Clinical Implant Dentistry and Related Research
Stoker GT, Wismeijer D. Immediate loading of two implants with a mandibular implant-retained overdenture:
a new treatment protocol. Clin Implant Dent Relat Res 2011;13(4):255-261.
Immediate loading of two bar-splinted SLActive implants with a mandibular overdenture (converted from a conventional denture) was performed in 124 edentulous patients. Resonance frequency analysis (RFA) was performed during the evaluation period to assess implant stability. For an evaluation period of 12-40 months, theimplant survival rate was 98.8%; three implants were lost. A significant increase in implant stability was observedduring the osseointegration period. Mandibular overdenture relining was necessary in 3% of patients, while 11% ofpatients required relining of the opposite maxillary denture. Loading of SLActive implants with a mandibularoverdenture on the day of implant placement can therefore be successful.
Nissan J, Ghelfan O, Mardinger O, Calderon S, Chaushu G. Efficacy of cancellous block allograft augmentationprior to implant placement in the posterior atrophic mandible. Clin Implant Dent Relat Res
A total of 21 patients with a bony deficiency of at least 3 mm received 29 cancellous allogeneic block grafts;
85 implants were placed after 6 months of healing. After a mean follow-up of 37 months, mean bone block survival was 79.3% and implant survival was 95.3%. Mean bone gains were 5.6 mm horizontally and 4.3 mm vertically. Atimplant placement, mean bone thickness buccal to the implant neck was 2.5 mm, reducing slightly to 2.3 mmat second-stage surgery. No vertical bone loss was apparent between implant placement
and second-stage surgery. Implant placement following cancellous block allograft was therefore considered to be asuitable treatment.
Cosyn J, Van Aelst L, Collaert B, Persson GR, De Bruyn H. The peri-implant sulcus compared with internalimplant and suprastructure components: a microbiological analysis. Clin Implant Dent Relat Res
A total of 58 implants placed in the maxillae of eight patients and loaded with screw-retained full-arch prostheseswere examined after a mean 9.6 years of loading. Microbiological analysis was performed on gingival fluidsamples collected from the peri-implant sulcus, the cotton pellets in the intra-coronal compartment and theabutment screws. Bacterial frequencies and levels were similar between the cotton pellets and the peri-implantsulcus, despite no microbial link between the compartments. However, frequencies and levels were lower for theabutment screws. A high prevalence of numerous species was observed in the peri-implant sulcus, despite noclinical signs of peri-implantitis. The results indicated that the restorative margin was possibly the main pathway forbacterial leakage.
Calandriello R, Tomatis M. Immediate occlusal loading of single lower molars using Brånemark System WidePlatform TiUnite implants: a 5-year follow-up report of a prospective clinical multicenter study. Clin Implant DentRelat Res 2011;13(4):311-318.
A total of 33 patients consecutively treated with 40 implants to replace single mandibular molars and
monitored for up to 5 years were evaluated. All implants were immediately loaded in full occlusion at the time ofsurgery. The cumulative implant success rate was 95.0% (two implants failed) and marginal bone loss was
-1.17 ± 0.90 mm after 5 years. The results indicated that the use of immediately loaded single molar implants wassuitable.
Lee D-H, Choi B-H, Jeong S-M, Xuan F, Kim H-R. Effects of flapless implant surgery on soft tissue profiles: aprospective clinical study. Clin Implant Dent Relat Res 2011;13(4):324-329.
A flapless implant procedure was used to place 76 implants in 44 patients. Marginal peri-implant soft tissue levelwas measured at 1 week, 1 month and 4 months. The results indicated a mean 0.7 ± 0.3 mm of coronal
soft tissue growth 1 week after surgery, with levels of 0.2 ± 0.2 mm and 0.0 ± 0.3 mm after 1 and 4 months. After4 months, soft tissue profiles were similar to those immediately before implant placement. Flapless implantsurgery can therefore help to maintain the mucosal form around implants.
Clinical Oral Implants Research
study in humans. Clin Oral Implants Res 2011;22(11):1214-1220.
In 31 patients with signs of peri-implantitis, a surgical procedure based on pocket elimination was performed, withbone contouring and plaque control before and after surgery. Bone loss at implants was recorded at surgery. After 2years, no signs of peri-implant disease were observed in 48% of subjects, while 77% had no implants with aprobing depth ≥ 6 mm associated with bleeding or suppuration. Of 86 implants with an initial diagnosis of peri-implantitis, 42% still showed peri-implant disease after treatment. Peri-implant health was more prevalent atimplants with minor initial bone loss (2-4 mm) than those with ≥ 5 mm bone loss, and of 18 implants with ≥ 7 mmbone loss, seven were extracted. The surgical therapy was therefore effective in the majority of subjects, butcomplete resolution appeared to be dependent on the initial bone loss.
Hatano N, Yamaguchi M, Yaita T, Ishibashi T, Sennerby L. New approach for immediate prostheticrehabilitation of the edentulous mandible with three implants: a retrospective study. Clin Oral Implants Res
A retrospective analysis was performed in 132 patients who received 396 implants with both machined and oxidized surfaces over an 11-year period. All implants were immediately loaded with a permanent acrylic bridge.The mean follow-up time was 5 years. The implant survival rate was 96.7% for implants and 92.4% for bridges; allimplant failures occurred within the first 12 months, and the failure rate was greater for machined surface implants(7% versus 1.2% for oxidized implants). Immediate loading of a fixed bridge on three implants in the mandible is therefore a viable treatment option.
Three groups of ball abutments (69 in total) that were in use for a mean of 12.3, 39 or 95.6 months (groups A, B andC, respectively) in 35 patients were analyzed versus a control group of 10 unused ball abutments. The diameters ofthe abutments in all three groups were significantly different from those in the control group. Diameters andvariations in circularity were not significantly different between abutments in groups B and C. The maximumreduction in diameter was 30 μm, and 90% diameter loss due to wear at the equator was observed in group B.Clinical wear therefore significantly reduced ball abutment diameter, and the maximum wear was found after 3years.
den Hartog L, Meijer HJA, Stegenga B, Tymstra N, Vissink A, Raghoebar GM. Single implants with different neckdesigns in the aesthetic zone: a randomized clinical trial. Clin Oral Implants Res 2011;22(11):1289-
Missing maxillary anterior teeth in 93 patients were replaced using implants with a 1.5 mm smooth neck, moderately rough neck with grooves, or a scalloped moderately rough neck with grooves. The implants were loadedafter 3 months and evaluated 6 and 18 months after placement. Significantly greater bone loss was observed inthe scalloped group (2.01 ± 0.77 mm) compared to the other two groups (1.19 ± 0.82 mm and
0.9 ± 0.57 mm for the smooth and rough groups, respectively), and significantly greater pocket depths and higherbleeding scores were also observed for the scalloped group. No differences were found for soft tissue levelsbetween the groups. Implant survival rates were 100% for the rough and scalloped implants and 97% for thesmooth implants. The scalloped implants therefore showed more marginal bone loss and less favorable clinicaloutcomes.
Degidi M, Nardi D, Piattelli A. One abutment at a time: non-removal of an immediate abutment and its effect onbone healing around subcrestal tapered implants. Clin Oral Implants Res 2011;22(11):1303-1307.
Two 3.5 mm diameter tapered implants were placed in each of 24 patients with partial posterior mandibular edentulism and immediately restored with a temporary restoration out of occlusion. After 24 weeks, abutments were removed and impressions taken on the implant platform (control; 12 patients) or impressions
were made of the abutments using snap-on copies (test; 12 patients). Final restorations were placed after 6 months, and bone changes were observed after surgery and at 6, 12, 24 and 36 months. No differences in verticalbone healing were observed between the two groups, but there was a small, significant horizontal bone loss in thehard tissue portion over the implant platform between 6 and 12 months in the control group. Non-removal of theimmediate abutments therefore reduced horizontal bone remodeling.
Ekfeldt A, Fürst B, Carlsson GE. Zirconia abutments for single-tooth implant restorations: a retrospective andclinical follow-up study. Clin Oral Implants Res 2011;22(11):1308-1314.
A retrospective evaluation of 185 implants with zirconia abutments in 130 patients was carried out, followed by aclinical examination of 40 restorations with zirconia abutments in place for > 3 years in 25 patients. Restorations were either cemented all-ceramic crowns or screw-retained one-piece restorations. Technical andbiological complications were low in both evaluations, and no fractures of all-ceramic crowns were observed. In theclinical examination, no significant differences were observed for soft tissue registrations or marginal bone levelbetween two-piece and one-piece restorations. Good results were therefore obtained for zirconia abutments forsingle implant crowns.
Vere J, Joshi R. Quality assessment of randomised controlled trials of dental implant surgery andprosthodontics published from 2004 to 2008: a systematic review. Clin Oral Implants Res
From an initial Medline search of randomized controlled trials of treatment interventions of implant surgery andprosthodontics, a total of 38 met the inclusion criteria. Outcome assessment was blinded in 12 trials (31%),randomization was adequate in 16 trials (42%) and allocation concealment was adequate in seven trials (18%).Only two trials (5%) reported confidence intervals, and a total of 17 different statistical assessments were used inthe 38 trials, although inferential statistical analysis was considered appropriate in only 22 trials (57%). Randomizedtrials in implant surgery and prosthodontics in the time frame examined are therefore poorly reported and provide littleunbiased evidence to support clinical decisions.
Mertens C, Steveling HG. Early and immediate loading of titanium implants with fluoride-modified surfaces:
results of 5-year prospective study. Clin Oral Implants Res 2011;22(12):1354-1360.
A total of 49 implants were placed in the maxillae and mandibles of 17 patients and loaded either immediately orafter a mean of 9.56 weeks. Full follow-up after 5 years was possible in 15 patients with 42 implants. The implantsurvival rate was 97% (one implant failure), while the mean bone loss was 0.1 ± 0.4 mm, with no significantdifference between implants loaded immediately or after a mean of 9.56 weeks. Healthy peri- implant softtissue was observed in the majority of cases, with plaque in 6.2% of cases and signs of inflammation in 4.2% ofcases. High success and survival reates were therefore observed after 5 years.
Vilhjálmsson V, Klock KS, Størksen K, Bårdsen A. Aesthetics of implant-supported single anterior maxillary
c r owns evaluated by obj ec tive indic es and par tic ipants ’ per c eptions . Clin Oral Implants Res
This study evaluated 50 subjects with implant-supported crowns to replace upper anterior teeth. Evaluation wasperformed using the pink esthetic score (PES), implant crown esthetics index (ICAI), modified ICAI and theCalifornian Dental Association (CDA) index. Satisfaction with crowns and adjacent soft tissue were rated by theparticipants. Crown form, color and adjacent mucosa were satisfactory for 88%, 84% and 72% of participants, respectively. There was a significant correlation between PES and ICAI and modified ICAI, and there was asignificant correlation between the modified ICAI and satisfaction with crown form and color, and between the sumof participants’ responses to questions about crown form and color and adjacent mucosa form and color. Goodaesthetic outcomes were therefore obtained.
Calvo-Guirado JL, Gómez-Moreno G, López-Mari L, Guardia J, Negri B, Martínez-González JM. Crestal bone loss evaluation in Osseotite expanded platform implants: a 5-year study. Clin Oral Implants Res
A total of 64 platform-switched implants were placed in fresh extraction sockets in the maxillae of 64 patients, withimmediate provisional restorations and final screwed restorations after 15 days. Primary stability was recorded, and mesial and distal bone heights were measured after 1, 3 6, 9, 12, 24 and 36 and 60 months. Mean mesial anddistal bone loss was 0.08 ± 0.42 mm and 0.14 ± 0.56 mm, and the mean implant stability, as measured byresonance frequency analysis, was 72.5 ± 3.1. The overall survival rate was 97.1%.
Rismanchian M, Fazel A, Rakhshan V, Eblaghian G. One-year clinical and radiographic assessment of fluoride-enhanced implants on immediate non-functional loading in posterior maxilla and mandible: a pilot prospectiveclinical series study. Clin Oral Implants Res 2011;22(12):1440-1445.
Implants were placed in the posterior maxillae and mandibles of 10 patients. Temporary prostheses were placedout of occlusion and replaced with permanent prostheses after 13 weeks. Implant stability and clinical andradiographic evaluations were performed at placement and after 3, 6 and 12 months. All implants survived andthere was no significant change in plaque or bleeding indices or pocket probing depth over time; however, there wasa significant increase in implant stability between implant placement and 1 year. Mean crestal bone loss was 0.4 ±0.55 mm, 0.48 ± 0.37 mm and 0.48 ± 0.21 mm at 3, 6 and 12 months, respectively; the change was not significant.
European Journal of Oral Implantology
Cannizzaro G, Felice P, Leone M, Checci V, Esposito M. Flapless versus open flap implant surgery in partiallyedentulous patients subjected to immediate loading: 1-year results from a split-mouth randomised controlled
trial. Eur J Oral Implantol 2011;4(3):177-188.
Implants were placed in a split-mouth design in 40 patients either with or without flap elevation (67 and 76 implants, respectively). Single crowns or metal-ceramic FPDs were placed after 2 months. Four flaps were raisedin the flapless group to control bur direction, and one hemorrhage and one buccal bone fracture occurred in the raised flap group. Primary stability was not reached for four implants, which were immediately replaced by implants with a larger diameter. There were two implant failures in each group, and no differences incomplications, ISQ values, marginal bone levels or prosthetic failures between the groups; however, operation time was significantly lower in the flapless group, and the procedure was associated with less pain, swelling andanalgesic consumption, and was the procedure preferred by patients.
Felice P, Soardi E, Pellegrino G, Pistilli R, Marchetti C, Gessaroli M, Esposito M. Treatment of the atrophicedentulous maxilla: short implants versus bone augmentation for placing longer implants. Five months post-loading results of a pilot randomised controlled trial. Eur J Oral Implantol 2011;4(3):191-202.
Each of 28 patients with atrophic edentulous maxillae received either 4-8 short implants (15 patients) or autogenousbone grafting for the placement of 11.5 mm implants (13 patients). Acrylic prostheses or bar- retainedoverdentures were placed after 4 months, and patients were followed up for 5 months after loading. One sinus liftprocedure failed, although short implants could still be placed. Two implant failures occurred in the short implantgroup and one occurred in the augmented group. Complications were significantly greater in the augmented group(eight in five patients, compared to no complications in the short implants group). All patients were satisfied withtreatment, but short implants may be a cheaper and faster alternative to longer implants in augmented bone.
Cannizzaro G, Felice P, Soardi E, Ferri V, Leone M, Esposito M. Immediate loading of 2 (all-on-2) versus 4 (all-on-4) implants placed with a flapless technique supporting mandibular cross-arch fixed prostheses: preliminaryresults from a pilot randomised controlled trial. Eur J Oral Implantol 2011;4(3):205-217.
Either two or four implants were placed in 60 patients (30 patients in each group), and complications and implantand prosthesis failures were recorded. There were no implant failures or drop-outs after 4 months. Fourbiomechanical complications occurred in the all-on-four group compared to one in the all-on-two group; thedifference was not significant. Two implants can therefore successfully be used to support immediately loadedmandibular cross-arch FPDs.
Maló P, Nobre M de A, Lopes A. The rehabilitation of completely edentulous maxillae with different degrees ofresorption with four or more immediately loaded implants: a 5-year retrospective study and a new classification.Eur J Oral Implantol 2011;4(3):227-243.
A total of 995 implants were placed in 221 patients with edentulous maxillae where bone was available to the firstmolar (group 1), second premolar (group 2), first premolar (group 3) or canine (group 4). After 5 years, there wereeighteen patient drop-outs and three prostheses lost due to implant failure, giving a prosthesis survival rate of98.6%. The implant survival rate was 88.7% at the patient level (41 implants lost in 25 patients) and 95.8%at the implant level. Patient-specific survival per group was 78.6%, 89.3%, 92.4% and
91.7% for groups 1, 2, 3 and 4, respectively. There were 129 biological complications (129 implants) in 66 patients (30%) and 170 mechanical complications (170 implants) in 71 patients (38%). Smoking and bruxism
were identified as risk factors for biological and mechanical complications, respectively. Rehabilitation of the edentulous maxilla with four or more implants is therefore a viable treatment option.
Gillot L, Noharet R, Buti J, Cannas B. A retrospective cohort study of 105 patients rehabilitated withimmediately loaded mandibular cross-arch bridges in combination with immediate implant placement. Eur J OralImplantol 2011;4(3):247-253.
In the mandibles of 105 patients, the remaining teeth were extracted and four to six implants were placed
(448 in total) in healed sites (266 implants) or fresh extraction sockets (182 implants). Provisional prostheses wereimmediately loaded and the patients followed up after 4 months, when definitive fixed prostheses were placed. Theimplant survival rate after 4 months was 98.2%; eight implants were lost in eight patients, four each in healed andextraction sites. There was no significant difference between the groups. High implant and prosthetic survivalrates were therefore obtained with immediate implant placement and loading.
Hansen EJ, Schou S, Harder F, Hjorting-Hansen E. Outcome of implant therapy involving localised lateralalveolar ridge and/or sinus floor augmentation: a clinical and radiographic retrospective 1-year study. Eur J OralImplantol 2011;4(3):257-267.
In 47 consecutively treated patients, 82 regions were augmented and 151 implants were placed
approximately 6.5 months after grafting. Block or particulate grafts (16% and 30%), or a combination of both (54%),were used. Most grafted areas were covered by an e-PTFE membrane (71%) or a resorbable collagen membrane(13%). Complications were noted in eight patients after bone harvesting, and membrane exposure occurred only withe-PTFE membranes. Prosthesis survival was 99% and implant survival in sinus lift, lateral augmentation andcombined sinus lift/lateral augmentation was 91%, 97% and 100%, respectively, with mean peri-implant bone loss of0.60 mm, 0.31 mm and 0.41 mm, respectively. There were no instances of technical complications.
Engelke W, Deccó EA, Cura AC, Ruscio ML. Immediate loading of freestanding implants using cortical
satellite implants: 3-year results of an ongoing prospective study. Implant Dent 2011;20(5):341-344.
Each of 20 patients received two free-standing implants that were stabilized during healing using cortical satellite implants. The implants were immediately loaded with ball-attached mandibular overdentures and the cortical satellite implants were removed after 3 months. After 3 years, implant survival was 100%, and the mean Periotest,bone resorption and pocket probing depth values were -5.89, 0.51 mm and 2.60 mm, respectively. Immediateloading of free-standing implants stabilized by satellite implants can therefore be successful.
Sohn D-S, Heo J-U, Kwak D-H, Kim D-E, Kim J-M, Moon J-W, Lee J-H, Park I-S. Bone regeneration in themaxillary sinus using an autologous fibrin-rich block with concentrated growth factors alone. Implant Dent
Sixty-one sinus grafts were performed using the lateral window approach, and following sinus membrane elevation a total of 113 implants were placed simultaneously with fibrin-rich blocks containing concentrated growthfactors. The bony window was then replaced and sinus augmentation was verified. New bone was observed alongall the implants by radiography and cone-beam computed tomography. After a mean of 10 months, the implant success rate was 98.2% and there were no significant post-operative complications. The use of fibrin-rich blocksmay therefore be