Surgical procedures in partially edentulous patients with ITI implants

Today, partially edentulous patients represent the majority of patients seeking treatment with implant-supported prostheses. This chapter presents the specific aspects of the surgical handling of partially edentulous patients with either single-tooth gaps, extended edentulous spaces or distal extension situations. Due to differences in treatment objectives, a distinction is made between sites without esthetic priority (non-esthetic sites) and with esthetic priority (esthetic sites). In non-esthetic sites, the primary goal of the surgical therapy is to achieve a predictable hard and soft tissue integration of the implant to re-establish function with the implant-supported prosthesis. In esthetic sites, the goal of surgical therapy is to achieve successful tissue integration and to obtain esthetic soft tissue contours to re-establish both function and esthetics. Therefore, the surgeon must have a clear understanding of the specific needs in a given situation, and must master the necessary surgical techniques concerning a correct implant placement and a correct soft tissue handling to achieve the treatment objectives. In non-esthetic sites, a non-submerged approach is clearly preferred, thus avoiding a second-stage procedure for abutment connection. If a soft tissue correction is necessary to re-establish keratinized peri-implant mucosa, this is done at the time of implant placement with mucogingival surgery. In esthetic sites, a submerged implant placement is preferred to achieve esthetically pleasing soft tissue contours. If a soft tissue augmentation is necessary, this is done at the time of implant placement with connective tissue grafts. Thus, the second surgical procedure after 8-10 weeks of healing is reduced to a mucosaplasty like a punch biopsy, avoiding an open flap procedure. Based on favorable properties of the TPS surface, short implants (6 or 8 mm) and short healing periods of 3-4 months have been successfully utilized in partially edentulous patients in the last 14 years. The introduction of the SLA surface allows a further reduction of the healing period to 6 weeks of healing in all sites with normal bone density (class I-III). In summary, the ITI philosophy offers straightforward surgical concepts to predictably achieve the treatment objectives with the least demanding surgical protocol, reducing the related chairtime and costs for the patient and the clinician.     

A 7-year life table analysis from a prospective study on ITI implants with special emphasis on the use of short implants. Results from a private practice

This paper reports on a 7-year life table analysis on ITI titanium plasma-sprayed (TPS) and sandblasted and etched (SLA) implants placed in a private practice and loaded for at least 1 year. In 236 patients, 528 (264 TPS and 264 SLA) implants were placed, 351 (66.5%) implants rehabilitated the posterior region and 71.1% implants were < or =11 mm. In the posterior mandible and maxilla, the mean implant length was 9.90 and 9.74 mm respectively. Implant length was determined through standard radiographs only. Increase of the number of implants or reduction of the width or length of the rehabilitations was no specifically sought for the shorter implants. One hundred and twenty-two SLA implants were loaded within 63 days. All early loaded SLA implants resisted the applied 35 N cm without rotation or pain. Three implants failed, one early and two late failures, all were SLA implants placed in the mandible. Shorter implants did not fail more than longer ones. The cumulative success rate was 99.40%. The predictable use of short implants supporting single crowns and small fixed partial dentures of 2-4 units supported by two to three implants permitted (1) restricting the need for sophisticated and expensive presurgical procedures aimed to determine precisely the available bone height by computerized radiographic methods, (2) the placement of prosthetically driven restoration instead os surgically driven ones, (3) reducing the indications span for complex invasive procedures like sinus lift and bon grafting procedures, (4) facilitating the surgery, without attempting to place the longest implant and (5) avoiding the occurrence of sensation disturbance. The safe use of short implants in a private practice should make implant therapy simpler and accessible to a higher number of patients and practitioners.     

A long-term follow-up study of non-submerged ITI implants in the treatment of totally edentulous jaws. Part I: Ten-year life table analysis of a prospective multicenter study with 1286 implants

In this prospective multicenter study, non-submerged ITI implants were followed in order to evaluate their long-term prognosis in fully edentulous jaws. A total of 1286 implants were inserted in 233 consecutive patients and, after a healing period of three to six months, the successfully integrated implants were restored with 163 overdentures and 95 fixed full-arch bridges. This prospective study not only calculated the 10-year cumulative survival and success rates for the 1286 implants by life table analysis, but also evaluated the actual survival and success rates for 498 implants after at least five years of functional loading. In addition, cumulative success rates were calculated for implant subgroups according to implant length and location. Additional analyses were performed to evaluate the estimated and actual survival and success rates of the implants in relation to various prosthetic rehabilitation techniques. The 10-year cumulative survival and success rates were 95.9% and 92.7%, respectively. The actual 5-year survival and success rates of the first 498 implants that were inserted were 97.7% and 95.0%, respectively. The analysis of implant subgroups showed slightly more favourable cumulative success rates for 12 mm long implants (93%), in comparison to 10 mm and 8 mm long implants (91.6% and 89.6%, respectively). The cumulative success rate for mandibular implants (approximately 94%) was also more favourable than that for maxillary implants (approximately 91%). Patients who were loaded with both maxillary and mandibular prostheses maintained success rates well above 90%; while only implants that were inserted to support maxillary overdentures that were retained by Dolder bars showed a success rate below 90%.     

Clinical analysis of the soft tissue integration of non-submerged (ITI) and submerged (3i) implants: a prospective-controlled cohort study

Aim: The aim of this study was to compare the soft tissue integration of submerged and non‐submerged implants by means of periodontal parameter assessments and analysis. Material and methods: Thirty‐one patients, who received 42 non‐submerged implants (ITI) and 48 submerged implants (3i), participated in the study. There was no significant difference (P>0.05) between both groups considering gender; educational level; handedness; toothbrushing frequency; the number of auxiliary devices used; and smoking habits. The parameters assessed were gingival index (GI), plaque index (PII), retention index (RI), pocket probing depth (PPD) and keratinized mucosa index. Results: At evaluation, 66.67% of all sites showed a GI of 0; 72.22% a PI of 0, and 93.33% the absence of calculus. The average PPD was 2.56 mm in the non‐submerged and 2.70 mm in the submerged group. With regard to the width of keratinized mucosa, 100% of the ITI implants showed a band of keratinized gingiva around the implant, whereas 14.58% in the 3i group showed a complete absence of keratinized mucosa. The intra‐examiner reproducibility was 90.96% for all parameters and the Kendall tau‐b analysis showed a powerless correlation between the chosen parameters for both studied groups. Conclusions: The study material showed no major differences between submerged and non‐submerged dental implants regarding GI, PII, RI and PPD, except the width of keratinized mucosa. Regarding the presence of keratinized mucosa, there is a need for further longitudinal studies to elucidate a possible benefit of one implant system over the other.     

A five-year life-table analysis on wide neck ITI implants with prosthetic evaluation and radiographic analysis: results from a private practice

This paper reports a 5-year life-table analysis on wide neck (WN) ITI implants placed in a private practice. In 212 patients, 263 implants were placed in the posterior region; 97% rehabilitated the molar area. Implants in the mandible and in the maxilla were 61.2% and 38.8%, respectively; the mean implant length was 9.7 and 8.9 mm, respectively. Eighty-nine percent sites had both vestibular and buccal bone lamellae > or =1 mm, 9.1% had one of them <1 mm and 1.9% had both lamellae <1 mm. Sinus perforation during surgery occurred in 52% of the maxillary implants. Prosthetic information was available for 249 implants; implants were involved in 157 single crowns (SC) and 80 fixed partial dentures (FPD). Radiographic analysis was performed on 102 implants that reached the 2-year control, and crestal bone loss (CBL) was measured. Results showed that five implants failed; the 5-year cumulative survival rate was 97.89%. The 1-year survival rate based on 259 implants was 98.8% and the 2-year survival rate based on 174 implants was 97.7%. In this 5-year timeframe, 94.3% of the SCs and 96.2% of the FPDs were free of complication. The mean CBL at the mesial and distal sides was 0.71 and 0.60 mm, respectively; bone losses >1 and >2 mm were recorded for 29.7% and 2.5% of the sides, respectively. This mid-term study showed that the WN ITI implants were highly predictable in private practice and that prosthetic complication in the molar area was an infrequent event.     

Dental implants placement in conjunction with osteotome sinus floor elevation: a 12-year life-table analysis from a prospective study on 588 ITI implants

OBJECTIVES: The purpose of this prospective study was to evaluate the clinical success of placing ITI dental implants in the posterior maxilla using the osteotome technique. MATERIAL AND METHODS: All implants were placed following a one-stage protocol (elevating the sinus floor and placing the implant at the same time). Five hundred and eighty-eight implants were placed in 323 consecutive patients with a residual vertical height of bone under the sinus ranging from 6 to 9 mm. The mean observation follow-up period was 59.7 months (with a range of 12-144 months). This prospective study not only calculated the 12-year cumulative survival and success rates for 588 implants by life-table analysis but also the cumulative success rates for implant subgroups divided per implant length and the percentage of sinus membrane perforation were evaluated. RESULTS: The 12-year cumulative survival and success rates were 94.8% and 90.8%, respectively. The analysis of implant subgroups showed slightly more favourable cumulative success rates for 12 mm long implants (93.4%) compared with 10 and 8 mm long implants (90.5% and 88.9%, respectively). During the study period, only 13 perforations of the Schneiderian membrane were detected with a perforation rate of 2.2% (13 perforations/601 treated sites). Ten perforations out of 13 were caused during the first half of the study period and of these, seven were detected during the first 3 years of this prospective study. CONCLUSION: Based on the results and within the limits of the present study, it can be concluded that ITI implant placement in conjunction with osteotome sinus floor elevation represents a safe modality of treating the posterior maxilla in areas with reduced bone height subjacent to the sinus as survival and success rates were maintained above 90% for a mean observation period of approximately 60 months. Shorter implants (8 mm implants) did not significantly fail more than longer ones (10 and 12 mm implants): the differences were small compared with the number of events; hence, no statistical conclusion could be drawn. But, from the clinical point of view, the predictable use of short implants in conjunction with osteotome sinus floor elevation may reduce the indication for complex invasive procedures like sinus lift and bone grafting procedures.     

Surgical advantages with ITI TE implants placement in conjunction with split crest technique. 18-month results of an ongoing prospective study

Implant rehabilitation of the edentulous maxilla may be somewhat problematic because of anatomic situations involving insufficient bone thickness. One approach in this situation is localized ridge augmentation with the split crest technique. This surgical approach allows the external cortical plate of the maxilla to be moved in a labial direction to gain an increase in width to introduce implants of appropriate diameter. This ongoing prospective study evaluated: (i) the surgical advantages that the new ITI TE implants have showed compared with the ITI standard solid-screw implants when placed in conjunction with the split crest technique and (ii) the implant success rate associated with 42 ITI TE implants and 40 ITI standard solid-screw implants placed in 40 patients in conjunction with the split crest technique. ITI TE implants have shown direct and indirect advantages in reducing the risk of fracture of the labial cortical plate during all the three fundamental surgical steps of this technique: (a) the ridge expansion with osteotomes; (b) implant site preparation with drills and (c) implant insertion. The overall success rates of ITI TE implants and standard screw implants were 100% and 95%, respectively. Based on the preliminary results of the present study, it can be concluded that ITI TE implants inserted in conjunction with split crest technique seem to be a promising surgical procedure to treat selected anatomic situations involving insufficient maxillary bone thickness.     

Osteotome sinus floor elevation without grafting material: a 1-year prospective pilot study with ITI implants

OBJECTIVE: The aim of the present pilot study was to evaluate: (1) the predictability of an osteotome sinus floor elevation procedure with ITI-SLA implants without placing a bone grafting material, and (2) the possibility to gain bone height without filling the created space with a bone grafting material. MATERIAL AND METHODS: Seventeen patients received 25 implants protruding in the sinus. Most implants (21/25) were 10 mm long, eight were inserted in type 2 bone, 12 in type 3 and five in type 4 bone. At implant placement, the mean residual bone height (RBH) under the maxillary sinus was 5.4+/-2.3 mm; it was 5.7+/-2.6 mm on the mesial side and 5.1+/-1.9 mm on the distal side. Nineteen implants had less than 6 mm of bone on at least one side and six implants had less than 6 mm on both sides. A healing period of 3-4 months was allowed before abutment tightening at 35 Ncm. The percentage of stable implants at abutment tightening and at the 1-year control was calculated. The endo-sinus bone gain and the crestal bone loss (CBL) at the mesial and distal sides were measured. RESULTS: Abutments were tightened after 3.1+/-0.4 months. All implants but one (96%) resisted the applied 35 Ncm torque. At the 1-year control, all implants were clinically stable and supported the definitive prosthesis. All showed endo-sinus bone gain; the mean gain was 2.5+/-1.2 mm. The mean CBL was 1.2+/-0.7 mm. Endo-sinus bone gain and RBH showed a strong negative correlation (r=-0.78 on the mesial side and -0.80 on the distal side). A good correlation (r=0.73) was found between implant penetration in the sinus and endo-sinus bone gain. CONCLUSION: Elevation of the sinus membrane alone without addition of bone grafting material can lead to bone formation beyond the original limits of the sinus floor. Despite a limited RBH at implant placement, a healing period of 3 months was sufficient to resist a torque of 35 N cm and to lead to a predictable implant function at the 1-year control.     

Resonance frequency analysis of stability on ITI implants with osteotome sinus floor elevation technique without grafting: a 5-month prospective study

Objective: The aim of the present study was to (1) monitor the stability changes of ITI implants placed in atrophic posterior maxillary ridges with osteotome sinus floor elevation (OSFE) without grafting during the first 5 months of healing utilizing resonance frequency analysis (RFA) and (2) determine the factors that affect the implant stability quotient (ISQ) at placement and healings. Material and methods: Forty‐two ITI implants were placed in the posterior maxilla in 32 patients with OSFE without bone grafting. The residual vertical bone height ranged from 4 to 8 mm (average 6.36 mm). Bone type was classified into one to four groups according to the Lekholm and Zarb index. ISQ was tested on the day of surgery and consecutively at 2, 4, 6, 8, 12, 16, and 20 weeks by RFA. Results: The 40 osseointegrated implants represented a survival rate of 95.2%. All the 40 implants achieved good primary stability and reached a comparably high stability at 16 weeks postoperation with a dip between 2 and 6 weeks in the stability curve. There was no significant difference of ISQ between type3 and type4 bone at implant placement and follow‐up. The mean ISQ and its changing pattern did not demonstrate a statistically significant difference according to the pretreatment vertical bone height and implant length. Conclusions: The findings of this study indicated that uneventful osseointegration may be predictable applying OSFE alone with no grafting in atrophic posterior maxilla. Residual bone height (RBH), implant length, and bone type did not seem to affect the implant stability in this clinical situation.     

Complication rate with prosthodontic reconstructions on ITI and IMZ dental implants

The aim of this study was to compare the complication rate of two implant systems with diffcrcnt prosthodontic concepts: rigid conical or rcsilicnt support of the suprastructure. In 66 patients, 138 ITI implants were inserted whereas 31 patients received a total of 50 IMZ implants. Over an average observation period of 3.5 years (range from 0.5 to 8 years), not only was implant survival recorded, but also prosthodontic complications such as screw loosening, fractures of screws, inserts (intramobile elements, intramobile connectors) and abutments, as well as fractures of metal framework and veneers. With the ITI system, 28.8% of all devices placed exhibited such problems during the observation period. With the IMZ system, this rate was significantly higher ( P <0.05), in that 77.4% of all reconstructions required a repair at some point. The various complications were divided into those occurrences which affected only the suprastructure, i.e., failures of frame‐works, veneers, bar devices or other retentive elements, and those which involved implant components per se, such as screws and abutment components. In the first category, adverse effects occurred more frequently with ITI‐supported prostheses (15.1%) versus IMZ suprastructures (6.4%). Regarding complications with implant components, the rate with IMZ components was considerably higher (71%) compared with ITI (13.5%). This was mainly due to the presence of intramobile elements (IME) and connectors (IMC) in the IMZ system. In this retrospective study, precise fitting, non‐resilient abutment components leading to rigid connections of suprastructures, proved to be clinically more successful than resilient anchoring components.     

Long‐term evaluation of non‐submerged ITI implants. Part 1: 8‐year life table analysis of a prospective multi‐center study with 2359 implants.

In the present multi-center study. non-submerged ITI implants were prospectively followed to evaluate their long-term prognosis in fully and partially edentulous patients. In a total of 1003 patients, 2359 implants were consecutively inserted. Following a healing period of 3–6 months, the successfully integrated implants were restored with 393 removable and 758 fixed restorations. Subsequently, all consecutive implants were documented annually up to 8 years. At each examination, the clinical status of all implants was evaluated according to predefined criteria of success. Therefore, the data base allowed the evaluation of 8-year cumulative survival and success rates for 2359 implants. In addition, cumulative success rates were calculated for implant subgroups divided per implant type, implant length. and implant location. Furthermore, the actual 5-year survival and success rates could be determined for 488 implants. During the healing period, 13 implants did not successfully integrate, whereas 2346 implants fulfilled the predefined criteria of success. This corresponds with an early failure rate of 0.55%. During follow-up, 19 implants were classified as failures due to several reasons. In addition, 17 implants (= 0.8%) demonstrated at the last annual examination a suppurative periimplant infection. Including 127 drop out implants (= 5.4% drop out rate) into the calculation, the 8-year cumulative survival and success rates resulted in 96.7% and 93.3%, respectively. The analysis of implant subgroups showed slightly more favorable cumulative success rates for screw type implants (> 95%) compared to hollow-cylinder implants (91.3%). and clearly better success rates for mandibular implants (= 95%) when compared to maxillary implants (= 87%). The actual 5-year survival and success rates of 488 implants with 98.2% and 97.3%. respectively, were slightly better than the estimated 5-year cumulative survival and success rates of 2359 implants indicating that the applied life table analysis is a reliable statistical method to evaluate the long-term prognosis of dental implants. It can be concluded that non-submerged ITI implants maintain success rates well above 90% in different clinical centers for observation periods up to 8 years.     

Implant-supported fixed prostheses in the edentulous maxilla. A 2-year clinical and radiological follow-up of treatment with non-submerged ITI implants

OBJECTIVES: To evaluate the survival rate of non-submerged solid-screw ITI dental implants with a rough (titanium plasma sprayed, TPS) surface in the edentulous maxilla after 1 and 2 years of loading. MATERIAL AND METHOD: Twenty-five patients (mean age 64 years) with edentulous upper jaws received five-seven implants and, after a mean healing time of 6.9 months, screw-retained implant-supported fixed prostheses. A total of 146 ITI solid screw TPS implants were inserted. The diameter of 56% of the implants was smaller (3.3 mm) than the standard (4.1 mm) and the diameter of the rest (44%) was standard. The bone quantity of the majority of the patients was low and the bone quality poor. Clinical parameters were registered at baseline and at two annual follow-ups. Radiological examinations and assessments were also made at these times. RESULTS: Mean marginal bone level at baseline was measured at a point 4.52 mm (range 1.45-7.70, SD 1.2) apical of the reference point. Mean bone loss from baseline to 1 year of loading was 0.24 mm (SD 0.9, P=0.002) and from 1 year to 2 years of loading 0.15 mm (SD 0.4, P<0.001). Five implants failed, four of which were early failures prior to loading. One implant failed shortly after bridge installation. The cumulative survival rate was 96.6% after 1 and 2 years. CONCLUSION: ITI TPS solid-screw implants in combination with fixed prostheses had successful survival rates and were found to be a viable treatment alternative in the edentulous maxilla.     

Long-term clinical effectiveness of oral implants in the treatment of partial edentulism. Seven-year life table analysis of a prospective study with ITI dental implants system used for single-tooth restorations

One hundred and eight-seven ITI implants were prospectively followed from November 1992 to July 2000, in order to evaluate the clinical efficiency and the long-term prognosis in 109 partially edentulous patients (69 women and 40 men; average age 41.3 years). Of these 187 implants, 69.5% were placed in the mandible and 30.5% in the maxilla. After a healing period that ranged from three to six months, the osseointegrated implants (n = 184) were restored with single crowns. Three implants were extracted prior to loading the fixture and were considered early failures. Each implant was reassessed on a yearly basis, both clinically and radiographically. The results of the investigation, which were evaluated according to predefined success criteria, were reviewed in accordance with a life table method. During the follow-up, six cases were deemed to be late failures. In each of these cases, a suppurative infection of the peri-implant tissue was diagnosed: in one implant, the infection could not be eradicated and the implant was removed. When 11 drop-outs were included in the analysis, the cumulative survival and success rates for the whole sample group were 96.77% and 93.6%, respectively. When only prosthetically loaded implants were considered, the results increased to 99.35% for the cumulative survival rate and 96.18% for the cumulative success rate. The analysis on disaggregated data showed better results for maxillary restorations (survival rate 100%) in comparison to mandible restorations (survival rate 95.11%). It was concluded that, under standard anatomic conditions (bone site height > 8 mm, thickness > 6 mm), prosthetic restoration of partially edentulous patients with the ITI system can be described as a reliable and efficient therapy in the long term.     

Tissue integration of non‐submerged implants. l‐year results of a prospective study with 100 ITI hollow‐cylinder and hollow‐screw implants.

It has been postulated that the wound healing in a closed submerged location is one of the prerequisites for osseointegration of dental implants. The purpose of the present study was to evaluate the tissue integration of intentionally non-submerged titanium implants inserted by a one-stage surgical procedure. 100 ITI implants were consecutively placed in 70 partially edentulous patients. After a healing period free of masticatory loading for at least 3 months, the implants were examined. The clinical status showed for all implants neither detectable mobility nor signs of a peri-implant infection. Therefore, prosthetic abutments were inserted, and the patients were restored with fixed partial dentures. All patients were regularly recalled at 3-month intervals, and no patient dropped out of the study. Thus, all 100 implants were re-evaluated 12 months following implantation. Plaque- and sulcus bleeding indices, probing depth, clinical attachment level, width of keratinized mucosa, and periotest scores were assessed. In addition, standardized radiographs were analyzed for the presence of peri-implant radiolucencies and for the location of alveolar bone levels around the implants. Based on predefined criteria, the implants were classified as successful or failing. 98 implants were considered successful, and 1 implant failing. The remaining implant exhibited a peri-implant infection requiring local and systemic antimicrobial treatment. The results of this short-term study indicate that intentionally non-submerged ITI implants yield a high predictability for successful tissue integration.     

Oral rehabilitation using Camlog screw-cylinder implants with a particle-blasted and acid-etched microstructured surface. Results from a prospective study with special consideration of short implants

OBJECTIVES: The purpose of the present clinical study was to report on the clinical performance of screw-cylinder implants with special consideration of the survival rate of short implants. MATERIAL AND METHODS: In this prospective study with consecutive patient recruitment, Camlog screw-cylinder implants with a particle-blasted and acid-etched microstructured surface and a triple-cam tube-in-tube implant-abutment connection have been used only. Two groups of implants were evaluated: implants of 9 and 11 mm in length were considered short, those of 13 and 16 mm were considered long. Besides clinical and radiographic parameters, data of complications, patients' subjective evaluation of treatment outcome, general medical history and smoking habits were recorded. RESULTS: Three hundred and thirty-three Camlog screw-cylinder implants were inserted in 133 patients. One hundred and twenty-nine patients were available for follow-up, representing 325 implants. The median observation period was 33 months (Q(25%) 26; Q(75%) 38). After a maximum observation period of 55 months, the Kaplan-Meier-survival analysis revealed no significant difference between the mean survival probabilities of 98.3% (n=59, patient-related) of short implants, and of 95.7% of long implants (n=70, patient-related) (P=0.162). No significant difference was found between implant survival rates considering maxilla (98.7%) and mandible (98.2%). A stratified analysis of short implants revealed a significant influence of premature cover screw exposures (P=0.02) and smoking (P=0.008) on implant survival. These influences were not found significant for long implants. CONCLUSIONS: The prognosis of short Camlog implants is comparable with that of long implants. Therefore, their clinical use instead of performance of sophisticated vertical augmentation procedures before installation of long implants might be considered as alternative treatment option. In smokers, the use of short implants should be considered cautiously, however. The risk of premature cover screw exposure should be minimized.     

Study of the osseointegration of dental implants placed with an adapted surgical technique

Objective: To study the osseointegration of dental implants placed with a modified surgical technique in Beagle dogs and to compare it with the conventional method. Materials and methods: Dental implants were placed bilaterally in the mandible of Beagle dogs using the press‐fit as well as undersized implant bed preparation technique. Micro computer tomography (micro‐CT) and histometric methods were used to analyze the bone implant contact and bone volume (BV) around the implants. Results: The bone‐to‐implant contact percentage (BIC: expressed as %), first BIC (1st BIC: expressed in mm), sulcus depth (SD: expressed in mm) and connective tissue thickness (CT: expressed in mm) were analyzed for both groups. The BIC percentage was significantly higher for the undersized installed implants (P=0.0118). Also, a significant difference existed between the undersized and press‐fit installed implants for the first screw thread showing bone contact (P=0.0145). There were no significant differences in mucosal response (SD and CT) for both installation procedures. Also, no significant difference was found in the BV, as measured using micro‐CT, between the implants placed with an undersized technique (59.3±4.6) compared with the press‐fit implants (56.6±4.3). Conclusion: From the observations of the study, it can be concluded that an undersized implant bed can enhance the implant–bone response. To cite this article:
Al‐Marshood MM, Junker R, Al‐Rasheed A, Al Farraj Aldosari A, Jansen JA, Anil S. Study of the osseointegration of dental implants placed with an adapted surgical technique
Clin. Oral Impl. Res. 22 , 2011; 753–759
doi: 10.1111/j.1600‐0501.2010.02055.x     

The scientific basis for and clinical experiences with Straumann implants including the ITI Dental Implant System: a consensus report

Successful endosseous implant therapy requires integration of the implant with bone, soft connective tissue and epithelium. This report from a consensus conference on Straumann dental implants including the ITI Dental Implant System documents the interaction of these nonsubmerged one-piece implants with the oral tissues and reviews clinical studies supporting the high success achievable with these implants in patients. Light and electron microscopy reveal that epithelial structures similar to teeth are found around the implants. A connective tissue zone exists between the apical extension of the junctional epithelium and the alveolar bone. This connective tissue comprises a dense circular avascular zone of connective tissue fibers surrounded by a loose vascular connective tissue. The histologic dimensions of the epithelium and connective tissue comprising the biologic width are similar to the same tissues around teeth. The nonsubmerged one-piece design of the Straumann implants, which have been used for over 20 years, has set a standard in implant dentistry, with other implants now being manufactured and placed using similar techniques. Straumann implants have an endosseous portion that is either coated with a well-characterized and well-documented titanium plasma-sprayed surface or is sandblasted and acid attacked. Both surfaces have been shown to have advantages for osseous integration compared to machined and other smoother implant surfaces. These advantages include greater amounts of bone-to-implant contact, more rapid integration with bone tissue, and higher removal torque values. The lack of component connection at or below the alveolar crest provides additional benefits. Component connection at the alveolar crest, as seen with submerged implants, results in microbial contamination, crestal bone loss and a more apical epithelial location. Numerous human clinical trials document the successful use of Straumann implants in a variety of indications and areas of the mouth. These include prospective long-term trials using strict criteria of success and life table analyses. Taken together, the clinical studies reveal that Straumann implants can be used predictably in partially edentulous and completely edentulous maxilla and mandibles with high success rates. Furthermore, the animal and microscopic studies reviewed provide a scientific basis for the integration of Straumann implants with bone, connective tissue and epithelium.