Conventional and advanced implant treatment in the type II diabetic patient: surgical protocol and long-term clinical results.

PURPOSE: To investigate the effect of type-2 diabetes on implant survival and complication rate. MATERIALS AND METHODS: Prospective study enrolling type-2 diabetic patients suffering from edentulism, having a mean perioperative HbA1c level of 7.2%, and compliant with a maintenance program. All the patients underwent dental and periodontal examinations and had laboratory testing for HbA1c, fasting plasma glucose, blood lipids, and microalbuminuria. Nondiabetic patients matched for implant treatment indication served as controls. The influence of clinical diabetes-related factors and periodontal parameters (Plaque Index, bleeding on probing, probing depth) on implant survival were assessed via univariate then multivariate methods. RESULTS: Forty-five diabetic patients, followed for 1 to 12 years, mean age 64.7 years, received 255 implants: 143 following a classical protocol and 112 in cases of sinus floor elevation, immediate loading, and guided bone regeneration. Forty-five nondiabetic control patients received 244 implants: 142 following a classical protocol and 102 in cases of advanced surgery. Implant survival following conventional or advanced implant therapy was not statistically different between the well-controlled (HbA1c < 7%, P = .33) and the fairly well-controlled group (HbA1c 7% to 9%, P = .37). The overall survival rate for the diabetic group was 97.2% (control 98.8%) and was not significantly different for age, gender, diabetes duration, smoking, or type of hypoglycemic therapy. The mean peri-implant bone loss was 0.41 +/- 0.58 mm (control, 0.49 +/- 0.64 mm). PI and BOP fairly correlated with postoperative complications. HbA1c was the only multivariate independent factor affecting the complication rate (P = .04). No statistically significant difference was found for patients (P = .81) or for implants (P = .66) for the advanced surgery cases or the conventional approach in diabetic patients compared to nondiabetic patients.

Influence of prosthetic parameters on the survival and complication rates of short implants.

PURPOSE: Implants shorter than 10 mm can be a long-term solution for sites with limited bone height. The purpose of this study was to determine the influence of some prosthetic factors on the survival and complication rates. MATERIALS AND METHODS: Two hundred sixty-two short machined-surface Brånemark System implants were consecutively placed in 109 patients and followed for a mean of 53 months. The prosthetic parameters were recorded, and the data were examined for relation to peri-implant bone loss and biologic or biomechanical complications. RESULTS: Relatively few crown-to-implant (C/I) ratios were < 1 or > 2 (16.2%). Occlusal table (OT) width ranged from 5.4 to 8.3 mm. Opposing dentition was most often natural teeth, a fixed prosthesis supported by natural teeth, or an implant-supported fixed restoration. Occlusion with a normal buccolingual maxillomandibular relationship was found in 72.7% of the cases. No significant difference in peri-implant bone loss was correlated with C/I ratio or OT. Neither cantilever length nor bruxism had a significant effect on peri-implant bone loss. Mean bone loss was 0.74 +/- .65 mm. The difference in the complication rate (15% overall) between the bruxer and the nonbruxer group was not statistically significant (P = .51). One implant was lost in a heavy bruxer after 7 years of function. DISCUSSION: Increased C/I and OT values do not seem to be a major risk factor in cases of favorable loading. In 67% of the cases, the mesiodistal length of the prosthesis was less than the corresponding natural tooth length, which may have contributed to better load distribution and more favorable results. CONCLUSIONS: Short implants appear to be a longterm viable solution in sites with reduced bone height, even when the prosthetic parameters exceed the normal values, provided that force orientation and load distribution are favorable and parafunction is controlled.

Clinical evaluation of short, machined-surface implants followed for 12 to 92 months.

PURPOSE: Bone resorption following tooth loss often limits the quantity of bone available for implant placement. The purpose of the present study was to evaluate the clinical outcome of 10-mm or shorter machined-surface implants when used exclusively in the treatment of various forms of edentulism. MATERIALS AND METHODS: Two hundred sixty-nine screw-type Brånemark System implants (Nobel Biocare), 10 mm or shorter, were placed in 111 consecutively treated patients. Of the total, 88.8% were placed in the mandible and 11.2% were placed in the maxilla; 95.2% were used to treat partially edentulous situations, including single-tooth losses, of which 96.6% were in the premolar and molar regions. The patients were followed for periods of 12 to 92 months. RESULTS: Of the 269 placed implants, 12 were lost. The overall survival rate was 95.5%. Bone quality 2 and 3 (Lekholm-Zarb classification of 1985) was found in 88.8% of the treated sites. There was no statistical difference in the survival rate of the 10-mm implants when compared to the shorter series (P > .05) or between the various implant diameters. The mean marginal bone loss was 0.71 +/- 0.65 mm. DISCUSSION: The failure rate of 4.5% compares favorably with that of implants of different shape, surface characteristics, and length. Bone quality appeared to be the critical factor in implant survival, rather than bone quantity, in this patient series. CONCLUSIONS: This study supports the survival of short, machined-surface implants when used for the treatment of partial edentulism in bone of good quality.