Dissertations / Theses on the topic 'Dental implants Complications'

Intrinsecamente, todo procedimento cirúrgico apresenta um certo índice de intercorrências e/ou complicações associadas. Hemorragias, infecções, parestesias ou disestesias e perda primária dos implantes são algumas das intercorrências e complicações mais comuns relacionadas a procedimentos cirúrgicos para implantodontia. Este estudo avaliou retrospectivamente o índice de intercorrências e complicações após cirurgia para a instalação de implantes dentais osteointegráveis. Foram avaliados, retrospectivamente, 660 prontuários clínicos de pacientes submetidos à instalação de implantes osteointegráveis no período 8 anos atendidos na Área de Cirurgia Buco-Maxilo-Facial da Faculdade de Odontologia de Piracicaba - Unicamp. Os resultados demonstraram que houve um maior índice de intercorrências e complicações quando os pacientes eram atendidos por alunos de especialização (p= 0,015) e quando o exame por imagem realizado era somente a radiografia panorâmica convencional (p= 0,011). Os resultados demonstraram também um maior índice de intercorrências e complicações nos pacientes quando estes eram submetidos a procedimentos cirúrgicos de reconstrução óssea alveolar (p< 0,0001). A presença de infecção pós-operatória influenciou significativamente para o aumento no índice de perda primária de implantes (p< 0,0001).
Intrinsically, every surgical procedure presents a certain rate of associated intercurrences and/or complications. Hemorrhages, infections, paresthesias or dysesthesias and primary loss of implants are some of the most common intercurrences and complications related to surgical procedures in implant dentistry. This study conducted a retrospective evaluation of the rate of intercurrences and complications related to patients submitted to osseointegratable dental implant placement. A retrospective evaluation was made of 660 clinical record charts of patients submitted to osseointegratable dental implants in the period of 8 years, attended in the Oral and Maxillofacial Surgery Department of Piracicaba Dental School - Unicamp. The results showed that there was a higher rate of intercurrences and complications when patients were attended by residents (p= 0.015) and when the panoramic radiograph was the only preoperative image exam requested (p= 0.011). The results also showed a higher rate of intercurrences and complications in patients when they were submitted to surgical procedures of alveolar bone reconstruction (p< 0.0001). The presence of post-operative infection had a significant influence on the increase in the primary loss of implants (p< 0.0001).

Orientador: Renato Mazzonetto
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: Existem várias pesquisas na literatura que relatam fatores considerados de risco para o insucesso dos implantes dentais. Porém, alguns estudos têm gerado controvérsia nos resultados. Alguns autores inclusive contra-indicam o tratamento de implantes dentais na presença destes fatores tais como doenças sistêmicas, abuso de substâncias nocivas à saúde, procedimentos reconstrutivos prévios à implantodontía, complicações pós-operatórias, entre outros fatores, quando alguns estudos demonstram que estes isoladamente representam apenas uma pequena parcela dos insucessos na implantodontia, sendo não significativos. Assim, o objetivo desse trabalho foi avaliar os fatores que podem influenciar na perda tardia dos implantes dentais, por meio de prontuários clínicos dos pacientes que foram tratados com implantes osseointegráveis para reabilitação implantossuportada no período de junho de 2001 a julho de 2006 pela Área de Cirurgia Buco-Maxilo- Facial da Faculdade de Odontologia de Piracicaba . Unicamp. Foram estudados diversos fatores dos pacientes em todos os grupos, tais como gênero, idade, queixa principal, história médica, procedimentos reconstrutivos, procedimentos implantodônticos, desenho do implante, complicações, procedimentos protéticos, acompanhamento mínimo de um ano após carga protética e perda dos implantes. Além disso, cada um destes fatores foi avaliado nos pacientes que apresentaram alguma perda tardia nos tratamentos implantodônticos, com a finalidade de obter a relação destes e sua influência na perda tardia dos tratamentos com implantes dentais. Forem incluídos 432 pacientes na avaliação deste estudo com um índice de 89,3% de sucesso no tratamento com implantes dentais. Perda primaria foi apresentada em 28 pacientes (6,4%) e Perda Tardia em 21 pacientes (4,8%). Dos pacientes que apresentarem perda tardia, nenhum deles relatou consumir substâncias nocivas à saúde, sete apresentavam alguma doença sistêmica e seis forem submetidos a procedimentos reconstrutivos prévios à colocação dos implantes dentais. Os fatores tabagismo, doenças sistêmicas, procedimentos reconstrutivos e complicações nos tratamentos cirúrgicos não resultaram ser significativos nos índices de perda tardia. Estudos prospectivos são necessários para um maior entendimento desses insucessos no tratamento de implantes dentais.
Abstract: Researches in literature considered some factors to be related to failure of dental implants treatments. However, some other studies have generated controversy in those results. Some authors also contraindicated dental implants treatment in presence of these factors like systemic diseases, substance abuse, bone grafting before implant installation, postoperative complications and others factors; when some studies demonstrate that these factors, separately, represent only one small parcel of failures in the dental implantology, being not significant. Thus, the objective of this work was to evaluate the factors that can influence in the delayed failure of dental implantations, by means of formularies of patients who had been treated with dental implants in the period of June of 2001 through July of 2006 at the Oral and Maxillofacial Surgery Department of the Piracicaba Dental School - Unicamp. The groups, such as gender, age, main complaint, medical history, reconstructive procedures, dental implant procedures, complications, prosthetic procedures, a minimum follow-up of one year after prosthetic load and implants failure, had been studied in this research. Moreover, each of these factors had been evaluated in the patients who had presented some delayed failure on dental implants treatments, with the purpose to establish any relation of these factors and their influence in the delayed failure of dental implant treatments. 432patients were included on the evaluation of this study with a success rate of 89.3% on dental implants treatment. Primary failure on dental implants presented on 28 patients (6.4%) and 21 patients (4.8%) presented delayed failure. Patients who presented delayed failure did not abuse substances, seven patients had a systemic disease and six treated previously with bone graft. Smoke, systemic disease, reconstructive procedures and complications during surgical treatments had not resulted to be significant on delayed failure indices. Prospective studies are necessary for a best comprehension of these failures in the treatment of dental implants.
Doutorado
Cirurgia e Traumatologia Buco-Maxilo-Faciais
Doutor em Clínica Odontológica

The purpose of this study was to ascertain whether simplifying mandibular overdenture treatment utilising single stage surgery and immediate prosthetic loading of a single implant, will achieve similar implant success rates and functional improvement to that expected using conventional techniques. As part of this study, the Mk III Brånemark implant with an oxidised surface (TiUnite™ Nobel Biocare AB, Göteborg, Sweden) was compared to the classical machined Mk III Brånemark fixture.Materials and Methods: 35 patients with a mean age of 68 years and problematic mandibular dentures were treated. The primary complaints among the patients referred to the clinic for treatment related to poor retention of the mandibular denture, instability, denture sores and phonetic problems. Patients were initially placed randomly into the “machined surface” or “oxidised surface” group. A single implant was placed into the mandibular midline with high initial stability. A ball attachment was placed and the retentive cap incorporated into the existing denture. Reviews took place at 3,12 6 6 and 36 months. Clinical assessments, radiographs made with custom film holders, and stability measurements by both manual and resonance frequency analysis methods were recorded. All complications, failures, maintenance and reasons for dropout were noted. Visual analogue scale questionnaires were utilised to record patient satisfaction. (ANOVA p<.05) Results: Three out of 8 machined surface implants failed, representing an unacceptably high failure rate (37.5%). The machined surface was therefore discontinued for this study. Three oxidised surface implants did not achieve sufficient primary stability to be immediately loaded, so were treated with a two stage delayed loading protocol. The 25 immediately loaded oxidised surface implants were all classified as surviving at the 36-month recall. Patient satisfaction was very high with a significant increase in all comfort and functional parameters. Conclusions: Within the limitations of this study and research design, it appears that the immediately loaded single implant retained mandibular overdenture, using an oxidised implant surface in a small group of maladaptive patients, can provide a beneficial treatment outcome over a three year observation period. If insufficient stability at insertion is not achieved for immediate loading, then a delayed loading protocol should be utilised.

Orientador: Jose Ricardo Albergaria Barbosa
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: Reabilitações na região posterior da maxila são geralmente confrontadas com atrofia óssea, associada à pneumatização do seio maxilar, impedindo a instalação de implantes de comprimento adequado. A cirurgia de elevação do seio maxilar foi introduzida na literatura em 1980, por Boyne & James, para permitir a instalação de implantes osseointegráveis nesta região, apresentando desde então algumas modificações que resultam em diferentes índices de sucesso e de complicações. Este estudo retrospectivo envolveu uma análise de 72 pacientes tratados em um período de 06 anos pela Área de Cirurgia Buco-Maxilo-Facial da Faculdade de Odontologia de Piracicaba - Unicamp. A amostra foi representada por um total de 91 seios maxilares, que receberam elevação associada a diferentes materiais de preenchimento para instalação de 101 implantes. Um total de 70 implantes (69,3%) foi instalado em um segundo procedimento cirúrgico, com um tempo médio decorrido desde a elevação de 9,88± 4,27 meses. Em 13 pacientes (18,5%) a reabilitação implanto-suportada foi abortada. Um total de 35 pacientes (48,61%) encontra-se em fase de reabilitação; 24 pacientes (33,33%) encontram-se reabilitados com próteses implanto-suportadas coroas unitárias, próteses fixas ou overdentures - com um tempo médio de acompanhamento de 25,54 ± 23,75 meses. O índice de sucesso neste período foi de 88,24%
Abstract: Rehabilitation of the posterior maxilla is often impaired by bone atrophy, associated with maxillary sinus pneumatization, preventing the installation of implants of ideal length. Maxillary sinus elevation was first introduced in the literature in 1980, by Boyne & James, as an attempt to allow the placement of osseointegrated implants in this region, and several modifications have been presented resulting in different success and complication rates. This retrospective study involved an analysis of 72 patients treated during a period of 6 years in the Oral and Maxillofacial Surgery Area, Piracicaba Dental School - Unicamp. The sample was represented by 91 maxillary sinuses that had been subjected to elevation associated with different grafting materiais, for the installation of 101 implants. In 13 patients (18.50%), implantsupported rehabilitation had been aborted; in 35 patients (48.61%), it had not been finished; 24 patients (33.33%) had already received rehabilitation with implant-supported prostheses unitary crowns, fixed prostheses or overdentures - with a mean follow-up period of 25.54 ± 23.75% months. The success rate in this period was 88.24%
Mestrado
Cirurgia e Traumatologia Buco-Maxilo-Faciais
Mestre em Clínica Odontológica

It was the aim of this 24-mo randomized controlled clinical trial to investigate whether the survival of a single median implant placed in the edentulous mandible to retain a complete denture is not compromised by immediate loading. Secondary outcomes were differences in prosthetic complications between the loading principles. Each of the 158 patients who received an implant was randomly assigned to the immediate loading group (n = 81) or the delayed loading group (n = 77). Recall visits were performed 1 mo after implant placement (for only the delayed loading group) and 1, 4, 12, and 24 mo after implant loading. Nine implants failed in the immediate loading group, all within the first 3 mo of implant loading, and 1 implant failed in the delayed loading group prior to loading. Noninferiority of implant survival of the immediate loading group, as compared with the delayed loading group, could not be shown (P = 0.81). Consistent with this result, a secondary analysis with Fisher exact test revealed that the observed difference in implant survival between the treatment groups was indeed statistically significant (P = 0.019). The most frequent prosthetic complications and maintenance interventions in the mandible were retention adjustments, denture fractures, pressure sores, and matrix exchanges. There was only 1 statistically significant difference between the groups regarding the parameter “fracture of the denture base in the ball attachment area” (P = 0.007). The results indicate that immediate loading of a single implant in the edentulous mandible reveals inferior survival than that of delayed loading and therefore should be considered only in exceptional cases (German Clinical Trials Register: DRKS00003730).

 

Introduktion: Tandlöshet är ett problem som drabbar många människor. Kraven på funktionella och snygga tänder i livets alla skeden har blivit tydligare på senare år. Dentala implantat är en möjlighet att ersätta förlorade tänder och har hjälpt många individer att få sin livskvalité tillbaka.

Syfte: Att kartlägga mjukvävnads- och hårdvävnadskomplikationer som kan uppkomma efter en behandling med dentalt implantat och vilka orsaker det finns till dessa.

Frågeställningar: Vad finns det för mjukvävnads- och hårdvävnadskomplikationer som kan uppkomma efter en behandling med dentalt implantat?

Vad finns det för orsaker till komplikationer efter behandling med dentalt implantat?

Metod: Studien är en systematisk litteraturstudie.

Resultat: Efter behandling med dentalt implantat kan olika mjukvävnads- och hårdvävnadskomplikationer uppstå. De två vanligaste mjukvävnadskomplikationer var peri-implantär mukosit och mukosal hyperplasi. Typiska hårdvävnadskomplikationer som upptäcktes var benförlust och apikal peri-implantit. Tidigare parodontiterfarenhet visade sig vara den viktigaste orsaken till komplikationer vid dentala implantat.

Konklusion: Dental implantatbehandling är inte riskfri. Studien visade att komplikationer är vanliga efter dental implantatbehandling samt att det fanns riskfaktorer som påverkar dental implantatbehandling på ett negativt sätt.

Introduction: Porcelain fractures belong to the most frequent technical complications in implant borne fixed restorations. Aim of this retrospective clinical study was to determine the prevalence and extent of porcelain fractures and to detect possible risk indicators. Methods: The study was designed by the Department of Prosthetic Dentistry, Dental School, University Hospital Carl Gustav Carus of Technical University of Dresden (TUD). Only adult patients (age ≥ 18 years) having previously received implant borne either metal-ceramic or all-ceramic fixed dental restorations from January 1995 until August 2011 were recruited. On the day of examination demographic and clinical parameters were systematically collected. Any present porcelain fracture was recorded systematically in terms of position and extent through clinical examination under relatively dry conditions. The fractures were classified in four categories according to their extent and respective reparability. Descriptive statistical analysis was conducted and contingency table analysis was used to determine the correlation between potential risk indicators and porcelain fractures on patient, restoration and unit level. Results: A total number of 144 patients (66 males, 78 females) was examined and entered the analysis. They represented 507 units (483 porcelain-fused-to-metal (PFM), 24 all-ceramic (AC)). Further these units represented 291 single crowns (SC)/ splinted crowns (S SC) (278 PFM, 13 AC) and 28 implant borne fixed dental prostheses (FDP) (28 PFM, 0 AC), 16 implant-tooth borne FDPs (14 PFM, 2 AC) and 14 implant borne cantilevered FDPs (13 PFM, 1 AC). The porcelain fracture rate on patient level was 23.6%, while on PFM FDP level this rate was 16.4%, on SC level was 12.2% and on unit level 9.5%. The results for AC restorations were 33.3%, 0.0% and 4.2% respectively. The parameters bruxism, age, gender, number of natural teeth, number of implants and implant supported FDPs per patient, former technical complication, implant system, opposing arch and splinted crowns or not had statistically significant correlation to porcelain fractures. Conclusion: Porcelain fracture in implant borne fixed restorations is a multicausal event. According to the limitations of the retrospective study design, this study showed that a male patient, bruxer, over 60-years-old, with ≤20 existing natural teeth, non-splinted crowns and former technical complications is prone to porcelain fracture. The results encourage further prospective clinical studies
Einführung: Unter den technischen Komplikationen bei festsitzenden implantatgetragenen Restaurationen zählen Verblendkeramikfrakturen zu den häufigsten. Ziel der vorliegenden klinischen retrospektiven Studie war die Bestimmung der Häufigkeit des Auftretens und Ausmaßes von Verblendkeramikfrakturen und möglicher Risikoindikatoren. Methode: Die Studie wurde in der Abteilung für Zahnärztliche Prothetik der UniversitätsZahnMedizin Carl Gustav Carus Dresden, Technische Universität Dresden (TUD) geplant und durchgeführt. Erwachsene Patienten (Alter ≥ 18 Jahre), die im Zeitraum von Januar 1995 bis August 2011 mit festsitzenden implantatgetragenen metall- oder vollkeramischen Restaurationen versorgt worden waren, wurden nachuntersucht. Dabei wurden demografische und klinische Parameter erhoben. Unter relativer Trockenlegung wurden alle Restaurationen systematisch auf Verblendkeramikfrakturen untersucht. Die Frakturen wurden in vier Gruppen je nach Ausmaß und Reparierbarkeit klassifiziert. Die Analyse der Daten erfolgte deskriptiv. Weiterhin erfolgte eine Kontingenztafelanalyse der Beziehungen zwischen den demografischen und klinischen Parametern und vorliegenden Verblendkeramikfrakturen auf Patienten-, Restaurations- und Einheitenebene. Ergebnisse: Eine Gesamtzahl von 144 Patienten wurde untersucht; 66 davon männlich und 78 weiblich. Es lagen 507 Einheiten (483 metallkeramisch/MK, 24 vollkeramisch/VK) vor, entsprechend 291 implantatgetragenen Einzelkronen/ verblockten Kronen (278 MK, 13 VK), 28 implantatgetragenen Brücken (28 MK, 0 VK), 16 Verbundbrücken (14 MK, 2 VK) und 14 implantatgetragenen Extensionsbrücken (13 MK, 1 VK). 23,6% der Patienten wiesen mindestens eine Verblendkeramikfraktur auf, wobei 16,4% der MK Brücken, 12,2% der MK Kronen und 9,5% der MK Einzeleinheiten betroffen waren. Die Ergebnisse für die VK Restorationen waren 33,3%, 0,0% und 4,2%. Es konnten Korrelationen zwischen den vorhandenen Veblendkeramikfrakturen und den Parametern Bruxismus, Alter des Patienten, Geschlecht, Anzahl der vorhandenen natürlichen Zähnen, Implantaten und implantatgetragenen Brücken pro Patient, frühere technische Komplikationen, Implantatsystem, Gegenkieferversrorgung und Verblockung der Einzelkronen ermittelt werden. Schlussfolgerung: Verblendkeramikfrakturen bei festsitzenden implantatgetragenen Restaurationen werden als multikausales Geschehen angesehen. Auf der Basis des vorliegenden retrospektiven Studiendesigns wurde ein männlicher Patient mit Bruxismus, über 60 Jahre alt, mit ≤20 vorhandenen natürlichen Zähnen, nicht verblockten Kronen und früheren technischen Komplikationen als Risikopatient für Verblendkeramikfrakturen identifiziert. Die Ergebnisse geben Anlass zu weiteren prospektiven klinischen Studien

Rehabilitation of edentulous patients with Implant-supported Complete Fixed Dental Prosthesis (ICFDP) is a well-documented treatment option. This dissertation assessed the relation between the rate of biological/mechanical complications and the type of metal framework alloy, length of cantilever extension. The results showed that long-term clinical outcomes of ICFDP were favorable. While 30% of patients experienced biological complications, 66.6% of the prostheses needed to be repaired during follow-up period. The risk of prosthesis failure and mechanical complications was significantly higher in silver-palladium frameworks as compared with palladium-silver or type IV gold alloys. The length of cantilever was not correlated with the amount of marginal bone loss. The rate of marginal bone loss around anterior implants was higher than that of posterior implants associated with cantilever segments. The treatment improved the patients’ quality of life and 96% of patients would undergo the same treatment again if required.

碩士
高雄醫學大學
口腔衛生學系碩士在職專班
103
Background The application of dental implants in replacing missing teeth is highly predictable and successful. There were some risk factors are recognized to affect the dental implant survival rate or postoperative complications. However, the risk factors in Taiwan patients with implants are not clear. The differences in these risk factors are not available between private dental clinics and dental clinics under teaching hospital. Objective To investigate the risk factors to affect the overall survival rate of dental implants and complication-free survival rate of dental implants. Materials and methods A retrospective study is designed for present study. The inform consent is signed by the patients before data collection .The implants are completed in two cooperated hospitals and one private dental clinic between 2002 to 2014. The data are collected from patients’ medical files. A self-administered questionnaire is used to collect the histories of cigarette smoking, alcoholic drinking, betel quid chewing , and the knowledge, attitude and health behaviors of oral hygiene in patients. Finally, statistical analysis is applied to determine the association. Results The average age of 117 patients ,54 males and 63 females, is 44.58 years old. Total number of implants are 429 including 4 failed implants. The cumulative survival rate was 98.85%. The dental clinics, gender , implant position, brand of implant, postoperative complication and the habit of betel quid chewing were associated with an increased risk of implants failure (P < 0.05).The dental clinics, gender, diabetes, periodontal history, implant position, brand of implant, smoking habit and oral health total score were associated with an increased risk of complications (P < 0.05). Multivariate Cox propositional hazard model also revealed that histories of periodontitis could be a significant risk factor for implant with early complications (adjusted hazard ratio (AHR) = 2.63, 95% CI = 1.22-5.66). Located at maxillary implant has a higher probability of early postoperative complications than mandible (AHR = 1.68, 95% CI = 1.19-2.38). The smokers who implanted in dental clinics were associated with an increased risk of early complications (AHR = 3.42, 95% CI = 1.95-6.01). Conclusion Present study shows that the success rate of dental implants is high while the failure rate is low. Diabetes, histories of periodontitis, implant position, and brand of implant can affect the survival rate of the implant and the chance of occurring postoperative complications. We also found that there are different risk factors between private dental clinics and dental clinics under teaching hospital. Currently, the number of our data collection location were too few, may not represent the actual situation, relevant findings still need further confirmation.

Objectives: The objective of this systematic review was to compare within the literature if titanium and titanium-zirconium implants show differences, when evaluated soft and hard tissue, compared to zirconia implants. Material and methods: The searches were electronically performed (PubMed and Web of Science) and by hand, in October 2020, to identify randomized controlled trials comparing either zirconia implants with titanium or titaniumzirconia implants. The focused question was determined according to PICOT strategy. Results: A total of 7 studies were included from a total of 202 articles initially found, which 4 of them were duplicates and 198 titles were screened and 191 of them excluded. The follow-up periods ranged from 12 months to 80 months and the mean age from 43.3 to 65.8. The survival rate for titanium implants ranged from 92.6% to 100% and for titanium-zirconium implants from 95.8% to 100%, whereas zirconia implants ranged from 87.5% to 91.25%. The mean marginal bone loss for titanium implants ranged from -1.17mm to -0.125mm, for titaniumzirconium implants from -0.6mm to -0.32mm, and for zirconia implants from - 0.25mm to -1.38mm. Regarding mucositis and peri-implantitis, the studies showed little incidence. For bleeding on probing, it was evaluated for zirconia implants a 16.43%, while for titanium implants ranged between 10% and 20% and for titanium-zirconium implants 10% to 13.8%. Probing-in-depth for titanium implants ranged from 1.6mm to 3.05mm, for zirconia implants ranged from 2.21mm to 2.6mm and for titanium-zirconium evaluated probing in depth recording 3.12mm. Regarding the diameters of implants, all types were used (narrow, regular, and wide). Conclusion: All three types of implants showed similar soft and hard tissue response and behavior, except for the survival rate involving the zirconia implants, which had the lowest value.

Aims and Objectives: To investigate the experience of implant complications and opinions on complications among dentists in private practices in Ontario. Methods: In 2010, a web-based anonymous survey was distributed to 2034 Ontario dentists with valid e-mail addresses. Results: 527 dentists replied to the survey, of which 469 utilized implants. Most complications were preventable. The most important cause of complications was “poor planning”. The most severe complication was “permanent paraesthesia”. Fewer than 5% of patients experienced a complication in 2009. There was little agreement among general dentists, oral surgeons, periodontists, and prosthodontists on the causes of complications, some agreement on preventive strategies to avoid complications, and significant agreement on severity of complications and their preventability. Conclusions: A significant proportion of dentists in Ontario had encountered an implant treatment complication in 2009. Since most complications are preventable, efforts at decreasing their prevalence and severity should be pursued.

A Implantologia tem ganho popularidade na medicina dentária pelos resultados previsíveis em reabilitações de áreas edêntulas, permitindo minimizar as consequências funcionais, fonéticas e estéticas que advém da perda de dentes através de uma solução fixa que satizfaz os pacientes. Esta é uma revisão da literatura existente sobre factores de risco, fracassos e complicações inerentes ao tratamento com implantes dentários. Categorizam-se os factores de risco em implantologia como relacionados com o médico e o procedimento; com o paciente; factores locais como quantidade e qualidade de osso e tecidos moles; relacionados com o implante e tipo de biomaterial; associados à fase protética; complicações e doenças peri-implantares. Para isso foi realizada uma pesquisa na base de dados online MEDLINE/PubMed usando palavras-chave “factores de risco em implantologia”, “complicações em implantologia”, “fracassos em implantologia”, tendo sido utilizados os artigos e publicações pertinentes para este trabalho. Ainda que a taxa de sucesso seja elevada, os implantes podem falhar. Não existem contra-indicações absolutas à colocação de implantes, no entanto alguns factores são consideradas de maior risco. O desafio na terapia com implantes está na capacidade do médico avaliar e classificar as condicionantes de cada paciente e elaborar apresentar um plano de tratamento concordante com o carácter multifactorial dessas limitações.
Dental implant teraphy has become very popular because of it’s predictable results in the reabilitation of edentulous sites, allowing the reduction of phonetic, aesthetic and functional consequences that come with tooth loss, and it does so by using a fixed and well-accepted solution. However, implant therapy must be carefully weighted as each pacient is unique. This is a literature review about risk factors, failures and complications inherent to implant therapy. The risk factors were organized according to it’s relationship with the surgeon’s experience, thecnique and surgical procedure; the patient; local factors such as bone and soft tissue quantity and quality; factors regarding the implant itself (dimentions, surface treatment and design); factors related to the prosthetic phase, such as type of prothesis and loading; and peri-implant deseases such as mucositis and peri-implantitis. A research was done using the online database MEDLINE/PubMed on the key-words “implantology risk factors”, “complications in implantology”, “implantology failures”, then the articles and publications found were used according to it’s relevance to the present work. Whilst the success rates of implant therapy are high, there are still failures. There are no absolute contraindications to implant therapy, nevertheless some conditions are considered a major risk. The challenge in implantsuported- rehabilitations relies on the physician's ability to evaluate and classify the constraints of each patient, and deliver a treatment plan according to these multifactorial limitations.

Introduction: Porcelain fractures belong to the most frequent technical complications in implant borne fixed restorations. Aim of this retrospective clinical study was to determine the prevalence and extent of porcelain fractures and to detect possible risk indicators. Methods: The study was designed by the Department of Prosthetic Dentistry, Dental School, University Hospital Carl Gustav Carus of Technical University of Dresden (TUD). Only adult patients (age ≥ 18 years) having previously received implant borne either metal-ceramic or all-ceramic fixed dental restorations from January 1995 until August 2011 were recruited. On the day of examination demographic and clinical parameters were systematically collected. Any present porcelain fracture was recorded systematically in terms of position and extent through clinical examination under relatively dry conditions. The fractures were classified in four categories according to their extent and respective reparability. Descriptive statistical analysis was conducted and contingency table analysis was used to determine the correlation between potential risk indicators and porcelain fractures on patient, restoration and unit level. Results: A total number of 144 patients (66 males, 78 females) was examined and entered the analysis. They represented 507 units (483 porcelain-fused-to-metal (PFM), 24 all-ceramic (AC)). Further these units represented 291 single crowns (SC)/ splinted crowns (S SC) (278 PFM, 13 AC) and 28 implant borne fixed dental prostheses (FDP) (28 PFM, 0 AC), 16 implant-tooth borne FDPs (14 PFM, 2 AC) and 14 implant borne cantilevered FDPs (13 PFM, 1 AC). The porcelain fracture rate on patient level was 23.6%, while on PFM FDP level this rate was 16.4%, on SC level was 12.2% and on unit level 9.5%. The results for AC restorations were 33.3%, 0.0% and 4.2% respectively. The parameters bruxism, age, gender, number of natural teeth, number of implants and implant supported FDPs per patient, former technical complication, implant system, opposing arch and splinted crowns or not had statistically significant correlation to porcelain fractures. Conclusion: Porcelain fracture in implant borne fixed restorations is a multicausal event. According to the limitations of the retrospective study design, this study showed that a male patient, bruxer, over 60-years-old, with ≤20 existing natural teeth, non-splinted crowns and former technical complications is prone to porcelain fracture. The results encourage further prospective clinical studies.
Einführung: Unter den technischen Komplikationen bei festsitzenden implantatgetragenen Restaurationen zählen Verblendkeramikfrakturen zu den häufigsten. Ziel der vorliegenden klinischen retrospektiven Studie war die Bestimmung der Häufigkeit des Auftretens und Ausmaßes von Verblendkeramikfrakturen und möglicher Risikoindikatoren. Methode: Die Studie wurde in der Abteilung für Zahnärztliche Prothetik der UniversitätsZahnMedizin Carl Gustav Carus Dresden, Technische Universität Dresden (TUD) geplant und durchgeführt. Erwachsene Patienten (Alter ≥ 18 Jahre), die im Zeitraum von Januar 1995 bis August 2011 mit festsitzenden implantatgetragenen metall- oder vollkeramischen Restaurationen versorgt worden waren, wurden nachuntersucht. Dabei wurden demografische und klinische Parameter erhoben. Unter relativer Trockenlegung wurden alle Restaurationen systematisch auf Verblendkeramikfrakturen untersucht. Die Frakturen wurden in vier Gruppen je nach Ausmaß und Reparierbarkeit klassifiziert. Die Analyse der Daten erfolgte deskriptiv. Weiterhin erfolgte eine Kontingenztafelanalyse der Beziehungen zwischen den demografischen und klinischen Parametern und vorliegenden Verblendkeramikfrakturen auf Patienten-, Restaurations- und Einheitenebene. Ergebnisse: Eine Gesamtzahl von 144 Patienten wurde untersucht; 66 davon männlich und 78 weiblich. Es lagen 507 Einheiten (483 metallkeramisch/MK, 24 vollkeramisch/VK) vor, entsprechend 291 implantatgetragenen Einzelkronen/ verblockten Kronen (278 MK, 13 VK), 28 implantatgetragenen Brücken (28 MK, 0 VK), 16 Verbundbrücken (14 MK, 2 VK) und 14 implantatgetragenen Extensionsbrücken (13 MK, 1 VK). 23,6% der Patienten wiesen mindestens eine Verblendkeramikfraktur auf, wobei 16,4% der MK Brücken, 12,2% der MK Kronen und 9,5% der MK Einzeleinheiten betroffen waren. Die Ergebnisse für die VK Restorationen waren 33,3%, 0,0% und 4,2%. Es konnten Korrelationen zwischen den vorhandenen Veblendkeramikfrakturen und den Parametern Bruxismus, Alter des Patienten, Geschlecht, Anzahl der vorhandenen natürlichen Zähnen, Implantaten und implantatgetragenen Brücken pro Patient, frühere technische Komplikationen, Implantatsystem, Gegenkieferversrorgung und Verblockung der Einzelkronen ermittelt werden. Schlussfolgerung: Verblendkeramikfrakturen bei festsitzenden implantatgetragenen Restaurationen werden als multikausales Geschehen angesehen. Auf der Basis des vorliegenden retrospektiven Studiendesigns wurde ein männlicher Patient mit Bruxismus, über 60 Jahre alt, mit ≤20 vorhandenen natürlichen Zähnen, nicht verblockten Kronen und früheren technischen Komplikationen als Risikopatient für Verblendkeramikfrakturen identifiziert. Die Ergebnisse geben Anlass zu weiteren prospektiven klinischen Studien.

Introdução: As próteses sobre implantes são uma das opções disponíveis para reabilitar espaços desdentados. São vários os componentes e as etapas no seu fabrico que podem afetar o sucesso do tratamento. Deste modo, a caracterização e a recolha de dados relativo a possíveis complicações pode ajudar na otimização dos tratamentos com próteses sobre implantes. Este estudo pretende contribuir para um melhor conhecimento da realidade das próteses sobre implantes fabricadas por Técnicos de Prótese Dentária em Portugal. Materiais e Métodos: A recolha de dados foi efetuada através de um questionário aplicado a Técnicos de Prótese Dentária. O questionário foi desenvolvido na plataforma digital Qualtrics® e partilhado de 3 formas: e-mail direto a Laboratórios de Prótese; e-mail à Associação Portuguesa de Técnicos de Prótese Dentária e pedido de resposta com hiperligação para o questionário em fóruns de Técnicos de Prótese Dentária. Foram enviados lembretes todas as semanas durante um mês. Resultados: De um total de 155 questionários, 60 foram considerados como amostra válida. 95 foram excluídos por estarem incorretamente preenchidos. A maioria dos Técnicos de Prótese, 68,3%, realizam tanto Prótese Fixa sobre Implantes como Prótese Removível sobre Implantes. Apenas 6,7% executa exclusivamente Prótese Removível sobre Implantes. A maioria da prótese fixa sobre implantes é cimento-aparafusada (53,6%). No sector anterior, o material mais utilizado é a zircónia com recobrimento vestibular, enquanto na secção posterior é a zircónia monolítica “pintada”. Os pedidos de reparação mais comuns ocorreram devido a chipping da restauração. Relativamente às próteses removíveis sobre implantes, o retentor mais usado é do tipo “locator®” e os pedidos de reparação mais comuns ocorreram devido à fratura de dentes ou da base da prótese e ainda a perda de dentes. Conclusão: Dentro das limitações deste estudo, podemos concluir que o chipping é ainda uma complicação importante da reabilitação protética com implantes dentários, o que deverá alertar os Técnicos de Prótese Dentária e os Médicos Dentistas de forma a otimizarem a escolha do material, a confeção da infra-estrutura, o desenho da prótese e a oclusão da mesma. As fraturas que podem ocorrer na prótese removível sobre implantes devem também alertar os profissionais para um correto desenho protético e para a verificação do assentamento perfeito da prótese na respetiva área de suporte.
Introduction: Implant-supported prostheses are one of the options available to rehabilitate an edentulous space. This type of dental prosthesis involves several components and steps in their production that may affect the success of the rehabilitation. The characterization of this prosthesis and the record of its possible complications may be helpful in the optimization of this type of rehabilitations. The aim of this study is to characterize implant-supported prostheses produced by Portuguese Dental Technicians. Material and Methods: The data was collected using a questionnaire applied to Dental Technicians. The survey was developed in the online platform Qualtrics® and shared by 3 ways: e-mail to Dental Prostheses Laboratories; e-mail to Portuguese Association of Dental Technicians (APTPD), and request with the survey link in Portuguese online forums of Dental Technicians. Reminders were sent every week, during a month. Results: A total of 155 surveys were answered. However, only 60 were considered for the valid sample. 95 were excluded because they were incomplete. The majority of the Dental Technicians, 68,3%, performed both fixed and removable implant-supported prostheses. Only 6,7% performed exclusively removable implant-supported prostheses. The majority of the fixed implant-supported prostheses is cement-screw (53,6%) or only screw-retained (44,6%). In the anterior sector, the material most used is zirconia with vestibular veneering. In the posterior section, stained monolithic zirconia. The most frequent repair demand is due to restauration chipping. Concerning removable implant-supported prostheses, the most used attachment is “locator®” type and the most frequent repair is the fracture of tooth or denture base, and tooth loss. Conclusion: Within the limitations of this research, we can conclude that restauration chipping is still one important complication in prosthetic rehabilitations with dental implants. This should alert Dental Technicians and Dentists to improve material selection, framework design and occlusion. The fractures that may occur on removable implant-supported prostheses should also alert the professionals for a better prosthetic design and the correct fit of the prostheses in their support area.