Fig. 7. Vestibular view of the final restoration
Fig. 7. Vestibular view of the final restoration
Fig. 6. Occlusal view of the final restoration. In this case, with the longest cantilever extension on a final restoration within this collective
Fig. 6. Occlusal view of the final restoration. In this case, with the longest cantilever extension on a final restoration within this collective
Fig. 5. One-year post-surgery panoramic radiograph with final restoration
Fig. 5. One-year post-surgery panoramic radiograph with final restoration
Fig. 4. Occlusal view of implant-abutments 3 months post-surgery at the first removal of the temporary restoration
Fig. 4. Occlusal view of implant-abutments 3 months post-surgery at the first removal of the temporary restoration
Fig. 3. Fill-in of the occlusal perforations with self-curing resin to connect the prostheses to the temporary titanium cylinders
Fig. 3. Fill-in of the occlusal perforations with self-curing resin to connect the prostheses to the temporary titanium cylinders
Fig. 2. Preparation of the composite veneers for making the temporary restoration
Fig. 2. Preparation of the composite veneers for making the temporary restoration
Fig. 1. Preparation of implant cavity through corresponding metal sleeves after extraction of the central incisors using a surgical template supported by hopeless remaining teeth
Fig. 1. Preparation of implant cavity through corresponding metal sleeves after extraction of the central incisors using a surgical template supported by hopeless remaining teeth
Collective
Mesial
Distal
1 year
55 months (40–84)
1 year
...
Collective
ISQ
P
At insertion
3 months
Total (n = 57)
61.3 ± 7.8
...
Collective
PT value
P
At insertion
3 months
Total (n = 57)
−1.8 ± 2.4
...
Period
# of implants
# of failures
Survival rate (%)
Cumulative survival rate (%)
0 t...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
The retrospective data analysis was conducted in accordance with the Helsinki Declaration of 1975, as revised in 2008, and all patients signed an informed consent. After consulting the local ethic committee, the decision was that due to the retrospective character of this study, with no additional data acquisition, no ethical approval is needed according to the hospital laws of the appropriate sta...
Department of Prosthetic Dentistry, University Medical Center of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131, Mainz, Germany
S. Wentaschek & S. Hartmann
Department of Oral and Maxillofacial Surgery - Plastic Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131, Mainz, Germany
C. Walter & W. Wagner
You can also search for ...
The authors would like to thank Bredent Medical (Senden, Germany) for providing the 3D-planning system and supporting the treatment nonfinancially.
Bayer G, Kistler F, Kistler S, Adler S, Neugebauer J. Sofortversorgung mit reduzierter Implantatanzahl: Wissenschaftliche Konzeption und klinische Ergebnisse. Berlin: Quintessenz; 2011.
Hanley JA. Receiver operating characteristic (ROC) methodology: the state of the art. Crit Rev Diagn Imaging. 1989;29(3):307–35.
Atieh MA, Alsabeeha NH, Payne AG, de Silva RK, Schwass DS, Duncan WJ. The prognos...
Pommer B, Mailath-Pokorny G, Haas R, Busenlechner D, Furhauser R, Watzek G. Patients’ preferences towards minimally invasive treatment alternatives for implant rehabilitation of edentulous jaws. Eur J Oral Implantol. 2014;7(Suppl 2):S91–109.
Monje A, Suarez F, Galindo-Moreno P, Garcia-Nogales A, Fu JH, Wang HL. A systematic review on marginal bone loss around short dental implants (
Area under the curve
Implant stability quotient
Periotest
Receiver operating characteristic
Within the limits of this small group (n = 10 patients/60 implants), the failure rate of the analyzed implant system (n = 3 respective 5% implant loss) seems to be comparable with other immediate-loading protocols. On the other side, the implant loss rate of tilted implants (n = 2 of 20) in the atrophic upper jaw was quite high, but still, the aimed treatment concept could be achieved in eve...
Between baseline and first removal of the temporary restoration after 3 months, the mean ISQ increased and the mean PT value decreased significantly in the axial and tilted implants. This is in contrast to some other studies which evaluated no significant differences of stability parameters between primary and secondary stability with immediate loading in edentulous maxilla [16, 21, 22].
The pre...
The overall implant survival rate of 95% is slightly lower than the reported mean survival rates of the concept of tilted implants and immediate loading in edentulous jaws [11] but still close to them and maybe more comparable to investigations in which implants were also immediately loaded in the edentulous maxilla which were partly placed in fresh extraction sites [15, 16]. Nevertheless, what is...
After the temporary restoration with a fixed prosthesis, all 10 patients selected a fixed final restoration. These consisted of a cast metal framework with a full ceramic veneering including the replacement of at least the second premolars. They were made after a new impression on the abutment level (Figs. 6 and 7). The neck of the 20 tilted distal implants was positioned in region 4 (n = 5 impl...
Ten patients with a mean age at implant insertion of 64 ± 11.3 years (range 38 to 81 years; six women, four men) were included. Sixty titanium screw implants (Table 1) were inserted and immediately loaded between 09/2009 and 01/2013.
Seven patients had remaining teeth until implant surgery (two patients with 4, four patients with 7, and one patient with 12 teeth). Twenty-one (35%) of the 60 ...
Changes in marginal bone level were measured using the routinely made digital panoramic radiographs if these were available. The measurement tool was calibrated with the known respective implant length. To evaluate the bone loss, the difference was formed between the bone level at follow-up examination (Fig. 5) and at implant placement which is the baseline.
An implant was considered as successfu...
The patients were screened with preliminary panoramic radiographs, and since all the implants were 3D planned (SKYplanX™ program, Bredent GmbH, Senden, Germany) and inserted with a guiding template, a cone-beam CT (CBCT) was obtained eventually (KaVo 3D eXam™ unit, KaVo Dental GmbH, Biberach/Riss, Germany).
The drillings were performed using a 3D-planned surgical template with different metal...
In a retrospective study, all patients with immediately loaded implants in an edentulous maxillae with limited posterior ridge dimensions that received an equal concept were included if they had a follow-up of at least 3 years. The concept contained immediate loading with distal tilted implants and six implants per edentulous maxillae of a single implant system (blueSky™ implants, Bredent GmbH,...
For a few years, there has been a trend towards minimally invasive implant treatment concepts avoiding bone augmentation even in very atrophic edentulous jaws. These concepts aim to make an implant treatment with a shorter duration, with less inconvenience such as swelling or pain and possibly also economically more attractive [1]. If the implant treatment is less invasive, because of the possible...
The aim of this retrospective study was to evaluate the treatment outcome of six Bredent blueSky™ implants (Bredent GmbH, Senden, Germany) immediately loaded with a fixed full-arch prosthesis (two tilted posterior and four axial frontal and premolar implants).
All 10 patients with atrophic edentulous maxillae being treated with a standardized procedure from 09/2009 to 01/2013, who had a follow-...
Fig. 7. Vestibular view of the final restoration
Fig. 7. Vestibular view of the final restoration
Fig. 6. Occlusal view of the final restoration. In this case, with the longest cantilever extension on a final restoration within this collective
Fig. 6. Occlusal view of the final restoration. In this case, with the longest cantilever extension on a final restoration within this collective
Fig. 5. One-year post-surgery panoramic radiograph with final restoration
Fig. 5. One-year post-surgery panoramic radiograph with final restoration
Fig. 4. Occlusal view of implant-abutments 3 months post-surgery at the first removal of the temporary restoration
Fig. 4. Occlusal view of implant-abutments 3 months post-surgery at the first removal of the temporary restoration
Fig. 3. Fill-in of the occlusal perforations with self-curing resin to connect the prostheses to the temporary titanium cylinders
Fig. 3. Fill-in of the occlusal perforations with self-curing resin to connect the prostheses to the temporary titanium cylinders
Fig. 2. Preparation of the composite veneers for making the temporary restoration
Fig. 2. Preparation of the composite veneers for making the temporary restoration
Fig. 1. Preparation of implant cavity through corresponding metal sleeves after extraction of the central incisors using a surgical template supported by hopeless remaining teeth
Fig. 1. Preparation of implant cavity through corresponding metal sleeves after extraction of the central incisors using a surgical template supported by hopeless remaining teeth
Collective
Mesial
Distal
1 year
55 months (40–84)
1 year
...
Collective
ISQ
P
At insertion
3 months
Total (n = 57)
61.3 ± 7.8
...
Collective
PT value
P
At insertion
3 months
Total (n = 57)
−1.8 ± 2.4
...
Period
# of implants
# of failures
Survival rate (%)
Cumulative survival rate (%)
0 t...
Diameter
Length
10 mm
12 mm
14 mm
16 mm
Axial
...
Wentaschek, S., Hartmann, S., Walter, C. et al. Six-implant-supported immediate fixed rehabilitation of atrophic edentulous maxillae with tilted distal implants.
Int J Implant Dent 3, 35 (2017). https://doi.org/10.1186/s40729-017-0096-0
Download citation
Received: 14 March 2017
Accepted: 13 July 2017
Published: 25 July 2017
DOI: https://doi.org/10.1186/s40729-017-0096-0
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
The retrospective data analysis was conducted in accordance with the Helsinki Declaration of 1975, as revised in 2008, and all patients signed an informed consent. After consulting the local ethic committee, the decision was that due to the retrospective character of this study, with no additional data acquisition, no ethical approval is needed according to the hospital laws of the appropriate sta...
Department of Prosthetic Dentistry, University Medical Center of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131, Mainz, Germany
S. Wentaschek & S. Hartmann
Department of Oral and Maxillofacial Surgery - Plastic Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131, Mainz, Germany
C. Walter & W. Wagner
You can also search for ...
The authors would like to thank Bredent Medical (Senden, Germany) for providing the 3D-planning system and supporting the treatment nonfinancially.
Bayer G, Kistler F, Kistler S, Adler S, Neugebauer J. Sofortversorgung mit reduzierter Implantatanzahl: Wissenschaftliche Konzeption und klinische Ergebnisse. Berlin: Quintessenz; 2011.
Hanley JA. Receiver operating characteristic (ROC) methodology: the state of the art. Crit Rev Diagn Imaging. 1989;29(3):307–35.
Atieh MA, Alsabeeha NH, Payne AG, de Silva RK, Schwass DS, Duncan WJ. The prognos...
Pommer B, Mailath-Pokorny G, Haas R, Busenlechner D, Furhauser R, Watzek G. Patients’ preferences towards minimally invasive treatment alternatives for implant rehabilitation of edentulous jaws. Eur J Oral Implantol. 2014;7(Suppl 2):S91–109.
Monje A, Suarez F, Galindo-Moreno P, Garcia-Nogales A, Fu JH, Wang HL. A systematic review on marginal bone loss around short dental implants (
Area under the curve
Implant stability quotient
Periotest
Receiver operating characteristic
Within the limits of this small group (n = 10 patients/60 implants), the failure rate of the analyzed implant system (n = 3 respective 5% implant loss) seems to be comparable with other immediate-loading protocols. On the other side, the implant loss rate of tilted implants (n = 2 of 20) in the atrophic upper jaw was quite high, but still, the aimed treatment concept could be achieved in eve...
Between baseline and first removal of the temporary restoration after 3 months, the mean ISQ increased and the mean PT value decreased significantly in the axial and tilted implants. This is in contrast to some other studies which evaluated no significant differences of stability parameters between primary and secondary stability with immediate loading in edentulous maxilla [16, 21, 22].
The pre...
The overall implant survival rate of 95% is slightly lower than the reported mean survival rates of the concept of tilted implants and immediate loading in edentulous jaws [11] but still close to them and maybe more comparable to investigations in which implants were also immediately loaded in the edentulous maxilla which were partly placed in fresh extraction sites [15, 16]. Nevertheless, what is...
After the temporary restoration with a fixed prosthesis, all 10 patients selected a fixed final restoration. These consisted of a cast metal framework with a full ceramic veneering including the replacement of at least the second premolars. They were made after a new impression on the abutment level (Figs. 6 and 7). The neck of the 20 tilted distal implants was positioned in region 4 (n = 5 impl...
Ten patients with a mean age at implant insertion of 64 ± 11.3 years (range 38 to 81 years; six women, four men) were included. Sixty titanium screw implants (Table 1) were inserted and immediately loaded between 09/2009 and 01/2013.
Seven patients had remaining teeth until implant surgery (two patients with 4, four patients with 7, and one patient with 12 teeth). Twenty-one (35%) of the 60 ...
Changes in marginal bone level were measured using the routinely made digital panoramic radiographs if these were available. The measurement tool was calibrated with the known respective implant length. To evaluate the bone loss, the difference was formed between the bone level at follow-up examination (Fig. 5) and at implant placement which is the baseline.
An implant was considered as successfu...
The patients were screened with preliminary panoramic radiographs, and since all the implants were 3D planned (SKYplanX™ program, Bredent GmbH, Senden, Germany) and inserted with a guiding template, a cone-beam CT (CBCT) was obtained eventually (KaVo 3D eXam™ unit, KaVo Dental GmbH, Biberach/Riss, Germany).
The drillings were performed using a 3D-planned surgical template with different metal...
In a retrospective study, all patients with immediately loaded implants in an edentulous maxillae with limited posterior ridge dimensions that received an equal concept were included if they had a follow-up of at least 3 years. The concept contained immediate loading with distal tilted implants and six implants per edentulous maxillae of a single implant system (blueSky™ implants, Bredent GmbH,...
For a few years, there has been a trend towards minimally invasive implant treatment concepts avoiding bone augmentation even in very atrophic edentulous jaws. These concepts aim to make an implant treatment with a shorter duration, with less inconvenience such as swelling or pain and possibly also economically more attractive [1]. If the implant treatment is less invasive, because of the possible...
The aim of this retrospective study was to evaluate the treatment outcome of six Bredent blueSky™ implants (Bredent GmbH, Senden, Germany) immediately loaded with a fixed full-arch prosthesis (two tilted posterior and four axial frontal and premolar implants).
All 10 patients with atrophic edentulous maxillae being treated with a standardized procedure from 09/2009 to 01/2013, who had a follow-...
Zygomatic implant group
Conventional implant group
Variable
N
Mean
PD
IC 95 %
N
Mean
PD
IC 95 %
p
Overall satisfaction
14
8.88
0.71
−1.17/−0.38
14
9.65
0.13
−1.19/−0.36
0.001
Stability
14
9.79
0.54
−0.50/0.09
14
10.00
0.00
−0.52/0.11
0.009
Ease of cleaning
14
5.82
1.99
−3.49/−1.14
14
8.15
0.78
−3....
Figure 8. Visual analog scale—evaluator version
Figure 7. Visual analog scale—patient version
Figure 6. Zygomatic implant probing using a WHO periodontal probe
Figure 5. Coronal slice from the CBCT showing small exteriorization of a zygomatic implant apex
Figure 4. Coronal slice from the CBCT showing implant apical third inside the zygomatic bone
Figure 3. Panoramic radiograph showing bone level maintenance around the conventional implants
Figure 2. Periapical radiographs using the parallelism technique. a Conventional implants—anterior. b Conventional implants—posterior
Figure 1. a Brånemark technique. b Sinus slot technique. c Extrasinus technique
References
Stievenart M, Malevez C. Rehabilitation of totally atrophied maxilla by means of four zygomatic implants and fixed prosthesis: a 6–40-month follow up. Int J Oral Maxillofac Surg. 2010;39:358–63.
Van der Mark EL, Bierenbroodspot F, Baas EM, De Lange J. Reconstruction of an atrophic maxilla: comparison of two methods. Br J Oral Maxillofac Surg. 2011;49:198–202.
Pelo S, Gasp...
The prostheses supported by zygomatic implants have a special design due to the location and a more palatal emergence profile of the implants in position when compared to conventional implants. This situation can hinder the tongue position and hygiene of the prosthesis and interfere with function. Some studies conducted an assessment of the level of patient satisfaction on the prosthesis sup...
Nakai et al. performed this exam 6 months following the placement of 15 zygomatic implants in nine patients and found an absence of signs and symptoms of sinusitis. Maló et al. evaluated the association between zygomatic implants and maxillary sinusitis using sinusoscopy on 14 patients and found no cases of infection or inflammation of the mucosa surrounding the implants, demonstrating that...
Becktor et al. report that patients with oral-sinus communication may develop suppuration with or without sinusitis. In such cases, treatment consists of the administration of antibiotics and/or the repositioning of the soft tissue and maintenance of a stable zygomatic implant, with no reports of the recurrence of sinusitis. Brånemark found fistula in five patients both before and aft...
Becktor et al. report that patients with oral-sinus communication may develop suppuration with or without sinusitis. In such cases, treatment consists of the administration of antibiotics and/or the repositioning of the soft tissue and maintenance of a stable zygomatic implant, with no reports of the recurrence of sinusitis. Brånemark found fistula in five patients both before and aft...
Other studies have reported the presence of problems with oral tissue in the region of the zygomatic implants, including infection and swelling, usually associated with loss of implant apical osseointegration. Hirsch et al. have reported the presence of hyperplasia, mucositis, and infection in eight patients in a total of ten throughout the monitoring period.
Although certain criteria to ev...
Our study demonstrated the absence of pain as well as of pus or bleeding on probing and palpation for both zygomatic and conventional implants, with good bone level for conventional implants. No periimplant radiolucency was noted around the conventional implants and in the apical portion of the zygomatic implants. These findings are similar to the studies of Stiévenart and Malevez, Peñarro...
As described by Hirsch et al., Aparicio et al., and Farzad et al., this criteria was assessed by periapical radiographs obtained by the parallelism technique combined with panoramic radiographs for conventional implants and CT scans for zygomatic implants. The bone loss was defined as a vertical change of bone level measured from the most inferior line of implant exposure. All previous studi...
Discussion
The morbidity caused by bone graft harvesting and the delay in the final treatment due to the time necessary for bone incorporation triggered the development of techniques without grafting as an option for the treatment of patients with edentulous jaws. Brånemark in 1998 developed a novel technique for placing implants in the zygomatic bone to treat severely atrophic maxilla wit...
Evaluation of the maxillary sinus health
Among the 14 patients submitted to zygomatic implants, only three reported having had nasal obstruction in the weeks preceding the evaluation. One of these patients had a cold, and the other two reported having self-medicated with antihistamines 1 week prior to the evaluation, with the subsequent disappearance of nasal obstruction. Only one patient re...
Results
Of the 17 operated patients, 14 were included in the study and 2 were excluded for not having enough data in the chart and 1 for refusing to return for evaluation of sinus health, totalizing 27 zygomatic implants and 55 conventional implants in group I, without losing any implant, representing 100 % survival of implants placed. The minimum follow-up was 15 and the maximum was 53 month...
For patients with signs indicating maxillary sinusitis, a quality of life questionnaire was administered and video-assisted nasal fibroscopy was performed.
The aim of the clinical exam was to investigate signs of sinusitis: (a) nasal obstruction, using a visual analog scale (VAS) ranging from 0 to 10 points, on which the patient marked his/her degree of obstruction, with the examiner’s subseque...
A ruler template with the respective magnifications was used, considering 25 to 0 % for panoramic and periapical radiographs, respectively. Additionally, the radiographic criteria recommended by Buser et al. were included to determine the success of the implants. These criteria consist of the absence of persistent radiolucency around the implant. The zygomatic implants were assessed only to verify...
All patients were rehabilitated with Conexão® implants system. The inclusion criteria for group I were patients with severe maxillary resorption, classified as classes IV and V of Cawood and Howell (1988), receiving zygomatic implants using Stella and Warner’s technique, performed by the Oral and Maxillofacial Surgery Department from the Rio Grande do Norte Federal University, and having full ...
The hypothesis of this study was to analyze if Stella and Warner’s technique have high survival rates and their rehabilitation have similar satisfaction when compared to total fixed prostheses with conventional implants.
Radiographic evaluation
Panoramic and periapical radiographs were obtained for conventional and zygomatic implants in group I (Figs. 2.a.b and 3). The purpose was to evaluate ...
Methods
This retrospective cohort study was submitted and approved by the Hospital Research Ethics Committee, receiving the registration number 137/201.
The sample consisted of 28 patients (21 females and 7 males), with age ranging from 46 to 63 years, and all of them have undergone either the placement of zygomatic implants using the Stella and Warner’s technique or conventional implants, ...
Background
The prosthodontic rehabilitation of patients with atrophic maxilla is a challenge for a clinician due to the severe compromise of masticatory function and speech with a significant quality of life impact. The poor bone volume found on these patients makes it difficult for conventional rehabilitation with fixed prosthesis and to insert dental implants.
Different surgical techniques w...
Abstract
Background
This study aimed to evaluate patients undergoing placement of zygomatic implants by Stella and Warner’s technique, considering the survival rate of conventional and zygomatic implants, and assess the health of the maxillary sinuses and the level of patient satisfaction.
Methods
In this retrospective cohort study, 28 patients had received a combination of conventional an...