Ultrasonic implant site preparation using piezosurgery: a multicenter case series study analyzing 3,579 implants with a 1- to 3-year follow-up.

This multicenter case series introduces an innovative ultrasonic implant site preparation (UISP) technique as an alternative to the use of traditional rotary instruments. A total of 3,579 implants were inserted in 1,885 subjects, and the sites were prepared using a specific ultrasonic device with a 1- to 3-year follow-up. No surgical complications related to the UISP protocol were reported for any of the implant sites. Seventy-eight implants (59 maxillary, 19 mandibular) failed within 5 months of insertion, for an overall osseointegration percentage of 97.82% (97.14% maxilla, 98.75% mandible). Three maxillary implants failed after 3 years of loading, with an overall implant survival rate of 97.74% (96.99% maxilla, 98.75% mandible).

The abutment duplication technique: a novel protocol for cementable implant-supported restorations.

The purpose of this study was to present a new laboratory technique for cementable implant-supported restorations and to evaluate its efficacy in reducing chair time for both patients and clinicians, while maintaining the precision of an indirect procedure for crown fabrication. The technique consisted of the duplication of the implant portion of a working cast prepared using double-pour or plastic base die systems for single or multiple crowns. For this purpose, a flask previously intended for the production of ceramic inlays and onlays was used. Duplication was obtained using a high-precision addition silicon material and a low-shrinkage polyurethane resin. The duplicated implant abutment was used to finalize the fixed partial denture restorations after the originals were delivered to the patients. Fifty abutments were tested consecutively. The castings (19 single crowns, 31 fixed partial dentures) produced on the original abutments were seated on the duplicate abutments and evaluated by two prosthodontists and two dental technicians using a visual inspection method (laboratory microscope at 163 magnification). Forty-eight restorations were "good" (completely seated, no marginal opening) and 2 were "acceptable" (incomplete seating but amendable), with a 98% success rate. The technique presented demonstrates efficacy and predictability in reducing the number of clinical sessions for delivering precisely fitting cementable implant-supported restorations.

A prospective, multicenter, randomized-controlled 5-year study of hybrid and fully etched implants for the incidence of peri-implantitis.

BACKGROUND: The dual acid-etched (DAE) implant was commercially introduced in 1996 with a hybrid design incorporating a machined surface in the coronal region from approximately the third thread to the seating surface. This design was intended to reduce the risks of peri-implantitis and other related soft tissue complications that were reported for implants with surface roughness in the coronal region. The objective of this prospective, randomized-controlled clinical trial was to determine the incidence of peri-implantitis for a fully etched implant with the DAE surface extending to the implant platform. METHODS: Patients had implant sites randomly assigned to receive one hybrid control implant and at least one fully etched test implant in support of a short-span fixed restoration to ensure that variables (e.g., demographics, jaw locations, and bone density) were consistent between groups. Prostheses were inserted 2 months after implant placement with follow-up evaluations scheduled annually for 5 years to assess mucosal health based on bleeding on probing, suppuration, and probing depths. Evaluations also included radiographic and mobility assessments. RESULTS: One hundred twelve patients who were enrolled at seven centers received 139 control and 165 test implants (total: 304 implants). With >5 years of postloading evaluations, there was one declaration of peri-implantitis associated with a control implant that was successfully treated later. Clinical probing and radiographic assessments did not reveal differences between groups in mucosal health outcomes or other signs of peri-implantitis. CONCLUSION: Five-year results of this randomized-controlled study showed no increased risk of peri-implantitis for fully etched implants compared to hybrid-designed implants.

Immediate provisionalization of NanoTite implants in support of single-tooth and unilateral restorations: one-year interim report of a prospective, multicenter study.

BACKGROUND: Clinical studies reporting immediate loading of endosseous implants for edentulous cases and for fixed partial restorations have been well documented with satisfactory survival rates. Implants with a recently developed, nanometer-scale surface topography (NanoTite, BIOMET 3i, Palm Beach Gardens, FL, USA), created by discrete crystalline depositions (DCD) of calcium phosphate nano-crystals onto a dual acid-etched (DAE) surface, show enhanced early fixation in preclinical studies when compared with DAE-surfaced implants. These outcomes suggest DCD-surfaced implants may be advantageous for immediate loading approaches. OBJECTIVE: The aim of this prospective, multicenter, observational study is to report clinical outcomes for DCD-surfaced implants placed in immediate functional support of single- and multi-unit restorations according to an immediate loading protocol. MATERIALS AND METHODS: One hundred eighty-five patients enrolled at 15 international study centers received a total of 335 implants supporting 216 immediate provisionalizations consisting of 128 single-tooth restorations and 88 fixed restorations. Of the 335 implants, 77% are located in posterior and 23% in anterior regions with 55.5% of the total in mandibles and 44.5% in maxillae. Patients were evaluated for implant mobility, gingival health, symptomatology, and radiographic outcomes. RESULTS: At the time of this 1-year interim report, a total of 17 failures have been observed in 11 patients, yielding a cumulative survival rate of 94.9%. CONCLUSION: Relative to other prospective, multicenter studies of immediately loaded implants with various surface enhancements, NanoTite implants perform comparatively well when immediately provisionalized with single-tooth and fixed restorations.

Early loading of Osseotite implants 2 months after placement in the maxilla and mandible: a 5-year report.

PURPOSE: In this multicenter study, the performance of Osseotite implants after a 1-stage surgery and abbreviated healing period of 2 months is reported. The implants were followed for up to 5 years. MATERIALS AND METHODS: Partially or completely edentulous patients treated at 10 private practice centers were included in the study. Oral hygiene was assessed using the plaque index and the gingival index prior to surgery and at recall visits at 6 months, 1, 2, 3, 4, and 5 years after initial loading. Bone density and implant/bone fit were evaluated at the time of surgery. Implants were loaded after a healing period of about 2 months. RESULTS: The mean age of the patients at time of enrollment was 60.4 +/- 13.0 years; 44% (86) of the patients were men and 56% (109) were women. In all, 526 implants were placed, 65.4% in the mandible and 34.6% in the maxilla, with 23.0% placed in anterior locations and 77.0% in the posterior. The cumulative success rate of these 526 implants was 97.9% at 5 years. Eight of the 11 implant failures occurred during nonsubmerged healing prior to prosthetic loading. Provisional restorations were placed at 2.1 +/- 0.5 months, at which time implants were evaluated for mobility, gingival health, symptomology, and radiolucency. The distribution of prosthesis types included 118 single-tooth restorations (118 implants), 134 short-span prostheses (327 implants), and 16 long-span restorations (81 implants). DISCUSSION: The benefits of early loading cannot be fully appreciated if there is a substantive increase in implant failures. In this study, a cumulative success rate greater than 97% was maintained throughout 5 years of observation. CONCLUSION: These results suggest that success can be expected with Osseotite implants after a nonsubmerged reduced healing period of 2 months in this patient population.

Guided Tissue Regeneration in Mucogingival Surgery.

The use of expanded polytetrafluoroethylene (ePTFE) membranes in the treatment of mucogingival problems such as gingival recession, has been recently described. The major issues raised dealt with creating and maintaining space under the membrane and designing a flap that could be coronally positioned and at the same time capable of maintaining a good blood supply. The authors proposed the use of a trapezoidal flap and some technical space-making solutions, such as the use of a suturing technique and different metal structures to support the membranes. J Periodontol 1993; 64:1184-1191.