Immediately Loaded Fixed Full-Arch Implant-Retained Prosthesis: Clinical Analysis When Using a Moderate Insertion Torque.

PURPOSE: This study uses intentionally tilted implants with a moderate insertion torque to retain an immediately loaded fixed full-arch implant-retained prosthesis using four implants. The aims of this study were to determine the likelihood that this type of implant-retained prosthesis can be predictably provided on the day of implant placement, the survival rate when providing immediate load, and the importance of insertion torque on the survival of the implants. MATERIALS AND METHODS: All implants that were placed after August 1, 2015 and before December 31, 2016 at the ClearChoice Dental Implant Center of Minneapolis were recorded. The performance of these implants was followed to determine the success rate in the category of "intention to treat" where the treatment is provided on the same day as implant placement. Insertion torque was recorded for all implants. Implants were followed to determine survival of the implants and complications observed. RESULTS: Between August 1, 2015 and December 31, 2016, a total of 1,903 implants were placed. These implants were utilized to support 441 prostheses, with 440 actually being restored with a provisional prosthesis on the day of implant placement. Mean follow-up time was 484 days with a maximum of 972 days and a median of 474 days. A total of 36 implants failed to achieve osseointegration, resulting in an overall survival rate of 98.1% with a confidence interval (CI) of 98.7% to 97.5%. Survival was 97.6% in the maxilla and 98.9% in the mandible. Insertion torque of less than 15 Ncm (n = 80, 77 survival), between 15 and 34 Ncm (n = 122, 120 survival), and greater than 35 Ncm (n = 1,701, 1,670 survival) demonstrated no difference in implant survival. CONCLUSION: Based on this study of 1,903 implants placed between August 1, 2015 and December 31, 2016, the following observations were made: (1) this surgical/prosthetic treatment approach succeeded in the "intention to treat" category with 440/441 (99.8%) prostheses inserted on the day of implant surgery; (2) overall implant survival was 98.1%; (3) insertion torque appeared to have no effect on implant survival.

Clinical performance of intentionally tilted implants versus axially positioned implants: A systematic review.

OBJECTIVES: The aim of this review was to determine the clinical performance of dental implants that are intentionally tilted when compared with implants that are placed following the long axis of the residual alveolar ridge. MATERIALS AND METHODS: A systematic review of the scientific literature using a predefined research question (PICO) and search strategy was undertaken. This search included five electronic databases. Two independent reviewers examined electronic databases and performed a manual review following search strategy to accomplish the item generation and reduction. Included articles were evaluated to determine the level of evidence. Data were extracted only from level I and level II studies, based on the Oxford Centre for Evidence-based Medicine-Levels of Evidence (March 2009). If included studies were homogeneous in nature, data were to be accumulated. However, if included studies were heterogeneous in nature, only descriptive data would be reviewed and analyzed. RESULTS: A total of 811 articles were identified through the PICO question and search strategy. Detailed review of the abstracts and articles resulted in further item reduction, and 46 articles were included for full-text review. A total of 42 articles were then selected for inclusion in the systematic review. The identified articles included two level I and 20 level II studies. In addition, 15 level IV, one gray literature, and four previous systematic reviews with meta-analyses were also used in the study. The extracted data from the included studies demonstrated heterogeneity that prevented quantitative assessment, and only one level II study directly compared tilted and axially placed implants. Assessment of the descriptive data demonstrated no differences in implant survival, marginal bone loss, prosthesis survival, or patient-reported outcome measures (PROMs) whether implants are placed axially or with intentional inclination of the coronal aspect of the implant toward the distal aspect of edentulous jaws. CONCLUSIONS: Based upon the systematic review of the literature, an analysis of the descriptive data suggested no differences in clinical performance between implants that are placed in an axial position relative to the residual alveolar ridge when compared with implants that are intentionally tilted toward the distal aspect of edentulous jaws.

Replacing Six Missing Adjacent Teeth in the Anterior Maxilla With Implant Prostheses: A Case Series.

Restoring multiple adjacent missing teeth in the anterior maxilla is one of the most challenging situations in clinical implant dentistry, as restorations need to be both functional and highly esthetic. The purpose of this article is to highlight the issues that arise during treatment planning for replacement of six missing maxillary anterior teeth with implant-supported fixed dental prostheses. Representative clinical reports are provided to illustrate the treatment planning and surgical and prosthodontic management. The authors describe the rationale for selecting the appropriate number and location of implants in relation to the amount of missing soft and hard tissues to achieve functional and esthetic prostheses.

Epidemiology of Implant Mortality Disparity Among Intraoral Positions and Prosthesis Types.

PURPOSE: To examine the disparity of single-crown implant failure with a similar loss of the splinted prosthesis in differing anatomical locations while controlling for other demographic and clinical variables that may confound the relationship between prosthesis types and implant loss. MATERIALS AND METHODS: A multicenter retrospective cohort study was designed to include patients treated with dental implants from 2003 to 2014. The variables included age, sex, systemic disease, bone graft, implant placement date, position of dental implant, length of dental implant, diameter of dental implant, loading time, type of prosthesis, type of opposing occlusion, latest check date, and survival or loss of the dental implant. The demographic and clinical variables' influence on the survival of dental implants was estimated by the Kaplan-Meier method. The position and diameter were adjusted for the accurate estimation of the relationship between the prosthesis type and survival of the dental implant with the Cox proportional hazard method. RESULTS: A total of 1,151 dental implants from 403 patients were ascertained. After adjusting for the confounding effect of position and diameter, single-crown prostheses were 38.1 (95% CI: 15.1-118) times more likely to be lost than the connected-type prostheses. For single-crown implants, the waiting time for osseointegration before loading was the highest for the maxillary molar position and the lowest for the mandibular molar position (P < .0001), while the most frequent implant loss occurred in the maxillary anterior area, and the second frequent area was the maxillary molar position; the lowest occurrence of implant loss was for the mandibular molar position. This disparity was statistically significant (P = .0271). CONCLUSION: Despite the high survival rates of endosseous implants as a whole, since the variation of implant loss was observed among the different anatomical positions for single-crown implants, special attention has to be given to the maxillary anterior and maxillary molar positions. A longer healing time assuming compensation for disadvantageous bone quality was not directly effective in increasing implant longevity in the vulnerable positions.

Comparative assessments, meta-analysis, and recommended guidelines for reporting studies on histomorphometric bone-implant contact in humans.

PURPOSE: To evaluate factors that have an influence on histomorphometric bone-to-implant contact (BIC) of dental implants in humans. MATERIALS AND METHODS: Using inclusion/exclusion criteria, eligible studies were searched in five databases and handsearched in 11 journals. A total of 351 articles were assigned to full text analysis. The extracted data were assigned to comparative statistical assessments and meta-analysis. RESULTS: A total of 55 articles were included in the analysis. The mean BIC found in comparative assessments and meta-analysis of implants in the mandible (70.97 and 69.744 ± 3.304, respectively) was higher than those in the maxilla (53.24 and 56.692 ± 3.598; P = .000 and P = .008, respectively). The mean BIC in the anterior mandible (79.42) and maxilla (74.19) were higher than the posterior mandible (69.14) and maxilla (36.68) (P < .05). Differences were detected in BIC of commercially available implants and experimental micro-implants (P < .05). Comparative assessments and meta-analysis showed that conventionally loaded implants (75.70 and 75.786 ± 4.889, respectively) had higher BIC than unloaded (54.07 and 53.24 ± 4.971, respectively) and immediately loaded implants (58.53 and 68.831 ± 4.972; P = .000 and P = .004, respectively). CONCLUSIONS: Based upon a meta-analysis of the literature the following conclusions can be made: The BIC in the mandible is higher than the maxilla. The BIC is higher in the anterior than the posterior regions. The implant design coupled with the anatomical region affects the amount of BIC. Placement of experimental micro-implants with different surfaces in the posterior region always result in low and almost comparable BIC. The loading state and healing period seems to have an influence on BIC. Specific reporting guidelines are required to improve reporting of studies on human BIC.

The effect of static load on dental implant survival: a systematic review.

PURPOSE: The purpose of this study was to systematically review the current evidence related to the effects of static loading on the long-term stability of the osseointegrated interface. MATERIALS AND METHODS: The literature search was conducted using Medline supplemented by SCOPUS and the Cochrane databases as well as hand searching from references of reviewed papers. Relevant studies were selected according to predetermined inclusion and exclusion criteria. Key words used in the search included: dental implant passive fit, dental implant misfit, dental implant static load, dental implant overload, orthodontic forces, and dental implants. RESULTS: The initial database search yielded 192 relevant titles. After the subsequent filtering process, 36 studies were finally selected. Twenty-eight articles involved animal studies and eight articles involved human studies. CONCLUSIONS: The results of this systematic review demonstrate that there is no apparent detrimental effect of static loading on osseointegrated dental implants.

Human Calmodulin-Like Protein CALML3: A Novel Marker for Normal Oral Squamous Mucosa That Is Downregulated in Malignant Transformation.

Oral cancer is often diagnosed only at advanced stages due to a lack of reliable disease markers. The purpose of this study was to determine if the epithelial-specific human calmodulin-like protein (CALML3) could be used as marker for the various phases of oral tumor progression. Immunohistochemical analysis using an affinity-purified CALML3 antibody was performed on biopsy-confirmed oral tissue samples representing these phases. A total of 90 tissue specimens were derived from 52 patients. Each specimen was analyzed in the superficial and basal mucosal cell layers for overall staining and staining of cellular subcompartments. CALML3 was strongly expressed in benign oral mucosal cells with downregulation of expression as squamous cells progress to invasive carcinoma. Based on the Cochran-Armitage test for trend, expression in the nucleus and at the cytoplasmic membrane significantly decreased with increasing disease severity. Chi-square test showed that benign tissue specimens had significantly more expression compared to dysplasia/CIS and invasive specimens. Dysplasia/CIS tissue had significantly more expression than invasive tissue. We conclude that CALML3 is expressed in benign oral mucosal cells with a statistically significant trend in downregulation as tumorigenesis occurs. CALML3 may thus be a sensitive new marker for oral cancer screening.

Long-term bone stability assessment around 1,187 immediately placed implants with 1- to 22-year follow-up.

PURPOSE: To evaluate the retention of bone around implants placed immediately following tooth extraction and used to support dental prostheses. MATERIALS AND METHODS: Patients from a previous study of implants placed immediately following tooth extraction were recalled to the original practice to obtain dental radiographs, which were then used to compare bone levels after 1 to 22 years of clinical function supporting dental prostheses. All radiographs were evaluated by measuring the bone within the implant threads. Implant bone maintenance was correlated with smoking history, type of implant surface, antibiotics used in conjunction with surgery, bisphosphonate use, presence of splinted restorations, anatomical location (mandible or maxilla and anterior or posterior), sex, and past periodontal disease status. Statistical analysis was performed using the Mann-Whitney test for statistical significance of differences in mean bone loss. RESULTS: A total of 1,187 implants were identified, with mean bone loss of 0.52 ± 0.79 mm. Overall bone loss was less than 1.5 mm in 90% of the implants studied. Bone loss was greater in women (0.61 ± 0.91 mm vs 0.44 ± 0.69 mm in men; P = .002). There was a correlation between bone loss and patient age at the time of tooth loss, with patients below the age of 50 experiencing significantly more loss (mean loss, 0.76 ± 1.07 mm at age < 50 and 0.46 ± 0.71 mm at age > 50; P = .008). Other significant differences were seen with implant surface (machined surface, 0.57 ± 0.77 mm; roughened surface, 0.44 ± 0.84 mm; P = .0049), maxilla vs mandible in molar areas (maxilla, 0.68 ± 0.83 mm; mandible, 0.43 ± 0.80 mm; P = .0001), and platform width (regular, 0.46 ± 0.77; wide, 0.83 ± 0.94 mm; P ≤ .0001). None of the other factors demonstrated significant differences. CONCLUSIONS: Bone loss of 1.5 mm or less was observed in 90% of the patients followed. Bone loss was correlated with age, sex, implant surface, anatomical location, and platform width. There was no statistical correlation between bone loss and any other factors evaluated.