Immediate maxillary lateral incisor implants with nonocclusal loading provisional crowns.

This clinical report series describes a treatment modality involving immediately placed dental implants in maxillary lateral incisor sites using noncemented immediate provisional crowns retained with calcinable copings (prosthetic complement used in preparing the metal for the definitive prosthesis). Ten implants were placed in eight patients for the replacement of maxillary lateral incisors: two immediate and eight corresponding to cases of agenesis. All were subjected to immediate rehabilitation with provisional acrylic resin crowns in nonocclusal loading. One implant failed 3 weeks after placement due to acute local trauma. The other nine remained functional within the mouth, with normal clinical and radiological characteristics after a minimum of 12-month follow-up. Immediate placement of implant fixed provisional restorations retained by friction in maxillary lateral incisors offers an esthetic solution, eliminates the need for a removable provisional restoration, and avoids implant failures associated with excess cement or screw loosening. Moreover, in the case of extractions, immediate placement and provisionalization of implants in maxillary lateral incisors can effectively optimize the peri-implant esthetic results by maintaining the existing hard and soft tissue architecture of the replaced tooth. As no cement or screws are required, and the provisional crowns are placed in nonocclusal loading, the risk of complications is minimized.     

Delayed immediate implants: alveolar bone chamzes durinrr the healing period

Delaying the placement of immediate fixtures by 6–8 weeks after extraction of the natural dentition allows for the elimination of associated infective processes, the achievement of maximum osteoblastic activity that theoretically could help the osseointegration process and complete wound covering that simplifies the placement of grafts or membranes. This study examines the healing associated with 21 fixtures in 14 patients. The fixtures were placed into sockets 6–8 weeks after tooth extraction without the use of barrier membranes or bone substitutes. Measurements were taken immediately prior to fixture placement and 3–6 months later at the abutment placement. Alveolar bone height, the remaining socket depth and diameter and the depth to which a 3.75 mm fixture could be inserted into the socket were measured. After fixture placement the vertical and horizontal measurements from the cover screw to the surrounding alveolar bone and the distance from the cover screw to the CEJ of the adjacent tooth were recorded. All fixtures were integrated at exposure with 1 failure during the follow-up period. The distance from the cover screw to the buccal plate decreased by a mean of 2.17 mm. There was an increase in the mean vertical bone height at all 4 surfaces. When horizontal defects were present, the mean vertical distance decreased from 2.5±0.37 mm to 0.36±0.64 mm. When horizontal defects were absent, the mean vertical distance decreased from 3.86±0.58 mm to 0.48±0.25 mm. There was also a marked decrease in the horizontal distance between the bone margin and the surface of the fixture from 1.6±l.73 mm 1 to 0.02±0.02 mm. These results indicate a strong tendency for the defects to fill-in in the horizontal plane and for bone growth to occur in the vertical plane to the height of the cover screw. In conclusion the delayed immediate placement of fixtures has a good short-term prognosis with bone regeneration occurring around the defect without the use of barrier membranes or bone substitutes.     

Two-year prospective clinical comparison of immediate replacement vs. immediate restoration of single tooth in the esthetic zone

Aim: To compare the immediate restoration of single implants in the esthetic zones performed on implants placed immediately after tooth extraction or 8 weeks later (immediate replacement vs. immediate restoration). Methods: Sixteen patients (10 women and 6 men) with a mean age of 35 years (ranging from 21 to 49 years old) were treated from 2004 to 2005 for single‐tooth replacement in the upper arch. The patients were randomly divided into two groups: in the test group patients received implants placed and restored (non‐occlusal loading) at the time of tooth extraction; in the control group implants were placed 8 weeks after tooth extraction and immediately restored. All the patients received tapered effect (TE) implants from the Straumann Dental Implant System. The following parameters were evaluated at the moment of provisional restoration (within 48 h after implant placement) and at the 2 years follow‐up visit: marginal bone resorption, papilla index, position of the mucosal margin. The implant stability quotient was measured at the moment of implant placement and at the moment of the delivery of the definitive restoration. Results: No statistically significant differences were found in any of the studied parameters between the test and the control groups (P>0.05). The implant stability quotient values between the test and control groups were significant (P<0.05) at the moment of implant placement but were no more significant at the loading of the definitive restoration (P>0.05). Conclusion: The results of the present study suggest that immediate replacement without functional loading may be considered a valuable therapeutic option for selected cases of single‐tooth replacement in the esthetic area when TE implants are used. Implant stability at the moment of implant placement is slightly inferior in the immediate replacement group, but it does not affect the treatment result.     

Immediate occlusal loading and tilted implants for the rehabilitation of the atrophic edentulous maxilla: 1-year interim results of a multicenter prospective study

OBJECTIVES: 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 fully edentulous maxillae and to compare the outcome of axial vs. tilted implants. MATERIAL AND METHODS: Forty-one patients with edentulous maxillae were included in the study. Each patient received a full-arch fixed bridge supported by four axial implants and two distal tilted implants. Loading was applied within 48 h from surgery. Patients were scheduled for follow-up at 6 months, 1 year and annually up to 5 years. Radiographic evaluation of marginal bone-level change was performed at 1 year. RESULTS: One patient died 4 months after surgery. Thirty patients were followed for a minimum of 1 year (range 3-42 months, mean 22.1 months). Three failures were recorded at 1-year follow-up (two axial implants and one tilted). Two more implants (one tilted and one axially placed) were lost within 18 months of loading. The 1-year implant survival rate was 98.8% for both axial and tilted implants. Prosthesis success rate was 100% at 1 year. Marginal bone loss around axial and tilted implants at 12-month evaluation was similar, being, respectively, 0.9+/-0.4 (standard deviation) mm and 0.8+/-0.5 mm. CONCLUSIONS: The present preliminary data suggest that immediate loading associated with tilted implants could be considered to be a viable treatment modality for the atrophic maxilla and that there does not seem to be a different clinical outcome between tilted and axial implants.     

Provisional implants: a clinical prospective study in 45 patients, from implant placement to delivery of the final bridge

Background: Protocols for submerged healing of dental implants often require the patient to have no teeth until suture removal and to wear a removable prosthesis during the remaining healing period. This may be inconvenient for the patient, and healing may be influenced negatively by the removable prosthesis. Purpose: The aim of the present prospective clinical study was to evaluate the use of provisional implants (PIS) to provide patients with a provisional fixed bridge during the healing of permanent implants. Materials and Methods: Twenty female and 25 male patients were consecutively included in the study. The 45 patients were treated for either partial (16 patients) or total (29 patients) edentulism in the maxilla. The permanent implants were placed first; as many PIS as possible were then installed between the permanent implants. After suturing, impressions from which to manufacture provisional bridges (to be cemented to the PIS) were taken. The patients were monitored with clinical and radiographic follow‐up from implant placement to delivery of the final prosthesis. Results: Five (2.2%) of the 230 permanent Brånemark System® implants (Nobel Biocare AB, Gothenburg, Sweden) did not integrate. None of the failures could be related to the presence of PIS between the permanent implants. Seven PIS failed during the observation period. In addition, 17 (9%) of the 192 PIS showed mobility at the second‐stage surgery although they had supported the provisional bridges without clinical symptoms. Forty‐four of 45 patients showed stabile PI bridges at the time of second‐stage surgery. Conclusion: Based on our experiences we concluded that provisional implants can be successfully used to provide patients with a fixed provisional bridge during the healing of permanent implants.     

Immediate loading of single-tooth ITI implants in the anterior maxilla: a prospective 5-year pilot study

The aim of the present study was to evaluate the success rate of immediately loaded single-tooth ITI solid plasma-sprayed (TPS) implants in the maxilla. Eight implants were loaded immediately after placement in eight different patients, and were followed for five years. Temporary acrylic resin restorations, which were fabricated from impressions that were taken immediately after implant placement, were connected one week later. These temporary restorations were adjusted in order to avoid any direct occlusive contacts. After six months, the provisional crowns were replaced by definitive ceramic crowns. Regular follow-ups were performed during the investigation period. No implants were lost, and the mean marginal bone level for the eight implants increased by 0.53 mm (range - 0.83 to + 1.54 mm) from placement to the final examination. Only minor complications were noted, and overall patient satisfaction was high.     

Tilted Implants for the Rehabilitation of Edentulous Jaws: A Systematic Review

Purpose: The aim of this review was to evaluate the survival rate of upright and tilted implants supporting fixed prosthetic reconstructions for the immediate rehabilitation of partially and fully edentulous jaws, after at least 1 year of function. Materials and Methods: An electronic search of databases plus a hand search on the most relevant journals up to December 2009 was performed. The articles were selected using specific inclusion criteria, independent of the study design. Results: The literature search yielded 347 articles. A first screening based on the title and abstract identified 25 eligible studies. After full‐text review of these studies, 10 articles were selected for analysis. Seven were prospective single‐cohort studies and three had a retrospective design. A total of 462 patients have been rehabilitated with 470 immediately loaded prostheses (257 in the maxilla, 213 in the mandible), supported by a total of 1,992 implants (1,026 upright and 966 tilted). Twenty‐five implants (1.25%) failed in 20 patients within the first year. All failures except one occurred in the maxilla. No significant difference in failure rate was found between tilted and upright implants, nor between maxillary and mandibular implants. No prosthesis failure was reported. Limited peri‐implant bone loss was reported with no difference between upright and tilted implants. Full patients' satisfaction for function, phonetics, and esthetics was reported in three studies, based on questionnaires. Conclusions: The use of tilted implants to support immediately loaded fixed prostheses for the rehabilitation of edentulous jaws can be considered a predictable technique, with an excellent prognosis in the short‐medium term. However, randomized long‐term trials are needed to determine the efficacy of this surgical approach.     

即刻种植的研究现状

<正>自瑞典Brnemark教授提出了骨结合的理论以来,"骨结合式钛种植体"已日渐成为一种常用的修复牙齿和牙列缺失的治疗方法,经十年以上的多中心跟踪研究显示,其成功率大于90%。经典的牙种植修复程序,要求患者在拔牙后3个月以上接受牙种植体植入术,植入后还要再等3～6个月行二期手术,整个治疗过程周期较长,部分患者不能接受。另外,患者拔牙后牙槽嵴存在一个进行性骨吸收过程,     

In-patient comparison of immediate and conventional loaded implants in mandibular molar sites within 12 months

Objectives: The aim of this prospective clinical study was to evaluate the clinical outcomes of dental implants placed in the mandibular molar sites and immediately functionally restored compared with conventionally loaded controls in an in‐patient study. Material and methods: Twenty‐four dental implants were placed in 12 patients who had first molar loss bilaterally in the mandibular area. One site of the patient was determined as immediately loaded (IL) and the other side was conventionally loaded (CL). Resonance frequency analyses for implant stability measurements, radiographic examinations for marginal bone levels and peri‐implant evaluations were performed during the clinical follow‐up appointments within 12 months. Results: During the 12‐month follow‐up period, only one implant was lost in the IL group. The mean implant stability quotient values were 74.18±5.72 and 75.18±3.51 for Groups IL and CL at surgery, respectively, and the corresponding values were 75.36±5.88 and 75.64±4.84 at 1‐year recall, respectively. The difference was not statistically significant between the two groups during the 12‐month study period (P>0.05). When peri‐implant parameters were evaluated, excellent peri‐implant health was demonstrated during the 1‐year observation period and all implants showed less than 1 mm of marginal bone resorption during the first year. Conclusions: In the present study, immediate functionally loading did not negatively affect implant stability, marginal bone levels and peri‐implant health when compared with conventional loading of single‐tooth implants.     

The establishment of a protocol for the total rehabilitation of atrophic maxillae employing four zygomatic fixtures in an immediate loading system--a 30-month clinical and radiographic follow-up

Background: The existing approaches to the treatment of the atrophic maxilla are difficult and involve an element of risk. Purpose: The aim of the present study was to establish a new surgical/prosthetic protocol for the treatment of extremely atrophic maxillae using four zygomatic implants (ZIs) in an immediate loading system. Materials and Methods: Twelve patients were treated with the surgical placement of 48 ZIs, and the totally edentulous maxillae were rehabilitated with protocol‐type maxillary prostheses rigidly fixed to the ZIs in an immediate loading system. Follow‐up was conducted at 6 months and again at 30 months. Results: Of the 48 ZIs inserted, one implant failed to achieve osseointegration. The prosthetic components fitted well and no sinus pathology was detected in any of the patients. Conclusion: The surgical/prosthetic protocol showed that it was possible to insert four ZIs in an immediate loading system and achieve stability for up to 30 months.     

Ridge alterations following immediate implant placement in the dog: flap versus flapless surgery

Objective: To assess the healing process after flap or flapless surgery in immediate implant placement.
Material and Methods: This study was carried out on five Beagle dogs. Four implants were placed in the lower jaw in each dog immediately after tooth extraction. Flap surgery was performed before the extraction on one side (control), and flapless on the contrary (test). After 3 months of healing, the dogs were sacrificed and prepared for histological analysis.
Results: Ten implants were placed in each group. Two failed (one of each group). The percentage of bone–implant contact was very similar in both groups: 64.8% and 65.1% for the flap and the flapless group, respectively. The difference between the mean distance from the peri-implant mucosa margin to the first bone–implant contact at the buccal aspect was statistically significant between both groups (3.02 mm. flapless and 3.69 mm. flap group). The mean first bone–implant contact at the buccal aspect was located in relation to the sand-blasted and acid-etched level at 0.82 mm for the flapless group and 1.33 mm for the flap group. This difference was not statistically significant.
Conclusion: Flapless immediate implant surgery produces a significant reduction in the vestibular biologic width and a minor reduction in buccal bone plate resorption.     

Efficiency of immediately loaded mandibular full-arch implant restorations

Background: The concept of immediately loading dental implants in fully edentulous patients offers patients many benefits, including the ability to eat post placement and improved comfort during healing. This approach may also minimize the number of patient visits when compared with the traditional approach of implant placement and healing over a 3‐ to 4‐month healing period. Purpose: The aim of this study was to compare the number of treatment visits for patients undergoing traditional implant placement and healing with that of patients receiving immediate implant loading prior to construction of the definitive prostheses. Materials and Methods: This case series evaluated two patient groups. Group 1 consisted of seven patients who were edentulous in the mandible. After implant placement, the implants were covered by oral mucosa during 3 to 4 months of healing. During this time patients wore relined mandibular dentures. Group 2 consisted of seven patients who had their implants immediately loaded with fixed prostheses on the day of implant placement. Results: The implants in both groups were integrated successfully; however, the number of patient visits between implant placement and construction of the definitive prostheses was 38 in the conventionally loaded group and 1 in the immediately loaded group. Conclusions: The group with immediate loading required significantly fewer postoperative visits compared with the conventionally loaded group.