A Retrospective Analysis of Early and Immediately Loaded Osseotite Implants in Cross-Arch Rehabilitations in Edentulous Maxillas and Mandibles Up to 7 Years

Nanofeatured surfaces in dental implants: contemporary insights and impending challenges

Dental implant therapy, established as standard-of-care nearly three decades ago with the advent of microrough titanium surfaces, revolutionized clinical outcomes through enhanced osseointegration. However, despite this pivotal advancement, challenges persist, including prolonged healing times, restricted clinical indications, plateauing success rates, and a notable incidence of peri-implantitis. This review explores the biological merits and constraints of microrough surfaces and evaluates the current landscape of nanofeatured dental implant surfaces, aiming to illuminate strategies for addressing existing impediments in implant therapy. Currently available nanofeatured dental implants incorporated nano-structures onto their predecessor microrough surfaces. While nanofeature integration into microrough surfaces demonstrates potential for enhancing early-stage osseointegration, it falls short of surpassing its predecessors in terms of osseointegration capacity. This discrepancy may be attributed, in part, to the inherent "dichotomy kinetics" of osteoblasts, wherein increased surface roughness by nanofeatures enhances osteoblast differentiation but concomitantly impedes cell attachment and proliferation. We also showcase a controllable, hybrid micro-nano titanium model surface and contrast it with commercially-available nanofeatured surfaces. Unlike the commercial nanofeatured surfaces, the controllable micro-nano hybrid surface exhibits superior potential for enhancing both cell differentiation and proliferation. Hence, present nanofeatured dental implants represent an evolutionary step from conventional microrough implants, yet they presently lack transformative capacity to surmount existing limitations. Further research and development endeavors are imperative to devise optimized surfaces rooted in fundamental science, thereby propelling technological progress in the field.

Radiographic assessment of the peri-implant site

While peri-implant mucositis relies solely on clinical parameters, radiological assessment becomes indispensable for diagnosing peri-implantitis. Intraoral radiography, with its simplicity of application, low radiation exposure, and adequate representation of peri-implant structures, stands out as the standard of care for both immediate and follow-up assessments. Standardization by custom-made radiologic splints allows for excellent comparability with previous images and allows for the determination of even small changes in contour and density of the peri-implant bone. Furthermore, other radiographic modalities like panoramic radiography and cone beam computed tomography (CBCT) may provide useful features for specific patients and clinical cases while also showing innate limitations. Beyond the assessment of the marginal peri-implant bone level as the crucial parameter of clinical relevance, radiologic assessment may reveal various other findings related to the prosthetic restoration itself, the precision of its fit to the implant, and the peri-implant soft and hard tissues. Since such findings can be crucial for the assessment of peri-implant health and the implants' prognosis, a systematic diagnostic evaluation pathway for a thorough assessment is recommended to extract all relevant information from radiologic imaging. This article also provides an overview of the clinical and chronological indications for different imaging modalities in peri-implant issues.

Will Zirconia Implants Replace Titanium Implants?

This review aims to discuss the advantages and disadvantages of zirconia implants compared with titanium implants. Moreover, it intends to review the relevant available long-term literature of these two materials regarding osteointegration, soft-tissue, microbiota, and peri-implantitis, focusing on clinical results. Briefly, titanium implants are a reliable alternative for missing teeth; however, they are not incapable of failure. In an attempt to provide an alternative implant material, implants made from ceramic-derivate products were developed. Owing to its optimal osseointegration competence, biocompatibility, and esthetic proprieties, zirconium dioxide (ZrO2), also known as zirconia, has gained popularity among researchers and clinicians, being a metal-free alternative for titanium implants with its main use in the anterior esthetic zones. This type of implant may present similar osseointegration as those noted on titanium implants with a greater soft-tissue response. Furthermore, this material does not show corrosion as its titanium analog, and it is less susceptible to bacterial adhesion. Lastly, even presenting a similar inflammatory response to titanium, zirconia implants offer less biofilm formation, suggesting less susceptibility to peri-implantitis. However, it is a relatively new material that has been commercially available for a decade; consequently, the literature still lacks studies with long follow-up periods.

The osseointegration and stability of dental implants with different surface treatments in animal models: a network meta-analysis

Dental implants are commonly used to repair missing teeth. The implant surface plays a critical role in promoting osseointegration and implant success. However, little information is available about which implant surface treatment technology best promotes osseointegration and implant stability. The aim of this network meta-analysis was to evaluate the osseointegration and stability of four commonly used dental implants (SLA, SLActive, TiUnite, and Osseotite). The protocol of the current meta-analysis is registered in PROSPERO (International Prospective Register of Systematic Reviews) under the code CRD42020190907 ( https://www.crd.york.ac.uk ). We conducted a systematic review following PRISMA and Cochrane Recommendations. Medline (PubMed), Cochrane Library, Embase, and the Web of Science databases were searched. Only randomized controlled trials were considered. Twelve studies were included in the current network meta-analysis, eleven studies were included concerning the osseointegration effect and five studies were included for stability analysis (four studies were used to assess both stability and osseointegration). Rank possibility shows that the SLActive surface best promoted bone formation at an early healing stage and TiUnite seemed to be the best surface for overall osseointegration. For stability, TiUnite seemed to be the best surface. The present network meta-analysis showed that the SLActive surface has the potential to promote osseointegration at an early stage. The TiUnite surface had the best effect on osseointegration regarding the overall healing period. The TiUnite surface also had the best effect in stability.

Long-Term Clinical Outcomes of Treatment with Dental Implants with Acid Etched Surface

Implant dentistry constitutes a therapeutic modality in the prosthodontic treatment of partially and totally edentulous patients. This study reports a long-term evaluation of treatment by the early loading of acid-etched surface implants. Forty-eight partially and totally edentulous patients were treated with 169 TSA Defcon® acid-etched surface implants for prosthodontic rehabilitation. Implants were loaded after a healing free-loading period of 6–8 weeks in mandible and maxilla, respectively. Implant and prosthodontic clinical findings were followed during at least 17 years. Clinical results indicate a survival and success rate of implants of 92.9%, demonstrating that acid-etched surface achieves and maintains successful osseointegration. Five implants in three patients were lost during the healing period. Sixty-five prostheses were placed in 45 patients over the remaining 164 implants, 30 single crowns, 21 partially fixed bridges, 9 overdentures, and 5 full-arch fixed rehabilitations. A total of 12 implants were lost during the follow-up period. Mean marginal bone loss was 1.91 ± 1.24 mm, ranging from 1.1 to 3.6 mm. The most frequent complication was prosthetic technical complications (14.2%), followed by peri-implantitis (10.6%). The mean follow-up was of 214.4 months (208–228 months). Prosthodontic rehabilitation with an early-loading protocol over acid-etched surface implants is a successful implant treatment.

A Systematic Review of Clinical Outcomes on Patients Rehabilitated with Complete-Arch Fixed Implant-Supported Prostheses According to the Time of Loading

PURPOSE

To perform a systematic review on studies assessing clinical outcomes in patients rehabilitated with complete-arch fixed implant-supported prostheses according to the time of loading.

MATERIALS AND METHODS

Data obtained from patient and clinical outcomes, as implant failure, success rate, survival rate, biological complications, technical complications, mechanical complications, and marginal bone loss, were included on this review. The search was performed on databases PubMed, Scopus, and Cochrane. Cochrane Collaboration tool was used to assess the risk of bias of randomized controlled studies, and an adapted version of Newcastle-Ottawa scale was used for observational studies. All data were tabulated according to the time of loading: (1) immediate restoration/loading, (2) early loading, and (3) conventional loading.

RESULTS

From a total of 4027 studies identified through the three databases, six of them were randomized controlled trials, five of them were prospective observational studies, and another five were retrospective observational studies. In total, 5954 implants, 1294 patients and 1305 full-arch fixed implant-supported prostheses were included in this review. There was a wide heterogeneity among clinical studies regarding the study design and treatment procedures. Thus, pooled estimates were not performed in order to avoid potential biases. The methodological assessment by the Modified Newcastle-Ottawa scale showed a moderate quality of observational studies. Regarding the RCTs studies, all of them presented at least one element of bias according to the Cochrane Collaboration tool for assessing risk of bias.

CONCLUSION

There is evidence of high survival-success implant rate (95-100%) for either loading protocols (immediate restoration/loading, early loading, and conventional loading). However, careful attention must be taken by clinician when interpreting the results reported in clinical studies. Future studies should be performed using standardized methodology in order to determine the true predictability regarding immediate, early, and conventional loading protocols.

Implant supported cantilevered fixed dental rehabilitations in partially edentulous patients: Systematic review of the literature. Part I

OBJECTIVES

To investigate in which clinical situations a cantilever fixed implant supported restorations can be a treatment alternative and which complications are reported.

MATERIALS AND METHODS

Two operators screened the literature (MEDLINE, EMBASE) and performed a hand search on the main journals dealing with implantology and prosthetics until 31 December 2017. Only articles that considered cantilever implant fixed restorations with at least 10 patients and with a mean follow-up of at least 5 year were selected. The outcome variables were survival of implants and prosthesis, mechanical, technical and biological complications, marginal bone loss. The review was performed according to the PRISMA statements. Risk of bias assessment was evaluated. Failure and complication rates were analysed using random effect Poisson regression models to obtain summary estimate of 5- and 10-year survival and complication rates.

RESULTS

A total of nine papers were selected for partially edentulous patients and reported high survival rate of the prosthesis. The estimated survival rate for 5-10 years was calculated to be 98.4% for the implants and 99.2% for the rehabilitations. Mechanical, technical and biological complications were reported with a cumulative 5-10 years complication rate of 28.66% and 26.57% for the patients and for the prosthesis, respectively. Two papers for single implant supporting 2-unit cantilever were not sufficient to draw conclusions.

CONCLUSIONS

There is evidence that cantilever can be successful treatment in partially edentulous patients. In two adjacent edentulous sites, data are not yet sufficient.

Clinical evaluation of full-arch screw-retained implant-supported fixed prostheses and full-arch telescopic-retained implant-supported fixed prostheses: A 5-12 year follow-up retrospective study

OBJECTIVE

To assess the prostheses and implants survival rate and peri-implantitis rate in edentulous patients treated with full-arch screw-retained implant-supported fixed dental prostheses (FSIFDPs) and full-arch telescopic-retained implant-supported fixed dental prostheses (FTIFDPs) over an observation period of at least 5 years.

MATERIALS AND METHODS

From 2004 to 2012, 696 implants were inserted into 78 patients with 102 prostheses. The FSIFDP group comprised 31 patients (37 prostheses, 232 implants), whereas the FTIFDP group comprised 47 patients (65 prostheses, 464 implants). Prosthesis and implant estimated cumulative survival rates (ECSR) and estimated cumulative peri-implantitis rates (ECPR) were assessed. The follow-up period was 5-12 years. Kaplan-Meier survival curves with the log-rank test were used to evaluate outcomes.

RESULTS

The 12-year prosthesis ECSR was 96.8% (95% CI: 79.2-99.5, 36/37 prostheses) in the FSIFDP group and 96.4% (95% CI: 86.3-99.1, 63/65 prostheses) in the FTIFDP group, whereas the 12-year implant ECSR was 99.5% (95% CI: 96.4-99.9, 231/232 implants) in the FSIFDP group and 98.7% (95% CI: 96.9-99.5, 459/464 implants) in the FTIFDP group. The 12-year ECPR at the prosthesis level was 12.8% (95% CI: 12.7-47.6, 4/37 prostheses) in the FSIFDP group and 12.8% (95% CI: 11.4-24.1, 6/65 prostheses) in the FTIFDP group. The 12-year ECPR at the implant level was 4.4% (95% CI: 4.3-23.0, 6/232 implants) in the FSIFDP group and 2.2% (95% CI: 2.0-12.3, 7/464 implants) in the FTIFDP group.

CONCLUSION

FTIFDPs have clinical results comparable to those of FSIFDPs. Therefore, FTIFDPs can be useful.

Long term follow-up of titanium implants installed in block-grafted areas: A systematic review

BACKGROUND

An enduring clinical question concerns the outcome (ie, success) of implants placed in areas grafted with block-grafts.

OBJECTIVE

To undertake a systematic review of the literature on the long term results (≥5 years) of implants placed in maxillofacial areas grafted with any type of osseous block-grafts in two-stage surgeries. Further, the review addresses how available success criteria were used within the studies.

MATERIALS AND METHODS

The MEDLINE (PubMed) and EMBASE bibliographic databases were searched up to March 2017 for studies evaluating the long term results of implants placed in grafted areas. The search strategy was restricted to English language publications using combined terms which referred to the treatment method (implants placed in areas grafted with bone blocks), and follow-up characteristics (≥5 years and assessment of at least one parameter related to implant success criteria). To qualify for inclusion, studies should present outcome measurements indicating the success (or at least the survival) of the implants.

RESULTS

The search strategy yielded 17 studies, which were included in this systematic review. These studies presented survival rates ranging from 88.7% (after 15 years follow-up) to 98.7% (after 5 years follow-up). Five studies presented data based on predefined success criteria with success rates ranging from 86.8% to 100%. In these studies, the term "success" was often not properly defined.

CONCLUSION

The long term survival (≥5 years) of implants placed into block-grafted areas in two-stage surgeries was not lower than 75%, while success rates ranged from 86.8% to 100%. Although it was possible to identify published success criteria for implant follow-up, there is no broad consensus on how to report implant success in a consistent manner.

Early Bone Response to Dual Acid-Etched and Machined Dental Implants Placed in the Posterior Maxilla: A Histologic and Histomorphometric Human Study

PURPOSE

To compare the early bone response to implants with dual acid-etched (DAE) and machined (MA) surface, when placed in the posterior human maxilla.

MATERIALS AND METHODS

Fourteen patients received 2 implants in the posterior maxilla: 1 DAE and 1 MA. After 2 months, the implants were retrieved for histologic/histomorphometric evaluation. The bone-to-implant contact (BIC%), bone density in the threaded area (BDTA%), and the bone density (BD%) were calculated. The Wilcoxon matched-pairs signed rank test was used to evaluate differences (BIC%, BDTA%, and BD%) between the surfaces.

RESULTS

In the MA implants, a mean (±SD) BIC%, BDTA%, and BD% of 21.76 (±12.79), 28.58 (±16.91), and 21.54 (±11.67), respectively, was reported. In the DAE implants, a mean (±SD) BIC%, BDTA%, and BD% of 37.49 (±29.51), 30.59 (±21.78), and 31.60 (±18.06), respectively, was reported. Although the mean BIC% of DAE implants value was almost double than that of MA implants, no significant differences were found between the 2 groups with regard to BIC% (P = 0.198) and with regard to BDTA% (P = 0.778) and BD% (P = 0.124).

CONCLUSIONS

The DAE surface increased the periimplant endosseous healing properties in the native bone of the posterior maxilla.

Impact of Second Stage Surgery on Bone Remodeling Around New Hybrid Titanium Implants: A Prospective Clinical Study in Humans

OBJECTIVE

The present prospective study aimed to more precisely identify the time points of bone changes around hybrid titanium implants up to 30 months of follow-up.

MATERIALS AND METHODS

Twelve hybrid T3 implants (Biomet 3i) were placed in 9 healthy patients with the 2-stage surgical approach. Standardized digital Rx were taken at implant insertion (T0); healing-abutment connection after 3.1 ± 0.2 weeks (TX); loading stage after 7.5 ± 0.6 weeks (T1); after 12 months (T2); and after 30 months (T3) of functional loading. The marginal bone loss was digitally measured.

RESULTS

The mean marginal bone loss was 0.76 ± 0.37 mm after 30 months. More than 60% (0.42 ± 0.29 mm) of the bone loss took place at healing-abutment connection (TX-T1). No statistically significant bone loss was found between T1-T2 and T2-T3, after 12 and 30 months, respectively. Approximately 40% of bone loss (0.34 mm) was noted between T1 and T3 (P < 0.05), which corresponds to the loading period.

CONCLUSIONS

The implant-oral environment connection represents a critical step point in crestal bone loss. The amount of marginal bone loss, measured after 30 months of loading (T1-T3), was much less than that reported in the literature, showing that correct loading has a minor impact on the periimplant bone remodeling as compared to surgical implant reopening.

Long-Term Effect of Surface Roughness and Patients' Factors on Crestal Bone Loss at Dental Implants. A Systematic Review and Meta-Analysis

Publications from 2011 to 2015 were selected to evaluate effect of implant surface roughness on long-term bone loss as surrogate for peri-implantitis risk. 87 out of 2,566 papers reported the mean bone loss after at least 5 years of function. Estimation of the proportion of implants with bone loss above 1, 2, and 3 mm as well as analysis the effect of implant surface roughness, smoking, and history of periodontitis was performed. By means of the provided statistical information of bone loss (mean and standard deviation) the prevalence of implants with bone loss ranging from 1 to 3 mm was estimated. The bone loss was used as a surrogate parameter for "peri-implantitis" given the fact that "peri-implantitis" prevalence was not reported in most studies or when reported, the diagnostic criteria were unclear or of dubious quality. The outcome of this review suggests that peri-implant bone loss around minimally rough implant systems was statistically significant less in comparison to the moderately rough and rough implant systems. No statistically significant difference was observed between moderately rough and rough implant systems. The studies that compared implants with comparable design and different surface roughness, showed less average peri-implant bone loss around the less rough surfaces in the meta-analysis. However, due to the heterogeneity of the papers and the multifactorial cause for bone loss, the impact of surface roughness alone seems rather limited and of minimal clinical importance. Irrespective of surface topography or implant brand, the average weighted implant survival rate was 97.3% after 5 years or more of loading. If considering 3 mm bone loss after at least 5 years to represent the presence of "peri-implantitis," less than 5% of the implants were affected. The meta-analysis indicated that periodontal history and smoking habits yielded more bone loss.

Systematic review of short- (5-10 years) and long-term (10 years or more) survival and success of full-arch fixed dental hybrid prostheses and supporting implants

OBJECTIVES

The aim of this systematic review was to investigate the short-term (5-10 year mean follow-up) and long-term (10 year or more) survival and success of fixed full arch dental hybrid prosthesis and supporting dental implants.

METHODS

Studies reporting interventions with full-arch fixed dental hybrid prostheses were identified by searching PubMed/Medline (NCBI), Web of Science (Thomson Reuters), the Cochrane Register of Controlled Clinical Trials (EBSCO), and Dentistry and Oral Sciences Source (DOSS; EBSCO) from the earliest available dates through July 17, 2013. Through a series of review process by two examiners, potentially qualifying studies were identified and assessed with respect to the inclusion criteria.

RESULTS

A total of 18 studies were included for the quality assessment and the systematic review. Within the limitation of available studies, high short-term survival rates of full arch fixed dental hybrid prostheses (93.3-100%) and supporting implants (87.89-100%) were found. However, the availability of studies investigating long-term outcomes seemed scarce. Furthermore, the included studies were subjected to potential sources of bias (i.e. publication, reporting, attrition bias).

CONCLUSIONS

Despite seemingly high short-term survival, long-term survival of implant supported full arch fixed dental hybrid prosthesis could not be determined due to limited availability of true long-term studies. Although it may be a valuable option for a patient with a completely edentulous ridge(s), the strategic removal of teeth with satisfactory prognosis for the sake of delivering an implant supported full-arch dental hybrid prosthesis should be avoided.

Comparative evaluation of two types of immediately loaded implants using biomechanical and histomorphometric tests: an animal case study

Introduction. In order to minimize the required time to regain esthetic and function, immediately loaded implants were suggested. The aim of this study was to comparatively evaluate the Nisastan and XIve implants using biomechanical and histomorphometric tests. Materials and Methods. In this experimental study, 6 Nisastan one-piece immediately loaded screw type implant (OPILS) and 6 Xive implants with 3.4 mm diameter and 11 mm long were used. The implants were immediately loaded with temporary coating. After three months, the torque required to break bone-implant contact was measured and was recorded. All implants were extracted with surrounding bone and histologically were evaluated. The data were inputted into the SPSS 11.5 to run student T-test statistical analyses (α = 0.05). Results. The success rates of both types of implants was 100%, and none of them failed due to mobility or bone loss. The mean removal torque value (RTV) was 142.08 and 40 N/Cm for Xive and Nisastan implants, respectively, and their RTVs showed a significant difference between two mentioned implants (P = 0.004). None of the histomorphometric values showed significant differences between the two implants (P > 0.05). Discussion. both systems have the capability to induce osseointegration under immediate loads but that Xive implants showed higher capability for bone contact.