Biological complications and peri-implant clinical and radiographic changes at immediately placed dental implants. A prospective 5-year cohort study.
ABSTRACT To evaluate clinically and radiographically immediate implants 5 years after insertion and to compare them with delayed-placed implants in the same subjects
Twenty-two consecutive patients that needed at least two implants for replacing hopeless teeth, one immediately upon extraction and the other in a delayed fashion (at least 4 months post-extraction) were selected in this prospective cohort study. Post-extraction immediate implants (II) and delayed implants (DI) groups were defined. One and 5 years after implant loading, clinical and radiographical outcome variables were recorded and analysed both at site and at implant level. Intra-group and inter-group comparisons were performed.
The intergroup comparison did not show significant differences for plaque index, bleeding on probing and suppuration. These parameters worsen in both groups along the study. This trend was stronger for the plaque index in the group II, which increased from 15.6% at 1 year to 25.9% at 5 years (P < 0.04). One year after loading, the sites with probing depth ≥5 mm were higher for the group II compared to DI (2.5% vs. 0%; P = 0.049). At the end of the study, no significant statistical differences were found. Radiographically, bone crestal changes did not yield significant differences. During the follow-up period, 25% of the implants (26.4% in group II and 23.5% in DI) showed biological complications: mucositis (20%) and/or periimplantitis (5.8%). No differences between groups were found.
Within the same patients, the implants placed with the immediate protocol demonstrated a higher tendency to crestal bone loss and to peri-implantitis, although these differences were not statistically significant.
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ABSTRACT: The purpose of the present investigation was to evaluate methods to detect periods of destructive periodontal disease activity in individual sites using pairs of repeated attachment level measurements. Attachment level measurements were made at 6 sites on every tooth in 22 individuals with radiographic evidence of periodontal destruction, and were repeated within 7 days. A total of 3414 sites were monitored at 2-month intervals for approximately 1 year. 3 analytical procedures were used to test for significant changes in attachment level. For regression analysis, a linear least squares fit function of time in days vs attachment level was computed for each site and the slope tested for difference from 0. Running medians of 3 were used to smooth attachment level measurements and changes greater than 2 mm in the smoothed curves were considered significant. By the tolerance method, differences between pairs of attachment level measurements were used to compare the mean change and the site specific variability of that change. The proportion of specific agreement (Ps) for breaking down sites was highest between the tolerance and running median methods (Ps = 0.63). Overall agreement (kappa), which included sites which showed "loss", "gain", and no change was 0.56. By regression analysis (P less than 0.01), 175 sites were identified as having significant attachment loss and 79 sites were identified as improving. By running medians these figures were 90 and 50, and by tolerance 94 and 40, respectively. Each of the 3 methods had certain advantages. Regression analysis was particularly sensitive to gradual changes in slope whereas the running median method detected abrupt changes in attachment level. The tolerance method was well suited to detecting changes over a short period of time. The tolerance and running median methods detected more breaking down sites on the molars and lower incisors and on interproximal surfaces; whereas regression analysis did not show these differences.Journal Of Clinical Periodontology 06/1983; 10(3):298-310. · 3.69 Impact Factor
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ABSTRACT: This 1-year prospective study evaluated the implant success rate, peri-implant tissue response, and esthetic outcome of immediately placed and provisionalized maxillary anterior single implants. Thirty-five patients (8 men, 27 women) with a mean age of 36.5 years (range 18 to 65) were included in this study. Thirty-five threaded, hydroxyapatite-coated implants were placed and provisionalized immediately after each failing tooth had been removed. The definitive restoration was placed 6 months later. The patients were evaluated clinically and radiographically at implant placement and at 3, 6, and 12 months after implant placement. At 12 months, all implants remained osseointegrated. The mean marginal bone change from the time of implant placement to 12 months was -0.26 +/- 0.40 mm mesially and -0.22 +/- 0.28 mm distally. No significant differences in the Plaque Index scores were noted at different time intervals. The mean midfacial gingival level and mesial and distal papilla level changes from pretreatment to 12 months were -0.55 +/- 0.53 mm, -0.53 +/- 0.39 mm, and -0.39 +/- 0.40 mm, respectively. All patients were very satisfied with the esthetic outcome and none had noticed any changes at the gingival level. Although marginal bone and gingival level changes were statistically significant from pretreatment to 12 months of follow-up, they were well within clinical expectations. The results of this study suggest that favorable implant success rates, peri-implant tissue responses, and esthetic outcomes can be achieved with immediately placed and provisionalized maxillary anterior single implants.The International journal of oral & maxillofacial implants 18(1):31-9. · 1.91 Impact Factor
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ABSTRACT: The aim of this randomized study was to evaluate and compare the long-term success rates of cylindric, screw-type titanium implants with a larger diameter (5.9 mm) that were placed in fresh extraction sockets in association with resorbable bone substitutes or a resorbable membrane. Eighty-three partially edentulous adult patients, selected from among those treated in 1997 and 1998 at the San Raffaele Institute in whom 1 or more implants had been placed into fresh posterior mandibular or maxillary sockets, were included in the study. A total of 111 implants were placed, 36 in mandibles and 75 in maxillae. Fifty-six implants were placed in combination with resorbable hydroxyapatite (HA group) and 55 with a resorbable membrane (MR group). Intraoral radiographs and follow-up examinations, including verification of implant stability via the Periotest, were carried out at second-stage surgery 3, 6, 9, and 12 months later; and then annually up to 4 years after placement of the definitive restoration. The radiographic examination was conducted by means of a standardized procedure to verify osseointegration. There was 100% attendance at the follow-up examination after 4 years. At second-stage surgery, which was performed after 4 to 6 months' healing time, none of the implants showed any signs of mobility, peri-implantitis, or bone loss. Two implants failed in the MR group, one at 3 months and one at 9 months after placement; 1 implant failed in the HA group at 4 months after placement. After 4 years, the implant success rate was 97.3% (108 of 111 implants were considered successful). The success rate did not differ significantly between the HA group (98.2%) and the MR group (96.4%). The use of larger-diameter implants served to minimize the anatomic discrepancies that would have evolved when substituting a molar with a standard-diameter implant. According to the accepted criteria for success, the 5-year success rate should be at least 85%; therefore both methods may be considered satisfactory. Implants placed in combination with a resorbable allogeneic material or with a resorbable membrane provided predictable long-term results when restored with a fixed partial denture.The International journal of oral & maxillofacial implants 18(6):856-64. · 1.91 Impact Factor