Hybrid Prosthesis Research Articles

Mandibular Ridge Augmentation With Interpositional Osteoplasty To Improve Crown Implant Ratio

Oral rehabilitation with implants is a predictable treatment modality. Long term survival of the implants is influenced by multitude of factors including biological, technical, physiological and biomechanical factors. Among the biomechanical factors, crown implant ratio plays a critical role. Improper crown implant ratio causes bending effect on the implants due to the horizontal forces during mastication. These forces act on the implant abutment connection area and at the marginal bone compromising the treatment prognosis. To negate this consequence surgically, a ridge augmentation procedure can be a viable option. This case report is one such scenario wherein inter-positional osteoplasty is used to augment the mandibular anterior ridge with autogenous bone graft from iliac crest along with the simultaneous placement of implants followed by the replacement of missing teeth with a fixed hybrid prosthesis. Key words: Crown implant ratio, hybrid prosthesis, sandwich osteoplasty

Redo aortic arch repair using trifurcated hybrid prosthesis after failed Ascyrus medical dissection stent treatment

BackgroundThe management of acute type A aortic dissection (ATAAD) using the Ascyrus Medical Dissection Stent (AMDS) can lead to complications due to the persistence of the false lumen (FL). This case report presents two instances of failed AMDS treatment for ATAAD, highlighting the novel use of a trifurcated hybrid prosthesis for redo aortic arch repair using a minimally invasive frozen elephant trunk (FET) technique.Case PresentationCase 1: A 57-year-old male, previously treated with AMDS for ATAAD, presented with an enlarging aortic arch and persistent FL two years post-surgery caused by re-entry in the distal aortic arch. Redo surgery using the FET technique with an E-vita OPEN NEO Trifurcated hybrid prosthesis resulted in successful repair and partial FL thrombosis. Case 2: A 51-year-old male with prior AMDS treatment for ATAAD presented with severe aortic valve regurgitation and a maintained FL perfusion due to a residual re-entry in the proximal region of the descending aorta. Redo surgery using the FET technique with the same hybrid prosthesis led to successful repair and good recovery, confirmed by follow-up imaging.ConclusionsThe use of the E-vita OPEN NEO Trifurcated hybrid prosthesis in the FET technique offers a promising solution for redo aortic arch repair in cases of failed AMDS treatment for ATAAD. This approach can improve patient outcomes by addressing complications associated with persistent FL and enhancing long-term survival.

Evaluation and Comparison of Stresses Between All-on-4 and All-on-6 Treatment Concepts With Three Different Prosthetic Materials in the Maxilla: A Finite Element Analysis Study.

This study aimed to evaluate the comparative analysis of stresses on and around implants and surrounding cortical bone using three different prosthetic materials in hybrid prosthesis using the all-on-4 technique and all-on-6 technique in the maxilla using finite element analysis (FEA). An in vitro FEA study was conducted where a three-dimensional (3D) model of an edentulous maxilla and four different models of the mandible were built using ANSYS software version 18 (Ansys, Inc., Canonsburg, Pennsylvania, United States). Group A comprised the all-on-4 technique where two vertical implants were placed in the lateral incisor area, and two tilted implants at 30o were placed in the second premolar area, whereas group B included the all-on-6 technique, where four vertical implants were placed in the central incisor and canine area, along with two tilted implants in second premolar area. Subsequently, prosthetic materials such as acrylic, porcelain fused to metal (PFM), and zirconia were studied. Four different opposing arch materials were made: natural teeth (A1 and B1), complete dentures (A2 and B2), implant-supported overdentures (A3 and B3), and hybrid prosthesis (A4 and B4). The von Mises stresses were recorded at the implant and cortical bone to summarize the effect of occlusal loads on the maxillary bone using the all-on-4 and all-on-6 techniques. In the all-on-4 technique, on evaluating stresses on implants, it was revealed that acrylic consistently demonstrated lower stress magnitudes in comparison to zirconia and PFM. The stress levels escalate from 38.72 MPa in model A1 to 72.43 MPa in model A4. Zirconia endured the most substantial stresses, ranging from 53.64 MPa (A1) to 84.87 MPa (A4). Similar results were obtained for the stresses on the cortical bone and for the all-on-6 technique. However, the stresses were lower in the all-on-6 technique than in the all-on-4 technique. The lowest stress values across all prosthetic materials were recorded when the maxillary arch was restored with acrylic teeth along with a titanium bar opposing natural dentition. The least stresses were noticed in the all-on-6 technique with acrylic prosthetic material opposing the natural dentition. As the all-on-6 treatment concept showed the most favorable biomechanical behavior, it can be considered a viable alternative for moderate atrophic maxillary rehabilitation.

Transition from Fixed to Hybrid Prosthesis: A Case Report

Transition from Fixed to Hybrid Prosthesis: A Case Report

Radiographic Evaluation of Crestal Bone Loss Around Implants in Mandibular All on 4 Implant Hybrid Prosthesis Using 2 Different Abutments (Multi-unit Versus OT Bridge)

Radiographic Evaluation of Crestal Bone Loss Around Implants in Mandibular All on 4 Implant Hybrid Prosthesis Using 2 Different Abutments (Multi-unit Versus OT Bridge)

Full-mouth dental implant rehabilitation for a patient suffering from PapillonLefevre syndrome

Papillon-Lefevre syndrome (PLS) is an autosomal recessive disorder that affects the primary and permanent dentitions. It is characterized by severe periodontitis. Titanium implants have emerged as a significant therapeutic option in recent years for both tooth replacement and oral rehabilitation in individuals with PLS. Due to the severe bone loss, these patients may require bone grafting procedures, sinus lifts, and the alveolar ridge splitting technique (ARST) in order to properly position the implants. This report aims to demonstrate how a patient with PLS can be successfully managed for full-mouth rehabilitation with dental implants and hybrid prosthesis. Periodontists and prosthodontists should combine their efforts for an optimal customized treatment plan. Dental implants have been successfully used to restore functionally and esthetically the patient’s mouth.

Qualitative and Radiographic Assessment of PEEK Bar Versus Titanium Bar Fabricated by CAD-CAM in Mandibular Hybrid Prosthesis: a randomized controlled clinical trial

Qualitative and Radiographic Assessment of PEEK Bar Versus Titanium Bar Fabricated by CAD-CAM in Mandibular Hybrid Prosthesis: a randomized controlled clinical trial

Assessment of patient’s centered prosthetic maintenance of two different materials and design of mandibular fixed hybrid prostheses

Assessment of patient’s centered prosthetic maintenance of two different materials and design of mandibular fixed hybrid prostheses

Commentator Discussion: A novel hybrid prosthesis for open repair of acute DeBakey type I dissection with malperfusion: Early results from the Prospective, Single Arm, Multi-center Clinical Investigation to Evaluate the Safety and Effectiveness of AMDS in the Treatment of acute DeBakey Type I Dissection trial

Commentator Discussion: A novel hybrid prosthesis for open repair of acute DeBakey type I dissection with malperfusion: Early results from the Prospective, Single Arm, Multi-center Clinical Investigation to Evaluate the Safety and Effectiveness of AMDS in the Treatment of acute DeBakey Type I Dissection trial

Branched hybrid prosthesis: in vivo experimental study

Branched hybrid prosthesis: in vivo experimental study

A novel hybrid prosthesis for open repair of acute DeBakey type I dissection with malperfusion: Early results from the PERSEVERE trial

BackgroundOutcomes after hemiarch repair for acute DeBakey type I aortic dissection (ADTI) remain unfavorable, with high rates of major adverse events and negative aortic remodeling. The PERSEVERE study evaluates the safety and effectiveness of the AMDS Hybrid prosthesis, a novel bare metal stent, in patients presenting with preoperative malperfusion. MethodsPERSEVERE is a prospective single-arm investigational study conducted at 26 sites in the United States. Ninety-three patients underwent ADTI aortic dissection repair with AMDS implantation. The 30-day primary endpoints are a composite rate of 4 major adverse events and the rate of distal anastomotic new entry tears. The secondary endpoints include aortic remodeling. ResultsClinical malperfusion was documented in 76 patients (82%); only radiographic malperfusion, in 17 (18%). The median follow-up in the 93 patients was 5.6 months. Within 30 days, 9 patients died (9.7%), 10 patients (10.8%) experienced new disabling stroke, and 18 patients (19.4%) had new-onset renal failure requiring ≥1 dialysis treatment. There were no cases of myocardial infarction. The composite rate of major adverse events (27%) was lower than that reported in the reference cohort (58%). There were no distal anastomotic new entry tears. Technical success was achieved in 99% of patients. Early remodeling indicated total aortic diameter stability, true lumen expansion, and false lumen reduction in the treated aortic segment. ConclusionsEarly results show significant reductions in major adverse events and distal anastomotic new entry tears, successfully meeting both primary endpoints. The technical success rate was high. AMDS can be used safely in patients with ADTI dissection with malperfusion.

The frozen elephant trunk technique in acute aortic dissection: the ultimate solution? An institutional experience.

Acute aortic dissection remains a serious emergency in the field of cardiovascular medicine and a challenge for cardiothoracic surgeons. In the present study, we seek to compare the outcomes of different surgical techniques in the repair of type A acute aortic dissection. Between April 2015 and May 2023, 213 patients (82 women, aged: 63.9 ± 13.3 years) with acute aortic dissection (205 type A and 8 non-A-non-B dissections) underwent surgical treatment in our department. A total of 45 patients were treated with the frozen elephant trunk (FET) technique supported by the Thoraflex™ Hybrid prosthesis, 33 received total aortic arch replacement (TAR)-standard or conventional elephant trunk-treatment, and 135 were treated with hemiarch replacement (HR). Aortic arch surgery was performed in most patients under moderate hypothermic (28°C on average) circulatory arrest, with selective antegrade cerebral perfusion through the right axillary artery. The rates of early mortality were 17.8% (38 perioperative deaths) in the whole population, 8.9% in the FET group of patients, and 33% and 17% in the TAR and HR group of patients, respectively (P-value 0.025). The rate of spinal cord injury was 2.3% (five patients), and a paresis of recurrent laryngeal occurred in 3.7% of patients (seven patients, four were treated with FET). Permanent neurological dysfunction occurred in 27 patients (12.7%). After a mean follow-up of 3 years, the rate of mid-term mortality of discharged patients was 19.4% (34 deaths: 7 FET, 4 TAR, and 23 HR) and the overall mortality rate was 33.8% [72 deaths: 11 FET (24.4%); 15 TAR (45.4%); 46 HR (34.1%)]. A total of 8 patients (17.8%) in whom FET was applied received additional endovascular treatment in the descending aorta. In our institutional experience, we found that the frozen elephant trunk technique with a high-end Thoraflex Hybrid prosthesis proved its surgical suitability in the treatment of acute aortic dissection with favorable outcomes. The FET technique and our perioperative management led to comparable neurological outcomes and reduced mortality rates in these emergency cases.

Evaluation of the Effectiveness of Semolina in Improving the Bond Strength of Metal Alloys and Acrylic Resins for the Fabrication of Hybrid Prostheses for Implant Restoration: An In Vitro Study.

Introduction Fixed prosthodontic solutions for restorations of multiple implants are often done using acrylic-metal hybrid prosthesis. These restorations have a high failure rate due to poor bond strength between metal and acrylic, despite using digital attachments and primers. This study has been done to demonstrate an economical yet effective method of increasing shear bond strength between acrylic and metal. Materials and methods Disc specimens of 10 mm diameter and 2 mm thickness were designed using the Meshmixer version 3.5 software (Autodesk Inc., San Rafael, USA). The standard tessellation (STL) file was imported and sent for direct metal laser sintering (DMLS) in cobalt-chromium (CoCr),titanium (Ti), and wax milling. The groups were defined. Ten samples were included in each group. Group 1: Conventional Casting in CoCr; Group 2: Conventional Casting with Opaquer (CoCr); Group 3: DMLS CoCr; Group 4: DMLS CoCr with Opaquer; Group 5: DMLS Ti; Group 6: DMLS Tiwith Opaquer; Group 7: Casting with Semolina (CoCr); and Group 8: Casting with Semolina and Opaquer (CoCr). Wax-up was performed using double wax sheet thickness of modeling wax. Flasking and acrylization were done using the injection moulding technique. A universal testing machine was used for shear bond strength. Results were tabulated and statistical analysis was done usingIBM SPSSStatistics for Windows (IBM Corp., Armonk, USA). The Shapiro-Wilk test was done to confirm the normality of the data, followed by the one-way analysis of variance (ANOVA) test to compare the shear bond strength between metal alloys and heat cure acrylic resin. Results The one-way ANOVA results reveal significant differences in bond strengths among the various groups. Conventional Casting with Opaquer showed no significant difference (p=0.335), but there were notable improvements in bond strength when compared to DMLS CoCr, DMLS CoCr with Opaquer, DMLS Ti, DMLS Ti with Opaquer, Semolina, and Semolina with Opaquer, with DMLS Ti having the largest mean difference (3.368). Conventional Casting with Opaquer significantly outperformed all groups, especially Semolina, which showed the highest mean difference (7.558). Similar trends were seen with DMLS CoCr and DMLS Ti, where Semolina consistently demonstrated superior bond strength. Overall, Semolina produced the highest bond strengths across all conditions. These results underscore the importance of material selection and treatment in enhancing bond strength. Conclusion Semolina can be used as an economicaland reliable method to increase the shear bond strength between acrylic and metal bonding. Its ability to burn out during dewaxing without any remains or remnants in mould deems it a useful material for increasing mechanical bonding.

Magnum of magnet: Rehabilitation of surgical defect post rhinocerebral mucormycosis with hybrid prosthesis

Midfacial defects are defined as ones limited to the middle one-third of the face in the horizontal axis which communes with intraoral maxillary defects. They affect patient’s phonation, chewing capacity, quality of life, and social and community behavior. Surgical reconstruction alone is inadequate to rehabilitate these large midfacial defects, thereby necessitating use of a maxillofacial prosthesis to restore form, function, esthetics and comfort. The present case report presents the prosthetic restoration of a surgical defect secondary to treatment of rhinocerebral mucormycosis with an extraoral (exenteration) and intraoral (Armany Class IV) defect connected with magnetic attachment.

The Effect of Accuracy of All on 4 Mandibular Implant Hybrid Prosthesis Fabricated by Two Different Impression Techniques (Digital versus Conventional) on Bone Loss.

The Effect of Accuracy of All on 4 Mandibular Implant Hybrid Prosthesis Fabricated by Two Different Impression Techniques (Digital versus Conventional) on Bone Loss.

Impact of using a local protocol for preoperative screening exams in hip arthroplasty surgeries: cross-sectional study

Purpose: To evaluate the adoption of a protocol for patients undergoing primary total hip arthroplasty (PTA). Methods: 72 medical records of patients undergoing ATPQ were evaluated between 2016 and 2022. This is a cross-sectional retrospective study. The eligible patients were divided into two groups: group 1 – 36 arthroplasties before the adoption of the protocol; group 2 – 36 arthroplasties after the adoption of the protocol. Statistical analysis was performed using SPSS 13.0. Results: The mean age of the patients was 61 ± 11.7 years, being 42 males and 30 females. Pre-existing comorbidities were: systemic arterial hypertension (58%) and diabetes (18%) patients. The dominant side was operated on in 65% of cases. Patients were treated with cementless prosthesis (54%) of the cases and with hybrid prosthesis (40.3%). Only nine (12.5%) patients had infection. A significant difference was observed with the presence of infection in the group after the implementation of the protocol with a lower incidence. There was a lower infection rate in group 2 submitted to the application of the protocol, however, statistically the significance was not confirmed. Conclusion: It is concluded that the design of the institutional protocol has the potential to reduce postoperative infections in hip arthroplasty surgeries.

Assessment of various treatment techniques in restoring articulatory balance in the mastication center of occlusion

In clinical practice, due to various factors, we are facing patients with few teeth left in the lower jaw, often without any perspective. As a result of the reduced load capacity, they are loosened and can be completely lost. On the other hand, prosthodontics has a great potential for a unique implant - prosthetic rehabilitation. The goal is to preserve the alveolar ridge and slow down its resorption. With the advancement of the technology, conventional dentures are being replaced with more sophisticated therapeutic methods, such as modern prosthodontic superstructures. One of the latest solutions for this problem is the application of the Brånemark system (Nobel Biocare). These restorations that are applied represent a multi-unit system of implants and one hybrid prosthesis. This represents a mobile prosthetic suprastructure, which can be fixed with specific attachments on 4 implants. This combination of placement of a hybrid prosthetic structure on 4 implants is known as „all on four“. There are many discussions and writings about this multidisciplinary concept in the professional world. Over these 4 implants, a suprastructure with maximum 12 teeth can be immediately placed. The prosthetic construction circularly covers the entire toothless mandibular ridge. The data obtained from the patients show difference in the development of the bite force in the mastication center. The results have also shown a better quality of life in patients using a hybrid denture compared to the conventional prosthetic rehabilitation

Mandibular Overdentures When Treating Failing Dentition With Immediate Prosthetic Loading.

Patients may present with failing mandibular dentition either involving the entire arch, partial arch that currently has a partial denture to replace the prior missing teeth or wearing a full denture. Finances may limit restoration of the arch with an All-on-X concept and the patient's goals are a stable prosthesis that does not move whenconcept and the patient's goals are a stable prosthesis that does not move when eating or speaking is the patient's expressed goal. Overdentures can fulfil that goal and provide a stable restored arch at a lower treatment cost than treatment with a fixed hybrid prosthesis. Traditionally, when these type cases have been treated, the remaining dentition has been extracted, depending on availability of bone, implants are placed. Those typically were left to osseointegrate and loaded several months later with a delayed loading approach. This requires relining the denture and the patient having a loose, non-stable prosthesis during that healing phase. An alternative approach utilizes immediate activation of the implants with overdenture attachments thus, providing an immediate stable retentive full arch mandibular removable prosthesis (overdenture) by immediate activation of overdenture attachments (ie.Locators) aids the patient in their goals without delays in treatment. This article will present two case examples of mandibular arches with failing dentition related to caries and periodontal issues and their treatment with immediate implant placement and loading with Locator attachments. Long-term follow-up of 1-year 8-months in one case and 33-months in the other case demonstrate crestal bone stability with this immediate overdenture loading protocol.

A Finite Element Analysis to Study the Stress Distribution on Distal Implants in All-on-Six Treatment Concepts as Affected Tilted and Short Implant.

The number of implants and their respective configurations for implant-supported treatment modalities have been studied for 4 implant-supported prostheses; however, it is not yet clear whether the use of tilting or short implants in rehabilitation would result in substantially improved bone/implant/prosthesis biomechanics in all-on-six concepts. This study compared the biomechanical behavior of tilted long implants and axially short implants to support fixed prostheses in an atrophic maxilla with all-on-six treatment concepts. Three different implant configurations were planned, and six models were obtained with posterior maxilla D3 and D4 bone densities in this study. Implants proper for the all-on-four concept were placed in all models. In models 1 and 2, the short implant was placed; in models 3 and 4, 30°, the mesial-angled implant was placed; and in models 5 and 6, 45°, the mesial-angled implant was placed to the molar region. In the models created, 200 N vertical and 150 N oblique (45° angled buccopalatal direction) forces were implemented to the bilateral tooth regions 4-5-6 on the rigid titanium-supported fixed hybrid prosthesis made on these models. When the stress values in the models were investigated, the oblique forces had higher stress values than the vertical forces did. When the stresses created by oblique forces were assessed, the highest values were observed in the models created with short implants, and the lowest stress values were observed in the models made with 30° angle to mesial. When bone densities were assessed, more stress values were noted in models with D4 bone density. It has been shown that mesial tilted long implants placed in the posterior molar region, in addition to all four implant treatment concepts, create less stress against undesirable oblique forces compared with short implants.

Aortic remodelling based on false lumen communications in patients undergoing acute type I dissection repair with AMDS hybrid prosthesis: a substudy of the DARTS trial.

The Dissected Aorta Repair Through Stent (DARTS) Implantation trial demonstrated positive proximal aortic remodelling following aortic dissection repair with the AMDS hybrid prosthesis. In this study, we look to identify predictors of aortic remodelling following aortic dissection repair with AMDS including whether communications between branch vessels and the false lumen (FL) predict aortic growth. The DARTS implantation trial included patients who underwent acute DeBakey type I aortic dissection (ATAD I) repair with the AMDS from March 2017 to January 2019. Anatomic measurements were collected from original computerized tomography scans. Measurements were taken at zones 2, 3, 6 and 9. Patients were grouped based on the number of FL communications with the supra-aortic branch vessels or visceral branch vessels. Forty-seven patients were included in the original DARTS implantation trial. Patients with FL communications with the supra-aortic branch vessels tended to have significant growth at zone 3 (P = 0.02-0.0018), while greater numbers of visceral FL communications tended to predict aortic growth at zones 3 (P = 0.003), 6 (P = 0.017-0.0087) and 9 (P = 0.0016-0.0003). Aortic remodelling following ATAD I repair using the AMDS may be predicted by local FL communications with branch vessels. Patients undergoing ATAD I repair were more likely to experience significant aortic growth in zone 3 with more head vessel communications and in zones 3, 6 and 9 with more visceral FL communications. Predictors of aortic remodelling may help to guide initial surgical management for aortic dissection patients.