Brown S.D.K., Payne A.G.T., Immediately Restored Single Implants in the Aesthetic Zone of the Maxilla Using a Novel Design: 1 year report Clinical Implant Dentistry & Related Research 2011, Issue. 22, p. 445-454.
OBJECTIVE: To evaluate immediate placement and immediate restoration of a novel implant with a 121-angled prosthodontic platform, in fresh extraction sockets of the aesthetic zone of the maxilla.
MATERIALS AND METHODS: Tapered, roughened surface implants of 4mm (n=15) or 5mm (n=13) diameter were placed in 27 participants (mean age: 47.1 years; range: 21–71 years) requiring an immediate replacement of single anterior maxillary teeth. Provisional screw-retained all-ceramic crowns were placed within 4 h following optical impressions. At 8 weeks (baseline), definitive screw retained all-ceramic crowns were placed in occlusion.
RESULTS: Twenty-six of the 28 implants met the inclusion criteria at surgery. Marginal bone levels revealed bone gain between surgery and baseline, and between baseline and 1 year of 0.2 mm (SD 0.75) and 0.78mm (SD 2.45). Mean mid-buccal mucosal margins showed gains of 0.2 mm (SD 0.44). Prosthodontic maintenance and the aesthetics of the screw-retained implant crowns were facilitated by the external hex 121-angled prosthodontic platform on the novel implant design, re-orientating the access cavity to the palatal or occlusal surfaces. All-ceramic implant crowns showed a high success rate with low maintenance issues over 1 year.
CONCLUSION: Tapered, roughened-surfaced implants with a novel 12°-angled prosthodontic platform immediately placed in fresh extraction sockets, immediately restored with provisional crowns and subsequent definitive crowns at 8 weeks were successful for 1 year.
Alsabeeha N.H., Payne A.G.T., DeSilva R.K., Thomson W.M. Mandibular single-implant overdentures: preliminary results of a randomized-control trial on early loading with different implant diamteters and attachment systems Clinical Implant Dentistry & Related Research 2011, Issue 22, p. 330-337.
OBJECTIVES: To determine surgical and prosthodontic outcomes of mandibular single-implant overdentures, opposing complete maxillary dentures, using a wide diameter implant and large ball attachment system compared with different regular diameter implants with standard attachment systems.
MATERIALS AND METHODS: Thirty-six edentulous participants (mean age 68 years, SD 9.2) were randomly assigned into three treatment groups (n¼12). A single implant was placed in the mandibular midline of participants to support an overdenture using a 6- week loading protocol. The control group received Southern regular implants and standard ball attachments. One group received Southern 8-mm-wide implants and large ball attachments. Another group received Neoss regular implants and Locator attachments. Parametric and non-parametric tests of a statistical software package (SPSS) were used to determine between groups differences in marginal bone loss, implant stability, implant, and prosthodontic success (Po0.05).
RESULTS: Implant success after 1 year was 75% for Southern regular implant (control) group; and 100% for the Southern wide and Neoss regular implant groups (P¼0.038). Mean marginal bone loss at 1 year was 0.19mm(SD 0.39)without significant differences observed. Implant stability quotient (ISQ) at baseline was significantly lower for the Southern regular (control) group than the other two groups (P¼0.001; P¼0.009). At 1 year, no significant difference in implant stability was observed (mean ISQ 74.6, SD 6.1). The change in implant stability from baseline to 1 year was significant for the control group (P¼0.025). Prosthodontic success was comparable between the groups but the maintenance (41 events overall, mean 1.2) was greater for the Locator and the standard ball attachments.
CONCLUSIONS: Mandibular single-implant overdentures are a successful treatment option for older edentulous adults with early loading protocol using implants of different diameters and with different attachment systems.
Vandeweghe S., Deferrerre R., Tschakaloff A., DeBruyn H.A. Wide-Body implant as as an Alternative for Sinus Lift or Bone Grafting International Journal of Oral Maxillofacial Implants 2011, June, Issue 69, Vol. 6, p. e67-74 (Epub 2011 Mar 21).
PURPOSE: The aim was to evaluate the outcome of a short wide-body implant in the atrophic posterior jaw without a grafting procedure.
MATERIALS AND METHODS: Patients treated with a tapered wide-body implant measuring 8 to 9 mm in width and 7 to 9 mm in length (Max implant; Southern Implants, Irene, South Africa) were recalled to scrutinize implant survival. Preoperative cone beam computed tomography images were analyzed to measure bone height in reference to the mandibular canal and sinus floor.
RESULTS: There were 57 implants inserted in 18 men and 24 women after a 2-stage procedure and delayed loading. The mean follow-up was 15 months (SD, 10; range, 1-32 months), with 63.2% of the implants having at least 1 year of follow-up and 26.3% having at least 2 years' follow-up. Forty-six implants were inserted in the posterior maxilla and eleven in the mandible. Fifteen were placed in an extraction socket and forty-two in healed bone. Thirteen implants were supporting a single crown. Two implants failed, resulting in a survival rate of 96.5% with rates of 90.9% and 97.8% for mandible and maxilla, respectively. This was not affected by gender, jaw, immediate or delayed placement, implant diameter and length, or use of a bone substitute. The mean preoperative bone height was 7.21mm in maxilla and 8.76mm in mandible. In 41 cases implant length surpassed available bone height.
CONCLUSION: Despite the comprised cone condition and height, the survival rate of 96.5% is comparable to normal implants and, therefore, placing a wide-body implant may be an alternative to avoid grafting procedures. This is probably related to the enlarged implant surface area and the good primary stability.
Atieh A.A./Payne A.G.T., Duncan W.J., deSilva R.K., Cullinan M.P. Immediate Placement or Immediate Restoration/Loading of Single Implants for Molar Tooth Replacement: A Systematic Review and Meta-Analysis International Journal of Oral Maxillofacial Implants 2010; Issue 1, Vol. 25, p. 401-415.
PURPOSE: This systematic review and meta-analysis assessed the survival of immediately placed single implants in fresh molar extractions sites and immediately restores/loaded single molar implants in healed molar sites.
MATERIALS AND METHODS: A search of the main electronic databases, including the Cochrane Oral Health Group's Trails Register, was conducted up to November 1, 2008. The meta-analysis was prepared in accordance with the guidelines of the Academy of Osseointegration Workshop on the State of the Science on Implant Dentistry. The data were analyzed with statistical software.
RESULTS: For immediately placed molar implants, nine studies describing 1,013 implants were included to support a survival placed of 99.0%. there were no significant differences between immediate and delayed loading/restoration in molar sites (relative risk of 0.30, 95% confidence interval 0.05 to 1.61; P -.16). For immediate restoration/loading of single in healed molar sites, seven studies with 188 single implants were identified. In the case, the implant survival rate was 97.9%, with no difference between immediate and delayed loading (relative risk of 3.0, 95% confidence interval: 0.33 to 27.16; P =.33). Favorable marginal bone level changes in the immediate loading group were detected at 12 months (mean difference of 0.31, 95% confidence interval: -0.53 to -0.096; P =.005).
CONCLUSION: The protocols of immediate placement restoration/ loading of single implants in mandibular molar regions showed encouraging results.
Alsabeeha N.H., DeSilva R.K., Thomson W.M., Payne A.G.T. Primary stability measurements of single implants in the middle of the edentulous mandible for overdentures Clinical Implant Dentistry & Related Research 2010, Issue 21, p. 563-566.
OBJECTIVES: To determine the primary stability of the Southern wide diameter (8mm) implants, Neoss regular diameter (4mm) implants, and Southern regular diameter (3.75mm) implants placed in the midline of edentulous mandibles for single-implant overdentures. Variables related to host site and implant characteristics were investigated to determine their influence on the primary stability of the implants.
MATERIALS AND METHODS: A total of 36 implants were placed in the midline symphysis of the edentulous mandibles of 36 participants. Their primary stability was then measured using the magnetic Osstell mentor device. Analysis of variance (ANOVA) was used to compare the mean implant stability quotient (ISQ) scores with one-way ANOVA for multiple comparisons.
RESULTS: The highest measurement (ISQ) of primary stability was for the Southern 8mm wide diameter implants (84.8, SD9.8), followed by the Neoss 4mm regular diameter (82.3, SD4.8) implants and the Southern 3.75mm regular diameter implants (75.3, SD8.4), respectively. The Southern 3.75mm regular diameter implants had a significantly lower mean ISQ value than the same system 8mm wide diameter (P¼0.004) and the Neoss 4mm regular diameter implants (P¼0.03). No significant differences were observed between the 8mm and the 4mm diameter implants (P40.05).
CONCLUSIONS: Host-site variables such as age, gender, bone volume, and quality do not appear to influence the primary stability of the implants. No clear correlation was established between ISQ values and implant diameter.
Vandeweghe S., Hattingh A., Wennerberg A., De Bruyn H., Surgical protocol and clinical outcome of immediate placement in molar extraction sockets using a wide body implant International Journal of Oral Maxillofacial Implants 2009, 24 Suppl., p.186-217.
INTRODUCTION: Immediate implant placement offers some advantages over delayed placement, such as reduced treatment time and number of surgical interventions. However, implant placement on molar extraction sockets can be difficult due to complex multi-root anatomy and the lack of predictable primary stability.
AIM: To evaluate retrospectively the outcome of an 8-9 mm diameter tapered implant, designed to be placed in molar extraction sockets.
MATERIALS AND METHODS: Patients treated at least 1 year before with a Max® implant (Southern Implants, Irene, South Africa) were invited for a clinical examination. Variables collected were surgical and prosthetic protocol, implant dimension and smoking habits. Peri-implant bone level was determined on peri-apical radiographs and compared to baseline, immediately after implant insertion.
RESULTS: In total, 89 patients representing 98 immediately placed implants were invited for examination. One implant had failed, resulting in a survival rate of 99%. 38 patients representing 47 implants (26 maxilla, 21 mandible) were available for clinical examination. All implants reached a stability of over 50Ncm when placed. Mean bone loss was 0.38 mm (SD 0.48; range -0.50 – 1.95) after a mean follow-up period of 20 months (SD 5.75; range 12-35). Overall implant success according to Albrektsson & Zarb (1994) was 97.9%. Around 30 implants, a bone substitute was used to fill the residual space. Bone loss was only significantly different between maxilla and mandible (0.48 mm vs. 0.27 mm) and between the 8 and 9 mm diameter implants (0.23mm vs. 0.55 mm). A full papilla was present at 71% of the inter-proximal sites.
CONCLUSION: The Max® implant demonstrated good primary stability when placed in molar extraction sockets, with limited bone loss over time.
Elian N. Special Report: Implants Compendium of Continuing Education in Dentistry Compendium 2009, September, Issue 7, Vol. 30, p. 455-458.
Vandewedhe S., Ackermann A., Bronner J., Hattingh A., Tschakaloff A., DeBruyn H., A Retrospective, Multicenter Study on a Novo Wide-body Implant for Posterior Regions Clinical Implant Dentistry & Related Research 2009, DOI: 10.1111/p. 1708- 8208.2009.00253 (Epub ahead of print).
BACKGROUND: Wide implants are recommended as "rescues" after failure to increase primary stability in extraction sockets or in poor quality bone. consequently, inferior results compared with regular diameter implants have been reported.
PURPOSE: The Purpose of the is study was to evaluate retrospectively the outcome of a novo wide-body implant (MAX® implant, Southern Implants®, Irene, South Africa) designed for placement in the posterior regions.
MATERIALS AND METHODS: In four private practices, patients with at least one MAX implant were examined by two independent examiners to determine implant survival and marginal bone loss. Surgical, prosthetic, and patient related parameters were evaluated to determine their influence on the treatment outcome.
RESULTS: Seventy-five patients (31 male, 44 female), with a mean age of 58 years, received 93 MAX implants (59 maxilla, 34 mandible) of 8 to 10 mm width. Twenty-seven implants in molar extraction sockets and two in mature bone were immediately loaded; 42 in extraction sockets and 22 in mature bone were delayed loaded. The mean follow-up was 14months (6-34), and four implants failed (4.3%); mean bone loss after 1 year was 0.46 mm (SD 1.08; range-5.45-3.25). A total of 91.4% lost ≤1.5mm during the first year. time of placement, time of loading surgical protocol, or prosthetic design did not affect the outcome.
CONCLUSION: Within the limitations of the study, the MAX implant demonstrated a survival rate of 95.7% and stable bone conditions after 1 year, irrespective of loading or surgical protocol. Future prospective studies are needed to evaluate the soft and hard tissue changes in time.
Vandewedhe S., De Bruyn H, The Effect of Smoking on Early Bone Remodeling on Surface Modified Southern Implants Clinical Implant Dentistry & Related Research 2009, September, vol. 9999, no. 9999, p.1523-0899 (Epub ahead of print)
INTRODUCTION: Smoking affects the survival of turned titanium implants. Although smoking has less impact on the failure rate of rough surface implants, the effect on bone loss on rough surface implants has not been studied yet and may be an important factor in biological stability.
AIM: To determine the effect of smoking on early implant failures and bone remodeling around moderately rough implants (Southern Implants®, Southern Implants, Irene, South Africa).
MATERIALS AND METHODS: Three hundred twenty-nine patient records, containing information on 712 installed implants, were scrutinized retrospectively and periapical radiographs were analyzed for interproximal bone level. Mann-Whitney U-test and Fisher's exact test were performed to compare bone level and implant survival in smokers and nonsmokers. Only implants with at least 6 months of function time were analyzed for bone level changes.
RESULTS: The overall survival rate was 98.3%. Implants in smokers had a threefold higher failure rate compared with nonsmokers (5/104=4.8% vs 7/608=1.2%). This was statistically significant on implant level (p = .007) but not on patient level (1/41 vs 7/288, p = .997). Readable radiographs from 363 implants in 169 patients were available with a mean follow-up of 12 months (SD 5.11; range 6-28). The mean interproximal bone level was 1.36 mm (n=363; SD 0.41; range 0.48-3.70). Bone levels were independent of jaw location. Sixty implants from 21 smokers lost statistically significantly (p=.001) more bone (mean 1.56; SD 0.53; range 0.75-3.22) than the 303 implants in 148 non smokers (mean 1.32 mm; SD 0.38; range 0.48-3.7). The maxilla is especially prone to bone loss compared with the mandible (1.70 mm vs 1.26 mm, p<.001).
CONCLUSION: The Southern Implants® system demonstrated a high absolute survival rate. Although smokers are not more prone to implant loss, more pronounced peri-implant bone loss was observed, especially in the maxilla. Whether this affects future biological complications remains to be investigated in prospective long-term studies.
Kurtzman G.M., Dompkowski Case report: Immediate Molar Placement with Southern Implants MAX Implant AAID AAID Annual Meeting, 2008, November, Issue 1, Vol.1.
CONCLUSION: The MAX implants from Southern Implants permits immediate placement into extraction molar sites. As this implant is able to achieve initial primary stability filling the extraction socket, the need for socket grafting is greatly reduced and this shortens the treatment time associated with molar extraction sites in the observed delayed implants placement approach.
Kurtzman G.M., Dompkowski D.F., Mahler B.A., Howes D.G., Off-Axis Implant Placement for Anatomical Considerations Using the Co-Axis Implant Inside Dentistry, 2008, May, Issue 5, Vol. 4, p. 96-102.
CONCLUSION: The use of tilted implants is being advocated by an increasing number of clinicians. Numerous possible benefits of the tilted placement of implants are found in the literature, including: significant reduction of bone grafting procedures resulting in shorter total treatment time, less patient morbidity, decreased cost, and possible immediate or early restoration which otherwise might be precluded when used in conjunction with most bone-grafting procedures; an increase in anterior-posterior spread, resulting in a more stable prosthesis; the elimination or shortening of cantilevers; the avoidance of various anatomical structures; and the facilitation of screw retention and common path of draw of implant-supported prostheses. Placement of tilted implants into the patient's available bone is usually easier for the surgeon than additional grafting procedures, with less morbidity. One possible disadvantage of the tilted placement of conventional dental implants is that they usually become more difficult to restore. Anatomical considerations may complicate the prosthetic phase of implant treatment. When using cemented restorations, costly custom abutments with extreme angles are often required. These angles often take up valuable space, potentially creating esthetic and/or soft tissue complications. In screw- retained cases, costly angled intermediate abutments create the same potential problems and also have a second, smaller-diameter screw. A recently developed solution to the difficulty in restoring tilted implants is the Co-Axis implant, with its 12° prosthetic axis correction built into the implant itself. This implant, therefore, helps to simplify the restoration of tilted implants, as it can overcome these issues permitting shorter treatment times and lower treatment costs. Therefore, the surgical dentist has the ability to place the implant in an ideal position and rotate it so that the restorative platform is in a position for easier restoration.
Esposito M., Murray-Curtis L., Grusovin M.G., Coulthard P., Worthington H.V., Cochran Study Cochrane Database of Systematic Reviews John Wiley & Sons Ltd. Chichester, UK DOI: 10.1002/14651858.CD003815.pub3, 2007, No. 4.
Hall J.A., Payne A.G., Purton D.G., Torr B, Duncan W.J., De Silva R.K., Immediately Restored, Single-Tapered Implants in the Anterior Maxilla: Prosthodontic and Aesthetic Outcomes after 1 Year. Clinical Implant Dentistry & Related Research 2007, March, Issue 1, Vol. 9, p.34-45.
BACKGROUND: Conventional implant protocols advocate a two-stage technique with a load-free, submerged healing period. Recent studies suggest that immediate restoration of single implants may be a viable treatment option.
PURPOSE: The purpose of this study was to evaluate prosthodontic and aesthetic peri-implant mucosal outcomes of immediately restored, Southern single-tapered implants in the anterior maxilla after 1 year.
MATERIALS AND METHODS: Participants (mean age: 43.25 years; range: 2371 years) satisfying specified inclusion criteria were randomly allocated to conventional two-stage restoration (control group; n=14) and immediate restoration groups (test group; n =14) in a randomized controlled clinical trial. Tapered, roughened-surface Southern implants were placed using a standardized technique, and implant level bone impressions were made. Provisional screw-retained crowns, out of occlusion, were placed at second-stage surgery after 26 weeks for the conventional restoration group, and within 4 hours of implant placement for the immediate restoration group. Both groups had definitive screw-retained metal-ceramic crowns placed in occlusion 8 weeks later. Peri-implant mucosal response and papilla index were recorded 4 weeks after definitive crown placement to allow for mucosal maturation and at 1 year. Prosthodontic and aesthetic outcomes were assessed using established criteria.
RESULTS: There were no significant differences within, or between, the control and test groups for age, gender, bone quality or quantity, implant stability measurements at surgery, or implant length. There were no significant differences in the implant success rate as determined by radiographic bone loss and stability tests after 1 year. There were no significant differences in prosthodontic maintenance, peri-implant mucosal response, and papilla index between the two groups over 1 year.
CONCLUSIONS: Tapered, roughened-surface implants immediately restored with single provisional crowns at surgery and definitive crowns 8 weeks later were as prosthodontically and aesthetically successful as conventionally restored two-stage implants during the first year of service. Restoring single implants immediately with screw-retained crowns is an efficient procedure, but the short-term outcome is by no means superior to a conventional two-stage approach.
Hall J.A., Payne A.G., Purton D.G., Torr B., A Randomized Controlled Clinical Trial of Conventional and Immediately Loaded Tapered Implants with Screw-Retained Crowns. International Journal of Prosthodontics 2006, January/February, Issue 1, Vol. 19, p.17-19.
PURPOSE: Surgical, prosthodontic, and esthetic outcomes of conventional and immediately loaded, single, tapered, roughened surface Southern implants in the anterior maxilla that were restored with screw-retained crowns were compared over 1 year.
MATERIALS AND METHODS: Standardized surgical and prosthodontic procedures were followed and accepted criteria were used for assessment.
RESULTS: There were no significant differences within or between the control and test groups for age, gender, bone quality or quantity, implant stability measurements at surgery, or implant length.
CONCLUSION: After 1 year, the implants that had been immediately loaded with single provisional crowns at surgery and definitive crowns 8 weeks later were as successful as conventionally loaded 2stage implants.
Esposito M., Grusovin, M.G., Coulthard, P., Thomsen, P., Worthington, H.V. A 5-Year Follow-Up Comparative Analysis of the Efficacy of Various Osseointegrated Dental Implant Systems: A Systematic Review of Randomized Controlled Clinical Trails. International Journal of Oral Maxillofacial Implants 2005, July/August, Issue 4, Vol. 20, p.557-68.
PURPOSE: To test the null hypothesis that there is no difference in failure rates between various root-formed osseointegrated dental implant systems after 5 years of loading.
MATERIALS AND METHODS: A search was conducted for all randomized controlled clinical trials (RCTs) comparing different implant systems with a follow-up of 5 years. The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE, and EMBASE were searched. Several dental journals were also searched by hand. Written contacts were established with authors of the identified RCTs and with more than 55 oral implant manufacturers and personal contacts to identify unpublished RCTs. No language restriction was applied. The last electronic search was conducted on February 1, 2005. Screening of eligible studies, quality assessment, and data extraction were conducted in duplicate. Results were expressed as random effect models using weighted mean differences for continuous outcomes and relative risk for dichotomous outcomes with 95% confidence intervals.
RESULTS: Ten RCTs were identified. Four of these RCTs, reporting results from a total of 204 patients, were considered suitable for inclusion. Six different implant types were compared. On a per-patient rather than a per-implant basis, there were no statistically significant differences, with the exception of more marginal bone loss around early loaded Southern implants when compared to early loaded Steri-Oss implants (mean difference 0.35 mm; 95% CI 0.70 to 0.01). However, the difference disappeared in the meta-analysis.
DISCUSSION AND CONCLUSIONS: There were no clinical differences among implant systems. However, these findings are based on only 4 RCTs with few participants. More RCTs should be conducted with larger patient samples.
Payne, A.G., Tawse-Smith, A., Thomson, W.M., Duncan, W.D., Kumara, R. One-Stage Surgery and Early Loading of Three Implants for Maxillary Overdentures: A 1-Year Report. Clinical Implant Dentistry & Related Research 2004, Issue 2, Vol. 6, p.61-74.
BACKGROUND: Maxillary implant overdentures opposing mandibular two-implant overdentures are an underused treatment option for edentulous patients. Fewer implants, simple surgery, and short healing periods may increase patients' acceptance of this treatment concept.
PURPOSE: To determine implant success, after overdenture loading, of three narrow-diameter roughened-surface implants placed in edentulous maxillas, using a one-stage surgical procedure, a 12-week healing period, and opposing mandibular two-implant overdentures.
MATERIALS AND METHODS: Forty edentulous participants with mandibular two-implant overdentures were allocated to two groups with similar implant systems. Each group had three narrow-diameter roughened-surface implants placed into their edentulous maxillas in a one-stage surgical procedure. Standardized intraoral radiography and implant stability tests were performed sequentially at surgery, at 12 weeks (prior to loading), and at 64 weeks (after 1 year of loading with maxillary overdentures).
RESULTS: One hundred seventeen implants were placed in 39 participants. After 1 year of loading, 15 implants had failed in 11 patients, 4 implants have been 'put to sleep' in 3 patients, and 1 patient has died. Data on marginal bone loss and resonance frequency analysis showed no significant differences between the implant systems. The mean marginal bone loss was 1.30 mm (± 0.44 mm) from surgery to 12 weeks and 0.32 mm (± 0.48 mm) between 12 and 64 weeks with loading. The mean implant stability quotient and resonance frequency values showed a statistically significant improvement over time, at 56.05 (5,891 Hz), 57.54 (5,981 Hz), and 60.88 (6,167 Hz) at surgery, 12 weeks, and 64 weeks, respectively. The overall success rate for all implants combined was 81%, and the cumulative survival rate was 84.61%.
CONCLUSION: In patients with mandibular two-implant overdentures, three narrow-diameter roughened-surface implants can be placed in the edentulous maxilla, using a one-stage surgical procedure, and can be loaded within 12 weeks with overdentures for 1 year.
Nikellis, I., Levi, A., Nicolopoulos, C. Immediate Loading of 190 Endosseous Dental Implants: A Prospective Observational Study of 40 Patient Treatments with Up to 2-Year Data. International Journal of Oral Maxillofacial Implants 2004, January-February, Issue 1, Vol. 19, p. 116-23.
PURPOSE: The present study was undertaken to determine the feasibility of using primary stability as a predictor of implant success in patients whose implants were immediately loaded.
MATERIALS AND METHODS: The study included 40 patients, in whom a total of 190 Southern implants were placed, 102 in maxillary sites and 88 in mandibular sites. All were loaded within 72 hours of placement. Sixteen patients were completely edentulous in the mandible and/pr maxilla. The remaining 25, who were partially edentulous, received fixed partial dentures or single implant restorations. All of the definitive implant restorations were screw retained. The criterion for loading was clinical judgment of primarily stability, verified by a (screw test.) Impressions were made after implant placement to facilitate the fabrication of a laboratory made heat processed provisional restoration from acrylic resin. Following a 4-month period for osseointegration and soft tissue healing, definitive prostheses were fabricated.
RESULTS: There were no surgical complications. After 1 to 2 years, all 190 implants had survived and were considered 100% successful, as determined by independent testing of mobility and radiographic evidence of osseointegration. In 4 patients, fracture of the provisional restoration occurred during the healing period.
DISCUSSION: Clinical research has shown that immediate loading is a viable treatment modality. The favorable success rate reported in this study for rough-surfaced implants suggests that adherence to a protocol, an important parameter of which is primary stability above 32 Ncm, can lead to osseointegration.
CONCLUSION: The results of this limited investigation suggest that patients who are partially or completely edentulous may be immediately restored with implants and fixed provisional restorations, provided that the dental implants are adequately stable immediately after their surgical placement. This alternative therapeutic approach did not appear to affect the upto2year survival of the implants in this patient population.
Jokstad A., Urs B., Brunski J.B., Carr A.B., Naert I., Wennerberg A. Quality of Dental Implants International Journal of Prosthodontics 2004, November/December, Issue 6, Vol. 17, p.607-641.
BACKGROUND: Clinicians need quality research data to decide whicj dental implant should be selected for patient treatment.
AIM/OBJECTIVE: To present the scientific evidence for claims of relationship between characteristics of dental implants and clinical performance.
STUDY DESIGN: Systematic search of promotional material and Internet sites to find claims of implant superiority related to specific characteristics of the implant, and of the dental research literature to find scientific support for the claims.
MAIN OUTCOME MEASURES: Critical appraisal of the research documentation to establish the scientific external and internal validity as a basis for the liklihood of reported treatment outcomes as a function of implant characteristics.
RESULTS: More than 220 implant brands have been identified, produced by about 80 manufactures. The implants are made from different materials, undergo different surface treatments and come in different shapes, lengths, widths and forms. The dentist can in theory choose among more than 2,000 implants in a given patient treatment situation. Implants made from titanium and titanium alloys appear to perform well clinically in properly surgically prepared bone, regardless of small variations of shapes and forms. Various surface treatments are currently being developed to improve the capacity of a more rapid anchorage of the implant into bone. A substantial number of claims made by different manufactures on alleged superiority due to design characteristics are not based on sound and log-term clinical scientific research. Implants are, in some parts of the world, manufactured and sold with no demonstration of adherence to any international standards.
CONCLUSIONS: The scientific literature does not provide any clear directives to claims of alleged benefits of specific morphological characteristics of dental Implants.
Payne, AG, Tawse-Smith, A, Thompson, WM, Kumara, R. Early Functional Loading of Unsplinted Roughened Surface Implants with Mandibular Overdentures 2 Weeks After Surgery. Clinical Implant Dentistry & Related Research 2003, Issue 3, Vol. 5, p. 143- 53.
BACKGROUND: Before early functional loading of unsplinted implants with mandibular overdentures can become widespread, more clinical studies are needed to investigate the success of the approach.
PURPOSE: To evaluate the success rates of two types of roughened titanium surface implants with early 2week functional loading of paired mandibular interforaminal implants with overdentures.
MATERIALS AND METHODS: Random allocation divided 24 strictly selected edentulous participants into two groups, with each group to receive a different implant system (ITI Dental Implant System, Straumann AG, Waldenburg, Switzerland; or Southern Implant System, Southern Implants, Irene, South Africa). Two implants were placed in the anterior mandible of all participants using one stage standardized surgical procedures. Previously constructed conventional mandibular dentures (opposing maxillary complete dentures) were temporarily relined and worn by the participants for the first 2 weeks; participants used a soft diet. Two weeks after implant surgery and following some mucosal healing, the mandibular dentures had the tissue conditioner removed and the appropriate matrices included for an unsplinted prosthodontic design.
RESULTS: No implant from either group was lost. Resonance frequency analysis (RFA) indicated higher primary stability at surgery for the Southern group than for the ITI group, with a statistically significant difference between the groups throughout the study period. The drop in RF values between surgery and 6 weeks was significant and was greater for the Southern group. RFA also indicated stabilized osseointegration between 6 to 12 and 12 to 52 weeks, with no participant showing any decrease in those values over time. Participants with type 3 bone showed a significant improvement in RF values between 12 and 52 weeks, eventually matching those of participants with type 2 bone. There were no significant differences in marginal bone loss, peri-implant parameters, or prosthodontic maintenance between the groups over the study period.
CONCLUSIONS: Using only strict patient selection criteria, 1-year follow-up data indicate that early functional loading of ITI and Southern implants with mandibular two-implant overdentures is possible as early as 2 weeks after implant surgery.
Howes, D.G., Boyes-Varley, J.G., Lownie, J.F., The Zygomatic Implant Protocol in the Treatment of the Severely Resorbed Maxilla. Journal of South African Dental Association 2003, April, Issue 3, Vol. 8, p.106-114.
ABSTRACT: The zygomaticus dental implant, designed by Nobel BioCare, was developed primarily for the treatment of the severely resorbed maxilla. Branemark has reported an overall success rate of 97.6% with the placement of over 200 zygomatic implants during the period 1989 to 2001. There are well-defined characteristics within the patient's resorbed skeletal frame which guide the surgical placement of the zygomatic implant, thus determining whether the surgeon should use an implant with a 45º or 55º angulated head. This allows implant-supported restoration of the resorbed maxilla with a fixed cross arch prosthesis in the maxilla without a bone graft to the posterior maxilla. The use of a modified head angulations of 55º, with implant placement as close to the crest of the edentulous ridge as possible, allows restorative clinicians to achieve an ideal restorative position in the posterior maxilla. The use of a zygomatic implant with a 55º head reduces the buccal cantilever by 20%.³
BoyesVarley, J.G., Lownie, J.F., Howes D.G., Blackbeard G.A. Surgical Modifications to the Branemark Zygomaticus Protocol in the Treatment of the Severely Resorbed Maxilla: A Clinical Report. International Journal of Oral Maxillofacial Implants 2003; Issue 2, Vol. 18, p.232-237.
PURPOSE: The Zygomaticus dental implant, designed by Nobel BioCare, was developed for the treatment of the severely resorbed maxilla. Branemark has reported an overall success rate of 97.6% with the placement of 183 implants over the last 12 years. The purpose of this article was to present a modification to the original Branemark surgical approach to achieve better access and optimal implant placement.
MATERIALS AND METHODS: There are parameters within the patient's resorbed skeletal frame that guide the surgical placement of the currently used implant however; there are shortcomings in the current surgical protocol. This report describes a simplified surgical approach in 45 patients (77 implants) using an implant with a modified head angulations of 55 degrees and a placement appliance to assist the surgeon in placing the implant as close to the crest of the edentulous ridge as possible.
DISCUSSION: The present technique allows restorative clinicians to achieve a more ideal restorative result in the posterior maxillary alveolus using the zygomatic implant, while reducing the buccal cantilever, improving tongue space, and access for maintenance.
CONCLUSION: By placing the implant closer to the crest of the alveolar ridge using the placement appliance and an implant with a 55- degree head, the emergence of the restorative head and resultant buccal cantilever can be reduced by as much as 20%.
Watson.G.K., Payne, A.G.T., Purton, D.G., Thomson W.M. Mandibular Overdentures: Comparative Evaluation of Prosthodontic Maintenance of Three Different Implant Systems During the First Year of Service International Journal of Prosthodontics 2002, May/June, Issue 3, Vol. 15, p. 259-266.
PURPOSE: The prospective study evaluated the prosthetic maintenance requirements during the first year of service of mandibular overdentures supported by two unsplinted implants using three different implants systems.
MATERIALS AND METHODS: Seventy-two patents randomly allocated to three equal groups were each provided with a conventional complete maxillary denture and a mandibular overdenture supported by two unsplinted implants. A different implant system was used for each group (Steri-Oss, ITI, or Southern Implants), and their prosthodontic maintenance requirements were compared, primarily for the patrix and matrix. Additional maintenance categories recorded included any type of overdenture fracture, reline or remake of the overdenture, and maintenance of the maxillary denture.
RESULTS: Sixty-eight percent of the patients, regardless of implant system, required prosthodontic maintenance in the first year, most commonly for the matrices. The Southern Implants matrices required less maintenance than those of Steri-Oss or ITI (P < .05). Additional overdenture maintenance was required by 28% of patients, irrespective of implant system. When all categories of prosthodontic maintenance were combined, there were no differences between implant groups. Evaluation of overall prosthodontic success using six-field tables revealed statistically significant differences between the three implant systems, with more ITI and Steri-Oss patients than Southern Implants patients requiring overdenture retreatment (repair).
CONCLUSION: During the first year of service, the matrix maintenance requirements of Southern Implants were significantly lower than those of the ITI or Steri-Oss groups; this was reflected in the number of retreatment (repair) categories recorded. Although the three systems did not differ significantly for overall prosthodontic maintenance, both the Steri-Oss and the ITI titanium matrices showed problems of clinical significance.
Tawse-Smith, A., Payne, A.G.T., Kumara, R., Thomson, W.M. Early Loading of Unsplinted Implants Supporting Mandibular Over- Dentures Using a One-Stage Operative Procedure with Two Different Implant Systems: A 2-Year Report. Clinical Implant Dentistry & Related Research 2002, Issue 1, Vol. 4, p. 33-42.
BACKGROUND: Step-wise reduction in loading protocols is necessary to evaluate early loading of implants with mandibular overdentures.
PURPOSE: To compare the success rates of two different dental implant systems following conventional or early loading protocols in patients being rehabilitated with mandibular overdentures.
RESULTS: There was no statistically significant difference in the success rates of the two systems in either control or test groups. At the 2-year evaluation, a success rate was found of 87.5% and 70.8% for the control and test Steri-Oss groups, respectively, and 83.3% and 100% for the control and test Southern Implants groups were observed. For the Steri-Oss groups, eight implants were lost at an early stage: seven in the test group and one in the control group. For the Southern Implants control and test groups, no failures were seen at any time interval. There were no significant differences in marginal bone loss, Periotest values, and peri-implant parameters between implant systems or between any of the control or test groups.
CONCLUSIONS: Early loading, with step-wise reductions in loading protocols, of unsplinted machined Steri-Oss and roughened Southern Implants fixtures with mandibular overdentures is possible for up to 2 years.
Soskolne A., Cohen S., Sennerby., Wennerberg A., Shapira L. The Effect of Titanium Surface Roughness on the Adhesion of Monocytes and their Secretion of TNF-α and PGE². Clinical and Oral Implant Related Research 2002; Issue 1, Vol. 13, p. 86-93.
Dental implant surfaces are important in determining the tissue/surface interaction. One of the first cells to adhere to the implant surface is the monocyte. This study examines the effect of surface roughness on monocyte adhesion and cytokine secretion. Monocyte adherence to titanium discs of 4 different degrees of surface roughness and plastic surfaces was assayed. Blood mononuclear cells were incubated for 1.5 h in 16 mm culture wells into which titanium discs had been placed. Non-adherent cells were washed off and the numbers of remaining adherent monocyte determined by DNA quantification. TNF-α and PGE2 secretion in media from overnight cultures of attached monocytes stimulated with lipopolysaccharide (LPS) was quantified using ELISA and RIA, respectively. Monocyte adherence to rough titanium surfaces was greater than to turned titanium surfaces, while the lowest adherence was to the plastic surface. No significant differences in adherence to 250, 75 or 25 µm blasted surfaces could be detected. The number of adherent monocytes increased with time, with maximum adhesion after 2 h of incubation. Incubation of monocytes adherent to titanium surfaces resulted in a decrease of less than 30% in their numbers over 7 days, whereas cells attached to plastic surfaces decreased to non- detectable numbers after 48 h. Porphyromonas gingivalis LPS stimulation unregulated TNF-α and PGE2 secretion into the media. The LPS-induced TNF-α and PGE2 secretion was independent of the titanium surface roughness, however the lowest amounts of TNF-α and PGE2 were secreted from cells attached to plastic surfaces. The results of this study indicate that the number of monocytes attached to blasted titanium surfaces is significantly greater than to machined titanium surfaces. PGE2 and TNF-α secretion is less influenced by titanium surface roughness.
Tawse-Smith, A., Payne, A.G.T., Kumara, R., Thomson, W.M. One-Stage Operative Procedure Using Two Different Implant Systems: A Prospective Study on Implant Overdentures in the Edentulous Mandible. Clinical Implant Dentistry & Related Research 2001, Issue 4, Vol. 3, p.185-193.
BACKGROUND: Evidence-based reports are needed to support the application of a one-stage surgical protocol for unsplinted implants supporting mandibular overdentures.
PURPOSE: To examine the feasibility and success of using two different dental implant systems (originally designed for two-stage operative technique) using a one-stage operative procedure in patients being rehabilitated with implant supported mandibular overdentures.
MATERIALS AND METHODS: The study sample involved 24 edentulous subjects (aged 55-80 yr) randomly allocated to two different implant systems, one with a machined titanium implant surface (Steri-Oss/Nobel Biocare, Göteborg, Sweden) and the other with a roughened titanium surface (Southern Implants, Ltd., Irene, South Africa). Two unsplinted implants to support implant overdentures were placed in the anterior mandible of all patients, using a standardized one-stage surgical and prosthodontic procedure. Primary stability and bicortical anchorage of the implants was mandatory before healing abutments were connected at the time of implant placement. Implant overdentures and their respective matrices were inserted following a standard 12-week healing period. Data relating to mobility tests, radiographs, and peri-implant parameters were documented at 12, 16, and 52 weeks after surgery.
RESULTS: A success rate of 95.8% for the Steri-Oss and 100% for the Southern Implants was found, without any statistically significant differences in the marginal bone loss. Significant changes in Periotest values were observed for both types between 12 and 52 weeks (p < .001). Minor changes were observed in the peri-implant parameters evaluated.
CONCLUSIONS: These preliminary findings show a successful application of this one-stage approach for unsplinted implants supporting mandibular overdentures with Steri-Oss and Southern Implant Systems.
Daly P.F., Pitsillis, A., Nicolopoulos, C., Occlusal Reconstruction of a Collapsed Bite by Orthodontic Treatment, Pre-Prosthetic Surgery and Implant Supported Prostheses: A Case Report. Journal of South African Dental Association June 2001; Issue 6, Vol. 56, p. 278-282.
The loss of mandibular molars can result in a 'collapsed bite' owing to tilting of teeth adjacent to the gap and over eruption of maxillary molar segments. The lost interarch and interdental space must be regained before prosthetic reconstruction. This case report documents the treatment of a patient by orthodontic, surgical and prosthetic means. The teeth were orthodontically aligned to meet predetermined surgical and prosthetic requirements. The surgical phase comprised a posterior segmental maxillary osteotomy and one- stage placement of three large-diameter implants in the mandible. Finally, the occlusion was restored with mandibular implant- supported prostheses.
Krekmanov L., Kahn M., Rangert B., Eng M., Lindstrom H. Tilting of Posterior Mandibular and Maxillary Implants for Improved Prosthesis Support Journal of Oral & Maxillofacial Implants 2000, Issue 3, Vol. 15, p. 405-414.
Rehabilitation of atrophied edentulous arches with endosseous implants in the posterior regions is often associated with anatomic problems such as jaw shape and location of the metal loop, mandibular canal, and maxillary sinuses. The purpose of this investigation was to modify the method for implant placement in the posterior part of the jaws to extend fixed implants-connected prostheses further distally, and to reduce the length of cantilevers in complete-arch prosthesesis without transpositioning the mandibular never or performing bone grafting in the maxilla. Forty-seven consecutive patients were treated with implants (25 patients/36 mandibular implants) placed in tilted positions. They were followed a mean of 40 month (mandibles) and 53 months (maxillae). In the mandible, implants close to the mental foramina were tilted posteriorly approximately 25 to 35 degrees. In the maxilla, the posterior implants were placed close to and parallel with the sinus wall and were tilted interiorly/posteriorly approximately 30 to 35 degrees. Patients gained a mean distance of 6.5 mm of prosthesis support in the mandible and 9.3 mm in the maxilla, as a result of implant tilting. There were no implant failures in mandibles. The cumulative success rates in the maxilla at 5 years were 98% for tilted implants and 93% for non-tilted implants. Parenthesias of the mental nerve were observed on 4 sides during the first 2 to 3 weeks after implant placement. Analysis of the load distribution in one mandibular case showed no significant difference between tilted and non-tilted implants, and the improved prosthesis support was confirmed. Satisfactory medium-term results concerning osseointegration and significant extension of prosthesis support show that the method can be recommended. This technique may allow for longer implants to be placed with improved bone anchorage.
Sutures & Resorable