Nicolò Cavalli

Medium- and Long-Term Complications in Full-Arch Rehabilitations Supported by Upright and Tilted Implants.

PURPOSE The purpose of this retrospective investigation was to present the incidence of biological and technical complications in patients treated with implant-supported, immediately loaded full-arch restorations. MATERIALS AND METHODS Clinical data of all patients treated with full-arch, immediately loaded rehabilitations supported by a combination of upright and tilted implants were screened. Data on both technical and biological complications (such as peri-implant mucositis and peri-implantitis) and their onset and frequency of occurrence were recorded and analyzed. RESULTS The clinical records of 86 patients (95 prosthetic rehabilitations) were included in this study. There were 61 mandibular rehabilitations and 34 maxillary ones, all of them immediately loaded within 8 to 48 hours of the surgical intervention. The follow-up time varied from 16.3 to 112 months of function (mean 65.36 months). The most common biological complications were hygiene-related (n = 81; 30.2% of patients displayed peri-implant mucositis and 10.4% peri-implantitis). Among all prosthetic complications, the detachment of an element of the definitive prosthesis was the most frequent event (n = 20; 23.2% of patients). The total number of prosthetic complications was 42. Most complications were reversible and did not affect the overall implant/prosthesis survival rate. CONCLUSIONS The occurrence in well-maintained patients of technical and biological complications in full-arch rehabilitations supported by a combination of tilted and upright implants in the medium to long term is lower than previously reported by the pertinent literature. Further studies are needed to confirm this result.

Prevalence of Peri-Implant Mucositis and Peri-Implantitis in Patients Treated with a Combination of Axial and Tilted Implants Supporting a Complete Fixed Denture

Objectives. The aim of this retrospective study was to assess the incidence and prevalence of peri-implant mucositis and peri-implantitis in patients with a fixed full-arch prosthesis supported by two axial and two tilted implants. Materials and Methods. Sixty-nine patients were included in the study. Each patient received a fixed full-arch prosthesis supported by two mesial axial and two distal tilted implants to rehabilitate the upper arch, the lower arch, or both. Three hundred thirty-six implants for 84 restorations were delivered. Patients were scheduled for follow-up visits every 6 months in the first 2 years and yearly after. At each follow-up visit peri-implant mucositis and peri-implantitis were diagnosed if present. Results. The overall follow-up range was from 12 to 130 months (mean 63,2 months). Three patients presented peri-implantitis. The prevalence of peri-implant mucositis ranged between 0 and 7,14% of patients (5,06% of implants) while the prevalence of peri-implantitis varied from 0 to 4,55% of patients (3,81% of implants). Conclusions. The prevalence and incidence of peri-implant mucositis and peri-implantitis are lower than most of the studies in literature. Therefore this kind of rehabilitation could be considered a feasible option, on the condition of adopting a systematic hygienic protocol.

Implant success rates in full-arch rehabilitations supported by upright and tilted implants: a retrospective investigation with up to five years of follow-up

Purpose The aim of this retrospective study was to investigate the cumulative success rate, the implant survival rate, and the occurrence of biological complications in implants supporting full-arch immediately loaded rehabilitations supported by upright and tilted implants. Methods The clinical records and periapical radiographs of patients who attended follow-up visits were collected, and information was recorded regarding marginal bone loss resorption, the occurrence of peri-implant infectious diseases, and the implant survival rate. Implants were classified as successful or not successful according to two distinct classifications for implant success. Results A total of 53 maxillary and mandibular restorations including 212 implants were analysed, of which 56 implants were studied over the full five-year follow-up period. After five years, the cumulative success rate was 76.04% according to the Misch classification and 56.34% according to the Albrektsson classification. The cumulative implant survival rate was 100%, although one implant was found to be affected by peri-implantitis at the second follow-up visit. Conclusions The cumulative success rate of the implants dropped over time, corresponding to the progression of marginal bone resorption. The prevalence of peri-implantitis was very low, and the implant survival rate was not found to be related to the cumulative success rate.

Biomechanical in vitro evaluation of two full-arch rehabilitations supported by four or five implants.

PURPOSE The aim of this in vitro study was to evaluate the stress pattern on the abutments in two different full-arch implant-supported clinically equivalent prosthetic rehabilitations. MATERIALS AND METHODS Two steel master casts were created and titanium implants were inserted in two different configurations. One configuration used four implants, with the distal implants tilted 30 degrees (4IMP configuration), and the other used five axially inclined implants (5IMP configuration). A straight multiunit abutment (MUA) was connected to every axial implant and a 30-degree angulated MUA was connected to each tilted implant. One titanium framework was fabricated for each configuration, with a 5-mm (4IMP configuration) or a 15-mm (5IMP configuration) distal cantilever length. Six cycles of vertical loading between 20 and 200 N were applied unilaterally at the most distal point of the frameworks on both sides. Readings of the deformations at the abutment level were obtained with the use of linear strain gauges. RESULTS A similar pattern of deformation was seen in both configurations. The greatest compressive stress was measured by the strain gauge on the abutment closest to load application and was similar for the 4IMP and 5IMP configurations. The tensile stress measured on the same abutment was higher in the 5IMP configuration than in the 4IMP configuration. In terms of the distribution of stresses, the deformation measured on the central abutment in the 5IMP configuration was less than 10% of the overall stress in all the tested conditions. CONCLUSION There was no difference in strain between the two different designs, so the use of tilted implants with angulated abutments to reduce cantilever length could be considered a viable clinical option.

Comparative evaluation of the use of magnification loupes in supragingival scaling procedures

AIM The main aim of the present investigation was to evaluate clinical and patient-centered outcomes of supragingival scaling performed with or without the use of 2.5× magnification loupes and illumination. METHODS A total of 30 patients, divided into three groups, were treated with 2.5× loupes and 2.5× loupes and illumination, and without any magnification device. Full-mouth plaque score percentage (FMPS%) and full-mouth bleeding score percentage (FMBS%) were registered before and after the treatment. Moreover, perceived pain and quality of the treatment were recorded using a visual analog scale. Appropriate statistical analysis was adopted to analyze between-group differences for the investigated parameters. RESULTS All of the patients completed the study protocol. All the groups were homogeneous at baseline. Supragingival scaling caused a significant reduction of FMPS% and FMBS% in all groups without differences among them. Moreover, no differences could be found for patient-centered outcomes. The duration of the treatment was significantly higher in the group in which loupes and illumination was used than in the control group. CONCLUSIONS The use of magnification loupes (with or without illumination) did not significantly improve clinical and patient-centered outcomes of supragingival scaling procedures.

Fifteen-Year Follow-Up of a Case of Surgical Retreatment of a Single Gingival Recession

Purpose The aim of the present case report was to describe the retreatment of the single gingival recession in aesthetic area, in the presence of scar formation and consequent impairment of aesthetic appearance. Methods A young patient with one single recession of 4 mm of 2.1 was treated with coronally advanced flap and subepithelial connective tissue graft, through a microsurgical approach that aimed at the removal of the scarred fibrous tissue. The intervention was performed using a surgical microscope as a magnification device. Results Fifteen years after the surgical treatment, a substantial stable resolution of the gingival recession could be observed. Moreover, a further improvement of the aesthetic appearance could be observed. Conclusions This case report suggests that periodontal microsurgery could be an effective approach for the retreatment of gingival recessions and, in long-term evaluation, to reduce the aesthetic problem due to the presence of scar formation. Further studies with a larger sample size are needed to better evaluate its efficacy.

Riabilitazioni implantoprotesiche nelle aree esteticamente rilevanti: il condizionamento dei tessuti molli

Riassunto Obiettivi Lo scopo di questo articolo e descrivere una serie di tecniche utili a migliorare l’estetica delle riabilitazioni implantari nel mascellare anteriore. Materiali e metodi Si descrive una sequenza di fasi cliniche per la realizzazione di una riabilitazione con particolare attenzione al condizionamento della mucosa perimplantare. Risultati Al termine del trattamento la corona risulta ben mimetizzata con gli elementi adiacenti e i tessuti molli perimplantari presentano un profilo simmetrico rispetto alla gengiva controlaterale. La valutazione media secondo il Pink Esthetic Score risulta di 11,125 punti su 14 (deviazione standard ± 1,553). Conclusioni Esiste una serie di tecniche che possono migliorare il risultato estetico delle riabilitazioni implantari. Il rimodellamento della mucosa perimplantare puo essere ottenuto in modo atraumatico modificando il provvisorio.