Success rate of immediately loaded implants in the posterior zone

Dental implants are considered an ideal treatment for a missing single tooth. Immediate loading of implants can hasten the procedure, providing comfort to the patients. Recently, immediate loading of implants has gained much importance as it helps hasten the procedure and provides more comfort to patients. A previous systematic review published 5 years ago compared the success rates between immediate and conventional loading. There are several factors that influence the success rate of implants that were not discussed in detail in the previous review. Hence, the present systematic review is done to report differences in the outcomes from single implant restorations of missing teeth in the posterior region in patients who were subjected to immediate loading and conventional loading. A follow up for 1 year was done. Electronic databases of Medline, Scopus, and Web of Science were searched for publications in the English Language during May 2021. The search results yielded 306 articles, out of which 225 were excluded based on title and abstract screening. Screening of the remaining 81 full text articles yielded 14 original research articles that satisfied the predefined inclusion criteria. Meta analysis was not possible due to the heterogeneity of the data. The overall success rate of the immediate loading of a single implant is 94.31%. Implants in the maxillary region had a higher survival rate than those in the mandibular region. The age range between 18 and 80 years showed good prognosis and outcomes in older individuals. Good oral hygiene was emphasized for all patients to prevent any secondary conditions or delays in healing.

Long-term stability of infrabony defects treated with enamel matrix derivative alone: A retrospective two-centre cohort study

AIM

To assess the long-term stability of attachment gain in infrabony defects (IBDs) 10 years after regenerative treatment with an enamel matrix derivative (EMD) alone.

MATERIALS AND METHODS

Two centres (Frankfurt [F] and Heidelberg [HD]) invited patients for re-examination 120 ± 12 months after regenerative therapy. Re-examination included clinical examination (periodontal probing depths (PPD), vertical clinical attachment level (CAL), plaque index (PlI), gingival index (GI), plaque control record, gingival bleeding index and periodontal risk assessment) and review of patient charts (number of supportive periodontal care [SPC] visits).

RESULTS

Both centres included 52 patients (29 female; median baseline age: 52.0 years; lower/upper quartile: 45.0/58.8 years; eight smokers), each contributing one IBD. Nine teeth were lost. For the remaining 43 teeth, regenerative therapy showed significant CAL gain after 1 year (3.0; 2.0/4.4 mm; p < .001) and 10 years (3.0; 1.5/4.1 mm; p < .001) during which CAL remained stable (-0.5; -1.0/1.0 mm; p = 1.000) after an average SPC of 9 years. Mixed-model regression analyses revealed a positive association of CAL gain from 1 to 10 years with CAL 12 months post operation (logistic: p = .01) as well as a higher probability for CAL loss with an increasing vertical extent of a three-walled defect component (linear: p = .008). Cox proportional hazard analysis showed a positive association between PlI after 12 months and tooth loss (p = .046).

CONCLUSION

Regenerative therapy of IBDs showed stable results over 9 years. CAL gain is associated with CAL after 12 months and decreasing initial defect depth in a three-walled defect morphology. Tooth loss is associated with PlI 12 months post operation.

CLINICAL TRIAL NUMBER

DRKS00021148 (URL: https://drks.de).

Implant stability in patients treated with platelet-rich fibrin and bovine bone substitute for alveolar ridge preservation is associated with peripheral blood cells and coagulation factors

AIMS

The aim of the present study was to assess the association between dental implant stability and peripheral blood cell composition and levels of coagulation factors in patients treated with alveolar ridge preservation with platelet-rich fibrin (PRF) and bovine bone substitute.

MATERIALS AND METHODS

Fifty patients were included between 2015 and 2017. PRF was prepared from autologous blood, in which blood cells and coagulation factor levels were measured. PRF and bovine bone were placed in the socket, followed by closure with PRF membrane. Implants were placed 14 (±2.5) weeks postextraction. The implant stability quotient was measured at t = 0, t = 10 days, t = 7 weeks, and t = 17 weeks by resonance frequency analysis.

RESULTS

Erythrocyte count was inversely associated with PRF membrane length, but not with implant stability. Conversely, platelet count did not correlate with membrane size but inversely correlated with implant stability at 7 and 17 weeks. In addition, implant stability was directly correlated with levels FXIII (t = 0, p < .01), active von Willebrand factor (VWF; t = 0 and 7 weeks, p < .05), and total VWF (t = 7 weeks, p = .012).

CONCLUSION

Implant stability following alveolar ridge preservation with PRF and bovine bone substitute is associated with circulating blood cells and coagulation factors. In particular, fibrin structure, VWF, and FXIII may be important modulators of implant stability.

Periprosthetic biomechanical response towards dental implants, with functional gradation, for single/multiple dental loss

The differences in shape and stiffness of the dental implants with respect to the natural teeth (especially, dental roots) cause a significant alteration of the periprosthetic biomechanical response, which typically leads to bone resorption and ultimately implant loosening. In order to avoid such clinical complications, the implant stiffness needs to be appropriately adapted. In this study, hollow channels were virtually introduced within the designed implant screws for reduction of the overall stiffness of the prototype. In particular, two opposing radial gradients of increasing hollow channel diameters, i.e., outside to inside (Channel 1) and inside to outside (Channel 2) were considered. Two clinical situations of edentulism were addressed in this finite element-based study, and these include a) loss of the first molar, and b) loss of all the three molars. Consequently, two implantation approaches were simulated for multiple teeth loss - individual implantation and implant supported dental bridge. The effects of implant length, approach and channel distribution on the biomechanical response were evaluated in terms of the von Mises stress within the interfacial periprosthetic bone, under normal masticatory loading. The results of our FE analysis clearly reveal significant variation in periprosthetic bone stress between the different implant designs and approaches. An implant screw length of 11 mm with the Channel 2 configuration was found to provide the best biomechanical response. This study also revealed that the implant supported dental bridge approach, which requires lower bone invasion, results in favorable biomechanical response in case of consecutive multiple dental loss.

Prosthetically Driven Computer-Guided Implant Placement and Restoration Using CEREC: A Case Report

Developments in 3-dimentional (3D) diagnostic technology and advanced digital optical imaging have improved the predictability, safety, and efficiency of restoratively driven implant dentistry. Surgical procedures may now be performed in a single visit utilizing chairside, computer-aided design/computer-aided manufacturing technology and in situations when a two-stage implant protocol is indicated as demonstrated in this case. The CEREC® GALILEOS® integration workflow system was used to prosthetically plan and place an implant in the lower right mandibular first molar site, No. 30, which had been previously grafted following tooth extraction. Preoperative planning was performed, taking into consideration all anatomic landmarks, current tissue status, and restorative needs while incorporating cone-beam computed tomography data to design and mill a stable, tooth-supported surgical guide (CEREC Guide 2.0). After placement and subsequent osseointegration, the implant was restored chairside in a pre-doctoral treatment center. The Sirona TiBase system and VITA ENAMIC® IS block were used to produce an esthetically pleasing and clinically excellent screw-retained implant crown.

Autotransplantation of teeth

Dental autotransplantation is the surgical transposition of a tooth from its original site to another site to replace a lost or compromised tooth in the same individual.1 It offers a method for replacing missing teeth or avulsed and traumatized teeth, particularly in children and adolescents. This surgical therapy is often overlooked as a treatment option by dentists and oral surgeons, who typically treat space closure by placing dental implants or bridges despite the fact that recent autotransplantation studies show high survival rates and success rates of 91.3%.2 Most tooth losses due to traumatic incidents occur in young patients, and implant placement is contraindicated until the completion of growth. In cases where there is no donor dilemma, and if a suitable graft is available, autotransplantation may be the therapy of choice.

Natural teeth-retained splint based on a patient-specific 3D-printed mandible used for implant surgery and vestibuloplasty: A case report

RATIONALE

With respect to improving the quality of oral rehabilitation, the management of keratinized mucosa is as important as bone condition for implant success. To enhance this management, a natural teeth-retained splint based on a patient-specific 3-dimensional (3D) printed mandible was used in vestibuloplasty to provide sufficient keratinized mucosa around dental implants to support long-term implant maintenance.

PATIENT CONCERNS

A 28-year-old male patient had a fracture of the anterior andible 1 year ago, and the fracture was treated with titanium.

DIAGNOSES

The patient had lost mandibular incisors on both the sides and had a shallow vestibule and little keratinized mucosa.

INTERVENTIONS

In the first-stage implant surgery, 2 implants were inserted and the titanium fracture fixation plates and screws were removed at the same time. During second-stage implant surgery, vestibuloplasty was performed, and the natural teeth-retained splint was applied. The splint was made based upon a patient-specific 3D-printed mandible. At 30-day follow-up, the splint was modified and reset. The modified splint was removed after an additional 60 days, and the patient received prosthetic treatment.

OUTCOMES

After prosthetic treatment, successful oral rehabilitation was achieved. Within 1 year and 3 years after implant prosthesis finished, the patient exhibited a good quantity of keratinized gingiva.

LESSONS SUBSECTIONS

The proposed splint is a simple and time-effective technique for correcting soft tissue defects in implant dentistry that ensures a good quantity of keratinized mucosa.

Oral Implant-Prostheses: New Teeth for a Brighter Brain

Several studies have demonstrated that chewing can be regarded as a preventive measure for cognitive impairment, whereas masticatory deficiency, associated with soft-diet feeding, is a risk factor for the development of dementia. At present the link between orofacial sensorimotor activity and cognitive functions is unknown. In subjects with unilateral molar loss we have shown asymmetries in both pupil size and masticatory muscles electromyographic (EMG) activity during clenching: the molar less side was characterized by a lower EMG activity and a smaller pupil. Since implant-prostheses, greatly reduced both the asymmetry in EMG activity and in pupil's size, trigeminal unbalance, leading to unbalance in the activity of the Locus Coeruleus (LC), may be responsible for the pupil's asymmetry. According to the findings obtained in animal models, we propose that the different activity of the right and left LC may induce an asymmetry in brain activity, thus leading to cognitive impairment. According to this hypothesis, prostheses improved the performance in a complex sensorimotor task and increased the mydriasis associated with haptic tasks. In conclusion, the present study indicates that the implant-prosthesis therapy, which reduces the unbalance of trigeminal proprioceptive afferents and the asymmetry in pupil's size, may improve arousal, boosting performance in a complex sensorimotor task.

Guided surgery with tooth-supported templates for single missing teeth: A critical review

AIM

To systematically scrutinise the scientific literature to evaluate the accuracy of computer-guided implant placement for single missing teeth, as well as to analyse the eventual clinical advantages and treatment outcomes.

MATERIAL AND METHODS

The electronic and manual literature search of clinical studies published from January 2002 up to November 2015 was carried out using specified indexing terms. Outcomes were accuracy; implant and prosthetic failures; biological and mechanical complications; marginal bone loss (MBL); sulcus bleeding index (SBI); plaque score (PS); pink esthetic score [PES]; aesthetic and clinical outcomes.

RESULTS

The search yielded 1027 relevant titles and abstracts, found during the electronic (n = 1020) and manual (n = 7) searches. After data extraction, and screening of titles, abstracts, and full-texts, 32 studies fulfilled inclusion criteria and were included in the critical review: two randomised controlled clinical trials, six prospective observational single cohort studies, one retrospective observational study, three in vitro comparative studies, 10 case reports and 10 systematic reviews. A total of 209 patients (18 to 67 years old) were treated with 342 implants using computer-guided implant surgery. The follow-up ranged from 12 to 52 months. The cumulative survival rate ranged from 96.5% to 100%. Eleven implant planning softwares and guided surgery systems were used and evaluated.

CONCLUSIONS

Computer-guided surgery for single missing teeth provides comprehensive treatment planning, reliable implant positioning, favourable clinical outcomes and aesthetics. A tooth-supported template for the treatment of single missing teeth results in greater accuracy of implant positioning than with mucosa-supported or bone-supported templates. The limited scientific evidence available suggests that guided surgery leads to implant survival rates as good as conventional freehand protocols. Computer-guided surgery implies additional costs, that should be analysed in terms of cost-effectiveness, considering the reduction of surgery time, postoperative pain and swelling, as well as, the potential increased accuracy. Long-term randomised clinical trials are eagerly needed to investigate the clinical performance of guided surgery in partially edentate patients.

Single implants in dorsal areas - A systematic review

AIM

This study evaluated the efficacy of replacing single missing teeth in the posterior quadrants of the maxilla and/or mandible with an implant-supported dental prosthesis.

MATERIAL AND METHODS

Three scientific literature databases - Medline (Pubmed), Ovid Medline and Cochrane Central Register of Controlled Trials (CENTRAL) - were used to perform a search of publications over a period from 1985 to 2014. One hundred and forty one (141) articles were reviewed; 36 articles met the inclusion criteria and were included in the final review.

RESULTS

The survival rates, success rates and mean bone loss for immediate implant placement were 96.9%, 100% and 0.85 mm, respectively. The survival rates, success rates and mean bone loss for delayed implant placement were 96.8%, 94.1% and 0.55 mm respectively. The survival rate, success rate and the mean bone loss in studies comparing immediate versus delayed implant placement showed 96.8% and 96.3%, 85.8% and 93.3%, and 0.57 ± 0.57 mm and 0.55 ± 0.37 mm, respectively.

CONCLUSION

The prognosis for single molar implants provides a viable treatment option for replacing a single missing tooth in the posterior quadrants of the maxilla and mandible. There does not appear to be a significant difference in the survival rates of immediately placed implants compared with delayed implant placement. However, the success rates were slightly higher with delayed loading protocols than immediate loading protocols.

Effects of connective tissue grafting on the facial gingival level following single immediate implant placement and provisionalization in the esthetic zone: a 1-year randomized controlled prospective study

PURPOSE

This 1-year randomized controlled prospective study evaluated the implant success rate and peri-implant tissue response following single immediate implant placement and provisionalization (IIPP) with and without subepithelial connective tissue graft (SCTG) in the esthetic zone.

MATERIALS AND METHODS

Implants were placed either IIPP with SCTG (test group) or IIPP without SCTG (control group). The implants were evaluated both clinically and radiographically before surgery, immediately after implant placement, and 3, 6, and 12 months after implant placement. Data were analyzed using Friedman, Wilcoxon signed-rank, and Mann-Whitney U tests at the significance level of α = .05.

RESULTS

Twenty implants (10 test, 10 control) were placed in 20 patients (7 men, 13 women) between the ages of 27 and 87 (mean age, 52.6 years). At 1 year, all implants remained osseointegrated, with overall mean marginal bone changes of -0.01 mm and -0.14 mm for the test and control groups, respectively. Mean facial gingival level change was significantly more pronounced in the control group (-0.70 mm) than in the test group (-0.25 mm). The modified Plaque Index scores showed that patients were able to maintain a good level of hygiene throughout the study. At 1 year, the Papilla Index indicated that more than 50% papilla fill was observed in 75% of the test sites and 80% of the control sites.

CONCLUSIONS

Within the limitations of this study, SCTG was shown to be beneficial in maintaining facial gingival level when performed in conjunction with IIPP procedures.

Long-term evaluation and clinical outcomes of children with dental transplants in Temuco city, Chile

AIM

To assess the clinical and radiographic outcomes of 36 transplanted teeth and the possible factors affecting the results.

MATERIALS AND METHODS

In 26 children, 36 teeth transplants were performed. The main reason for transplantations was the loss of anterior teeth due to trauma; 80.5% of transplanted teeth were immature bicuspids. The transplants were clinically and radiolographycally monitored in respect of pulp vitality, root canal obliteration, periradicular changes and root formation. Fisher Exact Test and Kaplan-Meier analyses were performed to determine the association between the variables and estimation of survival rates, respectively.

RESULTS

Thirty (83.3%) of the transplantations were recorded as successful and six as unsuccessful (16.7%). The survival rate was 97.2% during average time of 47.5 months ± 27.8 SD. Only one tooth had been extracted and 5 had survived in not ideal conditions. The majority of immature transplanted teeth developed pulp canal obliteration.

CONCLUSION

Factors associated to successful outcome were immature root formation of donor tooth and short flexible splinting period. The main factor associated to failure was replacement resorption. The surgical technique did not present statistical significance in the clinical outcome. Tooth transplantation has shown high success and survival rates, and should be considered as a real option in growing patients.

Interventions for replacing missing teeth: different times for loading dental implants

BACKGROUND

To minimise the risk of implant failures after their placement, dental implants are kept load-free for 3 to 8 months to establish osseointegration (conventional loading). It would be beneficial if the healing period could be shortened without jeopardising implant success. Nowadays implants are loaded early and even immediately and it would be useful to know whether there is a difference in success rates between immediately and early loaded implants compared with conventionally loaded implants.

OBJECTIVES

To evaluate the effects of (1) immediate (within 1 week), early (between 1 week and 2 months), and conventional (after 2 months) loading of osseointegrated implants; (2) immediate occlusal versus non-occlusal loading and early occlusal versus non-occlusal loading; (3) direct loading versus progressive loading immediately, early and conventionally.

SEARCH METHODS

The following electronic databases were searched: the Cochrane Oral Health Group's Trials Register (to 8 June 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2012, Issue 4), MEDLINE via OVID (1946 to 8 June 2012) and EMBASE via OVID (1980 to 8 June 2012). Authors of identified trials were contacted to find unpublished randomised controlled trials (RCTs). There were no restrictions regarding language or date of publication.

SELECTION CRITERIA

All RCTs of root-form osseointegrated dental implants, having a follow-up of 4 months to 1 year, comparing the same implant type immediately, early or conventionally loaded, occlusally or non-occlusally loaded, or progressively loaded or not. Outcome measures were: prosthesis and implant failures and radiographic marginal bone level changes.

DATA COLLECTION AND ANALYSIS

Data were independently extracted, in duplicate, by at least two review authors. Trial authors were contacted for missing information. Risk of bias was assessed for each trial by at least two review authors, and data were extracted independently, and in duplicate. Results were combined using fixed-effect models with mean differences (MD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI). A summary of findings table of the main findings was constructed.

MAIN RESULTS

Forty-five RCTs were identified and, from these, 26 trials including a total of 1217 participants and 2120 implants were included. Three trials were at low risk of bias, 12 were at high risk of bias and for the remaining 11 the risk of bias was unclear. In nine of the included studies there were no prosthetic failures within the first year, with no implant failures in 7 studies and the mean rate of implant failure in all 26 trials was a low 2.5%. From 15 RCTs comparing immediate with convential loading there was no evidence of a difference in either prosthesis failure (RR 1.87; 95% CI 0.70 to 5.01; 8 trials) or implant failure (RR 1.65; 95% CI 0.68 to 3.98; 10 trials) in the first year, but there is some evidence of a small reduction in bone loss favouring immediate loading (MD -0.10 mm; 95% CI -0.20 to -0.01; P = 0.03; 9 trials), with some heterogeneity (Tau² = 0.01; Chi² = 14.37, df = 8 (P = 0.07); I² = 44%). However, this very small difference may not be clinically important. From three RCTs which compared early loading with conventional loading, there is insufficient evidence to determine whether or not there is a clinically important difference in prosthesis failure, implant failure or bone loss. Six RCTs compared immediate and early loading and found insufficient evidence to determine whether or not there is a clinically important difference in prosthesis failure, implant failure or bone loss. From the two trials which compared occlusal loading with non-occlusal loading there is insufficient evidence to determine whether there is a clinically important difference in the outcomes of prosthesis failure, implant failure or bone loss. We did not identify any trials which evaluated progressive loading of implants.

AUTHORS' CONCLUSIONS

Overall there was no convincing evidence of a clinically important difference in prosthesis failure, implant failure, or bone loss associated with different loading times of implants. More well-designed RCTs are needed and should be reported according to the CONSORT guidelines (www.consort-statement.org/).

[Guidelines for staged maxilla bone and soft tissue augmentation]

The paper contains guidelines for implant placement in case of bone and soft tissue maxilla defects. The approach is based on the possibility of staged realization of tissue regenerative potential. Using conception of "osseointegration" and "reparative regeneration" the following terms were defined: distant reparative osteogenesis, bone regenerate, structure components of bone regenerate, ortho- and heterotopic osteogenesis, regenerative macro- and microenvironment.

[Russian dental implants system LIKO-M - 5 years clinical experience]

The study focuses on long term results of restorative treatment with dental implant system Liko-M. The study included 503 patients examined and 274 patients treated aged 20-69 with partial or complete teeth loss. The patients were examined and treated at the Department of Maxillofacial and Oral Surgery of Nizhny Novgorod State Medical Academy and in 4 dental practices in Moscow and Nizhny Novgorod. Two-staged implantation method was applied. The treatment met esthetic and functional requirements. Marginal bone resorption was estimated as 0,1 to 1 mm within 5 years follow-up. LIKO-M dental implant system thus proved to be efficient both esthetically and functionally and may be used for compete oral rehabilitation of edentulous patients.

[Clinical experience based guidelines for one-step dental implantation]

The paper presents guidelines for one-step immediate implantation with simultaneous loading by means of provisional crown and subsequent ceramic restoration placement.

[Dental implantation options and estimation of osseous integration in patients with complete teeth loss]

In 48 patients with full teeth loss 272 implants were placed with subsequent oral rehabilitation by fixed and removable dental restorations. Clinical efficiency rates after 5 years of follow-up were 99.6% for implants and 98.2% for restorations. High osseointegration values were obtained with mean "Periotest" value to be 3.6 and bone level loss of 0.7 mm. Best osseointegration features were revealed in cases of fixed restorations retained by 8 and more implants.

[The results of patients questioning regarding dental implantation procedures]

Dental implantation is a widespread method of oral rehabilitation by teeth loss. The purpose of the study was to evaluate patients need and awareness of dental implantation. 486 respondents were included in survey. The low level of knowledge about dental implantation was identified among patients in Saratov.

[Clinical aspects of bone augmentation procedures in complex topography in patients with partial or full teeth loss]

The paper concerns the problem of implant-based oral rehabilitation in complex alveolar bone topography. The study included 56 patients with partial and full teeth loss and significant alveolar bone atrophy Resonance frequency rates were used to assess intraosseous dental implants stability showing its improvement after alveolar bone augmentation procedures.

[Use of porous titanium nickelide dental implants]

The paper presents the results of 20 years clinical experience in dental prosthetics with the use of porous titanium nickelide dental implants. Implants were placed in 565 patients aged 15-17 years. Long-term results analysis showed restorations to function properly after mean follow-up period of 8 years in 435 patients (78.2%) proving this material to be clinically successful.

[Implant placement with metal ceramic restorations in a patient with type II diabetes and asthma]

In out-patient dental care a history of somatic pathology is of vital importance. Unfortunately patients are not always compliant enough not understanding the impact of somatic pathology on dental treatment. The current paper presents a case of dental implant placement and splint bridge fixation in a patient with type II diabetes and asthma. The authors summarize the most useful recommendations for treatment and follow-up of such patients.

[Mandible regional blood circulation peculiarities by dental implants placement]

The paper presents data on regional blood circulation in mandible implant placement sites. Rheographic assessment in 50 patients divided in two groups according to implant placement protocol revealed that circulation volume and peripheral vessels tonus restored on the 14th day after implant placement with wound draining while in conventional implant placement protocol these values remained disturbed even 21 days after surgical procedure.

[Use of metabolic drugs and psychotherapy in dental implantation in elderly patients]

The estimation of efficiency of metabolic drugs and psychotherapy in dental implantation in the elderly was carried out. On the basis of the study results an important pathogenetic significance of use of metabolic drug cytoflavin and cognitive therapy in the treatment of partially adentia at elderly patients was justified. It was proved that the optimization of the internal picture of health by means of the implementation of information and regulatory functions, and emotional reinforcement of the therapeutic process in patients receiving cytoflavin and cognitive therapy would improve the effectiveness of the treatment, to increase "survival" performance of implants and to approach to understanding the underlying mechanisms of forming health in elderly patients with partial adentia.

Tooth autotransplantation: an overview and case study

It is not uncommon for children or young adults to have congenitally missing teeth or early loss of teeth from trauma or caries. The restorative options are typically bridges, implants, and removable appliances. Often overlooked and misunderstood, another treatment option exists in autotransplantation, where a tooth is moved from one site to another in the same individual. Autotransplantation is well studied and has predictable results comparable to implants, with reported success rates often greater than 90%. This article will provide an overview of autotransplantation plantation, its indications, advantages, complications, and treatment considerations, along with a case of a third molar autotransplant that will serve to highlight these points.

[Clinical observation of alveolar bone status of ankylos dental implants with completion of restoration]

OBJECTIVE

To provide basis for clinical application of ANKYLOS dental implants by following up alveolar bone status of 318 pieces of restored ANKYLOS dental implants.

METHODS

Between February 2008 and August 2009, 170 patients with dentition defect underwent placement of ANKYLOS dental implants (318 pieces). There were 74 males (133 pieces) and 96 females (185 pieces) with an average age of 43.8 years (range, 23-68 years). After operation, the periapical X-ray films were taken to observe osseointegration around the neck of implant, alveolar bone resorption, and survival of implants.

RESULTS

All patients were followed up at 6, 12, and 24 months after operation. There were 9 failure implants with a total dental implants survival rate of 97.17% (309/318): 3 at 6 months, 4 at 6-12 months, and 2 at 12-24 months, showing no significant difference in dental implants survival rate among 3 time points (chi2=0.470 3, P=0.492 8). New bone formed around the neck of implant in 4 cases at 6 months and in 31 cases at 12 months; at 6, 12, and 24 months, the bone increase was (0.392 7 +/- 0.217 4), (0.633 5 +/- 0.202 1), and (0.709 0 +/- 0.199 1) mm, respectively, showing significant differences among 3 time points (P < 0.05). At 6, 12, and 24 months after operation, the bone loss of other patients was (0.392 7 +/- 0.217 4), (0.716 7 +/- 0.220 3), and (0.723 2 +/- 0.215 4) mm, respectively, showing significant differences among 3 time points (P < 0.05).

CONCLUSION

After restoration with ANKYLOS dental implant, alveolar bone status is good and the implant success rate is high during short-term follow-up. But further observation and study are required for long-term effectivness.

Interventions for replacing missing teeth: treatment of peri-implantitis

BACKGROUND

One of the key factors for the long-term success of oral implants is the maintenance of healthy tissues around them. Bacterial plaque accumulation induces inflammatory changes in the soft tissues surrounding oral implants and it may lead to their progressive destruction (peri-implantitis) and ultimately to implant failure. Different treatment strategies for peri-implantitis have been suggested, however it is unclear which are the most effective.

OBJECTIVES

To identify the most effective interventions for treating peri-implantitis around osseointegrated dental implants.

SEARCH METHODS

We searched the Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE. Handsearching included several dental journals. We checked the bibliographies of the identified randomised controlled trials (RCTs) and relevant review articles for studies outside the handsearched journals. We wrote to authors of all identified RCTs, to more than 55 dental implant manufacturers and an Internet discussion group to find unpublished or ongoing RCTs. No language restrictions were applied. The last electronic search was conducted on 9 June 2011.

SELECTION CRITERIA

All RCTs comparing agents or interventions for treating peri-implantitis around dental implants.

DATA COLLECTION AND ANALYSIS

Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. We contacted the authors for missing information. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals (CI). Heterogeneity was to be investigated including both clinical and methodological factors.

MAIN RESULTS

Fifteen eligible trials were identified, but six were excluded. The following interventions were compared in the nine included studies: different non-surgical interventions (five trials); adjunctive treatments to non-surgical interventions (one trial); different surgical interventions (two trials); adjunctive treatments to surgical interventions (one trial). Follow-up ranged from 3 months to 4 years. No study was judged to be at low risk of bias.Statistically significant differences were observed in two small single trials judged to be at unclear or high risk of bias. After 4 months, adjunctive local antibiotics to manual debridement in patients who lost at least 50% of the bone around implants showed improved mean probing attachment levels (PAL) of 0.61 mm (95% confidence interval (CI) 0.40 to 0.82) and reduced probing pockets depths (PPD) of 0.59 mm (95% CI 0.39 to 0.79). After 4 years, patients with peri-implant infrabony defects > 3 mm treated with Bio-Oss and resorbable barriers gained 1.4 mm more PAL (95% CI 0.24 to 2.56) and 1.4 mm PPD (95% CI 0.81 to 1.99) than patients treated with a nanocrystalline hydroxyapatite.

AUTHORS' CONCLUSIONS

There is no reliable evidence suggesting which could be the most effective interventions for treating peri-implantitis. This is not to say that currently used interventions are not effective.A single small trial at unclear risk of bias showed the use of local antibiotics in addition to manual subgingival debridement was associated with a 0.6 mm additional improvement for PAL and PPD over a 4-month period in patients affected by severe forms of peri-implantitis. Another small single trial at high risk of bias showed that after 4 years, improved PAL and PPD of about 1.4 mm were obtained when using Bio-Oss with resorbable barriers compared to a nanocrystalline hydroxyapatite in peri-implant infrabony defects. There is no evidence from four trials that the more complex and expensive therapies were more beneficial than the control therapies which basically consisted of simple subgingival mechanical debridement. Follow-up longer than 1 year suggested recurrence of peri-implantitis in up to 100% of the treated cases for some of the tested interventions. As this can be a chronic disease, re-treatment may be necessary. Larger well-designed RCTs with follow-up longer than 1 year are needed.

[Restorative treatment by means of short porous-surfaced implants]

to assess clinical efficiency of restorative treatment on short porous-surfaced implants. One hundred and fifty-five porous-surfaced 5, 7 and 9 mm implants were placed in 71 patients with partial teeth loss and significant alveolar bone loss. Only one implant failure was observed one month after placement. Other 154 implants were used as restoration abutments. One year after restorative treatment mean periotest rate was -5,3, mean radiologicaly confirmed marginal bone loss 0,31 mm. No treatment failure were revealed during 3 years of follow-up.

[Experience of using short Bicon implants for treatment of partial and complete teeth loss]

The paper deseriebes the use of short Bicon implants for treatment of complex clinical conditions associated with inadequate width and height of alveolar bone as well as high attachment of mobile mucosa in areas with pronounced bone atrophy. The use of ultraviolet apparatus "Piezosurgery" for sunustifting and alveolar bone splitting, minimal intraoperative trauma and unique design of the implants results in successful osteointegration and formation of phusiological gingival papilla. The application of the given system of implants for treatment of partial and complete teeth loss in complex coses allows achieving good long-term functional and esthetic results without preliminary operations for bone or softissue augmentation.

[Clinical application of a self-developed bone collector in dental implantation]

OBJECTIVE

To introduce a self-developed bone collector designed by the authors and evaluate its effect in clinical application.

METHODS

A self-developed bone collector was used in 38 patients who underwent the dental implant operation from May 2008 to October 2009. During the operation the bone particles were harvested, which was used for the reconstruction of the bone defects around the implant simultaneously. The defects were fenestrate in 29 regions and triangle in 23 regions on buccal or lingual side of the dental implants.

RESULTS

All cases had no surgical wound infection and dehiscence 7 - 10 days after operation. Three to six months after implantation, the X-ray showed that all the dental implants had perfect osseointergration and the alveolar bone were successfully augmented.

CONCLUSIONS

Bone debris harvested by self-developed bone collector could repair small peri-implant bone defects, which is simple to use in clinic.

[Implant restoration for patients with congenital missing teeth]

OBJECTIVE

To evaluate the treatment plan, clinical outcome and related problems in patients with congenital missing teeth.

METHODS

From November 2000 to February 2009, thirty seven patients with congenital missing teeth underwent thorough diagnostic workup, treatment planning and an interdisciplinary approach to ensure optimal treatment in Department of Implant Dentistry, Peking University, School and Hospital of Stomatology. A standard follow-up protocol was conducted for all the patients.

RESULTS

The enrolled cases in this study were classified in to 3 types: single tooth missing, multiple teeth missing and edentulous. Among them single tooth missing was found in 21 cases, multiple teeth missing was found in 12 cases and 4 cases were edentulous. 120 implants were placed and restored in 37 patients with the mean follow-up 39.3 months (10-109 months) after prosthetic functioning. Two implants lost after function about 6 months and the remaining implants functioned well until the last review. No adverse complications such as pain and nerve trauma was observed and the mean bone resorption was 1.91 mm.

CONCLUSION

An interdisciplinary approach ensures optimal treatment for patients with congenital missing teeth. Implant restorations provide an alternative way with predictable clinical results.

[Computer planning of dental implantations with the use of navigational implantological sampler made by CAD/CAM technology]

Use of implantological sampler during surgical stage of dental implantations reduced considerably the number of mistakes and complications. Clinical example of planning and execution of dental implantation with the use of navigational implantological sampler made by CAD/CAM-technology with fixation upon temporary implants was brought.

[The treatment and rehabilitation of patients with secondary adentia and atrophy of alveolar process of maxilla]

The novel method of surgical treatment and rehabilitation of patients with secondary adentia and atrophy of alveolar process of maxilla was suggested. The method allows to preserve satisfactory microcirculation of the implantation area and to achieve hermetizm by wound closure. The use of the endoscope for visualizing the operation field minimizes the possibility of the sinus membrane intraoperative perforation and decreases the overall surgical traumatizm.

[Planning and performing surgical stage of dental implantation in difficult clinical cases based on computer modeling]

Clinical experience of preoperative computer modeling of dental implant intervention is described. By studying the ergonomics and the accuracy a proper stereolithography guide is selected. This method allows performing a complex preoperative virtual study of dental implants placement depending on future prosthodontics restoration in difficult clinical cases. Requires collaboration at the planning stage of prosthodontist, surgeon, radiologist, 3D-modeling specialists.

[Advantage of computer planning of intraosseous dental implantation]

Results of experimental-clinical substantiation of computer technology of intraosseous dental implantation (Materialise, SiCat) planning and new computer technology of optical implantation navigation Monadent were expounded. Results of precision measurement of implant installation into experimental model according to computer planning data were brought. By the example of clinical analyses data of implantation efficacy in 352 patients the advantages of preliminary computer implantation planning were shown. When interviewing doctors and patients benefits of computer implantation planning were disclosed in cases when the plan of treatment was coordinated with the patient. It was forecasted that the use of computer planning in practical implantology would be widened.

Interventions for replacing missing teeth: treatment of perimplantitis

BACKGROUND

One of the key factors for the long-term success of oral implants is the maintenance of healthy tissues around them. Bacterial plaque accumulation induces inflammatory changes in the soft tissues surrounding oral implants and it may lead to their progressive destruction (perimplantitis) and ultimately to implant failure. Different treatment strategies for perimplantitis have been suggested, however it is unclear which are the most effective.

OBJECTIVES

To identify the most effective interventions for treating perimplantitis around osseointegrated dental implants.

SEARCH STRATEGY

We searched the Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE. Handsearching included several dental journals. We checked the bibliographies of the identified randomised controlled trials (RCTs) and relevant review articles for studies outside the handsearched journals. We wrote to authors of all identified RCTs, to more than 55 dental implant manufacturers and an Internet discussion group to find unpublished or ongoing RCTs. No language restrictions were applied. The last electronic search was conducted on 7th January 2010.

SELECTION CRITERIA

All RCTs comparing agents or interventions for treating perimplantitis around dental implants.

DATA COLLECTION AND ANALYSIS

Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. We contacted the authors for missing information. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals (CI). Heterogeneity was to be investigated including both clinical and methodological factors.

MAIN RESULTS

Twelve eligible trials were identified, but five were excluded. The following procedures were tested: (1) use of local antibiotics versus ultrasonic debridement; (2) benefits of adjunctive local antibiotics to debridement; (3) different techniques of subgingival debridement; (4) laser versus manual debridement and chlorhexidine irrigation/gel; (5) systemic antibiotics plus resective surgery plus two different local antibiotics with and without implant surface smoothening; and (6) nanocrystalline hydroxyapatite versus Bio-Oss and resorbable barriers. Follow-up ranged from 3 months to 4 years. The only statistically significant differences were observed in two trials judged to be at high risk of bias. After 4 months, adjunctive local antibiotics to manual debridement in patients who lost at least 50% of the bone around implants showed improved mean probing attachment levels (PAL) of 0.61 mm and reduced probing pockets depths (PPD) of 0.59 mm. After 4 years, patients with perimplant infrabony defects > 3 mm treated with Bio-Oss and resorbable barriers gained 1.4 mm more PAL and PPD than patients treated with a nanocrystalline hydroxyapatite.

AUTHORS' CONCLUSIONS

There is very little reliable evidence suggesting which could be the most effective interventions for treating perimplantitis. This is not to say that currently used interventions are not effective. The use of local antibiotics in addition to manual subgingival debridement was associated with a 0.6 mm additional improvement for PAL and PPD over a 4-month period in patients affected by severe forms of perimplantitis. After 4 years, improved PAL and PPD of about 1.4 mm were obtained when using Bio-Oss with resorbable barriers compared to a nanocrystalline hydroxyapatite in perimplant infrabony defects. In four trials, the control therapy which basically consisted of a simple subgingival mechanical debridement seemed to be sufficient to achieve similar results to the more complex and expensive therapies. Follow-up longer than 1 year suggested recurrence of perimplantitis up to 100% of the treated cases for some of the tested interventions. Sample sizes were very small and follow-up too short, therefore these findings have to be considered with great caution. Larger well-designed RCTs with follow-up longer than 1 year are needed.

[Use of computer technologies in prosthetic treatment of patients with front teeth loss]

Use of the proposed computer modeling technology with taking into account the individual face size based upon multivariate statistical analysis with the possibility of art editing during the final stage of modeling let to take into consideration individual peculiarities of face structure and gender differences and to recreate individual form and sizes of front artificial teeth for non removable prosthetics. The results of computer modeling use in prosthetic treatment of patients with front teeth loss and the results of comparison with traditional method and also with preliminary use of computer modeling were demonstrated.

[Microcirculation status in supporting tissues in cases of prosthetic treatment of mandible in patients with full secondary adentia with the use of implants]

By the method of laser Doppler fluometry microcirculation in gingival tissues was studied in the region of bearing implants in cases of making prosthetics for patients with full secondary adentia. It was established that after functional loading of the bearing implants in microcirculatory bed of gingival tissues hyperemia was developed that was cut short in 3 months that testified to normalization of tissue blood flow.

Interventions for replacing missing teeth: different times for loading dental implants

BACKGROUND

To minimize the risk of implant failure, osseointegrated dental implants are conventionally kept load-free during the healing period. During healing removable prostheses are used, however many patients find these temporary prostheses rather uncomfortable and it would be beneficial if the healing period could be shortened without jeopardizing implant success. Nowadays immediately and early loaded implants are commonly used in mandibles (lower jaws) of good bone quality. It would be useful to know whether there is a difference in success rates between immediately or early loaded implants compared with conventionally loaded implants.

OBJECTIVES

To evaluate the efficacy of (1) immediate (within 1 week), early (between 1 week and 2 months), and conventional (after 2 months) loading of osseointegrated implants, and of (2) immediate occlusal versus non-occlusal loading during the bone healing phase.

SEARCH STRATEGY

The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE were searched. Handsearching included several dental journals. Authors of all identified trials, an Internet discussion group and 55 dental implant manufacturers were contacted to find unpublished randomised controlled trials (RCTs). The last electronic search was conducted on 4 June 2008.

SELECTION CRITERIA

All RCTs of root-form osseointegrated dental implants, having a follow up of 4 months to 1 year, comparing the same implant type immediately, early and conventionally loaded or occlusally and non-occlusally loaded. Outcome measures were: prosthesis and implant failures and radiographic marginal bone level changes.

DATA COLLECTION AND ANALYSIS

Data were independently extracted, in duplicate, by two review authors. Authors were contacted for details of randomisation and withdrawals and a quality assessment was carried out. The Cochrane Collaboration's statistical guidelines were followed.

MAIN RESULTS

Thirty RCTs were identified and 22 trials including 976 participants in total were included. Twelve trials compared immediate versus conventional loading, three early versus conventional loading, six immediate versus early loading, and one occlusally versus non-occlusally loaded implants. On a patient, rather than per implant basis, there were no statistically significant differences for any of the meta-analyses.

AUTHORS' CONCLUSIONS

It is possible to successfully load dental implants immediately or early after their placement in selected patients, though not all clinicians may achieve optimal results. It is unclear whether it is beneficial to avoid occlusal contacts during the osseointegration phase. Trends suggest that immediately loaded implants fail more often than those conventionally loaded, but less commonly than those loaded early. If a clinician wishes to load the implants early, it might be wiser to load them immediately (within 1 week) rather than waiting for 1 or 2 months. A high degree of primary implant stability (high value of insertion torque) seems to be one of the prerequisites for a successful immediate/early loading procedure. More well designed RCTs are needed and should be reported according to the CONSORT guidelines (www.consort-statement.org/).

Interventions for replacing missing teeth: treatment of perimplantitis

BACKGROUND

One of the key factors for the long-term success of oral implants is the maintenance of healthy tissues around them. Bacterial plaque accumulation induces inflammatory changes in the soft tissues surrounding oral implants and it may lead to their progressive destruction (perimplantitis) and ultimately to implant failure. Different treatment strategies for perimplantitis have been suggested, however it is unclear which are the most effective.

OBJECTIVES

To identify the most effective interventions for treating perimplantitis around osseointegrated dental implants.

SEARCH STRATEGY

We searched the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Handsearching included several dental journals. We checked the bibliographies of the identified randomised controlled trials (RCTs) and relevant review articles for studies outside the handsearched journals. We wrote to authors of all identified RCTs, to more than 55 dental implant manufacturers and an Internet discussion group to find unpublished or ongoing RCTs. No language restrictions were applied. The last electronic search was conducted on 9 January 2008.

SELECTION CRITERIA

All RCTs comparing agents or interventions for treating perimplantitis around dental implants.

DATA COLLECTION AND ANALYSIS

Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. We contacted the authors for missing information. Results were expressed as random-effects models using weighted mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals (CI). Heterogeneity was to be investigated including both clinical and methodological factors.

MAIN RESULTS

Ten eligible trials were identified, but three were excluded. The following procedures were tested: (1) use of local antibiotics versus ultrasonic debridement; (2) benefits of adjunctive local antibiotics to debridement; (3) different techniques of subgingival debridement; (4) laser versus manual debridement and chlorhexidine irrigation/gel; (5) systemic antibiotics plus resective surgery plus two different local antibiotics with and without implant surface smoothening; and (6) nanocrystalline hydroxyapatite versus Bio-Oss and resorbable barriers. Follow up ranged from 3 months to 2 years. The only statistically significant differences were observed in two trials judged to be at high risk of bias. After 4 months, adjunctive local antibiotics to manual debridement in patients who lost at least 50% of the bone around implants showed improved mean probing attachment levels (PAL) of 0.61 mm and reduced probing pockets depths (PPD) of 0.59 mm. After 6 months, patients with perimplant infrabony defects > 3 mm treated with Bio-Oss and resorbable barriers gained 0.5 mm more PAL (borderline difference) and PPD than patients treated with a nanocrystalline hydroxyapatite.

AUTHORS' CONCLUSIONS

There is very little reliable evidence suggesting which could be the most effective interventions for treating perimplantitis. This is not to say that currently used interventions are not effective. The use of local antibiotics in addition to manual subgingival debridement was associated with a 0.6 mm additional improvement for PAL and PPD over a 4-month period in patients affected by severe forms of perimplantitis. After 6 months both augmentation therapies appeared to be successful but improved PAL and PPD (0.5 mm) were obtained when using Bio-Oss with resorbable barriers. In four trials, the control therapy which basically consisted of a simple subgingival mechanical debridement seemed to be sufficient to achieve results similar to the more complex and expensive therapies. Sample sizes were very small and follow up too short, therefore these conclusions have to be considered with great caution. Larger well-designed RCTs are needed.

The effectiveness of immediate, early, and conventional loading of dental implants: a Cochrane systematic review of randomized controlled clinical trials

PURPOSE

To test whether there is a difference in success rates between immediately, early, and conventionally loaded implants.

MATERIALS AND METHODS

All randomized controlled clinical trials (RCTs) of root-form osseointegrated oral implants having a follow-up of 6 months to 1 year comparing the same osseointegrated root-form oral implants loaded immediately (within 1 week); early (between 1 week to 2 months); or conventionally (after 2 months) were eligible. An exhaustive search was conducted with no language restriction on January 15, 2007. Outcome measures were prosthesis failures, implant failures, and marginal bone levels measured on intraoral radiographs. Screening of eligible studies, quality assessment, and data extraction were conducted in duplicate. Authors were contacted for any missing information. Results were expressed as random effects models using weighted mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. The statistical unit of the analysis was the patient.

RESULTS

Twenty RCTs were identified, and 11 trials including a total of 300 patients were included. Six trials compared immediate versus conventional loading, 3 early versus conventional loading, and 2 immediate versus early loading. None of the meta-analyses revealed any statistically significant differences.

CONCLUSIONS

It is possible to successfully load dental implants immediately or early after their placement in selected patients, although not all clinicians may achieve optimal results. A high degree of primary implant stability (high value of insertion torque) seems to be 1 of the prerequisites for a successful immediate/early loading procedure. More well-designed RCTs are needed. Priority should be given to trials comparing immediately versus early loaded implants. These trials should be reported according to the CONSORT guidelines (www.consort-statement.org).