Hybrid Prosthesis Research Articles

Single-centre experience with the frozen elephant trunk technique in 251 patients over 15 years†

Our goal was to present our 15-year experience (2001-2015) with the frozen elephant trunk (FET) technique. A total of 251 patients (82 with aortic aneurysms, 96 with acute aortic dissection type A, 4 with acute type B dissections, 52 with chronic aortic dissection type A, 17 with chronic type B dissection and 67 redo cases) underwent FET implantation with either the custom-made Chavan-Haverich (n = 66), the Jotec E-vita (n = 31) or the Vascutek Thoraflex hybrid (n = 154) prosthesis. The cases were assigned to an early period (2001-2011) and a contemporary period (2012-present). Mean cardiopulmonary bypass time, aortic cross-clamp time, circulatory arrest time and selective antegrade cerebral perfusion time were 241 ± 72, 125 ± 59, 56 ± 30 and 81 ± 34 min, respectively. Incidence of rethoracotomy for bleeding, stroke, spinal cord injury, prolonged ventilatory support (>96 h) and long-term dialysis were 18, 14, 2, 24 and 2%, respectively. The in-hospital mortality rate was 11% (in acute aortic dissection type A, 12%). Of the 2 patients with graft infections, 1 died and the other had a protracted hospital stay. There were 49 second-stage procedures in the downstream aorta: either open surgical [n = 25 (thoraco-abdominal, n = 15; descending, n = 6; infrarenal, n = 4)] or transfemoral endovascular (n = 23). Elective thoracic endovascular aneurysm repair R implantation was successful in all 23 cases. FET results are comparable with those of the published results of the conventional elephant trunk technique. FET is an ideal landing zone for subsequent transfemoral endovascular completion. Patients with graft infections may have dismal results.

Complications and Clinical Considerations of the Implant-Retained Zirconia Complete-Arch Prosthesis with Various Opposing Dentitions

To evaluate the performance of the implant-retained zirconia complete-arch prosthesis with various opposing dentitions. The 40 patients included in this retrospective case series study were treated with one or two implant-retained zirconia complete-arch prostheses (ZIRCAP) using the Zirkonzahn protocol. Prettau zirconia frames were created with strategic cutbacks in the structure to extend zirconia incisal coverage of the esthetic anterior sextants and complete monolithic zirconia in the molar areas; subsequent layers of porcelain were applied to nonfunctional and esthetic areas. Patients had three possible occlusal scenarios: (1) maxillary ZIRCAP and mandibular ZIRCAP, (2) maxillary ZIRCAP and mandibular natural dentition, and (3) maxillary ZIRCAP and mandibular conventional hybrid prosthesis. Complications were recorded during follow-up appointments 3, 6, and 12 months after definitive prosthesis delivery. The mean treatment observation period was 33 months. Eight prosthetic complications were noted for the 40 implant-retained zirconia complete-arch prostheses (18.18%), including six cases of minor porcelain chipping and two cases of debonding of the metal insert from the zirconia framework. Maxillary ZIRCAP opposing mandibular ZIRCAP and maxillary ZIRCAP opposing mandibular natural dentition occlusal scenarios presented the same complication ratio of 4. No complications were seen in the maxillary ZIRCAP opposing mandibular conventional hybrid prosthesis group, yet 16 complications were found as denture tooth fractures in 12 mandibular conventional hybrid prostheses (ratio of 0.75). The results indicate that the implant-retained zirconia complete-arch prosthesis offers acceptable performance for use as an alternative to the conventional titanium framework acrylic veneer prosthesis for complete edentulism with a lower incidence of prosthetic complications and fewer maintenance appointments. Chipping of veneering porcelain was the most common complication, but a low incidence was observed in this study. Acrylic denture teeth may represent the weakest link when restoring complete edentulism with a maxillary ZIRCAP and mandibular conventional hybrid prosthesis.

Elective frozen elephant trunk procedure using the E-Vita Open Plus prosthesis in 94 patients: a multicentre French registry.

Our goal was to evaluate the operative outcomes of the frozen elephant trunk technique using the E-Vita Open Plus® hybrid prosthesis in chronic aortic arch diseases and report clinical and radiological outcomes at the 1-year follow-up. As determined from a prospective multicentre registry, 94 patients underwent frozen elephant trunk procedures using the E-Vita Open Plus hybrid device for the treatment of chronic aortic conditions, including 50% chronic aortic dissections, 40% degenerative aneurysms and 10% miscellaneous indications. Fifty percent of the cases were reoperations. The perioperative mortality rate was 11.7%. Spinal cord ischaemia and stroke rates were 4% and 9.6%, respectively. The mean cardiopulmonary bypass time was 252 ± 97 min, cardiac ischaemia time was 152 ± 53 min and cerebral perfusion time was 82 ± 22 min. Concomitant procedures were observed in 15% of patients. Among the 83 surviving patients, the survival rate after the 1-year follow-up was 98%. Eleven percent of patients underwent endovascular completion, whereas 4% of patients required aortic reintervention at 1 year. The E-Vita Open Plus hybrid device confirms the favourable short- and mid-term outcomes offered by its predecessor in frozen elephant trunk procedures in patients with chronic aortic arch disease. Implantation of the E-Vita Open Plus is associated with good 1-year survival rates, good rates of favourable aortic remodelling in both chronic dissection and degenerative aneurysms and a reproducible technique in a multicentre registry. Continued follow-up is required due to the risk of evolution at the downstream aorta.

Biomechanical evaluation of implant-supported prosthesis with various tilting implant angles and bone types in atrophic maxilla: A finite element study

Background and ObjectiveThe purpose of this study is to evaluate and compare bone stress that occurs as a result of using vertical implants with simultaneous sinus augmentation with bone stress generated from oblique implants without sinus augmentation in atrophic maxilla. MethodsSix, three-dimensional (3D) finite element (FE) models of atrophic maxilla were generated with SolidWorks software. The maxilla models were varied for two different bone types. Models 2a, 2b and 2c represent maxilla models with D2 bone type. Models 3a, 3b and 3c represent maxilla models with D3 bone type. Five implants were embedded in each model with different configurations for vertical implant insertion with sinus augmentation: Model 2a/Model 3a, 30° tilted insertion; Model 2b/Model 3b and 45° tilted insertion; Model 2c/Model 3c. A 150 N load was applied obliquely on the hybrid prosthesis. The maximum von Mises stress values were comparatively evaluated using color scales. ResultsThe von Mises stress values predicted by the FE models were higher for all D3 bone models in both cortical and cancellous bone. For the vertical implant models, lower stress values were found in cortical bone. Tilting of the distal implants by 30° increased the stress in the cortical layer compared to vertical implant models. Tilting of the distal implant by 45° decreased the stress in the cortical bone compared to the 30° models, but higher stress values were detected in the 45° models compared to the vertical implant models. ConclusionsAugmentation should be the first treatment option in atrophic maxilla in terms of biomechanics. Tilted posterior implants can create higher stress values than vertical posterior implants. During tilting implant planning, the use of a 45° tilted implant results in better biomechanical performance in peri-implant bone than 30° tilted implant due to the decrease in cantilever length.

Evaluation of variables influencing success and complication rates in canine total hip replacement: results from the British Veterinary Orthopaedic Association Canine Hip Registry (collation of data: 2010–2012)

The objective of this study was to assess the variables associated with complications of total hip replacement (THR) and report owner-assessed outcomes. Entries into the British Veterinary Orthopaedic Association-Canine Hip...

The Frozen Elephant Trunk Technique: European Association for Cardio-Thoracic Surgery Position and Bologna Experience.

Complex lesions of the thoracic aorta are traditionally treated in 2 surgical steps with the elephant trunk technique. A relatively new approach is the frozen elephant trunk (FET) technique, which potentially allows combined lesions of the thoracic aorta to be treated in a 1-stage procedure combining endovascular treatment with conventional surgery using a hybrid prosthesis. These are very complex and time-consuming operations, and good results can be obtained only if appropriate strategies for myocardial, cerebral, and visceral protection are adopted. However, the FET technique is associated with a non-negligible incidence of spinal cord injury, due to the extensive coverage of the descending aorta with the excessive sacrifice of intercostal arteries. The indications for the FET technique include chronic thoracic aortic dissection, acute or chronic type B dissection when endovascular treatment is contraindicated, chronic aneurysm of the thoracic aorta, and chronic aneurysm of the distal arch. The FET technique is also indicated in acute type A aortic dissection, especially when the tear is localized in the aortic arch; in cases of distal malperfusion; and in young patients. In light of the great interest in the FET technique, the Vascular Domain of the European Association for cardio-thoracic Surgery published a position paper reporting the current knowledge and the state of the art of the FET technique. Herein, we describe the surgical techniques involved in the FET technique and we report our experience with the FET technique for the treatment of complex aortic disease of the thoracic aorta.

Clinical Evaluation of Zygomatic Implant-Supported Fixed and Removable Prosthesis.

The aim of our study was to present success and complication rates of 32 zygomatic implants (ZI) and compare satisfaction of patients rehabilitated with ZI supported hybrid prosthesis in atrophic jaws and removable prosthesis in maxillary defects. Sixteen patients who have been diagnosed as atrophic maxilla or maxillary defect were treated with ZI supported hybrid or removable prosthesis between 2008 and 2016 years, respectively. Thirty-two of 70 implants were placed in the zygomatic bone. Two prosthetic groups were compared 1 month after prosthesis delivery in terms of general satisfaction, stability, performance, esthetics, phonetics, hygiene level based on visual analog scale. Zygomatic implants success rate was found 93.7% after a mean follow-up of 28 ± 22 months (range 6-96 months). Thirty of 32 ZIs have been functioning with their prosthesis. The rate of biologic complications related to ZIs was found 9.3% and prosthetic complication's rate related to ZI was 3%. Two early failures of ZIs were recorded. Chewing performance (P: 0.003), stability (P: 0.0001), and phonetics (P: 0.003) were found higher in hybrid prosthetic group. On the other hand, there was a statistically significant difference between groups in favor of removable prosthetic group regarding ease of cleaning (P: 0.007). Our study shows high success rate and minimal complications for 32 ZIs. This procedure seems to be an alternative to the bone grafts or sinus lifting techniques in patient of severely resorbed maxilla or to the obturator prosthesis for maxillectomy patients.

Technical details making aortic arch replacement a safe procedure using the Thoraflex™ Hybrid prosthesis.

SummaryThe development of new devices to improve treatment and to explore new indications that have not yet been adequately addressed is a natural consequence of the clinical demand for solutions to as yet unmet needs. The frozen elephant trunk technique was one of the major steps within the last 15 years to improve on existing treatments as well as to explore new indications. The goal of this article is to provide technical details about advances in implantation techniques for the treatment of acute and chronic thoracic aortic pathological conditions.

Maxillary arch rehabilitation using implant-supported computer-assisted design-computer-assisted manufacturing-milled titanium framework

Esthetic and functional rehabilitation of completely edentulous maxillary arch with fixed implant supported prosthesis is a challenging task. Newer technologies such as computer assisted design computer assisted manufacturing (CAD CAM) and cone beam conventional tomography play an important role in achieving predictable results. Full mouth porcelain fused to metal (PFM) individual crowns on CAD CAM milled titanium framework provides positive esthetic and functional outcome. This is a case report of rehabilitation of partially edentulous maxillary arch patient. Staged rehabilitation of this patient was planned. In the first stage, root canal treatment of key abutment teeth was done, nonsalvageable teeth were removed, and immediate interim overdenture was provided. In the second stage, five Nobel Biocare dental implants were placed. After integration impressions were made, CAD CAM milled titanium bar was fabricated. Individual PFM crowns were made and cemented. This method gives better esthetic compared to acrylic fused to metal hybrid prosthesis with the advantage of retrievability just like screw retained prosthesis. Hence, this technique is good for rehabilitation of patients with high esthetic demands.

Influence of single-dose intravenous tranexamic acid on total hip replacement : Astudy on transfusions, collateral complications, and readmissions.

To determine the effects of tranexamic acid (TXA) on transfusions in patients undergoing hip replacement with a hybrid or cementless prosthesis. Agroup of 172 consecutive patients aged 18years or older who underwent elective hip replacement with uncemented or hybrid prostheses, undergoing surgery between January 2012 and January 2014 by the same primary surgeon and anesthesiologist, were retrospectively included. TXA (1g) was administered immediately before incision in the TXA group. Primary variables included number of red blood cell transfusions and the influence of TXA for each type of prosthesis. Secondary variables included hematocrit at discharge, length of hospital stay, thrombosis or pulmonary embolism, seizures, and death. Average transfusion was 1.53 units/patient in the control group compared to 0.6units/patient in the TXA group (z= 6.29; U= 1640.5; p< 0.0001). TXA use was significantly correlated with the number of units transfused (p< 0.0001, 95% CI -1.24 to -0.68). Odds risk reduction for transfusion was observed during surgery (OR: 0.14; CI 0.06-0.29; p< 0.0001) and during the rest of hospital stay (OR: 0.11; CI 0.01-0.96; p= 0.046). Both hybrid and cementless prostheses that received TXA were transfused less than control groups (0.57± 1 vs. 1.7± 1 p< 0.01 and 0.65± 1 vs. 1.24± 1 p< 0.01). No difference was observed between the groups regarding adverse effects. Hematocrit values at discharge and length of hospital stay were similar between groups. No deaths were observed during hospital stay. TXA reduced transfusions without increasing the prevalence of adverse effects. This reduction was observed during surgery and the following days of hospital stay for both for hybrid and cementless prosthesis.

Validation of the “Quality of Life related to function, aesthetics, socialization, and thoughts about health-behavioural habits (QoLFAST-10)” scale for wearers of implant-supported fixed partial dentures

ObjectivesTo validate the ‘Quality of Life related to function, aesthetics, socialization, and thoughts about health-behavioural habits (QoLFAST-10)’ questionnaire for assessing the whole concept of oral health-related quality of life (OHRQoL) of implant-supported fixed partial denture (FPD) wearers. Methods107 patients were assigned to: Group 1 (HP; n=37): fixed-detachable hybrid prostheses (control); Group 2 (C-PD, n=35): cemented partial dentures; and Group 3 (S-PD, n=35): screwed partial dentures. Patients answered the QoLFAST-10 and the Oral Health Impact Profile (OHIP-14sp) scales. Information on global oral satisfaction, socio-demographic, prosthetic, and clinical data was gathered. The psychometric capacity of the QoLFAST-10 was investigated. The correlations between both indices were explored by the Spearman’s rank test. The effect of the study variables on the OHRQoL was evaluated by descriptive and non-parametric probes (α=0.05). ResultsThe QoLFAST-10 was reliable and valid for implant-supported FPD wearers, who attained comparable results regardless of the connection system being cement or screws. Both fixed partial groups demonstrated significantly better social, functional, and total satisfaction than did HP wearers with this index. All groups revealed similar aesthetic-related well-being and consciousness about the importance of health-behavioural habits. Several study variables modulated the QoLFAST-10 scores. ConclusionsHybrid prostheses represent the least predictable treatment option, while cemented and screwed FPDs supplied equal OHRQoL as estimated by the QoLFAST-10 scale. Clinical significanceThe selection of cemented or screwed FPDs should mainly rely on clinical factors, since no differences in patient satisfaction may be expected between both types of implant rehabilitations.

Fabrication of an Implant‐Supported Fixed Interim Prosthesis Using a Duplicate Denture: An Alternative Technique

The fabrication of an implant-supported fixed complete denture prosthesis involves multiple clinical and laboratory steps. One of the main steps is to provide the patient with an interim fixed prosthesis to evaluate the patient's esthetic and functional needs as well as to enhance the patient's psychology before proceeding to the definitive prosthesis. Different techniques for fabricating interim prostheses have been described in the literature. This report describes an alternative technique that uses a duplicate denture made of self-curing acrylic resin to fabricate an implant-supported fixed interim prosthesis. The interim prosthesis was later used as a blueprint for the definitive implant-supported hybrid prosthesis.

Validation of a new, specific, complete, and short OHRQoL scale (QoLFAST-10) for wearers of implant overdentures and fixed-detachable hybrid prostheses

ObjectivesTo validate a new index for assessing the whole concept of oral health-related quality of life (OHRQoL) of implant-prosthesis wearers. Methods113 patients who were not requesting dental treatment were assigned to: Group 1 (CD; n=38): complete denture users (control); Group 2 (IO; n=38): implant overdenture wearers; and Group 3 (HP; n=37): hybrid implant prosthesis users. Patients answered the newly-designed ‘Quality of Life related to Function, Aesthetics, Socialization, and Thoughts about health-behavioural habits’ (QoLFAST-10) and the Oral Health Impact Profile (OHIP-20sp) questionnaires. Information on global oral satisfaction, socio-demographic, clinical, and prosthetic-related data were gathered. The QoLFAST-10 was investigated for reliability and validity. The Spearman’s test determined the correlations between both indices’ scores. Descriptive and non-parametric probes were run to assess the influence of the study variables on the OHRQoL (α=0.05). ResultsThe QoLFAST-10 confirmed its psychometric capacity. HP wearers reported significantly better global and functional satisfaction than did IO wearers. The latter revealed significantly less consciousness about the importance of health-behavioural habits than did CD and HP groups. The level of education, complaints about the mouth, and the global oral satisfaction measures significantly modulated the QoLFAST-10 scores. ConclusionsImplant overdentures supplied lower functional and global satisfaction than did hybrid prostheses, and represent the least predictable option concerning the maintenance of the restoration. Clinical significanceThe QoLFAST-10 may help in estimating the impact of implant restorations on patients’ well-being. In this regard, hybrid prostheses seem to be the implant treatment of choice when compared with overdentures.

Impact of fixed implant supported prostheses in edentulous patients: protocol for a systematic review

IntroductionEdentulism is a debilitating and irreversible condition described as the ‘final marker of disease burden for oral health’. Therapy with dental implants is being used on a large scale to...

The Retread: A Definition and Retrospective Analysis of 205 Implant-Supported Fixed Prostheses.

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

Minimally invasive approach for aortic arch surgery employing the frozen elephant trunk technique.

Classically, repair of extensive thoracic aortic pathologies including the aortic arch and descending aorta required two separate major surgical procedures via full sternotomy and a subsequent left lateral thoracotomy. We describe herein our preliminary institutional experience with minimally invasive single-stage extended thoracic aortic replacement employing the frozen elephant trunk (FET) technique via partial upper sternotomy (PUS) in 14 patients. Between December 2013 and January 2015, 14 consecutive patients with elective indications for FET underwent minimally invasive FET via PUS (PUS-FET) during moderate systemic hypothermia (28°C) and selective antegrade cerebral perfusion (ACP) using the E-vita Open® hybrid prosthesis (Jotec GmbH, Hechingen, Germany). The patients' mean age was 66 ± 6 years, and 9 patients (64%) were male. The arch vessels were reimplanted en bloc in all patients. Clinical data were prospectively entered into our institutional database. The surgical procedure was successful in all patients with no need for conversion to full sternotomy. An additional David procedure was performed in 1 patient, whereas 2 patients received a concomitant Bentall procedure. There was no perioperative death or 30-day mortality. The mean cardiopulmonary bypass time was 214 ± 35 min, and the myocardial ischaemic time was 125 ± 14 min. The ACP time was 54 ± 9 min, whereas the ventilation time reached 11 ± 4 h. Intensive care unit stay was 2 ± 3 days. Chest tube drainage within the first 24 h was 460 ± 130 ml. None of the 14 patients required re-exploration for bleeding. Patients were discharged after a hospital length of stay of 9 ± 2 days. No postoperative permanent neurological complication occurred. Two patients (14%) experienced temporary delirium with complete resolution of symptoms prior to discharge from the hospital. Our preliminary experience suggests that minimally invasive single-stage extended thoracic aortic replacement can safely and reproducibly be performed by employing the concept of PUS-FET.

Endovascular approach to complex aortic arch pathologies: state of the art.

Aortic geometry changes during life [1]. After relatively dynamic aortic length and diameter growth in the first two decades of life, it continuous to grow, attaining diameters 20 to 30% larger in the 7th than in the 2nd decade. Arterial hypertension, atherosclerosis, and still poorly-defined genetic risk factors add to natural aortic anatomy changes leading to rapid aortic segmental growth and ultimately aneurysms. Aortic arch aneurysms together with arch dissections and penetrating atherosclerotic ulcers are the most common arch pathologies requiring further therapy. New technologies give us an excellent opportunity to broaden the surgical armamentarium. Thoracic endovascular aortic repair (TEVAR) has dramatically changed aortic surgery within the last 15 years. It is not only a far less invasive approach than open surgery, but it also provides excellent results for complex pathologies in certain patients and may be applied even in those ineligible for open surgery [2, 3]. Thoracic endovascular aortic repair became the treatment of choice for traumatic aortic injury and acute complicated type B dissection. Aortic arch pathologies due to the arch's key role in maintaining cerebral perfusion usually require complex treatment. Several hybrid surgical techniques have been developed in the last decade, which combine an endovascular and open approach to obtain better results. The hybrid approach includes hybrid surgical procedures (TEVAR combined with surgical rerouting of supraaortic vessels) and the hybrid devices originating from traditional prostheses employed during open and endovascular procedures. The hybrid approach to the aortic arch is associated with less trauma, usually no need for the heart-lung-machine, no need for hypothermia or artificial cerebral perfusion, and no risk or recurrent nerve paresis. The complications related to hybrid procedures include retrograde aortic dissection type A, endoleaks, and stentgraft migration. According to the Penn classification, there are three types of hybrid approach to aortic arch pathologies [4]. Type I includes supraaortic vessels debranching using a 4 limb branched graft anastomosed to the very proximal ascending aorta (just above the sinotubular junction) and on the other side to all supraaortic vessels. The fourth branch is used to insert the stent graft in antegrade direction into the aortic arch. Type I is being performed only sporadically since it carries a relatively large risk of retrograde aortic dissection type A. Type I hybrid approach is contraindicated in case the ascending aorta diameter exceeds 3.8 cm. More popular is type II hybrid approach consisting of creating a zone 0 landing zone by replacing the ascending aorta in an open fashion and debranching the supraaortic vessels similar to type I, followed by the TEVAR procedure [5]. Its main advantage is that it is not associated with the risk of retrograde dissection. However, it necessitates sternotomy and the heart-lung-machine. Penn type III hybrid approach is a frozen-elephant-trunk procedure that includes total aortic arch replacement and stentgraft implantation in the proximal descending thoracic aorta using a hybrid prosthesis. Total endovascular arch replacement is now feasible, and two similar devices are already available. Both include one main stent graft specifically for implantation starting in the ascending and ending in the proximal thoracic descending aorta (Fig. 1). Both have 2 internal tunnels (inner branches) that are extended with stent grafts into the brachiocephalic trunk and the carotid artery. This operation requires prior carotid-subclavian bypass on the left side [6]. The ascending aorta diameter should not exceed 3.8 cm. Fig. 1 Double inner branched stent graft in the aortic arch of the patient with penetrating atherosclerotic ulcer. A – aortic stent graft, B – brachiocephalic trunk, C – left carotid artery, D – carotid-subclavian bypass The open-surgical approach to the aortic arch is the gold standard. Further development of less invasive endovascular treatment options is mandatory, since they may be beneficial for older patients with significant comorbidities who may not tolerate prolonged cross-clamp and circulatory arrest times. Transcatheter aortic valve implantation technology has not reduced the number of conventional aortic valve replacement procedures. Similarly, although endovascular aortic arch replacement is not likely to replace open surgery, it will expand our armamentarium and enable us to recruit new patients undergoing medical treatment only due to their excessive risk of conventional arch replacement.

Planning Implant Placement on 3D Stereolithographic Models Applied with Immediate Loading of Implant-Supported Hybrid Prostheses After Multiple Extractions: A Case Series

The aim of this noninterventional, retrospective case series was to evaluate the outcome of immediately loaded implants in patients with failing dentitions that require bone tabling using a bone reduction guide and a surgical guide manufactured directly on three-dimensional (3D) stereolithographic models. Consecutive patients with failing dentition and at least two remaining teeth who were treated in a single center between December 14, 2009 and September 23, 2013 were eligible. All patients receiving implants loaded with a hybrid prosthesis on the same day as extraction with their surgery planned on 3D models and performed using a surgical guide manufactured in a laboratory on the planning model were included. Patients who had undergone bone grafting procedures were excluded. Descriptive statistical analyses of available data were performed, including life-table calculations to derive a cumulative survival rate (CSR). Two hundred twenty-eight patients (105 females and 123 males) received 1,657 implants (NobelActive) in 321 arches, in most cases 5 implants (range, 5 to 7) per arch. Ten preexisting implants were used. The mean insertion torque was 60.02 ± 13.1 Ncm (range, 15 to 75 Ncm). The definitive abutment was placed on the same day as surgery in all cases, and the definitive prosthesis (n = 304) was delivered after a mean of 7.9 ± 2.6 months. All implants were followed for 20.01 ± 11.3 months (range, 0 to 52 months) from implant insertion. Four implants (3 patients) had delayed loading, and one implant was left as a sleeping implant. Eight implants among six patients failed, two of the implants after prosthesis delivery. The CSR of the placed implants was 99.4% at implant level and 96.2% at patient level. Planning on 3D models to remove bone and place implants using custom-made bone reduction and surgical guides with immediate loading on the same day as extraction of remaining teeth was safe and effective for implant survival and rehabilitation of patients with periodontitis and failing dentition.

Hybrid prosthesis or overdentures. Which to choose in our elderly the cantilever predicament

Hybrid prosthesis or overdentures. Which to choose in our elderly the cantilever predicament

Implant – Supported Full Mouth Rehabilitation: A Guided Surgical and Prosthetic Protocol

Implant – Supported Full Mouth Rehabilitation: A Guided Surgical and Prosthetic Protocol