Immediate Versus One-Stage Restoration of Small-Diameter Implants for a Single Missing Maxillary Lateral Incisor: A 3-Year Randomized Clinical Trial

Clinical outcomes of narrow- and regular-diameter implants with bone augmentation in the anterior maxilla: a systematic review and meta-analysis

OBJECTIVES

To evaluate the clinical outcomes of narrow-diameter implants (NDIs) and regular-diameter implants (RDIs) with bone augmentation in the anterior maxilla, with implant survival rate (ISR) as the primary outcome. Additionally, secondary outcomes such as peri-implant marginal bone loss (MBL), pocket probing depth (PPD), mechanical complications, and biological complications were also considered.

MATERIALS AND METHODS

A thorough literature search was performed to identify randomized controlled trials and cohort studies comparing outcomes of NDIs and RDIs with bone augmentation in the anterior maxilla published up to February 2024. Only studies with a minimum follow-up period of 12 months were selected for analysis. Meta-analysis was performed if at least two articles with similar characteristics were available.

RESULTS

Of the 288 articles initially considered, 5 were included in the analysis, involving 282 NDIs and 100 RDIs. At the 36-month follow-up, no statistically significant differences in ISR, which ranged 93.8-100% for NDIs and were 100% for RDIs, were observed between the two groups (relative risk, 0.989; 95% confidence interval, 0.839-1.165; p = 0.896). Similarly, MBL and PPD did not differ significantly between the two groups. Soft tissue dehiscence was the most common complication found in RDIs.

CONCLUSION

The results indicate that NDIs yield clinical outcomes similar to those of RDIs with bone augmentation in the anterior maxilla over a 36-month follow-up period.

CLINICAL RELEVANCE

Considering the similar clinical outcomes, the shortened treatment duration and more rapid esthetic improvement associated with NDIs may render them preferrable to RDIs with bone augmentation, particularly in this esthetic zone.

Impact of Implant Diameter on the Early Survival Rate of Dental Implants in the Saudi Population: A One-Year Retrospective Study

Introduction The use of dental implants provides a revolutionary solution to the problem of missing teeth in the oral cavity. The aim of this study was to assess the early implant survival rate in relation to implant diameter and site of placement. Methods The data were collected from 186 patients treated between January 2019 and June 2021. All the implants were evaluated and restored after three months of implant placement. The early implant survival was calculated for different implant diameters with the odds ratio (OR). Results A total of 373 implants were placed. Implants were placed in the following areas: upper posterior area (UPA), n = 123, upper anterior area (UAA), n = 49, lower posterior area (LPA), n = 184, and lower anterior area (LAA), n = 17. Implants of the following diameters were placed: 3.5 mm (n = 129), 4.3 mm (n = 166), and 5 mm (n = 78). The overall early survival rate was 97.32% after three months of placement. The highest early survival rate was at LAA (100%) and the lowest early survival rate was at UAA (95.9%). The implants 5 mm in diameter had the highest early survival rate (98.72%), while the implants 3.5 mm in diameter had the lowest early survival rate (94.57%). The ORs of the early implant survival were 4.7 [95% confidence interval (CI): 0.96-23.05)] and 4.42 (95% CI: 0.53-36.61) for the 4.3 mm and 5 mm implants, respectively, with no statistical significance. Conclusions The implants placed in the oral cavity had acceptable survival rates regardless of implant diameter or site of placement.

Same-Day Digital Dentistry Restorative Workflow for Single Immediate Provisionalization of Narrow-Diameter Implants: An Exploratory Prospective Study

This study evaluated the two-year clinical outcomes of 3.1 mm diameter dental implants, immediately provisionalized and later restored using same-day dentistry, in 10 patients receiving 11 narrow-diameter (3.1 mm) single implants. Each implant was placed and immediately restored with a provisional crown after placement. At least 2 months after placement, the implant was restored with a prefabricated titanium abutment and an all-ceramic crown using a same-day dentistry protocol. Clinical outcomes, including apical bone loss, probing depths, gingival index, and surgical and prosthetic complications, were documented. There was no implant failure over the course of two years. No surgical complications were reported. Two cases lost provisional crowns. One crown needed to be remade due to esthetic concern. The cumulative two-year survival rate of the implants was 100%. Implant bone loss after two years of functional loading was −0.56 ± 0.54 mm and −0.32 ± 0.68 mm for mesial and distal crestal bone, respectively. Two prosthetic complications included recementation of a crown and remaking of a crown. This exploratory study suggests that immediate provisionalization and a same-day restorative dentistry digital workflow protocol for narrow-diameter implants appear to be predictable clinical procedures with no reported surgical complications and minimal prosthetic complications.

Influence of diameter on mechanical behavior of morse taper narrow implants

Dental implants could give back function, esthetics and quality of life to patients. The correct choice of the implant, especially in borderline cases, is essential for a satisfactory result. Aim: Thus, the objective of this study was to evaluate the mechanical behavior of Morse taper implants with two different prosthetic interfaces. Methods: Twenty self-locking Morse taper implants, 2.9 mm in diameter (FAC), and 20 Morse taper implants, 3.5 mm in diameter (CM) were divided into two groups (n=10), and submitted to strength to failure test, optical microscopic evaluation of fracture, metallographic analysis of the alloy, finite element analysis (FEA) and strain gauge test. A Student’s t test (α = 0.05) was made for a statistical analysis. Results: For the strength to failure test, a statistically difference was observed (p <0.001) between FAC (225.0 ± 19.8 N) and CM (397.3 ± 12.5 N). The optical microscopic evaluation demonstrated a fracture pattern that corroborated with FEA´s results. The metallographic analysis determined that the implants of the FAC group have titanium-aluminum-vanadium alloy in their composition. In the strain gauge test, there was no statistical difference (p = 0.833) between CM (1064.8 ± 575.04 μS) and FAC (1002.2 ± 657.6 μS) groups. Conclusion: Based on the results obtained in this study, ultra-narrow implants (FAC) should ideally be restricted to areas with low masticatory effort.

Maintenance requirements and marginal bone loss associated with implant-retained overdentures: a retrospective cohort study

OBJECTIVES

To evaluate the maintenance requirements and the presence of prosthetic complications associated with marginal bone loss in the implant-retained bar and locator prostheses.

MATERIALS AND METHODS

The study was executed between the years 2013 and 2018 on 114 patients who had undergone 283 dental implants. Patients were examined at follow-up recall sessions at 12 and 24 months after the placement of the dentures. The clinical examination also included intraoral and extraoral examinations of the patients; compatibility of the prostheses placed to about occlusion; an adaptation of the prosthesis to the tissues, health, and continuity of the soft tissues; complaints of the patients; implant success rates; and marginal bone loss, and prosthetic complications were evaluated at follow-up sessions, and statistical analysis was performed.

RESULTS

Locator attachment was placed in 94 patients with separated mandibles and maxillae, and a removable prosthesis with a bar attachment was placed in 20 patients. When evaluating the level of marginal bone loss regardless of the presence of complications, the area where the implant was set, the number of days after loading, and the type of retainer, it was found to be significant at the end of the 12th the 24th months. The results showed a significant relationship between the prosthesis type and the presence of complications at month 24 (p < 0.05). There was no significant relationship between the position of the denture and the presence of complications at month 12 (p > 0.05). There was no significant relationship between the location of the denture and the presence of complications at month 24 (p > 0.05).

CONCLUSION

Complications do not affect marginal bone loss, but the resulting marginal bone loss is the result of the patient not paying enough attention to oral hygiene. Routine inspections of the prosthesis after the completion of treatment seem to be important. If the requirements resulting from these checks are met, complications that may occur in the future will be prevented.

CLINICAL RELEVANCE

The maintenance requirements and the presence of prosthetic complications associated with marginal bone loss in the implant-retained bar and locator prostheses were evaluated. Complications occurred more frequently with the bar-supported removable implant prostheses.

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

OBJECTIVES

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Long-term outcomes of maxillary single-tooth implants in relation to timing protocols of implant placement and loading: Systematic review and meta-analysis

OBJECTIVES

The aim of the present systematic literature review was to determine whether long-term treatment results with single-tooth implants may differ depending on the timing of implant placement in relation to tooth extraction (immediate IP/early EP/delayed DP) and the timing of prosthetic loading (immediate IL/early EL/delayed DL).

MATERIAL AND METHODS

Electronic and manual searches were performed to identify studies reporting on long-term results (survival rate and/or marginal bone resorption after ≥3 years) of maxillary single-tooth implants in the aesthetic zone using defined placement and loading protocols. Comparative trials were subjected to meta-analyses whilst data from single-arm studies were pooled to evaluate differences between timing protocols.

RESULTS

A total of 7 controlled trials were considered for meta-analyses: immediate loading was compared to delayed loading in 3 studies on immediate placement (IPIL vs. IPDL, p = .306) and in 2 studies on delayed placement (DPIL vs. DPDL, p = 1.000) whilst 2 studies compared early versus delayed placement with delayed loading (EPDL vs. DPDL, p = .600), however, without significant differences. Pooled data analysis of 29 studies (965 implants) did not show differences between timing of placement or loading as well as marginal bone remodelling. No impact of the one abutment - one time concept, flap design and simultaneous bone or soft tissue augmentation could be established.

CONCLUSIONS

Insufficient data are available for meta-analytic comparison of all combinations of implant placement and loading protocols.

Does immediate loading of a single implant in the healed anterior maxillary ridge improve the aesthetic outcome compared to conventional loading?

Background

Immediate loading is an attractive option for avoiding secondary surgery. However, it is unclear whether it provides a better aesthetic outcome compared to conventional loading with implants placed in healed ridges.

Aims

To compare the aesthetic outcomes of immediately and conventionally loaded single implants in healed anterior maxillary ridges.

Methodology

A systematic review using PICO was conducted. EMBASE, MEDLINE and DoSS databases were searched. The Cochrane Risk of Bias tool for Randomised Controlled Trials and the Effective Public Health Practice Project tool for other study designs were used for quality appraisal. A narrative synthesis was undertaken.

Results

A total of 622 articles were identified. After screening, a total of five papers were included. Results indicated no statistically significant difference in pink or white aesthetic scores between the immediate and conventional loading groups at 1- and 5-year review and the Papilla Index at the 1-year review.

Conclusion

Within the limitations of this review, immediate loading of single implants provides a comparable aesthetic outcome to conventional loading in healed ridges of the anterior maxillary.

Narrow-diameter implants versus regular-diameter implants for rehabilitation of the anterior region: a systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to evaluate studies comparing implant survival rates, marginal bone loss (MBL), and mechanical and biological complication rates between narrow-diameter implants (NDIs) and regular-diameter implants (RDIs) used for oral rehabilitation in the anterior region. The review was conducted according to the PRISMA checklist. Two independent reviewers performed a comprehensive search of the PubMed/MEDLINE, Embase, Scopus, and Cochrane Library databases for studies published until May 2020. A total of 843 implants (484 NDIs and 359 RDIs) were included. No significant difference in implant survival rate (risk difference (RD) 0.01, 95% confidence interval (CI) -0.01 to 0.03; P=0.34), MBL (standardised mean difference -0.51mm, 95% CI -1.29 to 0.26mm; P=0.19), mechanical complications (RD 0.01, 95% CI -0.02 to 0.04; P=0.40), or biological complications (RD 0.01, 95% CI -0.09 to 0.11; P=0.85) was found between the implant groups. Within the limitations of this study, it is concluded that NDIs are an effective alternative to RDIs due to similar survival rates, MBL, and mechanical and biological complication rates. However, future studies are highly encouraged due to the small number of interventional studies on this topic.

Is there any predictive bone parameter for implant stability in 2-dimensional and 3-dimensional radiologic images?

OBJECTIVES

This ex vivo study aimed to compare radiomorphometric parameters between 2-dimensional (2-D) and 3-dimensional (3-D) radiographs and evaluate the influence of preoperative radiologic bone parameters on the clinical outcomes of implant stability.

STUDY DESIGN

Implant recipient sites in fresh bovine blocks were evaluated on panoramic radiographs for gray value (GV), fractal dimension (FD), number of connected trabeculae (Co), and density of connected trabeculae (CoD). Cone beam computed tomography (CBCT) scans were evaluated for trabecular thickness (TbTh), cortical thickness (CTh), degree of anisotropy (DA), FD, and Co. Insertion torque (IT) and implant stability quotient (ISQ) were measured.

RESULTS

GV was significantly correlated with all parameters in 2-D and 3-D images except FD in 2-D and Co in 3-D, and with all surgical parameters (P ≤ .029). Co and CoD values on panoramic radiographs had significant correlation with TbTh, CTh, and DA values on CBCT images (P < .001). All 2-D parameters and TbTh and CTh in the CBCT data were significantly correlated with IT only (P ≤ .047). Only GV was correlated with ISQ measurements (P ≤ .029).

CONCLUSIONS

GV, Co, and CoD values on panoramic radiographs reflect the architecture of trabecular bone and the thickness of cortical bone, and might help predict implant stability in clinical situations.

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

STATEMENT OF PROBLEM

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

PURPOSE

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Biomechanical behavior of extra-narrow implants after fatigue and pull-out tests

STATEMENT OF PROBLEM

Narrow implants have limited indications, and implant fracture may occur when these indications are not followed.

PURPOSE

The purpose of this in vitro study was to investigate the mechanical behavior of a 2.9-mm-diameter implant using a fatigue limit test and to investigate the Morse effect of 2 different Morse taper systems, 2.9-mm-diameter (FAC group) and 3.75-mm-diameter (CM group) implants, using a pull-out test. The null hypothesis was that the tensile strengths of the components for both systems would be similar.

MATERIAL AND METHODS

The fatigue properties of 13 specimens under 6 loads were determined. The test was performed at 15 Hz and for 5×10⁶ cycles. In the pull-out test, the specimens were divided into 2 groups (n=8), the FAC group (2.9-mm-diameter) and the CM group (3.75-mm-diameter). Statistical analysis for the pull-out test was performed with the Student t test (α=.05).

RESULTS

Thirteen specimens underwent the fatigue test. Only 5 did not fail when subjected to the frequency and number of cycles examined. Three of the specimens did not fail under a load of 130 N. The pull-out test showed a significant difference between the FAC and CM groups (P<.001).

CONCLUSIONS

According to the fatigue test, the extra-narrow implant (Facility; Neodent) was compatible with the low masticatory effort regions, as indicated by the manufacturer. The better performance of the FAC group in the pull-out test may be due to its design, which promotes the pure Morse effect in the implant-abutment interface, and the angulation of its internal conical portion.

The treatment dilemma of missing maxillary lateral incisors-Part II: Implant restoration

OBJECTIVE

This second of a two-part series reviews the single dental implant as the most current treatment alternative for replacement of a missing or lost maxillary lateral incisor. Assessments of dental maturity for implant placement, implant space requirements, surgical and restorative influence on soft tissue profiles, and implant success are reviewed.

OVERVIEW

Recent data indicates that implant success rates are high, and esthetics and soft tissue profiles appear to be stable for maxillary lateral incisor implants. Implant placement should be assessed by dental maturity of the specific patient as opposed to chronological age, and implant spacing should be developed and assessed by all team members.

CONCLUSIONS

Implant replacement of a missing lateral incisor is a predictable treatment mode if implant placement is deferred until dental maturity and then accurately placed in a well-developed site. Treatment involves more complicated planning and execution from team members than other alternatives, but innovations in techniques and materials render it a favorable alternative for lateral incisor replacement.

CLINICAL SIGNIFICANCE

Implant restoration of a missing or lost maxillary lateral incisor is surgically and restoratively more complex than space closure or a resin-bonded fixed dental prosthesis but demonstrates high success rates and high esthetic potential when team members follow strict treatment protocols.

Digital workflow to provide an immediate interim restoration after single-implant placement by using a surgical guide and a matrix-positioning device

This article describes a workflow based on a top-down approach to provide a fixed-type immediate interim restoration after placing a single implant using a digitally driven surgical guide and a matrix-positioning device. A characteristic of the technique is that both the surgical guide and the matrix-positioning device are fabricated from a single diagnostic virtual trial restoration designed on computer-aided design (CAD) software. This workflow may shorten the time required for chairside placement of an interim restoration and enhance esthetics when rehabilitating anterior teeth.

Immediate function dental implants inserted with less than 30N·cm of torque in full-arch maxillary rehabilitations using the All-on-4 concept: retrospective study

The aim of this retrospective clinical study was to evaluate the short-term implant success rate and marginal bone loss in full-arch fixed prosthetic maxillary rehabilitations supported by implants in immediate function with the All-on-4 treatment concept placed with insertion torque of <30N·cm or ≥30N·cm. This study included 83 patients (69 female, 14 male) with 332 implants placed (120 inserted with <30N·cm and 212 inserted with ≥30N·cm) who were treated between January 2010 and March 2013. Outcome measures were implant success and marginal bone loss at 1year of follow-up. Ten patients (12.0%; 13 implants inserted with <30N·cm and 27 implants with ≥30N·cm) were lost to follow-up. The cumulative implant success rate was 97.5% at the patient level, and 98.3% for implants inserted with <30N·cm and 97.5% for implants inserted with ≥30N·cm. The mean±standard deviation marginal bone loss at 1year was 1.14±0.38mm for implants inserted with <30N·cm and 1.39±0.49mm for implants inserted with ≥30N·cm (significant difference; P<0.001, Wilcoxon signed rank test). These results indicate that implants with insertion torques of <30N·cm may render comparable success rates and marginal bone loss at 1year compared to implants inserted with insertion torques of ≥30N·cm.

Identification and appraisal of outcome measures used to evaluate hypodontia care: A systematic review

INTRODUCTION

Identification and appraisal of the outcome measures that have been used to evaluate hypodontia treatment and deliver services are essential for improving care. A lack of alignment between outcomes and patient values can limit the scope for patient-centered care. Our objectives were to identify and appraise the outcomes selected to evaluate hypodontia care.

METHODS

Data sources included 10 electronic databases and grey literature, searched using terms for hypodontia and its treatment methods. Study eligibility included mixed study designs to ensure comprehensive identification of outcomes, excluding case reports and case series with fewer than 10 participants and nonsystematic reviews. Participants and interventions involved people with hypodontia receiving any dental treatment to manage their hypodontia. Simulated treatment, purely laboratory-based interventions, and future treatments still in development were excluded. Research outcomes were identified and synthesised into 4 categories: clinical indicators, and patient-reported, clinician-reported, and lay-reported outcomes. No synthesis of efficacy data was planned, and consequently no methodologic quality appraisal of the studies was undertaken.

RESULTS

The search identified 497 abstracts, from which 106 eligible articles were retrieved in full. Fifty-six studies and 8 quality-improvement reports were included. Clinical indicators were reported in 49 studies (88%) including appearance, function, dental health, treatment longevity, treatment success and service delivery. Patient-reported outcomes were given in 22 studies (39%) including oral health-related quality of life, appearance, function, symptoms of temporomandibular dysfunction, and patient experience. Clinician-reported outcomes were limited to appearance. Variability was seen in the tools used for measuring outcomes.

CONCLUSIONS

There is a lack of rationale and consistency in the selection of outcome measures used to evaluate hypodontia care. Outcomes are largely clinician and researcher-driven with little evidence of their relevance to patients. There was a paucity of outcomes measuring access to care, quality of care, and cost. Evidence from hypodontia research is clinician-focused and likely to have limited value to support patients during decision making. Attempts to synthesise the evidence base for translation into practice will be challenging. There is a need for a core outcomes set with a patient-centric approach to drive improvements in health services.

Effect of the different implant protocols on peri-implant bone: a 6-month prospective study in beagle dogs

OBJECTIVE

To compare the effects of different implant placement and loading protocols on the marginal bone loss (MBL) in beagles by intraoral radiography.

METHODS AND MATERIALS

61 dental implants were inserted on 9 beagle dogs at bilateral lower posteriors according to 8 different protocols: immediate implant placement and immediate loading for 3 months (IIP + IL3) or 6 months (IIP + IL6) and unloading (IIP + UL), immediate implant placement and delayed loading for 3 months (IIP + DL3) or 6 months (IIP + DL6), delayed implant placement and immediate loading for 3 months (DIP + IL3) or delayed loading for 3 months (DIP + DL3) and unloading (DIP + UL). Intraoral radiography was performed to analyze the MBL during each surgery, before and after the implant placement and at 3-month intervals after the procedure.

RESULTS

In total, 57 samples were included. There was less MBL (p<0.05) in the IIP + IL3 group (1.22 ± 0.63 mm) compared to the DIP + IL3 group (1.89 ± 0.9 mm). The longer the loading time, the more bone loss appeared in the IIP + IL group; however, the results were reversed in the IIP + DL group. The MBL during the latter 3-month period was dramatically decreased compared to the former 3-month period in the IIP + DL3 group (p<0.05).

CONCLUSIONS

The IIP + IL group seems superior to the DL protocol and the MBL changed significantly during the first three months and thereafter became stable.

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

OBJECTIVES

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Effect of Implant Diameter on Fatigue Strength

PURPOSE

To investigate the effect of implant diameter on fatigue strength using static and cyclic load test.

MATERIALS AND METHODS

Four different implant systems-SuperLine (Φ4.0), NRLine (Φ3.1), SlimLine (Φ2.8, Φ2.3), and (Dentium)-were grouped by implant diameter. A static load test was conducted with 5 specimens for each group using a universal testing machine to measure the ultimate failure load (UFL). With 80% of the UFL in the weakest group, the starting load for a cyclic load test was determined and the test was performed with 8 specimens for each group. All tests were conducted according to ISO14801 (2007) until implant failure occurred. After dynamically loaded, each specimen was sectioned and stereo-microscopically examined. The failure modes of each implant system were classified. Static and cyclic load test data were respectively analyzed after the test of normality, with the level of significance at P = 0.05.

RESULTS

In the static load test, the higher maximum load of the standard-diameter implant was significant compared with the recorded narrow or mini-implants (P < 0.05). The yield strengths of the Φ2.8 and Φ3.1 implants were significantly greater than that of the Φ2.3 implant (P < 0.05). In a cyclic load test, the mean number of cycles until implant failure occurred was recorded for each specimen. The value for the Φ4.0 implant was significantly greater (P < 0.001).

CONCLUSION

Implant diameter has an effect on the ability to withstand both static and cyclic loads within Dentium implant systems, The UFLs and fatigue cycles decreased as the implants diameter became smaller.

Occlusal rehabilitation in patients with congenitally missing teeth-dental implants, conventional prosthetics, tooth autotransplants, and preservation of deciduous teeth-a systematic review

Background

Implant patients with congenitally missing teeth share some common charateristics and deserve special attention.

Methods

The PICO question was “In patients with congenitally missing teeth, does an early occlusal rehabilitation with dental implants in comparison to tooth autotransplants, conventional prosthetics on teeth or preservation of deciduous teeth have better general outcomes in terms of survival, success and better patient centered outcomes in terms of quality of life, self-esteem, satisfaction, chewing function?”

After electronic database search, a total of 63 relevant studies were eligible, of which 42 qualified for numerical data synthesis, 26 being retrospective studies. A data synthesis was performed by weighted means for survival/success/annual failure rates.

Results

The mean survival of implants was 95.3 % (prosthesis survival 97.8 %), autotransplants 94.4 %, deciduous teeth 89.6 %, and conventional prostheses 60.2 %. The implant survival in children, adolescents, and adults was 72.4, 93.0, and 97.4 %. Annual failure rates of implants 3.317 %, autotransplants 1.061 %, deciduous teeth 0.908 %, and conventional prostheses 5.144 % indicated better results for natural teeth and more maintenance needs for the both prosthetic treatments. The mean OHIP score was 27.8 at baseline and a mean improvement of 14.9 score points was reported after implant prosthetics. The mean satisfaction rates were 93.4 (implants), 76.6 (conventional prostheses), 72.0 (autotransplants), and 65.5 % (orthodontic space closure).

Conclusions

In synopsis of general and patient-centered outcomes, implants yielded the best results, however, not in children <13 years. Autotransplants and deciduous teeth had low annual failure rates and are appropriate treatments in children and adolescents at low costs. Conventional prosthetics had lower survival/success rates than the other options. Due to heterogeneity and low number of studies, patient-reported outcomes in this review have to be interpreted with caution.

Dental Implants With Immediate Loading Using Insertion Torque of 30 Ncm: A Systematic Review

OBJECTIVE

This study aimed to perform a review of the literature regarding the survival rate of dental implants with immediate loading using insertion torque of 30 Ncm.

MATERIAL AND METHODS

A systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Cochrane Handbook for Systematic Reviews of Interventions (PROSPERO CRD42014015323). The search was performed in the PubMed, Web of Science, Cochrane Library electronic, OVID, and Scielo databases. Manual searches were also performed. The articles identified were assessed independently by 3 researchers. Clinical trials reporting dental implants with immediate loading and 30 Ncm torque in patients ages 18 years or older were included.

RESULTS

The searches yielded 589 studies. Six studies were included in the systematic review. The survival rate of dental implants was 96.8%. Three studies showed a low potential risk of bias.

CONCLUSION

There is not strong evidence that insertion torque of 30 Ncm is enough for implant survival in cases of immediate loading.

A wide mesio-distal gap in sites of congenitally missing maxillary lateral incisors is related to a thin alveolar ridge

OBJECTIVES

To evaluate (i) a possible correlation between the mesio-distal gap width and the alveolar ridge (AR) dimensions in patients missing the maxillary lateral incisor (I2) either due to agenesis or loss and (ii) the possibility of straightforward implant placement based on simulation.

METHODS

The bucco-palatal width, area, and height of the AR at the position of I2, and the mesio-distal gap width between the central incisor and the canine, were assessed in maxillary CT scans of three groups: Patients with (i) agenesis of I2 (T_A ; n = 40); (ii) I2 regularly erupted but extracted (T_L ; n = 24); (iii) I2 regularly erupted and in situ (C; n = 40). Further, the possibility of straightforward placement of an implant 3 or 3.5 mm in diameter ×10 mm in length, with 1 mm distance from the buccal and palatal plate of the alveolar ridge was simulated and compared to the actual treatment delivered.

RESULTS

Bucco-palatal width and area of the AR at I2 and the adjacent teeth was significantly reduced in T_A compared to T_L and C. Further, in T_A , but not T_L , an increasing mesio-distal gap width between the central incisor and canine resulted in a significantly reduced bucco-palatal width of the edentulous AR. This impeded a simulated straightforward implant placement in >50% of the cases in T_A , even with a reduced implant diameter.

CONCLUSIONS

In patients congenitally missing I2, an increased mesio-distal gap width correlates significantly with reduced edentulous AR dimensions. A mesio-distal gap of >6 mm was associated with thin bucco-palatal alveolar ridges, precluding straightforward implant placement in 60-80% of the cases.

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

PURPOSE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

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.

Occlusion on oral implants: current clinical guidelines

Proper implant occlusion is essential for adequate oral function and the prevention of adverse consequences, such as implant overloading. Dental implants are thought to be more prone to occlusal overloading than natural teeth because of the loss of the periodontal ligament, which provides shock absorption and periodontal mechanoreceptors, which provide tactile sensitivity and proprioceptive motion feedback. Although many guidelines and theories on implant occlusion have been proposed, few have provided strong supportive evidence. Thus, we performed a narrative literature review to ascertain the influence of implant occlusion on the occurrence of complications of implant treatment and discuss the clinical considerations focused on the overloading factors at present. The search terms were 'dental implant', 'dental implantation', 'dental occlusion' and 'dental prosthesis'. The inclusion criteria were literature published in English up to September 2013. Randomised controlled trials (RCTs), prospective cohort studies and case-control studies with at least 20 cases and 12 months follow-up interval were included. Based on the selected literature, this review explores factors related to the implant prosthesis (cantilever, crown/implant ratio, premature contact, occlusal scheme, implant-abutment connection, splinting implants and tooth-implant connection) and other considerations, such as the number, diameter, length and angulation of implants. Over 700 abstracts were reviewed, from which more than 30 manuscripts were included. We found insufficient evidence to establish firm clinical guidelines for implant occlusion. To discuss the ideal occlusion for implants, further well-designed RCTs are required in the future.

Photoelastic stress analysis in prosthetic implants of different diameters: mini, narrow, standard or wide

PURPOSE

This study investigated the biomechanical behavior of screwed partial fixed prosthesis supported by implants with different diameters (2.5 mm; 3.3 mm and 3.75 mm) by using a photoelastic analysis.

MATERIALS AND METHODS

Six photoelastic models were fabricated in PL-2 resin as single crowns or splinted 3-unit piece. Models were positioned in a circular polariscope and 100-N axial and oblique (45 degrees) loads were applied in the occlusal surface of the crowns by using a universal testing machine (EMIC). The stresses were photographically recorded and qualitatively analyzed using a software (Adobe Photoshop).

RESULTS

Under axial loading, the number of fringes was inversely proportional to the diameter of the implants in the single crown models. In the splinted 3-unit piece, the 3.75-mm implant promoted lower number of fringes regardless of loading area application. Under oblique loading, a slight increase of fringes number was observed for all groups.

CONCLUSION

The standard implant diameter promoted better stress distribution than the narrow and mini diameter implants. Additionally, the splinted crowns showed a more uniform stress distribution.

Narrow-diameter implants: are they a predictable treatment option? A literature review

OBJECTIVE

To evaluate the predictability of narrow-diameter implants as a treatment option in routine clinical practice. A literature review was performed of studies reporting clinical results obtained with these implants. Survival rates, peri-implant bone loss and related complications were evaluated. The working hypothesis was that narrow-diameter implants offer clinical results similar to those obtained with implants of greater diameter.

MATERIAL AND METHODS

A Medline-PubMed search covering the period between 2002 and 2012 was carried out. Studies published in English and with a follow-up period of at least 12 months were considered for inclusion. A manual search was also conducted in different journals with an important impact factor. results: Twenty-one studies meeting the screening criteria were included in the literature review. A total of 2980 narrow-diameter implants placed in 1607 patients were analyzed.

CONCLUSIONS

The results obtained from the literature indicate that narrow-diameter implants are a predictable treatment option, since they afford clinical results comparable to those obtained with implants of greater diameter.

Minimally invasive transmucosal insertion and immediate provisonalization of one-piece implant in partially edentulous posterior mandible

Although dental implantology had evolved over number of years, many dental surgeons are unaware of the concept of immediate loading with use of titanium one-piece implants that began in the early 1960s. Although long term success have been revealed with the use of two piece implants over the period of years, many obstacles like pain, inflammation and the bacterial migration into the micro-gap of two-piece implants when they are loaded; loosening and even fractures of the internal screws when they are loaded which limits patient acceptance towards dental implants. Immediate loading of one piece implants by using provisional acrylic resin crown with minimally invasive or atraumatic, flapless surgical procedures provides a better soft tissue adhesion and seal to form a healthy collar, avoids a second stage surgical procedure and with higher patient acceptance . One-piece implant also allows a minimally invasive trans-mucosal flapless placement and limits the requirement of hard tissue grafting procedures. With all these conception, the present case report evaluated the clinical performance of a one-piece implant in a partially edentulous posterior mandible.

Biomechanical effects of the implant material and implant-abutment interface in immediately loaded small-diameter implants

OBJECTIVE

Small-diameter implants have been available since the 1990s, but few studies have analyzed their mechanical properties. This study evaluated the effects of the implant material and the implant-abutment connection designs on the primary stability and the marginal bone strain of small-diameter implant subject to immediate loading.

MATERIALS AND METHODS

Insertion torque value (ITV), implant stability quotient (ISQ), and Periotest value (PTV) of three implant systems with four parameters (titanium, titanium alloy, internal and external hexagon connections) were measured after placing implants into artificial type 2 jaw-bone models. Specimens were tested under both vertical and oblique static loads at 190 N. Peak values of the principal bone strain were recorded and analyzed statistically by the Kruskal-Wallis test and multiple-comparisons Bonferroni test.

RESULTS

PTV and ISQ were higher for the NIOSM311 (internal-hex and Ti alloy) and FOSM311 (external-hex and pure Ti) implants, respectively, than for the NOSM311 (external-hex and Ti alloy) implant. Under vertical loading the peak value of peri-implant bone strains did not differ significantly among these three implant systems. However, the peak bone strains were at least 32 % lower for the NIOSM311 and FOSM311 implants than for the NOSM311 implant under lateral loading.

CONCLUSIONS

The implant material and the implant-abutment connection design significantly influence the peri-implant bone strain of immediately loaded small-diameter implants, but barely affect their primary stability.

CLINICAL RELEVANCE

A commercially pure titanium implant with an internal connection has the potential to reduce the risk of implant failure of small-diameter implant related to biomechanical complications.

The influence of implant diameter on its survival: a meta-analysis based on prospective clinical trials

BACKGROUND

The use of narrow-diameter implants has been proposed to restore small edentulous spans, thus avoiding extensive bone augmentation procedures and reducing the surgical complexity of implant rehabilitations. Although success rates of narrow-diameter implants have already been analyzed in the literature, to the best of the authors' knowledge, no meta-analysis based on prospective and randomized controlled trials has been performed. The aim of this study is to analyze the survival rates of narrow-diameter implants compared with standard or wide-diameter implants.

METHODS

An electronic search from three databases and a hand search in implant-related journals of studies published in English before September 1, 2012 were performed. Prospective human clinical studies with at least 10 implants and a follow-up period of 1 year were included in the meta-analysis. Implants were divided into two groups based on their diameters.

RESULTS

The initial search yielded 484 articles, of which 49 were evaluated in full text for eligibility. Finally, 16 studies were chosen and separated into two groups: 1) implants of diameter <3.3 mm (group 1) and 2) implants of diameter ≥3.3 mm (group 2). A meta-analysis performed for groups 1 and 2 showed survival rates of 75% and 87%, respectively.

CONCLUSIONS

This meta-analysis showed that narrower implants (<3.3 mm) had significantly lower survival rates compared with wider implants (≥3.3 mm). Other variables, such as type of prosthesis, implant surface, and timing of prosthetic loading, were found to have influenced the implant survival rates.

Interventions for replacing missing teeth: different times for loading dental implants

BACKGROUND

To minimise the risk of implant failures after their placement, dental implants are kept load-free for 3 to 8 months to establish osseointegration (conventional loading). It would be beneficial if the healing period could be shortened without jeopardising implant success. Nowadays implants are loaded early and even immediately and it would be useful to know whether there is a difference in success rates between immediately and early loaded implants compared with conventionally loaded implants.

OBJECTIVES

To evaluate the effects of (1) immediate (within 1 week), early (between 1 week and 2 months), and conventional (after 2 months) loading of osseointegrated implants; (2) immediate occlusal versus non-occlusal loading and early occlusal versus non-occlusal loading; (3) direct loading versus progressive loading immediately, early and conventionally.

SEARCH METHODS

The following electronic databases were searched: the Cochrane Oral Health Group's Trials Register (to 8 June 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2012, Issue 4), MEDLINE via OVID (1946 to 8 June 2012) and EMBASE via OVID (1980 to 8 June 2012). Authors of identified trials were contacted to find unpublished randomised controlled trials (RCTs). There were no restrictions regarding language or date of publication.

SELECTION CRITERIA

All RCTs of root-form osseointegrated dental implants, having a follow-up of 4 months to 1 year, comparing the same implant type immediately, early or conventionally loaded, occlusally or non-occlusally loaded, or progressively loaded or not. Outcome measures were: prosthesis and implant failures and radiographic marginal bone level changes.

DATA COLLECTION AND ANALYSIS

Data were independently extracted, in duplicate, by at least two review authors. Trial authors were contacted for missing information. Risk of bias was assessed for each trial by at least two review authors, and data were extracted independently, and in duplicate. Results were combined using fixed-effect models with mean differences (MD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI). A summary of findings table of the main findings was constructed.

MAIN RESULTS

Forty-five RCTs were identified and, from these, 26 trials including a total of 1217 participants and 2120 implants were included. Three trials were at low risk of bias, 12 were at high risk of bias and for the remaining 11 the risk of bias was unclear. In nine of the included studies there were no prosthetic failures within the first year, with no implant failures in 7 studies and the mean rate of implant failure in all 26 trials was a low 2.5%. From 15 RCTs comparing immediate with convential loading there was no evidence of a difference in either prosthesis failure (RR 1.87; 95% CI 0.70 to 5.01; 8 trials) or implant failure (RR 1.65; 95% CI 0.68 to 3.98; 10 trials) in the first year, but there is some evidence of a small reduction in bone loss favouring immediate loading (MD -0.10 mm; 95% CI -0.20 to -0.01; P = 0.03; 9 trials), with some heterogeneity (Tau² = 0.01; Chi² = 14.37, df = 8 (P = 0.07); I² = 44%). However, this very small difference may not be clinically important. From three RCTs which compared early loading with conventional loading, there is insufficient evidence to determine whether or not there is a clinically important difference in prosthesis failure, implant failure or bone loss. Six RCTs compared immediate and early loading and found insufficient evidence to determine whether or not there is a clinically important difference in prosthesis failure, implant failure or bone loss. From the two trials which compared occlusal loading with non-occlusal loading there is insufficient evidence to determine whether there is a clinically important difference in the outcomes of prosthesis failure, implant failure or bone loss. We did not identify any trials which evaluated progressive loading of implants.

AUTHORS' CONCLUSIONS

Overall there was no convincing evidence of a clinically important difference in prosthesis failure, implant failure, or bone loss associated with different loading times of implants. More well-designed RCTs are needed and should be reported according to the CONSORT guidelines (www.consort-statement.org/).