This study aimed to compare the clinical outcomes of a conventional Erich's arch bar vs a modified screw-retained arch bar in maxillomandibular fixation of mandibular fracture.
This parallel-arm ...randomized control trial included patients from the outpatient clinic with single favorable mandibular fractures that are indicated for closed reduction. They were subjected to maxillomandibular fixation using conventional Erich's arch bars in the control group and modified screw-retained arch bars in the study group. The outcome measures included operating time, glove perforations, postoperative pain, oral hygiene, fixation stability, occlusion, and mucosal coverage.
A total of 20 patients (12 males and 8 females) with a 1:1 allocation ratio were included. There was a significant statistical difference regarding operation time and number of glove perforations in favor of group B as
< 0.001,
= 0.007, respectively. There was a significant statistical difference regarding pain after 1 day (
< 0.001), 1 week (
< 0.001) in favor of group B, and at 4 weeks (
= 0.015), and 6 weeks (
= 0.002) in favor of group A. Regarding oral hygiene at 1 week (
= 0.021) and at 6 weeks (
< 0.001), there was a significant statistical difference in favor of group B. Regarding mucosal coverage at 6 weeks, there was a significant statistical difference in favor of group A (
= 0.005).
The modified screw-retained arch bar can be considered an alternative to conventional arch bar as it provided less application time and better operator safety. It also showed better patient satisfaction regarding pain and oral hygiene.
Maxillomandibular fixation with the conventional technique was modified to screw-retained arch bar which is less time-consuming and provides better patient and operator satisfaction. How to cite this article: Elhadidi MH, Awad S, Elsheikh HAE,
. Comparison of Clinical Efficacy of Screw-retained Arch Bar vs Conventional Erich's Arch Bar in Maxillomandibular Fixation: A Randomized Clinical Trial. J Contemp Dent Pract 2023;24(12):928-935.
To assess the mechanical durability of monolithic zirconia implant-supported fixed dental prostheses (iFDP) design on one implant, with a distal and a mesial extension cantilever bonded to a titanium ...base compared to established designs on two implants.
Roxolid Tissue level (TL), and tissue level x (TLX) implants were used to manufacture screw-retained 3-unit iFDPs (n = 60, n = 10 per group), with following configurations (X: Cantilever; I: Implant, T: Test group, C: Control group): T1: X-I-X (TL); T2: X-I-X (TLX); T3: I-I-X (TL); T4: I-I-X (TLX); C1: I-X-I (TL); C2: I-X-I (TLX). The iFDPs were thermomechanically aged and subsequently loaded until fracture using a universal testing machine. The failure load at first crack (F
) and at catastrophic fracture (F
) were measured and statistical evaluation was performed using two-way ANOVA and Tukey's post-hoc tests.
The mean values ranged between 190 ± 73 and 510 ± 459 N for F
groups, and between 468 ± 76 and 1579 ± 249 N for F
, respectively. Regarding F
, neither the implant type, nor the iFDP configuration significantly influenced measured failure loads (all p > 0.05). The choice of implant type did not show any significant effect (p > 0.05), while reconstruction design significantly affected F
data (I-I-X
< X-I-X
< I-X-I
) (p < 0.05). The mesial and distal extension groups (X-I-X) showed fractures only at the cantilever extension site, while the distal extension group (I-I-X) showed one abutment and one connector fracture at the implant/reconstruction interface.
Results suggest that iFDPs with I-X-I design can be recommended regardless of tested implant type followed by the mesial and distal extension design on one implant abutment (X-I-X).
Objective: The purpose of this prospective clinical study was to evaluate peri‐implant soft‐tissue conditions and esthetic fulfillment during a 3‐year follow‐up period following prosthetic ...rehabilitation.
Material and methods: As part of a prospective multi‐center study, 152 ITI dental implants were placed in 80 patients in the maxillary anterior region. Fifty‐nine crowns (38.82%) were cement retained, while 93 (61.18%) crowns were screw retained. At loading and 3, 6, 12 and 36 months post‐loading, modified plaque index (MPI), sulcus bleeding index (SBI), keratinized mucosa (KM), gingival level (GL), and esthetic fulfillment were recorded.
Results: All patients completed the study and no complications were reported. While statistically not significant at all time points, cement‐retained crowns seemed to present a worsening trend in MPI and SBI scores. Interestingly, screw‐retained crowns seemed to present an opposite picture, their MPI and SBI scores improved over time. While plaque accumulation, prophylaxis and depth of crown margin significantly affected levels of sulcus bleeding, prophylaxis alone played a key role in reducing plaque accumulation. No soft tissue recession was observed in either cement‐ or screw‐retained crowns up to 3 years post‐loading. Esthetic fulfillment survey revealed that patients did not have a preference for crown types; however, dentists favored cement‐retained over screw‐retained crowns.
Conclusions: Peri‐implant soft tissues responded more favorably to screw‐retained crowns when compared with cement‐retained crowns. However, no soft‐tissue recession was observed in either type of crowns. Cement‐retained crowns were preferred by dentists, while patients were equally satisfied with either type of crowns they received.
Abstract The purpose of this study was to evaluate different retention systems (cement- or screw-retained) and crown designs (non-splinted or splinted) of fixed implant-supported restorations, in ...terms of stress distributions in implants/components and bone tissue, by 3-dimensional (3D) finite element analysis. Four 3D models were simulated with the InVesalius, Rhinoceros 3D, and SolidWorks programs. Models were made of type III bone from the posterior maxillary area. Models included three 4.0-mm-diameter Morse taper (MT) implants with different lengths, which supported metal-ceramic crowns. Models were processed by the Femap and NeiNastran programs, using an axial force of 400 N and oblique force of 200 N. Results were visualized as the von Mises stress and maximum principal stress (σmax). Under axial loading, there was no difference in the distribution of stress in implants/components between retention systems and splinted crowns; however, in oblique loading, cemented prostheses showed better stress distribution than screwed prostheses, whereas splinted crowns tended to reduce stress in the implant of the first molar. In the bone tissue cemented prostheses showed better stress distribution in bone tissue than screwed prostheses under axial and oblique loading. The splinted design only had an effect in the screwed prosthesis, with no influence in the cemented prosthesis. Cemented prostheses on MT implants showed more favorable stress distributions in implants/components and bone tissue. Splinting was favorable for stress distribution only for screwed prostheses under oblique loading.
Resumo O objetivo deste estudo foi avaliar diferentes sistemas de retenção (cimentada x parafusada) e configuração da coroas (unitárias x esplintadas) de próteses fixas implantossuportadas em relação a distribuição de tensões nos implantes/componentes e tecido ósseo pela análise de elementos finitos 3D. Quatro modelos 3D foram simulados com auxílio dos programas Invesalius, e Rhinoceros 3D, e SolidWorks. Os modelos foram confeccionados simulando bloco ósseo de região posterior da maxila (tipo ósseo III), com 3 implantes cone Morse com 4,0 mm de diâmetro e diferentes comprimentos, suportando prótese metalocerâmica de 3 elementos. Os modelos foram processados pelos programas FEMAP e NEiNastran sob força axial de 400 N e oblíqua de 200N. Os resultados foram plotados através de mapas de tensão de von Mises (vM) (implantes e componentes) e tensão máxima principal (TMP) (tecido ósseo). Sobre o carregamento axial, não foi observada diferenças entre os diferentes sistemas de retenção e tipo de prótese na distribuição das tensões nos implantes/componentes, porém, sobre o carregamento oblíquo as próteses cimentadas apresentaram melhor distribuição de tensões em comparação com as próteses parafusadas, enquanto que as próteses esplintadas apresentou uma tendência de redução das tensões no implante do primeiro molar. No tecido ósseo as próteses cimentadas apresentaram melhor distribuição das tensões em comparação com as próteses parafusadas, independente do carregamento. A esplintagem foi favorável somente para as próteses parafusadas, não havendo influência sobre as próteses cimentadas. As próteses cimentadas sobre implantes cone Morse apresentam melhor comportamento biomecânico nos implantes/componentes e tecido ósseo. A esplintagem foi efetiva somente nas próteses parafusadas sob carregamento oblíquo.
This study assessed the survival and marginal bone loss of single-unit short implants (≤ 8 mm in length) in the premolar-molar area. It also compared cemented with screw-retained restoration.
In this ...clinical retrospective study, short implants supporting a single crown in the premolar-molar region were selected. Demographic-, surgical-, implant-, and prosthesis-related data were obtained. The predictor variable was the type of prosthesis retention. The principal variables were survival rate and marginal bone loss. The secondary variables were prosthesis survival and technical and biologic complications.
A total of 113 patients (56 ± 11 years of age) with 128 short implants were assessed. The mean follow-up time from implant insertion was 25.47 ± 14.95 months. Fifty-one crowns were cemented and 77 were screw-retained. No failure events were recorded for the implants and the prostheses. The distal marginal bone loss was significantly lower in the screw-retained crowns than in the cemented crowns. Marginal bone loss ≥ 2 mm as a biologic complication was more frequent in the cemented crowns. Two screw-loosening events were observed in the screw-retained restorations. These events were resolved by screw retightening.
Short implants could be an effective option to support a single-unit prosthesis in the premolar-molar areas of the maxillae.
This randomized controlled trial aimed to evaluate the effect of implants' two different diameters and cantilever lengths on the marginal bone loss and stability of mplants supporting maxillary ...prostheses.
Ninety-six implants were placed in sixteen completely edentulous maxillary ridges. Patients were randomly divided into two groups: Group A, implants were placed with a cantilever to anterior-posterior AP spread length (CL:AP) at a ratio of 1:3; Group B, implants were placed with a CL:AP at a ratio of 1:2. Patients were further divided into four sub-groups: Groups A1, A2, B1, and B2. Groups A1 and B1 received small diameter implants while Groups A2 and B2 received standard diameter implants. Bone height and stability measurements around each implant were performed at 0, 4, 8 and 24 months after definitive prostheses delivery.
Statistical analysis of the mean implant stability and height values revealed an insignificant difference between Group A1 and Group A2 at all the different time intervals while significantly higher values in Group B1 in comparison with Group B2. Results also showed significantly higher values in Group A1 in comparison with Group B1 and an insignificant difference between Group A2 and Group B2 at all the different time intervals.
It can be concluded that the use of small diameter implants placed with a CL:AP at a ratio of 1:3 provided predictable results and that the 1:2 CL:AP significantly induced more critical bone loss in the small diameter implants group, which can significantly reduce long term success and survival of implants.
Introduction and aim: The missing tooth in the upper anterior zone is both aesthetically and functionally demanding. Patients extremely seek a satisfactory aesthetic and functional treatment. The ...solution can easily be complicated by a number of factors such as space closure or vestibular bone resorption.The aim of this paper is to briefly outline and show the issue of prosthetic tooth replacement by implant in the anterior zone. Particular attention is paid to the pitfalls and possibilities of treatment by implant-retained prosthesis. In this broad issue, there is a debate on indications of cementation of these prosthesis, and also a solution to the poor placement of the implant in the anterior zone. Methods, material: This case report focuses on the possibility of replacing a missing upper canine and describes in detail the individual clinical steps of the procedure in the fabrication of screw-retained crown on angled abutment. The protocol for impression making for a provisional crown, an individual impression for the definitive crown and the crown delivery is described. The discussion is focused on planning of the prosthesis, possible risks and their prevention and important points in decision making during planning, where the greatest emphasis is placed on the decision between the cemented and screw-retained prosthesis. Various alternatives for avoiding cemented restoration on dental implants are mentioned. Conclusion: The reason for our decision is to maximize the health of periimplant tissues, which differ from the biological width of the natural tooth both in height, histology, and in vascularity. In the vicinity of the dental implant there are multiple collagen fibers parallel to the implant axis with low adherence to the implant neck. The soft tissue around the implant is thus similar to a scar. Its stability is essential and is determined by multiple factors: tissue phenotype, width of the labial wall of the alveolar ridge, the height of the alveolar ridge and the margins of the prosthesis.
Reis INRD, Fukuoka GL, Nagay BE, Pannuti CM, Spin-Neto R, Silva EVFD. Incidence of peri-implant disease associated with cement- and screw-retained implant-supported prostheses: A systematic review ...and meta-analysis. J Prosthet Dent. 2023 Oct 2:S0022-3913(23)00563-2. doi:10.1016/j.prosdent.2023.08.030. Epub ahead of print. PMID: 37793953.
None declared.
Systematic review and meta-analysis.
For patients with existing implants in need of additional implant placement, the use of the existing implants for guide fixation seems to be a logical alternative. Current options for the fabrication ...of surgical guides involve creating surgical guides that are mucosa‐borne and/or retained by fixation pins. Since these existing techniques involve inherent inaccuracies, the fabrication of surgical guides that are screw‐retained at the implant‐ or abutment‐level would eliminate the introduction of those same fundamental inaccuracies. The purpose of the present technical report is to illustrate a step‐by‐step digitally planned guided implant placement protocol for terminal dentition patients with salvageable existing implants requiring full‐arch implant rehabilitation. The advantages of this protocol include enhancing the accuracy of guided implant placement with screw‐retention versus the traditional mucosa‐ or fixation pin support. Thus, this simplifies the transition from failing teeth to implants by ensuring that fixed provisionalization serves both functional and esthetic requirements. This protocol can also predictably reduce chairside time and adjustments at the surgical implant placement appointment.
The objective of the research was to review the literature on clinical evaluation and success of screw-retained dental implants by assessing the marginal bone loss (MBL).
Online electronic databases ...such as PubMed/MEDLINE, Google Scholar, and Cochrane Library were searched using appropriate keywords for the last 20 years, dated from January 1, 2000, till August 1, 2021, with a restriction on language. Additional sources like major journals, unpublished studies, conference proceedings, and cross-references were explored. Information curated for data extraction included methodology, population, type of implants used, and duration of follow-up.
The PubMed/MEDLINE, Google Scholar, Cochrane Library, and additional sources identified a huge number, out of which 637 search results were screened, out of which 322 were duplicates. The remaining 315 unique studies were screened for the titles and abstracts, and 23 articles were selected for full-text screening. A total of six articles that matched the eligibility criteria were processed for qualitative analysis.
Despite the uncertain retrievability of screw-retained implant-supported fixed restorations, this treatment option in fixed implant prosthodontics is a reliable and effective choice, especially for implant-supported long-span fixed partial dentures (FPDs), full-arch FPDs, and cantilever FPDs.
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