European Journal of Oral Implantology最新文献

Purpose: To compare outcomes of immediate non-occlusal loading with delayed implant loading in the bilateral replacement of mandibular first molars.

Materials and methods: This study was designed as a split-mouth, randomised controlled trial. Twenty patients with bilaterally missing mandibular first molars randomly received immediately or conventionally loaded single implants. One molar was restored with a non-occlusal temporary crown within 24 hours after implant placement (immediate loading group, IL) while the contralateral molar was restored with a definitive crown 4 to 5 months later (delayed loading group, DL). A total of 40 implants were installed. All implants were inserted in healed bone with an insertion torque between 35 and 45 Ncm. Outcome measures were implant failure, complications, radiographic marginal bone level changes, probing pocket depths (PPDs) and bleeding on probing (BOP). Clinical data were collected at implant placement, and after 6, 12 and 60 months.

Results: No patients dropped out and no implant failed. Only minor prosthetic complications were observed (two provisional acrylic crown fractures in the IL group and four ceramic chipping in the DL group). Two patients had bilateral peri-implant mucosal inflammation with BOP after 6 months. The differences between groups were not statistically significant (OR = 0.500; 95% CI: 0.045 to 3.489; P = 0.6831). At the 1-year follow-up examination, the mean marginal bone level was 0.83 ± 0.16 mm (95% CI: 0.75 to 0.91) in the IL group and 0.86 ± 0.16 mm (95% CI: 0.78 to 0.94) in the DL group, with no statistically significant differences between groups (difference = 0.03 ± 0.15 mm; 95% CI: -0.07 to 0.07; P = 0.53). After 5 years, mean marginal bone level was 1.06 ± 0.38 mm (95% CI: 0.97 to 1.15) in the IL group and 1.07 ± 0.32 mm (95% CI: 0.95 to 1.16) in the DL group, with no statistically significant differences between groups (difference = 0.01 ± 0.22 mm; 95% CI: -0.10 to 0.10; P = 0.96). The mean marginal bone loss after 5 years was 0.62 ± 0.45 mm in the IL group and 0.69 ± 0.33 mm in the DL group (difference = 0.07 ± 0.32 mm; 95% CI: -0.10 to 0.18; P = 0.567). At the 5-year follow-up the mean PPD and BOP values were 2.82 ± 0.65 mm and 1.17 ± 0.92 in the IL group, and 2.85 ± 0.53 mm and 1.17 ± 0.86 in the DL group, respectively. No significant differences were found (difference = 0.03 ± 0.15 mm; 95% CI: -0.15 to 0.21; P = 0.990; and 0.01 ± 0.07; 95% CI: -0.06 to 0.08; P = 1.000, respectively).

Conclusions: Within the limitations of this study, the present data seem to confirm the hypothesis that the clinical outcome of immediate versus delayed loading of implants in mandibular fist molar sites is comparable.

Aim: The objective of this systematic review was to evaluate the diagnostic value of CBCT compared with 2D imaging and clinical gold standard techniques in peri-implant bone defect detection and measurement.

Materials and methods: Literature search was performed using MEDLINE, Embase and Web of Science databases up to July 2017. Clinical, ex vivo, in vitro and animal studies that assessed and measured peri-implant bone defects using different imaging modalities were included in this review. Two reviewers performed data extraction and qualitative analysis. The methodological quality of each study was reviewed using the QUADAS-2 tool.

Results: The initial search revealed 2849 unique papers. Full-text analysis was performed on 60 articles. For the present review, nine studies were considered eligible to be included for qualitative analysis. CBCT performed similar to intraoral radiography in mesiodistal defect detection and measurements. Additional buccolingual visualisation and volumetric and morphological assessment of peri-implant bone defects are major advantages of 3D visualisation with CBCT. Nevertheless, one must be aware of metal artefacts masking osseointegration, shallow bony defects and other peri-implant radiolucencies, thus impeding early diagnosis of intrabony lesions.

Conclusions: The present review did not provide evidence to support the use of CBCT as standard postoperative procedure to evaluate peri-implant bone. Up to date, we are clinically forced to remain with intraoral radiography, notwithstanding the inherent limitations related to restricted field of view and two-dimensional overlap. A 3D imaging approach for postoperative implant evaluation is crucial, making further development of an optimised and artefact-free CBCT protocol indispensable.

Asepsis is described as a state free from microorganisms. In medicine, an aseptic environment is necessary and expected to avoid the spread of infection through contact between persons, sprays and splashes, inhalation, and sharps. Most dental procedures are performed in a "clean "environment with the common use of personal protective equipment (PPE) such as disposable gloves, masks and protective eyewear with disinfection of surfaces and sterilization of instruments. For surgical procedure such as the insertion of endosseous implants, the recommendations are not clear. The use of antimicrobials and antibiotics before and after the procedure remains a controversial issue The purpose of this literature review is to evaluate the current evidence as to what is generally expected and widely accepted in the use of aseptic techniques for the surgical placement of endosseous implants, and the impact on implant survival and overall success.

Aim: To present recent data regarding prosthetic complications with implant prostheses and crowns as well as compare this data with data presented in a 2003 publication.

Material and methods: An electronic Medline (PubMed) with MeSH terms search was performed, focussing on clinical studies that reported data on prosthetic complications associated with implant fixed complete dentures, implant overdentures, implant fixed partial dentures, and implant single crowns.

Results: There were nine prosthetic complications reported with implant fixed complete dentures, 17 with implant overdentures, four with implant fixed partial dentures, and six with implant single crowns. The greatest number of complications and the largest incidence of percentages occurred with implant overdentures. The lowest incidence percentages were recorded for implant single crowns. These findings are in agreement with the previous 2003 publication. It is of interest to note that some of the complications reported previously were not reported in this review, and some complications reported in this review were not listed in the 2003 publication, thereby limiting the number of direct comparisons between this paper and the earlier report. A surprising finding was that some complications associated with implant overdentures from the current data exceeded the incidence in 2003 (reactivation of the retentive attachment; mucosal hyperplasia; and the need for overdenture relines).

Conclusions: Implant overdentures are associated with more complications than implant fixed complete dentures, implant fixed partial dentures, and implant single crowns. The lowest incidence of complications was reported with implant single crowns. The most common complication reported with implant fixed complete dentures was denture tooth fracture. The most common complication associated with implant overdentures was the need for adjustments. Porcelain veneer fracture/chipping was the most common complication identified in the studies of implant fixed partial dentures. The most common complication reported with implant single crowns was abutment screw loosening.

Purpose: To present the medium-term results of one-stage guided bone regeneration (GBR) using autologous bone and anorganic bovine bone, placed in layers, in association with resorbable collagen membranes, for the reconstruction of horizontal bony defects.

Materials and methods: This study was designed as an uncontrolled prospective study. Partially edentulous patients, having less than 6.0 mm and more than 4.0 mm of residual horizontal bone width were selected and consecutively treated with simultaneously implant installation and bone regeneration by using 2.0 mm of autologous bone and 2.0 mm of anorganic bovine bone that was placed in layers and then covered with a resorbable collagen membrane. Outcome measures were: implant and prosthesis failures, any complications, peri-implant marginal bone level changes, probing pocket depth (PPD) and bleeding on probing (BOP).

Results: In total, 45 consecutive patients (20 male, 25 female) with a mean age of 52.1 years each received at least one GBR procedure, with contemporary placement of 63 implants. At the 3-year follow-up examination, no patient had dropped out and no deviation from the original protocol had occurred. No implant or prosthesis failed. In six patients (13.3%) the collagen membrane was slightly exposed 1 to 2 weeks after bone reconstruction. Four of these patients were moderate smokers. Post-hoc analysis using Fisher's exact test found significant association (P = 0.0139) between a smoking habit and early membrane exposure. Mean marginal bone loss experienced between initial loading and 30 months afterwards was 0.60 ± 0.20 mm (95% CI 0.54 - 0.66). The mean BOP values measured at the definitive restoration delivery were 1.23 ± 0.93, while 2 years later they were 1.17 ± 0.78. The difference was not statistically significant (-0.06 ± 0.76; P = 0.569). The mean PPD values measured at the definitive restoration delivery were 2.62 ± 0.59 mm, while 2 years later they were 2.60 ± 0.54 mm. The difference was not statistically significant (-0.03 ± 0.62; P = 0.765).

Conclusions: Within the limitations of the present study, the use of a 2.0 mm layer of particulated autologous bone on the implant threads, and a 2.0 mm layer of anorganic bovine to cover the resorbed ridge, in combination with the resorbable collagen membrane, seems to be a viable treatment option for the reconstruction of horizontal bony defects.

The aim of the present systematic review was to evaluate reported survival rate and marginal bone (MBL) loss of implants with different surface roughness and followed up for 10 years or longer. For the majority of the 62 included clinical studies, no direct comparison between different surfaces was made, thus our report is mainly based on reported survival rates and marginal bone loss for individual implant brands with known surface roughness. The survival rate was 82.9 to 100% for all implants after 10 or more years in function and the marginal bone loss was, on average, less than 2.0 mm for all implant surfaces included, i.e. turned, titanium plasma sprayed (TPS), blasted, anodised, blasted and acid-etched but the turned surface in general demonstrated the smallest MBL. However, the survival rates were in general higher for moderately rough surfaces. The roughest TPS surface demonstrated the highest probability for failure, while the anodised showed the lowest probability. In conclusion, the present systematic review demonstrates that it is possible to achieve very good long-term results with all types of included surfaces.

Purpose: To compare planning and patient rehabilitation using 3D implant planning software and dedicated surgical templates with conventional freehand implant placement for the rehabilitation of partially or fully edentulous patients using flapless or mini-flap procedures and immediate loading.

Materials and methods: Patients requiring at least two implants to be restored with a single prosthesis, having at least 7 mm of bone height and 4 mm in bone width were consecutively enrolled. Patients were randomised according to a parallel group study design into two groups: computerguided group or conventional freehand group. Implants were loaded immediately with a provisional prosthesis, replaced by a definitive prosthesis 4 months later. Outcome measures assessed by a blinded independent assessor were: implant and prosthesis failures, any complications, marginal bone levels, number of treatment sessions, duration of treatment, post-surgical pain and swelling, consumption of pain killers, surgical and prosthetic time, time required to solve complications, and patient satisfaction. Patients were followed up to 5 years after loading.

Results: Ten patients (32 implants) were randomised to the computer-guided group and 10 patients (30 implants) were randomised to the freehand group. At the 5-year follow-up examination one patient of the computer-guided group and one of the freehand group dropped-out (both moved to another country). No prostheses failed during the entire follow-up. Two implants failed in the conventional group (6.6%) vs none in the computer-guided group (P = 0.158). Ten patients (five in each group) experienced 11 complications (six in the computer-guided group and five in the freehand group), that were successfully solved. Differences between groups for implant failures and complications were not statistically significant. Five years after loading, the mean marginal bone loss was 0.87 mm ± 0.40 (95% CI: 0.54 to 1.06 mm) in the computer-guided group and 1.29 mm ± 0.31 (95% CI: 1.09 to 1.51 mm) in the freehand group. The difference was statistically significant (difference 0.42 mm ± 0.54; 95% CI: 0.05 to 0.75; P = 0.024). Patient self-reported post-surgical pain (P = 0.037) and swelling (P = 0.007) were found to be statistically significant higher in patients in the freehand group. Number of sessions from patient's recruitment to delivery of the definitive prosthesis, number of days from the initial CBCT scan to implant placement, consumption of painkillers, averaged surgical, prosthetic, and complication times, were not statistically significant different between the groups. At the 5-year followup, all the patients were fully satisfied with the function and aesthetics of their definitive prostheses.

Conclusions: Both approaches achieved successful results over the 5-year follow-up period. Statistically higher post-operative pain and swelling were experi

Purpose: To evaluate clinical safety and effectiveness of a novel calcium-incorporated titanium implant (Xpeed, MegaGen Implant Co. Limited, Gyeongbuk, South Korea).

Materials and methods: In total, 60 patients were randomised to receive one to six titanium implants in the maxilla with either calcium-incorporated (Xpeed) or control resorbable blasted media (RBM) surfaces, according to a parallel group design at two centres. Implants were submerged and exposed at three different endpoints in equal groups of 20 patients at 12, 10 and 8 weeks, respectively. Within 2 weeks, implants were functionally loaded with provisional or definitive prostheses. Outcome measures were prosthesis failures, implant failures, any complications and peri-implant marginal bone level changes.

Results: A total of 30 patients received 45 calcium-incorporated implants and 30 patients were given 42 control titanium implants. Five years after loading, eight patients dropped-out from the Xpeed group and nine left the RBM group. No prosthesis or implant failures occurred. Two patients were affected by three complications in the Xpeed group vs five patients from the RBM group, who experienced eight complications; the difference between groups being not statistically significant different (P = 0.187; difference in proportions = 14.7%; 95% CI: -10.7% to 39.4%). Five years after loading patients with Xpeed implants lost on average 1.19 ± 0.48 mm of peri-implant marginal bone vs 1.43 ± 0.98 mm of patients with RBM implants, the difference being not statistically significant (P = 0.35; mean difference: -0.23 mm; 95% CI: -0.73 to 0.27 mm).

Conclusions: Both implant surfaces provided good clinical results and no significant difference was found when comparing titanium implants with a nanostructured calcium-incorporated surface with implants with an RBM surface. Conflict-of-interest statement: MegaGen partially supported this trial and donated the implants and prosthetic components. The study design was negotiated with MegaGen Implant Co, Gyeongbuk, South Korea, however, data property belonged to the authors and by no means did MegaGen interfere with the conduct of the trial or the publication of its results.