An immediately loaded CAD/CAM-guided definitive prosthesis: a clinical report

Dental implants have had a major impact on the treatment of edentulous patients. Fixed complete dentures have allowed removable complete dentures to be replaced with fixed prostheses. A new treatment modality using immediately loaded implants placed with a CAD/CAM surgical template using a flapless surgical technique, then loaded with a prefabricated restorative prosthesis, is presented. This report describes the Teeth-in-an-Hour (Nobel Biocare, Yorba Linda, Calif) treatment provided for a patient.     

The management of a completely edentulous patient using simultaneous maxillary and mandibular CAD/CAM-guided immediately loaded definitive implant-supported prostheses: a clinical report

Functional rehabilitation of a completely edentulous patient with removable prostheses is a clinical challenge. A patient with an edentulous maxilla and mandible received 6 endosseous implants in the maxilla and 5 implants in the mandible using CAD/CAM surgical templates. Definitive maxillary and mandibular implant-supported fixed complete dentures were connected immediately after implant placement using a CAD/CAM-guided implant surgical placement protocol.     

CAD/CAM-guided implant surgery and fabrication of an immediately loaded prosthesis for a partially edentulous patient

The treatment planning, placement, and restoration of dental implants for the partially edentulous patient can be challenging. Anatomical limitations can make implant location difficult to determine. The use of CT scans and surgical planning software to produce a CAD/CAM surgical template, as well as the use of a flapless surgical technique, can make implant placement more predictable, safer, and easier for patients. The article describes a computer-guided surgical technique for the partially edentulous patient, with a restoration fabricated prior to implant placement, for immediate loading.     

Alveolar distraction osteogenesis and implant placement in a severely resorbed maxilla: a clinical report

Atrophy of maxillary alveolar bone can result in severe defects of the alveolar ridge. Such defects can make it difficult to achieve esthetic and functional restorations. This clinical report describes the use of alveolar distraction osteogenesis to promote the formation of new bone and soft tissue in a large, severely resorbed segment of maxillary alveolus.     

Definitive CAD/CAM-guided prosthesis for immediate loading of bone-grafted maxilla: a case report

Background The reconstruction of a functional occlusion in the presence of severe residual ridge resorption remains a significant challenge for maxillofacial surgeons and prosthodontists. Removable appliances are unsuccessful in severely resorbed cases and the advanced degree of bone loss precludes conventional implant‐retained prostehesis. In recent years, bone graft reconstruction of the maxilla and the mandible has been advocated to reverse the debilitating effects of alveolar ridge resorption. Purpose The surgical objective was the reconstruction of the osseous platform of the jaws, thereby allowing implant‐retained definitive prosthetic rehabilitation utilizing the Teeth‐in‐an‐Hour^TM concept within 4 months. Materials and Methods A completely edentulous patient received bone grafts from the posterior iliac crest to augment both the maxillary and mandibular alveolar ridges. The manmandible was augmented using Marx’s “soft issue matrix expansion procedure” and was restored in the conventional manor using an impression and a milled framework. The maxilla underwent “inlay/onlay” bone graft augmentation of the right and left maxilla at the same time as the mandiblular procedure. Implant placement was at 4 months post‐bone graft reconstruction. Immediate loading of implants into a bone graft using Nobel Biocare’s Teeth‐in‐an‐Hour^TM protocol prelaunch was implemented. This included CT‐based implant planning, simultaneous CAD/CAM fabrication of a surgical guide, a CNC‐milled framework, flapless surgical placement of the implants, and immediate placement of a pre‐fabricated definitive prosthesis. This approach reduced the time necessary for an edentulous patient to transform from severely atrophic alveolar support to implant‐retained maxillary and mandibular prosthetic restorations. Immediate loading with an implant retained definitive prosthesis using a bone graft‐reconstructed osseous platform was also performed. Conclusion The Teeth‐in‐an‐Hour^TM concept was utilized to restore bone grafted augmentation of the maxilla with immediate loading of a definitive prosthesis within 4 months. The remarkable accuracy of the software, minimally invasive and short surgery and treatment time, uneventful quick recovery with minimal discomfort is a benefit not only to the patient, also to the treating team.     

Dental rehabilitation using an implant-carrying plate system in a severely resorbed edentulous maxilla: a case report

This clinical article describes a case of dental rehabilitation using an implant-carrying plate system (EPITEC) for a patient with severely resorbed edentulous maxilla and microstomia. In this case, the presence of microstomia prevented bone augmentation procedures through an intraoral approach. Treatment using 2 endosseous implants inserted in the canine regions and an implant-supported overdenture was planned. However, endosseous implants were not feasible on the right side because of insufficient available bone volume. An implant-carrying plate system was then utilized on the right side. Four months later, an implant-supported ball-attachment overdenture was fabricated. At the 2-year follow-up, the clinical course remained uneventful, and the patient remained satisfied with the treatment.     

Maxillary osteotomy with an interpositional bone graft and implants for reconstruction of the severely resorbed maxilla: a clinical report

PURPOSE: The aim of this study was to report the outcome of using a maxillary osteotomy with an interpositional bone graft and implants in the treatment of extremely resorbed maxillae. MATERIALS AND METHODS: Twenty-two consecutive patients (mean age 65.7 years) were included in the study. Bone grafts from the iliac bone were used. The patients were followed in a standardized clinical and radiographic method for up to 5 years. RESULTS: A total of 176 Astra Tioblast ST implants were placed. Six implant losses occurred. All patients had fixed prostheses. Only minor bone resorption (1.0 to 1.5 mm) occurred in the bone graft, as well as a certain amount of marginal bone remodeling around the implants (1.0 to 1.9 mm) during periods up to 5 years. Remodeling and resorption in the bone graft and around the implants occurred during the first postoperative year. The results represent cumulative success and survival rates of 97%, which is comparative to implant integration in conventional maxillary bone. DISCUSSION AND CONCLUSIONS: The orthognathic surgical technique using maxillary osteotomy with interpositional bone graft and implants in a 2-stage procedure has been shown to be a predictable and reliable method for rehabilitation of patients with extreme resorption of the maxilla when conventional implant surgical methods cannot be used. Although the procedures are trying for the patients, overall satisfaction with the end result can be rewarding.     

Reconstruction of the severely resorbed atrophic edentulous ridge of the maxilla and mandible for implant rehabilitation: report of a case

We describe a case with a severely resorbed atrophic edentulous ridge in both the maxilla and mandible. The maxilla was reconstructed using a sinus-lifting procedure and onlay bone graft. The mandible was reconstructed by anterior osteotomy with an interpositional sandwich iliac bone graft at the symphysis area, subperiosteally with iliac bone chips mixed with hydroxylapatite bilaterally at the posterior atrophic ridge, and vestibuloplasty with a split thickness skin graft (STSG). After full-mouth implant rehabilitation, a 5-year follow-up of this case shows a satisfactory result.     

Restoring a severely resorbed maxillary anterior partially edentulous space using a one-piece titanium implant fixed partial denture: a clinical report

This article describes the treatment provided for a patient presenting with a severely resorbed partially edentulous maxillary anterior space and a previously placed implant. After the patient refused removal of the existing implant and additional grafting of hard and soft tissue, the nonsalvageable teeth were removed and 2 endosseous implants were placed. A 1-piece titanium implant fixed partial denture was used to restore the missing portions of the soft and hard tissues. This clinical report details the treatment of this challenging restorative dilemma.     

Immediate dental implant placement in calvarial bone grafts to rehabilitate the severely resorbed edentulous maxilla: A prospective pilot study

Purpose

The aim of this study was to describe the surgical technique of immediate dental implant placement in calvarial grafts for augmentation of the severely resorbed maxilla and to assess the treatment results.

Connection designs of three different implant systems in the resorbed edentulous maxilla: a case report

This report presents the mixed use of three different system implants for an implant-supported fixed bridge in a resorbed maxilla. Two of six implants that had been placed were lost. New implants were combined with the remaining implants that had been placed by the previous dentists in 1992 and 1997. The three implant systems consisted of the following: one incorporated an intramobile element into an implant device, and the other two were whole titanium screw-type implants (one with a machined surface and the other with a plasma-sprayed surface). This clinical report describes the connection designs of these different system implants to the fixed bridge and lists the complications that followed.     

Use of the multi-cup denture for a severely resorbed maxilla: a clinical report

Obtaining a satisfactory outcome for a patient with a severely resorbed maxilla can be extremely challenging. This clinical report describes the treatment of a patient with a history of multiple implant failures in the maxilla. A conventional upper complete denture had poor retention and so did not fulfil the patient's needs. Further surgery was not considered appropriate. A new upper complete denture was made with a fitting surface covered in multiple suction cups to attempt to improve the retention without surgery and resulted in a pleasing outcome for both the patient and authors.     

A custom template and definitive prosthesis allowing immediate implant loading in the maxilla: a clinical report

PURPOSE: The purpose of the present investigation was to examine to what extent precision data from 3-dimensional planning software for oral implants can be transferred to the operative field by means of a drilling template, containing high-precision drilling sleeves, fitted on the jawbone. It was investigated whether this procedure would allow advance preparation of a fixed definitive prosthesis that could be placed at the completion of surgery. MATERIALS AND METHODS: This procedure was experimentally carried out in 2 cadavers and later in 8 consecutive human patients. RESULTS: The results indicated a nearly perfect match between the positions and axes of the placed implants and those planned. DISCUSSION: This procedure permitted the placement of a definitive fixed prosthesis with limited freedom of space between the abutments and the metallic cylinders incorporated into the prosthesis. CONCLUSION: These encouraging results of the Leuven information technology-based oral rehabilitation by means of implants (LITORIM) are presently being further investigated at the clinical level.     

Reconstruction of the severely resorbed maxilla with bone grafting and osseointegrated implants: a preliminary report

This article describes a surgical procedure for rehabilitation of the severely atrophic maxillary alveolar ridge by bone grafting to the maxillary sinus and nasal floor followed by installation of implants in the grafted regions at a second operation. Five treated cases are presented. Further data are considered necessary to evaluate the procedure before it can be recommended for routine use.     

无牙颌患者种植即刻修复临床观察

目的:通过对上、下颌无牙颌患者即刻修复效果1年的回顾性研究,分析其成功率及相关影响因素。方法:从2009年7月至2010年9月,胡忠医院种植修复科行无牙颌即刻修复病例共18例118枚,8例60枚植入上颌无牙颌,10例58枚植入下颌无牙颌,术后丙烯酸树脂临时义齿即刻修复。3~6月后永久固定修复。结果:18例118枚种植体中,101枚即刻修复,12~26个月后种植体累积存留率100%,修复体成功率100%。结论:无牙颌即刻修复具有较好的短期临床效果     

Clinical application of zygomatic implants for rehabilitation of the severely resorbed maxilla: a clinical report

PURPOSE: A zygomatic implant can be an effective device for rehabilitation of the severely resorbed maxilla. If zygomatic implants are used, onlay bone grafting or sinus augmentation would likely not be necessary. Where an anterior onlay bone graft is required, extension of the graft in the posterior region could be reduced. The results of the application of zygomatic implants in 9 patients and clinical evaluation of this therapy are reported. MATERIALS AND METHODS: Nine patients received a total of 15 zygomatic implants. Six to 8 months elapsed for healing before second-stage surgery was performed. Six months after prosthetic treatment, patients' opinions were solicited by means of a questionnaire. RESULTS: No implant was removed at the time of abutment connection surgery or during the follow-up period. In many cases, the zygomatic implant platform was located palatal to the alveolar ridge. However, no patients complained of any continuing speech impediment following superstructure fabrication. Computed tomograms taken before implant placement and 6 months after implant placement showed no sign of sinusitis in any patient. DISCUSSION: The zygomatic implant allows shorter treatment time and hospitalization. However, there can be some problems in the application of zygomatic implants. CONCLUSION: It is necessary to investigate long-term clinical prognosis.     

The zygomaticus implant protocol in the treatment of the severely resorbed maxilla.

The zygomaticus dental implant, designed by NobelBiocare, was developed primarily for the treatment of the severely resorbed maxilla. Br?nemark has reported an overall success rate of 97.6% with the placement of over 200 zygomatic implants during the period 1989 to 2001. There are well-defined characteristics within the patient's resorbed skeletal frame which guide the surgical placement of the zygomatic implant, thus determining whether the surgeon should use an implant with a 45 degrees or 55 degrees angulated head. This allows implant-supported restoration of the resorbed maxilla with a fixed cross arch prosthesis in the maxilla without a bone graft to the posterior maxilla. The use of a modified head angulation of 55 degrees, with implant placement as close to the crest of the edentulous ridge as possible, allows restorative clinicians to achieve an ideal restorative position in the posterior maxilla. The use of a zygomatic implant with a 55 degrees head reduces the buccal cantilever by 20%.     

Bone graft remodelling and implant success rate in the treatment of the severely resorbed maxilla: a 5-year longitudinal study

A total of 30 patients, 10 in a developmental group and 20 in a routine group, with extremely resorbed maxillae were treated with bone grafting from the hip and implant placement in a one-stage procedure. All patients were followed for a minimum of 5 years and were examined regarding the long-term success rate of the implants and marginal bone level. The implant success rate was 74.6% for the whole patient group and 85.8% for the routine group, after 5 years. The marginal bone along the implant surface decreased continuously, up to 3 years and thereafter the bone level stabilized. In the routine group, changes in bone graft dimensions over time were also evaluated by computerized tomography. The mean height of the bone graft postoperatively at all implant sites was 8.3 mm. The total mean bone height, including bone graft and residual alveolar crest, was 12.4 mm. After 5 years the total bone height had decreased to a mean of 10 mm. The mean width of the bone graft was 12 mm postoperatively and 8.7 mm at the 5-year examination. A substantial amount of bone can be gained in patients with extremely resorbed maxillae, when treated with bone graft according to the procedure described in this study.