Pedro Nicolau

Immediate and Early Loading of Chemically Modified Implants in Posterior Jaws: 3-Year Results from a Prospective Randomized Multicenter Study

BACKGROUND There is a lack of well-designed prospective, randomized clinical trials evaluating the efficacy of immediate and early loading of implants placed in the partially edentulous posterior maxilla or mandible. PURPOSE The aim of this study was to evaluate crestal bone level changes over 3 years following immediate or early loading of Straumann implants with a chemically modified surface (SLActive®, Institut Straumann AG, Basel, Switzerland) placed in the posterior maxilla and mandible. MATERIALS AND METHODS Subjects received temporary restorations immediately or 28 to 34 days after surgery, with permanent restorations placed at 20 to 23 weeks. Bone level changes were measured by comparison of standardized radiographs taken on the day of implant placement and 5, 12, 24, and 36 months thereafter. RESULTS Two hundred thirty-nine of two hundred sixty-six patients (89.9%) completed the trial. Implant survival rates were 97.4% and 96.7% in the immediate and early loading groups, respectively (p = not significant). Over 36 months, the mean bone level change for immediately loaded implants was 0.88 ± 0.81 mm versus 0.57 ± 0.83 mm for the early-loaded group (p < .001). After adjusting for a slight difference in initial placement depth, the time of loading had no significant influence on bone level change. CONCLUSIONS Changes in crestal bone level occurred mostly during the first 5 months postloading. After this bone remodeling period, crestal bone level was stable up to 36 months. Implants with a chemically modified surface are safe and predictable for immediate and early loading in the posterior maxilla and mandible.

Platform switch versus platform match in the posterior mandible – 1-year results of a multicentre randomized clinical trial.

Objective The purpose of this ongoing randomized study was to assess differences in bone level changes and success rates using implants supporting single crowns in the posterior mandible either with platform matched or platform switched abutments. Material and Methods Patients aged 18 and above, missing at least two teeth in the posterior mandible and with a natural tooth mesial to the most proximal implant site were enrolled. Randomization followed implant placement. Definitive restorations were placed after a minimum transgingival healing period of 8 weeks. Changes in crestal bone level from surgery and loading (baseline) to 12-month post-loading were radiographically measured. Implant survival and success were determined. Results Sixty-eight patients received 74 implants in the platform switching group and 72 in the other one. The difference of mean marginal bone level change from surgery to 12 months was significant between groups (p < 0.004). Radiographical mean bone gain or no bone loss from loading was noted for 67.1% of the platform switching and 49.2% of the platform matching implants. Implant success rates were 97.3% and 100%, respectively. Conclusions Within the same implant system the platform switching concept showed a positive effect on marginal bone levels when compared with restorations with platform matching.

Effect of platform switching on crestal bone levels around implants in the posterior mandible: 3 years results from a multicentre randomized clinical trial

Abstract Objective Evaluation of differences in the clinical performance and crestal bone levels between implants restored with single crowns with platform‐matched or platform‐switched abutments after 3 years. Material and Methods The study enrolled adult patients missing two or more adjacent teeth in the posterior mandible with natural teeth mesial to the implant site. Randomization followed open‐flap implant insertion and the corresponding matching or switching healing abutments placed at surgery. Conventional loading was made with cemented crowns. Clinical follow‐up took place annually after loading up to 3 years. Bone level changes were measured in standardized radiographs as the variation in crestal bone from one evaluation to the next. Results Sixty‐three patients with a total of 135 implants (66 platform matching, 69 platform switching) were analysed. From surgery to 36 months, mean bone loss was 0.28 ± 0.56 mm for the platform‐switching group and 0.68 ± 0.64 mm for the platform‐matching group. A statistically significant difference was found between groups (p = 0.002) with an estimate of 0.39 mm (0.15–0.64, 95% CI) in favour of platform switching. Conclusions After 3 years, platform‐switching restorations showed a significant effect in the preservation of marginal bone levels compared to platform‐matching restorations.

Radiographic evaluation of conical tapered platform-switched implants in the posterior mandible: 1-year results of a two-center prospective study

Abstract Objective Long‐term success of dental implants depends on healthy peri‐implant soft tissues and adequate bone levels. This prospective study aims to assess bone level changes around implants with internal conical connection and platform‐switching abutments in the posterior mandible. Material and methods Adult patients missing at least two teeth in the posterior mandible and with a natural tooth mesial to the implant site received two or three adjacent internal conical connection implants. After a minimum transmucosal healing period of 8 weeks, single crown restorations were cemented over platform‐switching abutments. Changes in marginal bone levels were measured in standardized periapical radiographs from surgery and loading (baseline) to 12 months post‐loading. Results Twenty‐four patients received 52 implants. Bone remodeling took place between surgery and loading (−0.53 ± 0.40 mm). From loading to 12 months, there was a mean bone gain of 0.12 ± 0.42 mm which occurred mainly in the first 6 months after prosthesis delivery (0.11 ± 0.36 mm) and stabilized afterward. A total of 71.7% of all implants presented bone preservation or gain. No implant was lost at 1 year and the success rate was 100%. Patient inquiry revealed high satisfaction. Conclusion Internal conical connection implants with platform‐switching abutments presented high success rate and enhancement or preservation of marginal bone levels after 1 year of loading.

Effect of geometry on deformation of anterior implant-supported zirconia frameworks: An in vitro study using digital image correlation

PURPOSE To evaluate the effect of geometry on the displacement and the strain distribution of anterior implant-supported zirconia frameworks under static load using the 3D digital image correlation method. METHODS Two groups (n=5) of 4-unit zirconia frameworks were produced by CAD/CAM for the implant-abutment assembly. Group 1 comprised five straight configuration frameworks and group 2 consisted of five curved configuration frameworks. Specimens were cemented and submitted to static load up to 200N. Displacements were captured with two high-speed photographic cameras and analyzed with video correlation system in three spacial axes U, V, W. Statistical analysis was made using the nonparametric Mann-Whitney test. RESULTS Up to 150N loads, the vertical displacements (V axis) were statistically higher for curved frameworks (-267.83±23.76μm), when compared to the straight frameworks (-120.73±36.17μm) (p=0.008), as well as anterior displacements in the W transformed axis (589.55±64.51μm vs 224.29±50.38μm for the curved and straight frameworks), respectively (p=0.008). The mean von Mises strains over the surface frameworks were statistically higher for the curved frameworks under any load. CONCLUSION Within the limitations of this in vitro study, it is possible to conclude that the geometric configuration influences the deformation of 4-unit anterior frameworks under static load. The higher strain distribution and micro-movements of the curved frameworks reflect less rigidity and increased risk of fractures associated to FPDs.

Facial Temperature Recovery After Ice Therapy: A Comparative Study Based on Thermography Evaluation

Thermography is a non-radiating and contact-free technology which can be used to monitor skin temperature. The efficiency and safety of thermography technology make it a useful tool for detecting and locating thermal changes in skin surface, characterized by increases or decreases in temperature. This work intends to be a contribution for the use of thermography as a methodology for evaluation of skin temperature in the context of orofacial biomechanics. The study aims to identify the oscillations of skin temperature in hemiface’s region of the masseter muscle and estimate the time required to restore the initial temperature after the application of an ice stimulus. Using an infrared camera, a data acquisition protocol was followed with a group of volunteers in a controlled environment. The thermal stimulus involves the use of an ice volume and the skin surface temperature was recorded in two distinct situations, namely without further stimulus and with the addition of a complementary stimulus obtained by a chewing gum. The results shows that recovery is faster with the addition of the stimulus and may guide clinicians regarding the pre and post-operative times with ice therapy, in the presence or absence of mechanical stimulus that increase muscle functions.

Effect of round curvature of anterior implant-supported zirconia frameworks: finite element analysis and in vitro study using digital image correlation

Abstract Two groups of 4-unit zirconia frameworks were produced by CAD/CAM to simulate the restoration of an anterior edentulous gap supported by 2 implant-abutment assemblies. Group 1 comprised straight configuration frameworks and group 2 consisted of arched frameworks. Specimens were made with the same connector cross-section area and were cemented and submitted to static loads. Displacements were captured with two high-speed photographic cameras and analysed with video correlation system. Frameworks and the implant-abutment assembly were scanned and converted to 3DCAD objects by reverse engineering process. A specimen of each group was veneered and the corresponding 3D geometry was similarly obtained after scanning. Numerical models were created from the CAD objects and the FE analysis was performed on the zirconia frameworks and on the FPDs bi-layered with porcelain (veneered frameworks). Displacements were higher for the curved frameworks group, under any load. The predicted displacements correlated well with the experimental values of the two framework groups, but on the straight framework the experimental vertical displacements were superior to those predicted by the FEA. The results showed that the round curvature of zirconia anterior implant-supported FPDs plays a significant role on the deformation/stress of FPDs that cannot be neglected neither in testing nor in simulation and should be considered in the clinical setting.