Use of narrow-diameter implants in the posterior segments of the jaws: A retrospective observational study of 2 to 11 years.

STATEMENT OF PROBLEM: The placement of narrow-diameter implants (NDIs) in the posterior region is still debated in view of the high biomechanical risks in these areas. PURPOSE: The purpose of this retrospective observational study was to evaluate the success and survival rates of NDIs restored with fixed prostheses in the posterior region (primary outcome) and analyze whether splinting multiple units (prosthesis design) affects the biological and mechanical complications (secondary outcome). MATERIAL AND METHODS: Dental records from 2 private clinics were reviewed for NDIs in the posterior region installed between 2009 and 2018. Ninety study participants (58 women and 32 men) aged between 21 and 84 years (mean age 49.9 years) were recalled for the assessment of implant survival and success of 160 NDIs previously provided for partial posterior edentulism associated with moderate horizontal bone loss or reduced interradicular space (105 premolars and 55 molars). The implants were restored with metal-ceramic single crowns or splinted multiple-unit prostheses, either screw-retained or cemented on custom (n=100) or stock titanium abutments (n=60). Peri-implant probing depth (PPD), bleeding on probing (BOP), bone quality, type of edentulism, and patient satisfaction were scored. The chi-squared test for independence and 2-sample Welch t test were performed for statistical analysis (α=.05). RESULTS: The overall success rate was 89.37%. One implant had been removed 4 years after loading, another after 9 years, yielding a cumulative survival rate of 98.75%. Fourteen implants exhibited PPD > 5 mm. One implant and 1 abutment screw fractured, and 16 restorations demonstrated porcelain chipping. The chi-squared test showed no significant relationship between prosthetic design and complications whether biological (P=.087) or mechanical (P=.805). Eighty-two percent of patients were satisfied with esthetics, 76% with function, 85% with total duration of treatment, and 90% with overall treatment cost. CONCLUSIONS: Within the limitations of this retrospective study, NDIs may be considered a reliable option to replace posterior teeth. The prosthetic design had no significant impact on biological or mechanical complications.

Use of Connective Tissue Graft and Coronally Advanced Flap in Areas of Buccal Contour Concavities for Nonsubmerged Implant Placement.

There is a lack of scientific evidence concerning the best timing of soft tissue management around implants, as well as a divergence of topics concerning optimal procedures. The objective of this study is to evaluate the gain in buccal contour and soft tissue stability after a surgical technique combining nonsubmerged implant placement with submarginal connective tissue graft (CTG) and coronally advanced flap (CAF). Seven patients (4 males and 3 females) underwent surgery for transmucosal implant placement in partially edentulous areas showing mild to moderate buccal contour concavities using a technique combining CTG and CAF. The following parameters were evaluated: keratinized tissue height (KTH), soft tissue thickness (STT), and vertical soft tissue level (VSTL) at T0 (before surgery), T1 (6 months after surgery), T2 (12 months after surgery) and T3 (2 years after surgery). After two years, we observed an increase of 78.5% in buccal KTH, 64% in STT, and 24% in VSTL. No implant presented any sign of mucositis or bone loss. Non-submerged implant placement using an "envelope flap design" in addition to CTG and CAF is beneficial.

Use of narrow-diameter implants in the posterior jaw: a systematic review.

STATEMENT OF PROBLEM: Evidence is limited on the efficacy of narrow-diameter implants (NDIs) in the posterior jaw. PURPOSE: The purpose of this systematic review was to assess the survival of NDIs and provide guidelines for their safe use. MATERIALS AND METHODS: Electronic search of the English-language literature enriched by hand search to identify suitable publications was made. Only peer-reviewed clinical studies published from January 1990 through March 2014 were included. RESULTS: Seventeen studies with a total of 1644 implants met the inclusion criteria, with an observation period from 1 up to 12 years. The mean survival rate of 98.6% was reported. Technical and other complications were observed. CONCLUSION: Short-term clinical data suggest that NDIs may serve in the posterior jaw as an alternative to standard-diameter implants. However, certain clinical conditions must be observed to assure long-term success.