Introduction:

• Congenitally missing teeth most common malformation in humans
  
• Maxillary lateral incisors most commonly missing in anterior region, also the most commonly missing bilaterally
  
• Maxillary central incisors most commonly affected by trauma
  
• Main treatment options = autotransplantation, orthodontic space closure, resin-bonded fixed dental prostheses (RBFDP), implants, and conventional fixed dental prostheses
  
• Cantilever resin-bonded fixed dental prostheses (RBFDPs)
  
  • Minimally invasive
    
  • Low in cost
    
  • Reversible
    
  • No risk for pulpal irritation
    
  • No need for anesthesia
    
  • Minimal risk for caries development
    
  • Valid option for younger patients
    

Purpose:

• Determine the long-term success and survival rates of cantilever zirconia ceramic RBFDP replacing incisor (Cantilever “Maryland” bridge)
  

Material & Methods:

• Retrospective clinical evaluations
  
• Inclusion
  
  • 1 or 2 missing incisors
    
  • Abutment teeth were caries-free or minor defects, sound enamel
    
  • Abutment teeth free of periodontitis
    
  • Edentulous space is size of missing tooth
    
  • Appropriate occlusion with at least 0.7mm thickness of retainer wing
    
  • Retention phase of at least 3 months after active orthodontic therapy
    
  • COmmitment to attend annual recalls
    
• Impressions + die stone
  
• CAD/CAM milled pre-sintered zirconia ceramic blocks and manually veneered
  
• Minimal thickness of zirconia wing is 0.7mm, connector 2mm horizontally x 3mm vertically
  
• Protocol of insertion
  
  • Alumina particles abraded
    
  • Ultrasonic cleanse in 99% isopropanol
    
  • Rubber dam isolation
    
  • 37% phosphoric acid etch 30 secs
    
  • Adhesive system (Panavia 21TC or Multilink automix)
    
• 59 patients = 1 cantilever RBFDP
  
• 21 patients = 2 cantilever RBFDP
  
• 7 patients = bilateral cantilever RBFDP splinted at midline for maintain orthodontic diastema closure
  
• 3 Groups
  
  • G1 = Congenitally missing 59.6%
    
  • G2 = Traumatic 13.2%
    
  • G3 = Other reasons (Periodontitis, caries, orthodontic treatments) 27.2%
    

Results:

• Mean observations 92.2 months
  
• 6 restorations rebonded, no further complications
  
• With complications, success rate 92.0% after 10yrs
  
  • Despite debonding, no statistically significant difference among all 3 groups
    
• Loss of restoration as failure, survival rate 98.2% after 10 years
  

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PREFACE:
     This is one of the original literatures that introduced the osseointegration concept being an acceptable treatment modality for dentistry.  Did you know that the original treatment for dental implants was full mouth rehabilitation?  The "All-on-X" concept was how dental implantology made it's first impact.

PURPOSE:
     Update the survival rates for fixtures (implants) and prostheses for total edentulism after 25 years of osseointegration concept use.

MATERIALS & METHODS:

• 4636 Branemark fixtures
• 759 Edentulous jaws for 700 patients
• 56.8% Females vs 43.2% Males with mean age 55.3 (19-79yo)
• 4 Groups by time of fixture placement (Development, Routine 1, Routine 2, & Routine 3)
• After osseointegration, uncovered implants, and provided with abutments to support fixed prosthesis - "Standardized Branemark Guidelines"
• Development and Routine 1 groups with 10mm implants
• Routine 2 and 3 groups had fixtures of different lengths depending on bone volume
• Follow-up at least once every year, standardized radiographs at 1, 3, 5, 7, and 10 years
  • Prosthesis stability checked every year - defined by no saliva movement by manual prosthesis pivoting & percussion test with asymptomatic, high-pitched metallic sound
  • Maintain osseointegration - stable abutment connection, no peri-fixture radiolucency
• Mobile fixture removed, sites curetted and closed

RESULTS:

• Continuous prosthesis stability
  • Maxilla was 95% or more at 5 & 10 years, then 92% at 15 years
  • Mandible was 99% at all intervals
• Jaws requiring no supplementary fixtures
  • Maxilla routine groups
    • 5 years 88%, 89%, & 98%
    • 10 years 80%, 89%
    • 15 years 76%
  • Mandible routine groups
    • 5 years 91%, 97%, 99%
    • 10 years 86%, 96%
    • 15 year 83%
• Individual fixture survival rates
  • Maxilla routine groups
    • 5 years 89%
    • 10 years 81%
  • Mandible routine groups
    • 5 years 87%
    • 10 years 95%
• Fixture fractures < 5% (except Routine 1 group, maxilla had 13% and 16% fracture rates at 10 and 15 years)

CONCLUSION:

• For the past studies on osseointegration, Branemark's team method is basically unchanged, and provides sufficiently long observation period of success
• Routine treatment of edentulism with implant supported fixed prosthesis can provide predictable long-term success, represented by large population results in this study
• Mandible presents with better results than maxilla

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