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Trefoil System for the Treatment of Mandibular Edentulism: A Case Report with 30 Months Follow-Up
Case Reports in Dentistry, 2020
The purpose of this work is to describe a clinical case of full-arch mandible rehabilitation with a fixed prosthesis on three implants. The chosen protocol is the Trefoil system by Nobel (Nobel Biocare, Zurich, Switzerland) that allows to realize a mandibular fixed rehabilitation on three particularly designed fixtures through the use of prefabricated surgical guides and a preassembled bar on which the prosthesis is built. Both surgical and prosthetic procedures were completed without complications, and after 30 months, the rehabilitations are in good health conditions. The patient is able to maintain a good level of hygiene and is satisfied with the work from an aesthetic and functional point of view.
The International Journal of Oral & Maxillofacial Implants, 2019
To evaluate, through a systematic review of the literature, the published data regarding marginal bone loss, implant failure proportion, biologic and prosthetic complications, and risk factors associated with short (≤ 8 mm) implants supporting fixed or removable full-arch restorations in the edentulous mandible. Materials and Methods: Two reviewers performed a search of five databases, with handsearching through the reference lists and gray literature. Controlled clinical trials and prospective cohort studies were selected in a two-phase process. The data were independently gathered by the same two reviewers. Quality assessment of the studies was done using the Cochrane Handbook for Systematic Reviews of Interventions for Randomized Clinical Trials and the Newcastle-Ottawa Scale for Prospective Cohort Studies. Marginal bone loss and implant failure proportion were meta-analyzed using random and fixed-effects models, respectively, with 95% confidence intervals. A descriptive analysis was performed of the prevalence of biologic and prosthetic complications. Meta-regression analysis was run as fixed-effect models for risk factors. Results: Six studies met the eligibility criteria and had data extracted. A total of 291 short implants (lengths 5 to 8 mm) were placed in 122 patients (82 women; mean age, 64.7 ± 10.8 years) supporting 23 fixed and 99 removable full-arch restorations. The pooled marginal bone loss overall was 0.12 mm (0.07 to 0.17 mm). Marginal bone loss for fixed full-arch restorations was 0.11 mm (0.01 to 0.21 mm) and for removable full-arch restorations was 0.14 mm (0.07 to 0.21 mm). The pooled overall implant failure proportion was 2.0% (1.0% to 5.0%) for the studies. Implant failure proportion for fixed and removable restorations was 2.0% with confidence intervals of 0.0% to 9% and 0.0% to 6%, respectively. The prevalence of prosthetic complications was 34.5% for fixed restorations and 2.6% for removable restorations. No biologic complications were found for fixed restorations, while 13.1% of removable restorations did have biologic complications. Risk factors did not demonstrate statistical differences regarding implant failure proportion and marginal bone loss. All included studies demonstrated a high methodologic quality. Conclusion: Findings from this systematic review and meta-analysis suggest that full-arch restorations supported by short implants in atrophic edentulous mandibles might be a viable treatment option, presenting minimal marginal bone loss and implant failure in the short term. However, further well-performed prospective clinical trials with long-term observation are needed.
Possibilities of reconstruction and implant-prosthetic rehabilitation following mandible resection
Vojnosanitetski pregled, 2013
Introduction. Mandible reconstruction is still very challenging for surgeons. Mandible defects could be the consequence of ablative surgery for malignancies, huge jaw cysts, infection and trauma. Segmental resection of the mandible may compromise orofacial function and often lead to patients psychological disorders. Despite very frequent use of microvascular flaps, autogenous bone grafts are still very reliable technique for mandible reconstruction. Comprehensive therapy means not only mandible reconstruction, but prosthodontic rehabilitation supported by dental implants, which can significantly improve patients quality of life. The aim of this paper was to evaluate possible techniques of mandible reconstruction and to present a patient who had been submitted to mandible resection and reconstruction with autogenous iliac bone graft and prosthodontic rehabilitation with fixed denture anchoraged by disc-shaped implants in early loading protocol. Case report. Mandible reconstruction wa...
Quintessence International, 2006
Bone grafting has become an essential part of implant dentistry. Dental implants are no longer placed according to the available alveolar bone since techniques for alveolar ridge augmentation have evolved. Different bone grafting techniques currently used in implant dentistry include autogenous particulate/ block bone grafts, guided bone regeneration (GBR), allografts, xenografts, alloplasts, or a combination of 2 or more grafting materials. Autogenous bone grafts have been considered the gold standard because they demonstrate osteogenesis, osteoinduction, and osteoconduction. 1 Common intraoral donor areas include the mandibular symphysis and ramus and the maxillary tuberosity. The disadvantages of autogenous bone harvesting are often related to the risk or morbidity of the donor area, the necessity of an additional surgical procedure, and the limited donor sources.
Clinical Oral Implants Research, 2002
A group of 15 partially edentulous patients who needed alveolar ridge augmentation for implant placement, were consecutively treated using a two-stage technique in an outpatient environment. A total of 18 alveolar segments were grafted. During the first operation bone blocks harvested from the mandibular ramus or symphysis were placed as lateral or vertical onlay grafts and fixed with titanium osteosynthesis screws after exposure of the deficient alveolar ridge. After 6 months of healing the flap was re-opened, the screws were removed and the implants placed. Twelve months after the first operation implant-supported fixed bridges could be provided to the patients. Mean lateral augmentation obtained at the time of bone grafting was 6.5∫0.33 mm, that reduced during healing because of graft resorption to a mean of 5.0∫0.23 mm. Mean vertical augmentation obtained in the 9 sites where it was needed was 3.4∫0.66 mm at bone grafting and 2.2∫0.66 mm at implant placement. Mean lateral and vertical augmentation decreased by 23.5% and 42%, respectively, during bone graft healing (before implant insertion). Mandibular sites showed a larger amount of bone graft resorption than maxillary sites. All the 40 implants placed were integrated at the abutment connection and after prosthetic loading (mean follow-up was 12 months). No major complications were recorded at donor or recipient sites. Soft tissue healing was uneventful, and pain and swelling were comparable to usual dentoalveolar procedures. A visible ecchymosis was present for 4 to 7 days when the bone was harvested from the mandibular symphysis. From a clinical point of view this procedure appears to be simple, safe and effective for treating localised alveolar ridge defects in partially edentulous patients.
Revista Portuguesa de Estomatologia, Medicina Dentária e Cirurgia Maxilofacial, 2015
r e v p o r t e s t o m a t o l m e d d e n t c i r m a x i l o f a c . 2 0 1 5;5 6(2):117-121 a b s t r a c t The head and neck are commonly affected in gunshot injuries and this can cause functional and esthetic defects in the maxillofacial region. Mandibular discontinuity is an important esthetic and functional problem and its reconstruction represents a huge challenge. The opening, closing, lateral and protrusive movements of the mouth are diminished and malocclusion can occur. The purpose is to report a clinical case of a 44 years man who had an immediate loaded implant-supported prosthesis after six months of mandibular reconstruction with free iliac bone grafting of a greatmandibular defect caused by gun shot. Autogenous bone grafting is the most predictable treatment from the available reconstruction options for mandibular bone defects. Reconstructed patients can achieve good results with dental implants and implant-supported prostheses with immediate loading. This treatment can promote better masticatory function, improving the nutrition capacity, facial symmetry, muscular equilibrium, better diction and quality of life. article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Reconstruction of Mandibular Alveolar Ridge Defects for Implant Placement: Critical Review
International Journal of Dentistry and Oral Health, 2015
Background: Dental rehabilitation of partially or totally edentulous patients with oral implants has become a routine treatment modality in the last decades, with reliable long-term results. However, unfavorable local conditions of the alveolar ridge, due to atrophy, periodontal disease, and trauma sequelae may provide insufficient bone volume or unfavorable vertical, horizontal, and sagittal intermaxillary relationships, which may render implant placement impossible or incorrect from a functional and esthetic viewpoint. The aim of the current review is to discuss the different strategies for reconstruction of the alveolar ridge defect for implant placement. Study design: The study design includes a literature review of the articles that address the association between Reconstruction of Mandibular Alveolar Ridge Defects and Implant Placement. Results: Yet, despite an increasing number of publications related to the correction of deficient alveolar ridges, much controversy still exists concerning which is the more suitable and reliable technique. This is often because the publications are of insufficient methodological quality (inadequate sample size, lack of well-defined exclusion and inclusion criteria, insufficient follow-up, lack of well-defined success criteria, etc.). Conclusion: On the basis of available data it is difficult to conclude that a particular surgical procedure offered better outcome as compared to another. Hence the practical use of the available bone augmentation procedures for dental implants depends on the clinician's preference in general and the clinical findings in the patient in particular. Surgical techniques that reduce trauma, preserve and augment the alveolar ridge represent key areas in the goal to optimize implant results.