A computer-assisted measurement technique to assess bone proximal to oral implants on intraoral radiographs.

A computer-assisted measurement technique for measuring bone levels proximal (mesial and distal) to oral implants imaged on standardized intraoral radiographs offers promise for accuracy and reliability. There were no differences between bone measurements made directly from bone proximal to implants placed in a dry mandible and those resulting from the computer-assisted measurement technique. In addition, there were no differences between measurements made of bone proximal to oral implants in vivo using the microscope and the computer techniques. The computer technique had a low intra- and inter-operator variability, and operators found fewer "unreadable" sites compared to the microscope technique. The computer-assisted measurement of bone levels proximal to oral implants on standardized intraoral radiographs offers accuracy and reliability.

Longitudinal peri-implant clinical responses in anterior mandibles of female patients: a preliminary report.

STATEMENT OF PROBLEM: There is a need for specific documentation that successful osseointegration related to Brânemark implants can be maintained, despite an apparent clinically vulnerable peri-implant soft tissue status. PURPOSE: This study monitored longitudinal peri-implant clinical responses in the mandible and sought to question whether a relatively deep mucogingival pocket will give rise to a greater loss of peri-implant bone than a shallow pocket. METHODS AND MATERIAL: Subjects, 8 women patients (mean age 62 years), were treated with Brânemark mandibular osseointegrated implant-supported prostheses. Four of these subjects had limited (average <3.5 mm) and 4 had unlimited (average > or =3.5 mm) peri-implant pocket probing depths and constituted the control and test subgroups, respectively. Longitudinal changes in peri-implant PAL and radiographic bone support were assessed. RESULTS: Overall probing attachment levels (PALs) of the peri-implant mucogingival complex showed little change. The PAL loss was only minimally significant within the control subjects, and not significant for test subjects. The difference in these mucogingival responses between test and control subjects was significant (P = .04). There was no significant overall longitudinal change in peri-implant bone levels. The longitudinal change of peri-implant bone level was not significant within or between the control and test subjects.

Cardiovascular disease and treatment outcomes with osseointegration surgery.

STATEMENT OF PROBLEM: The frequency of prescription of implant-supported prostheses demands increased scrutiny of systemic health condition on treatment inclusion and exclusion criteria. The risks of an impaired healing response in patients with certain types of cardiovascular diseases (CVD) suggest a possible risk for implant failure in such patients. PURPOSE: This preliminary study surveyed implant treatment outcome of patients with cardiovascular diseases. METHODS: A retrospective analysis of 246 consecutively treated patients was conducted. The patients comprised a CVD interest group of 39 patients, and control subgroups of 98 healthy and 109 patients with a history of other systemic disease. RESULTS: Differences in implant failure rates between the groups were not found to be significant. Though the sample size is small, these results suggest that CVD may not be a risk factor for successful osseointegration.

Osseointegration of oral implants in older and younger adults.

Osseointegration involves an osseous healing response that may be compromised by aging. This study aimed to test the hypothesis that there is no difference between older and younger adults in osseointegration success. A comparison was made between closely matched groups of 39 older adults who had 190 implants supporting 45 oral prostheses and 43 younger adults who had 184 implants supporting 45 oral prostheses. Patients were monitored for a period of 4 to 16 years after prosthetic loading. At the most recent follow-up, the cumulative implant success was 92.0% for the older group compared to 86.5% for the younger group. No statistical significance could be attributed to the difference in implant survival between the groups throughout the study period. Furthermore, the most common outcome for individual prosthetic sites was 100% implant success, and the original prosthetic design was maintained for as long as each patient was monitored in 41 or 45 prosthetic prescriptions for the older patients, and in 39 of 45 prescriptions for the younger patients.

Treatment outcomes of patients with implant-supported fixed partial prostheses.

Implant and prosthesis success for 77 partially edentulous patients, provided with 97 fixed prostheses, supported by 230 Brånemark implants, in place for up to 12 years (mean 5.41 years), were documented in this study. Implant losses per location mirrored their placement, with no difference between zones I and II or between the maxilla and mandible. The implant success rate was 94%, and continuous prosthesis stability was 97%. These results indicate that the Brånemark implant-supported fixed partial prosthesis is a highly efficacious treatment.

The notion of implant-supported overdentures.

This article presents a brief review of the methods and techniques to manage the maladaptive edentulous patient. A discussion of the inclusion and exclusion criteria and treatment outcome measures associated with published prospective osseointegrated implant studies are included and specific therapy options are suggested. It is concluded that there is a need for less invasive, less expensive, less complex, and equally effective treatment options such as the implant-supported overdenture for the maladaptive edentulous patient.

Osseointegrated implants for single-tooth replacement: a prospective 5-year multicenter study.

One hundred seven Brånemark implants were placed in 92 patients participating in an international multicenter trial on single-implant restorations at seven centers. The patients were followed for 5 years in a prospective study focusing on implant success and crown function. Plaque and gingival indexes, as well as probing depths, were recorded around teeth and implants. The marginal bone level at implants was determined from intraoral radiographs. Only three implants (2.8%) had been lost at the final annual checkup. During the follow-up period, a total of 17 patients dropped out or were excluded because of nonconformity with the protocol. Based on the remaining patients, a total of 86 implants were clinically and radiographically evaluated at the 5-year follow-up period, resulting in a cumulative success rate of 96.6% (71 implants) in the maxillae and 100% (15 implants) in the mandibles. Plaque and gingival indexes showed a similar pattern of good health around both natural teeth and titanium abutments. The marginal bone loss during the 5-year period did not exceed 1 mm as a mean for all implants analyzed. The most frequent complication recorded during the follow-up was loosening of the abutment fixation screw. The outcome of this study indicated that safe and highly predictable results can be obtained for 5 years when Brånemark implants are used to support single-tooth restorations.

In vivo measurements of some functional aspects with mandibular fixed prostheses supported by implants.

Maximal occlusal force and oral tactile sensibility were recorded in 21 edentulous patients wearing maxillary complete dentures and mandibular fixed prostheses supported by Brånemark implants. Bite force was measured with a miniature force transducer between antagonistic molars and premolars, and the passive tactile sensibility of the fixtures was recorded in the horizontal and vertical directions with spring balances. The active tactile sensibility was tested using steel foils (100 to 10 microns). The range of maximal occlusal force recorded was from 35 to 330N with highest values observed on the second premolars (mean 143N). Significantly lower forces were found on molars and first premolars (p < 0.01). The detection threshold of minimal pressure was about 330 g in the horizontal, and 388 g in the vertical direction. This difference was not statistically significant. The average number of incorrect assessments when testing steel foils was 16.6 errors, out of 100 recordings. Similar results when using these 3 test modalities had been found on overdentures supported by two mandibular implants and occluding with maxillary complete dentures. The results of this study suggest that mandibular implants supporting fixed prostheses are not likely to improve oral tactile sensibility and maximal occlusal force in the presence of maxillary complete dentures.

Clinical effectiveness of implant-supported single-tooth replacement: the Toronto Study.

Forty-one patients received 49 single-tooth implants placed in different jaw locations. One implant was not osseointegrated at stage 2 surgery. Three successfully osseointegrated implants were not available for follow-up. Forty-five implants were monitored for 1 to 8 years after loading. Each one of the implants met all of the traditionally accepted success criteria, except for nine individual implants that did not meet the proposed bone level criterion. No success criteria exist for natural teeth adjacent to implants. Although preliminary results are favorable, extensive long-term studies are needed to determine which specific criteria comprise optimal functional and esthetic results with minimal risk of morbidity.

The edentulous predicament. I: A prospective study of the effectiveness of implant-supported fixed prostheses.

This prospective longitudinal study follows the treatment of 50 completely edentulous patients who could not successfully wear their complete dentures. After an initial phase of treatment in which the prostheses of all of the patients were optimized, the prosthodontists conducting the study prescribed osseointegrated implant-supported fixed prostheses for 45 patients and an implant-supported overdenture for one patient. Eventually, three of the remaining four patients were treated with implant-supported overdentures. This article details the results of treatment for all 50 patients over a period of 11 to 15.5 years.

The edentulous predicament. II: The longitudinal effectiveness of implant-supported overdentures.

Fifty consecutive completely edentulous patients who were unable to wear their complete dentures took part in this prospective longitudinal study. After providing initial optimization treatment of patients' existing prostheses, prosthodontists conducting the study prescribed osseointegrated implant-supported removable overdentures for 45 of the 50 patients. The remaining five underwent ongoing attempts at optimizing their complete dentures. This article details the results of treatment for the 50 patients over a period of three to 13 years.

Implant prosthodontic treatment options for the edentulous patient.

Longitudinally documented benefits for edentulous patients of treatment outcomes of the osseointegration technique demonstrate compelling therapeutic results. Heterogeneous population groups, treated in different centres by various dental specialists, have provided impressive evidence of a minimal burden of illness associated with the procedure. A critical appraisal of the many components of any implemented treatment paradigm demands repeated analysis of the factors which enable patients' informed consent and dentists' optimal decision making. This paper reviews those salient aspects which impact upon decision making with implant-supported prostheses. It emphasizes the predominance of bone structure in selecting the most likely favourable treatment outcome.