Short dental implants: a literature review and rationale for use

Implant prostheses are often used to restore partially or completely edentulous patients. The posterior regions of the mouth often have less available bone height than the anterior regions. The bone density of the remaining bone after tooth loss is often less in the posterior regions than the anterior region of the mouth. A review of the literature reveals implants shorter than 10 mm often have a higher failure rate than longer implants. These complications may be related to an increase in crown height, higher bite forces in the posterior regions, and less bone density. As a result, biomechanical methods to decrease stresses to the implant-bone interface are warranted. The forces to the implants may be reduced by eliminating lateral contacts in mandibular excursions and eliminating cantilevers on the prosthesis. The area of forces applied to the prosthesis may be increased by increasing the implant number, increasing the implant diameter, increasing the implant design surface area, and splinting the implants together. As a result of these biomechanical methods to decrease stress, Misch, et al reported a 99% implant survival with 7-mm and 9-mm implants in the posterior regions of the jaws. It is interesting to note that the natural teeth follow a similar biomechanical approach to accommodate the higher bite forces in the posterior regions of the mouth. The molar teeth do not become longer than the anterior teeth. The diameter is increased, the design of the roots is different, and the roots are splinted together. The anterior teeth have incisal guidance and eliminate posterior lateral forces to the posterior teeth in all mandibular excursions. A similar biomechanical approach is logical for posterior implants, especially when shorter implants are used to support the prosthesis.     

Radiotherapy and the survival of dental implants: a systematic review

For patients with head and neck cancer, the effects of treatment with adjuvant radiotherapy can be devastating. Frequently there is loss of function due to tooth loss, pain and discomfort from xerostomia and mucositis, and a significant psychosocial impact. Dental implants provide an effective means of rehabilitation for many, but irradiation poses a unique set of challenges that can affect the outcome of treatment. The aims of this review were to find out whether radiotherapy in these patients affects the survival of dental implants, and to discuss details of pertinent influencing factors. An electronic search of the Medline, Web of Science, and CENTRAL databases was done to identify studies on the survival of implants in irradiated patients within specified inclusion and exclusion criteria. No restriction was placed on the year of publication. The primary outcome measure was implant survival. Seven studies involving 441 participants and 1502 implants placed into irradiated bone were included. Meta-analysis indicated that survival was significantly higher in the mandible compared with the maxilla (p = 0.04), and in non-irradiated cases compared with irradiated cases (p < 0.001). Other factors that showed a strong association with survival were radiation dose and timing of surgery. Implant-based rehabilitation is a viable option for head and neck cancer patients who have undergone radiotherapy. Whilst the short to medium-term implant survival in these cases is high, multiple factors require careful consideration for a favourable outcome. Further high-quality research and randomised controlled trials are required in this field.     

Osseointegration and clinical success of zirconia dental implants: a systematic review

PURPOSE: Various ceramic implant systems made of yttria-stabilized tetragonal zirconia polycrystals (Y-TZP) have become commercially available in recent years. A systematic search of the literature was performed to assess the clinical success of dental Y-TZP implants and whether the osseointegration of Y-TZP is comparable to that of titanium, the standard implant material. MATERIALS AND METHODS: The internet database MEDPILOT was searched cumulatively for the keywords zircon* and dent* and implant as well as for zircon* and osseointegration. The last search was conducted on January 31st, 2007. Subsequently, the reference lists of the relevant publications were searched. Furthermore, a letter was sent to the 5 identified manufacturers of zirconia dental implants to ask for peer-reviewed publications. RESULTS: Ninety-six articles were found by the search strategy. No controlled clinical studies in humans regarding clinical outcomes or osseointegration could be identified. Clinical data were restricted to case studies and case series. Only 7 animal studies fulfilled the inclusion criteria. Osseointegration was evaluated at 4 weeks to 24 months after placement in different animal models and sites and under different loading conditions. The mean bone-implant contact percentage was above 60% in almost all experimental groups. In studies that used titanium implants as a control, Y-TZP implants were comparable to or even better than titanium implants. Surface modifications may further improve initial bone healing and resistance to removal torque. CONCLUSIONS: Y-TZP implants may have the potential to become an alternative to titanium implants but cannot currently be recommended for routine clinical use, as no long-term clinical data are available.     

Survival of dental implants placed in HIV-positive patients: a systematic review

No consensus has been reached on the use of dental implants in human immunodeficiency virus (HIV)-positive patients. This systematic review evaluated dental implants in HIV-positive patients in terms of implant survival and success rates, marginal bone loss, and complications. The review was conducted according to the PRISMA checklist. Two independent reviewers performed a comprehensive search of the PubMed/MEDLINE, Scopus, and Cochrane Library databases for studies published until October 2017. Six studies were selected for review. In total, 821 implants were placed: 493 in 169 HIV-positive patients, and 328 in 135 HIV-negative patients. The mean duration of follow-up was 47.9 months. Weighted mean survival rate, success rate, and marginal bone loss values were calculated for the HIV-positive patients. Mean survival and success rates at the patient level (according to the number of patients) were 94.76% and 93.81%, respectively; when calculated at the implant level (according to the number of implants), these rates were 94.53% and 90.37%, respectively. Mean marginal bone loss was 0.83 mm at the patient level and 0.99 mm at the implant level. Thus, dental implants are suitable for the rehabilitation of HIV-positive patients with controlled risk factors and normal CD4+ cell counts.     

Longevity of dental implants in type IV bone: a systematic review

Bone quality and quantity are important factors with regard to the survival rate of dental implants. The aim of this study was to conduct a systematic review of dental implants inserted in low-density bone and to determine the survival rate of dental implants with surface treatments over time. A systematic review of the literature was undertaken by two independent individuals; the Medline/PubMed database was searched for the period July 1975 to March 2013. Relevant reports on bone quality and osseointegration of dental implants were selected. The search retrieved 1018 references, and after inclusion and exclusion criteria were applied, 19 studies were selected for review. A total of 3937 patients, who had received a total of 12,465 dental implants, were analyzed. The survival rates of dental implants according to the bone density were: type I, 97.6%; type II, 96.2%; type III, 96.5%; and type IV, 88.8%. The survival rate of treated surface implants inserted in low-density bone was higher (97.1%) than that of machined surface implants (91.6%). Surface-treated dental implants inserted in low-density bone have a high survival rate and may be indicated for oral rehabilitation. However, more randomized studies are required to better evaluate this issue.     

Removal of osseointegrated dental implants: a systematic review of explantation techniques

Objectives

This systematic review aims to evaluate current literature regarding available techniques for removal of osseointegrated implants in terms of explantation’s success, complications, and bone loss.

Material and methods

Two reviewers conducted a systematic literature search through electronic databases (PubMed and EMBASE), complimented by manual and grey literature searches. Successful explantation was defined as the primary outcome. Complications and availability of residual bone for immediate implantation were defined as secondary outcomes.

Results

Eighteen articles, comprising 372 implants and 241 patients, were included. Five techniques were identified: reverse torque, trephines, burs, piezosurgery, and laser-assisted explantation. Peri-implantitis was the most common reason for explantation, followed by crestal bone loss, fracture, and malpositioning. The reverse torque was the most frequently reported technique (284 implants) with 87.7% success rate. Burs were used for explantation of 49 implants with a 100% success rate, while trephines were utilized for removal of 35 implants with 94% success. Piezosurgery (11 implants) and Er.Cr:YSGG laser (1 implant) showed 100% success. One study reported perforation of the sinus floor following trephine explantation, while another reported fracture of 3 implants following reverse torque application. Further analysis was hindered by the quality of the available studies and their lack of data.

Conclusions

Reverse torque seems the most conservative, and in the authors’ opinion, should be the first choice for explantation despite its inferior success rate. Additional studies with randomized controlled designs and larger sample sizes are required.

Clinical relevance

Dental implants have become the leading choice to replace missing teeth with gradually increasing numbers of complications and failures. An effective, conservative, and economic explantation technique is necessary to allow a successive implant placement.

     

Short versus standard implants at sinus augmented sites: a systematic review and meta-analysis

Clinical Oral Investigations - Short implants are proposed as a less invasive alternative with fewer complications than standard implants in combination with sinus lift. The aim of this systematic...     

Characteristics and management of dental implants displaced into the maxillary sinus: a systematic review

The displacement of dental implants into the maxillary sinus is increasingly reported and may lead to serious complications. Better knowledge of this condition could help clinicians improve their practice, but it is difficult to draw conclusions from the current literature. Therefore, a systematic review was performed to describe the main characteristics of dental implant displacement, as well as its management and temporal evolution over a 31-year period. This review was conducted according to the PRISMA methodology. The PubMed/Scopus electronic databases were searched to December 2021. Risk of bias was assessed using the Joanna Briggs Institute tools. A total of 73 articles reporting 321 patients with displaced dental implants were included. Implants located in the upper first molar site were the most frequently involved (23.7%). Displacement occurred mainly during the first 6 months after implant placement (62.6%). The majority became symptomatic (56.2%), most often due to maxillary sinusitis and/or oroantral communication (44.2%). The surgical approaches to remove displaced implants were the lateral approach (38.1%), the Caldwell–Luc approach (27.2%), and endoscopic nasal surgery (23.1%). This review highlights the importance of preventive measures: avoiding implant displacement by careful pre-implantation radiographic analysis, but also preventing infectious complications through early removal of the displaced implant (PROSPERO CRD42021279473).     

Satisfaction with dental implants: a literature review

Recent years have witnessed a consistent trend toward the introduction of patient assessment of different treatment outcomes in dental practice. Patient satisfaction with dental implants was considered among these treatment modalities. Few literature reviews have been published on this topic. This article critically analyzes the concerned topics related to patient satisfaction with dental implant. A MEDLINE search was completed from 1983 to 2004, along with a manual search, to locate related articles on the topic. Dental implants provided promising and predictable results regarding patient satisfaction and various aspects of life assessment.     

Immediate bleeding complications in dental implants: A systematic review

Objective: A review is made of the immediate or immediate postoperative bleeding complications in dental implants, with a view to identifying the areas of greatest bleeding risk, the causes of bleeding, the length of the implants associated with bleeding, the most frequently implicated blood vessels, and the treatments used to resolve these complications.Material and Methods: A Medline (PubMed) and Embase search was made of articles on immediate bleeding complications in dental implants published in English up until May 2014. Inclusion criteria: studies in humans subjects with severe bleeding immediately secondary to implant placement, which reported the time until the hemorrhage, the implant lenght, the possible cause of bleeding and the treatment. Exclusion criteria: patients receiving anticoagulation treatment.Results: Fifteen articles met the inclusion criteria. The area with the largest number of bleeding complications corresponded to the mandibular canine. The cause of bleeding was lingual cortical bone perforation during implant placement, with damage to the sublingual artery. The implants associated with bleeding were those measuring 15 mm in length or more. Management focused on securing the airway (with intubation or tracheostomy if necessary), with bleeding control.Conclusions: It’s important to pay special attention when the implants are placed in the mandibular anterior zone, especially if long implants are used. The most frequently cause of bleeding was the perforation of the lingual plate. Treatment involves securing the airway, with bleeding control. Key words:Hemorrhage, complications, immediate, bleeding, dental implants.     

Oral implants in radiated patients: a systematic review

PURPOSE: Oral malignancy is often treated with a combination of surgery and radiation therapy (RT). The aim of this systematic review was to examine the effects of pre- and postimplantation RT on dental implant failure. MATERIALS AND METHODS: The literature published from 1990 through 2006 was reviewed for studies assessing pre- and postimplantation RT. Potential studies were identified by searches of PubMed, SCIRUS, and the Cochrane Central Register of Controlled Trials (CENTRAL). The incidence of implant failure has been linked to the following variables: post- versus preimplantation RT, site of implant placement, RT dose, delay from RT to implant placement, and timing of implant failure after placement. RESULTS: Similar failure rates were found for implants placed post-RT compared to those placed pre-RT (3.2% and 5.4%). In preimplantation RT, the implant failure rate was lower for the mandible (4.4%) in comparison to the maxilla (17.5%; OR = 4.63; 95% CI: 2.25 to 9.49). Other results did not reach statistical significance. No failures were observed in association with an RT dose lower than 45 Gy. All implant failures observed occurred within 36 months after RT, and most occurred between 1 and 12 months after placement. CONCLUSION: Notwithstanding the low number of implants evaluated, this review showed similar failure rate for implants placed post-RT and those placed pre-RT (3.2% and 5.4%, respectively).     

Osseointegration of zirconia dental implants in animal investigations: A systematic review and meta-analysis

Objective

To determine the osseointegration rate of zirconium dioxide (ZrO₂) dental implants in preclinical investigations.

Stress amongst dental students: a systematic review

The present study was conducted to provide future researchers and dental educators with an overview of stress amongst undergraduate dental students reported in the literature. This overview is needed for the development of a new questionnaire measuring the level of stressors including students, staff and process of dental education. In addition, the review can be used to modify dental curricula to decrease such stress and produce better dentists. Our study consisted of a systematic review of 49 peer‐reviewed articles published between 1966 till October 2008 in English, discussing different aspects of stress amongst undergraduate dental students. These aspects are demographic variables of stress, sources of stress, impact of stress, indicators of stress, instruments measuring stress level and management of stress. Major sources of reported stress were related to examinations, clinical requirements and dental supervisors. Studies suggest using signs and symptoms for early detection of stress and proper intervention.     

Bioceramic in dental implants: A review

Biomaterials are non-drug substance suitable for inclusion in system which augment or replace the function of bodily tissue or organ. Orthopedic and dental applications represent approximately 55% of the total biomaterials market. Changes in biologic responses and device design have been the direct result of advances in material science. Bioceramics fulfill a unique function as biomedical materials. Bioceramics are non-toxic and bioinert, bioactive or bioresorbable. Bioceramics continue to be vital for bone repair and uncemented implant fixation with recent advances in its composition and coating technology.     

Ailing and failing endosseous dental implants: a literature review

Although the overall success rate of implant dentistry is very high, dental implants occasionally fail. It is essential for the clinician to recognize unhealthy implants and to determine whether they are ailing, failing, or failed prior to beginning any salvage efforts. Ailing and failing implants are amenable to therapy. Implants diagnosed as failed should be removed. This review provides the reader with information on non-surgical and surgical therapies available for managing ailing and failing implants. Undoubtedly, the best steps to avoid encountering ailing or failing implants involve proper case selection, excellent surgical technique, placing an adequate restoration on the implant, educating the implant patient to maintain meticulous oral hygiene, and evaluating the implant both clinically and radiographically at frequent recall visits.     

Success rate of dental implants inserted in horizontal and vertical guided bone regenerated areas: a systematic review

This study assessed the success rate of implants placed in horizontal and vertical guided bone regenerated areas. A systematic review was carried out of all prospective and retrospective studies, involving at least five consecutively treated patients, that analysed the success rate of implants placed simultaneously or as second surgery following ridge augmentation by means of a guided bone regeneration (GBR) technique. Studies reporting only the survival rate of implants and studies with a post-loading follow up less than 6 months were excluded. From 323 potentially relevant studies, 32 full text publications were screened and 8 were identified as fulfilling the inclusion criteria. The success rate of implants placed in GBR augmented ridges ranged from 61.5% to 100%; all studies, apart from three, reported a success rate higher than 90% (range 90-100%). The data obtained demonstrated that GBR is a predictable technique that allows the placement of implants in atrophic areas. Despite that, studies with well-defined implant success criteria after a longer follow-up are required.