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PubMed2004

Surgical and prosthetic concepts for predictable immediate loading of oral implants.

Immediate loading of oral implants is an established concept for lower jaw restoration using four intraforaminal implants splinted together with a bar. There is a lot of misunderstanding in the literature and not exact definition of the term "immediate loading." Moreover, the number of implants to restore edentulous jaws is relatively high to compensate for the loading forces and dependent on the bone quality and quantity. This report presents the different surgical and prosthetic concepts for immediate loading to get long-term success in the upper and lower jaw. When the primary stability is adequate, only six implants may be loaded immediately after surgery, if the implants are splinted using a provisional fixed restoration. Using a number of six primary stable implants, it is possible to restore edentulous jaws independent on the clinical situation. This concept may be used successfully in the posterior part of the mandible when three implants are splinted with provisional crowns and loaded immediately. The biomechanical aspects, the implant design and surface seem to be of great importance for the long-term success in compromised and advanced surgical cases. In conclusion, immediate loading of oral implants may be successful if a primary stability as well as immobilization (splinting) immediately after surgery are taken care.

Dental Abutments↗
PubMedDate not supplied

Immediate versus delayed loading of dental implants in the maxillae of minipigs: follow-up of implant stability and implant failures.

PURPOSE: To assess the course of the stability and the failure rate of dental implants placed in the partially edentulous maxillae of minipigs. MATERIALS AND METHODS: Three months after tooth removal, implants were placed in 9 minipigs. Six implants (XiVE; Friadent, Mannheim, Germany) were placed on each side of the posterior maxilla after preparation of the implant sites either by an osteotome technique or with spiral drills. Implant stability was assessed by resonance frequency analysis (RFA) at the time of placement, at second-stage surgery (which took place after a healing periods of 1, 2, 3, 4, or 5 months), and after a loading period of 6 months. RESULTS: Implant stability was significantly influenced by the healing period (P = .007). Implant stability decreased after 1 to 3 months of healing for both of the placement techniques and increased after a healing period of 4 months. After implant site preparation by an osteotome technique, 6 of 12 immediately loaded implants, 18 of 24 implants loaded after healing periods of 1 to 3 months, and 1 of 18 implants loaded after a healing period of 4 or 5 months were lost. After implant site preparation using spiral drills, 7 of 12 immediately loaded implants, 12 of 24 implants loaded after healing periods of 1 to 3 months, and 2 of 18 implants loaded after healing periods of 4 or 5 months were lost. Broad overlapping of confidence intervals for the number of implant failures revealed that there was no relevant difference between immediate and early functional loading for either of the 2 techniques. DISCUSSION AND CONCLUSION: Implant loading after healing periods of 1 to 3 months did not improve implant survival compared to immediate loading in the posterior maxillae of minipigs. Not until a healing period of 4 months was reached did implant stability begin to increase. Only when functional loading was started at this point in time was maximal implant survival achieved.

Analysis of Variance↗
PubMedDate not supplied

Immediate loading of single-tooth implants in the posterior region.

PURPOSE: The aim of this study was to evaluate the clinical response and safety of immediately loaded single-tooth implants placed in the posterior region of the maxilla and mandible. MATERIALS AND METHODS: Single-tooth implants were placed in healed extraction sites in 20 adult patients. Temporary pre-fabricated acrylic resin crowns were prepared and adjusted. The crown occlusion was adjusted to obtain minimal contacts in maximum intercuspation. After 6 weeks a ceramometal or all-ceramic crown was cemented. Radiographic and clinical examinations were made at baseline and at 3, 6, and 12 months. Cortical bone response and peri-implant mucosal responses were evaluated. RESULTS: The marginal bone level at the time of implant placement was preserved. The mean change in marginal bone level was 0.01 mm at 12 months. The mean Periotest value after 360 days was -4. The peri-implant mucosal adaptation to the anatomic form of the provisional crown resulted in a natural esthetic outcome, and a gain in papilla length was observed. One implant failure was recorded because of provisional luting cement impaction. DISCUSSION: Clinical research has shown that immediate loading is a possible treatment modality. The immediate functional loading of implants placed in this study resulted in bone adaptation to loading. A satisfactory success rate with positive tissue responses was achieved. CONCLUSIONS: The results of this limited investigation indicated that immediate loading of unsplinted single-tooth implants in the posterior region may be a viable treatment option with an esthetic outcome.

Adult↗
PubMedDate not supplied

Success and failure rates of osseointegrated implants in function in regenerated bone for 72 to 133 months.

PURPOSE: Guided bone regenerative therapy has become a significant component of clinical implant practice. Initial reports have demonstrated success rates of implants in regenerated bone under function comparable to the success rates of implants placed in native nonregenerated host bone. This report documents the success and failure rates of osseointegrated implants placed in regenerated bone for up to 133 months in function. MATERIALS AND METHODS: A retrospective analysis of a group of 607 titanium plasma-sprayed cylindric implants placed in regenerated bone, the success and failure rates of which were previously reported at 6 to 51 months in function, were assessed. RESULTS: The implants demonstrated cumulative success rates of 97.2% for the maxilla and 97.4% for the mandible, yielding an overall cumulative success rate of 97.4% for up to 133 months in function. DISCUSSION AND CONCLUSIONS: Titanium plasma-sprayed osseointegrated implants of various diameters, lengths, and designs, utilized in a variety of clinical scenarios, demonstrated functional cumulative success rates comparable to those of implants placed in nonregenerated host bone for extended periods of time in this patient population.

Adult↗
PubMedDate not supplied

Comparative analysis study of 702 dental implants subjected to immediate functional loading and immediate nonfunctional loading to traditional healing periods with a follow-up of up to 24 months.

PURPOSE: The aim of this study was to clinically evaluate immediate functionally loaded (IFL) and immediate nonfunctionally loaded (INFL) implants for various indications compared to a control group with a conventional healing period. MATERIALS AND METHODS: Two hundred fifty-three patients took part in the study. A total of 702 XiVE implants (Dentsply/Friadent, Mannheim, Germany) were placed: 253 IFL implants, 135 INFL implants, and 314 controls. RESULTS: In each of the 3 groups, 2 implants failed. For all the other implants involved, from a clinical and radiographic point of view, osseointegration was successful. DISCUSSION: As long as the prerequisites are fulfilled, immediate functional loading and immediate nonfunctional loading are predictable techniques, not only in completely edentulous patients but also in partially edentulous patients. CONCLUSION: Immediate functional loading and immediate nonfunctional loading appear to be techniques that can provide satisfactory implant success rates in selected cases.

Adult↗
PubMed2005

[Bar construction upon the implants--successful method of treatment of toothless jaws].

Frontal parts of jaws are the most convenient for invasion of sufficient number of supporting implants that can solve the problem of fixation of dentures (prosthesis). Bar Construction upon the implants that have supporting attachments are one of the best fixation systems of removable dentures (prosthesis) on toothless jaws white damaging alveolar ridge. Elastic metal patrice is the same kind of fixation. But the priority of it is the simplicity and cost effectiveness. We have discussed one clinical history. We have made implantation to 78 years old patient, and then we made bar construction and elastic metal patrice for him. After 6 years it will be clear whether this type of construction is successful or not.

Aged↗
PubMed2005

Issues and considerations in dental implant occlusion: what do we know, and what do we need to find out?

Implant dentistry continues to struggle with what are the appropriate occlusal concept(s) for implant-supported restorations. The biological and mechanical consequences of the loading environment leads to establishing and maintaining an implant interface in a wide variety of bone quality and quantity, implant and prosthesis designs. To the restorative dentist, the role of occlusion is more focused on extending the service life of the restoration and the connecting abutment(s) than protecting the osseous integration of the implant(s). This study reviews the relevant issues regarding implant occlusion along with implant and prosthesis design in order to provide optimal patient care.

Animals↗
PubMed2005

Immediate loading in oral implants. Present situation.

The earliest antecedents of immediate loading were introduced by Ledermann in 1979. He placed overdenture in four interforaminal implants on the same day the surgery was carried out. In the original implantological protocol of Brånemark the immediate loading did not appear indicated, currently, it is being presented as a predictable alternative in several studies. We revised different articles on immediate loading from 1997 to 2002. We analysed different variables and concluded that immediate loading produces a success rate in posterior maxilla similar to the differed loading (90-100%). The characteristics of the implant, favourable to immediate loading, are: screw-shaped, with a rough surface, sand blasted and acid etching processed and a minimum length of 10 mm. The initial stability and a micro movement of the implant, inferior to 150 microm and a marginal to the insertion equal or superior to 32 N/cm are defined as a proper osseous. The bruxism stands out as an adverse factor according to several authors.

Crowns↗
PubMedDate not supplied

A resonance frequency analysis assessment of maxillary and mandibular immediately loaded implants.

PURPOSE: This study evaluated the stability of implants in 51 patients following a clinical protocol of immediate functional loading. The stability during the first 3 months following implant placement was assessed according to bone type, implant location, and patient gender. MATERIALS AND METHODS: Twenty-two male and 29 female patients were treated with 344 Brånemark System implants placed in edentulous bone or extraction sites and put into functional loading using the Teeth in a Day protocol. Each implant was tested for primary stability with resonance frequency analysis (RFA) at the time of implant placement, and RFA was performed at examinations 30, 60, and 90 days following surgery. RESULTS: The analysis was based on the 276 implants that were successfully measured using RFA at all postoperative intervals. The clinical implant survival rate was 98.5% for the total population. RFA showed a decrease in bone-implant stability in the first month after implant placement from 70.35 +/- 0.5 to 66.38 +/- 0.50, followed by increases in stability in the second and third months (68.01 +/- 0.50 and 68.82 +/- 0.49, respectively), suggesting a process of adaptive bone remodeling around the implant. In general, lower initial stabilities were seen in softer bone types, in the posterior portions of the jaw compared to anterior areas, and in the female population. DISCUSSION AND CONCLUSION: The results of this study suggest an immediate loading protocol should have an undisturbed period of healing for the first 2 months following implant placement. The determination of "predictor" stability levels for different clinical conditions were based on multiple splinted implants, allowing a larger surface area to withstand the distribution of the load. The most significant "predictor" values from a surgical and prosthodontic perspective are those determined in soft bone, in reduced bone, or in areas where lever arms are created as a result of long spans between the implants.

Adolescent↗
PubMed2005

Immediate loading of mandibular implants in compromised patients: preliminary results.

To minimize the number of implant surgical procedures, a total of 72 single-stage, transgingival Frialoc implants (Friadent) were placed in the mandibles of 18 patients who required implant restoration. The patients' ability to undergo surgical implant treatment was restricted because of either poor general medical health or psychologic conditions. All implants were immediately loaded with a bar-retained overdenture. Only 4 of the 72 immediately loaded Frialoc implants (in one patient) failed over a control period of 29 months. The cumulative implant survival rate was 94.4%. Apart from an initial increase in bone resorption at two posterior implants supporting a cantilever bar (the cantilevers were removed 13 months after delivery of the prosthesis) and serious lip swelling in one patient, there were no further serious surgical, prosthetic, or general medical problems during the treatment period. The initial results of the study indicate that the single-stage Frialoc System allows fast prosthetic mandibular restorations. Because there is only one operation, the risk of local or general health complications in compromised patients is reduced.

Adolescent↗
PubMedDate not supplied

Stability measurements of 1-stage implants in the maxilla by means of resonance frequency analysis: a pilot study.

PURPOSE: The objective of the present study was to determine standard Implant Stability Quotient (ISQ) values for apparently successfully osseointegrated 1-stage implants in the maxilla. MATERIALS AND METHODS: To measure implant stability, resonance frequency analysis (RFA) was performed in 35 patients (18 women, 17 men) with a total of 120 maxillary ITI implants. Based on the time interval between implant placement and measurements, the ISQ values of anterior and posterior implants were divided into subgroups: unloaded (n = 41), loaded < or = 12 months (n = 31), and loaded > 1 year (n = 48). Statistical analysis was performed using a mixed-effects model with the variables lading, implant location, and gender as fixed effects. RESULTS: The mean ISQ of all measured implants was 52.5 +/- 7.9 (range 40 to 68). Statistical analysis showed no significant differences in ISQ values between the 3 tested time intervals: unloaded (48.8 +/- 3.6), loaded < or = 12 months (54.1 +/- 7.0), and loaded > 1 year (53.1 +/- 9.5). Neither for the location in the jaw nor for bone quality (assessed using radiographs) could a significant difference be found. Gender was the only parameter which was found to be significant (P < .003); on average, men showed higher implant stability than women (56.3 +/- 6.6 versus 48.7 +/- 7.4). DISCUSSION: Standard values for osseointegrated maxillary ITI implants exhibited an individual range. Single RFA measurements of an implant do not allow assessment of its current status or prediction of its performance. Repeated measurements over a longer time period would be necessary. CONCLUSIONS: No significant differences in ISQ values were found between implants with regard to loading period or location in the jaw. Postmenopausal women exhibited significantly lower ISQ values compared to men of the same age group.

Adult↗
PubMed2005

[A survey of implant-retained superstructure types in the edentulous mandible in The Netherlands].

Treatment of mandibular edentulousness with endosseous permucosal implants has evolved to a common treatment option during the last decades. In The Netherlands, the relative cheap prosthetic treatment of implant-supported overdentures is considered a qualitatively adequate treatment. The aim of the study described in this article was to survey the treatment of edentulous mandibles by fixed implant-supported prostheses and implant-supported overdentures, and to register the different mesostructures used. All clinics of special dental care and all larger clinics for implant dentistry in The Netherlands received a questionnaire. The data provided showed that more than 90% of patients treated with implants because of mandibular edentulousness, were provided with an overdenture. In 85% of cases a bar-clip mesostructure was used. Cost control was the most important reason to choose an overdenture above a fixed implant-supported prosthesis.

Dental Prosthesis Retention↗
PubMedDate not supplied

The influence of early loading on bony crest height and stability: a pilot study.

PURPOSE: The aim of this prospective pilot study was to investigate differences in changes in implant stability and crestal bone height between loaded and unloaded dental implants at 4 months after placement. MATERIALS AND METHODS: In the test group, 20 implants were placed in the anterior region of the mandible in 10 patients. They were connected with a Dolder bar within 10 days and placed into function immediately. In the control group, 21 implants were placed in the anterior region of the mandible in a 2-stage procedure in 12 patients. The implants used were TiUnite, with a diameter of 3.75 mm and a minimum length of 10 mm. Resonance frequency analysis was used to measure differences in implant stability, with the implant stability quotient (ISQ) as the unit of measure. An instrument was developed to measure the bone level directly. On a customized abutment, a probe with a stopper measured the distance between the shoulder of the instrument and the bone. Measurements were made on all 4 sides of each implant. Intra- and interexaminer variability showed an agreement that was greater than 99% (kappa > 0.99) for both sets of measurements. RESULTS: In the early loading group, the mean change in ISQ was -0.08 +/- 0.77 and the mean bone loss from buccal, mesial, distal, and lingual sites was 0.69 +/- 0.15 mm. In the unloaded group, the mean change in ISQ was 1.33 +/- 1.65 and the mean bone loss from buccal, mesial, distal, and lingual sites was 0.53 +/- 0.18 mm. There was no statistically significant difference across the 2 treatment groups. The changes in bone height at buccal and lingual sites were not statistically different from the changes at mesial and distal sites. When gender was included as a factor, the changes in stability and bone loss were statistically smaller among female patients than among male patients. CONCLUSION: In this preliminary study, early loading did not show an influence on bony crest height and stability in TiUnite implants placed in the anterior mandible during the first 4 months of service.

Alveolar Bone Loss↗
PubMed2005

Evolution of a dental implant practice. The Camlog implant system.

After extensive experience with a variety of implant systems dating back to the late 1960s, the author has begun placing Camlog implants, developed by Dr. Axel Kirsch. The design of this system eliminates the risk of rotation and screw-loosening, while at the same time offering extraordinary ease of use. The treatment of three patients with Camlog implants is described.

Aged↗
PubMedDate not supplied

A prosthodontic technique to improve the simplicity and the efficacy of angled abutments for divergent implant situations: a technical note.

Esthetic demands and nonparallel situations between the axial direction of the suprastructure and the implant require angulation of the abutment. The Conical Seal design avoids microleakage and micromovements after the abutment has been seated and finally retained via screw. However, there is no protection against rotation during the fixation procedure. Therefore, a control device and/or method for a reproduction of correct seating during each treatment step of permanent prosthesis fabrication is desirable. The purpose of this investigation was to develop a device to ensure the correct seating by less expensive, safer, easier, and more precise methods. The sequence of components and the standard procedure required modification: in the modified procedure, the impression is made at the implant level, and the straight implant replica is embedded in the laboratory cast. The angled abutment needs modification by grinding to create small margins in the mesial, distal, and palatal walls. Three materials that are used in daily dental practice are combined to fabricate an individual transfer device. Direct waxup of the restoration onto the angled abutment without a prefabricated component shortens the laboratory processing. The modified sequence and procedure, small alterations of the angled abutment, and an individual transfer device can simplify the transfer procedures, improve clinical performance and applicability, and shorten chair time.

Acrylic Resins↗
PubMed2006

Immediate transition to an implant-supported dentition.

Immediate implant placement and loading is becoming increasingly acceptable. However, to be successful, very careful case selection is required, and even if this is achieved, the clinical situation that develops as soon as the natural teeth are removed may prove much less adequate for implant stability, positioning, and survival than anticipated. It makes sense to "over engineer" a case and to place more implants rather than fewer to ensure adequate support during the critical early phase of therapy, particularly when the implants are loaded at the time of placement. It also should be appreciated that immediate transition induces gross changes that can make it difficult to predict the final esthetic outcome.

Crowns↗