A 22-Year Follow Up of Immediate Implant Placement without Bone Augmentation: A Case Series Study

Implant survival rate and marginal bone loss of 174 implants with different variables associated over a minimum observational period of 20 years: A retrospective study

PURPOSE

To investigate the long-term implant survival rate and marginal bone loss (MBL) of implants with different variables associated over an observational period of at least 20 years.

MATERIALS AND METHODS

Patients with at least one implant placed prior to 2001 were recalled and visited. Data on implant macro-design, prosthetic aspects, site distribution, and patient-related factors were collected. MBL was evaluated on intraoral X-rays and peri-implant soft tissue parameters were recorded. The patients were asked to fill out a questionnaire to evaluate their satisfaction with the treatment received. Descriptive statistics indicators were estimated. Analysis of variance and analysis of covariance models were used to investigate any differences in the MBL and peri-implant probing depth (PPD) among the variables. A chi-square analysis was performed to investigate any association between different types of prosthetic implant-supported rehabilitations and survival/success outcomes.

RESULTS

Forty-one (41) patients and 174 implants were included with a mean observational period of 23.3 ± 2.8 years. The implant survival and success rates were 96.5% and 83.3% respectively, while 3.5% of early failures were detected. The lowest success rates were observed for implants supporting fixed full-arch rehabilitations (71.05%) and overdenture rehabilitations (86.11%). A mean MBL of 1.81 ± 0.71 mm and a mean PPD of 3.38 ± 1.62 mm were recorded. The interaction between the collected data with MBL and PPD did not reveal any statistically significant differences between the variables (p > 0.05). A statistically significant difference was recorded when analyzing the association between the different types of prosthetic implant-supported rehabilitations and success rates (p = 0.014), with fixed and removable full-arch rehabilitations presenting with lower success rates. Answers to the questionnaire showed a generally high level of satisfaction.

CONCLUSIONS

Within the limits of this retrospective study and based on the results, an implant survival rate higher than 96% was observed after a mean observational period of 23.3 ± 2.8 years. Both the implant survival rate and MBL seemed stable after a mean observational period of 23.3 ± 2.8 years. Implants supporting fixed and removable full-arch rehabilitations seemed to present lower success rates over time. Implant rehabilitation seemed to provide patients with optimal long-term outcomes in terms of functional and psychological aspects.

Interdental Bone Level around Immediately Placed Implants at Maxillary and Mandibular Molar Sites: A Retrospective Radiographic Analysis

Background and Objectives: The current study aimed to compare the amount of interdental bone loss between early and immediate implant placements. Materials and Methods: A total of 16 immediate implants and 16 early implants radiographs were included in the current research. The bone level was assessed at two different stages: at the extraction appointment (T1) and after three to six months of implant placement (T2). A line was drawn from the cemento-enamel junction connecting adjacent teeth to the interdental line connecting the interdental alveolar crest at both stages. The difference between measurements in the T1 and T2 stages is the bone loss measurement for the early implant group. For the immediate implant placement sites, the measurements were taken from the interdental bone crest to the implant platform level. Results: A Mann-Whitney U test was performed to evaluate the differences between both groups. The descriptive statistics of the T1 and T2 stages for both groups suggest that the bone loss in the T2 stage was generally higher than T1 stage. The immediate implant group showed higher bone loss compared to the early implant group. Moreover, there was significantly higher bone loss (p = 0.039) in the immediate implant group compared to the early implant group. Conclusions: The results of this study indicate that immediate implant might have disadvantages over early implant in terms of bone loss after the extraction of maxillary and mandibular molar teeth.

Implications of considering peri-implant bone loss a disease, a narrative review

Background

Peri‐implantitis has been suggested to cause significant increasing proportions of implant failure with increasing time.

Purpose

To assess whether implant failure rates in long term studies are matching the supposed high prevalence of peri‐implantitis.

Material and Methods

This paper is written as a narrative review of the long‐term clinical investigations available in the literature.

Results

Some implant systems have seen unacceptable marginal bone loss figures with time coupled to increased implant failure rates, resulting in the withdrawal of these systems. The reasons for such mishap are generally unknown, with the exception of one system failure that was found to be due to improper clinical handling. Modern, moderately rough implant systems have functioned excellently over 10–15 years of follow up with minor problems with marginal bone loss and implant failure rates within a few per cent. Machined implants have functioned adequately over 20–30 years of follow up. Implant failures occur predominantly during the first few years after implant placement. No significant increase of implant failures has been observed thereafter over 20–30 years of follow up.

Over the years of our new millennium, scientific and technical advances have allowed the discovery of numerous molecular pathways and cellular interactions between the skeletal and immune system promoting the development of the interdisciplinary field called osteoimmunology. Nowadays, this knowledge has not only allowed the emergence of new etiologic paradigms for bone disease but also a new dynamic approach on the concept of osseointegration and MBL around oral implants, re‐evaluating our older disease oriented outlook. This facilitates at the same time the emergence of translational applications with immunological perspectives, scientific approaches based on omics sciences, and the beginning of an era of personalized dental implant therapy to improve the prognosis of oral implant treatment.

Conclusions

Oral implant systems have been found to function with very good clinical outcome over follow‐up times of 20–30 years. Registered implant failures have occurred predominantly during the first few years after implantation, and there has been no significant increase in late failures due to peri‐implantitis.