Auricular prostheses and osseointegrated implants: UCLA experience

A clinical study of 40 craniofacial implants placed in 13 auricular defects was conducted over a 6-year period. Implant-retained prostheses were fabricated, the implant success rate was determined, and the soft tissue responses were recorded at regular intervals. All of the implants became osseointegrated and none demonstrated failure during the study period. A five-point scale was used to record the health of the peri-implant soft tissues and the patients were followed up for up to 69 months. The results were as follows: 55.1% of the visit/sites demonstrated an absence of inflammation; 32.3% of the visit/sites demonstrated slight redness; 4.7% demonstrated red and moist peri-implant tissues; 5.5% demonstrated granulation tissue associated with the implants; and in 2.4% of the implants, infection of the peri-implant soft tissues was noted. Good patient hygiene compliance combined with thin and immobile peri-implant soft tissues resulted in minimal soft tissue complications.     

Osseointegrated Implants and Auricular Defects: A Case Series Study

Purpose: The objective of this study was to report on the survival rate of 16 patients treated with extraoral implants in the auricular region, analyze treatment outcomes, and discuss important clinical variables encountered during treatment. Materials and Methods: Sixteen patients who received extraoral dental implants to retain auricular prostheses between 1987 and 2003 were followed retrospectively. The variables recorded were gender, initial diagnosis, number and size of implants, implant placement date, age at implant placement, history of radiation to the treated field, abutment size, design of initial prosthesis, age of initial prosthesis (when a remake was indicated), date of prosthesis delivery, soft tissue response, grafting procedure, date of last follow‐up, and complications. All patients were thoroughly evaluated presurgically by the reconstruction team, which consisted of prosthodontists, a facial prosthetist, and an otolaryngologist. Surgical templates were used for all patients. The criteria for success of the prostheses included marginal accuracy, overall stability and function, symmetry/position, texture, color stability, and patient acceptance. Results: Thirty‐nine implants were placed in 16 patients. All 16 patients were completely satisfied with their reconstructions. No surgical complications, implant failures, or prosthetic failures were encountered. Therefore, the survival rate was 100%. Three patients (18.75%) had grade 0, seven (43.75%) had grade 1, five (31.25%) had grade 2, and one (6.25%) had grade 3 soft tissue inflammation. The inflammation completely resolved in 7 of the 13 patients (54%) with hygiene reinforcement or soft tissue reduction. Conclusions: The survival rate for bone‐anchored titanium implants and prostheses was 100%. Bone‐anchored titanium implants provided the 16 patients in this study with a safe, reliable, adhesive‐free method to anchor auricular prostheses with recovery of normal appearance. Under the guidance of an appropriate implant team, proper positioning of implants was optimized to allow prosthodontic rehabilitation using implant‐retained prostheses.     

A retrospective study of implant-retained auricular prostheses

PURPOSE: The purpose of this study was to retrospectively evaluate the clinical results of the implant-retained auricular prosthesis. MATERIALS AND METHODS: Data were collected from 46 patients who were treated between 1992 and 2004 with implant-retained auricular prostheses. A total of 156 implants and 1 plate (Epitec System) were placed in 46 patients, including 23 EO System implants, and 133 Br?nemark implants. The implant survival rate was 100%. Twenty patients with 53 implants were reexamined to evaluate the peri-implant soft tissue status. Two clinical peri-implant parameters were applied, skin probing depth and sulcus fluid flow rate. RESULTS: No adverse skin reactions were observed in 22 implants. Skin pockets were found in all of the 53 reexamined implants, which indicates the need for greater skin reduction. The mean skin probing depth and sulcus fluid flow rate were 2.1 +/- 0.9 mm and 1.8 +/- 1.3 mm, respectively, and a significant positive correlation was found between these 2 parameters. CONCLUSIONS: From these results, it can be concluded that the implant-retained auricular prosthesis promises long-term stability for patients with severe defects or total loss of the ear. Furthermore, sulcus fluid flow rate is a valuable parameter for the evaluation of peri-implant soft tissue.     

Modified technique for retaining silicone auricular prosthesis: a case report

Prosthetic rehabilitation of auricular defects can be a demanding procedure due to a broad variety of clinical presentations and a wide array of treatment options. The retention of auricular prostheses is a major factor influencing the successful outcome of rehabilitative treatment following cancer surgery or trauma. Auricular prostheses have been retained by methods including implants, adhesives and spectacle frames but the choice of repair ultimately depends on patient factors, amount of soft tissue loss, and location of the auricular defect. This article describes a newer technique of using resin template for silicone auricular prosthesis, for better retention and orientation. Moreover it is cost effective and aesthetically acceptable for patients who decline or need to postpone implant retained prosthesis reconstruction.     

Nasal defects and osseointegrated implants: UCLA experience

A clinical study of 23 craniofacial implants placed in 11 nasal defects was conducted over a 7-year period. Implant-retained nasal prostheses were fabricated, implant success rate was determined, and the soft tissue responses were recorded at 6-month intervals. No data were gathered on two implants because of patient death. The implant success rate was 71.4% (15/21) but varied significantly by anatomic site. The implant success rate in the glabella was 0% (0/4), whereas the success rate in the anterior nasal floor was 88.1% (15/17). All implant failures occurred within the first year of loading. A five-point scale was used to record the health of the peri-implant soft tissues, and the patients were followed up from 6 to 74 months. The unit of measure was a visit/site, and a unit was assigned for each instance an implant site was evaluated. Evaluations were conducted at 6-month intervals for a total of 76 visit/sites for the study period. The results revealed that 85.5% (65/76) of the visit/sites demonstrated an absence of inflammation; 10.5% (8/76) of the visit/sites demonstrated slight redness; 1.3% (1/76) demonstrated peri-implant red and moist tissues; 2.6% (2/76) demonstrated granulation tissue associated with the implants; and 0% (0/76) demonstrated infection of the peri-implant soft tissues. Severe soft tissue reactions around implants placed in the anterior nasal floor are rare.     

Peri-implant bone loss around posterior mandible dental implants placed after distraction osteogenesis: preliminary findings

BACKGROUND: The present study evaluates implant survival and peri-implant bone loss around posterior mandible dental implants placed at sites of distraction osteogenesis. METHODS: On removal of the distraction devices, 34 dental implants were inserted into 14 posterior mandible sites in 10 healthy, non-smoking female patients. Prosthetic treatment was performed 4 months after implant placement using fixed implant prostheses. After 6 to 16.5 months, periapical radiographs were taken and evaluated for peri-implant bone loss and radiolucency. The distance between the implant margin and the first visible bone-implant contact was measured on the mesial and distal aspects of the implants using imaging software. Radiographic dimensional distortion was corrected as a function of the known true dimension of the implant. RESULTS: Of the 34 implants placed, two (5.9%) failed to integrate at reentry surgery. Both were replaced and restored during the course of the study so that a total of 34 implants was followed for 12.1 +/- 3.8 months post-restoration and 16.1 +/- 3.8 months post-insertion. Mean loss of marginal bone height was 2.6 +/- 1.0 mm. During the follow-up period, radiolucent lines along the implant surface were absent. CONCLUSIONS: The mean peri-implant bone loss in areas of alveolar bone distraction was 1.9 mm/year. A high implant survival rate was observed.     

Five-year results of fixed implant-supported rehabilitations with distal cantilevers for the edentulous mandible

Objectives: The purpose of this study was to evaluate the survival rate, success rate and primary complications associated with mandibular fixed implant‐supported rehabilitations with distal cantilevers over 5 years of function. Material and methods: In this prospective multi‐center trial, 45 fully edentulous patients were treated with implant‐supported mandibular hybrid prostheses with distal extension cantilevers. Data were collected at numerous time points, including but not limited to: implant placement, abutment placement, final prosthesis delivery, 3 months and 5 years post‐loading. Biological, implant and prosthetic parameters defining survival and success were evaluated for each implant including: sulcus bleeding ndex (SBI) at four sites per implant, width of facial and lingual keratinized gingiva (mm), peri‐implant mucosal level (mid‐facial from the top of the implant collar, measured in mm), modified plaque index (MPI) at four sites per implant, mobility and peri‐implant radiolucency. Survival was defined as implants or prostheses that did not need to be replaced. Success rate was defined as meeting well‐established criteria that were chosen to indicate healthy peri‐implant mucosa osseointegration, prostheses success and complications. Results: A total of 237 implants in 45 completely edentulous patients were included in the study. In each patient, four to six implants were placed to support hybrid prostheses with distal cantilevers. Cantilevers ranged in length from 6 to 21 mm, with an average length of 15.6 mm. The ages of the patients ranged from 34 to 78 with a mean age of 59.5 years. The survival rate of implants was 100% (237/237) and for prostheses 95.5% (43/45). The overall treatment success rate was calculated as 86.7% (39/45). Of the six patients that have not met the criteria for success, two patients required replacement of the entire prosthesis and four patients presented >four complications events. Conclusion: Fixed implant‐supported rehabilitation with distal cantilever resulted in a reliable treatment modality over the 5‐year observation period. Although biological parameters of MPI, SBI, keratinized tissue and peri‐implant mucosal levels showed statistically significant differences over time, the mean values for each patient remained within the normal limits of oral health. Complications were categorized as biological or technical. The majority of complications were technical complications (54/79) and of these most involved fracture of the acrylic teeth and base (20/54). While the survival rate was 100% for implants and 95.5% for prostheses, the application of strict criteria for treatment success resulted in an overall treatment success rate of 86.7%.     

牙周因素对种植体周围病影响机制的研究进展

随着种植义齿在临床修复中的广泛应用,种植修复后最常见的生物学并发症——种植体周围病的发生发展也引起了学者们的广泛关注。种植体周围病所导致的软组织破坏和骨组织吸收对种植体在口内的长期稳定、美观及功能产生不良影响,且目前尚缺乏有效的治疗手段。牙周炎作为种植体周围病发生发展的一个关键危险因素,会显著增加种植体周围病的发生风险,降低种植体的成功率。目前认为,种植体周围较差的软组织封闭、牙周炎症状态对口腔微生物环境和宿主免疫微环境两方面的影响,共同导致了种植体周围病的发生。文章就现有牙周因素与种植体周围病的分子学研究进行了回顾总结,对牙周因素影响种植体周围病发生发展的可能机制做一综述,以期在临床上为种植体周围病提供有效的防治策略。     

Prospective Evaluation of 2,549 Morse Taper Connection Implants: 1‐ to 6‐Year Data

Background: The aim of this study is to evaluate the implant survival, the implant–crown success, and the prosthetic complications of 2,549 Morse taper interference–fit connection implants. Methods: A total of 2,549 Morse taper connection implants were inserted in 893 patients from January 2003 until December 2008. At each annual recall, clinical, radiographic, and prosthetic parameters were assessed. The implant–crown success criteria included the absence of pain, suppuration, and clinical mobility; an average distance between the implant shoulder and the first visible bone contact <2 mm from initial surgery; and the absence of prosthetic complications at the implant–abutment interface. Prosthetic restorations were fixed partial prostheses (462 units); fixed full‐arch prostheses (60 units); single crowns (531 units); and overdentures (93 units). Results: The cumulative implant survival rate was 98.23% (97.25% maxilla, 99.05% mandible). The implant–crown success was 92.49%. A few prosthetic complications at implant–abutment interface were reported (0.37%). After 6 years, distance between the implant shoulder and the first visible bone contact was 1.10 mm (± 0.30 mm). Conclusion: The use of Morse taper connection implants represents a successful procedure for the rehabilitation of partially and completely edentulous arches.     

A 1- to 12-year clinical evaluation of 106 endosseous implants supporting fixed and removable prostheses

The purpose of this article is to report on the long-term clinical evaluation of patients treated with dental implants. A total of 106 implants were placed in 34 patients and restored with fixed partial dentures and overdentures. The 12-year cumulative implant survival and success rates were 95.2% and 90.2%, respectively. Probing depths around mandibular implants were significantly lower than those around maxillary implants (P < .05). The cumulative implant success rate in nonsmokers was 97.7%, but this dropped to 75.81% in smokers. Also, patients rehabilitated with implant-supported overdentures had more peri-implant tissue inflammation than patients with fixed prostheses.     

Implant-supported mandibular overdentures retained with a milled bar: a retrospective study

PURPOSE: The aim of this retrospective study was to evaluate implant survival rate, peri-implant conditions, and prosthodontic maintenance for implant-supported mandibular overdentures rigidly retained with a milled bar. MATERIALS AND METHODS: Patients with 4 interforaminal implants (cylindric or screw-type) supporting an overdenture on a milled bar treated between 1996 and 2004 were asked to participate in a retrospective study. The cumulative implant survival rate and peri-implant conditions (marginal bone loss, pocket depth, Plaque Index, Gingival Index, Bleeding Index, and calculus presence) were evaluated and compared between cylindric and screw-type implants. The incidence and type of prosthodontic maintenance and subjective patient satisfaction rating were also evaluated. RESULTS: Fifty-eight of 67 patients (87.3%) and 232 implants (76 cylindric, 156 screw-type) were available for follow-up examination after a mean period of 59.2 +/- 26.9 months. The cumulative implant survival rate was 99%, and no differences in peri-implant soft tissue conditions were noted between the different implant types used. The cylindric implants showed more pronounced marginal bone resorption than the screw-type implants (1.9 +/- 0.6 mm vs 2.2 +/- 0.6 mm; P = .02) but the difference was not clinically significant. A low incidence of prosthodontic maintenance evenly distributed throughout the overall follow-up period and a high subjective satisfaction rating by the patients were noted. CONCLUSION: Interforaminal screw-type and cylindric implants supporting a milled bar for rigid overdenture anchorage were associated with a high survival rate and excellent peri-implant conditions. The incidence of prosthodontic maintenance was low and evenly distributed throughout the follow-up period as a result of rigid denture stabilization by the milled bar. Rigid anchorage of a mandibular overdenture with a milled bar unites the prosthodontic advantages of removable and fixed prostheses. (Clinical Trial) (More than 50 references.)     

Long-term results of implants treated with guided bone regeneration: a 5-year prospective study.

The aim of this prospective 5-year longitudinal study was to follow endosteal implants in which guided bone regeneration (GBR) was applied during implant placement. In 75 patients, defects around implants (Branemark System) were treated with Bio-Oss and Bio-Gide (112 implants). In split-mouth patients in this group, Bio-Oss and Gore-Tex were used in the second defect site (41 implants). All 75 patients had at least 1 implant that was entirely surrounded by bone and served as the control (112 implants). After placement of the definitive prostheses (single-tooth, fixed, or removable implant prostheses), patients were recalled after 6 months and then every 12 months during a 5-year observation period. The following variables were investigated: implant survival, marginal bone level (MBL), presence of plaque, peri-implant mucosal conditions, height of keratinized mucosa (KM), and marginal soft tissue level (MSTL). The cumulative implant survival rate after 5 years varied between 93% and 97% for implants treated with or without GBR. The mean MBL after 60 months was 1.83 mm for sites treated with Bio-Oss and Bio-Gide, 2.21 mm for sites treated with Bio-Oss and Gore-Tex, and 1.73 mm for the control sites. The MBL values were found to increase significantly with time and differed significantly among the treatment groups. During the observation period, KM varied between 3.16 and 3.02 mm. A slight recession of 0.1 mm was observed, and plaque was found in 15% of all sites and was associated with inflammatory symptoms of the peri-implant mucosa. It was observed that such symptoms and recession correlated more strongly with the type of restoration than with the type of treatment. This study demonstrated that implants placed with or without GBR techniques had similar survival rates after 5 years, but that bone resorption was more pronounced in sites with GBR treatment. It was assumed that the use of GBR is indeed indicated when the initial defect size is larger than 2 mm in the vertical dimension.     

Prospective clinical evaluation of 1920 Morse taper connection implants: results after 4 years of functional loading

Purpose: This study evaluated the survival rate and the clinical, radiographic and prosthetic success of 1920 Morse taper connection implants.
Material and methods: One thousand nine hundred and twenty Morse taper connection implants were inserted in 689 consecutive patients, from January 2003 until December 2006. Implants were clinically and radiographically evaluated at 12, 24, 36 and 48 months after insertion (mean follow-up per implant: 25.42 months). Modified plaque index (mPI), modified sulcus bleeding index, probing depth (PD) and the distance between implant shoulder and first crestal bone–implant contact (DIB) were measured in mm. Success criteria included the absence of suppuration and clinically detectable implant mobility, PD<5 mm, DIB<1.5 mm after 12 months of functional loading and not exceeding 0.2 mm for each following year, the absence of recurrent prosthetic complications at the implant–abutment interface. Prosthetic restorations were fixed partial prostheses (364 units), single crowns (SCs: 307 units), fixed full-arch prostheses (53 units) and overdentures (67 units).
Results: The overall cumulative implant survival rate was 97.56% (96.12% in the maxilla and 98.91% in the mandible). The cumulative implant success rate was 96.61% (95.25% in the maxilla and 98.64% in the mandible). Only a few prosthetic complications were reported (0.65% of loosening at implant–abutment interface in SCs).
Conclusion: The use of Morse taper connection implants represents a successful procedure for the rehabilitation of partially and completely edentulous arches. The absence of an implant–abutment interface (microgap) is associated with minimal crestal bone loss. The high mechanical stability significantly reduces prosthetic complications.     

Clinical evaluation of small-diameter ITI implants: a prospective study

PURPOSE: Dental implants with a reduced diameter are designed for specific clinical situations, such as placement of implants where bone width is narrow or between adjacent teeth that have only a narrow space between them. They are particularly useful when replacing small teeth such as lateral maxillary and mandibular incisors. The aim of the present study was the clinical evaluation of 2-part ITI implants (full-body screws with a 3.3-mm diameter). MATERIALS AND METHODS: One hundred forty-nine partially or completely edentulous patients received a total of 298 2-part ITI implants over a 10-year period. After a standard healing period (3 to 6 months), the implants were restored with fixed restorations such as single crowns or fixed partial or complete prostheses or overdentures. Complete prosthesis or overdenture in the edentulous jaw was the predominant type of restoration. All patients followed a strict maintenance program, with regular recalls at least once a year. The survival rate of the implants was analyzed, and prosthetic complications were assessed. RESULTS: Three implants were lost during the healing phase on account of peri-implant infection. Two implant body fractures with an osseous length of 8 mm were observed (one after 2 years of observation, the other after 6 years). Four implants exhibited transient peri-implant inflammation that was treated successfully by interceptive therapy. The cumulative 5-year survival rate of the implants was 98.7% (96.6% after 6 years). Prosthetic complications were mostly limited to loose occlusal screws and sore spots caused by the denture base. DISCUSSION: Within the limited observation period, failures of small-diameter implants were infrequent. Prosthetic complications were not dependent on the use of small-diameter implants. CONCLUSION: The use of 3.3-mm ITI implants appears to be predictable if clinical guidelines are followed and appropriate prosthetic restorations are provided. However, fatigue fracture may occur after a long period of function.     

Retrospective cohort study of the clinical performance of 1-stage dental implants

PURPOSE: To evaluate long-term clinical performance of 1-stage dental implant prostheses at a single clinic, emphasizing clinical and demographic characteristics that affect implant survival. MATERIALS AND METHODS: Dental records of all 308 patients (674 implants) treated with 1-stage implants at Mayo Clinic from October 1993 through May 2000 were reviewed from implant placement to last visit. Exposure and outcome variables affecting performance were collected separately to control bias in the data collection process. Additional confounding factors (age and sex) were adjusted with the stratified Cox proportional hazards model. Implant survival was determined by means of a Kaplan-Meier survival estimate. The log-rank test was used to determine the role of clinical and demographic variables in implant survival. The relative risk associated with the possible effect of clinical and demographic variables on implant survival was estimated with the Cox proportional hazards model. RESULTS: The implant survival rate (n = 654 implants) was 97% (mean +/- SD follow-up, 21.0 +/- 18.8 months; range, 1 to 78 months). Performance bias was limited because nearly all patients were treated by 1 prosthodontist. Two implants failed after loading (6 and 9 months). The incidence of complications was less than 4%. Among the implant failures, use of heterogeneous bone graft was associated with 4.8 times more failures than was use of autogenous bone graft (P = .04). After augmentation, delaying implant placement for 5 to 6 months resulted in 8.6 times more failures than the rate after earlier placement (P < .001). DISCUSSION: Retrospective review of the clinical performance of a 1-stage dental implant system yielded a 97% survival rate, with no failures noted after 13 months. Prosthetic complications were low, especially for fixed implant prostheses. CONCLUSION: Clinical performance of 1-stage dental implant prostheses between 1993 and 2000 demonstrated a high level of predictability.     

The longitudinal clinical effectiveness of ITI solid-screw implants in partially edentulous patients: a 5-year follow-up report

A total of 114 ITI solid-screw implants was consecutively placed in 55 partially edentulous patients and restored with 68 fixed prostheses. The patients were followed for at least 5 years in a prospective study that focused on implant success and longitudinal reactions of the peri-implant hard and soft tissues. During the study period, 5 implants failed and 15 implants were lost to follow-up, resulting in a cumulative survival rate of 95.3% after 5 years of loading. The success analysis included additional strictly defined events ("first occurrence of marginal bone loss > or = 4 mm," "first occurrence of pocket depth > or = 4 mm," and "first occurrence of crevicular fluid volume > or = 2.5 mm") and resulted in a cumulative 5-year success rate of 89.0%. Median loss of marginal bone, as observed on radiographs, was 0.7 mm between implant placement and prosthetic treatment and 0.5 mm between prosthesis placement and the 5-year evaluation. Compared to the previous year's value, the annual increase in marginal bone loss did not reach a level of statistical significance between 1 and 5 years of function, so that a steady state prevailed. The incidence of lingual-palatal surfaces affected with remarkable plaque deposits increased from 13% after prosthesis placement to 23% after 5 years. Sulcus Bleeding index, probing depth, attachment level, and crevicular fluid volume were used to describe the health of the peri-implant soft tissues. The research parameters remained almost unchanged and indicated a soft tissue response within physiologic levels. Most mechanical complications were experienced during the first year of loading and were related to loosening of occlusal screws, which occurred in 8 (12%) of 68 restorations.     

The use of dental implants to retain thumb prostheses: a short-term evaluation of 2 cases

This article presents the use of dental implants for the retention of thumb prostheses. Two patients with traumatic amputation of the thumb were rehabilitated with implant-supported digital prostheses. A dental implant was placed in the residual bone of the thumb. After a 3-month osseointegration period, retentive attachment and silicone prostheses were fabricated. Osseointegration of the implant, peri-implant skin health, and prosthesis function were assessed every 6 months. The follow-up period was 18 months for patient 1 and 21 months for patient 2. Osseointegration was achieved, and there were no skin problems. Some degree of tactile sensation was observed, and the patients were satisfied with the esthetic result.     

“All-on-4”种植即刻修复技术的临床应用研究

目的：评价应用＂All-on-4＂种植即刻修复技术对牙列缺失患者进行种植即刻修复的临床效果,探讨其技术要点及临床意义。方法：2008年4月至2009年11月共29例患者（男15例,女14例）接受了＂All-on-4＂种植即刻修复。29例（上无牙颌8例,下无牙颌15例,双颌无牙颌6例）共植入140枚种植体,在种植体植入当天完成即刻修复,一共完成35件＂All-on-4＂即刻义齿。即刻修复后观察种植体边缘骨吸收情况、追踪种植体和即刻修复体的存留率、患者满意率。平均追踪14.8个月（10～29个月）。结果：140枚种植体中,8枚于植入后6～8周脱落。其余132枚种植体至最后一次复查临床稳定,种植体存留率：94.3%。上颌种植体存留率89.3%,下颌种植体存留率97.8%,存在统计学差异（p〈0.05）。即刻修复义齿的存留率94%（33/35）。边缘骨吸收程度为（0.8±0.4）mm。患者满意率100%。结论：＂All-on-4＂种植即刻修复技术应用于无牙颌患者近期效果好,患者满意度高。远期效果需要进一步观察。     

Outcomes of fixed prostheses supported by immediately loaded endosseous implants

PURPOSE: The aim of this article was to evaluate the survival and success of Straumann implants after immediate loading. A new method for fabricating effective definitive prostheses to immediately load implants in edentulous patients was presented. MATERIALS AND METHODS: Nine patients received 4 implants each, and resin-metal prostheses were installed less than 48 hours after implant placement. Mobility was evaluated immediately after the surgical procedures and 3 months subsequently using the Periotest. Clinical evaluation of soft peri-implant tissues was conducted monthly after the sutures were removed, and radiographs were obtained 6, 12, and 24 months after the surgery. RESULTS: The Periotest revealed statistical values that were stable, with no mobility. No signs of inflammation and/or bleeding were observed. The radiographs did not reveal any continuous areas of radiolucency beyond the first thread of the 36 implants after 24 months. None of them failed, and the success rate was 100%. DISCUSSION: It is possible to submit implants to immediate load without jeopardizing osseointegration if parameters are met, such as suitable bone quality and quantity, lack of unfavorable systemic and psychologic factors, lack of parafunctional habits, strict maintenance of prosthetic requirements, minimization of micromotion, and use of an appropriate surgical protocol. CONCLUSION: Under immediate load, osseointegration of implants is possible, and the method presented for the fabrication of resin-metal prostheses has been reliable and predictable.