Esthetically driven immediate provisionalization in the anterior zone: 5-year results from a prospective study evaluating 3.0-mm-diameter tapered implants

OBJECTIVES

Evaluate the 5-year safety and efficacy of a narrow-diameter (3.0 mm) implant that was immediately provisionalized with a single crown in the maxillary lateral incisor or mandibular central or lateral incisor area.

MATERIALS AND METHODS

An open, prospective, single-cohort, multicenter study was conducted, in which narrow-diameter implants were placed in fresh, healed extraction, or congenitally missing sites. All patients were required to meet strict criteria for immediate loading. The primary endpoints were marginal bone levels (MBL) and MBL changes (MBLC) from implant placement to 5-year follow-up. Secondary endpoints included cumulative 5-year survival and success rates, soft tissue health, and esthetic parameters.

RESULTS

A total of 91 implants were placed in 77 patients. The mean MBL remained stable from the 1-year (- 0.79 ± 0.73 mm, n = 75) to 5-year (- 0.74 ± 0.87 mm, n = 65) follow-up. A marginal bone gain of 0.11 ± 0.83 mm was observed from the 1-year to 5-year follow-up. The cumulative 5-year survival rate was 96.5%, and the cumulative 5-year success rate was 93%. The clinical parameters, including the modified plaque index, modified sulcus bleeding index, Jemt's papilla index, and pink esthetic score improved throughout the 5-year study.

CONCLUSIONS

The study demonstrated that narrow-diameter implants represent a safe and predictable treatment option for subjects suitable for immediate loading and with limited bone volume or limited inter-dental space.

CLINICAL RELEVANCE

Narrow-diameter implants with immediate provisionalization can be considered for use to restore missing or damaged teeth with predictable functional and esthetic outcomes. This trial was registered with ClinicalTrials.gov (NCT02184845).

Comparison of implant placement and loading protocols for single anterior maxillary implants: A systematic review and network meta-analysis

STATEMENT OF PROBLEM

With increasing esthetic needs, patients prefer missing anterior teeth to be restored as soon as possible, but how the timing of implantation and prosthetic loading influences peri-implant tissue and the esthetic results remains unclear.

PURPOSE

The purpose of this systematic review and network meta-analysis of randomized controlled trials was to investigate and rank the hard-tissue and soft-tissue outcomes, esthetics, and patient satisfaction of single maxillary implant placement and loading protocols.

MATERIAL AND METHODS

A systematic search was conducted to identify studies with at least a 1-year follow-up that compared different implant placement and loading protocols and reported on survival, marginal bone loss (MBL), soft tissue, and esthetics. A random effects model and a Bayesian approach were applied to compare protocols by using mean differences (MD) with 95% credible intervals (CrI) and surface under the cumulative ranking curve (SUCRA) values.

RESULTS

A total of 43 articles were included, with a follow-up of 1 to 5 years. All protocols had high survival rates and no significant differences for 1-year or 2-year MBL. Immediate placement with immediate loading ranked first in pink and white esthetic scores and satisfaction and was statistically significantly better than immediate placement with delayed loading or late placement protocols in pink esthetic scores, where its advantage over late placement with late loading was also clinically relevant [MD: -1.74, CrI: -2.34 to -1.15].

CONCLUSIONS

Immediate implantation with immediate loading showed a considerable esthetic advantage over later rehabilitation, whereas only a slight difference in MBL resulted from different protocols.

Immediate loading on two adjacent single dental implants with definitive nonsplinted restorations: A proof of concept in the posterior zone

OBJECTIVES

To evaluate clinical, clinician- and patient-reported outcomes (PROs) of two adjacent single posterior implants immediately loaded with definitive single crowns up to 1 year. Ten patients in need of two adjacent posterior single implants were included. All implants were placed applying a fully digital workflow. Definitive screw-retained single zirconia crowns were delivered within 72 h after implant placement. Clinical parameters, patient- and clinician-reported outcomes were assessed up to 1 year of follow-up.

CLINICAL CONSIDERATIONS

Clinical outcomes remained stable, with no implant failures or technical and biological complications throughout the observation period. Patient satisfaction was very high at baseline (crown delivery) and remained consistently high at 6 and 12 months of follow-up. Crown insertion 3 days after implant placement was rated as an easy procedure by clinicians.

CONCLUSIONS

Two adjacent single implants with immediate definitive restorations (<72 h) in the posterior region appear to be a viable and easy treatment option to shorten the overall treatment time and potentially enhancing patient satisfaction. However, randomized controlled trials are needed to confirm the advantages of this treatment protocol over a delayed loading approach.

CLINICAL SIGNIFICANCE

In selected cases, immediate implant loading with definitive restorations in the posterior region appears a valuable and straightforward option to shorten the overall treatment time.

Impact of immediate interim restoration on peri-implant tissues around immediately placed single dental implants in the esthetic region: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Immediate implant placement with an immediate interim restoration is a well-established protocol. Nevertheless, a consensus regarding the impact of immediate interim restoration on peri-implant tissues around single dental implants is lacking.

PURPOSE

The purpose of this systematic review and meta-analysis was to address the research question: "Does the placement of an immediate interim restoration influence the mid-facial mucosal (MFM) marginal and interdental papilla (IDP) levels around single dental implants placed in the anterior esthetic region by using an immediate implant placement protocol?"

MATERIAL AND METHODS

A comprehensive literature search was made in the Medline/PubMed, Scopus, Cochrane, and Science Direct electronic databases for articles published in English evaluating the impact of immediate interim restoration on peri-implant tissues around single dental implants in the anterior esthetic region. The primary outcomes assessed were changes in the MFM marginal and IDP levels. Additional outcomes were marginal bone (MB) loss, esthetic outcomes involving the pink and white esthetic scores (PES and WES), implant survival rates, and patient reported outcome measures (PROMs). The risk of bias assessment was performed by using the RoB 2 tool for randomized trials and the Newcastle-Ottawa scale for nonrandomized studies. Meta-analysis was performed by using random and fixed effects model (α=.05) in the RevMan software program.

RESULTS

Sixteen studies were included that analyzed 836 single dental implants involving 823 patients. The meta-analysis showed no significant differences in implants with and without interim restoration in terms of MFM marginal level (MD=0.01; 95% CI=-1.23 to 1.25; P=.98), mesial IDP level (MD=0.12; 95% CI=-0.23 to 0.47; P=.50), distal IDP level (MD=0.20; 95% CI=-0.40 to 0.79; P=.52), and MB loss (MD=0.01; 95% CI=-0.42 to 0.43; P=.97). The systematic analysis for survival rates determined no notable difference in implants with or without an interim restoration. However, the esthetic outcomes and PROMs substantially improved with immediate interim restorations. The RoB 2 tool showed a moderate to low risk of bias, and the Newcastle-Ottawa scale indicated high-quality studies.

CONCLUSIONS

After a 12-month follow-up, immediate interim restoration had no significant impact on peri-implant soft (MFM marginal and IDP levels) and hard tissues (MB loss) around immediately placed single dental implants. Nevertheless, additional well-designed and well-implemented clinical trials with long-term follow-up periods are needed to provide more precise evidence-based recommendations.

Bone regeneration in implant dentistry: Which are the factors affecting the clinical outcome?

The key factors that are needed for bone regeneration to take place include cells (osteoprogenitor and immune-inflammatory cells), a scaffold (blood clot) that facilitates the deposition of the bone matrix, signaling molecules, blood supply, and mechanical stability. However, even when these principles are met, the overall amount of regenerated bone, its stability over time and the incidence of complications may significantly vary. This manuscript provides a critical review on the main local and systemic factors that may have an impact on bone regeneration, trying to focus, whenever possible, on bone regeneration simultaneous to implant placement to treat bone dehiscence/fenestration defects or for bone contouring. In the future, it is likely that bone tissue engineering will change our approach to bone regeneration in implant dentistry by replacing the current biomaterials with osteoinductive scaffolds combined with cells and mechanical/soluble factors and by employing immunomodulatory materials that can both modulate the immune response and control other bone regeneration processes such as osteogenesis, osteoclastogenesis, or inflammation. However, there are currently important knowledge gaps on the biology of osseous formation and on the factors that can influence it that require further investigation. It is recommended that future studies should combine traditional clinical and radiographic assessments with non-invasive imaging and with patient-reported outcome measures. We also envisage that the integration of multi-omics approaches will help uncover the mechanisms responsible for the variability in regenerative outcomes observed in clinical practice.

Full arch immediate occlusal loading using site specific implants: A clinical series of 10 patients (13 arches)

PURPOSE

Osseointegration of dental endosseous implants has proven to be effective, predictable, and clinically successful. Unloaded healing protocols were originally used in treating edentulous patients. Full arch immediate occlusal loading protocols have been shown to be as effective as unloaded healing protocols. This paper reports on the results, benefits, and limitations of one specific immediate loading protocol using site specific implants for fresh extraction and healed extraction sites.

MATERIALS AND METHODS

Ten consecutive patients [{13 arches} (age range: 64-81 years; average: 70.1) (4 males/6 females) were treated by the first 2 authors in private practice settings. Hopeless teeth were scheduled for extraction with immediate implant placement and immediate loading with insertion of full arch, screw-retained, acrylic resin interim prostheses within 24 hours. Implants were also placed into healed edentulous ridges. Insertion torque values for each implant were recorded. Interim prostheses were removed after at least 3 months of healing. Implants were reverse torque tested (35 Ncm) and evaluated for macroscopic mobility. Definitive full arch prostheses were made. Patients were followed for 21 to 48 months postimplant surgery. Panoramic radiographs were taken immediately postimplant placement and 1 year postoperative.

RESULTS

Thirteen arches were treated; 11 ultrawide diameter implants were placed into molar sockets, 26 inverted body-shift implants were placed into anterior sockets; 25 standard diameter, tapered implants were placed into edentulous sites; 2 zygomatic implants were placed in one patient. The total number of implants placed was 64 (4 preexisting implants were also used and not included in this study). The minimum implant insertion torque value was 20 Ncm. After 12 to 18 months of function (average 14 months), the implant and prosthetic survival rates were 100%. Eight patients were restored with definitive zirconia or acrylic resin hybrid fixed prostheses. Two patients were restored with bar titanium frameworks and removable overdenture prostheses. No prosthetic complications were reported for the definitive prostheses.

CONCLUSIONS

The results of this clinical series with site specific implants and immediate full arch occlusal loading in treating edentulous patients resulted in 100% clinical implant and prosthetic survival rates. According to this study, this protocol can be used with high levels of anticipated success.

Evaluation of esthetic outcome of delayed implants with de-epithelialized free gingival graft in thin gingival phenotype with or without immediate temporization: a randomized clinical trial

AIM

The current study investigates the effect of immediate temporization on the pink esthetics of delayed implants in patients with thin gingival phenotype in combination with a De-epithelialized Free Gingival Graft in the maxillary premolar area.

METHODOLOGY

The study population was randomly assigned into two groups. The two groups were treated with delayed implants with simultaneous placement of a de-epithelialized free gingiva graft. The test group was immediately temporized while the control group had no temporization. The pink esthetic score was assessed as the primary outcome. Additional secondary outcomes were assessed such as the keratinized tissue width and the soft tissue thickness.

RESULTS

Twenty implants were placed in the current study, split into 10 implants per group. The results showed that the Pink Esthetic Score of the IT group was 11.88 ± (1.13) and 11.33 ± (1.25) for the CTG group, which showed no statistical difference between the groups after 1 year of follow-up. There was also no significant difference between the two groups at 12 months regarding the keratinized tissue width and the soft tissue thickness.

CONCLUSIONS

Immediate and delayed temporizations have no effect on the Pink Esthetics of the delayed implants; however, immediate temporization allowed earlier provisional crown delivery. Soft tissue augmentation of the thin gingival phenotype improved esthetics for both groups. Trial registration Name of the registry: clinicaltrials.gov; trial registration number: NCT03792425. Date of registration: January 3, 2019. URL of trial registry record: https://clinicaltrials.gov/ct2/show/NCT03792425?term=NCT03792425&draw=2&rank=1.

Etiology and Treatment of Peri-Implant Soft Tissue Dehiscences: A Narrative Review

Implant soft tissue dehiscences compromise not only the aesthetics of the supported restorations but implant survival in the long run. The aim of this narrative review was to briefly present the causative factors of buccal peri-implant soft tissue dehiscences (PSTDs), how these are classified, and the current therapeutic approaches. Implant malposition and the thin peri-implant phenotype are the two major determinants for the occurrence of PSTDs, but other risk factors have also been identified. The most common surgical procedure for treating PSTDs is the split-thickness coronally advanced flap combined with either a connective tissue graft or acellular dermal matrix materials. However, depending on the class and subtype of the dehiscence, the combination of surgical techniques with modifications in the restoration may further ameliorate the final result. In general, within a five-year follow-up period, most techniques lead to a satisfactory aesthetic result, although full coverage of the implant/abutment surface is not always achievable, especially in more extended lesions.

Is the timing of implant placement and loading influencing esthetic outcomes in single-tooth implants?-A systematic review

OBJECTIVES

To address the following question: "Is the timing of implant placement and/or loading influencing the esthetic outcomes of implant-supported single crowns?"

MATERIAL AND METHODS

A literature screening was performed in four electronic databases until June 2020. Randomized controlled clinical trials with a minimum of 10 patients and 1 year of follow-up and reporting on dimensional changes of the peri-implant mucosa (midfacial recession, papilla level) and esthetic indexes were included. Cochrane Risk of Bias Tool was used, and comparable trials were subjected to meta-analyses.

RESULTS

Out of 8549 articles, 72 full-text articles were assessed for eligibility and 18 were included. Nine trials evaluated the timing of implant placement, and nine trials evaluated the timing of loading. The included trials comparing immediate implant placement to delayed implant placement evaluating the midfacial recession reported heterogeneous findings. No differences were found at 1 and 2-years, when comparing midfacial recession and papilla level between immediate and early implant placement. In immediate and delayed implant placement, when comparing conventional and immediate loading, the midfacial mucosal margin change was not statistically significant at the 1-year follow-up. When evaluating the timing of implant placement and/or loading the included trials found no differences in the Pink Esthetic score, White Esthetic score, and Papilla Index between groups.

CONCLUSIONS

Both immediate and early implant placement protocols presented stable treatment results in terms of esthetic outcomes at the 1-, 2-, and 10-years follow-up. Loading protocols did not seem to influence esthetic outcomes in short- and medium-term follow-ups.

3D Considerations and Outcomes of Immediate Single Implant Insertion and Provisionalization at the Maxillary Esthetic Zone: A Long-Term Retrospective Follow-Up Study of Up to 18 Years

AIM

Long-term studies addressing the outcomes of single immediate implantation and provisionalization at the maxillary esthetic zone are needed. The current study aimed to assess such outcomes along a follow-up period of up to 18 years.

MATERIALS AND METHODS

The current study is a continuation follow-up of our previously published up to 6-year follow-up study, dated between the years 2002-2008, performed in a private clinical practice in Tel-Aviv, Israel. A total of 15 patients (23 implants) who had been treated for single-tooth replacement at the maxillary esthetic zone since 2002, underwent clinical and radiographic follow-up evaluations. Primary outcomes included mean Marginal Bone Levels (MBL), with Bleeding on Probing (BOP), implant success rate, prosthetic and esthetic complications evaluated as secondary outcomes.

RESULTS

The implant success rate was at 100%. Bone remodeling processes were observed over the follow-up period, with 0.9 mm mean marginal bone loss observed during the first 6 years of observation, followed by -0.13 ± 0.06 mm mean loss after 6 to 18 years. The last finding suggests bone deposition, as reported by other studies (Donati et al., 2012). At the final radiographic evaluation, a mean MBL of 1.35 mm ± 0.16 was demonstrated. No differences with respect to implant type or site were found. A generalized absence of BOP and esthetic complications occurred in two cases as a result of continuous adjacent teeth eruption versus obvious implant ankylosis.

CONCLUSIONS

Adhering to careful clinical protocols and 3D bone to implant considerations while immediately placing an anterior implant, this treatment approach offers both stable and esthetically acceptable results for the replacement of missing teeth at the maxillary esthetic zone.

Clinical and radiological outcomes of novel digital workflow and dynamic navigation for single-implant immediate loading in aesthetic zone: 1-year prospective case series

Objectives

To evaluate clinical, radiological performance of novel digital workflow integrating dynamic navigation to streamline in one‐visit single‐implant immediate loading in aesthetic zone.

Material and methods

Consecutive patients requiring one single‐implant in aesthetic zone of both jaws were treated between May and September 2017. Primary outcomes were implant and prosthetic success rates, surgical and prosthetic complications, marginal bone loss (MBL), final pink aesthetic score (PES‐f), and implant stability quotient (ISQ‐f). Secondary outcomes were ISQ‐0 and PES‐0 at implant positioning and PES‐p at definitive prosthesis placement. Potential effect of jaw (maxilla vs mandible), biotype (thin vs thick), type of incision (flap vs flapless), and implant site (healed vs. post‐extractive) on the primary outcomes (MBL, PES‐f, and ISQ‐f) was evaluated through a multivariable analysis.

Results

Fifty‐two implants were placed (follow‐up 18.6, 15–20 months). One post‐extractive implant failed. No other surgical, biological complications occurred, accounting for 98.10% cumulative success rate (CSR). No definitive prostheses failed. Mean MBL was −0.63 ± 0.25 mm (−1.69 to −0.06). PES‐f was 12.34 ± 1.41 (9–14). ISQ‐f was 78.1 ± 3.2 (70–84). Age had significantly negative effect on MBL and PES‐f (p = .0058 and p = .0052). No other variables significantly affected primary outcomes.

Conclusions

Within study limitations, investigated digital workflow integrating dynamic navigation was reliable for single‐implant immediate loading in aesthetic zone in one visit. No statistically significant difference was found for MBL, PES‐f, and ISQ‐f, considering type of incision (flap vs. flapless), implant site (healed vs post‐extractive), jaw (maxilla vs. mandible), and biotype (thick vs. thin). Live‐tracked dynamic navigation may have contributed to improve operator clinical performance regardless of implant site characteristics. Further investigations are needed to confirm positive outcomes.

Peri-implant and esthetic outcomes of cemented and screw-retained crowns using zirconia abutments in single implant-supported restorations-A systematic review and meta-analysis

OBJECTIVES

To evaluate the peri-implant tissue changes and esthetic outcomes of cemented and screw-retained crowns of single-tooth implants in the esthetic zone using zirconia abutments.

MATERIAL AND METHODS

An electronic search was performed on nine databases. The risk-of-bias was assessed by the revised Cochrane risk-of-bias tool for randomized (RoB 2) and non-randomized (ROBINS-I) clinical trials. Marginal bone level change, soft tissue thickness, bleeding on probing, probing depth, survival rates of implants and crowns, complications, plaque and papilla indexes, and pink esthetic score data were extracted and analyzed. The certainty of evidence was accessed through the GRADE approach.

RESULTS

Nine records were included and 7 were used in the meta-analyses. Screw-retained crowns presented greater marginal bone level change (MD -0.04 [-0.08, -0.00] p = 0.04, I²  = 0%) compared to cemented crowns up to 1-year. At 3 and 4 years no significant differences (p > 0.05) were observed. Soft tissue thickness did not differ between groups (p > 0.05). The bleeding on probing was higher in cemented group than in screw-retained crowns at 1-year (MD 0.17 [0.08, 0.27] p = 0.0005, I²  = 0%), at medium-term periods (3 and 4 years) no statistically significant differences (p > 0.05) were observed for this outcome. Probing depth, survival rates of implants and crowns, complications, and plaque index, as well as esthetic analysis using the papilla index and pink esthetic score did not differ statistically (p > 0.05) between both retention systems at short and medium-term periods.

CONCLUSION

The connection system considering zirconia abutments presented no influence on peri-implant parameters and esthetics evaluation for medium-term periods (3 and 4 years).

Early peri-implant bone loss as a predictor for peri-implantitis: A 10-year prospective cohort study

PURPOSE

To evaluate the effect of early bone loss (EBL), on long-term bone stability and future peri-implantitis development.

MATERIALS AND METHODS

Patients referred for implant placement between 2005 and 2009 were consecutively treated and followed for 10 years. After 10 years, patients were invited for a scientific diagnostic visit to evaluate implant survival and bone loss. Bone level changes were compared with baseline. Non-parametric testing was performed in cross-tabs (Pearson Chi-square and Fishers's exact test). Kaplan-Meier-estimated survival curves were plotted for different thresholds for EBL at different timepoints. Generalized linear mixed models with binomial distribution and logit link for peri-implantitis were fitted. An adjusted logistic mixed model was made to evaluate peri-implantitis, in relation with smoking status, history of periodontitis, and EBL > 0.5 mm.

RESULTS

Four hundred and seven patients (mean age of 64.86 years [range 28-92, SD 10.11]), with 1482 implants, responded to the 10-year recall invitation. After an average follow-up time of 10.66 years (range 10-14, SD 0.87), implant survival was 94.74%. Mean crestal bone loss after 10 years was 0.81 mm (SD 1.58, range 0.00-17.00). One hundred and seventy five implants in 76 patients had peri-implantitis (11.8% on implant level, 18.7% on patient level). EBL of 0.5, 1, and 2 mm were significant predictors for peri-implantitis and implant loss after 10 years. Implants with EBL ≥0.5 mm during the first year of function showed a 5.43 times higher odds for future peri-implantitis development. Probability in developing peri-implantitis was 52.06% when smoking, Periodontal history and EBL of >0.5 mm was combined.

CONCLUSION

The present study suggests that EBL is a predictor for long-term peri-implant pathology, with a significant higher risk for peri-implantitis when early bone loss exceeds the thresholds of 0.5 and 1 mm, especially when additional risk factors such as smoking or susceptibility for periodontal disease prior to implant treatment are present. Clinical trial registration number B670201524796.

Immediate versus early or conventional loading dental implants with fixed prostheses: A systematic review and meta-analysis of randomized controlled clinical trials

STATEMENT OF PROBLEM

Immediate loading of dental implants has gained widespread popularity because of its advantages in shortening treatment duration and improving esthetics and patient acceptance. However, whether immediate loading can achieve clinical outcomes comparable with those of early or conventional delayed loading is still unclear.

PURPOSE

The purpose of this systematic review and meta-analysis was to compare the efficacy of immediate loading versus early or conventional loading implants in patients rehabilitated with fixed prostheses.

MATERIAL AND METHODS

Electronic searches of CENTRAL, EMBASE, and MEDLINE were supplemented by manual searches up to October 2018. Only human randomized controlled trials (RCTs) comparing immediate with early or conventional loading dental implants were included. Quality assessment was performed by using the Cochrane Collaboration tool. For the meta-analysis, the dichotomous and continuous variables were pooled and analyzed by using risk ratios (RRs) and weighted mean differences (WMDs), with 95% confidence intervals (95% CIs). The outcomes assessed included survival rate, marginal bone level changes, peri-implant gingival level, probing depth, and implant stability. The subgroup analyses included healing methods, implant time, occlusal contact, number of missing teeth, and tooth position.

RESULTS

Thirty-nine trials (49 articles) were included from the initial 763 references evaluated. When compared with conventional loading, with implants regarded as a statistical unit, a statistically significant lower survival rate was observed in the immediate loading dental implant (RR=0.974; 95% CI, 0.954, 0.994; P=.012). Regarding other outcomes, including marginal bone level changes, peri-implant gingival level, probing depth, and implant stability, no statistically significant differences were observed when comparing immediate versus early or conventional loading (P>.05).

CONCLUSIONS

Compared with early loading, immediate loading could achieve comparable implant survival rates and marginal bone level changes. Compared with conventional loading, immediate loading was associated with a higher incidence of implant failure.

Patient-reported outcome measures focusing on aesthetics of implant- and tooth-supported fixed dental prostheses: A systematic review and meta-analysis

OBJECTIVES

The aim of this systematic review and meta-analysis was to summarize the existing evidence on patient-reported aesthetic outcome measures (PROMs) of implant-supported, relative to tooth-supported fixed dental prostheses.

MATERIAL AND METHODS

In April 2017, two reviewers independently searched the Medline (PubMed), EMBASE, and Cochrane electronic databases, focusing on studies including patient-reported aesthetic outcomes of implant- and tooth-supported fixed dental prostheses (FDPs). Human studies with a mean follow-up period of at least 1 year, a minimum of ten patients, and English, German, or French publication were included. For the comparison of subgroups, random-effects meta-regression for aggregate-level data was used.

RESULTS

The systematic search for implant-supported prostheses focusing on patient-reported outcomes identified 2,675 titles, which were screened by two independent authors. Fifty full-text articles were analyzed, and finally, 16 publications (including 19 relevant study cohorts) were included. For tooth-supported prostheses, no studies could be included. A total of 816 implant-supported reconstructions were analyzed by patients. Overall aesthetic evaluation by the patients' visual analogue scale (VAS) rating was high in implant-supported FDPs (median: 90.3; min-max: 80.0-94.0) and the surrounding mucosa (median: 84.7; min-max: 73.0-92.0). Individual restorative materials, implant neck design (i.e., tissue or bone level type implants), and the use of a fixed provisional had no effect on patients' ratings of the definitive implant-supported FDPs.

CONCLUSIONS

Aesthetics is an important patient-reported measure, which lacks in standardized methods; however, patients' satisfaction was high for implant- supported FDPs and the surrounding mucosa.

Immediate placement of tapered implants with a moderately rough anodized surface and smooth collar in fresh extraction sockets: A retrospective analysis with 10-year follow-up

BACKGROUND

There is limited long-term data on hard- and soft-tissue outcomes of implants immediately placed in postextraction sockets with immediate or early loading.

PURPOSE

To evaluate the clinical outcomes of immediately placed anodized tapered implants in consecutive patients with at least 10 years of follow up.

MATERIALS AND METHODS

This retrospective analysis evaluated outcomes of 61 consecutive patients who received 89 tapered implants with an anodized implant body and machined collar. Implants were placed in fresh extraction sites and functionalized using an immediate- or early-loading protocol. Outcome measures included survival, marginal bone level change (ΔMBL), and papilla index.

RESULTS

The 10-year cumulative survival rate was 100%. ΔMBL at the 10-year follow up was -0.86 ± 2.10 mm. At 10 years, patients had mesial and distal papilla index scores of 2 or 3 for 95.9% and 87.8% of implants, respectively.

CONCLUSIONS

When used for immediate placement and immediate- or early-loading protocols, this implant produced excellent long-term hard- and soft-tissue outcomes.

Immediate provisionalization of bone level implants with a hydrophilic surface. A five-year follow-up of a randomized controlled clinical trial

OBJECTIVES

To follow-up the radiographic bone level changes and the clinical outcomes of immediately provisionalized and conventionally restored implants with a hydrophilic surface following 5 years of function.

MATERIALS AND METHODS

This was a 5-year follow-up of a prospective, randomized, single-blind controlled study involving 16 of the 24 originally recruited patients in need of a single-tooth replacement in the esthetic area. Implants were either immediately provisionalized with a non-occluding temporary crown (test group, n = 7), or left without a crown (control group, n = 9). In both groups, the definitive restoration was placed 16 weeks after implant placement. Radiographic and clinical parameters were evaluated at 36, 48, and 60 months post-implant placement, together with implant survival and success rates. The esthetic outcomes were measured with the Papilla Fill Index (PFI) and the Pink Esthetic Score (PES).

RESULTS

At 60 months, similar peri-implant bone loss was observed in the test (-0.42 mm ±0.17 mm) and in the control (-0.37 mm ±0.35 mm) groups. A tendency for an improved esthetic outcome from implant loading to the subsequent follow-ups was noticed in both groups. Both groups presented with high levels of long-term implant survival and success.

CONCLUSIONS

This study supports non-functional immediate provisionalization as a viable long-term option for the management of single-tooth implants in the esthetic area. However, the small sample size does not allow statistical inference at 60 months of follow-up and future adequately powered studies are warranted.

Esthetic assessments in implant dentistry: objective and subjective criteria for clinicians and patients

In recent years the scientific community has shown a clear interest in the esthetic outcome of implant treatment. The present paper provides an overview of the esthetic ratings that have been used in implant dentistry. A distinction can be made between objective evaluations by clinicians and subjective evaluations by patients. The former mainly include: midfacial and interproximal soft-tissue levels; two-dimensional/three-dimensional soft-tissue alterations; assessment of the color match between the natural dentition, on the one hand, and the peri-implant tissues and the reconstruction, on the other hand; and ordinal indices, such as the pink and white esthetic score. Patient's needs and judgment may differ from objective indicators of implant success and esthetics. As a result, assessing treatment on the basis of patient-reported outcomes measures should be considered important. Validated questionnaires have been used that mainly assess the impact of oral health on the overall well-being of individuals. The esthetic judgment of patients is usually based on nonstandardized questions with varying scoring methods, including visual analog scales, Likert and other category scales and open questions. The heterogeneity in scoring systems between studies may compromise proper comparison of objective and subjective esthetic outcomes between studies and therapeutic concepts.

Influence of implant location on the clinical outcomes of implant abutments: a systematic review and meta-analysis

Purpose

To compare the failure events and incidence of complications of different abutment materials in anterior and posterior regions. Failure was defined as complete loss of the abutment requiring replacement by a new abutment.

Materials and methods

Electronic searches using PubMed/Medline and Google Scholar complemented with manual searches were performed with specific search terms. Searches were restricted to publications in English between January 2006 and March 2016.

Results

A total of 863 and 1,264 implants were inserted in the anterior and posterior regions, respectively, in a total of 1,529 patients. No titanium abutments failed in anterior or posterior regions. On the other hand, 1.6% of zirconia abutments failed in the anterior region and 1.5% failed in the posterior region. Technical complications occurred mostly in the posterior region and mostly involved zirconia abutment. Meta-analysis was possible only for zirconia-abutment failure, due to considerable heterogeneity of studies and outcome variables. No significant difference in failure rate was found between anterior and posterior zirconia abutments (risk ratio 1.53, 95% CI 0.49–4.77; P=0.47).

Conclusion

This systematic review and meta-analysis showed similar outcomes of different abutment materials when used in anterior and posterior regions in terms of failure events and biological and aesthetic complications. The only significant finding was the increased incidence of technical complications in the posterior region, mostly involving zirconia abutments. Abutment-screw loosening was the most common technical complication.

The role of immediate provisional restorations on implants with a hydrophilic surface: A randomised, single-blind controlled clinical trial

OBJECTIVES

To compare the radiographic bone changes, clinical parameters and aesthetic outcomes of immediately provisionalised and conventionally restored implants at 12- and 24-months post-implant placement.

MATERIAL AND METHODS

In 24 patients, 24 bone level implants with a hydrophilic (SLActive) surface were placed in healed sites and they were either immediately provisionalised with a non-occluding temporary crown (test group) or left without a crown (control group). In both groups, the definitive restoration was placed 16 weeks after implant placement. Clinical and radiographic parameters were calculated at 12- and 24-months post-implant placement, together with implant success/survival rates according to three different sets of criteria. The aesthetic outcome was evaluated through the Papilla Fill Index and the Pink Aesthetic Score.

RESULTS

The mean marginal bone loss at 1 year was -0.73 mm (SD 0.83 mm) in the test group and -0.22 mm (SD 0.46 mm) in the control group (p > .05). Whilst 100% survival rate and positive aesthetic outcomes were recorded in both groups, three patients of the test group did not fulfil all success criteria.

CONCLUSIONS

Immediate provisionalisation may represent a viable option for the replacement of single missing teeth, with radiographic, clinical and aesthetic results comparable to those of conventionally loaded implants at 2 years of follow-up.

An open prospective single cohort multicenter study evaluating the novel, tapered, conical connection implants supporting single crowns in the anterior and premolar maxilla: interim 1-year results

OBJECTIVES

The aim of this multicenter prospective clinical study was to evaluate anodized tapered implants with a conical connection and integrated platform shifting placed in the anterior and premolar maxilla.

MATERIALS AND METHODS

The study enrolled patients requiring single-tooth restorations in healed sites of maxillary anterior and premolar teeth. All implants were immediately temporized. Clinical and radiographic evaluations were conducted at implant insertion, 6 months, and 1 year. Outcome measures included bone remodeling, cumulative survival rate (CSR), success rate, soft-tissue health and esthetics, and patient satisfaction. Bone remodeling and pink esthetic score were analyzed using Wilcoxon signed-rank tests. CSR was calculated using life table analysis. Other soft-tissue outcomes were analyzed using sign tests.

RESULTS

Out of 97 enrolled patients (102 implants), 87 patients (91 implants) completed the 1-year visit. Marginal bone remodeling was -0.85 ± 1.36 mm. After the expected initial bone loss, a mean bone gain of 0.11 ± 1.05 mm was observed between 6 months and 1 year. The CSR was 99.0%, and the cumulative success rate was 97.0%. Partial or full papilla was observed at 30.8% of sites at baseline, 87.2% at 6 months, and 90.5% at 1 year. Soft-tissue response, esthetics, and patient satisfaction all improved during the study period.

CONCLUSIONS

Bone gain was observed following the expected initial bone loss, and soft-tissue outcomes improved suggesting favorable tissue response using anodized tapered conical connection implants.

CLINICAL RELEVANCE

Rapid stabilization of bone remodeling and robust papilla regeneration indicate favorable tissue healing promoted by the conical connection, platform-shift design.

TRIAL REGISTRATION

clinicaltrials.gov NCT02175550.

Pre-surgical Provisional Prosthesis for Immediate Non-occlusal-loaded Flapless Implant

A 49-year-old patient reported for immediate replacement of missing maxillary anterior teeth with implant-retained prosthesis. Elevation of flap alters the mucosal level, causes discomfort, and delays the restorative procedure. To maintain the esthetics, flapless surgery was planned. Since placement of an implant is pre-planned in a predetermined site, fabrication of the prostheses before commencement of the surgery, especially when replacing the teeth in the anterior region, could be a viable option. This case report explains the method of fabrication of the provisional restoration for flapless surgery in the presurgical phase. The technique would avoid any micromotion and implant instability caused due to abutment preparation and impression procedure postsurgically.

Clinical and radiographic outcome following immediate loading and delayed loading of single-tooth implants: Randomized clinical trial

BACKGROUND

Immediate loading of single implants is generally considered a reliable procedure.

PURPOSE

The objective of the present prospective randomized clinical study was to compare the overall treatment outcome following immediate loading (IL) and delayed loading (DL) of single implants after 1 year of follow-up.

MATERIALS AND METHODS

Patients with a missing maxillary tooth (15-25) were randomly assigned to IL or DL. The protocol included implant installation in healed sites, immediate loading, delayed loading, temporary screw-retained restoration, and replacement with a permanent single implant crown. Outcome measures were implant survival, marginal bone level, soft tissue changes, papillae index, pink, and white esthetic score (PES and WES), patient judged aesthetics, and oral health impact profile (OHiP-14).

RESULTS

Implant survival rate was 100% and 96% for IL and DL, respectively. Implant success rate was 96% and 88% for IL and DL, respectively. Statistically significant lower papilla index scores were found in the IL group at temporary crown and definitive crown placement. An overall statistically significant improvement after 12 months for PES, WES and OHIP-14 was found.

CONCLUSION

This prospective randomized study showed that single implants in the maxilla can present satisfactory results with respect to either immediate loading or delayed loading after 12 months.

Effects of different loading protocols on the secondary stability and peri-implant bone density of the single implants in the posterior maxilla

BACKGROUND

Immediate or early loading of dental implants becomes a clinically feasible concept.

PURPOSE

The aim was to evaluate the effects of different loading protocols (immediate, early, and delayed) on secondary stability and peri-implant bone density of single implants in the posterior maxilla.

MATERIALS AND METHODS

Thirty-nine implants (Dentium, South-Korea) were placed in 39 patients. After placement, implant stability values (ISQ) and baseline peri-implant bone density values derived from cone-beam computed tomography were recorded. Thirteen implants were included randomly in each loading groups. The secondary ISQ values were recorded during follow-up visits. Peri-implant bone density values were measured 1 year after placement again. Data was statistically analyzed.

RESULTS

Immediate-loaded group showed the lowest ISQ values, 1 month after placement. During the next follow-up visits, delayed-loaded group showed the lowest ISQ values while other groups showed comparable results. Early loading increased the peri-implant bone density greater than the other groups.

CONCLUSIONS

The peri-implant bone of early-loaded implants was significantly denser than that of immediate- and delayed-loaded implants, 1 year after placement. Density increment can be judged as the radiological findings of loaded-bone, which may also reduce the need for histomorphometric analysis of human biopsy to evaluate the bone reaction around the implants.

Immediate loading for implant restoration compared with early or conventional loading: A meta-analysis

PURPOSE

This meta-analysis was to further confirm the no inferiority of immediate loading in clinical and radiographic outcomes compared with non-immediate loadings (early or conventional loading).

MATERIALS AND METHODS

Literature search on Pubmed and Embase was performed up to August 2015. The overall risk radios (RRs) and standard mean differences (SMDs) as well as their 95% confidence intervals (CI) were calculated for comparison.

RESULTS

Total 29 RCT with 1342 implants receiving immediate loading and 1279 implants receiving non-immediate loadings were included in this meta-analysis. Results indicated that there was no significant difference between immediate and non-immediate loadings in implant failure rate based on patients (RR = 1.45, 95% CI: 0.79 to 2.68) and implants (RR = 1.38, 95% CI: 0.86 to 2.21), MBL (SMD = -0.11, 95% CI: -0.39 to 0.17), and ISQ (SMD = -0.26, 95% CI: -0.53 to 0.01). Meanwhile, immediate loading showed significantly less MBL change than non-immediate loading. In addition, subgroup analyses showed that the immediate loading indicated slightly higher implant failure rate and lower ISQ than conventional loading.

CONCLUSIONS

Although overall analysis confirmed no inferiority of immediate loading compared with non-immediate loadings, the technique still need to be explored for improving implant success and stability during immediate loading based on the results in subgroup analyses.

Immediate Single-Tooth Implant Placement in Bony Defects in the Esthetic Zone: A 1-Year Randomized Controlled Trial

BACKGROUND

This study aims to assess, with regard to marginal bone level (MBL), whether the outcome of immediate implant placement in bony defects in the esthetic zone was non-inferior to delayed implant placement after 1 year.

METHODS

Forty patients with a failing tooth in the esthetic zone and a labial bony defect of ≥5 mm after removal of a tooth were randomly assigned for immediate (n = 20) or delayed (n = 20) implant placement. Second-stage surgery and provisionalization occurred after 3 months of healing. Follow-up was at 1 month and 1 year after definitive crown placement. The study was powered to detect a difference in MBL of >0.9 mm. Buccal bone thickness, soft tissue peri-implant parameters, esthetic indices, and patient satisfaction were also assessed.

RESULTS

One year after definitive crown placement, MBL loss was 0.56 ± 0.39 mm mesially and 0.74 ± 0.51 mm distally for the immediate placement group and 0.51 ± 0.43 mesially and 0.54 ± 0.45 distally mm for the delayed placement group, respectively (not significant). Regarding differences in means, non-inferiority was observed after 1 year (difference in mean for immediate versus delayed: mesially 0.04 mm [95% confidence interval (CI) = -0.22 to 0.30 mm, P = 0.40]; distally 0.21 mm [95% CI = -0.10 to 0.51 mm, P = 0.58]). No significant differences in the other outcome variables were observed.

CONCLUSIONS

Immediate implant placement with delayed provisionalization was non-inferior to delayed implant placement with delayed provisionalization in labial bony defects of ≥5 mm regarding change in MBL. Although not powered for other outcome variables, no clinically relevant differences were observed in these variables.

The Dermal Apron Technique for Immediate Implant Socket Management: A Novel Technique

With immediate implant placement and provisionalization (IIP) in the esthetic zone, measures to counter hard and soft tissue loss are frequently necessary. To reduce the morbidity associated with bone and connective tissue procurement, various exogenous materials are utilized. The "Dermal Apron Technique" presented in this article demonstrates the use of a composite bone particulate (allograft/xenograft) plus a dermal allograft, adapted around screw-retained temporary crowns and secured within a subperiosteal pouch. The purpose is to augment the thickness of peri-implant mucosa for the purpose of preserving ridge dimensions and preventing mucosal recession. Controlled studies are required to further support its use. Clinical significance: Soft tissue health and harmony are critical for successful implant therapy in the esthetic regions of the dentition. Often, autogenous soft tissue grafts are used to augment peri-implant soft tissues. The Dermal Apron Technique is a method, that in specific situations, obviates the need for autogenous grafting. This reduces treatment time and morbidity associated with procurement of these grafts. The Dermal Apron Technique is used simultaneous with immediate placement and provisionalization and can improve long-term esthetic outcomes for patients.

Marginal bone level changes and implant stability after loading are not influenced by baseline microstructural bone characteristics: 1-year follow-up

OBJECTIVE

The aim of this study was to investigate the influence of different bone tissue characteristics of implant sites on changes in marginal bone level and implant stability over time.

MATERIAL AND METHODS

One hundred and one implants were inserted in 41 patients. Cortical bone thickness of the alveolar ridge was measured on computed tomography (CT) images. Histomorphometric and microtomographic analyses (microCT) were performed in bone specimens obtained by using a trephine bur, at first drilling. Implant stability quotient (ISQ) measured by resonance frequency analysis (RFA) was registered at implant insertion. Implant stability quotient was measured also at the stages of uncovering, loading and at the 1-year follow-up, when standardized periapical radiographs were taken to measure the marginal bone level (MBL). Descriptive statistics, Spearman's rho correlation and multiple linear regression were used for data analysis (P < 0.05).

RESULTS

Comparison between groups of higher and lower values of ISQ changes and between groups of higher and lower values of MBL changes revealed no differences in histomorphometric and microtomographic parameters, according to non-parametric comparison tests, (P > 0.05). Bivariate correlation also showed no association among these microstructural parameters and the outcomes evaluated. There was no correlation between cortical thickness and MBL changes (r = -0.029; P = 0.832) and between cortical thickness and ISQ changes (r = 0.145; P = 0.292).

CONCLUSION

Microstructural bone characteristics of implant sites have no effect on changes in marginal bone level and implant stability as measured by RFA. Bone morphology cannot predict implant treatment success over time.

Clinical efficacy of immediate implant loading protocols compared to conventional loading depending on the type of the restoration: a systematic review

BACKGROUND AND OBJECTIVES

Immediate loading has become a predictable option to restore all clinical situations. The aim of this systematic review was to assess whether immediate loading protocols achieve comparable clinical outcomes when compared to conventional loading protocols depending on the type of prosthetic restoration.

METHODS

A protocol was developed aimed to answer the following focused question: "What are the effects of immediate implant loading protocols compared to conventional implant loading, in terms of implant failure, marginal bone levels, and biological and mechanical complications based on the type of restoration?" The next subanalysis were performed as follows: the extent, type, and material of the restoration and the type of occlusal contact in function. This systematic review only included randomized controlled trials (RCTs) with a follow-up of at least 6 months after implant loading.

RESULTS

Thirty-seven final papers were included. The results from the meta-analyses have shown that the immediately loading implants demonstrated a statistically significant higher risk of implant failure [RR = 1.92; 95% CI (1.04; 3.54); P = 0.036], a statistically significant lower bone loss [WMD = 0.046; 95% CI (0.043; 0.049); P = 0.000] and a smaller increase in ISQ values [WMD = -1.096; 95% CI (-1.615; -0.577); P < 0.001, although both groups attained high survival rates (98.2% in the test and 99.6% in the control). Single teeth implants were greater risk of failure, when compared to immediately loaded full arch restorations (RR = 2 vs. 0.9), so as the occlusal pattern when compared to non-occlusal (RR = 1.9 vs. 1.4).

CONCLUSIONS

Immediate loading may impose a greater risk for implant failure when compared to conventional loading, although the survival rates were high for both groups.

Immediately loaded non-submerged versus delayed loaded submerged dental implants: a meta-analysis

The purpose of the present meta-analysis was to test the null hypothesis of no difference in the implant failure rate, postoperative infection, and marginal bone loss for patients being rehabilitated with immediately loaded non-submerged dental implants or delayed loaded submerged implants, against the alternative hypothesis of a difference. An electronic search without time or language restrictions was undertaken in March 2014. Eligibility criteria included clinical human studies, either randomized or not. The search strategy resulted in 28 publications. The inverse variance method was used for a random- or fixed-effects model, depending on the heterogeneity. The estimates of an intervention were expressed as the risk ratio (RR) and mean difference (MD) in millimetres. Twenty-three studies were judged to be at high risk of bias, one at moderate risk of bias, and four studies were considered at low risk of bias. The difference between procedures (submerged vs. non-submerged implants) significantly affected the implant failure rate (P = 0.02), with a RR of 1.78 (95% confidence interval (CI) 1.12-2.83). There was no apparent significant effect of non-submerged dental implants on the occurrence of postoperative infection (P = 0.29; RR 2.13, CI 0.52-8.65) or on marginal bone loss (P = 0.77; MD -0.03, 95% CI -0.23 to 0.17).

Reasons for failures of oral implants

This study reviews the literature regarding the factors contributing to failures of dental implants. An electronic search was undertaken including papers from 2004 onwards. The titles and abstracts from these results were read to identify studies within the selection criteria. All reference lists of the selected studies were then hand-searched, this time without time restrictions. A narrative review discussed some findings from the first two parts where separate data from non-comparative studies may have indicated conclusions different from those possible to draw in the systematic analysis. It may be suggested that the following situations are correlated to increase the implant failure rate: a low insertion torque of implants that are planned to be immediately or early loaded, inexperienced surgeons inserting the implants, implant insertion in the maxilla, implant insertion in the posterior region of the jaws, implants in heavy smokers, implant insertion in bone qualities type III and IV, implant insertion in places with small bone volumes, use of shorter length implants, greater number of implants placed per patient, lack of initial implant stability, use of cylindrical (non-threaded) implants and prosthetic rehabilitation with implant-supported overdentures. Moreover, it may be suggested that the following situations may be correlated with an increase in the implant failure rate: use of the non-submerged technique, immediate loading, implant insertion in fresh extraction sockets, smaller diameter implants. Some recently published studies suggest that modern, moderately rough implants may present with similar results irrespective if placed in maxillas, in smoking patients or using only short implants.

Immediate placement and loading of maxillary single-tooth implants: a 3-year prospective study of marginal bone level

AIM

The purpose of this study was to evaluate marginal bone level around single-tooth implants placed in anterior maxilla and immediately restored.

MATERIALS AND METHODS

Twenty implants were placed in 20 patients (8 men and 12 women) that were selected for this study. Following atraumatic non-surgical extraction of tooth, all patients immediately received implants and the definitive prefabricated abutment was placed. Implant position was transferred to the scanning unit of the CAD/CAM system using prefabricated surgical guide. Temporary crowns were immediately fabricated and cemented. Eight weeks later final crowns were luted. Outcome assessment as implant survival and level of marginal bone radiographic evaluations were performed at 8 weeks, 1 and 3 years time period after loading.

RESULTS

All implants placed osseointegrated successfully after 3 years of functional loading. The mean marginal bone loss was 0.16 mm (SD, 0.167 mm), 0.275 mm (SD, 0.171 mm) and 0.265 mm (SD, 0.171 mm) at 8 weeks, 1 and 3 years time period respectively. Four out of the 20 implants showed no bone loss.

CONCLUSION

Immediate loading technique using the final abutment directly eliminated the need for a second stage surgery and prevented interruption of soft and hard tissue at implant neck, which resulted in better soft tissue response and reduced marginal bone loss. Clinical significance: Immediately loaded implants, in fresh extraction sockets by insertion of a provisional restoration on the titanium abutment without any later manipulation, helped to protect the initially forming blood clot and presented a template for soft tissue contouring that resulted in significant reduction of marginal bone resorption and maintenance of soft tissue architecture.

A multifactorial analysis to identify predictors of implant failure and peri-implant bone loss

OBJECTIVE

To identify risk factors for failure and bone loss of implants in a large study sample on the basis of multivariate analyses.

MATERIALS AND METHODS

Patient files of all patients referred for implant treatment from November 2004 to December 2007 were scrutinized, and information on implant- and patient-related factors was collected. The study sample in this retrospective cohort study consisted of both partially dentate and fully edentulous patients referred for various indications. The only inclusion criterion was a follow-up of at least 2 years. Implant survival and bone loss were assessed by an external investigator (SV) comparing digital periapical radiographs taken during recall visits with the postoperative ones. Univariate and multivariate tests were adopted to identify possible risk indicators for implant failure and peri-implant bone loss.

RESULTS

Twenty-one of 1,320 (1.6%) implants were lost in 19 of 376 (5.1%) patients (210 female, 166 male; mean age 56, range 17-82) after a mean follow-up of 32 months (range 24-62). Based on multivariate analysis, only smoking (p = .001) and recall compliance (p = .010) had a significant influence on implant failure, with smokers more prone to failure. The overall mean bone loss was 0.36 mm (SD 0.68, range 0.00-7.10). Smoking (p = .001) and jaw of treatment (p = .001) affected peri-implant bone loss. More peri-implant bone loss was observed in smokers and in the maxilla. A clear discrepancy was found between univariate and multivariate analysis with regard to identification of risk factors.

CONCLUSION

Multivariate analysis demonstrated that implant-related factors did not affect the clinical outcome, but smoking was identified as a predictor for implant failure. Predictors for peri-implant bone loss were smoking and jaw of treatment.

Disparity in embrasure fill and papilla height between tooth- and implant-borne fixed restorations in the anterior maxilla: a cross-sectional study

PURPOSE

The objective of the present study was to compare inter-proximal fill and papilla height between different embrasures.

MATERIAL & METHODS

One hundred and fifty non-smoking consecutive patients (mean age 54, range 32-73; 63 males and 87 females) without periodontal disease were selected in a multidisciplinary practice during regular supportive care. All had been treated for multiple tooth loss in the anterior maxilla at least 1 year earlier by means of a fixed restoration on teeth (n = 50) or implants (n = 100) using straightforward procedures (without hard and/or soft tissue augmentation). Embrasure fill was assessed by means of Jemt's papilla index and papilla height was registered following local anaesthesia by means of bone sounding by one clinician.

RESULTS

Tooth-pontic and tooth-implant embrasures demonstrated comparable inter-proximal fill and papilla height (≥58% Jemt's score 3; mean papilla height ≥4.1 mm). Between missing teeth, embrasure fill and papilla height were lower regardless of the embrasure type. The implant-implant and implant-pontic embrasure demonstrated comparable outcome (≤42% Jemt's score 3; mean papilla height ≤ 3.3 mm; p ≥ 0.416), which was significantly poorer when compared to the pontic-pontic embrasure (82% Jemt's score 3; mean papilla height 3.7 mm; p ≤ 0.019). Overall, papilla index and papilla height demonstrated a weak correlation (Spearman's correlation coefficient: 0.198; p = 0.002).

CONCLUSIONS

The re-establishment of a papilla is difficult when there is no tooth involved. In that scenario a short papilla should be expected and implant-borne restorations demonstrate the poorest outcome. Moreover, an implant with a pontic may not perform better than adjacent implants.

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/).

Performance of the Straumann Bone Level Implant system for anterior single-tooth replacements in augmented and nonaugmented sites: a prospective cohort study with 60 consecutive patients

AIM

The purpose of this prospective study was to evaluate radiographic, clinical and aesthetic outcomes and patient satisfaction of cases treated with platform-switched single implant restorations in the aesthetic region of the maxilla. Furthermore, the influence of an augmentation procedure 3 months before implant placement and the type of restoration (screw-retained vs. cement-retained) was evaluated.

MATERIAL AND METHODS

Sixty patients with a missing anterior tooth in the maxilla were treated with a Straumann Bone Level Implant. Bone augmentation was performed in 29 patients at 3 months before implant placement. Implants were loaded after 3 months of submerged healing. Follow-up was conducted at 7 and 18 months after implant placement. Peri-implant mucosa and implant crown aesthetic outcomes were determined using the Implant Crown Aesthetic Index (ICAI) and the Pink Esthetic Score-White Esthetic Score (PES-WES).

RESULTS

No implants were lost. At 18 months after implant placement, mean bone level change was -0.10 ± 0.27 mm and mean probing pocket depth was 2.57 mm. No differences were found between augmented and nonaugmented sites (P = 0.28). The ICAI indicated satisfactory mucosa and crown aesthetics in 67% and 75% of the cases, respectively, while the PES score was 14.4. ICAI mucosa (P = 0.004) and PES (P = 0.02) scores were significantly less favourable for augmented sites compared with nonaugmented sites. Patient satisfaction was high (8.9 ± 1.1 on VAS-score).

CONCLUSIONS

From the present prospective, clinical study, it can be concluded that the Straumann Bone Level Implant shows an excellent survival rate, marginal bone stability and good clinical and aesthetic results. Bone augmentation before implant placement does not lead to more marginal bone loss. However, less favourable pink aesthetic outcomes were found in augmented sites compared with nonaugmented sites, while no differences were found between cement-retained and screw-retained restorations.