Influence of Implant Connection Type on the Biomechanical Environment of Immediately Placed Implants – CT‐Based Nonlinear,Three‐Dimensional Finite Element Analysis

Purpose: The purpose of the present study was to evaluate the biomechanical environment of immediately placed implants, before and after osseointegration, by comparing three different implant‐abutment connection types. Materials and Methods: A computer tomography‐based finite element model of an upper central incisor extraction socket was constructed containing implants with either external hex, internal hex, or Morse‐taper connection. Frictional contact elements were used in the bone, implant, abutment, and abutment screw interfaces in the immediately placed simulations. In osseointegrated simulations, the repair of bone alveolar defect and a glued bone‐to‐implant interface were assumed. By analysis of variance, the influence was assessed of connection type, clinical situation, and loading magnitude on the peak equivalent strain in the bone, peak von Mises stress in the abutment screw, bone‐to‐implant relative displacement, and abutment gap. Results: The loading magnitudes had a significant contribution, regardless of the assessed variable. However, the critical clinical situation of an immediately placed implant itself was the main factor affecting the peak equivalent strain in the bone and bone‐to‐implant displacement. The largest influence of the connection type in this protocol was seen on the peak equivalent stress in the abutment screw. On the other hand, a higher influence of the various connection types on bone stress/strain could be noted in osseointegrated simulations. Conclusions: The implant‐abutment connection design did not significantly influence the biomechanical environment of immediately placed implants. Avoiding implant overloading and ensuring a sufficient initial intraosseous stability are the most relevant parameters for the promotion of a safe biomechanical environment in this protocol.     

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.     

Bone‐to‐Implant Contact Around Immediately Loaded Direct Laser Metal‐Forming Transitional Implants in Human Posterior Maxilla

Objective: Direct laser metal forming (DLMF) is a procedure in which a high‐power laser beam is directed onto a metal powder bed and programmed to fuse particles according to a computer‐aided design file, generating a thin metal layer. This histologic study evaluated the bone‐to‐implant contact (BIC%) around immediately loaded DLMF transitional implants retrieved after 2 months from posterior human maxillae. Methods: Twelve totally edentulous individuals (mean age, 66.14 ± 2.11 years) received DLMF transitional implants divided in twelve immediately loaded (IL) and twelve unloaded (UI) implants. These transitional implants were placed between conventional implants to support the interim complete maxillary denture during the healing period. After 8 weeks, the transitional implants and the surrounding tissue were removed and prepared for histomorphometric analysis. Results: Mature woven preexisting bone lined by newly formed bone in early stages of maturation were found around all retrieved implants. Histometric evaluation indicated that the mean BIC% was 45.20 ± 7.68% and 34.10 ± 7.85% for IL and UI, respectively (P <0.05). Conclusion: The present data obtained in humans showed that, although both IL and UI presented good BIC%, IL DLMF implants had a higher BIC% in the posterior maxilla.     

Immediate Postextractive Dental Implant Placement with Immediate Loading on Four Implants for Mandibular‐Full‐Arch Rehabilitation: A Retrospective Analysis

Background: To date, only few studies have reported on the clinical outcomes of immediate postextraction implant placement and immediate loading. Purpose: The purpose of this retrospective study was to report the results of immediately loading four implants placed in fresh extraction sockets in the mandible after a follow‐up of 24 months. Materials and Methods: Between January 2001 and January 2009, 50 patients (28 women and 22 men, average age 54 years), had 347 teeth extracted and a total of 200 dental implants placed in the mandible. The patients received a provisional fixed bridge the same day and a permanent one 3 months later. Clinical checkups were performed after 1, 2, 3, 6, 12, and 24 months. Marginal bone measurements were made in intraoral radiographs taken 1 day after surgery and after 1 year. A questionnaire was used to evaluate self‐perceived factors related to comfort, aesthetics, and function. Results: All bridges were stable and no implant failures were recorded during the follow‐up, giving a survival rate of 100%, at 2 years. The marginal bone loss amounted to 1.33 ± 0.36 mm after 1 year and 1.48 ± 0.39 mm after 2 years. Ten patients showed prosthetic complications with the provisional bridge, but all the definitive prostheses remained stable throughout the study period without any complications. The patients reported satisfaction with the treatment. Conclusions: The present retrospective study showed that immediate loading of four implants immediately placed in extraction sockets is a valid treatment modality for the totally edentulous mandible.     

Immediate Loading of Tapered Implants Placed in Postextraction Sockets: Retrospective Analysis of the 5‐Year Clinical Outcome

Introduction: The use of immediate implant loading protocols delivers obvious benefits to the patient. When applied in healed sites, this has not only been well documented in the totally edentolous mandible but has also been documented and reported to be predictable in the upper jaw, and in cases of partial edentoulism, as well. A further application of immediate loading protocol, although still controversial, especially when replacing single maxillary teeth in the anterior zone, is the immediate implant placement and provisionalization in postextractive sockets. In consideration of the oxidized surface promoting bone healing and the tapered shape of the implant body, the Replace Select Tapered TiUnite implants have been used for many years in our clinic when facing these clinical situations. This article will report about our long‐term clinical experience with such implants and the relevant role of a correct surgical and prosthetic treatment planning. Purpose: The aim of this retrospective study was to report on the 5‐year clinical and radiologic outcome of patients treated with Replace Select Tapered TiUnite implants when used according to an immediate loading protocol in postextraction sites. Method and Materials: In routine practice, 56 consecutive patients were treated with 79 implants. The patients, 23 males and 33 females, had a mean age of 50.9 years, range 21–76 years, at implant placement. Forty‐seven implants were placed in the maxilla and 32 implants were placed in the mandible. All implants were placed in postextraction sites and were immediately loaded. Provisional restorations were delivered within 2 hours from surgery and all were in occlusion. Forty‐three patients received a single implant while in the remaining 13 patients the implants were splinted. Definitive prosthetic restoration was delivered within 1 to 4 months following implant placement. Evaluations of soft tissue health and marginal bone remodeling were conducted. An independent radiologist performed the radiographic evaluation using the top of the implant as the reference point with negative values indicating a level below the reference point. Results: Forty‐eight patients, accounting for 66 implants, have passed the 5‐year follow‐up. No implants have failed resulting in a 5‐year cumulative implant survival rate of 100%. Three patients, with six implants, withdrew during the course of the follow‐up; one patient passed away and two patients moved. Five patients with seven implants did not show up at 5 years recall. At the 5‐year follow‐up, majority of the implants that were followed demonstrated normal periimplant mucosa and no visible plaque. The mean bone level at 5‐year follow‐up was ?2.45 mm (SD 1.29, n = 63) demonstrating a level in line with the first thread. Mean marginal bone loss from implant inserting to 5 years was 0.56 mm (SD 1.98, n = 63). In regard with complications, a fracture of the ceramic crown was reported 5 years after implant insertion in a patient who developed bruxism. No other biologic nor mechanical complications were reported. Conclusion: This retrospective 5‐year follow‐up study of 56 patients treated with implants immediately placed in postextraction sockets and immediately loaded demonstrates good treatment outcome with regard to implant survival, soft tissue condition, and marginal bone response.     

Immediate Occlusal Loading of NanoTite™ Tapered Implants: A Prospective 1‐Year Clinical and Radiographic Study

Background: During the last decade, high success rates have been reported for implants placed with immediate loading procedures, especially when bone quality and quantity provide good implant stability. In many of these studies, straight‐walled implants with moderately rough surfaces were employed. Tapered implants are becoming increasingly more popular due to standardized drilling protocols and reports of high initial primary stability. Purpose: The aim of the present prospective, single center clinical study was to evaluate surface topographical analysis and the clinical and radiographic outcomes of the NanoTite? (BIOMET 3i, Palm Beach Gardens, FL, USA) Tapered Implant when used for immediate loading of fixed prostheses and single‐tooth restorations. Materials and Methods: Forty‐two patients who needed implant treatment and met admission criteria agreed to participate in the study and were consecutively enrolled. Surgical implant placement requirements consisted of a final torque of a least 30 Ncm prior to final seating and an implant stability quotient above 55. A total of 139 NanoTite Tapered implants (112 maxillary and 27 mandibular) were placed by one investigator, and the majority of these implants (n = 77/55%) were placed in posterior regions, and in soft bone (n = 90/65%). A total of 57 prosthetic constructions were evaluated consisting of 20 single‐tooth restorations, 30 fixed partial dentures, and 7 complete, fixed maxillary restorations. Radiographs were taken at baseline and at 12 months of follow‐up. Results: Of the 139 study implants, one implant failure was declared. The overall cumulative survival rate at 1 year is 99.4%. Mean marginal bone resorption is 1.01 mm (SD 0.85) during the first year of function. Conclusion: Although limited to the short follow‐up, immediate loading of NanoTite Tapered implants seems to be a viable option in implant rehabilitation, when insertion torque of at least 30 Ncm is achieved. Further studies are needed to authenticate the finding of this study.