prosthetic rehabilitation

假肢康复
  • 文章类型: Journal Article
    牙种植学的发展是基于对植入物与周围组织相互作用的彻底检查,以及刺激植入物周围成骨的方法。在功能和美学方面恢复丢失的牙列的最常见方法现在由植入物代表。我们研究的目的是比较评估单独在植入物上进行修复治疗的效率与在基牙上进行修复治疗的效率。
    这项研究进行了七年(2016-2023年),评价只有一个,两个,三,还有五年.对于这个分析,MedCalc®12.5.0.0版(MedCalc®软件,Mariakerke,比利时)被用作医学统计软件。
    当使用牙种植体和天然牙基台进行修复时,与牙种植体康复相比,故障率上升了大约43倍;同样,骨质疏松症和糖尿病使失败率增加32和20倍,分别。牙龈炎症是在仅使用牙科植入物以及植入物和基牙进行假体修复的患者的随访期间观察到的常见事件(几乎50%的频率)。对于这两个群体来说,困难通常在两年后出现。
    UNASSIGNED: The development of dental implantology is based on a thorough examination of the interaction of implants with the surrounding tissues, as well as methods of stimulating osteogenesis around implants. The most common approach to restore lost dentition in terms of function and aesthetics is now represented by implants. The objective of our study was to comparatively assess the efficiency of prosthetic treatments performed on implants alone versus on implants in conjunction with abutment teeth.
    UNASSIGNED: The study was carried out over seven years (2016-2023), with evaluations at one, two, three, and five years. For this analysis, MedCalc® version 12.5.0.0 (MedCalc® Software, Mariakerke, Belgium) was utilised as the medical statistical software.
    UNASSIGNED: When using dental implants and natural teeth abutments for prosthodontic reconstruction, the failure rates rise approximately 43 times when compared to dental implant rehabilitation; similarly, osteoporosis and diabetes mellitus increase failure rates by 32 and 20 times, respectively. Gingival inflammation is a frequent event (almost 50% frequency) observed during follow-up of patients who had prosthetic restoration using dental implants alone as well as implants and abutment teeth. For both groups, difficulties usually arise two years later.
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  • 文章类型: Case Reports
    先前已经报道了将牙植入物放置在用于重建下颌骨或上颌骨的无微血管骨瓣中。然而,关于在旋髂深动脉(DCIA)微血管游离皮瓣中使用短牙科植入物的修复方案及其基本原理的信息很少.此病例报告描述了一名18岁的患者因左侧下颌骨麻木和隐痛而转诊到医院,她观察了三个月。由于下颌角左侧的“巨细胞病变”,该患者使用DCIA游离皮瓣进行了下颌骨切除和重建。在具有两个完整基牙冠的年轻患者中,放置了短的牙科植入物,并对切除中涉及的牙列进行了假体重建。短牙种植体的放置不会对游离皮瓣的血管蒂和活力产生负面影响。在我们的案例报告中,治愈两年后,DCIA皮瓣完成了出色的美学和功能,然后用短植入物修复。
    Placing dental implants in microvascular bone free flaps used for reconstructing the mandible or maxilla has been previously reported. However, there is scarce information available on the restorative protocol using short dental implants placed in a deep circumflex iliac artery (DCIA) microvascular free flap and the rationale behind it. This case report describes a 18-year-old patient referred to the hospital for numbness and dull pain of the left mandible, which she observed for three months. The patient underwent mandible resection and reconstruction using the DCIA free flap due to \"giant cell lesion\" on the left side of the mandibular angle. Short dental implants were placed and prosthetic reconstruction of the dentition involved in the resection was performed in a young patient with two integrated abutment crowns. The placement of short dental implants did not negatively affect the vascular pedicle and vitality of free flap. In our case report, two years after the healing, excellent aesthetic and function were accomplished with the DCIA flap followed by restoration with short implants.
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  • 文章类型: Journal Article
    手术干预是治疗诊断为毛霉菌病的患者的关键因素。进行了一项回顾性队列研究,对确诊为毛霉菌病的患者进行了为期10年的评估,根据MSGERC标准。临床特征的描述性分析,合并症,成像,和微生物学研究,以及医学和手术治疗和假体的类型进行了。共确认22例,其中54.5%(n=12)的人口是男性。此外,77.2%(n=17)的人群患有糖尿病。实施的主要抗真菌治疗是脂质体两性霉素B(77.2%,n=17)。我们的患者受影响最大的结构是鼻旁窦(n=18;81%),其次是上颌骨和眼眶(n=15;68%),鼻子(n=12;54%),中枢神经系统(n=11;50%),以及皮肤和软组织(n=2;<1%)。在总人口中,59.09%(n=13)的患者接受了颌面手术,其中61.53%(n=8)需要某种类型的假肢康复。眼眶切除术和上颌骨切除术是最常见的手术,占69.23%(n=9),4例(30.76%)进行颅底引流。在患者总数中(n=22),8人死亡(36.36%)。根据受影响的结构进行适当的手术管理,不仅考虑增加患者的生存率,但也考虑到美学和功能的后果,将需要随后的康复。
    Surgical intervention is a key element in the management of patients diagnosed with mucormycosis. A retrospective cohort study was carried out, in which patients with a proven diagnosis of mucormycosis were evaluated over a period of 10 years, according to the MSGERC criteria. A descriptive analysis of the clinical characteristics, comorbidities, imaging, and microbiology studies, as well as medical and surgical treatment and the type of prosthesis was carried out. A total of 22 cases were identified, of which 54.5% (n = 12) of the population were men. Furthermore, 77.2% (n = 17) of the population had diabetes mellitus. The main antifungal treatment implemented was liposomal amphotericin B (77.2%, n = 17). The most affected structures in our patients were the paranasal sinuses (n = 18; 81%), followed by the maxilla and orbit (n = 15; 68%), nose (n = 12; 54%), central nervous system (n = 11; 50%), and skin and soft tissues (n = 2; <1%). Of the total population, 59.09% (n = 13) of patients underwent maxillofacial surgery, of which 61.53% (n = 8) required some type of prosthetic rehabilitation. Orbital exenteration and maxillectomy were the most frequent surgeries, accounting for 69.23% (n = 9), while skull base drainage was performed in four patients (30.76%). Of the total number of patients (n = 22), eight died (36.36%). Appropriate surgical management according to the affected structures, considering not only increasing the patient\'s survival, but also considering the aesthetic and functional consequences, will require subsequent rehabilitation.
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  • 文章类型: Journal Article
    要系统地审查现有的科学文献,以确定,比较和评估成人萎缩性上颌骨中两种zy骨种植体与两种常规种植体的联合治疗的窦并发症和生存率。
    根据系统评价和荟萃分析指南的首选报告项目进行审查,并在PROSPERO-CRD42023392721电子数据库(如PubMed,从2000年至2022年12月,对Google学者和EBSCO宿主进行了搜索,以研究报告使用四核zygoma或两个zy骨植入物结合两个常规植入物治疗萎缩性上颌骨的研究。使用Cochrane偏见风险-2工具对随机对照试验(RCT)进行质量评估。使用RevMan软件版本5.3绘制偏差风险汇总图和偏差风险汇总适用性问题。以比值比(OR)和标准化均差(SMD)作为汇总统计量,随机效应模型和p值<0.05为统计学意义。
    11项研究符合资格标准,并被纳入定性综合。其中只有9项研究适合进行荟萃分析。通过比值比0.59得出的汇总估计值表明,与四zu植入物相比,四zy植入物平均具有0.59(0.18-1.93)倍或发生鼻窦并发症的几率,而SMD表明平均存活率(SR)比两个常规植入物的组合高0.35(-0.61至1.30)倍(p>0.05)。通过漏斗图的出版偏差显示出具有系统异质性的不对称分布。
    在萎缩性上颌骨中,与两个常规植入物结合使用的两个zy骨植入物可提供更好的存活率和更少的窦并发症。尽管观察到高SR,与其他技术相比,有必要进行更多的随机对照临床试验,以检查其疗效。
    UNASSIGNED: To systematically review existing scientific literature to determine, compare and evaluate the sinus complication and survival rates of quad zygoma against two zygomatic implants with combination of two regular implants in atrophic maxilla in adults.
    UNASSIGNED: Review was performed in accordance with preferred reporting items for systematic reviews and meta-analysis guidelines and registered in PROSPERO-CRD42023392721 Electronic databases like PubMed, Google scholar and EBSCO host were searched from 2000 to December 2022 for studies reporting treatment of Atrophic maxilla with either quad zygoma or two zygomatic implants in combination with two regular implants. Quality assessment was evaluated using Cochrane risk of bias-2 tool for randomized controlled trials (RCT). The risk of bias summary graph and risk of bias summary applicability concern was plotted using RevMan software version 5.3. The odds ratio (OR) and standardized mean difference (SMD) were used as summary statistic measure with random effect model and p value < 0.05 as statistically significant.
    UNASSIGNED: Eleven studies fulfilled the eligibility criteria and were included in qualitative synthesis, of which only nine studies were suitable for meta-analysis. The pooled estimate through the odds ratio 0.59 signifies that the quad zygomatic implants on an average has 0.59 (0.18-1.93) times or odds of developing sinus complications while the SMD signifies that better survival rate (SR) on an average is 0.35 (- 0.61 to 1.30) times more by two zygomatic implants with combination of two regular implants as compared to quad zygomatic implants (p > 0.05). Publication bias through the funnel plot showed asymmetric distribution with systematic heterogeneity.
    UNASSIGNED: Two zygomatic implants in combination with two regular implants provides better survival rate and less sinus complications compared to quad zygoma in atrophic maxilla. Despite the high SR observed, there is a need to conduct more randomized controlled clinical trials to examine their efficacy in comparison with other techniques.
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  • 文章类型: Journal Article
    评估和评估血清中骨代谢标志物骨钙蛋白和β-Cross-Laps的指标,作为监测下颌骨切除术和重建术后患者骨再生和确定植入时间的工具。游离腓骨瓣随后进行骨膜植入。
    为期6年的48名患者参加了这项研究,由于肿瘤切除。所有患者在肿瘤切除后行腓骨游离皮瓣重建,骨切除术后4-6个月,牙科植入物安装与进一步的矫形康复。为了评估移植后的骨重建率,用酶免疫法测定骨重塑中骨钙素和β-Cross-Laps血清生化指标的含量。
    所有46例腓骨游离皮瓣均愈合,无并发症,均存活。总共安装了326个植入物,8个植入物骨整合失败,和6个植入物失败后5年的负荷(种植体周围炎)。5年后植入成功率为95,7%。在手术前的患者中,平均骨钙蛋白水平为8.5ng/ml,两个月后,骨钙蛋白含量急剧增加15.4ng/ml,四个月后达到24.7ng/ml,在28.6ng/ml的六个月后,然后指标开始下降,12个月后接近14.7ng/ml的标准。在手术前的患者中,β-Cross-Laps的平均水平为0.76ng/ml,骨移植两个月后,β-Cross-Laps的平均水平降至-0.65ng/ml,四个月后,指标增加,达到0.98ng/ml,六个月后,指标为-1.56ng/ml,然后这些指标开始下降,12个月后,接近正常值-0.87ng/ml。不同浓度的骨钙蛋白或β-交叉圈与植入物的成功率之间存在相关性。植入物显示血清中低浓度的骨钙蛋白和高浓度的β-Cross-Laps不成功。
    研究表明,放置在重建区域的植入物的长期生存率和成功率可以保证植入物支持的假体的良好预后。血清骨钙蛋白和β-Cross-Laps中的骨标志物可用于评估骨重建率,这可以让你确定植入的时间。
    UNASSIGNED: To evaluate and assess the indicators of bone metabolism markers osteocalcin and β-Cross-Laps in blood serum as a tool for monitoring bone regeneration and determining the time of implantation in patients after mandibulectomy and reconstruction of a free fibular flap with subsequent endosteal implants.
    UNASSIGNED: Forty-eight patients in a 6-year period participated in this study, due to resection for tumors. All patients underwent reconstruction with fibula free flap after tumor resection, 4-6 months after osteoectomy, dental implants were installed with further orthopedic rehabilitation. To assess the rate of bone remodeling after transplantation, the content biochemical markers of bone remodeling osteocalcin and β-Cross-Laps serum were determined by enzyme immunoassay.
    UNASSIGNED: All 46 fibular free flaps were healed without complications and were survived. A total 326 implants installed, 8 implants failed to osseointegrate, and 6 implants failed after 5 years of loading (peri-implantitis). Success rate of implants after 5 years was 95,7%. In patients before surgery, the mean of osteocalcin levels was 8.5 ng/ml, two months later, there was a sharp increase in the content of osteocalcin by 15.4 ng/ml, after four months reached 24.7 ng/ml, after six months of 28.6 ng/ml, then the indicator began to decrease and after 12 months it was approaching the norm of 14.7 ng/ml. In patients before surgery, the mean level of β-Cross-Laps was 0.76 ng/ml, after two months bone transplantation the mean level of β-Cross-Laps decreased to - 0.65 ng/ml, after four months the indicator increased and reached of 0.98 ng/ml, after six months the indicator was - 1.56 ng/ml, then these indicators began to decrease and after 12 months, approaching normal values of - 0.87 ng/ml. There is a correlation between different concentrations of osteocalcin or β-Cross- Laps and the success rate of implants. Implants were shown to be unsuccessful low concentrations of osteocalcin and high concentrations of β-Cross-Laps in serum.
    UNASSIGNED: Studies have shown that the long-term survival and success rates of implants placed in the reconstructed areas may guarantee an excellent prognosis of implant-supported prostheses. Bone markers in blood serum osteocalcin and β-Cross-Laps can be used to evaluate the rate of bone remodeling, which allows you to determine the time of implantation.
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  • 文章类型: Journal Article
    背景:眶后切除术的重建有双重目的,即加速愈合,为美容修复奠定基础,并最大限度地减少并发症,如眶鼻孔瘘。这项研究的目的是介绍一种改良的“冰淇淋锥”(ICC)设计的径向前臂自由皮瓣(RFFF)技术,用于重建眼眶切除腔,连同肿瘤学,功能,和美学结果。
    方法:作者在2005年1月至2020年12月之间进行了一项回顾性研究。纳入标准包括接受直肠嗜酸性恶性肿瘤治疗的患者,这些患者接受了随后的RFFF重建ICC设计。
    结果:有22例患者接受了RFFF的ICC设计。在后续结论中,65%的患者定期使用眼眶假体。直到假体的平均等待时间为10个月。生活质量问卷的RFFFPOSAS平均得分为23.5(标准差为13,6),宫颈POSAS评分为8分(SD13,2),眶腔康复评分为5.9分(SD:3,32)。
    结论:RFFF的ICC设计是一种可靠的技术。可以在脑脊液(CSF)高风险的长期放肠的情况下提出,但在完全放肠的情况下更为普遍。该技术有助于最佳的术后伤口愈合,并适应早期放射治疗。重要的是,眼眶接受腔的碗形方面支持选择眼眶假体术后的患者进行有效的假体康复。
    BACKGROUND: Reconstruction post-orbital exenteration serves the dual purpose of expediting healing, laying the groundwork for cosmetic restoration, and minimising complications such as orbitosinusal fistulae. The aim of this study was to introduce a modified \"Ice cream cone\" (ICC) design of the Radial Forearm Free Flap (RFFF) technique used for reconstruction of orbital exenteration cavity, along with the oncological, functional, and aesthetic outcomes.
    METHODS: The authors conducted a retrospective study between January 2005 and December 2020. Inclusion criteria encompassed patients treated for orbitosinusal malignancies undergoing exenteration with subsequent ICC design of RFFF reconstruction.
    RESULTS: Twenty-two patients underwent exenteration with the ICC design of RFFF. At the follow-up conclusion, 65% of patients regularly used orbital prosthesis. The average waiting time until the prosthesis was 10 months. Quality of life questionnaires yielded average RFFF POSAS scores of 23.5 (SD 13,6), cervical POSAS scores of 8 (SD 13,2), and orbital cavity rehabilitation scores of 5.9 (SD: 3,32).
    CONCLUSIONS: ICC design of RFFF is a reliable technique. It can be proposed in cases of extended exenteration with a high risk of cerebrospinal fluid (CSF) but more generally in cases of total exenteration. This technique facilitates optimal postoperative wound healing and accommodates early radiotherapy. Importantly, the bowl-shaped aspect of the orbital socket supports effective prosthetic rehabilitation for patients opting for orbital prosthesis post-surgery.
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  • 文章类型: Journal Article
    目的:上颌肿瘤切除术后患者的假肢是一个复杂的问题,与口腔和鼻/鼻旁区的生理和解剖分离有关。本研究报告了由于上颌肿瘤而进行上颌切除术的患者使用zy骨植入物进行假体康复的临床结果。
    方法:该研究包括16例患者,这些患者在2021年至2023年的上颌骨切除术后使用zy骨植入物进行了修复。肿瘤切除后,立即放置手术闭塞器。肿瘤切除后6~12个月进行主要修复,但在此之前,制造并使用了一个临时闭塞器。肿瘤切除后6-12个月,将1-4个of骨植入物单侧或双侧插入the骨。总共安装了42个颧骨植入物,其中2例不成功,1例患者被切除。植入物是用手术导向器放置的,这是数字计划和准备的。
    结果:未发现术后并发症,患者在7-10天后出院。手术后7天,患者能够恢复正常饮食(硬食物),没有关于功能或疼痛的进一步抱怨,除了干预引起的残余水肿。
    结论:对于上颌骨缺损患者,在颌骨缺损后的复杂临床病例中使用固定假体修复是一种有效的修复方法。
    OBJECTIVE: Prosthetics for patients after oncological resection of the upper jaw is a complex problem associated with the physiological and anatomical separation of the oral cavity and the nasal/paranasal region. This study reports the clinical results of the use of the zygomatic implants for prosthetic rehabilitation in patients with maxillectomy due to upper jaw tumors.
    METHODS: The study included 16 patients who underwent prosthetic rehabilitation using a zygomatic implant after maxillectomy period from 2021 to 2023. After the tumor was removed, immediate surgical obturators were placed. Main prosthetic rehabilitation was performed 6-12 months after tumor removal, but before that, a temporary obturator was made and used. Six-twelve months after tumor resection, 1-4 zygomatic implants were inserted into the zygomatic bone unilaterally or bilaterally. A total of 42 zygomatic implants were installed, 2 of which were unsuccessful and were removed in 1 patient. The implants were placed using the surgical guide, which was planned and prepared digitally.
    RESULTS: No postsurgical complications were seen, and the patients were discharged from the hospital after 7-10 days. The patients were able to return to a normal diet (hard food) after just 7 days following surgery, with no further complaints regarding function or pain, apart from the residual edema caused by the intervention.
    CONCLUSIONS: The use of prostheses fixed on zygomatic implants in patients with maxillary defects is an effective method of prosthodontic rehabilitation in complex clinical cases after maxillectomy.
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  • 文章类型: Journal Article
    口腔癌是全球第六大流行的癌症类型。由于疾病及其治疗带来的功能和社会心理困难,患者陷入了严重的困境。外科医生和颌面修复医生都可能在癌症治疗后的重建和治疗方面遇到挑战。20多年来,腓骨一直是头颈部癌症重建的支柱。具有腓骨重建的上颌和下颌可以使用固定或可移除的假体康复解决方案。拟议的范围审查旨在确定有关腓骨重建头颈部癌症病例的假肢康复中的困难和纠正措施的证据的数量和性质。这些发现将有助于改善受影响人群的假体治疗护理。
    在制定和报告范围审查方法时,将遵循JoannaBriggsInstitute(JBI)范围审查方案。识别相关文献的方法将涉及对PubMed等数据库的系统搜索,Scopus,谷歌学者,科克伦图书馆,有关该主题的相关文章的灰色文献来源。只有发表在英文文献上的论文才会被考虑进行审查,数据收集期限于过去20年。筛选过程将利用定义的纳入/排除标准进行标题/摘要和全文筛选,由两个独立的审稿人进行,和第三审稿人将解决任何冲突。提取的数据将包括参与者的具体细节,概念,人口,研究方法,假肢康复期间遇到的挑战,和他们的管理。在适当情况下,将采用归纳专题分析和描述性统计。证据的叙述性综合将通过表格形式的数据提取来完成,结果将以叙述性总结的形式呈现。
    UNASSIGNED: Oral cancer is the sixth most prevalent cancer type worldwide. Patients are placed in a crippling predicament due to the functional and psychosocial difficulties brought on by the illness and its treatments. Both surgeons and maxillofacial prosthodontists may encounter challenges with reconstruction and therapy following cancer treatment. Over 20 years, the fibula has remained the mainstay of reconstructions for head and neck cancer. Maxillary and mandibular jaws with fibula reconstructions can use fixed or removable prosthetic rehabilitation solutions. The proposed scoping review aims to ascertain the volume and nature of evidence concerning the difficulties and corrective measures in the prosthetic rehabilitation of fibula-reconstructed head and neck cancer cases. The findings will aid in improving the prosthetic treatment care for the affected population.
    UNASSIGNED: The Joanna Briggs Institute (JBI) scoping review protocol will be followed in developing and reporting the scoping review methodology. Methods to identify the relevant literature will involve the systematic search of databases like PubMed, Scopus, Google Scholar, Cochrane Library, and gray literature sources for pertinent articles on the subject. Only papers published in English literature will be considered for the review, and the data collection period is limited to the past 20 years. The screening process will utilize defined inclusion/exclusion criteria for Title/Abstract and Full-text screening by two independent reviewers in covidence, and a third reviewer will resolve any conflicts. The data extracted will include specific details about the participants, concept, population, study methods, challenges encountered during prosthetic rehabilitation, and their management. Inductive thematic analysis and descriptive statistics will be applied where appropriate. The narrative synthesis of the evidence will be accomplished through data extraction in a tabular format, and the results will be presented as a narrative summary.
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  • 文章类型: Case Reports
    迄今为止,没有报道过Girdlestone手术后接受同侧股骨截肢后使用假体行走的病例.在Girdlestone手术后经股骨截肢后,我们对一名66岁的男子进行了为期四个月的假肢康复计划。因此,他能够使用假肢进行日常活动。假肢接受腔具有四边形构型。Girdlestone手术后患者的行走能力归因于他的坐骨结节是经股假体的主要承重部位。有了合适的假肢设计,fabrication,和康复,即使在Girdlestone手术后经股骨截肢的情况下,患者也可以使用经股假体行走。
    To date, there have been no reported cases of patients walking with a prosthesis after receiving an ipsilateral transfemoral amputation following the Girdlestone procedure. We administered a four-month prosthetic rehabilitation program to a 66-year-old man after his transfemoral amputation following the Girdlestone procedure. As a result, he was able to walk using the prosthesis for his daily activities. The prosthesis socket featured a quadrilateral configuration. The patient\'s ability to ambulate after the Girdlestone procedure was attributed to his ischial tuberosity serving as the primary load-bearing site in the transfemoral prosthesis. With appropriate prosthetic design, fabrication, and rehabilitation, patients can walk using a transfemoral prosthesis even in cases of transfemoral amputation following the Girdlestone procedure.
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  • 文章类型: Case Reports
    在无牙拱中,拔牙后牙槽嵴萎缩是影响患者舒适度和生活质量的常见问题。种植体支持的固定修复体是一种行之有效的治疗方法。植入物牙科的概念随着时间的推移而发展,以产生更好的美学和功能效果。为了缩短悬臂长度并启用12颗牙齿的假体,全对四技术需要轴向插入两个前部植入物,并向远端插入两个后部植入物。与常规加载相比,立即加载提供了各种好处而不影响质量。瞬时固定临时允许患者立即功能和保持他们的生活质量,同时也促进在美学方面的高度患者满意度,语音学,咀嚼,心理安慰。
    In edentulous arches, alveolar ridge atrophy after tooth extraction is a common problem that affects patient comfort and quality of life. Implant-supported fixed restorations are a well-proven treatment option for edentulism. The concepts of implant dentistry have developed over time to produce better aesthetics and functional results. To reduce cantilever length and enable prostheses with 12 teeth, the all-on-four technique entails inserting two anterior implants axially and distally orienting two posterior implants. Compared to conventional loading, immediate loading offers various benefits without compromising quality. An instantaneous fixed provisional allows patients immediate function and preserves their quality of life while also promoting a high degree of patient satisfaction in terms of aesthetics, phonetics, mastication, and psychological comfort.
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