Eight to eleven-year follow-up of immediately loaded implants placed in edentulous maxillae with compromised bone volume and poor bone quality: A prospective cohort study.

BACKGROUND: There is a lack of long-term evaluations of immediately loaded implants in patients with compromised maxillary bone. PURPOSE: To evaluate long-term survival and success of immediately loaded implants in subjects with poor maxillary bone quality and volume. MATERIAL AND METHODS: Follow-up was performed on subjects who received six implants loaded within 24 hours with screw-retained fixed prostheses. Twenty-five subjects with limited bone (Lekholm and Zarb, quantity 3 and 4, and quality C and D) were included in the study. Nineteen participated in the radiographic examination and of these 17 participated in the clinical examination at the last visit. Evaluations of marginal bone loss were performed at 1, 3, 5, and 8-11 years. The last clinical examination included removal of the prosthesis followed by registration of: plaque, pus, pocket depth, bleeding upon probing, mobility, and percussion testing. RESULTS: The mean follow-up was 9 years and 2 months (101-131 months) after surgery and showed a cumulative implant survival rate of 81.9% and success rate of 74.7%. Mean marginal bone loss was 1.29 mm (SD 2.47 mm range 0-11 mm) with a mean pocket depth of 3.1 mm (SD 2.4 mm, range 1.5-13.5 mm). 42.5% of the implants showed plaque retention and 72.2% showed bleeding on probing. CONCLUSION: This nonaugmenting immediate loaded implant protocol for maxillary edentulous patients is a satisfactory solution for selected patients.

Immediate Loading of Tilted and Axial Posterior Implants in the Edentulous Maxillary Arch: A Retrospective Comparison of 5-Year Outcomes.

PURPOSE: The purpose of this study was to retrospectively compare long-term outcomes for immediately loaded tilted and axial implants placed in the posterior region of the edentulous maxillary arch. MATERIALS AND METHODS: Data obtained from a 5-year prospective study designed to assess clinical outcomes following immediate loading of implants with screw-retained fixed restorations in the edentulous maxillary arch were retrospectively reviewed. Where insufficient alveolar bone was available for axial placement of the posterior-most implant on each side of the arch, tilted placement was employed. Implant survival and marginal bone level changes for these tilted and axial posterior implants were compared. RESULTS: Fifty-one subjects received 64 tilted and 38 axial posterior implants. Forty subjects with 53 tilted and 34 axial posterior implants returned for follow-up after 5 years. Five tilted and seven axial implants failed, representing an 89% and 86% survival proportion, respectively. The mean marginal bone loss was 0.79 (SD: 1.42) mm for tilted implants and 0.14 (SD: 0.34) mm for axial implants. The differences in survival proportions and marginal bone loss between axial and tilted implants were not statistically significant. CONCLUSION: Predictable long-term implant rehabilitation may be achieved in the edentulous maxillary arch using posterior tilted implants in combination with immediate loading.

The influence of immediately loaded implant treatment in the atrophic edentulous maxilla on oral health related quality of life of edentulous patients: 3-year results of a prospective study.

BACKGROUND: To evaluate oral health related quality of life (OHQoL) in edentulous patients treated with immediately loaded implants in the maxilla. METHODS: Fifty-one edentulous patients in two centers received six maxillary implants each were loaded within 24 h with provisional restoration. Definitive restoration was delivered 20-24 weeks later. OHQoL was evaluated preoperatively with the Oral Health Impact Profile 49 questionnaire (OHIP-49) and on five subsequent occasions. OHIP-49 includes seven domains representing functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap. A reduction in OHIP scores indicated an improved OHQoL. RESULTS: Forty-five patients reached the three-year follow up. OHQoL improved after treatment. A plateau of OHQoL improvement was observed at 12 months after surgery. The seven domains improved at different pace, 12 weeks to 12 months after treatment. OHIP showed continuously low scores with no significant changes at consecutive visits 12 months to three years after treatment. Dental status with removable prosthesis in the mandible had a negative impact on OHQoL prior to and during treatment, but did not affect OHQoL after permanent restoration was placed. Patients age or gender did not affect OHQoL. CONCLUSIONS: Patients with edentulous maxilla who received prosthetic rehabilitation on immediately loaded implants experienced the highest improved OHQoL 12 months after implant installation. Quality of life related to oral health continued to be high after three years. Edentulous patients with atrophy of the maxilla experience an improved OHQoL after implant treatment with immediate loading protocol. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT00711022 .

Immediate Loading of Implants in the Edentulous Maxilla with a Fixed Provisional Restoration without Bone Augmentation: A Report on 5-Year Outcomes Data Obtained from a Prospective Clinical Trial.

PURPOSE: Successful immediate loading of implants in the edentulous maxilla has been previously reported. The purpose of this 5-year prospective study was to further assess long-term outcomes following immediate loading of implants in the edentulous maxilla with fixed provisional restorations without the use of bone augmentation procedures. MATERIALS AND METHODS: Subjects with edentulous maxillary arches each received six implants placed in native bone without augmentation. Where insufficient posterior bone volume existed, angled implant placement was employed. Fixed provisional restorations were delivered within 24 hours of implant placement. Implant placement locations, insertion torque values, and implant dimensions were recorded. Definitive fixed prostheses were placed within 24 weeks following implantation. Baseline implant site marginal bone levels were measured using periapical radiographs. Baseline peri-implant plaque and bleeding scores were obtained. Subjects were examined 6 months after implant placement and then annually for 5 years with follow-up periapical radiographs and plaque/bleeding scores obtained. RESULTS: Fifty-one subjects received a total of 306 implants. Forty subjects with 232 implants returned for the final follow-up appointment representing a 5-year implant survival proportion of 93% with a mean marginal bone loss of 0.44 ± 1.25 mm for this group. Thirty-nine of these 40 subjects continued to function with fixed restorations with the remaining subject functioning with a non-implant-retained removable prosthesis. CONCLUSION: Within the limitations of this study, predictable long-term implant rehabilitation outcomes were demonstrated for the edentulous maxilla using an immediate loading protocol without bone augmentation.

Three-year follow-up of immediately loaded implants in the edentulous atrophic maxilla: a study in patients with poor bone quantity and quality.

PURPOSE: Immediate loading of implants in the edentulous maxilla has previously been successfully performed and reported. Severe resorption of the maxillary alveolar crest presents a more demanding situation for the restorative team. Thus, it would be valuable to assess outcomes for this immediate loading treatment protocol in subjects with marked maxillary alveolar crest atrophy. This study evaluated the 3-year results of dental implants that were immediately restored with provisional fixed prostheses in atrophic maxillae without previous augmentation. MATERIALS AND METHODS: Two centers enrolled subjects with resorbed edentulous maxillae (Lekholm and Zarb quality 3 or 4 and quantity C, D, or E). Six implants were placed in each subject and restored with screw-retained fixed provisionals within 24 hours. Impressions were taken for definitive restorations, which were placed 20 to 24 weeks later. Radiographs were used to analyze marginal bone level changes throughout the study. RESULTS: Fifty-one patients received 306 implants. Forty-five patients remained in the study at the 3-year follow-up visit and successfully used their definitive prostheses. Sixty-two percent of the implants were placed in bone quantity C and quality 3 or 4, and 38% were placed in quantity D and quality 3 or 4 bone. Thirteen implants in six subjects were lost, resulting in a cumulative survival rate of 96% after 3 years. The mean marginal bone loss during the first year was -0.4 ± 0.8 mm (255 implants); at 3 years it was -0.6 ± 1.1 mm (253 implants). CONCLUSION: Data from the first 3 years of this study revealed good clinical outcomes. Careful selection of patients and planning by the restorative team can enable successful treatment outcomes for patients presenting with marked resorption of the edentulous maxilla.

Three-year prospective multicenter study evaluating marginal bone levels and soft tissue health around a one-piece implant system.

PURPOSE: The aim of this clinical investigation was to evaluate marginal bone remodeling and soft tissue health surrounding a novel one-piece implant system over a 3-year study period. MATERIALS AND METHODS: Subjects missing at least one tooth in either arch were consecutively enrolled in this open prospective 3-year investigation. Five clinics were invited to participate. Strict inclusion and exclusion criteria were used. Marginal bone levels were evaluated using radiographs taken at implant insertion, 6 months, and annually thereafter. Plaque and bleeding indices were recorded at 3 and 6 months and 1 and 3 years following implant insertion. The shapes of papillae were evaluated at implant insertion with the provisional restoration in place, at the insertion of the definitive restoration, and at the 3-year follow-up, using Jemt's papilla index. Life tables and the Mann-Whitney U test were used for statistical analyses. RESULTS: Fifty-six patients were restored with a total of 82 one-piece implants; 47 patients attended the 3-year appointment. One implant had to be removed 1 month postinsertion, giving a cumulative survival rate of 98.8% for the 3-year study period. Most bone resorption (mean, 1.19 ± 1.38 mm; n = 61) occurred during the first year of function, while there was minimal change in mean marginal bone levels between 1 and 3 years (-0.07 ± 1.07 mm; n = 58). Normal peri-implant mucosa was registered for more than 81% of the sites, and no visible plaque was registered for more than 54% of the sites. CONCLUSION: This prospective 3-year multicenter study showed stable marginal bone levels, good soft tissue health, and a high implant survival rate, supporting the hypothesis that the presented one-piece implant system has the capacity to maintain both hard and soft tissues after the first year of initial bone remodeling.

Patient satisfaction following dental implant treatment with immediate loading in the edentulous atrophic maxilla.

PURPOSE: The present study evaluated patient satisfaction using the Oral Health Impact Profile 49 (OHIP-49) questionnaire for patients who received six implants in the severely resorbed maxilla and an implant-supported prosthesis that was delivered within 24 hours after surgery. MATERIALS AND METHODS: Fifty-one edentulous patients with severe atrophy in the maxilla were included in the study, which was performed at two centers. Six implants were placed in the maxilla and loaded within 24 hours with a provisional restoration. The definitive restorations were delivered 20 to 24 weeks later. Patients were asked to complete the OHIP-49 questionnaire (which includes seven domains representing functional limitation, physical pain, psychologic discomfort, physical disability, psychologic disability, social disability, and handicap) prior to implant placement and on three subsequent occasions. The data were collected and analyzed and OHIP scores were compared over time. RESULTS: Baseline satisfaction scores for the two different centers displayed no statistically significant differences. Treatment resulted in improved total OHIP-49 scores in both centers, with no significant difference between centers. Furthermore, no significant differences were observed in any of the individual pretreatment and posttreatment OHIP-49 domains between centers. All seven domains showed a statistically significant improvement posttreatment. Of the seven domains, social disability and handicap showed the least improvement and had the lowest pretreatment scores, indicating lower significance for these domains compared to the other domains during implant treatment. This study also indicated that domains one to five (functional limitation, physical pain, psychologic discomfort, physical disability, and psychologic disability) are the most important domains in patient satisfaction with implant therapy. CONCLUSION: Measurement with the OHIP-49 questionnaire displayed that patient satisfaction increases after treatment with a fixed restoration on implants loaded within 24 hours.

Mandibular reconstruction with vascularized fibula flap and osseointegrated implants: a clinical report.

Primary and secondary reconstruction of mandibular discontinuity defects with vascularized flap is currently the standard of care in many institutions. The most commonly used donor site for such flaps is fibula. Fibula provides enough bone length, allows 2-team approach, and has low donor site morbidity and abundant periosteal blood supply. The placement of endosseous implants in the vascularized fibula flap also facilitates functional dental rehabilitation. This clinical report describes the prosthetic rehabilitation and the complications of 2 mandibular discontinuity defects treated with vascularized fibula flap and implant-supported fixed prosthesis.

Implant rehabilitation of the atrophic edentulous maxilla including immediate fixed provisional restoration without the use of bone grafting: a review of 1-year outcome data from a long-term prospective clinical trial.

PURPOSE: The literature suggests that predictable integration can be achieved when dental implant placement is combined with immediate fixed provisional restoration in a variety of clinical situations. Fewer data are available, however, regarding outcomes for immediate provisional restoration of implants in the edentulous maxilla. This report presents 1-year data acquired from a long-term prospective clinical trial designed to assess outcomes following the immediate provisional fixed restoration of implants in the atrophic edentulous maxilla without the use of bone augmentation. MATERIALS AND METHODS: Fifty-one subjects diagnosed with an atrophic edentulous maxilla received a total of 306 implants (six implants per subject) followed by fixed provisional restoration within 24 hours of implant placement. No subjects underwent grafting to enhance bone volume in preparation for implant treatment. Data acquired included bone quantity and quality, implant dimensions, implant locations, and implant placement stability. Subjects returned for 1-year follow-up examinations to assess implant integration and restoration function. Periapical radiographs were obtained and compared to baseline images to assess marginal bone height maintenance. RESULTS: At the 3-month follow-up examination, 294 of 306 implants placed in 51 subjects were found to be integrated. This represents a cumulative implant survival rate of 96%. At the 1-year follow-up examination, mean marginal bone loss of 0.5 mm was noted, with no further loss of implants. CONCLUSIONS: These results support the contention that predictable long-term outcomes may be obtained for the atrophic edentulous maxilla when treated with an implant rehabilitation protocol that includes immediate fixed provisional restoration without the use of bone grafting. This strategy offers a promising treatment alternative for the patient with an atrophic edentulous maxilla.

A survey of clinicians: prioritization of dental treatment in leukemia patients prior to chemotherapy.

PURPOSE: Chronic oral and dental infections that may remain benign and asymptomatic in healthy individuals can develop into serious and life-threatening conditions when leukemia patients undergo chemotherapy. There is a general consensus that elimination of chronic dental and oral infections prior to chemotherapy reduces the risk of serious problems that may require hospitalization. The limited time available for dental treatment prior to chemotherapy forces clinicians to prioritize. The aim of this study was to determine how hospital-based clinicians who routinely see leukemia patients prioritize dental treatment prior to chemotherapy. MATERIALS AND METHODS: A survey was conducted that targeted the membership of the American Academy of Maxillofacial Prosthetics because a large number of these clinicians had first-hand experience in managing leukemia patients. RESULTS: The consensus was that apical radiolucencies and severe periodontitis must be eliminated. Opinions differed regarding whether and how mild periodontal pathology and caries lesions should be treated. CONCLUSION: Most of the surveyed practitioners believed that infectious processes that invade the bone pose the highest risk if left untreated prior to chemotherapy.

Clinical evaluation of a prospective multicenter study on 1-piece implants. part 1: marginal bone level evaluation after 1 year of follow-up.

PURPOSE: The aim of the present investigation was to evaluate the marginal bone level after 1 year of follow-up of 1-piece implants after immediate provisional restoration fabrication. MATERIALS AND METHODS: Patients received NobelDirect and NobelPerfect 1-piece implants (Nobel Biocare, G6teborg, Sweden) that were immediately restored and placed into function as part of a 3-year, multicenter investigation. Life table analysis was used for evaluation of implant cumulative survival rates. The Student t test (for dichotomous variables) and Pearson correlation (for continuous and ordered categorical variables) were used to estimate the influence of separate parameters on marginal bone. RESULTS: Eighty-seven patients received 152 NobelDirect or NobelPerfect 1-piece implants. Of these, 81 patients returned for the 1-year follow-up and 21 for the 2-year follow-up. Three implants were lost, resulting in a cumulative survival rate of 97.9% after up to 2 years. The average marginal bone level at implant placement was 0.33 mm (SD 1.20, n = 141) superior to the reference point (lower edge of the implant collar). Marginal bone level was -0.77 mm (SD 1.33, n = 138) at 6 months and -0.98 mm (SD 1.38, n = 123) at 1 year. Average bone level at the 2-year follow-up was 0.17 mm (SD 1.20, n = 26). After 1 year of loading, bone level in the maxilla was more apical compared to that in the mandible (P = .05), and a positive correlation was found between bone level at placement and bone level at 12 months (P = .008). Shallow implant positioning resulted in less marginal bone remodeling compared to deep implant positioning. CONCLUSION: On the basis of this prospective multicenter study, stable marginal bone level and soft tissue support the hypothesis that the 1-piece implant has the capacity to preserve both hard and soft tissue.

Prospective multicenter study of marginal bone level and soft tissue health of a one-piece implant after two years.

STATEMENT OF PROBLEM: A novel 1-piece implant purported to provide for stable tissue support, immediate function, and immediate placement in extraction sockets has been developed. Stabilization of the marginal bone level over time requires documentation. PURPOSE: The aim of this study was to evaluate marginal bone level differences and soft tissue health between the 1- and 2-year follow-up of a 1-piece implant design. MATERIAL AND METHODS: Eighty-two implants, restoring both single teeth and multiple edentulous situations, in 56 consecutively treated patients, were included. Marginal bone level was evaluated on radiographs made at implant insertion, 6-month follow-up, and annually thereafter. At 3-, 6-month, and 1-year follow-ups, presence of plaque and the soft tissue response were evaluated using plaque and bleeding on probing indexes. The papilla index was used to determine papilla size at implant insertion with the provisional restoration in place and at the insertion of the definitive restoration. The change over time in marginal bone level was analyzed with a 1-way analysis of variance (ANOVA) paired design with time as main effect (1 to 2 years) and subjects as block effect (alpha=.05). RESULTS: One implant failure occurred, resulting in a 98.8% cumulative survival rate (CSR) for the follow-up time of 2 years. The mean (SD) change in bone level between years 1 and 2 was 0.08 mm (1.19) (95% CI-0.30 to 0.46) (P=.68), demonstrating a stable marginal bone level. Normal implant mucosa was noted for approximately 90% of the sites at the 1-year follow-up. The mean (SD) papilla score at placement was 1.3 (0.66) and increased to 1.7 (0.67) at insertion of the definitive prosthesis. CONCLUSIONS: The stable marginal bone level and soft tissue health observed indicate that the 1-piece implant tested has the ability to preserve both hard and soft tissue. Based on the high implant survival rate and favorable tissue response, the 1-piece implant can be recommended for clinical use.

Osseointegrated craniofacial implants in the rehabilitation of orbital defects: an update of a retrospective experience in the United States.

STATEMENT OF PROBLEM: Since their introduction, craniofacial implants have been used in prosthetic rehabilitation of facial defects. The literature, however, indicates marked variability in outcomes using implants for the retention of orbital prostheses. PURPOSE: A multicenter report updating the experience in the United States with the use of craniofacial implants for prosthetic rehabilitation of orbital defects is presented. MATERIAL AND METHODS: Surveys were sent to clinicians at 25 centers where maxillofacial prosthetic treatment is provided to obtain retrospective data regarding patients who completed implant-retained orbital prosthetic rehabilitation. Data on implant placement location, radiation treatment history, and use of hyperbaric oxygen therapy were collected and assessed in relationship to implant survival over time. The Kaplan-Meier life table and Wilcoxon analyses (alpha = .05) were used to assess the significance of the findings. RESULTS: Ten centers responded, providing data suitable for statistical analysis on 153 implants placed to retain 44 orbital prostheses and followed for a mean period of 52.6 months. Forty-one implant integration failures occurred during this follow-up period, resulting in an overall integration survival rate of 73.2%. No significant relationship was found between radiation treatment history, hyperbaric oxygen therapy history, or implant placement location and implant survival. Individual responses revealed large variability between reporting centers in treatment outcomes. CONCLUSION: Craniofacial implants may offer marked benefits in the prosthetic rehabilitation of orbital defects when compared to conventional adhesive retention designs. However, questions remain regarding long-term predictability and the impact specific factors may have on treatment outcomes. Insufficient data is currently available from which to draw statistically meaningful conclusions. The establishment of a national database designed to acquire adequate data to assess treatment outcomes is recommended.

Randomized study evaluating recombinant human bone morphogenetic protein-2 for extraction socket augmentation.

BACKGROUND: Conventional dentoalveolar osseous reconstruction often involves the use of grafting materials with or without barrier membranes. The purpose of this study was to evaluate the efficacy of bone induction for the placement of dental implants by two concentrations of recombinant human bone morphogenetic protein-2 (rhBMP-2) delivered on a bioabsorbable collagen sponge (ACS) compared to placebo (ACS alone) and no treatment in a human buccal wall defect model following tooth extraction. METHODS: Eighty patients requiring local alveolar ridge augmentation for buccal wall defects (> or =50% buccal bone loss of the extraction socket) of the maxillary teeth (bicuspids forward) immediately following tooth extraction were enrolled. Two sequential cohorts of 40 patients each were randomized in a double-masked manner to receive 0.75 mg/ml or 1.50 mg/ml rhBMP-2/ACS, placebo (ACS alone), or no treatment in a 2:1:1 ratio. Efficacy was assessed by evaluating the amount of bone induction, the adequacy of the alveolar bone volume to support an endosseous dental implant, and the need for a secondary augmentation. RESULTS: Assessment of the alveolar bone indicated that patients treated with 1.50 mg/ml rhBMP-2/ACS had significantly greater bone augmentation compared to controls (P < or =0.05). The adequacy of bone for the placement of a dental implant was approximately twice as great in the rhBMP-2/ACS groups compared to no treatment or placebo. In addition, bone density and histology revealed no differences between newly induced and native bone. CONCLUSION: The data from this randomized, masked, placebo-controlled multicenter clinical study demonstrated that the novel combination of rhBMP-2 and a commonly utilized collagen sponge had a striking effect on de novo osseous formation for the placement of dental implants.

Adjunctive commissure splint therapy: a revised approach.

The management of trauma to the commissures has been an ongoing challenge for the medical and dental professions. Multiple surgical and prosthetic approaches have been used. Commissure splint therapy is often effective in association with surgery in reducing the effects of scar contraction that ultimately results in microstomia and reduced quality of life. This article describes methods of fabrication of the commissure splint appliance, the rationale for its modification, advantages, and disadvantages.

Early rehabilitation of facial defects using interim removable prostheses: report of two clinical cases.

Postsurgical facial defects often pose a challenge to patient rehabilitation. Such defects can have a severe adverse effect on patient perceptions of body image and self-esteem. When immediate surgical repair of the defect is not feasible, an interim removable facial prosthesis may be considered. This prosthesis can be fabricated and placed as soon as several days after surgery to provide a cosmetically acceptable appearance, permitting the patient to more comfortably and confidently resume social interactions during the postoperative healing period. This article presents two case reports describing the use of interim facial prostheses to provide rapid patient rehabilitation.

Dental follow-up compliance in a population of irradiated head and neck cancer patients.

OBJECTIVE: This study assessed post-radiation therapy dental follow-up compliance in a population of head and neck cancer patients. STUDY DESIGN: A total of 334 dental charts were retrospectively reviewed to determine the follow-up status of dentate patients. All patients were informed of the importance of returning, after completing radiotherapy, for regular follow-up dental examinations on an indefinite basis. Data regarding compliance with these follow-up instructions over time were obtained. RESULTS: Approximately 170 (51%) of the 334 dentate patients were identified as being lost to dental follow-up. The mean point in time at which follow-up failure occurred was 7.5 months after the initial preirradiation dental examination. CONCLUSION: Dental follow-up compliance may be poor in this irradiated patient population, with follow-up failures potentially occurring less than 1 year after the completion of radiotherapy. Preradiation dental care planning must take into account the likelihood of patients being lost to follow-up.