Implant-prosthetic Rehabilitation Research Articles

Oral health-related quality of life in implant-supported rehabilitations: a prospective single-center observational cohort study

BackgroundOral Health-Related Quality of Life (OHRQoL) is a comprehensive concept covering daily comfort, self-esteem, and satisfaction with oral health, including functional, psychological, and social aspects, as well as pain experiences. Despite abundant research on OHRQoL related to oral diseases and hygiene, there is limited data on how patients perceive changes after implant-prosthetic rehabilitation. This study aimed to evaluate OHRQoL and aesthetic perception using OHIP-14 and VAS scales respectively, before (baseline-TB), during (provisional prostheses-TP), and after (definitive prostheses-TD) implant-prosthetic rehabilitation. It also explored the impact of biological sex, substitution numbers, and aesthetic interventions on OHRQoL and VAS scores, along with changes in OHIP-14 domains.MethodsA longitudinal prospective single-center observational cohort study was conducted with patients requiring implant-prosthetic rehabilitation. Quality of life relating to dental implants was assessed through the Italian version of Oral Health Impact Profile-14 (IOHIP-14), which has a summary score from 14 to 70. Patients’ perceived aesthetic was analyzed through a VAS scale from 0 to 100. Generalized Linear Mixed Effect Models, Linear Mixed Effect Models, and Friedman test analyzed patient responses.Results99 patients (35 males, 64 females) aged 61–74, receiving various prosthetic interventions, were enrolled. Both provisional and definitive prosthetic interventions significantly decreased the odds of a worse quality of life compared to baseline, with odds ratios of 0.04 and 0.01 respectively. VAS scores increased significantly after both interventions, with estimated increases of 30.44 and 51.97 points respectively. Patient-level variability was notable, with an Intraclass Correlation Coefficient (ICC) of 0.43. While biological sex, substitution numbers, and aesthetic interventions didn’t significantly affect VAS scores, OHRQoL domains showed significant changes post-intervention.ConclusionsThese findings support the effectiveness of implant-prosthetic interventions in improving the quality of life and perceived aesthetics of patients undergoing oral rehabilitation. They have important implications for clinical practice, highlighting the importance of individualized treatment approaches to optimize patient outcomes and satisfaction in oral health care.

One Piece CAD/CAM Abutment for Screw-Retained Single-Tooth Restorations: A 5-Year Prospective Cohort Study.

The use of ceramic-coated patient-specific CAD/CAM titanium abutments represents a therapeutic option for the rehabilitation of single tooth. The utilization of highly customized abutments enables the accurate three-dimensional positioning of the prosthetic emergence. This study evaluates the clinical performance of implant-prosthetic rehabilitations carried out using ceramic-coated CAD/CAM titanium abutments. Thirty implants were placed in thirty patients and rehabilitated with thirty single crowns attached to CAD/CAM titanium abutments. A conventional procedure was applied, with implant placement after post-extraction socket healing and prosthetic restoration after implant healing. Implants of lengths ranging from 6-15 mm and widths of 3.6, 4.2, and 4.8 mm were used in this study. At the time of prosthesis delivery (T0), after two years (T1), and after five years (T2), plaque (PI) and bleeding (BoP) indices, probing depths (PPD), marginal bone levels (MBL), and PES/WES were evaluated for each implant. No patient dropped out of the study during the follow-up period. All thirty implants were clinically successful at five years post-prosthesis delivery (survival rate: 100%) and showed no signs of peri-implant infection. Peri-implant soft tissues were in good health (BoP at T2: 0% in 73% of patients; 25% in 13% of patients; 50% in 10% of patients; and 75% in 3% of patients). The mean PPD was 2.05±0.56 mm at T0, 1.992±0.6 mm at T1, and 1.867±0.439 mm at T2. The mean MBL at T0 was 0.413±0.440 mm, at T1 was 0.306±0.388 mm, and at T2 was 0.263±0.368 mm. The mean PES, WES, and PES/WES indices, 7.43±1.04, 7.57±0.82, and 15.00±1.17, respectively, indicate good integration of soft tissues, satisfactory aesthetics, and an overall positive outcome. The success rates, maintenance of marginal bone levels, and periodontal and aesthetic indices suggest the validity of implant-prosthetic rehabilitations with CAD/CAM abutments in cases of single crowns.

Outcomes of treatment with short dental implants compared with standard-length implants: a retrospective clinical study

BackgroundThe size of dental implants is a key success factor for appropriate osseointegration. Using shorter implants allows the possibility of avoiding complex surgical procedures and reduces the morbidity of treatment. Shorter implants also enable implant-prosthetic rehabilitation after maxillofacial reconstructions where only limited bone is available. In this study, the success rates of short implants were examined and compared to those of standard-sized implants.MethodsPatients who received dental implants between 2007 and 2016 at the Department of Oro-Maxillofacial Surgery and Stomatology Semmelweis University were enrolled in the study. Several clinical parameters were recorded and supplemented with radiological examinations. The data were statistically analysed.ResultsThirty-four patients with a total of 60 implants were included. The average time after prosthetic loading was 39.33 ± 21.96 months in the group with 8-mm implants and 41.6 ± 27.5 months in the group with > 8-mm implants. No significant differences were observed between the two groups in terms of probing depth (short implants, 2.84 ± 0.09 mm; standard implants, 2.91 ± 0.35 mm) or mean marginal bone loss (short implants, 1.2 ± 1.21-mm mesially and 1.36 ± 1.47-mm distally; standard implants: 0.63 ± 0.80-mm mesially and 0.78 ± 0.70-mm distally).ConclusionsIn this study, the success rate of short dental implants was comparable to that of standard-sized implants. Consequently, it can be claimed that the long-term success of short dental implants does not differ significantly from the long-term success of standard implants.

Computer-guided Surgery in Anterior Esthetic Area with Autologous Deciduous Tooth-Derived Material: Case Report

Background The literature has described several biomaterials for guided bone regeneration. Some authors have proposed using a material derived from dentin/ enamel among autologous biomaterials. This study aims to test the effectiveness of autologous material derived from deciduous teeth in guided bone regeneration. Case Presentation A 24-year-old female shows up with missing tooth #1.1 for a domestic accident. This requires implant-prosthetic rehabilitation. It is decided to be performed before implant therapy, a bone regeneration guided using biomaterial resulting from the patient’s deciduous teeth stored in a plastic box. GBR (Guided Bone Rehabilitation) is performed, and after 6 months, the implant is inserted by computer-guided surgery, and then a provisional prosthesis is placed. Discussion The material deriving from deciduous teeth, not preserved with precautions, has had excellent integration results. This allowed the implant to be placed in the best position for the final prosthetic rehabilitation. Conclusion This clinical case shows that using biomaterial derived from deciduous teeth has allowed an excellent result with negligible biological cost.

Full Arch Implant-Prosthetic Rehabilitation in Patients with Cardiovascular Diseases: A 7-Year Follow-Up Prospective Single Cohort Study.

Aim: The rising average age increases edentulous cases, demanding more implant-prosthetic rehabilitation, with cardiovascular diseases being significant factors. This study compared healthy patients (CG = Control Group) and those with cardiovascular disease (TG = Test Group) for implant survival, Marginal Bone Loss (MBL), peri-implant tissue level parameters as Periodontal Screening and Recording (PSR), Plaque Index (PI), Bleeding on Probing (BoP) Peri-implant Probing Depth (PPD), and surgical complications. Smoking impact on both groups and medication influence in the TG were secondary outcomes. Patients underwent full-arch implant prosthetic rehabilitation. Methods: Implant survival rate, MBL, and surgical complications were recorded during the monitoring period (7 years), while peri-implant parameters were assessed at the end of the observational time. A total of 26 and 28 CG and TG patients were recruited, respectively. Results: A total of 128 implants were placed in CG, while 142 in the TG. Implant survival and MBL showed no significant differences (p > 0.05). Nevertheless, peri-implant parameters were more unfavorable in TG. The only significant surgical complication was higher bleeding rates in the TG (p < 0.05). Conclusions: Cardiovascular patients showed similar implant survival and MBL but had adverse peri-implant parameters and increased bleeding rates. Higher smoking levels may relate to unfavorable implant outcomes. Further investigation is needed on drug impact with larger samples.

The possibilities of additive technologies for targeted tissue regeneration and implantation in a patient with a mandibular defect. A clinical case

After injury or removal of neoplasms, bone, soft tissue scar defects and deformities are formed. Methods of reconstructive bone surgery do not reliably allow to restore defects in full. The main problem is constriction, subsequent atrophy and deformation of soft tissues in the defect area. Dental implant-prosthetic rehabilitation in the area of significant bone defects requires the use of design and prototyping of the final result using computer programs and diagnostic models. The clinical experience of using an individual temporary endoprosthesis, a «tissue expander» made by layer-by-layer synthesis (3D printing) of biologically inert plastic according to CT data of the patient is presented. The expander is made in the form of a 3D element for the formation of the necessary volume of soft tissues in the patient for a period of 2–4 months, fixed under the periosteum, in the area of the lateral defect of the lower jaw with intraosseous screws. Dental implants are installed in front. Intraoperative direct prosthetics was performed. A temporary screw prosthesis is installed in the mouth. After 3 months, 3 implants were installed and bone grafting was performed. Final prosthetics 7 months after the start of treatment.

Rehabilitation of patients with severe atrophy of the upper jaw using the “quad zygoma” protocol. Clinical case

The implant-prosthetic rehabilitation of patients with severe atrophy of the upper jaw can be postponed only after the necessary bone supply has been created or through alternative implantation methods in anatomical areas adjacent to available bone, such as the zygomatic bone. Objective: To present the method of inserting zygomatic implants and analyzing the efficacy of the method. Based on a clinical case of implant-prosthetic rehabilitation using the “Quad Zygoma” protocol, patient A.M., aged 58, was diagnosed with “Kennedy Class I Partial Subtotal Edentulism. Misch Class D bone atrophy in the anterior region and Misch SA-4 in the posterior sectors of the maxilla. Generalized chronic periodontitis of moderate-advanced form.” The effectiveness of the applied method was demonstrated.

Early implant placement Type 2, using flapless technique in one surgical stage. Five years follow-up

Postextractional implants placement is frecvently discussed in the literature as a method aimed to facilitate implant-prosthetic rehabilitation and preservation of alveolar bone. However, the opinions are divergent while the obtained results often are unfavorable due to bone loss and mucosal recessions. An alternative for postextractional placement is early type 2 implants placement. The study was based on results evaluation of 51 implants insearted in early period after teeth extractions (type 2) in one surgical step, using flapless surgery, without removing the socket content. For evaluation of healing process in the socket, histological analyses of it’s content were performed at 2, 4 and 8 weeks periods. The obained results showed that early implant placement type 2 is a safe method with an integration rate similar to the conventional method. The presence of healed soft tissues is an advantage upon the postextractional placement. The preservation of socket primary matrix lead to a good bone healing around implants without necessity of grafting.

Peri-implant health after microvascular head and neck reconstruction-A retrospective analysis.

Prosthodontic rehabilitation after reconstruction with microvascular revascularized free flaps following ablative tumor surgery is challenging due to the altered anatomical and functional conditions. The aim of this retrospective study was to determine whether the type of graft and the type of peri-implant tissue have an effect on peri-implant inflammatory parameters and implant survival. Patients who received a free flap reconstruction with subsequent implant-prosthetic rehabilitation between 2010 and 2022 were retrospectively included. The primary outcome variable was the probing depth (PPD) at a minimum of 1 year after completion of prosthetic restoration. Predictive variables were type of free flap, emergence profile, and history of radiation. Seventy-one patients after free flap reconstruction were included in the analysis. At a minimum of 24 months after implant insertion the primary outcome, PPD showed no clinically relevant differences between the types of free flaps used. The emergence profile through a skin island resulted in an increase in BOP compared to native mucosa in the descriptive analysis (p-value > .05). The analysis showed a 5-year implant survival of 96.2% (95% CI: 0.929-0.996) in cases without irradiation and 87.6% (95% CI: 0.810-0.948) with irradiation of the region evaluated (p-value .034). Flap and associated soft tissue type had no significant effect on 5-year implant survival or peri-implant inflammatory parameters. However, the large heterogeneity of the patient population indicates that further prolonged studies are required for a more differentiated assessment of the long-term success.

Full-Arch Implant-Prosthetic Rehabilitation in Patients Affected by Hypertension: A Randomized Clinical Trial at 7 Years Follow-Up

The aim of this clinical study was to investigate and compare implant survival rates, marginal bone loss, and surgical and prosthetic complications of healthy patients and subjects affected by hypertension receiving full-arch implant-prosthetic rehabilitation. From January 2016 to November 2016, patients affected by total edentulism of one or both arches or severe impairment of residual teeth who needed full-arch implant-prosthetic rehabilitation and who had the absence of any systemic diseases or the presence of hypertension as a single pathology were randomly selected. According to the inclusion criteria, 39 patients were enrolled for this study. The sample was divided into two groups: A total of 18 patients were included in Group A (healthy patients), and 21 patients were included in Group B (patients affected by hypertension). No statistically significant difference in implant survival rates, marginal bone loss, and prosthetic complications were observed between Group A and Group B. Except for variable bleeding, the results of the Pearson’s chi-square test and z-test at a 99% confidence level suggest that there is no statistically significant difference in clinical complications between the groups. Within the limitations of this study, full-arch implant-prosthetic rehabilitation could be a feasible option for treating patients with hypertension, provided that hypertension is compensated and controlled.

Clinical and Radiographic Follow-Up of Full-Arch Implant Prosthetic Rehabilitations: Retrospective Clinical Study at 6-Year Follow-Up

Aim: the aim of this retrospective clinical study was to evaluate clinically and radiographically full-arch implant prosthetic rehabilitations supported by six axial implants or four implants placed according to the All-on-Four protocol. Materials and methods: Patients in need of immediately loaded full-arch implant prosthetic rehabilitations of one or both arches were considered. Follow-up visits were performed one week after surgery, at 3 and 6 months and then once a year for the next 6 years to record implant survival, peri-implant parameters, marginal bone loss, bone cortical thickness and possible muscular, articular and prosthetic complications. A satisfaction evaluation questionnaire was also made available to all patients at the end of the follow-up period. Results: A total of 30 patients with total edentulism of one or both arches or need for avulsion of residual impaired teeth were enrolled for this study and underwent implant prosthetic rehabilitation on four or six implants. The overall implant survival rate at the six-year follow-up was 98.09%. Statistical analysis revealed a significant association between implant site and higher plaque and bleeding index in the posterior site. The extent of keratinized tissue was statistically superior in anteriorly located implants. Statistical analysis showed a significant difference between the values of bone-marginal levels as a function of time. The vestibular and palatal/lingual bone cortices were preserved, with an increasing trend in the apical direction. Regarding muscular and articular complications, the results of this study showed statistically significant differences between the mean values recorded in male and female subjects, while the most frequently encountered problems during the clinical evaluation were the presence of joint clicks and pain in the masseter muscles. Two of the patients examined showed problems with mandibular latero-deviation and prosthetic fracture. Conclusion: within the limitations of the present study, immediate implant-retained prosthetic rehabilitations supported by six axial implants or four fixtures placed according to the All-on-Four method could represent a valid therapeutic alternative to provide edentulous patients with restoration of masticatory function and aesthetics and promote their acceptance.

Implant digital impression accuracy using extraoral scanners

Aim: To analyze the accuracy of extraoral systems (Ceramill Map400+, AutoScan-DS200+, and E2) in full implantprosthetic rehabilitation three-dimensionally. Methods: A metallic edentulous maxilla with four implants was digitalized by a contact scanner (MDX-40 - Roland, control) and used as a control image to compare with other images generated by three laboratory scanners (10 samples per group). Letters identified all the four components: A and D angled 45º, and B and C parallel. The BioCAD software exported the images (.STL) to compare and verify deviations of the analogs on the X, Y, and Z axes. The nonparametric Kruskal-Wallis test and the two-way ANOVA on ranks with a post hoc Tukey test analyzed the data with 5% significance. Results: No statistical differences were observed in the accuracy between the extraoral scanners (p=0.0806). However, when analyzing only the components, component D was more accurate when scanned with Ceramill Map400+ compared with AutoScan DS200+ (p&lt;0.001) and with E2 (p=0.002). Conclusions: All extraoral systems assessed showed digitalization accuracy but with more deviations in angled implants. The Ceramill Map400+ scanner showed the best results for the digital impression of a complete arch.

Clinical, Radiological, and Aesthetic Outcomes after Placement of a Bioactive-Surfaced Implant with Immediate or Delayed Loading in the Anterior Maxilla: 1-Year Retrospective Follow-Up Study

Background: Dental implants have become the standard for replacing missing teeth. However, patients’ demands for shorter treatment times and the desire for aesthetics in their results can complicate the rehabilitation process, particularly when poor-quality bone is involved. In order to address these challenges, new methods of treating implant surfaces have been introduced. These methods aim to make the implants superhydrophilic and bioactive, enhancing their functionality and interactions with the surrounding tissues. Aim: The aim of the study was to retrospectively examine the efficacy of a superhydrophilic and bioactive implant for treatment of the edentulous maxillary anterior area. The study also aimed to evaluate whether this improved implant surface, by enhancing the osseointegration processes, could serve as a factor in speeding up the loading protocols. Materials and Methods: For this retrospective study, a total of 13 implants were included: 6 delayed restored implants and 7 immediately loaded implants placed in the anterior maxillary area. Clinical, radiographic, and esthetic outcomes were assessed. Baseline measurements of the insertion torque value (ITV) and stability implant quotient (ISQ) were recorded for all implants. In the early-loaded group, these measurements were also taken 30 days (t30) and 45 days (t45) after the placement of the implant to monitor their changes over time. Marginal bone loss (MBL) was calculated according to the changes in marginal bone level on intraoral X-rays taken at two different time points: at baseline and one year after loading. To evaluate the esthetic results, the pink esthetic score (PES) and the white esthetic score (WES) were assessed. For this evaluation, intraoral photographs were taken one year after implant loading. Results: A total of 7 implants were immediately restored, with a mean ITV of 32.29 ± 9.01 Ncm and a mean ISQ of 72.71 ± 2.81. These implants were placed in a bone environment with a mean density of 410.00 ± 194.42 HU. On the other hand, 6 implants with delayed loading had a mean ITV of 28.50 ± 3.27 Ncm, an ISQ of 67.92 ± 8.43, and a mean bone density of 607.50 ± 140.83 HU. The mean PES and WES after 1 year were, respectively, 8.71 ± 1.89 and 8.57 ± 0.79 for immediate and 8.33 ± 1.36 and 9.17 ± 1.33 for delayed-loaded implants. At 12 months after loading, the immediately loaded group had a MBL of 0.29 ± 0.29 mm, while the delayed-loaded group had a MBL of 0.33 ± 0.25. No statistically significant differences between the two treatment groups were found for any of the evaluated outcomes. Conclusions: Despite the limitations of this study, the obtained results may support the use of a superhydrophilic and bioactive implant surface for implant-prosthetic rehabilitation in critical loading protocols with satisfactory esthetic results.

Prosthetic rehabilitation with implant-supported fixed prosthesis in a completely edentulous patient: A clinical report

To present clinical strategies for prosthetic rehabilitation of completely edentulous patients using immediate-loading basal implants.A 58-year-old female patient was referred to the Department of Prosthodontics for restoration of her completely edentulous maxilla and mandible with a fixed full-arch implant-prosthetic rehabilitation. Since the patient lacks adequate bone in the posterior maxilla and is not willing to undergo a removable interim prosthesis, an immediate loading protocol along with 8 single-piece basal implants, including 2 pterygoid implants in the maxillary arch and 6 single-piece basal implants in the mandibular arch, was selected as the treatment option, followed by an acrylic provisional restoration. Four months later, a definitive fixed implant-supported prosthesis was delivered.This treatment strategy may be considered for rehabilitating patients with atrophic ridges demanding fixed provisional prostheses throughout the healing period and can be employed even in immediate implant placement after extraction.

Lateral sinus floor elevation with simultaneous mucosal cysts management

Introduction. Specialists in the field often face uncertainty in deciding whether to perform sinus lifting surgery in the presence of a mucosal cyst during the pre-implantation preparation of patients with maxillary sinus pathology. While some specialists believe that the sinus lifting operation cannot be performed in the presence of sinus pathology and should be resorted to after a long period of healing, others believe that it can be performed in the presence of sinus pathology or simultaneously with sinus sanitation. As a result, there are more controversies about the treatment tactics, stages, and timing required to achieve the rehabilitation of these patients, demonstrating the significance of the problem at hand. Materials and methods. The study included twenty patients who were referred to the Department of OMF Surgery and Oral Implantology “Arsenie Guţan” and the dental clinic “OmniDent” between 20.06.2016 and 01.01.2019 for implant-prosthetic rehabilitation due to partial edentulism in the upper jaw in the lateral area and the presence of a mucosal cyst in the maxillary sinus. The first group comprised of seven patients in whom the mucosal cyst was completely removed while simultaneously undergoing lateral sinus lifting. The second group consisted of five patients, aged between 18 and 67 years (average 45 years), who underwent marsupialization of the mucosal cyst. The third group comprised of six patients in whom the cyst content was only aspirated, without removal or marsupialization of the cyst. Results. All three methods were found to be effective, although total perforations of the sinus mucosa were recorded in the first two groups, preventing the performance of sinus lifting at that stage. The method of aspirating the cystic content, however, is a simple and low-risk procedure that does not carry the risk of perforating the sinus membrane and provides predictable results. Conclusions. The mucosal cyst does not present a contraindication to sinus lifting but requires additional surgical procedures.

Assessment of fully digitalized workflow for implant-prosthetic rehabilitation in temporomandibular disorders patients: A clinical study

Digitalized workflow eliminates the need for the tray, impression materials, its decontamination, packaging and shipping, pouring with plaster, cast fabrication, mounting in an articulator, reducing storage spaces, and the risks of any loss or fracture of the plaster model is overcome by archiving on the computer. This clinical investigation aimed to evaluate the effectiveness of the fully digitalized rehabilitation [implant-supported prosthesis] method in partially edentulous patients and with TMD, using advanced software. Twelve patients requiring implant-supported prosthesis in the mandibular molar area with Temporomandibular disorders [TMD] were selected. The fully digitalized rehabilitation method with advanced software was used for rehabilitation. For each subject, Optical impressions, CBCT scan, and Digital recording of jaw movement data. Guided implant surgery and digitalized prosthetic rehabilitation; were performed. The effectiveness of the digitalized workflow was assessed by evaluating the changes in the joint symptoms before and after the end of the treatment, changes in the electromyographic tracings, the precision of the prosthetic artefact, assessed through the amount of chair adjustment operating time and the number of retouching/ modifications to be carried out before the completion of the work. The results showed that the mean operative time required in 12 patients was 9.42 min, significantly less than the time recorded in previous studies when the medium mean was 16.00 min. The mean number of touch-ups [adjustments] was less than 3, most of which were on the interproximal surfaces. There were no significant changes recorded in the electromyography tracings. There were also no changes in joint symptoms. It was found that this way of working was entirely reliable and significantly reduced operating times and the number of appointments. Digital flow is beneficial ei dysfunctional patients, not about improvements in temporomandibular symptoms but in times of operability and prosthetic retouching.

Effectiveness of Bichat's Buccal Fat Pad (BFP) Technique for Vertical Ridge Augmentation in the Maxilla.

This study evaluated the efficacy of buccal fat pad (BFP) as a natural barrier to cover nonresorbable devices for vertical ridge augmentation (VRA). Twelve consecutive patients with 14 vertical bone defects in need of bone augmentation for implantprosthetic rehabilitation were treated according to the described protocol. VRA was performed by means of customized titanium meshes, titanium-reinforced d-PTFE membranes, or resorbable membranes and titanium plates. After buccal flap release, the BFP was identified and isolated, then mesially and coronally advanced to cover the whole augmented area. BFP was used as a pedicle flap in 11 cases and as a free graft in 3 cases. The mean BFP surface area was 13.5 ± 5.5 cm2. Healing was uneventful in all 14 augmented sites. No patients reported healing complications or facial volumetric changes. The mean vertical bone gain (VBG) was 4.2 ± 1.8 mm. In this limited number of cases, using the BFP as a natural barrier has proven to be efficient in bone augmentation, as it improved the healing process while reducing the risk of complications. Int J Periodontics Restorative Dent 2023;43:e99-e109. doi: 10.11607/prd.5473.

Electromyographic Evaluation of Muscle Activity in Patients Rehabilitated with Full Arch Fixed Implant-Supported Prostheses

Background and Objectives: Implant rehabilitation of complete edentulous arches has become more and more popular because of the increased access of the population to this type of treatment. Furthermore, the development of new rehabilitation procedures can be applied in most clinical cases, including in those with severe atrophy. Hence, this study aimed to assess the functional changes that can occur in the stomatognathic system after implant rehabilitation procedures. Materials and Methods: A total of 63 patients were accepted in the study. They were divided into a first control (dentate) group (CG) and a second study group (edentulous, SG). For the latter, 30 patients received 204 two-stage implants immediately loaded with provisional prostheses. Surface electromyography (EMG) was assessed at the time of prostheses fixation, while for some patients it was applied six months after the fixation of the fixed prostheses, as well. These supplemental investigated patients formed a third, follow-up study group (FSG). All assessments were performed during the processes of clenching and mastication. The obtained data of the two study groups, SG and FSG, were compared with those of the control group, CG. Results: No statistical differences were found in the electrical muscular activity between the study and control groups during both clenching and mastication (p > 0.05). In addition, there were no differences within the same study group, both initially and after 6 months. The only changes were noticed between static and dynamic values for the right masseter muscle in the follow-up group FSG (p = 0.008). Deviations of the overlapping coefficients were similar for all groups (p = 0.086): for CG, 20.5%, median 11.1 (min. 0, max. 104); for SG, 21.4%, median 12.2 (min. 0, max. 103); for FSG, 36.1%, median 26.9 (min. 0, max. 160). This revealed no neuromuscular adaption to the prostheses. Conclusions: Implant-prosthetic rehabilitation led to an EMG activity that was similar to that of dentate patients immediately after the placement of the fixed implant-supported prostheses. Moreover, the measured values did not change after six months of functioning for all evaluated parameters. This may point to an immediate restoration of the muscle contraction capacity, without the necessity of adaptation over time. The study serves as an argument for the application and reliability of the immediate fixed implant-supported prostheses from the perspective of muscle adaptation and functioning.

Implant–Prosthetic Rehabilitation of Maxillary Lateral Incisor Agenesis with Narrow Diameter Implants and Metal–Ceramic vs. All-Ceramic Single Crowns: A 16-Year Prospective Clinical Study

The main objectives of the present prospective clinical study were to evaluate the marginal bone resorption and the peri-implant soft tissue conditions around narrow diameter implants, as well as the clinical performances of metal–ceramic and all-ceramic single crowns in the implant–prosthetic treatment of maxillary lateral incisors agenesis. Seventy-two patients affected by monolateral or bilateral agenesis of the maxillary lateral incisors were included in the study, and a total of 105 narrow diameter implants were inserted. The final single crowns were fabricated 4 months after the surgical procedures by means of either titanium abutments with Auro-Galvan Crowns (AGC) veneered with feldspathic ceramics or zirconia abutments with all-ceramic (alumina or zirconia) crowns layered with dedicated veneering ceramics. Both marginal bone resorption and soft tissue quality were evaluated after a maximum period of 16 years. Two independent survival curves for patients wearing AGC or all-ceramic crowns were calculated by means of Kaplan–Meier analysis, and a log-rank test was performed in order to compare these curves (p &lt; 0.05). After 16 years of clinical function, a mean marginal bone resorption of 1.2 ± 0.61 mm and good response of peri-implant soft tissues were observed. Descriptive statistics resulted in 80% and 87.1% cumulative success rates for patients provided with AGC prostheses onto titanium abutments and all-ceramic crowns on-to zirconia abutments, respectively. The cumulative survival rate calculated for AGC group was 93.3%, whereas all-ceramic group showed a cumulative survival rate of 95.7%. No statistically significant differences were found with the log-rank tests. The overall success and survival rates calculated were 85% and 95% for all the restorations, respectively. Mucositis, abutment unscrewing, loss of retention, chipping, core fracture, and esthetic failure were the major complications reported. The implant–prosthetic approach can be considered an effective and viable solution to treat cases of maxillary lateral incisor agenesis in the long term.

AN INTEGRATED APPROACH TO TREATMENT OF EDENTULOUS PATIENTS WITH PERIORAL WRINKLES OF THE SKIN

Objectives: The purpose of this study was to comparative analysis of effectiveness of use of intradermal injections of modified hyaluronic acid (Hyalorepair 04) and its combination with platelet-rich autologous plasma in edentulous patients with perioral wrinkles of the skin. Materials and Methods: A total of 56 patient’s presence of perioral wrinkles of the skin participate in the study after dental implant prosthodontics rehabilitations. They were randomly divided into 2 groups in accordance with the applied therapy method (29 isolated implementation of modified hyaluronic acid bio-repairing and 27 biorepairing combined with autologic plasmotherapy). Treatment included implant-prosthetic rehabilitation followed by hyaluronic acid injections in order to correct cheek-zygomatic sulcus, nasolabial folds and marionette wrinkles. Preparations in an amount from 1 to 4 ml were injected into the face area, depending on the zones to be corrected at the request of the patients. Results: The complex treatment restored the aesthetic profile of the face and oral cavity and increased the effectiveness of the chewing function. On M03 and M05, 2/3 of patients had significant improvement as assessed by physician and patient according to GAIS. Most of the patients also showed significant improvement at visit M12. Conclusion: An integrated approach to the treatment of edentulous patients with perioral wrinkles increases the functional and aesthetic effect of the treatment. Implementation of combined of bioreparation and autologous plasmotherapy is significantly more effective comparatively to the isolated implementation of modified hyaluronic acid.