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Foundation for Oral Rehabilitation – Report of expert consensus

by: Nobel Biocare

The FOR consensus conference held at the University of Pennsylvania School of Dental Medicine on November 30 to December 1, 2016 gathered a panel of international experts to discuss the topic of prosthetic protocols in implant-based rehabilitation.

FOR consensus conference

The methods by which single crowns and prostheses are designed and fabricated for implant-based treatments have changed over the years. Recently, new materials and innovative techniques have been introduced, and relevant scientific evidence has been compiled. Ten international experts each conducted a systematic review of the literature on a specific topic in the field of prosthodontics, yielding the following results.

Both fixed and removable complete arch implant prosthesis were associated with high implant survival rates (on average >90% after 10 years). Implant overdentures were associated with more maintenance needs / complications than fixed prostheses as well as with greater postplacement residual ridge resorption. The level of patient satisfaction was high, however, with both types of prostheses.

Monolithic zirconia with gingival coloring (“gingival staining”), or zirconia with veneered porcelain limited to the gingival area, offers promising results for fixed complete dentures.

The choice of prosthetic material seemed to have no influence on implant or prosthetic survival rates in fixed restorations.

A systematic review on the clinical outcome of monolithic ceramic implant-supported, single- and multi-unit prostheses determined that the risk of fracture and chipping was significantly reduced in monolithic restorations. Another systematic review determined that CAD/CAM abutments have good survival and success rates and provide comparable, if not better, clinical outcomes than conventional abutments. Ti-inserts for CAD/CAM monolithic implant-supported ceramic restorations improve the overall fracture strength of ceramic abutments and crowns, protect the implant connection from wear, and offer a better marginal fit when compared with all-ceramic abutments. However, independent clinical trials that document long-term performance need to be carried out.

Zygomatic implants offer an alternative treatment option for patients with severely resorbed maxillae, thus avoiding invasive bone graft procedures. The survival rate of prostheses is related to the number and position of the zygomatic implants. It reached 96–100 % with one to six years survival. Prosthetic complications included loosening and the fracture of prosthetic screws with the attendant fracture of abutment screws.

Intraoral scanning is more challenging than in-vitro scanning of a model, and more in vivo studies are needed to define clinical indications for different types of IOS. Such is also the case for the impact of the misfit at the prosthesis-implant interface on clinical outcomes of screw-retained implant prostheses, where the available literature does not provide sufficient evidence.

The Foundation for Oral Rehabilitation would like to express their appreciation to the organizers and all the presenters.

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