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Aim: The present split-mouth case report aims to describe the clinical and radiographic long-term outcomes of the implant rehabilitation of two mandibular premolars in which the digital workflow was used to apply different prosthetic protocols. Case description: A female 42-year-old patient with the absence of both mandibular second premolars was submitted to guided surgery for the placement of platform-switching Grand Morse connection implants. Digital workflow was used for implant and prosthetic planning, applying early loading protocol 21 days after surgery. The implant on the right side received the final abutment at the time of surgery (without loading), whereas the implant on the left side had a healing abutment placed, which was replaced by a temporary abutment and then by a final abutment. Two months after surgery, both implants had final ceramic restorations delivered. The patient was followed clinically and radiographically for 30 months, presenting excellent hard and soft tissue outcomes, with bone level changes lower than 2mm for both implants. Conclusion: The use of digital workflow and early loading, made the present implant-supported rehabilitation predictable, safe and time-efficient, resulting in total patient satisfaction. Peri-implant bone level was observed to be stable after early loading protocol for both platform-switching connection implants inserted, despite the prosthetic protocol applied.(AU)

Objetivo: O presente relato de caso de boca dividida tem como objetivo descrever os resultados clínicos e radiográficos a longo prazo da reabilitação com implante de dois pré-molares inferiores em que o fluxo de trabalho digital foi usado para aplicar os conceitos de "one abutment-one time" em uma das reabilitações e troca de componente no outro. Descrição do caso: Paciente do sexo feminino, 42 anos, com ausência de ambos os segundos pré-molares inferiores, foi submetida à cirurgia guiada para colocação de implantes de conexão Grand Morse plataforma-switching. Foi utilizado fluxo de trabalho digital para planejamento de implante e prótese, aplicando protocolo de carga antecipada 21 dias após a cirurgia. O implante do lado direito recebeu o componente protético definitivo no momento da cirurgia (sem carga), enquanto o implante do lado esquerdo recebeu um cicatrizador, que foi substituído por um pilar provisório e depois por um componente definitivo. Dois meses após a cirurgia, ambos os implantes tiveram restaurações cerâmicas finais entregues. A paciente foi acompanhada clínica e radiograficamente por 30 meses, apresentando excelentes resultados de tecidos duros emoles, com alterações do nível ósseo inferiores a 2mm para ambos os implantes. Conclusão: O fluxo de trabalho digital e carregamento precoce, tornou a presente reabilitação implantossuportada previsível, segura e eficiente em termos de tempo, resultando em total satisfação do paciente. O nível ósseo peri-implantar foi observado como estável após o protocolo de carregamento inicial para ambos os implantes de conexão plataforma-switching inseridos, independente do protocolo protético aplicado. (AU)

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ABSTRACT Objective: The aim of this study was to compare the stress distribution in internal tapered connection implants with different adaptation geometries submitted to oblique load simulation using the Finite Element Analysis (FEA) method. Methods: Three different internal tapered implant-abutment assemblies were modeled by varying only the diameter of the abutment body in the cone region. The dimensions of the implants were 4.0 mm in diameter and 13 mm in length. Oblique loads of 210 N angled 30 degrees to the long axis of the implant were applied to a hemispherical body positioned over the abutments simulating a dental crown. The stress generated by the implant-abutment assembly was analyzed by the FEA method using the von Mises criterion. Results: A higher concentration of stress in the coronal region (collar) and implant body on the opposite side of the load application was shown, as well as in the body region of the abutments and in the screw threads. The cervical region of the implants showed the highest von Mises stress values, the highest values being observed in G3 (1034 MPa), followed by G2 (841 MPa) and G1 (702 MPa). Conclusion: According to the results presented, it can be concluded that the stress distribution was more homogeneous and less concentrated in the G1 implant-abutment assembly. Therefore, the use of abutments with dimensions standardized by the implant manufacturer is recommended.

RESUMO Objetivo: O objetivo deste estudo foi comparar a distribuição de tensões em implantes de conexão cônica interna com diferentes geometrias de adaptação submetidos à simulação de carga oblíqua pelo método de Análise de Elementos Finitos (FEA). Métodos: Três diferentes conjuntos implante-pilar cônicos internos foram modelados variando apenas o diâmetro do corpo do pilar na região do cone. As dimensões dos implantes foram de 4,0 mm de diâmetro e 13 mm de comprimento. Cargas oblíquas de 210 N anguladas 30 graus em relação ao longo eixo do implante foram aplicadas sobre um corpo hemisférico posicionado sobre os pilares simulando uma coroa dentária. A tensão gerada pelo conjunto implante-pilar foi analisada pelo método FEA utilizando o critério de von Mises. Resultados: Foi evidenciada maior concentração de tensões na região coronal (colar) e corpo do implante no lado oposto da aplicação da carga, assim como na região do corpo dos pilares e nas roscas dos parafusos. A região cervical dos implantes apresentou os maiores valores de tensão de von Mises, sendo os maiores valores observados em G3 (1034 MPa), seguido de G2 (841 MPa) e G1 (702 MPa). Conclusão: De acordo com os resultados apresentados, pode-se concluir que a distribuição de tensões foi mais homogênea e menos concentrada no conjunto implante-pilar do G1. Portanto, recomenda-se o uso de pilares com dimensões padronizadas pelo fabricante do implante.

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This case series study evaluated the survival, success rate and marginal bone remodeling of Morse taper hydrophilic implants placed for full-arch rehabilitations over a 1-year follow-up period. Ten patients in need of maxillary and/or mandibular full-arch rehabilitation were selected. Sixty-six Morse taper implants and sixty-six abutments were inserted. All implants were placed using a surgical flap approach without bone regeneration and were immediately loaded with definitive prostheses according to the passive fitting technique. The patients underwent clinical and radiographic follow-up at different postoperative periods: T0 = immediate (up to 1 month after surgery); T1 = 3-4 months after surgery; T2 = 6-8 months after surgery; and T3 = 1 year after surgery. The survival and success rate of the implants and the marginal bone remodeling were evaluated. Normal distribution of the outcomes was verified by Kolmogorov-Smirnov tests. Therefore, changes in vertical and horizontal marginal bone levels were assessed with paired t-tests. Results were considered significant for P < 0.05. Survival and success rates of 100% and 92.4%, respectively, were observed. Statistically significant vertical bone level changes were shown for all periods. From T0 to T3, there was a mean difference in vertical bone loss of -1.02 mm on the mesial surface and of -0.93 mm on the distal surface, for horizontal bone loss in the same period, it was observed mean changes of -0.14 mm on the mesial surface and -0.09 mm on the distal surface. This 1-year case series follow-up of immediate full-arch rehabilitation, using one-step hybrid passive fitting supported by four to six hydrophilic tapered implants, suggests predictability with high survival and success rates in edentulous patients.

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OBJECTIVES: To compare implant and prosthesis survival rates between full-arch immediate prostheses supported by 4 hydrophilic implants with bicortical anchorage and by 5 or 6 hydrophilic implants placed without bicortical anchorage. MATERIAL AND METHODS: The sample was retrospectively selected and comprised completely edentulous patients treated with full-arch immediate prostheses supported by Morse Taper hydrophilic implants. The selected patients were divided into four groups, according to the region of implant placement and type of anchorage. Differences in implant and prosthesis survival rates between groups, as well as the influence of bicortical anchorage on implant primary stability, were verified using Fisher's exact tests (significant at p < .05). RESULTS: The sample comprised 392 implants, 72 were placed in the maxilla with bicortical anchorage, and 85 were placed without. In the mandible, 140 implants were placed with and 95 were placed without bicortical anchorage. The follow-up period was up to 24 months. A 98.8% implant survival rate was observed for the group of implants placed without bicortical anchorage in the maxilla, and of 100% for the other groups. The overall implant survival rate was 99.7% (391 of 392 implants). Prosthesis survival rate was 100% for all groups. No differences were observed between groups with respect to implant and prosthesis survival rates. Significantly higher primary stability was observed for implants placed with bicortical anchorage in both jaws. CONCLUSION: Predictable results and high survival rates were achieved within the period evaluated by the present retrospective study, with immediate full-arch prostheses when only four hydrophilic implants are placed bicortically.

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A reabilitação de maxilas atróficas com implantes dentários é sempre um desafio, visto que o uso de enxertos ósseos é quase sempre necessário para estabilização dos implantes. Os implantes zigomáticos têm sido utilizados como uma opção viável ao uso de procedimentos de enxertia óssea anterior à cirurgia. A interface cônica interna apresenta gap reduzido entre implante e componente protético, mostrando resultados biológicos e estéticos satisfatórios a longo prazo. Este artigo tem como objetivo relatar a reabilitação protética imediata de uma maxila atrófica com implantes convencionais e zigomáticos com interface cônica interna como opção ao uso de enxertos ósseos prévios. Paciente com 47 anos de idade, do sexo masculino, apresentava maxila atrófica e usava uma prótese total superior. O paciente foi reabilitado com quatro implantes convencionais na região anterior e dois implantes zigomáticos cônicos internos instalados nos ossos zigomáticos. Os torques de instalação dos implantes ≥ 60 N.cm proporcionaram estabilidade primária ideal e uma prótese (protocolo) foi instalada imediatamente utilizando a técnica do assentamento passivo. O caso clínico apresentado mostrou que, após 1 ano, resultados precisos e estéticos são possíveis de alcançar com a instalação de implantes zigomáticos combinados com implantes convencionais para reabilitação de maxilas atróficas de forma imediata e sem utilização de enxerto ósseos prévios.

The rehabilitation of atrophic upper jaws with dental implants is always a challenge, since the use of bone grafts is almost always necessary to stabilize the implants. Zygomatic implants have been used as a viable option for the use of bone grafting procedures prior to surgery. The internal tapered interface presents a reduced gap between implant and prosthetic component, showing satisfactory long-term biological and aesthetic results. This article aims to report the immediate prosthetic rehabilitation of an atrophic upper jaw with conventional and zygomatic implants with an internal tapered interface as an option for the use of previous bone grafts. A 47-year-old male patient presented with an atrophic upper jaw and used an upper total prosthesis. The patient was rehabilitated with four conventional implants in the anterior region and two internal tapered zygomatic implants placed in the zygomatic bones. The implant placement torques ≥ 60 N.cm provided ideal primary stability and a prosthesis (protocol) was installed immediately using the passive fit technique. The clinical case presented showed that, after 1 year, accurate and aesthetic results are possible to achieve with the placement of zygomatic implants combined with conventional implants for the rehabilitation of atrophic upper jaws immediately and without the use of previous bone grafts.

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ABSTRACT Precise planning for dental implant placement requires appreciation of anatomical limitations and restorative purpose. Diagnosis can be made by complementary exams such as panoramic radiography and cone-beam computed tomography. The purpose of this study was to rehabilitate the upper and lower jaw of a patient with severe periodontal disease using a guided osteotomy and implants placed with free hands and Morse taper implants. The concept of guided surgery was used to prepare the alveolar bone to place eight implants, four implants in the upper jaw and four implants in the lower jaw, all have achieved a minimum torque of 60 Ncm. The modified suture technique was used to better stabilize the soft tissue around the mini conical abutments. The analogues were scanned by CAD/CAM for confection of the metallic structures of the bridges. On the third day, the upper and lower full arch prostheses were installed and simultaneous bilateral contacts were adjusted. After 12 months of patient follow-up, the implants and prostheses were in good condition of aesthetics and function, maintaining the success of the rehabilitation. Within the limitations of this clinical case, it can be concluded that the implants placed with free hands was facilitated by a previous guided osteotomy.

RESUMO O planejamento preciso para a instalação de implantes dentários requer a apreciação das limitações anatômicas e objetivos restaurativos. O diagnóstico pode ser feito por exames complementares, como radiografia panorâmica e tomografia computadorizada de feixe cônico. O objetivo deste estudo foi reabilitar, a mandíbula superior e inferior de um paciente com doença periodontal severa, utilizando uma osteotomia guiada e implantes cone Morse instalados com as mãos livres. O conceito de cirurgia guiada foi utilizado para preparar o osso alveolar para a instalação de oito implantes, quatro implantes no maxilar superior e quatro implantes no maxilar inferior, todos alcançando um torque mínimo de 60 Ncm. A técnica de sutura modificada foi utilizada para melhor estabilizar o tecido mole ao redor dos mini-pilares cônicos. Os abutments foram escaneados por CAD/CAM para confecção das estruturas metálicas das próteses dentárias. No terceiro dia, as próteses de arco superior e inferior foram instaladas e os contatos bilaterais simultâneos foram ajustados. Após 12 meses de acompanhamento do paciente, os implantes e próteses estavam em boas condições de estética e função, mantendo o sucesso da reabilitação. Dentro das limitações deste caso clínico, pode-se concluir que os implantes instalados com as mãos livres foram facilitados pelo uso prévio da osteotomia guiada.

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A instalação imediata de implantes em região estética é uma prática frequente, pois reduzir a remodelação óssea e tecidual. Os implantes com interface cone Morse apresentam resultados biológicos e estéticos satisfatórios a longo prazo, pois apresentam gap reduzido entre implante e componente protético e a interface fica distante do tecido ósseo. Este artigo tem como objetivo relatar a reabilitação estética de um incisivo central superior comprometido através da instalação de um implante cone Morse utilizando a técnica da cirurgia guiada com provisionalização imediata. Paciente com 40 anos de idade, do sexo masculino, apresentava incisivo central superior (#21) com tratamento endodôntico prévio, recessão gengival vestibular, escurecimento coronário e mobilidade. O caso clínico apresentado mostrou que, após 12 meses, resultados precisos e estéticos são possíveis de alcançar com a instalação de implantes em alvéolos pós-extração e instalação de um dente provisório imediato em regiões estéticas.

The immediate placement of implant in fresh sockets in the aesthetic area is a frequent practice as it reduces bone and tissue remodeling. Morse taper implants present satisfactory biological and aesthetic results in the long term, since they present a reduced gap between implant and prosthetic component and this interface is distant from bone. This article aims to report the aesthetic restoration of a compromised central upper incisor with the placement of a Morse taper implant using guided surgery with immediate provision. A 40-year-old male patient had a central upper incisor (#21) with previous endodontic treatment, vestibular gingival recession, coronary browning, and mobility. The clinical case presented showed that, after 12 months, precise and aesthetic results are possible to achieve with the placement of implants in post-extracting alveolus and installation of an immediate provisional tooth in esthetic regions.

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This study tested the fracture strength of prosthetic abutments with different sizes and combinations to support a 5-implant milled framework with distal extension. Prosthetic abutments with different dimensions (4.8-mm diameter mini conical abutment and 3.5-mm diameter microconical abutment) were screwed to 5 threaded implants. The following groups were divided (n = 3): G1 with 5 miniconical abutments (standard size), G2 with 5 microconical abutments (small sized), G3 with a combination of 3 small sized abutments and 2 standard sized abutments, and G4 with a combination of 2 small sized abutments and 3 standard sized abutments. Standardized titanium frameworks for full-arch fixed dental prosthesis were milled with equidistant holes for each of the 5 implants and abutments. A loading point was selected at 18 mm away from both distal implants. A universal testing system was used for the fracture strength tests and load was applied at a crosshead speed of 0.5 mm/min on the previously described loading points until component fracture. Mean fracture strength for each group was statistically compared (α = 0.05). Prosthetic screws were the only fractured components for all tested groups. Mean fracture strength was: G1, 1130.22 N; G2, 1031.36 N; G3, 757.9 N; and G4 792.03 N (P < .05). All prosthetic abutments and combinations that were tested provide adequate fracture strength for clinical use. However, the combination of standard and small diameter abutments leads to lower fracture strength compared with when only standard sized prosthetic abutments were used, irrespective of the abutment diameter (4.8- or 3.5-mm).

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OBJECTIVES: This randomized clinical trial analyzed crestal bone changes and soft tissue dimensions surrounding implants with an internal tapered connection placed in the mandible anterior region at different depths (equicrestal and subcrestal). MATERIALS AND METHODS: Eleven edentulous patients (five implants per patient) were randomly divided in a split-mouth design: G1, 28 equicrestal implants; and G2, 27 subcrestal implants. All implants were immediately loaded. Correlation between keratinized tissue width (KTW) and vertical mucosa thickness (MT) with soft tissue recession was analyzed. Intraoral radiographs were used to evaluate crestal bone changes. Patients were assessed immediately, 4-, and 8-months after implant placement. Rank-based ANOVA-type statistical test was used for comparison between groups (α = 0.05). RESULTS: Fifty-five implants (G1 = 28 and G2 = 27) were assessed in 11 patients. Implant survival rate was 100% for both groups. Both tested implant placement depths presented similar crestal bone loss (P > 0.05). Significant crestal bone loss for each group was found in the different measurement times (T4 and T8) (P < 0.05). Implant placement depths, KTW, and vertical MT had no effect on soft tissue recession (P > 0.05). CONCLUSIONS: Different implant placement depths do not influence crestal bone changes. Soft tissue behavior is not influenced by different implant placement depths or by the amount of keratinized tissue.

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O propósito desse estudo foi avaliar, retrospectivamente, o índice de sobrevivência de implantes com tratamento de superfície para aumento de molhabilidade instalados em ambos os maxilares e submetidos ou não à carga imediata. Um total de 78 pacientes (17 homens e 61 mulheres), nos quais 182 implantes foram instalados, compuseram a amostra. Todos os implantes foram instalados em pacientes com diferentes situações clínicas, podendo ser reabilitações unitárias, parciais ou totais, nos cursos de pós-graduação do Instituto Latino Americano de Pesquisa e Ensino Odontológico (ILAPEO), entre 2011 e 2015. Cento e dezenove implantes (65,38%) foram instalados em maxila e 63 (34,61%) em mandíbula, sendo que em 156 (85,71%) foi aplicada carga imediata. O índice de sobrevivência total foi de 98,90% (180 implantes). Houve perda de apenas 2 implantes instalados em maxila. A perda foi constatada após 5 semanas em ambos os casos. Consideradas as características do estudo, a metodologia aplicada, o tamanho e as características da amostra, o tempo de acompanhamento, bem como a diversidade de variáveis daí decorrentes, parece aceitável concluir, com base nos resultados aqui encontrados e discutidos, que os implantes com tratamento de superfície com aumento de molhabilidade, ora observados, apresentaram altas taxas de sobrevivência dentro dos critérios estabelecidos neste estudo (AU).

The aim of this study was to evaluate, retrospectively, the survival rates of implants with surface treatment that increased wettability, installed in both jaws, and submitted or not to immediate loading. The sample was composed of 78 patients (17 men and 61 women), in which 182 implants were installed. All implants were installed by dentists in post-graduate courses of the Latin American Institute of Research and Dental Education (ILAPEO), between 2011 and 2015. One hundred and nineteen implants (65.38%) were installed in the maxilla and 63 (34.61%) in the mandible, and 156 (85.71%) was applied immediate load. The overall survival rate was of 98.90% (180 implants). Only 2 implants placed in the maxilla were lost, and in both cases the loss was noticed after 5 weeks. Considering the parameters of the study, the methodology, sample size and characteristics, follow-up period and diversity of the variables, it seems acceptable to conclude, based on the present discussed results, that the implants with surface treatment with increased wettability, presented high survival rates according to the criteria considered in this study (AU).

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The objective of this study was to evaluate the marginal and internal fit of zirconia copings obtained with different digital scanning methods. A human mandibular first molar was set in a typodont with its adjacent and antagonist teeth and prepared for an all-ceramic crown. Digital impressions were made using an intraoral scanner (3Shape). Polyvinyl siloxane impressions and Type IV gypsum models were also obtained and scanned with a benchtop laboratory scanner (3Shape D700). Ten zirconia copings were fabricated for each group using CAD-CAM technology. The marginal and internal fit of the zirconia copings was assessed by the silicone replica technique. Four sections of each replica were obtained, and each section was evaluated at four points: marginal gap (MG), axial wall (AW), axio-occlusal edge (AO) and centro-occlusal wall (CO), using an image analyzing software. The data were submitted to one-way ANOVA and Tukey's test (α = 0.05). They showed statistically significant differences for MG, AO and CO. Regarding MG, intraoral scanning showed lower gap values, whereas gypsum model scanning showed higher gap values. Regarding AO and CO, intraoral digital scanning showed lower gap values. Polyvinyl siloxane impression scanning and gypsum model scanning showed higher gap values and were statistically similar. It can be concluded that intraoral digital scanning provided a lower mean gap value, in comparison with conventional impressions and gypsum casts scanned with a standard benchtop laboratory scanner.

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