Prosthetic Rehabilitation Following Lateral Resection of the Mandible with a Long Cantilever Implant-Supported Fixed Prosthesis: A 3-Year Clinical Report

This clinical report describes the prosthetic management of the surgical reconstruction of a patient after mandibular resection. Complete oral rehabilitation was achieved with a maxillary complete denture and a mandibular implant-supported fixed prosthesis with a custom titanium framework and a long unilateral cantilever

In vitro comparative study of fibroblastic behaviour on polymethacrylate (PMMA) and lithium disilicate polymer surfaces

Polymethyl methacrylate (PMMA) and lithium disilicate are widely used materials in the dental field. PMMA is mainly used for the manufacture of removable prostheses; however, with the incorporation of CAD-CAM technology, new applications have been introduced for this material, including as a provisional implant attachment. Lithium disilicate is considered the gold standard for definitive attachment material. On the other hand, PMMA has begun to be used in clinics as a provisional attachment until the placement of a definitive one occurs. Although there are clinical studies regarding its use, there are few studies on cell reorganization around this type of material. This is why we carried out an in vitro comparative study using discs of both materials in which human gingival fibroblasts (HGFs) were cultured. After processing them, we analyzed various cellular parameters (cell count, cytoskeleton length, core size and coverage area). We analyzed the surface of the discs together with their composition. The results obtained were mostly not statistically significant, which shows that the qualities of PMMA make it a suitable material as an implant attachment

Custom abutments for dental implants, their evolution and uses: a narrative review

Introdução: Recentemente no mundo da dentística o uso de Computer Imaging and Computer Manufacturing (CAD/CAM) para criar pilares de implantes personalizados de Titânio ou Zircônia para atender às demandas funcionais e estéticas de nossos pacientes, está se tornando cada vez mais proeminente com vários métodos, cada um adequado para uma melhor localização e tipo de dente que deve substituir. Objetivo: Este estudo tem como objetivo a discussão dos pilares personalizados em implantes dentários, seus desenvolvimentos, vantagens e desvantagens, técnicas de fabrico, indicações e contraindicações e por fim sua viabilidade clínica. Metodologia: Pubmed, B-on (1990-2022) com as palavras-chave: : (“dental implant” OR” dental abutment” OR “custom dental abutment”) AND (“3D Printing” OR “zirconia” OR” titanium” OR “milled abutment” OR “sintering” OR “emergence profile” OR “peri-implant tissue” OR “replacement” OR “materials” OR “ CAD/CAM” OR “Clinical Trial” OR “Esthetic”). Resultado: Os Abutments Personalizados que atualmente apresentam melhor desempenho são os de Titânio, sendo que os copings de Zircônia sobre Titânio conseguem obter os melhores resultados estéticos e funcionais.Introduction: Recently in the world of dentistry the use of Computer Imaging and Computer Manufacturing (CAD/CAM) in order to create Titanium or Zirconia custom implant abutments to meet the functional and esthetic demands of our patients is becoming more and more prominent with several methods each suited to a better locale and type of tooth it’s supposed to replace. Objective: This study has as its objective the discussion of custom-made abutments in dental implants, their development, advantages and disadvantages, manufacturing techniques, indications and contraindications and finally their clinical viability. Methodology: Pubmed, B-on (1990-2022) with the following keywords: (“dental implant” OR” dental abutment” OR “custom dental abutment”) AND (“3D Printing” OR “zirconia” OR” titanium” OR “milled abutment” OR “sintering” OR “emergence profile” OR “peri-implant tissue” OR “replacement” OR “materials” OR “CAD/CAM” OR “Clinical Trial” OR “Esthetic”). Result: The Custom Abutments that currently perform the best are Titanium ones, with Zirconia copings on Titanium being able to achieve the best results both esthetically and functionally

Four-year outcomes of full-arch fixed dental prostheses using CAD/CAM frameworks : a retrospective review of 15 cases

The aim of this report is to analyze the clinical performance of 20 full-arch implant-supported titanium frameworks using CAD/CAM (Computer-Aided Design and Computer-Aided Manufacturing) technology. One hundred and four implants were placed in 15 patients using a one-stage protocol. After planning the location of all implants via 3-dimensional software (NobleClinician), 4-8 implants were placed in each edentulous arch based on anatomical measurements. Twenty edentulous arches were treated with full arch implant-supported fixed dental prostheses utilizing CAD/CAM milled titanium frameworks . All patients were followed up for 48±4 months. Clinical performance of the implants and restorations were evaluated for implant/prosthesis survival, framework fit, marginal bone levels, and maintenance requirements. One implant was lost during the follow up period, giving an implant survival rate of 99.1%. The average distance from the implant platform to first bone-implant contact was 1.1±0.2 mm from the time of metal-framework try-in to the time of the last recall appointment. None of the prostheses needed a replacement, indicating the prosthesis success rate was 100%. Sixteen occlusal adjustments and 5 broken denture teeth were repaired chairside during the study period. The results of this retrospective clinical report suggest that CAD/CAM milled titanium frameworks using the software and scanner presented in this study fit accurately and can be a viable treatment option to restore edentulous arches

Influence of Alveolar Ridge Morphology and Guide-hole Design on the Accuracy of Static Computer-Assisted Implant Surgery with two Implant Macro-designs: An in Vitro Study.

OBJECTIVES The primary aim of this in vitro study was to evaluate the influence of alveolar ridge morphologies on the accuracy of static Computer-Assisted Implant Surgery (sCAIS). The secondary aims were to evaluate the influence of guide-hole design and implant macro-design on the accuracy of the final implant position. METHODS Eighteen standardized partially edentulous maxillary models with two different types of alveolar ridge morphologies were used. Each model was scanned via cone beam computer tomography prior to implant placement and scanned with a laboratory scanner prior to and following implant placement using sCAIS. The postsurgical scans were superimposed on the initial treatment planning position to measure the deviations between planned and postsurgical implant positions. RESULTS Seventy-two implants were equally distributed to the study groups. Implants placed in healed alveolar ridges showed significantly lower mean deviations at the crest (0.36 ± 0.17 mm), apex (0.69 ± 0.36 mm), and angular deviation (1.86 ± 0.99°), compared to implants placed in fresh extraction sites (0.80 ± 0.29 mm, 1.61 ± 0.59 mm, and 4.33 ± 1.87°; all p<0.0001). Implants placed with a sleeveless guide-hole design demonstrated significantly lower apical (1.02 ± 0.66 mm) and angular (2.72 ± 1.93°) deviations compared to those placed with manufacturer's sleeves (1.27 ± 0.67 mm; p=0.01, and 3.46 ± 1.9°; p=0.02). Deep-threaded tapered bone level implants exhibited significantly lower deviations at the crest (0.49 ± 0.28 mm), apex (0.97 ± 0.63 mm), and angular deviations (2.63 ± 1.85°) compared to shallow-threaded parallel-walled bone level implants (0.67 ± 0.34 mm; p=0.0005, 1.32 ± 0.67 mm; p=0.003, and 3.56 ± 1.93°; p=0.01). CONCLUSIONS The accuracy of the final implant position with sCAIS is determined by the morphology of the alveolar ridge, the design of the guide holes, and the macrodesign of the implant. CLINICAL SIGNIFICANCE Higher accuracy in the final implant position was observed with implants placed in healed alveolar ridge morphologies, in implants with deep-threaded tapered macro-design, and when sleeveless surgical guide holes were used

Management of a Complex Case during COVID-19 Time Using One-day Digital Dentistry: A Case Report

Aim and objective: The aim of the present case report is to describe the digital management of an implant prosthetic rehabilitation performed by the use of different digital technologies, which allowed to successfully perform in 1 day both the surgical and the prosthetical stages with a minimally invasive approach and a high standard of care. Background: Coronavirus disease-2019 (COVID-19) pandemic is affecting dental everyday practice. Clinicians have to reduce the number of patients per day and the time they spend in the dental office. Minimally invasive and digital approaches, with less possible exposure and interaction, are suggested to reduce the risk of infection. Case description: The failure of a short-span implant prosthetic rehabilitation combined with pain and mobility of the involved teeth was the main complaint reported by a 78-year-old male patient, who asked an urgent appointment to solve the problem. An intraoral scanner allowed the clinician to immediately take a preliminary digital impression of the arch to be treated. The resulting 3D files were sent by e-mail to the dental technician who provided a digital wax-up for the computerized workflow. Computer-aided implantology (CAI) performed using an in-office cone-beam computed tomography (CBCT) allowed clinician to guide the surgical approach in a prosthetic manner. Such an integration inside a well-defined workflow was the key for a successful and rapid treatment. Conclusion: By using new innovative digital technology, the treatment was completed in 1 day, reducing the risk of COVID-19 by limiting the number of appointments and reducing contacts in confined environments like the dental office and public transportations. It also helped to reduce materials production and people movement in the treatment of dental emergency. Clinical significance: The possibility of performing an effective treatment saving time by using efficient technology and a minimally invasive procedure highlights the importance of digital planning in order to optimize every single step of the treatment. Digital workflow reduces also the movement of potentially infected materials from the office to the dental laboratory

Advantages and limitations of implant surgery with CAD/CAM surgical guides : a literature review

Background: The purpose of this study is to review the available literature associated with implant surgery using computer-aided design/computer-aided manufacturing (CAD/CAM) surgical guides and discuss the advantages and disadvantages of this advanced technique. Material and Methods: An electronic literature search was conducted in the PubMed database for the relevant in-formation on implant placement with CAD/CAM surgical guides. This review was constructed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Articles were limited to those published within the past 10 years and in the English language. Only clinical studies were included. Inclusion cri-teria were: studies including 10 implants or more and studies presenting angular deviations in degrees and linear deviations in millimeter. Observational studies, reviews, animal studies, in vitro studies, case reports, simulation studies were excluded. Nine articles were included for qualitative synthesis. Results: The initial search detected 61 articles, and after screening abstracts, a total of 15 articles were selected for full-text review. After the full-text analysis of the 15 articles, six articles were excluded as they did not meet inclusion criteria for study design, study population, and implant placement with data presentation for angular and linear deviations. Ultimately, nine articles providing angular and linear deviations between planned and actual pla-ced implants were used in this review. Common problems that may be encountered by clinicians were listed, and recommendations were made on how to avoid those problems.Conclusions: It has been suggested that although unrealistic expectations are often associated with implant place-ment with CAD/CAM surgical guides, there is no impeccable accuracy in the clinic. This review demonstrated that the practitioners should be aware of the angular and linear deviations up to 5 ° and 2.3 mm. Therefore, inexperien-ced dentists should obtain adequate training and be familiar with the basic steps with CAD/CAM surgical guides to avoid complications

Custom-made root analogue zirconia implants

O objectivo deste estudo foi conduzir uma revisão literária sobre os potenciais benefícios do uso de implantes dentários de zircónia customizados e análogos a estruturas radiculares. Uma pesquisa bibliográfica foi efectuada nas bases de dados Pub-Med e Science Direct desde 1969 a 2017. Foram explorados os seguintes itens de pesquisa: “zirconia” e “custom-made” e “dental implants”, “zirconia” e “root-analogue” e “dental implants”, “zirconia” e “anatomical” e “dental implants”, “zirconia” e “finite element” and “dental implants”, “zirconia” e ”customized” e “dental implants”, “zirconia” e “mechanical properties” e “dental implants”, “zirconia” e “biomechanical” e “dental implants”. Um total de 611 trabalhos foram selecionados a partir das bases de dados eletrónicas, sendo que um total de 81 foram preliminarmente selecionados para leitura completa. Um total final de 59 estudos foram selecionados para este estudo. Foi verificado pelos trabalhos selecionados que o uso de materiais à base de zirconia tem aumentado recentemente devido às suas propriedades estéticas e sucesso biológico. Além disso, os implantes análogos a estruturas radiculares estão-se a tornar uma solução viável para ultrapassar limitações relacionadas com distribuição de tensões ao osso peri-implantar, estética e peri-implantite por acúmulo de biofilme. Além disso, os avanços tecnológicos recentes têm levado a novas estratégias para melhorar a morfologia e superfícies dos implantes de zircónia. Entretanto, poucos estudos ainda são encontrados para os implantes análogos a estruturas radiculares e ainda torna-se difícil a comparação de resultados dentre inúmeras geometrias e condições intrínsecas dos pacientes.The aim of this study was to conduct a literature review on the potential benefits of custom-made root analogue zirconia implants. A PubMed and ScienceDirect bibliographical search was carried out from 1969 to 2017. The following search items were explored: “zirconia” and “custom-made” and “dental implants”, “zirconia” and “root-analogue” and “dental implants”, “zirconia” and “anatomical” and “dental implants”, “zirconia” and “finite element” and “dental implants”, “zirconia” and “customized” and “dental implants”, “zirconia” and “mechanical properties” and “dental implants”, “zirconia” and “biomechanical” and “dental implants”. The increased interest in zirconia-based dental structures linked to aesthetic and biological outcomes have been reported in literature. Also, custom-made root analogue implants have become a viable alternative to overcome limitations concerning stress distribution, aesthetics and peri-implantitis induced by biofilms. Recent technological advances have focused on novel strategies to modify zirconia-based surfaces to accelerate osseointegration. However, only a few studies revealed mechanical and biological benefits of zirconia custom-made root analogue implants and therefore further studies should investigate the influence of different geometries and surface modification on the performance of such implants