Provisionalization Of Implants Research Articles

Maxillary bone augmentation with calvarial bone graft for immediate full-arch rehabilitation: Insights from a 10-year proof-of-concept retrospective analysis.

Evaluate the long-term outcomes of full-arch rehabilitation using immediate dental implant placement and continuous functional loading with full-fixed dental prostheses (FFDPs). Fifty-six patients received temporary implants (n = 327) at maxillary augmentation with calvarial bone. A provisional acrylic FFDP was immediately loaded onto these implants. After 6 months, the temporary implants were replaced with definitive implants (n = 326) and immediately loaded with a second provisional FFDP (N = 55). Subsequently, a baseline radiograph was taken following a 6-month healing period. The second bridge was then substituted with a definitive FFDP. Primary outcomes included peri-implant marginal bone level (MBL) and definitive implant survival. Secondary outcomes evaluated provisional implant and prostheses survival, complications, and patient satisfaction. The provisional implants had a survival rate of 97.9%. One patient was excluded from further analysis due to loss of temporary implants and first FFDP. The definitive implant survival rate after 10 years was 92.2%, with a moderate but significant decrease in MBL between baseline radiography and 10 years later (-0.08 ± 0.18 vs. -0.24 ± 0.44). However, large individual variations were observed, with 65.8% of implants showing no bone loss and 9.2% showing loss ≥0.5 mm. Sinusitis was experienced by 14.3% of patients upon surgery. Patient satisfaction was high or reported no issues after protocol completion (80%). One patient lost all six definitive implants and definitive FFDP 8.2 years after implant placement. The described protocol can be regarded as a long-term, highly successful method for full-arch rehabilitation of atrophied maxillae while enabling continuous masticatory and speaking functionality.

Prosthodontic management in provisionalization of implants in esthetic zone

Prosthodontic management in provisionalization of implants in esthetic zone

Temporary implants and particulate dentin graft protecting traditional implants in severe periodontal patient: A case report

Provisional implants (PIs) can offer a total contribution to a patient's esthetic comfort and chew during the integration of standard implants. Although temporary implants are not intended for osseointegration and have to withdraw at there or 4 months, most of them begin to move during this process, and most of them had extracted before standard implants integration. Resin fixed prosthesis attached to temporary implant abutments gives the patient stability, gives esthetics, and gives protection to traditional implants, compared to removable prostheses, which more quickly leads to the loosening and loss of these temporary implants. Temporary implants could be used with cemented or screwed resin prosthesis or with titanium framework, depending on the patient's bite, bruxism, or clenching. All PIs are made in one piece, titanium grade 5, with V threads and a Bioetched surface (rough surface) to increase the insertion torque and bone to implant contact in soft and hard bone. Temporary upper fixed denture, relined with resin, is the easiest solution for protecting and reducing the risk of failure of some of the standard implants. The possible solution in such cases is the use of temporary implants as support for the fixed structure, acting as protection of traditional implants and bone grafts. Our clinical case was made with six temporary implants TR® 2.7 mm diameter by 13 mm length, grinding extracted teeth using smart dentin grinder, and fixed temporary denture for 3 months. At 4 months, a complete zirconium denture was screwed in standard implants.

Simultaneous Upper and Lower Jaw Extractions, Autogenous Bone Augmentation and Temporary Implant Placement with Immediate Loading

Aims: We expanded the known technique for simultaneously augmenting an atrophic maxilla and placement of immediate provisional implants (IPI), followed by immediate loading by performing surgery in both jaws simultaneously. Feasibility of this new technique, implant survival and success were evaluated as well as prosthetic success. Materials and Methods: All patients undergoing simultaneous bone grafting and IPI placement with immediate loading at our institute between the 1st of June 2016 and the 30th of May 2018 were included and followed up for at least one year postoperatively. Results: 3 patients were followed for a mean period of 25.67 months (20 - 29 months). 33 IPIs were placed. All were immobile at second stage surgery without signs of infection. No provisional bridges were lost and no infections were noted. After second stage surgery, none of these 36 final dental implants were lost. There was some bone loss at one implant. In all patients, good functional and aesthetic results were obtained without any unforeseen complications. This renders the implant survival at 100% and the success rate at 97%. Conclusion: The technique is complex due to the intricate step-by-step process that is required and depends on a dedicated team to ensure a proper workflow. When performed correctly, the protocol shows good and predictable results.

A Finite Element Analysis of the Fatigue Behavior and Risk of Failure of Immediate Provisional Implants

Background: Temporary dental implants are used to support provisional prostheses. The goal of this study was to obtain the stress–number (S–N) curves of cycles of five temporary dental implants employing finite element methods. Additionally, a probabilistic analysis was carried out to obtain the failure probability of each dental implant. Methods: To obtain these curves, first the maximum value of the fracture load was obtained by simulation of a compression test. Subsequently, the fatigue life was simulated by varying each of the loads from the maximum value to a minimum value (10% of the maximum value), and the minimum number of cycles that it should support was calculated. Results: The fatigue limit of titanium in these implants was around 200 MPa with the maximum number of cycles between 64,976 and 256,830. The maximum compression load was between 100 and 80 N. Regarding the probability of failure, all implants were expected to behave similarly. Conclusions: This study of finite elements provided the values of maximum load supported by each of the implants, and the relationship between the stress in the implant and the number of cycles that it could support with a probability of failure. An international standard on how to perform fatigue studies in temporary dental implants was deemed necessary.

Immediate placement and provisionalization of implants in the aesthetic zone with or without a connective tissue graft: A 1-year randomized controlled trial and volumetric study.

ObjectiveTo volumetrically compare peri‐implant mid‐facial soft tissue changes in immediately placed and provisionalized implants in the aesthetic zone, with or without a connective tissue graft.Material and methodsSixty patients were included. All implants were placed immediately after extraction. After randomization, in one group, a connective tissue graft (test group, n = 30) was inserted at the buccal aspect of the implant. The other group (control group, n = 30) received no connective tissue graft. Clinical parameters, digital photographs and conventional impressions were obtained before extraction (T pre) and at 12 months following definitive crown placement (T 12). The casts were digitized by a laboratory scanner, and a volumetric analysis was performed between T pre and T 12.ResultsTwenty‐five patients in each group were available for analysis at T 12. Volumetric change, transformed to a mean (±SD) change in thickness, was −0.68 ± 0.59 mm (test) and −0.49 ± 0.54 mm (control) with a non‐significant difference between groups (p = .189). The mid‐facial mucosa level was significantly different between both groups (p = .014), with a mean (±SD) change of +0.20 ± 0.70 mm (test) and −0.48 ± 1.13 mm (control). The Pink Esthetic Score was similar between both groups.ConclusionsThe use of a CTG in immediately placed and provisionalized implants in the aesthetic zone did not result in less mucosal volume loss after 12 months, leading to the assumption that a CTG cannot fully compensate for the underlying facial bone loss, although a significantly more coronally located mid‐facial mucosa level was found when a CTG was performed.

Clinical and esthetic outcome with immediate insertion and provisionalization with or without connective tissue grafting in presence of mucogingival recessions: A retrospective analysis with follow-up between 1 and 8 years.

Recessions following immediate implant insertion are frequently reported in the literature. Data regarding implant installation in presence of mucogingival recessions are rare. This study observes soft tissue level changes following immediate implant insertion and provisionalization of implants with or without connective tissue grafts in the anterior maxilla in patients with initial mucogingival recession within a follow-up period between one and eight years. Twenty-six patients with marginal gingival recessions, which were designated for extraction and immediate implant insertion in the anterior zone of the maxilla (13-23), were included. Out of a larger group of immediate implants only single tooth replacements with 1 to 3 mm recession and a pre- and post-op CB-CT were selected. Facial bone deficiencies were grafted flaplessly with autologous bone in all sites. In a group of 13 patients the recessions (mean 2.3 ± 0.7 mm, range 1.0-3.0 mm) were grafted additionally by connective tissue (ABG + CTG), in the remaining 13 patients no soft tissue grafting (mean recession 1.8 ± 0.6 mm, range 1.0-3.0 mm) was performed (ABG). The marginal hard and soft tissue level, the width of the keratinized mucosa, the PES, and implant success were evaluated. After a mean follow-up period of 45 months the recessions were significantly reduced in the ABG group from 1.8 to 0.9 mm. The improvement was even more pronounced in the ABG + CTG group (from 2.3 to 0.5 mm). The PES improved significantly in both groups. At final examination all implants were still in function. Within the observational period, in 5 of 13 implants a marginal bone loss of more than 1 mm was noticed in the ABG, but in none of the ABG + CTG group. These clinical results provide evidence that immediate implant placement might improve the facial soft tissue level. This was more evident in cases with a greater recession and an additional treatment with connective tissue grafts.

Immediate provisionalization of dental implants placed in healed alveolar ridges and extraction sockets: a 5-year prospective evaluation.

This 5-year prospective multicenter study compared implant survival and success, peri-implant health and soft tissue responses, crestal bone level stability, and complication rates following immediate loading of single OsseoSpeed implants placed in anterior maxillary healed ridges or extraction sockets. Individuals requiring anterior tooth replacement with single implants were treated and immediately provisionalized. Definitive all-ceramic crowns were placed at 12 weeks. Implant survival, bone levels, soft tissue levels, and peri-implant health were monitored for 5 years. One hundred thirteen patients received implants in fresh sockets (55) and healed ridges (58). After 5 years, 45 and 49 patients remained for evaluation, respectively. During the first year, three implants failed in the extraction socket group (94.6% survival) and one implant failed in the healed ridge group (98.3% survival); this difference was not significant. No further implant failures were recorded. After 5 years, the interproximal crestal bone levels were located a mean of 0.43 ± 0.63 mm and 0.38 ± 0.62 mm from the reference points of implants in sockets and healed ridges (not a significant difference). In both groups, papillae increased over time and peri-implant mucosal zenith positions were stable from the time of definitive crown placement in sockets and healed ridges. Compared to flap surgery for implants in healed ridges, flapless surgery resulted in increased peri-implant mucosal tissue dimension (average, 0.78 ± 1.34 mm vs 0.19 ± 0.79 mm). After 5 years, the bone and soft tissue parameters that characterize implant success and contribute to dental implant esthetics were similar following the immediate provisionalization of implants in sockets and healed ridges. The overall tissue responses and reported implant survival support the immediate provisionalization of dental implants in situations involving healed ridges and, under ideal circumstances, extraction sockets.

Patient-Related and Financial Outcomes Analysis of Conventional Full-Arch Rehabilitation Versus the All-on-4 Concept

Patient-related variables such as cost of treatment, length of the treatment period, and comfort provided by the interim prosthesis when treatment planning for full-arch rehabilitation are often neglected in dental publications. Two patient cohorts were followed up longitudinally in this study: the "All-on-4 treatment concept group" and the "historical group." The number of implants, total treatment time, number of surgical procedures, number of sinus grafts, necessity for immediate provisional implants, adjusted cost associated for treatment in each group, and the quality of interim prosthesis were compared. The total adjusted cost for patients receiving All-on-4 treatment concept averaged at $42,422 ± 3860 (&OV0556;31,392 ± 2856), whereas the mean total adjusted cost for the historical group was $57,944 ± 20,198 (&OV0556;42,879 ± 2113) (P = 0.01). The difference in cost had a mean value of $7307 (&OV0556;5407) per jaw. Factors associated with complexity of treatment and patient comfort, such as the quality of interim prosthesis, number of surgeries, and duration of treatment time, all significantly favored the All-on-4 treatment concept group in comparison with conventional treatment modalities. When implant rehabilitation of the total jaw is sought, the All-on-4 treatment concept should be considered the least costly and least time consuming treatment option.

Immediate Provisionalization of Implants Placed in Fresh Extraction Sockets Using a Definitive Abutment: The Chamber Concept

The purpose of this case series is to present radiographic results of implants immediately placed and restored with a definitive abutment and followed for 18 months. Ten patients who required extraction of the maxillary central or lateral incisor were treated with immediate extraction, implant placement, and provisionalization. Hard tissue measurements were performed using cone beam computed tomography. At follow-up, the mean buccal horizontal gap was -0.21 ± 0.3 mm. The mean vertical gap was 0.15 ± 0.23 mm. The mean distance between the bone crest and implant bevel was 1.73 ± 0.17 mm. The favorable results are related to a three-dimensional biologic space created around the abutment called the chamber.

Immediate Placement and Provisionalization of Implants Into Sites With Periradicular Infection With and Without Antibiotics: An Exploratory Study

This study explored the necessity of perioperative antibiotics on survival rates of implants immediately placed and provisionalized into sites with infection. Subjects were randomly assigned into antibiotic or placebo groups. Extraction, immediate placement, and provisionalization of an implant were performed. Eight subjects received placebo and five subjects received both a pre- and post-operative antibiotic regimen. One implant from each group failed. Perioperative antibiotic therapy may not be needed in selected immediate implant therapy.

Mini implants for definitive prosthodontic treatment: A systematic review

Mini implants are commonly used in orthodontics and for interim prosthodontic treatment, but evidence for their use in definitive prosthodontic treatment is not clear. This systematic review evaluated the mini-implant literature to analyze short-term (1 to 5 years), medium-term (5 to 10 years), and long-term (beyond 10 years) survival rates when used for definitive prosthodontic treatment. An electronic search of the English language literature for articles published between January 1974 and May 2012 was performed by using PubMed and Cochrane databases with predetermined inclusion criteria. Key terms included in the search were mini dental implants, narrow diameter implants, reduced diameter implants, small diameter implants, transitional implants, interim implants, and provisional implants. After a systematic filtering process, the selected articles were subjected to a detailed review, and the data collected were used to calculate the 1-year interval survival rate (ISR) and the cumulative survival rate (CSR). The electronic database search yielded 1807 titles. By scrutinizing the titles and abstracts with inclusion and exclusion criteria, the researchers identified 9 studies of mini implants for definitive prosthodontic treatment. Of the studies identified, 1 was a randomized controlled trial, 2 were prospective studies, and 6 were retrospective studies. The majority of mini implants were placed by using a flapless surgical technique in the mandibular anterior region to support an overdenture. The 1st year ISR was 94.7% and the CSR over a 9-year period, primarily attributed to data from 1 study, was 92.2%. Most implants were immediately loaded and almost all implant failures occurred during the first year after implant placement. For short-term survival, the first year ISR of 94.7% of mini dental implants appears encouraging, but the true 1-year survival rate is unknown, as the minimum follow-up period reported for several implants was less than a year. Insufficient information about failures after the first year makes it difficult to draw conclusions about the medium-term survival of these implants. Currently, there is no evidence for the long-term survival of mini implants.

Twelve-Year Clinical and Radiological Results of Maxillary and Mandibular Implant-Retained Bar Overdentures Carried out on Oxidized (TiUnite) Replace Select Implants: A Clinical Case

T he original Branemark protocol for successful implant osseointegration required a healing period of 3–6 months during which the implants were submerged for protection from premature loading. As a result, the use of provisional implants during the osseointegration period, as a means of stabilization of a full-arch interim fixed restoration, has gained popularity in implant prosthodontic treatment. Recently, implant reconstructive dentistry has strongly evolved into 1-stage surgery, such as immediate postextraction, implant placement, and immediate (occlusal/nonocclusal) loading. Nowadays, the cumulative implant survival rate after 10-year-in-function ranges between 96.52% and 98.05% for implants placed in healed and postextractive sites, respectively. One of the main contributions to the successful, long-term, clinical outcomes has been the development of an oxidized implant surface that may improve bone-toimplant contact in virgin healed bone, as well as regenerated bone. On the other hand, the treatment of periodontally susceptible patients is still controversial. Patients with periodontitis often experience early tooth loss that requires implant therapy. Nevertheless, smoking and a history of periodontitis have been associated with a higher prevalence of peri-implantitis. Since their introduction in the early 1970s, fixed partial dentures and implant-supported milled bar overdentures have developed into reliable treatment options in cases of partial as well as total edentulism in both the mandible and the maxilla. A high success rate for implant-retained overdentures has been reported, even if some late implant failures have been observed. Biomechanical evaluation suggests that implant overload is a major contributor to cortical bone loss. A favorable prognosis requires proper bar design and selection of the attachment system, based not only on retention or cost, but also on biomechanics since the attachment is the most fragile link between prosthesis and implant. This case report describes long-term results of a patient with a history of trauma from a motorcycle accident, chronic periodontal disease, recurrent decay, American Society of Anesthesiology (ASA) III clinical condition, insulin-dependent diabetes, and previous implants that had not been restored. The patient was treated in both jaws with multiple extractions of all remaining teeth, immediate implant placement, and implant-retained bar overdentures. Immediate provisional implants (IPIs) were placed between submerged implants to provide support and esthetics for a provisional restoration during healing. A multifactorial approach as well as a clinician-patient relationship was needed in order to ensure optimal treatment planning and a long-term successful result. 1 Cleveland ClearChoice Dental Implant Center, Pepper Pike, Ohio; Case School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio. 2 Department of Oral Rehabilitation, University of Rome Tor Vergata, Rome, Italy. * Corresponding author, e-mail: cab@thedentalimplantcenter.com DOI: 10.1563/AAID-JOI-D-12-00311

Immediate functional loading of provisional implants in the reconstructed atrophic maxilla: preliminary results of a prospective study after 6 months of loading with a provisional bridge

Implant-prosthetic rehabilitation of atrophic maxillae remains a challenging problem. The aim of this paper is to describe a novel treatment for functional rehabilitation of the atrophic maxilla and to discuss preliminary results of this treatment protocol. A prospective pilot study was carried out in 10 patients who underwent bony reconstruction of atrophic maxillae under general anaesthesia, with autologous calvarial bone grafts and simultaneous placement of six provisional implants. The provisional implants were loaded with a provisional acrylic bridge 1 day after surgery. After 6 months, the provisional implants were removed and final implants were placed under local anaesthesia, again in an immediate loading concept with a provisional bridge, followed by a final bridge after another 6 months of healing. The bone grafts integrated well in all 10 patients without infectious complications. The prosthetic survival of the provisional bridge at the time of placing the implants was 100%. All final implants could be placed and immediately loaded with a second provisional bridge. Patient satisfaction was high due to limited postoperative inconvenience and immediate fixed prosthetic rehabilitation. The preliminary results of this pilot study demonstrate that this treatment protocol is a well tolerated treatment for patients with maxillary atrophy desiring dental rehabilitation.

Minimum Criteria for Immediate Provisionalization of Single-Tooth Dental Implants in Extraction Sites: A 1-Year Retrospective Study of 100 Consecutive Cases

Minimum criteria were used in the placement of 100 consecutive provisional restorations on single-tooth dental implants placed into extraction sites within 3 days of surgery. Provisional restorations were placed on 4.1- and 4.8-mm diameter standard ITI (Straumann, Waltham, MA) implants in the anterior mandible and maxilla in 100 treatment sites over a 3-year period. Provisionals were placed despite low insertion torque values of 15 N-cm or 50 implant stability quotient using radiofrequency analysis. Implants had final impressions for definitive restorations done 8 to 12 weeks after implant placement. All patients were recalled 1 year after restoration and evaluated according to parameters suggested by Albrektsson et al (Int J Oral Maxillofac Implants 1:11, 1986). One implant was not osseointegrated. The remaining implants were judged successful at the 1-year recall appointment. Immediate provisionalization of implants placed into fresh extraction sites can be effective even when minimal provisionalization criteria are met.

A Chairside Technique to Preserve the Anatomy of the Pre-Existing Crown in Immediate Implant Provisionalization: A Case Report

El objetivo de este articulo es describir un metodo directo en el sillon de provisionalizacion inmediata del implante, que conserva el perfil de emergencia natural original y la anatomia de los dientes.

Use of Intraoral Welding to Stabilize Dental Implants in Augmented Sites for Immediate Provisionalization: A Case Report

Immediate implant rehabilitation of edentulous arches may be somewhat problematic because of anatomic situations involving insufficient bone thickness or height and tooth position. The aim of this report was to present a retrospective case series of dental implants placed into augmented sites (split crest or sinus augmentation) that were stabilized with an intraorally welded framework at the time of immediate provisionalization. An intraoral welding unit was used to join and stabilize implants as an orthopedic splint to break down forces applied on provisional restorations during healing and osseointegration. This approach allows for the immediate provisionalization of implants in bone-defective areas where multiple implant systems have been enacted. Forty-eight implants in 16 patients were inserted, welded together to a titanium framework, and immediately provisionalized during the same surgery in which split-crest or sinus augmentation procedures were performed. After removing the welded frameworks, 1 of 48 implants failed; the failed implant was associated with a sinus augmentation procedure. Intraoral welding stabilization may be a predictable procedure to allow immediate loading in augmented areas during healing time and to stabilize implants against nonaxial forces, thereby reducing the number of surgical and prosthetic sessions and making patients comfortable and accustomed to immediate fixed provisional and definitive restorations.

Immediate Maxillary Lateral Incisor Implants with Nonocclusal Loading Provisional Crowns

This clinical report series describes a treatment modality involving immediately placed dental implants in maxillary lateral incisor sites using noncemented immediate provisional crowns retained with calcinable copings (prosthetic complement used in preparing the metal for the definitive prosthesis). Ten implants were placed in eight patients for the replacement of maxillary lateral incisors: two immediate and eight corresponding to cases of agenesis. All were subjected to immediate rehabilitation with provisional acrylic resin crowns in nonocclusal loading. One implant failed 3 weeks after placement due to acute local trauma. The other nine remained functional within the mouth, with normal clinical and radiological characteristics after a minimum of 12-month follow-up. Immediate placement of implant fixed provisional restorations retained by friction in maxillary lateral incisors offers an esthetic solution, eliminates the need for a removable provisional restoration, and avoids implant failures associated with excess cement or screw loosening. Moreover, in the case of extractions, immediate placement and provisionalization of implants in maxillary lateral incisors can effectively optimize the peri-implant esthetic results by maintaining the existing hard and soft tissue architecture of the replaced tooth. As no cement or screws are required, and the provisional crowns are placed in nonocclusal loading, the risk of complications is minimized.

Poster 158: The Extra-Alveolar Provisional Implant System

Poster 158: The Extra-Alveolar Provisional Implant System

Transitional implants in a patient with Williams‐Beuren syndrome: a four‐year follow‐up

Williams-Beuren syndrome (WBS) is characterized by several diagnostic features, including oligodontia. Restoration of congenitally missing teeth in patients with WBS is a challenge, both emotionally and clinically. In the atrophied alveolar bone process of a juvenile patient with WBS, the maxillary lateral incisors were replaced with two Immediate Provisional Implants (IPI). Early implant loading was used with temporary acrylic resin crowns that were replaced by semi-permanent restorations; the case has been followed for four years. Restoration of the missing maxillary lateral incisors with IPIs and temporary crowns proved to be a convenient, long-lasting and psychologically acceptable solution to the patient and her family.