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 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.

Direct loading of Nobel Direct and Nobel Perfect one-piece implants: a 1-year prospective clinical and radiographic study.

OBJECTIVES: The aim of this prospective study was to evaluate the Nobel Direct and Nobel Perfect one-piece implants (OPIs) when used for immediate function. MATERIAL AND METHODS: Forty-eight patients were provided with 115 OPIs for loading with a provisional crown or a bridge within 24 h and followed for at least 12 months with clinical and radiographic examinations. A group of 97 patients previously treated under identical conditions by the same team with 380 two-piece implants (TPIs) for immediate loading in the mandible and maxilla served as the reference group. RESULTS: Six (5.2%) OPIs failed during the follow-up due to extensive bone loss. Five (1.3%) implants failed in the reference group. After 1 year, the mean marginal bone loss was 2.1 mm (SD 1.3) for OPIs and 0.8 mm (SD 1) for TPIs. 20% of OPIs showed more than 3 mm of bone loss compared with 0.6% for TPIs. When compensating for vertical placement depth, OPIs still showed a lower marginal bone level and thus more exposed threads than TPIs. Depending on the criteria used, the success rate for OPIs was 46.1% or 72.2% compared with 85% or 91.6% for TPIs. CONCLUSIONS: The Nobel Direct and Nobel Perfect OPIs show lower success rates and more bone resorption than TPIs after 1 year in function. Factors such as implant design, insertion depth, rough surface towards the mucosa, in situ preparation and immediate loading may have an influence on the clinical outcome.

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.

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.