Survival Rates of 8-mm or Shorter Tissue-Level Implants in Function for Up to 228 Months.

PURPOSE: Advances in surface technology and the understanding of the capabilities of osseointegrating implants have led to the use of shorter implants in a variety of clinical situations. Such implant use offers a number of potential advantages in the posterior maxilla and mandible. The purpose of this retrospective study was to examine the success rates of shorter, tissue-level implants in function for at least 60 months. MATERIALS AND METHODS: A retrospective study was conducted of all patients treated between January 1, 1998, and December 31, 2012, who received tissue-level endosseous implants 8 mm or less in length, which were restored with abutments and single crowns. Patient age, sex, location of implants, and diameter of implants were examined. Time in function and stability of peri-implant crestal bone were assessed. RESULTS: The retrospective analysis identified 4,251 tissue-level implants that were restored with single abutments and crowns. These implants were followed for up to 228 months in function, with a mean time in function of 127.2 months. Implant success was assessed using commonly utilized metrics combined with bone sounding on the midbuccal and midlingual/palatal aspects of the implants. The cumulative success rate was 99.5% for all implants. In the posterior mandible, the success rate for regular-neck implants was 99.3% (n = 680, mean time in function: 136.5 months) and was 99.7% for wideneck implants (n = 2,320, mean time in function: 124.5 months). In the posterior maxilla, the success rate for regular-neck implants was 97.8% (n = 211, mean time in function: 169.1 months), and for wide-neck implants, it was 99.2% (n = 1,040, mean time in function: 127.8 months). CONCLUSION: The use of shorter (8 mm or less in length) tissue-level implants in the maxilla and mandible, restored with single abutments and crowns, offers a viable treatment option, assuming specific criteria and protocols are followed. These criteria and protocols are discussed.

Success and Failure Rates of 1,344 6- to 9-mm-Length Rough-Surface Implants Placed at the Time of Transalveolar Sinus Elevations, Restored with Single Crowns, and Followed for 60 to 229 Months in Function.

PURPOSE: To assess the success and stability of 6-, 7-, 8-, and 9-mm-long, 6.5-mm-wide-neck tissue-level implants placed at the time of transalveolar sinus augmentation therapy, utilizing a trephine and osteotome approach, which were restored with single crowns. MATERIALS AND METHODS: In total, 1,344 implants were placed by the author, varying in length from 6 to 9 mm, with parallel-wall 4.8-mm-diameter implant bodies and 6.5-mm-diameter implant necks. The implants were restored with single abutments and crowns by a variety of practitioners. They were followed for 60 to 229 months in function, with a mean time of 121.1 months in function. Implant success was evaluated by the author utilizing a combination of the Albrektsson et al criteria, and buccal and palatal/lingual bone sounding under anesthesia. RESULTS: The overall cumulative success rate was 98.8%. One hundred ninety 6-mm-long implants demonstrated a cumulative success rate of 97.5% at a mean time of 109.2 months in function. Eleven 7-mm-long implants demonstrated a cumulative success rate of 100% at a mean time of 218.5 months in function. One thousand ninety-four 8-mm-long implants demonstrated a cumulative success rate of 98.9% at a mean time of 112.3 months in function. Forty-nine 9-mm-long implants demonstrated a cumulative success rate of 100% at a mean time of 212.1 months in function. CONCLUSION: Implants of 6 to 9 mm in length, placed at the time of trephine and osteotome transalveolar sinus elevation procedures and restored with abutments and single crowns, demonstrate a high level of long-term clinical success, assuming specific comprehensive treatment criteria are met.

Immediate implant placement in posterior areas: the mandibular arch.

When contemplating removal of a premolar or molar and its immediate replacement with an implant-supported prosthesis, the feasibility of other potentially less "aggressive" treatment approaches must first be considered. Treatment decisions must be made in the context of an appropriate definition of therapeutic success. Replacement of hopeless mandibular molars with implant restorations has undergone significant evolution since the introduction of osseointegrated implants some 30 years ago. Over the past decade, various treatment approaches have been advocated. This article discusses these approaches and other considerations needed for implant placement at the time of mandibular molar extraction.

A retrospective analysis of implants immediately placed in sites with and without periapical pathology in sixty-four patients.

BACKGROUND: Many patients requiring implant therapy present with hopeless teeth exhibiting periapical pathology. The advisability of implant placement in such situations has not been conclusively determined. METHODS: Sixty-four patients underwent therapy in their maxillary incisor region. Treatment consisted of immediate implant placement in a site demonstrating periapical pathology, and immediate implant placement in a "pristine" site, either during the same visit or during separate visits. The implants placed in the sites demonstrating periapical pathology were followed in function for ≤117 months, with a mean time in function of 64 months. The implants placed in pristine sites were followed in function for ≤120 months, with a mean time in function of 62 months. RESULTS: Two implants in the central incisor positions of one patient demonstrated 2 mm of buccal recession after ≈46 months in function. These implants were deemed esthetic failures, despite the absence of inflammation and continued clinical implant immobility, yielding cumulative survival rates of 98.1 and 98.2 for implants placed in sites with periapical pathology and implants placed in sites without periapical pathology, respectively, according to published criteria. CONCLUSIONS: Implants immediately placed in sites demonstrating periapical pathology yielded results comparable to those immediately placed in pristine sites. The difference in survival rates was not statistically significant.

Evidence-based decision making: replacement of the single missing tooth.

Single-tooth replacement may be effected through various methods, including the use of a resin-bonded fixed partial denture, a conventional fixed partial denture, and a single implant-supported crown. Although the introduction of newer therapeutic modalities, surgical and restorative techniques, and restorative materials has significantly expanded available treatment options, a greater demand is now placed on the diagnostic and treatment planning acumen of the clinician. The questions confronting each clinician are when to apply each treatment modality and how to use these therapeutic approaches to their maximum benefit for the patient. This article focuses on the factors that should be considered when making such clinical decisions and offers a framework within which to formulate appropriate treatment algorithms.

Shorter implants in clinical practice: rationale and treatment results.

INTRODUCTION: The use of shorter implants offers a number of potential advantages if such utilization yields the same level of treatment success as the use of longer implants. The purpose of this retrospective study was to assess the survival of short implants in various clinical situations in function over time. MATERIALS AND METHODS: A retrospective study was conducted of all patients treated between May 2000 and May 2007 who received endosseous implants that were less than 10 mm in length. Patient age, gender, location of implants, type of prosthesis, time in function, and stability of peri-implant crestal bone were assessed. RESULTS: The retrospective analysis identified 2,073 implants of 6 mm, 7 mm, 8 mm, or 9 mm in length placed in a variety of clinical situations in 1,774 patients. Cumulative implant survival rates for implants in function in various areas of the mouth supporting single crowns or short-span fixed prostheses ranged from 98.1% to 99.7%. Each indication was examined with regard to individual success and failure rates and mean time in function. CONCLUSIONS: When utilized appropriately, implants of 6 to 9 mm in length demonstrate cumulative survival rates under function comparable to those reported for longer implants.

Implant placement at the time of mandibular molar extraction: description of technique and preliminary results of 341 cases.

BACKGROUND: Theoretically, the ability to place implants in ideal positions at the time of mandibular molar extraction with concomitant regenerative therapy would simplify and shorten the course of therapy for patients. METHODS: A total of 341 implants were placed in 320 individuals at the time of mandibular molar hemisection and extraction. Concomitant regenerative therapy was performed around 332 of the placed implants. No regenerative therapy was performed around the remaining nine implants. Eleven additional sites, in which simultaneous implant placement was planned, were treated instead with regenerative therapy alone using graft material and a covering membrane. Implants were placed in these sites in subsequent surgical visits. RESULTS: One implant was mobile 3 weeks postinsertion. A second implant was lost after 30 months in function. All other implants were stable at the time of uncovery 3 to 7 months postinsertion. A total of 339 implants have been in function for up to 6 years, with a mean time in function of 30.8 months, yielding a cumulative survival rate of 99.1%. CONCLUSION: Implants may be placed in ideal restorative positions at the time of mandibular molar extraction with or without concomitant regenerative therapy.

Implant placement at the time of maxillary molar extraction: treatment protocols and report of results.

BACKGROUND: Implant placement at the time of maxillary molar extraction presents a number of potential benefits to patients. A technique to predictably attain implant placement in ideal positions was reported previously. METHODS: A total of 391 rough-surface implants were placed in 386 patients at the time of maxillary molar extraction. Concomitant regenerative therapy was performed as necessary. Implants were followed for up to 75 months with a mean follow-up of 40.3 months. RESULTS: A total of 389 of 391 implants were functioning successfully for up to 75 months with a cumulative survival rate of 99.5%. Criteria for determining implant morphology and dimension are presented. CONCLUSION: Implant placement at the time of maxillary molar extraction with concomitant regenerative therapy as needed and subsequent restoration is a predictable treatment modality.

Report of 1633 implants in 814 augmented sinus areas in function for up to 180 months.

PURPOSE: The long-term success of implants functioning in sinuses augmented with a variety of materials were evaluated in 2 private practices. MATERIALS: Treatment outcomes of 1814 augmented sinuses, and subsequent placement of 1633 implants into 763 augmented sinuses, were assessed through clinical and radiographic examinations in 2 private practices. Statistical analysis was carried out utilizing the analysis of variance method and step-wise linear regression at P < 0.001. RESULTS: Eight hundred fourteen sinus augmentation procedures were performed. Eight hundred six sinus augmentation procedures were deemed successful (99.0%), as defined by implants functioning successfully in the augmented sinus areas. A variety of augmentation materials were utilized to effect sinus augmentation. Of the 1633 implants placed in augmented sinuses, 1613 were functioning successfully, yielding an accumulate success rate and function of 98.1%. The mean implant time in function was 69.1 months. The longest functioning implants had been in function for 180 months. DISCUSSION: The results, from 2 private offices in conjunction with numerous restorative clinicians, utilizing a variety of augmentation materials and implants, were comparable to those reported by other authors. The clinical predictability of sinus augmentation therapy and of implants functioning in augmented sinuses were reinforced. CONCLUSION: Predictable sinus augmentation therapy may be obtained through the use of a variety of regenerative materials. Titanium implants of various configurations and surface topographies will function successfully in augmented sinuses over time.

Immediate implant therapy in clinical practice: single-tooth replacement.

Once viewed as an esoteric treatment option, implant therapy has demonstrated long-term predictability at least equal to that of more "conventional" treatment modalities. The continued evolution of implant surface technology and restorative options has made implant therapy the treatment modality of choice in many if not most, clinical situations. It is, therefore, only natural that the role of immediate implant therapy continues to expand. Proponents of immediate implant therapy advocate its use at the time of tooth removal or, in a partially or fully edentulous arch, to meet a variety of clinical challenges.

Implant placement with or without simultaneous tooth extraction in patients taking oral bisphosphonates: postoperative healing, early follow-up, and the incidence of complications in two private practices.

BACKGROUND: The development of bisphosphonate-associated osteonecrosis in patients with a history of intravenous bisphosphonate therapy is a significant cause of concern in clinical periodontal practice. The role of oral bisphosphonates in the development of bisphosphonate-associated osteonecrosis is less clear. This article documents the results of treatment of patients with a history of oral bisphosphonate therapy in two private periodontal practices. The study was a retrospective analysis of case records of patients treated as part of routine periodontal and implant treatment. METHODS: Patients with a history of oral bisphosphonate therapy of various durations were treated with implant placement and restoration or tooth extraction, immediate placement, and restoration. These patients were followed for 12 to 24 months after implant placement. The incidence of hard and soft tissue complications, including the development of osteonecrosis, was noted. RESULTS: No osteonecrosis was noted immediately postoperatively or during the follow-up period in 61 patients. One patient demonstrated a small tissue dehiscence at the 1-week postoperative examination following extraction of a mandibular first molar and simultaneous implant placement in the area of a prominent torus. No other postoperative complications were noted. All implants were functioning successfully by the Albrektsson criteria 12 to 24 months post-insertion. CONCLUSIONS: A history of oral bisphosphonate use for a mean period of 3.3 years (range, 1 to 5 years) was not found to be a contributing factor to the development of osteonecrosis following implant placement in intact ridges or tooth extraction with immediate implant placement. However, there is no doubt that larger controlled studies and retrospective reports are needed.

Maintaining primary closure after guided bone regeneration procedures: introduction of a new flap design and preliminary results.

BACKGROUND: Various flap designs have been proposed by numerous authors for the maintenance of passive primary soft tissue closures following guided bone regeneration (GBR) procedures. A previous publication by the present author documented the maintenance of passive soft tissue primary closures 96.1% of the time at least 6 months after GBR therapy in all areas of the mouth. Although seemingly impressive, a 96.1% success rate means that there is premature membrane exposure 3.9% of the time. A new flap design is introduced for use in conjunction with previously described flap designs to lessen the incidence of premature membrane exposure. METHODS: A total of 173 sites treated with GBR therapy were examined up to 6 months postoperatively to assess the ability to maintain passive soft tissue primary closure. Any membrane exposure during this 6-month postoperative period was deemed a failure, even if the site was successfully treated with an implant placement and restoration. RESULTS: A total of 171 of 173 GBR-treated sites demonstrated the maintenance of a soft tissue passive primary closure 6 months postoperatively, yielding a success rate of 98.8%. CONCLUSION: The introduction of the proposed flap design for use in conjunction with previously described flap designs significantly reduced the incidence of premature membrane exposure after a variety of GBR procedures.

Implant placement at the time of maxillary molar extraction: technique and report of preliminary results of 83 sites.

BACKGROUND: The purpose of this study was to evaluate the predictability of implant placement at the time of maxillary molar extraction using a modified insertion technique and implant design. METHODS: At the time of maxillary molar extraction, 83 tapered-end implants with an apical diameter of 4.1 mm and a neck diameter of 6.5 mm were placed in maxillary first or second molar sites, following manipulation of the remaining interradicular bone with osteotomes. Regenerative materials, consisting of demineralized freeze-dried bone allograft (DFDBA) and/or osseous coagulum, and bioabsorbable or non-resorbable membranes were placed, and passive soft-tissue primary closure was attained in all cases. RESULTS: Soft-tissue closure was maintained until the time of clinical reentry 6 months after implant insertion in 81 of 83 sites. Loss of primary soft-tissue closure in the other two areas did not result in complete uncovering of the cover screw and implant top. All implants were clinically immobile at the time of implant uncovery 6 months after insertion and were restored with single crowns. All implants were functioning successfully for up to 18 months (mean: 12.4 months). CONCLUSION: The combination of atraumatic removal of hopeless maxillary molars, controlled manipulation of the residual interradicular bone, insertion of implants of the aforementioned design, and use of appropriate regenerative materials at the time of implant insertion predictably afforded a stable implant for restoration with a single crown.