PDF
ePub
Citation
Print
Abstract
Purpose
The aim of this study was to evaluate clinical outcomes of implant supported fixed-hybrid prostheses (FHP) in the fully edentulous arches.
Materials and methods
Patients in this retrospective study were restored with fixed-hybrid prostheses supported by 4 to 6 implants and functioned more than 1 year of loading. Outcome measures were marginal bone change of implant related with sex, anatomical location (maxilla vs. mandible), opposing teeth, loading time of patients, tilting of posterior implant by Mann-Whitney U test and cantilever length of superstructure by regression analysis, and complication rates. Significance level was set P<.05.
Results
A total number of 84 implants (16 restorations) placed in 16 patients were observed for 28 months and mean marginal bone loss was 0.53 ± 0.39 mm. There were no differences of marginal bone loss according to sex, anatomical location (maxilla vs. mandible), opposing teeth, loading time of patients (P>.05), and cantilever length was not significantly related with a marginal bone loss of implant next to cantilever (P>.05). Complication was shown in 11 patients and veneer fracture and dislodging of artificial teeth were most prevalent.
Conclusion
Within the limitations of this study, although marginal bone loss of FHP was very little, complication rates were high. Irrespective of tilting of most posterior implants, marginal bone loss of most posterior implants next to cantilever was less than those of the other implants positioned anteriorly. Cantilever length (<17 mm) did not affect a marginal bone loss of most posterior implants. (J Korean Acad Prosthodont 2013;51:183-9)
REFERENCES
1.Wennerberg A., Albrektsson T. Current challenges in successful rehabilitation with oral implants. J Oral Rehabil. 2011. 38:286–94.
2.Park HS., Hwang JW. Implant overdenture & fixed complete prosthesis. Well Pub Co., Seoul, Korea;2005.
3.Ortorp A., Jemt T. Clinical experiences of computer numeric control-milled titanium frameworks supported by implants in the edentulous jaw: a 5-year prospective study. Clin Implant Dent Relat Res. 2004. 6:199–209.
4.Jemt T., Book K., Lie A., Bo¨rjesson T. Mucosal topography around implants in edentulous upper jaws. Photogrammetric three-dimensional measurements of the effect of replacement of a removable prosthesis with a fixed prosthesis. Clin Oral Implants Res. 1994. 5:220–8.
5.Jemt T., Bergendal B., Arvidson K., Bergendal T., Karlsson LD., Linden B., Rundcrantz T., Wendelhag I. Implant-supported welded titanium frameworks in the edentulous maxilla: a 5-year prospective multicenter study. Int J Prosthodont. 2002. 15:544–8.
6.Eliasson A., Palmqvist S., Svenson B., Sondell K. Five-year results with fixed complete-arch mandibular prostheses supported by 4 implants. Int J Oral Maxillofac Implants. 2000. 15:505–10.
7.Lindquist LW., Carlsson GE., Jemt T. A prospective 15-year follow-up study of mandibular fixed prostheses supported by os-seointegrated implants. Clinical results and marginal bone loss. Clin Oral Implants Res. 1996. 7:329–36.
8.Attard NJ., Zarb GA. Long-term treatment outcomes in edentulous patients with implant-fixed prostheses: the Toronto study. Int J Prosthodont. 2004. 17:417–24.
9.Makkonen TA., Holmberg S., Niemi L., Olsson C., Tammisalo T., Peltola J. A 5-year prospective clinical study of Astra Tech dental implants supporting fixed bridges or overdentures in the edentulous mandible. Clin Oral Implants Res. 1997. 8:469–75.
10.Bryant SR., MacDonald-Jankowski D., Kim K. Does the type of implant prosthesis affect outcomes for the completely edentulous arch? Int J Oral Maxillofac Implants. 2007. 22:117–39.
11.Sanna A., Nuytens P., Naert I., Quirynen M. Successful outcome of splinted implants supporting a 'planned' maxillary overdenture: a retrospective evaluation and comparison with fixed full dental prostheses. Clin Oral Implants Res. 2009. 20:406–13.
12.Malo P., de Arau′jo Nobre M., Lopes A., Moss SM., Molina GJ. A longitudinal study of the survival of All-on-4 implants in the mandible with up to 10 years of follow-up. J Am Dent Assoc. 2011. 142:310–20.
13.Kim Y., Oh TJ., Misch CE., Wang HL. Occlusal considerations in implant therapy: clinical guidelines with biomechanical rationale. Clin Oral Implants Res. 2005. 16:26–35.
14.Ha¨lg GA., Schmid J., Ha¨mmerle CH. Bone level changes at implants supporting crowns or fixed partial dentures with or without cantilevers. Clin Oral Implants Res. 2008. 19:983–90.
15.Wennstro¨m J., Zurdo J., Karlsson S., Ekestubbe A., Gro¨ndahl K., Lindhe J. Bone level change at implant-supported fixed partial dentures with and without cantilever extension after 5 years in function. J Clin Periodontol. 2004. 31:1077–83.
16.Ohkubo C., Baek KW. Does the presence of antagonist remaining teeth affect implant overdenture success? A systematic review. J Oral Rehabil. 2010. 37:306–12.
17.Shackleton JL., Carr L., Slabbert JC., Becker PJ. Survival of fixed implant-supported prostheses related to cantilever lengths. J Prosthet Dent. 1994. 71:23–6.
18.Rangert B., Jemt T., Jo¨rneus L. Forces and moments on Branemark implants. Int J Oral Maxillofac Implants. 1989. 4:241–7.
19.Rodriguez AM., Aquilino SA., Lund PS. Cantilever and implant biomechanics: a review of the literature. Part 1. J Prosthodont. 1994. 3:41–6.
20.Blanes RJ., Bernard JP., Blanes ZM., Belser UC. A 10-year prospective study of ITI dental implants placed in the posterior region. I: Clinical and radiographic results. Clin Oral Implants Res. 2007. 18:699–706.
21.Aglietta M., Siciliano VI., Zwahlen M., Bra¨gger U., Pjetursson BE., Lang NP., Salvi GE. A systematic review of the survival and complication rates of implant supported fixed dental prostheses with cantilever extensions after an observation period of at least 5 years. Clin Oral Implants Res. 2009. 20:441–51.
22.Capelli M., Zuffetti F., Del Fabbro M., Testori T. Immediate rehabilitation of the completely edentulous jaw with fixed prostheses supported by either upright or tilted implants: a multicenter clinical study. Int J Oral Maxillofac Implants. 2007. 22:639–44.
23.De Kok IJ., Chang KH., Lu TS., Cooper LF. Comparison of three-implant-supported fixed dentures and two-implant-retained overdentures in the edentulous mandible: a pilot study of treatment efficacy and patient satisfaction. Int J Oral Maxillofac Implants. 2011. 26:415–26.
24.Malo′ P., Nobre MD., Lopes A. The rehabilitation of completely edentulous maxillae with different degrees of resorption with four or more immediately loaded implants: a 5-year retrospective study and a new classification. Eur J Oral Implantol. 2011. 4:227–43.
25.Zampelis A., Rangert B., Heijl L. Tilting of splinted implants for improved prosthodontic support: a two-dimensional finite element analysis. J Prosthet Dent. 2007. 97:S35–43.
26.Kim KS., Kim YL., Bae JM., Cho HW. Biomechanical comparison of axial and tilted implants for mandibular full-arch fixed prostheses. Int J Oral Maxillofac Implants. 2011. 26:976–84.
27.Ogawa T., Dhaliwal S., Naert I., Mine A., Kronstrom M., Sasaki K., Duyck J. Effect of tilted and short distal implants on axial forces and bending moments in implants supporting fixed dental prostheses: an in vitro study. Int J Prosthodont. 2010. 23:566–73.
28.Misch CE., Qu Z., Bidez MW. Mechanical properties of trabecular bone in the human mandible: implications for dental implant treatment planning and surgical placement. J Oral Maxillofac Surg. 1999. 57:700–6. discussion 706-8.
29.Bergkvist G., Nilner K., Sahlholm S., Karlsson U., Lindh C. Immediate loading of implants in the edentulous maxilla: use of an interim fixed prosthesis followed by a permanent fixed prosthesis: a 32-month prospective radiological and clinical study. Clin Implant Dent Relat Res. 2009. 11:1–10.
30.Brosky ME., Korioth TW., Hodges J. The anterior cantilever in the implant-supported screw-retained mandibular prosthesis. J Prosthet Dent. 2003. 89:244–9.
31.Feine JS., de Grandmont P., Boudrias P., Brien N., LaMarche C., Tache′ R., Lund JP. Within-subject comparisons of implant-supported mandibular prostheses: choice of prosthesis. J Dent Res. 1994. 73:1105–11.
32.Preciado A., Del Rl′o J., Sua′rez-Garcl′a MJ., Montero J., Lynch CD., Castillo-Oyagu¨e R. Differences in impact of patient and prosthetic characteristics on oral health-related quality of life among implant-retained overdenture wearers. J Dent. 2012. 40:857–65.
Table 1.
Mean marginal bone loss by conditions
| Condition | Bone loss (Mean ± STD) (mm) | Sig∗ | |
|---|---|---|---|
| Sex | Male (n = 46) | 0.62 ± 0.41 | - |
| Female (n = 38) | 0.42 ± 0.33 | ||
| Anatomical location | Maxilla (n = 51) | 0.60 ± 0.39 | - |
| Mandible (n = 33) | 0.44 ± 0.36 | ||
| Opposing teeth | Fixed (natural teeth or implants) (n = 61) | 0.54 ± 0.41 | - |
| Removable (n = 23) | 0.52 ± 0.34 | ||
| Loading time | Early (n = 45) | 0.51 ± 0.30 | - |
| Delayed (n = 39) | 0.55 ± 0.46 | ||
| Location | Most posterior (n = 32) | 0.37 ± 0.06 | ∗ |
| Anterior (n = 52) | 0.61 ± 0.10 | ||
| Angulations (most posterior implant) | Tilting (n = 20) | 0.37 ± 0.49 | ∗ |
| Upright (n = 12) | 0.60 ± 0.87 | ||
XML Download