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Edentulous Maxilla (edentulous + maxilla)

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Medical Sciences	100%

Selected Abstracts

The Milled Bar-Retained Removable Bridge Implant-Supported Prosthesis: A Treatment Alternative for the Edentulous Maxilla

JOURNAL OF ESTHETIC AND RESTORATIVE DENTISTRY, Issue 4 2002
DGDP(UK), PAUL A. TIPTON BDS
ABSTRACT Restoration of the edentulous jaw with dental implants can be achieved using either an implant-supported prosthesis, such as a fixed bridge, or an implant-retained prosthesis, such as a traditional overdenture. The implant-retained prostheses use edentulous ridges as primary stress-bearing regions, and through stress-breaking mechanisms, the implants are not loaded during function. However, the success rates of maxillary overdentures do not appear to be as good as for mandibular overdentures; this may be attributable to the adverse loading conditions, short implant length, poor quality of bone, number of implants used, flexible bar design, or poor treatment planning. Many articles have also described the numerous problems and multiple visits required in maintaining a traditional bar-retained overdenture restoration, often making it more expensive in the long term than a fixed restoration. The milled bar implant-supported prosthesis offers the benefits of both fixed and removable restorations. Its infrastructure provides the same rigidity as the fixed restoration, owing to the precise fit to the superstructure, which is removable, to promote adequate access for hygiene, yet it still provides lip support and maintains close contact with the soft tissues. These advantages enhance phonetics, esthetics, correct lip support, maintenance, and patient comfort. CLINICAL SIGNIFICANCE Restoring esthetics and function for the edentulous patient requires a multidiscipline approach for success. This article discusses the techniques for restoring function and esthetics for these patients, using a milled bar restoration supported and retained by dental implants. [source]

A Prospective Clinical Study on Titanium Implants in the Zygomatic Arch for Prosthetic Rehabilitation of the Atrophic Edentulous Maxilla with a Follow-Up of 6 Months to 5 Years

CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 3 2006
Carlos Aparicio DDS
ABSTRACT Background, Prosthetic rehabilitation with implant-supported prostheses in the atrophic edentulous maxilla often requires a bone augmentation procedure to enable implant placement and integration. However, a rigid anchorage can also be achieved by using so-called zygomatic implants placed in the zygomatic arch in combination with regular implants placed in residual bone. Purpose, The aim of the present study was to report on the clinical outcome of using zygomatic and regular implants for prosthetic rehabilitation of the severely atrophic edentulous maxilla. Materials and Methods, Sixty-nine consecutive patients with severe maxillary atrophy were, during a 5-year period, treated with a total of 69 fixed full-arch prostheses anchored on 435 implants. Of these, 131 were zygomatic implants and 304 were regular implants. Fifty-seven bridges were screw-retained and 12 were cemented. The screw-retained bridges were removed at the examination appointments and each implant was tested for mobility. In addition, the zygomatic implants were subjected to Periotest® (Siemens AG, Bensheim, Germany) measurements. The patients had at the time of this report been followed for at least 6 months up to 5 years in loading. Results, Two regular implants failed during the study period giving a cumulative survival rate of 99.0%. None of the zygomatic implants was removed. All patients received and maintained a fixed full-arch bridge during the study. Periotest measurements of zygomatic implants showed a decreased Periotest values value with time, indictating an increased stability. Three patients presented with sinusitis 14,27 months postoperatively, which could be resolved with antibiotics. Loosening of the zygomatic implant gold screws was recorded in nine patients. Fracture of one gold screw as well as the prosthesis occurred twice in one patient. Fracture of anterior prosthetic teeth was experienced in four patients. Conclusions, The results from the present study show that the use of zygomatic and regular implants represents a predictable alternative to bone grafting in the rehabilitation of the atrophic edentulous maxilla. [source]

Early Complete Failures of Fixed Implant-Supported Prostheses in the Edentulous Maxilla: A 3-Year Analysis of 17 Consecutive Cluster Failure Patients

CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 2 2006
Odont Dr/PhD, Torsten Jemt DDS
ABSTRACT Background, Clusters of implant failures in the edentulous maxilla seem to occur in some patients. To create groups for analysis with higher numbers of these patients implies large original groups for inclusion. Purpose, The aim of this study was to retrospectively describe and compare a group of "cluster failure patients" with randomly selected patients treated in the edentulous maxilla. Materials and Methods, From a group of 1,267 consecutively treated patients in one clinic, all patients presenting failing fixed implant-supported prostheses within the first 3 years of follow-up were included. All patients were treated with turned titanium implants using two-stage surgery. A control group of equal number of patients were created for comparison. Data on patients were retrospectively retrieved from their records, and compared. Results, Seventeen patients (1.3%) met the inclusion criteria in the entire group. The bone resorption index revealed less bone quantity in the study group (p < .05) during implant placement, but there was no difference regarding primary implant stability at first-stage surgery. The distribution of short and long implants showed relatively higher number of short implants in the study group (p < .05), and more patients had a presurgical discussion on the risk of implant failure prior to treatment in this group (p < .05). Only 5 out of 102 implants (4.9%) were lost before prosthesis placement as compared to 38 and 25 lost implants during the following two years in the study group. Smoking habits and signs of bone loss related to periodontitis in the lower dentition were more frequent in the study group, but did not reach a significant level (p > .05). Conclusion, The results indicate that bone quantity, reflected in fixture length, has a significant impact on increased implant failure risk. Other factors of interest as predictors for implant failures could be smoking habits and also possibly signs of periodontitis in the opposing dentition. [source]

A Three-Year Follow-Up Report of a Comparative Study of ITI Dental Implants® and Brånemark System® Implants in the Treatment of the Partially Edentulous Maxilla

CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 3 2004
Per Åstrand DDS
ABSTRACT Background: Many longitudinal studies of different implant systems have been published but few controlled randomized investigations have been reported. A 1-year report of a comparative study of ITI Dental Implant System® implants (Straumann AG, Waldenburg, Switzerland) and Brånemark System® implants (Nobel Biocare AB, Gothenburg, Sweden) has been published by the present authors. This paper is a 3-year follow-up of that randomized study. Purpose: The aim of the study was to compare the outcome of fixed partial prostheses supported by ITI or Branemark implants. The outcome was evaluated primarily in terms of survival rates and changes in marginal bone level. Material and Methods: The study group comprised 28 patients with anterior residual dentition in the maxilla. The patients were provided with two to four implants on each side of the dentition and were randomly allocated to Brånemark implants or ITI implants; 77 ITI implants and 73 Brånemark implants were inserted. After 6 months abutment connections were made to both ITI and Brånemark implants. All patients were provided with fked partial prostheses of gold-ceramic. The patients were followed up annually with clinical and radiographic examinations for 3 years. Results: Two Brånemark implants and two ITI implants were lost. The Brånemark implants were lost before loading whereas the ITI implants were lost because of periimplantitis. The survival rate for both groups was 97.3%. The mean marginal bone level of the Brånemark implants was situated 1.8 mm from the reference point at both the baseline and the 3-year examinations. The corresponding values for the ITI implants were 1.4 mm at baseline and 1.3 mm after 3 years. There was no significant difference between the implant systems with regard to bone level or bone level change. A steady state of the marginal bone level was calculated to have been reached after 3 years for 95.5% of the Brånemark implants and 87.1% of the ITI implants. Periimplantitis (infection including pus and bone loss) was observed with seven ITI implants but with none of the Brånemark implants. This difference was statistically significant. Conclusions: No statistically significant differences were found between the implants studied, except for the frequency of periimplantitis, which was higher for the ITI implants. The survival rates were high, and the marginal bone loss was small for both systems. [source]

IMMEDIATE LOADING OF IMPLANTS IN THE ESTHETIC ZONE

JOURNAL OF ESTHETIC AND RESTORATIVE DENTISTRY, Issue 5 2005
Saj Jivraj DDS
The predictability of dental implants using the traditional Branemark protocol has been well documented. Since its inception, this protocol has been progressively challenged to decrease treatment time, minimize the number of surgical procedures, and maximize esthetic outcomes. Today, in specific clinical situations, implants may be placed and immediately loaded with provisional restorations. Immediate loading in the edentulous mandible has been well documented. There are also good data to show that immediate loading of the edentulous maxilla is also feasible if bone quality is suitable. The focus now has shifted toward immediate loading of implants placed in the esthetic zone. Clinicians have recognized that the challenge of providing anterior tooth replacements is in preserving the hard and soft tissue components that exist around natural teeth. The advantages of immediate restoration are obvious; however, the application of immediate or early load may pose an increased risk of implant failure in single-tooth situations. The prerequisites for achieving and maintaining acceptable results are not fully known. This review examines some of the literature concerning the reliability of early or immediate loading of implants placed in the esthetic zone. [source]

Turned Brånemark System® Implants in Wide and Narrow Edentulous Maxillae: A Retrospective Clinical Study

CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 2 2008
Bertil Friberg DDS
ABSTRACT Background: The available jawbone volume is regarded as one of the most important factors when assessing the prognosis of oral implants in the rehabilitation of the edentulous maxilla. Purpose: The aim of the current investigation was to retrospectively evaluate and compare the outcome of implants placed in edentulous maxillae with either wide or narrow jaw shapes. The marginal bone loss and implant cumulative survival rates (CSRs) were calculated and analyzed with special reference to smoking habits. Materials and Methods: The study included 75 individuals with edentulous maxillae, of which 33 patients exhibited wide (group A) and 42 patients exhibited narrow jaw shapes (group B). A total of 506 turned Brånemark System® (Nobel Biocare AB, Göteborg, Sweden) implants were inserted (226 in group A and 279 in group B) and followed clinically up to 7 years. Smoking habits were recorded. Radiographs were obtained at connection of prostheses, and at the 1- and 5-year follow-up visit. The marginal bone loss was calculated for the groups and analyzed using t -test. Results: Twenty-eight implants were lost during the study period, revealing implant CSRs at 7 years of 94.6% (11/226) and 93.6% (17/279) for wide and narrow crests, respectively. No difference in marginal bone loss was seen between the two groups, although a trend toward more bone loss was recorded for patients with wide crests. Smoking habits were more common in group A (45%) than in group B (31%). During the first year of function, smokers lost significantly more marginal bone than nonsmokers (p = .0447), albeit this difference did not prevail (p > .05) at the end of the study period. Conclusions: The implant CSRs at 7 years were equally good for the two groups of patients with various jaw shapes. Initially, smokers showed significantly more marginal bone loss than nonsmokers. [source]

A Prospective Clinical Study on Titanium Implants in the Zygomatic Arch for Prosthetic Rehabilitation of the Atrophic Edentulous Maxilla with a Follow-Up of 6 Months to 5 Years

Early Complete Failures of Fixed Implant-Supported Prostheses in the Edentulous Maxilla: A 3-Year Analysis of 17 Consecutive Cluster Failure Patients

Cutting Torque Measurements in Conjunction with Implant Placement in Grafted and Nongrafted Maxillas as an Objective Evaluation of Bone Density: A Possible Method for Identifying Early Implant Failures?

CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 1 2004
Björn Johansson DDS
ABSTRACT Background: Bone grafts are frequently used to enable the placement of dental implants in atrophied jaws. The biomechanical properties of bone grafts used in one- or two-stage implant procedures (in comparison with the use of nongrafted bone) are not well known. Purpose: The purpose of this study was (1) to measure cutting torques during the placement of self-tapping dental implants in nongrafted bone and in bone grafts, either as blocks or in a milled particulate form, in patients undergoing implant treatment in an edentulous maxilla and (2) to identify implants with reduced initial stability and to correlate these findings with a clinical classification of jawbone quality. Materials and Methods: The study included 40 consecutive patients with edentulous maxillas, 27 of whom were subjected to bone grafting prior to or in conjunction with implant placement (grafting group) and 13 of whom received implants without grafting (nongrafted group). Grafted bone from the iliac crest bone was used (1) as onlay blocks, (2) as maxillary sinus inlay blocks, or (3) in particulate form in the maxillary sinus. Implants were placed after 6 to 7 months of healing, except in the maxillary sinus inlay blocks, where implants were placed simultaneously. Cutting torque values were obtained from 113 grafted implant sites and from 109 nongrafted implant sites. Results: Significantly lower cutting torque values were assessed in grafted regions than in nongrafted regions, irrespective of grafting technique. Lower values were also seen for implants placed in block grafts after 6 months when compared to other grafting techniques used. The cutting torque values revealed an inverse linear relation to the Lekholm and Zarb bone quality index. Conclusion: The cutting torque values correlated well with the Lekholm and Zarb index of bone quality. Significantly lower cutting torque values were seen in grafted bone than in nongrafted bone. [source]

Immediate occlusal loading and tilted implants for the rehabilitation of the atrophic edentulous maxilla: 1-year interim results of a multicenter prospective study

CLINICAL ORAL IMPLANTS RESEARCH, Issue 3 2008
Tiziano Testori
Abstract Objectives: The aims of this prospective study were to assess the treatment outcome of immediately loaded full-arch fixed bridges anchored to both tilted and axially placed implants for the rehabilitation of fully edentulous maxillae and to compare the outcome of axial vs. tilted implants. Material and methods: Forty-one patients with edentulous maxillae were included in the study. Each patient received a full-arch fixed bridge supported by four axial implants and two distal tilted implants. Loading was applied within 48 h from surgery. Patients were scheduled for follow-up at 6 months, 1 year and annually up to 5 years. Radiographic evaluation of marginal bone-level change was performed at 1 year. Results: One patient died 4 months after surgery. Thirty patients were followed for a minimum of 1 year (range 3,42 months, mean 22.1 months). Three failures were recorded at 1-year follow-up (two axial implants and one tilted). Two more implants (one tilted and one axially placed) were lost within 18 months of loading. The 1-year implant survival rate was 98.8% for both axial and tilted implants. Prosthesis success rate was 100% at 1 year. Marginal bone loss around axial and tilted implants at 12-month evaluation was similar, being, respectively, 0.9±0.4 (standard deviation) mm and 0.8±0.5 mm. Conclusions: The present preliminary data suggest that immediate loading associated with tilted implants could be considered to be a viable treatment modality for the atrophic maxilla and that there does not seem to be a different clinical outcome between tilted and axial implants. [source]

Human ex vivo bone tissue strains around immediately loaded implants supporting maxillary overdentures

CLINICAL ORAL IMPLANTS RESEARCH, Issue 6 2005
vanç Akça
Abstract Purpose: To evaluate ex vivo bone tissue strains around maxillary implants supporting immediately loaded bar-retained overdentures. Material and methods: Ninety degree two-element rosette strain gauges were bonded on the labial bone of four ITI® dental implants placed in the maxillary anterior region of four completely edentulous maxilla of fresh human cadavers. The installation torque value (ITV) of each implant was measured by a custom-made torque wrench and resonance frequency analyses (RFAs) were undertaken. A bar-retained overdenture was fabricated for each cadaver, and two miniature load cells were integrated in the first molar region of the overdentures for controlled loading experiments. Strain measurements were performed at a sample rate of 10 kHz and under a maximum load of 100 N, simultaneously monitored from a computer connected to a data acquisition system. Finally, removal torque values (RTVs) of the implants were measured. Results: RFA values did not mirror ITVs, while RTVs of implants were slightly lower than the ITVs. Any correlation could not be obtained between RFA values and ITVs or RTVs. Maximum strains around loaded implants ranged between ,100 and ,550 ,, under 25,100 N. The axial and lateral strain values of posterior implants of both sides were higher than those of anterior implants under all loads (P<0.05). Conclusion: Because occlusal forces in humans tend to decrease because of age-related factors, maximum strains around immediately loaded implants supporting maxillary overdentures fall within physiologic levels. Résumé Le but de cette étude a été d'évaluer les tensions du tissu osseux ex vivo autour d'implants maxillaires portant des prothèses amovibles retenues sur une barre placée immédiatement après l'insertion des implants. Deux jauges de force en rosette à 90° ont été attachées au côté lingual de l'os de quatre implants dentaires ITI® placés dans la région antérieure du maxillaire de quatre cadavres humains frais aux maxillaires édentées. La valeur du couple de torsion lors de l'installation (ITV) de chaque implant a été mesurée par un couple fabriqué et des analyses de fréquence de résonnance (RFA) ont été faites. Une prothèse retenue par une barre a été fabriquée pour chaque cadavre et deux cellules de charge miniatures ont été intégrées dans la région de la première molaire de ces prothèses pour les expériences de charge contrôlées. Les mesures de force ont été effectuées à un taux d'échantillonnage de 10 kHz et sous une charge maximale de 100 N, suivies simultanément par un ordinateur connectéà un système d'acquisition de données. Finalement les valeurs des couples de torsion à l'enlèvement (RTV) des implants ont été mesurées. Les valeurs RFA n'étaient pas en ligne avec les ITV tandis que les RTV des implants étaient légèrement inférieurs aux ITV. Aucune corrélation n'a pûêtre établie entre les valeurs RFA et ITV ou RTV. Les forces maximales autour des implants chargés s'étalaient de ,100 ,e à,550 ,e sous 25 N à 100 N. Les valeurs des forces axiales et latérales des implants postérieurs des deux côtés étaient supérieures à celles des implants antérieurs sous toutes les charges (P<0.05). Zusammenfassung Ziel: Es war das Ziel dieser Arbeit, an bis vor kurzem vitalen Knochengewebe Spannungen um Oberkieferimplantate zu untersuchen, welche sofortbelastete und stegverankerte Hybridprothesen tragen. Material und Methoden: Auf den labialen Knochen von vier ITI-Implantaten in der vorderen Region des zahnlosen Oberkiefers von vier frisch verstorbenen Menschen klebte man Dehnmessinstrumente an. Man mass den Wert der Eindrehkraft (ITV) jedes einzelnen Implantates mit einem handelsblichen Drehmomentschlssel und fhrte eine Resonanzfrequenzanalyse (RFA) durch. Man stellte fr jede Leiche eine stegverankerte Hybridprothese her und man baute in der Region der ersten Molaren zwei kleine Messgerte ein, die kontrollierte Belastungsexperimente erlaubten. Dehnmessungen fhrte man mit einer Frequenz von 10 kHz und einer maximalen Belastung von 100 N durch, simultan aufgezeichnet von einem mit dem Messsystem verbundenen Komputer. Schliesslich mass man auch die Krfte, die es brauchte um die Implantate wieder auszudrehen (RTV). Resultate: Die RFA wiederspiegelte die ITV-Werte nicht, whrenddem die RTV-Werte der Implantate geringfgig tiefer waren als die ITV-Werte. Man konnte weder zwischen der RFA, den ITV-Werten oder den RTV-Werten eine Korrelation herstellen. Die maximalen Dehnungen um die Implantate erreichte Werte zwischen ,100 E und ,550 E bei einer Belastung zwischen 25 N und 100 N. Die axialen und lateralen Dehnkrfte bei posterioren Implantaten waren unter smtlichen getesteten Belastungen beidseits grsser als diejenigen der anterioren Implantate (P<0.05). Resumen Propósito: Evaluar las tensiones del tejido óseo ex vivo alrededor de implantes maxilares soportando sobredentaduras retenidas por barras con carga inmediata. Material y Métodos: Se pegaron dos indicadores de tensión de roseta de dos elementos de 90° en el hueso labial de cuatro implantes dentales ITI® colocados en la región maxilar anterior de cuatro maxilares completamente edéntulos de cadáveres humanos frescos. Se midió el valor del torque de instalación (ITV) de cada implante por medio de una chicharra de torque hecha a medida y se llevó a cabo análisis de frecuencia de resonancia (RFA). Se fabricó una sobredentadura retenida por barras para cada cadáver y se integraron dos células miniatura de carga en la región del primer molar de las sobredentaduras para los experimentos de carga controlada. Se llevaron a cabo mediciones de la tensión a un índice de muestra de 10 kHz y bajo una carga máxima de 100 N, simultáneamente monitorizada desde un ordenador conectado a sistema de adquisición de datos. Finalmente, se midieron los valores del torque de remoción (RTV) de los implantes. Resultados: Los valores de RFA no se reflejaron en los ITVs, mientras que los RTVs de los implantes fueron ligeramente más bajos que los ITVs. No se pudieron obtener correlaciones entre los valores de RFA y los ITVs o RTVE. Las tensiones máximas alrededor de los implantes cargados variaron entre ,100 ,, y ,550 ,, bajo 25 N a 100 N. Los valores de las tensiones axiales y laterales de los implantes posteriores de ambos lados fueron mayores que aquellos implantes anteriores bajo todas las cargas (P<0.05). [source]

Surgical advantages with ITI TE® implants placement in conjunction with split crest technique

CLINICAL ORAL IMPLANTS RESEARCH, Issue 2 2005
18-month results of an ongoing prospective study
Abstract: Implant rehabilitation of the edentulous maxilla may be somewhat problematic because of anatomic situations involving insufficient bone thickness. One approach in this situation is localized ridge augmentation with the split crest technique. This surgical approach allows the external cortical plate of the maxilla to be moved in a labial direction to gain an increase in width to introduce implants of appropriate diameter. This ongoing prospective study evaluated: (i) the surgical advantages that the new ITI TE® implants have showed compared with the ITI standard solid-screw implants when placed in conjunction with the split crest technique and (ii) the implant success rate associated with 42 ITI TE® implants and 40 ITI standard solid-screw implants placed in 40 patients in conjunction with the split crest technique. ITI TE® implants have shown direct and indirect advantages in reducing the risk of fracture of the labial cortical plate during all the three fundamental surgical steps of this technique: (a) the ridge expansion with osteotomes; (b) implant site preparation with drills and (c) implant insertion. The overall success rates of ITI TE® implants and standard screw implants were 100% and 95%, respectively. Based on the preliminary results of the present study, it can be concluded that ITI TE® implants inserted in conjunction with split crest technique seem to be a promising surgical procedure to treat selected anatomic situations involving insufficient maxillary bone thickness. Résumé La réhabilitation implantaire du maxillaire édenté peut être problèmatique à cause des situations anatomiques comportant une insuffisance de l'épaisseur osseuse. Une approche de cette situation est d'effectuer un épaississement du rebord localisé avec la technique du rebord osseux fendu. Cette approche chirurgicale permet au plateau cortical externe du maxillaire d'être déplacé en une direction linguale pour augmenter la largeur afin de pouvoir ensuite placer des implants d'un diamètre approprié. Cette étude prospective encore en cours a évalué 1) les avantages chirurgicaux des nouveaux implants ITI TE comparés aux implants ITI en vis solide ITI standard lorsqu'ils étaient placés en association avec cette technique de rebord osseux fendu et 2) le taux de succès implantaire associé avec 42 implants ITI TE et 40 implants vis solides ITI standard placés chez 40 patients en association avec cette technique de rebord osseux fendu. Les implants ITI TE ont montré des avantages directs et indirects en réduisant le risque de fracture de la corticale linguale durant les trois étapes chirurgicales fondamentales de cette technique : a) l'expansion du rebord alvéolaire avec les ostétomes, b) la préparation des sites implantaires avec les forets et c) l'insertion implantaire. Les taux de succès généraux des implants ITI TE et des implants vis standards étaient respectivement de 100 % et 95%. Basé sur le résultat préléminaire de cette étude, il peut être conclu que les implants ITI TE insérés en association avec la technique du rebord osseux fendu semble être un processus chirurgical prometteur pour traiter des situations anatomiques sélectionnées qui comportent une épaisseur osseuse insuffisante du maxillaire. Zusammenfassung Die Rekonstruktion einer zahnlosen Situation im Oberkiefer ist dann etwas problematischer, wenn anatomisch ungünstige Gegebenheiten wie zum Beispiel eine ungenügende vertikale Breite des Alveolarknochens besteht. Eine mögliche Vorgehensweise in dieser Situation ist die lokale Knochenaugmentation mittels Spaltung und Spreizung der Knochenkortikalis. Diese chirurgische Methode erlaubt uns, die äussere Kortikalis des Oberkiefers in labialer Richtung abzuspreizen und somit ein genügend breites Knochenbett zu erhalten, um Implantate mit dem geeigneten Durchmesser setzen zu können. Diese noch weiterverfolgte Langzeitstudie untersuchte: (i) die chirurgischen Vorteile, die uns das neue ITI TE-Implantat verglichen mit der Vollschraube des ITI-Standardimplantates in Verbindung mit der Kortikalisspreiztechnik bringt und (ii) die Implantaterfolgsrate von 42 ITI TE-Implantaten und 40 Vollschrauben der ITI-Standartimplantate, die man bei 40 Patienten in Verbindung mit der Kortikalisspreiztechnik gesetzt hat. Die ITI TE-Implantate zeigten direkte und indirekte Vorteile bei der Verminderung des Frakturrisikos in der labialen Kortikalisplatte während den drei grundlegenden Schritten dieser Technik: (a) Spreizung des Knochenkamms mit Osteotomen; (b) Vorbohren des Implantatbettes und (c) Eindrehen der Implantate. Die Erfolgsrate lag bei den ITI TE-Implantaten bei 100% und bei den Standartschraubenimplantaten bei 95%. Basierend auf diesen ersten Resultaten der Studie kann man schliessen, dass es sich bei ITI TE-Implantate, die in Verbindung mit der Kortikalisspreiztechnik eingesetzt worden waren, um eine vielversprechende chirugische Technik handelt, um ausgewählte anatomische Situationen, wie zu Beispiel eine ungenügende vertikale Breite des Alveolarknochens im Oberkiefer, zu behandeln. Resumen La rehabilitación con implantes del maxilar edéntulo puede ser un tanto problemática debido a situaciones anatómicas que comprenden situaciones de grosor óseo insuficiente. Un enfoque en esta situación, es el aumento localizado de la cresta con la técnica de cresta dividida. Este enfoque quirúrgico permite mover la placa cortical externa del maxilar en dirección labial para ganar un aumento en anchura para introducir implantes del diámetro apropiado. Este estudio prospectivo continuado evaluó: i) los avances quirúrgicos que los nuevos implantes ITI TE han mostrado en comparación con los implantes macizos roscados ITI estándar al colocarse en combinación con la técnica de cresta dividida y ii) el índice de éxito del implante asociado con 42 implantes ITI TE y 40 implantes macizos roscados estándar colocados en 40 pacientes en combinación con la técnica de cresta dividida. Los implantes ITI TE han mostrado ventajas directas e indirectas en reducir el riesgo de fractura de la placa cortical labial durante los tres pasos quirúrgicos fundamentales de esta técnica: a) expansión de la cresta con osteotomos; b) preparación del lecho implantario con fresas y c) inserción del implante. El índice total de éxito de los implantes ITI TE y de los implantes estándar roscados fue del 100% y del 95% respectivamente. Basado en los resultados preliminares del presente estudio, se puede concluir que los implantes ITI TE insertados en combinación con la técnica de cresta dividida parece ser un procedimiento quirúrgico prometedor para tratar situaciones anatómicas determinadas que conllevan un grosor óseo maxilar insuficiente. [source]

Implant-supported fixed prostheses in the edentulous maxilla

CLINICAL ORAL IMPLANTS RESEARCH, Issue 3 2004
A 2-year clinical, radiological follow-up of treatment with non-submerged ITI implants
Abstract Objectives: To evaluate the survival rate of non-submerged solid-screw ITI dental implants with a rough (titanium plasma sprayed, TPS) surface in the edentulous maxilla after 1 and 2 years of loading. Material and method:, Twenty-five patients (mean age 64 years) with edentulous upper jaws received five,seven implants and, after a mean healing time of 6.9 months, screw-retained implant-supported fixed prostheses. A total of 146 ITI solid screw TPS implants were inserted. The diameter of 56% of the implants was smaller (3.3 mm) than the standard (4.1 mm) and the diameter of the rest (44%) was standard. The bone quantity of the majority of the patients was low and the bone quality poor. Clinical parameters were registered at baseline and at two annual follow-ups. Radiological examinations and assessments were also made at these times. Results: Mean marginal bone level at baseline was measured at a point 4.52 mm (range 1.45,7.70, SD 1.2) apical of the reference point. Mean bone loss from baseline to 1 year of loading was 0.24 mm (SD 0.9, P=0.002) and from 1 year to 2 years of loading 0.15 mm (SD 0.4, P<0.001). Five implants failed, four of which were early failures prior to loading. One implant failed shortly after bridge installation. The cumulative survival rate was 96.6% after 1 and 2 years. Conclusion: ITI TPS solid-screw implants in combination with fixed prostheses had successful survival rates and were found to be a viable treatment alternative in the edentulous maxilla. Résumé Le but de cette étude a été d'évaluer le taux de survie d'implants dentaires ITI vis solides non-enfouis avec une surface TPS (titane plasma-spray) au niveau du maxillaire édenté après une ou deux années de mise en charge. Vingt-cinq patients d'un âge moyen de 64 ans avec des mâchoires supérieures édentées ont reçu de cinq à sept implants et, après un temps de guérison moyen de 6,9 mois, des prothèses fixées vissées à ces implants (ISFP). Un total de 146 implants TPS ITI vis pleines ont été insérés. Le diamètre de 56% des implants étaient plus petits (3,3 mm) que le reste des implants qui avaient un diamètre standard (4,1 mm). La longueur des implants variait de 6 à 16 mm. La quantité osseuse de la majorité des patients était faible et la qualité osseuse pauvre. Des paramètres cliniques ont été enregistrés lors de l'examen initial et après deux années. Des examens radiographiques ont également été effectués à ces moments. Le niveau osseux marginal moyen lors de l'examen initial a été mesuréà un point 4,52 mm (de 1,45 à 7,70 mm : SD 1,2 mm) en apical du point de référence. La perte osseuse moyenne entre l'examen de départ et un an après la mise en charge était de 0,24 mm (SD 0,9; p=0,0002) et entre la première et la deuxième année de 0,15 mm (SD 0,4; p<0,001). Cinq implants ont échoué, dont quatre avant la mise en charge. Un implant a échoué peu de temps après le placement du bridge. Le taux de survie cumulatif après une ou deux années était de 96,6%. Les implants ITI TPS vis pleines avec des prothèses fixées avaient des taux de survie excellents et représentaient un traitement alternatif de qualité pour les patients édentés du maxillaire supérieur. Zusammenfassung Ziele: Die Ueberlebensrate von transmukosalen dentalen ITI-Vollschraubenimplantaten mit einer rauen Oberfläche (titanplasmabeschichtet, TPS) im zahnlosen Oberkiefer nach 1 und 2 Jahren Belastung auszuwerten. Material und Methoden: Fünfundzwanzig Patienten (mittleres Alter 64 Jahre) mit zahnlosen Oberkiefern erhielten 5,7 Implantate und nach einer mittleren Einheilzeit von 6.9 Monaten wurden verschraubte festsitzende implantatgetragene Rekonstruktionen (ISFPs) eingesetzt. Insgesamt wurden 146 ITI-Vollschraubenimplantate eingesetzt. Der Durchmesser von 56% dieser Implantate war kleiner (3.3 mm) als der Standard (4.1 mm) und der Durchmesser der restlichen 44% war Standard. Bei der Mehrzahl der Patienten war die Knochenmenge gering und die Knochenqualität schlecht. Die klinischen Parameter wurden bei der Ausgangsuntersuchung und bei den zwei Nachuntersuchungen in jährlichen Abständen aufgenommen. Bei diesen Untersuchungen wurden auch radiologische Auswertungen durchgeführt. Resultate: Das marginale Knochenniveau zum Zeitpunkt der Ausgangsuntersuchung wurde an einem Punkt 4.52 mm (Bandbreite 1.45,7.70, SD 1.2) apikal des Referenzpunktes gemessen. Der mittlere Knochenverlust von der Ausgangsuntersuchung bis 1 Jahr nach Belastung betrug 0.24 mm (SD 0.9, P=0.002) und zwischen 1 und 2 Jahren nach Belastung betrug er 0.15 mm (SD 0.4, P>0.001). Fünf Implantate zeigten Misserfolge, vier davon waren Frühmisserfolge vor Belastung. Ein Implantat versagte kurz nach der Eingliederung der Brücke. Die kummulative Ueberlebensrate nach 1 und 2 Jahren betrug 96.6%. Schlussfolgerung: ITI TPS Vollschraubenimplantate in Kombination mit festsitzenden Rekonstruktion zeigten erfolgreiche Ueberlebensraten und scheinen eine überlebensfähige Behandlungsalternative im zahnlosen Oberkiefer darzustellen. Resumen Objetivos: Evaluar el índice de supervivencia de implantes ITI roscados macizos no sumergidos con una superficie rugosa (pulverizada con plasma de titanio, TPS) en el maxilar edéntulo tras 1 o 2 años de carga. Material y Métodos: Veinticinco pacientes (edad media 64 años) con maxilares superiores edéntulos recibieron 5,7 implantes y, tras un periodo de cicatrización medio de 6.9 meses, una prótesis fija atornillada implantosoportada (ISFPs). Se insertaron un total de 146 implantes ITI roscados macizos. El diámetro del 56% de los implantes fue menor (3.3 mm) que el estándar (4.1 mm) y el diámetro del resto (44%) fue estándar. La cantidad de hueso de la mayoría de los pacientes fue baja y la calidad de hueso baja. Los parámetros clínicos se registraron al inicio y en los exámenes anuales de seguimiento. También se realizaron exámenes radiológicos y valoraciones en estos momentos. Resultados: El nivel medio de hueso marginal al inicio se midió en un punto 4.52 (rango 1.45,7.70, SD 1.2) apical al punto de referencia. La pérdida de hueso desde el inicio hasta 1 año de carga fue de 0.24 mm (SD 0.9, P=0.002) y de 1 año a 2 años de carga fue de 0.15 mm (SD 0.4, P<0.001). Cinco implantes fracasaron al poco de instalar los puentes. El índice acumulativo de supervivencia fue del 95%. Conclusión: Los implantes roscados macizos ITI TPS en combinación con prótesis fijas tuvieron unos índices de supervivencia exitosos y se encontró que eran una alternativa de tratamiento viable en el maxilar edéntulo. [source]

Cutting Torque Measurements in Conjunction with Implant Placement in Grafted and Nongrafted Maxillas as an Objective Evaluation of Bone Density: A Possible Method for Identifying Early Implant Failures?

A comparison of two implant techniques on patient-based outcome measures: a report of flapless vs. conventional flapped implant placement

CLINICAL ORAL IMPLANTS RESEARCH, Issue 4 2010
Jerome A. Lindeboom
Abstract Background: Flapless implant surgery is considered to offer advantages over the traditional flap access approach. There may be minimized bleeding, decreased surgical times and minimal patient discomfort. Controlled studies comparing patient outcome variables to support these assumptions, however, are lacking. Aim: The objective of this clinical study was to compare patient outcome variables using flapless and flapped implant surgical techniques. Patients and methods: From January 2008 to October 2008, 16 consecutive patients with edentulous maxillas were included in the study. Patients were randomly allocated to either implant placement with a flapless procedure (eight patients, mean age 54.6±2.9 years) or surgery with a conventional flap procedure (eight patients, mean age 58.7±7.2 years). All implants were placed using a Nobel guide® CT-guided surgical template. Outcome measures were the Dutch version of the Impact of Event Scale-Revised (IES-R), dental anxiety using the s-DAI and oral health-related quality of life (OHIP-14). Results: Ninety-six implants were successfully placed. All implants were placed as two-phase implants and the after-implant placement dentures were adapted. No differences could be shown between conditions on dental anxiety (s-DAI), emotional impact (IES-R), anxiety, procedure duration or technical difficulty, although the flapless group did score consistently higher. The flap procedure group reported less impact on quality of life and included more patients who reported feeling no pain at all during placement. Conclusions: Differences found in the patient outcome variables do suggest that patients in the flapless implant group had to endure more than patients in the flap group. To cite this article: Lindeboom JA, van Wijk AJ. A comparison of two implant techniques on patient-based outcome measures: a report of flapless vs. conventional flapped implant placement. Clin. Oral Impl. Res. 21, 2010; 366,370. doi: 10.1111/j.1600-0501.2009.01866.x [source]