3-year prospective multicenter study on one-stage implant surgery and early loading in the edentulous mandible

Do dental implants installed in different types of bone (I, II, III, IV) have different success rates? A systematic review and meta-analysis

Purpose

The objective of this systematic review and meta-analysis was to evaluate the survival rate of implants installed in bone type IV (Lekholm and Zarb, 1995) compared to that of implants installed in bone types I, II, and III.

Material and methods

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA) and was registered in the PROSPERO International Database of Systematic Reviews (CRD42021229775). The PubMed/MEDLINE, Scopus, and Cochrane databases were searched through July 2021. The PICO question was: "Dental implants installed in type IV bone have a lower success rate when compared to implants installed in type I bone, II and III?". The established inclusion criteria were: 1) controlled and randomized clinical trials (RCT), 2) prospective and retrospective studies with at least 10 participants with dental implants, and 3) patients with dental implants installed in bone tissue types I, II, III, and IV (Lekholm and Zarb, 1985). The minimum followup duration was 1 year.

Results

After searching the identified databases, 117 articles were selected for full reading and 68 were excluded. Thus, 49 studies were included for qualitative and quantitative analyses. The total number of participants included was 12,056, with a mean age of 41.56 years and 29,905 implants installed. Bone types I, II, and III exhibit a lower implant failure rate when compared to bone type IV.

Conclusion

Dental implants installed in bone types I, II, and III showed significantly higher survival rates than those installed in type IV. The bone type I success rate was not significantly different than that of type II; however, the success rate of bone type I and II was higher than that of type III.

Patient-reported outcome measures and clinical assessment of implant-supported overdentures and fixed prostheses in mandibular edentulous patients: A systematic review and meta-analysis

STATEMENT OF PROBLEM

A consensus based on patients' perceptions as to whether to use overdentures or fixed prostheses to rehabilitate mandibular edentulous arches is limited.

PURPOSE

The purpose of this systematic review and meta-analysis was to compare the patient-reported outcome measures (PROMs) and clinical outcomes associated with implant-supported overdentures and fixed prostheses in edentulous mandibles.

MATERIAL AND METHODS

Nine electronic databases were searched for randomized clinical trials (RCTs) and nonrandomized clinical trials (N-RCTs). The risk of bias was assessed by the revised Cochrane risk of bias tool for RCTs (RoB 2) and N-RCT (ROBINS-I). Data sets for oral health-related quality of life (OHRQoL), satisfaction, survival rate, implant probing depth, and marginal bone loss were plotted, and the appropriate analyses were applied by using the Rev Man 5.3 software program. Certainty of evidence was also evaluated by means of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

RESULTS

Ten eligible trials were included and evaluated quantitatively. For 3 domains of OHRQoL, fixed prostheses showed significantly higher quality of life when compared with overdentures regarding functional limitation (P<.001), physical disability (P=.001), and physical pain (P=.003). Fixed prostheses also improved satisfaction, when compared with overdentures for comfort (P=.02), ease of chewing (P<.001), retention (P<.001), and stability (P<.001). The same pattern was observed for overall OHRQoL (P=.01) and satisfaction (P=.01) in which fixed prostheses improved patient satisfaction. Only ease of cleaning presented greater satisfaction for the overdenture group. Clinical parameters did not differ statistically (P>.05) between both types of prosthesis.

CONCLUSIONS

Fixed rehabilitations for mandibular edentulous patients seem to be a well-accepted treatment from the patients' oral health perspective. However, mandibular overdentures are no less efficient than fixed prostheses in terms of clinical outcomes.

Marginal bone loss around oral implants supporting fixed versus removable prostheses: a systematic review

Aim

The aim of this systematic review was to evaluate and compare the marginal bone loss (MBL) around implants of fixed (FISP) versus removable implant-supported prosthesis (RISP).

Material and methods

This review was conducted according to the PRISMA guidelines. A systematic search of the literature on Web of Science and Ovid (MEDLINE) was conducted in March 2019 to identify randomized controlled trials/quasi-randomized trials, prospective and retrospective studies written in German and English. Two reviewers screened the identified papers for eligibility and performed an independent data extraction. The Newcastle-Ottawa Scale was used to evaluate the level of evidence of the included studies.

Results

The search resulted in 2577 studies, of which 42 were selected for full-text evaluation. Finally, six studies were included in qualitative analyses, reporting results from 248 participants (81 FISP versus 167 RISP). Five of the included studies were prospective and one study was retrospective. MBL was highest in the first year after implant placement and ranged from 0.17 ± 0.07 mm to 2.1 ± 1.6 mm in FISP and from 0.22 ± 0.55 mm to 2.5 ± 2.7 mm in RISP. After 4 years, there was no statistically significant difference between the groups; MBL ranged from 0.36 ± 0.22 mm to 1.5 mm in FISP and 0.56 ± 0.45 mm to 1.4 mm in RISP. Of the six included studies, two each were rated as good quality, fair quality, and poor quality.

Conclusion

Fixed and removable implant-supported prostheses seem to have similar long-term outcomes regarding marginal bone loss. However, the evidence provided in this systematic review is limited due to the poor quality of two of the included studies. Future studies with study designs specified to the topic of this review are necessary to provide clear information about marginal bone level alterations in modern implant therapy.

Bite Reconstruction in the Aesthetic Zone Using One-Piece Bicortical Screw Implants

The aim of this article was to present the clinical application of a new, smooth surfaced one-piece bicortical screw implant with immediate loading protocol. An 18-year-old, healthy male patient with a history of total dislocation and replantation of teeth 11 and 21 in early childhood was admitted to the clinic. Teeth 11 and 21 were extracted, and two long one-piece implants were inserted at extraction sockets in one surgical session under local anesthesia. Temporary composite crowns were placed in the patient on the same day. After 3 months, the single-phase two-layer impression was made and the composite crowns were replaced with metal-ceramic crowns. After 12 months, satisfactory aesthetic and functional results were obtained.

Tardive Dyskinesia, Oral Parafunction, and Implant-Supported Rehabilitation

Oral movement disorders may lead to prosthesis and implant failure due to excessive loading. We report on an edentulous patient suffering from drug-induced tardive dyskinesia (TD) and oral parafunction (OP) rehabilitated with implant-supported screw-retained prostheses. The frequency and intensity of the movements were high, and no pharmacological intervention was possible. Moreover, the patient refused night-time splint therapy. A series of implant and prosthetic failures were experienced. Implant failures were all in the maxilla and stopped when a rigid titanium structure was placed to connect implants. Ad hoc designed studies are desirable to elucidate the mutual influence between oral movement disorders and implant-supported rehabilitation.

The influence of radiation therapy on dental implantology

Patients with a history of head and neck cancer resection require extensive prosthodontic rehabilitation following cancer treatment. The oral anatomy drastically changes from ablative therapy, and the oral tissue response becomes altered as a consequence of radiation and chemotherapy. Successful restoration of oral function in this specific patient population was increasingly difficult before the widespread use of dental implants. Implant-borne prosthetics are now often used. However, surgical guidelines remain unclear with regard to oncology-related parameters. In this article, guidelines are introduced for implant therapy in the cancer patients according to radiation dosage and timing. Indications for hyperbaric oxygen treatment are highlighted along with risk assessment associated with implant placement. These guidelines are intended to augment knowledge obtained through oncology consultation; moreover, provide a rationale for implant therapy within the course of cancer treatment.

Oral rehabilitation following removal of a rhabdomyosarcoma and subsequent microstomia: a case report

Rhabdomyosarcoma is a malignant tumor that is most often seen in children younger than 15 years of age. This pathology is found mainly in the head and neck region. Treatment of rhabdomyosarcoma at early stages of life usually affects the dental and osseous development of children. Because of impaired development, microstomia can arise, making dental treatment more difficult. This article presents a patient with microstomia caused by resection of an embryonal rhabdomyosarcoma in the nasolabial region. The patient was treated with 5 dental implants and fixed hybrid prosthesis in the maxilla and 2 implants supporting an overdenture in the mandible.

Parameters for successful implant integration revisited part I: immediate loading considered in light of the original prerequisites for osseointegration

PURPOSE

With the increasing popularity and publication of loading implants at the time of placement, including at time of dental extraction and simultaneous with reconstructive procedures, the objective was to evaluate known variables identified for a traditional unloaded healing period and determine the applicability of these variables to immediate loading.

MATERIALS

A total of 124 published reports available as of January 2008 that contained information about loading from the time of surgery up to 3 months postsurgically were examined in light of published variables affecting osseointegration based on a 2 stage surgical approach.

METHODS

The articles were examined to differentiate between immediate loading (within the initial 48 hours) and early/delayed loading of implants. Success or survival criteria were noted, and where reasons for failure were available, categorized according to six variables considered as determinants for maintaining a long-term bone-to-implant contact.

RESULTS

Approximately 60 of the 124 reports described immediately loading implants within 48 with single-tooth, partial, and full-arch restorations, as well as implant overdentures. The implant success or survival rates ranged from 70.8% to 100%. Most studies considered implant survival to be the only criterion for success.

CONCLUSIONS

Of six parameters identified in 1981 as influencing osseointegration, two parameters (the status of the bone/implant site and implant loading conditions) appear to have diagnostic implications, whereas three (implant design, surgical technique, and implant finish) may affect immediate loading positively or adversely.

Implant restoration of partially edentulous ridges: a review of 121 Nigerian patients

OBJECTIVE

Because of increasing health awareness, many Nigerian patients are demanding that their lost tooth/teeth be replaced with dental implants. This study reports the pattern and distribution of implant replacement of lost tooth/teeth in a private dental practice in Lagos, Nigeria.

METHODS

A retrospective review of implant replacement of lost tooth/teeth over a period of 6 years at Schubbs Private Dental Clinic, Lagos, was carried out. Data analysis included age, sex, occupation, habits and medical condition of patients, augmentation procedure, technique of implant placement (immediate vs conventional loading) tooth/teeth replaced, and follow-up period.

RESULTS

A total of 227 implants (Bicon, Boston, MA) with complete superstructure were placed in 121 patients(males = 68, females = 53; age range: 15-74 years). Majority of the patients were of high socioeconomic class. Ten (8.3%) patients had immediate implants and 111 (91.7%) undergone 2-stage implant procedures. The highest number (39.2%) of implants was placed in the molar region, and the replacement of the canines was the lowest (3.1%). Success rate over a period of 6 years was 96%. Of the 9 (4%) implants that failed, 2 were repeated and remained functional till date.

CONCLUSIONS

Dental implant therapy as a means of tooth replacement is gaining popularity among Nigerian social upper class. Success rate in this series is comparable with previous reports from Europe and America.

Basic research methods and current trends of dental implant surfaces

Among dental implant design alterations, surface modifications have been by far the most investigated topic. Regarding implant surface research, the lack of hierarchical approaches relating in vitro, in vivo, clinical trials, and ex vivo analyses has hindered biomaterials scientists with clear informed rationale guidelines for implant surface design. This manuscript provides a critical hierarchical overview of the in vitro, laboratory in vivo, clinical, and ex vivo methodologies used to investigate the performance of novel biomaterials aiming to allow dental professionals to better evaluate the past, present, and future dental implant surface research. This manuscript also contains an overview of the commercially available surface texture and chemistry modifications including novel nanotechnology-based fabrication processes. Over the last decade, surface texturing has been the most utilized parameter for increasing the host-to-implant response. Recently, dental implant surfaces utilizing reduced length scale physico/chemical features (atomic and nanometric) have shown the potential to synergistically use both texture and the inclusion of bioactive ceramic components on the surface. Although surface modifications have been shown to enhance osseointegration at early implantation times, information concerning its long-term benefit to peri-implant tissues is lacking due to the reduced number of controlled clinical trials. Given the various implants/surfaces under study, the clinician should ask, founded on the basic hierarchical approach described for the in vitro, laboratory in vivo data, as well as the results of clinical studies to effectiveness before use of any dental implant.

Prosthodontic rehabilitation of oral function in head-neck cancer patients with dental implants placed simultaneously during ablative tumour surgery: an assessment of treatment outcomes and quality of life

The aim of this prospective study was to assess treatment outcome and impact on quality of life of prosthodontic rehabilitation with implant-retained prostheses in head-neck cancer patients. Fifty patients were evaluated by standardized questionnaires and clinical assessment. All received the implants during ablative tumour surgery in native bone in the interforaminal area. About two-thirds of the patients (n=31) needed radiotherapy post-surgery. Both in irradiated and non-irradiated bone two implants were lost 18-24 months after installation. Peri-implant tissues had a healthy appearance. No cases of osteoradionecrosis occurred. In 15 patients no functional implant-retained lower dentures could be made for various reasons. The other 35 patients all functioned well, with an improvement in quality of life. Major improvement was observed in the non-irradiated patients. In the irradiated patients, less improvement in many functional items was observed, while items related to the oral sequelae of radiotherapy did not improve. Similar to the quality-of-life assessments, denture satisfaction was improved and tended to be higher in non-irradiated than irradiated patients. Implant-retained lower dentures can substantially improve the quality of life related to oral functioning and denture satisfaction in head-neck cancer patients. This effect is greater in non-irradiated than irradiated cancer patients.

Dental Implants for Immediate Fixed Restoration of Partially Edentulous Patients: A 1-Year Prospective Pilot Clinical Trial in Periodontally Susceptible Patients

BACKGROUND

The aim of this study was to evaluate the survival of dental implants in periodontally susceptible patients using immediate loading/restoration (ILR) protocols and the factors that modulate this response.

METHODS

Systemically healthy patients who were treated previously for chronic periodontitis and who required implant therapy were recruited. Following data collection, "surgical templates" and provisional fixed restorations were fabricated. Transgingival implants were inserted, and surgical measurements were performed. After abutment connection, the crown/bridge was relined and cemented. Patients were monitored for 12 months, at which time final measurements were performed.

RESULTS

Twenty patients (49 implants) completed this study; five implants failed and were removed (90% survival rate). All implants were removed during the first 6 months. At 12 months, the mean implants' probing depth was 2.87 +/- 0.9 mm. The mean electronic mobility testing device value (-1.3 +/- 0.7) was slightly higher than at baseline (-3.53 +/- 10.7). Radiographic bone loss ranged between -1.24 and 2.77 mm (mean +/- SD: 0.91 +/- 0.2 mm). All of the implants (16) that were inserted in the premolar region were successful, whereas three of nine implants in the molar region and two of 24 implants in the canine/incisor region failed (P = 0.0278). Survival in the immediately loaded group (83%) was slightly lower than in the immediately restored group (96%); however, these differences did not reach statistical significance. None of the other variables (smoking, arch, stability, implant length and diameter, and bone width) affected the outcome of this procedure.

CONCLUSIONS

ILR protocols are predictable alternatives in periodontally susceptible patients. Results in the molar regions suggested that careful consideration should be given to implants placed in these sites. Long-term success in these patients has not been addressed.

Computer-guided flapless placement and immediate loading of four conical screw-type implants in the edentulous mandible

AIM

The aim of this prospective study was to evaluate the outcome of computer-guided flapless placement and immediate loading of four conical screw-type implants in the interforaminal region.

PATIENTS AND METHODS

From May to August 2003, 25 consecutive patients (m : f=16 : 9) with edentulous mandibles were included in the study. After transmucosal drilling with computer-assisted navigation, four implants were placed in the interforaminal region. The lower dentures were converted and implants immediately loaded.

RESULTS

One-hundred implants were successfully placed. In two patients, all implants had to be submerged because of insufficient primary stability of one of the implants; another patient declined to receive immediate loading of implants after surgery and was lost to follow-up. During follow-up of the remaining 22 patients with 88 immediately loaded implants, loosening of four implants (4.5%) was seen in three patients. In these cases, immediate loading was terminated and all implants submerged; subsequently, two implants were lost in one patient, while the other two implants re-osseointegrated. The cumulative survival and success rates of immediately loaded implants were 97.7% after 2 years. Prosthetic success was 100%.

CONCLUSION

Transmucosal computer-assisted placement and immediate loading of mandibular implants is a high-end approach to edentulism that provides excellent results while being minimally invasive.

Immediate Loading of Implant Overdentures Using Modified Loading Protocol

To our knowledge, this study shows the first longitudinal results (range 12-30 months) of immediate loading of implant-support overdenture with ball attachment connection placed in the anterior mandible. Immediately after surgery, the overdenture was connected to the implants with 2-ball attachments. The housings were filled with Impregum (3M Espe AG; Seefeld, Germany) impression material to provide retention as well as reduce forces in the initial phase of loading. Of the 28 implants placed, only 1 failed; the 1 failed implant for total implants placed represents a success rate of 96.4%. The minimal bone loss (1 mm) in 2 sites represents a success rate of 92.8%.

Immediate and early implant loading protocols: a literature review of clinical studies

The purpose of this literature review is to present the outcomes of clinical studies on immediate and early loading protocols, identify shortcomings, and suggest a number of questions that still require exploration. English language clinical studies, limited to peer-reviewed journals between 1975 and 2004, were reviewed to identify treatment outcomes with these loading protocols. The data were tabulated from studies reporting on patients treated with fixed and overdenture prostheses. The former included partially edentulous patients treated with single or multi-unit prostheses. Within the limitations of this review, it can be concluded that these treatment protocols are predictable in the anterior mandible, irrespective of implant type, surface topography, and prosthesis design (success rates 90%-100%). Limited evidence for the edentulous maxilla (success rates 90%-100%) and the partially edentulous patient (success rates 93%-100%) are available, underscoring the need for further research. Studies suggest that to achieve predictable results in extraction sites, implant placement should be restricted to sites without a history of periodontal involvement (success rates 61%-100%). A number of questions require further exploration. There is a need to thoroughly investigate clinical outcomes to measure the economic benefit of these protocols and the impact of treatment on a patient's quality of life. Furthermore, more accurate long-term studies reporting on treatment protocols for separate clinical situations are required to allow meaningful comparisons.

Histologic Analysis of an Immediately Loaded Implant Retrieved After 2 Months

Human biopsy of immediately loaded implants is the most important way to determine the occurrence of osseointegration. Implants inserted in sites with poor bone quality have been associated with lower success rates. The aim of this study is to document the early healing processes in a man around an immediately loaded implant retrieved after a 2-month loading period. An implant was inserted in the mandible of a 32-year-old patient and was loaded into a nonfunctional loading mode with a fixed provisional prosthesis the same day of the implant surgery. After 2 months, because the patient had difficulty accepting the implant, the implant was retrieved with a 5-mm trephine drill. Before retrieval, the implant appeared to be clinically osseointegrated, and no mobility was present. The preexisting bone quality was type D4. The implant was surrounded by newly formed bone lamellae with a width of 200 to 400 microm. In many areas it was possible to observe osteoblasts producing osteoid matrix directly on the implant surface. Bone-to-implant contact percentage was 71% +/- 3.2%. Even in a poor bone site and after a healing period of only 2 months, we observed a high bone-to-implant contact percentage. We can confirm that immediately loaded implants placed in soft spongy bone after a 2-month healing period can present mineralized tissue at the interface.

Direct Implant Loading in the Edentulous Maxilla Using a Bone Density–Adapted Surgical Protocol and Primary Implant Stability Criteria for Inclusion

BACKGROUND

Long healing periods and submerged implant placement are commonly used in the maxilla. This extends the time of oral handicap and makes the use of immediate loading protocols an attractive option. The current clinical literature on direct loading of dental implants in the maxilla is limited.

PURPOSE

The purpose of this prospective clinical study was to evaluate the clinical outcome and stability of directly loaded Brånemark System or Replace Select Tapered implants (Nobel Biocare AB, Göteborg, Sweden) after using a modified surgical protocol and inclusion by primary implant stability. In addition, a reference group treated according to a two-stage protocol was used for comparison.

MATERIALS AND METHODS

Twenty patients planned for prosthetic rehabilitation with implant-supported bridges in the edentulous maxilla participated in the study group. The final decision on immediate loading was made after implant placement using insertion torque and resonance frequency analysis (RFA) as acceptance criteria. All patients were included, and 123 oxidized implants (TiUnite, Nobel Biocare AB) were placed using a surgical protocol for enhanced primary stability. A screw-retained temporary bridge was delivered within 12 hours and a final bridge within 3 months of implant placement. The patients were monitored through clinical and radiographic follow-up examinations from implant placement to at least 12 months. Marginal bone level was measured at bridge delivery and after 12 months of loading. Additional RFA measurements were made after 6 months of loading. A reference group comprising 20 patients with 120 implants treated according to a two-stage protocol was used for comparison.

RESULTS

One (0.8%) of the 123 implants in the study group failed, and no implant was lost in the reference group. The cumulative survival rates after 12 months of loading were thus 99.2% and 100% for immediate and delayed loading protocols, respectively. The marginal bone resorption was 0.78 (SD 0.9) in the study group and 0.91 (SD 1.04) in the reference group. RFA showed a mean value of 62.9 (SD 4.9) implant stability quotient (ISQ) at placement and 64.5 (SD 4.8) ISQ after 6 months for immediately loaded implants (not significant). The corresponding figures for the reference groups were 61.3 (SD 8.8) ISQ and 62.6 (SD 7.0) ISQ (not significant). There were no statistically significant differences between the groups at any time point.

CONCLUSION

The use of six to seven implants for immediate loading of a fixed provisional bridge is a viable option for implant treatment of the edentulous maxilla, at least when good primary implant stability can be ensured.

Simplified Methods of Implant Treatment in the Edentulous Lower Jaw: A 3-Year Follow-Up Report of a Controlled Prospective Study of One-Stage versus Two-Stage Surgery and Early Loading

BACKGROUND

Interest in the use of one-stage surgery and immediate loading of oral implants has lately been increasing.

PURPOSE

The aim of this study was to compare the 3-year results of one-stage surgery versus two-stage surgery, early loading versus loading after a 3-month healing period, and the use of one-piece implants versus the use of two-piece implants.

MATERIALS AND METHODS

The study included 108 patients with edentulous mandibles. Each patient was treated with four Brånemark System implants (Nobel Biocare AB, Göteborg, Sweden) and with full fixed prostheses. Patients were consecutively treated and were distributed in four groups: group A (one-stage surgery), group B (control group with two-stage surgery), group C (one-piece implants), and group D (early loading). In groups A and B Brånemark Standard implants and standard abutments were used. In group C the conical one-piece Brånemark implant was used, and in group D the patients had Brånemark System Mk III implants together with multiunit abutments. All patients were observed for 3 years.

RESULTS

Of the 432 inserted implants, 24 were lost. Survival rates in the three experimental groups ranged from 93.2 to 93.3% whereas the survival rate in group B (the control group with two-stage surgery) was 97.5%. The differences between the groups were not statistically significant. The changes in marginal bone level were measured from fixture insertion to the final follow-up at 3 years. The bone loss in group D (early loading) was significantly less than in group B (the control group) whereas there were no differences in marginal bone change between the other groups.

CONCLUSIONS

Early loading seemed to give good results in the anterior part of the mandible. The survival rate of the early-loaded implants did not significantly differ from that of implants inserted with the conventional two-stage procedure, but the mean marginal bone loss around the surviving implants was less with early loading.

The use of implant retained mandibular prostheses in the oral rehabilitation of head and neck cancer patients. A review and rationale for treatment planning

Surgical treatment of malignancies in the oral cavity (tongue, floor of the mouth, alveolus, buccal sulcus, oropharynx) often results in an unfavourable anatomic situation for prosthodontic rehabilitation. The outcome is a severe disturbance of oral functioning despite the improved surgical techniques for reconstruction that are currently available. Radiotherapy, which often is applied postsurgically, worsens oral functioning in many cases. Main problems that may hamper proper prosthodontic rehabilitation of these patients include a severe reduction of the neutral zone, an impaired function of the tongue, and a very poor load-bearing capacity of the remaining soft tissues and mandibular bone. Many of these problems can, at least in part, be diminished by the use of endosseous oral implants. These implants can contribute to the stabilisation of the prostheses and intercept the main part of the occlusal loading. Surgical interventions after radiotherapy are preferably avoided because of compromised healing, which may lead to development of radionecrosis of soft tissues and bone as well as to increased implant loss. If surgical treatment after radiotherapy is indicated, measures to prevent implant loss and development of radionecrosis have to be considered e.g. antibiotic prophylaxis and/or pre-treatment with hyperbaric oxygen (HBO). To avoid this problem, implant insertion during ablative surgery has to be taken into consideration if postoperative radiotherapy is scheduled or possibly will be applied. This approach is in need of a thorough pre-surgical examination and multidisciplinary consultation for a well-established treatment planning. The primary curative intent of the oncological treatment and the prognosis for later prosthodontic rehabilitation have to be taken into account too.

Quality of dental implants

BACKGROUND

Clinicians need quality research data to decide which dental implant should be selected for patient treatment. AIM(S)/OBJECTIVE(S): To present the scientific evidence for claims of relationship between characteristics of dental implants and clinical performance.

STUDY DESIGN

Systematic search of promotional material and Internet sites to find claims of implant superiority related to specific characteristics of the implant, and of the dental research literature to find scientific support for the claims.

MAIN OUTCOME MEASURES

Critical appraisal of the research documentation to establish the scientific external and internal validity as a basis for the likelihood of reported treatment outcomes as a function of implant characteristics.

RESULTS

More than 220 implant brands have been identified, produced by about 80 manufacturers. The implants are made from different materials, undergo different surface treatments and come in different shapes, lengths, widths and forms. The dentist can in theory choose among more than 2,000 implants in a given patient treatment situation. Implants made from titanium and titanium alloys appear to perform well clinically in properly surgically prepared bone, regardless of small variations of shapes and forms. Various surface treatments are currently being developed to improve the capacity of a more rapid anchorage of the implant into bone. A substantial number of claims made by different manufacturers on alleged superiority due to design characteristics are not based on sound and long-term clinical scientific research. Implants are, in some parts of the world, manufactured and sold with no demonstration of adherence to any international standards.

CONCLUSIONS

The scientific literature does not provide any clear directives to claims of alleged benefits of specific morphological characteristics of dental implants.