Five years clinical outcome of maxillary mini dental implant overdenture treatment: A prospective multicenter clinical cohort study

BACKGROUND

The long-term clinical outcome of mini dental implants (MDIs) to support an overdenture is underreported especially in severely atrophic maxillae and when installed flaplessly.

PURPOSE

The current report is a 5-years follow-up of the previously published 2- and 3-years clinical outcome of MDIs supporting a maxillary overdenture in narrow alveolar ridges. MDI survival, marginal bone level, peri-implant health, technical complications, and oral health related quality of life (OHIP) and respective changes over time are reported.

MATERIALS AND METHODS

Subjects aged 50 years or older, in need of improvement of maxillary denture retention, were included. The MDIs were 2.4 mm diameter one-piece tapered implants, Class 4 pure Titanium, and lengths 10 or 11.5 mm. Under local anesthesia, 5-6 MDIs were placed in atrophic maxillae with a free-handed flapless approach. One week postoperative the denture was adapted with a retentive soft reliner. The final prosthetic connection was established after 6 months with a metal-reinforced horse-shoe denture. Clinical outcome after 5 years was assessed with probing pocket depts (PPD), bleeding on probing (BoP), and additional cone beam computed tomography (CBCT) MDI bone level measurements were performed. Oral Health-Related Quality of Life (OHRQoL) investigated with OHIP-14 was assessed preoperative, during provisional loading, and after final prosthetic connection up to 5 years.

RESULTS

Initially, 31 patients (14 females and 17 males) with mean age 62.30 underwent treatment. In the provisional loading interval, 16 patients encountered 32/185 MDIs failures, resulting in a failure of 17.3%; 170 MDIs were functionally loaded in 29 patients. Additionally, 14 implants were lost in three patients, all of whom had had already previous failures. Reimplantation of 17 MDIs were performed during the provisional loading and 2 MDI after functional loading. After 5 years, the absolute implant failure rate was 46/204 (22.5%), corresponding to a cumulative failure rate of 23.2%. Prosthetic failure was observed in four patients due to implant loss and in two patients related to excessive one-piece implant ball attachment wear, making the 5-years prosthetic success 80.0%. The mean PPD and absence/presence of BoP for 149 implants at 5 years was 4.3 and 0.2 mm, respectively. Average mesial-distal-vestibular-palatal bone loss in the interval 2-5 years was 0.08 mm. No statistically significant difference in marginal MDI bone loss between male or female (p = 0.835), smoking and nonsmoking (p = 0.666) was observed. The five-years total measured CBCT interdental bone level (mesial and distal) correlates with the 5-years PPD (Pearson 0.434; p = 0.01). After 5 years, OHRQoL with the treatment procedure was assessed in 27/31 participants. Decreasing mean total OHIP-14 scores with improved OHRQoL, was observed in 27/31 participants, with values of 21.3 at baseline to 15.6 at the time of provisional loading which significantly (p = 0.006) decrease to 7.3 at the final prosthetic connection. The next 3-5 years further decrease was observed with 6.5 and 4.96, respectively.

CONCLUSIONS

Maxillary MDIs for overdentures are an accessible and acceptable treatment option. Although after 5 years between one fifth and one fourth of the MDIs were lost, prosthetic success remains 80.0% and high OHRQoL could be achieved.

Long-Term Effect of Guided Implant Surgery on Clinical Outcomes and Peri-Implantitis of Maxillary Implants-An Observational Cohort Study

(1) Although the accuracy of static computer-aided implant surgery (sCAIP) is well reported, information on its long-term effect on peri-implant health and complications is scarce. (2) Twenty-six patients initially treated were recalled. Implant survival, radiographic bone level, peri-implant health, and complications were registered. A multilevel regression model was applied to study the relationship between the research variables. (3) Sixteen patients participated in this study (average age 58.5 years; range 27.8-73.8). The mean follow-up time was 9.1 years (range 7.3-11.3). Two implants failed, resulting in a survival rate of 97.1%. The mean bone level change corresponded to a loss of 0.63 mm (SD 1.90) for the whole group, 0.17 mm (SD 1.46), and 0.91 mm (SD 2.09) for tooth- and mucosa-supported guides, respectively. The mean PPD for the total group was 4.24 mm (SD 1.25), and 3.79 mm (SD 0.97) and 4.51 mm (SD 1.33) for the tooth- and mucosa-supported guides, respectively. Four implants (6.3%) were diagnosed with peri-implantitis. Coronal deviation was slightly associated with having a negative impact on bone level at follow-up, but this was not statistically significant. Seven patients (43.8%) experienced technical complications. Biological complications were seen in 3/16 patients (18.75%). (4) SCAIP may contribute to more predictable implant placement; the long-term clinical outcome is similar to conventional nonguided surgery.

Incidence of Peri-Implantitis, Technical and Biological Complications of Single Implants Placed with Flap or Flapless Surgery-A 10-12-Year Case-Series

BACKGROUND

Long-term follow-up of single implants and crowns is scarce, especially when inserted using flapless surgery.

AIM

Evaluate survival, peri-implantitis incidence, and technical/biologic complications of solitary implants/crowns after 10-12 years of function.

MATERIAL AND METHODS

49 patients with 53 single implants, initially operated with a one-stage flap (F) or flapless (FL) surgery and delayed loading, were recalled. Implant survival, radiographic bone-level changes compared to baseline, peri-implant health, and soft tissue aesthetics were registered. Differences in implant level between and within groups were statistically tested using the Mann-Whitney U-Test and Wilcoxon Signed Ranks Test, respectively.

RESULTS

36 patients with 40 implants were reassessed, yielding 100% implant and 97.5% crown survival. The bone loss in F (n = 19) was 0.56 mm (SD 0.89; range -0.9-2.02) and -0.85 mm (SD 0.98; range -2.84-0.53) in FL (n = 21), indicative of bone gain in FL (p = 0.003), the latter due to a difference at baseline but bone-level was comparable (p = 0.126). Groups were comparable for probing pocket depth (PPD); (3.32 vs. 3.19 mm), Bleeding Index (BI); (0.15 vs. 0.22), and gingival recession; (0.38 vs. 0.17 mm). According to international criteria, the peri-implantitis incidence was 0%, but 32.5% of the implants/crowns experienced biological or technical complications irrespective of surgical technique.

CONCLUSIONS

Solitary implants and crowns show good long-term clinical outcomes and peri-implant health. Flapless surgery is a good alternative to conventional in straightforward cases with sufficient bone volume and proper treatment planning.

A Split-Mouth Study to Assess the Effect of Implant Surface Roughness on Implant Treatment Outcome After 5 Years

The aim of current split-mouth study was to compare the implant treatment outcomes of hybrid-surface implants (minimally rough implant collar and moderately rough body) with moderately rough implants after 5 years in patients with a bar-supported mandibular overdenture. Fully edentulous patients were enrolled, and each patient received two implants: one moderately rough and one hybrid-surface implant. A total of 18 patients with 36 implants attended the 5-year recall, and the implant survival rate was 100%. The 5-year evaluation showed no significant difference in crestal bone loss or peri-implant health between the hybrid and moderately rough implants.

Effect of Sinus Perforation with Flaplessly Placed Mini Dental Implants for Oral Rehabilitation: A 5-Year Clinical and Radiological Follow-Up

Background: Flaplessly placed one-piece mini dental implants (MDI) are an option to support maxillary overdentures. Evenly distribution of the implants over the atrophic alveolar process implies a risk of accidental sinus perforation in the posterior area which could induce sinus-related pathology. Methods: Thirty-one patients received 5–6 maxillary MDIs. Schneiderian membrane swelling was assessed with CBCT at the deepest point of the sinus in the mid-sagittal plane prior to surgery (baseline), after 2 and 5 years. Additionally, subjective patient-reported rhinosinusitis complaints, the effect of smoking, and gender differences were investigated. Results: Mean thickness of the Schneiderian membrane was 2.87 mm at baseline, 3.15 mm at 2 years, and 4.30 mm at 5 years in 27 of 31 initially treated patients. MDI perforation was detected in 21/54 sinuses. At 2 years, perforation length does not affect membrane thickness whereas baseline swelling does. In smokers, each perforated mm induced 0.87 mm additional swelling. After 5 years, the effect of baseline swelling becomes smaller whereas perforation length became statistically significant, with 0.53 mm increase for every perforated mm. The effect of smoking lost its significance. No relations between gender, membrane thickness changes, or subjective clinical sinus complaints and MDI perforation were found. Conclusion: Accidental MDI sinus perforation induces Schneiderian membrane swelling but does not interfere with clinical sinusal outcome after 5 years.

Implant-Retained Mandibular Overdentures: Patient-Related Outcome Measurements after Seven Years of Function

Denture wearers often complain about jeopardized function and reduced quality of life due to lack of prosthesis’ retention. Implant-retained mandibular overdentures, on two non-connected implants (2IOD) are well-proven solutions to overcome these issues. We prospectively assessed 69 patients and scrutinized clinical records until at least seven years of function. Thirty-six were retained on Locator^® Abutments (LA) and thirty-tree on Ball Abutments (BA). Both systems were compared regarding the type, amount, and total cost of required maintenance. One implant was lost, yielding 98.7% survival after seven years. In total, 438 technical issues occurred: 121 (27.35%) in BA and 317 (72.4%) in LA. Out of these, 343 events (78%) were solved chairside: 191 (43.6%) were replacements of retention caps, 113 (25.8%) were minor acrylic repairs, 26 (5.9%) pressure ulcers had to be relieved, and 13 (3%) were related to abutments. LA required 179 insert replacements compared to 12 in the BA group. The overall initial treatment cost was EUR 3850 (base year of the analysis: 2003). The average total maintenance cost in relation to the initial cost for the LA and BA groups was 19.11 (range 0–82.24%) and 18.91% (range 0–113.26%) respectively (p = 0.540). Conclusions: The seven-year maintenance costs for a 2IOD is acceptable when the patient is regularly checked and professionally maintained. Most events are easily solvable chairside, but a few patients required more expensive interventions, regardless of the type of attachment used.

Accuracy of Guided Implant Surgery Using an Intraoral Scanner and Desktop 3D-Printed Tooth-Supported Guides

PURPOSE

The increasing popularity of desktop 3D printers makes guided surgery more accessible. The aim of this in vitro study was to evaluate the accuracy of single-tooth guided implant surgery by means of a 3D-printed tooth-supported guide.

MATERIALS AND METHODS

Fifteen implants were virtually planned to replace a missing first mandibular molar, using planning software for guided implant surgery (Exoplan, Exocad). A tooth-supported guide was designed and manufactured using a desktop 3D printer (Asiga MAX UV). The implants were placed fully guided in resin casts, and a digital impression was taken to register their position. This scan was compared with the virtual implant position in the planning software, and the internal fit of the guides was evaluated using metrology software. One planning was executed six times for measuring precision.

RESULTS

For trueness, the mean angular deviation was 2.63 degrees (SD: 1.69 degrees; range: 0.38 to 5.99 degrees), the mean coronal deviation was 0.52 mm (SD: 0.25; range: 0.09 mm to 1.07 mm), and the mean apical deviation was 0.90 mm (SD: 0.47; range: 0.14 to 1.74 mm). The absolute apical mean deviation in the buccolingual direction (x-axis) was 0.70 mm (SD: 0.42, 0.12 to 1.65 mm; P < .001); in the mesiodistal direction (y-axis), it was 0.34 mm (SD: 0.26; range: 0.01 to 0.80 mm; P = .650); and in the vertical direction (z-axis), it was 0.32 mm (SD: 0.27; range: 0.02 to 1.00 mm; P = .010). The mean internal fit of the guides was 79.5 μm (SD: 19.6 μm; range: 51 to 118 μm).

CONCLUSION

Desktop 3D-printed tooth-supported guides demonstrate an acceptable fit and acceptable level of accuracy for single implant placement.

A Completely Digital Workflow for Nanoceramic Endocrowns: A 5-Year Prospective Study

PURPOSE

To evaluate the success of monolithic endocrowns fabricated using a digital workflow.

MATERIALS AND METHODS

Twenty-three patients requiring restoration of devitalized molars or premolars were included in the study. The preparation was scanned using an intraoral scanner (Cerec Bluecam, Dentsply Sirona), and a monolithic restoration was made from a nanoparticle resin-based hybrid composite (#10 Cerasmart [CS]; #10 Lava Ultimate [LU], 3M Espe) or a polymer-infiltrated ceramic (#10 Vita Enamic [VE]). At the time of placement and after 6 months, 1 year, and 5 years of function, radiographs were taken to evaluate the marginal integrity of the restorations, and clinical pictures were taken to assess the quality of the restoration using the USPHS criteria.

RESULTS

After 5 years, the restorative success rate was 70.8%, the restorative survival rate was 87.5%, and the tooth survival was 91.6%. Four chippings (two LU, two CS), three fractures (three LU), and two debonding of the restorations (two CS) occurred. Also, two teeth were extracted after 5 years of follow-up (two VE) because of secondary caries and a root fracture. The USPHS ratings were high, except for color match, which was rated the lowest at all time intervals.

CONCLUSION

Nanoceramic endocrowns made using a completely digital workflow have an acceptable survival rate after 5 years. However, the complication rate was high.

Case Series on the Long-Term Effect of Three Different Types of Maxillary Implant-Supported Overdentures on Clinical Outcomes and Complications

(1) Long-term data on maxillary implant overdentures (IODs) are scarce. This case series evaluated three types of IODs supported by six, four or three implants (Anyridge^®, Mega'Gen Implant Co., Ltd., Daegu, South-Korea), after 3-5 years in function. (2) A total of 31 patients, with 132 implants, were non-randomly allocated based on available bone or financial limitations. IOD-6 received a telescopic overdenture; IOD-4 a bar; and IOD-3, non-connected implants with locator abutments. Implant survival, bone level changes, probing pocket depth (PPD), plaque index, bleeding on probing (BOP), and technical, biological and aesthetic complications were registered. Impact of suprastructures on bone loss and PPD was analyzed using mixed-effect linear regression models. Differences between groups were analyzed using the ANOVA test for BOP, and Kruskal Wallis test for complications. (3) In total, 23 patients participated in the follow-up (9 female, 14 male), with average age of 62.2 years; 7, 11 and 5 patients in IOD-6, IOD-4 and IOD-3, respectively. Implant survival after 4.4 years on average, was 98% in total; 100%, 97.8% and 93.3% for IOD-6, IOD-4 and IOD-3, respectively. Mean bone loss corresponded to 0.68 mm (SD 1.06, range -4.57-1.51), 0.39 mm (SD 1.06, range -3.6-2.43), and 1.42 mm (SD 1.68, range -5.11-0.74) for IOD-6, IOD-4 and IOD-3, respectively. A statistically significant difference was seen in bone level when comparing IOD-6 to IOD-3 (p = 0.044), and IOD-4 to IOD-3 (p = 0.018). Mean PPD was 3.8 mm (SD: 0.69; range 2.5-5.3), 3.5 mm (SD 0.59; range 2.33-5), and 3.2 mm (SD 0.56; range 2-4) for IOD-6, IOD-4 and IOD-3, respectively, and differed significantly between IOD-6 and IOD-3 (p = 0.029). Incidence of peri-implantitis was 1%. No differences were seen for complications between groups. (4) Maxillary IOD supported by four to six implants is the most reliable treatment regarding implant survival and peri-implant health. More research is needed in the clinical outcomes, in particular the peri-implant health, and complications of maxillary IODs, especially with a reduced number of implants.

Four-implant-supported overdenture treatment in the maxilla. Part I: A randomized controlled split mouth trial assessing the effect of microthreads and abutment connection type on 4 years peri-implant health

BACKGROUND

According to literature, peri-implant bone loss is minimized on implants with microthreaded neck design and internal type of abutment connection. However, most clinical studies may be biased due to confounding factors.

PURPOSE

This nonblinded RCT assessed the effect of implant neck (microthreaded vs non-microthreaded) as well as the type of abutment connection (internal conical vs external flat-to-flat) on peri-implant bone stability and peri-implant health after at least 36 months.

MATERIALS AND METHODS

Twenty-five patients were treated with a maxillary implant-supported bar-retained overdenture on four different implant types: internal connection with microthreads (I-MT), internal connection without microthreads (I-NMT), external connection with microthreads (E-MT), and external connection without microthreads (E-NMT). To control confounding factors, all other design features were similar. A linear mixed-model analysis or mixed-model logistic regression analysis was used to determine the effect of implant type on bone level, probing pocket depth, bleeding on probing, and plaque.

RESULTS

Four out of 98 implants (4.1%) placed in 25 patients failed during provisionalization and were replaced. Mean overall bone loss after 6 months was 0.39 mm (SD 0.62, range 0.00-3.48) with limited additional bone loss of 0.04 mm (SD 0.54, range -1.80-1.63) after at least 3 years. Microthreads or connection type had no effect on the bone level, probing pocket depth, bleeding on probing, nor plaque.

CONCLUSIONS

With 96% of implant survival, the maxillary overdenture supported with a bar on four implants yield a predictable outcome and the implant-abutment connection type (internal vs external) and implant neck design (microthreaded vs non-microthreaded) have no influence on peri-implant bone remodeling after initial bone remodeling nor up to 4 years of function. Peri-implant bone levels are within international success standards and peri-implant health is indicative of absence of peri-implantitis.

Four-implant-supported overdenture treatment in the maxilla. Part II: Speech- and oral health-related quality of life in patients with implant-supported overdentures in the maxilla-A prospective 3-year follow-up

BACKGROUND

Implant-supported overdentures (IOD) are becoming a more commonly used treatment in the dental practice and it risks causing speech problems.

PURPOSE

The aim of this study was investigating the changes in speech, satisfaction with speech, and overall oral health-related quality of life (OHRQoL) in edentulous patients during and after treatment with maxillary IODs.

MATERIALS AND METHODS

Twenty-one patients receiving an IOD participated in speech assessment. They were examined preoperatively with their conventional denture (CD) with full palatal coverage, after connection of the implant-bar connected denture, without palatal coverage, and 3 years thereafter. The examination included assessment of articulation in speech, OHRQoL based on total OHIP-14, and satisfaction with overall oral health and speech (visual analogue scale).

RESULTS

There was a reduction in mean number of articulation disorders from 1.00 at baseline to 0.55 at connection, although statistically insignificant (p = 0.059). Especially the /s/ sound is vulnerable. At 3 years follow-up, still 6/16 (37.5%) of the patients suffered from this speech problem. Overall satisfaction improved from 64.05/100 at baseline to 82.95/100 at connection (p = 0.008) and remained unchanged with 81.69/100 after 3 years follow-up. Patients' satisfaction with speech increased from 70.62/100 with CD to 82.63/100, 3 years follow-up (p = 0.009). Total OHIP-14 decreased from 21.45/56 with CD to 8.00/56 (p < 0.001) with IOD and 6.13/56 3 years after connection (p = 0.001). Significant improvement of all seven domains in OHRQoL was observed with IOD compared to CD.

CONCLUSIONS

Patients treated with maxillary IODs show improved OHRQoL 3 years after connection of the IOD compared to the CD. Even though patients reported improvement of satisfaction and OHRQoL, articulation disorders were still present, suggesting that patients should be informed about possible speech issues.

Early peri-implant bone loss as a predictor for peri-implantitis: A 10-year prospective cohort study

PURPOSE

To evaluate the effect of early bone loss (EBL), on long-term bone stability and future peri-implantitis development.

MATERIALS AND METHODS

Patients referred for implant placement between 2005 and 2009 were consecutively treated and followed for 10 years. After 10 years, patients were invited for a scientific diagnostic visit to evaluate implant survival and bone loss. Bone level changes were compared with baseline. Non-parametric testing was performed in cross-tabs (Pearson Chi-square and Fishers's exact test). Kaplan-Meier-estimated survival curves were plotted for different thresholds for EBL at different timepoints. Generalized linear mixed models with binomial distribution and logit link for peri-implantitis were fitted. An adjusted logistic mixed model was made to evaluate peri-implantitis, in relation with smoking status, history of periodontitis, and EBL > 0.5 mm.

RESULTS

Four hundred and seven patients (mean age of 64.86 years [range 28-92, SD 10.11]), with 1482 implants, responded to the 10-year recall invitation. After an average follow-up time of 10.66 years (range 10-14, SD 0.87), implant survival was 94.74%. Mean crestal bone loss after 10 years was 0.81 mm (SD 1.58, range 0.00-17.00). One hundred and seventy five implants in 76 patients had peri-implantitis (11.8% on implant level, 18.7% on patient level). EBL of 0.5, 1, and 2 mm were significant predictors for peri-implantitis and implant loss after 10 years. Implants with EBL ≥0.5 mm during the first year of function showed a 5.43 times higher odds for future peri-implantitis development. Probability in developing peri-implantitis was 52.06% when smoking, Periodontal history and EBL of >0.5 mm was combined.

CONCLUSION

The present study suggests that EBL is a predictor for long-term peri-implant pathology, with a significant higher risk for peri-implantitis when early bone loss exceeds the thresholds of 0.5 and 1 mm, especially when additional risk factors such as smoking or susceptibility for periodontal disease prior to implant treatment are present. Clinical trial registration number B670201524796.

A controlled study on the diagnostic accuracy of panoramic and peri-apical radiography for detecting furcation involvement

BACKGROUND

The aims of this study were (1) to determine the accuracy, sensitivity, and specificity of panoramic and peri-apical radiographs in diagnosing furcation involvement, as well as (2) to evaluate the possible impact of clinical experience on these diagnostic parameters.

METHODS

An existing radiographic dataset of periodontitis patients requiring implant surgery was retrospectively examined for furcation involvement. Criteria for inclusion were the presence of a CBCT, panoramic and peri-apical radiograph of the site of interest within a one-year time frame. All furcation sites were classified using the CBCT, which was considered as the gold standard, according to Hamp's index (1975). Ten experienced examiners and 10 trainees were asked to assess furcation involvement for the same defects using only the corresponding panoramic and peri-apical radiographs. Absolute agreement, Cohen's weighted kappa, sensitivity, specificity and ROC-curves were analyzed.

RESULTS

The study sample included 60 furcation sites in 29 multi-rooted teeth from 17 patients. On average, 20/60 furcations were correctly classified according to the panoramic radiographs, corresponding to a weighted kappa score of 0.209, indicating slight agreement. Similarly, an average of 19/60 furcations were correctly classified according to the peri-apical radiographs, corresponding to a weighted kappa score of 0.211, also indicating slight agreement. No significant difference between panoramic and peri-apical radiography was found (P = 0.903). When recategorizing FI Grades into 'no to limited FI' (FI Grade 0 and I) and 'advanced FI' (FI Grade II and III), the panoramic and peri-apical radiography showed low sensitivity (0.558 and 0.441, respectively), yet high specificity (0.791 and 0.790, respectively) for identifying advanced FI. The ROC-curves for the panoramic and peri-apical radiographs were 0.79 and 0.69 respectively. No significant difference was found between experienced periodontists and trainees (P = 0.257 versus P = 0.880).

CONCLUSION

Panoramic and peri-apical radiography are relevant tools in the diagnosis of FI and provide high specificity. Ideally, they are best used in combination with furcation probing, which shows high sensitivity. Furthermore, clinical experience does not seem to improve the accuracy of a radiological diagnosis of furcation sites.

TRIAL REGISTRATION

Patient radiographic datasets were retrospectively analyzed.

Articulation, oral function, and quality of life in patients treated with implant overdentures in the mandible: A prospective study

BACKGROUND

Modifications of facial and oral structures affect aesthetic appearance, orofacial functions, and have impact on quality of life.

PURPOSE

This study determined alterations of articulation, oromyofunctional behavior, and Oral Health Related Quality of Life (OHRQoL) in patients replacing complete removable dentures by implant retained overdentures in the mandible.

MATERIALS AND METHODS

Twenty-one fully edentulous patients received mandibular overdenture retained on a bar connecting two titanium dental implants. Patients were evaluated after receiving a new set of fully removable dentures (stage 1), after surgery during provisionalization on healing abutments (stage 2), and after final connection to the bar (stage 3). Assessments were taken by speech therapists and included evaluation of: articulation (picture naming and reading); oromyofunctional behavior; OHRQoL (OHIP-14 questionnaire), and overall satisfaction and speech (VAS). To measure changes over time, Wilcoxon matched-pairs signed-rank-test and McNemar test was used.

RESULTS

There was no significant impact of the treatment on speech nor on the results of oromyofunction. In stage 1, patients had different kinds of articulation errors (mean:1.21) which evolved to 0.71 and 0.67. In stage 3, especially problems with the /s/ sound are seen in 37% (7/19) of the participants. Results of OHRQoL and satisfaction reveal that the average of satisfaction with oral health evolved from 67% to 63% and finally 78%. OHIP-14 total score was 17.4/56 in stage 1, remained unchanged in stage 2 and evolved in stage 3 to 9.8/56 (P: .010). This indicates improvement. Satisfaction with speech evolved significantly from 68% pretreatment to 82% in stage 3 (P: .013).

CONCLUSION

Despite existing articulation and oromyofunctional disorders after treatment, people are very satisfied with their OHRQoL and their speech. Impact of mandibular denture wearing on OHRQoL declines once connected. It's important to inform patients that speech and oromyofunctional disorders may occur during treatment where especially the /s/ sound is vulnerable.

A 5 to 7-year case series on single angulated implants installed following papilla-sparing flap elevation

BACKGROUND

Bony concavities at the buccal aspect may cause a distortion between the implant axis and ideal prosthetic axis. Angulated implants can overcome this problem, yet long-term data are lacking. In addition, papilla-sparing incisions have been proposed to reduce tissue loss, yet aesthetic outcomes have not been published.

PURPOSE

To evaluate the 5 to 7-year outcome of single angulated implants installed following papilla-sparing flap elevation.

MATERIALS AND METHODS

Patients who had been consecutively treated with a single angulated implant (Co-axis®, Southern Implants, Irene, South Africa) in the anterior maxilla were re-examined after 5 to 7 years. Available data at 1 year (T1) were compared to those obtained at 5 to 7 years (T2).

RESULTS

Twenty out of 22 treated patients (11 females, 9 males, mean age of 52) with 22 implants attended the 5 to 7-year reassessment. All implants survived and stable clinical conditions could be reached with mean marginal bone loss of 1.28 mm at T2. Papilla-sparing flap elevation resulted in Pink Esthetic Score of 9.83 at T1 and 8.23 at T2 (p = 0.072). Mucosal Scarring Index was 4.61 at T1 and 3.50 at T2 (p = 0.165). The overall appearance of scarring significantly improved over time (p = 0.032), yet 59% of the cases still demonstrated scarring at T2.c CONCLUSIONS: Within the limitations of the study, angulated implants (Co-axis®, Southern Implants) reached stable clinical conditions. Papilla-sparing incisions may not be recommended in aesthetically demanding patients due to high risk of scarring.

Accuracy of Guided Implant Surgery in the Edentulous Jaw Using Desktop 3D-Printed Mucosal Supported Guides

Purpose: The aim of this in vitro study is to evaluate the accuracy of implant position using mucosal supported surgical guides, produced by a desktop 3D printer. Methods: Ninety implants (Bone Level Roxolid, 4.1 mm × 10 mm, Straumann, Villerat, Switzerland) were placed in fifteen mandibular casts (Bonemodels, Castellón de la Plana, Spain). A mucosa-supported guide was designed and printed for each of the fifteen casts. After placement of the implants, the location was assessed by scanning the cast and scan bodies with an intra-oral scanner (Primescan^®, Dentsply Sirona, York, PA, USA). Two comparisons were performed: one with the mucosa as a reference, and one where only the implants were aligned. Angular, coronal and apical deviations were measured. Results: The mean implant angular deviation for tissue and implant alignment were 3.25° (SD 1.69°) and 2.39° (SD 1.42°) respectively, the coronal deviation 0.82 mm (SD 0.43 mm) and 0.45 mm (SD 0.31 mm) and the apical deviation 0.99 mm (SD 0.45 mm) and 0.71 mm (SD 0.43 mm). All three variables were significantly different between the tissue and implant alignment (p < 0.001). Conclusion: Based on the results of this study, we conclude that guided implant surgery using desktop 3D printed mucosa-supported guides has a clinically acceptable level of accuracy. The resilience of the mucosa has a negative effect on the guide stability and increases the deviation in implant position.

"Longitudinal Oral Health-Related Quality of Life in maxillary mini dental implant overdentures after 3 years in function"

OBJECTIVES

Longitudinal evaluation of Oral Health-Related Quality of Life (OHRQoL) during treatment of flaplessly placed, one-piece mini-dental-implants (MDIs) for maxillary overdentures is rarely investigated, nor is the impact of MDI failures.

MATERIAL AND METHODS

This multicenter prospective cohort study evaluated the 3-year outcome of 5-6 MDIs in the edentulous maxilla in patients above 50 years with dentate mandible. Provisional dentures were provided before final prosthetic connection was established at 6 months. Postoperative discomfort was assessed using a visual analogue score (VAS). OHRQoL was investigated using the Oral Health Impact Profile (OHIP)-14 at baseline (preoperatively), postoperatively, post-prosthetic connection and after 3 years in function.

RESULTS

164 (78.4%) of the 204 placed MDIs were still in situ after 3 years, in 29/31 patients. Two patients lost 5/6 MDIs resulting in two prosthetic failures (6.45%). With regard to pain, a score of 4.1/10 (SD 2.8) was recorded on day 1, and 1.1/10 (SD 1.7) on day 7. A decrease in total OHIP-14 scores was observed postoperatively (15.6; SD 12.8) as compared to baseline (21.3; SD 13.1), with improvement of OHRQoL. Furthermore, this was statistically significant at connection of the final prosthesis (7.3; SD 6.7) (p = .006). The OHIP-14 improved less (p = .011) when experiencing one or more implant losses (9.5; SD: 9.85), in comparison with no implant loss (20.7; SD: 13.97). A failure of one MDI did not affect OHIP-14 score (p = .658); however, multiple failures did (p = .007).

CONCLUSION

Maxillary MDI overdenture treatment yields significant OHRQoL improvement when at least 5 MDIs survive, preserving functional comfort.

Contour Changes Following Immediate Placement of Ultra-Wide Implants in Molar Extraction Sockets without Bone Grafting

The aim was to evaluate ridge reduction and mucosal recession following immediate placement of ultra-wide implants in molar sockets, without bone grafting. Impressions were taken prior to tooth extraction, 4 months and 1 year after implant placement. The casts were digitized and compared. Mucosal recessions and horizontal ridge reduction were measured. A total of 16 implants were in the maxilla and 11 in the mandible. At the buccal aspect, there was a mean reduction of 0.94 mm after 4 months and 0.89 mm after one year (p = 0.933). At the palatal/lingual aspect, this was 1.09 mm after 4 months and 0.69 mm after 1 year (p = 0.001). After 1 year, a recession of 0.59 mm was measured at the zenith, 1.04 mm at the mesial and 0.98 mm at the distal papilla. The mean midfacial horizontal ridge reduction was 1.23 mm after 4 months and 1.45 mm after 1 year. At the midpalatal/midlingual aspect, the mean horizontal reduction was 1.43 mm after 4 months and 1.16 mm after 1 year. Immediate implant placement without bone grafting in the posterior jaw yields a significant horizontal ridge reduction and minor mucosal recession. Clinicians should anticipate the amount of ridge reduction and consider augmentation at the time of implant placement.

Quality of life and social participation in dental rehabilitation: A personality and multi-informant perspective

OBJECTIVES

Contemporary research on the impact of dental rehabilitation scarcely focuses on the role of personality and social relationships in QoL related to dental implant treatment. To overcome biases related to evaluation with self-reports, descriptions provided by informed external observers are recommended.

AIMS

To investigate the impact of implant-supported rehabilitation on quality of life and social participation taking into account patient's personality.

MATERIALS AND METHODS

Fifty-four patients were included in this study and assigned to either a single unit group (n = 15) or a complete jaw restoration group (n = 39). Of the 54 participants, 49 nominated an external observer who can evaluate the daily behavior of the patient. Before and after treatment patients and their external observer completed the OHIP-14, the NEO-FFI and the MSPP questionnaires respectively focusing on Oral Health related Quality of Life, Personality and Social participation.

RESULTS AND CONCLUSION

The correlations between self- and observer ratings on pre and post treatment outcomes on were insignificant (QoL pre: p = 0.086, post: p = 0.115, freq. soc. part pre: p = 0.944, post: p = 0.876, div. soc. part pre: p = 0.798, post: p = 0.167), suggesting considerable differences in observer perspectives. The traits Neuroticism, Extraversion and Agreeableness were associated with QoL. Openness, Conscientiousness and Agreeableness were associated with social participation. Patients in the complete jaw restoration group reported more impact of the implant treatment on quality of life as compared to the single unit group (p = 0.007). The complete jaw restoration group reported an improved quality of life after treatment and significant increases of both frequency (p = 0.001) and diversity of social participation (p = 0.036). In conclusion there was a minor impact of treatment with single crowns on quality of life and social participation compared to the full denture group. The role of personality and the use of multi-informants in evaluating dental treatment was found important.

Narrative review regarding the applicability, accuracy, and clinical outcome of flapless implant surgery with or without computer guidance

Background

The advent of computer‐guided surgery removed the need for complex surgical interventions such as extensive flap elevations, second stage implant exposure, and complications usually associated with conventional protocols.

Purpose

(a) Analyze available literature reporting on applicability, accuracy, clinical outcome of flapless surgery with or without computer guidance. (b) Evaluate quality of studies, in terms of scientific level of evidence and ethical committee approval.

Materials and methods

A PUBMED search was performed in July 2018. A first search was based on a general search string limited to “Dental Implants” and “flapless surgery.” A second search focused on accuracy of computer‐guided surgery using search string “Surgery, Computer‐Assisted” or “guided surgery,” and “Dental implants.” The following inclusion criteria were applied: (a) studies in English; (b) human studies (excluding cadaver); (c) systematic reviews; (d) systematic reviews with meta‐analysis. Reviews not mentioning accuracy were excluded in search 2.

Results

Nine reviews included in total. Implant survival ranged between 89% and 100%. Early surgical and prosthetic complications reported in 9.1% to 36.4% of reviewed papers. Tooth‐supported guides show more accuracy than bone or mucosa‐supported guides. Fully guided surgery yields higher accuracy, with lower values for horizontal coronal, horizontal apical and angular deviation (1.00, 1.23, and 3.13°mm, respectively) than those placed with half guided surgery (1.44, 1.91, and 4.30 mm, respectively). Thirty‐four of 71 human studies included in nine reviews, mentioned ethical committee approval or compliance with Declaration of Helsinki.

Conclusions

Guided flapless surgery is comparable to free‐hand surgery in terms of implant survival, marginal bone remodeling, and peri‐implant variables. Clinicians advised to take care in all steps of the protocol, and include safety margins around virtually planned implants. Regarding compliance with research ethics, we should question whether scientific reports of clinical trials performed without an ethical umbrella are trustworthy. Compliance of ethics standards is imperative for submitted research papers.

Cost-effectiveness analysis of two attachment systems for mandibular overdenture

Objectives

This study analysed the cost‐effectiveness of two different attachments for the 2‐implant overdenture (2IOD) in edentulous mandibles.

Materials and methods

When considering alternative treatments, cost‐effectiveness analysis is an important factor for stakeholders (patient, clinician, social security, insurance company, etc.). A general practice population (n = 116) was treated between 2003 and 2013 with a mandibular 2IOD with 2 different ball/stud attachment systems, one spherical (Group D) and one cylindrical (Group L). Patient well‐being was assessed with OHIP‐14‐Total (OHIP‐14‐T), at intake and annually up to 5 years, to calculate the health effect. Initial and maintenance costs of both treatments were inventoried. The cost‐effectiveness was compared. Annual discount rates of 4% and 1.5% were applied to future costs and health outcomes, following Dutch guidelines. Prices were adjusted to the year 2003. To offset the uncertainty in relevant input parameters, a sensitivity analysis was performed using bootstrap analysis. Significance was set at p < .05.

Results

The health effect was 6.36 (SD 5.32) for Group D and 8.54 (SD 5.63) for Group L. The sum of the discounted costs up to 5 years was EUR 4,210.98 (SD 634.75) for the D and EUR 3,840.62 (SD 302.63) for the Group L (p = .005). The bootstrapping reports that L abutment clearly dominates the D abutment in terms of cost‐effectiveness.

Conclusions

The 2IOD on the L abutment is dominant compared to the 2IOD on D abutment, in a 5‐year perspective.

The Long-Term Effect of Smoking on 10 Years' Survival and Success of Dental Implants: A Prospective Analysis of 453 Implants in a Non-University Setting

Background: The purpose of this study was to compare the survival and peri-implant bone loss of implants with a fluoride-modified surface in smokers and non-smokers. Material and Methods: All patients referred for implant treatment between November 2004 and 2007 were scrutinized. All implants were placed by the same surgeon (B.C.). The single inclusion criterion was a follow-up time of at least 10 years. Implant survival, health, and bone loss were evaluated by an external calibrated examiner (S.W.) during recall visits. Radiographs taken at recall visits were compared with the post-surgical ones. Implant success was based on two arbitrarily chosen success criteria for bone loss (≤1 mm and ≤2 mm bone loss after 10 years). Implant survival in smokers and non-smokers was compared using the log-rank test. Both non-parametric tests and fixed model analysis were used to assess bone loss in both groups. Results: A total of 453 implants in 121 patients were included for survival analysis, and 397 implants in 121 patients were included for peri-implant bone-loss analysis. After a mean follow-up time of 11.38 years (SD 0.78; range 10.00–13.65), 33 implants out of 453 initially placed had failed in 21 patients, giving an overall survival rate of 92.7% and 82.6% on the implant and patient level, respectively. Cumulative 10 years’ survival rate was 81% on the patient level and 91% on the implant level. The hazard of implant loss in the maxilla was 5.64 times higher in smokers compared to non-smokers (p = 0.003). The hazard of implant loss for implants of non-smokers was 2.92 times higher in the mandible compared to the maxilla (p = 0.01). The overall mean bone loss was 0.97 mm (SD 1.79, range 0–17) at the implant level and 0.90 mm (SD 1.39, range 0–7.85) at the patient level. Smokers lost significantly more bone compared to non-smokers in the maxilla (p = 0.024) but not in the mandible. Only the maxilla showed a significant difference in the probability of implant success between smokers and non-smokers (≤1 mm criterion p = 0.003, ≤2 mm criterion p = 0.007). Taking jaw into account, implants in smokers experienced a 2.6 higher risk of developing peri-implantitis compared to non-smokers (p = 0.053). Conclusion: Dental implants with a fluoride-modified surface provided a high 10 years’ survival with limited bone loss. Smokers were, however, more prone to peri-implant bone loss and experienced a higher rate of implant failure, especially in the upper jaw. The overall bone loss over time was significantly higher in smoking patients, which might be suggestive for a higher peri-implantitis risk. Hence, smoking cessation should be advised and maintained after implant placement from the perspective of peri-implant disease prevention.

Biomaterials and regenerative technologies used in bone regeneration in the craniomaxillofacial region: Consensus report of group 2 of the 15th European Workshop on Periodontology on Bone Regeneration

BACKGROUND AND AIMS

To review the regenerative technologies used in bone regeneration: bone grafts, barrier membranes, bioactive factors and cell therapies.

MATERIAL AND METHODS

Four background review publications served to elaborate this consensus report.

RESULTS AND CONCLUSIONS

Biomaterials used as bone grafts must meet specific requirements: biocompatibility, porosity, osteoconductivity, osteoinductivity, surface properties, biodegradability, mechanical properties, angiogenicity, handling and manufacturing processes. Currently used biomaterials have demonstrated advantages and limitations based on the fulfilment of these requirements. Similarly, membranes for guided bone regeneration (GBR) must fulfil specific properties and potential biological mechanisms to improve their clinical applicability. Pre-clinical and clinical studies have evaluated the added effect of bone morphogenetic proteins (mainly BMP-2) and autologous platelet concentrates (APCs) when used as bioactive agents to enhance bone regeneration. Three main approaches using cell therapies to enhance bone regeneration have been evaluated: (a) "minimally manipulated" whole tissue fractions; (b) ex vivo expanded "uncommitted" stem/progenitor cells; and (c) ex vivo expanded "committed" bone-/periosteum-derived cells. Based on the evidence from clinical trials, transplantation of cells, most commonly whole bone marrow aspirates (BMA) or bone marrow aspirate concentrations (BMAC), in combination with biomaterial scaffolds has demonstrated an additional effect in sinus augmentation and horizontal ridge augmentation, and comparable bone regeneration to autogenous bone in alveolar cleft repair.

Speech evaluation during maxillary mini-dental implant overdenture treatment: A prospective study

Large proportions of patients are edentulous and wear removable dentures leading to reduced functional comfort and less oral health‐related quality of life. Satisfaction with the oral situation after implantation depends on the outcome in eating comfort, speech comfort and aesthetics. Modification in form and location of the teeth may affect speech. The aim of this study is to determine speech, oromyofunctional behaviour, satisfaction with the treatment and the impact on quality of life of the horse‐shoe overdenture retained by mini‐dental implants (MDIs) in the maxilla. This prospective multicentre cohort study included 32 patients for treatment. 5 to 6 implants were placed, traumatically piercing the mucosa. Patients were evaluated three times during treatment (pre‐operatively with conventional prosthesis including full palatal coverage (CD), post‐operatively with provisionally relined CD and with horse‐shoe overdenture on MDI). The assessment included a phonetic evaluation, examination of oromyofunctional behaviour, evaluation of the impact on quality of life (OHIP‐14) and a rating of satisfaction with the treatment and speech on a visual analogue scale. Several speech sounds are found to be disturbed before treatment. In the next two stages of the treatment, the number of speech issues decreases. In the final stage, ten people show minor speech problems, especially with the /s/ sound. In this stage, seven people still present with oromyofunctional problems, especially whistling problems. In this last stage, people are very satisfied with the treatment (83%) and with speech (84%). The impact on quality of life is low (8.23/56).

Biological aspects: Summary and consensus statements of group 2. The 5th EAO Consensus Conference 2018

OBJECTIVES

This publication reports the EAO Workshop group-2 discussions and consensus statements which provided the scientific evidence on the influence of biological parameters on implant-related clinical outcomes.

MATERIAL AND METHODS

The first publication was a systematic review on the biological effects of abutment material on the stability of peri-implant marginal bone levels and the second, a critical narrative review on how peri-implant diagnostic parameters correspond with long-term implant survival and success. The group evaluated the content of both publications, made corrections and recommendations to the authors and agreed on the consensus statements, clinical recommendations and recommendations for future research, which are described in this consensus report.

RESULTS

Tested abutment materials can be considered appropriate for clinical use according to the observation period studied (mean 3.5 years). Mean peri-implant bone loss and mean probing pocket depths are not adequate outcomes to study the prevalence of peri-implantitis, while the reporting of frequency distributions is considered more appropriate.

CONCLUSIONS

Titanium is currently considered the standard of care as abutment material, although other materials may be more suitable for aesthetic locations. Peri-implantitis should be diagnosed through composite evaluations of peri-implant tissue inflammation and assessment of marginal bone loss with different thresholds.

How do peri-implant biologic parameters correspond with implant survival and peri-implantitis? A critical review

Objectives

The aim of this critical review was to evaluate whether commonly used biologic diagnostic parameters correspond to implant survival and peri‐implantitis prevalence.

Materials and methods

Publications from 2011 to 2017 were selected by an electronic search using the Pubmed database of the US National Library of Medicine. Prospective and retrospective studies with a mean follow‐up time of at least 5 years and reporting prevalence of peri‐implantitis as well as mean bone loss and standard deviation were selected. The correlation between reported prevalence of peri‐implantitis and reported implant survival, mean follow‐up time, mean bone loss, mean probing depth, and mean bleeding on probing was calculated. Mean bone loss and standard deviation were used for estimation of proportion of implants with bone loss exceeding 1, 2, and 3 mm.

Results

Full‐text analysis was performed for 255 papers from 4,173 available ones, and 41 met all the inclusion criteria. The overall mean weighted survival rate was 96.9% (89.9%–100%) and the reported prevalence of peri‐implantitis ranged between 0% and 39.7%, based on 15 different case definitions. The overall weighted bone loss was 1.1 mm based on 8,182 implants and an average mean loading time ranging from 5 to 20 years. No correlation was found between mean bone loss and the reported prevalence of peri‐implantitis. The estimated prevalence of implants with bone loss above 2 mm was 23%. The overall weighted mean probing depth was 3.3 mm, and mean weighted bleeding was 52.2%. Only a weak correlation was found between survival and function time (r = −0.49). There was no relation between the probing depth or bleeding and the mean bone loss, mean follow‐up time, and reported prevalence of peri‐implantitis.

Conclusion

Biologic parameters mean probing depth and mean bleeding on probing do not correlate with mean bone loss and this irrespective of follow‐up. Case definition for peri‐implantitis varied significantly between studies indicating that an unambiguous definition based on a specified threshold for bone loss is not agreed upon in the literature.

Dental implant register: Summary and consensus statements of group 2. The 5th EAO Consensus Conference 2018

OBJECTIVES

This publication reports the EAO Workshop group-2 and consensus plenary discussions and statements on a narrative review providing the background and possible facilities and importance of a dental implant register, to allow for a systematic follow-up of the clinical outcome of dental implant treatment in various clinical settings. It should be observed that the format of the review and the subsequent consensus report consciously departs from conventional consensus publications and reports.

MATERIAL AND METHODS

The publication was a narrative review on the presence and significance of quality registers regarding select medical conditions and procedures. The group discussed and evaluated the publication and made corrections and recommendations to the authors and agreed on the statements and recommendations described in this consensus report.

RESULTS

Possible registrations to be included in an implant register were discussed and agreed as a preliminary basis for further development, meaning that additional parameters be included or some be deleted.

CONCLUSIONS

It was agreed to bring the idea of an implant quality register, including the presented results of discussions and proposals by the group- and plenary sessions, to the EAO Board for further discussion and decision.

Clinical Outcome After 8 to 10 Years of Immediately Restored Single Implants Placed in Extraction Sockets and Healed Ridges

Recent systematic reviews point to the scarcity of single implants followed up longer than 5 years, and the incidence of biologic/technical complications is underreported. This prospective follow-up study documents 8- to 10-year clinical outcomes of immediately restored single implants in extraction sockets (immediate implant treatment [IIT]) and healed bone (conventional implant treatment [CIT]). Patients received a single, chemically modified, moderately rough titanium implant and a provisional crown on the day of surgery in the anterior maxilla (second premolar to second premolar). Provisional crowns were replaced by permanent crowns after 10 weeks. Implant survival, complications, crestal bone changes, plaque score, probing depth, and bleeding on probing were regularly recorded up to 10 years of follow-up. Of 16 patients who underwent IIT, 11 could be evaluated after 8 years. Of the 23 patients who received an implant in healed bone, 18 were finally evaluated. One implant failed in the IIT group at 12 weeks; all implants survived in the CIT group; 38% of the patients experienced at least one complication; 10% had one or more biologic complications, whereas 31% experienced one or more technical complications. There were no significant changes in crestal bone level from 1 to ≥ 8 years of follow-up for either group or between IIT and CIT at any time point (P ≥ .129). Only 6.9% (2 of 29) implants demonstrated progressive bone loss > 2 mm combined with pockets ≥ 6 mm. Immediately restored single implants in extraction sockets and healed ridges demonstrate good long-term outcomes in terms of implant survival, crestal bone loss, and peri-implant health. However, biologic and especially technical complications are common.

Immediate Placement of Ultrawide-Diameter Implants in Molar Sockets: Description of a Recommended Technique

Immediate implant placement is performed less frequently in molar extraction sockets than in single root sockets. This is mainly due to the tripodal anatomical configuration of molar roots, which is perceived as complex and therefore unsuitable. The mechanical burden of molar sites, combined with much larger socket dimensions, make it amenable to the use of ultrawide-diameter dental implants. This article describes a practical, sequenced technique that can be used predictably for immediate implant placement in maxillary and mandibular first molar sockets, using a dry skull model for clarification. This detailed description is based on the experience of more than 580 clinical cases over a 10-year period.

The Influence of Initial Hard and Soft Tissue Dimensions on Initial Crestal Bone Loss of Immediately Loaded Dental Implants

The aim of this case-control study was to evaluate the influence of soft tissue thickness at implant placement (thin [< 3 mm] vs thick [≥ 3 mm]) and bone volume (abundant vs limited) on initial crestal bone remodeling of immediate postextraction and delayed (healed site) implants in immediate loading situations. A total of 67 patients with 133 implants could be evaluated, of which 77 were placed immediately after extraction and 56 in healed ridges. If sufficient bone volume is present and primary stability is achieved, immediate loading of the implant yields good clinical and radiographic outcomes, yet implants placed in healed ridges with thin soft tissues are more prone to initial crestal bone loss.

A prospective study on ultra-wide diameter dental implants for immediate molar replacement

BACKGROUND

Although wide diameter implants are well documented, little is known about ultra-wide diameter implants (>6 mm). This study evaluates the clinical outcome of ultra-wide diameter implants, placed in molar extraction sockets.

MATERIALS AND METHODS

Ultra-wide diameter implants (7-9 mm) were placed immediately after molar extraction in a 1-stage protocol, without raising a flap or using any bone grafts. After 4 months, the implant was loaded with a single screw-retained crown. Bone loss was evaluated using peri-apical radiographs. Plaque and bleeding were recorded. Crown and papilla dimensions were measured and compared with the contra-lateral tooth.

RESULTS

Fifty-one patients (36 male and 15 female), mean ages 61 years old, were treated with 26 implants in the maxilla and 25 implants in the mandible. The majority had a thick (#19) or medium (#31) biotype. After a mean-follow-up period of 23 months, the mean bone level was located 1.16 mm apical of the implant-abutment junction (SD 0.42, range 0.00-2.45) while the actual bone remodeling associated with socket healing resulted in a mean coronal movement of the bone level of 0.15 mm. The mean insertion torque was 116 Ncm (SD 53, range 10-250). There were no differences in papilla height (P = .55), crown length (P = .32), zenith (P = .84), and bucco-palatal dimensions (P = .38). There was a significant difference in the mesio-distal dimension (P = .01). Mean probing depth was 2.59 mm at the implant and 2.23 mm at the contra-lateral tooth (P = .001). There was significantly more plaque at the tooth compared to the implant (P = .01), but there was no significant difference in terms of bleeding on probing (P = .08). Patient satisfaction was high with 72.5% of the patients experiencing no problems at all.

CONCLUSIONS

Ultra-wide diameter implants have a predictable outcome, demonstrating very little bone loss. Papilla and crown dimensions were comparable to the contra-lateral natural tooth.

Oral Implantology: Myths Exposed in Recent Research

Today, a variety of surgical and prosthetic protocols, implant designs, and prosthetic devices are used for implant dentistry, employing many different dental technologies. With a plethora of options available, choosing an implant system has become highly challenging for practitioners. Having an understanding of the role of different implant design properties may help clinicians make informed decisions. This article provides an overview of factors affecting osseointegration and preservation of bone and discusses the importance of surgical and prosthetic treatments that respect the biologic width and avoid interventions, such as cementation, that may disturb the surrounding soft and hard tissues.

Long-term clinical outcome of single implants inserted flaplessly or conventionally

BACKGROUND

Flapless implant surgery is mostly performed using guided surgical protocols, however, long-term studies on free-handed flapless surgery for single implants are lacking.

PURPOSE

This prospective study evaluates bone level changes, peri-implant health, and complications of solitary implants placed using a conventional flap (F) or flaplessly (FL) after 6-9 years.

MATERIALS AND METHODS

Fifty-three single TiUnite Brånemark implants were originally inserted in 49 patients using an one-stage delayed loading protocol with flap (n = 27, F) or flaplessly (n = 26, FL) based on available bone volume and surgeon's decision-making. Thirty-six patients with 37 implants participated in the prospective follow-up investigation 6-9 years later whereby survival, bone level changes, peri-implant health, and complications were assessed.

RESULTS

After 88 months (range 76-107), all implants were survived. For F and FL combined, the overall average radiographic bone level was above the first implant thread, 1.26 mm apical of the implant-abutment junction (SD 1.08; 0-4.9) and statistically comparable. Bone loss from time of loading was 0.49 mm (SD 1.1; -1.3 to 2.8) for F and -0.89 mm (SD 1.0; -2.8 to 0.7) for FL (P < .01), suggesting regrowth of bone in FL due to initial countersinking. One implant (2.7%) had a probing depth above 5 mm.

CONCLUSION

Free-handed flapless implant surgery for single implants with neighboring teeth is a predictable long-term treatment provided when there is sufficient bone volume.

Ten-year follow-up of dental implants used for immediate loading in the edentulous mandible: A prospective clinical study

PURPOSE

The purpose of this study is to evaluate the 10-year outcome of 25 patients with immediate loading in the edentulous mandible.

MATERIAL AND METHODS

Twenty-five patients were consecutively treated with 5 immediately loaded fluoride-modified implants in the edentulous mandible. Implant survival and bone loss were evaluated by an external researcher comparing digital periapical radiographs taken during recall visits with baseline (at implant insertion). Statistical descriptive analysis and nonparametric tests were performed using SPSS v23, multilevel analysis was performed by means of R version 3.1.0. to identify risk factors for bone loss.

RESULTS

Twenty-one patients (8 males, 13 females, mean age 68.4, range 49-84) responded to the 10-year recall invitation. No implants were lost during follow-up, resulting in a 100% survival rate. After 10 years, bleeding on probing and plaque were present at 49.5% and 67.6% of the sites, respectively. The mean pocket probing depth was 3.77 mm (SD 0.73, range 3.0-6.83). Bone loss on implant level after 3, 12, 24, and 120 months was 0.16 mm (SD 0.33, range 0-1.75), 0.14 mm (SD 0.24, range 0-1.05), 0.17 mm (SD 0.27, range 0-1.5), and 0.49 mm (SD 1.08, range 0-7.8). Five implants were identified with or at risk for progressive bone loss. Forty-seven percent of the implants did not show any bone loss after 10 years in function and 87% lost less than 1 mm. Multilevel statistical analysis identified 2-year bone loss as a predictor for bone loss after 10 years of function.

CONCLUSION

Immediate loading of 5 fluoride-modified dental implants with a fixed prosthetic rehabilitation is a predictable and reliable treatment in the edentulous mandible, based on a 100% implant survival and limited peri-implant bone loss. Implants used for immediate loading in the edentulous mandible who are showing early bone loss may be at higher risk to develop peri-implantitis.

Impact of crestal bone resorption on quality of life and professional maintenance with conventional dentures or Locator-retained mandibular implant overdentures

STATEMENT OF PROBLEM

The influence of the mandibular resorption profile on clinical outcome after converting a conventional complete denture into a Locator-retained implant overdenture is unknown.

PURPOSE

The purpose of this prospective study was to assess the oral health-related quality of life (OHRQoL) and prosthetic maintenance of mandibular overdentures on 2 Locator abutments in relation to the resorption degree of the edentulous mandible.

MATERIAL AND METHODS

Twenty-five participants were treated and classified according to the Cawood and Howell (CAW-H) resorption classification for the resorption profile of the mandible, CAW-H group III-IV (n=14) and CAW-H group V (n=11). Participants received conventional complete dentures (CDs) before implant placement and immediate nonfunctional loading on Locators with a resilient liner. After 3 months, the attachments were functionally activated. Assessments were made using the Oral Health Impact Profile 14 (OHIP-14) questionnaires with existing CDs and new CDs at 1, 3, and 15 months after loading. Prosthetic maintenance (repairs, rebasings, replacement of retention parts) and biological prosthetic aftercare were assessed. For comparison between groups, the Kruskal-Wallis and Mann-Whitney U tests were applied for continuous and ordinal variables and the chi-square test for cross-tabulations. To analyze repeated OHIP-14 scores, the Friedman test was used for ordered alternatives to test whether the measurements differed (overall significance level α=.05). Then the Wilcoxon signed rank test was conducted to detect specific differences (α=.05).

RESULTS

OHIP-14 scores decreased significantly after implant placement and functional connection for the whole population (P<.001) and for both sub groups, the CAW-H group III-IV (P<.001) and the CAW-H group V (P=.013). CAW-H group V participants needed more retention inserts than CAW-H group III-IV participants (26 versus 3, respectively; P=.006). The incidence of repair and rebasing was limited for both groups, and biological aftercare and pain relief were comparable.

CONCLUSIONS

Changing a CD to an overdenture significantly improved ORLQoL regardless of the resorption degree, but heavily resorbed mandibles require more replacements of retention inserts.

Esthetic assessments in implant dentistry: objective and subjective criteria for clinicians and patients

In recent years the scientific community has shown a clear interest in the esthetic outcome of implant treatment. The present paper provides an overview of the esthetic ratings that have been used in implant dentistry. A distinction can be made between objective evaluations by clinicians and subjective evaluations by patients. The former mainly include: midfacial and interproximal soft-tissue levels; two-dimensional/three-dimensional soft-tissue alterations; assessment of the color match between the natural dentition, on the one hand, and the peri-implant tissues and the reconstruction, on the other hand; and ordinal indices, such as the pink and white esthetic score. Patient's needs and judgment may differ from objective indicators of implant success and esthetics. As a result, assessing treatment on the basis of patient-reported outcomes measures should be considered important. Validated questionnaires have been used that mainly assess the impact of oral health on the overall well-being of individuals. The esthetic judgment of patients is usually based on nonstandardized questions with varying scoring methods, including visual analog scales, Likert and other category scales and open questions. The heterogeneity in scoring systems between studies may compromise proper comparison of objective and subjective esthetic outcomes between studies and therapeutic concepts.

Peri-implant health, clinical outcome and patient-centred outcomes of implant-supported overdentures in the mandible and the maxilla

Objectives/Aims:

The primary aim of this retrospective pilot study was to evaluate the clinical outcome of overdentures on four non-splinted maxillary implants compared to the mandible using locator attachments and secondly to assess patient's opinion of the treatment.

Materials and Methods:

The treatment protocol used here is summarised as a single-stage surgical approach followed by immediate loading (same day in 12 of 17 patients) of a removable prosthesis in the maxilla and mandible. Most of the implants were installed into fresh extraction sockets. Clinical outcomes were evaluated in 68 southern implants, straight (non co-axis) or angulated (co-axis) in 17 patients. Patients were examined by independent examiners at an average follow-up of 14.5 months after implant placement.

Results:

Outcomes measured were implant survival, bone loss, bleeding on probing, probing pocket depths and plaque score in addition to quality of life measured with OHIP-14 questionnaires. An overall implant survival of 100% was achieved. The mean marginal bone level (mm) over the entire cohort of 66 measured implants was (1.4 mm; range, 0–5.5). A significant difference (P=0.01) was found between bone level, from implant head to bone contact in the maxilla (M, 0.9 mm; s.d., 1.1; range, 0–4) and the mandible (M, 1.7; s.d., 1.0; range, 0–5.5). The marginal bone-to-implant head distance with the angulated co-axis implants was 1.9 mm (s.d., 1.5; range, 0–5.5) compared to non co-axis, mean 1.2 mm (s.d., 1.1; range, 0–4) (P=0.01). The OHIP-14 overall mean was 3.3 (out of a maximum of 56).

Conclusion:

The implant survival was 100% and the patients benefited from the overdenture treatment on four non-connected implants. The extremely low OHIP-14 indicated a very high level of patient satisfaction following treatment. The results of this study merit further long-term investigation to fully investigate the success of immediately loading implants in the maxilla as well as cost-benefit.

Adapting the vertical position of implants with a conical connection in relation to soft tissue thickness prevents early implant surface exposure: A 2-year prospective intra-subject comparison

AIM

To evaluate the effect of soft tissue thickness on bone remodelling and to investigate whether implant surface exposure can be avoided by adapting the vertical implant position in relation to the soft tissue thickness.

MATERIALS AND METHODS

Twenty-five patients received two non-splinted implants supporting an overdenture in the mandible. Soft tissue thickness was measured using bone sounding and ultrasonically. One implant was installed equicrestally (control), and the vertical position of the second implant was adapted to the site-specific soft tissue thickness (test). Crestal bone levels were determined on digital peri-apical radiographs and compared with baseline (implant placement).

RESULTS

Twenty-five patients were consecutively treated. No implants failed during the follow-up. A significant correlation was observed between soft tissue thickness and bone level alterations after 6 months (ultrasound ICC = 0.610; bone sounding ICC = 0.641) with inferior bone levels for equicrestal implants when thin tissues are present. Subcrestal implants showed significantly better bone levels after 6-month (n = 24, 0.04 mm versus 0.72 mm; p < .001), 1-year (n = 24, 0.03 mm versus 0.77 mm; p < .001) and 2-year follow-up (n = 24, 0.04 mm versus 0.73 mm; p < .001).

CONCLUSION

Initial bone remodelling was affected by soft tissue thickness. Anticipating biologic width re-establishment by adapting the vertical position of the implant seemed highly successful to avoid implant surface exposure.