Cost-effectiveness modeling of dental implant vs. bridge.

AIMS: We assess the cost-effectiveness of dental implant first-line strategy vs. fixed partial denture strategy in patients suffering from one single missing tooth. MATERIALS AND METHODS: The model used a simulation decision framework over a 20-year period. Potential treatment switches can occur every 5 years. Transition probabilities come from literature, epidemiological reports or expert opinions. They have been programmed using specific distribution ranges to simulate the patients' and practice variability, and to take into account parameter uncertainty. Direct medical costs have been assessed according to a cost survey. Probabilistic sensitivity analyses were conducted using 5000 Monte-Carlo simulations, generating confidence intervals of model outcomes. RESULTS: We found that mean cost-effectiveness of the bridge strategy is higher than the implant strategy. CONCLUSION: Implant as the first-line strategy appears to be the 'dominant' strategy, considering the lower overall costs and the higher success rate.

Immediate and delayed implant placement into extraction sockets: a 5-year report.

BACKGROUND: As a complement to the earlier reported 3-year results from a prospective multicenter study of immediate and delayed placement of implants into fresh extraction sockets, the 5-year results are reported. PURPOSE: The purpose of this 5-year report was to evaluate the immediate and long-term success of implants placed into fresh extraction sockets, with respect to implant size and type, bone quality and quantity, implant position, initial socket depth, and reason for tooth extraction. MATERIALS AND METHODS: This paper presents the 5-year results of the original 12 centers that participated with 143 consecutively included patients. A total of 264 implants were placed either immediately after tooth extraction or after a short soft-tissue healing time (3-5 weeks). The patients were divided into five subgroups, depending on the type of insertion method used. RESULTS: The outcome demonstrated that the cumulative implant survival rate after 5 years of loading has not changed and remains 92.4% in the maxilla and 94.7% in the mandible. No difference in failure rates can be seen between the groups when relating the failures to insertion method. CONCLUSION: This prospective study demonstrated that placing Brånemark implants into fresh extraction sites can be successful over a period of 5 years of loading. One of the outcomes of the study shows that there is a clinical correlation between implant failure and periodontitis as a reason for tooth extraction, even if it is difficult to give it a casual association. It can be hypothesized that periodontitis affected tissues might have a negative local influence because of the presence of infrabony defects that could possibly increase the gap between bone and implant or jeopardize achievement of primary stability.

A 3-year prospective multicenter follow-up report on the immediate and delayed-immediate placement of implants.

A total of 264 implants was placed in 143 patients using different immediate or delayed-immediate implant placement techniques in 12 different centers participating in a prospective multicenter study. The reason for tooth extraction was evaluated; bone quality and quantity were classified; socket depths were registered; and data on implant type, size, and position were collected. One hundred thirty-nine suprastructures were placed on 228 implants in 126 patients. A follow-up evaluation was done on 125 patients after 1 year of loading and on 107 patients after 3 years of loading. Clinical parameters (bleeding or not bleeding, pocket depth, and implant mobility) were evaluated after 1 and 3 years, and the marginal bone level after 1 year of loading was measured on radiographs. Clinical comparisons were performed to evaluate implant loss in relation to implant type, size, position, bone quality and quantity, socket depth, reason for tooth extraction, and placement method. In addition, life table analysis was done for cumulative implant survival rates. There was no clinical difference with respect to socket depth or when comparing the different placement methods. A higher failure rate was found for short implants in the posterior region of the maxilla and when periodontitis was cited as a reason for tooth extraction. Mean marginal bone resorption from the time of loading to the 1-year follow-up was 0.8 mm in the maxilla and 0.5 mm in the mandible. Over a period of 3 years, the implant survival rate was 92.4% in the maxilla and 94.7% in the mandible.

Five-mm-diameter implants without a smooth surface collar: report on 98 consecutive placements.

In recent years, indications for endosseous dental implants have been extended to include partially edentulous jaws with areas of limited bone density and bone volume. Wide-diameter implants are particularly well suited for these situations. The purpose of this paper was to report on 98 consecutively placed 5-mm-diameter implants without smooth surface collars. Eight implants failed-6 at second-stage surgery, and 2 after 1 year of loading (91.8% survival rate). Sixty percent of the remaining implants had no thread above the bone level after 1 year of loading. The authors discuss the possible causes for failure and suggest guidelines to avoid failure.

[Implants and orthodontics]. / Implants et orthodontie.

After a detailed historical review of implantology applied to orthodontics, and an analysis of experimental studies on orthodontic implants, the authors assess the interest of implant clinical uses as anchorage for orthodontic movement, prosthetic supports in agenetic cases or retention devices after orthodontic therapy. Different specifications and requirements are also given for a multidisciplinary approach of treatment plants.

[The role of healing abutments in the implant protocol]. / Intérêt des piliers de cicatrisation dans le protocole implantaire.

The utilization of implants requires a close interrelationship between the prosthodontist and the surgeon who performs the implant procedure. The choice of abutments and other aspects of the work should be in the domain of both individuals. After the surgical procedures, the prosthodontist can wait until soft tissue healing occurs before deciding the type and length of the abutments that will be utilized for the reconstruction. If necessary, the surgeon can perform mucogingival surgery to enhance the implant-gingival environment.

[Use of the scanner and Scanlam models in preimplant evaluation]. / Utilisation du scanner et des maquettes Scanlam dans le bilan preimplantaire.

The experience with dental implants has been so satisfactory so as to suggest their usage beyond the limits of their normal indications. Preoperative examinations have been improved by the use of the scanner. The employment of "Scanlam" models simplifies and enhances the interpretation of scanner negatives. By repositioning the surgical guide on the "Scanlam" model, both surgical and prosthetic teams are aided. It should be noted, however, that "Scanlam" models have limitations and are simply volumetric expressions of the scanner. The use of the drilling guide should be used to assist the surgeon, but not to replace his clinical judgement.

[Ambulatory vigil anesthesia for implant surgery]. / Interet de l'anesthesie vigile ambulatoire en chirurgie implantaire.

The length of certain implant surgery operation as well as their precision requires the complete cooperation of patients. The vigilambulant anesthesia, regularly used in other medical specialties, ensures in total security, anxiolism, sedation, analgesia and amnesia for patients. The presence of an anesthesist having at his disposal all the material and all drugs for anesthesia and reanimation gives the surgeon an unequalled operatory comfort.