Early Implant Failures Related to Individual Surgeons: An Analysis Covering 11,074 Operations Performed during 28 Years

Early Implant Failure: A Meta-Analysis of 7 Years of Experience

Background: The use of dental implant rehabilitation in the treatment of complete and partial edentulism has become an integral treatment today. This treatment is performed on healthy patients, but in some situations, also on those with associated general ailments. The presence of associated conditions increases the degree of difficulty of this type of treatment and tests the doctor's ability to manage the clinical case. The purpose of the study was to perform a meta-analysis of dental implants inserted over seven years and evaluate early implant failure in correspondence with age, sex, region of insertion, type of implant, and general state of health. Methods: A retrospective study was performed over 7 years of experience. For the study, 213 patients who fit the established inclusion criteria were selected. Patients were grouped taking into account age, sex, the type of implant used, and general associated conditions. The collected data were analyzed using IBM SPSS STATISTICS 25.0 for windows Results: There were no highlighted situations in which the rejection of the dental implant occurred 10 days postoperatively or later during the healing period. Conclusions: Our results confirm and strengthen the existing data in the specialized literature, especially those related to the loss of implants in patients with associated general diseases.

Evaluation of Survival Rates of Dental Implants and the Risk Factors: A Retrospective Follow-Up Study

Introduction The current research sets out to assess implant early survival rates and identify relevant parameters. Methods The research spanned the years 2021 and 2022 and included all individuals who had dental implants. Various criteria, such as age, sex, maxilla/mandible, implant location, immediate implant, implant diameter, implant length, and others, were used to determine the implant survival rate in the research. A multiple logistic regression model was used to show the risk variables for early survival rates of implants, and components with p < 0.05 were further included after the Chi-square test was employed to filter them. Results The current research included 128 patients who had a single implant procedure, including 70 males and 58 females. The early survival rate was 91.40%, and 117 implants were retained after implantation. Risk variables that were shown to be associated with early survival rates were patients aged 30-60 years (OR: 2.542), immediate implant placement (OR: 3.742), and implant length less than 10 mm (OR: 3.972). Conclusions Age, tooth location, implant length, and immediate implantation were risk variables that contributed to our subjects' above 91% early survival rate of implants.

Inter- and intraindividual variability in virtual single-tooth implant positioning

OBJECTIVES

The purpose of this prospective study was to determine the inter- and intraindividual variability in virtual single-tooth implant positioning based on the level of expertise, specialty, total time spent, and the use of a prosthetic tooth setup.

MATERIALS AND METHODS

Virtual implant planning was performed on matched pre- and post-extraction intraoral scans (IOS), and cone-beam computed tomography scans of 15 patients. Twelve individual examiners, involving six novices and experts from oral surgery and prosthodontics positioned the implants, first based on anatomical landmarks utilizing only the post-extraction, and second with the use of the pre-extraction IOS as a setup. The time for implant positioning was recorded. After 1 month, all virtual plannings were performed again. The individual implant positions were superimposed to obtain 3D deviations using a software algorithm.

RESULTS

An interindividual variability with mean angular, crestal, and apical positional deviations of 3.8 ± 1.94°, 1.11 ± 0.55, and 1.54 ± 0.66 mm, respectively, was found. When assessing intraindividual variability, deviations of 3.28 ± 1.99°, 0.78 ± 0.46, and 1.12 ± 0.61 mm, respectively, were observed. Implants planned by experts exhibited statistically lower deviations compared to those planned by novices. Longer planning times resulted in lower deviations in the experts' group but not in the novices. Oral surgeons demonstrated lower crestal, but not angular and apical deviations than prosthodontists. The use of a setup only led to minor adjustments.

CONCLUSIONS

Substantial inter- and intraindividual variability exists during implant positioning utilizing specialized software planning. The level of expertise and the time invested influenced the deviations of the implant position during the planning sequence.

A Retrospective Analysis to Assess the Reasons for the Failure of Dental Implants

Background

To assess the reasons for dental implant failures.

Materials and Methods

A total of 100 implants were studied in 80 subjects. The radiographic investigations were performed to assess the record length of implant and diameter of implant. Risk factors, such as habit of smoking, history of diabetes, and hypertension, were recorded. The data were collected and assessed using Statistical Package for the Social Sciences (SPSS) software. The one-way analysis of variance (ANOVA) test was used to assess the failure rate in dental implants. A P-value less than 0.05 was considered statistically significant.

Results

A total of 100 dental implants were included. The maximum dental implant failure was seen with a diameter <3.75 mm (30%) followed by 3.75-4.5 mm (16%) and >4.5 mm (6.15%). The difference was found to be significant (P < 0.05).

Conclusion

Dental implant failure was high in dental implants with <3.75 mm diameter, dental implants with a length <10.0 mm, and among smokers.

Increasing the margin of patient safety for periodontal and implant treatments: The role of human factors

Early complications following periodontal and dental implant surgeries are typically attributed to technique or poor biological response, ignoring the possibility of the human element. Interestingly, significant experience is not correlated with increased success, whereas evidence supports the impact of clinical behavior on patient outcome. This is the result of errors, much like those scrutinized in other high-risk technical fields, such as aviation. What can be surprising is that those who make these errors are very well acquainted with best practices. Given this, how is it possible for the conscientious practitioner to fail to apply protocols that are nonetheless very well known? Recently, the concepts of human and organizational factors have been translated to medicine, though dentistry has been slow to recognize their potential benefit. This review lists specific human factor behaviors, such as use of checklists and crew resource management, which might improve postsurgical outcome.

Effect of self-reported clinician experience level on perceptions of the relative rankings of risk factors for biological complications with dental implant therapy

STATEMENT OF PROBLEM

The effect of clinician experience on the perception of risks for biological complications associated with dental implant therapy is unknown.

PURPOSE

The purpose of this study was to determine whether clinician experience levels, as assessed by the number of implants placed and/or restored, as well as by type of clinical experience (restorative/prosthodontic and/or surgical), influence the perception of risk for biological complications with dental implant therapy.

MATERIAL AND METHODS

A 10-item survey instrument was developed that asked participants from a convenience sample to rank different risk factors for peri-implant complications in the areas of patient history, clinical findings, and clinician choices and postimplant placement findings. Information about participant experience (number of implants placed and restored and type of experience) was also captured. The Kruskal-Wallis and Mann-Whitney U test statistical analyses were performed to determine the degree, if any, to which the level of clinician experience influenced risk factor rankings (α=.05).

RESULTS

Clinicians with more experience viewed the use of selective serotonin reuptake inhibitor (SSRI) medications and clinician inexperience as more important risk factors than did less experienced clinicians. Clinicians with less experience viewed treated moderate or severe chronic periodontitis and thin tissue biotype as more important risk factors than did more experienced clinicians. Clinicians with predominantly surgical experience viewed a heavy plaque index as a more important risk factor than clinicians with predominantly restorative experience.

CONCLUSIONS

The data indicate that the level of clinical experience influences how risk factors associated with biological complications of dental implant therapy are viewed by clinicians.

Is There a Doctors' Effect on Patients' Physical Health, Beyond the Intervention and All Known Factors? A Systematic Review

Purpose

Despite billions of doctor visits worldwide each year, little is known on whether doctors themselves affect patients’ physical health after accounting for intervention and confounders such as patients’ and doctors’ data, hospital effects, nor how strong that doctors’ effect is. Knowledge of surgeons’ and psychotherapists’ effects exists, but not for 102 other medical specialties notwithstanding the importance of such knowledge.

Methods

Eligibility Criteria: Randomized controlled trials (RCTs), case-control, and cohort studies including medical doctors except surgeons for any intervention, reporting the proportion of variance in patients’ outcomes owing to the doctors (random effects), or the fixed effects of grading doctors by outcomes, after multivariate adjustment. Exclusions: studies of <15 doctors or solely reporting doctors’ effects for known variables.

Sources

Medline, Embase, PsycINFO, inception to June 2020. Manual search for papers referring/referred to by resulting studies.

Risk of Bias

Using Newcastle–Ottawa scale.

Results

Despite all medical interventions bar surgery being eligible, only thirty cohort papers were found, covering 36,239 doctors, with 10 specialties, 21 interventions, 60 outcomes (17 unique). Studies reported doctors’ effects by grading doctors from best to worst, or by diversely calculating the doctor-attributed percentage of patients’ outcome variation, ie the intra-class correlation coefficient (ICC). Sixteen studies presented fixed effects, 18 random effects, and 3 another approach. No RCTs found. Thirteen studies reported exceptionally good and/or poor performers with confidence intervals wholly outside the average performance. ICC range 0 to 33%, mean 3.9%. Highly diverse reporting, meta-analysis therefore not applicable.

Conclusion

Doctors, on their own, can affect patients’ physical health for many interventions and outcomes. Effects range from negligible to substantial, even after accounting for all known variables. Many published cohorts may reveal valuable information by reanalyzing their data for doctors’ effects. Positive and negative doctor outliers appear regularly. Therefore, it can matter which doctor is chosen.

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The Doctors' Effect on Patients' Physical Health Outcomes Beyond the Intervention: A Methodological Review

Background

Previous research suggests that when a treatment is delivered, patients’ outcomes may vary systematically by medical practitioner.

Objective

To conduct a methodological review of studies reporting on the effect of doctors on patients’ physical health outcomes and to provide recommendations on how this effect could be measured and reported in a consistent and appropriate way.

Methods

The data source was 79 included studies and randomized controlled trials from a systematic review of doctors’ effects on patients’ physical health. We qualitatively assessed the studies and summarized how the doctors’ effect was measured and reported.

Results

The doctors’ effects on patients’ physical health outcomes were reported as fixed effects, identifying high and low outliers, or random effects, which estimate the variation in patient health outcomes due to the doctor after accounting for all available variables via the intra-class correlation coefficient. Multivariable multilevel regression is commonly used to adjust for patient risk, doctor experience and other demographics, and also to account for the clustering effect of hospitals in estimating both fixed and random effects.

Conclusion

This methodological review identified inconsistencies in how the doctor’s effect on patients’ physical health outcomes is measured and reported. For grading doctors from worst to best performances and estimating random effects, specific recommendations are given along with the specific data points to report.

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Long-term clinical outcomes of short implant (6mm) in relation to Implant Disease Risk Assessment (IDRA)

AIM

To evaluate the long-term survivals of short implants and to investigate the association of the Implant Disease Risk Assessment (IDRA) with the occurrence of biological complications.

MATERIAL AND METHODS

This study was designed as a cohort study with a median follow-up of 10.0 years. Patients who had received 6-mm implants were reviewed and assigned into low-, moderate- and high-risk groups (Group L, M and H) based on the IDRA tool. The implant survival, biological complications, soft tissue condition, hardware complications and marginal bone loss (MBL) were evaluated. Kaplan-Meier curves and Cox regression were performed for survival analysis.

RESULTS

A hundred and ten patients were included. The overall cumulative survival rate was 90.9% (L:100.0%, M: 93.3% and H: 80.6%). A higher risk profile was significantly associated with a decreased implant survival (hazard ratio: 4.11, 95% CI: 1.17-14.36, p<0.05). Higher risk profile (hazard ratio: 2.63, 95% CI: 1.32-5.25, p<0.05) was a potential risk factor for biological complications. At follow-up, significant differences in bleeding index, modified plaque index and peri-implant probing depth were found among groups (p<0.01). No significant difference was found in MBL.

CONCLUSION

Acceptable long-term clinical outcomes could be achieved after 10 years for short implants. Despite a statistically nonsignificant difference in MBL, patients with a high-risk profile of IDRA seem to be at greater risk of implant loss and biological complications.

Analysis of acute sinusitis-related early failed implant surface: a combined histological, electron microscopy, and X-ray spectroscopy approach

Background

Even though dental implants are a reliable choice for dental rehabilitation, implant failures due to various etiologies have been reported. Early implant failures account for 2 to 6% of installed implants and are reported to have a higher rate than late failures, regardless of loading time. We herein report three cases of acute sinusitis and early implant failure with implants that failed within 1 month after installation. The aim of this study was to evaluate the surface properties of early failed implants and peri-implant tissue to determine the early osseointegration pattern in acute sinusitis-related failed implants as well as the possible role of surface contamination in the failure of osseointegration.

Results

A combined histological, electron microscopy, and X-ray spectroscopy approach was used to characterize the surface of non-osseointegrated titanium implants and the surrounding biological tissues. Morphologic scanning electron microscopy revealed a heterogeneous surface and irregular osseointegration. The implant surface was covered mostly by carbon- and oxygen-rich organic matter. Energy-dispersive X-ray spectroscopy surface analysis of three implants showed the incorporation of some contaminants in both the upper and apical regions. Carbon, nitrogen, sodium, silicon, chlorine, sulfur, gold, and zirconium were detected on the surface of one or more failed implants. Fibrosis, lymphocytic, and macrophage infiltrates and a high activation of osteoclasts surrounding the bone graft particles were detected in the surrounding tissues.

Conclusions

The etiology and mechanism of early implant failure, especially in sinus-related cases, as well as the proper management interventions to minimize the rate of early implant failures, are of great concern. No matter how confident and accurate the surgeon’s operation, there may be unknown errors in the whole procedure that no one knows about. Rather than errors related to the implant surface, it is expected that there were invisible problems during the evaluation of the patient’s own unique sinus mucosal inflammation or the operator’s own procedure. Furthermore, well-designed researches are necessary to reveal the effect of material-related factors on acute sinus complication and early implant failure.

Influence of clinician gender, age, and geographic work location on the relative rankings of risk factors for biological complications with dental implant therapy

STATEMENT OF PROBLEM

Clinician perceptions of risk factors influencing biologic complications with dental implants are poorly understood but are relevant to how clinicians manage conversations with patients seeking dental implant therapy.

PURPOSE

The purpose of this clinician survey was to assess the relative ranking of biologic risk factors with dental implants identified via the history, clinical examination, and clinical decisions and postimplant placement findings.

MATERIALS AND METHODS

A 10-item survey instrument was tested, refined, and distributed to past participants of the Future Leaders in Prosthodontics (FLIP) workshop series asking for their opinion on the relative ranking of commonly identified risk factors in the areas of patient history, clinical examination, and clinical decisions and postimplant placement findings. Descriptive statistics and frequency tables were developed to identify age groupings, geographic work location, and gender. Group differences with respect to risk factor rankings were identified by using Kruskal-Wallis H tests, and, if significant, paired comparisons were conducted using the Mann-Whitney U test with adjustments for Type I error (α=.05).

RESULTS

Significant differences were found by gender, age, and geographic work location. Women viewed "implant placement in site of previous implant loss" (P=.013) and "treated moderate or severe chronic periodontitis" (P=.021) as having significantly greater relative importance than did men, yet men ranked "implant position closer than 1.5 mm from adjacent tooth" (P=.023), "currently using selective serotonin reuptake inhibitor drugs (SSRI)" (P=.001), and "heavy plaque index (PI>50%)" (P=.023) as having significantly greater relative importance than did women. Significant differences were found by geographic work location of practice with respondents from Australasia viewing "treatment plan includes prostheses that limit access for cleaning resulting in an increase in bacterial load" as having greater relative importance than did respondents from Africa (P<.001) and from South America (P<.001). Respondents from South America viewed "implant lacks 2.0 mm of attached tissue around implants" as having greater relative importance than did respondents from Australasia (P<.002) or Asia (P<.001).

CONCLUSIONS

Clinicians viewed the relative importance of risk factors for biologic complications with dental implants differently, and those differences varied by clinicians' age, gender, and geographic location of practice.

The survival rates and risk factors of implants in the early stage: a retrospective study

Background

Few large-sample studies in China have focused on the early survival of dental implants. The present study aimed to report the early survival rates of implants and determine the related influencing factors.

Methods

All patients receiving dental implants at our institution between 2006 and 2017 were included. The endpoint of the study was early survival rates of implants, according to gender, age, maxilla/mandible, dental position, bone augmentation, bone augmentation category, immediate implant, submerged implant category, implant diameter, implant length, implant torque, and other related factors. Initially, SPSS22.0 was used for statistical analysis. The Chi-square test was used to screen all factors, and those with p < 0.05 were further introduced into a multiple logistic regression model to illustrate the risk factors for early survival rates of implants.

Results

In this study, we included 1078 cases (601 males and 477 females) with 2053 implants. After implantation, 1974 implants were retained, and the early survival rate was 96.15%. Patients aged 30–60 years (OR  2.392), with Class I bone quality (OR  3.689), bone augmentation (OR  1.742), immediate implantation (OR  3.509), and implant length < 10 mm (OR  2.972), were said to possess risk factors conducive to early survival rates.

Conclusions

The early survival rate of implants in our cohort exceeded 96%, with risk factors including age, tooth position, bone quality, implant length, bone augmentation surgery, and immediate implantation. When the above factors coexist, implant placement should be treated carefully.

Evaluation of the Association of Early Implant Failure With Local, Environmental, and Systemic Factors: A Retrospective Study

PURPOSE

This study aimed to assess the association of early implant failure (EIF) with demographic, local, environmental, and systemic factors.

METHODS

Clinical charts of 594 individuals with 2,537 dental implants were assessed. EIF was characterized by implant loss before and up to the abutment connection. Logistic regression analysis was used to verify the association between EIF and local, environmental, and systemic factors at the individual and implant levels. The chosen level of significance was 5%.

RESULTS

EIF occurred in 144 implants (5.68%) and in 97 individuals (16.3%). At the individual level, smoking habits (odds ratio [OR] = 2.54; 95% confidence interval [CI] = 1.00 to 6.47; P = .05), absence of postoperative antibiotic therapy (OR = 2.73; CI = 1.22 to 6.13; P = .02), and bone augmentation (OR = 1.83; CI = 1.17 to 2.85; P = .01) were significantly associated with EIF. At the implant level, smoking habits (OR = 2.90; CI = 1.60 to 5.26, P < .001), absence of postoperative antibiotic therapy (OR = 2.77; CI = 1.36 to 5.63, P = .005), postoperative complications (OR = 28.35; CI = 6.79 to 118.45, P < .001), implant length ≤8.5 mm (OR = 1.79; CI = 1.07 to 2.99; P = .03), and diameter <3.75 mm (OR = 1.65; CI = 1.08 to 2.52, P = .02) were associated with EIF. Age, sex, alcohol abuse, diabetes, hypertension, and long-term medication use were not associated with EIF at both individual and implant levels (P ≥ .12).

CONCLUSIONS

Smoking habits, absence of antibiotic therapy, bone augmentation, postoperative complications, implant diameter <3.75 mm, and implant length ≤8.5 mm were associated with EIF. Clinicians should be aware of these associations that should be controlled for when feasible. Future cohort studies are required to confirm the risk factors.

[Prevention of complications and risk reduction in oral implantology considering human factors and situation awareness]

In recent years, the percentage of dental implant placement has increased, and the presence of adverse events and complications are not uncommon. The vast majority of recommendations for reducing complications associated with dental implant placement are analyzed from the point of view of their direct causes, evaluating the technique and/or the individual, but not the system as a whole, being this the actual etiology of complications. The inclusion of human factors and situation awareness has recently gained increasing importance in oral implantology complications and has allowed global analysis of both the individual and the environment, providing solutions based on prevention. However, knowledge and use of these aspects in oral implantology are still in the process of popularization, and therefore, the objective of this article was to describe the human factors involved and situation awareness for preventing complications and reducing the risks associated with dental implant placement procedures.

Titanium Corrosion in Peri-Implantitis

Titanium (Ti) corrodes clinically in the presence of bacteria. We investigated this phenomenon as a function of Ti particles found in biopsied tissues around peri-implantitis sites and surface roughness of failed Ti implants. Tissue biopsies were surgically collected from peri-implantitis sites, processed, and embedded in resin. The resin-embedded samples were hand trimmed to the region of interest and semi-thick (500 nm) sections were collected onto coverslips. One section was toluidine blue post-stained as a reference. The remainder sections were left unstained for energy-dispersive X-ray spectroscopy (EDX) analysis. Processed samples were examined under scanning electron microscopy (SEM) and EDX. Corresponding failed implants were also removed and examined under SEM and EDX. Five out of eight biopsied samples demonstrated the presence of Ti particles in the soft tissue, suggesting the true rate among all failures was between 24.5% and 91.5% (the lower bound of a 95% confidence interval for the true rate of Ti presence). SEM analysis of failed implant bodies also indicated changes in surface morphology and appeared less detailed with decreased weight percent of Ti on the surface of the failed implants. In conclusion, Ti particles were noted in 5/8 biopsied samples. Surface morphologies were smoother in failed implants compared with the reference implant.

Early implant failure: a retrospective analysis of contributing factors

Purpose

The aim of this retrospective study was to determine the prevalence of early implant failure using a single implant system and to identify the factors contributing to early implant failure.

Methods

Patients who received implant treatment with a single implant system (Luna^®, Shinhung, Seoul, Korea) at Dankook University Dental Hospital from 2015 to 2017 were enrolled. The following data were collected for analysis: sex and age of the patient, seniority of the surgeon, diameter and length of the implant, position in the dental arch, access approach for sinus-floor elevation, and type of guided bone regeneration (GBR) procedure. The effect of each predictor was evaluated using the crude hazard ratio and the adjusted hazard ratio (aHR) in univariate and multivariate Cox regression analyses, respectively.

Results

This study analyzed 1,031 implants in 409 patients, who comprised 169 females and 240 males with a median age of 54 years (interquartile range [IQR], 47–61 years) and were followed up for a median of 7.2 months (IQR, 5.6–9.9 months) after implant placement. Thirty-five implants were removed prior to final prosthesis delivery, and the cumulative survival rate in the early phase at the implant level was 95.6%. Multivariate regression analysis revealed that seniority of the surgeon (residents: aHR=2.86; 95% confidence interval [CI], 1.37–5.94) and the jaw in which the implant was placed (mandible: aHR=2.31; 95% CI, 1.12–4.76) exerted statistically significant effects on early implant failure after adjusting for sex, age, dimensions of the implant, and type of GBR procedure (preoperative and/or simultaneous) (P<0.05).

Conclusions

Prospective studies are warranted to further elucidate the factors contributing to early implant failure. In the meantime, surgeons should receive appropriate training and carefully select the bone bed in order to minimize the risk of early implant failure.

Guided Nitinol-Retained (Smileloc) Single-Tooth Dental Restorations

Nitinol metal alloy that changes shape according to temperature has been in clinical use at select clinics worldwide for the past 2 years and is now released for general use. The Smileloc Abutment and nitinol sleeve enable "cementless," "screwless," crown fastening that saves time and cost with the prospect of replacement of much of the present, sometimes troublesome, anthropic, soon to be anachronistic, technology.

Comparison of postoperative intraoral scan versus cone beam computerised tomography to measure accuracy of guided implant placement-A prospective clinical study

OBJECTIVE

To evaluate the accuracy of implant placement with a digitally planned guided implant procedure. Two methods for identifying the actual postoperative positioning of the implants were compared: CBCT and IO scanning.

MATERIAL AND METHODS

Twenty-eight implants with a sandblasted and acid-etched surface were placed in thirteen patients using tooth-supported surgical guides following a digital planning procedure. The implants were submerged for 12-15 weeks. New CBCT images were taken for identification of the implant position. After second stage surgery, scan bodies were mounted on the implants and scanned with an IO digital scanner. The recordings from the CBCT images and the IO scans were compared with respect to the identified positions of the implants.

RESULTS

The study did not resolve any significant differences of the identified positioning of the implants as measured by CBCT or IO, except for the apical deviations at the coronal and apical points. The angular difference between CBCT and IO scanning at the coronal point was -0.011 (±0.6) degrees, whereas the 3D deviation was 0.03(±0.17) mm. The distal deviation between CBCT and IO scanning was 0.01(± 0.16) mm, and the vestibular deviation 0.033(± 0.16) mm and the apical deviation difference was 0.09(± 0.16) mm. The 3D deviation at the apical point was 0.04(± 0.22) mm. The distal deviation between CBCT and IO scanning was 0.06(± 0.19) mm, and the vestibular deviation 0.032(± 0.23) mm and the apical deviation difference was 0.09(± 0. 16) mm.

CONCLUSION

The study demonstrated that accuracy measurements using IO scanning yields comparable results to those obtained by CBCT.

Is clinical experience important for obtaining the primary stability of dental implants with aggressive threads? An ex vivo study

Background

The aim of this study was to investigate the clinicians’ experience on maintaining the primary stability of implants with aggressive threads belonging to a novel dental implant system.

Material and Methods

Three hundred implants with aggressive threads were inserted in fresh bovine ribs mimicking Type IV bone by five clinicians which were classified according to their previous experience of total number of implant insertion. An independent examiner measured the primary stability of all implants after insertion by using resonance frequency analysis (RFA), electronic percussive testing (EPT) and removal torque methods.

Results

No significant differences were detected between the stability values measured by the clinicians (p< 0.05) except the Periotest values (PTVs) of the non-experienced clinician. PTVs of the non-experienced clinician were significantly higher than the PTVs of the expert and good clinicians (p >0.05). Significantly higher stability values were detected in the secondary insertion of the non-experienced clinician as compared to her initial insertion values (p >0.05). No significant differences were detected between the first and second measurements of the other clinicians (p< 0.05).

Conclusions

Within the limitations of this ex-vivo study, it may be concluded that experience does not play an important role in maintaining the stability of implants with aggressive threads.

Key words:Implantology, experimental design, osseointegration.

Dense cancellous bone as evidenced by a high HU value is predictive of late implant failure: a preliminary study

OBJECTIVES

The mechanism of late implant failure is unclear. This study examined the association between sclerosing cancellous bone images and the risk of late implant failures using multi-detector row computed tomography (CT) imaging data.

METHODS

We performed a case-control study. The study group consisted of consecutive patients with implant failures treated at Kyushu Dental University between 2001 and 2016. CT data for late failure of 36 implants in 16 patients were available. The study cohort consisted of 16 patients with 36 late failed implants and 28 patients with 113 successful implants.

RESULTS

The mean survival rate was 6.9 months for early implant failure, 76.6 months for late failure with marginal bone resorption, inflammation symptoms, and so-called peri-implantitis, and 95.0 months for late failure caused by implant fracture. The mean HU value for cases in the control group was 507 compared with 1231 for cases with late failure implants. Logistic regression was used for analysis. There were signs of high radiodensity of peri-implant cancellous bone when comparing adjusted radiodensity per 100 HU using CT data (OR 2.35; 95% CI 1.73-3.20; p < 0.001).

CONCLUSIONS

Within the limits of our study, the presence of high radiodensity and cancellous bone consolidation on imaging may be related to risk factors for late implant failure. Therefore, CT images of the host cancellous bone status for observation of visible sclerosis could be a useful diagnostic indicator for late implant failure.

Initial and long-term crestal bone responses to modern dental implants

Successful osseointegration is the result of a controlled foreign body reaction to dental implants. Osseointegrated implants have demonstrated excellent long-term survivability, although they may be subject to limited marginal bone loss. Marginal bone loss during the first few years after implant placement seldom represents disease, but is instead the result of an adaptive bone response to surgical trauma and implant loading. It is not uncommon for implants with early marginal bone loss to enter a long-lasting state of bone stability. Extensive bone resorption after the first year is generally due to an exacerbation of adverse body reactions caused by non-optimal implant components, adverse surgery or prosthodontics and/or compromised patient factors. Disease in the form of peri-implantitis is a late complication that affects some implants with suppuration and rapid loss of crestal bone, and is probably caused by bacterial pathogens and immunological reactions. Unfortunately, the literature is not consistent with respect to the type or magnitude of clinical implant problems, including how they are defined and diagnosed. If the peri-implantitis diagnosis is confined to cases with infection, suppuration and significant bone loss, the frequency of the disease is relatively low, which is in sharp contrast to the frequencies reported with unrealistic definitions of peri-implantitis. We suggest that when modern implants are placed by properly trained individuals, only 1-2% of implants show true peri-implantitis during follow-up periods of 10 years or more. Peri-implantitis must be separated from the initial and self-limiting marginal bone loss.

An up to 17-year follow-up retrospective analysis of a minimally invasive, flapless approach: 18 945 implants in 7783 patients

BACKGROUND

This study investigates gender, age, jaw, implant position, loading protocol (immediate vs delayed), smoking, and type of surgery (punch vs flap) as influential factors of implant survival in a large patient collective.

PURPOSE

To evaluate the survival rates of implants in patients using a mucoperiosteal punch for flapless implantation in the majority of cases in order to evaluate its medical efficacy and safety.

MATERIALS AND METHODS

Between 1994 and 2015 all patients with complete data treated at the Wienerberg Dental Clinic, Vienna, Austria, were included and statistically analyzed in Cox proportional hazard (PH) models. As patients with multiple implants were included, a clustering term was added to the Cox PH model to respect pooled failures in patients.

RESULTS

Of the initial 24 282 ANKYLOS/Dentsply implants placed in 8137 patients a total of 7783 patients with 18 945 implants were finally included. The mean follow-up was 2.8 ± 3.2 up to 17.9 years. Cumulative survival rates (CSRs) after 1, 3, 5, and 10 years were 98.5%, 97.7%, 96.7%, and 93.0%, respectively. Of these, 17 517 (92.5%) implants were placed minimally invasive via a flapless approach by use of the ATP-Punch with comparable survival rates as observed for flap surgery. The Cox PH models proved smoking (hazard ratio [HR] = 2.2) and implant position as significant factors of implant survival. In the maxilla, canines and third molars were identified as low risk sites in comparison to the most frequently implanted first premolar site. In the mandible, the central incisor and second premolar were identified as high-risk sites, the canine as low risk site in comparison to the most frequently placed first molar site.

CONCLUSION

The analyzed data concludes the safety and medical efficacy of the ATP-Punch. The CSRs using this flapless technique are comparable to the classic surgical flap approach.

Knowledge, aptitudes, and preferences in implant dentistry teaching/training among undergraduate dental students at the University of Barcelona

Background

Oral implant rehabilitation should be considered a treatment option for any edentulous patient and Implant Dentistry is currently a discipline taught in the undergraduate formation. The level of knowledge acquired and how the students perceive the quality of training in Implant Dentistry could assess to know if it is necessary to improve the syllabus.

Material and Methods

A questionnaire was developed with 11 questions: Basic knowledge (7); Perception of training received (2); Ways in which students would receive training (2). To be responded anonymously and voluntarily for undergraduates students in the Faculty of Dentistry (University of Barcelona, Spain).

Results

One hundred and seven students, 76 third year (Group A) and 31 fourth year (Group B) answered the questionnaire. In Group A, 98.68% of students and in Group B 93.54% believed they were poorly informed; 100% of both groups would prefer to receive more training as part of the degree or as postgraduate training through modular courses imparted by experts (A: 71,05%, B: 70,96%) Training through postgraduate programs or training given by private businesses were the least desirable options (A: 42%, B: 64.51%). Questions about basic knowledge acquired received varying responses, which might indicate a certain level of confusion in this area.

Conclusions

The undergraduate syllabus must be revised to include sufficient content and training to allow the student to indicate implant-based treatments based on evidence. Students would prefer training to be included in the undergraduate syllabus.

Key words:Dental implants, dental students, dental education, dental syllabus, implant dentistry.

What do sales data tell us about implant survival?

Objective

The aim of this study was to evaluate the influence of implant diameter, length and shape on a surrogate parameter of implant survival; i.e. the implant return rate in a big data analysis.

Materials and methods

A retrospective study was conducted and the factors influencing the success rates of 69,377 sold implants over a seven-year period were evaluated. The osseointegration program of a reseller provides reliable data of a single country. Implant loss rates were investigated using logistic regression models and regressed by implant type, diameter, and length.

Results

The return rate of 69,377 sold implants was 2.78% and comparable to implant loss rates in previous published prospective studies as its surrogate parameter. A total of 80% of implant returns had occurred within 157 days, and an additional 15% within 750.25 days. Diameters of 3.8 to 5.0mm showed the lowest return rates with its bottom in the 4.3mm implant whilst 6.0mm implants had significantly higher return rates. In comparison to the most sold implant length (13mm) shorter implants showed significantly higher early return rates.

Conclusions

The study provides evidence that in cases of standard indications and sufficient bone, the use of screw typed dental implants with 3.8 or 4.3 diameter and 11 or 13 mm length shows the lowest implant return rates. Other implants may be selected only in specific indications.

[Is human behavior the leading cause of complications in medical practice?]

Medical errors and the resulting complications are most often analyzed from a purely technical viewpoint. The impact of human behavior is very seldom raised among the major causes of severe undesirable events (SUE) in the medical field. When human responsibility is advanced, the thrust is always negative and critical, i.e. the "culprit" did not comply with the rules. However, in other risk-related human activities, such as aeronautics or the nuclear energy sector, the influence of human behavior in triggering SUEs has been examined and is now acknowledged to be one of the main causes of complications and problems. Specific protocols have been devised to reduce the number of mistakes made and to eliminate repercussions when errors inevitably occur. This novel approach has considerably reduced the accident rate in this type of industry. The aim of this article is to show that the same approach can be adopted in medicine and that taking human factors into account when analyzing medical practices can lead to significant improvements in safety and security.