Clinical Implant Dentistry and Related Research
Komiyama A, Hultin M, Näsström K, Benchimol D, Klinge B. Soft tissue conditions and marginal bonechanges around immediately loaded implants inserted in edentate jaws following computer guided treatment
planning and f laples s s urger y: a ≥ 1 -year clinical follow-up study. Clin Implant Dent Relat Res
Patients with edentulous maxillae or mandibles were treated using the Teeth-in-an-Hour protocol with 165 implants, and hard and soft tissue conditions were evaluated after 1 year. Mean marginal bone change was
-1.2 ± 1.4 mm, with marginal bone loss > 1.5 mm or 2.0 mm at 42% and 27% of sites, respectively. The mean
probing depth was 2.6 ± 0.6 mm. A wide range of bone loss was therefore observed, with several sites displaying > 1.5 mm bone loss.
Sorrentino R, Galasso L, Tetè S, De Simone G, Zarone F. Clinical evaluation of 209 all-ceramic single crownscemented on natural and implant-supported abutments with different luting agents: a 6-year retrospectivestudy. Clin Implant Dent Relat Res 2012;14(2):184-197.
A total of 209 Procera All-Ceram crowns were placed in 112 patients and cemented using zinc phosphate and resin luting agents. At the 6-year follow-up, 206 crowns were available for evaluation, of which seven failed and nine were affected by mechanical complications, giving cumulative survival and success rates of 95.2% and 90.9%, respectively. Procera All-Ceram crowns therefore appeared to be a reliable option to restore anterior or posterior missing teeth.
Fermergård R, Åstrand P. Osteotome sinus floor elevation without bone grafts – a 3-year retrospective studywith Astra Tech implants. Clin Implant Dent Relat Res 2012;14(2):198-205.
Osteotome sinus floor elevation (OSFE) was performed in 36 patients and 53 implants were placed. The
mean height of the alveolar process at intended implant sites was 6.3 ± 0.3 mm and the mean sinus floor elevation was 4.4 ± 0.2 mm. Three implants were lost, giving a cumulative 3-year implant survival rate of
94%, and the mean bone loss after 1 and 3 years was 0.4 ± 0.05 mm and 0.6 ± 0.09 mm, respectively. The
OSFE technique without bone grafts therefore produced predictable results.
Linsen SS, Martini M, Stark H. Long-term results of endosteal implants following radical oral cancer surgerywith and without adjuvant radiation therapy. Clin Implant Dent Relat Res 2012;14(2):250-258.
Following ablative tumor surgery in the oral cavity, 66 patients were treated with 262 dental implants; 34
patients received radiation therapy. Removable dentures (53) or fixed prostheses (17) were placed. The mean follow-up period was 47.99 ± 34.31 months, and the 1- 5- and 10-year survival rates were 96.6%,
96.6% and 86.9%, respectively. Nine patients lost a total of 14 implants. No differences in implant survival were noted between implants placed in irradiated bone and/or soft tissue grafts, or between the maxilla and
mandible. Implants can therefore be safely used in patients with a history of ablative tumor surgery with or without radiation therapy.
Dasmah A, Hallman M, Sennerby L, Rasmusson L. A clinical and histological case series study on calciumsulfate for maxillary sinus floor augmentation and delayed placement of dental implants. Clin Implant Dent Relat Res 2012;14(2):259-265.
In 10 patients with edentulous maxillae and atrophy of the posterior maxilla, calcium sulphate was used as a
graft material in the maxillary sinus and covered by a membrane. Dental implants (40) were placed after 4 months and radiographic and histomorphometric analysis was performed. At abutment placement, the implant survival rate was 94.5% (one implant failure). Mean shrinkage of the augmented area of 26.5% was noted, and there was significant resorption of the graft material (8.8% remaining graft). New bone formation was noted, with signs of acellular substitution of calcium sulphate with bone-like tissue.
Fenlon MR, Lyons A, Farell S, Bavisha K, Banerjee A, Palmer RM. Factors affecting survival andusefulness of implants placed in vascularized free composite grafts used in post-head and neck cancerreconstruction. Clin Implant Dent Relat Res 2012;14(2):266-272.
A total of 145 implants in 41 patients treated with 47 bone-containing vascularized grafts wereanalyzed; implants were placed either immediately of after 3 months. An increased implant failure rate wasobserved for immediately placed implants, and there was a significant increase in the number of implantsthat were prosthodontically unusable or sub-optimally placed. A significant increase in implant failure wasalso observed with radiation therapy.
Enkling N, Heussner S, Nicolay C, Bayer S, Mericske-Stern R, Utz K-H. Tactile sensibility of single-tooth implants and natural teeth under local anesthesia of the natural antagonistic teeth. Clin Implant DentRelat Res 2012;14(2):273-280.
In 32 subjects with single implants and natural opposing teeth, the natural antagonistic tooth and
corresponding natural contralateral tooth were anesthetized. Copper foils were then placed between the
opposing teeth to investigate tactile sensibility. Average tactile sensibility at implants was 20 ± 11 μm atthe
50% value, compared to 16 ± 9 μm at natural teeth. Average tactile sensibility at the support area was 77±
89 μm and 48.4 ± 93 μm for implants and teeth, respectively. For the 50% value, equivalent tactile sensibility for teeth and implants was found, suggesting that active tactile sensibility at implants may partlybe attributed to a perception over the implant itself.
Vandeweghe S, Ackermann A, Bronner J, Hattingh A, Tschakaloff A, De Bruyn H. A retrospectivemulticenter study on a de novo wide-body implant for posterior regions. Clin Implant Dent Relat Res2012;14(2):281-
A total of 93 wide body implants were placed 75 patients; 29 implants were immediately loaded and 64were delayed loaded. For a mean follow-up time of 14 months, the implant survival rate was 95.7%(implant survival 89.7% and 98.4% for immediately and delayed loaded implants, respectively) and themean 1-year bone loss was 0.46 ± 1.08 mm. A high survival rate and stable bone conditions were thereforeobserved after
D’haese J, Van De Velde T, Elaut L, De Bruyn H. A prospective study on the accuracy ofmucosally supported stereolithographic surgical guides in fully edentulous maxillae. Clin Implant DentRelat Res
Locations, axes and inter-implant distances of 78 planned and actually placed implants were evaluated in13 patients. Mean deviation at the entrance point was 0.91 ± 0.44 mm and mean deviation at the apicalpoint was 1.13 ± 0.52 mm. Mean angle deviation was 2.60° ± 1.61° and the mean deviation of inter-implant distance was 0.18 ± 0.15 mm and 0.33 ± 0.28 mm at the coronal and apical points, respectively.Angular and linear deviations are therefore to be expected, and deviations are significantly lower with shortcompared to long implants.
Gahlert M, Roehling S, Sprecher CM, Kniha H, Milz S, Bormann K. In vivo performance of zirconiaand
titanium implants: a histomorphometric study in mini pig maxillae. Clin Oral Implants Res2012;23(3):281-
Zirconia implants with an acid-etched surface were placed 6 months after extraction of the incisors and canines in 18 pigs; titanium implants with the same shape and an SLA surface were placed as controls.Peri- implant bone density for zirconia and titanium implants was 60.4 ± 9.9% and 61.1 ± 6.2%, respectivelyafter 4 weeks, 65.4 ±13.8% and 63.6 ± 6.8%, respectively, after 8 weeks, and 63.3 ± 21.5% and 68.2± 5.8%, respectively, after 12 weeks. Mean BIC ranged from 67.1 ± 21.1% to 70 ± 14.5% for zirconiaimplants and from 64.7 ± 9.4% to 83.7 ± 10.3% for titanium implants. No significant differences were foundbetween the implant types.
Of 170 zirconia implants in 79 patients, 13 fractured implants (after a mean in situ period of 36.75months)
were prepared for failure analysis; 12 of the implants had a diameter of 3.25 mm and one had a diameterof
4 mm. All fractured implants were in the anterior region. Mechanical overloading appeared to be the cause of failure in all the fractured implants. Due to the fracture rate, the authors did not recommend reduceddiameter zirconia implants for clinical use; the ceramic material and implant geometry should first be improved.
Almaguer-Flores A, Olivares-Navarette R, Wieland M, Ximénez-Fyvie LA, Schwartz Z, Boyan BD. Influenceof topography and hydrophilicity on initial oral biofilm formation and titanium surfaces in vitro. Clin Oral Implants Res 2012;23(3):301-307.
Nine oral bacterial species were assessed on titanium disks with five surfaces: pretreatment (PT);acid-
etched (A); hydrophilic acid-etched (modA); sandblasted and acid-etched (SLA); and hydrophilic SLA (modSLA). The disks were incubated for 24 h in normal culture medium or human saliva. Disks incubated in culture medium showed higher counts of bacteria on all surfaces, but bacterial adhesion wassignificantly increased in human saliva for SLA and modSLA surfaces. The proportion of species such as A
actinomycetemcomitans and S sanguinis was also increased on SLA and modSLA in both media.Initial biofilm formation and composition were therefore influenced by topography and hydrophilicity of thesurface.
Mihatovic I, Becker J, Golubovic V, Hegewald A, Schwarz F. Influence of two barrier membranes onstaged bone regeneration and osseointegration of titanium implants in dogs. Part 2: augmentation usingbone graft substitutes. Clin Oral Implants Res 2012;23(3):308-315.
Defects were prepared in the mandibles of six dogs and treated using natural bone mineral or biphasic calcium phosphate (Straumann BoneCeramic) and covered with a PEG (MembraGel) or a collagen membrane. Implants were placed after 8 weeks, and histomorphometric analyses were carried out at 8 +2
weeks. Mean mineralized tissue and BIC were higher in the PEG groups compared to the collagen membrane groups, but the differences were not significant. All augmentation procedures thereforesupported bone regeneration and osseointegration of implants.
Roccuzzo M, Bonino F, Aglietta M, Dalmasso P. Ten-year results of a three arms prospective cohort studyon implants in periodontally compromised patients. Part 2: clinical results. Clin Oral Implants Res
Implants were placed after initial periodontal therapy in 112 partially edentulous patients who were periodontally healthy, periodontally compromised or severely periodontally compromised. Patients were also asked to follow a supportive periodontal therapy program. Clinical measurements were performed after 10 years in 101 patients. Eighteen implants were removed due to biological complications, and antibioticand/or surgical therapy was performed in 10.7% of periodontally healthy, 27% of periodontallycompromised and
47.2% of severely periodontally compromised cases; the differences were significant. The percentageof
implants with probing depth ≥ 6 mm was 1.7%, 15.9% and 27.2% in periodontally healthy,periodontally
compromised and severely periodontally compromised cases, respectively; the differences weresignificant. Patients with a history of periodontitis therefore had a higher number of sites requiringadditional treatment and should be informed that they are at a greater risk for peri-implant disease.
Behneke A, Burwinkel M, Behneke N. Factors influencing transfer accuracy of cone beam CT-derived template-based implant placement. Clin Oral Implants Res 2012;23(4):416-423.
A total of 132 implants were placed in 52 patients following cone-beam CT diagnostics and tooth-borne
templates. Deviations between virtually planned and placed implants were measured. Transfer accuracywas found to be similar between the maxilla and mandible and between flapless and open flap approaches. Discrepancies were greater with reduced residual dentition compared to single-tooth gaps, but there were no differences between free ending templates in shortened arches and bilateral anchored templates in interrupted arches.
Ritter L, Reiz SD, Rothamel D, Dreiseidler T, Karapetian V, Scheer M, Zöller JE. Registration accuracyof three-dimensional surface and cone beam computed tomography data for virtual implant planning. ClinOral Implants Res 2012;23(4):447-452.
For 16 patients scheduled for implant planning, cone-beam CT and 3D surface data were registered and the
discrepancy measured. All data pairs were successfully matched, with mean distances from 0.03 ± 0.33mm to 0.14 ± 0.18 mm between CBCT and 3D surface data. Significant correlations between the measurederror and the presence and type of restorations were found at two of the seven measuring points,and no significant registration errors were noted between maxillae and mandibles.
Krennmair G, Sütö D, Seemann R, Piehslinger E. Removable four implant-supported mandibularoverdentures rigidly retained with telescopic crowns or milled bars: a 3-year prospective study. ClinOral Implants Res 2012;23(4):481-488.
Each of 51 edentulous patients received four implants to support maxillary overdentures with eithermilled
bars (26 patients) or double telescopic crowns (25 patients). After 3 years, 45 patients were availablefor evaluation; the implant survival and success rates were both 100%. No differences in peri-implant marginal bone resorption, bleeding index or gingival index were noted between the groups, but the plaque andcalculus indices were significantly higher for the bar group. Prosthodontic maintenance was similarbetween the groups, but bar retention showed benefits for prosthodontics adaptation for handlingmechanism.
Elsyad MA, Al-Mahdy YF, Fouad MM. Marginal bone loss adjacent to conventional and immediate loadedtwo implants supporting a ball-retained mandibular overdenture: a 3-year randomized clinical trial. Clin Oral Implants Res 2012;23(4):496-503.
Each of 36 patients received two implants loaded with mandibular overdentures retained by ballattachments
either immediately or after 3 months. Significant vertical bone loss at the distal and labial sides was notedin the immediate loading group after 3 years, but there were no significant differences for horizontal boneloss. The immediate loading group also showed higher probing depth values, but there were no significant differences in plaque scores, gingival scores or Periotest values. The clinical outcomes were notsignificantly different between the two groups.
Kämmerer PW; Gabriel M, Al-Nawas B, Scholz T, Kirchmaier CM, Klein MO. Early implant healing:promotion of platelet activation and cytokine release by topographical, chemical and biomimetical titaniumsurface modifications in vitro. Clin Oral Implants Res 2012;23(4):504-510.
On titanium disks with five surfaces (pretreatment (PT), acid-etched (A), hydrophilic acid-etched(modA), sandblasted and acid-etched (SLA), and hydrophilic SLA (modSLA)), and also on PT, A and SLAsurfaces with RGD peptides (PT-RGD, A-RGD and SLA-RGD), platelet concentrate was incubated for 15and 30 mins.
Platelet count was strongly decreased on SLA after 15 mins, and VEGF and PDGF levels were increased; after 30 mins, high VEGF and PDGF levels and high platelet consumption were observed on modA, PT-RGD and A-RGD surfaces. The surface modifications therefore had a delayed effect on platelet activation.
European Journal of OralImplantology
Grandi T, Guazzi P, Samarani R, Garuti G. Immediate positioning of definitive abutments versusrepeated abutment replacements in immediately loaded implants: effects on bone healing at the 1-yearfollow-up of a
multicentre randomised controlled trial. Eur J Oral Implantol 2012;5(1):9-16.
In each of 28 partially edentulous patients, two implants were placed to support an immediate restorationwith either platform-switched provisional or platform-switched definitive abutments. All implants weredefinitively restored after 3 months. Peri-implant bone resorption was 0.359 mm and 0.065 mm in theprovisional and definitive abutment groups, respectively, after 3 months and 0.435 mm and 0.094 mm,respectively, after 1 year. Non-removal of abutments therefore significantly reduced bone resorption around immediately restored implants.
Esposito M, Cannizzaro G, Soardi E, Pistilli R, Piattelli M, Corvino V, Felice P. Posterior atrophic jawsrehabilitated with prostheses supported by 6 mm-long, 4 mm-wide implants or by longer implants inaugmented bone. Preliminary results from a pilot randomised controlled trial. Eur J Oral Implantol
One to three 4 mm wide implants, either 6 mm or 10 mm long, were placed in 40 patients withatrophic maxillae (20 patients) or mandibles (20 patients). The 10 mm implants were placedsimultaneously with augmentation in maxillae and 3 months after augmentation in mandibles. Definitiveprostheses were placed after 4 months. No significant differences in graft, implant or prosthesis failureswere observed, but there were significantly more complications at grafted sites (14 versus none at short implant sites). All patients with mandibular implants and 15/20 patients with maxillary implants preferredshort implants; the remaining five patients indicated that both procedures were equally acceptable. Shortimplants may therefore an alternative to some bone augmentation procedures.
Maló P, Nobre MdeA, Lopes A, Francischone C, Rogolizzo M. Three-year outcome of a retrospectivecohort study on the rehabilitation of completely edentulous atrophic maxillae with immediately loaded extra-maxillary zygomatic implants. Eur J Oral Implantol 2012;5(1):37-46.
A total of 39 patients with 39 fixed prostheses on 169 implants (92 zygomatic and 77 regular) in atrophied edentulous maxillae were retrospectively evaluated; prostheses were placed on the day of surgery. After 3 years, five patients had dropped out and one patient had died; no prostheses or implants were lost in the remaining patients, but six complications occurred. Immediately loaded zygomatic implants are therefore a viable treatment option in the atrophic maxilla.
Cannizzaro G, Felice P, Giorgi A, Lazzarini M, Ferri V, Leone M, Esposito M. Immediate loading of 2 (all-on-2) flapless-placed mandibular implants supporting cross-arch fixed prostheses: interim data from a 1-year follow-up prospective single cohort study. Eur J Oral Implantol 2012;5(1):49-58.
Two implants were planned to be placed and immediately restored in the edentulous mandibles of 80 patients in a flapless procedure. In seven patients, 12 implants did not reach the desired insertion torque; four were replaced by larger diameter implants, and the remainder were immediately loaded anyway. There were two early implant failures, which were successfully replaced. After 1 month, 90% of patients werecompletely satisfied with the therapy. Mean marginal bone loss after 1 year was 0.3 mm, and the meanISQ value decreased from 75.4 to 72.4. Immediately loaded mandibular cross-arch prostheses cantherefore be supported by two implants.
Grandi T, Guazzi P, Samarani R, Garuti G, Grandi G. Immediate loading of two unsplinted implants retaining the existing complete mandibular denture in elderly edentulous patients: 1-year results from amulticentre prospective cohort study. Eur J Oral Implantol 2012;5(1):61-68.
Mandibular complete dentures in 42 patients were stabilized with two implants placed mesial to the canine position bilaterally, attached to the denture using ball abutments. All implant survived at 12 months, and the mean bone resorption was 0.203 mm after 6 months and 0.298 mm after 12 months. Majorprosthetic
complications were noted in three cases, and minor extra maintenance appointments were required for five patients. Immediate loading of two unsplinted implants with existing complete dentures may therefore be a viable treatment option.
Gillot L, Cannas B, Buti J, Noharet R. A retrospective cohort study of 113 patients rehabilitatedwith immediately loaded maxillary cross-arch fixed dental prostheses in combination with immediateimplant placement. Eur J Oral Implantol 2012;5(1):71-79.
Four to eight implants were placed in healed sites (323 implants) or extraction sockets (352 implants) in113 patients and immediately loaded; definitive fixed prostheses were placed after 6 months. Implantsurvival after 6 months was 99.1% (six implants were lost, five in extraction sockets and one in a healed site). Provisional prostheses were fractured in 10 patients. There was no significant difference betweenimplants placed in healed sites or extraction sockets.
Shibuya Y, Takeuchi Y, Asai T, Takeuchi J, Suzuki H, Komori T. Maxillary sinus floor elevation combinedwith
a vertical onlay graft. Implant Dent 2012;21(2):91-96.
Maxillary sinus elevation with vertical onlay graft was performed in nine patients (11 sinuses). Meanminimum alveolar bone thickness was improved from 1.8 mm to 15.2&am