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The purpose of this literature review is to present the outcomes of clinical studies on immediate and early loading protocols, identify shortcomings, and suggest a number of questions that still require exploration. English language clinical studies, limited to peer-reviewed journals between 1975 and 2004, were reviewed to identify treatment outcomes with these loading protocols. The data were tabulated from studies reporting on patients treated with fixed and overdenture prostheses. The former included partially edentulous patients treated with single or multi-unit prostheses. Within the limitations of this review, it can be concluded that these treatment protocols are predictable in the anterior mandible, irrespective of implant type, surface topography, and prosthesis design (success rates 90%-100%). Limited evidence for the edentulous maxilla (success rates 90%-100%) and the partially edentulous patient (success rates 93%-100%) are available, underscoring the need for further research. Studies suggest that to achieve predictable results in extraction sites, implant placement should be restricted to sites without a history of periodontal involvement (success rates 61%-100%). A number of questions require further exploration. There is a need to thoroughly investigate clinical outcomes to measure the economic benefit of these protocols and the impact of treatment on a patient's quality of life. Furthermore, more accurate long-term studies reporting on treatment protocols for separate clinical situations are required to allow meaningful comparisons.

Older adults often have bone loss and may be at risk of bone resorption around oral implants.This study tested the hypothesis that there is no difference in crestal bone loss proximal to oral implants in the complete implant prosthesis sites of older and younger adults.Two groups of 35 complete dental implant prosthesis sites (23 screw-retained fixed prostheses and 12 bar-retained overdentures) were selected by matching sites in 32 older adults (60 to 74 years old with 166 Bränemark implants) to sites in 34 younger adults (29 to 49 years old with 162 Bränemark implants) on the basis of possible confounding factors including gender, prosthetic design, implant number, arch, year of surgery, and opposing dentition. Statistical comparisons (Mann-Whitney test at P.05) were made of mean crestal bone level at loading and mean annual crestal bone loss during the first year, first to fourth year, after first year, and after fourth year of loading with periapical radiographic measurements of the vertical distance in millimeters from the apical edge of the implant collar to the most apical initial point of contact between the implant and bone.No significant differences were found between the groups. Mean bone levels at loading were 1.4 mm below the collar in both groups and mean annual crestal bone loss after the first year of loading was 0.04 mm/y in both groups. However, significant differences were found between some old and young subgroups stratified by arch and prosthetic design.Within the limitations of this study, elders should expect no more rapid bone resorption around oral implants in edentulous jaws than that seen in young adults.

Statement of problem. The frequency of prescription of implant-supported prostheses demands increased scrutiny of systemic health condition on treatment inclusion and exclusion criteria. The risks of an impaired healing response in patients with certain types of cardiovascular diseases (CVD) suggest a possible risk for implant failure in such patients. Purpose. This preliminary study surveyed implant treatment outcome of patients with cardiovascular diseases. Methods. A retrospective analysis of 246 consecutively treated patients was conducted. The patients comprised a CVD interest group of 39 patients, and control subgroups of 98 healthy and 109 patients with a history of other systemic disease. Results. Differences in implant failure rates between the groups were not found to be significant. Though the sample size is small, these results suggest that CVD may not be a risk factor for successful osseointegration. (J Prosthet Dent 1999;81:533-6.)

This article presents a brief review of the methods and techniques to manage the maladaptive edentulous patient. A discussion of the inclusion and exclusion criteria and treatment outcome measures associated with published prospective osseointegrated implant studies are included and specific therapy options are suggested. It is concluded that there is a need for less invasive, less expensive, less complex, and equally effective treatment options such as the implant-supported overdenture for the maladaptive edentulous patient. (J Prosthet Dent 1998;79:60-5.)

Forty-six patients who had shown chronic maladaptive behavior in using complete dentures were treated with osseointegrated implant-supported prostheses. Forty patients needed mandibular treatment, three patients needed treatment in the maxillae, and three required treatment in both dental arches. At the most recent data collection (4 to 9 years after surgical placement of the implants), the 49 dental arches remained successfully treated with 44 implant-supported fixed partial dentures and five implant-supported overdentures. The efficacy of the osseointegration technique in maladaptive prosthetic patients is demonstrated in this descriptive study.

In this prospective study, 46 edentulous patients who had undergone traditional denture optimization therapy without success were treated with osseointegrated implants according to the surgical protocol described by Dr. P.I. Branemark. Two hundred seventy-four implants were placed in 49 dental arches—43 mandibles and six maxillae. At the time of writing, 4 to 9 years after insertion of the implants, 244 or 89.05% remained osseointegrated. Of the 262 implants in place more than 5 years, 232 or 88.55% were still integrated. The implant success criteria developed in this clinical study endorsed the predictably favorable outcome of the Branemark technique.

Statement of the Problem. The clinical success of implant-supported fixed partial dentures has been documented. However, few studies have reported long-term results or any association between implant outcomes and host determinants. Purpose. This study reports on implant and prosthesis outcomes in a group of partially edentulous patients treated with Branemark implants in the posterior zones. It also examines factors described in the medical history that may influence implant survival. Material and Methods. The charts of patients treated with implants from 1983 and followed prospectively through December 2001 at the University of Toronto were reviewed. One hundred thirty partially edentulous patients treated with implant-supported restorations in the posterior zones (area distal to mental foramen) were selected. Implant and prosthesis treatment outcomes were recorded and analyzed through the Kaplan-Meier and Cox regression methods ( P Results. A total of 130 patients received 432 Branemark dental implants in 174 posterior edentulous spans. The mean age of the patients at the time of insertion of the implants was 50.97 ± 13.27 years. At 15 years, the overall implant and prosthesis survival rates were 91.6% and 89%, respectively. At 5 years, the survival rate of the wide-platform 5-mm-diameter implants was 76.3%. Implant diameter ( P =.0001) and a history of a chronic medical condition ( P =.01) were correlated with implant survival outcomes. Conclusions. High success of implant-supported prostheses in the posterior zones of both the maxilla and mandible. It corroborated other studies that have shown higher failure rates for wide-platform implants, emphasizing the need for proper establishment of clinical trials prior to marketing of new implant designs. (J Prosthet Dent 2003;89:352-9.)

There is a need for specific documentation that successful osseointegration related to Brânemark implants can be maintained, despite an apparent clinically vulnerable peri-implant soft tissue status.This study monitored longitudinal peri-implant clinical responses in the mandible and sought to question whether a relatively deep mucogingival pocket will give rise to a greater loss of peri-implant bone than a shallow pocket.Subjects, 8 women patients (mean age 62 years), were treated with Brânemark mandibular osseointegrated implant-supported prostheses. Four of these subjects had limited (average3.5 mm) and 4 had unlimited (averageor =3.5 mm) peri-implant pocket probing depths and constituted the control and test subgroups, respectively. Longitudinal changes in peri-implant PAL and radiographic bone support were assessed.Overall probing attachment levels (PALs) of the peri-implant mucogingival complex showed little change. The PAL loss was only minimally significant within the control subjects, and not significant for test subjects. The difference in these mucogingival responses between test and control subjects was significant (P = .04). There was no significant overall longitudinal change in peri-implant bone levels. The longitudinal change of peri-implant bone level was not significant within or between the control and test subjects.

Two hundred seventy-four implants were placed in 49 dental arches of 46 consecutively treated patients. The success rate for individual implants in this study, 4 to 9 years after placement, was 89.05% and for the prosthetic treatment it was 100%. Problems and complications were observed and recorded at stage I surgery, between stage I and stage II surgery, at stage II surgery, and in the healing period that followed. Also noted were the complications subsequent to prosthodontic treatment and during the years of follow-up. Virtually all of the problems encountered were iatrogenic in nature. These clinical results indicate a safe and retrievable technique with negligible associated morbidity.

Purpose The aims of this report are to present the patient-based outcomes and associated clinical costs of an immediate loading protocol for mandibular overdentures in edentulous patients. Materials and Methods Two groups of patients were selected. Thirty-five consecutively treated patients received an immediate protocol, while 42 patients treated with a conventional protocol served as a historical control. Patient-based concerns for patients in the immediate group were measured at various stages of treatment with 2 questionnaires: the Denture Satisfaction Scale and the Oral Health Impact Profile. Direct clinical and time costs over a 1-year period were estimated and deflated to 2002 Canadian dollars. Salary rates by occupation, age, and gender were used to evaluate the patients' time costs. Treatment costs were compared between the 2 groups. Additionally, incremental cost-effectiveness ratios for various stages with the immediate protocol were calculated. Results Significant improvements posttreatment were observed with both the Denture Satisfaction Scale (Wilcoxon signed rank test, P P P Conclusions This study suggests that implants in 1 jawbone lead to a substantial improvement in perceived oral health status. Furthermore, the immediate loading protocol was not cheaper than a conventional protocol.— Reprinted with permission of Quintessence Publishing.

Purpose The aim of this report is to present the implant and clinical outcomes of an immediate-loading protocol of TiUnite implants with mandibular overdentures in edentulous patients. Materials and Methods Two groups of edentulous patients were selected. Thirty-five consecutively treated patients received 70 immediately loaded TiUnite implants and 69 Branemark implants as backup (1 patient received 1 Branemark implant). The control group was a historical cohort that comprised 42 patients who received 111 Branemark implants. All overdentures were supported by a resilient bar mechanism. Implant and clinical outcomes, including maintenance events for the first year, were recorded. Results Implant success rates were in excess of 95% with both protocols. Immediately loaded implants had less bone loss than did implants loaded with the conventional protocol (Mann-Whitney U test; P =.001). Patients in the immediate-loading group required more prosthodontic maintenance, consisting of overdenture remakes and laboratory relining of prostheses (Chi-square test; P P Conclusion The favorable implant and bone level outcomes with immediate loading attest to its biologic success. The prosthetic maintenance encountered in the immediate-loading group does not negate the clinical potential of the treatment but rather suggests that the protocol may benefit from modifications.— Reprinted with permission of Quintessence Publishing.

Purpose The study's aim was to report long-term costs in edentulous patients treated with mandibular implant-supported prostheses. Materials and Methods Ninety patients were divided into four groups based on the type of implant prosthesis (fixed or overdenture) and treatment year. Records were obtained from dental charts, and an economic analysis from the patient's perspective was conducted. Clinical time associated with various procedures was measured and applied to the four groups. Salary rates by age, occupation, and gender were used to value patients' time. Direct clinical and time costs over 10 years were converted to 2002 Canadian dollars using the Consumer Price Index and discounted at a 3% rate. A sensitivity analysis at an equal salary rate was carried out to test the robustness of the time costs. Results Initial treatment and maintenance costs over the observation period were significantly higher for fixed compared to overdenture prostheses. A significant improvement in maintenance costs for the first patient group treated with fixed prostheses was observed over the follow-up period. Longer term (15 years) treatment costs for the initial two groups were significantly higher for the fixed group. The sensitivity analysis at an equal salary rate demonstrated the same trend: Time costs were significantly higher for the fixed groups. Conclusion Long-term treatment costs indicated that the mandibular overdenture was a less expensive treatment compared to the fixed implant prosthesis.— Reprinted with permission of Quintessence Publishing.

Purpose Few long-term studies on overdentures report both implant and prosthodontic outcomes. The aim of this prospective study was to report long-term prosthodontic- and implant-related treatment outcomes of patients treated with design-specific implant-supported overdentures. Materials and methods Between 1982 and 1992, 45 consecutively treated patients received a total of 47 overdentures (42 mandibular and maxillary) supported by Branemark implants. Prospective clinical and radiographic data were collected over the observation period; this study presents the most recent treatment outcomes. Results Thirty patients (mean age 70 years) with 32 prostheses attended the final recall visit, with 67% of patients followed for 15.53 years (range 10 to 19 years). Six implants failed, and the prosthetic plan and implant cumulative survival rates were both in excess of 90%. Mean marginal bone loss around implants after the first year of loading was small (0.05 mm/year), although the individual variation was high. Linear regression analysis of bone loss indicated that gender, bicortical stabilization, bone quality, and healing time were predictors of bone loss for the first year of loading but not for the ensuing years. Prosthetic maintenance included fractured components, denture relining, and replacement of prostheses. On average, the longevity of overdenture prostheses was 12 years, and laboratory relining was necessary every 4 years. Conclusion This study confirmed the long-term outcome success of patients treated with design-specific overdenture prostheses supported by Branemark implants. However, prosthetic maintenance was required, a fact that should be discussed with patients prior to treatment.—Reprinted with permission of Quintessence Publishing.

Purpose The aim of this prospective study was to report long-term treatment outcomes (prosthetic and implant related) of edentulous patients treated with implant-supported fixed prostheses who participated in the first clinical implant study in North America. Materials and methods Forty-five patients were treated with Branemark implants supporting a total of 47 fixed prostheses (42 mandibular and 5 maxillary) between 1979 and 1984. All patients were recalled regularly for comprehensive prospective clinical and radiographic assessments. Results Thirty-one patients (33 prostheses) attended a final recall visit in 2002; 71% of patients had been followed for 20 years (range 18 to 23 years), with overall prosthetic plan and implant outcome success rates of 84% and 87%, respectively. Mean marginal bone loss around the implants after the first year of loading was small (0.05 mm/year), with high individual variations. Poor oral hygiene, smoking history, and implant position appeared to be predictors of marginal bone loss. Prosthetic maintenance was ongoing and included fractured components and replacement of prostheses; the longevity of a fixed prosthesis for this group of patients was 8.39 ± 5.30 years. Conclusion This study confirmed the overall long-term treatment outcome success of patients treated with fixed prostheses supported by Branemark implants. Successful osseointegration with small mean bone loss was maintained as study patients aged, although prosthetic maintenance was required. The latter consideration should be discussed with all patients seeking such treatment.— Reprinted with permission of Quintessence Publishing.

1 emporomandibular joint dysfunctions are fairly common occurrences and are comprehensively documented in the dental literature. Several authors maintain that inadequate dentitions and unsatisfactory occlusions are the most frequent causes of temporomandibular joint disorders. l-4 Other investigators, while noting that hyperfunction may give rise to myofascial pain, assert that temporomandibular joint disturbances are usually related to dysfunction of the masticatory muscles and/or to emotional disorders.5-10 The objective of this investigation was to assess, from a clinical point of view, the history, symptomatology, clinical findings, radiographic appearance, dental status, treatment, and longitudinal follow-up of patients suffering from functional temporomandibular joint disturbances. This article is a preliminary report based on a 30 to 36 month follow-up of a sample of treated patients. For each patient, an assessment was made of (1) the chief complaint and its duration, (2) the onset of pain and associated joint activity, (3) bruxing and/or clenching activity, (4) the medical history findings, (5) the emotional state, (6) subjective symptoms, (7) clinical findings, (8) pain distribution, (9) the occlusal/prosthetic status, (10) the occlusion, (11) a charting of the existing teeth, carious lesions, periodontal status, attrition, facets, and the like, (12) full-mouth and Panorex radiographs, (13) the treatment prescribed, (14) the time interval in obtaining relief, (15) the permanent treatment plan, and (16) referral consultations.

Because of the proliferation of implant systems, a set of criteria for implant success based on scientific investigations is essential. A review of the literature and the analysis of the results indicate that six criteria are supported as valid for determining the clinical success of endosseous dental implants. These criteria are proposed for use in clinical investigation on implants.

The mechanism of support for oral prostheses varies qualitatively and quantitatively, depending on the type of prosthesis worn. Some prostheses are partially supported by natural teeth, and others rely for their support on the residual tissues, mucosa, alveolar bone. Nondental prosthetic support demonstrates progressive longitudinal changes and poses special problems for the denture wearer. In this review, the masticatory system is considered as a biomechanical interaction of three components: function/dysfunction adaptive responses, and TMJs. It appears that oral behavior is related to all three components, but its role is not completely understood.

The surgical anatomy of a maxillary resection has been described. The osseous structures involved have been identified, and the residual anatomic structures correlated with replacement prostheses. The prosthetic rehabilitation of a patient with a resected maxilla has been discussed.

lhe successful replacement of lost natural teeth by implanted prostheses would significantly advance dental treatment. Thousands of middle-aged and elderly edentulous patients suffer from advanced residual ridge reduction. These individuals cannot cope with conventional complete dentures and often confront the profession with problems that cannot be solved. Over the years several inventive and well-meaning dentists attempted to circumvent such prosthodontic problems by prescribing dental implants. Regrettably the optimal combination of materials, designs, and implant techniques has not yet been developed and standardized. As a result many patients have suffered unnecessarily from the well-intentioned application of human experimentation without genuinely informed consent. Recent research in the biologic response to different medical prostheses underscores the viability of a direct biologic attachment for dental implants. The term osseointegrution was coined by Branemark almost 20 years ago to describe the result of a large body of basic science, surgical, biomaterials, and prosthodontic research in the discipline (subject) of dental implants. The applied form of this research provides evidence of a breakthrough in this field. A conference on osseointegration in clinical dentistry, therefore, became a priority, and such a conferena was held in Toronto in May 1982. It was cosponsored by the University of Giiteborg and the University of Toronto with invitations sent to senior university prosthodontists and oral surgeons from North America. The preliminary objective of the conference was to subject the Swedish basic and clinical research to a collective scientific scrutiny prior to the establishment of training centers in academic health institutions in North America. This issue and the following two issues of the JOURNAL OF PROSTHETIC DENTISTRY will feature edited versions of the papers presented at the Toronto Conference on Osseointegration in Clinical Dentistry. Collated reprints of these articles will be available latar for distribution to all interested dentists, researchen, and librarians.