Ten-year retrospective follow-up study of the TiOblast dental implant.

PURPOSE: Long-term results in the clinical outcome of different implant systems, including high patient numbers and a long follow-up time, are rare. This retrospective study evaluated the cumulative survival rate of a self-tapping, cylindrical implant system with a conical implant-abutment connection after 10 years of prosthetic loading. MATERIALS AND METHODS: A total of 516 TiOblast implants (Astra Tech AB, Mölndal, Sweden) were placed in 108 patients. The patients were treated in the Department of Oral and Maxillofacial Surgery, Johannes Gutenberg University, Mainz, Germany, between September 1994 and May 2005. The main indications for implantation were the treatment of edentulous mandibles (74%) and partial edentulism (15%). Twenty-three implants were placed postradiation, and a further 64 implants were irradiated after insertion. In 153 implants, a bony augmentation was conducted prior to implantation. RESULTS: The in situ rate was 89.7% after an average implantation time of 108 months. Eighty-three patients with 403 implants were available for investigation. Seventeen patients with 76 implants have died since 1994. Absence of osseointegration (n = 22), peri-implantitis (n = 18), fracture of the implants (n = 9), failing of primary stability (n = 2), and implants next to tumors (n = 2) were the reasons of explantation in 26 patients. Under analysis with different implant success-assessment criteria, the success rate showed results from 76 to 89%. CONCLUSION: With respect to the critical patient selection including a high number of patients with minor and major augmentations, the 10-year clinical use of the studied implant system showed acceptable results.

Retrospective clinical evaluation of an internal tube-in-tube dental implant after 4 years, with special emphasis on peri-implant bone resorption.

PURPOSE: A clinical evaluation of the long-term survival rate of three subtypes of a dental tube-in-tube implant with special emphasis on peri-implant bone resorption was conducted and is presented here. MATERIALS AND METHODS: A retrospective follow-up examination of patients treated with tube-in-tube implants between August 2001 and August 2005 was conducted. For patients available for clinical recall, success criteria according to Albrektsson and Buser were evaluated. Differences in peri-implant bone resorption with regard to implant subtype and depth of implant placement (supracrestal or crestal) were calculated via the Student t test. RESULTS: One hundred twenty-seven patients were provided with a total of 382 Camlog implants. Of the implants placed, 239 were root-line (RL), 129 were screw-line (SL), and 14 were cylindric. One hundred four patients with 318 implants could be contacted. In 59 cases, bony augmentation was performed. After an average time in situ of 32 months (range, 8 to 56 months), 307 of 318 surveyed implants (96.5%) remained in function. Six implants were lost as a result of absence of osseointegration, four following peri-implantitis, and one owing to hypesthesia. Two patients with eight implants have died since 2005, and 21 patients with 47 implants could not be contacted. In 75 patients with 240 implants, clinical success rates were 94% (Albrektsson) and 97% (Buser). A significant difference in bone resorption was found between RL and SL implants (P < .0001). Implants that had been placed supracrestally showed significantly less bone resorption than crestally inserted implants, both overall and in subgroup analyses (RL, P = .015; SL, P < .0001). CONCLUSION: The internal tube-in-tube implant system showed promising long-term results. Significantly less bone resorption was seen for RL implants as well as for implants that were placed supracrestally.

Severe third molar complications including death-lessons from 100 cases requiring hospitalization.

PURPOSE: In this study we investigated patients that were hospitalized due to third molar (M3) complications. Specifically we analyzed frequency, age distribution, and outcome with respect to the M3 clinical status. PATIENTS AND METHODS: We set up a prospective cohort study and included 100 subjects admitted for management of acute M3-associated complications. The clinical status of the M3 was defined as 1) prophylactic M3 removal, 2) therapeutic (nonelective) M3 removal, or 3) M3 present at the time of admission. Outcome variables were clinical infection markers (C-reactive protein, leukocyte counts) and economic parameters (treatment costs, length of hospital stay, and days of disability). Nonparametric tests were used for comparison of subpopulations (surgical vs nonsurgical, prophylaxis-related vs nonprophylaxis-related). RESULTS: One third of the 100 patients were age 40 or older. Overall 80 severe infections, 11 mandibular fractures, 3 nerve injuries, 5 tooth/root luxations, and 1 postoperative hemorrhage were noticed. Twenty-seven complications resulted from prophylactic surgery, 44 from nonelective removal, and 29 from pericoronitis. Postoperatively, a 77-year-old male patient hospitalized with nonelective removal sustained fatal myocardial infarction. Treatment costs were 260,086 euro (mean 2,608 euro/case); total days of disability were 1,534. The postsurgical complications showed higher C-reactive protein values compared with pericoronitis-induced complications. CONCLUSIONS: Within the catchment area of our institution, the majority of complications requiring hospitalization resulted from diseased third molars or their removal. Side effects of observational strategies such as the shifting of complications to higher ages deserve future attention.

Immediate function with NobelPerfect implants in the anterior dental arch.

This study examined the clinical performance of the scalloped NobelPerfect implant in a one-stage procedure (immediate provisionalization in the esthetic zone). In 20 patients, immediate prosthetic restorations were placed on 31 NobelPerfect implants and followed for up to 27 months. Outcome variables were success rates, marginal bone levels, and Pink Esthetic Score (PES) assessed per implant. One implant failed (success rate: 96.8%). Marginal bone levels averaged 1.7 mm above the first thread and remained stable during the observation period. Mean PES ratings were 11.3 (range, 8 to 14). Survival rates, marginal bone levels, and esthetic results suggest proof of principle for the preservation of the interproximal bony lamella with a scalloped implant design.

Third molar complications requiring hospitalization.

OBJECTIVE: The aim of this study was to describe demographic and clinical patterns of subjects hospitalized with complications associated with third molars (M3). STUDY DESIGN: The investigation was designed as a prospective cohort study composed of subjects admitted to hospital for management of M3-associated complications. The predictor variable was "clinical status of the M3" defined as (A) prophylactic M3 removal, (B) nonelective M3 removal, or (C) M3 present at the time of admission. Outcome variables were infection parameters, treatment costs, length of hospital stay, and days of disability. Postoperative complications (A and B) were compared to complications based on pericoronitis (C). Complications due to prophylactic removal (A) were compared to those arising from pericoronitis or from the removal of symptomatic teeth (B and C). RESULTS: From January 2003 to December 2004, 45 deep space infections, 6 mandibular fractures, 2 lingual nerve injuries, 1 parapharyngeal tooth luxation, and 1 osteomyelitis were noticed. Fifteen complications resulted from prophylactic surgery (A), 25 from nonelective removal (B), and 15 from pericoronitis (C). Direct treatment costs were 147,000 euro (A: 42,000 euro; B: 74,000 euro; C: 31,000 euro). In 10 of the 15 patients of group C, deep space involvement resulted immediately from the first episode of pericoronitis. Neither clinical markers of infection nor economic parameters showed significant differences between the groups. CONCLUSION: Within the catchment area of our institution, the majority of third molar-related hospitalizations resulted from diseased third molars or their removal.

[Wisdom teeth-complications requiring in-patient treatment. A 1-year prospective study]. / Weisheitszähne -- Stationär behandlungsbedürftige Komplikationen. Eine Prospektive Untersuchung über 1 Jahr.

BACKGROUND: In view of the conflicting guidelines issued by national and international scientific societies, debate about the indications for prophylactic extraction of wisdom teeth is ongoing. This prospective study was therefore set up to explore the complications associated with wisdom teeth and requiring in-patient treatment. PATIENTS AND METHODS: From January /2003 to December 2003, 21 subjects were admitted for treatment of complications associated with wisdom teeth. The medical history was recorded for each of these patients, as were the cause and type of the complications. The parameter used to quantify the severity of any infections was the CRP, and the overall clinical complexity level of each case was assessed by the length of stay in hospital (and the duration of intensive care if this had been necessary). The characteristics of patients in the group with postoperative complications were compared to those of patients with complications attributable to pericoronitis. Moreover, complications in patients who had undergone prophylactic extraction of wisdom teeth that had not been causing any symptoms were compared with those in patients whose wisdom teeth had been extracted because of morbidity. RESULTS: Overall, 18 deep-space infections (15 abscesses, 2 inflammatory infiltrations, 1 case of phlegmonous cellulitis), 2 mandibular fractures and 1 lingual nerve injury were noted within 1 year. The complications resulted from surgical procedures in 15 of the 21 cases, while in 6 they had their origin in pericoronitis. Extensive surgery or intensive care was required only for patients with postoperative complications. The length of stay in hospital was significantly greater for patients with postoperative complications ( p= 0.007, U-test). However, 9 of these 15 patients reported preoperative episodes of infection. Thus, more than two thirds of the complications could be traced back to wisdom teeth that were causing symptoms. CONCLUSION: In our clinic's catchment area, infectious complications were more frequent and more severe and required more intensive and longer treatment in hospital than complications arising from pericoronitis. However, complications of prophylactic extraction of wisdom teeth were decidedly less frequent than direct or indirect complications of extraction of symptomatic teeth. Thus, our data tend to support the concept of elective extraction of wisdom teeth with the aim of preventing serious infections.