European Journal Of Oral Implantology[JOURNAL]
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200 papers
Extra-short (< 7 mm) and extra-narrow diameter (< 3.5 mm) implants: a meta-analytic literature review.
Pommer B, Mailath-Pokorny G, Haas R … +3 more , Buseniechner D, Millesi W, Fürhauser R
Eur J Oral Implantol · 2018 · PMID 30109305
AIM: To review available evidence in scientific literature on oral implants of severely reduced length or diameter. MATERIALS AND METHODS: Electronic and hand searches up to May 2017 were performed in order to identify c...
AIM: To review available evidence in scientific literature on oral implants of severely reduced length or diameter. MATERIALS AND METHODS: Electronic and hand searches up to May 2017 were performed in order to identify clinical investigations providing implant survival and/or marginal bone resorption data for extra-short implants < 7.0 mm in length and extra-narrow implants < 3.5 mm in diameter (excluding one-piece mini-implants). RESULTS: A total of 2929 extra-short implants and 3048 extra-narrow diameter implants were investigated in 53 and 29 clinical studies, respectively. Shorter implants between 4.0 mm and 5.4 mm in length showed comparable results to implant lengths of 5.5 mm to 6.5 mm (95.1% vs. 96.4%, P = 0.121) and no difference regarding marginal bone resorption (0.7 mm vs 0.5 mm, P = 0.086). Implant lengths of 5.5 mm to 6.5 mm, however, performed significantly better in the mandible compared with the maxilla (P = 0.010). Smaller diameters between 3.0 mm and 3.25 mm yielded a significantly lower survival rate of 94.3% than wider implants of 3.3 mm to 3.4 mm diameter (97.7%, P < 0.001), while marginal bone resorption did not differ (0.4 mm vs 0.5 mm, P = 0.447). CONCLUSIONS: The results of the present literature review suggest that extra-short and extra-narrow-diameter implants show satisfactory survival rates of around 95% and little marginal bone resorption of around 0.5 mm after a mean follow-up of 3 years. However, implant lengths < 7 mm in the maxilla and < 5.5 mm in the mandible as well as diameters < 3.3 mm may increase early failure rates.
Long-term clinical outcome of implants with different surface modifications.
Wennerberg A, Albrektsson T, Chrcanovic B
Eur J Oral Implantol · 2018 · PMID 30109304
The aim of the present systematic review was to evaluate reported survival rate and marginal bone (MBL) loss of implants with different surface roughness and followed up for 10 years or longer. For the majority of the 62...
The aim of the present systematic review was to evaluate reported survival rate and marginal bone (MBL) loss of implants with different surface roughness and followed up for 10 years or longer. For the majority of the 62 included clinical studies, no direct comparison between different surfaces was made, thus our report is mainly based on reported survival rates and marginal bone loss for individual implant brands with known surface roughness. The survival rate was 82.9 to 100% for all implants after 10 or more years in function and the marginal bone loss was, on average, less than 2.0 mm for all implant surfaces included, i.e. turned, titanium plasma sprayed (TPS), blasted, anodised, blasted and acid-etched but the turned surface in general demonstrated the smallest MBL. However, the survival rates were in general higher for moderately rough surfaces. The roughest TPS surface demonstrated the highest probability for failure, while the anodised showed the lowest probability. In conclusion, the present systematic review demonstrates that it is possible to achieve very good long-term results with all types of included surfaces.
Impact of asepsis technique on implant success. A review.
Veitz-Keenan A, Ferraiolo DM, Keenan JR
Eur J Oral Implantol · 2018 · PMID 30109303
Asepsis is described as a state free from microorganisms. In medicine, an aseptic environment is necessary and expected to avoid the spread of infection through contact between persons, sprays and splashes, inhalation, a...
Asepsis is described as a state free from microorganisms. In medicine, an aseptic environment is necessary and expected to avoid the spread of infection through contact between persons, sprays and splashes, inhalation, and sharps. Most dental procedures are performed in a "clean "environment with the common use of personal protective equipment (PPE) such as disposable gloves, masks and protective eyewear with disinfection of surfaces and sterilization of instruments. For surgical procedure such as the insertion of endosseous implants, the recommendations are not clear. The use of antimicrobials and antibiotics before and after the procedure remains a controversial issue The purpose of this literature review is to evaluate the current evidence as to what is generally expected and widely accepted in the use of aseptic techniques for the surgical placement of endosseous implants, and the impact on implant survival and overall success.
Oral implant survival in patients with bisphosphonate (BP)/antiresorptive and radiation therapy and their impact on osteonecrosis of the jaws. A systematic review.
Schmitt CM, Buchbender M, Lutz R … +1 more , Neukam FW
Eur J Oral Implantol · 2018 · PMID 30109302
AIM: In this systematic review, we aimed to assess the impact of endosseous implants on the formation of an osteonecrosis of the jaw, as well as implant survival rates for patients under bisphosphonate (BP), antiresorpti...
AIM: In this systematic review, we aimed to assess the impact of endosseous implants on the formation of an osteonecrosis of the jaw, as well as implant survival rates for patients under bisphosphonate (BP), antiresorptive and radiation therapy. MATERIALS AND METHODS: An electronic search was performed using PubMed, Embase, and Medline databases with the logical operators: "dental implant", "antiresorptive", "bisphosphonate", "irradiation", "radiotherapy", "radiation", "necrosis" and "survival". The search was limited to articles published up to 15 December 2016. Recent publications were also searched manually to find any relevant studies that might have been missed using the search criteria noted above. The outcome variables were the implant survival rate and the frequency of osteonecrosis of the jaws. RESULTS: In total, 18 studies addressing oral implants in patients with BP or antiresorptive therapy and 23 with radiation therapy met the inclusion criteria and were included in this systematic review. Most of the studies had a retrospective design with a level of evidence (LoE) of III (moderately high risk of bias). Implant survival rate ranged from 92.86% to 100% in patients with BP/antiresorptive therapy (all due to osteoporosis) and 38.5% to 97.9% in patients with radiation therapy. For BP patients, osteonecrosis in relation to oral implants more frequently occurred in patients taking BPs due to malignant diseases. In patients with radiation therapy, an "implant triggered" necrosis is also a potential complication. The lack of data in the current literature concerning this issue does not allow a proper risk assessment to date. CONCLUSIONS: Within the limits of this systematic review, implant treatment concepts seem to be a valuable approach in patients with radiation therapy and patients with BP therapy due to an osteoporosis. In patients taking BPs due to a malignant disease, implant treatments are not recommended due to the high number of reported implant-related necrosis in this patient cohort. Outcomes of this review should, however, be regarded with caution due to the low level of evidence of the currently existing data.
CBCT vs other imaging modalities to assess peri-implant bone and diagnose complications: a systematic review.
Jacobs R, Vranckx M, Vanderstuyft T … +2 more , Quirynen M, Salmon B
Eur J Oral Implantol · 2018 · PMID 30109301
AIM: The objective of this systematic review was to evaluate the diagnostic value of CBCT compared with 2D imaging and clinical gold standard techniques in peri-implant bone defect detection and measurement. MATERIALS AN...
AIM: The objective of this systematic review was to evaluate the diagnostic value of CBCT compared with 2D imaging and clinical gold standard techniques in peri-implant bone defect detection and measurement. MATERIALS AND METHODS: Literature search was performed using MEDLINE, Embase and Web of Science databases up to July 2017. Clinical, ex vivo, in vitro and animal studies that assessed and measured peri-implant bone defects using different imaging modalities were included in this review. Two reviewers performed data extraction and qualitative analysis. The methodological quality of each study was reviewed using the QUADAS-2 tool. RESULTS: The initial search revealed 2849 unique papers. Full-text analysis was performed on 60 articles. For the present review, nine studies were considered eligible to be included for qualitative analysis. CBCT performed similar to intraoral radiography in mesiodistal defect detection and measurements. Additional buccolingual visualisation and volumetric and morphological assessment of peri-implant bone defects are major advantages of 3D visualisation with CBCT. Nevertheless, one must be aware of metal artefacts masking osseointegration, shallow bony defects and other peri-implant radiolucencies, thus impeding early diagnosis of intrabony lesions. CONCLUSIONS: The present review did not provide evidence to support the use of CBCT as standard postoperative procedure to evaluate peri-implant bone. Up to date, we are clinically forced to remain with intraoral radiography, notwithstanding the inherent limitations related to restricted field of view and two-dimensional overlap. A 3D imaging approach for postoperative implant evaluation is crucial, making further development of an optimised and artefact-free CBCT protocol indispensable.
Patients' expectations of oral implants: a systematic review.
Korfage A, Raghoebar GM, Meijer HJA … +1 more , Vissink A
Eur J Oral Implantol · 2018 · PMID 30109300
AIM: Nowadays, oral implants are a leading concept in oral rehabilitation. Patient satisfaction with this treatment is high, but are the expectations of the patients met? The aim of this review was to systematically scre...
AIM: Nowadays, oral implants are a leading concept in oral rehabilitation. Patient satisfaction with this treatment is high, but are the expectations of the patients met? The aim of this review was to systematically screen the literature on patients' expectations of implant-based therapy before treatment and to assess whether these expectations were being met. MATERIALS AND METHODS: A search strategy was developed for manuscripts dealing with patients' expectations of implant-based therapy to support different types of prosthodontics. Patients had an indication for implants, were seeking implants or had received implants. PubMed/MEDLINE, Ovid/EMBASE and Cochrane/CENTRAL were searched to identify eligible studies. Two reviewers independently assessed the articles. RESULTS: In total, 16 out of 3312 studies assessing patients' expectations of patients before implant-based therapy matched the inclusion criteria. A variety of methods were used in the studies. Patients had high expectations, with function followed by aesthetics being the most important expected improvements. Women had higher expectations than men. Costs were a major factor against implant-based therapy. The expectations that implants will last a lifetime and require no special needs of oral hygiene were of concern. CONCLUSION: Prior to treatment, patients have high expectations of implant therapy. In general, these expectations are met. Most studies revealed that women have higher expectations than men. The variety of applied study designs impaired comparability of results. Thus, standardised methods for measuring expectations of implant-based therapy are eagerly needed.
A review of the outcome of dental implant provision in individuals with movement disorders.
Packer ME
Eur J Oral Implantol · 2018 · PMID 30109299
UNLABELLED: Movement disorders encompass a wide range of medical conditions that demonstrate changes to muscle function and tone which present with orofacial dyskinesia and dystonia. The most common conditions exhibiting...
UNLABELLED: Movement disorders encompass a wide range of medical conditions that demonstrate changes to muscle function and tone which present with orofacial dyskinesia and dystonia. The most common conditions exhibiting these features are Parkinson's disease, Down syndrome, chorea and epilepsy. AIM: To establish whether implant success in patients suffering from movement disorders is similar to the general population, identifying risk factors and noting recommendations that may aid maintenance programmes. METHOD: PubMed and Medline searches, combined with a manual search of the reference lists of identified full text studies. In total, 19 patient case reports and 11 patient case series were identified for inclusion in the review. RESULTS: Implant survival in patients may be less than expected in patients with movement disorders, but evidence points to early rather than late failures. Oral hygiene control was widely reported as an issue, although there was insufficient evidence to imply that a lack of oral care will cause more rapid deterioration in implant patients with movement disorders. Maintenance requirements were low for fixed restorations, but more frequently reported in patients treated with overdentures, with the attachment mechanism and the prostheses requiring replacement. Chewing and quality of life in relation to prosthesis wear were improved. CONCLUSION: Provision of implant-supported prostheses improves chewing and quality of life for patients with movement disorders and should be considered as an option in the treatment planning for tooth loss in this group of patients. However, straightforward designs that lend themselves to easier long-term maintenance should be adopted.
Foreign body reactions, marginal bone loss and allergies in relation to titanium implants.
Albrektsson T, Chrcanovic B, Mölne J … +1 more , Wennerberg A
Eur J Oral Implantol · 2018 · PMID 30109298
AIM: To describe general observations of immunological reactions to foreign materials and to realize that CP titanium gives rise to a foreign body reaction with subsequent bone embedment when placed as oral implants. To...
AIM: To describe general observations of immunological reactions to foreign materials and to realize that CP titanium gives rise to a foreign body reaction with subsequent bone embedment when placed as oral implants. To analyse the possibility of titanium allergy. MATERIALS AND METHODS: The present paper is of a narrative review type. Hand and Medline searches were performed to evaluate marginal bone loss of oral implants and the potential of titanium allergy. RESULTS: Immunological reactions to foreign substances include Type I hypersensitivity reactions such as allergy, Type II hypersensitivity reactions characterised by IgM or IgG antibodies that may react with blood group antigens at transfusion, and Type III hypersensitivity caused by antigen-antibody immune complexes exemplified by acute serum sickness. There is also Type IV hypersensitivity, or delayed hypersensitivity, which is typically found in drug and foreign body reactions. It proved very difficult to find a universally acceptable definition of reasons for marginal bone loss around oral implants, which lead to most varying figures of so-called peri-implantitis being 1% to 2% in some 10-year follow-up papers to between 28% and 56% of all placed implants in other papers. It was recognised that bone resorption to oral as well as orthopaedic implants may be due to immunological reactions. Today, osseointegration is seen as an immune-modulated inflammatory process where the immune system is locally either up- or downregulated. Titanium implant allergy is a rare condition, if it exists. The authors found only two papers presenting strong evidence of allergy to CP titanium, but with the lack of universally accepted and tested patch tests, the precise diagnosis is difficult. CONCLUSIONS: CP titanium acts as a foreign body when placed in live tissues. There may be immunological reasons behind marginal bone loss. Titanium allergy may exist in rare cases, but there is a lack of properly designed and analysed patch tests at present.
Prosthetic complications with implant prostheses (2001-2017).
Goodacre BJ, Goodacre SE, Goodacre CJ
Eur J Oral Implantol · 2018 · PMID 30109297
AIM: To present recent data regarding prosthetic complications with implant prostheses and crowns as well as compare this data with data presented in a 2003 publication. MATERIAL AND METHODS: An electronic Medline (PubMe...
AIM: To present recent data regarding prosthetic complications with implant prostheses and crowns as well as compare this data with data presented in a 2003 publication. MATERIAL AND METHODS: An electronic Medline (PubMed) with MeSH terms search was performed, focussing on clinical studies that reported data on prosthetic complications associated with implant fixed complete dentures, implant overdentures, implant fixed partial dentures, and implant single crowns. RESULTS: There were nine prosthetic complications reported with implant fixed complete dentures, 17 with implant overdentures, four with implant fixed partial dentures, and six with implant single crowns. The greatest number of complications and the largest incidence of percentages occurred with implant overdentures. The lowest incidence percentages were recorded for implant single crowns. These findings are in agreement with the previous 2003 publication. It is of interest to note that some of the complications reported previously were not reported in this review, and some complications reported in this review were not listed in the 2003 publication, thereby limiting the number of direct comparisons between this paper and the earlier report. A surprising finding was that some complications associated with implant overdentures from the current data exceeded the incidence in 2003 (reactivation of the retentive attachment; mucosal hyperplasia; and the need for overdenture relines). CONCLUSIONS: Implant overdentures are associated with more complications than implant fixed complete dentures, implant fixed partial dentures, and implant single crowns. The lowest incidence of complications was reported with implant single crowns. The most common complication reported with implant fixed complete dentures was denture tooth fracture. The most common complication associated with implant overdentures was the need for adjustments. Porcelain veneer fracture/chipping was the most common complication identified in the studies of implant fixed partial dentures. The most common complication reported with implant single crowns was abutment screw loosening.
Diagnosis, avoidance and management of complications of implant-based treatments.
Lutz R, Schmitt C, Buchbender M … +1 more , Neukam FW
Eur J Oral Implantol · 2018 · PMID 30109296
This review provides an overview of review and consensus articles of the past 5 years regarding surgical complications in implant dentistry. The focus in this article is on surgical complications occurring after implant...
This review provides an overview of review and consensus articles of the past 5 years regarding surgical complications in implant dentistry. The focus in this article is on surgical complications occurring after implant insertion and on risk factors that compromise oral implant osseointegration.
Diagnosis, avoidance and management of complications of implant-based treatments.
van Steenberghe D
Eur J Oral Implantol · 2018 · PMID 30109295
"If terms be incorrect, then statements do not accord with facts". (Confucius) "Words form the thread on which we string our experiences". (Aldous Huxley) Semantics is a term coined by Michel Bréal (1832 to 1915) a Jewis...
"If terms be incorrect, then statements do not accord with facts". (Confucius) "Words form the thread on which we string our experiences". (Aldous Huxley) Semantics is a term coined by Michel Bréal (1832 to 1915) a Jewish German-French linguist referring to the Greek semantikos (= meaning) in his 1897 book, "Essai de sémantique". He was a very gifted man: for example, he was the one who suggested to Pierre de Coubertin to include the marathon in the Olympic Games and who also, with the help of a Francophile American dental practitioner, Thomas William Evans, created the "Doctorat d'Université", finally allowing American students to pursue their doctorate at a French university.
FOR Consensus Conference - November 16 & 17, 2017.
Albrektsson T, Goodacre C, Jacobs R … +9 more , Jerjes W, Korfage A, Larsson C, Neukam F, Packer M, Pommer B, van Steenberghe D, Veitz-Keenan A, Wennerberg A
Eur J Oral Implantol · 2018 · PMID 30109294
Abstract loading — click title to view on PubMed.
Guest Editorial: The Foundation for Oral Rehabilitation (FOR) as the basis for this consensus conference.
Jacobs R, van Steenberghe D
Eur J Oral Implantol · 2018 · PMID 30109293
Abstract loading — click title to view on PubMed.
Editorial.
Esposito M, Jacobs R, Nieri M
Eur J Oral Implantol · 2018 · PMID 30109292
Abstract loading — click title to view on PubMed.
Research in focus.
Eur J Oral Implantol · 2018 · PMID 29806671
This section presents a brief review of articles on dental implants considered of special interest for the reader, in order to encourage the developing of research, the interest for data analysis and the attention to sci...
This section presents a brief review of articles on dental implants considered of special interest for the reader, in order to encourage the developing of research, the interest for data analysis and the attention to scientific publications. Your comments are welcome. Please contact Dr Michele Nieri at michelenieri@gmail.com.
Displacement of a dental implant in the mandible body: an unusual case report.
Pistilli V, Checchi V, De Paolis F … +2 more , Pistilli R, Barausse C
Eur J Oral Implantol · 2018 · PMID 29806670
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, th...
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.
Autogenous transplant of two impacted mandibular canines: a case report with 2-year follow-up.
Testori T, Scaini R, Weinstein T … +3 more , Deflorian M, Taschieri S, Del Fabbro M
Eur J Oral Implantol · 2018 · PMID 29806669
PURPOSE: To present a case report of autogenous transplant of two impacted mandibular canines. MATERIALS AND METHODS: A 12-year-old girl, with vestibular impaction of mandibular left and right canines had them extracted...
PURPOSE: To present a case report of autogenous transplant of two impacted mandibular canines. MATERIALS AND METHODS: A 12-year-old girl, with vestibular impaction of mandibular left and right canines had them extracted and transplanted in the anatomically corrected sites, after an unsuccessful orthodontic treatment including surgical exposure. RESULTS: After 2 years the teeth are stable and their vitality is maintained. CONCLUSIONS: In this case the transplantation of the mandibular canines was successful and maintained the vitality of the transplanted teeth for at least 2 years. By preserving the periodontal ligament is it possible to re-establish a functional tooth unit, which allows a physiologic growth of the jaws.
5-year outcomes after coverage of soft tissue dehiscence around single implants: A prospective cohort study.
Zucchelli G, Felice P, Mazzotti C … +4 more , Marzadori M, Mounssif I, Monaco C, Stefanini M
Eur J Oral Implantol · 2018 · PMID 29806668
PURPOSE: To report the 5-year clinical and aesthetic outcomes of a novel surgical-prosthetic approach for the treatment of buccal soft tissue dehiscence around single dental implants. MATERIALS AND METHODS: Twenty patien...
PURPOSE: To report the 5-year clinical and aesthetic outcomes of a novel surgical-prosthetic approach for the treatment of buccal soft tissue dehiscence around single dental implants. MATERIALS AND METHODS: Twenty patients with buccal soft tissues dehiscence around single implants in the aesthetic area were treated by removing the implant-supported crown, reducing the implant abutment, coronally advanced flap in combination with connective tissue graft and final restoration. After the first year, patients were recalled three times a year until the final clinical re-evaluation performed 5 years after the final prosthetic crown. Complications, bleeding on probing (BoP), peri-implant probing depth (PPD), clinical attachment level (CAL), keratinized tissue height (KTH), soft tissue coverage and thickness (STT), patient satisfaction (VAS) and aesthetic assessment (PES/WES) were evaluated 5 years after the final restoration. RESULTS: Of the 20 patients enrolled in the study, 19 completed the study at 5 years. A total of 99.2% mean soft tissue dehiscence coverage, with 79% of complete dehiscence coverage, was achieved at 5 years. A statistically significant increase in buccal soft tissue thickness (0.3 mm 0.1-0.4 P < 0.001) and keratinized tissue height (0.5 mm 0.0-1.0; P < 0.001) at 5 years with respect to 1 year was demonstrated. The patient aesthetic evaluation showed high VAS scores with no statistical difference between 1 year and 5 years (8.75 ± 1.02 and 8.95 ± 0.91 respectively). A statistical significant PES/WES score improvement was observed between baseline and 5 years (9.48 ± 2.68; P < 0.001), but not between 1 and 5 years. CONCLUSIONS: Successful aesthetic and soft tissue dehiscence coverage outcomes were well maintained at 5 years. The strict regimen of post-surgical control visits and the emphasis placed on the control of the toothbrushing technique could be critical for the successful long-term maintenance of soft tissue dehiscence coverage results.
Computer-guided vs freehand placement of immediately loaded dental implants: 5-year postloading results of a randomised controlled trial.
Tallarico M, Esposito M, Xhanari E … +2 more , Caneva M, Meloni SM
Eur J Oral Implantol · 2018 · PMID 29806667
PURPOSE: To compare planning and patient rehabilitation using 3D implant planning software and dedicated surgical templates with conventional freehand implant placement for the rehabilitation of partially or fully edentu...
PURPOSE: To compare planning and patient rehabilitation using 3D implant planning software and dedicated surgical templates with conventional freehand implant placement for the rehabilitation of partially or fully edentulous patients using flapless or mini-flap procedures and immediate loading. MATERIALS AND METHODS: Patients requiring at least two implants to be restored with a single prosthesis, having at least 7 mm of bone height and 4 mm in bone width were consecutively enrolled. Patients were randomised according to a parallel group study design into two groups: computerguided group or conventional freehand group. Implants were loaded immediately with a provisional prosthesis, replaced by a definitive prosthesis 4 months later. Outcome measures assessed by a blinded independent assessor were: implant and prosthesis failures, any complications, marginal bone levels, number of treatment sessions, duration of treatment, post-surgical pain and swelling, consumption of pain killers, surgical and prosthetic time, time required to solve complications, and patient satisfaction. Patients were followed up to 5 years after loading. RESULTS: Ten patients (32 implants) were randomised to the computer-guided group and 10 patients (30 implants) were randomised to the freehand group. At the 5-year follow-up examination one patient of the computer-guided group and one of the freehand group dropped-out (both moved to another country). No prostheses failed during the entire follow-up. Two implants failed in the conventional group (6.6%) vs none in the computer-guided group (P = 0.158). Ten patients (five in each group) experienced 11 complications (six in the computer-guided group and five in the freehand group), that were successfully solved. Differences between groups for implant failures and complications were not statistically significant. Five years after loading, the mean marginal bone loss was 0.87 mm ± 0.40 (95% CI: 0.54 to 1.06 mm) in the computer-guided group and 1.29 mm ± 0.31 (95% CI: 1.09 to 1.51 mm) in the freehand group. The difference was statistically significant (difference 0.42 mm ± 0.54; 95% CI: 0.05 to 0.75; P = 0.024). Patient self-reported post-surgical pain (P = 0.037) and swelling (P = 0.007) were found to be statistically significant higher in patients in the freehand group. Number of sessions from patient's recruitment to delivery of the definitive prosthesis, number of days from the initial CBCT scan to implant placement, consumption of painkillers, averaged surgical, prosthetic, and complication times, were not statistically significant different between the groups. At the 5-year followup, all the patients were fully satisfied with the function and aesthetics of their definitive prostheses. CONCLUSIONS: Both approaches achieved successful results over the 5-year follow-up period. Statistically higher post-operative pain and swelling were experienced at sites treated freehand with flap elevation. Less marginal bone loss (0.4 mm) was observed in the computer-guided group, at 5 years follow-up.
Natural or palatal positioning of immediate post-extractive implants in the aesthetic zone? 1-year results of a multicentre randomised controlled trial.
Esposito M, González-García A, Peñarrocha Diago M … +4 more , Fernández Encinas R, Trullenque-Eriksson A, Xhanari E, Peñarrocha Oltra D
Eur J Oral Implantol · 2018 · PMID 29806666
PURPOSE: To evaluate whether there is a difference in aesthetic outcomes positioning immediate post-extractive implants in the natural position (where the tooth should have been in relation to adjacent teeth/implants) or...
PURPOSE: To evaluate whether there is a difference in aesthetic outcomes positioning immediate post-extractive implants in the natural position (where the tooth should have been in relation to adjacent teeth/implants) or about 3 mm more palatally. MATERIALS AND METHODS: Just after tooth extraction, 30 patients requiring one single immediate maxillary post-extractive implant, from second to second premolar, were randomly allocated to receive either an implant positioned in the natural "central" position where the tooth should have been (central group; 15 patients) or about 3 mm more palatally (palatal group; 15 patients) according to a parallel group design at three different centres. When needed, sites were reconstructed and bone-to-implant gaps were filled with granules of anorganic bovine bone, covered by resorbable collagen barriers. Implants were left submerged for 4 months and rehabilitated with provisional crowns, replaced after 4 months by metal-ceramic definitive crowns. Patients were followed to 1 year after loading. Outcome measures were: crown and implant failures, complications, aesthetics assessed using the pink esthetic score (PES), peri-implant marginal bone level changes and patient satisfaction, recorded by blinded assessors. RESULTS: Two patients from the palatal group dropped-out up to 1 year after loading. One implant failed in each group (6.7%), the difference being not statistically significant (difference in proportion = -0.01; 95% CI -0.20 to 0.18; P (Fisher's exact test) = 1.000). One patient from the central group was affected by one complication, vs two palatal group patients (two complications); the difference being not statistically significant (difference in proportion = -0.09; 95% CI -0.32 to 0.15; P (Fisher's exact test) = 0.583). One year after loading, the mean PES was 9.93 ± 2.67 for the central and 8.75 ± 4.37 for the palatal group; the difference being not statistically significant (mean difference = 1.18; 95% CI: -1.87 to 4.23; P (t test) = 0.427). One year after loading, patients in the central group lost on average 0.23 ± 0.17 mm of peri-implant marginal bone and those of the palatal group 0.24 ± 0.25 mm, the difference being not statistically significant (mean difference = -0.01; 95% CI: -0.23 to 0.21; P (t test) = 0.926). Patients in both groups were equally satisfied at 1 year after loading for both function and aesthetics (P (Mann-Whitney U test) = 0.494 and P (Mann-Whitney U test) = 0.076, respectively). CONCLUSIONS: These preliminary results suggest that positioning of immediate post-extractive implants 3 mm more palatally is not improving aesthetics, however, the sample size of the present study was limited, thus larger trials are needed to confirm of reject the present findings.
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