The clinical and radiographic outcome of implants placed in the posterior maxilla with a guided flapless approach and immediately restored with a provisional rehabilitation: a randomized clinical trial

Objectives: To evaluate and compare the outcome of dental implants placed using a flapless protocol and immediate loading with a conventional protocol and loading after 6 weeks. Materials and methods: Fourteen patients with bilateral maxillary edentulous areas were treated using Straumann SLA‐implants. Using a randomized split‐mouth design, implants were placed in one side of the maxilla using a stereolithographic surgical guide for flapless surgery and immediately loaded on temporary abutments with a bridge (test). Implants in the other side were placed using the conventional protocol and loaded after 6 weeks of healing (control). Clinical and radiographic evaluation of peri‐implant tissues was performed at time of implant surgery, and after 1 week, 6 weeks, 3, 6, 12 and 18 months. Results: A total of 70 implants were placed (36 test and 34 control). One implant (test) was lost after 3 months, resulting in a survival rate of 97.3% for the test implants and 100% for the control implants. Marginal bone levels were not statistically significantly different between the test and control implants but at baseline the marginal bone level was significantly lower compared to the other evaluation periods (P < 0.05). The mean bone level for test and control implants was 1.95 mm ± 0.70 and 1.93 mm ±0.42 after 18 months, respectively. There was a significant change in height of the attached mucosa at implants placed with a conventional flap between post‐operative and 1 week and between 1 week and 6 weeks. Statistically significant differences were found between the test side and the control side for opinion about speech, function, aesthetics, self‐confidence and overall appreciation the first 6 weeks. Conclusion: Implants can successfully integrate in the posterior maxilla using a flapless approach with immediate loading similar to a conventional protocol. The mucosal tissues around implants placed with a conventional flap changed significantly compared with flapless placed implants. To cite this article:
Van de Velde T, Sennerby L, De Bruyn H. The clinical and radiographic outcome of implants placed in the posterior maxilla with a guided flapless approach and immediately restored with a provisional rehabilitation: a randomized clinical trial.
Clin. Oral Impl. Res. 21 , 2010; 1223–1233.
doi: 10.1111/j.1600‐0501.2009.01924.x     

Five‐year outcomes of a randomized clinical trial comparing bone‐level implants with either submerged or transmucosal healing

Aim

To evaluate the long‐term hard and soft tissue peri‐implant tissue stability of bone‐level implants using a different implant placement protocol (submerged versus transmucosal).

Materials and methods

This study was partly a subset analysis of a multicentre study where in 40 patients, a single bone‐level implant with platform switching and a conical implant‐abutment interface was placed either submerged or transmucosal in non‐molar sites. Changes in the peri‐implant tissues between implant placement and 5 years were assessed clinically and radiologically. Patient‐related outcomes were also recorded.

Results

Thirty patients completed the 5‐year follow‐up. Implant survival rate was 100%. The mean radiographic changes in crestal bone levels between baseline and 5 years were 0.59 (0.92) mm and 0.78 (1.03) mm for the submerged and the transmucosal groups, respectively. No statistical significant differences were found between the groups for any of the investigated variables. Peri‐implantitis, defined as changes in the level of crestal bone of ≥2 mm together with bleeding on probing, was only diagnosed in one patient. Patients in both groups were highly satisfied with the treatment received.

Conclusions

Bone‐level implants with submerged or transmucosal healing protocols demonstrated similar outcomes after 5 years. Both protocols yielded optimal clinical and radiographic results when bone‐level implants were placed in non‐molar positions for single tooth replacement.     

Immediate non-occlusal vs. early loading of dental implants in partially edentulous patients: a multicentre randomized clinical trial. Peri-implant bone and soft-tissue levels

Objectives: To compare peri‐implant bone and soft‐tissue levels of immediately non‐occlusally loaded vs. non‐submerged early loaded implants in partially edentulous patients up to 14 months after placement. Material and methods: Fifty‐two patients were randomized in five Italian private practices: 25 in the immediately loaded group and 27 in the early loaded group. To be immediately loaded, single implants had to be inserted with a torque of ≥30 N cm, and splinted implants with a torque of ≥20 N cm. Immediately loaded implants were provided with non‐occluding temporary restorations within 48 h. After 2 months, the provisional restorations were placed in full occlusion. Implants were early loaded after 2 months. Final restorations were provided 8 months after placement. Blinded assessors evaluated peri‐implant bone and soft‐tissue levels. Results: Fifty‐two implants were immediately loaded and 52 were early loaded. No drop‐out occurred. One single immediately loaded implant failed 2 months after placement. Both groups gradually lost peri‐implant bone in a highly statistically significant manner at 2, 8, and 14 months. After 14 months, patients of both groups lost an average of 1.1 mm of peri‐implant bone. There were no statistically significant differences between the two loading strategies for peri‐implant bone and soft‐tissue level changes (P>0.05). After 14 months, the position of the soft tissues did not change significantly from baseline (delivery of the final restorations 8 months after placement). Conclusions: There were no statistically or clinically significant differences between immediate and early loading of dental implants with regard to peri‐implant bone and soft‐tissue levels as evaluated in the present study.