Early loading of endosseous implants in the augmented maxilla: a 1-year prospective study

In 10 patients, 68 endosseous implants were inserted in the augmented edentulous maxilla using a one-stage implant placement technique. Three months before implant insertion, the width and height of the alveolar crest were augmented with autologous bone grafts from the iliac crest. In all cases, the resulting bone volume was sufficient for implant insertion. According to an early loading protocol, the implant-supported overdenture was fabricated 2 months after insertion of the implants. Evaluation was performed according to a standardised protocol immediately and 1 year after fabrication of the prosthetic construction. The protocol included assessment of both clinical (bleeding score, pocket depth, implant mobility) and radiographic (marginal bone level on standardised radiographs) parameters. Three implants in two patients in the upper jaw were lost (survival rate: 95.6%). The peri-implant tissues had a healthy appearance and bone loss was minimal. Overall, the patients were very satisfied with the prosthetic construction. From this preliminary study, it is concluded that in selected cases, early loading of implants may develop into a predictable treatment modality after augmentation of the maxilla.     

Early and immediate loading of titanium implants with fluoride-modified surfaces: results of 5-year prospective study

Objective: Multiple experimental and animal studies have shown that topographic, mechanical and chemical properties of implant surfaces lead to in vivo responses such as increased bone formation, increased bone anchorage and reduced healing time. A fluoride modification of the titanium implant surface also seems to positively influence bone anchorage as compared with unmodified titanium implants. Using implant survival and marginal bone loss as primary outcome parameters, the purpose of the present prospective study was to investigate whether a fluoride modification of the titanium implant surface has positive clinical effects. Materials and methods: The 17 patients included in this study received 49 Astra Tech OsseoSpeed^? implants for various indications in the maxilla and mandible. Implants were either loaded immediately or after a mean healing period of 9.56 weeks. Fifteen patients were followed up clinically including radiographic examination for 5 years. Forty‐two implants were assessed for implant survival, marginal bone loss, surgical and/or prosthetic complications, presence or absence of plaque, signs of inflammation and size of the papilla. Results: Of the original 17 patients, 15 patients were available for the full 60‐month follow‐up. One early implant failure occurred, leading to an implant survival rate of 97%. Radiographic analyses demonstrated stable bone conditions with a mean marginal bone loss of 0.1 mm (SD 0.4 mm, min ?0.7 mm, max 1.7 mm) after 5 years of function. Immediately loaded implants did not show a different mean marginal bone loss as compared with implants that were not loaded immediately. Repeated soft‐tissue examinations revealed healthy conditions in terms of 6.1% plaque and 4.2% of the implants with signs of inflammation at the 5‐year control. Discussion: Implants used in this study had high survival and success rates after 5 years. Marginal bone was well maintained, irrespective of the loading regime. To cite this article:
Mertens C, Steveling HG. Early and immediate loading of titanium implants with fluoride‐modified surfaces: results of 5‐year prospective study.
Clin. Oral Impl. Res. xx , 2011; 000–000.     

Long-term results and survival rate of implants treated with guided bone regeneration: a 5-year case series prospective study

One of the key factors for attaining osseointegration is the presence of an adequate osseous volume. In patients with inadequate osseous width or height, a bone augmentation using the guided bone regeneration (GBR) concept may be applied either with a simultaneous or a staged approach. The aim of this multicenter prospective case series study was to evaluate the efficacy and predictability of the GBR technique (simultaneous approach) in patients with peri-implant osseous defects, both dehiscences and fenestrations. Results 5 years post-treatment (survival rates and marginal bone level) were assessed. A total of 19 consecutive patients with 26 peri-implant osseous defects (20 dehiscences and six fenestrations) were treated during the period from September 1992 to June 1993 with a simultaneous GBR approach using non-resorbable membranes combined with autogenous bone grafts or decalcified freeze-dried bone allograft. The mean osseous augmentation was 94.8%. Marginal bone levels at re-entry and 5 years after surgery were calculated from standardized periapical radiographs. One implant was lost 3 months after loading. Thus, the cumulative survival rate was 96.1% after 5 years. The mean marginal bone level after 5 years was 2.03 mm (SD=+/-0.5), without a difference between mesial and distal sites. This study demonstrates that implants with peri-implant defects that are treated with GBR had similar survival rates and crestal bone levels compared with implants in native bone.     

Immediate and early loading of Straumann implants with a chemically modified surface (SLActive) in the posterior mandible and maxilla: 1-year results from a prospective multicenter study

Objective: Immediate and early loading of implants can simplify treatment and increase patient satisfaction. This 3‐year randomized‐controlled trial will therefore evaluate survival rates and bone‐level changes with immediately and early loaded Straumann implants with the SLActive surface. Material and methods: Partially edentulous patients ≥18 years of age were enrolled. Patients received a temporary restoration (single crown or two to four unit fixed partial denture) out of occlusal contact either immediately (immediate loading) or 28–34 days later (early loading group), with permanent restorations placed 20–23 weeks after surgery. The primary endpoint was change in crestal bone level from baseline (implant placement) to 12 months; the secondary variables were implant survival and success rates. Results: A total of 383 implants (197 immediate and 186 early) were placed in 266 patients; 41.8% were placed in type III and IV bone. The mean patient age was 46.3±12.8 years. Four implants failed in the immediate loading group and six in the early loading group, giving implant survival rates of 98% and 97%, respectively (P=NS). There were no implant failures in type IV bone. The overall mean bone level change from baseline to 12 months was 0.77±0.93 mm (0.90±0.90 and 0.63±0.95 mm in the immediate and early groups, respectively; P<0.001). However, a significant difference in implantation depth between the two groups (P<0.0001) was found. After adjusting for this slight difference in initial surgical placement depth, time to loading no longer had a significant influence on bone‐level change. Significant influence was found for: center (P<0.0001), implant length (P<0.05) and implant position (P<0.0001). Bone gain was observed in approximately 16% of implants. Conclusions: The results demonstrated that Straumann implants with the SLActive surface are safe and predictable when used in immediate and early loading procedures. Even in poor‐quality bone, survival rates were comparable with those from conventional or delayed loading. The mean bone‐level change was not deemed to be clinically significant and compared well with the typical bone resorption observed in conventional implant loading.     

Immediate loading of implants placed with the osteotome technique: one-year prospective case series

Background: There is limited information regarding marginal bone‐level changes around immediately loaded implants placed with the osteotome technique. The aim of this case series is to prospectively evaluate the clinical and radiographic outcome of immediately loaded implants placed with the osteotome technique over a 12‐month period. Methods: Eighteen patients in need of oral prosthetic rehabilitation that included single implant placement in positions #4 to #13 and/or #20 to #29 participated in this prospective trial. A modified implant installation procedure with an under preparation of the implant bed using the osteotome technique and immediate loading of the implant was performed. Clinical examinations were performed at 2 weeks, 6 months, and 12 months of follow‐up. Radiographic examinations were performed at implant installation and at the 6‐ and 12‐month follow‐up visits. Results: One implant failed to integrate and was removed at 3 months after implant installation. Four of 20 implants had insertion torque value >35 Ncm. The mean marginal bone loss was ‐0.09 mm at the 6‐month and ‐0.19 mm at the 12‐month follow‐up visits. Conclusion: The present case series indicates that implants placed with the osteotome technique and immediately loaded did not demonstrate a high insertion torque and exhibited minimal marginal bone loss.     

Early loading of four or five Astra Tech fixtures with a fixed cross-arch restoration in the mandible

Background: A change in implant placement has emerged recently from two‐stage to one‐stage surgery and to earlier and even immediate loading of the fixtures. Purpose: The aim of this study was to verify whether four or five fixtures installed in the edentulous mandible were suitable for early loading with a cross‐arch fixed restoration. Materials and Methods: In 25 consecutively treated patients (28–88 yr), four or five Astra Tech fixtures (Mölndal, Sweden) were installed in edentulous mandibles. During the same surgical procedure, the abutments were connected. An impression was taken immediately after surgery. All patients received a fixed prosthetic rehabilitation of 10 to 12 teeth made of a cast metal framework and acrylic teeth/gingiva within a month. The fixtures were followed up clinically and radiographically for 7 to 24 months. Bone level was measured from the most coronal point of the vertical part of the fixture to the most apical bone level mesially or distally. Results: No fixtures were lost during follow‐up. No postoperative complications occurred. Radiographic analysis showed a mean bone level of 0.6 mm after 7 to 12 months. Fixtures followed up from 13 to 18 and 19 to 24 months showed a mean bone level of 0.7 mm. Around two fixtures, the bone level was found at the first implant thread. All other fixtures showed the bone level somewhere along the vertical unthreaded part of the fixture. Conclusions: Early loading within 1 month of four or five Astra Tech fixtures in the edentulous mandible is a predictable procedure for a follow‐up period of 6 to 24 months.     

Immediate functional loading of TiOblast dental implants in full‐arch edentulous maxillae: a 3‐year prospective study

Introduction: Immediate functional loading of dental implants for full‐arch restoration is a patient‐friendly approach, shown to be feasible with a good long‐term prognosis in a completely edentulous mandible. For the complete restoration of the maxilla, acceptable long‐term clinical follow‐up is lacking or based on case reports rather than on prospective studies. Objectives: This prospective mono‐centre study reports the 3‐year outcome of immediately functionally loaded Astra Tech Dental implants in completely edentulous maxillae based on clinical survival and success based on radiographical assessment of bone level. Material and methods: One hundred and ninety‐five Astra Tech TiOblast surface fixtures were installed in 25 consecutively treated patients (age range: 42–76 years), of whom eight were smokers, 12 had a confirmed history of periodontitis and six had poor bone quality normally deemed for delayed loading. Fixtures and abutments were inserted in a one‐stage procedure and functionally loaded within 24 h with a 10‐unit provisional glass‐fibre or metal‐reinforced screw‐retained restoration. After 6 months, each implant was checked for stability using a manual torque of 20 N cm and the provisional restoration was replaced by a 10–12‐unit screw‐retained metal–ceramic or metal–resin cantilever bridge. Bone level was assessed radiographically from the day of surgery up to 3 years and used to calculate mean bone loss at the patient level and individual implant success. Results: No failures occurred in implants or prostheses, the total survival rate being 100%. Mean marginal bone loss was 0.58 mm (SD 0.58); 0.6 mm (SD 0.53); 0.63 (SD 0.61); and 0.72 (SD 0.63) after 6 and 12 months, and 2 and 3 years, respectively, yielding a 100% success at the patient level. Wilcoxon's signed ranks test showed only statistically significant bone loss between baseline and 6 months and a steady‐state condition during all other intervals. At the individual fixture level, 82% lost <1 mm marginal bone between baseline and 1 year. After 3 years, 86% have <1.5 mm total bone loss and can be considered a success. The fixtures expressing more bone loss were all inserted in smokers. Conclusion: Immediate loading of a full‐arch maxillary bridgework on 7–9 Astra Tech TiOblast implants is a predictable treatment option with 100% fixture survival and stable bone‐to‐implant contact up to 3 years. The steady state in bone remodelling is indicative of a good long‐term prognosis in non‐smokers but smokers seem to be more prone to bone loss.     

Immediate and early non-occlusal loading of Straumann implants with a chemically modified surface (SLActive) in the posterior mandible and maxilla: interim results from a prospective multicenter randomized-controlled study

Objective: Immediate and early loading of dental implants can simplify treatment and increase overall patient satisfaction. The purpose of this 3‐year prospective randomized‐controlled multicenter study was to assess the differences in survival rates and bone level changes between immediately and early‐loaded implants with a new chemically modified surface (SLActive). This investigation shows interim results obtained after 5 months. Material and methods: Patients ≥18 years of age missing at least one tooth in the posterior maxilla or mandible were enrolled in the study. Following implant placement, patients received a temporary restoration either on the day of surgery (immediate loading) or 28–34 days after surgery (early loading); restorations consisted of single crowns or two to four unit fixed dental prostheses. Permanent restorations were placed 20–23 weeks following surgery. The primary efficacy variable was change in bone level (assessed by standardized radiographs) from baseline to 5 months; secondary variables included implant survival and success rates. Results: A total of 266 patients were enrolled (118 males and 148 females), and a total of 383 implants were placed (197 and 186 in the immediate and early loading groups, respectively). Mean patient age was 46.3±12.8 years. After 5 months, implant survival rates were 98% in the immediate group and 97% in the early group. Mean bone level change from baseline was 0.81±0.89 mm in the immediate group and 0.56±0.73 mm in the early group (P<0.05). Statistical analysis revealed a significant center effect (P<0.0001) and a significant treatment × center interaction (P=0.008). Conclusions: The results suggested that Straumann implants with an SLActive can be used predictably in time‐critical (early or immediate) loading treatment protocols when appropriate patient selection criteria are observed. The mean bone level changes observed from baseline to 5 months (0.56 and 0.81 mm) corresponded to physiological observations from other studies, i.e., were not clinically significant. The presence of a significant center effect and treatment × center interaction indicated that the differences in bone level changes between the two groups were center dependent.     

Stability, marginal bone loss and survival of standard and modified sand-blasted, acid-etched implants in bilateral edentulous spaces: a prospective 15-month evaluation

Objectives: Chemical modification of the already proven sand‐blasted and acid‐etched (SLA) implant had increased its surface wettability and consequent early‐term osseointegration characteristics. The aim of this clinical trial was to compare the stability changes, success, survival, peri‐implant parameters and marginal bone loss (MBL) of the early‐loaded standard (SLA) and modified sand‐blasted, acid‐etched (modSLA) implants. Material and methods: A total of 96 SLA and modSLA implants were placed in a bi‐lateral, cross‐arch position to the jaws of 22 patients. Resonance frequency analysis (RFA) was used to measure the implant stability in the surgery and following healing after 1, 3 and 6 weeks. At the stage of loading, a panoramic X‐ray was obtained and RFA measurement was repeated for all implants. Implants were restored by metal–ceramic crowns and followed for 1 year to determine the success, survival rate, peri‐implant parameters and MBL. Results were compared by one‐ and two‐way ANOVA, log‐rank test and generalized linear mixed models (P<0.05). Results: One modSLA implant was lost after 3 weeks following the surgery yielding to a 100 and 97.91% success rate for SLA and modSLA implants, respectively (P=0.323). At the loading stage, modSLA implants showed significantly lower MBL (0.18 ± 0.05 mm) than SLA implants (0.22 ± 0.06 mm; P=0.002). In the loading stage, RFA value of the modSLA implants (60.42 ± 6.82) was significantly higher than the both implant types in the surgical stage (55.46 ± 8.29 and 56.68 ± 8.19), and following 1 (56.08 ± 7.01 and 55.60 ± 9.07) and 3 weeks of healing (55.94 ± 5.95 and 55.40 ± 6.50 for SLA and modSLA implants, respectively). Conclusions: modSLA implants demonstrated a better stability and a reduced MBL at the loading stage. Both SLA and modSLA implants demonstrated a favorable success and survival at the end of 15‐month follow‐up. To cite this article :
Karabuda ZC, Abdel‐Haq J. Arιsan V. Stability, marginal bone loss and survival of standard and modified sand‐blasted, acid‐etched implants in bilateral edentulous spaces: a prospective 15‐month evaluation.
Clin. Oral Impl. Res. 22 , 2011; 840–849
doi: 10.1111/j.1600‐0501.2010.02065.x     

Early loading of sandblasted and acid-etched (SLA) implants: a prospective split-mouth comparative study

Sandblasted and acid-etched (SLA) implants were recently introduced to reduce the healing period between surgery and prosthesis. In this split-mouth study, SLA implants were compared to titanium plasma-sprayed (TPS) implants under loaded conditions one year after placement in 32 healthy patients, with comparable bilateral edentulous sites and no discrepancies in the opposing dentition. The surgical procedure was performed by the same operator and was identical at 68 SLA (test) and 68 TPS (control) sites. Tapping was never performed and primary stability was always achieved. Abutment connection was carried out at 35 Ncm 6 weeks postsurgery for test sites and 12 weeks for the controls, by the same dentist blind to the type of surface of the implant. In 4 of the 68 test sites the implant rotated slightly, patients reported minor pain and connection was not completed. Provisional restoration was fabricated and a new tightening was performed after six weeks. Similar gold-ceramic restorations were cemented on the same type of solid abutments on both sites. No implant was lost. Clinical measures and radiographic changes were recorded by the same operator, blind to the type of surface of the implant, 1 year post surgery. No significant differences were found with respect to presence of plaque (24% vs. 27%), bleeding on probing (24% vs. 31%), mean pocket depth (3.3 mm vs. 2.9 mm) or mean marginal bone loss (0.65 mm vs. 0.77 mm). The results suggest that SLA implants are suitable for early loading at 6 weeks. Limited implant spinning may occasionally be found but, if properly handled, it produces no detrimental effect on the clinical outcome.     

Immediate functional loading of TiOblast dental implants in full-arch edentulous mandibles: a 3-year prospective study

Introduction: Implant-prosthetic rehabilitation of the completely edentulous mandible has evolved to a simplified procedure with shorter treatment time and survival rates of 95–100% depending on the implant system used.
Purpose: The aim was to evaluate the 3-year clinical success of Astra Tech TiOblast implants, functionally loaded on the day of surgery with a fixed full-arch bridge in the mandible.
Materials and methods: One hundred and twenty-five implants of 3.5–4 mm width and 11–17 mm length were installed in 25 edentulous mandibles of 15 female and 10 male patients. Implants were functionally loaded on the day of surgery with a provisional, acrylic, glassfibre reinforced, 10 unit bridge. After 3–4 months, the final 12-unit bridge was constructed. Radiographical bone loss was measured on peri-apical radiographs after 3, 12, 24 and 36 months.
Results: All implants were functional during the whole study period yielding a survival rate of 100%. None of the fixtures showed pain or mobility after manual torque with 20 N cm at the 3-month control. Mean radiographical bone loss after 3 months and 1, 2 and 3 years was 0.6 mm (SD 0.7), 0.8 mm (SD 0.8), 1 mm (SD 0.8) and 1.3 (SD 1) respectively, which was statistically significantly increasing up to 1 year.
Conclusion: Immediate loading of full-arch mandibular bridgework on five TiOblast implants offers a long-lasting clinical result with 100% fixture survival and stable bone-to-implant contact up to 3 years.     

A 2-year prospective study on immediate loading with fluoride-modified implants in the edentulous mandible

Objectives: Chemically modified surfaces were introduced during the last decade to improve indications for implant treatment. The fluoride‐modified implant (Osseospeed^®) was launched in 2004 and clinical studies suggest a more rapid bone formation and stronger bone to implant contact. However, limited clinical data are available on marginal bone loss and the outcome after >1 year under immediate loading conditions is not fully understood. Hence, the purpose of this prospective study was to present implant survival and marginal bone level data when fluoride‐modified implants are supporting a fully functional rehabilitation from the day after surgery in the completely edentulous mandible. Materials and methods: Twenty‐five patients, completely edentulous in the mandible, were consecutively treated with five fluoride‐modified implants that were functionally loaded with a provisional screw retained restoration. Marginal bone loss was measured from day of surgery to 3, 6, 12 and 24 months. Implants were considered successful after 24 months if radiographic bone loss did not exceed 1 mm and no pain or mobility was caused under a torque of 20 N cm. Statistical analysis was carried out on both patient and implant levels. Results: All implants survived and mean bone loss on implant level after 3, 6, 12 and 24 months was 0.14, 0.13, 0.11 and 0.11 mm, respectively. Bone loss was only statistically significant between baseline and 3 months (P<0.001) and remained unchanged afterward. None of the implants lost >1 mm of bone after 2 years. On the patient level, the mean bone loss after 2 years was 0.12 mm (SD 0.14; range ?0.06 to 0.55) with probing pocket depth 2.45 mm (SD 0.43; range 1.3–3.1) and bleeding index 0.55% (SD 0.34; range 0–1). Conclusion: Immediate loading of fluoride‐modified implants is a predictable treatment yielding a high survival and success rate after 2 years. To cite this article:
Collaert B, Wijnen L, De Bruyn H. A 2‐year prospective study on immediate loading with fluoride‐modified implants in the edentulous mandible.
Clin. Oral Impl. Res. 22 , 2011; 1111–1116.
doi: 10.1111/j.1600‐0501.2010.02077.x     

Early loading of mandibular full-arch bridges screw retained after 1 week to four to five Monotype implants: 3-year results from a prospective multicentre study

Objectives: This prospective multicentre study provides clinical experience up to 3 years to support a simplified treatment for mandibular edentulism within 1 week by using one‐stage implant surgery and a screw‐retained full‐arch bridge. Methods: Two hundred and fifty ITI Monotype^® implants were installed in 62 patients out of 66 patients; 60 patients got four implants each and two got five implants. After 1 week, a final bridge was in function. Radiographs were taken as baseline for vertical bone loss up to 3 years post‐loading for the whole cluster and specific effects of gender, centre, age, bone class, implant length over time were compiled. Clinical (mPI, SBI) and subjective parameters such as general oral hygiene and patient satisfaction were recorded and repeated at specified intervals up to 3 years. Results: Four patients were excluded at surgery and are not involved in the follow‐ups. At 1 year, 61 patients (244 implants) were evaluable and all bridges were in function. After 3 years, 49 patients (194 implants) came to control. Eight patients died during the follow‐up period. Three patients lost one implant each. The cumulative implant survival rate was 98.55% and the success rate for the prosthesis was 100%. As calculated from measurable radiographs, the mean bone level at baseline was 1.63±0.78 and at 1 and 3 years 2.50±0.60 and 2.56±0.74, respectively. Using the mixed model analysis and Friedman test, the time in situ, centre and bone class had significant effect on the bone resorption and to some small extent even, the implant length. Gender and age were unaffected. Oral hygiene and patient satisfaction of the treatment were improved. Conclusions: The results indicate that one‐part self‐tapping sandblasted, large‐grit, acid‐etched (SLA) implants are suitable for loading within 1 week. In the whole period, the mean bone crestal resorption was <1 mm, which is in agreement with other similar studies.     

A prospective study evaluating a protocol for 6 weeks' loading of SLA implants in the posterior maxilla: one year results

Experimental and clinical studies have shown that modification of implant surfaces can result in increased bone-to-implant contact at earlier times thus reducing the healing period between surgery and prosthesis. Sandblasted and acid-etched (SLA) implants are in this category and have successfully undergone early loading in patients with good bone quality and quantity. Nevertheless, premature loading of SLA implants was not routinely possible in predominantly trabecular bone, such as the posterior maxilla, as it is often characterized by a deficiency in initial bone to implant contact. The purpose of this prospective clinical investigation is to evaluate the efficacy of a modified surgical protocol followed by loading SLA implants at 6 weeks in the posterior maxilla. Drilling was limited to the minimum, and most of the site preparation was produced with osteotomes. Screw tapping was never performed and primary stability was always achieved. Abutment connection was carried out at 15 Ncm 43 (+/- 1) days after surgery and provisional restoration was fabricated. Further abutment tightening at 35 Ncm was performed after an additional 6 weeks. Of the 36 SLA implants placed in 19 patients, one was lost before final restoration. Clinical and radiographic measures were taken at baseline and 1 year postoperatively. The preliminary results suggest that, by means of the surgical and restorative technique presented, SLA implants are suitable for loading at 6 weeks in the posterior maxilla. More years of observation will verify whether osseointegration can be equally maintained over a long period.