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Clinical Advantages and Limitations of Monolithic Zirconia Restorations Full Arch Implant Supported Reconstruction: Case Series

Identifieur interne : 005C81 ( Ncbi/Merge ); précédent : 005C80; suivant : 005C82

Clinical Advantages and Limitations of Monolithic Zirconia Restorations Full Arch Implant Supported Reconstruction: Case Series

Auteurs : Joao Carames [Portugal] ; Loana Tovar Suinaga [États-Unis] ; Yung Cheng Paul Yu [États-Unis] ; Alejandro Pérez [États-Unis] ; Mary Kang [États-Unis]

Source :

RBID : PMC:4466384

Abstract

Purpose. The purpose of this retrospective case series is to evaluate the clinical advantages and limitations of monolithic zirconia restorations for full arch implant supported restorations and report the rate of complications up to 2 years after insertion. Materials and Methods. Fourteen patients received implant placement for monolithic zirconia full arch reconstructions. Four implants were placed in seven arches, eleven arches received six implants, two arches received seven implants, two arches received eight implants, and one arch received nine implants. Results. No implant failures or complications were reported for an implant survival rate of 100% with follow-up ranging from 3 to 24 months. Conclusions. Monolithic zirconia CAD-/CAM-milled framework restorations are a treatment option for full arch restorations over implants, showing a 96% success rate in the present study. Some of the benefits are accuracy, reduced veneering porcelain, and minimal occlusal adjustments. The outcome of the present study showed high success in function, aesthetics, phonetics, and high patient satisfaction.


Url:
DOI: 10.1155/2015/392496
PubMed: 26124835
PubMed Central: 4466384

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<italic>Purpose</italic>
. The purpose of this retrospective case series is to evaluate the clinical advantages and limitations of monolithic zirconia restorations for full arch implant supported restorations and report the rate of complications up to 2 years after insertion.
<italic>Materials and Methods</italic>
. Fourteen patients received implant placement for monolithic zirconia full arch reconstructions. Four implants were placed in seven arches, eleven arches received six implants, two arches received seven implants, two arches received eight implants, and one arch received nine implants.
<italic>Results</italic>
. No implant failures or complications were reported for an implant survival rate of 100% with follow-up ranging from 3 to 24 months.
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. Monolithic zirconia CAD-/CAM-milled framework restorations are a treatment option for full arch restorations over implants, showing a 96% success rate in the present study. Some of the benefits are accuracy, reduced veneering porcelain, and minimal occlusal adjustments. The outcome of the present study showed high success in function, aesthetics, phonetics, and high patient satisfaction.</p>
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<journal-meta>
<journal-id journal-id-type="nlm-ta">Int J Dent</journal-id>
<journal-id journal-id-type="iso-abbrev">Int J Dent</journal-id>
<journal-id journal-id-type="publisher-id">IJD</journal-id>
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<publisher-name>Hindawi Publishing Corporation</publisher-name>
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<subject>Clinical Study</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Clinical Advantages and Limitations of Monolithic Zirconia Restorations Full Arch Implant Supported Reconstruction: Case Series</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Carames</surname>
<given-names>Joao</given-names>
</name>
<xref ref-type="aff" rid="I1">
<sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0003-4178-8458</contrib-id>
<name>
<surname>Tovar Suinaga</surname>
<given-names>Loana</given-names>
</name>
<xref ref-type="aff" rid="I2">
<sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Yu</surname>
<given-names>Yung Cheng Paul</given-names>
</name>
<xref ref-type="aff" rid="I2">
<sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Pérez</surname>
<given-names>Alejandro</given-names>
</name>
<xref ref-type="aff" rid="I2">
<sup>2</sup>
</xref>
<xref ref-type="corresp" rid="cor1">
<sup>*</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Kang</surname>
<given-names>Mary</given-names>
</name>
<xref ref-type="aff" rid="I2">
<sup>2</sup>
</xref>
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<aff id="I1">
<sup>1</sup>
Faculty of Dental Medicine at the University of Lisbon, Lisbon, Portugal</aff>
<aff id="I2">
<sup>2</sup>
Ashman Department of Periodontology and Implant Dentistry, New York University College of Dentistry, 345 East 24th Street, Suite 3W, New York, NY 10010, USA</aff>
<author-notes>
<corresp id="cor1">*Alejandro Pérez:
<email>apa270@nyu.edu</email>
</corresp>
<fn fn-type="other">
<p>Academic Editor: Sang-Choon Cho</p>
</fn>
</author-notes>
<pub-date pub-type="ppub">
<year>2015</year>
</pub-date>
<pub-date pub-type="epub">
<day>1</day>
<month>6</month>
<year>2015</year>
</pub-date>
<volume>2015</volume>
<elocation-id>392496</elocation-id>
<history>
<date date-type="received">
<day>18</day>
<month>3</month>
<year>2014</year>
</date>
<date date-type="accepted">
<day>23</day>
<month>9</month>
<year>2014</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright © 2015 Joao Carames et al.</copyright-statement>
<copyright-year>2015</copyright-year>
<license xlink:href="https://creativecommons.org/licenses/by/3.0/">
<license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>
<abstract>
<p>
<italic>Purpose</italic>
. The purpose of this retrospective case series is to evaluate the clinical advantages and limitations of monolithic zirconia restorations for full arch implant supported restorations and report the rate of complications up to 2 years after insertion.
<italic>Materials and Methods</italic>
. Fourteen patients received implant placement for monolithic zirconia full arch reconstructions. Four implants were placed in seven arches, eleven arches received six implants, two arches received seven implants, two arches received eight implants, and one arch received nine implants.
<italic>Results</italic>
. No implant failures or complications were reported for an implant survival rate of 100% with follow-up ranging from 3 to 24 months.
<italic>Conclusions</italic>
. Monolithic zirconia CAD-/CAM-milled framework restorations are a treatment option for full arch restorations over implants, showing a 96% success rate in the present study. Some of the benefits are accuracy, reduced veneering porcelain, and minimal occlusal adjustments. The outcome of the present study showed high success in function, aesthetics, phonetics, and high patient satisfaction.</p>
</abstract>
</article-meta>
</front>
<floats-group>
<fig id="fig1" orientation="portrait" position="float">
<label>Figure 1</label>
<caption>
<p>Maxillary occlusal view after tissue healing.</p>
</caption>
<graphic xlink:href="IJD2015-392496.001"></graphic>
</fig>
<fig id="fig2" orientation="portrait" position="float">
<label>Figure 2</label>
<caption>
<p>Intraoral frontal view of artificial teeth arrangement.</p>
</caption>
<graphic xlink:href="IJD2015-392496.002"></graphic>
</fig>
<fig id="fig3" orientation="portrait" position="float">
<label>Figure 3</label>
<caption>
<p>Smile view with artificial teeth arrangement.</p>
</caption>
<graphic xlink:href="IJD2015-392496.003"></graphic>
</fig>
<fig id="fig4" orientation="portrait" position="float">
<label>Figure 4</label>
<caption>
<p>Digital preview of the maxillary monolithic prosthesis.</p>
</caption>
<graphic xlink:href="IJD2015-392496.004"></graphic>
</fig>
<fig id="fig5" orientation="portrait" position="float">
<label>Figure 5</label>
<caption>
<p>Intraoral frontal view with the epoxy resin prototype.</p>
</caption>
<graphic xlink:href="IJD2015-392496.005"></graphic>
</fig>
<fig id="fig6" orientation="portrait" position="float">
<label>Figure 6</label>
<caption>
<p>Maxillary monolithic prosthesis with teeth characterization.</p>
</caption>
<graphic xlink:href="IJD2015-392496.006"></graphic>
</fig>
<fig id="fig7" orientation="portrait" position="float">
<label>Figure 7</label>
<caption>
<p>Ceramic application for gingiva colors and teeth ceramic.</p>
</caption>
<graphic xlink:href="IJD2015-392496.007"></graphic>
</fig>
<fig id="fig8" orientation="portrait" position="float">
<label>Figure 8</label>
<caption>
<p>Prostheses after final sintering.</p>
</caption>
<graphic xlink:href="IJD2015-392496.008"></graphic>
</fig>
<fig id="fig9" orientation="portrait" position="float">
<label>Figure 9</label>
<caption>
<p>Translucency effect in the anterior maxilla after application of ceramics in the digital cut back.</p>
</caption>
<graphic xlink:href="IJD2015-392496.009"></graphic>
</fig>
<fig id="fig10" orientation="portrait" position="float">
<label>Figure 10</label>
<caption>
<p>Intraoral lateral view of the final prostheses.</p>
</caption>
<graphic xlink:href="IJD2015-392496.010"></graphic>
</fig>
<fig id="fig11" orientation="portrait" position="float">
<label>Figure 11</label>
<caption>
<p>Intraoral frontal view of the final prostheses.</p>
</caption>
<graphic xlink:href="IJD2015-392496.011"></graphic>
</fig>
<fig id="fig12" orientation="portrait" position="float">
<label>Figure 12</label>
<caption>
<p>Smile view of the final prostheses.</p>
</caption>
<graphic xlink:href="IJD2015-392496.012"></graphic>
</fig>
<table-wrap id="tab1" orientation="portrait" position="float">
<label>Table 1</label>
<caption>
<p>Literatures of monolithic zirconia.</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="left" rowspan="1" colspan="1">Author</th>
<th align="center" rowspan="1" colspan="1">Publication date</th>
<th align="center" rowspan="1" colspan="1">Study type</th>
<th align="center" rowspan="1" colspan="1">
<italic>N</italic>
(number of arches)</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" rowspan="1" colspan="1">Papaspyridakos and Lal [
<xref rid="B12" ref-type="bibr">12</xref>
]</td>
<td align="center" rowspan="1" colspan="1">2008</td>
<td align="center" rowspan="1" colspan="1">Case report</td>
<td align="center" rowspan="1" colspan="1">1</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Lazetera [
<xref rid="B13" ref-type="bibr">13</xref>
]</td>
<td align="center" rowspan="1" colspan="1">2009</td>
<td align="center" rowspan="1" colspan="1">Case report</td>
<td align="center" rowspan="1" colspan="1">1</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Papaspyridakos and Lal [
<xref rid="B9" ref-type="bibr">9</xref>
]</td>
<td align="center" rowspan="1" colspan="1">2010</td>
<td align="center" rowspan="1" colspan="1">Case report</td>
<td align="center" rowspan="1" colspan="1">1</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Larsson et al. [
<xref rid="B11" ref-type="bibr">11</xref>
]</td>
<td align="center" rowspan="1" colspan="1">2010</td>
<td align="center" rowspan="1" colspan="1">Prospective study</td>
<td align="center" rowspan="1" colspan="1">10</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Rojas-Vizcaya [
<xref rid="B1" ref-type="bibr">1</xref>
]</td>
<td align="center" rowspan="1" colspan="1">2011</td>
<td align="center" rowspan="1" colspan="1">Case report</td>
<td align="center" rowspan="1" colspan="1">2</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Sadid-Zadeh et al. [
<xref rid="B5" ref-type="bibr">5</xref>
]</td>
<td align="center" rowspan="1" colspan="1">2013</td>
<td align="center" rowspan="1" colspan="1">Case report</td>
<td align="center" rowspan="1" colspan="1">1</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Pozzi et al. [
<xref rid="B10" ref-type="bibr">10</xref>
]</td>
<td align="center" rowspan="1" colspan="1">2013</td>
<td align="center" rowspan="1" colspan="1">Retrospective study</td>
<td align="center" rowspan="1" colspan="1">26</td>
</tr>
</tbody>
</table>
</table-wrap>
<table-wrap id="tab2" orientation="portrait" position="float">
<label>Table 2</label>
<caption>
<p>Results of 14 cases in which monolithic zirconia framework for full arch implant supported reconstruction was used.</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="left" rowspan="1" colspan="1">Subjects </th>
<th align="center" rowspan="1" colspan="1">Location </th>
<th align="center" rowspan="1" colspan="1">Number of implants </th>
<th align="center" rowspan="1" colspan="1">Type of restoration </th>
<th align="center" rowspan="1" colspan="1">Time of follow-up</th>
<th align="center" rowspan="1" colspan="1">Complications</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" rowspan="2" colspan="1">1</td>
<td align="center" rowspan="1" colspan="1">Mandible</td>
<td align="center" rowspan="1" colspan="1">4</td>
<td align="center" rowspan="1" colspan="1">Screw-retained </td>
<td align="center" rowspan="1" colspan="1">10 months</td>
<td align="center" rowspan="1" colspan="1">None</td>
</tr>
<tr>
<td align="center" rowspan="1" colspan="1">Maxilla</td>
<td align="center" rowspan="1" colspan="1">6</td>
<td align="center" rowspan="1" colspan="1">Screw-retained </td>
<td align="center" rowspan="1" colspan="1">10 months</td>
<td align="center" rowspan="1" colspan="1">None</td>
</tr>
<tr>
<td align="center" colspan="6" rowspan="1">
<hr></hr>
</td>
</tr>
<tr>
<td align="left" rowspan="2" colspan="1">2</td>
<td align="center" rowspan="1" colspan="1">Mandible</td>
<td align="center" rowspan="1" colspan="1">4</td>
<td align="center" rowspan="1" colspan="1">Screw-retained </td>
<td align="center" rowspan="1" colspan="1">1 year, 10 months</td>
<td align="center" rowspan="1" colspan="1">None</td>
</tr>
<tr>
<td align="center" rowspan="1" colspan="1">Maxilla</td>
<td align="center" rowspan="1" colspan="1">7</td>
<td align="center" rowspan="1" colspan="1">Screw-retained </td>
<td align="center" rowspan="1" colspan="1">1 year, 10 months</td>
<td align="center" rowspan="1" colspan="1">None</td>
</tr>
<tr>
<td align="center" colspan="6" rowspan="1">
<hr></hr>
</td>
</tr>
<tr>
<td align="left" rowspan="2" colspan="1">3</td>
<td align="center" rowspan="1" colspan="1">Mandible</td>
<td align="center" rowspan="1" colspan="1">6</td>
<td align="center" rowspan="1" colspan="1">Screw-retained </td>
<td align="center" rowspan="1" colspan="1">1 year, 8 months</td>
<td align="center" rowspan="1" colspan="1">None</td>
</tr>
<tr>
<td align="center" rowspan="1" colspan="1">Maxilla</td>
<td align="center" rowspan="1" colspan="1">6</td>
<td align="center" rowspan="1" colspan="1">Screw-retained </td>
<td align="center" rowspan="1" colspan="1">1 year, 8 months</td>
<td align="center" rowspan="1" colspan="1">None</td>
</tr>
<tr>
<td align="center" colspan="6" rowspan="1">
<hr></hr>
</td>
</tr>
<tr>
<td align="left" rowspan="2" colspan="1">4</td>
<td align="center" rowspan="1" colspan="1">Mandible</td>
<td align="center" rowspan="1" colspan="1">4</td>
<td align="center" rowspan="1" colspan="1">Screw-retained </td>
<td align="center" rowspan="1" colspan="1">5 months</td>
<td align="center" rowspan="1" colspan="1">None</td>
</tr>
<tr>
<td align="center" rowspan="1" colspan="1">Maxilla</td>
<td align="center" rowspan="1" colspan="1">6</td>
<td align="center" rowspan="1" colspan="1">Screw-retained </td>
<td align="center" rowspan="1" colspan="1">5 months</td>
<td align="center" rowspan="1" colspan="1">None</td>
</tr>
<tr>
<td align="center" colspan="6" rowspan="1">
<hr></hr>
</td>
</tr>
<tr>
<td align="left" rowspan="2" colspan="1">5</td>
<td align="center" rowspan="1" colspan="1">Mandible</td>
<td align="center" rowspan="1" colspan="1">6</td>
<td align="center" rowspan="1" colspan="1">Screw-retained </td>
<td align="center" rowspan="1" colspan="1">1 year</td>
<td align="center" rowspan="1" colspan="1">None</td>
</tr>
<tr>
<td align="center" rowspan="1" colspan="1">Maxilla</td>
<td align="center" rowspan="1" colspan="1">6</td>
<td align="center" rowspan="1" colspan="1">Screw-retained </td>
<td align="center" rowspan="1" colspan="1">1 year</td>
<td align="center" rowspan="1" colspan="1">None</td>
</tr>
<tr>
<td align="center" colspan="6" rowspan="1">
<hr></hr>
</td>
</tr>
<tr>
<td align="left" rowspan="2" colspan="1">6</td>
<td align="center" rowspan="1" colspan="1">Mandible</td>
<td align="center" rowspan="1" colspan="1">4</td>
<td align="center" rowspan="1" colspan="1">Screw-retained </td>
<td align="center" rowspan="1" colspan="1">7 months</td>
<td align="center" rowspan="1" colspan="1">None</td>
</tr>
<tr>
<td align="center" rowspan="1" colspan="1">Maxilla</td>
<td align="center" rowspan="1" colspan="1">6</td>
<td align="center" rowspan="1" colspan="1">Screw-retained </td>
<td align="center" rowspan="1" colspan="1">7 months</td>
<td align="center" rowspan="1" colspan="1">None</td>
</tr>
<tr>
<td align="center" colspan="6" rowspan="1">
<hr></hr>
</td>
</tr>
<tr>
<td align="left" rowspan="2" colspan="1">7</td>
<td align="center" rowspan="1" colspan="1">Mandible</td>
<td align="center" rowspan="1" colspan="1">4</td>
<td align="center" rowspan="1" colspan="1">Screw-retained </td>
<td align="center" rowspan="1" colspan="1">3 months</td>
<td align="center" rowspan="1" colspan="1">None</td>
</tr>
<tr>
<td align="center" rowspan="1" colspan="1">Maxilla</td>
<td align="center" rowspan="1" colspan="1">4</td>
<td align="center" rowspan="1" colspan="1">Screw-retained </td>
<td align="center" rowspan="1" colspan="1">3 months</td>
<td align="center" rowspan="1" colspan="1">None</td>
</tr>
<tr>
<td align="center" colspan="6" rowspan="1">
<hr></hr>
</td>
</tr>
<tr>
<td align="left" rowspan="2" colspan="1">8</td>
<td align="center" rowspan="1" colspan="1">Mandible</td>
<td align="center" rowspan="1" colspan="1">4</td>
<td align="center" rowspan="1" colspan="1">Screw-retained </td>
<td align="center" rowspan="1" colspan="1">1 year, 3 months</td>
<td align="center" rowspan="1" colspan="1">None</td>
</tr>
<tr>
<td align="center" rowspan="1" colspan="1">Maxilla</td>
<td align="center" rowspan="1" colspan="1">8</td>
<td align="center" rowspan="1" colspan="1">Screw-retained </td>
<td align="center" rowspan="1" colspan="1">1 year, 3 months</td>
<td align="center" rowspan="1" colspan="1">Chipping #9, at 1-year follow-up</td>
</tr>
<tr>
<td align="center" colspan="6" rowspan="1">
<hr></hr>
</td>
</tr>
<tr>
<td align="left" rowspan="2" colspan="1">9</td>
<td align="center" rowspan="1" colspan="1">Mandible</td>
<td align="center" rowspan="1" colspan="1">6</td>
<td align="center" rowspan="1" colspan="1">Screw-retained </td>
<td align="center" rowspan="1" colspan="1">10 months</td>
<td align="center" rowspan="1" colspan="1">None</td>
</tr>
<tr>
<td align="center" rowspan="1" colspan="1">Maxilla</td>
<td align="center" rowspan="1" colspan="1">7</td>
<td align="center" rowspan="1" colspan="1">Screw-retained </td>
<td align="center" rowspan="1" colspan="1">10 months</td>
<td align="center" rowspan="1" colspan="1">None</td>
</tr>
<tr>
<td align="center" colspan="6" rowspan="1">
<hr></hr>
</td>
</tr>
<tr>
<td align="left" rowspan="2" colspan="1">10</td>
<td align="center" rowspan="1" colspan="1">Mandible</td>
<td align="center" rowspan="1" colspan="1">6</td>
<td align="center" rowspan="1" colspan="1">Screw-retained </td>
<td align="center" rowspan="1" colspan="1">2 years</td>
<td align="center" rowspan="1" colspan="1">None</td>
</tr>
<tr>
<td align="center" rowspan="1" colspan="1">Maxilla</td>
<td align="center" rowspan="1" colspan="1">8</td>
<td align="center" rowspan="1" colspan="1">Screw-retained </td>
<td align="center" rowspan="1" colspan="1">2 years</td>
<td align="center" rowspan="1" colspan="1">None</td>
</tr>
<tr>
<td align="center" colspan="6" rowspan="1">
<hr></hr>
</td>
</tr>
<tr>
<td align="left" rowspan="2" colspan="1">11</td>
<td align="center" rowspan="1" colspan="1">Mandible</td>
<td align="center" rowspan="1" colspan="1">7</td>
<td align="center" rowspan="1" colspan="1">Screw- and cement-retained</td>
<td align="center" rowspan="1" colspan="1">3 years, 6 months </td>
<td align="center" rowspan="1" colspan="1">None</td>
</tr>
<tr>
<td align="center" rowspan="1" colspan="1">Maxilla</td>
<td align="center" rowspan="1" colspan="1">8</td>
<td align="center" rowspan="1" colspan="1">Screw- and cement-retained </td>
<td align="center" rowspan="1" colspan="1">3 years, 6 months </td>
<td align="center" rowspan="1" colspan="1">None</td>
</tr>
<tr>
<td align="center" colspan="6" rowspan="1">
<hr></hr>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">12</td>
<td align="center" rowspan="1" colspan="1">Maxilla</td>
<td align="center" rowspan="1" colspan="1">8</td>
<td align="center" rowspan="1" colspan="1">Screw-retained </td>
<td align="center" rowspan="1" colspan="1">3 years, 6 months </td>
<td align="center" rowspan="1" colspan="1">None</td>
</tr>
<tr>
<td align="center" colspan="6" rowspan="1">
<hr></hr>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">13</td>
<td align="center" rowspan="1" colspan="1">Maxilla</td>
<td align="center" rowspan="1" colspan="1">9</td>
<td align="center" rowspan="1" colspan="1">Screw-retained </td>
<td align="center" rowspan="1" colspan="1">1 year</td>
<td align="center" rowspan="1" colspan="1">None</td>
</tr>
<tr>
<td align="center" colspan="6" rowspan="1">
<hr></hr>
</td>
</tr>
<tr>
<td align="left" rowspan="2" colspan="1">14</td>
<td align="center" rowspan="1" colspan="1">Maxilla</td>
<td align="center" rowspan="1" colspan="1">6 </td>
<td align="center" rowspan="1" colspan="1">Screw-retained </td>
<td align="center" rowspan="1" colspan="1">4 months</td>
<td align="center" rowspan="1" colspan="1">None</td>
</tr>
<tr>
<td align="center" rowspan="1" colspan="1">Mandible</td>
<td align="center" rowspan="1" colspan="1">6</td>
<td align="center" rowspan="1" colspan="1">Screw-retained </td>
<td align="center" rowspan="1" colspan="1">4 months</td>
<td align="center" rowspan="1" colspan="1">None</td>
</tr>
</tbody>
</table>
</table-wrap>
</floats-group>
</pmc>
<affiliations>
<list>
<country>
<li>Portugal</li>
<li>États-Unis</li>
</country>
<region>
<li>État de New York</li>
</region>
</list>
<tree>
<country name="Portugal">
<noRegion>
<name sortKey="Carames, Joao" sort="Carames, Joao" uniqKey="Carames J" first="Joao" last="Carames">Joao Carames</name>
</noRegion>
</country>
<country name="États-Unis">
<region name="État de New York">
<name sortKey="Tovar Suinaga, Loana" sort="Tovar Suinaga, Loana" uniqKey="Tovar Suinaga L" first="Loana" last="Tovar Suinaga">Loana Tovar Suinaga</name>
</region>
<name sortKey="Kang, Mary" sort="Kang, Mary" uniqKey="Kang M" first="Mary" last="Kang">Mary Kang</name>
<name sortKey="Perez, Alejandro" sort="Perez, Alejandro" uniqKey="Perez A" first="Alejandro" last="Pérez">Alejandro Pérez</name>
<name sortKey="Yu, Yung Cheng Paul" sort="Yu, Yung Cheng Paul" uniqKey="Yu Y" first="Yung Cheng Paul" last="Yu">Yung Cheng Paul Yu</name>
</country>
</tree>
</affiliations>
</record>

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