Luca Francetti

Immediate occlusal loading and tilted implants for the rehabilitation of the atrophic edentulous maxilla: 1-year interim results of a multicenter prospective study

OBJECTIVES 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 fully edentulous maxillae and to compare the outcome of axial vs. tilted implants. MATERIAL AND METHODS Forty-one patients with edentulous maxillae were included in the study. Each patient received a full-arch fixed bridge supported by four axial implants and two distal tilted implants. Loading was applied within 48 h from surgery. Patients were scheduled for follow-up at 6 months, 1 year and annually up to 5 years. Radiographic evaluation of marginal bone-level change was performed at 1 year. RESULTS One patient died 4 months after surgery. Thirty patients were followed for a minimum of 1 year (range 3-42 months, mean 22.1 months). Three failures were recorded at 1-year follow-up (two axial implants and one tilted). Two more implants (one tilted and one axially placed) were lost within 18 months of loading. The 1-year implant survival rate was 98.8% for both axial and tilted implants. Prosthesis success rate was 100% at 1 year. Marginal bone loss around axial and tilted implants at 12-month evaluation was similar, being, respectively, 0.9+/-0.4 (standard deviation) mm and 0.8+/-0.5 mm. CONCLUSIONS The present preliminary data suggest that immediate loading associated with tilted implants could be considered to be a viable treatment modality for the atrophic maxilla and that there does not seem to be a different clinical outcome between tilted and axial implants.

Does placement of a connective tissue graft improve the outcomes of coronally advanced flap for coverage of single gingival recessions in upper anterior teeth? A multi‐centre, randomized, double‐blind, clinical trial

AIMS This parallel-group, multi-centre, double-blind, randomized-controlled clinical trial was undertaken to compare the clinical outcomes and patient morbidity of coronally advanced flap (CAF) alone or in combination with a connective tissue graft (CAF+CTG) in single Miller Class I and II gingival recessions. MATERIAL AND METHODS Three centres enrolled 85 patients with one recession each. Surgery was performed elevating a pedicle flap; 42 sites randomly received a graft under the flap. Measurements were taken by blind and calibrated examiners. Outcome measures included recession reduction, complete root coverage (CRC), intra-operative and post-operative morbidity, dentine sensitivity, and side effects. RESULTS No differences were noted in the intra-operative and post-operative patient-related variables between the two groups. Surgical time was significantly shorter in the CAF group. Recession reduction was not statistically different between the two groups, even though a model showed a tendency towards improved outcomes in sites treated with CAF+CTG (adjusted difference 0.33 mm, 95% CI=-0.06 to 0.72, p=0.1002). Significantly greater probability of CRC was observed after CAF+CTG (adjusted OR=5.09, 95% CI=1.69-17.57, p=0.0033). Dentine hypersensitivity improved in both the groups. CONCLUSIONS Both treatments were effective in providing a significant reduction of the baseline recession and dentine hypersensitivity, with only limited intra-operative and post-operative morbidity and side effects. Adjunctive application of a CTG under a CAF increased the probability of achieving CRC in maxillary Miller Class I and II defects.

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.

Clinical evaluation of an implant maintenance protocol for the prevention of peri‐implant diseases in patients treated with immediately loaded full‐arch rehabilitations

OBJECTIVE The aim of this prospective study was to assess the outcomes of an implant maintenance protocol for implants supporting a full-arch rehabilitation. MATERIALS AND METHODS Sixty-one patients (28 women and 33 men) treated with immediately loaded full-arch rehabilitation, both mandibular and maxillary, supported by a combination of two tilted and two axial implants, were included in the study. Patients were scheduled for follow-up visits every 6 months for +2 years, then yearly up to 4 years. Each patient received professional oral hygiene treatment and detailed oral hygiene instructions. During each visit, modified plaque index, bleeding index and probing depth were assessed. The presence of peri-implant tissue inflammation was also evaluated. RESULTS Mean observation time, considering both mandible and maxilla, was 18.3 months ranging from 6 months to 5 years. Both plaque and bleeding indexes frequency decreased over time. Probing depth was stable (2.46 ± 0.5 mm at 4 years). Only three implants were lost due to peri-implantitis (1.4% at 12 months), whereas the incidence of peri-implant mucositis was less than 10% in each considered period. CONCLUSIONS The adoption of a systematic hygienic protocol is effective in keeping low the incidence of peri-implant mucositis as well as in controlling plaque accumulation and clinical attachment loss.

Effect of periodontal treatment on glycemic control of patients with diabetes: A systematic review and meta-analysis

The aim of the present study was to investigate whether non‐surgical periodontal treatment reduces glycated hemoglobin (HbA1c) and fasting plasma glucose (FPG) levels in diabetic patients.

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.

Periodontal disease as a risk factor for adverse pregnancy outcomes: a systematic review and meta-analysis of case-control studies.

Periodontal disease is a highly prevalent group of illnesses of microbial etiology, whose consequence is a severe breakdown of tooth-supporting structures. A link between periodontal infection and several systemic conditions, among which adverse pregnancy outcomes, has been suggested in the recent years. The aim of this review based on case–control studies was to evaluate if periodontal disease could be considered as a risk factor for preterm birth, low birth-weight and preterm low birth-weight. An electronic search (via Pubmed) was performed for case–control studies investigating the relationship between periodontal disease and adverse pregnancy outcomes. From the initially retrieved 417 articles, 17 case–control studies, accounting for a total of 10,148 patients, were included in the review and in the meta-analysis. The estimated odds ratio was 1.78 (CI 95%: 1.58, 2.01) for preterm birth, 1.82 (CI 95%: 1.51, 1.20) for low birth-weight and 3.00 (CI 95%: 1.93, 4.68) for preterm low birth-weight. Despite the results of the analysis of pooled data suggested a link between periodontal diseases and adverse pregnancy outcomes, the presence of important confounders, whose effect could not be addressed, prevents a validation of the meta-analysis outcomes. Further more accurate investigations based on individual data analysis could give a better insight into the topic of the present review.

Root Coverage Esthetic Score After Treatment of Gingival Recession: An Interrater Agreement Multicenter Study

BACKGROUND The root coverage esthetic score (RES) system was proposed for evaluating esthetic outcomes of root coverage procedures. The aim of this multicenter study is to assess the interrater agreement of the RES among expert periodontists. METHODS Eleven periodontists were selected in different clinical centers. Each operator had ≥15 years of experience in mucogingival surgery. Each periodontist was trained to use RES before the beginning of the study. Subsequently, baseline and post-treatment (6 months) photographs of 41 Class I and II gingival recessions in 41 patients were separately given to each operator who evaluated the outcomes according to the RES method. A two-way random interclass correlation coefficient and 95% confidence interval (CI) were used to assess the global interrater agreement for RESs. RESULTS The total interrater agreement for RESs was 0.92 (95% CI: 0.88 to 0.95), which indicated that an almost perfect agreement was achieved. CONCLUSION Tested individually by a group of periodontists, the RES seems to be a reliable method for assessing the esthetic outcomes of root coverage procedures.

Immediate occlusal loading the same day or the after implant placement: comparison of 2 different time frames in total edentulous lower jaws.

Immediate loading of endosseous implants is becoming a widespread therapeutic procedure for the rehabilitation of patients with edentulous jaws. The purpose of this prospective clinical trial was to evaluate the long-term success rate of endosseous implants placed in the edentulous lower jaw and loaded on either the same day of surgery or the next day. Nineteen patients were enrolled in the study. Eleven patients, accounting for 64 implants, received their provisional prosthesis the same day of implant placement, and 8 patients, accounting for 52 implants, were rehabilitated the day after surgery. All patients were rehabilitated by a hybrid prosthesis supported by 5 to 6 Osseotite implants. Two implants failed in the group of patients who had their implants loaded the same day (96.9% success rate), whereas 1 implant failed in the other group (98.1% success rate). The overall implant success rate was 97.4%. All failures occurred within 2 months of function. No other complication was reported. The mean follow-up for this interim report was 37.8 +/- 16.5 months (range 8-65 months). Crestal bone loss was similar to that reported for standard delayed loading protocols. The results of this study suggest that the rehabilitation of the edentulous lower jaw by an immediate occlusally loaded implant-supported hybrid prosthesis is equally successful when loading is applied the same day or the day after implant placement. Immediate loading with 5 to 6 implant-supported prostheses represents a viable alternative treatment to classic delayed loading protocols.

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.