Clinical Outcome and Bone Preservation of Single TiUnite™ Implants Installed with Flapless or Flap Surgery

Background: Flapless, free‐handed implant surgery offers advantages for patient comfort, but studies on long‐term clinical success based on marginal bone loss are scarce. Aim: The aim of this study was to compare single implants installed with a flap (F) or flapless (FL) surgery with respect to survival and marginal bone preservation after at least 3 years. Materials and Methods: Fifty‐three TiUnite? Brånemark implants, installed in 49 patients (27 females; 22 males; mean age 53 years) were examined. Then, 25 F and 28 FL were delayed loaded; bone level from the abutment‐implant level was measured on intraoral radiographs. From 44 (21 F, 23 FL), 31 (18F, 13FL), and 36 (18 F, 18 FL) implants, radiographs were available at baseline and after 1 and 3 years of function. Results: The overall survival rate was 100% and the overall mean bone loss after an average of 38 months was 1.35 mm (SD 0.91; range 0–3.7). Both F and FL showed increasing bone loss during the first year with a higher bone loss for FL than for F sites (p < .01). Afterward, no further bone loss occurred and both groups were statistically equal (p > .7). On individual implant level, nearly 80% in both F and FL were considered a success showing bone loss between 1.5 and 1.9 mm. Conclusions: Single implants yield an excellent prognosis with stable bone levels irrespective of the surgical technique, and free‐handed flapless surgery is a viable alternative to more extensively planned guided surgery. Proper case selection and clinical experience are considered prerequisites for a predictable treatment outcome.     

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.     

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.     

Soft Tissue Conditions and Marginal Bone Changes around Immediately Loaded Implants Inserted in Edentate Jaws Following Computer Guided Treatment Planning and Flapless Surgery: A ≥1‐Year Clinical Follow‐Up Study

Background: Evaluation of the clinical conditions following computer guided treatment planning and flapless surgery is still limited. Objectives: The objective was to evaluate the soft tissue conditions and marginal bone changes after 1 year of function around immediately loaded implants inserted in edentate jaws following computer guided treatment planning and flapless surgery. Material and Methods: Twenty‐nine edentate jaws (19 maxillae, 10 mandibles) treated with 165 implants using the Teeth‐in‐an‐Hour? protocol were included. In these patients, peri‐implant soft tissue conditions and radiographic marginal bone changes were evaluated after ≥1 year of functional loading (mean: 19 months). Results: The mean probing depth at case level was 2.6 mm (SD: 0.6). Bleeding on probing was recorded as a mean of 81.9% (SD: 23.0). Plaque index showed a wide range of 0–100%. The mean marginal bone change of measured sites evaluated on intraoral radiographs was ?1.2 mm (SD: 1.4). A marginal bone loss more than 1.5 mm or 2.0 mm was observed in 42% and 27% of the measured sites, respectively. A pressure‐like‐ulcer was found in 9 cases. Implants with marginal bone loss of >1.5 mm were more frequently observed in cases with an ulcer than cases where no ulcer was found. Conclusion: Although the mean marginal bone loss after function in the present study was within the range of other reports presenting mean bone loss data after immediate implant loading, our patients showed a wide range of bone loss with several sites, where the bone loss was greater than the commonly used successful level (>1.5 mm).     

A Retrospective Analysis of Early and Immediately Loaded Osseotite Implants in Cross‐Arch Rehabilitations in Edentulous Maxillas and Mandibles Up to 7 Years

Background: Immediate loading of full‐arch restorations yields good results in selected cases, but long‐term follow‐up and the outcome in compromised bone are scarcely evaluated. Purpose: To evaluate immediately loaded Osseotite implants (Biomet 3i, Palm Beach, FL, USA) installed in healed or grafted bone, with regard to implant survival and peri‐implant bone loss up to 7 years in function. Materials and Methods: Information was retrospectively retrieved from 83 patients' records with 749 Osseotite implants supporting immediately loaded semipermanent full‐arch acrylic restorations. Five hundred sixty‐eight (75.8%) implants were placed in healed bone and 181 (24.2%) in augmented bone, regenerated with sinus lifting and/or onlay/inlay grafts with/without biomaterials and membranes. Implant survival and success based on radiological peri‐implant bone loss were registered. Wilcoxon rank sum tests evaluated peri‐implant bone loss in compromised versus healed bone or between jaws or time intervals with p < .05 as statistically significant. Results: Sixteen of 749 implants failed (2.1%), 11/343 in maxilla (3.2%) and 5/406 (1.2%) in mandible. After 7 years, the cumulative failure rate was 9%. Mean peri‐implant bone loss increased to 1.2 mm (SD 1.0) during the first 2 years but remained unchanged thereafter. Around implants in grafted bone, on average, 0.3 mm more bone loss was found. Conclusion: The Osseotite implants offer a predictable long‐term outcome in terms of implant survival and stable peri‐implant bone under immediate loading even in grafted bone. However, the high incidence of technical repair because of fractures of the semipermanent provisionals requires attention because it may be negative from a cost‐benefit perspective. Implants in grafted bone show a tendency to a more pronounced initial bone remodeling without clinical consequence in the long term.