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"dental implants"
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Peri-implant soft tissue conditioning of immediate posterior implants by CAD-CAM socket sealing abutments: a randomized clinical trial
Background
Anatomically formed healing abutments were suggested in literature to address many of the issues associated with immediate posterior implant insertion such as large extraction sockets that are extremely hard to seal without reflecting the mucoperiosteal flap, extraction sockets anatomy that are not suitable for regular healing abutment placement, and potentially high occlusal stresses when planning a temporary implant supported prothesis to improve the conditioning of supra implant tissue architecture and the emergence profile of the implant supported restorations.
Purpose
To clinically evaluate the peri-implant soft tissue profile of single posterior implant retained restorations and to assess patient related outcomes of the implant restorations that were conditioned immediately by CAD-CAM socket sealing abutments (SSA) versus those conditioned by Titanium (Ti) standard healing abutments (SHA).
Methods
Twenty participants received twenty-two single maxillary immediate implants after flapless minimally invasive tooth extraction and 3D guided implant placement in the posterior area (premolar and molar) and allocated randomly into two groups (
n
= 11), the intervention group: patients received PEEK SSA and the control group: the patients received Ti SHA. Modified Pink Esthetic Score (PES) was evaluated at 3 observation periods: Baseline T0 (immediate after implant supported crown insertion), 6 months T1 and 1 year of clinical performance T2. Patient satisfaction was assessed one week and one year after crown insertion using visual analogue scale (VAS).
Results
At base line, after six as well as 12 months, SSA group showed statistically significant higher total modified PES scores than SHA group (
P
-value < 0.001). At the 2 clinical observation periods (baseline and after one year), SSA group showed statistically significantly higher overall satisfaction score than SHA group (
P
-value < 0.001).
Conclusion
After one year of clinical observation period, CAD-CAM PEEK socket sealing abutments together with flapless minimally invasive tooth extraction and 3D guided implant placement provided superior outcomes compared to Ti SHA in terms of peri-implant soft tissue profile.
Trial registration
This study was registered on clinicaltrials.gov with ID no. NCT05276765 on 03/03/2022.
Journal Article
Biomedical Applications of Titanium Alloys: A Comprehensive Review
Titanium alloys have emerged as the most successful metallic material to ever be applied in the field of biomedical engineering. This comprehensive review covers the history of titanium in medicine, the properties of titanium and its alloys, the production technologies used to produce biomedical implants, and the most common uses for titanium and its alloys, ranging from orthopedic implants to dental prosthetics and cardiovascular devices. At the core of this success lies the combination of machinability, mechanical strength, biocompatibility, and corrosion resistance. This unique combination of useful traits has positioned titanium alloys as an indispensable material for biomedical engineering applications, enabling safer, more durable, and more efficient treatments for patients affected by various kinds of pathologies. This review takes an in-depth journey into the inherent properties that define titanium alloys and which of them are advantageous for biomedical use. It explores their production techniques and the fabrication methodologies that are utilized to machine them into their final shape. The biomedical applications of titanium alloys are then categorized and described in detail, focusing on which specific advantages titanium alloys are present when compared to other materials. This review not only captures the current state of the art, but also explores the future possibilities and limitations of titanium alloys applied in the biomedical field.
Journal Article
Influence of intermediate abutment height and timing of placement on marginal bone loss in single implant-supported crowns: a 12-month follow-up randomized clinical trial
Objectives
To determine the most effective combination of abutment height and timing of placement in reducing marginal bone loss (MBL).
Materials and methods
54 patients received at least one single screw-retained crown on an implant replacing a posterior tooth (60 implants). Implants were divided into six groups based on intermediate abutment height (1.5 mm, 2 mm, 3 mm) and timing of placement (immediate: surgery 1; delayed: surgery 2): Group
A3I
(height 3, surgery 1), Group
A2I
(height 2, surgery 1), Group
A15I
(height 1.5, surgery 1), Group
A3D
(height 3, surgery 2), Group
A2D
(height 2, surgery 2), Group
A15D
(height 1.5, surgery 2). Mesial and distal linear radiographic measurements were taken at five follow-up points: implant surgery, crown placement (T1), and 3 (T2), 6 (T3), and 12 months after loading (T4). Partial and total MBL were compared between groups.
Results
After 12 months, the lowest MBL was found in groups
A3I
(0.13 ± 0.11 mm) and
A2I
(0.24 ± 0.11 mm), with no statistical difference between them. Groups
A15I
(0.70 ± 0.12 mm),
A3D
(0.66 ± 0.11 mm),
A2D
(0.62 ± 0.12 mm), and
A15D
(0.78 ± 0.11 mm) showed significantly higher MBL than groups 1 and 2, with no statistical difference among them.
Conclusions
Immediate abutments of 2–3 mm resulted in lower MBL compared to 1.5 mm immediate abutments or any delayed abutments.
Clinical Relevance
This study provides data on the optimal combination of intermediate abutment height and placement timing in preventing MBL.
Clinical Trial Registration
Clinical trial registration number: NCT06667531. link:
https://clinicaltrials.gov/study/NCT06667531
.
Journal Article
Peri-implant bone behavior after single drilling technique versus undersized drilling technique of immediately loaded implant in posterior maxilla: a one-year prospective study
Background
Implant placement in the posterior maxilla is challenging, so modifications of the surgical techniques were introduced to overcome these challenges. The undersized drilling technique uses a final drill smaller than the diameter of the implant. The single drilling technique is a simplified method where the osteotomy is made using a single drill without sequential widening. This study was directed to evaluate the peri-implant bone behavior of the undersized drilling technique versus the single drilling technique of immediately loaded dental implants inserted in the posterior maxilla.
Patients and methods
32 patients were selected for prosthetic replacement of a missing maxillary posterior single tooth by an immediately loaded dental implant and divided randomly into two equal groups. In Group I: 16 patients received 16 implants using the undersized drilling technique, while in Group II: 16 patients received 16 implants using the single drilling technique. Insertion torque, implant stability, modified sulcus bleeding index (mBI), peri-implant probing depth, bone density, and marginal bone height were evaluated for both groups. Statistical analysis was made for clinical and radiographic data.
Results
32 implants were inserted in the posterior maxilla. During a 12-month follow-up, every dental implant was successful with no complications. Both techniques showed high insertion torque (≥ 35 Ncm) and primary stability (> 70 ISQ) with no significant difference between the two groups (
P
> 0.05). Also, there were no significant differences between the study groups regarding peri-implant soft tissue health, bone density, and marginal bone loss (
P
> 0.05).
Conclusion
Both techniques revealed comparable, promising clinical and radiographic outcomes over a 12-month post-loading follow-up period when the immediate loading protocol was used in the posterior maxilla, where bone density is poor, but preparing the implant bed using the single drilling technique offers several merits for both the patient and clinician. In addition to avoiding excessive heat generation, mechanical damage, and high frictional forces during drilling procedures, surgical operations, and surgical site exposure take less time.
Trial registration
Clinical-Trials.gov PRS (
https://register.clinicaltrials.gov
) had this study registered under the identifier number. NCT06770231 on 01/01/2025.
Journal Article
Comparing success of immediate versus delay loading of implants in fresh sockets: a systematic review and meta-analysis
Background and aims
The replacement of teeth with osseointegrated implants is one of the significant advances in the field of restorative dentistry. The time interval between tooth extraction and the implant can be very short or long. This systematic review and meta-analysis aimed to collect and evaluate articles related to determining the effect of instant loading of dental implants are placed in the fresh socket initial stability on the clinical success of the implant compared to delay loading dental implants.
Materials and methods
In this study, all the available articles indexed in leading databases, including PubMed, ISI Web of Science, Embase, PsycINFO, PROSPERO, and Scopus, were searched. The full text of the articles meeting the primary criteria to be included in this research was obtained and appraised. Data of studies were extracted if they were scored as a high or moderate level of evidence.
Results
A total of 2258 published articles were found through electronic database searching. After screening the titles and abstracts, and full text of articles, 16 studies met the inclusion criteria and were included in the analysis. The results of this study revealed that regarding the success rate, although there was no significant difference between immediate and delayed of dental implants, immediate procedure showed a lower incidence of bone loss in single implants.
Conclusion
Based on the results of this study, immediate loading of dental implant, under certain conditions, is a successful treatment process and is effective in reducing treatment time. Thus, immediate loading represents a valid alternative to the traditional delayed loading rehabilitation.
Journal Article
Dental implant and abutment in PEEK: stress assessment in single crown retainers on anterior region
Objective
Stress distribution assessment by finite elements analysis in poly(etheretherketone) (PEEK) implant and abutment as retainers of single crowns in the anterior region.
Materials and methods
Five 3D models were created, varying implant/abutment manufacturing materials: titanium (Ti), zirconia (Zr), pure PEEK (PEEKp), carbon fiber-reinforced PEEK (PEEKc), glass fiber-reinforced PEEK (PEEKg). A 50 N load was applied 30
o
off-axis at the incisal edge of the upper central incisor. The Von Mises stress (σvM) was evaluated on abutment, implant/screw, and minimum principal stress (σmin) and maximum shear stress (τmax) for cortical and cancellous bone.
Results
The abutment σvM lowest stress was observed in PEEKp group, being 70% lower than Ti and 74% than Zr. On the implant, PEEKp reduced 68% compared to Ti and a 71% to Zr. In the abutment screws, an increase of at least 33% was found in PEEKc compared to Ti, and of at least 81% to Zr. For cortical bone, the highest τmax values were in the PEEKp group, and a slight increase in stress was observed compared to all PEEK groups with Ti and Zr. For σmin, the highest stress was found in the PEEKc. Stress increased at least 7% in cancellous bone for all PEEK groups.
Conclusion
Abutments and implants made by PEEKc concentrate less σvM stress, transmitting greater stress to the cortical and medullary bone.
Clinical relevance
The best stress distribution in PEEKc components may contribute to decreased stress shielding; in vitro and in vivo research is recommended to investigate this.
Journal Article
Prosthetic rehabilitation of maxillary lateral incisors agenesis using dental mini-implants: a multicenter 10-year follow-up
ObjectivesImplants are used to replace congenitally missing lateral incisors but often the space across the alveolar crest is too narrow to permit their use. This multicenter study (Dental Clinic of the University of Foggia, Odontostomatology Clinic of the University of L’Aquila) evaluated the efficacy of mini-implants in cases of maxillary lateral incisor agenesis with severe osseous atrophy in 10-year follow-up.Materials and methodsForty-seven mini-implants have been inserted in 35 patients affected by lateral incisors agenesis (23 single and 12 bilateral ageneses). All patients underwent orthodontic opening of the space of the upper lateral incisors. After the insertion of the implants, the immediate, non-functional loading, positioning of crowns, presence of pain during percussion and mini-implant function, horizontal and vertical movement when a force of 5 N was applied, ridge loss, and plaque index have been evaluated 1 month after loading, 1 year after loading, and then every 5 years in the following 10 years. Little’s test was used to evaluate the assumption that data of loss to follow-up implants are missing completely at random (MCAR) and that a complete-case scenario could be adopted. Wilcoxon test was carried out to look statistically significant differences between the various parameters resulting in the complete-case scenario and those assumed for the worst scenario. The software R (v. 3.6.1, 2019) was employed to perform the statistical analysis.ResultsThe results obtained over 10 years range from 89% of success rate in a worst-case scenario to the 100% using a complete-case analysis with satisfactory values of marginal bone resorption and good conditions of the peri-implant tissue. Ten-year follow-up using complete-case analysis shows survival rates of 100% for implants with no signs of peri-implantitis, stability of the marginal bone levels and soft tissue around the dental implants.ConclusionsThe data collected show very good implant stability, absence of progressive peri-implantitis, and satisfactory aesthetical results in time (no signs of infraocclusion).Clinical relevanceMini-implants can be considered a valid and stable over time solution in the restorative treatment of maxillary lateral incisors agenesis.
Journal Article
Static and dynamic stress analysis of different crown materials on a titanium base abutment in an implant-supported single crown: a 3D finite element analysis
Background
This Finite Element Analysis was conducted to analyze the biomechanical behaviors of titanium base abutments and several crown materials with respect to fatigue lifetime and stress distribution in implants and prosthetic components.
Methods
Five distinct designs of implant-supported single crowns were modeled, including a polyetheretherketone (PEEK), polymer-infiltrated ceramic network, monolithic lithium disilicate, and precrystallized and crystallized zirconia-reinforced lithium silicates supported by a titanium base abutment. For the static load, a 100 N oblique load was applied to the buccal incline of the palatal cusp of the maxillary right first premolar. The dynamic load was applied in the same way as in static loading with a frequency of 1 Hz. The principal stresses in the peripheral bone as well as the von Mises stresses and fatigue strength of the implants, abutments, prosthetic screws, and crowns were assessed.
Results
All of the models had comparable von Mises stress values from the implants and abutments, as well as comparable maximum and minimum principal stress values from the cortical and trabecular bones. The PEEK crown showed the lowest stress (46.89 MPa) in the cervical region. The prosthetic screws and implants exhibited the highest von Mises stress among the models. The lithium disilicate crown model had approximately 9.5 times more cycles to fatique values for implants and 1.7 times more cycles to fatique values for abutments than for the lowest ones.
Conclusions
With the promise of at least ten years of clinical success and favorable stress distributions in implants and prosthetic components, clinicians can suggest using an implant-supported lithium disilicate crown with a titanium base abutment.
Journal Article