Therapeutic concepts and methods for improving dental implant outcomes. Summary and consensus statements. The 4th EAO Consensus Conference 2015.

BACKGROUND: Different therapeutic concepts and methods have been proposed for improving dental implant outcomes in three specific clinical situations: (i) the fresh extraction socket with alveolar ridge preservation protocols; (ii) the posterior maxilla with limited bone height with either the placement of regular-sized implants after sinus elevation and grafting or short dental implants and; (iii) the posterior mandible with limited bone height with either vertical bone augmentation and placement of implants or short dental implants. MATERIALS AND METHODS: Three systematic reviews, based on randomized and controlled clinical trials have evaluated the efficacy of these different therapeutic modalities in terms of dental implant outcomes. RESULTS AND CONCLUSIONS: Interventions aimed for alveolar ridge preservation have shown efficacy in terms of allowing the placement of dental implants and for reducing the need of further augmentation procedures at implant placement. Both therapeutic options, the placement of implants after sinus elevation and grafting or short dental implants, were valid alternatives in the treatment of the posterior maxilla with deficient bone availability, although short implants resulted in fewer complications. Similarly, the placement of implants in vertically augmented bone rendered comparable outcomes with those of short implants in the treatment of the posterior mandible, but short implants resulted in fewer complications.

Short implant in limited bone volume.

Rehabilitation of severely resorbed jaws with dental implants remains a surgical and prosthetic challenge for clinicians. The purpose of this review was to evaluate the available data on short-length implants and discuss their indications and limitations in daily clinical practice. A structured review of MEDLINE and a manual search were conducted. Thirty-two case series devoted to short-length implants, 14 reviews and 3 randomized controlled trials were identified. Of this group of papers, we can conclude that short-length implants can be successfully used to support single and multiple fixed reconstructions in posterior atrophied jaws, even in those with increased crown-to-implant ratios. The use of short-length implants allows treatment of patients who are unable to undergo complex surgical techniques for medical, anatomic or financial reasons. Moreover, the use of short-length implants in daily clinical practice reduces the need for complex surgeries, thus reducing morbidity, cost and treatment time. The use of short implants promotes the new concept of stress-minimizing surgery, allowing the surgeon to focus more on the correct three-dimensional positioning of the implant.

Equine-derived bone mineral matrix for maxillary sinus floor augmentation: a clinical, radiographic, histologic, and histomorphometric case series.

The objective of this proof-of-principle multicenter case series was to examine the bone regenerative potential of a newly introduced equine-derived bone mineral matrix (Equimatrix) to provide human sinus augmentation for the purpose of implant placement in the posterior maxilla. There were 10 patients requiring 12 maxillary sinus augmentations enrolled in this study. Histologic results at 6 months demonstrated abundant amounts of vital new bone in intimate contact with residual graft particles. Active bridging between residual graft particles with newly regenerated bone was routinely observed in intact core specimens. A mean value of 23.4% vital bone formation was observed at 6 months. This compared favorably with previous results using xenografts to produce bone in the maxillary sinus for the purpose of dental implant placement. Both the qualitative and quantitative results of this case series suggest comparable bone regenerative results at 6 months to bovine-derived xenografts.

A review assessing the quality of reporting of risk factor research in implant dentistry using smoking, diabetes and periodontitis and implant loss as an outcome: critical aspects in design and outcome assessment.

AIM: To assess, using a structured review, the quality of reporting (design and outcome assessment) of risk factor research using the STROBE statements. The outcome was implant loss, and the risk factors assessed were smoking, diabetes and periodontitis. MATERIALS AND METHODS: Literature search was performed individually for each of the risk factors and the outcome using three sets of database: (a) MEDLINE, (b) references derived from relevant reviews and (c) references derived from identified manuscripts. Only case-control and cohort studies were included and assessed using the STROBE statements. RESULTS: A total of 104 papers were retrieved, three of which were found to be cohort studies (one in the diabetes and two in the periodontitis review) and none was a case-control study. A total of 101 of 104 papers were case series or cross-sectional study. CONCLUSIONS: Risk factor research in implant dentistry is mostly comprised of case series studies. These are used to generate hypotheses, but are the wrong tool to test these hypotheses. In the near future, well-designed observational studies are needed and should be reported according to the proposed checklist.

EAO summer camp: a facilitated sharing experience.

AIM: The purpose of the EAO summer camp was to create visions and ideas for future developments in the field of implant dentistry. An additional goal was the installation of a young, strong and enduring network for scientific exchange among participants. SUMMER CAMP ACTIVITY: Forty participants younger than 40 years of age, from 16 different European countries, discussed potential future developments of implant dentistry in a professionally moderated workshop. Participants worked in a competitive manner over 3 days in small teams on four topics: future teaching and education, surgery in 2030, prosthetics in 2030 and futuristic tissue development related to the field of implantology. Various innovative conference and moderation techniques were applied to achieve a maximum output from the creative potential present. RESULTS: Plenum consensus was obtained for several key factors potentially influencing future development in implant dentistry. In particular, teaching and education will be improved by the establishment of curriculum standards and novel teaching technologies. Surgery in 2030 will benefit from an improved cost-effectiveness of new technologies and biomaterials. A more comprehensive knowledge on host susceptibility will have an impact on treatment planning and the predictability of implant therapy. A virtual patient concept and tissue engineering will influence Prosthodontics in 2030. Futuristic tissue development will set a "platinum standard" for tissue regeneration. SUMMARY: Visions on all four topics were generated and discussed intensively during the conference. "Future teaching and education" was voted unanimously as the winning team based on the presented ideas and the special interest this topic generated.

Efficacy of the supraperiosteal envelope technique: a preliminary comparative clinical study.

The purpose of this clinical study was to compare the effectiveness of the supraperiosteal envelope technique as performed by three surgeons with different amounts of professional experience during a 6-month observation period. Sixty-eight gingival recessions in 35 healthy patients were selected and included in clinical recordings. They were statistically evaluated at baseline and 6 months later. First, clinical parameters (attachment level, pocket depth, recession height, recession width, and gingival keratinized tissue height) were calibrated between the three operators. Then, single or multiple gingival recessions were selected and surgical techniques were standardized by the surgeons (A, B, C). The root coverage percentages obtained by the three operators were 81% for operator A, 85% for operator B, and 89% for operator C, for an average of 85%; initial recession height values were 2.5 mm (A), 4.3 mm (B), and 4.4 mm (C). The preliminary results of this trial showed the capacity of this surgical technique to provide favorable clinical benefits irrespective of the initial dimensions of recession-type defects and irrespective of the learning curve and experience of operators.

Impact of implant length and diameter on survival rates.

INTRODUCTION: Despite the high success rates of endosseous oral implants, restrictions have been advocated to their placement with regard to the bone available in height and volume. The use of short or nonstandard-diameter implants could be one way to overcome this limitation. MATERIAL AND METHODS: In order to explore the relationship between implant survival rates and their length and diameter, a Medline and a hand search was conducted covering the period 1990-2005. Papers were included which reported: (1) relevant data on implant length and diameter, (2) implant survival rates; either clearly indicated or calculable from data in the paper, (3) clearly defined criteria for implant failure, and in which (4) implants were placed in healed sites and (5) studies were in human subjects. RESULTS: A total of 53 human studies fulfilled the inclusion criteria. Concerning implant length, a relatively high number of published studies (12) indicated an increased failure rate with short implants which was associated with operators' learning curves, a routine surgical preparation (independent of the bone density), the use of machined-surfaced implants, and the placement in sites with poor bone density. Recent publications (22) reporting an adapted surgical preparation and the use of textured-surfaced implants have indicated survival rates of short implants comparable with those obtained with longer ones. Considering implant diameter, a few publications on wide-diameter implants have reported an increased failure rate, which was mainly associated with the operators' learning curves, poor bone density, implant design and site preparation, and the use of a wide implant when primary stability had not been achieved with a standard-diameter implant. More recent publications with an adapted surgical preparation, new implant designs and adequate indications have demonstrated that implant survival rate and diameter have no relationship. DISCUSSION: When surgical preparation is related to bone density, textured-surfaced implants are employed, operators' surgical skills are developed, and indications for implant treatment duly considered, the survival rates for short and for wide-diameter implants has been found to be comparable with those obtained with longer implants and those of a standard diameter. The use of a short or wide implant may be considered in sites thought unfavourable for implant success, such as those associated with bone resorption or previous injury and trauma. While in these situations implant failure rates may be increased, outcomes should be compared with those associated with advanced surgical procedure such as bone grafting, sinus lifting, and the transposition of the alveolar nerve.

Short implants in the severely resorbed maxilla: a 2-year retrospective clinical study.

BACKGROUND: Although the predictability of endosseous dental implants is well documented, the restoration of the posterior region of the maxilla remains a challenge. The placement of short implants is one therapeutic option that reduces the need for augmentation therapy. PURPOSE: The purpose of this retrospective study was to assess the survival rates of 6 to 8.5 mm-long implants in the severely resorbed maxilla following a surgical protocol for optimized initial implant stability. MATERIALS AND METHODS: The study included 85 patients with 96 short (6-8.5 mm) implants (Brånemark System, Nobel Biocare AB, Göteborg, Sweden) supporting single-tooth and partial reconstructions. The implants had a machined (54) or an oxidized (TiUnite, Nobel Biocare AB) (42) surface. A one-stage surgical protocol with delayed loading was used. The patients were followed for at least 2 years after loading (average follow-up period 37.6 months). The marginal bone resorption was assessed by radiographic readings. RESULTS: Five implants were lost during the first 9 months, and four implants were lost to follow-up. The cumulative survival rate was 94.6%. Four of the failed implants had a machined surface, and one had an oxidized surface. The mean marginal bone resorption after 2 years in function was 0.44 +/- 0.52 mm. CONCLUSION: This study demonstrates that the use of short implants may be considered for prosthetic rehabilitation of the severely resorbed maxilla as an alternative to more complicated surgical techniques.