Description

This highly regarded, often-cited journal integrates clinical and scientific data to improve methods and results of oral and maxillofacial implant therapy, compiles research, technology, clinical applications, reviews of the literature, and new developments in reconstructive dentistry and implant techniques. Regular features include "Current Issues Forum," which presents opinions of invited experts on controversial issues, and "Literature Review," which keeps readers informed about implant-related publications. Official Journal of the Academy of Osseointegration.

Publications in this journal

• A systematic review of biologic and technical complications with fixed implant rehabilitations for edentulous patients

  Authors: Papaspyridakos P, Chen CJ, Chuang SK, Weber HP, Gallucci GO

  The International journal of oral & maxillofacial implants.

• Oral and maxillofacial surgery.

  Authors: Michael S Block

  The International journal of oral & maxillofacial implants. 26 Suppl:107-8.

• Prosthodontics.

  Authors: Thomas D Taylor

  The International journal of oral & maxillofacial implants. 26 Suppl:110-2.

• Bioengineering in the oral cavity: insights from articular cartilage tissue engineering.

  Authors: Grayson Duraine, Jerry Hu, Kyriacos Athanasoiu

  The International journal of oral & maxillofacial implants. 26 Suppl:11-9; discussion 20-4.

  Cartilage failure in diarthrodial joints results in pain and a reduction in quality of life. The goal of cartilage tissue engineering is to replace or regenerate these mechanically loaded tissues toCartilage failure in diarthrodial joints results in pain and a reduction in quality of life. The goal of cartilage tissue engineering is to replace or regenerate these mechanically loaded tissues to restore function to the joint. Recent advances in the authors' laboratory have resulted in the production of cartilage and fibrocartilage with clinically relevant properties. A review of salient results will constitute the bulk of this manuscript. After providing a brief background of the clinical problem, this review will highlight several specific tissue engineering tools. The approaches used to produce mechanically functional cartilage through tissue engineering have several parallels to the problems faced in osseointegration, eg, the need for mechanically appropriate tissues at the implantation site. The discussion that follows will focus on how approaches developed in identifying alternative cell sources and various exogenous stimuli for producing new cartilage may be applicable to osseointegration.

• Role of adult stem/progenitor cells in osseointegration and implant loosening.

  Authors: Rocky S Tuan

  The International journal of oral & maxillofacial implants. 26 Suppl:50-62; discussion 63-9.

  The long-term stability of prosthetic implants is ultimately a function of the integrity of the biologic interaction between the resident tissues and cells and the biomaterial. Connective tissues ofThe long-term stability of prosthetic implants is ultimately a function of the integrity of the biologic interaction between the resident tissues and cells and the biomaterial. Connective tissues of the skeleton undergo constant remodeling and turnover, and the interface with the implant biomaterial is therefore a dynamic structure that results from ongoing differentiation of progenitor cells into functional cellular phenotypes. An understanding of the regulation of the mechanisms by which progenitor cells initiate and maintain their interactions with the biomaterial surface while undergoing the necessary differentiation processes is thus essential to optimizing the long-term stability of prosthetic implants. This review presents evidence that the interactions between adult mesenchymal stem cells, as the principal progenitor cell type of skeletal connective tissues, and the biomaterial surfaces are influenced by surface chemistry and topography and regulated by the extracellular matrix and growth factors. Mesenchymal stem cells are also the targets of the wear debris particles that are a by-product of implant biomaterials, resulting in direct and microenvironmental effects, including apoptosis, suppression of proliferation and osteogenic differentiation, and the production of proinflammatory cytokines, that compromise the long-term stability of the bone-implant interface. These effects are initiated by endocytosis of the submicron particles by the mesenchymal stem cells. These observations strongly suggest that optimization of the stability of implant osseointegration must address factors that enhance and promote the biologic activities of the stem/progenitor cells of skeletal connective tissues.

• Capturing patient benefits of treatment.

  Authors: Alan Carr, John Wolfaardt, Neal Garrett

  The International journal of oral & maxillofacial implants. 26 Suppl:85-92; discussion 101-2.

  Findings from the Academy of Osseointegration State of the Science on Implant Dentistry Conference clearly demonstrate that data are lacking regarding both quality of design and adequate outcomeFindings from the Academy of Osseointegration State of the Science on Implant Dentistry Conference clearly demonstrate that data are lacking regarding both quality of design and adequate outcome measures (standardization, validity, and relevance to patient) to support an evidence-based systematic evaluation of implant efficacy. Despite the dearth of controlled trials and the variability in defining implant survival/success, the preponderance of evidence is viewed as lending support for consideration of dental implant therapy as a safe and predictable alternative to conventional restorations for many applications. However, this minimal conclusion undermines the best intentions of the dental profession, which is striving to substantiate to the patient, third-party providers, and the government the relative benefits and risks of various prosthetic treatment alternatives. The conclusions of multiple consensus conferences have repeatedly stressed that additional research with good strength of evidence following a broad spectrum of outcomes is vital to extend the breadth of conclusions regarding dental implant treatment efficacy. However, without a set of consensus-based core outcome measures addressing pertinent clinical and patient-centered factors, future expensive, time-consuming, and technically complex clinical studies may suffer the same critical flaws seen in the current body of research. It may be possible and useful to establish a core set of well-defined, discriminatory, and feasible outcome measures for common utilization and a hierarchy of additional recommended outcome measures for specific benefit categories. Such a standardized group of outcome measures would be likely to significantly enhance the potential for future research. In addition, with the formation of consensus guidelines, there would be an opportunity for scientific journals to promote the quality of implant dentistry research by suggesting the inclusion of these core outcome measures in studies submitted for publication.

• Periodontics.

  Authors: Myron Nevins

  The International journal of oral & maxillofacial implants. 26 Suppl:109.

• The Academy of Osseointegration Silver Anniversary Summit: impact of biological and technological advances on implant dentistry. Introduction.

  Authors: Peter K Moy, Vincent J Iacono

  The International journal of oral & maxillofacial implants. 26 Suppl:7-10.

• Nanotechnology approaches to improve dental implants.

  Authors: Antoni P Tomisa, Maximilien E Launey, Janice S Lee, Mahesh H Mankani, Ulrike G K Wegst, Eduardo Saiz

  The International journal of oral & maxillofacial implants. 26 Suppl:25-44; discussion 45-9.

  The requirements imposed by the enormous scale and overall complexity of designing new implants or complete organ regeneration are well beyond the reach of present technology in many dimensions,The requirements imposed by the enormous scale and overall complexity of designing new implants or complete organ regeneration are well beyond the reach of present technology in many dimensions, including nanoscale, as researchers do not yet have the basic knowledge required to achieve these goals. The need for a synthetic implant to address multiple physical and biologic factors imposes tremendous constraints on the choice of suitable materials. There is a strong belief that nanoscale materials will produce a new generation of implant materials with high efficiency, low cost, and high volume. The nanoscale in materials processing is truly a new frontier. Metallic dental implants have been used successfully for decades, but they have serious shortcomings related to their osseointegration and the fact that their mechanical properties do not match those of bone. This paper reviews recent advances in the fabrication of novel coatings and nanopatterning of dental implants. It also provides a general summary of the state of the art in dental implant science and describes possible advantages of nanotechnology for future improvements. The ultimate goal is to produce materials and therapies that will bring state-of-the-art technology to the bedside and improve quality of life and current standards of care.

• The use of soluble signals to harness the power of the bone microenvironment for implant therapeutics.

  Authors: Erica L Scheller, Paul H Krebsbach

  The International journal of oral & maxillofacial implants. 26 Suppl:70-9; discussion 80-4.

  The use of soluble signals for modulation of bone formation has become a significant area of clinical research in recent years. Improvements in implant site preparation and osseointegration haveThe use of soluble signals for modulation of bone formation has become a significant area of clinical research in recent years. Improvements in implant site preparation and osseointegration have already been achieved with the use of recombinant platelet-derived growth factor and bone morphogenetic proteins on osteogenic scaffolds. Other states of insufficient bone such as osteoporosis are frequently treated with inhibitors of osteoclast function or osteoblast anabolic agents. However, despite the existence of promising therapies targeting osteoblasts and osteoclasts directly, therapies utilizing indirect regulation through secondary cellular nodes of control (NOC) are just beginning to emerge. This article will review current strategies for regulation of bone formation by targeting two primary NOCs, the osteoblast and osteoclast, as well as four secondary NOCs, the vascular, hematopoietic, mesenchymal, and neural.

• Health technology assessment in oral health.

  Authors: Shahrokh Esfandiari, Jocelyne Feine

  The International journal of oral & maxillofacial implants. 26 Suppl:93-100; discussion 101-2.

  Health-care costs are rising at an alarmingly fast rate worldwide, particularly in developed countries such as the United States. This is predominantly a result of the development of new, high-costHealth-care costs are rising at an alarmingly fast rate worldwide, particularly in developed countries such as the United States. This is predominantly a result of the development of new, high-cost health technologies intended for improved diagnosis and treatment. The purpose of health technology assessment is to systematically determine the true benefits of new technologies, taking into account clinical efficacy/effectiveness and cost as well as societal preference and ethical issues. In this report, the purpose of health technology assessment is explained in light of new developments in oral health technology, particularly intraoral implants. This information is intended to educate and to challenge oral health opinion leaders to consider all of the issues involved in the development and diffusion of new oral health technologies.

• Systemic conditions and treatments as risks for implant therapy.

  Authors: Michael M Bornstein, Norbert Cionca, Andrea Mombelli

  The International journal of oral & maxillofacial implants. 24 Suppl:12-27.

  To evaluate whether systemic diseases with/without systemic medication increase the risk of implant failure and therefore diminish success and survival rates of dental implants. A MEDLINE search wasTo evaluate whether systemic diseases with/without systemic medication increase the risk of implant failure and therefore diminish success and survival rates of dental implants. A MEDLINE search was undertaken to find human studies reporting implant survival in subjects treated with osseointegrated dental implants who were diagnosed with at least one of 12 systemic diseases. For most conditions, no studies comparing patients with and without the condition in a controlled setting were found. For most systemic diseases there are only case reports or case series demonstrating that implant placement, integration, and function are possible in affected patients. For diabetes, heterogeneity of the material and the method of reporting data precluded a formal meta-analysis. No unequivocal tendency for subjects with diabetes to have higher failure rates emerged. The data from papers reporting on osteoporotic patients were also heterogeneous. The evidence for an association between osteoporosis and implant failure was low. Nevertheless, some reports now tend to focus on the medication used in osteoporotic patients, with oral bisphosphonates considered a potential risk factor for osteonecrosis of the jaws, rather than osteoporosis as a risk factor for implant success and survival on its own. The level of evidence indicative of absolute and relative contraindications for implant therapy due to systemic diseases is low. Studies comparing patients with and without the condition in a controlled setting are sparse. Especially for patients with manifest osteoporosis under an oral regime of bisphosphonates, prospective controlled studies are urgently needed.

• History of treated periodontitis and smoking as risks for implant therapy.

  Authors: Lisa J A Heitz-Mayfield, Guy Huynh-Ba

  The International journal of oral & maxillofacial implants. 24 Suppl:39-68.

  The aim of this review was to evaluate a history of treated periodontitis and smoking, both alone and combined, as risk factors for adverse dental implant outcomes. A literature search of MEDLINEThe aim of this review was to evaluate a history of treated periodontitis and smoking, both alone and combined, as risk factors for adverse dental implant outcomes. A literature search of MEDLINE (Ovid) and EMBASE from January 1, 1966, to June 30, 2008, was performed, and the outcome variables implant survival, implant success, occurrence of peri-implantitis and marginal bone loss were evaluated. Considerable heterogeneity in study design was found, and few studies accounted for confounding variables. For patients with a history of treated periodontitis, the majority of studies reported implant survival rates > 90%. Three cohort studies showed a higher risk of peri-implantitis in patients with a history of treated periodontitis compared with those without a history of periodontitis (reported odds ratios from 3.1 to 4.7). In three of four systematic reviews, smoking was found to be a significant risk for adverse implant outcome. While the majority of studies reported implant survival rates ranging from 80% to 96% in smokers, most studies found statistically significantly lower survival rates than for nonsmokers. There is an increased risk of peri-implantitis in smokers compared with nonsmokers (reported odds ratios from 3.6 to 4.6). The combination of a history of treated periodontitis and smoking increases the risk of implant failure and peri-implant bone loss.

• Consensus statements and recommended clinical procedures regarding risk factors in implant therapy.

  Authors: David L Cochran, Søren Schou, Lisa J A Heitz-Mayfield, Michael M Bornstein, Giovanni E Salvi, William C Martin

  The International journal of oral & maxillofacial implants. 24 Suppl:86-9.

• Computer-aided design and computer-assisted manufacturing in prosthetic implant dentistry.

  Authors: Theodoros Kapos, Linah M Ashy, German O Gallucci, Hans-Peter Weber, Daniel Wismeijer

  The International journal of oral & maxillofacial implants. 24 Suppl:110-7.

  The aim of this systematic review was to evaluate the existing scientific evidence on human clinical studies describing the application of computer-aided design/computer-assisted manufacturingThe aim of this systematic review was to evaluate the existing scientific evidence on human clinical studies describing the application of computer-aided design/computer-assisted manufacturing (CAD/CAM) technology in restorative implant dentistry. Electronic searches for clinical studies from 1966 through May 2008 focusing on long-term follow-up were performed using the PubMed search engine. Concentrating on the restorative aspect of the CAD/CAM technology applicable to implant dentistry, pertinent literature was divided into articles related to implant abutments and implant frameworks. Of the 885 articles initially reviewed, 5 articles (3 CAD/CAM framework and 2 CAD/CAM abutment) satisfied the search criteria of the literature search performed. Combining the results from the framework clinical trial studies, there were a total of 189 prostheses supported by 888 implants. The follow-up varied between 12 and 60 months. Four implants were lost prior to the insertion of the prosthesis and 46 after the insertion. One prosthesis failure was reported. Similarly, in the 2 abutment clinical trial studies there were a total of 53 ceramic abutments supported by 53 implants. The patients were followed between 12 and 44 months. No significant failures or complications were reported in association with the implants and their restorations. Based on a systematic review of literature concerning CAD/CAM used for fabrication of frameworks and abutments, preliminary proof of concept was established. Clinical studies on the use of these techniques were too preliminary and underpowered to provide meaningful conclusions regarding the performance of these abutments/frameworks.

• Consensus statements and recommended clinical procedures regarding computer-assisted implant dentistry.

  Authors: Christoph H F Hämmerle, Paul Stone, Ronald E Jung, Theodoros Kapos, Nadine Brodala

  The International journal of oral & maxillofacial implants. 24 Suppl:126-31.

• Implant loading protocols for partially edentulous maxillary posterior sites.

  Authors: Mario Roccuzzo, Marco Aglietta, Luca Cordaro

  The International journal of oral & maxillofacial implants. 24 Suppl:147-57.

  To evaluate early and immediate loading of implants in the posterior maxilla and to investigate whether there is a difference in success rates, survival rates, and peri-implant parameters, includingTo evaluate early and immediate loading of implants in the posterior maxilla and to investigate whether there is a difference in success rates, survival rates, and peri-implant parameters, including marginal bone level changes. A comprehensive systematic review of the literature was conducted. The selection of publications reporting on human clinical studies was based on predetermined inclusion criteria and was agreed upon by two reviewers. Twelve papers were identified on early loading (two randomized controlled clinical trials [RCTs] and 10 prospective case series studies). Six papers were found on immediate loading (one RCT, four prospective case series, and one retrospective study). Under certain circumstances it is possible to successfully load dental implants in the posterior maxilla early or immediately after their placement in selected patients. The success rate appears to be technique sensitive, although no study has directly assessed this. A high degree of primary implant stability (high value of insertion torque) and implant surface characteristics play an important role. It is not possible to draw evidence-based conclusions concerning contraindications, threshold values for implant stability, bone quality and quantity needed, or impact of occlusal loading forces. As for the impact of the surgical technique on implant outcome in different bone densities, no studies prove significant superior results with one technique over another. Well-designed RCTs with a large number of patients are necessary to make early/immediate loading protocols in posterior maxilla evidence based, but ethical and practical considerations may limit the real possibility of such studies in the near future.

• Implant loading protocols for the partially edentulous esthetic zone.

  Authors: Linda Grütter, Urs C Belser

  The International journal of oral & maxillofacial implants. 24 Suppl:169-79.

  The scientific evidence related to different or novel implant loading (primary objective) and directly associated implant placement (secondary objective) protocols developed for the anterior maxillaeThe scientific evidence related to different or novel implant loading (primary objective) and directly associated implant placement (secondary objective) protocols developed for the anterior maxillae of partially edentulous patients was reviewed. A comprehensive search of electronic databases and a hand search of six relevant journals was performed. The principal outcome variables were implant survival, implant success, and esthetic appearance. Concerning esthetic treatment outcomes, articles were specifically screened for the presence of objective evaluation parameters and patient satisfaction assessment. The analysis of the literature on immediately restored or conventionally loaded implants in the esthetic zone revealed an initial survival rate of 97.3% after 1 year (10 prospective cohort studies and one case series). For periods of 1 to 5 years, the survival rate was 96.7%. These survival rates are consistent with previous reports on more traditional loading modalities. However, for immediately placed implants with immediate restoration and occlusal loading, the survival rate dropped by approximately 10% (four studies). Success criteria such as stable crestal bone levels, soft tissue recession, and probing depth could not be evaluated on the basis of the available literature. There is a paucity of prospective cohort studies addressing patient-centered outcomes. No parameters specific to immediate loading protocols were available for evaluation. In order to validate or reject such implant protocols for use in the esthetically sensitive anterior maxilla, long-term clinical trials should routinely include objective esthetic criteria that comprehensively embrace the pertinent elements of "pink and white esthetics" in the form of readily used indices.

• Clinical and esthetic outcomes of implants placed in postextraction sites.

  Authors: Stephen T Chen, Daniel Buser

  The International journal of oral & maxillofacial implants. 24 Suppl:186-217.

  The aim of this review was to evaluate the clinical outcomes for the different time points of implant placement following tooth extraction. A PubMed search and a hand search of selected journals wereThe aim of this review was to evaluate the clinical outcomes for the different time points of implant placement following tooth extraction. A PubMed search and a hand search of selected journals were performed to identify clinical studies published in English that reported on outcomes of implants in postextraction sites. Only studies that included 10 or more patients were accepted. For implant success/survival outcomes, only studies with a mean follow-up period of at least 12 months from the time of implant placement were included. The following outcomes were identified: (1) change in peri-implant defect dimension, (2) implant survival and success, and (3) esthetic outcomes. Of 1,107 abstracts and 170 full-text articles considered, 91 studies met the inclusion criteria for this review. Bone augmentation procedures are effective in promoting bone fill and defect resolution at implants in postextraction sites, and are more successful with immediate (type 1) and early placement (type 2 and type 3) than with late placement (type 4). The majority of studies reported survival rates of over 95%. Similar survival rates were observed for immediate (type 1) and early (type 2) placement. Recession of the facial mucosal margin is common with immediate (type 1) placement. Risk indicators included a thin tissue biotype, a facial malposition of the implant, and a thin or damaged facial bone wall. Early implant placement (type 2 and type 3) is associated with a lower frequency of mucosal recession compared to immediate placement (type 1).

• Bone augmentation procedures in implant dentistry.

  Authors: Matteo Chiapasco, Paolo Casentini, Marco Zaniboni

  The International journal of oral & maxillofacial implants. 24 Suppl:237-59.

  This review evaluated (1) the success of different surgical techniques for the reconstruction of edentulous deficient alveolar ridges and (2) the survival/success rates of implants placed in theThis review evaluated (1) the success of different surgical techniques for the reconstruction of edentulous deficient alveolar ridges and (2) the survival/success rates of implants placed in the augmented areas. Clinical investigations published in English involving more than 10 consecutively treated patients and mean follow-up of at least 12 months after commencement of prosthetic loading were included. The following procedures were considered: onlay bone grafts, sinus floor elevation via a lateral approach, Le Fort I osteotomy with interpositional grafts, split ridge/ridge expansion techniques, and alveolar distraction osteogenesis. Full-text articles were identified using computerized and hand searches by key words. Success and related morbidity of augmentation procedures and survival/success rates of implants placed in the augmented sites were analyzed. A wide range of surgical procedures were identified. However, it was difficult to demonstrate that one surgical procedure offered better outcomes than another. Moreover, it is not yet known if some surgical procedures, eg, reconstruction of atrophic edentulous mandibles with onlay autogenous bone grafts or maxillary sinus grafting procedures in case of limited/moderate sinus pneumatization, improve long-term implant survival. Every surgical procedure presents advantages and disadvantages. Priority should be given to those procedures which are simpler and less invasive, involve less risk of complications, and reach their goals within the shortest time frame. The main limit encountered in this literature review was the overall poor methodological quality of the published articles. Larger well-designed long-term trials are needed.

• Consensus statements and recommended clinical procedures regarding surgical techniques.

  Authors: Stephen T Chen, Jay Beagle, Simon Storgard Jensen, Matteo Chiapasco, Ivan Darby

  The International journal of oral & maxillofacial implants. 24 Suppl:272-8.

• Local risk factors for implant therapy.

  Authors: William Martin, Emma Lewis, Ailsa Nicol

  The International journal of oral & maxillofacial implants. 24 Suppl:28-38.

  The aim of this review was to determine the effect of several potential local risk factors on implant survival and success (primary outcomes) as well as on mucosal recession, bleeding on probing, andThe aim of this review was to determine the effect of several potential local risk factors on implant survival and success (primary outcomes) as well as on mucosal recession, bleeding on probing, and proximal marginal bone loss (secondary outcomes). A comprehensive review of the literature was conducted. The selection of publications reporting on human clinical studies was based on predetermined inclusion criteria and was agreed upon by three reviewers. After title and abstract screening of 2,681 publications obtained from the search, 19 articles were deemed to be relevant to the topic and the search criteria. Limited data show that when an implant is placed within 3 mm of the neighboring tooth, proximal bone is at risk. The data regarding the placement of implants into infected sites are still insufficient, but studies have shown that this may be possible. Soft tissue thickness has not been shown to be a risk factor in implant survival. There is also no evidence to support a relationship between the width of keratinized tissue and implant survival. No studies were found that directly related bone density to implant survival. Implant stability was also difficult to examine due to the lack of validated stability measures. One critical factor that faced the group during the review of the literature and interpretation of the data was the multifactorial nature of implant therapy. This makes isolation of specific risk factors difficult. Conclusions are limited by the current lack of quality clinical trials in this area.

• Mechanical and technical risks in implant therapy.

  Authors: Giovanni E Salvi, Urs Brägger

  The International journal of oral & maxillofacial implants. 24 Suppl:69-85.

  To systematically appraise the impact of mechanical/technical risk factors on implant-supported reconstructions. A MEDLINE (PubMed) database search from 1966 to April 2008 was conducted. The searchTo systematically appraise the impact of mechanical/technical risk factors on implant-supported reconstructions. A MEDLINE (PubMed) database search from 1966 to April 2008 was conducted. The search strategy was a combination of MeSH terms and the key words: design, dental implant(s), risk, prosthodontics, fixed prosthodontics, fixed partial denture(s), fixed dental prosthesis (FDP), fixed reconstruction(s), oral rehabilitation, bridge(s), removable partial denture(s), overdenture(s). Randomized controlled trials, controlled trials, and prospective and retrospective cohort studies with a mean follow-up of at least 4 years were included. The material evaluated in each study had to include cases with/without exposure to the risk factor. From 3,568 articles, 111 were selected for full text analysis. Of the 111 articles, 33 were included for data extraction after grouping the outcomes into 10 risk factors: type of retentive elements supporting overdentures, presence of cantilever extension(s), cemented versus screw-retained FDPs, angled/angulated abutments, bruxism, crown/implant ratio, length of the suprastructure, prosthetic materials, number of implants supporting an FDP, and history of mechanical/technical complications. The absence of a metal framework in overdentures, the presence of cantilever extension(s) > 15 mm and of bruxism, the length of the reconstruction, and a history of repeated complications were associated with increased mechanical/technical complications. The type of retention, the presence of angled abutments, the crown-implant ratio, and the number of implants supporting an FDP were not associated with increased mechanical/technical complications. None of the mechanical/technical risk factors had an impact on implant survival and success rates.

• Computer technology applications in surgical implant dentistry: a systematic review.

  Authors: Ronald E Jung, David Schneider, Jeffrey Ganeles, Daniel Wismeijer, Marcel Zwahlen, Christoph H F Hämmerle, Ali Tahmaseb

  The International journal of oral & maxillofacial implants. 24 Suppl:92-109.

  To assess the literature on accuracy and clinical performance of computer technology applications in surgical implant dentistry. Electronic and manual literature searches were conducted to collectTo assess the literature on accuracy and clinical performance of computer technology applications in surgical implant dentistry. Electronic and manual literature searches were conducted to collect information about (1) the accuracy and (2) clinical performance of computer-assisted implant systems. Meta-regression analysis was performed for summarizing the accuracy studies. Failure/complication rates were analyzed using random-effects Poisson regression models to obtain summary estimates of 12-month proportions. Twenty-nine different image guidance systems were included. From 2,827 articles, 13 clinical and 19 accuracy studies were included in this systematic review. The meta-analysis of the accuracy (19 clinical and preclinical studies) revealed a total mean error of 0.74 mm (maximum of 4.5 mm) at the entry point in the bone and 0.85 mm at the apex (maximum of 7.1 mm). For the 5 included clinical studies (total of 506 implants) using computer-assisted implant dentistry, the mean failure rate was 3.36% (0% to 8.45%) after an observation period of at least 12 months. In 4.6% of the treated cases, intraoperative complications were reported; these included limited interocclusal distances to perform guided implant placement, limited primary implant stability, or need for additional grafting procedures. Differing levels and quantity of evidence were available for computer-assisted implant placement, revealing high implant survival rates after only 12 months of observation in different indications and a reasonable level of accuracy. However, future long-term clinical data are necessary to identify clinical indications and to justify additional radiation doses, effort, and costs associated with computer-assisted implant surgery.

• Flapless surgery and its effect on dental implant outcomes.

  Authors: Nadine Brodala

  The International journal of oral & maxillofacial implants. 24 Suppl:118-25.

  The aim of this article was to review the current literature with regard to the efficacy and effectiveness of flapless surgery for endosseous dental implants. The available data were evaluated forThe aim of this article was to review the current literature with regard to the efficacy and effectiveness of flapless surgery for endosseous dental implants. The available data were evaluated for short- and long-term outcomes. A MEDLINE search was conducted on studies published between 1966 and 2008. For the purpose of this review, only clinical (human) studies with five or more subjects were included, and clinical opinion papers were excluded. Clinical studies or reports were further rated in terms of the level or weight of evidence using criteria defined by the Oxford Center for Evidence-Based Medicine in 2001. The available data on flapless technique indicate high implant survival overall. The prospective cohort studies demonstrated approximately 98.6% (95% CI: 97.6 to 99.6) survival, suggesting clinical efficacy, while the retrospective studies or case series demonstrated 95.9% (95% CI: 94.8 to 97.0) survival, suggesting effective treatment. Six studies reported mean radiographic alveolar bone loss ranging from 0.7 to 2.6 mm after 1 year of implant placement. Intraoperative complications were reported in four studies, and these included perforation of the buccal or lingual bony plate. Overall, the incidence of intraoperative complications was 3.8% of reported surgical procedures. Flapless surgery appears to be a plausible treatment modality for implant placement, demonstrating both efficacy and clinical effectiveness. However, these data are derived from short-term studies with a mean interval of 19 months, and a successful outcome with this technique is dependent on advanced imaging, clinical training, and surgical judgment.

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