单颗上颌前牙美学修复临床体会

目的：通过对美学区单个上前牙种植修复临床疗效一年的回顾性研究,评估美学修复效果及影响因素。方法：20例上颌单个无法保留患牙,拔除后即刻植入种植体,6个月后复诊取模选择合适基台制作永久金属烤瓷修复体。永久修复体戴入后1年复诊,比较刚戴入修复体（基线）与1年后随诊时种植体周软组织健康状况以及红色美学指数PES的变化情况。结果：种植体成功率为100％。基线与1年后随诊时PES值分别为10.2±2．1和11．3±1．8。结论：在严格选择病例的情况下,单牙即刻种植可取得良好的美学效果,是一种可行的方法。     

Long-term cumulative survival and mechanical complications of single-tooth Ankylos Implants: focus on the abutment neck fractures

PURPOSE

To evaluate the cumulative survival rate (CSR) and mechanical complications of single-tooth Ankylos® implants.

MATERIALS AND METHODS

This was a retrospective clinical study that analyzed 450 single Ankylos® implants installed in 275 patients between December 2005 and December 2012. The main outcomes were survival results CSR and implant failure) and mechanical complications (screw loosening, fracture, and cumulative fracture rate [CFR]). The main outcomes were analyzed according to age, sex, implant length or diameter, bone graft, arch, and position.

RESULTS

The 8-year CSR was 96.9%. Thirteen (2.9%) implants failed because of early osseointegration failure in 3, marginal bone loss in 6, and abutment fracture in 4. Screw loosening occurred in 10 implants (2.2%), and 10 abutment fractures occurred. All abutment fractures were located in the neck, and concurrent screw fractures were observed. The CSR and rate of screw loosening did not differ significantly according to factors. The CFR was higher in middle-aged patients (5.3% vs 0.0% in younger and older patients); for teeth in a molar position (5.8% vs 0.0% for premolar or 1.1% for anterior position); and for larger-diameter implants (4.5% for 4.5 mm and 6.7% for 5.5 mm diameter vs 0.5% for 3.5 mm diameter) (all P<.05).

CONCLUSION

The Ankylos® implant is suitable for single-tooth restoration in Koreans. However, relatively frequent abutment fractures (2.2%) were observed and some fractures resulted in implant failures. Middle-aged patients, the molar position, and a large implant diameter were associated with a high incidence of abutment fracture.     

Ankylos implant system: concept and clinical application

PROBLEM: The Ankylos system was developed in 1985 and has been in clinical use since 1987. Some of its significant design features include (1) a progressive thread structure of the endosseous implant body for targeted load distribution to the apically positioned spongy bone; and (2) the gap-free subgingival tapered connection to the abutments. PURPOSE: The purpose of this report is to demonstrate that the Ankylos Implant System meets both the patients' and the dentists' standards of success and is suitable for use as single tooth replacements, bridge abutments, and retention elements for all regions and prosthetic indications. METHOD: The data from 5439 implants were evaluated between October 1991 and October 2002. The implants were considered successful if the following criteria were met: (1) clinical stability and function; (2) no inflammation of the peri-implant hard and soft tissue; (3) no progressive loss of the peri-implant bone; (4) no progressive loss of the peri-implant mucosa; and (5) satisfaction of the patient. All implants placed during this period were included in the evaluation as a prospective study. The average loading period was 56.8 months. Postoperative follow-ups were made once a year by a standardized protocol. The results were classified by prosthetic application in Table 1. A total of 943 implants were placed as single tooth restoration and were followed for the duration of the study. RESULTS: The success rate for this type of restoration was 98.7%. For free-end implant restorations, there were 1679 implants placed with a 97.9% success rate. When the edentulous area involved a large gap, a total of 805 implants were placed with a 97.3% success rate. For cases involving reduced dentition, 606 implants were used with a 95.8% success rate. Another significant finding was that the success rates classified by maxilla and mandible showed no differences.     

The orthodontic appliance: esthetic considerations

The importance of attractive dental and facial appearance is at an all-time high for the American consumer. Because of this emphasis on appearance, the esthetic impact of the orthodontic appliance is a matter of great concern to prospective patients. This article presents an overview of the esthetic features of currently available orthodontic appliances.     

Clinical and esthetic outcomes of single-tooth implants in the anterior maxilla

The aim of this study was to evaluate the clinical and esthetic outcomes of 10 consecutive single-tooth implant restorations in the anterior maxilla. A specific treatment protocol consisting of (1) atraumatic extraction of the failing tooth, (2) placement of an SLActive bone-level implant with simultaneous guided bone regeneration at 6 to 8 weeks postextraction, (3) loading of a provisional restoration at 2 to 3 months following implant placement, (4) production of a customized impression coping, and (5) loading of the definitive all-ceramic abutment and crown 6 months after delivery of the provisional restoration was utilized in all cases. The outcomes were assessed 1 year after loading of the definitive restoration using standard clinical parameters: pink (PES) and white esthetic scores (WES). All implants were successfully integrated, accounting for a 100% survival and success rate. Besides clinical success, the application of the specific treatment protocol may be able to provide esthetically pleasing single-tooth implant restorations in the anterior maxilla, as was demonstrated by the results for PES (7.9 ± 1.7) and WES (7.0 ± 1.5).     

Long-term clinical performance of esthetic primary molar crowns

PURPOSE: The aim of the study was to report the long-term clinical performance of esthetic primary molar crowns and compare them to that of stainless steel crowns (SSC). METHODS: Twenty crowns (10 conventional and 10 esthetic) placed in 10 children who had participated in a previously reported study, were assessed again after 4 years. The crowns were evaluated clinically and radiographically according to the following parameters: gingival health, marginal extension, crown adequacy, proper occlusion, proximal contact, chipping of the facing (for esthetic crowns only), and cement removal. RESULTS: At the 4 year evaluation, all the esthetic crowns showed chipping of the facing. No difference was found for marginal extension, occlusion, crown adequacy and periodontal health between SSCs and the esthetic crowns. CONCLUSIONS: After 4 years, all the esthetic crowns presented chipping of the facing and, consequently, a very poor esthetic appearance.     

Evaluation of soft tissue around single-tooth implant crowns: the pink esthetic score

AIM: In this study, the reproducibility of a newly developed pink esthetic score (PES) for evaluating soft tissue around single-tooth implant crowns was assessed. The effect of observer specialization was another point of interest. MATERIAL AND METHODS: Twenty observers (five prosthodontists, five oral surgeons, five orthodontists and five dental students) were given photographs of 30 single-tooth implant crowns. Seven variables were evaluated vs. a natural reference tooth: mesial papilla, distal papilla, soft-tissue level, soft-tissue contour, alveolar process deficiency, soft-tissue color and texture. Using a 0-1-2 scoring system, 0 being the lowest, 2 being the highest value, the maximum achievable PES was 14. Each observer was requested to make two assessments at an interval of 4 weeks. At the second assessment, the photographs were scored in the reverse order. RESULTS: The mean PES of evaluations at the first assessment (n=600) was 9.46 (+/-3.81 SD), and 9.24 (+/-3.8 SD) at the second one. The difference between these two means was not significant statistically (P=0.6379). Implant-related mean PES for single-tooth implants varied from 2.28 to 13.8, with standard deviations between 0.46 and 3.51. Very poor and very esthetic restorations showed the smallest standard deviations. The mean total PES was 10.6 for the prosthodontists, 9.2 for the oral surgeons, 9.9 for the dental students and 7.6 for the orthodontists. CONCLUSIONS: The PES reproducibly evaluates peri-implant soft tissue around single-tooth implants. Thus, an objective outcome of different surgical or prosthodontic protocols can be assessed. Orthodontists were clearly more critical than the other observers.     

Ankylos种植系统前牙美学区即刻修复临时冠制作新方法及疗效评估

目的:介绍一种适用于Ankylos种植系统即刻修复临时冠制作的新方法,并评估其疗效。方法:选择22例单颗上前牙进行即刻种植或者常规种植Ankylos种植体共22枚,采用改良的临时冠制作新方法,均于1小时内完成即刻临时修复。3-6个月后评估临时修复体与相邻天然牙唇侧牙龈的协调性和患者主观满意度,1年后评估种植体的存留率。结果:在观察期内,22枚种植体均获得了良好的骨结合,无松动,未见病理性骨吸收,存留率为100%;18枚种植修复体唇侧龈缘位置与邻牙协调无差异,4枚轻度差异;19枚种植修复体与邻牙牙龈颜色质地协调无差异,3枚轻度差异。患者主观满意度VAS平均值为88。结论:采用本方法制作即刻修复临时冠,能够获得理想的美学效果和成功率。     

Early implant placement following single-tooth extraction in the esthetic zone: biologic rationale and surgical procedures

Early implant placement is one treatment option for implant therapy following single-tooth extraction in the anterior maxilla. The surgical technique presented here is characterized by tooth extraction without flap elevation, a 4- to 8-week soft tissue healing period, implant placement in a correct three-dimensional position, simultaneous contour augmentation on the facial aspect with guided bone regeneration using a bioabsorbable collagen membrane combined with autogenous bone chips and a low-substitution bone filler, and tension-free primary wound closure. The surgical step-by-step procedure is presented with a case report. In addition, the biologic rationale is discussed.     

Anterior esthetic fixed appliances for the preschooler: considerations and a technique for placement

One of the pediatric dentist's greatest restorative challenges is the esthetic rehabilitation of a young toddler who has suffered multiple tooth loss subsequent to rampant early childhood caries or extensive dental trauma. An anterior esthetic appliance may be used to replace lost teeth. The most decisive factor for placing an anterior esthetic appliance is parental desire. Other considerations include: space maintenance, masticatory function, speech development, and tongue habits. However, there is no strong evidence that early loss of maxillary incisors will have any significant, long lasting effect on the growth and development of the child. This paper discusses in detail one type of fixed anterior esthetic appliance and the considerations to be made when deciding when and why to place them.     

Congenitally missing maxillary lateral incisors and orthodontic treatment considerations for the single-tooth implant

Implant restorations have become a primary treatment option for the replacement of congenitally missing lateral incisors. The central incisor and canine often erupt in less than optimal positions adjacent to the edentulous lateral incisor space, and therefore preprosthetic orthodontic treatment is frequently required. Derotation of the central incisor and canine, space closure and correction of root proximities may be required to create appropriate space in which to place the implant and achieve an esthetic restoration. This paper discusses aspects of preprosthetic orthodontic diagnosis and treatment that need to be considered with implant restorations.     

Implant repositioning for esthetic reasons: a clinical report

This article describes the correction of an unesthetic implant position that resulted from unexpected postpubertal growth. Surgical implant repositioning, a technique similar to single-tooth osteotomies, was used. The implant and surrounding bone were mobilized, and a green stick fracture was made on the buccal plate. With pivoting on the buccal plate, the implant was moved to a more palatal position and restored. Although some degree of asymmetry could still be detected, a satisfactory esthetic result was achieved.     

An overview of treatment considerations for esthetic restorations: a review of the literature

Controversy persists regarding the treatment planning criteria for esthetic restorations. This article reviews the literature regarding the biocompatibility, marginal adaptation, color matching, patient selection, technique sensitivity, and mode and rate of failure of tooth-colored restorations. A Medline search was completed for the period from 1986 to 2006, along with a manual search, to identify pertinent English peer-reviewed articles and textbooks. The key words used were amalgam, posterior composite resin, ceramic inlays/onlays, CEREC, porcelain laminate veneers, all-ceramic crowns, and all-ceramic fixed partial dentures.