Laser-welded titanium frameworks supported by implants in the edentulous maxilla: a 2-year prospective multicenter study

PURPOSE: The aim of this study was to evaluate the clinical and radiographic performance of patients who received implants and fixed prostheses with laser-welded titanium frameworks. MATERIALS AND METHODS: Fifty-eight consecutive patients were treated with 349 osseointegrated implants ad modum Br?nemark in the edentulous maxilla at 6 implant centers. The patients were randomly arranged into 2 groups at the time of final impression. Twenty-eight patients received laser-welded titanium frameworks and 30 patients received conventional cast frameworks. Clinical and radiographic data were collected for 2 years in function. RESULTS: The 2 groups of patients showed similar results. The 2-year overall cumulative implant survival rate from the time of implant placement and prosthesis insertion was 93.7% and 96.2%, respectively. The corresponding cumulative survival rate for prostheses was 96.6%. Two patients, 1 from each group, failed completely and resumed using conventional complete dentures. The only obvious factor that could possibly be related to the 2 complete failures was a smoking habit. However, it was not possible to significantly correlate implant failures to smoking habits in this study. No fractures were observed in the frameworks or implant components, and both groups experienced the same frequency of resin veneering material fractures. The overall average marginal bone loss was 0.4 mm (SD 0.8 mm). CONCLUSION: Patients treated with implant-supported prostheses fabricated with laser-welded titanium frameworks in the edentulous maxilla presented comparable results to patients with conventional cast frameworks after 2 years in function.     

Clinical experiences of implant-supported prostheses with laser-welded titanium frameworks in the partially edentulous jaw: a 5-year follow-up study

Background: Titanium frameworks have been used in the endentulous implant patient for the last 10 years. However, knowledge of titanium frameworks for the partially dentate patient is limited. Purpose: To report the 5-year clinical performance of implant-supported prostheses with laser-welded titanium frameworks in the partially edentulous jaw. Materials and Methods: A consecutive group of 383 partially edentulous patients were, on a routine basis, provided with fixed partial prostheses supported by Brånemark implants in the mandible or maxilla. Besides conventional frameworks in cast gold alloy, 58 patients were provided with titanium frameworks with three different veneering techniques, and clinical and radiographic 5-year data were collected for this group. Results: The overall cumulative survival rate was 95.6% for titanium-framework prostheses and 93.6% for implants. Average bone loss during the follow-up period was 0.4 mm. The most common complications were minor veneering fractures. Loose and fractured implant screw components were fewer than 2%. An observation was that patients on medications for cardiovascular problems may lose more implants than others (p <.05). Conclusions: The clinical performance of prostheses with implant-supported laser-welded titanium frameworks was similar to that reported for conventional cast frames in partially edentulous jaws. Low-fusing porcelain veneers also showed clinical performance comparable to that reported for conventional porcelain-fused-to-metal techniques.     

A comparison of laser-welded titanium and conventional cast frameworks supported by implants in the partially edentulous jaw: a 3-year prospective multicenter study

PURPOSE: The purpose of this prospective multicenter study was to evaluate and compare the clinical performance of laser-welded titanium fixed partial implant-supported prostheses with conventional cast frameworks. MATERIALS AND METHODS: Forty-two partially edentulous patients were provided with Br?nemark system implants and arranged into 2 groups. Group A was provided with a conventional cast framework with porcelain veneers in one side of the jaw and a laser-welded titanium framework with low-fusing porcelain on the other side. The patients in group B had an old implant prosthesis replaced by a titanium framework prosthesis. The patients were followed for 3 years after prosthesis placement. Clinical and radiographic data were collected and analyzed. RESULTS: Only one implant was lost, and all prostheses were still in function after 3 years. The 2 framework designs showed similar clinical performance with few clinical complications. Only one abutment screw (1%) and 9 porcelain tooth units (5%) fractured. Four prostheses experienced loose gold screws (6%). In group A, marginal bone loss was similar for both designs of prostheses, with a mean of 1.0 mm and 0.3 mm in the maxilla and mandible, respectively. No bone loss was observed on average in group B. No significant relationship (P > 0.05) was observed between marginal bone loss and placement of prosthesis margin or prosthesis design. CONCLUSION: The use of laser-welded titanium frameworks seems to present similar clinical performance to conventional cast frameworks in partial implant situations after 3 years.     

Implant-supported laser-welded titanium and conventional cast frameworks in the partially edentulous law: a 5-year prospective multicenter study

PURPOSE: This study evaluated and compared the clinical performance of laser-welded titanium fixed partial implant-supported prostheses with that of conventional cast frameworks in the partially edentulous jaw. MATERIALS AND METHODS: Forty-two patients provided with Br?nemark system implants were arranged into two groups. Twenty-one patients (group A) were provided with a conventional cast ceramometal framework in one side of the jaw and a laser-welded titanium framework with low-fusing porcelain in the other side. In group B, 21 patients received a titanium framework prosthesis to replace a conventional implant prosthesis. Clinical and radiographic data were collected for 5 years. RESULTS: Four implants and one titanium framework were lost during the follow-up period. The two framework designs did not show any significant differences with regard to implant or prosthesis survival (P > .05). Few clinical complications were observed. In group A, marginal bone loss after 5 years was similar for both prosthesis designs, with an average of 0.1 mm and 0.3 mm in the maxilla and mandible, respectively. Basically, no bone loss was observed on average in group B. Furthermore, no significant relationship was observed between marginal bone loss and placement of prosthesis margin or prosthesis design. CONCLUSION: Except for an insignificant tendency toward a slightly higher incidence of small chips of porcelain veneers, laser-welded titanium frameworks presented an overall similar clinical performance as conventional cast frameworks in partial implant situations after 5 years.     

CNC‐Milled Titanium Frameworks Supported by Implants in the Edentulous Jaw: A 10‐Year Comparative Clinical Study

Background: No long‐term clinical studies covering more than 5 years are available on Computer Numeric Controlled (CNC) milled titanium frameworks. Aim: To evaluate and compare the clinical and radiographic performance of implant‐supported prostheses provided with CNC titanium frameworks in the edentulous jaw with prostheses with cast gold‐alloy frameworks during the first 10 years of function. Material and Methods: Altogether, 126 edentulous patients were by random provided with 67 prostheses with titanium frameworks (test) in 23 maxillas and 44 mandibles, and with 62 prostheses with gold‐alloy castings (control) in 31 maxillas and 31 mandibles. Clinical and radiographic 10‐year data were collected for the groups and statistically compared on patient level. Results: The 10‐year prosthesis and implant cumulative survival rate was 95.6% compared with 98.3%, and 95.0% compared with 97.9% for test and control groups, respectively (p > .05). No implants were lost after 5 years of follow‐up. Smokers lost more implants than nonsmokers after 5 years of follow‐up (p < .01). Mean marginal bone loss in the test group was 0.7 mm (SD 0.61) and 0.7 mm (SD 0.85) in the maxilla and mandible, with similar pattern in the control group (p > .05), respectively. One prosthesis was lost in each group due to loss of implants, and one prosthesis failed due to framework fracture in the test group. Two metal fractures were registered in each group. More appointments of maintenance were needed for the prostheses in the maxilla compared with those in the mandible (p < .001). Conclusion: The frequency of complications was low with similar clinical and radiological performance for both groups during 10 years. CNC‐milled titanium frameworks are a viable alternative to gold‐alloy castings for restoring patients with implant‐supported prostheses in the edentulous jaw.     

Clinical experiences with laser-welded titanium frameworks supported by implants in the edentulous mandible: a 5-year follow-up study

PURPOSE: The purpose of this study was to report the 5-year clinical performance of implant-supported prostheses with laser-welded titanium frameworks and to compare their performance with that of prostheses provided with conventional cast frameworks. MATERIALS AND METHODS: On a routine basis, a consecutive group of 824 edentulous patients were provided with fixed prostheses supported by implants in the edentulous mandible. In addition to conventional gold-alloy castings, patients were at random provided with 2 kinds of laser-welded titanium frameworks. In all, 155 patients were included in the 2 titanium framework groups. A control group of 53 randomly selected patients with conventional gold-alloy castings was used for comparison. Clinical and radiographic 5-year data was collected for the 3 groups. RESULTS: All followed patients still had fixed prostheses in the mandible after 5 years. The overall cumulative success rates were 95.9% and 99.7% for titanium-framework prostheses and implants, respectively. The corresponding success rates for the control group were 100% and 99.6%, respectively. Bone loss was 0.5 mm on average during the 5-year follow-up period. The most common complications for titanium frameworks were resin or tooth fractures, gingival inflammation, and fractures of the metal frames (10%). One of the cast frameworks fractured and was resoldered. Loose and fractured implant screw components were few (< 1%). CONCLUSION: Even though the cast frameworks had a higher success rate, the overall titanium framework treatment result was well in accordance with the result of the control group. The test groups performed better after clinicians had gained some experience with the technique, and laser-welded titanium frameworks seem to be a viable alternative to conventional castings in the edentulous mandible.     

Early laser-welded titanium frameworks supported by implants in the edentulous mandible: a 15-year comparative follow-up study

Background: Comparative long‐term knowledge of different framework materials in the edentulous implant patient is not available for 15 years of follow‐up. Purpose: To report and compare a 15‐year retrospective data on implant‐supported prostheses in the edentulous mandible provided with laser‐welded titanium frameworks (test) and gold alloy frameworks (control). Materials and Methods: Altogether, 155 patients were consecutively treated with abutment‐level prostheses with two early generations of fixed laser‐welded titanium frameworks (titanium group). Fifty‐three selected patients with gold alloy castings formed the control group. Clinical and radiographic 15‐year data were collected and compared for the groups. Results: All patients who were followed up for 15 years (n = 72) still had a fixed prosthesis in the mandible at the termination of the study. The 15‐year original prosthesis cumulative survival rate (CSR) was 89.2 and 100% for titanium and control frameworks (p = .057), respectively (overall CSR 91.7%). The overall 15‐year implant CSR was 98.7%. The average 15‐year bone loss was 0.59 mm (SD 0.56) and 0.98 mm (SD 0.64) for the test and control groups (p = .027), respectively. Few (1.3%) implants had >3.1‐mm accumulated bone loss after 15 years. The most common complications for titanium frameworks were resin or veneer fractures and soft tissue inflammation. Fractures of the titanium metal frame were observed in 15.5% of the patients. More patients had framework fractures in the earliest titanium group (Ti‐1 group) compared to the gold alloy group (p = .034). Loose and fractured implant screw components were few (2.4%). Conclusion: Predictable overall long‐term results could be maintained with the present treatment modality. Fractures of the metal frames and remade prostheses were more common in the test group, and the gold alloy frameworks had a tendency to work better when compared with welded titanium frameworks during 15 years. However, on the average, more bone loss was observed for implants supporting gold alloy frameworks.     

Long-term marginal periimplant bone loss in edentulous patients

PURPOSE: The aim of this study was to examine the long-term periimplant bone loss in patients treated with implant-supported fixed prostheses in both jaws. MATERIALS AND METHODS: The participants comprised 44 edentulous patients who have been followed for a 15-year period after treatment with a fixed implant-supported prosthesis in the mandible. Thirteen of them also received an implant-supported fixed prosthesis in the maxilla, on average 4.5 years after the mandibular treatment. The periimplant bone level was measured on intraoral radiographs. RESULTS: The long-term results of the implant treatment were successful, and only 1% (3/273) of the implants were lost in the mandible and 7% (5/75) in the maxilla. All but one of the failures occurred before the connection of the prostheses. The mean marginal bone loss around the implants was small (less than 1 mm for a 10-year period after implant placement), and was of similar magnitude in both jaws. However, the individual variation was relatively great. There was no significant difference in marginal bone loss between those who had a maxillary complete denture during the entire observation period and those who had received a fixed implant-supported maxillary prosthesis. Smokers lost more periimplant bone than did the nonsmokers; the difference was significant in the mandible but small and nonsignificant in the maxilla. CONCLUSION: The long-term periimplant bone loss was small and of similar magnitude in the mandible and the maxilla in subjects who had received implant-supported fixed prostheses in both jaws. The prosthetic status in the maxilla, i.e., complete denture or fixed implant-supported prosthesis, had no significant influence on the mandibular periimplant bone loss.     

Clinical experiences with laser-welded titanium frameworks supported by implants in the edentulous mandible: a 10-year follow-up study

Background: Long‐term follow‐up studies for more than 5 years are not available on laser‐welded titanium frameworks. Purpose: To report and compare 10‐year data on implant‐supported prostheses in the edentulous mandible provided with laser‐welded titanium frameworks and conventional gold alloy frameworks. Materials and Methods: Altogether, 155 patients were consecutively treated with prostheses at abutment level with two generations of fixed laser‐welded titanium frameworks (test groups). A control group of 53 randomly selected patients with conventional gold alloy castings was used for comparison. Clinical and radiographic 10‐year data were collected for the three groups. Results: All patients followed‐up for 10 years (n=112) still had fixed prostheses in the mandible (cumulative success rate CSR] 100%). The overall 10‐year cumulative success rate (CSR) was 92.8 and 100.0% for titanium and gold alloy frameworks, respectively. Ten‐year implant cumulative survival rate (CSR) was 99.4 and 99.6% for the test and control groups, respectively. Average 10‐year bone loss was 0.56 (SD 0.45) mm for the titanium group and 0.77 (SD 0.36) mm for the control group (p < 0.05). The most common complications for titanium frameworks were resin or veneer fractures, soft tissue inflammation, and fractures (12.9%) of the metal frame. Loose and fractured implant screw components were below 3%. Conclusion: Excellent overall long‐term results with 100% CSR could be achieved with the present treatment modality. Fractures of the metal frames and remade prostheses were more common for the laser‐welded titanium frameworks, and the first generation of titanium frameworks worked poorly when compared with gold alloy frameworks during 10 years (p < 0.05). However, on average more bone loss was observed for implants supporting gold alloy frameworks during 10 years. The reasons for this difference are not clear.     

Laser-welded titanium frameworks supported by implants in the partially edentulous mandible: a 10-year comparative follow-up study

Background: Comparative long‐term knowledge of different framework materials in the partially edentulous implant patient is not available. Purpose: To report and compare 10‐year data on free‐standing implant‐supported partial prostheses with laser‐welded titanium (test) and conventional gold alloy (control) frameworks. Materials and Methods: Altogether, 52 partially edentulous patients were consecutively provided with laser‐welded prostheses (n = 60) in the partially edentulous lower jaw (test group). A control group of 52 randomly selected patients with gold alloy castings (n = 60) was used for comparison. Clinical and radiographic 10‐year data were retrospectively collected and evaluated for both groups. Results: The overall 10‐year implant cumulative survival rate (CSR) was 93.0% (loaded implants, 96.4%), with a 10‐year implant CSR of 91.5 and 94.7% for test and control implants, respectively (p > .05). Out of a total of 22 lost implants, 17 implants (77.3%) were shorter than 10 mm. The overall 10‐year prosthesis CSR was 93.7%, with a corresponding 10‐year CSR of 88.4 and 100% for test and control groups, respectively (p < .05). Average 10‐year bone loss was 0.46 mm (SD 0.47) and 0.69 mm (SD 0.53) for the test and control groups (p < .001), respectively. Only 1% of the implants had >3 mm accumulated bone loss after 10 years. Altogether, 10 of the prostheses in both groups had implant component mechanical problems (8.3%). None of the frameworks or implants fractured, but more fractures of porcelain veneers were observed in the test group (p < .05). Conclusion: The protocol of implant treatment in the partially edentulous jaw functioned well during 10 years, although prosthodontic maintenance was required. However, laser‐welded titanium frameworks presented more problems as compared with gold alloy frameworks. More loaded implants were lost (p < .05), and higher incidence of porcelain chipping was noted in the test group (p < .05). However, bone loss was on an average lower for the test group during the 10 years of follow‐up (p < .001).     

Restoration with implants in patients with recessive dystrophic epidermolysis bullosa and patient satisfaction with the implant-supported superstructure

PURPOSE: The use of endosseous implants in the prosthetic restoration of edentulous patients with recessive dystrophic epidermolysis bullosa (RDEB) may provide improved outcomes when compared with traditional prosthetic methods. The aim of this study was to evaluate the feasibility of placing endosseous implants in patients with RDEB and to compare the treatment outcomes of fixed and removable implant-supported restorations in the edentulous maxilla or mandible with the main emphasis on patient response. MATERIALS AND METHODS: Six patients with RDEB were treated with implants. All patients were completely edentulous in either the maxilla or mandible and had marked oral involvement, with alterations in the soft and hard tissues in all cases. Three patients were treated with fixed, screw-retained implant-supported prostheses, and 3 were treated with removable implant-supported prostheses. Six months after prosthetic restoration, patients were given a questionnaire to assess their psychologic well-being and satisfaction with the implant-supported restoration marked on a visual analog scale. RESULTS: A total of 38 dental implants (21 maxillary, 17 mandibular) were placed in 6 patients. The implant success rate was 97.9%. The average follow-up from implant placement was 5.5 years (range, 1 to 9). The fixed and removable implant-supported prostheses were associated with improvements in comfort and retention, function, esthetics and appearance, taste, speech, and self-esteem. The level of satisfaction was slightly higher in patients with a fixed prosthesis. CONCLUSION: These findings suggest that endosseous implants can be successfully placed and provide support for prostheses in patients with RDEB. Patients with fixed prostheses and overdentures were satisfied with their implant-supported prostheses in the edentulous maxilla and mandible.     

“All-on-four” concept and immediate loading for simultaneous rehabilitation of the atrophic maxilla and mandible with conventional and zygomatic implants

We report the simultaneous rehabilitation of an edentulous patient with a hybrid (zygomatic and conventional implants) all-on-four implant-supported prosthesis for the maxilla and a standard (conventional implants) all-on-four implant-supported prosthesis for the mandible. The transfer impression was made with a multifunctional guide and the upper and lower prostheses were placed 24 h postoperatively. Clinical and radiographic examinations showed no infection or bony resorption 2 years later. Simultaneous maxillary and mandibular rehabilitation with all-on-four immediate loading is a viable, fast and effective option for edentulous patients.     

On the role of number of fixtures, surgical technique and timing of loading

AIMS: The aims of this thesis were to analyze reduced number of implants supporting full arch fixed mandibular prostheses and fixed partial dentures (FPDs), non-submerged healing and early loading in the edentulous mandible. A further aim was to evaluate fit of Computer Numerical Controlled (CNC) milled I-Bridge frameworks. MATERIAL & METHODS: Paper I. One hundred and nineteen patients rehabilitated with full arch mandibular prostheses supported by four implants were evaluated after a mean follow-up of 4.4 years. Paper II. A total of 178 patients provided with FPDs supported by two (n=92) or three implants (n=122) of whom 123 were evaluated after a mean follow-up of 9.4 years. Paper III. Early and delayed loading of full arch mandibular prostheses were evaluated in 109 patients, 54 with delayed loading and 55 with early loading, with a mean follow-up of 3.6 years. Paper IV. Submerged and non-submerged implant placement for supporting fixed prostheses in the edentulous mandible were evaluated after five years in 29 patients. Paper V. The precision of fit of CNC-milled I-Bridge frameworks was evaluated using two different implant systems. RESULTS: Paper I. The five-year cumulative survival rate (CSR) for implants was 99.1% and for prostheses 100%. Mean bone loss from baseline to five-year follow-up was 0.5 mm. No indication could be found that the number of supporting implants influenced the prosthetic complications. Paper II. The five-year implant and prosthesis CSR was 97.7% for two-implant supported FPDs and 97.3% for three-implant supported FPDs. Mean bone loss at five years was 0.4 mm. Significantly more prosthetic and abutment screw loosening were seen in two-implant supported FPDs. Paper III. Five-year CSR for implants was 94.4% and 92.5% for prostheses in early loading, and 97.9% and 98.0% in the delayed loading group. More prostheses needed adjustment or replacement in the early group, but patients treated with early loading were more pleased with the treatment procedure. Paper IV. Five-year CSR survival rate was 99.4%. Three implants fractured in one patient. Mean bone loss at five years was 0.7 mm in submerged implants and 0.5 mm in non-submerged implants. Paper V. All frameworks demonstrated clinically acceptable fit with mean distortion values within 23 microm (x-axis), 26 microm (y), 4 microm (z- axis) and 34 microm (3-D) for all frameworks. Control frameworks displayed greater levels of distortion than frameworks produced in a strict test situation. CONCLUSION: A reduction of the number of supporting implants to four implants in full arch mandibular prostheses and two implants in three unit FPDs in partial edentulous jaws resulted in the same clinical outcome as when more implants are used. Non-submerged implant placement in the edentulous mandible was as predictable as submerged, but early loading of implant-supported mandibular prostheses incurred more prosthetic complications. Computer numerical controlled milled frameworks presented levels of precision of fit within limits considered to be clinically acceptable and superior to earlier published results on cast frameworks.     

Clinical experiences of CNC-milled titanium frameworks supported by implants in the edentulous jaw: 1-year prospective study

Background: A new type of titanium framework has been introduced, but so far no clinical reports have been made in this treatment modality. Purpose: The aim of this study was to report the clinical performance of implant‐supported prostheses with computer numeric controlled (CNC)‐milled titanium frameworks in the edentulous jaw and to compare the results with prostheses provided with conventional cast frameworks during the first year of function. Material and Methods: A consecutive group of 65 patients with 67 prostheses were provided with CNC‐milled titanium frameworks in 23 upper and 44 lower jaws. During the same period, 61 consecutive patients were treated on a routine basis with 31 upper and 31 lower conventional gold alloy casting prostheses. Clinical and radiographic 1‐year data were collected for both the test and control groups. Results: A total of 14 of 729 inserted implants were lost during the follow‐up period (1.9%). All prostheses were functioning after 1 year except a conventional prosthesis with a cast framework, which was replaced by an implant‐supported over‐denture due to implant loss. The 1‐year cumulative survival rate (CSR) was 100% and 97.8% for CNC prostheses and implants, respectively. The corresponding CSR for the control group was 98.3% and 98.3%, respectively. Few problems were reported in both groups, and the clinical and the radiologic performances were similar for both groups. No mechanical complications except some resin veneer fractures (n = 6) were observed. The mean marginal bone loss for the test group during the first year in function was 0.4 mm (SD = 0.35) and 0.4 mm (SD = 0.33) in the upper and lower jaws, respectively. A similar pattern of bone reaction was also observed in the control group. Conclusion: CNC‐milled titanium frameworks can be used as an alternative to conventional castings in the edentulous jaw, presenting similar clinical and radiologic performances as conventional cast frameworks during the first year of function.     

Immediate loading of implants in the edentulous maxilla

The overall aim of this thesis was to investigate different therapeutic strategies in treatment of the edentulous maxilla with dental implants and their importance for treatment outcome. The introduction of one-stage surgery, in place of two-stage surgery, was a paradigm shift in the area of implant treatment since submerged implant healing underneath the mucosa was considered a prerequisite for healing in the original concept. The advantages of a one-stage method are that a second surgery is unnecessary, costs are lower, and patients complain less about the surgical procedures. The development of implant treatment, regardless of whether it is performed in the mandible or the maxilla, strives to shorten the period from implant placement to implant loading. For the edentulous patient--due to esthetic, economical, or psychological reasons--shortening this time and thus avoiding a long period of wearing a transitional removable prosthesis is advantageous. Use of conventional one-stage surgery makes possible and is a prerequisite for immediate loading of implants. Successful treatment outcome has been demonstrated for immediate loading of implants in the mandible, but documentation of the method in the maxilla is still sparse. Two prospective clinical studies compared (i) one- and two-stage surgery and (ii) immediate and conventional loading in patients consecutively treated in the edentulous maxilla with implant-supported fixed prostheses. The first study found that the cumulative survival rate (CSR) after one-stage surgery performed according to a conventional protocol was consistent with two-stage protocol CSRs reported in previous studies. The second study evaluated an immediate loading protocol that provided patients with interim fixed prostheses within 24 hours after implant placement. A comparison of the studies found no significant difference in CSRs. But it was found that when a conventional protocol was used, transitional removable prostheses could traumatize the bone-implant interface during healing by adverse loading on the implants, which pierced the mucosa. Moreover, splinting the implants immediately after surgery with an interim fixed prosthesis might protect them from adverse loading. In a finite element analysis comparing uncoupled and splinted implants--imitations of the clinical situations in the two studies--splinted implants drastically reduced stresses in the bone tissue surrounding the implant, which might facilitate bone healing. Two factors considered important for a successful treatment outcome, especially when loading implants immediately, are (i) jawbone quality and (ii) primary implant stability at placement. In implant literature, bone quality is generally equivalent to bone density. Results of the third clinical study in this thesis indicate that use of computed tomography with calculations of bone mineral density can be a useful tool in bone tissue evaluation before implant placement. After 1 year of loading, changes in marginal bone level, compared to baseline, did not differ between implants that were stable and implants that were not stable at placement. The results of this thesis do not strengthen earlier recommendations that immediate and early loading is a treatment alternative that can be considered only in jaws with good bone quality. In conclusion, immediate loading with interim fixed prostheses in the edentulous maxilla is a viable treatment alternative. Splinting of implants seems to be important in immediate loading, especially when bone density is low.     

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.     

A prospective 5-year study of two cast framework alloys for fixed implant-supported mandibular prostheses

PURPOSE: A longitudinal 5-year clinical investigation was carried out to compare screw-retained frameworks constructed from two alloys with different mechanical properties, either gold or silver-palladium, supported in the mandible by the Astra Tech implant system. MATERIALS AND METHODS: Twenty-six edentulous patients with mandibular implants were divided into two groups: group A was provided with Chicago IV gold alloy superstructures, and group B was provided with Palliag M silver-palladium alloy superstructures. The surgical procedures for placing the mandibular bone implants and the prosthodontic and laboratory techniques for constructing the prostheses were carried out according to standard, well-documented practices. All patients wore conventional maxillary complete dentures. The integrity of prostheses and health of supporting tissues were compared over a 5-year period. RESULTS: Both materials had similar accuracy of fit and resistance to functional stress, although silver-palladium was technique sensitive and necessitated meticulous laboratory practice to achieve accuracy of casting. Clinical performance of both prostheses was similar, and radiographic assessment showed no statistically significant differences in periimplant bone changes. CONCLUSION: There were no differences in clinical performance and radiographic changes between the two materials. Therefore, silver-palladium alloy may be considered a suitable low-cost substitute for gold alloy for fixed implant-supported prostheses.     

Full-arch restoration of the jaw with fixed ceramo-metal prosthesis: late implant placement

BACKGROUND: The completely edentulous patient has few treatment options in conventional dentistry. When implants are considered, treatment plans range from a 2-implant overdenture to a completely implant-supported prosthesis. Fixed prosthesis is often the preferred selection of the edentulous patient. This study assesses the 5-year cumulative survival rate of implants placed to support full-arch fixed restoration. METHODS: During 1990 to 1995, 171 implants were placed in 22 completely edentulous jaws of 20 patients. All patients were discharged wearing immediate dentures. The implants were analyzed as to the number of implants per jaw, implant location, length, and diameter. RESULTS: The 5-year cumulative survival rate was 89.9%. The mean number of implants per jaw was 7.7 for the maxilla and 8 for the mandible. In the maxilla, the preferred implant locations were the canines, centrals, laterals, and first premolars; in the mandible, they were the canines, laterals, and first molars. The mean implant length was 14.2 mm for the mandible and 13.2 mm for the maxilla. The mean implant diameter was 3.6 mm for the maxilla and 3.8 for the mandible. CONCLUSIONS: The results of the present study indicate that fixed full-arch ceramo-metal restorations can be a predictable implant treatment modality for the edentulous patient.     

Implant prosthodontic management of partially edentulous patients missing posterior teeth: the Toronto experience

STATEMENT OF THE PROBLEM: The clinical success of implant-supported fixed partial dentures has been documented. However, few studies have reported long-term results or any association between implant outcomes and host determinants. PURPOSE: This study reports on implant and prosthesis outcomes in a group of partially edentulous patients treated with Br?nemark implants in the posterior zones. It also examines factors described in the medical history that may influence implant survival. MATERIAL AND METHODS: The charts of patients treated with implants from 1983 and followed prospectively through December 2001 at the University of Toronto were reviewed. One hundred thirty partially edentulous patients treated with implant-supported restorations in the posterior zones (area distal to mental foramen) were selected. Implant and prosthesis treatment outcomes were recorded and analyzed through the Kaplan-Meier and Cox regression methods (P<.05). RESULTS: A total of 130 patients received 432 Br?nemark dental implants in 174 posterior edentulous spans. The mean age of the patients at the time of insertion of the implants was 50.97 +/- 13.27 years. At 15 years, the overall implant and prosthesis survival rates were 91.6% and 89%, respectively. At 5 years, the survival rate of the wide-platform 5-mm-diameter implants was 76.3%. Implant diameter (P=.0001) and a history of a chronic medical condition (P=.01) were correlated with implant survival outcomes. CONCLUSIONS: High success of implant-supported prostheses in the posterior zones of both the maxilla and mandible. It corroborated other studies that have shown higher failure rates for wide-platform implants, emphasizing the need for proper establishment of clinical trials prior to marketing of new implant designs.     

Fixed implant‐supported prostheses in the edentulous maxilla. A five‐year follow‐up report.

Seventy‐six patients were consecutively treated with fixed prostheses supported by osseointegrated implants in the edentulous maxilla and followed up for 5 years. The mean bone quality and resorption indices were 3.1 and 2.7 at the time of implant placement, respectively. Altogether, 449 standard Brånemark implants were placed. Two patients resumed to complete dentures, and the cumulative implant and prosthesis survival rates were 92.1% and 95.9% for 5 years, respectively. The mean marginal bone level was 0.6 mm below the reference point at the time of placement and 1.2 mm below the same point 5 years later. Speech problems was the most frequent complaint during the first year of function, while resin fractures caused most adjustments during the follow‐up period. No implant, abutment or gold alloy screws were found to be fractured, and only 4 patients had their prostheses re‐tightened due to loose gold alloy screws.