Publications by authors named "Stefano Storelli"

18 Publications

  • Page 1 of 1

A digital workflow for computer-guided implant surgery integrating CBCT, model scanning, and CAD/CAM for a complete edentulism implant-supported prosthesis: a technique procedure.

Int J Comput Dent 2020 ;23(3):269-279

The utilization of digital 3D surface images (STL format) for planning cases of computer-guided implant surgery is very useful in partially edentulous cases. In fully edentulous cases, however, the absence of teeth makes it necessary to add reference markers. The proposed protocol demonstrates a simple procedure that allows for the superimposition of STL and radiologic data (DICOM format). In the presented patient case, the tissue-bearing area of the prosthesis was relined with a polysulfide impression material and sent to the laboratory. A master cast was produced. The prosthesis was relined to improve intraoral stability and was provided with at least three radiopaque 3D markers. An STL copy of the prosthesis and the model was generated through a laboratory scanner. The patient wore the prosthesis with the attached markers during the 3D radiologic examination. In the planning software (CoDiagnostiX; Dental Wings), the prosthesis markers on the STL were matched to the corresponding markers visible on the DICOM data. Then, the STL of the model was matched to that of the prosthesis. Once the STL of the mucosa and the prosthesis were imported into the software, new possibilities arose, ie, the option to add other digital or traditional tooth setups to the same radiologic data or to design a surgical guide based on the actual mucosa of the patient.
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August 2020

Severe Case of Osteonecrosis Following Implant Placement in a Patient in Therapy With Bisphosphonates: A Case Report.

J Oral Implantol 2019 Apr 19;45(2):139-144. Epub 2018 Nov 19.

Department of Biomedical, Surgical and Dental Sciences, San Paolo and Carlo Hospital, University of Milan, Milan, Italy.

Osteonecrosis of the jaw is a rare complication that has been associated with the use of bisphosphonates. A 77-year-old patient presented in April 2013 asking for a consultation. She reported that in May 2009, she underwent an implant rehabilitation with 8 implants and an immediately loaded fixed prosthesis in the maxilla. After a few months the patient started to report pain and purulent secretions that were neglected by the clinician for several years. She decided to refer to the Dental Clinic after another acute pain episode. Once the fixed prosthesis was removed, exposed necrotic bone was found in relation to the implants. The patient reported having taken oral alendronic acid to treat osteoporosis since before 2006. The patient underwent a functional endoscopic sinus surgery and a removal of necrotic bone blocks. Three years of follow-up showed healed tissues with no recurrence, although the alveolar crest appeared irregular on radiographs.
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http://dx.doi.org/10.1563/aaid-joi-D-17-00309DOI Listing
April 2019

Group 3 ITI Consensus Report: Patient-reported outcome measures associated with implant dentistry.

Clin Oral Implants Res 2018 Oct;29 Suppl 16:270-275

Universidad Inter Continental, Mexico City, Mexico.

Objectives: The aim of Working Group 3 was to focus on three topics that were assessed using patient-reported outcome measures (PROMs). These topics included the following: (a) the aesthetics of tooth and implant-supported fixed dental prostheses focusing on partially edentulous patients, (b) a comparison of fixed and removable implant-retained prostheses for edentulous populations, and (c) immediate versus early/conventional loading of immediately placed implants in partially edentate patients. PROMs include ratings of satisfaction and oral health-related quality of life (QHRQoL), as well as other indicators, that is, pain, general health-related quality of life (e.g., SF-36).

Materials And Methods: The Consensus Conference Group 3 participants discussed the findings of the three systematic review manuscripts. Following comprehensive discussions, participants developed consensus statements and recommendations that were then discussed in larger plenary sessions. Following this, any necessary modifications were made and approved.

Results: Patients were very satisfied with the aesthetics of implant-supported fixed dental prostheses and the surrounding mucosa. Implant neck design, restorative material, or use of a provisional restoration did not influence patients' ratings. Edentulous patients highly rate both removable and fixed implant-supported prostheses. However, they rate their ability to maintain their oral hygiene significantly higher with the removable prosthesis. Both immediate provisionalization and conventional loading receive positive patient-reported outcomes.

Conclusions: Patient-reported outcome measures should be gathered in every clinical study in which the outcomes of oral rehabilitation with dental implants are investigated. PROMs, such as patients' satisfaction and QHRQoL, should supplement other clinical parameters in our clinical definition of success.
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http://dx.doi.org/10.1111/clr.13299DOI Listing
October 2018

Biomechanical aspects: Summary and consensus statements of group 4. The 5 EAO Consensus Conference 2018.

Clin Oral Implants Res 2018 Oct;29 Suppl 18:326-331

Implaneo Dental Center, Munich, Germany.

Objectives: The aim of the present publication was to report on the EAO Workshop group-4 discussions and consensus statements on the five reviews previously prepared. These reviews provided the scientific evidence on the effect of crown-to-implant ratio, on reconstructions with cantilevers in fully and partially edentulous patients, on biological and technical complications of tilted in comparison with straight implants, and on the effects of osseointegrated implants functioning in a residual dentition.

Material And Methods: The group discussed, evaluated, corrected where deemed appropriate, and made recommendations to the authors regarding the following five reviews submitted: (a) Is there an effect of crown-to-implant ratio on implant treatment outcomes?; (b) Implant-supported cantilevered fixed dental rehabilitations in fully edentulous patients; (c) and in partially edentulous patients; (d) Biological and technical complications of tilted implants in comparison with straight implants supporting fixed dental prostheses; (e) What are the adverse effects of osseointegrated implants functioning among natural teeth of a residual dentition? Based on the five manuscripts and the discussion among the group as well as the plenum members, the major findings were summarized, consensus statements were formulated, clinical recommendations were proposed, and areas of future research were identified.

Results: Crown-to-implant ratios ranging from 0.9 to 2.2 did not influence the occurrence of biological or technical complications also in single-tooth restorations. Reconstructions with cantilevers for the rehabilitation of fully and partially edentulous jaws showed high implant and reconstruction survival rates. In contrast, the rate of complications-in particular associated with veneering material-was high during the observation period of 5-10 years. The data reported were primarily derived from studies with high risk of bias. The data for single-implant reconstructions were small. There was no evidence that distally tilted implants were associated with higher failure rates and increased amounts of marginal bone loss. The data supporting these findings, however, were at high risk of bias and frequently incompletely reported. Frequent positional changes occurred between the natural teeth and the implant-supported restorations. These changes were more pronounced in younger individuals, and even though they were reduced with age, they still occurred in adult patients. Even though these changes were frequent, potential implications for the patient are unclear.

Conclusions: The use of single-tooth restorations with crown-to-implant ratio in between 0.9 and 2.2 may be considered a viable treatment option. Multiunit reconstructions with cantilevers are a viable treatment option in fully and partially edentulous patients. Clinicians and patients should be aware, however, that complications are frequent and primarily related to resin material used for veneering. There is some evidence that tilting an implant does affect stability of the implant and the surrounding bone. Treatment options to tilted implants should carefully be considered, as the effect on soft tissues and on prosthesis behavior is poorly reported for tilted implants. Positional changes in the dentition in relation to implant-supported restorations occur frequently. The patient should be informed about the possible need for a treatment related to these changes in the long term.
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http://dx.doi.org/10.1111/clr.13284DOI Listing
October 2018

Implant-supported cantilevered fixed dental rehabilitations in fully edentulous patients: Systematic review of the literature. Part II.

Clin Oral Implants Res 2018 Oct;29 Suppl 18:275-294

Department of Biomedical, Surgical and Dental Sciences, Clinica Odontoiatrica ASST Santi Paolo e Carlo, University of Milan, Milan, Italy.

Aim: To investigate fully edentulous patients rehabilitated with cantilever-fixed implant-supported restorations and to analyse which complications are reported for this type of treatment.

Materials And Methods: Two operators screened the literature (MEDLINE, EMBASE) and performed a hand search on the main journals dealing with implantology and prosthetics until 31 December 2017. Only articles that considered cantilever implant-fixed restorations with at least 10 patients and with a mean follow-up of at least 5 years were selected. The outcome variables were survival of implants and prosthesis, mechanical, technical and biological complications, marginal bone loss. The review was performed according to the PRISMA statements. The risk of bias was evaluated for each article. Failure and complication rates were analysed using random effect Poisson regression models to obtain summary estimate of 5- and 10-year survival and complication rates.

Results: Fourteen papers for fully edentulous patients were selected. The estimated 5 to 10 years survival rate was calculated to be 99.00% and 96.7% for the implants and the prosthesis, respectively. A total of 299 complications (technical and biological) were reported with a cumulative 5-10 years complication rate of 44.41% and 39.46% for the patients and for the prosthesis, respectively.

Conclusions: There is evidence that cantilever can be successful treatment in fully edentulous patients.
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http://dx.doi.org/10.1111/clr.13310DOI Listing
October 2018

Implant supported cantilevered fixed dental rehabilitations in partially edentulous patients: Systematic review of the literature. Part I.

Clin Oral Implants Res 2018 Oct;29 Suppl 18:253-274

Department of Biomedical, Surgical and Dental Sciences, Clinica Odontoiatrica ASST Santi Paolo e Carlo, University of Milan, Milan, Italy.

Objectives: To investigate in which clinical situations a cantilever fixed implant supported restorations can be a treatment alternative and which complications are reported.

Materials And Methods: Two operators screened the literature (MEDLINE, EMBASE) and performed a hand search on the main journals dealing with implantology and prosthetics until 31 December 2017. Only articles that considered cantilever implant fixed restorations with at least 10 patients and with a mean follow-up of at least 5 year were selected. The outcome variables were survival of implants and prosthesis, mechanical, technical and biological complications, marginal bone loss. The review was performed according to the PRISMA statements. Risk of bias assessment was evaluated. Failure and complication rates were analysed using random effect Poisson regression models to obtain summary estimate of 5- and 10-year survival and complication rates.

Results: A total of nine papers were selected for partially edentulous patients and reported high survival rate of the prosthesis. The estimated survival rate for 5-10 years was calculated to be 98.4% for the implants and 99.2% for the rehabilitations. Mechanical, technical and biological complications were reported with a cumulative 5-10 years complication rate of 28.66% and 26.57% for the patients and for the prosthesis, respectively. Two papers for single implant supporting 2-unit cantilever were not sufficient to draw conclusions.

Conclusions: There is evidence that cantilever can be successful treatment in partially edentulous patients. In two adjacent edentulous sites, data are not yet sufficient.
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http://dx.doi.org/10.1111/clr.13311DOI Listing
October 2018

6 mm vs 10 mm-long implants in the rehabilitation of posterior jaws: A 10-year follow-up of a randomised controlled trial.

Eur J Oral Implantol 2018 ;11(3):283-292

Purpose: The aim of this study was to compare survival and success rates of 6 mm-long and 10 mm-long implants in partially edentulous posterior areas.

Materials And Methods: Twenty-four patients with a partially edentulous area were included in the study. Patients were randomly allocated according to a parallel group design to receive 6 mm or 10 mm-long implants. A total of 54 implants were placed (26 × 6 mm implants). Patients were followed for 10 years after prosthetic loading. Outcome measures were prosthesis and implant survival, marginal bone level changes and complications.

Results: After 10 years, 17 patients (eight with 6 mm implants and nine with 10 mm implants) were available: three 6 mm and four 10 mm patients were lost to follow-up. One 6 mm implant failed during the healing period and its related prosthesis could not be placed. No implants were lost after loading. Nine patients in the 6 mm group registered a total of 15 complications: two mucositis, six decementations and seven chippings. Ten patients in the 10 mm group registered a total of 13 complications: five mucositis, two decementations and six chippings. Overall the difference for complications between the two groups was not statistically significant (P = 0.22; difference in proportion = -0.02; 95% CI: -0.31 to 0.27). Decementations in the 6 mm group were statistically significant higher than the 10 mm group (P = 0.04; difference in proportion = 0.39; 95% CI: 0.03 to 0.74). Marginal bone loss at 10 years was 0.84 and 0.37 mm with the 6 mm and 10 mm groups, respectively (difference between the two groups 0.49 mm; 95% CI -0.31; 1.29; not statistically significant: t test P = 0.22).

Conclusions: Rehabilitations supported by 6 mm or 10 mm-long implants showed similar clinical outcomes in terms of survival and success rates, although 6 mm implants had more decementations.
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February 2020

Comparison of Cemented vs Screw-Retained, Customized Computer-Aided Design/Computer-Assisted Manufacture Zirconia Abutments for Esthetically Located Single-Tooth Implants: A 10-Year Randomized Prospective Study.

Int J Prosthodont 2018 July/August;31(4):359–366. Epub 2018 Apr 6.

Purpose: To compare the clinical outcomes of screw-retained vs cemented single crowns supported by customized zirconia abutments on implants.

Materials And Methods: Thirty-two patients received implant-supported (Regular Neck, Tissue-Level, Straumann AG), single-tooth restorations with customized zirconia abutments in the anterior areas. Participants were randomly assigned to the screw-retained (full-crown abutment [FCA]) group or the cemented (zirconia crown [ZrC]) group and followed up over a 10-year period. Prosthetic and biologic complications, marginal bone level (MBL), mucosal recession, and pink and white esthetic scores (PES and WES, respectively) were evaluated.

Results And Conclusion: There were no implant failures during the study period; after 10 years, 94% of crowns were functional. Prosthetic complications were recorded in both groups (three FCA and two ZrC), and no significant difference was found (P = .65). Two cases of mucositis were recorded, one in each group. Esthetic outcomes were assessed using PES and WES scores. MBL was 0.95 mm in the ZrC group and 0.82 mm in the FCA group, with no significant difference between groups. These encouraging preliminary results need to be confirmed with long-term follow-up on larger study samples.
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http://dx.doi.org/10.11607/ijp.5305DOI Listing
November 2018

Design and validation of a DNA-microarray for phylogenetic analysis of bacterial communities in different oral samples and dental implants.

Sci Rep 2017 07 24;7(1):6280. Epub 2017 Jul 24.

Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy.

The quali-quantitative characterization of the oral microbiota is crucial for an exhaustive knowledge of the oral ecology and the modifications of the microbial composition that occur during periodontal pathologies. In this study, we designed and validated a new phylogenetic DNA-microarray (OralArray) to quickly and reliably characterize the most representative bacterial groups that colonize the oral cavity. The OralArray is based on the Ligation Detection Reaction technology associated to Universal Arrays (LDR-UA), and includes 22 probe sets targeted to bacteria belonging to the phyla Firmicutes, Proteobacteria, Actinobacteria, Bacteroidetes, Fusobacteria, and Spirochaete. The tool is characterized by high specificity, sensitivity and reproducibility. The OralArray was successfully tested and validated on different oral samples (saliva, lingual plaque, supragingival plaque, and healing cap) collected from 10 healthy subjects. For each specimen, a microbial signature was obtained, and our results established the presence of an oral microbial profile specific for each subject. Moreover, the tool was applied to evaluate the efficacy of a disinfectant treatment on the healing caps before their usage. The OralArray is, thus, suitable to study the microbiota associated with various oral sites and to monitor changes arising from therapeutic treatments.
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http://dx.doi.org/10.1038/s41598-017-06743-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5524749PMC
July 2017

Stratification of prosthetic complications by manufacturer in implant-supported restorations with a 5 years' follow-up: systematic review of the literature.

Minerva Stomatol 2017 Aug 31;66(4):178-191. Epub 2017 May 31.

Department of Biomedical Sciences, Surgery and Dentistry, University of Milan, Milan, Italy.

Introduction: Prosthetic complications on implant-supported restorations have been documented in several papers published in the literature. Several manufacturers are present on the market but results are often cumulated and may thus be misleading. The objective of the present review is to assess the prosthetic complications of implant-supported restorations with particular interest of the results obtained with prostheses from different manufacturers.

Evidence Acquisition: A manual search of Medline/PubMed was carried out up to June 2016, yielding a total of 6832 articles, which were narrowed down to 1450, then 347 abstracts to include 55 papers after full text reading. Papers with at least 5 years of follow-up reporting on prosthetic complications of single and fixed partial prosthesis were included. Prosthetic complications were divided into mechanical and technical complications, and reported in a table.

Evidence Synthesis: Overall 14.4% of prosthetic complication was found for a total of 6623 restorations followed for an average of 7.4 years (range 5-16 years). Results where then sorted and compared. Single crowns were affected by 1.4% of mechanical complications and 10.9% of technical complications after a mean of 7.4 years. Fixed partial prosthesis were affected by 2.5% of mechanical complications and 18% of technical complications. Screw-retained and cemented restorations were calculated to have a 5 years rate of complications of 21.2% and 9.3%, respectively, which demonstrated a statistically difference with fisher exact test with P<0.1. Only 3 manufacturers presented more than 10 articles and were directly compared with Fisher's exact test with P<0.1. The incidence of overall complications was estimated to be after 5 years of 11.2%, 10.8% and 13.8% for Straumann, Nobel, and Astratech, respectively, but dividing results in mechanical and technical complications, gave different results. Straumann was estimated to have less mechanical complications after 5 years in respect to Nobel and Astratech, but the three were similar for technical complications.

Conclusions: although studies present very different material and methods and do not report all data, some conclusions can be made. The difference between mechanical complications lead the authors to suppose that there might be a difference in results obtained by different implant abutment connections. It is also noticed that all papers were published by expert clinicians and universities research centers that apply rigid surgical and prosthetic protocols and use original abutments.
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http://dx.doi.org/10.23736/S0026-4970.17.04019-5DOI Listing
August 2017

Small-diameter titanium grade IV and titanium-zirconium implants in edentulous mandibles: five-year results from a double-blind, randomized controlled trial.

BMC Oral Health 2015 Oct 12;15(1):123. Epub 2015 Oct 12.

Division of Gerodontology and Removable Prosthodontics, University of Geneva, Geneva, Switzerland.

Background: The aim of this study was to compare the 5-year survival and success rates of 3.3 mm dental implants either made from titanium-zirconium (TiZr) alloy or from Grade IV titanium (Ti Grade IV) in mandibular implant-based removable overdentures.

Methods: The core study had a follow-up period of 36 months and was designed as a randomized, controlled, double-blind, split-mouth multicenter clinical trial. Patients with edentulous mandibles received two Straumann Bone Level implants (diameter 3.3 mm, SLActive®), one of TiZr (test) and one of Ti Grade IV (control), in the interforaminal region. This follow-up study recruited patients from the core study and evaluated the plaque and sulcus bleeding indices, radiographic crestal bone level, as well as implant survival and success 60 months after implant placement.

Results: Of the 91 patients who initially received implants, 75 completed the 36 month follow-up and 49 were available for the 60 month examination. Two patients were excluded so that a total of 47 patients with an average age of 72 ± 8 years were analysed. The characteristics and 36-month performance of the present study cohort did not differ from the non-included initial participants (p > 0.05). In the period since the 36-month follow-up examination, no implant was lost. The cumulative implant survival rate was 98.9 % for the TiZr group and 97.8 % for the Ti Grade IV group. Crestal bone level changes at 60 months were not different in the test and control group (TiZr -0.60 ± 0.69 mm and Ti Grade IV -0.61 ± 0.83 mm; p = 0.96). The cumulative implant success rate after 60 months was 95.8 and 92.6 % for TiZr and Ti Grade IV, respectively.

Conclusions: After 60 months, the positive outcomes of the 36 month results for TiZr and Ti Grade IV implants were confirmed, with no significant differences with regard to crestal bone level change, clinical parameters and survival or success rates. TiZr implants performed equally well compared to conventional Ti Grade IV 3.3 mm diameter-reduced implants for mandibular removable overdentures.

Trial Registration: Registered on www.clinicaltrials.gov: NCT01878331.
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http://dx.doi.org/10.1186/s12903-015-0107-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4603635PMC
October 2015

Use of short implants (6 mm) in a single-tooth replacement: a 5-year follow-up prospective randomized controlled multicenter clinical study.

Clin Oral Implants Res 2016 Apr 18;27(4):458-64. Epub 2015 Feb 18.

Center for Dental Medicine, University of Zurich, Zurich, Switzerland.

Objective: To evaluate prospectively clinical and radiographic outcomes of 6- or 10 mm-long implants with moderately rough surface (SLA(®) ) loaded within 7 weeks from installation and supporting single crowns in the posterior regions in the course of 5 years of loading.

Material And Methods: Sixty implants with a moderately rough surface, 30 tests (6 mm long, 4.1 mm in diameter) and 30 controls (10 mm long, 4.1 mm in diameter), were placed in posterior regions in 45 patients. After 6 weeks, impressions were taken and the implants were restored with a single fixed prosthesis made with gold-palladium alloy and porcelain. Survival rate and marginal bone loss were evaluated yearly. The clinical crown/implant ratio was calculated.

Results: During the follow-up period, five implants, four tests and one control, were lost. Of the four test implants, one was lost before loading, two between the 2nd and the 3rd years, and one during the 4th year of the follow-up period. The control implant was lost during the first year of function. Consequently, after 5 years of follow-up, a survival rate of 86.7% and 96.7% was observed at the test and control sites, respectively.

Conclusion: The results of this study showed that 6-mm-long implants supporting single crowns loaded within 7 weeks from installation lose a small amount of marginal bone during 5 years of functional loading, similar to that of 10-mm-long implants. However, a higher degree of implant loss was recorded at the short implants, probably due to the fracturing of the surrounding bone.
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http://dx.doi.org/10.1111/clr.12564DOI Listing
April 2016

Six-mm versus 10-mm long implants in the rehabilitation of posterior edentulous jaws: a 5-year follow-up of a randomised controlled trial.

Eur J Oral Implantol 2014 ;7(4):371-81

Purpose: To compare the clinical outcome of 6-mm and 10-mm long implants in partially edentulous posterior areas.

Materials And Methods: Twenty-four patients, with a partially edentulous area in the jaws with a height and width allowing the positioning of 2 to 3 adjacent 10 × 4.1 mm implants without any augmentation procedure, were randomly allocated according to a parallel group design to receive 6-mm long or 10-mm long implants. A total of 54 implants were placed (26 × 6 mm and 28 × 10 mm implants). Patients were restored 8 weeks after surgery and were followed for 5 years. Outcome measures were prosthesis and implant survival, as well as marginal bone level changes and complications.

Results: After 5 years, 18 patients were available. One 6 mm implant failed during the healing period and its related prosthesis could not be placed. No implants were lost after loading. The 6 mm group registered 5 complications (1 mucositis, 3 prosthesis decementations and 1 chipping), while only 3 were registered in the 10 mm group (2 decementations and 1 chipping). The difference in complications between the two groups was not statistically significant (P = 0.39). Marginal bone loss at 5 years was 0.43 and 0.24 mm with the 6 mm and 10 mm groups, respectively (not statistically significant; difference between the two groups 0.19 mm; SD 0.23 mm; 95% CI -0.34;0.73; t test P = 0.42).

Conclusions: Implant and prosthetic survival and success rates were similar between prostheses supported by 6-mm or 10-mm long implants.
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February 2015

Small-diameter titanium Grade IV and titanium-zirconium implants in edentulous mandibles: three-year results from a double-blind, randomized controlled trial.

Clin Oral Implants Res 2015 Jul 9;26(7):831-40. Epub 2014 Apr 9.

University of Milan Dental Clinic, San Paolo Hospital, Milan, Italy.

Objective: The aim of this study was to compare crestal bone-level changes, soft tissue parameters and implant success and survival between small-diameter implants made of titanium/zirconium (TiZr) alloy or of Grade IV titanium (Ti) in edentulous mandibles restored with removable overdentures.

Materials And Methods: This was a randomized, controlled, double-blind, split-mouth multicenter clinical trial. Patients with edentulous mandibles received two Straumann bone-level implants (diameter 3.3 mm), one of Ti Grade IV (control) and one of TiZr (test), in the interforaminal region. Implants were loaded after 6-8 weeks and removable Locator-retained overdentures were placed within 2 weeks of loading. Modified plaque and sulcus bleeding indices, radiographic bone level, and implant survival and success were evaluated up to 36 months.

Results: Of 91 treated patients, 75 completed the three-year follow-up. Three implants were lost (two control and one test implant). The survival rates were 98.7% and 97.3%, and the mean marginal bone level change was -0.78 ± 0.75 and -0.60 ± 0.71 mm for TiZr and Ti Grade IV implants. Most patients had a plaque score of 0 or 1 (54% for test and 51.7% for control), and a sulcus bleeding score of 0 (46.1% for test and 44.9% for control). No significant differences were found between the two implant types for bone-level change, soft tissue parameters, survival and success.

Conclusions: After 36 months, similar outcomes were found between Ti Grade IV and TiZr implants. The results confirm that the results seen at 12 months continue over time.
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http://dx.doi.org/10.1111/clr.12367DOI Listing
July 2015

Histological evaluation of the peri-implant tissues of three human-retrieved Straumann implants.

J Investig Clin Dent 2011 Aug 15;2(3):216-20. Epub 2011 Mar 15.

Department of Human Morphology and Biomedical Sciences "Città Studi", Università degli Studi di Milano, Milan, Italy Dental Clinic, Department of Medicine, Surgery and Dentistry, Università degli Studi di Milano, Milan, Italy.

The most frequently-used histological parameters to define dental implant osseointegration include bone-to-implant contact and quantitative and qualitative assessments of the surrounding tissue (rate of mineralized/non-mineralized tissue and proportion of lamellar and woven bone compared to soft tissue or bone marrow). The aim of this paper was to present the histological features of the bone tissue surrounding three well-functioning Straumann SLA and SLActive implants placed in two patients after 12 and 60 months of loading. The percentage of osseointegration ranged from 66.4% and 71.9% for SLA surfaces, to 88.3% for the SLActive implant. Such results confirm that osseointegration occurs with high rates of bone-to-implant contact in humans, and that implants can be similarly clinically successful, although they show different bone-to-implant contact values.
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http://dx.doi.org/10.1111/j.2041-1626.2011.00052.xDOI Listing
August 2011

Rehabilitation of a dentate mandible requiring a full arch rehabilitation. Immediate loading of a fixed complete denture on 8 implants placed with a bone-supported surgical computer-planned guide: a case report.

J Oral Implantol 2011 Mar;37 Spec No:106-13

University of Milan, Dental Clinic, Department of Implantology and Prosthodontics, San Paolo Hospital, Milan, Italy.

The use of technologies that merge computerized tomography X-ray imaging and 3-dimensional (3D) planning software allow the surgeon to digitally elaborate on the computer the position, length, and diameter of every implant to be placed. Following this approach, the placement is guided in a 3D digital model, and the implants are placed in the final position avoiding eventual anatomic structures. In this case report, the patient's remaining mandibular teeth were extracted, and the patient received 8 implants with the help of a computer surgical guide. The case was planned using SimPlant and a bone-supported guide. Because of the high precision of the planning, it was possible to realize a provisional rehabilitation before the actual surgery. The planning allows placement of parallel implants to optimize the prosthetic procedure and outcome. An immediate provisional implant was fixed with a flow composite on the temporary abutments and then refined in the dental laboratory. The patient received the provisional rehabilitation the same day of the surgery. After 6 weeks of healing, the final impression was taken and the prosthesis was finalized with a computer-aided design/computer-aided manufacturing titanium full-arch screwed framework with composite veneering. A 6-month follow-up showed good integration of the prostheses and success of all 8 implants. The use of surgical computer-guided planning changes the surgeon's approach: whereas before the use of conventional guides permitted a certain degree of offset from what was planned, the use of computer guides allows the implant to be inserted in a far more precise way. It is obvious that careful planning is the key factor to avoid implant misplacement.
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http://dx.doi.org/10.1563/AAID-JOI-D-10-00059DOI Listing
March 2011

A double-blind randomized controlled trial (RCT) of Titanium-13Zirconium versus Titanium Grade IV small-diameter bone level implants in edentulous mandibles--results from a 1-year observation period.

Clin Implant Dent Relat Res 2012 Dec 17;14(6):896-904. Epub 2011 Mar 17.

Johannes-Gutenberg University, Mainz, Germany.

Background: The use of endosseous dental implants has become common practice for the rehabilitation of edentulous patients, and a two-implant overdenture has been recommended as the standard of care. The use of small-diameter implants may extend treatment options and reduce the necessity for bone augmentation. However, the mechanical strength of titanium is limited, so titanium alloys with greater tensile and fatigue strength may be preferable.

Purpose: This randomized, controlled, double-blind, multicenter study investigated in a split-mouth model whether small-diameter implants made from Titanium-13Zirconium alloy (TiZr, Roxolid™) perform at least as well as Titanium Grade IV implants.

Methods And Materials: Patients with an edentulous mandible received one TiZr and one Ti Grade IV small-diameter bone level implant (3.3 mm, SLActive®) in the interforaminal region. The site distribution was randomized and double-blinded. Outcome measures included change in radiological peri-implant bone level from surgery to 12 months post-insertion (primary), implant survival, success, soft tissue conditions, and safety (secondary).

Results: Of 91 treated patients, 87 were available for the 12-month follow-up. Peri-implant bone level change (-0.3 ± 0.5 mm vs -0.3 ± 0.6 mm), plaque, and sulcus bleeding indices were not significantly different between TiZr and Ti Grade IV implants. Implant survival rates were 98.9 percent and 97.8 percent, success rates were 96.6 percent and 94.4 percent, respectively. Nineteen minor and no serious adverse events were related to the study devices.

Conclusion: This study confirms that TiZr small-diameter bone level implants provide at least the same outcomes after 12 months as Ti Grade IV bone level implants. The improved mechanical properties of TiZr implants may extend implant therapy to more challenging clinical situations.
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http://dx.doi.org/10.1111/j.1708-8208.2010.00324.xDOI Listing
December 2012

Surgical and prosthetic management of interproximal region with single-implant restorations: 1-year prospective study.

J Periodontol 2008 Jun;79(6):1048-55

Department of Prosthodontics, Dental Clinic, School of Dentistry, University of Milan, Via Beldiletto 1/3, Milan, Italy.

Background: Gingival esthetics around dental implants have become a main focus for clinicians. This study analyzed the surgical, prosthetic, and anatomic factors involved in the management of peri-implant tissues.

Methods: Forty-eight subjects with one tooth scheduled for tooth extraction and immediate implant placement were included in the study. After healing, the implants were restored with single-crown fixed prostheses. The following parameters were assessed after 12 months: presence/absence of the interproximal papilla, interimplant-tooth distance (ITD), distance from the base of the contact point to the interdental bone (CPB), and soft tissue biotype. ITD and CPB values were derived from computer analysis of periapical radiographs. A statistical analysis determined the effect of ITD and CPB on the presence of the interproximal papilla.

Results: Papilla was significantly present (P <0.05) for ITD of 2.5 to 4 mm in anterior and posterior areas and for CPB < or =7 mm in posterior areas. Thick biotype was significantly associated (P <0.05) with the presence of the papilla.

Conclusions: The combination of surgical and prosthetic plans represents the key factor to optimize predictability in single-implant esthetics. The recommended interproximal distance between the implant and the adjacent tooth is 2.5 to 4 mm. The distance from the contact point to the interdental bone is recommended to be <7 mm. Papilla presence is also correlated with a thick gingival biotype.
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http://dx.doi.org/10.1902/jop.2008.070431DOI Listing
June 2008