Journal of Oral Science & Rehabilitation No. 3, 2019
Cover
/ Editorial
/ Contents
/ About the Journal of Oral Science & Rehabilitation
/ Evaluation of primary stability and early healing of 2 implant macrodesigns placed in the posterior maxilla: A split-mouth prospective randomized controlled clinical study
/ All-on-4 with tapered neck implants and a hybrid prosthesis with a fiberglassreinforced structure (TriLor Arch)
/ An unusual case of sublingual ranula with submandibular gland involvement
/ Immediate dentoalveolar restoration
/ Guidelines for authors
/ Imprint
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[1] =>
Volume 5 | Issue 3/2019
ISSN 2365 - 6891 (ONLINE)
Journal of
www.dtscience.com
Oral Science & Rehabilitation
Journal for periodontology, implant dentistry,
dental prosthodontics and maxillofacial surgery
[2] =>
Kapitelüberschriften
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| Volume 5 – Issue 3/2019
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[3] =>
Editorial
In atrophic edentulous maxillae,
should we regenerate or use
residual bone?
In the world, there are 500 million of completely edentulous people. Edentulism has a significant impact on
quality of life: esthetic concerns due to alteration of the
vertical dimension and facial profile, decreased masticatory efficiency, temporomandibular joint dysfunction
and problems associated with the use of removable
complete prostheses, such as stomatitis, angular
cheilitis, oral candidiasis, ulcers and hyperplasia.1, 2
Edentulism has repercussions in social life and dayto-day activities. Edentulous patients may feel embarrassed when talking, smiling or eating in front of other
people, and this can lead to social isolation and subsequent loneliness.3
The best solution for patients with complete edentulism
is rehabilitation with prostheses supported on implants.
Improved oral health and quality of life can be seen
in edentulous patients with atrophied maxillae after
implant treatment with an immediate loading protocol.4
It is frequent that edentulous patients present severe
bone atrophy. In these cases we should ask ourselves
whether we need to regenerate before placing the implants or if can use the residual pristine bone. Therefore, we must establish whether it is better to place an
implant with or without bone grafting.
A problem of regenerative procedures is bone graft resorption. Volumetric measurements of the grafts evidence progressive and unavoidable bone resorption of
almost all the grafted bone in the maxilla and mandible.
In a study with a number of years of follow-up, after
vertical and horizontal alveolar ridge augmentation of
atrophic maxillae and mandibles with autogenous crest
block bone grafts, very high percentages of bone graft
resorption were found.5 The use of anatomical buttresses is an alternative that overcomes the higher morbidity and higher treatment fees of regenerative procedures, as well as the longer postoperative periods for
delivery of the definitive restorations. Flying buttresses
are external discharge elements used in Gothic archi-
tecture in the form of a half arch. Buttresses collect
the pressure at the start of the vault and transmit it to
another buttress attached to the wall of a lateral nave.
They were first used in 1180 in the construction of the
central nave of the Notre Dame of Paris to reinforce its
vault. In orofacial structures, buttresses are areas of
dense bone that form a protective frame and dissipate
forces around the craniofacial cavities: fronto-maxillary
buttress, pterygomaxillary buttress, zygomatic buttress, palatal cortical bone and nasopalatine duct (an
additional area of residual bone).6–8
A study that compared conventional dental implants
placed in augmented atrophic maxillae and the placement of implants in buttresses found a greater loss of
implants in the augmentation group.9 It also found that
the mean period for functional restoration was 1 week
in the buttresses group and more than 1 year in the
augmented patients.9
Prof. Miguel Peñarrocha Diago
Editor-in-Chief
Editorial note: A list of references is available from the
publisher.
Journal of Oral Science & Rehabilitation | Volume 5 – Issue 3/2019
3
[4] =>
Contents
Contents
3
Editorial
6
About the Journal of Oral Science & Rehabilitation
8
Marino Sánchez-Siles et al.
Prof. Miguel Peñarrocha Diago
Evaluation of primary stability and early healing of 2 implant macrodesigns placed
in the posterior maxilla: A split-mouth prospective randomized controlled clinical study
16
Guillermo Cabanes Gumbau et al.
24
Lim Min Jim
28
Igor da Silva Brum et al.
36
Guidelines for authors
38
Imprint — About the publisher
4
All-on-4 with tapered neck implants and a hybrid prosthesis with a fiberglass-reinforced
structure (TriLor Arch)
An unusual case of sublingual ranula with submandibular gland involvement
Immediate dentoalveolar restoration
Journal of Oral Science & Rehabilitation | Volume 5 – Issue 3/2019
[5] =>
Kapitelüberschriften
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Tribune Group GmbH is an ADA CERP Recognized Provider.
ADA CERP is a service of the American Dental Association to assist dental professionals in identifying
quality providers of continuing dental education. ADA CERP does not approve or endorse individual
courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.
Tribune Group GmbH designates this activity for 1 continuing education credits.
This continuing education activity has been planned and implemented in accordance with the
standards of the ADA Continuing Education Recognition Program (ADA CERP) through joint efforts
between Tribune Group GmbH and Dental Tribune Int. GmbH.
Journal of Oral Science & Rehabilitation | Volume 5 – Issue 3/2019
5
[6] =>
About
About
the Journal of Oral Science & Rehabilitation
The aim of the Journal of Oral Science & Rehabilitation
is to promote rapid communication of scientific information between academia, industry and dental practitioners, thereby influencing the decision-making in
clinical practice on an international level.
The Journal of Oral Science & Rehabilitation publishes
original and high quality research and clinical papers in
the fields of periodontology, implant dentistry, prosthodontics and maxillofacial surgery. Priority is given
to papers focusing on clinical techniques and with a
direct impact on clinical decision-making and outcomes in the above-mentioned fields. Furthermore,
book reviews, summaries and abstracts of scientific
meetings are published in the journal.
Papers submitted to the Journal of Oral Science &
Rehabilitation are subject to rigorous double-blind
peer review. Papers are initially screened for relevance
to the scope of the journal, as well as for scientific
content and quality. Once accepted, the manuscript
is sent to the relevant associate editors and reviewers of the journal for peer review. It is then returned to
the author for revision and thereafter submitted for
copy editing. The decision of the Editor-in-Chief is
made after the review process and is considered final.
About
Dental Tribune Science
Dental Tribune Science (DT Science) is an online openaccess publishing platform (www.dtscience.com) on
which the Journal of Oral Science & Rehabilitation is
hosted and published.
DT Science is a project of the Dental Tribune International Publishing Group (DTI). DTI is composed of
the leading dental trade publishers around the world.
For more, visit → www.dental-tribune.com
6
Journal of Oral Science & Rehabilitation | Volume 5 – Issue 3/2019
[7] =>
About
Benefits of publishing in the journal
for authors
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Journal of Oral Science & Rehabilitation | Volume 5 – Issue 3/2019
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[8] =>
Primary stability of 2 implant macrodesigns
Evaluation of primary stability and early
healing of 2 implant macrodesigns placed
in the posterior maxilla: A split-mouth
prospective randomized controlled
clinical study
Marino Sánchez-Siles,a Joao Baptista Ilha,b
Juan Alberto Fernández Ruizc &
Fabio Camacho Alonsod
a
b
c
d
Private practice, Murcia, Spain
Department of Oral Practice, State University of Maringá,
Maringá, Brazil
Private practice, Ibiza, Spain
Department of Oral Surgery, University of Murcia,
Murcia, Spain
Corresponding author:
Dr. Fabio Camacho Alonso
Clínica Odontológica Universitaria
Unidad Docente de Cirugía Bucal
Hospital Morales Meseguer (2 planta)
Avda. Marqués de los Vélez s/n
30008 Murcia
Spain
fcamacho@um.es
How to cite this article: Sánchez-Siles M, Baptista Ilha
J, Fernández Ruiz JA, Camacho Alonso F. Evaluation
of primary stability and early healing of 2 implant macrodesigns placed in the posterior maxilla: A split-mouth
prospective randomized controlled clinical study.
J Oral Science Rehabilitation. 2019 Sep;5(3):8–15.
Abstract
Objective
The aim of this study was to evaluate the clinical behavior of 2 implants of different macrodesigns placed
in low-density bone at the moment of insertion and
during bone healing.
8
Materials and methods
In this split-mouth prospective randomized controlled
clinical study, 60 Avinent dental implants (Avinent
Implant System) were placed in the posterior maxillae
of 30 patients. Each patient received 1 tapered implant
with a wide thread (OCEAN) and 1 cylindrical implant
with a narrow thread (CORAL). Primary stability was
evaluated at baseline by measuring the insertion
torque applied and registering the implant stability quotient (ISQ). Periimplant crestal bone loss was evaluated from intraoral radiographs taken at 1 and 4 months
after implant placement. Lastly, ISQ was registered
after 4 months.
Results
At baseline, both insertion torque and ISQ values were
significantly higher for tapered implants (P = 0.008).
There was less periimplant crestal bone loss at 1 and
4 months with tapered implants with a wide thread
(0.43 ± 0.27 mm and 0.59 ± 0.31 mm, respectively)
than with cylindrical implants with a narrow thread
(0.73 ± 0.28 mm and 0.95 ± 0.43 mm, respectively),
and the differences at both evaluation times were significant (P < 0.001 and P = 0.001, respectively). The
ISQ values at 4 months were higher for tapered implants with a wide thread, and the difference was significant (P = 0.014).
Conclusion
Although both implant macrodesigns can be placed in
low-density bone, tapered implants with a wide thread
appear to produce better results in terms of insertion torque, ISQ and crestal bone loss 4 months after
placement.
Keywords: Dental implant macrodesign; tapered implant; cylindrical implant; low-density bone; thread.
Journal of Oral Science & Rehabilitation | Volume 5 – Issue 3/2019
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Primary stability of 2 implant macrodesigns
Introduction
Bone density and especially cortical thickness are important factors in achieving adequate primary stability
and a successful clinical outcome when placing dental
implants.1 Primary stability is defined as the absence
of movement after the intraosseous insertion of the
implant.2 Different types of bone in the jaws have been
clinically classified in various ways according to structural characteristics related to the proportion of cortical
to trabecular bone. The most commonly used classification is that of Lekholm and Zarb,3 according to which
type I is the most densely compacted bone type, and
type IV the most trabeculated, with lower density and
thinner cortical bone, which is generally considered
less suitable for supporting dental implants.4 Nevertheless, none of the classification systems take the bone’s
biological capacity into account.5
In recent years, various quantitative methods for assessing primary stability have been introduced. These
can be used to monitor implant stability repeatedly
over time.6 Resonance frequency analysis (RFA) consists of applying a bending load that imitates clinical
implant loading and its direction. This provides information about the rigidity of the bone-to-implant union,
and the result is registered as a parameter known as
the implant stability quotient (ISQ). ISQ values range
from 1 (low stability) to 100 (maximum stability).7 Alternatively, insertion torque is a direct measure of
the bone’s cutting resistance during implant insertion
surgery.8 But insertion torque is a mechanical parameter that can be influenced by the surgical procedure,
implant design and bone quality.
The success of an implant depends largely on its
primary stability, as mechanical stability provides a
basis for osseointegration.9 Bone density and quality,
surgical technique, primary stability and, of course, the
implant’s geometry are all important factors in achieving implant osseointegration.9, 2, 10
Implant design and shape have undergone various
modifications over the years, aimed at increasing
the contact between implant surface and bone, and
increasing primary and secondary stability.11, 12 An
adequate macrodesign must balance compression
and traction forces and minimize shear forces,12 to
maintain micromovement at a level below 50–150 µm
during the healing period.13 A tapered shape provides
the implant with a good basis for primary stability, as it
allows the gradual expansion of the bone and minimizes stress at its interface with the surrounding bone.10
It has been shown clinically that implants with a tapered
design present better stability in areas with lower bone
density.14,15 The pitch and shape of the thread also
influence primary stability, stress and initial bone-toimplant contact.16 According to some studies, a reduced
pitch improves surface contact with bone, reduces the
distribution of stress and improves primary stability in
low-density bone.17,18
Thus, the aim of this split-mouth prospective randomized controlled study was to evaluate the clinical
behavior of 2 implants of different macrodesigns at the
moment of insertion in the low-density bone of the posterior upper jaw and during bone healing.
Methods and materials
Recruitment and patient characteristics
The study protocol was approved by the University of
Murcia’s ethics committee (Spain) (1933/2018) and
was carried out between June 2018 and December
2018 at the university’s dental clinic. Subjects were
treated according to guidelines established by the
Declaration of Helsiki for medical research involving human subjects. All the subjects provided their
informed consent to participate. The entire protocol
(clinical, surgical and radiographic) was carried out by
a single clinician.
The inclusion criteria were as follows: aged over
18 years; total edentulism in the maxilla necessitating
bilateral implant insertion in the posterior third in type III
bone within a range of 350–830 Hounsfield units (HU),
according to Norton and Gamble’s classification; 3
absence of medical contraindications to oral surgical
procedures (ASA I/II); and willingness to provide informed consent to take part. The exclusion criteria
were as follows: presence of a disease or condition or use of medication that could compromise
healing or osseointegration (diabetes mellitus,
severe osteoporosis or bisphosphonate administration); pregnancy or lactation; and radiotherapy of
Journal of Oral Science & Rehabilitation | Volume 5 – Issue 3/2019
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Primary stability of 2 implant macrodesigns
the head and neck during the previous 18 months;
and refusal to provide informed consent to take part.
Thirty patients fulfilled the inclusion criteria and were
invited to take part in the trial. Before surgery, the patients’ sociodemographic data were registered, as well
as their status regarding smoking and alcohol consumption, and their complete medical histories.
Bone mineral density measurements
To measure bone mineral density (BMD) in the maxillary posterior third in cone beam computed tomography (CBCT) images, a 3D circular region of interest
was determined in each and it was between 10 and
20 mm2 in area. BMD was calculated in HU. The CBCT
images were taken using a Kodak CS 8100 CBCT
unit (Kodak) with the following specifications:
18 × 21 cm field of view, 90 kVp, 10 mA, exposure
time of 15 s, and spatial resolution of 10 lp/cm
and 0.2 mm voxel size. This CBCT unit was calibrated every 6 months in accordance with the Spanish
Royal Decree of Dec. 23, 1976/1999. Images were
constructed with Carestream 3D imaging software
(Carestream Health).
Dental implant surgery and randomization
All the surgical interventions were performed under
local anesthesia (1:100,000 articaine) by a single clinician at the same drilling speed of 50 rpm with irrigation. Each patient received 2 Avinent dental implants
(Avinent Implant System), 1 tapered implant with a
wide thread (OCEAN) and 1 cylindrical implant with a
narrow thread (CORAL). The insertion of one or the
other design in each posterior region was determined
using an online randomization service (www.randomization.com). The characteristics of the tapered implant
with a wide thread were as follows: internal hex connection, wide thread pitch (1.5 mm), square-shaped
thread and thread depth of 0.5 mm. The characteristics
of the cylindrical implant with a narrow thread were as
follows: narrow thread pitch (0.5 mm), V-shaped thread
and thread depth of 0.36 mm (Figs. 1 & 2). The insertion torque of the 60 implants was registered with an
Implantmed SI-1023 surgical micromotor (W&H), first
establishing an initial insertion torque of 20 N cm and
then increasing torque by 5 N cm increments as necessary until the required insertion torque was reached. All
the implants were submerged. No healing abutments
or provisionalization crowns were placed during the
10
Fig. 1
Fig. 2
4-month healing period. In all the cases, the postoperative medication prescribed was amoxicillin (500 mg)
every 8 h for 7 days (in case of penicillin allergy, clindamycin [300 mg] every 8 h was prescribed) and ibuprofen (600 mg) every 8 h for 3 days.
Resonance frequency analysis
RFA was performed at baseline and 30 days after
implant insertion using the Osstell Mentor (Integration Diagnostics). Each measurement was performed
twice, 1 from each 90° angle, parallel to the crestal
line; the highest ISQ value was taken as the reference
value.
Radiographic parameters
For evaluation of radiographic bone loss (1 and
4 months after implant placement), a digital radiographic system (RVG 5100, Kodak) was used with
Journal of Oral Science & Rehabilitation | Volume 5 – Issue 3/2019
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Primary stability of 2 implant macrodesigns
Patient sample characteristics
Patients: n
30
Age (years): mean ± SD†
64.07 ± 9.02
Sex: n (%)
Male
9 (30.00)
Female
21 (70.00)
Smoking status: n (%)
Nonsmoker
22 (73.34)
≤ 10 cigarettes
4 (13.33)
11–20 cigarettes
4 (13.33)
Alcohol consumption: n (%)
None
25 (83.33)
Daily
2 (6.67)
Weekend drinker
3 (10.00)
Diseases: n (%)
†
Arterial hypertension
9 (30.00)
Auricular fibrillation
1 (3.33)
Acute myocardial infarction
1 (3.33)
Hypercholesterolemia
3 (10.00)
Fibromyalgia
1 (3.33)
Anxiety
3 (10.00)
Depression
2 (6.67)
Diabetes mellitus type II
2 (6.67)
Thyroid hypofunction
2 (6.67)
Chronic obstructive bronchitis
1 (3.33)
SD = standard deviation.
Table 1: Study population characteristics.
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Primary stability of 2 implant macrodesigns
Variable
Tapered implants with
wide thread (n = 30)
Cylindrical implants with
narrow thread (n = 30)
P value
29.14 ± 3.85
26.25 ± 3.94
0.008
53.66 ± 12.04
49.48 ± 7.66
0.118
Insertion torque
value (N cm;
mean ± SD†)
ISQ value
(mean ± SD)
Table 2: Comparison of primary stability (at baseline) between study groups (Student t test).
SD = standard deviation.
†
Variable
Tapered implants with
wide thread (n = 30)
Cylindrical implants with
narrow thread (n = 29)
P value
0.43 ± 0.27
0.73 ± 0.28
< 0.001
0.59 ± 0.31
0.95 ± 0.43
0.001
54.21 ± 7.67
49.25 ± 7.24
0.014
1-month M + D/2†
radiographic
bone loss
(mm; mean ± SD‡)
4-month M + D/2
radiographic
bone loss (mm;
mean ± SD)
4-month M + D/2
ISQ value
(mean ± SD)
†
‡
Rinn XCP support (DENTSPLY RINN). All the radiographs were captured at 70 kV, 8 mA and a focal
distance of 30 cm. Mesial, distal and total crestal
bone loss (mesial + distal/2; vertical distance from
the implant shoulder to the first bone-to-implant
contact) were measured using ImageJ digital image
analysis software (Version 1.46, National Institutes of
Health).
Statistical analysis
Data were analyzed using the SPSS statistical package
(Version 20.0, IBM Corp.). A descriptive study of each
variable was performed. The Student t test for 2 independent samples was used in application to quantitative variables, in each case determining whether variances were homogeneous. Statistical significance was
established at P ≤ 0.05.
12
Table 3: Comparison of implant osseointegration
between study groups (Student t test).
M + D/2 = average mesial and distal surface values;
SD = standard deviation.
Results
This study recruited 30 patients (9 men and 21 women),
with an average age of 64.07 ± 9.02 years. Most
did not smoke (73.34%) or drink alcohol (83.33%;
Table 1). At baseline, both insertion torque and ISQ
values were higher for tapered implants with a wide
thread (29.14 ± 3.85 and 53.66 ± 2.04, respectively) than for cylindrical implants with a narrow thread
(26.25 ± 3.94 and 49.48 ± 7.66, respectively), and the
differences in insertion torque were statistically significant (P = 0.008; Table 2). There was less periimplant
crestal bone loss at 1 and 4 months with tapered implants (0.43 ± 0.27 mm and 0.59 ± 0.31 mm, respectively) than with cylindrical implants (0.73 ± 0.28 mm
and 0.95 ± 0.43 mm, respectively), and the differences
at both evaluation times were significant (P < 0.001
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Primary stability of 2 implant macrodesigns
and P = 0.001, respectively; Table 3). Lastly, the ISQ
values at 4 months after implant insertion were higher
for tapered implants (54.21 ± 7.67) than for cylindrical
implants (49.25 ± 7.24), and the difference was statistically significant (P = 0.014; Table 3).
Discussion
This study included 30 patients who received a total of
60 dental implants in the posterior third of the maxilla
(with low type III BMD), 30 with a tapered design with
a wide thread and 30 with a cylindrical design with
a narrow thread. Insertion torque, ISQ and crestal
bone loss were measured during the first 4 months of
healing.
Insertion torque was found to be higher for tapered
implants than for cylindrical implants. This finding coincides with the results obtained in most other investigations of this topic. Menicucci et al. compared insertion
torque achieved for tapered and cylindrical implants
and also obtained significantly higher torque values for
tapered implants (31.5 N cm) than for cylindrical implants (25.5 N cm).19 In 2000, O’Sullivan et al. also obtained similar results in an ex vivo study,20 and in 2006,
Akça et al. concluded that tapered implants achieve
higher insertion torque than cylindrical implants do.21
They also argued that insertion torque values are more
sensitive than ISQ values in terms of revealing biomechanical conditions at the bone-to-implant interface.23
As for ISQ, tapered implants obtained higher values
both at baseline and after 4 months of osseointegration (although without a statistically significant difference at baseline). Other studies have also registered
ISQ obtaining higher values for tapered implants than
for cylindrical implants.22, 23 This finding could be due
to tapered implants exerting higher lateral compression force against the crestal and middle bone walls,
leading to small differences in ISQ values between
implant types, despite significant differences in insertion torque. Similar results were obtained by Sakoh
et al., who found no differences in ISQ values
between tapered and cylindrical implants in an in
vitro study.15 Other authors have also reported that,
although insertion torque was higher for tapered
implants, ISQ values were similar for the 2 types of
implant.10, 15, 24, 25
Thread geometry can be considered an important
factor of implant stability and osseointegration. In a
study by Steigenga et al., 72 implants with differing
thread geometries were placed (V-shaped vs. squareshaped thread) in 12 New Zealand rabbit tibias.26 After
12 weeks, the outcomes were analyzed by radiography and histomorphometric analysis, registering the
bone-to-implant contact area and reverse torque. It
was concluded that the square thread shape obtained
better results in all the analyses performed.
Few studies have been published on the influence
of implant shape on implant stability, osseointegration and survival when the implant is placed in lowdensity bone (such as the posterior third of the
maxilla), as shown by the systematic review by
Alshehri and Alshehri of clinical studies in humans
of tapered and/or cylindrical implants in the posterior
maxilla.27 For this reason, further prospective clinical
trials are needed to confirm that tapered implants could
be a better option for maximizing primary stability and
bone healing in critical areas with low bone density.
Conclusion
In conclusion, although both the implant designs
tested (tapered and cylindrical) may be inserted in lowdensity bone (such as the posterior third of the maxilla),
tapered implants with a wide thread would appear to
offer better results in terms of insertion torque, ISQ and
crestal bone loss at 4 months after insertion.
Competing interests
The authors declare that they have no competing interests.
Figure legends
Fig. 1 – Tapered implant with wide thread (A = 3.5 mm,
B = 11.5 mm, F = 1.5 mm, G = 0.5 mm, H = 4.1 mm).
Fig. 2 – Cylindrical implant with narrow thread
(A = 4.1 mm, B = 11.5 mm, F = 0.5 mm, G = 0.36 mm,
H = 4.1 mm).
Journal of Oral Science & Rehabilitation | Volume 5 – Issue 3/2019
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Primary stability of 2 implant macrodesigns
References
1. Rozé J, Babu S, Saffarzadeh A, Gayet-Delacroix M,
Hoomaert, A, Layrolle P. Correlating implant stability to
bone structure.
→ Clin Oral Implants Res.
2009 Oct;20(10):1140–5.
2. Bahat O, Sullivan RM. Parameters for successful
implant integration revisited part I: immediate loading
considered in light of the original prerequisites for osseointegration.
→ Clin Implant Dent Relat Res.
2010 May;12 Suppl 1:e2–12. doi: 10.1111/j.17088208.2010.00279.x.
3. Norton MR, Gamble C. Bone classification: an objective scale of bone density using the computerized
tomography scan.
→ Clin Oral Implants Res.
2001 Feb;12(1):79–84.
4. He J, Zhao B, Deng C, Shang D, Zhang C. Assessment of implant cumulative survival rates in sites with
different bone density and related prognostic factors: an
8-year retrospective study of 2,684 implants.
→ Int J Oral Maxillofac Implants.
2015 Mar–Apr;30(2):360–71.
5. Li J, Yin X, Huang L, Mouraret S, Brunski JB,
Cordova L, Salmon B, Helms JA. Relationships
among bone quality, implant osseointegration, and
Wnt signaling.
→ J Dent Res.
2017 Jul;96(7):822–31.
6. Cehreli MC, Karasoy D, Akca K, Eckert SE.
Meta-analysis of methods used to assess implant
stability.
→ Int J Oral Maxillofac Implants.
2009 Nov–Dec;24(6):1015–32.
7. Sennerby L, Meredith N. Implant stability measurements using resonance frequency analysis: biological
and biomechanical aspects and clinical implications.
→ Periodontol 2000.
2008 Jun;47:51–66.
8. Meredith N. Assessment of implant stability as a
prognostic determinant.
→ Int J Prosthodont.
1998 Sep–Oct;11(5):491–501.
14
9. Suer BT, Yaman Z, Buyuksarac B. Correlation of
fractal dimension values with implant insertion torque
and resonance frequency values at implant recipient
sites.
→ Int J Oral Maxillofac Implants.
2016 Jan–Feb;31(1):55–62.
10. Dos Santos MV, Elias CN, Cavalcanti Lima JH.
The effects of superficial roughness and design on the
primary stability of dental implants.
→ Clin Implant Dent Relat Res.
2011 Sep;13(3):215–23.
11. Pimentel Lopes de Oliveira G, Leite FC, Pontes AE,
Sakakura CE, Junior EM. Comparison of the primary
and secondary stability of implants with anodized surfaces and implants treated by acids: a split-mouth randomized controlled clinical trial.
→ Int J Oral Maxillofac Implants.
2016 Jan–Feb;31(1):186–90.
12. Abuhussein H, Pagni G, Rebaudi A, Wang HL. The
effect of thread pattern upon implant osseointegration.
→ Clin Oral Implants Res.
2010 Feb;21(2):129–36.
13. Szmukler-Moncler S, Salama H, Reingewirtz Y,
Dubruille JH. Timing of loading and effect of micromotion
on bone-dental implant interface: review of experimental literature.
→ J Biomed Mater Res.
1998 Summer;43(2):192–203.
14. Pozzi A, Tallarico M, Moy PK. Immediate loading
with a novel implant featured by variable-threaded geometry, internal conical connection and platform shifting: three-year results from a prospective cohort study.
→ Eur J Oral Implantol.
2015 Spring;8(1):51–63.
15. Sakoh J, Wahlmann U, Stender E, Nat R, Al-Nawas
B, Wagner W. Primary stability of a conical implant and
a hybrid, cylindric screw-type implant in vitro.
→ Int J Oral Maxillofac Implants.
2006 Jul–Aug;21(4):560–6.
16. Kielbassa AM, Marrinez-de Fuentes R, Goldstein M,
Arnhart C, Barlattani A, Jackowski J, Knauf M,
Lorenzoni M, Maiorana C, Mericske-Stern R,
Rompen E, Sanz M. Randomized controlled trial
comparing a variable-thread novel tapered and a
standard tapered implant: interim one-year results.
→ J Prosthet Dent.
2009 May;101(5):293–305.
Journal of Oral Science & Rehabilitation | Volume 5 – Issue 3/2019
[15] =>
Primary stability of 2 implant macrodesigns
17. Chung SH, Heo SJ, Koak JY, Kim SK, Lee JB, Han
JS, Han CH, Rhyu IC, Lee SJ. Effects of implant geometry and surface treatment on osseointegration after
functional loading: a dog study.
→ J Oral Rehabil.
2008 Mar;35(3):229–36.
18. Orsini E, Giavaresi G, Trirè A, Ottani V, Salgarello S.
Dental implant thread pitch and its influence on the
osseointegration process: an in vivo comparison study.
→ Int J Oral Maxillofac Implants.
2012 Mar–Apr;27(2):383–92.
19. Menicucci G, Pachie E, Lorenzetti M, Migliaretti G,
Carossa S. Comparison of primary stability of straightwalled and tapered implants using an insertion torque
device.
→ Int J Prosthodont.
2012 Sep–Oct;25(5):465–71.
20. O’Sullivan D, Sennerby L, Meredith N. Measurements comparing the initial stability of five designs of
dental implants: a human cadaver study.
→ Clin Implant Dent Relat Res.
2000 Apr;2(2):85–92.
Brånemark implant.
→ Clin Implant Dent Relat Res.
2003;5(2):71–7.
25. Al-Nawas B, Wagner W, Grötz KA. Insertion torque
and resonance frequency analysis of dental implant
systems in an animal model with loaded implants.
→ Int J Oral Maxillofac Implants.
2006 Sep–Oct;21(5):726–32.
26. Steigenga J, Al-Shammari K, Misch C, Nociti FH Jr,
Wang HL. Effects of implant thread geometry on percentage of osseointegration and resistance to reverse
torque in the tibia of rabbits.
→ J Periodontol.
2004 Sep;75(9):1233–41.
27. Alshehri M, Alshehri F. Influence of implant shape
(tapered vs cylindrical) on the survival of dental implants
placed in the posterior maxilla: a systematic review.
→ Implant Dent.
2016 Dec;25(6):855–60.
21. Akça K, Chang TL, Tekdemir I, Fanuscu MI. Biomechanical aspects of initial intraosseous stability and
implant design: a quantitative micro-morphometric analysis.
→ Clin Oral Implants Res.
2006 Aug;17(4):465–72.
22. Romanos GE, Basha-Hijazi A, Gupta B, Ren YF,
Malmstrom H. Role of clinician’s experience and implant
design on implant stability. An ex vivo study in artificial
soft bones.
→ Clin Implant Dent Relat Res.
2014 Apr;16(2):166–71.
23. García-Vives N, Andrés-García R, Rios-Santos V,
Fernández-Palacín A, Bullón-Fernández P, Herrero-Climent M, Herrero-Climent F. In vitro evaluation of the
type of implant bed preparation with osteotomes in bone
type IV and its influence on the stability of two implant
systems.
→ Med Oral Patol Oral Cir Bucal.
2009 Sep;14(9):e455–60.
24. Friberg B, Jisander S, Widmark G, Lundgren A,
Ivanoff CJ, Sennerby L, Thorén C. One-year prospective three-center study comparing the outcome of a “soft
bone implant” (prototype Mk IV) and the standard
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[16] =>
All-on-4 with TriLor Arch
All-on-4 with tapered neck implants and a
hybrid prosthesis with a fiberglassreinforced structure
Guillermo Cabanes Gumbau,a
Álvaro Canet López,a
Miguel Peñarrocha Diagoa &
María Peñarrocha Diagoa
a
Oral Surgery Unit, Department of Stomatology, Faculty of
Medicine and Dentistry, University of Valencia, Valencia, Spain
Corresponding author:
Dr. Álvaro Canet López
Universidad de Valencia
Facultad de Medicina y Odontología
Clínica Odontológica. Cirugía bucal
C/ Gascó Oliag, 1
46021 Valencia
Spain
falvarocanet@hotmail.com
How to cite this article: Cabanes Gumbau G, Canet
López Á, Peñarrocha Diago M, Peñarrocha Diago M.
All-on-4 with tapered neck implants and a hybrid prosthesis with a fiberglass-reinforced structure. J Oral
Science Rehabilitation. 2019 Sep;5(3):16–23.
Abstract
Introduction
The All-on-4 treatment concept (Nobel Biocare) was
developed to optimize remaining bone in completely edentulous patients, allowing immediate rehabilitation and avoiding the need for other regenerative
procedures, which increase morbidity and costs. The
present article describes a patient followed up on for
2 years after the placement of 4 transmucosal tapered
neck implants restored with a hybrid prosthesis with a
novel fiberglass- and resin-reinforced structure (TriLor
Arch, Harvest Dental Products).
16
Clinical case
A 68-year-old woman presented with teeth in the anterior mandibular segment, numerous caries-affected
teeth, missing teeth in the posterior segment, and
mandibular bone atrophy. An All-on-4 procedure for
immediate occlusal loading on 4 implants with a resin
provisional fixed prosthesis was planned. Restoration
with the definitive fixed prosthesis took place 6 months
after surgery.
Conclusion
In atrophic mandibles, the use of tapered neck implants
in conjunction with a novel nonmetallic fiberglass- and
resin-reinforced structure (Trilor Arch) through an All
on 4 technique, provides adequate functional and esthetic results after 2 years of follow-up.
Keywords: All-on-4; tilted implants; dental prostheses;
immediate occlusal loading; fiberglass-reinforced composite structure.
Introduction
The All-on-4 treatment concept (Nobel Biocare) was
developed to optimize the use of remaining bone in
atrophic mandibles, allowing immediate rehabilitation
and avoiding the need for other regenerative procedures that increase morbidity and cost.1 The treatment
protocol involves the placement of 4 implants in the
anterior maxillary segment or in the space between the
mental foramina of the mandible. The 2 most anterior
implants are positioned axially, while the 2 posterior
implants are distalized and tilted in order to minimize
the cantilever length and thus allow extension of the
prosthesis to the area of the first molar, thereby improving masticatory efficiency.2, 3 This treatment strategy affords promising results over the short and middle
term and is highly successful in terms of implant survival rate, as described in the literature,4 provided adequate surgical and prosthetic protocols are used.5
Journal of Oral Science & Rehabilitation | Volume 5 – Issue 3/2019
[17] =>
All-on-4 with TriLor Arch
Fig. 1
Primary implant stability is an essential pre-requisite
for immediate loading, it can be improved by adapting drilling protocols to enhance lateral compression of
the bone and by using tapered implant designs.6 The
prosthetic restoration should provide rigidity and not be
flexible in order to avoid micro-movements, and should
be strong enough to not fracture.5
The original Brånemark surgical and prosthetic protocol advocated the placement of 4 implants for the
restoration of a resorbed mandible and 6 implants in
the case of mandibles with minimal or moderate resorption.6 Other guidelines were subsequently also
developed.2 The present clinical case describes the
results after 2 years of follow-up in a patient subjected to All-on-4 rehabilitation involving 2 novel elements
that appear to offer interesting advantages over the
conventional technique. From the surgical perspective, the dental implants used present a new tapered
neck design, while from the prosthodontic perspective,
the definitive prosthesis is manufactured with a novel
nonmetallic fiberglass- and resin-reinforced structure
(TriLor Arch, Harvest Dental Products).
Clinical case
A 68-year-old woman presented with teeth in the anterior mandibular segment, numerous caries-affected
teeth, missing teeth in the posterior segment, and
mandibular bone atrophy (Fig. 1). After extractions
and preoperative examination, it was observed that
the posterior segment was located close to the inferior
alveolar nerve. An All-on-4 procedure was planned involving 4 Prama implants (Sweden & Martina, Padua,
Italy), with immediate occlusal loading of the resin
provisional fixed prosthesis. Restoration with the definitive fixed prosthesis with TriLor Arch internal reinforcement would take place 6 months after surgery.
Surgical technique
A full-thickness mucoperiosteal flap was raised with
central and distal releasing incisions, allowing us to
visualize emergence of the mental nerves and access
the anterior bone. A 2 × 10 mm central bone perforation was performed, the axis coinciding with the
facial midline, in order to insert the stem of a standard
metal surgical guide with vertical marks to help orientate dental implant placement tilted at 30°, while also
keeping the tongue away from the surgical field.
Two tilted distal implants (3.8 × 13.0 mm) were
placed with a minimum insertion torque of 35–40 N cm.
Transmucosal abutments were placed on the 2 distal
implants to correct tilting in the screw-retained prosthesis, applying a torque of 25 N cm, and 2 provisional straight titanium abutments were fitted over
them. Then, the beds of the 2 mesial implants were
Journal of Oral Science & Rehabilitation | Volume 5 – Issue 3/2019
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[18] =>
All-on-4 with TriLor Arch
A
B
D
C
E
F
Fig. 2
A
B
C
D
Fig. 3
prepared, seeking to maintain equidistance and parallelism between them and the 2 distal abutments. Two
cylindrical implants (3.8 × 11.5 mm) were placed in
these positions with undersized drilling using conical
burs and a minimum insertion torque of 35–45 N cm.
Two provisional straight titanium abutments (Sweden &
18
Martina, Padua, Italy) without a hexagonal base were
screwed over these 2 central implants, with no need
for an intermediate abutment thanks to the large
transmucosal portion specific to implants of this kind.
Panoramic radiographs were obtained, thereby completing the surgical phase of the All-on-4 procedure (Fig. 2).
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[19] =>
All-on-4 with TriLor Arch
B
A
C
Fig. 4
Immediate occlusal loading prosthodontic
technique
A thin layer of soft warm wax on the tissue aspect
of the provisional prosthesis allowed pressure marking of the healing abutments as a simple way to indicate the location of the implants for making 4
perforations in the prosthesis where photopolymerizing fluid composite was used to splint the provisional
titanium abutments directly in the mouth (Fig. 3).
These abutments were then definitively incorporated
into the prosthesis in the laboratory, the lateral
posterior wings of the prosthesis were trimmed, and
3 h after surgery, we were able to position the prosthesis in the mouth with correct passive and occlusal
fit (Fig. 4).
Prosthodontic technique for the definitive
prosthesis
A screw-retained hybrid prosthesis containing a
fiberglass- and resin-reinforced structure (TriLor Arch)
was manufactured. The definitive prosthetic phase
started by unscrewing the provisional prosthesis,
performing hygiene and fitting 4 transfer copings
for impression taking using the open-tray technique
with silicone of 2 consistencies. The impression thus
obtained recorded the positioning of the implants and
of the soft tissue (Fig. 5).
A mandibular baseplate was prepared in the laboratory for a maxillomandibular relationship record
to determine the vertical dimension. The provisional
prosthesis also served as reference, thanks to correct
adaptation and patient comfort. The passive fit of the
resin-splinted definitive abutments was checked, and
the assembly was sent to the laboratory again (Fig. 6).
Separate testing was done of the teeth and TriLor
Arch bar, which bore the orifices for fitting of the definitive abutments, and these were later cemented in
the laboratory (fixed with dual-polymerizing composite
cement [URC Bioloren]). The occlusion was checked,
and the assembly was sent to the laboratory for integration of the TriLor Arch structure to the tooth (Fig. 7).
The definitive prosthesis therefore contained the reinforcing structure integrated into the resin, which had
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[20] =>
All-on-4 with TriLor Arch
A
B
Fig. 5
B
A
Fig. 6
Fig. 7
Fig. 8
convex compressive fit on its tissue aspect, in the
inter-implant zones, to facilitate hygiene and ensure
less plaque retention (Fig. 8).
After 2 years of follow-up, correct periimplant soft
tissue conditions were confirmed, as was integrity
of the structure and good bone stability (Fig. 9). The
20
mean marginal bone loss after 24 months was 0.5 ± 0.09
for tilted straight implants. A similar bone loss pattern
between tilted and straight implants is observed. The
bleeding on probing (BOP) according to Mombelli index
was 0 in all implants.7 Hygiene was performed every 6
months, and the patient received instructions on how
to maintain good implant conditions and health.
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[21] =>
All-on-4 with TriLor Arch
B
C
A
D
Fig. 9
machined portion specific to implants
of this kind.
A
Discussion
The present 2-year follow-up study has provided a detailed description of the All-on-4 technique and shown
it to be a reliable, immediate, simple, safe and costeffective solution for the implant-based rehabilitation
of patients involving immediate occlusal loading with
a screw-retained prosthesis followed by the fitting of
a hybrid prosthesis with a novel fiberglass- and resinreinforced structure (TriLor Arch). Moreover, the use
of tissue level implants with a tapered design at the
transmucosal portion appears to offer a number of additional advantages thanks to the large transepithelial
Implants of this kind eliminate the
need observed with other types of implants to perform aggressive drilling of
the bone crest to accommodate the
tilted implant in order to submerge its
distal occlusal table in the bone and
avoid mesial thread exposure. This type
of treatment avoids the appearance of
cratering effects arising from the location of the implant–transepithelial junction gap at infrabony level (Fig. 10).
There is no need to use transmucosal abutments on the 2 mesial straight
implants on which the provisional titanium prosthesis is directly screwed.
B
The resulting intraoral clinical work is
more convenient as a result, and fewer
Fig. 10
screws and accessories are used. Furthermore, the chosen titanium abutment design, with
anatomical emergence, facilitates smooth and hygienic fitting of the resin of the prosthesis on its tissue
aspect facing the implant.
Frequent exposure of the polished neck of the
implant secondary to physiological gingival retraction
in the context of the postoperative tissue remodeling
process is no problem for the definitive prosthesis,
since the tapered coronal part of the implant has no
limiting chamfer or shoulder, and the prosthesis can be
freely adjusted over any level of its coronal hyperbolic
portion.8–12
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[22] =>
All-on-4 with TriLor Arch
This All-on-4 immediate occlusal loading protocol
for completely edentulous mandibles has yielded longterm success rates of over 95% at 7 years for implants
and 99% for prostheses and a mean crestal bone loss
of 1.81 mm at 5 years.13
Competing interests
Biomechanical properties are an essential element
in this rehabilitation protocol. The tilted implants afford
an optimum distance between implants, allowing
support of the free ends of the prosthesis.14 In a systematic review and meta-analysis no effect of implant
inclination on implant survival or periimplant bone loss
were found as in our case.15 With regard to the restoration phase in our patient, the novel fiberglass- and
resin-reinforced internal structure appears to offer a
number of interesting advantages. It consists of a newgeneration polymer composed of thermally hardened
resin with multidirectional fiberglass reinforcement.
Such fiber-reinforced composites (FRCs) are used
in aeronautical engineering and in many other fields
where high resistance and low weight are key requirements. The multidirectional braided-fiber structure of
the reinforcement offers good performance in terms
of load and tension distribution in response to forces
applied from different incident angles.
Figure legends
The technique simplifies the manufacture of reinforcing superstructures with passive fit by only requiring
manual processing in the laboratory, with no need for
CAD/CAM procedures. The preformed presentation
in the form of a flat arc makes it possible to establish
connecting structures between the implant abutments
or reinforcing elements for removable prostheses.
These structures and elements can easily be incorporated within the fiberglass- and resin-reinforced internal
structure of the prosthesis, establishing true chemical
bonding, in contrast to what is seen with metal reinforcement structures.
Fig. 1 – Initial panoramic radiographic view.
Fig. 2 – (A)
Full-thickness mucoperiosteal flap. (B)
Placement of the tilted distal implant with the surgical
guide. (C) Implants placed with 2 transmucosal abutments to correct tilting of the distal implants. (D) Provisional straight titanium abutments. (E) Wound suture.
(F) Final panoramic radiographic view after placement
of the 4 Prama implants.
Fig. 3 – (A) Tissue aspect of the prosthesis coated with
soft wax. (B) Perforations in the provisional complete
prosthesis. (C) & (D) Fitting and splinting of the titanium abutments in the provisional prosthesis.
Fig. 4 – (A) Tissue aspect of the provisional prosthe-
sis with the wings trimmed. (B) Provisional prosthesis
placed 3 h after surgery. (C) Control radiograph after
placing of the prosthesis.
Fig. 5 – (A) & (B) Impression using silicone of 2 con-
sistencies, registering the soft tissue and implant positioning.
Fig. 6 – Mandibular
baseplate for determining vertical dimension (A) and checking of passive fit of the
resin-splinted abutments (B).
Fig. 7 – TriLor Arch structure with the orifices for fitting
of the definitive titanium abutments with composite
cement and wax tooth testing.
Fig. 8 – Completed definitive implant-supported hybrid
prosthesis with TriLor Arch reinforcement.
Fig. 9 – (A) Tissue aspect of the prosthesis after 2 years.
(B) & (C) Periimplant soft tissue condition after 2 years.
(D) Panoramic radiographic view after 2 years of followup.
Conclusion
In the case reported, tapered neck implants with immediate occlusal loading based on the All-on-4 technique,
with the use of a nonmetallic reinforcing structure in
the hybrid prosthesis, afforded optimum biomechanical performance and hygiene after 2 years of follow-up.
Further studies are needed to assess the mid- and
long-term outcomes of the procedure.
22
The authors declare that they have no competing interests.
Fig. 10 – Advantages of tapered neck transmucosal im-
plants (A) over conventional implants (B).
References
1. Maló P, Rangert B, Dvärsäter L. Immediate function
of Brånemark implants in the esthetic zone: a retrospec-
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[23] =>
All-on-4 with TriLor Arch
tive clinical study with 6 months to 4 years of follow-up.
→ Clin Implant Dent Relat Res.
2000 Jul;2(3):138–46.
2. Maló P, Rangert B, Nobre M. “All-on-four” immediatefunction concept with Brånemark System implants for
completely edentulous mandibles: a retrospective clinical study.
→ Clin Implant Dent Relat Res.
2003 Mar;5 Suppl 1:2–9.
3. Maló P, Friberg B, Polizzi G, Gualini F, Vighagen T,
Rangert B. Immediate and early function of Brånemark
System implants placed in the esthetic zone: a 1-year
prospective clinical multicenter study.
→ Clin Implant Dent Relat Res.
2003 Mar;5 Suppl 1:37–46.
4. Soto-Penaloza D, Zaragozí-Alonso R, PenarrochaDiago M, Penarrocha-Diago M. The all-on-four treatment
concept: systematic review.
→ J Clin Exp Dent.
2017 Mar 1;9(3):e474–88. doi: 10.4317/jced.53613.
5. Penarrocha-Diago M, Penarrocha-Diago M, ZaragozíAlonso R, Soto-Penaloza D, on behalf of the Ticare
Consensus M. Consensus statements and clinical recommendations on treatment indications, surgical procedures, prosthetic protocols and complications following
All-on-4 standard treatment. 9th Mozo-Grau Ticare Conference in Quintanilla, Spain.
→ J Clin Exp Dent.
2017 May;9(5):e712–5. doi: 10.4317/jced.53759.
6. De Bruyn, H. , Raes, S. , Östman, P. and Cosyn, J.
(2014), Immediate loading in partially and completely
edentulous jaws: a review of the literature with clinical
guidelines.
→ Periodontol.
2000;66:153-87.
7. Hashim D, Cionca N, Combescure C, Mombelli A.
The diagnosis of peri-implantitis: A systematic review
on the predictive value of bleeding on probing.
→ Clin Oral Implants Res.
2018 Oct;29 Suppl 16:276-93.
8. Brånemark PI, Engstrand P, Ohrnell LO, Gröndahl K,
Nilsson P, Hagberg K. Brånemark Novum®: a new treatment concept for rehabilitation of the edentulous mandible. Preliminary results from a prospective clinical follow-up study.
→ Clin Implant Dent Relat Res.
1999;1:2–16.
9. Loi I, Scutellà F, Galli F. Tecnica di preparazione orientata biologicamente (BOPT). Un nuovo approccio nella
preparazione protesica in odontostomatologia (The biologically oriented preparation technique [BOPT]. A new
approach to prosthetic preparation in oral surgery).
→ Quintessenza Int.
2008 Sep–Oct;24(5):69–75.
10. Loi I. Protesi su denti naturali nei settori di rilevanza
estetica con tecnica BOPT: Case series report (Prosthesis on natural teeth in areas of aesthetic relevance with
BOPT technique: Case series report).
→ Dent Cadmos.
2008;76:51–9.
11. Loi I, Galli F, Scutellà F, Felice A. Il contorno coronale protesico con tecnica di preparazione BOPT (biologically oriented preparation technique): considerazioni tecniche.
→ Quintessenza Int.
2009 Jul–Aug;25(4):4–19.
12. Loi I, Di Felice A. Biologically oriented preparation
technique (BOPT): a new approach for prosthetic restoration of periodontically healthy teeth.
→ Eur J Esthet Dent.
2013 Spring;8(1):10–23.
13. Cabanes G. Experiencia en clínica de la técnica
BOPT sobre implantes: preparación vertical de pilares y
conformación de la emergencia coronaria. In: AgustinPanadero R, Chust López C, editors. Protocolo clinicoprotésico de la técnica BOPT.
→ Barcelona: Ediciones Especializadas Europeas;
2016. p. 207–13.
14. Maló P, de Araújo Nobre M, Lopes A, Ferro A,
Gravito I. All-on-4® treatment concept for the rehabilitation of the completely edentulous mandible: a 7-year
clinical and 5-year radiographic retrospective case
series with risk assessment for implant failure and
marginal bone level.
→ Clin Implant Dent Relat Res.
2015 Oct;17 Suppl 2:e531–41. doi: 10.1111/cid.12282.
15. Apaza Alccayhuaman, KA, Soto-Peñaloza, D,
Nakajima, Y, Papageorgiou, SN, Botticelli, D, Lang, NP.
Biological and technical complications of tilted implants
in comparison with straight implants supporting fixed
dental prostheses. A systematic review and metaanalysis.
→ Clin Oral Impl Res.
2018; 29(Suppl. 18): 295– 308.
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[24] =>
An unusual case of sublingual ranula
An unusual case of sublingual ranula with
submandibular gland involvement
Lim Min Jim a
a
Oral and Maxillofacial Surgery Unit, Hospital Tanah Merah,
Kementerian Kesihatan Malaysia, Kelantan, Malaysia
Corresponding author:
Dr. Lim Min Jim
Pejabat Kesihatan Pergigian Daerah Tanah Merah
Jalan Pasir Mas
17500 Tanah Merah
Kelantan
Malaysia
minjimlim@hotmail.com
How to cite this article: Min Jim L. An unusual case
of sublingual ranula with submandibular gland involvement. J Oral Science Rehabilitation. 2019 Sep;5(3):
24–27.
Abstract
Conclusion
This article highlights that misleading signs may lead
to unnecessary surgery and cosmetic disfigurement,
as submandibular gland excision is approached extraorally. If the pathology is suspected in both glands, an
intraoral approach should be opted for first.
Keywords: Ranula; sublingual gland; submandibular
gland; obstruction; sialadenitis.
Introduction
A ranula is formed mainly from extravasation of the
saliva, forming cyst on the floor of the mouth. It can
be derived from either the sublingual gland or the submandibular gland.1 The most common presentation of
a ranula is as a soft, fluctuant, slow-growing mass on
the floor of the mouth. If the ranula is left in situ, it may
continue enlarging and thus cause compression of the
nearby structures. In this paper, we report an unusual
case of a ranula that originated from the sublingual
gland, but presented with signs and symptoms of submandibular gland involvement.
Background
A ranula is a diffuse swelling on the floor of the mouth
resulting from extravasation of mucous secretion from
salivary glands. A ranula is commonly presented as
a painless, soft, mobile, slow-growing mass on the
floor of the mouth. Occasionally, a ranula may present
with misleading signs and symptoms. We present an
unusual case of intraoral swelling associated with
signs of submandibular gland involvement.
Methods
Ranulas of both the submandibular gland and the sublingual gland were suspected and excisions of both
glands were planned. Surgical exploration revealed
only sublingual gland swelling causing obstruction of
the submandibular gland. Sublingual gland removal resulted in complete restoration of salivary flow from the
submandibular gland.
24
Journal of Oral Science & Rehabilitation | Volume 5 – Issue 3/2019
Fig. 1
[25] =>
An unusual case of sublingual ranula
Fig. 2
Case report
A 39-year-old female patient was referred to our oral
and maxillofacial surgery department for an intraoral
swelling that had persisted, waxing and waning, for
2 years. The swelling had been increasing in size gradually. It was associated with discomfort on the floor of
mouth and pain in the right submandibular region. The
patient was otherwise in good health with no history of
systemic or constitutional symptoms.
There was no significant swelling in the head and
neck region. However, tenderness was elicited on bimanual palpation over the left submandibular gland
region. The overlying skin was normal in both color and
temperature. Intraoral examination revealed a diffuse,
soft, fluctuant swelling with a size of 4 × 3 cm on the
right side of the floor of mouth (Fig. 1). The swelling was
not tender or discolored and did not cross the midline.
Posteriorly, the swelling extended up to the first molar.
The right submandibular duct was not visible, unlike
the contralateral duct. On milking of both submandibular glands separately, there was limited flow of saliva
Fig. 3
from the right submandibular duct opening compared
with the left. Radiographic examination showed no
sign of calcification (Fig. 2). An initial diagnosis of a
ranula with sublingual gland and submandibular gland
involvement was made, and surgery was advised.
After preparing the patient for the surgery, adequate
local anesthesia was administered in the surrounding
region. The lesion was approached intraorally through
a mucosal incision directly above the swelling. Blunt
dissection was performed carefully in the submucosal
plane to reveal an enlarged sublingual gland with multiple well-encapsulated cysts attached to it. The right
submandibular duct was located after careful dissection. The right submandibular duct was found to have
been displaced by the swollen sublingual gland. It
was positioned posteriorly and inferiorly in relation to
the sublingual gland. Blunt dissection was performed
around the sublingual gland to separate it from the surrounding tissue (Fig. 3). The sublingual gland with its
duct was then completely excised. The right submandibular duct was checked again to ensure no dissection
(Fig. 4). Immediately after the surgical site had been
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[26] =>
An unusual case of sublingual ranula
Fig. 4
closed and sutured, there was significant improvement
in salivary flow from the right submandibular duct. Histological examination confirmed a ranula with moderate chronic inflammatory infiltration, suggestive of
sialadenitis of the sublingual gland. The subsequent
follow-up showed full recovery with no complication or
recurrence (Fig. 5).
Discussion
A ranula is a cystic formation that develops from extravasation of saliva due to traumatic rupture of a salivary duct may lead to accumulation of saliva within the
tissue. When the saliva-filled cyst herniates through
26
the mylohyoid muscle into the submental or submandibular space, it is termed plunging ranula.2 However,
the patient did not recall any trauma to the floor of the
mouth. The decision to surgically excise the sublingual
gland was made as quickly as possible owing to the
fact that the patient experienced tenderness of the
submandibular gland region.
The main concern for this patient was the tenderness on the right submandibular region, accompanied
by reduced salivary flow from the submandibular duct.
These signs indicated that there was a partial obstruction of the right submandibular duct. It was postulated that the enlargement of the sublingual gland had
resulted in significant pressure on the submandibu-
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[27] =>
An unusual case of sublingual ranula
Acknowledgment
We would like to thank the Director General of Health,
Ministry of Health, Malaysia, for his permission to
publish this article.
Competing interests
The author declares that he has no competing interests.
Fig. 5
lar duct. This postulation was proved intraoperatively, as the submandibular duct had been significantly
displaced. A similar finding in the literature has been
reported regarding a case in which the submandibular
duct was compressed by a tumor originating from the
sublingual gland.3
The partial obstruction of the submandibular duct
could lead to the formation of a sialolith.4 In this case,
the enlarged sublingual gland was compressing the
submandibular duct. A sialolith is commonly formed
in the submandibular gland, as it produces mainly
mucous saliva with a high level of calcium and phosphate. If the surgical removal of the sublingual gland is
further delayed, the submandibular duct may become
fully obstructed. This may lead to the formation of a
sialolith along the submandibular duct and gland,
leading to sialadenitis of the submandibular gland.4
Although the occlusal radiograph did not show any
radiopaque calculi in this case, it is critical to assess
the salivary flow after removal of the sublingual gland.
This is because 20% of sialoliths in the submandibular
gland system are radiolucent. If the salivary flow is still
obstructed, sialography may be required.
Conclusion
This case report highlights that misleading signs may
lead to the wrong initial diagnosis. It is important to take
into account the surrounding structure when treating
a case of ranula. An incorrect diagnosis may lead to
unnecessary surgery and cosmetic disfigurement, as
submandibular gland excision is usually approached
extraorally. If pathology of both glands is suspected, an
intraoral approach should be opted for first.
Figure legends
Fig. 1 – Intraoral swelling on the right side of the floor of
the mouth.
Fig. 2 – Occlusal radiograph of the mandible shows no
abnormalities.
Fig. 3 – Excision of sublingual gland.
Fig. 4 – Ensuring the right submandibular duct is intact.
Fig. 5 – Postoperative healing after 1 week. Good healing
with slight inflammation.
References
1. Peters E, Kola H, Doyle-Chan W. Bilateral congenital oral mucous extravasation cysts.
→ Pediatr Dent.
1999 Jul–Aug;21(4):285–8.
2. Arunachalam P, Priyadharshini N. Recurrent plunging ranula.
→ J Indian Assoc Pediatr Surg.
2010 Jan–Mar;15(1):36–8.
3. Kumar VS, Prathi VS, Manne RK, Beeraka S,
Natarajan K. Adenoid cystic carcinoma of sublingual
salivary gland obstructing the submandibular salivary
gland duct.
→ J Clin Imaging Sci.
2013 Oct;3(Suppl 1):10.
4. Leung AK, Choi MC, Wagner GA. Multiple sialoliths
and a sialolith of unusual size in submandibular duct:
a case report.
→ Oral Surg Oral Med Oral Pathol Oral Radiol Endod.
1999 Mar;87(3):331–3.
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[28] =>
Immediate dentoalveolar restoration
Immediate dentoalveolar restoration
Igor da Silva Brum,a
Renan Ferreira Natal,a
Jorge Luís da Silva Pires,a
Paulo Gonçalo Pinto dos Santos,a
Marco Antonio Alencar de Carvalho,a
Jorge José de Carvalhoa
a
Department of Implantology, faculty of Dentistry, State University
of Rio de Janeiro, Rio de Janeiro, Brazil
Corresponding author:
Dr. Igor da Silva Brum
Universidade do Estado do Rio de Janeiro
Rua Leite Ribeiro 122, Apt. 702
Fonseca
Niteroi—RJ
2412-210
Brazil
How to cite this article: da Silva Brum I, Ferreira Natal R,
da Silva Pires JL, Pinto dos Santos PG, Alencar de
Carvalho MA, de Carvalho JJ. Immediate dentoalveolar restoration. J Oral Science Rehabilitation. 2019
Sep;5(3):28–35.
Abstract
Background
The replacement of an anterior tooth with an implant
has become frequent in the daily routine of an implantologist. This procedure is an enormous challenge
because of its esthetic potential and possibility of
implant failure. In this article, we report a case of immediate dentoalveolar restoration, based on the 1-stage
protocol proposed by José Carlos Martins da Rosa.
A 57-year-old female patient presented with pain and a
fractured root with mobility of the crown. After analysis
of the cone beam computed tomography scan, fracture
of the maxillary left central incisor was confirmed and
periapical inflammatory lesions affecting both central
incisors could be seen. A cross-sectional image revealed substantial loss of the buccal bone wall and
confirmed the 7 mm probing depth.
28
The treatment entailed atraumatic extraction of
both central incisors, curettage and preparation of the
sockets. Two provisional crowns were fabricated previously using composite, simulating the implants’ position on the cast. The implants and abutments were
placed. The crowns were adjusted. A cortical triangular
bone graft was removed from the maxillary tuberosity
and inserted into the socket of the left central incisor.
After that, the provisional restorations were reinserted
to seal the gingival margin. After 1 week, the patient
showed no postoperative pain or swelling. No mobility of the crowns or implants was observed. Periodic
follow-ups were necessary to assess bone formation
in the grafted area and to check whether the gingival
profile had been maintained.
Conclusion
The technique proved to be clinically effective for esthetic edentulous areas and showed significant predictability of results. Throughout the follow-up, the stability of the hard and soft tissue had been observed.
Keywords: Dental implant; fresh socket; immediate
provisionalization; immediate loading; maxillary tuberosity; autologous bone graft.
Introduction
Periapical infections caused by periodontal disease,
fractures, endodontic lesions or root resorption may
directly promote severe alveolar bone resorption and
soft-tissue loss surrounding the tooth. When such infections are present, more surgical procedures may be
needed to regenerate and prepare the tissue to receive
the implant.1 The lack of a buccal bone wall to support
the attached gingiva can cause recession and papillary
loss, influencing the esthetic characteristics. Furthermore, further reconstructive stages such as bone and
soft-tissue grafts may be needed.
Owing to the evolution of implantology, techniques
are being improved and the period of healing between
surgery and prosthetic restoration is being reduced.
Several authors have described success rates of higher
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[29] =>
Immediate dentoalveolar restoration
Fig. 1
than 90% for implants placed immediately after tooth
extraction and immediately loaded using provisional
crowns. The technique is indicated for low-stress areas
and when initial stability has been achieved. Some
papers have shown that certain forces are important
for triggering a series of biological reactions that accelerate the bone repair process, thus supporting 1-stage
implant treatment .2
Immediate implant placement followed by immediate loading can provide numerous advantages, such
as reduced treatment time and procedures, a potentially lower cost and a smaller number of provisional
crown adjustments. Furthermore, the esthetic benefits
are the maintenance of the gingival architecture and a
reduced loss of bone volume. If correctly planned and
executed, the procedure promotes really impressive
results, though there are requisites that must be followed for clinical safety. Among them are initial implant
stability, adequate bone volume to accommodate the
implant, no gingival recession, and proximity to vital
structures.3
Fig. 2a
Fig. 2b
The immediate dentoalveolar restoration (IDR) technique was created to enhance the clinical efficacy and
esthetics in these kinds of clinical cases. Furthermore,
it reduces the treatment time and promote superior results. To achieve the expected esthetic results,
careful surgical and prosthetic protocols are of great
importance.4
Case report
A 57-year-old woman was referred to the department of implantology for treatment of her maxillary
Journal of Oral Science & Rehabilitation | Volume 5 – Issue 3/2019
Fig. 2c
29
[30] =>
Immediate dentoalveolar restoration
Fig. 3a
Fig. 3b
Fig. 4a
Fig. 4b
Fig. 4c
Fig. 4d
central incisors. The patient complained of pain and
a fractured root with mobility of the crown. She had
no relevant medical history and denied deleterious
habits such as smoking or alcohol consumption. Her
oral hygiene was satisfactory. During the clinical examination, the left central incisor presented class I mobility and a probing depth of 7 mm in the buccal region,
indicating a vertical bone defect (Fig. 1). A cone beam
computed tomography (CBCT) scan was captured,
from which fracture of the left central incisor was confirmed and periapical inflammatory lesions affecting
both central incisors could be seen (Figs. 2a–c).
incisors had large metal core buildups. The mentioned
features confirmed the need to extract the incisors.
Subsequently, planning was performed based on the
IDR technique, and the procedures to be performed
were explained to the patient. The informed consent
form was signed and a blood analysis was done to
evaluate the patient’s general health. The results permitted us to proceed with the surgical procedure.
A cross section on the CBCT scan showed substantial loss of the buccal bone wall, which accounted for
the deep probing depth at that aspect of the tooth. The
maxillary right central incisor presented a recurrent
periapical inflammatory lesion. Both maxillary central
30
Pharmacological protocol
Antibiotic therapy (amoxicillin, 1 g) was administered
1 h before the surgical procedure, and antibiotic doses
(500 mg) 3 times a day for 7 days after the procedure
were prescribed. Dexamethasone (4 mg, 2 tablets) was
administered 1 h before the surgical procedure and
continued twice a day for 3 days. Ibuprofen (600 mg,
1 tablet) 3 times a day for 5 days after the procedure
was prescribed.
Journal of Oral Science & Rehabilitation | Volume 5 – Issue 3/2019
[31] =>
Immediate dentoalveolar restoration
were used to realize the minimally invasive procedure
and avoid the necessity of flap creation. During the extraction, the inflammatory lesions came out attached to
the roots (Fig. 3a). After the tooth removal, socket curettage was performed to remove any granulomatous
tissue and the remains of the periodontal ligament. The
fresh socket was evaluated using a millimeter probe to
confirm the buccal bone defect observed on the CBCT
scan (Fig. 3b).
Fig. 5
Fig. 6a
Fig. 6b
Technique
Local infiltration of anesthetic near the roots of the
maxillary central incisors and a block of the nasopalatine nerve were done. Afterward, an intrasulcular incision was made following the contour of the incisors.
Furthermore, periotomes and a manual root extractor
The preparation of the sockets for the implants was
performed approaching the palatal bone. Two Systhex
implants were placed (Attract and Attract ts; Figs. 4a–d).
Both implants were 3.5 mm in diameter and 12.0 mm in
height, had a Morse taper connection and had undergone the same surface treatment. The initial torque
achieved was approximately 45 N cm. The provisional crowns were fabricated using composite before the
procedure and adjusted to the ideal emergence profile
and vestibular-palatal angle. It is important to note the
necessity of 3 mm in height, from the bone crest to
the contact point, to stimulate coronal growth of the
papilla. This distance extends from the bone crest to
the contact point.
Anesthesia of the maxillary tuberosity was then
administered and the triangular bone graft removed.
The cortical bone fragment was positioned between
the vestibular plate and the implant placed in the left
central incisor region (Fig. 5). The right central implant
did not need any grafting. The occlusion was adjusted for both incisors, and any occlusal contact was
avoided. Thereafter, the provisional crowns were polished and reinserted. Finally, the tissue was sutured
with simple stitches.
After the procedure, the patient was instructed to
avoid any loading on the area for 3 months, as also
spitting over 3 days. Application of a 0.12% chlorhexidine gluconate topical gel (Perioxidin, Gross) once
a day before bedtime was recommended. Follow-ups
were done once a week for 1 month and continued
every 15 days for 1 month. After 1 week, the patient
showed amazing results, with no complaint of postoperative pain or swelling. No mobility of the crowns
or implants was observed. Periodic clinical monitoring
is necessary to assess whether there has been bone
formation in the grafted area and whether the gingival
profile has been maintained over the years.
Journal of Oral Science & Rehabilitation | Volume 5 – Issue 3/2019
31
[32] =>
Immediate dentoalveolar restoration
Fig. 7a
Fig. 7b
Fig. 8a
Fig. 8b
Final restoration
Prosthetic procedures were started with a transfer impression of the esthetic abutments. A final impression
was carefully performed using autopolymerizing resin
to copy the emergence profiles (Figs. 7a & b) and
addition silicone for the impression (Figs. 8a–c). The
working cast was sent to the laboratory for production
of the metal superstructure and porcelain application.
Monolithic ceramic crowns were prepared, adjusted
and screwed onto the abutments (Figs. 9a–c). In both
steps, periapical radiographs were taken to evaluate
the adaptation level. Additionally, features such as
emergence profile, contact point and esthetic were analyzed.
Fig. 8c
After 6 months, the period of bone remodeling and
soft-tissue healing was done, and the periimplant
tissue analyzed. Furthermore, a periapical radiograph
was performed to evaluate the final aspect of the
healing and bone–implant contact (Figs. 6a & b). The
results showed complete adaptation of the periimplant
tissue without any sign of inflammation.
32
Discussion
The IDR technique in compromised sockets of anterior
teeth has been proved to be a complex clinical challenge. Immediate loading of implants placed immediately after extraction has been very well documented
in the literature in cases where the supporting tissue is
undamaged.5 Furthermore, for the initial stability, the
Journal of Oral Science & Rehabilitation | Volume 5 – Issue 3/2019
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Immediate dentoalveolar restoration
Fig. 9a
Fig. 9b
Fig. 9c
biological changes that occur when immediate loading
is performed are of great importance in the repair
process.6 The maintenance of the tissue is more predictable than the re-covering of the buccal bone wall
and the emergence profile.
was achieved in more cases of immediate loading than
in cases of conventional loading.11, 12
According to Zhang, their analysis of patients who
had received immediate, early or conventional loading
showed that the patients who had undergone immediate loading had reduced marginal bone level changes
in comparison with those who had not received immediate loading. Although, some factors, such as the loading
protocol for non immediate loading, implant number
and location, type of prosthesis, loading concept and
follow-up time, could modify these results.7 Marginal
bone level is a surrogate measurement for the esthetic
outcome.8
The cosmetology assessment has been used in
some papers to analyze the clinical outcomes of treatment with dental implants. This index is of great importance and should be evaluated in further studies. When
comparing immediate and non immediate loading,
some authors 9, 10 found that the ideal gingival margin
The loss of tooth support greatly increases the risk
of poor esthetics reducing the predictability of results.
Implants inserted in association with bone grafts or
membranes are indicated for procedures on the esthetic zone, but function is restored only after the
healing period.13 Many types of grafts have been used
to restore bone and gingival defects. The maxillary
tuberosity is one of the important donor areas mentioned in many papers14,15 for correcting socket defects
in esthetic areas. This kind of graft has shown some
advantages, such as bone malleability facilitating adaptation to the defect, greater speed of graft repair,
the ease of harvesting and excellent postoperative
recovery; however, the disadvantages are low bone
quality, limited quantity of material and difficult surgical
access.16
In the present study, there was total adaptation of
the soft tissue in relation to the metal-free zirconia
prostheses. According to papers 17 comparing the cell
infiltration and expression of pro-inflammatory cyto-
Journal of Oral Science & Rehabilitation | Volume 5 – Issue 3/2019
33
[34] =>
Immediate dentoalveolar restoration
kines (lymphocytes, plasma cells) between titanium
and zirconia implant abutments, higher rates were
found around the titanium abutments, and our clinical
results showed the same.
Figs. 6a & b – Final aspect after 6 months of healing.
In the present study, we can observe that the physical properties of zirconia, like those of other ceramics,
can deteriorate over time; however, a long period is
necessary for this deterioration to appear, so it is very
safe to predict long-lasting results for customized zirconia crowns supported on implants.18
Figs. 9a–c – Final prosthesis.
Conclusion
The proposed technique, as described in the literature,
has proved clinically effective for esthetic edentulous
areas and shown significant predictability of results.
The immediate reconstruction of the buccal plate
with an autologous graft was an efficient procedure
for recovering lost anatomical structure. Throughout
the follow-up, the stability of hard and soft tissue was
observed. Despite the positive outcomes, there is a
need for further research to improve the technique and
compare the results between different types of grafts
for use in this type of case.
Competing interests
The authors declare that they have no competing interests.
Legends
Fig. 1 – Initial clinical condition.
Figs. 2a–c – Confirmation of fracture and inflammatory
lesions on the CBCT scan.
Fig. 3a – Inflammatory lesion attached to the fractured
tooth.
Fig. 3b – Confirmation of the probing depth and buccal
bone loss.
Figs. 4a–d – Socket preparation and placement of the
dental implants.
Fig. 5 – Maxillary tuberosity graft positioned between
the vestibular plate and the implant.
34
Figs. 7a & b – Copying the emergence profiles.
Figs. 8a–c – Final impression and working cast.
References
1. Muhamad AH, Georges C, Azzaldeen A. Immediate
Implants Placed Into Infected Sockets: Clinical Update
with 3-Year Follow-Up.
→ J Dent Med Sci.
2017, 16, pp.0853-160109105111.
2. Esposito M, Trullenque-Eriksson A, Blasone R,
Malaguti G, Gaffuri C, Caneva M, Minciarelli A, Luongo
G. Clinical evaluation of a novel dental implant system
as single implants under immediate loading conditions—4-month post-loading results from a multicentre
randomised controlled trial.
→ Eur J Oral Implantol.
2016;9(4):367–79.
3. De Molon RS, de Avila ED, Cirelli JA, Mollo F de A Jr,
de Andrade MF, Filho LA, Barros LA. A combined
approach for the treatment of resorbed fresh sockets
allowing immediate implant restoration: a 2-year followup.
→ J Oral Implantol.
2015 Dec;41(6):712–8.
4. De Molon RS, de Avila ED, de Barros-Filho LA,
Ricci WA, Tetradis S, Cirelli JA, Borelli de Barros LA.
Reconstruction of the alveolar buccal bone plate in
compromised fresh socket after immediate implant
placement followed by immediate provisionalization.
→ J Esthet Restor Dent.
2015 May–Jun;27(3):122–35.
5. Rosa AC, Francischone CE, Cardoso Mde A, Alonso
AC, Filho LC, Da Rosa JC. Post-traumatic treatment
of maxillary incisors by immediate dentoalveolar restoration with long-term follow-up.
→ Compend Contin Educ Dent.
2015 Feb;36(2):130–4.
6. Rosa JC, Rosa AC, Francischone CE, Sotto-Maior BS.
Esthetic outcomes and tissue stability of implant placement in compromised sockets following immediate
dentoalveolar restoration: results of a prospective case
series at 58 months follow-up.
→ Int J Periodontics Restorative Dent.
2014 Mar–Apr;34(2):199–208.
Journal of Oral Science & Rehabilitation | Volume 5 – Issue 3/2019
[35] =>
Immediate dentoalveolar restoration
7. Zhang S, Wang S, Song Y. Immediate loading for
implant restoration compared with early or conventional loading: A meta-analysis.
→ J Craniomaxillofac Surg.
2017 Jun;45(6):793–803. doi: 10.1016/j.jcms.2016.05.002.
Epub 2016 May 14.
16. Slagter KW, den Hartog L, Bakker NA, Vissink A,
Meijer HJ, Raghoebar GM. Immediate placement
of dental implants in the esthetic zone: a systematic
review and pooled analysis.
→ J Periodontol.
2014 Jul;85(7):e241–50. doi: 10.1902/jop.2014.130632.
8. Da Rosa JC, Rosa AC, da Rosa DM, Zardo CM.
Immediate dentoalveolar restoration of compromised
sockets: a novel technique.
→ Eur J Esthet Dent.
2013 Autumn;8(3):432–43.
17. Barwacz CA, Brogden KA, Stanford CM, Dawson
DV, Recker EN, Blanchette D. Comparison of proinflammatory cytokines and bone metabolism mediators around titanium and zirconia dental implant abutments following a minimum of 6 months of clinical
function.
→ Clin Oral Implants Res.
2015 Apr;26(4):e35–41. doi: 10.1111/clr.12326.
9. Crespi R, Capparè P, Gherlone E, Romanos GE.
Immediate occlusal loading of implants placed in fresh
sockets after tooth extraction.
→ Int J Oral Maxillofac Implants.
2007 Nov–Dec;22(6):955–62.
10. Vandamme K, Naert I, Geris L, Sloten JV, Puers R,
Duyck J. Histodynamics of bone tissue formation
around immediately loaded cylindrical implants in the
rabbit.
→ Clinical oral implants research.
2007;18(4):471–80.
18. Studart AR, Filser F, Kocher P, Gauckler LJ. In
vitro lifetime of dental ceramics under cyclic loading
in water.
→ Biomaterials.
2007 Jun;28(17):2695–705.
11. Rojas-Vizcaya F. Rehabilitation of the maxillary
arch with implant-supported fixed restorations guided
by the most apical buccal bone level in the esthetic
zone: A clinical report.
→ The Journal of prosthetic dentistry.
2012. 107(4);213–20.
12. De Rouck T, Collys K, Cosyn J. Single-tooth replacement in the anterior maxilla by means of immediate implantation and provisionalization: a review.
→ Int J Oral Maxillofac Implants.
2008 Sep–Oct;23(5):897–904.
13. Grandi T, Guazzi P, Samarani R, Grandi G. Clinical
outcome and bone healing of implants placed with high
insertion torque: 12-month results from a multicenter
controlled cohort study.
→ International journal of oral and maxillofacial surgery.
2013. 42(4);516–20.
14. Balasubramaniam AS, Raja SV, Thomas LJ.
Peri-implant esthetics assessment and management.
→ Dent Res J (Isfahan).
2013 Jan;10(1):7–14. doi: 10.4103/1735-3327.111757.
15. Silva DB, Neves LC, Querino E, Rosa JC, Barreto MA.
Behavior of peri-implant tissues in immediate implant
with provisionalization: A literature review.
→ Dent Press Implantol.
2013 Jul–Sep;7(3):41–51.
Journal of Oral Science & Rehabilitation | Volume 5 – Issue 3/2019
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[40] =>
GMT 60588 GB © Nobel Biocare Services AG, 2019. All rights reserved. Nobel Biocare, the Nobel Biocare logotype and all other trademarks are, if nothing else is stated or is
evident from the context in a certain case, trademarks of Nobel Biocare. Please refer to nobelbicare.com/trademarks for more information. Product images are not
necessarily to scale. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current
product assortment and availability. For prescription use only. Caution: Federal (United States) law restricts this device to sale by or on the order of a licensed dentist. See
Instructions For Use for full prescribing information, including indications, contraindications, warnings and precautions.
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40
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NobelActive®
and& Rehabilitation | Volume 5 – Issue 3/2019
Journal
Oral Science
NobelParallel™ CC implants.
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