Group 1 ITI Consensus Report: The influence of implant length and design and medications on clinical and patient-reported outcomes.

OBJECTIVES: The aim of Working Group 1 was to address the influence of different local (implant length, diameter, and design) and systemic (medications) factors on clinical, radiographic, and patient-reported outcomes in implant dentistry. Focused questions on (a) short posterior dental implants (≤6 mm), (b) narrow diameter implants, (c) implant design (tapered compared to a non-tapered implant design), and (d) medication-related dental implant failures were addressed. MATERIALS AND METHODS: Four systematic reviews were prepared in advance of the Consensus Conference and were discussed among the participants of Group 1. Consensus statements, clinical recommendations, and recommendations for future research were based on structured group discussions until consensus was reached among the entire expert Group 1. The statements were then presented and accepted following further discussion and modifications as required by the plenary. RESULTS: Short implants (≤6 mm) revealed a survival rate ranging from 86.7% to 100%, whereas standard implant survival rate ranged from 95% to 100% with a follow-up from 1 to 5 years. Short implants demonstrated a higher variability and a higher Risk Ratio [RR: 1.24 (95% CI: 0.63, 2.44, p = 0.54)] for failure compared to standard implants. Narrow diameter implants (NDI) have been classified into three categories: Category 1: Implants with a diameter of <2.5 mm ("Mini-implants"); Category 2: Implants with a diameter of 2.5 mm to <3.3 mm; Category 3: Implants with a diameter of 3.3 mm to 3.5 mm. Mean survival rates were 94.7 ± 5%, 97.3 ± 5% and 97.7 ± 2.3% for category 1, 2 and 3. Tapered versus non-tapered implants demonstrated only insignificant differences regarding clinical, radiographic, and patient-reported outcomes. The intake of certain selective serotonin reuptake inhibitors and proton pump inhibitors is associated with a statistically significant increased implant failure rate. The intake of bisphosphonates related to the treatment of osteoporosis was not associated with an increased implant failure rate. CONCLUSIONS: It is concluded that short implants (≤6 mm) are a valid option in situations of reduced bone height to avoid possible morbidity associated with augmentation procedures; however, they reveal a higher variability and lower predictability in survival rates. Narrow diameter implants with diameters of 2.5 mm and more demonstrated no difference in implant survival rates compared to standard diameter implants. In contrast, it is concluded that narrow diameter implants with diameters of less than 2.5 mm exhibited lower survival rates compared to standard diameter implants. It is further concluded that there are no differences between tapered versus non-tapered dental implants. Certain medications such as selective serotonin reuptake inhibitors and proton pump inhibitors showed an association with a higher implant failure rate.

A pilot study to evaluate the success and survival rate of titanium-zirconium implants in partially edentulous patients: results after 24 months of follow-up.

OBJECTIVES: Implants made from a new titanium-zirconium (TiZr) alloy (Roxolid) have shown good osseointegration with no adverse effects in animal studies. This single-cohort pilot study was performed to evaluate the performance and safe use of reduced-diameter implants made from this new TiZr alloy for the first time in human subjects, in a prospective case-controlled series. METHODS: In two private specialist clinics, each of 22 patients received one 3.3 mm TiZr test implant with a Regular Neck Standard Plus design. The use of the new implant was restricted to the indications and protocol for the use of the existing 3.3 mm diameter regular-neck implant made from Grade IV titanium. The test implants were splinted to a standard Grade IV titanium Regular Neck implant with a fixed dental prosthesis. RESULTS: Twenty of 22 patients had a successful and surviving implant at the 2-year follow-up; one study implant was lost 80 days after placement due to infection spreading from an adjacent tooth and one patient did not complete the 2-year assessment. The mean change in the functional bone level 2 years after loading was -0.33 ± 0.54 mm (-0.32 ± 0.61 mm and -0.34 ± 0.63 mm mesial and distal, respectively). Patients had healthy peri-implant soft tissues, as indicated by mean probing pocket depths ranging from 2.21 to 2.89 mm after 2 years. CONCLUSIONS: Within the limits of this pilot study, the performance of the new implant material was safe and reliable. The new implants meet established success and survival criteria after 2 years.

Computer-aided implant placement in the reconstruction of a severely resorbed maxilla-a 5-year clinical study.

Many studies have shown success with implants placed in grafted bone, and there is an emerging desire to simplify the treatment process by placing implants via a flapless approach using navigation or computer-aided design/computer-assisted manufacture techniques. This paper reports a preliminary study of laboratory and clinical procedures that may enable flapless implant placement in patients treated previously with extensive onlay grafting of the severely resorbed maxilla, thereby avoiding secondary exposure of the grafted site. Six patients received 39 implants, with a cumulative survival rate of 97.7% over an average of 48.8 months; all prosthetic reconstructions are successful to date.