Does a large dehiscent implant surface at placement affect the 5-year treatment outcome? An assessment of implants placed to support a maxillary overdenture.

The aim of this study was to assess the 5-year clinical and radiographic outcome of implants with a dehiscent surface at implant placement. A total of 26 consecutive patients (mean age 61.6 years; SD 8.0 years) with at least one implant with a dehiscent implant surface of ≥ two thirds of the implant length on the labial side were included. All implants were placed to support a maxillary overdenture. The implants were placed with adequate primary stability and the dehiscent surface was covered with autologous bone, inorganic bovine bone and a resorbable membrane. Outcome measures were soft tissue conditions, change of radiographic marginal bone level and implant survival. Baseline data (at loading, T0) were compared with 1-year (T1) and 5-year (T5) post loading data. Of the 116 implants, 40 implants had no dehiscence, 16 had a buccal dehiscence < two thirds of the implant length, and 60 implants had a dehiscence ≥ two thirds. The peri-implant tissues were healthy and 5-year marginal bone changes were well within normal limits (-0.4 mm; range: -0.8 to -0.1). One implant was lost during the osseointegration period. Even when implants are placed with a dehiscence ≥ two thirds of the buccal implant surface, favorable 5-year peri-implant health can be achieved provided these dehiscences are covered with autologous bone, inorganic bone and a resorbable membrane, and there is good initial stability of the implants.

[Treatment of a single-tooth space in the occlusal system]. / Behandeling van een enkelvoudig diasteem in het occlusiesysteem.

The space created by the absence of 1 not-free-ending tooth in an occlusal system can be indicated as a single-tooth space. For treating a single-tooth space, several options are available to restore the functions of the occlusal system. Feasible options are a resin-bonded fixed prosthesis, a conventional fixed prosthesis, and an implant-supported restoration. Implant-supported restorations have a good prognosis, high patient satisfaction, and the advantage that adjacent teeth are not involved in the treatment. Anxiety about surgical treatment, the width of the single-tooth space, and financial aspects may be reasons not to consider an implant-supported restoration as first-choice treatment.

[Prosthetic dilemmas. Choice of superstructure for the edentulous maxilla]. / Prothetische dilemma's. Suprastructuurkeuze in de edentate bovenkaak.

Patients with an edentulous maxilla can experience problems with a full upper denture. The most common problems are a lack of retention and the stability of the denture, but also other factors, such as an extreme gagging reflex, influence satisfaction. Attachment of a prosthesis on dental implants is a reliable solution to solve or diminish the above mentioned problems. The choice of the kind of superstructure, a removable overdenture or a fixed prosthesis, depends on a variety of factors, such as degree of resorption of the maxilla, cleaning possibilities, patients'wishes and financial possibilities