Simplified treatment of the atrophic posterior maxilla via immediate/early function and tilted implants: A prospective 1-year clinical study.

BACKGROUND: Posterior maxillae are often difficult to treat owing to the sinus antrum. Placing implants in remaining bone regions in the atrophic maxilla, without performing sinus grafting, is a challenge. Immediate function adds to this challenge. PURPOSE: The purpose of this study was to suggest and evaluate a simplified treatment concept for the rehabilitation of the atrophic maxilla using tilted implants subjected to immediate/early function. MATERIALS AND METHODS: Eighteen patients were included in the study. Sixty implants were placed to support 19 fixed partial or full-arch prostheses. Immediate/early function was applied. The patients were followed for a minimum of 1 year after prosthesis connection. Stability measurements and radiographic evaluation of the change of the marginal bone level were performed. RESULTS: One axial and one tilted implant failed in one patient, giving a cumulative survival rate of 96.7%. No failure of provisional prostheses occurred. The mean marginal bone resorption recorded after 1 year was low (0.82 mm for axial implants and 0.34 mm for tilted implants). CONCLUSION: The results of the present study suggest that tilted implants placed in immediate function may be a viable treatment approach for the rehabilitation of the atrophied maxilla. Simplified treatment procedures, reduced surgical invasion, shorter treatment time, and reduced costs constitute some of the benefits for the patient and the clinician.

Immediate functional loading of Brånemark System implants with enhanced initial stability: a prospective 1- to 2-year clinical and radiographic study.

BACKGROUND: The interest in the benefits of immediate loading of titanium implants has recently involved fixed prostheses for partially edentulous areas. The advantages of this approach well justify the need for extending the procedure to all regions of the mouth. Current available clinical literature on this subject is incomplete. PURPOSE: The purpose of this study is to investigate the clinical outcome of the immediate loading of Brånemark System implants (Nobel Biocare AB, Gothenburg, Sweden) inserted with enhanced initial stability principally in posterior sites (78%). MATERIALS AND METHODS: The present study was conducted in 26 consecutively treated patients. A total of 50 Brånemark System machined surface implants were placed supporting 30 fixed temporary partial dentures in light occlusion. All implants were followed up for a minimum of 1 year of function. Minimum requirements for immediate loading were proposed. Bone quality and quantity were classified according to Lekholm and Zarb's criteria. Stability of the marginal bone level, both mesial and distal, was measured on the basis of radiographic analysis. Implant survival rate was calculated according to Kaplan-Meier analysis. The peak insertion torque employed during fixture placement was between 40 and 72 Ncm, except in the case of one implant that was lost. RESULTS: Overall survival rate was 98%. An unpaired t-test revealed bone remodeling conforming to biologic width establishment (p <.005). CONCLUSIONS: Within the limit of this study, immediate loading appears to be a viable procedure in posterior sites and for a growing number of clinical indications. Enhanced implant stability and light occlusion seem to be security factors. In spite of unfavorable conditions such as the presence of quality 4 bone and a lack of splinting, all implants with enhanced primary stability survived.

Immediate occlusal loading of single lower molars using Brånemark System Wide-Platform TiUnite implants: an interim report of a prospective open-ended clinical multicenter study.

BACKGROUND: First and second molars in the lower jaw are the most commonly missing teeth. As in other jaw regions with tooth loss, implant therapy is an attractive concept. Owing to the wide dimension of the molar teeth, wide implants seem to be a natural choice. However, wide implants in posterior mandibular regions sometimes present a problem. As an oxidized surface seems to facilitate implant integration and to result in a stronger fixation to bone, it was hypothesized that this surface would improve the performance of wide implants in posterior mandibles. As high initial stability most often is achieved in this region, it was hypothesized that the load per se is not a problem. PURPOSE: The purpose of the present study is to evaluate immediate loading of Brånemark System TiUnite Wide-Platform implants (Nobel Biocare AB, Gothenburg, Sweden) supporting single molar crowns in the lower jaw. MATERIALS AND METHODS: The study includes 44 patients treated in three separate private dental offices between March 2001 and June 2002. A total of 50 implants were placed, and all implants have passed the 6-month follow-up; 24 have been followed up for 1 year. All implants were provided with provisional crowns in centric occlusion at the time of surgery. RESULTS: No implant has been lost. Marginal bone levels were found in accordance with normal biologic width requirements. Resonance frequency analysis showed high and consistent implant stability. No biomechanical problems were found associated with the use of wide implants, and the potential physiologic problem in dense mandibular bone was eliminated. CONCLUSION: Although limited by being a short-term study, the result encourages immediate loading of single Brånemark System TiUnite Wide-Platform implants placed in the molar regions in the lower jaw.

Immediate occlusal loading of single lower molars using Brånemark System® Wide Platform TiUnite™ implants: a 5-year follow-up report of a prospective clinical multicenter study.

INTRODUCTION: Although not essential, molars hold their importance in terms of functional jaw stability, antagonist opposition, and support of facial height. Therefore, implant therapy is an attractive concept in molar areas. However, especially in the posterior mandible, the conventional two-stage surgical approach to implant therapy was reported to cause higher bone loss and/or higher implant failures with machined implants because of the peculiar anatomic and physiologic conditions of this area. As the TiUnite™ (Nobel Biocare AB, Göteborg, Sweden) surface results in faster bone healing than with machined-surface implants, it was hypothesized that this surface would also improve the performance of wide implants in posterior mandibles. Based on these assumptions, a protocol for immediately loaded implants for single molar replacement was developed. PURPOSE: This paper aimed to report on the clinical and radiological performance of Brånemark System® TiUnite Wide Platform implants supporting single molars in the lower jaw, loaded immediately and followed for up to 5 years, and to assess if the benefit delivered by oxidized surfaces in the short run is also present after 5 years. MATERIALS AND METHODS: The study includes 33 consecutive patients treated between March 2001 and September 2003 and monitored until September 2008 in two private dental offices. A total of 40 Brånemark System TiUnite Wide Platform MK III implants were placed. All implants were provided with provisional crowns in full centric occlusion at the time of surgery. Patients were clinically and radiologically followed up for up to 5 years. RESULTS: Two implant failed so that the cumulative success rate at 5 years was 95.0%. The mean marginal bone remodeling (n = 38) expressed as mesial plus distal value averages was -1.17 mm (SD ± 0.90) at the 5-year time point. CONCLUSION: Although limited by the number of patients treated in accordance with the protocol described, 5-year results encourage the use of immediately loaded single lower molars supported by Brånemark System Wide Platform TiUnite implants and further document the clinical advantages of titanium oxidized surfaces.