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: BackgroundA successful implant reconstruction with optimal esthetics consists of a visually pleasing prosthesis and complete and healthy surrounding soft tissue. In the current literature, numerous indices used to qualitatively assess esthetics have been described. However, studies comparing the indices and their reproducibility are scarce.PurposeThe aim of this study was to compare three different esthetic indices for the evaluation of single implant-supported crowns.Materials and MethodsA total of 10 prosthodontists (P), 10 orthodontists (O), 10 general dentists (G), and 10 lay people (L) independently performed the same assessment using 30 photographs and corresponding casts with three different esthetic indices (Peri-Implant and Crown Index [PICI], Implant Crown Aesthetic Index [ICAI], “Pink Esthetic Score/White Esthetic Score [PES/WES]) and repeated the evaluations 4 weeks later.ResultsThe PES/WES and the PICI showed significantly higher esthetic scores (pink, white, total) and clinical acceptance compared with the ICAI in all four groups and in both assessments. The highest intraobserver agreement was achieved using the PES/WES and the least with the ICAI. The mean Kappa per group ranged from 0.18 (group L with ICAI) to 0.63 (group G with PICI).Conclusion In comparison with the ICAI, the PES/WES and PICI were more reproducible. Therefore, PES/WES and PICI seem to be more suitable as esthetic indices for single implant crowns.Clinical Implant Dentistry and Related Research 03/2015; DOI:10.1111/cid.12306 · 2.80 Impact Factor
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ABSTRACT: Background Diverging opinions exist regarding rough surface abutment usage, and abutment exclusion effects are unstudied.PurposeThe study aims to: (1) assess tissue response to oxidized or machined abutments or no abutment; and (2) evaluate immediate implant-loading effects.Materials and Methods In a 2005–2008 parallel-group randomized, clinical trial, 50 partially edentulous subjects received three Brånemark TiUnite™ (Nobel Biocare®, Gothenburg, Sweden) implants. Superstructures were attached via abutments (one with a TiUnite surface – AOX, and one with a machine-milled surface – AM) or directly at implant level (IL). Implants were immediately loaded (test) or unloaded for 3 months (control). Postoperative examinations were done up to 3 years.ResultsForty-seven subjects were reexamined after 3 years. Four and two implants were lost in test and control groups, respectively, during the first year. Thereafter, no implant loss occurred (95.7% survival). After 1 year, mean (SEM) peri-implant marginal bone loss (MBL) was 1.33 (0.08) mm (test) and 1.25 (0.08) mm (control). Between 1 and 3 years, a nonsignificant MBL occurred: 0.36 (0.08) mm (test) and 0.33 (0.06) mm (control). Similar MBL was found at IL (1.81 [0.93] mm) and AOX (1.77 [0.14] mm) after 3 years and was significantly lower at AM (1.42 [0.17] mm) than at IL (groups merged); 42% of the implants displayed mucosal bleeding at 3 years and probing pocket depths varied between 2.13 (0.12) mm and 3.62 (0.15) mm, significantly lower buccally. Bleeding on probing (BoP) in minute amounts was found in 30–45% of the sites and abundant BoP at about 20% of the sites. Soft tissue retracted mostly during year 1 and was more pronounced buccally. Regression analyses revealed significant effects from smoking, periodontal disease, abundant BoP, and a low initial implant stability quotient on MBL.Conclusions No further significant MBL was found between 1 and 3 years, irrespective of loading protocol. Use of machined abutments may benefit marginal bone stability over time.Clinical Implant Dentistry and Related Research 04/2015; DOI:10.1111/cid.12315 · 2.80 Impact Factor
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ABSTRACT: RESUMEN La literatura ha establecido que la extracción dentaria siempre es seguida por la reducción de la cresta alveolar en sentido buco-lingual y apico-coronal. Aunque se ha intentado neutralizar esta reabsorción fisiológica con la colocación de injertos óseos e implantes dentales, la mayoría de casos no se ha tenido resultados favorables. El siguiente articulo muestra un reporte de caso donde se perdieron dos implantes pos extracción con restauración inmediata en el tratamiento de una paciente con agenesia de incisivos laterales superiores permanentes (Kiru 2012; 9(2):151-156). Palabras clave: Agenesia dental, implantes dentales, extracción dental, remodelación ósea (Fuente: DeCS BIREME). ABSTRACT The literature has established that dental extraction is always followed by the reduction of the alveolar ridge in bucco-lingual and apico-coronal direction. Although many attempts have been made to neutralize this physiological resorption with bone graft and dental implants placement, most cases had no favorable results. The following article shows a case report where two implants were lost post extraction with immediate restoration in the treatment of a patient with agenesis of permanent upper lateral incisors (Kiru 2012; 9(2):151-156).