New surgical techniques using narrow, tilted implants positioned through a magneto-dynamic tool in guided surgery for a Toronto restoration. A 69-year-old woman wanted fixed rehabilitation to replace her removable complete dentures. A cone-beam computed tomography showed significant bone resorption in both the maxillary and mandibular regions. The plan was to load the entire upper arch with six implants immediately, while removable partial dentures were recommended for the lower jaw. The guided surgery project was aligned with the new dentures, and the laboratory created a printed cast with dental implant analogues in planned positions. A metal-reinforced denture was constructed, and surgery was performed to place six narrow implants using the magneto-dynamic instrument. The denture was directly screwed onto multi-unit abutments. Final rehabilitation was completed after 6 months. Narrow implants can be a good option for fixed, full-arch rehabilitations. Further research is needed to confirm these findings on a larger scale.

Background: Short implants have been used in the restoration of edentulous jaws in the past several years. However, some studies have suggested that short implants are less successful than standard implants. The aim of this study is to investigate the outcome of short implants placed in the posterior maxilla or mandible following one-stage or immediate-function protocols with a follow-up of 7 years (clinically) and 5 years (radiographically). Methods: This study included 127 patients rehabilitated with 217 implants measuring 7 mm and supporting 157 fixed prostheses in the posterior segments of both jaws. Final abutments were delivered at the surgery stage and were loaded after 4 months in 116 patients (199 implants). The primary outcome measure was implant survival measured through life tables. Secondary outcome measures were marginal bone loss and the incidence of biological and mechanical complications at the patient level and implant level (evaluated through descriptive statistics). Results: Twenty-four patients (18.9%) with 45 implants (20.7%) were lost to the follow-up. In total, 32 implants failed (14.8%) in 22 patients (17.3%), resulting in a cumulative survival rate at 7 years of 81.2% for 7 mm implants in the rehabilitation of the posterior regions of the maxilla and mandible. The average (standard deviation) marginal bone loss was 1.47 mm (0.99 mm) at 5 years. The incidence rate of biological complications was 12.6% and 10.6% at the patient and implant levels, respectively. The incidence rate of mechanical complications was 21.3% for patients and 16.1% for implants. A higher failure rate was registered in smokers and in implant arrangements with a sequence of three fixtures in proximity. Conclusions: Within the limitations of this study, it can be concluded that the placement of 7 mm long implants for the partial implant-supported rehabilitation of atrophic posterior jaws is possible in the long term, judging by the survival rate and stable average marginal bone loss. Nevertheless, strict case selection should be performed, especially in smokers and with implant arrangements that provide a minimum of one unit in inter-implant distance.

Scanning edentulous arches during complete denture fabrication is a crucial step; however, the quality of the resulting digital scan is still questionable. The purpose of this study is to systematically review studies (both clinical and in vitro) and determine whether intraoral scanners have clinically acceptable accuracy when recording completely edentulous arches for the fabrication of removable complete dentures. An electronic search in medical databases like PubMed, Scopus, and Web of Science (WOS), using a combination of relevant keywords, retrieved 334 articles. After full-text evaluation, twelve articles fulfilled the inclusion criteria for this review (eight clinical studies and four in vitro studies). A quality analysis of the included studies was carried out using the QUADAS-2 tool. The accuracy values varied between different intraoral scanners. Different regions of the edentulous arches showed differences in trueness and precision values in both in vitro and clinical studies. Peripheral borders, the inner seal, and poorly traceable structures like the soft palate showed maximum discrepancies. The accuracy of intraoral scanners in recording clear anatomic landmarks like hard tissues with attached mucosa was comparable to conventional edentulous arch impressions. However, higher discrepancies were recorded when digitizing mobile and poorly traceable structures. Intraoral scanners can be used to digitize denture-bearing areas, but the interpretation of the peripheral border and the soft palate should be carefully carried out.

OBJECTIVE: To compare the accuracy of implant position, using a combination of static and dynamic computer-assisted implant surgery (CAIS), with either static, dynamic, or freehand implant placement, in fully edentulous arches.
METHODS: Twenty-one patients with a total of 88 fixtures were included. Implants were divided equally into four groups: a combination of static and dynamic CAIS (SD group), static CAIS (S group), dynamic CAIS (D group), and freehand placement (FH group). Angular deviation, as well as the 3D platform and apex deviations, were measured for all groups. Furthermore, the direction of implant deviation was recorded and compared.
RESULTS: The FH group showed significantly more deviation compared to all groups, considering all the aspects, and at both the implant platform and apex. A significant difference in angular deviation between the SD and S groups (p < .001), and between the SD and D groups (p < .001) was noted, favoring the SD group. When evaluating implant distribution, the FH group showed a tendency towards the buccal, apical, and distal directions at platform and apex, while in the D group, implants shifted more to the buccal. In contrast, the SD group did not show a trend toward any specific direction. The S and SD groups did not show a statistical significance considering any direction.
CONCLUSIONS: The combination of static and dynamic CAIS increases the accuracy of implant placement in fully edentulous arches when compared with either static or dynamic CAIS alone, as well as freehand placement.

OBJECTIVE: The objective of this finite element study was to investigate the effect of different framework designs, framework materials, and bone densities on the stress distribution of fixed implant-supported prostheses for edentulous mandibles.
METHODS: Under the condition of 2-mm cortical bone, 16 models were created in the edentulous mandible to simulate different framework designs (1-piece or 3-piece frameworks) with different framework material (pure titanium, zirconia, polyetheretherketone, or carbon fiber-reinforced polyetheretherketone) in-high or low-density trabecular bone. Then, vertical loading and oblique loading at 75° were applied to the anterior and posterior regions. The stress distribution and stress concentration region of implant and peri-implant bone with different combinations were compared by finite element analysis.
RESULTS: The use of the 1-piece zirconia framework in high-density trabecular bone improved stress distribution on implants and peri-implant bone. The region of stress concentration is located in the buccal cervix of the distal implants and the distobuccal portion of the cortical bone in all models. To improve the stress distribution on fixed implant-supported dentures for edentulous mandibles, the 1-piece framework and zirconia represent the better combination.
CONCLUSIONS: Under the condition of 2-mm cortical bone thickness, the full-arch zirconia framework had minimum von Mises stress on implants and peri-implant bone in all models, and high trabecular bone density greatly decreased the stress on cortical bone.

With the beginning of the twenty-first century, population aging has emerged as a major worldwide phenomenon. The dentist must respond to this demographic change by taking into consideration the possibility of restoring oral function in the elderly patient with the use of dental implants. This article aims to provide a narrative review of the literature regarding the implant survival rate in geriatric patients and the relative importance and advantages of implant-prosthetic rehabilitation through a scientific analysis of the literature through online databases and dental journals. Tooth loss can have a significant impact on patients\' oral function and significantly affects quality of life, self-esteem, and nutritional status. Although many studies in the past have reported that implant success is age-dependent, more recent studies suggest that they are safe and predictable for geriatric patients, improving quality of life, with similar results to those of younger age groups. Advanced age does not necessarily represent a contraindication for implant placement and osseointegration and success is influenced by patient and site-specific factors. Aging is a process that affects each patient differently, consequently, there should be a specific therapeutic approach for everyone, which must consider the functional and cognitive status of the patient, his medical condition, and his social situation-economic and motivational.

We examined 408 patients (151 male, 257 female) in an age range from 54 to 85 years (mean age 73,9±4,9) performing clinical (anamnesis, visual analysis, palpation, percussion, auscultation) sociological (GOHAI), additional (chewing efficiency evaluation, phonetic analysis, weight deficit of body calculation, OPG, CBCT) assessment. Among 322 of examined subjects working syndromological diagnosis was «decompensated dentition» related to lower jaw in 167 cases, 65 to upper jaw, 90 to both upper and lower jaws (altogether 412 dental arches). Chewing efficiency among edentulous patients was low considering that majority of patients had dentures. Score range for Geriartric General Oral Health Assessment Index (GOHAI) was from 7 to 25 points (mean 18,23±4,19) which is attributed as low level. General syndromes among patients were rough, disfiguring, ageing changes in facial appearance, major alteration of aesthetic norms. Equally important or even more was incapacitation impact of total loss of proper mastication, speech problems, phonetic alteration, problematic food swallowing. In our research we highlighted two pathological conditions among elderly and senile age groups: decompensated dentition, and fully edentulous jaws. Taking into consideration suffering of the patients due to morphological functional and psychosocial disabling conditions, accompanying these diseases, we might consider this group of patients as handicapped and that could lead to the need to introduction of setting quotas of implant prosthetics treatment of the elderly and senile patients. The result, efficacy and efficiency of such rehabilitation are considered in compliance with the system of adequate treatment result for this part of population.
Были обследованы 408 пациентов (151 мужчина и 257 женщин) 54–85 лет (средний возраст 73,9±4,9 года) с помощью клинических (опрос, осмотр, пальпация, перкуссия, аускультация), социологических («GOHAI»), параклинических (определение эффективности жевания, чистоты речи, исследование дефицита массы тела, ортопантомография, КТ) методов. Все пожилые пациенты были с двумя патологическими состояниями — декомпенсированным зубным рядом и полной потерей зубов. У 322 человек рабочий синдромологический диагноз — декомпенсированный зубной ряд — относился к 167 нижним челюстям, 65 верхним челюстям и у 90 человек — и к верхним, и к нижним челюстям (всего 412 зубных рядов). Эффективность жевания у контингента беззубых также была невысокой, несмотря на наличие у большинства из них съемных зубных протезов. Согласно гериатрическому показателю здоровья полости рта («GOHAI»), ответы обследуемых колебались от 7 до 25 баллов (в среднем 18,23±4,19 балла), что относилось к низкому уровню. Общими синдромами пациентов оказались грубые, уродующие, старящие изменения внешнего вида лица, значительное нарушение эстетических норм. Не менее важны инвалидизирующие факторы почти полного отсутствия способности к жеванию, звукообразования, речи, затруднённого проглатывания пищи. В силу явных морфофункциональных и психосоциальных нарушений, социальной дезадаптации, сопровождающих эти заболевания, таких пациентов следовало бы считать инвалидами для повышения доступности геронтостоматологической реабилитации и включения их в программу государственных гарантий оказания стоматологической ортопедической помощи. Необходимо также ввести квотирование имплантационного зубного протезирования для пациентов пожилого и старческого возраста, которое по своей результативности и эффективности вписывается в систему адекватной реабилитации указанного контингента лиц и является мерой профилактики инвалидности.

OBJECTIVE: To assess the accuracy of half-way digital mucosa-supported implant guides (HDMIGs) for edentulous jaws.
METHODS: Ninety-five consecutive patients (859 implants) with edentulous jaws who underwent implant placement using an HDMIG from July 2012 to June 2018 were retrospectively identified. The primary endpoint was implant-related complications (nerve injury and unexpected perforation), and the secondary endpoints were the faciolingual distance, mesiodistal distance, buccolingual angle, and mesiodistal angle. Follow-ups occurred at 1 month, 2 months, and then every 2 months following implant placement.
RESULTS: Twenty-seven (28.4%) patients met the exclusion criteria, leaving 68 eligible patients (636 implants) for the final analysis. The median follow-up was 24 months (range, 18-27 months). No patients developed nerve injury, revision, or unexpected perforation. At the final follow-up, the mean faciolingual distance was 0.65 ± 0.16 mm, the mean mesiodistal distance was 1.16 ± 0.61 mm, the mean buccolingual angle was 4.04° ± 2.26°, and the mean mesiodistal angle was 3.75° ± 2.56°. In the comparison of the first month after surgery and the last follow-up, no significant differences were detected in any of the four measured variables.
CONCLUSIONS: Use of an HDMIG may be a convenient and safe method to ensure correct implantation.

OBJECTIVE: This systematic review was conducted to evaluate the outcome of dental implant therapy in elderly patients (≥65 years).
METHODS: Online database and hand searches were systematically performed to identify studies reporting on dental implants placed in the partially/completely edentulous jaws of elderly patients. Only prospective studies reporting on regular-diameter (≥3 mm), micro-rough surface implants were included in this review. Two investigators performed the search and data extraction. An inter-investigator reliability was verified using kappa statistics (κ). A meta-analysis was performed on implant survival rates, while the mean peri-implant marginal bone level changes (PI-MBL), technical/mechanical complications, and biological complications were reported descriptively.
RESULTS: The systematic search yielded 2221 publications, of which 11 studies were included for statistical analyses. The calculated κ for the various parameters extracted was κ = 0.818-1.000. A meta-analysis was performed on the post-loading implant survival rates at 1, 3, 5, and 10 years. The random-effects model revealed an overall 1-year implant survival of 97.7% (95% CI: 95.8, 98.8; I2  = 0.00%, P = 0.968; n = 11 studies). The model further revealed an overall implant survival of 96.3% (95% CI: 92.8, 98.1; I2  = 0.00%, P = 0.618; n = 6 studies), 96.2% (95% CI: 93.0, 97.9; I2  = 0.00%, P = 0.850; n = 7 studies), and 91.2% (95% CI: 83.4, 95.6; I2  = 0.00%, P = 0.381; n = 3 studies) for 3, 5, and 10 years, respectively. The reported 1-year average PI-MBL ranged between 0.1 and 0.3 mm, while the reported 5- and 10-year PI-MBL were 0.7 and 1.5 mm, respectively. Information obtained pertaining to the technical and biological complications in the included studies was inadequate for statistical analysis. The frequent technical/mechanical complications reported were abutment screw loosening, fracture of the overdenture prostheses, activation of retentive clips, ceramic chipping, and fractures. The common biological complication reported included peri-implant mucositis, mucosal enlargement, bone loss, pain, and implant loss.
CONCLUSIONS: This review provides robust evidence favoring dental implant therapy in elderly patients as a predictable long-term treatment option, in terms of implant survival, clinically acceptable PI-MBL changes, and minimal complications. Therefore, age alone should not be a limiting factor for dental implant therapy.

A fracture of the maxillary or mandibular bone requires the afflicted to undergo a maxillo mandibular fixation for the establishment of pre traumatic occlusion. This process is quiet tedious and consumes a considerable period of time before any surgical procedure can commence. Such a situation can be complicated in case the individual with maxillomandibular fracture has sparse or absent dentition; for such cases a splint is fabricated or an erstwhile existing denture is used for maintaining a vertical jaw proportion. Stabilizing such splints to the jaw requires various invasive approaches that can bring into harm\'s way, adjacent soft tissue vital structures. We describe here an innovative technique combining the time tested method of the \"gunning splint\" and the advanced minimally invasive MMF screws for obtaining closed reduction in edentulous jaw fractures.