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Objectives: Bioactive surfaces were designed to increase the interaction between the surface and the cells. This may speed up the biological stability and loading protocols., Materials and Methods: 36 patients with D3-D4 bone density were recruited and allocated into two groups. 30 bioactive (test group) and 30 traditional (control group) surfaced implants were placed. Insertion torque value (Ncm), insertion torque curve integral (cumulative torque, Ncm), torque density (Ncm/sec), implant stability quotient (ISQ) measured at three timepoints (baseline (T0), 30 (T30) and 45 (T45) days after surgery), and marginal bone loss (MBL) at 6 months of loading were assessed., Results: The mean ISQ and standard deviation at T0, T30, T45 were respectively 74.57 ± 7.85, 74.78 ± 7.31, 74.97 ± 6.34 in test group, and 77.12 ± 5.83, 73.33 ± 6.13, 73.44 ± 7.89 in control group, respectively. Data analysis showed significant differences between groups in ΔISQ at T0-T30 (p = 0.005) and T30-T45 (p = 0.012). Control group showed a significant decrease in ISQ at T30 (p = 0.01) and T45 (p = 0.03) compared to baseline, while no significant change was observed in test group. Due to the stability of the ISQ value ≥ 70, 26 test group and 23 control group implants were functionally loaded after 45 days. Conversely, due to the ISQ < 70 at T45, four test group implants and one control group implant were loaded after 90 days, and 6 control group implants were loaded after 180 days. Neither insertion torque nor ISQ at baseline were correlated with bone density (in Hounsfield units). There was no significant correlation between cumulative torque and ISQ at baseline. There was a significant positive slope in the correlation between torque density and ISQ at baseline, more accentuated in D3 than D4. This correlation remained significant for the test group in D3 bone at day 30 and 45 (p < 0.01 in both time frames), but not in D4 bone, and it was not significant in CG., Conclusions: The bioactive surface showed better behavior in terms of implant stability in D3-D4 bone quality in the early stages of bone healing. Clinical relevance This study demonstrated that the transition from primary to secondary stability is improved using bioactive surface, especially in cases of poor bone environment (D3/D4 bone)., (© 2024. The Author(s).)

Purpose: There is no clinical consensus to determine the right balance between underpreparation and marginal bone level changes. The purpose of this systematic review and meta-regression was to investigate the influence of the type of drilling preparation of the implant site in relation to the bone mineral density on the clinical success, expressed in terms of the MBL and implant failure rate., Study Selection: A thorough search was performed using the digital databases MEDLINE PubMed, EMBASE, and Cochrane Central Register of Controlled Trials by entering research lines or various combinations of free words. The main keywords used were "dental implants", "bone density", and "torque"., Results: The mean bone resorption in the conventional preparation group was -0.43 (± 0.28) mm, whereas it was -0.80 (± 0.37) mm in the underprepared group. For the D1/D2/D3 bone group, the slope was significantly different from zero and linearity; the D4 bone group slope was not significantly different from zero and was almost parallel, although it was significantly different from linearity. The box and whiskers plot shows that the MBL in underprepared sites tended to be significantly higher with a higher variation than that in conventionally prepared sites., Conclusions: Within its limits, our meta-regression analysis showed that MBL is influenced by the type of drilling preparation and bone mineral density. In particular, a lower MBL was observed in the D1 bone with conventional preparation than with underpreparation. Moreover, a greater implant-to-osteotomy site mismatch was positively associated with greater MBLs in the bone densities of D1/D2/D3.

Purpose: To assess whether bone grafting is associated with early implant failure (defined as a lack of osseointegration detected prior to functional loading) and to evaluate the association between bone grafting procedures and other risk factors for early implant failure., Materials and Methods: Two independent reviewers conducted an electronic search of MEDLINE (via PubMed). Meta-analysis was performed for the odds ratio of bone grafting procedures associated with early implant failure. The Newcastle-Ottawa Scale for cohort studies was used to assess the risk of bias., Results: Of the 231 articles selected for full-text review, 10 were included in the qualitative analysis and for quantitative meta-analysis. An odds ratio of 1.50 (95% confidence interval 1.06-2.13) was recorded for bone grafting procedures associated with early implant failure. Data regarding the association of bone grafting and other risk factors in determining early implant failure were insufficient for quantitative analysis., Conclusions: Within the limitations of this study, a significant positive association was found between bone grafting procedures and early implant failure. The possible negative effect of bone grafting procedures on implant osseointegration should be considered when planning implant therapy.

Purpose: The aim of this retrospective clinical case series report was to evaluate the outcomes of patients who underwent zygomatic implant surgery with a recent technical modification of the extrasinus surgical protocol., Materials and Methods: The implant system presented in this study had a novel designed unthreaded body with a 12.5-mm sharp threaded apical end for obtaining maximum retention to the zygomatic bone. A total of 92 patients with severely atrophic maxillae were included in this study. All the patients were treated with a modification of the extrasinus protocol for insertion of 261 zygomatic implants. The mean follow-up of the patients was 34.5 ± 17.1 (SD) months (range: 6 to 72 months). The implant survival rate was the primary outcome. The intraoperative and postoperative complications were evaluated as additional criteria for success., Results: The cumulative implant survival rate was 97.99%. Definitive or provisional prostheses were delivered on the same day of surgery, which resulted in an improvement in the quality of life of the patients. Five implants failed in four patients. No sinusitis or mucositis was seen in any of the patients. Eleven postoperative complications occurred in seven patients., Conclusion: The novel zygomatic surgery protocol introduced in this study can be an effective alternative to augmentation procedures and conventional implants, especially in cases of extremely atrophic posterior maxillae.

Survival, differentiation capability, and activity of cells are strictly related to structural features and the composition of the extracellular matrix, and its variation affects tissue homeostasis. Placement of a dental implant in bone tissue activates a sequence of molecular and cellular events that lead to the apposition of newly-formed bone directly onto the titanium surface. Due to implant's interaction with the mineralized tissue, osseointegration is affected by the surface structure of the implanted material. Surface nanotopography and microtopography can modify the shape and activity of mesenchymal stem cells leading to a higher differentiation rate of these cells into osteogenic lineage with the upregulation of osteoblastic genes. Several approaches for implant surface modification are currently under investigation or have been recently proposed to improve osseointegration. Most surface treatments are aimed at the formation of a thick layer of titanium oxide, at the alteration of surface chemical composition by incorporating bioactive molecules and drugs, and at the creation of a surface topography that is more attractive for osteoblast differentiation, adhesion, and osteogenic activity. Data on the cellular-substrate interaction, as well as in vivo studies assessing the response to these novel surfaces, are reviewed in the present study. The application of modern surfaces in dental clinical practice might increase and accelerate implant osseointegration, but could also reduce the occurrence of peri-implant bone loss and favor the re-osseointegration of an affected surface., (© 2018 John Wiley & Sons Australia, Ltd.)

Background: Lateral approach to maxillary sinus floor elevation (LSFE) with autologous bone grafts and simultaneous implant insertion is a widespread technique for prosthetic rehabilitation of the atrophic maxilla., Purpose: To analyze implant survival and autologous bone graft resorption after LSFE, in patients with at least 5 years follow-up., Materials and Methods: Thirty-three patients (mean age 56 years, range 46-68 years) who had undergone LSFE with intraoral autologous bone graft from mandibular ramus and simultaneous implant insertion were included. A minimum of 5 years of follow-up was required. The total peri-implant bone height was measured at mesial and distal aspects of the implants immediately after surgery (T0) and after a period ranging from 5 to 11.5 years after surgery (mean 7.65 ± 1.80 years) (T1) on digital panoramic and periapical radiographs. Wilcoxon matched-pairs signed rank test was used to compare bone graft height at T0 and T1. The influence of patient-, surgery-, and implant-related factors on the outcomes was investigated., Results: Of the 58 implants placed, no one was lost. All prostheses were in function, and no biological or mechanical complications occurred. The residual ridge height at the involved sites averaged 6.48 ± 1.72 mm. The mean bone height at grafted regions was 12.05 ± 2.47 mm at T0 and 12.13 ± 2.39 mm at T1 (not statistically significant). Marginal bone level change at T1 averaged -1.22 ± 1.60 mm. None of the evaluated factors significantly affected the results., Conclusion: Autologous bone grafts from intraoral donor sites display excellent volume stability over time that may contribute to optimal outcomes of the procedure., (© 2018 Wiley Periodicals, Inc.)

Objective: The aim of this study was to compare, through biomechanical and histological analysis, the aluminium (AlO2) and titanium dioxide (TiO2) microparticles for blasting during the sandblasting acid surface treatment in titanium dental implants using a rabbit tibia model., Materials and Methods: Forty-eight commercially available titanium dental implants were divided into two test groups (n = 24 per group): implants with surface treated by AlO2 followed by acid etching as control group (Con group) and implants with surface treated by TiO2 followed by acid etching as test group (Test group). The implants were randomly installed in both tibias of eight rabbits and block samples were removed 4 and 8 weeks after implantation. Resonance Frequency Analyses were performed immediately after the implantation and at 8 weeks. Twelve implants of each group were removed to measure the reverse torque. The remaining implants were used for histological analysis. The data were compared using statistical tests (α = 0.05)., Results: In comparing the implant stability quotient at the two time points, no significant statistical differences were found (P > 0.05), as well as in the removal torque test at 8 weeks after implant placement, no found significant difference between the two groups was tested. Histomorphometric analysis showed a high degree of bone organization in all samples with no significant difference between groups in the bone-to-implant contact (P > 0.05)., Conclusion: Within the limitations of this study, the results indicate that the media of surface blasting (AlO2 or TiO2 microparticles) did not show significant differences in the tested parameters for assessing the osseointegration of the implants., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: To present the clinical, radiographic, and patient-related outcomes of patients presenting with severely resorbed ridges reconstructed with autogenous calvarial bone blocks and rehabilitated with implant-supported prostheses., Material and Methods: From 1998 to 2014, 72 patients presenting with severe bone defects were reconstructed with autogenous calvarial bone blocks covered with bovine bone mineral granules and collagen membranes. Four to 9 months later, 330 implants were placed and loaded 3-9 months later. The follow-up ranged from 3 to 19 years (mean: 8.1 years). The following parameters were recorded: (a) complication rate of the reconstructive procedure; (b) bone resorption before implant placement; (c) implant survival rate and implant-related complications; (d) peri-implant bone resorption; and (e) patient's satisfaction inquired with a dedicated questionnaire., Results: No patients developed severe complications, such as complete loss or resorption of the grafts. A dehiscence occurred in six patients, which developed a mild graft resorption. The mean peri-implant bone resorption before implant placement was 0.13 mm (SD ± 0.71). All patients received the planned number of implants. Three patients were lost during the follow-up. The survival rate of implants at the end of the observation period was 98.5%. The mean peri-implant bone resorption ranged from 0.00 to 4.87 mm (mean: 1.11 mm). At last, 90% of the patients were very satisfied as regards the treatment received., Conclusions: Results from this study suggested that: (a) bone volume in the areas reconstructed with calvarial grafts was stable over time; (b) survival rates of implants were consistent with those reported for implants placed in native bone; (c) patient's satisfaction was high., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Several treatment options exist for the implant-supported rehabilitation of edentulous posterior maxilla., Purpose: To compare maxillary sinus floor augmentation associated to standard length implants, with direct placement of implants of reduced length in the available residual bone., Materials and Methods: Patients with edentulous posterior maxilla and a residual height of 4-7 mm were randomly allocated to the test (short implants [SIs], 6.5 to 8.5mm long) or the control (sinus augmentation [SA] and implants ≥10mm long) group. Anorganic bovine bone was the grafting material for the control group. In both groups pure platelet-rich plasma was used to bioactivate implant surface prior to insertion. Implant and prosthesis survival, clinical variables, radiographic bone level change, quality of life, and patient satisfaction were assessed., Results: Twenty-five patients were treated in the control group (58 standard length implants) and 27 in the test group (42 SIs). After 3 years of follow-up no implant failure and biological or mechanical complications were recorded. Marginal bone loss, soft tissue, and oral hygiene parameters were similar in the 2 groups at both 1 and 3 years' follow-up. Postoperative pain, swelling and other symptoms and daily activities were better in the SIs group than in the SA group, while patients' satisfaction after 1 year was similar., Conclusions: In spite of comparable medium-term clinical and radiographic outcomes, when the residual ridge height is sufficient for a safe placement, SIs may be preferred due to simplified protocol, less invasiveness, shorter treatment time, and reduced postoperative discomfort as compared to SA., (© 2017 Wiley Periodicals, Inc.)

Purpose: To compare the long-term clinical and radiographic outcomes between immediate loading (IL) and conventional loading of implants placed immediately in fresh extraction sockets., Materials and Methods: Demographic data, implant details, and periapical radiographs of patients were collected. The long-term marginal bone level remodeling and implant survival rate were calculated., Results: Twenty-one patients (mean age 52.55 ± 14.61 years) with 35 implants immediately inserted into postextraction sites (22 immediate loaded and 13 delayed loaded) were analyzed. The mean follow-up duration was 6 years (range 2-11 years). The implant cumulative survival rate was 96.5%. At the longest follow-up, the mean crestal bone level averaged 0.144 ± 0.705 for IL and 0.161 ± 0.877 for delayed loading, respectively. The mean implant aesthetic score was 7., Conclusions: IL does not negatively influence the long-term prognosis of implants inserted into fresh extraction sockets.

Purpose: The aim of this study was to assess whether immediate implant placement into post-extraction sites presenting a chronic infection poses a greater risk of implant failure than immediate placement in non-infected sites., Materials and Methods: Records of patients who underwent extraction and immediate implant placement into both infected and non-infected sites from January 1998 to September 2014 at 5 different dental centers were considered for inclusion. Included records were subjected to statistical analysis of survival rates, along with a number of other patient-, implant-, surgery-, and prosthesis-related variables., Results: The inclusion criteria were met by 369 patients who received a total of 527 implants. The follow-up averaged 53.2 months (range 0.9-158.3) for implants placed into non-infected sockets (N = 334) and 50.1 months (range 1.6-146.1) for those placed into infected sites (N = 193). Seven implants failed in non-infected sites and 3 in infected ones. All failures occurred within 1 year of placement. Cumulative implant survival rate for non-infected and infected sites was, respectively, 97.9% ± 0.8% and 98.4% ± 0.9%, being not significantly different (P = .66). None of the investigated variables affected the outcome., Conclusions: Placement of implants into periodontally or endodontically infected sites immediately after tooth extraction is a safe option, even when the implants are loaded immediately or early., (© 2017 Wiley Periodicals, Inc.)

Purpose: The purpose of this study was comparison of clinical and radiographic outcomes of immediate post-extraction implants with or without the use of pure platelet-rich plasma (P-PRP) in the short- and medium-term follow-up., Methods: A retrospective analysis was performed to assess soft tissue healing, implant and prosthesis survival, marginal bone level changes and biological complications., Results: A total of 109 partially edentulous patients with 126 implants were included in this analysis. At 4-5 years after loading, cumulative survival rate in test group was 97.4% and in control group was 97.8%, with no significant differences. After 5 years of function, marginal bone loss (MBL) in test group was 0.8 ± 0.35 and 1.02 ± 0.27 mm for immediate and delayed loading, respectively, and in control group was 0.6 ± 0.16 and 0.8 ± 0.89 mm for immediate and delayed loading, respectively. No significant differences in MBL were observed intragroups and intergroups at any time point considered. Soft tissue healing score was significantly higher in test group compared to the control at 3 and 7 days after surgery, with significant differences., Conclusions: P-PRP implant group showed a better soft tissue management and wound healing in the first 7 days after surgery compared to non-P-PRP implant group. In the medium-term follow-up, comparable clinical and radiographic outcomes were noticed between two groups.

Objectives: The aims of this prospective study were to evaluate bone dimensions after immediate implant placement with simultaneous grafting of the buccal gap, to determine if initial buccal bone width had an influence on bone remodelling and to compare bone volume changes using a flap or a flapless approach after 6 months of healing., Material and Methods: This prospective study included patients who required an extraction and a subsequent immediate implant placement at a non-molar site. In those cases where tooth extraction was not feasible with a flapless approach (test group) a mucoperiosteal flap was carefully elevated (control group). After extraction, a cone beam computed tomography (CBCT) was taken. Then, an implant was placed and the buccal gap was grafted using anorganic bovine bone. After 6 months of healing, a second CBCT was performed. A blinded investigator superimposed both images and performed a series of measurements to determine bone volume changes between the two time points., Results: Thirty-five patients were included in this study, 20 of which belonged to the test group. All together, the differences between baseline and 6 months in buccal plate height, lingual plate height and in ridge width at 2, 4 and 6 mm were 0.48 ± 1.35; 0.58 ± 1.51; 0.64 ± 0.81; 0.59 ± 1.36 and 0.52 ± 1.16, respectively. Only a moderate correlation was observed between initial buccal plate width and buccal plate height at 6 months (P = 0.0001). No statistically significant differences were observed between flap and flapless approach., Conclusions: A mean reduction of around 0.5 mm in height and width after placing immediate implants and filling the residual gap with anorganic bovine bone may be expected. No significant association between initial buccal bone width and ridge width at 6 months was seen. No statistically significant differences were found between the two treatment protocols although more ridge reduction was observed for the flap group., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose: Additional grafting procedures for the treatment of extremely atrophic jaws may be demanding, expensive, and sometimes require long time and multiple surgical sessions, which may reduce patient's acceptance and quality of life. This study evaluated the outcomes of 10 patients with extensive alveolar bone defects in the posterior jaws, treated in a single surgical session with grafting and implants., Materials and Methods: Ten consecutive patients were treated within 3 months of extraction. After ridge exposure, implants were positioned in 4-wall defects without contact with pristine bone, and mineralized particulate allograft packed around to stabilize them. Sites were covered with resorbable membranes and soft tissues were sutured tension-free. Five months later, implants were restored in centric occlusion., Results: At uncovering, newly formed bone filled all defects and all implants resisted at 30 Ncm of reverse torque. No complication was recorded throughout the study; survival rate was 100% for both implants and grafts. After 24 months of follow-up, mean periimplant bone level change was 0.15 ± 0.53 mm and mean bone gain at the defect site was 11.62 ± 1.04 mm., Conclusion: Rehabilitation of wide postextraction defects may achieve successful outcomes using allograft and a special implant design, even in the absence of optimal primary stability.

Purpose: Maxillary sinus floor elevation procedure has the objective of augmenting available bone in atrophic posterior maxilla to allow dental implants placement. The main aim of this prospective study was to evaluate clinically and histomorphometrically the performance of biphasic calcium phosphate (BCP) used in conjunction with platelet-rich plasma (PRP) compared with demineralized bovine bone matrix (DBBM) and PRP in sinus floor elevation surgery., Materials and Methods: Patients candidate to sinus floor elevation were treated using either BCP and PRP or DBBM and PRP. Biopsies were retrieved using trephine bur during implant placement surgery 6 months after grafting. Clinical success of implants was evaluated 1 year after prosthesis delivery. Histomorphometric analysis was performed assessing the relative volume of newly formed bone., Results: A total of 20 patients were recruited, and 20 sinus augmentation procedures were performed, 10 for each group. A total of 42 implants were placed. One year after prosthetic loading a 100% implant survival rate was reported in both groups. Histomorphometric analysis revealed that the mean amount of new bone formation was 18.6 ± 3.3% in BCP group and it was 21.9 ± 4.9% in DBBM group, without statistically significant difference. In BCP group a greater amount of collagen type I was found with respect to DBBM group., Conclusions: Both grafting materials led to an excellent performance regarding implant survival rate after 1 year follow-up, without any significant adverse sequelae. A similar capability of inducing new bone formation was observed in both groups, even though the higher quantity of collagen type I in BCP group may suggest a greater potential for bone formation over time as compared with DBBM.

The aim of this retrospective study was to report preliminary outcomes of a modified technique for transcrestal sinus floor elevation with simultaneous implant placement. A total of 165 implants were placed in 110 patients using a modified Summers technique. During implant site preparation, after fracturing the sinus floor, a small perforation of the membrane was made using the first osteotome. After grafting with anorganic bovine bone mixed with venous blood, standard-length implants were inserted. The prosthetic phase occurred after 4 to 5 months. Patients were followed for at least 2 years after loading. During the follow-up, sinus condition was assessed by cone beam computed tomography. Periapical radiographs were taken to assess graft height and peri-implant bone levels. Three implants failed within 2 months of placement, yielding an overall implant survival of 98.2%. The mean follow-up was 38.3 months (range: 28 to 60 months) from placement. All other implants were stable and peri-implant soft tissues were healthy throughout the observation period. Peri-implant bone loss averaged 0.62 ± 0.26 mm after 1 year of function. No biologic or biomechanical complications occurred. No evidence of graft material dispersion into the sinus space was detected, except for two cases that resolved spontaneously. After 1 year of loading the graft height averaged 4.8 ± 1.3 mm above the sinus floor level. In the presence of sinus membrane perforation, the proposed modified osteotome technique may allow a predictable rehabilitation of the atrophic posterior maxilla by means of standard length implants without the occurrence of adverse events.

Objectives: The main objective of this study was to evaluate clinical and radiographic outcomes of implant-supported fixed partial prostheses, comparing platform switching and standard platform concepts., Materials and Methods: Patients with single or multiple partial edentulism were included in this prospective multicenter study. Success rate, as well as crestal bone loss and occurrence of complications were evaluated over time, for a minimum of 3 years after prosthesis delivery. Radiographic and clinical examination served to evaluate implant and prosthesis conditions., Results: A total of 51 patients with 117 implants (55 in the centralized platform group and 62 in the standard platform group) were considered in the analysis. After 3 years of loading, the cumulative implant survival in test group was 90.3 %, while in the control group, it was 96.5 % without any statistically significant difference. After 3 years of function, the bone loss was 0.33 ± 0.19 mm in the test group and 0.48 ± 0.26 mm, revealing a significant difference., Conclusions: Platform switching concept may lead to a reduction of marginal bone loss over time if compared to standardized one. Such effect seemed not to be related to a reduction of overall success rate of the treatment., Clinical Relevance: Platform switching could be a viable prosthetic option for implant treatment of partial edentulism.

The purpose of this study was to assess implant stability in relation to implant design (conical vs. semiconical and wide-pitch vs narrow-pitch) using resonance frequency analysis. Twenty patients with bilateral edentulous maxillary premolar region were selected. In one hemiarch, conical implants with wide pitch (group 1) were installed; in the other hemiarch, semiconical implants with narrow pitch were installed (group 2). The implant allocation was randomized. The implant stability quotient (ISQ) was measured by resonance frequency analysis immediately following implant placement to assess primary stability (time 1) and at 90 days after placement (time 2). In group 1, the mean and standard deviation ISQ for time 1 was 65.8 ± 6.22 (95% confidence interval [CI], 55 to 80), and for time 2, it was 68.0 ± 5.52 (95% CI, 57 to 77). In group 2, the mean and standard deviation ISQ was 63.6 ± 5.95 (95% CI, 52 to 78) for time 1 and 67.0 ± 5.71 (95% CI, 58 to 78) for time 2. The statistical analysis demonstrated significant difference in the ISQ values between groups at time 1 (P = .007) and no statistical difference at time 2 (P = .54). The greater primary stability of conical implants with wide pitch compared with semiconical implants with narrow pitch might suggest a preference for the former in case of the adoption of immediate or early loading protocols.

Objectives: The study aims to test the hypothesis of no differences in temperature variation by using a single bur for implant site preparation as compared with conventional drilling sequence using multiple burs with incremental diameter., Materials and Methods: Synthetic blocks of bone (type I density) were used for drilling procedures., Three Groups Were Evaluated: Group 1 and Group 2 - drilling with three consecutive burs for a 4.1 mm cylindrical implant and for a 4.3 mm conical implant, respectively; Group 3 - drilling with a single bur for a 4.2 mm conical implant. For each group, 20 drilling procedures were performed without irrigation and 20 with external irrigation. The temperature in the cortical bone during osteotomy for implant site preparation was measured through a thermocouple., Results: The mean temperatures and standard deviations for the drilling without irrigation were: 25.5 ± 1.24°C for Group 1; 28.1 ± 1.76°C for Group 2; 26.5 ± 1.79°C for Group 3. Considering the drilling with irrigation, the mean values and standard deviations were: 20.4 ± 1.17°C for Group 1; 22.2 ± 1.38°C for Group 2; 20.2 ± 0.83°C for Group 3. Groups 1 and 3 yielded similar results, while Group 2 displayed significantly higher temperature increase than the other two groups., Conclusions: The single bur drilling protocol did not produce greater bone heating than the conventional protocol and may be considered a safe procedure., (© 2013 Wiley Periodicals, Inc.)

Purpose: The aim of this in vitro study was to evaluate the stress pattern on the abutments in two different full-arch implant-supported clinically equivalent prosthetic rehabilitations., Materials and Methods: Two steel master casts were created and titanium implants were inserted in two different configurations. One configuration used four implants, with the distal implants tilted 30 degrees (4IMP configuration), and the other used five axially inclined implants (5IMP configuration). A straight multiunit abutment (MUA) was connected to every axial implant and a 30-degree angulated MUA was connected to each tilted implant. One titanium framework was fabricated for each configuration, with a 5-mm (4IMP configuration) or a 15-mm (5IMP configuration) distal cantilever length. Six cycles of vertical loading between 20 and 200 N were applied unilaterally at the most distal point of the frameworks on both sides. Readings of the deformations at the abutment level were obtained with the use of linear strain gauges., Results: A similar pattern of deformation was seen in both configurations. The greatest compressive stress was measured by the strain gauge on the abutment closest to load application and was similar for the 4IMP and 5IMP configurations. The tensile stress measured on the same abutment was higher in the 5IMP configuration than in the 4IMP configuration. In terms of the distribution of stresses, the deformation measured on the central abutment in the 5IMP configuration was less than 10% of the overall stress in all the tested conditions., Conclusion: There was no difference in strain between the two different designs, so the use of tilted implants with angulated abutments to reduce cantilever length could be considered a viable clinical option.

Purpose: The aim of the present systematic review was to estimate the implant survival rate in different types of techniques for the rehabilitation of posterior atrophic maxilla, after at least 3 years of follow-up., Materials and Methods: MEDLINE database was searched using a combination of specific terms. A hand searching of the relevant journals and of the reference lists of systematic reviews was also performed. All retrospective and prospective studies evaluating short implants in posterior maxilla, osteotome sinus floor elevation and lateral approach sinus floor elevation, and having a follow-up of at least 3 years, were included., Results: Forty-four articles were included in the review. In four studies reporting on a total of 901 short implants, the implant survival rate varied from 86.5% to 98.2% with up to 5 years follow-up. For the osteotome technique, 1,208 implants in eight studies were considered, showing a survival rate varying from 95.4% to 100% after 3-year follow-up. Twenty-nine studies, accounting for 6,940 implants placed in 2,707 sinuses augmented through lateral technique were considered. Implant survival rate varied from 75.57% to 100%. Only three comparative studies were found that showed no significant difference in clinical outcomes between lateral approach and osteotome technique., Conclusions: Sinus floor elevation with the lateral approach and with the osteotome technique is an effective and well-documented therapeutic option for the rehabilitation of atrophic posterior maxilla. The use of short implants is promising but needs further investigation to be considered as effective as the other techniques in the long term. However, the indication for the three different techniques is not perfectly equivalent and the treatment choice should be based on a careful evaluation of the individual case, in particular on the available residual bone., (© 2013 Wiley Periodicals, Inc.)

Background: Implant site preparation usually consists of several consecutive drilling steps, performed using different burs with increasing diameter., Purpose: The purpose of the present study was to report the clinical outcomes of edentulous patients that underwent implant treatment, in which a special bur that allows preparation of the implant site in a single drilling step was used., Material and Methods: One hundred forty-nine patients (79 males, 70 females, mean age 51.8 ± 12.2 [SD] years, range 20-80 years) have been rehabilitated using different oral surgery procedures. A total of 350 implants were inserted (171 in the maxilla and 179 in the mandible). A barrier membrane was used for covering a total of 126 implants. Fifteen implants were placed by using the osteotome technique and 52 by using the lateral sinus lift procedure. Eighty-nine implants were placed in postextraction sockets. Thirty-six implants underwent immediate loading. Implant survival, peri-implant bone level change, and patients' satisfaction were the main variables assessed., Results: No patient dropout occurred. The mean follow-up on a patient basis was 21.5 ± 3.1 months (range 12-27 months). A total of seven implant failures were recorded in six patients, leading to a mean implant survival of 98.0% (96.0% on a patient basis). The mean peri-implant bone loss after 1 year was 0.58 ± 0.44 mm (n = 282). Apart from implant failures, no biological nor mechanical complications occurred. All patients demonstrated full satisfaction., Conclusions: The use of a single bur for implant site preparation allows the reduction of the time needed for the surgical procedure, without compromising the clinical outcomes. Further, long-term comparative studies are needed to confirm the results of this study., (© 2013 Wiley Periodicals, Inc.)

Objective: To evaluate the efficacy of the topical administration of bisphosphonates in implant therapy., Materials and Methods: Thirty-nine consecutive patients were selected for a split-mouth study. Inclusion criteria were: presence of a bilateral or total edentulism, ability to tolerate conventional implant procedures, older than 18 years. Ten patients were smokers. Ten patients were fully edentulous in both maxilla and mandible, 12 patients had fully edentulous maxilla or mandible, and 17 were bilaterally partially edentulous (9 in the mandible and 8 in the maxilla). A one-stage procedure was adopted in all cases. The prosthetic phase started 10 weeks after implant insertion. Each patient received implants on the control side and the test side, with insertion performed in the conventional way on the control side; on the test side, a 3% clodronate solution mixed with a surfactant (Tween-20) at a 1:3 ratio was topically administered both at the implant surface and at the implant site., Results: One hundred fifty-five implants were inserted. The test and control groups included 75 and 80 implants, respectively. The implant insertion torque was no less than 30 Ncm. A total of 7 implants failed in the control group (6 before loading and one after 12 months of loading). No failure occurred on the test side. By the 5-year follow-up, no further implant failure had been recorded. Overall, implant survival rates at 5 years for the test and control groups were, respectively, 100% and 91.3%, the difference being significant (p < .01). Mean marginal bone loss was 0.85 ± 0.71 mm in the test group and 1.12 ± 0.85 mm in the control group after 1 year of loading and stable thereafter. The difference was not significant., Conclusions: The topical administration of bisphosphonates may positively affect implant survival in the preloading and postloading phases in partially and fully edentulous patients. However, a larger study population is needed to verify these promising clinical results., (© 2013 Wiley Periodicals, Inc.)

Purpose: This retrospective study deals with the issue of how to realize the transition from a failing dentition to an implant-supported prosthesis. The main aim was to assess the reliability of immediate implant and immediate loading (IL) protocols in the edentulous jaws. A further aim was to investigate the role of patient-related, implant-related, and surgery-related secondary variables in the occurrence of implant failure., Materials and Methods: Patients with at least a 4-year post-loading follow-up undergoing the transition from a failing dentition to an implant-supported prosthesis were retrospectively investigated. Primary variables of implant failure were immediate placement and IL. Secondary variables were categorized as demographic, anatomic, site, and prosthetically related. Cumulative survival rates (CSRs) were compared using the Kaplan-Meier survival estimate method. Predictors of failure were included in a multivariate Cox regression model to evaluate the simultaneous effects of multiple covariates and control for correlated observation. Crestal bone loss was also measured at the delayed and the immediately loaded implants., Results: Five hundred nineteen implants rehabilitating 91 jaws in 80 patients were followed. The Kaplan-Meier survival estimate method showed that immediate implant and IL decreased the CSR significantly in the maxilla but not in the mandible. Some secondary variables were found to affect the CSR: maxillary location, age over 70 years, prostheses supported by only immediate implants or a majority of them, temporary cementation, implant diameter, and length. Crestal bone loss was not significantly related to the outcomes., Conclusions: The present data may provide clinical recommendations to the practitioner treating the transitional patient. In the mandible, the use of immediate implants and IL does not increase the failure rate. In the maxilla however, combining immediate placement and IL may significantly increase the failure rate., (© 2013 Wiley Periodicals, Inc.)

Aims: The use of tilted implants has recently gained popularity as a feasible option for the treatment of edentulous jaws by means of implant-supported rehabilitations without recurring to grafting procedures. The aim of this review was to compare the crestal bone level change around axially placed vs. tilted implants supporting fixed prosthetic reconstructions for the rehabilitation of partially and fully edentulous jaws, after at least 1 year of function., Materials and Methods: An electronic search of databases plus a hand search on the most relevant journals up to January 2014 was performed. The articles were selected using specific inclusion criteria, independent of the study design. Data on marginal bone loss and implant survival were extracted from included articles and statistically analysed to investigate the effect of implant tilting, location, prosthesis type, loading mode and study design. The difference in crestal bone level change around axial vs. tilted implants was analysed using meta-analysis., Results: The literature search yielded 758 articles. A first screening based on titles and abstracts identified 62 eligible studies. After a full-text review, 19 articles (14 prospective and five retrospective studies) were selected for analysis. A total of 670 patients have been rehabilitated with 716 prostheses (415 in the maxilla, 301 in the mandible), supported by a total of 1494 axial and 1338 tilted implants. Periimplant crestal bone loss after 1 year of function ranged from 0.43 to 1.13 mm for axial implants and from 0.34 to 1.14 mm for tilted implants. In spite of a trend for a lower bone loss around axial implants with respect to tilted ones at 12 months, as well as after 3 or more years of function, no significant difference could be found (P = 0.09 and P = 0.30, respectively). The location (maxilla vs. mandible), the loading mode (immediate vs. delayed), the restoration type (full vs. partial prosthesis) and the study design (prospective vs. retrospective) had no significant effect on marginal bone loss. Forty-six implants (18 axial and 28 tilted) failed in 38 patients within the first year of function. All failures except five occurred in the maxilla. After 12 months of loading, the survival rate of implants placed in the maxilla (97.4%) was significantly lower as compared to the mandible (99.6%). No prosthesis failure was reported., Conclusions: Tilting of the implants does not induce significant alteration in crestal bone level change as compared to conventional axial placement after 1 year of function. The trend seems to be unchanged over time even though the amount of long-term data is still scarce. The use of tilted implants to support fixed partial and full-arch prostheses for the rehabilitation of edentulous jaws can be considered a predictable technique, with an excellent prognosis in the short and mid-term. Further long-term trials, possibly randomised, are needed to determine the efficacy of this surgical approach and the remodelling pattern of marginal bone in the long term.

The predictability of maxillary sinus augmentation has been extensively reported. Procedural outcomes, most often measured as implant survival rates, have customarily used inclusion criteria that included a minimum 1-year loading time. The inclusion criteria of this review extended the minimum postloading evaluation to 3 years to determine if the previously reported short-term survival rates are maintained. An electronic search of the literature was performed and retrieved articles were screened using specific inclusion criteria, paramount of which was a minimum of 3 years of follow-up. The search revealed 18 articles for the lateral window approach (6,500 implants in 2,149 patients) and 7 for the transalveolar approach (1,257 implants in 704 patients). Overall, implant survival after a minimum of 3 years loading was 93.7% and 97.2% for the lateral window and transalveolar approaches, respectively. Of importance is the fact that 80% of failures occurred within the first year and 93.1% of the failures occurred within 3 years. The risk of implant failure after 3 years can now be directly calculated as the overall risk of failure after 3 years (6.3%) × the incidence of late failures (6.9%), thus equaling 0.43%. This review discredits the theory that studies of a lower level of evidence report inflated results when compared with prospective randomized controlled clinical trials.

Purpose: To evaluate whether grafting with additional anorganic bovine bone to augment horizontally the buccal plate (internal and external grafting [IEG]) at single post-extractive implants preserves the alveolar ridge, improving aesthetics, better than internal socket grafting alone (ISGA)., Material and Methods: A total of 78 patients, treated in four Italian private practices, requiring a single immediate post-extractive implant, having at least 1 mm of implant-to-buccal bone gap after implant insertion and a preserved buccal bone, had the residual bone-to-implant gap filled with anorganic bovine bone. Thirty-nine randomly allocated patients received additional buccal horizontal augmentation of about 2 mm thickness with the same bone substitute (IEG group) covered with collagen resorbable membranes. Implants were submerged for 4 months before being loaded with provisional acrylic crowns. Definitive crowns were delivered after 6 months. Outcome measures were crown/implant failures, complications and aesthetics recorded by blinded assessors 6 months after initial loading, at delivery of definitive crowns., Results: Six months after initial loading, 8 patients dropped out, did not complete the treatment or were treated twice and therefore had to be excluded (4 from each group). There were no statistically significant differences for implant failures and complications between the two groups. Two implants failed in the IEG group versus 1 in the ISGA group. Four complications occurred, 2 in each group. The mean implant aesthetic score (IAS) was 7.8 at ISGA sites and 8.0 at IEG sites. There were no statistically significant differences between the two groups (P = 0.492; difference 0.2 mm; 95% CI -0.769, 0.369) for IAS score. There were no statistically significant differences in the outcomes between the centres., Conclusions: The use of adjunctive anorganic bovine bone placed buccally at preserved buccal sites of immediate post-extractive implants may not improve the aesthetic outcome, however additional research is needed to confirm or reject these preliminary findings.

Purpose: To evaluate tilted trans-sinus implants for rehabilitation of the atrophic maxilla., Materials and Methods: A case series of 35 patients (32 consecutive edentulous and 3 partially edentulous patients) treated with trans-sinus dental implants is presented. Edentulous patients received 4 or 6 implants depending on anatomic conditions and a 12-unit final restoration; partially edentulous patients received 2 implants supporting a 3-unit partial fixed bridge., Results: Thirty-five patients (14 men, 21 women) underwent rehabilitation. Thirty-two patients with 190 implants placed received a full-arch fixed prosthesis supported by axial and trans-sinus tilted implants. Three patients each received 2 implants with a 3-unit fixed restoration. The mean age at surgery was 59.2 ± 9.5 years. The cumulative survival rate was calculated only for the full-arch fixed prosthesis group and was 98.42%. Crestal bone loss averaged 0.9 ± 0.4 and 0.8 ± 0.5 mm for the axial and tilted implants, respectively, at the 12-month evaluation. Biological complications at the implant level were 1 case of peri-implantitis and 3 cases of mucositis; no patient developed sinus infections. The prosthetic complications encountered were screw loosening in 17.5% of cases and chipping of the esthetic part in 30% of cases. These complications were easily resolved chairside and did not lead to prosthetic failure., Conclusions: Trans-sinus tilted implants and sinus membrane distal displacement appear to be a viable minimally invasive alternative for the treatment of maxillary atrophy., (Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Achieving an excellent aesthetic outcome in postextraction dental implant placement in the anterior maxilla is a challenging procedure for clinicians. In fact, there is an increased risk for soft tissue recession at the facial aspect which may require supplementary connective tissue grafts to accomplish the final aesthetic result. The aim of this case report is to describe a regenerative technique using autologous plasma rich in growth factors fibrin plug for preservation of soft tissue architecture around an implant immediately placed into an extraction site in the anterior maxilla. Such a procedure allowed for guided bone regeneration without the need for vertical releasing incisions and primary healing, thus showing a pleasant gingival contour at the facial aspect after a single stage surgery. Integrating this technique into common practice could provide important benefits for the patients regarding aesthetics, without any risk of infection or transmission of diseases.

Purpose: Implant-supported rehabilitation of the atrophic posterior maxilla often necessitates maxillary sinus surgery to augment existing bone volumes. Recent systematic reviews have reported implant survival rates above 90% following sinus elevation. However, statistical assessment of the effect of anatomic factors, implant design and surface, individual risk factors, and complications related to sinus floor elevation procedures on implant survival through analyzing patient data has not yet been performed. The aim of this study is to identify risk factors that might affect implant survival following sinus elevation., Materials and Methods: Three centers were involved in this retrospective multicenter study; 106 patients were treated with 144 sinus elevation procedures and received 328 implants. The mean follow-up was 48.4 months, and the longest follow-up period was 72 months. The analysis considered patient age, gender, health status, and smoking habit; implant size, shape, and surface; residual ridge height; timing of implant placement with respect to grafting; graft material; and the occurrence of surgical complications. For quantitative variables, the Pearson correlation was used. The chi-square test and Fisher exact test (for samples smaller than five units) were used for qualitative variables., Results: The cumulative implant survival rate was 93.0% up to 5 years. Complications occurred in 41 patients. Intraoperative sinus membrane perforation occurred in 40 sinuses (28%) and was not a significant risk factor for implant survival. Six patients experienced postoperative infection leading to graft failure, and two patients had considerable intraoperative bleeding. Smoking more than 15 cigarettes/day and a residual ridge height < 4 mm were significantly associated with reduced implant survival., Conclusions: Smoking habits and residual ridge height should be evaluated carefully prior to sinus elevation procedures.

Purpose: The aim of this review was to evaluate the survival rate of upright and tilted implants supporting fixed prosthetic reconstructions for the immediate rehabilitation of partially and fully edentulous jaws, after at least 1 year of function., Materials and Methods: An electronic search of databases plus a hand search on the most relevant journals up to December 2009 was performed. The articles were selected using specific inclusion criteria, independent of the study design., Results: The literature search yielded 347 articles. A first screening based on the title and abstract identified 25 eligible studies. After full-text review of these studies, 10 articles were selected for analysis. Seven were prospective single-cohort studies and three had a retrospective design. A total of 462 patients have been rehabilitated with 470 immediately loaded prostheses (257 in the maxilla, 213 in the mandible), supported by a total of 1,992 implants (1,026 upright and 966 tilted). Twenty-five implants (1.25%) failed in 20 patients within the first year. All failures except one occurred in the maxilla. No significant difference in failure rate was found between tilted and upright implants, nor between maxillary and mandibular implants. No prosthesis failure was reported. Limited peri-implant bone loss was reported with no difference between upright and tilted implants. Full patients' satisfaction for function, phonetics, and esthetics was reported in three studies, based on questionnaires., Conclusions: The use of tilted implants to support immediately loaded fixed prostheses for the rehabilitation of edentulous jaws can be considered a predictable technique, with an excellent prognosis in the short-medium term. However, randomized long-term trials are needed to determine the efficacy of this surgical approach., (© 2010 Wiley Periodicals, Inc.)

Purpose: The purpose of this prospective study was to evaluate the clinical outcome of implants immediately placed into fresh extraction sockets for the replacement of endodontically treated teeth with signs of vertical root fracture., Material: Sixteen partially edentulous patients, with 1 tooth scheduled for extraction and showing clinical signs and symptoms and/or radiological evidence of vertical root fracture, were included in the study. Sixteen transmucosal implants were installed immediately after extraction and careful debridement. The gap between the implant surface and the socket walls was filled using synthetic bone grafting cement. Prosthetic phase occurred 3 to 4 months after surgery. Implant success and survival and radiographic bone loss were evaluated after 1 year of function. Patient satisfaction for mastication function, phonetics, and aesthetics was also assessed by means of a questionnaire., Results: No implant failure occurred. The overall implant success and survival was 100% at 1 year. The mean follow-up was 13.5 months. All prostheses were successful. Periimplant bone loss after 1 year averaged 0.48 ± 0.20 mm. All patients reported full satisfaction for mastication function, phonetics, and aesthetics., Conclusions: The use of a synthetic bone grafting cement in combination with immediate implant placement procedure can be considered a safe, effective, and predictable treatment option for the rehabilitation of fresh postextraction sockets.

Purpose: The purpose of this prospective study was to evaluate the clinical outcome of implants immediately placed into fresh extraction sockets of teeth affected by chronic periapical pathologic findings, using plasma rich in growth factors (PRGFs) as an adjunct during the surgical procedure., Materials and Methods: A total of 30 partially edentulous patients with teeth requiring extraction and chronic periapical lesions were included in the present study. A total of 61 transmucosal implants were installed immediately after extraction and careful debridement combined with PRGF placement into the socket. Before insertion, the implant surface was bioactivated by humidification with liquid PRGFs. The prosthetic phase occurred 3 to 4 months after surgery. The implant success and survival and radiographic bone loss were evaluated after 1 year of function. Patient satisfaction for mastication function, phonetics, and esthetics was assessed using a questionnaire., Results: Of the 61 implants, 1 had failed 2 months after insertion because of infection. No additional complications were recorded. The overall implant success and survival rate was 98.4% at 1 year of function. The mean follow-up was 18.5 months (range 10 to 21). All prostheses were successful. The peri-implant bone loss after 1 year averaged 0.41 +/- 0.22 mm. All patients reported full satisfaction for mastication function, phonetics, and esthetics., Conclusions: The use of PRGFs combined with an immediate implant placement procedure can be considered a safe, effective, and predictable treatment option for the rehabilitation of fresh postextraction infected sockets.

Bisphosphonates are pharmacologic compounds characterized by high tropism to bone tissue. They affect bone metabolism by inhibition of osteoclast recruitment, proliferation, differentiation, and function. Because they can reduce bone resorption, bisphosphonates are used mainly for the treatment of osteometabolic conditions, particularly osteoporosis, Paget disease, multiple myeloma, and other solid tumors with bone metastases. Their use has conferred great benefits to patients affected by these diseases, significantly improving their quality of life. Bisphosponates' inhibition of bone resorption might be exploited to maintain implant primary stability during the process of implant osseointegration. The aim of this histologic clinical study was to compare the response of bone tissue around an implant treated with a bisphosphonate solution (test) to that of the bone around an untreated implant (control). The bisphosphonate-treated implant showed more contact with newly formed bone than the control implant.

Purpose: The aims of this prospective study were to assess the treatment outcome of immediately loaded full-arch fixed bridges anchored to both tilted and axially placed implants for the rehabilitation of the mandible and to compare the outcome of axial versus tilted implants., Materials and Methods: Sixty-two patients (34 women and 28 men) were included in the study. Each patient received a full-arch fixed bridge supported by two axial implants and two distal tilted implants (All-on-Four, Nobel Biocare AB, Göteborg, Sweden). Loading was applied within 48 hours of surgery. Patients were scheduled for follow-up at 6, 12, 18, and 24 months, and annually up to 5 years. At each follow-up, plaque level and bleeding scores were assessed; moreover, patient's satisfaction for aesthetics and function was evaluated by a questionnaire. Radiographic evaluation of marginal bone level change was performed at 1 year., Results: The overall follow-up range was 6 to 43 months (mean 22.4 months). Forty-four patients were followed for a minimum of 1 year. No implant failures were recorded to date, leading to a cumulative implant survival and prosthesis success rate of 100%. Plaque level and bleeding scores showed progressive decrease over time, parallel to increase of satisfaction for both aesthetics and function. No significant difference in marginal bone loss was found between tilted and axial implants at 1-year evaluation., Conclusion: The present preliminary data suggest that immediate loading associated with tilted implants could be considered a viable treatment modality for the mandible.

Objectives: The aims of this prospective study were to assess the treatment outcome of immediately loaded full-arch fixed bridges anchored to both tilted and axially placed implants for the rehabilitation of fully edentulous maxillae and to compare the outcome of axial vs. tilted implants., Material and Methods: Forty-one patients with edentulous maxillae were included in the study. Each patient received a full-arch fixed bridge supported by four axial implants and two distal tilted implants. Loading was applied within 48 h from surgery. Patients were scheduled for follow-up at 6 months, 1 year and annually up to 5 years. Radiographic evaluation of marginal bone-level change was performed at 1 year., Results: One patient died 4 months after surgery. Thirty patients were followed for a minimum of 1 year (range 3-42 months, mean 22.1 months). Three failures were recorded at 1-year follow-up (two axial implants and one tilted). Two more implants (one tilted and one axially placed) were lost within 18 months of loading. The 1-year implant survival rate was 98.8% for both axial and tilted implants. Prosthesis success rate was 100% at 1 year. Marginal bone loss around axial and tilted implants at 12-month evaluation was similar, being, respectively, 0.9+/-0.4 (standard deviation) mm and 0.8+/-0.5 mm., Conclusions: The present preliminary data suggest that immediate loading associated with tilted implants could be considered to be a viable treatment modality for the atrophic maxilla and that there does not seem to be a different clinical outcome between tilted and axial implants.

Surgical procedures carried out between the chin foramina at the anterior mandible level are usually considered free of severe neurovascular complications, due to the excellent bone density in that region and the absence of important neurovascular structures. However, the international scientific literature on this issue reports rare but severe hemorrhagic complications following implant surgery at this level. The aim of this review article is to offer the clinician, through an accurate investigation of the anatomy of the median mandibular region, the tools to carry out oral surgery operations at this level under safe conditions, reducing the possible intraoperative risks to a minimum.

Purpose: The aims of this study were to assess the treatment outcome of immediately loaded full-arch screw-retained prostheses with distal extensions supported by both upright and tilted implants for the rehabilitation of edentulous jaws and to compare the outcomes of upright versus tilted implants., Materials and Methods: At 4 study centers, 342 Osseotite NT implants were consecutively placed in 65 patients (96 implants were placed in 24 mandibles and 246 implants in 41 maxillae). The 2 distal implants were tilted by 25 to 35 degrees. Provisional full-arch restorations made of a titanium framework and acrylic resin teeth were delivered within 48 hours of surgery and immediately loaded. The final prosthesis was delivered after 3 months of healing., Results: Three implants failed during the first year and another 2 within 18 months of loading in the maxilla. The cumulative implant survival rate for the maxilla was 97.59% for up to 40 months of follow-up. No implant failure was recorded for the mandible. The prosthetic success rate was 100%. Marginal bone loss around upright and tilted implants was similar. Patients were satisfied of their esthetics, phonetics, and function., Conclusion: The preliminary results of this study suggest that immediate rehabilitation of the edentulous maxilla and mandible by a hybrid prosthesis supported by 6 or 4 implants, respectively, may represent a viable treatment alternative with respect to more demanding surgical procedures. The clinical results indicate that immediately loaded tilted implants may achieve the same outcome as upright implants in both jaws.

The primary goal of this paper was to determine the survival rate of immediately loaded (IL) dental implants based on a systematic review of the literature. Secondary goals were to determine the influence of several factors on the implant survival rate, such as the type of reconstruction, implant location, and implant surface characteristics. An electronic search of databases was performed, in addition to a hand search of the most relevant journals. All relevant articles were independently screened according to specific inclusion criteria. The selected papers were reviewed. The literature search yielded 270 applicable articles up to December 2005. Of these, 71 met the inclusion criteria for qualitative data analysis. Eight articles were randomized controlled trials. The overall implant survival rate for the included studies was 96.39%. The database included 10,491 IL implants placed in 2,977 patients, with a maximum follow-up of 13 years. IL is well documented and predictable for the edentulous mandible (overdentures and full-arch prostheses) and for maxillary single crowns. Fewer data were found for maxillary full-arch reconstructions, fixed partial prostheses, and mandibular single crowns. For the latter two types of reconstructions, implants placed in anterior sites generally displayed a higher survival rate versus those placed in posterior sites. Rough surfaces displayed a higher survival rate than machined surfaces in all types of reconstructions. Most failures (97.1%) occurred within the first 12 months of loading. This review showed that it is possible to apply IL with excellent survival rates. Implant micromorphology and careful patient selection may affect treatment outcomes.

Implant restorations delivered according to the Brånemark protocol have proven to be highly predictable. To shorten the length of treatment associated with the Brånemark protocol, as well as to preserve soft and hard tissues, newer protocols have focused on reducing or even eliminating the time between tooth extraction and implant placement and between implant placement and prosthetic restoration delivery. The authors present a case in which control of postextraction implant placement, optimal implant positioning, and immediate loading contributed to clinical success.

Immediate loading of endosseous implants is becoming a widespread therapeutic procedure for the rehabilitation of patients with edentulous jaws. The purpose of this prospective clinical trial was to evaluate the long-term success rate of endosseous implants placed in the edentulous lower jaw and loaded on either the same day of surgery or the next day. Nineteen patients were enrolled in the study. Eleven patients, accounting for 64 implants, received their provisional prosthesis the same day of implant placement, and 8 patients, accounting for 52 implants, were rehabilitated the day after surgery. All patients were rehabilitated by a hybrid prosthesis supported by 5 to 6 Osseotite implants. Two implants failed in the group of patients who had their implants loaded the same day (96.9% success rate), whereas 1 implant failed in the other group (98.1% success rate). The overall implant success rate was 97.4%. All failures occurred within 2 months of function. No other complication was reported. The mean follow-up for this interim report was 37.8 +/- 16.5 months (range 8-65 months). Crestal bone loss was similar to that reported for standard delayed loading protocols. The results of this study suggest that the rehabilitation of the edentulous lower jaw by an immediate occlusally loaded implant-supported hybrid prosthesis is equally successful when loading is applied the same day or the day after implant placement. Immediate loading with 5 to 6 implant-supported prostheses represents a viable alternative treatment to classic delayed loading protocols.

Immediate loading of dental implants can reduce treatment time and management concerns, thus increasing patient acceptance. This paper reports the authors' preliminary experience with partially edentulous patients having received non-occlusally loaded provisional restorations within 24 hours of surgery, compared to patients treated according to an early loading protocol. The present data suggest that implant supported fixed partial prostheses can be immediately non-occlusally loaded and restored with a predictability similar to early loaded implants.