From practitioner to practitioner - ZZI 04/2012

Prospective five-year follow-up of immediate definitive rehabilitation of the edentulous patient using an intraoral welded titanium framework

M. Degidi1, D. Nardi2, A. Piattelli3

Objectives: The aim of this prospective study was to evaluate the concept of intraoral welding as a suitable technique for the placement of a final restoration in the edentulous patient on the same day as surgery.

Materials and Methods: Any patient with a completely edentulous arch received a fixed restoration supported by an intraoral welded titanium bar. Definitive abutments were connected to the implants and then welded to a titanium bar using an intraoral welding unit. This framework was used to support the definitive acrylic restoration, which was fitted on the same day as implant placement. Restoration and implant success, mean marginal bone loss, pocket probing depth and bleeding on probing were assessed over a 60-month follow-up period.

Results: 36 patients with an edentulous maxilla and 44 patients with an edentulous mandible, with an average age of 58.1 years (SD = 16.8; n = 80), were consecutively treated with 320 immediately-loaded implants. No fractures or radiographically detectable alteration of the welded framework were evident. 317 (99.06 %) implants osseointegrated and were clinically stable at the six-month follow-up. At the 60-month follow-up the accumulated mean marginal bone loss was respectively 0.967 mm (SD = 0.361) for the maxillary cases and 1.016 mm (SD = 0.413) for the mandible cases.

Conclusions: It is possible on the same day of surgery to successfully rehabilitate the edentulous patient with a fixed, definitive prosthesis supported by an intraoral welded titanium framework.

Keywords: Implantology; Osseointegration; Prosthodontics

One sentence summary: It is possible to successfully rehabilitate edentulous patients on the same day as implant placement with a definitive fixed restoration supported by an intraoral welded titanium framework without jeopardizing osseointegration and implant success.

Introduction

The increase of life expectancy in the western countries continuously brings new challenges to the dental practitioner, as there is an increase in the number of edentulous patients in one or both arches [11]. These patients often do not accept a rehabilitation with a removable prosthesis, for either functional or psychological reasons. The rehabilitation with a temporary, immediately loaded, implant supported restoration has already proven to be a viable option for the treatment of the edentulous maxilla [13, 22, 24, 26, 27] and for the edentulous mandible [1, 5, 6, 12, 21, 28] when good primary implant stability is obtained [25].

Only a few studies have reported the rehabilitation of a completely edentulous site with an immediately loaded final restoration.

In 1999, Branemark et al. [4] proposed a clinical protocol with prefabricated components and surgical guides, elimination of the prosthetic impression procedure and attachment of a definitive fixed prosthesis on the day of implant placement. The authors reported a 98 % success rate for both the implants and prostheses in the rehabilitation of mandibular edentulism, and that definitive reconstruction can be carried out on the day of surgery.

Using Branemark’s clinical protocol, van Steenberghe et al. [30] observed a cumulative failure rate for implants and prostheses of 7.3 % and 5.0 % respectively after one year. The authors stated that marginal bone levels can be maintained around immediately loaded implants in the mandible in an average patient population for at least one year.

In a case series published in 2005, Ibanez et al. [16] successfully treated twelve edentulous maxillae with a definitive implant supported restoration (either metal-acrylic or metal-ceramic) inserted 6 to 24 hours after surgery.

In the same year, van Steenberghe et al. [29] treated 27 patients with edentulous maxillae using a CT scan-derived customized surgical template for flapless surgery and a prefabricated customized prosthetic superstructure. All patients received their final prosthetic restoration immediately after implant placement.

Klee de Vasconcellos et al. [18] proposed the rehabilitation of the mandible with a definitive fixed prosthesis fabricated on a titanium bar attached to the implants on the day of implant placement. The overall implant and prosthetic survival rates were 100 %. The authors concluded that an occlusally loaded complete arch-fixed prosthesis supported by four immediately placed implants does not appear to jeopardize osseointegration and represents a viable treatment option.

In 2006 Degidi et al. [7] published a protocol for the immediate loading of multiple implants by welding a titanium bar to implant abutments directly in the oral cavity, so as to create a customized metal-reinforced provisional restoration. Recently, this clinical protocol was successfully evaluated and applied in a selected number of cases for the fabrication and placement of a definitive restoration in both the edentulous mandible [9] and maxilla [8].

The aim of this prospective study was to evaluate the concept of intra-oral welding in the edentulous patient over a longer period of time in order to better determine the long-term success of this approach.

Materials and Methods

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