Success and High Predictability of Intraorally …...Case Report Success and High Predictability of...
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Case Report Success and High Predictability of Intraorally Welded Titanium Bar in the Immediate Loading Implants Vaniel Fogli, 1 Michele Camerini, 1 Dorina Lauritano, 2 and Francesco Carinci 3 Private Practicing, Via Mariotti Franceschino n o , Ravenna, Italy Neuroscience and Biotechnology Department, University of Milano-Bicocca, Via Cadore n o , Monza, Italy Department of Morphology, Surgery and Experimental Medicine, Maxillofacial School, University of Ferrara, Via Fossato di Mortara n o , Ferrara, Italy Correspondence should be addressed to Dorina Lauritano; [email protected] Received February ; Revised April ; Accepted May ; Published May Academic Editor: Jamil Awad Shibli Copyright © Vaniel Fogli et al. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. e implants failure may be caused by micromotion and stress exerted on implants during the phase of bone healing. is concept is especially true in case of implants placed in atrophic ridges. So the primary stabilization and xation of implants are an important goal that can also allow immediate loading and oral rehabilitation on the same day of surgery. is goal may be achieved thanks to the technique of welding titanium bars on implant abutments. In fact, the procedure can be performed directly in the mouth eliminating possibility of errors or distortions due to impression. is paper describes a case report and the most recent data about long-term success and high predictability of intraorally welded titanium bar in immediate loading implants. 1. Introduction e technique of welding portions of intraoral prosthesis has demonstrated many advantages in clinical practise. In fact, the procedure can be performed directly in the mouth eliminating the possibility of errors or distortions due to impressions. In particular, the intraoral welding is very eec- tive in immediate loading of dental implants positioned in atrophic edentulous ridges. So, in case of immediate loading, adequate xation and stability of implants are very important conditions to prevent the risk of micromovements and loss of implants. In this context, a rigid splinting seems to have an important role in response of peri-implant tissues, since it is able to reduce stress exerted on implants. e immediate xation of more implants can be achieved by intraoral welding of abutments. Intraoral welding allows getting immediate retention of osseointegrated implants. e method consists in welding a titanium bar directly to the abutments in the oral cavity before the immediate loading. e main advantage of intraoral welding consists in placing denitive restoration on the same day of surgery, or few days later. In fact, the lack of stability and retention of denture is the main discomfort complained about by totally edentulous patients. Degidi and coll [–] have published numerous studies about immediate loading of multiple implants by welding a titanium bar directly on abutments in order to create a metal- reinforced temporary or denitive restoration. e results showed that one-piece implant is better than two-piece for intraoral welding. In Degidi and coll [] published a new method dened syncrystallization. is technique consists in splint- ing multiple implants with a rigid titanium bar welded on abutments. It presents the advantage of immediate restoration on the same day of surgery, stability, and retention of implants in the early stages of bone healing and less implant fractures due to reducing time of restoration []. Here we describe a case of atrophic mandible treated with ve implants and a welded bar. 2. Case Report A -year old female came to our clinic for an examination. e medical history did not reveal any systemic diseases Hindawi Publishing Corporation Case Reports in Dentistry Volume 2014, Article ID 215378, 5 pages http://dx.doi.org/10.1155/2014/215378
Transcript of Success and High Predictability of Intraorally …...Case Report Success and High Predictability of...
Case ReportSuccess and High Predictability of Intraorally Welded TitaniumBar in the Immediate Loading Implants
Vaniel Fogli,1 Michele Camerini,1 Dorina Lauritano,2 and Francesco Carinci3
! Private Practicing, Via Mariotti Franceschino no ", #"$%% Ravenna, Italy%Neuroscience and Biotechnology Department, University of Milano-Bicocca, Via Cadore no #", %$$&%Monza, Italy'Department of Morphology, Surgery and Experimental Medicine, Maxillofacial School, University of Ferrara,Via Fossato di Mortara no &%, Ferrara, Italy
Correspondence should be addressed to Dorina Lauritano; [email protected]
Received !" February #$!%; Revised !& April #$!%; Accepted &May #$!%; Published ##May #$!%
Academic Editor: Jamil Awad Shibli
Copyright © #$!% Vaniel Fogli et al. 'is is an open access article distributed under the Creative Commons Attribution License,which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
'e implants failure may be caused by micromotion and stress exerted on implants during the phase of bone healing.'is conceptis especially true in case of implants placed in atrophic ridges. So the primary stabilization and (xation of implants are an importantgoal that can also allow immediate loading and oral rehabilitation on the same day of surgery. 'is goal may be achieved thanksto the technique of welding titanium bars on implant abutments. In fact, the procedure can be performed directly in the moutheliminating possibility of errors or distortions due to impression.'is paper describes a case report and the most recent data aboutlong-term success and high predictability of intraorally welded titanium bar in immediate loading implants.
1. Introduction
'e technique of welding portions of intraoral prosthesishas demonstrated many advantages in clinical practise. Infact, the procedure can be performed directly in the moutheliminating the possibility of errors or distortions due toimpressions. In particular, the intraoral welding is very e)ec-tive in immediate loading of dental implants positioned inatrophic edentulous ridges. So, in case of immediate loading,adequate (xation and stability of implants are very importantconditions to prevent the risk of micromovements and loss ofimplants. In this context, a rigid splinting seems to have animportant role in response of peri-implant tissues, since it isable to reduce stress exerted on implants.
'e immediate (xation of more implants can be achievedby intraoral welding of abutments. Intraoral welding allowsgetting immediate retention of osseointegrated implants.'emethod consists in welding a titanium bar directly to theabutments in the oral cavity before the immediate loading.
'e main advantage of intraoral welding consists inplacing de(nitive restoration on the same day of surgery, orfew days later. In fact, the lack of stability and retention of
denture is the main discomfort complained about by totallyedentulous patients.
Degidi and coll [!–*] have published numerous studiesabout immediate loading of multiple implants by welding atitanium bar directly on abutments in order to create ametal-reinforced temporary or de(nitive restoration. 'e resultsshowed that one-piece implant is better than two-piece forintraoral welding.
In #$$" Degidi and coll [!] published a new methodde(ned syncrystallization. 'is technique consists in splint-ing multiple implants with a rigid titanium bar welded onabutments. It presents the advantage of immediate restorationon the same day of surgery, stability, and retention of implantsin the early stages of bone healing and less implant fracturesdue to reducing time of restoration [!].
Here we describe a case of atrophicmandible treated with(ve implants and a welded bar.
2. Case Report
A "+-year old female came to our clinic for an examination.'e medical history did not reveal any systemic diseases
Hindawi Publishing Corporation
Case Reports in Dentistry
Volume 2014, Article ID 215378, 5 pages
http://dx.doi.org/10.1155/2014/215378
# Case Reports in Dentistry
F,-./0 !: Panoramic X-ray with periodontal teeth.
and the patient con(rmed she did not take any kind ofmedication. 'e orthopantomography showed periodontalteeth which subsequently were extracted (Figure !). Beforeextraction, an impression was taken to perform a provisionaldenture. 'is device was not stable and she had a greatdiscomfort in speaking and eating. It was performed aConeBeam (Sirona ORTHOPHOS XG) to study the anatomyof themandible in relation to the position of the inferior alve-olar nerve. Based on the data collected we decided to place(ve implants to stabilize her denture. Two radiopaque mark-ers were inserted in the denture (Figure #) used as template.'en the patient was undermitted to another panoramic X-ray, wearing the dentures with markers, and on this basis,a computer guided implantology surgery was programmedwith the appropriate so1ware (Figure 2). Subsequently theimplants were placed in the mandible in a computer guidedway. 'e anaesthesia of the mandibula was obtained by theinjection of articaine. Five implants (Dentalplanet Modena,Italy) were inserted, preparing sites with continuous phys-iological solution irrigation. A1er the surgical procedure(Figure %), (ve abutments with but joint connection werescrewed to the implants (Figure &). 'en, a bar previouslyconstructed by the dental technician (Figure ") was weldedintraorally (welding produced by Implamed srl. Cremona,Italy) (Figure +) in order to (x the position. 'e bar wasremoved from the mouth with the abutments (Figure *) andcovered with pink opaque (lm (Figure 3).'e prosthesis wasthen connected to the bar with acrylic resin (Figure !$) andtightening screws to abutments (Figure !!). 'e patient waschecked a1er two days and (1een days and during this periodno problems were noted (Figures !# and !2).
Patient was very satis(ed and no adverse e)ect wasdetected in the subsequent ! year follow-up (Figure !%).
3. Discussion
'e lack of stability and retention is responsible for oral com-plains associated with dentures. Besides, sometime implantrehabilitation of atrophic mandible may be impossiblebecause of insu4cient bone. Immediate loading implantswith de(nitive denture have demonstrated long-term successand high predictability. Other studies con(rm successful oralrehabilitation of edentulous atrophic maxilla with a (xed,
F,-./0 #: Denture with radiopaque markers used as template.
F,-./0 2: Computer-guided implants technique.
F,-./0 %: Implants positioned in the mandible.
F,-./0 &: Abutments screwed to implants.
Case Reports in Dentistry 2
F,-./0 ": Titanium bar constructed by the dental technician.
F,-./0 +: Titanium bar welded on abutments.
F,-./0 *: Titanium bar removed from mouth.
F,-./0 3: Titanium bar covered with pink opaque.
F,-./0 !$: Titanium bar (xed to the denture with acrylic resin.
F,-./0 !!: Final prosthesis with drilling for screw tightening.
F,-./0 !#: Final restoration.
F,-./0 !2: Final restoration.
% Case Reports in Dentistry
F,-./0 !%: Panoramic X-ray a1er one-year follow-up.
de(nitive restoration supported by an intraorally weldedtitanium bar on the same day of implant placement surgery[#, 2].
Avvanzo demonstrated that dental abutments, intrao-rally welded with a titanium bar, allow immediate loadingimplants and provisional or de(nitive restoration duringhealing of bone, without problems of micromovements andimplants loss. Immediate denture improves patient’s compli-ance due to a more comfortable prosthesis [3].
Immediate loading of implants may be successfullyachieved with intraoral welding technique when they arepositioned in zygomatic bone too. In fact it is possible tosuccessfully rehabilitate the edentulous atrophic maxilla witha permanently (xed prosthesis supported by an intraorallywelded titanium framework attached to standard and zygo-matic implants on the day of surgery.'ey show stability andprosthetic success rate at the !#-month [%] and 2-year follow-up [&, "]. 'e intraoral welding technique seems to have noadverse e)ect onmarginal bone loss and implant survival too[+]. Successful oral rehabilitation has been demonstrated inthe edentulous mandible using SynCone &-degree abutmentsfor an immediate and de(nitive restoration supported by anintraorally welded titanium bar [*].
Another method to connect the abutments to the bars isrepresented by the laser welding. Kuo et al. in #$$" describeda new technology for immediate loading implants using laserwelded bars applicable to various implant systems and clinicalsituations [!$].
In today’s dental literature, most frequently, estheticsare addressed with (xed restorations. 'is technique givesthe opportunity to provide patients with very good estheticoutcomes with a hopeless dentition utilizing dental implants,laser-welded titanium components, and characterized acrylicresin prostheses. 'e de(nitive prostheses provide excellentfacial support, phonetics, esthetics, smile line, and function.Laser-welded titanium frameworks o)ermany advantages forthe patient, clinician, and dental technician [!!]. Supportingthe data that laser welding is safe for patients and implantsurvival, Fornaini et al. published a case report suggestingthat there are no side e)ects in using intraorally laser weldingtechnique [!#].
A study by Silva investigated the in5uence of laserweldingand electroerosion procedure on the passive (t of (xedimplant-supported titanium frameworks, concluding thatframeworks may show a more precise adaptation if they are
sectioned and laser welded. In the same way, electroerosionimproves the precision in the framework adaptation [!2, !%].
De Aguiar in his study compared the accuracy of (t ofthree types of implant-supported frameworks cast in Ni-Cralloy: speci(cally, a framework cast as one piece comparedto frameworks cast separately in sections to the transverse orthe diagonal axis and later laser welded. Results of this studyshowed that casting diagonally sectioned frameworks lowersmis(t levels of prosthetic implant-supported frameworks andalso improves the levels of passivity to the same frameworkswhen compared to structures cast as one piece [!&].
Lack of passivity has been associated with biomechan-ical problems in implant-supported prosthesis. De Castroevaluated the passivity of three techniques to fabricate animplant framework from a Co-Cr alloy by photoelasticity. Itwas concluded that therewere no di)erences in forces exertedon implants [!"].
4. Conclusion
Rigid splinting of multiple implants with intraoral weldingtechnique results in a predictable (xation in the early stagefor bone healing with a signi(cant reduction of the micro-movement problem and implants loss.
Conflict of Interests
'e authors declare that there is no con5ict of interestsregarding the publication of this paper.
References
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