The intra- and inter-rater reproducibility of bone level measurements at strategic mini-implants using dental panoramic radiography

OBJECTIVES

This experimental study focused on the intra- and inter-rater reproducibility of vertical bone level (VBL) measurements at strategic mini-implants (MI) using digital panoramic radiographs (PR).

STUDY DESIGN

VBLs of 152 MIs for removable partial denture stabilization at 50 randomly chosen PRs from a clinical trial were digitally evaluated by three ratters. Rater deviations exceeding 0.5 mm were re-examined. The intra-class correlation coefficient (ICC) was applied to estimate reliability. The smallest detectable change (SDC) was interrelated to the minimal clinically important change of 0.2 mm.

RESULTS

The first measurement round revealed intra- and inter-rater ICCs of > 0.8. However, 28 sites (9 %) were unreadable, and 97 sites (32 %) revealed differences between observers of ≥ 0.5 mm. Following a consensus session and re-training, an additional 8 sites were excluded and all remaining VBL differences were ≤ 0.5 mm. Thus, the SDCs with 95 % credibility were improved from 0.73 to 0.31 mm in the intra-rater and from 1.52 to 0.34 mm in the inter-rater statistics. Given a 50 % credibility for this special setting, both the intra- and inter-rater SDCs were 0.11 mm.

CONCLUSIONS

Digital PR can be reliably utilized to determine VBLs around MIs under conditions of at least two trained observers, mutual calibration sessions, and exclusion of unquantifiable radiographs.

GERMAN CLINICAL TRIALS REGISTER ID

DRKS00007589, www.germanctr.de.

Difference in marginal bone loss around implants between short implant-supported partial fixed prostheses with and without cantilever: a retrospective clinical study

PURPOSE

To investigate the influence of cantilever prosthetic arm on the marginal bone loss (MBL) over time around dental implants supporting short fixed partial dentures (FPDs), in a record-based retrospective study.

METHODS

All cases of 3-unit implant-supported FPDs, supported by 2-3 implants, from the database of cases treated at one specialist clinic were considered for inclusion. Only implants with a minimum of 36 months of radiological follow-up were considered. Univariate linear regression models were used to compare MBL over time between 12 clinical covariates, after which a linear mixed-effects model was built.

RESULTS

One-hundred-thirty-nine patients (64 men, 75 women) with 164 3-unit implant-supported FPDs (333 implants supporting non-cantilevered FPDs, 94 supporting cantilevered FPDs) were included in the study. The patients were followed up clinically and radiographically for a mean of 154.1 ± 78.0 (min-max, 37.3-364.6) and 132.9 ± 77.3 months (min-max, 36.8-329.9), respectively. The total number of marginal bone level double measurements (mesial and distal sides of each implant) was 2909. FPDs with cantilever presented an estimated greater MBL over time compared to FPDs without cantilever. Bruxism, sex (women), implant (modified) surface, and (poor) bone quality were also associated with higher MBL over time.

CONCLUSIONS

The use of a cantilever extension is suggested to negatively affect the bone marginal level over time around implants supporting 3-unit FPDs. Due to the small difference of the estimated MBL over long periods of follow-up between the groups, it is a matter of debate if the observed negative effect may be of clinical significance.

Marginal Bone Level and Biomechanical Behavior of Titanium-Indexed Abutment Base of Conical Connection Used for Single Ceramic Crowns on Morse-Taper Implant: A Clinical Retrospective Study

The goal of this retrospective clinical study was to evaluate the behavior of Morse-taper indexed abutments by analyzing the marginal bone level (MBL) after at least 12 months of function. Patients rehabilitated with single ceramic crowns between May 2015 and December 2020 received single Morse-taper connection implants (DuoCone implant) with two-piece straight abutment baseT used for at least 12 months, presenting periapical radiograph immediately after crown installation were enrolled. The position of the rehabilitated tooth and arch (maxilla or mandible), crown installation period, implant dimensions, abutment transmucosal height, installation site (immediate implant placement or healed area), associated with bone regeneration, immediate provisionalization, and complications after installation of the final crown were analyzed. The initial and final MBL was evaluated by comparing the initial and final X-rays. The level of significance was α = 0.05. Seventy-five patients (49 women and 26 men) enrolled had a mean period of evaluation of 22.7 ± 6.2 months. Thirty-one implant-abutment (IA) sets had between 12–18 months, 34 between 19–24 months, and 44 between 25–33 months. Only one patient failed due to an abutment fracture after 25 months of function. Fifty-eight implants were placed in the maxilla (53.2%) and 51 in the mandible (46.8%). Seventy-four implants were installed in healed sites (67.9%), and 35 were in fresh socket sites (32.1%). Thirty-two out of these 35 implants placed in fresh sockets had the gap filled with bone graft particles. Twenty-six implants received immediate provisionalization. The average MBL was −0.67 ± 0.65 mm in mesial and −0.70 ± 0.63 mm in distal (p = 0.5072). The most important finding was the statistically significant difference comparing the values obtained for MBL between the abutments with different transmucosal height portions, which were better for abutments with heights greater than 2.5 mm. Regarding the abutments’ diameter, 58 had 3.5 mm (53.2%) and 51 had 4.5 mm (46.8%). There was no statistical difference between them, with the following means and standard deviation, respectively, −0.57 ± 0.53 mm (mesial) and −0.66 ± 0.50 mm (distal), and −0.78 ± 0.75 mm (mesial) and −0.746 ± 0.76 mm (distal). Regarding the implant dimensions, 24 implants were 3.5 mm (22%), and 85 implants (78%) had 4.0 mm. In length, 51 implants had 9 mm (46.8%), 25 had 11 mm (22.9%), and 33 implants were 13 mm (30.3%). There was no statistical difference between the abutment diameters (p > 0.05). Within the limitations of this study, it was possible to conclude that better behavior and lesser marginal bone loss were observed when using abutment heights greater than 2.5 mm of transmucosal portion and when placed implants with 13 mm length. Furthermore, this type of abutment showed a little incidence of failures within the period analyzed in our study.

Comparative evaluation of dental implants in posterior maxilla placed using unicortical and bicortical anchorage-A split-mouth prospective study

Background

The use of dental implants has become a very predictive method of rehabilitation for patients with partial or complete edentulism. It is more challenging to treat the posterior quadrants of the maxillary ridges using dental implants due to their anatomical and physiological characteristics. So to overcome the limitations of other techniques, short implants were introduced recently as a new approach to simplify implant placement in compromised alveolar bone and to prevent possible damage to vital structures.

Purpose

This study aims to compare the clinical outcomes of dental implants placed using the osteotomized sinus floor elevation (OSFE) technique side engaging the bony floor of the maxillary sinus (bicortical anchorage) on one side and the conventional technique by split mouth on the other side.

Materials and Method

This study included 15 patients. Study participants had dental implants placed on both sides of the mouth at the same time, so one side was implanted according to the test method, while the other side used the control method. Randomization determined which side would be implanted.

Conclusion

The OSFE technique provides greater stability to the implant via bicortical anchorage than conventional techniques, which only provide unicortical anchorage.

Marginal Bone Level Evaluation of Fixed Partial Dental Prostheses Using Preformed Stock versus CAD/CAM Customized Abutments

Background: The maintenance of marginal bone levels around dental implants is an important criterion for evaluating the success of implants. Although computer-aided design/computer-aided manufacturing (CAD/CAM) customized abutments (CAs) provide more flexible solutions, compared with the original preformed stock abutments (PAs), there are dimensional tolerances and underlying drawbacks in the production of CAD/CAM CAs, which may change the tightness and seamless connection between fixtures and abutments set by the manufacturer and then affect the long-term stability of the abutments. This study aimed to examine the change in both mesial and distal bone levels using digital periapical radiographs to evaluate the difference between CAD/CAM CAs and original PAs.Material and methods: Radiographs were taken before delivery; after functional loading for 1 month; and after 3, 6, and 12 months; and the vertical marginal bone levels (vMBLs) of both the mesial and distal surrounding implant bones were measured. All data are presented as means ± standard errors and were analyzed using Student’s t-test. A p-value < 0.05 was judged to represent a significant difference. Results: A total of 57 implants in 50 patients were divided into 22 CAD/CAM CAs and 35 original stock abutments. The PAs appeared to have a more stable bone level. By contrast, the amount of bone level change in the CAs was higher than that in the PAs. The change in the vMBL of the CAs was significantly more than that of the PAs after functional loading for 1 month (p = 0.006), 3 months (p = 0.013), 6 months (p = 0.014), and 12 months (p = 0.002). In contrast, the distal marginal bone level was lower than the mesial marginal bone level in any period. Nevertheless, the bone levels of the CAs and PAs in any period were comparable with no significant difference. Conclusions: Significant differences were found between the mesial and distal bone levels in the PAs. The CAD/CAM CAs showed a significantly greater bone level change than the original stock abutments after functional loading.

Two-Dimensional Analysis of Digital Images through Vector Graphic Editors in Dentistry: New Calibration and Analysis Protocol Based on a Scoping Review

This review was carried out to analyse the functions of three Vector Graphic Editor applications (VGEs) applicable to clinical or research practice, and through this we propose a two-dimensional image analysis protocol in a VGE. We adapted the review method from the PRISMA-ScR protocol. Pubmed, Embase, Web of Science, and Scopus were searched until June 2020 with the following keywords: Vector Graphics Editor, Vector Graphics Editor Dentistry, Adobe Illustrator, Adobe Illustrator Dentistry, Coreldraw, Coreldraw Dentistry, Inkscape, Inkscape Dentistry. The publications found described the functions of the following VGEs: Adobe Illustrator, CorelDRAW, and Inkscape. The possibility of replicating the procedures to perform the VGE functions was analysed using each study's data. The search yielded 1032 publications. After the selection, 21 articles met the eligibility criteria. They described eight VGE functions: line tracing, landmarks tracing, linear measurement recording, angular measurement recording, image calibration, image overlay, file transfer, and vector graphics development. The features offered by the VGEs bring great precision and objectivity to two-dimensional image analysis. The image analysis and editing procedures are currently not protocolised. Thus, a protocol for image calibration and measurement recording is proposed in order to guarantee the protocol's replication.

Retrospective evaluation of marginal bone loss around implants in a mandibular locator-retained denture using panoramic radiographic images and finite element analysis: A pilot study

BACKGROUND

The follow-up of the peri-implant marginal bone loss is the most important criterion for the determination of implant success.

PURPOSE

The purpose of this study is to measure marginal bone loss using panoramic radiographic images (PRI) of patients treated using a mandibular, two implant-supported, locator-retained denture and to evaluate the compatibility of these findings with those of the finite element analysis (FEA).

MATERIALS AND METHODS

The PRI of patients who had a mandibular, two implant-supported, locator-retained denture were assessed, and the mesial and distal marginal bone loss of both right- and left-sided implants was measured. Mandibular and maxillary models, which have the features of bilateral balanced occlusion, were created. The surfaces of the generated models were converted in a computer-aided design model that could be transferred to the FEA software, and the forces were defined on contacts formed in maximum intercuspation, lateral, and protrusive movement position for bilateral balanced occlusion.

RESULTS

The bone loss in the mesial and distal regions at the right- and left-sided implants was not statistically significant. Higher stresses were formed on the vestibular side under protrusive movement, on the lingual side under maximum intercuspation, on the distolingual side under left unilateral biting, and on the mesiolingual side under right unilateral biting in the FEA.

CONCLUSION

According to FEA, peri-implant bone resorption may be higher in the buccal and palatal regions, implying that panoramic radiographs can be misleading in understanding the amount of peri-implant bone resorption.

Finite element analysis of stress concentration between surface coated implants and non surface coated implants - An in vitro study

Background

To determine qualitative comparison in stress distribution between surface coated implants and non surface coated implants using 2 different lengths and vertical, oblique, and lateral forces.

Material and Methods

3 dimensional finite element study was carried out at first molar site with 4 surface coated and 4 non surface coated implants using mimic 8.11, solid edge 2004, hypermesh 9.0, and ansys12.1 software.

Results

The pattern of stress distribution was almost similar between vertical and oblique loading but varied with lateral loads between surface coated and non surface coated implants. As the length of the implants increased stress concentration had no significant variation between surface coated and non surface coated implants, but had a tendency to increase at the abutment and abutment screw on all 3 forces.

Conclusions

Among the surface coated and non surface implants the pattern of stress distribution was similar signifying that surface coating of implants had no significant role in stress distribution using 3d finite element analysis and within the limitations of this study.

Key words:Surface coating, non surface coating, implants, stress and bone.

Dental Implants With a Platform-Switched Morse Taper Connection and an Osteo Growth Induction Surface

AIM

The aim of this study was to analyze the clinical outcomes after using an innovative implant system characterized by a modern platform-switched Morse taper connection and an osteo growth induction titanium surface (a particular type of SLA surface). Peri-implant bone loss (PBL) and implant success rate were examined after a 1- to 3-year follow-up.

METHODS

The study was conducted as a cross-sectional analysis on all patients treated from January 2011 to December 2014 using CLC CONIC implants. Implants were divided into 3 main groups, based on the duration of the follow-up (1 year, 2 years, and 3 years), then subgrouped by diameter, length, and type of prosthetic rehabilitation to compare differences in PBL. X-rays were taken at the time of surgery, at prosthetic loading, at 1 year, and then annually thereafter. Previously-established success criteria were used to assess the implants. Frequency analyses and comparisons between the means (with 95% CI) were conducted for the statistical analysis of the data collected.

RESULTS

One hundred twenty patients met inclusion and exclusion criteria, and completed the follow-up, and were thus eligible for the study, with a total of 261 CLC CONIC implants. The mean follow-up was 22.45 months. No implants failed, giving an overall success rate of 100%. The average PBL at 1-year follow-up was 0.047 mm, at 2 years it was 0.128 mm, and at 3 years it was 0.236 mm.

CONCLUSIONS

The CLC CONIC implant system had a high success rate after 1 to 3 years of follow-up, in line with previous reports in the scientific literature. Combining platform switching with the Morse taper connection enabled stable bone levels to be achieved in the short to medium term.

Effect of Smoking and Locations of Dental Implants on Peri-Implant Parameters: 3-Year Follow-Up

BACKGROUND Smoking may be a risk factor for marginal bone loss (MBL) and oral mucosal inflammation surrounding dental implants. This retrospective study evaluated the effects of smoking on dental implants in patients with fixed implant-supported prostheses over a period of 36 months following loading. MATERIAL AND METHODS We assessed 120 patients (68 women, 52 men, ages 19-74 years (mean age: 55.10 years) with 315 implants. Implants were classified according to location in the upper and lower jaws and anterior (placed between canines) or posterior (placed between pre-molars and molars) as follows: 1=maxilla anterior, 2=maxilla posterior, 3=mandible anterior, 4=mandible posterior. We also measured MBL, plaque index (PI), sulcus bleeding index (SBI), and probing depth (PD). P-values less than 0.05 were considered statistically significant. RESULTS MBL was statistically greater in smokers (P<0.001) as compared to non-smokers in both jaws. MBL did not vary significantly by location in either group (smokers: p=0.415; non-smokers: p=0.175). Mean PI and PD scores were significantly higher in smokers as compared to non-smokers (P<0.001). A positive correlation was found between PI and PD scores in both groups. No statistically significant difference in SBI was observed between the 2 groups (P>0.05). CONCLUSIONS Smoking was associated with increases in marginal bone loss around implants, independent of their location in the jaws. Also, both plaque indices and probing depths were greater in smokers than in non-smokers.

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

PURPOSE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

Covalently-Linked Hyaluronan versus Acid Etched Titanium Dental Implants: A Crossover RCT in Humans

Biochemical modification of titanium surfaces (BMTiS) entails immobilization of biomolecules to implant surfaces in order to induce specific host responses. This crossover randomized clinical trial assesses clinical success and marginal bone resorption of dental implants bearing a surface molecular layer of covalently-linked hyaluronan in comparison with control implants up to 36 months after loading. Patients requiring bilateral implant rehabilitation received hyaluronan covered implants in one side of the mouth and traditional implants in the other side. Two months after the first surgery, a second surgery was undergone to uncover the screw and to place a healing abutment. After two weeks, the operator proceeded with prosthetic procedures. Implants were evaluated by periapical radiographs and the crestal bone level was recorded at mesial and distal sites—at baseline and up to 36 months. One hundred and six implants were positioned, 52 HY-coated, and 48 controls were followed up. No differences were observed in terms of insertion and stability, wound healing, implant success, and crestal bone resorption at any time considered. All interventions had an optimal healing, and no adverse events were recorded. This trial shows, for the first time, a successful use in humans of biochemical-modified implants in routine clinical practice and in healthy patients and tissues with satisfactory outcomes.

Impact of jaw location on clinical and radiological status of dental implants placed in cigarette-smokers and never-smokers: 5-year follow-up results

PURPOSE

The aim of this 60 months follow-up investigation was to investigate the impact of jaw location on clinical and radiological status of dental-implant therapy in cigarette-smokers and never-smokers.

MATERIALS AND METHODS

Twenty-nine self-reported cigarette-smokers and 27 nonsmokers were assessed. All implants were categorized into three regions with reference to their location in the maxilla or mandible: (a) Anterior zone: implants located in anterior teeth; (b) Middle zone: Implants located in the premolar region; and (c) posterior zone: implants located in the molar region. Peri-implant crestal bone loss (CBL), bleeding-on-probing (BOP) and probing-depth (PD) ≥ 4 mm and were assessed. Level of statistical significance was set at P < .05.

RESULTS

Mean age of cigarette-smokers (n = 29) and never-smokers (n = 27) was 44.5 years (39-51 years) and 43.6 years (35-49 years), respectively. The average duration of cigarette-smoking was 20.3 years (17-26 years). The mean periimplant PD (P < .05) and CBL (P < .05) were significantly higher in cigarette-smokers in contrast to never-smokers in all zones. No statistically significant differences in CBL, PD, and BOP were observed in the three zones of implant location among cigarette-smokers and never-smokers.

CONCLUSION

Smoking enhanced PD and CBL around dental implants and this relationship was independent of site of implant placement and jaw location.

Marginal bone loss around cement and screw-retained fixed implant prosthesis

Background

Implant-supported fixed restorations are considered as the standard treatment for replacement of missing teeth. These can be either screw or cement retained. The success or failure of implant restorations depend upon amount of marginal bone loss (MBL). The present study is to determine the MBL around cement and screw-retained implant prosthesis and to determine various predictors of the MBL.

Material and Methods

A retrospective charts review was conducted at the dental clinics, Aga Khan University Hospital, Karachi from February 2017 to June 2017 in which 104 implants restorations were assessed using periapical radiographs. MBL was calculated at baseline and at 12 months and the difference was recorded on a proforma. SPSS version 21.0 was used for statistical analysis. Descriptive statistics was computed. Generalized estimation equation analysis (GEE) was applied to determine the predictors of MBL. Level of significance was kept at ≤ 0.05.

Results

There were 104 implant restorations belonging to 41 patients. Screw retained prosthesis showed significantly greater MBL than cement retained prosthesis (p-value =0 .018) (irrespective of crowns or fixed partial dentures). Other factors that turned out to be significant predictors of MBL were male gender (p-value= <0.01), age >65 yrs. (p-value=0.028) and sites where bone grafting was performed (p-value=0.003).

Conclusions

Male patients of age >65 yrs. with sites needing bone grafts who were provided with screw retained prosthesis (irrespective of crown or fixed partial dentures) had significantly greater marginal bone loss around implants. Key words:Dental implants, dental prosthesis, implant supported dental prosthesis, alveolar bone loss.

Influence of implant location in patients with and without type 2 diabetes mellitus: 2-year follow-up

The aim of the present cross-sectional retrospective 2-year follow-up clinical study was to assess the influence of implant location on clinical and radiographic parameters around dental implants placed in patients with and without type 2 diabetes mellitus (T2DM). Twenty-seven patients with T2DM and 25 non-diabetic controls were included. Implants were classified into three zones according to their location: (1) anterior zone: implant/s replacing anterior teeth, (2) middle zone: implant/s replacing premolars, and (3) posterior zone: implant/s replacing molars. Peri-implant bleeding on probing (BOP), probing depth (PD), and crestal bone loss (CBL) were measured. P-values less than 0.05 were considered statistically significant. The mean age of patients with T2DM was 42.5 years and that of non-diabetic controls was 40.6 years. The mean fasting blood glucose levels of patients with and without T2DM were 74.5mg/dl (66-80mg/dl) and 82.5mg/dl (79-88.1mg/dl), respectively. The mean duration of T2DM was 4.3 years. There was no significant difference in BOP, PD, or CBL around implants placed in any of the zones in the jaws of patients with and without T2DM. There is no influence of implant location on clinical and radiographic parameters around dental implants placed in patients with and without T2DM.

The Prosthetic Influence and Biomechanics on Peri-Implant Strain: a Systematic Literature Review of Finite Element Studies

Objectives

To systematically review risks of mechanical impact on peri-implant strain and prosthetic influence on stability across finite element studies.

Material and Methods

An online literature search was performed on MEDLINE and EMBASE databases published between 2011 and 2016. Following keywords tiered screening and selection of the title, abstract and full-text were performed. Studies of finite element analysis (FEA) were considered for inclusion that were written in English and revealed stress concentrations or strain at peri-implant bone level.

Results

There were included 20 FEA studies in total. Data were organized according to the following topics: bone layers, type of bone, osseointegration level, bone level, design of implant, diameter and length of implant, implant-abutment connection, type of supra-construction, loading axis, measurement units. The stress or strain at implant-bone contact was measured over all studies and numerical values estimated. Risks of overloading were accented as non-axial loading, misfits, cantilevers and the stability of peri-implant bone was related with the usage of platform switch connection of abutment.

Conclusions

Peri-implant area could be affected by non-axial loading, cantilever prosthetic elements, crown/implant ratio, type of implant-abutment connection, misfits, properties of restoration materials and antagonistic tooth. The heterogeneity of finite element analysis studies limits systematization of data. Results of these studies are comparable with other findings of in vitro, in vivo, prospective and retrospective studies.

Does increasing the number of short implants reduce marginal bone loss in the posterior mandible? A prospective study

Marginal bone loss is a concern in the long-term prognosis of short dental implants. The aim of this prospective cohort study was to evaluate the loss when variable numbers of short implants were used in the posterior mandible. The subjects were allocated into three groups according to the number of short implants. The first group was given two, the second three, and the third four. Each patient had radiographs taken immediately after loading and repeated 36 months later. Twenty- three subjects with 65 implants were entered in the three groups. The mean (SD) marginal bone loss was 0.49 (0.04) mm in the two implant group, 0.41 (0.25) mm in the three implant group, and 0.35 (0.25) mm in the four implant group. There were significant differences in marginal bone loss among the three groups (p=0.001), in that the fewer the number of short implant-supported fixed prostheses in the posterior mandible, the greater the marginal bone loss. When we used more short implants the amount of marginal bone loss decreased.

Comparison of clinical and radiographic status of platform-switched implants placed in patients with and without type 2 diabetes mellitus: a 24-month follow-up longitudinal study

OBJECTIVE

The purpose of the present 24-month follow-up longitudinal study was to compare the clinical and radiographic status of platform-switched implants placed in patients with and without type 2 diabetes mellitus (T2DM).

MATERIAL AND METHODS

In total, 45 male non-smokers were included. In Group-1, there were 23 patients with T2DM, and patients in Group-2 comprised of 22 self-reported non-diabetic controls. Under local anesthesia, platform-switched implants were placed in the mandible. Peri-implant bleeding on probing (BOP), probing depth (PD), marginal bone loss (MBL) and hemoglobin A1c (HbA1c) levels were measured at 12 and 24 months of follow-up. Participants were also enrolled in a biannual oral hygiene maintenance program.

RESULTS

The mean age of participants in groups 1 and 2 were 42.4 years (40-46 years) and 41.8 years (39-44 years), respectively. In Group-1, the mean duration of T2DM was 14.5 ± 0.7 months. At 12 and 24 months of follow-up, there was no significant difference in the mean HbA1c levels among patients in groups 1 and 2. At 12 and 24 months of follow-up, there was no significant difference in peri-implant BOP, PD and MBL in both groups.

CONCLUSIONS

Platform-switched implants can remain clinically and radiographically stable in patients with T2DM in a manner similar to non-diabetic individuals. However, it is emphasized that bone loss around implants is influenced by several factors (such as oral hygiene status, glycemic control and tobacco smoking) and not merely platform switching.

Systematic review of the survival rate and the biological, technical, and aesthetic complications of fixed dental prostheses with cantilevers on implants reported in longitudinal studies with a mean of 5 years follow-up

OBJECTIVE

A systematic review was carried out to evaluate the success and survival rate of implants supporting cantilever prosthesis, as well as the incidence of technical and biological complications.

MATERIAL AND METHODS

A MEDLINE search was conducted up to December 2011 for studies with a mean follow-up of 5 years or more. Two independent reviewers screened the retrieved articles and extracted the data independently. Data on survival, failure, mechanical/technical and biological complications were analyzed.

RESULTS

One-hundred and sixty articles were selected as abstract. Only 18 underwent a full-text analysis and only six were included in the study. The estimated cumulative survival rate of implants supporting cantilevered prosthesis was 98.9% (95% CI: 97.4-99.5%), whereas ICFDP survival was estimated to be about 97.1% (95% CI: 90.1-99.2%). Implant failures before prosthetic delivery were not considered. Biological complications were estimated to be 5.7% (95% CI: 4.2-7.6%) at implant level after 5 years. Technical complications were analyzed: the most common complications were veneer fractures (5-year estimate: 10.1%; 95% CI: 3.7-16.5%) and abutment screw fractures (5-year estimate: 1.6%; 95% CI: 0.8-3.5%). Decementation and screw loosening were estimated to be at 5 years 5.9% (95% CI: 1.7-16.8%) and 7.9% (95% CI: 3.2-18.2%), respectively. Implant fracture was rare (5-year estimate: 0.7%; 95% CI: 0.1-4.7%); no framework fracture was reported. Radiographic bone level changes did not yield statistically significant differences. No aesthetic outcome was reported.

CONCLUSIONS

ICFDPS can be considered a reliable treatment: the systematic review assessed that there is no increase in complication rate due to the presence of the cantilever.