Purpose: To compare the load to failure values of different ceramic CAD/CAM implant crown materials with drilled screw access holes with and without cyclic loading applied. Materials and methods: Forty zirconia abutments with a titanium base were pre-loaded onto implants to support maxillary right first premolar crowns that were milled from four different CAD/CAM ceramic materials (zirconia reinforced lithium silicate, hybrid ceramic, lithium disilicate, and zirconia; n = 10 each). After cementing the crowns, screw access channels were prepared by drilling through occlusal surfaces. Half of the specimens were subjected to cyclic loading for 5 million cycles at 2 Hz (n = 5/material). After cyclic loading, vertical loads were applied to failure, and the load to failure values of all crowns were recorded and statistically analyzed. Two-way analysis of variance was used with restricted maximum likelihood estimation and Tukey-Kramer adjustments (α = .05). Results: During cyclic loading, the zirconia abutment in one lithium disilicate specimen cracked at 2 million cycles, as well as a zirconia-reinforced lithium silicate crown. Results for the load to failure test series showed statistical differences between the materials. Zirconia resulted in significantly higher failure loads when compared to the other materials (P < .001). Cyclic loading did not significantly affect the load to failure values. Conclusion: Cyclic loading did not significantly influence the load to failure of any of the materials tested. Zirconia crowns with drilled screw access channels cemented on zirconia abutments with a titanium base had higher load to failure values compared to the other ceramic crown materials.

Purpose: To investigate the volumetric facial soft tissue changes associated with wearing complete dentures using 3D facial scans. Materials and Methods: A total of 40 volunteers (20 men and 20 women) were recruited for this study and were treated with maxillary and mandibular complete dentures. Six facial scans were taken of each subject; three scans wearing a complete denture and three without the complete denture. The 3D facial scans were taken with the mouth in three positions: closed, relaxed, and smiling. Each scan was superimposed in order to analyze and quantify linear measurements involving 14 soft tissue landmarks and the total volume that the subject gained with the prosthesis. Results: Three variables were evaluated in each analysis: gender, mouth position, and age. In the analysis of the soft tissue landmarks, there was a significant effect of age, with patients > 75 years showing the greatest changes (P < .05). The landmarks that showed the most changes were those located around the mouth. In the volumetric analysis, the variable with the highest influence was gender, with men gaining more volume than women (P < .05). Conclusion: Complete dentures have a significant effect on volumetric changes in perioral tissues. These changes are more marked in patients > 75 years. Compared to women, men depicted greater volumetric changes with complete dentures. These results provide a new avenue for clinicians and developers using facial scans to design future restorations for edentulous patients.

Ziel: Dieser Fallbericht beschreibt einen digitalen Workflow für die prothetisch orientierte Behandlungsplanung, Implantatinsertion und Herstellung zweier verschraubter, implantatgetragener Full-arch-Brücken bei einem zahnlosen Patienten. Ziel der Kasuistik ist es, die digitalen Arbeitsschritte des Workflows, insbesondere die Scantechnik für die Erfassung der zentrischen Kondylenposition, anhand eines klinischen Falls zu zeigen und zu erläutern. Außerdem werden die Grenzen des Workflows diskutiert.Material und Methoden: Die statische computergestützte Implantation (static Computer-aided Implant Surgery, s-CAIS) wurde auf Basis einer digitalen Volumentomografie, eines Intraoralscans und eines digitalen Bissregistrats dreidimensional geplant. Mittels s-CAIS wurden vier Implantate im Unter- und sechs Implantate im Oberkiefer des unbezahnten Patienten platziert. Die definitiven Full-arch-Restaurationen aus monolithischem Zirkonoxid wurden in einem digitalen Workflow hergestellt, der die zuvor benutzte Röntgenschablone in modifizierter Form für die digitale Kieferrelationsbestimmung nutzte.Schlussfolgerungen: Die Entwicklung digitaler Methoden ermöglicht die Konstruktion, Verarbeitung und Herstellung implantatgetragener Full-arch-Versorgungen in einem chirurgischen, prothetischen und zahntechnischen Workflow auf Grundlage eines dreidimensionalen Backward-Planning. Anhand der digitalen prothetischen Aufstellung lassen sich mittels CAD/CAM-Technik intraorale Prototypen herstellen, die als Vorlage für die definitive monolithische Zirkonoxid-Suprastruktur dienen. Schlagwörter: Backward Planning, unbezahnt, implantatgetragen, Full-arch-Brücke, Oberkiefer, Unterkiefer, CAD/CAM, monolithisch, Zirkonoxid, Röntgenschablone

Die Implantattherapie bei älteren Menschen bedarf einer gezielten Planung. Dabei spielt die Unterscheidung zwischen dem dritten und vierten Lebensabschnitt für die Behandlungsplanung und die anschließende zahnärztliche Betreuung eine wichtige Rolle, da diese Patientengruppen sich fundamental voneinander unterscheiden. Für Menschen des dritten Lebensabschnitts steht das gesamte Spektrum der zahnärztlichen Implantologie zur Verfügung, allerdings müssen chronische Erkrankungen, Medikation und manuelle Geschicklichkeit beachtet werden. Da dentale Implantate meist deutlich länger als 20 Jahre im Mund verbleiben, muss prospektiv die zukünftige Abnahme der biologischen, sozialen und kognitiven Funktionen bei der Planung berücksichtigt werden. Im vierten Lebensabschnitt ist das Leben von der Abhängigkeit bei den Aktivitäten des täglichen Lebens (ADL), Multimorbidität, Polypharmazie und Institutionalisierung bestimmt. Es gibt fast keine wissenschaftliche Evidenz zur Implantattherapie dieser Patientengruppe. Die wenigen vorhandenen Studien zeigen eine sehr hohe Implantatüberlebensrate und es gibt Hinweise auf verringerte akute periimplantäre Entzündungsreaktionen. Gerade Patienten in der vierten Lebensphase könnten am meisten vom funktionellen Gewinn einer implantatstabiliserten Totalprothese profitieren, wenn die muskulären Fähigkeiten zur Stabilisierung einer Prothese nachlassen. Allerdings müssen Handhabung, Nachsorge und tägliche Pflege gesichert werden, bevor mit einer solchen Therapie im Sinne des Nichtschadensgebots begonnen wird. Menschen im palliativen Kontext weisen zunehmend Implantate auf, die die Betroffenen und die Pflegenden vor große Herausforderungen stellen können. Hier müssen die Implantatprothesen rechtzeitig „rückgebaut“ werden, um Schmerzen und Infektionen zu vermeiden. Manuskripteingang: 06.01.2021, Annahme: 19.02.2021 Schlagwörter: Implantologie, Gerodontologie, dritter Lebensabschnitt, vierter Lebensabschnitt, chirurgische Strategien, prothetische Strategien

With the so-called "baby boomer" generation reaching retirement, a new challenge in implant dentistry has emerged. Predominantly, tooth loss occurs later in life, accompanied by increased demand for partial dental prostheses. edentulous patients are more difficult to treat due to advanced age, functional dependence, illness, and financial instability. Prosthetic planning becomes more complex as interindividual diversity increases with age. Considerations such as resilience, physical and mental status, medical history, and drug prescriptions must be individually assessed. Treatment planning and restoration design should fulfill both functional requirements and esthetic demands. Prosthesis design should prevent further harm to the patient. This tertiary prevention approach should prevent local inflammation of the oral tissues, but also prevent secondary systemic infections, such as aspiration pneumonia. There are many prosthetic options for partially or fully edentulous patients. Dental technicians should be aware of the advantages and disadvantages of the various treatment concepts and materials, and contribute professional knowledge to the patient, dentist, and often thirdparty milling centers. Using CAD/CAM technology, customized attachments and prostheses can be individualized according to each patient's requirements. Utilizing a combination of manual and digital production techniques, oral reconstructions can be rationally manufactured. The duration of implant osseointegration remains unknown, but reports of up to 30 years' follow-up are emerging. hence, the environment of the implant - the patient - will change significantly, and implant restorations should be flexibly designed to meet the changing needs of an aging patient. This "back-off strategy" should be implemented, and prostheses should be continuously subjected to critical reevaluations and adaptation. Schlagwörter: Gerodontology, prostheses, edentulous, dental laboratory work

Full-arch rehabilitation of patients with severe tooth wear due to parafunctional behavior is a challenge for dentists and dental technicians, especially when a highly esthetic outcome is desired. A variety of different treatment options and prosthetic materials are available for such a clinical undertaking. The ongoing progress of computer-aided design/computer-assisted manufacture technologies in combination with all-ceramic materials provides a predictable workflow for these complex cases. This case history report describes a comprehensive, stepby- step treatment protocol leading to an optimally predictable treatment outcome for an esthetically compromised patient.

Aim: The impact of prosthetic material selection on implant survival is not clear. The current criteria for choosing a prosthetic material seem to be based on clinician preferences. This systematic review aims to evaluate the impact of restorative materials on the mid- and long-term survival of implants supporting single crowns and fixed partial dentures. Materials and methods: Hand and MEDLINE searches were performed to identify relevant literature for single crowns (SC) and fixed partial dentures (FPD). Further inclusion criteria were a mean follow-up period of at least 3 years, the inclusion of at least 10 patients in a relevant study cohort, and a clear description of prosthesis type and prosthetic material. Results: A total of 63 studies for the SC group and 11 studies for the FPD group were included. Full arch restorations were not included. The materials utilised in the SC group were metal-ceramic (precious and non-precious), lithium-disilicate, veneered zirconia, veneered alumina, and nanoceramics. The materials used in the FPD group were metal-ceramic (precious), veneered titanium, metal-resin (precious), and veneered zirconia. No significant impact on the prosthetic material relating to mid- or long-term implant survival was identified. Furthermore, there were no statistically significant differences between the survival rates of the dental prostheses made from different materials (SC and FPD group). Single crowns made of nanoceramics showed a higher risk for decementation relative to other materials (0.80, 95% CI [0.67; 0.89]; P < 0.0001), whereas metal-resin FPDs showed a higher risk for chipping (0.36, 95% CI [0.23; 0.52]; P = 0.0072). Conclusion: The current evidence suggests that prosthetic material selection has no influence on mid- and long-term survival of implants restored with single crowns and fixed partial dentures. Similarly, the prosthetic material seems to have no significant impact on prosthetic survival rates. Further research is required to provide more evidence regarding the impact of the prosthetic material on long-term outcome. Schlagwörter: fixed partial dentures, implants, material selection, meta-analysis, single crowns, systematic review Conflict-of-interest statement: The authors declare that they have no conflict of interest.

Purpose: The aim of this multicenter single mandibular implant study was to compare the clinical outcome of an immediately loaded implant placed in the midline of an edentulous mandible with the clinical outcome when closed healing and delayed loading is chosen. Here, the patient recruitment period and the main reasons for exclusion were analyzed. Materials and Methods: Patient recruitment was performed at nine German universities. Rather conservative inclusion and exclusion criteria, including denture satisfaction, denture status, a psychologic symptom checklist, and a defined bone height in the posterior mandible, had to be fulfilled. It was initially calculated that 230 persons would have to be screened within 13 months to include 180 persons in the trial. Results: Within 13 months (December 2012 to December 2013), 201 patients were screened for possible inclusion in the trial and 148 met the inclusion criteria. Finally, after the recruitment period was extended by 2.5 months, 224 patients were screened and 169 were included. Of those screened, 55 (24.6%) did not meet the inclusion criteria and were excluded. Another 4 patients (1.8%) were excluded based on their psychologic symptom checklist score, while 5 others (2.8%) showed signs of noncompliance. A further 8 patients (4.4%) decided not to participate and withdrew their informed consent, and another 3 (1.3%) were no longer available after screening. Another 2 patients were excluded due to medical contraindications and 1 due to an insufficient mandibular denture. In 34 cases (15.2%), the residual bone height did not comply with McGarry type II or III. Conclusion: Within the limitations of this patient recruitment period, it can be concluded that residual bone height is the most important factor when considering elderly edentulous patients for implant therapy. The psychologic symptom checklist score was less important.