Diego Nardi

10‐Year Follow‐Up of Immediately Loaded Implants with TiUnite Porous Anodized Surface

BACKGROUND The immediate loading of implants with a porous anodized surface is a well-described technique. Few data are however available on the long-term outcomes. PURPOSE The aim of this prospective study was to assess the 10-year performance of TiUnite implants supporting fixed prostheses placed with an immediate loading approach in both postextractive and healed sites. MATERIALS AND METHODS All patients received a fixed provisional restoration supported by immediately loaded parallel design, self-tapping implants with a porous anodized TiUnite surface, and an external-hexagonal connection. Both healed and postextractive cases were included. Success and survival rate for restorations and implants, changes in marginal peri-implant bone level, probing depth measurements, biological or technical complications, and any other adverse event were recorded at yearly follow-up up to 10 years after surgery. RESULTS A total of 210 implants fulfilled the inclusion criteria and were consecutively placed in 59 patients. Forty-seven (22.38%) implants were lost because of the recalled patient refused to attend the planned 10-year follow-up. Five over 210 (2.38%) implants were lost. At the final follow-up, the accumulated mean marginal bone loss and probing depth were, respectively, 1.93 mm (SD 0.40) and 2.54 mm (SD 0.44) for the implants placed in healed sites (n = 84); 1.98 mm (SD 0.37) and 2.63 mm (SD 0.39) for the implants placed in postextractive sites (n = 74). The restorations examined achieved a cumulative 65.26% success rate and 97.96% survival rate. The implants placed in healed and postextractive sites, respectively, achieved a 98.05% and a 96.52% cumulative survival rate. CONCLUSIONS Positive results in terms of bone maintenance in the long-term perspective are to be expected using immediately loaded implants with a TiUnite porous anodized surface in both postextractive and healed sites when adequate levels of oral hygiene are kept.

Immediate Versus One-Stage Restoration of Small-Diameter Implants for a Single Missing Maxillary Lateral Incisor: A 3-Year Randomized Clinical Trial

BACKGROUND The aim of this study was to compare the bone loss pattern and soft tissue healing of immediately versus one-stage loaded 3.0-mm-diameter implants in cases involving a single missing lateral maxillary incisor. METHODS Sixty patients with a missing lateral incisor in the maxilla were randomized to one of the treatments: 30 patients in the immediate-restoration group and 30 patients in the one-stage group. All implants were placed in healed sites and had to be inserted with a torque >25 Ncm. The implants in the immediate-restoration group were fitted with a non-occluding temporary crown on the day of surgery. Both groups received a full occluding final crown 6 months after surgery. Mean marginal bone loss, probing depth, and bleeding on probing were assessed at 6-, 12-, 24-, and 36-month follow-up examinations by a masked examiner. RESULTS Sixty 3.0-mm-diameter implants were placed between July 2003 and February 2006; 27 (45.0%) were in men, and 33 (55.0%) were in women. All implants osseointegrated and were clinically stable at the 6-month follow-up. No statistically significant differences were observed for bleeding or plaque index. No implant fractures occurred. At the 36-month follow-up, the accumulated mean marginal bone loss and probing depth were 0.85 +/- 0.71 mm and 1.91 +/- 0.59 mm, respectively, for the immediate-loading group (n = 30) and 0.75 +/- 0.63 mm and 2.27 +/- 0.81 mm, respectively, for the one-stage group (n = 30). There was no statistically significant difference (P >0.05) for the tested outcome measures between the two procedures. CONCLUSIONS In the rehabilitation of a single missing lateral maxillary incisor, no statistically significant difference was assessed between immediately and one-stage restored small-diameter implants with regard to implant survival, mean marginal bone loss, and probing depth. Three-millimeter-diameter implants proved to be a predictable treatment option in our test and control groups if a strict clinical protocol was followed.

Buccal bone plate in the immediately placed and restored maxillary single implant: a 7-year retrospective study using computed tomography.

Aim: The aim of this retrospective study is to assess the long-term buccal bone plate changes in cases of single implants in the maxillary aesthetic area placed and restored immediately after extraction. Material and Methods: A private practices database was reviewed to find patients who had a standard computed tomography (CT) scan taken no more than 24 hours after insertion of a single, immediately restored, postextractive implant in the anterior maxilla. After a minimum period of 7 years, a cone beam computed tomography (CBCT) was performed. Buccal bone plate measurements were performed on CT and CBCT Dicom images and in vivo records. Results: Two thousand nine hundred eighty patient records were scanned. Sixteen of them met the primary inclusion criteria. Three CTs were excluded because of poor imaging. Thirteen patients were then eligible to be recalled and 12 of them agreed to a follow-up. One implant failed due to severe periimplantitis. The resulting 11 patients were scanned by CBCT. Vertical mean resorption of 0.5 mm at buccal aspect and an average of 0.9-mm thick buccal bone plate was revealed. In 2 patients (18.18%), the bone peak resorbed under the level of the implant shoulder. Conclusion: The buccal bone plate of single implants placed and restored immediately after tooth extraction in the maxillary aesthetic areas was subjected to a moderate vertical and horizontal reabsorption 7 years after surgery. If a careful selection of the patient and strict clinical protocol are observed, the immediate placement of a single implant in a fresh extraction socket and its immediate restoration do not compromise the preservation of the buccal bone plate.

A comparison between immediate loading and immediate restoration in cases of partial posterior mandibular edentulism: a 3-year randomized clinical trial.

OBJECTIVE The aim of this study was to compare the survival rate, the bone loss and soft-tissue healing patterns of immediately loaded and immediately restored implants in cases of partial posterior mandibular edentulism. MATERIAL AND METHODS Fifty patients with partial posterior mandibular edentulism were randomly selected for two treatments: 25 were included in the immediate loading group (test) and 25 in the immediate restoration group (control). All implants were placed in healed sites with a torque of >25 N cm. The temporary prosthesis of the immediate restoration group was placed so as to avoid occlusal contact in centric and lateral excursions. Both groups received fully occluding final restorations 6 months after surgery. Mean marginal bone loss was assessed at 6-, 12-, 24- and 36-month follow-up examinations by a blinded examiner. RESULTS A total of 100 implants were placed in the period between February 2004 and October 2006, of which 42 (42%) were for men and 58 (58%) for women. Five and 7 weeks after surgery, mobility of one implant was assessed in one (4%) patient in the test group and one (4%) patient in the control group, respectively. At the 36-month follow-up, the accumulated mean marginal bone loss was 0.987 mm (SD=0.375) for the immediate restoration group (n=48) and 0.947 mm (SD=0.323) for the immediate loading group (n=48). There was no statistically significant difference (P>0.05) for the tested outcome measures between the two procedures. CONCLUSIONS This study was unable to detect any statistically significant difference in the survival rate, bone loss and soft tissue healing patterns between the immediately loaded and the immediately restored implants in cases of partial posterior mandibular edentulism. The immediate temporary rehabilitation of the partially edentulous posterior mandible is a predictable procedure using both procedures.

Buccal bone plate in immediately placed and restored implant with Bio‐Oss® collagen graft: a 1‐year follow‐up study

OBJECTIVES The aim of this study was to radiographically assess the vertical and horizontal alterations of buccal alveolar bone after the insertion of a post-extractive implant using Bio-Oss(®) Collagen graft. MATERIAL AND METHODS The study was designed as a prospective study. Adult patients were eligible for the study if they needed one or more immediately inserted and immediately restored implant replacing teeth to be extracted within region 15-25. After the insertion, the buccal gap was carefully grafted using Bio-Oss(®) Collagen and the implant immediately restored. Cone-Beam Computed Tomography (CBCT) was performed immediately after surgery and a series of measurements were made to determine the dimension of the buccal bone plate and the void between implant and extraction socket. A second CBCT was taken and the measurements repeated after 12 months. RESULTS Altogether, 69 patients were included in the study; a total of 69 implants were inserted. The study demonstrated that the extraction of a tooth and the immediate insertion of an implant together with an xenograft resulted in alterations of the vertical and horizontal dimension of the buccal bone plate (respectively, 25.6% and 29.3%). Nevertheless, the vertical and horizontal gap reduction was nearly complete (respectively, 99.3% and 99.1%) and the implant was normally in contact with buccal bone. CONCLUSIONS Implant placement into extraction sockets can result in favorable radiological results even in the presence of evident alterations of the buccal bone wall.

Immediate Restoration of Small-Diameter Implants in Cases of Partial Posterior Edentulism: A 4-Year Case Series

BACKGROUND The aim of this prospective study was to evaluate the use of immediate restorations supported by 3.0-mm-diameter implants as a suitable technique for the rehabilitation of partial posterior edentulism. METHODS Forty consecutive patients, 18 males and 22 females with a mean age of 54.7 +/- 17.2 years, with partial edentulism in the posterior region were treated with 93 immediately restored 3.0-mm-diameter implants. Forty-eight and 45 implants were placed in the maxilla and mandible, respectively. All implants were placed in healed sites and splinted by the temporary restoration, which was placed to avoid occlusal contact. The final restoration was delivered approximately 6 months after implant insertion. Mean marginal bone loss was assessed using standard periapical radiographs immediately after surgery and at 6-, 12-, 24-, 36-, and 48-month follow-up examinations. RESULTS All implants had osseointegrated and were clinically stable at the 6-month follow-up. The accumulated mean marginal bone loss was 1.16 +/- 0.90 mm (N = 89) at the 48-month follow-up. No implant fractures occurred. CONCLUSION The use of immediately loaded small-diameter implants supporting fixed partial restorations is a predictable procedure for the rehabilitation of partial posterior edentulism.

Prospective study with a 2‐year follow‐up on immediate implant loading in the edentulous mandible with a definitive restoration using intra‐oral welding

OBJECTIVES The aim of this prospective study was to evaluate the concept of intra-oral welding as a suitable technique for the fabrication of a restoration for edentulous mandibles on the same day as surgery using tapered connection implants. MATERIAL AND METHODS Each of 20 patients had an edentulous mandible and received four inter-foraminal, tapered connection implants. All implants were immediately loaded with a fixed restoration supported by an intra-orally welded titanium framework. Final abutments were connected to the implants and then a titanium bar was welded to them using an intra-oral welding unit. This framework was used as a support for the final restoration, which was fitted on the same day as implant placement. Mean marginal bone loss and radiographically detectable alteration of the welded framework were assessed using periapical radiographs immediately after surgery, and at 6-, 12- and 24-month follow-up examinations. RESULTS Seven males and 13 females, with an average age of 56.5 years (SD=15.1; n=20), were consecutively treated with 80 immediately loaded implants. No fracture or radiographically detectable alteration of the welded frameworks was evident. All implants osseointegrated and a 100% implant survival rate was achieved at the 24-month follow-up. The accumulated mean marginal bone growth was 0.21 mm (SD 0.25, n=80). The average pocket probing depth was 1.38 mm (SD 0.41). CONCLUSIONS The intra-oral welding technique applied to the delivery of a final restoration of the edentulous mandible over immediately restored tapered connection implants seems to have no adverse effect on marginal bone loss and implant survival.

A six-year follow-up of full-arch immediate restorations fabricated with an intraoral welding technique.

Purpose: The aim of this study was to evaluate the 6-year effectiveness of maxillary and mandibular full-arch immediately loaded prostheses fabricated using an intraoral welding technique. Methods: All patients received the same day of surgery a fixed, full-arch prosthesis supported by an intraorally welded titanium framework created directly in the patients mouth using a titanium bar. Life table analysis of implant survival, complications, and any other adverse events were recorded at yearly follow-up for a period of 6 years. Results: One hundred twenty-four (86.11%) of 144 implants placed in maxillary cases and 87 (77.68%) of 112 implants placed in mandible cases completed the planned 6-year follow-up. At the 72-month follow-up, the accumulated mean marginal bone loss was, respectively, 1.39 mm (SD = 0.67) for the implants placed in the maxilla (n = 124) and 1.29 mm (SD = 0.71) for the implants placed in the mandible (n = 87). Fracturing of the composite resin superstructure was the most common adverse event. Conclusions: After a 6-year follow-up period, the intraoral welding technique proved to be a predictable technique for successfully rehabilitating the fully edentulous patient with a fixed and immediate prosthesis.

Immediate provisionalization of implants placed in fresh extraction sockets using a definitive abutment: the chamber concept.

The purpose of this case series is to present radiographic results of implants immediately placed and restored with a definitive abutment and followed for 18 months. Ten patients who required extraction of the maxillary central or lateral incisor were treated with immediate extraction, implant placement, and provisionalization. Hard tissue measurements were performed using cone beam computed tomography. At follow-up, the mean buccal horizontal gap was -0.21 ± 0.3 mm. The mean vertical gap was 0.15 ± 0.23 mm. The mean distance between the bone crest and implant bevel was 1.73 ± 0.17 mm. The favorable results are related to a three-dimensional biologic space created around the abutment called the chamber.

The Conometric Concept: Coupling Connection for Immediately Loaded Titanium-Reinforced Provisional Fixed Partial Dentures-A Case Series.

The aim of this prospective study was to demonstrate the feasibility of the conic coupling connection as a novel approach for the retention of immediately loaded, titanium-reinforced, temporary fixed partial restorations. The patients received a fixed, immediate partial restoration, attached using the conic coupling connection to two implants placed in a fresh extraction socket. Changes in marginal peri-implant bone level or probing depth measurements, biologic or technical complications, and any other adverse event were recorded at yearly follow-ups up to 3 years after implantation. A total of 78 implants placed in 39 patients reached the 3-year follow-up. A trend of bone overgrowth over the implant platform (mean: 0.2 mm) and a complete fill of the vertical gap between the implant platform level and the first point of contact of the bone with the implant surface was seen after the 6-month follow-up. No disconnection of any prosthesis was noted during 3 years of full occlusal function. The results of this study suggest that titanium-reinforced, temporary partial restorations with conic coupling retention supported by immediate implants provide a successful, cost-effective treatment modality.