The aim of this simulation study to evaluate stresses induced on supporting implants by different... more The aim of this simulation study to evaluate stresses induced on supporting implants by different framework materials BioHPP and PEKK in mandibular implant supported fixed-detachable prosthesis following all-on-4 concept using strain gauge analysis. Material and methods: For this study, 3D printed model simulating completely edentulous mandibular arch with4implants placed in all-on-4 configuration to support fixed-detachable prosthesis were constructed. According to framework material of screw-retained fixed-detachable prosthesis: Model I: framework made from Bio-High Performance Polyether (BioHPP) while Model II: framework made from Poly-ether-ketone-ketone (PEKK). Strain gauges were installed at mesial of central implants and distal to distal implants. Bilateral and unilateral load was applied starting from 0-60 N. Microstrains were recorded at each strain gauge with enough time elapsed between tests. The process was repeated 5times for each group, average strains were recorded and statistically analyzed. Results: Individually results for both models showed unilateral loading induced more stresses compared to bilateral loading. Statistical significant higher microstrains were induced at distal of distal implants than mesial of central ones in both unilateral and bilateral loading. Comparing the two models although less stresses were detected in model II (PEKK framework) compared to model I (BioHPP framework) statistical analysis of data revealed significant difference at distal aspect of distal implants in both unilateral and bilateral loading. Conclusion: Within limitation of this simulation study, using polyether-ketone-ketone (PEKK) for constructing the framework of prosthesis lead to favorable stress distribution and reduces stresses induced to supporting implants. Further clinical studies are required to confirm this finding.
Background: An accurate fit at the implant-abutment connection is a key factor to preclude biolog... more Background: An accurate fit at the implant-abutment connection is a key factor to preclude biological and mechanical complications. Purpose: The aim of this study was to compare marginal bone level (MBL), modified sulcus bleeding index (mSBI), simplified gingival index (sGI), modified plaque index (mPI) and prosthetic maintenance in conical and trilobe implant-abutment connections (IACs) in mandibular implant assisted overdenture during 3 years in service. Materials and method: new complete dentures were constructed for fourteen completely edentulous patients. After 3 months of use and adaption to their new denture, 28 implants were inserted such that 14 implants with conical implant-abutment connection (group I) and 14 implants with trilobe implant-abutment connection (group II). Split mouth design was used for all patients participated in this study. Statistical software was used to randomly assign which type of connection to be inserted intraorally in the two contralateral sides for each patient. The implants were inserted in the mandibular canine region using two-stage surgical technique and following conventional loading protocol. After 3 months, each patient received two ball and socket attachments; and pick up was done to the denture fitting surface. The MBL, mSBI, sGI, mPI, and prosthetic complications and maintenance requirements for each group of implants were evaluated at loading time, after 6, 12, 24, and 36 months follow up visits. Data were collected, organized, tabulated, and statistically analyzed. Results: The implant survival rate at the end of follow up period in conical and trilobe IAC groups were 100% and 92.8% respectively. On comparing MBL in both groups, no significant difference was found at 0-6 months, while at the 0-12 and 0-36 follow up periods a significant (2544)
The International Arabic Journal of Antimicrobial Agents, Jun 3, 2022
Objective: Emergence of COVID-19 infection and its persistence globally for three years in a row ... more Objective: Emergence of COVID-19 infection and its persistence globally for three years in a row (2020-2022) entailed several modifications in healthcare services, among which drug prescribing was an important outcome. This review aims to highlight changing trends in azithromycin prescribing during pandemic years.
Egyptian Journal of Oral & Maxillofacial Surgery, Apr 1, 2022
The advantages of this treatment option that implants are placed in high density bone, tilting th... more The advantages of this treatment option that implants are placed in high density bone, tilting the two distal implants permits the use of longer implants, enhanced more distal position of the abutments with prosthetic support of shorter cantilever extension, enhanced interimplant distance and increased anchorage to bone [3-5] Distal implants angulation facilitates for the surgeon to avoid the critical anatomical structures. Biomechanically,
Purpose: The aim of this study was to evaluate and compare two different implant locations in pre... more Purpose: The aim of this study was to evaluate and compare two different implant locations in premolar and molar regions in mandibular implant assisted partial overdentures restoring Kennedy class I cases. The parameters of evaluation were the peri-implant bone level changes, pocket depth around the last abutment and patient's satisfaction with the prosthesis. Materials and method: Twenty-eight partially edentulous patients with lower bilateral free-end saddle, having first premolar the last standing tooth opposed to dentate maxillary arch, were selected. For all patients chromium cobalt partial denture was constructed following the conventional steps. Proper planning for implant placement bilaterally was made, where participants were randomly allocated into two groups. In group I; the implant was placed in the premolar area while in group II; the implant was placed in the second molar area. Implants were inserted using two-stage surgical technique following the conventional loading protocol. After 3 months, implants were exposed and the attachments were picked up to the denture base fitting surface using self-cure acrylic resin and implant assisted partial overdenture was delivered. Pocket depth around the last abutment and peri-implant marginal bone height were evaluated at loading time, after 6, 9, 12 and 18 months follow up visits. In addition participants answered patient's satisfaction questionnaire in the sixth month follow up visit. Data collected were statistically analyzed. Results: Results showed statistically significant higher mean bone loss around the implants in group I compared to group II at measurements after 6m, 9m, 12m and 18m. In addition, group II showed statistically significantly higher mean pocket depth compared to group I at measurements after 6m and 18m. Visual analogue scale showed a statistically significant higher pain score in group II compared to group I regarding the mastication.
Objectives: This research was carried out to evaluate the effect of bio-modulation of the osteoto... more Objectives: This research was carried out to evaluate the effect of bio-modulation of the osteotomy site with Er,Cr:YSGG LASER on peri-implant crestal bone level changes in cases having edentulous mandible opposed with maxillary natural teeth rehabilitated with fixed detachable prosthesis constructed from BioHPP (High Performance Polymer) using CAD/CAM technology. Materials and Methods: This is a split mouth design study in which ten male patients exhibiting completely edentulous mandibular arch opposed by dentate maxillary arch were rehabilitated with fixed detachable lower single denture supported by six dental implants constructed from BioHPP. The osteotomy segment bio-modulated using Er,Cr:YSGG (2790 nm) LASER was randomly selected and considered as the study group while the other segment (non laser mediated osteotomy) as the control group. Lower single complete dentures were constructed to all participants following the same basic principles. All patients were rehabilitated with fixed detachable lower dentures using Computer-aided design/computer-aided manufacturing (CAD/CAM) technology supported by six dental implants. The application of 3 dimensional (3D) imaging (computerized tomography scan), 3D software for proper treatment planning, and fabrication of computer-generated surgical guides using additive prototyping were followed for all patients. Surgical installation of the implants was performed under strict aseptic conditions The selected osteotomy segment (study group) was biomodulated using Er,Cr:YSGG (2790 nm) LASER and the implants were immediately loaded using the modified existing denture. After 3 months, the patients were scheduled for construction of the definitive prosthesis from which milling was performed in BioHPP polyether-ether ketone (PEEK) disc material. Peri-implant crestal bone level changes were assessed using digital periapical radiographs taken with the standardized long cone paralleling technique at six, twelve and eighteen months after loading. Data collected were statistically analyzed using (ANOVA-test P < 0.05).
Egyptian Journal of Oral and Maxillofacial Surgery
The advantages of this treatment option that implants are placed in high density bone, tilting th... more The advantages of this treatment option that implants are placed in high density bone, tilting the two distal implants permits the use of longer implants, enhanced more distal position of the abutments with prosthetic support of shorter cantilever extension, enhanced interimplant distance and increased anchorage to bone [3-5] Distal implants angulation facilitates for the surgeon to avoid the critical anatomical structures. Biomechanically,
Egyptian Journal of Oral and Maxillofacial Surgery
The objective of this study was to compare the use of BioHPP and zirconia CAD/CAM fabricated mate... more The objective of this study was to compare the use of BioHPP and zirconia CAD/CAM fabricated materials in implant supported maxillary fixed-detachable prosthesis opposing dentate mandibular arch, where peri-implants bone level changes were evaluated for two years. Materials and method: Ten patients with edentulous single maxilla opposing dentate mandibular arch were selected to share in this study. For all patients, proper planning for implant placement was made where the participants were randomly allocated into two groups five patients in each group. Six implants were inserted guided by the sterolithographic surgical guide following flapless surgical approach. Immediate loading protocol was followed, where the milled acrylic temporary prosthesis, which was planned for each patient according to the computer software, was screwed to the implants. After 4 months, the final restoration was placed according to the following grouping. In group I, patients were rehabilitated with fixed-detachable zirconium restoration while in group II patients were rehabilitated with fixed-detachable BioHpp Peek restoration. Peri-implant marginal bone changes were evaluated at loading time, after 6 month, 1 and 2 years follow up visits. Data collected were tabulated and statistically analyzed. Results: In intragroup comparisons, peri implant bone loss was significant. Where in group I, the mean value of peri-implant bone height change measures from implants insertion to 6 month was 0.35 mm, from insertion to 12 months was 0.62 mm while from insertion to 24 months follow up was found to be 0.96 mm. While in group II at same time intervals were 0.39 mm, 0.69 mm and 1.23 mm respectively. On the other hand in intergroup comparison, to compare the mean amount of peri-implant bone height changes in the two studied groups during the follow up intervals, student t test was performed and showed that group II had a non significant higher bone loss. Conclusion: Based on these results and within the limitation of this study. Both Zirconia and BioHpp when used as framework material for fixed-detachable maxillary single prosthesis had successful results on the supporting implants. However, BioHpp fixed-detachable prosthesis had higher effect on the peri-implant marginal bone loss but it was not of statistical significance.
The researchers investigated the influence of low-level laser irradiation (LLLI) on implant stabi... more The researchers investigated the influence of low-level laser irradiation (LLLI) on implant stability and marginal bone of small-diameter implants retaining mandibular overdentures in patients with moderately controlled diabetes. Twenty patients (mean age ¼ 59.32 6 4.1 years) with moderately controlled diabetes mellitus (glycated hemoglobin A1c [HbA1c] ¼ 8.1%-10.0 %) were rehabilitated by maxillary and mandibular conventional dentures. Two small-diameter implants (3 3 12 mm) were inserted in the canine areas of the mandible and immediately loaded by mandibular dentures. In a split-mouth design, LLLI was applied to 1 of the 2 implants in a random order (study group [SG]); the other implant was left as a control (control group [CG]). For each patient, gallium aluminum-arsenide diode low-level laser (940-nm wavelength, 0.50 6 2 mW output power, 0.004 cm 2 spot size; Epic, Biolase, Inc, San Clemente, Calif) was applied around each implant with total delivered energy of 90 J (equally divided by 6 irradiation points) in 3 sessions. The application was done immediately after implant insertion, 3 days and 1 week after surgery. Implant stability (measured by Periotest) and marginal bone loss (MBL; measured by cone beam computerized tomography) were evaluated at implant loading (T1), 6 months (T6), and 12 months (T12). One implant failed in the CG and no failures occurred in the SG, resulting in 95% and 100% survival rates, respectively. The SG recorded higher Periotest values than the CG at all observation times. However, the difference was significant (P ¼ .039) at T6 only. The SG recorded lower MBL values than the CG. No difference in MBL was detected between groups or peri-implant sites (mesial, distal, buccal, and lingual) at T6 and T12. Within the limits of this study, LLLI had no effect on marginal bone around immediately loaded small-diameter implants retaining overdentures in patients with moderately controlled diabetes. However, it was beneficial in improving implant stability 6 months after overdenture insertion.
Purpose: This study aimed to compare two treatment modalities; All on four fixed prostheses and l... more Purpose: This study aimed to compare two treatment modalities; All on four fixed prostheses and locator retained overdentures; to rehabilitate patients having problems associated with edentulous maxilla opposing mandibular implant assisted overdentures. Materials and methods: Ten patients complaining from looseness and instability of their maxillary dentures that oppose mandibular 2-implant-retained overdentures were randomly divided into 2 groups: Group I included 5 patients who received four implants according to the All-on-four Concept (2 parallel middle implants and 2 posterior implants with distal inclination). Implants were immediately loaded with fixed acrylic prosthesis, then after 6 months the prosthesis was replaced with fixed ceramometal restoration, Group II, included 5 patients who received four implants that were immediately loaded with Locator retained maxillary overdentures using new maxillary dentures. Clinical (plaque index (PI), gingival index (GI), probing depth (PD) and implant stability (IS)) and radiographic (marginal bone loss (MBL) outcomes were recorded at baseline (T0), 6 (T6) and 12 (T12) month after prosthesis insertion. Results: PI, GI, PD, IS, and MBL increased significantly by time for the fixed prosthesis group. PD, IS, and MBL increased significantly by time for the overdenture group. However no significant difference between observation times was noted for PI, and GI in the overdenture group. The fixed detachable prosthesis group recorded significant higher PI, GI, PD, and MBL than overdenture group after 6 (T6) and 12 month (T12) of prosthesis insertion. Conclusion: Within the limitations of this short-term study, maxillary implant overdentures can be recommended to rehabilitate the edentulous maxilla opposed by implant assisted mandibular overdentures as it is associated with favorable clinical and radiographical outcomes compared to all on four fixed prostheses.
Objectives: This research was carried out to evaluate the effect of different degree of resilienc... more Objectives: This research was carried out to evaluate the effect of different degree of resiliency of ERA attachment; white and grey nylon male components in mini-implant retained mandibular overdenture on the peri-implant crestal bone level. Materials and Methods: Twenty completely edentulous patients with maladaptive experience of wearing mandibular dentures were selected to participate in this study. Patients participating in this study were rehabilitated by maxillary complete denture and implant retained mandibular overdenture by four mini-implants with ERA head abutments. For all selected patients four mini implants 2.2 mm in diameter and 14 mm in length (ZIMMER ERA) were inserted in the interforaminal area following the non-submerged flapless surgical approach with the help of a modified transparent acrylic template. Standard clinical and laboratory techniques were followed for denture construction for all patients. Patients were randomly divided into two equal groups according to the resiliency of the male nylon insert. A white replacement insert was seated into the metal housing for group I, while a grey replacement insert was used for group II. Mesial, distal, buccal and lingual marginal bone height around the mini implants were evaluated, using the linear measurement system of the software (Ondemand 3D) with flat panel detector supplied by the cone beam CT. The measurements were carried out at the end of each follow-up appointment (at overdenture insertion, 6, 12 and 18 months post insertion). The marginal bone loss at different intervals was obtained by calculating the difference in bone height at that interval from the base line measurement and statistically analyzed. Results: The results of this study showed that there was statistically significant increase in the marginal bone height loss around the mini implants in both groups at the end of 18 months follow up. Comparing the two studied retentive elements of ERA attachment; statistically significant difference between the two groups was found at the end of 18 months follow up period, where group I showed less bone resorption in comparison to group II. There was also significant difference between both groups concerning the distal and the labial surfaces after 18 months.
This article investigated the influence of Low-Level Laser Irradiation (LLLI) on implant stabilit... more This article investigated the influence of Low-Level Laser Irradiation (LLLI) on implant stability and marginal bone of small diameter implants retaining mandibular overdentures in moderately controlled diabetic patients. Twenty patients (mean age =59.32±4.1 years) with moderately controlled diabetes mellitus (HbA1c 8.1–10.0 %) were rehabilitated by maxillary and mandibular conventional dentures. Two small- diameter implants (3×12mm) were inserted in the canine areas of the mandible and immediately loaded by mandibular dentures. In a split mouth design, LLLI was applied to one of the two implants in a random order (study group, SG) and the other implant was left as a control (control group, CG). For each patient, Gallium aluminum-arsenide (GaAlAs) diode low-level laser (940 nm wavelength, 0.50±2 mW output power, .004 cm2 spot size, Epic Tm, Biolase®, Inc, San Clemente, California, USA) was applied around each implant with total delivered energy of 90 J (equally divided by 6 irradiat...
Open Access Macedonian Journal of Medical Sciences, 2016
AIM: This study aimed to estimate the stress patterns induced by the masticatory loads on a remov... more AIM: This study aimed to estimate the stress patterns induced by the masticatory loads on a removable prosthesis supported and retained by bar splinted implants placed in the reconstructed mandible with two different clip materials and without clip, in the fibula-jaw bone and prosthesis using finite element analysis.METHODS: Two 3D finite element models were constructed, that models components were modeled on commercial CAD/CAM software then assembled into finite element package. Vertical loads were applied simulating the masticatory forces unilaterally in the resected site and bilaterally in the central fossa of the lower first molar as 100N (tension and compression). Analysis was based on the assumption full osseointegration between different types of bones, and between implants and fibula while fixing the top surface of the TMJ in place.RESULTS: The metallic bar connecting the three implants is insensitive to the clips material. Its supporting implants showed typical behavior wit...
The aim of this simulation study to evaluate stresses induced on supporting implants by different... more The aim of this simulation study to evaluate stresses induced on supporting implants by different framework materials BioHPP and PEKK in mandibular implant supported fixed-detachable prosthesis following all-on-4 concept using strain gauge analysis. Material and methods: For this study, 3D printed model simulating completely edentulous mandibular arch with4implants placed in all-on-4 configuration to support fixed-detachable prosthesis were constructed. According to framework material of screw-retained fixed-detachable prosthesis: Model I: framework made from Bio-High Performance Polyether (BioHPP) while Model II: framework made from Poly-ether-ketone-ketone (PEKK). Strain gauges were installed at mesial of central implants and distal to distal implants. Bilateral and unilateral load was applied starting from 0-60 N. Microstrains were recorded at each strain gauge with enough time elapsed between tests. The process was repeated 5times for each group, average strains were recorded and statistically analyzed. Results: Individually results for both models showed unilateral loading induced more stresses compared to bilateral loading. Statistical significant higher microstrains were induced at distal of distal implants than mesial of central ones in both unilateral and bilateral loading. Comparing the two models although less stresses were detected in model II (PEKK framework) compared to model I (BioHPP framework) statistical analysis of data revealed significant difference at distal aspect of distal implants in both unilateral and bilateral loading. Conclusion: Within limitation of this simulation study, using polyether-ketone-ketone (PEKK) for constructing the framework of prosthesis lead to favorable stress distribution and reduces stresses induced to supporting implants. Further clinical studies are required to confirm this finding.
Background: An accurate fit at the implant-abutment connection is a key factor to preclude biolog... more Background: An accurate fit at the implant-abutment connection is a key factor to preclude biological and mechanical complications. Purpose: The aim of this study was to compare marginal bone level (MBL), modified sulcus bleeding index (mSBI), simplified gingival index (sGI), modified plaque index (mPI) and prosthetic maintenance in conical and trilobe implant-abutment connections (IACs) in mandibular implant assisted overdenture during 3 years in service. Materials and method: new complete dentures were constructed for fourteen completely edentulous patients. After 3 months of use and adaption to their new denture, 28 implants were inserted such that 14 implants with conical implant-abutment connection (group I) and 14 implants with trilobe implant-abutment connection (group II). Split mouth design was used for all patients participated in this study. Statistical software was used to randomly assign which type of connection to be inserted intraorally in the two contralateral sides for each patient. The implants were inserted in the mandibular canine region using two-stage surgical technique and following conventional loading protocol. After 3 months, each patient received two ball and socket attachments; and pick up was done to the denture fitting surface. The MBL, mSBI, sGI, mPI, and prosthetic complications and maintenance requirements for each group of implants were evaluated at loading time, after 6, 12, 24, and 36 months follow up visits. Data were collected, organized, tabulated, and statistically analyzed. Results: The implant survival rate at the end of follow up period in conical and trilobe IAC groups were 100% and 92.8% respectively. On comparing MBL in both groups, no significant difference was found at 0-6 months, while at the 0-12 and 0-36 follow up periods a significant (2544)
The International Arabic Journal of Antimicrobial Agents, Jun 3, 2022
Objective: Emergence of COVID-19 infection and its persistence globally for three years in a row ... more Objective: Emergence of COVID-19 infection and its persistence globally for three years in a row (2020-2022) entailed several modifications in healthcare services, among which drug prescribing was an important outcome. This review aims to highlight changing trends in azithromycin prescribing during pandemic years.
Egyptian Journal of Oral & Maxillofacial Surgery, Apr 1, 2022
The advantages of this treatment option that implants are placed in high density bone, tilting th... more The advantages of this treatment option that implants are placed in high density bone, tilting the two distal implants permits the use of longer implants, enhanced more distal position of the abutments with prosthetic support of shorter cantilever extension, enhanced interimplant distance and increased anchorage to bone [3-5] Distal implants angulation facilitates for the surgeon to avoid the critical anatomical structures. Biomechanically,
Purpose: The aim of this study was to evaluate and compare two different implant locations in pre... more Purpose: The aim of this study was to evaluate and compare two different implant locations in premolar and molar regions in mandibular implant assisted partial overdentures restoring Kennedy class I cases. The parameters of evaluation were the peri-implant bone level changes, pocket depth around the last abutment and patient's satisfaction with the prosthesis. Materials and method: Twenty-eight partially edentulous patients with lower bilateral free-end saddle, having first premolar the last standing tooth opposed to dentate maxillary arch, were selected. For all patients chromium cobalt partial denture was constructed following the conventional steps. Proper planning for implant placement bilaterally was made, where participants were randomly allocated into two groups. In group I; the implant was placed in the premolar area while in group II; the implant was placed in the second molar area. Implants were inserted using two-stage surgical technique following the conventional loading protocol. After 3 months, implants were exposed and the attachments were picked up to the denture base fitting surface using self-cure acrylic resin and implant assisted partial overdenture was delivered. Pocket depth around the last abutment and peri-implant marginal bone height were evaluated at loading time, after 6, 9, 12 and 18 months follow up visits. In addition participants answered patient's satisfaction questionnaire in the sixth month follow up visit. Data collected were statistically analyzed. Results: Results showed statistically significant higher mean bone loss around the implants in group I compared to group II at measurements after 6m, 9m, 12m and 18m. In addition, group II showed statistically significantly higher mean pocket depth compared to group I at measurements after 6m and 18m. Visual analogue scale showed a statistically significant higher pain score in group II compared to group I regarding the mastication.
Objectives: This research was carried out to evaluate the effect of bio-modulation of the osteoto... more Objectives: This research was carried out to evaluate the effect of bio-modulation of the osteotomy site with Er,Cr:YSGG LASER on peri-implant crestal bone level changes in cases having edentulous mandible opposed with maxillary natural teeth rehabilitated with fixed detachable prosthesis constructed from BioHPP (High Performance Polymer) using CAD/CAM technology. Materials and Methods: This is a split mouth design study in which ten male patients exhibiting completely edentulous mandibular arch opposed by dentate maxillary arch were rehabilitated with fixed detachable lower single denture supported by six dental implants constructed from BioHPP. The osteotomy segment bio-modulated using Er,Cr:YSGG (2790 nm) LASER was randomly selected and considered as the study group while the other segment (non laser mediated osteotomy) as the control group. Lower single complete dentures were constructed to all participants following the same basic principles. All patients were rehabilitated with fixed detachable lower dentures using Computer-aided design/computer-aided manufacturing (CAD/CAM) technology supported by six dental implants. The application of 3 dimensional (3D) imaging (computerized tomography scan), 3D software for proper treatment planning, and fabrication of computer-generated surgical guides using additive prototyping were followed for all patients. Surgical installation of the implants was performed under strict aseptic conditions The selected osteotomy segment (study group) was biomodulated using Er,Cr:YSGG (2790 nm) LASER and the implants were immediately loaded using the modified existing denture. After 3 months, the patients were scheduled for construction of the definitive prosthesis from which milling was performed in BioHPP polyether-ether ketone (PEEK) disc material. Peri-implant crestal bone level changes were assessed using digital periapical radiographs taken with the standardized long cone paralleling technique at six, twelve and eighteen months after loading. Data collected were statistically analyzed using (ANOVA-test P < 0.05).
Egyptian Journal of Oral and Maxillofacial Surgery
The advantages of this treatment option that implants are placed in high density bone, tilting th... more The advantages of this treatment option that implants are placed in high density bone, tilting the two distal implants permits the use of longer implants, enhanced more distal position of the abutments with prosthetic support of shorter cantilever extension, enhanced interimplant distance and increased anchorage to bone [3-5] Distal implants angulation facilitates for the surgeon to avoid the critical anatomical structures. Biomechanically,
Egyptian Journal of Oral and Maxillofacial Surgery
The objective of this study was to compare the use of BioHPP and zirconia CAD/CAM fabricated mate... more The objective of this study was to compare the use of BioHPP and zirconia CAD/CAM fabricated materials in implant supported maxillary fixed-detachable prosthesis opposing dentate mandibular arch, where peri-implants bone level changes were evaluated for two years. Materials and method: Ten patients with edentulous single maxilla opposing dentate mandibular arch were selected to share in this study. For all patients, proper planning for implant placement was made where the participants were randomly allocated into two groups five patients in each group. Six implants were inserted guided by the sterolithographic surgical guide following flapless surgical approach. Immediate loading protocol was followed, where the milled acrylic temporary prosthesis, which was planned for each patient according to the computer software, was screwed to the implants. After 4 months, the final restoration was placed according to the following grouping. In group I, patients were rehabilitated with fixed-detachable zirconium restoration while in group II patients were rehabilitated with fixed-detachable BioHpp Peek restoration. Peri-implant marginal bone changes were evaluated at loading time, after 6 month, 1 and 2 years follow up visits. Data collected were tabulated and statistically analyzed. Results: In intragroup comparisons, peri implant bone loss was significant. Where in group I, the mean value of peri-implant bone height change measures from implants insertion to 6 month was 0.35 mm, from insertion to 12 months was 0.62 mm while from insertion to 24 months follow up was found to be 0.96 mm. While in group II at same time intervals were 0.39 mm, 0.69 mm and 1.23 mm respectively. On the other hand in intergroup comparison, to compare the mean amount of peri-implant bone height changes in the two studied groups during the follow up intervals, student t test was performed and showed that group II had a non significant higher bone loss. Conclusion: Based on these results and within the limitation of this study. Both Zirconia and BioHpp when used as framework material for fixed-detachable maxillary single prosthesis had successful results on the supporting implants. However, BioHpp fixed-detachable prosthesis had higher effect on the peri-implant marginal bone loss but it was not of statistical significance.
The researchers investigated the influence of low-level laser irradiation (LLLI) on implant stabi... more The researchers investigated the influence of low-level laser irradiation (LLLI) on implant stability and marginal bone of small-diameter implants retaining mandibular overdentures in patients with moderately controlled diabetes. Twenty patients (mean age ¼ 59.32 6 4.1 years) with moderately controlled diabetes mellitus (glycated hemoglobin A1c [HbA1c] ¼ 8.1%-10.0 %) were rehabilitated by maxillary and mandibular conventional dentures. Two small-diameter implants (3 3 12 mm) were inserted in the canine areas of the mandible and immediately loaded by mandibular dentures. In a split-mouth design, LLLI was applied to 1 of the 2 implants in a random order (study group [SG]); the other implant was left as a control (control group [CG]). For each patient, gallium aluminum-arsenide diode low-level laser (940-nm wavelength, 0.50 6 2 mW output power, 0.004 cm 2 spot size; Epic, Biolase, Inc, San Clemente, Calif) was applied around each implant with total delivered energy of 90 J (equally divided by 6 irradiation points) in 3 sessions. The application was done immediately after implant insertion, 3 days and 1 week after surgery. Implant stability (measured by Periotest) and marginal bone loss (MBL; measured by cone beam computerized tomography) were evaluated at implant loading (T1), 6 months (T6), and 12 months (T12). One implant failed in the CG and no failures occurred in the SG, resulting in 95% and 100% survival rates, respectively. The SG recorded higher Periotest values than the CG at all observation times. However, the difference was significant (P ¼ .039) at T6 only. The SG recorded lower MBL values than the CG. No difference in MBL was detected between groups or peri-implant sites (mesial, distal, buccal, and lingual) at T6 and T12. Within the limits of this study, LLLI had no effect on marginal bone around immediately loaded small-diameter implants retaining overdentures in patients with moderately controlled diabetes. However, it was beneficial in improving implant stability 6 months after overdenture insertion.
Purpose: This study aimed to compare two treatment modalities; All on four fixed prostheses and l... more Purpose: This study aimed to compare two treatment modalities; All on four fixed prostheses and locator retained overdentures; to rehabilitate patients having problems associated with edentulous maxilla opposing mandibular implant assisted overdentures. Materials and methods: Ten patients complaining from looseness and instability of their maxillary dentures that oppose mandibular 2-implant-retained overdentures were randomly divided into 2 groups: Group I included 5 patients who received four implants according to the All-on-four Concept (2 parallel middle implants and 2 posterior implants with distal inclination). Implants were immediately loaded with fixed acrylic prosthesis, then after 6 months the prosthesis was replaced with fixed ceramometal restoration, Group II, included 5 patients who received four implants that were immediately loaded with Locator retained maxillary overdentures using new maxillary dentures. Clinical (plaque index (PI), gingival index (GI), probing depth (PD) and implant stability (IS)) and radiographic (marginal bone loss (MBL) outcomes were recorded at baseline (T0), 6 (T6) and 12 (T12) month after prosthesis insertion. Results: PI, GI, PD, IS, and MBL increased significantly by time for the fixed prosthesis group. PD, IS, and MBL increased significantly by time for the overdenture group. However no significant difference between observation times was noted for PI, and GI in the overdenture group. The fixed detachable prosthesis group recorded significant higher PI, GI, PD, and MBL than overdenture group after 6 (T6) and 12 month (T12) of prosthesis insertion. Conclusion: Within the limitations of this short-term study, maxillary implant overdentures can be recommended to rehabilitate the edentulous maxilla opposed by implant assisted mandibular overdentures as it is associated with favorable clinical and radiographical outcomes compared to all on four fixed prostheses.
Objectives: This research was carried out to evaluate the effect of different degree of resilienc... more Objectives: This research was carried out to evaluate the effect of different degree of resiliency of ERA attachment; white and grey nylon male components in mini-implant retained mandibular overdenture on the peri-implant crestal bone level. Materials and Methods: Twenty completely edentulous patients with maladaptive experience of wearing mandibular dentures were selected to participate in this study. Patients participating in this study were rehabilitated by maxillary complete denture and implant retained mandibular overdenture by four mini-implants with ERA head abutments. For all selected patients four mini implants 2.2 mm in diameter and 14 mm in length (ZIMMER ERA) were inserted in the interforaminal area following the non-submerged flapless surgical approach with the help of a modified transparent acrylic template. Standard clinical and laboratory techniques were followed for denture construction for all patients. Patients were randomly divided into two equal groups according to the resiliency of the male nylon insert. A white replacement insert was seated into the metal housing for group I, while a grey replacement insert was used for group II. Mesial, distal, buccal and lingual marginal bone height around the mini implants were evaluated, using the linear measurement system of the software (Ondemand 3D) with flat panel detector supplied by the cone beam CT. The measurements were carried out at the end of each follow-up appointment (at overdenture insertion, 6, 12 and 18 months post insertion). The marginal bone loss at different intervals was obtained by calculating the difference in bone height at that interval from the base line measurement and statistically analyzed. Results: The results of this study showed that there was statistically significant increase in the marginal bone height loss around the mini implants in both groups at the end of 18 months follow up. Comparing the two studied retentive elements of ERA attachment; statistically significant difference between the two groups was found at the end of 18 months follow up period, where group I showed less bone resorption in comparison to group II. There was also significant difference between both groups concerning the distal and the labial surfaces after 18 months.
This article investigated the influence of Low-Level Laser Irradiation (LLLI) on implant stabilit... more This article investigated the influence of Low-Level Laser Irradiation (LLLI) on implant stability and marginal bone of small diameter implants retaining mandibular overdentures in moderately controlled diabetic patients. Twenty patients (mean age =59.32±4.1 years) with moderately controlled diabetes mellitus (HbA1c 8.1–10.0 %) were rehabilitated by maxillary and mandibular conventional dentures. Two small- diameter implants (3×12mm) were inserted in the canine areas of the mandible and immediately loaded by mandibular dentures. In a split mouth design, LLLI was applied to one of the two implants in a random order (study group, SG) and the other implant was left as a control (control group, CG). For each patient, Gallium aluminum-arsenide (GaAlAs) diode low-level laser (940 nm wavelength, 0.50±2 mW output power, .004 cm2 spot size, Epic Tm, Biolase®, Inc, San Clemente, California, USA) was applied around each implant with total delivered energy of 90 J (equally divided by 6 irradiat...
Open Access Macedonian Journal of Medical Sciences, 2016
AIM: This study aimed to estimate the stress patterns induced by the masticatory loads on a remov... more AIM: This study aimed to estimate the stress patterns induced by the masticatory loads on a removable prosthesis supported and retained by bar splinted implants placed in the reconstructed mandible with two different clip materials and without clip, in the fibula-jaw bone and prosthesis using finite element analysis.METHODS: Two 3D finite element models were constructed, that models components were modeled on commercial CAD/CAM software then assembled into finite element package. Vertical loads were applied simulating the masticatory forces unilaterally in the resected site and bilaterally in the central fossa of the lower first molar as 100N (tension and compression). Analysis was based on the assumption full osseointegration between different types of bones, and between implants and fibula while fixing the top surface of the TMJ in place.RESULTS: The metallic bar connecting the three implants is insensitive to the clips material. Its supporting implants showed typical behavior wit...
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