OBJECTIVES: The objective of this systematic review was to assess the 5-year survival rates and incidences of complications associated with ceramic abutments and to compare them with those of metal abutments. METHODS: An electronic Medline search complemented by manual searching was conducted to identify randomized-controlled clinical trials, and prospective and retrospective studies providing information on ceramic and metal abutments with a mean follow-up time of at least 3 years. Patients had to have been examined clinically at the follow-up visit. Assessment of the identified studies and data abstraction was performed independently by three reviewers. Failure rates were analyzed using standard and random-effects Poisson regression models to obtain summary estimates of 5-year survival proportions. RESULTS: Twenty-nine clinical and 22 laboratory studies were selected from an initial yield of 7136 titles and data were extracted. The estimated 5-year survival rate of ceramic abutments was 99.1% [95% confidence interval (CI): 93.8-99.9%] and 97.4% (95% CI: 96-98.3%) for metal abutments. The estimated cumulative incidence of technical complications after 5 years was 6.9% (95% CI: 3.5-13.4%) for ceramic abutments and 15.9% (95% CI: 11.6-21.5%) for metal abutments. Abutment screw loosening was the most frequent technical problem, occurring at an estimated cumulative incidence after 5 years of 5.1% (95% CI: 3.3-7.7%). All-ceramic crowns supported by ceramic abutments exhibited similar annual fracture rates as metal-ceramic crowns supported by metal abutments. The cumulative incidence of biological complications after 5 years was estimated at 5.2% (95% CI: 0.4-52%) for ceramic and 7.7% (95% CI: 4.7-12.5%) for metal abutments. Esthetic complications tended to be more frequent at metal abutments. A meta-analysis of the laboratory data was impossible due to the non-standardized test methods of the studies included. CONCLUSION: The 5-year survival rates estimated from annual failure rates appeared to be similar for ceramic and metal abutments. The information included in this review did not provide evidence for differences of the technical and biological outcomes of ceramic and metal abutments. However, the information for ceramic abutments was limited in the number of studies and abutments analyzed as well as the accrued follow-up time. Standardized methods for the analysis of abutment strength are needed.

/pdf/a-systematic-review-of-the-performance-of-ceramic-and-metal-16xzkab5ea.pdf

A systematic review of the performance of ceramic and metal implant abutments supporting fixed implant reconstructions.

Purpose: To systematically appraise the impact of mechanical/technical risk factors on implant-supported reconstructions. Material and Methods: A MEDLINE (PubMed) database search from 1966 to April 2008 was conducted. The search strategy was a combination of MeSH terms and the key words: design, dental implant(s), risk, prosthodontics, fixed prosthodontics, fixed partial denture(s), fixed dental prosthesis (FDP), fixed reconstruction(s), oral rehabilitation, bridge(s), removable partial denture(s), overdenture(s). Randomized controlled trials, controlled trials, and prospective and retrospective cohort studies with a mean follow-up of at least 4 years were included. The material evaluated in each study had to include cases with/without exposure to the risk factor. Results: From 3,568 articles, 111 were selected for full text analysis. Of the 111 articles, 33 were included for data extraction after grouping the outcomes into 10 risk factors: type of retentive elements supporting overdentures, presence of cantilever extension(s), cemented versus screw-retained FDPs, angled/angulated abutments, bruxism, crown/implant ratio, length of the suprastructure, prosthetic materials, number of implants supporting an FDP, and history of mechanical/technical complications. Conclusions: The absence of a metal framework in overdentures, the presence of cantilever extension(s) > 15 mm and of bruxism, the length of the reconstruction, and a history of repeated complications were associated with increased mechanical/technical complications. The type of retention, the presence of angled abutments, the crown-implant ratio, and the number of implants supporting an FDP were not associated with increased mechanical/technical complications. None of the mechanical/technical risk factors had an impact on implant survival and success rates. INT J ORAL MAXILLOFAC IMPLANTS 2009;24(SUPPL):69–85

Mechanical and technical risks in implant therapy

Purpose Implant restoration of the partially edentulous patient has become highly predictable. The scientific information on the specifics of restorative designs and their influence on the long-term outcome is sparse. The main objective of this systematic review was to determine what scientific evidence exists regarding the influence of prosthodontic design features on the long-term outcomes of implant therapy (implant success and survival, prosthesis success and survival) in the partially edentulous patient. Materials and methods Four questions of primary interest regarding implant prosthodontic design options were selected by the 2 reviewers: abutment type, retention type (cemented, screw-retained), support type (implant support alone versus combined implant-tooth support), and the type of restorative material. Inclusion and exclusion criteria were formulated and applied to a total of 1,720 titles. The list of titles was primarily based on a PubMed-type search provided by the State of the Science of Implant Dentistry workshop leadership. It was supplemented by a hand search of relevant journals at the Countway Library of the Harvard Medical School and of a personal collection of relevant publications of the 2 reviewers. Information on the survival and success of implants and prostheses as defined by the respective authors was retrieved from the included articles, entered into data extraction tables, and submitted for statistical analysis. Results Seventy-four articles were selected for data extraction and analysis after critical appraisal and application of the exclusion criteria. The kappa value for reviewer agreement was 100% between the 2 reviewers. The majority of studies were in the "average" range and were published between 1995 and 2003. Only 2 "best" trials, ie, randomized controlled clinical trials, were identified. For the method of retention (screw-retained versus cemented), no differences were found in implant success or survival rates between screw-retained and cemented restorations. Prosthesis success rates showed greater variations between cemented and screw-retained restorations at the various evaluation times; however, the differences never reached statistical significance. The prosthesis success rate at the last reported examination (> 72 mo) was 93.2% for cemented and 83.4% for screw-retained restorations (P > .05). Regarding the type of support, implant success rates at the last reported evaluation were 97.1% for implant-supported fixed partial dentures (FPDs), 94.3% for single-implant restorations, and 89.2% for implant-tooth-supported FPDs. None of the differences reached statistical significance. Implant survival at the last examination (> 72 mo) was highest for implant-supported FPDs (97.7%), followed by single-implant restorations (95.6%) and implant-tooth-supported FPDs (91.1%). Differences were not statistically significant. Prosthesis success at the last examination (> 72 mo) resulted in overall lower percentage rates than implant success or survival (89.7% for implant-supported FPDs, 87.5% for implant-tooth-supported FPDs, and 85.4% for single-implant restorations; differences not statistically significant). Insufficient extractable information was available regarding the influence of abutment type or restorative material. Conclusion The scientific evidence obtained from this review is insufficient to establish unequivocal clinical guidelines for the design of implant-supported fixed prostheses in the partially edentulous patient.

Does the type of implant prosthesis affect outcomes in the partially edentulous patient

Purpose: The aim of this study was to determine the relative contribution of changes in implant system, position, bone type, and loading condition on the biomechanical response of a single-unit implant-supported restoration using nonlinear 3-dimensional finite element analysis (3D FEA). Materials and Methods: FEA models of a single-unit (crown) restoration supported by the Frialit-2 implant and MH-6 abutment or the Straumann standard implant with the Straumann solid abutment were used. Each system was analyzed by FEA with both straight and 20-degree angled abutments. Simulated implant placement was performed in the maxillary premolar area with 3 variations in implant orientation relative to the residual ridge. Analysis of each orientation was conducted for each of 4 bone quality types described by Lekholm and Zarb, with lateral and axial loading conditions imposed. The effect of each variable was expressed as a percentage of the total sum of squares as computed using analysis of variance. Results: Larger strain values were noted in cortical bone with lateral force and the Frialit-2 system. Bone strain increased with decreasing bone density and was affected primarily by bone quality. Implant stress was influenced mainly by implant position. Conclusions: Better stress/strain distribution is possible when implants are placed along the axis of loading with multiple areas of cortical contact. The Straumann solid abutment performed better as a force-transmission mechanism. INT J ORAL MAXILLOFAC IMPLANTS 2008;23:57–64

https://ir.kmu.edu.tw/retrieve/5371/770265-1.pdf

Biomechanical response of implant systems placed in the maxillary posterior region under various conditions of angulation, bone density, and loading.

Background When dental implants are not placed parallel to adjacent teeth or contiguous implants, the clinician can use angled abutments to achieve proper restorative contours However, increased stresses on implants and bone have been associated with use of angled abutments In this regard, there are unresolved issues concerning implant survival and potential prosthetic complications that can arise when angled abutments are used to align prosthetic positions Types of Studies Reviewed The authors searched the dental literature for clinical trials that appraised the survival rate and complications (biological and technical) associated with pros-theses that are supported by angled abutments Results The results of photoelastic stress assessments, finite element analysis and strain-gauge studies indicated that increased abutment angulations result in the placement of a greater amount of stress on prostheses and the surrounding bone than that associated with straight abutments However, survival studies did not demonstrate a significant decrease of prostheses' longevity associated with angled abutments Furthermore, there was no additional bone loss adjacent to implants that supported angled abutments compared with straight abutments, and angled abutments did not manifest an increased incidence of screw loosening Clinical Implications The use of angled abutments facilitates paralleling nonaligned implants, thereby making prosthesis fabrication easier These abutments also can aid the clinician in avoiding anatomical structures when placing the implants In addition, use of angled abutments can reduce treatment time, fees and the need to perform guided bone regeneration procedures

Angled Implant Abutments: A Practical Application of Available Knowledge

This paper describes the evolution of the concept of selecting the abutment at first-stage surgery and presents clinical data accumulated over 14 years of the use of this concept with angulated abutments. The concept was developed for implants using internal and external hexed connections and has evolved in its use for implants using a Morse taper connection as a result of the considerable clinical advantages that this type of connection offers. A total of 3101 implants were restored using angled abutments ranging from 0 to 45 degrees and were observed over a period of up to 151 months. After an observation time of 120 months (10 years) after placement, the calculated 95% confidence interval of the mean survival estimation, according to Aalen et al, was 98.2% (+/- 0.7%). The magnitude of the angles did not influence the survival rate. The need to refine the implant position in terms of the depth to which it was placed and the angulation and rotational orientation, as well as the size and pivot point of the final abutment, were recognized as contributing to the harmonious emergence profile of the restoration. Good esthetic and functional outcomes were achieved by the use of conventional cement-retained restorations made possible by parallel and aligned abutments.

Evolution of the concept of angulated abutments in implant dentistry: 14-year clinical data.

The present invention relates to an impression jig assembly for coupling to a bone implant (10) comprising: a split sleeve having co-axial upper and lower sleeve members (31, 32); and a fixing screw (5) for clamping the split sleeve to the implant. The fixing screw in use passes through the split sleeve, and can be withdrawn once impression material has hardened around the assembly to allow the upper sleeve member to separate from the lower sleeve member.

Impression jig assembly for use with dental implants

Fixation of dental castings using a bush and screw

Safe clinical practice in implant dentistry requires an accurate investigation of the availability of bone for implant placement and the avoidance of critical anatomical structures. Modern imaging techniques using computed tomography (CT) and cone beam computed tomography (CBCT) provide the clinician with the required information. The imaging thus obtained provides accurate representation of the height, width and length of the available bone. In addition, whenever adequate radiation dose is used, accurate information about the bone density in Hounsfield units can be obtained. Important spatial information regarding the orientation of the ridges and the relationship to the proposed prosthetic reconstruction can be obtained with the aid of radiopaque templates during the acquisition of CT scan data. Modern software also provides the facility to decide interactively upon the positioning of the implants and is able to relate this to a stereolithographic model constructed from the imaging data. A surgical guide for the accurate positioning of the implants can be constructed. The construction of screw retained prostheses is fraught with difficulties regarding the accuracy of the construction. Accurate fit of the prosthesis is difficult to obtain due to the inherent errors in impression taking, component discrepancies, investing and casting inaccuracies. CAD/CAM technology eliminates the inaccuracies involved with the investing and casting of superstructures.

Managing the edentulous mandible using recent technological developments: a case study.

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Papers

Evolution of the concept of angulated abutments in implant dentistry: 14-year clinical data.

Impression jig assembly for use with dental implants

Fixation of dental castings using a bush and screw

Managing the edentulous mandible using recent technological developments: a case study.