Faculty Bibliography

BACKGROUND: When restoring multiple implants in the completely edentulous mandible, fabrication of a passive-fitting framework using traditional casting procedures is difficult. The introduction of computer-aided design and manufacturing techniques for fabricating custom 1-piece titanium frameworks simplifies this challenge and reduces time spent by the restorative dentist. PURPOSE: The aim of this case presentation is to explain how to fabricate a milled titanium framework using Procera technique step by step. MATERIALS AND METHODS: A 79-year-old woman with an edentulous maxilla and mandible received a maxillary complete denture in 3 appointments by duplicating her existing complete denture, and a mandibular screw-retained fixed dental prosthesis using a milled titanium framework. The patient did not have any problems regarding her implants and restorations in a year of service. CONCLUSION: This clinical report presents a complete oral rehabilitation, in which a custom-milled titanium complete-arch mandibular framework was fabricated with an overdenture, and a maxillary complete denture was fabricated using a denture duplication technique in 3 appointments.

Immediate loading procedures may cause discomfort to the patient and increase the possibility of damage to the surgical site during prosthetic restorations. The aim of this clinical report is to describe an alternative method to fabricating a mandibular hybrid prosthesis in 3 days without taking an impression. Five implants were placed in the anterior region of an edentulous mandible and restored with a definitive mandibular hybrid prosthesis using a unique acrylic resin framework. This acrylic resin framework enabled the fabrication of the metal framework of the mandibular hybrid prosthesis without taking a final impression. The step-by-step technique is described.

Dental implant therapy has become successful with improved surgical and prosthodontic techniques. However, most clinical trials, even though well controlled, are limited in longevity. There are few clinical reports that show long-term results with dental implants. Although there are many similarities among criteria for success in these studies, these criteria may vary from what the individual patient reports as a success. This clinical report describes the 28-year successful clinical outcome of a 62-year-old woman with dental implants supporting a mandibular screw-retained fixed dental prosthesis.

BACKGROUND AND PURPOSE: Implant-supported mandibular overdentures have recently become a popular treatment alternative for edentulous patients desiring increased retention of complete dentures. The goal of this study was to evaluate and present treatment outcomes of mandibular overdentures retained by two unsplinted, early-loaded implants and compare these results with those for delayed-loaded implants. MATERIAL AND METHODS: Twenty-six edentulous patients had two interforaminal implants placed with a one-stage protocol. The patients were each treated with a mandibular overdenture supported by ball abutments. In the test group, the overdenture was loaded 1 week after surgery and in the control group, the overdenture was loaded 3 months after surgery. Standardized clinical and radiographic parameters were recorded at surgery, and after 3, 6, 12, and 18 months, and 2, 3, 4, 5, and 7 years. RESULTS: Because two patients did not make the 7-year recall, only 24 patients (48 implants) were evaluated in this study. No implants were lost, and 1.31 +/- 0.2 mm marginal bone resorption was noted for all implants after 7 years. Implant stability measurements, clinical peri-implant parameters and marginal bone levels exhibited no statistically significant differences between the two groups over 7 years. CONCLUSION: The results of this clinical trial show that there is no significant difference in the clinical and radiographic outcomes of patients treated with mandibular overdentures supported by TiUnite implants that are either early or delayed loaded.

BACKGROUND: Although dental implant treatment is a very successful option today, a meticulous treatment planning and close collaboration between the oral surgeon and restorative doctor is crucial to eliminate undesired outcomes. PURPOSE: To present a challenging case restored with a maxillary screw-retained fixed prosthesis using malpositioned/malaligned implants. MATERIALS AND METHODS: A 47-year-old female had a Lefort I fracture and lost all maxillary teeth due to traumatic injury in a traffic accident. Seven maxillary implants were placed using a 1-stage surgical approach, 6 months after open reduction surgery in a private practice. Radiographic and clinical evaluation indicated marginal bone loss around 3 anterior implants. The malposition and malalignment of implants made impression and casting procedures very complicated. The other challenging factors with this patient were microstomia, limited mouth opening due to scar tissue from previous plastic surgery, and a very small maxilla. The 1-piece metal framework did not fit accurately so it was sectioned into 3 segments. The 3 separate segments were screwed on the abutments individually, then connected to each other using an acrylic resin. The 3 framework segments were laser welded. After the laser welding, a passive fit of the framework was achieved. CONCLUSION: It has been suggested that providing an implant treatment to a patient with implants placed in wrong positions with undesired angulations can be very difficult. Also, laser welding may be a viable option to eliminate misfit of full-arch metal frameworks.

A need for dental implant treatment in the older population is recognized considering the prevalence of partial and complete edentulism and the positive predictability of implant therapy. Even with a number of barriers to overcome for the older adult seeking implant care, dental implants provide stabilizing support for removable dental appliances and have been shown to be successful in that population. In this paper, we describe quality of life, systemic, surgical, and prosthodontic considerations of this prosthetic treatment along with maintenance challenges.

BACKGROUND: The aim of this study was to evaluate the correlation between the density of bone where implants were placed and the angular deviations that occurred between the virtually planned and actually placed implants using 2 different stereolithographic surgical guides. METHODS: The study population consisted of 54 patients who received 216 implants. Computed tomography machine was used for preoperative evaluation of the jawbone for implant therapy as well as determination of the bone density values (Hounsfield units [HU]) of the implantation site. All implant sockets were prepared using 2 different types of stereolithographic surgical guide. Ninety-four implants were installed using the surgical guides (Stentcad Beyond, Ay-Design; Kos-gep, ODTU, Ankara, Turkey) in the mouth, whereas 122 implants were placed after the surgical guides (Stentcad Classic; Kos-gep, ODTU) were removed. RESULTS: The mean bone densities of maxilla and mandible were 561.36 (SD, 229.46) HU and 890.63 (SD, 361.85) HU, respectively. The mean angular deviations between planned and placed implants using Stentcad Classic and Stentcad Beyond surgical guides were 5.32 (SD, 1.96) degrees and 3.73 (SD, 1.14) degrees, respectively. Highly negative correlation was found between the bone density of the placed implant sites and angular deviations in the group in whom implants were installed with freehand. CONCLUSIONS: The lower bone density values have resulted in the greater angular deviations in the group, in whom the implants were placed after the surgical guides were removed. This deviation might have been derived from the freehand placement of the implants and the poor quality of the bone.

The aim of this human cadaver study was to determine the correlation between bone quality and implant stability parameters, and the relationship between resonance frequency value and peri-implant bone loss. Thirty-two implants were placed into four human cadaver mandibles. The bone density of the implant recipient site was determined using computerized tomography (CT) in Hounsfield units (HU). The peak insertion torque values were recorded. The resonance frequency (RF) measurements were performed immediately following implant insertion and also after one, two and three turns of the implant in a counterclockwise direction, representing peri-implant bone loss. The mean bone density, insertion torque and RFA values of all implants were 152 +/- 264 HU, 41.7 +/- 6 Ncm and 69.7 +/- 9 ISQ. Statistically significant correlations were found between bone density and insertion torque values, bone density and ISQ values, and insertion torque and ISQ values. A significant influence of the peri-implant bone loss on ISQ value was also observed. The findings from this study illustrate significant correlation between bone density and implant stability parameters, and a linear relationship between peri-implant bone levels and resonance frequency value.

This study describes a clinical case in which a primary maxillary canine with both mobility and root resorption was replaced with an immediately restored dental implant placed into the fresh extraction socket. The implant achieved high primary stability, as determined by resonance frequency analysis, and it was immediately restored with a provisional acrylic resin crown with no centric occlusion. An all-ceramic permanent crown replaced the provisonal crown four months after implant surgery. The implant was stable and no periapical radiolucencies, bleeding on probing, or pathologic probing depth were recorded after one year. The peri-implant soft tissue level appeared stable, and the interdental papillae were preserved, contributing to an optimum final esthetic result. This case supports the use of single implants for the replacement of extracted primary teeth, especially in areas where esthetics is a high priority. The immediate provisional crown maintained soft tissue contours and papillary height.

Loss of an anterior tooth as the result of trauma is relatively common, especially in the young. Orthodontic treatment is not always the definitive therapy of choice; instead, an implant can be placed to replace the missing tooth. This article describes the case of a 19-year-old woman whose maxillary left central incisor was replaced by an immediately restored dental implant, placed using flapless surgery. The implant achieved excellent primary stability, as determined by resonance frequency analysis, so it was immediately restored with a provisional acrylic resin crown in no centric occlusion. This case report supports the use of single implants for replacing a missing anterior tooth where esthetics are a priority.