Prosthetic Complications Research Articles

Computer-assisted implant placement and full-arch immediate loading with digitally prefabricated provisional prostheses without cast: a prospective pilot cohort study

BackgroundImmediate loading of implant-supported full-arch rehabilitations has become routine practice when treating edentulous patients. The combination of static computer-aided implant surgery (s-CAIS) and digital prosthetic workflow could eliminate several treatment steps and facilitate prostheses delivery.The aim of this study is to evaluate the 1-year results of digitally prefabricated polymethyl methacrylate (PMMA) provisional prostheses without a cast for full-arch computer-assisted immediate loading.Materials and methodsA digital pre-operative treatment planning was realized for all patients: dental implants and screw-retained abutments were selected in the planning software and two surgical templates were fabricated for each patient. The first template was mucosa or teeth-supported to drill the holes for fixating pins, while the second template was placed after raising a full-thickness flap and was supported by pins as well as soft or hard tissue distal support. Furthermore, based on the surgical planning, interim prostheses were digitally designed and milled of PMMA resin blocks with subsequent pink resin veneering. Osteotomies and implant placement were performed through the surgical guides and all implants were immediately loaded with prefabricated full-arch interim prostheses directly connected to titanium copings with a flowable resin.ResultsA total of 55 dental implants were placed in ten patients. In all cases, interim prostheses allowed the insertion of titanium copings without the need of access hole enlargement or adaptation. All the prostheses had 1 year of functional loading to simulate the long provisional phase. No screw loosening occurred at the first removal of the prostheses after implant osseointegration. No fracture occurred during the whole period. After 1 year, the mean marginal bone loss level was 0.37 ± 0.06 mm, while the implant survival rate was 98.18% (n=54/55), with just one implant failing but not affecting final prosthesis delivery to the patient.ConclusionsWithin the limitations of the present study, the authors concluded that digitally prefabricated provisional prostheses for full-arch immediate loading with s-CAIS could be a valid alternative treatment modality. Milled PMMA restorations proved to be durable enough during the long provisional phase, without prosthetic complications.

Diagnostic utility of open biopsy in patients with two culture-negative aspirations in the diagnostic work-up of periprosthetic joint infection.

Different approaches have been proposed for bacterial identification in patients with a suspected periprosthetic joint infection (PJI). If a one-stage procedure is considered, a higher rate of preoperative bacterial identification can be achieved if biopsy is included in the diagnostic work-up. The performance of open biopsy (OB) in the context of PJI has not been clearly determined yet. The purpose of this study was to determine the value of an OB added to two consecutive culture-negative joint aspirations during PJI workup. We retrospectively analyzed the OB data from a single institution. Patients under PJI work-up of the hip or knee with two culture-negative periprosthetic aspirations who underwent OB were included. Sensitivity and specificity were calculated using the musculoskeletal infection society (MSIS) criteria as gold standard. Patients undergoing urgent irrigation and debridement and patients with history of surgery to the affected joint in the prior 6weeks were excluded. 126 patients were included in this study. 62 (49.2%) patients had prior revisions, 48 of them due to PJI. The sensitivity and specificity of OB was 69.4% and 89.1%, respectively. The OB procedure led to the identification of the causative germ in 50 out of 126 (40%) cases so they could undergo one-stage (septic) exchange. The OB is a valuable resource if preoperative synovial fluid cultures are negative, a high suspicion of infection persists and a one-stage procedure is preferred. It intends bacteria identification and allows surgeons to evaluate prosthetic complications for further surgical procedures.

Differences in self-perceived OHRQoL between fully dentate subjects and edentulous patients depending on their prosthesis type, socio-demographic profile, and clinical features

ObjectivesThis observational cross-sectional study aimed to evaluate and compare the oral health-related quality of life (OHRQoL) and clinical performance between dentate subjects and edentulous patients restored with conventional dentures or implant overdentures. Methods85 edentulous patients were grouped as follows: Group-1 (CD): conventional denture wearers (n = 42), and Group-2 (IO): implant-retained overdenture wearers (n = 43). For the OHRQoL comparisons, a control group of subjects with a healthy natural dentition (Group-3, ND; n = 50) was included. Participants completed three validated questionnaires (OHIP-14sp, OHIP-20sp, and QoLIP-10). Socio-demographic data, prosthesis-related factors, clinical condition of the mouth, and patient subjective evaluations, were gathered. Descriptive and non-parametric probes were run (α = 0.05). ResultsThe ND group was the most unsatisfied (OHIP-14sp; p ≤ 0.001). The OHIP-20sp attributed significantly worse Psychological disability (p = 0.029) and Handicap (p = 0.027) to CD wearers when compared to IO wearers. The CD group showed the significantly highest need for relining (p = 0.041), and the lowest retention (p = 0.011). The OHIP-14sp disclosed a significantly worse OHRQoL for those volunteers who had a job (p = 0.003), a basic education instead of a secondary one (p = 0.022), and no partner (p = 0.006). ConclusionsThe overall OHRQoL was comparable for both prosthodontic groups, being modulated by socio-demographic and prosthesis-related features. Nonetheless, CD wearers presented prosthetic complications more frequently.Clinical significance: While dentate subjects were the most critical about their oral condition and its repercussion in their life, implant overdenture wearers tended to observe a better OHRQoL and clinical performance compared to conventional denture wearers.

Implant-prosthetic rehabilitation of patients with severe horizontal bone deficit on mini-implants with two-piece design\u2014retrospective analysis after a mean follow-up of 5 years

BackgroundAs a consequence of tooth loss due to trauma or extraction, a reduced alveolar crest volume limits the deployment of standard implants in certain patient cases. For this reason, minimal-invasive treatment with mini-dental implants (MDI) might be an option to allow implant treatment even in cases with severe horizontal bone loss without augmentation measures. The aim of this retrospective cohort study was to investigate clinical and radiological implant, as well as patient-related parameters after treatment with MDI.ResultsClinical and radiological records of 19 female (82.6%) and 4 male patients (17.4%) (N = 23), who received 52 mini-dental implants with a two-piece design in a single surgical center between November 2011 and October 2018, were retrospectively analyzed. Implants were submitted to conventional loading on different types of screwed superstructures. Crestal bone loss was measured on standardized periapical radiographs. Patient-related outcome parameters (PROMs) were recorded during follow-up period. Mean clinical and radiological follow-up was 69.6 months (5.8 years) and 51.6 months (4.3 years), respectively. Three implants were lost in two patients, leading to an implant survival rate of 94.2%. Mean radiological crestal bone loss was 1.6 mm. Both amount of peri-implant recession and crestal bone loss were significantly correlated (r = 0.65; p < 0.001). Likewise, a significant correlation was observed between deeper probing depths and increased peri-implant bone loss (r = 0.41; p = 0.012). Alveolar ridges with a reduced alveolar crest width were significantly correlated with higher peri-implant bone loss as well (r = − 0.33; p = 0.011). No prosthetic complications were reported during follow-up. Extent of midfacial recession and papilla height loss had a significant negative impact on most of the PROMs.ConclusionsTreatment with MDI seems to be a successful alternative treatment option, especially for elderly patients with reduced crest width at implant sites. Due to the good clinical results and high survival and success rates, this treatment option was associated with high patient satisfaction. Despite the promising results, particular consideration should be given to appropriate treatment planning in these patients due to the strong correlation between peri-implant soft-tissue parameters, crestal bone loss, and reduced alveolar crest width.

Long-term effectiveness of 6mm micro-rough implants in various indications: A 4.6- to 18.2-year retrospective study.

ObjectivesTo evaluate the long‐term effectiveness of 6 mm implants in various indications with a micro‐rough surface after 4.6–18.2 years in function and to assess key factors associated with implant survival, success, and biologic/technical complications.Materials and methodsFifty‐five patients with seventy‐four 6 mm implants placed from 2000 to 2013 attended the re‐examination assessing well‐established clinical and radiographic parameters, biologic and prosthetic complications, and patient‐reported outcome measures.ResultsFive implants were lost after a mean follow‐up period of 9.1 years resulting in a survival rate of 93.2%. All losses occurred in free‐end situations in the mandible. Smoking habit significantly reduced implant survival (hazard ratio 36.25). Two implants exhibited a history of peri‐implantitis, and one implant showed progressive marginal bone loss (MBL) resulting in a success rate of 89.2%. The mean MBL amounted to 0.029 mm. Increased MBL was found for implants placed in the maxilla (0.057 mm) and for implants with a diameter of 4.1 mm (0.043 mm). Soft tissue thickness (1.39 mm) and width of keratinized mucosa (1.91 mm) had no effect on MBL. Patient‐reported outcome measures showed high satisfaction (mean VAS scores 88%) and high quality of life (mean OHIP‐G14 score 2.2).ConclusionThe present study demonstrated survival and success rates of 93.2% and 89.2% for 6 mm implants used in various indications. A factor leading to higher implant failure was smoking, whereas modulating factors increasing annual MBL included implants placed in the maxilla and implants with a diameter of 4.1 mm compared to 4.8 mm.

Maxillary implant overdentures on two or four implants. A prospective randomized cross-over clinical trial of implant and denture success and survival.

To determine implant survival and success of four conventionally but initially asynchronously loaded implants in implant-supported overdentures for the edentulous maxilla, in participants with opposing mandibular two-implant overdentures. Twenty-six participants received four implants in the region of the maxillary canines and molars. After healing, 24 of these participants (mean age: 68.3years) were randomly allocated to one of two treatment groups, and the adapted overdenture was attached to two unsplinted cylindrical attachments. The other two matrixes remained unattached to the implants for 3months. After this period, the other two implants were loaded for 3months (cross-over design). Then, all four implants were loaded for another 3months. Kaplan-Meier curves were used to evaluate survival and success of implants and dentures. During the active prosthetic study phase, three participants lost one implant. Two participants lost three implants during the recall period. Implant survival after loading was 93.8% after a mean observation period of 3.1years. Denture survival was 100%, but denture success was 95.8%, due to major prosthetic complications. Most participants preferred four implants to two. Within the limitations of the study, it can be concluded that maxillary implant overdentures on two or four implants are both recommendable treatment options. Two posterior implants are not superior to two anterior implants under overdentures retained by unsplinted cylindrical attachments. Implant and prosthetic complications and aftercare measures are common but are mostly easy to handle. However, 23 of the 24 participants preferred the 4-implant maxillary overdenture.

Practical Considerations in Inflatable Penile Implant Surgery

BackgroundPenile prosthesis implantation remains an effective solution for men with medical-refractory erectile dysfunction (ED) following radical pelvic surgery. Despite the distortion of pelvic anatomy, a penile implant can be performed with excellent clinical outcomes provided strict patient selection, proper preoperative workup and safe surgical principles are adhered to. AimTo provide practical recommendations on inflatable penile prosthesis (IPP) implantation in patients with medical-refractory ED, with an emphasis on patient selection and counselling, preoperative workup as well as surgical considerations to minimize intraoperative complications. MethodsA Medline search on relevant English-only articles on penile prostheses and pelvic surgery was undertaken and the following terms were included in the search for articles of interest: “bladder cancer”, “prostate cancer”, “rectal cancer”, “pelvic surgery” and “inflatable penile implant”. OutcomesClinical key recommendations on patient selection, preoperative workup and surgical principles. ResultsPatients should be made aware of the mechanics of IPP and the informed consent process should outline the benefits and disadvantages of IPP surgery, alternative treatment options, cost, potential prosthetic complications and patient's expectations on clinical outcomes. Specialised diagnostic test for workup for ED is often not necessary although preoperative workup should include screening for active infection and optimising pre-existing medical comorbidities. Precautionary measures should be carried out to minimise infective complication. Corporal dilation and reservoir placement can be challenging in this group, and surgeons may require knowledge of advanced reconstructive surgical techniques when dealing with specific cases such as coexisting Peyronie's disease and continence issue. Clinical translationStrict patient selection and counselling process coupled with safe surgical principles are important to achieve excellent linical outcomes and patient satisfaction rates. Strengths and limitationsThis masterclass paper provides an overview of the practical considerations for men who are undergoing IPP surgery following radical pelvic surgery. Limitations include the lack of highquality data and detailed surgical description on each surgical troubleshooting steps for various prosthetic-related complications. ConclusionThe IPP implantation can be performed efficiently and safely in patients following radical pelvic surgery. Chung E, Mulhall J. Practical Considerations in Inflatable Penile Implant Surgery. J Sex Med 2021;18:1320–1327.

Bar fracture of implant-retained overdenture: Protocol of a systematic review and meta-analysis

Aim The fractured bar is a common prosthetic complication that deteriorates the patient’s experience and prosthesis functionality; therefore, we aim to determine risk factors, prevalence, and incidence of bar fracture. Methods We will conduct a systematic review using the guidelines of Cochrane’s Handbook and Joanna Briggs Institute’s (JBI) Manual and will adhere to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A three-step search strategy will be conducted to retrieve interventional and observational studies from biomedical bibliographic databases as well as grey literature. Two authors will assess the retrieved studies according to the predefined eligibility criteria. Data collection will be conducted using Extraction Forms. Risk of bias of included interventional studies will be assessed using the Risk of Bias 2 tool, while observational studies will be evaluated by ROBINS-E. Studies findings will be qualitatively and quantitively synthesized using JBI SUMARI. Results The results of this systematic review will be presented to clinicians and researchers in speciality conferences and a peer-reviewed journal. Conclusion This review is the first to identify the clinical and biological risk factors of bar fracture and to evaluate its prevalence and incidence rates; aiming to provide evidence-based recommendations for treatment planning and maintenance of implant-retained overdenture using bar-clip attachment system.

Failures in Single Extra-Short Implants (≤ 6 mm): A Systematic Review and Meta-analysis.

The aim of this systematic review with meta-analysis was to compare the survival rate of single crowns supported by extra-short implants (≤ 6 mm) to those supported by conventional implants, with or without previous maxillary sinus augmentation. The proportion of failures was described according to the type of complication and follow-up periods. Randomized and prospective clinical trials were selected from six databases and gray literature. The risk of bias was evaluated by Joanna Briggs Institute Critical Appraisal Checklist, and the certainty of the evidence was analyzed with Grading of Recommendations Assessment, Development, and Evaluation. Meta-analyses were processed with RevMan and MedCalc Statistical Software. Single crowns supported by extra-short implants had a similar risk of failure to those supported by conventional implants, regardless of previous maxillary sinus augmentation (P > .05). Overall failure proportion of extra-short implants was 5.19%, but it varied according to follow-up (1.18% before loading, 1.56% at 12 months, 1.20% at 24 months, 2.10% at 48 months). Biologic failure complications were 37.90% for bleeding on probing, 22.45% for peri-implantitis, and 11.29% for infection. Prosthodontics failure complications were 14.88% for abutment failures and 14.73% for prosthetic screw loosening. Considering the risk of bias, most studies were classified at moderate risk. The risk of failure of single crowns supported by extra-short implants is similar to those supported by conventional implants, regardless of previous maxillary sinus augmentation or follow-up period. The most frequent biologic and prosthetic complications were bleeding on probing and abutment failures, respectively.

Prosthetic complications and maintenance of implant retained maxillary and mandibular overdentures constructed with fully balanced and lingualized occlusal schemes : Randomized control clinical trial

Aim: The purpose of this study was to evaluate the prosthetic complications and maintenance of implant retained maxillary and mandibular overdentures constructed with fully balanced and lingualized balanced occlusal schemes. Materials and methods: Eight participants with edentulous maxillary and mandibular ridges received 4 implant fixtures in the lateral incisor and first premolar areas of maxilla and 2 implant fixtures in the cuspid areas of the mandible using the submerged surgical protocol. Maxillary and mandibular overdentures were constructed with either fully balanced occlusal scheme (group I) or lingualized balanced occlusal scheme (group II) and connected to the implants with Locator attachments after 6 months of implant insertion. Evaluation of prosthetic maintenance and complications for both maxillary and mandibular dentures in both groups were made after one year of denture insertion. Results: For maxillary and mandibular overdentures, group I had significant higher incidence of screw loosening, insert wear, insert replacement than Group II. While Group II had higher incidence of teeth wear than Group I. No significant difference in denture reline and insert distortion between both groups was noted. For mandibular overdentures, group I was associated with significant higher mucositis, soreness, ulcer decubitus than Group II. For maxillary overdentures, no significant difference in mucositis, soreness, hyperplasia or flabby ridges between groups was noted. Conclusion: Within the limitations of this study, Lingualized balanced occlusal concept is recommended for maxillary and mandibular implant overdentures as it was associated with significant lower prosthetic and soft tissue complications than fully balanced occlusal concept.

Visual inspection of implant screw access hole with an endoscope camera

Prosthetic complications may necessitate the removal of an implant-supported restoration.1-4 Retrieval of cement-retained implant prostheses without any preexisting index of the screw access hole is challenging as it requires precision from the clinician during attempts to locate the abutment screws.5,6 Implants placed in unfavorable positions make the visibility of the screw access hole difficult, and the retrieval attempts in such situations pose a threat to the implant components, the intaglio surface of the implant, or the abutment screw.

Survival Rate and Prosthetic and Sinus Complications of Zygomatic Dental Implants for the Rehabilitation of the Atrophic Edentulous Maxilla: A Systematic Review and Meta-Analysis.

Simple SummaryZygomatic dental implants have been proposed as an alternative to atrophic total edentulous maxillae rehabilitation with the necessity of bone grafting procedures. However, surgical, prosthetic, and maxillary sinus complications have been associated with this surgical procedure. Therefore, it is necessary to produce a systematic review and meta-analysis that provides evidence associated with the prognosis when using zygomatic dental implants as an alternative to atrophic total edentulous maxillae rehabilitation.The aim of this systematic review and meta-analysis was to analyze and compare the survival rate and prosthetic and sinus complications of zygomatic dental implants for the rehabilitation of the atrophic edentulous maxilla. Materials and methods: We conducted a systematic literature review and meta-analysis, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, of clinical studies that evaluated the survival rate and prosthetic and sinus complications of zygomatic dental implants for the rehabilitation of the atrophic edentulous maxilla. Four databases were consulted during the literature search: Pubmed–Medline, Scopus, Embase, and Web of Science. After eliminating duplicate articles and applying the inclusion criteria, 46 articles were selected for the qualitative analysis and 32 for the quantitative analysis. Results: Four randomized controlled trials, 19 prospective clinical studies, 20 retrospective studies, and 3 case series were included in the meta-analysis. Conventional dental implants failure (n = 3549) were seen in 2.89% (IC-95% 1.83–3.96%), while zygomatic dental implants failure (n = 1895) were seen in 0.69% (IC-95% 0.21–1.16%). The measure of the effect size used was the Odds Ratio, which was estimated at 2.05 with a confidence interval of 95% between 1.22 and 3.44 (z test = 2.73; p-value = 0.006). The failure risk of conventional dental implants is 2.1 times higher than that of zygomatic dental implants. Slight heterogeneity was determined in the meta-analysis between 23 combined studies (Q test = 32.4; p-value = 0.070; I2 = 32.1%). Prosthetic complications were recorded in 4.9% (IC-95% 2.7–7.3%) and mild heterogeneity was observed in a meta-analysis of 28 combined studies (Q test = 88.2; p-value = 0.001; I2 = 69.4%). Sinus complications were seen in 4.7% (IC-95% 2.8–6.5%) and mild heterogeneity was observed in a meta-analysis of 32 combined studies (Q test = 75.3; p-value = 0.001; I2 = 58.8%). Conclusions: The high survival rate and low prosthetic and sinus complications related to zygomatic dental implants suggest the use of zygomatic dental implants for the rehabilitation of the atrophic edentulous maxilla.

Clinical outcomes and biological and mechanical complications of immediate fixed prostheses supported by zygomatic implants: A retrospective analysis from a prospective clinical study with up to 11 years of follow-up.

Zygomatic implants alone or in combination with conventional implants have been used for severe atrophic maxillary arches. Long-term outcomes of extramaxillary technique need validations. To retrospectively assess the clinical outcomes and the prevalence of surgical, biological, and prosthetic complications of implant-fixed complete dental prostheses (IFCDPs) supported by zygomatic implants up to 11 years of follow-up. Dental records of 34 subjects treated between October 2008 and June 2019 were reviewed. Patients received an immediate fixed full-arch prosthesis supported solely by zygomatic implants or by a combination of zygomatic and conventional implants. A total of 90 zygomatic implants and 53 standard implants were placed. Up to 11 years of follow-up, two conventional implants were lost, leading to 96.2% success rate for conventional implants and 100% for zygomatic implants. Marginal bone loss for conventional implants averaged 0.85 ± 0.17 mm after the first year and 1.36± 0.12 mm after 10 years, resulting in full implant success. No prosthesis was lost. The main surgical complication was the perforations of the Schneiderian membrane, occurring in five patients and in seven sinus cavities. Considering the biological complications, mucositis for standard and zygomatic implants ranged between 21%-35% and 26%-40%, respectively. No peri-implantitis were reported. Soft tissue hypertrophy ranged between 1.8% and 30% for conventional implants and 1.1%-35% for zygomatic implants. Inflammation under the prosthesis ranged between 33% and 50%. For the mechanical complications, abutment loosening was recorded in 5.8% of cases (two patients), tooth debonding and fracture of the prosthesis happened in five subjects (14.7%), and loosening of the prosthetic screws was reported in one patient (2.9%). Immediate rehabilitation of the severely atrophic maxilla with zygomatic implants alone or in combination with standard implants could be considered a viable treatment modality.

Clinical Performance of Implant Crown Retained Removable Partial Dentures for Mandibular Edentulism-A Retrospective Study.

The studies on implant-crown-retained removable partial dentures (IC-RPDs) for edentulism are scarce. The purpose of this study was to evaluate survival rates and marginal bone loss (MBL) of IC-RPDs compared to implant overdentures (IODs) in mandibular edentulism. Variables that influenced survival and marginal bone loss (MBL) of implants in both treatment modalities were analyzed and the functional/esthetic satisfaction of patients as well as prosthetic complications were also observed. Eighteen IC-RPDs with a total of 60 implant-supported survey crowns and 24 IODs with a total 94 implants retained with magnet attachments were observed. After a median observation period of 46.6 months (up to 149 months), we observed 98.3% implant survival rates for IC-RPDs and 92.5% for IODs. Kaplan–Meier survival curves based on the treatment modality showed that, at 96 months, cumulative survival rates were 98.3% in IC-RPD and 83.1% in IOD. For implant survival rates, no statistical differences were observed according to age, sex, opposing dentition, or implant positions (p = 0.515, 0.666, 0.201, 0.749, respectively). The implant MBL measurements for IC-RPD and IOD groups at the final recall check were 0.93 ± 1.22 mm and 2.12 ± 2.09 mm, respectively. Additionally, there were no significant differences between groups (p = 0.554). The implants with peri-implantitis at year 1 showed significantly higher MBL at final check-up (p < 0.001). The MBL of implants showed significant differences based on age (p = 0.008) and opposing dentition (p = 0.003). No significant differences of implant MBL were observed for the position of placed implants (p = 0.621) or sex (p = 0.666). Patient-reported outcome measures (PROMs) on functional and esthetic satisfaction were significantly improved after IC-RPD or IOD treatment (p < 0.001). The most frequent prosthetic complication of IC-RPD was clasp loosening, while for IOD group, it was attachment dislodgement. Within the limitations of this retrospective study, we concluded that IC-RPDs could be considered as a viable treatment option for edentulous patients who need few fixed abutments for satisfaction.

Mid-term results and survival rates following a single-design rotating hinge knee arthroplasty in non-tumor conditions in a Pakistani population

BackgroundInformation regarding the use of hinged implants in non-oncological conditions is limited in our region due to a lack of adequate data collection and follow-up. The purpose of this study is to evaluate mid-term results and risk factors affecting the survivorship of third-generation rotating hinge knee (RHK) patients in non-oncological conditions.MethodsWe retrospectively reviewed 41 single, third-generation, rotating hinge prostheses in three complex primary knee procedures and 38 revision knee surgeries in between 2007 to 2014. Implant survival was assessed using the Kaplan-Meier method. Factors influencing implant survival were identified using the log-rank test. During the study period, clinical results along with complications were assessed. Clinical outcomes were assessed by using the Knee Society Score (KSS).ResultsRHK arthroplasty was used in 41 patients. Out of 41 patients, a RHK was used in three patients with a complex primary deformed knee whereas in 38 patients, a RHK was used in revision arthroplasty surgery. The cumulative implant survival rate with re-revision due to any cause was found to be 87.8% (95% CI 69.2–90.1) at 5–7 years. Prosthetic joint infection, peri-prosthetic fracture and extensor mechanism complications were the commonest mode of failure. The P value was found to be significant when comparing KSS pre-operatively and post-operatively.ConclusionThe cumulative implant survival rate was found to be 87.8%. Prosthetic joint infection was the commonest mode of failure in patients who underwent third-generation RHK surgery for variable indications. Being a patient with a high Charlson comorbidity index is the main risk factor associated with failure of the rotating hinge implant.

Clinical Application of PEEK as a Provisional Fixed Dental Prosthesis Retained by Reciprocated Guide Surfaces of Healing Abutments During Dental Implant Treatment.

The aim of this study was to evaluate the clinical use of a high-performance polymer, polyether ether ketone (PEEK), as a material for use in provisional fixed dental prostheses (FDPs) that can be retained by reciprocated guide surfaces of hexagonal-shaped healing abutments during dental implant treatment. Patients requiring teeth replacement with dental implants for partially and fully edentulous cases in the maxilla and mandible were included. The provisional FDP was fabricated with hex castable copings and PEEK granules using the lost wax technique. The common path of insertion was established by reducing the coping that is in obstruction to the healing abutment. Retention was provided by the reciprocated guide surfaces of multiple hexagonal-shaped healing abutments. Twenty-three custom provisional PEEK FDPs supported by 166 implants in 20 partially and fully edentulous patients were provided during the treatment period. The mean functional periods of the provisional PEEK FDPs for maxillary and mandibular cases were 6.95 ± 0.84 months and 1.90 ± 0.62 months, respectively. All provisional PEEK FDPs functioned as intended for the entire treatment period. There were a total of 10 complications: 4 cases had resin and denture veneers debond from the PEEK framework; 3 partially edentulous cases required supplementary screw retention; and 3 implants in separate cases did not osseointegrate, requiring extended use of the provisional prosthesis. Two provisional mandibular PEEK FDPs with prolonged usage (over 2 years) were excluded from calculations. No fracture of the PEEK framework was observed. The results from this study suggest that PEEK can be a suitable material for use in provisional FDPs during dental implant treatment. Prosthetic complications were frequent but were resolved intraorally. The reciprocated guide surfaces of multiple hexagonal-shaped healing abutments can provide adequate retention and resistance for edentulous cases during the implant treatment period. However, in partially edentulous cases, a prosthesis without cross-arch stabilization supplementary screw retention was required.

Obstructive thrombosis of mitral prosthesis — diagnostic trap during a pandemic

Prosthetic obstructive thrombosis, being a major emergency, requires the identification of symptoms of heart failure, which are crucial elements in the early diagnosis and initiation of prompt therapeutic management. Adequate clinical, preclinical and instrumental assessment is the key tactic, used both to confirm the diagnosis and to assess the severity of the general condition and the prognosis of survival of the patient with obstructive thrombosis of the valve prosthesis. Prosthetic heart valve thrombosis is a rare but serious complication. Surgery is the first-line therapy in symptomatic obstructive mechanical valve thrombosis, thrombolytic therapy has been used as an alternative to surgical treatment. In this case report we described a 63-year-old woman who had undergone mitral valve replacement operation 11 months ago, presenting to the guard room in an extremely serious general condition, in polyvisceral and polysystemic dysfunction syndrome (MODS). A thrombus was detected on the prosthetic mitral valve with high transmitral gradient by transthoracic echocardiography. Tissue plasminogen activator treatment was administered successfully. The gradient was improved on prosthetic mitral valve and embolic complications or bleeding were not occurred.

Conversion of Digital Dentures for Immediate Loading of Complete Arch Implant Prostheses.

The development and expanded use of digital dentures has led to their use in the immediate loading of complete arch implant prostheses. This paper reviews the prosthetic complications that can occur with immediately loaded conversion prostheses along with the advantages afforded by digital dentures in minimizing or eliminating these complications. The process of using digital dentures in the fabrication of conversion dentures for immediate loading of complete arch implant prostheses is presented as well as the use of digital dentures for definitive prostheses. The described procedures include methods of obtaining clinical records, the fabrication of conversion dentures, the immediate loading procedure using a conversion prosthesis, and use of a conversion denture in the fabrication of a definitive prosthesis.

New Rehabilitation Concept for Maxillary Edentulism: A Clinical Retrospective Study of Implant Crown Retained Removable Partial Dentures.

There have been no studies of implant-crown-retained removable partial dentures (IC-RPD) for the treatment of maxillary edentulism. The purpose of this study was to perform clinical and radiographic evaluations of implants in IC-RPD compared to implant overdentures (IOD) in maxillary edentulous patients. Twenty IC-RPDs with 74 splinted implant crowns and 18 IODs with 71 implants retained with magnet attachments were observed in 38 patients. We statistically analyzed survival rates and marginal bone loss (MBL) of implants based on multiple variables including first year pathologic condition, location of placed implant, age, and sex in both treatments. Patient reported oral measurements (PROMs) regarding functional/esthetic improvement after IC-RPD or IOD treatments and prosthetic complications were also statistically analyzed. After a median observation period of 47.1 months (up to 147 months), we observed 97.3% implant survival rates for IC-RPD and 70.4% for IOD (p < 0.001). Among variables, first year pathologic condition (p < 0.001) and sex (p = 0.027) influenced implant survival rates. The MBL of implants for IC-RPD and IOD groups at the final check-up were 1.12 ± 1.19 mm and 3.31 ± 1.71 mm, respectively (p < 0.001). In both groups, patients with peri-implantitis (p < 0.001) and patients older than 65 years (p = 0.029) showed significantly higher implant MBL regardless of treatment modality. Functional and esthetic satisfaction were significantly improved (p < 0.001) after both treatments. The IOD group showed more frequent prosthetic complications compared to the IC-RPD group. Within the limitations of a retrospective study, we concluded that RPD with few splinted implant crowns is a feasible alternative treatment modality for maxillary edentulous patients with anatomical limitations.

A 5-Year Retrospective Analysis of Biologic and Prosthetic Complications Associated With Single-Tooth Endosseous Dental Implants: Practical Applications.

What are the key considerations of the incidence and timing for single-tooth implant complications, including early failure, biological complications, and prosthetic complications? Single-tooth dental implants have been shown to have a high overall survival rate, but implant complications affect patient satisfaction and may lead to costly and/or time-consuming repair and revision. Assessing the incidence and types of biologic and prosthetic complications and the timing of such complications is helpful so that the underlying causes can be addressed during the treatment planning process. Furthermore, identification of patient demographics, patient-, implant-, and site-specific factors associated with such complications may allow for more comprehensive risk assessment during treatment planning. Overall, dental implants have a high survival rate. Identification of the incidence of both biologic and prosthetic complications and minimizing their impact in patients with dental implants is critical to overall implant success. Utilization of careful treatment planning and dental implant fixtures, surgical protocols, and prosthetic designs that reduce complication rates can improve patient acceptance and outcomes. Further research is necessary to fully assess complication rates and risk factors.