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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.)

Fifty consecutive completely edentulous patients who were unable to wear their complete dentures took part in this prospective longitudinal study. After providing initial optimization treatment of patients' existing prostheses, prosthodontists conducting the study prescribed osseointegrated implant-supported removable overdentures for 45 of the 50 patients. The remaining five underwent ongoing attempts at optimizing their complete dentures. This article details the results of treatment for the 50 patients over a period of three to 13 years.

Successful osseointegration promises a virtual panacea for the edentulous predicament. However, the impact of this technique on specific age groups is far from clear. In an attempt to determine the efficacy and effectiveness of implant-supported prostheses in geriatric patients, the treatment outcomes of elderly patients already included in ongoing clinical trials were assessed. The following preliminary observations were made: (1) being elderly is not a contraindication to long-term implant survival; (2) successful osseointegration can be maintained irrespective of a patient's oral hygiene performance; and (3) diverse prosthesis designs appear feasible.

Throughout the 1980s and '90s, a small core group of clinical scholars played a major and pivotal role in the combined surgical and prosthodontic dissemination of osseointegration scholarship. As professor of oromaxillofacial surgery at the University of Washington, Dr Philip Worthington was one such pioneering educator. His academic leadership was acknowledged via numerous academic honors and tributes, including his recent postretirement recognition as distinguished professor at his university. This invited paper is a personal assessment of the impact of clinical changes ushered in by the osseointegration technique and was recently presented at the University of Washington's unique celebratory tribute to Professor Worthington.

This prospective study at the University of Toronto reports the 5-10-year results of treatment of edentulous patients with osseointegrated implant supported bridges. It comprised 46 consecutively treated patients, chosen because optimisation of traditional prostheses was not successful and because they were in sufficiently good health to allow minor out-patient surgery. Two hundred and seventy-four implants were surgically placed in 49 arches (three patients were treated in both arches) between October 1979 and March 1984. At the end of the 5-10-year observation period, 242 (88.32%) of the implants remained osseointegrated and 233 or 85.04% of these implants were used to support 43 fixed bridges and five overdentures. Nine implants, though osseointegrated, were not exposed and were not used to support the prostheses. Forty-eight of the 49 arches continue to be successfully restored with implant retained prostheses

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.

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.

Recent studies implicate smoking as a significant factor in the failure of dental implants. The purpose of this long-term retrospective study was to evaluate the survival of Brånemark endosseous dental implants in relation to cigarette smoking.The sample consisted of 464 consecutively treated completely and partially edentulous patients who had a total of 1852 implants placed between 1979 and 1999, and who were part of a surgical/prosthodontic prospective treatment outcomes study. The effect of cigarette smoking on implant survival in relation to the time of implant failure, gender, age, surgeon, date and site of implant placement, implant length and diameter, prosthesis design, and occlusal loading considerations was assessed in bivariate and multivariate survival analyses.The overall implant failure rate was 7.72%. Patients who were smokers at the time of implant surgery had a significantly higher implant failure rate (23.08%) than nonsmokers (13.33%). Multivariate survival analysis showed early implant failure to be significantly associated with smoking at the time of stage 1 surgery and late implant failure to be significantly associated with a positive smoking history. Short implants and implant placement in the maxilla were additional independent risk factors for implant failure.Cigarette smoking should not be an absolute contraindication for implant therapy; however, patients should be informed that they are at a slightly greater risk of implant failure if they smoke during the initial healing phase following implant insertion or if they have a significant smoking history.

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.Forty-five patients were treated with Brånemark 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.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.This study confirmed the overall long-term treatment outcome success of patients treated with fixed prostheses supported by Brånemark implants. Successful osseointegration with a 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.

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.)

A series of prospective studies started in the mid-1980s at the University of Toronto have provided evidence of the efficacy and effectiveness of implants in the treatment of the fully and partially edentulous patients. These studies have focused primarily on treatment outcomes at the surgical and prosthodontic levels, with an overall failure rate of 7.7% over a 20-year period. Because a considerable proportion of these failures (4.2%) occurred before insertion of the prosthesis, and because osseointegration is essentially a wound-healing process, factors that interfere with healing, including systemic conditions, may contribute to implant failure. This paper reviews studies on the impact of selected systemic conditions, including osteoporosis, cardiovascular diseases, diabetes mellitus, and hypothyroidism, as well as smoking behaviour, on the success or survival of oral implants in patients treated in the Implant Prosthodontic Unit at the University of Toronto.

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.

This prospective longitudinal study follows the treatment of 50 completely edentulous patients who could not successfully wear their complete dentures. After an initial phase of treatment in which the prostheses of all of the patients were optimized, the prosthodontists conducting the study prescribed osseointegrated implant-supported fixed prostheses for 45 patients and an implant-supported overdenture for one patient. Eventually, three of the remaining four patients were treated with implant-supported overdentures. This article details the results of treatment for all 50 patients over a period of 11 to 15.5 years.

The predicament of being both elderly and edentulous undermines life quality for both patient and dentist. The former suffer because of morphological and functional compromises, the latter because of a dearth of safe and predictably successful clinical techniques. The introduction of the osseointegration technique suggested great promise for profoundly changing this predicament, but the specific merits of this approach have been mainly extrapolated ones. The purpose of this study was to examine the clinical success of treatment with osseointegration for patients who were 65 or older at the time of implant insertion. A second group of patients, who became 65 during the course of the study was also studied and the results recorded separately. Data regarding the longevity of implants and prosthodontic restorations and the numbers and types of problems encountered were recorded. The evidence suggests that the biological anchorage of tooth root analogues in elderly jaws is predicatbly successful and enhances the quality of life for geriatric patients who are edentulous.

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 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.

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– Twenty-one patients with osseointegrated implant bridges (OIB), with an average age of 65 yr, were functionally examined at a 10-yr follow-up. Altogether 27 OIBs, supported by 138 fixtures, were examined. The examination comprised an anamnestic and clinical examination and registration of bite force. 90% of the patients were very satisfied with the outcome of the treatment. According to the anamnestic dysfunction index (Ai), 80% of the patients were symptom free in their masticatory system. The occlusal state was found to be good. Seventy-five percent of the patients were found to have only mild dysfunction of their masticatory system or to be symptomless according to the clinical dysfunction index (Di). The bite force ranged from 3 to 118 N at gentle biting, from 25 to 250 N at “biting as when chewing” and from 77.5 to 495.5 N at maximal bite force. On average the bite force had improved significantly at all biteforce levels tested compared to an examination 10 yr earlier. It is concluded that oral function in patients with OIBs is very favorable.

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.

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.