临时种植体即刻负载在半颌即刻种植中的应用

目的：评价临时种植体即刻负载在半颌即刻种植中的应用效果。方法：20例半颌即刻种植患者行136枚即刻种植体植入,采用95枚临时种植体即刻负载恢复患者牙列。3-6月后行固定修复。结果：即刻负载临时种植体和即刻种植体成功率达100%。结论：临时种植体即刻负载半颌即刻种植是很好的临床方法。     

Fixed Implant‐Retained Rehabilitation of the Edentulous Maxilla: 11‐Year Results of a Prospective Study

Objectives: The aim of the present study was to assess long‐term survival and success rates of implants in the edentulous maxilla restored with an implant‐supported fixed prosthesis. Materials and Methods: Seventeen edentulous patients received six to eight implants and implant‐supported fixed prostheses by one surgeon. Yearly recalls were conducted by two examiners over a period of 11 years. Survival and success rates (biological complications) were determined; marginal bone loss was examined radiographically. Furthermore, microbiological tests as well as test for interleukin‐1 composite genotype were assessed and potential risk factors were evaluated. Results: After a mean time of 11.26 years, 15 patients of 17 could be reexamined. Out of 94 implants, three were lost in one patient. Mean marginal bone loss reached 0.88 mm, two patients (at seven implants) showed bone loss of ≥3.2 mm. Survival rate of implants reached 96.8%. Success rates on implant level hit 92.6% according to the criteria of Albrektsson and colleagues and 83.0% in accordance with Karoussis and colleagues. One prosthesis had to be renewed. Conclusion: Within the limitation of this study, restoration of the edentulous maxilla with an implant‐supported fixed prosthesis represents an effective tool for rehabilitation over a period of 11 years.     

Immediate loading of implants in the edentulous maxilla

The overall aim of this thesis was to investigate different therapeutic strategies in treatment of the edentulous maxilla with dental implants and their importance for treatment outcome. The introduction of one-stage surgery, in place of two-stage surgery, was a paradigm shift in the area of implant treatment since submerged implant healing underneath the mucosa was considered a prerequisite for healing in the original concept. The advantages of a one-stage method are that a second surgery is unnecessary, costs are lower, and patients complain less about the surgical procedures. The development of implant treatment, regardless of whether it is performed in the mandible or the maxilla, strives to shorten the period from implant placement to implant loading. For the edentulous patient--due to esthetic, economical, or psychological reasons--shortening this time and thus avoiding a long period of wearing a transitional removable prosthesis is advantageous. Use of conventional one-stage surgery makes possible and is a prerequisite for immediate loading of implants. Successful treatment outcome has been demonstrated for immediate loading of implants in the mandible, but documentation of the method in the maxilla is still sparse. Two prospective clinical studies compared (i) one- and two-stage surgery and (ii) immediate and conventional loading in patients consecutively treated in the edentulous maxilla with implant-supported fixed prostheses. The first study found that the cumulative survival rate (CSR) after one-stage surgery performed according to a conventional protocol was consistent with two-stage protocol CSRs reported in previous studies. The second study evaluated an immediate loading protocol that provided patients with interim fixed prostheses within 24 hours after implant placement. A comparison of the studies found no significant difference in CSRs. But it was found that when a conventional protocol was used, transitional removable prostheses could traumatize the bone-implant interface during healing by adverse loading on the implants, which pierced the mucosa. Moreover, splinting the implants immediately after surgery with an interim fixed prosthesis might protect them from adverse loading. In a finite element analysis comparing uncoupled and splinted implants--imitations of the clinical situations in the two studies--splinted implants drastically reduced stresses in the bone tissue surrounding the implant, which might facilitate bone healing. Two factors considered important for a successful treatment outcome, especially when loading implants immediately, are (i) jawbone quality and (ii) primary implant stability at placement. In implant literature, bone quality is generally equivalent to bone density. Results of the third clinical study in this thesis indicate that use of computed tomography with calculations of bone mineral density can be a useful tool in bone tissue evaluation before implant placement. After 1 year of loading, changes in marginal bone level, compared to baseline, did not differ between implants that were stable and implants that were not stable at placement. The results of this thesis do not strengthen earlier recommendations that immediate and early loading is a treatment alternative that can be considered only in jaws with good bone quality. In conclusion, immediate loading with interim fixed prostheses in the edentulous maxilla is a viable treatment alternative. Splinting of implants seems to be important in immediate loading, especially when bone density is low.     

“All-on-4”种植即刻修复技术的临床应用研究

目的：评价应用＂All-on-4＂种植即刻修复技术对牙列缺失患者进行种植即刻修复的临床效果,探讨其技术要点及临床意义。方法：2008年4月至2009年11月共29例患者（男15例,女14例）接受了＂All-on-4＂种植即刻修复。29例（上无牙颌8例,下无牙颌15例,双颌无牙颌6例）共植入140枚种植体,在种植体植入当天完成即刻修复,一共完成35件＂All-on-4＂即刻义齿。即刻修复后观察种植体边缘骨吸收情况、追踪种植体和即刻修复体的存留率、患者满意率。平均追踪14.8个月（10～29个月）。结果：140枚种植体中,8枚于植入后6～8周脱落。其余132枚种植体至最后一次复查临床稳定,种植体存留率：94.3%。上颌种植体存留率89.3%,下颌种植体存留率97.8%,存在统计学差异（p〈0.05）。即刻修复义齿的存留率94%（33/35）。边缘骨吸收程度为（0.8±0.4）mm。患者满意率100%。结论：＂All-on-4＂种植即刻修复技术应用于无牙颌患者近期效果好,患者满意度高。远期效果需要进一步观察。     

Prospective clinical evaluation of 1920 Morse taper connection implants: results after 4 years of functional loading

Purpose: This study evaluated the survival rate and the clinical, radiographic and prosthetic success of 1920 Morse taper connection implants.
Material and methods: One thousand nine hundred and twenty Morse taper connection implants were inserted in 689 consecutive patients, from January 2003 until December 2006. Implants were clinically and radiographically evaluated at 12, 24, 36 and 48 months after insertion (mean follow-up per implant: 25.42 months). Modified plaque index (mPI), modified sulcus bleeding index, probing depth (PD) and the distance between implant shoulder and first crestal bone–implant contact (DIB) were measured in mm. Success criteria included the absence of suppuration and clinically detectable implant mobility, PD<5 mm, DIB<1.5 mm after 12 months of functional loading and not exceeding 0.2 mm for each following year, the absence of recurrent prosthetic complications at the implant–abutment interface. Prosthetic restorations were fixed partial prostheses (364 units), single crowns (SCs: 307 units), fixed full-arch prostheses (53 units) and overdentures (67 units).
Results: The overall cumulative implant survival rate was 97.56% (96.12% in the maxilla and 98.91% in the mandible). The cumulative implant success rate was 96.61% (95.25% in the maxilla and 98.64% in the mandible). Only a few prosthetic complications were reported (0.65% of loosening at implant–abutment interface in SCs).
Conclusion: The use of Morse taper connection implants represents a successful procedure for the rehabilitation of partially and completely edentulous arches. The absence of an implant–abutment interface (microgap) is associated with minimal crestal bone loss. The high mechanical stability significantly reduces prosthetic complications.     

Full-arch restoration of the jaw with fixed ceramo-metal prosthesis: late implant placement

BACKGROUND: The completely edentulous patient has few treatment options in conventional dentistry. When implants are considered, treatment plans range from a 2-implant overdenture to a completely implant-supported prosthesis. Fixed prosthesis is often the preferred selection of the edentulous patient. This study assesses the 5-year cumulative survival rate of implants placed to support full-arch fixed restoration. METHODS: During 1990 to 1995, 171 implants were placed in 22 completely edentulous jaws of 20 patients. All patients were discharged wearing immediate dentures. The implants were analyzed as to the number of implants per jaw, implant location, length, and diameter. RESULTS: The 5-year cumulative survival rate was 89.9%. The mean number of implants per jaw was 7.7 for the maxilla and 8 for the mandible. In the maxilla, the preferred implant locations were the canines, centrals, laterals, and first premolars; in the mandible, they were the canines, laterals, and first molars. The mean implant length was 14.2 mm for the mandible and 13.2 mm for the maxilla. The mean implant diameter was 3.6 mm for the maxilla and 3.8 for the mandible. CONCLUSIONS: The results of the present study indicate that fixed full-arch ceramo-metal restorations can be a predictable implant treatment modality for the edentulous patient.     

Immediate loading of four or six implants in completely edentulous patients

In this retrospective study, 44 patients received screw-retained full-arch acrylic resin provisional prostheses connected on 4 or 6 implants in the mandible or maxilla, respectively. With a mean follow-up of 17.6 months, 3 of 205 implants were lost and replaced successfully. Cosmetic fractures were shown in six patients; one abutment loosening, one abutment fracture, and one implant fracture were also observed. Prosthetic fracture was shown in one patient. Marginal bone loss reached two to five threads on 13 implants (6.4%). The results confirmed that immediate loading of 4 mandibular or 6 maxillary implants with an acrylic resin prosthesis for full-arch rehabilitation is a reliable technique in the short- and midterm.     

Immediately loaded implants supporting fixed prostheses in the edentulous maxilla: a preliminary clinical and radiologic report

PURPOSE: To evaluate the survival rate of immediately loaded ITI sand-blasted, large-grit, acid-etched (SLA) solid-screw dental implants in the edentulous maxilla after 8 months of loading. MATERIALS AND METHODS: Twenty-eight patients (mean age 63 years) with edentulous maxillae each received 6 implants and 1 implant-supported fixed provisional prosthesis within 24 hours after surgery. After a mean healing time of 15 weeks, the patient received a definitive, screw-retained, implant-supported fixed prosthesis. A total of 168 implants were placed. Clinical parameters were registered after 1 month of loading with the implant-supported fixed prostheses as well as 8 months after implant placement. Radiologic examinations and assessments were made at implant placement and after 8 months. RESULTS: The mean marginal bone level at implant placement was 1.6 mm (range 0 to 5.1; SD 1.1) apical of the reference point (the implant shoulder). The mean marginal bone level at the 8-month follow-up was 3.2 mm (range 0.4 to 5.9; SD 1.1) apical of the reference point. Three implants failed during the healing period. DISCUSSION: The improved results in the present study might be a result of the positive effect of splinting the implants immediately after placement. CONCLUSION: ITI SLA solid-screw implants immediately loaded (ie, loaded within 24 hours of placement) and supporting fixed prostheses had successful survival rates after 8 months. The present results constitute a solid baseline for future follow-up studies.     

Immediate rehabilitation of the completely edentulous jaw with fixed prostheses supported by either upright or tilted implants: a multicenter clinical study

PURPOSE: The aims of this study were to assess the treatment outcome of immediately loaded full-arch screw-retained prostheses with distal extensions supported by both upright and tilted implants for the rehabilitation of edentulous jaws and to compare the outcomes of upright versus tilted implants. MATERIALS AND METHODS: At 4 study centers, 342 Osseotite NT implants were consecutively placed in 65 patients (96 implants were placed in 24 mandibles and 246 implants in 41 maxillae). The 2 distal implants were tilted by 25 to 35 degrees. Provisional full-arch restorations made of a titanium framework and acrylic resin teeth were delivered within 48 hours of surgery and immediately loaded. The final prosthesis was delivered after 3 months of healing. RESULTS: Three implants failed during the first year and another 2 within 18 months of loading in the maxilla. The cumulative implant survival rate for the maxilla was 97.59% for up to 40 months of follow-up. No implant failure was recorded for the mandible. The prosthetic success rate was 100%. Marginal bone loss around upright and tilted implants was similar. Patients were satisfied of their esthetics, phonetics, and function. CONCLUSION: The preliminary results of this study suggest that immediate rehabilitation of the edentulous maxilla and mandible by a hybrid prosthesis supported by 6 or 4 implants, respectively, may represent a viable treatment alternative with respect to more demanding surgical procedures. The clinical results indicate that immediately loaded tilted implants may achieve the same outcome as upright implants in both jaws.     

Immediate occlusal loading of double acid-etched surface titanium implants in 41 consecutive full-arch cases in the mandible and maxilla: 6- to 74-month results

BACKGROUND: The high success rate of dental implants has changed the quality of life for many patients. Immediate loading finds its application in some clinical cases and certainly adds another modality of treatment for the implant patient. Starting with a few implants immediately loaded with a bar overdenture in the mandible, the concept of immediate loading evolved to loading multiple implants in both the maxilla and mandible. METHODS: In this investigation, 41 consecutive patients who needed full-arch restorations were treated with 343 double acid-etched surface implants between May 1998 and March 2004. The sample included smokers and bruxers. Twenty-three mandibular and 26 maxillary cases were treated, loading the implants within 48 hours, by using resin provisional prostheses, metal-reinforced provisional prostheses, or definitive prostheses (metal-acrylic or metal-ceramic). All implants were followed for 12 to 74 months. Follow-up consisted of clinical as well as radiographic examination. Furthermore, resonance frequency analysis was done in most of the implants during the last 2 years. RESULTS: The success rate obtained was 99.42% (only two mandibular implants that are still surviving were considered failures). The bone level was measured every year. The average radiographic bone level change was 0.56 mm at 12, 0.76 mm at 24, 0.84 mm at 36, 0.82 mm at 48, 0.83 mm at 60, and 0.94 mm at 72 months. CONCLUSION: A high success rate can be achieved when double acid-etched surface implants are immediately loaded with fixed full-arch restorations in the maxilla and mandible.     

Long-term marginal periimplant bone loss in edentulous patients

PURPOSE: The aim of this study was to examine the long-term periimplant bone loss in patients treated with implant-supported fixed prostheses in both jaws. MATERIALS AND METHODS: The participants comprised 44 edentulous patients who have been followed for a 15-year period after treatment with a fixed implant-supported prosthesis in the mandible. Thirteen of them also received an implant-supported fixed prosthesis in the maxilla, on average 4.5 years after the mandibular treatment. The periimplant bone level was measured on intraoral radiographs. RESULTS: The long-term results of the implant treatment were successful, and only 1% (3/273) of the implants were lost in the mandible and 7% (5/75) in the maxilla. All but one of the failures occurred before the connection of the prostheses. The mean marginal bone loss around the implants was small (less than 1 mm for a 10-year period after implant placement), and was of similar magnitude in both jaws. However, the individual variation was relatively great. There was no significant difference in marginal bone loss between those who had a maxillary complete denture during the entire observation period and those who had received a fixed implant-supported maxillary prosthesis. Smokers lost more periimplant bone than did the nonsmokers; the difference was significant in the mandible but small and nonsignificant in the maxilla. CONCLUSION: The long-term periimplant bone loss was small and of similar magnitude in the mandible and the maxilla in subjects who had received implant-supported fixed prostheses in both jaws. The prosthetic status in the maxilla, i.e., complete denture or fixed implant-supported prosthesis, had no significant influence on the mandibular periimplant bone loss.     

Immediate versus delayed loading of dental implants in edentulous maxillae: a 36-month prospective study

Purpose: The aim of this study was to compare survival rates and radiographic outcomes of immediate and delayed implant loading in edentulous maxillae. Materials and Methods: Forty-nine patients in need of maxillary full-arch treatment were randomized into two groups: test group (n = 34) treated following the Columbus Bridge Protocol with 4 to 6 implants loaded within 24 hours and a control group (n = 15) treated following the ad modum Branemark protocol with 6 to 9 implants loaded a mean 8.75 months after surgery. Two hundred sixty implants (test: n = 163, control: n = 97) were placed, and subjects were treated with screw-retained full-arch prostheses. Bone levels were measured at baseline and at 1, 2, and 3 years and analyzed using repeated-measures analysis of variance. Results: All patients appeared at all scheduled recall visits. No differences in cumulative survival rates were found between groups at 36 months. Ten implants (6.1%) failed in the test group; four (4.1%) failed in the control group. At 36 months, no prosthetic failures were detected. Significantly less bone loss was found in the test group at all time intervals (P < .001). The average bone level from the implant-abutment connection was 1.3 mm in the test group and 1.9 mm in the control group at 12 months, 1.5 mm and 2.2 mm at 24 months, and 1.6 mm and 2.3 mm at 36 months, respectively. Conclusion: In the edentulous maxilla, the Columbus Bridge Protocol involving immediate loading of implants placed in both healed and fresh extraction sites exhibited equivalent implant survival and less marginal bone loss at 3 years compared to the conventional two-stage delayed loading protocol. Int J Prosthodont 2011;24:294-302.     

Prospective Evaluation of 2,549 Morse Taper Connection Implants: 1‐ to 6‐Year Data

Background: The aim of this study is to evaluate the implant survival, the implant–crown success, and the prosthetic complications of 2,549 Morse taper interference–fit connection implants. Methods: A total of 2,549 Morse taper connection implants were inserted in 893 patients from January 2003 until December 2008. At each annual recall, clinical, radiographic, and prosthetic parameters were assessed. The implant–crown success criteria included the absence of pain, suppuration, and clinical mobility; an average distance between the implant shoulder and the first visible bone contact <2 mm from initial surgery; and the absence of prosthetic complications at the implant–abutment interface. Prosthetic restorations were fixed partial prostheses (462 units); fixed full‐arch prostheses (60 units); single crowns (531 units); and overdentures (93 units). Results: The cumulative implant survival rate was 98.23% (97.25% maxilla, 99.05% mandible). The implant–crown success was 92.49%. A few prosthetic complications at implant–abutment interface were reported (0.37%). After 6 years, distance between the implant shoulder and the first visible bone contact was 1.10 mm (± 0.30 mm). Conclusion: The use of Morse taper connection implants represents a successful procedure for the rehabilitation of partially and completely edentulous arches.     

Single-blind randomized clinical trial to evaluate clinical and radiological outcomes after one year of immediate versus delayed implant placement supporting full-arch prostheses

Purpose: To evaluate and compare peri-implant health, marginal bone loss and success of immediate and delayed implant placement for rehabilitation with full-arch fixed prostheses. Material and Methods: The present study was a prospective, randomized, single-blind, clinical preliminary trial. Patients were randomized into two treatment groups. In Group A implants were placed immediately post-extraction and in Group B six months after extraction. The following control time-points were established: one week, six months and twelve months after loading. Measurements were taken of peri-implant crevicular fluid volume, plaque index, gingival retraction, keratinized mucosa, probing depth, modified gingival index and presence of mucositis. Implant success rates were evaluated for the two groups. The study sample included fifteen patients (nine women and six men) with a mean average age of 63.7 years. One hundred and forty-four implants were placed: 76 placed in healed sites and 68 placed immediately. Results: At the moment of prosthetic loading, keratinized mucosa width and probing depth were higher in immediate implants than delayed implants, with statistically significant differences. However, after six and twelve months, differences between groups had disappeared. Bone loss was 0.54 ± 0.39 mm for immediate implants and 0.66 ± 0.25 mm for delayed implants (p=0.201). No implants failed in either group. Conclusions: The present study with a short follow-up and a small sample yielded no statistically significant differences in implant success and peri-implant marginal bone loss between immediate and delayed implants with fixed full-arch prostheses. Peri-implant health showed no statistically significant differences for any of the studied parameters (crevicular fluid volume, plaque index, gingival retraction, keratinized mucosa, probing depth, modified gingival index and presence of mucositis) at the twelve-month follow-up. Key words:Immediate implants, delayed implants, peri-implant health, success rate.     

Immediate rehabilitation of the edentulous jaws with full fixed prostheses supported by four implants: interim results of a single cohort prospective study

Objectives: The purpose of this study was to prospectively evaluate the clinical and radiographic outcomes of immediately loaded full‐arch fixed prostheses supported by a combination of axially and non‐axially positioned implants in a large cohort of patients with completely edentulous jaws, up to 5 years of function. Materials and methods: One hundred and seventy‐three edentulous patients (80 males and 93 females) were enrolled according to specific selection criteria. Each patient received a full‐arch fixed prosthesis supported by two distal tilted implants and two anterior axially placed implants. The provisional functional acrylic prosthesis was delivered the same day as surgery in all cases. All cases were finalized 4–6 months later. The patients were scheduled for follow‐up at 6 and 12 months of function, and annually up to 5 years. At each follow‐up plaque and bleeding score was assessed and radiographic evaluation of marginal bone level was performed. Results: The overall follow‐up range was 4–59 months. A total of 154 immediately loaded prostheses (61 in the maxilla and 93 in the mandible) were in function for at least 1 year and were considered for the analysis. Four axially placed implants failed in the maxilla and one tilted implant in the mandible, all within 6 months of loading. No further implant failure occurred to date. Implant survival at 1 year was 98.36% and 99.73% for the maxilla and the mandible, respectively. Marginal bone loss at 1 year averaged 0.9±0.7 mm in the maxilla (204 implants) and 1.2±0.9 mm in the mandible (292 implants). No difference was found in marginal bone loss between axial and tilted implants. Plaque and bleeding scores progressively improved from 6 to 12 months. Fracture of the acrylic prosthesis occurred in 14% of total cases. Conclusions: The present preliminary results from a relatively large sample size suggest that the present technique can be considered a viable treatment option for the immediate rehabilitation of both mandible and maxilla. To cite this article:
Agliardi E, Panigatti S, Clericò M, Villa C, Malò P. Immediate rehabilitation of the edentulous jaws with full fixed prostheses supported by four implants: interim results of a single cohort prospective study.
Clin. Oral Impl. Res. 21 , 2010; 459–465.
doi: 10.1111/j.1600‐0501.2009.01852.x     

Tooth- and implant-supported prostheses: a retrospective clinical follow-up up to 8 years

PURPOSE: The purpose of this study was to evaluate clinical treatment outcome of fixed prostheses in different sizes and with combinations of different numbers of teeth and implants as abutments. MATERIALS AND METHODS: A total of 115 implants were placed in 36 patients, 75 (65%) in the maxilla and 40 (35%) in the mandible. The implants were connected to 85 abutment teeth, 50 in the maxilla and 35 in the mandible. Of the prosthetic restorations, 19 were gold ceramic, 17 were gold acrylic, three were titanium acrylic, one was titanium ceramic, and one was titanium composite. The observation period ranged from 14 months to 8.9 years. The treatments comprised both fixed partial dentures supported by one tooth and one implant as well as complete-arch fixed prostheses supported by a number of teeth and implants. RESULTS: A total of nine implants were lost, three during healing and six after loading. The postloading cumulative implant survival rate was 89.8% after 5 years. Five abutment teeth were lost, and of the 41 prostheses included in the study, only two (5%) were lost during the observation period. Marginal bone loss was registered around 46 implants at the 1-year follow-up examination. During the following observation period, only slight changes in the marginal bone level adjacent to the implants and teeth were registered. The magnitude of technical complications was low. CONCLUSION: This investigation confirms the findings in similar studies that treatments with periodontally healthy teeth and implants splinted together in rigid one-piece superstructures show excellent long-term follow-up results.     

Implants with an Oxidized Surface Placed Predominately in Soft Bone Quality and Subjected to Immediate Occlusal Loading: Results from a 7‐Year Clinical Follow‐Up

Purpose: The purpose of this clinical follow‐up was to document the 7‐year outcome of immediately loaded implants exhibiting an oxidized surface. Material and Methods: Thirty‐eight patients received a total of 51 implant‐supported fixed prostheses. The restorations were supported by 102 implants, the majority of which were placed in posterior regions (88%) and primarily in soft bone quality (76%). Radiographic examinations were performed at prosthesis insertion, at 1‐ and 6‐month follow‐ups, and annually at the 1‐ through 5‐year follow‐up visits. Marginal peri‐implant soft tissue evaluations were conducted at all these follow‐ups. This report presents the results after at least 7 years of loading. Results: After 7 years of prosthetic loading, the cumulative implant survival rate was 97.1% and the mean marginal bone remodeling was ?1.51 mm (SD 1.00, n = 73) with significantly more initial remodeling at sites having received marginal guided bone regeneration procedures. A low rate of biological and technical complications was detected after 7 years of function. The quantification of intrasulcular plaque sampling showed no significant difference between teeth and implants. Conclusion: The 7‐year follow‐up data indicate that the introduced immediate loading protocol is a successful treatment alternative also including regions exhibiting soft bone conditions.     

A longitudinal study of the survival of All-on-4 implants in the mandible with up to 10 years of follow-up

BackgroundImmediate-function implants have become an accepted alternative for fixed restoration protocols in edentulous mandibles on the basis of documented high success rates. The All-on-4 concept (Nobel Biocare, Göteborg, Sweden), a surgical and prosthetic protocol for immediate function involving the use of four implants to support a fixed prosthesis in patients with completely edentulous mandibles, represents one of these protocols. The authors conducted a study to document long-term follow-up of the All-on-4 concept.MethodsThis longitudinal study included 245 patients with a total of 980 immediate-function implants (four per patient), all placed in the anterior region, to support fixed full-arch mandibular prostheses. The inclusion criterion was having an edentulous mandible, or a mandible with hopeless teeth, in need of fixed implant restorations.ResultsA total of 21 implants failed in 13 patients, giving cumulative patient-related and implant-related success rates of 94.8 percent and 98.1 percent, respectively, at five years, and 93.8 percent and 94.8 percent, respectively, with up to 10 years of follow-up. The prostheses’ survival rate was 99.2 percent with up to 10 years of follow up.ConclusionsThe results support the conclusion that use of the All-on-4 immediate-function implant concept in completely edentulous mandibles is viable in the long term.Clinical ImplicationsHigh prosthesis survival rates can be achieved by the use of four implants to support a full-arch fixed prosthesis in the mandible.     

Immediate functional loading of Brånemark system implants in edentulous mandibles: clinical report of the results of developmental and simplified protocols

PURPOSE: This report evaluates the 5-year results of 9 of 10 patients in a clinical investigation of immediate functional loading of Br?nemark System implants in edentulous mandibles, and of 24 patients treated with a simplified protocol for the same indication. The purpose of the paper is to suggest a simple, reliable, and documented method for immediate implant loading of complete-arch mandibular prostheses. MATERIALS AND METHODS: Ten healthy patients in need of full-arch mandibular implant reconstruction (development group) were treated between December 1993 and December 1994 with 130 Br?nemark System standard Implants, placed in fresh extraction and healed sites. Four implants per patient were immediately loaded with acrylic resin fixed prostheses. The prostheses were replaced by metal-framework conversion prostheses approximately 6 weeks later, and definitive metal-reinforced prostheses incorporating all implants were placed after second-stage surgery. An additional 24 patients were treated with a simplified protocol using a total of 144 implants placed between March 1997 and October 2000. In these patients, the acrylic resin prostheses were not disturbed for 3 months, and fewer implants were used with an increasing ratio of implants loaded. Eventually, all Implants were loaded immediately for the last patients treated. RESULTS: The prosthesis survival rate was 100% for the total material. In the developmental group, the implant cumulative survival rate was 80% for the immediately loaded implants after 5 years, while the 2-stage implants reached 96%. Bone level measurements showed no differences between immediate and 2-stage protocols for this group. The implant cumulative survival rate was 97% for the simplified treatment group. DISCUSSION AND CONCLUSION: A predictable and simple concept for loading of immediate implant prostheses in edentulous mandibles was demonstrated. Results from the development of this technique suggest that it may be essential to maintain the initial implant splinting over a healing period of about 3 months and that implant placement between the mental foramina provides optimal support.     

Immediate loading of mandibular overdentures supported by unsplinted direct laser metal-forming implants: results from a 1-year prospective study

Background: At present, only some studies have dealt with immediate loading of unsplinted implants supporting mandibular overdentures. The aim of this prospective study is to evaluate treatment outcomes of mandibular overdentures supported by four one‐piece, unsplinted, immediately loaded, direct laser metal‐forming (DLMF) implants by assessing implant survival rate, implant success, marginal bone loss, and prosthetic complications. Methods: A total of 96 one‐piece DLMF implants were inserted in the edentulous mandible of 24 patients. Four implants were placed in each edentulous mandible. Immediately after implant placement, a mandibular overdenture was connected to the implants. At 1‐year follow‐up, clinical, radiographic, and prosthetic parameters were assessed. Success criteria included absence of pain, suppuration, and implant mobility; absence of continuous peri‐implant radiolucency; and distance between the implant shoulder and the first visible bone contact <1.5 mm. Results: After a 1‐year loading time, the overall implant survival rate was 98.9%, with only one implant lost. Among the surviving 95 implants, two did not fulfill the success criteria; therefore, the implant success rate was 97.8%. The mean distance between the implant shoulder and the first visible bone contact was 0.28 ± 0.30 mm (95% confidence interval, 0.24 to 0.32). Some prosthetic complications were reported. Conclusion: Based on the present results and within the limits of this study, the immediate loading of four unsplinted DLMF implants by means of ball attachment–supported mandibular overdentures seems to represent a safe and successful procedure.