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1.
Artículo en Inglés | MEDLINE | ID: mdl-33528453

RESUMEN

In everyday practice, surgeons have to deal with bone atrophy. These rehabilitations are even more complex in the posterior mandible, and it is still unclear in the literature which fixed rehabilitation option is best. The purpose of this article was to help oral surgeons to choose the proper and updated treatment for their atrophic patients. Posterior mandible bone atrophies were divided into four main groups depending on the bone height measured above the inferior alveolar nerve: (1) ≤ 4 mm; (2) > 4 mm ≤ 5 mm; (3) > 5 mm ≤ 6 mm; (4) > 6 mm < 7 mm. Different approaches were proposed for each group, considering patient expectations. If ≤ 4 mm of bone height was available, guided bone regeneration was used as the adequate approach. For bone heights > 4 mm and ≤ 6 mm, the "sandwich" technique and/or short implants were used, depending on esthetics. In cases with > 6 mm and < 7 mm above the mandibular canal, short implants might be the proper option. The authors' clinical experience and the literature were considered in order to suggest a possible correct treatment decision based on the residual bone height in the posterior mandible.


Asunto(s)
Aumento de la Cresta Alveolar , Implantes Dentales , Atrofia/patología , Implantación Dental Endoósea , Prótesis Dental de Soporte Implantado , Humanos , Mandíbula/diagnóstico por imagen , Mandíbula/patología , Mandíbula/cirugía , Resultado del Tratamiento
2.
Int J Periodontics Restorative Dent ; 40(6): e235-e240, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33151196

RESUMEN

This case report describes the rehabilitation of an extremely atrophic posterior mandible using 4-mm ultrashort implants and reports clinical and radiographic outcomes 7 years after loading. The patient refused to undergo any other treatment, from the removable prosthesis to the reconstructive surgery, and asked for a fixed, minimally invasive solution in the shortest possible time. The residual bone height above the alveolar nerve was an average of about 5 mm, so it was decided to treat the patient with four 4-mm ultrashort implants. Within the limitations of this case report, this procedure appears successful at 7 years after loading in this specific case and could reduce invasiveness, rehabilitative times, and costs. However, longer follow-ups on a large number of patients coming from randomized controlled clinical trials are necessary before making more reliable recommendations.


Asunto(s)
Pérdida de Hueso Alveolar , Aumento de la Cresta Alveolar , Implantes Dentales , Pérdida de Hueso Alveolar/cirugía , Implantación Dental Endoósea , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Estudios de Seguimiento , Humanos , Mandíbula/diagnóstico por imagen , Mandíbula/cirugía , Resultado del Tratamiento
3.
Clin Implant Dent Relat Res ; 22(5): 552-566, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32902123

RESUMEN

PURPOSE: To compare clinical and radiographic outcomes of <7 mm short (SH) implants inserted in native bone vs longer (ST) implants placed in vertically augmented partially edentulous posterior jaws. A further aim was to evaluate if the residual bone dimension plays a role in the outcomes of SH and extra-SH implants. MATERIALS AND METHODS: This review was registered with PROSPERO. An electronic literature search was performed on PubMed, Scopus and Web of Science. Randomized controlled trials (RCTs) with at least 1-year follow-up, comparing fixed prostheses supported by SH vs ST implants in augmented sites were included. Marginal bone level (MBL) changes, implant survival rate, and complications were evaluated through a meta-analysis. Subgroup analysis was performed dividing the SH implants according to length at each follow-up (1-, 3-, 5-year of function). RESULTS: Twenty-five articles fulfilled the inclusion criteria, featuring a total of 650 SH implants placed in 415 patients and 685 ST implants placed in 403 patients. There was a trend for a significantly lower MBL associated with SH implants respect to ST implants at each follow-up, whilst there was no evidence of a difference in failure rates between SH and ST implants, for any SH length considered and at any follow-up. There was evidence for a lower incidence of complications in favor of SH implants at both 1-year (P < .0001) and 3-year follow-up (P = .01), while at 5-year follow-up there was no evidence of a difference between SH and ST groups (P = .30). CONCLUSION: SH implants supporting partial fixed rehabilitations represent a valuable alternative to augmentation procedures in the medium term. While the performance of implants at least 5-mm long is well documented, more studies with at least 5-year follow-up are needed to confirm the promising outcomes observed with <5 mm-long fixtures.

4.
Artículo en Inglés | MEDLINE | ID: mdl-32925998

RESUMEN

The aim of this retrospective study was to evaluate clinical and radiographic outcomes of guided bone regeneration (GBR) procedures in the rehabilitation of partially edentulous atrophic arches. A total of 58 patients were included with a follow-up of 3 to 7 years after loading. Data seem to indicate that GBR with nonresorbable membranes can be a good clinical choice and suggest that it could be used to vertically reconstruct no more than 6 mm of bone in the posterior mandible. However, this technique remains difficult and requires expert surgeons.


Asunto(s)
Pérdida de Hueso Alveolar , Implantes Dentales , Regeneración Ósea , Implantación Dental Endoósea , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Estudios de Seguimiento , Humanos , Membranas Artificiales , Estudios Retrospectivos
5.
Artículo en Inglés | MEDLINE | ID: mdl-32559036

RESUMEN

This case report describes the minimally invasive full fixed rehabilitation of a totally edentulous severely atrophic mandible. The patient refused to undergo any other treatment, from the reconstructive surgery to the removable prosthesis, and asked for a fixed minimally invasive solution in the shortest possible time. Considering that the posterior mandibular bone was inadequate in height and that the interforaminal bone was only 4.3 to 5 mm in height, the patient received four 4-mm-ultrashort implants in the interforaminal area that were immediately loaded. Within all the limitations of this case report this procedure in this specific case appears successful through 2 years of loading.


Asunto(s)
Implantes Dentales , Arcada Edéntula/cirugía , Atrofia , Implantación Dental Endoósea , Prótesis Dental de Soporte Implantado , Prótesis de Recubrimiento , Humanos , Mandíbula/cirugía , Resultado del Tratamiento
6.
Int J Oral Implantol (Berl) ; 12(3): 267-280, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31535097

RESUMEN

PURPOSE: To compare the clinical outcome of fixed prostheses supported by 4- to 8-mm-long implants with prostheses supported by longer implants placed in vertically augmented atrophic mandibles after a follow-up of 5 years in function. MATERIALS AND METHODS: The Cochrane Central Register of Controlled Trials (CENTRAL) and MEDLINE were searched up to 1st September 2018 for randomised controlled trials (RCTs) with a follow-up of at least 5 years in function comparing fixed prostheses supported by 4- to 8-mm-long implants with prostheses supported by longer implants placed in vertically augmented atrophic mandibles. Outcome measures were prosthesis failure, implant failures, augmentation procedure failures, complications, and peri-implant marginal bone level changes. Screening of eligible studies, assessment of the risk of bias and data extraction were conducted in duplicate and independently by two review authors. The statistical unit of the analysis was the prosthesis. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CIs). RESULTS: Four eligible RCTs that included originally 135 patients were included. Two RCTs had a parallel-group design and two a split-mouth design. Short implants were 5.0 to 6.6 mm long and were compared with longer implants placed in posterior mandibles augmented with interpositional blocks of bone substitutes. All trials were judged at unclear risk of bias. Twelve (14%) bone augmentation procedures failed to achieve the planned bone height to allow placement of implants with the planned length. Five years after loading, 28 patients (21%) had dropped out from the four RCTs. There were no differences for patients having prosthesis (RR = 1.46; 95% CI: 0.52 to 4.09; P = 0.47; I2 = 0%) or implant (RR = 1.00; 95% CI: 0.31 to 3.21; P = 1.00; I2 = 0%) failures between the two interventions, but there were more patients experiencing complications (RR = 4.72; 95% CI: 2.43 to 9.17; P < 0.00001; I2 = 0%) and peri-implant marginal bone loss (mean difference = 0.60 mm; 95% CI: 0.36 to 0.83; P < 0.00001; I2 = 45%) at longer implants in augmented bone. CONCLUSIONS: Five years after loading, prosthetic and implant failures were similar between the two interventions, but complications and peri-implant marginal bone loss were higher and more severe at longer implants placed in vertically augmented mandibles. Larger trials and longer follow-ups up to 10 years after loading are needed to confirm or reject the present preliminary findings. However in the meantime short implants could be the preferable option.


Asunto(s)
Aumento de la Cresta Alveolar , Implantes Dentales , Implantación Dental Endoósea , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Estudios de Seguimiento , Humanos , Mandíbula , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
7.
Int J Oral Implantol (Berl) ; 12(1): 25-37, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31116186

RESUMEN

PURPOSE: To evaluate whether 5-mm short dental implants could be an alternative to augmentation with anorganic bovine bone and placement of at least 10-mm long implants in posterior atrophic jaws. MATERIALS AND METHODS: Fifteen patients with bilateral atrophic mandibles (5 to 7 mm bone height above the mandibular canal) and 15 patients with bilateral atrophic maxillae (4 to 6 mm bone height below the maxillary sinus), and bone thickness of at least 8 mm, were randomised according to a split-mouth design to receive one to three 5-mm short implants or at least 10-mm long implants in augmented bone. Mandibles were vertically augmented with interpositional bone blocks and maxillary sinuses with particulated bone via a lateral window. Implants were placed after 4 months, submerged and loaded, after another 4 months, with provisional prostheses. Four months later, definitive provisionally cemented prostheses were delivered. Outcome measures were: prosthesis and implant failures, any complication and peri-implant marginal bone level changes. RESULTS: In five augmented mandibles the planned 10-mm long implants could not be placed and shorter implants (7.0 and 8.5 mm) had to be used instead. Five years after loading, six patients, five treated in the mandible and one in the maxilla, dropped out. Three prostheses (one mandibular and two maxillary) failed in the short-implant group versus none in the long-implant group. In mandibles one long implant failed versus two short implants in one patient. In maxillae one long implant failed versus three short implants in two patients. There were no statistically significant differences in implant (n = 26; P = 1.00, difference = 3.85%, 95% CI: -12.95% to 20.64%) and prosthetic (n = 26; P = 0.250, difference = 11.54%, 95% CI: -0.74% to 23.82%) failures. Eleven patients had 16 complications at short implants (one patient accounted for six complications) and 12 patients had 14 complications at long implants. There were no statistically significant differences in complications (n = 28; P = 1.00, difference = -3.57%, 95% CI: -30.65% to 23.51%). Five years after loading, patients with mandibular implants lost on average 1.72 mm at short implants and 2.10 mm at long implants of peri-implant marginal bone. This difference was statistically significant (difference = 0.37 ± 0.43 mm; 95% CI: 0.07 to 0.68 mm; P = 0.022). In maxillae, patients lost on average 1.31 mm at short implants and 1.79 mm at long implants. This difference was statistically significant (difference = 0.48 ± 0.43 mm; 95% CI: 0.22 to 0.74 mm; P = 0.002). CONCLUSIONS: Five years after loading, 5-mm short implants achieved similar results to longer implants in augmented bone. The choice of short implants might be preferable to vertical bone augmentation, especially in mandibles, since the treatment is faster and cheaper.


Asunto(s)
Aumento de la Cresta Alveolar , Arcada Edéntula , Animales , Bovinos , Implantación Dental Endoósea , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Humanos
8.
Int J Oral Implantol (Berl) ; 12(1): 39-54, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31116187

RESUMEN

PURPOSE: To evaluate whether 5 × 5 mm dental implants with a novel nanostructured calcium-incorporated titanium surface could be an alternative to implants at least 10-mm long placed in bone augmented with bone substitutes in posterior atrophic jaws. MATERIALS AND METHODS: Forty patients with atrophic posterior (premolar and molar areas) mandibles having 5- to 7-mm bone height above the mandibular canal, and 40 patients with atrophic maxillae having 4- to 6-mm bone height below the maxillary sinus, were randomised according to a parallel-group design to receive one to three 5-mm implants or one to three at least 10-mm long implants in augmented bone at two centres. All implants had a diameter of 5 mm. Mandibles were vertically augmented with interpositional bovine bone blocks covered with resorbable barriers. Implants were placed after 4 months. Maxillary sinuses were augmented with particulated porcine bone via a lateral window covered with resorbable barriers and implants were placed simultaneously. All implants were submerged and loaded after 4 months with provisional prostheses. Four months later, definitive screw-retained or provisionally cemented metal-ceramic or zirconia prostheses were delivered. Patients were followed to 5 years post-loading and the outcome measures were: prosthesis and implant failures, any complication and peri-implant marginal bone level changes. RESULTS: Sixteen patients dropped out before the 5-year evaluation (four short mandibles, three short maxillae, six augmented mandibles and three augmented maxillae). In mandibles, two grafted patients were not prosthetically rehabilitated because of multiple complications, and three implants failed in the same patient (one was a replacement implant) versus one patient who lost his short implant and crown 2 years after loading. In maxillae one short implant failed with its provisional crown 3 months post-loading. There were no statistically significant differences in prostheses (difference in proportion = -0.003; 95% CI: -0.14 to 0.13; P = 1.000) and implant failures (difference in proportion = -0.03; 95% CI: -0.17 to 0.09; P = 0.609) up to 5 years after loading. Significantly more complications occurred at mandibular grafted sites: 17 augmented patients were affected by complications versus nine patients treated with short implants in mandibles (difference in proportion = 0.39; 95% CI: 0.10 to 0.62; P = 0.013). In the maxilla seven sinus-elevated patients versus two patients treated with short implants were affected by complications, the difference not being statistically significant (difference in proportion = 0.25; 95% CI: -0.04 to 0.49; P = 0.128). Patients with mandibular short implants lost on average 1.22 mm of peri-implant bone at 5 years and patients with 10-mm or longer mandibular implants lost 1.70 mm. Patients with maxillary short implants lost on average 1.25 mm of peri-implant bone at 5 years and patients with 10-mm or longer maxillary implants lost 1.73 mm. Longer implants showed a greater bone loss up to 5 years after loading than short implants both in maxillae (mean difference: -0.48 mm; 95% CI: -0.89 to -0.07 mm; P = 0.024) and in mandibles (mean difference: -0.48 mm; 95% CI: -0.79 to -0.18 mm; P = 0.004). CONCLUSIONS: Five years after loading, 5 × 5 mm implants achieved similar results to longer implants placed in augmented bone. Short implants might be a preferable choice to bone augmentation especially in posterior mandibles since the treatment is faster, cheaper and associated with less morbidity; however, 10-year post-loading data are necessary before making reliable recommendations.


Asunto(s)
Aumento de la Cresta Alveolar , Titanio , Animales , Bovinos , Implantación Dental Endoósea , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Humanos
9.
Int J Oral Implantol (Berl) ; 12(1): 57-72, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31116188

RESUMEN

PURPOSE: To evaluate whether 6-mm-long by 4-mm-wide dental implants could be an alternative to implants at least 10-mm long placed in bone augmented with bone substitutes in posterior atrophic jaws. MATERIALS AND METHODS: A total of 20 patients with bilateral atrophic mandibles and 20 patients with bilateral atrophic maxillae, having 5 to 7 mm of bone height below the maxillary sinus or 6 to 8 mm above the mandibular canal, had their sides of the jaws randomly allocated according to a split-mouth design. They were allocated to receive one to three 6-mm-long and 4-mm-wide implants, or implants at least 10-mm long in augmented bone by two different surgeons in different centres. Mandibles were vertically augmented with interpositional equine bone blocks and resorbable barriers, and implants were placed 3 months later. Maxillary sinuses were augmented with particulated porcine bone via a lateral window and implants were placed simultaneously. All implants were submerged and loaded, after 4 months, with provisional prostheses. Four months later, definitive prostheses were delivered. Outcome measures were prosthesis and implant failures, any complication and radiographic peri-implant marginal bone level changes. The follow-up was 5 years after loading for all patients. RESULTS: Eight patients (five treated in mandibles and three in maxillae) dropped out before the 5-year post-loading follow-up. Four short implants (two maxillary and two mandibular) affected by peri-implantitis failed together with their prostheses versus three mandibular prostheses which could not be placed on implants at least 10-mm long due to graft failures; one was associated with the loss of three implants because of infection. There were no statistically significant differences in implant (P = 1.0) and prosthesis failures (P = 1.0). In total, 19 complications occurred in 14 patients at augmented sites versus five complications in four patients with 6-mm-long implants (P = 0.118). More complications occurred at grafted sites both in mandibles (P = 0.727), and maxillae (P = 0.063), although the differences were not statistically significant. In mandibles, patients with 6-mm-long implants lost an average of 1.34 ± 0.35 mm of peri-implant bone at 5 years versus 2.11 ± 0.59 mm in patients with implants at least 10-mm long. The difference was statistically significant (mean difference = 0.77 ± 0.70 mm; 95% CI: 0.32 to 1.21 mm; P = 0.003). In maxillae, patients with 6-mm-long implants lost an average of 1.52 ± 0.47 mm of peri-implant bone at 5 years versus 1.85 ± 0.51 mm in patients with implants at least 10-mm long. The difference was statistically significant (mean difference = 0.33 ± 0.36 mm; 95% CI: 0.14 to 0.53 mm; P = 0.002). CONCLUSIONS: Results at 5 years after loading indicate that 6-mm-long implants with a conventional diameter of 4 mm achieved similar results to longer implants placed in augmented bone. Short implants might be a preferable choice to bone augmentation, especially in posterior mandibles since the treatment was faster, cheaper and associated with less morbidity. However, 10-year post-loading data are necessary before making reliable recommendations.


Asunto(s)
Aumento de la Cresta Alveolar , Implantación Dental Endoósea , Animales , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Caballos , Humanos
10.
Eur J Oral Implantol ; 11(4): 385-395, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30515480

RESUMEN

PURPOSE: To evaluate whether 6.6-mm long implants could be a suitable alternative to longer implants placed in vertically augmented atrophic posterior mandibles. MATERIALS AND METHODS: Sixty partially edentulous patients having 7 to 8 mm of residual crestal height and at least 5.5-mm thickness measured on computed tomography scans above the mandibular canal were randomly allocated according to a parallel-group design either to receive one to three submerged 6.6-mm long implants or 9.6-mm or longer implants (30 patients per group) placed in vertically augmented bone. Bone was augmented with interpositional anorganic bovine bone blocks fixed with titanium plates and covered with resorbable barriers. Grafts were left to heal for 5 months before implant placement. Four months after implant placement, provisional acrylic prostheses were delivered, replaced, after 4 months, by definitive metal-ceramic prostheses. Outcome measures were: prosthesis and implant failures, complications, and radiographic peri-implant marginal bone level changes. Patients were followed up to 8 years after loading. RESULTS: Eight years after loading 12 patients dropped out, five from the short implant group and seven from the augmented group. The augmentation procedure failed in two patients and only 6.6-mm long implants could be inserted. There were no statistically significant differences for prosthesis and implant failures. Four prostheses failed in three patients of the short implant group versus three prostheses in three patients of the augmented group (Fisher exact test P = 1.000; difference in proportions = 0.01; 95% CI: -0.19 to 0.22). Five short implants failed in three patients versus three long implants in three patients (Fisher exact test P = 1.000; difference in proportions = 0.01; 95% CI: -0.19 to 0.22). There were statistically more complications in augmented patients (27 complications in 22 augmented patients versus 9 complications in 8 patients of the short implant group) (Fisher exact test P < 0.001; difference in proportions = 0.64; 95% CI: 0.38 to 0.79). Both groups gradually lost peri-implant bone in a statistically significant way. Eight years after loading, short implant group patients lost an average of 1.58 mm of peri-implant bone compared with 2.46 mm in the augmented group. Short implants experienced statistically significantly less bone loss (0.88 mm, 95% CI: 0.50 to 1.26 mm) than long implants. CONCLUSIONS: When residual bone height over the mandibular canal is between 7 and 8 mm, 6.6-mm short implants are an interesting alternative to vertical augmentation in posterior atrophic mandibles since the treatment is faster, cheaper and associated with less morbidity.


Asunto(s)
Implantes Dentales , Arcada Parcialmente Edéntula , Mandíbula , Diseño de Prótesis Dental , Humanos , Arcada Parcialmente Edéntula/cirugía , Titanio , Resultado del Tratamiento
11.
Biomed Res Int ; 2018: 2908484, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30140692

RESUMEN

Novel one-piece implants with concave smooth neck have been introduced to promote the formation of a thick mucosal layer and preserve marginal bone. A retrospective study on 70 patients with 1- to 6-year follow-up was carried out. Cumulative survival rates were assessed. Variations of marginal bone level were measured on periapical radiographs as distance of the implant-abutment junction from the bone crest. Influence of different variables on treatment outcome was evaluated. Cumulative success rate after 6 years was 99.4 % at implant level and 98.6 % at patient level. Marginal bone level changed in a significant way over time. After 4 months, an increase of radiographic bone level of 0.173 ± 1.088 mm at implant level and 0.18 ± 1.019 mm at patient level was recorded. Mean marginal bone loss after 5 years was 0.573 ± 0.966 mm at implant level and 0.783 ± 1.213 mm at patient level. Age, sex, smoking habits, implant sites, implant lengths and diameters, prosthetic retentions, and timing of loading did not influence marginal bone remodeling in a statistically significant way. At 4-year follow-up partial restorations lost a mean of 0.96 mm of more marginal bone compared with single restorations. This difference was statistically significant.


Asunto(s)
Implantación Dental Endoósea , Diseño de Prótesis Dental , Adulto , Anciano , Pérdida de Hueso Alveolar , Implantes Dentales , Implantes Dentales de Diente Único , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
12.
Biomed Res Int ; 2018: 6758245, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29955608

RESUMEN

Purpose: The majority of the techniques used to assess the primary implant stability are subjective and empirical and can be used during or after the surgery. The aim of this study is to evaluate the bone density prior to surgery, in order to give recommendations to the clinician about the best surgical technique and the type of implant which is needed. Materials and Methods: A surgeon operated on 75 patients for 269 implants over the period 2010-2014. He required a CT to plan the surgery and he documented the type, the diameters, and the lengths of the implants, the insertion torque, and the ISQ values. At a later stage another clinician measured bone density and cortical thickness. We endeavoured to get the most accurate superimposition between the implants placed by the surgeon and those placed by the clinician. Results: In maxilla ISQ showed a significant positive correlation with HU values detected for coronal-buccal (r = 0.302; p = 0.020) and middle-lingual (r = 0.295; p = 0.023). Torque showed a positive correlation with cortical bone thickness at the middle of the ridge (ρ = 0.196; p = 0.032). Conclusion: It is important to take into consideration the Hounsfield Units and the cortical thickness as predictive parameters during the preoperative assessment, with regard to the choice of the implant type as well as the surgical technique.


Asunto(s)
Densidad Ósea , Implantación Dental Endoósea , Implantes Dentales , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Maxilar , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Torque , Adulto Joven
13.
Eur J Oral Implantol ; 11(2): 145-161, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29806663

RESUMEN

PURPOSE: To compare the clinical outcome of immediately loaded cross-arch maxillary prostheses supported by zygomatic implants vs conventional implants placed in augmented bone. MATERIALS AND METHODS: In total, 71 edentulous patients with severely atrophic maxillas without sufficient bone volumes for placing dental implants, or when it was possible to place only two implants in the anterior area (minimal diameter 3.5 mm and length of 8 mm) and less than 4 mm of bone height subantrally, were randomised according to a parallel group design to receive zygomatic implants (35 patients) to be loaded immediately vs grafting with a xenograft, followed after 6 months of graft consolidation by placement of six to eight conventional dental implants submerged for 4 months (36 patients). For immediate loading, zygomatic implants had to be inserted with an insertion torque superior to 40 Ncm. Screw-retained metal reinforced acrylic provisional prostheses were provided, to be replaced by definitive Procera Implant Bridge Titanium prostheses (Nobel Biocare, Göteborg, Sweden), with ceramic or acrylic veneer materials 4 months after initial loading. Outcome measures were: prosthesis, implant and augmentation failures, any complications, quality of life (OHIP-14), patients' number of days with total or partial impaired activity, time to function and number of dental visits, assessed by independent assessors. Patients were followed up to 1 year after loading. RESULTS: No augmentation procedure failed. Five patients dropped out from the augmentation group. Six prostheses could not be delivered or failed in the augmentation group vs one prosthesis in the zygomatic group, the difference being statistically significant (difference in proportions = -16.5%; P = 0.045; 95% CI: -0.34 to -0.01). Eight patients lost 35 implants in the augmentation group vs two patients who lost four zygomatic implants, the difference being statistically significant (difference in proportions = -20.1%; P = 0.037; 95% CI: -0.38 to -0.02). A total of 14 augmented patients were affected by 22 complications, vs 28 zygomatic patients (40 complications), the difference being statistically significant (difference in proportions = 34.8%; P = 0.005; 95% CI: 0.12 to 0.54). The 1-year OHIP-14 score was 3.93 ± 5.86 for augmented patients and 3.97 ± 4.32 for zygomatic patients with no statistically significant differences between groups (mean difference = 0.04; 95% CI: -2.56 to 2.65; P = 0.747). Both groups had significantly improved OHIP-14 scores from before rehabilitation (P < 0.001 for both augmented and zygomatic patients). On average, the number of days of total infirmity was 7.42 ± 3.17 for the augmented group and 7.17 ± 1.96 for the zygomatic group, the difference not being statistically significant (mean difference = -0.25; 95% CI: -1.52 to 1.02; P = 0.692). The number of days of partial infirmity were on average 14.24 ± 4.64 for the augmented group and 12.17 ± 3.82 for the zygomatic group, the difference being statistically significant (mean difference = -2.07; 95% CI: -4.12 to -0.02; P = 0.048). The mean number of days that needed to have a functional prosthesis was 444.32 ± 207.86 for augmented patients and 1.34 ± 2.27 for zygomatic patients, the difference being statistically significant (mean difference = -442.98; 95% CI: -513.10 to -372.86; P < 0.001). The average number of dental visits was 19.72 ± 12.22 for augmented patients and 15.12 ± 5.76 for zygomatic patients, the difference not being statistically significant (mean difference = -4.61; 95% CI: -9.31 to 0.92; P = 0.055). CONCLUSIONS: Preliminary 1-year post-loading data suggest that immediately loaded zygomatic implants were associated with statistically significantly fewer prosthetic failures (one vs six patients), implant failures (two vs eight patients) and time needed to functional loading (1.3 days vs 444.3 days) when compared to augmentation procedures and conventionally loaded dental implants. Even if more complications were reported for zygomatic implants, they proved to be a better rehabilitation modality for severely atrophic maxillae. Long-term data are absolutely needed to confirm or dispute these preliminary results.


Asunto(s)
Aumento de la Cresta Alveolar , Implantación Dental Endoósea , Carga Inmediata del Implante Dental , Maxilar/patología , Adulto , Anciano , Atrofia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo , Resultado del Tratamiento , Cigoma
14.
Eur J Oral Implantol ; 11(2): 175-187, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29806665

RESUMEN

PURPOSE: To evaluate whether 6 mm long × 4 mm wide dental implants could be an alternative to implants of at least 10 mm long placed in bone augmented with bone substitutes in posterior atrophic jaws. MATERIALS AND METHODS: A total of 20 patients with bilateral atrophic mandibles, and 20 patients with bilateral atrophic maxillae, having 5 mm to 7 mm of bone height below the maxillary sinus or 6 mm to 8 mm above the mandibular canal, had their side of the jaws randomly allocated according to a split-mouth design. They were allocated to receive one to three 6 mm long × 4 mm wide implants, or implants of at least 10 mm long in augmented bone by two different surgeons at different centres. Mandibles were vertically augmented with interpositional equine bone blocks and resorbable barriers, and implants were placed 3 months later. Maxillary sinuses were augmented with particulated porcine bone via a lateral window and implants were placed simultaneously. After 4 months, all implants were submerged and loaded with provisional prostheses. Four months later, definitive prostheses were delivered. Outcome measures were prosthesis and implant failures, any complication and radiographic peri-implant marginal bone level changes. RESULTS: Five patients (three treated in mandibles and two in maxillae) dropped out before the 3-year post-loading follow-up. Two short maxillary implants affected by peri-implantitis failed together with their prosthesis vs three mandibular prostheses that could not be placed on implants at least 10 mm long due to graft failures; one was associated with the loss of three implants because of infection. There were no statistically significant differences in implant (difference in proportions = 0.000; 95% CI: -0.140 to 0.140; P = 1.000) and prosthesis failures (difference in proportions = 0.057; 95% CI: -0.094 to 0.216; P = 0.625). In total, 18 complications occurred in 13 patients at augmented sites vs four complications in three patients with 6 mm long implants. Significantly more complications occurred at grafted sites in mandibles (difference in proportions = 0.353; 95% CI: 0.005 to 0.616; P = 0.031), but not in maxillae (difference in proportions = 0.222; 95% CI: -0.071 to 0.486; P = 0.219). In mandibles, patients with 6 mm long implants lost an average of 1.25 mm of peri-implant bone at 3 years vs 1.54 mm in patients with implants of at least 10 mm long. The difference was statistically significant (mean difference = 0.29 mm; 95% CI: 0.08 to 0.51 mm; P = 0.010). In maxillas, patients with 6 mm-long implants lost an average of 1.28 mm of peri-implant bone at 3 years vs 1.50 mm in patients with implants of at least 10 mm long. The difference was statistically significant (mean difference = 0.22 mm; 95% CI: 0.08 to 0.35 mm; P = 0.003). CONCLUSIONS: Results at 3 years after loading indicate that 6 mm long implants with a conventional diameter of 4 mm achieved similar, if not better, results than longer implants placed in augmented bone. Short implants might be a preferable choice to bone augmentation, especially in posterior mandibles, since the treatment is faster, cheaper and associated with less morbidity. However, data obtained 5 to 10 years after loading are necessary before making reliable recommendations.


Asunto(s)
Pérdida de Hueso Alveolar/rehabilitación , Pérdida de Hueso Alveolar/cirugía , Aumento de la Cresta Alveolar , Implantación Dental Endoósea , Prótesis Dental de Soporte Implantado , Adulto , Anciano , Anciano de 80 o más Años , Diseño de Prótesis Dental , Femenino , Humanos , Masculino , Persona de Mediana Edad
15.
Eur J Oral Implantol ; 11(2): 235-240, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29806670

RESUMEN

PURPOSE: To present a case of a woman referred for the management of displacement of one implant in her right posterior mandible that had occurred three days previously. MATERIALS AND METHODS: After implant placement, the practitioner was no longer able to detect the implant and inserted a second one at the same site without taking a control radiograph. At the end of surgery, when a radiograph was finally taken, the first implant appeared displaced into the mandible body. The patient suffered total paresthesia on the right lower lip and chin. A flap was raised and bone osteotomies were performed on the lateral side of the mandible to create a rectangular cortical bone window that was removed. The implant was stuck by the second implant placed coronally, and only after unscrewing this second implant was it possible to remove the first one. RESULTS: After 18 months, the patient recovered full sensitivity. CONCLUSIONS: In cases of implant displacement, it is always recommended that appropriate radiographs are performed to visualise where the implants could have been displaced in order to avoid more serious consequences.


Asunto(s)
Implantes Dentales , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Mandíbula , Femenino , Humanos , Persona de Mediana Edad
16.
Eur J Oral Implantol ; 11(1): 11-28, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29557398

RESUMEN

PURPOSE: To compare the clinical outcome of immediately loaded cross-arch maxillary prostheses supported by zygomatic implants vs conventional implants placed in augmented bone. MATERIALS AND METHODS: A total of 71 edentulous patients with severely atrophic maxillas, who did not have sufficient bone volume to place dental implants or when it was possible to place only two implants in the front area (minimal diameter 3.5 mm and length of 8 mm) and less than 4.0 mm of bone height subantrally, were randomised according to a parallel group design. They (35 patients) received zygomatic implants to be loaded immediately vs grafting with a xenograft, followed, after 6 months of graft consolidation, by the placement of six to eight conventional dental implants, submerged for 4 months (36 patients). To be loaded immediately, zygomatic implants had to be inserted with an insertion torque superior to 40 Ncm. Screw-retained, metal-reinforced, acrylic provisional prostheses were provided to be replaced by definitive Procera Implant Bridge Titanium prostheses (Nobel Biocare, Göteborg, Sweden) with ceramic or acrylic veneer materials 4 months after initial loading. Outcome measures were: prosthesis, implant and augmentation failures, any complications, quality of life (OHIP-14), the number of days that patients experienced total or partial impaired activity, time to function, and number of dental visits, assessed by independent assessors. Patients were followed up to 4 months after loading. RESULTS: No augmentation procedure failed. Three patients dropped out from the augmentation group. Six prostheses could not be delivered or failed in the augmentation group vs one prosthesis in the zygomatic group, the difference being statistically significant (difference in proportions = 15.32%; P = 0.04; 95% CI: 0.23 to 31.7). Eight patients lost 35 implants in the augmentation group vs three implants in one patient from the zygomatic group, the difference being statistically significant (difference in proportions = 21.38%; P = 0.001; 95% CI: 3.53 to 39.61). In total, 14 augmented patients were affected by 20 complications vs 26 zygomatic patients (35 complications), the difference being statistically significant (difference in proportions = 31.87%; P = 0.008; 95% CI: 6.48 to 53.37). The OHIP-14 score was 3.68 ± 5.41 for augmented patients and 4.97 ± 5.79 for zygomatic patients, with no statistically significant differences between groups (mean difference = 1.29; 95%CI -1.60 to 4.18; P = 0.439). Both groups had significantly improved OHIP-14 scores from before rehabilitation (P < 0.001 for both augmented and zygomatic patients). The number of days of total infirmity was, on average, 7.42 ± 3.17 for the augmented group and 7.17 ± 1.96 for the zygomatic group, the difference not being statistically significant (mean difference = -0.25; 95% CI: -1.52 to 1.02; P = 0.692). Days of partial infirmity were on average 14.24 ± 4.64 for the augmented group and 12.17 ± 3.82 for the zygomatic group, the difference being statistically significant (mean difference = -2.07; 95% CI: -4.12 to -0.02; P = 0.048). The mean number of days to have a functional prosthesis was 444.32 ± 207.86 for augmented patients and 1.34 ± 2.27 for zygomatic patients, the difference being statistically significant (mean difference = -442.9; 95% CI: -513.10 to -372.86; P < 0.001). The average number of dental visits was 16.79 ± 10.88 for augmented patients and 12.58 ± 5.21 for zygomatic patients, the difference not being statistically significant (mean difference = -4.21; 95% CI -8.48 to 0.06; P = 0.053). CONCLUSIONS: Preliminary 4-months post-loading data suggest zygomatic implants were associated with statistically significantly less prosthetic (one vs six patients) and implant failures (one patient lost three implants versus 35 implants in eight patients) as well as time needed to functional loading (1.3 days vs 444.3 days) when compared with augmentation procedures and conventionally loaded dental implants. Even if more complications were reported for zygomatic implants, which were solved spontaneously or could be handled, zygomatic implants proved to be a better rehabilitation modality for severely atrophic maxillae. Long-term data are essential to confirm or dispute these preliminary results. Conflict of interest statement: This study was originally supported by Nobel Biocare, the manufacturer of the implants, and the provisional and definitive prosthetic components used in this study, which were provided free for the patients. However, before any results were known, Nobel Biocare withdrew the financial support and recruitment had to be stopped. Tecnoss (Giaveno, Torino, Italy) kindly donated the bone substitutes and the membranes, whereas Global D (Brignais, France) donated the osteosynthesis screws. Data property belonged to the authors and by no means did the manufacturers interfere with the publication of the results.


Asunto(s)
Aumento de la Cresta Alveolar/métodos , Implantación Dental Endoósea/métodos , Implantes Dentales , Cigoma/cirugía , Adulto , Anciano , Pérdida de Hueso Alveolar/patología , Pérdida de Hueso Alveolar/cirugía , Atrofia/patología , Atrofia/cirugía , Sustitutos de Huesos/uso terapéutico , Prótesis Dental de Soporte Implantado , Femenino , Xenoinjertos , Humanos , Carga Inmediata del Implante Dental , Arcada Edéntula/rehabilitación , Masculino , Maxilar/patología , Maxilar/cirugía , Persona de Mediana Edad , Calidad de Vida , Resultado del Tratamiento
17.
Eur J Oral Implantol ; 11(1): 31-47, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29557399

RESUMEN

PURPOSE: To evaluate whether 4.0 mm short dental implants could be an alternative to augmentation with xenographs in the maxilla and placement of at least 10.0 mm long implants in posterior atrophic jaws. MATERIALS AND METHODS: A group of 40 patients with atrophic posterior (premolar and molar areas) mandibles with 5.0 mm to 6.0 mm bone height above the mandibular canal and 40 patients with atrophic maxillas having 4.0 mm to 5.0 mm below the maxillary sinus, were randomised according to a parallel group design to receive between one and three 4.0 mm long implants or one to three implants of at least 10.0 mm long in augmented bone, at two centres. All implants had a diameter of 4.0 mm or 4.5 mm. Mandibles were vertically augmented with inter-positional equine bone blocks and resorbable barriers. Implants were placed 4 months after the inter-positional grafting. Maxillary sinuses were augmented with particulated porcine bone via a lateral window covered with resorbable barriers, and implants were placed simultaneously. Implants were not submerged and were loaded after 4 months with provisional screw-retained reinforced acrylic restorations replaced after another 4 months by definitive screw-retained metal-composite prostheses. Patients were followed up to 1 year post-loading. Outcome measures were: prosthesis and implant failures, any complication, and peri-implant marginal bone level changes. RESULTS: Three patients dropped out; one from the maxillary augmented group, one from the mandibular augmented group, and one from the maxillary short implant group. In six augmented mandibles (30%) it was not possible to place implants of at least 10.0 mm, so shorter implants were placed instead. In mandibles, one implant from the augmented group failed vs two 4.0 mm implants in two patients from the short implant group. In maxillae, three short implants failed in two patients vs seven long implants in four patients (two long implants and one short implant dropped into the maxillary sinus). Two prostheses on short implants (one mandibular and one maxillary) were placed at a later stage because of implant failures, vs six prostheses (one mandibular and five maxillary) at augmented sites (one mandibular prosthesis not delivered, three maxillary prostheses delivered with delays, one not delivered, and one failed) at augmented sites. In particular, three patients in the augmented group (one mandible and two maxillae) were not wearing a prosthesis. There were no statistically significant differences in implant failures (P (chi-square test) = 0.693; difference in proportion = 0.03; CI 95% -0.11 to 0.17) or prostheses failures (P (chi-square test) = 0.126; difference in proportion = 0.10; CI 95% -0.03 to 0.24). At mandibular sites, nine augmented patients were affected by complications vs two patients treated with short implants (P (chi-square test) = 0.01; difference in proportion = 0.37; CI 95% 0.11 to 0.63), the difference being statistically significant. No significant differences were found for maxillae: nine sinus-lifted patients vs four short implant patients were affected by complications (P (chi-square test) = 0.091; difference in proportion = 0.25; CI 95% -0.03 to 0.53). At 1-year post-loading, average peri-implant bone loss was 0.51 mm at 4 mm long mandibular implants, 0.77 mm at 10 mm or longer mandibular implants, 0.63 mm at short maxillary implants and 0.72 mm at long maxillary implants. The difference was statistically significant in mandibles (mean difference -0.26 mm, 95% CI -0.39 to -0.13, P (ANCOVA) < 0.001), but not in maxillae (mean difference -0.09 mm, 95% CI -0.24 to 0.05, P (ANCOVA) = 0.196). CONCLUSIONS: One year after loading 4.0 mm long implants achieved similar results, if not better, than longer implants in augmented jaws, but were affected by fewer complications. Short implants might be a preferable choice over bone augmentation, especially in mandibles, since the treatment is less invasive, faster, cheaper, and associated with less morbidity. However, 5 to 10 years post-loading data are necessary before making reliable recommendations.


Asunto(s)
Aumento de la Cresta Alveolar/métodos , Implantación Dental Endoósea/métodos , Implantes Dentales , Adulto , Anciano , Atrofia/patología , Atrofia/cirugía , Trasplante Óseo/métodos , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Femenino , Xenoinjertos , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Resultado del Tratamiento
18.
Eur J Oral Implantol ; 11(1): 49-61, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29557400

RESUMEN

PURPOSE: To evaluate whether 5.0 × 5.0 mm dental implants with a novel nanostructured calcium-incorporated titanium surface could be an alternative to implants of at least 10.0 mm long placed in bone augmented with bone substitutes in posterior atrophic jaws. MATERIALS AND METHODS: Forty patients with atrophic posterior (premolar and molar areas) mandibles with 5.0 mm to 7.0 mm bone height above the mandibular canal, and 40 patients with atrophic maxillas with 4.0 mm to 6.0 mm below the maxillary sinus, were randomised according to a parallel group design to receive between one and three 5.0 mm implants or one to three at least 10.0 mm-long implants in augmented bone at two centres. All implants had a diameter of 5.0 mm. Mandibles were vertically augmented with interpositional bovine bone blocks covered with resorbable barriers. Implants were placed after 4 months. Maxillary sinuses were augmented with particulated porcine bone via a lateral window covered with resorbable barriers, and implants were placed simultaneously. All implants were submerged and loaded after 4 months with provisional prostheses. Four months later, definitive screw-retained or provisionally cement metal-ceramic or zirconia prostheses were delivered. Patients were followed to 3 years post-loading and the outcome measures were: prosthesis and implant failures, any complication, and peri-implant marginal bone level changes. RESULTS: Seven patients dropped out before the 3-year evaluation (two short mandibles, one short maxilla, two augmented mandibles and two augmented maxillae). In mandibles, two grafted patients were not prosthetically rehabilitated because of multiple complications and two implants failed in the same patient (the second was a replacement implant) vs one patient who lost a short implant and crown 2 years after loading. In maxillas one short implant failed with its provisional crown 3 months post-loading. There were no statistically significant differences in prostheses (difference in proportion = 0.001; 95% CI: -0.12 to 0.13; P = 1.000) and implant failures (difference in proportion = 0.00; 95% CI: -0.13 to 0.13; P = 1.000) up to 3 years after loading. Significantly, more complications occurred at mandibular grafted sites: 17 augmented patients were affected by complications vs eight patients treated with short implants in mandibles (difference in proportion = 0.43; 95% CI: 0.13 to 0.64; P = 0.008). In the maxilla, six sinus-lifted patients vs two patients treated with short implants were affected by complications; the difference not being statistically significant (difference in proportion = 0.21; 95% CI: -0.05 to 0.45; P = 0.232). Patients with mandibular short implants lost on average 1.10 mm of peri-implant bone at 3 years and patients with 10.0 mm or longer mandibular implants lost 1.39 mm. Patients with maxillary short implants lost on average 1.04 mm of peri-implant bone at 3 years and patients with 10 mm or longer maxillary implants lost 1.43 mm. Longer implants showed a greater bone loss up to 3 years after loading than short implants both in maxillae (mean difference: -0.39 mm; 95% CI: -0.70 to -0.07 mm; P = 0.017) and in mandibles (mean difference: -0.29 mm; 95% CI: -0.53 to -0.05 mm; P = 0.020). CONCLUSIONS: Three years after loading, 5.0 mm × 5.0 mm implants achieved similar results than longer implants placed in augmented bone. Short implants might be a preferable choice to bone augmentation especially in posterior mandibles since the treatment is faster, cheaper and associated with less morbidity. However, 5- to 10-year post-loading data are necessary before making reliable recommendations.


Asunto(s)
Aumento de la Cresta Alveolar/métodos , Implantación Dental Endoósea/métodos , Implantes Dentales , Prótesis Dental de Soporte Implantado , Adulto , Anciano , Anciano de 80 o más Años , Atrofia/patología , Atrofia/cirugía , Trasplante Óseo/métodos , Calcio , Diseño de Prótesis Dental , Fracaso de la Restauración Dental , Femenino , Xenoinjertos , Humanos , Arcada Parcialmente Edéntula/rehabilitación , Masculino , Mandíbula/patología , Mandíbula/cirugía , Persona de Mediana Edad , Complicaciones Posoperatorias , Elevación del Piso del Seno Maxilar/métodos , Titanio , Resultado del Tratamiento
19.
Eur J Oral Implantol ; 10(4): 391-400, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29234746

RESUMEN

PURPOSE: To evaluate the efficacy of short (5 or 6 mm long) dental implants vs 10 mm or longer implants placed in crestally lifted sinuses. MATERIALS AND METHODS: Twenty partially edentulous patients with 5 to 7 mm of residual crestal height and at least 7 mm thickness below the maxillary sinuses as measured on computed tomography scans were randomised according to a parallel group design to receive either one to two 5 or 6 mm long implants (10 patients) or 10 mm long implants (10 patients) after crestal sinus lifting and grafting with anorganic bovine bone. Implants were left to heal submerged for 4 months and were loaded with reinforced acrylic provisional prostheses, replaced, after 4 months, by definitive provisionally cemented or screw-retained metal-ceramic or metal-composite prostheses. Outcome measures were: prosthesis and implant failures, any complications, radiographic peri-implant marginal bone level changes, and patient's satisfaction assessed by blinded assessors, when possible. All patients were followed up to 3 years after loading. RESULTS: Two patients from the augmented group dropped out after the 1-year follow-up. No implant or prosthesis failure occurred. One short implant patient was affected by two complications vs one complication in the long implant group. There was no difference for patients experiencing complications between the two groups (difference in proportions = -0.03 %; 95%CI: -0.32 to 0.27; P = 1.000). Short implants lost 0.89 ± 0.25 mm and long implants lost 1.08 ± 0.29 mm of peri-implant marginal bone 3 years after loading, the difference between the two groups being not statistically significant (difference = -0.19 mm; 95%CI: -0.46 to 0.09; P = 0.165). All patients were fully or partially satisfied with function and fully satisfied with aesthetics. CONCLUSIONS: Both techniques achieved excellent results and no differences were observed between prostheses supported by one to two 5 or 6 mm long implants vs 10 mm long in posterior atrophic maxillae up to 3 years after loading; therefore it is up to clinicians to decide which procedure to use, although longer follow-ups with larger patient populations are needed to better understand if one of these procedures could be more effective in the long-term. Conflict of interest statement: this study was partially supported by Zimmer Biomet. However, data property belonged to the authors, and by no means did the manufacturer interfere with the conduct of the trial or the publication of its results.


Asunto(s)
Implantes Dentales , Adulto , Anciano , Diseño de Prótesis Dental , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo
20.
Eur J Oral Implantol ; 10(4): 415-424, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29234748

RESUMEN

PURPOSE: To evaluate clinical safety and effectiveness of a novel calcium-incorporated titanium implant (Xpeed, MegaGen Implant Co. Limited, Gyeongbuk, South Korea). MATERIALS AND METHODS: In total, 60 patients were randomised to receive one to six titanium implants in the maxilla with either calcium-incorporated (Xpeed) or control resorbable blasted media (RBM) surfaces, according to a parallel group design at two centres. Implants were submerged and exposed at three different endpoints in equal groups of 20 patients at 12, 10 and 8 weeks, respectively. Within 2 weeks, implants were functionally loaded with provisional or definitive prostheses. Outcome measures were prosthesis failures, implant failures, any complications and peri-implant marginal bone level changes. RESULTS: A total of 30 patients received 45 calcium-incorporated implants and 30 patients were given 42 control titanium implants. Five years after loading, eight patients dropped-out from the Xpeed group and nine left the RBM group. No prosthesis or implant failures occurred. Two patients were affected by three complications in the Xpeed group vs five patients from the RBM group, who experienced eight complications; the difference between groups being not statistically significant different (P = 0.187; difference in proportions = 14.7%; 95% CI: -10.7% to 39.4%). Five years after loading patients with Xpeed implants lost on average 1.19 ± 0.48 mm of peri-implant marginal bone vs 1.43 ± 0.98 mm of patients with RBM implants, the difference being not statistically significant (P = 0.35; mean difference: -0.23 mm; 95% CI: -0.73 to 0.27 mm). CONCLUSIONS: Both implant surfaces provided good clinical results and no significant difference was found when comparing titanium implants with a nanostructured calcium-incorporated surface with implants with an RBM surface. Conflict-of-interest statement: MegaGen partially supported this trial and donated the implants and prosthetic components. The study design was negotiated with MegaGen Implant Co, Gyeongbuk, South Korea, however, data property belonged to the authors and by no means did MegaGen interfere with the conduct of the trial or the publication of its results.


Asunto(s)
Calcio , Carga Inmediata del Implante Dental , Maxilar/cirugía , Nanoestructuras , Titanio , Adulto , Anciano , Anciano de 80 o más Años , Diseño de Prótesis Dental , Femenino , Humanos , Masculino , Persona de Mediana Edad , Método Simple Ciego , Factores de Tiempo
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