A Prospective Report of the Clinical Outcome of TiUnite Implants at 20 Years of Follow-up.

PURPOSE: To present a survival analysis of 133 consecutively placed moderately rough implants, all with a total follow-up of 20 years. MATERIALS AND METHODS: A total of 133 implants of the same brand placed in 46 patients at the same county clinic in Sweden were followed up prospectively over 20 years and analyzed for survival and bone height, the latter evaluated in periapical radiographs. RESULTS: A total of 7 implants failed, 4 of which were in the same patient. Implant failure was associated with a combination of smoking and bruxism in 5 of the 7 failed cases. A 20-year survival rate of 94.7% was observed. Average marginal bone loss (MBL) at 20 years of follow-up was 0.543 ± 1.193 mm, with 9 implants having more than 2 mm of MBL. A total of 20 patients with 25 implants dropped out of the study; however, if death of the patient is excluded as a dropout reason, only 3 implants in 3 patients were unaccounted for. CONCLUSIONS: Good clinical results in the 95% survival range were observed with moderately rough implants over a 20-year follow-up period.

Immediate Tooth Replacement Therapy in Postextraction Sockets: A Comparative Prospective Study on the Effect of Variable Platform-Switched Subcrestal Angle Correction Implants.

Immediate tooth replacement therapy (ITRT), ie, immediate implant placement and provisional restoration in postextraction sockets, has been shown to achieve favorable outcomes in reference to soft tissue stability and esthetics. However, avoiding socket perforation with uniaxial implants in the anterior maxilla can be challenging due to the inherent anatomy. Dual or co-axis subcrestal angle correction (SAC) implants have been developed to change the restorative angle of the clinical crown restoration subcrestally at the implant-abutment interface to enhance the incidence of screw-retained definitive restorations. An additional benefit of this macrodesign implant feature is variable platform switching (VPS) that increases soft tissue gap distance above the implant platform. The purpose of this prospective study on ITRT in maxillary anterior postextraction sockets was to investigate the effect of SAC with VPS (SAC/VPS) compared to conventional platform-switch-design implants (PS) relative to ridge dimension stability and peri-implant soft tissue thickness. A total of 29 patients had undergone ITRT and received either a PS or SAC/VPS implant; previously described measurements were made compared to the contralateral natural tooth sites. When the comparison of buccal soft tissue thickness was made, SAC/VPS showed a greater increase compared to PS (3.12 mm vs 2.39 mm, respectively) with statistical significance (P = .05). The increase was independent from periodontal phenotype. Therefore, SAC/VPS may increase peri-implant soft tissue thickness and help minimize recession following ITRT.

Tapered Versus Inverted Body-Shift Implants Placed Into Anterior Post-extraction Sockets: A Retrospective Comparative Study.

BACKGROUND: A retrospective comparative radiographic and clinical studywas performed to evaluate primary stability, bone volume, and esthetic outcomes of tapered (T) implants (control group) versus inverted body-shift (INV) implants (test group). METHODS: A total of 42 platform-switched implants, 21 T and 21 INV, were used to replace nonrestorable teeth in maxillary central incisor post-extraction sockets. Implant primary stability and insertion torque values in addition to radiographic differences in labial plate dimension, tooth-to-implant distance, and marginal bone levels were correlated with clinical outcomes using the pink esthetic score (PES). RESULTS: Statistically significant differences (P ≤ .05) were found between groups, with T implants having not only lower primary stability at immediate implant placement than INV implants but also less circumferential bone volume at recall. Consequently, lower PESs were seen in the T implant group that equated to an increased frequency of midfacial recession, tissue discoloration, and papilla loss. CONCLUSIONS: INV implants, which feature a unique macro hybrid design, may offer advantages over T implants in maxillary anterior post-extraction sockets with regard to achieving both higher primary stability and superior esthetic outcomes.

Clinical Outcomes of Maxillary Anterior Postextraction Socket Implants with Immediate Provisional Restorations Using a Novel Macro-Hybrid Implant Design: An 18- to 24-Month Single-Cohort Prospective Study.

Extraction and immediate implant placement/restoration in the esthetic zone is clinically challenging; benefits include fewer surgical appointments and maintenance of peri-implant soft tissues throughout the treatment period, and limitations include gingival recession and bone dehiscence during surgery. Macro-hybrid implants (large-diameter apical/narrow-diameter occlusal) were placed in 19 patients immediately following the extraction of hopeless maxillary anterior teeth. Immediate restorations were fabricated without occlusal contacts. Pre- and postplacement cone beam computed tomography (CBCT) scans were taken. Nineteen implants were available for recall 13 to 25 months postoperatively. The overall implant cumulative survival rate was 100% (range: 13 to 25 months, mean: 19 months), and mean insertion torque value was 65 Ncm. Mean Pink Esthetic Score was 12.63 at 6 months, and was 13 at the 18- to 24-month follow-up. Mean mesial and distal tooth-to-implant distances immediately after implant placement were 2.55 ± 1.29 mm and 2.29 ± 0.82 mm, respectively. Interproximal bone crest width, distance, and height were maintained at implant platforms, mesially and distally, 18 to 24 months postoperative. The results of this study indicated that the macro-hybrid implant geometry for this immediate surgical/restorative protocol provided excellent and stable 2-year results relative to implant survival (100%), labial plate thickness via CBCT evaluations, tooth-to-implant distances immediately post-implant placement, PES, and interproximal bone crest width, distance, and heights, which were maintained at the implant platforms.

The Influence of Initial Hard and Soft Tissue Dimensions on Initial Crestal Bone Loss of Immediately Loaded Dental Implants.

The aim of this case-control study was to evaluate the influence of soft tissue thickness at implant placement (thin [< 3 mm] vs thick [≥ 3 mm]) and bone volume (abundant vs limited) on initial crestal bone remodeling of immediate postextraction and delayed (healed site) implants in immediate loading situations. A total of 67 patients with 133 implants could be evaluated, of which 77 were placed immediately after extraction and 56 in healed ridges. If sufficient bone volume is present and primary stability is achieved, immediate loading of the implant yields good clinical and radiographic outcomes, yet implants placed in healed ridges with thin soft tissues are more prone to initial crestal bone loss.

Prospective Multicenter Clinical Cohort Study of a Novel Macro Hybrid Implant in Maxillary Anterior Postextraction Sockets: 1-Year Results.

A prospective cohort clinical study was performed to evaluate the concept and design of a novel macro hybrid implant placed into maxillary anterior postextraction sockets. Thirty-three patients with an equal number of hybrid implants were used to replace nonrestorable single anterior teeth with immediate tooth replacement therapy (immediate implant placement and immediate provisional restoration). The macro features of this hybrid implant are unique in geometry, as it combines two different shapes-a cylindrical coronal and tapered apical portion-into a singular body design, each comprising roughly half of the implant length. The hybrid design of this platform-switched implant also has a subcrestal angle correction, or Co-Axis feature, that facilitates screw-retained restorations. Mean implant survival at 1 year relative to primary stability, labial bone plate thickness with socket grafting at two reference points (L1 and L2), tooth-to-implant interproximal bone crest thickness, and pink esthetic score (PES) were evaluated. A mean insertion torque value of 65 Ncm (range 45 to 100 Ncm) was reached with the use of the tapered apical half of the implant body. No implants failed during an average healing period of 1 year. A labial plate dimension between 1.8 and 2.1 mm was attained immediately posttreatment and remained stable over time. A tooth-to-implant interdental bone crest distance and dimension of 2.3 to 2.6 mm was reached; it was also sustained at the 1-year follow-up. The average PES was 12.5 (range 9.0 to 14.0), with nearly 90% of treated sites with an "almost perfect" score. This macro hybrid implant in concept and design may be useful in immediate tooth replacement therapy of maxillary anterior postextraction sockets to achieve successful implant survival and esthetic outcomes, specifically labial plate and papilla preservation without midfacial or interdental tissue loss and discoloration.

A randomized controlled clinical trial to assess crestal bone remodeling of four different implant designs.

BACKGROUND: It is claimed that bone remodeling is limited when the implant neck has microthreads and an internal abutment connection. However, comparative studies, excluding confounding factors, are scarce. AIM: This RCT aims to assess whether a coronal microthreaded design and an internal abutment connection affects crestal bone loss, up to one year of function. MATERIALS AND METHODS: Twenty-one maxillary edentulous patients were consecutively treated for a bar supported maxillary overdenture on four different implants with respectively: internal connection and microthreads on the implant neck (I MT); internal connection, no microthreads (I NMT), external connection, with microthreads (E MT), and external connection, without microthreads (E NMT). Other design features, s.a. width, surface topography, platform switch as well as surgical placement and prosthetic protocol were consistent. Implant survival and crestal bone loss in relation to the implant type were considered the main variables and a Friedman test for ordered alternatives was used to assess the difference in crestal bone loss between the different study implants. RESULTS: Twenty-one patients received 83 study implants. Three implants failed within three months and required replacement. The total survival rate was 96.39% after one year and based on 21 patients and 80 implants a mean crestal bone loss of 0.25 mm (SD: 0.38; range: 0-1.48) was measured. After a follow-up of 3, 6, 12, and 21 months no statistically significant differences in crestal bone loss between the different study implants or the different time intervals could be identified. CONCLUSIONS: From this RCT, it is concluded that the implant-abutment connection and a microthreaded external thread configuration have limited influence on crestal bone remodeling. The latter can be considered a multifactorial process and is more dependent on other factors such as biologic considerations than on implant design.

Six-Year Radiographic, Clinical, and Soft Tissue Outcomes of Immediately Loaded, Straight-Walled, Platform-Switched, Titanium-Alloy Implants with Nanosurface Topography.

PURPOSE: This prospective, longitudinal study evaluated the survival, marginal bone levels, and soft tissue conditions for immediately loaded, straight-walled, platform-switched, titanium-alloy implants with an internal connection and nanosurface topography. MATERIALS AND METHODS: Patients were enrolled at a single center. The immediate loading protocol required a final insertion torque ≥ 25 Ncm, an implant stability quotient (ISQ) > 55, and placement of the provisional prosthesis on the same day as implant placement. Posttreatment follow-up examinations were scheduled at 3, 6, and 12 months and annually thereafter. Soft tissue evaluation consisted of assessment of the implant sites for signs of peri-implant infection including mucosal inflammation, bleeding on probing or suppuration, and progressive bone loss. Oral hygiene was evaluated, and radiographic marginal bone levels were analyzed and compared to baseline at the time of provisional loading. RESULTS: Forty-eight consecutively treated patients received 122 implants; 112 qualified for immediate loading and were included. ISQ scores ranged from 51 to 87, with a mean value of 75.1 (SD = 6.8). One implant failed (after 3 months). After an average follow-up period of 6.2 years (SD = 0.37; range, 5.4 to 6.9), no further losses occurred, leading to an overall cumulative survival rate of 99.1%. Average bone loss for the 111 implants after 6 years was 0.35 mm (SD = 0.45; range: -0.35 to 2.20). Four implants (3.6%) in two patients showed concomitant peri-implant infections associated with bleeding on probing and/or purulence after 2 years in function. Exploratory surgery revealed residual submucosal cement. After its removal, the progressive bone loss stopped, and peri-implant tissue in both patients returned to a healthy condition. CONCLUSION: This study based on 40 patients treated with 112 straight-walled, platform-switched, titanium-alloy implants with nanosurface topography yielded a 99.1% survival rate after a mean follow-up time of 6.2 years. Additionally, mean crestal bone loss was limited to 0.26 mm (SD = 0.38) after 1 year and 0.35 mm (SD = 0.45) after 6 years. Peri-implant infection associated with excessive bone loss above 2 mm was only encountered in one implant, and residual cement was shown to be responsible.

Clinical and Radiographic Comparison between Platform-Shifted and Nonplatform-Shifted Implant: A One-Year Prospective Study.

BACKGROUND: Developments in implant hardware and biologic understanding improved treatment predictability in terms of implant survival. Current research focuses on accelerated loading protocols and crestal bone preservation. PURPOSE: This prospective, monocenter study analyzed the clinical and radiographic outcome of a novel parallel-walled implant, with and without platform shift. MATERIALS AND METHODS: Forty-eight consecutively treated patients (30 women, 18 men) with crowns/bridges supported by 115 implants were included. Eighty-three percent of implants were nonocclusal, immediately loaded, and 17% were subjected to one-stage surgery and delayed loading after 10 weeks; 39.1% were of diameter 5.0 mm, enabling platform shifting with a 4.0 mm-wide prosthetic component; 60.9% were of diameter 4.0 mm with a 4.0 mm component. Radiographic crestal bone levels were assessed at baseline and 1 year. A multivariate statistical analysis was performed to determine factors affecting crestal bone loss after 1 year. RESULTS: All implants survived and mean marginal bone loss was 0.73 mm (SD: 0.13; range: -0.60 to 5.0 mm). There was a statistically significant difference between platform-shifted (0.63 mm; SD: 0.18) and nonplatform-shifted (1.02 mm; SD: 0.14) implants. Implants in abundant bone volume lost significant less crestal bone (0.45 mm; SD: 0.14) compared with implants in small volume (1.20 mm; SD: 0.21). Implant diameter, loading time, anatomical position, smoking, and bone quality did not affect crestal bone loss. CONCLUSION: After 1 year of loading, both implant-prosthetic features yield a high survival and limited crestal bone loss. Crestal bone loss is minimized using platform-shifted implants placed in sufficiently voluminous bone. To limit the crestal bone loss, an adopted implant diameter with platform shifting should be considered.

Immediate loading in partially and completely edentulous jaws: a review of the literature with clinical guidelines.

The introduction of immediate loading was a paradigm shift in implant dentistry as it was previously believed that an unloaded period was essential for bone healing in order to promote osseointegration. However, this belief could not be confirmed by clinical studies or by human histology. Hitherto, numerous reports have been published on immediate loading in various indications. An important factor for success is primary implant stability. The latter can be improved by adapting drilling protocols to enhance lateral compression of the bone and by using tapered implant designs with apical thread fixation. To some extent, the use of implants with a microrough surface and rigid splinting may compensate for suboptimal stability. It is important to avoid fracture of the provisional restoration at all times as this may result in local overloading and implant failure. Also, unevenly distributed occlusal contacts may contribute to failure and therefore occlusion ought to be evaluated at every occasion, especially during the early phase of healing. Taking these aspects into account, immediate loading in the fully edentulous mandible by means of an overdenture has been shown to be predictable in terms of implant survival (94.4-100%). However, the procedure may result in additional costs as a result of the need for repeated relining. In addition, the scientific basis for this treatment concept in the maxilla is very scarce. Immediate loading in the fully edentulous jaw by means of a fixed prosthesis is a well-documented treatment concept. In the mandible, three implants have been shown to be insufficient, given the failure rate of up to 10%. With at least four implants a failure rate of 0-3.3% may be expected. In the maxilla, four to six implants could be too limited, given the failure rate up to 7.2%. Increasing the number of implants may reduce implant failure to 3.3%. Provisional fixed prostheses are particularly prone to fracture in the maxilla and hence reinforcement is warranted. Immediately loaded single implants have lower survival rates, of 85.7-100%, with no clear impact of occlusal contact. In fact, a meta-analysis demonstrated a five times higher risk of failure for immediately loaded single implants when compared with delayed loading. No study showed superior soft-tissue preservation or esthetics following immediate loading of single implants compared with other loading protocols. However, this finding may not imply that a provisional implant crown becomes redundant when soft-tissue conditioning is deemed necessary. Taking into account earlier factors for success, immediate loading in the partially edentulous jaw by means of a fixed prosthesis seems predictable in terms of implant survival (95.5-100%). However, there are no studies with data on soft-tissue parameters, esthetic aspects or patient-centered outcomes, and the available studies mainly relate to the load-carrying part of the dentition. Clinical studies focusing on these aspects of treatment outcome are clearly needed. High patient satisfaction is the most important advantage of immediate loading, especially during the early healing phase. In this context, one should also realize that studies have revealed comparable patient satisfaction in patients following delayed loading once their prosthesis is in place. In the decision-making process, this aspect should be properly discussed with the patient along with other advantages and disadvantages of immediate loading.

Immediate occlusal loading of NanoTite™ tapered implants: a prospective 1-year clinical and radiographic study.

BACKGROUND: During the last decade, high success rates have been reported for implants placed with immediate loading procedures, especially when bone quality and quantity provide good implant stability. In many of these studies, straight-walled implants with moderately rough surfaces were employed. Tapered implants are becoming increasingly more popular due to standardized drilling protocols and reports of high initial primary stability. PURPOSE: The aim of the present prospective, single center clinical study was to evaluate surface topographical analysis and the clinical and radiographic outcomes of the NanoTite™ (BIOMET 3i, Palm Beach Gardens, FL, USA) Tapered Implant when used for immediate loading of fixed prostheses and single-tooth restorations. MATERIALS AND METHODS: Forty-two patients who needed implant treatment and met admission criteria agreed to participate in the study and were consecutively enrolled. Surgical implant placement requirements consisted of a final torque of a least 30 Ncm prior to final seating and an implant stability quotient above 55. A total of 139 NanoTite Tapered implants (112 maxillary and 27 mandibular) were placed by one investigator, and the majority of these implants (n = 77/55%) were placed in posterior regions, and in soft bone (n = 90/65%). A total of 57 prosthetic constructions were evaluated consisting of 20 single-tooth restorations, 30 fixed partial dentures, and 7 complete, fixed maxillary restorations. Radiographs were taken at baseline and at 12 months of follow-up. RESULTS: Of the 139 study implants, one implant failure was declared. The overall cumulative survival rate at 1 year is 99.4%. Mean marginal bone resorption is 1.01 mm (SD 0.85) during the first year of function. CONCLUSION: Although limited to the short follow-up, immediate loading of NanoTite Tapered implants seems to be a viable option in implant rehabilitation, when insertion torque of at least 30 Ncm is achieved. Further studies are needed to authenticate the finding of this study.

Ten years later. Results from a prospective single-centre clinical study on 121 oxidized (TiUnite™) Brånemark implants in 46 patients.

BACKGROUND: Concerns have been raised that use of surface-modified implants may result in peri-implant infection and marked marginal bone loss over time. PURPOSE: The aim of this prospective study was to evaluate the survival rate, marginal bone, and soft tissue conditions at surface-modified titanium dental implants after 10 years of function. MATERIAL AND METHODS: Forty-six totally and partially edentulous patients were provided with 121 Brånemark oxidized implants (TiUnite™, Nobel Biocare AB, Gothenburg, Sweden). Twenty-four (20%) implants were immediate loaded and 97 (80%) were placed using a two-stage procedure. A total of 22 single, 23 partial, and 7 total restorations were delivered. Clinical and radiographic checkups were carried out after 3, 6, 12 months, and thereafter annually up to 10 years. At these occasions, oral hygiene was evaluated and peri-implant mucosa examined by probing. If needed, patients were enrolled in an individual program for hygiene controls and professional cleaning. Marginal bone loss was evaluated in intraoral radiographs taken at baseline and after 1, 5, and 10 years of function. RESULTS: One (0.8%) implant failed after 8 years giving a Survival Rate (SR) of 99.2% after 10 years. A total of 11 sites (9.2%) showed bleeding on probing (BP) at the 10th annual checkup. The mean marginal bone loss was 0.7 ± 1.35 mm based on 106 readable pairs of radiographs from baseline and from the 10th annual examination. Twelve (11.3%) implants showed more than 2 mm bone loss, and five (4.7%) showed more than 3 mm of bone loss after 10 years. For the latter, all patients were smokers and had poor or acceptable oral hygiene. All five implants with >3 mm bone loss showed BP and two (1.9%) showed suppuration from the pocket. For the remaining seven implants with more than 2 mm bone loss, no correlation to smoking, oral hygiene, bleeding, or pus could be seen. Time/marginal bone level plots of the 12 implants with more than 2 mm bone loss after 10 years, showed minor changes from the first annual checkup except for the two infected implants. CONCLUSIONS: It is concluded that good long-term clinical outcomes can be obtained with oxidized titanium dental implants. Only 1.9% of examined implants showed significant marginal bone loss together with bleeding and suppuration after 10 years of function.

Immediate occlusal loading of NanoTite PREVAIL implants: a prospective 1-year clinical and radiographic study.

BACKGROUND: Recently, a new implant surface texture, featuring application of nanometer-scale calcium phosphate has been shown to enhance early bone fixation and formation in preclinical studies and in human histomorphometric studies, which may be beneficial in immediate loading situations. AIM: The purpose of the present prospective clinical study was to, during 1 year, clinically and radiographically evaluate a nanometer scale surface modified implant placed for immediate loading of fixed prostheses in both maxillary and mandibular regions. MATERIALS AND METHODS: Thirty-five out of 38 patients who needed implant treatment and met inclusion criteria agreed to participate in the study and were consecutively enrolled. Surgical implant placement requirements consisted of a final torque of a least 25 Ncm prior to final seating and an implant stability quotient above 55. A total of 102 NanoTite PREVAIL (NTP) implants (BIOMET 3i, Palm Beach Gardens, FL, USA) (66 maxillary and 36 mandibular) were placed by one investigator, and the majority of these were placed in posterior regions (65%) and in soft bone (69%). A total of 44 prosthetic constructions were evaluated consisting of 14 single-tooth restorations, 26 fixed partial dentures, and four complete fixed restorations. All provisional constructions were delivered within 1 hour, and the final constructions placed after 4 months. Implants were monitored for clinical and radiographic outcomes at follow-up examinations scheduled for 3, 6, and 12 months. RESULTS: Of the 102 study implants, one implant failed. The simple cumulative survival rate value at 1 year was 99.2%. The average marginal bone resorption was 0.37 mm (SD 0.39) during the first year in function. According to the success criteria of Albrektsson and Zarb, success grade 1 was found with 93% of the implants. CONCLUSION: Although limited to the short follow-up, immediate loading of NanoTite Prevail implants seems to be a viable option in implant rehabilitation, at least when a good initial fixation is achieved.

Immediate provisionalization of NanoTite implants in support of single-tooth and unilateral restorations: one-year interim report of a prospective, multicenter study.

BACKGROUND: Clinical studies reporting immediate loading of endosseous implants for edentulous cases and for fixed partial restorations have been well documented with satisfactory survival rates. Implants with a recently developed, nanometer-scale surface topography (NanoTite, BIOMET 3i, Palm Beach Gardens, FL, USA), created by discrete crystalline depositions (DCD) of calcium phosphate nano-crystals onto a dual acid-etched (DAE) surface, show enhanced early fixation in preclinical studies when compared with DAE-surfaced implants. These outcomes suggest DCD-surfaced implants may be advantageous for immediate loading approaches. OBJECTIVE: The aim of this prospective, multicenter, observational study is to report clinical outcomes for DCD-surfaced implants placed in immediate functional support of single- and multi-unit restorations according to an immediate loading protocol. MATERIALS AND METHODS: One hundred eighty-five patients enrolled at 15 international study centers received a total of 335 implants supporting 216 immediate provisionalizations consisting of 128 single-tooth restorations and 88 fixed restorations. Of the 335 implants, 77% are located in posterior and 23% in anterior regions with 55.5% of the total in mandibles and 44.5% in maxillae. Patients were evaluated for implant mobility, gingival health, symptomatology, and radiographic outcomes. RESULTS: At the time of this 1-year interim report, a total of 17 failures have been observed in 11 patients, yielding a cumulative survival rate of 94.9%. CONCLUSION: Relative to other prospective, multicenter studies of immediately loaded implants with various surface enhancements, NanoTite implants perform comparatively well when immediately provisionalized with single-tooth and fixed restorations.

Immediate occlusal loading of implants in the partially edentate mandible: a prospective 1-year radiographic and 4-year clinical study.

PURPOSE: The purpose of the present prospective clinical study was to evaluate the radiographic and clinical outcome of immediately loaded implants in the partial edentulous mandible over a 4-year follow-up period using a modified surgical protocol, primary implant stability criteria, and splinting for inclusion. MATERIALS AND METHODS: Patients in need of implant treatment in the partial edentate mandible were consecutively included in the study. The implant sites were underprepared to obtain maximal stability. Inclusion criteria for the study were torque of a least 30 Ncm before final seating of the implant and an ISQ greater than 60. A provisional fixed partial denture was delivered within 24 hours and a definitive fixed partial denture within 3 months. The patients were monitored with clinical and radiographic follow-up examinations for up to 4 years. Stability of the implants was measured with resonance frequency analysis at placement and after 6 months. RESULTS: Ninety-six patients were evaluated, and 77 patients who met the inclusion criteria were included. A total of 111 fixed partial dentures supported by 257 Brånemark System implants (77 turned and 180 TiUnite implants) were delivered. Four (1.6%) of the 257 implants did not osseointegrate, giving an overall survival rate of 98.4% after 4 years. Three turned (3.9%) implants and 1 oxidized implant (0.6%) failed after 4 to 13 months. The average marginal bone resorption was 0.7 mm (SD 0.78) during the first year in function. Turned implants showed an average bone loss of 0.5 mm (SD 0.8) and oxidized implants an average of 0.7 mm (SD 0.8). Resonance frequency analysis showed a mean implant stability quotient of 72.2 (SD 7.5) at placement and 72.5 (SD 5.7) after 6 months of loading. CONCLUSION: It is concluded that immediate loading of implants with firm primary stability in partially edentulous areas of the mandible appears to be a viable procedure with predictable outcome.

Temporary implant-supported prosthesis for immediate loading according to a chair-side concept: technical note and results from 37 consecutive cases.

BACKGROUND: During the last years, focus has been paid to implant treatment using immediate function protocols, and different approaches to provide patients with temporary constructions have been presented. Most of these techniques involve dental technicians producing the temporary construction, for example, rebuilding existing dentures, acrylic bridges, etc. PURPOSE: The purpose of this prospective clinical study was to evaluate the clinical outcome of a chair-side technique of a cost-effective temporary prosthesis. Fixture survival rate and risk of temporary bridge failure were analyzed. MATERIALS AND METHODS: Thirty-seven partially or totally edentate patients (18 female and 19 male; mean age: 66.7 years) treated with chair-side manufactured temporary restorations (QuickBridge, BIOMET 3i, Palm Beach, Fl, USA) for immediate loading have been evaluated. The prostheses extended from two unit bridges supported by two implants to full-arch construction supported by six implants. The temporary prostheses were monitored from the day of surgery and delivery to the time of replacement with a permanent prosthetic construction 3 to 6 months later. RESULTS: No implants were lost during the observation time. One (3%) temporary prosthesis fractured and additional two (6%) loosened during the follow-up time. CONCLUSIONS: The study indicated that the tested chair-side concept for manufacturing of temporary prosthesis for immediate loading of dental implants is a viable approach.

Resonance frequency analysis measurements of implants at placement surgery.

PURPOSE: The knowledge of what levels of primary stability can be obtained in different jawbone regions and of what factors influence primary stability is limited. The objective of this study was to evaluate primary stability by resonance frequency analysis (RFA) measurements of implants placed according to a surgical protocol that aimed for high primary stability. The aim was also to correlate RFA measurements with factors related to the surgical technique, the patient, and implant design. MATERIALS AND METHODS: A total of 905 Brånemark dental implants used in 267 consecutive patients were measured with RFA at the time of placement surgery. RESULTS: A mean ISQ value of 67.4 (SD 8.6) was obtained for all implants. Univariate analyses with the implant or patient as unit showed higher ISQ values in men compared with women, in mandibles compared with maxillae, in posterior compared with anterior sites, and for wide-platform implants in comparison with regular/narrow-platform implants. There was a correlation between bone quality and primary stability, with lower ISQ values obtained for implants placed in softer bone. A lower stability was seen with increased implant length. A stepwise multiple regression analysis using the patient as unit showed that jaw type and gender had independent effects on primary stability. CONCLUSION: The results suggest that factors related to bone density and implant diameter/length may affect the level of primary implant stability. Furthermore, greater stability was observed in male than in female patients. High primary implant stability was achieved in all jaw regions, although the use of thinner drills and/or tapered implants cannot fully compensate for the effect of soft bone. The research design does not permit conclusions regarding long-term treatment outcome with implants.

Direct implant loading in the edentulous maxilla using a bone density-adapted surgical protocol and primary implant stability criteria for inclusion.

BACKGROUND: Long healing periods and submerged implant placement are commonly used in the maxilla. This extends the time of oral handicap and makes the use of immediate loading protocols an attractive option. The current clinical literature on direct loading of dental implants in the maxilla is limited. PURPOSE: The purpose of this prospective clinical study was to evaluate the clinical outcome and stability of directly loaded Brånemark System or Replace Select Tapered implants (Nobel Biocare AB, Göteborg, Sweden) after using a modified surgical protocol and inclusion by primary implant stability. In addition, a reference group treated according to a two-stage protocol was used for comparison. MATERIALS AND METHODS: Twenty patients planned for prosthetic rehabilitation with implant-supported bridges in the edentulous maxilla participated in the study group. The final decision on immediate loading was made after implant placement using insertion torque and resonance frequency analysis (RFA) as acceptance criteria. All patients were included, and 123 oxidized implants (TiUnite, Nobel Biocare AB) were placed using a surgical protocol for enhanced primary stability. A screw-retained temporary bridge was delivered within 12 hours and a final bridge within 3 months of implant placement. The patients were monitored through clinical and radiographic follow-up examinations from implant placement to at least 12 months. Marginal bone level was measured at bridge delivery and after 12 months of loading. Additional RFA measurements were made after 6 months of loading. A reference group comprising 20 patients with 120 implants treated according to a two-stage protocol was used for comparison. RESULTS: One (0.8%) of the 123 implants in the study group failed, and no implant was lost in the reference group. The cumulative survival rates after 12 months of loading were thus 99.2% and 100% for immediate and delayed loading protocols, respectively. The marginal bone resorption was 0.78 (SD 0.9) in the study group and 0.91 (SD 1.04) in the reference group. RFA showed a mean value of 62.9 (SD 4.9) implant stability quotient (ISQ) at placement and 64.5 (SD 4.8) ISQ after 6 months for immediately loaded implants (not significant). The corresponding figures for the reference groups were 61.3 (SD 8.8) ISQ and 62.6 (SD 7.0) ISQ (not significant). There were no statistically significant differences between the groups at any time point. CONCLUSION: The use of six to seven implants for immediate loading of a fixed provisional bridge is a viable option for implant treatment of the edentulous maxilla, at least when good primary implant stability can be ensured.

One-year results of a prospective multicenter study on Brånemark System implants with a TiUnite surface.

BACKGROUND: A moderately rough surface implant (TiUnite, Nobel Biocare AB, Göteborg, Sweden) was introduced in 2000. Laboratory studies and some clinical studies have demonstrated excellent bone response in the early healing phase. PURPOSE: The aim of this prospective multicenter study was to follow a large number of consecutively treated patients using Brånemark System implants with the TiUnite surface. The current report constitutes the 1-year data of a planned 3-year study. MATERIALS AND METHODS: Originally, the study comprised 43 surgeons from 22 centers in Sweden, Norway, and Finland. Five centers were excluded from the study because of poor compliance. Thus, 187 patients treated with 478 TiUnite implants were followed during 1 year of function. The majority of implants were inserted in maxillae (357 implants), and 78 of the implant sites were assigned the quality 4 figure. Radiographic evaluations were performed. RESULTS: Five implants were lost up to and including the 1-year follow-up, revealing implant cumulative survival rates of 98.6% and 100% for maxillae and mandibles, respectively. Three implants failed in quality 4 bone (3.8%). The mean marginal bone resorption at the end of the study period was 1.4 mm. The number of withdrawals of patients during the first year was high (19.3%). CONCLUSION: The present investigation showed a high implant cumulative survival rate of 98.9%. Values of marginal bone resorption were within normal ranges. No adverse effects of the TiUnite surface were reported, and complications during the study period were few and similar to those reported for the turned implant surface. However, the high number of excluded patients and the relatively high number of withdrawals must be observed and considered when interpreting data.