Immediate vs. early loading of dental implants: 3‐year results of a randomized controlled clinical trial

Objectives: The aim of the present study was to test whether or not immediately loaded implants exhibit the same survival rates as early loaded implants. Material and methods: Eleven patients with bilateral free end mandibles were randomly assigned to treatment either with immediately (test) or early loaded implants (control). Test implants received provisionals in occlusion on the day of surgery, control implants 6 weeks later. Parameters assessed included implant stability quotient (ISQ), plaque, prosthesis stability and radiographs at baseline (implant insertion), 1 and 3 years. The statistical analysis was performed by means of Student's paired t‐test and Wilcoxon's signed‐rank test. The level of significance was set at P<0.05. Results: After a mean observation period of 39.8 months (36.7–53.1), three test implants were lost in two patients resulting in a survival rate of 85% compared with 100% for control implants. At baseline, the mean marginal bone level was significantly higher at test implants (mean=0.36 mm, SD ±0.5) compared with control implants (1.08±0.37 mm). For both test and control implants, the bone level significantly decreased from baseline to 3 years (test: 1.51±0.79 mm; control: 0.89±0.94 mm). The bone loss until 3 years was not significantly different between test and control group. There was no significant difference for ISQ both at test and control implants between baseline (test: 63.59±4.62 mm, control: 65.35±7.43 mm) and 3 years (test: 66.47±7.47 mm, control 68.80±8.75 mm). Conclusions: Immediate loading was associated with a lower implant survival rate. Although the test implants were placed with increased sink depth compared with the control implants, the marginal bone levels were not different between test and control at 3 years. To cite this article:
Zembi? A, Glauser R, Khraisat A, Hämmerle CHF. Immediate vs. early loading of dental implants: 3‐year results of a randomized controlled clinical trial.
Clin. Oral Impl. Res. 21 , 2010; 481–489.
doi: 10.1111/j.1600‐0501.2009.01898.x     

A 3‐year prospective radiographic evaluation of marginal bone level around different implant systems

Summary The aim of this study was to evaluate the change of marginal bone level radiographically around three different implant systems after 3 years in function. Fifty‐four patients were included and randomly assigned to three treatment groups of rough‐surface implants (TiUnite, n = 37), hybrid of smooth and rough‐surface implants (Restore, n = 38) and rough surface with microthread implants (Hexplant, n = 45). Clinical and radiographic examinations were conducted at the time of implant loading (baseline), 1 and 3 years after loading. A three‐level mixed‐effect analysis of covariance (ancova ) was used to test the significance of the mean marginal bone change of the three implant groups. A total 120 of 135 implants completed the study. None of the implants failed to integrate. Significant differences were noted in the marginal bone loss recorded for the three groups (P < 0·0001). At 3 years, the rough surface with microthread implants had a mean crestal bone loss of 0·59 ± 0·30 mm; the rough‐surface implants, 0·95 ± 0·27 mm; and the hybrid surface implants, 1·05 ± 0·34 mm. Within the limitations of this study, rough‐surface implants with microthread at the coronal part might have a long‐term positive effect in maintaining the marginal bone level against functional loading in comparison with implants without these two features.     

Long‐term,retrospective evaluation (implant and patient‐centred outcome) of the two‐implant‐supported overdenture in the mandible. Part 2: marginal bone loss

Objective: In part 2 of this long‐term, retrospective study on the two‐implant‐supported overdenture in the mandible, the annual marginal bone loss was evaluated in detail and parameters, with a significant effect on the annual bone loss, were verified. Material and methods: For all 495 patients with an overdenture in the mandible at least 5 years in function, data up to their last follow‐up visit had been collected, including long‐cone radiographs (taken at the abutment connection and after years 1, 3, 5, 8, 12 and 16 of loading) and probing data at their last evaluation. General information (medical history, implant data, report on surgery) was retrieved from the patient's file. Two hundred and forty‐eight patients had been clinically examined recently. For the others, information on bone level and probing depths were retrieved from the patient's files, as all patients had been enrolled in our annual follow‐up schedule. Results: The mean annual bone loss on a site level (without considering the first year of bone remodelling) after 3 years of loading was 0.08 mm/year (SD=0.22, n=1105), after 5 years of loading 0.07 mm/year (SD=0.14, n=892), after 8 years of loading 0.06 mm/year (SD=0.12, n=598), after 12 years 0.04 mm/year (SD=0.07, n=370) and 0.05 mm/year (SD=0.05, n=154) after 16 years of loading. Ongoing bone loss was seen in a number of implants (n=26) with the annual bone loss exceeding 0.2 mm. Some factors clearly showed a significant impact on bone loss: smoking (≥10 cigarettes/day), GBR, the presence of dehiscence and bone quantity(the latter only during the first year). The probing data showed a favourable condition, with <1.2% of the approximal pockets being ≥6 mm, and 4.1%=5 mm. Conclusions: The mean annual bone loss over the study period was <0.1 mm/year after the first year of loading. However, a small number (2.5%) of the implants showed continuing bone loss. To cite this article :
Vercruyssen M, Quirynen M. Long‐term, retrospective evaluation (implant and patient‐centred outcome) of the two‐implants‐supported overdenture in the mandible. Part 2: marginal bone loss.
Clin. Oral Impl. Res. 21 , 2010; 466–472.
doi: 10.1111/j.1600‐0501.2009.01902.x     

Prospective Clinical Trial Evaluating a New Implant System for Implant Survival,Implant Stability and Radiographic Bone Changes

Background: There are a few prospective studies reporting on new implant systems. When a new implant is brought to market, prospective trials should be carried out to determine the predictability of that system. Purpose: This prospective study evaluates implant survival, Resonance Frequency Analysis (RFA), and crestal bone level changes for a new implant system (Neoss System, Bimodal surface, Neoss Ltd, Harrogate, UK). Materials and Methods: Seventy‐six patients, 38 females (age ranging from 23 to 57 years) and 38 males (ranging in age from 17 to 85 years) received 100 Neoss implants. Patients were consecutively enrolled in the study if they were missing one or more teeth in either arch, or a single tooth was scheduled for removal and immediate implant replacement. Evaluated implants were 4, 4.5, or 5 mm wide and were 7, 9, 11, 13, or 15 mm long. A one‐stage approach was followed. At first stage and prior to healing abutment placement RFA measurements were taken. Measurements were retaken at second stage. Fifty‐one implants were placed for restoration of single missing teeth and 49 were for short span implant bridges. Results: The cumulative survival rate at 1‐ to 2‐year interval was 93%. Average initial RFA measurement for all implants was 72.06, while the average final score was 72.58. These changes were not statistically significant. Changes in RFA scores for maxillary implants were insignificant. Forty‐two paired mandibular RFA measurements were evaluated. Initial and final mean mandibular RAF measurements were 73.65 (SD 9.203) and 77.186 (SD 6.177), respectively. These changes were statistically significant (p = .02). Sixty‐four paired radiographs were available for evaluation. Between examinations, there was an average –0.6 mm of bone loss, which was statistically significant (p = .03). On average, 4.0‐mm‐wide implants lost 0.1 mm of bone when compared with 5‐mm‐wide implants. These differences were insignificant (p = .86). Bone loss was adjusted for implant length, and tooth position and there were small, but clinically insignificant changes. Five‐millimeter‐wide implants lose 0.2 mm more than 4.0‐mm‐wide implants (p = .7). Maxillary incisors lose the least amount of bone 0.152 (p = .33). Conclusions: The implants tested in this study had initially high RAF readings, indicating good primary stability. RFA readings for implants placed in the mandible improved from baseline and the changes were statistically significant. Marginal bone levels revealed clinically insignificant bone loss from implant installation to second stage. Loss of seven implants with initially high RFA readings is surprising.     

Long‐Term Follow‐Up of CeraOne™ Single‐Implant Restorations: An 18‐Year Follow‐Up Study Based on a Prospective Patient Cohort

Background: Knowledge on long‐term clinical performance of more than 5 years on the single‐implant CeraOne? (Nobel Biocare AB, Gothenburg, Sweden) concept is limited. Purpose: The aim of this study is to report the long‐term clinical performance of the first CeraOne single‐implant restorations, installed 17 to 19 years ago. Materials and Methods: The group comprised 57 patients provided with 65 CeraOne single‐tooth restorations. Sixty‐two all‐ceramic and three metal‐ceramic crowns were cemented between 1989 and 1991. Patients were followed up clinically and with intraoral radiographs at placement, after 1, 5, and between 17 and 19 years after placement. Results: Data were available for altogether 48 patients, followed up on an average time of 18 years. Excluding deceased patients (n = 2) and failed implant patients (n = 2), only five patients were lost to follow‐up (8.8%). Two implants failed, resulting in an 18‐year implant cumulative success rate (CSR) of 96.8%, and altogether eight original single‐crown restorations were replaced (CSR 83.8%). The most common reason for crown replacement was infra‐position of the implant crown (n = 3). Many of the remaining original crowns showed various signs of implant crown infraposition at the termination of the study. In general, the soft tissue at the restorations was assessed to be healthy and comparable with the gingiva at the adjacent natural teeth. Bone levels were on an average stable with only few patients exhibiting bone loss of more than 2 mm during 18 years in function. Conclusion: This long‐term follow‐up study of single‐implant restorations shows encouraging results with few implant failures and minimal bone loss over an 18‐year period. Original single‐crown restorations were replaced more frequently, because of, for example, implant crown infraposition and veneer fractures. The CeraOne concept proved to be a highly predictable and safe prosthodontic treatment.     

Mandibular single‐implant overdentures: preliminary results of a randomised‐control trial on early loading with different implant diameters and attachment systems

Objectives: To determine surgical and prosthodontic outcomes of mandibular single‐implant overdentures, opposing complete maxillary dentures, using a wide diameter implant and large ball attachment system compared with different regular diameter implants with standard attachment systems. Materials and methods: Thirty‐six edentulous participants (mean age 68 years, SD 9.2) were randomly assigned into three treatment groups (n=12). A single implant was placed in the mandibular midline of participants to support an overdenture using a 6‐week loading protocol. The control group received Southern regular implants and standard ball attachments. One group received Southern 8‐mm‐wide implants and large ball attachments. Another group received Neoss regular implants and Locator attachments. Parametric and non‐parametric tests of a statistical software package (SPSS) were used to determine between groups differences in marginal bone loss, implant stability, implant, and prosthodontic success (P<0.05). Results: Implant success after 1 year was 75% for Southern regular implant (control) group; and 100% for the Southern wide and Neoss regular implant groups (P=0.038). Mean marginal bone loss at 1 year was 0.19 mm (SD 0.39) without significant differences observed. Implant stability quotient (ISQ) at baseline was significantly lower for the Southern regular (control) group than the other two groups (P=0.001; P=0.009). At 1 year, no significant difference in implant stability was observed (mean ISQ 74.6, SD 6.1). The change in implant stability from baseline to 1 year was significant for the control group (P=0.025). Prosthodontic success was comparable between the groups but the maintenance (41 events overall, mean 1.2) was greater for the Locator and the standard ball attachments. Conclusions: Mandibular single‐implant overdentures are a successful treatment option for older edentulous adults with early loading protocol using implants of different diameters and with different attachment systems. To cite this article:
Alsabeeha NHM, Payne AGT, De Silva RK, Thomson WM. Mandibular single‐implant overdentures: preliminary results of a randomised‐control trial on early loading with different implant diameters and attachment systems.
Clin. Oral Impl. Res. 22 , 2011; 330–337.
doi: 10.1111/j.1600‐0501.2010.02004.x     

Evaluation of Clinical Outcomes and Bone Loss around Titanium Implants with Oxidized Surface: Six‐Year Follow‐Up Results from a Prospective Case Series Study

Purpose: The aim of this prospective study was to assess long‐term clinical outcomes and peri‐implant bone level changes around oxidized implants supporting partial fixed rehabilitations. Materials and Methods: Twenty‐two partially edentulous patients were included in the study. A total of 33 fixed rehabilitations were placed, supported by 54 titanium implants with oxidized microtextured surface. Prostheses were delivered after 3 and 6 months of implant placement in the mandible and maxilla, respectively. Patients were scheduled for follow‐up at 6 and 12 months and then yearly. At each follow‐up, plaque level and bleeding scores were assessed and periapical radiographs were taken. The main outcomes were prosthesis success, implant survival, implant success, and marginal bone level change. Results: Three patients were excluded from the study because they did not attend the 1‐year follow‐up. Nineteen patients, accounting for 49 implants, were followed for at least 6 years after prosthesis delivery. The mean follow‐up duration was 81.8 months (range 75–96 months). One mandibular single‐tooth implant failed after 1 year in a smoker woman. Cumulative implant survival and success at 6 years were 98.0% and 95.9%, respectively. Prosthesis success was 96.7%. The mean peri‐implant bone loss at 6 years was 0.76 ± 0.47 mm. Not significantly (p = .75) greater bone loss was found in the maxilla (0.78 ± 0.14 mm, n = 19) as compared with the mandible (0.74 ± 0.59 mm, n = 30). In the maxilla, bone loss was significantly greater around implants supporting partial prostheses as compared with single‐tooth implants (p = .03). Full patient satisfaction was reported. Conclusion: Implants with oxidized microtextured surface may achieve excellent long‐term clinical outcomes in the rehabilitation of partial edentulism.     

Clinical Outcomes of an Osteotome Technique and Simultaneous Placement of Neoss Implants in the Posterior Maxilla

Background: Insufficient bone volume often hamper placement of dental implants in the posterior maxilla. Purpose: The aim of the present clinical study was to evaluate retrospectively the clinical outcome of implant placement in the resorbed posterior maxilla using an osteotome technique without adding any grafting material. Materials and Methods: Twenty patients with 5 to 9 mm of residual alveolar bone height in the posterior maxilla received twenty‐nine implants (Neoss Ltd., Harrogate, UK) using an osteotomy technique without bone grafts. Intraoral radiographs were taken before and after implant placement, at the time of loading and after 11 to 32 months of loading (mean 16.4 months), to evaluate bone formation below the sinus membrane and marginal bone loss. Implant stability measurements (Osstell^TM, Gothenburg, Sweden) were performed after implant installation and at abutment connection 5 months later. All implants were installed with the prosthetic platform level with the bone crest. Results: No implant was lost giving a survival rate of 100% after a mean follow‐up time of 16.4 months. The average vertical bone height was 7.2 ± 1.5 mm at placement and 10.0 ± 1.0 mm after 11 to 32 months. The average increase of 2.8 ± 1.1 mm was statistically significant. There was a statistically significant improvement in implant stability from 70.7 ± 9.2 implant stability quotient (ISQ) at placement to 76.7 ± 5.7 ISQ at abutment connection, 5 months later. The mean marginal bone loss amounted to 0.7 ± 0.3 mm after 11 to 32 months of loading. Conclusion: It is concluded that the osteotome technique evaluated resulted in predictable intrasinus bone formation, firm implant stability, and good clinical outcomes as no implants were lost and minimal marginal bone loss was observed.     

Bone alterations at implant‐supported FDPs in relation to inter‐unit distances: a 5‐year radiographic study

Objectives: The aim of this 5‐year study was to longitudinally evaluate bone alterations around implants with a conical implant–abutment interface in relation to implant–tooth and inter–implant distances. Material and methods: The patient sample comprised 43 partially dentate patients with a total of 48 implant‐supported fixed dental prostheses (FDPs) supported by 130 Astra Tech^® implants. Following FDP placement (baseline), the patients were enrolled in an individually designed supportive care program. Radiographic examinations were performed at the time of FDP installation, 1 and 5 years of follow‐up. Variables regarding implant position and proximal bone topography at tooth/implant units (n=36) and implant/implant units (n=67) were assessed with the use of a software program after scanning of the radiographs. Results: At tooth/implant units, the mean 5‐year marginal bone loss at the tooth, the implant and the mid‐proximal bone crest was 0.1, 0.4 and 0.2 mm, respectively. The mean longitudinal bone loss at the implant/implant units was 0.5 mm at the implants and 0.3 mm mid‐proximally. Multilevel regression analysis revealed that at implant/implant units, the change in the bone‐to‐implant contact level was a significant predictor with regard to the 5‐year mid‐proximal bone‐level change, whereas the horizontal inter‐unit distance showed a borderline significance (P=0.052). At tooth/implant units, no statistically significant associations were identified. Conclusions: The results of this 5‐year study revealed differences between inter‐implant and tooth–implant proximal areas with regard to bone crest alterations and associated factors. To cite this article:
Chang M, Wennström JL. Bone alterations at implant‐supported FDPs in relation to inter‐unit distances: a 5‐year radiographic study.
Clin. Oral Impl. Res. 21 , 2010; 735–740.
doi: 10.1111/j.1600‐0501.2009.01893.x     

Early loading of single crowns supported by 6‐mm‐long implants with a moderately rough surface: a prospective 2‐year follow‐up cohort study

Aim: To evaluate prospectively the clinical and radiographic outcomes after 2 years of loading of 6 mm long moderately rough implants supporting single crowns in the posterior regions. Material and methods: Forty SLActive Straumann^® short (6 mm) implants were placed in 35 consecutively treated patients. Nineteen implants, 4.1 mm in diameter, and 21 implants, 4.8 mm in diameter, were installed. Implants were loaded after 6 weeks of healing. Implant survival rate, marginal bone loss and resonance frequency analysis (RFA) were evaluated at different intervals. The clinical crown/implant ratio was also calculated. Results: Two out of 40 implants were lost before loading. Hence, the survival rate before loading was 95%. No further technical or biological complications were encountered during the 2‐year follow‐up. The mean marginal bone loss before loading was 0.34±0.38 mm. After loading, the mean marginal bone loss was 0.23±0.33 and 0.21±0.39 mm at the 1‐ and 2‐year follow‐ups. The RFA values increased between insertion (70.2±9) and the 6‐week evaluation (74.8±6.1). The clinical crown/implant ratio increased with time from 1.5 at the delivery of the prosthesis to 1.8 after 2 years of loading. Conclusion: Short implants (6 mm) with a moderately rough surface loaded early (after 6 weeks) during healing yielded high implant survival rates and moderate loss of bone after 2 years of loading. Longer observation periods are needed to draw more definite conclusions on the reliability of short implants supporting single crowns. To cite this article:
Rossi F, Ricci E, Marchetti C, Lang NP, Botticelli D. Early loading of single crowns supported by 6‐mm‐long implants with a moderately rough surface: a prospective 2‐year follow‐up cohort study.
Clin. Oral Impl. Res. 21 , 2010; 937–943.
doi: 10.1111/j.1600‐0501.2010.01942.x     

One‐Year Outcomes of Neoss Bimodal Implants. A Prospective Clinical,Radiographic, and RFA Study

Background: The Neoss implant system has been available since 2004. Few studies documenting the clinical performance of this implant are available. Purpose: To study the stability and clinical/radiographic outcomes of Neoss implants 1 year of loading when using a two‐stage protocol. Materials and Methods: Ninety (90) consecutive patients scheduled for implant treatment using a two‐stage procedure were enrolled in a prospective follow‐up study. A total of 218 implants (Neoss System, Bimodal surface, Neoss Ltd, Harrogate, UK) in diameters of 3.5, 4.0, and 4.5 mm and in lengths from 7 to 15 mm were placed to support 29 single tooth replacements, 53 partial bridges, 5 full bridges, and 10 overdentures in both jaws. Abutment connection was made after a healing period of 3–4 months. The patients were followed during 1 year of loading with clinical, radiographic, and resonance frequency analysis (Osstell Mentor?, Osstell AB, Gothenburg, Sweden) examinations. Prostheses were removed at the annual check‐up for individual testing of implant stability. Results: Three implant failures were experienced, giving a survival rate of 98.6% after 1 year. A mean bone loss of 0.6 mm (SD 0.8) was observed after 1 year. There was a significant inverse correlation between implant diameter and marginal bone loss (p < .003). The mean implant stability quotient levels were 73.7 (SD 7.6), 74.4 (SD 6.4), and 76.7 (SD 5.2) at placement, abutment connection, and first annual check‐up, respectively. The stability had increased significantly from placement to 1 year (p < .001) and from abutment to 1 year (p < .0001). Implant stability was higher in the mandible than in the maxilla at all time points. There was a significant correlation between bone quality and stability at placement (p < .0001) and abutment connection (p < .001) but not after 1 year. Conclusions: The use of Neoss implants for prosthetic rehabilitation of consecutive edentate patients with different needs resulted in predictable clinical and radiographic outcomes after 1 year of loading. Implant stability measurements revealed a favorable bone tissue reaction to the implants.     

Bone level alterations at implants placed in the posterior segments of the dentition: outcome of submerged/non-submerged healing. A 5-year multicenter, randomized, controlled clinical trial

Objective: To determine if longitudinal bone level change at Astra Tech^? implants placed in the posterior part of the dentition was influenced by the healing conditions provided following implant placement, i.e., submerged or non‐submerged healing. Material and methods: Eighty‐four patients and 115 fixed partial dentures (FPDs or cases) entered the study. The cases were randomized into two implant installation groups: initially non‐submerged (group A) or initially submerged (group B) implants. Three hundred and twenty‐four implants were installed (group A=153; group B=171): 145 in the maxilla and 179 in the mandible. Radiographs from the implant sites were obtained at FPD insertion (baseline) and subsequently every 12 months. In the radiographs, the position of the marginal bone at the mesial and distal aspects of the implants was determined and the radiographic (Rx) bone level change over time was calculated. Results: Seven implants failed to integrate (four in group A and three in group B). During the 5 years of monitoring, three implants had to be removed and 35 implants were lost to follow‐up. The Rx bone level alteration that occurred during year 1 was 0.02±0.38 mm in group A and 0.17±0.51 mm in group B. During the subsequent 4 years there was some further Rx bone loss in group B (0.02±0.62 mm), while in group A there was some gain of bone (0.07±0.5 mm). Conclusion: The peri‐implant bone level change and number of biological complications that took place during the 5 years was small and unrelated to the surgical protocol used for implant placement.     

Splinted and Unsplinted Short Implants in Mandibles: A Retrospective Evaluation With 5 to 16 Years of Follow‐Up

Background: The aim of this retrospective study is to investigate the medium‐ to long‐term prognosis of short implants in partially and totally edentulous patients with mandibular bone atrophy. Methods: The study involved 109 patients with 280 implants placed in the mandible. The implants were 7 or 8.5 mm long and 3.75 or 4 mm in diameter. The implant surfaces were machined (M; n = 176) or rough (R; n = 104). Patients were asked to attend a radiographic and clinical follow‐up, and their previous clinical records and radiographs were assessed. Implant‐related and prosthetic failures and complications were recorded. Results: The mean follow‐up was 9 years (range of 5 to 16 years). The survival rate (SSR) and success rate (SR) were calculated using life‐table analysis for both M and R short implants. The M implants had a 16‐year SSR of 95.7% and a corresponding SR of 93.9%, whereas the 16‐year SSR and SR for the R implants were 97.2% and 95.2%, respectively. The mean ± SD bone resorption for all implants was 1.37 ± 0.5 mm. For marginal bone loss, there was no statistically significant difference between the two implant lengths (P = 0.38) or diameters (P = 0.34) or between the M and R implant surfaces (P = 0.47). Conclusions: Different implant lengths, diameters, and surface treatments do not appear to influence the prognosis of the implant. Within the limitation that most of the short implants were splinted to longer implants, the reduced length of the fixtures did not worsen the long‐term survival of the implant‐supported fixed prostheses.     

Impact of Platform Switching on Peri‐Implant Bone Remodeling around Short Implants in the Posterior Region, 1‐Year Results from a Split‐Mouth Clinical Trial

Aim: To assess the effect of platform switching on peri‐implant bone remodeling around short implants (8.5 mm) placed in the resorbed posterior mandibular and maxillary region of partially edentulous patients. Materials and Methods: Seventeen patients with one or more missing teeth at both sides in the posterior region were, according to a split‐mouth design, randomly assigned to be treated with a platform‐matched (control) implant on the one side and a platform‐switched implant (test) on the other side. A total of 62 short implants (8.5 mm) with a dual‐acid etched surface with nanometer‐sized calcium phosphate particles was placed. Follow‐up visits were conducted one month and one year after placing the implant crown. Outcome measures were interproximal bone level changes, implant survival and clinical parameters. Results: One year after loading, peri‐implant bone remodeling around test implants (0.53 ± 0.54 mm) was significant less than around control implants (0.85 ± 0.65 mm; p = .003). With regard to implant survival and clinical parameters no significant differences were observed between test and control implants. Conclusions: This study suggested that peri‐implant bone remodeling is affected by platform switching. One year after loading, interproximal bone levels were better maintained at implants restored according to the platform switching concept.     

Prospective study with a 2‐year follow‐up on immediate implant loading in the edentulous mandible with a definitive restoration using intra‐oral welding

Objectives: The aim of this prospective study was to evaluate the concept of intra‐oral welding as a suitable technique for the fabrication of a restoration for edentulous mandibles on the same day as surgery using tapered connection implants. Material and methods: Each of 20 patients had an edentulous mandible and received four inter‐foraminal, tapered connection implants. All implants were immediately loaded with a fixed restoration supported by an intra‐orally welded titanium framework. Final abutments were connected to the implants and then a titanium bar was welded to them using an intra‐oral welding unit. This framework was used as a support for the final restoration, which was fitted on the same day as implant placement. Mean marginal bone loss and radiographically detectable alteration of the welded framework were assessed using periapical radiographs immediately after surgery, and at 6‐, 12‐ and 24‐month follow‐up examinations. Results: Seven males and 13 females, with an average age of 56.5 years (SD=15.1; n=20), were consecutively treated with 80 immediately loaded implants. No fracture or radiographically detectable alteration of the welded frameworks was evident. All implants osseointegrated and a 100% implant survival rate was achieved at the 24‐month follow‐up. The accumulated mean marginal bone growth was 0.21 mm (SD 0.25, n=80). The average pocket probing depth was 1.38 mm (SD 0.41). Conclusions: The intra‐oral welding technique applied to the delivery of a final restoration of the edentulous mandible over immediately restored tapered connection implants seems to have no adverse effect on marginal bone loss and implant survival. To cite this article:
Degidi M, Nardi D, Piattelli A. Prospective study with a 2‐year follow‐up on immediate implant loading in the edentulous mandible with a definitive restoration using intra‐oral welding.
Clin. Oral Impl. Res. 21 , 2010; 379–385.
doi: 10.1111/j.1600‐0501.2009.01865.x     

Malpositioned Osseointegrated Implants Relocated with Segmental Osteotomies: A Retrospective Analysis of a Multicenter Case Series with a 1‐ to 15‐Year Follow‐Up

Purpose: This multicenter case series evaluates retrospectively the clinical outcomes of malpositioned implants surgically relocated in a more convenient position by segmental osteotomies. Materials and Methods: Authors who published, on indexed journals or books, works about malpositioned implant correction by segmental osteotomies were contacted. Five centers, out of 11 selected, accepted to participate in this study. The dental records of patients who underwent implant relocation procedures were reviewed. Implant survival rates were analyzed and a blinded assessor examined clinical photos and periapical radiographs to evaluate esthetic outcome (pink esthetic score [PES]) and changes of marginal bone level over time. Patients were requested to fill a verbal rating scale form about discomfort, compliance, and satisfaction related to the procedure. Results: Fifteen malpositioned implants relocated by segmental osteotomies were followed for a period ranging from 1 to 15 years (mean 6.0 ± 3.9 years). The overall implant survival rate from baseline to the last follow‐up visit was 100%. The mean marginal bone loss was 0.36 mm at the 12‐month follow‐up visit and no relevant further changes were observed at the following examinations. Significant esthetic improvement was recorded at 1‐year examination with PES evaluation (p < .0001). Patients' feedback described this procedure as not excessively invasive and uncomfortable, reporting a high final satisfaction rate. Conclusions: The present study suggests that implant relocation with segmental osteotomies could be an effective alternative method to correct the position of unrestorable malpositioned implants in a single‐stage surgery.     

Ten Years Later. Results from a Prospective Single‐Centre Clinical Study on 121 Oxidized (TiUnite™) Brånemark Implants in 46 Patients

Background: Concerns have been raised that use of surface‐modified implants may result in peri‐implant infection and marked marginal bone loss over time. Purpose: The aim of this prospective study was to evaluate the survival rate, marginal bone, and soft tissue conditions at surface‐modified titanium dental implants after 10 years of function. Material and Methods: Forty‐six totally and partially edentulous patients were provided with 121 Brånemark oxidized implants (TiUnite?, Nobel Biocare AB, Gothenburg, Sweden). Twenty‐four (20%) implants were immediate loaded and 97 (80%) were placed using a two‐stage procedure. A total of 22 single, 23 partial, and 7 total restorations were delivered. Clinical and radiographic checkups were carried out after 3, 6, 12 months, and thereafter annually up to 10 years. At these occasions, oral hygiene was evaluated and peri‐implant mucosa examined by probing. If needed, patients were enrolled in an individual program for hygiene controls and professional cleaning. Marginal bone loss was evaluated in intraoral radiographs taken at baseline and after 1, 5, and 10 years of function. Results: One (0.8%) implant failed after 8 years giving a Survival Rate (SR) of 99.2% after 10 years. A total of 11 sites (9.2%) showed bleeding on probing (BP) at the 10th annual checkup. The mean marginal bone loss was 0.7 ± 1.35 mm based on 106 readable pairs of radiographs from baseline and from the 10th annual examination. Twelve (11.3%) implants showed more than 2 mm bone loss, and five (4.7%) showed more than 3 mm of bone loss after 10 years. For the latter, all patients were smokers and had poor or acceptable oral hygiene. All five implants with >3 mm bone loss showed BP and two (1.9%) showed suppuration from the pocket. For the remaining seven implants with more than 2 mm bone loss, no correlation to smoking, oral hygiene, bleeding, or pus could be seen. Time/marginal bone level plots of the 12 implants with more than 2 mm bone loss after 10 years, showed minor changes from the first annual checkup except for the two infected implants. Conclusions: It is concluded that good long‐term clinical outcomes can be obtained with oxidized titanium dental implants. Only 1.9% of examined implants showed significant marginal bone loss together with bleeding and suppuration after 10 years of function.     

Evaluation of postsurgical crestal bone levels adjacent to non‐submerged dental implants

In most of the studies on long-term radiographic evaluations of crestal bone levels adjacent to dental implants, no baseline radiographs taken immediately post-surgically had been obtained.The aim of this study was to test the reproducibility of a simple radiographic method for linear measurements of changes in bone levels and to evaluate changes in crestal bone levels adjacent co non-submerged ITI® implants 1 year following the surgical procedure. From 128 patients enrolled in a clinical and radiographic longitudinal study 40 patients also had radiographs taken immediately postsurgically. They were, however, not obtained as “identical” images. The radiographs were mounted onto slides and projected on a screen. Mesially and distally from 57 implants triplicate linear measurements of the distance implant shoulder to bone crest were taken, using known dimensions of the implants as internal reference distances. The median difference of 213 (out of 228 possible) duplicate measurements was 0.00 mm (ranging from ?1.72 mm to +1.47 mm when comparing the second co the third reading). Some 81% of the double measurements were within ±0.5 mm and the precision was 0.30 mm. In the immediate postoperative radiographs the median mesial bone level was located at 2.07 mm (distally 2.19 mm) from the implant shoulder. A statistically significant amount of bone loss in the first year was observed mesially (median=?0.78 mm) and distally (0.85 mm)(Wilcoxon matched pairs signed rank test ±0.001). No statistically significant influence of the implant location, the implant length, type of the implant (screw; cylinder) was observed (Kruskal-Wallis P>0.05).The age of the patients was not correlated significantly to the amount of bone loss observed. In conclusion, methodological limitations existed when evaluating linear bone changes in non-identical radiographs using reference dimensions of the implants. The amount of postsurgical bone loss estimated in other studies was confirmed when using an immediate postoperative radiograph as a baseline.     

A 1‐Year Controlled Clinical Trial of Immediate Implants Placed in Fresh Extraction Sockets: Stability Measurements and Crestal Bone Level Changes

Purpose: The aim of this study was to measure stability and crestal bone level changes of implants placed in fresh extraction sockets in elderly patients. Methods: Thirty‐five patients who were in need of tooth extractions were recruited for this study. They received a total of 65 implants in both jaws to support fixed or removable prostheses. The teeth were carefully extracted, the implants set directly in the root socket, and resonance frequency analysis (RFA) measurements were simultaneously performed (Time 1 = T1). After a healing time of 6 to 10 weeks the measurements were repeated (Time 2 = T2). Orthograd periapical radiographs were taken when the new prostheses were fabricated and after 1 year of loaded period. The distance between the first visible bone implant contact (BIC) and the implant‐shoulder was measured and crestal bone loss was calculated (ΔBIC). Mean RFA and BIC were compared for various subgroups (p < .05). By means of a fixed effects model, the impact of the parameters gender, jaw, and prosthetic indication on RFA measurements was analyzed (p < .016). Results: The mean implant stability quotient (ISQ) values were 64.4 ± 6.7 at T1 and 64.0 ± at 8.6 T2, with a trend to higher values for male patients. The mixed model showed that only the jaw had a statistically significant impact on ISQ values, with higher values for the mandible. Mean crestal bone loss was small with 0.49 ± 0.81 mm, ranging form 0.1 to 2.4 mm. Twenty percent of the implant sites lost more than 1‐mm crestal bone. No differences were found in subgroups. Conclusions: Good primary and secondary stability of the implants was reached in both jaws. Crestal bone loss was small but may not be fully predictable for a single site. This treatment modality can be applied successfully in elderly patients and can be suggested for various prosthetic indications in both jaws.     

10‐Year Follow‐Up of Immediately Loaded Implants with TiUnite Porous Anodized Surface

Background: The immediate loading of implants with a porous anodized surface is a well‐described technique. Few data are however available on the long‐term outcomes. Purpose: The aim of this prospective study was to assess the 10‐year performance of TiUnite implants supporting fixed prostheses placed with an immediate loading approach in both postextractive and healed sites. Materials and Methods: All patients received a fixed provisional restoration supported by immediately loaded parallel design, self‐tapping implants with a porous anodized TiUnite surface, and an external‐hexagonal connection. Both healed and postextractive cases were included. Success and survival rate for restorations and implants, changes in marginal peri‐implant bone level, probing depth measurements, biological or technical complications, and any other adverse event were recorded at yearly follow‐up up to 10 years after surgery. Results: A total of 210 implants fulfilled the inclusion criteria and were consecutively placed in 59 patients. Forty‐seven (22.38%) implants were lost because of the recalled patient refused to attend the planned 10‐year follow‐up. Five over 210 (2.38%) implants were lost. At the final follow‐up, the accumulated mean marginal bone loss and probing depth were, respectively, 1.93 mm (SD 0.40) and 2.54 mm (SD 0.44) for the implants placed in healed sites (n = 84); 1.98 mm (SD 0.37) and 2.63 mm (SD 0.39) for the implants placed in postextractive sites (n = 74). The restorations examined achieved a cumulative 65.26% success rate and 97.96% survival rate. The implants placed in healed and postextractive sites, respectively, achieved a 98.05% and a 96.52% cumulative survival rate. Conclusions: Positive results in terms of bone maintenance in the long‐term perspective are to be expected using immediately loaded implants with a TiUnite porous anodized surface in both postextractive and healed sites when adequate levels of oral hygiene are kept.