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

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

The immediate rehabilitation by means of a ready-made final fixed prosthesis in the edentulous mandible: a 1-year follow-up study on 50 consecutive patients

Although a two-stage procedure with symphyseal oral implants can lead to a long-term (15 years) 99% cumulative survival rate, a one-stage approach with immediate loading via prefabricated elements seems to offer a short-term acceptable outcome with significantly lower costs. A series of 50 consecutive patients, not eliminated for any systemic or smoking condition, received at the department of periodontology three implants in the symphyseal area, connected by a very rigid horse shoe-shaped titanium bar. A final screw retained prosthetic framework was placed on top of it at the department of prosthetic dentistry within 2 days after surgery (44) or after a delay, due to purely external factors, of up to 10 days (6). Forty-five patients were followed for 1 year. In one patient, all three implants failed and another four patients were lost to follow-up. The cumulative failure rates for implants and prostheses at 1 year were, respectively, 7.3% and 5%. The mean marginal bone loss at 1 year was 1.08 mm (SD: 1.62; range -5.68 to +2.55). This study shows that stable marginal bone levels can be maintained around immediately loaded implants in the lower jaw in an average patient population for at least 1 year. The survival rate is, however, lower than for a staged approach.     

高龄患者下颌牙列即刻负重种植的修复对策

目的探讨老年患者下颌牙列缺失后采用即刻负重种植技术的治疗方案的制定及临床效果。方法对1例下颌牙列缺失的82岁高龄患者保留上颌残根和不良固定修复体，下颌植入4颗Xive种植体，同期接入TempBase临时基台行复合树脂临时桥修复。术后8个月，参照上颌义齿，完成短牙弓烤瓷固定桥修复体。结果种植体植入后追踪26个月，没有种植体失败。患者对临时义齿及终义齿的咀嚼效能及美学效果均非常满意。结论对高龄患者采用即刻负重种植修复时应严格掌握适应证，同时还要具有前瞻性，必须考虑全面，兼顾高龄患者的生理和心理上的特殊性，综合设计。     

Immediate rehabilitation of the mandible with fixed full prosthesis supported by axial and tilted implants: interim results of a single cohort prospective study

Purpose: The aims of this prospective study were to assess the treatment outcome of immediately loaded full‐arch fixed bridges anchored to both tilted and axially placed implants for the rehabilitation of the mandible and to compare the outcome of axial versus tilted implants. Materials and Methods: Sixty‐two patients (34 women and 28 men) were included in the study. Each patient received a full‐arch fixed bridge supported by two axial implants and two distal tilted implants (All‐on‐Four®, Nobel Biocare AB, Göteborg, Sweden). Loading was applied within 48 hours of surgery. Patients were scheduled for follow‐up at 6, 12, 18, and 24 months, and annually up to 5 years. At each follow‐up, plaque level and bleeding scores were assessed; moreover, patient's satisfaction for aesthetics and function was evaluated by a questionnaire. Radiographic evaluation of marginal bone level change was performed at 1 year. Results: The overall follow‐up range was 6 to 43 months (mean 22.4 months). Forty‐four patients were followed for a minimum of 1 year. No implant failures were recorded to date, leading to a cumulative implant survival and prosthesis success rate of 100%. Plaque level and bleeding scores showed progressive decrease over time, parallel to increase of satisfaction for both aesthetics and function. No significant difference in marginal bone loss was found between tilted and axial implants at 1‐year evaluation. Conclusion: The present preliminary data suggest that immediate loading associated with tilted implants could be considered a viable treatment modality for the mandible.     

New approach for immediate prosthetic rehabilitation of the edentulous mandible with three implants: a retrospective study

Background: Immediate/early prosthetic rehabilitation of the edentulous mandible with four or more implants for support of a fixed bridge is a well‐documented procedure. Only a few studies have reported on the outcome of using three implants for this purpose. Aim: To retrospectively analyze the clinical outcome when using three implants for support of an immediately loaded fixed bridge in the totally edentulous mandible. Materials and methods: In total, 132 patients (67 females and 65 males, mean age 62.6 years, range 35–85 years) treated with 396 implants (Brånemark System) over an 11‐year period in one clinic were retrospectively analyzed with regard to implant survival. Implants with both machined and oxidized surface had been used. Eighty percent of the implants were 13 mm in length or longer. The permanent bridge with acrylic teeth was delivered to the patient the same day. The patients were re‐called annually for clinical examinations. Results: All patients had been followed for at least 1 year, with the longest follow‐up of 10 years and a mean follow‐up of 5 years. Thirteen implant failures in 10 patients were experienced, all occurring during the first 12 months of loading. The overall survival rate was 96.7% for implants and 92.4% for original bridges. More machined than oxidized implants failed, 7% vs. 1.2%. Fourteen additional implants were placed at the time of removal of the failed implants when also the fixed bridge was adjusted on the same day. Thus, all patients received and maintained a fixed bridge, except for a few hours in the 10 failure cases when the bridges were adjusted. Conclusions: This retrospective survival analysis shows that three implants can be used to support a fixed bridge for immediate loading in the edentulous mandible. The study indicated that oxidized implants were more successful than machined ones. To cite this article:
Hatano N, Yamaguchi M, Yaita T, Ishibashi T, Sennerby L. New approach for immediate prosthetic rehabilitation of the edentulous mandible with three implants: a rettrospective study.
Clin. Oral Impl. Res. 22 , 2011; 1265–1269.
doi: 10.1111/j.1600‐0501.2010.02101.x     

Complications related to zygomatic implants placement: A retrospective evaluation with 5 years follow-up

This retrospective study assessed zygoma implants in patients treated for upper maxilla extreme atrophy, trauma, cleft palate, or failed reconstruction.The implants were placed using Quad (4 zygoma implants) or mixed (zygoma and conventional implants in premaxilla) surgical technique, with intra-sinus or extra-sinus approach, followed by immediate or deferred loading. Clinical and radiographic evaluations were carried out at 5-year follow-up from loading. Implant survival, symptoms and signs of sinusitis, radiological alterations in terms of mucosal thickening or obliteration of the maxillary sinuses, oroantral communications, and peri-implant soft tissues were examined.A total of 42 patients, with 116 zygoma implants, were included in the study. The cumulative survival rate was 97.41%. One zygomatic bone fracture was assessed. Eight patients reported sinusitis, and two showed oro-antral communications. A comparison between mean pre- and post-operative Lund–Mackay scores showed a statistically significant increase of sino-nasal disease in the post-operative scores (p = 0.0019). Mucositis and gingival recession was observed in 21 and 8 implants respectively. Average recession was 2.52 ± 2.35 mm.According to our results, placement of zygoma implants has proved to be a predictable procedure, with a lower rate of severe complications compared to other treatment options in extreme upper jaw atrophy.     

比较All-on-4种植修复中倾斜种植体与轴向种植体临床效果的5年回顾性研究

目的 通过回顾性研究分析,比较All-on-4种植修复中倾斜种植体与轴向种植体的5年临床效果。方法 回顾2013年10月—2015年10月在南京大学医学院附属口腔医院种植科完成上颌和/或下颌All-on-4种植修复治疗的26例患者,共植入120颗种植体,其中倾斜种植体60颗,轴向种植体60颗。术后行种植体支持式即刻修复,3~6个月后行最终修复。对患者进行随访,对倾斜与轴向种植体、不同倾斜角度的倾斜种植体以及上、下颌种植体之间的种植体存留率、种植体边缘骨吸收以及并发症发生率进行统计分析。结果 ①All-on-4种植修复中种植体总体5年存留率为98.33%,倾斜种植体5年存留率为96.67%,轴向种植体5年存留率为100%,两者之间差异无统计学意义（P=0.496）。②负载5年后,倾斜种植体边缘骨吸收量平均(1.16±0.98)mm,轴向种植体边缘骨吸收量平均(1.11±0.76)mm,两者边缘骨吸收量差异无统计学意义（P=0.709）。③倾斜与轴向种植体之间并发症发生率无统计学差异。结论 在All-on-4种植修复中,倾斜种植体具有与轴向种植体相似的较高的5年种植体存留率以及较为稳定的种植体边缘骨水平维持。All-on-4种植修复中远端倾斜种植体的应用具有良好的负载5年临床效果。     

Evaluation of implants placed with barrier membranes. A restrospective follow-up study up to five years

This follow-up study evaluated clinical and radiographic parameters of dental implants placed in combination with guided bone regeneration with barrier membranes. All implants functioned well up to 60 months after insertion. Forty-one patients, with a total of 72 augmented implants, who participated in a regular maintenance protocol, were investigated. Annual Periotest values (median value, - 3) revealed stable periimplant conditions and sustained osseointegration. At 6 months and annually thereafter up to five years, the radiographic evaluation yielded mean bone losses of 0.8, 1.25, 1.39, 1.42, 1.42 and 1.39 mm, respectively, with a range from 0 to 3.5 mm. No implant failures or losses were recorded. The results demonstrated stable periimplant conditions up to five years after membrane-protected osseous regeneration, with no significant differences in the radiographic bone level in regard to region, jaw or bone graft. Premature membrane exposure resulted in a significantly higher crestal bone loss up to 24 months. The newly formed bone appeared to be able to withstand functional loading for up to 60 months in a predictable manner.     

Immediate Loading of Mandibular Overdentures Supported by One‐Piece,Direct Metal Laser Sintering Mini‐Implants: A Short‐Term Prospective Clinical Study

Background: Only a few studies have dealt with immediately loaded, unsplinted mini‐implants supporting ball attachment–retained mandibular overdentures (ODs). The aim of this study is to evaluate treatment outcomes of ball attachment–retained mandibular ODs supported by one‐piece, unsplinted, immediately loaded, direct metal laser sintering (DMLS) mini‐implants. Methods: Over a 4‐year period (2009 to 2012), all patients referred to the Dental Clinic, University of Varese, and to a private practice for treatment with mandibular ODs were considered for inclusion in this study. Each patient received three or four DMLS mini‐implants. Immediately after implant placement, a mandibular OD was connected to the implants. At each annual follow‐up session, clinical and radiographic parameters were assessed, including the following outcome measures: 1) implant failures; 2) peri‐implant marginal bone loss; and 3) complications. Statistical analysis was conducted using a life‐table analysis. Results: A total of 231 one‐piece DMLS mini‐implants were inserted in 62 patients. After 4 years of loading, six implants failed, giving an overall cumulative survival rate of 96.9%. The mean distance between the implant shoulder and the first visible bone‐to‐implant contact was 0.38 ± 0.25 and 0.62 ± 0.20 mm at the 1‐ and 4‐year follow‐up examinations, respectively. An incidence of 6.0% of biologic complications was reported; prosthetic complications were more frequent (12.9%). Conclusions: Within the limits of this study, it can be concluded that the immediate loading of one‐piece, unsplinted, DMLS titanium mini‐implants by means of ball attachment–supported mandibular ODs is a successful treatment procedure. Long‐term follow‐up studies are needed to confirm these results.     

Parallel screw cylinder implants: comparative analysis between immediate loading and two-stage healing of 1,005 dental implants with a 2-year follow up

Background Recently, several authors have focused on the possibility of an immediate functional loading of dental implants to minimize the delay between surgical and prosthetic phases. Purpose The aim of this study was a reevaluation of the XiVE® dental implant (Dentsply‐Friadent, Mannheim, Germany) with: (1) a longer follow‐up period; (2) a higher number of fixture; and (3) a proper statistical method. Materials and Methods In July 2001 and December 2002, 371 patients (180 males and 191 females; ages ranging from 17 to 83; mean age, 53 years) were consecutively enrolled in this study. In 371 patients, a total of 1005 XiVE dental implants were distributed as follows: 484 immediately loaded implants (test group) were inserted in 130 patients, whereas 521 unloaded implants were inserted in 241 patients (control group). Results The implant survival was 98.7 and 99.4% in immediate loading and control group, respectively. Univariate analysis showed no statistically significant difference between the two groups. Conclusion In a previous report, we showed that immediate loading offered a predictable and reliable procedure also for XiVE implants, at least in the short period. In this study, we confirmed the results of the previous study and added information regarding the survival rate and marginal bone level stability with a 2‐year follow up.     

Immediate loading in the completely edentulous mandible: technical procedure and clinical results up to 3 years of functional loading

Objectives: This prospective mono‐center study describes a clinical technique to provide dental implants with a temporary cross‐arch cantilever bridge functionally loaded on the day of fixture insertion and discusses the 3‐year follow‐up of four to six machined surface Brånemark implants installed in the interforamina area. Material and methods: Ninety Brånemark implants were installed in 18 edentulous mandibles. Five patients were heavy smokers and one had Down syndrome. The day of surgery, a 10 unit provisional glassfiber‐reinforced cantilever bridge was installed. The final 12 unit bridge was in place after an average of 144 days (range 10–332). Bone‐to‐implant level was assessed radiologically from the day of surgery up to 3 years. Results: Two out of five fixtures were lost within 3 months in the Down syndrome patient but the provisional bridge continued to function on the three remaining implants until the patient was successfully reoperated. Another implant was lost after 11 months due to a non‐detected fracture in the metal framework, resulting in overloading of the cantilever part. As no additional losses occurred during the follow‐up time (range 57–26 months), the total failure rate is 3/91 (3.3%). Seventeen of the 18 patients are loading their implants more than 3 years and nine have moved beyond the 4‐year period. Average bone remodelling as measured on the apical radiographs from 12 patients at 0, 12 and 36 months revealed a statistically significant bone loss from the initial 0.1 mm [standard deviation (SD) 0.2; range 0–0.7] toward 1.8 mm (SD 0.2; range 1.6–2.2) during the first year of function. (Wilcoxon's signed rank test; P<0.002). After 3 years, no further significant bone loss occurred. Conclusion: This 3‐year study shows that machined surface Brånemark implants can be immediately loaded with cross‐arch cantilever bridges with an average bone‐remodelling pattern indicative of a steady state after 1 year of loading.     

Reconstruction of the extremely atrophied mandible with iliac crest onlay grafts followed by two endosteal implants: a retrospective study with long-term follow-up

Treatment outcomes of implant-retained lower dentures on two endosseous implants placed in severely atrophied mandibles after reconstruction with iliac crest onlay grafts were assessed in a retrospective observational study. All consecutive patients treated between 2000 and 2007 were recalled in 2012 (n = 40). Survival of the implants, the condition of hard and soft peri-implant tissues, and patient satisfaction were scored. One implant was lost after 5.5 years. The mean mandibular symphysis height was 8.9 ± 2.2, 16.4 ± 2.7, 15.7 ± 2.7, and 15.4 ± 2.5 mm at intake, after augmentation, after implantation, and at the last recall visit, respectively. Mean radiographic peri-implant bone loss was 0.6 ± 0.7 mm. Mean clinical index scores were very low. Patient satisfaction was high. Surgical complications related to the donor site were seroma (n = 1), haematoma (n = 2), and sensory disturbance of the lateral femoral cutaneous nerve (n = 1); all had resolved before placement of the implants. Eleven patients reported postsurgical sensory disturbances of the mental nerve, of whom five still experienced some sensory disturbance at the last recall visit. Augmentation of the extremely resorbed mandible with an iliac crest onlay graft followed by placement of two implants 4 months later provides a solid basis for a bar-retained overdenture with favourable clinical and radiographic results.