Group 5 ITI Consensus Report: Implant placement and loading protocols

OBJECTIVES

Working Group 5 was convened to discuss and find consensus on the topics of implant placement and loading protocols associated with single missing teeth in the anterior maxilla (aesthetic zone). Consensus statements, clinical recommendations, patient perspectives and future research suggestions were developed and presented to the plenary for discussion and approval.

MATERIALS AND METHODS

Two systematic reviews were developed and submitted prior to the conference. The group considered in detail the systematic reviews and developed statements, clinical recommendations, patient perspectives and future research suggestions based on the findings of the reviews and experience of group members. Definitive versions were developed after presentation to and discussion by the plenary.

RESULTS

Five consensus statements were developed and approved from each systematic review. Twelve clinical recommendations were developed by the group based on both reviews and experience. Three patient perspectives were developed, and five suggestions made for future research.

CONCLUSIONS

Based on the findings of the systematic reviews and experience of group members, the Type 1A protocol (immediate placement and immediate loading), when utilized in the anterior maxilla under favorable conditions, is considered predictable and is associated with high survival rates. The procedure is considered clinically viable and is associated with aesthetic outcomes, although surgical, technical, and biological complications can occur.

Biological and technical complications in root cap-retained overdentures after 3-15 years in situ: a retrospective clinical study

OBJECTIVES

This retrospective clinical study investigates the frequency of biological and technical complications in patients rehabilitated by natural root-retained overdentures (RODs) with cast post-and-cores (root caps) wearing precision attachments and analyses factors influencing complication rates (e.g. oral hygiene routines).

MATERIALS AND METHODS

Patients formerly treated with RODs were invited for a cost-free clinical visit to evaluate their intraoral status. Furthermore, they were interviewed and patient records were screened for complications occurring since denture delivery. Statistical models include descriptive analyses, Fisher's exact test, odds ratios, and a multivariate regression model.

RESULTS

A total of 114 patients wearing 128 RODs with a total of 280 abutment teeth were evaluated (mean service time: 7.9 years). Technical complications occurred in 68.8% of the RODs, with matrix loosening being the most frequent complication (50.1%). Biological complications occurred in 53.9% of all RODs, with the presence of denture stomatitis being the most common biological complication (38.3%). The presence of denture stomatitis was significantly higher in the maxilla relative to the mandible (p = 0.0029), in subjects cleaning their dentures less than twice a day (p < 0.001), in subjects regularly using CHX-containing products (p = 0.036) and in subjects with a plaque index > 40% (p < 0.001).

CONCLUSIONS

Root cap-retained overdentures with precision attachments are a viable treatment option in partially dentate subjects, even over long-term periods. However, high complication rates should be expected.

CLINICAL RELEVANCE

Establishing good oral hygiene is a decisive factor in preventing complications in RODs. Furthermore, CHX-containing products may not be recommended for routine domestic use.

Stability of contour augmentation and esthetic outcomes of implant-supported single crowns in the esthetic zone: 3-year results of a prospective study with early implant placement postextraction

BACKGROUND

Early implant placement is one of the treatment options after tooth extraction. Implant surgery is performed after a healing period of 4 to 8 weeks and combined with a simultaneous contour augmentation using the guided bone regeneration technique to rebuild stable esthetic facial hard- and soft-tissue contours.

METHODS

In this prospective study, 20 patients were treated with an implant-born single crown and followed for 3 years. Clinical, radiologic, and esthetic parameters were recorded to assess treatment outcomes.

RESULTS

At the 3-year examination, all 20 implants were successfully integrated, demonstrating ankylotic stability and healthy peri-implant soft tissues as documented by standard clinical parameters. Esthetic outcomes were assessed by the pink esthetic score (PES) and white esthetic score (WES) and confirmed pleasing results overall. WES values were slightly superior to PES values. Periapical radiographs showed minimal crestal bone loss around used bone-level implants with a mean bone loss of 0.18 mm at 3 years. Only two implants revealed bone loss between 0.5 and 1.0 mm. One of these implants had minor mucosal recession <1.0 mm.

CONCLUSIONS

This prospective study evaluates the concept of early implant placement and demonstrated successful tissue integration for all 20 implants and stable bone-crest levels around implant-abutment interfaces according to the platform-switching concept. The midterm 3-year follow-up revealed pleasing esthetic outcomes and stable facial soft tissues. The risk of mucosal recession was low, with only one patient showing minor recession of the facial mucosa. These encouraging results need to be confirmed with a 5-year follow-up examination.