European Journal Of Oral Implantology[JOURNAL]
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200 papers
Do repeated changes of abutments have any influence on the stability of peri-implant tissues? One-year post-loading results from a multicentre randomised controlled trial.
Esposito M, Bressan E, Grusovin MG … +4 more , D'Avenia F, Neumann K, Sbricoli L, Luongo G
Eur J Oral Implantol · 2017 · PMID 28327695
PURPOSE: To evaluate the influence of at least three abutment changes in conventionally loaded implants against placement of a definitive abutment in immediately non-occlusal loaded implants on hard and soft tissue chang...
PURPOSE: To evaluate the influence of at least three abutment changes in conventionally loaded implants against placement of a definitive abutment in immediately non-occlusal loaded implants on hard and soft tissue changes. MATERIALS AND METHODS: Eighty patients requiring one single crown or one fixed partial prosthesis supported by a maximum of three implants were randomised, after implants were placed with more than 35 Ncm, according to a parallel group design to receive definitive abutments which were loaded immediately (definitive abutment or immediate loading group) or transmucosal abutments. These were delayed loaded after 3 months and were removed at least three times: 1) at impression taking (3 months after implant placement); 2) when checking the zirconium core on titanium abutments at single crowns or the fitting the metal structure at prostheses supported by multiple implants; 3) at delivery of the definitive prostheses (repeated disconnection or conventional loading group). Patients were treated in four centres and each patient contributed to the study with only one prosthesis followed for 1 year after initial loading. Outcome measures were: prosthesis failures, implant failures, complications, pink esthetic score (PES), buccal recessions, patient satisfaction, peri-implant marginal bone level changes and height of the keratinised mucosa. RESULTS: Forty patients were randomly allocated to each group according to a parallel group design. Two patients dropped out from the definitive abutment group but no implant failed. Four provisional and one definitive single crowns had to be remade (due of misfitting) and one definitive crown (due to ceramic fracture) in the repeated disconnection group versus one provisional prosthesis of the immediate loading group due to frequent debondings (difference = 12%; CI95%: 0%, 25%; P = 0.109). Eight patients were affected by complications: four patients from each group (difference = 1%; CI95%: -13%, 14%; P = 1). PES scores assessed at 1 year post-loading were 11.4 (1.5) mm for the definitive abutment group and 11.0 (2.0) mm for the repeated abutment changes group (difference = 0.4; CI95%: -0.4, 1.2; P = 0.289). Buccal recessions at 1 year post-loading amounted to 0.07 (0.35) mm for the definitive abutment group and 0.12 (0.65) mm for the repeated abutment changes group (actually it was a soft tissue gain; difference = 0.05 CI 95%: -0.19, 0.29; P = 0.659). All patients declared to be very satisfied or satisfied with the function and aesthetics of the prostheses and would undergo the same procedure again. Mean peri-implant marginal bone loss at 1 year after loading was 0.06 (0.12) mm for the definitive abutment group and 0.23 (0.49) mm for the repeated abutment changes group (difference = -0.16; CI95%: -0.33,-0.00; P = 0.046). The height of the keratinised mucosa at 1 year post-loading was 2.8 (1.5) mm for the definitive abutment group and 2.8 (1.7) mm for the repeated abutment changes group (difference = -0.0; CI 95%: -0.8, 0.7); P = 0.966. Up to 1 year after initial loading, there were no statistically significant differences between the two procedures, with the exception of 0.16 mm more marginal bone loss at implants subjected to three abutment removals. CONCLUSIONS: One-year post-loading data showed that repeated abutment changes significantly increased bone loss of 0.16, but this difference cannot be considered clinically relevant, therefore clinicians can use the procedure they find more convenient for their specific patient. In addition, immediately non-occlusally loaded dental implants are a viable alternative to conventional loading. Conflict-of-interest statement: This trial was partially funded by Dentsply Sirona Implants, the manufacturer of the implants and other products evaluated in this investigation. However, data belonged to the authors and by no means did the manufacturer interfere with the conduct of the trial or the publication of the results with exception of rejecting the proposal of changing the protocol, after the trial was started, allowing the use of indexed abutments.
Safety and efficacy of a biomimetic monolayer of permanently bound multiphosphonic acid molecules on dental implants: 3 years post-loading results from a pilot quadruple-blinded randomised controlled trial.
Esposito M, Dojcinovic I, Buchini S … +2 more , Péchy P, Aronsson BO
Eur J Oral Implantol · 2017 · PMID 28327694
PURPOSE: To evaluate the safety and clinical efficacy of a novel surface treatment (SurfLink, Nano Bridging Molecules, Gland, Switzerland) on titanium dental implants. SurfLink consists of a monolayer of permanently boun...
PURPOSE: To evaluate the safety and clinical efficacy of a novel surface treatment (SurfLink, Nano Bridging Molecules, Gland, Switzerland) on titanium dental implants. SurfLink consists of a monolayer of permanently bound multiphosphonic acid molecules, which mimics the surface of naturally occurring hydroxyapatite. MATERIALS AND METHODS: Twenty-three patients requiring at least two single dental implants had their sites randomised according to a split-mouth design to receive one titanium grade 4 implant treated with SurfLink and one untreated control implant. Additional SurfLink-treated implants were placed if needed. Implants were submerged for 3 months in mandibles and 6 months in maxillae, then loaded with definitive metal-ceramic crowns and followed for 3 years after loading. Outcome measures were crown/implant failures, any complication, radiographic peri-implant marginal bone level changes and marginal bleeding. RESULTS: Three patients dropped out but all remaining patients were followed up to 3-years post-loading. No implant failed. Complications were reported for three patients, affecting both types of implant in two patients and only SurfLink implant in one patient. No differences for complications between the two implant types was observed (McNemar test, P = 1, difference in proportions = -0.04, 95% CI: -0.22 to 0.14). No bleeding was observed when a periodontal probe was run in the peri-implant soft tissues around any of the implants, with the exception of three implants affected by peri-implantitis. There were no statistically significant differences in marginal bone level changes between the two groups (at 3 years post-loading P = 0.86, mean difference = -0.05; SD = 1.15; 95% CI: -0.56 to 0.47). CONCLUSIONS: Medium-term data (3-years post-loading) of implants with a biomimetic monolayer of permanently bound multiphosphonic acid molecules (SurfLink surface treatment) presented no safety issues. Clinical healing in both control and SurfLink-treated implant groups was uneventful and did not differ significantly. More challenging clinical situations need to be investigated to evaluate the real effectiveness of this surface treatment. Conflict-of-interest statement: Marco Esposito and Ivan Dojcinovic declare that they have no conflict of interest, and they acted as consultants for Nano Bridging Molecules (NBM). Sabrina Buchini, Péter Péchy and Björn-Owe Aronsson are employed at NBM. NBM, the manufacturer of the SurfLink surface treatment, supported and carefully monitored this trial without interfering with the presentation of its results.
Single versus two visits with 1-week intracanal calcium hydroxide medication for endodontic treatment: One-year post-treatment results from a multicentre randomised controlled trial.
Fonzar F, Mollo A, Venturi M … +4 more , Pini P, Fabian Fonzar R, Trullenque-Eriksson A, Esposito M
Eur J Oral Implantol · 2017 · PMID 28327693
PURPOSE: To evaluate whether it is more effective to complete endodontic treatment in a single visit or in two visits with 1-week intracanal calcium hydroxide medication in symptomatic teeth and teeth with periapical les...
PURPOSE: To evaluate whether it is more effective to complete endodontic treatment in a single visit or in two visits with 1-week intracanal calcium hydroxide medication in symptomatic teeth and teeth with periapical lesions. MATERIALS AND METHODS: One hundred and ninety-nine patients, with one symptomatic tooth or a tooth with a periapical lesion, were randomised, according to a parallel group design, to receive a complete endodontic treatment in a single visit (99 patients) or in two visits with 1-week intracanal calcium hydroxide medication (100 patients), at two centres. Patients were followed for up to 1 year post-treatment and the outcome measures were tooth loss, radiographic healing, any complication, post-treatment pain and amount of painkillers used. RESULTS: Seven patients dropped out from the single-visit and ten patients from the two-visit group (all patients from one centre only). One patient lost his tooth from the single-visit and two patients from the two-visit group (difference in proportion = -0.01; 95% CI: -0.05 to 0.03; P = 0.619). Five single-visit patients and nine two-visit patients experienced one complication each (difference in proportion = -0.05; 95% CI: -0.12 to 0.03; P = 0.278). There were no statistically significant differences in tooth loss and complications. One year after treatment, complete radiographic healing was observed in 22 patients of the single-visit group and in 19 patients of the two-visit group; improvement in 43 patients of the single-visit group and in 54 patients of the two-visit group; and no changes/worsening in 24 patients of the single-visit group and in 15 patients of the two-visit group. There were no statistically significant differences in radiographic healing between the two groups (P = 0.509). Pre-treatment pain was reported by 68 single-visit patients and by 68 two-visit patients; 1-week post-treatment pain was reported by 27 single-visit patients and by 46 two-visit patients, and 2-week post-treatment pain was reported by 2 single-visit patients and 11 two-visit patients. For the first week, an average of 0.53 ± 1.23 tablets was taken by single-visit patients and 1.44 ± 3.32 tablets by two-visit patients. For the second week, no single-visit patients needed tablets and in the two-visit group the average was 0.37 ± 1.72 tablets. Patients of the two-visits group had statistically significant more post-treatment pain at 1 (P = 0.002) and 2 weeks (P = 0.011), and took more ibuprofen tablets at 1 (difference = -0.92; 95% CI: -1.62 to -0.21; P = 0.011) and 2 weeks after treatment (difference = -0.37; 95% CI: -0.72 to -0.03; P = 0.033), than in patients treated in a single visit. CONCLUSIONS: One year after treatment, both groups achieved similar clinical results; however, patients endodontically treated in a single visit suffered less postoperative pain and took less analgesics than patients treated in two visits, therefore a single-visit treatment should be recommended. Conflict-of-interest statement: This trial was self-funded and the authors have no conflict of interests to declare, however, rotary instruments were kindly provided by Sweden & Martina, Due Carrare PD, Italy.
Immediate, immediate-delayed (6 weeks) and delayed (4 months) post-extractive single implants: 1-year post-loading data from a randomised controlled trial.
Esposito M, Zucchelli G, Cannizzaro G … +4 more , Checchi L, Barausse C, Trullenque-Eriksson A, Felice P
Eur J Oral Implantol · 2017 · PMID 28327692
PURPOSE: To compare the clinical outcome of single implants placed immediately after tooth extraction with implants placed 6 weeks after tooth extraction (immediate-delayed placement), and with implants placed after 4-mo...
PURPOSE: To compare the clinical outcome of single implants placed immediately after tooth extraction with implants placed 6 weeks after tooth extraction (immediate-delayed placement), and with implants placed after 4-month extraction and socket healing (delayed placement). MATERIALS AND METHODS: Two-hundred and ten (210) patients requiring a single implant-supported crown to replace a tooth to be extracted were randomised to receive immediate post-extractive implants (70 patients), immediate-delayed implants at 6 weeks (70 patients), and delayed implants after 4 months of healing (70 patients) according to a parallel group design. When needed, patients of the immediate and immediate-delayed group had the socket grafted with a bone substitute and covered with a resorbable membrane at implant placement. Sockets randomised to delayed implants were grafted in the same manner if poorly preserved or in the aesthetic areas (from second upper to second upper premolars). Implants inserted with at least 25 Ncm torque were left to heal unloaded for 4 months, whereas those inserted with less than 25 Ncm were left to heal unloaded for 6 months. Temporary crowns were delivered and were to be replaced by definitive ones after 4 months. Outcome measures were crown and implant failures, complications, peri-implant marginal bone level changes, aesthetically assessed using the pink esthetic score (PES), and patient satisfaction recorded by blinded assessors. Patients were followed up to 1 year post-loading. RESULTS: One year after loading, three patients dropped out from the immediate group, five from the immediate-delayed group, and six from the delayed group. Four implants (6%) failed in the immediate, four (6.2%) in the immediate-delayed, and one (1.6%) from the delayed group (P (chi-square test) = 0.369). Apart from the crowns (which failed due to implant losses), no other crown had to be remade. Six immediate, six immediate-delayed and four delayed implants were affected by one complication each (P (chi-square test) = 0.792). Mean peri-implant marginal bone loss after 1 year was -0.25 ± 0.17 mm (CI 95% -0.29; -0.20) at immediate, -0.29 ± 0.14 mm (CI 95% -0.32; -0.25) at immediate-delayed, and -0.31 ± 0.16 mm (CI 95% -0.35; -0.27) at delayed placed implants (P (Kruskal-Wallis test) = 0.015). One year after loading, the mean total aesthetic score was 12.52, 12.49 and 11.78 at the immediate, immediate-delayed and delayed groups, respectively (P (Kruskal-Wallis test) <0.001). All patients were fully satisfied both with function and aesthetics, and would undergo the same procedure again, with four exceptions (one from the immediate, one from the immediate-delayed and two from the delayed group), who were only partially satisfied with aesthetics (P = 0.785). CONCLUSIONS: No statistically significant differences for failures, complications and patient satisfaction were observed when placing single implants immediately, 6 weeks or 4 months after tooth extraction; nevertheless, failures were more frequent at immediate and immediate-delayed placed implants. Bone level changes were similar between the different procedures, but aesthetics were better results at immediate and immediate-delayed implants. Conflict-of-interest statement: This trial was partially funded by Nobel Biocare Services (code: 2010-894), the manufacturer of the implants evaluated in this investigation; however, data belonged to the authors and by no means did the manufacturer interfere with the conduct of the trial or the publication of the results.
Editorial: A new type of bias in research: The research ethical committees' bias.
Esposito M
Eur J Oral Implantol · 2017 · PMID 28327691
Abstract loading — click title to view on PubMed.
Matteo Chiapasco, SIO President, Gianluca Paniz and Grazia Tommasato present the Italian Association of Osseointegration events in 2016.
Chiapasco M
Eur J Oral Implantol · 2016 · PMID 28112283
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Editorial: Publication of 'gray literature' in EJOI.
Esposito M
Eur J Oral Implantol · 2016 · PMID 28112282
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Research in focus.
Eur J Oral Implantol · 2016 · PMID 27990511
This section presents a brief review of articles on dental implants considered to be of special interest to the reader in order to encourage the development of research, the interest in data analysis, and the attention t...
This section presents a brief review of articles on dental implants considered to be of special interest to the reader in order to encourage the development of research, the interest in data analysis, and the attention to scientific publications. Your comments are welcome. Please contact Dr Michele Nieri at: michelenieri@gmail.com.
Mandibular osteomyelitis associated with dental implants. A case series.
Semel G, Wolff A, Shilo D … +3 more , Akrish S, Emodi O, Rachmiel A
Eur J Oral Implantol · 2016 · PMID 27990510
PURPOSE: To present a series of rare and serious complications associated with endosseous implant therapy. MATERIALS AND METHODS: Five cases of mandibular osteomyelitis emerging in dental implant insertion sites are pres...
PURPOSE: To present a series of rare and serious complications associated with endosseous implant therapy. MATERIALS AND METHODS: Five cases of mandibular osteomyelitis emerging in dental implant insertion sites are presented. In three cases, the clinical signs and symptoms of osteomyelitis occurred almost immediately following implant insertion. All cases occurred in patients with stable pre-existing medical conditions. Three of the patients were females and two were males, all of whom were in their sixth and seventh decades of life. RESULTS: Clinical symptoms such as pain and local infection were observed in all cases, despite long-term antibiotic treatment. All cases underwent progressive surgical treatment including corticotomy, saucerization, sequestrectomy and drainage. Two cases exhibited spreading of bone infection in the mandible which required segmental mandibulectomy and fixation using reconstruction plates. The symptom-free state was only achieved following surgical intervention and antibiotic treatment in four patients. A minimal follow-up of 1 year revealed complete resolution of the infection and symptoms in four out of five patients. The outcome of the fifth patient is unknown. CONCLUSIONS: Osteomyelitis related to dental implants is a rare and serious complication. Prolonged antibiotics at high dosage together with aggressive surgical treatment is required. Increasing the awareness among dental surgeons and maintaining correct surgical principles are essential in order to reduce the risk of osteomyelitis. Conflict of interest statement: We have no conflict of interests to report.
Removal of dental implants displaced into the maxillary sinus: A case series.
de Jong MA, Rushinek H, Eliashar R
Eur J Oral Implantol · 2016 · PMID 27990509
PURPOSE: To present a retrospective case series of displaced dental implants in the maxillary sinus. MATERIALS AND METHODS: Patients with unintentional displacement of dental implants in the maxillary sinus over a 5-year...
PURPOSE: To present a retrospective case series of displaced dental implants in the maxillary sinus. MATERIALS AND METHODS: Patients with unintentional displacement of dental implants in the maxillary sinus over a 5-year period who underwent or were candidates for surgical implant removal were included. The patients' characteristics, medical history, clinical and imaging results, and post-removal outcome were retrospectively assessed. RESULTS: Out of 14 patients, 13 underwent surgical removal. In one case the implant spontaneously exiled into the nose before surgery. The timespan between dental implantation and presentation ranged from 3 months to 9 years. Imaging evaluation showed a displaced implant (100%), oroantral fistula (65%), complete opacification of the maxillary sinus (28%), circumferential opacification (21%), isolated maxillary sinus outflow obstruction (7%) and a sinus which appeared normal (43%). Symptoms and signs included nasal obstruction (36%), purulent secretions (36%), facial pain (21%), tenderness on percussion (21%) and foul smell (14%). Two patients (14%) were asymptomatic. Intraoperative inspection of nine sinuses revealed mucosal changes and purulent secretions in 55% of patients. In all cases the implant had migrated from the maxillary sinus floor towards the natural ostium. Endoscopic removal was carried out successfully in all operated cases. All sinuses eventually healed. CONCLUSIONS: Migration of displaced implants and mucosal changes may occur over a short period, eventually causing secondary sinusitis. We therefore favour surgical removal. Surgery should be as close as possible to displacement in order to minimise mucosal inflammation and to prevent unnecessary manipulation during surgical removal. Conflict of interest statement: None of the authors report any financial interests or potential conflict of interests.
Quantification of bone quality using different cone beam computed tomography devices: Accuracy assessment for edentulous human mandibles.
Van Dessel J, Nicolielo LF, Huang Y … +4 more , Slagmolen P, Politis C, Lambrichts I, Jacobs R
Eur J Oral Implantol · 2016 · PMID 27990508
PURPOSE: To determine the accuracy of the latest cone beam computed tomography (CBCT) machines in comparison to multi-slice computer tomography (MSCT) and micro computed tomography (micro-CT) for objectively assessing tr...
PURPOSE: To determine the accuracy of the latest cone beam computed tomography (CBCT) machines in comparison to multi-slice computer tomography (MSCT) and micro computed tomography (micro-CT) for objectively assessing trabecular and cortical bone quality prior to implant placement. MATERIALS AND METHODS: Eight edentulous human mandibular bone samples were scanned with seven CBCT scanners (3D Accuitomo 170, i-CAT Next Generation, ProMax 3D Max, Scanora 3D, Cranex 3D, Newtom GiANO and Carestream 9300) and one MSCT system (Somatom Definition Flash) using the clinical exposure protocol with the highest resolution. Micro-CT (SkyScan 1174) images served as a gold standard. A volume of interest (VOI) comprising trabecular and cortical bone only was delineated on the micro-CT. After spatial alignment of all scan types, micro-CT VOIs were overlaid on the CBCT and MSCT images. Segmentation was applied and morphometric parameters were calculated for each scanner. CBCT and MSCT morphometric parameters were compared with micro-CT using mixed-effect models. Intraclass correlation analysis was used to grade the accuracy of each scanner in assessing trabecular and cortical quality in comparison with the gold standard. Bone structure patterns of each scanner were compared with micro-CT in 2D and 3D to facilitate the interpretation of the morphometric analysis. RESULTS: Morphometric analysis showed an overestimation of the cortical and trabecular bone quantity during CBCT and MSCT evaluation compared to the gold standard micro-CT. The trabecular thickness (Tb.Th) was found to be significantly (P < 0.05) different and the smallest overestimation was found for the ProMax 3D Max (180 µm), followed by the 3D Accuitomo 170 (200 µm), Carestream 9300 (220 µm), Newtom GiANO (240 µm), Cranex 3D (280 µm), Scanora 3D (300 µm), high resolution MSCT (310 µm), i-CAT Next Generation (430 µm) and standard resolution MSCT (510 µm). The underestimation of the cortical thickness (Ct.Th) in ProMax 3D Max (-10 µm), the overestimation in Newtom GiANO (10 µm) and the high resolution MSCT (10 µm) were neglible. However, a significant overestimation (P < 0.05) was found for 3D Accuitomo 170 (110 µm), Scanora 3D (140 µm), standard resolution MSCT (150 µm), Carestream 9300 (190 µm), Cranex 3D (190 µm) and i-CAT Next Generation (230 µm). Comparison of the 2D network and 3D surface distance confirmed the overestimation in bone quantity, but only demonstrated a deviant trabecular network for the i-CAT Next Generation and the standard resolution MSCT. Intraclass correlation coefficients (ICCs) showed a significant (P < 0.05) high intra-observer reliability (ICC > 0.70) in morphometric evaluation between micro-CT and commercially available CBCT scanners (3D Accuitomo 170, Newtom GiANO and ProMax 3D Max). The ICC for Tb.Th and Ct.Th were 0.72 and 0.98 (3D Accuitomo 170), 0.71 and 0.96 (Newtom GiANO), and 0.87 and 0.92 (ProMax 3D Max), respectively. CONCLUSIONS: High resolution CBCT offers a clinical alternative to MSCT to objectively determine the bone quality prior to implant placement. However, not all tested CBCT machines have sufficient resolution to accurately depict the trabecular network or cortical bone. Conflict-of-interest statement: There is no conflict of interest to declare. FUNDING: Fellowship support came from Research Foundation Flanders (FWO) from the Belgian government, and Coordination for the Improvement of Higher Education Personnel (CAPES) program and Science without borders from the Brazilian government.
Four mm-long versus longer implants in augmented bone in atrophic posterior jaws: 4-month post-loading results from a multicentre randomised controlled trial.
Esposito M, Zucchelli G, Barausse C … +3 more , Pistilli R, Trullenque-Eriksson A, Felice P
Eur J Oral Implantol · 2016 · PMID 27990507
PURPOSE: To evaluate whether 4-mm long dental implants could be an alternative to augmentation with equine bone blocks and the placement of at least 10-mm long implants in atrophic posterior jaws. MATERIALS AND METHODS:...
PURPOSE: To evaluate whether 4-mm long dental implants could be an alternative to augmentation with equine bone blocks and the placement of at least 10-mm long implants in atrophic posterior jaws. MATERIALS AND METHODS: Forty patients with atrophic posterior (premolar and molar areas) mandibles having 5 to 6 mm bone height above the mandibular canal and 40 patients with atrophic maxillae having 4 to 5 mm below the maxillary sinus, were randomised according to a parallel group design to receive one to three 4.0 mm-long implants or one to three implants, which were at least 10 mm long, in augmented bone at two centres. All implants had a diameter of 4.0 or 4.5 mm. Mandibles were vertically augmented with interpositional equine bone blocks and resorbable barriers. Implants were placed 4 months after interpositional 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 prostheses. Four months later, screw-retained reinforced acrylic restorations were delivered, and then replaced after 4 months by definitive screw-retained metal-composite prostheses. Patients were followed up to 4-months post-loading. Outcome measures included prosthesis and implant failures, any complication and peri-implant marginal bone level changes. RESULTS: No patient dropped out. In six augmented mandibles (30%), it was not possible to place implants which were at least 10.0-mm long, therefore shorter implants had to be placed instead. In particular, one mandible fractured and the patient did not want to go ahead with the treatment. One implant of the patient with the mandible fracture from the augmented group failed versus two 4.0 mm implants in two patients from the short implant group. In the maxillae, three short implants failed in two patients versus five long implants in three 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 versus four prostheses (one mandibular and three maxillary) at augmented sites. In particular, three patients of the augmented group (one mandible and two maxillary) were not prosthetically rehabilitated. There were no statistically significant differences in implant failures (P (chi-square test) = 1.000; difference in proportion = 0; 95% Cl: -0.13 to 0.13 or prostheses failures (P (chi-square test) = 0.399; difference in proportion = 0.05; 95% Cl: -0.06 to 0.16). At mandibular sites, nine augmented patients were affected by complications versus one patient treated with short implants (P (chi-square test) = 0.003; difference in proportion = 0.40; 95% Cl: 0.16 to 0.64), with the difference being statistically significant. No significant differences were found for the maxillae: eight sinus lift patients versus three patients rehabilitated with maxillary short implants were affected by complications (P (chi-square test) = 0.077; difference in proportion = 0.25; 95% Cl: -0.02 to 0.52). Patients with mandibular short implants lost on average 0.40 mm of peri-implant bone at 4 months and patients with 10 mm or longer mandibular implants lost 0.52 mm. Patients with short maxillary implants lost on average 0.48 mm peri-implant bone at 4 months and patients with 10 mm or longer maxillary implants lost 0.50 mm. The difference was statistically significant in the mandibles (mean difference: -0.12 mm, 95% CI: -0.20 to -0.04, P (ANCOVA) = 0.006), but not in the maxillae (mean difference: -0.02 mm, 95% CI: -0.10 to 0.07, P (ANCOVA) = 0.711). CONCLUSIONS: Four months 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 to bone augmentation, especially in mandibles, since the treatment is less invasive, faster, cheaper, and associated with less morbidity; however, 5- to 10-year post-loading data is necessary before making reliable recommendations. Conflict-of-interest statement: Global-D (Brignais, France) partially supported this trial and donated the implants and prosthetic components; however, data property belonged to the authors and by no means did Global-D interfere with the conduct of the trial or the publication of the results.
Platform switching versus regular platform implants: 3-year post-loading results from a randomised controlled trial.
Meloni SM, Jovanovic SA, Pisano M … +1 more , Tallarico M
Eur J Oral Implantol · 2016 · PMID 27990506
PURPOSE: To test the hypothesis that platform switching and regular platform implants would have different outcomes in single-tooth replacement against the alternative hypothesis of no difference. MATERIAL AND METHODS: T...
PURPOSE: To test the hypothesis that platform switching and regular platform implants would have different outcomes in single-tooth replacement against the alternative hypothesis of no difference. MATERIAL AND METHODS: This study was designed as a randomised controlled split-mouth trial. Eighteen patients with bilaterally missing single premolars or molars to be restored with implant-supported single crowns, were consecutively enrolled. Implant sites were randomly assigned to be treated according to the platform switching concept (PS group), or with matching implant-abutment diameters (RP group). A total of 36 Nobel Replace Tapered Groovy implants were installed. All the implants were inserted in healed bone, with an insertion torque between 35 and 45 Ncm, according to a one-stage protocol. Both implant types were loaded with a screw-retained temporary crown 3 months after implant insertion. Definitive screw-retained single crowns were delivered 2 months later. Outcome measures were implant and prosthetic survival rates, biological and prosthetic complications, radiographic marginal bone level (MBL) changes, pocket probing depth (PPD) and bleeding on probing (BOP). Clinical data was collected at implant placement (baseline), and at 3, 9 and 36 months after loading. RESULTS: No patients dropped out and no implant failed. No prosthetic complications were recorded. One patient experienced mucosal inflammation with positive BOP (RP group) after 3 months, three patients had bilateral peri-implant mucosal inflammation with positive BOP at 6, 24 and 30 months after loading, respectively. There were no statistically significant differences between groups for complications (3/18 versus 4/18; P = 1.0; Odds Ratio = 1.333; 95% CI: 0.3467 to 5.1272). Nine months after loading, the mean MBL was 0.93 ± 0.26 mm in the RP group and 0.84 ± 0.23 mm in the PS group, with no statistically significant differences between groups (mean difference = 0.09 mm, 95% CI: -0.22 to 0.04, P = 0.18). Three years after loading, mean MBL was 1.09 ± 0.31 mm in the RP group and 1.06 ± 0.24 mm in the PS group, with no statistically significant differences between groups (mean difference = 0.02 mm, 95% CI: -0.06 to 0.10, P = 0.70). Marginal bone level changes between 3 years and baseline were 0.72 ± 0.28 mm in the RP group and 0.71 ± 0.27 mm in the PS group, with no statistically significant differences between the groups (mean difference = -0.00 mm, 95% CI: -0.07 to 0.07, P = 0.89). Mean PPD was 2.70 ± 0.52 mm in the RP group and 2.46 ± 0.69 mm in the PS group at 36 months after loading, with no statistically significant differences between the groups (mean difference = 0.23 mm, 95% CI: -0.05 to 0.35, P = 0.43). Mean BOP was 0.83 ± 0.96 mm in the RP group and 0.89 ± 0.99 mm in the PS group at 36 months after loading, with no statistically significant differences between the groups (mean difference = 0.07 mm, 95% CI: -0.03 to 0.17, P = 0.77).
Conclusions: The clinical and radiographic outcomes of implants restored according to the platform-switching concept versus implants restored with the matching implant-abutment diameters are comparable, 3 years after loading. Conflict of interest statement: This study was not supported by any company. All authors declare no conflict of interest.
Clinical evaluation of a novel dental implant system as single implants under immediate loading conditions - 4-month post-loading results from a multicentre randomised controlled trial.
Esposito M, Trullenque-Eriksson A, Blasone R … +5 more , Malaguti G, Gaffuri C, Caneva M, Minciarelli A, Luongo G
Eur J Oral Implantol · 2016 · PMID 27990505
PURPOSE: To evaluate the safety and clinical effectiveness of a novel dental implant system (GENESIS Implant System, Keystone Dental, Massachusetts, USA) using another dental implant system by the same manufacturer as a...
PURPOSE: To evaluate the safety and clinical effectiveness of a novel dental implant system (GENESIS Implant System, Keystone Dental, Massachusetts, USA) using another dental implant system by the same manufacturer as a control (PRIMA Implant System, Keystone Dental). MATERIALS AND METHODS: A total of 53 patients requiring at least two single crowns had their sites randomised according to a split-mouth design to receive both implant systems at six centres. If implants could be placed with a torque superior to 40 Ncm they were to be loaded immediately with provisional crowns, otherwise after 3 months of submerged healing. Provisional crowns were replaced by definitive crowns 4 months after initial loading, when the follow-up period for the initial part of this study was completed. Outcome measures were crown/implant failures, complications, pink esthetic score (PES), peri-implant marginal bone level changes, plaque score, marginal bleeding, patients and preference of the clinician. RESULTS: In total 53 PRIMA and 53 GENESIS implants were placed. Three patients dropped out but all of the remaining patients were followed up to 4-months post-loading. No PRIMA implant failed whereas four GENESIS implants failed. Only two complications were reported for PRIMA implants. There were no statistically significant differences for crown/implant failures (difference in proportions = 0.080; P (McNemar test) = 0.125) and complications (difference in proportions = -0.04; P (McNemar test) = 0.500) between the implant systems. There were no differences at 4-months post-loading for plaque (difference = -0.54, 95% CI: -3.01 to 1.93; P (Paired t-test) = 0.660), marginal bleeding (difference = -3.8, 95% CI: -7.63 to 0.019; P (Paired t-test) = 0.051), PES (difference = 0.47, 95% CI: -0.56 to 1.50; P (Paired t-test) = 0.365) and marginal bone level changes (difference in mm = -0.04, 95% CI: -0.33 to 0.26; P (Paired t-test) = 0.795). The majority of the patients (46) had no preference regarding the two implant systems evaluated. Three operators preferred GENESIS implants, two had no preference and one preferred GENESIS in medium and soft bone and PRIMA in hard bone. CONCLUSIONS: No statistically significant differences were observed between the systems' implant types, although four GENESIS implants failed versus none of the PRIMA type. Longer follow-ups of wider patient populations are needed to better understand whether there is an effective advantage with one of the two implant designs. Conflict-of-interest statement: This research project was originally funded by Keystone Italia, Dental spa (Verona, Italy), the manufacturer of the implants evaluated in this investigation.
However, when Keystone Italia received the data of the present manuscript, they refused to honour the financial agreement for the present publication. Therefore, no further follow-ups of this trial will be considered. A legal action was initiated against Keystone Italia. The data belonged to the authors and by no means was the manufacturer allowed to interfere with the conduct of the trial or the publication of the results.
The clinical value of membranes in bone augmentation procedures in oral implantology: A systematic review of randomised controlled trials.
Jonker BP, Roeloffs MW, Wolvius EB … +1 more , Pijpe J
Eur J Oral Implantol · 2016 · PMID 27990504
PURPOSE: To determine the clinical value of membranes in bone augmentation procedures such as ridge augmentation with simultaneous (one-stage) and delayed (two-stage) implant placement, sinus augmentation surgery, ridge...
PURPOSE: To determine the clinical value of membranes in bone augmentation procedures such as ridge augmentation with simultaneous (one-stage) and delayed (two-stage) implant placement, sinus augmentation surgery, ridge preservation and immediate implant placement. MATERIALS AND METHODS: In April 2016, Embase, Medline (Ovid-SP), Cochrane Central, Web of Science and PubMed (as supplied by the publisher) were searched. There were no restrictions regarding language or publication date. Randomised controlled trials that reported membranes in bone augmentation procedures with a minimum follow-up period of 6 months after implant loading or that described geometrical changes of the bone graft at re-entry were included. Membrane placement had to be the only variable in the procedure. Outcomes were implant failure, complications, horizontal bone gain and resorption, graft resorption, defect height reduction, marginal bone loss around implants, aesthetic results and patient satisfaction. The results were pooled using fixed-effect models with mean differences (MDs) for continuous outcomes and odds ratios (ORs) for dichotomous outcomes. RESULTS: After screening the titles and abstracts of 1843 papers, 32 potentially eligible articles were selected. Seventeen articles involving 10 trials were included in this review. These studies presented outcome data for 355 patients. Seven trials were considered to be at a high risk of bias, two at a low risk of bias and one at an unclear risk of bias. Insufficient evidence was found to determine whether there were differences in implant failure rates, marginal bone level changes, aesthetic results or patient satisfaction. For one-stage ridge augmentation (two trials; n = 52), there was evidence of more horizontal bone gain (MD: 0.84 mm, 95% CI: 0.46 to 1.21, P < 0.00001; two trials), defect height reduction (MD: 18.36%, 95% CI: 10.23 to 26.50, P < 0.00001; two trials), and prevention of graft resorption (P = 0.004; one trial) in favour of the membrane-covered group, although substantial heterogeneity was found for horizontal bone gain (Chi2; P = 0.05, I2=74%). There was insufficient evidence to determine whether any differences exist in two-stage ridge augmentation (three trials; n = 81), sinus augmentation (one trial; n = 104) and ridge preservation (one trial; n = 20). For immediate implant placement (three trials; n = 98), there was evidence of an increased defect height reduction in favour of the membrane-covered groups (MD: 6.25%, 95% CI: 1.67 to 10.82, P = 0.007; two trials), although with substantial heterogeneity (Chi2; P = 0.03, I2 = 79%). More complications were observed when a membrane was used (OR: 2.52, 95% CI: 1.07 to 5.93, P = 0.03; three trials). CONCLUSIONS: There is insufficient evidence regarding the effects of membranes on bone augmentation procedures to support any definitive conclusions. Only 10 studies were included; they had limited sample sizes and short follow-up periods, and the majority were at a high risk of bias. However, no difference in implant failure was found, and the possible clinical value is still unknown, as long-term clinical parameters such as marginal bone loss, aesthetic results and patient satisfaction have been insufficiently studied. Conflict-of-interest and source-of-funding statement: The authors declare that they have no possible conflicts of interest. No funding for this review was received.
Editorial: Is new necessarily better than old? ... and the story of the chameleon that behaved like an ostrich.
Esposito M
Eur J Oral Implantol · 2016 · PMID 27990503
Abstract loading — click title to view on PubMed.
Artefacts of implant-supported single crowns - Impact of material composition on artefact volume on dental MRI.
Hilgenfeld T, Prager M, Schwindling FS … +5 more , Heil A, Kuchenbecker S, Rammelsberg P, Bendszus M, Heiland S
Eur J Oral Implantol · 2016 · PMID 27722227
PURPOSE: MRI allows radiation-free imaging of the head and neck area. However, implant-supported prostheses may severely impair image quality due to artefacts. Therefore, identification of preferable material composition...
PURPOSE: MRI allows radiation-free imaging of the head and neck area. However, implant-supported prostheses may severely impair image quality due to artefacts. Therefore, identification of preferable material compositions for implants and supported prostheses with little impact on MR image quality is mandatory. MATERIALS AND METHODS: Overall, one zirconia and four titanium dental implants were provided with different single crown materials: porcelain-fused-to-metal precious alloy (GP-T), porcelain-fused-to-metal non-precious alloy (CCT-T), porcelain-fused-to-zirconia (ZC-T) and monolithic zirconia (Z-T, Z-Z). Three-dimensional artefact volume was determined on a 3 Tesla MRI, applying two standard sequence types (SPACE and TSE). Two-way ANOVA and pair-wise post-hoc Turkey test were performed for comparison of artefact size. RESULTS: Fewest MR artefacts were observed with zirconia implant combined with monolithic zirconia crown. A titanium implant combined with a single crown framework out of the non-precious alloys was unfavourable in terms of artefact volume. Smaller and comparable artefact volumes were noted for titanium implants with the remaining three crown materials (GP-T, ZC-T and Z-T). CONCLUSIONS: Material composition of dental implants provided with single crowns has a profound impact on artefact volume. In comparison with crowns containing cobalt, chromium and tungsten, the MRI artefacts are reduced in precious alloy- and zirconia-based crowns. Further studies are needed to assess whether residual artefacts allow sufficient diagnostic imaging with these crowns. Conflict-of-interest statement: The authors have nothing to disclose.
Effectiveness of subperiosteal bone anchor (Onplant) placement in the anterior highly atrophic maxilla for cross-arch prosthetic rehabilitation: Results from a pilot study.
Heuberer S, Ulm C, Zauza K … +3 more , Zechner W, Watzek G, Dvorak G
Eur J Oral Implantol · 2016 · PMID 27722226
PURPOSE: The present prospective pilot study aimed to evaluate the feasibility of Onplants (Onplant Orthodontic System) off label use in the highly atrophic edentulous maxillae of adult patients to avoid bone grafting an...
PURPOSE: The present prospective pilot study aimed to evaluate the feasibility of Onplants (Onplant Orthodontic System) off label use in the highly atrophic edentulous maxillae of adult patients to avoid bone grafting and conventional dental or zygomatic implants. MATERIAL AND METHODS: Two Onplants were placed subperiosteally in the anterior part of the hard palate in five adult patients presenting a highly atrophic edentulous maxilla, class V or VI, according to Cawood and Howell. After a healing period of 4 months the prosthetic procedures were started. Outcome measures were the survival rate of the Onplant system, complication rate and OHRQoL using a OHIP-G questionnaire at three different stages: before and after the Onplant placement and at the end of treatment. RESULTS: Unexpectedly, the present study had to be discontinued due to the early loss of all 10 Onplants at the time of prosthetic loading. In total, 16 patients were meant to participate, but the study was stopped after complete failures of the first five patients. While all inserted Onplants became unstable, no other complications like penetration of the nasal cavity, infections or fractures of the abutment screw were observed. The patient satisfaction and the oral health-related quality of life declined with the number of surgical interventions and finally with the Onplant failure. CONCLUSIONS: The anterior part of the adult hard palate apparently did not present adequate bone regenerative capacity to support Onplant-prosthetic rehabilitation. Off-label Onplant-supported prostheses are contraindicated for permanent maxillary rehabilitation in edentulous adult patients. Conflict-of-interest statement: The original manufacturer provided the materials free of charge in this investigator-sponsored research (code: 2011-1027). The authors declare no conflicts of interest in relation to this study.
Implants inserted with graftless osteotome sinus floor elevation - A 5-year post-loading retrospective study.
Zill A, Precht C, Beck-Broichsitter B … +5 more , Sehner S, Smeets R, Heiland M, Rendenbach C, Henningsen A
Eur J Oral Implantol · 2016 · PMID 27722225
PURPOSE: To report the outcome of graftless osteotome sinus floor elevation (OSFE) in order to evaluate whether apical bone gain depends on the initial residual bone height and whether the initial residual bone height ha...
PURPOSE: To report the outcome of graftless osteotome sinus floor elevation (OSFE) in order to evaluate whether apical bone gain depends on the initial residual bone height and whether the initial residual bone height has an influence on the amount of marginal bone loss. Furthermore the study aimed to assess if perforations of the Schneiderian membrane or residual bone height are potential predictors of implant survival. MATERIALS AND METHODS: In this retrospective study all patients were included who were treated between 2001 and 2010 and received dental implants in combination with OSFE in a private practice. Patients having 1 to 11 mm of residual bone height were subjected to crestal sinus lift elevation. One hundred and thirteen patients with 233 implants were included in this study. The follow-up period was 5-years post-loading for all patients. The average initial bone level height was 5.9 ± 1.7 mm. No bone graft or substitute material was used. All implants healed transgingivally and were loaded 3 months after insertion. Outcome measures were prosthetic success, implant success, complications, radiographic crestal bone level changes and apical (sinus floor) bone height. RESULTS: Sixty-three patients dropped out during the 5-year post-loading follow-up. Seven implants in 7 patients failed. Implant survival rate 5 years after loading was 93.8% at patient level. Implants succeeded in 92.7% of all cases. In six patients (5.3%), prostheses failed and had to be remade. Minor complications like small ceramic fractures and loosening of prosthetics were observed in seven patients (6.2%). Average marginal bone loss at 5 years of follow-up was 0.5 ± 0.8 mm per patient. No correlation was found between marginal bone loss and initial residual bone height. Average gained bone height was 4.5 ± 1.4 mm after 5 years of loading. We found a significantly negative linear correlation for apical bone gain depending on the baseline bone level (P < 0.001). The apical bone gain was higher in cases with less residual bone. CONCLUSIONS: Implants after graftless osteotome sinus floor elevation showed excellent survival and success rates after 5 years of loading. Apical gain of newly formed bone was positively correlated with the initial bone height showing a statistical significance. However, initial residual bone height is also a predictor for implant survival, i.e. survival increases by 1.6 times with every additional millimetre of initial residual bone height. Conflict-of-interest statement: All authors declare that they have neither financial nor non-financial competing interests.
Single post-extractive ultra-wide 7 mm-diameter implants versus implants placed in molar healed sites after socket preservation for molar replacement: 6-month post-loading results from a randomised controlled trial.
Tallarico M, Xhanari E, Pisano M … +3 more , De Riu G, Tullio A, Meloni SM
Eur J Oral Implantol · 2016 · PMID 27722224
PURPOSE: To test the hypothesis that there is no difference in clinical, radiographic and aesthetic outcomes positioning single post-extractive ultra-wide 7 mm-diameter implants or waiting 4 months to place implant, afte...
PURPOSE: To test the hypothesis that there is no difference in clinical, radiographic and aesthetic outcomes positioning single post-extractive ultra-wide 7 mm-diameter implants or waiting 4 months to place implant, after molar extraction and the socket preservation procedure. MATERIAL AND METHODS: Patients requiring one implant-supported single restoration to replace a failed tooth in the molar region of both maxilla and mandible were selected. Patients were randomised according to a parallel group design into two arms: implant installation in fresh extraction sockets augmented with corticocancellous heterologous bone and porcine derma (group A) or delayed implant installation 4 months after tooth extraction and socket preservation using the same materials (group B). Ultra-wide 7 mm-diameter implants were submerged for 4 months. Outcome measures were implant success and survival; complications; horizontal dimensional changes measured on cone beam computed tomography (CBCT) scans at three levels, localised 1, 2 and 3 mm below the most coronal aspect of the bone crest (level A, B and C); peri-implant marginal bone level changes; implant stability quotient (ISQ); and pink esthetic score (PES). RESULTS: Twelve patients were randomised to group A and 12 to group B. No patients dropped out. No implant failed or complications occurred up to 6-months post-loading. Six months after loading there was more horizontal alveolar bone reduction at immediate post-extractive implants, which was statistically significant. At level A was 1.78 mm ± 1.30 in group A, 0.45 mm ± 0.42 in group B, (difference 1.33 mm ± 1.39; 95% CI: 0.38 to 1.95; P = 0.003); at level B was 0.98 mm ± 1.13 in group A, 0.14 mm ± 0.22 in group B, (difference 0.84 mm ± 1.16; 95% CI: 0.24 to 1.07; P = 0.019); at level C was 0.55 mm ± 0.74 in group A, 0.03 mm ± 0.24 in group B, (difference 0.51 mm ± 0.76, 95% CI: 0.01 to 0.87; P = 0.032). One year after implant placement, mean peri-implant marginal bone loss was 0.43 mm ± 0.37 for group A and 0.10 mm ± 0.10 for group B, showing a statistically significant difference between groups (difference 0.33 mm ± 0.30; 95% CI: 18 to 0.52; P = 0.010). Mean ISQ value was 78.8 ± 2.8 for group A and 79.9 ± 3.6 for group B, showing no statistically significant differences between groups (difference 1.1 ± 2.6; 95% CI: 0.04 to 2.96; P = 0.422). Mean PES was similar in both groups (10.7 ± 1.5 [range: 8 to 13] in group A and 11.7 ± 1.2 [range: 10 to 13] in group B; difference 1.0 ± 2.2; 95% CI: -0.23 to 2.23; P = 0.081). CONCLUSIONS: Single post-extractive ultra-wide 7 mm-diameter implants, in combination with socket preservation, might be a possible strategy in the replacement of hopeless molars in both jaws, with high implant and prosthetic survival and success rates, and good aesthetic outcomes. Longer follow-ups are needed to properly evaluate this therapeutic option. Conflict-of-interest statement: Dr Marco Tallarico is Research and Scientific Project Manager of Osstem AIC Italy. However, this study was not supported by any company and all authors declare no conflicts of interest.
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