth (PD). The addressed PICO question was: In partially edentulous patients in the upper-anterior sector, do zirconium dioxide implants provide aesthetic benefits over conventional titanium implants?

Results

In the 15 articles included after the screening were evaluated respectively, the pink aesthetic score, white aesthetics score, the peri-implant, and crown index, bleeding on probing, plaque index, probing pocket depth, radiographic bone loss, papilla height, and survival and success rate. The results show how the aesthetic and clinical benefits and the survival and success rate of zirconium dioxide implants are, in general, better than titanium implants.

Conclusions

Despite the optimal aesthetics, clinical and survival results obtained in the review, more studies are needed to confirm these data.

Key words:Ceramic dental implants, zirconia implants, esthetics, zirconium dioxide and zirconia.

Static computer-aided, partially guided, and free-handed implant placement: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

To analyze the outcomes of static computer-aided implant placement (sCAIP) compared to partially guided (PGIP) and free-handed (FHIP) implant placement.

MATERIAL AND METHODS

This study was registered in PROSPERO (CRD42019131397). A comprehensive literature search was performed by two independent examiners. Only randomized controlled trials (RCTs) were selected. Treatment modalities included sCAIP, PGIP, and FHIP. Data pertaining to the outcomes of interest were extracted. Random-effects meta-analyses were feasible for a subset of outcomes.

RESULTS

From an initial list of 2,870 records, fourteen articles for a total of ten RCTs were selected. Data from 7 of these studies allowed for the conduction of three meta-analyses comparing accuracy of implant placement across modalities. Survival rate up to 12 months post-loading was high (>98%) and comparable between treatments (low-quality evidence). No tangible differences in terms of patient perception of intra- or postoperative discomfort were observed (low-quality evidence). Quantitative analyses revealed significantly lower angular (MD = 4.41°, 95% CI 3.99-4.83, p < .00001), coronal (MD = 0.65 mm, 95% CI 0.50-0.79, p < .00001), and apical (MD = 1.13 mm, 95% CI 0.92-1.34, p < .00001) deviation values for sCAIP as compared to FHIP (8 studies, 383 patients, 878 implants, high-quality evidence). A similar discrepancy, in favor of sCAIP, was observed for angular deviation only as compared to PGIP (MD = 2.11°, 95% CI 1.06-3.16, p < .00001).

CONCLUSIONS

sCAIP is associated with superior accuracy compared to PGIP and FHIP.

Modified surgical drilling protocols influence osseointegration performance and predict value of implant stability parameters during implant healing process

OBJECTIVE

The aim of this study was to evaluate the effects of three different surgical drilling protocols on changes of implant stability parameters and osseointegration performance during the healing period in rabbit femoral condyles.

MATERIAL AND METHODS

Thirty New Zealand white rabbits were used in this study. Three experimental groups according to different surgical drilling protocols (undersized, standard and oversized preparation) were designed. Measurements of implant stability parameters were performed immediately after implant insertion and then at 1, 2, 4, and 8 weeks after the operation. After the animals were sacrificed, the bone blocks with implant were prepared for histological evaluation and histomorphometric analysis.

RESULTS

The results demonstrated that the ISQ values of each group increased gradually through the whole healing period, while the damping factor showed the opposite tendency. The histomorphometric analysis revealed that BIC (bone-implant contact) values gradually increased with time until 8 weeks of healing at each group. In addition, the undersized group has the highest initial BIC (25.16% ± 7.25%) and the lowest values were found in oversized group (9.13% ± 5.89%). Moreover, a higher correlation (R² = 0. 9817) between ISQ and BIC values in oversized group and moderate correlations between DF and BIC values in undersized group (R² = 0.823) were demonstrated.

CONCLUSIONS

The undersized drilling protocol group presented the highest implant stability and BIC values in the whole healing period, while the similar tendency of results was found between standard and oversized drilling protocol groups.

CLINICAL RELEVANCE

These results suggested that undersized drilling protocol is mechanically and biologically beneficial in low-density bone. The modifications of surgical drilling protocols would influence the predictive value of implant stability parameters for osseointegration performance.

Immediate versus early or conventional loading dental implants with fixed prostheses: A systematic review and meta-analysis of randomized controlled clinical trials

STATEMENT OF PROBLEM

Immediate loading of dental implants has gained widespread popularity because of its advantages in shortening treatment duration and improving esthetics and patient acceptance. However, whether immediate loading can achieve clinical outcomes comparable with those of early or conventional delayed loading is still unclear.

PURPOSE

The purpose of this systematic review and meta-analysis was to compare the efficacy of immediate loading versus early or conventional loading implants in patients rehabilitated with fixed prostheses.

MATERIAL AND METHODS

Electronic searches of CENTRAL, EMBASE, and MEDLINE were supplemented by manual searches up to October 2018. Only human randomized controlled trials (RCTs) comparing immediate with early or conventional loading dental implants were included. Quality assessment was performed by using the Cochrane Collaboration tool. For the meta-analysis, the dichotomous and continuous variables were pooled and analyzed by using risk ratios (RRs) and weighted mean differences (WMDs), with 95% confidence intervals (95% CIs). The outcomes assessed included survival rate, marginal bone level changes, peri-implant gingival level, probing depth, and implant stability. The subgroup analyses included healing methods, implant time, occlusal contact, number of missing teeth, and tooth position.

RESULTS

Thirty-nine trials (49 articles) were included from the initial 763 references evaluated. When compared with conventional loading, with implants regarded as a statistical unit, a statistically significant lower survival rate was observed in the immediate loading dental implant (RR=0.974; 95% CI, 0.954, 0.994; P=.012). Regarding other outcomes, including marginal bone level changes, peri-implant gingival level, probing depth, and implant stability, no statistically significant differences were observed when comparing immediate versus early or conventional loading (P>.05).

CONCLUSIONS

Compared with early loading, immediate loading could achieve comparable implant survival rates and marginal bone level changes. Compared with conventional loading, immediate loading was associated with a higher incidence of implant failure.

Influence of Implant Length and Associated Parameters Upon Biomechanical Forces in Finite Element Analyses: A Systematic Review

PURPOSE

The aim of this systematic review is to provide an overview of finite element analyses comparing standard and short dental implants concerning biomechanical properties and to detect the most relevant parameters affecting periimplant stress concentrations.

MATERIAL AND METHODS

After screening the literature and assessment of studies, 36 studies were included in this review.

RESULTS

Eighty-three percent of the studies state that short dental implants have to bear higher stress concentrations compared with standard length implants. At the same time, 44% of articles note that implant diameter can be considered a more effective design parameter than implant length to reduce stress concentrations and to avoid an overload of periimplant bone. Regardless of implant dimension, in all studies, the highest stress concentrations are found in the cortical section around the upper part of the implant.

CONCLUSIONS

Unaffected of bone quality, implant diameter is found to play a key role to minimize periimplant stress concentrations. Concerning stress reduction implant length gains increasing relevance with decreasing bone density. Furthermore, splinting of short implants constitute an appropriate tool to avoid crestal overloading.

Effect of connective tissue grafting on peri-implant tissue in single immediate implant sites: A RCT

AIM

To assess the effect of connective tissue grafting on the mid-buccal mucosal level (MBML) of immediately placed and provisionalized single implants in the maxillofacial aesthetic zone.

MATERIALS AND METHODS

Sixty patients with a failing tooth were provided with an immediately placed and provisionalized implant. During implant placement, patients randomly received either a connective tissue graft from the maxillary tuberosity (n = 30, test group) or no graft (n = 30, control group). Follow-up visits were at one (T₁ ) and twelve months (T₁₂ ) after final crown placement. The primary outcome measure was any change in MBML compared to the pre-operative situation. In addition, gingival biotype, aesthetics (using the Pink Esthetic Score-White Esthetic Score), marginal bone level, soft tissue peri-implant parameters and patient satisfaction were assessed.

RESULTS

The mean MBML change at T₁₂ was -0.5 ± 1.1 mm in the control group and 0.1 ± 0.8 mm in the test group (p = .03). No significant differences regarding other outcome variables were observed, neither was gingival biotype associated with a gain or loss in MBML.

CONCLUSIONS

This one-year study shows that connective tissue grafting in single, immediately placed and provisionalized implants leads to less recession of the peri-implant soft tissue at the mid-buccal aspect, irrespective of the gingival biotype (www.trialregister.nl: TC3815).