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>> Immediate loading in the fully edentulous maxilla without bone grafting: the V-II-V technique

Agliardi E, Francetti L, Romeo D, Taschieri S, Del Fabbro M.

Minerva Stomatol. 2008;57(5):251-9, 259-263

PURPOSE: The aim of this prospective study was to evaluate a new surgical approach for the immediate rehabilitation of fully edentulous maxilla without any type of bone grafting.

METHODS: The technique named ''V-II-V'' consists of an immediately loaded full-arch bridge supported by six implants. Two distal implants engage the posterior wall of the maxillary sinus, being tilted 30-45 degrees relative to the occlusal plane. Two other tilted implants engage the anterior wall of the sinus, and finally two axial implants are inserted in the anterior maxilla. An acrylic provisional restoration is delivered within 4 hours of implant placement. At each follow-up, plaque and bleeding indexes were scored, marginal bone level change around tilted and axial implants were evaluated, and a questionnaire was compiled to assess patient's satisfaction for function and aesthetics.

RESULTS: Twenty-one patients were rehabilitated. A total of 126 implants were inserted. Nineteen prostheses were in function for more than 12 months. The average follow-up was 20 months (range 4-35 months). No implant failure occurred to date, leading to 100% survival rate and 100% prosthesis success. No complication was recorded. Peri-implant bone loss at axial and tilted fixtures was similar at one year, being 0.8 mm (SD 0.4, N.=28) and.0.9 mm (SD 0.5 mm, N.=56) respectively (P>0.05).

CONCLUSION: The ''V-II-V'' technique is a viable treatment modality for the immediate rehabilitation of the edentulous maxilla, avoiding bone grafting or sinus augmentation. Long-term evaluation is needed to confirm these encouraging preliminary results.

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>> Immediate rehabilitation of the mandible with full prosthesis supported by axial and tilted implants: interim results of a single cohort prospective study

L Francetti, E Agliardi, T Testori, D Romeo, S Taschieri, M Del Fabbro.

Clinical Implant Dentistry and Related Research 2008;10(4);255-263.

PURPOSE: The aims of this prospective study were to assess the treatment outcome of immediately loaded full-arch fixed bridges anchored to both tilted and axially placed implants for the rehabilitation of the mandible and to compare the outcome of axial versus tilted implants.

MATERIALS AND METHODS: Sixty-two patients (34 women and 28 men) were included in the study. Each patient received a full-arch fixed bridge supported by two axial implants and two distal tilted implants (All-on-Four, Nobel Biocare AB, Göteborg, Sweden). Loading was applied within 48 hours of surgery. Patients were scheduled for follow-up at 6, 12, 18, and 24 months, and annually up to 5 years. At each follow-up, plaque level and bleeding scores were assessed; moreover, patient's satisfaction for aesthetics and function was evaluated by a questionnaire. Radiographic evaluation of marginal bone level change was performed at 1 year.

RESULTS: The overall follow-up range was 6 to 43 months (mean 22.4 months). Forty-four patients were followed for a minimum of 1 year. No implant failures were recorded to date, leading to a cumulative implant survival and prosthesis success rate of 100%. Plaque level and bleeding scores showed progressive decrease over time, parallel to increase of satisfaction for both aesthetics and function. No significant difference in marginal bone loss was found between tilted and axial implants at 1-year evaluation.

CONCLUSION: The present preliminary data suggest that immediate loading associated with tilted implants could be considered a viable treatment modality for the mandible.

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>> A finite element analysis on tilted versus non-tilted implant configuration in the edentulous maxilla

CM Bellini, D Romeo, F Galbusera, Agliardi E, Pietrabissa R, Zampelis A, L Francetti.

The International Journal of Prosthodontics 2009;22(5):155-157

The aim of this study was to evaluate stress patterns at the bone-implant interface of tilted versus nontilted implant configurations in edentulous maxillae using finite element models of two tilted and one nontilted configuration. Analysis predicted the maximum absolute value of principal compressive stress near the cervical area of the distal implant for all models. The tilted configurations showed a lower absolute value of compressive stress compared with the nontilted, indicating a possible biomechanical advantage (in reducing stresses at the bone-implant interface.

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>> Rehabilitation of completely edentulous mandibles. All-on-Four ® versus Toronto – Brånemark: a biomechanical study

CM Bellini, D Romeo, F Galbusera, S Taschieri, MT Raimondi, Zampelis A, L Francetti.

The International Journal of Oral & Maxillofacial Implants (Accepted for publication)

PURPOSE: The purpose of the study was to evaluate stress patterns induced in the cortical
bone by three distinct implant supported prosthetic designs using finite element

MATERIALS AND METHODS The first two models consisted of a prosthesis supported by four implants, the distal two of which were tilted, with different cantilever lengths (5mm and 15mm). The third one consisted of a prosthesis supported by five, conventionally placed, implants and 15mm cantilever.

RESULTS: Comparing the tilted model with 5mm cantilever to the non-tilted model, the maximum value of compressive stress was found near the cervical area of the distal
implant and was predicted -18 MPa, for both models. Higher values of compressive stress were predicted near the cervical area of the distal implant in the tilted model with 15 mm cantilever, as compared to the tilted model with 5 mm cantilever. For the tilted model with 5mm cantilever peak values of tensile stress were predicted near the cervical area of both the distal (1.25 MPa) and the mesial implant (2.5 MPa). For the 3 non-tilted model, the peak value was found near the cervical area of the in-between implant (5 MPa). For the tilted model with 15mm cantilever, tensile stress values were higher, with respect to the tilted model with 5mm cantilever.

CONCLUSIONS: No significant difference in stress patterns between the tilted 5 mm and the
non-tilted 15 mm configuration was predicted. The tilted configuration with a 15 mm cantilever was found to induce higher stress values, as compared to the tilted 5 mm.

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>> Riabilitazione implantoprotesica immediata della mandibola totalmente edentula mediante protocollo “All-on-Four ®”

L Francetti L, D Romeo, D Spasari, M Basso, C Tassera, C Folegatti, M Del Fabbro,T Testori.

Italian Oral Surgery 2008;7(4):7-18.

Abstract not available

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