Davide Romeo

Immediate Rehabilitation of the Mandible with Fixed Full Prosthesis Supported by Axial and Tilted Implants: Interim Results of a Single Cohort Prospective Study

PURPOSE The aims of this prospective study were to assess the treatment outcome of immediately loaded full-arch fixed bridges anchored to both tilted and axially placed implants for the rehabilitation of the mandible and to compare the outcome of axial versus tilted implants. MATERIALS AND METHODS Sixty-two patients (34 women and 28 men) were included in the study. Each patient received a full-arch fixed bridge supported by two axial implants and two distal tilted implants (All-on-Four, Nobel Biocare AB, Göteborg, Sweden). Loading was applied within 48 hours of surgery. Patients were scheduled for follow-up at 6, 12, 18, and 24 months, and annually up to 5 years. At each follow-up, plaque level and bleeding scores were assessed; moreover, patients satisfaction for aesthetics and function was evaluated by a questionnaire. Radiographic evaluation of marginal bone level change was performed at 1 year. RESULTS The overall follow-up range was 6 to 43 months (mean 22.4 months). Forty-four patients were followed for a minimum of 1 year. No implant failures were recorded to date, leading to a cumulative implant survival and prosthesis success rate of 100%. Plaque level and bleeding scores showed progressive decrease over time, parallel to increase of satisfaction for both aesthetics and function. No significant difference in marginal bone loss was found between tilted and axial implants at 1-year evaluation. CONCLUSION The present preliminary data suggest that immediate loading associated with tilted implants could be considered a viable treatment modality for the mandible.

Bone level changes around axial and tilted implants in full-arch fixed immediate restorations. Interim results of a prospective study.

PURPOSE The aim of this prospective study was to assess clinical outcomes and peri-implant bone level changes around tilted and axial implants supporting full-arch fixed immediate rehabilitations up to 60 months of loading. MATERIAL AND METHODS Forty-seven patients (22 women and 25 men) were included in the study. Each patient received a full-arch fixed bridge supported by two axial and two distal tilted implants. Loading was applied within 48 hours of surgery. Patients were scheduled for follow-up at 6, 12, 18, 24 months, and annually up to 5 years. At each follow-up, plaque level and bleeding scores were assessed and radiographic evaluation of marginal bone level change was performed. Periapical radiographs were taken using a paralleling technique, and subsequently scanned at 600 dpi. An image analysis software was used to assess bone level. RESULTS A total of 33 mandibles and 16 maxillae were rehabilitated (two patients received a fixed prosthesis in both arches). One hundred ninety-six Nobel Biocare implants of 4 mm diameter were placed. The mean follow-up duration was 52.8 months (range 30-66 months) in the mandible, and 33.8 months (range 22-40 months) in the maxilla. All subjects attended the scheduled follow-up visits. No implant was lost. No significant difference in marginal bone loss was found between axial and tilted implants in both jaws, at each follow-up. No significant difference in bone loss was found between mandible and maxilla, for both axial and tilted implants at each comparable time frame, although slightly higher mean values were always found for the mandible. CONCLUSION The use of tilted implants in the immediate rehabilitation of fully edentulous jaws is safe and is not associated to a higher marginal bone loss as compared to axially placed implants.

Immediate Rehabilitation of the Extremely Atrophic Mandible with Fixed Full-Prosthesis Supported by Four Implants

PURPOSE To prospectively assess the outcome of immediate rehabilitation of extremely atrophic mandibles by a full-arch fixed bridge anchored to four implants. MATERIAL AND METHODS Twenty patients with edentulous mandibles were included in the study. Each patient received a full-arch fixed bridge supported by two axial and two distal tilted implants. Prosthetic loading was applied within 48 hours of surgery. Patients were scheduled for follow-up every 6 months up to 2 years and annually until 5 years. Radiographic evaluation of marginal bone level change was performed at 1 year. RESULTS All patients were followed for a minimum of 1 year (range 20-48 months, mean 30.1 months). No failures were recorded to date. The 1-year implant survival rate and prosthesis success rate were 100%. Marginal bone loss around axial and tilted implants was similar at 12-month evaluation, being, respectively, 0.6 ± 0.3 (standard deviation) mm and 0.7 ± 0.4 mm. High patients level of satisfaction was recorded for function, phonetics, and aesthetics. CONCLUSION This technique could be considered a viable treatment option for the rehabilitation of the atrophic mandible.

Immediate Fixed Rehabilitation of the Edentulous Maxilla: A Prospective Clinical and Radiological Study after 3 Years of Loading

PURPOSE The aim of this study was to prospectively evaluate the clinical and radiographic outcomes of immediate full-arch fixed maxillary prosthesis supported by two axial and four tilted implants after 3 years of loading. MATERIALS AND METHODS Thirty-two patients with atrophic maxilla were consecutively enrolled and treated. Each patient received a fixed full-arch maxillary rehabilitation supported by four tilted implants that engaged the posterior and the anterior sinus walls and two axial anterior implants. A total of 192 implants (30 Brånemark System MK IV and 162 NobelSpeedy Groovy, Nobel Biocare AB, Göteborg, Sweden) were inserted and immediately loaded. The definitive restorations were placed 6 months later, and follow-up visits were scheduled every 6 months. During follow-ups, marginal bone loss (MBL), plaque and bleeding scores, and patients satisfaction were recorded. RESULTS All patients reached at least 3-year follow-up examination (range 36-78, average 55.53 months). Two tilted implants failed before delivering the definitive restoration, resulting in a cumulative survival rate of 98.96%. All final prostheses were stable and functional, resulting in a cumulative survival and success rate of 100%. At the 3-year follow-up there was no significant difference in MBL between axial (1.55 ± 0.31 mm) and tilted implants (1.46 ± 0.19 mm) (p = .05). Plaque and bleeding scores decreased over time, while patients satisfaction in both aesthetics and function increased. CONCLUSIONS Implants placement with this configuration could be considered a predictable and cost- and time-effective alternative approach for the immediate restoration of the edentulous maxilla, avoiding bone grafting procedures, even with a medium-term follow-up.

Immediate function of partial fixed rehabilitation with axial and tilted implants having intrasinus insertion.

AbstractImplant-supported rehabilitation of the posterior maxilla could be challenging because hyperpneumatization of the maxillary sinus might reduce the bone height. In this study, the authors report preliminary results of a new treatment modality for the partial fixed rehabilitation of posterior maxilla with immediate function by using 1 anterior axial implant and 1 posterior tilted implant with intrasinus mesial insertion.From 2009 to 2011, 10 patients (6 women and 4 men) with missing upper premolars and molars were recruited and treated accordingto this protocol. Each patient received a partial fixed bridge supported by 1 axial anterior implant and 1 posterior implant placed with a 30-degree mesial inclination and intrasinus insertion. Autologous bone was positioned to fill the maxillary sinus cavity and to cover the exposed implant surface after elevation of the anterior sinus membrane. A prosthesis with immediate function was positioned within 3 hours, whereas a CAD/CAM final restoration was delivered 6 months later. Follow-ups at 6 and 12 months, and then annually, were scheduled. At each follow-up, plaque level and bleeding scores were assessed, and radiographic evaluation of marginal bone level change was performed at 1 year. The patients were followed up for a mean of 50 months (range, 42–57 mo). No implants were lost, and all prostheses were stable and functional, reporting 100% of implant and prosthetic success rates. After 1 year, bone loss had a mean (SD) of 1.0 (0.4) and 0.9 (0.5) mm for axial and tilted implants, respectively, with no statistically significant differences between them (P > 0.05).The preliminary results suggest that this approach could allow the rehabilitation of posterior maxilla with immediate function in case of reduced bone volume, representing an alternative technique to bone grafting, short implants, and zygomatic or pterygoid implants.