Success of immediate loading implants compared to conventionally‐loaded implants: a literature review

The purpose of this systematic literature review was to compare the clinical performance between conventionally‐ (delayed) and immediately‐loaded implants. A literature search of studies published between 1995 and 2012 was performed using several electronic databases and the following key words: “immediate loading”, “dental implants”, “immediate function”, “early loading”, “oral implants”, “immediate restoration”, and “systematic review” was performed. The electronic search was supplemented with hand‐searching in dental journals and cross‐referencing within the selected articles. Studies were considered for inclusion if they analyzed the success of the immediate loading protocol for implants, with emphasis given to randomized, controlled clinical trials. Among the clinical studies extracted from the literature, 120 studies met the inclusion criteria and were included in this systematic review. These studies included trials that involved yielded consistent results of success rates of immediately‐loaded implants comparable to those known from conventionally‐loaded implants, which were subjected to the immediate loading protocol or other loading protocols. According to the findings, there is evidence to suggest that immediate loading protocols demonstrate high implant survival rates and could be cautiously recommended for certain clinical situations. However, studies with a high level of evidence, especially randomized, controlled trials, performed over a longer timeframe are required to show a clear benefit over conventional and other loading types.     

牙片屏障即刻种植术与常规即刻种植临床效果比较的Meta分析

目的:系统评价牙片屏障即刻种植术(socket shield technique,SST)与常规即刻种植在美学及骨组织保存方面的临床效果.方法:检索Pubmed、Embase、Cochrane library、知网、万方、CBM数据库及中国、美国临床试验注册中心2020-09-20日前发表的比较牙片屏障即刻种植术与常规...     

Clinical outcomes of pterygoid implants: Systematic review and meta-analysis

The aim of this systematic literature review was to analyze clinical outcomes of pterygoid implant for the treatment of patients with atrophic posterior maxillae and to provide clinical recommendations for this dental implant technique. An extensive search of electronic databases (PubMed/Medline, Science Direct, Lilacs, Embase, and Cochrane Library) was conducted, for articles published between January 1995 and January 2018, to identify literature presenting clinical outcomes of pterygoid implants in the treatment of patients with atrophic posterior maxillae. The systematic review was performed in accordance with PRISMA/PICO statement guidelines, and the risk of bias was assessed (Australian National Health and Medical Research Council scale). The relative risk of implant failure was analyzed within a 95% confidence interval (95% CI). After screening 331 abstracts from the electronic databases, 36 full-text articles were accessed for eligibility, and a total of 6 studies were included in this systematic review (after applying the inclusion and exclusion criteria). All studies were retrospective in nature and were classified with a poor level of evidence. A total of 634 patients received 1.893 pterygoid implants, with a mean implant survival rate of 94.87%. The mean prevalence of implant failure was 0.056 with a 95% CI of 0.04–0.077. This study demonstrates that pterygoid implants can be successfully used in patients with atrophic posterior maxilla. However, the results should be interpreted with caution, given the presence of uncontrolled confounding factors in the included studies.     

One‐Piece Implants: Placement Timing,Surgical Technique,Loading Protocol,and Marginal Bone Loss

Purpose : Osseointegration being an accepted and well‐documented concept, attention is now directed towards simplification of the mechanical design of implants and towards achieving biomechanical success. The aim of this literature review is to provide an overview of the one‐piece implant, with its advantages and disadvantages over a conventional two‐piece implant. Methods : The PubMed database was searched in the English language using the keywords one‐piece implant, single‐piece implant, single‐stage implant surgery, and two‐piece implant. Articles were selected on the basis of whether they had sufficient information related to placement timing, surgical procedure used, loading protocol, follow‐up periods, marginal bone loss, and implant success rates of one‐piece implants. For inclusion, a study group must have had a minimum of 30 one‐piece implants followed for at least 1 year. Discussion : Nineteen articles were subjected to the selection criteria. Out of 19 clinical trials only 11 met the selection criteria. Five parameters were taken into consideration for studying one‐piece implants: placement timing, surgical technique, loading protocol, marginal bone loss, and implant survival rate. The data from the identified studies were tabulated according to these parameters and discussed. Conclusion : Delayed placement of one‐piece implants is more commonly practiced than extraction and immediate placement. Most surgeons prefer surgeries using flaps as compared to flapless surgeries, and in most cases, one‐piece implants were loaded immediately. Limited literature reveals both positive and negative results regarding the effect of a one‐piece implant system on surrounding hard and soft tissues.     

Clinical Outcomes of Using Lasers for Peri‐Implantitis Surface Detoxification: A Systematic Review and Meta‐Analysis

The aim of this systematic review is to compare the clinical outcomes of lasers with other commonly applied detoxification methods for treating peri‐implantitis. An electronic search of four databases and a hand search of peer‐reviewed journals for relevant articles were conducted. Comparative human clinical trials and case series with ≥6 months of follow‐up in ≥10 patients with peri‐implantitis treated with lasers were included. Additionally, animal studies applying lasers for treating peri‐implantitis were also included. The included studies had to report probing depth (PD) reduction after the therapy. Results: Seven human prospective clinical trials and two animal studies were included. In four and three human studies, lasers were accompanied with surgical and non‐surgical treatments, respectively. The meta‐analyses showed an overall weighted mean difference of 0.00 mm (95% confidence interval = ?0.18 to 0.19 mm) PD reduction between the laser and conventional treatment groups (P = 0.98) for non‐surgical intervention. In animal studies, laser‐treated rough‐surface implants had a higher percentage of bone‐to‐implant contact than smooth‐surface implants. In a short‐term follow‐up, lasers resulted in similar PD reduction when compared with conventional implant surface decontamination methods.     

Effect of the Timing of Restoration on Implant Marginal Bone Loss: A Systematic Review

Background: The advancement in implant dentistry has allowed shortened treatment time by restoring the implants earlier. Whether the timing of restoration has an impact on implant marginal bone level has not been systematically analyzed. The aim of this study is to compare marginal bone loss (MBL) between implants that were restored with the following protocols: 1) immediate restoration/loading (IR/L); 2) early loading (EL); and 3) conventional loading (CL). Methods: An electronic literature search from three databases (until November 2011) and a hand search in implant‐related journals were conducted. Clinical human studies in English language that had reported a comparison of MBL between implants with IR/L, EL, or CL with ≥12‐month follow‐up were included. In addition, the minimal number of implants had to be 10 for each group. Implants with both immediate placement (IP) and delayed placement (DP) were included and analyzed separately. An assessment of the publication bias for the included randomized clinical trials (RCTs) was performed. Results: The initial search resulted in 1,640 articles, of which 27 articles in full text were further evaluated for eligibility. Finally, 11 studies (eight RCTs, two controlled clinical trials, and one retrospective study) were qualified and classified into four groups: 1) IR/L + DP versus CL + DP (n = 6 articles); 2) IR + DP versus EL + DP (n = 2 articles); 3) EL + DP versus CL + DP (n = 1 article); and (4) IL + IP versus CL + IP (n = 2 articles). A meta‐analysis performed for group 1 showed 0.09 mm (95% confidence interval = ?0.27 to 0.09 mm) difference in the mean MBL, favoring the IR/L protocol but without significant difference (P = 0.33). No significant difference in MBL was found for groups 2 through 4 after adjusting for the implant placement level. The eight RCTs were determined to be at moderate‐to‐high risk of publication bias. Conclusions: This meta‐analysis does not show an effect of the timing of restorations on implant MBL. The selection of restoration protocols should be based on factors other than MBL.     

Short implants (5‐8 mm) vs long implants (≥10 mm) with augmentation in atrophic posterior jaws: A meta‐analysis of randomised controlled trials

The aim of this systematic review was to compare the survival rate, marginal bone loss changes and complications between short implants (5‐8 mm) and long implants (≥10 mm) with a bone‐augmented procedure in the posterior jaw. An electronic search of the MEDLINE (PubMed), Embase and Cochrane Library databases through September 2018 was done to identify randomised controlled trials (RCT) assessing short implants and long implants with at least a 1‐year follow‐up period after loading. A quantitative meta‐analysis was conducted on the survival rate, marginal bone loss changes and complications. Ten RCTs met the inclusion criteria. There were no significant differences in the survival rate (RR: 1.01; 95% CI: [0.99, 1.03]; P = .32) and complications (RR: 0.48; 95% CI: [0.20, 1.17]; P = .11) between the two groups. Compared with the long implant group, the short implant group had a lower marginal bone loss change, and the effect measure was significant (mean difference: ?0.13; 95% CI: [?0.20, ?0.06]; P < .05). This systematic review showed no difference between the survival rates and complications of short implants (5‐8 mm) and long implants (≥10 mm). The marginal bone loss changes in short implants are lower than those in long implants.     

Prosthodontic considerations designed to optimize outcomes for single-tooth implants. A review of the literature

Background: The aim of this study was to review the literature on the restoration of single‐tooth implants, and to develop evidence‐based conclusions to optimize aesthetic, biologic and patient‐related outcomes. Methods: An electronic and hand search was conducted using the search terms ‘dental implants, single‐tooth; dental restoration, temporary; dental impression materials; dental impression technique; dental prosthesis, implant‐supported; dental prosthesis design; dental abutments; dental occlusion; maintenance; survival; and survival analysis’. Resultant titles were screened, and full text was obtained where relevant. The authors selected the most appropriate articles, giving preference to systematic reviews and long‐term, patient‐based outcome data. Results: Thirty‐nine articles were selected and critiqued by the authors. Conclusions: There was strong suggestion by several authors that peri‐implant soft tissue aesthetics can be sculpted through provisional restoration contour, but there are no clinical outcome studies to define or support this claim. Laboratory studies demonstrate that pick‐up type impression copings in conjunction with elastomeric impressions are the most accurate means for transferring implant position to a dental cast. Laboratory and finite‐element analysis studies suggest implants with an internal‐type connection show improved stress distribution, but supportive clinical data are lacking. The authors of this review favour a screw‐retained prosthesis for retrievability. Clinical and histological studies show that gold, titanium and zirconia ceramic abutment materials exhibit excellent biological responses, although there is insufficient data on the clinical service provided by zirconia as an implant‐substructure material. The literature does not associate any particular occlusal scheme with superior clinical outcomes. Implant‐borne single crowns offer comparable clinical service to tooth‐borne fixed dental prostheses. However, single‐tooth implant restorations are associated with an increased incidence of biological and technical complications.     

Influence of Crown/Implant Ratio on Marginal Bone Loss: A Systematic Review

Background: With the increased use of short dental implants (<10 mm), a high crown/implant (C/I) ratio has become a common finding. However, the effect of the C/I ratio on the marginal bone loss (MBL) has not yet been examined extensively. Hence, the aim of the present systematic review is to explore the influence of the C/I ratio on the success rate and MBL of dental implants. Methods: Three electronic databases (PubMed, Ovid MEDLINE, and Cochrane Central) and a manual search for human trials with a minimal follow‐up of 6 months are used for the present study. A statistical analysis of the influence of the C/I ratio was performed on the peri‐implant MBL while considering follow‐up period, type of implants, implant connection, and technical and biologic complications. Results: One hundred ninety‐six potential articles were identified on the selected databases. Only 57 articles were selected for full‐text evaluation. According to the inclusion criteria, a total of 13 articles were included in this systematic review. A significant negative association between the C/I ratio and the MBL was found (P = 0.012). However, no statistically significant difference was found (P >0.15) for potential effects regarding the observation period, the type of implant connection, or between both methods of evaluating the C/I ratio. Conclusions: Within the limitations of the present study, the C/I ratio of implant‐supported restorations has an effect on peri‐implant marginal bone level. Within the range of 0.6/1 to 2.36/1, the higher the C/I ratio, the less the peri‐implant MBL.     

在后牙区应用4 mm超短种植体临床效果的Meta分析

目的 通过系统评价及Meta分析的方法评估在后牙区骨量不足植入4 mm超短种植体（ESI）的安全性和效用。方法 电子检索2010年1月1日—2022年8月31日PubMed、Embase、Cochrane Library、Web of Science、CNKI、万方数据库有关ESI与标准种植体（SI）（≥8 mm）的随机对照试验或临床对照试验，并进行引文检索。应用RevMan 5.4版软件进行Meta分析。结果 共11篇研究符合纳入标准，其中随机对照试验6篇，临床对照试验5篇。Meta分析结果：在后牙区种植时，ESI与SI的存留率差异无统计学意义[RR=1.23,95%CI(0.66,2.27),P=0.52];ESI表现出更稳定的边缘骨水平[MD=-0.16,95%CI （-0.25，-0.07）,P=0.000 7]，更少的生物并发症[RR=0.34,95%CI (0.19,0.62),P=0.000 4]，然而机械并发症更多[RR=2.89,95%CI (1.05,7.92),P=0.04]。结论 基于有限的证据，在后牙牙槽嵴高度低于5 mm时应用ESI可以获得媲美SI的临床效果...     

Prognosis of implants and fixed restorations after lateral sinus elevation: a literature review

Aim of this review was to investigate the prognosis of implants inserted in augmented sinuses and fixed restorations supported by these implants. Special attention was given to the impact of grafting material, time of implant placement, residual bone height and type of fixed restoration. An electronic search in PubMed, the German database medpilot and the Cochrane Library was executed followed by supplementary manual search in relevant journals. The search was limited to human studies published up to November 2010. Only publications in English and German, in peer-reviewed journals, were considered. After the initial search and application of selection criteria on titles and abstracts, a full-text analysis of 67 articles was performed, out of which six prospective and three retrospective studies were finally included in the review. The heterogeneous properties of the identified articles did not allow systematic analysis of the data. Success rates of implants were between 96·3% and 100%, survival rates were between 75% and 100%, and survival rates of single crowns, splinted crowns and fixed partial dentures ranged between 96·4% and 100% after a follow-up of 12-101 months. Within the limits of this review, the prognosis of implants and fixed restorations seemed not to be influenced by the type of restorations, graft material, residual bone height and time of implant placement. However, conclusions of this review are based on studies with low level of evidence; therefore, careful interpretation is required. Multicentre randomised controlled clinical trials with sufficient statistical power concentrating on few factors are needed to reach sound conclusions.     

The Influence of Implant Diameter on Its Survival: A Meta‐Analysis Based on Prospective Clinical Trials

Background: The use of narrow‐diameter implants has been proposed to restore small edentulous spans, thus avoiding extensive bone augmentation procedures and reducing the surgical complexity of implant rehabilitations. Although success rates of narrow‐diameter implants have already been analyzed in the literature, to the best of the authors’ knowledge, no meta‐analysis based on prospective and randomized controlled trials has been performed. The aim of this study is to analyze the survival rates of narrow‐diameter implants compared with standard or wide‐diameter implants. Methods: An electronic search from three databases and a hand search in implant‐related journals of studies published in English before September 1, 2012 were performed. Prospective human clinical studies with at least 10 implants and a follow‐up period of 1 year were included in the meta‐analysis. Implants were divided into two groups based on their diameters. Results: The initial search yielded 484 articles, of which 49 were evaluated in full text for eligibility. Finally, 16 studies were chosen and separated into two groups: 1) implants of diameter <3.3 mm (group 1) and 2) implants of diameter ≥3.3 mm (group 2). A meta‐analysis performed for groups 1 and 2 showed survival rates of 75% and 87%, respectively. Conclusions: This meta‐analysis showed that narrower implants (<3.3 mm) had significantly lower survival rates compared with wider implants (≥3.3 mm). Other variables, such as type of prosthesis, implant surface, and timing of prosthetic loading, were found to have influenced the implant survival rates.     

Tooth‐to‐Implant Connection: A Systematic Review of the Literature and a Case Report Utilizing a New Connection Design

Background: In the treatment of partially edentulous patients, implants have often been connected to natural teeth. Numerous studies have reported significant complications and problems, while others have demonstrated favorable outcomes. Purpose: The purpose of this article was to systematically review the literature regarding the splinting of implants and teeth. The difference in the biomechanical behavior between osseointegrated implants and teeth and the efficacy of the different modes of connection that have been employed are explored. Materials and Methods: A MEDLINE search between 1966 and October 2006 was performed to retrieve relevant articles. A further manual search from the bibliographies of the former articles was performed to include as many references as possible. Prospective and retrospective clinical studies, as well as laboratory and computer‐generated research, were included. Results: A pronounced difference in the biomechanics of teeth and implants has been revealed in theoretical models. This disparity has also been supported by the majority of the experimental work published. As a result, principal complications, such as intrusion of teeth and higher risk of overload and greater marginal bone loss around the implants have been reported. Among the several types of connections utilized, the rigid connection showed fewer complications but unfortunately did not eliminate them. Conclusion: Totally implant‐supported prostheses should be the treatment of choice. However, there are cases where combining teeth and implants is inevitable. The authors propose a rationale design of connecting implants and teeth. This design minimizes the biologic and technical complications.     

Improving masticatory performance,bite force,nutritional state and patient's satisfaction with implant overdentures: a systematic review of the literature

Oral function with removable dentures is improved when dental implants are used for support. A variety of methods is used to measure change in masticatory performance, bite force, patient's satisfaction and nutritional state. A systematic review describing the outcome of the various methods to assess patients' appreciation has not been reported. The objective is to systematically review the literature on the possible methods to measure change in masticatory performance, bite force, patient's satisfaction and nutritional state of patients with removable dentures and to describe the outcome of these. Medline, Embase and The Cochrane Central Register of Controlled Trials were searched (last search July 1, 2014). The search was completed by hand to identify eligible studies. Two reviewers independently assessed the articles. Articles should be written in English. Study design should be prospective. The outcome should be any assessment of function/satisfaction before and at least 1 year after treatment. Study population should consist of fully edentulous subjects. Treatment should be placement of any kind of root‐form implant(s) to support a mandibular and/or maxillary overdenture. Fifty‐three of 920 found articles fulfilled the inclusion criteria. A variety of methods was used to measure oral function; mostly follow‐up was 1 year. Most studies included mandibular overdentures, three studies included maxillary overdentures. Implant‐supported dentures were accompanied by high patient's satisfaction with regard to denture comfort, but this high satisfaction was not always accompanied by improvement in general quality of life (QoL) and/or health‐related QoL. Bite force improved, masseter thickness increased and muscle activity in rest decreased. Patients could chew better and eat more tough foods. No changes were seen in dietary intake, BMI and blood markers. Improvements reported after 1 year apparently decreased slightly with time, at least on the long run. Treating complete denture wearers with implants to support their denture improves their chewing efficiency, increases maximum bite force and clearly improves satisfaction. The effect on QoL is uncertain, and there is no effect on nutritional state.     

Single puncture versus standard double needle arthrocentesis for the management of temporomandibular joint disorders: A systematic review

The aim of this systematic review was to investigate the current evidence in order to assess the efficacy of single puncture arthrocentesis vs standard double needle arthrocentesis in the management of temporomandibular joint(TMJ) disorders. An electronic search of the PubMed, Scopus, Cochrane CENTRAL and Google Scholar databases was performed to identify English studies published up until October 2017. Eligible studies were selected based on inclusion criteria and included randomised controlled trials(RCTs) comparing single puncture arthrocentesis and standard double needle arthrocentesis for the management TMJ disorders. The initial screening identified 984 records, of which only 5 fulfilled the inclusion criteria. A high degree of heterogeneity was found in the 5 studies with each reporting different sample selection and arthrocentesis protocol. All 5 studies reported no difference in reduction in pain intensity and improvement in maximal mouth opening between the single puncture technique and standard double needle technique. This review provides some evidence that single puncture arthrocentesis is clinically as efficacious as standard double needle arthrocentesis. There is a need of well‐designed RCT with standard protocol of arthrocentesis comparing different single puncture techniques and standard double needle technique for the management of TMJ disorders.     

Effects of Currently Available Surgical and Restorative Interventions on Reducing Midfacial Mucosal Recession of Immediately Placed Single‐Tooth Implants: A Systematic Review

Background: Procedures to improve peri‐implant soft‐tissue outcomes of single, immediately placed implants are a topic of interest. This systematic review investigates the effect of various surgical and restorative interventions on implant mid‐buccal mucosal level. Methods: An electronic search of five databases (January 1990 to December 2012) and a manual search of peer‐reviewed journals for relevant articles were performed. Randomized controlled clinical trials (RCTs), prospective cohort studies, and case series with at least nine participants were included, with data on midfacial mucosal recession (MR) of immediately placed implants following various surgical and restorative interventions with a follow‐up period of at least 6 months. Results: Thirty‐six studies, eight RCTs, one cohort study, and 27 case series were eligible. Six interventions were identified and reviewed: 1) palatal/lingual implant position; 2) platform‐switched abutments; 3) flapless approach; 4) bone grafts to fill the gap between buccal plate and fixture; 5) connective tissue grafts; and 6) immediate provisionalization. Three studies consistently showed that palatally/lingually positioned implants had significantly less MR when using tissue‐level implants. Mixed results were reported for interventions 2, 3, 5, and 6. One study was available for intervention 4 and did not show a benefit. Conclusions: Some interventions might be adopted to reduce the amount of MR on implants with the immediate placement approach, as suggested by the included studies, with various levels of evidence. The conflicting results among studies might be a result of differences in patient and site characteristics, e.g., tissue biotype and buccal plate thickness. Therefore, the use of these interventions might be reserved for patients with moderate to high risk of esthetic complications.     

Rehabilitation of Deficient Alveolar Ridges Using Titanium Grids Before and Simultaneously With Implant Placement: A Systematic Review

Background: The aim of the present study is to perform a systematic review of the literature on the use of titanium grids for implant surgery before and simultaneously with implant placement and to assess the success rate of the procedure, as well as survival and success rates of implants placed in the regenerated areas. Methods: Medline was used to identify studies in English published from 1996 to 2011. An additional hand search was performed of the relevant journals and of the bibliographies of the papers identified. Articles retrieved by two independent authors were screened using specific inclusion criteria: randomized controlled trials (RCTs), controlled clinical trials, and prospective clinical studies regarding vertical and/or horizontal regeneration of the alveolar ridge using titanium grids, in association or not with biomaterials, before and simultaneously with implant placement. Results: Six articles were selected, including a total of 79 patients, 87 titanium grids, and 141 implants. Twenty‐four implants were placed simultaneously with titanium grids, and 117 implants were inserted after a period of 4 to 9 months. Titanium grids in combination with autogenous bone were used in 43 cases, 25 in combination with a mixture of autogenous bone and bone substitutes, 14 in association with bone substitutes, five using only titanium grids. The overall success rate of the regenerative procedures was 98.86%; the overall survival and success rates of implants were 100% and 93.2%, respectively. Conclusions: The main limit of the present systematic review is the scarcity of papers with an adequate and consistent methodology regarding the data collection and analysis and the lack of RCTs and large well‐designed long‐term trials. Survival and success rates of implants placed in the areas treated with titanium grids were comparable to those of implants placed in native, non‐regenerated bone and of implants placed in bone regenerated with resorbable and non‐resorbable membranes.     

Does bone mineral density influence the primary stability of dental implants? A systematic review

Objective: The aim of this systematic review was to investigate the influence of bone mineral density on the primary stability of dental implants. Material and methods: A search of health science databases (Cochrane Library, MEDLINE‐PubMed, ISI Web of Knowledge, EMBASE, LILACS) and grey literature was performed, including papers published until January 2011. The main key words used were “bone density” (MeSH/DeCS), “dental implant” (MeSH/DeCS), “implant stability”, “implant stability quotient”, “ISQ”, “resonance frequency analysis”, “RFA”, “Osstell”, “Periotest value”, “PTV”, “Periostest”, “insertion torque”, “placement torque”, “cutting torque”. The inclusion criteria comprised observational clinical studies performed in patients who received dental implants for rehabilitation; studies that evaluated the association between bone mineral density and implant primary stability; bone density assessment performed by measurement of Hounsfield units using cone beam computed tomography; and dental implant primary stability evaluated by ISQ value, PTV value or insertion torque measurement. The articles selected were carefully read and classified as low, moderate and high methodological quality, and data of interest were tabulated. Results: Ten articles met the inclusion criteria, but only seven were included because of overlapping patients. They were classified as low or moderate methodological quality and control of bias, and presented positive association between primary stability and bone density. Conclusions: There is a positive association between implant primary stability and bone mineral density of the receptor site. However, the methodological quality and control of bias of the studies should be improved to produce stronger evidences. To cite this article:
Marquezan M, Osório A, Sant'Anna E, Souza MM, Maia L, Does bone mineral density influence the primary stability of dental implants? A systematic review.
Clin. Oral Impl. Res. 23 , 2012; 767–774.
doi: 10.1111/j.1600‐0501.2011.02228.x