0000000000047309
AUTHOR
Ugo Covani
Introduction to Immediate Loading in Implantology
Branemark traditional recommendation was to perform implant rehabilitation in two stages: the first entry was only for implant placement; after 3–6 months of undisturbed submerged healing for mandible and maxilla, respectively, a second surgical entry would have allowed loading of the implants. The rationale behind this approach was that implant micro-movements as consequence by an inadequate primary stability, caused by functional forces at the bone-implant interface in the early wound healing stages, could have induced fibrous tissue formation rather than new bone, eventually causing clinical failure. The main request was to reduce the overall rehabilitation time from surgery to final res…
In-vitro fatigue and fracture performance of three different ferrulized implant connections used in fixed prosthesis
Background/purpose: The aim of the present in vitro study was to evaluate fatigue resistance of dental fixtures in three different types of fixture/abutment finishing line. Materials and methods: Transmucosal dental implants, with or without ferrulized neck, underwent fatigue tests (static and dynamic load) using the following standard protocol: UNI EN ISO 14801:2016. Two types of loading devices (screw- or cement-retained restoration) were also tested, and fatigue cycle tests were run to failure. Data of static and dynamic load tests were analyzed by proper statistical methods. Results: Following standard protocol for fatigue testing, the ILC type (Implant Level with ferrulized neck and ce…
Microbiological assessment of the implant-abutment interface in different connections: cross-sectional study after 5 years of functional loading.
Objective To evaluate the bacterial microflora present inside the implant connection and in the peri-implant sulcus fluid of healthy implants, and to analyze the relationships between these harboring sites for four different implant systems after at least 5 years of functional loading. Materials and methods A cross-sectional study was performed involving 40 patients treated with metal-ceramic cemented bridges supported by at least two healthy implants functionally loaded for 5 years. Four different implant-abutment connections were studied: external hexagon (control group), double internal hexagon (test group 1), internal hexagon with external collar (test group 2), and conical connection (…
Immediate loading with fixed full-arch prostheses in the maxilla: review of the literature
Objectives: To critically review the evidence-based literature on immediate loading of implants with fixed full- arch prostheses in the maxilla to determine 1) currently recommended performance criteria and 2) the outcomes that can be expected with this procedure. Study Desing: Studies from 2001 to 2011 on immediate loading with fixed full-arch maxillary prostheses were reviewed. Clinical series with at least 5 patients and 12 months of follow-up were included. Case reports, studies with missing data and repeatedly published studies were excluded. In each study the following was assessed: type of study, implant type, number of patients, number of implants, number of implants per patient, us…
Radiological Outcomes of Bone-Level and Tissue-Level Dental Implants: Systematic Review
Purpose: to assess any differences on marginal bone loss between bone-level or tissue-level dental implants through a review of literature until September 2019. Materials and methods: MEDLINE, Embase and other database were searched by two independent authors. The search was limited to articles in English. Results: The search provided 1028 records and, after removing the duplicates through titles and abstracts screening, 45 full-text articles were assessed for eligibility. For qualitative analysis 20 articles were included, 17 articles of them for quantitative analysis. A total of 1161 patients (mean age 54,4 years) and 2933 implants were observed, 1427 (Tissue-level) and 1506 (Bone-level).…
The effectiveness of the information‐motivation model and domestic brushing with a hypochlorite‐based formula on peri‐implant mucositis: A randomized clinical study
OBJECTIVE Management of mucositis is essential for the long-term maintenance of dental implants. This study determined the efficacy, in terms of clinical parameters, of an adjunctive domiciliary agent paired with non-surgical periodontal therapy (NSPT) for patients with peri-implant mucositis. MATERIALS AND METHODS Patients involved in a periodontal maintenance program were randomly distributed to the domestic use of a chlorhexidine toothpaste and mouthwash (control) or a hypochlorite-based formula brushing solution (test) after diagnosis of peri-implant mucositis. A modified approach towards NSPTwas performed after 10 days of domestic use of the assigned maintenance product in both groups.…
Oral health-related quality of life and clinical outcomes of immediately or delayed loaded implants in the rehabilitation of edentulous jaws: A retrospective comparative study
Background Patient-centered outcomes are being given great attention by the dental scientific community. The Oral Health Impact Profile -14 questionnaire (OHIP-14) has been introduced to address patients' success criteria when describing the impact of oral rehabilitations on quality of life (OHrQoL). Methods Thirty-five patients wearing a full-arch implant-prosthesis being in place between 4 and 6 years before this analysis were considered eligible and then enrolled in the present retrospective study. According to their prosthetic anamnesis, two groups were defined: delayed loading group (IL-group) and immediate loading group (IL-group). At the moment of analysis, clinical and radiographic …
Er:YAG laser in defocused mode for scaling of periodontally involved root surfaces: An in vitro pilot study
Item does not contain fulltext BACKGROUND: The Er:YAG laser may be used on periodontally involved teeth in combination with conventional periodontal therapy in order to improve the efficacy of root instrumentation. The aim of this study was to compare the effect of hand instrumentation on root surfaces of periodontally involved teeth with Er:YAG laser application. METHODS: Thirty freshly extracted, non-carious, single-rooted, periodontally diseased human teeth from adult humans with advanced periodontal disease were used in this study. The teeth were divided into three groups of 10 specimens each. Group A was treated with scaling and root planing (SRP) with curets only (control). In group B…
Immediate Loading with Fixed Full-Arch Prosthesis in the Edentulous Patient: Treatment Protocol
Immediate loading is basically a prosthetic concept. However, the surgical implantological planning is very important to ensure a primary stability in the total edentulous patient. This characteristic is crucial to allow immediate loading in this type of patients. For the first time, the incisional design has allowed the clinician to overview about the surgical side. Later, maybe, the bone will need an osteoplasty to regularize possible bone defects. To ensure primary stability, it can use methods to enhance primary stability as undersized drilling technique and use of osteotomes and bi-cortical anchorage implants. There are two main protocols to obtain temporary immediate loading full-arch…
Diagnosis and Planning in Immediate Loading: Implant Selection
Despite the increasing patients’ desire for immediate prosthetic loading of implants, several factors must be taken into account before pursuing the immediate loading (IL) protocol. In general, the number, size, characterization, and distribution of implants should be based on the implant-prosthodontic plan, arch form, and available bone quality and quantity, regardless of the loading protocol. However, implant selection in IL represents one of the most important clinical challenges due to the primary stability requirement.
General Diagnosis and Medical Evaluation
Current literature does not contribute to a high level of evidence regarding possible indications for immediate loading. A great variety of exclusion criteria for immediate loading of dental implants are used in different studies. However, the reported criteria are similar to those chosen for conventional loading of dental implants. Despite its several clinical advantages, the immediate loading protocol should be performed respecting a rigorous preliminary diagnostic algorithm. Primary indication for immediate implant loading is certainly patients’ desire to reduce the overall treatment time. Additionally, several psychological factors, related to the preservation of functional and esthetic…
Diagnosis and Planning in Immediate Loading: Surgical Diagnosis
For several decades, two-dimensional images were the only available for the surgical diagnosis prior to implant placement. The introduction of digital radiology and software applications for three-dimensional imaging has increased the prospects of success in implant diagnosis and surgical placement. The CBCT is definitely more precise and complete than panoramic radiography, but it is not always mandatory for every case. Success for fixed implant-supported rehabilitations, especially in immediate provisionalization techniques, depends on accurate pre-surgical evaluation of the following issues: (1) recognize feasible restoration procedures to rehabilitate patient edentulism; (2) list all th…
Clinical and microbiological findings in patients with peri-implantitis: a cross-sectional study
Objective The aim of this study was to analyze clinical and microbiological characters in subjects and implants affected and not affected by peri-implantitis. Additionally, same features were analyzed also intra-individually, comparing healthy and diseased implants within the same subject. Materials and methods A total of 534 patients who received at least 1 implant and coming to routine check-up or spontaneous visits at the University of Valencia were recruited. Clinical parameters including Bleeding on probing (BoP), Probing pocket depth (PPD), and Pi were screened. Samples for microbiological analysis were obtained from three locations: peri-implant sulci (PIS), inner parts of the implan…
Minimally invasive prosthetic procedures in the rehabilitation of a bulimic patient affected by dental erosion
The population affected by dental erosion due to bulimia is generally very young. This population group has a high aesthetic requirement; the dentition in these patients is severely damaged, especially in the anterior maxillary quadrant. In terms of treatment, it is still controversial whether an adhesive rehabilitation is preferable to a longer-lasting but more aggressive conventional treatment, such as full-crown coverage of the majority of teeth. This case report describes the prosthetic rehabilitation of a young female patient previously affected by bulimia nervosa and presenting erosion of the maxillary teeth. The prosthetic rehabilitation was performed through indirect adhesive restor…
Microbial Leakage at the Implant-Abutment Connection Due to Implant Insertion Maneuvers: Cross-Sectional Study 5 Years Postloading in Healthy Patients.
The aim of this study was to test if stress on the prosthetic connection during insertion maneuvers can induce micro-warping at the implant connection. From September 2011 to July 2013, patients with implants loaded for at least 5 years that were placed with 2 different insertion implant mounters—MP (conventional) and ME (mountless)—were selected from all of those who had received dental implant therapy in the past and were attending routine check-up or spontaneous visits during the study period. Samples were obtained from inside the connection and the abutment surface using absorbent sterile paper tips. Quantitative real-time polymerase chain reaction was performed for total bacterial coun…
In-Vitro Investigation of Fatigue and Fracture Behavior of Transmucosal versus Submerged Bone Level Implants Used in Fixed Prosthesis
Background: The present in vitro study aimed to investigate the fatigue performance of different dental fixtures in two different emergence profiles. Biological failures are frequently reported because the problem canonly be solved by replacing a failing implant with a new one. Clinicians addressed minor mechanical failures, such as bending, loosening or the fracture of screws, abutment, or the entire prosthesis, by simply replacing or fixing them. Methods: Transmucosal and submerged bone-level dental implants underwent fatigue strength tests (statical and dynamical performance) by a standardized test: UNI EN ISO 14801:2016. Two types of emergence profiles (Premium sub-crestal straight impl…
Definitive Abutments Placed at Implant Insertion and Never Removed: Is It an Effective Approach? A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Purpose To assess whether repeated abutment disconnections and reconnections have any impact on peri-implant bone resorption and soft tissue healing. Materials and Methods Electronic and manual searches were conducted for English-language articles published up to March 2017 that identified a relation between repeated disconnections of implant abutments (PA group) and prosthetic or implant failures, complications, marginal bone loss (MBL), soft tissue healing, and esthetic evaluation (pink esthetic score [PES]) after at least 1 year of function compared with implants receiving a final abutment at the time of implant placement (DA group). Results Fourteen articles (535 patients with 994 impla…