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      The Ball Welding Bar: A New Solution for the Immediate Loading of Screw-Retained, Mandibular Fixed Full Arch Prostheses

      research-article
      1 , 2 , *
      International Journal of Dentistry
      Hindawi

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          Abstract

          Purpose

          To present a new intraoral welding technique, which can be used to manufacture screw-retained, mandibular fixed full-arch prostheses.

          Methods

          Over a 4-year period, all patients with complete mandibular edentulism or irreparably compromised mandibular dentition, who will restore the masticatory function with a fixed mandibular prosthesis, were considered for inclusion in this study. The “Ball Welding Bar” (BWB) technique is characterised by smooth prosthetic cylinders, interconnected by means of titanium bars which are adjustable in terms of distance from ball terminals and are inserted in the rotating rings of the cylinders. All the components are welded and self-posing.

          Results

          Forty-two patients (18 males; 24 females; mean age 64.2 ± 6.7 years) were enrolled and 210 fixtures were inserted to support 42 mandibular screw-retained, fixed full-arch prostheses. After two years of loading, 2 fixtures were lost, for an implant survival rate of 97.7%. Five implants suffered from peri-implant mucositis and 3 implants for peri-implantitis. Three of the prostheses (3/42) required repair for fracture (7.1%): the prosthetic success was 92.9%.

          Conclusions

          The BWB technique seems to represent a reliable technique for the fabrication of screw-retained mandibular fixed full-arch prostheses. This study was registered in the ISRCTN register with number ISRCTN71229338.

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          Most cited references25

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          Smoking and dental implants: A systematic review and meta-analysis.

          Recent studies implicate smoking as a significant factor in the failure of dental implants. This review aims to test the null hypothesis of no difference in the implant failure rates, risk of postoperative infection, and marginal bone loss for smokers versus non-smokers, against the alternative hypothesis of a difference.
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            "Peri-Implantitis": A Complication of a Foreign Body or a Man-Made "Disease". Facts and Fiction.

            The discrepancy between some scientific views and the daily clinical experience with dental implants has made the topic of "periimplantitis" highly controversial, especially the discussion whether "periimplantitis" should even be considered a "disease" or whether marginal bone loss instead would represent a complication of having a foreign body placed in the oral cavity.
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              Immediate loading in partially and completely edentulous jaws: a review of the literature with clinical guidelines.

              The introduction of immediate loading was a paradigm shift in implant dentistry as it was previously believed that an unloaded period was essential for bone healing in order to promote osseointegration. However, this belief could not be confirmed by clinical studies or by human histology. Hitherto, numerous reports have been published on immediate loading in various indications. An important factor for success is primary implant stability. The latter can be improved by adapting drilling protocols to enhance lateral compression of the bone and by using tapered implant designs with apical thread fixation. To some extent, the use of implants with a microrough surface and rigid splinting may compensate for suboptimal stability. It is important to avoid fracture of the provisional restoration at all times as this may result in local overloading and implant failure. Also, unevenly distributed occlusal contacts may contribute to failure and therefore occlusion ought to be evaluated at every occasion, especially during the early phase of healing. Taking these aspects into account, immediate loading in the fully edentulous mandible by means of an overdenture has been shown to be predictable in terms of implant survival (94.4-100%). However, the procedure may result in additional costs as a result of the need for repeated relining. In addition, the scientific basis for this treatment concept in the maxilla is very scarce. Immediate loading in the fully edentulous jaw by means of a fixed prosthesis is a well-documented treatment concept. In the mandible, three implants have been shown to be insufficient, given the failure rate of up to 10%. With at least four implants a failure rate of 0-3.3% may be expected. In the maxilla, four to six implants could be too limited, given the failure rate up to 7.2%. Increasing the number of implants may reduce implant failure to 3.3%. Provisional fixed prostheses are particularly prone to fracture in the maxilla and hence reinforcement is warranted. Immediately loaded single implants have lower survival rates, of 85.7-100%, with no clear impact of occlusal contact. In fact, a meta-analysis demonstrated a five times higher risk of failure for immediately loaded single implants when compared with delayed loading. No study showed superior soft-tissue preservation or esthetics following immediate loading of single implants compared with other loading protocols. However, this finding may not imply that a provisional implant crown becomes redundant when soft-tissue conditioning is deemed necessary. Taking into account earlier factors for success, immediate loading in the partially edentulous jaw by means of a fixed prosthesis seems predictable in terms of implant survival (95.5-100%). However, there are no studies with data on soft-tissue parameters, esthetic aspects or patient-centered outcomes, and the available studies mainly relate to the load-carrying part of the dentition. Clinical studies focusing on these aspects of treatment outcome are clearly needed. High patient satisfaction is the most important advantage of immediate loading, especially during the early healing phase. In this context, one should also realize that studies have revealed comparable patient satisfaction in patients following delayed loading once their prosthesis is in place. In the decision-making process, this aspect should be properly discussed with the patient along with other advantages and disadvantages of immediate loading.
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                Author and article information

                Journal
                Int J Dent
                Int J Dent
                IJD
                International Journal of Dentistry
                Hindawi
                1687-8728
                1687-8736
                2017
                1 August 2017
                : 2017
                : 2679085
                Affiliations
                1Private Practice, Castelfidardo, 60022 Ancona, Italy
                2Fundacao Universitaria Vida Crista (FUNVIC), 12400-010 Pindamonhangaba, SP, Brazil
                Author notes

                Academic Editor: Eitan Mijiritsky

                Author information
                http://orcid.org/0000-0002-1462-7205
                Article
                10.1155/2017/2679085
                5557257
                5a6c6853-bed3-4f4b-aef9-8086b1a60037
                Copyright © 2017 Danilo Bacchiocchi and Andrea Guida.

                This 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.

                History
                : 15 March 2017
                : 24 May 2017
                Categories
                Clinical Study

                Dentistry
                Dentistry

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