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Limited information is available on the association between prosthesis-associated risk factors and biologic complications for patients with implant fixed complete dental prostheses (IFCDPs).The purpose of this retrospective study was to assess the implant survival and biologic complications of IFCDPs up to 5 years of follow-up.Patients who had received IFCDPs between August 1, 2009 and August 1, 2014 were identified through an electronic health record review. Those who consented to participate in the study attended a single-visit study appointment. Clinical and radiographic examinations, intraoral photographs, and peri-implant hard and soft tissues parameters were assessed. Only prostheses which could be removed during the study visit were included. Associations between biologic complications and prosthetic factors, such as time with prosthesis in place, prosthesis material, number of implants, cantilever length, and type of prosthesis retention, were assessed.A total of 37 participants (mean ±standard deviation age 62.35 ±10.39 years) with 43 IFCDPs were included. None of the implants had failed, leading to an implant survival of 100% at 5.1 ±2.21 years. Ten of the prostheses were metal-ceramic (Group MC) and 33 were metal-acrylic resin (Group MR). Minor complications were more frequent than major ones. Considering minor complications, peri-implant mucositis was found in 53% of the implant sites, more often in the maxilla (P=.001). The most common major biologic complication was peri-implantitis, which affected 4.0% of the implants, more often in the mandible (P=.025). Peri-implant soft tissue hypertrophy was present 2.79 times more often (95% CI: 1.35 - 5.76, P.003) around implants supporting metal-acrylic resin prostheses than metal-ceramic ones, with the former type also showing significantly more plaque accumulation (P.003).Biologic complications such as soft tissue hypertrophy and plaque accumulation were more often associated with metal-acrylic resin prostheses. Peri-implant mucositis occurred more often under maxillary IFCDPs, while peri-implantitis appeared more common around mandibular implants.

To determine the survival rate, incidence of prosthetic complications, and patient satisfaction of implant fixed complete dental prostheses (IFCDPs) after a mean observation period of 1.4 years.Twenty-eight (28) eligible participants were recruited according to specific inclusion and exclusion criteria. The definitive metal-acrylic resin IFCDPs consisted of titanium bars veneered with acrylic resin and acrylic denture teeth. Prosthodontic complications, divided into major and minor, were monitored. Parameters such as gender, jaw location, bruxism, and occlusal scheme were evaluated. Moreover, a questionnaire was administered throughout the study to assess patient satisfaction. Poisson regression as well as repeated measures ANOVA were used for statistical analysis.Fourteen (14) males and 14 females were enrolled and followed-up at 3, 6, and 12 months. All IFCDPs survived (100% survival rate). The most frequent minor complication was the loss of material used to close the screw access hole (20% out of total complications). The most frequent major complication was chipping of the acrylic denture teeth (77.14% out of total complications). Gender (p = 0.008) and bruxism (p = 0.030) were significant predictors for the total major complications (major wear and major chipping) while occlusal scheme was a significant predictor for major chipping events (p = 0.030).While IFCDPs demonstrated high prosthetic survival rates, they also exhibited a high number of chipping events of the acrylic veneering material, especially in males, bruxers, and individuals with canine guidance occlusion. However, the occurrence of these prosthetic complications did not negatively affect patient satisfaction.

To compare in vitro the accuracy of fit of a reference prosthesis seated on three-dimensional (3D) printed casts generated from digital implant scans vs stone casts made by conventional implant impressions.A partially edentulous maxillary master cast with two internal connection implants was generated, while a reference implant-supported prosthesis was fabricated. Conventional splinted open-tray impressions were taken to create stone casts (n = 10) (control group). A digital scan was taken of the master cast using a white light intraoral optical scanner (IOS) (TRIOS, 3Shape), and a Standard Tessellation Language (STL) file was obtained. Four 3D printers were used to print the casts (n = 10 from each 3D printer): Straumann® P30+, Varseo S, Form 3b+and M2 Carbon. Accuracy of fit of the reference prosthesis on all control and test casts was assessed using the screw resistance test and radiographic test. Additionally, all casts were digitized using the same IOS, and the STL files were superimposed to the master cast STL file (reference) to evaluate the 3D accuracy with inspection Geomagic Control software using the root-mean-square (RMS) error.The reference prosthesis presented with clinically acceptable fit on all casts. The highest median RMS error was found in the stone cast group (94.6 μm) while the lowest median was in the M2 Carbon group (46.9 μm). The Kruskal-Wallis test revealed a statistically significant difference between the groups (p 0.001). For post hoc comparisons, Dunn's test with the Holm-Bonferroni correction resulted in a statistically significant difference in four tests, with M2 Carbon exhibiting lower RMS error than the stone cast (p 0.001) and P30+ (p 0.001) groups, Form 3b exhibiting lower RMS error than the stone cast (p 0.001) group, and Varseo S exhibiting lower RMS error than the stone cast (p = 0.006) group.Using the screw-resistance test and radiographic assessment, the reference prosthesis fit presented with clinically acceptable accuracy of fit on all casts. Printed casts from 3 different printers demonstrated statistically significant lower 3D deviations than stone casts generated using a conventional implant impression for the present partially edentulous scenario with two implants, but this did not affect prosthesis fit.Even though there were 3D deviations between the master cast and all control and test casts generated from conventional impressions and digital scans respectively, the reference prosthesis presented with accurate fit on all casts. This indicates that there is a threshold for clinically acceptable accuracy of fit and that 3D-printed casts may be used as definitive master casts to fabricate implant-supported fixed dental prostheses for the partially edentulous anterior maxilla.

There is a paucity of comparative clinical studies assessing the accuracy of full-arch digital scans versus conventional implant impressions. The aim of this retrospective study was to compare the three-dimensional (3D) deviations between full-arch digital scans and conventional implant impressions for edentulous maxillae and mandibles.Twenty-seven patients (36 edentulous jaws) were treated with one-piece, screw-retained implant-supported fixed complete dental prostheses (IFCDPs). Twenty-one jaws were maxillary, and 15 were mandibular. Full-arch conventional impressions and intraoral digital scans with scan bodies and an intraoral scanner had been taken during the impression phase. Following verification of the conventional stone casts, the casts were digitized. The generated standard tessellation language (STL) files from both impression techniques were merged and analyzed with reverse engineering software. The primary aim was to evaluate the accuracy between conventional and digital full-arch scans, while the effect of the edentulous jaw in 3D accuracy was the secondary aim.The cumulative 3D (mean ± SD) deviations between virtual casts from intraoral full-arch digital scans and digitized stone casts generated from conventional implant impressions were found to be 88 ±24 μm. In the maxillary group, the mean ± SD 3D deviation was 85 ±25 μm, compared to 92 ±23 μm for the mandibular group (p = 0.444).The 3D implant deviations found between the full-arch digital and conventional impressions lie within the clinically acceptable threshold. No statistically significant difference was identified between maxillary and mandibular jaws in terms of 3D deviations.

To assess the accuracy of a complete digital workflow protocol for fabrication of printed prosthesis prototypes for maxillary immediate loading treatment.A maxillary stone cast with 4 abutment-level implant analogs with adequate antero-posterior spread was fabricated. This stone cast served as a reference cast and a zirconia prosthesis was also fabricated to serve as an interim prosthesis. Double digital scanning was used for digital scans of the reference cast and the interim prosthesis, respectively. An intraoral scanner (TRIOSOut of the 90 digitally fabricated prototypes, 86 (95.6%) presented with accurate fit. The accuracy of fit ranged from 87% (26/30) for Sprintray Pro95 to 100% (30/30) for the Form 3b+ and M2 Carbon groups .Digitally fabricated prosthesis prototypes can be generated with a complete digital workflow leading to clinically acceptable fit, while reducing the number of appointments and treatment time. The 3D printer had an effect on the accuracy of prosthesis prototype fit.

AIM The aim of this retrospective clinical study was to compare the accuracy of static Computer-assisted implant surgery (sCAIS) in posterior single edentulous patients using different surgical guide designs. MATERIALS AND METHODS Thirty-seven partially edentulous patients with a total of 54 implants were included in the study. Seventeen implants were included in Group 1-Unbounded Tooth-Mucosa Supported; 18 implants in Group 2-Unbounded Tooth Supported; and 19 implants in Group 3 (Control)-Bounded Tooth Supported. All partially edentulous patients were treated with fully guided implant surgery using the corresponding surgical guide. Discrepancies between the pre-planned and post-operative implant position were evaluated. RESULTS The mean angular deviation ± standard deviation (SD) was 2.91 ± 1.56°, 3.33 ± 1.72° and 2.25 ± 1.13° for Groups 1, 2, and 3, respectively. The mean ± SD 3D offset at base was 0.66 ± 0.29 mm, 0.77 ± 0.24 mm, and 0.49 ± 0.22 mm; and 3D offset at tip was 0.84 ± 0.45 mm, 1.07 ± 0.38 mm, and 0.75 ± 0.25 mm for Groups 1, 2, and 3, respectively. No statistically significant differences between groups were found for angular deviation. There were statistically significant differences between Groups 2 and 3 for 3D offset at base (p = .002) and 3D offset at tip (p = .010). CONCLUSIONS Different surgical guide designs for posterior single edentulous areas appear to be associated with the accuracy level of sCAIS. In unbounded sites, having additional posterior attached soft tissue support is preferable.

To assess the accuracy of fit of complete-arch printed prosthesis prototypes generated with a digital workflow protocol for completely edentulous jaws.Forty-five edentulous jaws (35 patients) underwent intraoral complete-arch digital scans with the double digital scanning (DDS) technique and the generated standard tessellation language (STL) files were superimposed and imported into computer-aided design (CAD) software. After STL merging, each master STL file was used for printing a prosthesis prototype. The primary outcome was the accuracy of fit assessment of the printed prototypes on verified master stone casts. Two experienced clinicians tested the accuracy of fit with radiographs and screw-resistance test. Secondary outcomes were the effect of the scan body shape and implant number on the accuracy of fit.Out of the 45 DDS-generated prosthesis prototypes, 39 presented with accurate fit on verified master stone casts, yielding an 86.70% accuracy of fit. Cylindrical scan bodies led to 100% accuracy of fit (25/25), whereas polygonal scan bodies presented with 70% accuracy of fit (14/20). Four implant-supported prostheses yielded 100% accuracy of fit (12/12), compared with 25/29 (86.30%) accuracy of fit for the 6-implant-supported ones. Fisher's exact test was used to assess the effect of different scan body shape (P = 0.005) and implant number on accuracy of fit. Chi-squared test was used to assess the association between the number of implants per arch and accuracy of fit (P = 0.039).Thirty-nine out of 45 complete-arch prosthesis prototypes generated with a completely digital workflow presented with clinically acceptable fit. The effect of the scan body design and implant number was statistically significant, favoring cylindrical scan bodies and 4-implant-supported prostheses. This article is protected by copyright. All rights reserved.

Purpose To conduct an in vitro comparison of the amount of three-dimensional (3D) deviation of 3D printed casts generated from digital implant impressions with an intraoral scanner (IOS) to stone casts made of conventional impressions. Material and methods A maxillary master cast with partially edentulous anterior area was fabricated with two internal connection implants (Regular CrossFit, Straumann). Stone casts (n = 10) that served as a control were fabricated with the splinted open-tray impression technique. Twenty digital impressions were made using a white light IOS (TRIOS, 3shape) and the Standard Tesselation Language (STL) files obtained were saved. Based on the STL files, a digital light processing (DLP) and a stereolithographic (SLA) 3D printer (Varseo S and Form 2) were used to print casts (n = 10 from each 3D printer). The master cast and all casts generated from each group were digitized using the same IOS. The STL files obtained were superimposed on the master cast STL file (reference) to evaluate the amount of 3D deviation with inspection software using the root mean square value (RMS). The independent-samples Kruskal-Wallis test and Dunn's test with Bonferroni correction (for post hoc comparisons) were used for statistical analyses. Results The Varseo S group had the lowest median RMS value [77.5 µm (IQR = 91.4-135.4)], followed closely by the Conventional group [77.7 µm (IQR = 61.5-93.4)]. The Form 2 had the highest mean value [98.8 µm (IQR = 57.6-87.9)]. The independent-samples Kruskal-Wallis test revealed a significant difference between the groups (p = 0.018). Post hoc testing revealed a significant difference between Varseo S and Form 2 (p = 0.009). Conclusion The casts generated from the Varseo S 3D printer had better 3D accuracy than did those from the Form 2 3D printer. Both the Varseo S group and the conventional stone casts groups had similar 3D accuracy.

Statement of problem Implant fixed complete dental prostheses (IFCDPs) are widely used in the rehabilitation of completely edentulous patients, yet limited information is available on the relationship between prosthetic complications and patient-associated and prosthesis-associated risk factors. Purpose The purpose of this retrospective study was to assess the prosthetic complication and survival rates of IFCDPs after a mean observational period of 3.5 years. Material and methods Eligible participants were identified by an electronic health record review. The study consisted of a review of the dental record and a single-visit study appointment when a comprehensive examination was performed, including a review of the medical and dental history, clinical and radiographic examination, intraoral photographs, patient satisfaction questionnaire, and occlusal analysis. Prosthodontic parameters and risk factors were assessed, including time with the prosthesis in place, bruxism, occlusal device use, prosthesis material, number of implants, cantilever length, and mode of prosthesis retention. Association between these prosthodontic parameters and risk factors and the observed prosthetic complications was assessed. Results A total of 37 participants (mean age 62.35 ±10.39 years) with 48 IFCDPs were included. Thirty-eight prostheses were metal-acrylic resin (MR group), whereas 10 were metal-ceramic (MC group). Five of the 48 prostheses failed during the follow-up period, a cumulative prosthesis survival rate of 88%. Minor complications were more frequent than major complications. The most frequent minor complication was loss of screw access hole material (5.18%/year), whereas the most frequently observed major complication was major wear of the prosthetic material (5.85%/year). A significant association was found between not wearing an occlusal device and minor chipping, loss of access hole material, and framework fracture. Minor chipping was significantly associated with bruxism, whereas the opposing dentition significantly affected the total number of prosthetic complications. Conclusions High survival rates were observed with both MR and MC IFCDPs. No significant difference was found between MR and MC groups in terms of patient satisfaction, as well as total number of prosthetic complications.

Purpose To assess the accuracy of template-guided implant surgery for edentulous arches. Materials and methods The stone master casts of 25 edentulous arches treated with either 4 or 6 implants with CBCT generated template-guided surgery were included in this observational cohort study. The stone casts generated from the surgical templates (group one) prior to implant placement were digitized into Standard Tesselation (STL) files with a reference scanner. For comparison, the stone master casts derived from intraoral complete-arch impressions after implant placement (group two) were also digitized. The resultant STL files were superimposed and best-fit-alignment algorithm was used to quantify the 3D deviations present between the two groups. Descriptive statistics were computed for all categorical variables. Due to the presence of nonindependent samples between maxillary and mandibular casts, a mixed-effects model was used. Results Deviations between the implant analogs of the stone casts representing digitally planned versus actually placed implants were found. The mean root-mean-square error (RMSE) between all 25 arches was found to be 0.2 mm (SD ± 0.15). The mean RMSE between presurgical and postsurgical maxillary stone casts were 0.19 ± 0.15 mm, while between mandibular stone casts were 0.21 ± 0.16 mm and were not significant (p = 0.67). The mean RMSE between presurgical and postsurgical stone casts arches with 4 versus 6 implants were found to be significant (p = 0.01). Conclusions According to the results of the study and based on the amount of 3D deviations between the digitally planned implant positions and the actually placed implants, template-guided surgery is a safe treatment modality for implant placement in edentulous arches.

Purpose To systematically review in vitro and clinical studies comparing quantitatively the 3D accuracy (global implant deviations) of digital vs conventional implant impressions for partially and completely edentulous patients. Materials and methods Electronic and manual searches were conducted to identify in vitro and clinical studies, reporting on the 3D accuracy between digital and conventional implant impressions. Secondary outcomes were the effect of implant angulation, type of conventional impression technique, and type of intraoral scanner on the accuracy of implant impressions. Results The inclusion criteria were met by 9 in vitro studies and 1 clinical study reporting on completely edentulous impressions, while 6 in vitro and 2 clinical studies reported on partially edentulous impressions. Quantitative meta-analysis was performed for 5 completely edentulous and 6 partially edentulous studies. The studies exhibited high values for heterogeneity. A random effects model was conducted to estimate the effect size. Based on 5 in vitro studies on completely edentulous impressions, the mean 3D implant deviation between conventional and digital impressions was 8.20 µm (95% CI: -53.56, 37.15) and the digital impressions had nominally less deviation (p = 0.72). Based on 1 clinical and 5 in vitro studies on partially edentulous impressions, the mean 3D implant deviation between conventional and digital impressions was 52.31 µm (95% CI: 6.30, 98.33) and the conventional impressions had nominally less deviation (p = 0.03). Five in vitro and 2 clinical studies were not included in the quantitative analysis due to heterogeneity in the methodology. Implant angulation affected the accuracy in favor of the partially edentulous conventional impressions whereas the effect of different scanners was not statistically significant on the completely edentulous impressions (p = 0.82). Conclusions Digital scans appear to have comparable 3D accuracy with conventional implant impressions based mainly on in vitro studies. However, clinical trials are recommended to investigate the clinical accuracy of digital scans and digitally fabricated interim or prototype prostheses, before digital implant scans can be recommended for routine clinical use.

Purpose This is a single center, retrospective study to assess the prevalence of peri-implant disease and biologic complications in a cohort of partially edentulous subjects in relation to selected prosthetic factors. Materials and methods Subjects previously treated with one or more implant-supported fixed dental prosthesis (ISFDPs) were recalled for a comprehensive examination. Clinical and radiographic records were taken and questionnaires were administered. The prevalence of implant failure, peri-implant disease and other biologic complications were correlated with selected prosthetic, clinical and patient-related factors using chi-square and multiple regression analyses. Results A convenience sample of 71 subjects with 100 prostheses supported by 222 dental implants were enrolled in the study. The mean follow-up time after prosthesis delivery was 3.3 ± 1.5 years (range of 1-9 years). The cumulative implant survival rate was 99.1%. Peri-implantitis was the most frequent major biologic complication (5% of implants), while the most frequent minor biologic complication was peri-implant mucositis (84.10% of implants). A diagnosis of peri-implant mucositis was more likely associated with cement-retained prostheses compared to screw-retained prostheses (OR 6.8, 95% CI 1.1-78.6, p = 0.045) and for short-span prostheses (≤3 prosthetic units) (OR 2.3, 95% CI 1.1-5.0, p = 0.034). Subject-reported quality of life measures were high regardless of the existence of major and/or minor complications, but decreased with increasing number of minor and total biologic complications. Conclusions Peri-implant mucositis and other minor biologic complications were highly prevalent. The distribution of the observed complications differed based on the method of prosthesis retention and the number of prosthetic units replaced.

The purpose of the present report is to illustrate a proof-of-concept protocol with the double digital scanning (DDS) technique for complete digital workflow in double full-arch implant rehabilitation. Two patients (4 restored arches) presented with hopeless dentitions and they were treated with a 4-appointment prosthodontic protocol and monolithic zirconia prostheses implementing a complete digital workflow. The outcomes are presented after clinical and radiographic observation for 2 years.

For patients with existing implants in need of additional implant placement, the use of the existing implants for guide fixation seems to be a logical alternative. Current options for the fabrication of surgical guides involve creating surgical guides that are mucosa-borne and/or retained by fixation pins. Since these existing techniques involve inherent inaccuracies, the fabrication of surgical guides that are screw-retained at the implant- or abutment-level would eliminate the introduction of those same fundamental inaccuracies. The purpose of the present technical report is to illustrate a step-by-step digitally planned guided implant placement protocol for terminal dentition patients with salvageable existing implants requiring full-arch implant rehabilitation. The advantages of this protocol include enhancing the accuracy of guided implant placement with screw-retention versus the traditional mucosa- or fixation pin support. Thus, this simplifies the transition from failing teeth to implants by ensuring that fixed provisionalization serves both functional and esthetic requirements. This protocol can also predictably reduce chairside time and adjustments at the surgical implant placement appointment.

The aims of this study were to evaluate the effect of (1) the different surgical guide designs and (2) implant placement location on the accuracy of fully guided implant placement in single edentulous sites using an in vitro study model. Forty-five partially edentulous models were scanned and divided into 3 groups: group 1, tooth-supported full-arch surgical guide; group 2, 3 different tooth-supported shortened surgical guides (SSGs); and group 3, tooth-supported full-arch surgical guide with a crossbar. All surgical guides were printed and used for fully guided implant placement. A total of 180 implants (60 per group) were placed, and scan bodies were positioned on all models, and postoperative surface scan files (STL) files were obtained. Superimposition of preoperative and postoperative STL files was performed, and the accuracy of implant position was evaluated. The interaction between group and implant location was statistically significant for angle, 3D offset at the base, and at the tip (P < .001). The post-hoc tests showed a statistically significantly higher deviation for group 2 compared to group 3 for all outcomes for implants #4 (P < .05) and #7 (P < .05). There was also a statistically significant difference in all outcomes between groups 1 and 3 for implant #7 (P < .05). All surgical guide designs presented satisfactory performance with clinically acceptable levels of deviation. However, SSGs presented higher accuracy for guided implant placement in a single-edentulous site, whereas a full-arch surgical guide with a crossbar presented superior outcomes when 2 or more guided implants were placed simultaneously.

Treatment planning for the transition of patients from terminal dentition to full-arch implant rehabilitation poses challenges. Such challenges pertain to achieving the new orientation of the occlusal and esthetic plane as well as the change of vertical dimension of occlusion (VDO), while the fixed provisionalization using a digital workflow still tends to be considered complex and hard to perform. This article illustrates step-by-step the utilization of a digital workflow protocol in the treatment planning for rehabilitation of terminal dentition patients, simplifying the smile design and ensuring that fixed provisionalization serves both functional and esthetic requirements. This protocol includes facially driven, three-dimensional (3D) digital smile design and chairside mock-up restoration workflows that enable prosthetically driven assessment prior to implant treatment planning and 3D printing of surgical templates and prefabricated interim prostheses, which can predictably reduce chairside time and adjustments at the surgical and fixed provisionalization appointment.

The purpose of this clinical report is to present a complete digital workflow for the fabrication of complete arch fixed zirconia implant restorations. An intraoral scanner was used to capture the implants' position at the abutment level and also the patient's existing interim prostheses with the double digital scanning technique. A novel scan body and impression pin were utilized throughout the scanning process which allowed for the accurate and reproducible superimposition of the generated Standard Tesselation Language (STL) files. Prosthesis prototypes were digitally designed and fabricated, tried in, and verified intraorally. The definitive zirconia prostheses were then fabricated and delivered to the patient. This technique can be utilized in both arches overcoming the absence of stable intraoral landmarks for superimposition of STL files.

The objective of the present report is to illustrate a proof-of-concept protocol for CAD/CAM fabrication of milled verification jigs during full-arch implant rehabilitation using photogrammetry for data acquisition. The present report aims to bridge the gap between analog and digital workflows by introducing a CAD/CAM technique to intraorally verify digitally acquired information without the use of the technique-sensitive and labor-intensive conventional resin verification jig. One patient was treated with a digital prosthodontic protocol where a digitally designed CAD/CAM milled verification jig (generated from intraoral digital scans) was used to confirm implant 3D positioning prior to the fabrication of double full-arch monolithic definitive zirconia prostheses. The procedures are presented step-by-step after clinical and radiographic observation.

During complete-arch digital implant scanning, one of the most technique-sensitive steps is the data registration and superimposition or matching of different surface geometry data sets because of the absence of fixed landmarks. This article describes a straightforward technique for facilitating the accurate superimposition or matching of surface scan files from digital scans for the fabrication of the prosthesis prototype with a complete digital workflow.

Purpose To retrospectively assess complications and clinical and radiographic outcomes of edentulous patients treated with double full-arch implant-supported fixed complete dental prostheses (IFCDPs) after a mean observation period of 5.1 years. Materials and methods The single-visit clinical and radiographic examination included medical and dental history review and clinical assessment of biologic and technical complications encountered with all implants and IFCDPs. Life table analysis and Kaplan-Meier survival curves were calculated. Analysis was conducted to evaluate the association between prosthesis survival and several risk factors such as type of opposing occlusion, nightguard use, and presence of bruxism. Results Nineteen edentulous patients restored with 38 IFCDPs were included. A total of 249 implants were placed and 2 implants failed after a mean observation period of 5.1 years (range: 1-12 years), yielding an overall implant survival rate of 99.2% and prosthesis survival rate of 92.1%. Three out of 38 IFCDPs were lost, 1 after implant losses and 2 due to technical complications. The most frequent minor biologic complication was soft tissue recession with an estimated 5-year rate of 45.5% (95% CI: 39.4-57.5), while the most frequent major complication was peri-implantitis with an estimated 5-year implant-based rate of 9.5% (95% CI: 6.7-11.3). The most frequent minor technical complication was wear of the prosthetic material with an estimated 5-year rate of 49.0% (95% CI: 37.4-76.4), while the most frequent major technical complication was fracture of the prosthetic material with an estimated 5-year dental unit-based rate of 8.0% (95% CI: 6.6-10.1). Conclusions After a mean use time of 5.1 years, high implant and prosthesis survival rates were observed. The most frequent major biologic complication was peri-implantitis, and the most frequent major technical complication was fracture of the prosthetic material. The 5-year estimated cumulative rates for "prosthesis free of biologic complications" was 50.7% (95% CI: 33.7-65.4) and for "prosthesis free of technical complications" was 57.1% (95% CI: 39.3-71.5).

The aim of this clinical report is to describe a complete digital workflow protocol for mandibular full-arch implant rehabilitation from guided surgery to definitive prosthesis in only 3 appointments. This expedited protocol allows for guided implant placement with a system of stackable surgical templates and CAD/CAM prosthodontic rehabilitation using a digital workflow. At the first appointment, a guided implant placement protocol with the stackable template concept was done followed by immediate loading with a prefabricated interim prosthesis. At the same appointment, the Double Digital Scanning (DDS) technique was used for scanning, maxillomandibular relationship registration and virtual articulation. The anchor pins from guided surgery were used as fiducial markers for DDS data superimposition. At the second appointment, the prosthesis prototype was tried-in and adjustments were made. At the third appointment, the definitive monolithic zirconia full-arch prosthesis was delivered.

This article describes the case of a partially edentulous patient who had undergone template-guided implant placement and was treated using a triple digital scanning protocol that allowed for CAD/CAM prosthodontic rehabilitation in a complete digital workflow. At the impression appointment, the provisional implant-supported screw-retained prosthesis was digitally scanned both intraorally (first scan) and, after removal, extraorally (second scan). After the second scan, scan bodies were placed intraorally and an implant-level digital impression was taken (third scan). The three standard tessellation language (STL) files derived from the three digital scans were imported in a CAD software and superimposed into one file that contained all of the information from the implant 3D position, prosthesis contours, and transmucosal part of the peri-implant soft tissues. The superimposition of the three STL files led to one master file to serve as a blueprint for the definitive prosthesis. The definitive monolithic zirconia prosthesis was CAM copy-milled, externally stained, and inserted. The patient was satisfied with both the esthetic and functional outcome and the minimally invasive, time-efficient, two-visit restorative protocol. In summary, this case report illustrates a technique for a complete digital workflow in an implant rehabilitation for the replacement of multiple missing teeth in the esthetic zone in two visits.

Aim To systematically review buccal bone thickness (BBT) in the anterior maxilla in different teeth, age groups and genders. Materials and methods PubMed, EMBASE and Cochrane databases were searched up to April 2020. Clinical and radiographic studies reporting on BBT of maxillary anterior teeth, with at least 10 patients, were included. A meta-analysis was performed using random effect models to report differences of BBT. Results 50 studies were included. Using bone crest (BC) as a reference point, no significant differences were found in BBT between different tooth types, except for 0.16 mm (95%-CI: 0.02-0.30) increased mid-root thickness of premolars compared to canines. Using the CEJ as a reference point, canines presented with a significantly increased thickness of 0.32 mm (95%-CI: 0.11-0.54) coronally compared to laterals. When BC was used as reference, males demonstrated a significantly increased thickness of 0.21 mm (95%-CI: 0.15-0.27) apically, while middle-aged adults showed a 0.06 mm (95%-CI: -0.12, -0.01) statistically significant increase in the coronal level compared to older adults. Conclusions Few maxillary anterior teeth have BBT greater than 1 mm. Buccal bone tends to get thicker from a coronal to apical position along the root surface and from an anterior to posterior position in the arch.

Purpose To determine the prevalence and distribution of prosthetic complications affecting implant-supported fixed dental prostheses (ISFDPs). Materials and methods Subjects previously treated with one or more ISFDP(s) were identified from an electronic health record search and recalled for comprehensive clinical examination. Past prosthesis failures and complications were identified from the patient records while any existing complications, not previously recorded, were assessed during examination. ISFDP survival and failure rates were calculated with Kaplan-Meier curves and life table analysis, while regression Poisson analysis was used to identify associations between outcomes and possible patient- and prosthesis-based risk factors. Results Seventy-four subjects with 107 ISFDPs were enrolled in the study with a mean time between prosthesis delivery and exam of 3.14 years (range: 1.00-9.00 years). Four prostheses failed, resulting in a cumulative prosthesis survival rate of 96.26%. Prosthetic complications affected 48.59% of ISFDPs, the majority (94.87%) of them minor complications. Only the use of a nightguard was associated with a lower prevalence of prosthetic screw loosening (HR 0.11, 95% CI 0.02-0.59, p = 0.007) while no outcome differences were noted for other variables. Patient satisfaction was high regardless of presence or number of complications. Conclusions ISFDPs demonstrated a high survival rate and overall high, patient-reported satisfaction. Minor prosthetic complications were common but were only significantly associated with nightguard use.

Purpose A prospective clinical study to compare for the first time the accuracy of digital and conventional maxillary implant impressions for completely edentulous patients. Materials and methods Sixteen patients received maxillary implant supported fixed complete dentures. After the verification of the conventional final casts, the casts were scanned with a desktop (extraoral) scanner. Intraoral full-arch digital scans were also obtained with scan bodies and STL files. Extraoral and intraoral scans were superimposed and analyzed with reverse engineering software. The primary outcome measure was the assessment of accuracy between scans of the verified conventional casts and digital full-arch impressions. The secondary outcome was the effect of the implant number on the 3D accuracy of impressions with Spearman's rank correlation coefficient. Results The 3D deviations between virtual casts from intraoral full-arch digital scans and digitized final stone casts generated from conventional implant impressions were found to be 162 ± 77 μm. In the 4-implant group, 5-implant group, and 6-implant group the 3D deviations were found to be 139 ± 56 μm, 146 ± 90 μm, and 185 ± 81 μm, respectively. There was a positive correlation between increased implant number and 3D-deviations, but there was no statistically significant difference (p = 0.191). Conclusions The 3D accuracy of full-arch digital implant scans lies within previously reported clinically acceptable threshold. Full-arch digital scans and a complete digital workflow in the fabrication of maxillary fixed complete dentures may be clinically feasible.

A clinical and laboratory workflow for fabricating and retrofitting a monolithic ceramic crown to an existing removable partial denture (RPD) is described. A conventional polyvinyl siloxane impression was made of the prepared tooth with the RPD in place. A stone cast was poured and, after die sectioning, scanned with a tabletop scanner. The ceramic crown was designed and fabricated by using a digital workflow to fit the RPD clasp assembly, providing an adequate undercut for the clasp. The crown was then delivered and the RPD evaluated for adequate fit.

Purpose To systematically review randomized controlled clinical trials (RCTs) reporting on the long-term survival and failure rates, as well as the complications of short implants (≤6 mm) versus longer implants (>6 mm) in posterior jaw areas. Materials and methods Electronic and manual searches were conducted to identify studies, specifically RCTs, reporting on short dental implants (≤6 mm) and their survival and complication rates compared with implants longer than 6 mm. Secondary outcomes analyzed were marginal bone loss and prosthesis survival rates. Results Ten RCTs fulfilled the inclusion criteria and featured a total of 637 short (≤6 mm) implants placed in 392 patients, while 653 standard implants (>6 mm) were inserted in 383 patients. The short implant survival rate ranged from 86.7% to 100%, whereas standard implant survival rate ranged from 95% to 100% with a follow-up from 1 to 5 years. The risk ratio (RR) for short implant failure compared to standard implants was 1.29 (95% CI: 0.67, 2.50, p = 0.45), demonstrating that overall, short implants presented higher risk of failure compared to longer implants. The heterogeneity test did not reach statistical significance (p = 0.67), suggesting low between-study heterogeneity. The prosthesis survival rates from the short implant groups ranged from 90% to 100% and from 95% to 100% for longer implant groups, respectively. Conclusion Short implants (≤6 mm) were found to have higher variability and lower predictability in survival rates compared to longer implants (>6 mm) after periods of 1-5 years in function. The mean survival rate was 96% (range: 86.7%-100%) for short implants, and 98% (range 95%-100%) for longer implants. Based on the quantity and quality of the evidence provided by 10 RCTs, short implants with ≤6 mm length should be carefully selected because they may present a greater risk for failure compared to implants longer than 6 mm.

OBJECTIVES The aim of this in vitro study was to compare the accuracy of printed implant casts from digital impressions with two intra-oral scanners (IOS) to stone casts from conventional impressions. The hypothesis was that printed casts would be more accurate than stone casts from conventional impressions. MATERIALS AND METHODS A mandibular stone cast with Kennedy class II edentulism was fabricated using two internal connection tissue-level implants at 30 degrees to each other (Replace Select RP, Nobel Biocare) to serve as master. Digital impressions (n = 10) were made with the white light (WL) and Active Wavefront Sampling technology (AWST) IOS. The resultant standard tessellation language (STL) datasets were used to print implant casts through stereolithography (SLA) prototyping. The conventional casts (n = 10) were produced with splinted open tray impression technique and polyether material in type IV stone. The master cast and all groups were digitized with lab reference scanner. The test groups STL datasets were superimposed to master cast STL in inspection software (Geomagic control 2015) to calculate root-mean-square error. RESULTS The conventional, WL IOS and AWST IOS groups had mean values of 53.49 μm (SD 9.47), 108.09 μm (SD 9.59) and 120.39 μm (SD 5.91), respectively. The Shapiro-Wilk test showed no evidence of nonnormality (p = 0.131) and Levene's test showed no evidence of heterogeneity of variance (p = 0.518). The one-way ANOVA demonstrated a statistically significant difference (p

Purpose The purpose of this randomized controlled clinical trial was to investigate the prosthetic outcomes of posterior implant-supported single crowns (SCs) with a modified monolithic zirconia or metal-ceramic design at 1 year of loading. Materials and methods Forty participants with 73 dental implants in need of at least 1 maxillary or mandibular posterior implant-supported SC were consecutively selected for this study. The included participants were randomly divided into modified monolithic zirconia (MMZ) and metal-ceramic (MC) groups. The implant-supported SCs were examined after 1 year for survival and technical complications. Descriptive statistics were used to illustrate the data, and the association associated risks of complications were estimated using the logistic regression model with Firth's approach for rare outcome (α = 0.05). Results During the observation period, 2 participants in the MC group were lost to follow-up. A total of 38 participants with 70 posterior implant-supported SCs (36 and 34 SCs in the MMZ and MC groups respectively) completed the 1-year follow-up examination. One implant failed in the MMZ group. The 1-year survival rates for implants and crowns were both 97.2% in the MMZ group. The survival rates for implants and crowns were both 100% in the MC group. One screw loosening event was observed in one screw-retained SC in the MMZ group; however, 8 complication events occurred in 7 SCs in the MC group. Therefore, the complication-free rates were 97.1% and 79.4% in the MMZ and MC SCs respectively. The most common complication in the MC group was screw loosening (14.7%), followed by loss of retention (5.9%), and ceramic fracture (2.9%). Significantly more technical complications were observed in the MC SCs than MMZ SCs (p = 0.0432). Conclusion The modified monolithic zirconia design applied to the posterior implant-supported SCs had a significantly lower technical complication rate than did the metal-ceramic one.

PURPOSE The purpose of this clinical trial was to investigate the clinical outcomes of implant-supported modified monolithic zirconia single crowns (SCs) and short-span fixed dental prostheses (FDPs) after a follow-up of 2 years. MATERIALS AND METHODS Twenty-seven patients in need of implant-supported SCs or 3-unit FDPs in the posterior maxilla or mandible were consecutively selected for this study. A total of 56 modified monolithic zirconia prostheses including 44 SCs (8 screw-retained, 36 cement-retained) and twelve 3-unit FDPs (5 screw-retained, 7 cement-retained) were included in this study. All patients were followed at 6 months, 12 months, 18 months, and 2 years after placement of the modified monolithic zirconia prostheses. During the follow-up period, all prostheses were evaluated with clinical and radiographic examinations. The following technical parameters were assessed: framework fracture, fracture of veneering porcelain, screw loosening, loss of retention because of prosthesis de-cementation and opposing tooth fracture. RESULTS No implant was lost during the follow-up period, yielding a 2-year implant survival of 100%. One FDP failed because of framework fracture. The overall prosthesis survival rate was 98.2% after 2 years of clinical service. During the study, 5 complication events were observed in 3 SCs and one FDP, including one fracture of veneering porcelain and 2 screw loosenings in 3 SCs, and loss of retention and opposing tooth fracture in the same FDP. Therefore, the complication-free rate of prostheses was 91.1%. CONCLUSION According to the results of this study, the modified monolithic zirconia design used in this study resulted in a favorable short-term outcome for posterior implant-supported SCs and 3-unit FDPs.

Objective To present a rationale to reduce treatment complexity, number of surgeries, and overall treatment time for patients with extreme mandibular ridge deficiency. Clinical Considerations A 67-year-old fully edentulous male presented with a chief complaint of poor retention and stability of the mandibular complete denture with consequent discomfort and inability to chew. A novel 3-appointment protocol from guided implant placement to definitive prosthesis delivery was implemented. At the first appointment, a guided surgery protocol with the All-on-4 concept was used in the mandible. Implant placement was followed by immediate loading with a fixed provisional prosthesis providing the patient with immediate function. Final impression, cast verification and articulation, determination of VDO, and interocclusal records were obtained in the same appointment. In the second appointment, the framework try-in was performed and a pick-up impression was taken after a new CR record. The third appointment included the delivery of the final screw-retained, one-piece, full-arch prosthesis opposed by a maxillary complete denture. Conclusion This expedited protocol allows for implant placement with a surgical template generated from preoperative virtual planning of the implants and the CAD/CAM prosthodontic rehabilitation using a digital workflow. The patient was satisfied with the esthetic and functional outcome and was enrolled into a 6-month recall program. Clinical Significance This article describes an expedited protocol illustrating a digital workflow for full arch implant rehabilitation of the extremely atrophic mandible. Flapless implant placement with a surgical template generated from virtual planning was followed by immediate loading with a fixed prosthesis. Digital impression/digitization of the working cast and CAD/CAM technology were used to mill the definitive prosthesis. From guided surgery to the definitive rehabilitation only three appointments were necessary. This digital workflow can enhance patient acceptance and comfort and serve as an alternative treatment in the indicated clinical scenario. (J Esthet Restor Dent 29:178–188, 2017)

Purpose To report the rate of technical complications and prosthesis survival in a cohort of edentulous patients treated with implant-supported fixed complete dental prostheses (IFCDPs) after a mean observation period of at least 1 year. Materials and methods The single-visit examination included clinical and radiographic assessment, occlusal analysis, photographs and questionnaire assessing patient satisfaction in a cohort of 52 patients rehabilitated with 71 IFCDPs (supported by 457 implants). The IFCDPs were assessed for technical complications, number of implants and cantilever extension, retention type and prosthetic material type. Comparison was made between ceramic IFCDPs (Group 1) and metal-resin IFCDPs (Group 2). Kaplan-Meier survival curve analysis was carried out for assessment of prosthesis survival and was done for both Groups 1 and 2 separately. The Cox proportional hazard model was used for survival analysis, adjusting for a number of potential confounders, to evaluate the association between prosthesis survival and several risk factors such as type of opposing occlusion, nightguard use, and presence of bruxism. Responses to patient satisfaction questions were compared with Fisher's exact test. Results Out of 71 edentulous arches (52 patients) restored with IFCDPs, 6 IFCDPs had failed, yielding a cumulative prosthesis survival rate of 91.6 % after a mean observation period of 5.2 years (range: 1-12 years) after definitive prosthesis insertion. Three IFCDPs were lost due to implant failures after 5.8 to 11 years of functional loading. Additionally, 3 metal-resin IFCDPs failed due to technical complications. Minor complications were the most frequent complications observed, namely wear of the prosthetic material (9.8% annual rate) being the most common, followed by decementation of cement-retained IFCDPs (2.9%), and loss of the screw access filing material of the screw-retained IFCDPs (2.7%). The most frequently observed major complication was fracture of the prosthetic material (1.9% annual rate), followed by fracture of occlusal screw (0.3%), and fracture of framework (0.3%). The annual rate of wear of prosthetic material was 7.3% for porcelain IFCDPs (n = 19/55) and 19.4% for metal-resin IFCDPs (n = 13/16), yielding a statistically significant difference between the 2 groups (p = 0.01). Conclusions After a mean exposure time of 5.2 years, 91.6% prosthesis survival rates were achieved (65 out of 71 IFCDPs). The most frequent minor technical complication was wear of the prosthetic material with estimated 5-year rate of 49.0%, while the most frequent major complication was fracture of the prosthetic material with estimated 5-year dental unit-based rate of 9.5%. The cumulative rates for "prosthesis free of minor complications" at 5- and 10-years were 60.5% (95% CI: 47.2-71.3%) and 8.9% (95% CI: 2.9-18.0%), respectively. The cumulative rates for "prosthesis free of major technical complications" at 5- and 10-years were 85.5% (95% CI: 73.0-92.5%) and 30.1% (95% CI: 12.0-50.6%), respectively. Presence of bruxism, and absence of a nightguard were associated with increased risk for chipping of the prosthetic material of the IFCDPs.

With the advancement of computer-aided design/computer-aided manufacturing (CAD/CAM) in dentistry, the use of digital technologies is being increasingly adopted by clinicians and laboratory technicians. Clinicians are using intraoral scanners (IOSs) more and more to perform computer-aided impressions. While these are mainly used to digitize dentate or partially edentulous jaws, it is feasible with a few of the available systems to scan edentulous jaws, with or without implants. To scan edentulous jaws, the registration and articulation of patient-relevant references and planes is difficult without the use of physical casts. The present article introduces simple yet effective methods to integrate individual interocclusal information during the intraoral scan procedure. The techniques described aim to simplify the digital registration procedure of edentulous jaws, with or without implants, and integrate patient-relevant information in the virtual articulator without the need to manufacture and articulate casts after the intraoral scan.

PURPOSE To analyse randomised controlled clinical trials (RCTs) and prospective cohort studies reporting on the survival and failure rates of functionally loaded short implants (SI) based on the actual length of time in function. MATERIALS AND METHODS This meta-analysis was conducted according to PRISMA guidelines for systematic reviews. Electronic and manual searches were conducted to identify RCTs and prospective cohort studies reporting survival and complication rates of short dental implants (≤6 mm) based on the time in function. Secondary outcomes included the location (maxilla or mandible), type of restoration (single crown [SC] versus fixed dental prosthesis [FDP]) and marginal bone loss (MBL). RESULTS A total of 20 studies (11 RCTs and 9 prospective) fulfilled the inclusion criteria and featured a total of 1238 SI placed in 747 patients. The overall (early and late) mean percentage of short implant failure was 4%. SI with up to 1-year follow-up presented failure rate of 2%, while SI followed up for >3 years showed a failure rate of 10%. SI restored with SC presented a late failure rate of 4% while SI restored with FPD 2%. The late failure rate did not differ in terms of location (maxilla or mandible) both with 3%. CONCLUSION Short implants in function for more than 3 years presented higher failure rates compared to SI in function for

Statement of problem Data on the accuracy of printed casts from complete-arch digital implant scans are lacking. Purpose The purpose of this in vitro study was to compare the 3D accuracy of printed casts from a complete-arch digital implant intraoral scan with stone casts from conventional impressions. Material and methods An edentulous mandibular cast with 4 multiunit abutments with adequate anteroposterior spread was used as the master cast. Digital scans (n=25) were made by using a white light intraoral scanner (IOS). The generated standard tessellation language (STL) data sets were imported into a computer-assisted design (CAD) software program to generate complete-arch implant casts through 3D printing technology. The 25 printed casts and the mandibular master cast were further digitized by using a laboratory reference scanner (Activity 880; Smart Optics). These STL data sets were superimposed on the digitized master cast in a metrology software program (Geomagic Control X) for virtual analysis. The root mean square (RMS) error and the average offset were measured. Results When compared with the master cast, the printed casts had a mean ±standard deviation RMS error of 59 ±16 μm (95% CI: 53, 66). The maximum RMS error reached 98 μm. The average offsets were all negative, with a significant difference compared with zero (P Conclusions The implant 3D deviations of the printed casts from complete-arch digital scans had statistically significant differences compared with those of the master cast but may still be within the acceptable range for clinical application.

Fixed dental prostheses are a common and predictable option for the replacement of missing teeth. These restorations require the preparation of the abutment teeth in order to allow adequate space for the materials used to fabricate the prosthesis. Once the preparation is completed, the three-dimensional information relative to the oral hard and soft tissues is captured through a digital or an analog impression to allow the design and fabrication of the prosthesis using CAD-CAM technology. Clinical evidence has shown the predictable long-term survival of fixed dental prostheses, which varies depending on the length of the edentulous span, the abutment status, and prosthetic materials.

Purpose: The purpose of this chapter was to review the scientific literature on implant impression techniques for partially edentulous patients and to propose evidence-based clinical guidelines for implant treatment in the aesthetic zone.

Limited information is available regarding the fabrication of tooth-supported interim single crowns (SCs) with either a digital or a conventional workflow.The purpose of this randomized clinical trial was to compare the time efficiency and fit of interim crowns fabricated by using either a digital or a conventional workflow.Forty participants in need of posterior tooth-supported SCs were enrolled and randomly allocated to either the digital or conventional group. In the digital group, the interim SCs were fabricated by using digital sextant scans and computer-aided design and computer-aided manufacturing (CAD-CAM) technology without definitive casts. The conventional group included conventional impressions and direct fabrication of the interim restorations intraorally. Five experienced and 5 less experienced clinicians were randomly assigned to fabricate the interim SCs. The total fabrication time (laboratory and clinical) was recorded for time efficiency. The fit assessment included marginal fit, proximal contact, occlusal contact, and crown morphology. The evaluated parameters were analyzed with the Mann-Whitney U Test (α=.05).The digital workflow required significantly less total fabrication time (laboratory and clinical) than the conventional workflow (P.001). The less-experienced clinicians needed longer clinical time with the conventional workflow than the experienced ones (P=.023). In contrast, the laboratory time and total fabrication time were shorter for less-experienced clinicians using the digital workflow (P=.005 and P=.015). The interim SCs fabricated with the digital workflow had significantly better fit and occlusal contacts than those fabricated with the conventional workflow (P=.005 and P.001). With the digital workflow, the interim SCs made by less-experienced clinicians were of the same quality as those made by experienced clinicians. When using the conventional workflow, the fit of the experienced clinicians was significantly better than that of the less-experienced clinicians.The interim SCs fabricated with a digital workflow required a shorter fabrication time and resulted in better fit than those fabricated with a conventional workflow, especially for less-experienced clinicians.

The purpose of this article is to report a digital workflow protocol for full-arch implant rehabilitation from guided surgery to final prosthesis in only three visits. This expedited protocol allows for implant placement with a surgical template generated from preoperative virtual planning and production of the CAD/CAM prosthodontic rehabilitation using a digital workflow. At the first visit, a guided implant placement protocol with the All-on-4 concept and immediate loading with the conversion prosthesis technique was done. At the same visit, final impression and interocclusal records, cast verification and mounting, as well as digital scanning of the conversion prosthesis were carried out. During the second visit, the framework try-in was performed. Lastly, the third visit included delivery of the final full-arch prosthesis opposed by a maxillary complete denture.

Restoring multiple adjacent missing teeth in the anterior maxilla is one of the most challenging situations in clinical implant dentistry, as restorations need to be both functional and highly esthetic. The purpose of this article is to highlight the issues that arise during treatment planning for replacement of six missing maxillary anterior teeth with implant-supported fixed dental prostheses. Representative clinical reports are provided to illustrate the treatment planning and surgical and prosthodontic management. The authors describe the rationale for selecting the appropriate number and location of implants in relation to the amount of missing soft and hard tissues to achieve functional and esthetic prostheses.

Monolithic ceramics have been introduced in dentistry to help reduce technical complications reported with implant-supported metal-resin hybrid prostheses. This clinical report describes the maintenance and technical complications that occurred during a full-mouth implant rehabilitation using different prosthetic materials over a 7-year period. During the course of 4 of those years, multiple technical complications were encountered with the metal-resin hybrid prostheses, prompting the need for increased maintenance.New prostheses were inserted with screw-retained titanium frameworks and individually cemented single crowns, and subsequently no technical complications were encountered after 2 years of follow-up.

Objectives To assess the rate of biologic complications and implant survival in edentulous patients treated with implant-supported fixed complete dental prostheses (IFCDPs) after a mean observation period of 5.2 years (range: 1-12 years). Materials and methods A single-visit clinical and radiographic examination was performed to assess types and rates of biologic complications with ceramic IFCDPs (Group 1) and metal-resin IFCDPs (Group 2). Results Of 457 rough surface dental implants supporting 71 IFCDPs (52 patients), six had failed, yielding an implant survival rate of 98.7% after a mean observation period of 5.2 years after definitive prosthesis insertion. The most frequent minor biologic complication was soft tissue recession (7.7% annual rate), inflammation under the IFCDP (7.4% annual rate), and peri-implant mucositis (6.3% annual rate). The most frequent major biologic complication was peri-implantitis (2.0% annual rate), in 46/457 implants (10.1%) supporting 19 IFCDPs and late implant failure (0.3% annual rate). The frequency of biologic complications was not statistically different between Group 1 and Group 2. The presence of high plaque index had significant effect on bone loss. Conclusions After a mean exposure time of 5.2 years postdefinitive prosthesis insertion (range: 1-12 years), implant survival rate of 98.7% was achieved. The six implant failures in three patients occurred after 5 years and affected the prosthesis survival. Soft tissue recession was the most frequent minor biologic complication, whereas peri-implantitis was the most frequent major biologic complication. A 10-year implant-based mucosal recession rate of 77% (95% CI: 68.2-87.9) and a 10-year implant-based peri-implantitis rate of 20% (95% CI: 16.9-24.9) were found.

The following article: Jung, R.E., Al-Nawas, B., Araujo, M., Avila-Ortiz, G., Barter, S., Brodala, N., ... Windisch, P. (2018). Group 1 ITI Consensus Report: The influence of implant length and design and medications on clinical and patient-reported outcomes. Clinical Oral Implants Research, 29(S16), 69-77, can be accessed at https://doi.org/10.1111/clr.13342. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. Objectives: The aim of Working Group 1 was to address the influence of different local (implant length, diameter, and design) and systemic (medications) factors on clinical, radiographic, and patient‐reported outcomes in implant dentistry. Focused questions on (a) short posterior dental implants (≤6 mm), (b) narrow diameter implants, (c) implant design (tapered compared to a non‐tapered implant design), and (d) medication‐related dental implant failures were addressed. Materials and methods: Four systematic reviews were prepared in advance of the Consensus Conference and were discussed among the participants of Group 1. Consensus statements, clinical recommendations, and recommendations for future research were based on structured group discussions until consensus was reached among the entire expert Group 1. The statements were then presented and accepted following further discussion and modifications as required by the plenary. Results: Short implants (≤6 mm) revealed a survival rate ranging from 86.7% to 100%, whereas standard implant survival rate ranged from 95% to 100% with a follow‐up from 1 to 5 years. Short implants demonstrated a higher variability and a higher Risk Ratio [RR: 1.24 (95% CI: 0.63, 2.44, p = 0.54)] for failure compared to standard implants. Narrow diameter implants (NDI) have been classified into three categories: Category 1: Implants with a diameter of Tapered versus non‐tapered implants demonstrated only insignificant differences regarding clinical, radiographic, and patient‐reported outcomes. The intake of certain selective serotonin reuptake inhibitors and proton pump inhibitors is associated with a statistically significant increased implant failure rate. The intake of bisphosphonates related to the treatment of osteoporosis was not associated with an increased implant failure rate. Conclusions: It is concluded that short implants (≤6 mm) are a valid option in situations of reduced bone height to avoid possible morbidity associated with augmentation procedures; however, they reveal a higher variability and lower predictability in survival rates. Narrow diameter implants with diameters of 2.5 mm and more demonstrated no difference in implant survival rates compared to standard diameter implants. In contrast, it is concluded that narrow diameter implants with diameters of less than 2.5 mm exhibited lower survival rates compared to standard diameter implants. It is further concluded that there are no differences between tapered versus non‐tapered dental implants. Certain medications such as selective serotonin reuptake inhibitors and proton pump inhibitors showed an association with a higher implant failure rate.

PURPOSE The aim of this study was to assess the effect of connection type and impression technique on the accuracy of fit of implant-supported fixed complete-arch dental prostheses (IFCDPs). MATERIALS AND METHODS An edentulous mandibular cast with five implants was fabricated to serve as master cast (control) for both implant- and abutment-level baselines. A titanium one-piece framework for an IFCDP was milled at abutment level and used for accuracy of fit measurements. Polyether impressions were made using a splinted and non-splinted technique at the implant and abutment level leading to four test groups, n = 10 each. Hence, four groups of test casts were generated. The impression accuracy was evaluated indirectly by assessing the fit of the IFCDP framework on the generated casts of the test groups, clinically and radiographically. Additionally, the control and all test casts were digitized with a high-resolution reference scanner (IScan D103i, Imetric, Courgenay, Switzerland) and standard tessellation language datasets were generated and superimposed. Potential correlations between the clinical accuracy of fit data and the data from the digital scanning were investigated. To compare the accuracy of casts of the test groups versus the control at the implant and abutment level, Fisher's exact test was used. RESULTS Of the 10 casts of test group I (implant-level splint), all 10 presented with accurate clinical fit when the framework was seated on its respective cast, while only five of 10 casts of test group II (implant-level non-splint) showed adequate fit. All casts of group III (abutment-level splint) presented with accurate fit, whereas nine of 10 of the casts of test group IV (abutment-level non-splint) were accurate. Significant 3D deviations (P

Objective The transition of patients from failing dentition to complete arch implant rehabilitation often requires that the patient is rendered edentulous and has to wear a removable complete denture for varying periods of time. In order to avoid removable provisionalization, the staged treatment approach allows for fixed interim prosthesis throughout the rehabilitation process, patient comfort, and prosthodontic control. Clinical considerations The purpose of this clinical report is to describe a combination of staged approach with guided flapless surgery for minimally invasive treatment. The patient had fixed interim prostheses during the entire rehabilitation process. The various implant prosthodontic stages are illustrated for the complete arch prosthetic rehabilitation and the 6-year follow-up outcome is reported. A patient with debilitated dentition was treated with this combined protocol and was followed for 6 years after definitive prosthesis insertion. Conclusion Implant and prosthesis success rates were 100% with minor biologic and no technical complications encountered up to 6-year recall. Guided surgery has the advantage of prosthetically driven implant placement and minimal postoperative sequelae, whereas the staged approach allows for fixed provisionalization throughout the entire treatment period. Clinical Significance As the computer-guided surgery protocols continue to evolve and improve, further clinical studies are necessary to assess accuracy and make this exciting technology even safer for the average clinician. The clinical significance of this case report lies in the treatment sequence combined with cutting edge technology for maximum patient comfort and prosthodontic control. Guided flapless surgery with prosthodontically driven implant placement led to predictable rehabilitation with no major complications after 6 years. A staged approach with fixed interim prostheses was used throughout the entire rehabilitation period, optimizing patient satisfaction and comfort. Natural canine guidance was the occlusal scheme of choice.

To compare the accuracy of digital and conventional impression techniques for completely edentulous patients and to determine the effect of different variables on the accuracy outcomes.A stone cast of an edentulous mandible with five implants was fabricated to serve as master cast (control) for both implant- and abutment-level impressions. Digital impressions (n = 10) were taken with an intraoral optical scanner (TRIOS, 3shape, Denmark) after connecting polymer scan bodies. For the conventional polyether impressions of the master cast, a splinted and a non-splinted technique were used for implant-level and abutment-level impressions (4 cast groups, n = 10 each). Master casts and conventional impression casts were digitized with an extraoral high-resolution scanner (IScan D103i, Imetric, Courgenay, Switzerland) to obtain digital volumes. Standard tessellation language (STL) datasets from the five groups of digital and conventional impressions were superimposed with the STL dataset from the master cast to assess the 3D (global) deviations. To compare the master cast with digital and conventional impressions at the implant level, analysis of variance (ANOVA) and Scheffe's post hoc test was used, while Wilcoxon's rank-sum test was used for testing the difference between abutment-level conventional impressions.Significant 3D deviations (P0.001) were found between Group II (non-splinted, implant level) and control. No significant differences were found between Groups I (splinted, implant level), III (digital, implant level), IV (splinted, abutment level), and V (non-splinted, abutment level) compared with the control. Implant angulation up to 15° did not affect the 3D accuracy of implant impressions (P0.001).Digital implant impressions are as accurate as conventional implant impressions. The splinted, implant-level impression technique is more accurate than the non-splinted one for completely edentulous patients, whereas there was no difference in the accuracy at the abutment level. The implant angulation up to 15° did not affect the accuracy of implant impressions.