“All-on-Four” Immediate-Function Concept with Brånemark System® Implants for Completely Edentulous Mandibles: A Retrospective Clinical Study

Patients often present with a variety of soft tissue defects around teeth and implants that can lead to functional and esthetic problems. An array of surgical procedures has been developed to manage these soft tissue defects. The initial procedures were mainly resective in nature and aimed at correcting aberrant frenum attachments, shallow vestibules, and inadequate attached gingiva. These procedures were collectively referred to as “mucogingival surgery” [1]. In recent years, surgical procedures to deal with soft tissue deficiencies have been refined and have incorporated regenerative therapies, as well as adopted the goal of esthetic enhancement. This broadening of the range of surgical procedures leads to the introduction of “periodontal plastic surgery,” as a new term, coined by Miller [2]. Soft tissue abnormalities could be treated in a predictable manner, improving soft tissue health, function, and esthetics [3].

To compare two ridge preservation techniques and spontaneous healing in terms of hard and soft tissue changes 2 months after tooth extraction. The study was designed as a randomized controlled trial and included 75 patients. After single tooth extraction in the maxillary incisor/premolar area, patients were randomly allocated to one of the following groups: (a) ridge preservation with a xenogeneic bone substitute covered with a collagen matrix (CM-group), (b) ridge preservation with a xenogeneic bone substitute covered with a free palatal graft (PGgroup) or (c) spontaneous healing (control). Eight weeks after tooth extraction, implants were placed and clinical, profilometric and radiographic evaluations were performed. In addition, the need for further guided bone regeneration (GBR) at implant placement was assessed. The differences between the treatment groups were compared with the One-way ANOVA or Kruskal–Wallis test with the corresponding post hoc analysis. The proportions of the categorical parameters were compared with the Fisher´s exact test.

Pathological tooth wear is a multifactorial and cumulative process that involves the destruction of dental hard tissues and compromises the patient’s oral health. After an accurate assessment of the amount of worn dental tissues, possible loss of the vertical dimension, aesthetic and phonetic problems, minimally invasive restorations can be used in the rehabilitation of worn teeth after cost-benefit analysis. In addition, the patient should be informedabout the problem, the etiological factors and the clinical performance of the restorations needs to be monitored periodically.

This paper presents European expert consensus guidelines on the management of severe tooth wear. It focuses on the definition of physiological vs pathological tooth wear and recommends diagnosis, prevention, counseling, and monitoring aimed at elucidating the etiology, nature, rate and means of controlling pathological tooth wear. Management decisions are multifactorial, depending principally on the severity and effects of the wear and the wishes of the patient. Restorative intervention is typically best delayed as long as possible. When such intervention is indicated and agreed upon with the patient, a conservative, minimally invasive approach is recommended, complemented by supportive preventive measures. Examples of adhesive, minimum-intervention management protocols are presented.

Selection of the appropriate material for dental restoration has become more and more difficult owing to the increasing vari- ety of restoration materials. A decision flow chart is presented to guide the treatment team (dentist and dental technician) in the selection of the restoration material. This material selection is based on the available interocclusal space, esthetic aspects (eg, brightness value or translucency of the neighboring teeth), as well as clinical evidence extracted from survival rates.

Immediate-function Brånemark System® implants (Nobel Biocare AB, Gothenburg, Sweden) have become an accepted alternative for fixed restorations in edentulous mandibles, based on documented high success rates. Continuous development is ongoing to find simple protocols for their use.