Long-Term Bone Stability around 312 Rough-Surfaced Immediately Placed Implants with 2-12-Year Follow-Up

A pattern of peri-implantitis affecting middle implants in 3-implant splinted prostheses

BACKGROUND

Previous investigators have noted an increased risk of crestal bone loss and failure of the middle implant of 3-implant-splinted (3-IS) fixed dental prostheses (FDPs). Possible causes have included ill-fitting prostheses, unhygienic prosthetic contours, and discrepancies in prosthetic platform heights.

METHODS & RESULTS

We identified four cases in which the middle implant of a 3-IS multiunit FDP suffered advanced bone loss, ultimately leading to implant removal. While more than one possible risk for implant failure existed in each case, a common thread was that the prosthetic platform of the middle implant for all patients was coronally positioned relative to the corresponding mesial and/or distal implants.

CONCLUSIONS

Splinting three adjacent implants into one prosthesis may add risk for a variety of reasons possibly including small differences in the heights of the three prosthetic tables.

KEY POINTS

Why are these cases new information? Our observations suggest that discrepancies between implant prosthetic platforms supporting 3-implant splinted, multiunit FDPs may be an added risk factor for middle implant failure. What are the keys to successful management of these cases? It is possible that small differences in apico-coronal implant positioning with 3-implant splinted multiunit FDPs may affect the success of the middle implants. What are the primary limitations to success in these cases? There is limited literature involving precise protocols and long-term outcomes of 3-implant splinted implant restorations. Studies comparing 3-implant splinted FDPs to other configurations are needed.

A comparison of marginal bone loss, survival rate, and prosthetic complications in implant-supported splinted and nonsplinted restorations: A systematic review and meta-analysis

Aim

To compare marginal bone loss (MBL), implant survival rate and prosthetic complications of implant-supported splinted and non-splinted restorations (NSR).

Settings and Design

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines (PRISMA). The PROSPERO registry, which keeps track of prospective systematic reviews, also received this paper (CRD42021229477).

Material and Methods

An electronic search was done in PubMed, the Cochrane Central Trials Register, Scopus, Science Direct, and Google Scholar searches were carried out. The search was limited to articles published in English and covered the period from January 2010 to August 2020.

Statistical Analysis Used

To conduct the meta analysis, researchers employed methodologies such as continuous measurement and odds ratios.

Results

For both qualitative and quantitative analysis, 19 scientific studies were chosen. 3682 implants were placed in 2099 patients with a mean age of 59 years (splinted, 2529; non-splinted, 1153); the mean age was not provided in 5 trials. For splinted restorations, there were statistically significant differences in MBL, indicating the former has less MBL than for NSR. Splinted restorations had much greater survival rates than NSR, according to a qualitative study. Rest prosthesis complications with or without splinting were essentially the same.

Conclusions

Splinted implant restorations lost less bone than non-splinted implant restorations, according to this meta analysis. This was particularly true for posterior restorations. Lower implant failure was associated with splinted restorations. Restorations with and without splinting had the same level of prosthetic problems.

Evaluation of the relationship between Periotest values, marginal bone loss, and stability of single dental implants: A 3-year prospective study

STATEMENT OF PROBLEM

Although the Periotest has been shown to provide reliable information about initial implant stability, whether Periotest values (PTVs) can be correlated with the stability of implants in function for several years is unclear.

PURPOSE

The purpose of this prospective clinical study was to investigate implant stability by using PTVs, as well as changes in stability and peri-implant marginal bone levels (as measured by radiographs) over a 3-year follow-up period. The exploratory hypothesis was that there is a significant correlation between PTVs and bone loss around the implant and that PTVs can provide predictive information about marginal bone-level changes and implant stability over time.

MATERIAL AND METHODS

The study population included patients who needed single-tooth replacement with restoration of cemented fixed partial dentures. Clinical data, PTVs, and periapical radiographs were collected at the time points of implant placement, 3 to 6 months after insertion, and 1 year, 2 years, and 3 years after the final definitive prosthetic restoration. Pearson correlation coefficient tests were performed to estimate the correlation between the PTVs received at the first follow-up time point and the subsequent PTVs received during the follow-up period (up to 3 years after the restoration). The Pearson test was applied, as well as the t test and repeated-measures ANOVA, to evaluate PTVs and bone loss changes over time. The Pearson test was also applied to estimate the correlation between the bone loss values measured at the first follow-up visit and the subsequent bone loss values at the annual follow-up time points (up to and including 3 years after the restoration).

RESULTS

A total of 43 implants were inserted in 34 patients (26 men and 8 women); the average patient age was 52.8 years. A significant reduction in implant stability was detected between implant insertion and the 3- to 6-month follow-up time point, which was then followed by a significant increase in stability at the 1-year follow-up time point and then stabilized during the 2- and 3-year follow-up time points (P<.014). Furthermore, a significant correlation was found between PTVs at the 1-year follow-up and the PTVs at all measured follow-up time points (P<.05). A positive correlation was obtained with high-strength correlation coefficient R (R>0.7) at all follow-up time points. Bone loss changes during the follow-up time points were significantly different and correlated with PTVs (P<.001).

CONCLUSIONS

The Periotest is a reliable device for assessing implant stability and providing predictive information about marginal bone level changes around an implant.

Effect of Implant-Abutment Connection Type on Bone Around Dental Implants in Long-Term Observation: Internal Cone Versus Internal Hex

PURPOSE

The purpose of this study was to evaluate the influence of the implant-abutment connection type on the bone level around dental implants in long-term observation and the survival rate for the different types of implant-abutment connections.

MATERIALS AND METHODS

Two groups of implants made of titanium grade 23 alloy and with sandblasted and acid-etched (SLA) surface were included in the study: (a) the internal hex implant-abutment connection group (480 SPI dental implants; Alpha-Bio Tec, Petach Tikwa, Israel, 184 patients) and (b) the internal cone implant-abutment connection group (60 C1 dental implants; MIS Implant Technologies, Shlomi, Israel, 34 patients). Certain inclusion and exclusion criteria were applied. Marginal bone loss (MBL) around the dental implants was measured in intraoral radiographs taken with parallel technique with a film holder and by bite recording index. X-rays were performed at the moment of functional loading, and at 12, 24, 36, and 60 months after loading. The digital analysis was conducted using Dental Studio 2.0 computer software.

RESULTS

Average MBL was significantly lower in the conical connection compared with internal hex group-0.68 ± 0.59 versus 0.99 ± 0.89 mm (12 months), 0.78 ± 0.80 versus 1.12 ± 1.00 mm (24 months), 0.83 ± 0.87 versus 1.22 ± 1.03 mm (36 months), and 0.96 ± 1.02 versus 1.30 ± 1.15 mm (60 months after loading). Both groups of implants achieved a 100% survival rate.

CONCLUSION

The internal cone connection reduced bone resorption compared with the internal hex. Both groups of implants had a 100% survival rate.

Biological and Technical Complications of Splinted or Nonsplinted Dental Implants: A Decision Tree for Selection

PURPOSE

To present an in-depth review on splinting versus nonsplinting the restorations of adjacent dental implants, in addition to discussing biological and technical complications associated with either choice; and to provide the clinician with a decision tree that serves in everyday judgments when it comes to addressing this issue.

MATERIALS AND METHODS

A comprehensive literature review was performed for articles comparing success of splinted versus nonsplinted dental implants.

RESULTS

There is no evidence to suggest that implementing either prosthetic design results in higher implant survival. Both designs tend to have their own set of complications, but there is compelling evidence to suggest that splinted restorations generally have less technical complications.

CONCLUSION

Either splinting or nonsplinting are valid options for restoring adjacent implants, but each tend to face different biological and technical complications. Knowing which patients are more likely to face particular complications is strategic to provide patients with successful restorations.

Should the restoration of adjacent implants be splinted or nonsplinted? A systematic review and meta-analysis

STATEMENT OF PROBLEM

The decision to splint or to restore independently generally occurs during the planning stage, when the advantages and disadvantages of each clinical situation are considered based on the proposed treatment. However, clinical evidence to help clinicians make this decision is lacking.

PURPOSE

The purpose of this systematic review and meta-analysis was to assess the marginal bone loss, implant survival rate, and prosthetic complications of splinted and nonsplinted implant restorations.

MATERIAL AND METHODS

This study was designed according to the Cochrane criteria for elaborating a systematic review and meta-analysis and adopted the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Also, this review was registered at the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42017080162). An electronic search in the PubMed/MEDLINE, Cochrane Library, and Scopus databases was conducted up to November 2017. A specific clinical question was structured according to the population, intervention, comparison, outcome (PICO) approach. The addressed focused question was "Should the restoration of adjacent implants be splinted or nonsplinted?" The meta-analysis was based on the Mantel-Haenszel and inverse variance methods to assess the marginal bone loss, implant survival, and prosthetic complications of splinted and nonsplinted implant restorations.

RESULTS

Nineteen studies were selected for qualitative and quantitative analyses. A total of 4215 implants were placed in 2185 patients (splinted, 2768; nonsplinted, 1447); the mean follow-up was 87.8 months (range=12-264 months). Quantitative analysis found no significant differences between splinted and nonsplinted restorations for marginal bone loss. The assessed studies reported that 75 implants failed (3.4%), of which 24 were splinted (99.1% of survival rate) and 51 were nonsplinted (96.5% of survival rate). Quantitative analysis of all studies showed statistically significant higher survival rates for splinted restorations than for nonsplinted restorations. Ceramic chipping, screw loosening, abutment screw breakage, and soft tissue inflammation were reported in the selected studies. The quantitative analysis found no statistically significant difference in the prosthetic complications of splinted and nonsplinted restorations.

CONCLUSIONS

Within the limitations of this systematic review and meta-analysis, it was concluded that there was no difference in the marginal bone loss and prosthetic complications of splinted and nonsplinted implant restorations; this is especially true for restorations in the posterior region. However, splinted restorations were associated with decreased implant failure.

Occurrence of Progressive Bone Loss Around Anodized Surface Implants and Resorbable Blasting Media Implants: A Retrospective Cohort Study

BACKGROUND

This study evaluates occurrence of progressive bone loss (PBL) around implants with different implant surfaces.

METHODS

Retrospective examination of 2,517 implants was performed in 903 patients, including 1,147 anodized-surface implants in 454 patients and 1,370 resorbable blasting media (RBM)-surface implants in 449 patients, which were placed from January 2006 to December 2010. Through regular check-up radiographs and records, presence of PBL (up to >50% of fixture length) was investigated. Implant removal for any reason was regarded a failure.

RESULTS

In total, 2,186 implants (979 anodized implants and 1,207 RBM implants) in 793 patients were included in this study. PBL was more frequently observed among anodized implants (n = 36 in 21 patients; 4%) than among RBM implants (n = 19 in 14 patients; 2%), and this difference was statistically significant (P <0.001). Occurrence of PBL was significantly influenced by surface modification and implant diameter (odds ratio [OR] of anodized surface = 4.40, 95% confidence interval [CI] = 1.78 to 10.89, P = 0.001; OR of wide implants = 9.62, 95% CI = 1.13 to 81.68, P = 0.038; determined by mixed-effects logistic regression analysis with random patient effect). However, total survival rate was significantly influenced by implant diameter and not by surface modification (P = 0.019), although effect of implant diameter was observed to be significant on anodized implants (P = 0.030).

CONCLUSION

Implant surface modification and implant diameter are significantly associated with occurrence of PBL.

Crestal Bone Loss Around Adjacent Dental Implants Restored with Splinted and Nonsplinted Fixed Restorations: A Systematic Literature Review

PURPOSE

The aim of this systematic review was to compare the crestal bone loss around splinted and nonsplinted adjacent implants.

MATERIALS AND METHODS

To address the focused question, "Is crestal bone loss around adjacent implants different with splinted from that with nonsplinted restorations?," indexed databases were searched from 1965 up to and including May 2016 using various combinations of the following keywords: "implant," "splinted," "nonsplinted," "unsplinted," "connected," "unconnected," "nonconnected," and "bone loss." Letters to the editor, commentaries, historic reviews, case reports, case series, animal studies, and studies on full-arch rehabilitation were excluded.

RESULTS

Six studies were included with titanium implants ranging from 114 to 1187 implants. All studies had nonsplinted and splinted restorations that ranged from 20 to 234 restorations and from 60 to 970 restorations, respectively. In all the studies, the follow-up period after the restoration placement ranged between 1 and 22 years, with a mean follow-up ranging between 3 and 10.18 ± 3.18 years. In all studies, the mean crestal bone loss for implants restored with nonsplinted restorations ranged between 0.30 ± 0.65 and 1.3 ± 0.2 mm, whereas the mean crestal bone loss for implants restored with splinted restorations ranged between 0.50 ± 0.8 and 1.22 ± 0.95 mm.

CONCLUSION

Within the limitations of this review it is concluded that adjacent implants restored with splinted and nonsplinted fixed restorations did not exhibit a difference in crestal bone loss. The evidence from this systematic review suggests further investigation.