Subcrestal retention of endodontically treated roots: discussion and report of case.
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Adolescent↗
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Augmentation of the maxillary sinus floor with autogenous bone for the placement of endosseous implants: a preliminary report.
Placement of endosseous implants in the atrophic maxilla is often restricted because of lack of supporting bone. In this article, experience with augmentation of the maxillary sinus floor with autogenous bone grafts to enable insertion of endosseous implants is described. The technique is aimed at providing a cortical layer on top of the graft to ensure a reliable seal of the maxillary sinus and to achieve optimal stability of the bone graft in case of simultaneously placement of dental implants. The procedure was used in 25 patients, using iliac crest grafts (22 patients, 86 implants), symphyseal bone grafts (two patients, six implants), or a maxillary tuberosity bone graft (one patient, one implant). Ninety-three Brånemark implants (Nobelpharma, Götenburg, Sweden) were inserted in 47 grafted maxillary sinuses. The mean follow-up was 16 months (range, 6 to 36 months). No inflammation of the bone grafts nor of the maxillary sinus occurred. The sinus membrane was perforated accidentally in eight cases during the surgical procedure. Five implants (5.4%), all inserted in iliac crest grafts, were lost during the healing period. The patients received implant supported overdentures (16 patients) or bone-anchored bridges (nine patients). From this preliminary study it is concluded that augmentation of the maxillary sinus floor with bone grafts for the insertion of endosseous implants is a promising solution for patients with atrophic maxillae and functional problems with their partial or full dentures.
Adult↗
Reconstruction of the severely resorbed maxilla with a combination of sinus augmentation, onlay bone grafting, and implants.
PURPOSE: A new method of reconstruction of the atrophic maxilla by combining a bilateral sinus floor elevation and cancellous bone graft with buccal and labial onlay graft using L-shaped corticocancellous blocks from the posterior iliac crest is presented. PATIENTS AND METHODS: Seventeen patients were treated with this procedure. One hundred one IMZ implants were placed in 14 patients, and 22 Brånemark implants were placed in three patients. Patients were observed for 6 months after prosthetic rehabilitation. RESULTS: All patients were fully rehabilitated with fixed bridges except one, who preferred an overdenture. Only two implants were lost at the time of the abutment connection. Some bone resorption was seen around six implants. The success rate with this procedure was 92.7% 6 months after prosthetic rehabilitation if implants with bone resorption were considered failures. CONCLUSIONS: These preliminary results indicate that this surgical procedure is suitable for reconstruction of most atrophic maxillas.
Adult↗
Bone maintenance 5 to 10 years after sinus grafting.
PURPOSE: This radiographic study determined the amount of bone around hydroxyapatite (HA)-coated dental implants that were placed into bone-grafted maxillary sinuses. PATIENTS AND METHODS: Postoperative complex motion tomograms using the Grossman technique were taken on 16 patients who had 27 maxillary sinus grafts performed using particulate autogenous iliac bone with and without demineralized bone, autogenous iliac corticocancellous block with and without demineralized bone, and autogenous jaw bone with demineralized bone. Bone levels were measured from the new floor of the grafted sinus to the apex of the implant and to the alveolar crest. The resulting bone level measures were compared with the type of graft used. All patients had been restored for 5 to 10 years after simultaneous graft and implant placement. RESULTS: For all patients summed together, the average amount of bone from the top of the graft to the apex of the implant was 3.3 +/- 3.1 mm, and the average amount of bone from the top of the graft to the alveolar crest was 17.6 +/- 3.1 mm. The average level of bone in the sinuses of patients grafted with autogenous iliac bone was greater than the average level of bone in those grafted with autogenous bone combined with demineralized bone. CONCLUSION: The results of this study indicate that autogenous bone grafts are maintained in the maxillary sinus, but the results with autogenous bone alone are better than when demineralized bone is added. However, this difference may not be clinically significant.
Adolescent↗
Titanium implants and onlay bone graft to the atrophic edentulous maxilla: a 3-year longitudinal study.
Treatment of the atrophic maxilla using an onlay bone-grafting technique in combination with simultaneous insertion of endosteal implants (Branemark System) was performed in 17 patients. They were followed during a 3-year period. At the end of this period, 14 patients had stable bridges in use and one patient had an overdenture. Two patients had had to return to conventional dentures due to implant losses. The survival rate of the implants after 3 years use was 75%. It is concluded that, in spite of the implant losses, onlay bone grafting to the maxilla is a valuable method in cases of severe maxillary atrophy.
Adult↗
Prosthetic rehabilitation of the cleft palate patient.
This article is a brief overview of prosthodontic and restorative methods used in the treatment of unilateral and bilateral cleft palate patients. Some past, present, and future methods of rehabilitation are discussed.
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A comparative study of the clinical efficacy of Screw Vent implants versus Brånemark fixtures, installed in a periodontal clinic.
The clinical success of 85 Screw Vent and 107 Brånemark implants, consecutively installed in a private periodontal clinic under the same conditions and by the same operator, is compared. Mobile implants were removed and considered as failures. Intra-oral radiographs were assessed for the presence of peri-implant radiolucencies and for analysis of bone loss after functional loading. 85 Screw Vent implants were installed in 31 patients. Of 23 implants installed in 9 mandibles, none failed after 16.8 (range 12-25) months of function. Of 62 Screw Vent implants installed in 23 maxillae, 6 failed at abutment connection, 1 failed after 2 months and 2 after 13 months of function. The absolute failure rate after 13.2 (range 6-24) months was 9/62. Mean loss of bone was 1.47 mm (-1.0- +4) after 12 months of functional loading. 107 Brånemark fixtures were installed in 25 patients. Of 51 fixtures inserted in 12 mandibles, none failed; of 56 fixtures installed in 13 maxillae 1 failed before and 2 failed during abutment connection. The absolute failure is 3/56. All remaining fixtures were immobile after loading. 13 fixtures were more than 6 months in function. Only short-term comparison between both systems is possible because the observation time is longer for the Screw Vent implants. In the 1st year, only 1 implant system was available to the periodontist. Short-term comparison reveals 11.3% versus 5.3% of cumulative failure after 6 months for the Screw Vent and Brånemark implants, respectively. The results indicate that clinical efficacy is as effectively obtained with Screw Vent as with Brånemark implants in the mandible. The outcome of treatment with Screw Vent implants in the maxilla seems less predictable.
Adult↗
The effect of periodontal parameters on the subgingival microbiota around implants.
The study aimed to examine the relationship between the subgingival flora around implants and their periodontal parameters. Plaque samples from 561 implants (279 patients) were analyzed by means of differential phase contrast microscopy and compared with the sample site's probing depth, bleeding tendency on probing, and plaque and gingivitis indices. If possible, one implant with deep and one with shallow pockets were selected within the same patient. The impact of the intraoral exposure time on the microbial composition around the implants was examined cross-sectionally, with the same group of patients. Only tendencies can be detected by the latter, and no concrete conclusions can be drawn. From the clinical parameters, increased probing depth was found to detrimentally increase the proportion of spirochetes and motile organisms, whereas the other parameters were found to be of minor importance. For partially edentulous patients only, there was a tendency for increased proportions of spirochetes and motile organisms the longer the intraoral exposure time. These observations emphasize the importance of the periodontal health of the remaining teeth (as a reservoir of pathogenic microorganisms) in partial edentulous patients rehabilitated by means of implants and indicate the importance of shallow pockets around implants (flap trimming when aesthetics and phonetics allow).
Bacteria↗
A clinical retrospective evaluation of FA/HA coated (Biocomp) dental implants. Results after 1 year.
In this retrospective clinical evaluation, the performance of loaded titanium implants with a bilayer bioactive surface coating of the relatively reactive hydroxylapatite (HA, outer layer) and the more stable fluorapatite (FA, inner layer) was evaluated. 98 consecutive patients were included in the study for a total of 354 implants, loaded by overdentures, fixed partial dentures and single tooth replacements. Statistical analyses revealed a cumulative probability of implant survival on a per patient basis of 94.5% (s.e. 2.7%), one year after implant installation. On implants that were lost parts of the bilayer FA/HA coating had vanished as a result of primary or secondary infection and subsequently epithelial down growth. Most complications were associated with implants placed in the maxilla. Periotest values (PTV) were generally high, indicating adequate osseointegration. The PTV's were statistically significantly less favorable in implants placed in the maxilla. The most favorable PTV's and gingival index scores were found around implants servicing overdentures. Marginal bone loss averaged approximately 2mm during the observation period. The amount of marginal bone loss corresponded with the distance from the neck of the implant to the first thread of the implant's cervical screw-section. It is concluded that, during the relatively short observation period, the FA/HA coated implants function adequately. However, in the absence of a direct implant-to-bone contact preceding implant loss, part of the FA/HA coating on the titanium implants generally dissolves.
Adult↗
Periodontal parameters of osseointegrated dental implants. A 4-year controlled follow-up study.
The aim of this study was to evaluate the periodontal parameters of osseointegrated dental implants. The condition of the peri-implant mucosa was assessed using periodontal parameters, i.e., of plaque index, bleeding on probing, probing pocket depth, probing attachment level and Periotest scores as well as a radiographic parameter, over a 4-year follow-up period. 32 non-submerged ITI dental implants, all placed in the mandible, were studied in 12 patients who had good oral hygiene. All patients were regularly recalled at 6-month intervals. The overall implant success rate was 100%. None of the implants showed any signs of inflammation, radiographic bone loss or any detectable mobility during the follow-up period. Methods similar to those used to evaluate the natural dentition were effectively employed to assess the clinical status of the dental implants. The diagnostic value of these parameters could not, however, be determined from this study due to the absence of any peri-implant tissue complications. The results indicated that some periodontal parameters of healthy peri-implant mucosa might be slightly different from healthy periodontal tissue.
Alveolar Process↗
A 5-year prospective clinical study of Astra Tech dental implants supporting fixed bridges or overdentures in the edentulous mandible.
In a 5-year prospective clinical study, 155 endosseous implants were installed in the mandible anterior to the mental foramina in 33 edentulous patients (13 males and 20 females). Usually 6 implants were installed for fixed prostheses (FP), 13 patients with 77 implants, and 4 implants for overdentures (OD) with a Dolder bar, 20 patients with 78 implants. At the time of abutment connection 1 implant in 2 patients was found to be loose and removed. However, in both these patients overdentures were successfully placed on the remaining 3 implants. Narrow-beam radiography was used for radiological evaluation. The mean (SD) total marginal bone loss in 5 years was 0.48 (0.38) mm (0.36 (0.22) mm in the FP group and 0.56 (0.45) mm in the OD group). Very few complications were reported during the 5 years, most of them being related to the superstructures. The overall cumulative implant survival rate was 98.7% (100% in the FP group and 97.4% in the OD group). The survival rate of the superstructures was 100%. The present study has demonstrated that Astra Tech implants offer reliable and predictable medium-term support for fixed prostheses and overdentures in the edentulous mandible.
Adult↗
Complication rate with prosthodontic reconstructions on ITI and IMZ dental implants. Internationales Team für Implantologie.
The aim of this study was to compare the complication rate of two implant systems with different prosthodontic concepts: rigid conical or resilient support of the suprastructure. In 66 patients, 138 ITI implants were inserted whereas 31 patients received a total of 50 IMZ implants. Over an average observation period of 3.5 years (range from 0.5 to 8 years), not only was implant survival recorded, but also prosthodontic complications such as screw loosening, fractures of screws, inserts (intramobile elements, intramobile connectors) and abutments, as well as fractures of metal framework and veneers. With the ITI system, 28.8% of all devices placed exhibited such problems during the observation period. With the IMZ system, this rate was significantly higher (P < 0.05), in that 77.4% of all reconstructions required a repair at some point. The various complications were divided into those occurrences which affected only the suprastructure, i.e., failures of frameworks, veneers, bar devices or other retentive elements, and those which involved implant components per se, such as screws and abutment components. In the first category, adverse effects occurred more frequently with ITI-supported prostheses (15.1%) versus IMZ suprastructures (6.4%). Regarding complications with implant components, the rate with IMZ components was considerably higher (71%) compared with ITI (13.5%). This was mainly due to the presence of intramobile elements (IME) and connectors (IMC) in the IMZ system. In this retrospective study, precise fitting, non-resilient abutment components leading to rigid connections of suprastructures, proved to be clinically more successful than resilient anchoring components.
Adolescent↗
Dental implants in the atrophic maxilla: measurements of patients' satisfaction and treatment experience.
Maxillary bone reconstruction in combination with placement of dental implants is a treatment modality reported since 1980 for patients suffering from maxillary atrophy and difficulties with wearing removable prosthesis. This study reports on patient experience and satisfaction among 88 consecutive patients concerning surgical and prosthetic aspects of their treatment. A questionnaire was used to gather the data. Patient satisfaction was measured on a scale from 1 to 5 (1 = bad/few, 5 = very good/much). The satisfaction index with regard to the total treatment was 4.1 +/- 0.9. A total of 90% of the patients responded that they would go through the treatment again or recommend the treatment to a friend if necessary. The post-operative pain index scored 2.6 +/- 1.2. The acceptation of the post-operative pain at the crista iliaca was 86.1% and of the maxilla 89.9%. It is concluded that the results of measurements of patient satisfaction after maxillary bone reconstruction in combination with placement of dental implants were acceptable.
Adult↗
Considerations preliminary to the application of early and immediate loading protocols in dental implantology.
In oral implantology, a 3-6 month stress-free healing period is presently accepted as a prerequisite to achieve bone apposition without interposition of a fibrous scar tissue. This protocol was introduced by Brånemark and co-workers in 1977. The aim of the present paper is to review the reasons that led Brånemark and collaborators to require long delayed loading periods. It is shown that the requirement for long delayed loading periods was drawn from the initiation and development periods of their original clinical trial. Demanding conditions were met involving simultaneously: 1) patients with poor bone quality and quantity, 2) non-optimized implant design, 3) short implants, 4) non-optimized surgical placement, 5) non-optimized surgical protocol and 6) biomechanically non-optimized prosthesis. Extrapolation of the requirement for long healing periods from these particular conditions to more standard situations involving refined surgical protocols and careful patient selection might be questioned. Albeit premature loading has been interpreted as inducing fibrous tissue interposition, immediate loading per se is not responsible for fibrous encapsulation. It is the excess of micromotion during the healing phase that interferes with bone repair. A threshold of tolerated micromotion exists, that is somewhere between 50 microns and 150 microns. It is suggested that loading protocols might be shortened through 2 different approaches. The first way would be to decrease stepwise the delayed loading period for free-standing implants below the presently accepted 3-6 months of healing. The second way would be to identify immediate loading protocols that are capable of keeping the amount of micromotion beneath the threshold of deleterious micromotion. Immediate loading protocols for implants-retained overdentures and fixed bridges are reviewed. It is shown that successful premature loading protocols require a careful and strict patient selection aimed to achieve the best primary stability. These various protocols need to be further documented in order to assess their predictability.
Clinical Protocols↗
Biological and technical complications and failures with fixed partial dentures (FPD) on implants and teeth after four to five years of function.
The aim of this study was to compare the frequency of biological and technical complications with fixed partial dentures (FPDs) on implants, teeth and as mixed tooth-implant supported FPDs over 4 to 5 years of function. All implants belonged to the ITI Dental Implant System. Group I-I (implant FPD) included 33 patients with 40 FPDs, group T-T (tooth FPDs) 40 patients with 58 FPDs, group I-T (mixed tooth-implant FPDs) 15 with 18 FPD. Of the bridge abutments 144 were teeth and 105 were implants. The median number of units replaced by the FPDs was 3 (range 2-14). The mean age of the patients was 55.7 years (range 23-83). Complete failures resulted in the loss of one FPD in each group. Two implants were lost due to fracture secondarily to development of a bone defect. One tooth had a vertical fracture and 1 tooth was lost due to periodontitis. Biological complications (peri-implantitis, PPD > or = 5 mm and BOP+) occurred at 9.6% (10) of the implants. This number was, however, reduced to 5% if the threshold for definition of peri-implantitis was set at PPD > or = 6 mm and BOP+. Biological complications occurred in 11.8% (17) of the abutment teeth (NS compared to implants); 2.8% (4) had secondary caries, 4.9% (7) endodontic problems and 4.1% (6) had periodontitis (PPD > or = 5 mm, BOP+). Ten out of 32 patients with a general health problem indicated a biological complication, whereas 9 out of 53 patients with no general health problem had a biological complication (chi 2: NS). Statistically significantly more technical complications were found in FPDs on implants (chi 2, P < or = 0.05). The technical complications were associated with bruxism. Out of 10 bruxers 6 had a technical complication whereas 13 out of 75 non-bruxers had such a complication (chi 2 < or = 0.01). Extensions were associated with more technical complications (13 out of 35 with extensions versus 9 out of 81 without). In conclusion, favourable clinical conditions were found at tooth and implant abutments after 4-5 years of function. Loss of FPD over 4-5 years occurred at a similar rate with mixed, implant or tooth supported reconstructions. Significantly more porcelain fractures were found in FPDs on implants. Impaired general health status was not significantly associated with more biological failures but bruxism as well as extensions were associated with more technical failures.
Adult↗
A comparison of hydroxylapatite coated implant retained fixed and removable mandibular prostheses over 4 to 6 years.
In a 6-year prospective clinical study, 181 hydroxylapatite coated endosseous dental implants were placed into the anterior mandible of 48 patients. Twenty-one patients were treated with fixed prostheses and 27 patients with an overdenture. When the implants were exposed all 181 had integrated. To date, there is 100% survival of all implants and they all retain a functioning prostheses. The initial results were very promising, in both groups the interval success was over 95% in the first 4 years of the study. However, by year 6, the interval success rates had fallen to 83% for both the fixed and removable groups. This study also compares the construction and maintenance complications for the two types of restorations. The clinical time taken, after implant exposure, to construct the prostheses was similar whether the fixed (mean of 8 visits) or removable option (mean of 7 visits) was chosen. However, the removable restoration cost less than half the price of the fixed when both technical time and implant component costs were evaluated. Maintenance for both groups was higher than expected, but patients required more appointments in the removable group both in the first year and beyond. Regarding the prostheses itself, the incidence of remakes, relines and general adjustments was higher in the removable group. This study has shown that the overdenture offers an effective and initially a more economical alternative to the fixed prostheses, in the treatment of the edentulous mandible. However, long-term maintenance of such a prosthesis can be significant.
Adult↗
Long-term evaluation of non-submerged hollow cylinder implants. Clinical and radiographic results.
From 1974 various types of hollow cylinder ITI-implants were placed before the new generation of Bonefit ITI-implants was developed in the mid-eighties. The aim of this study was the clinical and radiographic evaluation of hollow cylinder implants that were inserted during the time period of 1978-1987 in partially and completely edentulous patients to support overdentures, fixed partial prostheses and single crowns. Altogether, 71 patients with a total of 132 hollow cylinder ITI-implants still in situ had been followed regularly during the entire observation period of 11.4 to 19.7 years (mean 14.1). Thirteen implants had to be removed before an observation period of 10 years was completed, 4 additional implants were lost after being in function for over 10 years and two further implants were considered to be failures at the time of the examination. Thus 91.4% of the implants were still in situ after 10 years and the survival rate for a mean observation period of 14.1 years was 84.6%. Periimplant parameters were used to assess the clinical conditions of the implants. On the radiographs, horizontal bone loss or angular defects could be detected on 40% of all implants if compared to the base-line situation. The probing depths around these implants were significantly increased compared to implants with an unchanged bone level, however the mean probing depths did not exceed 3.5 mm and 2.8 mm respectively. From this clinical evaluation one may conclude that with the early generation of hollow cylinder ITI-implants favorable long-term results were achieved.
Adult↗
Maxillary bone grafting for insertion of endosseous implants: results after 12-124 months.
Insertion of endosseous implants in the atrophic maxilla is often complicated because of lack of supporting bone. Augmentation of the floor of the maxillary sinus with autogenous bone graft has been proven to be a reliable treatment modality, at least in the short term. The long-term clinical and radiographic outcome with regard to the grafts, the implants and satisfaction of the patients with their implant-supported overdenture was studied in 99 patients. The sinus floor was augmented with bone grafts derived from the iliac crest (83 subjects, 162 sinuses, 353 implants), the mandibular symphysis (14, 18, 37), or the maxillary tuberosity (2, 2, 2). Before implant installation, the width and height of the alveolar crest were increased in a first stage procedure in 74 patients, while in the other 25 patients augmentation and implant installation could be performed simultaneously (width and height of the alveolar crest >5 mm). Perforation of the sinus membrane occurred in 47 cases, which did not predispose to the development of sinusitis. Loss of bone particles and sequestration were observed in one (diabetic) patient only, in whom a dehiscence of the oral mucosa occurred. A second augmentation procedure was successful in this patient. Symptoms of transient sinusitis were observed in 3 patients. These symptoms were successfully treated with decongestants and antibiotics. 2 other patients developed a purulent sinusitis which resolved after a nasal antrostomy. In all cases, the bone volume was sufficient for implant insertion. 32 of 392 inserted Brånemark implants (8.2%) were lost during the follow-up. After the healing period of the bone grafts, no sinus pathology was observed. The patients received implant-supported overdentures (72 patients) or fixed bridges (27 patients). Overall, the patients were very satisfied with the prosthetic construction. We conclude that bone grafting of the floor of the maxillary sinus floor with autogenous bone for the insertion of implants is a reliable treatment modality with good long-term results.
Adolescent↗