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BACKGROUND Short implants (up to 5-mm long) have shown good results when compared to longer implants placed in augmented bone. PURPOSE To evaluate if 4-mm ultrashort implants could also be an alternative to bone augmentation in the severely atrophic posterior jaws. The primary aim of the study was to compare implant survival rates between study groups. MATERIALS AND METHODS Eighty partially edentulous patients with posterior atrophic jaws (5-6 mm of bone above the mandibular canal and 4-5 mm below the maxillary sinus) were included: 40 patients in the maxilla and 40 in mandible. The patients were randomized to receive one to three 4-mm ultrashort implants or one to three implants at least 10-mm long in augmented bone. Results are reported 5 years after loading with the following outcome measures: implant and prosthetic failures, complications and peri-implant marginal bone level changes. RESULTS Thirty-two complications were reported for the control group in 18 patients versus 13 complications in 10 patients in the test group, the difference being not statistically significant (p = 0.103). In the augmented group, 12 implants failed in 6 patients versus 7 short implants in 6 cases, and 9 prostheses failed in the control group while 4 in the test one, without statistically significant differences (p = 1.000 and 0.363, respectively). At 5 years after loading, short implants lost on average 0.58 ± 0.40 mm of peri-implant marginal bone and long implants 0.99 ± 0.58 mm, the difference was statistically significant (p = 0.006). CONCLUSION Four-millimeter ultrashort implants showed similar if not better results when compared to longer implants placed in augmented jaws 5 years after loading. For this reason, their use could be in specific cases preferable to bone augmentation since the treatment is less invasive, faster, cheaper and associated with less morbidity. However, longer follow-ups and larger trials are needed.

The new trend of the last years is the research of minimally invasive approach for the implant-supported rehabilitations. The new three-dimensional technologies, like static and dynamic navigation, as well as the use of tilted and zygomatic implants, allow the surgeons to reduce bone grafting procedures. Zygomatic implants can be considered a reliable method to treat severe maxillary bone atrophy or defects due to resection for cancer. The aim of this study is to compare, in a cohort patients group, the outcomes of computer-assisted zygomatic implant rehabilitation in atrophic and oncologic patients.Since 2013, 16 patients were treated: 8 patients with a severe maxillary atrophy and 8 patients with a defect of the upper jaw due to resection for cancer. All of the patients carried out a three-dimensional virtual planning to choose the implant length and the surgeon used a dynamic navigation system for trying to reproduce it clinically. The mean follow-up period was 28 months ( 8 - 48 months). The patient age ranged from 45-87 years (mean 66 months). 58 zygomatic implants were placed. A screw-retained prosthesis was delivered for both groups. An immediate-loading of the implants was possible in 14 cases. Two oncologic patients received a delayed loading. Clinical and radiographic outcomes were evaluated, complications were recorded and the correspondence between the planned implant length and the postoperative one was also evaluated. All the patients filled the quality of life questionnaire before the surgery, after the prosthetic rehabilitation and during the follow-up period.The implant survival rate was 96.54 %. No surgical complications occurred in the short term. A correspondence between the planned implant length and the real one was found in most of the cases. Two implant's failures occurred in the first year, one implant for each group. A long-term biological complication occurred in two oncologic-patients (transient mucositis); Prosthetic complication occurred more often in atrophic patients than in oncologic ones ( 4 cases versus 1 case ); all the complications were easily solved. The OHIP14 score increased with 65% in terms of satisfaction.The zygomatic-implant rehabilitation seems to be a reliable technique in the atrophic maxillae as well as oncologic patients. The three-dimensional computer-aided approach could allow the surgeon to plan the surgery increasing the predictability of it. The early prosthesis-loading certainly allows gaining better functional outcomes. More clinical trials with a longer follow-up period are required to confirm definitely the reliability of this method.

Background : Dental rehabilitation with conventional prostheses after microvascular jaw reconstruction could result often unsuccessful because of the altered oral anatomy and the lack of adequate dentition for fixation. Although the efficacy and long-term safety of osseointegrated implants have been documented in atrophic patients, their outcomes in the oral cancer population remain unclear.Aim: to evaluate the long-term clinical outcomes and the survival and success rates of implants placed in patients who underwent mandibular or maxillary reconstruction with a fibula free flap; to investigate the relationship between implant prognosis and therapeutic variables.Materials and Methods: Between 1998 and 2015, 21 patients underwent maxillary or mandibular resections for benign or malignant oral tumors and simultaneous microvascular reconstructions with fibula free flaps. 20.8 (8u201338) months after the reconstructive surgery 108 dental implants were placed. Eighteen patients received a fixed prosthesis while three received an implant-supported overdenture. Clinical data as the probing pocket depth, the presence of suppuration and bleeding on probing and the occurrence of hyperplastic tissue formation were collected from medical records and implant bone loss was measured on radiographs to determine survival and success rates. The possible influence of radiation therapy, the reconstructive technique and the use of soft tissue grafts as prognostic factors were determined. To statistically analyze the results Kruskal-Wallis test and Fisher test were used. For the survival analysis, Kaplan-Meier curves and Log-rank test were employed.Results: The mean follow-up after implant insertion was 90.2 (20u2013204) months. The implant survival and success rate was respectively 97.2% and 95.4% at the 12-month follow-up, 86.5% and 73.5% at 60 months, and 79.3% and 64.7% at 120 months. Implant failure was more common in patients that had implants placed after they underwent radiation therapy (p = 0.001) versus those who did not. Peri-implant probing depth measures ranged from 2 mm to 9 mm (mean 3.8u00b12 mm). Peri-implant bone loss ranged from 0.5 mm to 8.1 mm (mean 2.2u00b11 mm) at the 10-year follow-up. Peri-implant bone loss values were higher in case of fibular distraction (p=0,04). Peri-implant hyperplasic tissue was identified in 20.3% of the surviving implants at the 10-year follow-up and its presence impacted the rate of peri-implant bone loss (p=0,001). Connective tissue and skin grafts positively influenced both survival and success of implants and reduced the risk of peri-implant hyperplastic tissue formation.Conclusion:The overall implant survival rate was acceptable. However, a relevant number of implants was identified as unsuccessful at a long-term follow-up. The use of soft tissue grafts can be considered a reliable procedure to significantly improve the long-term outcomes.

The new trend of the last years is the research of the minimally invasive approach for the implant-supported rehabilitations. The new three-dimensional technologies, like static and dynamic navigation, as well as the use of tilted and zygomatic implants, allow the surgeons to reduce bone grafting procedures. Zygomatic implants can be considered a reliable method to treat severe maxillary bone atrophy or defects due to resection for cancer. The aim of this study is to evaluate the survival and success of rehabilitation with zygomatic implants in atrophic and oncologic patients using 3D computer technologies.Since 2013, 20 patients were treated with zygomatic implants (Southern Implants, Irene, South Africa) u201311 with severely atrophic maxilla and 9 with maxillary defects for oncologic issues. All of the patients carried out 3D virtual planning to choose the implant length and the surgeon used a dynamic navigation system (Implanav) for trying to reproduce it clinically. A screw-retained prosthesis was delivered for both groups. Clinical and radiographic outcomes and correspondence between planned implant length and the postoperative one were evaluated. Complications were recorded. All the patients filled the quality of life questionnaire before the surgery, after the prosthetic rehabilitation and during the follow up period.The mean follow-up period was 31 months (10-60 months). The patient age ranged from 50 to 88 years (mean 64 months). 74 zygomatic implants were placed. The implant survival rate was 97.3%. The prosthetic survival rate was 100%. An immediate-loading of the implants was possible in 18 cases. Two oncologic patients received a delayed loading. A correspondence of 74.8% between the planned and real implant length was found. Two implantu2019s failures occurred in the first year, one implant for each group. Biological complications (transient mucositis) occurred more often in oncologic patients while prosthetic complications were more frequent in atrophic patients. All the complications were easily solved. The OHIP14 score increased with 65% in terms of satisfaction.Rehabilitation with zygomatic-implants seems to be a reliable technique in atrophic and oncologic patients. The three-dimensional computer-aided approach could help the surgeon in the surgical planning increasing the surgical and prosthetic outcomes. The early prosthesis-loading certainly allows a better functional outcomes. However, clinical trials with longer follow-up are necessary to definitively assure the reliability of this technique.

Background Dental rehabilitation with conventional prostheses after microvascular jaw reconstruction is often unsuccessful because of the altered oral anatomy and the lack of adequate dentition for fixation. Purpose This retrospective study evaluated the long-term outcomes of patients who underwent jaws reconstruction with a fibula free flap and subsequent rehabilitation with implant-supported prostheses. Materials and methods In total, 21 patients were enrolled; 108 osseointegrated dental implants, positioned on 21 fibular free flaps were assessed. Follow-up examinations were performed according to a standardized protocol, including clinical and radiological evaluations. The mean follow-up after implant insertion was 90.2 (range, 20-204) months. Results The overall implant survival rate was 97.2% at the 12-month follow-up, 86.5% at 60 months, and 79.3% at 120 months. The rate of overall implant success was 95.4% at the 12-month follow-up, 73.5% at 60 months, and 64.7% at 120 months. Implant failure was more common in patients that had implants placed after they underwent radiation therapy. Peri-implantitis and mucositis were identified in 14.8% and 20.3% of surviving implants, respectively, at the 5- and 10-year follow-up. The risk of developing peri-implantitis was estimated to be higher (odds ratio = 1.5) for patients without connective tissue or skin grafts versus patients with one of them (18.2% vs 9.5%). Conclusions Long-term implant-related outcomes show that the survival rate of implants placed into the fibula is acceptable. Radiotherapy negatively impacts survival and success, in particular in the short and medium-term follow-up. Moreover, a relevant peri-implant bone resorption does occur over time and ultimately influences implants success, and it is mainly related to peri-implant gingival mucositis. In this regard skin or connective tissue grafts seem to offer an aid to manage this problem.

The aim of this study was to evaluate the survival and clinical success rate, complications, and patients&rsquo, quality of life after computer-aided rehabilitation supported by zygomatic implants in cases of severe maxillary atrophy (ten patients) and in bone defects in oncologic patients (ten patients). All patients underwent computer-aided planning and surgery. Seventy-three zygomatic implants were placed. The mean follow-up period was 39.9 months. Implant survival and clinical success rate, the effectiveness of planning the implant length, biological and prosthetic complications, and the quality of life were evaluated. The five-year implant survival rate for patients with maxillary atrophy and oncologic patients was 97.4% and 96.7%, respectively. The prosthetic survival rate was 100%. Two implant failures occurred in the first year. One implant failure was observed in each group. Minor biological and prosthetic complications occurred in both groups without significant differences. All complications were managed without affecting the treatment. The quality of life increased by 71.3% in the atrophic group and by 82.9% in the oncologic group. Zygomatic implant rehabilitation seems to be a reliable technique for patients with maxillary atrophy and for oncologic patients. The three-dimensional computer-aided approach allows the surgeon to plan the surgery and increase its predictability. Early prosthesis loading certainly allows for better functional outcomes.