Implant-supported Fixed Dental Prostheses Research Articles

A proof of concept on implant-supported bilateral cantilever bridges: The T-Bridge approach.

The concept of bilateral cantilevers on a single central implant (T-design) for three-unit implant-supported fixed dental prostheses (ISFDPs) has not been explored nor tested. This technical hypothesis aimed to explore the feasibility of such an approach as a cost-effective alternative to conventional treatments. Careful considerations regarding implant diameter, length, ideal position, occlusal scheme, and bone remodeling are essential to ensure adequate support, stability, and prevention of complications. In this proof of concept, we present a preliminary case with this novel design to replace missing posterior teeth in a patient with narrow bone conditions. In addition, a series of planned investigations and preliminary results, including preclinical studies, are presented to illustrate our concept and its potential clinical implications. Clinically, after two-year follow-up, healthy and stable peri-implant tissues around the ISFDP exemplarily demonstrated excellent stability, functionality, and comfort, which is supported by acceptable fracture resistance data in vitro, suggesting indeed the practical potential and suitability. Thus, we claim that such a treatment modality has the at least theoretical potential to revolutionize implant dentistry by providing innovative and cost-effective treatment options for patients with partial ISFDPs in very specific cases. Of course, further research and evaluations are necessary to validate the clinical implications of this innovative hypothesis. Implementing the 3-on-1 T-bridge approach in partial ISFDPs could offer a promising alternative to traditional methods. If proven successful, this technique may lead to significant advancements in clinical practice, providing a less invasive cost-effective treatment option.

Clinical Outcomes of Implant-supported Fixed Dental Prosthesis for Full-mouth Rehabilitation Using Different Restorative Materials: A Systematic Review

Introduction: A fixed dental prosthesis supported by implants can be made from a variety of restorative materials for full-mouth rehabilitation. Since scientific study on the materials utilized has a variety of design features, evaluating the effects of various prosthetic materials on the oral environment is a challenge. Furthermore, the impact of prosthodontic material choice on the clinical outcome is still not entirely clear. The current systematic review’s goal was to examine how different restorative materials performed clinically in patients who were receiving fixed dental prosthesis (FDP) supported by implants. Materials and Methods: Using the developed search approach, a systematic electronic search was conducted. “Does the use of different restorative materials have any effect on the clinical outcomes of full-mouth rehabilitation with implant-supported fixed dental prosthesis?” was the main research question for this study, which was formulated using the Population, Intervention, Comparison and Outcome (PICO) framework. Results: Technical issues were far more common than biological ones, with “fracture of veneering material” and “fracture of framework” being the most frequent technical mishaps. The most common biological outcome was “marginal bone loss of 2 mm.” Conclusions: The clinical results of rehabilitation using implant-supported FDPs are significantly influenced by the prosthesis’s design and manufacturing process as well as the restorative material. To ascertain the use of innovative materials and specify their precise therapeutic indications with randomized clinical trials and extended follow-up, more comparative clinical investigations are needed.

Articulation distortion in Mandarin-speaking individuals with complete arch maxillary implant-supported fixed dental prostheses

Implant-supported fixed dental prostheses (IFPs) have been increasingly used to restore edentulous jaws, yet few studies have utilized acoustic analysis for objective evaluation of postrestoration speech outcomes. The purpose of this clinical study was to assess speech articulation in edentulous individuals before and after the provision of IFPs by combining the results of subjective evaluations and objective acoustic analysis parameters. The study included thirty-four individuals who had an edentulous maxilla and had been provided with an IFP for over 6 months, along with 6 dentate controls. Acoustic analysis was conducted, and mean opinion scores (MOS) were rated from recordings. The participants were interviewed about perceived speech changes. Changes in the parameters were evaluated using the paired t test or Wilcoxon signed-rank test (α=.05). A comparison between dentate controls and edentulous individuals (with or without prostheses) was made using an independent t test or Mann-Whitney U test (α=.025). Following restoration, the center of gravity (CoG) changes occurred in 11 of 12 consonants in edentulous individuals (P<.05). Prosthesis use allowed the CoG of all affricates and fricatives to appear larger and closer to control values. Before restoration, the CoG of 9 of 12 consonants in edentulous individuals differed from controls (P<.01); after restoration, this reduced to 3 out of 12 (P<.01). MOS improved in 10 of 12 consonants (P<.01), nearing a score of 4. Despite restoration, the CoG of alveolo-palatals [tɕh], [tɕ], and [ɕ] remained different from controls (P<.01). Most participants were satisfied with the improvement, with few reporting discomfort with alveolars [s] and [tsh]. IFPs can enhance speech in edentulous individuals, yet articulation distortions of alveolar and alveolo-palatal consonants persist. The improper palatal shape of IFPs or an abrupt joint between the IFP and atrophic natural bone may contribute to these distortions.

The Impact of Implant Angulation on the Stress Distribution and Survival Rate of Implant-Supported Fixed Dental Prostheses: A Retrospective Study.

Background Implant-supported fixed dental prostheses (FDPs) have become a reliable method for the rehabilitation of edentulous patients, offering improved contour, function, esthetics, and overall oral health. This retrospective study aimed to evaluate the impact of implant angulation on the stress distribution and survival rate of implant-supported FDPsusingfinite element analysis (FEA). Methods A retrospective cross-sectional design was employed, utilizing existing patient records and radiographic data. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for transparent and comprehensive reporting. Sample size calculation was based on a reference study, considering a standard deviation of 2.5 for stress distribution measurements and a minimum detectable effect size of 1.0. Data collection included demographic and clinical characteristics, implant selection and placement details, prosthetic design and fabrication, as well as stress distribution analysis using FEA. Results The study included a total of 307 participants who met the inclusion criteria. Demographic variables demonstrated a balanced gender distribution (p = 0.172), with 51.5% males and 48.5% females. Smoking status (p < 0.001) and income level (p = 0.026) were significantly associated with the research outcomes. Implant characteristics analysis revealed three main types: NobelReplace Select (53.6%), Straumann Bone Level (31.9%), and BioHorizons Tapered Internal (14.5%). Implant type (p < 0.001), length (p = 0.003), diameter (p = 0.019), and manufacturer (p < 0.001) were all found to have statistically significant associations with the research outcomes. Conclusion The findings of this retrospective study highlight the importance of implant angulation on the stress distribution and survival rate of implant-supported FDPs. The evaluation of stress distribution patterns and the analysis of implant characteristics provide valuable insights for optimizing implant design and placement strategies.

Muscle activity between dentate and edentulous patients rehabilitated with dental prostheses: A systematic review.

Adequate muscle activity is important for the success of oral rehabilitation: it maintains the integrity of the stomatognathic system and is responsible for chewing movements needed to break, crush and grind food. To compare muscle activity using electromyography (EMG) while clenching or chewing soft and/or hard foods among individuals with natural dentition (ND) and edentulous patients rehabilitated with dental prostheses. This review was conducted until March, 2023, and the research question was "Is the muscle activity of edentulous patients rehabilitated with dental prostheses similar to that of dentate individuals?" A search strategy was conducted in PubMed/MEDLINE, The Cochrane Library, Web of Science, Lilacs, Embase and manual journal searches. Ten studies were included in the analysis. Most of them reported that individuals with ND had significant higher muscle activity (clenching or chewing) than complete dentures (CD) users. However, no difference was observed between patients with full mouth implant-supported fixed dental prosthesis (ISFDP) and ND. Additionally, two studies compared patients with mandibular ISFDP with maxillary CD and individuals with ND and found no differences; however, one study concluded that patients with ISFDP with CD (maxillary or mandibular) had lower muscle activity than individuals with ND. Only one study reported a higher muscle activity in patients with full-mouth ISFDP than in individuals with ND. Bimaxillary CD users had lower muscle activity than individuals with ND. During rehabilitation, the muscle activity of patients with full-mouth ISFDP and mandibular ISFDP with maxillary CD is similar to individuals with ND.

Screw-retained ceramic-veneered/monolithic zirconia partial implant-supported fixed dental prostheses: A 5 to 10-year retrospective study on survival and complications.

To assess the clinical performance of screw-retained, ceramic-veneered, monolithic zirconia partial implant-supported fixed dental prostheses (ISFDP) over 5-10 years and to evaluate implant- and prosthesis-related factors influencing treatment failure and complications. Partially edentulous patients treated with screw-retained all-ceramic ISFDPs with 2-4 prosthetic units with a documented follow-up of ≥5 years after implant loading were included in this retrospective study. The outcomes analyzed included implant/prosthesis failure and biological/technical complications. Possible risk factors were identified using the mixed effects Cox regression analysis. A screened sample of 171 participants with 208 prostheses (95% of the restorations were splinted crowns without a pontic) supported by 451 dental implants were enrolled in this study. The mean follow-up duration after prosthesis delivery was 82.4 ±17.2months. By the end of the follow-up period, 431 (95.57%) of the 451 implants remained functional at the implant level. At the prosthesis level, 185 (88.94%) of the 208 partial ISFDPs remained functional. Biological complications were observed in 67 implants (14.86%), and technical complications were observed in 62 ISFDPs (29.81%). Analysis revealed only emergence profiles (over-contoured) as a significant risk factor for implant failure (P<0.001) and biological complications (P<0.001). Full-coverage ceramic-veneered zirconia prostheses had a significantly greater chance of chipping (P<0.001) compared with buccal-ceramic-veneered or monolithic zirconia prostheses. Screw-retained ceramic-veneered, monolithic partial ISFDPs have a favorable long-term survival rate. Over-contoured emergence profile is a significant risk factor associated with implant failure and biological complications. Buccal-ceramic-veneered and monolithic zirconia partial ISFDPs lower the initial prevalence of chipping compared with a full-coverage veneered design.

Retention of titanium copings to implant-supported fixed dental prostheses.

The aim of this in vitro study was to assess the effects of using different cements and titanium copings designs on the retention of implant-supported fixed dental prostheses (IFDPs) using a pull-out test. Fifty zirconia (ZirCAD; Ivoclar Vivadent) and 20 prepolymerized denture acrylic resin (AvaDent) rectangular (36mm × 12mm × 8mm) specimens were milled to mimic the lower left segmental portion of the All-on-Four IFDPs. Cylindrical titanium copings (Variobase; Straumann) (V) were used in 2 prepolymerized denture acrylic resin groups (n = 10) while conical titanium copings (Straumann) (C) were used as a control group for zirconia with 4 groups using cylindrical titanium copings. Before cementation, the outer surfaces of all titanium copings and the intaglio bonding surface of prosthetic specimens were airborne-particle abraded. All specimens were cemented following the manufacturer's recommendations and instructions according to the experimental design. After artificial aging (5000 cycles of 5°C 55°C, dwelling time 20s; 150 N, 1.5Hz in a 37°C water bath), all specimens were subjected to retention force testing using a pull-out test using a universal testing machine and a custom fixture with a crosshead speed 5mm/min. Modes of failure were classified as Type 1, 2, or 3. Retention force values were analyzed by the t-test for the prepolymerized denture acrylic resin specimen groups, and 1-way ANOVA and the Tukey test for the zirconia groups at α = 0.05. Mean and standard deviation retention force values varied from 101.1±67.1 to 509.0±65.2 N for the prepolymerized denture acrylic resin specimen groups. The zirconia groups ranged from 572.8±274.7 to 1416.1 ±258.0 N. There is no statistically significant difference in retention force values between V and C specimens cementing to zirconia with Panavia SA cement (Kuraray Noritake) (p = 0.587). The retention forces and failure modes were influenced by the cement used (p < 0.05). Modes of failure were predominantly Type 2 (mixed failure) and Type 1 (adhesive fracture from prosthetic materials) except for the quick-set resin group (Type 3, adhesive failure from coping). When bonding IFDPs onto titanium copings, quick-set resin provided significantly higher retention force for prepolymerized denture acrylic resin prostheses. Conical and cylindrical titanium copings performed similarly when cemented to zirconia with Panavia SA cement under the same protocol. The stability of the bonded interface and retention forces between zirconia prostheses and titanium copings varied from the cement used.

Implant Survival and Complication Prevalence in Complete-Arch Implant-Supported Fixed Dental Prostheses: A Retrospective Study with a Mean Follow-up of 5 Years.

Purpose: To evaluate the implant survival and the prevalence of biologic and mechanical complications in edentulous patients restored with complete-arch implant-supported fixed dental prostheses (IFDPs). Materials and Methods: Patients restored with complete-arch screw-retained IFDPs between January 2012 and December 2019 with a minimum 2-year follow-up were included. Outcome measures were cumulative survival rate (CSR) for implants and prostheses, biologic complications, and mechanical complications. A generalized estimating equation model was used to estimate potential risk factors for mechanical complications. Patient satisfaction was investigated using a standardized questionnaire. Results: A total of 44 prostheses supported by 268 implants in 30 patients were included for a mean duration of 4.8 years (range: 2 to 9 years). Eighteen of the prostheses were zirconia-ceramic (group ZC), and 26 were titanium-ceramic (group TC). The CSR for the implants and IFDPs was 99.3% (95% CI: 98.2% to 100.3%) and 92.5% (95% CI: 84.2% to 100.8%), respectively. The most common biologic complication was peri-implant mucositis (4.5%), followed by peri-implantitis (3.0%). The most common mechanical complication was ceramic chipping (45.5%), followed by crown debonding (13.6%) and framework fracture (4.5%). There was no significant difference in the prevalence of complications between groups TC and ZC (P > .050). The presence of cantilever (OR = 5.54, P = .048) and maxillary arch (OR = 5.94, P = .041) were significantly associated with mechanical complications. Patient satisfaction scores were generally high, but some continued to be bothered by speech problems (13.6%). Conclusion: Complete-arch IFDPs presented reliable clinical outcomes for edentulous patients with a high implant survival rate and a high level of patient satisfaction. However, a high incidence of mechanical complications occurred in the long term.

Stress Distribution in Implant-Supported Fixed Dental Prosthesis (Pontic Design) using Two Different Framework Materials: A Finite Element Analysis

Aim and Objectives: The stresses transferred from the implant to the surrounding bone greatly influence the clinical outcome of the implant-supported prosthesis. The role of implant-supported prostheses made from zirconia and polyether ether ketone (PEEK) material in transferring stresses is not much known. The purpose of the finite element analysis study was to evaluate stress distribution in an implant-supported fixed dental prosthesis (FDP) using two different framework materials. Materials and Methods: Two three-dimensional models of implant-supported FDPs were designed using ANSYS software, with implants in right maxillary central incisor and canine regions supporting a three-unit fixed partial denture. Model 1 was made using zirconia as a framework material and model 2 using PEEK as a framework material. A static load of 100 N was applied in two directions, i.e., vertically and obliquely at an angle of 30° along the long axis of the implant. The von Mises stress analysis was done to find stresses generated in implants and the prosthesis, and the maximum and minimum principal stress analyses were used to find the stress generated in the bone. Results: Under both the loading conditions, maximum stress concentration was observed in the connector region of model 1 (zirconia group) compared to model 2 (PEEK group); 6.28 MPa versus 2.17 MPa in vertical loading and 8.85 MPa versus 2.69 MPa in oblique loading, respectively. The stresses generated in bone were nearly similar in both models. Conclusion: The framework material does affect the load-bearing capacity of the prosthesis. Stresses observed with PEEK as framework material were lesser compared to zirconia. Therefore, PEEK can be considered a suitable framework material for implant-supported FDPs.

Prosthetic Treatment of Implant-supported Double-crown Retained Removable Denture in a Failure Case of Implant-supported Fixed Dental Prosthesis

A 78-year-old female patient presented with implant failure in the maxillary and mandibular anterior areas due to medication-related osteonecrosis of the jaw. Implant-supported fixed dental prosthesis (FDP) in the maxilla and mandible were removed, and implants with osteomyelitis were removed in the anterior area (three implants in the maxilla and two implants in the mandible). After the healing period, the maxillary anterior area was recovered with 6-unit implant-supported FDP, and the mandible was reconstructed using an implant-supported double-crown-retained removable denture with friction pins. The patient was satisfied with the functionality and maintenance of the new prostheses.

Finite Element Analysis of an Implant-Supported FDP with Different Connector Heights

All-ceramic fixed dental prostheses (FDPs) tend to fracture in the connector areas, due to the concentration of tensile stresses. This study aimed to evaluate the role of connector height on the stress distribution of a posterior three-unit implant-supported all-ceramic FDP using finite element analysis (FEA). Two titanium dental implants, their abutments, screws, and a three-unit all-ceramic FDP were scanned using a micro-CT scanner. Three 3D models with altered distal connector heights (3, 4, and 5 mm) were generated and analyzed on ABAQUS FEA software. The maximum principal stress values in MPa observed for each model with different connector heights and their respective locations (MA = mesial abutment; DA = distal abutment; F = framework; V = veneer) were: 3 mm—219 (MA), 88 (DA), 11 (F), 16 (V); 4 mm—194 (MA), 82 (DA), 8 (F), 18 (V); 5 mm—194 (MA), 80 (DA), 8 (F), and 18 (V). All the assembled models demonstrated the peak stresses at the neck area on the mesial abutments. The connector height had a significant influence on the stress distribution of the prosthesis. The models with higher distal connectors (4 and 5 mm) had a lower and more uniform distribution of maximum principal stresses (except for the veneer layer) when compared with the model with the smallest distal connector.

Fully Digital versus Conventional Workflows for Fabricating Posterior Three-Unit Implant-Supported Reconstructions: A Prospective Crossover Clinical Trial.

This study assessed the clinical variables influencing the success of three-unit implant-supported fixed dental prostheses (ISFDPs) fabricated using either fully digital or conventional workflows. The clinical trial evaluated 10 patients requiring three-unit ISFDPs in the posterior mandible. Maxillomandibular relation records, and digital and conventional impressions were obtained from each patient using an intraoral scanner (IoS) and polyvinylsiloxane (PVS), and the frameworks were fabricated using zirconia and cobalt–chromium, respectively. A 2 µm accuracy scanner scanned the conventional master casts and standard reference models. The stereolithography (STL) files of the digital and conventional impressions were superimposed on the standard model file, and the accuracy was calculated with the best-fit algorithm. The framework adaptation and passivity were assessed using the one-screw and screw resistance tests. The time required for occlusal adjustment of both types of reconstructions, including the duration of the whole treatment, was recorded. The aesthetic appearance of ISFDPs was rated by each patient and clinician using a self-administered visual analogue scale questionnaire and the FDI World Dental Federation aesthetic parameters, respectively. The sample size was based on the power calculation, and alpha was set at 0.05 for the statistical analyses. The impression accuracy, framework adaptation and passivity, and reconstructions aesthetics did not significantly differ between the digital and conventional approaches. The total fabrication time was significantly shorter using the digital workflow. Within the limitations of this clinical study, the fully digital workflow can be used for the fabrication of ISFDPs with a clinical outcome comparable to that of the conventional workflow.

Prognosis of Implants with Implant-Supported Fixed Dental Prostheses in the Elderly Population: A Retrospective Study with a 5- to 10-Year Follow-Up.

This retrospective study aimed to investigate the survival rate of implants from 5 to 10 years after the placement of implant-supported fixed dental prostheses (ISFDPs) and the management of implant loss in the elderly population. Elderly patients (≥65 years old) who had been treated with ISFDPs and followed up with for at least 5 years between October 2009 and March 2020 were enrolled. Patient profiles and implant-related data were extracted. The survival rate of implants up to 5 years as well as the 10-year cumulative survival rate were evaluated. The management of implant loss and prosthetic interventions were also investigated. In total, 195 patients (mean age: 70.1 ± 4.5 years old) and 687 implants (287 ISFDPs) were assessed. The 5-year survival rate was 99.0% and the 10-year cumulative survival rate was 98.1%. Seven of the eleven implants lost were lost due to peri-implantitis. Only three implants in two patients were placed after the loss of the implants; most were restored using non-invasive procedures. Two patients underwent a conversion from ISFDPs to removable prostheses. This study showed that high survival rates were observed in an elderly population with ISFDPs and that non-invasive procedures were often applied after the loss of an implant.

Up to 10-Year Incidence of Complications in Fixed vs Removable Implant-Supported Restorations for Edentulous Arches.

To retrospectively compare the incidence of biologic and prosthetic complications in implant-supported fixed dental prostheses (FDP) and removable dental prostheses (RDP) in edentulous patients after up to 10 years. A total of 13 patients (mean age: 58.8 years, women = 9, men = 4) who had received 14 implant-supported FDPs and a total of 43 patients (mean age: 64.4 years, 22 women, 21 men) who were provided with 50 implant-supported RDPs were included in the study. The RDPs were fixed using locator attachments, ball heads, bars, or double-crowns. Technical, biologic, and prosthetic complications were assessed over a 73.3-month (± 37.7) follow-up period, and the collected data covered the period between 2000 and 2016. Using Kaplan-Meier curve and Breslow tests, the data were statistically analyzed. The level of peri-implant bone margins was determined at least every 2 years. Of the 328 implants placed, 2 had to be removed during the follow-up period. All implant superstructures were still in situ at the end of the observation period. The mean overall complication rate was 0.24 per restoration per year for FDPs and 0.37 per year for RDPs. Reasonable therapeutic interventions allowed for preserving and reestablishing the integrity of all implants and full operability of all superstructures. Prosthetic complications occurred about four to five times more frequently than biologic ones; however, according to Breslow test, the distribution of biologic and prosthetic complications was not significantly different (P > .05) when comparing FDPs and RDPs over 10 years. Implant-supported FDPs were not significantly more prone to complications than implant-supported RDPs over time. Prosthetic intervention was required more often than biologic interventions in both approaches.

Effect of Fiber Reinforcement on the Flexural Strength of the Transitional Implant-Supported Fixed Dental Prosthesis.

The aim of this in vitro study was to assess the efficacy of fiber reinforcement to enhance flexural strength of the transitional implant-supported fixed dental prosthesis (TISFDP). One hundred and forty denture acrylic resin plates (64 mm × 12 mm × 5 mm) with two 7 mm diameter holes were fabricated using heat-polymerized type (Lucitone 199) and CAD-CAM prepolymerized type (AvaDent) materials to simulate a chair-side reconstruction of the TISFDP. Specimens were divided into 7 groups (n = 10) according to the airborne-particle abrasion of titanium cylinder (Straumann) surface and locations of fiber reinforcement ribbons (Ribbond-ULTRA). No cylinder surface abrasion and no fiber added acrylate specimens were used as the controls. The prosthetic screws were hand-tightened on a custom fixture with analogs. Specimen hole and cylinder were joined using a 50:50 mixture of chemically polymerized resin (QYK-SET; Holmes Dental) and repair resin (Dentsply Sirona). Ten acrylate specimens with no holes were fabricated from each tested material and assigned as positive controls. A modified four-point bending test (ASTM standard-D6272) was conducted using a universal testing machine and a custom fixture with a crosshead speed 1 mm/min. The maximum failure loads were recorded. Data were statistically analyzed using 2-way ANOVA and the Tukey tests at α = 0.05. The flexural strength values ranged from 55.4 ±8.3 to 140.9 ±15.4 MPa. The flexural strength decreased significantly when fiber was attached on the titanium cylinder surface (p < 0.05). There were no statistically significant differences in flexural strength values between specimens with and without titanium cylinder surface abrasion (p > 0.05). Statistically significant improvement in flexural strength was observed in specimens with fibers attached around the specimen holes (p < 0.05) buccally and lingually. The obtained values were not statistically significantly different from the positive controls (p > 0.05). Some fixation screw fractures were observed before catastrophic failure of specimens during testing. Fiber reinforcement significantly improved the flexural strength of denture acrylic resins only if placed around the specimen holes on the tension side at the site of initiation of crack propagation. Even when the specimens underwent catastrophic failure, the segments remained attached to each other with the attached fibers.

New generation CAD-CAM materials for implant-supported definitive frameworks fabricated by using subtractive technologies.

Innovations in digital manufacturing enabled the fabrication of implant-supported fixed dental prostheses (ISFDPs) in a wide variety of recently introduced materials. Computer-aided design and computer-aided manufacturing (CAD-CAM) milling allows the fabrication of ISFDPs with high accuracy by reducing the fabrication steps of large-span frameworks. The longevity of ISFDPs depends on the overall mechanical properties of the framework material including its fit, and the physical properties of the veneering material and its bond with the framework. This comprehensive review summarizes the recent information on millable CAD-CAM framework materials such as pre-sintered soft alloys, fiber-reinforced composite resins, PEEK, and PEKK in high-performance polymer family, and 4Y-TZP. Even though promising results have been obtained with the use of new generation millable CAD-CAM materials for ISFDPs, clinical studies are lacking and future research should focus on the overall performance of these millable materials in both static and dynamic conditions.

EAO Position Paper: Material Selection for Implant-Supported Restorations

In recent years, numerous new dental materials have been introduced as alternatives to metal-ceramics for restorations on teeth and implants. This position paper presents the current evidence and respective clinical recommendations of the European Association for Osseointegration (EAO), one of the scientific partners of the International Journal of Prosthodontics, on material selection for single crowns (SCs) and multiple-unit implant-supported fixed dental prostheses (FDPs). Metal-ceramic restorations can be utilized in most clinical indications and are preferred to ceramic restorations in incidences such as long clinical implant crowns; cantilever implant restorations where one implant is supporting two crowns; implant-supported FDPs with extension units extending more than 7 to 8 mm (premolar size); implant-supported FDPs with more than two pontics; and implant-supported FDPs with small connector diameters due to limited intraocclusal space. Veneered or monolithic zirconia-ceramic and veneered or monolithic reinforced glass-ceramic implant-supported SCs are indicated for most SC cases in both the anterior and posterior areas. Today, implant-supported zirconia-ceramic FDPs that are conventionally veneered cannot be considered the material of first priority due to the pronounced risk for fracture of the framework and catastrophic fracture of the veneering material. Monolithic zirconia FDPs are a promising alternative to veneered implant-supported zirconia-ceramic FDPs. The mechanical stability of the translucent and shaded zirconia differs significantly between the grades of translucency. This must always be considered when clinical indications are recommended. As this specific area of prosthodontics is evolving fast, numerous studies evaluating different material options in implant prosthodontics are currently performed worldwide, and future consensus meetings will refine the present recommendations. The EAO will therefore regularly publish updated position papers on relevant topics.

Evaluation of the demographic profile of patients with implant-supported fixed dental prostheses: A retrospective clinical study

Aim: In this study, the aim is to evaluate the demographic profile as well as clinical aspects of patients who received implant-supported fixed dental prostheses (FDP) between 2016 and 2019 years.&#x0D; Methodology: Among 150 patients with implant-supported FDP, 120 contacted patients were included in the study. The patients were examined in terms of gender, age groups, edentulism, restoration type, implant location, implant survival rate, and abutment type by using the computer software. Data results were analyzed by descriptive statistical methods.&#x0D; Results: Three hundred and six dental implants were evaluated in a total of 120 patients, 55 men, and 65 women. The average age of the patients was 49.61 ± 11.84, and the most common dental implant application was in the 51–60 age group. Dental implants were frequently applied to the posterior mandible, and 31.9% of them were applied to patients in the 51–60 age group. A 94.8% implant survival rate was observed. A significant difference was found among age groups with laser-sintered metal-ceramics (LSMC) and all-ceramics (p&lt;0.05). LSMC was the most common type of restoration, and straight abutments were frequently used.&#x0D; Conclusion: Although the survival rate of dental implants is high, implants with a medium length and diameter are frequently used. The type of restoration, type of abutment, and implant location in implant-supported FDP vary depending on the age and gender of the patients.&#x0D; &#x0D; How to cite this article: Demirci F, Tanık A. Evaluation of the demographic profile of patients with implant-supported fixed dental prostheses: A retrospective clinical study. Int Dent Res 2021;11(3):165-71. https://doi.org/10.5577/intdentres.2021.vol11.no1.5&#x0D; &#x0D; Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

Performance of crowns cemented on a fiber-reinforced composite framework 5-unit implant-supported prostheses: in silico and fatigue analyses

ObjectiveTo characterize the biomechanical performance of fiber-reinforced composite 5-unit implant-supported fixed dental prostheses (FDPs) receiving individually milled crowns by insilico and fatigue analyses. MethodsEighteen implant-supported five-unit fiber-reinforced composite frameworks with an individually prepared abutment design were fabricated, and ninety resin-matrix ceramic crowns were milled to fit each abutment. FDPs were subjected to step-stress accelerated-life testing with load delivered at the center of the pontic and at 2nd molar and 1st premolar until failure. The reliability of the prostheses combining all loaded data and of each loaded tooth was estimated for a mission of 50,000 cycles at 300, 600 and 900 N. Weibull parameters were calculated and plotted. Fractographic and finite element analysis were performed. ResultsFatigue analysis demonstrated high probability of survival at 300 N, with no significant differences when the set load was increased to 600 and 900 N. 1st and 2nd molar dataset showed high reliability at 300 N, which remained high for the higher load missions; whereas 1st premolar dataset showed a significant decrease when the reliability at 300 N was compared to higher load missions. The characteristic-strength of the combined dataset was 1252 N, with 1st molar dataset presenting higher values relative to 2nd molar and 1st premolar, both significantly different. Failure modes comprised chiefly cohesive fracture within the crown material originated from cracks at the occlusal area, matching the maximum principal strain location. SignificanceFive-unit implant-supported FDP with crowns individually cemented in a fiber-reinforced composite framework presented a high survival probability. Crown fracture comprised the main failure mode.

Are ceramic implant-supported single crowns clinically better than metal-ceramic implant-supported single crowns?

Data sources Data was collected from six databases (Medline, Embase, Web of Science, The Cochrane Central Register of Controlled Trials [CENTRAL], China National Knowledge Infrastructure [CNKI] and Chinese Biomedical Literature Database). Studies published in English and Chinese languages comparing ceramic and metal-ceramic implant-supported fixed dental prostheses (FDPs) were searched. The literature search was performed on studies published until 2018. Manual search of the reference lists of the identified articles was also performed to find related review articles and studies.Study selection Randomised controlled trials (RCTs), prospective and retrospective cohort studies involving the comparison of ceramic and metal-ceramic implant-supported FDPs were selected using the PICOS model for the meta-analysis. For ceramic and metal-ceramic single crowns, the survival rate, marginal adaptation, marginal bone loss, pocket probing depth, crown colour match and mucosal discolouration were assessed. The authors also included studies on survival rate of implant-supported fixed partial dental prostheses (FPDPs) in this meta-analysis.Data extraction and synthesis Two investigators independently screened the articles from the literature search and extracted and analysed data from the included studies. The quality of the included RCTs were assessed using the Cochrane collaboration tool for assessment of risk of bias. For the selected non-randomised studies, the quality and risk of bias were assessed using the Newcastle-Ottawa scale. Twenty studies were included in data synthesis.Results Of the selected 20 studies, ten were RCTs and ten were prospective or retrospective cohort studies.Conclusions The results of this study can be useful to clinicians in making decisions between ceramic and metal-ceramic implant-supported single crowns. This study concluded that the ceramic implant-supported single crown has better crown colour match over a metal-ceramic single crown, but poorer marginal adaptation, and there was no difference observed in other parameters studied (survival rate, marginal bone loss, pocket probing depth and mucosal discolouration). The conclusions on survival rate of implant-supported FPDPs needs to be further evaluated with RCTs with larger samples.