Implant loading protocols for the partially edentulous esthetic zone.
ABSTRACT The 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.
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ABSTRACT: Background To assess the suitability of dental implants for immediate loading, primary stability is usually evaluated intraoperatively.PurposeThis retrospective study aimed to assess the suitability of three stability parameters – namely, insertion torque (IT), implant stability quotient (ISQ; measured by resonance frequency analysis), and Periotest (PT) values – as potential predictors for the risk of nonosseointegration of immediately loaded splinted implants. The stability parameters were routinely collected under immediate loading.Materials and Methods Nineteen patients with 11 edentulous and 8 partially edentulous maxillae were treated with 105 dental implants, which were immediately loaded using temporary fixed dentures. The IT results, PT values, and ISQ results were recorded. Receiver operating characteristic analysis was performed to assess the quality of each parameter as a diagnostic test.ResultsAfter a 3-month observation period, 11 implants in four patients were not osseointegrated. The IT and ISQ (IT 25.0 ± 12.5 Ncm and 8.4 ± 2.3 Ncm; PT −1.5 ± 3.0 and +2.7 ± 3.0; and ISQ 62.6 ± 6.7 and 54.7 ± 6.2) differed significantly between the osseointegrated and failed implants (p < .005). The IT showed the greatest specificity at a sensitivity of 1 and the greatest area under the curve (AUC; 0.929), followed by the PT value (AUC = 0.836) and ISQ (AUC = 0.811).Conclusions Among the intraoperative parameters analyzed, IT showed the highest specificity at a high sensitivity of 1. Therefore, the IT can be considered the most valid prognostic factor for osseointegration of immediately loaded splinted dental implants.Clinical Implant Dentistry and Related Research 01/2015; · 3.82 Impact Factor
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ABSTRACT: To assess the survival percentage, clinical and radiographic outcomes of sandblasted and acid-etched (SLA) dental implants and its modified surface (SLActive) in protocols involving immediate and early occlusal loading. MEDLINE, EMBASE and the Cochrane Oral Health Group's Trials Register CENTRAL were searched in duplicate up to, and including, June 2013 to include randomised controlled trials (RCTs) and prospective observational studies of at least 6-month duration published in all languages. Studies limited to patients treated with SLA and/or SLActive implants involving a treatment protocol describing immediate and early loading of these implants were eligible for inclusion. Data on clinical and/or radiographic outcomes following implant placement were considered for inclusion. Of the 447 potentially eligible publications identified by the search strategy, seven RCTs comprising a total of 853 implants (8% titanium plasma-sprayed, 41.5% SLA and 50.5% SLActive) and 12 prospective observational studies including 1394 SLA and 145 SLActive implants were included in this review. According to the Cochrane Collaboration's tool for assessing risk of bias, one of the studies was considered to be at a low risk of bias, whereas the remaining studies were considered to be at an unclear risk. Regarding the observational studies, all of them presented a medium methodological quality based on the Modified Newcastle-Ottawa scale. There were no significant differences reported in the studies in relation to implant loss or clinical parameters between the immediate/early loading and delayed loading protocols. Overall, 95% of SLA and 97% of SLActive implants still survive at the end of follow-up. Despite of the positive findings achieved by the included studies, few RCTs were available for analysis for SLActive implants. Study heterogeneity, scarcity of data and the lack of pooled estimates represent a limitation between studies' comparisons and should be considered when interpreting the present findings.Clinical Oral Implants Research 02/2014; · 3.43 Impact Factor
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ABSTRACT: Background and aims. Maintenance of interdental soft tissue and the need for aesthetics are increasingly recognized as important criteria for implant success. The aim of this prospective clinical study was to compare the peri-implant and prosthetic conditions for single-tooth implants, placed according to the immediate (Im) and the delayed (De) placement protocols at 18-month follow-up examination. Materials and methods. After random allocation to the Immediate and Delayed groups, 14 patients were treated with a single-tooth implant in the anterior or molar region of the maxilla or the mandible immediately (Im) or 6 months (De) after tooth extraction, respectively. Patients attended a follow-up visit 18 months after implant placement corresponding to one year of loading of the implant restorations. Peri-implant and prosthetic parameters were evaluated clinically and marginal bone levels were measured on radiographs. Results. None of the implant restorations had failed after one year of function. Probing pocket depths decreased by up to 1.5 mm on average from the time of loading to the 18-month follow-up, no significant difference between the Im and De groups was found (4.3 versus 4.2 mm). A statistically significant radiographic marginal bone loss had occurred in the Im group (13.46%) as well as in the De group (15.62%) in the follow-up period. Conclusion. Soft and hard tissue responses to single-tooth implants placed either in the anterior or molar region of the maxilla or the mandible immediately (Im) or 6 months (De) after tooth ex04/2013, Degree: MDS, Supervisor: Sugumari Elavarasu