Role of New Hydrophilic Surfaces on Early Success Rate and Implant Stability: 1-Year Post-loading Results of a Multicenter, Split-Mouth, Randomized Controlled Trial.

OBJECTIVE: To compare early implant failure and implant stability of one-stage Hiossen ET III implants with its new hydrophilic (NH) surface, compared with Hiossen ET III implants with the sandblasted and acid-etched (SA) surface at 1-year follow-up. MATERIALS AND METHODS: This study was designed as a split-mouth, multicenter randomized controlled trial aimed to compare SA surface implants (SA group) and NH surface, (NH group). Outcomes were implant and prosthetic survival rates, complications, the insertion torque at implant placement, and implant stability quotient (ISQ) values. RESULTS: Twenty-nine patients (mean age 59.9 ± 11.3 years) were treated and followed up to 1 year after loading. No patient dropped out. Fifty-eight implants (29 SA group and 29 NH group) were placed. No implants or prostheses failed and no complications were experienced during follow-up. The mean insertion torque was 40.5 ± 3.23 (38.17-41.83) Ncm in the SA group and 40.48 ± 3.49 (38.02-41.98) Ncm in the NH group (p = 0.981). There was a statistically significant difference at the second week (T2) with higher values in the NH group (p = 0.041). Similar results were found in the maxilla (p = 0.045), but not in the mandible (p = 0.362). A positive correlation was found between initial insertion torque and ISQ with higher value in the NH group (0.73 vs. 0.66). CONCLUSIONS: NH implants are a viable alternative to SA surface, as they seem to avoid the ISQ drop during the bone remodeling phase.

Errors in Implant Positioning Due to Lack of Planning: A Clinical Case Report of New Prosthetic Materials and Solutions.

The achievement of the optimal implant position is a critical consideration in implant surgery, as it can facilitate the ideal prosthesis design and allow adequate oral hygiene maintenance. The switch from bone-driven to prosthetic-driven implant placement, through a comprehensive diagnosis and adequate treatment plan, is a prerequisite for long-term successful implant-based therapy. The aim of the present case report is to describe a step-by-step prosthetic retreatment of a patient with primary treatment failure due to incorrect dental implant placement. Although dental implants achieve high survival rates, the success of implant prosthetic therapy significantly relies on an appropriate implant position. Malpositioned implants can cause damage to vital structures, like nerves or vessels. Moreover, improper implant positioning can result in esthetic, biological, and technical complications and can, in extreme situations, render the desired prosthetic rehabilitation impossible to achieve.

Effectiveness of Ball Attachment Systems in Implant Retained- and Supported-Overdentures: A Three- to Five-Year Retrospective Examination.

PURPOSE: To evaluate implant and prosthetic survival rates, complications, patient satisfaction, and biological outcomes of patients rehabilitated with a ball attachment system for implant retained- and supported-overdentures (IOV), which was in function for 3 to 5 years. METHODS: This retrospective study evaluated data collected from patients treated between April 2001 and May 2018 with IOV on splinted and non-splinted implants and a ball attachment system. Patients were followed for 36 to 206 months (mean follow-up was 128.1 ± 51.9 months). Data were collected at the 3- and 5-year follow-up examination. Outcome measures were implant and prosthetic survival rates, technical complications, marginal bone loss (MBL), oral health impact profile (OHIP), and periodontal parameters (bleeding on probing and plaque index). RESULTS: A total of 46 patients (16 males and 30 females) with 124 implants were included in this study. Twenty-five implant-retained overdentures were delivered on 53 unsplinted implants, while the other 21 patients received an implant-supported overdentures and the implants were splinted. At the five-year follow-up examination, one implant and one prosthesis failed in the unsplinted group, resulting in a cumulative survival rate of 97.8% at the patient level. Two minor technical complications were experienced. CONCLUSIONS: Implant overdenture retained or supported by ball attachment systems showed high implant and prosthetic survival and success rates. A low number of complications, high patient satisfaction, and successful biological parameters were experienced in the mid-term follow-up. Data need to be confirmed by further randomized trials.

Do the New Hydrophilic Surface Have Any Influence on Early Success Rate and Implant Stability during Osseointegration Period? Four-Month Preliminary Results from a Split-Mouth, Randomized Controlled Trial.

OBJECTIVE: The objective of this study is to compare the implant stability of Hiossen ET III implants with its new hydrophilic (NH) surface and Hiossen ET III implants with the sandblasted and acid-etched (SA) surface. MATERIALS AND METHODS: Patients required at least two teeth to be rehabilitated with a fixed, implant-supported restoration, consecutively enrolled. Patients randomly received SA surface implants (SA group) or SA implants with a newly developed bioabsorbable apatite nanocoating (NH group). Outcome measures were implant and prosthetic survival rate, complications, insertion torque, and implant stability quotient (ISQ) measured at implant placement and every week up to 8 weeks after implant placement. Comparison between groups was made by unpaired t-test, while the comparison between each follow-up will be made by paired t-tests to detect any change during the follow-up. Complications and failures were compared using Fisher's exact test. RESULTS: A total of 14 patients were treated with 28 implants (14 SA and 14 NH). No implant and prosthesis failed 4 months after implant placement. No complications were experienced. At the 2nd week after implants placement, two implants in the SA group showed discontinuous measurements versus none in the NH group (p = 0.4815). Implants unscrewed during ISQ measurements and were rescrewed. Data recording stopped for 6 weeks. Both implants osseointegrated without any further complication. The NH implants did not show physiological ISQ decrease between 2nd and 4th week after implant placement, showing a more even pattern of ISQ values compared with SA implants (77.1 ± 4.6 vs. 72.9 ± 11.5; difference: 4.2 ± 12.1; p = 0.258). High ISQ values were found in both groups at each time point. CONCLUSIONS: NH implants are a viable alternative to SA surface, as they seem to avoid the ISQ drop during the remodeling phase.

Accuracy of computer-assisted template-based implant placement using conventional impression and scan model or intraoral digital impression: A randomised controlled trial with 1 year of follow-up.

PURPOSE: To compare accuracy and complications of computer-assisted template-based implant placement using conventional impression and scan of a physical stone cast or intraoral scanning to rehabilitate partially edentulous patients. MATERIALS AND METHODS: Any partially edentulous patients with at least five residual teeth, requiring at least one implant to be planned on three-dimensional (3D) cone beam computed tomography (CBCT) scan according to a computer-assisted template-based protocol were enrolled. Patients were randomised according to a parallel-group design into two arms: intraoral digital impression (fully digital group) or conventional impression and scan model (conventional group). Implants were placed flapless or with a minimally invasive flap, and conventionally loaded after 5 months. Outcome measures were implant and prosthetic success, complications, accuracy and peri-implant marginal bone loss. Three deviation parameters (angular, horizontal and vertical) were defined to evaluate the discrepancy between the planned and placed implant positions. Results were compared using a mixed-model repeated-measures analysis of variance (α = 0.05). RESULTS: Twenty patients (11 females and 9 males; mean age 44.6 years old) were randomised to the fully digital group (10 patients with 28 implants) or conventional group (10 patients with 29 implants). No patients dropped out. No implant or prosthesis failed up to 1 year after loading. One implant in the fully digital group was placed freehand due to limited inter-arch space. No biological or mechanical complications were experienced during follow-up. Difference between groups were not statistically significant (P = 0.999). The mean error in angle was 2.25 ± 1.41 degrees (range 0.30 to 5.00 degrees; 95% CI: 1.38 to 3.12 degrees) in the fully digital group and 2.10 ± 1.18 degrees (range 0.30 to 5.80 degrees; 95% CI: 1.37 to 2.83 degrees) in the conventional group. The difference was not statistically significant (-0.15 ± 1.63 degrees; range -3.20 to 2.90 degrees; 95% CI: -0.87 to 0.57 degrees; P = 0.668); in the horizontal plane (mesio-distal), the mean error was 0.52 ± 0.30 mm (range 0.10 to 1.10 mm; 95% CI: 0.33 to 0.70 mm) in the fully digital group and 0.44 ± 0.26 mm (range 0.10 to 0.90 mm; 95% CI: 0.27 to 0.60 mm) in the conventional group. The difference was not statistically significant (-0.08 ± 0.38 degrees; range -1.0 to 0.60 degrees; 95% CI: -0.32 to 0.16 degrees; P = 0.279); in the vertical plane (apico-coronal), the mean error was 0.58 ± 0.44 mm (range 0.00 to 1.60 mm; 95% CI: 0.31 to 0.85) in the fully digital group and 0.46 ± 0.34 mm (range 0.00 to 1.20 mm; 95% CI: 0.25 to 0.67) in the conventional group. The difference was not statistically significant (-0.12 ± 0.59 degrees; range -1.20 to 1.00 degrees; 95% CI: -0.49 to 0.24 degrees; P = 0.250). One year after loading, the mean marginal bone loss was 0.14 ± 0.12 mm (range -0.10 to 0.40 mm; 95% CI: 0.07 to 0.21 mm) in the fully digital group and 0.18 ± 0.13 mm (range -0.10 to 0.60 mm; 95% CI: 0.09 to 0.26 mm). The difference was not statistically significant (-0.04 ± 0.19 mm; range -0.50 to 0.30 mm; 95% CI: -0.16 to 0.08 mm; P = 0.294). CONCLUSIONS: With the limitations of the present trial, implant rehabilitations planned using intraoral digital impressions showed similar results compared to conventional impression and scan model. Digital impression may be a viable option for the rehabilitation of partial edentulous patients when computer-guided template-assisted implant placement is used.

Effect of Simultaneous Immediate Implant Placement and Guided Bone Reconstruction with Ultra-Fine Titanium Mesh Membranes on Radiographic and Clinical Parameters after 18 Months of Loading.

BACKGROUND: The aim of the present prospective case series study was to evaluate the implant and prosthetic survival rates, complications and marginal bone loss using ultra-fine titanium mesh membrane with simultaneous implant placement, to provide space maintenance mandatory for guided bone reconstruction of alveolar bone defects. MATERIALS AND METHODS: patients were recruited and treated at a private clinic in Rome, Italy, between March 2016 and October 2017. Self-tapping tapered implants were placed through a computer-guided template-assisted approach. Autogenous bone was placed alone over the exposed implant surface, then mixed with inorganic bovine bone material. Finally, the membrane was connected and shaped in order to securely enclose the graft area, and the healing cap was connected and screwed onto the height connector. Outcome measures were: implant and prosthetic failure, biological and mechanical complications, marginal and volumetric bone level changes, esthetic evaluation performed according to the pink aesthetic score (PES). RESULTS: in total, seven patients (five women, two men) with a mean age of 52.7 ± 20.3 years (range: 27-71) received 10 self-tapping tapered implants and simultaneous guided bone regeneration with ultra-fine titanium mesh membranes. No implants and no prostheses failed during the entire follow-up period. One slightly membrane exposure was observed one month after implant placement in one patient. The mean marginal bone loss (MBL) at implant loading was 0.13 ± 0.09 mm (95 % CI 0.08-0.19). At the 18-month follow-up examination, the mean MBL was 0.28 ± 0.33 mm (95 % CI 0.07-0.50) The difference was not statistically significant (0.15 ± 0.31; 95% CI 0.05-0.35; P = 0.1888). The mean horizontal alveolar ridge width was 3.72 ± 1.08 mm (95% CI 3.22-4.22 mm). At the II-stage surgery, the mean bone width was 8.79 ± 0.98 mm (95% CI 8.51-9.07 mm). The mean bone gain was 5.06 ± 1.13 mm (95% CI 4.68-5.44 mm; P = 0.000). The mean volume of the grafted bone calculated using the superimposition technique was 0.99 ± 0.38 CC (95% CI 0.75-1.23 CC). The mean PES at implant loading was 8.2 ± 0.8 mm (95 % CI 7.7-8.7). At the 18-month follow-up examination, the mean PES was 12.0 ± 0.7 mm (95 % CI 11.5-12.5) The difference was statistically significant (3.8 ± 0.4; 95 % CI 3.5-4.1; P = 0.0000); Conclusion: with the limitation of the present prospective study, the guided bone reconstruction using an ultra-fine titanium mesh membrane with simultaneous implant placement seems to provide good and stable results in implant/prosthesis success. Further research with a longer follow-up and a higher sample size are needed to confirm the results from this preliminary report.

Accuracy of Computer-Assisted Template-Based Implant Placement Using Two Different Surgical Templates Designed with or without Metallic Sleeves: A Randomized Controlled Trial.

Purpose: To compare virtual planning accuracy of novel computer-assisted, template-based implant placement techniques, which make use of CAD/CAM stereolithographic surgical templates with or without metallic sleeves. Furthermore, to compare open versus closed sleeves for templates without metallic sleeves. Materials and methods: Any partially edentulous patients requiring at least one implant to be placed according to a computer-assisted template-based protocol were enrolled. Patients were randomized according to a parallel group design into two arms: Surgical template with or without metallic sleeves. Three deviation parameters (angular, horizontal, vertical) were defined to evaluate the discrepancy between the planned and placed implant positions. Results: No implants failed, and no complications were experienced. Forty-one implants were placed using surgical templates with metallic sleeves while 49 implants were placed with a surgical template without metallic sleeves. Of these, 16 implants were placed through open sleeves and 33 through closed sleeves. There was a statistically significant difference in angle (p = 0.0212) and in the vertical plan (p = 0.0073) with lower values for implants placed with a surgical template without metallic sleeves. In the test group, close sleeves were more accurate compared with open sleeves in angle (p = 0.0268) and in horizontal plan (p = 0.0477). Conclusion: With the limitations of the present study, surgical templates without metallic sleeves were more accurate in the vertical plan and angle compared to the conventional template with metallic sleeves. Open sleeves should be used with caution in the molar region only in case of reduced interarch space. Further research is needed to confirm these preliminary results.

Long-term survival analysis of standard-length and short implants with multifunctional abutments.

BACKGROUND: Spherical shape and connecting bypass screw of the OT Equator abutment (Rhein83, Italy) provides several retentive possibilities, even in non-parallel implants. OBJECTIVE: This study assessed the long-term survival of standard-length and short implants receiving this multifunctional abutment. METHODS: Partially, edentulous patients (44 males and 64 females) (mean age 58.2 ± 10.5 years) rehabilitated with a fixed implant-supported prosthesis where the OT Equator abutments (Rhein83) were applied. Follow-up evaluations were performed up to 5 years following prosthesis delivery. Kaplan-Meier survival analysis and Cox regression analysis were used to determine whether the distribution of time to failure differed based on implant characteristics (length and region), adjusting for sex (α = 0.05). RESULTS: In total, 216 implants (5 × 8 mm, n = 126; 5 × 6 mm, n = 90) (Betwice, Mech & Human, Italy) were installed. The average follow-up period was 25.3 months (±19.3 months). Eight failures occurred, with most observed before loading (n = 6). Cumulative survival rates (CSR) at implant and abutment levels were 94.3% and 97.1%, respectively. Regarding implant length, CSRs were 97.8% and 90.6% for short and standard-length implants, respectively, with no difference between subgroups (logrank: χ2  = 1.34, df = 1, P = 0.25). No significant difference was also found between implants of maxilla (CSR = 92.2%) and mandible (CSR = 95.5%; logrank: χ2  = 0.08, df = 1, P = 0.78). CONCLUSION: The OT Equator abutment (Rhein83) showed a stable clinical performance, with continuous and predictable survival.

Accuracy of newly developed sleeve-designed templates for insertion of dental implants: A prospective multicenters clinical trial.

BACKGROUND: The insertion of dental implants by means of computer-assisted template-based surgery is an established method. PURPOSE: To investigate the accuracy of a newly developed sleeve-designed template and to evaluate differences between maxillary and mandibular implants as well as anterior versus posterior area. MATERIALS AND METHODS: Any partially edentulous patients requiring at least one implant to be planned on three-dimensional cone beam computed tomography scan, according to a computer-assisted template-based protocol, were consecutively enrolled at two centers. Any potential implant position was considered eligible for the present trial. Outcome measures were: implant failure, complications, and accuracy. RESULTS: A total of 39 patients with 119 implants were evaluated. No patients dropped out during the study period (mean follow-up 12.4 ± 7.1 months). Three implants failed at centre two, whereas, one complication was experienced at centre one (limited access in posterior area). Differences were not statistically significant (P > .05). The mean deviations were 0.53 ± 0.46 mm (range 0.05-3.38 mm; 95% CI 0.32-0.48 mm) in the horizontal plan (mesio-distal); 0.42 ± 0.37 mm (range 0.0-1.53 mm; 95% CI 0.26-0.40 mm) in the vertical plan (apico-coronal); and 1.43 ± 1.98° (range 0.03-11.8°; 95% CI 0.31-1.01°) in angle. Differences between centers were compared using the nonparametric Mann-Whitney U test (P > .05). More accurate results were found for anterior implants in both horizontal plan and angle. CONCLUSION: This study showed good precision in all the parameters measured. The results were thus in a range equal to or better than the mean precision found in numerous clinical trials described in the literature. Posterior implants were less accurate because of the use of open sleeves template.

Multicenter Retrospective Analysis of Implant Overdentures Delivered with Different Design and Attachment Systems: Results Between One and 17 Years of Follow-Up.

PURPOSE: To analyze implant and prosthetic survival rates, complications, patient satisfaction, and biological parameters of patients rehabilitated with implant overdentures (IOV) on splinted and nonsplinted implants and different attachment systems, in function for one to 17 years. METHODS: This retrospective study evaluated data collected from patients rehabilitated with implant overdentures between January 2001 and December 2016 in nine different centers. Outcome measures were implant and prosthetic success rates, mechanical complications, marginal bone loss (MBL), oral health impact profile (OHIP), bleeding on probing, and plaque index. RESULTS: A total of 581 implants were installed in 194 patients. Patients were followed for a mean period of 60.6 months (range 6⁻206). Eighty-nine patients received 296 low profile attachment (OT Equator), 62 patients received 124 ball attachments, and 43 patients received 107 Locator attachments. In eighty-three patients the implants were splinted with computer aided design/computer aided manufacturing (CAD/CAM) or casted bar. At the last follow-up, 10 implants failed in eight patients. Statistical significance was found for failed prostheses (P = 0.0723) and complications (P = 0.0165), with better values for splinted implants. No statistically significant differences were found in proportion of implant and prosthetic failure (P > 0.05). At a five-year follow-up, proportion of complications (P = 0.0289) and failed prostheses (P = 0.0069) were statistically higher for IOV on Locator attachments. No difference was founded in MBL at one- and two-year follow-up between different attachment systems (P > 0.05). Statistically significant improvement in all the OHIP categories was reported in all the patients, after one year of function. CONCLUSIONS: Implant overdenture showed high implant and prosthetic survival rates, low complications, high patient satisfaction, and good biological parameters in the long-term follow-up. Splinting the implants may reduce number of mechanical complications. Locator attachments showed higher number of complications. Further studies are needed to confirm these preliminary results.

Long-term Short Implants Performance: Systematic Review and Meta-Analysis of the Essential Assessment Parameters.

Lack of standard criteria in the outcome assessment makes it difficult to draw conclusions on the clinical performance of short implants and, under these circumstances, determine the reasons for implant failure. This study evaluated, through a systematic review of the literature and meta-analysis, the essential parameters required to assess the long-term clinical performance of short and extra-short implants. Electronic databases (Pubmed-MEDLINE, Cochrane Library Database, Embase, and Lilacs) were searched by two independent reviewers, without language limitation, to identify eligible papers. References from the selected articles were also reviewed. The review included clinical trials involving short dental implants placed in humans, published between January 2000 and March 2014, which described the parameters applied for outcome's measurements and provided data on survival rates. Thirteen methodologically acceptable studies were selected and 24 parameters were identified. The most frequent parameters assessed were the marginal bone loss and the cumulative implant survival rate, followed by implant failure rate and biological complications such as bleeding on probing and probing pocket depths. Only cumulative implant survival rate data allows meta-analysis revealing a positive effect size (from 0.052 (fixed) to 0.042 (random)), which means that short implant appears to be a successful treatment option. Mechanical complications and crown-to-implant (C/I) ratio measurement were also commonly described, however, considering the available evidence; no strong conclusions could be drawn since different methods were used to assess each parameter. By means of this literature review, a standard evaluation scheme is proposed, being helpful to regiment further investigations and comparisons on future studies.

Long-term Short Implants Performance: Systematic Review and Meta-Analysis of the Essential Assessment Parameters

Lack of standard criteria in the outcome assessment makes it difficult to draw conclusions on the clinical performance of short implants and, under these circumstances, determine the reasons for implant failure. This study evaluated, through a systematic review of the literature and meta-analysis, the essential parameters required to assess the long-term clinical performance of short and extra-short implants. Electronic databases (Pubmed-MEDLINE, Cochrane Library Database, Embase, and Lilacs) were searched by two independent reviewers, without language limitation, to identify eligible papers. References from the selected articles were also reviewed. The review included clinical trials involving short dental implants placed in humans, published between January 2000 and March 2014, which described the parameters applied for outcome's measurements and provided data on survival rates. Thirteen methodologically acceptable studies were selected and 24 parameters were identified. The most frequent parameters assessed were the marginal bone loss and the cumulative implant survival rate, followed by implant failure rate and biological complications such as bleeding on probing and probing pocket depths. Only cumulative implant survival rate data allows meta-analysis revealing a positive effect size (from 0.052 (fixed) to 0.042 (random)), which means that short implant appears to be a successful treatment option. Mechanical complications and crown-to-implant (C/I) ratio measurement were also commonly described, however, considering the available evidence; no strong conclusions could be drawn since different methods were used to assess each parameter. By means of this literature review, a standard evaluation scheme is proposed, being helpful to regiment further investigations and comparisons on future studies.

A falta de critérios padronizados para a avaliação dos resultados faz com que seja difícil tirar conclusões sobre o desempenho clínico dos implantes curtos e, nestas circunstâncias, determinar as razões para o fracasso do implante. Este estudo avaliou, através de uma revisão sistemática da literatura, os parâmetros essenciais necessários para avaliar o desempenho clínico em longo prazo de implantes curtos e extra-curtos. Bases de dados eletrônicas (PubMed-MEDLINE, Base de dados da Biblioteca Cochrane, Embase e Lilacs) foram avaliadas por dois revisores independentes, sem limitação da linguagem, de modo a identificar artigos elegíveis. As referências dos artigos selecionados foram também analisadas. A revisão incluiu estudos clínicos, publicados entre janeiro de 2000 e março de 2014, envolvendo implantes dentais curtos, instalados em seres humanos, nos quais foram descritos os parâmetros utilizados para mensuração dos resultados e fornecidos dados sobre as taxas de sobrevivência. Treze estudos metodologicamente aceitáveis foram selecionados, sendo identificados 24 parâmetros. Os parâmetros avaliados com maior frequencia foram a perda óssea marginal e a taxa cumulativa de sobrevivência do implante, seguida pela taxa de falha dos implantes e complicações biológicas, tais como sangramento à sondagem e profundidade de sondagem. Apenas a taxa cumulativa de sobrevivência dos implantes permitiu a meta-análise revelando efeito positivo (variação de 0.052 (efeito fixo) até 0.042 (efeito aleatório)), demonstrando que os implantes curtos parecem ser uma opção de tratamento bem sucedida. Complicações mecânicas e a mensuração da proporção coroa-implante foram também referidas, entretanto, considerando-se as evidências disponíveis, não se pode chegar a fortes conclusões, pois diferentes métodos foram utilizados para avaliar cada parâmetro. Por meio desta revisão da literatura, um esquema padronizado de avaliação é proposto, sendo útil para arregimentar ...