Abstract Statement of Problem The clinical outcomes of anterior implant abutments are not well reported. Purpose of the Study To systematically review the existing literature to identify survival, mechanical, biological, and esthetic outcomes of anterior implant abutments. Material and Methods An electronic search was performed using PubMed / MEDLINE with specific search terms and predetermined criteria. After application of inclusion and exclusion criteria, the final list of articles was reviewed in‐depth to meet the objectives of this review. Results Systematic application of inclusion and exclusion criteria resulted in identification of 27 studies that described outcomes of anterior implant abutments. Because of substantial heterogeneity of data, true survival, or cumulative survival of abutments could not be calculated. However, the mean failure of abutments was 1.15%, attributable to fractures restricted to ceramic abutments. Mechanical complications included abutment screw loosening, primarily restricted to external hex implants. Biological complications included fistulas and mucosal recession. Esthetic outcomes showed lesser gingival discoloration for zirconia abutments compared with metal abutments. Conclusions Minimal anterior abutment fractures have been reported and are restricted to ceramic abutments. Studies using spectrophotometry showed lesser gingival discoloration with zirconia abutments, but there is no evidence for difference in patient's esthetic satisfaction between ceramic and metal abutments. Clinical Significance For the anterior region, selection of an implant with internal connection and a customized metal abutment (titanium or cast metal) can have the least mechanical complications. Limited existing clinical data indicate reduced peri‐implant mucosal discoloration from zirconia abutments, which may be preferable over metal abutments, in patients with thinner mucosal tissues or patients with high or gummy smiles.
Abstract Purpose To evaluate the current scientific evidence on patient recall and maintenance of dental restorations on natural teeth, standardize patient care regimens, and improve maintenance of oral health. An additional purpose was to examine areas of deficiency in the current scientific literature and provide recommendations for future studies. Materials and Methods An electronic search for articles in the English language literature from the past 15 years was performed independently by multiple investigators using a systematic search process. After application of predetermined inclusion and exclusion criteria, the final list of articles was reviewed in depth to meet the objectives of this review. Results The initial electronic search resulted in 2161 titles. The systematic application of inclusion and exclusion criteria resulted in 12 articles that met the objectives of the study. An additional 4 articles were added through a supplemental search process for a total of 16 studies. Out of these, 9 were randomized controlled clinical trials and 7 were observational studies. The majority of the studies (14 out of 16) were conducted in the past 5 years, and most of the studies were conducted in Europe (10). Results from the qualitative data, on a combined 3569 patients, indicated that outcome improvements in recall and maintenance regimen were related to (1) patient/treatment characteristics (adherence to recall appointments, type of restoration and type of restorative material); (2) agent (chlorhexidine, fluoride, triclosan); and (3) professional interventions (repeated oral hygiene instruction, regular oral hygiene intervention). Conclusions There is minimal evidence related to recall regimens in patients with removable and fixed tooth‐borne restorations; however, there is considerable evidence indicating that patients with tooth‐borne removable and fixed restorations require lifelong dental professional maintenance to provide repeated oral hygiene instruction and regular oral hygiene intervention customized to each patient's treatment. Current evidence also indicates that use of specific oral topical agents like chlorhexidine, fluoride, and triclosan can aid in reducing risk for gingival inflammation, dental caries, and candidiasis. Therefore, these agents may aid in improvement of professional and at‐home maintenance of various tooth‐borne dental restorations. Furthermore, due to the heterogeneity of patient populations, restorations, and treatment needs, the evidence compels forethought of creating clinical practice guidelines for recall and maintenance of patients with tooth‐borne dental restorations.
Fabrication of esthetic interim restorations by a chairside technique often challenges the clinician with regard to the required time and skills, as well as meeting the expectations of the patient. Autopolymerizing polymethyl methacrylate resin has been reported to be the most popular material for fabricating provisional restorations. However, this material does not routinely yield esthetic provisional restorations via a chairside technique. This article describes a simple technique to overcome some of the disadvantages of this material by using prefabricated polycarbonate facings backed with autopolymerizing acrylic resin. This technique can be used chairside for fabricating esthetic anterior interim restorations, utilizing the beneficial properties of both materials. It exploits the manufactured smooth-surface finish, superior esthetics, color stability, and durability of polycarbonate facings, as well as the marginal adaptation, strength, and low cost of autopolymerizing acrylic resin.
Late cluster implant failures can be one of the most devasting outcomes of implant therapy for patients. It can have anatomic, functional, psychological and financial consequences for patients, and sometimes the loss of residual bone can preclude subsequent implant placement. Fortunately, management of cluster implant failures in the maxilla can be mitigated by using implant anchorage from remote sites like zygomatic and pterygoid regions. Few reports exist in the literature that have described the management of cluster implant failure using extra-maxillary implants such as zygomatic and pterygoid implants. This case report describes the management of a female patient with bruxism who experienced late cluster implant failure in the maxilla after 9 years of function with an overdenture. Due to the loss of residual bone, subsequent implant therapy involved the use of bilateral zygomatic, pterygoid and anterior maxillary implants, which were immediately loaded and thereafter used to support a complete arch fixed implant-supported zirconia prosthesis.
