Comparative Analysis of Immediate Functional Loading and Immediate Nonfunctional Loading to Traditional Healing Periods: A 5-Year Follow-Up of 550 Dental Implants

Pulsed Electromagnetic Therapy: Literature Review and Current Update

This manuscript provides a comprehensive review of Pulsed Electromagnetic Fields (PEMFs), highlighting their therapeutic potential and historical evolution. PEMFs, recognized for their non-invasive and safe therapeutic benefits, interact with biological systems to influence processes such as DNA synthesis, gene expression, and cell migration. Clinically, PEMFs are applied in diverse treatments, including pain relief, inflammation management, and enhancing bone and wound healing. The manuscript delves into the historical development of PEMF technology, tracing its origins to the 19th century and exploring significant advancements, such as the discovery of the piezoelectric effect in bones. It presents detailed in-vitro and in-vivo studies demonstrating PEMFs' impact on cellular activities and their modulation of key biological pathways. Additionally, the review emphasizes PEMFs' applications in general medicine and dentistry, showcasing their role in promoting tissue healing, osseointegration in dental implants, and antimicrobial effects. The introduction of the Miniaturized Electromagnetic Device (MED) in dental implantology marks a significant advancement, enhancing implant stability and reducing inflammatory responses. Overall, the manuscript underscores PEMFs' promising applications in advancing patient care and treatment methodologies across medical and dental fields.

Implant failure rate and the prevalence of associated risk factors: a 6-year retrospective observational survey

Introduction: The purpose of this monocentric retrospective observational investigation is to evaluate the implant failure rate observed in an oral surgery department and analyze the risk factors associated with them. Preventative measures will be suggested to reduce the incidence of implant failure. Material and method: All implants removed between 2014 and 2020 were analyzed. The main criterion assessed was the overall failure rate over 6 years of activity;the secondary criteria were the risk factors associated with implant failure. Results: 12 out of 376 implants placed between 2014 and 2019 in 11 patients (mean age: 55.5 ±11.5 years);sex ratio M/F=5/6) were removed, for an overall failure rate of 3.11%. The majority, 83% (10/12) of the lost implants, were in the maxilla, while only 17% (2/12) were placed in the mandible. The main risk factors identified were: a III−IV bone type density (75%, 9/12), pre-implant sinus lift surgery (42%, 5/12) smoking (8.3%, 1/12), surgical site infection (8.3%, 1/12) and rheumatoid arthritis (8.3%, 1/12). Conclusion: The failure rate observed in this oral surgery unit is consistent with the other international studies, confirming the compliance with good clinical practices of the healthcare team. Pre-implant bone surgery is the major risk factor to consider before implant surgery.

A 3-Year Prospective Clinical Study to Evaluate the Outcome of Single-Piece Implant-Prosthetic Complex after Immediate NonFunctional Loading in the Maxillary Anterior and Mandibular Posterior Areas in Varied Bone Densities

Context

There is limited evidence on the outcome of single-piece implant-prosthetic complex after immediate nonfunctional loading in varied bone densities.

Aim

The aim of this study was to report the outcome of single-piece implant-prosthetic complex with a novel cervical platform design in the anterior and posterior jaws 3 years after loading.

Setting and Design

Prospective clinical study.

Materials and Methods

The present study included placement of 90 single-piece implants in the anterior and the posterior jaws in varied bone densities. After immediate loading, survival and marginal bone loss was recorded at regular intervals.

Statistical Analysis

Independent sample t-test and paired t-test were done (P = 0.05).

Results

Group I, annual marginal bone loss at the end of one, 2 and 3 years was 0.21, respectively, in both bone densities. Group II, annual marginal bone loss in D2 regions was 0.75,0.38 and 0.18; 0.64, 0.28 and 0.18 in D3 regions at the end of 1, 2, and 3 years, respectively. Group I showed no statistically significant difference in marginal bone loss between D2 and D3 bone annually in contrast to Group II. Intragroup comparisons of mean between baseline and various time intervals showed statistically significant bone loss in both bone densities.

Conclusion

Three years after loading, single-piece implants with the novel cervical platform design provided survival rates of 93% in the maxillary anteriors and 91% in the mandibular posteriors. D3 bone showed more marginal bone loss than D2 bone.

Effect of the Pulsed Electromagnetic Field (PEMF) on Dental Implants Stability: A Randomized Controlled Clinical Trial

A pulsed electromagnetic field (PEMF) has been shown to contribute to heightening bone regeneration in a range of clinical areas, including dentistry. Due to the scarcity of studies using PEMF in oral implantology, the present experiment scrutinized the effect of PEMF can lead to improving the stability of the implant. A total of 19 subjects (40 implants in total) were selected to participate in the current study and were randomly allocated to either the PEMF group or control group. Subjects in the PEMF group received an activated miniaturized electromagnetic device (MED) while the control group received a sham healing cup. Implants stability was assessed by resonance frequency analyses (RFA) via implant stability quotient (ISQ) calculations. RFA were recorded as following: immediately after procedure, and then 2, 4, 6, 8 and 12 weeks later. Radiographic analysis was performed at baseline, 6 and 12 weeks after implant placement. Proinflammatory cytokines were evaluated in peri-implant crevicular fluid (PICF). The PEMF group presented higher ISQ mean values when compared to the control group. The primary stability time frame (the first 2 weeks) MED group depicted an increase in stability of 6.8%, compared to a decrease of 7.6% in the control group related to the baseline. An overall stability increase of 13% was found in MED treated group (p = 0.02), in contrast, the overall stability in the control group decreased by 2% (p = 0.008). TNF-α concentration during first 4 weeks was lower in the MED treated group. The data strongly suggests that MED generated continuing a PEMF may be considered as a new way to stimulate the stability of the implants at the early healing period.

A Systematic Review of Survival Rates of Osseointegrated Implants in Fully and Partially Edentulous Patients Following Immediate Loading

Background: The aim of this systematic review was to evaluate the survival rates of immediately loaded implants after at least five years. Besides implant failure, the amount of marginal bone loss around implants and the complication type were assessed. Methods: The electronic search was undertaken on Medline, Scopus, and Cochrane Central Register of Controlled Trials using key terms such as: “immediate loading”, “immediate function”, “immediate restoration”, “immediate temporization”, “dental implants”, “fully edentulous patients”, “partially edentulous patients”. The search terms were combined using the Boolean operators AND, OR. The last electronic search was performed on 15 February 2018. Two authors independently screened the studies, extracted the data, and assessed the risk-of bias. The main outcomes recorded for each study were: implant and prosthesis success and survival, marginal bone level change, incidence and type of complications. Kaplan–Meier analysis was used to estimate cumulative survival rates. Results: Thirty-four prospective studies with at least five-year follow-up, published between 2007 and 2017 were included. A total of 5349 immediately loaded implants in 1738 patients were analyzed. The mean follow-up was 72.4 months (median 60 months, 95% confidence intervals (CI): 64.53, 80.25 months, range 60 to 147 months). The mean weighted implant survival was 97.4% (median 98.15%, 95% CI: 96.29%, 98.54%, range 83.80% to 100%). Cumulative survival rate of implants placed in the mandible was significantly higher than for the maxilla (p < 0.01). No significant difference in failure rate was found among the types of prosthesis employed (p = 0.27). The mean peri-implant bone level change at the end of the follow-up in each study ranged from 0.3 to 1.7 mm. Conclusion: Immediate loading of implants appears to have long-term predictability and success rate under well-defined circumstances.

Mechanical aspects of dental implants and osseointegration: A narrative review

With the need of rapid healing and long-term stability of dental implants, the existing Ti-based implant materials do not meet completely the current expectation of patients. Low elastic modulus Ti-alloys have shown superior biocompatibility and can achieve comparable or even faster bone formation in vivo at the interface of bone and the implant. Porous structured Ti alloys have shown to allow rapid bone ingrowth through their open structure and to achieve anchorage with bone tissue by increasing the bone-implant interface area. In addition to the mechanical properties of implant materials, the design of the implant body can be used to optimize load transfer and affect the ultimate results of osseointegration. The aim of this narrative review is to define the mechanical properties of dental implants, summarize the relationship between implant stability and osseointegration, discuss the effect of metallic implant mechanical properties (e.g. stiffness and porosity) on the bone response based on existing in vitro and in vivo information, and analyze load transfer through mechanical properties of the implant body. This narrative review concluded that although several studies have presented the advantages of low elastic modulus or high porosity alloys and their effect on osseointegration, further in vivo studies, especially long-term observational studies are needed to justify these novel materials as a replacement for current Ti-based implant materials.

The influence of prosthetic material on implant and prosthetic survival of implant-supported fixed complete dentures: a systematic review and meta-analysis

PURPOSE

Evaluating the impact of the prosthetic material on implant- and prosthetic survival of implant-supported fixed complete dentures.

STUDY SELECTION

Electronic and hand searches were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to identify clinical studies including at least 10 patients restored with implant-supported dentures. The primary outcome was to evaluate the implant survival rate according to the applied restorative materials. The prosthetic survival rate was evaluated as secondary outcomes.

RESULTS

Forty-one of 2254 studies were finally selected. A statistically significant difference (p = 0.0337) was found between implant survival rates in the main restorative groups (metal-ceramic:97%(95%CI [0.96;0.98]), all-ceramic:99%(95%CI [0.98;1.00]), metal-resin:97%(95%CI [0.96;0.98])). Prosthetic survival rates were: (metal-ceramic:95%(95%CI [0.89;0.97]), all-ceramic:97%(95%CI [0.92;0.99]), metal-resin:97%(95%CI [0.95;0.98]), with no statistically significant difference (p = 0.3796) between the groups. Chipping incidence rates were as follows: metal-ceramic:8%(95%CI[0.03;0.20]), all-ceramic:15%(95%CI [0.06;0.32]), and metal-resin:22%(95%CI [0.13;0.33]). Five types of exact restorative materials were identified (porcelain-fused-to-non-precious alloy, porcelain-fused-to-zirconia, precious-metal-acrylic-resin, non-precious-metal-acrylic resin, and PMMA). Again, implant survival rates were statistically significantly influenced by the applied restorative materials (p = 0.0126), whereas, no significant differences were reported regarding prosthetic survival rate.

CONCLUSIONS

Prosthetic material selection seems to have no clinically relevant influence on implant- and prosthetic survival rate in implant-supported fixed complete dentures. Due to the high chipping rate, quantifying prosthetic survival alone does not seem to be a reliable tool for evaluating the outcome of the restorations and providing recommendations. These results, along with the obvious lack of evidence, suggest that clinicians must exercise caution whenever porcelain-fused-to-zirconia or metal-resin restorations are considered.

Implant supported cantilevered fixed dental rehabilitations in partially edentulous patients: Systematic review of the literature. Part I

OBJECTIVES

To investigate in which clinical situations a cantilever fixed implant supported restorations can be a treatment alternative and which complications are reported.

MATERIALS AND METHODS

Two operators screened the literature (MEDLINE, EMBASE) and performed a hand search on the main journals dealing with implantology and prosthetics until 31 December 2017. Only articles that considered cantilever implant fixed restorations with at least 10 patients and with a mean follow-up of at least 5 year were selected. The outcome variables were survival of implants and prosthesis, mechanical, technical and biological complications, marginal bone loss. The review was performed according to the PRISMA statements. Risk of bias assessment was evaluated. Failure and complication rates were analysed using random effect Poisson regression models to obtain summary estimate of 5- and 10-year survival and complication rates.

RESULTS

A total of nine papers were selected for partially edentulous patients and reported high survival rate of the prosthesis. The estimated survival rate for 5-10 years was calculated to be 98.4% for the implants and 99.2% for the rehabilitations. Mechanical, technical and biological complications were reported with a cumulative 5-10 years complication rate of 28.66% and 26.57% for the patients and for the prosthesis, respectively. Two papers for single implant supporting 2-unit cantilever were not sufficient to draw conclusions.

CONCLUSIONS

There is evidence that cantilever can be successful treatment in partially edentulous patients. In two adjacent edentulous sites, data are not yet sufficient.

Risk factors for implant failure: a retrospective study in an educational institution using GEE analyses

This study aimed to evaluate dental implant outcomes and to identify risk factors associated with implant failure over 12 years via dental records of patients attending an educational institution. Dental records of 202 patients receiving 774 dental implants from 2002 to 2014 were analyzed by adopting a more reliable statistical method to evaluate risk factors with patients as the unit [generalized estimating equation (GEE)]. Information regarding patient age at implantation, sex, use of tobacco, and history of systemic diseases was collected. Information about implant location in the arch region and implant length, diameter, and placement in a grafted area was evaluated after 2 years under load. Systemic and local risk factors for early and late implant failure were studied. A total of 18 patients experienced 25 implant failures, resulting in an overall survival rate of 96.8% (2.84% and 0.38% early and late implant failures, respectively). The patient-based survival rate was 91.8%. GEE univariate and multivariate analyses revealed that a significant risk factor for implant failure was the maxillary implant (p = 0.006 and p = 0.014, respectively). Bone grafting appeared to be a risk factor for implant failure (p = 0.054). According to GEE analyses, maxillary implants had significantly worse outcomes in this population and were considered to be a risk factor for implant failure. Our results suggested that implants placed in a bone augmentation area had a tendency to fail.

Peri-implant bone changes in immediate and non-immediate root-analog stepped implants-a matched comparative prospective study up to 10 years

BACKGROUND

The purpose of this retrospective long-term study was to evaluate the peri-implant bone changes in immediate implants and matched non-immediate implants as a control group using a specific and proven measurement protocol over a 10-year period, because there are no similar studies published.

METHODS

One hundred and thirty-three patients received 174 implants (immediate implants (IM) n = 87; control group (CG) n = 87). The two groups were matched following specific criteria for comparison: implant length, diameter, site of the implant, and patient's gender. For the evaluation, radiographic images were taken, digitalized, and assessed using the "coronal bone defect (CBD)".

RESULTS

The differences between the means and medians showed a statistically significant difference at the time of insertion, while to the other control dates, no significant differences could be concluded. The median CBD for the control group was 0 mm at the time of insertion and increased to 1.7 mm after 10 years while the CBD for the IM group was 0.7 mm at the time of insertion and increased to 1.5 mm over the 10 years.

CONCLUSIONS

Both surgical protocols lead in our study to similar outcomes regarding the loss of bone around dental implants.

A new device for improving dental implants anchorage: a histological and micro-computed tomography study in the rabbit

OBJECTIVE

In the present study, a new healing cap that could generate a pulsed electromagnetic field (PEMF) around titanium implants to stimulate peri-implant osteogenesis was tested in the rabbit model.

MATERIALS AND METHODS

A total of 22 implants were inserted in the proximal tibial metaphysis of 22 rabbits. A healing cap containing the active device was inserted in half of the implants (11 test implants); an "empty" healing cap was inserted in the other ones (11 control implants). The animals were euthanized after 2 and 4 weeks, and the samples were processed for micro-computed tomography and histology. The peri-implant volume was divided into coronal (where the PEMF was the strongest) and apical regions.

RESULTS

Most of the effects of the tested device were confined to the coronal region. Two weeks post-implantation, test implants showed a significant 56% higher trabecular bone fraction (BV/TV), associated with enhanced trabecular number (Tb.N, +37%) and connectivity density (Conn.D, +73%) as compared to the control group; at 4 weeks, the PEMF induced a 69% increase in BV/TV and 34% increase of Tb.N. There was no difference in the trabecular thickness (Tb.Th) at either time point. Furthermore, we observed a 48% higher bone-to-implant contact (BIC) in the test implants vs. controls after 2 weeks; this increase tended to remain stable until the fourth week. Mature trabecular and woven bone were observed in direct contact with the implant surface with no gaps or connective tissue at the bone-implant interface.

CONCLUSIONS

These results indicate that the PEMF device stimulated early bone formation around dental implants resulting in higher peri-implant BIC and bone mass already after 2 weeks which suggests an acceleration of the osseointegration process by more than three times.

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.

Immediate nonfunctional versus immediate functional loading and dental implant failure rates: a systematic review and meta-analysis

OBJECTIVES

The purpose of the present review was to test the null hypothesis of no difference in the implant failure rates, postoperative infection, and marginal bone loss for patients being rehabilitated using dental implants with immediate nonfunctional loading (INFL) compared to immediate functional loading (IFL), against the alternative hypothesis of a difference.

METHODS

An electronic search without time or language restrictions was undertaken in March 2014. Eligibility criteria included clinical human studies, either randomized or not. The estimates of relative effect were expressed in risk ratio (RR) and mean difference (MD) in millimeters.

RESULTS

1059 studies were identified and 11 studies were included, of which 7 were of high risk of bias, whereas four studies were of low risk of bias. The results showed that the procedure used (nonfunctional vs. functional) did not significantly affect the implant failure rates (P=0.70), with a RR of 0.87 (95% CI 0.44-1.75). The wide CI demonstrates uncertainty about the effect size. The analysis of postoperative infection was not possible due to lack of data. No apparent significant effects of non-occlusal loading on the marginal bone loss (MD 0.01mm, 95% CI -0.04-0.06; P=0.74) were observed.

CONCLUSIONS

The results of this study suggest that the differences in occlusal loading between INFL and IFL might not affect the survival of these dental implants and that there is no apparent significant effect on the marginal bone loss.

CLINICAL SIGNIFICANCE

There has been a controversy concerning whether dental implants should be subjected to immediate functional or nonfunctional loading. As the philosophies of treatment may alter over time, a periodic review of the different concepts is necessary to refine techniques and eliminate unnecessary procedures. This would form a basis for optimum treatment.

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.

A systematic review of the survival and complication rates of implant-supported fixed dental prostheses (FDPs) after a mean observation period of at least 5 years

OBJECTIVES

The objective of this systematic review was to assess the 5- and 10-year survival of implant-supported fixed dental prostheses (FDPs) and to describe the incidence of biological and technical complications.

METHODS

An electronic Medline search complemented by manual searching was conducted to identify prospective and retrospective cohort studies and case series on FDPs with a mean follow-up time of at least 5 years. Patients had to have been examined clinically at the follow-up visit. Failure and complication rates were analyzed using standard and random-effects Poisson regression models to obtain summary estimates of 5-year and 10-year survival and complication rates.

RESULTS

The updated search provided 979 titles and 257 abstracts. Full-text analysis was performed for 90 articles resulting in a total 32 studies that met the inclusion criteria. Meta-analysis of these studies indicated an estimated survival of implants supporting FDPs of 95.6% after 5 years and 93.1% after 10 years. When machined surface implants were excluded from the analysis and only rough surface implants included, the survival rate increased to 97.2% after 5 years. The survival rate of implant-supported FDPs was 95.4% after 5 years and 80.1% after 10 years of function. When the analysis was done exclusively for metal-ceramic FDPs, hence the old gold-acrylic FDPs were excluded, the survival rate increased significantly. The survival rate of metal-ceramic implant-supported FDPs was 96.4% after 5 years and 93.9% after 10 years. Only 66.4% of the patients were free of any complications after 5 years. The most frequent complications over the 5-year observation period were fractures of the veneering material (13.5%), peri-implantitis and soft tissue complications (8.5%), loss of access hole restoration (5.4%), abutment or screw loosening (5.3%), and loss of retention of cemented FDPs (4.7%).

CONCLUSION

It may be concluded that implant-supported fixed dental prostheses (FDPs) are a safe and predictable treatment method with high survival rates. However, biological and technical complications were frequent (33.6%). To minimize the incidence of complications, dental professionals should make great effort in choosing reliable components and materials for implant-supported FDPs and the patients should be placed in well-structured maintenance system after treatment.

Systematic review of the survival rate and the incidence of biological, technical, and aesthetic complications of single crowns on implants reported in longitudinal studies with a mean follow-up of 5 years

OBJECTIVE

To assess the 5-year survival of implant-supported single crowns (SCs) and to describe the incidence of biological, technical, and aesthetic complications. The focused question was: What is the survival rate of implants supporting single crowns and implant-supported crowns with a mean follow-up of 5 years and to which extent do biological, technical, and aesthetic complications occur?

METHODS

A Medline search (2006-2011) was performed for clinical studies focusing on implant-supported SCs with a mean follow-up of at least 5 years. The search was complemented by an additional hand search and the inclusion of 24 studies from a previous systematic review (Jung et al. 2008a). Survival and complication rates were analyzed using random-effects Poisson's regression models to obtain summary estimates of 5- and 10-year proportions.

RESULTS

Forty-six studies derived from an initial search count of 1083 titles and the complementary publications from the previous systematic review (Jung et al. 2008a) were selected and the data were extracted. Based on the meta-analysis, survival of implants supporting SCs at 5 years amounted to 97.2% (95% CI: 96.3-97.9%), and at 10 years amounted to 95.2% (95% CI: 91.8-97.2%). The survival of implant-supported SCs was 96.3% (95% CI: 94.2-97.6%) after 5 years and 89.4% (95% CI: 82.8-93.6%) after 10 years. For biological complications, a 5-year cumulative soft tissue complication rate of 7.1% (95% CI: 4.4-11.3%) and a cumulative complication rate for implants with bone loss >2 mm of 5.2% (95% CI: 3.1-8.6%) were calculated. Technical complications reached a cumulative incidence of 8.8% (95% CI: 5.1-15.0%) for screw-loosening, 4.1% (95% CI: 2.2-7.5%) for loss of retention, and 3.5% (95% CI: 2.4-5.2%) for fracture of the veneering material after 5 years. The cumulative 5-year aesthetic complication rate amounted to 7.1% (95% CI: 3.6-13.6%).

CONCLUSIONS

The outcomes of the meta-analysis demonstrated high implant survival rates for both the single tooth implants and the respective single crowns after 5 and 10 years. However, technical, biological, and aesthetic complications were frequent.

Implant and prosthodontic survival rates with implant fixed complete dental prostheses in the edentulous mandible after at least 5 years: a systematic review

BACKGROUND

The treatment of mandibular edentulism with implant fixed complete dental prostheses (IFCDPs) is a routinely used treatment option.

PURPOSE

The study aims to report the implant and prosthodontic survival rates associated with IFCDPs for the edentulous mandible after an observation period of a minimum 5 years.

MATERIALS AND METHODS

An electronic MEDLINE/PubMED search was conducted to identify randomized controlled clinical trials and prospective studies with IFCDPs for the edentulous mandible. Clinical studies with at least 5-year follow-up were selected. Pooled data were statistically analyzed and cumulative implant- and prosthesis survival rates were calculated by meta-analysis, regression, and chi-square statistics. Implant-related and prosthesis-related factors were identified and their impact on survival rates was assessed.

RESULTS

Seventeen prospective studies, including 501 patients and 2,827 implants, were selected for meta-analysis. The majority of the implants (88.5% of all placed implants) had been placed in the interforaminal area. Cumulative implant survival rates for rough surface ranged from 98.42% (95% confidence interval [CI]: 97.98-98.86) (5 years) to 96.86% (95% CI: 96.00-97.73) (10 years); smooth surface implant survival rates ranged from 98.93% (95% CI: 98.38-99.49) (5 years) to 97.88% (95% CI: 96.78-98.98) (10 years). The prosthodontic survival rates for 1-piece IFCDPs ranged from 98.61% (95% CI: 97.80-99.43) (5 years) to 97.25% (95% CI: 95.66-98.86) (10 years).

CONCLUSION

Treatment with mandibular IFCDPs yields high implant and prosthodontic survival rates (more than 96% after 10 years). Rough surface implants exhibited cumulative survival rates similar to the smooth surface ones (p > .05) in the edentulous mandible. The number of supporting implants and the antero-posterior implant distribution had no influence (p > .05) on the implant survival rate. The prosthetic design and veneering material, the retention type, and the loading protocol (delayed, early, and immediate) had no influence (p > .05) on the prosthodontic survival rates.

In vitro and in vivo studies of surface-structured implants for bone formation

Background and methods

Micronanoscale topologies play an important role in implant osteointegration and determine the success of an implant. We investigated the effect of three different implant surface topologies on osteoblast response and bone regeneration. In this study, implants with nanotubes and micropores were used, and implants with flat surfaces were used as the control group.

Results

Our in vitro studies showed that the nanostructured topologies improved the proliferation, differentiation, and development of the osteoblastic phenotype. Histological analysis further revealed that the nanotopology increased cell aggregation at the implant-tissue interfaces and enhanced bone-forming ability. Pushout testing indicated that the nanostructured topology greatly increased the bone-implant interfacial strength within 4 weeks of implantation.

Conclusion

Nanotopography may improve regeneration of bone tissue and shows promise for dental implant applications.

Immediate nonfunctional loading of NobelPerfect implants in the anterior dental arch in private practice--5-year data

BACKGROUND

The concept of scalloped implants to maintain the natural contour of the alveolar ridge has been a source of controversy for many years.

PURPOSE

This study examined the long-term clinical performance of the scalloped NobelPerfect implant in a one-stage procedure (immediate loading in the esthetic zone).

MATERIALS AND METHODS

In 20 patients, immediate prosthetic restorations were placed on 31 NobelPerfect implants in a private practice and followed for up to 78 months. Twenty-one implants were placed immediately after extraction, seven implants were placed after osseous consolidation of the extraction sockets, and three implants were placed secondary to extended alveolar ridge augmentation procedures. All implants were provisionalized on the day of implant placement and adjusted to clear all contacts in centric occlusion and during eccentric movements. Outcome variables were success rates, marginal bone levels, and pink esthetic score (PES) assessed per implant.

RESULTS

One implant failed after 1.4 months. Five patients with six implants in total were scored in the 5-year follow-up as dropouts. Mean follow-up period of remaining 24 implants was 65 months (range, 55-78 months). Cumulative success rates according to the criteria specified by Smith and Zarb were 96.8%. Marginal bone levels averaged 1.1 mm above the first thread. Mean PES ratings were 10.5 (range, 3-13).

CONCLUSIONS

Survival rates, marginal bone levels, and esthetic results suggest proof of principle for the preservation of the interproximal bony lamella with a scalloped implant design in long-term data.

Success Criteria in Implant Dentistry

The purpose of this study was to examine the most frequently used criteria to define treatment success in implant dentistry. An electronic MEDLINE/PubMED search was conducted to identify randomized controlled trials and prospective studies reporting on outcomes of implant dentistry. Only studies conducted with roughened surface implants and at least five-year follow-up were included. Data were analyzed for success at the implant level, peri-implant soft tissue, prosthetics, and patient satisfaction. Most frequently reported criteria for success at the implant level were mobility, pain, radiolucency, and peri-implant bone loss (> 1.5 mm), and for success at the peri-implant soft-tissue level, suppuration, and bleeding. The criteria for success at the prosthetic level were the occurrence of technical complications/prosthetic maintenance, adequate function, and esthetics during the five-year period. The criteria at patient satisfaction level were discomfort and paresthesia, satisfaction with appearance, and ability to chew/taste. Success in implant dentistry should ideally evaluate a long-term primary outcome of an implant-prosthetic complex as a whole.

Immediate provisional restoration of screw-type implants in the posterior mandible: results after 5 years of clinical function

OBJECTIVE

The aim of this prospective study was to evaluate the outcome of immediately provisionally restored implants in the posterior mandible after a minimum of 60 months in function.

MATERIAL AND METHODS

Twenty-four patients were treated with 40 screw-type implants replacing mandibular molars and premolars. Implants were provisionalized immediately after placement. Radiographic coronal bone levels, implant survival and success were evaluated 12, 24, 36, 48 and 60 months after the final restoration.

RESULTS

Measurements of the mean marginal bone levels around immediately loaded implants after 12 months showed a significant bone loss (P<0.001) within the first year after the final restoration. Measurements of coronal bone levels after 24, 36, 48 and 60 months, respectively, showed no further significant increase of bone resorption. Two implants were lost within the first year after the final restoration, resulting in an overall survival rate of 95%; a total of three implants were recorded as failures (two implant losses and one excessive bone resorption above 50%), resulting in an overall success rate of 92.5 after an implant observation period of up to 8 years.

CONCLUSION

The present data revealed results comparable to conventionally loaded implants. Careful patient selection in combination with high primary stability seem to be key factors for immediately loaded implants. Larger long-term randomized clinical trials are needed to confirm the final evidence of this protocol as the standard treatment concept for the partially edentulous mandible.