Clinical outcomes of fully and partially threaded zygomatic implants in a cohort of patients with minimum 7.5-year follow-up

OBJECTIVE: The aim of this retrospective case series report was to evaluate the results of oral rehabilitation with extra-sinus zygomatic implant surgery with a minimum follow-up of 7.5 years. PATIENTS AND METHODS: A total of 35 patients with 87 zygomatic implants were included. The mean follow-up period of the patients was 93 months. The zygomatic implant survival and complications were evaluated as criteria for success. RESULTS: There were no implant failures. Overall success rate without complications for zygomatic implant was 88.5%. Complications developed in 4 patients (1 cutaneous fistula and 3 mucositis). According to the results on an implant basis, patients with previously failed conventional implants had greater probability of complications. Patients with quad zygomatic implants had higher incidence of complications than those with two zygomatic implants. Fully threaded implant design was associated with higher incidence of mucositis than partially threaded design. No relation was found between implant success and smoking, prosthesis type, and antagonist dentition. When conducting the analysis using the patient as unit, only the antagonist dentition showed significant difference, the worst outcome being associated with the Toronto resin prosthesis. CONCLUSIONS: Zygomatic implants can be considered as a safe alternative to conventional implant insertions and bone grafting procedures in oral rehabilitation of patients with severely atrophic maxillary bone

Immediate rehabilitation of the edentulous maxilla: preliminary results of a single-cohort prospective study

PURPOSE: This article reports preliminary results of a single-cohort prospective study that sought to evaluate a new surgical protocol for the immediate rehabilitation of edentulous maxilla without using bone grafting. MATERIALS AND METHODS: Twenty consecutive patients in need of a full-arch maxillary rehabilitation were included in the study. Each patient received four tilted implants that engaged the posterior and the anterior sinus wall and two axial implants in the anterior maxilla. A total of 120 implants (30 Branemark System MK IV and 90 NobelSpeedy Groovy) was inserted. Acrylic resin provisional prostheses were delivered within 4 hours of implant placement, and definitive restorations were placed 4 to 6 months later. Follow-up visits were scheduled every 6 months for the first 2 years and yearly thereafter. At each follow-up appointment, plaque and bleeding indexes were scored, periapical radiographs were obtained to assess marginal bone level changes, and patient satisfaction was recorded by means of a questionnaire. RESULTS: The follow-up ranged between 18 and 42 months (average, 27.2 months). No implants failed. All prostheses were stable and functional. No adverse events occurred. At 1 year, mean marginal bone loss around axial and tilted implants was similar: 0.8 mm for axial implants (SD 0.4, n = 30) and 0.9 mm for tilted implants (SD 0.5 mm, n = 60) (P > .05). Plaque and bleeding scores decreased over time, and patient satisfaction with both esthetics and function increased. CONCLUSIONS: This technique can be considered a viable treatment modality for the immediate rehabilitation of the edentulous maxilla, as it provides optimal support in the posterior region, minimizes distal cantilevers, and avoids bone grafting or sinus augmentation

Immediate rehabilitation of the extremely atrophic mandible with fixed full-prosthesis supported by four implants

Purpose: To prospectively assess the outcome of immediate rehabilitation of extremely atrophic mandibles by a full-arch fixed bridge anchored to four implants. Material and Methods: Twenty patients with edentulous mandibles were included in the study. Each patient received a full-arch fixed bridge supported by two axial and two distal tilted implants. Prosthetic loading was applied within 48 hours of surgery. Patients were scheduled for follow-up every 6 months up to 2 years and annually until 5 years. Radiographic evaluation of marginal bone level change was performed at 1 year. Results: All patients were followed for a minimum of 1 year (range 20-48 months, mean 30.1 months). No failures were recorded to date. The 1-year implant survival rate and prosthesis success rate were 100%. Marginal bone loss around axial and tilted implants was similar at 12-month evaluation, being, respectively, 0.6\u2003\ub1\u20030.3 (standard deviation)\u2003mm and 0.7\u2003\ub1\u20030.4\u2003mm. High patient's level of satisfaction was recorded for function, phonetics, and aesthetics. Conclusion: This technique could be considered a viable treatment option for the rehabilitation of the atrophic mandible

Immediate loading in the fully edentulous maxilla without bone grafting : the V-II-V technique

Background. This prospective study aimed at evaluating a new surgical approach for the immediate rehabilitation of fully edentulous maxilla without any type of bone grafting. Methods. The technique named \u201cV-II-V\u201d consists of an immediately loaded full-arch bridge supported by six implants. Two distal implants engage the posterior wall of the maxillary sinus, being tilted 30-45\ub0 relative to the occlusal plane. Two other tilted implants engage the anterior wall of the sinus, and finally two axial implants are inserted in the anterior maxilla. An acrylic provisional restoration is delivered within 4 hours of implant placement. At each follow-up plaque and bleeding indexes were scored, marginal bone level change around tilted and axial implants were evaluated, and a questionnaire was compiled to assess patient\u2019s satisfaction for function and aesthetics. Results. Twenty-one patients were rehabilitated. A total of 126 implants were inserted. Nineteen prostheses were in function for more than 12 months. The average follow-up was 20 months (range 4-35 months). No implant failure occurred to date, leading to 100% survival rate and 100% prosthesis success. No complication was recorded. Peri-implant bone loss at axial and tilted fixtures was similar at one year, being 0.8 mm (SD 0.4, n=28) and.0.9 mm (SD 0.5 mm, n=56) respectively (P> 0.05). Conclusion. The \u201cV-II-V\u201d technique is a viable treatment modality for the immediate rehabilitation of the edentulous maxilla, avoiding bone grafting or sinus augmentation. Long-term evaluation is needed to confirm these encouraging preliminary results

A modified technique for using the endoscope in periradicular surgery : a case report

The aim of this case report was to describe a modified endoscopic technique for enhancing visualization in endodontic microsurgery. Methods: Tooth treated surgically showed a periradicular lesion of strictly endodontic origin. Following the reflection of a full mucoperiosteal papilla base incision flap, surgical access to the root was made through the cortical bone. The periradicular lesion was curetted, root end was resected, and root-end cavity was prepared with a zirconium nitrate tip driven by ultrasonic device unit. Finally zinc oxide EBA-reinforced cement root-end filling was placed. Root-end management procedure was performed using an endoscope. Diving of the endoscope lens in the bone cavity filled with saline solution contributed to improve visualization and keep clear the lens. Results: Following clinical and radiographic assessment at 12 months post surgery, the case was classified as success. Conclusion: In the present clinical case, the endoscope provided excellent visualization of the surgical field during root-end cavity preparation

Immediate rehabilitation of the mandible with fixed full prosthesis supported by axial and tilted implants : interim results of a single cohort prospective study

Purpose: The aims of this prospective study were to assess the treatment outcome of immediately loaded full-arch fixed bridges anchored to both tilted and axially placed implants for the rehabilitation of the mandible and to compare the outcome of axial versus tilted implants. Materials and Methods: Sixty-two patients (34 women and 28 men) were included in the study. Each patient received a full-arch fixed bridge supported by two axial implants and two distal tilted implants (All-on-Four, Nobel Biocare AB, Göteborg, Sweden). Loading was applied within 48 hours of surgery. Patients were scheduled for follow-up at 6, 12, 18, and 24 months, and annually up to 5 years. At each follow-up, plaque level and bleeding scores were assessed; moreover, patient's satisfaction for aesthetics and function was evaluated by a questionnaire. Radiographic evaluation of marginal bone level change was performed at 1 year. Results: The overall follow-up range was 6 to 43 months (mean 22.4 months). Forty-four patients were followed for a minimum of 1 year. No implant failures were recorded to date, leading to a cumulative implant survival and prosthesis success rate of 100%. Plaque level and bleeding scores showed progressive decrease over time, parallel to increase of satisfaction for both aesthetics and function. No significant difference in marginal bone loss was found between tilted and axial implants at 1-year evaluation. Conclusion: The present preliminary data suggest that immediate loading associated with tilted implants could be considered a viable treatment modality for the mandible