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Implant Success, Survival, and Failure: The International Congress of Oral Implantologists (ICOI) Pisa Consensus Conference

  • Implant Dentistry, Journal

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The primary function of a dental implant is to act as an abutment for a prosthetic device, similar to a natural tooth root and crown. Any success criteria, therefore, must include first and foremost support of a functional prosthesis. In addition, although clinical criteria for prosthetic success are beyond the scope of this article, patient satisfaction with the esthetic appearance of the implant restoration is necessary in clinical practice. The restoring dentist designs and fabricates a prosthesis similar to one supported by a tooth, and as such often evaluates and treats the dental implant similarly to a natural tooth. Yet, fundamental differences in the support system between these entities should be recognized. The purpose of this article is to use a few indices developed for natural teeth as an index that is specific for endosteal root-form implants. This article is also intended to update and upgrade what is purported to be implant success, implant survival, and implant failure. The Health Scale presented in this article was developed and accepted by the International Congress of Oral Implantologists Consensus Conference for Implant Success in Pisa, Italy, October 2007.
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Implant Success, Survival, and Failure:
The International Congress of Oral
Implantologists (ICOI) Pisa
Consensus Conference
Carl E. Misch, DDS, MDS,* Morton L. Perel, DDS, MScD,† Hom-Lay Wang, DDS, MScD,‡
Gilberto Sammartino, MD, DDS,§ Pablo Galindo-Moreno, DDS, PhD,Paolo Trisi, DDS,¶ Marius Steigmann, Dr. Med,#
Alberto Rebaudi, MD, DDS,** Ady Palti, DDS,†† Michael A. Pikos, DDS,‡‡ D. Schwartz-Arad, DMD, PhD,§§
Joseph Choukroun, MD,储储 Jose-Luis Gutierrez-Perez, MD, PhD, DDS,¶¶ Gaetano Marenzi, DMD, DDS,##
and Dimosthenis K. Valavanis, MD, DDS, DMD***
Success criteria for endosteal im-
plants have been proposed previ-
ously by several authors1– 6 The
report by Albrektsson et al4is widely
used today. However, it does not con-
sider the amount of crestal bone lost
during the first year. In addition, success
rates suggested in this guideline describe
an ideal implant quality of health for a
study or clinical report, but does not
address individual implants that may
have a stable condition in the mouth
after a brief episode of bone loss.
The success criterion most com-
monly reported in clinical reports is
the survival rate, meaning whether the
implant is still physically in the mouth
or has been removed.7Proponents of
this method say it provides the clearest
presentation of the data. Critics argue
that implants that should be removed
because of pain or disease may be
maintained and are wrongfully re-
ported as being successful.
A natural tooth is not described in
the literature as clinical success or fail-
ure. Instead, ideal conditions for a
tooth are reported, and a quality of
health scale is used to describe in-
traoral clinical conditions. In 1993, an
implant quality of health scale was
established by James and further de-
veloped by Misch.8,9 On 5th October,
2007, a Pisa, Italy Consensus Confer-
ence (sponsored by the International
Congress of Oral Implantologists)
modified the James–Misch Health
Scale and approved 4 clinical category
that contain conditions of implant suc-
cess, survival, and failure. Survival
conditions for implants may have 2
different categories: satisfactory sur-
vival describes an implant with less
than ideal conditions, yet does not re-
quire clinical management; and compro-
mised survival includes implants with
less than ideal conditions, which require
clinical treatment to reduce the risk of
implant failure. Implant failure is the
term used for implants that require re-
moval or have already been lost.
*Professor and Director of Oral Implantology, Department of
Periodontology and Implant Dentistry, Temple Dental School,
Philadelphia, PA.
†Private Practice, Providence, RI; Visiting Faculty, Boston
University, Goldman School for Dental Medicine, Boston, MA.
‡Professor and Director of Graduate Periodontics, Department
of Periodontics and Oral Medicine, School of Dentistry,
University of Michigan, Ann Arbor, MI.
§Professor of Oral and Maxillofacial Surgery, Faculty of
Medicine, Head of Department of Oral Surgery, University of
Naples “Federico II”, Naples, Italy.
Associate Professor, Oral Surgery and Implant Dentistry
Department, University of Granada, Spain.
¶Private Practice, Pescara, Italy; Scientific Director of Bio.
C.R.A Biomaterials Clinical Research Association, Pescara,
Italy; Director Biomaterial Research Laboratory, Instituto
Ortopedico Galeazzi, Milano, Italy.
#Private Practice, Neckargemund, Germany; Adjunct Assistant
Professor, Boston University, Boston, MA.
**Assistant Professor, University of Genova, Italy; Vice
President of Bio. C.R.A. Biomaterials Clinical Research
Association, Pescara, Italy; Private Practice, Italy.
††Private Practice, Baden-Baden, Germany; Clinical Professor, New
York University, College of Dentistry, New York, NY.
‡‡Private Practice, Palm Harbor, FL.
§§Faculty, Department of Oral and Maxillofacial Surgery, The
Maurice and Gabriela Goldschleger School of Dental Medicine,
Tel Aviv University, Tel Aviv, Israel.
储储Private Pain Clinic, Nice, France.
¶¶Dean and Professor of Oral and Maxillofacial Surgery, University
Hospital, School of Dentistry, University of Seveille, Spain.
##Clinical Assistant, Department of Oral and Maxillofacial
Sciences, University of Naples (Federico II).
***Private practice, Athens, Greece.
ISSN 1056-6163/08/01701-005
Implant Dentistry
Volume 17 Number 1
Copyright © 2008 by Lippincott Williams & Wilkins
DOI: 10.1097/ID.0b013e3181676059
The primary function of a dental
implant is to act as an abutment for
a prosthetic device, similar to a nat-
ural tooth root and crown. Any suc-
cess criteria, therefore, must include
first and foremost support of a func-
tional prosthesis. In addition, al-
though clinical criteria for prosthetic
success are beyond the scope of this
article, patient satisfaction with the
esthetic appearance of the implant res-
toration is necessary in clinical practice.
The restoring dentist designs and
fabricates a prosthesis similar to one
supported by a tooth, and as such of-
ten evaluates and treats the dental im-
plant similarly to a natural tooth. Yet,
fundamental differences in the support
system between these entities should
be recognized. The purpose of this ar-
ticle is to use a few indices developed
for natural teeth as an index that is
specific for endosteal root-form im-
plants. This article is also intended to
update and upgrade what is purported
to be implant success, implant sur-
vival, and implant failure. The Health
Scale presented in this article was
developed and accepted by the Inter-
national Congress of Oral Implantolo-
gists Consensus Conference for Implant
Success in Pisa, Italy, October 2007.
(Implant Dent 2008;17:5–15)
Key Words: implant clinical suc-
cess, implant clinical survival, im-
plant clinical failure
The term implant success may be
used to describe ideal clinical condi-
tions. It should include a time period
of at least 12 months for implants
serving as prosthetic abutments. The
term early implant success is sug-
gested for a span of 1 to 3 years,
intermediate implant success for 3 to 7
years, and long-term success for more
than 7 years. The implant success rate
should also include the associated
prosthetic survival rate in a clinical
Periodontal indices are often used
for the evaluation of dental im-
plants.10,11 Periodontal indices, of
themselves, do not define implant suc-
cess or failure. These clinical indices
must be related to other factors such as
exudate or overloading of the prosthe-
sis. However, understanding the basis
of a few clinical indices for evaluation
allows these criteria to establish a
health-disease implant quality scale
related to implant therapy.
Most clinical implant positions in
the literature do not invade the struc-
tures of the infraorbital or inferior al-
veolar nerves. Therefore, in the
success-to-failure criteria, it is as-
sumed that the implant does not vio-
late the major nerves of the jaws.12,13
Subjective findings of pain or tender-
ness associated with an implant body
are more difficult to assess than these
conditions with natural teeth.
Once the implant has achieved
primary healing, absence of pain un-
der vertical or horizontal forces is a
primary subjective criterion. Pain
should not be associated with the im-
plant after healing. When present, it is
more often an improper fitting pros-
thetic component, or pressure on the
soft tissue from the prosthesis. Percus-
sion and forces up to 500 g (1.2 psi)
may be used clinically to evaluate im-
plant pain or discomfort. Percussion is
used for the impact force to the im-
plant, not for the audible effect asso-
ciated with integration. Usually, pain
from the implant body does not occur
unless the implant is mobile and sur-
rounded by inflamed tissue or has
rigid fixation but impinges on a nerve.
Pain during function from an implant
body is a subjective criterion that
places the implant in the failure cate-
gory. Sensitivity from an implant dur-
ing function may place the implant in
the survival criteria, and may warrant
some clinical treatment.
Rigid fixation is a clinical term for
implants, which describes the absence
of observed clinical mobility with ver-
tical or horizontal forces under 500 g,
similar to evaluating teeth. Osseointe-
gration is a histologic term defined as
the surrounding bone in direct contact
with an implant surface at the magni-
fication of a light microscope.12 Over
the years, rigid fixation and osseointe-
gration have been used interchange-
ably. Today, the clinical term “lack of
mobility” may be used to describe im-
plant movement, and is a clinical con-
dition most often used to determine as
to whether the implant is integrated. A
root-form implant supported prosthe-
sis is most predictable with this type of
support system.
Lack of clinical movement does not
mean the true absence of mobility. A
healthy implant may move less than 75
m; yet, it appears as zero clinical mo-
bility.14 Clinical lack of implant mobility
does not always coincide with a direct
bone–implant interface.3However,
when observed clinically, lack of mobil-
ity usually means that at least a portion
of the implant is in direct contact with
bone, although the percentage of bone
contact cannot be specified.15 A clini-
cally mobile implant indicates the pres-
ence of connective tissue between the
implant and bone, and suggests clinical
failure for an endosteal root-form
implant. Implant “mobility” may be as-
sessed by computer or various instru-
ments,16,17 but at this point in time
these instruments are not necessary to
determine clinical movement in a hor-
izontal or vertical direction as being
implant failure.
Radiographic Crestal Bone Loss
The marginal bone around the im-
plant crestal region is usually a signif-
icant indicator of implant health. The
level of the crestal bone may be mea-
sured from the crestal position of the
implant at the initial implant surgery.
The most common method (in the lit-
erature) to asses bone loss after heal-
ing is by radiographic evaluation. Of
course, conventional radiographics
only monitor the mesial or distal as-
pect of bone loss around the implant
Several studies report yearly ra-
diographic marginal bone loss after
the first year of function in the range
of 0 to 0.2 mm.18 –20 The marginal bone
loss for the quality of health scale
should include the first year. Although
there are many different aspects that
contribute to early bone loss, regard-
less of the cause the overall amount of
bone loss may affect clinical criteria of
success to failure. Clinical studies of-
ten report statistical average bone
loss—not the range of bone loss ob-
served in the study. If 1 implant of 10
loses 5 mm of bone, the average bone
loss in the study is 0.5 mm; yet, the
range of bone loss was 0 to 5 mm.
Each implant should be monitored as
an independent unit when assessing
bone loss for a clinical evaluation of
success, survival, or failure.
Clinical observations obtained by
probing or radiographic measurements
of 0.1 mm for bone loss are operator
sensitive and are not reliable. There-
fore, the Pisa Consensus in this report
suggests that the clinical assessment
for each implant monitors marginal
bone loss in increments of 1.0 mm.
The bone loss measurement should be
related to the original marginal bone
level at implant insertion, rather than
to a previous measurement (e.g.,1
year prior).
The most common method to as-
sess the marginal bone loss is with a
conventional periapical radiograph.
Although this only determines the mesial
and distal bone loss, it is a time-tested
method. Computer-assisted image
analysis and customized x-ray posi-
tioning devices may be superior meth-
ods of measuring bone loss,17 but are
not required for the criteria established
at this consensus.
Probing Depths
Probing depths around teeth are
an excellent proven means to assess
the past and present health of natural
teeth, but probing depths around im-
plants may be of little diagnostic
value, unless accompanied by signs
(e.g., radiographic radiolucencies, purulent
exudate, bleeding) and/or symptoms
(e.g., discomfort, pain). The benefit of
probing the implant sulcus has been
challenged in the literature because
sound scientific criteria are lacking.
Increasing probing depths over time
may indicate bone loss, but not neces-
sarily indicate disease for an endosteal
implant. Stable, rigid, fixated implants
have been reported with pocket depths
ranging from 2 to 6 mm. Lekholm et
al20 found that the presence of deep
pockets was not accompanied by ac-
celerated marginal bone loss. Healthy,
partially edentulous implant patients
consistently exhibit greater probing
depths around implants than around
Probing pressures are subjective,
as is the angulation of the probe next
to an implant crown. The “correct
pressure” for probing has not been de-
fined for implants, but may be less
important than with teeth, because
there is no connective tissue attach-
ment zone next to an implant. The
potential for damage to the fragile at-
tachment or marring of the implant
surface may exist during probing.3On
the other hand, there is no clinical or
experimental evidence supporting this
hypothesis.21 Future research in the
area of probing is needed before in-
cluding this as a primary criteria in a
consensus for success, survival, and/or
On the other hand, charting the
attachment level in implant permucosal
areas does aid the dentist in monitor-
ing these regions. Probing to monitor
implants has been suggested in several
implant workshops and position arti-
cles.22–25 Sulcus depths greater than 5
to 6 mm around implants have a
greater incidence of anaerobic bacte-
ria26 –28 and may require intervention in
the presence of inflammation or exu-
date (e.g., surgery, antibiotic regi-
mens). Probing not only measures
pocket depth, but also reveals tissue
consistency, bleeding, and the pres-
ence of exudate.29
It is of benefit to probe and estab-
lish a baseline measurement after the
initial soft tissue healing around the
permucosal aspect of the implant. In-
creases in this baseline measurement
over time most often represents mar-
ginal bone loss. In the presence of
other signs and/or symptoms, the
probing depth compared with the
baseline measurement may be diag-
nostic in a clinical evaluation.
Although routine probing healthy
implants on a regular basis seems un-
warranted, a baseline measurement
and probing in the presence of other
symptoms and/or signs is indicated.
As such, in the ICOI Pisa Consensus
Criteria, probing depths are not as-
sessed in the success or satisfactory
health conditions, but are included in
the compromised survival condition.
Peri-implant Disease
The term peri-implantitis de-
scribes the bone loss from bacteria
around an implant.30 Peri-implantitis is
defined as an inflammatory process
affecting the tissue around an implant
in function that has resulted in loss of
supporting bone.28 Bacteria, on occa-
sion, may be the primary factor for
bone loss around an implant. Anaero-
bic bacteria have been observed in the
sulcus of implants, especially when
probing depths are greater than 5
Stress-induced bone loss (e.g.,
overloading the bone implant inter-
face) occurs without bacteria as the
primary causative agent.31–34 However,
once the bone loss from stress or bac-
teria deepens the sulcular crevice and
decreases the oxygen tension, anaero-
bic bacteria may become the primary
promoters of the continued bone loss.
In other words, the bacteria involved
in peri-implatitis may oftentimes be
secondary to one of the prime caus-
ative factors, such as overloading the
bone–implant interface.
Exudate or an abscess around an
implant indicates exacerbation of the
peri-implant disease and possible ac-
celerated bone loss. An exudate per-
sisting for more than 1 to 2 weeks
usually warrants surgical revision of
the peri-implant area to eliminate
causative elements. The reduced bone
height, after the exudate episode,
makes the implant more prone to sec-
ondary occlusal trauma. Therefore, the
dentist must reevaluate stress factors
for the new bony condition and often
must reduce them to improve long-
term performance.
The ICOI Pisa Implant Quality of
Health Scale
The ICOI Pisa Implant Quality of
Health is based on clinical evaluation.
This scale allows the dentist to evalu-
ate an implant using the listed criteria,
place it in the appropriate category of
health or disease, and then treat the
implant accordingly. Three primary
categories were established by the
Consensus: success, survival, and fail-
ure. The success category describes
optimum conditions, the survival cat-
egory describes implants still in func-
tion but not with ideal conditions, and
the failure of an implant represents an
implant that should be or already has
been removed. There are 4 implant
groups to describe the clinical condi-
tions of success, survival, or failure
(Table 1).
Group I represents success and is
considered optimum health conditions.
No pain is observed with palpation,
percussion, or function. No clinical
implant mobility is noted in any direc-
tion with loads less than 500 g. Less
than 2.0 mm of radiographically cr-
estal bone loss is observed compared
with the implant insertion surgery.
The implant has no history of exudate.
The prognosis of Group I implants is
very good to excellent.
Group II implants are categorized
as “survival” and have satisfactory
health. They are stable, but show a
history of, or potential for, clinical
problems. No pain or tenderness is
observed on palpation, percussion, or
function. No observable mobility ex-
ists with loads less than 500 g. Radio-
graphic crestal bone loss is between
2.0 and 4.0 mm from the implant in-
sertion. The prognosis is good to very
good, depending on the stable condi-
tion of the crestal bone.
Group III implants are also in the
“survival” category, but exhibit a
slight to moderate peri-implantitis and
compromised health status. Group III
implants are characterized by no pain
in function. No vertical or initial hor-
izontal mobility is evident. Greater
than 4 mm radiographic crestal bone
loss has occurred since implant place-
ment, but bone loss is less than 50%
from around the implant. Probing
depths have increased from baseline
up to one-half the length of the im-
plant, often accompanied with bleed-
ing on probing. Exudate episodes (if
present) may have lasted more than 2
weeks. The prognosis is good to
guarded, depending on the ability to
reduce and control stress once the sur-
gical corrections have improved the
soft and hard tissue health.
The Group IV of the Pisa Implant
Health Scale is clinical or absolute
failure. The implant should be re-
moved under any of these conditions:
(1) pain on palpation, percussion or
function, (2) horizontal and/or vertical
mobility, (3) uncontrolled progressive
bone loss, (4) uncontrolled exudate, or
(5) more than 50% bone loss around
the implant. Implants surgically
placed but unable to be restored
(sleepers) are also included in Group
IV failure. Regardless of whether the
implant is still in the mouth or re-
moved, the implant is recorded in this
category as a failure in all statistical
data. Implants that have exfoliated or
have been surgically removed are also
in this failure category.
Implant success is as difficult to
describe as the success criteria re-
quired for a tooth. A range from health
to disease exists in both conditions.
The primary criteria for assessing im-
plant, quality, or health are pain and
mobility. The presence of either one
greatly compromises the implant and
removal usually is indicated. Routine
probing depths are not suggested in
the absence of other sings or symp-
toms and may be related to the pres-
ence of local disease or preexisting
tissue thickness before the implant
was inserted. Bone loss is most often
evaluated with radiographs, which
only monitor the mesial and distal
marginal bone next to the implant.
Implant failure is easier to de-
scribe than implant success or survival
and may consist of a variety of factors.
Any pain, vertical mobility, and un-
controlled progressive bone loss war-
rant implant removal.
The ICOI Pisa Consensus Confer-
ence has simplified and updated a
Health Scale specific for endosteal im-
plants and included categories of suc-
cess, survival, and failure. In addition,
these categories of health may be re-
lated to the prognosis of the existing
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Implant Quality Scale
Clinical ConditionsGroup
I. Success (optimum health) a) No pain or tenderness upon function
b) 0 mobility
c) 2 mm radiographic bone loss from initial
d) No exudates history
II. Satisfactory survival a) No pain on function
b) 0 mobility
c) 2–4 mm radiographic bone loss
d) No exudates history
III. Compromised survival a) May have sensitivity on function
b) No mobility
c) Radiographic bone loss 4 mm (less than
1/2 of implant body)
d) Probing depth 7mm
e) May have exudates history
IV. Failure (clinical or absolute failure) Any of following:
a) Pain on function
b) Mobility
c) Radiographic bone loss 1/2 length of
d) Uncontrolled exudate
e) No longer in mouth
*International Congress of Oral Implantologists, Pisa, Italy, Consensus Conference, 2007.
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Reprint requests and correspondence to:
Carl E. Misch, DDS, MDS
16231 Fourteen Mile Road
Birmingham, MI 48025
Table Translations
Tabelle 1. Gesundheitstechnische Einteilung fur¨ Zahnimplantate
Qualitätsstaffelung fur¨ Implantate*
Klinische BedingungenGruppe
I Erfolg (Optimaler
a) Keine Schmerzen oder Empfindlichkeiten bei Aufnahme der
b) 0 Mobilität
c) 2 mm radiographisch festgestellter Knochengewebsverlust
nach orster Operation
d) Keine Exsudathistorie
II Zufrieden stellende
a) Keine Schmerzen bei Funktionsaufnahme
b) 0 Mobilität
c) 2–4mmradiographisch festgestellter Knochengewebsverlust
d) Keine Exsudathistorie
III Beeinträchtige Ub
¨erlebensrate a) Eventuell auftretende Sensitivitäten bei Funktionsaufnahme
b) Keine Mobilität
c) Radiographisch festgestellter Knochengewebsverlust 4mm
(weniger als die Hälfte des Implantatkor¨perumfangs)
d) Sondierungstiefe 7mm
e) Eventuell vorliegende Exsudathistorie
IV Versagensfälle (Klinisches oder
absolutes Versagen)
Einer der nachfolgenden Grun¨ de:
a) Auftreten von Schmerzen bei Funktionsub
b) Mobilität
c) Radiographisch festgestellter Knochengewebsverlust 1/2 der
Länge des Implantats
d) Unkontrolliertes Exsudat
e) Nicht mehr im Mundraum vorhanden
* Internationaler Kongress der Oralimplantologen, Pisa, Italien, Ub
¨ereinstimmungsbildende Konferenz, 2007.
Tabla 1. Escala de salud para implantes dentales
Escala de calidad de los implantes*
Situación clínicaGrupo
I Exitoso (óptimo estado de salud) a) Sin dolor ni sensibilidad después de funcionar
b) 0 movilidad
c) pérdida ósea de 2 mm a partir de la cirugía inicial
d) Sin antecedentes de exudados
II Supervivencia satisfactoria a) Sin dolor después de funcionar
b) 0 movilidad
c) pérdida ósea de2a4mm
d) Sin antecedentes de exudados
III Supervivencia comprometida a) Posible sensibilidad después de funcionar
b) Sin movilidad
c) Pérdida ósea de 4mm (menos de la mitad del cuerpo del implante)
d) Profundidad de 7mm
e) Posibles antecedentes de exudados
IV Fracasó (Fracaso clínico o absoluto) Cualquiera de los siguientes:
a) Dolor después de funcionar
b) Movilidad
c) Pérdida ósea de 1/2 del largo del implante
d) Exudado sin control
e) Ya no se encuentra en la boca
* Congreso Internacional de Implantólogos Orales, Pisa, Italia, Conferencia de Consenso 2007.
Tabela 1. Escala de Saúde para Implantes Dentários
Escala de Qualidade de Implante*
Condiçñes ClínicasGrupo
I Sucesso (Saúde ótima) a) Sem dor ou maciez durante atividade
b) 0 mobilidade
c) 2 mm perda de osso radiográfico a partir da cirurgia inicial
d) Sem história de exsudatos
II Sobrevivência Satisfatória a) Sem dor durante atividade
b) 0 mobilidade
c)2–4mmperda de osso radiográfico
d) Sem história de exsudatos
III Sobrevivência Comprometida a) Pode ter sensibilidade durante atividade
b) Sem mobilidade
c) Perda de osso radiográfico 4 mm (menos que 1/2 de corpo de implante)
d) Profundidade da sondagem 7mm
e) Pode ter história de exsudatos
IV Falha (Falha clínica ou absoluta) Qualquer dos seguintes: Dor durante atividade
b) Mobilidade
c) Perda de osso radiográfico 1/2 extensào do implante
d) Exsudatos nào-controlados
e) Nào mais na boca
* Congresso Internacional de Implantologistas Orais, Pisa, Itália, Conferência de Consenso, 2007.
бл 1. кл ок кс дло л
кл кс л*
Клск сосоГу
IУс л (Оло
a) Осус бол л услос  фукоо
b) Осус одос
c) догфск ок о косо сс! 2
осл о о
d) Осус "кссуд
II Удолол ос a) Осус бол  фукоо
b) Осус одос
c) догфск ок о косо сс! 2–4
d) Осус "кссуд
III Ого# ос a) $оо услос  фукоо
b) Осус одос
c) догфск ок о косо сс! 4 (
d) Глуб о#у! 7
e) $оо "кссуд
IV %уд л (Клск л
Л&бо  слду&#го:
a) Бол  фукоо
b) одос
c) догфск ок о косо сс! 1/2 дл
! л
d) %ул "кссуд
e) Осус ооо олос
*)дуод! когсс уб!* лолого,,+л,+г коф, 2007.
Tablo 1. Dental Im˙ plantlar için Sagl
˘ık Ol
Im˙ plant Kalite Ölçegı˘*
Klinik Kosu¸ llarGrup
I Basa¸ (Optimum sagl
˘ık) a) Fonksiyonda agr˘ı veya acı yok
b) 0 hareketlilik (mobilite)
c) ilk cerrahiden beri radyografik kemik kaybı: 2mm
d) Eksud
¨aoy¨ kus¨ yok
II Tatmin Edici Sagk
˘alım a) Fonksiyonda agr˘ı yok
b) 0 hareketlilik
c)2-4mm’lik radyografik kemik kaybı
d) Eksud
¨aoy¨ kus¨ yok
III Sagk
˘alımda Bozukluk a) Fonksiyon sırasında hassasiyet olabilir
b) Hareketlilik yok
c) Radyografik kemik kaybı 4 mm (implant
gov¨ desinin 1/2’inden daha az)
d) Prob derinligı˘ 7mm
e) Eksud
¨aoy¨ kus¨ olabilir
IV Basa¸ rısız (Klinik veya Kesin basa¸ rısızlık) Asa¸ ˘dakilerin herhangi biri:
a) Fonksiyon sırasında agr˘ı
b) Hareketlilik
c) Radyografik kemik kaybı: implant uzunlugu˘ nun
1/2’inden fazla
d) Kontrol edilemeyen eksud
e) Agı˘zda yerlesı¸k degı˘l
* Oral Im˙ plantolojistlerin Uluslararası Kongresi, Pisa, It
˙alya, Ortak Gor¨ us¨ ¸ Konferansı, 2007.
... The success or failure of an implant is not just determined by periodontal indicators [9]. These clinical indices must be connected to additional elements, such as exudate or prosthesis overloading [10]. ...
... Four groups on the implant health scale define the clinical conditions of success, satisfactory survival, compromised survival, or failure. While making these evaluations, pain, mobility, radiographic bone loss, pocket depth, and exudate were examined [9]. The eight vectors of the diagram in the IDRA include an assessment of a history of periodontitis, the percentage of sites with bleeding on probing, the number of teeth or implants with probing depths ≥ 5 mm, the ratio of periodontal bone loss (evaluated from a radiograph) divided by the patient's age, periodontitis susceptibility as described from the 2017 World Workshop on the Classification of Periodontal and Periimplant Diseases [22] the frequency/compliance with supportive periodontal therapy, the distance from the restorative margin of the implant-supported prosthesis to the marginal bone crest, and prosthesis-related factors, including cleanability and fit of the implant-supported prosthesis [17]. ...
... The "success" category describes optimum conditions, the "survival" category describes implants that are functional but not associated with ideal conditions, and the "failure" of an implant indicates that the implant should be removed or has already been removed [9]. Based on a study's measure for evaluating dental implant health, 98.4% were effective and in excellent condition [11]. ...
Full-text available
Background This study examined how smoking affects esthetics, peri-implant health, gingiva around the implant, and implant disease risk assessment in patients with implants. Methods The study included two hundred ninety-eight implants of systemically healthy patients aged between 38 and 62 who applied to the Periodontology Clinic and whose functionally prosthesis-loaded implants had been at least six months and at most five years old. Implants of patients with bruxism were not included in the study. Implants are divided into two according to the patient’s smoking. Vestibule depth around the implant, keratinized gingival thickness and width, gingival recession, bleeding on probing, pocket depth, and gingival index by a sole clinician. The pink esthetic score, peri-implant disease risk assessment, and implant health scale were also examined to measure implant esthetics and success. Results There was a statistically significant difference in the implant disease risk assesment scores for the examined implants of smokers and nonsmokers (p < 0.05). People who had peri-implantitis had higher implant disease risk assesment score levels. The dental implant health scale revealed a statistically significant difference (p < 0.05) in the likelihood of implant disease. According to the dental implant health scale, dental implants were 100% successful for non-smokers. There was a significant difference in the keratinized gingiva width between smokers and nonsmokers (p < 0.05). The results of the study showed that nonsmokers had a wider keratinized gingiva. Conclusions Research has demonstrated that the act of smoking has the potential to jeopardize the long-term survival of dental implants and the surrounding peri-implant tissues. The results of this study indicate that it would be advisable for dentists to provide guidance to their patients on smoking cessation and to monitor any alterations in behavior closely. Furthermore, it would be advantageous for dental professionals to elucidate the impact of smoking on the susceptibility of smokers to peri-implant disease.
... Criteria to assess the success of dental implant therapy have changed over time. The most frequently considered criteria have been survival of dental implants, stability of prosthesis, radiographic evidence of bone loss, and the absence of infection of the peri-implant tissues [12][13][14]. Based on the available criteria, dental implant therapy is considered successful if there is no mobility of the implant at the start of the prosthetic phase, bone loss is less than 0.2 mm per year after the first year, there is no radiolucency around the implant, there are no signs of peri-implantitis with suppuration, and no symptoms of pain, neuropathy or nerve paraesthesia [12,15,16]. ...
... The appearance of the soft tissues surrounding the implant, assessment of prosthodontic supra-structure, aesthetics and patient satisfaction were also proposed as criteria of success [17][18][19]. Heterogeneity in defining the success and failure of dental treatment therapy in clinical practice indicates the possibility that clinical studies may use different outcomes [12][13][14]. Furthermore, inconsistent outcomes across studies make it impossible to directly compare and systematically summarize all available evidence by combining results from various studies [12,15,17]. ...
Full-text available
Background Consistency in outcomes across clinical trials allows for comparing and combining results from different studies. A core outcome set (COS), representing a minimally agreed standardized group of outcomes that should be monitored and measured through research in a specific field of medicine, is not yet available for trials in implant prosthodontic (dental implant) therapy. This meta-research study aimed to analyze outcomes used in clinical trials on implant prosthodontic therapy. Methods We searched the Cochrane Oral Health Group (COHG) register to identify systematic reviews of interventions in implant prosthodontic therapy published by October 2023. From the randomized controlled trials (RCTs) included in the relevant reviews, we extracted data on the characteristics of the included trials and the outcomes used. We categorized outcomes into domains. Results From 182 systematic reviews in the COHG register, we included 11 systematic reviews on dental implant therapy. The reviews included 117 unique RCTs with 4725 participants, published from 1995 to 2020, which analyzed 74 different outcomes. Using different definitions, implant failure was analyzed in 73 RCTs. Seventeen RCTs did not define implant failure. Failure was most often (30 RCTs) followed up for one year. Only one RCT assessed implant failure after five years. Trials used 17 definitions of implant failure, while 17 trials did not report on the criteria of implant failure. Complications were analyzed in 48 RCTs, although they were not clearly defined in 12 RCTs. Failure of prosthodontic supra-structure was analyzed in 74 RCTs, with definitions of failure and criteria not clearly defined in 44 RCTs. Trials considered adverse events, peri-implant tissue health, patient attitudes, and other outcomes, including cost, aesthetics, or procedure duration. These outcomes were often different between trials. Twenty-six outcomes were used only once per study. Conclusions Clinical trials in implant prosthodontics used different outcomes, different definitions of outcomes and used different times to monitor them. Standardization of outcomes is necessary to allow comparability and evidence synthesis about the effectiveness of implant prosthodontic therapy.
... An implant is said to have failed if it had to or had been removed. 10 Success of dental implant treatment is highly dependent on osseointegration. Failure of bone osseointegration with dental implants occurs when bone decreases in mass and density. ...
Full-text available
Background: Systemic diseases may impact osseointegration of dental implants. Osteoporosis has become one of the concerning diseases since its prevalence reached 18.3% in the world and 10.3% in Indonesia. It is characterized by the decrease in bone thickness, alteration of trabecular structures, and increase in ratio of carbonate and phosphate, making the bone more fragile and prone to fracture. Consequently, the issue of bone quantity and quality will have a great impact on dental implant survival rate. Objectives: To know the effect of osteoporosis on survival rate and osseointegration of dental implants. Conclusion: Dentists should be more cautious if patients receiving dental implant treatment have a bone mineral density score of-2.5 < T-Score <-1 and an estrogen deficiency, because both are directly related to osteoporosis. Consumption of bisphosphonates should also be asked because it could cause osteonecrosis of the jaw. Most studies show no significant differences between survival rate of implants placed on osteoporotic patients and healthy patients after a short time period, 0-1 year. However, most studies show significant differences after a long time period, 5-7 years, so evaluation of implants is recommended.
... Implant-supported fixed prostheses represent a highly reliable therapeutic option and one of the most predictable dental procedures for treating partial posterior jaw edentulisms [1][2][3] . The rehabilitation of posterior jaws may be clinically challenging, especially when the residual bone volume does not allow the proper insertion of implants with a standard length of at least ten mm 4 . ...
The rehabilitation of the posterior sites of the maxilla with dental implants is a therapeutic procedure often influenced by the atrophy of the maxillary bone, caused by either the loss of dental elements or by the maxillary sinus pneumatization. Bone loss in the upper maxillae which prevents the placement of implant fixture, may be fixed with surgical bone regenerations techniques, such as the sinus lift, or with the placement of zygomatic and/or pterygoid implants. Although the proved effectiveness of these invasive therapeutic approaches, the biological and economic costs may be high. Also, the failure of these procedure, may further prevent the possibility of a second implant rehabilitation. In this scenario, the use of the short and ultra-short implants may be considered a valid minimally invasive alternative for the rehabilitation of the atrophic edentulous crests. Here, we describe a case of a female patient presenting with atrophic posterior maxilla which was rehabilitated with an implant of 3 millimeters in length after the failure of a previous surgical maxillary sinus lift through lateral window approach and with a total follow-up of 36 months.
... Implant survival (at implant level, CSR-Impl; at patient level, CSR-Pt) was defined as absence of implant failure, registered with presence of one of the following clinical conditions: implant-related pain on function; implant mobility; peri-implant radiolucency > 1/2 length of the implant; and/ [30]. ...
Full-text available
Objectives Up-to-date literature regarding long-term success of implant rehabilitations after microvascular reconstructions with free fibula flap (FFF) is still very scarce. This study aimed to evaluate clinical outcomes, especially related to oral hygiene conditions, of patients rehabilitated with this technique. Materials and methods A total of 25 patients who underwent maxillofacial reconstructive surgery with FFF were retrospectively evaluated for soft tissues conditions, oral hygiene habits, and implant survival and success, assessed with a mean follow-up of 6 (range 2–15) years after loading. Results Fourteen patients received full-arch fixed prostheses and 11 removable bar-supported overdentures. At the follow-up evaluation, 52% of prostheses did not allow proper accessibility for oral hygiene. Overall prosthetic survival was 100%, and implant survival and success were respectively 93.6% and 72%. Prevalence of peri-implantitis was 29% at implant level and that at patient level 96%. Conclusions Six-year clinical outcomes of this study reveal that poor oral hygiene practices and compliance by patients who underwent maxillofacial reconstruction with FFF are significantly associated with peri-implant disease. Clinical relevance Findings of the present study underline the need by clinicians for a careful assessment, in reference to a specific implant therapy, of patient’s prosthetic accessibility for oral hygiene procedures.
... The occurrence of biological and prosthetic complications from the implants was investigated. (Table 1) 6 . We defined implant survival as meeting the condition for either "satisfactory survival" or "compromised survival." ...
Full-text available
Objectives This review assessed the performance of implant-supported fixed hybrid prostheses in 21 patients who received a total of 137 implants between 2003 and 2010. The implants were evaluated for marginal bone resorption, complications, success rate, and survival rate based on their vertical angularity, type of bone graft, and measured implant stability. Materials and Methods One-way ANOVA and chi-square tests were used to analyze the relationships among long-term evaluation factors and these variables. The mean initial bone resorption in the implant group with a vertical angle of more than 20° was 0.33 mm and mean final bone resorption was 0.76 mm. In contrast, the mean initial bone resorption in the implant group with a vertical angle of less than 10° was 1.19 mm and mean final bone resorption was 2.17 mm. Results The results showed that mean bone resorption decreased with an increase in the vertical placement angle of the implants used in fixed hybrid prostheses, as well as in the group without additional bone grafts and those with high implant stability. The success rate of implants placed after bone grafting was found to be higher than those placed simultaneously. Conclusion These results suggest that implant-supported fixed hybrid prostheses may be an effective treatment option for edentulous patients, and intentionally placing implants with high angularity may improve outcomes.
... No implant was lost during the follow-up of this study. Only 0.15% of implants were radiographically affected with MBL of 3 mm or more, so, if radiographical success is established at 2 mm of MBL, as it has been classically defined [27], our series has a 95.3% probability of success. Moreover, 18.9% of implants showed a cut-point of MBL higher than 0.5 mm. ...
Full-text available
The aim of this study was to analyze the long-term marginal bone level (MBL) of implants supporting fixed full-arch restoration in patients who had previously lost their dentition due to severe periodontitis. This retrospective study included 35 patients in whom 342 implants with internal tapered conical connections were placed. MBL was analyzed radiographically over time and a long-term estimation of MBL was calculated. A mixed linear model with abutment height, graft, diameter and location (maxilla/mandible) as factors and gender, age, implant length and prosthetic variables as covariates was used to evaluate the influence on MBL. MBL in these patients showed an estimator of predictions at 4108 days after loading of −0.307 mm, SE = 0.042. Only 0.15% of implants were radiographically affected with MBL of 3 mm or more. The mixed linear model results showed a main effect of the type of opposing dentition, gender, implant diameter, and abutment height. Particularly, an abutment height of 1 mm had associated larger MBL than the remaining heights. Thus, it can be concluded that dental implants restored with fixed segmented full-arch rehabilitation in patients with a history of severe periodontal disease do not suffer important marginal bone loss if some specific factors are considered, mainly the use of long transmucosal abutments (≥2 mm).
Dental implants are essential in modern dentistry, playing a crucial role in the predictability and success of oral rehabilitation procedures, restoring chewing function and aesthetics to the patient. Implant surface treatments offer greater opportunity to capture proteins, stabilize the blood clot and cells responsible for bone formation and remodeling, accelerating the biomechanical relationship of the implant-bone unit. A literature review was carried out using publications from various authors in the form of scientific articles and course conclusion works, which were available in vital databases: Google Scholar, Pubmed, Scientific Electronic Library Online (Scielo). The key words used for the search were: “Implantes dentários”, “Osseointegração”, “Reabilitação bucal” and “Propriedades de superfície”, the same terms being searched in English: “Dental implants”, “Osseointegration”, “Mouth rehabilitation”, “Surface properties”. The search period was from April to August 2023 and included articles in Portuguese and English. In this sense, the present study aimed to present a narrative review of the literature regarding surface modification techniques in surviving titanium implants and their relevance for osseointegration. It was possible to conclude that titanium implants with surface treatment have advantages when compared to the machined surface in influencing the bone integration procedure. Macro-, micro-, nano-textured and biomimetic surfaces can improve bone/implant connection, deposition of osteogenic molecules and initial firmness.
Abstract In this study the microbiota associated with oral endosteal titanium hollow cylinder implants (ITI) was studied using microscopic, immunochemical and cultural methods. Samples from 5 edentulous patients with successfully incorporated implants serving as abutments for overdentures for more than one year were compared with samples from 7 patients with clinically failing implants. Unsuccessful sites were characterized by pocket probing depths of 6 mm or more, suppuration and visible loss of alveolar bone around the implant as visualized on radiographs. These sites harbored a complex microbiota with a large proportion of Gram-negative anaerobic rods. Black-pigmented Bacteroides and Fusobacterium spp. were regularly found. Spirochetes, fusiform bacteria as well as motile and curved rods were a common feature in the darkfield microscopic specimens of these sites. Control sites in the same patients harbored small amounts of bacteria. The predominant morphotype was coccoid cells. Spirochetes were not present, fusiform bacteria, motile and curved rods were found infrequently and in low numbers. The microbiota in control sites in unsuccessful patients and in site in successful patients were very similar. On the basis of these results, it is suggested that “periimplantitis” be regarded as a site specific infection which yields many features in common with chronic adult periodontitis.
The conference sought a balanced and realistic appraisal of four commonly used implants in current clinical practice: the subperiosteal, stapleltransosteal, vitreous carbon, and blade. Definitions of success, benefit and risk, and guidelines for use of the implants are provided in conference recommendations.
It has been documented that the long-term clinical outcome of the Brånemark system is very favourable. However, failures do occur before and after loading. This study examined the differences in marginal bone loss between standard and self-tapping fixtures and attempted to explain excessive marginal bone loss or loss of osseointegration during the first 3 years of loading. Marginal bone loss (scored on long cone radiographs) and fixture failure rate were compared for different fixture designs. For standard fixtures, in comparison with self-tapping fixtures, the failure rate was clearly higher before as well as after loading. However, for successful fixtures no difference in marginal bone loss was observed. For the conical fixtures an increased marginal bone loss around the smooth part was observed. The effect of fixture overload, marginal bone height and loss of osseointegration was examined in 69 patients with 1 and 15 patients with 2 fixed full prostheses, and in 9 patients with an overdenture in the upper jaw. Excessive marginal bone loss (more than 1 mm) after the first year of loading and/or fixture loss correlated well with the presence of overload due to a lack of anterior contact, the presence of parafunctional activity and osseointegrated full fixed prostheses in both jaws.
Nine clinical centers using the Brånemark System participated in a prospective study of 159 partially edentulous patients between 18 and 70 years of age. Clinical parameters evaluated were plaque index, gingivitis, pocket depth, bleeding index, tooth mobility, and stomatognathic function. Initially, 558 fixtures were placed and 521 remained in the study following prosthesis placement (199 prostheses in 154 patients). Fixtures were lost or unaccounted for because of nonintegration prior to prosthesis fabrication (19), patient withdrawal (11), prosthodontic reasons (6), and failure during prosthetic procedures (1). Failure was primarily attributable to unfavorable bone quality, sex (more in males), and smaller fixture size. Complications and failure related to other patient characteristics are presented. After 1 year of a 5-year study, preliminary results suggest that a success rate equal to or better than that obtained with edentulous patients may be expected.