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PubMed2001

Preliminary report of immediately loaded Altiva Natural Tooth Replacement dental implants.

BACKGROUND: Osseointegration may be described as a direct contact between living bone and an alloplastic implant. It is thought that a period of undisturbed healing is required to ensure osseointegration. The length of the healing period is dependent on a number of factors, such as implant material, surface configuration, site preparation technique, bone quality, healing capacity of the osteotomy, and implant design. Elimination of the healing period offers distinct advantages in terms of cost of therapy and convenience to patients. Recently, a new one-piece implant design was proposed that provides improved stability of the implant to allow immediate support of an interim prosthesis. PURPOSE: This article presents the initial clinical experiences when the Altiva Natural Tooth Replacement one-piece implant was used in a human clinical trial. MATERIALS AND METHODS: This was a prospective multicenter study of the placement and immediate loading of the one-piece implant. A total of 142 implants were placed in the jaws of 93 patients. Implants were placed consecutively and were followed at specified intervals in three private clinical practices. Clinical performance was recorded relative to implant survival and prosthesis support. RESULTS: The implant survival rate was 93.7%, with similar responses in the maxilla (95.0%) and the mandible (92.7%). When implant failure occurred, it was observed as mobility without infection within 3 to 5 weeks of implant insertion. CONCLUSIONS: On the basis of this trial, there is promising evidence that this implant design can succeed at rates similar to other designs that require conventional healing times.

Adult↗
PubMed2001

Osseotite implant: 3-year prospective multicenter evaluation.

PURPOSE: This prospective multicenter study evaluates the cumulative success rate of the Osseotite implant after 3 years of prosthetic loading. MATERIALS AND METHODS: A total of 413 Osseotite implants (Implant Innovations) were placed in 142 patients (completely or partially edentulous) in five dental offices exclusively devoted to implants. The average age of the patients was 58.3 years. Of the 413 implants, 191 were placed in the maxilla and 222 in the mandible; 271 (65.6%) were posterior implants and 142 (34.4%) were anterior implants. Clinical and radiographic evaluations were made after completion of the prosthetic restoration, after 6 months of loading, at 1 year, and at 3 years. RESULTS: A cumulative success rate of 95.3% was obtained after 3 years of prosthetic loading. The success rate was similar in both arches: 95.1% in the maxilla and 96.8% in the mandible. Early failures (before prosthetic loading) were greater (n = 12) than late failures (n = 2). After 3 years of prosthetic loading, the marginal bone level of 385 (93.2%) implants were evaluated radiographically. Bone level was at the first thread for 91.4% of the implants. A slightly increased loss was observed around 26 implants (6.7%). Including survival implants, the cumulative implant success rate after 3 years was 96%. A success rate of 98.4% was obtained with 187 short implants (8, 5 and 10 mm) reported in this multicenter evaluation. CONCLUSION: This multicenter evaluation demonstrates excellent predictability for Osseotite implants.

Adult↗
PubMed2002

Early loading of four or five Astra Tech fixtures with a fixed cross-arch restoration in the mandible.

BACKGROUND: A change in implant placement has emerged recently from two-stage to one-stage surgery and to earlier and even immediate loading of the fixtures. PURPOSE: The aim of this study was to verify whether four or five fixtures installed in the edentulous mandible were suitable for early loading with a cross-arch fixed restoration. MATERIALS AND METHODS: In 25 consecutively treated patients (28-88 yr), four or five Astra Tech fixtures (Mölndal, Sweden) were installed in edentulous mandibles. During the same surgical procedure, the abutments were connected. An impression was taken immediately after surgery. All patients received a fixed prosthetic rehabilitation of 10 to 12 teeth made of a cast metal framework and acrylic teeth/gingiva within a month. The fixtures were followed up clinically and radiographically for 7 to 24 months. Bone level was measured from the most coronal point of the vertical part of the fixture to the most apical bone level mesially or distally. RESULTS: No fixtures were lost during follow-up. No postoperative complications occurred. Radiographic analysis showed a mean bone level of 0.6 mm after 7 to 12 months. Fixtures followed up from 13 to 18 and 19 to 24 months showed a mean bone level of 0.7 mm. Around two fixtures, the bone level was found at the first implant thread. All other fixtures showed the bone level somewhere along the vertical unthreaded part of the fixture. CONCLUSIONS: Early loading within 1 month of four or five Astra Tech fixtures in the edentulous mandible is a predictable procedure for a follow-up period of 6 to 24 months.

Adult↗
PubMed2002

Early loading of machined-surface Brånemark implants in completely edentulous mandibles: healed bone versus fresh extraction sites.

BACKGROUND: Restoration of edentulous mandibles with dental implants installed with a two-stage or one-stage surgical approach, yet with delayed loading, is a predictable and successful treatment. PURPOSE: The present prospective study evaluated the success up to 3 years of function of nonroughened machined-surface Brånemark System implants (Nobel Biocare AB, Gothenburg, Sweden) loaded early or immediately with a fixed 12-unit bridge. MATERIALS AND METHODS: In total, 184 implants were installed in 36 patients: 30 with healed bone and 6 with some remaining teeth, which were extracted simultaneously with implant installation. The provisional or final prostheses were installed 0 to 52 (mean 18.2) days later. RESULTS: Thirteen of 184 (7.1%) implants failed within 3 months of loading in 5 of 36 (13.9%) patients: 1 of 153 implants (0.7%) failed in healed bone, and 12 of 31 (39%) failed in fresh extraction sites. This consequently meant a loss of 3 of 36 (8.3%) prostheses, all in the extraction group. No implants were lost during 3 years of functional loading (16 patients, 75 implants). The average marginal bone level measured initially and after 1, 2, and 3 years was 0.8 mm (SD = 0.5), 1.0 mm (SD = 0.4), 1.1 mm (SD = 0.3), and 1.4 mm (SD = 0.5), respectively. CONCLUSIONS: Four to six Brånemark implants with nonroughened machined titanium surfaces can be loaded early or immediately with cross-arch restorations in healed mandibulary bone, but this cannot be recommended for fresh extraction sites.

Aged↗
PubMed2003

"All-on-Four" immediate-function concept with Brånemark System implants for completely edentulous mandibles: a retrospective clinical study.

BACKGROUND: Immediate-function Brånemark System implants (Nobel Biocare AB, Gothenburg, Sweden) have become an accepted alternative for fixed restorations in edentulous mandibles, based on documented high success rates. Continuous development is ongoing to find simple protocols for their use. PURPOSE: The purpose of this study was to develop and document a simple, safe, and effective surgical and prosthetic protocol for immediate function (within 2 hours) of four Brånemark System implants supporting fixed prostheses in completely edentulous mandibles: the "All-on-Four" concept. MATERIALS AND METHODS: This retrospective clinical study included 44 patients with 176 immediately loaded implants, placed in the anterior region, supporting fixed complete-arch mandibular prostheses in acrylic. In addition to the immediately loaded implants, 24 of the 44 patients had 62 rescue implants not incorporated in the provisional prostheses but incorporated in final prostheses later on. RESULTS: Five immediately loaded implants were lost in five patients before the 6-month follow-up, giving cumulative survival rates of 96.7 and 98.2% for development and routine groups, respectively. The prostheses' survival was 100%, and the average bone resorption was low. CONCLUSIONS: The high cumulative implant and prostheses survival rates indicate that the "All-on-Four" immediate-function concept with Brånemark System implants used in completely edentulous mandibles is a viable concept.

Acrylic Resins↗
PubMed2003

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.

Adult↗
PubMed2003

Early function of splinted implants in maxillas and posterior mandibles using Brånemark system machined-surface implants: an 18-month prospective clinical multicenter study.

BACKGROUND: There are limited clinical data available for immediately or early loaded implants placed in posterior mandibles and maxillas. This is probably because bone density often is low in these areas, making it difficult to establish good initial implant stability. By eliminating countersinking and using slightly tapered implants (Brånemark System , Mk IV, Nobel Biocare AB, Gothenburg, Sweden), however, high initial implant stability might be achieved in these regions. PURPOSE: The aim of this study was to investigate the possibility of early application of implant function in oral locations where the bone density is often low, namely the maxilla and posterior mandible. MATERIALS AND METHODS: Thirty-one patients were included consecutively in the study, and 36 edentulous areas in maxillas and posterior mandibles were treated. All patients were nonsmokers in good general health. Bruxism and uncontrolled periodontal disease were exclusion criteria. One hundred twenty-four machined-surface implants were placed using an insertion torque of at least 40 Ncm. Temporary prostheses with narrow occlusal platforms, flat cusps, and light occlusal contacts were generally placed within 1 week and not exceeding 20 days from implant placement. RESULTS: Of the 124 implants installed, 4 failed, 1 in each of four patients, giving an overall survival rate of 96.8% after 18 months. Two implants failed in maxillas and two in mandibles. One implant in a maxilla and one in a mandible were lost in an early stage, and the other two were lost a few months after placement. The prostheses' survival was 100%. CONCLUSIONS: This study shows that early implant function rehabilitation in maxillas and posterior mandibles is viable using the present clinical protocol. The results are comparable with those of conventional two-stage protocols.

Adult↗
PubMed2003

Immediate loading in the maxilla using flapless surgery, implants placed in predetermined positions, and prefabricated provisional restorations: a retrospective 3-year clinical study.

BACKGROUND: Immediate loading of dental implants shortens the treatment time and makes it possible to give the patient an esthetic appearance during the whole treatment period. PURPOSE: The aim of the present study was to evaluate an immediate-loading treatment protocol, which included flapless surgery, implants placed in predetermined positions and connected to prefabricated provisional restorations, and the 3-year clinical results. MATERIALS AND METHODS: A total of 97 Brånemark System Mk IV implants (Nobel Biocare AB, Gothenburg, Sweden) with a machined surface were inserted in the maxillas of 46 patients. A presurgical three-dimensional model of the patients' soft tissue and underlying alveolar bone anatomy was created, which allowed the clinician to place the implants in predetermined positions and connect them to prefabricated provisional restorations. A surgical template with drilling guides corresponding to each implant was used. The apical part of the master guide was equipped with a circular "mucotome," which punched out a 5 mm hole in the mucosa to eliminate the need for flap elevation. The patients received 25 fixed partial prostheses and 27 single-tooth restorations. Bone quality and quantity were assessed. Radiographic examinations were performed on the day of surgery/loading and at the 1-, 2-, and 3-year follow-up visits. RESULTS: All implant sites showed intact buccal and lingual bone walls during surgery, confirming the accuracy of the bone-mapping procedure. The prefabricated temporary restorations fitted, meaning that the implants were positioned clinically in the same way as on the cast. Nine implants in eight patients failed during the first 8 weeks of loading. This resulted in a cumulative survival rate of 91% after 3 years of prosthetic load. The survival rate of splinted implants was 94%. The number of failed implants was significantly higher in cases of single-tooth replacements and placement in soft bone sites and smokers. The failed implants were successfully replaced according to a two-stage protocol. All patients finally received the expected restoration. The marginal bone resorption was on average 1.0 mm during the first year of loading, 0.4 mm during the second year, and 0.1 mm during the third year. CONCLUSIONS: The study confirmed the feasibility of an immediate-loading treatment protocol in the maxilla, which included flapless surgery, implants and abutments placed in predetermined positions, and prefabricated provisional restorations. All failures occurred within the first 2 months of loading. The unchanged survival rate and the low average bone loss found during the following 34-month study period indicate a good long-term prognosis for the performed immediate-loading treatment.

Adult↗
PubMed2003

Immediate and early function of Brånemark System implants placed in the esthetic zone: a 1-year prospective clinical multicenter study.

BACKGROUND: Immediate/early implant function means great benefits for patients and therapists because treatment time and cost can be substantially reduced. This concept has become an accepted alternative for complete arch fixed restorations in the mandible, and clinical documentation is emerging for other indications. PURPOSE: The purpose of this prospective clinical multicenter study was to evaluate the outcome of implants placed in incisor, canine, and premolar regions in maxillas or mandibles. Implants were loaded with provisional crowns and bridges on the same day or within a few days and were followed up for 1 year during function. MATERIALS AND METHODS: Four centers treated 76 patients each in need of an implant-retained prosthesis in the anterior and premolar regions in the maxilla or mandible. A total of 116 titanium implants with machined surfaces (Brånemark System , Nobel Biocare AB, Gothenburg, Sweden) were placed: 74 in maxillas and 42 in mandibles. Eighty-seven prostheses were made, of which 63 were single crowns and 24 were bridges (supported by 53 splinted implants). Twenty-two implants in 14 patients were placed in fresh extraction sites. The goal with the preparation and insertion technique was to achieve good primary implant stability and a minimum implant insertion torque of 30 Ncm before the implant was completely seated. The occlusion was adjusted to eliminate direct contact with the provisional prostheses. After 6 months, the patients received their permanent prostheses. Sixty-seven patients were followed for 1 year. RESULTS: Five implants were lost in five patients, three in the maxilla and two in the mandible. Four of the lost implants were single-tooth replacements and one was splinted. The cumulative survival rate (CSR) was 95.7% for all implants after 1 year and 93.7% and 98.1% for single-tooth and splinted implants, respectively. There were no implant losses in the extraction sites. CONCLUSIONS: The CSR of 96% at 1 year indicates that immediate function of Brånemark System implants placed in incisor to premolar regions in both jaws is a viable concept. More failures occurred with single-tooth replacements (6.3%) than with splinted implants (1.9%).

Adolescent↗
PubMed2003

Immediate occlusal loading of Brånemark TiUnite implants placed predominantly in soft bone: 1-year results of a prospective clinical study.

BACKGROUND: The original Brånemark protocol for dental implant treatment was based on submerged healing prior to loading. However, immediate loading has been reported possible with high success rates for various indications, provided that good bone quality and quantity are present. In many of these studies, machined-surface implants have been used. Recently, a new surface texture has been developed, based on an oxidation processing, that aims to enhance the early bone response (Brånemark System Mk IV TiUnite , Nobel Biocare AB, Gothenburg, Sweden). It has been documented that this surface texture may help to better maintain primary implant stability during the early healing period and that secondary implant stability can be reached earlier compared with results when using a machined surface. Such a positive influence on implant stability might be an advantage when applying an immediate-loading protocol, especially in soft bone regions where a tendency toward reduced success rates has been reported. PURPOSE: The aim of this report was to present the short-term success rates of TiUnite-surfaced immediate occlusally loaded Brånemark System Mk IV implants placed in various regions of the jaws. MATERIALS AND METHODS: Thirty-eight patients received a total of 51 prosthetic reconstructions, all of which were connected on the day the implants were inserted. Of these, 20 were single-tooth restorations, 30 were fixed partial dentures, and 1 was a complete fixed lower jaw restoration. These prostheses were supported by 102 Brånemark System Mk IV TiUnite implants (38 maxillary and 64 mandibular), the majority of which were placed in posterior regions (88%) and mainly in soft bone (76%). Cutting resistance measurements were performed during implant insertion, and resonance frequency measurements were conducted during the course of the study. Furthermore, radiographic examinations were performed in connection with the delivery of the prostheses and at the 1-, 6-, and 12-month follow-up visits. This article reports on the results after 1 year of loading. RESULTS: Three maxillary implants were removed, although stable, in one patient at the 8-week follow-up because of postoperative infection in the adjacent area of guided bone regeneration (GBR). This resulted in a cumulative success rate of the implants of 97.1% after 1 year of prosthetic loading. The mean marginal bone resorption after 1 year of loading was 1.2 +/- 0.9 mm (SD). CONCLUSIONS: The applied immediate loading protocol in combination with a slightly tapered implant and a modified implant surface texture was shown to be a successful treatment alternative even in regions exhibiting soft bone.

Adult↗
PubMed2003

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.

Adult↗
PubMed2003

Early loading of maxillary fixed cross-arch dental prostheses supported by six or eight oxidized titanium implants: results after 1 year of loading, case series.

BACKGROUND: Recent reports have demonstrated that immediate/early loading of dental implants is a clinically feasible concept with results similar to those for two-stage procedures, at least in good bone qualities. However, documentation of the outcome of immediate/early loading in the totally edentulous maxilla is scarce. PURPOSE: The present investigation was undertaken to evaluate the outcome over 1 year of oxidized titanium implants when loaded with a fixed full-arch bridge in the maxilla 1 to 9 days after implant placement. MATERIALS AND METHODS: Ten patients with totally edentulous maxillas were treated with 61 oxidized titanium implants, and a provisional fixed bridge was delivered after 1 to 9 days (mean 2.5 d). Nine patients had six implants and one patient had eight implants supporting the bridge. The provisional bridge was replaced with a permanent bridge after 2 to 7 months (mean 4.1 mo) of loading. Resonance frequency analysis (RFA) for implant stability measurements was made at implant placement in eight patients and in conjunction with permanent bridge connection in five patients. The patients were followed up for 1 year with clinical and radiographic examinations. RESULTS: Four implants (6.6%) were lost in one patient after 10 weeks of loading owing to an infection. All other implants were clinically stable with a mean marginal bone loss of 1.3 +/- 0.6 mm after 1 year of loading. RFA showed a mean primary stability of 60.1 +/- 3.6 ISQ (implant stability quotient), which increased to 62.8 +/- 1.6 ISQ after, on average, 4 months. CONCLUSIONS: The results from this limited study on 10 cases indicate that early loading protocols can be applied for cross-arch dental bridges supported by six to eight implants in the maxilla. However, more clinical trials are needed to establish the long-term predictability of the treatment.

Aged↗
PubMed2003

Teeth in a day for the maxilla and mandible: case report.

BACKGROUND: A growing body of evidence indicates that successful osseointegration of dental implants can take place in the wake of immediate loading, providing that bone quality and quantity are adequate, and patients follow postsurgical instructions carefully. PURPOSE: The goal of this report is to demonstrate the efficient treatment protocol based on immediate loading for both the maxilla and mandible, including extraction site locations. MATERIALS AND METHODS: Following extraction of the remaining anterior mandibular teeth, 18 Brånemark implants (Nobel Biocare AB, Gothenburg, Sweden), including two zygoma and two pterygoid implants, were installed in both arches in accordance with the Teeth in a DayTM protocol developed by the authors 9 years ago. This protocol uses an acrylic screw-retained prosthesis, with steel prosthetic copings embedded, supported by full-size Brånemark implants to prevent micromotion at the bone-to-implant interface. RESULTS: Only 1 of the 18 immediately loaded implants failed to osseointegrate. Three years after completion of treatment, the patient reported functioning well with no complications. CONCLUSIONS: When appropriate subjects are selected, the Teeth in a Day protocol offers patients a number of significant advantages, including condensed treatment time, reduced postsurgical discomfort, and almost instantaneous improvement in speech and masticatory function, esthetics, and patient self-image.

Acrylic Resins↗
PubMed2003

Implant-retained mandibular overdentures with immediate loading: a 3- to 8-year prospective study on 328 implants.

PURPOSE: The purpose of this study is to evaluate prospectively survival and success rates of implants placed in the interforaminal area of edentulous mandibles and immediately loaded with an implant-supported overdenture. MATERIALS AND METHODS: Eighty-two patients, 33 males and 49 females, aged between 42 and 87 years (mean age 58.6 yr), presenting edentulous mandibles were rehabilitated with an implant-supported overdenture in the mandible. Three hundred twenty-eight screw-type osseointegrated implants (164 Ha-Ti, Mathys Dental, Bettlach, Switzerland; 84 ITI Dental Implant System, Straumann Institute, Waldenburg, Switzerland; 40 Brånemark Conical, Nobel Biocare AB, Gothenburg, Sweden; 40 Frialoc, Friatec, AG Mannheiti, Germany), were placed in the intraforaminal area of the mental symphysis (4 implants per patient). Immediately after implant placement, a U-shaped gold or titanium bar was fabricated and implants were rigidly connected with the bar and immediately loaded with an implant-retained overdenture. Success rate of implants was evaluated clinically and radiographically every year after the loading of the prostheses according to the following parameters: (1) absence of clinical mobility of implants tested individually after bar removal, (2) absence of periimplant radiolucency evaluated on panoramic radiographs, (3) absence of pain and radiologic or clinical signs of neural lesion, and (4) periimplant bone resorption mesial and distal to each implant less than 0.2 mm after the first year of prosthetic load. RESULTS: Of 328 implants placed, 296 were followed up from a minimum of 36 months to a maximum of 96 months, with a mean follow-up of 62 months. Seven implants in 6 different patients were removed owing to loss of osseointegration, whereas 18 implants, although still osseointegrated, did not fulfill success criteria due to bone resorption > 0.2 mm/year after the first year of loading. Despite implant losses, all patients maintained their bars supporting overdentures, although in 6 patients they were supported by 3 instead of 4 implants. The only patient who lost 2 implants received 2 new implants, which survived normally. Therefore, the absolute success and survival rates were 91.6% and 97.6%, respectively, whereas the cumulative survival and success rates of implants obtained with a life table analysis were 96.1% and 88.2%, respectively. CONCLUSIONS: Results of this study seem to demonstrate that survival and success rates of immediately loaded implants placed in the intraforaminal area of the mandible and rigidly connected with a bar through an implant-supported overdenture are consistent with those reported in the international literature as far as delayed loading is concerned after 3 years of loading. After longer observation times, this study demonstrated that, while survival rates of implants and bar-supported overdentures are still consistent with results published in the international literature pertaining to delayed loading, a moderate decrease in success rates of implants was found. Nevertheless, it must be stressed that this decrease (88.8 and 90.4% after a 7- to 8-year observation period for Ha-Ti and ITI implants) is related only to two implant systems; no data are available for the other two implant systems because of the shorter follow-up period.

Adult↗
PubMed2003

3-year prospective multicenter study on one-stage implant surgery and early loading in the edentulous mandible.

BACKGROUND: The long-term success rates achieved in dental implantology suggest that flexibility might well exist within the various implant systems to a degree that an altered protocol (ie, one-stage surgery and immediate or early loading) can be performed under controlled conditions. However, before variations of the protocol can be considered for general use, they must be subjected to critical analysis, particularly with respect to the predictability of osseointegration, alteration of soft tissue barrier, and relative change in bone height around the implants. PURPOSE: The aim of this prospective multicenter study was to evaluate implant survival and periimplant conditions around endosseous implants placed in a one-stage surgical procedure and early loading. MATERIALS AND METHODS: A total of 170 implants were placed in 40 patients with mandibular edentulism and were functionally loaded within 6 weeks with overdentures (n = 30) or fixed prostheses (n = 10). All patients and prosthetic constructions were evaluated according to a standardized protocol during 3 years of follow-up. Cumulative implant survival rates were calculated, and implant loss in relation to implant size and bone quality and quantity were evaluated. Furthermore, the protocol included assessment of clinical (plaque and bleeding scores, prosthesis stability) and radiographic parameters. RESULTS: Over a period of 3 years, the implant survival rate was 93% for both implants and prostheses (fixed or removable). No implants were lost after the first year of loading. The periimplant tissues were in a healthy condition. Mean marginal bone resorption from the time of loading to the 3-year follow-up was 0.41 mm (SD 0.52). CONCLUSIONS: From this study it may be concluded that early loading results in good implant survival and proper periimplant health in edentulous mandibles.

Adult↗
PubMed2003

Immediate/early loading of dental implants: a report from the Sociedad Española de Implantes World Congress consensus meeting in Barcelona, Spain, 2002.

BACKGROUND: Immediate/early loading protocols are becoming frequently used in implant dentistry, but the prerequisites for achieving good results and the limitations of such protocols are not fully known. Moreover, the terminology used in immediate/early loading is still confusing. PURPOSE: The purpose of this article is to present the outcome of a consensus meeting on immediate/early loading. MATERIALS AND METHODS: A consensus meeting was organized during the Sociedad Española de Implantes World Congress in Barcelona on May 23, 2002, with the objective to present and discuss the experiences from immediate/early loading protocols in dental implant treatment. The purpose was also to discuss definitions of the terminology used in immediate/early loading. The consensus meeting agenda included presentations from invited experts, followed by a consensus discussion. RESULTS: A consensus statement was agreed on. CONCLUSIONS: Multiple independent investigators have demonstrated that immediate/early loading of implants is possible in many clinical situations; however, additional documentation is required.

Dental Implantation, Endosseous↗
PubMed2003

Tapered implants in jaws with soft bone quality: a clinical and radiographic 1-year study of the Brånemark System Mark IV fixture.

BACKGROUND: The survival rate of oral implants in soft-quality bone has been demonstrated to be inferior to that of implants inserted in good-quality bone. A possible way to increase the survival rate in soft-quality bone may be to use a tapered implant. Such an implant has been developed and manufactured by Nobel Biocare AB, Gothenburg, Sweden. So far, there have been only a few publications regarding this implant. PURPOSE: The aim of the study was to compare the outcome of using the tapered Brånemark System Mark IV fixture with the outcome of using earlier Brånemark fixtures in a controlled prospective study. MATERIALS AND METHODS: The study was performed as a multicenter study including seven specialist centers. The material consisted of 40 patients in need of implant-supported bridges in the maxilla. Twenty-five patients belonged to the test group, in which the tapered Mark IV implants were inserted, and 15 patients belonged to the control group, in which Brånemark Standard or Mark II implants were used. The patients were allocated to the test group or the control group according to randomization schedules. The implants were inserted according to the guidelines for Brånemark implants. A two-stage surgical protocol was used, and abutment connection was made 6 months after fixture insertion. The test group comprised 97 Mark IV implants, and the control group made up 92 implants. The prosthetic procedure followed the guidelines for Brånemark implants, and all patients were provided with full fixed maxillary bridges. The patients were followed up with clinical and radiographic records for 1 year after loading. RESULTS: The survival rate was 96.9% for the Mark IV implants and 98.9% for the control implants. There was no significant difference between the two groups. There was a mean marginal bone loss of 0.2 mm during the observation period, and there was no difference between test implants and control implants. CONCLUSIONS: With regard to survival rate and marginal bone level changes, no differences could be demonstrated between the Mark IV tapered implant and the Brånemark implants used earlier. However, compared with earlier results of Brånemark implants in soft-quality bone, the Mark IV implant demonstrated an improved survival rate.

Adult↗
PubMed2003

Immediately loaded bar-connected implants with an anodized surface inserted in the anterior mandible in a patient treated with diphosphonates for osteoporosis: a case report with a 12-month follow-up.

BACKGROUND: It has been suggested that tooth loss is greater in the osteoporotic patient population. Only a few cases have been reported in the literature about the use of dental implants in patients with osteoporosis. Diphosphonates are stable analogs of pyrophosphate, a physiologic regulator of calcification and bone resorption. Multiple implant failures have been reported in a patient undergoing treatment with diphosphonates. Recently, several clinical and experimental reports have shown that immediate loading of dental implants is possible in selected situations. PURPOSE: The aim of this case report was to present the clinical outcome of immediate loading of implants in a patient undergoing diphosphonate treatment for osteoporosis. MATERIALS AND METHODS: In a 65-year-old patient undergoing diphosphonate treatment for osteoporosis, four implants were inserted in the anterior mandible. The implants were connected with a bar supporting an overdenture and were then loaded the same day. RESULTS: No problems occurred in the postoperative period. At 1-year follow-up, all four of the implants appeared to be clinically osseointegrated, and no mobility was present. Minimal bone resorption was present around all implants. CONCLUSIONS: Our case report points to the fact that, contrary to what has been reported in the literature, it is possible to successfully insert and load immediately after surgery dental implants in a patient undergoing diphosphonate treatment for osteoporosis.

Aged↗