Implant loading protocols for partially edentulous patients with extended edentulous sites--a systematic review and meta-analysis.

PURPOSE: The aim of this study was to systematically review the evidence for immediate implant loading in partially edentulous patients with extended edentulous sites and evaluate potential treatment modifiers. MATERIALS AND METHODS: An electronic search was performed in Medline, Embase, and Central to identify studies investigating the outcome of implants subjected to immediate loading (IL) (less than 1 week), early loading (EL) (1 week to 2 months), or conventional loading (CL) (more than 2 months) with implant-supported fixed dental prostheses (IFDPs) in partially edentulous patients with extended edentulous sites, ie, at least two adjacent teeth are missing. Only human studies with at least 10 cases and a minimum follow-up time of 12 months, reporting on solid-screw-type implants with rough surfaces and a diameter of at least 3 mm, were included. Weighted means of implant survival rates and risk ratios for implant survival at 1 year using meta-analytic tools were calculated to perform the following comparisons: IL vs EL, IL vs CL, and IL in the maxilla vs mandible. Noncomparative studies reporting on IL and EL protocols were summarized through descriptive methods. RESULTS: The search provided 3,872 titles, 837 abstracts, and 444 full-text articles. A total of 24 publications that comprised six comparative studies (five randomized controlled trials, one nonrandomized controlled trial) and 18 noncomparative studies were included for analysis. The comparison of weighted mean survival rates revealed no statistically significant difference between IL (97.9%) and EL (97.8%, P = .9405), and between IL (100%) and CL (99.3%, P = .3280). Meta-analysis showed no statistically significant difference in implant survival at 1 year between IL and EL (RR 0.90; 95% CI 0.30, 2.70; P = .502). A meta-analysis comparing IL and CL could not be performed due to the low number of failures. No statistically significant difference was found for IL implants placed in the maxilla vs the mandible (RR 1.55; 95% CI 0.49, 4.84; P > .05). Due to the small number of IL implants placed in the anterior, a comparison between implant survival in anterior vs posterior zones was not performed. Treatment modifiers were bone quality, primary stability, insertion torque, ISQ values, implant length, the need for substantial bone augmentation, the timing of implant placement, and the presence of parafunctional and smoking habits. CONCLUSIONS: IL presents similar implant survival rates as EL or CL for partially edentulous patients with extended edentulous sites in the posterior zone, as long as strict inclusion/exclusion criteria are followed. There is a lack of evidence for IL of multiple implants in the anterior zone of partially edentulous patients. Preliminary evidence suggests that IL may be equally successful in either the maxilla or mandible. Further research is needed before IL in partially edentulous patients with extended edentulous sites can be recommended in everyday practice.

Immediate loading as a vehicle for interdisciplinary training in implant placement and restoration.

Recently, implant surgery has been introduced into postdoctoral prosthodontic programs; however, efficient training models to teach this have not been described to date. For training models to be effective and acceptable to all parties, a mutually beneficial situation must be created, and guidelines that can be followed easily need to be described. The purpose of this report is to suggest immediate loading of dental implants as an example for an interdisciplinary training model that integrates both the surgical aspects of implant therapy into the education of prosthodontic graduate students and the prosthodontic aspects of implant therapy into the training of periodontal graduate students. A flow chart of training steps is described for a patient treated with an immediately loaded mandibular fixed full-arch prosthesis on five interforaminal implants. Both the prosthodontic and the periodontal residents were involved in all phases of treatment. These postdoctoral students were in the final year of their program. Therefore, individual treatment steps could be taught interchangeably and accomplished by the student of the other specialty under the supervision of a clinical instructor. The unique characteristic of the immediate loading procedure, which includes surgical implant placement as well as immediate conversion of an existing denture into a fixed implant-supported provisional prosthesis, allows each postgraduate student to experience detailed surgical and prosthodontic treatment in a controlled environment on the day of surgery.

Immediate loading as a vehicle for interdisciplinary training in implant placement and restoration.

Recently, implant surgery has been introduced into postdoctoral prosthodontic programs; however, efficient training models to teach this have not been described to date. For training models to be effective and acceptable to all parties, a mutually beneficial situation must be created, and guidelines that can be followed easily need to be described. The purpose of this report is to suggest immediate loading of dental implants as an example for an interdisciplinary training model that integrates both the surgical aspects of implant therapy into the education of prosthodontic graduate students and the prosthodontic aspects of implant therapy into the training of periodontal graduate students. A flow chart of training steps is described for a patient treated with an immediately loaded mandibular fixed full-arch prosthesis on five interforaminal implants. Both the prosthodontic and the periodontal residents were involved in all phases of treatment. These postdoctoral students were in the final year of their program. Therefore, individual treatment steps could be taught interchangeably and accomplished by the student of the other specialty under the supervision of a clinical instructor. The unique characteristic of the immediate loading procedure, which includes surgical implant placement as well as immediate conversion of an existing denture into a fixed implant-supported provisional prosthesis, allows each postgraduate student to experience detailed surgical and prosthodontic treatment in a controlled environment on the day of surgery.

Five-year evaluation of the influence of keratinized mucosa on peri-implant soft-tissue health and stability around implants supporting full-arch mandibular fixed prostheses.

BACKGROUND: The question of the importance of keratinized mucosa around dental implants for the prevention of peri-implant disease could not be answered in the relevant literature so far. OBJECTIVE: To investigate the influence of peri-implant keratinized mucosa on long-term peri-implant soft-tissue health and stability over a period of 5 years. MATERIAL AND METHODS: A total of 386 mandibular dental implants were placed in 73 completely edentulous patients, and subsequently restored with fixed full-arch prostheses. At prosthesis delivery (baseline) and after 3, 6, 12, 18, 24, 36, 48 and 60 months, modified plaque index (mPlI), modified sulcus bleeding index (mBI), distance between implant shoulder and mucosal margin (DIM) and width of peri-implant keratinized mucosa (KM) were recorded. Statistical analysis included multivariate logistic regression, multivariate ordinal logistic regression, generalized estimating equations and Bonferroni's correction. RESULTS: Fifty-eight patients with 307 implants completed the 5-year study. Statistically significantly higher plaque accumulation on lingual sites (mean mPlI 0.67, SD 0.85), bleeding tendencies on lingual sites (mean mBI 0.22, SD 0.53) and larger soft-tissue recession on buccal sites (mean DIM -0.69 mm, SD 1.11 mm) were found when the width of KM was <2 mm, compared to sites with>or=2 mm of KM (mean mPlI 0.40, SD 0.68, P=0.001; mean mBI 0.13, SD 0.41, P<0.01; mean DIM -0.08 mm, SD 0.86 mm, P<0.001). The width of keratinized mucosa had no effect on bleeding tendency or plaque accumulation on buccal sites (P>0.05). CONCLUSION: In patients exercising good oral hygiene and receiving regular implant maintenance therapy, implants with a reduced width of <2 mm of peri-implant keratinized mucosa were more prone to lingual plaque accumulation and bleeding as well as buccal soft-tissue recession over a period of 5 years.

Mandibular two-implant telescopic overdentures.

To stabilize mandibular overdentures in edentulous patients, various connector types which can be attached to between two and four implants placed in the anterior mandible are possible. Treatment using non-rigid telescopic connectors on two interforaminal implants for overdenture stabilization began in 1989. The objective of this study is to investigate soft- and hard-tissue conditions as well as prosthesis function after a period of 10 years. This also involved an evaluation of correlations between radiographic and clinical parameters. Twenty-three subjects with 46 interforaminal implants (ITI solid screw implants, 12 mm in length, 4.1 mm in diameter; 10.4 years in situ, range, 8-12.8 years) were investigated. Modified plaque index (mPI), sulcus fluid flow rate (SFFR), modified sulcus bleeding index (mBI), probing depth (PD), distance from implant crown margin to the coronal border of the peri-implant mucosa (DIM), attachment level (AL), width of keratinized mucosa (KM), Periotest values (PTVs) and prosthesis function were evaluated. In the radiographic evaluation, the distance between implant shoulder and first crestal bone-implant contact (DIB) in mm and the horizontal bone loss (HBL) in mm were measured. The relatively high mPI scores (mean, 0.82; score, 0 in 44.4%; SD, 0.83) did not result in increased SFFR scores (mean, 12; min, 3, max, 38; SD, 7.43) or higher mBI scores (mean, 0.35; score, 0 in 70.8%; SD, 0.59), which was commensurate with healthy peri-implant mucosa. A mean PD value of 2.15 mm (min, 1 mm; max, 5 mm; SD, 0.96) and a mean DIM value of 0.28 mm (min, 0 mm; max, 2 mm; SD, 0.52) were measured. The implants were stable, showing a mean Periotest value of -1.91 (max, 02, min, -6; SD, 1.76). A mean DIB of 3.19+/-0.95 mm (range, 1.3-5.16 mm) and a mean HBL of 1.6+/-1.52 mm (range, 0.28-8.33 mm) were calculated. A correlation was found between DIB and the parameters SFFR (P=0.060), DIM (P=0.042), AL (P=0.050) and especially PTV (P<0.01), leading to the assumption that these clinical parameters may be useful indicators of peri-implant bone loss. The results of the 10-year follow-up examination show that non-rigid telescopic connectors with two interforaminal implants for overdenture stabilization appear to be an efficient and effective long-term treatment modality in severely resorbed edentulous mandibles. Particularly in geriatric patient treatment this concept may provide advantages in terms of handling, cleaning and long-term satisfaction.