Prosthetic Phase Research Articles

The Punch Graft Technique: A Simplified Protocol for Three-Dimensional Peri-Implant Soft and/or Hard Tissue Augmentation in a Single Step.

This article describes a clinical protocol utilizing soft tissue augmentation alone or in combination with guided bone regeneration (GBR), introducing simultaneous application of the one abutment one time concept for three-dimensional reconstruction of the deficient ridge. Soft and hard tissue quality and dimensions are fundamental elements for long lasting results in implant dentistry. Different techniques have been described for soft and hard tissue augmentation at time of implant placement presenting favorable results. However, multiple abutment disconnections during the prosthetic phase of treatment can compromise the results achieved during surgery. The purpose of this article is to present a surgical protocol that allows three-dimensional ridge reconstruction involving soft tissue augmentation alone, or in combination with hard tissue augmentation in one single step with the use of an one-time intermediate abutment as an anchorage device for the regenerative materials. Two clinical cases utilizing the proposed protocol are also presented, demonstrating favorable results. The application of the proposed protocol simplifies the surgical phase of treatment, protects the achieved result and enables a favorable outcome in decreased time. Utilising an intermediate abutment as an anchorage device at time of surgery can be proven an easy to apply and biologically favorable alternative way to other methods of soft tissue graft stabilization proposed in the past.

Intraoral scanning for implant-supported complete-arch fixed dental prostheses (ISCFDPs): Four clinical reports.

Although there are difficulties with using intraoral scans for implant-supported complete-arch fixed dental prostheses (ISCFDPs), several commercially available systems have become helpful in simplifying the treatment process in the prosthetic phase. These systems help patients move from interim ISCFDPs to receiving definitive prostheses in just three clinical visits. This clinical report summarizes the indications, benefits, and limitations of the four systems. The information provided in this report about the digital prosthetic workflow of ISCFDPs aims to help clinicians make well-informed choices and improve treatment results. With digital technologies advancing, refining these tools and protocols, and validating research is crucial for continued evolution in the field.

A prosthetic-surgical approach for aesthetic treatment of peri-implant soft tissue defects: A case report

Peri-implant soft tissue defects (PSTD) in the esthetic zone affect approximately 54% cases of post-implant insertion, leading to aesthetic concerns and increasing the risk of peri-implantitis. Various surgical techniques are aimed at addressing these issues, but the outcomes can be unpredictable, especially for severely mispositioned implants. This report details a combined prosthetic and surgical approach to treat a severely angulated single central maxillary implant with mid-labial mucosal recession. A 38-year-old female expressed dissatisfaction with the implant at 21 area, which appeared elongated due to peri-implant mucosal recession of almost 4 mm. Treatment involved two phases: 1) prosthetic phase involves replacing the original crown of implant at 21 area with a temporary crown to promote mucosal growth and 2) surgical phase that involves soft tissue surgery three months later using an envelope flap technique at the recipient site and a connective tissue graft harvested from the palate. Upon three months after the surgery, full coverage with thick mucosal tissue was achieved, and a new zirconia crown was placed. The outcome remained stable throughout the nine-month follow-up. This case demonstrates that PSTD in angulated implants in the esthetic zone can be effectively treated through a combination of prosthetic and surgical modalities.

Effect of one-time placement of the definitive abutment versus multiple healing abutment disconnections and reconnections during the prosthetic phase on radiographic and clinical outcomes: A 12-month randomized clinical trial.

The aim of this investigation was to evaluate the effect on clinical and radiological outcomes of the one-abutment, one-time protocol (test) versus placing the definitive abutment on the day of functional loading after having disconnected and connected three times the healing abutment during the prosthetic phase (control). Forty patients with 80 implants were randomly allocated to either the test or the control group. Changes in the radiographic marginal bone levels (MBLs), clinical outcomes, prosthetic-related outcomes, and patient-reported outcomes measures (PROMs) were assessed and compared 6 and 12 months after functional loading. Thirty-seven patients with 74 implants were followed at 12 months. A statistically significant bone remodeling was observed in both groups following implant placement. MBLs were significantly greater in the control group at the 6- (-0.13 mm vs. -0.61 mm) and 12-month visits (-0.01 mm vs. -0.53 mm). Bone loss was significantly greater in the control group from surgery to 6 and 12 months and from loading to 6 and 12 months. The abutment height was significantly greater in the test group, however, there were no significant differences in the restorative angle. Similarly, there were no statistically significant differences between groups for the measured clinical variables (probing depth, plaque, and bleeding index) and PROMs. Disconnecting and reconnecting the healing abutment was associated with significantly higher bone loss after 12 months, as compared to the placement of the definitive abutment at implant installation.

A Simple Modified Open Tray Implant Impression Technique in a Patient with Fixed Orthodontic Appliance Therapy

Background: Implant based restorations are an integral part of orthodontic treatment currently and this combination provides increased treatment options. Making impressions for implant based restorations in subjects undergoing orthodontic treatment is a challenging task. Aim: This article presents a simple technique to achieve precise impressions utilizing commonly available materials in dental operatory. Case Description: Patient undergoing orthodontic therapy requiring replacement of missing lateral incisor was planned for implant placement and crown fabrication simultaneously during fixed appliance therapy. A modified open tray implant impression with polyvinyl siloxane was made during the prosthetic phase for successful rehabilitation of the edentulous space in the anterior region. Clinical Significance: Multidisciplinary approach to treatment is time saving, which includes simultaneous Orthodontic and Prosthodontic procedures. A simple modification of the open tray impression procedure can result in an accurate final cast in the region of interest to overcome the difficulties of impression making in a patient with fixed orthodontic appliance.

Towards efficient motor imagery interventions after lower-limb amputation

BackgroundThe therapeutic benefits of motor imagery (MI) are now well-established in different populations of persons suffering from central nervous system impairments. However, research on similar efficacy of MI interventions after amputation remains scarce, and experimental studies were primarily designed to explore the effects of MI after upper-limb amputations.ObjectivesThe present comparative study therefore aimed to assess the effects of MI on locomotion recovery following unilateral lower-limb amputation.MethodsNineteen participants were assigned either to a MI group (n = 9) or a control group (n = 10). In addition to the course of physical therapy, they respectively performed 10 min per day of locomotor MI training or neutral cognitive exercises, five days per week. Participants’ locomotion functions were assessed through two functional tasks: 10 m walking and the Timed Up and Go Test. Force of the amputated limb and functional level score reflecting the required assistance for walking were also measured. Evaluations were scheduled at the arrival at the rehabilitation center (right after amputation), after prosthesis fitting (three weeks later), and at the end of the rehabilitation program. A retention test was also programed after 6 weeks.ResultsWhile there was no additional effect of MI on pain management, data revealed an early positive impact of MI for the 10 m walking task during the pre-prosthetic phase, and greater performance during the Timed Up and Go Test during the prosthetic phase. Also, a lower proportion of participants still needed a walking aid after MI training. Finally, the force of the amputated limb was greater at the end of rehabilitation for the MI group.ConclusionTaken together, these data support the integration of MI within the course of physical therapy in persons suffering from lower-limb amputations.

Comparative Study of the Expansive Behaviour of Different Internal Bleaching Agents

Internal bleaching is a conservative treatment applied to a darkened endodontically treated tooth to restore its original colour, either as a single treatment or as a treatment prior to a subsequent prosthetic phase. The aim of this study was to objectively measure and compare using an experimental model the expansive capacity of four bleaching groups: carbamide peroxide 37% (CP 37%), hydrogen peroxide 30% (HP 30%), HP 30% mixed with sodium perborate (SP) and SP mixed with distilled water. A total of 150 lower incisors (n = 30 in each group) were prepared for the Walking Bleach technique and a glass tube with oil was introduced into the coronal access cavity to measure the expansive capacity through oil displacement, due to the reaction that occurs when bleaching agents interact with dental tissues. The results after 10 days were analysed with the Games–Howell post hoc test to compare the samples. Significant higher expansion was observed with HP 30% (p < 0.05) and lower expansion with SP (p < 0.05) compared to the other groups. No significant differences were observed between CP 37% (p > 0.05) and HP 30% + SP (p > 0.05). This provides significant and observable information on the behaviour of each bleaching group and its evolution after 10 days.

Bilateral Digitally Aided Tooth Autotransplantation: A 2-Year Case Report.

Tooth autotransplantation is an effective treatment to replace missing teeth. Digital planning can facilitate successful autotransplantation. Guiding templates are highly recommended when performing cases in healed ridges in the posterior area to reduce excessive bone loss and increase the chances of fitting the donor tooth in the new socket. This case report highlights the use of 3D planning tools and fully guided drilling templates for successful tooth autotransplantation in the posterior area. Two tooth autotransplantations were performed in a 51-year-old patient using mandibular third molars to replace hopeless mandibular first and second molars. Root canal treatments were carried out before the surgeries, and different alveoloplasty techniques were used in each recipient area. The prosthetic phase was carried out after 9 months. Both teeth were asymptomatic, functional, and exhibited no signs of resorption or apical radiolucency and showed complete regeneration of the periodontal apparatus at the 2-year follow-up.

Oral implant rehabilitation under general anesthesia for patients with cognitive and physical disabilities: A 14-year cohort study

Statement of problemOral rehabilitation with implants is an alternative to the provision of removable dentures in all patients for whom missing teeth require replacement. However, individuals with cognitive, mental health issues, and/or physical disabilities are often excluded from implant-supported prostheses because of the high perceived risk of failure linked to poor oral health, presence of parafunction, or systemic conditions. PurposeThe purpose of this cohort study was to describe the protocols, outcomes, and survival rates of oral rehabilitation with implant-supported prostheses in patients with cognitive and physical disabilities treated under general anesthesia (GA) in a French unit of Special Care Dentistry. Material and methodsA retrospective cohort study was conducted on patient files. Data collected included demographics and information about the surgical and prosthetic phases of rehabilitation. Clinical and radiological reports were retrieved to establish the survival, success, and failure rates of implant placement according to the Health Scale for Dental Implants (HDSI) classification. ResultsA total of 298 dental implants had been placed under GA in 57 patients between January 2007 and August 2021. The prevalence of technical and biological postoperative complications was found to be 14% and 13% respectively. Thirty implants were determined to be failures. The estimated survival time in the population studied for loaded implants was 144.7 months [138.0; 151.3]. The cumulative survival rate was estimated to be 86% at 157 months. ConclusionsImplant-supported prostheses were found to be effective, and oral rehabilitation carried out under the conditions described was determined to be stable.

PROPHYLACTIC ANTIBIOTICS DURING THE IMPLANT PROSTHETIC PHASE MAY NOT SUBSTANTIALLY DECREASE THE INCIDENCE OF INFECTIOUS COMPLICATIONS

Does the Prosthetic Phase of Dental Implants Justify the Prescription of Preventive Antibiotics in Healthy Patients? A Systematic Review. Salgado-Peralvo AO, Uribarri A, Peña-Cardelles JF, Kewalramani N, Rodríguez JLG, Velasco-Ortega E. J Oral Implantol. 2023 Feb 1;49(1):93-101. The authors declared that no funding was received to support the study. Systematic review.

Efficacy of Socket Shield Technique for Immediate Implant Placement in Maxillary Anterior Region – A Case Series with Review.


 
 The socket-shield technique is the most crucial treatment modality for esthetic enhancement and ridge preservation technique but it has been less discussed and documented. This case series describes the placement of implants immediately following extraction of a non-restorable which are all fractured and hopeless maxillary teeth and using this technique and functional and esthetic outcomes of the treatment was a successful event.
 In this review, immediate implant were placed using socket shield protocol to treat ten patients with non-restorable teeth. Dissection was performed along the long axis of the roots in a mesiodistal direction; and atraumatically the buccal fragment of the root was left attached to the bone while the palatal fragment was extracted. Implants were placed after sequential osteotomy drilling. A customized healing abutment was fabricated chairside to create an emergence profile. During the prosthetic phase, patients had follow-up visits after 4 weeks and after 6 months. The definitive prosthesis was cemented using a cement-retained porcelain fused to metal.
 

One phase prosthetic and orthodontic treatment in children: Case study

Background: Dental trauma in children is reported about 25–33%. Besides dental trauma, children are also at high risk for malocclusion. The prevalence of malocclusion in children was reported as 39% in children and 93% in adolescents. If the patient has malocclusion and a history of tooth loss due to trauma at the same time, there is often a dilemma as to which treatment should be prioritized. This case report will combine the Prosthetic phase and the orthodontic phase at the same time. Case reports regarding denture-modified removable orthodontic appliances in children have so far not been found. Case Report: An 11-year-old boy came with his mother to pediatric dentistry department at Universitas Airlangga with the chief complaint of missing teeth due to extraction at the dentist two years ago due to trauma. On intraoral clinical examination, it was found missing 11, crossbite 21 with 31 and 32. Case Management: Patients were planned treatment of malocclusion with removable orthodontic appliances added with riding pontic 11. Discussion: Tooth loss in children will affect speech, eating, and self-confidence. Several authors have reported appliance modifications and reported satisfactory results. During malocclusion treatment, dentures may not provide optimal aesthetic results. However, the advantages provided by the presence of dentures during the treatment of malocclusion are considered to be greater. Conclusion: Modification of removable orthodontic appliances combined with dentures can be a solution to both prosthodontic treatment needs and malocclusion.

Evaluation of crestal bone loss and MMP-8 levels around platform matched and switched implants – A quasi control study

Bone loss around an implant is an inevitable occurrence, mostly occurring during the first year of function. Various modifications have been tried to reduce this bone loss, one of them being Platform switching (PS). Present study compared the bone loss and MMP-8 levels in PISF between Platform Matched (PM) and Platform Switched (PS) implants using same implant geometry and surgical protocols and loading mechanisms in all patients. 50 implants of diameter 4.6 mm were placed crestally in selected patients. After 3 months, 25 implants were restored with platform matched abutment (Group A) and 25 with platform switched abutment (Group B). Bone loss was evaluated radiographically and MMP-8 levels were assessed in peri-implant sulcus fluid and gingival crevicular fluid of adjacent tooth by ELISA, at the time of prosthetic loading(baseline) and again after one year of loading. Prosthetic phase bone loss was calculated by subtracting baseline loss from total bone loss.After 1 year of loading, the total bone loss in platform matched group was 1.29 ± 0.39 mm and platform switched group was 1.31 ± 0.38 mm. Prosthetic phase bone loss (0.41 ± 0.14 mm and 0.48 ± 0.24 mm) and MMP-8 levels (83.6 ± 26.1 ng/ml and 78.4 ± 27.2 ng/ml) were insignificantly different between the two groups. MMP-8 levels were significantly higher in peri-implant sulcus fluid than gingival crevicular fluid in all patients at both stages. MMP-8 levels significantly correlated with bone loss. In the present study, altering the abutment diameter did not influence the extent of bone resorption within similar clinical and treatment protocols of implant supported restorations.

Effect of Low-Level Diode Laser Bio-Stimulation on Implant Stability Before, During and After Immediate Implants in Mandibular Molars. (A Randomized Clinical Study)

Aim: Tooth loss can affect the person’s life dramatically. Tooth loss is accompanied by bone loss in all dimensions, so preservation of the bone is mandatory for placement of dental implant. Immediate implant can preserve alveolar bone. Due to difference in shape between the implants and extracted roots a gap appears between the immediately placed implant and the extraction socket resulting in jumping distance, Bone grafts are commonly used to fill this gap, recent studies suggest that jumping gaps shouldn’t always be grafted. Low level bio stimulation has stimulatory effect on bone cells so it can be used in immediate implants to increase bone formation around the implants. Materials and methods: this study was carried in the hospital of future university. A total of twelve patients with non-restorable mandibular molar participated in this study. A total of twenty implants were placed immediately in mandibular molar region without bone grafting, thew were divided equally into two groups. Surgical technique was similar for both groups. After immediate implant placement with primary stability of 35 N, both groups received custom made healing collar using flowable composite to seal the jumping distance.The study group (intervention) received a total of 60J/cm2 .10J/cm2 3 days before extraction, another 10J/cm2 at the fresh socket, another 10 J/cm2 after osteotomy, another 10J/cm2 after implant placement, another 20J/cm2 at the follow up visit with 3 days interval. After six weeks secondary implant stability was measured for both groups using Resonance Frequency Analysis device (RFA). Prosthetic phases started for implants that showed sufficient secondary stability. Results: All implants enrolled in this study showed sufficient secondary stability except for one totally avulsed implant from the control group. Study group showed more stability upon measuring using RFA device after six weeks of implant placement. The study group has shown a higher secondary stability compared to control group, the mean ISQ value of study (71.89±2.67) was significantly higher than control (62.43±8.62). Conclusion: Based on the results of our study we concluded that low level diode laser 980nm has a stimulatory effect on bone formation when applied before, during and after immediate implant placement, According to this study 60J/cm2 is recommended dose and it also gave better soft tissue healing results

Assessment of KAP among the Dental Practitioners towards Prosthetic Phase of Implant in Vidarbha Region of India: A Questionnaire Study

Aims & Objectives: Implant therapy has become a significant part of day-to-today dental practice. Adequate knowledge of diagnostic as well as therapeutic options is therefore necessary for all general dental practitioners. The present study is designed to evaluate and assess the knowledge, attitude and practice of practitioners about the prosthetic phase of dental implant. As the dental implant therapy is emerging in Vidarbha region of India and lack of studies evaluating the same, we recommend that awareness regarding prosthetic phase will allow practitioners to offer extensive treatment options for patient with missing teeth using dental implants.
 Materials and Methods: This is an observational questionnaire survey conducted among 210 General Dental Practitioners in Vidarbha Region of India. A google form validated questionnaires distributed to assess their knowledge, attitude and practice among the study participants. Data were analysed using SPSS 22.0 version software.
 Results: A total of 210 dentists, nearly 69% of the participants had good knowledge of prosthetic phase of implant and majority of practitioners in the study had positive attitudes and practices toward the prosthetic phase of implant placement. Results were significant for KAP but co-relation between them was statistically not significant (p=0.12).
 Conclusion: In overall, practitioners have a significant level of knowledge about the prosthetic phase of an implant. There is a limitation of practise and exposure of dentists in this field of prosthetics because the majority of practitioners have not placed enough implants. Implant training and prospective prosthetic rehabilitation are thus adjuvant learning aids that will improve general dental practitioners' knowledge, attitude, and practice.

Impact of Kinesiotherapy and Hydrokinetic Therapy on the Rehabilitation of Balance, Gait and Functional Capacity in Patients with Lower Limb Amputation: A Pilot Study.

The purpose of this pilot study was to identify impact differences in the rehabilitation of balance, gait and functional capacity in patients with lower limb amputation performing hydrokinetic therapy and kinesiotherapy programs during the pre-prosthetic and prosthetic phases. The study included 16 male patients aged 40–60 years with amputated lower limbs for 6 to 12 months, which involved transfemoral amputation (TFA), transtibial amputation (TTA), traumatic and vascular amputation, who were divided into the following two groups: the hydrokinetic therapy (HKT) group and the kinesiotherapy (KT) group, named after the content of the rehabilitation programs that were implemented for 2 weeks in the pre-prosthetic and prosthetic periods. The initial and final evaluation of the participants included the following tests: the Berg Scale and the four square test for the evaluation of the balance; the PodoSmart device for gait assessment; through the walking test over 6 min, we evaluated the functional capacity. The results were processed in SPSS 24. Analysis of the results on balance rehabilitation through the Berg Scale highlighted that the progress related to the mean of the total score was 7.62 points, p = 0.00 for the HKT group and 7.50 points, p = 0.00 for the KT group, while in the four square step test, the mean of progress was 6.125 s, p = 0.00 for the HKT group and 6 s, p = 0.000 for the KT group. The PodoSmart gait analysis revealed that the HKT group showed a progress mean of 4.875%, p = 0.00, for the foot symmetry parameter, which was 1.875% less than the score achieved by the KT group whose symmetry progress mean was 6.75%, p = 0.00, while the average progress mean for the cadence parameter was 2.75 steps/min higher for the KT group than the HKT group. The comparative analysis of the impact of these two programs on the patients’ functional capacity indicated that the score recorded by the KT group was a progress mean of 15.12 m, p = 0.00 better than the HKT group for the travelled distance parameter; the implementation of the hydrokinetic therapy program led to better exercise adaptation for the HKT group compared to the KT group at an average HR (HRavg) with 0.50 BPM, p = 0.00. After analyzing the results, it has been found that hydrokinetic therapy programs have a greater impact on balance rehabilitation and exercise adaptation, while kinesiotherapy programs have a greater impact on gait rehabilitation and functional capacity optimization for the travelled distance parameter.

Consensus Report on Preventive Antibiotic Therapy in Dental Implant Procedures: Summary of Recommendations from the Spanish Society of Implants.

Current patterns of preventive antibiotic prescribing are encouraging the spread of antimicrobial resistance. Recently, the Spanish Society of Implants (SEI) developed the first clinical practice guidelines published to date, providing clear guidelines on how to prescribe responsible and informed preventive antibiotic therapy (PAT) based on the available scientific evidence on dental implant treatments (DIs). The present document aims to summarise and disseminate the recommendations established by this expert panel. These were based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies were analysed using the Scottish Intercollegiate Guidelines Network (SIGN) checklist templates and ranked according to their level of evidence. They were then assigned a level of recommendation using the Grading of Recommendations, Assessment, Development and Evaluation system (GRADE). Guidelines were established on the type of PAT, antibiotic and dosage of administration in the placement of DIs without anatomical constraints, in bone augmentation with the placement of DIs in one or two stages, placement of immediate DIs, sinus elevations, implant prosthetic phase, as well as recommendations in patients allergic to penicillin. Therefore, the PAT must be adapted to the type of implant procedure to be performed.

Marijuana - Clinical Concerns for Implant Dentistry - Part 1.

Recently published surveys data show that the routine prescription of preventive antibiotics (PA) in the prosthetic phase of dental implants is more common than might be expected. The present study aimed to answer the PICO question " In healthy patients starting the implant prosthetic phase, does the prescription of PA compared to not prescribing PA decrease the incidence of infectious complications? " by a systematic literature review. A search was performed in 5 databases. The criteria employed were those described in the PRISMA® Declaration. Studies included were those that provided information on the need to prescribe PA in the prosthetic phase of implants, i.e., in second-stage surgeries, impression-taking and prosthesis placement. The electronic search identified three studies that met the established criteria. The prescription of PA in the prosthetic phase of implants does not show a justified benefit/risk ratio. PA may be indicated in the second stages or in peri-implant plastic surgery procedures lasting more than two hours and/or where soft tissue grafts are used extensively. In these cases, given the current lack of evidence, it is recommended to prescribe 2 g of amoxicillin 1 h before surgery and, in allergic patients, to prescribe 500 mg of azithromycin 1 h preoperatively.

The bisection: still a reliable treatment option of the first mandibular molar: A 3 years follow up case report

Conservation of mandibular molar teeth exhibiting furcation involvement and perforation of the pulp floor have always been a challenge. Section of the affected tooth at the furcation zone, and preservation of the mesial and distal roots individually with its crown portion, helps to preserve the tooth structure, alveolar bone and avoids sacrificing a strategic tooth. Therapeutic planning is multidisciplinary. It contains surgical, endodontic and prosthetic phase. Long-term success depends on thorough diagnosis and careful selection of cases. This article describes a simple procedure for bisection in mandibular molar. This is illustrated by a clinical case while detailing the entire operative sequences of bisection procedure.

MANAGEMENT OF STAGE III PERIODONTITIS: AN INTERDISCIPLINARY APPROACH

Periodontitis is a chronic inflammatory disease with varied symptoms that may be bleeding gums, malodour, tooth mobility or irritation and inflammation of the gingiva. Signs of severe periodontitis include tooth loss, masticatory dysfunction, negative effects on aesthetics and function. Depending upon the severity of the symptoms the treatment varies from case to case. This case report describes the management of a Stage III periodontitis in a 23 years old female patient, who was concerned by the impact of pathological migration on aesthetics. Treatment planning was done with focus on management of the pathology keeping in mind the concerns presented by the patient. The primary treatment was focused on management of periodontitis by removal of local factors and antimicrobial therapy to prevent further destruction of periodontal tissues. The prosthetic phase was planned to address the aesthetic concerns of the patient.Hence, an interdisciplinary approach was used to restore function and aesthetics.