Objective Polymeric framework represent an innovative approach for implant-supported dental prostheses. However, the mechanical response of ultra-high performance polymers as frameworks for full-arch prostheses under the “all-on-four concept” remains unclear. The present study applied finite element analysis to examine the behavior of polyetherketoneketone (PEKK) and polyetheretherketone (PEEK) prosthetic frameworks. Materials and Methods A three-dimensional maxillary model received four axially positioned morse-taper implants, over which a polymeric bar was simulated. The full-arch prosthesis was created from a previously reported database model, and the imported geometries were divided into a mesh composed of nodes and tetrahedral elements in the analysis software. The materials were assumed as isotropic, elastic, and homogeneous, and all contacts were considered bonded. A normal load (500 N magnitude) was applied at the occlusal surface of the first left molar after the model was fixed at the base of the cortical bone. The microstrain and von-Mises stress were selected as criteria for analysis. Results Similarities in the mechanical response were observed in both framework for the peri-implant tissue, as well as for stress generated in the implants (263–264 MPa) and abutments (274–273 MPa). The prosthetic screw and prosthetic base concentrated more stress with PEEK (211 and 58 MPa, respectively) than with PEKK (192 and 49 MPa), while the prosthetic framework showed the opposite behavior (59 MPa for PEEK and 67 MPa for PEKK). Conclusion The main differences related to the mechanical behavior of PEKK and PEEK frameworks for full-arch prostheses under the “all-on-four concept” were reflected in the prosthetic screw and the acrylic base. The superior shock absorbance of PEKK resulted in a lower stress concentration on the prosthetic screw and prosthetic base. This would clinically represent a lower fracture risk on the acrylic base and screw loosening. Conversely, lower stress concentration was observed on PEEK frameworks.

/pdf/mechanical-response-of-pekk-and-peek-as-frameworks-for-2o4wizgueu.pdf

Mechanical Response of PEKK and PEEK As Frameworks for Implant-Supported Full-Arch Fixed Dental Prosthesis: 3D Finite Element Analysis

This study evaluated the influence of distal implants angulation and framework material in the stress concentration of an All-on-4 full-arch prosthesis. A full-arch implant-supported prosthesis 3D model was created with different distal implant angulations and cantilever arms (30° with 10-millimeter cantilever; 45° with 10-millimeter cantilever and 45° with 6-millimeter cantilever) and framework materials (Cobalt–chrome [CoCr alloy], Yttria-stabilized tetragonal zirconia polycrystal [Y-TZP] and polyetheretherketone [PEEK]). Each solid was imported to computer-aided engineering software, and tetrahedral elements formed the mesh. Material properties were assigned to each solid with isotropic and homogeneous behavior. The contacts were considered bonded. A vertical load of 200 N was applied in the distal region of the cantilever arm, and stress was evaluated in Von Misses (σVM) for prosthesis components and the Maximum (σMAX) and Minimum (σMIN) Principal Stresses for the bone. Distal implants angled in 45° with a 10-millimeter cantilever arm showed the highest stress concentration for all structures with higher stress magnitudes when the PEEK framework was considered. However, distal implants angled in 45° with a 6-millimeter cantilever arm showed promising mechanical responses with the lowest stress peaks. For the All-on-4 concept, a 45° distal implants angulation is only beneficial if it is possible to reduce the cantilever’s length; otherwise, the use of 30° should be considered. Comparing with PEEK, the YTZP and CoCr concentrated stress in the framework structure, reducing the stress in the prosthetic screw.

/pdf/influence-of-framework-material-and-posterior-implant-21q8vpo3.pdf

Influence of Framework Material and Posterior Implant Angulation in Full-Arch All-on-4 Implant-Supported Prosthesis Stress Concentration

Purpose To synthesize evidence derived from systematic reviews (SRs) on different interventions for rehabilitation of the edentulous maxilla with implant-supported restorations. Materials and methods A protocol-oriented search was established to address the PICO question: What is the current evidence regarding rehabilitation of the edentulous maxilla with different implant-supported prostheses in terms of implant and prosthesis survival? The primary outcomes were implant and prosthesis survival rates evaluated from SRs of clinical studies including adult patients with complete edentulism of the maxilla and comparing different implant-supported rehabilitation strategies. Methodologic quality of the SRs was assessed with the AMSTAR-2 tool. Results The final selection process led to the inclusion of 36 SRs that were grouped as: (1) addressing maxillae with sufficient bone to place implants; (2) addressing maxillae with insufficient bone to place implants; and (3) comparing different types of prosthesis, number of implants, patient-reported outcomes, and economic evaluations. The literature describes four or more implants as suitable for full-arch fixed prostheses and implant-supported overdentures; in both cases, the overall survival rate is > 95%. Mini-implants present very high short-term failure rates (> 30%). Poor description of technical complications, adjustments, and maintenance and corresponding costs precluded a cost-effectiveness analysis. Conclusion No implant-supported rehabilitation of the edentulous maxilla (fixed or removable) should be supported on fewer than four implants. A one-piece full-arch fixed dental prosthesis can be supported by a minimum of two anterior axial plus two posterior distally tilted implants or by six to eight axial implants symmetrically distributed through the posterior and anterior regions of the arch. Four to six implants is the advised number to support an overdenture. The use of mini-implants in the maxilla is inadvisable.

/pdf/different-interventions-for-rehabilitation-of-the-edentulous-wupyq9r6c9.pdf

Different Interventions for Rehabilitation of the Edentulous Maxilla with Implant-Supported Prostheses: An Overview of Systematic Reviews

All-on-4 Concept Update.

In today’s world, restoring function and esthetics in fully edentulous patients has gone beyond the conventional treatment of removable dentures to enter the domain of full-mouth rehabilitation with implants. The All-on-fourTM concept was initially introduced in 2003 as a treatment for edentulous mandibles followed by immediate loading. However, it has now become a common line of treatment for both edentulous, often atrophic, arches, with various restorative options depending on the case’s requirements. This chapter aims at discussing the All-on-four concept, its variants, and workflow, both conventional and digital, along with the biological and technical complications associated with this technique.

The All-on-Four Concept

Objective: The objective of this review is to evaluate maxillary and mandibular all-on-four implant designs, their indications and contraindications, advantages and disadvantages. Methods: By using Pubmed, Cochrane Library, and Google Scholar, data from January 2003 to February 2018 were scanned electronically and manually as the title, abstract, and full text. The keywords specified were determined to be the all-on-four concept, full-arch implant prostheses, 4-implant full-arch, and tilted implants. The inclusion criteria consisted of the all-on-four implant design, its use in completely edentulous maxillary and mandibular cases, advantages and disadvantages of the technique, and changes observed in the maxilla and mandible in completely edentulous cases. Clinical trials and laboratory studies on the subject using the full text and English language were evaluated. Results: A total of 176 articles were found as a result of Google Scholar, Pubmed, and Cochrane Library. Thirty-seven articles were selected according to inclusion criteria; of these, 20 were related to the clinical trials. In addition, a total of 13 articles were found as a result of an additional hand search by screening the reference list of all included publications; of these, 11 was related to the clinical trials. Conclusions: It is necessary to carry out longer-term clinical and laboratory studies to determine long-term success criteria in all-on-four implant designs and to use new ceramic systems.

Maxillary and mandibular all-on-four implant designs: A review.

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Maxillary and mandibular all-on-four implant designs: A review.