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Purpose: This clinical study using a specific technique was carried out to determine the clinical effectiveness of zygomatic implants under an immediate loading protocol. Materials and Methods: All patients treated between May 2000 and October 2006 who received zygomatic implants were included in this retrospective analysis. All patients were treated using the same surgical and restorative protocol. The following data were recorded: gender, age, type of implant, number of implants placed, dimensions of implants, and implant and prosthesis survival. Results: Fifty-six consecutive patients (29 women, 27 men; mean age of 60.58 years [range, 38.78 to 84.01]) were treated. All were in need of oral reconstruction and had maxillary atrophy that warranted zygomatic implant placement. One hundred ten zygomatic implants were placed in these 56 patients. Four of the 110 zygomatic implants failed, resulting in a cumulative survival rate of 96.37% with follow-up data no less than 9 months and in excess of 5 years. All four failures were turned-surface zygomatic implants. There have been no failures to date with the titanium anodized-surface zygomatic implants. The prosthesis survival rate was 100.0%. Conclusion: In this retrospective analysis of 56 patients receiving 110 zygomatic implants, the survival rate of zygomatic implants was in excess of 96% over a period of 9 months to 5 years. This technique resulted in a stable and predictable prosthetic reconstruction. INT J ORAL MAXILLOFAC IMPLANTS 2009;24:335-341 [ABSTRACT FROM AUTHOR]

PURPOSE: The aim of this study was to determine the osseointegration potential of implants with apical primary stability but no resistance to rotation in variable clinical conditions. MATERIALS AND METHODS: Patient records of treatment performed between October 1993 and May 2004 were reviewed for primary implant stability. Patients who exhibited implants without rotational primary stability (RPS) were reviewed further to determine patient age, gender, implant type, implant surface, loading protocol, and prosthesis type. RESULTS: Forty-four implants without RPS were reported in 12.8% of patients treated during the period reviewed. Statistical significant differences in cumulative survival rate (CSR) were seen with implant location and surface. No significant difference in CSR was observed in relation to loading protocol, despite a higher success rate (17.4% higher) for the immediate loading population. No difference in CSR was observed with respect to gender. DISCUSSION AND CONCLUSION: In the early years of machined implants, there was a higher failure rate of implants without RPS. The results for this implant population show that there are statistically significant differences in survival rate between the maxilla and mandible, and also between titanium oxide-surfaced implants and machined implants. The sample size of this study limited the statistical significance of the difference in CSR observed between loading protocols. Implants without RPS that are not removed at the time of surgery can become osseointegrated with a survival rate of 82%. Survival rates increase when testing sample is limited to titanium oxide-surfaced implants under an immediate loading protocol. Under the appropriate level of risk, implants that have apical primary stability but no resistance to rotation can become osseointegrated when incorporated in a rigid prosthesis under immediate loading circumstances. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To evaluate the stability of 18 immediately loaded Brånemark System dental implants in an insulin-controlled, diabetic, 71-year-old patient over the first 30 months after surgery, and to correlate this data with implant stability in healthy patients. METHOD AND MATERIALS: Stability measurements were taken using resonance frequency analysis on all implants at surgery placement and at 5 postsurgical examinations (1, 2, 3, 6, and 30 months). RESULTS: All 18 implants remained in function after 2.5 years of follow-up. The mean stability of the implants decreased 12.7% during the first 30 days, a value twice as much as seen in the general population. After the first 30 days, the stability of the implants increased slightly over the next 60 days. After 30 months of follow-up, the mean implant stability continued to increase, however, not to a value equal to that of the initial measurement taken at the time of implant placement. CONCLUSION: Despite the metabolic differences seen in diabetic patients, an immediate loading protocol can be successful and result in osseointegration. [ABSTRACT FROM AUTHOR]

PURPOSE: The goal of this study was to evaluate retrospectively the efficacy of a treatment modality for a lesion at the apical portion of a nonmobile dental implant. MATERIALS AND METHODS: All patients were treated with an intraoral treatment approach. A flap was elevated facial to the effected implant site, exposing the bone. A carbide bur was used to open a window in the bone. The bur was then used to cut the implant and completely remove the affected portion of the implant. The surgical site was then closed with interrupted vicryl sutures, and patients were prescribed. RESULTS: Thirty-nine implants in 35 patients with a mean age of 58.3 years were identified clinically and radiographically with the presence of a periapical lesion. These 39 implants, which constituted 9.9% of implants (39 of 395) placed in these 35 patients, were consecutively treated using the intraoral apicoectomy procedure. Thirty-eight of the 39 implants (97.4%) treated with this technique remained stable and continued in function with no further complication. Follow-up time averaged 4.54 years; the longest follow-up time exceeded 15 years. CONCLUSION: Based upon the results of this retrospective study, lesions in the apical region of implants can be treated successfully using an intraoral apicoectomy procedure. [ABSTRACT FROM AUTHOR]

This report describes a protocol that uses computerized tomography (CT), computer-aided design/computer-assisted manufacture (CAD/CAM) technology, and the Internet to plan placement of anterior and posterior dental implants and construct a precise surgical template and definitive prosthesis, which is connected at the time of implant placement. This procedure drastically reduces surgical treatment time and the recovery period. Patients with an edentulous arch had a denture with radiopaque markers constructed for CT scans of the appropriate jaw. The CT images, with acquisition slices of 0.5 mm, were transferred into a three-dimensional image-based program for planning and strategic placement of dental implants. After implants were virtually placed on the computer, the surgical treatment plan was sent to a manufacturing facility for construction of a surgical template and the prosthesis, Special surgical guide components were also manufactured for placement of implants in the pterygomaxillary region. The manufactured surgical components, surgical template, and definitive prosthesis were then delivered to the clinical site. Implant placement surgery was performed using the surgical template, without a flap, and the prosthesis was delivered, achieving immediate functional loading. Minor occlusal adjustments were made. The total surgical treatment time required was less than 60 minutes. Postoperative symptoms, such as pain, swelling, and inflammation, were minimal. Identification of the bone in relationship to the tooth position via three-dimensional CT prior to surgery allows precise placement of implants. CAD/CAM technology using the three-dimensional images allows for fabrication of the surgical guide and final prosthesis. This is a significant advancement in implant dentistry and prosthodontics. [ABSTRACT FROM AUTHOR]

PURPOSE: The purpose of the article was to evaluate the survival rates of TiUnite implants and then compare them to a previous similar study of machined-surface implants. MATERIALS AND METHODS: This report presents the results of 82 consecutive patients treated since the introduction of Nobel Biocare's TiUnite surface. The patients were treated with complete-arch restorations using bilateral pterygomaxillary implants in edentulous maxillae. A total of 840 implants were placed in immediate extraction or healed sites, with a mean of 10 implants placed per patient. RESULTS: In all, 826 of the 840 implants osseointegrated, for a cumulative survival rate (CSR) of 98.3%. One hundred fifty-eight of 164 pterygomaxillary implants successfully osseointegrated, yielding a 96.3% survival rate. DISCUSSION AND CONCLUSION: The results of this complete-arch maxillary prospective study suggest that Brånemark System TiUnite implants are more predicable than implants with a machined surface. Compared to a similar 1999 study in which the survival rate for machined-surface implants was 92.1%, the present study had a significantly higher survival rate of 98.6% with the TiUnite surface (P < .001). In the pterygomaxillary region, there was an increase of 8% with the TiUnite surface as opposed to the machined surface (P < .001). In addition, 62% of the implants in the present study were immediately loaded, compared to 0% in the machined-surface implant study. The titanium oxide surface appears to assist the healing response of the bone-implant interface. [ABSTRACT FROM AUTHOR]

This patient report describes the treatment of a 42-year-old woman with cleidocranial dysplasia. Endosseous implants were used to restore the mandibular and maxillary arches with fixed prostheses. Six implants were placed in the mandible and immediately loaded with an acrylic resin fixed prosthesis. In the maxillary arch, 10 implants were submerged for 4 months prior to functional loading. A transitional denture was relined and placed in the maxilla 10 days after implant placement. Three months later, a definitive mandibular prosthesis was fabricated. The definitive maxillary restoration was delivered 6 months after surgery. The most recent follow-up, 6 months after delivery, confirmed a satisfactory treatment result to date. [ABSTRACT FROM AUTHOR]

One thousand eight hundred seventeen implants were placed in the completely edentulous maxillae of 189 patients (122 female; 67 male). The patients' mean age was 60 years (range 28 to 91 years). Three hundred fifty-six of the 1,817 implants were placed in the pterygomaxillary area, and all patients were restored with complete-arch fixed detachable prostheses. The mean number of implants per maxillary prosthesis was 9.0 (range 6 to 15). During stage II surgery and before loading, 41 pterygomaxillary implants (11.5%) were not osseointegrated and were removed. After a mean loading period of 4.68 years (range 0.06 to 9.20 years), 1 additional pterygomaxillary implant was lost. Altogether, 42 of 356 pterygomaxillary implants (11.8%) were removed. Survival rates according to implant size, bone quality, and tooth position were also recorded. This study illustrates a cumulative survival rate of 88.2% for pterygomaxillary site implant placement in edentulous maxillary arches. [ABSTRACT FROM AUTHOR]

This clinical report focuses on the challenges and solutions for a child subjected to craniofacial trauma from a wild hyena biting off his nose and anterior maxilla. Unique considerations in prosthodontics and biomedical engineering were required based on future craniofacial growth and development of the child. The physical requirement of a maximum retentive prosthesis for an active, athletic child required unique engineering designs and executions. The sequence of treatment and prosthesis fabrication are detailed. The patient has been followed for 9 years without physiologic complications and only minor prosthodontic complications., (© 2022 by the American College of Prosthodontists.)

Purpose: The purpose of this study is to analyze the frequency and elevate the awareness of the prevalence of nondental pathology in cone beam computed tomography (CBCT) scans taken for implant placement treatment planning and postplacement evaluation. The data from the CBCT should be read by an oral and maxillofacial radiologist for proper diagnosis of dental and nondental pathology and referred to the medical specialist for proper management when necessary., Materials and Methods: This retrospective study analyzed 1002 consecutive CBCT scans taken at a single private practice noting the prevalence of nondental pathology in CBCT images for all dental implant procedures. All scans were taken from November 2007 to March 2020. One board certified oral and maxillofacial radiologist systemically read all scans and reported all findings in the maxilla and mandible, condyles and TMJ, paranasal sinuses, nasal fossa, pharyngeal airway, skull base and temporal bone, neck soft tissues, and cervical spine. The incidental findings, variation of normal anatomy, or pathology reported in these structures were categorized based on anatomic location and significance and the incidence was investigated., Results: Pathologies ranged from innocuous sinusitis, to more serious atherosclerotic calcification of the carotid arteries, narrowed airways, and neoplastic lesions. Fifty-one different findings were noted, of which 36 were pathologies that required referral or follow-up., Conclusions: Incidental findings can be detected in CBCT scans for dental implants. The clinician must be familiar with the radiographic diagnosis of head and neck pathology, and/or must refer these images to an appropriate specialist for the radiographic interpretation of the full volume., (© 2021 by the American College of Prosthodontists.)

Mandibular complete-arch fixed implant-supported prostheses are recognized as one of the earliest and most popular prostheses in implant dentistry. This prosthesis was the main focus in the early era of osseointegration. Despite its widespread popularity, few clinical reports have described long-term follow-up greater than 10 years for this type of prosthesis. This report describes a 30-year follow-up of a patient who underwent treatment for a mandibular complete-arch fixed implant-supported prosthesis with 4 machined surfaced implants, opposing a maxillary complete denture. This report documents a variety of photographs and radiographs taken over a period of 30 years to compare bone levels at various stages of care and maintenance, including de novo bone formation underneath the distal cantilevers due to functional loading. The biologic and biomechanical response to this treatment protocol and long-term clinical observations and prosthodontic outcome and maintenance needs are also addressed., (© 2018 by the American College of Prosthodontists.)

Osseointegrated dental implants have become an integral factor in the replacement of missing teeth. These implants have demonstrated long-term success for periodontally compromised patients, who require a high level of success to maintain a sense of optimism. This case report offers 32-year results of implant treatment in the maxilla and 25-year results in the mandible. Some maxillary implants suffered a few threads of bone loss, but all seven mandibular implants met Albrektsson's definition of success after 25 years. The purpose of this case report is to provide evidence that further supports the findings of osseointegrated implant treatment's longevity and success, as reported in other studies.

Purpose: Acrylic resin teeth on fixed implant prostheses are subject to time-dependent wear. The purpose of this retrospective analysis is to evaluate and describe the management of such wear in the context of selected variables--patient gender and age, dental arch location, and opposing dentition. The clinical and dental laboratory process to replace the worn teeth is defined as a retread., Materials and Methods: A retrospective database review from a single private prosthodontic practice was carried out on all patients who had undergone a retread procedure. The patient pool included 205 arches in 194 patients (70 in men, 135 in women) with a mean age of 57.4 years (range: 19.9 to 80.5 years). The retread procedure is described., Results: The mean time between final prosthesis delivery and retread was 7.8 years (range: 1.1 to 22.9 years). Statistical analysis was significant according to dental arch and opposing dentition. A statistical difference was also noted in patients undergoing multiple retread procedures, with a reduction in time between the subsequent procedures., Conclusion: Acrylic resin components of implant-supported hybrid prostheses wear over time and are influenced by a combination of the nature of the opposing dentition and patient habits. The dental laboratory process to retread the implant-supported framework is important for long-term patient care and maintenance of an appropriate vertical dimension of occlusion.

Positioning handles and occlusal locks have evolved as improvements to the Teeth-in-a-Day protocol. These improvements have enabled a more accurate alignment of the removable dental prosthesis during the conversion prosthesis technique. These improvements can be easily incorporated through computer-aided design and computer-aided manufacturing digital denture fabrication process., (Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

The technique for fabricating an accurate implant master cast following the 12-week healing period after Teeth in a Day® dental implant surgery is detailed. The clinical, functional, and esthetic details captured during the final master impression are vital to creating an accurate master cast. This technique uses the properties of the all-acrylic resin interim prosthesis to capture these details. This impression captures the relationship between the remodeled soft tissue and the interim prosthesis. This provides the laboratory technician with an accurate orientation of the implant replicas in the master cast with which a passive fitting restoration can be fabricated., (© 2015 by the American College of Prosthodontists.)

Purpose: To retrospectively analyze the survival rate of endosseous dental implants placed in the edentulous or partially edentulous mandible over a long-term follow-up period of 10 years or more., Materials and Methods: The charts of patients who underwent mandibular implant placement at a private prosthodontics practice and received follow-up care for 10 years or more were included in this study. Implants were examined according to the following study variables: patient sex, patient age, degree of edentulism (fully vs partially edentulous), implant location, time of loading (delayed vs immediate), implant size and type, bone quality, prosthesis type, and the presence of other implants during placement., Results: The study sample was composed of 2,394 implants placed in 470 patients with 10 to 27 years of follow-up. Of these 2,394 implants, 176 failed, resulting in an overall cumulative survival rate (CSR) of 92.6%. A total of 1,482 implants were placed in edentulous mandibles, and 912 implants were placed in partially edentulous mandibles, with CSRs of 92.6% and 92.7%, respectively. Comparisons of the study variables with respect to CSR were largely nonsignificant. However, there were significant differences in CSRs between anterior vs posterior locations and rough- vs smooth-surfaced implants in addition to some prosthesis types, ages, and bone qualities. The overall CSR of 92.6% in the present study is high and comparable to survival rates observed in previous long-term analyses of mandibular implants. The significant differences observed between implant locations, patient age groups, bone qualities, and prostheses were not suggestive of any remarkable trends., Conclusion: Patient sex, age, degree of edentulism, implant location, time of loading, implant size and type, bone quality, prosthesis type, and the presence of multiple implants did not result in any significant effect on long-term implant survival. The CSR observed after 10 to 27 years of follow-up in a single private prosthodontic center was high (92.6%) and supports the use of endosseous dental implants as a long-term treatment option for the rehabilitation of the edentulous and partially edentulous mandible.

Purpose: The purpose of this patient report is to accurately portray the clinical experience of treating an active bulimic patient by employing an immediately loaded dental implant protocol to provide the patient with an expedited esthetic and functional result. Implementation of a psychometric component statistically quantifies the psychological effects of the oral rehabilitation., Materials and Methods: A 34-year-old woman presented with severe dental perimolysis (erosion) resulting from a 28-year history of bulimic behaviors. Clinical and radiographic evaluation of the existing dentition indicated advanced dental erosion and previous restoration attempts in a state of failure. The patient's existing teeth were extracted and treated with full maxillary and mandibular implant-supported prostheses, following the Teeth in a Day® (TIAD) immediate functional loading protocol. Psychometric assessment was conducted through administration of a 20-item questionnaire, as seen in previous literature., Results: Radiographic and clinical analysis suggested all implant fixtures to be viable and accompanied by normal levels of alveolar bone 7 months into treatment. Questionnaire results at the new-patient presentation (T1) resulted in a composite score of 4.0 (SD = 2.9; P = 0.004), indicating severe body-image dysphoria. At 3 months postoperative (T2), the questionnaire score was 0.4 (SD = -1.7; P = 0.09). The final psychometric questionnaire at 7 months (T3) resulted in a score of 0.5 (SD = -1.5; P = 0.12). The patient was followed for a total of 7 years following implant placement., Conclusion: In this patient report, oral rehabilitation using the TIAD protocol provided an expedited and predictable alternative method for restoring functional abilities, esthetics, and self-esteem to a severely depressed bulimic patient. Psychometrically, at the postoperative (T2) and final testing period (T3), the patient's body image profile was no longer considered to be significantly different from established normative values.

Patients missing portions or all of the maxillary alveolar bone who are restored with zygomatic implants frequently have threads exposed that can be a mucosal irritant. If such irritation is reported, covering the threads with a highly polished titanium sleeve is recommended. The technique of placing said custom sleeve is described. This adjunctive treatment method has eliminated mucosal irritation.

A gunshot injury is one of the main trauma injuries that affect the head and neck region. Severe esthetic, functional, and psychologic deficiencies are consequences of gunshot injuries. The use of implants anchored in the zygomatic bone has been advocated as an approach to the prosthetic rehabilitation of a severely deficient maxilla. This approach provides the patient with an immediate, high-quality, esthetic, and functional complete fixed prosthesis and eliminates the need for bone grafting. In this case report, a patient with a severely deficient maxilla caused by a gunshot injury was rehabilitated by placement of four zygomatic and two pterygomaxillary implants, which were immediately loaded with a complete fixed all-acrylic resin interim prosthesis. The definitive CM Prosthesis (CM Prosthetics) was constructed using computer-aided design/computer-assisted manufacture (CAD/CAM) technology.

The widespread use of oral implants in recent years has resulted in various types of complications. One of those complications is the periapical implant lesion. Different factors have been proposed to play a role in the development and emergence of a periapical implant lesion. To date, there is no consensus on the etiology and therefore periapical lesions around dental implants are considered to have a multifactorial etiology. The diagnosis of an implant periapical lesion should be based on both clinical and radiological findings. Additionally, in order to apply the best treatment strategy the evolution of the lesion should be taken into account. The treatment of this kind of lesion, however, is still empiric. Data, primarily from case reports, seem to indicate that the removal of all granulation tissue is a first step to arrest the progression of the bone destruction. The removal of the apical part of the implant seems a valuable treatment strategy., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose: To describe 2 different treatment approaches for a 20-year-old Caucasian man and his 22-year-old sister who were affected by ectodermal dysplasia (ED) and compromised maxillary bone., Materials and Methods: The sister had a history of an iliac crest transplant with 6 implants placed in the maxillary and mandibular arches, 6 years before complications. It was necessary to debride the right sinus, remove the failing infected bone graft and 2 implants. Her brother presented with missing teeth, few remaining deciduous teeth, and wearing all-acrylic resin temporary partials in both the maxillary and mandibular arches., Results: Zygomatic and pterygomaxillary implants were used to rehabilitate the brother with a screw-retained fixed prostheses. His sister had 6 new maxillary implants. Both siblings' mandibular arches were restored with screw-retained implant-supported prostheses., Conclusion: Although these siblings affected with ED had different treatment approaches, they both eventually obtained successful outcomes. The brother's treatment was expedited. Both siblings have been followed for a period of 11 years, and all postoperative evaluations have been uneventful.

Purpose: The purpose of this study was to retrospectively evaluate implant survival rates in patients treated with the All-on-Four™ protocol according to edentulous jaws, gender, and implant orientation (tilted vs. axial)., Materials and Methods: All Brånemark System implants placed in patients following the All-on-Four™ protocol in a single private practice were separated into multiple classifications (maxilla vs. mandible; male vs. female; tilted vs. axial) by retrospective patient chart review. Inclusion criteria consisted of any Brånemark System implant placed with the All-on-Four™ protocol from the clinical inception (May 2005) until December 2011. Life tables were constructed to determine cumulative implant survival rates (CSR). The arches, genders, and implant orientations were statistically compared with ANOVA., Results: One hundred fifty-two patients, comprising 200 arches (800 implants) from May 2005 until December 2011, were included in the study. Overall implant CSR was 97.3% (778 of 800). Two hundred eighty-nine of 300 maxillary implants and 489 of 500 mandibular implants survived, for CSRs of 96.3% and 97.8%, respectively. In male patients, 251 of 256 implants (98.1%) remain in function while 527 of 544 implants (96.9%) in female patients survived. Regarding implant orientation, 389 of 400 tilted implants and 389 of 400 axial implants osseointegrated, for identical CSRs of 97.3%. All comparisons were found to be statistically insignificant. The prosthesis survival rate was 99.0%., Conclusions: The results from this study suggest that edentulous jaws, gender, and implant orientation are not significant parameters when formulating an All-on-Four™ treatment plan. The high CSRs for each variable analyzed demonstrate the All-on-Four™ treatment as a viable alternative to more extensive protocols for rehabilitating the edentulous maxilla or mandible., (© 2013 by the American College of Prosthodontists.)

Purpose: Implants that engage the cortical bone of the pterygomaxillary region help restore dentition to the posterior maxilla. However, proper implant length is required. The purpose of this study was to determine if there is a statistically significant difference in the survival rates between different sized implants placed in the pterygomaxillary region., Materials and Methods: All Brånemark System 4.0-mm-diameter implants delivered into the pterygomaxillary region in a single private practice were separated into 7- to 13-mm and 15- to 18-mm groups by retrospective patient chart review. Cumulative survival rates (CSR) were calculated., Results: Of all implants delivered, 930 of the 992 osseointegrated for a CSR of 93.75%. Fifty-nine of the 67 implants in the 7- to 13-mm grouping and 871 of the 925 implants in the 15- to 18-mm grouping osseointegrated for CSRs of 88.06% and 94.16%, respectively. The results were statistically significant (P < 0.05)., Conclusions: The results suggest that increased implant length in the pterygomaxillary region may result in higher osseointegration rates. The implant apex better engages the cortical bone between the medial and lateral pterygoid plates and therefore increases primary and secondary stability.

Purpose: Implants placed into the pterygomaxillary region allow for increased posterior support and a full complement of teeth without the need for distal cantilevers. With advancements in research and technology, implant delivery has evolved from the traditional two-stage procedure to immediate loading freehand and guided surgical template protocols. The purpose of this retrospective study is to determine if there is a significant difference in implant survival rates between these protocols., Materials and Methods: All pterygomaxillary implants placed in a single private practice from September 1985 to July 2011 were categorized into three separate classifications (two-stage freehand, single-stage freehand, or single-stage guided) by retrospective chart review. Life tables were constructed to determine the cumulative survival rates (CSR), and ANOVA was used to identify statistical significance., Results: A total of 981 patients comprising 371 males and 610 females were included in the study. Of all pterygomaxillary implants, 1,460 of 1,608 implants osseointegrated for a CSR of 90.80%. Seven hundred nine of the 825 two-stage, 624 of the 647 single-stage, and 127 of the 136 guided surgery implants osseointegrated for CSRs of 85.94%, 96.45%, and 93.38%, respectively. The comparison between two-stage and single-stage protocols was statistically significant, (P < .05) while the difference between single-stage guided versus freehand protocols was found to be statistically insignificant (P > .05)., Conclusion: The results from this retrospective study reinforce that immediate loading of pterygomaxillary implants with a provisional prosthesis is beneficial to both doctor and patient. The lower CSR for the guided surgery protocol compared with the single-stage freehand procedure is statistically insignificant, suggesting guided surgery is still a viable and recommended option for qualified patients.

Purpose: Specifically with zygomatic implants, the bone-to-implant contact (BIC) at the zygomatic bone correlates with the survival of the implant because there is little anchorage at the alveolus. The purpose of this retrospective study was to view and measure the BIC of zygomatic implants in the zygomatic bone., Materials and Methods: The patients in this study received zygomatic implants at a single private dental implant center. All patients were treated with the same immediate-loading protocol followed by postoperative cone beam computed tomography. The scans were exported to a computer-aided design system, where the BICs could be measured digitally. The BIC was analyzed by gender, and any statistical difference was determined by analysis of variance., Results: The study sample was composed of 77 patients (62.3% women) receiving 173 zygomatic implants. The mean age of the sample was 59 ± 8.7 years. The mean BIC was 15.3 ± 5.6 mm (range, 4.9 to 32.9 mm) in the zygomatic bone. On average, 35.9% ± 11.7% (range, 12.2% to 67.3%) of the implant came into contact with the zygomatic bone. The average BIC in men was 16.5 ± 6.0 mm, and the average BIC in women was 14.7 ± 5.4 mm, a statistically significant difference by analysis of variance (P < .05)., Conclusions: Evidence from this report indicates the zygomatic BIC varies greatly from patient to patient. These data show that the typical male patient has a greater zygomatic BIC than the typical female patient; however, these data do not support the hypothesis that the zygomatic BIC influences the zygomatic implant survival rate., (Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

A 64-year-old totally edentulous female initially presented with ill-fitting removable prostheses. A comprehensive treatment plan with dental implants was accepted by the patient. Clinical and laboratory procedures were executed using various computer technologies including computed tomography, rapid prototyping, and optical scanning using conoscopic holography. A review of the patient's treatment and various modalities used are the focus of this patient report.

This patient report describes the treatment of a 45-year-old Caucasian woman with cleidocranial dysplasia who had significant dental problems that greatly affected her quality of life. The patient had orthodontic treatment in her earlier years along with surgical removal of supernumerary teeth. Using implants, the maxillary and mandibular arches were restored with fixed screw-retained prostheses. Eight implants and six implants were placed in the maxilla and mandible, respectively. Both arches were immediately loaded following the Teeth in a Day™ protocol using an all-acrylic resin provisional prosthesis. Five months later, definitive maxillary and mandibular prostheses were fabricated. The patient has been followed for a period of 5 years, and all postoperative evaluations have been uneventful., (© 2011 by The American College of Prosthodontists.)

Computer-aided design/computer-assisted manufacture technology is changing the way clinicians are planning treatment and delivering dental implant therapy. Although the current technology is impressive and successful clinically, there are limitations in the design that prevent all patients from benefiting immediately from this computer-designed modality. This article describes a unique prosthetically driven protocol that will allow the delivery of a prefabricated screw-retained all-acrylic prosthesis immediately after an alveoplasty with the immediate placement of dental implants.

Purpose: The purpose of this study was to analyze retrospectively the survival rate of implants used in pairs to support a single molar crown over a long-term follow-up period and to compare the efficacy of this technique to other existing methods of treatment., Materials and Methods: The charts and radiographs of 105 patients who each received two implants to support a screw-retained single molar were examined according to the following criteria: age, gender, location of implant, time of loading (delayed versus immediate), opposing dentition, and the existence of adjacent implants., Results: Patients with follow-up between 3 and 12 years were selected to illustrate the long-term outcomes of the two-implant replacement procedure. Two hundred fifty implants were placed in 125 molar sites in 105 patients. Five of the 250 implants failed, resulting in a cumulative survival rate of 98.0%. Seven of 125 restorations experienced porcelain fracture (5.6%), seven prosthetic screws loosened (5.6%), and one abutment screw loosened (< 1.0%)., Discussion: The placement of two implants to support a screw-retained single molar successfully reduces rotational forces that create stress on the implant. A single regular-diameter or even a wide-diameter implant is susceptible to these forces, which may lead to fatigue over the long term., Conclusions: Two implants for the replacement of a single molar represent an effective method that provides a high survival rate over a long-term follow-up period. This approach produced a cumulative survival rate higher than that usually seen in studies of single implants used for molar replacement. The two implant-supported molar crown showed fewer complications than single implant-supported molar crowns.

Purpose: The purpose of this prospective study was to evaluate the viability of immediately provisionalized single-tooth implants., Materials and Methods: One hundred forty patients (86 female, 54 male) with a mean age at implant placement of 45 years (range, 15-88 years) needing single-tooth replacement, were treated between July 1999 and December 2004. Single-tooth implants were placed and provisionalized the day of the surgery. All implants were manufactured by Nobel Biocare (Yorba Linda, CA) and had multiple diameters and configurations. The majority of the implants used in this study had oxidized titanium surfaces. The contours of the restorations were designed to mimic the original teeth and root forms. The morphology of the restorations provides support of the labial gingiva., Results: Over 5.5 years, 164 implants were placed and immediately provisionalized. Sixty-four implants were placed immediately post extraction. Seven implants failed, yielding an overall survival rate of 95.73%., Conclusion: The application of an immediate provisionalization protocol to a single implant can be successful if the proper precautions are taken in achieving passive occlusion., (© 2010 by The American College of Prosthodontists.)

This report describes a clinical approach to using the zygomatic and pterygomaxillary bones to provide additional anchorage for longer implants to support an immediately functional maxillary screw-retained provisional fixed prosthesis. The purpose is to report the problems of patients who have experienced the most severe form of maxillary alveolar resorption and to demonstrate a specific protocol which provides immediately loaded implants without bone grafting., ((c) 2010 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.)

Purpose: The aim of this study is to demonstrate the accuracy and clinical precision of a guided surgery protocol by using traditional Brånemark System abutments in conjunction with a prefabricated all-acrylic provisional prosthesis that is immediately installed after implant placement., Materials: All presurgical methods in this treatment follow the standard NobelGuide protocol with the exception of the laboratory phase. Once the master cast is retroengineered from the surgical template, traditional Brånemark System abutments were secured onto the implant replicas (master cast) and an all-acrylic provisional prosthesis was constructed at the abutment level. The typical abutments used with this protocol, adjustable Guided Abutments, were not used., Results: Twenty-three patients were treated in this pilot study. Via the surgical template, all implants were placed to the desired depth as planned in the virtual implant planning program. After the traditional Brånemark Abutments were installed, the provisional prosthesis was delivered and occlusion verified. The prosthesis fit was checked at abutment level clinically and radiographically., Conclusion: This report shows the extreme accuracy of this guided surgery protocol. If each step of this protocol is followed precisely, it is possible to deliver a prefabricated prosthesis built to traditional Brånemark System Abutments, which is extremely favorable for long-term patient and prosthesis management.

This article describes a new technique using 3-D computerized tomography and virtual implant planning with flapless guided surgery and placement of prefabricated, custom-milled zirconia implant abutments. After extraction of the mandibular right first and second molars and healing of the sockets, a removable prosthesis replacing these teeth was fabricated and scanned. Implant placement was planned via interactive imaging and CAD/CAM software and then placed with a CAD/CAM fabricated surgical guide, using a flapless surgical technique. Custom zirconia abutments were fabricated on an altered master cast, placed, and torqued to 35 Ncm at the time of implant surgery. Abutment positions, contours, and soft tissue marginal adaptation were in close agreement with those on the master cast. Acrylic resin provisional crowns were cemented into position and left in passive occlusion during healing. Computerized tomography and interactive planning software can be used to allow precise placement of implants and the fabrication and immediate insertion of custom-made final abutments, providing clinicians with a surgically and prosthetically efficient clinical technique.

This clinical report demonstrates the history of a patient with progressive periodontal deterioration and illustrates how prosthodontic treatment has evolved over time. In 1974, maxillary and mandibular telescopic porcelain-fused-to-gold fixed prostheses and a semi-precision maxillary distal-extension removable partial denture represented leading edge technology. Over time, a gradual deterioration in the patient's intraoral condition occurred secondary to chronic, inflammatory periodontal disease, failed appointments, and recurrent caries. Prosthodontic treatment was also evolving. The patient's teeth were extracted and ultimately replaced with two implant-supported fixed prostheses. This clinical report is one example of how patients continually benefit from continued research in biology and materials science.

Unlabelled: This report describes a protocol that uses computer technology and medical imaging to virtually place anterior and posterior dental implants and to construct a precise surgical template and prosthesis, which is connected at the time of implant placement. This procedure drastically reduces patient office time, surgical treatment time, and the degree of post-treatment recovery. Patients with an edentulous arch or a partially edentulous area had a denture with radiopaque markers constructed for computed tomography (CT) scans of the appropriate jaw. The CT images, having acquisition slices of 0.4 mm, are transposed in a three-dimensional image-based program for planning and strategic placement of dental implants. After virtual implant placement on the computer, the surgical treatment plan is sent to a manufacturing facility for construction of the surgical template. The manufactured surgical components and surgical template arrive on the clinical site. From the surgical template, the dental laboratory retro-engineers the master cast, articulates it with the opposing dentition based on a duplicate of the scanning denture, and creates the prosthesis. Using the surgical template, minimally invasive surgery is performed without a flap, and the prosthesis is delivered, achieving immediate functional loading to the implants. Minor occlusal adjustments are made. The total surgical treatment time required is typically between 30 and 60 minutes. Postoperative symptoms such as pain, swelling, and inflammation are dramatically reduced., Clinical Significance: Identification of the bone in relationship to the tooth position via three-dimensional CT prior to surgery allows the clinician to precisely place implants. Computer-aided design/computer-assisted manufacture technology using the three-dimensional images allows for fabrication of the surgical template. This is a significant advancement in implant dentistry and promotes interdisciplinary approaches to patient treatment. The implant surgeon and restorative dentist can agree upon implant locations and screw access locations prior to the surgical episode.

Functional and esthetic reconstruction of a patient with microgenia who sustained traumatic injury was successfully accomplished using Brånemark System osseointegrated implants (Nobel Biocare USA, Inc., Yorba Linda, CA) to support a permanent dental prosthesis following mechanical and biologic reconstruction of the anterior mandible and chin. A 25-year-old glycine chin implant previously used for facial esthetic enhancement had eroded the anterior cortical plate and migrated through the medullary bone, compressing the periosteum into the apex of the anterior tooth roots. Further destruction of the lingual cortex with risk of fracture was imminent. After removal of the chin implant, a cancellous bone graft was held in place with a titanium mesh frame. The prosthetic rehabilitation consisted of two phases of mandibular implant placement followed by the construction of a porcelain-fused-to-gold implant-supported fixed prosthesis, restoring the occlusal vertical dimension as well as appropriate lip support. Restoration of function was superior to the pretreatment condition.

Purpose: This study evaluated the stability of implants in 51 patients following a clinical protocol of immediate functional loading. The stability during the first 3 months following implant placement was assessed according to bone type, implant location, and patient gender., Materials and Methods: Twenty-two male and 29 female patients were treated with 344 Brånemark System implants placed in edentulous bone or extraction sites and put into functional loading using the Teeth in a Day protocol. Each implant was tested for primary stability with resonance frequency analysis (RFA) at the time of implant placement, and RFA was performed at examinations 30, 60, and 90 days following surgery., Results: The analysis was based on the 276 implants that were successfully measured using RFA at all postoperative intervals. The clinical implant survival rate was 98.5% for the total population. RFA showed a decrease in bone-implant stability in the first month after implant placement from 70.35 +/- 0.5 to 66.38 +/- 0.50, followed by increases in stability in the second and third months (68.01 +/- 0.50 and 68.82 +/- 0.49, respectively), suggesting a process of adaptive bone remodeling around the implant. In general, lower initial stabilities were seen in softer bone types, in the posterior portions of the jaw compared to anterior areas, and in the female population., Discussion and Conclusion: The results of this study suggest an immediate loading protocol should have an undisturbed period of healing for the first 2 months following implant placement. The determination of "predictor" stability levels for different clinical conditions were based on multiple splinted implants, allowing a larger surface area to withstand the distribution of the load. The most significant "predictor" values from a surgical and prosthodontic perspective are those determined in soft bone, in reduced bone, or in areas where lever arms are created as a result of long spans between the implants.

Background: Immediate loading of dental implants is increasingly gaining recognition as a viable option for both patient and clinician., Purpose: The aim of this study was to evaluate the results of 55 patients in a clinical investigation of immediate functional loading of Brånemark System implants (Nobel Biocare USA, Yorba Linda, CA) in edentulous maxillas. Its further purpose is to suggest a reliable and evidence-based protocol for immediate implant loading of full-arch prostheses in the maxilla., Materials and Methods: A total of 552 Brånemark System implants were placed in immediate extraction or healed sites; a mean number of 10 implants were placed per patient. The healthy subjects in need of full-arch maxillary implant reconstruction were treated between December 1999 and February 2004; 522 of the 552 implants were immediately loaded with screw-retained all-acrylic fixed prostheses at the time of surgery. Approximately 4 to 6 months later, the 30 submerged implants were uncovered, and a definitive metal-reinforced prosthesis was delivered to each patient., Results: The immediately loaded implant cumulative survival rate was 99.0% for these patients. The prosthesis survival rate was 100%., Conclusions: The results of this prospective study of full-arch maxillary immediate loading suggests that this protocol is suitable for most patients in need of full maxillary implant reconstruction. The protocol, as shown in this study, is highly successful in providing a lasting state of osseointegration as the foundation for long-term stability of screw-retained fixed prostheses.

The purpose of this report is to present a reliable surgical and prosthodontic protocol for immediate loading of implants, allowing patients to receive a fixed implant-supported prosthesis in a matter of hours. The surgical, prosthodontic, and laboratory steps for this protocol of immediate functionally loading the implants are described for the treatment of a 51-year-old woman who presented with a hopeless mandibular dentition and an edentulous maxillary arch. It is possible to decrease the treatment time in successfully restoring the patient's oral function by means of immediate functional loading of dental implants and immediately placing a fixed implant-supported prosthesis. Compared with the traditional implant protocols, this protocol of a one-visit approach for patient treatment 1) decreases the number of office visits; 2) decreases the treatment time; 3) reduces the patients' costs; 4) allows the patient to avoid wearing a removable interim prosthesis; and 5) increases the patients' acceptance of treatment while maintaining predictability in treating mandibular edentulism.