Seven-year follow-up results of TiUnite implants supporting mandibular overdentures: early versus delayed loading

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.

Clinical efficacy of early and delayed loading implants: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Whether early loaded implants have similar clinical outcomes to delayed loaded implants is unclear.

PURPOSE

The purpose of this systematic review and meta-analysis was to compare the outcomes of early and delayed loading dental implants.

MATERIAL AND METHODS

Comprehensive searches of the MEDLINE, EMBASE, and Ovid databases were enriched by hand searches. Only human randomized controlled trials (RCTs) that compared the clinical efficacy of early and delayed loading were included. The survival rates and marginal bone level (MBL) changes were pooled and analyzed by risk ratios (RRs) and weighted mean differences (WMDs), respectively. The subgroup analyses, which were based on the Mantel-Haenszel and inverse-variance methods, included the types of prosthesis, implant time, occlusion, number of missing teeth, operation methods, dental position, healing methods, and type of first restoration. A funnel plot was used for heterogeneity analysis.

RESULTS

Eighteen trials were included from the initial 601 articles. The dental implant survival rates for the early and delayed loading were similar (P>.05). Regarding the marginal bone level changes, the 2 loading protocols also reached a comparable clinical outcome (P>.05).

CONCLUSIONS

Early implant loading should achieve the same clinical efficacy as the delayed loading method.

Early Loading of Two Implants Supporting Mandibular Overdentures in Geriatric Edentulous Patients: A 12-Year Follow-Up Study

Background: This study aims to show the clinical outcomes of implants supporting mandibular overdentures in edentulous patients. Methods: Mandibular edentulous patients were diagnosed with an oral examination, panoramic radiograph, and diagnostic casts for intermaxillary relations and treated with overdentures over two implants. After two-stage surgery, implants were early loaded with an overdenture at 6 weeks. Results: Fifty-four patients (28 females and 24 males) were treated with 108 implants. Thirty-two patients (59.2%) had a previous history of periodontitis. Twenty-three patients (46%) were smokers. Forty patients (74.1%) suffered from systemic diseases (i.e., diabetes, cardiovascular diseases). The clinical follow-up of the study was 147.8 ± 10.4 months. The clinical outcomes showed a global success of 94.5% of implants. Fifty-four overdentures were placed in the patients over the implants. The mean marginal bone loss was 1.12 ± 0.34 mm. Nineteen patients (35.2%) showed some kind of mechanical prosthodontic complication. Sixteen implants (14.8%) were associated with peri-implantitis. Conclusions: Based on the clinical results obtained, we can determine that the treatment of elderly edentulous patients with mandibular overdentures through the early loading of two placed implants is a successful implant protocol.

Fabrication of immediately loaded implant-retained maxillary overdenture with flapless surgery using a CAD/CAM surgical guide: A technical report

This report describes a digital workflow and two-year follow-up of an immediately loaded implant-retained overdenture using flapless surgery and a computer-aided design/computer-aided manufacturing (CAD/CAM) surgical guide. A prosthetically-driven approach, utilising a three-dimensional (3D) planning software and a CAD/CAM surgical guide, was used to place four implants in the edentulous maxillary arch of a 59-year-old male patient. All four implants were inserted through the surgical guide without raising soft tissue flaps. After placement, the patient was delivered an immediately loaded maxillary overdenture. Surgical implant placement was well tolerated by the patient, who reported no discomfort. Following a four-month period, a new implant-retained maxillary overdenture reinforced by a metal framework was fabricated and delivered to the patient. There were no adverse issues noted with neither the implants nor the maxillary overdenture during the two-year follow up period. The technique using the workflow described in this report may be a predictable and affordable alternative in the restoration of edentulous arches as compared to full-arch fixed restorations.

Patient-reported outcomes with immediate-loaded two-implant-supported mandibular overdentures: Results of a 5-year prospective study

Background/purpose

Few studies have comprehensively assessed long-term patient-reported outcomes for overdentures supported by two immediate implants. The purpose of the study was to evaluate patient-reported outcomes of immediately loaded two-implant-supported overdentures retained by ball attachments over a 5-year evaluation period.

Material and methods

Nineteen participants with edentulous mandibles were provided with immediately loaded two-unsplinted-implant-supported overdentures retained by ball attachments. The participants completed the Japanese version of the Oral Health Impact Profile (OHIP)-EDENT-19 and the Patient's Denture Assessment (PDA). Additionally, patient satisfaction was measured by a 100-mm visual analog scale (VAS). Measurements were performed at baseline, and at 1 and 5 years following implant surgery.

Results

Seventeen participants and 14 participants were evaluated at the 1-year and 5-year assessment, respectively. Considering the OHIP-EDENT-19, there was a significant decrease in the total (p = 0.046), “functional limitation” (p = 0.021), and “physical disability” (p = 0.034) scores at 1 year and the total (p = 0.045) and “physical disability” (p = 0.024) scores at 5 years following surgery, compared to the baseline scores. Considering the PDA, there was a significant increase in the “function” (p = 0.038) and “lower denture” (p = 0.003) scores at 1 year and the “function” (p = 0.032), “lower denture” (p = 0.008), and “esthetic and speech” (p = 0.043) scores at 5 years following surgery, compared to the baseline scores. Patient satisfaction at 1 year following surgery was significantly greater than that at baseline (p = 0.005).

Conclusion

Immediately loaded two-unsplinted-implant-supported overdentures retained by ball attachments improved the oral health-related quality of life and self-assessment of dentures by the patients up to 5 years following implant surgery.

Patient-reported outcomes for the immediate loading of mandibular overdentures supported by two implants soon after implant surgery

Background/purpose

No studies have comprehensively assessed short-term patient-reported outcomes after the provision of overdentures supported by two immediate implants. The purpose of this study was to evaluate short-term patient-reported outcomes for mandibular overdentures retained by ball attachments on two immediately loaded implants.

Materials and methods

Nineteen participants with mandibular edentulism were provided with overdentures retained by ball attachments on two immediately loaded, unsplinted implants. The participants' self-assessment of their dentures and oral health-related quality of life were evaluated with the 22-item Patient's Denture Assessment (PDA), and the 19-item Japanese version of the Oral Health Impact Profile (OHIP-EDENT), respectively. Patient satisfaction was measured on a 100 mm visual analogue scale. Assessments were conducted at baseline, and at 1 and 6 months after implant surgery.

Results

There were significant increases in the PDA “Lower denture” (P = 0.009) at 1 month, as well as “Function” (P = 0.002) and “Lower denture” (P = 0.009) scores at 6 months. Patient satisfaction was also significantly increased at 1 month (P = 0.007) and 6 months (P ≤ 0.000). Significant decreases were observed in the OHIP-EDENT “Physical pain” (P = 0.046) score at 1 month, as well as the summary score (P = 0.033), “Functional limitation” (P = 0.020) and “Psychological discomfort” (P = 0.019) scores at 6 months.

Conclusion

The use of two immediately loaded implants for lower mandibular complete overdentures is associated with improvements in patient's self-assessment of dentures, satisfaction, and oral health-related quality of life, up to 6 months after implant surgery.

Clinical efficacy of anodized dental implants for implant-supported prostheses after different loading protocols: A systematic review and meta-analysis

OBJECTIVES

To summarize the clinical performance of anodized implants connected to different prostheses design after immediate/early (IL) or conventional loading (CL) protocols.

MATERIALS AND METHODS

Seven databases were surveyed for randomized (RCTs) and non-randomized controlled clinical trials (CCTs). Studies comparing IL vs. CL protocol of anodized implants supporting single crown, fixed partial denture (FPD), full-arch fixed dental prosthesis (FDP), or overdenture were included. Risk-of-bias was evaluated using Cochrane Collaboration tools. Meta-analyses for different follow-up were analyzed, followed by heterogeneity source assessment and GRADE approach. The outcomes included implant survival rate, marginal bone loss (MBL), implant stability quotient (ISQ), probing depth (PD), plaque index (PI), and peri-implantitis prevalence.

RESULTS

From 24 eligible studies, 22 were included for quantitative evaluation. Most RCTs (58%, n = 11) and all the 5 CCTs had high and serious risk-of-bias, respectively. Overall, pooling all prosthesis design, no difference between IL vs. CL protocols was observed for all outcomes (p > .05). However, according to prosthesis type subgroups, CL reduced MBL for full-arch FDP (p < .05). In a point-in-time assessment, with overdenture, although IL presented higher PI (12 months), it showed lower MBL (≥24 months), higher ISQ (3 months), and lower PD (6 and 12 months) (p < .05). Conversely, PD was higher for IL in single crown (3 and 6 months) (p < .05). Regarding MBL, IL demonstrated higher mean difference for full-arch FDP (36 months) and FPD (12 and 36 months) (p < .05).

CONCLUSION

Within the limitations of this study, overall, there is no significant difference in the outcomes between IL and CL loading protocols.

Implant loss and crestal bone loss in early loading versus delayed and immediate loading in edentulous mandibles. A systematic review and meta-analysis

Background

Information about the risk of early loss and crestal bone loss of dental implants which have been loaded early is scant if compared with data available for those conventionally or immediately loaded. A meta-analysis of early loss and crestal bone loss in immediate or delayed loaded full mandibular denture retaining dental implants has been recently published. It is interesting to evaluate also the risks of early versus immediate and delayed loading in complete mandibular restorations. The purpose of this systematic review and meta-analysis was to study early (EL) versus immediate (IL) and delayed loading (DL) protocols in edentulous mandibles to determine whether differences exist in implant success and crestal bone loss.

Material and Methods

The literature review was conducted in PubMed, Web of Science, and the Cochrane Library. Seven randomized clinical trials were included.

Results

The result of a meta-analysis of implant loss before 1 year in EL versus IL was 0.34 (95% CI: 0.08, 1.52), favoring the EL control group, while the outcome for crestal bone loss at the three-year observation was -0.10 (95% CI: -0.28, 0.09), with a tendency toward reduced bone loss for EL. In the EL versus DL group, the result of the meta-analysis of implant loss before one year was inconclusive, while in the comparison regarding crestal bone loss in the first year of observation, the result was -0.03 (95% CI: -0.08,-0.02) with a tendency to less bone loss in EL.

Conclusions

The risk of early implant loss in the IL group was higher than in the EL group. The results in terms of early implant loss in EL versus DL are inconclusive. Besides, crestal bone loss is greater in immediately and delayed loaded implants, at 1 and 3 years of observation, compared to those loaded early.

Key words:Dental implants, early dental implant loading, dental prostheses, implant- supported, alveolar bone loss, meta-analysis.

Effects of immediate and delayed loading protocols on marginal bone loss around implants in unsplinted mandibular implant-retained overdentures: a systematic review and meta-analysis

BACKGROUND

Immediate loading has recently been introduced into unsplinted mandibular implant-retained overdentures for the management of edentulous patients due to their increasing demand on immediate aesthetics and function. However, there is still a scarcity of meta-analytical evidence on the efficacy of immediate loading compared to delayed loading in unsplinted mandibular implant-retained overdentures. The purpose of this study was to compare the marginal bone loss (MBL) around implants between immediate and delayed loading of unsplinted mandibular implant-retained overdentures.

METHODS

Randomized controlled trials (RCTs), controlled clinical trials (CCTs), and cohort studies quantitatively comparing the MBL around implants between immediate loading protocol (ILP) and delayed loading protocol (DLP) of unsplinted mandibular overdentures were included. A systematic search was carried out in PubMed, EMBASE, and CENTRAL databases on December 02, 2020. "Grey" literature was also searched. A meta-analysis was conducted to compare the pooled MBL of two different loading protocols of unsplinted mandibular overdentures through weighted mean differences (WMDs) with 95% confidence intervals (95% CIs). The subgroup analysis was performed between different attachment types (i.e. Locator attachment vs. ball anchor). The risk of bias within and across studies were assessed using the Cochrane Collaboration's tool, the Newcastle-Ottawa scale, and Egger's test.

RESULTS

Of 328 records, five RCTs and two cohort studies were included and evaluated, which totally contained 191 participants with 400 implants. The MBL of ILP group showed no significant difference with that of DLP group (WMD 0.04, CI - 0.13 to 0.21, P > .05). The subgroup analysis revealed similar results with Locator attachments or ball anchors (P > .05). Apart from one RCT (20%) with a high risk of bias, four RCTs (80%) showed a moderate risk of bias. Two prospective cohort studies were proved with acceptable quality. Seven included studies have reported 5.03% implant failure rate (10 of 199 implants) in ILP group and 1.00% failure rate (2 of 201 implants) in DLP group in total.

CONCLUSIONS

For unsplinted mandibular implant-retained overdentures, the MBL around implants after ILP seems comparable to that of implants after DLP. Immediate loading may be a promising alternative to delayed loading for the management of unsplinted mandibular implant-retained overdentures. PROSPERO registration number: CRD42020159124.

Fractal analysis as a useful predictor for determining osseointegration of dental implant? A retrospective study

PURPOSE

The present study aimed at evaluating the effectiveness of fractal analysis on determining the osseointegration of dental implants.

MATERIAL AND METHODS

In a single center, retrospective clinical trial, patients with dental implants in the mandibular premolar/molar region, ASA I-II and < 65-year-old patients were included. Orthopantomograph (OPG) were taken before implant surgery (t0), within a week of surgery (t1), and 1 (t2) and 2 (t3) months after surgery, respectively. Three regions of interest (ROIs) from mesial, distal, and apical sites of the implants were chosen and fractal analysis (FA) was conducted with the box-counting algorithm using White and Rudolph's method.

RESULTS

A total of 39 patients 19 women and 20 men, with a mean age of 52.2 years (52.3 and 52.1 years, respectively) were included. The mean, minimum and maximum values of mesial (roi1), distal (roi2), and apical (roi3) surfaces were compared. The fractal dimension (FD) values of t1 were significantly lower compared with t0 as they decreased during the first week. FD values gradually increased after the first week although never exceeded the FD values of t0. Also, difference between mean FD values of t0 and t3 were found statistically significant (p < 0.05).

DISCUSSION

FA is a promising and noninvasive method to predict osseointegration of a dental implant based on dental radiographs, and it can help shorten the total treatment time.

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.

Peri-implant mucosal response to implant-supported overdentures: A systematic review and meta-analysis

OBJECTIVES

To systematically review and evaluate the effects of different types of attachments, implant numbers and loading protocols on the peri-implant mucosa of implant-supported overdentures (ISODs).

BACKGROUND

The impact of peri-implant tissue health on the ISOD treatment outcome is unclear, and current evidence is inadequate on this aspect.

MATERIALS AND METHODS

A systematic literature search for randomised controlled trials or prospective studies was conducted in indexed databases from 1995 to April 2020. The focused question was as follows: How does the peri-implant mucosa respond to implant-supported or implant-tissue-supported complete overdentures based on different types of attachments, implant numbers, and loading protocols, in terms of clinical outcomes achieved [plaque index (PI), gingival index (GI), probing pocket depth (PD) and bleeding index (BI)]? A random- or fixed-effects model was applied to measure the significance of standardised mean differences (SMD) of PD between the groups.

RESULTS

Seventeen studies met the eligibility criteria. The SMD for PD between splinted/bar and unsplinted/stud attachments was 0.10 mm (95% CI: -0.27 to 0.47; P = .60) and between 2- and 4-implant groups was 0.15 mm (95% CI: -0.16 to 0.45; P = .34), which were not statistically significant. Significant difference (P = .003) was observed between immediate/early loading and delayed loading (SMD = 0.46 mm [95% CI: 0.16 to 0.75]).

CONCLUSIONS

Probing depth for the immediate loaded implants was significantly higher than for the delayed loading group. No attachment type, implant number or loading protocol seemed to have a clear advantage over the other, in terms of other peri-implant mucosal outcome measures.

Immediately loaded mini-implants supporting mandibular overdentures: A one-year comparative prospective cohort study

BACKGROUND

Little is known about differences between mini-implants and conventional immediately loaded implants for overdentures.

OBJECTIVES

To compare clinical outcomes using two immediately loaded conventional or mini-implants for mandibular overdentures.

MATERIALS AND METHODS

Edentulous patients receiving either conventional (4.1 mm) or mini-implants (2.9 mm or less), based on available bone width were analyzed. All implants were immediately loaded with mandibular overdentures installed using locator attachments. Digital periapical radiographs for measuring marginal bone loss and clinical outcomes (ie, periodontal probing, plaque, and bleeding indices) were assessed at 1, 3, 6, and 12-month follow-up periods.

RESULTS

Fifty patients (25 receiving conventional implants-12 females, mean age of 65.3 ± 7.3 years; and 25 receiving mini-implants-11 females, mean age of 66.8 ± 8.1 years) was analyzed. Peak insertion torque (P = .001) and bone loss (P = .02), as well as change in plaque (P = .02) and bleeding (P = .04) indices at 12 months differed significantly between groups. Furthermore, linear regression revealed the height of the locator as a risk factor for bone loss (P = .038).

CONCLUSIONS

The present findings suggest that two mini-implants are significantly more susceptible to bone loss after immediate loading, for which the height of locator might be considered a risk factor.

Advantages and limitations of implant surgery with CAD/CAM surgical guides: A literature review

Background

The purpose of this study is to review the available literature associated with implant surgery using computer-aided design/computer-aided manufacturing (CAD/CAM) surgical guides and discuss the advantages and disadvantages of this advanced technique.

Material and Methods

An electronic literature search was conducted in the PubMed database for the relevant information on implant placement with CAD/CAM surgical guides. This review was constructed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Articles were limited to those published within the past 10 years and in the English language. Only clinical studies were included. Inclusion criteria were: studies including 10 implants or more and studies presenting angular deviations in degrees and linear deviations in millimeter. Observational studies, reviews, animal studies, in vitro studies, case reports, simulation studies were excluded. Nine articles were included for qualitative synthesis.

Results

The initial search detected 61 articles, and after screening abstracts, a total of 15 articles were selected for full-text review. After the full-text analysis of the 15 articles, six articles were excluded as they did not meet inclusion criteria for study design, study population, and implant placement with data presentation for angular and linear deviations. Ultimately, nine articles providing angular and linear deviations between planned and actual placed implants were used in this review. Common problems that may be encountered by clinicians were listed, and recommendations were made on how to avoid those problems.

Conclusions

It has been suggested that although unrealistic expectations are often associated with implant placement with CAD/CAM surgical guides, there is no impeccable accuracy in the clinic. This review demonstrated that the practitioners should be aware of the angular and linear deviations up to 5 ° and 2.3 mm. Therefore, inexperienced dentists should obtain adequate training and be familiar with the basic steps with CAD/CAM surgical guides to avoid complications.

Key words:CAD/CAM, CBCT, implant, stereolithography, surgical guide.

Immediate versus delayed loading of mandibular implant-retained overdentures: A 60-month follow-up of a randomized clinical trial

AIM

The purpose of this observational, post-trial follow-up study was to evaluate 60-month outcomes of a randomized controlled clinical trial that compared immediately and delayed loaded two unsplinted implants, supporting a locator-retained mandibular overdenture.

MATERIALS AND METHODS

Patients from a randomized controlled clinical trial, treated with either immediate or delayed loading of two implants, supporting a locator-retained mandibular overdenture, were recalled for 60-month evaluation. Patients underwent a clinical and radiographic examination to evaluate the peri-implant soft tissue parameters and bone. Prosthetic maintenance needs and complications were also recorded.

RESULTS

Twenty three of the 30 patients were available for the 60-month follow-up. The mean radiographic bone level change measured using standardized periapical radiographs from baseline to 60 months was 0.89 mm (±0.74) and 0.18 (±0.41) for delayed loading and immediate loading groups, respectively. A statistically significant difference was observed at 60 months with a smaller radiographic bone level change in the immediate loading group. No implants were lost between 12 and 60 months. At 60 months, per-protocol implant survival rate was 100% for both the groups. No difference was found in the peri-implant soft tissue parameters and prosthetic needs between the groups.

CONCLUSION

Both immediately and delayed loaded implants supporting a locator-retained mandibular overdenture showed similar clinical outcomes.

Mandibular Implant-supported Overdentures: Prosthetic Overview

Implant-supported overdentures are becoming the treatment of choice for the completely edentulous mandible. They significantly improve the quality of life in edentulous patients. For this review article, the literature was searched to identify pertinent studies. No meta-analysis was conducted because of high heterogeneity within the literature. Accordingly, in this review article, the author provides an update on implant-supported mandible overdentures with regard to the number of implants, type of loading, stress-strain distribution, mode of implant-to-denture attachment, occlusal considerations and complications.

Radiographic Fractal and Clinical Resonance Frequency Analyses of Posterior Mandibular Dental Implants: Their Possible Association With Mandibular Cortical Index With 12-Month Follow-up

BACKGROUND

The aim of the present study was to investigate whether the mandibular cortical index (MCI) has a relationship with fractal dimension of bone and/or implant stability, and to justify the possible association between MCI, fractal dimension, and stability.

MATERIALS AND METHODS

Eighty-two subjects who received dental implants to replace missing mandibular premolar/molar sites were selected. Three months after surgical placement, implants were restored with fixed ceramic fused metal crowns. MCI was evaluated at baseline; fractal dimensions were measured with fractal analysis (FA) and implant stability quotient (ISQ) with resonance frequency analysis immediately after surgery and 12-month follow-up.

RESULTS

FA at mesial and distal regions for Class 1, Class 2, and Class 3 MCI resulted with significant increases at 12-month follow-up compared to baseline. The ISQ in patients with Class 2 and Class 3 MCI resulted with a significant decrease compared to Class 1 MCI at baseline and at 12 months. All MCI classes evaluated with ISQ and FA at baseline values resulted with significant increases at 12 months. Significant correlations were considered for all mandibular posterior implants between baseline and 12-month measurements for ISQ and FA evaluations.

CONCLUSIONS

Fractal analysis may be a useful method for understanding the healing process around implants and implant stability quotient values. Mandibular cortical index evaluations should be considered before implant procedures, which may provide a presurgical treatment plan and may provide information about the mandibular bone quality.

A comparative study on 7-year results of "All-on-Four™" immediate-function concept for completely edentulous mandibles: metal-ceramic vs. bar-retained superstructures

The study aims to document the clinical outcomes over a 7-year period of two techniques used for the rehabilitation of edentulous mandibles according to the "All-on-Four™" concept: (1) fixed complete-arch prostheses fabricated with metal-ceramic implant-supported fixed prosthesis with a titanium framework and all-ceramic crowns and (2) bar-retained implant-supported removable prosthesis with acrylic resin prosthetic teeth. The study was performed on 32 patients who received immediately loaded "All-on-Four™" fixed mandibular prostheses. (Fixed prostheses with ceramic superstructures, n:16; bar-retained removable acrylic prostheses, n:16). The patients were evaluated for up to 7 years after prosthesis completion. The endpoints included the evaluation of prosthodontic complications, bone resorption, plaque accumulation, bleeding on probing, periodontal probing depth and an oral health impact profile (OHIP). Bone loss remained under 1.2 mm in all of the implants, and no difference was observed between two groups. Plaque accumulation increased gradually in both groups, and the bar-retained acrylic-bearing implants showed significantly higher values during the first 5 years. Immediate improvement was assessed by the OHIP score in both groups. The observed bone loss and the subjective outcomes showed equivalent levels of clinical success for bar-retained and ceramic superstructures over a 7-year period. The higher level of plaque accumulation observed around implants with bar-retained superstructures requires that patients with acrylic superstructures be highly motivated to maintain their personal oral hygiene. Further studies are needed to clarify the occurrence of prosthodontic complications and assess their economic aspects.

Immediate loading of implants in the edentulous mandible: a multicentre study

PURPOSE

The aim of this prospective study was to investigate the two-year outcomes following immediate loading of mono-cortically engaged implants.

MATERIALS AND METHODS

Thirty healthy mandible edentulous patients with an average age of 67.3 years and presenting with sufficient bony ridge at the mandible symphysis were included in the study. Four Astra Tech, Ti-Oblast^® implants were installed between the mental foramina using the mono-cortical anchorage technique. The primary stability of the implants was assessed by resonance frequency analysis (RFA). After uni-abutments were placed, a temporary bridge was constructed and fixed the same day. The definitive bridges were installed 6 weeks after implant surgery. Five of 120 placed implants were lost in four patients during the first 6 weeks and these patients were excluded from the follow-up. The changes in marginal bone level (n = 20) were evaluated in Brazilian and Swedish groups at baseline, 6 weeks, 6 months, 12 months and 24 months. The RFA (n = 30) was evaluated at baseline, 6 weeks, 6 months, 12 months and 24 months postoperatively.

RESULTS

Compared with baseline measurements, the postoperative values for marginal bone level (6 weeks, 6 months, 12 months and 24 months) were significantly reduced (p < 0.05), while no differences were observed in the RFA analysis (12 months and 24 months).

CONCLUSIONS

The immediate loading of mono-cortically engaged implants in the edentulous mandible is safe and predictable and implant stability remains excellent after 2-year follow-up.

Long-Term Effect of Surface Roughness and Patients' Factors on Crestal Bone Loss at Dental Implants. A Systematic Review and Meta-Analysis

Publications from 2011 to 2015 were selected to evaluate effect of implant surface roughness on long-term bone loss as surrogate for peri-implantitis risk. 87 out of 2,566 papers reported the mean bone loss after at least 5 years of function. Estimation of the proportion of implants with bone loss above 1, 2, and 3 mm as well as analysis the effect of implant surface roughness, smoking, and history of periodontitis was performed. By means of the provided statistical information of bone loss (mean and standard deviation) the prevalence of implants with bone loss ranging from 1 to 3 mm was estimated. The bone loss was used as a surrogate parameter for "peri-implantitis" given the fact that "peri-implantitis" prevalence was not reported in most studies or when reported, the diagnostic criteria were unclear or of dubious quality. The outcome of this review suggests that peri-implant bone loss around minimally rough implant systems was statistically significant less in comparison to the moderately rough and rough implant systems. No statistically significant difference was observed between moderately rough and rough implant systems. The studies that compared implants with comparable design and different surface roughness, showed less average peri-implant bone loss around the less rough surfaces in the meta-analysis. However, due to the heterogeneity of the papers and the multifactorial cause for bone loss, the impact of surface roughness alone seems rather limited and of minimal clinical importance. Irrespective of surface topography or implant brand, the average weighted implant survival rate was 97.3% after 5 years or more of loading. If considering 3 mm bone loss after at least 5 years to represent the presence of "peri-implantitis," less than 5% of the implants were affected. The meta-analysis indicated that periodontal history and smoking habits yielded more bone loss.

Implant survival in 1- versus 2-implant mandibular overdentures: a systematic review and meta-analysis

OBJECTIVE

This systematic review was performed to compare the survival of 1- vs. 2-implant overdentures (IODs) in the edentulous mandible.

MATERIALS AND METHODS

Manual and electronic database (PubMed, EMBASE and CENTRAL) searches were performed to identify scientific articles, published in English, reporting on mandibular IODs utilizing unsplinted attachments. Studies were included if they were prospective human studies reporting on two-piece microrough surface implants with a diameter ≥3 mm. Data were extracted by two independent investigators, and an overall inter-investigator kappa score was calculated. A meta-analysis was performed on the included comparative studies.

RESULTS

The search shortlisted 30 prospective studies for data extraction and statistical analysis. The included studies comprised of only two randomized controlled trials (RCTs) comparing 1- vs. 2-IODs, and a further 28 prospective studies. The kappa score calculated was between 0.86 and 1 for the various parameters. One RCT favored 1-IODs (RD: 0.08, 95% CI: 0.01, 0.14) while the other favored 2-IODs (RD:-0.04, 95% CI: -0.27, 0.19). However, the overall random effects model did not reveal a significant risk difference (RD) for implant failure between the two interventions (I(2) = 36.6%, P = 0.209; RD: 0.05, 95% CI: -0.07, 0.18).

CONCLUSIONS

The results of this meta-analysis conclude that the postloading implant survival of 1-IODs is not significantly different from 2-IODs. However, the existing scientific evidence in the literature in terms of prospective comparative studies is scarce. Hence, before recommending the 1-IOD as a treatment modality, long-term observations are needed and a larger range of functional, prosthodontic, and patient-centered outcome measures should be considered.

Clinical efficacy of early loading versus conventional loading of dental implants

The aim of this study was to determine the clinical differences between early and conventional loading protocols for dental implants. A comprehensive search of the Medline, Embase, and OVID databases for studies published through January 10, 2015 was conducted. Fourteen studies were included in our analysis. We found that early loading imposed a significantly higher risk of implant failure than did conventional loading (risk ratio = 2.09, 95% confidence interval [CI] [1.18, 3.69], P = 0.01), while no significant differences between the methods were found with regards to the marginal bone loss (weighted mean differences [WMD] = 0.11, 95% CI [-0.07, 0.28], P = 0.23), periotest value (WMD = 0.02, 95% CI [-0.83, 0.87], P = 0.96), or implant stability quotient (WMD = 0.79, 95% CI [-0.03, 1.62], P = 0.06). As for the health status of the peri-implant tissue, conventionally loaded implants demonstrated better performance than did early loaded implants. Subgroup analyses demonstrated that the sample size, time of publication, loading definition, implant position, extent, and restoration type influenced the results. Although early implant loading is convenient and comfortable for patients, this method still cannot achieve the same clinical outcomes as the conventional loading method.

Immediate loading of two freestanding implants placed by computer-guided flapless surgery supporting a mandibular overdenture with magnetic attachments

PURPOSE

The present article describes a novel clinical procedure for mandibular overdentures supported by two freestanding implants loaded immediately after placement via computer-guided flapless surgery.

METHODS

A conventional acrylic complete denture was fabricated, and CT scans obtained using the denture as a radiographic guide. Preoperative computer-assisted planning was performed using commercially available software, permitting simulation of implant placement at optimal positions. Using simulation data, a surgical guide was manufactured and used during surgery. The surgical guide was placed and local anesthesia injected for drilling of anchor pins to stabilize the surgical guide. The drilling protocol for each osteotomy site achieved an insertion torque greater than 35 Ncm. Immediately after implant placement, a keeper of the magnetic attachment was connected to each implant, and the magnetic assembly incorporated into the denture. The mucosal surface of the denture around the magnet was relieved to avoid excessive tissue pressure. The patients were instructed to wear the denture in place continually for the following 7 days. After six months of healing and follow-up, a final denture with a metal framework may be fabricated if necessary.

CONCLUSION

A novel treatment protocol for immediately loaded implant-supported mandibular overdentures is described in detail. The protocol ensures secure precise and safe implant placement, successful osseointegration, and immediate improvement of oral health-related quality of life for patients with unstable complete dentures.

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.

The relationship between various parameters of complete denture quality and patients' satisfaction

BACKGROUND

Patients' appreciation of their conventional complete dentures might be affected by the quality of the dentures.

METHODS

A random sample of 33 edentulous patients who were rehabilitated by means of conventional complete dentures participated in the study. Three independent investigators who underwent technique calibration evaluated the dentures on the basis of seven clinical criteria by using a validated examination form. The patients filled out a validated denture satisfaction scale. The author used Pearson product-moment correlation and analysis of covariance to identify possible correlations.

RESULTS

The study results showed that most patients were between "reasonably satisfied" and "very satisfied" with their dentures. The author found nominally higher satisfaction among those receiving both mandibular and maxillary dentures and significant positive correlations between the overall denture satisfaction score and the stability of the mandibular denture (P = .039) and retention of the mandibular denture (P = .005). In contrast, esthetic lip support and lower lip line, occlusion, and maxillary stability and retention were not correlated with participants' overall satisfaction level (P > .064).

CONCLUSIONS

The results of this study show that a clinically stable mandibular denture was the most important determinant of patients' satisfaction.

PRACTICAL IMPLICATIONS

The study findings highlight the most important denture quality parameters that can aid clinicians in meeting their patients' expectations.

Immediate Loading of Two Dental Implants, in Edentulous Mandibles, with Locator® Attachments or Dolder® Bars: First Results from a Prospective Randomized Clinical Study

OBJECTIVE

The study aims to evaluate survival and the incidence of complications for pairs of implants placed in the frontal area of edentulous mandibles and immediately loaded with either bar or Locator® (Zest Anchors LLC, Escondido, CA, USA) attachments.

MATERIAL AND METHODS

Forty-six patients (mean age 69.4 years; 73.9% male) with edentulous mandibles each received two immediately loaded implants in the interforaminal area of the symphysis. Immediately after implant placement, Dolder® bar (Sub-Tec Wirobond; BEGO Implant Systems GmbH & Co. KG, Bremen, Germany) or Locator® attachments, allocated randomly, were attached, and both clips and a framework were incorporated into the denture by the dental technician. The implants were loaded within 72 hours.

RESULTS

During a mean observation period of 6 months (maximum 24 months, SD 0.43) eight implants in five patients were lost. Survival was 93.5% for the Locator® group and 89.1% for the bar group. Estimated cumulative survival after 1 year of function was 93.4% for the Locator® group and 87.1% for the bar group. During the observation period, 12 prosthetic complications required aftercare. No superstructure was lost or had to be remade for prosthetic reasons, but five dentures had to be removed or reworked after implant failure. Survival of the original dentures was, therefore, 95.7% for the Locator® group and 93.5% for the bar group.

CONCLUSION

Within the limitations of this study, immediate loading of two implants in the edentulous mandible with either Locator® or bar attachments did hardly differ. Ease of repair and cleaning, in particular, might be arguments for choosing the single attachment system.

Influence of immediate and early loading on bone metabolic activity around dental implants in rat tibiae

OBJECTIVES

The aim of this study was to examine the influence of immediate and early loading on dynamic changes in bone metabolism around dental implants using bone scintigraphy.

MATERIAL AND METHODS

Two titanium implants were inserted in the right tibiae of 21 rats. Closed coil springs with 4.0-N loads were applied parallel to the upper portion of the implants for 35 days. According to the load application timing, rats were divided into three groups: immediate loading (IL) group, early loading 1 day after implant insertion (1-D early loading [EL]) group, and loading 3 days after implant insertion (3-D EL) group. Rats were intravenously injected with technetium-99 m-methylene diphosphonate (Tc99 m-MDP) (74 MBq/rat) and scanned by bone scintigraphy at 1, 4, 7, 11, 14, 21, 28, and 35 days after load application. The ratio of accumulation of Tc99 m-MDP around the implants to that of a reference site (uptake ratio) was calculated to evaluate bone metabolism.

RESULTS

In every group, the uptake ratio increased until 7 days after load application and then gradually decreased. It was significantly higher than baseline at 4, 7, 11, and 14 days (P < 0.001). The uptake ratio in the 1-D EL and 3-D EL groups were significantly higher than that in the control group and also that in the IL group (P < 0.001).

CONCLUSIONS

Bone metabolism initially increased and then gradually decreased to baseline despite differences in load timing. Increases in bone metabolic activity differed according to load application timing; the later the load application, the more enhanced the bone metabolism.