Tilted Implants in the Immediate Loading Rehabilitation of the Maxilla: A Systematic Review

Article (PDF Available)inJournal of dental research 91(9):821-7 · July 2012with363 Reads
DOI: 10.1177/0022034512455802 · Source: PubMed
Tilted implants have been proposed as an alternative to traditional protocols in the rehabilitation of edentulous maxillae. The aim of this meta-analysis was to evaluate the outcomes of upright and tilted implants supporting full-arch fixed dentures for the immediate rehabilitation of edentulous maxillae, after at least 1 year of function. An electronic search of databases and a hand search of relevant journals in oral implantology were performed according to PRISMA guidelines through August, 2011. The literature search yielded 1,069 articles. Eleven articles were available for analysis. A total of 1,623 implants (778 tilted, 845 upright) were inserted into the maxillae of 324 patients. Seventeen tilted (2.19%) and 16 upright implants (1.89%) failed during the first year. No significant difference in failure rate was found between tilted and upright implants (p value = 0.52). Marginal bone level results were obtained from 6 studies. A non-significant mean difference between tilted and upright implants was found with regard to bone loss. Tilted implants demonstrated a favorable short-term prognosis in full-arch immediate loading rehabilitations of the maxillae. Randomized long-term trials are needed to better elucidate long-term success of tilted vs. upright-positioned implants.

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    • "The drawbacks of these procedures are more complications, longer treatment time, more costs, higher morbidity and post-operative discomfort for the patient (Milinkovic & Cordaro 2014). The question could rise whether in cases without aesthetic demands these invasive treatments are justified when less invasive options are available such as tilted implants (Menini et al. 2012), short implants (Annibali et al. 2012b), cantilever extensions on implants (Aglietta et al. 2009) and the,rarely used, cantilever extensions on natural teeth (Pjetursson et al. 2004;Tan et al. 2004). "
    [Show abstract] [Hide abstract] ABSTRACT: Whenever bone of sufficient quantity and quality is available, oral implants are considered to be a valuable treatment option to replace missing teeth. Consequently implants became part of mainstream dentistry (Adell et al. 1981;Albrektsson et al. 1981). Survival rates of over 95% in non-compromised patients have been reported (den Hartog et al. 2008). Unfortunately, an oral implant does not always osseointegrate. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Article · Feb 2015
    • "No further quality assessment of the publications was carried out. A total of 42 review articles dealt with comparative evaluation relevant to clinical decision making related to 14 surgical and six prosthodontic issues of oral implant therapy: one review on administration of antibiotics (Esposito et al. 2013a,b), one on bone-level vs. tissue-level implants (Vouros et al. 2012), 2 on diabetes mellitus (Salvi et al. 2008; Bornstein et al. 2009), one on flapless implant placement (Esposito et al. 2012), 2 on tilted implant placement (Menini et al. 2012; Monje et al. 2012), 2 on rough implant surfaces (Shalabi et al. 2006; Esposito et al. 2007), one on hydroxyapatite-coated implants (Alsabeeha et al. 2012 ), one on ceramic vs. titanium abutments (Linkevicius & Apse 2008), 3 on short dental implants (Kotsovilis et al. 2009; Pommer et al. 2011c; Monje et al. 2013), one on osteoporosis (Bornstein et al. 2009), one on overdentures vs. cross-arch bridges (Bryant et al. 2007), 4 on patients with a history of periodontal disease (Karoussis et al. 2007; Ong et al. 2008; Schou 2008; Safii et al. 2010 ), 2 on platform switching (Atieh et al. 2010a,b; Annibali et al. 2012), one on radiation therapy (Chambrone et al. 2013), 3 on smoking (Hinode et al. 2006; Strietzel et al. 2007; Clementini et al. 2014), 3 on bone substitutes vs. autogenous bone in sinus floor augmentation surgery (Esposito et al. 2010a,b; Jensen et al. 2012; Rickert et al. 2012), 9 on immediate prosthetic loading (Ioannidou & Doufexi 2005; Kawai & Taylor 2007; Rutkunas et al. 2008; Atieh et al. 2009a Atieh et al. ,b, 2010a Alsabeeha et al. 2010; Esposito et al. 2013a,b; Suarez et al. 2013), 4 on immediate implant placement (Quirynen et al. 2007; den Hartog et al. 2008; Atieh et al. 2009a,b; Esposito et al. 2010a,b), one on submucosal vs. transmucosal healing modality (Esposito et al. 2009 ) and one on cementvs . screw-retained prosthetic restoration (de Brand~ ao et al. 2013). "
    [Show abstract] [Hide abstract] ABSTRACT: To investigate the impact of meta-analytic evidence in scientific literature on clinical decision making in the field of oral implantology. A Delphi opinion poll was performed at the meeting of the "Next Generation" Committees of the Austrian, German and Swiss Societies for Implantology (ÖGI, DGI and SGI). First, the experts gave their opinion on 20 questions regarding routine implant treatment (uninformed decisions), then they were confronted with up-to-date Level I evidence from scientific literature on these topics and again asked to give their opinion (informed decisions) as well as to rate the available evidence as satisfactory or insufficient. Topics involved surgical issues, such as immediate implant placement, flapless surgery, tilted and short implants and bone substitute materials, as well as opinions on prosthodontic paradigms, such as immediate loading, abutment materials and platform switching. Compared to their uninformed decisions prior to confrontation with recent scientific literature, on average, 37% of experts (range: 15-50%) changed their opinion on the topic. When originally favoring one treatment alternative, less than half were still convinced after review of meta-analytic evidence. Discrepancy between uninformed and informed decisions was significantly associated with insufficient evidence (P = 0.014, 49% change of opinion vs. 26% on topics rated as sufficiently backed with evidence). Agreement regarding strength of evidence could be reached for eight topics (40%), in three issues toward sufficiency and in five issues toward lack of evidence. Confrontation with literature results significantly changes clinical decisions of implantologists, particularly in cases of ambiguous or lacking meta-analytic evidence. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
    Full-text · Article · Dec 2014
    • "Nowadays, immediate loading procedures are widespread in clinical practice (Mal o et al. 2011; Tealdo et al. 2011; Menini et al. 2012). However, in the earliest reports, the implant loss has, in general, tended to be higher than when a delayed loading has been applied (Balshi & Wolfinger 1997; Schnitman et al. 1997). "
    [Show abstract] [Hide abstract] ABSTRACT: Objectives Short-term results indicated that the Brånemark Novum® protocol (Nobel Biocare AB, Goteborg, Sweden) allowed successful rehabilitation of mandibular edentulism with immediately loaded implants. Yet, long-term studies are lacking. The aim of the present retrospective study was to report the 11-year outcomes for patients treated according to this protocol. Material and methodsFour patients treated according to the Brånemark Novum protocol (Nobel Biocare AB) were followed-up to evaluate implant and prosthesis cumulative survival rate (CSR), implant stability (RFA), marginal bone loss by periapical radiographs, probing depth (PD), and possible complications. Clinical and radiographic parameters were evaluated immediately after completion of the treatment and 1, 5, and 11 years after loading. ResultsThe 11-year implant and prosthesis CSRs were 100%. Implant stability (RFA values) remained stable over the 11-year follow-up. Small bone resorption was found next to distal implants (median 1 mm) after 11 years, while central implants showed greater bone resorption (median 4.5 mm). The PD (mean 3.75 mm at 11 years) grew together with marginal bone loss. One implant complication was detected on a central implant (crater-form bone destruction), and 10 prosthetic complications (fractures of resin or teeth), 80% of which registered on the same parafunctional patient. Conclusions The 11-year results demonstrated that the Brånemark Novum protocol (Nobel Biocare AB) is a predictable technique with favorable long-term outcomes. This was a rigid protocol, which could be applied only in patients with specific anatomical characteristics of the lower jaw, but it had the merit of indicating the key factors for full-arch immediate loading rehabilitations.
    Article · Nov 2013
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