Use of an Immediate Provisional Implant to Support a Full-Arch Interim Restoration: A Clinical Report

The use of provisional implants as the sole or adjunct mean of stabilization for interim fixed partial dentures has gained popularity in implant prosthodontic treatment. These implants can be used between submerged implants during the healing phase to provide support for interim fixed or removable partial dentures. In this clinical report, a provisional implant used to provide support for a full-arch fixed interim restoration is described. Positioned between adjacent conventional implants, the provisional implant was placed during the same surgical procedure. As a result, an immediate acrylic fixed partial denture supported by natural teeth and the provisional implant provided a comfortable and esthetic interim restoration during the osseointegration period.     

Correction of Buccal Dehiscence During Immediate Implant Placement Using the Flapless Technique: A Tomographic Evaluation

Background: The aim of this study was to evaluate a new technique for treating dehiscence buccal bone sites (Class II) with immediate implant and collagen‐enriched bovine‐derived xenograft blocks without a surgical flap or membrane. Methods: Individuals with at least 5 mm of buccal bone dehiscence were selected for a flapless surgical approach to insert xenograft blocks into buccal dehiscence defects as well as the gap between implant and residual bone wall. No membrane was used. Buccal bone wall height was measured by computed tomography in the preoperative period (T0) and 6 to 12 months after procedure (T1). Likewise, buccal‐lingual width of alveolar ridge as well as thickness of buccal wall was compared with the contralateral tooth. Results: Fourteen patients were selected. Buccal wall height at T1 was not significantly different after 6 to 12 months between the treated and contralateral teeth, although both were greater than T0 (P <0.01). The heights ranged from 6.4 to 16.30 mm at T0, 12.8 to 25.6 mm at T1, and 14.8 to 25.29 mm in the contralateral teeth. Significant differences were observed between treated teeth (T1) and their contralateral, both buccal‐lingually in the alveolar ridge (P = 0.007) and in buccal wall thickness (P = 0.003). Wall thickness ranged from 0.9 mm to 3.81 mm at T1 and 0.25 mm to 1.60 mm in the contralateral teeth. Conclusion: Immediate implant placement at dehiscence buccal bone sites using flapless surgery combined with xenograft blocks provided complete formation of the buccal bone wall up to the implant shoulder.     

Immediate definitive CAD/CAM restoration of a non-submerged implant

Implant placement has become a widely accepted treatment for tooth replacement. There are many restorative options, but it is best for the patient and most efficient for the office if the implant is placed and restored in as few appointments as possible. If diagnosis is thorough and accurate, placing the implant and doing a definitive restoration in 1 appointment can be as predictable as the traditional 2 appointment technique. Restoring the implant with computer-assisted designed and machined porcelain can provide predictable fit, esthetics, and restoration and be clinically efficient.     

计算机辅助设计制造牙种植导板的应用及形变分析

目的：自主研发软件计算机辅助设计和制造（CAD／CAM）牙种植导板应用于牙种植手术,并对其进行手术前后的形变分析。方法：通过制作诊断性活动义齿,运用锥形束CT对其进行扫描,采集数据,利用自主研发的设计软件进行导板设计,应用三维打印快速成型技术完成导板的制作,在CAD／CAM导板指导下进行牙种植手术。术前、术后分别采用激光扫描仪进行导板的三维扫描,应用逆向工程软件进行术前、术后导板的三维配准,分析导板的形变情况。结果：成功植入8颗种植体。术前、术后导板平均形变量为0．132mm,最大形变量为1．037mm。结论：自主研发CAD／CAM牙种植导板具有良好的准确性和稳定性。     

Single unit CAD/CAM restorations: a literature review

Computer-aided design/computer-aided manufacture (CAD/CAM) has been used in dentistry since 1987. Since then, many CAD/CAM systems have been described, which enable the production of chair-side single unit dental restorations. These restorations are of comparable quality to those made by conventional techniques and have some specific advantages, including rapid production, improved wear properties, decreased laboratory fee and improved cross infection control. This literature review investigates the evidence base for the use of single unit CAD/CAM restorations. Materials, marginal gap, aesthetics, post-operative sensitivity, cementation, cost-effectiveness and longevity are discussed.     

Using a Motion‐Capture System to Record Dynamic Articulation for Application in CAD/CAM Software

Purpose: One of the current limitations of computer software programs for the virtual articulation of the opposing teeth is the static nature of the intercuspal position. Currently, software programs cannot identify eccentric occlusal contacts during masticatory cyclic movements of the mandible. Materials and Methods: Chewing trajectories with six degrees of freedom (DOF) were recorded and imposed on a computer model of one subject's maxillary and mandibular teeth. The computer model was generated from a set of high‐resolution μ‐CT images. To obtain natural chewing trajectories with six DOF, an optoelectronic motion‐capturing system (VICON MX) was used. For this purpose, a special mandibular motion‐tracking appliance was developed for this subject. Results: Mandibular movements while chewing elastic and plastic food samples were recorded and reproduced with the computer model. Examples of mandibular movements at intraoral points are presented for elastic and plastic food samples. The potential of such a kinematic computer model to analyze the dynamic nature of an occlusion was demonstrated by investigating the interaction of the second molars and the direction of the biting force during a chewing cycle. Conclusions: The article described a methodology that measured mandibular movements during mastication for one subject. This produced kinematic input to 3D computer modeling for the production of a virtual dynamic articulation that is suitable for incorporation into dental CAD/CAM software.     

Immediate Postextractive Dental Implant Placement with Immediate Loading on Four Implants for Mandibular‐Full‐Arch Rehabilitation: A Retrospective Analysis

Background: To date, only few studies have reported on the clinical outcomes of immediate postextraction implant placement and immediate loading. Purpose: The purpose of this retrospective study was to report the results of immediately loading four implants placed in fresh extraction sockets in the mandible after a follow‐up of 24 months. Materials and Methods: Between January 2001 and January 2009, 50 patients (28 women and 22 men, average age 54 years), had 347 teeth extracted and a total of 200 dental implants placed in the mandible. The patients received a provisional fixed bridge the same day and a permanent one 3 months later. Clinical checkups were performed after 1, 2, 3, 6, 12, and 24 months. Marginal bone measurements were made in intraoral radiographs taken 1 day after surgery and after 1 year. A questionnaire was used to evaluate self‐perceived factors related to comfort, aesthetics, and function. Results: All bridges were stable and no implant failures were recorded during the follow‐up, giving a survival rate of 100%, at 2 years. The marginal bone loss amounted to 1.33 ± 0.36 mm after 1 year and 1.48 ± 0.39 mm after 2 years. Ten patients showed prosthetic complications with the provisional bridge, but all the definitive prostheses remained stable throughout the study period without any complications. The patients reported satisfaction with the treatment. Conclusions: The present retrospective study showed that immediate loading of four implants immediately placed in extraction sockets is a valid treatment modality for the totally edentulous mandible.     

Systematic Review of Soft Tissue Alterations and Esthetic Outcomes Following Immediate Implant Placement and Restoration of Single Implants in the Anterior Maxilla

Background: The aim of this review is to assess the outcome of single‐tooth immediate implant placement and restoration (IPR) in the maxillary anterior region, with a particular emphasis on soft tissue and esthetic outcomes. Methods: An electronic search in Medline, EBSCOhost, and Ovid (PubMed) was performed to identify studies that reported on soft tissue outcomes following immediate placement and restoration of implants in the maxillary esthetic region with a mean follow‐up of ≥1 year. Results: Nineteen studies on single implants inserted immediately into fresh extraction sockets and provisionally restored in the maxillary esthetic region were included. Soft tissue changes were found to be acceptable, with most studies reporting mean gingival recession of 0.27 ± 0.38 mm and mean papillary height loss of 0.23 ± 0.27 mm after follow‐up of ≥1 year. Advanced buccal recession (>1 mm) occurred in 11% of cases. Long‐term follow‐up studies (>2 years) reported that the interdental papillae, in particular, showed a tendency to rebound over time. The few studies that reported on patient‐centered outcomes showed a high level of patient satisfaction with the outcomes of IPR treatment. Conclusions: The IPR protocol resulted in generally acceptable soft tissue and esthetic outcomes, with suboptimal results reported in ≈11% of low‐risk cases. Factors such as preoperative tissue biotype or use of a flap or connective tissue graft did not significantly influence soft tissue and esthetic outcomes. Long‐term prospective controlled clinical trials are necessary to identify factors that may influence the esthetic outcomes associated with IPR.     

Long‐Term Outcomes of Immediate Implant Placement Into Infected Sockets in Association With Immediate Loading: A Retrospective Cohort Study

Background: There is a paucity of studies examining long‐term outcomes of immediate loading of dental implants immediately placed into infected sites. This study aims to evaluate long‐term outcomes of immediate loading of postextraction implants placed in infected sites. Methods: Patients were selected if they had postextraction implants in the anterior maxilla that were inserted in the period from December 2006 to June 2015 and immediately loaded. Information collected about patients included: 1) demographic data; 2) implant details; 3) soft tissue stability; and 4) prosthodontics data. Marginal bone loss (BL) and implant and prosthesis survival rates were calculated. Results: Thirty patients (mean age: 56 years) had 43 implants immediately inserted into infected sites and immediately loaded. Implants were inserted at torque ≥35 Ncm. Mean follow‐up time was 6 years (range: 1 to 8 years), and 65% of implants had a follow‐up time >5 years. No implant failure occurred, and implant success rate was 93%. Proximal BL was 1.42 mm (range: 0.21 to 5.61 mm). Three prosthetic complications (all fracture of veneer material) occurred. Conclusions: Immediate loading of implants inserted into fresh and infected extraction sockets is not a risk factor for implant survival. However, stability of peri‐implant soft and hard tissues indicates the need to take measures that minimize loss.     

Immediate Implant Placement and Provisionalization Following Tumor‐Resective Surgery in the Midfacial Region: A Case Series

Surgical and prosthodontic restoration of the midfacial region following tumor resection has always posed a considerable challenge, as this area serves crucial functional and esthetic roles. Being diagnosed and subsequently treated for facial tumors can have an immense psychosocial impact on a patient, as the resulting defects are often disfiguring, and lead to an inability to masticate, swallow, and speak clearly. Provision of an immediate facial and dental prosthesis at the time of surgery can limit these side effects and help reduce mental duress on these patients and their families, as well as aid in the process of rehabilitation. Rapid prototyping (RP) and 3D printing, as this paper shows, assists presurgical planning of the tumor resection, as well as the manufacture of maxillofacial and dental prostheses. Often these defects are extensive, so prosthesis retention is aided by zygomatic implants placed at the time of surgical resection. When placed at this time, and prior to radiation therapy, these craniofacial implants have improved survival rates. Thus, this treatment modality can improve postoperative recovery considerably, while at the same time allowing for cleaning and monitoring of the resected site for tumor recurrence.     

Three‐Dimensional Location of the Retaining Screw Axis for a Cemented Single Tooth Implant Restoration

Retrievability is a major concern with cemented versus screw‐retained implant restorations. This article describes the use of cone beam radiography to help target and create a precise screw access opening for a loosened implant‐supported single crown retained by cement to its abutment.