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Recent advances in dental implants


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Dental implants are a common treatment for the loss of teeth. This paper summarizes current knowledge on implant surfaces, immediate loading versus conventional loading, short implants, sinus lifting, and custom implants using three-dimensional printing. Most of the implant surface modifications showed good osseointegration results. Regarding biomolecular coatings, which have been recently developed and studied, good results were observed in animal experiments. Immediate loading had similar clinical outcomes compared to conventional loading and can be used as a successful treatment because it has the advantage of reducing treatment times and providing early function and aesthetics. Short implants showed similar clinical outcomes compared to standard implants. A variety of sinus augmentation techniques, grafting materials, and alternative techniques, such as tilted implants, zygomatic implants, and short implants, can be used. With the development of new technologies in three-dimension and computer-aided design/computer-aided manufacturing (CAD/CAM) customized implants can be used as an alternative to conventional implant designs. However, there are limitations due to the lack of long-term studies or clinical studies. A long-term clinical trial and a more predictive study are needed.
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R E V I E W Open Access
Recent advances in dental implants
Do Gia Khang Hong and Ji-hyeon Oh
Dental implants are a common treatment for the loss of teeth. This paper summarizes current knowledge on
implant surfaces, immediate loading versus conventional loading, short implants, sinus lifting, and custom implants
using three-dimensional printing. Most of the implant surface modifications showed good osseointegration results.
Regarding biomolecular coatings, which have been recently developed and studied, good results were observed in
animal experiments. Immediate loading had similar clinical outcomes compared to conventional loading and can
be used as a successful treatment because it has the advantage of reducing treatment times and providing early
function and aesthetics. Short implants showed similar clinical outcomes compared to standard implants. A variety
of sinus augmentation techniques, grafting materials, and alternative techniques, such as tilted implants, zygomatic
implants, and short implants, can be used. With the development of new technologies in three-dimension and
computer-aided design/computer-aided manufacturing (CAD/CAM) customized implants can be used as an
alternative to conventional implant designs. However, there are limitations due to the lack of long-term studies or
clinical studies. A long-term clinical trial and a more predictive study are needed.
Keywords: Dental implants, Osseointegration, Immediate dental implant loading, Sinus floor augmentation,
Computer-aided design
The most common cause of teeth loss is periodontitis,
and other causes include dental caries, trauma, develop-
mental defects, and genetic disorders [1]. The use of
dental implants to rehabilitate the loss of teeth has in-
creased in the last 30 years [2]. Before dental implants,
dentures and bridges were used, but dental implants
have become a very popular solution due to the high
success rate and predictability of the procedure, as well
as its relatively few complications [1, 3].
Many studies related to dental implants have been
published and some are in progress. In this paper,
current knowledge of dental implants is summarized in
each section (implant surface, immediate loading versus
conventional loading, short implant, sinus lifting, and
custom implant using three-dimensional printing).
Implant surface
Modification of the implant surface has been studied and
applied to improve biological surface properties favoring
osseointegration [4]. The surface roughness of implants has
been increased by various methods such as machining,
plasma spray coating, grit blasting, acid etching, sandblasted
and acid etching (SLA), anodizing, and biomimetic coating
[36]. The key factor in implant osseointegration is surface
roughness, which shows increased osteoblast activity at 1 to
100 μm of the surface roughness compared to a smooth sur-
face [6]. It is believed that rough surfaces have better
osseointegration than smooth surfaces, but the results of the
research have been diverse and it is not clear that multiple
treatments provide better predictive results [7].
The machined implant surface is the first-generation im-
plant surface design with a turned surface implant [4, 7].
Plasma spray coating generally forms a thick layer of depos-
ition such as hydroxyapatite (HA) and titanium by spraying
a material dissolved in heat on the surface of the implant
[5]. Grit-blasting is a process of spraying particles onto the
surface of the implant using ceramic material or silica.
Sand, HA, alumina or titanium dioxide (TiO
) particles are
used and acid etching is performed to remove the
remaining blasting particles [5]. Acid-etching is the rough-
ening of the titanium implant surfaces using strong acids
such as hydrofluoric acid (HF), nitric acid (HNO
), and
sulfuric acid (H
) or combinations of these acids [5].
* Correspondence:
Department of Oral and MaxilloFacial Surgery, Dental Hospital,
Gangneung-Wonju National University, Gangneung-si, Gangwon-do, Korea,
Republic of
Maxillofacial Plastic and
Reconstructive Surgery
© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
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Hong and Oh Maxillofacial Plastic and Reconstructive Surgery (2017) 39:33
DOI 10.1186/s40902-017-0132-2
SLA is acid etching after sandblasting with 250500 μm
large grit particles [7]. Anodizing is the dielectric break-
down of the TiO
layer by applying an increased voltage to
generate a micro-arc. This process forms a porous layer on
the titanium surface [8].
In the short-term, the survival rate of SLA, HA coat-
ing, and oxidized surface modifications was reported to
be 100%, but the survival rate tended to be slightly lower
in the long-term [911]. The long-term survival rate of
each surface modification is shown in Table 1. In SLA,
the survival rate at 10 years follow-up was 98.8 ~ 99.7%
[12, 13] and in titanium plasma sprayed (TPS), the sur-
vival rate at 20 years follow-up was 89.5% [14]. With
anodizing, the survival rate at 8 ~ 12 years follow-up
was 96.5 ~ 100% [1517]. With HA coating, although
the survival rate at 10 years follow-up in 2007 was as
low as 82.0% [18], there was also report of 98.5 and
93.2% in published papers in 2000, respectively, which
was similar to uncoated titanium implants [19].
There are various surface modifications as mentioned
above. It is said that any surface modification provides a
good surface for osseointegration when the surface rough-
ness is 0.44 ~ 8.68 μm [5]. It is said that acid etching and
coating are the most preferred for making good roughness
of the implant surface [7]. There is a study that suggested
HA is superior to sandblasting, SLA, TPS, and/or ma-
chined surfaces in bone-implant contact ratio [20]. On the
other hand, there is a study that suggested a bone-to-
implant contact of a blasted-etched and covered with HA
group was better than a blasted group, acid-etched group,
and blasted and acid-etched group; however, there were
no significant differences [21].
Recently, research on implant surface modifications
using inorganic materials (HA, calcium phosphate, bis-
phosphonate, etc.), growth factors (bone morphogenetic
protein, platelet-derived growth factor, transforming
growth factor beta, fibroblast growth factor, vascular
endothelial growth factor, etc.), peptides, and extracellu-
lar matrix components (collagen, chondroitin sulfate,
vitronectin, hyaluronic acid, etc.) has been underway as
part of bioactive surface modification [2, 4, 22].
In animal studies, modifications of the implant surface
by biomolecular coating seemed to enhance osseointegra-
tion by promoting peri-implant bone formation in the
early stages of healing, and it seemed to improve histo-
morphometric analysis and biomechanical testing results
[4]. In animal studies, biological coating did not have a
statistically significant effect on peri-implant bone growth,
but statistically significant effects were observed with inor-
ganic and extracellular matrix component coatings [2].
Furthermore, such modifications of the implant surface
do not always provide beneficial effects on osseointegra-
tion [4]. Long-term clinical studies are needed.
Immediate loading versus conventional (delayed) loading
According to many previous studies, many researchers
believed that after implantation in the jaw for a future
prosthesis, titanium implants should be left submerged to
undergo a healing process before they are capable of func-
tional loading. This healing process, which is called osseoin-
tegration, could be completely achieved in a period from 3
to 6 months [23]. The reason for the delayed loading was
to avoid micro-movement on the implant, which could
interfere with the healing process. If this situation occurs,
connective tissue can develop at the interface between the
implant surface and the bone. The result would be failure
of the implant due to not being able to resist the mastica-
tory forces [24].
Following the progressive development of technologies and
the wide spread of implantation in dentistry, more recent re-
search has focused on the mechanism of bone healing. It has
provided a better understanding of osseointegration [25]. It
was suggested that it would be possible to reduce the period
between implantation and the placement of a prosthesis [26].
Over the past 20 years, a number of studies and trials
have reported similar results with trans-mucosal implants
compared with submerged implants. As a result, it is not
necessary to submerge the implants under the mucosa
during the healing period, which eventually introduced
the immediate loading protocol [27, 28].
This protocol was initially developed for the treatment of
edentulous patients, and its main purpose was to restore
Table 1 The survival rates by modifications of the implant surface
Author/year Modification material of implant surface Follow up Survival rate
Buser D, et al./2012 [12] Sandblasted and acid-etched (SLA) 10 years 98.8%
van Velzen FJ, et al./2015 [13] Sandblasted and acid-etched (SLA) 10 years 99.7%
Chappuis V, et al./2013 [14] Titanium plasma sprayed (TPS) 20 years 89.5%
Degidi M, et al./2012 [15] Anodized 10 years 96.5%
Mozzati M, et al./2015 [16] Oxidized 912 years 97.1%
Pozzi A, et al./2014 [17] Oxidized 810 years 100%
Binahmed A, et al./2007 [18] Hydroxyapatite (HA) 10 years 82.0%
Lee JJ, et al./2000 [19] Hydroxyapatite (HA) 48 years 93.298.5%
Hong and Oh Maxillofacial Plastic and Reconstructive Surgery (2017) 39:33 Page 2 of 10
immediate function and aesthetics, which are usually the
main concerns of patients [29]. Numerous recent studies
that focused on this concept have shown excellent results
because the primary outcome was survival of the implant.
A study showed an implant survival rate of 91.7% for im-
mediately loaded implants at the 2 years of follow-up [30].
A 100% survival rate was reported in 11 edentulous pa-
tients treated with immediate full-arch implants [31].
In studies that compared the immediately loaded im-
plants with conventionally loaded implants, the results
showed high survival rates in both groups. The first part
of a study about late inter-antral implantation in the
nonaugmented edentulous maxilla reported survival
rates of 98.3% in the immediate loaded implants group
and 96.7% in the conventional group at a mean observa-
tion period of 4.7 years [32]. The results in the second
part of the study, in cases of immediate inter-antral im-
plantation, also showed similar findings. They were 97.6
and 96.6% for a mean observation period of 3.9 years
[33]. A systematic review reported a survival rate of
98.2% in the immediate loading versus 99.6% in the con-
ventional loading when reviewing 29 randomized-
control studies [34].
However, when considering the rate of failure between
immediate loading and conventional loading in edentu-
lous patients, there were publications that showed a
higher risk of failure in treatment with an immediate
loading protocol. Another article of meta-analysis
showed that immediate loading indicated a slightly
higher implant failure rate than conventional loading
[35]. A similar finding was also reported, but with a
more significant difference [34].
Marginal bone loss (MBL) is also considering as a pri-
mary outcome when comparing immediate loading and
conventional loading. Progressive MBL was demon-
strated as one of the measurements for evaluation of im-
plant failure [36]. There were many recent publications
that focused on the comparison of MBL in both im-
plantation of single-tooth cases and edentulous cases.
A minimal MBL with no mobility and peri-implant
radiolucency in both treatment modalities were reported
when evaluated clinically and radiographically in 20 pa-
tients with the need for fixed implant-supported pros-
thesis for missing mandibular first molars over a period of
72 months [37]. Another study on implantation for single-
tooth cases also showed similar findings. There were no
significant differences in bone loss between the immediate
implant loading and conventional implant loading groups
at 1 year follow-up after implantation of a single tooth in
the anterior maxilla [38].
This trend could also be found in many studies that fo-
cused on edentulous cases. When immediate loading four
implants with a pre-existing denture converted to a fixed
dental prosthesis compared with conventional loading (3
6 months), it was reported that the same change of
1.2 mm in marginal bone over 5 years in both groups was
observed [39]. Also an insignificant difference in mean
MBL between the two treatment modalities in both late
and immediate inter-antral implantation in the nonaug-
mented edentulous maxilla was reported [32].
Patient-related outcomes were frequently chosen as a
secondary outcome in many publications related to imme-
diate loading versus conventional loading. In a previously
mentioned systematic review, most patients preferred im-
mediate loading rather than the conventional loading de-
pending on general and aesthetic satisfaction as well as on
postoperative outcomes, such as pain, edema or the need
for medications [34]. Other different findings were found.
Patients in the immediate loading group reported higher
satisfaction than the conventional loading group. How-
ever, at the end of a 1 year observation period, functional
differences between the two groups had disappeared. Post-
operative pain was the only significant difference, with a
lower value in the immediate loading groups after the
third day [40]. A study, however, showed that immediate
loading evoked more postoperative pain on the first day
and more swelling on the third day rather compared to
the delayed loading. The study compared immediate and
delayed loading of single implants to support mandibular
overdentures, thus suggesting that the number of implants
could affect the decision about whether immediate loading
or conventional loading should be considered [41].
Based on the current evidence pool, it could be sug-
gested that immediate loading can be used as a success-
ful treatment modality. It reduces treatment times,
provides early function and aesthetics, preserves the al-
veolar bone as well as prevents unwanted migration of
an adjacent tooth in the case of missing a single tooth.
However, to achieve the desired treatment outcome,
some factors must be taken into consideration when im-
mediate loading is chosen as a treatment procedure (ad-
equate primary stability, patient compliance, and the
number of implants).
Short implant
In an atrophic alveolar ridge, there are many anatomical
limitations (maxillary sinus, nasal floor, nasopalatine
canal, inferior alveolar canal) that make placement of a
standard implant difficult [42]. To overcome these limi-
tations and vertical bone deficits, additional surgical pro-
cedures, such as guided bone regeneration, block bone
grafting, maxillary sinus lift, distraction osteogenesis,
and nerve repositioning, are performed to place a stand-
ard implant [42, 43]. However, the procedure is sensitive,
challenging, costly, and time-consuming and increases
surgical morbidity and causes many complications such
as sinusitis, infection, hemorrhage, nerve injury, and gait
disturbance [42, 44, 45].
Hong and Oh Maxillofacial Plastic and Reconstructive Surgery (2017) 39:33 Page 3 of 10
Short implants are considered to be simpler and more
effective by reducing the likelihood of such complica-
tions, patient discomfort, procedure costs, and proced-
ure times in rehabilitation of the atrophic alveolar ridge
[42, 4649]. The term of a short dental implant is sub-
jective, and there is no clear criteria for the length of a
short dental implant [43, 46, 47]. Some articles defined
10 mm or less as the criterion of a short dental implant
[47, 50], and some defined less than 10 mm as a short
dental implant [46, 51]. Some defined the short implant
as 8 mm or less [43, 52, 53]. Implant companies have re-
cently offered short implants of less than 8 mm [47]. In
this paper, a short dental implant was defined as less
than 8 mm, which is similar to other papers [48, 5456].
The list of the papers reviewed and the results are shown
in Table 2. The papers were published within the last 5 years
(from 2013 to 2017) and included dental implants that were
less than 8 mm. The period of follow-up ranged from 1 to
5 years. The length of the dental implant varied from 4 to
6.6 mm, and a comparison with long or standard dental im-
plants also varied with and without bone grafts. In this
paper, failure was defined as implant loss.
The clinical outcome of short implants in these various
criteria is controversial. The lower survival rate of 86.7%
for 6-mm short implants after 5 years was reported [57].
On the other hand, the survival rate of 100% for 6-mm
short implants after 3 years [54] and the survival rate of
97.6% for 4-mm short implants after 1 year were reported
[58]. The survival rate of 95.2% for 6-mm short implants
after 5 years [59], and the survival rate of 100% for 6-mm
short implants after 1 year were reported [60]. The sur-
vival rate of 97.1% for 5-mm short implants after 1 year
[61], and the survival rate of 97.2% for 6-mm short im-
plants after 1 year were reported [62].
In studies comparing standard implants without a bone
graft and short implants, the survival rate ranged from
86.7 to 97.6% [5759]. In studies comparing standard im-
plants with a bone graft and short implants, the survival
rate ranged from 91.7 to 100% [54, 60, 61, 63, 64]. There
was also a statistically significant higher incidence of com-
plications in the group with a standard implant with a
bone graft [60, 64]. In addition, there was also statistically
significant higher marginal bone loss in the group with a
standard implant with a bone graft [63, 64].
Recent studies have indicated that single-crown im-
plants in the posterior region can be considered as a
predictable treatment option [51, 65, 66]. However, the
implant placement on type IV bone or with the length
of 8 mm or less should be used with caution, because of
the higher risk of failure compared to the standard im-
plant [65, 66].
In conclusion, the use of a short implant of less than
8 mm had similar clinical outcomes compared with a
standard implant, but long-term follow-up data for more
than 5 years is needed.
Sinus lifting
Sinus augmentation technique
Sinus augmentation, in other words, sinus lifting was
first described as a surgical technique for creating a bone
window in the vestibular wall of the sinus. After that,
the sinus epithelium was gently raised to create a space
for bone grafting. Bone harvesting was performed in the
iliac crest area and then placed in the prepared space.
The healing period took about 6 months before implant-
ation [67]. The use of autogenous bone, allograft and
alloplast material for bone grafting during sinus aug-
mentation was suggested. In addition, the one-stage ap-
proach was demonstrated, in which sinus augmentation
and implantation are performed in one surgery while the
two-stage approach had the implantation taking place
after several months of sinus augmentation [68]. The
abovementioned technique has been known as sinus lift-
ing with the lateral window and is still widely used in
modern implant dentistry due to its reliable efficiency.
Osteotome sinus floor elevation was a less invasive
one-stage technique. In this technique, the sinus epithe-
lium was accessed via a crestal approach. The tip of the
Table 2 The survival rate of standard and short implants
Author/year Length standard implants
and number of implants
Length short implants
and number of implants
(Ø mm)
Follow up Survival rate
standard implants
Survival rate
short implants
Pohl V, et al./2017 [54] 11, 13, 15 mm 68 6 mm 61 4 mm 3 years 100% 100%
Rossi F, et al./2016 [57] 10 mm 30 6 mm 30 4.1 mm 5 years 96.7% 86.7%
Felice P, et al./2016 [58]8.5 mm 116 4 mm 124 4 mm 1 year 98.28% 97.58%
Romeo E, et al./2014 [59] 10 mm 19 6 mm 21 4 mm 5 years 100% 95.24%
Pistilli R, et al./2013 [60]10 mm 91 6 mm 80 4 mm 1 year 96.7% 100%
Pistilli R, et al./2013 [61]10 mm 69 5 mm 68 5 mm 1 year 98.55% 97.1%
Gulje F, et al./2013 [62] 11 mm 101 6 mm 107 4 mm 1 year 99.01% 97.2%
Esposito M, et al./2014 [63]10 mm 68 5 mm 60 Standard : 4 and
6 mm Short : 6 mm
3 years 97.06% 91.67%
Felice P, et al./2014 [64]9.6 mm 61 6.6 mm 60 4 mm 5 years 95.08% 91.67%
Hong and Oh Maxillofacial Plastic and Reconstructive Surgery (2017) 39:33 Page 4 of 10
osteotomes, with increasing diameter, push a mass of
bone to a required level that beyond the original sinus
floor, eventually elevating the sinus epithelium. The im-
plants were then inserted without drilling after sinus
augmentation, followed by bone grafting if necessary.
However, it was suggested that a minimum of 6-mm al-
veolar bone height was needed for primary stability [69].
One of the most common complications of sinus aug-
mentation was perforation of the sinus epithelium,
which could be a result of sinusitis, excessive bleeding
and delayed healing. Many modified techniques and sur-
gical instruments were introduced to avoid complica-
tions of sinus augmentation. A crestal approach using a
non-traumatic drill to decrease the risk of tearing the
sinus membrane was suggested. In retrospective study,
long implants (13 mm and 15 mm) were inserted in 265
cases. For bone grafting, many options were available.
The bone can be harvested from the osteotomy site, or a
bone substitute can be used. In the case of experienced
surgeons, implants could be inserted without grafting,
and the tip of the implants could act as a support for the
sinus membrane. Similar to crestal approach technique,
a primary stability is achieved if a minimum of 3 mm of
alveolar bone height is available [70].
In addition, there were good results with the use of ab-
sorbable collagen membranes in perforated sinus for sinus
elevation and implant placement [71]. In other technique
for treatment of the posterior edentulous maxilla, im-
plants were first placed in the ulna. After 6 weeks, bone
blocks containing implants were harvested and trans-
planted into the sinus area protruding 3 to 4 mm. Im-
plants were then left to heal for 6 weeks. To compare the
efficiency of this treatment modality, patients treated with
particulate bone grafts (an autogenous bone graft from
the symphysis, tibia, or iliac crest) acted as controls. Grafts
were allowed to heal for 6 months before implantation in
the control group. There were no differences between the
two groups in terms of implant stability. There was a sig-
nificant increase in implant stability at 6 and 12 months in
both groups. An ulna implant block, in combination with
sinus grafting, could be an effective solution for increasing
the vertical bone height, especially in severe cases of bone
atrophy [72].
Grafting materials
In terms of grafting materials, the autogenous graft is
considered to be the most predictable and reliable
source of grafting for the replacement of deficient bones.
The characteristics of the autogenous bone graft are that
they are osteoconductive, osteoinductive, and osteogenic,
and hardly any other grafting materials from other
sources have the same capabilities. Intra-oral donor sites
are convenient to harvest and share the same biological
and molecular structures with the recipient site but yield
a limited volume. Extra-oral donor sites could provide a
significant volume of grafting material, but there is an
increase in surgical complexity, morbidity, and scarring
[73]. Therefore, bone substitutes have been developed to
further increase the option for choosing grafting
Allografts consist of same speciestissue, which is har-
vested from cadaveric bone and undergoes various pro-
cedures to reduce antigenicity. Xenografts consist of
different species tissue. The organic components are re-
moved to create a mineral scaffold containing residual
collagen. Alloplasts are synthetic bone substitutes. There
are many types, which are classified by porosity. These
graft materials could be manufactured as bone particles
or large blocks can be mixed with autogenous bone [45].
Following the introduction of many types of grafting
material, a controversy arose focusing on the question of
which material should be chosen as the best solution for
grafting augmentation and the related procedures.
The osseointegration of micro-implants was compared
when performing sinus augmentation with the use of one
of the three types of grafting materials: autogenous bone,
bovine hydroxyapatite (BH), or mixture of BH with au-
togenous bone. The results of clinical and histological
evaluations concluded that there were no statistically sig-
nificant differences between any of the grafting materials;
however, it was suggested that adding autogenous bone
might accelerate the healing time [74]. This similar trend
was also demonstrated. A randomized controlled trial
(RCT) was conducted to compare the effectiveness be-
tween pure bovine bone matrix grafts with pure autogen-
ous grafts. The final results also suggested that using
bovine bone matrix grafts or autogenous grafts yielded no
differences in terms of the implant or prosthetic failure,
complications, discomfort, and bone level; however, there
was an increase in operating times for autogenous bone
grafts. The reason could be it required a longer time for
the bone harvesting procedure [75].
With the advancement in genetic and molecular re-
search, numerous studies have been conducted in the
past decade to establish a better understanding of the ef-
ficiency, safety, and mechanism characteristics of recom-
binant human bone morphogenetic protein-2 (rhBMP-
2), which is an osteoinductive protein that is essential
for bone growth and regeneration. Some of the growth
factors, platelet-rich plasma (PRP) and other molecules,
were found [76]. Many types of research were conducted
to determine the effectiveness of using grafting material
with the addition of rhBMP-2 in sinus augmentation for
enhancing osseointegration.
A study aimed to determine whether the use of PRP
could have a positive effect on osseointegration of autogen-
ous bone grafts used for sinus augmentation. Both maxil-
lary sinuses in five edentulous patients were augmented
Hong and Oh Maxillofacial Plastic and Reconstructive Surgery (2017) 39:33 Page 5 of 10
with an autogenous bone graft. PRP was only added to one
grafting site. Micro-radiographical and histomorphological
examination revealed no significant difference between the
PRP and non-PRP sides, suggesting that PRP has no useful
characteristic in promoting healing of autogenous bone
grafting [77]. In animal study, the bovine bone graft with
PRP had less new bone formation and bone healing process
than xenograft alone [78]. On the other hand, there was a
study to confirm the effect of using PRP when using the bo-
vine bone as the grafting material in a RCT. Patients under-
went sinus augmentation with bovine bone graft alone or
bovine bone graft with PRP. Additionally, a split-mouth
study was conducted, which performed histological evalu-
ation. Analysis of the results revealed that grafting sites
treated with PRP showed better bone remodeling, suggest-
ing the possibility of an increase in the new volume of bone
when PRP is used with bovine bone grafting [79].
Alternative techniques
Despite the reliability and efficiency of various sinus
augmentation techniques, there is still a high rate of
complications and complexity for such procedures. With
the advances in technology and improvements in design
and manufacture of implants, some alternative concepts
suggested implantation without sinus augmentation
could be possible.
The use of a tilted (angulated) implant in the posterior
maxilla was suggested to avoid sinus augmentation. In
this study, an evaluation was made to compare the effi-
ciency between tilted and axial implants with no sinus
grafting. After 5 years of follow-up, the implant success
rate was 95.2% (survival: rate 100%) for the tilted im-
plants and 91.3% (survival rate 96.5%) for the axial im-
plants. The average marginal bone loss was 1.21 mm for
the tilted implants and 0.92 mm for the axial ones [80].
The concept of using tilt implant was further en-
hanced. Trans-sinus tilted implants, with the implant
body inside the sinus, were utilized in the All-on-4 con-
cept for complete edentulous maxilla patients (Fig. 1). A
survival rate of 96.4% was achieved at the implant level.
The survival rate of prostheses was 100%. Sinusitis oc-
curred in two patients (2.9%). The high survival rate and
low complication rate suggest that trans-sinus implants
could be an alternative solution to avoid sinus augmen-
tation [81].
Zygomatic implants offer another option treatment
modality to sinus augmentation. Almost similar to trans-
sinus tilted implants, zygomatic implants are long im-
plants that pass through the sinus or laterally to the
sinus [82]. The difference was the anchorage position.
While the tip of a trans-sinus tilted implant is positioned
in the bone between the anterior sinus wall and the
nasal cortical bone [81], a zygomatic implant will anchor
itself into the zygomatic process for stability.
The use of a short implant (4 to 8 mm long) was also
an interesting and straight forward alternate treatment
modality for sinus augmentation followed by longer im-
plant placement. In a recent systematic review, there
was further clarification of this concept. Eight RCTs
from an initial search count of 851 titles were selected,
and data extraction was performed. Both long-term
follow-up (1618 months) and short-term follow-up (8
9 months) study showed no significant differences when
comparing implant survival rates. Most common com-
plications were membrane perforations, and they were
almost three times higher for longer implants in the aug-
mented sinus compared to shorter implants. Morbidity,
surgical time, and cost-effectiveness also showed more
favorable data in the shorter implant group [83].
Sinus augmentation is the most common indication as-
sociated with implant placement in patients with severe
edentulous maxilla. With the advancement of implant
dentistry, there have been introductions of new techniques
and grafting materials, which were aimed to improve the
treatment outcomes of sinus augmentation. Several new
concepts, such as the use of an angulated implant, zygo-
matic implant, or short implant, could provide another
option for implantation in the posterior maxilla without
the need for sinus augmentation, thus making treatment
time shorter and reducing the rate of complications and
the complexity of the treatment procedure.
Custom implant using three-dimensional printing
Custom implant using three-dimensional printing (3DP)
was first used in the fields of rapid tooling and rapid
prototyping. Initially, specifically single, personalized ob-
jects were manufactured by 3DP in restorative dentistry.
By combining oral scanning with a CAD/CAM design
and using 3DP, dental labs can produce dental pros-
theses (crowns, bridges) and plaster/stone models more
rapidly and with excellent precision than most tradition
procedures performed by lab technicians [84].
With the advancement of implant dentistry, there was
an increase in utilizing CAD/CAM as a supportive means
to maximize the results of implant treatment. Customized
implant abutments have been successfully produced using
CAD/CAM for difficult cases when standard abutments
may not provide a suitable option for a future prosthesis.
Thus, to combine with customized abutments, customized
coping was also manufactured for such cases to provide a
more accurate impression [85].
In addition to the usage of 3DP and CAD/CAM in the
making of prosthesis-related components, some have
presented concepts of utilizing this advanced technology
in the planning phase of implantation. The use of cone
beam computed tomography (CBCT) combined with
CAD/CAM was suggested to produce a surgical guide
for implant placement (Fig. 2). In this scenario, mini-
Hong and Oh Maxillofacial Plastic and Reconstructive Surgery (2017) 39:33 Page 6 of 10
implants were used as reference points. A software cre-
ated the three-dimensional simulation and allowed the
clinician to plan an ideal implant placement, virtually in-
tegrating the future prosthetic for a complete rehabilita-
tion treatment. A digital file of the surgical template was
exported, and fabrication of surgical guide was per-
formed by 3DP [86]. There was a study showing favor-
able results in the accuracy evaluation of computer-
guided implant surgery [87].
3DP and CAD/CAM has involved itself in almost
every aspect of implant dentistry, from the planning
phase to finalizing the prosthesis. The only component
left is the implant itself, which is still commonly manu-
factured by traditional methods. One of the new possible
theories with 3DP technology is to produce a custom-
ized implant with the analog that mimics the root of the
missing tooth, as an alternative to the traditional implant
design (threaded, straight, or tapered). With similar di-
mensions to the original root, the customized implant
could provide better matching with the root socket [88].
Recently, many types of research have further explained
that this theory have been conducted on cadaver models,
animal models, or in clinical trials.
There was an experiment to clinically and histologi-
cally evaluate the customized implant placed in an
already extracted socket in monkeys. After the extraction
of the single-root teeth (upper central and lateral inci-
sors), fabrication of the customized implant was per-
formed with a CAD/CAM system after the root was
machine copied to a titanium analog. The implants were
then inserted into the respective sockets. Histological
findings showed an average mineralized bone-to-implant
contact of 41.2 ± 20.6%, suggesting that osseointegration
could occur after the placement of titanium implants
created by a laser-copy machine [89].
With a more sophisticated study design, the effective-
ness of customized zirconia implants with two different
surface modifications was compared in 18 patients. The
customized implants were fabricated after the extraction
of the corresponding teeth. The implant surface then
underwent the sandblasting process. However, in group
1(n= 12), implants were modified with additional
macro retention while the implants for the other group
(n= 6) were not. No complications occurred during the
healing period. All implants without additional macro
retention were lost within 2 months. In the other group,
the overall survival rate was 92%. As a result, it could be
confirmed that customized zirconia implants, with spe-
cific modifications, could achieve primary stability and
osseointegration [90].
However, it should be noted that two of the previous
studies used a concept of fabricating the customized im-
plant based on the three-dimensional (3D) data of an
already extracted tooth. Thus, it could be indicated that,
in the cases of a patient requiring implant replacement
for a single-tooth, the tooth has to be extracted as the
first surgery, and only then could implantation be per-
formed later in another surgery. It would seem more ef-
ficient to have the customized implant ready before
tooth extraction, allowing immediate implantation and
omitting the need for a second surgery. A question arose
about whether a pre-extracted tooth or a post-extracted
Fig. 1 The all-on-4 concept for complete edentulism. It is a concept that rehabilitates the complete edentulism using four implants. The anterior
implants are placed vertically and the posterior implants are tilted to avoid anatomical structures such as the maxillary sinus
Fig. 2 The surgical guide for implant placement. CBCT and CAD/
CAM are used to produce a surgical guide for implant placement
Hong and Oh Maxillofacial Plastic and Reconstructive Surgery (2017) 39:33 Page 7 of 10
tooth could provide more accurate 3D data as a basic
model for the fabrication of a customized implant.
There was a study that compared the accuracy of a
customized implant created by 3DP and a fused depos-
ition modeling technique (FDM) based on the pre-
extraction CBCT data of the tooth (in vivo) with the real
original tooth after extraction (in vitro) from orthodontic
patients. The 3D deviations between the in vivo teeth, in
vitro teeth, and the 3DP customized implant were com-
pared using studio software. According to the results, an
independent ttest showed that no statistically significant
difference was observed between the in vitro teeth and
in vivo teeth in terms of average deviation. It could be
concluded that with the combination of 3DP and FDM,
CBCT data of a pre-extracted tooth could be used for
fabricating the corresponding customized implants with
high precision as an alternative to 3D data of the post-
extraction tooth [91].
A study with a similar design and method was also
conducted, with data collected from a human cadaver.
After comparisons, the results showed that the greatest
differences between the customized implant and the op-
tical scan of the extracted tooth were observed at the
apex and the cement-enamel junction (CEJ) areas on the
buccal and lingual side. There was an overall decrease in
the surface area of 6.33% for the customized implant
compared to the original tooth [88].
In addition to the decision of choosing the optimal 3D
data between the pre-extraction or post-extraction tooth
for fabrication of a customized implant, the intactness of
the tooth must also be taken into account, particularly
in the root area. Teeth that need to be replaced by im-
plants are commonly damaged or even already extracted;
thus, it is suggested that recreating a 3D model based on
the contra-lateral tooth could be a suitable option. Add-
itionally, the concept of using 3D data of the tooth with-
out extraction could achieve better accuracy because
there was no damage to the tooth by the elevator or
dental forceps [88].
With the ongoing development of new technology in
3D and CAD/CAM, it is predicted that customized im-
plants could be the promising future of implant dentistry
as an alternative to conventional implant designs.
However, more clinical trials are needed to evaluate the
effectiveness of this approach.
Recent findings about surface modifications, immediate
loading, short implants, sinus lifting, and custom im-
plants have improved the success rate of implants re-
garding. However, there are limitations due to the lack
of long-term or clinical studies. A long-term clinical trial
and a more predictive study are needed.
Not applicable.
This research was conducted with the support of the Cooperative Research
Program for Agriculture Science and Technology Development (Project no.
PJ01121404), Rural Development Administration, Republic of Korea.
All authors wrote the manuscript. Both authors read and approved the final
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.
Received: 15 August 2017 Accepted: 25 September 2017
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91. Wang N, Li J, Wang X, Liu G, Liu B (2015) 3D printing personalized implant
manufactured via fused deposition modeling: an accuracy research. Hua Xi
Kou Qiang Yi Xue Za Zhi 33:509512
Hong and Oh Maxillofacial Plastic and Reconstructive Surgery (2017) 39:33 Page 10 of 10
... In the choice between categories, considering the micromovements and peri-implant stresses and strains associated with ultra-short (5 mm length) implants [10,11], tilted implants or sinus floor elevation via a lateral approach is promoted in the case of severe bone atrophy (less than 5 mm) [12][13][14][15], and the transcrestal sinus lift technique is recommended if the residual bone height is at a minimum of 5 mm [16][17][18]. 2 of 14 Although tilted implants might be the least risky choice [9], the following prerequisites should always be provided: adequate bone volume in the retrocanine area for implant placement at least 10 mm in length and combination with an axial implant [19,20]. ...
... The choice of surgical procedure between sinus lift with a lateral or transcrestal approach and tilted implants may depend on several criteria such as the residual bone height, maxillary sinus conformation, and presence of any pathology affecting the maxillary sinus; as with any other surgical procedure, a risk-benefit ratio assessment could be crucial [12][13][14]. ...
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The aim of this study was to evaluate the implant survival rate, marginal bone loss, and surgical and prosthetic complications of implants placed through sinus floor elevation and tilted implants engaged in basal bone to bypass the maxillary sinus. Sixty patients were enrolled for this study. According to the residual bone height of the posterior maxilla, the sample was divided into three groups of 20 patients: Group A (lateral sinus floor elevation), Group B (transcrestal sinus floor elevation), and Group C (tilted implants employed to bypass the sinus floor). Follow-up visits were performed one week after surgery, at three and six months, and then once a year for the next 4 years. The outcomes were the implant survival rate, marginal bone loss, and surgical and prosthetic complications. Although Groups A, B, and C demonstrated implant survival rates of 83.3%, 86.7%, and 98.3%, respectively, the statistical analysis showed no statistically significant difference between groups. Statistically significant differences between groups were also not found concerning marginal bone loss, as recorded by intra-oral X-ray measurements during follow-up examinations. Regarding complications, it was not possible to perform a statistical analysis. To reduce possible surgical risks, implant placement in basal bone could be preferred.
... The edentulous jaw can resorb over time if no teeth or implants are present, affecting the bone in that jaw and the sagittal relationship between the upper and lower jaws [1]. The implant placement operation is a common procedure for replacing missing teeth [2]. The implant site must be thoroughly examined clinically and radiographically [3]. ...
... So, this study aimed to use available CBCT to determine the difference in bone condition around posterior maxillary and mandibular dental implants in Chinese Adults. Null hypotheses (H0): (1) no relationship between the initial bone condition and bone loss; (2) no difference between the bone density and bone thickness with implant placement. ...
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Purpose The aim of this study was to assess bone density and thickness changed following dental implant placement in the maxillary and mandibular jaws. Also, observe the form of bone loss around the implant and the relationship between preoperative bone density and bone thickness with bone loss around dental implants. Methods 65 patients, including 102 dental implants, were assessed in this study. CBCT was utilized to determine the bone condition (bone thickness and density at three levels (sub-crestal bone at 3 mm (CB3), 6 mm (CB6), and 9 mm (CB9)) before implant placement, and 2 to 3 years after placement, also determine the bone loss pattern. Results The difference in bone thickness was 0.32 ± 0.50 mm at CB3, 0.18 ± 0.40 mm at CB6, and 0.14 ± 0.07 mm at CB9. The change buccal bone density at CB3, CB6, and CB9 were 344.5 ± 278.9, 260.5 ± 276, and 138.9 ± 313.9 HU, respectively, and the change in lingual bone density was 252.7 ± 247, 179.9 ± 244.1, and 281 ± 4063 HU, respectively. Only the CB3 level showed a significant decrease in bone thickness (p < 0.001), and a change in bone density was observed at the three levels (p < 0.001). The means of vertical and horizontal bone loss were 0.19 ± 0.23 mm and 0.18 ± 0.22 mm, respectively. Splinted or adjacent dental implants have more horizontal bone loss, with statistically significant (p < 0.001). Age, gender, and implant position were not statistically related to the outcome variables. There was a negative correlation between the preoperative status of the bone condition and pattern bone loss, as indicated by Pearson's correlation coefficient. Conclusion CBCT detected a significant bone thickness decrease was found only at the crestal third. A significant bone density increase was found at three levels around dental implants. Implant areas with higher bone thickness and density had less bone loss.
... Recent decades have seen dental implants become extremely popular due to their high success rates, predictability, and relative lack of problems. [1,2,3,23,26]. A dental implant is made up of three parts: the crown, the abutment, and the implant or fixture. ...
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Implant-based restoration is currently seen to be a more reliable option with higher success rates. Biological and technological problems, on the other hand, are common. An implant insertion complication well known to many is the loosening of the abutment screw. Fractures of the implant-abutment may cause the implant to fail to function efficiently as they may leave a fragment inside the implant. This study aimed to introduce the modified design of a tool to extract the stripped abutment screw from the implant body and to analyses the deformation, stress and strain acting on the tool using the finite element method.
... Oral implants are considered a predictable and safe treatment modality for the rehabilitation of missing teeth [1]. However, there are reports on oral implant failure [2]). ...
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Objectives To assess the effect of preoperative oral clindamycin in reducing early implant failure in healthy adults undergoing conventional implant placement. Materials and methods We conducted a prospective, randomised, double-blind, placebo-controlled clinical trial in accordance with the ethical principles and Consolidated Standards of Reporting Trials statement. We included healthy adults who underwent a single oral implant without previous infection of the surgical bed or the need for bone grafting. They were randomly treated with a single dose of oral clindamycin (600 mg) 1 h before surgery or a placebo. All surgical procedures were performed by one surgeon. A single trained observer evaluated all patients on postoperative days 1, 7, 14, 28, and 56. Early dental implant failure was defined as the loss or removal of an implant for any reason. We recorded the clinical, radiological, and surgical variables, adverse events, and postoperative complications. The study outcomes were statistically analysed to evaluate differences between the groups. Furthermore, we calculated the number required to treat or harm (NNT/NNH). Results Both the control group and clindamycin group had 31 patients each. Two implant failures occurred in the clindamycin group (NNH = 15, p = 0.246). Three patients had postoperative infections, namely two placebo-treated and one clindamycin-treated, which failed (relative risk: 0.5, CI: 0.05–5.23, absolute risk reduction = 0.03, confidence interval: − 0.07–0.13, NNT = 31, CI: 7.2–∞, and p = 0.5). One clindamycin-treated patient experienced gastrointestinal disturbances and diarrhoea. Conclusions Preoperative clindamycin administration during oral implant surgery in healthy adults may not reduce implant failure or post-surgical-complications. Clinical relevance Oral clindamycin is not efficacy. Trial registration The present trial was registered (EudraCT number: 2017-002,168-42). It was approved by the Committee for the Ethics of Research with Medicines of Euskadi (CEIm-E) on 31 October 2018 (internal code number: 201862) and the Spanish Agency of Medicines and Medical Devices (AEMPS) on 18 December 2018.
... Dental implants are considered one of the most suitable options for the treatment of edentulous patients [6]. Some patients have reported complications after receiving dental implants. ...
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There is a growing trend with respect to the use of ceramic materials in dental practice. With an increase in the number of cases of head and neck cancer, the use of dental implants in these patients is subject to controversy. Consequently, the purpose of the present study was to evaluate the impact of two ceramic materials on the viability, proliferation, migration, and structure of the cytoskeleton and nuclei of pharyngeal cancer cells. Therefore, samples of the two ceramic were immersed in artificial saliva with three different pH values in order to better simulate the natural biological environment. A 21-day immersion period was followed by testing of the saliva on pharyngeal cancer cell line Detroit-562 for its viability, morphology, and migration, as well as its effects on the nucleus and cytoskeleton. The results of the study after stimulation of Detroit-562 cells for 72 h with the three types of artificial saliva in which the ceramic materials were immersed indicated the following: (i) viability of cells did not change significantly, with the percentage of viable cells not falling below 90%; (ii) no morphological changes were recorded, with the shape and number of cells being similar to that of the control cells; (iii) the scratch assay method indicated that the two types of ceramics do not stimulate cell migration; and (iv) fluorescence immunocytochemistry revealed that both the nucleus and the cytoskeleton distributions were unaltered, as they were observed in unstimulated cells. The preliminary results of the study indicate that the investigated ceramic materials did not interact unfavorably with tumor cells when immersed in artificial saliva, thereby supporting the possibility of their safe use in cancer patients.
... According to the study's findings, undergraduate instruction is relatively broad and comprehensive, with modest decreases in some topics, maybe due to low participation. The following subjects saw the most changes: 'Implant patient education'; a rise of 20-30% in growth in 2015 may be related to implantology becoming a more mainstream technique to replace teeth [18]. 'Screw retained vs cement retained restorations'; this may be owing to the evolution of implantology and the necessity for retrievability in restorative repair and maintenance [19]. ...
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Dental Implants are a popular treatment option for tooth replacement, with documented long-term success and survival rates of more than 95% over a period of 10 years. However, incorporating dental implantology into an undergraduate dental curriculum has issues associated. Therefore, the aim of this research was to examine and evaluate current undergraduate dental implantology education in the UK, investigate the amount of time allocated to this subject and analyse the barriers that are currently impeding the development of the programmes. An online questionnaire hosted by Online Surveys was designed, piloted, and sent to 16 dental schools providing undergraduate education in the UK. Ethical approval was gained from The University of Salford to conduct the study. Out of the 16 dental schools contacted, eight questionnaire responses were received, hence a response rate of 50% was achieved. The hours dedicated to the implant teaching programme varied from 3 h to 25 h, with a mean average of 11 h. It was identified from the results that no teaching of dental implantology was conducted in year 2; 12% of the schools responded that the subject was taught in year 1, 37% in year 3, 75% in year 4 and 50% in year 5. The methods used to deliver the programme were mainly lecture-based teaching, with only one dental school allowing students to place implants on patients. The main barriers to progression of the programme were financial (75%), followed by time limitations imposed by the curriculum (37%) and liability insurance (37%). However, there appears to be a consensus that further training beyond bachelor's degree level is required to teach implantology effectively.
... Titanium, a lustrous transition metal with atomic number 22, is widely used to manufacture dental implants [13]. Its biocompatibility due to inert behavior in the living tissue was already documented in 1951 by Gottlieb Leventhal [14]. ...
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This article focuses on preclinical studies and reviews the available evidence from the literature on dental implant and abutment materials in the last decade. Specifically, different peri-implantitis materials and how surface modifications may affect the peri-implant soft-tissue seal and subsequently delay or hinder peri-implantitis are examined. This review analyzed more than 30 studies that were Randomized Controlled Trials (RCTs), Controlled Clinical Trials (CCTs), or prospective case series (CS) with at least six months of follow-up. Meta-analyses were performed to make a comparison between different implant materials (titanium vs. zirconia), including impact on bone changes, probing depth, plaque levels, and peri-implant mucosal inflammation, as well as how the properties of the implant material and surface modifications would affect the peri-implant soft-tissue seal and peri-implant health conditions. However, there was no clear evidence regarding whether titanium is better than other implant materials. Clinical evidence suggests no difference between different implant materials in peri-implant bone stability. The metal analysis offered a statistically significant advantage of zirconia implants over titanium regarding developing a favorable response to the alveolar bone.
... Implant-prosthodontic therapy is an established treatment modality in dental practice that provides high success rates [1]. Implant-abutment connection (IAC) is recognized as a crucial factor for the long-term success and stability of implant-supported prosthodontic restoration and its surrounding tissues, with emphasis on benefits of original abutments [2]. ...
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Implant–abutment connection (IAC) is a key factor for the long-term success and stability of implant-supported prosthodontic restoration and its surrounding tissues. Misfit between prosthodontic abutment and implant at the IAC leads to technical and biological complications. Two kinds of prosthodontic abutments are currently available on the market: original and third-party abutments. The aim of this pilot study was to test and compare the internal fit (gap) at the implant–abutment interface depending on the abutment fabrication method based on microbial leakage in static conditions and the need for the use of gap sealing material. Two groups of 40 implants were formed on the basis of the type of abutment. In each of the groups of two implant systems, two subgroups of 10 implants were formed. The tested subgroups consisted of 10 implants with sealing material and a negative control subgroups consisting of 10 implants without any sealing material. The test material, GapSeal (Hager and Werken, Duisburg, Germany) was applied in the test subgroups. The implant–abutment assemblies were contaminated with a solution containing Staphylococcus aureus and Candida albicans for 14 days under aerobic conditions. Results showed that there was no statistically significant difference regarding the microbial leakage between the original and third-party custom-made abutments, regardless of the use of sealing material. It can be concluded that the abutment fabrication method has no significant influence on sealing efficacy regarding the bacterial and fungal leakage in static conditions.
Implantology in dentistry incorporating biomaterials and simulation techniques essentially, had become greatly acceptable procedure for the reconstruction of the human apparatus in modern era. To achieve success of treatment method, biomaterial selected should be compactable and should show positive biological response with the surrounding environment. Prediction of biomechanical parameters in clinical practices affecting implantology is difficult and challenging in vivo. Advancements in engineering innovation and research made Finite Element Analysis (FEA) have proven to be one of the promising simulation techniques to understand the clinical variables and decrease mechanical failures. This review provides insights on biomaterials and FEA in implant dentistry and help to identify gaps in future research.
Dental implant is one of the most proving ways to replace our missing tooth with artificial tooth. Due to the plenty of advancement in the field of medical science we have many options by which we can do implant. In this review paper we will deal with the all those things which are associated with Dental Implants. Moreover, we will also discuss the factors responsible for the stability of the implants and which are factors that we need to consider before selecting implant material. This review paper highlights some of the most widely used implant material, types of dental implant, different pros and cons of material, different surface modification technique or methods used.
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Introduction: Emergence of dental implants made the replacement of missing tooth easy. During the early days of introduction, implants were loaded three to six months after implant insertion, but understanding of healing cascade and improved production technology has changed the phase of restoration from delayed to immediate loading. Aim: To evaluate and compare the clinical outcome of immediate and delayed loaded implant supported prosthesis for missing mandibular first molar. The objectives were bleeding on probing, probing depth, implant mobility, marginal bone level and peri-implant radiolucency were evaluated during follow up period. Materials and methods: Twenty patients were included in this study who were in the need of fixed implant supported prosthesis for missing mandibular first molar. Single tooth implant with immediate loading done within two days of implant insertion in one group and another group were loaded after three months of implant insertion. These groups were evaluated clinically and radiographically over a period of 72 months after loading using Wilcoxon matched pairs test and Mann-Whitney U test. Results: The study consists of 14 male and six female patients with the age range of 19 to 31 years. There was no bleeding on probing and probing depth remained well within the normal range even after 72 months of loading among both the groups. Minimal marginal bone loss observed with no mobility and peri-implant radiolucency. Conclusion: Implant supported prosthesis for missing mandibular first molar with immediate loading can be used as a successful treatment modality. It reduces treatment time, provides early function and prevents undue migration of adjacent tooth. Immediate loading showed similar clinical and radiographic results as that of delayed loading, indicating it as an equally efficient technique for implant supported prosthesis.
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Aim: To test whether or not the use of short dental implants (6 mm) results in an implant survival rate similar to that with longer implants (11-15 mm) in combination with sinus grafting. Methods: This multi-center study enrolled 101 patients with partial edentulism in the posterior maxilla and a remaining bone height of 5-7 mm. Included patients were randomly assigned to receive short implants (6 mm; GS / group short) or long implants (11-15 mm) simultaneously with sinus grafting (GG / group graft). Six months after implant placement (IP), implants were loaded with single crowns (PR) and patients were re-examined yearly thereafter. Assessed outcomes included: implant survival, marginal bone level changes (MBL), probing pocket depth (PPD), bleeding on probing (BoP) and plaque accumulation (PCR) during 3 years of loading as well as recording of any adverse effects. In addition to descriptive statistics, statistical analysis has been performed for the two treatment modalities using a non-parametric approach. Results: In 101 patients, 137 implants were placed. At the 3-year follow-up (FU-3), 94 patients with 129 implants were re-examined. The implant survival rate was 100% in both groups. MBL at FU-3 was 0.45 mm (GG) and 0.44 mm (GS) (p>.05). A statistically significant loss of MBL was observed in both GG (-0.43mm±0.58mm) and GS (-0.44mm±0.56mm) from IP to FU-3, and from PR to FU-3 in GG (-0.25mm±0.58mm) but not in GS (-0.1mm±0.54mm). PCR and BoP at FU-3 did not show any difference between the groups but for PPD (p=0.035). Conclusions: Within the limitations of this study implants with a length of 6 mm as well as longer implants in combination with a lateral sinus lift may be considered as a treatment option provided a residual ridge height of 5-7 mm in the atrophied posterior maxilla is present. This article is protected by copyright. All rights reserved.
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Background: The purpose of this article is to review and update the current developments of biologically active dental implant surfaces and their effect on osseointegration. Methods: PubMed was searched for entries from January 2006 to January 2016. Only in-vivo studies that evaluated the effects of biomolecular coatings on titanium dental implants inserted into the bone of animals or humans were included. Results: Thirty four non-review studies provided data and observations were included in this review. Within the criteria, four categories of biomolecular coatings were evaluated. The potential biomolecules include bone morphogenetic proteins in 8 articles, other growth factors in 8 articles, peptides in 5 articles, and extracellular matrix in 13 articles. Most articles had a healing period of 1 to 3 months and the longest time of study was 6 months. In addition, all studies comprised of implants inserted in animals except for one, which evaluated implants placed in both animals and humans. The results indicate that dental implant surface modification with biological molecules seem to improve performance as demonstrated by histomorphometric analysis (such as percentage of bone-to-implant contact and peri-implant bone density) and biomechanical testing (such as removal torque, push-out/pull-out tests, and resonance frequency analysis). Conclusions: Bioactive surface modifications on implant surfaces do not always offer a beneficial effect on osseointegration. Nevertheless, surface modifications of titanium dental implants with biomolecular coatings seem to promote peri-implant bone formation, resulting in enhanced osseointegration during the early stages of healing. However, long-term clinical studies are needed to validate this result. In addition, clinicians must keep in mind that results from animal experiments need not necessarily reflect the human clinical reality.
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Background The aim of this study was to evaluate the clinical outcomes of implants that were placed within the maxillary sinus that has a perforated sinus membrane by the lateral window approach. Methods We examined the medical records of the patients who had implants placed within the maxillary sinus that has a perforated sinus membrane by the lateral approach at the Department of Oral and Maxillofacial Surgery of Chonnam National University Dental Hospital from January 2009 to December 2015. There were 41 patients (male:female = 28:13). The mean age of patients was 57.2 ± 7.2 years at the time of operation (range, 20–76 years). The mean follow-up duration was 2.1 years (range, 0.5–5 years) after implant placement. Regarding the method of sinus elevation, only the lateral approach was included in this study. Results Ninety-nine implants were placed in 41 patients whose sinus membranes were perforated during lateral approach. The perforated sinus membranes were repaired with a resorbable collagen membrane. Simultaneous implant placements with sinus bone grafting were performed in 37 patients, whereas delayed placements were done in four patients. The average residual bone height was 3.4 ± 2.0 mm in cases of simultaneous implant placement and 0.6 ± 0.9 mm in cases of delayed placement. Maxillary bone graft with implant placement, performed on the patients with a perforated maxillary sinus membrane did not fail, and the cumulative implant survival rate was 100%. Conclusions In patients with perforations of the sinus mucosa, sinus elevation and implant placement are possible regardless of the location and size of membrane perforation. Repair using resorbable collagen membrane is a predictable and reliable technique.
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Background The purpose of this retrospective study was to evaluate the clinical utility of an implant with a sandblasted, large-grit, acid-etched (SLA) surface and internal connection. Methods Six patients who received dental implants in the Department of Oral and Maxillofacial Surgery, Chonnam National University Dental Hospital, were analyzed by factors influencing the success rate and marginal bone loss. Factors included patient’s age, sex, implant installation site, whether bone graft was done, type of bone graft materials, approaching method if sinus lift was done, and the size of the fixture. In addition, the marginal bone loss was analyzed by using a radiograph. Results All implants were successful, and the cumulative survival rate was 100 %. Average marginal bone loss of 6 months after the installation was 0.52 mm and 20 months after the functional loading was 1.06 mm. Total marginal bone resorption was 1.58 mm on average. There was no statistically significant difference in mesial and distal marginal bone loss. Conclusions The short-term clinical success rate of the implant with an SLA surface and internal connection was satisfactory. Moreover, the marginal bone loss was also consistent with the implant success criteria.
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The choice of implant length is an essential factor in deciding the survival rates of these implants and the overall success of the prosthesis. Placing an implant in the posterior part of the maxilla and mandible has always been very critical due to poor bone quality and quantity. Long implants can be placed in association with complex surgical procedures such as sinus lift and bone augmentation. These techniques are associated with higher cost, increased treatment time and greater morbidity. Hence, there is need for a less invasive treatment option in areas of poor bone quantity and quality. Data related to survival rates of short implants, their design and prosthetic considerations has been compiled and structured in this manuscript with emphasis on the indications, advantages of short implants and critical biomechanical factors to be taken into consideration when choosing to place them. Studies have shown that comparable success rates can be achieved with short implants as those with long implants by decreasing the lateral forces to the prosthesis, eliminating cantilevers, increasing implant surface area and improving implant to abutment connection. Short implants can be considered as an effective treatment alternative in resorbed ridges. Short implants can be considered as a viable treatment option in atrophic ridge cases in order to avoid complex surgical procedures required to place long implants. With improvement in the implant surface geometry and surface texture, there is an increase in the bone implant contact area which provides a good primary stability during osseo-integration.
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Purpose: To compare long-term survival and marginal bone loss of immediate interantral implants in the nonaugmented maxilla subjected to immediate vs delayed loading. Materials and methods: Graftless maxillary cross-arch rehabilitation was performed in a total of 362 patients in the years 2004 to 2013 (1,797 implants). Of the 240 patients with immediate implants replacing their failing maxillary dentition, 81% were subjected to immediate loading and 19% to delayed loading of their 4 to 6 interantral implants (980 and 235 implants, respectively). Kaplan-Meier survival estimates were computed and marginal bone loss was evaluated in a stratified random sample of 20 patients per group. Results: Thirty-one of 1,215 implants failed within the mean observation period of 3.9 years, and no difference in 8-year survival estimates could be seen between immediate (97.6% [95% CI: 96.7 to 98.6]) and delayed (96.6% [95% CI: 94.3 to 98.9]) loading protocols (P = .359). Mean marginal bone resorption following implant insertion did not differ significantly between the groups (1.5 ± 1.7 mm vs 0.7 ± 1.1 mm, P = .379); however, it was significantly associated with a reduced number of implants (P = .017) and patient history of periodontal disease (P < .001). Conclusion: Immediate loading of interantral implants yields satisfactory results in the transition of patients from a failing maxillary dentition to full-arch implant rehabilitation and thus may be favored over delayed loading concepts.
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Purpose: To compare long-term survival and marginal bone loss of late interantral implants in the nonaugmented edentulous maxilla subjected to immediate vs delayed loading. Materials and methods: One hundred twenty-two edentulous patients with implants in native, healed jawbone were subjected to either immediate loading (179 implants) or delayed loading (403 implants) of their four to six interantral implants (part I of 362 graftless maxillary cross-arch rehabilitations performed in the years 2004 to 2013). Kaplan-Meier survival estimates were computed, and marginal bone loss was evaluated in a stratified random sample of 20 patients per group. Results: Fifteen of 582 implants failed within the mean observation period of 4.7 years, and no difference in 8-year survival estimates could be seen between immediate (98.3% [95% CI: 96.4-100.0]) and delayed (96.7% [95% CI: 94.7-98.6]) loading protocols (P = .370). Mean marginal bone resorption following implant insertion did not differ significantly between the groups (1.1 ± 1.3 mm vs 1.4 ± 1.3 mm, P = .490). Conclusion: Immediate loading of interantral implants in the nonaugmented edentulous maxilla yields favorable results comparable to delayed loading and may be considered to shorten periods of removable provisional prostheses in maxillary edentulism.
Objective: The aim of this study was to determine the accuracy of personalized implant fabricated via 3D printing and fused deposition modeling technique (FDM) and to compare the results with a real tooth. Methods: Six prepared extracted orthodontic teeth (in vivo) were scanned via cone beam computed tomography (CBCT) to obtain 3D data and to build the data models by using Mimics 15.0 software. The extracted orthodontic teeth (in vitro) and the personalized implants designed via 3D printing and FDM were scanned via CBCT to obtain data and to build the data models at the same parameters. The 3D deviations were compared among the in vivo teeth data models, in vitro teeth data models, and printing personalized implant data models by using the Geomagic studio software. Results: The average deviations of high and low areas between date models of in vivo teeth and personalized implants were 0.19 mm and -0.16 mm, respectively, and the average deviations between in vitro and in vivo teeth were 0.14 mm and -0.07 mm, respectively. The independent t test showed that no statistically significant difference was observed between the two groups (P>0.05). Conclusion: 1) The personalized dental implants were manufactured via 3D printing and FDM with a high degree of precision. 2) Errors between the data models of in vitro and in vivo teeth were observed at the same CBCT parameters.
Data sources PubMed/Medline, Embase and Cochrane Library databases supplemented by searches of the journals; Clinical Implant Dentistry and Related Research, Clinical Oral Implants Research, International Journal of Oral and Maxillofacial Implants, International Journal of Oral and Maxillofacial Surgery, Journal of Clinical Periodontology, Journal of Dentistry, Journal of Oral and Maxillofacial Surgery, Journal of Oral Implantology, Journal of Oral Rehabilitation, Journal of Periodontology, Periodontology 2000. Study selection Randomised controlled trials (RCTs) and prospective studies with at least ten patients, published in the last ten years that compared short and standard implants and published in English were considered. Data extraction and synthesis A single author abstracted data with checking by a second reviewer. Methodological quality was assessed using the Jadad Scale and the Cochrane risk of bias tool. Risk ratios (RR) were calculated for implant survival rates, complications and prostheses failures and marginal bone loss was evaluated using mean difference (MD). Results Thirteen studies consisting of ten RCTs and three prospective studies were included. The ten RCTs were considered to be of high quality. Two thousand six hundred and thirty-one implants were placed in 1269 patients (981 short and 1650 standard implants). Thirty-eight short implants failed (3.87%) and 45 standard implants (2.72%). Random effects meta-analysis found no statistically significant difference between standard implants and short implants placed in the posterior regions; RR =1.35 (95% CI; 0.82-2.22: P=0.24). Marginal bone loss was evaluated in nine studies and no differences in marginal bone loss were observed. Complications were reported by seven studies and no significant difference was seen between standard and short implants; RR= 0.54 (95% CI; 0.27-1.09: P = 0.08). There was also no significant difference in prosthesis failures between standard and short implants; RR= 0.96 (95% CI: 0.44–2.09: P = 0.92) Conclusions Short implants showed marginal bone loss, prosthesis failures and complication rates similar to standard implants, being considered a predictable treatment for posterior jaws, especially in cases that require complementary surgical procedures. However, short implants with length less than 8 mm (4-7 mm) should be used with caution because they present greater risks for implant failures when compared to standard implants.