{"id":31513,"date":"2022-11-07T15:51:05","date_gmt":"2022-11-07T14:51:05","guid":{"rendered":"https:\/\/bedentalexpert.com\/clinical-investigation-of-an-immediate-load-protocol-using-axial-and-tilted-implants\/"},"modified":"2023-12-14T03:34:06","modified_gmt":"2023-12-14T02:34:06","slug":"clinical-investigation-of-an-immediate-load-protocol-using-axial-and-tilted-implants","status":"publish","type":"post","link":"https:\/\/bedentalexpert.com\/en\/clinical-investigation-of-an-immediate-load-protocol-using-axial-and-tilted-implants\/","title":{"rendered":"Clinical Investigation of an Immediate Load Protocol Using Axial and Tilted Implants to Treat Patients with Failing Dentition or Complete Edentulism"},"content":{"rendered":"\t\t
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Preliminary Results of a Multicenter Cohort Study<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Abstract<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Objective: <\/strong>This clinical investigation evaluated a specific surgical\/prosthetic protocol for full-arch fixed dental restorations supported by immediate loaded axial and axial and tilted implants in a multicenter cohort study. Evaluation was based on a comparison of the survival rates of axial and tilted implants, as well as the overall prosthetic survival rate.<\/p>

Materials and Methods: <\/strong>From 2013 to 2019, 38 patients (22 males and 16 females) were recruited and treated with tapered internal dental implants. Provisional fixed-dental prostheses\u00a0 were\u00a0 screw-retained\u00a0 over\u00a0 axial or axial and tilted implants within a\u00a0 24-\u00a0 to \u00a048-hour period after surgery. Follow-ups\u00a0 were\u00a0 scheduled\u00a0 at\u00a0 6, 12, and 24 months and annually\u00a0 for\u00a0 up\u00a0 to\u00a0 four\u00a0 years, and radiographic evaluations of peri-implant bone level changes were conducted.<\/p>

Results:<\/strong> The 38 patients were followed up for an average of 43 months. Eight patients received both upper and lower implant rehabilitations, resulting in 42 restorations. A total of 210 implants were placed (i.e., 118 maxillary implants; 92 mandibular implants) and 64% of the fixtures were evaluated at the six-year recall. Cumulative survival rates were 97.96% for implants (i.e., 98.96% axial implants and 94.94% tilted implants) and 96.95% for prosthetics. At the two-year evaluation, no significant difference in marginal bone loss was found between tilted and axial implants placed in either jaw<\/p>

Conclusion:<\/strong> Mid-study results confirmed that immediate loading of axial and tilted implants following the studied protocol provides a viable treatment modality for the rehabilitation of edentulous arches and terminal dentition.<\/p>

Key Words: immediate loading, axial implants, straight <\/strong>implants, tilted implants, failing dentition, edentulous<\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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\u00ab<\/strong>Full arch immediate restorations over tilted and axial implants reported high percentage of survival rates, in line with rehabilitations supported solely by conventionally placed fixtures.<\/strong>\u00bb<\/strong><\/span><\/p>\t\t\t\t<\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\"Introduction\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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Introduction<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Elderly patients commonly present with failing dentition or complete edentulism. Many of these patients wear either complete dentures or old failing restorations, and\/or exhibit periodontally compromised teeth, as well as complain about chewing ability, overall esthetics, functional loss, decreased motor control of the tongue, reduced bite force, and diminished oral sensory function.1,2<\/sup> With greater frequency and in growing numbers, patients with failing dentition are consulting clinicians for alternatives to wearing removable dentures. Currently, a treatment of choice for these types of patients is the use of a fixed prosthesis anchored to an endosseous implant, an option that significantly improves their quality of life (Figs 1 & 2)<\/strong>.3,4<\/sup><\/p>

However, post-extraction edentulous patients or long-time full denture patients often present with minimal posterior bone support. Additionally, anatomical structures (e.g., the maxillary sinuses and mandibular nerves) may prevent implant placement in the posterior regions (Fig 3)<\/strong>. To face these limitations, clinicians have different therapeutic options (e.g., long distal cantilever,5<\/sup> short implants,6,7<\/sup> sinus lift,8<\/sup> bone regeneration,9<\/sup> or implants placed in specific anatomical areas such as the pterygoid region,10<\/sup> the tuber,11,12<\/sup> or the zygoma).13,14<\/sup> Each of these procedures requires surgical and prosthetic expertise and has its own specific limitations, risks, and complications, which can reduce patients\u2019 acceptance.<\/p>

Clinical15-17<\/sup>\u00a0and experimental studies18-20<\/sup>\u00a0have shown several surgical and prosthetic advantages in tilting posterior implants, representing a viable alternative to grafting. Partial21<\/sup> or total immediate restorations over tilted and axial implants22,23<\/sup> reported high percentages of survival rates, in line with rehabilitations supported solely by conventionally placed fixtures.24,25<\/sup><\/p>

During the last decades materials and techniques have improved continuously and immediate loading has proved to be a predictable and reliable procedure, especially for full-arch rehabilitations.23,24<\/sup> Earlier studies on immediate loading have included a high number of dental implants,25,26<\/sup> specifically when applied in the maxilla, which typically exhibits poor bone density. Recent reports have shown good outcomes with the use of only four implants (i.e., two axial and two tilted).27,28<\/sup> However, at this point, the ideal number of dental implants and their distribution supporting immediate fixed full-arch restorations is not reported in the literature and no clear up-to-date guidelines are present for immediate loading applications.<\/p>

This study\u2019s aims were to evaluate the clinical outcomes and levels of patient satisfaction with immediately loaded full-arch fixed prostheses utilizing a particular surgical\/prosthetic protocol supported solely by axial implants or by a combination of axial and tilted implants in both jaws and to compare the outcome of tilted versus axial fixtures in the same patients for a period of up to six years. The null hypothesis was that there would be no difference in survival rate and marginal bone level change between axial and tilted implants, and no difference in prosthetic survival rate between rehabilitations supported only by axial implants or by a combination of axial and tilted implants.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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Figure<\/strong> 1:<\/strong> The dentolabial analysis highlighted a low smile, thin upper lip, inappropriate occlusal planes, and a smile width of 10 teeth.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t

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Figure 2: <\/strong>Intraoral analysis showing the removable appliance in the anterior upper arch, dental disproportions, and gingival asymmetries.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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Figure 3: <\/strong>Full-mouth periapical x-ray images illustrate that potentially edentulous patients or patients with failing dentition require a thorough multidisciplinary approach due to the complexity of clinical and psychological issues. Note the moderate horizontal bone resorption, short roots, several significant areas of decay, and periapical lesions on the remaining teeth.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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Study Specifics<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Study Design<\/h3>

This was a retrospective multicenter controlled clinical study evaluating a specific surgical\/prosthetic protocol (TeethXpress, BioHorizons; Birmingham, AL); survival rate, marginal bone levels, peri-implant tissue conditions, and prosthetic complications of axial and tilted implants were compared after six years of function.<\/p>

Inclusion criteria: <\/strong>They were as follows:<\/p>