Dental specialists today are facing a major influx of completely edentulous patients and patients with generalized compromised teeth who ask for cost-effective full mouth rehabilitation. The choice of overdenture as a treatment modality is significantly less expensive and is within the reach of many patients who are on a limited financial support. Various types of attachment systems are currently available to restore implant-supported over-denture. Clinicians have selected various attachment systems based on factors such as durability, patient demand, cost-effectiveness, technical simplicity, and retention. The decision-making process to select certain types of attachment system still remains unclear. This article explains about various attachment system available, their advantages and disadvantages and their use in different clinical conditions.

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Achieving and maintaining implant stability are prerequisites for a dental implant to be successful. Implant stability can be defined as the absence of clinical mobility, which is also the suggested definition of osseointegration. Primary implant stability at placement is a mechanical phenomenon that is related to the local bone quality and quantity, the type of implant and placement technique used. Secondary implant stability is the increase instability attributable to bone formation and remodeling at the implant/tissue interface and in the surrounding bone. There are many ways in which the implant stability can be evaluated such as clinical measurement of cutting resistance during implant placement, reverse torque test, the periotest. This article aims to throw light on the various methods to determine implant stability.

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Patients wearing conventional removable dentures often complain particularly about the instability of the mandibular denture. Due to instability of mandibular dentures, there is an increase in the severity of mandibular atrophy. Furthermore, denture instability leads to a feeling of insecurity, inefficient mastication, and overall dissatisfaction with the prosthesis. Placement of endosseous dental implants to retain and support mandibular overdentures or fixed complete dentures have been developed and studied as a method for solving the problem of instability associated with conventional dentures. Implant-retained dentures have many advantages compared to conventional removable dentures. Occasionally, anatomical or financial limitations may prohibit the patient to use of a fixed implant-retained prosthesis. In these cases, a removable implant-retained denture with a limited number of implants may be the possible choice. The aim of this article is to review the literature to compare implant-retained or supported dentures versus conventional dentures in terms of masticatory efficiency, stability, and patient satisfaction.

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Aims: To survey the current radiographic prescriptions in dental implant assessment among dentists in Libya. Settings and Design: Eighty dentists were interviewed during a dental meeting by two calibrated graduate students, using a 19-question questionnaire, considering imaging modality options for preoperative implant site assessment with respect to cost, patient radiation dose, and broad coverage of facial bones and teeth. Statistical Analysis Used: Epi-Info 6.04 software was used to analyze the database file. Results: The radiographic examinations more often prescribed for dental implant assessment were the panoramic radiograph (70%), followed by panoramic plus periapical radiographs (15%). Only 6.25% of the dentists prescribed computed tomography as a single examination. The most common reason for prescribing a specific radiographic examination was the desire for broad coverage of the facial bones and teeth (44.64%), cost (14.3%) was the second most common cause. Conclusions: The interviewed dentist in this study prescribed panoramic radiographs in dental implant assessment based on broad coverage and cost.

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Purpose: The objective of this paper was to compare histologically and histomorphometrically a hydroxyapatite originated by algae (Algipore) versus demineralized bovine bone (Bio-Oss Geistlich Pharma, Wolhusen, Switzerland) utilised as bone substitutes in maxillary sinus floor elevation with a split-mouth design. Materials and Methods: Five healthy patients underwent a bilateral maxillary sinus floor elevation procedure under local anesthesia. In each case, residual posterior maxillary bone height was between 2 mm and 5 mm. The original bone was augmented with a split-mouth design with 100% Algipore on the test side and 100% Bio-Oss on the contralateral control side. After a healing period of 6-8 months during the re-opening surgery biopsies were retrieved and Xive Implants (Dentsply Implants, Mannheim, Germany) were placed. Results: At microscopic level both Bio-Oss and Algipore blocks resulted well osseointegrated, without inflammatory infiltrate, with an high level of mineralization, without gap between the bone and biomaterial interfaces that resulted indistinguishable. A close contact between the two faces was observed without the presence of slits. Histomorphometrical analysis showed that, on average, the percentage of medullary space was higher for the Bio-Oss compared with Algipore (38.61% ±8.90% vs. 29.23% ±7.89%). In contrast, the mean value of residual particles of biomaterials was higher in Algipore than in Bio-Oss specimens (42.86% ±18.61% vs. 22.30% ±6.40% respectively). Conclusions: The data confirmed that sinus lift carried out with Algipore performed in a similar way of that carried out with Bio-Oss and that this material is safe, predictable and without invasiveness.

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Morphology of the peri-implant soft tissue adjoining the implant components plays a pivotal role in displaying the implant esthetics. Creating an implant restoration that cannot be distinguished from the rest of the natural dentition is the ultimate goal. Second stage surgery is often overlooked and is considered non essential phase but actually could determine the health of the peri-implant tissue .This phase gives an excellent opportunity to preserve, reconstruct and even maneuver the soft tissue to optimize the soft tissue profile around the implant components. The article aims at enumerating the various modalities available to contour the soft tissue profile around implants and thus help the practioners in optimizing esthetics during second stage surgery.

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Background : To determine the value and direction of the stress and strain across the different implants placed in the bone when loaded with normal or heavy forces; with either a healthy or compromised anatomical condition is always a controversial topic with quite a bit of ambiguity. Studies suggest more favorable stress distribution in bone with a wider diameter implant and by selecting threaded implant. Ideally 12 mm implant length needs to be maintained in favorable condition but the same rule cannot be applied in compromised anatomical conditions. There is a need for a study to evaluate the favorable stress distribution in bone using different implant dimensions and designs both threaded and nonthreaded, to achieve a better control over loading and stress release. Objectives: A finite element analysis (FEA) study was designed to study ideal stress distribution in cancellous and cortical bone under axial and nonaxial loading using, (1) different implant dimensions and (2) designs. Materials and Methods: A finite element models of eight dental implants with crowns were modeled using Catia, a modeling software with material properties as limitation (FEA elements = 113,388, FEA nodes = 173,212). Results: Magnitude of stresses along the implants and surrounding bone did not increase appreciably when the implant length was changed from 10 to 14 mm. With the increase in implant diameter, the stress levels within the bone reduced in threaded implant and in nonthreaded implant the stress levels increased. Conclusion: The results indicate that, for implants with a wider diameter and in threaded implant with a shorter length, there was favorable distribution of stress and strain pattern during axial and nonaxial loading.

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Predictable retrievability of cement retained prosthesis has been a major clinical concern. This article presents review of techniques used for implant prosthesis removal without any potential damage to abutments and implants.

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Severe atrophy of the maxilla can be due to various factors such as tumor resection, generalized aggressive periodontitis, genetic disorders or syndromes. Fabrication of a prosthesis with adequate retention and stability for patients with an atrophic edentulous maxilla presents a significant challenge. Treatment concepts with zygomatic implants have evolved as an alternative for bone augmentation procedures. This review describes the restoration of the maxillary dentition using four zygomatic implants (quad zygomatic implant technique). Within the limitations of this observation, we can state that full mouth rehabilitation with quadruple zygomatic implant technique can definitely be considered as a viable treatment option treating patients with atrophic maxillae. However, studies with more follow-up time and controlled clinical trials should be done in order to document the longevity of this treatment modality.

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The aim of this case report is to show a predictable approach toward a prosthetic rehabilitation of a traumatized anterior maxilla using alveolar distraction osteogenesis (ADO) and dental implants. Although distraction osteogenesis has been thoroughly discussed in literature as a method of increasing alveolar bone length, there are still some challenges that must be considered prior to prosthetic rehabilitation. This report describes the predictable use of ADO and dental implants in the traumatized anterior maxilla, thereby enabling the final construction of a fixed partial prosthesis with tissue-colored ceramics.

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Vertical defects of the anterior alveolar crest limit esthetic and functional success of the implant supported prosthesis. Hard tissue grafting is often required before implant grafting. Although many techniques exist for hard tissue augmentation the outcome of vertical alveolar ridge augmentation is often unpredictable. Vertical bone augmentation historically has been a very difficult objective to complete. Due to soft tissue tension it often results in the displacement or complete resorbtion of the graft, dehiscence of the overlying soft tissue and subsequent loss of the graft. This case report describes a new approach to vertical alveolar ridge augmentation using a titanium mesh scaffold, Bio-GIde collagen membrane, and an admixture of cortico-cancellous anterior iliac crest bone and Bio-Oss xenograft material. The titanium mesh scaffold was used to establish and contain the desired height and bulk of the graft. The collagen membrane which was laid over the titanium mesh was used to isolate and seal the graft from the oral cavity as well and to prevent infiltration of granulation tissue into the hard tissue matrix. There was a small area of membrane perforation over the titanium mesh during the healing period. This area was noted to have some soft tissue infiltration and a small loss of graft material. The overall bulk and height of the graft under the mesh was maintained, and significant alveolar ridge height and bulk was achieved. The titanium scaffold technique showed promising initial results for vertical ridge height and bulk augmentation. It is a tool that can be used to augment large defects where other techniques may be less predictable. Our hypothesis is that if there were not a membrane perforation complete retention of the graft would have been achievable. This may be rectified in using a dual membrane or a thicker material. More cases and further study are needed to establish predictability and long-term retention of the graft.

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An open bite (apertognathia) is a malocclusion or an abnormal bite in which usually the front teeth cannot be brought into contact with opposing teeth. The causes of open bite are multifactorial in nature. Correct diagnosis and analysis are important to identify and address the causes of the problems in the treatment plan. Distraction osteogenesis is the most common treatment of choice, in posttraumatic injury. It has the benefit of simultaneously increasing vertical dimension and volume of surrounding soft tissues and bone. The re-constructed site is suitable for implant placement and prosthetic pontic placement. This presentation encompasses a case report of a patient with trauma induced open bite and was rehabilitated with osteogenic distractor in mandible and extensive fixed dental prosthesis in the maxilla.

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Introduction: Microbial plaque is the main etiologic factor which causes disease in soft tissue around dental implants. The purpose of this study was to evaluate the bone level around implants using conventional radiography. They were evaluated for radiographic changes in the peri-implant crestal bone at intervals of 1, 3 and 6 months. The radiographic findings were correlated with clinical parameters of mobility, probing depth, bleeding, etc. Aim: The aim of the present study was to evaluate the hard and soft tissue changes around two-stage implant both radiographically and clinically to assess the success of implants. Materials and Methods: Seven patients with 10 dental implants were examined clinically for 6 months after prosthodontic treatment. Plaque index and health indices of soft tissue including pocket depth, mobility, bleeding index, calculus and gingival index were measured. Marginal crestal bone loss and peri-implant radiolucency were checked radiographically. The criteria both subjective and objective were used to evaluate the success of the implant process. The necessary statistical analysis was performed for radiographic and clinical evaluation methods. Results: The results of this study showed that the values of all clinical criteria under study had no significant changes from baseline to 6 months. The vertical crestal bone loss on the mesial and distal side was within the normal range of bone loss given by Brånemark. There was no mobility and no peri-implant radiolucency around any of the implants. Conclusion: Our study clearly demonstrated that in a group of patients with no periodontal disease the survival rate of two-stage, countersunk, submerged implants in the edentulous sites is 100% during the follow-up period of 6 months.

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Objective: The aim was to assess marginal adaptation of zirconium crowns made up by manual milling (pantograph) and computerized (computer assisted designing/computer assisted machining [CAD/CAM]) before and after cementation; and the efficiency of 3 types of cements in retaining these crowns: Zinc phosphate, resin modified glass ionomer cement (RelyX Luting 2) and resin cement (RelyX U200). Materials and Methods: Out of 30 zirconium crowns, 15 were milled by the pantograph, and 15 by CAD/CAM. Each group was divided into 3 subgroups according to the cement used. Cementation was done over the analog universal pin 4.5 mm × 4 mm and submitted to mensuration of marginal interface of its four faces with stereoscopic magnifier (×20). Then, they were directed to a machine of universal test (EMIC), and submitted to an axial traction with speed of 0.5 mm/min until its displacement. Results: Before cementation, CAD/CAM crowns (47.60; 40.20; 43.40 μm) demonstrated a greater desadaptation comparing to pantograph crowns (28.20; 35.60; 30.40 μm). RelyX Luting 2 showed less marginal desadaptation postcementation on CAD/CAM crowns (53.80 μm ± 8.43 μm) and pantograph (39.80 μm ± 12.696 μm), when compared with zinc phosphate (62.00 μm ± 12.86; 45.20 μm ± 24.035) and to RelyX U200 (73.80 μm ± 44.49 μm; e 53.00 μm ± 10.817 μm). RelyX Luting 2 also obtained better efficiency on traction resistance (9.48 Kgf ± 2.49 Kgf; e 24.54 Kgf ± 6.73 Kgf), when compared to zinc phosphate (8.71 Kgf ± 4.00 Kgf; and 11.85 Kgf ± 3.15 Kgf) and RelyX U200 (8.08 Kgf ± 0.62 Kgf; and 14.78 Kgf ± 5.94 Kgf). Conclusions: Lower values on marginal discrepancy were found on pantograph crowns comparing to CAD/CAM crowns. RelyX Luting 2 obtained not only a lower marginal desadaptation, but also a better efficiency on traction resistance among the three cements. However, there was no significant statistical difference that could prove the influence of desadaptation on displacement resistance.

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Purpose: Assessment of location of vital anatomic structures is required while enterprising quality dental care. In this study, an assessment of the location of inferior alveolar canal (IAC) and mental foramen (MF) in the mandible was done by using computed tomography (CT). An attempt was done to compare the variation in the location in various age groups. Materials and Methods: The mean location of the IAC and MF from the alveolar crest was done on 30 patients by using cross-sectional CT. A comparison of the mean distance in the three age groups was done by using ANOVA. Results: The mean distance of the superior border of the IAC upto the alveolar crest of the mandibular second premolar was at 12.56 on the right side and 12.65 on the left side. The mean distance of mandibular first molar was up to about 12.29 mm on the right side and 12.71 on the left side. Mandibular second molar showed the mean distance of 11.97 mm on the right side and 11.94 mm on the left side. The mean distance of the superior border of the MF upto the alveolar crest was at 11.99 mm on the right side and 12.20 mm on the left side. A comparison between the three age groups showed a statistical difference (P < 0.05). Conclusion: Assessment of vital anatomic structures for its presence and distribution is important in the preoperative planning of dental implants so as to avoid bleeding due to damage of vessels within the jaw. The mean distance of the IAC with respect to the alveolar crest was decreasing as it was moving posteriorly.

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Background: Many factors lead to failure of dental implant prosthesis. One of the most important factors is the microbial infection, which might be effective factor in the case of presence a gingivally micro-leakage of the fixture in relation to its supported bone. Aim >of the Study: The study aims to investigate the most dominant types of microbiota that associated with the implant fixtures and to evaluate the efficiency of chlorhexidine gloganate 0.2% as mouth rinse in reducing the level of microbiotic adherence in the sites of implant fixtures. Materials and Methods: Thirty participants were subjected to this study in regards to specific criteria, group I, group II and following the clinical and laboratory procedures of investigations their swabs before and after using chlorhexidine gloganate 0.2% mouth wash. Results: The study was identified many types of microbiota and the mean values of the microbial growth for group I before mouth wash and group II after mouth wash using spectrophotometer 0.4-0.8 and 0.2 ± 0.1 respectively. Conclusion: The study concluded that chlorhexidine gluconate 0.2% mouthwash is an effective prophylactic material to prevent and treat oral pathogens in association with the implant prosthesis. And it is advisable to be prescribed besides specific antibiotic in respect to this study besides as a choice of treatment in treating peri-implantitis.

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Placement of implants in the posterior part of jaws remains complicated due to difficult approach, close approximity and fear of perforating the maxillary sinus. Hence, many techniques for providing fixed prosthesis in atrophic jaws have been tried including iliac crestal bone augmentation, mandibular nerve repositioning, sinus floor elevation, and distraction osteogenesis. However, these techniques remain unpredictable with insufficient documented data calibrating their success and remain invasive for the patient. The introduction of short dental implants (SDIs) tends to overcome more than many difficulties experienced by the operator in carrying out above procedures. Furthermore, less invasiveness, decreased chair side time and patient acceptance and comfort for SDIs have led to clinicians preferring them over other modalities. Aspects like decrease in length of these unique implants has been questioned over years thus challenging their success rate. This review on SDIs takes us through the concept, salient features, factors to be considered and clinical feasibility of SDIs thus giving the reader a broader outlook over them.

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