Ott 2025
Giacomo Fabbri, Francesco Mintrone, Fabiana Aellos, Joseph Lee
The long-term success of implant-supported restorations depends on achieving both esthetic and biologic stability through proper management of the transmucosal space. This article introduces a novel concept for comprehensive surgical, restorative, and laboratory interpretation of the subgingival implant complex by dividing it into two functional compartments: the Biological Room (BR) and the Restorative Room (RR). The BR, located immediately coronal from the bone-to-implant contact, is responsible for peri-implant tissue integration which serves as a biologic barrier. This biologic barrier is achieved by the connective tissue and apical peri-implant epithelium which is populated by hemidesmosomal attachments. It must be managed using biocompatible materials (eg, titanium or zirconia) with specific surface properties (roughness 0.1-0.2 microns) to promote stable mucointegration. A minimum height of 2.0 mm is recommended for optimal hemidesmosomal function. The RR, located coronal to the BR, supports soft tissue architecture and esthetics and extends up to 3.0 mm. The prosthetic component in the RR is shaped to accommodate restorative needs and optimize the esthetic interface. Materials used here must balance esthetics, cleanability, and biocompatibility with highly polished surfaces to minimize plaque accumulation. This biologically driven framework enables clinicians and dental technicians to provide implant restorations that respect both esthetic and biologic principles, while promoting long-term peri-implant tissue health and clinical success. Previously, these concepts were described separately, but the Biological Room and Restorative Room concept serves as a guideline for all team members to achieve a desirable implant therapy.Int J Periodontics Restorative Dent. 2025 Oct 22;0(0):1-32. doi: 10.11607/prd.7779.
Mag 2024
Giacomo Fabbri, Fernando Zarone, Gianluca Dellificorelli, Giorgio Cannistraro, Marco De Lorenzi, Alberto Mosca, Renato Leone, Roberto Sorrentino
This retrospective study aimed at evaluating the clinical outcomes of lithium disilicate prostheses onto teeth and implants. A total of 860 restorations were delivered to 312 patients, including crowns, veneers and onlays. Patients with uncontrolled gingival inflammation and/or periodontitis were excluded, whilst subjects with occlusal parafunctions were included. The retrospective observational period ranged between 13 to 17 years. The mechanical and esthetic performances of the restorations were rated according to the modified CDA criteria. The recorded data were analyzed statistically. In total, 26 mechanical complications were noticed: 17 ceramic chippings, 5 core fractures and 4 losses of retention. Mechanical complications occurred predominantly in posterior areas; monolithic prostheses showed the lowest percentage of structural problems. The clinical scores of layered and monolithic restorations were fully satisfactory according to the modified CDA rating. The cumulative survival and success rates ranged between 95.46-100% and 93.75-100% respectively up to 17 years of follow-up. Although patient selection and the rigorous application of validated clinical protocols were considered paramount, the use of lithium disilicate prostheses onto teeth and implants was reported to be a viable and reliable treatment option in the long-term.
PMID: 38820271
Mag 2024
Aellos F, Grauer JA, Harder KG, Dworan JS, Fabbri G, Cuevas PL, Yuan X, Liu B, Brunski JB, Helms JA.
Aim: To qualitatively and quantitatively evaluate the formation and maturation of peri-implant soft tissues around ‘immediate’ and ‘delayed’ implants.
Materials and methods: Miniaturized titanium implants were placed in either maxillary first molar (mxM1) fresh extraction sockets or healed mxM1 sites in mice. Peri-implant soft tissues were evaluated at multiple timepoints to assess the molecular mechanisms of attachment and the efficacy of the soft tissue as a barrier. A healthy junctional epithelium (JE) served as positive control.
Results: No differences were observed in the rate of soft-tissue integration of immediate versus delayed implants; however, overall, mucosal integration took at least twice as long as osseointegration in this model. Qualitative assessment of Vimentin expression over the time course of soft-tissue integration indicated an initially disorganized peri-implant connective tissue envelope that gradually matured with time. Quantitative analyses showed significantly less total collagen in peri-implant connective tissues compared to connective tissue around teeth around implants. Quantitative analyses also showed a gradual increase in expression of hemidesmosomal attachment proteins in the peri-implant epithelium (PIE), which was accompanied by a significant inflammatory marker reduction.
Gen 2023
Alessandro Pozzi, Lorenzo Arcuri, Giacomo Fabbri, Guido Singer, Jimmy Londono
Statement of problem: Despite the broad clinical application of zirconia for fixed implant-supported prostheses, evidence of long-term performance is sparse.
Purpose: The purpose of this retrospective study was to evaluate the long-term clinical and radiographic outcomes of zirconia-based partial and complete screw-retained implant-supported zirconia fixed dental prostheses (ISZFDPs).
Ago 2022
Giacomo Fabbri, Tristan Staas, Istvan Urban
A novel, biologically friendly implant concept system introduces low-speed (50 rpm) site preparation instruments used without irrigation and a tri-oval, tapered implant designed to reduce stress on cortical bone without sacrificing mechanical stability. This retrospective, observational, multicenter study (clinicaltrials.gov NCT04736771) collected data from consecutive patients treated with at least one novel concept system implant to evaluate clinical outcomes after 1 year in function. The primary endpoint was a marginal bone level change (MBLC) from loading to 1 year, and secondary endpoints included implant survival and clinician feedback. Ninety-five patients (54 women and 41 men, mean age: 58 ± 12 years) were treated with 165 implants. For 94.5% of implants, site preparation was performed in two steps. The mean follow-up from implant insertion was 1.8 ± 0.2 years. Mean MBLC from implant loading to 1-year follow-up was +0.15 ± 0.85 mm (n = 124 implants). At the last follow-up, the implant survival rate was 98.0%. Clinician satisfaction with the novel concept system was high. The novel concept system offers an easy-to-use implant placement protocol, with most implants placed using two steps. The minimal bone remodeling and high survival rate observed across a variety of indications and treatment protocols demonstrate broad versatility and confirm the clinical benefits of this biologically friendly innovation.
PMID: 36013098
Nov 2021
Giacomo Fabbri, Roberto Sorrentino
The emergence profile is a crucial factor in facilitating favorable esthetic outcomes and maintaining peri-implant health and stability. It should be evaluated not simply in terms of morphology but as a clinical variable closely related to material properties and clinical approaches; in this way, this critical factor-which can significantly influence the integration, stability, and preservation of bone and soft tissues-can be comprehensively planned. Soft tissue integration and adherence to prosthetic components are paramount elements in the preservation and protection of bone from contamination and infection. The present narrative paper presents a prosthetic concept suggested as an operative strategy to preserve peri-implant hard and soft tissues and achieve predictable prosthetic outcomes, optimizing soft tissue integration. Achieving an ideal soft tissue seal around implants is paramount in achieving stable restorations and protecting the bone interface from possible contamination and infection.Int J Periodontics Restorative Dent. Nov-Dec 2021;41(6):913-921.doi: 10.11607/prd.5063.
Apr 2021
Giacomo Fabbri, Tristan Staas, Tomas Linkevicius, Valda Valantiejiene, Oscar González-Martin, Eric Rompen
Development of a stable and healthy soft-tissue barrier around dental implants is key to long-term success of implant-supported prostheses. The novel two-piece abutment concept shifts the prosthetic interface to the soft-tissue level to protect bone interface/connective tissue during the healing phase and restorative procedures. This prospective study included 72 patients treated with 106 implants to support a single-tooth or a three-unit bridge restored with two-piece abutments. The evaluation included marginal bone level change (MBLC), implant and prosthetic survival, soft-tissue health including keratinized mucosa height and mucosal margin position, patient quality of life (QoL) and satisfaction, and clinician satisfaction and ease-of-use rating of the concept. Mean MBLC from implant placement to 1 year was -0.36 ± 1.26 mm (n = 89), the 1-year implant and prosthetic survival rates were 97.1 and 96.7%, respectively, while keratinized mucosa height increased from 2.9 ± 1.2 mm at prosthetic delivery to 3.2 ± 1.3 mm, and mucosal margin migrated coronally by 0.49 ± 0.61 mm by 1 year. Patient satisfaction and QoL were high. Clinicians were satisfied with the esthetic and functional results and rated the concept as easy to use. In conclusion, the novel two-piece abutment concept promotes good peri-implant tissue health, while providing an easy-to-use workflow and high treatment satisfaction to both patients and clinicians.
PMID: 33918898
Mag 2018
Giacomo Fabbri, Roberto Sorrentino, Giorgio Cannistraro, Francesco Mintrone, Leonardo Bacherini, Roberto Turrini, Tiziano Bombardelli, Michele Nieri, Mauro Fradeani
This multicenter retrospective clinical study was aimed at comparing the effects of an increase in vertical dimension of occlusion (VDO) in patients with xed rehabilitations. Expert prosthodontists retrospectively evaluated 100 patients treated with an increase of the VDO and xed dental prostheses (FDPs) supported by teeth, implants, or both. The patients were divided into three study groups according to the type of support of restorations in posterior areas, as follows: partially edentulous patients with posterior teeth-supported rehabilitations and no implants in posterior segments (group A), partially edentulous patients with posterior mixed rehabilitations and at least one osseointegrated implant in posterior segments (group B), and completely edentulous patients with posterior implant-supported rehabilitations (group C). The new VDO was tested with mock-ups, temporary restorations, or removable appliances. The patients were followed up for at least 1 year after the delivery of final restorations. Clinical variables were collected retrospectively, such as presence of referred self-reported bruxism and temporomandibular joint or muscle symptoms before treatment, extension of the dental arches, increase in VDO, restorative materials, and functional complications. Descriptive statistics were analyzed; the three experimental groups were compared with one-way analysis of variance (ANOVA) followed by Tukey post hoc test for the quantitative variables and with logistic regression using the likelihood ratio test for the qualitative variables. Statistically signi cant differences were reported among the experimental groups for functional complications. Functional and prosthetic complications after the VDO increase were not frequent. Functional complications were mainly noticed in group C but usually were no longer evident after 2 weeks. No signi cant differences were found between groups in terms of prosthetic complications and self-reported bruxism. Int J Periodontics Restorative Dent 2018.
Mar 2018
Fabbri G., Cannistraro G., Pulcini C., Sorrentino R.
The mock-up is a diagnostic technique allowing for the intraoral try-in of a prosthetic project. The communication with patients can be significantly improved showing the potential final outcome of the treatment, making an easy and quick comparison of the pre- and post-operative conditions. Moreover, the mock-up permits the clinicians to check the functional aspects of the therapy The purpose of the present article was to describe the use of the full-mouth mock-up technique for testing all the functional and esthetical parameters in case of extensive rehabilitations associated with a VDO increase with completely additive wax-ups. The proposed clinical procedures describe an easy and reversible technique to manage complex prosthetic cases with a more conservative and operator-friendly approach in comparison with conventional prosthetic therapies, reducing time and costs. All the clinical and technical phases of this approach were described step by step.
Gen 2017
Giacomo Fabbri, Mauro Fradeani, Gianluca Dellificorelli, Marco De Lorenzi, Fernando Zarone, Roberto Sorrentino
This multicenter retrospective clinical study aimed to evaluate the clinical performance of zirconia abutments in anterior and posterior regions, focusing on implant-abutment connections and restoration vertical height (RVH). Six experienced prosthodontists used 965 computer-aided design/computer-assisted manufacture zirconia abutments in 601 patients. Different surgical approaches were taken according to the needs of each patient. The final restorations were all-ceramic single crowns and short-span fixed dental prostheses. Screw-retained restorations were mainly used in anterior areas, whereas cemented prostheses were chosen in cases where the implant position was not ideal. Different types of implant-abutment connections were compared: external, internal with metal components, and internal full-zirconia conical connection. All the restorations were followed up for 4 to 10 years. Technical and biologic complications were assessed in relation to several biomechanical variables, such as RVH. Differences between groups were statistically analyzed, and longevity of abutments was evaluated according to Kaplan-Meier survival analysis. Zirconia abutments resulted in overall survival and success rates of 98.9% and 94.8%, respectively. External connections reported survival and success rates of 99.7% and 94.5%, internal metal connections 99.8% and 95.5%, and internal zirconia connections 93.1% and 93.1%, respectively. Overall complication rates of 1.14%, 3.42%, and 0.62% were reported for fractures, chipping, and unscrewing, respectively. The external connection showed the longest survival while the internal zirconia connection showed the highest fracture incidence over the observation period. The clinical risk limit of RVH was identified as 14 mm. Zirconia abutments showed satisfactory clinical performance in anterior and posterior regions after 4 to 10 years. RVH and connection type influenced the clinical longevity of restorations; in particular, internal connections with secondary metallic components reduced the incidence of complications.
PMID: 27977814
Nov 2016
Purpose: The design of an implant connection that allows prosthetic suprastructures to be attached to implants has long been debated in the dental literature. The goal of this retrospective study was to evaluate the 5-year clinical results for a large number of single implants restored by certified prosthodontists in an attempt to establish whether different clinical outcomes could be detected for external- or internal-connection implants.
Materials and methods: All single implants with internal or external connections inserted in 27 private dental practices from January 1, 2003 to December 31, 2007 were evaluated. An initial statistical analysis was performed to describe the sample population at baseline and then to compare the two types of implant-abutment connection configurations and their clinical outcomes. All data were statistically analyzed with STATA12 (StataCorp).
Results: Twenty-eight of the 85 active members of the Italian Academy of Prosthetic Dentistry (AIOP) participated in this study. The sample included 1,159 patients and 2,010 implants. Of the implants, 75 were dropped because there was no information about follow-up. Of the remaining implants, 1,431 (74.0%) were followed for at least 5 years, and 332 implants (17.2%) were followed for more than 8 years. Nearly 99% (98.9%) of the implants survived. The difference between the survival frequencies of the two types of implant-abutment connection configurations was not significant for each negative event (log-rank test, P > .05). There was no difference between the two types of implants regarding restoration fracture, implant screw loosening, and peri-implant disease.
Gen 2015
Pozzi A, Holst S, Fabbri G, Tallarico M.
PURPOSE: The purpose of this study is to retrospectively evaluate the implant and prosthetic survival and success rates of zirconia-based, implant-supported, screw-retained, cross-arch restorations up to 5 years after placement.
MATERIALS AND METHODS: Twenty-two consecutive edentulous patients (11 males and females, each; mean age 68.3 years) received 26 CAD/CAM cross-arch zirconia implant bridges (NobelProcera™ Implant Bridge Zirconia; Nobel Biocare AG, Zurich, Switzerland) supported by 4 to 10 implants each. All patients were followed for at least 3 years (range 36-60 months, mean 42.3 months). Clinical assessments were scheduled every 4 months during hygiene maintenance. Outcomes were implant and prosthetic survival rates, prosthetic success rate, any observed clinical complications, patient satisfaction, and soft tissue parameters. Fisher’s exact test was used to assess associations between categorical variables.
RESULTS: No dropouts occurred. The overall implant and prostheses survival rate up to 5 years was 100%. Three out of 26 restorations (five out of three hundred forty eight dental units) showed an adhesive chip-off fracture of the veneering ceramic, scoring a cumulative prosthetic success rate of 88.5% at the prosthetic level and 98.6% at the unit level. All 22 patients were functionally and aesthetically highly satisfied with their restorations. Successful soft tissue parameters were found around all implants.
Dic 2014
Giacomo Fabbri, Roberto Sorrentino, Myra Brennan, Antonio Cerutti
The use of zirconia is an esthetic alternative to metal for implant-supported frameworks, and it has increased primarily for its high biocompatibility, low bacterial surface adhesion, high flexural strength and high mechanical features. The zirconia frameworks in fixed prosthetic restorations that are supported by implants is commonly covered with hand-layered overlay porcelain. This technical procedure is highly esthetic but it can cause some complications, such as porcelain fractures. The purpose of this article is to introduce an innovative approach to create an esthetic fixed ceramic implant restoration to minimize and facilitate the repair of the mechanical complications, by combining the adhesive-cementation of lithium disilicate full coverage restorations on implant screw-retained zirconia frameworks.
PMID: 25289384
Mar 2014
Giacomo Fabbri, Fernando Zarone, Gianluca Dellificorelli, Giorgio Cannistraro, Marco De Lorenzi, Alberto Mosca, Roberto Sorrentino
This study aimed to assess the clinical performance of lithium disilicate restorations supported by natural teeth or implants. Eight hundred sixty lithium disilicate adhesive restorations, including crowns on natural teeth and implant abutments, veneers, and onlays, were made in 312 patients. Parafunctional patients were included, but subjects with uncontrolled periodontitis and gingival inflammation were excluded. Veneers up to 0.5 mm thick were luted with flowable composite resin or light curing cements, while dual-curing composite systems were used with veneers up to 0.8 mm thick. Onlays up to 2 mm in thickness were luted with flowable composite resins or dual-curing composite cements. Crowns up to 1 mm in thickness were cemented with self-adhesive or dual-curing resin cements. The observational period ranged from 12 to 72 months, with a mean follow-up of 3 years. The mechanical and esthetic outcomes of the restorations were evaluated according to the modified California Dental Association (CDA) criteria. Data were analyzed with descriptive statistics. Twenty-six mechanical complications were observed: 17 porcelain chippings, 5 fractures, and 4 losses of retention. Structural drawbacks occurred mainly in posterior segments, and monolithic restorations showed the lowest number of mechanical complications. The clinical ratings of the successful restorations, both monolithic and layered, were satisfactory according to the modified CDA criteria for color match, porcelain surface, and marginal integrity. The cumulative survival rates of lithium disilicate restorations ranged from 95.46% to 100%, while cumulative success rates ranged from 95.39% to 100%. All restorations recorded very high survival and success rates. The use of lithium disilicate restorations in fixed prosthodontics proved to be effective and reliable in the short- and medium-term.
PMID: 24600653
Mag 2011
Giacomo Fabbri, Roberto Mancini, Valentina Marinelli, Giorgio Ban
The most common esthetic challenge associated with endodontics is the discoloration of natural tooth structure. Also in fixed prosthesis, discolorations represent an esthetic limit, particularly in the case of all-ceramic restorations. In fact, the final esthetic result can be compromised by the grey radiated through the coping and soft tissue.
Purpose: The aim of the study was to evaluate the masking ability of Procera alumina restorations.
Ott 2009
Giacomo Fabbri, Myra Brennan, Massimiliano Manfredi, Giorgio Ban
The use of biodegradable fixation materials or devices during maxillofacial, craniofacial, and orthopedic reconstructive surgical procedures reduces or eliminates the need to perform a second surgical procedure, which would otherwise be required to remove a nonbiodegradable device. This article presents a novel approach to augment a horizontally deficient alveolar ridge using both a resorbable plate/screw fixation system composed of a polylactic acid-polyglycolic acid (PLLA-PGA) copolymer to provide a rigid scaffolding for the bone chips and a resorbable collagen barrier (Bio-Gide, Osteohealth) to secure the graft material. For periodontal reconstructive procedures, such as guided bone regeneration, the clinical application of this technique may be advantageous and also provide a more esthetic result by minimizing the need for an additional surgical procedure. (Int J Periodontics Restorative Dent 2009;29:543-547.).
PMID: 19888498
Dic 2008
Giacomo Fabbri, Giorgio Ban, Roberto Mancini
The aesthetic rehabilitation of patients with functionally compromised dentition frequently involves a multidisciplinary approach. A correct aesthetic diagnosis, treatment plan, and careful material selection are critical factors in successful restoration. A team approach that includes the clinicians, the laboratory technician, and the patient is essential to achieve the desired result. The following case presentation demonstrates a successful multidisciplinary approach used to recreate an aesthetic smile in a young patient with functionally and aesthetically compromised anterior maxillary dentition..
PMID: 19274955
Nov 2008
Giacomo Fabbri, Giorgio Ban, Roberto Mancini
Tooth extraction inevitably implies significant alterations to the hard and soft tissues with a loss of the preexisting tissue morphology. The re-establishment of the normal tissue architecture is the greatest challenge that the dental professional must overcome in order to obtain pleasing aesthetic results. The following case presentations depict single-tooth immediate implant restoration in aesthetic regions using a flapless approach with immediate loading. This technique is relatively simple, can be used in a variety of clinical situations, and can provide excellent results.
PMID: 19274961
