Faculty Bibliography

The second part of this JPD Digital presentation focused on the treatment planning, treatment coordination, and execution of implant therapy. The clinical application of the evidence-based criteria in implant therapy was emphasized including the surgical parameters, restorative parameters, and implant features reviewed in part 1. The objective was to achieve predictable results that improve the longevity of the implant and restoration, maintain peri-implant health, and optimize the esthetic outcome. Examples of several clinical scenarios of single tooth replacement treatment in the esthetic zone were reviewed by using options that included immediate placement, immediate loading, and resin-bonded interim restoration. In addition, patients requiring multiple implants, combinations of tooth-supported and implant-supported restorations, and a complete arch prosthesis supported by implants were presented. Many clinically challenging patients can be treated more effectively by using a digital workflow to plan and execute implant therapy.

OBJECTIVES/OBJECTIVE:Report the results with a novel workflow of digital restoration for completely edentulous patients with implant supported full arch fixed dental prostheses (ISFDP). METHODS:This multicenter retrospective clinical study was based on the evaluation from a cohort of 29 patients restored with 37 ISFDP designed and manufactured from the data captured by a direct intraoral scan, using a novel full digital system (NEXUS IOS®, Osteon Medical, a Keystone Dental Group company, Melbourne, Australia). Data was collected over a 3-year period, in six different dental centers. This study reported on the clinical parameters including: precision of marginal fit, functional and aesthetic integration of Nexus ISFDP. All patients were followed for a period of one year post delivery. Implant survival, biologic and prosthetic complications were assessed, at one year. A statistical analysis was conducted. RESULTS:All 37 ISFDP were deemed clinically acceptable on insertion. Implant survival at one year was 100 %. The biologic and prosthetic complications were minimal during the follow-up period. CONCLUSIONS:ISFDP, designed and manufactured using the NEXUS IOS® system, are clinically acceptable, with a low incidence of complications at one year. Long-term clinical studies are needed. STATEMENT OF CLINICAL RELEVANCE/UNASSIGNED:Within the limitations of this study (retrospective design, small patient sample, limited follow-up) the NEXUS IOS® system seems to represent a viable solution for the restoration of completely edentulous patients with ISFDP, in a full digital workflow.

As dental implants have evolved into a universally accepted treatment option, it is essential to identify nuances of the peri-implant complex and their impact on treatment given the increasing evidence of peri-implantitis and implant loss. A thorough knowledge of anatomy and biology, careful treatment planning, correct placement, prosthetic and occlusal design, and proper long-term maintenance all play a role in dental implant therapy. The goal of this part 1 presentation is to review evidence-based criteria in implant treatment including the surgical and restorative parameters, and the desired implant features, with the objective of achieving predictable results that improve the longevity of the implant and restoration, maintain peri-implant health, and optimize the esthetic outcome. By following science-based guidelines, implant treatment can be improved and simplified with more predictable results, especially in the esthetic zone, where demands are greater and there is less room for error.

Selecting the appropriate abutment can be both complex and confusing with the ever-increasing number of implant choices and transepithelial abutments available. Many restorative dentists resort to fabricating costly custom abutments to avoid the selection process. Although custom abutments are at times necessary, prefabricated abutments are usually more desirable. This article will describe the various abutments available and how to select the correct abutment for a given clinical situation in an organized, systematic fashion. Criteria discussed include implant position, angulation, soft tissue height, and interocclusal space. The latest modifications and developments in implant abutments are reviewed along with an indirect method of selecting abutments in a laboratory setting